醫療居家護理與補貼政策質詢

The Chairman : Head O, Ministry of Health. Dr Tan Wu Meng.

6.16 pm

Health and Care – Thinking Outside the Box

Dr Tan Wu Meng (Jurong) : Chairman, I beg to move, "That the total sum to be allocated for Head O of the Estimates be reduced by $100".

I declare that I am a doctor working at a public hospital. I will speak on our healthcare system and thinking outside the box.

Today, we have already started thinking outside the box in healthcare policy. Subsidising health screening in Healthier SG so that illness can be detected earlier, treated upstream, reducing the burden of human suffering down the line years later, all this while maintaining the approach of co-payment established many years ago as part of keeping Singapore's healthcare system sustainable.

But there are other boxes we need to think outside of, as part of the next bound of healthcare policy. I will share about this today.

Today, we also need to think outside the box of space and place – bringing the care, bringing the subsidy to where the patient is, where the person in need is. Some public hospitals have been testing hospital-at-home services, or what is called mobile inpatient care at home. Can the Ministry of Health (MOH) provide an update on the progress of these efforts? Are they being scaled up? What has been the experience? Can we make it easier as well for MediShield Life and MediSave to be claimable for care that is delivered to patients at home where medically necessary?

I want to speak also about the ecosystem of care because bringing care closer to home goes beyond medical care, nursing care or allied healthcare. It must also look at Government programmes that support the sick and unwell.

I remember my Clementi resident who passed away. We got to know each other over my eight, coming to nine years in Clementi. She was my resident. We became friends over the years. We visited her in hospital, visited her funeral wake. She was getting more ill, getting more frail – more frail, more prone to falls. She was ill with kidney failure for many years, on peritoneal dialysis, finding it heavy going doing her own peritoneal dialysis at home every night.

She applied for a migrant domestic worker levy concession – maid levy concession. But she was not old enough to fit the Ministry of Manpower's (MOM's) aged person scheme. So, she applied to the Agency for Integrated Care (AIC) under MOH. She was told that because she did not always require assistance with at least one of the activities of daily living (ADL), did not always require assistance with one ADL and so, she could not qualify.

But I ask the Ministry, could the ADL have been looked at in context? Could the ADL have been considered in context of someone who was frail, getting more and more frail, many medical conditions and on peritoneal dialysis at home? Could it have been asked by the agencies, would the patient – would the resident – find it difficult to do peritoneal dialysis at home without the extra help?

And if you speak with real-world practitioners on the ground, there are residents – there are patients – who may not fit the technical criteria, always requires assistance with at least one ADL. Many who met my resident in person would have found her frail, even if she did not fit the letter of the policy, many would have felt she fit the spirit of the policy. So, I call upon MOH to consider such situations, see if there is a way to take into account the medical situation of the patient – the spirit of the policy, in addition to the letter.

There is another group of patients – palliative care patients with a limited lifespan, life-limiting disease, not much time left.

And likewise, I call upon MOH, can our agencies, in assessing the concessionary levy for migrant domestic workers in the approval process for frail patients on home peritoneal dialysis, who already find it difficult to cope without a helper, can they be considered more holistically? For patients with a serious life-limiting disease, not much time left, can they be considered holistically as well?

Sir, we must also think outside the box of individual agencies and individual Ministries because home care does not just help the patient, it also helps caregivers who otherwise might have to follow the patient for appointments, accompanying to see the doctor, for treatments, for blood tests and scans, depending on the condition.

Back in January 2022, two years ago, I asked a question in Parliament, how many specialist outpatient clinic visits a patient might have in an individual year at a public hospital? The 2019 figures from before COVID-19 showed that over 7,000 patients had 24 or more outpatient visits a year. In short, on average, two outpatient visits a month. There were over 2,000 patients with 36 or more outpatient visits a year, averaging three or more a month for an entire year.

Imagine being a patient or a caregiver, this many visits, trying to hold down a job, because we know that not every employer allows flexible working arrangements. We know that not every job makes that flexibility possible. We know that while some employers are kind, there are employers who can be one kind. And so, Mr Chairman, this is something our agencies need to look at.

I have Clementi sons and daughters – filial, caring for their parents – but they had to give up their careers to accompany their parents for treatment, the many visits each month.

So, if we can reduce the number of trips to the clinic, have more care delivered closer to home, it will help patients and caregivers, especially workers who find it harder to take leave and take time-off; workers who are lower-wage; with less bargaining power at the workplace; workers with jobs that cannot be done remotely. I called upon MOH to look into this two years ago during the MOH Committee of Supply (COS). Can MOH give an update on how they are looking at this?

Some might ask, why should MOH subsidise home medical care, care closer to home, in order to save jobs for patients and caregivers? But we already accept in principle, in other Ministries, that subsidy and funding can be used to save jobs or create a more level playing field for workers who encounter disadvantages.

For example, MOM has the Enabling Employment Credit to help persons with disabilities find work in an uneven job market. MOM has the Uplifting Employment Credit to help people find a second chance in life. MOM has the Part-Time Re-Employment Grant to help senior workers who need part-time employment opportunities or flexible work arrangements.

And so, given this precedent in other Ministries across the whole of Government, I call upon MOH and the Government as a whole to look at access to home medical care and home medical treatment through the lens of a coordinated approach to economic and social policies.

In short, if better home care helps save the job of a patient, if it helps save the job and career of a caregiver, can the case be made at whole of Government with MOH, MOM and MOF looking together at this?

Let me speak on means testing. In particular, can we further reduce the visits to a public hospital for patients who are undergoing means testing for assistance and MediFund? In 2016, nearly eight years ago, I asked in Parliament: can we make it smoother for patients on MediFund who are seeking treatment across different public hospitals in Singapore?

Last November, Minister for Health Ong Ye Kung, announced the roll-out of mutual recognition agreements for MediFund across hospitals and between acute hospitals and step-down care, intermediate care hospitals.

Can we also empower the Social Service Offices (SSOs) or the local Family Service Centres (FSCs) or the Active Ageing Centres (AACs) to assist the public hospitals, medical social workers, to do some of these means test assessments? This can reduce the need for an additional trip to see the medical social worker at the hospital. Reduce the need for additional appointments, especially for lower-wage, lower-resource families for whom travel may be more challenging.

On patients with mobility needs, can we also make it easier to find access to subsidised transport for patients who are less mobile with medically necessary visits to the clinic or medically necessary trips to receive treatment? Some months back, a fellow Singaporean and her family – this fellow Singaporean was undergoing treatment for a serious illness at a public hospital – shared about how the multiple visits to clinics for treatment to and fro, this, over the span of a month, especially where some trips were made during rush or peak hour. In one month, the family had clocked up more than $400 in private hire vehicle fares just to get their loved one to treatment because their loved one was less mobile.

I will now speak on home personal care because care for a senior goes beyond the clinic and we must look at their daily life at home. Many seniors want to stay in the community where friends, coffee shop "kawans", "kakis" are. But some need help with daily living, showering, cleaning up the home. Support for home personal care can make the difference in whether someone is in the community or later institutionalised. Can MOH look at how we can support seniors better on home personal care?

On seniors living alone, falls are a worry for our seniors, not just the injury but some seniors having fallen, cannot get up. If the senior is socially isolated, living alone, it may mean not getting help till someone passes by. Or worse still, what happens if the senior has fallen, cannot call for help, does not have anyone coming by and the community only discovers later after that senior has died?

Two years ago, in a Parliamentary Question in 2022, I asked MOH about using technology to help look out for frail seniors who had fallen at home. Can MOH give an update?

