SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2025

Advancing Primary Care, Medical Workforce Well-being and Community-Based Healthcare in Singapore

Recognising Family Medicine as a Specialty 

             Sir, Family Physicians have been, and are, central to the provision of primary, community and preventive medical services. The role they play will only grow as the care needs of our ageing population become more complex. They are critical to the Healthier SG initiative. 

2.             Today, Family Medicine is not listed as a recognised medical specialty in Singapore. The healthcare profession recognises the complexity of the work, the importance of our colleagues in primary care, and that specialised training and experience are needed to perform this role well. Hence the Specialists Accreditation Board has approved for Family Medicine to be recognised as a specialty, on par with other specialties. Together with the Family Medicine fraternity, we are now working out the accreditation and training pathways to recognise Family Physicians with advanced Family Medicine training and relevant experience as specialists.

3.             With their broad skillsets and long-term relationships with patients, Family Medicine Specialists will enable more patients with complex care needs to receive comprehensive care in the community. Further details on the entry criteria to become a Family Medicine Specialist, training requirements, and implementation timeline will be shared later this year. 

Improving Access to Affordable Primary Care 

4.             In advancing our primary care system, we will also ensure Singaporeans can access affordable care, including medications for chronic conditions. Today, the Healthier SG Chronic Tier offers enhanced subsidies for selected chronic medications at enrolled Healthier SG General Practitioner (GP) clinics. By mid-2025, we will expand the range of medications under the Healthier SG Chronic Tier, to include three Medication Assistance Fund  drug products for specific medication indications. For example, eligible patients requiring Evolocumab for very high cholesterol levels or Familial Hypercholesterolemia despite being on other cholesterol lowering medications, could see their monthly out-of-pocket expenses reduced from over $230 to about $30-$60, depending on their means-test status. We will continually review the expansion of the range of medications which are subsidised under the Healthier SG Chronic Tier. 

5.             To respond to Dr Tan Wu Meng, today, polyclinics provide multiple appointment booking options, including online booking with staff guidance, phone bookings, and walk-in services. Designated caregivers can also manage their dependant’s appointments from their own HealthHub or cluster app account. 

6.             Urgent cases and patients who are frail or who have mobility issues will continue to be prioritised, even if they do not have a polyclinic appointment. Non-urgent cases may be scheduled for later appointments or advised to seek treatment at a nearby CHAS GP clinic. Subsidies for GP visits are also already available through CHAS, with enhanced benefits for Pioneer and Merdeka Generation seniors. Under Healthier SG, enrolled patients can access chronic medications at GP clinics at prices similar to the polyclinics. MediSave can be used at both CHAS GP clinics and polyclinics. 

Improving the Well-being of our Junior Doctors 

7.             Building on Minister Ong's earlier comments, let me elaborate our ongoing efforts to support our healthcare workforce. 

8.             Generations of doctors have indeed built our healthcare system through dedication and hard work under quite demanding schedules. But they are not alone. This applies to all of our professional colleagues – the allied health professionals, the nurses, and the many, many staff members who work together to make sure that our healthcare system functions for our patients. We recognise that times and expectations have changed, and our practices must evolve accordingly. 

9.             However, our public hospitals see many patients every day, with many requiring urgent, time-sensitive care. Shorter working hours mean more frequent handovers between doctors, requiring careful management and changes to work processes to prevent risks to patient care and longer waiting times. 

10.          We have taken a measured approach to grow the healthcare workforce, including doctors, to meet the needs of our ageing population. We have already increased our annual intakes significantly. But we are mindful that today, already one in 12 Singaporean students joins a healthcare programme and any significant expansion will require foreign healthcare professionals. We must take care not to deprive other important sectors. And this raises a critical question: how do we balance our growing healthcare manpower needs against the many concerns raised in this House about foreign manpower dependency? 

11.          As we grow the workforce, we have progressively made improvements, such as limiting junior doctors to 24 hours of continuous work periods and establishing rest day guidelines. Nearly half of the clinical departments with junior doctors in public hospitals have adopted this, and the rest will follow suit gradually. 

