動議 · 2023-05-10 · 屆國會 14
支援醫療健康發展
辯論聚焦疫情後持續支援醫療健康，特別強調學術界心理健康問題。議員指出學術壓力導致研究人員和研究生焦慮抑鬱比例高，呼籲關注精神健康。政府未直接回應，核心爭議在於如何平衡學術績效壓力與心理健康保障。
關鍵要點
- • 學術界心理健康問題突出
- • 學術壓力導致焦慮抑鬱
- • 需持續支援醫療健康
關注學術心理健康
“graduate students are more than six times as likely to experience anxiety and depression compared to the general population.”
參與人員 (16)
- Jamus Jerome Lim
- Community and Youth and Minister for Social and Family Development
- Hoon Hian Teck
- Janet Ang
- Koh Lian Pin
- Leon Perera
- Leong Mun Wai
- Mark Chay
- Minister of State for Education
- Ong Ye Kung
- Raj Joshua Thomas
- Senior Minister of State for Health
- Senior Parliamentary Secretary to the Minister for Culture
- Tan Yia Swam
- Wan Rizal
- Yip Hon Weng
完整譯文（中文）
Hansard 原始記錄 · 2026-05-02
[(程式文本) 議事程式：恢復辯論議題的秩序宣讀[2023年5月9日]。(程式文本)]
[(程式文本) “本院承諾支援新冠疫情後的醫療保健工作，以及全政府範圍內為持續和穩定支援所做的努力。”——[陳雅森醫生] (程式文本)]
[(程式文本) 議題再次提出。(程式文本)]
副議長：許連彬教授。
下午1時39分
許連彬教授（提名議員）：副議長先生，我支援這項動議。今天我想加入辯論，強調學術界日益嚴重的醫療保健問題。
我們的大學和學術機構是高等教育、研究和創新的場所，同時也是教職員、研究人員和學生花費大量時間的工作場所。
近年來，學術工作環境日益緊張，導致大學研究人員和研究生中心理健康問題的發病率和患病率上升。
2018年進行的一項全球研究發現，全球41%的研究生患有中度至重度焦慮，39%表現出中度至重度抑鬱的跡象。該調查基於來自26個國家230所機構的2000多名學生的回應，報告顯示，研究生患焦慮和抑鬱的可能性是普通人群的六倍以上。
學術界心理健康問題日益普遍可能有多種原因。其中最大的原因之一無疑是持續的績效壓力。
學術道路既漫長又狹窄，且伴隨顯著的機會成本。作為早期職業研究人員，通常在20多歲和30多歲期間投入約10至15年最具生產力的時間，獲得日益專業化的技能，隨著他們作為研究生、博士後研究員再到初級教授的培訓進展，轉向其他職業的空間越來越狹窄。繼續沿著這條道路併成功成為終身教職學者的壓力巨大。
此外，某些學科的學術研究性質艱苦且不可預測。實驗室實驗或實地調查的要求通常需要個人在下班後和週末工作。這些漫長、不規律且艱苦的研究時間不可避免地影響工作與生活的平衡，對早期職業研究人員的心理健康產生重大影響。
他們中的許多人正處於試圖組建家庭的年齡，因此這些心理健康影響可能也會波及其伴侶和其他親人。
此外，許多以研究為主的大學在評估教職員和研究人員績效時，會考慮各種與發表相關的指標。這可能導致“發表或滅亡”的心態，特別是在早期職業研究人員中產生巨大壓力，促使他們快速、頻繁地在最受認可的科學期刊上發表文章。
強有力的發表記錄對獲得良好的博士後職位和學術終身職位至關重要。然而，持續不斷的發表壓力可能導致持續的焦慮感，進而引發倦怠和其他心理健康問題。
早期職業研究人員心理健康問題的另一個主要原因是工作不穩定。許多選擇學術職業的人希望有朝一日成為終身教授，但教授職位遠遠不足以滿足日益增長的博士畢業生人數，尤其是在新加坡。
因此，許多早期職業研究人員依靠研究經費支援的短期合同工作。這些經費的期限和規模可能變化且不可預測，導致長期就業的不確定性。這種缺乏工作保障也會導致持續的壓力和焦慮，因為研究人員不斷擔心下一份合同和未來的職業前景。
在研究生中，尤其是那些來自海外、來新加坡攻讀研究生研究的學生，生活成本的上升可能是當今最大的壓力因素之一。許多新加坡的博士生依靠研究獎學金，這些獎學金提供的津貼相對較低，與他們在職場上的同齡人收入相比差距明顯。持續的生活成本擔憂可能導致惡性迴圈，造成心理健康惡化和學業表現下降，個人在應對研究生嚴格學業要求的同時，還要管理作為年輕成人的經濟壓力。
最後，學術文化本身也可能成為解決心理健康問題的重大障礙。事實上，學術界中可能存在一種普遍但錯誤的看法，認為承認自己心理健康有問題是軟弱、無能或不夠格的表現。這種汙名化可能導致個人覺得必須隱藏自己的困境以融入環境或維持學術地位。如果不加以挑戰，這種汙名化會導致個人延遲尋求心理健康幫助或治療，進而加重症狀，對個人和學術生活產生不利影響。
為應對學術界日益嚴重的心理健康問題，我們可以考慮以下建議，其中一些已在本地大學和研究機構實施，但我們總能做得更多。
首先，我們可以加大對心理健康研究的投入，以瞭解新加坡學術界心理健康問題的範圍和性質，從而幫助我們制定更有效和定製化的解決方案。
其次，我們可以提供更多心理健康支援服務，包括工作坊、支援小組和心理健康專業人員，營造校園內負擔得起且易於獲得的心理健康資源生態系統，幫助有需要的人。
第三，我們可以加大力度提高心理健康意識，減少學術界的汙名化。重要的是，我們可以通過為高階教職員和工作人員提供培訓，教他們如何識別和支援可能面臨困境的個人，營造開放和支援的文化。這樣，我們可以去汙名化並使心理健康討論成為常態。
最後，我們還可以努力使學術界的工作與生活平衡更加健康。這可能包括提供更多遠端工作和靈活工作時間的機會，制定限制下班後傳送郵件和召開會議的政策。
作為已有舉措的鼓舞人心的例子，新加坡國立大學自2021年起開展了#AreuOK心理健康關懷運動。其主要目標是消除NUS社群對心理健康狀況的汙名，並支援尋求幫助的人。該運動提供免費且保密的心理健康檢查、情緒支援會談和24小時熱線等服務。我宣告我是NUS教授。當然，新加坡其他大學也為其學術社群提供類似的舉措和支援。
在國家層面，健康促進局開展了全國心理健康運動“It's OKAY to Reach Out”，旨在使心理健康和福祉話題成為常態，增強理解和意識，鼓勵新加坡人尋求支援。
先生，新加坡是全球研究和創新的領導者。我們大學和研究機構的質量在維持這一地位中發揮關鍵作用。更重要的是，身體和心理健康的研究人員隊伍，包括各級研究生和研究人員，是確保新加坡持續產出高質量研究的必要條件。
此外，新加坡的學術界多元且國際化，來自不同文化、背景和經歷的個人共同努力，致力於創造有影響力的新知識、科學和技術。提供支援性和包容性的環境，促進學術社群所有成員的心理健康，將使我們能夠吸引和留住來自世界各地的頂尖人才，保持新加坡作為全球知識和創新中心的地位。
解決學術界的心理健康問題不僅是道德責任，也是經濟責任。世界衛生組織最近報告稱，抑鬱和焦慮障礙每年給全球經濟造成超過1萬億美元的損失。杜克-國大醫學院和心理健康研究所最近的一項研究估計，新加坡因焦慮和抑鬱導致的生產力損失的經濟負擔每年近160億新元。通過投資學術界的心理健康專案，我們可以提升學術人員的生產力和表現，從而對整體經濟產生積極影響。
總之，解決學術界的心理健康問題對新加坡作為知識和創新中心的成功至關重要，有助於吸引和留住頂尖人才，強化經濟，建設有韌性的勞動力和社會。
讓我們共同努力，在學術界營造開放、支援和理解的文化，使個人能夠無懼汙名和評判地尋求幫助，發揮其全部潛力。
最後，我與其他議員一道，感謝護士、醫生及所有醫療工作者為國家的身心健康所做的不懈努力、奉獻和犧牲。副議長先生，我支援這項動議。
副議長：李安佩拉先生。
下午1時51分
李安佩拉先生（阿裕尼選區）：副議長先生，閣下，在評判一個社會的宜居性和先程序度時，其醫療保健部門的質量和可負擔性起著關鍵作用。
在大多數國家，醫療保健的提供性質因其重要性而備受爭議和辯論。在包括我們國家在內的許多國家，醫療保健也是經濟的重要部門，直接和間接創造大量就業機會。
疫情後，我希望像兀蘭醫療園區和陳篤生醫院綜合護理中心等新設施的建設進展加快。然而，滿足我們長期醫療需求的主要障礙——主要挑戰——不在於建設實體設施，而在於醫療人員的招聘、留任和提升生產力。今天我的發言將圍繞這一主題展開。
在我的發言中，我將支援該動議，討論：（一）解決醫療人員的招聘和留任問題；（二）提升醫療人員的生產力；（三）通過解決上游健康問題來源及其他方式，在不成比例增加成本的情況下改善整個醫療系統的成果。
在此之前，我宣告本人是某公司董事長，該公司在醫療領域及其他行業提供諮詢服務。
先生，在準備這次發言時，我在家庭晚餐桌上提出瞭如何吸引更多新加坡人進入醫療行業的話題。我的女兒毫不猶豫地回答，我引用她的話：“給他們體面的工作時間、工作中的尊重和良好的薪酬。”
這確實是我們面臨的一個重大長期挑戰。我們可以建造病房和診所，購買裝置，但如何吸引和留住醫療行業的工作人員，減少人員流失，確保有一批專業人員作為未來領導者的儲備，確保良好的學習曲線和足夠的經驗與技能積累，從而提升服務和效率，確保患者獲得良好治療效果？
有媒體和傳聞報道因人手不足導致設施閒置。例如，今日報最近援引一位私人醫生的話稱，“事實上，幾家私立醫院因護士短缺關閉了一些病房和手術室。”
醫療行業至關重要的人力資源挑戰可細分為幾個方面——薪酬、工作時間、工作條件和職業晉升，以及生產力，同時確保工作具有意義感。
首先，關於薪酬。雖然護士薪酬去年有所提高——這是值得歡迎的——但這是七年來的首次基本工資上漲。初級醫生的薪酬也最近有所提升，但根據我最近的議會質詢回覆，7%至13%的起薪增長適用於實習醫生和第一年醫務官（MO）。然而，更有經驗的初級醫生，即符合條件的在職醫務官或住院醫生至博士後第6年，以及牙科醫生至博士後第4年，預計薪酬調整將基於其服務年限和合同期，而非統一漲幅，據我瞭解。
顯然，為了吸引和留住人才，薪酬必須具有競爭力。此外，在醫療領域，人才可以跨國流動。許多國家缺乏經驗豐富的醫療人員，許多國家希望挖角我們講英語且訓練有素的醫療工作者。
因此，我想詢問是否可以基於每小時薪酬——即每小時總收入——監測和跟蹤醫療人員的薪酬，並定期與我們爭奪醫療人才的其他發達國家地區進行基準比較，並公佈結果，以便我們清楚瞭解自身狀況，判斷是否將面臨需要注意的波動。
我知道偶爾會有相關學術研究發表，但我不清楚政府是否有定期釋出此類報告。
接下來，關於管理工作時間和防止倦怠。提高薪酬沒有意義，如果人手不足導致工作時間增加，使得每小時薪酬保持不變甚至下降。
先生，我之前在議會多次提出初級醫生工作時間的問題。我想重申呼籲，將初級醫生每週工作時長從80小時減少到70小時，並加強執行，確保遵守。
有證據表明，70小時每週的工作上限與80小時相比，培訓效果相同，正如我在之前的供應委員會發言中所述。這還需要簡化系統，使初級醫生和護士能更多時間用於患者護理和培訓，而非行政事務。
我還呼籲實現目前10小時值班間隔的100%合規率，從目前的90%提高，確保無工作時間漏報，並採取具體措施縮短交接行政和外圍任務的時間。
我瞭解到，公共醫療系統正在審查初級醫生的工作條件。希望在此過程中充分考慮最佳化工作時間的必要性。
接下來，副議長先生，關於工作負荷。工作負荷當然是醫療需求與人力容量的函式。隨著人口老齡化，我們的醫療需求將穩步上升，我們也是全球老齡化最快的國家之一。
翁部長表示，護理學生的年招生人數將從2100人增至2300人。如果護士能留在行業，這將有助於滿足需求。
目前，新加坡註冊護士中新加坡人的比例略高於60%。對於如此關鍵的職業，保持強大的新加坡核心力量和良好的職業晉升通道非常重要，使護士能夠晉升為高階護士執業者和領導崗位。
我知道目前護理獎學金主要由醫療集團頒發。我想知道這個數量是否足以滿足未來需求，培養足夠的護士人才儲備，以擔任未來高階護士執業者、導師和領導角色。
衛生部是否會基於此進行護理獎學金數量的審查？此類審查是否也涵蓋護理研究生獎學金的發放，鑑於未來醫療行業日益複雜且依賴技術？目前似乎只有一個學術專案提供高階執業護士所需的護理碩士學位。
最後，關於工作負荷。為了加強護理等職業中的新加坡核心力量，我們應優先考慮那些在相關職業中已在本地生活和工作一段時間、且表現出良好社會融合能力的外國人，給予他們永久居民身份，最終獲得公民身份。
我相信本院其他議員此前也提出過類似呼籲，政府表示對此持開放態度。對此，我重申呼籲，使公民身份授予過程更加透明，例如提供線上積分計算器，類似其他國家的做法。這可能通過提供更清晰和有保障的資訊，使新加坡對來自其他國家的醫療專業人員更具吸引力。
接下來，副議長先生，關於藥劑師的角色。為了提高我們整個系統的生產力，政府是否會考慮賦予藥劑師在某些疾病情況下開藥的權力？澳大利亞已經在考慮這一點，儘管對此有一些反對聲音。我們的藥劑師已經在某些慢性病藥物的劑量調整方面發揮作用，先進執業護士在本地醫療機構也有合作處方模式。
我建議政府關注國際動態，並根據新興的國際證據，考慮是否以及如何賦予藥劑師更大的處方權。這可能最初會對全科醫生（GP）產生負面影響，但我稍後會提出一些關於全科醫生的建議。
接下來，副議長先生，我想談談其他相關醫療專業人員和醫務人員的必要角色。我注意到政府計劃讓社群藥劑師在推廣健康篩查和疫苗接種等方面發揮更大作用。
我去年在關於預防醫療的休會動議以及之前通過質詢中都談到了健康篩查和疫苗接種的重要作用。mRNA技術已經催生了可能在未來幾十年帶來革命性突破的醫學發展。但回到當前現實，我們似乎在更常規的疫苗接種方面，如流感疫苗，落後於許多發達國家。這限制了下游慢性或災難性疾病的發生率。
此外，令人擔憂的是，2021年國家人口健康調查顯示，2021年參與慢性病和癌症篩查的新加坡居民比2019年減少。
政府計劃增加相關醫療專業人員的數量。這些專業人員在社群醫療中可以發揮關鍵作用，推動更健康的生活方式和適當的求助行為，包括心理健康狀況，同時幫助慢性病患者預防併發症的發生。
在亞逸組群選區實龍崗選區，我和志願者有幸與陳篤生醫院（TTSH）社群合作伙伴合作，在一棟租賃組屋舉辦健康講座和諮詢活動。我們還會將遇到的病例轉介給陳篤生醫院社群合作伙伴（TTSH CP），該機構也會在實龍崗北的金姜社群關懷服務中心安排護士駐點，向當地居民提供篩查和建議。
這些都是值得稱讚且有益的干預措施，我希望能在其他目前缺乏此類服務的地區複製。這些最終應由中央資助，因為它們不需要昂貴的基礎設施，也可以讓本地護士、物理治療師、職業治療師和足病醫生等有家庭的專業人員，或許能在自己社群附近兼職工作。
部署此類相關醫療專業人員的模式通常是利用吸引人們關注健康問題的活動。然而，利潔時進行的一項調查顯示，大多數新加坡人對自身健康採取較為被動的態度，並不經常或總是主動尋求改善健康的資訊。因此，我們有必要尋找更符合商業營銷中所謂“狩獵”式（直接銷售）而非“耕耘”式（吸引客戶主動上門）的方法。
為此，我想知道一旦我們擁有足夠數量的健康教練，是否可以作為一項舉措，將他們派往組屋底層、熟食中心和溼市場。這些地方人流量大，尤其是老年人較多，他們可能更需要醫療干預。如果能有流利使用方言的人員在這些場所以更主動的方式接觸他們，推廣疫苗接種和健康篩查等理念，甚至現場進行某些基本篩查活動，可能會很有幫助。對於年輕群體，或許更適合依賴社交媒體的策略。
接下來，副議長先生，讓我談談全科醫生的角色。我們大約有1800家全科診所，在醫療系統中作為非緊急情況的第一道防線發揮重要作用。隨著“更健康的新加坡”計劃的推進，這一角色將更加重要。在吸引和留住優秀醫療專業人員時，我們不應忽視全科醫生。
然而，有一些令人擔憂的跡象。南洋理工大學2022年在《BMC初級保健》雜誌發表的一項針對300名全科醫生的調查顯示，14.4%計劃永久離開全科醫療，12.6%計劃休職業假，51.3%計劃減少臨床工作時間。提高薪酬、將全科和家庭醫學認定為醫學專科、減少醫療訴訟壓力被認為是這些決定中最重要的因素，同時該群體對管理保險安排的第三方管理員日益不滿。如果全科醫生大量流失，可能會影響我們實現初級醫療和“更健康的新加坡”目標的能力。
此外，國家醫療集團2014年在《亞太家庭醫學》雜誌發表的一項關於初級醫療質量的研究，調查了85名專家，結論是新加坡系統存在若干問題，我引用：“新加坡的初級醫療系統得分為30分中的10.9分……專家將新加坡歸類為‘低’水平的初級醫療國家。”初級醫療醫生的收入相較專科醫生是被提及的幾個因素之一。
先生，我這裡有幾點建議，旨在解決全科醫生群體和初級醫療面臨的一些問題。
首先，我們是否應定期對全科醫生群體進行調查，瞭解他們的經歷、痛點、對生態系統缺口的看法以及對政府、保險公司和其他利益相關者的建議？我認為，我們的大多數全科醫生都是深思熟慮且見多識廣的人，他們應有建設性政策變革的好主意。衛生部（MOH）大約每十年進行一次初級醫療調查，主要確定初級醫療部門的經濟引數，但可以做得更多。
其次，政府是否可以探索將個別全科醫生和經營全科診所的企業集團納入政府藥品採購系統，以便各方基於更大批次採購獲得更低價格？目前，藥品銷售代表通常向個別全科醫生銷售藥品，這導致採購分散，議價能力和規模經濟大大降低。
順便說一句，我曾排隊看全科醫生，排在我後面的人卻先被叫進去。我不介意，只是好奇，於是問接待員原因，她說因為我當時戴著領帶，她誤以為我是藥品銷售代表而非病人，所以優先安排了別人。
無論如何，我瞭解到政府目前正在研究允許私營醫療提供者使用政府藥品採購系統（ALPS）的想法，我希望政府能儘快推進，實現公私部門的聯合採購，儘可能發揮最大效益。
最後，作為我之前提到的調查工作的一部分，政府是否可以識別那些有空閒接診能力的全科醫生——即某些時段患者較少——並尋找方式吸引他們，如果他們願意的話，協助增加多元診所或其他公共醫療機構的接診能力？據傳，全科醫生網路密度長期有所增加，競爭加劇，這可能導致部分全科醫生在某些時段有空閒能力。
副議長先生，我現在進入演講的最後部分——如何提高醫療人員的勞動生產率？我想起我年輕時作為經濟發展局（EDB）官員時的一段有趣對話。一位同事與另一位經理交談，經理說沒有相應增加人數就無法提高產出，同事回答：“啊，是的，但那是假設生產率零增長。”這句簡潔的智慧我至今難忘。
當然，隨著醫療需求增長，我們需要招聘更多員工。但我們需要控制增長速度，以管理成本，同時避免因過多外來勞動力湧入而帶來的人口壓力——這裡我使用“勞動力”一詞，當然是性別中性的。
如何做到這一點？我們可以借鑑醫療技術進步和全球最佳實踐。例如，遠端醫療可以提高員工利用率，也節省患者時間。一些調查顯示，新加坡人對虛擬診療持開放態度。還有機器人技術，例如服務機器人可以承擔醫療禮賓的一些職能，機器人裝置也能在康復醫學中發揮作用。
我知道這些創新已經進入我們的醫療系統，且更多創新正在考慮中。我也知道這不是新話題。2012年，衛生部推出了醫療生產力路線圖，2017年設立了醫療生產力基金，還有國家醫療生產力與創新獎。然而，我這裡有幾點建議。
首先，人工智慧（AI）、計算機和機器人等前沿技術在醫療領域的應用潛力巨大。例如，埃森哲2019年關於新加坡醫療勞動力的研究指出，技術可為醫生節省10%的時間，藥劑師10%，護士22%，實驗室科學家31%，藥房技術員50%，醫療記錄員高達68%。
我建議政府不時測量醫療勞動生產率，並公佈結果，與其他全球城市的生產率標準進行基準比較。我認為進行城市間比較非常有用。可以考慮多種指標。理想情況下，應分別測量公立和私立醫療，以便比較。這些資料可用於識別表現優異的案例，記錄並分享最佳實踐和案例研究。如果不知道現狀，就無法達到目標。
其次，特別是在心理健康護理方面，我們面臨挑戰。一些專家談及青少年心理健康危機，這種現象可能並非新加坡獨有。我們的臨床心理學家和精神科醫生比例落後於一些發達國家，我和其他議員此前也曾提出。政府是否會探索利用人工智慧技術增強心理健康護理能力？
例如，總部位於波士頓的公司“OM1”最近開發了名為“PHenOM”的人工智慧平臺，幫助精神科醫生提升診斷和治療的效果與效率。新加坡公司Holmusk與英國國家醫療服務體系（NHS）及利物浦大學合作，建立了心理健康分析與研究中心。Holmusk的心理健康分析平臺規模龐大。我希望政府考慮與此類公司，尤其是本地公司合作，推動創新。
總之，副議長先生，隨著人口老齡化，我們未來對醫療系統的需求將更大。但未來也將有更多機會利用技術和創新提高效率，強化上游預防。我們需要抓住機遇，應對挑戰。
這必須由我們的醫療專業人員完成，他們是醫療工作的核心，沒有他們，一切皆無可能。歸根結底，醫療是且必須始終是深具人文關懷的事業。吸引、留住併發揮我們優秀醫療工作者的最大潛力，是醫療中最重要的目標。
在結束前，副議長先生，我想與尊敬的賈瑞德議員及其他議員一道，代表全社會向我們出色的護士們表達深切感謝，並提前祝願他們即將到來的護士節快樂。
副議長：馬克·蔡議員。
下午2時10分
馬克·蔡議員（提名議員）：副議長先生，感謝您給予我機會，就我的同僚提名議員陳雅心博士、莎希拉·阿卜杜拉博士和阿卜杜勒·薩馬德先生提出的動議發言，支援疫情後醫療保健，並呼籲政府整體努力，提供持續穩定的支援。先生，我支援這項動議。
我首先要衷心感謝新加坡的醫療專業人員，他們在新冠疫情期間表現出非凡的奉獻精神和無私精神，努力照顧患者。儘管醫療服務需求大幅增加，他們依然以專業和同理心提供卓越的護理。
我們對醫療工作者和管理人員在這段艱難時期的不懈努力深表感激。你們的勇氣和韌性對抗擊疫情產生了巨大影響，我謹向你們的卓越工作致以最深切的謝意。
在新冠疫情期間，新加坡政府為醫療工作者提供了重要支援，包括財政援助、資源和培訓，幫助他們應對不斷增長的需求，同時治療新冠患者。然而，我們不應僅在危機時期認可醫療專業人員的貢獻，未來在與新冠共存的世界中，我們仍應認可他們的寶貴貢獻。
新加坡卓越的醫療體系容易被忽視，人們往往未能體會到為全國提供一流醫療服務所付出的奉獻和努力。政府在公共衛生基礎設施和醫療補貼方面投入巨大，使新加坡人無論經濟狀況如何，都能獲得適當的醫療照顧。我們應繼續堅持這一點，不是為了全球競爭，而是因為這是對新加坡人負責任的做法。
副議長先生，醫療保健是關乎每個人的重要議題，因為每個人一生中都需要獲得醫療服務。良好的健康是個人過上富有成效和充實生活的基礎，獲得優質醫療服務對維持健康至關重要。正因醫療影響每個人，我很高興看到這項動議的提出。我完全同意尊敬議員們的觀點，我們應採取政府整體協作的方式推進醫療保健。
這很關鍵，因為它認識到醫療不僅是醫療部門的責任，還涉及許多其他部門和因素。通過綜合方法，新加坡可以識別並解決醫療問題的根源，改善公民的健康結果。我想談談以下四個我認為應更多關注的方面。
首先，關於老年人和殘疾人士的醫療服務可及性。新加坡人口老齡化，老年醫療服務需求預計將增加。隨著人口老齡化，慢性病、認知障礙、跌倒、虛弱等問題更為普遍，嚴重影響生活質量。這需要對老齡化過程及多種疾病、藥物和身體障礙的最佳管理具備專業知識。
教導新加坡人如何優雅老去也應得到投資，需要整體方法，不僅關注診斷和治療，還要重視功能能力、社互動動和心理健康。為此，衛生部若能與技能未來合作，增加適合老年人的課程的獲取和採用，將是好事。現有課程如藝術、營養和數字素養，但我相信可以提供更多促進身心健康的課程。
隨著新加坡老年人口增加，老年學的重要性不容忽視，它幫助我們的銀髮一代保持獨立、改善健康結果並過上充實生活。
副議長先生，確保殘疾人士（PwDs）獲得醫療服務同樣對促進公平包容的醫療至關重要。不幸的是，殘疾人士常面臨身體、溝通和態度等障礙，阻礙他們獲得醫療服務。
我很高興已經採取措施讓殘疾人士（PwDs）更容易獲得醫療服務，例如無障礙設施如輪椅坡道、高度可調節的檢查臺和無障礙洗手間。除了現有的努力外，醫療服務提供者還可以通過確保員工接受手語培訓或提供助聽器、視覺輔助等溝通輔助工具，改善與視力和聽力障礙者的溝通。
除了物理無障礙，醫療服務提供者還可以通過為員工提供教育和培訓，改善他們對殘疾人士的態度。他們還可以致力於在醫療政策和程式中促進殘疾包容。
目前，有許多中小企業（SMEs）和非政府組織（NGOs）致力於幫助殘疾人士，開展更多關於持續改進殘疾人士服務以及提高殘疾人士對這些服務的訪問和認知的對話將是有益的。
通過採取這些措施，醫療服務提供者可以確保殘疾人士獲得與非殘疾人士同等質量的醫療服務。優先考慮無障礙和公平的醫療服務對於建設一個更健康、更包容的社會至關重要。
我現在轉到第二點，當我們慶祝新加坡代表隊運動員在金邊取得的勝利時，我們也應認可運動員及其隨行人員為新加坡爭光所付出的辛勤努力和犧牲。我們的精英運動員常常面臨巨大的身體和心理壓力。這些壓力可能影響他們的表現、長期身體健康和整體福祉。
為了在運動中取得優異成績，運動員必須保持嚴格的訓練紀律，遵守嚴格的飲食要求，並克服身體傷害。不幸的是，這些壓力常常導致心理健康問題，如焦慮、抑鬱和飲食失調。
除了身體壓力，許多運動員還面臨顯著的社會壓力。他們可能感受到來自隊友、教練、粉絲和媒體的壓力。這可能導致額外的心理健康問題，包括壓力、倦怠和自信心缺失。
精英運動員需要獲得資源來幫助他們應對這些壓力。這可以包括心理健康支援、運動心理學和有經驗運動員的指導。
運動員也必須明白，優先考慮他們的心理和身體健康而非運動是可以接受的。許多運動員，如黃美（May Ooi）和連康斯坦斯（Constance Lien），已經認識到這一點，併成為心理健康意識和自我關懷的倡導者。
通過承認精英運動員面臨的壓力並提供必要的支援，我們可以幫助他們在保持長期身體和心理健康的同時發揮最佳表現。因此，我希望能投入更多支援來應對我們國家隊的這些獨特需求。
第三，關於營造充滿活力的體育和健身文化。我們常常忽視健康，直到某個事件直接影響我們。最近，一位朋友因心臟病發作去世。他還很年輕，他的悲劇和突然離世引發了我同齡人之間關於健康與體能的討論，以及我們對健康和福祉的整體教育。如果衛生部（MOH）、教育部（MOE）和體育理事會（SportSG）能在新加坡人進入職場時，在高等教育階段教授如何鍛鍊，那將是很好的。訓練和鍛鍊是有區別的。我們參加課外活動（CCA），體育CCA教你如何訓練——突破身體極限以提升表現，但鍛鍊是關於維護、靈活性和生活方式。
鍛鍊應成為一種習慣，而形成習慣很大程度上取決於便利性、常規和可及性。有些議員可能知道陳雅心醫生（Dr Tan Yia Swam）是熱衷跑酷的運動者。跑酷是一項跳躍、攀爬和滑行穿越地形的運動。在新加坡，這種地形是城市地形，我很高興看到索美塞（Somerset）和湖畔（Lakeside）等地建有相關專案和設施。
我希望能建造更多符合新加坡城市景觀和興趣的城市體育設施。我也希望並鼓勵配套專案與這些設施同步開展。為此，教練需要接受培訓、獲得資格並被聘用。我很高興看到今年預算委員會（COS）上，文化、社區及青年部（MCCY）宣佈了涵蓋多種活動和學科的私人教練註冊制度。但為了賦能該註冊，教練需要擁有更新且相關的教學內容。我鼓勵體育理事會（SportSG）、健康促進局（HPB）、教育部（MOE）和人民協會（PA）就提供相關、適齡的體育專案進行更多討論，以滿足充滿活力、積極的新加坡人口需求。
第四，針對在疫情期間辛勤工作的前線人員遭受言語辱罵的問題令人痛心。儘管他們堅定不移地承擔繁重工作，醫護人員、關鍵崗位工作人員及其他公眾服務人員仍遭受言語辱罵、羞辱和批評。
除了情緒上的消耗，言語辱罵還可能導致心理和身體健康問題，影響受害者的職業和個人生活。因此，認識到前線人員的價值並通過表達感激、認可他們的辛勤工作以及承擔我們的共同責任來支援他們至關重要。前線人員應獲得我們最充分的尊重、支援和同情。
認識並解決這一問題對於追究責任人責任至關重要。醫療機構可以為員工提供緩解緊張局勢的培訓，並實施報告和處理言語辱罵的政策。此外，公眾宣傳活動可以教育人們尊重前線工作人員的重要性及其行為的後果。
總之，副議長先生，新冠疫情展示了我們醫護人員和抗疫前線工作人員的勇敢、奉獻和無私。他們在艱難條件下長時間工作，冒著健康風險照顧病人。隨著疫情逐漸緩解，政府必須繼續支援醫護人員，即使疫情結束後也是如此。
我希望政府為醫護人員提供持續的心理健康支援，以應對他們經歷帶來的心理影響。疫情對他們的心理健康和福祉造成了影響，他們必須獲得支援和資源來應對任何長期影響。
我們的政府還應投資於健康和安全措施，以保護醫護人員免受未來疫情的影響。這包括提供充足的個人防護裝備、培訓和疫苗接種。處於傳染病爆發前線的醫護人員必須得到充分保護，免受未來可能面臨的任何潛在危險。
通過在疫情後表達對醫護人員的支援和感激，我們為他們在社會中的角色創造了價值感。他們的犧牲和辛勤工作值得認可，這將極大激勵和鼓舞他們。政府應繼續支援醫護人員，為我們的醫療行業和依賴他們的患者建設更光明的未來。
副議長先生：黃瑞扎爾醫生。
下午2時24分
黃瑞扎爾醫生（惹蘭勿剎選區）：副議長先生，感謝尊敬的議員們，陳雅心醫生、阿都沙末先生和沙希拉醫生提出這項動議。作為國會議員，我們有著共同的目標：為子孫後代創造一個更健康、更有韌性的獅城。
我國的醫療體系是實現這一目標的重要組成部分，我很感激有機會就這一重要議題展開建設性對話。我想談兩個廣泛的話題。首先，不出意外，是關於心理健康；其次，是我們通過“健康股份”（Saham Kesihatan）計劃在馬來社群的努力。
先生，心理健康是我們醫療體系的關鍵組成部分。它不僅關係到個人的福祉，也關係到社會的健康和生產力。我很高興陳雅心醫生提到了這一點。我們必須正視陳醫生提出的挑戰，並繼續協作尋找有效解決方案。
近年來，新加坡人之間關於心理健康的對話變得更加容易，這絕非偶然。這得益於政府通過心理健康與福祉跨部門工作組、私營部門、社群夥伴和草根團體的努力，致力於消除心理健康問題的汙名。
雖然我們在心理健康意識方面取得了進展，但必須認識到仍有許多工作要做，特別是在如何直接緩解心理健康問題方面。
