SPEECH BY MDM RAHAYU MAHZAM, SENIOR PARLIAMENTARY SECRETARY, MINISTRY OF HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2024, ON WEDNESDAY 6 MARCH 2024

         Mr Chairman, let me begin with healthcare manpower.

Healthcare Manpower

2.       Dr Syed Harun has rightly pointed out that healthcare manpower needs to keep pace with the growing demand for healthcare.

3.       We factor in population needs into the planning of our healthcare manpower. Over the last 10 years, we grew our healthcare manpower by about 40%, and increased our local healthcare student intakes at our Institutes of Higher Learning by a similar margin, translating to a combined intake of 3,600 healthcare students in 2023. We will continue to grow our healthcare workforce sustainably, while moderating demand through innovative ways of delivering care.

4.       To this end, we will continue to work with public healthcare institutions (PHIs) and the community care sector to attract and retain manpower across the board.

a)    For nurses, we announced the Award for Nurses’ Grace, Excellence and Loyalty (ANGEL) scheme last month. This would allow us to improve the attractiveness of the profession and retain the nurses we have.

b)    We are engaging Allied Health Professionals to better understand their needs and to co-create the vision for their professions, with a view to come up with a National Allied Health Strategy.

c)    We are working on the PharmForce initiative to look into manpower development, shaping pharmacy practice to meet population needs, promoting wellness and building resilience of our pharmacy workforce, and increasing visibility and recognition for the profession.

d)    Operations and support staff play important roles in our public healthcare system. Our healthcare clusters have embarked on job redesign initiatives to enhance the career value proposition and better attract and retain them.

e)    Across the board, PHIs will continue to keep salaries competitive. For example, starting salaries for nurses, allied health professionals and pharmacists were increased by up to 12% in 2023.

f)      We have done the same for the community care sector with the recent salary guidelines to keep salaries competitive and provide greater transparency to jobseekers and workers in the sector. These guidelines will be reviewed regularly, to ensure that they are up to date. We hope that the guidelines will help attract and retain workers across all job groups, including support staff.

g)    We will continue to provide funding to community care organisations and PHIs to support them in keeping their salaries competitive.

5.       I also stressed the importance of ensuring the well-being of our healthcare workers. I thank Mr Ang Wei Neng and Mr Louis Ng for their concern on workload of junior doctors and rest time for nurses.

6.       We are working with clusters on measures to support the welfare and well-being of healthcare workers, including doctors and nurses. For doctors, this will include clearer work hour guidelines, reviews on work processes to improve efficiency and workload balancing, and to enhance support for staff. As the context differs across healthcare institutions, these changes may take time to effect.

7.       On ensuring sufficient rest for nurses, our healthcare clusters no longer actively roster nurses on the PAPA shift pattern. However, this may happen occasionally when there are operational exigencies, such as when there is unplanned absence amongst staff and the ward needs to ensure the appropriate skills mix amongst nurses on duty to ensure patient safety. When this happens, measures are in place to support affected nurses, such as by rostering them on shorter shifts that week and allowing flexibility for swaps. In 2023, we also exceeded our national target of bringing 4,000 new nurses into our workforce and with that, we can expect the situation on the ground to improve.

8.       Additionally, we announced our tripartite framework on the prevention of abuse and harassment of healthcare workers, and in the coming year we will be putting out additional publicity to raise awareness.

Healthier Lifestyles

9.       I will now talk about our efforts to support Singaporeans to achieve healthier lifestyles.

10.      We have supported Singaporeans in adopting healthier diets and an active lifestyle, through various initiatives over the years. For example, we have introduced easy-to-use symbols and labels to help Singaporeans identify healthier products and ensured access to healthier and affordable ingredients through the Healthier Ingredient Development Scheme. A wide range of physical activities has also been provided island-wide

11.      We are starting to see positive results from these efforts. The National Nutrition Survey 2022 revealed that average daily sugar intake has decreased, and more Singaporeans were meeting the recommended sugar limit. Participation rates in exercise programmes have also increased.

