Speech by Minister of State for Health, Mr Chee Hong Tat, at the MOH Committee of Supply Debate 2017

FORMING PARTNERSHIPS FOR A HEALTHY AND SUSTAINABLE FUTURE

A) Introduction

1.        Madam Chair, I will focus on how MOH is partnering communities, healthcare institutions, unions and companies to implement the three shifts that Minister Gan spoke about so that we can we can develop a sustainable healthcare system for all Singaporeans.

B) Enhancing value in healthcare through productivity improvements, innovation and partnership

2.        I agree with Dr Tan Wu Meng and Prof Fatimah Lateef that we need to raise healthcare productivity through innovation and process improvements, to deliver quality care and better value for our patients.

3.        Since April 2012, we have supported more than 200 ground-up projects under the Healthcare Productivity Roadmap. Let me give some examples of how we have improved productivity in the healthcare sector.

4.        Our public healthcare institutions did a successful pilot where selected patients with conditions like back pain can be directly referred by their polyclinic doctors for subsidised physiotherapy services, without having to go through a specialist.

5.        This improves patients’ access to physiotherapy services, and reduces unnecessary delays and referrals. It also allows the specialists to focus on other patients who require their services. MOH will work with our healthcare institutions to look at other areas where we can apply this approach to encourage right-siting and effective use of healthcare resources.

6.        Dr Tan Wu Meng is right that we need to reduce administrative work for healthcare professionals, so that they can focus on patient care. With this in mind, the National University Hospital reviewed its processes for documenting patient information, and replaced hardcopy forms with electronic ones. Patient information is now collected just once, then stored and pre-populated, enabling our nurses to spend 10% less time on documentation.

7.        We will look at further measures to cut down the administrative load for our healthcare workers across the healthcare system, including doing away with unnecessary surveys and form-filling.

8.        Dr Tan also asked about the design of hospital wards and clinics. Tan Tock Seng Hospital has reduced walking distance for healthcare staff by nearly half through a remodelling of their wards. There is scope to further improve productivity through clever use of design and technology. This includes doing time-motion studies to monitor operational work flows and finding ways to optimise the processes and reduce inefficiencies.

9.        Technology is a key enabler in our efforts to improve productivity. Our strategy for technology is three-pronged: digitise, connect, analyse.

a.        Our institutions first need to digitise their information and processes to provide healthcare professionals the information they need for decision-making.

b.        Next, we are strengthening connections across IT systems to facilitate the exchange of information, especially across different clusters and institutions. This includes linkages with VWOs and private sector providers.

c.        Third, we are analysing the healthcare data collected to better predict care needs and utilisation patterns. For example, using data to identify and reach out to seniors who visit hospitals regularly, to see how their healthcare needs can be better met through community and home care.

10.       Madam, while technology is an enabler, the most critical factor for improving productivity lies with our people. Our healthcare professionals are well-trained and dedicated. Often, going the extra mile to look after their patients.

11.       I would like to thank our healthcare workers for their service, their sacrifices and their care to go beyond.

12.       I also want to acknowledge the strong support from Ms Thanaletchimi and our brothers and sisters from HSEU, and thank them for their valuable feedback and active participation in improving our healthcare system. MOH greatly appreciates our partnership with the Union. By working together as trusted partners, we increase our chances of success and shorten the time we need to reach our goals.

Partnering with industry and private sector

13.       Madam, we need to look beyond the public healthcare sector, to work with private sector partners in both healthcare and non-healthcare related industries like design, engineering and infocomm technologies.

14.       Earlier this year, I launched the Philips Health Continuum Space in Toa Payoh.

15.       The company is now focusing on health-related products as a core business, bringing together expertise from different fields including design and engineering. The innovation facility is a living lab for healthcare professionals to collaborate, co-create and test out healthcare solutions. I am glad that Philips is interested to work with local SMEs and start-ups to use this facility, and also to test-bed their solutions in the community.

16.       Our start-ups are also providing innovative solutions to tackle healthcare-related challenges in Singapore. Ms Tin Pei Ling spoke about using digital technology to enhance eldercare.

a.        Home-grown company Jaga-me offers “home care on demand” to give patients and their families access to professional home nursing and caregiving services. I met the founders. They are a group of young Singaporeans who are keen to make a difference in improving lives.

b.        Another technology solution is T-Rehab, where patients carry out physiotherapy exercises at home using wearable sensors, with their progress monitored remotely by physiotherapists.

