Motions · 2023-05-10 · 第 14 届国会
支持医疗健康发展
Supporting Healthcare
辩论聚焦疫情后持续支持医疗健康，特别强调学术界心理健康问题。议员指出学术压力导致研究人员和研究生焦虑抑郁比例高，呼吁关注精神健康。政府未直接回应，核心争议在于如何平衡学术绩效压力与心理健康保障。
关键要点
- • 学术界心理健康问题突出
- • 学术压力导致焦虑抑郁
- • 需持续支持医疗健康
关注学术心理健康
"graduate students are more than six times as likely to experience anxiety and depression compared to the general population."
参与人员（16）
- Jamus Jerome Lim
- Community and Youth and Minister for Social and Family Development
- Hoon Hian Teck
- Janet Ang
- Koh Lian Pin
- Leon Perera
- Leong Mun Wai
- Mark Chay
- Minister of State for Education
- Ong Ye Kung
- Raj Joshua Thomas
- Senior Minister of State for Health
- Senior Parliamentary Secretary to the Minister for Culture
- Tan Yia Swam
- Wan Rizal
- Yip Hon Weng
完整译文（中文）
Hansard 英文原文译文 · 翻译日期：2026-05-02
[(程序文本) 议事程序：恢复辩论议题的秩序宣读[2023年5月9日]。(程序文本)]
[(程序文本) “本院承诺支持新冠疫情后的医疗保健工作，以及全政府范围内为持续和稳定支持所做的努力。”——[陈雅森医生] (程序文本)]
[(程序文本) 议题再次提出。(程序文本)]
副议长：许连彬教授。
下午1时39分
许连彬教授（提名议员）：副议长先生，我支持这项动议。今天我想加入辩论，强调学术界日益严重的医疗保健问题。
我们的大学和学术机构是高等教育、研究和创新的场所，同时也是教职员、研究人员和学生花费大量时间的工作场所。
近年来，学术工作环境日益紧张，导致大学研究人员和研究生中心理健康问题的发病率和患病率上升。
2018年进行的一项全球研究发现，全球41%的研究生患有中度至重度焦虑，39%表现出中度至重度抑郁的迹象。该调查基于来自26个国家230所机构的2000多名学生的回应，报告显示，研究生患焦虑和抑郁的可能性是普通人群的六倍以上。
学术界心理健康问题日益普遍可能有多种原因。其中最大的原因之一无疑是持续的绩效压力。
学术道路既漫长又狭窄，且伴随显著的机会成本。作为早期职业研究人员，通常在20多岁和30多岁期间投入约10至15年最具生产力的时间，获得日益专业化的技能，随着他们作为研究生、博士后研究员再到初级教授的培训进展，转向其他职业的空间越来越狭窄。继续沿着这条道路并成功成为终身教职学者的压力巨大。
此外，某些学科的学术研究性质艰苦且不可预测。实验室实验或实地调查的要求通常需要个人在下班后和周末工作。这些漫长、不规律且艰苦的研究时间不可避免地影响工作与生活的平衡，对早期职业研究人员的心理健康产生重大影响。
他们中的许多人正处于试图组建家庭的年龄，因此这些心理健康影响可能也会波及其伴侣和其他亲人。
此外，许多以研究为主的大学在评估教职员和研究人员绩效时，会考虑各种与发表相关的指标。这可能导致“发表或灭亡”的心态，特别是在早期职业研究人员中产生巨大压力，促使他们快速、频繁地在最受认可的科学期刊上发表文章。
强有力的发表记录对获得良好的博士后职位和学术终身职位至关重要。然而，持续不断的发表压力可能导致持续的焦虑感，进而引发倦怠和其他心理健康问题。
早期职业研究人员心理健康问题的另一个主要原因是工作不稳定。许多选择学术职业的人希望有朝一日成为终身教授，但教授职位远远不足以满足日益增长的博士毕业生人数，尤其是在新加坡。
因此，许多早期职业研究人员依靠研究经费支持的短期合同工作。这些经费的期限和规模可能变化且不可预测，导致长期就业的不确定性。这种缺乏工作保障也会导致持续的压力和焦虑，因为研究人员不断担心下一份合同和未来的职业前景。
在研究生中，尤其是那些来自海外、来新加坡攻读研究生研究的学生，生活成本的上升可能是当今最大的压力因素之一。许多新加坡的博士生依靠研究奖学金，这些奖学金提供的津贴相对较低，与他们在职场上的同龄人收入相比差距明显。持续的生活成本担忧可能导致恶性循环，造成心理健康恶化和学业表现下降，个人在应对研究生严格学业要求的同时，还要管理作为年轻成人的经济压力。
最后，学术文化本身也可能成为解决心理健康问题的重大障碍。事实上，学术界中可能存在一种普遍但错误的看法，认为承认自己心理健康有问题是软弱、无能或不够格的表现。这种污名化可能导致个人觉得必须隐藏自己的困境以融入环境或维持学术地位。如果不加以挑战，这种污名化会导致个人延迟寻求心理健康帮助或治疗，进而加重症状，对个人和学术生活产生不利影响。
为应对学术界日益严重的心理健康问题，我们可以考虑以下建议，其中一些已在本地大学和研究机构实施，但我们总能做得更多。
首先，我们可以加大对心理健康研究的投入，以了解新加坡学术界心理健康问题的范围和性质，从而帮助我们制定更有效和定制化的解决方案。
其次，我们可以提供更多心理健康支持服务，包括工作坊、支持小组和心理健康专业人员，营造校园内负担得起且易于获得的心理健康资源生态系统，帮助有需要的人。
第三，我们可以加大力度提高心理健康意识，减少学术界的污名化。重要的是，我们可以通过为高级教职员和工作人员提供培训，教他们如何识别和支持可能面临困境的个人，营造开放和支持的文化。这样，我们可以去污名化并使心理健康讨论成为常态。
最后，我们还可以努力使学术界的工作与生活平衡更加健康。这可能包括提供更多远程工作和灵活工作时间的机会，制定限制下班后发送邮件和召开会议的政策。
作为已有举措的鼓舞人心的例子，新加坡国立大学自2021年起开展了#AreuOK心理健康关怀运动。其主要目标是消除NUS社区对心理健康状况的污名，并支持寻求帮助的人。该运动提供免费且保密的心理健康检查、情绪支持会谈和24小时热线等服务。我声明我是NUS教授。当然，新加坡其他大学也为其学术社区提供类似的举措和支持。
在国家层面，健康促进局开展了全国心理健康运动“It's OKAY to Reach Out”，旨在使心理健康和福祉话题成为常态，增强理解和意识，鼓励新加坡人寻求支持。
先生，新加坡是全球研究和创新的领导者。我们大学和研究机构的质量在维持这一地位中发挥关键作用。更重要的是，身体和心理健康的研究人员队伍，包括各级研究生和研究人员，是确保新加坡持续产出高质量研究的必要条件。
此外，新加坡的学术界多元且国际化，来自不同文化、背景和经历的个人共同努力，致力于创造有影响力的新知识、科学和技术。提供支持性和包容性的环境，促进学术社区所有成员的心理健康，将使我们能够吸引和留住来自世界各地的顶尖人才，保持新加坡作为全球知识和创新中心的地位。
解决学术界的心理健康问题不仅是道德责任，也是经济责任。世界卫生组织最近报告称，抑郁和焦虑障碍每年给全球经济造成超过1万亿美元的损失。杜克-国大医学院和心理健康研究所最近的一项研究估计，新加坡因焦虑和抑郁导致的生产力损失的经济负担每年近160亿新元。通过投资学术界的心理健康项目，我们可以提升学术人员的生产力和表现，从而对整体经济产生积极影响。
总之，解决学术界的心理健康问题对新加坡作为知识和创新中心的成功至关重要，有助于吸引和留住顶尖人才，强化经济，建设有韧性的劳动力和社会。
让我们共同努力，在学术界营造开放、支持和理解的文化，使个人能够无惧污名和评判地寻求帮助，发挥其全部潜力。
最后，我与其他议员一道，感谢护士、医生及所有医疗工作者为国家的身心健康所做的不懈努力、奉献和牺牲。副议长先生，我支持这项动议。
副议长：李安佩拉先生。
下午1时51分
李安佩拉先生（阿裕尼选区）：副议长先生，阁下，在评判一个社会的宜居性和先进程度时，其医疗保健部门的质量和可负担性起着关键作用。
在大多数国家，医疗保健的提供性质因其重要性而备受争议和辩论。在包括我们国家在内的许多国家，医疗保健也是经济的重要部门，直接和间接创造大量就业机会。
疫情后，我希望像兀兰医疗园区和陈笃生医院综合护理中心等新设施的建设进展加快。然而，满足我们长期医疗需求的主要障碍——主要挑战——不在于建设实体设施，而在于医疗人员的招聘、留任和提升生产力。今天我的发言将围绕这一主题展开。
在我的发言中，我将支持该动议，讨论：（一）解决医疗人员的招聘和留任问题；（二）提升医疗人员的生产力；（三）通过解决上游健康问题来源及其他方式，在不成比例增加成本的情况下改善整个医疗系统的成果。
在此之前，我声明本人是某公司董事长，该公司在医疗领域及其他行业提供咨询服务。
先生，在准备这次发言时，我在家庭晚餐桌上提出了如何吸引更多新加坡人进入医疗行业的话题。我的女儿毫不犹豫地回答，我引用她的话：“给他们体面的工作时间、工作中的尊重和良好的薪酬。”
这确实是我们面临的一个重大长期挑战。我们可以建造病房和诊所，购买设备，但如何吸引和留住医疗行业的工作人员，减少人员流失，确保有一批专业人员作为未来领导者的储备，确保良好的学习曲线和足够的经验与技能积累，从而提升服务和效率，确保患者获得良好治疗效果？
有媒体和传闻报道因人手不足导致设施闲置。例如，今日报最近援引一位私人医生的话称，“事实上，几家私立医院因护士短缺关闭了一些病房和手术室。”
医疗行业至关重要的人力资源挑战可细分为几个方面——薪酬、工作时间、工作条件和职业晋升，以及生产力，同时确保工作具有意义感。
首先，关于薪酬。虽然护士薪酬去年有所提高——这是值得欢迎的——但这是七年来的首次基本工资上涨。初级医生的薪酬也最近有所提升，但根据我最近的议会质询回复，7%至13%的起薪增长适用于实习医生和第一年医务官（MO）。然而，更有经验的初级医生，即符合条件的在职医务官或住院医生至博士后第6年，以及牙科医生至博士后第4年，预计薪酬调整将基于其服务年限和合同期，而非统一涨幅，据我了解。
显然，为了吸引和留住人才，薪酬必须具有竞争力。此外，在医疗领域，人才可以跨国流动。许多国家缺乏经验丰富的医疗人员，许多国家希望挖角我们讲英语且训练有素的医疗工作者。
因此，我想询问是否可以基于每小时薪酬——即每小时总收入——监测和跟踪医疗人员的薪酬，并定期与我们争夺医疗人才的其他发达国家地区进行基准比较，并公布结果，以便我们清楚了解自身状况，判断是否将面临需要注意的波动。
我知道偶尔会有相关学术研究发表，但我不清楚政府是否有定期发布此类报告。
接下来，关于管理工作时间和防止倦怠。提高薪酬没有意义，如果人手不足导致工作时间增加，使得每小时薪酬保持不变甚至下降。
先生，我之前在议会多次提出初级医生工作时间的问题。我想重申呼吁，将初级医生每周工作时长从80小时减少到70小时，并加强执行，确保遵守。
有证据表明，70小时每周的工作上限与80小时相比，培训效果相同，正如我在之前的供应委员会发言中所述。这还需要简化系统，使初级医生和护士能更多时间用于患者护理和培训，而非行政事务。
我还呼吁实现目前10小时值班间隔的100%合规率，从目前的90%提高，确保无工作时间漏报，并采取具体措施缩短交接行政和外围任务的时间。
我了解到，公共医疗系统正在审查初级医生的工作条件。希望在此过程中充分考虑优化工作时间的必要性。
接下来，副议长先生，关于工作负荷。工作负荷当然是医疗需求与人力容量的函数。随着人口老龄化，我们的医疗需求将稳步上升，我们也是全球老龄化最快的国家之一。
翁部长表示，护理学生的年招生人数将从2100人增至2300人。如果护士能留在行业，这将有助于满足需求。
目前，新加坡注册护士中新加坡人的比例略高于60%。对于如此关键的职业，保持强大的新加坡核心力量和良好的职业晋升通道非常重要，使护士能够晋升为高级护士执业者和领导岗位。
我知道目前护理奖学金主要由医疗集团颁发。我想知道这个数量是否足以满足未来需求，培养足够的护士人才储备，以担任未来高级护士执业者、导师和领导角色。
卫生部是否会基于此进行护理奖学金数量的审查？此类审查是否也涵盖护理研究生奖学金的发放，鉴于未来医疗行业日益复杂且依赖技术？目前似乎只有一个学术项目提供高级执业护士所需的护理硕士学位。
最后，关于工作负荷。为了加强护理等职业中的新加坡核心力量，我们应优先考虑那些在相关职业中已在本地生活和工作一段时间、且表现出良好社会融合能力的外国人，给予他们永久居民身份，最终获得公民身份。
我相信本院其他议员此前也提出过类似呼吁，政府表示对此持开放态度。对此，我重申呼吁，使公民身份授予过程更加透明，例如提供在线积分计算器，类似其他国家的做法。这可能通过提供更清晰和有保障的信息，使新加坡对来自其他国家的医疗专业人员更具吸引力。
接下来，副议长先生，关于药剂师的角色。为了提高我们整个系统的生产力，政府是否会考虑赋予药剂师在某些疾病情况下开药的权力？澳大利亚已经在考虑这一点，尽管对此有一些反对声音。我们的药剂师已经在某些慢性病药物的剂量调整方面发挥作用，先进执业护士在本地医疗机构也有合作处方模式。
我建议政府关注国际动态，并根据新兴的国际证据，考虑是否以及如何赋予药剂师更大的处方权。这可能最初会对全科医生（GP）产生负面影响，但我稍后会提出一些关于全科医生的建议。
接下来，副议长先生，我想谈谈其他相关医疗专业人员和医务人员的必要角色。我注意到政府计划让社区药剂师在推广健康筛查和疫苗接种等方面发挥更大作用。
我去年在关于预防医疗的休会动议以及之前通过质询中都谈到了健康筛查和疫苗接种的重要作用。mRNA技术已经催生了可能在未来几十年带来革命性突破的医学发展。但回到当前现实，我们似乎在更常规的疫苗接种方面，如流感疫苗，落后于许多发达国家。这限制了下游慢性或灾难性疾病的发生率。
此外，令人担忧的是，2021年国家人口健康调查显示，2021年参与慢性病和癌症筛查的新加坡居民比2019年减少。
政府计划增加相关医疗专业人员的数量。这些专业人员在社区医疗中可以发挥关键作用，推动更健康的生活方式和适当的求助行为，包括心理健康状况，同时帮助慢性病患者预防并发症的发生。
在亚逸组群选区实龙岗选区，我和志愿者有幸与陈笃生医院（TTSH）社区合作伙伴合作，在一栋租赁组屋举办健康讲座和咨询活动。我们还会将遇到的病例转介给陈笃生医院社区合作伙伴（TTSH CP），该机构也会在实龙岗北的金姜社区关怀服务中心安排护士驻点，向当地居民提供筛查和建议。
这些都是值得称赞且有益的干预措施，我希望能在其他目前缺乏此类服务的地区复制。这些最终应由中央资助，因为它们不需要昂贵的基础设施，也可以让本地护士、物理治疗师、职业治疗师和足病医生等有家庭的专业人员，或许能在自己社区附近兼职工作。
部署此类相关医疗专业人员的模式通常是利用吸引人们关注健康问题的活动。然而，利洁时进行的一项调查显示，大多数新加坡人对自身健康采取较为被动的态度，并不经常或总是主动寻求改善健康的信息。因此，我们有必要寻找更符合商业营销中所谓“狩猎”式（直接销售）而非“耕耘”式（吸引客户主动上门）的方法。
为此，我想知道一旦我们拥有足够数量的健康教练，是否可以作为一项举措，将他们派往组屋底层、熟食中心和湿市场。这些地方人流量大，尤其是老年人较多，他们可能更需要医疗干预。如果能有流利使用方言的人员在这些场所以更主动的方式接触他们，推广疫苗接种和健康筛查等理念，甚至现场进行某些基本筛查活动，可能会很有帮助。对于年轻群体，或许更适合依赖社交媒体的策略。
接下来，副议长先生，让我谈谈全科医生的角色。我们大约有1800家全科诊所，在医疗系统中作为非紧急情况的第一道防线发挥重要作用。随着“更健康的新加坡”计划的推进，这一角色将更加重要。在吸引和留住优秀医疗专业人员时，我们不应忽视全科医生。
然而，有一些令人担忧的迹象。南洋理工大学2022年在《BMC初级保健》杂志发表的一项针对300名全科医生的调查显示，14.4%计划永久离开全科医疗，12.6%计划休职业假，51.3%计划减少临床工作时间。提高薪酬、将全科和家庭医学认定为医学专科、减少医疗诉讼压力被认为是这些决定中最重要的因素，同时该群体对管理保险安排的第三方管理员日益不满。如果全科医生大量流失，可能会影响我们实现初级医疗和“更健康的新加坡”目标的能力。
此外，国家医疗集团2014年在《亚太家庭医学》杂志发表的一项关于初级医疗质量的研究，调查了85名专家，结论是新加坡系统存在若干问题，我引用：“新加坡的初级医疗系统得分为30分中的10.9分……专家将新加坡归类为‘低’水平的初级医疗国家。”初级医疗医生的收入相较专科医生是被提及的几个因素之一。
先生，我这里有几点建议，旨在解决全科医生群体和初级医疗面临的一些问题。
首先，我们是否应定期对全科医生群体进行调查，了解他们的经历、痛点、对生态系统缺口的看法以及对政府、保险公司和其他利益相关者的建议？我认为，我们的大多数全科医生都是深思熟虑且见多识广的人，他们应有建设性政策变革的好主意。卫生部（MOH）大约每十年进行一次初级医疗调查，主要确定初级医疗部门的经济参数，但可以做得更多。
其次，政府是否可以探索将个别全科医生和经营全科诊所的企业集团纳入政府药品采购系统，以便各方基于更大批量采购获得更低价格？目前，药品销售代表通常向个别全科医生销售药品，这导致采购分散，议价能力和规模经济大大降低。
顺便说一句，我曾排队看全科医生，排在我后面的人却先被叫进去。我不介意，只是好奇，于是问接待员原因，她说因为我当时戴着领带，她误以为我是药品销售代表而非病人，所以优先安排了别人。
无论如何，我了解到政府目前正在研究允许私营医疗提供者使用政府药品采购系统（ALPS）的想法，我希望政府能尽快推进，实现公私部门的联合采购，尽可能发挥最大效益。
最后，作为我之前提到的调查工作的一部分，政府是否可以识别那些有空闲接诊能力的全科医生——即某些时段患者较少——并寻找方式吸引他们，如果他们愿意的话，协助增加多元诊所或其他公共医疗机构的接诊能力？据传，全科医生网络密度长期有所增加，竞争加剧，这可能导致部分全科医生在某些时段有空闲能力。
副议长先生，我现在进入演讲的最后部分——如何提高医疗人员的劳动生产率？我想起我年轻时作为经济发展局（EDB）官员时的一段有趣对话。一位同事与另一位经理交谈，经理说没有相应增加人数就无法提高产出，同事回答：“啊，是的，但那是假设生产率零增长。”这句简洁的智慧我至今难忘。
当然，随着医疗需求增长，我们需要招聘更多员工。但我们需要控制增长速度，以管理成本，同时避免因过多外来劳动力涌入而带来的人口压力——这里我使用“劳动力”一词，当然是性别中性的。
如何做到这一点？我们可以借鉴医疗技术进步和全球最佳实践。例如，远程医疗可以提高员工利用率，也节省患者时间。一些调查显示，新加坡人对虚拟诊疗持开放态度。还有机器人技术，例如服务机器人可以承担医疗礼宾的一些职能，机器人设备也能在康复医学中发挥作用。
我知道这些创新已经进入我们的医疗系统，且更多创新正在考虑中。我也知道这不是新话题。2012年，卫生部推出了医疗生产力路线图，2017年设立了医疗生产力基金，还有国家医疗生产力与创新奖。然而，我这里有几点建议。
首先，人工智能（AI）、计算机和机器人等前沿技术在医疗领域的应用潜力巨大。例如，埃森哲2019年关于新加坡医疗劳动力的研究指出，技术可为医生节省10%的时间，药剂师10%，护士22%，实验室科学家31%，药房技术员50%，医疗记录员高达68%。
我建议政府不时测量医疗劳动生产率，并公布结果，与其他全球城市的生产率标准进行基准比较。我认为进行城市间比较非常有用。可以考虑多种指标。理想情况下，应分别测量公立和私立医疗，以便比较。这些数据可用于识别表现优异的案例，记录并分享最佳实践和案例研究。如果不知道现状，就无法达到目标。
其次，特别是在心理健康护理方面，我们面临挑战。一些专家谈及青少年心理健康危机，这种现象可能并非新加坡独有。我们的临床心理学家和精神科医生比例落后于一些发达国家，我和其他议员此前也曾提出。政府是否会探索利用人工智能技术增强心理健康护理能力？
例如，总部位于波士顿的公司“OM1”最近开发了名为“PHenOM”的人工智能平台，帮助精神科医生提升诊断和治疗的效果与效率。新加坡公司Holmusk与英国国家医疗服务体系（NHS）及利物浦大学合作，建立了心理健康分析与研究中心。Holmusk的心理健康分析平台规模庞大。我希望政府考虑与此类公司，尤其是本地公司合作，推动创新。
总之，副议长先生，随着人口老龄化，我们未来对医疗系统的需求将更大。但未来也将有更多机会利用技术和创新提高效率，强化上游预防。我们需要抓住机遇，应对挑战。
这必须由我们的医疗专业人员完成，他们是医疗工作的核心，没有他们，一切皆无可能。归根结底，医疗是且必须始终是深具人文关怀的事业。吸引、留住并发挥我们优秀医疗工作者的最大潜力，是医疗中最重要的目标。
在结束前，副议长先生，我想与尊敬的贾瑞德议员及其他议员一道，代表全社会向我们出色的护士们表达深切感谢，并提前祝愿他们即将到来的护士节快乐。
副议长：马克·蔡议员。
下午2时10分
马克·蔡议员（提名议员）：副议长先生，感谢您给予我机会，就我的同僚提名议员陈雅心博士、莎希拉·阿卜杜拉博士和阿卜杜勒·萨马德先生提出的动议发言，支持疫情后医疗保健，并呼吁政府整体努力，提供持续稳定的支持。先生，我支持这项动议。
我首先要衷心感谢新加坡的医疗专业人员，他们在新冠疫情期间表现出非凡的奉献精神和无私精神，努力照顾患者。尽管医疗服务需求大幅增加，他们依然以专业和同理心提供卓越的护理。
我们对医疗工作者和管理人员在这段艰难时期的不懈努力深表感激。你们的勇气和韧性对抗击疫情产生了巨大影响，我谨向你们的卓越工作致以最深切的谢意。
在新冠疫情期间，新加坡政府为医疗工作者提供了重要支持，包括财政援助、资源和培训，帮助他们应对不断增长的需求，同时治疗新冠患者。然而，我们不应仅在危机时期认可医疗专业人员的贡献，未来在与新冠共存的世界中，我们仍应认可他们的宝贵贡献。
新加坡卓越的医疗体系容易被忽视，人们往往未能体会到为全国提供一流医疗服务所付出的奉献和努力。政府在公共卫生基础设施和医疗补贴方面投入巨大，使新加坡人无论经济状况如何，都能获得适当的医疗照顾。我们应继续坚持这一点，不是为了全球竞争，而是因为这是对新加坡人负责任的做法。
副议长先生，医疗保健是关乎每个人的重要议题，因为每个人一生中都需要获得医疗服务。良好的健康是个人过上富有成效和充实生活的基础，获得优质医疗服务对维持健康至关重要。正因医疗影响每个人，我很高兴看到这项动议的提出。我完全同意尊敬议员们的观点，我们应采取政府整体协作的方式推进医疗保健。
这很关键，因为它认识到医疗不仅是医疗部门的责任，还涉及许多其他部门和因素。通过综合方法，新加坡可以识别并解决医疗问题的根源，改善公民的健康结果。我想谈谈以下四个我认为应更多关注的方面。
首先，关于老年人和残疾人士的医疗服务可及性。新加坡人口老龄化，老年医疗服务需求预计将增加。随着人口老龄化，慢性病、认知障碍、跌倒、虚弱等问题更为普遍，严重影响生活质量。这需要对老龄化过程及多种疾病、药物和身体障碍的最佳管理具备专业知识。
教导新加坡人如何优雅老去也应得到投资，需要整体方法，不仅关注诊断和治疗，还要重视功能能力、社交互动和心理健康。为此，卫生部若能与技能未来合作，增加适合老年人的课程的获取和采用，将是好事。现有课程如艺术、营养和数字素养，但我相信可以提供更多促进身心健康的课程。
随着新加坡老年人口增加，老年学的重要性不容忽视，它帮助我们的银发一代保持独立、改善健康结果并过上充实生活。
副议长先生，确保残疾人士（PwDs）获得医疗服务同样对促进公平包容的医疗至关重要。不幸的是，残疾人士常面临身体、沟通和态度等障碍，阻碍他们获得医疗服务。
我很高兴已经采取措施让残疾人士（PwDs）更容易获得医疗服务，例如无障碍设施如轮椅坡道、高度可调节的检查台和无障碍洗手间。除了现有的努力外，医疗服务提供者还可以通过确保员工接受手语培训或提供助听器、视觉辅助等沟通辅助工具，改善与视力和听力障碍者的沟通。
除了物理无障碍，医疗服务提供者还可以通过为员工提供教育和培训，改善他们对残疾人士的态度。他们还可以致力于在医疗政策和程序中促进残疾包容。
目前，有许多中小企业（SMEs）和非政府组织（NGOs）致力于帮助残疾人士，开展更多关于持续改进残疾人士服务以及提高残疾人士对这些服务的访问和认知的对话将是有益的。
通过采取这些措施，医疗服务提供者可以确保残疾人士获得与非残疾人士同等质量的医疗服务。优先考虑无障碍和公平的医疗服务对于建设一个更健康、更包容的社会至关重要。
我现在转到第二点，当我们庆祝新加坡代表队运动员在金边取得的胜利时，我们也应认可运动员及其随行人员为新加坡争光所付出的辛勤努力和牺牲。我们的精英运动员常常面临巨大的身体和心理压力。这些压力可能影响他们的表现、长期身体健康和整体福祉。
为了在运动中取得优异成绩，运动员必须保持严格的训练纪律，遵守严格的饮食要求，并克服身体伤害。不幸的是，这些压力常常导致心理健康问题，如焦虑、抑郁和饮食失调。
除了身体压力，许多运动员还面临显著的社会压力。他们可能感受到来自队友、教练、粉丝和媒体的压力。这可能导致额外的心理健康问题，包括压力、倦怠和自信心缺失。
精英运动员需要获得资源来帮助他们应对这些压力。这可以包括心理健康支持、运动心理学和有经验运动员的指导。
运动员也必须明白，优先考虑他们的心理和身体健康而非运动是可以接受的。许多运动员，如黄美（May Ooi）和连康斯坦斯（Constance Lien），已经认识到这一点，并成为心理健康意识和自我关怀的倡导者。
通过承认精英运动员面临的压力并提供必要的支持，我们可以帮助他们在保持长期身体和心理健康的同时发挥最佳表现。因此，我希望能投入更多支持来应对我们国家队的这些独特需求。
第三，关于营造充满活力的体育和健身文化。我们常常忽视健康，直到某个事件直接影响我们。最近，一位朋友因心脏病发作去世。他还很年轻，他的悲剧和突然离世引发了我同龄人之间关于健康与体能的讨论，以及我们对健康和福祉的整体教育。如果卫生部（MOH）、教育部（MOE）和体育理事会（SportSG）能在新加坡人进入职场时，在高等教育阶段教授如何锻炼，那将是很好的。训练和锻炼是有区别的。我们参加课外活动（CCA），体育CCA教你如何训练——突破身体极限以提升表现，但锻炼是关于维护、灵活性和生活方式。
锻炼应成为一种习惯，而形成习惯很大程度上取决于便利性、常规和可及性。有些议员可能知道陈雅心医生（Dr Tan Yia Swam）是热衷跑酷的运动者。跑酷是一项跳跃、攀爬和滑行穿越地形的运动。在新加坡，这种地形是城市地形，我很高兴看到索美塞（Somerset）和湖畔（Lakeside）等地建有相关项目和设施。
我希望能建造更多符合新加坡城市景观和兴趣的城市体育设施。我也希望并鼓励配套项目与这些设施同步开展。为此，教练需要接受培训、获得资格并被聘用。我很高兴看到今年预算委员会（COS）上，文化、社区及青年部（MCCY）宣布了涵盖多种活动和学科的私人教练注册制度。但为了赋能该注册，教练需要拥有更新且相关的教学内容。我鼓励体育理事会（SportSG）、健康促进局（HPB）、教育部（MOE）和人民协会（PA）就提供相关、适龄的体育项目进行更多讨论，以满足充满活力、积极的新加坡人口需求。
第四，针对在疫情期间辛勤工作的前线人员遭受言语辱骂的问题令人痛心。尽管他们坚定不移地承担繁重工作，医护人员、关键岗位工作人员及其他公众服务人员仍遭受言语辱骂、羞辱和批评。
除了情绪上的消耗，言语辱骂还可能导致心理和身体健康问题，影响受害者的职业和个人生活。因此，认识到前线人员的价值并通过表达感激、认可他们的辛勤工作以及承担我们的共同责任来支持他们至关重要。前线人员应获得我们最充分的尊重、支持和同情。
认识并解决这一问题对于追究责任人责任至关重要。医疗机构可以为员工提供缓解紧张局势的培训，并实施报告和处理言语辱骂的政策。此外，公众宣传活动可以教育人们尊重前线工作人员的重要性及其行为的后果。
总之，副议长先生，新冠疫情展示了我们医护人员和抗疫前线工作人员的勇敢、奉献和无私。他们在艰难条件下长时间工作，冒着健康风险照顾病人。随着疫情逐渐缓解，政府必须继续支持医护人员，即使疫情结束后也是如此。
我希望政府为医护人员提供持续的心理健康支持，以应对他们经历带来的心理影响。疫情对他们的心理健康和福祉造成了影响，他们必须获得支持和资源来应对任何长期影响。
我们的政府还应投资于健康和安全措施，以保护医护人员免受未来疫情的影响。这包括提供充足的个人防护装备、培训和疫苗接种。处于传染病爆发前线的医护人员必须得到充分保护，免受未来可能面临的任何潜在危险。
通过在疫情后表达对医护人员的支持和感激，我们为他们在社会中的角色创造了价值感。他们的牺牲和辛勤工作值得认可，这将极大激励和鼓舞他们。政府应继续支持医护人员，为我们的医疗行业和依赖他们的患者建设更光明的未来。
副议长先生：黄瑞扎尔医生。
下午2时24分
黄瑞扎尔医生（惹兰勿刹选区）：副议长先生，感谢尊敬的议员们，陈雅心医生、阿都沙末先生和沙希拉医生提出这项动议。作为国会议员，我们有着共同的目标：为子孙后代创造一个更健康、更有韧性的狮城。
我国的医疗体系是实现这一目标的重要组成部分，我很感激有机会就这一重要议题展开建设性对话。我想谈两个广泛的话题。首先，不出意外，是关于心理健康；其次，是我们通过“健康股份”（Saham Kesihatan）计划在马来社区的努力。
先生，心理健康是我们医疗体系的关键组成部分。它不仅关系到个人的福祉，也关系到社会的健康和生产力。我很高兴陈雅心医生提到了这一点。我们必须正视陈医生提出的挑战，并继续协作寻找有效解决方案。
近年来，新加坡人之间关于心理健康的对话变得更加容易，这绝非偶然。这得益于政府通过心理健康与福祉跨部门工作组、私营部门、社区伙伴和草根团体的努力，致力于消除心理健康问题的污名。
虽然我们在心理健康意识方面取得了进展，但必须认识到仍有许多工作要做，特别是在如何直接缓解心理健康问题方面。
我想回顾一下2020年我在休会动议中提出的一些观点，以呼应陈雅心医生。在那次发言中，我分享了“LAST”缩写。简要来说，“L”代表识字率（literacy），“A”代表可及性（accessibility），“S”代表筛查（screening），“T”代表休息时间（time-outs）。
作为一名教育者，我非常认同陈雅心医生关于教育重要性的观点。我们必须继续提高公民的心理健康素养，应从学校开始早期引入。因此，我很高兴教育部已经更新了涵盖身体、心理和情绪健康的青少年课程。
但我希望我们能更直接地影响心理健康，超越教育或意识层面，将心理健康筛查纳入常规体检。目的很简单，我们希望创造常态，促进心理健康问题的早期发现和干预，从而带来更好的个人生活质量和结果。这也有助于减轻社会因未治疗心理健康问题带来的负担，促进社区整体福祉。
现在，我有信心我们可以培育一个消除心理健康污名的社区。但我也必须提醒自己，这种观念转变不会轻易、不会立刻或很快发生。像许多教育项目一样，改变可能需要相当长的时间。
二十年前，作为教师，我班上有需要特别关注的学生。当时有人质疑我为何要采取差异化教学方法。二十年后，我们可以看到社会变得更加包容，感谢公共和私营部门的努力，包括像尊敬议员兼惹兰勿刹集选区同事Denise Phua这样的倡导者，现在需要特别关注的学生得到了接纳和及时适当的干预。
虽然我们尚未达到心理健康同等程度的接受度，但我们必须坚持不懈。我们必须继续采取“全社会”方法对待心理健康，这意味着政府整体、私营部门、社区伙伴、草根团体和宗教组织的积极参与。
作为国会议员，我们必须全心全意相信这一事业，并努力使之成为现实。我赞赏本院议员及前辈们为心理健康所做的倡导。当我们作为一个社会、全社会放大经历过心理健康问题者的声音时，我们有助于打破阻碍个人寻求帮助的障碍，营造更包容和支持的环境。
