SPEECH BY DR AMY KHOR, SENIOR MINISTER OF STATE FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2019, ON WEDNESDAY 6 MARCH 2019

Planning for Seniors Today and Tomorrow

Updating our Action Plan for Successful Ageing

            This House recently saw a lively debate on ageing. I was encouraged by the support for the Action Plan for Successful Ageing launched in 2015, when I shared about its progress.     

2           As Minister Gan Kim Yong shared, our Life Expectancy and Healthy Life Expectancy are good. Nonetheless, through the Action Plan, we want to further help Singaporeans add more life to years, and not just years to life. As we provide for seniors today, we will do more for seniors of tomorrow, who will live longer, be better educated and have different aspirations. The Ministry of Health (MOH) will conduct a public consultation later this year with stakeholders, including seniors, community and business partners to develop an updated Action Plan.

Strengthening the Nexus Between Social and Health Care
3           A study by the Duke-NUS Centre for Ageing Research and Education showed that seniors who are supported by social networks and befriending can better manage their chronic diseases¹. Strengthening integration between social and health care is key to successful ageing. Let me elaborate on our efforts, which I call the “3 Ps” – People, Places and Programmes.

People

4           First, we want to further enable people in the social and health sectors to integrate care for our seniors. Since the beginning of 2018, about 3,000 Silver Generation (SG) Ambassadors have engaged around 280,000 seniors, identifying seniors with needs and working with stakeholders to link them to active ageing, befriending and care services. Seniors can have their social and health care needs managed jointly by the Silver Generation Office (SGO) and Social Service Offices. More of these offices will be co-located where possible. SGO is recruiting more SG Ambassadors, to reach out to seniors, including the Merdeka Generation (MG). I encourage Singaporeans to come forward and join this endeavour.

5           MOH works closely with our community care providers and healthcare professionals to deliver quality care, ensuring good governance over our services, while allowing room for the sector to evolve. To Ms Anthea Ong’s query, in 2015, MOH developed developmental guidelines for home and day care providers to work towards quality care. Healthcare professionals providing these services, such as doctors, nurses and therapists, must also be licensed by their professional bodies.

6           Looking ahead, MOH will review the need for more formal regulation, including licensing under the proposed Healthcare Services Act, as Mr Louis Ng has also asked in a parliamentary question. We will adopt a risk-based approach, and subject services with higher patient risks to higher levels of regulation. Hence, we will start with licensing home medical services, and review the need to licence other services as the sector evolves.

Places and Programmes
7           Second, we will strengthen integration by providing places and programmes to address the social and health care needs of our seniors. Following the transfer of functions from the Ministry of Social and Family Development, as of end 2018, MOH oversees 127 Senior Activity Centres (SACs) providing wellness programmes to seniors living in studio apartments and rental flats, 118 Senior Care Centres (SCCs) providing day care and community rehabilitation services, and five Active Ageing Hubs (AAHs) serving seniors across a spectrum of needs.

8           In response to Ms Joan Pereira and Dr Lily Neo, we aspire towards more age-friendly neighbourhoods, with accessible care and amenities. We are expanding aged care services capacity but must do so sustainably. MOH will partner our operators to enhance the scope and reach of services in all our Senior Centres. For example, those currently providing day care services may offer additional wellness programmes. Services will be made available to all seniors, not just those living in studio apartments and rental flats. We will work with operators, enhancing their capacity and capabilities, to implement this common vision of SACs, SCCs and AAHs as places where seniors can access a range of services from FY2020. 

9           In relation to Mr Leon Perera’s question, since 2012, we introduced the Build-Own-Lease framework to support efforts to increase capacity, encourage improvements in care quality, while keeping fees affordable. Our tender process covers quality, including innovative care models, and affordable fees. The Agency for Integrated Care (AIC) supports providers in capability development, including leadership development, manpower recruitment and quality improvement programmes.

10         To support preventive health, we grew the number of Community Health Posts to around 150. We will now expand the number of areas covered by Community Nursing teams, from 18 to 29 areas around Singapore. We will also partner more Senior Centres to make community nursing services accessible to more seniors by 2020.

New Models of Ageing-in-Place
11         Members such as Ms Rahayu Mahzam have called for Assisted Living options.

12         MOH and the Ministry of National Development (MND) plan to launch a pilot where seniors buy a home, bundled with a package of programmes and services that can be customised to suit their needs and preferences. For instance, healthy seniors could buy into basic services such as light housekeeping. Additional services like care coordination can be layered on as their needs change. We have identified a possible location, and MND will share more on this.