我想回顧一下2020年我在休會動議中提出的一些觀點，以呼應陳雅心醫生。在那次發言中，我分享了“LAST”縮寫。簡要來說，“L”代表識字率（literacy），“A”代表可及性（accessibility），“S”代表篩查（screening），“T”代表休息時間（time-outs）。
作為一名教育者，我非常認同陳雅心醫生關於教育重要性的觀點。我們必須繼續提高公民的心理健康素養，應從學校開始早期引入。因此，我很高興教育部已經更新了涵蓋身體、心理和情緒健康的青少年課程。
但我希望我們能更直接地影響心理健康，超越教育或意識層面，將心理健康篩查納入常規體檢。目的很簡單，我們希望創造常態，促進心理健康問題的早期發現和干預，從而帶來更好的個人生活質量和結果。這也有助於減輕社會因未治療心理健康問題帶來的負擔，促進社群整體福祉。
現在，我有信心我們可以培育一個消除心理健康汙名的社群。但我也必須提醒自己，這種觀念轉變不會輕易、不會立刻或很快發生。像許多教育專案一樣，改變可能需要相當長的時間。
二十年前，作為教師，我班上有需要特別關注的學生。當時有人質疑我為何要採取差異化教學方法。二十年後，我們可以看到社會變得更加包容，感謝公共和私營部門的努力，包括像尊敬議員兼惹蘭勿剎集選區同事Denise Phua這樣的倡導者，現在需要特別關注的學生得到了接納和及時適當的干預。
雖然我們尚未達到心理健康同等程度的接受度，但我們必須堅持不懈。我們必須繼續採取“全社會”方法對待心理健康，這意味著政府整體、私營部門、社群夥伴、草根團體和宗教組織的積極參與。
作為國會議員，我們必須全心全意相信這一事業，並努力使之成為現實。我讚賞本院議員及前輩們為心理健康所做的倡導。當我們作為一個社會、全社會放大經歷過心理健康問題者的聲音時，我們有助於打破阻礙個人尋求幫助的障礙，營造更包容和支援的環境。
先生，除了教育和篩查，談及心理健康，心理健康服務的可及性仍是鼓勵個人尋求幫助的關鍵。我們希望他們能無懼汙名、歧視或成本、等待時間、交通甚至距離等障礙，獲得心理健康服務。此外，創造一個支援和歡迎的環境，使他們感到舒適和安全，能夠無羞恥和無評判地尋求幫助也很重要。
我很高興衛生部通過多元診所和遠端醫療服務增加了服務點，使心理健康服務更廣泛地惠及有需要的人群。然而，我也意識到缺乏受過培訓的心理健康專業人員，他們能為尋求幫助者提供有效且有證據支援的治療。由於資源不足，需要幫助的人可能會轉向未經培訓的心理健康從業者或依賴自助資源，這可能無法提供同等水平的支援和專業知識。這也可能導致治療不足或有害，惡化個人的心理健康和整體福祉。因此，我們必須不斷審視心理健康基礎設施，我希望對該行業進行規範。
先生，陳醫生和阿都沙末先生強調了醫護人員面臨的問題。我想聚焦於醫護人員的心理健康。他們的工作性質不僅僅是一份工作，而是一種需要深厚承諾和奉獻精神的使命。我們必須提供支援和資源，幫助他們應對職業固有的壓力和挑戰，這最終將提升病患護理質量。
此外，我們必須解決醫護人員面臨的身體和網路騷擾與虐待問題，因為這直接影響他們的心理健康。我們不僅要為醫護人員創造安全和支援的環境，還要制定明確的保護指南。因此，我很感激當局將採取零容忍態度，對騷擾或虐待醫護人員的個人採取適當行動。我們必須明確表示，“如果你虐待我們的醫護人員，將會有後果”。我期待這些保護措施的落實。先生，請用馬來語。
（馬來語）：[請參閱本地語演講。] 馬薩戈斯部長最近宣佈，馬來社群在多個健康指標上取得了進展。
其中包括高膽固醇患者人數的減少。然而，我們仍需繼續努力照顧社群健康。我們的社群肥胖率在各族群中最高。眾所周知，肥胖可能導致心臟病、糖尿病和高血壓等健康問題。因此，部長宣佈將M3計劃設立第五個重點領域，使其成為我們社群的優先事項之一。
通過M3下的健康投資計劃，這一新重點領域旨在動員社群為“更健康的新加坡”計劃做好準備。該計劃與“更健康的新加坡”目標一致，強調將疾病預防作為個人承諾。我們需要採取積極措施，定期進行健康篩查，保持積極生活方式和健康飲食。
除了個人努力，這一全社群倡議也能帶來改變。M3 @Towns的健康投資計劃可提供體育活動機會，提高保持健康生活方式重要性的意識，並識別與肥胖相關的潛在風險。
通過與健康促進局（HPB）、Active SG等機構合作，以及個人做出健康選擇，我們可以持續推進，改善社群健康，減少肥胖及其他健康相關問題的發生率。
我呼籲社群抓住機會，參與M3 @Towns組織的活動。
請記住，保持健康是我們的責任。如果我們健康，就能積極為家庭、社群和國家的發展做出貢獻。
（英語）：在繼續討論我們的醫療體系時，必須承認我們擁有堅實的基礎，並必須繼續建設。作為個人，我們必須認識到每個人在塑造社會結構中扮演的重要角色。這必須始終是全社會的共同努力。社會中的每個人都是國家福祉這臺複雜機器中的重要齒輪。每個齒輪，無論多小或看似微不足道，都對系統的順利運轉和整體成功做出貢獻。當一個人遇到困難時，其他人必須挺身而出，關心和幫助。只有通過我們的集體努力，每個人和諧合作，我們才能對我們珍愛的國家健康領域產生持久而積極的影響。
先生，在此，我要衷心感謝非選區議員提出這項重要動議。他們的熱情、深厚知識和堅定承諾，在議會期間始終保持有意義且富有洞察力的討論，令人欽佩。
先生，最後，讓我們記住，醫療進步及其持續成功依賴於我們的集體決心和團結。我們攜手共建一個更光明、更有韌性、更健康的未來。
副議長先生：楊潔婷女士。
下午2時35分
楊潔婷女士（非選區議員）：副議長先生，我支援尊敬的非選區議員陳雅心醫生、阿都沙末先生和沙希拉醫生提出的動議。
在過去幾個月裡，我們先後就“更健康的新加坡”（Healthier SG）以及應對新冠疫情的白皮書進行了辯論。王部長也向本院通報了新加坡未來醫療保健的三大戰略支柱——急性護理、公共衛生和老年護理。還有多場“前進新加坡”（Forward SG）對話，催生了許多想法和舉措。我讚賞衛生部和整個政府採取的全面整體方法，但我們必須認識到，這是一場馬拉松，而非短跑。
還有很多工作要做，需要全新加坡共同努力，尤其是在我們人口迅速老齡化的背景下，為建設一個更健康的新加坡而行動。各利益相關方之間持續對話非常重要，傾聽、澄清、優先處理問題，並在前進過程中協作解決方案，將是關鍵任務。
在本次辯論中，我將重點關注社群和私營部門可以且應當做些什麼，以補充和支援整個政府的努力，支援我們的醫療保健勞動力和醫療戰略轉型舉措。不可避免地，我也會提出一些政策考慮的問題和建議，希望衛生部和整個政府能夠採納。
我有五個討論主題。首先，是對我們的醫護人員的尊重和感激。考慮到新加坡的醫療體系被評為世界頂尖，我認為是時候讓新加坡醫療體系的使用者——即患者、家屬、訪客以及我們所有人——努力成為醫療體系中“最有禮貌”的群體之一。
有時人們對醫院存在不切實際的“被服務”期待。像在餐廳那樣要求送水是不合理的期待。頻繁按呼叫鈴提出小請求是不體貼的。對任何人，尤其是那些真正幫助我們的人進行辱罵，是絕對不可接受的。相反，一個微笑、一聲“請”、一句“謝謝”，就能極大地表達關心和感激。
醫院是高壓場所。我相信醫護人員都接受過同理心和同情心的培訓，如果沒有，也應該接受。儘管如此，患者和家屬不應認為自己有權將憤怒和挫折發洩到醫護人員身上，無論是醫生、護士、輔助醫療專業人員、支援護理人員，還是醫院保安。深呼吸，想想一件你感激的事情，並考慮那句古老的金科玉律：“己所不欲，勿施於人”。
話雖如此，仍會有不良行為發生，我支援衛生部制定統一的政策，協調處理和應對我們中的“害群之馬”，同時我也希望並期待作為一個社群，我們都能做得更好。
第二點，社群參與。隨著新加坡邁向超級老齡化社會，護士、輔助醫療和護理支援人員將變得越來越重要，和家庭醫生、醫生及醫療專家一樣。社群自身必須認識到，我們也有同樣重要的角色。
首要任務是個人保持積極健康的生活方式，以預防慢性疾病。作為“更健康的新加坡”計劃的一部分，系統將激勵積極行為，而不良的健康生活方式和行為應被抑制或懲罰。
接下來，社群可以通過在居民或鄰里間組建小型互助小組來互相支援。這些小組可以像小型衛星一樣接收和傳播正確的醫療相關資訊。每位全科醫生（GP）可以擔任幾個小組的顧問，定期與他們聯絡，建議活動甚至參與其中，類似於國會議員在選區的工作。這些小組可以自我組織，設立一定的治理結構，幫助探訪鄰居，帶需要的人去醫院檢查，確認他們是否按時服藥，等等。
我瞭解到部分此類活動已經在進行，但可能缺乏連貫和組織性。我想最好的例子是我們在新冠疫情期間所動員的力量。那麼，現在和平時期，我們如何複製這種模式？未來，我們可以更加協調和協作。社群可以組織健康篩查、社群運動如尊巴舞、麥裡芝徒步、太極等。關鍵是如何吸引更多人參與並保持持續性。也許藉助“更健康的新加坡”，參與者可獲得積分，這些積分可用於醫療保健或購買健康主食如燕麥、牛奶等。
在“更健康的新加坡”辯論中，我分享了蒙福關懷家庭服務中心（Montfort Care FSC）在海洋露臺52座發起的“好生活！美食”活動，以及位於大巴窯的嘉利達愛加倍村（Caritas Agape Village）的“分享一鍋”計劃。這些以及其他自發的基層舉措，如新加坡心理健康網路、失智症新加坡的智慧家庭（Family of Wisdom），或協助視障、肢體殘疾或患有失智症老年人乘坐公共交通的關懷通勤冠軍，都是社群參與新加坡醫療生態系統的例子。
巧合的是，我今天上午剛參加了濱海藝術中心（Esplanade）舉辦的一場溫馨的“大聲唱”（Sing Out Loud!）表演，九位患有失智症的長者與九位幼兒園一、二班的孩子同臺演出。長者是聖若瑟之家（St Joseph's Home）的居民，孩子們則就讀於同一院區內的托兒中心。大聲唱是濱海藝術中心於2016年與失智症新加坡合作開發的社群參與專案，但這是首次涉及跨代群體。
我若不提及育基修道院（Convent Yuki）及其在朋友們步入退休後半程時發起的蓬勃基金專案，將是不完整的。這些專案支援像我岳母謝莉莉女士那樣的長者，即使到了90多歲，仍能過上有意義且相對活躍的生活。順便說一句，我岳母下週將慶祝她的100歲生日。
這類舉措可以成為“更健康的新加坡”社群夥伴關係的一部分。若能納入“更健康的新加坡”的獎勵體系並獲得認可，將是極好的。
關於社群參與的最後一點。隨著人口老齡化，人人掌握護理技能可能很快成為必需。或許將來每個人都需接受基礎護理培訓，在家庭或社群中提供服務，或參與某種形式的國家社群服務。這可以適用於年輕男性的國民服役，也可作為年輕女性入學前的社群服務培訓。退休人員也可參與。這可以是志願性質，也可能被視為某種有償零工。
第三點：護士及輔助醫療人員短缺。王部長多次提到，我們醫院面臨的關鍵挑戰是擁有足夠的護士、輔助醫療專業人員和支援護理人員來運營醫院、診所和養老中心。護士和輔助醫療人員不足時，現職員工包括初級醫生不得不承擔額外工作，導致過勞、倦怠和心理健康問題。自2020年應對新冠疫情以來，我們的醫護人員可能因此增加了數年年齡。
衛生部如何應對這些問題？私營部門如何協助？社群能做些什麼支援？
一些想法包括：
（a）拓寬現有護士、輔助醫療專業人員和藥劑師的培訓和職責，使他們能與醫生並肩承擔關鍵角色。這有助於提升這些崗位對新加坡人的吸引力。我知道衛生部在這方面已做了很多，但仍有更多工作要做。
（b）護士薪酬也在審議和實施中，這很好。我的觀點是，我們必須實現按技能付薪。談到薪酬，更多總是受歡迎的。但據我瞭解，選擇護理和輔助醫療職業時，金錢並非最重要因素。請確保他們薪酬合理。如果他們想賺大錢，會去做投資銀行家等職業。重要的是崗位受到尊重和認可，有更多靈活性以實現工作與生活平衡，有職業晉升和個人成長機會，或能說自己過著有意義的生活。
（c）社群應改變對“服務”人員的看法和待遇。我們的護士和輔助醫療專業人員應受到尊嚴、尊重和感激的對待。
（d）設計人力資源政策，提供機會讓他們選擇職業發展路徑，獲得更高資格認證甚至學位，給予兼職學位或專業培訓的學習假和考試假，類似醫生待遇。這些員工常因排班困難而感到不好意思提出調班請求。如果我們認真對待終身學習，這必須解決。無需全薪假，只需排班靈活即可。
（e）技術可自動化重複工作，增強護士和醫護人員技能。新加坡在全球醫療創新中享有盛譽，是少數充分利用技術的醫療體系之一。無論是機器人流程自動化（RPA）、人工智慧（AI）還是資料分析，都已被證明能支援積極的患者結果，同時提升組織效率和效能。
心態轉變和易於採用是關鍵挑戰。一個好例子是使用感測器讀取生命體徵，減少護士和醫生逐個患者測量的時間。這只是其中之一。抱怨很多，但時間有限，我直奔主題。
技術輔助和增強的崗位對年輕一代更具吸引力。我相信機器人已能根據患者腕帶條碼發藥，未來條碼可讀取視網膜，準確發放藥物。
（f）設計能支援靈活班次/工時的排班系統。這樣的系統對需要兼顧工作、家庭、照護責任和學習的員工極具吸引力，也可能吸引退休護士或兼職護士重返職場。
據新加坡護士協會了解，已有“重返護理”計劃，針對因家庭原因離職者。但據我所知，新加坡護士委員會已停止為離職超過五年的護士重新註冊。這些護士在休息前有多年經驗，願意重返崗位，但可能難以恢復註冊。適當再培訓後，這將是一個很好的候選人庫，可按適當級別重新加入，而非從初級護士重新開始。
還有護理職業轉換計劃，據說報名情況相當成功。若能獲得該計劃畢業生填補職位的統計資料，將很有意義。
（g）對於外籍護士和輔助醫療人員，無法攜家屬一同來是最大難題，尤其其他國家提供此福利。我們知道這對新加坡是挑戰，但或許衛生部、人力部和內政部能分享吸引和留住外籍護士及輔助醫療專業人員的策略？
（h）社群能做什麼？我希望所有家長都能鼓勵在海外取得醫療資格的子女回國。我建議衛生部對護理和輔助醫療專業人員採取與吸引海外醫學院畢業的新加坡公民和永久居民類似的措施。我聽說我們的宣傳活動讓畢業生感受到被急需。
（i）關於人力短缺的最後一點。我們或許應激勵在海外受訓並取得資格的新加坡公民和永久居民回國，填補空缺崗位並完成註冊。我聽說有新加坡物理治療師在澳大利亞有執業資格，卻無法在新加坡註冊。顯然，他們需接受與本地培訓同等廣度的培訓。或許衛生部可考慮對這些海外資格的物理治療師和輔助醫療人員實行有條件註冊，同時他們繼續學習海外培訓中未涵蓋的課程。如此，我們可迎回另一位新加坡兒女，成為勞動力的加分項。
第四，私營部門如何發揮作用。總有資深醫生在培訓後選擇退出公立系統，轉投私營部門。這是公立部門管理專科醫生的長期挑戰。要實現“更健康的新加坡”，需要全員參與。
一個建議是私營專科醫生定期為補貼患者提供義診或低價服務，或為無力支付者開設免費診所。執行不易，但如同新冠疫情期間，私營醫療被納入併發揮重要作用，補充公共醫療資源。在這方面，我們可以向法律界學習。
在“更健康的新加坡”中，全科醫生和家庭醫學診所將成為社群護理的關鍵節點。我相信衛生部不斷審視各專科的比例。顯然，我們應鼓勵更多初級醫生專攻家庭醫學，走上成為全科醫生或家庭醫生的道路。據我瞭解，家庭醫學已是專科。吸引更多醫務官選擇家庭醫學路線需要什麼？如果成功說服醫務官，年培訓名額有多少？
私營全科醫生和診所必須提升，提供專科培訓崗位給初級醫生。我們可能還需關注各專科間的薪酬差距。如何激勵全科醫生參與初級保健網路，共同推動預防健康的共同目標？
新的按人頭付費模式將發揮關鍵作用，需設計激勵和抑制各級護理行為的機制，包括全科醫生和公眾。預防和上游干預已被證明是改善臨床結果的最佳途徑。例如，Intermountain激勵初級保健網路儘量減少患者入院。對糖尿病患者額外投入4%預算，實現住院率下降22%，其他可避免就診和入院下降21%，整體提升護理價值並長期降低成本。新加坡或可借鑑類似模式。
我常聽到的問題是，全科醫生難以應對增加的行政和資訊科技工作量。或許衛生部可建立統一平臺，或由某機構或私營部門提供規模化行政服務。關鍵是全科醫生需主動參與工作流程和激勵機制的重新設計，確保“更健康的新加坡”實施高效、有效，且實現預期目標。全科醫生需積極參與，助力自身，也助力新加坡醫療生態系統的初級護理創新，利用技術支援醫療團隊。
第五，居家醫療。為實現可持續醫療體系，居家醫療必須在護理連續性中發揮關鍵作用。一位醫生朋友分享，曾有一項計劃（現已取消），允許產婦出院回家，護士會在出院後三天內上門探訪母嬰。這類家庭醫療服務正是我們向“在適當時間、適當地點、以適當護理”轉型時所需的。
副議長：洪女士，您發言已達19分40秒。
簡妮特·昂女士：抱歉。好的。誰將負責招募、培訓和管理所有這些人員？也許，可以有某種形式的認證醫療專業人員，他們像優步司機一樣自行安排班次，可能在他們的社群內“巡邏”，這可能是最好的方式。
在結束髮言時，我不禁擔憂我們集體以這樣的速度進行轉型的能力。過於倉促，風險在於努力可能流於表面，導致我們只得形式而失去實質。變革從來都不容易。我們很幸運擁有世界上最好的醫療系統之一。最新的2023年樂觀繁榮指數將新加坡的健康指數評分定為86.9，排名第一。
我想以向所有參與醫療生態系統的人致敬來結束：清潔工、護理支援人員、輔助醫療專業人員、護士、醫生、醫療專業人員和醫療管理人員。對所有在醫療領域及其周邊工作的人，引用教皇方濟各的話，“同情是你們所做工作的核心。你們知道這不僅僅是良好的組織，更是傾聽、陪伴和支援你們所照顧的人的一顆心。”
這不是一份輕鬆的工作，但對你們大多數人來說，這是一種使命。因此，非常感謝你們不懈的努力和貢獻，使新加坡和新加坡人在生命的每個階段都保持健康意識、準備充分、包容、有韌性和有尊嚴。副議長先生，我支援這項動議。
副議長先生：拉傑·約書亞·托馬斯先生。
下午2時57分
拉傑·約書亞·托馬斯先生（提名議員）：先生，防止虐待和騷擾醫療工作者三方工作組於2022年4月成立，旨在研究如何解決醫療工作者遭受虐待和騷擾的問題。該工作組於今年3月提交了其調查結果和建議。他們關於虐待程度的發現令人擔憂。超過三分之二的醫療工作者在過去一年中目睹或經歷過虐待或騷擾。三分之一的醫療工作者每週至少目睹或經歷一次虐待或騷擾。
醫療工作者處於特別脆弱的位置。他們的工作本質上涉及與需要某種幫助或關注，甚至可能處於痛苦中的人互動。因此，許多醫療工作者內化了某些虐待是工作中不可避免的，這往往導致舉報不足。
工作組發現，像藥劑師、病人服務助理和護士這樣的前線醫療工作者更可能遭受虐待和騷擾，最常見的虐待形式是被大聲喊叫、遭受貶低性評論以及被威脅投訴或採取法律行動。換句話說，許多虐待和騷擾形式源於患者和/或照顧者對待遇的某種期望，認為他們有某些權利未被滿足，或應享有一定的服務水平或及時性。
這種針對前線服務人員的虐待現象在其他行業也有發現。因此，關鍵問題是，為什麼這些施虐者會有這些期望，為什麼他們認為可以通過喊叫、貶低性言論或威脅投訴來達到目的？
我想知道這是否正是因為我們的醫療系統被譽為世界上最好的之一，是否與新加坡人對效率和問責的典型追求有關。這是否已經深深植根於我們的人民心中，成為對所有服務和工作人員的基本期望？
當這種期望未被滿足時，新加坡人會感到沮喪，覺得系統辜負了他們。在這方面，我們在效率和生產力上的成功可能成為雙刃劍，因為即使稍有不足也可能引發反彈。
報告中令我印象深刻的一點是，較為普遍的虐待形式之一是威脅投訴或採取法律行動。這似乎是對舉報程式、通過反饋改進的願望以及法治的扭曲應用。我們是否正在變得更加訴訟化？這是否因為我們認為任何感知到的輕視或不便都可以通過訴訟、投訴或法院解決？所有這些都影響醫療工作者計程車氣及其履職能力。
就在今天早上，陳雅森醫生與我分享了一個軼事，她的一位醫療朋友因受到威脅而辭職。這包括一名施虐者威脅要在她工作場所外找她。
他說——他說的是中文，我不嘗試逐字複述，但翻譯是，“新加坡這麼小，連老鼠都能找到。”這是我被告知的翻譯。
對於我們基層的工作人員來說，他們關注的是完成工作。技術和流程讓我們更快更好，但有時也有行政流程需要遵循。
例如，《個人資料保護法》現在對資料收集和處理施加了某些要求，以保護個人身份資訊。
另一個例子是，隨著人口老齡化，委任代理人的需求將增加。必須遵守某些法定程式，照顧者可能不完全理解。這可能導致對醫院管理人員的挫敗感，情緒可能激動。
因此，防止虐待和保護醫療工作者的關鍵措施之一應是向患者、照顧者和公眾灌輸這樣一種觀念：無論他們對行政流程或感知的系統低效有多大挫敗感，都不能將這些挫敗發洩到僅僅是在其所處系統內工作的工作人員身上。
這不僅僅是擁有法律下的法定保護和處罰。它要求我們採納一種社會心態，即文明和善良，而非傲慢的期望和權利意識。事實上，這正是尊敬的溫·裡扎爾議員早先所說的——我們需要全社會的努力。
例如，日本有一種“おもてなし”（omotenashi）文化，即無私的款待，被視為日本人以關懷為中心而非期望的心態的縮影。おもてなし認為良好的禮儀和禮貌不僅是個人社互動動中的期望，也是尊重和良好聲望的標誌。其原則包括謙遜、耐心、迅速道歉和語調平和。
為了強調おもてなし並確保這一日本核心特質在現代化社會中不被遺忘，東京都政府於2016年啟動了“東京良好禮儀專案”，該專案仍在進行中。
衛生部控股公司已宣佈將啟動一項全國公共教育運動，促進醫療工作者、患者及其照顧者之間的信任與尊重的積極關係。我真心希望這項運動能成功減少虐待事件，為我們的醫療工作者提供社會支援，打造我們自己的おもてなし文化。
醫療工作者遭受的虐待通常來自兩類人——患者及其照顧者或家屬。
關於患者，醫療專業人員可能面臨困境。年長者、精神健康問題患者或疼痛中的患者有時可能變得具有攻擊性，包括身體攻擊。
對此，工作組建議明確規定施害者的後果。對於施虐患者，可發出警告，若不需緊急治療可予以出院。此外，醫療工作者也可通過拒絕不合理請求來脫離施虐患者。
我想制定這些指南將頗具挑戰，因為必須在提供醫療服務與保護醫療工作者免受身體、心理和情緒虐待之間取得平衡。
同樣，對於因親人醫療緊急情況或狀況而心煩意亂的照顧者和家屬，也可能出現施虐情況。
我認為，雖然我們可以對家屬表示同情，但如果他們言語或身體虐待或騷擾醫療工作者，應實行零容忍。
雖然醫療工作者的職責之一是為這些人提供支援，但沒有義務為他們提供醫療服務。因此，處理非患者施虐者的程式應比處理施虐患者更嚴格，並應積極執行。
主管和醫院管理層必須支援他們的工作人員。我們的國家醫療集團已表示將支援並實施包括零容忍政策在內的建議。我也很欣慰翁部長表示，即使是部長也會支援醫療工作者，醫療工作者應當知道這一點。
當虐待達到一定嚴重程度時，相關部門也應準備起訴此類案件。
我希望今年下半年釋出的指南能顯著減少針對醫療工作者的虐待事件，讓他們每天安心上班。
先生，我支援我的三位提名議員同事提出的動議。我也藉此機會支援我們的醫療工作者，感謝他們為此所做的犧牲和持續的付出。
我們的護士、醫生、治療師、阿嬤、輔導員、藥劑師和行政人員從事的是保護人類核心——生命和福祉的職業。他們不僅是高尚的職業，更是最崇高的職業。因此，讓我們確保盡最大努力照顧他們——照顧那些照顧我們的人。
副議長先生：洪顯德教授。
下午3時07分
洪顯德教授（提名議員）：副議長先生，先生，從根本上講，我們都認識到個人生活中存在一些不可預見的負面事件，比如嚴重生病。
為了保護公民免受此類偶發事件的影響，人們可能認為我們可以完全依賴私人保險公司。理由是風險厭惡者會出於自身利益購買按精算公平價格提供的保險。
然而，由於資訊不對稱，市場一方擁有另一方無法輕易獲得的私人資訊，導致逆向選擇。
完全保險通常不可得。在逆向選擇特徵的市場中，成本較高的客戶知道自己是誰，但賣方不知道。保險公司知道潛在客戶中有些風險較低，但不知道具體是誰。
被保險人比保險公司更瞭解自己的風險水平，這可能導致風險較高者購買保險，從而使保險公司虧損。結果是私人保險供給不足。
因此，在存在逆向選擇問題時，政府有責任通過提供社會保險形式的MediShield Life介入，該計劃於2015年11月推出。該國家健康保險計劃有三個重要特點。
第一，有公共強制性，所有新加坡公民和永久居民均納入計劃。沒有此強制性，健康居民有動機退出購買反映不健康居民更高醫療成本的保險。
第二，涵蓋既往病症，儘管對需要密集醫療干預或長期治療的嚴重既往病症收取額外保費。
第三，政府為低收入居民提供補貼，幫助他們支付保費。
MediShield Life由中央公積金局管理，屬於確定繳款制社會保障系統。與通過向年輕工作者徵收工資稅為退休老人提供福利的確定福利制不同，中央公積金繳款是個人儲蓄的一部分。
為了確保國家健康保險計劃的財務可持續性，經濟必須持續創造優質就業機會。這是因為保費支付的主要資金來源是個人的MediSave賬戶。
動議呼籲全政府協作的做法非常恰當。
平臺工作者諮詢委員會最近建議平臺公司與政府合作，建立平臺工作者定期向MediSave繳款的機制，這也有助於國家健康保險計劃的財務可持續性。
副議長先生，先生，因此我支援由我三位尊敬的提名議員同事提出的動議。
副議長先生：葉漢榮先生。
下午3時12分
葉漢榮先生（耀祖康）：副議長先生，先生，今天的動議提出了一些重要問題。我想談談老齡化問題，並探討如何更好地賦能我們的長者，讓他們繼續過上充實的生活。
我們的醫療系統必須具備應對超級老齡社會獨特挑戰的能力。我們必須未雨綢繆，立即解決問題，否則未來我們的基礎設施和設施將無法滿足需求，這將給新加坡帶來重大財政負擔。我想談三個問題。
首先，副議長先生，先生，我們需要更好地組織護理整合。我同意陳雅森醫生的觀點，需要加強跨部門合作，但我想補充的是，這在衛生部（MOH）和社會及家庭發展部（MSF）負責的醫療與社會護理之間尤為重要。
“更健康的新加坡”計劃無疑是朝正確方向邁出的一步。我們追求的是健康，而非僅僅是醫療。社會處方是關鍵組成部分。我們需要鼓勵長者參與促進整體健康的活動。體育新加坡、人民協會和各社會服務機構（SSA）提供了許多免費運動和健康專案，但我們必須動員基層支援，積極參與。在這方面，有哪些措施將兩者連線起來？否則，這隻會成為另一個啟動專案——聽起來不錯，但可能無法有效幫助居民。
社會處方和醫療必須齊頭並進。醫療與社會護理之間需要更緊密的整合。醫療專業人員，包括全科醫生（GP）及其診所助理，是否瞭解社群內各種組織提供的運動專案？如果瞭解，他們是否有足夠知識向患者推薦？同樣，我們的社會服務專業人員是否知道如何識別長者的健康相關問題並轉介給適當的醫療專業人員？
一個概念在紙面上看似有前景，但關鍵在於實施。我們如何幫助衛生部以外的醫療人員準備參與該專案？我們需要擺脫對醫療過度醫療化的恐懼，鼓勵醫療與社會護理的更大合作。
是否到了放棄跨部門部長級委員會，考慮設立老齡事務部的時候？組織決定行為。專門的部門可以領導與老齡相關的綜合政策，確保滿足長者需求，使新加坡成為適合養老的好地方。
其次，副議長先生，先生，我們需要更好的支援工具來促進護理整合。必須建立一個整合系統，實現醫療與社會護理的無縫協作。為此，我們需要解決當前醫療遺留資訊科技問題以及不同醫療集團使用的IT系統。我在之前的議會發言和供應委員會辯論中提到過這一點。
例如，一些醫療集團使用Health Buddy，而其他使用HealthHub。社群、初級和三級醫療提供者使用的計算機系統多種多樣，從CCMS、Epic到Citrix。系統能互操作嗎？能否合併這些IT系統，確保醫療專業人員訪問統一平臺，管理患者的醫療需求？
同樣，合併GovTech系統和綜合健康資訊系統（IHiS）也很重要，以確保醫療與社會部門之間更好的資料共享。
我們還必須探索更好地促進政府與社會服務機構（SSA）之間關於老年人健康和社會福祉資訊的資料共享方式。目前，資料共享顯得相當零散。我們應努力實現對老年人的整體視角，涵蓋健康和社會兩個方面。
最後，我們必須探索利用遠端醫療促進護理整合的方法。擴大現有試點專案的計劃是什麼？我們如何確保遠端醫療被有效利用，為我們的老年人提供全面的護理？
第三，在我們尋求改善老年人護理整合的同時，也必須關注進一步賦能護理整合。我們必須提出一個關鍵問題：我們能否更好地賦能老年人，使他們更好地照顧自己？
為回答這個問題，我們需要探索老年人在老齡化過程中應關注的關鍵資訊和舉措。
一種可能的解決方案是為老年人及其照護者提供一本健康手冊，包含相關資訊，幫助他們有效管理健康。這類似於為小學生及其家長提供的兒童健康手冊。
雖然我們承認這對文盲或視力障礙者可能不可行，但對於許多需要指導的老年人和照護者來說，這仍將是一個有用的工具。
事實上，隨著我們老齡人口未來變得更加受教育和識字，我們預計大部分賦能將需要老年人自助和主動。老年人希望被賦能以做出獨立且明智的決定。我們需要引導他們走向正確的方向。一個關鍵舉措是促進更好的透明度，推送更多關於各種健康相關主題的資訊，如癌症篩查清單和保險。
在這方面，我們應探索銀髮一代辦公室（Silver Generation Office）如何在此領域提供幫助。通過為老年人提供必要的資訊和資源，我們可以使他們更好地照顧自己的健康和福祉。最終，這將帶來更好的健康結果和更大的獨立性。
總之，副議長先生，我們需要改變為老年人口提供護理的方式。我們需要整合，而非碎片化。那麼，真正的整合系統是什麼樣的？
對我來說，這是一個圍繞老年人組織的護理服務無縫整合的系統，具備對其身體、心理和情感健康的360度視角。
我們如何實現這一目標？這需要在急性護理與長期護理之間、急性護理與初級護理之間、以及初級護理與社群護理之間無縫製定護理方案。
這意味著採用多學科和以人為本的方法。醫生需與其他健康和社會護理專業人員緊密合作，如輔助醫療官員、社會工作者甚至社群友伴，共同識別老年人的共同護理需求，並提供整合干預。健康和社會護理必須跨越界限，幫助老年人在社群中健康老齡化。這也意味著資訊應在醫院與社群護理專業人員之間無縫流動，以更好地管理老年人的健康和社會狀況。
最終目標是實現一名患者、一份健康或健康狀況記錄、一套資訊科技系統，並希望由一個老齡事務部統一監管，提供協調的、整體的和整合的護理，將新加坡打造成為最佳宜居地。我支援該動議。
副議長先生：秩序。我建議現在休息。我宣佈休會，下午3點40分繼續主持會議。
會議於下午3點22分休會，至下午3點40分。
會議於下午3點40分恢復。
[副議長（Christopher de Souza先生）主持]
支援醫療保健
[（程式文本）辯論繼續。（程式文本）]
副議長先生：文化、社區及青年部和社會及家庭發展部高階議會秘書蔡恩燦先生。
下午3點40分
文化、社區及青年部和社會及家庭發展部高階議會秘書（蔡恩燦先生）：先生，我同意各位議員的看法，支援醫療保健超越新冠疫情需要新加坡社會的共同努力。