先生，除了教育和筛查，谈及心理健康，心理健康服务的可及性仍是鼓励个人寻求帮助的关键。我们希望他们能无惧污名、歧视或成本、等待时间、交通甚至距离等障碍，获得心理健康服务。此外，创造一个支持和欢迎的环境，使他们感到舒适和安全，能够无羞耻和无评判地寻求帮助也很重要。
我很高兴卫生部通过多元诊所和远程医疗服务增加了服务点，使心理健康服务更广泛地惠及有需要的人群。然而，我也意识到缺乏受过培训的心理健康专业人员，他们能为寻求帮助者提供有效且有证据支持的治疗。由于资源不足，需要帮助的人可能会转向未经培训的心理健康从业者或依赖自助资源，这可能无法提供同等水平的支持和专业知识。这也可能导致治疗不足或有害，恶化个人的心理健康和整体福祉。因此，我们必须不断审视心理健康基础设施，我希望对该行业进行规范。
先生，陈医生和阿都沙末先生强调了医护人员面临的问题。我想聚焦于医护人员的心理健康。他们的工作性质不仅仅是一份工作，而是一种需要深厚承诺和奉献精神的使命。我们必须提供支持和资源，帮助他们应对职业固有的压力和挑战，这最终将提升病患护理质量。
此外，我们必须解决医护人员面临的身体和网络骚扰与虐待问题，因为这直接影响他们的心理健康。我们不仅要为医护人员创造安全和支持的环境，还要制定明确的保护指南。因此，我很感激当局将采取零容忍态度，对骚扰或虐待医护人员的个人采取适当行动。我们必须明确表示，“如果你虐待我们的医护人员，将会有后果”。我期待这些保护措施的落实。先生，请用马来语。
（马来语）：[请参阅本地语演讲。] 马萨戈斯部长最近宣布，马来社区在多个健康指标上取得了进展。
其中包括高胆固醇患者人数的减少。然而，我们仍需继续努力照顾社区健康。我们的社区肥胖率在各族群中最高。众所周知，肥胖可能导致心脏病、糖尿病和高血压等健康问题。因此，部长宣布将M3计划设立第五个重点领域，使其成为我们社区的优先事项之一。
通过M3下的健康投资计划，这一新重点领域旨在动员社区为“更健康的新加坡”计划做好准备。该计划与“更健康的新加坡”目标一致，强调将疾病预防作为个人承诺。我们需要采取积极措施，定期进行健康筛查，保持积极生活方式和健康饮食。
除了个人努力，这一全社区倡议也能带来改变。M3 @Towns的健康投资计划可提供体育活动机会，提高保持健康生活方式重要性的意识，并识别与肥胖相关的潜在风险。
通过与健康促进局（HPB）、Active SG等机构合作，以及个人做出健康选择，我们可以持续推进，改善社区健康，减少肥胖及其他健康相关问题的发生率。
我呼吁社区抓住机会，参与M3 @Towns组织的活动。
请记住，保持健康是我们的责任。如果我们健康，就能积极为家庭、社区和国家的发展做出贡献。
（英语）：在继续讨论我们的医疗体系时，必须承认我们拥有坚实的基础，并必须继续建设。作为个人，我们必须认识到每个人在塑造社会结构中扮演的重要角色。这必须始终是全社会的共同努力。社会中的每个人都是国家福祉这台复杂机器中的重要齿轮。每个齿轮，无论多小或看似微不足道，都对系统的顺利运转和整体成功做出贡献。当一个人遇到困难时，其他人必须挺身而出，关心和帮助。只有通过我们的集体努力，每个人和谐合作，我们才能对我们珍爱的国家健康领域产生持久而积极的影响。
先生，在此，我要衷心感谢非选区议员提出这项重要动议。他们的热情、深厚知识和坚定承诺，在议会期间始终保持有意义且富有洞察力的讨论，令人钦佩。
先生，最后，让我们记住，医疗进步及其持续成功依赖于我们的集体决心和团结。我们携手共建一个更光明、更有韧性、更健康的未来。
副议长先生：杨洁婷女士。
下午2时35分
杨洁婷女士（非选区议员）：副议长先生，我支持尊敬的非选区议员陈雅心医生、阿都沙末先生和沙希拉医生提出的动议。
在过去几个月里，我们先后就“更健康的新加坡”（Healthier SG）以及应对新冠疫情的白皮书进行了辩论。王部长也向本院通报了新加坡未来医疗保健的三大战略支柱——急性护理、公共卫生和老年护理。还有多场“前进新加坡”（Forward SG）对话，催生了许多想法和举措。我赞赏卫生部和整个政府采取的全面整体方法，但我们必须认识到，这是一场马拉松，而非短跑。
还有很多工作要做，需要全新加坡共同努力，尤其是在我们人口迅速老龄化的背景下，为建设一个更健康的新加坡而行动。各利益相关方之间持续对话非常重要，倾听、澄清、优先处理问题，并在前进过程中协作解决方案，将是关键任务。
在本次辩论中，我将重点关注社区和私营部门可以且应当做些什么，以补充和支持整个政府的努力，支持我们的医疗保健劳动力和医疗战略转型举措。不可避免地，我也会提出一些政策考虑的问题和建议，希望卫生部和整个政府能够采纳。
我有五个讨论主题。首先，是对我们的医护人员的尊重和感激。考虑到新加坡的医疗体系被评为世界顶尖，我认为是时候让新加坡医疗体系的使用者——即患者、家属、访客以及我们所有人——努力成为医疗体系中“最有礼貌”的群体之一。
有时人们对医院存在不切实际的“被服务”期待。像在餐厅那样要求送水是不合理的期待。频繁按呼叫铃提出小请求是不体贴的。对任何人，尤其是那些真正帮助我们的人进行辱骂，是绝对不可接受的。相反，一个微笑、一声“请”、一句“谢谢”，就能极大地表达关心和感激。
医院是高压场所。我相信医护人员都接受过同理心和同情心的培训，如果没有，也应该接受。尽管如此，患者和家属不应认为自己有权将愤怒和挫折发泄到医护人员身上，无论是医生、护士、辅助医疗专业人员、支持护理人员，还是医院保安。深呼吸，想想一件你感激的事情，并考虑那句古老的金科玉律：“己所不欲，勿施于人”。
话虽如此，仍会有不良行为发生，我支持卫生部制定统一的政策，协调处理和应对我们中的“害群之马”，同时我也希望并期待作为一个社区，我们都能做得更好。
第二点，社区参与。随着新加坡迈向超级老龄化社会，护士、辅助医疗和护理支持人员将变得越来越重要，和家庭医生、医生及医疗专家一样。社区自身必须认识到，我们也有同样重要的角色。
首要任务是个人保持积极健康的生活方式，以预防慢性疾病。作为“更健康的新加坡”计划的一部分，系统将激励积极行为，而不良的健康生活方式和行为应被抑制或惩罚。
接下来，社区可以通过在居民或邻里间组建小型互助小组来互相支持。这些小组可以像小型卫星一样接收和传播正确的医疗相关信息。每位全科医生（GP）可以担任几个小组的顾问，定期与他们联系，建议活动甚至参与其中，类似于国会议员在选区的工作。这些小组可以自我组织，设立一定的治理结构，帮助探访邻居，带需要的人去医院检查，确认他们是否按时服药，等等。
我了解到部分此类活动已经在进行，但可能缺乏连贯和组织性。我想最好的例子是我们在新冠疫情期间所动员的力量。那么，现在和平时期，我们如何复制这种模式？未来，我们可以更加协调和协作。社区可以组织健康筛查、社区运动如尊巴舞、麦里芝徒步、太极等。关键是如何吸引更多人参与并保持持续性。也许借助“更健康的新加坡”，参与者可获得积分，这些积分可用于医疗保健或购买健康主食如燕麦、牛奶等。
在“更健康的新加坡”辩论中，我分享了蒙福关怀家庭服务中心（Montfort Care FSC）在海洋露台52座发起的“好生活！美食”活动，以及位于大巴窑的嘉利达爱加倍村（Caritas Agape Village）的“分享一锅”计划。这些以及其他自发的基层举措，如新加坡心理健康网络、失智症新加坡的智慧家庭（Family of Wisdom），或协助视障、肢体残疾或患有失智症老年人乘坐公共交通的关怀通勤冠军，都是社区参与新加坡医疗生态系统的例子。
巧合的是，我今天上午刚参加了滨海艺术中心（Esplanade）举办的一场温馨的“大声唱”（Sing Out Loud!）表演，九位患有失智症的长者与九位幼儿园一、二班的孩子同台演出。长者是圣若瑟之家（St Joseph's Home）的居民，孩子们则就读于同一院区内的托儿中心。大声唱是滨海艺术中心于2016年与失智症新加坡合作开发的社区参与项目，但这是首次涉及跨代群体。
我若不提及育基修道院（Convent Yuki）及其在朋友们步入退休后半程时发起的蓬勃基金项目，将是不完整的。这些项目支持像我岳母谢莉莉女士那样的长者，即使到了90多岁，仍能过上有意义且相对活跃的生活。顺便说一句，我岳母下周将庆祝她的100岁生日。
这类举措可以成为“更健康的新加坡”社区伙伴关系的一部分。若能纳入“更健康的新加坡”的奖励体系并获得认可，将是极好的。
关于社区参与的最后一点。随着人口老龄化，人人掌握护理技能可能很快成为必需。或许将来每个人都需接受基础护理培训，在家庭或社区中提供服务，或参与某种形式的国家社区服务。这可以适用于年轻男性的国民服役，也可作为年轻女性入学前的社区服务培训。退休人员也可参与。这可以是志愿性质，也可能被视为某种有偿零工。
第三点：护士及辅助医疗人员短缺。王部长多次提到，我们医院面临的关键挑战是拥有足够的护士、辅助医疗专业人员和支持护理人员来运营医院、诊所和养老中心。护士和辅助医疗人员不足时，现职员工包括初级医生不得不承担额外工作，导致过劳、倦怠和心理健康问题。自2020年应对新冠疫情以来，我们的医护人员可能因此增加了数年年龄。
卫生部如何应对这些问题？私营部门如何协助？社区能做些什么支持？
一些想法包括：
（a）拓宽现有护士、辅助医疗专业人员和药剂师的培训和职责，使他们能与医生并肩承担关键角色。这有助于提升这些岗位对新加坡人的吸引力。我知道卫生部在这方面已做了很多，但仍有更多工作要做。
（b）护士薪酬也在审议和实施中，这很好。我的观点是，我们必须实现按技能付薪。谈到薪酬，更多总是受欢迎的。但据我了解，选择护理和辅助医疗职业时，金钱并非最重要因素。请确保他们薪酬合理。如果他们想赚大钱，会去做投资银行家等职业。重要的是岗位受到尊重和认可，有更多灵活性以实现工作与生活平衡，有职业晋升和个人成长机会，或能说自己过着有意义的生活。
（c）社区应改变对“服务”人员的看法和待遇。我们的护士和辅助医疗专业人员应受到尊严、尊重和感激的对待。
（d）设计人力资源政策，提供机会让他们选择职业发展路径，获得更高资格认证甚至学位，给予兼职学位或专业培训的学习假和考试假，类似医生待遇。这些员工常因排班困难而感到不好意思提出调班请求。如果我们认真对待终身学习，这必须解决。无需全薪假，只需排班灵活即可。
（e）技术可自动化重复工作，增强护士和医护人员技能。新加坡在全球医疗创新中享有盛誉，是少数充分利用技术的医疗体系之一。无论是机器人流程自动化（RPA）、人工智能（AI）还是数据分析，都已被证明能支持积极的患者结果，同时提升组织效率和效能。
心态转变和易于采用是关键挑战。一个好例子是使用传感器读取生命体征，减少护士和医生逐个患者测量的时间。这只是其中之一。抱怨很多，但时间有限，我直奔主题。
技术辅助和增强的岗位对年轻一代更具吸引力。我相信机器人已能根据患者腕带条码发药，未来条码可读取视网膜，准确发放药物。
（f）设计能支持灵活班次/工时的排班系统。这样的系统对需要兼顾工作、家庭、照护责任和学习的员工极具吸引力，也可能吸引退休护士或兼职护士重返职场。
据新加坡护士协会了解，已有“重返护理”计划，针对因家庭原因离职者。但据我所知，新加坡护士委员会已停止为离职超过五年的护士重新注册。这些护士在休息前有多年经验，愿意重返岗位，但可能难以恢复注册。适当再培训后，这将是一个很好的候选人库，可按适当级别重新加入，而非从初级护士重新开始。
还有护理职业转换计划，据说报名情况相当成功。若能获得该计划毕业生填补职位的统计数据，将很有意义。
（g）对于外籍护士和辅助医疗人员，无法携家属一同来是最大难题，尤其其他国家提供此福利。我们知道这对新加坡是挑战，但或许卫生部、人力部和内政部能分享吸引和留住外籍护士及辅助医疗专业人员的策略？
（h）社区能做什么？我希望所有家长都能鼓励在海外取得医疗资格的子女回国。我建议卫生部对护理和辅助医疗专业人员采取与吸引海外医学院毕业的新加坡公民和永久居民类似的措施。我听说我们的宣传活动让毕业生感受到被急需。
（i）关于人力短缺的最后一点。我们或许应激励在海外受训并取得资格的新加坡公民和永久居民回国，填补空缺岗位并完成注册。我听说有新加坡物理治疗师在澳大利亚有执业资格，却无法在新加坡注册。显然，他们需接受与本地培训同等广度的培训。或许卫生部可考虑对这些海外资格的物理治疗师和辅助医疗人员实行有条件注册，同时他们继续学习海外培训中未涵盖的课程。如此，我们可迎回另一位新加坡儿女，成为劳动力的加分项。
第四，私营部门如何发挥作用。总有资深医生在培训后选择退出公立系统，转投私营部门。这是公立部门管理专科医生的长期挑战。要实现“更健康的新加坡”，需要全员参与。
一个建议是私营专科医生定期为补贴患者提供义诊或低价服务，或为无力支付者开设免费诊所。执行不易，但如同新冠疫情期间，私营医疗被纳入并发挥重要作用，补充公共医疗资源。在这方面，我们可以向法律界学习。
在“更健康的新加坡”中，全科医生和家庭医学诊所将成为社区护理的关键节点。我相信卫生部不断审视各专科的比例。显然，我们应鼓励更多初级医生专攻家庭医学，走上成为全科医生或家庭医生的道路。据我了解，家庭医学已是专科。吸引更多医务官选择家庭医学路线需要什么？如果成功说服医务官，年培训名额有多少？
私营全科医生和诊所必须提升，提供专科培训岗位给初级医生。我们可能还需关注各专科间的薪酬差距。如何激励全科医生参与初级保健网络，共同推动预防健康的共同目标？
新的按人头付费模式将发挥关键作用，需设计激励和抑制各级护理行为的机制，包括全科医生和公众。预防和上游干预已被证明是改善临床结果的最佳途径。例如，Intermountain激励初级保健网络尽量减少患者入院。对糖尿病患者额外投入4%预算，实现住院率下降22%，其他可避免就诊和入院下降21%，整体提升护理价值并长期降低成本。新加坡或可借鉴类似模式。
我常听到的问题是，全科医生难以应对增加的行政和信息技术工作量。或许卫生部可建立统一平台，或由某机构或私营部门提供规模化行政服务。关键是全科医生需主动参与工作流程和激励机制的重新设计，确保“更健康的新加坡”实施高效、有效，且实现预期目标。全科医生需积极参与，助力自身，也助力新加坡医疗生态系统的初级护理创新，利用技术支持医疗团队。
第五，居家医疗。为实现可持续医疗体系，居家医疗必须在护理连续性中发挥关键作用。一位医生朋友分享，曾有一项计划（现已取消），允许产妇出院回家，护士会在出院后三天内上门探访母婴。这类家庭医疗服务正是我们向“在适当时间、适当地点、以适当护理”转型时所需的。
副议长：洪女士，您发言已达19分40秒。
简妮特·昂女士：抱歉。好的。谁将负责招募、培训和管理所有这些人员？也许，可以有某种形式的认证医疗专业人员，他们像优步司机一样自行安排班次，可能在他们的社区内“巡逻”，这可能是最好的方式。
在结束发言时，我不禁担忧我们集体以这样的速度进行转型的能力。过于仓促，风险在于努力可能流于表面，导致我们只得形式而失去实质。变革从来都不容易。我们很幸运拥有世界上最好的医疗系统之一。最新的2023年乐观繁荣指数将新加坡的健康指数评分定为86.9，排名第一。
我想以向所有参与医疗生态系统的人致敬来结束：清洁工、护理支持人员、辅助医疗专业人员、护士、医生、医疗专业人员和医疗管理人员。对所有在医疗领域及其周边工作的人，引用教皇方济各的话，“同情是你们所做工作的核心。你们知道这不仅仅是良好的组织，更是倾听、陪伴和支持你们所照顾的人的一颗心。”
这不是一份轻松的工作，但对你们大多数人来说，这是一种使命。因此，非常感谢你们不懈的努力和贡献，使新加坡和新加坡人在生命的每个阶段都保持健康意识、准备充分、包容、有韧性和有尊严。副议长先生，我支持这项动议。
副议长先生：拉杰·约书亚·托马斯先生。
下午2时57分
拉杰·约书亚·托马斯先生（提名议员）：先生，防止虐待和骚扰医疗工作者三方工作组于2022年4月成立，旨在研究如何解决医疗工作者遭受虐待和骚扰的问题。该工作组于今年3月提交了其调查结果和建议。他们关于虐待程度的发现令人担忧。超过三分之二的医疗工作者在过去一年中目睹或经历过虐待或骚扰。三分之一的医疗工作者每周至少目睹或经历一次虐待或骚扰。
医疗工作者处于特别脆弱的位置。他们的工作本质上涉及与需要某种帮助或关注，甚至可能处于痛苦中的人互动。因此，许多医疗工作者内化了某些虐待是工作中不可避免的，这往往导致举报不足。
工作组发现，像药剂师、病人服务助理和护士这样的前线医疗工作者更可能遭受虐待和骚扰，最常见的虐待形式是被大声喊叫、遭受贬低性评论以及被威胁投诉或采取法律行动。换句话说，许多虐待和骚扰形式源于患者和/或照顾者对待遇的某种期望，认为他们有某些权利未被满足，或应享有一定的服务水平或及时性。
这种针对前线服务人员的虐待现象在其他行业也有发现。因此，关键问题是，为什么这些施虐者会有这些期望，为什么他们认为可以通过喊叫、贬低性言论或威胁投诉来达到目的？
我想知道这是否正是因为我们的医疗系统被誉为世界上最好的之一，是否与新加坡人对效率和问责的典型追求有关。这是否已经深深植根于我们的人民心中，成为对所有服务和工作人员的基本期望？
当这种期望未被满足时，新加坡人会感到沮丧，觉得系统辜负了他们。在这方面，我们在效率和生产力上的成功可能成为双刃剑，因为即使稍有不足也可能引发反弹。
报告中令我印象深刻的一点是，较为普遍的虐待形式之一是威胁投诉或采取法律行动。这似乎是对举报程序、通过反馈改进的愿望以及法治的扭曲应用。我们是否正在变得更加诉讼化？这是否因为我们认为任何感知到的轻视或不便都可以通过诉讼、投诉或法院解决？所有这些都影响医疗工作者的士气及其履职能力。
就在今天早上，陈雅森医生与我分享了一个轶事，她的一位医疗朋友因受到威胁而辞职。这包括一名施虐者威胁要在她工作场所外找她。
他说——他说的是中文，我不尝试逐字复述，但翻译是，“新加坡这么小，连老鼠都能找到。”这是我被告知的翻译。
对于我们基层的工作人员来说，他们关注的是完成工作。技术和流程让我们更快更好，但有时也有行政流程需要遵循。
例如，《个人数据保护法》现在对数据收集和处理施加了某些要求，以保护个人身份信息。
另一个例子是，随着人口老龄化，委任代理人的需求将增加。必须遵守某些法定程序，照顾者可能不完全理解。这可能导致对医院管理人员的挫败感，情绪可能激动。
因此，防止虐待和保护医疗工作者的关键措施之一应是向患者、照顾者和公众灌输这样一种观念：无论他们对行政流程或感知的系统低效有多大挫败感，都不能将这些挫败发泄到仅仅是在其所处系统内工作的工作人员身上。
这不仅仅是拥有法律下的法定保护和处罚。它要求我们采纳一种社会心态，即文明和善良，而非傲慢的期望和权利意识。事实上，这正是尊敬的温·里扎尔议员早先所说的——我们需要全社会的努力。
例如，日本有一种“おもてなし”（omotenashi）文化，即无私的款待，被视为日本人以关怀为中心而非期望的心态的缩影。おもてなし认为良好的礼仪和礼貌不仅是个人社交互动中的期望，也是尊重和良好声望的标志。其原则包括谦逊、耐心、迅速道歉和语调平和。
为了强调おもてなし并确保这一日本核心特质在现代化社会中不被遗忘，东京都政府于2016年启动了“东京良好礼仪项目”，该项目仍在进行中。
卫生部控股公司已宣布将启动一项全国公共教育运动，促进医疗工作者、患者及其照顾者之间的信任与尊重的积极关系。我真心希望这项运动能成功减少虐待事件，为我们的医疗工作者提供社会支持，打造我们自己的おもてなし文化。
医疗工作者遭受的虐待通常来自两类人——患者及其照顾者或家属。
关于患者，医疗专业人员可能面临困境。年长者、精神健康问题患者或疼痛中的患者有时可能变得具有攻击性，包括身体攻击。
对此，工作组建议明确规定施害者的后果。对于施虐患者，可发出警告，若不需紧急治疗可予以出院。此外，医疗工作者也可通过拒绝不合理请求来脱离施虐患者。
我想制定这些指南将颇具挑战，因为必须在提供医疗服务与保护医疗工作者免受身体、心理和情绪虐待之间取得平衡。
同样，对于因亲人医疗紧急情况或状况而心烦意乱的照顾者和家属，也可能出现施虐情况。
我认为，虽然我们可以对家属表示同情，但如果他们言语或身体虐待或骚扰医疗工作者，应实行零容忍。
虽然医疗工作者的职责之一是为这些人提供支持，但没有义务为他们提供医疗服务。因此，处理非患者施虐者的程序应比处理施虐患者更严格，并应积极执行。
主管和医院管理层必须支持他们的工作人员。我们的国家医疗集团已表示将支持并实施包括零容忍政策在内的建议。我也很欣慰翁部长表示，即使是部长也会支持医疗工作者，医疗工作者应当知道这一点。
当虐待达到一定严重程度时，相关部门也应准备起诉此类案件。
我希望今年下半年发布的指南能显著减少针对医疗工作者的虐待事件，让他们每天安心上班。
先生，我支持我的三位提名议员同事提出的动议。我也借此机会支持我们的医疗工作者，感谢他们为此所做的牺牲和持续的付出。
我们的护士、医生、治疗师、阿嬷、辅导员、药剂师和行政人员从事的是保护人类核心——生命和福祉的职业。他们不仅是高尚的职业，更是最崇高的职业。因此，让我们确保尽最大努力照顾他们——照顾那些照顾我们的人。
副议长先生：洪显德教授。
下午3时07分
洪显德教授（提名议员）：副议长先生，先生，从根本上讲，我们都认识到个人生活中存在一些不可预见的负面事件，比如严重生病。
为了保护公民免受此类偶发事件的影响，人们可能认为我们可以完全依赖私人保险公司。理由是风险厌恶者会出于自身利益购买按精算公平价格提供的保险。
然而，由于信息不对称，市场一方拥有另一方无法轻易获得的私人信息，导致逆向选择。
完全保险通常不可得。在逆向选择特征的市场中，成本较高的客户知道自己是谁，但卖方不知道。保险公司知道潜在客户中有些风险较低，但不知道具体是谁。
被保险人比保险公司更了解自己的风险水平，这可能导致风险较高者购买保险，从而使保险公司亏损。结果是私人保险供给不足。
因此，在存在逆向选择问题时，政府有责任通过提供社会保险形式的MediShield Life介入，该计划于2015年11月推出。该国家健康保险计划有三个重要特点。
第一，有公共强制性，所有新加坡公民和永久居民均纳入计划。没有此强制性，健康居民有动机退出购买反映不健康居民更高医疗成本的保险。
第二，涵盖既往病症，尽管对需要密集医疗干预或长期治疗的严重既往病症收取额外保费。
第三，政府为低收入居民提供补贴，帮助他们支付保费。
MediShield Life由中央公积金局管理，属于确定缴款制社会保障系统。与通过向年轻工作者征收工资税为退休老人提供福利的确定福利制不同，中央公积金缴款是个人储蓄的一部分。
为了确保国家健康保险计划的财务可持续性，经济必须持续创造优质就业机会。这是因为保费支付的主要资金来源是个人的MediSave账户。
动议呼吁全政府协作的做法非常恰当。
平台工作者咨询委员会最近建议平台公司与政府合作，建立平台工作者定期向MediSave缴款的机制，这也有助于国家健康保险计划的财务可持续性。
副议长先生，先生，因此我支持由我三位尊敬的提名议员同事提出的动议。
副议长先生：叶汉荣先生。
下午3时12分
叶汉荣先生（耀祖康）：副议长先生，先生，今天的动议提出了一些重要问题。我想谈谈老龄化问题，并探讨如何更好地赋能我们的长者，让他们继续过上充实的生活。
我们的医疗系统必须具备应对超级老龄社会独特挑战的能力。我们必须未雨绸缪，立即解决问题，否则未来我们的基础设施和设施将无法满足需求，这将给新加坡带来重大财政负担。我想谈三个问题。
首先，副议长先生，先生，我们需要更好地组织护理整合。我同意陈雅森医生的观点，需要加强跨部门合作，但我想补充的是，这在卫生部（MOH）和社会及家庭发展部（MSF）负责的医疗与社会护理之间尤为重要。
“更健康的新加坡”计划无疑是朝正确方向迈出的一步。我们追求的是健康，而非仅仅是医疗。社会处方是关键组成部分。我们需要鼓励长者参与促进整体健康的活动。体育新加坡、人民协会和各社会服务机构（SSA）提供了许多免费运动和健康项目，但我们必须动员基层支持，积极参与。在这方面，有哪些措施将两者连接起来？否则，这只会成为另一个启动项目——听起来不错，但可能无法有效帮助居民。
社会处方和医疗必须齐头并进。医疗与社会护理之间需要更紧密的整合。医疗专业人员，包括全科医生（GP）及其诊所助理，是否了解社区内各种组织提供的运动项目？如果了解，他们是否有足够知识向患者推荐？同样，我们的社会服务专业人员是否知道如何识别长者的健康相关问题并转介给适当的医疗专业人员？
一个概念在纸面上看似有前景，但关键在于实施。我们如何帮助卫生部以外的医疗人员准备参与该项目？我们需要摆脱对医疗过度医疗化的恐惧，鼓励医疗与社会护理的更大合作。
是否到了放弃跨部门部长级委员会，考虑设立老龄事务部的时候？组织决定行为。专门的部门可以领导与老龄相关的综合政策，确保满足长者需求，使新加坡成为适合养老的好地方。
其次，副议长先生，先生，我们需要更好的支持工具来促进护理整合。必须建立一个集成系统，实现医疗与社会护理的无缝协作。为此，我们需要解决当前医疗遗留信息技术问题以及不同医疗集团使用的IT系统。我在之前的议会发言和供应委员会辩论中提到过这一点。
例如，一些医疗集团使用Health Buddy，而其他使用HealthHub。社区、初级和三级医疗提供者使用的计算机系统多种多样，从CCMS、Epic到Citrix。系统能互操作吗？能否合并这些IT系统，确保医疗专业人员访问统一平台，管理患者的医疗需求？
同样，合并GovTech系统和综合健康信息系统（IHiS）也很重要，以确保医疗与社会部门之间更好的数据共享。
我们还必须探索更好地促进政府与社会服务机构（SSA）之间关于老年人健康和社会福祉信息的数据共享方式。目前，数据共享显得相当零散。我们应努力实现对老年人的整体视角，涵盖健康和社会两个方面。
最后，我们必须探索利用远程医疗促进护理整合的方法。扩大现有试点项目的计划是什么？我们如何确保远程医疗被有效利用，为我们的老年人提供全面的护理？
第三，在我们寻求改善老年人护理整合的同时，也必须关注进一步赋能护理整合。我们必须提出一个关键问题：我们能否更好地赋能老年人，使他们更好地照顾自己？
为回答这个问题，我们需要探索老年人在老龄化过程中应关注的关键信息和举措。
一种可能的解决方案是为老年人及其照护者提供一本健康手册，包含相关信息，帮助他们有效管理健康。这类似于为小学生及其家长提供的儿童健康手册。
虽然我们承认这对文盲或视力障碍者可能不可行，但对于许多需要指导的老年人和照护者来说，这仍将是一个有用的工具。
事实上，随着我们老龄人口未来变得更加受教育和识字，我们预计大部分赋能将需要老年人自助和主动。老年人希望被赋能以做出独立且明智的决定。我们需要引导他们走向正确的方向。一个关键举措是促进更好的透明度，推送更多关于各种健康相关主题的信息，如癌症筛查清单和保险。
在这方面，我们应探索银发一代办公室（Silver Generation Office）如何在此领域提供帮助。通过为老年人提供必要的信息和资源，我们可以使他们更好地照顾自己的健康和福祉。最终，这将带来更好的健康结果和更大的独立性。
总之，副议长先生，我们需要改变为老年人口提供护理的方式。我们需要整合，而非碎片化。那么，真正的整合系统是什么样的？
对我来说，这是一个围绕老年人组织的护理服务无缝整合的系统，具备对其身体、心理和情感健康的360度视角。
我们如何实现这一目标？这需要在急性护理与长期护理之间、急性护理与初级护理之间、以及初级护理与社区护理之间无缝制定护理方案。
这意味着采用多学科和以人为本的方法。医生需与其他健康和社会护理专业人员紧密合作，如辅助医疗官员、社会工作者甚至社区友伴，共同识别老年人的共同护理需求，并提供整合干预。健康和社会护理必须跨越界限，帮助老年人在社区中健康老龄化。这也意味着信息应在医院与社区护理专业人员之间无缝流动，以更好地管理老年人的健康和社会状况。
最终目标是实现一名患者、一份健康或健康状况记录、一套信息技术系统，并希望由一个老龄事务部统一监管，提供协调的、整体的和整合的护理，将新加坡打造成为最佳宜居地。我支持该动议。
副议长先生：秩序。我建议现在休息。我宣布休会，下午3点40分继续主持会议。
会议于下午3点22分休会，至下午3点40分。
会议于下午3点40分恢复。
[副议长（Christopher de Souza先生）主持]
支持医疗保健
[（程序文本）辩论继续。（程序文本）]
副议长先生：文化、社区及青年部和社会及家庭发展部高级议会秘书蔡恩灿先生。
下午3点40分
文化、社区及青年部和社会及家庭发展部高级议会秘书（蔡恩灿先生）：先生，我同意各位议员的看法，支持医疗保健超越新冠疫情需要新加坡社会的共同努力。
先生，在准备这次发言时，我问了ChatGPT对新加坡医疗体系的看法。翁永康部长和卫生部团队会高兴地注意到，ChatGPT对我的回答是，我引用：“新加坡医疗体系常被誉为世界上最好的医疗体系之一，以其高效、高质量的护理和低医疗成本著称。”
话虽如此，我们不能假设这一较为光彩的评价会保持不变。新加坡是全球老龄化最快的社会之一。我们非常清楚数字：到2030年，每四个新加坡人中就有一位是老年人，到2050年，每两个新加坡人中就有一位是老年人。
如果我们要充分收获有意义且富有成效的长寿，我们必须努力缩小健康寿命与实际寿命之间长达十年的明显差距。这一点很重要，我觉得有必要重复。如果我们希望新加坡人不仅活得更长，而且活得更好，我们有一个长达十年的健康与寿命差距需要弥合。从长远来看，我们必须利用老龄化带来的积极面。
2017年，新加坡体育理事会（SportSG）启动了“积极健康”国家倡议，旨在激励新加坡人主动管理自己的健康和福祉，并通过共享体验促进更强的社区精神。我们希望推动思维转变，从“缺陷导向”——即“我只有生病时才寻求治疗”——转向“愿景导向”的积极健康生活模式。在后一种模式中，每个人都被赋能以更好地生活，延缓或预防慢性病的发生。
过去十年，SportSG积极落实2030愿景的建议。因此，全国定期参与体育活动的人数增加了约20%，从2015年的54%提升至2022年的74%。在2022年进行的一项积极健康调查中，约96%的受访者在被问及健康和福祉的重要性时给出了8分（满分10分）。然而，只有60%的人表示有信心改善和/或维持自己的健康和福祉。许多人不了解自己的健康状况，也不知道如何轻松迈出积极健康生活的小步伐。
我同意议员们的看法，支持需要新加坡社会各界的共同努力，确保每个人都能实现其健康和福祉的愿望。
其中一项协同努力是皇后镇健康区试点。该试点由建屋发展局（HDB）、新加坡国立大学（NUS）和国立大学医疗系统（NUHS）牵头，旨在通过为各年龄段人群提供健康和福祉项目，促进健康长寿和代际联结。
在皇后镇，由狮子会友伴组织（Lion Befrienders）协助，老年人参与力量和平衡训练项目，如舞蹈健身、改良运动和虚拟方格步行练习。老年人还参与代际体育周五活动，如足球、积极耕作和舞蹈健身，适合所有年龄段参与者。
学生们参与“积极健康课堂冠军”项目，该项目采用整体健康方法，促进体育和课外体育活动的参与。根据SportSG的学校体育合作计划，皇后镇的学校引入了更多多项体育项目，促进学生的整体健康、福祉和社会凝聚力。
家庭参与工作坊和项目，如“公园积极健康探索步行”，强调例如阻力训练在增加肌肉质量中的重要性，同时进行定期散步。
还有针对弱势群体和残障人士的项目。例如，SportCares FUN Starters多项体育和周六夜灯足球项目为租赁住房和其他弱势社区的儿童和青少年提供运动机会，帮助他们养成终身体育习惯，提升基本运动技能和身体素质，并培养社区归属感。
除了项目安排，SportSG还与建屋发展局合作，提升皇后镇健康区的基础设施，帮助居民保持健康和活跃。例如，作为邻里更新计划（NRP）的一部分，将在皇后镇美灵区安装由SportSG设计的“积极健康健身步道”，配备行为引导，旨在发展力量、柔韧性和平衡，并配备适当的健身器材，以提升健身和锻炼空间。
在健康区之外，我们已在全岛设立了约八个积极健康实验室，位于我们的ActiveSG体育中心和积极健康合作伙伴场所。我们的目标是帮助人们了解自己的身体成分、体能和健康状况，并从合格的积极健康教练那里学习如何维持积极健康的生活方式。