13         The development could comprise flats with senior-friendly features, complemented by communal spaces like recreation cum dining rooms with light programming to encourage interaction. MOH and MND will start focus group discussions over the next few months to better understand Singaporeans’ aspirations, and fine-tune this new option for ageing-in-place before going to market.

14         As Ms Tin Pei Ling suggested, we are tapping on technology to benefit seniors, starting with MG seniors who are more IT literate. MOH is partnering the Smart Nation and Digital Government Office, and Public Service Division to include a new module under the existing Moments of Life app to support active ageing. I have seen a prototype and found it useful! The app will include an Active Ageing Programme finder that can show seniors programmes near their homes. Seniors can also use the app to check their eligibility for Government benefits like the Merdeka Generation Package (MGP) and GST Voucher scheme. In a later phase, we will explore features such as allowing bookings for active ageing programmes. The app will be piloted later this year, and I look forward to using and sharing it.

Community Mental Health 
15         An ageing population raises demand for community health services.Someone once jokingly said to me, “The nice thing about ageing and losing your memory, is that you make new friends every day!” Joke aside, in reality, dementia can be debilitating, not just to patients but also caregivers. I agree with Mr Christopher de Souza, Mr Melvin Yong and Ms Anthea Ong that we must support persons with mental health conditions and their caregivers. In 2017, arising from the recommendations of the Inter-Agency Committee on Community Mental Health, MOH launched the enhanced Community Mental Health Masterplan to further strengthen mental health care. We have made good progress since, in increasing outreach, early detection and providing care and support in the community.

Increasing Outreach and Early Detection
16         Through a multi-pronged approach strategy, we bring the community together, to raise awareness and support for seniors with, or are, at-risk of dementia and depression. 39 community outreach teams have been set up and have reached out to over 210,000 people. We are on track to meet our 2021 target of 50 teams. We established eight Dementia-Friendly Communities, building networks of support around those with dementia and their caregivers. Our Dementia Friends Mobile App has encouraged more than 4,100 people to sign up as Dementia Friends and assisted over 50 persons since its launch in October 2018.

17         Our Community Networks for Seniors (CNS) has been expanded nationwide to anchor a strong community care system for seniors, including those with mental health conditions. Under the CNS, SG Ambassadors proactively reach out to seniors, referring those with possible mental health conditions to support services. Community befrienders visit lonely seniors regularly, providing them with emotional support to keep social isolation and depression at bay.

18         Furthermore, AIC has trained over 14,000 frontline staff from government agencies and community partners, to identify and respond to persons with mental health conditions. Over 2,700 individuals have been supported with medical care or social support according to their needs. We will continue to work with agencies like the Ministry of Home Affairs and Housing Development Board, grassroots leaders and voluntary welfare organisations to identify and provide social and medical support for those in need, including persons who exhibit behavioural challenges in the community.

19         Addressing the stigma associated with mental health conditions is also a collective effort. The National Council of Social Service (NCSS) and Institute of Mental Health (IMH) launched the “Beyond the Label” campaign in September 2018. We hope this will catalyse more conversations about mental health, and encourage those facing such challenges to seek help.

Providing Care and Support
20         To strengthen care and support in the community, we increased access to mental health and dementia services in 12 polyclinics, up from eight in 2018 and also at our General Practitioner (GP) clinics. As of December 2018, over 190 GPs have been trained to diagnose and support persons with mental health conditions. 20 allied health-led community intervention teams were established to support GPs and community organisations in managing persons with mental health conditions.

Supporting Youth Mental Health

21         Beyond building on existing efforts and scaling up programmes, we are developing new initiatives to better address emerging areas. Following the NurtureSG Taskforce’s recommendation to better support youths, the Ministry of Education and Health Promotion Board (HPB) have been establishing peer support structures in mainstream schools and Institutes of Higher Learning to equip students to look-out for signs of mental stress among peers, and support and encourage them to seek help when needed. Since 2007, about 2,400 Allied Educators have received training to identify and support students who require referrals to mental health services. We will train more moving forward. The Community Health Assessment Team (CHAT) operates a mental health wellness centre for youths, which has reached out and provided mental health assessment to more than 3,100 at-risk youths as of December last year.