Sir, I want to speak about Clementi, the town which I help look after. I want to speak about the upcoming new Clementi Polyclinic. Today's Clementi Polyclinic is in the town centre, near to the Clementi MRT station, near to Clementi Bus Interchange, with sheltered, barrier-free access for many blocks around the Clementi Town Centre.

In June 2022, MOH announced that the Clementi Polyclinic would be redeveloped at a new site, about 650 metres away from the existing site and 250 metres from the Clementi MRT station. There would be addition of new features – bigger polyclinic, more capacity, more services.

But there also would be one important subtraction. Many residents no longer will have sheltered last-mile barrier-free access to the new location. Many residents who previously had sheltered last-mile access will have to cross Clementi Avenue 3.

6.30 pm

It is not a small matter. For less mobile seniors with a walking stick or mobility aid, imagine holding an umbrella in the rain. If you are an elderly caregiver pushing your loved one in a wheelchair, imagine doing that in rainy weather and trying to hold an umbrella for the two of you at the same time.

Mr Chairman, this crossing is right next to Clementi MRT station. And my Clementi residents have been keeping up to date on LTA policy. They have read LTA’s explanation of the Walk2Ride programme, and I quote, “Where feasible, walkways have been built to schools, healthcare facilities and other public amenities within a 400-metre radius of MRT stations.”

The new polyclinic is a healthcare facility. The new polyclinic is within 400-metres from Clementi MRT. So, can I ask the Ministries, MOH and the Government more broadly, surely it would be feasible to build that shelter across Clementi Avenue 3 to help seniors and less mobile residents? Especially since we have many Clementi residents who today attend the existing Clementi Polyclinic with sheltered barrier-free access and will find it harder to get to the new polyclinic location on a rainy day, and it would benefit young families as well, children in prams being brought by their parents or sometimes their grandparents too.

So, I call upon MOH and LTA to work together, see what can be done, whether this sheltered last-mile barrier-free access can be costed and factored in fiscally as part of the project holistically, because access to care goes beyond having a new, larger polyclinic. It is also about whether frail seniors with mobility needs can feasibly get to that polyclinic the same way they did to the existing polyclinic in the Clementi Town Centre.

As I said to Deputy Prime Minister Lawrence Wong, eight years ago in 2016, during an Adjournment Motion debate when Deputy Prime Minister was Minister for National Development, and I quote, “When we add new innovations, we must be mindful not to subtract from what came before, especially when it affects the vulnerable and disadvantaged among us.”

Sir, the current Minister for Transport used to serve at MOH. The current Health Minister used to look after MOT. May I humbly ask MOH and MOT to work together, look at this, do the costing together with the Ministry of Finance and see what can be done to help our seniors in Clementi, especially our frail seniors.

Sir, on healthcare capacity. Because even as we think outside the box, we also have to ask ourselves are the existing boxes big enough, deep enough. In short, do we have enough capacity, enough capability?

Can MOH tell us, is it tracking the doctor-to-population ratio and how Singapore compares with other advanced economies, in particular, the doctor-to-population ratio when we look at public sector doctors serving the Singaporean population?

Is MOH getting ready for what happens when there is more health screening as part of Healthier SG? Residents with pre-existing illness, did not know they were ill, but having gone for screening, having had illness discovered, will need follow-up, will need treatment. Are we looking at the projected increase in demand?

Is MOH taking a good look at how much time is needed to deliver holistic care, 21st century care, in Singapore? Because, whether you persuade someone to stop smoking, help someone with a mental health crisis, or support someone with a life-threatening illness and with limited time, all this needs holistic care.

As I said 11 years ago in The Straits Times and last year in Parliament, if a clinic is too busy and consultation times are too short, it becomes harder to promote health. Because six consultations of five minutes each are not the same as a 30-minute consultation. So, we need to accurately measure how much work is actually being done on the ground, how much work is needed for tomorrow so that we can do right by our patients, caregivers and healthcare workers.

When our decision-makers understand the actual amount of work that is needed, the ground situation, it is like flying an airplane. Even the best pilot needs to know what is the altitude, what is the air speed, how much is in the fuel tank. You need that for good decisions. Otherwise, we know what can happen.

On healthcare financing, when thinking outside the box, we need to keep the toolbox stocked with new tools. Is MOH working to ensure fair, equitable access to new treatments, such as cell, tissue and gene therapy products?

For certain new treatments where the chance of success is very slim, but the cost is very high, are there new billing models such as a “no cure, no pay” funding model? Expensive drug, if it does not work, does not cure the patient, is there a refund from the manufacturer?

So, in summary, Mr Speaker, we will need resources, energy and imagination for tomorrow to keep our healthcare system fit for purpose.

[(proc text) Question proposed. (proc text)]

Waiting Times and Bed Availability

Mr Pritam Singh (Aljunied) : Chairman, having to be hospitalised is physiologically and emotionally stressful in many ways. Fortunately, our health workers work hard to minimise the inconveniences of the experience as much as possible.

Even so, to know that you have to wait long hours for a bed in Singapore does not correspond with what many older Singaporeans in particular expect of our healthcare system. At their moment of need, many of our seniors and even citizens across various age groups did not believe that they would have to wait hours in a chair in an A&E department or be decamped to beds located at a temporary car park where the lights are never turned off at their moment of critical need.

MOH currently publishes the daily median waiting time at emergency departments on a delayed basis of two weeks. In some hospitals, even at the median, the waiting time for a bed can exceed 16 hours. This was the situation at the end of January at Khoo Teck Puat and Changi General Hospital. Imagine being ill and uncomfortable and having to wait 16 hours for a bed. This hospital experience is being narrated anecdotally to me by an increasing number of seniors.

In order to have a more accurate perspective of the problem, would the Ministry be prepared to publish the waiting time for an admission to a ward, not just at the median which it does now, but at the 75th and 90th percentiles as well, for a more holistic overview of the situation on the ground?

Secondly, in view of the situation today and in the short term, can the Ministry generate a publicly accessible or build within mobile health applications such as HealthHub, a resource that provides information on waiting times at A&E departments in our public hospitals, and details on bed occupancy in as close to real-time as possible, perhaps even on a two-hourly basis, so that patients and their caregivers can exercise the option of going to an A&E department that is less crowded? This would also relieve and better spread the patient load at hospitals where doctors and nurses, allied health workers and staff consistently see higher A&E admissions and bed utilisation.

Sir, the reality of our growing senior population has been on the radar for decades. I understand moves are underway to increase the number of hospitals and polyclinics. In fact, piling works have just begun last month for the Eastern Integrated Health Campus in my ward of Eunos in Aljunied Group Representation Constituency, the development of which is expected to take some patient load off Changi General Hospital. These developments should improve the situation, but it has to account for the rising number of seniors and Singaporeans who inevitably will have to tap onto the healthcare system in some shape or form, and also to account for the rising healthcare manpower needs.

Thirdly, there have been reports of patients preferring to stay in a hospital longer than they are supposed to, despite being medically fit for discharge. One report cited an expert as postulating, for example, that three out of 10 patients at the National University Hospital (NUH) or their family members have to contend with discharge issues. While each situation would have to be looked at on a case-by-case basis, such patients can exacerbate the problems faced by the primary healthcare system. How many patients were labelled as overstayers in our public hospitals in 2023, and how serious is this problem?

The Ministry has announced plans to increase beds over the next five years and the number is 1,900. Can the Ministry share its plans on how it intends to expand home care services over the next five years as well, to reduce patient load in hospitals, and so as to ensure that the load on our healthcare workers is not more than it needs to be?

The Chairman : Ms Ng Ling Ling, you can take your four cuts together.