12.      Despite these, we must remain vigilant about other health trends.

13.      Based on the National Nutrition Survey, Singaporeans are eating more and 90% have exceeded the recommended daily limit of two grams of sodium. The National Population Health Survey 2022 also showed that the prevalence of obesity has continued to increase, from 8.6% in 2013, to 10.5% in 2020 and 11.6% in 2022.

14.      We can make small shifts to incorporate healthier habits in our lives.

h)    Continue to use the suite of user-friendly symbols and labels to make healthier purchases.

i)      Plan, monitor and moderate calorie intake using the Meal Log tool on the Healthy 365 app.

j)      When dining out, ask for less gravy and sauces, and avoid drinking all the soup in soup-based dishes.

k)    Access a myriad of physical activities on the Healthy 365 app and participate in those of your liking.

15.      Another health risk is smoking.

16.      Mr Gerald Giam asked about a Tobacco Cohort Ban. The idea has been raised by several Members in the past. Our focus is on protecting public health and we do not rule out any measure that would help us achieve that effectively. As Mr Giam pointed out, New Zealand had reversed their initial plans to implement a Tobacco Cohort Ban. A salient point to note here, is that New Zealand allows vaping and was prepared for people to switch from smoking to vaping. Similarly, Malaysia recently reversed their decision.

17.      That leaves the United Kingdom, and we will monitor closely how they intend to implement the ban. For a Tobacco Cohort Ban to be effective, we need to consider various implementation issues. For example, can someone older buy cigarettes for someone younger who is affected by the ban? If not, how should we go about enforcing? Does the ban apply to tourists?

18.      Mr Giam mentioned that gains from existing measures have diminutive impact. That is not the case. We have made good progress in reducing smoking prevalence in Singapore. Our recent efforts include the Standardised Packaging measures, raising the Minimum Legal Age of smoking to 21 years old, and raising tobacco taxes by 15% last year. Cessation support is also strengthened through Healthier SG. These efforts have continued to suppress smoking prevalence, and we have achieved an all-time low of 9.2% in 2022. And it is still declining.

19.      Hence, even as we study the feasibility of a Tobacco Cohort Ban, we will continue efforts to reduce smoking prevalence.

20.      As several Members and Singaporeans have raised, the emerging and urgent issue is vaping..

21.      There is a growing body of evidence that e-vaporisers are harmful, as they contain nicotine, a highly addictive substance, that can also harm the developing brains of youths. The cancer-causing chemicals and other toxic substances in e-vaporisers also increase the risk of heart and lung diseases.

22.      To Mr Ang and Dr Wan Rizal’s questions, vaping is a multi-faceted issue and requires coordinated Whole-of-Government efforts to tackle. MOH, along with the Health Sciences Authority (HSA) and the Health Promotion Board (HPB) take a serious view on vaping. The public can access information on the prohibition of e-vaporisers and its health harms across HSA and HPB’s websites. We have worked across Ministries and agencies, to step up enforcement and education measures to protect our population and prevent e-vaporisers from taking hold in Singapore.

23.      Upstream, all sales and advertisements of e-vaporisers are prohibited under the law, in Singapore. Digital platform owners are expected to proactively moderate content by detecting and removing sales and advertisements of e-vaporisers. We will continue to work with the Ministry of Communications and Information and the Infocomm Media Development Authority to engage platform owners. At the borders, HSA has worked with the Immigration & Checkpoints Authority on a series of joint operations at Changi Airport, Woodlands and Tuas Checkpoints, and will continue to collaborate on a regular basis.

24.      In the community, HSA is already working with agencies, such as the National Environment Agency and National Parks Board, which have stepped up and will continue to step up enforcement checks at public places. In addition, the Singapore Police Force  and Central Narcotics Bureau continue to refer cases to HSA, when detected in the course of their duties.