先生，在準備這次發言時，我問了ChatGPT對新加坡醫療體系的看法。翁永康部長和衛生部團隊會高興地注意到，ChatGPT對我的回答是，我引用：“新加坡醫療體系常被譽為世界上最好的醫療體系之一，以其高效、高質量的護理和低醫療成本著稱。”
話雖如此，我們不能假設這一較為光彩的評價會保持不變。新加坡是全球老齡化最快的社會之一。我們非常清楚數字：到2030年，每四個新加坡人中就有一位是老年人，到2050年，每兩個新加坡人中就有一位是老年人。
如果我們要充分收穫有意義且富有成效的長壽，我們必須努力縮小健康壽命與實際壽命之間長達十年的明顯差距。這一點很重要，我覺得有必要重複。如果我們希望新加坡人不僅活得更長，而且活得更好，我們有一個長達十年的健康與壽命差距需要彌合。從長遠來看，我們必須利用老齡化帶來的積極面。
2017年，新加坡體育理事會（SportSG）啟動了“積極健康”國家倡議，旨在激勵新加坡人主動管理自己的健康和福祉，並通過共享體驗促進更強的社群精神。我們希望推動思維轉變，從“缺陷導向”——即“我只有生病時才尋求治療”——轉向“願景導向”的積極健康生活模式。在後一種模式中，每個人都被賦能以更好地生活，延緩或預防慢性病的發生。
過去十年，SportSG積極落實2030願景的建議。因此，全國定期參與體育活動的人數增加了約20%，從2015年的54%提升至2022年的74%。在2022年進行的一項積極健康調查中，約96%的受訪者在被問及健康和福祉的重要性時給出了8分（滿分10分）。然而，只有60%的人表示有信心改善和/或維持自己的健康和福祉。許多人不瞭解自己的健康狀況，也不知道如何輕鬆邁出積極健康生活的小步伐。
我同意議員們的看法，支援需要新加坡社會各界的共同努力，確保每個人都能實現其健康和福祉的願望。
其中一項協同努力是皇后鎮健康區試點。該試點由建屋發展局（HDB）、新加坡國立大學（NUS）和國立大學醫療系統（NUHS）牽頭，旨在通過為各年齡段人群提供健康和福祉專案，促進健康長壽和代際聯結。
在皇后鎮，由獅子會友伴組織（Lion Befrienders）協助，老年人參與力量和平衡訓練專案，如舞蹈健身、改良運動和虛擬方格步行練習。老年人還參與代際體育週五活動，如足球、積極耕作和舞蹈健身，適合所有年齡段參與者。
學生們參與“積極健康課堂冠軍”專案，該專案採用整體健康方法，促進體育和課外體育活動的參與。根據SportSG的學校體育合作計劃，皇后鎮的學校引入了更多多項體育專案，促進學生的整體健康、福祉和社會凝聚力。
家庭參與工作坊和專案，如“公園積極健康探索步行”，強調例如阻力訓練在增加肌肉質量中的重要性，同時進行定期散步。
還有針對弱勢群體和殘障人士的專案。例如，SportCares FUN Starters多項體育和週六夜燈足球專案為租賃住房和其他弱勢社群的兒童和青少年提供運動機會，幫助他們養成終身體育習慣，提升基本運動技能和身體素質，並培養社群歸屬感。
除了專案安排，SportSG還與建屋發展局合作，提升皇后鎮健康區的基礎設施，幫助居民保持健康和活躍。例如，作為鄰里更新計劃（NRP）的一部分，將在皇后鎮美靈區安裝由SportSG設計的“積極健康健身步道”，配備行為引導，旨在發展力量、柔韌性和平衡，並配備適當的健身器材，以提升健身和鍛鍊空間。
在健康區之外，我們已在全島設立了約八個積極健康實驗室，位於我們的ActiveSG體育中心和積極健康合作伙伴場所。我們的目標是幫助人們瞭解自己的身體成分、體能和健康狀況，並從合格的積極健康教練那裡學習如何維持積極健康的生活方式。
居民來到我們的ActiveSG中心不僅是為了鍛鍊，也是為了社交和建立網路。根據2022年全國體育參與調查，95%的受訪者表示與他人一起參與體育活動後，福祉有所改善；94%的受訪者表示體育活動提升了他們的生活質量。
就在上週末，我與數百名皇后鎮居民一起，暫別我們心愛的皇后鎮體育中心。該設施服務居民超過五十年，曾在七十年代承辦分散式國慶閱兵，並曾是丹戎巴葛聯足球俱樂部和國家水球隊的主場。體育和體育設施在塑造地方感和形成共同身份方面也發揮著關鍵作用。
因此，我呼籲大家前往遍佈全島的ActiveSG體育中心，嘗試各種專案和活動，參觀我們的積極健康實驗室，開啟您的健康和福祉之旅。
除了體育活動，SportSG將繼續與衛生部和健康促進局（HPB）合作，鼓勵全科醫生（GP）將患者轉介至合適的社群活動，幫助他們改善或維持健康，並瞭解其體能和健康狀況。要做好這項工作，我們需要團隊合作。
個人公民可以主動前往積極健康實驗室，瞭解自己的健康和福祉，並考慮將相關的健身和飲食建議融入日常生活。家庭成員也可以發揮作用，溫和地推動親人邁出掌控自身健康和體能的第一步，前往積極健康實驗室。
醫療服務提供者則可以將客戶轉介至積極健康實驗室，在認證教練的指導下學習安全鍛鍊。政府方面，SportSG將與健康促進局和人民協會合作，確保有穩定的專案、體育興趣小組和社交活動，供醫療服務提供者推薦給客戶。先生，請用中文發言。
（中文）：[請參閱方言發言。] 新加坡是全球老齡化最快的國家之一。當然，我們希望新加坡人長壽，但同時也希望他們在黃金歲月中健康且有意義地生活。
SportSG於2017年啟動積極健康倡議，激勵新加坡人主動管理健康，並促進更強的社群精神。為實現這一目標，我們社會的所有利益相關者都必須發揮作用。皇后鎮醫療區試點就是一個很好的例子。
此外，我們已在全島設立了八個積極健康實驗室，位於ActiveSG體育中心和積極健康合作伙伴場所。我們的目標是幫助人們瞭解自己的身體成分和健康狀況，並從合格的積極健康教練那裡學習如何維持健康生活方式。
我呼籲大家前往遍佈全島的ActiveSG體育中心，嘗試我們為您組織的各種專案和活動，參觀積極健康實驗室，開啟您的健康和福祉之旅！
（英文）：先生，令人欣慰的是，許多人認識到健康和福祉的重要性。通過積極健康，我們希望讓居民更快樂、更健康，能夠長壽並在“親社會”空間中茁壯成長——年輕人與老年人相互關心，互相推動積極生活和健康、有意義的長壽。先生，我支援該動議。
副議長先生：副教授林志明。您有請求嗎？
副教授林志明（盛港）：是的，副議長先生，我希望參與這場辯論。
副議長先生：在您發言之前，我想指出這是臨時請求。為了更好地安排議會會議，我鼓勵所有議員如果打算參與辯論，請提前通知我們。這有助於時間安排和會議排程。希望各位議員配合。我現在請您發言，您可以開始。
下午3點52分
副教授林志明：感謝副議長先生給予我參與辯論的機會。我將談談作為一個國家，我們可以採取哪些步驟，更好地平衡醫療資源支出。我會分享一些細節，說明為什麼我認為我們可以提高醫療系統的承載能力，儘管這可能會在效率上帶來一些損失，並在成本上帶來邊際壓力，但我相信這將換來更強的長期韌性。
正如本院其他議員所分享的，政府也深知，我們即將面臨的公共醫療支出將遠高於目前的預算。這主要是由於社會老齡化和老年人口帶來的更大醫療需求。但我的觀點更為根本。即使在當前，我們的醫療系統在某種程度上仍未達到我們對處於此發展階段經濟體的合理預期。
明確地說，我並不是說我們現有系統存在根本缺陷，也不是說它應被徹底改革。事實上，我認為我們可以理直氣壯地為現有系統所提供的護理質量感到自豪，該系統融合了公共和私人部分，並且如高階議會秘書蔡恩燦剛才向本院分享的那樣，證明了其極高的成本效益。
雖然我當然更傾向於公共部分佔比更大——這是我今年三月關於《醫療服務法》修訂辯論中曾談及的議題——但這不是我今天關注的重點。
我想強調的是，我認為新冠疫情暴露了一個明顯的短板：由於我們執行系統過於精簡，面對大規模、意外但完全可預見的衝擊（如疫情）時，系統變得脆弱。
這裡，或許需要一點哲學討論。經濟學家的基本職能是最大化給定目標，受制於約束條件。這通常意味著我們不斷尋找最優解，並在找到時感到非常滿意。我的妻子經常取笑我，如何通過規劃去雜貨店的路線，同時完成加油、取款、打包晚餐等所有事務，使行程順暢連貫。在這方面，經濟學家是容易滿足的生物。
但還有另一種同樣合理的世界觀，常見於工程師。工程師不會完全剔除系統中的低效元素。他們認識到冗餘的重要性，因為在正常條件下，這些未充分利用的元素可能顯得浪費，但它們在壓力過大時至關重要，可以防止系統整體崩潰。因此，他們設計的橋樑承載能力遠超正常交通需求——甚至還要多一點。他們設計的飛機即使一臺引擎停機也能飛行。他們設計的發電廠擁有多重安全保障，可以在部分裝置維修時保持整體執行。
先生，新加坡每10萬人口的重症監護病房（ICU）床位數目前為5.7張。經濟合作與發展組織（OECD）成員國的平均值接近12張，是我們的兩倍。在床位覆蓋率低於我們的四個經濟體中，只有日本的人口老齡比例顯著更高。
更普遍地說，我們的醫院床位數也較低。我們每千人擁有略多於兩張床位，遠低於其他東亞經濟體，如日本和韓國約為12張；中國約為5張；以及丹麥、荷蘭、以色列和美國等其他發達經濟體，床位比率接近3張。
明確來說，床位數量偏低並不能直接證明現行系統存在問題。我們需要關注這些床位的使用率，甚至可以認為高效的康復意味著我們能夠維持較低的承載能力。
在我尊敬的朋友Leon Perera先生去年提出的一項議會質詢中，資深國務部長Janil Puthucheary分享了未來五年目標床位使用率約為80%，他補充說這一比例通常被學術界和醫療機構推薦。在前一年向本院的宣告中，他還解釋了我們能夠迅速增加重症監護病床，正如疫情期間所做的那樣。
但在該宣告中，他也承認需要增加ICU床位容量，儘管他指出這一過程並非易事，主要受限於增加醫務人員以配備這些床位的需求。
此外，近期我們主要醫院的床位使用率資料顯示，這80%的目標似乎經常被突破，過去一個月內，譚篤生醫院、黃廷芳醫院和邱德拔醫院的使用率常常超過90%，而且是在非疫情期間。
綜合來看，這表明政府意識到醫療基礎設施過於緊縮會在壓力時期帶來問題，並且即使迴歸常態，我們仍未完全解決這一問題。
衛生部已透露計劃在兀蘭建設新的醫療園區，以及在勿洛建設另一園區，但其餘專案均為現有設施的擴建。部長是否願意分享這些專案是否足以應對因人口老齡化帶來的需求增長，同時緩解現有的容量限制？還是主要聚焦於匹配新增需求，而現有容量基本保持不變？
這引出了關鍵瓶頸：醫療人力。
目前，我們的醫生和護士覆蓋率相對較低。截至2021年，新加坡每千人擁有2.7名醫生，約為經合組織平均水平3.8的三分之二。
不出意外，這導致了醫務人員的倦怠、壓力和高流失率，議院其他成員也有提及。解決方案看似簡單且無爭議：我們需要增加醫療人員供應。政府也強調，增加醫療培訓人員是優先事項。問題是如何實現。
全球護士短缺，世界衛生組織估計缺口接近600萬，而國際護士理事會——雖為利益相關方——則估計缺口更高，約1300萬。
在此背景下，短期內我們需吸引並留住全球人才，長期則需擴大本地培訓醫務人員。
有限床位和醫生的實際表現是，許多設施的入院等待時間持續偏高。邱德拔醫院尤為嚴重，黃廷芳綜合醫院和我所代表選區的盛港綜合醫院也出現過高峰期。某些日子，等待時間甚至超過24小時。
我們應問自己：是否願意接受患者偶爾需等待超過一天才能入院的現狀？或許我們認為這是控制整體醫療成本的合理權衡，亦或將此視為現有系統承載能力需提升的訊號。
我在早前發言中提出了一些中期建議，以緩解系統壓力。我們可考慮增加認可的基礎醫學學位大學數量，超過目前的100所。對於在其他司法管轄區有豐富經驗的醫生，可簡化申請和認證流程，或設立衛生部指定流程主動尋找並鼓勵他們申請。
在與其他面臨護士短缺的發達經濟體競爭全球護理人才時，培養更多本地護士也很有意義。我們可為培訓生提供更優厚條件，例如完全免除學費，儘管現有學費已相對低廉，條件是畢業後在新加坡從事護理工作一定年限。
這也適用於考慮中年轉行者。我們可確保技能未來基金不僅全額覆蓋轉職課程，還可能對既有培訓提供更多學分。例如，幼兒教育者和教師肯定已掌握護理課程中的溝通、批判性思維、資料分析和行為科學等通用課程。
緩解供應壓力需超越數量政策，也應關注價格。最簡單的做法是提高該領域薪資。持續漲薪的限制之一是成本已高昂，這主要由私立醫院的商業租金推動，進而影響公立醫院定價。高租金源於——你猜對了——高昂的土地價格。
但這不僅僅是提高工資——如果同時伴隨更長工時則無益。更理想的是增加醫生和護士總數，同時保持合理工時。總工資支出不變，但護理質量可能提升。
我們還可增加護理層級——其他國家多達五至六級，而我們目前僅有註冊護士、註冊護士和高階執業護士三級。這為職業發展提供更多上升通道，吸引更多人入行。
先生，正如我開頭所述，我們的醫療系統容量並無根本缺陷，但面臨日益加劇的壓力。明智之舉是在相對平靜時期調整適應即將到來的需求，而非在未來疫情爆發時倉促應對。
副議長：教育國務部長顏曉芳。
下午4時04分
教育國務部長（顏曉芳女士）：副議長，健康就是財富。我們的健康賬戶就像銀行賬戶，投入越多，回報越多。現在投資健康，將為終生帶來回報。
大多數人同意，孩子們需要從小養成健康生活習慣，並持續實踐，才能有最佳機會保持健康，充分享受生活。
感謝陳雅心醫生強調健康教育的重要性。教育部採取整體方法，從學生入學起促進其整體福祉和健康。在整個教育過程中，學生獲得知識、技能和態度，培養積極健康的生活方式，並延續至學業結束後。
在學前階段，教育部的“培養早期學習者”（NEL）框架強調全面發展，鼓勵健康習慣和積極參與體育活動的態度。
在學校，學生學習良好健康習慣，如定期鍛鍊、充足睡眠和健康飲食。在體育課上，他們學習多種運動和遊戲，裝備他們終身參與體育活動。理工學院設有多種健康與保健課程，工藝教育學院（ITE）則有每週體育課程。
教育部學校和高等學府（IHLs）也為學生提供課外體育活動機會。學生可參加課外活動（CCA）、興趣小組或體育俱樂部，利用校內體育設施和器材保持活躍。
健康促進局（HPB）與願意採納專案的學校和高等學府合作，如“活躍青年計劃”，通過定期現代鍛鍊課程增加體育活動參與。
營養是身體健康的另一關鍵方面。所有學校和高等學府積極推廣健康飲食。中學低年級學生在食品與消費者教育課上學習規劃和準備更健康的飲食。與HPB合作，所有學校實施“學校健康餐計劃”，食堂提供更健康的食物和飲料選擇。
同樣，理工學院和工藝教育學院參與HPB的“更健康餐飲計劃”，鼓勵餐飲經營者提供更健康的選擇。自治大學（AUs）也通過與餐飲供應商合作，支援校園健康飲食。
接下來談心理健康。溫瑞扎爾醫生談及學生心理健康素養的重要性，我贊同。學校和高等學府為學生提供知識和技能，增強心理健康，建立韌性，應對挑戰。例如，學生在品格與公民教育（CCE）課程中學習常見心理健康問題及尋求幫助的重要性。鑑於數字世界對心理健康的影響，學生還學習管理社交媒體使用和培養健康的線上同伴支援文化。
副議長，兒童健康福祉需要全社會共同努力。家庭和社群在營造支援健康習慣的環境中發揮重要作用。家長可在家中強化並示範健康習慣。教育部通過家長工具包、教育部育兒Instagram和家長通道等平臺，向家長分享實用建議，幫助營造積極家庭環境，促進兒童身心社會情感健康。
我們聽到許多家長積極參與，與孩子共同建立健康生活方式，增強親子關係。一位父親分享他與孩子定期鍛鍊的習慣，孩子教他學校體育課學到的各種運動和遊戲。家長強化並示範學校所學，我相信更多孩子將養成終生健康習慣。
我們欣慰看到家長支援團體（PSGs）、學校支援家長與社群（COMPASS）、健康促進局（HPB）及多家社會服務機構合作，支援家長加強兒童健康福祉。
感謝家長和社群夥伴與我們攜手促進學生福祉。期待與更多夥伴持續深化合作，讓孩子們從小積累健康賬戶，充分享受生活。副議長，我支援本議案。
副議長：衛生資深國務部長Janil Puthucheary。
下午4時11分
衛生資深國務部長（Janil Puthucheary博士）：副議長，先生，我支援由陳雅心醫生、莎希拉·阿卜杜拉醫生和阿卜杜勒·薩馬德先生提出的議案。
先生，我們每個人都在確保人口健康福祉中扮演關鍵角色。作為個體，我們需積極採取措施，過更健康生活，降低患病風險，同時政府構建支援環境助力實現這一目標。我將談及心理健康、口腔健康及支援個人健康生活的醫療資訊科技基礎設施和數字工具。
先生，良好心理健康至關重要。心理健康是一個光譜，具有多面性。心理健康問題可能由多種因素引發，包括身體健康和社會決定因素。解決這些問題需多部門協作，涵蓋衛生、社會、教育、職場和社群領域。
這已在進行中。例如，在社群心理健康總體規劃下，衛生部、綜合護理機構和社會服務機構合作，在新加坡各地建立社群心理健康團隊。這些團隊向居民提供心理健康教育，將心理健康篩查、評估和治療等服務帶到社群，減少汙名化，讓個人更安心尋求幫助。
高林斌教授談及學術環境中的心理健康。健康促進局與高等學府合作，建立同伴支援結構，提供同理傾聽和基礎心理急救技能培訓，支援出現情緒困擾跡象的同伴。此外，願意學習心理健康和自我關懷技巧者可訪問MindSG門戶，獲取由心理健康專家策劃的資源。
重要的是解決職場中的心理健康問題，無論職場是學術環境還是其他。2020年，勞工部、全國職工總會（NTUC）和新加坡全國僱主聯合會（SNEF）聯合釋出《職場心理健康三方建議》，支援員工心理健康，為僱主、員工和自僱人士提供資源。
陳雅心醫生分享她作為初級醫生時，有時值班超過24小時的經歷。
衛生部正在審查初級醫生的總工作時長，包括值班時間。公立醫療集團在部分科室試點縮短初級醫生值班時間，並通過電子記錄和調查監控工作時長。
這是複雜議題，需根本重新審視人力部署及資深與初級醫生職責分擔。研究和制定方案需要時間，我們正積極推進。
陳雅心醫生和高林斌教授強調心理健康教育和去汙名化的重要性。健康促進局於2021年10月發起“尋求幫助沒問題”運動，旨在提升心理健康意識，鼓勵對話。2022年運動聚焦青年，幫助他們克服尋求支援的猶豫，解決相關顧慮。活動包括教師引導的課堂討論，推廣至主流學校和高等學府。線上和線下推廣心理健康意識和素養的工作持續進行。
此外，社會服務理事會（NCSS）於2018年啟動的“超越標籤”（BTL）運動持續推進。BTL 2.0階段旨在激勵行動，NCSS聯合來自民間、公共和私營部門的26個合作伙伴，促進並支援學校、職場和社群中的尋求幫助與提供幫助行為。
先生，心理健康與福祉跨部門工作組於2021年7月成立，負責監督和協調各部門心理健康工作，聚焦需跨部門協作的綜合議題。
工作組已提出12項初步建議，並於去年開展公眾諮詢，收集超過950份反饋，涵蓋青年、家長、心理健康患者、服務提供者、僱主和社群機構等群體。
反饋普遍支援所有建議，工作組將很快釋出諮詢報告摘要，同時啟動建議實施計劃。
其中一項建議是實施分級護理模式，依據心理健康需求程度匹配護理水平，實現更有效的服務分配，針對個體需求的嚴重性和複雜性。
公眾諮詢中，我們收到關於實施的寶貴反饋。例如，為確保分級模式有效，服務提供者需具備足夠能力履行職責。
我們完全同意，要有效實施分層護理模式，一個重要方面是確保所有心理健康從業人員具備足夠的能力和標準。因此，我們成立了國家心理健康能力培訓框架工作組。他們正在制定的框架將指導心理健康從業人員掌握提供優質有效護理所需的知識、技能和能力。該框架適用於所有從業人員，從同行支持者等非專業響應者，到包括護士、社會工作者和輔導員在內的心理健康專業人士。我感謝萬瑞扎爾醫生強調這一點的重要性。
此外，目前已有系統保障專業執業。心理健康專業人員通過專業委員會和理事會進行監管，並通過專業協會制定執業標準。
例如，精神科醫生、護士和職業治療師分別由新加坡醫學委員會、新加坡護理委員會和輔助衛生專業委員會監管。新加坡輔導協會和新加坡心理學會等專業協會分別為輔導員和心理學家提供專業和倫理行為指導。
還需要幫助有心理健康需求的個人及時獲得適當服務。工作組的一項建議是指定幾個首站接觸點，為個人提供便捷的心理健康支援和諮詢。
部分諮詢反饋者認為，提供多種服務方式以考慮使用者偏好是有價值的。我們正在開發多種服務模式，如熱線、簡訊、面對面服務和數字資源，確保人們有足夠且多樣的途徑訪問這些心理健康首站接觸點。
先生，如果我現在可以轉向回應沙希拉·阿卜杜拉醫生關於新加坡老年人、特殊需求人士和外籍勞工口腔護理的問題。
政府已推出多項舉措，確保新加坡人能夠獲得負擔得起且優質的醫療服務，例如通過社群健康援助計劃（CHAS）。這些群體的大多數口腔健康需求可由多診所、CHAS診所和私人牙科診所的一般牙醫滿足。對於有複雜需求及患有醫療狀況或多重疾病、需要更高水平護理的個人，可由國家專科牙科中心和醫院牙科診所的專家提供護理。
為方便就醫，衛生部已與社會及家庭發展部合作，列出提供特殊護理牙科服務的牙醫和私人牙科診所的詳細資訊，以提高公眾對殘疾人士服務可用性的認識。
此外，除了現有的啟能村、愛加倍村、HealthServe和聖安德魯傳教醫院等公私合作專案外，我們將進一步探索公私合作伙伴關係，更好地服務包括外籍勞工在內的服務不足社群的初級醫療和牙科需求。
針對外籍勞工，人力部（MOM）也將繼續探索與非政府組織等關鍵合作伙伴合作，通過口腔及慢性病管理專案（Project MOCCA）促進外籍勞工可及的牙科護理並提供口腔健康教育。Project MOCCA由人力部去年啟動，是一項預防健康框架，旨在提升工人群體口腔及慢性疾病的護理水平。人力部與MigrantWell Singapore等合作伙伴緊密合作。
我們認可獨立志願者倡議在社群、中長期護理環境及特殊需求組織中提供牙科服務的努力。為改善這些服務的協調，我們將鼓勵較大的志願者協會提供溝通、資源共享和協調的平臺。
隨著人口結構變化、技術進步和護理方式轉變，牙科實踐也在不斷演進，本地牙科格局將相應調整。
為更好支援為老年人和特殊需求人士提供護理的牙科專業人員及其他醫療和非醫療專業人員，我們將考慮制定臨床實踐指南和適當的護理指南，幫助建立護理標準，促進更佳健康結果。此外，我們將繼續審查補貼框架，併為牙科各學科的住院醫師培訓專案頒發獎學金，確保牙科人才隊伍持續滿足各年齡段和護理環境的口腔健康需求。
先生，接下來我想強調擁有一個良好整合且可靠的資訊科技系統以連線醫療服務提供者、社群合作伙伴和居民的重要性。議員們在過去的議會會議中，如《更健康的新加坡白皮書》和2023年供應委員會辯論中，都提出了這一點。我感謝陳雅森醫生和葉漢榮先生強調其重要性。
一個關鍵系統是國家電子健康記錄系統（NEHR），這是一個通用平臺，收集來自各醫療服務提供者的選定患者健康資訊，並允許提供者檢視這些健康記錄以便患者護理。賈米爾·賈姆先生詢問了NEHR安全增強措施的實施情況。NEHR已接受網路安全審查、基礎設施漏洞掃描和應用滲透測試。衛生部和綜合健康資訊系統（IHiS）已審查結果，大部分關鍵增強已完成，剩餘一項預計於2025年完成。
關於賈米爾·賈姆先生提出的全科診所資訊科技支援問題，我們希望全科醫生使用支援日常運營且連線關鍵IT系統的診所管理系統（CMS），以節省行政時間。我們一直與CMS供應商密切合作，改進產品並加強後臺服務以支援全科診所。
我們正引入更多醫療服務提供者參與NEHR，通過將早期貢獻激勵計劃擴充套件至全科醫生、私立醫院、放射實驗室和臨床實驗室，支援他們貢獻資料。隨著《健康資訊法案》（HIB）的實施，他們將被強制向NEHR貢獻患者資料。
我們已廣泛諮詢持牌人和醫療專業人士等利益相關者，討論與HIB相關的資料隱私和共享問題。我們原計劃今年某時將HIB提交議會，但鑑於該法案的重要性，我們認為需要更多時間與利益相關者和公眾溝通。因此，預計將在2024年上半年在本院提出該法案。我也感謝葉漢榮先生提出促進衛生與社會部門資料共享的需求，這確實是HIB的目標之一，旨在支援更整合的護理並減少行政工作，同時確保資料安全。
黃玲玲女士和葉漢榮先生也提出需要賦能新加坡人，增強其健康管理知識和支援。我們將通過HealthHub和Healthy 365應用等工具實現。例如，居民及其授權照護者可通過HealthHub檢視NEHR中的健康資訊，如出院摘要、部分血液檢測和放射結果。我們將探索如何在這些平臺反映更多檢測結果。居民及其授權照護者還可使用HealthHub預約和管理所有公立醫療機構的醫療預約，註冊“更健康的新加坡”計劃並檢視健康計劃。
居民可通過Healthy 365檢視並報名參加附近的健康生活專案，跟蹤身體活動，並通過計步和選擇更健康食物獲得健康積分。我們將持續增強此類數字工具，幫助居民維持良好健康和福祉。
先生，總結來說，通過增加對可信平臺的可及性，提供適當的健康資訊和干預，以及醫療服務提供者和社群合作伙伴的支援，我們希望個人能夠做出明智選擇，實現更好的心理健康、更好的口腔健康和更好的整體健康，為自己和所愛的人創造更美好的生活。副議長先生，我支援該動議。
副議長：衛生部長王乙康先生。
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衛生部長（王乙康先生）：副議長先生，我支援該動議。我要感謝陳雅森醫生、沙希拉醫生和阿卜杜勒·薩馬德先生提出該動議，並熱情指出健康是每個人的關切，只有大家共同努力，才能改善個人和國家的健康。
我也感謝所有議員和各部代表通過發言支援各項健康相關政策，並提出改進建議。這包括“更健康的新加坡”預防護理策略；倡導醫療工作者福祉；開發更集中化的資訊科技系統；與私人醫生團購藥品；確保醫療服務對所有人負擔得起等。
議員們還提出了醫療系統面臨的各種挑戰和挫折。確實，醫療服務可能是我們整個公共服務中最複雜的系統之一。如果我說我們對你們提出的每個問題都有解決方案，那是不現實的。即使理論上有，也不可能全部實施。我們必須在預算和時間資源、管理能力以及公眾接受變革的意願範圍內逐步改進。
我們將優先處理那些能帶來最大效益的領域，集中力量。這就是我們的做法。
因此，我們重點擴充醫療容量，包括人力資源，推廣“更健康的新加坡”，並建立有效的社群養老系統。它們共同代表了我們醫療系統的中期重大轉型。
但在談這些優先事項之前，我先回應議員們提出的三個具體醫療問題：人力、融資，以及正如林佔武教授剛才提到的醫療容量。雖然時間緊迫，我還是回應一下。
首先是人力。任何醫療系統的核心都是工作人員。多位議員如陳雅森醫生、洪潔恩女士、萬瑞扎爾醫生、賈米爾·賈姆先生、阿卜杜勒·薩馬德先生和拉傑·約書亞·托馬斯先生都談到了他們面臨的問題。
我們必須盡力支援醫療工作者。全國職工總會和醫療服務員工工會（HSEU）一直積極支援醫療工作者福利。HSEU主席達娜萊奇米女士曾是本院提名議員，多次發言關注此事。
人民行動黨政府與勞工運動的合作是強有力的制度安排，衛生部期待繼續攜手推動醫療工作者福利。
這項工作的重要部分是定期審查醫療工作者薪酬，確保認可他們的貢獻，並保持薪酬競爭力。李安·佩雷拉先生建議進行一些基準比較。我們將內部進行薪酬、稅收（因各國不同）以及生活條件和租金的基準比較。但我建議內部進行，因為競爭激烈，不宜公開比較。但我們肯定要確保競爭力。目前，租金成為外籍護士來新加坡的難題，且自付費用高昂。這些都是我們需要解決的問題。
當前尤為緊迫的是積極招聘本地和外籍醫療工作者，以應對過去兩年因新冠疫情導致的人員流失。
對於本地醫療工作者，我們期待最新一批理工學院畢業生加入，他們剛畢業，很快將進入醫院工作。
阿卜杜勒·薩馬德先生反饋實習生未獲實習津貼。我想澄清，所有工藝教育學院（ITE）和理工學院護理學生在實習期間均有津貼。但某些醫療相關課程，如生物醫學科學，津貼由僱主與學校協商，且各醫療集團做法不同。鑑於議員反饋，我們將調查公立醫療機構未提供實習津貼的具體情況。
至於外籍醫療工作者，海外選拔和考試及候選人遷移需時。他們已陸續抵新加坡，我們希望今年下半年有更多人加入。
對於表現優異且致力於新加坡的外籍醫療工作者，我們歡迎他們申請永久居民（PR）身份。多位議員建議也給予其家屬PR身份，我們感謝建議，值得認真考慮。
對於所有醫療工作者，我們必須確保他們的福祉。我很高興許多議員反對虐待和騷擾醫療工作者。這是醫療工作者最關心的問題之一。
總體而言，我認為新冠疫情後社會對醫療工作者的尊重和感激普遍提升。大多數公眾對醫療工作者表示感激和尊重。
那些對醫療工作者進行身體攻擊、威脅或辱罵的人，確實是少數。但因行為極端，感覺問題嚴重。我們不能容忍此類行為。這對醫療工作者不公，也對尊重他們的廣大公眾不公。
如議員所知，衛生部最近宣佈對虐待和騷擾醫療工作者實行零容忍政策。我們計劃今年下半年將此政策轉化為所有醫療機構的程式和指南。我之前已談及，不再贅述。
政策宣佈後，我注意到一些反應。首先，大多數公眾支援該政策。其次，有人擔憂醫療工作者有時行為不當。我們承認，少數“害群之馬”存在，但有適當渠道舉報，醫院管理層會認真處理。
有人認為虐待根源是醫院工作負荷重、等待時間長，應先解決這些問題。我們正努力緩解疫情後醫院壓力，但需時間。工作負荷重不能成為虐待醫療工作者的藉口。
拉傑·托馬斯先生提到另一個原因是期望值高，未達預期時人們不滿。期望和要求優質服務完全合理，但服務不到位不應虐待醫療工作者。
我想說，儘管工作負荷重且偶有虐待騷擾，我遇到的大多數醫療工作者——我希望不僅僅是因為我是部長——依然積極、專業且熱愛工作。
例如，許芳綺女士自2015年起在郭特拔醫院擔任高階護士，現為護士經理。多年來，她處理過許多虐待患者及其親屬，但始終冷靜同理地應對，成為該領域專家。
有一次，她目睹一名初級護士被患者親屬身體和言語虐待，她勇敢站出來，控制局面並將事件上報相關部門，整個過程中保持冷靜。
儘管面臨諸多挑戰，你可以看出她熱愛工作。她繼續以關懷和善意對待患者及其親屬，並不斷與同事分享處理虐待案例的知識和經驗。
零容忍政策的考驗將在今年下半年，當我們有了指導方針和監督人員來斷絕與辱罵患者或更可能是他們的近親的聯絡時。我確實預計會有人寫信給衛生部，向我投訴為什麼我們的監督人員和護士會這樣做。我們會非常謹慎。我們會確保只有在最真實的案例中才會實施後果，且始終優先考慮護理。如果我收到投訴，我會支援我們的基層監督人員和醫護人員。如果這事鬧到議會，因為我認為一些居民會向他們的國會議員投訴：“為什麼衛生部這樣做，他們能否對此提出上訴，他們斷絕了與我的聯絡，而我只是要求良好的服務。”
當時機和考驗來臨時，我希望得到本議院的支援。如果我們不得不與辱罵患者或近親斷絕聯絡，我們會謹慎且明智地執行，因此，我尋求全院的支援。
讓我轉到醫療融資。梁文韜先生昨天提出了幾點。