17.       I encourage our healthcare institutions to work with start-ups like Jaga-Me and T-Rehab to support their innovations and use these new ideas to help transform our healthcare system. Not all ideas will succeed, we must expect some to fail.  The key is to have an environment where we can try new ideas and fail safely, so that we can learn from these failures and continue to innovate by pushing the boundaries.    

C) Working together as one nation in the War on Diabetes

18.       Madam, a priority for MOH is to promote healthy living. This is also a key focus for the War on Diabetes. Mr Christopher de Souza has asked for an update. Let me start with what we have done to encourage physical activity.

Physical activity

19.       Minister Gan spoke about the National Steps Challenge. So far, nearly 500,000 Singaporeans of all ages have participated. For Season 2 of the National Steps Challenge, participants have hit key milestones more quickly than Season 1. 150,000 people clocked 10,000 steps or more on at least 5 days per week. Well done!

20.       To step up the momentum, HPB has been working with SportSG to scale up popular programmes like Sundays @ The Park, Sunrise in the City and Fitness@Work to increase the variety of activities.

Healthy eating

21.       Next, on healthy eating. When it comes to preventing and managing diabetes, diet is a critical factor. While the decision and responsibility to eat healthily rests with the individual, MOH will continue to work with our partners to foster a supportive environment for Singaporeans to make healthy food choices.

Healthier dining in the community

22.       We have increased availability of healthier meals in restaurants, food courts and hawker centres. HPB works closely with industry players through the Healthier Dining Programme and Healthier Choice Symbol programme. With MOE’s support, schools can only sell packaged drinks with lower sugar content of less than 6%. It is important to help our children adopt healthy habits from young.

23.       I applaud the People’s Association for their initiative to cater healthier foods at grassroots events since December 2016. I have also done this for my constituency events, and received positive feedback from my residents who appreciate our efforts to provide them with healthier meals and healthier snacks.

24.       Madam, I am pleased to announce that from 1 April 2017, the public sector will likewise adopt healthier catering guidelines for all events and training courses. We want to provide tasty healthier choices for our public officers and guests, so that they can enjoy the food while staying healthy and active.    

Healthier ingredient development scheme

25.       I thank Mr Chen Show Mao for his suggestions on how we can promote healthy eating. HPB has been working on this important area over the last few years.  To further encourage the use of healthier ingredients by the food industry, we will introduce the Healthier Ingredient Development Scheme, or HIDS, from 1 July this year.

26..       HIDS will provide funding support for food manufacturers to innovate and develop tasty products with healthier ingredients, such as incorporating more whole grains and using healthier cooking oils. The aim is to go upstream in the food manufacturing process, to increase the proportion of whole grains and healthier oils served in restaurants, food courts and hawker centres. Through this scheme, consumers can benefit from a wider variety of healthier meals, to help prevent and manage diabetes.

27.       Food manufacturing is one of Singapore’s strengths, and our manufacturers are recognised worldwide for the quality and taste of their products.  By working closely with the industry, I am confident we can further enhance the sector’s value-add by developing healthier products which taste just as delicious, and riding on the trusted Singapore brand to expand our markets overseas.

Studying possible measures on sugar

28.       I am encouraged to see more Singaporeans switching to healthier choices. The market share of Healthier Choice Symbol (HCS) products has increased from 15% in 2012 to 18% in 2016. I believe this can grow further.  Companies have also reformulated their products to reduce the amount of salt, oil and sugar, so that they can qualify for HCS certification.

29.       For example, the median sugar level of pre-packaged beverages has decreased from 9.5% to 6.5% over the past decade. Today, there are over 2,500 HCS products available across 70 food categories, compared to just 300 products when HCS started in 2001. The sales of HCS products has been growing at 9 per cent annually, compared to 2 to 3 percent for other food products.

30.       While Singaporeans are eating more healthily, we are still consuming too much sugar.  This increases our risk of getting diabetes.  On average, Singaporeans consume 12 teaspoons of sugar daily, more than the 5 teaspoons limit recommended by the World Health Organisation. We also see a worrying trend of children and youths consuming more sugar-sweetened beverages (SSB) than before.

31.       Compared to food, SSBs are easy to over-consume as they do not provide a sense of fullness. Many are also low in nutrients and are essentially “empty calories”. In Singapore, SSBs contribute 60% of our total sugar intake, higher than many other countries. Two-thirds of this sugar come from pre-packaged SSBs such as soft drinks and packet drinks. Other countries have implemented a range of measures targeted at lowering SSB consumption, to reduce obesity and chronic diseases like diabetes.

