Speech by Senior Minister of State for Health Dr Amy Khor at the MOH Committee of Supply Debate, 12 Mar 2015

SPEECH BY SENIOR MINISTER OF STATE FOR HEALTH DR AMY KHOR AT THE MOH COMMITTEE OF SUPPLY DEBATE, 12 MAR 2015

(A) A Future Ready Aged Care System 

1    Madam Chair, in the next few decades, our population will age more rapidly, and we need to plan ahead to ensure that our aged care system is future ready.

2    Ms Tin Pei Ling and Ms Ellen Lee spoke about ageing in place and asked about our plans for home and community care. MOH will expand home and community care as the anchor of our aged care system, because we want to fulfil our seniors’ aspirations to age in place and enable children to take care of their parents at home for as long as possible. 

Enhancing Home and Community Care

3    Over the past four years, MOH has been building up capacity rapidly, and enhancing the quality and affordability of home and community care. Since 2011, we increased the number of home care places by 2,700 (71%), and the number of home palliative care places by 1,200 (32%). We have also increased the number of day care places by 1,000 (48%). This expansion will be an ongoing effort that will span a number of years, because population ageing will be massive in the next decade. By 2020, we can expect 10,000 home care places, 6,200 day care places and 6,000 home palliative care places. 

4    This year, we will open the provision of subsidised home and community care services to the private sector just like what we have done for nursing homes. Operators, whether VWO or private, can tender to provide these services. These operators will be selected based on care models and affordable fees. Recently, we launched a Request for Proposal (RFP) under the Build-Own-Lease model for a Senior Care Centre at Ci Yuan CC that is open to both the VWO and private sectors. Providers have to tender to operate day services in the senior care centre as well as offer home care services out of the centre. 

5    Ms Tin Pei Ling and Mr Low Thia Khiang asked about rehabilitation services. Yes, we anticipate an increase in rehabilitation needs with an ageing population, so we have been adding capacity in community hospitals, day centres and home rehabilitation, including an upcoming day centre at Kaki Bukit. In addition to the expansion of day centres, which will mean more day rehab places, we are also adding capacity in community hospitals. 

6    The fact that elderly may not follow up with rehab could be due to other factors as well, such as no transport to day rehab. This April, we will enhance transport subsidies under the SMF so that more seniors can benefit from it. We will extend transport subsidy under SMF to all seniors requiring some form of mobility assistance and not just to wheelchair bound seniors attending rehabilitation and dialysis services or those attending dementia day care services, to get to MOH-funded eldercare and dialysis centres. The level of funding support given will be based on mobility needs, and MOH will provide more funding support to eldercare providers to arrange for specialised transport for less ambulant seniors. MOH expects to provide additional funding of some $14 million from the SMF to support eldercare providers to provide transportation to clients. An additional 1,000 elderly will benefit from this enhancement, up from some 2,000 seniors now. 

7    We are also piloting tele-rehab which can further enhance the access of patients to rehab services, without even needing them to leave home. 

8    We raised subsidies for intermediate and long term care in 2012, including for day rehab services. We also started subsidies for home rehab last year. Since subsidies started from 1 April last year, some 370 patients have benefited as at the end of 2014. The number of patients on home rehab annually has steadily increased from 302 in 2012 to 731 in 2014. 

9    Between 2010 and 2014, the number of physiotherapists, occupational therapists and speech therapists in the public healthcare and ILTC sectors has grown by about 40% to more than 1,200 today.  The total physiotherapy and occupational therapy intakes at Nanyang Polytechnic have increased by 58%, from 104 in 2007 to 164 in 2014.  Similarly, the biennial intake for speech therapy at National University of Singapore has increased by 15%, from 20 in 2007 to 23 in this year.  We will continue to review the manpower demand and supply regularly, and build up the local training pipelines. We have also worked with some home and community care providers to redesign jobs and train Singaporeans to take up jobs in providing maintenance rehab. 

Better Care

10    While it is important to enhance capacity, we have also worked to improve the quality of home and community care. Last year, we announced the development of the new home-based care, community care and palliative care guidelines. We have since conducted a series of focus group discussions with providers, patients and caregivers. There has been overwhelming support and some suggestions to enhance the guidelines, which we have incorporated. The home-based care and community care guidelines have now been finalised and AIC will work with providers to make improvements to their quality of care based on these guidelines. 