我很高興他同意我們使用醫療基金（MediFund）支援低收入家庭的政策。醫療基金在2021財年發放了1.64億新元，而不是梁先生昨天所說的1億新元。政府在2023財年進一步向醫療基金注資15億新元。
然而，梁先生昨天也發表了政治宣告。他宣佈進步新加坡黨（PSP）的立場，即政府應像其他經合組織國家一樣增加醫療支出。
讓我做幾點回應。
首先，眾所周知，增加醫療支出並不意味著健康結果更好。大多數健康經濟學家都知道這一點。既然梁先生以經合組織國家為標杆，我們就舉兩個例子，美國和英國。他們分別花費約佔GDP的17%和10%用於醫療，而我們只有4%。然而，美國和英國仍然面臨慢性病高發、肥胖率高，且預期壽命低於新加坡。
我受到蔡恩福先生的啟發，也查閱了ChatGPT：“你怎麼看美國的醫療體系，怎麼看英國的醫療體系”。實際上，這已是眾所周知的事實。在美國，儘管醫療支出佔GDP的17%，醫療費用仍然非常昂貴。在英國，國家醫療服務體系（NHS）因工作量過大而不堪重負。儘管醫療支出佔GDP的10%，等待時間遠長於新加坡。
鑑於我們的支出，我們已經取得了良好的健康成果。
第二點，無論我們花費多少，我們都能讓中低收入群體負擔得起醫療費用。如今，大約七成在補貼病房的居民無需支付任何自付費用。八成支付的現金自付費用低於100新元；九成低於500新元。
因此，當梁先生要求政府增加支出以進一步降低自付費用時，他實際上是想將資源引導給非補貼患者，即住在A類病房或私立醫院的患者。這部分支出巨大，將推動我們的醫療支出達到經合組織國家的水平。
第三，雖然梁先生要求政府增加醫療支出，但他未提及政府支出最終必須通過稅收從人民那裡籌集。梁先生未說明PSP將從何處獲得資金。
第四，事實是我們已經在不斷增加醫療支出。我們不需要梁先生的督促。醫療支出正在上升。2010年後十年，我們的政府名義醫療支出翻了三倍。接下來的十年，即到2030年，預計還將再翻三倍。三倍再三倍——意味著20年內增長了九倍。這主要由人口老齡化和健康狀況惡化驅動。衛生部預算已是僅次於國防部的第二大部委預算。
未來幾年，我們的挑戰不是花更多錢，而是確保不走上許多經合組織國家那樣醫療財政負擔失控、螺旋上升的道路。
最後，因此我們繼續採取明智且務實的方法更為合適：設立不同層次的安全網——補貼、醫療保險（MediShield Life，我感謝溫賢德教授解釋其必要性）、醫療儲蓄（MediSave）和醫療基金（MediFund）。這就是S+3M方法，效果相當好。
我們現在結合了“更健康的新加坡”（Healthier SG）中的一項非常重要策略，以及促進社群養老的努力，以便在人口老齡化的同時避免疾病，減輕疾病負擔。
梁先生還談到了先驅一代（Pioneer Generation，PG）和獨立一代（Merdeka Generation，MG）基金中看似龐大的餘額，並得出結論認為可以向PG和MG成員提供更多補貼。
他的理解有誤。兩個基金的規模是基於預估的終身福利成本，並考慮了通脹和利息收入。
舉例來說，最年長和最年輕的MG成員分別約為73歲和64歲。PG成員至少比他們大10歲，最年輕的現在74歲。他們仍有相當長的壽命預期，我們預計許多人能活到90歲甚至100歲。因此，他們的終身福利需要由MG和PG基金資助。但政府將繼續定期審查這兩個基金的充足性。
第三個問題是醫療容量，正如林俊明副教授剛才提出的。我們同意80%至85%的床位使用率可能是理想的。你不需要工程師也能得出結論，系統中必須有冗餘。這不是新概念，我想我們都同意。
但為什麼現在會出現緊張？當然，COVID-19期間會有緊張。這是緊急情況，是一代人的危機。我認為沒有任何國家或系統能為那種危機規劃足夠的容量。但危機過後，我們確實面臨緊張。
我之前在議會解釋過，我想是在COVID-19白皮書辯論期間，緊張的主要原因是在短短兩年內，平均住院天數顯著上升。過去是6天，現在是7.1天。[請參閱《衛生部長澄清》，官方報告，2023年5月10日，第95卷，第104期，書面宣告更正部分。]
這意味著你的利用率在兩年內突然上升了15%，這是COVID-19後的現象。
我認為隨著時間推移，研究人員和臨床醫生會研究原因。但可能有幾個假設。一個是免疫債務——更多老年人在COVID-19後感染病毒和細菌。當他們感染時，病情嚴重，住院時間較長，推高了平均住院天數。
另一個可能的原因是，COVID-19期間，太多老年人選擇躲在家裡，害怕外出。社群活動停止，而這些活動對保持健康至關重要。社會隔離導致他們健康惡化，感染後住院時間較長。
僅15%的利用率增長就解釋了我們現在的緊張。這不僅發生在新加坡，全球各國都面臨床位緊張。我們都同意必須有冗餘，但包括經合組織國家在內的所有國家都面臨緊張，儘管他們的床位與人口比例更高。
那麼，我們需要做什麼？首先，趕上容量建設。許多專案因COVID-19延誤。我們必須趕上，但有些事情不能急於求成，只能逐步實施。
今年某個時候，諾維娜綜合護理中心將開放，增加數百張床位。伍德蘭綜合健康園區年底可能開放一個病區；希望明年能開放更多病區。還有亞歷山大醫院和林俊明副教授提到的東部區域醫院的重建。新加坡中央醫院（SGH）園區的重建也在進行中。雖然是現有園區，但這是重大重建，將增加許多床位。
第二，建設更多過渡護理設施（TCFs），我之前解釋過。這非常有用。如今醫院裡仍有不少老年人不是因醫療原因而住院，而是因社會原因。過渡護理設施提供康復護理和良好的醫療設施，我們可以讓穩定的患者轉移到過渡護理設施，從而釋放急性病床。我們正在積極建設這些設施。
第三是招聘，我之前也解釋過。雖然競爭激烈，新加坡仍然是外國護士願意來工作的有吸引力的地方。醫療職業對本地人也很有吸引力。如今，每25名學生中就有一人選擇護理專業，這已經不錯了，考慮到他們有很多選擇。我認為我們獲得了公平的本地人才份額，也在招聘外國護士方面具有競爭力。
當然，我希望議院在提出所有這些問題後，支援我們為招聘本地和外國護士所需採取的必要措施。
讓我回到動議的實質內容，這也是我們今天在這裡的原因——這是一個重要的動議，呼籲政府整體協作支援醫療，即使COVID-19危機已經過去。
我們的公共服務部門有著長期的跨機構合作歷史。但COVID-19是特殊時期。我們見證了跨機構合作的巨大潛力，大家團結一致，共同克服國家危機。
看看我們的學校，它們保持了教育的連續性，僅僅轉為居家學習幾個月。我們的經濟和社會機構協作支援企業和工人。多個機構聯合設立隔離設施、檢測和社群護理設施。我無法強調這對醫院系統的重要性，否則醫院將承擔疫情的全部壓力，我們很可能會崩潰。
最近，一位著名的中國傳染病專家張文宏博士觀察到中國五一黃金週期間生活恢復正常後，寫了一篇部落格，他說：“好像什麼都沒發生，但一切都發生了。”用中文表達就是“一切都沒發生，一切都已發生”。
這是一種頗具深意的危機後心態表達，可能適用於新加坡，也適用於今天的辯論。我們不想沉溺於危機，反覆經歷危機。我們需要走出陰影，把它拋諸腦後，展望未來。然而，許多事情已經發生。經驗和教訓將重塑我們看待醫療和跨機構合作的方式。這些不能被遺忘或浪費。
因此，我與議員們的希望一致，雖然危機可能已經結束，和平時期的工作負荷已恢復，但不能照舊行事。我們應開啟一個更加緊密的跨機構合作新時代。這對醫療尤其重要，有兩個原因。
第一，正如我所解釋的，老齡化可能是未來十年新加坡最大的社會變革，我們將成為“超級老齡”社會。這將在就業、競爭力、退休保障、城市規劃、教育以及醫療等多個政策領域產生影響。它將促使各部委協同工作。
第二，COVID-19危機後，我們決定條件和時機成熟，推動重大醫療轉型，建立在過去多年的工作基礎上。我在議會解釋過為什麼以及我們在轉型中做什麼。基本理念是醫療不僅僅是醫院和診所治療疾病，而是在家庭和社群創造健康。換言之，健康不僅關乎生病的患者，而是關乎所有人。這就是為什麼我們現在將醫療系統視為三個相互關聯的系統。
如果我可以簡要回顧一下。簡妮特·昂女士剛才也解釋過。首先是急性護理系統，確保生病者得到治療。第二是人口健康系統，我們通過“更健康的新加坡”建設，動員所有家庭醫生和全科醫生專注於以社群為基礎的預防護理。第三是老年護理系統。老年護理的預設選項不能是養老院或獨居無社會支援的老人。
在其他國家，老年人的孤獨和社會隔離已成為流行病。我們也看到這種情況在新加坡發生。我認為這也是住院天數增加的原因之一，尤其是在COVID-19之後。
如果我們能做好這點，我認為我們可以實現葉漢榮先生建議的——跨醫療和社會領域整合護理。
我們需要緊急加強全社會的努力，使我們的老年人能夠有尊嚴地度過晚年，在社群中積極老齡化，與朋友和家人共處，參與包括培訓專案在內的活動，就像蔡明傑先生建議的那樣。如果他們願意，也能在家庭環境中安詳離世，親人環繞。因此，社群老年護理是醫療的下一個重點領域。
為了實現全民健康，我們需要每個利益相關者的貢獻，無論是公共還是私營部門。當醫療主要是治療疾病時，屬於醫院的範疇。但當醫療是創造健康、關愛家庭和社群中的人時，它成為每個人的事。因此，為了實現全民健康，我們也需要全民參與健康。我認為這正是議員們提出動議的精神所在。
特別是以下利益相關者可以為健康做出重大貢獻。
第一，僱主。感謝陳雅心醫生髮言。我們許多人成年後大部分時間都在工作，因此工作場所對塑造健康習慣影響巨大。我重視我們與全國職工總會（NTUC）、新加坡企業聯合會（SNEF）和三方工作場所安全與健康監督委員會（TOC）的現有合作，他們一直與企業合作推廣良好的工作場所健康實踐。
通過“更健康的新加坡”，僱主可以與指定醫生密切合作，加入“更健康的新加坡”，繼續為員工提供定期和適當的健康篩查，提供更健康的食堂食品、體育活動專案、心理健康專案和更好的工作與生活平衡。我們也敦促僱主確保所有符合條件者都參與“更健康的新加坡”。通過促進健康，僱主將擁有更高效、更快樂的員工，這對企業有利。
第二是我們的社群合作伙伴。資深議員蔡恩福分享了文化、社區及青年部（MCCY）動員社群促進社會凝聚力、推動健康和與家庭醫生建立強大夥伴關係的努力。陳雅心醫生也建議需要開展適合不同人口群體及其多樣興趣的活動。確實，在“更健康的新加坡”諮詢公眾時，我們聽到許多居民表示，朋輩和家庭影響是激勵他們養成健康生活習慣（如定期鍛鍊和健康飲食）的關鍵因素。
因此，在“更健康的新加坡”下，我們的醫療集團將與社群合作伙伴——健康促進局（HPB）、人民協會（PA）、體育理事會（SportSG）合作，在社群推廣體育活動，鼓勵居民積極參與。我們歡迎其他自發的社群倡議和活動。如果今天我們在公共公園散步，可以看到許多此類活動，很多並非由任何機構組織。朋友們聚在一起騎行、跑步、踢足球。師傅教徒弟氣功或太極。這些現在都是醫療系統的一部分。
第三個領域是學校和教育機構。感謝國務部長顏曉芳談及教育部（MOE）在為年輕人建立健康基礎方面的努力。
確實，良好的健康始於我們的價值觀、習慣和選擇。我們的學校幫助建立健康素養基礎。它們引導年輕人參與體育運動，幫助他們結交朋友、形成社交群體，教授生活技能和知識，成為有用公民，這些都是良好健康的基本要素。正如顏曉芳國務部長早先提到的，多年來，教育部與衛生部合作，精心將健康教育融入從幼兒園、小學、中學到高等教育的課程中。
研究發現，從三四歲開始培養良好的健康習慣，如合理飲食和裝置使用，對兒童後期的認知發展和福祉有深遠影響。實際上，這也影響他們的小學離校考試（PSLE）成績，基於我們的研究結果。[笑聲]也許這是正確的切入點，我不知道。
因此，衛生部、教育部和社會及家庭發展部（MSF）正在研究早期教育與健康之間的聯絡，並開發可能的干預措施。
第四，媒體。資訊和媒體素養是我們抵禦虛假和病毒性健康謠言的第一道防線。我們將繼續與通訊及新聞部（MCI）及其他媒體機構合作，就像我們在COVID-19期間所做的那樣，打擊關於疫苗接種的謠言。
健康新加坡（Healthier SG）為我們提供了一個解決健康錯誤資訊問題的機會。為什麼？這是因為我們倡導並努力建立更牢固的醫患關係。因為有了信任的關係，家庭醫生及其護理團隊瞭解患者的健康狀況和病史，他們就成為患者可信賴的醫療資訊和建議來源。
在這個資訊過載的數字時代，網路謠言、迷思和人工智慧機器人層出不窮，也許我們在醫療保健中需要的是更強的人際關係，尤其是醫生與患者之間的關係。我們可以利用技術來加強這種關係，提高護理質量，而不是取代人際關係。這最終必須成為人類與人工智慧共存的模式。
最後，談談我們的基礎設施和交通規劃者。多年來，國土發展部（MND）和交通部（MOT）的同事們在全島範圍內擴充套件了綠地、公路腳踏車道和健身角，以支援積極的生活方式。還有計劃在更多的銀髮區（Silver Zones）和行人過街處設定綠人+（Green Man+），讓我們的長者能夠更安全、更自信地在社群內出行。
這些都是各機構攜手合作，更好支援健康的眾多例子，我們承諾將繼續這樣做。
副議長先生，請允許我作結。
我注意到我們的提名議員（NMP）任期即將結束。這可能是你們倒數第二次議會會議。我不確定，但領袖告訴我，可能是你們倒數第二次會議。我知道你們中的一些人希望得到保證，即使你們卸任，關心的問題仍會在本議院得到關注。
因此，我感到榮幸和自豪——雖然這讓我有點忙碌——你們選擇提出一項關於醫療保健的動議，正如你們在任期內積極發聲關注醫療保健問題。特別是陳雅心醫生，她也是新加坡醫師協會（SMA）主席，一直是各種醫療相關議題的堅定倡導者。
我曾參加過她主持的一次SMA晚宴。在那次活動的演講中——這是公開的，所以我想我可以說——她說自己曾是一個憤怒的年輕醫生。現在，你是一位不那麼憤怒的中年醫生。但不同的是，你學會了如何將精力引導向更大的善，併成為更好的倡導者。
我認為陳醫生在SMA和本議院都做得很好。但我不認為陳醫生是憤怒的。我們對事業充滿熱情並積極倡導是很重要的。
我非常感謝這項動議，強調衛生部（MOH）需要與其他機構合作，其他機構也應支援我們。今天，我們有教育部（MOE）和文化、社區及青年部（MCCY）的政治任命官員（POHs）發表演講。實際上，我們本可以邀請更多人發言，但不想讓辯論時間過長。
人口老齡化將成為影響我們所有人的重大挑戰——衛生部不能獨自承擔。
我們提名議員的熱情和積極行動提升了本議院辯論的水平，對新加坡的民主話語權發展大有裨益。
所以，請放心，即使你們的任期結束，你們關心的問題仍將繼續在本議院得到應有的關注。將會有新一批同樣熱衷於議題的提名議員，繼續關注你們關心的問題。
在醫療保健方面，將有醫療專業人士議員、衛生政府議會委員會（GPC）成員、勞工議員和提名議員，以及對醫療保健有強烈關注的議員繼續傳承這份責任。最重要的是，衛生部的政治任命官員將繼續推動我們的議程，回應利益相關者的關切。我們不是對立的雙方，我們都站在同一邊，努力讓系統為新加坡人變得更好。
對於提名議員，卸任後，我希望你們繼續在旁邊給予建議和支援。讓我們共同為每個人爭取更好的醫療保健系統。健康屬於所有人，所有人為健康而努力。[掌聲]
副議長先生：陳雅心醫生。
下午5時03分
陳雅心醫生（提名議員）：謝謝您，先生。首先感謝翁部長。好吧，聽了您的好話，我可能不那麼憤怒了。如果您像顏國興先生那樣待十年，我也會繼續建議和幫助十年。
先生，我對這項動議獲得的強烈支援感到非常鼓舞。
首先，感謝所有出席的提名議員，他們各自分享瞭如何在各自領域支援醫療保健的見解。這正是我們需要的協同創新思路。
接下來，感謝所有議員發表的涵蓋廣泛主題的演講，涉及支援醫療保健的各個方面，即：（a）招募、再培訓和留住醫療人員；（b）公平薪酬、合理工時；（c）融資和業務需求；（d）更好的資訊科技系統；（e）堅決反對欺凌和騷擾；（f）強調預防和初級護理；（g）法律保護和支援；（h）照顧弱勢群體，特別是兒童、老人、外勞和殘障人士。
不過，我必須回應梁先生昨天提出的一些觀點。我感謝他關於審查醫療儲蓄賬戶（MediSave）的意見，但我敦促他與衛生部深入討論，更好地瞭解當前資金情況，並在必要時協助未來的審查。
醫療儲蓄賬戶和醫療保險生命計劃（MediShield Life）已被廣泛且嚴格審查，以確保大多數新加坡公民和永久居民在選擇重組醫院的補貼病房時能夠負擔得起醫療費用。如果你們認識經濟困難的居民，請引導他們聯絡經驗豐富的醫療社會工作者，獲得更多可用補貼的建議。
我還需要向梁先生澄清他關於“非補貼患者的藥品價格不應被不合理地加價以補貼補貼患者”的評論。
首先，有證據表明這種情況存在嗎？其次，什麼是“不合理”的加價定義？
如果我用另一個食物比喻，而非雞飯，一罐汽水在廉價雜貨店賣60分，在超級市場賣1.30元，在咖啡店賣1.60元，在餐廳賣3元，在酒店賣5元。藥品合理的加價是多少？
非補貼患者通常是選擇A或B1等級病房的患者，或外國人。作為醫生，我認為讓市場力量決定價格是公平的。梁先生是否也希望納稅人為所有人買單？
我也感謝來自不同部委的政治任命官員對支援醫療保健的承諾和保證。
感謝高階議員蔡艾立積極推動跨政府機構的體育運動和社群參與。像我這樣的跑酷阿姨很高興，不再被警察驅趕。
國會議員顏紹煌也概述瞭如何在各教育階段融入運動和健康飲食教學。
感謝高階國務部長潘志成和翁業強部長坦誠詳細地回應了人力、資訊科技和融資等複雜問題。
專業團體將繼續與衛生部密切合作，解決醫療保健中的問題，特別是培訓和工時相關問題。坦白說，只有臨床醫生真正理解所需的微妙平衡。我很高興我們都達成共識——醫療保健必須是全政府的努力。
最後，我回到“為什麼”。為什麼我們站出來倡導一個事業？是為了留下一個比我們出生時更美好的世界。
關於下一輪提名議員申請的最新訊息再次引發一些批評。我相信提名議員的角色給予了像我這樣的普通公民在國家平臺上發聲的機會。普通，因為我是一位夾心層的辛苦工作母親。普通，因為我也擔心孩子們的未來。我的孩子們將成長在怎樣的新加坡？
各位議員都知道準備演講有多難。這不僅僅是走到麥克風前說些華麗的話。需要背景調研，控制時間，避免被議長或副議長訓斥；還要以易於接受的方式講真話，強調重點。
我曾說過——我們都說了很多話，但誰在聽？公眾在聽嗎？
直播通常只有400多名觀眾。少數人會故意製作我們失誤的搞笑片段。是的，一旦我克服了尷尬，我得說，真的很有趣，謝謝你們讓我們笑！
但我真正想對話的是那些關心新加坡整體利益的公民，他們在聽並考慮政策。
也許你們中有些是公務員。新加坡有15萬名公務員，他們向政府負責，而非任何政黨。我強調，公務員是有自己不同政治信仰和立場的個人。他們服務於新加坡人民。
盲目支援或反對任何政黨，嘲笑提名議員是傀儡或代言人，或將一切責任歸咎於政府——我問你們，這合邏輯嗎？這對任何人有益嗎？
在反應和發言前，請考慮三點：一、這是真的嗎？二、這有必要嗎？三、這善意嗎？如果任何一項答案是否定的，也許最好不要說。
我相信你們許多人有醫療行業的朋友。請與他們交談，瞭解我們面臨的問題。組建你們自己的小型非正式智庫，集思廣益，解決更大的醫療問題。
無論你們是部委工作人員，還是像我一樣的普通公民，我希望你們也思考如何確保醫療保健獲得所需支援，並優先考慮自己的醫療需求。
我們現在生活在一個快速變化且不穩定的世界。看看新冠疫情如何讓世界停擺三年。看看烏克蘭戰爭、美國銀行倒閉。世界一夜之間改變。這並不新鮮，歷史在重複——也許週期比以前更快。
現代人必須適應一個答案不那麼明顯、沒有規則手冊或十年考題可參考的世界。可能沒有單一正確答案，選擇必然有權衡。
如果戰爭降臨新加坡，如果發生末日，我們需要戰士，需要領導者。但我告訴你，我們還需要懂得照顧他人的人，懂得止血、防感染、接生、種植食物、獲取清潔水源的人——任何確保我們生存的知識。
但我們是在積累有用知識，還是在社交媒體上無意義地消磨時間？
我見過患者，醫療治療演算法其實很簡單。有乳房腫塊，需要檢查。但情緒壓力常常成為障礙，表現為猶豫、恐懼、擔憂，甚至對我發怒——“為什麼會有腫塊？”
我理解，但處理負面情緒的衝擊並不容易。醫療工作者、教師、司機——實際上所有一線服務人員，都承受了大量負面情緒的衝擊。
這就是我們的社會。一個壓力鍋。人們在日常生活中不快樂卻未察覺，感到易怒、暴躁、過度批評、擔憂一切，覺得無法應對。
我重複我之前演講中的一點。認識到自己或親人的心理健康問題。如果你患有焦慮或憤怒管理問題，不要把情緒發洩在醫療工作者身上，也不要發洩在他人身上。尋求心理健康專業人士的幫助。
雖然我是乳腺外科醫生，但我不能只做癌症手術。我必須全面考慮患者。她的整體健康——是否有其他影響手術和恢復的疾病？她的首選語言——是否完全理解我說的話？她是否做出真正知情的決定？她的性格如何？她的社交網路？她在家和工作場所是否得到良好支援，還是因為認為他人需求優先而放棄治療？
手術本身在專家手中很簡單。挑戰是幫助患者克服所有這些情緒和心理障礙，尋求健康，最終走上康復之路——這就是我呼籲全球變革和全政府支援的原因。
感謝所有參與辯論的人，我強調：第一，深入基層，獲得真實反饋，承認醫療問題。第二，持續在各層面開展教育。第三，跨部委、跨行業、跨公私部門合作。
人類記憶短暫。讓我們從過去的錯誤中學習，避免重蹈覆轍。人們只有在事情影響到自己時才會關心。幫助我，讓每個人都關心。
最後，打破正式禮節，我要感謝Shahirah、Samad、蓮斌、Mark、Janet、Joshua、Hian Teck和Hsing Yao。感謝你們的友誼。這是一次多彩且有趣的提名議員旅程。
感謝兩黨所有議員，我很高興有機會認識你們作為人，而不僅僅是海報上的公眾人物。這是我在本議院的最後一次發言。下次見面，可能是在人民見面會時向你們投訴。[笑聲]
感謝你們所有人——兩黨議員——為新加坡的服務。如果可以，我會為你們祈禱智慧和善良，願你們繼續有意義地辯論，引導新加坡安全度過未來挑戰。[掌聲]
副議長先生：梁文韜先生，我即將向議院提出表決。你對剛才的發言有澄清嗎？你想對陳醫生的問題作回應嗎？
下午5時13分
梁文韜先生（非選區議員）：謝謝副議長。我感謝陳醫生提出關於藥物補貼的問題。
據我瞭解以及許多居民的反饋，他們在不同等級病房支付不同價格。當然，這是預期之內的。目前，不同等級收費不同。
但從某個角度，我在演講中提到，服務收費可以，但為什麼不同等級的藥品價格差異如此之大？這就是我所說的。我不明白陳醫生為何將此作為問題提出。
也許我可以向陳醫生澄清，她是否同意我們的建議，即政府應啟動新加坡所有藥品的集中採購流程。我想聽聽她的意見。
副議長先生：陳醫生，你想回應嗎？
陳雅心醫生：是的，我想回應，因為我是醫生，我對醫療保健略知一二。
首先，關於賬單，尊敬的議員，建議你讓受影響的居民向他們所在醫院的業務辦公室查詢賬單明細。那裡有非常清晰的補貼等級說明，不同藥品，無論是品牌藥還是仿製藥，成本都非常明確。
所以，我想了解更多細節，而不是一概而論說成本不公平。
關於第二個問題，即政府是否應統一採購所有藥品，我瞭解到目前公共醫療機構對慢性病藥物已有集中採購。
但在私營部門，我恭敬地指出，所有私營醫生都有自己的商業模式和不同的收入方式。因此，並非所有醫生都願意參與政府的採購計劃。感謝議員的建議，我們會帶回專業團體，進一步徵求會員意見。
副議長先生：翁業強部長，你有澄清嗎？
翁業強先生：我覺得讓提名議員回答政策問題不太公平，還是由衛生部來說明比較好。
我們的醫療體系是多元化的，不同於英國國民保健服務（NHS）那樣全部國有化，藥品價格基本統一、集中採購。
我們有意滿足多元市場需求。正如陳雅心醫生所說，私營醫生有不同的經營模式。有些醫生諮詢費很低，但通過賣藥賺取利潤；有些則相反。
所以，如果我們提出一個想法——幸運的是這是議員提出的，而不是我——說“大家都賣同一價格”，實際上會影響醫生的飯碗，這對他們來說是個大問題。
因此，我認為陳醫生的話有一定道理。在私營領域，有時你希望市場力量發揮作用，但同時通過保險結構、補貼政策等方式加以規範。我認為這就是我們控制不必要醫療費用的方式。
副議長先生，我知道梁先生還有更多問題。但實際上，我認為這是一項關於各部委以及我們所有利益相關者共同參與的動議，非常有意義。我敦促大家不要再拖延這場來回爭論，讓我們給予即將卸任的非選區議員對他們這項非常有意義的動議以強有力的支援。[掌聲]
[（程式文本）提問，獲得通過。（程式文本）]
[（程式文本）決議：“本院承諾支援疫情後醫療保健工作以及全政府為實現持續和穩定支援所做的努力。”（程式文本）]
副議長先生：領袖。
英文原文
SPRS Hansard · Fetched: 2026-05-02
[(proc text) Order read for the Resumption of Debate on Question [9 May 2023]. (proc text)]
[(proc text) "That this House commits to supporting healthcare beyond the COVID-19 pandemic and the whole-of-Government efforts for consistent and sustainable support.” – [Dr Tan Yia Swam] (proc text)]
[(proc text) Question again proposed. (proc text)]
Mr Deputy Speaker : Prof Koh Lian Pin.
1.39 pm
Prof Koh Lian Pin (Nominated Member) : Mr Deputy Speaker, I stand in support of this Motion. I would like to join the debate today by highlighting a growing healthcare issue facing the academic community.
Our universities and academic institutions are places of higher learning, research and innovation. They are also workplaces where faculty members, researchers and students spend a significant amount of their time.
In recent years the academic work environment has become increasingly stressful, leading to the rising incidence and prevalence of mental health issues among university researchers and graduate students.
A global study conducted in 2018 found that 41% of graduate students worldwide suffered from moderate to severe anxiety, while 39% showed signs of moderate to severe depression. This survey which was based on the responses of over 2,000 students from 230 institutions across 26 countries reported that in general, graduate students are more than six times as likely to experience anxiety and depression compared to the general population.
There may be several reasons why mental health issues are becoming prevalent in academia. One of the biggest causes arguably is the constant pressure to perform.
The academic path can be both long and narrow. It may also come with significant opportunity costs. Having committed typically around 10 to 15 of the most productive years in their 20s and 30s to acquiring an increasingly specialised skill set as an early career researcher, the scope for an alternative career tends to get increasingly narrower as they progress in their training as graduate student, postdoctoral researcher and then junior professor. The pressure to continue down this path and succeed as a tenured academic can be enormous.
Additionally, the nature of academic research for some disciplines can be arduous and unpredictable. The demands of laboratory experiments or field surveys typically require individuals to work after hours and over weekends. These long, irregular and gruelling hours of research inevitably compromise work-life balance and can have significant impacts on the mental health of early career researchers.