Expanding Mobile Inpatient Care at Home

Ms Ng Ling Ling (Ang Mo Kio) : Chairman, the Mobile Inpatient Care at Home (MIC@Home) pilot seems to be demonstrating the potential of transforming patient care by providing a sustainable alternative to traditional hospital settings. I was encouraged to read from a Straits Times article in August 2023 that, as of June last year, around 1,000 patients have been admitted to the programme, staying for seven days on average, and resulting in an estimated savings of 7,000 bed days. By end of 2023, more than 2,000 patients would have experienced the virtual wards according to the article.

In such an at-home care setting, family and community involvement seems crucial to maximise the benefits of patients’ recovery. This may involve training family members in basic care protocols and procedures to create a conducive and supportive home environment for the recovery of the patient.

I would like to ask for an update on how MOH is intending to scale up MIC@Home, including extending the care model to more patient types in palliative care or even paediatrics. I believe that such scale-up can provide more options to patients and caregivers, especially for senior patients who may prefer to recover in the comfort of their own home.

I would like to ask MOH what more can the community and individual families learn and do to make such a scale-up possible for more groups of patients, especially our senior patients for the years to come.

Managing Healthcare Cost Increases

MediShield Life has undergone several rounds of enhancement to ensure that Singaporeans can continue to afford paying for large hospital bills in times of catastrophic medical episodes and selected costly outpatient treatments, such as dialysis and chemotherapy for cancer.

I am glad to note from the World Health Organization (WHO) Global Health Expenditure database that the out-of-pocket expenditure in terms of percentage of the current health expenditure in Singapore has decreased between years 2000 and 2020 from 48.1% to 18.9%. It is also note-worthy that eight in 10 Singaporeans pay little or no cash for their subsidised hospital bills.

However, given an ageing population where healthcare needs will increase and prolong, as well as advancements in medical treatment options that can be more costly, there is a concern on rising healthcare costs that may lead to higher out-of-pocket expenditures for Singaporeans in the years ahead. Another concern is the cost drivers in public hospitals that may increase operating expenditures, which can all indirectly increase bill sizes and out-of-pocket expenses for Singaporeans.

I would like to ask MOH the following questions.

One, what are the primary drivers behind the increase in healthcare costs in Singapore and how can they contribute to hospital bill sizes?

Two, what cost control mechanisms are currently in place or will be in place in our public hospitals to mitigate cost increases and ensure healthcare remains affordable?

Three, how does MOH intend to help public hospitals manage their costs and become more cost-efficient?

Four, is the MediShield Life coverage expected to continue to be adequate to help Singaporeans defray a substantial portion of their bill sizes and keep out-of-pocket expenditures low?

Lastly, how can MediShield Life adapt its coverage to reflect these rising costs while ensuring that the premiums remain financially sustainable for Singaporeans?

Progress of Healthier SG

Chairman, the Healthier SG initiative marks a pivotal shift in our national healthcare strategy towards preventive care with an emphasis on community-based health management. I would like to commend the efforts of MOH and all the partners that has brought about very encouraging enrolment figure – I think I last read, almost 700,000 residents have been enrolled.

The successful implementation of this initiative relies heavily on the active collaboration between MOH, Primary Care Networks (PCN), polyclinics and private general practitioners (GPs). I would like to seek an update on what is the percentage of the enrolled residents that did so with GP clinics and what is the percentage that have enrolled with the polyclinics?

6.45 pm

As more Singaporeans enrol on this initiative, besides focusing on reaching a wide base, I believe that there must be also healthcare indicators that can show that our population health is improving. I would like to further understand the development and efficacy of Healthier SG for enrolled residents such as: one, what are specific health outcomes that are being targeted for improvement under the personalised health plans for those who are enrolled? How has the personalised health plans been monitored for the enrolled residents?

Secondly, in cases where enrolled residents are not meeting their health goals, what are the interventions or additional support that are given under Healthier SG to help them overcome their challenges?

Lastly, does MOH expect that the prevalence rates for the most common chronic diseases faced by Singaporeans, including high cholesterol, high blood pressure and diabetes to ease or reverse as Healthier SG initiative rolls out?

Professional Development of GPs

Chairman, in Singapore, about 80% of our primary care demand are met by our GP clinics. Many of our GP clinics are well located in most neighbourhoods. As such, their involvement in Healthier SG is an important collaboration in the population preventive health approach that we are increasingly taking. As we integrate social prescription and increase access of mental health treatment through our primary care providers in the Healthier SG and other national health strategies, our GPs will increasingly need help in expanding their capacities and capabilities, including receiving comprehensive and continuing training. This is especially so when areas such as social prescriptions and mental health treatment may be relatively newer areas that our GPs need to increase proficiency in.

In this regard, I would like to ask MOH to provide updates on whether it has overall capacity building and professional development plans for our GPs, especially on: one, how are the GPs going to be supported to make time for continuing education training when time away from their clinics can mean opportunity costs from seeing patients in their clinics?

Two, what are the support and resources provided to GPs on the latest research findings and protocols for the most effective treatment options in common chronic diseases, especially those where we are seeing increasing prevalence rates, such as hypertension?

Lastly, for social prescription and mental health treatment, which usually require a multi-disciplinary treatment involvement, how will the GPs be equipped and how will the joint training be done for such multi-disciplinary teams to provide best health intervention to patients who need them?

Progress of Healthier SG Implementation

Dr Syed Harun Alhabsyi (Nominated Member) : Chairman, I would like ask the Ministry regarding the progress update for Healthier SG implementation thus far.

First, whether the manpower, infrastructure and systems implementation plans are keeping pace with the timeline and envisioned capacity of the national healthcare system as it pivots to Healthier SG. I note that the Government announced last month regarding changes to and guidance on the salary of our nurses, but are there similar concerns and plans for the retention of other healthcare professionals including doctors and allied health professionals. I also wonder whether the remaining eight polyclinics slated to be open by 2030 are on track, and whether there have been any challenges to the system integration efforts between private GPs, polyclinics and hospital clusters to realise the full potential of Healthier SG over time.

Second, could the Minister also share whether early indicators suggest that Healthier SG plans are achieving its articulated goals and outcomes? Is the approach towards better preventive healthcare being realised? Have both doctors and patients, at the last mile, reported stronger patient-doctor relationships and are patients having better experiences when receiving their care with their primary healthcare provider through Healthier SG?

Third, part of the vision of Healthier SG is that there be more rooted partnerships and the integration of health and social ecosystems of care. Have partnerships been strongly established with agencies like AIC, the Health Promotion Board (HPB), People's Association (PA) as well as Sport Singapore to realise the vision of Healthier SG? Could the Ministry share specific examples of how this has been done and expected to evolve over time? Have there been any barriers in this regard and could the Ministry share the forward steps that can be anticipated in this space?

Finally, much has been said about the promulgation of the National Mental Health and Well-being Strategy and the anticipated greater awareness of mental illness and mental wellbeing over time. Are there any changes to be made to the Healthier SG implementation plans, especially towards incorporating the four tiers of the tiered care model and to realise the four articulated focus areas as outlined by the strategy?

The Chairman : Mr Yip Hon Weng. You can take your two cuts together.

Implementing Healthier SG

Mr Yip Hon Weng (Yio Chu Kang) : The Healthier SG initiative holds immense promise for transforming our healthcare system towards upstream and preventive care.

Firstly, can the Minister share the latest enrolment figures for Healthier SG as of today, as well as the statistics for the number of participants who have attended their first consultation? Understanding the level of public engagement is important to gauge the programme's effectiveness.

Secondly, can the Minister elaborate on the format of personalised health plans or social prescriptions? Will they include a list of recommended activities tailored to individual needs? How will compliance and implementation be ensured? The recent rollout of Healthier SG chronic tier subsidies and the broader direction to encourage GPs to manage more chronic conditions, is welcomed news.

