SPEECH BY MR MASAGOS ZULKIFLI, SECOND MINISTER FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2024, ON WEDNESDAY 6 MARCH 2024

Chairman, I thank members for their questions and suggestions. I will start on how we can build a Singapore where our families and seniors can flourish.

2.       Strong families are the building blocks for an ecosystem of care within our communities. They help to ensure the health of their children and are pivotal to supporting our seniors to age well.

Families and Age Well SG

3.       Ageing well starts from home, and families should always be the first bastion of care. Studies show that most seniors prefer to age in the community, close to their families and friends. Likewise, many families have a desire to care for their loved ones at home.

4.       To support these aspirations, the Government will dedicate at least $3.5 billion over the next decade to support the implementation of Age Well SG, of which $1.9 billion will be dedicated to MOH’s initiatives.

5.       Age Well SG is led by the Ministry of Health (MOH), Ministry of National Development (MND), Ministry of Transport (MOT) with other partner agencies like People’s Association (PA), Ministry of Social and Family Development and other volunteer organisations to enable seniors to lead vibrant and fulfilling lives in the community with their families. The whole village will work together to realise the Age Well SG plans.

6.       First, we will invest in Active Ageing Centres (AACs), which will be a key enabler for seniors to Age Well within the community.

7.       Ultimately, we want seniors to be engaged and connected with their friends and families, which is key to keeping healthy and we would also like to make it easier for seniors and families to access available care services and resources in the community.

8.       The AACs are expanding the quality and range of their programmes and adapting their offerings to suit the preferences of seniors living in the vicinity. To make it easier for seniors to join in, most AACs also extend these programmes at community spaces like PA’s Residents’ Network. I am told that seniors can participate in classes and activities, and there are also programmes which have been proven to help seniors to age well physically and cognitively.

9.       Take learning as an example, the National Silver Academy (NSA) offers a diverse range of courses at about 60 AACs ranging from topics like health and wellness, financial literacy to IT and science. There are also courses for seniors to pick up practical skills like taking professional photos or floral arrangement. Most of these courses held at the AACs are affordable and around three-quarters of them are eligible for SkillsFuture Credits.

10.      Mr Yip Hon Weng asked about our plans for the roll-out of AACs, our outreach efforts, especially for those who might be socially isolated and how our initiatives can help to foster intergenerational bonding. I will address these points below.

11.      We are scaling up our network of AACs. Since the implementation of the AAC service, we have grown to 157 AACs, and have seen a steady increase in seniors engaged yearly – from 17,000 in 2021 to more than 49,000 seniors in 2022. We will do more and expand the network of AACs to 220 by end 2025. This means that by 2025, eight in ten seniors will have access to AAC activities near their homes.

12.      AACs serve all seniors regardless of housing type. Therefore, if you have seniors among your loved ones, especially those living on their own, please encourage them to join a nearby AAC.

Seniors at Risk of Isolation

13.      Secondly, under Age Well SG, we envision all seniors to be supported within the community, regardless of whether they live alone or with family. This is where the community is key.

14.      We have started this community effort. Together with volunteer ambassadors, the Silver Generation Office has engaged more than 330,000 seniors in the past four years through house visits, including those who live alone or may have no family. They help to connect the seniors to community events or activities organised by AACs, such as communal dining.

Senior Volunteerism

15.      As such, in addition to participating in activities at the AACs, we also hope for our seniors to join in our efforts in reaching out to other seniors in the community, together with their family and friends.

a.       Let me share about Mdm Yuling Siah. For about eight years now, Mdm Siah has been actively reaching out to fellow seniors in the community through home visits and telephone engagements. Mdm Siah says that she finds it especially meaningful when she has good conversations with the people she outreaches to, who have now become her friends. And Mdm Siah is 72 years old!

b.       Her spirit has caught on and now her daughter, granddaughter, and son-in-law, also joined in. We are happy that Mdm Siah is finding such meaning in her senior years, and their volunteering has fostered and strengthened intergenerational bonds across the family.