Many of them are also at an age when they are trying to start a family, and so these mental health impacts may extend to their partners and other loved ones as well.
Furthermore, many research-intensive universities now consider various publication related metrics when evaluating the performance of their faculty members and researchers. This can create a "publish or perish" mentality which in turn creates immense pressures, especially among early career researchers to publish quickly, frequently and in the most highly regarded scientific journals.
A strong publication track record is critical for securing a good post-doctoral position and academic tenure. However, the overwhelming and constant pressure to publish can lead to persistent feelings of anxiety, resulting in burnouts and other mental health issues.
Another major contributor to mental health issues among early career researchers is job insecurity. Many individuals who embark on an academic career may aspire to be a tenured professor someday. But there are just not enough professor positions for the growing number of PhD graduates to fill. Certainly, not in Singapore alone.
As a result, many early career researchers are on short-term contracts supported by research grants. The duration and size of these grants can be variable and unpredictable, leading to uncertainties for long-term employment. This lack of job security can also lead to persistent stress and anxiety as researchers constantly worry about their next contract and future career prospects.
Among graduate students, and especially for students from overseas who have come to Singapore to pursue their graduate research, the rising cost of living in Singapore is probably one of the greatest stress factors today. Many PhD students in Singapore are on research scholarships, which provide a relatively modest stipend compared to the salaries that their peers in the workforce may be getting. The constant cost of living concerns can lead to a vicious cycle of poor mental health and decreased academic performance, with individuals struggling to cope with the rigorous demands of academic life as graduate students while also managing their challenging financial situation as young adults.
Finally, the academic culture itself can also be a significant barrier to addressing mental health. Indeed, there may be a common but misguided perception in academia that admitting to struggling with one's mental health is somehow a sign of weakness, incompetence or inadequacy. This stigma can lead individuals to feel like they need to hide their struggles to fit in or to maintain their academic standing among their peers. Left unchallenged, this stigma can cause individuals to delay seeking help or treatment for mental health concerns, which can lead to a worsening of symptoms and other detrimental impacts on their personal and academic life.
To address the growing mental health issues facing the academic community, we may wish to consider the following suggestions, some of which are already being implemented in our local universities and research institutions, but we can always do more.
First, we could invest more in mental health research to contextualise and better understand the extent and nature of the mental health problem within Singapore's academic community. This may help us develop more effective and bespoke solutions.
Second, we could provide more mental health support services, including workshops, support groups and mental health professionals to create an ecosystem of affordable and accessible mental health resources on campus for those in need.
Third, we could make greater efforts to raise awareness and reduce the stigma associated with mental health in academia. Importantly, we could create a culture of openness and support by providing training for senior faculty and staff on how to identify and support individuals who may be struggling. By doing so, we can destigmatise and normalise our discussions on mental health.
Finally, we could also do more to normalise a healthier work-life balance in academia. This may include providing more opportunities for remote work and flexible schedules and creating policies that limit after-work emails and meetings.
As an encouraging example of what is already being done, the National University of Singapore has been running a #AreuOK mental healthcare campaign since 2021. Its main goals are to destigmatise mental health conditions in the NUS community and support those who seek help. It provides free and confidential mental well-being check-ins, emotional support sessions and a 24-hour hotline, among other services. I declare that I am an NUS professor. Of course, other universities in Singapore provide similar initiatives and support to their academic communities as well.
At the national level, the Health Promotion Board runs our national mental well-being campaign, "It's OKAY to Reach Out", which seeks to normalise the topic of mental health and well-being, generate greater understanding and awareness and encourage Singaporeans to reach out for support.
Sir, Singapore is a global leader in research and innovation. The quality of our universities and research institutions plays a critical role in maintaining this status. More importantly, a physically and mentally healthy research workforce, which includes graduate students and researchers at all levels, is needed to ensure the consistent production of top-quality research in Singapore.
Furthermore, the academic community in Singapore is diverse and international, with individuals from different cultures, backgrounds and experiences working together towards the common goal of creating impactful, new knowledge, science and technologies. Providing a supportive and inclusive environment that promotes the mental well-being of all members of our academic community will enable us to attract and retain top talents from around the world and maintain Singapore's role as a global knowledge and innovation hub.
Addressing mental health in academia is not just a moral imperative but also an economic one. The World Health Organization recently reported that depression and anxiety disorders cost the global economy over $1 trillion every year. Another recent study by the Duke-NUS Medical School and the Institute of Mental Health estimated the total economic burden of lost productivity due to anxiety and depression in Singapore to be almost $16 billion annually. By investing in mental health initiatives in academia, we can improve the productivity and performance of our academic workforce, which can have a positive impact on our economy as a whole.
In conclusion, addressing mental health in academia is critical for Singapore to succeed as a knowledge and innovation hub, attract and retain top talents, strengthen our economy and build a resilient workforce and society.
Let us work together to create a culture of openness, support and understanding in the academic community, where individuals can seek help without fear of stigma or judgement and realise their full potential.
Finally, I joined my fellow Members in thanking the nurses, doctors and all healthcare workers for their indefatigable spirit, dedication and sacrifices in their contributions to the physical and mental well-being of our nation. Mr Deputy Speaker, I support this Motion.
Mr Deputy Speaker : Mr Leon Perera.
1.51 pm
Mr Leon Perera (Aljunied) : Mr Deputy Speaker, Sir, when deciding how liveable and how advanced a society is, the quality and affordability of its healthcare sector play a key role.
In most countries, the nature of healthcare provision is highly contested and debated because of its critical importance. In many countries, including our own, healthcare is also a vital sector for the economy, creating many jobs directly and indirectly.
Post-COVID-19, I am hopeful that progress on constructing new facilities like the Woodlands Health Campus and the Integrated Care Hub at Tan Tock Seng Hospital is picking up. However, the main impediment – the main challenge – in meeting our long-term healthcare needs lies not in the building of physical facilities, it lies in the recruitment and retention and raising the productivity of our healthcare workers. It is this single theme that my speech will address today.
In my speech, which supports the Motion, I will talk about: (a) addressing recruitment and retention among healthcare workers; (b) raising the productivity of healthcare workers; and (c) improving the outcomes from the healthcare system as a whole without increasing cost proportionately by addressing sources of health problems upstream and by other means.
Before I proceed, I declare my interest as the chairman of a company that does consulting work in the healthcare space, among other verticals.
Sir, in preparing this speech, I raised the topic of how we can attract more Singaporeans into the healthcare sector at my family dinner table. Without a micro-second's hesitation, my daughter said, and I quote, "Give them decent working hours, respect at work and good pay."
Indeed, this is a major long-term challenge we face. We can build the wards and clinics, we can buy the equipment, but how can we attract and retain workers in the sector such that churn is minimised, such that there is a core of professionals from whom future leaders can be drawn, such that there is a good learning curve, a sufficient accumulation of experience and skills to elevate service and effectiveness so as to ensure good outcomes for patients?
There are media and anecdotal reports of facilities that are unused due to a lack of manpower. For example, a recent report from TODAY, citing a private doctor, said, "As a matter of fact, several private hospitals have closed some hospital wards and operating theatres due to a shortage of nurses.”
The all-important manpower challenge in healthcare unpacks itself into a few bundles of issues – compensation, working hours, working conditions and career laddering, and productivity and, also, as part of that, that should address ensuring that the work feels meaningful.
Firstly, Sir, on compensation. While nurses' pay was increased last year – and this is welcome – this was the first base salary increase in seven years. Junior doctors' pay was increased as well recently but, as per the reply to my recent Parliamentary Question (PQ) on this, the 7% to 13% starting salary increase applies to house officers and first-year medical officers (MOs). However, more experienced junior doctors, namely, eligible in-service MOs or residents up to postgraduate Year 6 and dental officers up to postgraduate Year 4, could expect a salary adjustment based on their years in service and bond period rather than an across-the-board increase, as I understand it.
Clearly, to attract and retain talent, compensation has to be competitive. Moreover, in healthcare, talent can migrate across national borders. Many countries are short of experienced healthcare staff. Many countries would like to poach our English-speaking and well-trained healthcare workers.
Hence, I would like to ask if compensation for healthcare personnel could be monitored and tracked based on hourly compensation – total pay per hour worked – and regularly benchmarked against other developed country locations against which we compete for healthcare talent, with the results published so that we have a clear indicator of how we are doing and whether or not we will face choppy waters ahead that we would need to take heed of.
I am aware of academic studies that are occasionally published to this effect but I am not aware that there is a regular Government publication to this effect.
Next, Sir, on managing working hours and burnout. There is no point raising pay if there is under-capacity and working hours rise after that such that pay per hour remains the same or actually falls.
Sir, I have raised this in the House previously in relation to the issue of junior doctors' working hours a few times. I would like to repeat my call to lessen the weekly working hour requirement for junior doctors from 80 to 70 and to step up enforcement to make sure that this is adhered to.
There is evidence that the same training outcomes can be obtained with a cap of 70 hours per week versus 80, as I explained in my previous Committee of Supply speech. This would also require systems to be streamlined so that junior doctors and, indeed, nurses, spend more time on patient care and training rather than administrative tasks.
I would also repeat my calls to move towards 100% compliance with the current 10-hour intervals between duty periods and after in-house calls, up from 90% now, ensuring no under-reporting of hours and taking concrete steps to shorten the time spent on handing over administrative and peripheral duties.
I understand that conditions for junior doctors are being reviewed in the public healthcare system now. I hope that the need to optimise working hours will be fully considered in that process.
Next, Mr Deputy Speaker, Sir, on workload. Workload is, of course, a function of healthcare demand vs manpower capacity. Healthcare demand will rise steadily as our population ages and, indeed, we are one of the fastest-ageing populations in the world.
Minister Ong has said that the annual intake of nursing students will rise from 2,100 to 2,300 a year. This should help with meeting demand if nurses stay in the profession.
Right now, the proportion of Singaporeans among enrolled nurses is a little over 60%. It is important for such a critical profession to maintain a strong Singapore Core and good career progression for nurses who can progress into more senior nurse practitioner and leadership roles.
I know that there are currently nursing scholarships primarily awarded by the healthcare clusters. I wonder if this number is sufficient to meet the needs of the future to generate enough of a pipeline of nurses for future senior nurse practitioner, mentoring and leadership roles.
Does the Ministry review the number of nursing scholarships given with this in mind? Do such reviews extend to the awarding of a sufficient number of postgraduate scholarships in nursing, given the increasing complexity and technology dependence in the healthcare sector going forward? Currently there appears to be only one academic programme which provides a Masters in Nursing requirement for advanced practice nurses.
Lastly, on the topic of workload. So as to strengthen the Singapore Core in professions like nursing, we should provide preferential consideration to foreigners who are in these professions who have lived and worked here for some time and have demonstrated a capacity to integrate well into our society to obtain permanent residency and, eventually, citizenship.
I believe some other Members of this House have called for this before and the Government has said it is open to such an idea. To add on to this, I would repeat my call for the giving of citizenship to be made more transparent, with the availability, for example, of an online points-based calculator, similar to what you see in some other countries. This may make Singapore more attractive to healthcare professionals from other countries by providing more clarity and assurance.
Next, Mr Deputy Speaker, Sir, on the role of pharmacists. To raise the productivity of our whole system, will the Government consider giving pharmacists some powers to prescribe drugs for certain conditions? This is already being considered in Australia, though there has been some pushback associated with this. Our pharmacists already make adjustments to dosing of drugs for some chronic medications, and advanced practice nurses also have cooperative prescribing models in our local healthcare institutions.
I would like to suggest that the Government monitor international developments and consider if and how to accord greater powers for prescription to pharmacists, depending on the emerging international evidence. This may negatively impact general practitioners (GPs) initially but I have some suggestions relating to GPs which I will come to in a minute.
Next, Mr Deputy Speaker, Sir, I would like to touch on the necessary role of other allied healthcare professionals and medical personnel. I note that the Government has plans for a greater role for community pharmacists in promoting things like health screening and vaccinations.
I spoke about the vital role of both health screening and vaccinations in my Adjournment Motion on preventive healthcare last year as well as via PQs previously. MRNA technology is already spawning potentially revolutionary developments in medicine that could lead to radical breakthroughs in decades to come. But turning back to current realities, it would seem that we are lagging behind many developed countries in terms of the more routine types of vaccination, like influenza vaccines. This can limit the incidence of chronic or catastrophic conditions further downstream.
Moreover, alarmingly, the National Population Health Survey 2021 showed that fewer Singapore residents participated in chronic disease and cancer screenings in 2021, compared to 2019.
There are plans to raise the number of allied healthcare professionals. Such professionals can play a critical role in community healthcare, nudging healthier lifestyles and appropriate help-seeking behaviours, including for mental health conditions, as well as helping those with chronic conditions prevent the development of complications.
In the Serangoon ward of Aljunied Group Representation Constituency (GRC), my volunteers and I have had the honour of working with Tan Tock Seng Hospital (TTSH) Community Partners to conduct a health talk and consultation session at a rental block. We also refer cases we come across to TTSH Community Partners, or TTSH CP, which also stations nurses at the Community Care Services Singapore facility at Golden Ginger in Serangoon North at certain times, to make some screening and advice available to the people who live in the area.
These are commendable and beneficial interventions, and I hope that these can be replicated in other areas that currently lack this. These should eventually be funded centrally as they do not require costly infrastructure and could also allow local nurses, physiotherapists, occupational therapists and podiatrists with families to, perhaps, work part-time near their homes in their own communities.
The model for deployment of such allied healthcare professionals is often to leverage events that attract people to consider health issues. However, some evidence from a survey conducted by Lifebuoy suggests that most Singaporeans take a rather passive approach to their own health and do not often or always proactively seek out information on how to improve their health. Hence, it behooves us to find methods that are more in line with what, in business marketing, is referred to as "hunting", that is, direct sales, as opposed to "farming", or attracting people to come to you.
To that end, I wonder if, once we have the health coaches in sufficient numbers, we can, as one initiative, deploy them to void decks, hawker centres and wet markets. These are areas of high footfall, particularly among older people, who may benefit more from healthcare interventions. It may be helpful if personnel who are fluent in vernacular languages can approach them in these settings, in a more proactive way, to promote ideas, such as vaccination and health screening, or even to perform certain basic screening activities on the spot. For younger demographic segments, what might work better are, perhaps, strategies that rely on social media.
Next, Mr Deputy Speaker, Sir, let me move on to the role of GPs. Our roughly 1,800 GP clinics play an important role in our healthcare system as the first line of defence for non-emergencies. This role is set to increase with the advent of Healthier SG. When we speak of attracting and retaining good healthcare professionals in our system, we should not neglect our GPs.
Yet, there are worrying signs. In a survey of 300 GPs by NTU published in the journal BMC Primary Care in 2022, 14.4% said they plan to leave general practice permanently, 12.6% plan to take a career break, and 51.3% plan to reduce their clinical hours. Higher remuneration, recognising general practice and family medicine as a medical specialty, and reducing the litigious pressures on medical practice were rated as the most important factors in these decisions, while there was growing dissatisfaction within this community with the third-party administrators that manage insurance arrangements. If there are too many exits from the GP sector, this may dent our ability to achieve our primary healthcare and Healthier SG goals.
Also, a study of primary healthcare quality by the National Healthcare Group published in the journal "Asia Pacific Family Medicine" in 2014, which polled 85 experts, concluded that Singapore's system suffers from several issues, and I quote: "The primary care system in Singapore received an average of 10.9 out of 30 possible points... Singapore was categorised as a 'low' primary care country according to the experts." The earnings of primary care physicians, compared to specialists, were one of several factors cited.
Sir, I have a few suggestions here to address some of the issues faced by the GP population and primary healthcare in general.
Firstly, should we not regularly survey our population of GPs to understand their experience, their pain points, their perception of gaps in the ecosystem and their suggestions to the Government, insurers and other stakeholders? In my opinion, most of our GPs are thoughtful and well-informed individuals, who should have good ideas for constructive policy change. The Ministry of Health (MOH) does Primary Care Surveys every 10 years or so to determine, primarily, the economic parameters around the primary care sector, but much more can be done.
Secondly, can the Government explore onboarding individual GPs and corporate groups that run GP clinics onto the Government procurement system for drugs, so that all parties can obtain lower prices on the basis of larger bulk purchases? Right now, drug sales representatives often sell drugs to individual GPs. And this means fragmentation and far less bargaining power and economies of scale.
As an aside, I was once queuing to see a GP and someone behind me in the queue got in to see the GP before me. I did not mind, but I was just curious. So, I went up to the receptionist and I asked the receptionist why this happened and she said she had deprioritised me as I was wearing a tie at the time and she thought I was a drug sales rep rather than a patient.
Anyway, I understand that the Government is currently studying the idea of allowing private healthcare providers to tap on the Government drug procurement system, or ALPS, and I hope the Government will move on this soon to enable combined purchasing across the public and private sectors to the fullest extent practicable.
Lastly, would the Government, as part of the surveying effort I referred to earlier, identify GPs who have spare capacity – meaning that there are certain times of day when they do not see so many patients – and find ways to engage such GPs to augment the capacity in polyclinics or other public healthcare institutions, if they are keen to do so? Anecdotally, it seems that the density of GP networks has seen some long-term increase and competition has risen. One effect of this may be that some GPs – not all – have some spare capacity at certain times of the day, on certain days.
Mr Deputy Speaker, Sir, I come now to the last part of my speech – how do we raise the labour productivity of our healthcare workers? I am reminded of an amusing conversation I had once as a young Economic Development Board (EDB) officer. One of my colleagues was talking to another manager. The manager said that he could not increase output without a commensurate increase in headcount, to which, the first person said, "Ah, yes, but that assumes zero productivity growth." I have never forgotten this little bit of wisdom, so pithily conveyed.
Of course, as healthcare demand grows, we will need to hire more staff. But we need to manage the rate of that increase so as to manage cost, as well as to manage population pressures that may arise from excessive inflows of foreign manpower – and I use the term "manpower" here in a gender-neutral way, of course.
How can this be done? There are advances in healthcare technology to draw upon and best practices available worldwide. For example, telemedicine can enhance staff utilisation and save time for patients as well. Some survey evidence suggests that Singaporeans are open to virtual consultations. There is also robotics. For example, service robots could perform some of the functions of a healthcare concierge. Robotics devices can also play a role in rehabilitative medicine.
I am aware that some of these innovations have come to our healthcare system and more are being considered. I am also aware that this is not a new topic. In 2012, MOH launched the Healthcare Productivity Roadmap and, in 2017, MOH announced the Healthcare Productivity Fund. There are also the National Healthcare Productivity and Innovation Awards. However, I have a few suggestions here.
Firstly, the potential to apply cutting-edge developments in fields like artificial intelligence (AI), computing and robotics to healthcare is high. For example, a 2019 Accenture study on Singapore's health workforce concluded that technology could free up 10% of time for doctors, 10% for pharmacists, 22% for nurses, 31% for laboratory scientists, 50% for pharmacy technicians and a whopping 68% for medical records clerks in Singapore.
My suggestion here is that the Government measure healthcare labour productivity from time to time and publish the results, benchmarked against productivity standards in other global cities. I think it would be useful to make city-by-city comparisons in this regard. There would be various types of metrics that could be considered. Ideally, we should measure public and private healthcare separately for the sake of comparison. And this data could be used to identify good outliers, where best practices and case studies can be documented and shared. If we do not know where we are at, we cannot get to where we want to go.
Secondly, and specifically for mental health care, this is an area where we are seeing challenges. Some experts speak of a youth mental health crisis, a phenomenon which may not be unique to Singapore by any means. Our ratio of clinical psychologists and psychiatrists lags behind some other developed countries, a subject that I and other Members have raised previously. Will the Government explore using AI technology to augment capacity in mental healthcare?
For example, a Boston-based company called "OM1" recently built an AI platform called "PHenOM" to help psychiatrists enhance their diagnostic and treatment effectiveness and efficiency. Singapore-based company Holmusk has partnered the UK's NHS and Liverpool University to establish a mental health analytics and research hub. Holmusk's mental health analytics platform is of a large scale. I hope the Government will consider working with companies like this, particularly locally based ones, to push the envelope.
In conclusion, Mr Deputy Speaker, Sir, our future is one where demands on our healthcare system will be greater, as our population ages. But our future is also one where there will be greater opportunities to exploit technology and innovation to increase efficiency; and to enhance prevention upstream. We need to grasp the opportunities to meet those challenges.
And this will have to be done by our healthcare professionals, the people who must be at the heart of all we do in healthcare, for, without them, nothing is possible. At the end of the day, healthcare is, and will remain, must remain, a profoundly human endeavour. There is no more important goal in healthcare than attracting, retaining and bringing out the best from our great healthcare workers.
And before I conclude, Mr Deputy Speaker, Sir, I would just like to join my hon friend Mr Gerald Giam and other hon Members of the House in expressing our whole society's profound gratitude to our wonderful nurses, and to wish them in advance a very happy Nurses' Day to come.
Mr Deputy Speaker : Mr Mark Chay.
2.10 pm
Mr Mark Chay (Nominated Member) : Mr Deputy Speaker, thank you for this opportunity to speak on this Motion put forth by my fellow Nominated Members of Parliament (NMPs) Dr Tan Yia Swam, Dr Shahira Abdullah and Mr Abdul Samad to support healthcare beyond the COVID-19 pandemic, and call for a whole-of-Government effort for consistent and sustainable support. Sir, I stand in support of this Motion.
I would like to start by extending my heartfelt gratitude to the healthcare professionals in Singapore, who have shown extraordinary dedication and selflessness in their efforts to care for patients amidst the COVID-19 pandemic. Despite the tremendous increase in demand for medical services, they have continued to provide exceptional care with professionalism and empathy.
We are truly indebted to our healthcare workers and administrators for their tireless efforts throughout this challenging period. Your courage and resilience have made a tremendous impact in our fight against the pandemic, and I would like to express my deepest gratitude for your incredible work.
During the COVID-19 pandemic, the Singapore Government provided the healthcare workers with vital support in the form of financial assistance, resources and training to help them manage their increasing demands while treating COVID-19 patients. The contributions of our healthcare professionals should not, however, only just be recognised during times of crisis. We should still recognise their invaluable contributions moving forward, as we work towards living in a world with COVID-19, post-COVID-19.
It is easy to overlook the exceptional healthcare system in Singapore and fail to appreciate the dedication and hard work that go into providing top-notch healthcare services across the country. The Government has invested significantly in public health infrastructure and subsidised medical care, making it possible for Singaporeans to receive adequate medical attention when required, regardless of their financial background. And we should continue to uphold this, not because we want to remain competitive globally, but because it is the responsible thing to do for Singaporeans.
Mr Deputy Speaker, healthcare is a critical issue that concerns everyone because everyone needs access to healthcare at some point in their lives. Good health is essential for individuals to lead productive and fulfilling lives, and access to quality healthcare is crucial for maintaining good health. And because healthcare impacts everyone, I was happy to see this Motion tabled. I fully agree with the hon Members that we should take a whole-of-Government approach to healthcare.
This is critical because it recognises that healthcare is not just the responsibility of the healthcare sector, but also involves many other sectors and factors. By taking a comprehensive approach, Singapore can identify and address the root causes of healthcare issues and improve health outcomes for its citizens. I want to speak on the following four points which I believe should be given more attention.
First, on accessibility of healthcare services for the elderly and persons with disabilities. Singapore's population is ageing and the demand for geriatric services looks to increase. As our population ages, it becomes more disposed to chronic medical conditions, cognitive impairments, falls, frailty which can significantly impact the quality of life. This calls for specialised knowledge about the ageing process and the optimal management of multiple medical conditions, medications and physical impairments.
Teaching Singaporeans how to age is something which should be invested in as well, and a holistic approach is required, prioritising not just diagnosis and treatment but also functional ability, social interaction and psychological well-being. For this purpose, it will be good if MOH can work with SkillsFuture to increase the access and adoption of courses which are suitable for our seniors. Courses, such as arts, nutrition and digital literacy, exist. However, I believe more can be done to provide more physical and mental well-being courses.
With an increasing Singaporean population of elderly individuals, the importance of gerontology cannot be understated, as it enables our silver generation to maintain independence, improve outcomes and live fulfilling lives.
Mr Deputy Speaker, ensuring healthcare access for Persons with Disabilities (PwDs) is also essential for promoting equitable and inclusive healthcare. Unfortunately, PwDs often face barriers to accessing healthcare, including physical, communication and attitudinal barriers.
I am happy that steps have been made to make healthcare more accessible for PwDs, such as accessible facilities like wheelchair ramps, height-adjustable examination tables and accessible bathrooms. In addition to existing efforts, healthcare providers may improve communications for the visual and hearing impaired by ensuring that their staff is trained in sign language or providing communication aids such as hearing aids or visual aids.
In addition to physical accessibility, healthcare providers can also improve their attitudes towards PwDs by providing education and training for their staff. They can also work towards promoting disability inclusion in healthcare policies and procedures.
Currently, there are many small- and medium-sized enterprises (SMEs) and Non-Governmental Organisation (NGOs) that are in the space of enabling PwDs and it would be good to have more dialogues on continual improvement of services for PwDs and increasing access and awareness of such services for PwDs.
By taking these steps, healthcare providers can ensure that PwDs have access to the same quality of healthcare services as those without disabilities. It is essential to prioritise accessible and equitable healthcare to better build a healthier and more inclusive society.
I now move on to my second point, as we celebrate the triumphs of our Team Singapore athletes in Phnom Penh, we should also recognise the hard work and sacrifice our athletes and their entourage have made to bring glory to Singapore. Our elite athletes often face intense physical and mental pressures. These pressures can affect their performance, long-term physical health and overall well-being.
To excel in their sport, athletes must maintain a rigorous training discipline, adhere to strict dietary requirements and overcome physical injuries. Unfortunately, these pressures can often lead to mental health problems such as anxiety, depression and eating disorders.
In addition to physical pressures, many athletes face significant social pressures. They may feel pressure from teammates, coaches, fans and the media. This can lead to additional mental health problems, including stress, burnout and a lack of self-confidence.
Elite athletes need access to resources to help them cope with these pressures. This can include mental health support, sports psychology and mentoring from experienced athletes.
It is also essential for athletes to understand that it is okay to prioritise their mental and physical health over their sport. Many athletes, such as May Ooi and Constance Lien, have recognised this and have become advocates for mental health awareness and self-care.
By acknowledging the pressures that elite athletes face and providing the necessary support, we can help them perform at their best while maintaining their long-term physical and mental health. Therefore, I hope that more support can be put into handling these unique needs of our national teams.
Third, on creating a vibrant sports and fitness culture. It is true that we often take our health for granted until an event impacts us directly. Recently, a friend passed away from a heart attack. He was still young and his tragic and sudden death ignited conversations amongst my peers about being healthy versus being fit, as well as our general education on health and well-being. It would be good if MOH and the Ministry of Education (MOE) together with SportSG teach Singaporeans at a tertiary level how to exercise when Singaporeans enter the workforce. There is a difference between training and exercising. We participate in Co-curricular activities (CCA), and sports CCAs teach you how to train – push your physical boundaries for performance, but exercise is about maintenance, mobility and lifestyle.
Exercise should be a habit and a lot to do with forming habits has to do with convenience, routine and accessibility. Some Members may know that Dr Tan Yia Swam is an avid parkour practitioner. Parkour, is a sport of jumping, climbing and sliding over and through a terrain. In Singapore, this happens to be an urban terrain and I am happy to see that such projects and facilities being built in Somerset and Lakeside.
I hope more urban-centric sport facilities will be built to match Singapore's landscape and interests. I hope and would also like to also encourage programmes to go together with these facilities. To do that, instructors need to be trained, qualified and hired. I am happy to see that at this year's Committee of Supply (COS), the Ministry of Culture, Community and Youth (MCCY) announced a registration of personal trainers that cover a range of activities and disciplines. But to empower this registry, the trainers need to have updated and relevant content to teach. I would encourage SportSG, Health Promotion Board (HPB), MOE and People's Association (PA) to have more discussions about the delivery of relevant, age-appropriate physical programmes that cater to a vibrant, active Singapore population.
Fourth, verbal abuse towards frontliners working tirelessly to keep society functioning during this pandemic is a deplorable issue. Despite their unwavering commitment to rigorous job demands, healthcare workers, essential workers and other public-facing roles have been subject to verbal abuse, shaming and criticism.
In addition to it being emotionally draining, verbal abuse can lead to mental and physical health issues and impact the professional and personal lives of those affected. Therefore, it is crucial to recognise the value of our frontliners and to show support by offering gratitude, recognising their hard work and taking ownership of our collective responsibilities. Frontliners deserve our fullest respect, support and empathy.
Recognising and addressing this issue is vital in holding those responsible accountable for their actions. Healthcare facilities can provide training for their staff to de-escalate tense situations and implement policies for reporting and addressing verbal abuse. In addition, public campaigns can educate people on the importance of respecting frontline workers and the consequences of their actions.
In conclusion, Mr Deputy Speaker, the COVID-19 pandemic has showcased the bravery, dedication and selflessness of our medical workers and workforce at the forefront of fighting the virus. They have worked long hours under challenging conditions while risking their health to care for patients. As the pandemic begins to subside, the Government must continue to support medical workers even after the pandemic.
I would like to ask the Government for healthcare workers to be provided with ongoing mental health support to deal with the psychological impact of their experiences. The pandemic has taken a toll on their mental health and well-being, and they must receive support and resources to deal with any long-term effects.
Our Government should also invest in health and safety measures to protect medical workers from future pandemics. This includes providing adequate personal protective equipment, training and vaccination. Healthcare workers at the forefront of infectious disease outbreaks must be thoroughly protected against any potential hazard they may face in the future.
By showing support and appreciation for medical workers after the pandemic, we create a sense of value for their role within our society. Their sacrifice and hard work deserve recognition, and this can go a long way in keeping them motivated and inspired. The Government should continue to support medical workers to build a brighter future for our healthcare industry and the patients that rely on them.
Mr Deputy Speaker : Dr Wan Rizal.
2.24 pm
Dr Wan Rizal (Jalan Besar) : Mr Deputy Speaker, I thank hon Members, Dr Tan Yia Swam, Mr Abdul Samad and Dr Shahirah, for raising this Motion. As Members of Parliament, we share the same goal: to create a healthier, more resilient Singapore, for generations to come.
Our nation's healthcare system is an essential part of that objective and I am grateful for the opportunity to engage in a constructive dialogue on this vital issue. I want to touch on two broad topics. First, and unsurprisingly, on mental health and second, on our efforts in the Malay Community through the "Saham Kesihatan" initiative.
Sir, mental health is a crucial component of our healthcare system. It is integral not only to an individual's well-being but also to the health and productivity of our society. I am glad that Dr Tan Yia Swam brought it up. We must acknowledge the challenges posed by Dr Tan Yia Swam head-on and continue to work collaboratively to find effective solutions.
Conversations around mental health have become much easier amongst Singaporeans over the years and this is not a coincidence. It is made possible by the efforts from the Government through the Inter-Agency Taskforce on Mental Health and Well-being, private sectors, community partners and ground-up groups to destigmatise mental health issues.
While we have made strides in terms of awareness on mental health, we must recognise that there is still much to be done, particularly in how we can directly mitigate issues of mental health.
I want to revisit some of the points raised in my Adjournment Motion back in 2020 to align with Dr Tan Yia Swam. During that speech, I shared the acronym "LAST". Briefly, "L" for literacy, "A" for accessibility, "S" for screening and "T" for time-outs.
Being an educator, I truly share Dr Tan Yia Swam's sentiment on the importance of education. We must continue to raise mental health literacy among our citizens. It should be introduced early, starting with our schools. Therefore, I am glad that MOE has refreshed our youths' curriculum that covers physical, mental and emotional well-being.
But I hope we can impact mental health more directly, go beyond education or awareness and include mental health screenings as part of our regular physical health screening. The intention is simple, we want to create some normalcy and promote early detection and intervention of mental health issues, leading to better outcomes and quality of life for individuals. It would also be helpful to reduce the societal burden of untreated mental health issues and contribute to the overall well-being of our community.
Now, I am confident that we can foster a community that eradicates mental health stigmatisation. But I also have to remind myself that such shifts in mindsets will not come easy, will not come instantaneously nor come so soon. And like many education programmes, changes can take quite some time.
As a teacher 20 years ago, I had students who needed special attention in class. People questioned me on why I bothered to take such differentiated approach at that time. Twenty years on, we can observe that people, the society, have become accepting, and thanks to the efforts of both public and private sectors including advocates like Hon Member and Jalan Besar Group Representation Constituency (GRC) colleague, Denise Phua, students now who require special attention in class are now embraced and provided with timely and appropriate intervention.
Although we have not achieved the same level of acceptance for mental health, we must persevere. We must continue with a "whole-of-society" approach towards mental health and this means an active participation from the whole-of-Government, private sectors, community partners, ground-up groups and religious organisations.
As Members of Parliament, we must wholeheartedly believe in this cause and strive to make it a reality. I commend the efforts by Members of this house and those before us who have been advocating for mental health. When we, as a society, a whole-of-society amplify the voices of those who have experienced mental health issues, we help to break down the barriers that prevent individuals from seeking help and create a more inclusive and supportive environment.
Sir, beyond education and screening, and speaking about mental health, accessibility to mental health services remains the most crucial in encouraging individuals to seek for help. We want them to access mental health services without fear or stigma, discrimination or barriers such as cost, waiting time, transportation, or even distance. Additionally, it is important to create a supportive and welcoming environment so that they can feel comfortable and feel safe to seek help without any shame or judgement.
I am glad that MOH has increased the number of access points via the polyclinics and telehealth services, making mental health services more widely available to people in need. However, I am aware of the shortage of trained mental health professionals who can provide effective and evidence-based treatment for those seeking help. Due to the lack of resources, people who need help may turn to untrained mental health practitioners or rely on self-help resources, this may not provide the same level of support and expertise as a trained one. This, too, can lead to inadequate or harmful treatment, worsening the individual's mental health and overall well-being. Therefore, we must continually review our mental health infrastructure, I hope we regulate this profession.
Sir, Dr Tan and Mr Abdul Samad highlighted problems faced by healthcare workers. I want to draw focus on the mental well-being of our healthcare workers. The nature of their work is more than just a job; it is a calling that requires deep commitment and dedication. We must provide support and resources to help them cope with the stress and challenges inherent in their professions, which will ultimately lead to improved patient care.
Moreover, we must address the harassment and abuse faced by healthcare workers, both physically and online, as it directly impacts their mental well-being. We not only must create a safe and supportive environment for our healthcare workers but enact clear guidelines to protect them. Thus, I am grateful that the authorities will take a zero-tolerance approach and will take appropriate actions against individuals who harass or abuse our healthcare workers. We must say, “If you abuse our healthcare workers, there will be consequences”. I look forward to the implementation of the measures to protect them. Sir, in Malay, please.
( In Malay ) : [ Please refer to Vernacular Speech .] Minister Masagos recently announced that the Malay community has shown progress in several health indicators.
This includes the number of Malay patients with high blood cholesterol. However, we still need to continue efforts to look after our community's health. Our community's obesity rate is the highest compared to the other groups. As we are aware, obesity can lead to health problems like heart disease, diabetes, and high blood pressure, among others. Therefore, Minister had announced the establishment of a fifth focus area for M 3 so that it counts as one of our community’s priorities.
This new focus area, through the Healthy Investment programme under M3, aims to mobilise our community to be ready for the Healthier SG programme. This programme is in line with Healthier SG's goal of making disease prevention a personal commitment. We need to take proactive steps to undergo frequent health screenings, adopt an active lifestyle and have a healthy diet.
Besides individual efforts, this whole-of-community initiative can also bring about changes. This is where the Healthy Investment Programme by M 3 @Towns can provide opportunities for physical activities, raise awareness on the importance of maintaining a healthy lifestyle and identify potential risks linked to obesity.
By working with other agencies such as HPB and Active SG, and as individuals making healthy choices, we can continue to progress and improve the health of our community and reduce the prevalence of obesity and other health-related issues.
I urge our community to take this opportunity to participate in the activities organised by M 3 @Towns.
Remember, it is our obligation to stay healthy. And if we are healthy, we will be able actively contribute to our family and the development of our community and nation.
( In English ): As we continue the discourse on our healthcare system, it is important to acknowledge that we have a strong foundation and must continue to build on it. As individuals, we must recognise the vital role each one of us plays in shaping the fabric of our society. It must always be a whole-of-society approach. Each individual in our society serves as a vital cog in this complex machinery of our nation’s well-being. Every cog, no matter how small or seemingly insignificant, contributes to the smooth operation and overall success of the system. And when one individual is down, others must step up to care and help. It is only through our collective efforts, with each and everyone of us working in harmony, that we can make a lasting, positive impact on the health landscape of our cherished nation.
Sir, at this juncture, I would like to express my heartfelt gratitude to the NMPs for raising this crucial Motion. Their passion, deep knowledge and unwavering commitment to balance meaningful, insightful discourse throughout their time in Parliament have not gone unnoticed.
Sir, to conclude, let us remember that progress in healthcare, its continued success depends on our collective determination and unity. Together, we can build a brighter, more resilient and healthier future for all.
Mr Deputy Speaker : Ms Janet Ang.
2.35 pm
Ms Janet Ang (Nominated Member) : Mr Deputy Speaker, I stand in support of the Motion put up by hon NMPs, Dr Tan Yia Swam, Mr Abdul Samad and Dr Shahira Abdullah.
Over the past few months, we have debated on Healthier SG and then the White Paper on COVID-19 Response. Minister Ong has also updated this House on the three strategic pillars of Singapore healthcare going forward – acute care, public health and aged care. There were also several Forward SG dialogues giving birth to lots of ideas and initiatives. I applaud MOH and the whole-of-Government for the comprehensive holistic approach that is being taken, but we must all recognise that this is a marathon and not a sprint.
There is a lot to be done and will need whole of Singapore to be committed to act together for a healthier Singapore especially as we mature rather rapidly in age. Continued dialogue amongst all stakeholders is very important to listen, to clarify, to prioritise issues and to collaborate on solutions as we move forward, will be a key imperative.
For this debate, I will focus my attention on what the community and the private sector can and ought to do to complement and supplement the whole-of-Government efforts to support our healthcare workforce and our healthcare strategic transformation initiatives. Inevitably, I will also have policy consideration questions and recommendations which I hope MOH and the whole-of-Government can consider to take on board.
I have five topics for discussion. Firstly, respect and gratitude for our healthcare workers. Considering that Singapore’s healthcare system is ranked amongst the best in the world, I think it is time for the users of our Singapore healthcare system, that is patients, families, visitors, all of us to aspire to be ranked amongst the “most gracious” in healthcare systems.
There sometimes is this unrealistic expectation of “being served” in hospitals. Asking to be served water much like what we would do at a restaurant is the wrong expectation. Overusing of call buttons for minor requests is not being considerate. And hurling abuses at anyone, let alone folks who are actually helping us, is absolutely unacceptable. Instead, a smile, a "please", a "thank you" would go a long way to show some consideration and appreciation.
Hospitals are high-stress places. I am sure the healthcare staff are trained to be empathetic and sympathetic, which if not so, they should be. Still, the families and the patients should not think it our right to let go of our anger and frustrations on the healthcare staff, be they doctors, nurses, allied health professionals, support care staff or even the hospital security guards. Take a deep breath. Think of one thing we are grateful for. And consider the wise age-old golden rule: “Do unto others as you would have them do unto you”.
That said, still, there will be bad behaviours and I support MOH’s plans to have a concerted, across-the-board policy to handle and address the bad apples amongst us even as I wish and hope that as a community, we can all do better.
The second point, community involvement. Nurses, allied healthcare and care support workers will become increasingly important along with family physicians, doctors and medical specialists, as Singapore heads into becoming a super-aged nation. The community ourselves must recognise that we have just as important a role to play.
The first order of the day is to individually keep an active and healthy lifestyle to prevent chronic illnesses. As part of the Healthier SG, the system will incentivise positive behaviours, and poor healthcare lifestyles and behaviours should be disincentivised or penalised.
Next, the community can help ourselves by forming little support groups among residents or neighbours to support one another. These little support groups can be like little satellites receiving and disseminating correct, right healthcare-related information. Each general practitioner (GP) can be Advisor to a few groups to check in with them, to advise on activities or even join in, similar to what Members of Parliament do in a constituency. These groups can organise themselves with some governance and help to visit their neighbours and bring those in need for hospital checks, check that they are taking their medication and so on.
I understand that some of this is already happening but perhaps not in a cohesive, organised way. I guess the best example is whatever we managed to rally during COVID-19. So, now, in peace times, how do we repeat that? Going forward, we can be more coordinated and more collaborative. Then, the community may organise health screening, community exercises like Zumba, hikes to MacRitchie, Tai Chi and so on. The issue is how to get more people involved and keep it sustained. Maybe with Healthier SG, where you have credits for participation and these can be used for healthcare or purchase of healthy staples like oats, milk and so on.
In my speech at the Healthier SG debate, I shared about GoodLife! Makan at Block 52 Marine Terrace, an initiative of Montfort Care FSC as well as “Share-a-Pot” at the Caritas Agape Village in Toa Payoh. These and other ground-up initiatives like the SG Mental Well-being Network or the Family of Wisdom by Dementia Singapore or Caring Commuter Champions who assist our public transport commuters who have visual impairment or physical disabilities or may be seniors with dementia, during their daily public transport commute. These are examples of what the community can do to be a part of the Singapore healthcare ecosystem.
Serendipity has it that I just attended this morning a heartwarming Sing Out Loud! performance at Esplanade by nine seniors with dementia accompanied by nine Kindergarten 1 and 2 children. The seniors are residents of the St Joseph's Home and the children are preschoolers attending the childcare centre which is located in the same compound as the St Joseph's Home Infant and Childcare Centre. Sing Out Loud! or 大声唱 is a community engagement programme by Esplanade, developed in partnership with Dementia Singapore in 2016, but this is the first time involving an inter-generational group.
It will be remiss of me not to mention the Convent Yuki and the flourishing fund initiatives sprouted out when friends transitioned into the second half of their retirement and supported seniors like my mother-in-law Mrs Lily Chia to continue having a meaningful and reasonably active life even into their 90s. By the way, my mother-in-law celebrates her 100th birthday next week.
These kind of initiatives can become a part of the Healthier SG community partnership. It would be wonderful to see how these can qualify or be recognised under the rewards of Healthier SG as well.
One last point on community involvement. With an ageing population, it may soon become an imperative for everyone to be equipped with care skills. Perhaps that will come a time for everyone to be trained in basic nursing and care skills and be providing the services in their own families or communities or to be involved in some form of national community services. This could apply to young men as part of their National Service and for young ladies as part of their pre-IHL community service training. This can also apply to retirees as well. It could be a voluntary basis or perhaps even considered as some form of paid gig work of sorts.
My third point: shortage of nurses and a llied healthcare workers. Minister Ong has shared often enough that the key challenge in our hospitals is to have sufficient nurses, allied health professionals and support care staff to operate hospitals, clinics and eldercare centres. When there are insufficient nurses and allied healthcare workers, the in-service staff including junior doctors all have to take up the slack, resulting in everyone overworking, experiencing burnout and mental wellness issues. In having to manage the COVID-19 response since 2020, our healthcare workers must likely added several years to their age.
How is MOH addressing these issues? How can the private sector help? What can the community do to support?
Some ideas include:
(a) broadening training and responsibilities for existing nurses, allied health professionals and pharmacists so that they can take on crucial roles alongside doctors. This can help make these pertinent roles more attractive to Singaporeans. A lot, I know, is already being done by MOH in this aspect but more still yet to be done.
(b) nurses' pay is also being reviewed and implemented which is great. My point is that we have to align to pay for skills. When it comes to compensation, more is always welcome. That said, from the conversations I have had, what carries more weight when choosing nursing and allied health as careers is not exactly money. Please pay them enough. If they want to make lots of money, they will go and become investment bankers and so on. But what is important is being on a role that is respected and appreciated, having more flexibility so that work life balance can be better achieved and having the opportunity for career progression and personal growth, perhaps being able to say that living a life with a purpose.
(c) the community can help by changing our mindset when it comes to perceiving and treating "service" staff. Our nurses and allied healthcare professionals should be treated with every dignity, respect and gratitude.
(d) designing human resource (HR) policies that offer opportunities for them to choose pathways to progress in their career toward further certifications and even degree qualifications, granting study leave and examination leave for those doing their part-time degree or part-time specialised training, much like what we do for the doctors. These staff often struggle with roster and they feel bad for requesting shifts. If we are serious about lifelong learning, this is something that needs to be addressed. It need not necessarily be fully paid leave but just provide some flexibility in rostering.
(e) technology can automate repetitive work and augment the skills of the nurses and healthcare staff. Singapore is well recognised for our innovations on the world stage as amongst the top dozen or so healthcare systems that leverage technology well. Whether it is Robotic Process Automation (RPA) or artificial intelligence (AI) or data analytics, they have been proven to support positive patient outcomes, in addition to efficiency and effectiveness in the organisation.
Mindset change and ease of adoption are key challenges that need to be done. One good example is the use of sensors to read vital signs, reducing the time nurses and doctors have to spend going from patient to patient to take their vitals physically. That is one and grumble. I have got plenty to give but, due to short of time, I will just go straight to the point.
Jobs that are well assisted and enhanced with technology are more attractive especially for the younger generation. I am sure it is already doable for robots to serve the medication based on the barcode of the patient's tag and the day will come when barcode can read our retina and serve out the correct medication.
(f) design scheduling system that can accommodate flexible shifts/hours. Such a system will be very attractive for staff who needs to juggle work with family and caregiving duties as well as studies as pointed out earlier. This may attract also retired nurses or part-time nurses to return to the workforce.
I understand from the Singapore Nursing Association that there is already a "return back to nursing" scheme for those who left for family reasons. I understand, however, that the Singapore Nursing Board has stopped registration for previously-registered nurses who have not been practising in the field for more than five years. Some of these nurses have had years of experience prior to their break and would like to rejoin the service but perhaps, are experiencing difficulty getting back their registration. With appropriate retraining, this would be a good pool of candidates to bring back into the workforce, at an appropriate level and not make them start with the junior nurses all over again.
There is also a Nursing Career Conversion programme and this programme, I hear, has been pretty successful in terms of enrolment. It will be interesting to get the statistics on the number of jobs which get filled by the graduates of such programmes and schemes.
(g) for foreign nurses and allied health staff, not being able to bring their family with them seems to be the biggest bugbear especially as other countries dangle that benefit. We know it is a challenge for Singapore but perhaps, MOH, Ministry of Manpower (MOM) and Ministry of Home Affairs (MHA) can share the strategy for attracting and retaining foreign nurses and allied health professionals?
(h) what can the community do? Well, I hope that all parents can do our part to encourage our children who went overseas to attain their healthcare degrees and qualifications, to come home. I would recommend for MOH to do for nursing and allied health professionals, the same or similar as what is being done to attract overseas medical school graduates who are Singaporeans and Permanent Residents (PRs) to return and work here. I hear that our marketing campaign makes the graduates feel very much needed.
(i) one last point on this issue of manpower shortage. We might want to incentivise qualified professionals who are Singaporeans and PRs schooled and qualified overseas to return to Singapore and take up the open positions and get themselves registered. I have heard anecdotal stories that Singaporean physiotherapists who are qualified to practise in Australia, cannot get registered in Singapore. Apparently, they are expected to have undergone the same breadth of training as Singapore-trained physiotherapists. Perhaps, MOH can consider conditional registration for these overseas qualified physiotherapists and allied health workers, while they take up continuous learning in the subjects that might not have been part of their training overseas. In this way, we bring home another Singaporean son or daughter, who becomes a plus to our workforce.
Four, how can private sector play a part. There will always be senior doctors who, after their training, opt out of the public system, quit and go private. That is a perennial challenge for the public sector in the management of specialists. To have a Healthier SG, we need all hands-on deck.
One suggestion is for private sector specialists to regularly attend to subsidised patients on a pro bono basis or subsidised rate or they could run free clinics for those assessed to be unable to pay. Execution may not be easy but as during COVID-19, we see how the private sector healthcare was roped in and played an important role in complementing public healthcare resources. In this regard, we can learn from the legal community.
With the Healthier SG, general practitioner (GP) doctors and family medicine clinics are going to be the key nodes of care, in the community. I am sure that MOH is constantly reviewing the split between various specialisation. It is quite clear that we should be encouraging more junior doctors to specialise in family medicine and pursue the path of becoming GPs or family doctors. From my understanding, family medicine is already a speciality. What will it take to attract more medical officers to choose the family medicine route? How many training positions are there each year if we are successful in convincing medical officers that it is as good as any other specialisation?
Private sector GPs and clinics must step up to offer specialisation traineeships for our junior doctors. And we probably need to look into pay gaps amongst these specialities. What will it take to motivate the GPs to engage and be part of the primary care network so that together, we can work toward a common goal of preventive health?
The new capitation funding model will play a key part and it needs to be designed to incentivise as well as disincentivise behaviours at all levels of care, including the GPs and the population. Prevention and going upstream has been proven to be the best way to improve clinical outcome. For example, at Intermountain, they incentivise the primary care network to keep people out of hospitals as much as possible. For their diabetic population, they invested additional 4% of budget in this group and achieved a decrease in hospital admits by 22% and a decrease of 21% for other avoidable visits and admissions, resulting in overall improvement in value of care and reducing overall costs over time. In Singapore, we should perhaps look to modelling something similar.
One of the issues that I hear often is that GPs are not set up to handle and cope with the increased administration and IT workload. It might be worth considering for MOH to set up a standardised platform or for an agency or a private sector to provide the administrative services required to be done at scale. It is important that the GPs step forward and engage themselves in the redesign of work processes and incentives that will help make Healthier SG implementation efficient, effective and most importantly, deliver on its intended purpose. The GPs need to lean in, to help themselves and to help reinvent primary care for our Singapore healthcare ecosystem, help technology to help our medical teams.
Five, home medical care. For a sustainable healthcare system, home medical care must play a key part in the continuum of care. A doctor friend shared that there was a scheme at one time, which has since been pulled back, where post-delivery patients could go home because there were nurses visiting baby and mom for three days after discharge. This would be the kind of domiciliary services needed as we transition to a right care at the right time in the right setting, often at home.
Mr Deputy Speaker : Ms Ang, you are at 19 minutes 40 seconds.
Ms Janet Ang : Sorry. Okay. Who will be responsible for recruiting, training and managing all of them? Perhaps, some form of uberised certified healthcare professionals who schedule their own rosters and probably work the "beat" in their neighbourhood could be the best.
As I conclude, I cannot help but worry about our collective ability to transform at this pace. To rush too much, risks the effort being channelled to the superficial, resulting in us getting the form and losing the substance. Change is never going to be easy. We are blessed to have a healthcare system that is amongst the best in the world. The latest Legatum Prosperity Index 2023 ranked Singapore in number one position with a health index score of 86.9.
I would like to close by paying tribute to everyone involved with the healthcare ecosystem: the cleaners, care support staff, allied healthcare professionals, nurses, doctors, medical professionals and healthcare administrators. To all of you in and around healthcare, to quote Pope Francis, "Compassion is the heart of what you do. You know that it is not just about good organisation but a heart of all that is listening, accompanying and supporting the people under your care."
It is not an easy job but for most of you, it is a vocation. So, a big thank you for your tireless efforts and contributions to keeping Singapore and Singaporeans health aware, ready, inclusive, resilient and dignified through every stage of our lives. Mr Deputy Speaker, I stand in support of the Motion.
Mr Deputy Speaker : Mr Raj Joshua Thomas.
2.57 pm
Mr Raj Joshua Thomas (Nominated Member) : Sir, the Tripartite Workgroup for the Prevention of Abuse and Harassment of Healthcare Workers was set up in April 2022 to look at how to address the abuse and harassment of healthcare workers. The work group presented its findings and recommendations in March this year. Their findings on the extent of abuse is troubling. More than two in three healthcare workers had witnesses or experienced abuse or harassment in the past year. A third of all healthcare workers had witnessed or experienced abuse or harassment at least once a week.
Healthcare workers are in a particularly vulnerable position. Their job inherently involves interaction with people who are in need of some form of assistance or attention, or whom may even be in distress. Many healthcare workers therefore internalise that some abuse is to be expected as they carry out their jobs and this often leads to under-reporting.
The work group found that that frontline healthcare workers like pharmacists, patient service associates and nurses are more likely to face abuse and harassment, with the most common type of abuse being shouting, making demeaning comments and threatening to file complaints or to take legal action against the healthcare workers. In other words, many of these forms of abuse and harassment arise out of an expectation that the patient and/or the caregiver should be treated in a certain way, that they may have some entitlements that they are not getting or that they should have some level of service or timeliness.
This prevalence of abuse against frontline service workers has also been found in other sectors. The critical question, therefore, is why do these abusers have these expectations and why do they think they think they can resort to shouting, making demeaning remarks or threatening to make complaints?
I wonder whether it is precisely because of the fact that our healthcare system is reputed to be one of the best in the world and whether it has something to do with the quintessential Singaporean aspiration towards efficiency and accountability. Has this now become so ingrained in our people that it has become a basic expectation of all services and workers in Singapore?
Then, when this expectation is not met, Singaporeans become frustrated as they feel that the system has failed them. In this regard, our success at being efficient and productive may have turned out to be a double-edged sword, because even falling slightly short can lead to backlash.
One thing that stood out for me in the report was that one of the more prevalent types of abuse was threatening to file complaints or to take legal action against the worker. Again, this appears to be an aberrant, twisted application of the whistle-blowing process, the desire to improve through feedback as well as the rule of law. Are we becoming more litigious as a society and is it happening because we believe that any perceived slight or inconvenience can be remedied by litigation by complaining or through the courts? All these affect the morale of the healthcare workforce and their ability to carry out their jobs.
Just this morning, Dr Tan Yia Swam shared with me an anecdote of how one of her friends in healthcare was so affected by threats that she had resigned. This included the threat from an abusive individual who threatened to look for her outside her workplace.
He said – he said it in Mandarin, which I shall not try to say verbatim, but the translation of it is, "Singapore is so small. Even mouse also can find." This is what I was told the translation is.
When it comes down to our workers on the ground, what they are focused on is getting their job done. Technology and processes have made us faster and better but there are also sometimes administrative processes that workers have to follow.
For example, the Personal Data Protection Act now imposes certain requirements on data collection and processing that are necessary to protect personally identifying information.
Another example is that as our population ages, there will be an increasing need to appoint deputies. There are certain statutory procedures that must be complied with that caregivers may not fully understand. This could lead to frustration with hospital administrators and tempers could flare.
As such, a key plank of the effort to prevent abuse and protect our healthcare workers should be to instill in patients, caregivers and members of the public that regardless of their frustration with administrative processes or perceived systematic inefficiencies, it is not acceptable to take out these frustrations on the workers who are merely working within the system that they find themselves.
This goes beyond having mere statutory protections and penalties under the law. It requires that we adopt a societal mindset of civility and kindness instead of imperious expectation and entitlement. In fact, this is what the hon Member Dr Wan Rizal said earlier – that we need to have an all-of-society effort.
Japan, for example, has a culture of omotenashi, or selfless hospitality, which is seen as a microcosm of the Japanese mindset to be centred on care rather than expectation. Omotenashi provides that good manners and a polite bearing are not just expected in interactions between individuals in social contexts but that they are also indications of respectability and good standing. Principles include humility, patience, a quickness to apologise and an even tone in conversation.
To emphasise omotenashi and ensure that this core Japanese characteristic is not lost amidst a modernising society, the Tokyo municipal government launched the Tokyo Good Manners Project in 2016, which is ongoing.
MOH Holdings had already announced that it would be launching a national public education campaign to promote positive relationships of trust and respect between healthcare workers, patients and their caregivers. I truly hope that this campaign will be successful in reducing incidents of abuse, giving societal support to our healthcare workers and building our very own omotenashi.
Abuse of healthcare workers comes generally from two categories of individuals – patients and caregivers or family members of patients.
As regards patients, healthcare professionals may find themselves in a conundrum. Patients who are elderly, have mental health issues or who are in pain may sometimes turn abusive, including physically abusive.
In this regard, one of the work group's recommendations was to stipulate clear consequences for perpetrators. For patients who are abusive, warnings may be issued and they may be discharged if they do not require urgent attention. Further to this, healthcare workers may also disengage from abusive patients by refusing unreasonable requests.
I imagine that it will be challenging drafting the guidelines for this as it would have to balance the need to provide medical care to patients while, at the same time, protecting healthcare workers from physical, mental and emotional abuse.
Likewise, for caregivers and family members who may be distraught due to a medical emergency or condition of their loved one, there may also be instances where they turn abusive.
My view is that while we can be sympathetic to family members in such situations, there should be zero tolerance if they turn verbally or physically abusive or harass healthcare workers.
While it is a part of the healthcare worker's role to provide support to these people, there is no overriding obligation of providing medical care to them. As such, the procedures to deal with abusive non-patients should be far stricter than those for abusive patients and should be actively enforced.
Supervisors and hospital management must stand by their workers. Our national healthcare groups have already said that they will support and implement the recommendations, including a zero-tolerance policy. I was also heartened that Minister Ong has said that even the Minister will have their back and that healthcare workers should know this.
Authorities should also be prepared to prosecute such cases of abuse if they are beyond a certain threshold of severity.
I hope that the guidelines that will be issued in the second half of this year will see a sharp reduction in incidence of abuse against our healthcare workers and that it will give them peace of mind as they go to work every day.
Sir, I support the Motion raised by my fellow Nominated Members. I would also like to take this opportunity to support our healthcare workers and to thank them for all of the sacrifices that they have made and continue to make every day.
Our nurses, doctors, therapists, ah mahs, counsellors, pharmacists and administrators are in vocations that protect what is central to humankind – life and well-being. Theirs are not merely noble professions but the noblest of all professions. Let us therefore ensure that we do our very best to take care of them – that we take care of those who take care of us.
Mr Deputy Speaker : Prof Hoon.
3.07 pm
Prof Hoon Hian Teck (Nominated Member) : Mr Deputy Speaker, Sir, at a fundamental level, we all recognise that there are some negative events in an individual's life that are unforeseen, such as falling seriously ill.
To provide protection to its citizens against such contingent events, one might think that we could rely solely on private insurance companies. The argument is that risk-averse individuals would find it in their self-interest to purchase insurance policies that are offered at actuarially fair prices.
However, because of asymmetric information, one side of the market has private information not readily available to the other side, leading to adverse selection.
Full insurance is generally not available. In a market that is characterised by adverse selection, more-costly-to-serve customers know who they are but sellers do not. The insurance company knows that among the potential pool of customers, some individuals are better risks than others but it does not know who the better risks are.
The fact that insured individuals know their own risk level better than the insurer might cause those who are more likely to have an adverse health outcome to purchase an insurance policy, thus leading the insurer to lose money if it offers insurance. The result is that there is an inadequate provision of private insurance.
Thus, in the presence of an adverse selection problem, there is a role for the Government to intervene by providing social insurance in the form of MediShield Life, which was introduced in November 2015. This national health insurance scheme has three important features.
First, there is a public mandate so that all Singapore citizens and permanent residents are included in the scheme. Absent such a mandate, more healthy residents would have an incentive to opt out of buying coverage at a premium that reflects the much higher healthcare costs of less healthy residents.
Second, pre-existing medical conditions are covered, although there are additional premiums for serious pre-existing medical conditions that require intensive medical intervention to treat or require prolonged treatment.
Third, the Government provides subsidies to low-income residents to help them make their premium payments.
MediShield Life is administered by the CPF Board, which is a defined contribution social security system. In contrast to a defined benefit social security system where payroll taxes are collected from the working young to finance the benefits received by the retired old, CPF contributions form part of an individual's savings.
In order for our national health insurance scheme to be financially sustainable, it is vital that the economy continues to generate good jobs. This is because the main source of financing the premium payments comes from an individual's MediSave Account.
The Motion's call for a whole-of-Government approach is therefore very appropriate.
The recent recommendation by the Advisory Committee on Platform Workers for platform companies to work with the Government to develop a mechanism for platform workers to make regular contributions to MediSave is also timely as it contributes to a financially sustainable national health insurance scheme.
Mr Deputy Speaker, Sir, I therefore support the Motion standing in the names of my three hon fellow NMPs.
Mr Deputy Speaker : Mr Yip Hon Weng.
3.12 pm
Mr Yip Hon Weng (Yio Chu Kang) : Mr Deputy Speaker, Sir, today's Motion has raised some salient issues. I would like to speak on ageing issues and explore ways in which we can better empower our seniors to continue to lead fulfilling lives.
It is imperative that our healthcare system is equipped to handle the unique challenges that comes with a super aged society. We have to be forward-looking and address the issues now or we risk seeing our infrastructure and facilities unable to cope with demands. This will impose a significant fiscal burden on Singapore in the future. I would like to speak on three issues.
First, Mr Deputy Speaker, Sir, we need to better organise care integration. I agree with Dr Tan Yia Swam that greater cross-collaboration is necessary but I wish to add that this is particularly pertinent between health and social care, which falls under the purview of MOH (MOH) and the Ministry of Social and Family Development (MSF) respectively.
The Healthier SG initiative is undoubtedly a step in the right direction. We want health, not healthcare. Social prescription is a key component in this. We need to encourage our seniors to engage in activities that promote their overall health. There are plenty of free exercise and wellness programmes to do. This is made available by Sport Singapore, PA and various social service agencies (SSAs), but we must rally the ground-up support and get active participation. What is being done in this respect to link up the two sides? Otherwise, it is just another startup project – good for sound bites but may be ineffective in helping our residents.
Social prescription and healthcare must go hand in hand. There needs to be greater integration between health and social care. Do healthcare professionals, including general practitioners (GPs) and their clinic assistants, know what kinds or types of exercise programmes exist or are provided by various organisations in the neighbourhood? If so, are they knowledgeable enough to recommend them to their patients? Similarly, do our social service professionals know how to identify health-related issues in seniors and refer them to the appropriate healthcare professionals?
A concept may look promising on paper, but the devil is always in implementation. How do we help prepare healthcare staff outside of MOH who are to be part of this project? We need to move away from the fear of over-medicalising healthcare and encourage greater collaboration between health and social care.
Is it time to move away from an interagency ministerial committee and consider establishing a Ministry of Ageing? Organisation drives behaviour. A dedicated ministry can spearhead integrated policies relating to ageing, ensure that the needs of our seniors are met and make Singapore a great place to age in.
Second, Mr Deputy Speaker, Sir, we need better enablers to support care integration. It is essential that we have an integrated system that allows for seamless collaboration between health and social care. To achieve this we need to address the current issue of healthcare legacy IT as well as IT systems being used by different clusters. I mentioned about this in my previous Parliamentary speeches and during the Committee of Supply debate.
For example, some clusters use Health Buddy where others use HealthHub. There are also a myriad of different computer systems across community, primary and tertiary healthcare providers, ranging from CCMS, Epic to Citrix. Can the systems inter-operate? Can we merge these IT systems to ensure that healthcare professionals have access to a unified platform to manage their patients' healthcare needs?
The same applies to merging GovTech systems and Integrated Health Information Systems (IHiS), ensuring that we have better data sharing between health and social sectors.
We must also explore ways to better enable data sharing between Government and SSAs on information regarding the wellness of seniors, both from the health and social sectors. Currently, data sharing seems rather fragmented. We should strive for a holistic view of the senior, encompassing both health and social aspects.
Finally, we must explore ways to leverage telehealth to facilitate care integration. What are the plans to scale up current pilots? How can we ensure that telehealth is utilised effectively to provide comprehensive care for our seniors?
Third, as we seek to improve care integration for seniors. We must also focus on further empowerment for care integration. One critical question that we must ask is this: can we better empower our seniors to better take care of themselves?
To answer this question, we need to explore key messages and initiatives that seniors should look out for as they age.
One possible solution is to provide seniors and caregivers with a health booklet containing relevant information to help them manage their health effectively. This is similar to the child health booklet provided to primary school students and their parents.
While we acknowledge this may not be feasible for those who are illiterate or have visual disabilities, it will still be a useful tool for many seniors and caregivers who need guidance.
In fact, as our aged population becomes increasingly educated and literate in years to come, we expect much of this empowerment to require self-help and initiation on the part of our seniors. Seniors would want to be empowered to make independent and informed decisions. We need to nudge them in the right direction. A key move is to promote better transparency, push out more information on various health related topics, such as the cancer CDL list and insurance.
In this regard, we should explore ways that the Silver Generation Office can help in this area. By providing seniors with the necessary information and resources, we can enable them to take better care of their health and well-being. Ultimately, this will lead to better health outcomes and greater independence for our seniors.
In conclusion, Mr Deputy Speaker, Sir, we need to transform the way we deliver care for our aged population. We need integration not fragmentation. But what does a truly integrated system look like?
For me, it is a system where there will be a seamless integration of care services organised around the senior, with a 360 view of his physical, mental and emotional health.
How can we achieve this? This will require drawing up care in a seamless manner across settings between acute and long-term care, between acute and primary care and between primary and care in the community.