Bridging Mental and Physical Health in Primary Care 

12.          I agree with Ms Mariam Jaafar we must close the gaps in the treatment for physical health and mental health. This is why Healthier SG will include care for our residents’ mental health. Healthier SG Care Protocols for major depressive disorder and general anxiety disorder are being developed and will be rolled out next year. These care protocols will ensure consistent and quality care are being delivered across primary care providers. 

13.          We have also begun pairing Healthier SG clinics with the Community Intervention Teams (COMIT) who provide psychosocial interventions for mental health needs in the community. These pairings enable smoother referrals. 

Strengthening Community and Workplace Mental Health Support 

Progress on the National Mental Health and Well-being Strategy 

14.          Sir, many Members have asked for updates on our community mental health support and programmes. They asked about costs, public awareness of programmes like the Community Outreach Teams (CREST), and how effectiveness and progress in mental health programmes and care will be tracked. 

15.          Last year, during the Parliamentary Motion Debate on Advancing Mental Health, I shared our plan to have 90 CREST and 50 COMIT teams by 2030, including 15 youth-oriented teams each. We are on track to achieve our targets. As of December 2024, there were 86 CREST and 32 COMIT teams including the youth teams in operation. 

16.          As one of the key first-stop touchpoints for in-person mental health services, CREST has strengthened local service linkages and networks across health and social care providers in the community, including GPs, polyclinics, and hospitals. 

17.          To build greater awareness of CREST in the community, CREST teams conduct outreach to share information about their services. The Agency for Integrated Care (AIC) also promotes CREST through advertisements on social media, bus stops, and HDB lift lobbies. To further promote CREST, AIC has developed a Community Mental Health Wayfinding Tool, available on various platforms, including realspace.sg, mindline.sg, and MindSG, to help users find the right mental health services, such as CREST. 

18.          The performance of CREST and COMIT teams, along with other public healthcare institutions such as our public hospitals and polyclinics, are assessed through key indicators such as access, response time, volume of clients supported, improvement in patient outcomes and client satisfaction. Patients' mental health outcomes are specifically measured through validated assessment tools such as the WHO Disability Assessment Schedule and the Patient Health Questionnaire for Depression, which assess patients' functional levels and severity of symptoms. The National Mental Health Office (NMHO) works closely with our public health institutions and community service providers to track and analyse aggregated data for the purposes of policy review, service planning, and evaluating the effectiveness of our national mental health initiatives. 

19.          Community mental health services provided by CREST and COMIT are fully funded by the government with no out-of-pocket cost. Eligible patients can also receive subsidised mental health treatment at polyclinics and participating GP clinics for the management of mental health conditions under the Chronic Disease Management Programme. 

20.          At last year’s Debate, I also outlined our goal to train 130,000 frontline personnel and volunteers by 2030, to better equip them to identify individuals with signs of mental distress, provide a listening ear, and refer them for support as needed. I share Dr Wan Rizal's view that religious organisations must be part of our mental health ecosystem. Since September 2024, NMHO, together with AIC, has partnered with the Ministry of Culture, Community and Youth to engage religious organisations and leaders, to provide them with mental health training programmes. The training equips participants with skillsets to provide basic emotional support, while ensuring they understand when to refer individuals to professional mental health services. When professional mental health care is required, religious leaders are encouraged to direct individuals to formal mental health services within the community.  

21.          This is part of our ongoing effort to strengthen community-based mental health support networks. We have exceeded our target, with over 137,000 individuals trained to date, including religious leaders and volunteers. 

22.          I agree with Mr Ong Hua Han that mental health first aid resources are crucial. I thank him for the suggestion to integrate more of such resources on existing apps and we will explore its feasibility. Meanwhile, we will continue to sustain our frontliner and volunteer training through structured mental health programmes, including e-learning modules developed by AIC and the Health Promotion Board, with psychological first aid training to be rolled out by mid-2025. 

23.          For members of the public, mindline.sg and MindSG offer comprehensive mental health resources, including information on supporting others and self-help tools. mindline.sg also provides clinically validated self-assessment tools for depression and anxiety. 