居民来到我们的ActiveSG中心不仅是为了锻炼，也是为了社交和建立网络。根据2022年全国体育参与调查，95%的受访者表示与他人一起参与体育活动后，福祉有所改善；94%的受访者表示体育活动提升了他们的生活质量。
就在上周末，我与数百名皇后镇居民一起，暂别我们心爱的皇后镇体育中心。该设施服务居民超过五十年，曾在七十年代承办分散式国庆阅兵，并曾是丹戎巴葛联足球俱乐部和国家水球队的主场。体育和体育设施在塑造地方感和形成共同身份方面也发挥着关键作用。
因此，我呼吁大家前往遍布全岛的ActiveSG体育中心，尝试各种项目和活动，参观我们的积极健康实验室，开启您的健康和福祉之旅。
除了体育活动，SportSG将继续与卫生部和健康促进局（HPB）合作，鼓励全科医生（GP）将患者转介至合适的社区活动，帮助他们改善或维持健康，并了解其体能和健康状况。要做好这项工作，我们需要团队合作。
个人公民可以主动前往积极健康实验室，了解自己的健康和福祉，并考虑将相关的健身和饮食建议融入日常生活。家庭成员也可以发挥作用，温和地推动亲人迈出掌控自身健康和体能的第一步，前往积极健康实验室。
医疗服务提供者则可以将客户转介至积极健康实验室，在认证教练的指导下学习安全锻炼。政府方面，SportSG将与健康促进局和人民协会合作，确保有稳定的项目、体育兴趣小组和社交活动，供医疗服务提供者推荐给客户。先生，请用中文发言。
（中文）：[请参阅方言发言。] 新加坡是全球老龄化最快的国家之一。当然，我们希望新加坡人长寿，但同时也希望他们在黄金岁月中健康且有意义地生活。
SportSG于2017年启动积极健康倡议，激励新加坡人主动管理健康，并促进更强的社区精神。为实现这一目标，我们社会的所有利益相关者都必须发挥作用。皇后镇医疗区试点就是一个很好的例子。
此外，我们已在全岛设立了八个积极健康实验室，位于ActiveSG体育中心和积极健康合作伙伴场所。我们的目标是帮助人们了解自己的身体成分和健康状况，并从合格的积极健康教练那里学习如何维持健康生活方式。
我呼吁大家前往遍布全岛的ActiveSG体育中心，尝试我们为您组织的各种项目和活动，参观积极健康实验室，开启您的健康和福祉之旅！
（英文）：先生，令人欣慰的是，许多人认识到健康和福祉的重要性。通过积极健康，我们希望让居民更快乐、更健康，能够长寿并在“亲社会”空间中茁壮成长——年轻人与老年人相互关心，互相推动积极生活和健康、有意义的长寿。先生，我支持该动议。
副议长先生：副教授林志明。您有请求吗？
副教授林志明（盛港）：是的，副议长先生，我希望参与这场辩论。
副议长先生：在您发言之前，我想指出这是临时请求。为了更好地安排议会会议，我鼓励所有议员如果打算参与辩论，请提前通知我们。这有助于时间安排和会议调度。希望各位议员配合。我现在请您发言，您可以开始。
下午3点52分
副教授林志明：感谢副议长先生给予我参与辩论的机会。我将谈谈作为一个国家，我们可以采取哪些步骤，更好地平衡医疗资源支出。我会分享一些细节，说明为什么我认为我们可以提高医疗系统的承载能力，尽管这可能会在效率上带来一些损失，并在成本上带来边际压力，但我相信这将换来更强的长期韧性。
正如本院其他议员所分享的，政府也深知，我们即将面临的公共医疗支出将远高于目前的预算。这主要是由于社会老龄化和老年人口带来的更大医疗需求。但我的观点更为根本。即使在当前，我们的医疗系统在某种程度上仍未达到我们对处于此发展阶段经济体的合理预期。
明确地说，我并不是说我们现有系统存在根本缺陷，也不是说它应被彻底改革。事实上，我认为我们可以理直气壮地为现有系统所提供的护理质量感到自豪，该系统融合了公共和私人部分，并且如高级议会秘书蔡恩灿刚才向本院分享的那样，证明了其极高的成本效益。
虽然我当然更倾向于公共部分占比更大——这是我今年三月关于《医疗服务法》修订辩论中曾谈及的议题——但这不是我今天关注的重点。
我想强调的是，我认为新冠疫情暴露了一个明显的短板：由于我们运行系统过于精简，面对大规模、意外但完全可预见的冲击（如疫情）时，系统变得脆弱。
这里，或许需要一点哲学讨论。经济学家的基本职能是最大化给定目标，受制于约束条件。这通常意味着我们不断寻找最优解，并在找到时感到非常满意。我的妻子经常取笑我，如何通过规划去杂货店的路线，同时完成加油、取款、打包晚餐等所有事务，使行程顺畅连贯。在这方面，经济学家是容易满足的生物。
但还有另一种同样合理的世界观，常见于工程师。工程师不会完全剔除系统中的低效元素。他们认识到冗余的重要性，因为在正常条件下，这些未充分利用的元素可能显得浪费，但它们在压力过大时至关重要，可以防止系统整体崩溃。因此，他们设计的桥梁承载能力远超正常交通需求——甚至还要多一点。他们设计的飞机即使一台引擎停机也能飞行。他们设计的发电厂拥有多重安全保障，可以在部分设备维修时保持整体运行。
先生，新加坡每10万人口的重症监护病房（ICU）床位数目前为5.7张。经济合作与发展组织（OECD）成员国的平均值接近12张，是我们的两倍。在床位覆盖率低于我们的四个经济体中，只有日本的人口老龄比例显著更高。
更普遍地说，我们的医院床位数也较低。我们每千人拥有略多于两张床位，远低于其他东亚经济体，如日本和韩国约为12张；中国约为5张；以及丹麦、荷兰、以色列和美国等其他发达经济体，床位比率接近3张。
明确来说，床位数量偏低并不能直接证明现行系统存在问题。我们需要关注这些床位的使用率，甚至可以认为高效的康复意味着我们能够维持较低的承载能力。
在我尊敬的朋友Leon Perera先生去年提出的一项议会质询中，资深国务部长Janil Puthucheary分享了未来五年目标床位使用率约为80%，他补充说这一比例通常被学术界和医疗机构推荐。在前一年向本院的声明中，他还解释了我们能够迅速增加重症监护病床，正如疫情期间所做的那样。
但在该声明中，他也承认需要增加ICU床位容量，尽管他指出这一过程并非易事，主要受限于增加医务人员以配备这些床位的需求。
此外，近期我们主要医院的床位使用率数据显示，这80%的目标似乎经常被突破，过去一个月内，谭笃生医院、黄廷芳医院和邱德拔医院的使用率常常超过90%，而且是在非疫情期间。
综合来看，这表明政府意识到医疗基础设施过于紧缩会在压力时期带来问题，并且即使回归常态，我们仍未完全解决这一问题。
卫生部已透露计划在兀兰建设新的医疗园区，以及在勿洛建设另一园区，但其余项目均为现有设施的扩建。部长是否愿意分享这些项目是否足以应对因人口老龄化带来的需求增长，同时缓解现有的容量限制？还是主要聚焦于匹配新增需求，而现有容量基本保持不变？
这引出了关键瓶颈：医疗人力。
目前，我们的医生和护士覆盖率相对较低。截至2021年，新加坡每千人拥有2.7名医生，约为经合组织平均水平3.8的三分之二。
不出意外，这导致了医务人员的倦怠、压力和高流失率，议院其他成员也有提及。解决方案看似简单且无争议：我们需要增加医疗人员供应。政府也强调，增加医疗培训人员是优先事项。问题是如何实现。
全球护士短缺，世界卫生组织估计缺口接近600万，而国际护士理事会——虽为利益相关方——则估计缺口更高，约1300万。
在此背景下，短期内我们需吸引并留住全球人才，长期则需扩大本地培训医务人员。
有限床位和医生的实际表现是，许多设施的入院等待时间持续偏高。邱德拔医院尤为严重，黄廷芳综合医院和我所代表选区的盛港综合医院也出现过高峰期。某些日子，等待时间甚至超过24小时。
我们应问自己：是否愿意接受患者偶尔需等待超过一天才能入院的现状？或许我们认为这是控制整体医疗成本的合理权衡，亦或将此视为现有系统承载能力需提升的信号。
我在早前发言中提出了一些中期建议，以缓解系统压力。我们可考虑增加认可的基础医学学位大学数量，超过目前的100所。对于在其他司法管辖区有丰富经验的医生，可简化申请和认证流程，或设立卫生部指定流程主动寻找并鼓励他们申请。
在与其他面临护士短缺的发达经济体竞争全球护理人才时，培养更多本地护士也很有意义。我们可为培训生提供更优厚条件，例如完全免除学费，尽管现有学费已相对低廉，条件是毕业后在新加坡从事护理工作一定年限。
这也适用于考虑中年转行者。我们可确保技能未来基金不仅全额覆盖转职课程，还可能对既有培训提供更多学分。例如，幼儿教育者和教师肯定已掌握护理课程中的沟通、批判性思维、数据分析和行为科学等通用课程。
缓解供应压力需超越数量政策，也应关注价格。最简单的做法是提高该领域薪资。持续涨薪的限制之一是成本已高昂，这主要由私立医院的商业租金推动，进而影响公立医院定价。高租金源于——你猜对了——高昂的土地价格。
但这不仅仅是提高工资——如果同时伴随更长工时则无益。更理想的是增加医生和护士总数，同时保持合理工时。总工资支出不变，但护理质量可能提升。
我们还可增加护理层级——其他国家多达五至六级，而我们目前仅有注册护士、注册护士和高级执业护士三级。这为职业发展提供更多上升通道，吸引更多人入行。
先生，正如我开头所述，我们的医疗系统容量并无根本缺陷，但面临日益加剧的压力。明智之举是在相对平静时期调整适应即将到来的需求，而非在未来疫情爆发时仓促应对。
副议长：教育国务部长颜晓芳。
下午4时04分
教育国务部长（颜晓芳女士）：副议长，健康就是财富。我们的健康账户就像银行账户，投入越多，回报越多。现在投资健康，将为终生带来回报。
大多数人同意，孩子们需要从小养成健康生活习惯，并持续实践，才能有最佳机会保持健康，充分享受生活。
感谢陈雅心医生强调健康教育的重要性。教育部采取整体方法，从学生入学起促进其整体福祉和健康。在整个教育过程中，学生获得知识、技能和态度，培养积极健康的生活方式，并延续至学业结束后。
在学前阶段，教育部的“培养早期学习者”（NEL）框架强调全面发展，鼓励健康习惯和积极参与体育活动的态度。
在学校，学生学习良好健康习惯，如定期锻炼、充足睡眠和健康饮食。在体育课上，他们学习多种运动和游戏，装备他们终身参与体育活动。理工学院设有多种健康与保健课程，工艺教育学院（ITE）则有每周体育课程。
教育部学校和高等学府（IHLs）也为学生提供课外体育活动机会。学生可参加课外活动（CCA）、兴趣小组或体育俱乐部，利用校内体育设施和器材保持活跃。
健康促进局（HPB）与愿意采纳项目的学校和高等学府合作，如“活跃青年计划”，通过定期现代锻炼课程增加体育活动参与。
营养是身体健康的另一关键方面。所有学校和高等学府积极推广健康饮食。中学低年级学生在食品与消费者教育课上学习规划和准备更健康的饮食。与HPB合作，所有学校实施“学校健康餐计划”，食堂提供更健康的食物和饮料选择。
同样，理工学院和工艺教育学院参与HPB的“更健康餐饮计划”，鼓励餐饮经营者提供更健康的选择。自治大学（AUs）也通过与餐饮供应商合作，支持校园健康饮食。
接下来谈心理健康。温瑞扎尔医生谈及学生心理健康素养的重要性，我赞同。学校和高等学府为学生提供知识和技能，增强心理健康，建立韧性，应对挑战。例如，学生在品格与公民教育（CCE）课程中学习常见心理健康问题及寻求帮助的重要性。鉴于数字世界对心理健康的影响，学生还学习管理社交媒体使用和培养健康的线上同伴支持文化。
副议长，儿童健康福祉需要全社会共同努力。家庭和社区在营造支持健康习惯的环境中发挥重要作用。家长可在家中强化并示范健康习惯。教育部通过家长工具包、教育部育儿Instagram和家长通道等平台，向家长分享实用建议，帮助营造积极家庭环境，促进儿童身心社会情感健康。
我们听到许多家长积极参与，与孩子共同建立健康生活方式，增强亲子关系。一位父亲分享他与孩子定期锻炼的习惯，孩子教他学校体育课学到的各种运动和游戏。家长强化并示范学校所学，我相信更多孩子将养成终生健康习惯。
我们欣慰看到家长支持团体（PSGs）、学校支持家长与社区（COMPASS）、健康促进局（HPB）及多家社会服务机构合作，支持家长加强儿童健康福祉。
感谢家长和社区伙伴与我们携手促进学生福祉。期待与更多伙伴持续深化合作，让孩子们从小积累健康账户，充分享受生活。副议长，我支持本议案。
副议长：卫生资深国务部长Janil Puthucheary。
下午4时11分
卫生资深国务部长（Janil Puthucheary博士）：副议长，先生，我支持由陈雅心医生、莎希拉·阿卜杜拉医生和阿卜杜勒·萨马德先生提出的议案。
先生，我们每个人都在确保人口健康福祉中扮演关键角色。作为个体，我们需积极采取措施，过更健康生活，降低患病风险，同时政府构建支持环境助力实现这一目标。我将谈及心理健康、口腔健康及支持个人健康生活的医疗信息技术基础设施和数字工具。
先生，良好心理健康至关重要。心理健康是一个光谱，具有多面性。心理健康问题可能由多种因素引发，包括身体健康和社会决定因素。解决这些问题需多部门协作，涵盖卫生、社会、教育、职场和社区领域。
这已在进行中。例如，在社区心理健康总体规划下，卫生部、综合护理机构和社会服务机构合作，在新加坡各地建立社区心理健康团队。这些团队向居民提供心理健康教育，将心理健康筛查、评估和治疗等服务带到社区，减少污名化，让个人更安心寻求帮助。
高林斌教授谈及学术环境中的心理健康。健康促进局与高等学府合作，建立同伴支持结构，提供同理倾听和基础心理急救技能培训，支持出现情绪困扰迹象的同伴。此外，愿意学习心理健康和自我关怀技巧者可访问MindSG门户，获取由心理健康专家策划的资源。
重要的是解决职场中的心理健康问题，无论职场是学术环境还是其他。2020年，劳工部、全国职工总会（NTUC）和新加坡全国雇主联合会（SNEF）联合发布《职场心理健康三方建议》，支持员工心理健康，为雇主、员工和自雇人士提供资源。
陈雅心医生分享她作为初级医生时，有时值班超过24小时的经历。
卫生部正在审查初级医生的总工作时长，包括值班时间。公立医疗集团在部分科室试点缩短初级医生值班时间，并通过电子记录和调查监控工作时长。
这是复杂议题，需根本重新审视人力部署及资深与初级医生职责分担。研究和制定方案需要时间，我们正积极推进。
陈雅心医生和高林斌教授强调心理健康教育和去污名化的重要性。健康促进局于2021年10月发起“寻求帮助没问题”运动，旨在提升心理健康意识，鼓励对话。2022年运动聚焦青年，帮助他们克服寻求支持的犹豫，解决相关顾虑。活动包括教师引导的课堂讨论，推广至主流学校和高等学府。线上和线下推广心理健康意识和素养的工作持续进行。
此外，社会服务理事会（NCSS）于2018年启动的“超越标签”（BTL）运动持续推进。BTL 2.0阶段旨在激励行动，NCSS联合来自民间、公共和私营部门的26个合作伙伴，促进并支持学校、职场和社区中的寻求帮助与提供帮助行为。
先生，心理健康与福祉跨部门工作组于2021年7月成立，负责监督和协调各部门心理健康工作，聚焦需跨部门协作的综合议题。
工作组已提出12项初步建议，并于去年开展公众咨询，收集超过950份反馈，涵盖青年、家长、心理健康患者、服务提供者、雇主和社区机构等群体。
反馈普遍支持所有建议，工作组将很快发布咨询报告摘要，同时启动建议实施计划。
其中一项建议是实施分级护理模式，依据心理健康需求程度匹配护理水平，实现更有效的服务分配，针对个体需求的严重性和复杂性。
公众咨询中，我们收到关于实施的宝贵反馈。例如，为确保分级模式有效，服务提供者需具备足够能力履行职责。
我们完全同意，要有效实施分层护理模式，一个重要方面是确保所有心理健康从业人员具备足够的能力和标准。因此，我们成立了国家心理健康能力培训框架工作组。他们正在制定的框架将指导心理健康从业人员掌握提供优质有效护理所需的知识、技能和能力。该框架适用于所有从业人员，从同行支持者等非专业响应者，到包括护士、社会工作者和辅导员在内的心理健康专业人士。我感谢万瑞扎尔医生强调这一点的重要性。
此外，目前已有系统保障专业执业。心理健康专业人员通过专业委员会和理事会进行监管，并通过专业协会制定执业标准。
例如，精神科医生、护士和职业治疗师分别由新加坡医学委员会、新加坡护理委员会和辅助卫生专业委员会监管。新加坡辅导协会和新加坡心理学会等专业协会分别为辅导员和心理学家提供专业和伦理行为指导。
还需要帮助有心理健康需求的个人及时获得适当服务。工作组的一项建议是指定几个首站接触点，为个人提供便捷的心理健康支持和咨询。
部分咨询反馈者认为，提供多种服务方式以考虑用户偏好是有价值的。我们正在开发多种服务模式，如热线、短信、面对面服务和数字资源，确保人们有足够且多样的途径访问这些心理健康首站接触点。
先生，如果我现在可以转向回应沙希拉·阿卜杜拉医生关于新加坡老年人、特殊需求人士和外籍劳工口腔护理的问题。
政府已推出多项举措，确保新加坡人能够获得负担得起且优质的医疗服务，例如通过社区健康援助计划（CHAS）。这些群体的大多数口腔健康需求可由多诊所、CHAS诊所和私人牙科诊所的一般牙医满足。对于有复杂需求及患有医疗状况或多重疾病、需要更高水平护理的个人，可由国家专科牙科中心和医院牙科诊所的专家提供护理。
为方便就医，卫生部已与社会及家庭发展部合作，列出提供特殊护理牙科服务的牙医和私人牙科诊所的详细信息，以提高公众对残疾人士服务可用性的认识。
此外，除了现有的启能村、爱加倍村、HealthServe和圣安德鲁传教医院等公私合作项目外，我们将进一步探索公私合作伙伴关系，更好地服务包括外籍劳工在内的服务不足社区的初级医疗和牙科需求。
针对外籍劳工，人力部（MOM）也将继续探索与非政府组织等关键合作伙伴合作，通过口腔及慢性病管理项目（Project MOCCA）促进外籍劳工可及的牙科护理并提供口腔健康教育。Project MOCCA由人力部去年启动，是一项预防健康框架，旨在提升工人群体口腔及慢性疾病的护理水平。人力部与MigrantWell Singapore等合作伙伴紧密合作。
我们认可独立志愿者倡议在社区、中长期护理环境及特殊需求组织中提供牙科服务的努力。为改善这些服务的协调，我们将鼓励较大的志愿者协会提供沟通、资源共享和协调的平台。
随着人口结构变化、技术进步和护理方式转变，牙科实践也在不断演进，本地牙科格局将相应调整。
为更好支持为老年人和特殊需求人士提供护理的牙科专业人员及其他医疗和非医疗专业人员，我们将考虑制定临床实践指南和适当的护理指南，帮助建立护理标准，促进更佳健康结果。此外，我们将继续审查补贴框架，并为牙科各学科的住院医师培训项目颁发奖学金，确保牙科人才队伍持续满足各年龄段和护理环境的口腔健康需求。
先生，接下来我想强调拥有一个良好整合且可靠的信息技术系统以连接医疗服务提供者、社区合作伙伴和居民的重要性。议员们在过去的议会会议中，如《更健康的新加坡白皮书》和2023年供应委员会辩论中，都提出了这一点。我感谢陈雅森医生和叶汉荣先生强调其重要性。
一个关键系统是国家电子健康记录系统（NEHR），这是一个通用平台，收集来自各医疗服务提供者的选定患者健康信息，并允许提供者查看这些健康记录以便患者护理。贾米尔·贾姆先生询问了NEHR安全增强措施的实施情况。NEHR已接受网络安全审查、基础设施漏洞扫描和应用渗透测试。卫生部和综合健康信息系统（IHiS）已审查结果，大部分关键增强已完成，剩余一项预计于2025年完成。
关于贾米尔·贾姆先生提出的全科诊所信息技术支持问题，我们希望全科医生使用支持日常运营且连接关键IT系统的诊所管理系统（CMS），以节省行政时间。我们一直与CMS供应商密切合作，改进产品并加强后台服务以支持全科诊所。
我们正引入更多医疗服务提供者参与NEHR，通过将早期贡献激励计划扩展至全科医生、私立医院、放射实验室和临床实验室，支持他们贡献数据。随着《健康信息法案》（HIB）的实施，他们将被强制向NEHR贡献患者数据。
我们已广泛咨询持牌人和医疗专业人士等利益相关者，讨论与HIB相关的数据隐私和共享问题。我们原计划今年某时将HIB提交议会，但鉴于该法案的重要性，我们认为需要更多时间与利益相关者和公众沟通。因此，预计将在2024年上半年在本院提出该法案。我也感谢叶汉荣先生提出促进卫生与社会部门数据共享的需求，这确实是HIB的目标之一，旨在支持更整合的护理并减少行政工作，同时确保数据安全。
黄玲玲女士和叶汉荣先生也提出需要赋能新加坡人，增强其健康管理知识和支持。我们将通过HealthHub和Healthy 365应用等工具实现。例如，居民及其授权照护者可通过HealthHub查看NEHR中的健康信息，如出院摘要、部分血液检测和放射结果。我们将探索如何在这些平台反映更多检测结果。居民及其授权照护者还可使用HealthHub预约和管理所有公立医疗机构的医疗预约，注册“更健康的新加坡”计划并查看健康计划。
居民可通过Healthy 365查看并报名参加附近的健康生活项目，跟踪身体活动，并通过计步和选择更健康食物获得健康积分。我们将持续增强此类数字工具，帮助居民维持良好健康和福祉。
先生，总结来说，通过增加对可信平台的可及性，提供适当的健康信息和干预，以及医疗服务提供者和社区合作伙伴的支持，我们希望个人能够做出明智选择，实现更好的心理健康、更好的口腔健康和更好的整体健康，为自己和所爱的人创造更美好的生活。副议长先生，我支持该动议。
副议长：卫生部长王乙康先生。
下午4时26分
卫生部长（王乙康先生）：副议长先生，我支持该动议。我要感谢陈雅森医生、沙希拉医生和阿卜杜勒·萨马德先生提出该动议，并热情指出健康是每个人的关切，只有大家共同努力，才能改善个人和国家的健康。
我也感谢所有议员和各部代表通过发言支持各项健康相关政策，并提出改进建议。这包括“更健康的新加坡”预防护理策略；倡导医疗工作者福祉；开发更集中化的信息技术系统；与私人医生团购药品；确保医疗服务对所有人负担得起等。
议员们还提出了医疗系统面临的各种挑战和挫折。确实，医疗服务可能是我们整个公共服务中最复杂的系统之一。如果我说我们对你们提出的每个问题都有解决方案，那是不现实的。即使理论上有，也不可能全部实施。我们必须在预算和时间资源、管理能力以及公众接受变革的意愿范围内逐步改进。
我们将优先处理那些能带来最大效益的领域，集中力量。这就是我们的做法。
因此，我们重点扩充医疗容量，包括人力资源，推广“更健康的新加坡”，并建立有效的社区养老系统。它们共同代表了我们医疗系统的中期重大转型。
但在谈这些优先事项之前，我先回应议员们提出的三个具体医疗问题：人力、融资，以及正如林占武教授刚才提到的医疗容量。虽然时间紧迫，我还是回应一下。
首先是人力。任何医疗系统的核心都是工作人员。多位议员如陈雅森医生、洪洁恩女士、万瑞扎尔医生、贾米尔·贾姆先生、阿卜杜勒·萨马德先生和拉杰·约书亚·托马斯先生都谈到了他们面临的问题。
我们必须尽力支持医疗工作者。全国职工总会和医疗服务员工工会（HSEU）一直积极支持医疗工作者福利。HSEU主席达娜莱奇米女士曾是本院提名议员，多次发言关注此事。
人民行动党政府与劳工运动的合作是强有力的制度安排，卫生部期待继续携手推动医疗工作者福利。
这项工作的重要部分是定期审查医疗工作者薪酬，确保认可他们的贡献，并保持薪酬竞争力。李安·佩雷拉先生建议进行一些基准比较。我们将内部进行薪酬、税收（因各国不同）以及生活条件和租金的基准比较。但我建议内部进行，因为竞争激烈，不宜公开比较。但我们肯定要确保竞争力。目前，租金成为外籍护士来新加坡的难题，且自付费用高昂。这些都是我们需要解决的问题。
当前尤为紧迫的是积极招聘本地和外籍医疗工作者，以应对过去两年因新冠疫情导致的人员流失。
对于本地医疗工作者，我们期待最新一批理工学院毕业生加入，他们刚毕业，很快将进入医院工作。
阿卜杜勒·萨马德先生反馈实习生未获实习津贴。我想澄清，所有工艺教育学院（ITE）和理工学院护理学生在实习期间均有津贴。但某些医疗相关课程，如生物医学科学，津贴由雇主与学校协商，且各医疗集团做法不同。鉴于议员反馈，我们将调查公立医疗机构未提供实习津贴的具体情况。
至于外籍医疗工作者，海外选拔和考试及候选人迁移需时。他们已陆续抵新加坡，我们希望今年下半年有更多人加入。
对于表现优异且致力于新加坡的外籍医疗工作者，我们欢迎他们申请永久居民（PR）身份。多位议员建议也给予其家属PR身份，我们感谢建议，值得认真考虑。
对于所有医疗工作者，我们必须确保他们的福祉。我很高兴许多议员反对虐待和骚扰医疗工作者。这是医疗工作者最关心的问题之一。
总体而言，我认为新冠疫情后社会对医疗工作者的尊重和感激普遍提升。大多数公众对医疗工作者表示感激和尊重。
那些对医疗工作者进行身体攻击、威胁或辱骂的人，确实是少数。但因行为极端，感觉问题严重。我们不能容忍此类行为。这对医疗工作者不公，也对尊重他们的广大公众不公。
如议员所知，卫生部最近宣布对虐待和骚扰医疗工作者实行零容忍政策。我们计划今年下半年将此政策转化为所有医疗机构的程序和指南。我之前已谈及，不再赘述。
政策宣布后，我注意到一些反应。首先，大多数公众支持该政策。其次，有人担忧医疗工作者有时行为不当。我们承认，少数“害群之马”存在，但有适当渠道举报，医院管理层会认真处理。
有人认为虐待根源是医院工作负荷重、等待时间长，应先解决这些问题。我们正努力缓解疫情后医院压力，但需时间。工作负荷重不能成为虐待医疗工作者的借口。
拉杰·托马斯先生提到另一个原因是期望值高，未达预期时人们不满。期望和要求优质服务完全合理，但服务不到位不应虐待医疗工作者。
我想说，尽管工作负荷重且偶有虐待骚扰，我遇到的大多数医疗工作者——我希望不仅仅是因为我是部长——依然积极、专业且热爱工作。
例如，许芳绮女士自2015年起在郭特拔医院担任高级护士，现为护士经理。多年来，她处理过许多虐待患者及其亲属，但始终冷静同理地应对，成为该领域专家。
有一次，她目睹一名初级护士被患者亲属身体和言语虐待，她勇敢站出来，控制局面并将事件上报相关部门，整个过程中保持冷静。
尽管面临诸多挑战，你可以看出她热爱工作。她继续以关怀和善意对待患者及其亲属，并不断与同事分享处理虐待案例的知识和经验。
零容忍政策的考验将在今年下半年，当我们有了指导方针和监督人员来断绝与辱骂患者或更可能是他们的近亲的联系时。我确实预计会有人写信给卫生部，向我投诉为什么我们的监督人员和护士会这样做。我们会非常谨慎。我们会确保只有在最真实的案例中才会实施后果，且始终优先考虑护理。如果我收到投诉，我会支持我们的基层监督人员和医护人员。如果这事闹到议会，因为我认为一些居民会向他们的国会议员投诉：“为什么卫生部这样做，他们能否对此提出上诉，他们断绝了与我的联系，而我只是要求良好的服务。”
当时机和考验来临时，我希望得到本议院的支持。如果我们不得不与辱骂患者或近亲断绝联系，我们会谨慎且明智地执行，因此，我寻求全院的支持。
让我转到医疗融资。梁文韬先生昨天提出了几点。
我很高兴他同意我们使用医疗基金（MediFund）支持低收入家庭的政策。医疗基金在2021财年发放了1.64亿新元，而不是梁先生昨天所说的1亿新元。政府在2023财年进一步向医疗基金注资15亿新元。
然而，梁先生昨天也发表了政治声明。他宣布进步新加坡党（PSP）的立场，即政府应像其他经合组织国家一样增加医疗支出。
让我做几点回应。
首先，众所周知，增加医疗支出并不意味着健康结果更好。大多数健康经济学家都知道这一点。既然梁先生以经合组织国家为标杆，我们就举两个例子，美国和英国。他们分别花费约占GDP的17%和10%用于医疗，而我们只有4%。然而，美国和英国仍然面临慢性病高发、肥胖率高，且预期寿命低于新加坡。
我受到蔡恩福先生的启发，也查阅了ChatGPT：“你怎么看美国的医疗体系，怎么看英国的医疗体系”。实际上，这已是众所周知的事实。在美国，尽管医疗支出占GDP的17%，医疗费用仍然非常昂贵。在英国，国家医疗服务体系（NHS）因工作量过大而不堪重负。尽管医疗支出占GDP的10%，等待时间远长于新加坡。
鉴于我们的支出，我们已经取得了良好的健康成果。
第二点，无论我们花费多少，我们都能让中低收入群体负担得起医疗费用。如今，大约七成在补贴病房的居民无需支付任何自付费用。八成支付的现金自付费用低于100新元；九成低于500新元。
因此，当梁先生要求政府增加支出以进一步降低自付费用时，他实际上是想将资源引导给非补贴患者，即住在A类病房或私立医院的患者。这部分支出巨大，将推动我们的医疗支出达到经合组织国家的水平。
第三，虽然梁先生要求政府增加医疗支出，但他未提及政府支出最终必须通过税收从人民那里筹集。梁先生未说明PSP将从何处获得资金。
第四，事实是我们已经在不断增加医疗支出。我们不需要梁先生的督促。医疗支出正在上升。2010年后十年，我们的政府名义医疗支出翻了三倍。接下来的十年，即到2030年，预计还将再翻三倍。三倍再三倍——意味着20年内增长了九倍。这主要由人口老龄化和健康状况恶化驱动。卫生部预算已是仅次于国防部的第二大部委预算。
未来几年，我们的挑战不是花更多钱，而是确保不走上许多经合组织国家那样医疗财政负担失控、螺旋上升的道路。
最后，因此我们继续采取明智且务实的方法更为合适：设立不同层次的安全网——补贴、医疗保险（MediShield Life，我感谢温贤德教授解释其必要性）、医疗储蓄（MediSave）和医疗基金（MediFund）。这就是S+3M方法，效果相当好。
我们现在结合了“更健康的新加坡”（Healthier SG）中的一项非常重要策略，以及促进社区养老的努力，以便在人口老龄化的同时避免疾病，减轻疾病负担。
梁先生还谈到了先驱一代（Pioneer Generation，PG）和独立一代（Merdeka Generation，MG）基金中看似庞大的余额，并得出结论认为可以向PG和MG成员提供更多补贴。
他的理解有误。两个基金的规模是基于预估的终身福利成本，并考虑了通胀和利息收入。
举例来说，最年长和最年轻的MG成员分别约为73岁和64岁。PG成员至少比他们大10岁，最年轻的现在74岁。他们仍有相当长的寿命预期，我们预计许多人能活到90岁甚至100岁。因此，他们的终身福利需要由MG和PG基金资助。但政府将继续定期审查这两个基金的充足性。
第三个问题是医疗容量，正如林俊明副教授刚才提出的。我们同意80%至85%的床位使用率可能是理想的。你不需要工程师也能得出结论，系统中必须有冗余。这不是新概念，我想我们都同意。
但为什么现在会出现紧张？当然，COVID-19期间会有紧张。这是紧急情况，是一代人的危机。我认为没有任何国家或系统能为那种危机规划足够的容量。但危机过后，我们确实面临紧张。
我之前在议会解释过，我想是在COVID-19白皮书辩论期间，紧张的主要原因是在短短两年内，平均住院天数显著上升。过去是6天，现在是7.1天。[请参阅《卫生部长澄清》，官方报告，2023年5月10日，第95卷，第104期，书面声明更正部分。]
这意味着你的利用率在两年内突然上升了15%，这是COVID-19后的现象。
我认为随着时间推移，研究人员和临床医生会研究原因。但可能有几个假设。一个是免疫债务——更多老年人在COVID-19后感染病毒和细菌。当他们感染时，病情严重，住院时间较长，推高了平均住院天数。
另一个可能的原因是，COVID-19期间，太多老年人选择躲在家里，害怕外出。社区活动停止，而这些活动对保持健康至关重要。社会隔离导致他们健康恶化，感染后住院时间较长。
仅15%的利用率增长就解释了我们现在的紧张。这不仅发生在新加坡，全球各国都面临床位紧张。我们都同意必须有冗余，但包括经合组织国家在内的所有国家都面临紧张，尽管他们的床位与人口比例更高。
那么，我们需要做什么？首先，赶上容量建设。许多项目因COVID-19延误。我们必须赶上，但有些事情不能急于求成，只能逐步实施。
今年某个时候，诺维娜综合护理中心将开放，增加数百张床位。伍德兰综合健康园区年底可能开放一个病区；希望明年能开放更多病区。还有亚历山大医院和林俊明副教授提到的东部区域医院的重建。新加坡中央医院（SGH）园区的重建也在进行中。虽然是现有园区，但这是重大重建，将增加许多床位。
第二，建设更多过渡护理设施（TCFs），我之前解释过。这非常有用。如今医院里仍有不少老年人不是因医疗原因而住院，而是因社会原因。过渡护理设施提供康复护理和良好的医疗设施，我们可以让稳定的患者转移到过渡护理设施，从而释放急性病床。我们正在积极建设这些设施。