However, I have some concerns regarding its impact on the wider population.

Firstly, not all GPs have equal expertise in managing every chronic condition, especially relating to issues of mental health. Will this expansion lead to patients having to switch GPs to access the full benefits of Healthier SG? Secondly, ensuring participating GPs have the necessary resources and expertise is critical. How will the Ministry equip them with the training, tools, and support they need to effectively manage these additional chronic conditions, particularly those requiring specialised knowledge? We need to avoid overburdening GPs and jeopardising the quality of care for existing patients.

Preparing for a Super-aged Society

As we witness an increasing number of seniors living alone, the potential for social isolation and unmet care needs becomes a pressing concern. I want to focus on how we can ensure that our seniors stay active, connected and well-cared for within their communities, aligning with the Age Well SG strategy.

Firstly, how will the Ministry evaluate the success of Age Well SG initiatives? This could involve metrics on senior well-being, programme effectiveness and cost-efficiency. How will the Ministry implement the shift from insititutionalised care to community and home-based care, highlighting specific initiatives, take-up rates and timelines?

Secondly, understanding the current state of care is critical. Can the Minister share the current average waiting time for nursing home beds? What novel models of care are available to bridge the gap and prevent institutionalisation?

Thirdly, can the Minister update on the progress of rolling out Active Ageing Centres (AACs) to seniors in non-rental flats, ensuring broader accessibility? When will the expansion cover all seniors? How will AACs implement initiatives that specifically foster inter-generational relationships, tackling social isolation for seniors while providing learning opportunities for younger generations? How do we specifically reach out to those seniors who are reluctant to socialise, as they are most vulnerable to loneliness?

Fourthly, enhancing home-based care for seniors with higher needs is critical. Does the Ministry also have a target of how many patients do we aim to onboard for home-based care? As home care can be resource-intensive, can the Ministry also share about the long-term financial sustainability of such programmes, especially regarding potential future cost increases and affordability for seniors? How can we increase public awareness of home-based care?

Similarly, improving our seniors’ home environment through initiatives like EASE 2.0 is important. I am glad the Housing and Development Board (HDB) is going to roll-out EASE 2.0 from 1 April onwards, which includes the expansion of the wireless Alert Alarm System to benefit more seniors. How will the Ministry raise awareness about this system and other fall detection solutions, especially among seniors who live alone? At the broader level, will the Ministry partner with technology companies to develop similar senior-friendly applications? These solutions can also be used for social interaction, health monitoring or for accessing services.

Chairman, building a society where everyone ages well necessitates a multi-pronged approach. By addressing social isolation, providing accessible care options and investing in community infrastructure and manpower, we can ensure our seniors live fulfilled and dignified lives within their communities.

Healthcare Capacity in Ageing Society

Assoc Prof Jamus Jerome Lim (Sengkang) : In my speech on the Motion on supporting healthcare in May last year, I spoke about how hospital bed and medical personnel capacity in our fair nation falls short of what may be expected, not just compared to almost every other advanced economy, but also to our own internal benchmarks. This has led to us failing to meet health service quality targets set by MOH. Things have improved somewhat since then, but capacity still remains constrained. Medium wait times at the end of January can still exceed half a day in Changi General and Khoo Teck Puat, while the bed occupancy rate for all but one of the public hospitals hovers above the Ministry's own preferred 80% ceiling.

There is a dire need to relieve not only our capacity shortfalls in the short run, but also any projected long-run need. Indeed, the planned expansion of Alexandra Hospital and the Woodlands Health Campus is likely to only fix current shortfalls, but remain insufficient as our population grows and ages.

What this comes down to is a willingness to sacrifice short-run efficiency by accepting a certain amount of redundancy in the interim, at least until the needs inevitably arise. My sense is that this will only occur when our current occupancy rate for hospitals remains substantially below 80%, at least for a certain duration. To achieve this, I believe that the current system can stand to expand its transition care offerings. I will suggest three ideas.

First, we can ramp up our urgent care offerings as an intermediate option, complementing existing GP polyclinics versus A&E solutions. While still uncommon, there are already several urgent care centres (UCCs) in Singapore, including the reclassification of Alexandra Hospital's A&E department into a UCC, along with several private providers. Singaporeans should be educated about using this channel for non-life-threatening medical emergencies, especially with regard to the substantially shorter wait times compared to A&E. It can also relieve the pressure on polyclinics to triage such cases for which they are not designed for.

Second, we can improve the incentives for transition care at home, perhaps with cash incentives paid directly to patients using savings that would otherwise go toward hospitalisation expenses. The Government can directly encourage this by providing rebates to insurance companies for encouraging select cases to pursue this route.

Third, while I support the decision to expand the non-profit model, whether the experiment will ultimately prove viable, will also hinge crucially on whether the associated tax exemptions are accompanied by increased or decreased flexibility of operations. Otherwise, if the approach is simply one of delivering more subsidies that exchange for greater health price regulation, economy plus healthcare, the true advantage of the non-profit model may be lost. At the same time, I encourage MOH to also look at public health bills.

The Chairman : Mr Ang Wei Neng. You can take your three cuts together.

Hospital and Polyclinic Capacity

Mr Ang Wei Neng (West Coast) : Chairman, I am deeply concerned about the recent report in The Straits Times regarding the predicament of 12 ambulances, out of a fleet of 92 Singapore Civil Defence Force (SCDF) ambulances, being stuck at Changi General Hospital on 29 January 2024. This situation is alarming and warrants immediate attention. Regrettably, the situation in the West does not appear to be any better. Residents in Nanyang have voiced their frustrations over prolonged wait times at hospital A&E departments, with some even having to endure further delays in securing a hospital bed, often relegated to corridors along hospital wards.

Singapore's ratio of hospital beds per 1,000 people stood at approximately 2.55 in 2023, last year. This figure pales in comparison to countries like the United States – 2.8 beds; China – 5.2 beds; and Japan – 12.6 beds. In light of our ageing population, I would like to ask the Minister for Health if he believes that we have insufficient number of hospital beds in Singapore right now. If so, is MOH prepared to expedite the construction of additional hospitals beyond those already slated for development?

Chairman, many residents in the West, particularly those in Nanyang, encounter difficulties securing appointments at Pioneer Polyclinic. Given the demographic shift towards an ageing population, I would like to inquire whether MOH has plans to build additional polyclinics in Jurong West to alleviate these concerns.

7.00 pm

Adequacy of Medical Staff

I would like to extend my congratulations to MOH for recruiting 5,000 nurses, surpassing the initial target of 4,000 last year. However, this success raises concerns about whether we have enough doctors to meet healthcare demands.

Many young Singaporeans, including residents from Nanyang, possess a strong desire to pursue careers in medicine. Unfortunately, the doors to the local medical schools remain largely closed to the majority, despite their excellent results. It is disheartening to note that Singaporean students with perfect GCE "A" level scores of 90 points have been turned away from our medical schools. As a result, some have to go overseas to study medicine, imposing a significant financial burden on their parents and contributing to a brain drain from Singapore.

We understand that about 2,400 Singaporeans applied to medical schools at the National University of Singapore (NUS) and Nanyang Technological University (NTU) every year but were rejected due to an intake of only about 510 students per cohort.

Singapore's doctor-to-population ratio stands at 2.8 doctors per 1,000 people, which is quite low compared to countries like the United Kingdom, 3.2; United States, 3.6; Australia, 4.1; and the EU average of 4.3 doctors per 1,000 people. Given our ageing population, there is room for an increase in the number of doctors in Singapore.

