SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES, AT THE LAUNCH OF THE NEW NATIONAL KIDNEY FOUNDATION CENTRE

Mr Ang Hao Yao, Chairman, National Kidney Foundation (NKF)

Ms Yen Tan, CEO, NKF

Mr Shawn Loh, Adviser and MP for Jalan Besar GRC (Whampoa)

Donors, colleagues, partners, friends, ladies and gentlemen

1.               I am very happy to join you at NKF once again, and today it is for the official launch of the new NKF Centre.

Kidney Disease Situation in Singapore Today

2.               When I was last here, that was in 2024. You saw my picture there – we still had to wear masks at that time. I spoke about the deadly travelator that carries too many Singaporeans from the initial onset of chronic disease to ultimately kidney failure. The travelator, I think was coined by an old friend, Philip Choo, then-CEO of the National Healthcare Group (NHG).

3.               And there are two common precursors to individuals stepping on this deadly travelator – diabetes and hypertension. Once on the travelator, the disease progresses, and kidney function steadily declines. All these happen quietly.

4.               By the time symptoms appear, significant damage may already have been done, and the patient may be quite far down the travelator. So if left untreated, the individual will be at the far end of the travelator, where the kidneys can no longer function independently, and dialysis or a transplant becomes necessary.

5.               But we are not destined to step onto the travelator and to be carried along with it. For years, we implemented many preventive care initiatives to go against the direction of the travelator. And it is timely to take stock of our progress. It is not easy – whatever we do that involves suffering for the future is commonly ignored, because it is in the future. But we have to bring forward the suffering for people to imagine that you can now do something simple to prevent this possible suffering. Easier said than done.

Tackling the Challenge Together

6.               Preventing people from stepping onto and slowing down the travelator requires some taiji methods – a sustained, steady, long-term effort that builds strength. And NKF has been an integral partner in this multi-pronged endeavour.

7.               First, we have strengthened our preventive efforts. High sugar intake is strongly linked to increased risk of diabetes and obesity. We are therefore shaping our living environment to make healthier choices easier – through Nutri-Grade labelling and advertising prohibitions to reduce sugar intake. And next year, we will implement measures to address high sodium and saturated fat intake. I am waiting very patiently. We are giving a very long lead time for the industry to reformulate. So in the meantime, for one year or so, it will be as if nothing is happening. But I assure you, actually within the industry, things are stirring. A lot of activities are ongoing to reformulate all kinds of sauces – dark sauce, soy sauce and oyster sauce – to reduce sodium. We have belacan as well. Sometimes some people think belacan does not have (sodium). It is full of sodium. We have undertaken many measures to reduce smoking, which is probably the biggest driver of chronic diseases. Our smoking prevalence in Singapore now is at an all-time low – 8.4% – and I do hope and expect it to be driven down more.

8.               It would appear that these efforts are starting to pay off. Two dots and two data points do not make a trend, but I think the arrows are at least pointing in the right direction. Between 2019 and 2024, the prevalence of diabetes and high blood pressure has broadly remained stable. Age-standardised prevalence of diabetes dipped slightly from 9.5% to 8.8% from 2019 to 2024, while that for hypertension declined slightly from 35.4% to 33%. We are bucking the trend of rising prevalence for many years.

9.               However, over the same period, the absolute number of people with chronic kidney disease (CKD), and those requiring dialysis has continued to rise. Prevalence might come down but the absolute number is rising. This is because even though the age-standardised prevalence of diabetes and hypertension remains stable, they are age-standardised. The fact is that the denominator has grown, as more Singaporeans are older and more susceptible to CKD, leading to kidney failure. So, much work remains.

10.           Second, we need to detect signs of chronic disease, early. Early detection enables proper management of chronic diseases, which significantly reduces the risk of kidney disease in patients with these conditions. You might already be stepping onto the travelator but that is not the end of the world. You do not have to follow it down.

11.           Since Healthier SG was launched about three years ago, regular screening for diabetes and high blood pressure has become more accessible to many Singaporeans. Such patients are also screened yearly for kidney function as part of their care.

12.           And in parallel, NKF has also worked with clinics across our public healthcare system and General Practitioners (GPs) to offer complimentary kidney function screening for at-risk individuals, and we have reached more than 9,000 people to date.