第三是招聘，我之前也解释过。虽然竞争激烈，新加坡仍然是外国护士愿意来工作的有吸引力的地方。医疗职业对本地人也很有吸引力。如今，每25名学生中就有一人选择护理专业，这已经不错了，考虑到他们有很多选择。我认为我们获得了公平的本地人才份额，也在招聘外国护士方面具有竞争力。
当然，我希望议院在提出所有这些问题后，支持我们为招聘本地和外国护士所需采取的必要措施。
让我回到动议的实质内容，这也是我们今天在这里的原因——这是一个重要的动议，呼吁政府整体协作支持医疗，即使COVID-19危机已经过去。
我们的公共服务部门有着长期的跨机构合作历史。但COVID-19是特殊时期。我们见证了跨机构合作的巨大潜力，大家团结一致，共同克服国家危机。
看看我们的学校，它们保持了教育的连续性，仅仅转为居家学习几个月。我们的经济和社会机构协作支持企业和工人。多个机构联合设立隔离设施、检测和社区护理设施。我无法强调这对医院系统的重要性，否则医院将承担疫情的全部压力，我们很可能会崩溃。
最近，一位著名的中国传染病专家张文宏博士观察到中国五一黄金周期间生活恢复正常后，写了一篇博客，他说：“好像什么都没发生，但一切都发生了。”用中文表达就是“一切都没发生，一切都已发生”。
这是一种颇具深意的危机后心态表达，可能适用于新加坡，也适用于今天的辩论。我们不想沉溺于危机，反复经历危机。我们需要走出阴影，把它抛诸脑后，展望未来。然而，许多事情已经发生。经验和教训将重塑我们看待医疗和跨机构合作的方式。这些不能被遗忘或浪费。
因此，我与议员们的希望一致，虽然危机可能已经结束，和平时期的工作负荷已恢复，但不能照旧行事。我们应开启一个更加紧密的跨机构合作新时代。这对医疗尤其重要，有两个原因。
第一，正如我所解释的，老龄化可能是未来十年新加坡最大的社会变革，我们将成为“超级老龄”社会。这将在就业、竞争力、退休保障、城市规划、教育以及医疗等多个政策领域产生影响。它将促使各部委协同工作。
第二，COVID-19危机后，我们决定条件和时机成熟，推动重大医疗转型，建立在过去多年的工作基础上。我在议会解释过为什么以及我们在转型中做什么。基本理念是医疗不仅仅是医院和诊所治疗疾病，而是在家庭和社区创造健康。换言之，健康不仅关乎生病的患者，而是关乎所有人。这就是为什么我们现在将医疗系统视为三个相互关联的系统。
如果我可以简要回顾一下。简妮特·昂女士刚才也解释过。首先是急性护理系统，确保生病者得到治疗。第二是人口健康系统，我们通过“更健康的新加坡”建设，动员所有家庭医生和全科医生专注于以社区为基础的预防护理。第三是老年护理系统。老年护理的默认选项不能是养老院或独居无社会支持的老人。
在其他国家，老年人的孤独和社会隔离已成为流行病。我们也看到这种情况在新加坡发生。我认为这也是住院天数增加的原因之一，尤其是在COVID-19之后。
如果我们能做好这点，我认为我们可以实现叶汉荣先生建议的——跨医疗和社会领域整合护理。
我们需要紧急加强全社会的努力，使我们的老年人能够有尊严地度过晚年，在社区中积极老龄化，与朋友和家人共处，参与包括培训项目在内的活动，就像蔡明杰先生建议的那样。如果他们愿意，也能在家庭环境中安详离世，亲人环绕。因此，社区老年护理是医疗的下一个重点领域。
为了实现全民健康，我们需要每个利益相关者的贡献，无论是公共还是私营部门。当医疗主要是治疗疾病时，属于医院的范畴。但当医疗是创造健康、关爱家庭和社区中的人时，它成为每个人的事。因此，为了实现全民健康，我们也需要全民参与健康。我认为这正是议员们提出动议的精神所在。
特别是以下利益相关者可以为健康做出重大贡献。
第一，雇主。感谢陈雅心医生发言。我们许多人成年后大部分时间都在工作，因此工作场所对塑造健康习惯影响巨大。我重视我们与全国职工总会（NTUC）、新加坡企业联合会（SNEF）和三方工作场所安全与健康监督委员会（TOC）的现有合作，他们一直与企业合作推广良好的工作场所健康实践。
通过“更健康的新加坡”，雇主可以与指定医生密切合作，加入“更健康的新加坡”，继续为员工提供定期和适当的健康筛查，提供更健康的食堂食品、体育活动项目、心理健康项目和更好的工作与生活平衡。我们也敦促雇主确保所有符合条件者都参与“更健康的新加坡”。通过促进健康，雇主将拥有更高效、更快乐的员工，这对企业有利。
第二是我们的社区合作伙伴。资深议员蔡恩福分享了文化、社区及青年部（MCCY）动员社区促进社会凝聚力、推动健康和与家庭医生建立强大伙伴关系的努力。陈雅心医生也建议需要开展适合不同人口群体及其多样兴趣的活动。确实，在“更健康的新加坡”咨询公众时，我们听到许多居民表示，朋辈和家庭影响是激励他们养成健康生活习惯（如定期锻炼和健康饮食）的关键因素。
因此，在“更健康的新加坡”下，我们的医疗集团将与社区合作伙伴——健康促进局（HPB）、人民协会（PA）、体育理事会（SportSG）合作，在社区推广体育活动，鼓励居民积极参与。我们欢迎其他自发的社区倡议和活动。如果今天我们在公共公园散步，可以看到许多此类活动，很多并非由任何机构组织。朋友们聚在一起骑行、跑步、踢足球。师傅教徒弟气功或太极。这些现在都是医疗系统的一部分。
第三个领域是学校和教育机构。感谢国务部长颜晓芳谈及教育部（MOE）在为年轻人建立健康基础方面的努力。
确实，良好的健康始于我们的价值观、习惯和选择。我们的学校帮助建立健康素养基础。它们引导年轻人参与体育运动，帮助他们结交朋友、形成社交群体，教授生活技能和知识，成为有用公民，这些都是良好健康的基本要素。正如颜晓芳国务部长早先提到的，多年来，教育部与卫生部合作，精心将健康教育融入从幼儿园、小学、中学到高等教育的课程中。
研究发现，从三四岁开始培养良好的健康习惯，如合理饮食和设备使用，对儿童后期的认知发展和福祉有深远影响。实际上，这也影响他们的小学离校考试（PSLE）成绩，基于我们的研究结果。[笑声]也许这是正确的切入点，我不知道。
因此，卫生部、教育部和社会及家庭发展部（MSF）正在研究早期教育与健康之间的联系，并开发可能的干预措施。
第四，媒体。信息和媒体素养是我们抵御虚假和病毒性健康谣言的第一道防线。我们将继续与通讯及新闻部（MCI）及其他媒体机构合作，就像我们在COVID-19期间所做的那样，打击关于疫苗接种的谣言。
健康新加坡（Healthier SG）为我们提供了一个解决健康错误信息问题的机会。为什么？这是因为我们倡导并努力建立更牢固的医患关系。因为有了信任的关系，家庭医生及其护理团队了解患者的健康状况和病史，他们就成为患者可信赖的医疗信息和建议来源。
在这个信息过载的数字时代，网络谣言、迷思和人工智能机器人层出不穷，也许我们在医疗保健中需要的是更强的人际关系，尤其是医生与患者之间的关系。我们可以利用技术来加强这种关系，提高护理质量，而不是取代人际关系。这最终必须成为人类与人工智能共存的模式。
最后，谈谈我们的基础设施和交通规划者。多年来，国土发展部（MND）和交通部（MOT）的同事们在全岛范围内扩展了绿地、公路自行车道和健身角，以支持积极的生活方式。还有计划在更多的银发区（Silver Zones）和行人过街处设置绿人+（Green Man+），让我们的长者能够更安全、更自信地在社区内出行。
这些都是各机构携手合作，更好支持健康的众多例子，我们承诺将继续这样做。
副议长先生，请允许我作结。
我注意到我们的提名议员（NMP）任期即将结束。这可能是你们倒数第二次议会会议。我不确定，但领袖告诉我，可能是你们倒数第二次会议。我知道你们中的一些人希望得到保证，即使你们卸任，关心的问题仍会在本议院得到关注。
因此，我感到荣幸和自豪——虽然这让我有点忙碌——你们选择提出一项关于医疗保健的动议，正如你们在任期内积极发声关注医疗保健问题。特别是陈雅心医生，她也是新加坡医师协会（SMA）主席，一直是各种医疗相关议题的坚定倡导者。
我曾参加过她主持的一次SMA晚宴。在那次活动的演讲中——这是公开的，所以我想我可以说——她说自己曾是一个愤怒的年轻医生。现在，你是一位不那么愤怒的中年医生。但不同的是，你学会了如何将精力引导向更大的善，并成为更好的倡导者。
我认为陈医生在SMA和本议院都做得很好。但我不认为陈医生是愤怒的。我们对事业充满热情并积极倡导是很重要的。
我非常感谢这项动议，强调卫生部（MOH）需要与其他机构合作，其他机构也应支持我们。今天，我们有教育部（MOE）和文化、社区及青年部（MCCY）的政治任命官员（POHs）发表演讲。实际上，我们本可以邀请更多人发言，但不想让辩论时间过长。
人口老龄化将成为影响我们所有人的重大挑战——卫生部不能独自承担。
我们提名议员的热情和积极行动提升了本议院辩论的水平，对新加坡的民主话语权发展大有裨益。
所以，请放心，即使你们的任期结束，你们关心的问题仍将继续在本议院得到应有的关注。将会有新一批同样热衷于议题的提名议员，继续关注你们关心的问题。
在医疗保健方面，将有医疗专业人士议员、卫生政府议会委员会（GPC）成员、劳工议员和提名议员，以及对医疗保健有强烈关注的议员继续传承这份责任。最重要的是，卫生部的政治任命官员将继续推动我们的议程，回应利益相关者的关切。我们不是对立的双方，我们都站在同一边，努力让系统为新加坡人变得更好。
对于提名议员，卸任后，我希望你们继续在旁边给予建议和支持。让我们共同为每个人争取更好的医疗保健系统。健康属于所有人，所有人为健康而努力。[掌声]
副议长先生：陈雅心医生。
下午5时03分
陈雅心医生（提名议员）：谢谢您，先生。首先感谢翁部长。好吧，听了您的好话，我可能不那么愤怒了。如果您像颜国兴先生那样待十年，我也会继续建议和帮助十年。
先生，我对这项动议获得的强烈支持感到非常鼓舞。
首先，感谢所有出席的提名议员，他们各自分享了如何在各自领域支持医疗保健的见解。这正是我们需要的协同创新思路。
接下来，感谢所有议员发表的涵盖广泛主题的演讲，涉及支持医疗保健的各个方面，即：（a）招募、再培训和留住医疗人员；（b）公平薪酬、合理工时；（c）融资和业务需求；（d）更好的信息技术系统；（e）坚决反对欺凌和骚扰；（f）强调预防和初级护理；（g）法律保护和支持；（h）照顾弱势群体，特别是儿童、老人、外劳和残障人士。
不过，我必须回应梁先生昨天提出的一些观点。我感谢他关于审查医疗储蓄账户（MediSave）的意见，但我敦促他与卫生部深入讨论，更好地了解当前资金情况，并在必要时协助未来的审查。
医疗储蓄账户和医疗保险生命计划（MediShield Life）已被广泛且严格审查，以确保大多数新加坡公民和永久居民在选择重组医院的补贴病房时能够负担得起医疗费用。如果你们认识经济困难的居民，请引导他们联系经验丰富的医疗社会工作者，获得更多可用补贴的建议。
我还需要向梁先生澄清他关于“非补贴患者的药品价格不应被不合理地加价以补贴补贴患者”的评论。
首先，有证据表明这种情况存在吗？其次，什么是“不合理”的加价定义？
如果我用另一个食物比喻，而非鸡饭，一罐汽水在廉价杂货店卖60分，在超级市场卖1.30元，在咖啡店卖1.60元，在餐厅卖3元，在酒店卖5元。药品合理的加价是多少？
非补贴患者通常是选择A或B1等级病房的患者，或外国人。作为医生，我认为让市场力量决定价格是公平的。梁先生是否也希望纳税人为所有人买单？
我也感谢来自不同部委的政治任命官员对支持医疗保健的承诺和保证。
感谢高级议员蔡艾立积极推动跨政府机构的体育运动和社区参与。像我这样的跑酷阿姨很高兴，不再被警察驱赶。
国会议员颜绍煌也概述了如何在各教育阶段融入运动和健康饮食教学。
感谢高级国务部长潘志成和翁业强部长坦诚详细地回应了人力、信息技术和融资等复杂问题。
专业团体将继续与卫生部密切合作，解决医疗保健中的问题，特别是培训和工时相关问题。坦白说，只有临床医生真正理解所需的微妙平衡。我很高兴我们都达成共识——医疗保健必须是全政府的努力。
最后，我回到“为什么”。为什么我们站出来倡导一个事业？是为了留下一个比我们出生时更美好的世界。
关于下一轮提名议员申请的最新消息再次引发一些批评。我相信提名议员的角色给予了像我这样的普通公民在国家平台上发声的机会。普通，因为我是一位夹心层的辛苦工作母亲。普通，因为我也担心孩子们的未来。我的孩子们将成长在怎样的新加坡？
各位议员都知道准备演讲有多难。这不仅仅是走到麦克风前说些华丽的话。需要背景调研，控制时间，避免被议长或副议长训斥；还要以易于接受的方式讲真话，强调重点。
我曾说过——我们都说了很多话，但谁在听？公众在听吗？
直播通常只有400多名观众。少数人会故意制作我们失误的搞笑片段。是的，一旦我克服了尴尬，我得说，真的很有趣，谢谢你们让我们笑！
但我真正想对话的是那些关心新加坡整体利益的公民，他们在听并考虑政策。
也许你们中有些是公务员。新加坡有15万名公务员，他们向政府负责，而非任何政党。我强调，公务员是有自己不同政治信仰和立场的个人。他们服务于新加坡人民。
盲目支持或反对任何政党，嘲笑提名议员是傀儡或代言人，或将一切责任归咎于政府——我问你们，这合逻辑吗？这对任何人有益吗？
在反应和发言前，请考虑三点：一、这是真的吗？二、这有必要吗？三、这善意吗？如果任何一项答案是否定的，也许最好不要说。
我相信你们许多人有医疗行业的朋友。请与他们交谈，了解我们面临的问题。组建你们自己的小型非正式智库，集思广益，解决更大的医疗问题。
无论你们是部委工作人员，还是像我一样的普通公民，我希望你们也思考如何确保医疗保健获得所需支持，并优先考虑自己的医疗需求。
我们现在生活在一个快速变化且不稳定的世界。看看新冠疫情如何让世界停摆三年。看看乌克兰战争、美国银行倒闭。世界一夜之间改变。这并不新鲜，历史在重复——也许周期比以前更快。
现代人必须适应一个答案不那么明显、没有规则手册或十年考题可参考的世界。可能没有单一正确答案，选择必然有权衡。
如果战争降临新加坡，如果发生末日，我们需要战士，需要领导者。但我告诉你，我们还需要懂得照顾他人的人，懂得止血、防感染、接生、种植食物、获取清洁水源的人——任何确保我们生存的知识。
但我们是在积累有用知识，还是在社交媒体上无意义地消磨时间？
我见过患者，医疗治疗算法其实很简单。有乳房肿块，需要检查。但情绪压力常常成为障碍，表现为犹豫、恐惧、担忧，甚至对我发怒——“为什么会有肿块？”
我理解，但处理负面情绪的冲击并不容易。医疗工作者、教师、司机——实际上所有一线服务人员，都承受了大量负面情绪的冲击。
这就是我们的社会。一个压力锅。人们在日常生活中不快乐却未察觉，感到易怒、暴躁、过度批评、担忧一切，觉得无法应对。
我重复我之前演讲中的一点。认识到自己或亲人的心理健康问题。如果你患有焦虑或愤怒管理问题，不要把情绪发泄在医疗工作者身上，也不要发泄在他人身上。寻求心理健康专业人士的帮助。
虽然我是乳腺外科医生，但我不能只做癌症手术。我必须全面考虑患者。她的整体健康——是否有其他影响手术和恢复的疾病？她的首选语言——是否完全理解我说的话？她是否做出真正知情的决定？她的性格如何？她的社交网络？她在家和工作场所是否得到良好支持，还是因为认为他人需求优先而放弃治疗？
手术本身在专家手中很简单。挑战是帮助患者克服所有这些情绪和心理障碍，寻求健康，最终走上康复之路——这就是我呼吁全球变革和全政府支持的原因。
感谢所有参与辩论的人，我强调：第一，深入基层，获得真实反馈，承认医疗问题。第二，持续在各层面开展教育。第三，跨部委、跨行业、跨公私部门合作。
人类记忆短暂。让我们从过去的错误中学习，避免重蹈覆辙。人们只有在事情影响到自己时才会关心。帮助我，让每个人都关心。
最后，打破正式礼节，我要感谢Shahirah、Samad、莲斌、Mark、Janet、Joshua、Hian Teck和Hsing Yao。感谢你们的友谊。这是一次多彩且有趣的提名议员旅程。
感谢两党所有议员，我很高兴有机会认识你们作为人，而不仅仅是海报上的公众人物。这是我在本议院的最后一次发言。下次见面，可能是在人民见面会时向你们投诉。[笑声]
感谢你们所有人——两党议员——为新加坡的服务。如果可以，我会为你们祈祷智慧和善良，愿你们继续有意义地辩论，引导新加坡安全度过未来挑战。[掌声]
副议长先生：梁文韬先生，我即将向议院提出表决。你对刚才的发言有澄清吗？你想对陈医生的问题作回应吗？
下午5时13分
梁文韬先生（非选区议员）：谢谢副议长。我感谢陈医生提出关于药物补贴的问题。
据我了解以及许多居民的反馈，他们在不同等级病房支付不同价格。当然，这是预期之内的。目前，不同等级收费不同。
但从某个角度，我在演讲中提到，服务收费可以，但为什么不同等级的药品价格差异如此之大？这就是我所说的。我不明白陈医生为何将此作为问题提出。
也许我可以向陈医生澄清，她是否同意我们的建议，即政府应启动新加坡所有药品的集中采购流程。我想听听她的意见。
副议长先生：陈医生，你想回应吗？
陈雅心医生：是的，我想回应，因为我是医生，我对医疗保健略知一二。
首先，关于账单，尊敬的议员，建议你让受影响的居民向他们所在医院的业务办公室查询账单明细。那里有非常清晰的补贴等级说明，不同药品，无论是品牌药还是仿制药，成本都非常明确。
所以，我想了解更多细节，而不是一概而论说成本不公平。
关于第二个问题，即政府是否应统一采购所有药品，我了解到目前公共医疗机构对慢性病药物已有集中采购。
但在私营部门，我恭敬地指出，所有私营医生都有自己的商业模式和不同的收入方式。因此，并非所有医生都愿意参与政府的采购计划。感谢议员的建议，我们会带回专业团体，进一步征求会员意见。
副议长先生：翁业强部长，你有澄清吗？
翁业强先生：我觉得让提名议员回答政策问题不太公平，还是由卫生部来说明比较好。
我们的医疗体系是多元化的，不同于英国国民保健服务（NHS）那样全部国有化，药品价格基本统一、集中采购。
我们有意满足多元市场需求。正如陈雅心医生所说，私营医生有不同的经营模式。有些医生咨询费很低，但通过卖药赚取利润；有些则相反。
所以，如果我们提出一个想法——幸运的是这是议员提出的，而不是我——说“大家都卖同一价格”，实际上会影响医生的饭碗，这对他们来说是个大问题。
因此，我认为陈医生的话有一定道理。在私营领域，有时你希望市场力量发挥作用，但同时通过保险结构、补贴政策等方式加以规范。我认为这就是我们控制不必要医疗费用的方式。
副议长先生，我知道梁先生还有更多问题。但实际上，我认为这是一项关于各部委以及我们所有利益相关者共同参与的动议，非常有意义。我敦促大家不要再拖延这场来回争论，让我们给予即将卸任的非选区议员对他们这项非常有意义的动议以强有力的支持。[掌声]
[（程序文本）提问，获得通过。（程序文本）]
[（程序文本）决议：“本院承诺支持疫情后医疗保健工作以及全政府为实现持续和稳定支持所做的努力。”（程序文本）]
副议长先生：领袖。
英文原文
SPRS Hansard 原始记录 · 抓取日期：2026-05-02
[(proc text) Order read for the Resumption of Debate on Question [9 May 2023]. (proc text)]
[(proc text) "That this House commits to supporting healthcare beyond the COVID-19 pandemic and the whole-of-Government efforts for consistent and sustainable support.” – [Dr Tan Yia Swam] (proc text)]
[(proc text) Question again proposed. (proc text)]
Mr Deputy Speaker : Prof Koh Lian Pin.
1.39 pm
Prof Koh Lian Pin (Nominated Member) : Mr Deputy Speaker, I stand in support of this Motion. I would like to join the debate today by highlighting a growing healthcare issue facing the academic community.
Our universities and academic institutions are places of higher learning, research and innovation. They are also workplaces where faculty members, researchers and students spend a significant amount of their time.
In recent years the academic work environment has become increasingly stressful, leading to the rising incidence and prevalence of mental health issues among university researchers and graduate students.
A global study conducted in 2018 found that 41% of graduate students worldwide suffered from moderate to severe anxiety, while 39% showed signs of moderate to severe depression. This survey which was based on the responses of over 2,000 students from 230 institutions across 26 countries reported that in general, graduate students are more than six times as likely to experience anxiety and depression compared to the general population.
There may be several reasons why mental health issues are becoming prevalent in academia. One of the biggest causes arguably is the constant pressure to perform.
The academic path can be both long and narrow. It may also come with significant opportunity costs. Having committed typically around 10 to 15 of the most productive years in their 20s and 30s to acquiring an increasingly specialised skill set as an early career researcher, the scope for an alternative career tends to get increasingly narrower as they progress in their training as graduate student, postdoctoral researcher and then junior professor. The pressure to continue down this path and succeed as a tenured academic can be enormous.
Additionally, the nature of academic research for some disciplines can be arduous and unpredictable. The demands of laboratory experiments or field surveys typically require individuals to work after hours and over weekends. These long, irregular and gruelling hours of research inevitably compromise work-life balance and can have significant impacts on the mental health of early career researchers.
Many of them are also at an age when they are trying to start a family, and so these mental health impacts may extend to their partners and other loved ones as well.
Furthermore, many research-intensive universities now consider various publication related metrics when evaluating the performance of their faculty members and researchers. This can create a "publish or perish" mentality which in turn creates immense pressures, especially among early career researchers to publish quickly, frequently and in the most highly regarded scientific journals.
A strong publication track record is critical for securing a good post-doctoral position and academic tenure. However, the overwhelming and constant pressure to publish can lead to persistent feelings of anxiety, resulting in burnouts and other mental health issues.
Another major contributor to mental health issues among early career researchers is job insecurity. Many individuals who embark on an academic career may aspire to be a tenured professor someday. But there are just not enough professor positions for the growing number of PhD graduates to fill. Certainly, not in Singapore alone.
As a result, many early career researchers are on short-term contracts supported by research grants. The duration and size of these grants can be variable and unpredictable, leading to uncertainties for long-term employment. This lack of job security can also lead to persistent stress and anxiety as researchers constantly worry about their next contract and future career prospects.
Among graduate students, and especially for students from overseas who have come to Singapore to pursue their graduate research, the rising cost of living in Singapore is probably one of the greatest stress factors today. Many PhD students in Singapore are on research scholarships, which provide a relatively modest stipend compared to the salaries that their peers in the workforce may be getting. The constant cost of living concerns can lead to a vicious cycle of poor mental health and decreased academic performance, with individuals struggling to cope with the rigorous demands of academic life as graduate students while also managing their challenging financial situation as young adults.
Finally, the academic culture itself can also be a significant barrier to addressing mental health. Indeed, there may be a common but misguided perception in academia that admitting to struggling with one's mental health is somehow a sign of weakness, incompetence or inadequacy. This stigma can lead individuals to feel like they need to hide their struggles to fit in or to maintain their academic standing among their peers. Left unchallenged, this stigma can cause individuals to delay seeking help or treatment for mental health concerns, which can lead to a worsening of symptoms and other detrimental impacts on their personal and academic life.
To address the growing mental health issues facing the academic community, we may wish to consider the following suggestions, some of which are already being implemented in our local universities and research institutions, but we can always do more.