32.       The Diabetes Taskforce has obtained views from industry players and individuals on how to reduce sugar consumption in Singapore, including from pre-packaged SSBs. We studied the practices in other countries, which include regulatory measures like soda tax, warning labels for high-sugar drinks and advertising restrictions. Mr Chen Show Mao has also highlighted some of these examples.

33.       Madam, it is important to do further consultation with businesses and consumers before we decide on what to implement in Singapore. We will also continue to monitor the situation in other countries, to assess the effectiveness of the measures that they have implemented in changing dietary preferences and consumer behaviours.

Social Impact Bonds (SIBs) for tackling diabetes

34.       Madam, I thank Mr Leon Perera for his suggestion on using social impact bonds, or SIBs, to fund efforts by NGOs to tackle diabetes.  NGOs and VWOs are important partners for MOH.  In our War on Diabetes, we work with the Diabetic Society of Singapore, or DSS, and TOUCH Community Services in areas such as diabetes education, patient and caregiver support, and disease management. 

35.         We work with and support the work of NGOs in different ways, such as funding them to provide services, extending seed funding for them to experiment with new ideas and collaborating with them through our Regional Health Systems.  For SIBs, some observers have noted benefits, including those which Mr Perera highlighted.  Others saw downsides, such as the complex negotiations among multiple parties resulting in delays and high transaction cost, and possible diversion of attention and resources away from important causes which are less measurable and harder to achieve outcomes. 

36.       In some countries, SIBs are used out of financial necessity, due to insufficient public budget to support certain social programmes.  Singapore is fortunate to be in a stronger fiscal position, thanks to our stable political system and a government which has been planning long-term and spending prudently within our means.  We will continue to study different ways of funding and working with NGOs.  Ultimately, regardless of the funding arrangement, what we need is collective action and strong partnerships between government, NGOs, industry players, communities and individuals to win the War on Diabetes. 

Diabetes risk assessment

37.       Another important area is to encourage early and regular health screening. For diabetes, the current arrangement is for Singaporeans aged 40 and above to go for screening every three years. Madam, age is only one factor. There are also other factors such as family history, body mass index and so on.

38.       Learning from the experiences of other countries such as the US, UK, Australia and Finland, MOH will roll out the Diabetes Risk Assessment (DRA) tool from 1 September this year.

39.       The DRA is an evidence-based, self-administered questionnaire to assess an individual’s diabetes risk. It will supplement our current screening efforts.

Enhanced SFL subsidies

40.       From 1 September this year, we will also enhance government subsidies for the Screen For Life programme to encourage more Singaporeans to go for screening and post-screening consultation at CHAS clinics.

a..        The fee for screening and the first post-screening consultation will be fixed at $5 for eligible Singaporeans and $2 for CHAS cardholders, both Blue and Orange. Pioneers will not have to pay, we will offer these services to them for free as a special benefit to our PGs. 

b.        The fixed fee of $2 and $5 will cover both the initial screening and the first post-screening consultation, if the test results show that a consultation is required. We want to reduce the drop-off rate of someone who is tested positive, but does not follow-up to see a doctor for post-screening consultation.

c.        Through these enhancements, we hope that more Singaporeans will go for screening, including those who face higher risks of getting diabetes. Early detection and intervention are important in preventing diabetes and managing the disease.

Pneumococcal vaccination

41.       Madam, Mr Low Thia Khiang asked about pneumococcal vaccination. This has also been raised by other Members in the past, most recently by Ms Cheng Li Hui in October 2016.

42..       Our vaccination subsidy policies are guided by recommendations from the Expert Committee on Immunisation, or ECI. This is a committee which comprises specialists from public and private healthcare institutions in infectious diseases, microbiology, paediatrics and public health.

43.       The ECI will assess a vaccine based on factors such as the burden of the disease in Singapore, safety and efficacy, and cost-effectiveness of the vaccine. Vaccinations such as for measles and diphtheria are subsidised to achieve sufficient population immunity to prevent community outbreaks.

44..       For pneumococcal disease, the risk of an outbreak is currently assessed to be low. Our incidence of serious invasive pneumococcal disease in Singapore is also lower than other countries such as the US and Australia. Hence, the Committee has recommended a targeted approach for specific high-risk groups, such as children below 5, seniors above 65, and individuals with chronic medical conditions such as diabetes, asthma and heart diseases. They can use Medisave for pneumococcal vaccination.