Thus, I would like to inquire if MOH is prepared to collaborate with the Ministry of Education (MOE) to expand the number of vacancies in the medical schools at NUS, NTU and Duke-NUS. Meanwhile, I also receive feedback that junior doctors in local public hospitals have overwhelming workloads, particularly during their housemanship. I would like to ask if MOH is prepared to take measures to ease their burden, which is vital for both their well-being and the patient care quality.

Vaping

Chairman, during a recent cycling trip to Serangoon East Dam, I was dismayed to witness a group of teenagers openly vaping. Regrettably, similar incidents seem commonplace, as echoed by my residents from their experiences. One friend, in particular, recounted reporting a vaping incident to the Police. Then the Police redirected her to the Health Sciences Authority (HSA). Despite her complaint, there was no follow-up from HSA. Probably, HSA does not have sufficient resources to follow-through.

Vaping poses a significant problem in schools, with many students obtaining vaping accessories from family members, including their parents. To combat this issue, we must intensify the efforts to raise awareness about the harms of vaping and promote responsible behaviour. Initiatives, such as the "Truth Initiative" campaign by the United States' Centres for Disease Control and Prevention (CDC) have proven to be effective in reducing vaping prevalence through public education.

While education is crucial, strict enforcement is equally necessary. We are pleased with the recent Government measures to curb vaping imports and restrict its use in schools and public spaces. However, questions linger regarding the adequacy and effectiveness of the enforcement actions.

I have just visited HSA's website. It is concerning that the Chairman and CEO of HSA did not even mention anything about enforcement action against vaping in their messages on the website. On the website, the messages are on the front of the website; no mention about anti-vaping measures. This raises doubts about the priority placed on anti-vaping efforts within HSA.

Hence, I urge the Minister to provide insights into the size and effectiveness of the HSA's enforcement team and whether the Minister is satisfied with the current state of the vaping scene in Singapore.

If the Minister is not satisfied, I would question whether relying solely on HSA as the enforcement authority against vaping is sufficient. Considering the Government's concern that vaping is harmful, I would like to ask the Minister whether the Minister thinks that vaping is more harmful than smoking or it is about the same as smoking. But if vaping is harmful and we think that we need to enforce with greater strength, I would like to suggest that agencies like the Central Narcotics Bureau and the Police, with their larger enforcement personnel, could assist in the anti-vaping efforts.

Healthcare Costs and Productivity

Dr Lim Wee Kiak (Sembawang) : Mr Chairman, I want to declare my interest as an ophthalmologist in a private group practice.

The issue of healthcare costs and productivity is one that weighs heavily on the minds of many Singaporeans. While we strive for accessibility, quality of care for all, rising costs and long waiting times paint a concerning picture for all of us. Over the past decade, healthcare expenditure has skyrocketed, raising questions about sustainability as well. Long wait times for appointments and procedures frustrate patients and strain the healthcare system.

The Government has taken steps to address these concerns and increased hospital bed capacity and medical personnel recruitment are commendable efforts. The recently unveiled nurse retention scheme as well as initiatives to improve healthcare workers' welfare are all welcomed. But all these belated responses are after years of groundswell feedback and growing pressure. The prompt question now is: why now, when the bed capacity issue has been a concern for years, even before COVID-19? This reactive approach highlights a need for a more proactive as well as an anticipatory strategy. What is being done now to move towards a more forward-looking approach in healthcare administration? Therefore, I raise the following questions.

What are the key drivers to cost escalation in healthcare delivery? Are these primarily driven by medical technology advancements, rising drug prices, inflation or other factors or all of the above? Are there specific areas, such as medications, technology as well as administrative costs, that drive cost increases?

Beyond medical procedures, cost concerns are driving some Singaporeans to buy prescription medication from online marketplaces and over the counter across the border without prior medical consultation, potentially jeopardising their healthcare. This raises serious concerns about accessibility and affordability of essential medication within our healthcare system. We need to understand the root cause of this behaviour and explore solutions that prioritise both public health as well as affordability.

What specific measures are being taken to slow down cost increases? We need concrete actions, be it exploring alternative treatment options, revisiting procurement strategies or leveraging on technology for cost optimisation. Are there plans to leverage on more bulk purchasing, negotiate for better pricing with pharmaceutical companies or explore alternative treatment options completely? Costs of a surgical procedure done in a day surgery setting is significantly much lower than that of a same procedure done as inpatient of the hospital. Can MOH explore how we can further expand the capacity of day surgeries to moderate our medical cost increases and reduce inpatient hospitalisation?

Can the Ministry also elaborate on the utilisation of smart solutions and artificial intelligence (AI) in healthcare delivery? Can these technologies be used to optimise resource allocation, streamline administrative processes or personalise healthcare for individual patients, leading to cost savings as well as improved outcomes? Smart medical monitoring devices or wearables can be used to substitute and reduce the reliance on our nurses for patient monitoring in the hospitals and, in same cases, outpatient settings as well.

Because of the small size of our island, proximity to hospitals is a blessing. But it is also contributing to the overuse of A&E services for non-emergencies, resulting in a gridlock at the A&E and also a knock-on effect on bed shortage. This is often driven by a lack of knowledge about recognising and managing their health conditions. While long-term education efforts are crucial, we also need immediate solutions to address the current strain. Leveraging smart solutions and AI-powered triage systems can be a game-changer. Patients can rely on virtual consultations to connect with healthcare professionals remotely for initial assessments, potentially avoiding unnecessary A&E visits. AI-powered tools with symptom checkers and decision-support tools can also guide patients towards appropriate care options based on their symptoms, directing them to clinics, pharmacies or telemedicine consultations instead of the A&E.

While I acknowledge the Government's efforts to address healthcare challenges, there remains a need for a more proactive, data-driven and cost-conscious approach. By embracing innovation, empowering patients and leveraging technologies, we can navigate the crossroads of healthcare costs as well as productivity, ensuring accessible, affordable and quality healthcare for all Singaporeans.

Urgent Financial help for Patients with Spinal Muscular Atrophy

Mr Ong Hua Han (Nominated Member) : Chairman, today, I raise a matter of urgent concern: the need for financial assistance for those living with spinal muscular atrophy (SMA). SMA is a rare and debilitating genetic disease. Last year, I got to know Ms Sherry Toh, a 25-year-old socio-political and gaming journalist who lives with SMA type 2.

SMA is a progressive disease that affects the nervous system and muscles, resulting in severe physical disabilities. Despite the challenges posed by SMA, Sherry is an incredibly resilient person, determined to live her life to the fullest. Members can read about her story online.

Without treatment, SMA patients like Sherry face the grim prospect of progressive deterioration, respiratory failure and a bedridden future. However, there is hope. There is an HSA-approved oral medication called Risdiplam, which improves motor function and stabilises SMA's progression. Roche, which markets the drug, donated a three-month supply to Sherry last year.

This intervention led to noticeable improvements in her energy levels, swallowing abilities and overall well-being. It gave Sherry a newfound taste of freedom and independence, enabling her to live her life more fully. Yet, this was a temporary lifeline. Risdiplam needs to be consumed daily and consistently for its effects to last. An annual supply of Risdiplam costs $375,000 per year. This is far beyond the reach of an average Singaporean. As soon as the third day without medication, Sherry felt a notable deterioration. It took her longer to swallow water compared to when she had been on Risdiplam for two months.

While there is hope that SMA treatments may be included in the Rare Disease Fund in the future, I raised this topic in my Parliamentary Question last year, patients like Sherry cannot afford to wait any longer. Every day without treatment access is a missed opportunity to improve their quality of life and prolong lifespan. Therefore, I urge MOH to expedite its review of SMA treatments for subsidies and mainstream financing.