First, we could invest more in mental health research to contextualise and better understand the extent and nature of the mental health problem within Singapore's academic community. This may help us develop more effective and bespoke solutions.
Second, we could provide more mental health support services, including workshops, support groups and mental health professionals to create an ecosystem of affordable and accessible mental health resources on campus for those in need.
Third, we could make greater efforts to raise awareness and reduce the stigma associated with mental health in academia. Importantly, we could create a culture of openness and support by providing training for senior faculty and staff on how to identify and support individuals who may be struggling. By doing so, we can destigmatise and normalise our discussions on mental health.
Finally, we could also do more to normalise a healthier work-life balance in academia. This may include providing more opportunities for remote work and flexible schedules and creating policies that limit after-work emails and meetings.
As an encouraging example of what is already being done, the National University of Singapore has been running a #AreuOK mental healthcare campaign since 2021. Its main goals are to destigmatise mental health conditions in the NUS community and support those who seek help. It provides free and confidential mental well-being check-ins, emotional support sessions and a 24-hour hotline, among other services. I declare that I am an NUS professor. Of course, other universities in Singapore provide similar initiatives and support to their academic communities as well.
At the national level, the Health Promotion Board runs our national mental well-being campaign, "It's OKAY to Reach Out", which seeks to normalise the topic of mental health and well-being, generate greater understanding and awareness and encourage Singaporeans to reach out for support.
Sir, Singapore is a global leader in research and innovation. The quality of our universities and research institutions plays a critical role in maintaining this status. More importantly, a physically and mentally healthy research workforce, which includes graduate students and researchers at all levels, is needed to ensure the consistent production of top-quality research in Singapore.
Furthermore, the academic community in Singapore is diverse and international, with individuals from different cultures, backgrounds and experiences working together towards the common goal of creating impactful, new knowledge, science and technologies. Providing a supportive and inclusive environment that promotes the mental well-being of all members of our academic community will enable us to attract and retain top talents from around the world and maintain Singapore's role as a global knowledge and innovation hub.
Addressing mental health in academia is not just a moral imperative but also an economic one. The World Health Organization recently reported that depression and anxiety disorders cost the global economy over $1 trillion every year. Another recent study by the Duke-NUS Medical School and the Institute of Mental Health estimated the total economic burden of lost productivity due to anxiety and depression in Singapore to be almost $16 billion annually. By investing in mental health initiatives in academia, we can improve the productivity and performance of our academic workforce, which can have a positive impact on our economy as a whole.
In conclusion, addressing mental health in academia is critical for Singapore to succeed as a knowledge and innovation hub, attract and retain top talents, strengthen our economy and build a resilient workforce and society.
Let us work together to create a culture of openness, support and understanding in the academic community, where individuals can seek help without fear of stigma or judgement and realise their full potential.
Finally, I joined my fellow Members in thanking the nurses, doctors and all healthcare workers for their indefatigable spirit, dedication and sacrifices in their contributions to the physical and mental well-being of our nation. Mr Deputy Speaker, I support this Motion.
Mr Deputy Speaker : Mr Leon Perera.
1.51 pm
Mr Leon Perera (Aljunied) : Mr Deputy Speaker, Sir, when deciding how liveable and how advanced a society is, the quality and affordability of its healthcare sector play a key role.
In most countries, the nature of healthcare provision is highly contested and debated because of its critical importance. In many countries, including our own, healthcare is also a vital sector for the economy, creating many jobs directly and indirectly.
Post-COVID-19, I am hopeful that progress on constructing new facilities like the Woodlands Health Campus and the Integrated Care Hub at Tan Tock Seng Hospital is picking up. However, the main impediment – the main challenge – in meeting our long-term healthcare needs lies not in the building of physical facilities, it lies in the recruitment and retention and raising the productivity of our healthcare workers. It is this single theme that my speech will address today.
In my speech, which supports the Motion, I will talk about: (a) addressing recruitment and retention among healthcare workers; (b) raising the productivity of healthcare workers; and (c) improving the outcomes from the healthcare system as a whole without increasing cost proportionately by addressing sources of health problems upstream and by other means.
Before I proceed, I declare my interest as the chairman of a company that does consulting work in the healthcare space, among other verticals.
Sir, in preparing this speech, I raised the topic of how we can attract more Singaporeans into the healthcare sector at my family dinner table. Without a micro-second's hesitation, my daughter said, and I quote, "Give them decent working hours, respect at work and good pay."
Indeed, this is a major long-term challenge we face. We can build the wards and clinics, we can buy the equipment, but how can we attract and retain workers in the sector such that churn is minimised, such that there is a core of professionals from whom future leaders can be drawn, such that there is a good learning curve, a sufficient accumulation of experience and skills to elevate service and effectiveness so as to ensure good outcomes for patients?
There are media and anecdotal reports of facilities that are unused due to a lack of manpower. For example, a recent report from TODAY, citing a private doctor, said, "As a matter of fact, several private hospitals have closed some hospital wards and operating theatres due to a shortage of nurses.”
The all-important manpower challenge in healthcare unpacks itself into a few bundles of issues – compensation, working hours, working conditions and career laddering, and productivity and, also, as part of that, that should address ensuring that the work feels meaningful.
Firstly, Sir, on compensation. While nurses' pay was increased last year – and this is welcome – this was the first base salary increase in seven years. Junior doctors' pay was increased as well recently but, as per the reply to my recent Parliamentary Question (PQ) on this, the 7% to 13% starting salary increase applies to house officers and first-year medical officers (MOs). However, more experienced junior doctors, namely, eligible in-service MOs or residents up to postgraduate Year 6 and dental officers up to postgraduate Year 4, could expect a salary adjustment based on their years in service and bond period rather than an across-the-board increase, as I understand it.
Clearly, to attract and retain talent, compensation has to be competitive. Moreover, in healthcare, talent can migrate across national borders. Many countries are short of experienced healthcare staff. Many countries would like to poach our English-speaking and well-trained healthcare workers.
Hence, I would like to ask if compensation for healthcare personnel could be monitored and tracked based on hourly compensation – total pay per hour worked – and regularly benchmarked against other developed country locations against which we compete for healthcare talent, with the results published so that we have a clear indicator of how we are doing and whether or not we will face choppy waters ahead that we would need to take heed of.
I am aware of academic studies that are occasionally published to this effect but I am not aware that there is a regular Government publication to this effect.
Next, Sir, on managing working hours and burnout. There is no point raising pay if there is under-capacity and working hours rise after that such that pay per hour remains the same or actually falls.
Sir, I have raised this in the House previously in relation to the issue of junior doctors' working hours a few times. I would like to repeat my call to lessen the weekly working hour requirement for junior doctors from 80 to 70 and to step up enforcement to make sure that this is adhered to.
There is evidence that the same training outcomes can be obtained with a cap of 70 hours per week versus 80, as I explained in my previous Committee of Supply speech. This would also require systems to be streamlined so that junior doctors and, indeed, nurses, spend more time on patient care and training rather than administrative tasks.
I would also repeat my calls to move towards 100% compliance with the current 10-hour intervals between duty periods and after in-house calls, up from 90% now, ensuring no under-reporting of hours and taking concrete steps to shorten the time spent on handing over administrative and peripheral duties.
I understand that conditions for junior doctors are being reviewed in the public healthcare system now. I hope that the need to optimise working hours will be fully considered in that process.
Next, Mr Deputy Speaker, Sir, on workload. Workload is, of course, a function of healthcare demand vs manpower capacity. Healthcare demand will rise steadily as our population ages and, indeed, we are one of the fastest-ageing populations in the world.
Minister Ong has said that the annual intake of nursing students will rise from 2,100 to 2,300 a year. This should help with meeting demand if nurses stay in the profession.
Right now, the proportion of Singaporeans among enrolled nurses is a little over 60%. It is important for such a critical profession to maintain a strong Singapore Core and good career progression for nurses who can progress into more senior nurse practitioner and leadership roles.
I know that there are currently nursing scholarships primarily awarded by the healthcare clusters. I wonder if this number is sufficient to meet the needs of the future to generate enough of a pipeline of nurses for future senior nurse practitioner, mentoring and leadership roles.
Does the Ministry review the number of nursing scholarships given with this in mind? Do such reviews extend to the awarding of a sufficient number of postgraduate scholarships in nursing, given the increasing complexity and technology dependence in the healthcare sector going forward? Currently there appears to be only one academic programme which provides a Masters in Nursing requirement for advanced practice nurses.
Lastly, on the topic of workload. So as to strengthen the Singapore Core in professions like nursing, we should provide preferential consideration to foreigners who are in these professions who have lived and worked here for some time and have demonstrated a capacity to integrate well into our society to obtain permanent residency and, eventually, citizenship.
I believe some other Members of this House have called for this before and the Government has said it is open to such an idea. To add on to this, I would repeat my call for the giving of citizenship to be made more transparent, with the availability, for example, of an online points-based calculator, similar to what you see in some other countries. This may make Singapore more attractive to healthcare professionals from other countries by providing more clarity and assurance.
Next, Mr Deputy Speaker, Sir, on the role of pharmacists. To raise the productivity of our whole system, will the Government consider giving pharmacists some powers to prescribe drugs for certain conditions? This is already being considered in Australia, though there has been some pushback associated with this. Our pharmacists already make adjustments to dosing of drugs for some chronic medications, and advanced practice nurses also have cooperative prescribing models in our local healthcare institutions.
I would like to suggest that the Government monitor international developments and consider if and how to accord greater powers for prescription to pharmacists, depending on the emerging international evidence. This may negatively impact general practitioners (GPs) initially but I have some suggestions relating to GPs which I will come to in a minute.
Next, Mr Deputy Speaker, Sir, I would like to touch on the necessary role of other allied healthcare professionals and medical personnel. I note that the Government has plans for a greater role for community pharmacists in promoting things like health screening and vaccinations.
I spoke about the vital role of both health screening and vaccinations in my Adjournment Motion on preventive healthcare last year as well as via PQs previously. MRNA technology is already spawning potentially revolutionary developments in medicine that could lead to radical breakthroughs in decades to come. But turning back to current realities, it would seem that we are lagging behind many developed countries in terms of the more routine types of vaccination, like influenza vaccines. This can limit the incidence of chronic or catastrophic conditions further downstream.
Moreover, alarmingly, the National Population Health Survey 2021 showed that fewer Singapore residents participated in chronic disease and cancer screenings in 2021, compared to 2019.
There are plans to raise the number of allied healthcare professionals. Such professionals can play a critical role in community healthcare, nudging healthier lifestyles and appropriate help-seeking behaviours, including for mental health conditions, as well as helping those with chronic conditions prevent the development of complications.
In the Serangoon ward of Aljunied Group Representation Constituency (GRC), my volunteers and I have had the honour of working with Tan Tock Seng Hospital (TTSH) Community Partners to conduct a health talk and consultation session at a rental block. We also refer cases we come across to TTSH Community Partners, or TTSH CP, which also stations nurses at the Community Care Services Singapore facility at Golden Ginger in Serangoon North at certain times, to make some screening and advice available to the people who live in the area.
These are commendable and beneficial interventions, and I hope that these can be replicated in other areas that currently lack this. These should eventually be funded centrally as they do not require costly infrastructure and could also allow local nurses, physiotherapists, occupational therapists and podiatrists with families to, perhaps, work part-time near their homes in their own communities.
The model for deployment of such allied healthcare professionals is often to leverage events that attract people to consider health issues. However, some evidence from a survey conducted by Lifebuoy suggests that most Singaporeans take a rather passive approach to their own health and do not often or always proactively seek out information on how to improve their health. Hence, it behooves us to find methods that are more in line with what, in business marketing, is referred to as "hunting", that is, direct sales, as opposed to "farming", or attracting people to come to you.
To that end, I wonder if, once we have the health coaches in sufficient numbers, we can, as one initiative, deploy them to void decks, hawker centres and wet markets. These are areas of high footfall, particularly among older people, who may benefit more from healthcare interventions. It may be helpful if personnel who are fluent in vernacular languages can approach them in these settings, in a more proactive way, to promote ideas, such as vaccination and health screening, or even to perform certain basic screening activities on the spot. For younger demographic segments, what might work better are, perhaps, strategies that rely on social media.
Next, Mr Deputy Speaker, Sir, let me move on to the role of GPs. Our roughly 1,800 GP clinics play an important role in our healthcare system as the first line of defence for non-emergencies. This role is set to increase with the advent of Healthier SG. When we speak of attracting and retaining good healthcare professionals in our system, we should not neglect our GPs.
Yet, there are worrying signs. In a survey of 300 GPs by NTU published in the journal BMC Primary Care in 2022, 14.4% said they plan to leave general practice permanently, 12.6% plan to take a career break, and 51.3% plan to reduce their clinical hours. Higher remuneration, recognising general practice and family medicine as a medical specialty, and reducing the litigious pressures on medical practice were rated as the most important factors in these decisions, while there was growing dissatisfaction within this community with the third-party administrators that manage insurance arrangements. If there are too many exits from the GP sector, this may dent our ability to achieve our primary healthcare and Healthier SG goals.
Also, a study of primary healthcare quality by the National Healthcare Group published in the journal "Asia Pacific Family Medicine" in 2014, which polled 85 experts, concluded that Singapore's system suffers from several issues, and I quote: "The primary care system in Singapore received an average of 10.9 out of 30 possible points... Singapore was categorised as a 'low' primary care country according to the experts." The earnings of primary care physicians, compared to specialists, were one of several factors cited.
Sir, I have a few suggestions here to address some of the issues faced by the GP population and primary healthcare in general.
Firstly, should we not regularly survey our population of GPs to understand their experience, their pain points, their perception of gaps in the ecosystem and their suggestions to the Government, insurers and other stakeholders? In my opinion, most of our GPs are thoughtful and well-informed individuals, who should have good ideas for constructive policy change. The Ministry of Health (MOH) does Primary Care Surveys every 10 years or so to determine, primarily, the economic parameters around the primary care sector, but much more can be done.
Secondly, can the Government explore onboarding individual GPs and corporate groups that run GP clinics onto the Government procurement system for drugs, so that all parties can obtain lower prices on the basis of larger bulk purchases? Right now, drug sales representatives often sell drugs to individual GPs. And this means fragmentation and far less bargaining power and economies of scale.
As an aside, I was once queuing to see a GP and someone behind me in the queue got in to see the GP before me. I did not mind, but I was just curious. So, I went up to the receptionist and I asked the receptionist why this happened and she said she had deprioritised me as I was wearing a tie at the time and she thought I was a drug sales rep rather than a patient.
Anyway, I understand that the Government is currently studying the idea of allowing private healthcare providers to tap on the Government drug procurement system, or ALPS, and I hope the Government will move on this soon to enable combined purchasing across the public and private sectors to the fullest extent practicable.
Lastly, would the Government, as part of the surveying effort I referred to earlier, identify GPs who have spare capacity – meaning that there are certain times of day when they do not see so many patients – and find ways to engage such GPs to augment the capacity in polyclinics or other public healthcare institutions, if they are keen to do so? Anecdotally, it seems that the density of GP networks has seen some long-term increase and competition has risen. One effect of this may be that some GPs – not all – have some spare capacity at certain times of the day, on certain days.
Mr Deputy Speaker, Sir, I come now to the last part of my speech – how do we raise the labour productivity of our healthcare workers? I am reminded of an amusing conversation I had once as a young Economic Development Board (EDB) officer. One of my colleagues was talking to another manager. The manager said that he could not increase output without a commensurate increase in headcount, to which, the first person said, "Ah, yes, but that assumes zero productivity growth." I have never forgotten this little bit of wisdom, so pithily conveyed.
Of course, as healthcare demand grows, we will need to hire more staff. But we need to manage the rate of that increase so as to manage cost, as well as to manage population pressures that may arise from excessive inflows of foreign manpower – and I use the term "manpower" here in a gender-neutral way, of course.
How can this be done? There are advances in healthcare technology to draw upon and best practices available worldwide. For example, telemedicine can enhance staff utilisation and save time for patients as well. Some survey evidence suggests that Singaporeans are open to virtual consultations. There is also robotics. For example, service robots could perform some of the functions of a healthcare concierge. Robotics devices can also play a role in rehabilitative medicine.
I am aware that some of these innovations have come to our healthcare system and more are being considered. I am also aware that this is not a new topic. In 2012, MOH launched the Healthcare Productivity Roadmap and, in 2017, MOH announced the Healthcare Productivity Fund. There are also the National Healthcare Productivity and Innovation Awards. However, I have a few suggestions here.
Firstly, the potential to apply cutting-edge developments in fields like artificial intelligence (AI), computing and robotics to healthcare is high. For example, a 2019 Accenture study on Singapore's health workforce concluded that technology could free up 10% of time for doctors, 10% for pharmacists, 22% for nurses, 31% for laboratory scientists, 50% for pharmacy technicians and a whopping 68% for medical records clerks in Singapore.
My suggestion here is that the Government measure healthcare labour productivity from time to time and publish the results, benchmarked against productivity standards in other global cities. I think it would be useful to make city-by-city comparisons in this regard. There would be various types of metrics that could be considered. Ideally, we should measure public and private healthcare separately for the sake of comparison. And this data could be used to identify good outliers, where best practices and case studies can be documented and shared. If we do not know where we are at, we cannot get to where we want to go.
Secondly, and specifically for mental health care, this is an area where we are seeing challenges. Some experts speak of a youth mental health crisis, a phenomenon which may not be unique to Singapore by any means. Our ratio of clinical psychologists and psychiatrists lags behind some other developed countries, a subject that I and other Members have raised previously. Will the Government explore using AI technology to augment capacity in mental healthcare?
For example, a Boston-based company called "OM1" recently built an AI platform called "PHenOM" to help psychiatrists enhance their diagnostic and treatment effectiveness and efficiency. Singapore-based company Holmusk has partnered the UK's NHS and Liverpool University to establish a mental health analytics and research hub. Holmusk's mental health analytics platform is of a large scale. I hope the Government will consider working with companies like this, particularly locally based ones, to push the envelope.
In conclusion, Mr Deputy Speaker, Sir, our future is one where demands on our healthcare system will be greater, as our population ages. But our future is also one where there will be greater opportunities to exploit technology and innovation to increase efficiency; and to enhance prevention upstream. We need to grasp the opportunities to meet those challenges.
And this will have to be done by our healthcare professionals, the people who must be at the heart of all we do in healthcare, for, without them, nothing is possible. At the end of the day, healthcare is, and will remain, must remain, a profoundly human endeavour. There is no more important goal in healthcare than attracting, retaining and bringing out the best from our great healthcare workers.
And before I conclude, Mr Deputy Speaker, Sir, I would just like to join my hon friend Mr Gerald Giam and other hon Members of the House in expressing our whole society's profound gratitude to our wonderful nurses, and to wish them in advance a very happy Nurses' Day to come.
Mr Deputy Speaker : Mr Mark Chay.
2.10 pm
Mr Mark Chay (Nominated Member) : Mr Deputy Speaker, thank you for this opportunity to speak on this Motion put forth by my fellow Nominated Members of Parliament (NMPs) Dr Tan Yia Swam, Dr Shahira Abdullah and Mr Abdul Samad to support healthcare beyond the COVID-19 pandemic, and call for a whole-of-Government effort for consistent and sustainable support. Sir, I stand in support of this Motion.
I would like to start by extending my heartfelt gratitude to the healthcare professionals in Singapore, who have shown extraordinary dedication and selflessness in their efforts to care for patients amidst the COVID-19 pandemic. Despite the tremendous increase in demand for medical services, they have continued to provide exceptional care with professionalism and empathy.
We are truly indebted to our healthcare workers and administrators for their tireless efforts throughout this challenging period. Your courage and resilience have made a tremendous impact in our fight against the pandemic, and I would like to express my deepest gratitude for your incredible work.
During the COVID-19 pandemic, the Singapore Government provided the healthcare workers with vital support in the form of financial assistance, resources and training to help them manage their increasing demands while treating COVID-19 patients. The contributions of our healthcare professionals should not, however, only just be recognised during times of crisis. We should still recognise their invaluable contributions moving forward, as we work towards living in a world with COVID-19, post-COVID-19.
It is easy to overlook the exceptional healthcare system in Singapore and fail to appreciate the dedication and hard work that go into providing top-notch healthcare services across the country. The Government has invested significantly in public health infrastructure and subsidised medical care, making it possible for Singaporeans to receive adequate medical attention when required, regardless of their financial background. And we should continue to uphold this, not because we want to remain competitive globally, but because it is the responsible thing to do for Singaporeans.
Mr Deputy Speaker, healthcare is a critical issue that concerns everyone because everyone needs access to healthcare at some point in their lives. Good health is essential for individuals to lead productive and fulfilling lives, and access to quality healthcare is crucial for maintaining good health. And because healthcare impacts everyone, I was happy to see this Motion tabled. I fully agree with the hon Members that we should take a whole-of-Government approach to healthcare.
This is critical because it recognises that healthcare is not just the responsibility of the healthcare sector, but also involves many other sectors and factors. By taking a comprehensive approach, Singapore can identify and address the root causes of healthcare issues and improve health outcomes for its citizens. I want to speak on the following four points which I believe should be given more attention.
First, on accessibility of healthcare services for the elderly and persons with disabilities. Singapore's population is ageing and the demand for geriatric services looks to increase. As our population ages, it becomes more disposed to chronic medical conditions, cognitive impairments, falls, frailty which can significantly impact the quality of life. This calls for specialised knowledge about the ageing process and the optimal management of multiple medical conditions, medications and physical impairments.
Teaching Singaporeans how to age is something which should be invested in as well, and a holistic approach is required, prioritising not just diagnosis and treatment but also functional ability, social interaction and psychological well-being. For this purpose, it will be good if MOH can work with SkillsFuture to increase the access and adoption of courses which are suitable for our seniors. Courses, such as arts, nutrition and digital literacy, exist. However, I believe more can be done to provide more physical and mental well-being courses.
With an increasing Singaporean population of elderly individuals, the importance of gerontology cannot be understated, as it enables our silver generation to maintain independence, improve outcomes and live fulfilling lives.
Mr Deputy Speaker, ensuring healthcare access for Persons with Disabilities (PwDs) is also essential for promoting equitable and inclusive healthcare. Unfortunately, PwDs often face barriers to accessing healthcare, including physical, communication and attitudinal barriers.
I am happy that steps have been made to make healthcare more accessible for PwDs, such as accessible facilities like wheelchair ramps, height-adjustable examination tables and accessible bathrooms. In addition to existing efforts, healthcare providers may improve communications for the visual and hearing impaired by ensuring that their staff is trained in sign language or providing communication aids such as hearing aids or visual aids.
In addition to physical accessibility, healthcare providers can also improve their attitudes towards PwDs by providing education and training for their staff. They can also work towards promoting disability inclusion in healthcare policies and procedures.
Currently, there are many small- and medium-sized enterprises (SMEs) and Non-Governmental Organisation (NGOs) that are in the space of enabling PwDs and it would be good to have more dialogues on continual improvement of services for PwDs and increasing access and awareness of such services for PwDs.
By taking these steps, healthcare providers can ensure that PwDs have access to the same quality of healthcare services as those without disabilities. It is essential to prioritise accessible and equitable healthcare to better build a healthier and more inclusive society.
I now move on to my second point, as we celebrate the triumphs of our Team Singapore athletes in Phnom Penh, we should also recognise the hard work and sacrifice our athletes and their entourage have made to bring glory to Singapore. Our elite athletes often face intense physical and mental pressures. These pressures can affect their performance, long-term physical health and overall well-being.
To excel in their sport, athletes must maintain a rigorous training discipline, adhere to strict dietary requirements and overcome physical injuries. Unfortunately, these pressures can often lead to mental health problems such as anxiety, depression and eating disorders.
In addition to physical pressures, many athletes face significant social pressures. They may feel pressure from teammates, coaches, fans and the media. This can lead to additional mental health problems, including stress, burnout and a lack of self-confidence.
Elite athletes need access to resources to help them cope with these pressures. This can include mental health support, sports psychology and mentoring from experienced athletes.
It is also essential for athletes to understand that it is okay to prioritise their mental and physical health over their sport. Many athletes, such as May Ooi and Constance Lien, have recognised this and have become advocates for mental health awareness and self-care.
By acknowledging the pressures that elite athletes face and providing the necessary support, we can help them perform at their best while maintaining their long-term physical and mental health. Therefore, I hope that more support can be put into handling these unique needs of our national teams.
Third, on creating a vibrant sports and fitness culture. It is true that we often take our health for granted until an event impacts us directly. Recently, a friend passed away from a heart attack. He was still young and his tragic and sudden death ignited conversations amongst my peers about being healthy versus being fit, as well as our general education on health and well-being. It would be good if MOH and the Ministry of Education (MOE) together with SportSG teach Singaporeans at a tertiary level how to exercise when Singaporeans enter the workforce. There is a difference between training and exercising. We participate in Co-curricular activities (CCA), and sports CCAs teach you how to train – push your physical boundaries for performance, but exercise is about maintenance, mobility and lifestyle.
Exercise should be a habit and a lot to do with forming habits has to do with convenience, routine and accessibility. Some Members may know that Dr Tan Yia Swam is an avid parkour practitioner. Parkour, is a sport of jumping, climbing and sliding over and through a terrain. In Singapore, this happens to be an urban terrain and I am happy to see that such projects and facilities being built in Somerset and Lakeside.
I hope more urban-centric sport facilities will be built to match Singapore's landscape and interests. I hope and would also like to also encourage programmes to go together with these facilities. To do that, instructors need to be trained, qualified and hired. I am happy to see that at this year's Committee of Supply (COS), the Ministry of Culture, Community and Youth (MCCY) announced a registration of personal trainers that cover a range of activities and disciplines. But to empower this registry, the trainers need to have updated and relevant content to teach. I would encourage SportSG, Health Promotion Board (HPB), MOE and People's Association (PA) to have more discussions about the delivery of relevant, age-appropriate physical programmes that cater to a vibrant, active Singapore population.
Fourth, verbal abuse towards frontliners working tirelessly to keep society functioning during this pandemic is a deplorable issue. Despite their unwavering commitment to rigorous job demands, healthcare workers, essential workers and other public-facing roles have been subject to verbal abuse, shaming and criticism.
In addition to it being emotionally draining, verbal abuse can lead to mental and physical health issues and impact the professional and personal lives of those affected. Therefore, it is crucial to recognise the value of our frontliners and to show support by offering gratitude, recognising their hard work and taking ownership of our collective responsibilities. Frontliners deserve our fullest respect, support and empathy.
Recognising and addressing this issue is vital in holding those responsible accountable for their actions. Healthcare facilities can provide training for their staff to de-escalate tense situations and implement policies for reporting and addressing verbal abuse. In addition, public campaigns can educate people on the importance of respecting frontline workers and the consequences of their actions.
In conclusion, Mr Deputy Speaker, the COVID-19 pandemic has showcased the bravery, dedication and selflessness of our medical workers and workforce at the forefront of fighting the virus. They have worked long hours under challenging conditions while risking their health to care for patients. As the pandemic begins to subside, the Government must continue to support medical workers even after the pandemic.
I would like to ask the Government for healthcare workers to be provided with ongoing mental health support to deal with the psychological impact of their experiences. The pandemic has taken a toll on their mental health and well-being, and they must receive support and resources to deal with any long-term effects.
Our Government should also invest in health and safety measures to protect medical workers from future pandemics. This includes providing adequate personal protective equipment, training and vaccination. Healthcare workers at the forefront of infectious disease outbreaks must be thoroughly protected against any potential hazard they may face in the future.
By showing support and appreciation for medical workers after the pandemic, we create a sense of value for their role within our society. Their sacrifice and hard work deserve recognition, and this can go a long way in keeping them motivated and inspired. The Government should continue to support medical workers to build a brighter future for our healthcare industry and the patients that rely on them.
Mr Deputy Speaker : Dr Wan Rizal.
2.24 pm
Dr Wan Rizal (Jalan Besar) : Mr Deputy Speaker, I thank hon Members, Dr Tan Yia Swam, Mr Abdul Samad and Dr Shahirah, for raising this Motion. As Members of Parliament, we share the same goal: to create a healthier, more resilient Singapore, for generations to come.
Our nation's healthcare system is an essential part of that objective and I am grateful for the opportunity to engage in a constructive dialogue on this vital issue. I want to touch on two broad topics. First, and unsurprisingly, on mental health and second, on our efforts in the Malay Community through the "Saham Kesihatan" initiative.
Sir, mental health is a crucial component of our healthcare system. It is integral not only to an individual's well-being but also to the health and productivity of our society. I am glad that Dr Tan Yia Swam brought it up. We must acknowledge the challenges posed by Dr Tan Yia Swam head-on and continue to work collaboratively to find effective solutions.
Conversations around mental health have become much easier amongst Singaporeans over the years and this is not a coincidence. It is made possible by the efforts from the Government through the Inter-Agency Taskforce on Mental Health and Well-being, private sectors, community partners and ground-up groups to destigmatise mental health issues.
While we have made strides in terms of awareness on mental health, we must recognise that there is still much to be done, particularly in how we can directly mitigate issues of mental health.
I want to revisit some of the points raised in my Adjournment Motion back in 2020 to align with Dr Tan Yia Swam. During that speech, I shared the acronym "LAST". Briefly, "L" for literacy, "A" for accessibility, "S" for screening and "T" for time-outs.
Being an educator, I truly share Dr Tan Yia Swam's sentiment on the importance of education. We must continue to raise mental health literacy among our citizens. It should be introduced early, starting with our schools. Therefore, I am glad that MOE has refreshed our youths' curriculum that covers physical, mental and emotional well-being.
But I hope we can impact mental health more directly, go beyond education or awareness and include mental health screenings as part of our regular physical health screening. The intention is simple, we want to create some normalcy and promote early detection and intervention of mental health issues, leading to better outcomes and quality of life for individuals. It would also be helpful to reduce the societal burden of untreated mental health issues and contribute to the overall well-being of our community.
Now, I am confident that we can foster a community that eradicates mental health stigmatisation. But I also have to remind myself that such shifts in mindsets will not come easy, will not come instantaneously nor come so soon. And like many education programmes, changes can take quite some time.
As a teacher 20 years ago, I had students who needed special attention in class. People questioned me on why I bothered to take such differentiated approach at that time. Twenty years on, we can observe that people, the society, have become accepting, and thanks to the efforts of both public and private sectors including advocates like Hon Member and Jalan Besar Group Representation Constituency (GRC) colleague, Denise Phua, students now who require special attention in class are now embraced and provided with timely and appropriate intervention.
Although we have not achieved the same level of acceptance for mental health, we must persevere. We must continue with a "whole-of-society" approach towards mental health and this means an active participation from the whole-of-Government, private sectors, community partners, ground-up groups and religious organisations.
As Members of Parliament, we must wholeheartedly believe in this cause and strive to make it a reality. I commend the efforts by Members of this house and those before us who have been advocating for mental health. When we, as a society, a whole-of-society amplify the voices of those who have experienced mental health issues, we help to break down the barriers that prevent individuals from seeking help and create a more inclusive and supportive environment.
Sir, beyond education and screening, and speaking about mental health, accessibility to mental health services remains the most crucial in encouraging individuals to seek for help. We want them to access mental health services without fear or stigma, discrimination or barriers such as cost, waiting time, transportation, or even distance. Additionally, it is important to create a supportive and welcoming environment so that they can feel comfortable and feel safe to seek help without any shame or judgement.
I am glad that MOH has increased the number of access points via the polyclinics and telehealth services, making mental health services more widely available to people in need. However, I am aware of the shortage of trained mental health professionals who can provide effective and evidence-based treatment for those seeking help. Due to the lack of resources, people who need help may turn to untrained mental health practitioners or rely on self-help resources, this may not provide the same level of support and expertise as a trained one. This, too, can lead to inadequate or harmful treatment, worsening the individual's mental health and overall well-being. Therefore, we must continually review our mental health infrastructure, I hope we regulate this profession.
Sir, Dr Tan and Mr Abdul Samad highlighted problems faced by healthcare workers. I want to draw focus on the mental well-being of our healthcare workers. The nature of their work is more than just a job; it is a calling that requires deep commitment and dedication. We must provide support and resources to help them cope with the stress and challenges inherent in their professions, which will ultimately lead to improved patient care.
Moreover, we must address the harassment and abuse faced by healthcare workers, both physically and online, as it directly impacts their mental well-being. We not only must create a safe and supportive environment for our healthcare workers but enact clear guidelines to protect them. Thus, I am grateful that the authorities will take a zero-tolerance approach and will take appropriate actions against individuals who harass or abuse our healthcare workers. We must say, “If you abuse our healthcare workers, there will be consequences”. I look forward to the implementation of the measures to protect them. Sir, in Malay, please.
( In Malay ) : [ Please refer to Vernacular Speech .] Minister Masagos recently announced that the Malay community has shown progress in several health indicators.
This includes the number of Malay patients with high blood cholesterol. However, we still need to continue efforts to look after our community's health. Our community's obesity rate is the highest compared to the other groups. As we are aware, obesity can lead to health problems like heart disease, diabetes, and high blood pressure, among others. Therefore, Minister had announced the establishment of a fifth focus area for M 3 so that it counts as one of our community’s priorities.
This new focus area, through the Healthy Investment programme under M3, aims to mobilise our community to be ready for the Healthier SG programme. This programme is in line with Healthier SG's goal of making disease prevention a personal commitment. We need to take proactive steps to undergo frequent health screenings, adopt an active lifestyle and have a healthy diet.
Besides individual efforts, this whole-of-community initiative can also bring about changes. This is where the Healthy Investment Programme by M 3 @Towns can provide opportunities for physical activities, raise awareness on the importance of maintaining a healthy lifestyle and identify potential risks linked to obesity.
By working with other agencies such as HPB and Active SG, and as individuals making healthy choices, we can continue to progress and improve the health of our community and reduce the prevalence of obesity and other health-related issues.
I urge our community to take this opportunity to participate in the activities organised by M 3 @Towns.
Remember, it is our obligation to stay healthy. And if we are healthy, we will be able actively contribute to our family and the development of our community and nation.
( In English ): As we continue the discourse on our healthcare system, it is important to acknowledge that we have a strong foundation and must continue to build on it. As individuals, we must recognise the vital role each one of us plays in shaping the fabric of our society. It must always be a whole-of-society approach. Each individual in our society serves as a vital cog in this complex machinery of our nation’s well-being. Every cog, no matter how small or seemingly insignificant, contributes to the smooth operation and overall success of the system. And when one individual is down, others must step up to care and help. It is only through our collective efforts, with each and everyone of us working in harmony, that we can make a lasting, positive impact on the health landscape of our cherished nation.
Sir, at this juncture, I would like to express my heartfelt gratitude to the NMPs for raising this crucial Motion. Their passion, deep knowledge and unwavering commitment to balance meaningful, insightful discourse throughout their time in Parliament have not gone unnoticed.
Sir, to conclude, let us remember that progress in healthcare, its continued success depends on our collective determination and unity. Together, we can build a brighter, more resilient and healthier future for all.
Mr Deputy Speaker : Ms Janet Ang.
2.35 pm
Ms Janet Ang (Nominated Member) : Mr Deputy Speaker, I stand in support of the Motion put up by hon NMPs, Dr Tan Yia Swam, Mr Abdul Samad and Dr Shahira Abdullah.
Over the past few months, we have debated on Healthier SG and then the White Paper on COVID-19 Response. Minister Ong has also updated this House on the three strategic pillars of Singapore healthcare going forward – acute care, public health and aged care. There were also several Forward SG dialogues giving birth to lots of ideas and initiatives. I applaud MOH and the whole-of-Government for the comprehensive holistic approach that is being taken, but we must all recognise that this is a marathon and not a sprint.
There is a lot to be done and will need whole of Singapore to be committed to act together for a healthier Singapore especially as we mature rather rapidly in age. Continued dialogue amongst all stakeholders is very important to listen, to clarify, to prioritise issues and to collaborate on solutions as we move forward, will be a key imperative.
For this debate, I will focus my attention on what the community and the private sector can and ought to do to complement and supplement the whole-of-Government efforts to support our healthcare workforce and our healthcare strategic transformation initiatives. Inevitably, I will also have policy consideration questions and recommendations which I hope MOH and the whole-of-Government can consider to take on board.
I have five topics for discussion. Firstly, respect and gratitude for our healthcare workers. Considering that Singapore’s healthcare system is ranked amongst the best in the world, I think it is time for the users of our Singapore healthcare system, that is patients, families, visitors, all of us to aspire to be ranked amongst the “most gracious” in healthcare systems.
There sometimes is this unrealistic expectation of “being served” in hospitals. Asking to be served water much like what we would do at a restaurant is the wrong expectation. Overusing of call buttons for minor requests is not being considerate. And hurling abuses at anyone, let alone folks who are actually helping us, is absolutely unacceptable. Instead, a smile, a "please", a "thank you" would go a long way to show some consideration and appreciation.
Hospitals are high-stress places. I am sure the healthcare staff are trained to be empathetic and sympathetic, which if not so, they should be. Still, the families and the patients should not think it our right to let go of our anger and frustrations on the healthcare staff, be they doctors, nurses, allied health professionals, support care staff or even the hospital security guards. Take a deep breath. Think of one thing we are grateful for. And consider the wise age-old golden rule: “Do unto others as you would have them do unto you”.
That said, still, there will be bad behaviours and I support MOH’s plans to have a concerted, across-the-board policy to handle and address the bad apples amongst us even as I wish and hope that as a community, we can all do better.
The second point, community involvement. Nurses, allied healthcare and care support workers will become increasingly important along with family physicians, doctors and medical specialists, as Singapore heads into becoming a super-aged nation. The community ourselves must recognise that we have just as important a role to play.
The first order of the day is to individually keep an active and healthy lifestyle to prevent chronic illnesses. As part of the Healthier SG, the system will incentivise positive behaviours, and poor healthcare lifestyles and behaviours should be disincentivised or penalised.
Next, the community can help ourselves by forming little support groups among residents or neighbours to support one another. These little support groups can be like little satellites receiving and disseminating correct, right healthcare-related information. Each general practitioner (GP) can be Advisor to a few groups to check in with them, to advise on activities or even join in, similar to what Members of Parliament do in a constituency. These groups can organise themselves with some governance and help to visit their neighbours and bring those in need for hospital checks, check that they are taking their medication and so on.
I understand that some of this is already happening but perhaps not in a cohesive, organised way. I guess the best example is whatever we managed to rally during COVID-19. So, now, in peace times, how do we repeat that? Going forward, we can be more coordinated and more collaborative. Then, the community may organise health screening, community exercises like Zumba, hikes to MacRitchie, Tai Chi and so on. The issue is how to get more people involved and keep it sustained. Maybe with Healthier SG, where you have credits for participation and these can be used for healthcare or purchase of healthy staples like oats, milk and so on.
In my speech at the Healthier SG debate, I shared about GoodLife! Makan at Block 52 Marine Terrace, an initiative of Montfort Care FSC as well as “Share-a-Pot” at the Caritas Agape Village in Toa Payoh. These and other ground-up initiatives like the SG Mental Well-being Network or the Family of Wisdom by Dementia Singapore or Caring Commuter Champions who assist our public transport commuters who have visual impairment or physical disabilities or may be seniors with dementia, during their daily public transport commute. These are examples of what the community can do to be a part of the Singapore healthcare ecosystem.
Serendipity has it that I just attended this morning a heartwarming Sing Out Loud! performance at Esplanade by nine seniors with dementia accompanied by nine Kindergarten 1 and 2 children. The seniors are residents of the St Joseph's Home and the children are preschoolers attending the childcare centre which is located in the same compound as the St Joseph's Home Infant and Childcare Centre. Sing Out Loud! or 大声唱 is a community engagement programme by Esplanade, developed in partnership with Dementia Singapore in 2016, but this is the first time involving an inter-generational group.
It will be remiss of me not to mention the Convent Yuki and the flourishing fund initiatives sprouted out when friends transitioned into the second half of their retirement and supported seniors like my mother-in-law Mrs Lily Chia to continue having a meaningful and reasonably active life even into their 90s. By the way, my mother-in-law celebrates her 100th birthday next week.
These kind of initiatives can become a part of the Healthier SG community partnership. It would be wonderful to see how these can qualify or be recognised under the rewards of Healthier SG as well.
One last point on community involvement. With an ageing population, it may soon become an imperative for everyone to be equipped with care skills. Perhaps that will come a time for everyone to be trained in basic nursing and care skills and be providing the services in their own families or communities or to be involved in some form of national community services. This could apply to young men as part of their National Service and for young ladies as part of their pre-IHL community service training. This can also apply to retirees as well. It could be a voluntary basis or perhaps even considered as some form of paid gig work of sorts.
My third point: shortage of nurses and a llied healthcare workers. Minister Ong has shared often enough that the key challenge in our hospitals is to have sufficient nurses, allied health professionals and support care staff to operate hospitals, clinics and eldercare centres. When there are insufficient nurses and allied healthcare workers, the in-service staff including junior doctors all have to take up the slack, resulting in everyone overworking, experiencing burnout and mental wellness issues. In having to manage the COVID-19 response since 2020, our healthcare workers must likely added several years to their age.
How is MOH addressing these issues? How can the private sector help? What can the community do to support?
Some ideas include:
(a) broadening training and responsibilities for existing nurses, allied health professionals and pharmacists so that they can take on crucial roles alongside doctors. This can help make these pertinent roles more attractive to Singaporeans. A lot, I know, is already being done by MOH in this aspect but more still yet to be done.
(b) nurses' pay is also being reviewed and implemented which is great. My point is that we have to align to pay for skills. When it comes to compensation, more is always welcome. That said, from the conversations I have had, what carries more weight when choosing nursing and allied health as careers is not exactly money. Please pay them enough. If they want to make lots of money, they will go and become investment bankers and so on. But what is important is being on a role that is respected and appreciated, having more flexibility so that work life balance can be better achieved and having the opportunity for career progression and personal growth, perhaps being able to say that living a life with a purpose.
(c) the community can help by changing our mindset when it comes to perceiving and treating "service" staff. Our nurses and allied healthcare professionals should be treated with every dignity, respect and gratitude.
(d) designing human resource (HR) policies that offer opportunities for them to choose pathways to progress in their career toward further certifications and even degree qualifications, granting study leave and examination leave for those doing their part-time degree or part-time specialised training, much like what we do for the doctors. These staff often struggle with roster and they feel bad for requesting shifts. If we are serious about lifelong learning, this is something that needs to be addressed. It need not necessarily be fully paid leave but just provide some flexibility in rostering.
(e) technology can automate repetitive work and augment the skills of the nurses and healthcare staff. Singapore is well recognised for our innovations on the world stage as amongst the top dozen or so healthcare systems that leverage technology well. Whether it is Robotic Process Automation (RPA) or artificial intelligence (AI) or data analytics, they have been proven to support positive patient outcomes, in addition to efficiency and effectiveness in the organisation.
Mindset change and ease of adoption are key challenges that need to be done. One good example is the use of sensors to read vital signs, reducing the time nurses and doctors have to spend going from patient to patient to take their vitals physically. That is one and grumble. I have got plenty to give but, due to short of time, I will just go straight to the point.
Jobs that are well assisted and enhanced with technology are more attractive especially for the younger generation. I am sure it is already doable for robots to serve the medication based on the barcode of the patient's tag and the day will come when barcode can read our retina and serve out the correct medication.
(f) design scheduling system that can accommodate flexible shifts/hours. Such a system will be very attractive for staff who needs to juggle work with family and caregiving duties as well as studies as pointed out earlier. This may attract also retired nurses or part-time nurses to return to the workforce.
I understand from the Singapore Nursing Association that there is already a "return back to nursing" scheme for those who left for family reasons. I understand, however, that the Singapore Nursing Board has stopped registration for previously-registered nurses who have not been practising in the field for more than five years. Some of these nurses have had years of experience prior to their break and would like to rejoin the service but perhaps, are experiencing difficulty getting back their registration. With appropriate retraining, this would be a good pool of candidates to bring back into the workforce, at an appropriate level and not make them start with the junior nurses all over again.
There is also a Nursing Career Conversion programme and this programme, I hear, has been pretty successful in terms of enrolment. It will be interesting to get the statistics on the number of jobs which get filled by the graduates of such programmes and schemes.
(g) for foreign nurses and allied health staff, not being able to bring their family with them seems to be the biggest bugbear especially as other countries dangle that benefit. We know it is a challenge for Singapore but perhaps, MOH, Ministry of Manpower (MOM) and Ministry of Home Affairs (MHA) can share the strategy for attracting and retaining foreign nurses and allied health professionals?
(h) what can the community do? Well, I hope that all parents can do our part to encourage our children who went overseas to attain their healthcare degrees and qualifications, to come home. I would recommend for MOH to do for nursing and allied health professionals, the same or similar as what is being done to attract overseas medical school graduates who are Singaporeans and Permanent Residents (PRs) to return and work here. I hear that our marketing campaign makes the graduates feel very much needed.
(i) one last point on this issue of manpower shortage. We might want to incentivise qualified professionals who are Singaporeans and PRs schooled and qualified overseas to return to Singapore and take up the open positions and get themselves registered. I have heard anecdotal stories that Singaporean physiotherapists who are qualified to practise in Australia, cannot get registered in Singapore. Apparently, they are expected to have undergone the same breadth of training as Singapore-trained physiotherapists. Perhaps, MOH can consider conditional registration for these overseas qualified physiotherapists and allied health workers, while they take up continuous learning in the subjects that might not have been part of their training overseas. In this way, we bring home another Singaporean son or daughter, who becomes a plus to our workforce.
Four, how can private sector play a part. There will always be senior doctors who, after their training, opt out of the public system, quit and go private. That is a perennial challenge for the public sector in the management of specialists. To have a Healthier SG, we need all hands-on deck.
One suggestion is for private sector specialists to regularly attend to subsidised patients on a pro bono basis or subsidised rate or they could run free clinics for those assessed to be unable to pay. Execution may not be easy but as during COVID-19, we see how the private sector healthcare was roped in and played an important role in complementing public healthcare resources. In this regard, we can learn from the legal community.
With the Healthier SG, general practitioner (GP) doctors and family medicine clinics are going to be the key nodes of care, in the community. I am sure that MOH is constantly reviewing the split between various specialisation. It is quite clear that we should be encouraging more junior doctors to specialise in family medicine and pursue the path of becoming GPs or family doctors. From my understanding, family medicine is already a speciality. What will it take to attract more medical officers to choose the family medicine route? How many training positions are there each year if we are successful in convincing medical officers that it is as good as any other specialisation?
Private sector GPs and clinics must step up to offer specialisation traineeships for our junior doctors. And we probably need to look into pay gaps amongst these specialities. What will it take to motivate the GPs to engage and be part of the primary care network so that together, we can work toward a common goal of preventive health?
The new capitation funding model will play a key part and it needs to be designed to incentivise as well as disincentivise behaviours at all levels of care, including the GPs and the population. Prevention and going upstream has been proven to be the best way to improve clinical outcome. For example, at Intermountain, they incentivise the primary care network to keep people out of hospitals as much as possible. For their diabetic population, they invested additional 4% of budget in this group and achieved a decrease in hospital admits by 22% and a decrease of 21% for other avoidable visits and admissions, resulting in overall improvement in value of care and reducing overall costs over time. In Singapore, we should perhaps look to modelling something similar.
One of the issues that I hear often is that GPs are not set up to handle and cope with the increased administration and IT workload. It might be worth considering for MOH to set up a standardised platform or for an agency or a private sector to provide the administrative services required to be done at scale. It is important that the GPs step forward and engage themselves in the redesign of work processes and incentives that will help make Healthier SG implementation efficient, effective and most importantly, deliver on its intended purpose. The GPs need to lean in, to help themselves and to help reinvent primary care for our Singapore healthcare ecosystem, help technology to help our medical teams.
Five, home medical care. For a sustainable healthcare system, home medical care must play a key part in the continuum of care. A doctor friend shared that there was a scheme at one time, which has since been pulled back, where post-delivery patients could go home because there were nurses visiting baby and mom for three days after discharge. This would be the kind of domiciliary services needed as we transition to a right care at the right time in the right setting, often at home.
Mr Deputy Speaker : Ms Ang, you are at 19 minutes 40 seconds.
Ms Janet Ang : Sorry. Okay. Who will be responsible for recruiting, training and managing all of them? Perhaps, some form of uberised certified healthcare professionals who schedule their own rosters and probably work the "beat" in their neighbourhood could be the best.
As I conclude, I cannot help but worry about our collective ability to transform at this pace. To rush too much, risks the effort being channelled to the superficial, resulting in us getting the form and losing the substance. Change is never going to be easy. We are blessed to have a healthcare system that is amongst the best in the world. The latest Legatum Prosperity Index 2023 ranked Singapore in number one position with a health index score of 86.9.
I would like to close by paying tribute to everyone involved with the healthcare ecosystem: the cleaners, care support staff, allied healthcare professionals, nurses, doctors, medical professionals and healthcare administrators. To all of you in and around healthcare, to quote Pope Francis, "Compassion is the heart of what you do. You know that it is not just about good organisation but a heart of all that is listening, accompanying and supporting the people under your care."
It is not an easy job but for most of you, it is a vocation. So, a big thank you for your tireless efforts and contributions to keeping Singapore and Singaporeans health aware, ready, inclusive, resilient and dignified through every stage of our lives. Mr Deputy Speaker, I stand in support of the Motion.
Mr Deputy Speaker : Mr Raj Joshua Thomas.
2.57 pm
Mr Raj Joshua Thomas (Nominated Member) : Sir, the Tripartite Workgroup for the Prevention of Abuse and Harassment of Healthcare Workers was set up in April 2022 to look at how to address the abuse and harassment of healthcare workers. The work group presented its findings and recommendations in March this year. Their findings on the extent of abuse is troubling. More than two in three healthcare workers had witnesses or experienced abuse or harassment in the past year. A third of all healthcare workers had witnessed or experienced abuse or harassment at least once a week.
Healthcare workers are in a particularly vulnerable position. Their job inherently involves interaction with people who are in need of some form of assistance or attention, or whom may even be in distress. Many healthcare workers therefore internalise that some abuse is to be expected as they carry out their jobs and this often leads to under-reporting.
The work group found that that frontline healthcare workers like pharmacists, patient service associates and nurses are more likely to face abuse and harassment, with the most common type of abuse being shouting, making demeaning comments and threatening to file complaints or to take legal action against the healthcare workers. In other words, many of these forms of abuse and harassment arise out of an expectation that the patient and/or the caregiver should be treated in a certain way, that they may have some entitlements that they are not getting or that they should have some level of service or timeliness.
This prevalence of abuse against frontline service workers has also been found in other sectors. The critical question, therefore, is why do these abusers have these expectations and why do they think they think they can resort to shouting, making demeaning remarks or threatening to make complaints?
I wonder whether it is precisely because of the fact that our healthcare system is reputed to be one of the best in the world and whether it has something to do with the quintessential Singaporean aspiration towards efficiency and accountability. Has this now become so ingrained in our people that it has become a basic expectation of all services and workers in Singapore?
Then, when this expectation is not met, Singaporeans become frustrated as they feel that the system has failed them. In this regard, our success at being efficient and productive may have turned out to be a double-edged sword, because even falling slightly short can lead to backlash.
One thing that stood out for me in the report was that one of the more prevalent types of abuse was threatening to file complaints or to take legal action against the worker. Again, this appears to be an aberrant, twisted application of the whistle-blowing process, the desire to improve through feedback as well as the rule of law. Are we becoming more litigious as a society and is it happening because we believe that any perceived slight or inconvenience can be remedied by litigation by complaining or through the courts? All these affect the morale of the healthcare workforce and their ability to carry out their jobs.
Just this morning, Dr Tan Yia Swam shared with me an anecdote of how one of her friends in healthcare was so affected by threats that she had resigned. This included the threat from an abusive individual who threatened to look for her outside her workplace.
He said – he said it in Mandarin, which I shall not try to say verbatim, but the translation of it is, "Singapore is so small. Even mouse also can find." This is what I was told the translation is.
When it comes down to our workers on the ground, what they are focused on is getting their job done. Technology and processes have made us faster and better but there are also sometimes administrative processes that workers have to follow.
For example, the Personal Data Protection Act now imposes certain requirements on data collection and processing that are necessary to protect personally identifying information.
Another example is that as our population ages, there will be an increasing need to appoint deputies. There are certain statutory procedures that must be complied with that caregivers may not fully understand. This could lead to frustration with hospital administrators and tempers could flare.
As such, a key plank of the effort to prevent abuse and protect our healthcare workers should be to instill in patients, caregivers and members of the public that regardless of their frustration with administrative processes or perceived systematic inefficiencies, it is not acceptable to take out these frustrations on the workers who are merely working within the system that they find themselves.
This goes beyond having mere statutory protections and penalties under the law. It requires that we adopt a societal mindset of civility and kindness instead of imperious expectation and entitlement. In fact, this is what the hon Member Dr Wan Rizal said earlier – that we need to have an all-of-society effort.
Japan, for example, has a culture of omotenashi, or selfless hospitality, which is seen as a microcosm of the Japanese mindset to be centred on care rather than expectation. Omotenashi provides that good manners and a polite bearing are not just expected in interactions between individuals in social contexts but that they are also indications of respectability and good standing. Principles include humility, patience, a quickness to apologise and an even tone in conversation.
To emphasise omotenashi and ensure that this core Japanese characteristic is not lost amidst a modernising society, the Tokyo municipal government launched the Tokyo Good Manners Project in 2016, which is ongoing.
MOH Holdings had already announced that it would be launching a national public education campaign to promote positive relationships of trust and respect between healthcare workers, patients and their caregivers. I truly hope that this campaign will be successful in reducing incidents of abuse, giving societal support to our healthcare workers and building our very own omotenashi.
Abuse of healthcare workers comes generally from two categories of individuals – patients and caregivers or family members of patients.
As regards patients, healthcare professionals may find themselves in a conundrum. Patients who are elderly, have mental health issues or who are in pain may sometimes turn abusive, including physically abusive.
In this regard, one of the work group's recommendations was to stipulate clear consequences for perpetrators. For patients who are abusive, warnings may be issued and they may be discharged if they do not require urgent attention. Further to this, healthcare workers may also disengage from abusive patients by refusing unreasonable requests.
I imagine that it will be challenging drafting the guidelines for this as it would have to balance the need to provide medical care to patients while, at the same time, protecting healthcare workers from physical, mental and emotional abuse.
Likewise, for caregivers and family members who may be distraught due to a medical emergency or condition of their loved one, there may also be instances where they turn abusive.
My view is that while we can be sympathetic to family members in such situations, there should be zero tolerance if they turn verbally or physically abusive or harass healthcare workers.
While it is a part of the healthcare worker's role to provide support to these people, there is no overriding obligation of providing medical care to them. As such, the procedures to deal with abusive non-patients should be far stricter than those for abusive patients and should be actively enforced.
Supervisors and hospital management must stand by their workers. Our national healthcare groups have already said that they will support and implement the recommendations, including a zero-tolerance policy. I was also heartened that Minister Ong has said that even the Minister will have their back and that healthcare workers should know this.
Authorities should also be prepared to prosecute such cases of abuse if they are beyond a certain threshold of severity.
I hope that the guidelines that will be issued in the second half of this year will see a sharp reduction in incidence of abuse against our healthcare workers and that it will give them peace of mind as they go to work every day.
Sir, I support the Motion raised by my fellow Nominated Members. I would also like to take this opportunity to support our healthcare workers and to thank them for all of the sacrifices that they have made and continue to make every day.
Our nurses, doctors, therapists, ah mahs, counsellors, pharmacists and administrators are in vocations that protect what is central to humankind – life and well-being. Theirs are not merely noble professions but the noblest of all professions. Let us therefore ensure that we do our very best to take care of them – that we take care of those who take care of us.
Mr Deputy Speaker : Prof Hoon.
3.07 pm
Prof Hoon Hian Teck (Nominated Member) : Mr Deputy Speaker, Sir, at a fundamental level, we all recognise that there are some negative events in an individual's life that are unforeseen, such as falling seriously ill.
To provide protection to its citizens against such contingent events, one might think that we could rely solely on private insurance companies. The argument is that risk-averse individuals would find it in their self-interest to purchase insurance policies that are offered at actuarially fair prices.
However, because of asymmetric information, one side of the market has private information not readily available to the other side, leading to adverse selection.
Full insurance is generally not available. In a market that is characterised by adverse selection, more-costly-to-serve customers know who they are but sellers do not. The insurance company knows that among the potential pool of customers, some individuals are better risks than others but it does not know who the better risks are.
The fact that insured individuals know their own risk level better than the insurer might cause those who are more likely to have an adverse health outcome to purchase an insurance policy, thus leading the insurer to lose money if it offers insurance. The result is that there is an inadequate provision of private insurance.
Thus, in the presence of an adverse selection problem, there is a role for the Government to intervene by providing social insurance in the form of MediShield Life, which was introduced in November 2015. This national health insurance scheme has three important features.
First, there is a public mandate so that all Singapore citizens and permanent residents are included in the scheme. Absent such a mandate, more healthy residents would have an incentive to opt out of buying coverage at a premium that reflects the much higher healthcare costs of less healthy residents.
Second, pre-existing medical conditions are covered, although there are additional premiums for serious pre-existing medical conditions that require intensive medical intervention to treat or require prolonged treatment.
Third, the Government provides subsidies to low-income residents to help them make their premium payments.
MediShield Life is administered by the CPF Board, which is a defined contribution social security system. In contrast to a defined benefit social security system where payroll taxes are collected from the working young to finance the benefits received by the retired old, CPF contributions form part of an individual's savings.
In order for our national health insurance scheme to be financially sustainable, it is vital that the economy continues to generate good jobs. This is because the main source of financing the premium payments comes from an individual's MediSave Account.
The Motion's call for a whole-of-Government approach is therefore very appropriate.
The recent recommendation by the Advisory Committee on Platform Workers for platform companies to work with the Government to develop a mechanism for platform workers to make regular contributions to MediSave is also timely as it contributes to a financially sustainable national health insurance scheme.
Mr Deputy Speaker, Sir, I therefore support the Motion standing in the names of my three hon fellow NMPs.
Mr Deputy Speaker : Mr Yip Hon Weng.
3.12 pm
Mr Yip Hon Weng (Yio Chu Kang) : Mr Deputy Speaker, Sir, today's Motion has raised some salient issues. I would like to speak on ageing issues and explore ways in which we can better empower our seniors to continue to lead fulfilling lives.
It is imperative that our healthcare system is equipped to handle the unique challenges that comes with a super aged society. We have to be forward-looking and address the issues now or we risk seeing our infrastructure and facilities unable to cope with demands. This will impose a significant fiscal burden on Singapore in the future. I would like to speak on three issues.
First, Mr Deputy Speaker, Sir, we need to better organise care integration. I agree with Dr Tan Yia Swam that greater cross-collaboration is necessary but I wish to add that this is particularly pertinent between health and social care, which falls under the purview of MOH (MOH) and the Ministry of Social and Family Development (MSF) respectively.
The Healthier SG initiative is undoubtedly a step in the right direction. We want health, not healthcare. Social prescription is a key component in this. We need to encourage our seniors to engage in activities that promote their overall health. There are plenty of free exercise and wellness programmes to do. This is made available by Sport Singapore, PA and various social service agencies (SSAs), but we must rally the ground-up support and get active participation. What is being done in this respect to link up the two sides? Otherwise, it is just another startup project – good for sound bites but may be ineffective in helping our residents.
Social prescription and healthcare must go hand in hand. There needs to be greater integration between health and social care. Do healthcare professionals, including general practitioners (GPs) and their clinic assistants, know what kinds or types of exercise programmes exist or are provided by various organisations in the neighbourhood? If so, are they knowledgeable enough to recommend them to their patients? Similarly, do our social service professionals know how to identify health-related issues in seniors and refer them to the appropriate healthcare professionals?
A concept may look promising on paper, but the devil is always in implementation. How do we help prepare healthcare staff outside of MOH who are to be part of this project? We need to move away from the fear of over-medicalising healthcare and encourage greater collaboration between health and social care.
Is it time to move away from an interagency ministerial committee and consider establishing a Ministry of Ageing? Organisation drives behaviour. A dedicated ministry can spearhead integrated policies relating to ageing, ensure that the needs of our seniors are met and make Singapore a great place to age in.
Second, Mr Deputy Speaker, Sir, we need better enablers to support care integration. It is essential that we have an integrated system that allows for seamless collaboration between health and social care. To achieve this we need to address the current issue of healthcare legacy IT as well as IT systems being used by different clusters. I mentioned about this in my previous Parliamentary speeches and during the Committee of Supply debate.
For example, some clusters use Health Buddy where others use HealthHub. There are also a myriad of different computer systems across community, primary and tertiary healthcare providers, ranging from CCMS, Epic to Citrix. Can the systems inter-operate? Can we merge these IT systems to ensure that healthcare professionals have access to a unified platform to manage their patients' healthcare needs?
The same applies to merging GovTech systems and Integrated Health Information Systems (IHiS), ensuring that we have better data sharing between health and social sectors.
We must also explore ways to better enable data sharing between Government and SSAs on information regarding the wellness of seniors, both from the health and social sectors. Currently, data sharing seems rather fragmented. We should strive for a holistic view of the senior, encompassing both health and social aspects.
Finally, we must explore ways to leverage telehealth to facilitate care integration. What are the plans to scale up current pilots? How can we ensure that telehealth is utilised effectively to provide comprehensive care for our seniors?
Third, as we seek to improve care integration for seniors. We must also focus on further empowerment for care integration. One critical question that we must ask is this: can we better empower our seniors to better take care of themselves?
To answer this question, we need to explore key messages and initiatives that seniors should look out for as they age.
One possible solution is to provide seniors and caregivers with a health booklet containing relevant information to help them manage their health effectively. This is similar to the child health booklet provided to primary school students and their parents.
While we acknowledge this may not be feasible for those who are illiterate or have visual disabilities, it will still be a useful tool for many seniors and caregivers who need guidance.
In fact, as our aged population becomes increasingly educated and literate in years to come, we expect much of this empowerment to require self-help and initiation on the part of our seniors. Seniors would want to be empowered to make independent and informed decisions. We need to nudge them in the right direction. A key move is to promote better transparency, push out more information on various health related topics, such as the cancer CDL list and insurance.
In this regard, we should explore ways that the Silver Generation Office can help in this area. By providing seniors with the necessary information and resources, we can enable them to take better care of their health and well-being. Ultimately, this will lead to better health outcomes and greater independence for our seniors.
In conclusion, Mr Deputy Speaker, Sir, we need to transform the way we deliver care for our aged population. We need integration not fragmentation. But what does a truly integrated system look like?
For me, it is a system where there will be a seamless integration of care services organised around the senior, with a 360 view of his physical, mental and emotional health.
How can we achieve this? This will require drawing up care in a seamless manner across settings between acute and long-term care, between acute and primary care and between primary and care in the community.
It would mean adopting a multidisciplinary and person-centric approach. It entails doctors working closely with other health and social care professionals such as Allied Health Officers, social workers and even community befrienders to identify the common care needs for seniors and to offer integrated interventions. Health and social care must transcend boundaries to help seniors to age well in the community. It will also mean that information should flow seamlessly between hospitals to care professionals in the community to better manage seniors health and social conditions.
The eventual end state would be one patient, one health record or wellness record, one IT system and hopefully all these overseen by one Ministry of Ageing, to deliver coordinated holistic and integrated care to transform Singapore into the best place to live in. I support the Motion.
Mr Deputy Speaker : Order. I propose to take a break now. I suspend the Sitting and will take the Chair at 3.40 pm.
Sitting accordingly suspended
at 3.22 pm until 3.40 pm.
Sitting resumed at 3.40 pm.
[Deputy Speaker (Mr Christopher de Souza) in the Chair]
Supporting Healthcare
[(proc text) Debate resumed. (proc text)]
Mr Deputy Speaker : Senior Parliamentary Secretary Eric Chua.