45.       Madam, currently, all Singapore Citizen babies receive a $4,000 government grant in their Medisave account. Parents can draw from this grant to defray the cost of recommended vaccinations, including pneumococcal. There are also generous government grants, via the Baby Bonus cash gift and the Child Development Account (CDA) which can be used for pneumococcal vaccination.

D) Supporting the Palliative Care Sector

46.       Madam, I will now touch on palliative care. MOH has been increasing our support for this sector over the past years.

Increasing public awareness

47.       Ms Joan Pereira asked how MOH is working with VWOs to improve public awareness, quality and accessibility of palliative care. This remains a priority for us. We will work with community providers to reach out to the public through different channels. Including, using art as one of the ways to reach out to Singaporeans. Alongside such efforts, MOH will work with the Singapore Hospice Council on a structured 3-year initiative to promote public understanding of palliative care, including how we can better support caregivers during grief and bereavement.

Advance Care Planning

48.       An important initiative is to help Singaporeans plan ahead for their care preferences through Advance Care Planning, or ACP, together with their loved ones and care team. ACP is about respecting patient choice. We aim to reach out to 25,000 Singaporeans over the next 4 years.

49.       MOH will work with our community partners, Regional Health Systems and the Agency for Integrated Care to expand ACP in different care settings such as specialist outpatient clinics and primary care.

Closer partnerships in enhancing palliative care: Capacity

50.       Another area is to increase the capacity, accessibility and quality of palliative care services.

51.       I recently visited Assisi Hospice again. They have a new building with 85 palliative beds, including 5 beds for paediatric palliative care. They are also increasing their home palliative care services to about 1,000 patients each year. At the national level, we currently have 232 palliative care beds and about 5,500 home palliative care places per year, and we are on track to meet the target of 360 palliative care beds and 6,000 home palliative care places per year by 2020. The palliative care workforce has also increased by 50% from 2011 to 2016.

Enhancing quality of palliative care services

52.       With the added capacity, more Singaporeans with terminal illnesses can benefit from palliative care services. We are working with the Singapore Hospice Council to launch a quality improvement programme for palliative care providers, to maintain high quality standards as we increase our capacity in this sector.

Home palliative care

53.       Madam, based on a 2014 survey by Lien Foundation, 77% of Singaporeans preferred to pass on at home. To further enhance home palliative care services, our Regional Health Systems will work with community providers and VWOs, to pilot integrated home palliative care programmes.

54.       Under these programmes, patients can receive medical and nursing care at home, as well as assistance in their daily activities. Patients requiring short inpatient stays will be cared for in community hospitals, before they return home.

55.       I agree with Dr Tan Wu Meng on the need to support children with life-limiting illnesses. It is a difficult time for families who are facing this situation.  From 1 August 2017, MOH will extend subsidies to paediatrics home palliative care, to provide the families of these children with more financial support. This follows earlier measures by MOH such as removal of Medisave withdrawal limit in 2015, for patients on home palliative care for cancer and end-stage organ failure. We also introduced subsidies and Medisave coverage for day hospice care in 2016.

E) ElderShield

56.       Madam, I thank Dr Chia Shi-Lu, Dr Lily Neo and Mr Louis Ng for their comments on ElderShield. We have formed the ElderShield Review Committee chaired by Mr Chaly Mah in October last year. The Committee has engaged different groups of stakeholders such as caregivers, service providers, insurers and members of the public through focus group discussions. The consultation process is still on-going. 

57.       In doing its review, the Committee is looking at ways to enhance the benefits and payout period, while balancing the need to keep premiums affordable for all Singaporeans. It will continue to consult widely to gather further views and feedback.

58.       Madam, ElderShield is an important risk-pooling scheme to prepare ourselves for an ageing society, as some of us will require extra help if we become seriously disabled when we grow old.

F) Conclusion

59.       To sum up, MOH will focus on three key shifts for the next few years: beyond healthcare to health, beyond hospital to community and beyond quality to value.

a.        We will continue to grow a future-ready healthcare workforce, and strengthen primary and community care.

b.        We will achieve these outcomes by working in partnership with communities, healthcare institutions, unions and companies.

60.       Our goal, Madam, is to help all Singaporeans achieve better health, better care and a better life. Thank you.