의료 건강 발전 지원

[(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.