Crowdfunding is not a suitable nor sustainable alternative. Sherry has extended her crowdfunding campaign many times now. Yet, she has only managed to reach 12% of her $375,000 target, just to secure one year's supply of medication. Mr Chairman, Sherry is only trying to buy time, time to witness policy change, time to hope for a brighter tomorrow.

Managing Cancer Treatment Costs

Ms Sylvia Lim (Aljunied) : Sir, cancer remains the leading cause of death in Singapore, claiming nearly 24% of all recorded deaths in 2022. One in four Singaporeans is expected to develop cancer in their lifetimes. According to the Singapore Cancer Society, over the five-year period from 2017 to 2021, an average of 46 people per day were diagnosed with cancer in Singapore, while 16 people per day died of it.

A study last September commissioned by DBS Bank and conducted by Black Box Research surveyed approximately 1,200 participants on their financial readiness to tackle cancer costs. Three key findings emerged: first, that responders perceived difficulty coping with the cost of cancer care; second, that cost concerns may significantly impact decisions about treatment; and third, part of the solution lay in improving financial literacy.

The survey is ongoing. Among those surveyed on why they did not purchase additional coverage, some cited unaffordable premiums and a lack of understanding about policy benefits. One in three participants expressed concerns about the exorbitant cost of cancer care. An earlier study by National University Cancer Institute and Research for Impact showed that patients of lower socioeconomic status were at higher risk of financial toxicity.

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Financial toxicity means that patients are likely to experience significant financial distress due to the cost of care, which usually coincides with a period of lost income. This not only affects their quality of life and mental well-being, but also that of their family members.

Empowering people early with financial knowledge on private insurance options would instill confidence to prepare for the unexpected catastrophic medical expenditure and allow patients to focus on treatment. It is also important to ensure that the national coverage for cancer under MediShield Life remains meaningful. How is the Ministry working with the relevant stakeholders to raise awareness of cancer treatment costs and to mitigate financial toxicity?

Egg Freezing

Ms Hazel Poa (Non-Constituency Member) : Mr Chairman, last July, the Government amended the law to allow women between 21 and 37 years old to undergo elective egg freezing. The Progress Singapore Party (PSP) supports this as it provides women with the option to preserve fertility and their chances of having children later in life. This is necessary as young Singaporeans are getting married later and our TFR has fallen to 0.97 in 2023.

However, we can do more to support women who are thinking of or currently undergoing egg freezing.

Firstly, the procedure is still very costly in Singapore. Elective egg freezing can cost between $7,000 and $9,000 per cycle in a public hospital, or $10,000 to $15,000 per cycle in a private fertility clinic. Currently, there are no subsidies, co-funding, or Medisave available for elective egg freezing. There are only certain subsidies that couples can avail of when undergoing in vitro fertilisation (IVF) treatment, if and when they choose to use the frozen eggs in the future. But if young women cannot afford to freeze their eggs at the optimal age, there will be no frozen eggs for couples to use later.

PSP therefore calls on the Government to consider some level of subsidies in public hospitals and allow the use of MediSave for this procedure. Conditions on subsidies can be imposed to prevent abuse and ensure that unutilised frozen eggs can be donated to other couples or used for other purposes like research or education.

Countries like South Korea, Japan, Australia and France already subsidise elective egg freezing. The Government can also encourage businesses to subsidise or cover the costs of such procedures and other fertility treatments as part of a package of fertility benefits for their employees. This is already common in the US, where many large employers routinely provide generous coverage for fertility treatments such as egg freezing and IVF as part of their employee benefits. We should encourage this to become the norm in a Singapore made for families.

Secondly, we can also do more to increase the resources available to young women who wish to go through egg freezing, which can be physically, psychologically, and financially taxing. Young women should be given fertility information through healthcare providers and institutes of higher learning. This would include information about contraception, pregnancy and fertility treatments. Space must be created for young women to have informed conversations about fertility and maternal health issues, so that they can be empowered to make decisions that are best for themselves.

The Chairman : Mr Louis Ng. Your three cuts together.

Extend IVF Subsidies to Private Clinics

Mr Louis Ng Kok Kwang (Nee Soon) : Many couples tell me of the long waits at public hospitals for IVF procedures. We can help reduce this. Co-funding support from the Government is important to allow couples to access IVF which is extremely expensive. However, there is no support when couples go to private clinics for IVF. Channeling some couples to private clinics will help ease the load on our public hospitals. Can MOH consider allowing couples who have failed two IVF cycles in a public hospital to receive co-funding for treatment at a private clinic?

There is no fiscal loss to the Government. For couples who have failed twice at public hospitals, this allows them to try a different approach to increase the chances of success. We are doing so much to get Singaporeans to have children. Couples undergoing IVF are a group that is trying so hard to have children and we are not doing enough to help them.

Provide Subsidies for Fertility Testing

Prime Minister Lee talked about how couples who want kids put off starting families, not realising how quickly it gets harder with each passing year. Couples are starting their families late and a study showed that Singaporean couples try for 3.4 years to conceive before seeking help if they are unable to conceive.

Early fertility screening helps people catch problems early and avoid even more costly fertility treatments later when they are older and when it is harder to conceive. Not only does it save costs, but it also saves couples from the heartache and stress of multiple rounds of unsuccessful IVF if needed.

The Government can view this also as cost savings. Again, spending more on fertility testing at an early stage might reduce future spending on subsidies for repeated IVF cycles as the success rates of IVF decreases with age. I have raised this previously and I am asking again that the Government provide more subsidies for fertility screening and create a separate MediSave category for fertility screening.

Ensure Nurses Have Sufficient Rest

All of us are grateful for the life-saving work of our nurses and healthcare workers during COVID-19. They put themselves on the frontline to save lives. They were stretched during COVID-19, and we all hoped that things will get better for them post-COVID-19. Unfortunately, things have not gotten better yet. Our hospitals remain stretched. In December 2023, the median waiting time to be warded was around 17 to 20 hours, and even exceeded 20 hours in certain hospitals.

In my Budget speech last year, I spoke up for more rest time for nurses. The ANGEL scheme announced by MOH is a positive move. But in addition to financial incentives, nurses hope we can do more to ensure they have sufficient rest. For already exhausted nurses, they dread the PM-AM-PM-AM shift, or PAPA shift. This means that nurses work two consecutive sets of afternoon shifts followed by morning shifts. I understand that Khoo Teck Puat Hospital has looked into PAPA shifts and has made positive changes. Can MOH ensure that all hospitals do away with this PAPA shift and that we look into ensuring nurses have a minimum amount of rest between shifts, similar to what we do for flight attendants?

The Chairman : Mr Gerald Giam. Take your two cuts together.

Healthcare Subsidies for PwDs or Persons with Special Needs

Mr Gerald Giam Yean Song (Aljunied) : Sir, currently Pioneer Generation, Merdeka Generation and Public Assistance cardholders receive special subsidies under the Community Health Assist Scheme (CHAS). I would like to propose adding persons with disabilities or special needs as another group of Singaporeans to receive special subsidies under CHAS. They should also receive additional MediSave top-ups and more subsidies for intermediate and long-term care. All this will help persons with disabilities or special needs and their families to defray their medical expenses, which are likely to be larger over their lifetimes.

I would also like to suggest that MOH track the number of individuals under CHAS who are persons with disabilities or special needs, so as to better understand the healthcare expenses and needs of this group of Singaporeans.