16.      Ultimately, we want our communities to be places where seniors gather with friends, keep active, and stay healthy, starting with Active Ageing Centres.

Improvements to the Living Environment

17.      Thirdly, we will enable seniors to be active and move around their neighbourhoods with ease.

a.       We will enhance our infrastructure. MND and MOT will be making our flats, neighbourhoods and streets more senior-friendly through EASE 2.0, the upgrading of selected older precincts, and MOT’s Friendly Streets initiative. I’m sure members have seen how Silver Zones and the lifts at pedestrian overhead bridges bring much joy to our seniors.

b.       We will also make enhancements to the home environment. Dr Tan Wu Meng and Mr Yip Hon Weng would be happy to note that we will also introduce in-flat fall detectors to provide peace of mind for families with seniors.

Supporting Families in Caring for Seniors with Care Needs

18.      Mr Chairman, while we want seniors to be able to age in the community, with their families and friends, we recognise that families caring for seniors with care needs may face additional stresses. Therefore, we will do more to support these families in caring for their loved ones.

Access and Affordability for Home Medical Care

19.      We have increased access to home medical care and improved affordability.

a.       Today, the Government provides up to 80% means-tested subsidies to   patients for home care services such as Home Medical, Home Nursing and Home Therapy. Since October 2023, MediSave500/700 and Flexi-MediSave schemes have been extended to homebound patients receiving home medical care from MOH-funded providers.

b.       Dr Tan Wu Meng and Ms Mariam Jaafar asked about allaying costs beyond medical expenses. MOH’s primary focus is to ensure healthcare services are affordable for all. Our mainstream financing S+3Ms framework is thus focused on covering acute care, primary care, as well as long-term care services.

c.        Nevertheless, we recognise that there are ancillary costs associated with caregiving, and that health and social care are closely related. Hence, MOH has targeted grant schemes to better support families to defray other caregiving expenses, especially for the lower-income. This includes the Medical Escort and Transport (MET) services to help frail seniors attend medical appointments or travel to Senior Care Centres, the Home Caregiving Grant and Seniors’ Mobility and Enabling Fund. We will continue to monitor and review. We try to help but there is a limit to how much more we can cover. Expanding scope of our financing would further push up national healthcare expenditure, and ultimately result in a greater burden on people.

Enhanced Services and New Care Models

20.      To better support families and caregivers within the community, we will improve existing services and pilot new care models, as Dr Tan Wu Meng, Mr Yip Hon Weng and Mr Henry Kwek have suggested.

a.       We are studying more options for home care, via an ongoing pilot. Under the enhanced Home Personal Care (HPC+), seniors are assisted in their daily activities and this also includes housekeeping services. As of January 2024, there are 328 clients enrolled under the HPC+ pilot. We will evaluate the pilot by end 2024 before determining whether to expand it nationwide.

b.       We thank Mr Henry Kwek for his query on the stay-in shared caregiving sandbox which was launched to mitigate the impact of shrinking family sizes on family caregiving. Under this sandbox, a shared caregiver assists a group of seniors living in public or private estates with their activities of daily living. This sandbox will be in place for at least a year until Q1 2025. MOH will review its outcomes and take Mr Henry Kwek’s feedback into consideration when determining next steps, which we will announce when finalised.

c.        MOH will also introduce standardised care assessments and progressively appoint bundled-services providers, so that seniors can enjoy more seamless care delivery. This reduces the need for multiple assessments and unnecessary referrals by different care providers.  

d.       For seniors who require further care in Nursing Homes, the median wait time for nursing home placement is around one month. In the interim, the Agency for Integrated Care (AIC) works closely with the seniors and their caregivers to make alternative interim care arrangements as needed.

21.      These efforts will go some way to support families and caregivers. We want to make it easier for them to manage the cognitive and physical load of providing care for their loved ones at home. This includes senior caregivers who may be caring for senior family members.   