3.40 pm
The Senior Parliamentary Secretary to the Minister for Culture, Community and Youth and Minister for Social and Family Development (Mr Eric Chua) : Sir, I agree with hon Members that supporting healthcare beyond the COVID-19 pandemic takes a collective effort by Singapore society.
Sir, in preparing for this speech, I asked ChatGPT what it thought of the Singapore healthcare system. Minister Ong Ye Kung and the MOH team would be glad to note that ChatGPT’s reply to me was, and I quote, “The Singapore healthcare system is often cited as one of the best healthcare systems in the world, known for its efficiency, high quality care and low healthcare costs.”
That said, one cannot assume that this somewhat glowing review will remain status quo. Singapore is one of the fastest-ageing societies globally. We know the numbers very well: one in four Singaporeans a senior by 2030, and every other Singaporean a senior by 2050.
If we are to reap the full harvest of meaningful and productive longevity, we must strive to close the glaring decade-long gap between health-span and lifespan. This is important, and I thought I ought to repeat this. If we want Singaporeans to not just live longer, but to live longer and better, we have a good 10-year health- and lifespan gap to close. And in the longer run, we must capitalise on the upsides of ageing.
In 2017, Sport Singapore (SportSG) launched the Active Health national initiative to inspire Singaporeans to take ownership of their own health and well-being, and to foster greater community spirit through shared experiences. We wanted to nudge a mindset shift from one which is “deficit-focused”, that is, “I seek treatment only when I’m unwell”, to an “aspiration-focused” model of active, healthy living. In the latter model, everyone is empowered to live better, and to delay, or prevent the onset of chronic diseases.
Over the past decade, SportSG has been vigorously implementing the Vision 2030 recommendations. As such, national regular sports participation has risen by some 20%, from 54% in 2015 to 74% in 2022, last year. In an Active Health survey conducted in 2022, about 96% of the respondents gave a score of eight out of 10 when asked about the importance of health and wellness. Yet, only 60% said they are confident of improving and/or maintaining their own health and wellness. Many are unaware of their own health status and how they can easily take a small step towards an active, healthier lifestyle.
I agree with Members that support is needed from all sectors of Singapore society to ensure that everyone can realise their health and wellness aspirations.
One such concerted effort is the Queenstown Health District pilot. Spearheaded by HDB, National University of Singapore (NUS) and the National University Health System (NUHS), the Health District seeks to increase healthy longevity and intergenerational bonding through the provision of health and wellness programmes for people of all ages.
In Queenstown, facilitated by the Lion Befrienders, seniors participate in strength and balancing programmes, such as dance fitness, modified sports and virtual square-stepping exercise. Seniors also take part in intergenerational sporting Friday activities, such as football, active-farming and dance fitness, designed for participants of all ages.
Students take part in an Active Health Classroom Champions programme that adopts a holistic approach to their health and promotes the participation of sport and physical activity beyond curriculum hours. Under SportSG’s school sports partnership scheme, schools in Queenstown have introduced more multi-sport programmes to promote general health and well-being and social cohesion amongst students.
Families take part in workshops and programmes, such as Active Health Discovery Walk in the Park, which emphasises, for instance, the importance of resistance exercises in increasing muscle mass as they go for their regular walks.
There are also programmes catered for the vulnerable and persons with disabilities. For instance, the SportCares FUN Starters multi-sport and Saturday Night Lights football programmes provide children and youth living in rental housing and other vulnerable communities, the opportunity to play and develop a lifelong habit in sports, improve fundamental movement skills and physical fitness as well as to instil a sense of belonging with the community.
Besides programming, SportSG collaborates with HDB to enhance infrastructure within the Queenstown Health District to enable residents to keep fit and to stay active. For example, an "Active Health Fitness Trail" with behavioural nudges designed by SportSG to develop strength, flexibility and balance as well as appropriate fitness equipment will be installed as part of the Neighbourhood Renewal Programme (NRP) to enhance the fitness and exercise spaces around the Mei Ling precinct in Queenstown.
Beyond the Health District, we have today set up some eight Active Health Labs island wide, at our ActiveSG sport centres and Active Health partner premises. Our objective is to enable people to understand their body composition, fitness and health status, and to learn tips from qualified Active Health Coaches on how to sustain an active and healthy lifestyle.
Residents come to our ActiveSG centres not just to do their workouts, but also to connect and to network. Based on the 2022 National Sports Participation Survey, when participating with others, 95% of respondents indicated that their well-being has improved through sport and physical activity; and 94% of respondents indicated participation in physical activity has improved their quality of life.
Just last weekend, I joined hundreds of Queenstown residents as we bade a temporary farewell to our beloved Queenstown Sport Centre. The facility has served our residents very well for more than five decades, and has played host to decentralised National Day Parades, that was in the seventies, and was home to the Tanjong Pagar United Football Club and our National Water Polo team in the earlier days. Indeed, sport and our sporting facilities also plays a critical role in place-making and the formation of a common identity.
I would, therefore, like to call upon everyone to head down to our ActiveSG sport centres located island-wide, try out the various programs and activities, and to visit our Active Health Labs to kickstart your health and wellness journey today.
Beyond physical activity, SportSG will continue to work with MOH and HPB to engage general practitioners (GPs) to refer clients to suitable community-based activities that can help them improve or maintain their health, as well as understand their fitness and health status. To do this well, we need to work as a team.
Individual citizens can take the initiative to make a trip to the Active Health Labs, learn more about their own health and wellness, and consider working relevant fitness and dietary advice into their everyday lives. Family members, too, can play a part by gently nudging loved ones to take the first step to taking charge of their own health and fitness by making the trip to the Active Health Labs.
Healthcare providers, on the other hand, can refer their clients to the Active Health Labs, to learn how to exercise safely with guidance from accredited training coaches. On the Government's end, SportSG will work with HPB and PA to ensure a steady pipeline of programmes, sport interest groups and social activities that healthcare providers can connect their clients to. Sir, in Mandarin, please.
( In Mandarin ) : [ Please refer to Vernacular Speech .] Singapore is one of the fastest ageing countries in the world. Of course, we hope that Singaporeans can live long, but at the same time, we also hope that they can live healthily and meaningfully in their golden years.
SportSG launched the Active Health initiative in 2017 to inspire Singaporeans to take ownership of their own health, and to foster greater community spirit. In order to achieve this, all stakeholders in our society will have to play a role. The Queenstown Healthcare District pilot is a good example.
In addition, we have set up eight Active Health Labs island-wide, at our ActiveSG sport centres and Active Health partner premises. Our aim is to enable people to understand their own body composition and health status, and to learn from qualified Active Health Coaches on how to sustain a healthy lifestyle.
I would like to call on everyone to head down to our ActiveSG sports centres located island-wide, try out the various programs and activities that we have organised for you, and visit our Active Health Labs to kickstart your health and wellness journey!
( In English ): Sir, it is heartening to note that many recognise the importance of health and wellness. Through Active Health, we hope to enable happier and healthier residents where they can live longer and flourish in "pro-social" spaces – where the young and old care for and nudge one another towards active living and healthy, purposeful longevity. Sir, I support the Motion.
Mr Deputy Speaker : Assoc Prof Jamus Lim. You have a request?
Assoc Prof Jamus Jerome Lim (Sengkang) : Yes, Mr Deputy Speaker, I wish to participate in this debate.
Mr Deputy Speaker : Before you do, I just like to point out that it is a last-minute request and to allow for better scheduling of Parliament Sittings, I would encourage all Members to continue to give us advance notice if they intend to participate in Parliamentary debates. This helps with the timetabling and the scheduling. I seek Members' cooperation in this regard. I now call on you to give your speech, you may deliver it.
3.52 pm
Assoc Prof Jamus Jerome Lim : Thank you, Mr Deputy Speaker, for the opportunity to participate in this debate. I will speak about the steps we can take as a nation towards moving to a better balance in our expenditure on healthcare resources. I will share some details on why I think we can increase the carrying capacity of our healthcare system, perhaps, to some detriment in efficiency and some marginal pressure in costs that will pay off, I believe, in terms of greater long-term resilience.
As others in this House have shared, and is well understood by this Government, our impending public expenditures on medical care would be substantially greater than what we have currently allocated for spending today. This is due predominantly to societal ageing and greater healthcare needs associated with the more elderly population. But my point is more fundamental. It is that, even at present, our healthcare system falls somewhat short of what we might reasonably expect for an economy at our stage of development.
To be clear, I am not suggesting that our current system is fundamentally flawed, nor am I saying that it should be completely overhauled. Indeed, I believe that we can justifiably be proud of the quality of care delivered by our existing system, which blends public as well as private components, and has proven to be remarkably cost-efficient in doing so, as Senior Parliamentary Secretary Eric Chua has just shared with this House.
While I certainly prefer the balance to be tilted more toward a larger public share – a matter on which I had spoken about before, in the context of the debate on the amendments to the Healthcare Services Act in March this year – that is not the focus of my concerns today.
Rather, I wish to highlight what I believe is one glaring shortcoming that was raised by the COVID-19 episode: because we run our systems so lean, it has become fragile in the face of large, unanticipated, albeit, fully predictable shocks, such as the pandemic.
Here, a little philosophical discussion may, perhaps, be in order. The bread and butter function of economists is to maximise a given objective, subject to constraints. This, generally, means that we are constantly looking for optimal solutions and we are very happy when we find such solutions. My wife often makes fun of me, about how I gain enormous satisfaction by planning my visit to the grocery store along with all my other errands – pumping gas, drawing cash, "dabao" dinner – so that I can make one smooth, continuous trip. In this regard, economists are easily satisfied creatures.
But there is another, equally tenable, worldview and that is one often held by engineers. Engineers do not look to wholly strip systems of inefficiencies. They recognise that redundancies are important, because while under normal conditions, such under-utilised elements may seem wasteful, they are mission-critical and can prevent the entire failure of the system during times of undue stress. Accordingly, they build bridges that can bear far more weight than one might expect with normal traffic – and then add a little more. They design planes that can run with one engine, even when the other stops. They design power plants that can possess multiple fail-safes, so that they can keep the whole thing running while a compromised part is being repaired.
Sir, the number of i ntensive care units (ICU) beds in Singapore, per 100,000 of our population, currently stands at 5.7. The average of the Organisation for Economic Co-operation and Development (OECD), an association of industrialised nations, is closer to a dozen, twice our number. Of the four economies that have a lower coverage than we do, only one, Japan, has a significantly larger elderly share in its population.
More generally, our hospital bed count is also low. We maintain a little more than two beds per 1,000 of our population, a fraction of that of other East Asian economies, like Japan and South Korea which have around a dozen; China, which has around five; and other advanced economies like Denmark, the Netherlands, Israel and the United States, where the ratio is closer to three.
To be clear, this low bed count is not prima facie evidence that there is a problem with the present system. We need to look at the occupancy of said beds, and one could even make the argument that efficient recovery means that we are able to sustain a lower carrying capacity.
In a response to a Parliamentary Question filed last year by my hon friend Mr Leon Perera, Senior Minister of State Janil Puthucheary shared that the target bed occupancy rate over the next five years was around 80%, which he added was generally recommended by academic communities as well as healthcare authorities. And in a statement to this House the year prior, he also explained that we have been able to ramp up ICU beds very quickly, as we did during the pandemic.
But in that statement, he also acknowledged the need to ramp up ICU bed capacity, although he qualified this by pointing out that this process was non-trivial, being limited, principally, by the need to increase the medical personnel required to staff such beds.
Moreover, recent data on bed occupancy rates at our major hospitals reveal that this 80% appears to be systematically breached, and over the past month, the rate has routinely exceeded even 90% in Tan Tock Seng, Ng Teng Fong and Khoo Teck Puat hospitals. And that is under non-pandemic conditions.
Taken together, these suggest that the Government is both aware that running our medical infrastructure too lean can come back to bite us during periods of stress, and that we have yet to fully address this problem even though we are back in normal times.
MOH has shared that it plans to roll out a new health campus in Woodlands, as well as another in Bedok, but the remaining projects are all expansions of current facilities. Will the Minister be willing to share if these will be sufficient to cater, to not just anticipated increases in demand due to an aging population, but also relieve some of the existing capacity constraints faced? Or will they be mainly focused on matching resources with new incoming demand, leaving current capacity largely unaltered?
This brings us to what appears to be the key constraint: medical manpower.
At present, we also have a comparatively low coverage of doctors and nurses. As of 2021, Singapore has 2.7 physicians per 1,000 people, around two-thirds the OECD average of 3.8.
Unsurprisingly, this has led to burn-out, stress and high turnover among our medical professionals, which others in this House have articulated. The solution appears straightforward and is uncontentious: we need to increase our supply of medical personnel. The Government has stressed the same, that ramping up medically-trained staff is a priority. The question then, is how.
There is a global nurse shortage which the World Health Organization (WHO) estimates may be close to six million and the International Council of Nurses – to be fair, an interested party – places this at a higher number of around 13 million.
Given this context, increasing supply calls for us to attract as well as retain global talent in the short term while looking for ways to expand domestically trained workers in the longer term.
The practical manifestation of our limited beds and doctors is that wait times for admission to a ward has remained elevated at many facilities. This has been most chronic at Khoo Teck Puat Hospital, although we have seen spikes at Ng Teng Fong General Hospital as well as Sengkang General Hospital, which is located in the constituency that I represent. On certain days, this could lead to waits even exceeding 24 hours.
The question we should ask ourselves is this: are we willing to accept the status quo where our patients may occasionally need to wait for more than a day to be admitted to a hospital? Perhaps, we think that this is a reasonable trade-off to keep overall medical costs down or we may use this fact as symptomatic of a need to increase the carrying capacity of the present system.
In my earlier speech, I offered some medium-term suggestions for how we could relieve some of the existing pressure on our system. We could consider increasing the number of recognised universities for basic medical degrees, up from the present 100. For experienced doctors who have a long track record of working in other jurisdictions, we can simplify the application and accreditation process, perhaps, with designated processes based at MOH that would seek out such doctors and encourage them to apply.
As we compete for global nursing talent with other advanced economies, many of whom are facing their own nursing shortages, it also makes sense to train more of our homegrown workforce to take this on. We could offer more generous terms for trainees. We could fully waive course fees, for instance, which, to be fair, is already relatively modest, on the condition that these trainees also work as nurses in Singapore for a certain duration after graduation.
This could also apply to those who would consider a mid-career switch. We can ensure that SkillsFuture funds not only fully cover conversion courses but also perhaps provide more credit for prior training. For example, early childhood educators and teachers surely would satisfy general courses in communications, critical thinking, data analysis and behavioural science, all of which are part of the nursing curriculum today.
Easing the supply pressure will require that we go beyond policies on the quantity dimension. We could also work on price. At the simplest, this means that salaries in the field should rise. One existing limitation to more sustained increases in wages is that costs are already high. This, in turn, seems to be led by commercial rental rates for private hospitals, which can spill over into public pricing. The high rent is a function of – well, you guessed it – elevated land pricing.
But it is not simply about higher wages – if these are simultaneously accompanied by longer hours. If anything, it would be better to increase the total number of doctors and nurses while keeping hours sane. The total wage bill will remain the same but the quality of care is likely to improve.
We could also increase the number of tiers within nursing – the number is as many as five or six in other countries – from our present three of enrolled, registered and advanced practice nurses. This offers additional upward mobility pathways, making the profession more attractive for those contemplating entry.
Sir, as I explained at the outset, our healthcare system capacity does not appear to be fundamentally flawed but it is facing increasing pressure. It is wise to adjust and adapt to impending needs at a time of relative calm rather than feel the need to "kelam-kabut" to make up for these during a future pandemic scenario.
Mr Deputy Speaker : Minister of State Gan Siow Huang.
4.04 pm
The Minister of State for Education (Ms Gan Siow Huang) : Mr Deputy Speaker, health is wealth. Our own health account is like a bank account. The more we put in it, the more we can get out of it. Investing in your health now will pay dividends for the rest of your life.
Most of us would agree that our children need to start healthy living habits from young and consistently practise healthy living in order to have the best chance of staying healthy and living life to the fullest.
I thank Dr Tan Yia Swam for highlighting the importance of health education. MOE takes a holistic approach towards promoting the overall well-being and health of our students from the time they start going to school. Throughout their educational journey, students acquire knowledge, skills and attitudes to cultivate an active and healthy lifestyle and maintain it beyond their schooling years.
At the preschool stage, MOE's Nurturing Early Learners (NEL) Framework emphasises holistic development by encouraging healthy habits and a positive attitude towards participating in physical activities.
In schools, students learn about good health practices, such as regular exercise, sufficient sleep and healthy eating. During Physical Education (PE) lessons, they learn to play a variety of sports and games that equip them to participate in physical activities well into adulthood. Our polytechnics have various health and wellness modules for our students while ITE has weekly PE curriculum.
MOE schools and our Institutes of Higher Learning (IHLs) also provide opportunities for students to be physically active outside formal curriculum hours. Students can take part in Co-Curricular Activities (CCAs) and join interest groups or sports clubs. They can make use of sports facilities and equipment in schools and on campus to remain physically active.
HPB works with schools and IHLs that wish to adopt programmes, such as the Active Youth Programme, to increase physical activity participation through regular contemporary workout sessions.
Nutrition is another critical aspect of physical health. All schools and IHLs actively promote healthy eating. In Food and Consumer Education lessons, lower secondary school students learn to plan and prepare healthier meals to suit their diets. In collaboration with HPB, all schools have implemented the Healthy Meals in Schools Programme, where school canteens provide healthier food and drink options.
Similarly, polytechnics and ITE participate in HPB's Healthier Dining Programme, which encourages food operators to offer healthier choices. The autonomous universities (AUs) also support healthy eating on campus by working with F&B vendors to provide healthier meals to the students.
Next, on mental health. Dr Wan Rizal spoke about the importance of mental health literacy for our students. I agree. Our schools and IHLs equip students with knowledge and skills to strengthen their mental well-being, build resilience and thrive amidst challenges. For example, students learn about common mental health issues and the importance of help-seeking within the Character and Citizenship Education (CCE) curriculum. As the digital world has an impact on mental health, our students are taught ways to manage their social media use and develop healthy online peer support culture.
Mr Deputy Speaker, the health and well-being of our children require a whole-of-society effort. Families and the wider community play an important role in providing an enabling environment to support the adoption of healthy habits. At home, parents can help to reinforce and role model healthy habits. MOE shares practical and actionable tips with parents on building a positive family environment to develop strong physical, social, mental and emotional well-being for their children. These tips are shared with parents via MOE platforms, such as the Parent Kit, MOE Parenting IG and Parents Gateway.
We have heard of positive stories from parents who play an active role to build a healthy lifestyle together with their children and, in doing so, have strengthened parent-child relationship. One father shared with us how he had started a routine to exercise with his child regularly, who had taught him the various types of sports and games that he learnt from PE lessons in school. With parents reinforcing and role modelling what their children are learning in school, I am confident that more children will develop healthy habits for life.
We are heartened to see stakeholders, such as the Parent Support Groups (PSGs), COMPASS which stands for COMmunity and PArents in Support of Schools council, HPB and various social service agencies working in partnership to support parents on ways to strengthen children's health and well-being.
We thank parents and our community partners for working with us to promote the well-being of our students. We look forward to continued and strengthened partnerships with more so that our children can build up their health accounts from young and live their lives to the fullest. Mr Deputy Speaker, I support the Motion.
Mr Deputy Speaker : Senior Minister of State Janil Puthucheary.
4.11 pm
The Senior Minister of State for Health (Dr Janil Puthucheary) : Mr Deputy Speaker, Sir, I rise in the support of the Motion standing in the name of Dr Tan Yia Swam, Dr Shahira Abdullah and Mr Abdul Samad.
Sir, all of us play a key role in ensuring the good health and well-being of the population. As individuals, we need to take active steps to live healthier lives and minimise the risk of falling ill even as the Government builds a supportive environment to help us do this. I will speak about mental health, oral health and the healthcare IT infrastructure and digital tools to support individuals on healthy living.
Sir, good mental health is essential. It lies along a spectrum and is multifaceted. Mental health issues can arise from a range of factors, including physical health and social determinants. Addressing these issues will require a collaborative and integrated approach that involves multiple stakeholders from the health, social, education, workplace and community sectors.
This is already happening. For example, under the Community Mental Health Masterplan, MOH, the Agency for Integrated Care and social service agencies have worked together to establish community mental health teams across Singapore. These teams provide mental health education to residents and bring care, such as mental health screening, assessment and therapy, closer to home, where there is less stigma and individuals feel safe to seek help.
Prof Koh Lian Pin spoke about mental health in academic settings. HPB has worked with Institutes of Higher Learning (IHLs) to establish peer support structures. Training is provided in empathetic listening and basic mental health first aid skills to support one's peers who show signs of emotional distress. In addition, those who wish to learn about mental health and self-care tips can access MindSG, a portal for mental health and well-being resources that are curated by mental health experts.
It is important to address mental health issues that affect us at the workplace, whether that workplace is an academic setting or otherwise. The Tripartite Advisory on Mental Well-being at Workplaces was jointly launched in 2020 by MOM, the National Trades Union Congress (NTUC) and the Singapore National Employers Federation (SNEF) to support employees' mental well-being and provide resources for employers, employees and self-employed persons.
Dr Tan Yia Swam shared her experience as a junior doctor where there were occasions when she worked for more than 24 hours a day when she was on call.
The Ministry is reviewing the total working hours of junior doctors, including hours worked while on call. The public healthcare clusters have been piloting shorter call hours for junior doctors in selected departments as well as using electronic logging and surveys to monitor junior doctors' working hours.
This is a complex subject which requires a fundamental relook at manpower deployment and the sharing of responsibilities between senior and junior doctors. This will take some time to study and work out and we are engaged on this matter.
Dr Tan Yia Swam and Prof Koh Lian Pin shared about the importance of mental health education and de-stigmatisation. HPB launched the "It's OKAY to Reach Out" campaign in October 2021 to normalise the topic of mental health by building awareness and encouraging conversations. The campaign in 2022 was focused on youths to help them overcome their hesitation to seek support and address their concerns about seeking help. Activities such as teacher-guided class discussions were brought to mainstream schools and Institutes of Higher Learning (IHLs). Outreach efforts to promote mental health awareness and literacy among Singaporeans have continued through online efforts and in-person programmes.
In addition to all this, the National Council of Social Services (NCSS)' Beyond the Label (BTL) movement which was launched in 2018 by NCSS, continues. In the next phase, BTL 2.0 moves to inspire action. NCSS has brought together 26 partners across the people, public and private sectors to promote and enable help-seeking and help-giving behaviours in schools, workplaces and the community.
Sir, the Interagency Taskforce on Mental Health and Well-being was established in July 2021 to oversee and coordinate mental health efforts across different sectors, focusing on cross-cutting issues that require interagency collaboration.
At the task force, we have identified 12 preliminary recommendations and sought the public's views in a consultation process last year. There were over 950 responses, with feedback from groups such as youths, parents, persons with mental health conditions, service providers, employers and community agencies.
The respondents were supportive of all the recommendations and the task force will be releasing a short report of the consultation's findings soon, even as we commence with the implementation plans for these recommendations.
One of the recommendations is to implement a tiered care model for mental healthcare delivery. This is a framework that matches the level of care to the degree of mental health need, allowing for a more effective allocation of mental health services based on the severity and complexity of an individual's needs.
As part of the public consultation, we received very useful feedback on the implementation. One example would be, for the tiered model to work well, service providers need to be sufficiently competent to fulfil their roles and responsibilities.
We completely agree, that for this tiered care model to be implemented effectively, an important aspect is to ensure adequate competencies and standards amongst all mental health practitioners. So, we have the National Mental Health Competency Training Framework Workgroup. The framework that they are developing will guide mental health practitioners on the knowledge, skills and competencies necessary to deliver quality and effective care. It will apply to all practitioners, from lay responders such as peer supporters, to mental health professionals, including nurses, social workers and counsellors, amongst others. I thank Dr Wan Rizal for highlighting the importance of this.
In addition, there is already a system in place to safeguard professional practice today. Mental health professionals are regulated through professional boards and councils and set practice standards through professional associations.
For example, psychiatrists, nurses and occupational therapists are regulated by the Singapore Medical Council, the Singapore Nursing Board and the Allied Health Professions Council, respectively. Professional associations such as a Singapore Association for Counselling and the Singapore Psychological Society provide guidance on the professional and ethical conduct for counsellors and psychologists respectively.
There is also the need to help individuals with mental health needs access the appropriate services in a timely manner. One recommendation from the task force is to designate a few first-stop touch points to provide individuals with easy access to mental health support and advice.
Some respondents from the consultation felt that there was value in having more than one way to deliver a service to take into account user preference. We are developing a number of service modalities such as hotlines, text messaging, in-person services and digital resources to ensure that there are sufficient and different ways for people to access these first-stop touch points for mental health.
Sir, if I now may shift to oral health care for older adults, persons with special needs and migrant workers in Singapore in response to Dr Shahira Abdullah.
The Government has introduced initiatives to ensure the access to affordable and quality health care for Singaporeans such as through the Community Health Assist Scheme (CHAS). Most oral health needs of these population groups can be met by general dentists at the polyclinics, CHAS clinics and private dental clinics. Individuals with complex needs and those with medical conditions or multiple morbidities that require a higher level of care are cared for and can be cared for by specialists at our National Specialty Dental Centres and the hospital dental clinics.
To facilitate access, MOH has worked with MSF to list the details of dentists and private dental clinics providing special care dentistry services so as to raise the awareness regarding the availability of services for persons with disabilities.
Additionally public-private partnerships in addition to the existing ones like Enabling Village, Agape Village, HealthServe and Saint Andrews Mission Hospital will be further explored to better serve the primary medical and dental care needs of underserved communities including migrant workers.
For our migrant workers, the Ministry of Manpower (MOM) will also continue to explore working with key partners such as NGOs to facilitate accessible dental care for migrant workers and provide oral health education through Project MOCCA, the Management of Oral and Chronic Conditions and Ailments. Project MOCCA was launched by MOM last year and is a preventive health framework to enhance the care of oral and chronic diseases among workers. And in this, MOM works closely with partners such as MigrantWell Singapore.
We recognise the efforts of independent volunteer initiatives that provide dental services within the community, intermediate and long-term care settings and in special needs organisations. To improve the coordination of these services, we will be encouraging larger volunteer associations to help provide a platform for communication, for sharing of resources and for coordination.
As the practice of dentistry constantly evolves with changes in population demographics, advances in technology and shifts in care approaches, the local dental landscape will shift accordingly.
To better support dental professionals and other healthcare and non-healthcare professionals providing care for older adults and persons with special needs, we will look into the development of clinical practice guidelines and appropriate care guides to help establish standards of care and promote better health outcomes. Additionally, we will continue to review our subsidy framework and award scholarships for residency training programmes in the various disciplines of dentistry so as to ensure our dental workforce can continue to meet the oral health needs across all ages and care settings.
Sir, I would next like to highlight the importance of having a well-integrated and reliable IT system to connect the healthcare providers, community partners and our residents. Members of the House have raised this in past Parliamentary sessions such as the White Paper for Healthier SG and also at the Committee of Supply 2023 debate. I thank both Dr Tan Yia Swam and Mr Yip Hon Weng for emphasising its importance.
One key system will be the National Electronic Health Record System (NEHR), which is a common platform that captures selected patient health information from various healthcare providers and allows providers to view these health records for patient care. Mr Gerald Giam asked about the implementation of security enhancements for NEHR. The NEHR has been subjected to cybersecurity reviews, infrastructure vulnerability scans and application penetration tests. MOH and Integrated Health Information Systems (IHiS) have reviewed the findings and most of the key enhancements to NEHR have been completed, with one further to be completed tentatively by 2025.
On the matter of IT support for GP clinics, that Mr Gerald Giam also raised. We do want GPs to use a Clinic Management System (CMS) that supports their daily operations well and connects to key IT systems, to save them time on administration. We have been working closely with the CMS vendors to improve their products and strengthen their backend services to support the GP clinics.
We are bringing onboard more healthcare providers to contribute to the NEHR, by extending the Early Contribution Incentive scheme to GPs, private hospitals, radiological laboratories and clinical laboratories to support them in data contribution. With the Health Information Bill (HIB), it will become mandatory for them to contribute patients' data to NEHR.
We have been extensively consulting stakeholders such as our licensees and healthcare professionals, on issues surrounding data privacy and sharing, related to the HIB. We had intended to table the HIB to Parliament sometime this year. But this is quite a very significant Bill and we felt more time is needed to engage our stakeholders and members of the public. We thus expect to introduce the Bill in this House, in the first half of 2024. I would also like to thank Mr Yip Hon Weng for raising the need to enable data sharing between the health and social sectors, this is indeed one of our aims under the HIB to support more integrated care and reduce administrative work, while ensuring data security.
Ms Ng Ling Ling and Mr Yip Hon Weng also raised the need to empower Singaporeans with more knowledge and support to manage their health better. We will do this through tools such as the HealthHub and Healthy 365 applications. For example, residents and their authorised caregivers can view health information from the NEHR, such as discharge summaries, selected blood test and radiology results, via HealthHub. We will explore how we can reflect more results in these platforms. Residents and their authorised caregivers can also use HealthHub to book and manage their medical appointments across all public healthcare institutions, as well as to enrol in Healthier SG and view their Health Plan.
Residents can use Healthy 365 to see and sign up for nearby healthy lifestyle programmes, track their physical activity and collect health points from clocking steps and making healthier food choices. We will continue to enhance such digital tools to help residents sustain good health and well-being.
Sir, in summary, with increased accessibility to trusted platforms for appropriate health information and interventions, and support from healthcare providers and community partners, we hope individuals can make informed choices to enable better mental health, better oral health and better health for themselves and their loved ones. Mr Deputy Speaker, Sir, I support the Motion.
Mr Deputy Speaker : Minister Ong Ye Kung.
4.26 pm
The Minister for Health (Mr Ong Ye Kung) : Mr Deputy Speaker, I rise in support of the Motion. I want to thank Dr Tan Yia Swam, Dr Shahira and Mr Abdul Samad for tabling this Motion, and pointing out passionately that health is everyone's concern, and it is only with everyone’s action that we can improve the health of individuals and our nation.
I would also like to thank all the Members of Parliament and representatives of Ministries who have, through your speeches, supported the various health-related policies and also given suggestions for improvements. This includes Healthier SG, our preventive care strategy; championing the well-being of our healthcare workers; developing more centralised IT systems; group buying of drugs with private doctors; ensuring that healthcare remains affordable for everyone and so on.
Members have also raised a range of challenges and frustrations of the healthcare system. Indeed, healthcare is probably one of, if not the most, complex public service systems in our whole public service. It will be unrealistic of me if I were to say we have a solution to every problem that you have raised. Even if we have, theoretically, it is not practical to implement them all. We will need to work within the budget and time resources we have, our management bandwidth to plan and effect change, our people's appetite to accept changes. We have to improve step by step.
What we will do is to prioritise the areas that we can make the most meaningful changes, where there is bang for the buck and focus on them. This is what we are doing.
So, we are focusing on expanding our healthcare capacity, which includes manpower, rolling out Healthier SG, and building up an effective system for ageing in community. Together, they represent a major transformation of our healthcare system in the medium-term.
But before I talk about these priorities, let me first address three specific issues on healthcare that were raised by Members: manpower, financing and as Prof Jamus Lim just raised, healthcare capacity. It is last minute, but I will respond to you.
First, manpower. At the heart of any healthcare system are the workers. Several Members of Parliament such as Dr Tan Yia Swam, Ms Janet Ang, Dr Wan Rizal, Mr Gerald Giam, Mr Abdul Samad and Mr Raj Joshua Thomas have spoken about the issues confronting them.
We have to support healthcare workers as much as we can. The NTUC and Healthcare Services Employees' Union (HSEU) have been fervent supporters for the welfare of healthcare workers. Ms Thanaletchimi, President of HSEU, used to be a Nominated Member of Parliament in this House and spoken about it many times.
The partnership between the People's Action Party (PAP) Government and the Labour Movement is a strong institutionalised arrangement, and MOH looks forward to our continued partnership in advancing the welfare of our healthcare workers.