Smoke-free Generation

The healthcare costs and lost productivity caused by smoking in Singapore has been estimated to be at least $600 million a year. Singapore has one of the world's toughest anti-smoking laws. Yet, continuing to raise tobacco taxes and extending public smoking bans may start seeing diminishing returns. Stricter rules in public places have ironically driven smokers to light up at home or create informal smoking corners, harming their children's health and sparking neighbour complaints about second-hand smoke.

In January 2023, MOH stated that it is reviewing international practices on cohort smoking bans. The United Kingdom (UK) plans to increase the minimum smoking age every year until eventually no person can illegally buy cigarettes. New Zealand initially implemented a cohort smoking ban, but the new Conservative Government revoked it to fund tax cuts. Deputy Prime Minister Lawrence Wong stated in January 2024 that public health and not potential tobacco tax revenue loss were factors in banning e-cigarettes. I trust this principle will also apply to any Government decision on cohort smoking ban.

A generational smoking ban is specifically designed to safeguard the future without imposing restrictions on current smokers. This forward-looking approach ensures that today's adults can make their own choices while laying the groundwork for a healthier legacy for their children and grandchildren. I urge the Government to implement a cohort smoking ban for all individuals in Singapore born on or after 2010. This will give us four years to prepare new smoking regulations before we see our first smoke-free generation for all children aged 14 and under today.

The Chairman : Ms Mariam Jaafar. Take your five cuts together.

Healthcare Costs

Ms Mariam Jaafar (Sembawang) : Healthcare costs have grown rapidly and the MOH budget is now second only to that of the Ministry of Defence. Hospital bills and insurance premiums continue to rise.

The shift to preventive care under Healthier SG will be a critical lever to bending the cost curve in the long term. But we must also drive cost reduction in the here and now. We have residents who come to us complaining that the cost of medical treatment is higher in Singapore than in the region, but even other wealth developed nations like Japan, that the cost of unsubsidised consultations are sometimes more expensive in our polyclinics that at private GPs.

Yes, we have an ageing population. Yes, there is a rise in chronic diseases. Yes, there are global shortages. Yes, we are disadvantaged as a small and rich nation when it comes to drug pricing, but what are the other material drivers of rising health costs that could be controlled?

Healthcare economics is a complex field, rife with principal-agent problems, moral hazards, human emotions and behaviours, and the Government has worked hard to address these challenges over time. But there are proven levers to reduce costs – value-based heathcare, digital technology, strategic procurement – but for their impact to be sustained, changes to ways of working, processes, people and incentives all have to be aligned; otherwise, the costs come back or just move somewhere else.

With the move to capitation funding, what benchmarking studies have been done and what targets have been set to get healthcare systems and insurers to go after cost savings. How can we get individuals to make decisions for the good of their loved ones and society as a whole? What more is being done to keep healthcare costs under control?

Value-based Healthcare

During the Healthier SG White Paper debate, I spoke about value-based healthcare, which is a transformative model of healthcare that focused on delivering better health outcomes with the same or lower costs by optimising available resources, citing several international best practices. Minister Ong Ye Kung had assured the House then that our hospitals have always been implementing value-based healthcare, have also been through many such initiatives, such as community measures to help resuscitate out of hospital cardiac arrests.

I am heartened that we have seen many successful value based healthcare pilots in our healthcare system that demonstrate the potential. However, to fully realise this potential, we must scale up these pilots and integrate them across our healthcare system. This requires a concerted effort involving multiple stakeholders across the health care continuum. We must invest in technology, infrastructure, data, workforce training and culture to support this transition and ensure incentives are tied to outcomes, as well as address disparities in access to care and social determinants of health.

By embracing value-based care models and scaling up successful pilots, we can improve patient outcomes, enhance health care quality and bend the cost curve. Can the Minister provide an update on the status of these pilots, what results have come out of them, whether some have been scaled up across the healthcare system and why or why not? What is the expected contribution of value-based healthcare to bending the cost curve.

Digital and AI in Healthcare

Digital technology and AI are rapidly transforming the healthcare landscape around the world. Digitisation and automation of healthcare systems, has the potential to both improve health outcomes and reduce costs in every area of the industry. The rapid development in GenAI has exciting promises in healthcare, with many emerging AI use cases from aspects as diverse as healthcare R&D, consumer billing and other efficiency, productivity and cost improvements. The roll-out of the National Electronic Health Record (NEHR) and the Next Gen Electronic Medical Record (EMR) alongside Healthier SG, adds vast array of new sources of data, AI and GenAI, offering exciting opportunities to improve preventive care and empower patients to manage their own healthcare.

Alternative health care models are also gaining momentum. Telehealth is advancing further, moving from consultations to remote diagnostics, including using AI to analyse symptoms and enable at home lab tests. Wearables and at home smart medical devices are also being rolled out. Virtual hospital wards will facilitate the remote continuous monitoring of patients, helping to reduce demands on hospital beds and manpower as well as reduce the need for hospital trips.

What is MOH doing to further harness the potential of digital technology and AI? What has been the impact thus far, and how do we ensure that these efforts drive sustainable value creation and outcomes?

Ancillary Costs of Healthcare

While the focus on healthcare costs discussions often centres around the costs of medical treatments and procedures, the ancillary costs associated with healthcare are often overlooked. These include medication, transportation and caregiving expenses, and they can add up very quickly to become a significant financial burden. For example, transportation costs can be particularly significant for patients with mobility needs, patients who need access to health services frequently, patients with elderly caregivers, and caregivers who do not stay in the same household. For many families, the Home Caregiver Grant barely begins to cover their caregiving costs. And while the chronic tier of Healthier SG is welcome, patients still face high costs of medications and consumables.

It is imperative that we recognise and address these ancillary costs to ensure equitable access to healthcare for all. This requires a comprehensive approach that encompasses various facets of healthcare costs. For example, addressing transportation barriers could involve subsidies for transportation costs for low income families and scaling up medical transport services, but they can also involve promoting telehealth services, as well as ensuring that HDB and public transportation designs are supportive of people with mobility needs.

Has the Minister studied the ancillary cost burden for patients under different scenarios? What support can the Government provide to alleviate this burden for more families?

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Ageing Caregivers

On a recent house visit, I met Mdm G who is her 90s. She has multiple medical conditions and is bedridden. She lives with three daughters. They are all in their 70s. They sought my help to apply for medical escort services as they struggle to lift her into a wheelchair for her frequent trips to the hospital.

On the same visit, I met Mdm M who takes care of her special-needs grandson. His parents are not in the picture. In her 70s, Mdm M has her own health problems and she was very worried about who would take care of her grandson when she is gone.

As our population ages, many caregivers are ageing or already elderly themselves, grappling with their own age-related health issues, financial constraints and social isolation. The toll of caregiving can be immense physically, emotionally and financially.

The Government has announced many measures to better support caregivers, from higher caregiving grants to enhanced caregiving services and training, to pushing for flexible work arrangements to facilitating special needs trust services. But the challenges are particularly significant when the caregivers themselves are ageing.

Plans under Age Well SG, such as shared stay-in senior care services sandbox, are welcomed, but we must ensure that the solutions are scalable. What can we learn from other aged societies? For example, Japan has been at the forefront of leveraging technology, with robotic assistants, robotic exoskeletons, telepresence robots and smart home systems. What is Singapore doing in this regard?

How can the Government better support ageing caregivers? What other scalable solutions are there to address this issue?

Supporting Seniors with Care Needs

Mr Kwek Hian Chuan Henry (Kebun Baru) : Chairman, as a member of the People's Action Party's (PAP's) Senior Group, I am delighted to hear about the added emphasis by MOH to strengthen home-care services and options for our seniors.

This is timely and much needed. Most seniors, even when they get frail, prefer to age-in-place in the comfort of their homes. Some seniors are fortunate to have their loved ones who can serve as caregivers or can afford to hire full-time caregivers. But not every senior is so fortunate.