Resources and Support for Caregivers in the Community

22.      In addition, we will provide caregivers with resources so that they can be supported in caring for their loved ones.

23.      Since November 2023, caregivers have also been able to use their SkillsFuture Credits for eligible caregiver training courses. This year, we will be enhancing the Caregivers Training Grant from the current $200 per year to up to $400 per year per care recipient, to subsidise the cost of caregiving training conducted by approved training providers. With these schemes, caregivers can receive more affordable and accessible caregiver training to help them care for their loved ones in the community. 

24.      I would like to assure Ms Carrie Tan that support for caregivers can be found in the community.

a.       Today, caregivers can access the AIC hotline and online resources available on AIC’s website, as well as a Care Services Recommender on the Support-Go-Where portal.

b.       We will also progressively level up all AACs as community touchpoints to provide information and referral services. For example, families and caregivers can visit an AAC to discuss how they can obtain the appropriate care for their seniors. There are also nine AIC links located in public hospitals to provide caregivers who are planning for the discharge of their loved ones from the hospital.

c.        AIC also runs Community Resource, Engagement and Support Team (CREST) and Community Intervention Teams (COMIT)  teams that provides support for seniors and caregivers with mental health needs. For socio-emotional support, caregivers can also tap on the Caregiver Support Networks (CSNs) and WIN Caregivers Network by PA.

25.      Chairman, we have an ambitious vision to be a society where we Age Well. We are rolling out plans in the community that enable seniors to live active lives. We are investing in infrastructure across neighbourhoods. We are supporting families in caring for their loved ones. But ultimately, it is about the heartware, each of us looking out for one another, helping our seniors lead vibrant and fulfilling lives in the community.

Promoting Healthy Mothers and Supporting Our Children to Grow Up Well

26.      Even as we are investing in more support for our seniors, we are also enhancing support for our young families to have healthy and happy lives.

27.      In 2021, we set up the Taskforce on Child and Maternal Health and Well-being, or CAMH in short. Comprising an interdisciplinary team of policymakers and practitioners from across the health, social and education domains, the Taskforce came together to explore how children and their families can attain good health and well-being.

a.       I thank the Taskforce members for their hard work over the past three years. They engaged parents and caregivers, brainstormed with partners, and developed sound recommendations. Relying on evidence-based research such as the Growing Up in Singapore Towards Healthy Outcomes or GUSTO study, we were able to formulate ways to improve the health of our children and families. I am glad to announce that the Taskforce has completed the development of the CAMH Strategy and Action Plan.

28.      Recommendations under the Strategy have been translated into 48 initiatives under the Action Plan. Currently, 28 out of the 48 initiatives have been or are being implemented, while the remainder are under review in preparation for launch. A detailed report will be shared later this year.

29.      Let me now speak on two recommendations that exemplify our commitment to strengthen support for children and their families.

Providing Parents with Assurance in their Journey through Parenthood

30.      One of these recommendations is to enhance support for couples from pre-conception and pregnancy, through to parenthood. Many parents-to-be recognise that antenatal care is important as they prepare for the birth of their child. However, not all parents have access to resources and support.

31.      Therefore, we have looked into increasing access to antenatal care, and I am pleased to share that we will be piloting antenatal education classes for parents within the community. Those who attend these classes will have convenient access to subsidised antenatal support close to their homes. Couples can look forward to learning about nutrition and exercises during pregnancy and after delivery, and be equipped to care for their newborn. The classes will be conducted via a hybrid model, incorporating online lectures and videos, so that parents can easily access these useful resources virtually.

32.      It is important that we support and celebrate active fathering too. In collaboration with the Families for Life Council and Centre for Fathering, we are strengthening the participation of fathers in parents’ support groups in schools. This will provide more avenues for fathers to share and learn valuable parenting insights and tips.