24.          To simplify the help-seeking process, we will launch the National Mental Health Helpline and Textline service in mid-2025 as a centralised mental health first-stop touchpoint. This round-the-clock service will feature an easy-to-remember four-digit number and offer chat support through the mindline.sg website. It will be staffed by trained counsellors, and this service streamlines access and connects Singaporeans to necessary resources. More details will be shared when the service launches later this year. 

Workplace Well-being Initiatives 

25.          Dr Wan Rizal asked about workplace mental health support. Government agencies and the tripartite partners have implemented comprehensive workplace mental health initiatives like the Well-being Champions Network, which now consists of over 450 organisations representing 230,000 employees. Other initiatives include training employee peer supporters and conducting public education campaigns and workshops to combat workplace stigma, share best practices, and facilitate employees’ transition back to work. 

26.          Specialised employment support is available through agencies like Singapore Anglican Community Services, the Institute of Mental Health’s Job Club, and Singapore Association for Mental Health's MINDSET Learning Hub. These organisations offer customised vocational training and job placement services, and have helped more than 6,000 individuals with mental health conditions gain and maintain employment. 

27.          The Tripartite Guidelines on Fair Employment Practices upholds employment fairness through merit-based recruitment, restricting unnecessary mental health declarations, and providing proper grievance handling processes. These practices will be further strengthened by the Workplace Fairness Legislation, which prohibits workplace discrimination based on mental health conditions. 

Improving Access to Youth Mental Health Services

Addressing Parental Consent Barriers in Youth Mental Health Services 

28.          Sir, if I may turn to the mental health of our youth. We recognise the crucial role parents play in the minors’ well-being. However, the need for parental consent can sometimes deter minors from seeking help. After consulting medical ethics experts and mental health service providers, MOH has decided to take a nuanced approach by convening an expert group to develop guidelines in this area. Parental involvement in their children’s care journey is very important for better outcomes. For the Singapore Children's Society for example, in their work, they have found that consistent parental engagement, and parental involvement in case planning, and family sessions have achieved sustained positive results and supported long-term recovery.  

Creating Safe Spaces for Youth to Thrive 

29.          We are also introducing ‘grovve’, an integrated wellness centre for youths at *SCAPE at the end of this year. Co-developed by the National Council of Social Service and various stakeholders, including youths, ‘grovve’ will be the first centre to provide integrated intervention services alongside general wellness activities. Its youth-centric location seeks to improve accessibility and normalise mental health care. ‘grovve’ will foster communities where youths can become champions and supporters for mental well-being. 

Strengthening Singapore's Mental Health Framework

Coordinating Suicide Prevention and Postvention Efforts 

30.          Mr Keith Chua asked about continuity of care, especially for those affected by suicide, and the coordinating role of the National Mental Health Office. 

31.          Suicide prevention and post-incident support requires a whole-of-government and whole-of-society approach to address the issues holistically. Existing community-based support available includes the Light in the Dark support programme by the Samaritans of Singapore and the Live On! programme by TOUCH Community Services. Next-of-kin or loved ones affected by suicide may also benefit from suicide bereavement support programmes run by SOS, such as Healing Within and Healing Bridge, as well as Local Outreach to Suicide Survivors. 

32.          NMHO coordinates with ministries and agencies, including the Ministry of Education, the Ministry of Social and Family Development, and the Institute of Mental Health in implementing policies and reviewing data and trends. 

33.          A prime example of multi-stakeholder collaboration is the development of the Youth Crisis Facility. Expected to be operational in 2027, this 24/7 facility will provide intervention for youths in crisis, including those struggling with suicidal behaviour or severe self-harm. It will support youths referred from the community, or discharged from acute hospitals, offering psychosocial intervention in a safe and non-stigmatising environment to aid community reintegration. The multi-stakeholder project team is currently developing clinical protocols and operational details for this facility, which will bridge between acute hospitals and community care.

Enhancing Healthcare Standards and Regulation 

Ensuring Fair Mental Health Insurance Practices 

34.          Dr Tan Wu Meng asked about insurers' practices for those with mental health history. Apart from MediShield Life, which covers all Singapore Citizens and Permanent Residents regardless of pre-existing conditions including mental health conditions, individuals can opt for additional coverage through Integrated Shield Plans (IPs) and other private insurance plans. 