As such, I am delighted to hear that MOH, AIC and MOM have recently rolled out the Stay-in Shared Caregiving Sandbox, where five companies will come on board to serve an estimated 800 senior clients. This could mean a different option for our seniors, especially if the companies bring on board well-trained caregivers who can serve multiple seniors, say, living in the same HDB precinct.

Can MOH share more about the details of this sandbox, such as the expected range and pricing of the services, whether the Government will be putting aside spaces within HDB estates to efficiently house these professional caregivers?

Can MOH also share about the proposed single-point of contact plan which is part of Age Well SG and whether this single-point of contact plan will lead to better flow of information which can then be incorporated into this sandbox? It will also be helpful if MOH can provide an update on when they intend to scale up the sandbox to the rest of Singapore and whether constituencies like Kebun Baru with a congregation of seniors in both public and private estates can be considered for early inclusion into this subsequent roll-out or pilot.

The next question is whether MOH can share more details broadly about the single-point of contact and how this effort is complementary to the personal health plan which is part of Healthier SG.

Caregivers' Support and Capacity-building

Ms Carrie Tan (Nee Soon) : Mr Chairman, I would like to bring up an area of work called Caregiver Equipping and seek a review on whether MOH or the Ministry of Social Family Development (MSF) should be the lead agency in charge of this.

While MOH rightly takes care of healthcare, the support and enabling of caregivers should be a community effort with the national strategy of ageing-in-place and, hence, should fall within MSF's purview.

Given the rapidly ageing population, more Singaporeans are finding themselves juggling careers and caregiving. Support for them should be made widely available in their neighbourhoods and not be relegated to healthcare settings or experts, which is costly and unsustainable.

In Khatib, we launched the Caregiver Resource Centre last year to bring capacity-building and a network of peer support to caregivers. Such services should be ramped up quickly so that every caregiver or prospective caregiver can be prepared and equipped to go on this journey whenever it happens.

Many residents shared with me that they were suddenly thrown into a caregiving situation when their aged parents fall ill or have a fall. This was also my experience when my mom was diagnosed with cancer. Luckily, because I have been looking into caregiver provisions and interacting with residents who are caregivers, I found myself much more equipped to know what to do.

I recommend that MOH work closely with MSF to set up community-based caregiver resource centres in every neighbourhood and start training the community with caregiving knowledge and navigation of resources before the care avalanche overwhelms a generation of Singaporeans.

Just like how the Community Emergency and Engagement Committees (C2Es) is a joint effort between the People's Association and the Ministry of Home Affairs (MHA), now ubiquitous in many neighbourhoods, preparing citizens with first-aid and first-responder skills, a similar platform can be set up between MSF and AIC to prepare Singaporeans for caregiving.

The natural place to locate such premises is next to polyclinics and hospitals, and I urge MOH to work closely and in consultation with MSF, which oversees social service agencies to work closely together in such programmes.

The Chairman : Dr Wan Rizal, take your three cuts together.

Tobacco and Vape Control

Dr Wan Rizal (Jalan Besar) : Chairman, in our commitment to foster a healthier Singapore, we confront a persistent challenge that has evolved over the years, combating smoking and its modern counterpart, vaping.

MOH has been at the forefront of this battle, implementing comprehensive strategies to reduce smoking rates and preventing the adoption of alternative smoking habits, such as e-vaporisers.

In recent years, the landscape of smoking has shifted dramatically with the emergence of vaping which is often mistakenly perceived as a less harmful alternative to traditional cigarettes. This misconception poses a challenge in our fight against smoking. We need innovative approaches and robust measures to combat the rise of vaping among Singaporeans.

This evolving challenge leads us to a series of pertinent questions.

What are the Ministry's ongoing plans and future strategies to minimise smoking rates, particularly concerning anti-vaping measures? Will there be a review of the legislative penalties related to e-vaporisers? Additionally, would MOH consider intensifying public education campaigns to dispel myths around vaping? Finally, would MOH consider enhancing surveillance and enforcement measures to prevent the import, distribution and use of e-vaporisers in Singapore?

Community Health

Sir, one of the challenges that all ethnic communities in Singapore face is the promotion of healthier lifestyles, which includes the reduction of smoking prevalence. MOH recognises the complexity of this challenge, understanding that it requires a multifaceted approach that addresses the issues at large and pays close attention to the cultural nuances and specific needs of a diverse population.

Smoking, as we are all aware, is a leading cause of preventable diseases and premature deaths worldwide. In Singapore, our commitment to creating a healthier nation means taking decisive action to curb this habit and mitigate its impact on society. This endeavour, however, cannot be successful without considering the cultural and socio-economic factors that influence lifestyle choices.

Therefore, what initiatives has MOH undertaken to decrease the smoking prevalence and to support the different ethnic groups in leading healthier lifestyles, including details on culturally sensitive interventions to address both physical health disparities and also acknowledge the potential role of mental well-being?

Additionally, would MOH consider forging strong partnerships with community leaders and organisations within these communities? I believe that through this collaboration, we can create culturally resonant messaging that addresses mental health stigmas and increases community buy-in to promote healthier lifestyles with sensitivity and effectiveness.

Mental Health

Chairman, in the recent Mental Health Motion, the Health Government Parliamentary Committee (GPC) brought forth the need for a comprehensive, accessible and compassionate mental health ecosystem, a cornerstone of a resilient and healthier Singapore.

Our journey towards improving mental healthcare is not just about enhancing services. It is about changing perceptions, breaking down stigma and fostering a support system that supports mental well-being at every level.

MOH has undertaken various initiatives to expand the availability and quality of mental health services. Furthermore, the Government recognises that mental health is a priority and integral to overall health and well-being. To that end, I would like to ask: what progress has MOH made in advancing mental healthcare and what are the forthcoming strategies and structures being implemented to enhance the accessibility and integration of mental health services within the community?

Additionally, would MOH consider working closely with religious organisations by providing them with the training and support for their staff as we expand into a more community-based approach? Training staff as Tier 1 care providers to recognise common mental health issues not only aids in intervention but also supports our idea of long-term care and rehabilitation within the community.

Sir, with the rapid advancement of AI technology, is the Ministry considering using AI in telehealth and digital mental health interventions? This could alleviate the manpower shortage and make mental healthcare a more flexible and accessible approach. However, it is vital to ensure quality control and efficacy of such platforms, backed by robust research.

Sir, the Government's commitment to advancing mental healthcare is evident and we are grateful for that. We know that the journey is long and we must take it as a marathon, not just a sprint.

So, let us move towards a future where mental health is prioritised, supported and integrated into every aspect of our community. We must ensure that everyone has the access to the support they need to lead a mentally healthy lifestyle.

National Mental Health Office

Mr Keith Chua (Nominated Member) : Mr Chairman, providing necessary mental health and wellness services and support cuts across many Ministries. The several Ministries include MOH, MSF, MOE, the Ministry of Culture, Community and Youth (MCCY), MOM and MHA. Current service providers, whether under MOH, MSF or MOE, therefore, welcome the establishment of the National Mental Health Office.

Seamless continuum of care is essential to delivering the best care to persons with mental health issues. Also key will be the continual efforts to reduce stigma and early diagnosis and intervention.

We also need to keep strengthening support networks for recovery in the community. This Parliament recently called for a whole-of-nation approach to addressing the current and future mental health challenges in our nation.

May I seek updates, therefore, on the key areas the National Mental Health Office will initially focus on and whether there has been agreement on initial key indicators to determine outcomes that we can all work towards?

The Chairman : Senior Parliamentary Secretary Rahayu Mahzam.