13.           Third area – we must help patients manage CKD well. With proper treatment and management, managing CKD is like walking against the flow of the travelator. You have stepped on it, but you do not have to follow it. You can walk against it so at least you are staying on the spot. And it is possible with proper management of chronic diseases. The Holistic Approach to Lowering and Tracking Chronic Kidney Disease (HALT-CKD) Programme helps individuals manage their conditions through medication optimisation and monitoring of risk factors. And the programme has enrolled over 165,000 patients since its launch in 2017, and many of its components have since been incorporated into our standard care protocols.

14.           Fourth, we strengthen support for those already living with kidney failure. Kidney failure is one of the most challenging medical conditions. It reshapes daily life – physically, emotionally and financially. That is why we hope to progressively increase uptake of Peritoneal Dialysis (PD) for suitable patients. I am glad that Yen updated me that you are making some progress, and more hospitals are coming on stream to encourage their kidney (failure) patients to use PD instead of haemodialysis (HD). PD allows dialysis to be performed at home, offering greater flexibility and enabling some patients to continue working and caring for their families.

15.           Alongside the National PD Home Support Programme, NKF has expanded its efforts over the past two years to help patients take up PD. This includes training staff at nursing homes such as the Man Fut Tong and Singapore Christian Nursing Home to support PD patients. Today, about 20% of new dialysis patients adopt PD, and we hope to increase it over time. Now it is one in five. Let us hope that in the next three years, let us raise it to one in three if we can.

16.           We are also enhancing financial support to keep dialysis affordable. Last year, we increased the quantum of dialysis subsidies. We also raised the monthly MediShield Life dialysis claim limit from $1,100 to $1,750. It is a significant increase. Subsidy has gone up, the MediShield Life monthly claim limit has also gone up.

17.           And this year, we will further enhance subsidies by adjusting the income eligibility thresholds. The rates do not change but the thresholds and eligibility will be adjusted. We will raise the eligibility threshold from $3,600 to $4,800 per capita household income from 1 July this year. This means seven in ten households will be eligible for subsidies, compared to six in ten today.

18.           The caveat is actually that patients would not feel any difference, because of the increase in subsidy as well as MediShield Life claims, because most already do not incur any out-of-pocket cash payment for kidney dialysis today. The reason is because providers such as NKF, and may I also mention the Kidney Dialysis Foundation (KDF), raise sufficient charity dollars to cover patients’ co-payments. So, the impact patients feel last time is zero dollars, now it is still zero dollars. But it does have an impact. Stronger Government funding support for dialysis treatment will help free up charity dollars. So NKF can then deploy the funds to other important uses.

19.           To all the donors out here, with government funding, there is more leverage in your donation. You can do a lot more for every million dollars that you donate to healthcare. I used the word “million”. Think of it that way, government plus charities and donors, we are like the choir just now. When we sing different keys, there is harmony. So between the government and donors, let us work in harmony to support various good causes in healthcare.

Conclusion

20.           In conclusion, as our fight against kidney failure continues, we are grateful for the support and help from everybody – the staff, the donors, the partners, the patients, as well as their families.

21.           Today, we are witnessing the launch of a new initiative to provide enhanced support across the care continuum, from pre-dialysis counselling to PD training, for 300 new PD patients over the next three years. It is jointly led by NKF and four public healthcare institutions: Khoo Teck Puat Hospital, National University Hospital, Singapore General Hospital, and Tan Tock Seng Hospital. The initiative is made possible by a $3 million pledge from the estate of Khoo Teck Puat – thank you.

22.           We are also officially opening the new NKF Centre. The revitalised Centre brings together public education, screening, counselling, and dialysis under one roof. It is designed to be accessible to the public and incorporates innovations such as automating the preparation, delivery, and disposal of dialysis fluids. And I think there is a whole new Discovery Centre thanks to the donation from Keppel Ltd.

23.           I would like to express my appreciation to NKF – the Board, management, staff, donors and volunteers, for your relentless efforts in fighting kidney diseases, and bringing life, hope and empowerment to patients and their families. May you continue to innovate, inspire, and lead the way in community kidney care. Thank you.