Affordable Care 

11    Sir, we agree with Dr Janil Puthucheary that more can be done in the area of innovation related to successful ageing. MOH’s National Medical Research Council has earlier provided grants for innovations related to hearing problems in seniors. We will study with A*STAR and NRF on how to promote research, innovation and market access of products needed by our seniors, including hearing aids. Currently, Singaporean seniors who are 60 years old and above with hearing difficulties can apply under the SMF or Seniors’ Mobility and Enabling Fund  for up to 90% subsidies to defray the cost of hearing aids. So far, more than 1,400 seniors have benefited from SMF subsidies for hearing aids. The SMF is the main source of help for Singaporean seniors while the Special Assistance Fund (SAF) targets persons with disabilities of other age groups. A senior who is eligible for SMF will not be eligible for the SAF. AIC works closely with SGEnable to refer applications to the appropriate fund. Since July 2013, close to $17 million in subsidies have been disbursed from the SMF.

12    Caregivers are the unsung heroes of home and community care. We need to support them and encourage them. Last year, we announced the establishment of respite care services in Eldercare centres during weekends on top of existing nursing home respite care services. Caregivers can drop off their loved ones for a few hours and run their errands or just chill out. We now have 280 places each weekend, since introducing the service in April last year. To date, more than 500 seniors have benefited from both services. 

Senior Friendly Built Environment

13    Madam Chair, we also need a senior friendly urban environment so that seniors can move around independently and safely. 

14    Ms Chia Yong Yong asked about falls and disability prevention. We have started community efforts to prevent falls among seniors. Under the City for All Ages project at Marine Parade, we took a holistic approach to preventing falls. We screened seniors for fall risk, and conducted seminars for seniors and their caregivers to understand how to prevent falls. We twinned this with hardware retrofits in the town and home retrofits. The home retrofits are now part of the EASE programme under HDB. We will do more in public education as suggested by Ms Chia Yong Yong. 

(B) Community Mental Health 

15    A/Prof Fatimah Lateef, Ms Ellen Lee and Ms Tin Pei Ling asked about the progress of our community mental health efforts and our plans ahead. Mr Low Thia Kiang asked about our approach to mental health patients living in the community. 

16    So we believe that it is possible for psychiatric patients to stay well in the community, if we set up a good system to support them. Let me elaborate.

17    First, the Institute of Mental Health (IMH) has in place an after-care programme to support discharged patients who are assessed to be at higher risk of default or had more severe illnesses.  IMH reminds these patients of their follow-up treatment through regular telephone calls and even home visits when necessary. Second, IMH has put in place a 24-hour Mental Health Helpline to provide immediate support for patients and their caregivers whenever needed. Community partners can also call the hotline, regardless of whether the cases have pre-existing records with IMH. If a patient refuses or defaults on treatment, IMH will work closely with family members, caregivers and other community partners to engage the patients. 

18    Sometimes it does take a village to enable patients to recover and recover well in the community. Hence, a third area is to further strengthen community support by building local community support networks (LCSNs) among grassroots leaders and volunteers, social work agencies, the police and town councils, to enable them to respond to residents who may have mental health issues. Over the past year, we have been in touch with over 20 constituencies and trained over 400 grassroots leaders and volunteers. Take Kembangan Chai Chee (KCC) as an example. A network of volunteers comprising 120 grassroots leaders, volunteers and partners have been given basic mental health and eldercare education, and are equipped to identify residents in need and link them to various help needed. 

19    Finally, we want to enhance the capability of primary and community care to help detect and support the treatment of mental health patients. Since 2012, we have partnered and trained 70 GP partners to attend to mental health patients. We established 9 community-based specialist and allied health teams to support GPs with clinical advice and allied health services. To date, these teams served over 4,700 patients, providing them with access to holistic care closer to home. 

20    MOH launched the Community Mental Health Masterplan in 2012 to strengthen access to psychiatric care. With the pilots that we have started in the past 2 years in primary care and fostering community support systems, we are ready to scale up our efforts over the next 3 years.

21    First, we aim to train and partner 120 GPs and set up a total of 17 allied health and specialist-led teams in the community with a total capacity to serve up to 21,000 clients by 2017. Second, through our outreach, we hope to set up similar local community support networks (LCSNs) and engage a total of 50 constituencies. Third, we target to expand IMH’s aftercare services and enlist more community-based VWO teams to provide long-term support. Together with the constituency-level community support, these community-based aftercare teams aim to serve around 5,000 clients by 2017. 