22         As social and mental health issues are interlinked, we will take a more holistic approach for at-risk youths. MOH will develop a new integrated youth service together with community youth partners, IMH, AIC, NCSS and HPB. We will expand on the success of the CHAT model, to increase outreach and educate youths on resilience and mental wellbeing. Those who need help will be referred to social and health services for assistance and intervention in an integrated manner.

23         MOH will update the enhanced Community Mental Health Masterplan, and rally a whole-of-society effort to build communities of care around mental health patients and their caregivers.

Supporting Aspirations, Providing Assurance
24         The MGP is a major fiscal undertaking and is our show of appreciation and support for the Merdeka Generation in their silver years. After Prime Minister announced the MGP at National Day Rally last year, many of my MG cohort friends excitedly asked me “What, what, what are the benefits?” Following Minister Heng’s Budget speech, the constant refrain became “When, when, when will I get the benefits?”

Merdeka Generation Package
25         We want our MG seniors to benefit from the package as soon as possible.Implementing the MGP is a major effort involving multiple Government agencies and partners, and we are working closely to roll out the benefits quickly. The bulk of the MGP benefits will be available in two tranches – July and November 2019.

26         From July 2019, MG seniors will receive three benefits. One, their MediSave accounts will be automatically credited with their first $200 top-up, which they will continue to get once every year until 2023. Two, additional MediShield Life premium subsidies for MG seniors will take effect. MG seniors will receive subsidies starting from 5% of their MediShield Life annual premiums, and increasing to 10% after reaching 75 years old. Although system changes to automatically apply the additional subsidies will be ready only towards the end of this year, we will backdate the subsidies to 1 July, to allow more MG seniors to enjoy them. MG seniors with policy renewals between 1 July and 31 October this year will pay the full premium first, and receive the additional subsidies as a refund automatically by end-December 2019. Three, the one-time $100 top-up to their PAssion Silver cards. We will share more details on how to redeem the top-up when ready. As you will have till 31 December next year to do so, and the credits do not expire, we would like to assure all our MG seniors that there is no need to rush.

27         Come 1 November 2019, MG seniors will receive additional subsidies for outpatient care, for life. Implementing the outpatient subsidies involves many healthcare partners, who need to train frontline staff and make necessary system changes. We need time to do this properly and correctly, so implementation can be as smooth as possible. When MG seniors visit polyclinics and public specialist outpatient clinics from 1 November 2019 onwards, they will automatically receive an additional 25% off their subsidised bills. MG seniors can also bring their MG cards when they visit Community Health Assist Scheme (CHAS) GP and dental clinics, to enjoy special subsidies of up to $23.50 per visit for common illnesses, $520 in annual chronic subsidies and $261.50 per procedure for dental procedures. Also, eligible MG seniors will pay only $2 for screenings recommended under the Screen for Life programme, compared to up to $5 today.

28         Finally, in 2021, when CareShield Life becomes available for existing cohorts, we will give an additional participation incentive of $1,500 to each MG senior who joins the scheme, on top of the $2,500 previously announced. MG seniors who join CareShield Life will hence receive participation incentives totalling $4,000 each, which will offset annual premiums for 10 years.

Communications and Engagement Efforts

29         Eligible seniors will receive a notification letter for the MGP by April 2019. From the same month, SGO will start to proactively reach out to 500,000 MG seniors to share details on the MGP. To Dr Chia Shi-Lu’s query, beyond home visits, SGO will employ new approaches such as group engagements at workplaces, which may be preferred by MG seniors, among whom one in two is working. SGO will also conduct engagements at community locations frequented by MG seniors, like hawker centres. It will connect MG seniors to volunteering and learning opportunities such as the Retire with a Purpose programme under the RSVP Singapore and National Silver Academy courses.

30         As mentioned by Minister Gan, SMS Sim Ann and I will co-chair a Merdeka Generation Communications and Engagement Taskforce to ensure effective communications and outreach to our MGs and their family members. The taskforce comprises 23 members from the public, private and people sector, which had its first meeting two weeks ago.

Women’s Health

31         Ms Tin noted that women are living longer and we must address their healthcare needs. The Women’s Health Committee will continue to champion good health among Singaporean women at all stages of their life.