25.      In schools and Institutes of Higher Learning (IHLs), the Ministry of Education continues to take a firm stance against vaping, and strengthen detection and enforcement efforts. Schools and IHLs take disciplinary actions against students caught using or possessing e-vaporisers, including suspension, or caning for boys in schools, and refer them to HSA for penalties under the law.

26.      We have also strengthened efforts on the education front, to increase awareness about the harms and illegality of vaping. In 2023, HPB launched a vape-free campaign targeted at youths and younger adults. In schools, HPB has shared these messages with close to 90,000 students. Parents, who are important stakeholders in this effort, are also kept up to date on the harms and illegality of vaping through advisories and resources available on Parent Hub.

27.      We will continue to support those who smoke or vape to quit. Cessation programmes are accessible across various settings, including healthcare institutions, workplaces, uniformed services, education institutions, and in the community, through initiatives such as HPB’s I Quit programme and Healthier SG. In 2023, HPB supported 4,700 adults and 2,300 children and youths in their quit journey. I strongly urge all who are smoking or vaping to seek advice from a healthcare professional and quit as soon as possible. Those with family or friends who smoke or vape should also encourage them to lead a nicotine-free lifestyle.

28.      Even while we step up enforcement and education efforts, we will be reviewing the legal penalties to ensure a strong deterrence against vaping and related offences.

Ethnic Minority Groups

29.      Allow me to move on to talk about how we have strengthened targeted support as well.

30.      To Dr Wan Rizal’s question, we have kept up the momentum of our efforts to support ethnic minority groups to lead healthier lifestyles. I am encouraged to share that with the strong support from community leaders and organisations, over 40,000 Malay/Muslim residents and over 32,000 Indian residents participated in healthy living programmes encompassing physical activities, health talks and Saham Kesihatan programmes, as well as healthier groceries distribution during the festive periods of Ramadan, Hari Raya and Deepavali, in 2023.

31.      With the rollout of Healthier SG, in the Indian community, we have also partnered SINDA to set up a Health Task Force, comprising members from private and PHIs, and other health-related organisations. The Health Task Force will strengthen efforts to encourage Healthier SG enrolment among the Indian community, to supplement HPB’s existing collaborations with the Hindu Endowment Board, Sikh Welfare Association, among other partners.

32.      Mr Chairman, please allow me to say a few words in Malay.

33.      Dalam kalangan masyarakat Melayu/Islam kita, kita ada bidang focus atau ‘focus area’ (FA) yang baru diperkenalkan iaitu FA5, "Komuniti Sihat untuk Semua". Usaha ini bertujuan untuk mempromosikan gaya hidup yang lebih sihat dan memperkasakan individu-individu dan kumpulan-kumpulan untuk merancang dan memperluaskan inisiatif yang dipimpin oleh komuniti itu sendiri.

34.      Antara fokus utama di bawah FA5 adalah menggalakkan pendaftaran ke dalam inisiatif SG Yang Lebih Sihat (Healthier SG) dalam kalangan komuniti Melayu/Islam. Bagi mereka yang masih memikirkan sama ada untuk mendaftar atau tidak, saya ingin berkongsi tentang bagaimana inisiatif SG Yang Lebih Sihat boleh menjadi langkah selanjutnya untuk penjagaan pencegahan kesihatan anda.

35.      Puan Shamima telah menjadi sukarelawan sebagai duta kesihatan sejak tahun 2011, mempromosikan ilmu pengetahuan tentang kesihatan dan mengambil bahagian dalam pameran Lembaga Penggalakan Kesihatan (HPB) secara aktif. Kesungguhannya untuk memberi motivasi kepada orang lain supaya mengamalkan gaya hidup yang lebih sihat, tercetus kerana transformasinya sendiri melalui program Lose To Win HPB, di mana beliau berjaya menurunkan berat badannya kira-kira 16kg. Beliau juga secara aktif mengambil bahagian dalam pelbagai aktiviti fizikal yang terdapat dalam aplikasi Healthy 365, termasuklah Zumba, Yoga, Pilates, dan juga Kickboxing. Anda mungkin tertanya-tanya bagaimana seorang penduduk yang aktif, seperti Puan Shamima, boleh mendapat faedah yang lebih dengan mendaftar ke dalam inisiatif SG Yang Lebih Sihat?