It would mean adopting a multidisciplinary and person-centric approach. It entails doctors working closely with other health and social care professionals such as Allied Health Officers, social workers and even community befrienders to identify the common care needs for seniors and to offer integrated interventions. Health and social care must transcend boundaries to help seniors to age well in the community. It will also mean that information should flow seamlessly between hospitals to care professionals in the community to better manage seniors health and social conditions.
The eventual end state would be one patient, one health record or wellness record, one IT system and hopefully all these overseen by one Ministry of Ageing, to deliver coordinated holistic and integrated care to transform Singapore into the best place to live in. I support the Motion.
Mr Deputy Speaker : Order. I propose to take a break now. I suspend the Sitting and will take the Chair at 3.40 pm.
Sitting accordingly suspended
at 3.22 pm until 3.40 pm.
Sitting resumed at 3.40 pm.
[Deputy Speaker (Mr Christopher de Souza) in the Chair]
Supporting Healthcare
[(proc text) Debate resumed. (proc text)]
Mr Deputy Speaker : Senior Parliamentary Secretary Eric Chua.
3.40 pm
The Senior Parliamentary Secretary to the Minister for Culture, Community and Youth and Minister for Social and Family Development (Mr Eric Chua) : Sir, I agree with hon Members that supporting healthcare beyond the COVID-19 pandemic takes a collective effort by Singapore society.
Sir, in preparing for this speech, I asked ChatGPT what it thought of the Singapore healthcare system. Minister Ong Ye Kung and the MOH team would be glad to note that ChatGPT’s reply to me was, and I quote, “The Singapore healthcare system is often cited as one of the best healthcare systems in the world, known for its efficiency, high quality care and low healthcare costs.”
That said, one cannot assume that this somewhat glowing review will remain status quo. Singapore is one of the fastest-ageing societies globally. We know the numbers very well: one in four Singaporeans a senior by 2030, and every other Singaporean a senior by 2050.
If we are to reap the full harvest of meaningful and productive longevity, we must strive to close the glaring decade-long gap between health-span and lifespan. This is important, and I thought I ought to repeat this. If we want Singaporeans to not just live longer, but to live longer and better, we have a good 10-year health- and lifespan gap to close. And in the longer run, we must capitalise on the upsides of ageing.
In 2017, Sport Singapore (SportSG) launched the Active Health national initiative to inspire Singaporeans to take ownership of their own health and well-being, and to foster greater community spirit through shared experiences. We wanted to nudge a mindset shift from one which is “deficit-focused”, that is, “I seek treatment only when I’m unwell”, to an “aspiration-focused” model of active, healthy living. In the latter model, everyone is empowered to live better, and to delay, or prevent the onset of chronic diseases.
Over the past decade, SportSG has been vigorously implementing the Vision 2030 recommendations. As such, national regular sports participation has risen by some 20%, from 54% in 2015 to 74% in 2022, last year. In an Active Health survey conducted in 2022, about 96% of the respondents gave a score of eight out of 10 when asked about the importance of health and wellness. Yet, only 60% said they are confident of improving and/or maintaining their own health and wellness. Many are unaware of their own health status and how they can easily take a small step towards an active, healthier lifestyle.
I agree with Members that support is needed from all sectors of Singapore society to ensure that everyone can realise their health and wellness aspirations.
One such concerted effort is the Queenstown Health District pilot. Spearheaded by HDB, National University of Singapore (NUS) and the National University Health System (NUHS), the Health District seeks to increase healthy longevity and intergenerational bonding through the provision of health and wellness programmes for people of all ages.
In Queenstown, facilitated by the Lion Befrienders, seniors participate in strength and balancing programmes, such as dance fitness, modified sports and virtual square-stepping exercise. Seniors also take part in intergenerational sporting Friday activities, such as football, active-farming and dance fitness, designed for participants of all ages.
Students take part in an Active Health Classroom Champions programme that adopts a holistic approach to their health and promotes the participation of sport and physical activity beyond curriculum hours. Under SportSG’s school sports partnership scheme, schools in Queenstown have introduced more multi-sport programmes to promote general health and well-being and social cohesion amongst students.
Families take part in workshops and programmes, such as Active Health Discovery Walk in the Park, which emphasises, for instance, the importance of resistance exercises in increasing muscle mass as they go for their regular walks.
There are also programmes catered for the vulnerable and persons with disabilities. For instance, the SportCares FUN Starters multi-sport and Saturday Night Lights football programmes provide children and youth living in rental housing and other vulnerable communities, the opportunity to play and develop a lifelong habit in sports, improve fundamental movement skills and physical fitness as well as to instil a sense of belonging with the community.
Besides programming, SportSG collaborates with HDB to enhance infrastructure within the Queenstown Health District to enable residents to keep fit and to stay active. For example, an "Active Health Fitness Trail" with behavioural nudges designed by SportSG to develop strength, flexibility and balance as well as appropriate fitness equipment will be installed as part of the Neighbourhood Renewal Programme (NRP) to enhance the fitness and exercise spaces around the Mei Ling precinct in Queenstown.
Beyond the Health District, we have today set up some eight Active Health Labs island wide, at our ActiveSG sport centres and Active Health partner premises. Our objective is to enable people to understand their body composition, fitness and health status, and to learn tips from qualified Active Health Coaches on how to sustain an active and healthy lifestyle.
Residents come to our ActiveSG centres not just to do their workouts, but also to connect and to network. Based on the 2022 National Sports Participation Survey, when participating with others, 95% of respondents indicated that their well-being has improved through sport and physical activity; and 94% of respondents indicated participation in physical activity has improved their quality of life.
Just last weekend, I joined hundreds of Queenstown residents as we bade a temporary farewell to our beloved Queenstown Sport Centre. The facility has served our residents very well for more than five decades, and has played host to decentralised National Day Parades, that was in the seventies, and was home to the Tanjong Pagar United Football Club and our National Water Polo team in the earlier days. Indeed, sport and our sporting facilities also plays a critical role in place-making and the formation of a common identity.
I would, therefore, like to call upon everyone to head down to our ActiveSG sport centres located island-wide, try out the various programs and activities, and to visit our Active Health Labs to kickstart your health and wellness journey today.
Beyond physical activity, SportSG will continue to work with MOH and HPB to engage general practitioners (GPs) to refer clients to suitable community-based activities that can help them improve or maintain their health, as well as understand their fitness and health status. To do this well, we need to work as a team.
Individual citizens can take the initiative to make a trip to the Active Health Labs, learn more about their own health and wellness, and consider working relevant fitness and dietary advice into their everyday lives. Family members, too, can play a part by gently nudging loved ones to take the first step to taking charge of their own health and fitness by making the trip to the Active Health Labs.
Healthcare providers, on the other hand, can refer their clients to the Active Health Labs, to learn how to exercise safely with guidance from accredited training coaches. On the Government's end, SportSG will work with HPB and PA to ensure a steady pipeline of programmes, sport interest groups and social activities that healthcare providers can connect their clients to. Sir, in Mandarin, please.
( In Mandarin ) : [ Please refer to Vernacular Speech .] Singapore is one of the fastest ageing countries in the world. Of course, we hope that Singaporeans can live long, but at the same time, we also hope that they can live healthily and meaningfully in their golden years.
SportSG launched the Active Health initiative in 2017 to inspire Singaporeans to take ownership of their own health, and to foster greater community spirit. In order to achieve this, all stakeholders in our society will have to play a role. The Queenstown Healthcare District pilot is a good example.
In addition, we have set up eight Active Health Labs island-wide, at our ActiveSG sport centres and Active Health partner premises. Our aim is to enable people to understand their own body composition and health status, and to learn from qualified Active Health Coaches on how to sustain a healthy lifestyle.
I would like to call on everyone to head down to our ActiveSG sports centres located island-wide, try out the various programs and activities that we have organised for you, and visit our Active Health Labs to kickstart your health and wellness journey!
( In English ): Sir, it is heartening to note that many recognise the importance of health and wellness. Through Active Health, we hope to enable happier and healthier residents where they can live longer and flourish in "pro-social" spaces – where the young and old care for and nudge one another towards active living and healthy, purposeful longevity. Sir, I support the Motion.
Mr Deputy Speaker : Assoc Prof Jamus Lim. You have a request?
Assoc Prof Jamus Jerome Lim (Sengkang) : Yes, Mr Deputy Speaker, I wish to participate in this debate.
Mr Deputy Speaker : Before you do, I just like to point out that it is a last-minute request and to allow for better scheduling of Parliament Sittings, I would encourage all Members to continue to give us advance notice if they intend to participate in Parliamentary debates. This helps with the timetabling and the scheduling. I seek Members' cooperation in this regard. I now call on you to give your speech, you may deliver it.
3.52 pm
Assoc Prof Jamus Jerome Lim : Thank you, Mr Deputy Speaker, for the opportunity to participate in this debate. I will speak about the steps we can take as a nation towards moving to a better balance in our expenditure on healthcare resources. I will share some details on why I think we can increase the carrying capacity of our healthcare system, perhaps, to some detriment in efficiency and some marginal pressure in costs that will pay off, I believe, in terms of greater long-term resilience.
As others in this House have shared, and is well understood by this Government, our impending public expenditures on medical care would be substantially greater than what we have currently allocated for spending today. This is due predominantly to societal ageing and greater healthcare needs associated with the more elderly population. But my point is more fundamental. It is that, even at present, our healthcare system falls somewhat short of what we might reasonably expect for an economy at our stage of development.
To be clear, I am not suggesting that our current system is fundamentally flawed, nor am I saying that it should be completely overhauled. Indeed, I believe that we can justifiably be proud of the quality of care delivered by our existing system, which blends public as well as private components, and has proven to be remarkably cost-efficient in doing so, as Senior Parliamentary Secretary Eric Chua has just shared with this House.
While I certainly prefer the balance to be tilted more toward a larger public share – a matter on which I had spoken about before, in the context of the debate on the amendments to the Healthcare Services Act in March this year – that is not the focus of my concerns today.
Rather, I wish to highlight what I believe is one glaring shortcoming that was raised by the COVID-19 episode: because we run our systems so lean, it has become fragile in the face of large, unanticipated, albeit, fully predictable shocks, such as the pandemic.
Here, a little philosophical discussion may, perhaps, be in order. The bread and butter function of economists is to maximise a given objective, subject to constraints. This, generally, means that we are constantly looking for optimal solutions and we are very happy when we find such solutions. My wife often makes fun of me, about how I gain enormous satisfaction by planning my visit to the grocery store along with all my other errands – pumping gas, drawing cash, "dabao" dinner – so that I can make one smooth, continuous trip. In this regard, economists are easily satisfied creatures.
But there is another, equally tenable, worldview and that is one often held by engineers. Engineers do not look to wholly strip systems of inefficiencies. They recognise that redundancies are important, because while under normal conditions, such under-utilised elements may seem wasteful, they are mission-critical and can prevent the entire failure of the system during times of undue stress. Accordingly, they build bridges that can bear far more weight than one might expect with normal traffic – and then add a little more. They design planes that can run with one engine, even when the other stops. They design power plants that can possess multiple fail-safes, so that they can keep the whole thing running while a compromised part is being repaired.
Sir, the number of i ntensive care units (ICU) beds in Singapore, per 100,000 of our population, currently stands at 5.7. The average of the Organisation for Economic Co-operation and Development (OECD), an association of industrialised nations, is closer to a dozen, twice our number. Of the four economies that have a lower coverage than we do, only one, Japan, has a significantly larger elderly share in its population.
More generally, our hospital bed count is also low. We maintain a little more than two beds per 1,000 of our population, a fraction of that of other East Asian economies, like Japan and South Korea which have around a dozen; China, which has around five; and other advanced economies like Denmark, the Netherlands, Israel and the United States, where the ratio is closer to three.
To be clear, this low bed count is not prima facie evidence that there is a problem with the present system. We need to look at the occupancy of said beds, and one could even make the argument that efficient recovery means that we are able to sustain a lower carrying capacity.
In a response to a Parliamentary Question filed last year by my hon friend Mr Leon Perera, Senior Minister of State Janil Puthucheary shared that the target bed occupancy rate over the next five years was around 80%, which he added was generally recommended by academic communities as well as healthcare authorities. And in a statement to this House the year prior, he also explained that we have been able to ramp up ICU beds very quickly, as we did during the pandemic.
But in that statement, he also acknowledged the need to ramp up ICU bed capacity, although he qualified this by pointing out that this process was non-trivial, being limited, principally, by the need to increase the medical personnel required to staff such beds.
Moreover, recent data on bed occupancy rates at our major hospitals reveal that this 80% appears to be systematically breached, and over the past month, the rate has routinely exceeded even 90% in Tan Tock Seng, Ng Teng Fong and Khoo Teck Puat hospitals. And that is under non-pandemic conditions.
Taken together, these suggest that the Government is both aware that running our medical infrastructure too lean can come back to bite us during periods of stress, and that we have yet to fully address this problem even though we are back in normal times.
MOH has shared that it plans to roll out a new health campus in Woodlands, as well as another in Bedok, but the remaining projects are all expansions of current facilities. Will the Minister be willing to share if these will be sufficient to cater, to not just anticipated increases in demand due to an aging population, but also relieve some of the existing capacity constraints faced? Or will they be mainly focused on matching resources with new incoming demand, leaving current capacity largely unaltered?
This brings us to what appears to be the key constraint: medical manpower.
At present, we also have a comparatively low coverage of doctors and nurses. As of 2021, Singapore has 2.7 physicians per 1,000 people, around two-thirds the OECD average of 3.8.
Unsurprisingly, this has led to burn-out, stress and high turnover among our medical professionals, which others in this House have articulated. The solution appears straightforward and is uncontentious: we need to increase our supply of medical personnel. The Government has stressed the same, that ramping up medically-trained staff is a priority. The question then, is how.
There is a global nurse shortage which the World Health Organization (WHO) estimates may be close to six million and the International Council of Nurses – to be fair, an interested party – places this at a higher number of around 13 million.
Given this context, increasing supply calls for us to attract as well as retain global talent in the short term while looking for ways to expand domestically trained workers in the longer term.
The practical manifestation of our limited beds and doctors is that wait times for admission to a ward has remained elevated at many facilities. This has been most chronic at Khoo Teck Puat Hospital, although we have seen spikes at Ng Teng Fong General Hospital as well as Sengkang General Hospital, which is located in the constituency that I represent. On certain days, this could lead to waits even exceeding 24 hours.
The question we should ask ourselves is this: are we willing to accept the status quo where our patients may occasionally need to wait for more than a day to be admitted to a hospital? Perhaps, we think that this is a reasonable trade-off to keep overall medical costs down or we may use this fact as symptomatic of a need to increase the carrying capacity of the present system.
In my earlier speech, I offered some medium-term suggestions for how we could relieve some of the existing pressure on our system. We could consider increasing the number of recognised universities for basic medical degrees, up from the present 100. For experienced doctors who have a long track record of working in other jurisdictions, we can simplify the application and accreditation process, perhaps, with designated processes based at MOH that would seek out such doctors and encourage them to apply.
As we compete for global nursing talent with other advanced economies, many of whom are facing their own nursing shortages, it also makes sense to train more of our homegrown workforce to take this on. We could offer more generous terms for trainees. We could fully waive course fees, for instance, which, to be fair, is already relatively modest, on the condition that these trainees also work as nurses in Singapore for a certain duration after graduation.
This could also apply to those who would consider a mid-career switch. We can ensure that SkillsFuture funds not only fully cover conversion courses but also perhaps provide more credit for prior training. For example, early childhood educators and teachers surely would satisfy general courses in communications, critical thinking, data analysis and behavioural science, all of which are part of the nursing curriculum today.
Easing the supply pressure will require that we go beyond policies on the quantity dimension. We could also work on price. At the simplest, this means that salaries in the field should rise. One existing limitation to more sustained increases in wages is that costs are already high. This, in turn, seems to be led by commercial rental rates for private hospitals, which can spill over into public pricing. The high rent is a function of – well, you guessed it – elevated land pricing.
But it is not simply about higher wages – if these are simultaneously accompanied by longer hours. If anything, it would be better to increase the total number of doctors and nurses while keeping hours sane. The total wage bill will remain the same but the quality of care is likely to improve.
We could also increase the number of tiers within nursing – the number is as many as five or six in other countries – from our present three of enrolled, registered and advanced practice nurses. This offers additional upward mobility pathways, making the profession more attractive for those contemplating entry.
Sir, as I explained at the outset, our healthcare system capacity does not appear to be fundamentally flawed but it is facing increasing pressure. It is wise to adjust and adapt to impending needs at a time of relative calm rather than feel the need to "kelam-kabut" to make up for these during a future pandemic scenario.
Mr Deputy Speaker : Minister of State Gan Siow Huang.
4.04 pm
The Minister of State for Education (Ms Gan Siow Huang) : Mr Deputy Speaker, health is wealth. Our own health account is like a bank account. The more we put in it, the more we can get out of it. Investing in your health now will pay dividends for the rest of your life.
Most of us would agree that our children need to start healthy living habits from young and consistently practise healthy living in order to have the best chance of staying healthy and living life to the fullest.
I thank Dr Tan Yia Swam for highlighting the importance of health education. MOE takes a holistic approach towards promoting the overall well-being and health of our students from the time they start going to school. Throughout their educational journey, students acquire knowledge, skills and attitudes to cultivate an active and healthy lifestyle and maintain it beyond their schooling years.
At the preschool stage, MOE's Nurturing Early Learners (NEL) Framework emphasises holistic development by encouraging healthy habits and a positive attitude towards participating in physical activities.
In schools, students learn about good health practices, such as regular exercise, sufficient sleep and healthy eating. During Physical Education (PE) lessons, they learn to play a variety of sports and games that equip them to participate in physical activities well into adulthood. Our polytechnics have various health and wellness modules for our students while ITE has weekly PE curriculum.
MOE schools and our Institutes of Higher Learning (IHLs) also provide opportunities for students to be physically active outside formal curriculum hours. Students can take part in Co-Curricular Activities (CCAs) and join interest groups or sports clubs. They can make use of sports facilities and equipment in schools and on campus to remain physically active.
HPB works with schools and IHLs that wish to adopt programmes, such as the Active Youth Programme, to increase physical activity participation through regular contemporary workout sessions.
Nutrition is another critical aspect of physical health. All schools and IHLs actively promote healthy eating. In Food and Consumer Education lessons, lower secondary school students learn to plan and prepare healthier meals to suit their diets. In collaboration with HPB, all schools have implemented the Healthy Meals in Schools Programme, where school canteens provide healthier food and drink options.
Similarly, polytechnics and ITE participate in HPB's Healthier Dining Programme, which encourages food operators to offer healthier choices. The autonomous universities (AUs) also support healthy eating on campus by working with F&B vendors to provide healthier meals to the students.
Next, on mental health. Dr Wan Rizal spoke about the importance of mental health literacy for our students. I agree. Our schools and IHLs equip students with knowledge and skills to strengthen their mental well-being, build resilience and thrive amidst challenges. For example, students learn about common mental health issues and the importance of help-seeking within the Character and Citizenship Education (CCE) curriculum. As the digital world has an impact on mental health, our students are taught ways to manage their social media use and develop healthy online peer support culture.
Mr Deputy Speaker, the health and well-being of our children require a whole-of-society effort. Families and the wider community play an important role in providing an enabling environment to support the adoption of healthy habits. At home, parents can help to reinforce and role model healthy habits. MOE shares practical and actionable tips with parents on building a positive family environment to develop strong physical, social, mental and emotional well-being for their children. These tips are shared with parents via MOE platforms, such as the Parent Kit, MOE Parenting IG and Parents Gateway.
We have heard of positive stories from parents who play an active role to build a healthy lifestyle together with their children and, in doing so, have strengthened parent-child relationship. One father shared with us how he had started a routine to exercise with his child regularly, who had taught him the various types of sports and games that he learnt from PE lessons in school. With parents reinforcing and role modelling what their children are learning in school, I am confident that more children will develop healthy habits for life.
We are heartened to see stakeholders, such as the Parent Support Groups (PSGs), COMPASS which stands for COMmunity and PArents in Support of Schools council, HPB and various social service agencies working in partnership to support parents on ways to strengthen children's health and well-being.
We thank parents and our community partners for working with us to promote the well-being of our students. We look forward to continued and strengthened partnerships with more so that our children can build up their health accounts from young and live their lives to the fullest. Mr Deputy Speaker, I support the Motion.
Mr Deputy Speaker : Senior Minister of State Janil Puthucheary.
4.11 pm
The Senior Minister of State for Health (Dr Janil Puthucheary) : Mr Deputy Speaker, Sir, I rise in the support of the Motion standing in the name of Dr Tan Yia Swam, Dr Shahira Abdullah and Mr Abdul Samad.
Sir, all of us play a key role in ensuring the good health and well-being of the population. As individuals, we need to take active steps to live healthier lives and minimise the risk of falling ill even as the Government builds a supportive environment to help us do this. I will speak about mental health, oral health and the healthcare IT infrastructure and digital tools to support individuals on healthy living.
Sir, good mental health is essential. It lies along a spectrum and is multifaceted. Mental health issues can arise from a range of factors, including physical health and social determinants. Addressing these issues will require a collaborative and integrated approach that involves multiple stakeholders from the health, social, education, workplace and community sectors.
This is already happening. For example, under the Community Mental Health Masterplan, MOH, the Agency for Integrated Care and social service agencies have worked together to establish community mental health teams across Singapore. These teams provide mental health education to residents and bring care, such as mental health screening, assessment and therapy, closer to home, where there is less stigma and individuals feel safe to seek help.
Prof Koh Lian Pin spoke about mental health in academic settings. HPB has worked with Institutes of Higher Learning (IHLs) to establish peer support structures. Training is provided in empathetic listening and basic mental health first aid skills to support one's peers who show signs of emotional distress. In addition, those who wish to learn about mental health and self-care tips can access MindSG, a portal for mental health and well-being resources that are curated by mental health experts.
It is important to address mental health issues that affect us at the workplace, whether that workplace is an academic setting or otherwise. The Tripartite Advisory on Mental Well-being at Workplaces was jointly launched in 2020 by MOM, the National Trades Union Congress (NTUC) and the Singapore National Employers Federation (SNEF) to support employees' mental well-being and provide resources for employers, employees and self-employed persons.
Dr Tan Yia Swam shared her experience as a junior doctor where there were occasions when she worked for more than 24 hours a day when she was on call.
The Ministry is reviewing the total working hours of junior doctors, including hours worked while on call. The public healthcare clusters have been piloting shorter call hours for junior doctors in selected departments as well as using electronic logging and surveys to monitor junior doctors' working hours.
This is a complex subject which requires a fundamental relook at manpower deployment and the sharing of responsibilities between senior and junior doctors. This will take some time to study and work out and we are engaged on this matter.
Dr Tan Yia Swam and Prof Koh Lian Pin shared about the importance of mental health education and de-stigmatisation. HPB launched the "It's OKAY to Reach Out" campaign in October 2021 to normalise the topic of mental health by building awareness and encouraging conversations. The campaign in 2022 was focused on youths to help them overcome their hesitation to seek support and address their concerns about seeking help. Activities such as teacher-guided class discussions were brought to mainstream schools and Institutes of Higher Learning (IHLs). Outreach efforts to promote mental health awareness and literacy among Singaporeans have continued through online efforts and in-person programmes.
In addition to all this, the National Council of Social Services (NCSS)' Beyond the Label (BTL) movement which was launched in 2018 by NCSS, continues. In the next phase, BTL 2.0 moves to inspire action. NCSS has brought together 26 partners across the people, public and private sectors to promote and enable help-seeking and help-giving behaviours in schools, workplaces and the community.
Sir, the Interagency Taskforce on Mental Health and Well-being was established in July 2021 to oversee and coordinate mental health efforts across different sectors, focusing on cross-cutting issues that require interagency collaboration.
At the task force, we have identified 12 preliminary recommendations and sought the public's views in a consultation process last year. There were over 950 responses, with feedback from groups such as youths, parents, persons with mental health conditions, service providers, employers and community agencies.
The respondents were supportive of all the recommendations and the task force will be releasing a short report of the consultation's findings soon, even as we commence with the implementation plans for these recommendations.
One of the recommendations is to implement a tiered care model for mental healthcare delivery. This is a framework that matches the level of care to the degree of mental health need, allowing for a more effective allocation of mental health services based on the severity and complexity of an individual's needs.
As part of the public consultation, we received very useful feedback on the implementation. One example would be, for the tiered model to work well, service providers need to be sufficiently competent to fulfil their roles and responsibilities.
We completely agree, that for this tiered care model to be implemented effectively, an important aspect is to ensure adequate competencies and standards amongst all mental health practitioners. So, we have the National Mental Health Competency Training Framework Workgroup. The framework that they are developing will guide mental health practitioners on the knowledge, skills and competencies necessary to deliver quality and effective care. It will apply to all practitioners, from lay responders such as peer supporters, to mental health professionals, including nurses, social workers and counsellors, amongst others. I thank Dr Wan Rizal for highlighting the importance of this.
In addition, there is already a system in place to safeguard professional practice today. Mental health professionals are regulated through professional boards and councils and set practice standards through professional associations.
For example, psychiatrists, nurses and occupational therapists are regulated by the Singapore Medical Council, the Singapore Nursing Board and the Allied Health Professions Council, respectively. Professional associations such as a Singapore Association for Counselling and the Singapore Psychological Society provide guidance on the professional and ethical conduct for counsellors and psychologists respectively.
There is also the need to help individuals with mental health needs access the appropriate services in a timely manner. One recommendation from the task force is to designate a few first-stop touch points to provide individuals with easy access to mental health support and advice.
Some respondents from the consultation felt that there was value in having more than one way to deliver a service to take into account user preference. We are developing a number of service modalities such as hotlines, text messaging, in-person services and digital resources to ensure that there are sufficient and different ways for people to access these first-stop touch points for mental health.
Sir, if I now may shift to oral health care for older adults, persons with special needs and migrant workers in Singapore in response to Dr Shahira Abdullah.
The Government has introduced initiatives to ensure the access to affordable and quality health care for Singaporeans such as through the Community Health Assist Scheme (CHAS). Most oral health needs of these population groups can be met by general dentists at the polyclinics, CHAS clinics and private dental clinics. Individuals with complex needs and those with medical conditions or multiple morbidities that require a higher level of care are cared for and can be cared for by specialists at our National Specialty Dental Centres and the hospital dental clinics.
To facilitate access, MOH has worked with MSF to list the details of dentists and private dental clinics providing special care dentistry services so as to raise the awareness regarding the availability of services for persons with disabilities.
Additionally public-private partnerships in addition to the existing ones like Enabling Village, Agape Village, HealthServe and Saint Andrews Mission Hospital will be further explored to better serve the primary medical and dental care needs of underserved communities including migrant workers.
For our migrant workers, the Ministry of Manpower (MOM) will also continue to explore working with key partners such as NGOs to facilitate accessible dental care for migrant workers and provide oral health education through Project MOCCA, the Management of Oral and Chronic Conditions and Ailments. Project MOCCA was launched by MOM last year and is a preventive health framework to enhance the care of oral and chronic diseases among workers. And in this, MOM works closely with partners such as MigrantWell Singapore.
We recognise the efforts of independent volunteer initiatives that provide dental services within the community, intermediate and long-term care settings and in special needs organisations. To improve the coordination of these services, we will be encouraging larger volunteer associations to help provide a platform for communication, for sharing of resources and for coordination.
As the practice of dentistry constantly evolves with changes in population demographics, advances in technology and shifts in care approaches, the local dental landscape will shift accordingly.
To better support dental professionals and other healthcare and non-healthcare professionals providing care for older adults and persons with special needs, we will look into the development of clinical practice guidelines and appropriate care guides to help establish standards of care and promote better health outcomes. Additionally, we will continue to review our subsidy framework and award scholarships for residency training programmes in the various disciplines of dentistry so as to ensure our dental workforce can continue to meet the oral health needs across all ages and care settings.
Sir, I would next like to highlight the importance of having a well-integrated and reliable IT system to connect the healthcare providers, community partners and our residents. Members of the House have raised this in past Parliamentary sessions such as the White Paper for Healthier SG and also at the Committee of Supply 2023 debate. I thank both Dr Tan Yia Swam and Mr Yip Hon Weng for emphasising its importance.
One key system will be the National Electronic Health Record System (NEHR), which is a common platform that captures selected patient health information from various healthcare providers and allows providers to view these health records for patient care. Mr Gerald Giam asked about the implementation of security enhancements for NEHR. The NEHR has been subjected to cybersecurity reviews, infrastructure vulnerability scans and application penetration tests. MOH and Integrated Health Information Systems (IHiS) have reviewed the findings and most of the key enhancements to NEHR have been completed, with one further to be completed tentatively by 2025.
On the matter of IT support for GP clinics, that Mr Gerald Giam also raised. We do want GPs to use a Clinic Management System (CMS) that supports their daily operations well and connects to key IT systems, to save them time on administration. We have been working closely with the CMS vendors to improve their products and strengthen their backend services to support the GP clinics.
We are bringing onboard more healthcare providers to contribute to the NEHR, by extending the Early Contribution Incentive scheme to GPs, private hospitals, radiological laboratories and clinical laboratories to support them in data contribution. With the Health Information Bill (HIB), it will become mandatory for them to contribute patients' data to NEHR.
We have been extensively consulting stakeholders such as our licensees and healthcare professionals, on issues surrounding data privacy and sharing, related to the HIB. We had intended to table the HIB to Parliament sometime this year. But this is quite a very significant Bill and we felt more time is needed to engage our stakeholders and members of the public. We thus expect to introduce the Bill in this House, in the first half of 2024. I would also like to thank Mr Yip Hon Weng for raising the need to enable data sharing between the health and social sectors, this is indeed one of our aims under the HIB to support more integrated care and reduce administrative work, while ensuring data security.
Ms Ng Ling Ling and Mr Yip Hon Weng also raised the need to empower Singaporeans with more knowledge and support to manage their health better. We will do this through tools such as the HealthHub and Healthy 365 applications. For example, residents and their authorised caregivers can view health information from the NEHR, such as discharge summaries, selected blood test and radiology results, via HealthHub. We will explore how we can reflect more results in these platforms. Residents and their authorised caregivers can also use HealthHub to book and manage their medical appointments across all public healthcare institutions, as well as to enrol in Healthier SG and view their Health Plan.
Residents can use Healthy 365 to see and sign up for nearby healthy lifestyle programmes, track their physical activity and collect health points from clocking steps and making healthier food choices. We will continue to enhance such digital tools to help residents sustain good health and well-being.
Sir, in summary, with increased accessibility to trusted platforms for appropriate health information and interventions, and support from healthcare providers and community partners, we hope individuals can make informed choices to enable better mental health, better oral health and better health for themselves and their loved ones. Mr Deputy Speaker, Sir, I support the Motion.
Mr Deputy Speaker : Minister Ong Ye Kung.
4.26 pm
The Minister for Health (Mr Ong Ye Kung) : Mr Deputy Speaker, I rise in support of the Motion. I want to thank Dr Tan Yia Swam, Dr Shahira and Mr Abdul Samad for tabling this Motion, and pointing out passionately that health is everyone's concern, and it is only with everyone’s action that we can improve the health of individuals and our nation.
I would also like to thank all the Members of Parliament and representatives of Ministries who have, through your speeches, supported the various health-related policies and also given suggestions for improvements. This includes Healthier SG, our preventive care strategy; championing the well-being of our healthcare workers; developing more centralised IT systems; group buying of drugs with private doctors; ensuring that healthcare remains affordable for everyone and so on.
Members have also raised a range of challenges and frustrations of the healthcare system. Indeed, healthcare is probably one of, if not the most, complex public service systems in our whole public service. It will be unrealistic of me if I were to say we have a solution to every problem that you have raised. Even if we have, theoretically, it is not practical to implement them all. We will need to work within the budget and time resources we have, our management bandwidth to plan and effect change, our people's appetite to accept changes. We have to improve step by step.
What we will do is to prioritise the areas that we can make the most meaningful changes, where there is bang for the buck and focus on them. This is what we are doing.
So, we are focusing on expanding our healthcare capacity, which includes manpower, rolling out Healthier SG, and building up an effective system for ageing in community. Together, they represent a major transformation of our healthcare system in the medium-term.
But before I talk about these priorities, let me first address three specific issues on healthcare that were raised by Members: manpower, financing and as Prof Jamus Lim just raised, healthcare capacity. It is last minute, but I will respond to you.
First, manpower. At the heart of any healthcare system are the workers. Several Members of Parliament such as Dr Tan Yia Swam, Ms Janet Ang, Dr Wan Rizal, Mr Gerald Giam, Mr Abdul Samad and Mr Raj Joshua Thomas have spoken about the issues confronting them.