32         One focus area is cervical cancer. From 2011 to 2015, about 200 new cases were diagnosed annually and around 70 die of the disease every year. This cancer which is caused by infection with the Human Papilloma Virus (HPV) can be prevented with vaccination and screening. To bring about more comprehensive coverage of HPV vaccination for cervical cancer prevention, MOH will offer fully-subsidised HPV vaccination from April 2019 as part of our national school-based health programme, similar to countries such as the United Kingdom and Brunei. Current and future cohorts of Secondary 1 female students will be offered the HPV vaccination, and a one-time catch-up programme will be progressively provided for current cohorts of secondary school female students. All other female Singapore Citizens and Permanent Residents from the same age-equivalent cohorts, including those studying in private education institutions, will also be eligible. The vaccination will be fully subsidised, as part of an opt-in scheme.

33         For women aged 30 years and above, we are introducing a more accurate HPV screening test for cervical cancer, which only needs to be done every five years, compared to the current recommended protocol involving Pap smear test which needs to be done once every three years. The better test will cost more, but the Government will provide more subsidies, so the cost to women will be the same in the long run.

34         We will also make early screening more convenient for women with a history of gestational diabetes, who are at higher risk of diabetes later in life and need to start regular screening soon after pregnancy. They will be automatically eligible for subsidised cardiovascular risk screening under the Screen for Life programme, and will no longer need to take the online diabetes risk assessment tool to qualify.

35         For women intending to enrol in In-vitro Fertilisation, Mr Ng will be pleased to know that we will lift the requirement for purchase of Assisted Reproduction Programme insurance from 1 April 2019. This is because MediShield Life and MediSave now provide basic healthcare coverage for all Singaporeans from birth.

Meaningful Opportunities, Multiple Pathways

36         Mr de Souza and Mr Dennis Tan asked about attracting more Singaporeans to nursing, and supporting continuing development and career progression of healthcare professionals.

Meaningful Job Opportunities through Multiple Entry Points

37         Over the last five years, we increased nursing intakes by around 30%. In 2018, we admitted more than 2,100 students, our highest intake to date, up from 1,600 in 2013. But it will be challenging to continually increase student intakes in view of falling cohort sizes, so we need to look at mid-careerists too, beyond supplementing our local workforce with foreigners. For those looking for a second career in healthcare, our Professional Conversion Programmes (PCPs) provide sponsorship for course fees and an allowance. In 2018, about 130 mid-career individuals embarked on our nursing PCPs, our highest intake in ten years. MOH will continue to work with healthcare employers to improve retention, provide meaningful job opportunities, and enhance careers through multiple progression pathways and entry points, to ensure we maintain a strong local core of the nursing workforce.

Enhancing Careers through Multiple Progression Pathways
38         In line with the SkillsFuture movement, we worked with Nanyang and Ngee Ann Polytechnics to create a new, faster progression pathway for Enrolled Nurses who did well during their Institute of Technical Education (ITE) training, to upskill to a Registered Nurse. We now have a 2+2 Diploma in Nursing which will allow ITE Upgraders to complete the Diploma in Nursing course in two years instead of the current 2.5 years.

New National Nursing Academy

39         We will strengthen and better recognise workplace-based learning, to achieve the twin objectives of better care for our patients and professional growth for our healthcare staff. Assuring our staff of continued opportunities for professional development is key to retaining them in the healthcare workforce.

40         I am pleased to announce that we will set up the National Nursing Academy (NNA) to coordinate and support lifelong learning across healthcare institutions, schools and training providers. The NNA will oversee Continuing Education and Training efforts to develop future-ready nurses with the requisite skills and competencies to meet evolving healthcare needs. In line with the push towards digitalisation, the NNA platform will allow nurses and healthcare leaders to access a comprehensive suite of high-quality courses and learning opportunities online.

41         Today, many healthcare providers have in-house training programmes which are often not recognised and transferrable across different institutions. The NNA will accredit and strengthen the quality of workplace-based training and develop a system to recognise the skills and competencies attained by a nurse at the workplace. This will make the skills portable and stackable to advance nurses’ careers and professional practice across healthcare institutions and settings.

42         To facilitate this, the NNA will articulate the skills and competencies needed for nurses’ evolving roles, as part of a larger Skills Framework for Healthcare. We will deepen this framework, starting with the Community Nursing Competency Framework, which will be completed by May this year. This will be followed by frameworks for palliative and gerontology care in 2020.

43         The NNA’s efforts will benefit all nurses and healthcare providers in the public, private and community sectors.

Conclusion
44         In conclusion, as MOH continues to empower all Singaporeans to take charge of our health, I invite everyone to work with us to add more life to years.

Thank you.

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(1) June May-Ling Lee and Angelique Chan (2016) “Do social networks and access to community care increase chronic disease self-management among low-income older adults in Singapore”, Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore.