Speech by Dr Lam Pin Min, Minister of State for Health, in response to substantive Motion on Aspirations of Singapore Women, 3 April 2017

1          Madam speaker, thank you for allowing me to join in the debate. I would like to thank Ms Tin Pei Ling and the Members for raising the need to recognise and support Singapore women, many of whom have made personal sacrifices to care for their loved ones. Caregiving is no easy feat. It is an important responsibility, which will only grow heavier with Singapore’s ageing population. The Government is strengthening efforts in a number of areas so that caregivers feel more supported in caring for their loved ones.

Enhancing accessibility to care services

2          First, we are enhancing accessibility to eldercare services in the community.  Ms Tin Pei Ling and Ms Joan Pereira asked that we provide more eldercare services, and locate them in convenient locations. We have expanded our home care capacity from 3,800 places in 2011 to around 7,500 home care places today. We have also increased our day care places from 2,100 in 2011 to 4,000 today. We are on target to grow this to 10,000 home care and 6,200 day care places by 2020.  We are building our eldercare centres across Singapore and ramping up transport services so that it is more convenient for seniors to travel to the centres. New centres will operate minimally from 7am to 7pm so that it is more convenient for working caregivers. Some centres now operate on weekends. We are also encouraging more centres to extend their operating hours, and establishing home care services at the centres to make care more accessible.

3          We will need more manpower to support this expansion, and are enhancing schemes such as the Return to Nursing scheme, which aims to attract retired and non-practising nurses to return to work in the healthcare sector. We also have Professional Conversion Programmes to attract mid-career Singaporeans to be trained as nurses and allied health professionals, and organise job fairs as well as put in place the Community Care Traineeship Programme to attract Singaporeans to be trained as support care staff for the aged care sector.

Expanding respite services 

4          Second, we are expanding our respite services so that caregivers can rest and recharge and working caregivers can travel for overseas trips. Other than weekend respite services at our eldercare centres, more than 40 nursing homes now provide residential respite services ranging from a few days to a month. Caregivers of seniors with dementia can also tap on the Eldersit programme which offers home-based respite aimed at keeping the seniors engaged in activities in a familiar environment while their caregivers take a break.

Equipping caregivers to provide better care

5          Third, we are equipping our caregivers to provide better care for their loved ones. We currently provide subsidies of up to $200 per annum from the Caregivers’ Training Grant (CTG) for caregivers who are caring for seniors or those with a disability, including foreign domestic workers (FDWs), to attend training courses on caregiving or self-care skills. Caregivers co-pay as little as $10 after taking into account training subsidies. To date, more than 35,000 caregivers have utilised the grant.

6          In October last year, we started piloting an eldercare training scheme for our FDWs to better care for seniors. These FDWs undergo a comprehensive training before deployment. As of last month, about 60 FDWs have been trained, of which 50 have been placed with families.

Increased touchpoints to help caregivers

7          Fourth, we are increasing the touch points in the community to help caregivers navigate the social and healthcare systems. In 2014, we launched the Singapore Silver Line which is a one-stop call centre to help seniors and their caregivers with information on care services and schemes in the community. The Agency for Integrated Care  or AIC has also set up AICareLinks centres at 5 hospitals and at its office in Maxwell Road. These are one-stop counters where caregivers can receive advice on services and schemes. To facilitate easier access to information, AIC will set up information booths at selected polyclinics. We now have booths in 3 polyclinics at Chua Chu Kang, Marine Parade and Yishun. AIC will roll this out to another 6 polyclinics by early next year.

Eldercare Leave & Flexible Work Arrangements

8          Many members suggested that employers provide flexible work arrangements (FWAs) to allow employees to better manage work demands with family and caregiving needs. Today, more employers are now adopting flexible work arrangements. In 2016, about 67% of the employees worked in firms that offer formal FWAs, up from 56% in 2011. More than eight in ten employees worked in firms that offer unplanned time-off or ad-hoc teleworking for their employees to attend to personal matters, up from seven in ten in 2011. Ms Cheryl Chan has suggested that the public sector take the lead in enabling flexible work arrangements. We agree with the suggestion, and would like to update the House that all our public healthcare clusters have done so to help staff balance work and personal demands. For instance, more than 4,200 nurses are benefitting from flexible work arrangements such as having more flexible rosters enabled by e-scheduling system.