36.      Puan Shamima memutuskan untuk mendaftar ke dalam inisiatif SG Yang Lebih Sihat untuk mendapatkan gambaran yang lebih baik tentang kesihatan beliau agar dapat membuat keputusan yang tepat untuk dirinya sendiri. Melalui konsultasi Rancangan Kesihatan pertamanya dengan doktor keluarganya, beliau kini lebih prihatin tentang pengambilan makanannya dan kepentingan mengambil ubat pada waktu tertentunya, supaya beliau dapat menguruskan tahap gula dalam darahnya dengan lebih baik. Melalui pemeriksaan kesihatan yang diatur, doktor keluarganya akan dapat memberi panduan dan dorongan kepada beliau untuk menjalani gaya hidup yang lebih sihat.

37.      Saya ingin menggalakkan semua orang untuk mengambil langkah seterusnya untuk menguruskan kesihatan anda sendiri seperti Puan Shamima, dengan mendaftarkan diri ke dalam inisiatif SG Yang Lebih Sihat hari ini.

38.      FA5 akan terus berusaha untuk menangani isu-isu kesihatan utama di dalam masyarakat Melayu/Islam seperti pemeriksaan kesihatan, merokok dan juga kesejahteraan mental, seperti yang disebut oleh Dr Wan Rizal. Kita akan mengambil pendekatan yang sesuai untuk masyarakat Melayu/Islam agar mendapat hasil yang lebih berkesan.

Financial Support for Targeted Groups

39.      Another dimension of providing targeted support, is ensuring affordability, particularly for those who need it more. We thank Members for your questions on how we are doing so.

40.      First, at the earlier Budget Debate, Ms Jessica Tan requested clarifications on our means-testing criteria for long-term care subsidies. These subsidies are means-tested using Per Capita Household Income (PCHI) and Annual Value of residence to ensure that subsidies are targeted at those who need it more. While these are not perfect proxies, they are the best available to measure an individual’s means and family support, and only a small minority of long-term care clients do not qualify for subsidies because of the Annual Value criterion.

41.      To ensure that those with greater needs receive continued support, the Government recently raised the PCHI and Annual Value thresholds for all means-tested social support schemes and grants. Seniors who face difficulties paying for their long-term care expenses may apply for discretionary financial assistance.

42.      Second, Dr Tan Wu Meng has made two suggestions on empowering more organisations to assist with MediFund applications, and taking a holistic approach to Migrant Domestic Worker Levy Concession applications.

43.      We agree with the intent to smoothen help-seeking processes for needy patients. This is why today, Singaporeans identified by Social Service Offices to receive ComCare assistance automatically receive MediFund assistance at approved healthcare institutions. We have recently introduced guidelines to institutions to allow mutual recognition of MediFund assessments for more types of circumstances.

44.      On the ground, institutions have also put in place patient-centric processes and leverage IT platforms to smoothen the application process. While tapping on other organisations could improve convenience of applying MediFund for some patients, it introduces an additional layer in the process and therefore needs to be studied further to avoid lengthening the application process inadvertently.

45.      As for the Migrant Domestic Worker Levy Concession, Activities of Daily Living (ADLs) remain a relevant basis for the purposes of assessing these applications. Frail patients with multiple conditions, or those at end-of-life, tend to require some assistance with at least one ADL and would qualify for the concession. Exceptions will  be assessed on a case-by-case basis. We will continue to review the adequacy of financing schemes to support caregivers and their seniors.

46.      Regarding the case raised by Dr Tan, Dr Tan would be aware of the correspondences by the Agency for Integrated Care (AIC) and Ms See. There was a positive outcome after she was re-engaged by AIC. Unfortunately, there was an earlier miscommunication where AIC was led to believe that Ms See’s cousin was the employer of the migrant domestic worker, when it was in fact Ms See. She eventually qualified for and received the concession and Home Caregiving Grant, both backdated to when she qualified.