33.      We will continue to support fathers who may require more support in their parenthood journey. At the committee Of Supply last year, I shared how the National University Hospital expanded the Women’s Emotional Health Service Plus or WEHS+ pilot, extending mental health support services to fathers in need. This support is important at the antenatal and postnatal stages, as they take on a new role of a father. This pilot has also since extended support for mothers up to six years postnatal, up from the previous one year.

34.      We want couples to feel supported and assured during their parenthood journey, even and especially when they meet challenges.

a.       Let me share how Ms S and her husband benefited from the WEHS+ programme. As Ms S experienced postnatal depression and anxiety, the WEHS+ team followed up with regularly check-ins and emotional support to ensure she was coping well. The team also ensured that her husband received timely assistance and treatment.

b.       Both are faring better now, and the good news is Ms S is expecting another baby! I am glad that this programme has given them the confidence and reassurance that they are well-supported in their journey.

35.      Over time, Ms S and her husband will be able to transit to Family Nexus, which supports families with children aged 0 to 6, enabling them to access cross-domain services at a one-stop community touchpoint near their homes. Last year, I announced the launch of the Family Nexus pilot at Our Tampines Hub. I am delighted to update that the Family Nexus pilot has been rolled out to three more sites in Singapore, at Choa Chu Kang, Punggol and Sembawang Polyclinics, to extend support to more families.

Foster Healthy habits among our Children in the Early Years

36.      Helping our children pick up good habits for good health during their formative years paves the way for better long-term health. Therefore, we want to empower parents with more resources and information to nurture healthy habits in their children. This too is one of the Taskforce’s recommendations.

a.       During our engagements, many parents shared that they were on the lookout for accessible and reliable information to support them in nurturing their children. We shared about Parent Hub in 2022, a one-stop resource portal to provide timely information on pregnancy and parenting to families. Since its launch, Parent Hub has garnered over three million views, with over 100,000 page views monthly. We will continue to expand this resource, such as by making new interactive evidence-based resources on nurturing healthy eating in childhood and other relevant topics available on the portal.

37.      To better support individuals in nurturing healthy eating habits in children from young, I am happy to share that KK Women’s and Children’s Hospital and the College of Paediatrics and Child Health Singapore, launched the Singapore Guidelines for Feeding and Eating in Infants and Young Children last month. These guidelines support those involved in the care of children aged 0 to 2 to in nurturing healthy eating habits, providing goals and milestones in the transition from infant feeding to eating as a young child. I urge parents, caregivers, and healthcare professionals to refer to these guidelines to promote a positive environment for the adoption of healthier eating habits in our young children, which would be beneficial to them in years to come.

38.      We will make resources available beyond the early years. Students will be able to access online interactive resources through the Ministry of Education’s Student Learning Space this year. These resources will help students learn more about healthier eating habits and ways to have a balanced meal. These efforts are aligned with the GUSTO research study which shows that children’s eating behaviours, such as portion size, food choice and nutrition, are key risk factors for childhood obesity.

39.      Allow me to summarise in Malay: Kementerian Kesihatan (MOH) telah membangun rancangan untuk strategi dan tindakan bagi kesihatan dan kesejahteran golongan lanjut usia serta kanak-kanak dan ibu (CAMH). Kami telah menyelesaikan pembangunan CAMH, yang memberi tumpuan kepada pelbagai peringkat dari prenatal hingga remaja, membangunkan inisiatif untuk menyokong kanak-kanak dan keluarga dalam bidang seperti penjagaan prenatal, sokongan ibu bapa, dan tabiat pemakanan yang sihat. Inisiatif-inisiatif ini akan memberi kuasa dan menyokong keluarga kita dalam menjaga golongan lanjut usia dan kanak-kanak kita.

Closing

40.      Mr Chairman, in closing, families are fundamental to enabling our seniors to age well, and to fostering a nurturing environment for our children to grow, learn and thrive. We will continue to strengthen support for families. Together, we can build a society where every family is empowered to grow and age well and enjoy a life of health and well-being. Thank you.

As of 12 March 2024,  paragraph 17b has been amended for accuracy.