Part of this work, very importantly, is to regularly review remuneration of healthcare workers, to ensure that we recognise their contribution and to make sure that remuneration is competitive. Mr Leon Perera suggested some benchmarking. We will internally benchmark not just the pay but also taxes – because it varies across countries – and also the living conditions and rental. But I suggest we do this internally, because competition is now so tough, you do not want to benchmark and then show everybody. But we certainly want to benchmark and make sure we are competitive. Right now, in fact, rental becomes a problem for foreign nurses to come to Singapore and out of pocket expenses are high. These are some things we need to address to make sure we are competitive.
Of particular urgency now is to actively recruit both local and foreign healthcare workers to boost the workforce, given the rising attrition suffered in the last two years due to the COVID-19 pandemic.
For local healthcare workers, we are looking forward to the inflow of the latest batch of polytechnic graduates who, I think, just graduated and they will be joining the workforce and our hospitals soon.
Mr Abdul Samad had feedback about interns not getting paid for their internships. I would like to clarify this. All Institute of Technical Education (ITE) and polytechnic nursing students are given allowances for their internship attachments. However, for certain healthcare-related courses, such as Biomedical Science, allowances are an arrangement left between employers and the school to set, and practices can differ across health clusters. But given the Member's feedback, let us look into the specific instances where our public health institutions do not offer internship allowances.
As for foreign healthcare workers, it takes time to conduct selection and examinations overseas and for the shortlisted candidates to move here. They have so far been trickling into Singapore, but we hope in the second half of the year, more of them will start to come onboard.
And for those who have performed well and are committed to Singapore, we welcome them to apply for permanent residency (PR). A few Members of Parliament (MPs) have suggested granting PR status to their dependents as well. We thank the MPs for their suggestion. This is worth serious consideration.
For everyone in our healthcare workforce, we will need to ensure their well-being. I am glad many MPs spoke up against abuse and harassment of healthcare workers. This is one of the top issues in the minds of our healthcare workers.
I think, in general, I would say, to be fair, the regard and appreciation for healthcare workers has generally gone up amongst our society post COVID-19. And for the majority of the public, they are appreciative and respectful towards our healthcare workers.
Those who physically assault, threaten or hurl vulgar and condescending remarks against healthcare workers, I think is really a small minority. But because the acts are so egregious, it feels like a big thing. And it is a big thing. We cannot tolerate such behaviour. This is unfair to healthcare workers and unfair to the great majority of the public who respect our healthcare workers.
As Members know, MOH has recently announced a zero-tolerance policy against abuse and harassment of healthcare workers. And we intend to translate this to procedures and guidelines for all our healthcare institutions in the second half of this year. I will not elaborate what it entails as I have spoken about this before.
But since the announcement of the policy, I have noticed some reactions. First and the best is that most members of the public support the policy. Second, a few raised concerns that there were occasions where healthcare workers did not behave appropriately. We acknowledged that. There are always a minority of black sheep. But there are appropriate channels to report such matters and the hospital management will look into them seriously.
Some have said that one of the root causes of abuse is the heavy workload at the hospitals and long waiting times, and therefore, we should address that first. We are doing what we can to alleviate the situation at the hospitals post COVID-19. It will take time. But heavy workload cannot be an excuse for anyone to physically or verbally abuse our healthcare workers.
Mr Raj Thomas mentioned that another reason is expectations are high and when it is not met, people get upset. It is totally all right to have expectations and to demand good service. By all means, do that, but there is no need to abuse healthcare workers should service delivery fall short.
I should say that notwithstanding the heavy workload and the occasional abuse and harassment, most healthcare workers I have met – and I hope it is not just because I am Minister – remain positive, professional and passionate about their jobs.
Ms Koh Fang Qi, for example, was a senior staff nurse in Khoo Teck Puat Hospital since 2015. She has now become a Nurse Manager. Over the years, she dealt with many abusive patients and next-of-kin, but she continued to calmly handle each one with empathy and became an expert in this field.
Once, she witnessed a junior nurse being abused physically and verbally by the next-of-kin of a patient. So, she bravely stood up, managed the situation and escalated the incident to the authorities for follow-up and remained calm throughout the incident.
And despite all these challenges, you can tell she loves her job. She continues to treat patients and their loved ones with care and kindness. She constantly shares her knowledge and experience dealing with abuse cases with her colleagues.
The test of zero-tolerance policy is in the second half of this year when we have guidelines and supervisors to disengage abusive patients or most likely, their next-of-kin. I do expect some to write to the Ministry to complain to me why do our supervisors and nurses act this way. We will be very careful. We will make sure that we will effect the consequences only for the most genuine cases and care will always be prioritised. Should I get a complaint, I will back our ground supervisors; and healthcare workers. Should it comes to this Chamber, because I think some of the residents will complain to their MPs: "why MOH act like that, can they appeal against this, they disengaged with me and I was just demanding good service."
When the time comes and test comes, I hope to have the support of this House. We will be careful and we will do it judiciously if we ever have to disengage an abusive patient or next-of-kin, so, I seek the support of the whole House.
Let me move to healthcare financing. Mr Leong Mun Wai made a few points yesterday.
I am glad he agreed with our policy to use MediFund to support low-income families. The MediFund disbursed $164 million in FY2021, not $100 million as stated by Mr Leong yesterday. The Government further topped up MediFund by $1.5 billion in FY2023.
However, Mr Leong also delivered a political statement yesterday. He declared the Progress Singapore Party (PSP)'s position that Government ought to spend more in healthcare like other OECD countries.
Let me make a few points in response.
First, it is widely known that spending more on healthcare does not mean better health outcomes. Most health economists will know that. Since Mr Leong is benchmarking ourselves against OECD countries, let us just cite two examples, US and UK. They are spending about 17% and 10% of their GDPs on healthcare, compared to us, 4%. Yet, US and UK continue to face high incidence of chronic illnesses, high obesity rates and their expected lifespans are lower than Singapore.
I was inspired by Mr Eric Chua and also checked out ChatGPT: "what do you think of the US system, what do you think of the UK system". Actually, it is quite well-known. In the US, healthcare is very expensive, despite spending 17% of their GDP. In the UK, the National Health Service (NHS) is crushed down by the workload. The waiting times are far longer than in Singapore, despite spending 10% of their GDP on healthcare.
We have delivered good health outcomes given what we are spending.
The second point, for whatever we are spending, we are able to make healthcare affordable for middle to lower-income groups. Today, about seven in 10 of Singaporeans in subsidised wards do not have to pay any out-of-pocket expenses. Eight in 10 pay less than $100 cash out-of-pocket; nine in 10 pay less than $500 in cash out-of-pocket.
So, when Mr Leong asked the Government to spend more to lower out-of-pocket expenses further, he really meant to channel resources to unsubsidised patients, that is, those staying in A class wards or private hospitals. This is where the big bucks and the big expenditure are, and it will push our healthcare expenditure and spending to the levels of the OECD countries.
Third, while Mr Leong asked Government to spend on healthcare, he failed to mention that Government expenditure ultimately has to be raised from the people through taxes. Mr Leong had not made any mention of where PSP will get the funding from.
Fourth, the fact is that we are already spending more and more on healthcare. We do not need Mr Leong's urging. Healthcare spending is going up. In the decade after 2010, our nominal Government health expenditure tripled. In the following decade, that means up to 2030, it is expected to triple again. So, triple and triple – it means an increase by nine times over 20 years. This is driven by an ageing population, who is also getting sicker. MOH already has the second largest Ministry budget, after Ministry of Defence (MINDEF).
In the coming years, our challenge is not to spend more, but to ensure we do not go the way of many OCED countries, with the healthcare fiscal burden spiralling and escalating out of control.
Finally, it is therefore much better that we continue our sensible and practical approach: have different layers of safety nets – subsidies, MediShield Life, which I thank Prof Hoon Hian Teck for explaining why it is necessary, MediSave and MediFund. This is the S+3Ms approach, which has worked quite well.
We now combine this with a very important strategy in Healthier SG and our effort to enable ageing in communities, so that we can avoid sickness and reduce our disease burden even as our population ages.
Mr Leong also talked about the seemingly large balances in the Pioneer Generation (PG) and Merdeka Generation (MG) Funds, and concluded that more subsidies can therefore be given to PG and MG members.
His understanding is misplaced. Both Funds were sized based on the projected lifetime cost of the benefits, and accounting for inflation and interest accrued.
To illustrate, the oldest and youngest MG member is about 73 and 64 years old. PG members will be at least 10 years older, with the youngest at 74 years old now. They still have quite a bit of runway ahead of them and we do expect many of them to live until 90 or 100 years old. So, their lifetime benefits need to be funded from the MG and PG Funds. But the Government will continue to regularly review the adequacies of these two Funds.
Third issue is healthcare capacity that Assoc Prof Jamus Lim just raised. We agree that 80%, 85% occupancy rate is probably ideal. And you do not need an engineer to conclude that you must have redundancy in your system. It is not a new concept. It is something that I think we all agree to.
But why is there a crunch now? Of course, there will be crunch during COVID-19. It was an emergency, it was a crisis of a generation. I do not think any country or any system can plan for that kind of capacity to cater to a crisis. But post-crisis, we do have a crunch today.
I explained in this House before, I think it was during the White Paper debate on COVID-19, that the main reason for the crunch is that within a very short span of two years, you suddenly see average length of stay going up significantly. It used to be six days. Now, it is 7.1 days. [ Please refer to " Clarification by Minister for Health ", Official Report, 10 May 2023, Vol 95, Issue 104, Correction By Written Statement section. ]
This means your utilisation has suddenly gone up by 15%, over two years, post-COVID-19.
It is a post-COVID-19 phenomenon. I think in time, researchers and clinicians will study why. But there could be a few hypotheses. One is that there is some kind of immunity debt – more old folks are getting infected with viruses, bacteria post-COVID-19. And when they do, they fall quite sick and they actually stay in hospitals for quite long. And that pushes up average length of stay.
Another reason, which is a possible one, is that during COVID-19, too many of our seniors decided to hide at home, afraid to come out. There were no more community activities, which actually is so crucial to keep them healthy. So, with social isolation, their health deteriorated. And then, when they get infected, they stay in the hospital for very long.
The 15% increase in utilisation alone explains why we have a crunch now. And it is happening not just in Singapore. It is happening all over the world. Every country is facing a crunch in their beds. All of us agree we must have redundancy but all of us are facing a crunch, including and especially in OECD countries, despite their higher bed to population ratio.
So, what do we need to do? First, catch up on the capacity. Many of our projects have been delayed due to COVID-19. We have to catch up but some things cannot be rushed. We just have to implement them.
So, sometime this year, the Integrated Care Hub at Novena will open. It will add a couple hundred beds. The Woodlands Integrated Health Campus, by end of the year, may have one ward open; hopefully, next year more wards will open. And then we have the redevelopment of Alexandra Hospital and the eastern regional hospital Assoc Prof Jamus Lim talked about. We have the redevelopment of SGH campus that is ongoing. Although it is an existing campus, it is a significant redevelopment with many more beds added.
Two, is to build more Transitional Care Facilities (TCFs), which I have explained before. It is actually very useful. Today, in our hospitals, there is still quite a number of seniors who are staying there not because of medical reason, but because of social reasons. TCFs have rehabilitative care and good medical facilities, and we can allow those who are stable to move to TCFs, thus freeing up acute beds. So, we are building that up quite actively.
Third is recruitment, which I have explained before. I think although it is very competitive, Singapore continues to be an attractive location for foreign nurses to want to come to Singapore. The healthcare profession continues to be quite attractive to our locals as well. Today, one in 25 students will join nursing and I cannot hope for more. That is not bad at all considering the number of options they have. So, I think we are getting our fair share of local talent and we are competitive in hiring foreign nurses as well.
But of course, I hope the House, having raised all these issues, will support the necessary steps that we need to take in order to recruit local as well as foreign nurses.
Let me come back to the substance of the Motion, which is really why we are here – and it is an important Motion, urging a whole-of-Government approach to support healthcare, even after the COVID-19 crisis has passed.
Our Public Service has a long history of inter-agency collaboration. But COVID-19 was special. It was a period when we witnessed the tremendous potential of inter-agency cooperation, united in a common objective to overcome a national crisis.
If you look at our schools, they kept education going, shifted to home-based learning only for a couple of months. Our economic and social agencies worked together to support businesses and workers. Various agencies got together to set up quarantine facilities, testing and community care facilities. I cannot emphasise enough how much that meant to the hospital system, which would have, otherwise, borne the full brunt of the pandemic and we would have likely collapsed.
Recently, a well-known Chinese infectious disease expert, Dr Zhang Wen Hong, after he observed how life in China has gone back to normal during the May Day Golden Week, he wrote a blog post and he said, “It was as if nothing had happened, yet everything has happened”. In Chinese, 一切都没发生，一切都已发生.
It was a rather poignant expression of the post-crisis state of mind which may be relevant in Singapore and relevant to today’s debate. We do not want to hang on to and relive the crisis. We need to walk out of the shadows, put it behind us and look into the future. And yet so much has happened. The experience and lessons learnt will reshape the way we look at healthcare and the way we look at inter-agency collaboration. Those cannot be forgotten and go to waste.
So, I share Members’ hope that while the crisis may be over and peace time workload has resumed, it cannot be business as usual. We should usher in a new era of even tighter inter-agency collaboration. And this is especially relevant for healthcare for two reasons.
Number one, as I have explained, ageing is probably the biggest social transformation for Singapore in the next 10 years, as we become a “super-aged” society. This will have implications across multiple policy areas – in employment, in our competitiveness, retirement adequacy, urban planning, education and, of course, healthcare. It will draw Ministries together to work in concert.
Second, post COVID-19 crisis, we have decided that the conditions and timing are right for us to effect a major healthcare transformation, building upon all the work that was done in previous years. I have explained in this House why and what we are doing in this transformation. Essentially, the idea is that healthcare needs to go beyond treating sickness in hospitals and clinics, but creating health in homes and communities. In other words, health is not just relevant to patients who have fallen sick. Health is for all. And that is why we now regard the healthcare system as three inter-linked systems.
If I may briefly recapitulate. Ms Janet Ang has just explained this earlier. First, we have the acute care system, which is essential in ensuring that those who are sick get treatment. Second, the population health system, which we are building up through Healthier SG, and we are mobilising all our family doctors and GPs to focus on preventive care that is anchored in the community. The third system is the aged care system. The default for aged care cannot be nursing homes or seniors living alone with no social support.
In other countries, loneliness and social isolation of seniors have become an epidemic. We also see this happening in Singapore. I think it is one of the reasons why length of stay has gone up, especially after COVID-19.
If we can do this right, I think we can do what Mr Yip Hon Weng suggested – integrate care across medical and social realms.
And we need to urgently step up this whole-of-society efforts to enable our seniors to live their golden years in dignity, age actively in their community with their friends and family, involve them in activities including training programmes, like what Mr Mark Chay has suggested. And if they wish, leave well in a family environment surrounded by their loved ones. So, this aged care in community is the next major area of work in healthcare.
To make Health for All possible, we need the contribution of every stakeholder, public or private. When healthcare is mostly treating sickness, it falls under the domain of hospitals. But when healthcare is about creating health and caring for people in their homes and communities, it becomes everyone’s business. Hence, in order to realise Health for All, we also need All for Health. I think this is really the spirit behind the Motion put forward by the Members.
In particular, the following stakeholders can make significant contributions to health.
First, employers. I thank Dr Tan Yia Swam for speaking on this. Many of us spend a considerable amount of our adult lives at work and hence the workplace is highly influential in shaping our health habits. I value our existing partnerships with NTUC, SNEF and the Tripartite Oversight Committee on Workplace Safety and Health (TOC) who have been working with companies to promote good workplace health practices.
With Healthier SG, employers can work closely with your panel doctors to join Healthier SG and to continue providing regular and proper screenings for employees, provide healthier canteen food, physical activity programmes, mental well-being programmes and better work-life balance. We also urge employers to play their part in making sure those eligible are all part of Healthier SG. By promoting good health, employers will have more productive and happier employees, which is good for businesses.
Second are our community partners. Senior Parliamentary Secretary Eric Chua has shared about MCCY’s efforts to mobilise the community to foster social cohesion, promote health and develop a strong partnership with family doctors. Dr Tan Yia Swam also suggested the need to have activities that cater to different segments of population and their varied interests. Indeed, when we consulted the public during Healthier SG, we heard from many residents that peer and family influence is a key factor in motivating them to adopt healthy life habits, such as regular exercise and to eat healthily.
So, under Healthier SG, our healthcare clusters will work with community partners – HPB, PA, SportSG – to proliferate physical activities in the community and encourage strong participation by residents. We welcome other ground-up initiatives and activities that rally the community. If we take a walk in our public parks today, we can spot many of these activities. Many of them not organised by any agencies. Friends getting together to cycle, run, play football. Masters teaching their disciples qigong or tai-chi. All of them are now part of the healthcare system.
Third area, schools and education institutions. I thank Minister of State Gan Siow Huang for speaking about MOE’s efforts in building this health foundation for our young.
Indeed, good health starts from our values, habits and choices. Our schools help to build this foundation of health literacy. They introduce our young to sports, help them make friends and form social groups, teach them life skills and knowledge to be useful citizens, all of which are essential building blocks to good health. As mentioned by Minister of State Gan Siow Huang earlier, through the years, MOE has worked with MOH to thoughtfully infuse health education in its curriculum from early childhood to primary, secondary and tertiary education.
Research findings now show good health habits, such as proper diet and use of devices, inculcated from as young as three or four years old, have a profound impact on the cognitive development and well-being of the child later on in life. And it actually does affect their PSLE results, based on our research findings. [ Laughter .] Maybe that is the right button to push, I do not know.
So, MOH, MOE and MSF; we are studying the linkages between early education and health, and developing possible interventions.
Fourth, the media. Information and media literacy is our first line of defense against false and viral health myths. We will continue to work with the Ministry of Communications and Information (MCI) and other media agencies to do this, just as we did during COVID-19 to dispel falsehoods about vaccination.
Healthier SG gives us an opportunity to address the problem of health misinformation. How so? This is because we are advocating and trying to build stronger patient-doctor relationships. Because with a trusted relationship and the family doctor and his care team knowing the health condition and history of the patient, they become the patient’s trusted source of medical information and advice.
In this digital era of information overload, online falsehoods, myths and AI bots, perhaps what we need in healthcare is stronger human relationships, especially between doctors and patients. We can use technology to strengthen the relationship and improve the quality of care rather than replace the human relationship. That must ultimately be the mode of co-existence between humans and AI.
Finally, our infrastructure and transport planners. Over the years, MND and MOT colleagues have expanded green spaces, cycling paths and fitness corners islandwide to support active living. There are also plans to have more Silver Zones and Green Man+ at pedestrian crossings to allow our seniors to travel more safely and with confidence in their neighourhood.
These are many examples of how agencies are coming together to better support health and we are committed to continue to do so.
Mr Deputy Speaker, let me conclude.
I am mindful that our Nominated Members of Parliament are coming to the end of their term. This is perhaps your second last Sitting. I do not know for sure, but Leader told me, it might be your second last Sitting. I know some of you hope to have the assurance that even as you step down, the issues close to your heart continue to receive attention in this Chamber.
So, I feel honoured and privileged – although it got me a bit busy – that you have chosen to table a Motion on healthcare, just as you have actively been speaking up on healthcare issues during your term. In particular, Dr Tan Yia Swam, who was also the President of the Singapore Medical Association (SMA). She has been a strong advocate for various healthcare-related issues.
I attended an SMA dinner some time ago hosted by her. In her speech during that event – it is public, so I think I can say it – she said that she was an angry young doctor. And now, you are a less angry middle-aged doctor. But the difference is that you have learned how to channel your energy to a greater good and be a better advocate.
I say Dr Tan is doing a good job, both in SMA as well as in this House. But I do not think Dr Tan is angry. It is important that we are passionate in our cause and be active in our advocacy.
I greatly appreciate this Motion, highlighting the need for MOH to work with other agencies and for other agencies to support us. Today, we have MOE and MCCY's political officeholders (POHs) deliver their speeches. Actually, we could have gotten many more, but we did not want to prolong the debate for too long.
Ageing is going to be the big challenge that affects all of us – and MOH cannot be alone in this.
The passion and activism of our NMPs help uplift the standard of debate in this House and bode well for the democratic discourse for Singapore.
So, please rest assured that the issues close to your hearts will continue to be given due attention in this House, even as your term comes to an end. There will be a new batch of NMPs who are passionate about issues too, and take up the issues that you care about.
On healthcare, there will be MPs who are healthcare professionals, Government Parliamentary Committee (GPC) Members for Health, Labour MPs and NMPs, Members who feel strongly about healthcare who will carry the torch forward. Most importantly, the MOH political officeholders will continue to put forth our agenda and address the concerns of our stakeholders. We are not on different sides. We are all on the same side, trying to make the system better for Singaporeans.
For NMPs, after you have stepped down, I hope you will continue to advise and cheer us on, at the side. So, let us all continue to advocate for a better healthcare system for everyone. Health is for All and All is for health. [ Applause. ]
Mr Deputy Speaker : Dr Tan Yia Swam.
5.03 pm
Dr Tan Yia Swam (Nominated Member) : Thank you, Sir. First, I thank Minister Ong. Okay, maybe not so angry anymore, after all your kind words. If you are going to stay 10 years like Mr Gan, then I will continue to advise and help for 10 years.
Sir, I am very heartened by the strong support for the Motion.
First of all, I thank all my fellow NMPs in attendance who have each shared their insights into how healthcare can be supported in their various sectors. This is the kind of fresh ideas that we need to have a synergistic whole.
Next, I thank all Members for their various speeches covering a wide range of topics in relation to support for healthcare, namely: (a) recruit, reskill and retain healthcare workers; (b) fair pay, reasonable working hours; (c) financing and business needs; (d) better IT systems; (e) taking a firm stand against bullying and harassment; (f) emphasis on prevention and primary care; (g) legal protection and support; and (h) looking after vulnerable groups, in particular, children, the elderly, migrant workers and the differently-abled.
However, I must address some of the points that the Member Mr Leong brought up yesterday. I appreciate his points about reviewing MediSave but I urge him to have in-depth discussions with MOH to better understand the current funding and to help in future reviews if necessary.
MediSave and MediShield Life have been extensively and rigorously reviewed to ensure that the majority of Singaporeans and Permanent Residents can afford medical care when they opt for subsidised wards in restructured hospitals. If any of you know residents in financial distress, please direct them to an experienced medical social worker who will be able to further advise on additional available subsidies.
I also need to seek clarification from Mr Leong on his comment that, I quote, "drug prices should not be marked up unreasonably for non-subsidised patients to cross-subsidise subsidised patients."
Firstly, is there have evidence of this happening? Secondly, what is the definition of an "unreasonable" mark-up?
If I can use another food analogy other than chicken rice, a can of soda can be sixty cents at a budget grocery mart, $1.30 at a super mart, $1.60 at a coffee shop, $3 in a restaurant and $5 in a hotel. How much is a reasonable mark-up for medications?
Patients who are not subsidised will be patients who opt in for A or B1 class, or foreigners. I, as a doctor, would think that allowing market forces to determine costings are fair. Would Mr Leong also want taxpayers to pay for everyone?
I also thank the political office holders from different Ministries for your assurance and commitment to support healthcare.
I thank Senior Parliamentary Secretary Eric Chua in advocating for sports across different Government agencies and active community engagement. Parkour aunties like myself rejoice. No more Police chasing us off.
Minister of State Gan Siow Huang has also given an overview of how teaching on exercise and healthy eating is integrated at all levels of education.
I thank Senior Minister of State Janil Puthucheary and Minister Ong Ye Kung for their detailed and candid replies in recognising complex problems of manpower, IT and financing.
The professional bodies will continue to work closely with MOH in resolving issues within healthcare, especially those that pertain to training and working hours. Honestly, only clinicians truly understand the delicate balance needed. I am glad that we are all aligned in this – that healthcare has to be a whole-of-Government effort.
In my closing, I come full circle, back to "Why". Why do we stand up to advocate for a cause? To leave behind a better world than the one we were born in.
Recent news regarding the next round of NMP applications has again raised some criticism. I believe the NMP role has given an ordinary citizen like myself the chance to voice opinions at a national platform. Ordinary, because I am a struggling working mother in the sandwiched generation. Ordinary, because I also fear and worry about my children's future. What kind of Singapore will my children grow up in?
Fellow MPs will appreciate how hard it is to prepare for a speech. It is not just simply coming up to the microphone and saying some fancy words. There is background research, sticking to the timing before getting scolded by the Speaker or Deputy Speakers; and speaking the truth – in a palatable way and driving home a point.
I commented before – we are all talking a lot, but who is listening? Is the public listening?
The livestreaming only has 400 plus viewers, usually. A few people will deliberately make funny clips of our mistakes or slip-ups. And yes. Once I get over the embarrassment of my own, I have to say, it is actually very funny, so, thanks for making us laugh!
But the people I am really speaking to are fellow citizens who share my interest in the larger good of Singapore, the citizens listening in and considering policy.
Maybe some of you are civil servants. Singapore has 150,000 public officers who report to the Government, not to any one political party. I rephrase for emphasis. Civil servants are individuals who would have their own different political beliefs and alignments. They serve the people of Singapore.
Blindly supporting or opposing any political party or mocking NMPs for being mouthpieces or puppets or blaming the Government for everything – I ask you, is it logical? Does it serve anyone?
Before reacting and speaking, consider three points: one, is it true? Two, is it necessary? Three, is it kind? If the answer is no to any of the above, maybe it is better not to say.
I am sure that many of you have friends who are in healthcare. Do speak to them and understand the problems we face. Create your own small little informal think tanks and brainstorm on how to solve larger healthcare issues.
For all the people listening in, whether you are working in Ministries, whether you are an ordinary citizen like myself, I hope that you will also think of ways to ensure that healthcare gets the support it needs and prioritise your own healthcare needs.
We now live in a rapidly changing and volatile world. Look at how COVID-19 brought the world to a standstill for three lost years. Look at the Ukraine war, the US bank collapses. Overnight, the world changes. Nothing is new. History repeats itself – maybe in a much faster cycle than before.
The modern person has to be able to adapt to a world where answers may be less obvious, where there is no rulebook or 10-year-series to refer to. There may be no single right answer and choices will have trade-offs.
Should war ever come to Singapore, should there be an apocalypse, we will need warriors, we will need leaders. But I tell you, we will need people who know how to look after others, people who know how to stop bleeding, prevent infections, deliver babies, how to grow food, how to get clean water – any kind of knowledge to ensure that we survive.
But are we building up on useful knowledge or frittering our time away on social media in mindless entertainment?
I see patients and the medical treatment algorithms are actually quite simple. There is a breast lump. It needs to be checked. But frequently, emotional stress gets in the way. This manifests as hesitation, fear, worry and even anger at me – "Why is there a lump?"
I understand but it is not easy to process the onslaught of negative emotions. Healthcare workers, teachers, drivers – all frontline service workers, in fact – have received the brunt of a lot of negative outpouring of emotions.
This is our society now. A pressure cooker. People being unhappy in their daily lives without even realising it, feeling irritable, snappy, overly critical, worried about everything and feeling unable to cope.
I repeat a point from my previous speech. Recognise mental health issues in yourself or your loved ones. If you suffer from anxiety or anger management, do not take it out on your healthcare worker. Do not take it out on others. Get help from a mental health professional.
Even though I am a breast surgeon, I cannot just operate on the cancer. I have to consider the patient in her whole entirety. Her overall health – does she have other medical conditions that impact her surgery and recovery? Her preferred language – does she fully understand what I am saying? Is she making a true informed decision? How is her personality like? Her social network? Is she going to be well supported at home and at the workplace or will she forgo care because she perceives that others' needs come before her?
The surgery itself is simple in expert hands. It is helping the patient to overcome all these other emotional and mental barriers to seek health and to eventually be on the road to recovery – that is the challenge for which I call for a global change and a whole-of-Government support.
I thank everyone who has taken part in the debate and I emphasise. First, walk the ground, get real feedback and acknowledge problems in healthcare. Second, continue education at all levels of engagement. Third, cross-collaborate across Ministries, across industries, across the public-private divide.
Humans have short memories. Let us learn from the mistakes of the past so that we do not repeat it. People care only when things affect them. Help me and make everyone care.
Finally, breaking formal protocol, I want to thank Shahirah, Samad, Lian Pin, Mark, Janet, Joshua, Hian Teck and Hsing Yao. Thank you all for your friendship. It has been an eventful and fun NMP journey.
To all MPs from both sides of the House, I am glad for the chance to get to know you all as people and real humans, not just as public figures on your posters. This is my last speech in this Chamber. The next time we meet again, it may be when I complain to you at Meet-the-People sessions. [ Laughter. ]
I thank you all – both sides of the House – for your service to Singapore. If I may, I will pray for wisdom and kindness for you as you all continue to debate meaningfully on issues to guide Singapore safely through future challenges. [ Applause. ]
Mr Deputy Speaker : Mr Leong, I am about to put the question to the House. You have a clarification arising from a speech that has been given? Do you have a clarification for Dr Tan? Yes, you want to respond to her questions, right?
5.13 pm
Mr Leong Mun Wai (Non-Constituency Member) : Thank you, Deputy Speaker. I thank Dr Tan for asking the questions on drug subsidies.
According to my understanding and a lot of the feedback from residents, they pay different prices when they are in different classes. Of course, that is expected. Currently, different classes have different charges.
But from a certain angle, which I have mentioned in my speech, it is okay to charge the services, but why is there such a big difference in the drug prices being charged for different classes? So, this is what I have said. I do not know why Dr Tan raised it as an issue.
Maybe I can also clarify with Dr Tan whether she agrees with our proposal that the Government should actually start a central procurement process for all drugs in Singapore. I would like to ask for her opinion on this.
Mr Deputy Speaker : Dr Tan, do you wish to respond?
Dr Tan Yia Swam : Yes, I would like to respond because I am a doctor and I think I know a bit about healthcare.
I think firstly, regarding bills, to the hon Member, it would be useful to ask your affected residents to approach the hospital's business office that they were in to seek clarification on the bill breakdown. There are very clear explanations and breakdowns on the tiers of subsidies available and different drugs, whether it is branded or generic, have very, very clear costings.
So, I would like to know more details of the case rather than make a blanket statement that the costings are unfair.
In relation to the second question for the Government to procure all medicines, I understand that right now, there is a procurement for all medications for chronic conditions, for public medical institutions.
In the private sector, though, may I respectfully state that all doctors in the private sector have our own business models and different ways of generating income. So, not all doctors may want to be part of the Government effort. I thank the Member for his suggestion. We can take it back to the professional bodies and further get our members' feedback.
Mr Deputy Speaker : Minister Ong Ye Kung, you have a clarification?
Mr Ong Ye Kung : I just thought that it is not very fair that the NMP has to answer a policy question. So, it is better for MOH to say something.
Ours is a variegated healthcare system, unlike, say, NHS, where everything is nationalised, all drug prices are more or less the same, centrally procured.
We are deliberately catered to a variegated market. And for private sector doctors, as Dr Tan Yia Swam said, they do have different models. There are doctors that charge very low consultation fees, but instead, they earn some margins by selling their drugs. Others do the reverse.
So, when we put forward an idea – but, luckily, it is from the Member and not from me. If we put forward an idea to say, "Let us all sell at the same price", actually, doctors, their rice bowls gets affected and it can be quite a major issue for them.
So, I think there is some wisdom in what Dr Tan Yia Swam said. In the private space, sometimes, you want to let market forces operate, but, at the same time, have some discipline through how we structure insurance, what we subsidise, what we do not. And I think that is how we reign in unnecessary healthcare costs.
Mr Deputy Speaker, I know Mr Leong has more questions. But really, I think this is a Motion about Ministries and all of us, all stakeholders coming together, a very meaningful Motion. And I would urge that we do not prolong further this to-ing and fro-ing and let us give our stepping-down NMPs strong support for their very meaningful Motion. [ Applause. ]
[(proc text) Question put, and agreed to. (proc text)]
[(proc text) Resolved, "That this House commits to supporting healthcare beyond the COVID-19 pandemic and the whole-of-Government efforts for consistent and sustainable support." (proc text)]
Mr Deputy Speaker : Leader.