9          Ms Cheryl Chan and Ms Joan Pereira also suggested to provide more eldercare leave for working caregivers to take care of the seniors. We have been studying the issue in consultation with unions and employers. We are not ready to legislate eldercare leave at this time because we need to strike a balance between employers’ concern on business costs and manpower constraints, and caregivers’ need for more leave for eldercare purposes. Existing leave provisions can be used for this purpose today. We encourage more employers to provide family-related leave benefits which can be used for different purposes, as well as flexible work arrangements such as time-off to look after their elderly parents. Public service agencies currently provide two days of parent care leave annually. Some private companies have also done so. For example, OCBC offers two days of family leave for employees who are not entitled to childcare leave. This would include caregivers who are singles and taking care of their elderly parents. We encourage more employers to do likewise. We will continue to review the need to legislate eldercare leave as our social-economic circumstances change over time.

Using smart technology to monitor seniors at home

10        Ms Tin Pei Ling suggested to leverage on technology for remote monitoring of our seniors while caregivers are at work. I am happy to share with Ms Tin that we are piloting the use of technology to find an effective and sustainable model which can be scaled up. As part of HDB’s Smart Homes Trial, we are testing elderly monitoring systems which can send out alerts to their caregivers if the seniors are in distress. This allows caregivers a greater peace of mind. For example, in Yuhua, residents can install solutions such as Smart Elderly Monitoring & Alert System or SEMAS. The system can provide alerts to caregivers when the seniors trigger the distress buttons. It can also send automated notifications if the system detects an anomaly in the seniors’ behaviour such as lack of movement over a prolonged duration.

Supporting Caregivers Collectively

11        Ultimately, supporting our caregivers is a collective responsibility. We need to build a community support system where our seniors and their caregivers are supported and cared for.  Under the Community Network for Seniors pilot programme, we are partnering community stakeholders to reach out, befriend and support seniors living in each community. We are also promoting dementia friendly communities by encouraging the community-at-large to be trained to help seniors with dementia. In these “dementia-friendly communities”, seniors with dementia can stay active and caregivers do not have to be afraid of them going out, because there will be people around to help them home.

12        Together, we hope to foster a more inclusive and compassionate society where caregivers are well-supported in their caregiving roles. The government will also continue to study new ways to support our caregivers.

Assisted Reproductive Technology and social egg freezing

13        We agree with Mr Desmond Choo that we need to support women’s aspiration to raise healthy children. He suggested measures such as extending subsidies for Assisted Reproductive Technology or  ART, and allowing egg freezing.

14        We have no plans to extend ART subsidies to private centres at this point in time.  There is sufficient capacity in ART facilities in our public hospitals. Clinical data in Singapore also shows that public and private centres’ success rates are comparable. From 2011 to 2015, the average live birth rate from ART was 20.7% at public centres compared to 19.8% at private centres. Nevertheless, couples seeking treatment at private ART centres may tap on their Medisave to defray the cost of ART treatment. 

15        On egg freezing, licensed Assisted Reproduction (AR) Centres in Singapore are allowed to do this when there are medical needs. For example, egg freezing can be performed on women who need to undergo medical treatment such as chemotherapy or radiotherapy that may adversely affect their fertility. 

16        We would also like to highlight that egg freezing carries some risks to the woman. The process of stimulating production and collecting a woman’s eggs for freezing can result in complications such as over-stimulation of the ovaries, bleeding and infection. 

17        In addition, the issue of allowing egg freezing for non-medical or social reasons is a complex one due to various ethical and social implications. First, egg freezing is not a guaranteed solution to delaying parenthood. Second, the risks of developing certain age-related complications during pregnancy are not mitigated by egg freezing. For this reason, the Government still encourages couples to have more children when they are relatively young and healthy. 

18        Nevertheless, we are currently studying the feasibility of allowing social egg freezing. We are weighing the social, ethical and religious concerns very carefully. Should social egg freezing be allowed, we will need to build a robust regulatory framework with adequate controls not just to ensure the safety and welfare of women undergoing social egg freezing, but to also mitigate the potential social, ethical and religious considerations. 

Conclusion 

19        We recognize many important roles that women play in our lives. Through various measures, we hope women can be better supported to fulfill their aspirations as well as their many essential roles in our society. With that, I support the motion.