35.          IP insurers’ approach to underwriting persons with mental health conditions mirrors that of other conditions. It is based on reliable information relevant to the risks being insured. Factors considered may include age at onset of condition, symptom severity, management of the condition, and the presence of comorbidities. After the assessments, insurers may choose to accept applications as is, apply higher premiums, exclude specific benefits, or reject applications in view of the risks presented, with proper justification to customers. There are cases where IP insurers have offered cover to customers with mental health conditions, either with or without exclusions. 

36.          All IP insurers allow customers to request for a review of their exclusions or submit a fresh application, if their condition has improved and they can provide favourable medical evidence. 

37.          All insurers, including IP providers are to adopt sound and objective processes to assess applications received from their customers. For example, insurers should not reject an application solely based on the customer’s declaration of a mental health condition. 

38.          Customers concerned about the underwriting decisions should raise the matter with their insurer for investigation or review. If they are not satisfied with the insurer’s response, they can write to MOH or the Monetary Authority of Singapore to follow up and assess the full case details with consent. 

Implementing Registration for Psychologists 

39.          We have been working to register psychologists to ensure high standards of professionalism and better protect clients. The increased focus on mental health in recent years has prompted changes in psychological practice, with more psychologists now working beyond traditional clinical settings, in the community and private sector. 

40.          Recognising this shift, we are working towards the registration of psychologists, focusing on psychologists who provide direct patient care, perform higher-risk assessments and interventions, and whose practices may span across various sectors. An inter-agency implementation committee has been set up to look into this. This will raise professional standards, safeguard patient safety, and increase public confidence in psychological services. Further details will be announced at a later date. 

Refining Advertising Guidelines for Healthcare Services 

41.          To prevent the public from being misled by services that are not licensed by MOH, the Healthcare Services Act (HCSA) currently prohibits providers of such services from advertising that they are able to “treat” a medical condition. However, certain professions, such as allied health and Traditional Chinese Medicine, are regulated under their respective professional Acts. Their interventions are low risk, because they manage conditions in accordance with clear standards of practice set by their professional bodies. 

42.          We will review the HCSA advertising controls to enable these selected professions to advertise their services. Even so, they will still have to ensure the accuracy of their advertisement. We will share more details when ready.   

Advancing Healthcare Technologies and Treatment

Consolidating Digital Health Platforms 

43.          To improve the online accessibility of public healthcare services, we are planning to consolidate the public healthcare clinical apps, HealthHub and the cluster-specific apps – Health Buddy, NHG Cares App and NUHS App – into a unified platform by 2027. Patients who now have to use different apps to access services at the public healthcare institutions will be able to do so on this unified app in future for an improved, user-friendly experience. We will consider adding Healthy 365 to the unified platform in the future. 

Expanding Treatment Approaches 

44.          Ms He Ting Ru asked how we are harnessing the potential of precision medicine. MOH is taking steps to embrace precision medicine in a cautious manner as we identify appropriate precision medicine applications with clear evidence of public benefit for scaling up. One such application is genetic testing for Familial Hypercholesterolemia, which we will be rolling out nationally in mid-2025. We will also put in appropriate safeguards to mitigate risks such as increased healthcare costs. To do so, we will only extend government financing schemes, mainly subsidies, MediShield Life, and MediSave, to precision medicine use cases that are assessed to be cost and clinically effective. 

45.          Dr Lim Wee Kiak asked about the potential of regenerative medicine. MOH has been supporting research in this through various schemes under the national Research, Innovation, and Enterprise Plans. However, we recognise the risks and ethical considerations associated with such nascent investigational therapies. We will continue to evaluate the evidence from both local and overseas studies for clinical efficacy and cost-effectiveness.

Closing

46.          Sir, the changing healthcare landscape presents both challenges and opportunities. Navigating these will require collective effort. We look forward to working closely with healthcare professionals, community partners, and citizens to capitalise on these opportunities and effectively implement the initiatives I covered today.