47.      Third, to Mr Gerald Giam’s question, we support the needs of Persons with Disabilities and Persons with Special Needs through various financing schemes, including subsidies, national insurance schemes, MediSave, grants, and safety nets such as MediFund. We have recently enhanced some of these schemes. For example, in 2023, the payouts under the Home Caregiving Grant were increased from $200 to up to $400 per month to further reduce caregiving costs. In general, healthcare subsidies are not based on specific conditions and are instead tiered based on income level, to target those who need more help.

48.      Fourth, to Mr Ong Hua Han’s question on the support for patients with Spinal Muscular Atrophy, there are a few treatments available currently, including drugs and a Cell, Tissue and Gene Therapy Product (CTGTP). We are reviewing the clinical and cost-effectiveness of these treatments and are engaging pharmaceutical companies to achieve reasonable prices. As Minister mentioned, the MediShield Life Council is considering extending coverage to eligible CTGTPs and studying the safeguards needed to ensure that any such extension is sustainable. In the interim, those who face concerns may apply for discretionary funding support through MediFund or the Rare Disease Fund.

49.      Lastly, a few Members have also asked about the support that is provided for those who are planning for a family. There are a few considerations that guide our approach in designing the financing schemes to better support this group of Singaporeans. These include clinical safety and effectiveness of fertility tests and treatments, ensuring affordability for those who need it, and keeping our financing schemes sustainable.

50.      We have answered Mr Louis Ng’s question on support for fertility screening previously. Fertility tests are offered to couples who are medically indicated as there is currently no evidence to support the need for early fertility checks for the general population. At our public specialist outpatient clinics, these couples can enjoy subsidies of up to 70 percent for their fertility tests. Those who face financial difficulties can also apply for MediFund for assistance. This offers more targeted support for those with needs, while safeguarding MediSave to ensure it remains adequate for other needs, and keeping CPF contribution rates reasonable for all.

51.      Co-funding also applies to those who are undergoing In-Vitro Fertilisation (IVF) at public Assisted Reproduction centres. These public centres currently have sufficient capacity, with utilisation rates of about 61 percent. Currently, you can get an appointment at our public Assisted Reproduction centres for a first consult within a week, if you are open to seeing any of our IVF specialists.

52.      To Mr Louis Ng’s suggestion, we do not advise couples to switch providers after failed IVF cycles as it breaks the doctor-patient relationship and may result in additional cost and time from repeated investigations and assessments. The outcomes of IVF treatments at private and public Assisted Reproduction centres are also comparable. Nonetheless, we recognise that some couples may prefer seeking treatment at private centres and are reviewing whether to extend co-funding to these settings.

53.      To Ms Hazel Poa’s ask for financial support  for egg freezing, married women will be able to tap on co-funding and their MediSave when using their frozen eggs for assisted reproduction treatment. This is to support couples who have decided to have a child, but may face challenges in conceiving.

54.      We recognise the desire for women to freeze their eggs when they are young. It is a pre-emptive step, perhaps not different from buying private insurance. Providing financial support for it will be quite unprecedented in healthcare policy. We think it is better to focus our resources to directly help couples who are trying to conceive, and who face difficulties.

Closing

55.      Mr Chairman. I have shared about broad efforts to support Singaporeans in adopting healthier lifestyles. I have also shared about the targeted support for the ethnic minority groups and ensuring affordability for those who need it more, so that all Singaporeans can achieve better health and access care that they need.

56.      Our efforts can only succeed with the strong participation of Singaporeans and support from families and community. We are heartened that many have stepped up and made choices to lead a healthier lifestyle today, such as those who have enrolled in Healthier SG, made the switch to healthier eating, participated in healthy programmes and activities. Let us choose better health for ourselves and our loved ones today. Thank you.