We have to support healthcare workers as much as we can. The NTUC and Healthcare Services Employees' Union (HSEU) have been fervent supporters for the welfare of healthcare workers. Ms Thanaletchimi, President of HSEU, used to be a Nominated Member of Parliament in this House and spoken about it many times.
The partnership between the People's Action Party (PAP) Government and the Labour Movement is a strong institutionalised arrangement, and MOH looks forward to our continued partnership in advancing the welfare of our healthcare workers.
Part of this work, very importantly, is to regularly review remuneration of healthcare workers, to ensure that we recognise their contribution and to make sure that remuneration is competitive. Mr Leon Perera suggested some benchmarking. We will internally benchmark not just the pay but also taxes – because it varies across countries – and also the living conditions and rental. But I suggest we do this internally, because competition is now so tough, you do not want to benchmark and then show everybody. But we certainly want to benchmark and make sure we are competitive. Right now, in fact, rental becomes a problem for foreign nurses to come to Singapore and out of pocket expenses are high. These are some things we need to address to make sure we are competitive.
Of particular urgency now is to actively recruit both local and foreign healthcare workers to boost the workforce, given the rising attrition suffered in the last two years due to the COVID-19 pandemic.
For local healthcare workers, we are looking forward to the inflow of the latest batch of polytechnic graduates who, I think, just graduated and they will be joining the workforce and our hospitals soon.
Mr Abdul Samad had feedback about interns not getting paid for their internships. I would like to clarify this. All Institute of Technical Education (ITE) and polytechnic nursing students are given allowances for their internship attachments. However, for certain healthcare-related courses, such as Biomedical Science, allowances are an arrangement left between employers and the school to set, and practices can differ across health clusters. But given the Member's feedback, let us look into the specific instances where our public health institutions do not offer internship allowances.
As for foreign healthcare workers, it takes time to conduct selection and examinations overseas and for the shortlisted candidates to move here. They have so far been trickling into Singapore, but we hope in the second half of the year, more of them will start to come onboard.
And for those who have performed well and are committed to Singapore, we welcome them to apply for permanent residency (PR). A few Members of Parliament (MPs) have suggested granting PR status to their dependents as well. We thank the MPs for their suggestion. This is worth serious consideration.
For everyone in our healthcare workforce, we will need to ensure their well-being. I am glad many MPs spoke up against abuse and harassment of healthcare workers. This is one of the top issues in the minds of our healthcare workers.
I think, in general, I would say, to be fair, the regard and appreciation for healthcare workers has generally gone up amongst our society post COVID-19. And for the majority of the public, they are appreciative and respectful towards our healthcare workers.
Those who physically assault, threaten or hurl vulgar and condescending remarks against healthcare workers, I think is really a small minority. But because the acts are so egregious, it feels like a big thing. And it is a big thing. We cannot tolerate such behaviour. This is unfair to healthcare workers and unfair to the great majority of the public who respect our healthcare workers.
As Members know, MOH has recently announced a zero-tolerance policy against abuse and harassment of healthcare workers. And we intend to translate this to procedures and guidelines for all our healthcare institutions in the second half of this year. I will not elaborate what it entails as I have spoken about this before.
But since the announcement of the policy, I have noticed some reactions. First and the best is that most members of the public support the policy. Second, a few raised concerns that there were occasions where healthcare workers did not behave appropriately. We acknowledged that. There are always a minority of black sheep. But there are appropriate channels to report such matters and the hospital management will look into them seriously.
Some have said that one of the root causes of abuse is the heavy workload at the hospitals and long waiting times, and therefore, we should address that first. We are doing what we can to alleviate the situation at the hospitals post COVID-19. It will take time. But heavy workload cannot be an excuse for anyone to physically or verbally abuse our healthcare workers.
Mr Raj Thomas mentioned that another reason is expectations are high and when it is not met, people get upset. It is totally all right to have expectations and to demand good service. By all means, do that, but there is no need to abuse healthcare workers should service delivery fall short.
I should say that notwithstanding the heavy workload and the occasional abuse and harassment, most healthcare workers I have met – and I hope it is not just because I am Minister – remain positive, professional and passionate about their jobs.
Ms Koh Fang Qi, for example, was a senior staff nurse in Khoo Teck Puat Hospital since 2015. She has now become a Nurse Manager. Over the years, she dealt with many abusive patients and next-of-kin, but she continued to calmly handle each one with empathy and became an expert in this field.
Once, she witnessed a junior nurse being abused physically and verbally by the next-of-kin of a patient. So, she bravely stood up, managed the situation and escalated the incident to the authorities for follow-up and remained calm throughout the incident.
And despite all these challenges, you can tell she loves her job. She continues to treat patients and their loved ones with care and kindness. She constantly shares her knowledge and experience dealing with abuse cases with her colleagues.
The test of zero-tolerance policy is in the second half of this year when we have guidelines and supervisors to disengage abusive patients or most likely, their next-of-kin. I do expect some to write to the Ministry to complain to me why do our supervisors and nurses act this way. We will be very careful. We will make sure that we will effect the consequences only for the most genuine cases and care will always be prioritised. Should I get a complaint, I will back our ground supervisors; and healthcare workers. Should it comes to this Chamber, because I think some of the residents will complain to their MPs: "why MOH act like that, can they appeal against this, they disengaged with me and I was just demanding good service."
When the time comes and test comes, I hope to have the support of this House. We will be careful and we will do it judiciously if we ever have to disengage an abusive patient or next-of-kin, so, I seek the support of the whole House.
Let me move to healthcare financing. Mr Leong Mun Wai made a few points yesterday.
I am glad he agreed with our policy to use MediFund to support low-income families. The MediFund disbursed $164 million in FY2021, not $100 million as stated by Mr Leong yesterday. The Government further topped up MediFund by $1.5 billion in FY2023.
However, Mr Leong also delivered a political statement yesterday. He declared the Progress Singapore Party (PSP)'s position that Government ought to spend more in healthcare like other OECD countries.
Let me make a few points in response.
First, it is widely known that spending more on healthcare does not mean better health outcomes. Most health economists will know that. Since Mr Leong is benchmarking ourselves against OECD countries, let us just cite two examples, US and UK. They are spending about 17% and 10% of their GDPs on healthcare, compared to us, 4%. Yet, US and UK continue to face high incidence of chronic illnesses, high obesity rates and their expected lifespans are lower than Singapore.
I was inspired by Mr Eric Chua and also checked out ChatGPT: "what do you think of the US system, what do you think of the UK system". Actually, it is quite well-known. In the US, healthcare is very expensive, despite spending 17% of their GDP. In the UK, the National Health Service (NHS) is crushed down by the workload. The waiting times are far longer than in Singapore, despite spending 10% of their GDP on healthcare.
We have delivered good health outcomes given what we are spending.
The second point, for whatever we are spending, we are able to make healthcare affordable for middle to lower-income groups. Today, about seven in 10 of Singaporeans in subsidised wards do not have to pay any out-of-pocket expenses. Eight in 10 pay less than $100 cash out-of-pocket; nine in 10 pay less than $500 in cash out-of-pocket.
So, when Mr Leong asked the Government to spend more to lower out-of-pocket expenses further, he really meant to channel resources to unsubsidised patients, that is, those staying in A class wards or private hospitals. This is where the big bucks and the big expenditure are, and it will push our healthcare expenditure and spending to the levels of the OECD countries.
Third, while Mr Leong asked Government to spend on healthcare, he failed to mention that Government expenditure ultimately has to be raised from the people through taxes. Mr Leong had not made any mention of where PSP will get the funding from.
Fourth, the fact is that we are already spending more and more on healthcare. We do not need Mr Leong's urging. Healthcare spending is going up. In the decade after 2010, our nominal Government health expenditure tripled. In the following decade, that means up to 2030, it is expected to triple again. So, triple and triple – it means an increase by nine times over 20 years. This is driven by an ageing population, who is also getting sicker. MOH already has the second largest Ministry budget, after Ministry of Defence (MINDEF).
In the coming years, our challenge is not to spend more, but to ensure we do not go the way of many OCED countries, with the healthcare fiscal burden spiralling and escalating out of control.
Finally, it is therefore much better that we continue our sensible and practical approach: have different layers of safety nets – subsidies, MediShield Life, which I thank Prof Hoon Hian Teck for explaining why it is necessary, MediSave and MediFund. This is the S+3Ms approach, which has worked quite well.
We now combine this with a very important strategy in Healthier SG and our effort to enable ageing in communities, so that we can avoid sickness and reduce our disease burden even as our population ages.
Mr Leong also talked about the seemingly large balances in the Pioneer Generation (PG) and Merdeka Generation (MG) Funds, and concluded that more subsidies can therefore be given to PG and MG members.
His understanding is misplaced. Both Funds were sized based on the projected lifetime cost of the benefits, and accounting for inflation and interest accrued.
To illustrate, the oldest and youngest MG member is about 73 and 64 years old. PG members will be at least 10 years older, with the youngest at 74 years old now. They still have quite a bit of runway ahead of them and we do expect many of them to live until 90 or 100 years old. So, their lifetime benefits need to be funded from the MG and PG Funds. But the Government will continue to regularly review the adequacies of these two Funds.
Third issue is healthcare capacity that Assoc Prof Jamus Lim just raised. We agree that 80%, 85% occupancy rate is probably ideal. And you do not need an engineer to conclude that you must have redundancy in your system. It is not a new concept. It is something that I think we all agree to.
But why is there a crunch now? Of course, there will be crunch during COVID-19. It was an emergency, it was a crisis of a generation. I do not think any country or any system can plan for that kind of capacity to cater to a crisis. But post-crisis, we do have a crunch today.
I explained in this House before, I think it was during the White Paper debate on COVID-19, that the main reason for the crunch is that within a very short span of two years, you suddenly see average length of stay going up significantly. It used to be six days. Now, it is 7.1 days. [ Please refer to " Clarification by Minister for Health ", Official Report, 10 May 2023, Vol 95, Issue 104, Correction By Written Statement section. ]
This means your utilisation has suddenly gone up by 15%, over two years, post-COVID-19.
It is a post-COVID-19 phenomenon. I think in time, researchers and clinicians will study why. But there could be a few hypotheses. One is that there is some kind of immunity debt – more old folks are getting infected with viruses, bacteria post-COVID-19. And when they do, they fall quite sick and they actually stay in hospitals for quite long. And that pushes up average length of stay.
Another reason, which is a possible one, is that during COVID-19, too many of our seniors decided to hide at home, afraid to come out. There were no more community activities, which actually is so crucial to keep them healthy. So, with social isolation, their health deteriorated. And then, when they get infected, they stay in the hospital for very long.
The 15% increase in utilisation alone explains why we have a crunch now. And it is happening not just in Singapore. It is happening all over the world. Every country is facing a crunch in their beds. All of us agree we must have redundancy but all of us are facing a crunch, including and especially in OECD countries, despite their higher bed to population ratio.
So, what do we need to do? First, catch up on the capacity. Many of our projects have been delayed due to COVID-19. We have to catch up but some things cannot be rushed. We just have to implement them.
So, sometime this year, the Integrated Care Hub at Novena will open. It will add a couple hundred beds. The Woodlands Integrated Health Campus, by end of the year, may have one ward open; hopefully, next year more wards will open. And then we have the redevelopment of Alexandra Hospital and the eastern regional hospital Assoc Prof Jamus Lim talked about. We have the redevelopment of SGH campus that is ongoing. Although it is an existing campus, it is a significant redevelopment with many more beds added.
Two, is to build more Transitional Care Facilities (TCFs), which I have explained before. It is actually very useful. Today, in our hospitals, there is still quite a number of seniors who are staying there not because of medical reason, but because of social reasons. TCFs have rehabilitative care and good medical facilities, and we can allow those who are stable to move to TCFs, thus freeing up acute beds. So, we are building that up quite actively.
Third is recruitment, which I have explained before. I think although it is very competitive, Singapore continues to be an attractive location for foreign nurses to want to come to Singapore. The healthcare profession continues to be quite attractive to our locals as well. Today, one in 25 students will join nursing and I cannot hope for more. That is not bad at all considering the number of options they have. So, I think we are getting our fair share of local talent and we are competitive in hiring foreign nurses as well.
But of course, I hope the House, having raised all these issues, will support the necessary steps that we need to take in order to recruit local as well as foreign nurses.
Let me come back to the substance of the Motion, which is really why we are here – and it is an important Motion, urging a whole-of-Government approach to support healthcare, even after the COVID-19 crisis has passed.
Our Public Service has a long history of inter-agency collaboration. But COVID-19 was special. It was a period when we witnessed the tremendous potential of inter-agency cooperation, united in a common objective to overcome a national crisis.
If you look at our schools, they kept education going, shifted to home-based learning only for a couple of months. Our economic and social agencies worked together to support businesses and workers. Various agencies got together to set up quarantine facilities, testing and community care facilities. I cannot emphasise enough how much that meant to the hospital system, which would have, otherwise, borne the full brunt of the pandemic and we would have likely collapsed.
Recently, a well-known Chinese infectious disease expert, Dr Zhang Wen Hong, after he observed how life in China has gone back to normal during the May Day Golden Week, he wrote a blog post and he said, “It was as if nothing had happened, yet everything has happened”. In Chinese, 一切都没发生，一切都已发生.
It was a rather poignant expression of the post-crisis state of mind which may be relevant in Singapore and relevant to today’s debate. We do not want to hang on to and relive the crisis. We need to walk out of the shadows, put it behind us and look into the future. And yet so much has happened. The experience and lessons learnt will reshape the way we look at healthcare and the way we look at inter-agency collaboration. Those cannot be forgotten and go to waste.
So, I share Members’ hope that while the crisis may be over and peace time workload has resumed, it cannot be business as usual. We should usher in a new era of even tighter inter-agency collaboration. And this is especially relevant for healthcare for two reasons.
Number one, as I have explained, ageing is probably the biggest social transformation for Singapore in the next 10 years, as we become a “super-aged” society. This will have implications across multiple policy areas – in employment, in our competitiveness, retirement adequacy, urban planning, education and, of course, healthcare. It will draw Ministries together to work in concert.
Second, post COVID-19 crisis, we have decided that the conditions and timing are right for us to effect a major healthcare transformation, building upon all the work that was done in previous years. I have explained in this House why and what we are doing in this transformation. Essentially, the idea is that healthcare needs to go beyond treating sickness in hospitals and clinics, but creating health in homes and communities. In other words, health is not just relevant to patients who have fallen sick. Health is for all. And that is why we now regard the healthcare system as three inter-linked systems.
If I may briefly recapitulate. Ms Janet Ang has just explained this earlier. First, we have the acute care system, which is essential in ensuring that those who are sick get treatment. Second, the population health system, which we are building up through Healthier SG, and we are mobilising all our family doctors and GPs to focus on preventive care that is anchored in the community. The third system is the aged care system. The default for aged care cannot be nursing homes or seniors living alone with no social support.
In other countries, loneliness and social isolation of seniors have become an epidemic. We also see this happening in Singapore. I think it is one of the reasons why length of stay has gone up, especially after COVID-19.
If we can do this right, I think we can do what Mr Yip Hon Weng suggested – integrate care across medical and social realms.
And we need to urgently step up this whole-of-society efforts to enable our seniors to live their golden years in dignity, age actively in their community with their friends and family, involve them in activities including training programmes, like what Mr Mark Chay has suggested. And if they wish, leave well in a family environment surrounded by their loved ones. So, this aged care in community is the next major area of work in healthcare.
To make Health for All possible, we need the contribution of every stakeholder, public or private. When healthcare is mostly treating sickness, it falls under the domain of hospitals. But when healthcare is about creating health and caring for people in their homes and communities, it becomes everyone’s business. Hence, in order to realise Health for All, we also need All for Health. I think this is really the spirit behind the Motion put forward by the Members.
In particular, the following stakeholders can make significant contributions to health.
First, employers. I thank Dr Tan Yia Swam for speaking on this. Many of us spend a considerable amount of our adult lives at work and hence the workplace is highly influential in shaping our health habits. I value our existing partnerships with NTUC, SNEF and the Tripartite Oversight Committee on Workplace Safety and Health (TOC) who have been working with companies to promote good workplace health practices.
With Healthier SG, employers can work closely with your panel doctors to join Healthier SG and to continue providing regular and proper screenings for employees, provide healthier canteen food, physical activity programmes, mental well-being programmes and better work-life balance. We also urge employers to play their part in making sure those eligible are all part of Healthier SG. By promoting good health, employers will have more productive and happier employees, which is good for businesses.
Second are our community partners. Senior Parliamentary Secretary Eric Chua has shared about MCCY’s efforts to mobilise the community to foster social cohesion, promote health and develop a strong partnership with family doctors. Dr Tan Yia Swam also suggested the need to have activities that cater to different segments of population and their varied interests. Indeed, when we consulted the public during Healthier SG, we heard from many residents that peer and family influence is a key factor in motivating them to adopt healthy life habits, such as regular exercise and to eat healthily.
So, under Healthier SG, our healthcare clusters will work with community partners – HPB, PA, SportSG – to proliferate physical activities in the community and encourage strong participation by residents. We welcome other ground-up initiatives and activities that rally the community. If we take a walk in our public parks today, we can spot many of these activities. Many of them not organised by any agencies. Friends getting together to cycle, run, play football. Masters teaching their disciples qigong or tai-chi. All of them are now part of the healthcare system.
Third area, schools and education institutions. I thank Minister of State Gan Siow Huang for speaking about MOE’s efforts in building this health foundation for our young.
Indeed, good health starts from our values, habits and choices. Our schools help to build this foundation of health literacy. They introduce our young to sports, help them make friends and form social groups, teach them life skills and knowledge to be useful citizens, all of which are essential building blocks to good health. As mentioned by Minister of State Gan Siow Huang earlier, through the years, MOE has worked with MOH to thoughtfully infuse health education in its curriculum from early childhood to primary, secondary and tertiary education.
Research findings now show good health habits, such as proper diet and use of devices, inculcated from as young as three or four years old, have a profound impact on the cognitive development and well-being of the child later on in life. And it actually does affect their PSLE results, based on our research findings. [ Laughter .] Maybe that is the right button to push, I do not know.
So, MOH, MOE and MSF; we are studying the linkages between early education and health, and developing possible interventions.
Fourth, the media. Information and media literacy is our first line of defense against false and viral health myths. We will continue to work with the Ministry of Communications and Information (MCI) and other media agencies to do this, just as we did during COVID-19 to dispel falsehoods about vaccination.
Healthier SG gives us an opportunity to address the problem of health misinformation. How so? This is because we are advocating and trying to build stronger patient-doctor relationships. Because with a trusted relationship and the family doctor and his care team knowing the health condition and history of the patient, they become the patient’s trusted source of medical information and advice.
In this digital era of information overload, online falsehoods, myths and AI bots, perhaps what we need in healthcare is stronger human relationships, especially between doctors and patients. We can use technology to strengthen the relationship and improve the quality of care rather than replace the human relationship. That must ultimately be the mode of co-existence between humans and AI.
Finally, our infrastructure and transport planners. Over the years, MND and MOT colleagues have expanded green spaces, cycling paths and fitness corners islandwide to support active living. There are also plans to have more Silver Zones and Green Man+ at pedestrian crossings to allow our seniors to travel more safely and with confidence in their neighourhood.
These are many examples of how agencies are coming together to better support health and we are committed to continue to do so.
Mr Deputy Speaker, let me conclude.
I am mindful that our Nominated Members of Parliament are coming to the end of their term. This is perhaps your second last Sitting. I do not know for sure, but Leader told me, it might be your second last Sitting. I know some of you hope to have the assurance that even as you step down, the issues close to your heart continue to receive attention in this Chamber.
So, I feel honoured and privileged – although it got me a bit busy – that you have chosen to table a Motion on healthcare, just as you have actively been speaking up on healthcare issues during your term. In particular, Dr Tan Yia Swam, who was also the President of the Singapore Medical Association (SMA). She has been a strong advocate for various healthcare-related issues.
I attended an SMA dinner some time ago hosted by her. In her speech during that event – it is public, so I think I can say it – she said that she was an angry young doctor. And now, you are a less angry middle-aged doctor. But the difference is that you have learned how to channel your energy to a greater good and be a better advocate.
I say Dr Tan is doing a good job, both in SMA as well as in this House. But I do not think Dr Tan is angry. It is important that we are passionate in our cause and be active in our advocacy.
I greatly appreciate this Motion, highlighting the need for MOH to work with other agencies and for other agencies to support us. Today, we have MOE and MCCY's political officeholders (POHs) deliver their speeches. Actually, we could have gotten many more, but we did not want to prolong the debate for too long.
Ageing is going to be the big challenge that affects all of us – and MOH cannot be alone in this.
The passion and activism of our NMPs help uplift the standard of debate in this House and bode well for the democratic discourse for Singapore.
So, please rest assured that the issues close to your hearts will continue to be given due attention in this House, even as your term comes to an end. There will be a new batch of NMPs who are passionate about issues too, and take up the issues that you care about.
On healthcare, there will be MPs who are healthcare professionals, Government Parliamentary Committee (GPC) Members for Health, Labour MPs and NMPs, Members who feel strongly about healthcare who will carry the torch forward. Most importantly, the MOH political officeholders will continue to put forth our agenda and address the concerns of our stakeholders. We are not on different sides. We are all on the same side, trying to make the system better for Singaporeans.
For NMPs, after you have stepped down, I hope you will continue to advise and cheer us on, at the side. So, let us all continue to advocate for a better healthcare system for everyone. Health is for All and All is for health. [ Applause. ]
Mr Deputy Speaker : Dr Tan Yia Swam.
5.03 pm
Dr Tan Yia Swam (Nominated Member) : Thank you, Sir. First, I thank Minister Ong. Okay, maybe not so angry anymore, after all your kind words. If you are going to stay 10 years like Mr Gan, then I will continue to advise and help for 10 years.
Sir, I am very heartened by the strong support for the Motion.
First of all, I thank all my fellow NMPs in attendance who have each shared their insights into how healthcare can be supported in their various sectors. This is the kind of fresh ideas that we need to have a synergistic whole.
Next, I thank all Members for their various speeches covering a wide range of topics in relation to support for healthcare, namely: (a) recruit, reskill and retain healthcare workers; (b) fair pay, reasonable working hours; (c) financing and business needs; (d) better IT systems; (e) taking a firm stand against bullying and harassment; (f) emphasis on prevention and primary care; (g) legal protection and support; and (h) looking after vulnerable groups, in particular, children, the elderly, migrant workers and the differently-abled.
However, I must address some of the points that the Member Mr Leong brought up yesterday. I appreciate his points about reviewing MediSave but I urge him to have in-depth discussions with MOH to better understand the current funding and to help in future reviews if necessary.
MediSave and MediShield Life have been extensively and rigorously reviewed to ensure that the majority of Singaporeans and Permanent Residents can afford medical care when they opt for subsidised wards in restructured hospitals. If any of you know residents in financial distress, please direct them to an experienced medical social worker who will be able to further advise on additional available subsidies.
I also need to seek clarification from Mr Leong on his comment that, I quote, "drug prices should not be marked up unreasonably for non-subsidised patients to cross-subsidise subsidised patients."
Firstly, is there have evidence of this happening? Secondly, what is the definition of an "unreasonable" mark-up?
If I can use another food analogy other than chicken rice, a can of soda can be sixty cents at a budget grocery mart, $1.30 at a super mart, $1.60 at a coffee shop, $3 in a restaurant and $5 in a hotel. How much is a reasonable mark-up for medications?
Patients who are not subsidised will be patients who opt in for A or B1 class, or foreigners. I, as a doctor, would think that allowing market forces to determine costings are fair. Would Mr Leong also want taxpayers to pay for everyone?
I also thank the political office holders from different Ministries for your assurance and commitment to support healthcare.
I thank Senior Parliamentary Secretary Eric Chua in advocating for sports across different Government agencies and active community engagement. Parkour aunties like myself rejoice. No more Police chasing us off.
Minister of State Gan Siow Huang has also given an overview of how teaching on exercise and healthy eating is integrated at all levels of education.
I thank Senior Minister of State Janil Puthucheary and Minister Ong Ye Kung for their detailed and candid replies in recognising complex problems of manpower, IT and financing.
The professional bodies will continue to work closely with MOH in resolving issues within healthcare, especially those that pertain to training and working hours. Honestly, only clinicians truly understand the delicate balance needed. I am glad that we are all aligned in this – that healthcare has to be a whole-of-Government effort.
In my closing, I come full circle, back to "Why". Why do we stand up to advocate for a cause? To leave behind a better world than the one we were born in.
Recent news regarding the next round of NMP applications has again raised some criticism. I believe the NMP role has given an ordinary citizen like myself the chance to voice opinions at a national platform. Ordinary, because I am a struggling working mother in the sandwiched generation. Ordinary, because I also fear and worry about my children's future. What kind of Singapore will my children grow up in?
Fellow MPs will appreciate how hard it is to prepare for a speech. It is not just simply coming up to the microphone and saying some fancy words. There is background research, sticking to the timing before getting scolded by the Speaker or Deputy Speakers; and speaking the truth – in a palatable way and driving home a point.
I commented before – we are all talking a lot, but who is listening? Is the public listening?
The livestreaming only has 400 plus viewers, usually. A few people will deliberately make funny clips of our mistakes or slip-ups. And yes. Once I get over the embarrassment of my own, I have to say, it is actually very funny, so, thanks for making us laugh!
But the people I am really speaking to are fellow citizens who share my interest in the larger good of Singapore, the citizens listening in and considering policy.
Maybe some of you are civil servants. Singapore has 150,000 public officers who report to the Government, not to any one political party. I rephrase for emphasis. Civil servants are individuals who would have their own different political beliefs and alignments. They serve the people of Singapore.
Blindly supporting or opposing any political party or mocking NMPs for being mouthpieces or puppets or blaming the Government for everything – I ask you, is it logical? Does it serve anyone?
Before reacting and speaking, consider three points: one, is it true? Two, is it necessary? Three, is it kind? If the answer is no to any of the above, maybe it is better not to say.
I am sure that many of you have friends who are in healthcare. Do speak to them and understand the problems we face. Create your own small little informal think tanks and brainstorm on how to solve larger healthcare issues.
For all the people listening in, whether you are working in Ministries, whether you are an ordinary citizen like myself, I hope that you will also think of ways to ensure that healthcare gets the support it needs and prioritise your own healthcare needs.
We now live in a rapidly changing and volatile world. Look at how COVID-19 brought the world to a standstill for three lost years. Look at the Ukraine war, the US bank collapses. Overnight, the world changes. Nothing is new. History repeats itself – maybe in a much faster cycle than before.
The modern person has to be able to adapt to a world where answers may be less obvious, where there is no rulebook or 10-year-series to refer to. There may be no single right answer and choices will have trade-offs.
Should war ever come to Singapore, should there be an apocalypse, we will need warriors, we will need leaders. But I tell you, we will need people who know how to look after others, people who know how to stop bleeding, prevent infections, deliver babies, how to grow food, how to get clean water – any kind of knowledge to ensure that we survive.
But are we building up on useful knowledge or frittering our time away on social media in mindless entertainment?
I see patients and the medical treatment algorithms are actually quite simple. There is a breast lump. It needs to be checked. But frequently, emotional stress gets in the way. This manifests as hesitation, fear, worry and even anger at me – "Why is there a lump?"
I understand but it is not easy to process the onslaught of negative emotions. Healthcare workers, teachers, drivers – all frontline service workers, in fact – have received the brunt of a lot of negative outpouring of emotions.
This is our society now. A pressure cooker. People being unhappy in their daily lives without even realising it, feeling irritable, snappy, overly critical, worried about everything and feeling unable to cope.
I repeat a point from my previous speech. Recognise mental health issues in yourself or your loved ones. If you suffer from anxiety or anger management, do not take it out on your healthcare worker. Do not take it out on others. Get help from a mental health professional.
Even though I am a breast surgeon, I cannot just operate on the cancer. I have to consider the patient in her whole entirety. Her overall health – does she have other medical conditions that impact her surgery and recovery? Her preferred language – does she fully understand what I am saying? Is she making a true informed decision? How is her personality like? Her social network? Is she going to be well supported at home and at the workplace or will she forgo care because she perceives that others' needs come before her?
The surgery itself is simple in expert hands. It is helping the patient to overcome all these other emotional and mental barriers to seek health and to eventually be on the road to recovery – that is the challenge for which I call for a global change and a whole-of-Government support.
I thank everyone who has taken part in the debate and I emphasise. First, walk the ground, get real feedback and acknowledge problems in healthcare. Second, continue education at all levels of engagement. Third, cross-collaborate across Ministries, across industries, across the public-private divide.
Humans have short memories. Let us learn from the mistakes of the past so that we do not repeat it. People care only when things affect them. Help me and make everyone care.
Finally, breaking formal protocol, I want to thank Shahirah, Samad, Lian Pin, Mark, Janet, Joshua, Hian Teck and Hsing Yao. Thank you all for your friendship. It has been an eventful and fun NMP journey.
To all MPs from both sides of the House, I am glad for the chance to get to know you all as people and real humans, not just as public figures on your posters. This is my last speech in this Chamber. The next time we meet again, it may be when I complain to you at Meet-the-People sessions. [ Laughter. ]
I thank you all – both sides of the House – for your service to Singapore. If I may, I will pray for wisdom and kindness for you as you all continue to debate meaningfully on issues to guide Singapore safely through future challenges. [ Applause. ]
Mr Deputy Speaker : Mr Leong, I am about to put the question to the House. You have a clarification arising from a speech that has been given? Do you have a clarification for Dr Tan? Yes, you want to respond to her questions, right?
5.13 pm
Mr Leong Mun Wai (Non-Constituency Member) : Thank you, Deputy Speaker. I thank Dr Tan for asking the questions on drug subsidies.
According to my understanding and a lot of the feedback from residents, they pay different prices when they are in different classes. Of course, that is expected. Currently, different classes have different charges.
But from a certain angle, which I have mentioned in my speech, it is okay to charge the services, but why is there such a big difference in the drug prices being charged for different classes? So, this is what I have said. I do not know why Dr Tan raised it as an issue.
Maybe I can also clarify with Dr Tan whether she agrees with our proposal that the Government should actually start a central procurement process for all drugs in Singapore. I would like to ask for her opinion on this.
Mr Deputy Speaker : Dr Tan, do you wish to respond?
Dr Tan Yia Swam : Yes, I would like to respond because I am a doctor and I think I know a bit about healthcare.
I think firstly, regarding bills, to the hon Member, it would be useful to ask your affected residents to approach the hospital's business office that they were in to seek clarification on the bill breakdown. There are very clear explanations and breakdowns on the tiers of subsidies available and different drugs, whether it is branded or generic, have very, very clear costings.
So, I would like to know more details of the case rather than make a blanket statement that the costings are unfair.
In relation to the second question for the Government to procure all medicines, I understand that right now, there is a procurement for all medications for chronic conditions, for public medical institutions.
In the private sector, though, may I respectfully state that all doctors in the private sector have our own business models and different ways of generating income. So, not all doctors may want to be part of the Government effort. I thank the Member for his suggestion. We can take it back to the professional bodies and further get our members' feedback.
Mr Deputy Speaker : Minister Ong Ye Kung, you have a clarification?
Mr Ong Ye Kung : I just thought that it is not very fair that the NMP has to answer a policy question. So, it is better for MOH to say something.
Ours is a variegated healthcare system, unlike, say, NHS, where everything is nationalised, all drug prices are more or less the same, centrally procured.
We are deliberately catered to a variegated market. And for private sector doctors, as Dr Tan Yia Swam said, they do have different models. There are doctors that charge very low consultation fees, but instead, they earn some margins by selling their drugs. Others do the reverse.
So, when we put forward an idea – but, luckily, it is from the Member and not from me. If we put forward an idea to say, "Let us all sell at the same price", actually, doctors, their rice bowls gets affected and it can be quite a major issue for them.
So, I think there is some wisdom in what Dr Tan Yia Swam said. In the private space, sometimes, you want to let market forces operate, but, at the same time, have some discipline through how we structure insurance, what we subsidise, what we do not. And I think that is how we reign in unnecessary healthcare costs.
Mr Deputy Speaker, I know Mr Leong has more questions. But really, I think this is a Motion about Ministries and all of us, all stakeholders coming together, a very meaningful Motion. And I would urge that we do not prolong further this to-ing and fro-ing and let us give our stepping-down NMPs strong support for their very meaningful Motion. [ Applause. ]
[(proc text) Question put, and agreed to. (proc text)]
[(proc text) Resolved, "That this House commits to supporting healthcare beyond the COVID-19 pandemic and the whole-of-Government efforts for consistent and sustainable support." (proc text)]
Mr Deputy Speaker : Leader.