22    We will also beef up our capability to support seniors with dementia, under our community mental health plans. According to a recent study conducted by IMH on the Well-being of the Singapore Elderly (WISE), we understand that the prevalence of dementia amongst seniors aged 60 years and above is 10%. Hence, with an ageing population, there will be more elderly with dementia in the future. We will enhance the capability in public hospitals and the community for seniors requiring assessment for dementia. To date, we have expanded capacity in 6 outpatient memory clinics in the public hospitals to provide early assessment and intervention for dementia patients. Specialists from the RHSes will also partner 50 GPs to manage dementia clients within the community. 

23    We will also be scaling up the capacity of community based dementia care services. As of December last year, we have put in place (i) around 650 day dementia care places, (ii) increased the number of eldersitters to 90 and (iii) put in place 575 dementia nursing home beds. By 2020, we will (i) increase day dementia care places to at least 3,000; (ii) increase the number of eldersitters to 160; and (iii) increase dementia nursing home beds to 1,970 beds.

24    We will expand our partnership with voluntary welfare organizations to outreach and educate seniors and their caregivers on how to pick up early signs of dementia and seek help. We will more than triple the number of community outreach teams from the current seven to 24 teams by 2017, to reach out to seniors island-wide. 

25    In addition, we want to put in place support programmes to help caregivers of dementia patients cope. For example, we have the dementia home intervention services for caregivers of seniors who display behavioural issues. For caregivers who need time away from their caregiving duties, we have put in place the weekend respite care and eldersitter service.

26    We are partnering some VWOs to innovate new responses to support patients and caregivers. For example, Montfort Care set up the Happy Kopitiam located at Marine Drive and Telok Blangah. This is led by a social worker with the help of volunteers to provide caregivers with education, support and respite care. Both caregivers and clients are also encouraged to participate in activities together. And this is an example of a ground-driven initiative to enable our seniors to age gracefully at home without over-medicalising our care.  

(C) Enhancing Healthcare Manpower Capability 

27    We will be embarking on a major ramp up of our health and aged care services in the next 5 years. We need more Singaporeans to join us in our mission to provide the best care for our citizens. And this is a concern that is also shared by Dr Chia Shi-Lu, Mr Patrick Tay and Ms Tin Pei Ling.

28    To support these expansions, we have estimated that the healthcare professional workforce will need to grow by about 50%, or 20,000 more between 2011 and 2020.

29    We are on track to meet our manpower needs. Our healthcare professional workforce expanded by 9,000 between 2011 and 2014. We are expanding the local training pipelines and would also like to see more mid-career entrants, especially women re-entering the workforce and retired nurses to join us. 

30    There is a wide choice of employment locations near home, especially in the aged care sector. AIC has been working with WDA, NTUC, e2i and CDCs to organise geographically-targeted recruitment fairs to attract more residents to take up jobs in the ILTC sector. Since April last year, AIC has co-organised 20 recruitment fairs and will continue to do so this year. 

31    Our work to enhance the attractiveness of healthcare careers will continue.  MOH will continue to review salaries regularly for all healthcare staff to recognise their contributions fairly and to keep pace with the market. Beyond remuneration, our public healthcare institutions and aged care providers have enabled healthcare staff to better meet their work-life priorities through flexible employment options and part-time work arrangements.  There is also progress in adopting IT innovations to lessen the administrative work of healthcare staff. With less time spent on administrative work, our Patient Service Associates (PSAs) in Tan Tock Seng Hospital for example, can then be up-skilled to take on certain roles that are traditionally performed by pharmacy technicians or nurses. PSAs’ career progression is enhanced, while nurses and pharmacy technicians have their time freed up to focus on more complex work.  

32    Let me now move on to issues on women’s health. 

(D) Women’s Health 

33    Ms Ellen Lee and Ms Tin Pei Ling asked for an update on the workplace health grant for women’s health.Sir, the Women’s Health Advisory Committee (WHAC) which I chair introduced the Workplace Health Grant for women in July 2013. Organisations may use the grant to encourage female employees to go for breast and cervical cancer screening and organise women’s health talks on chronic diseases and other conditions. And it has been well received. As of February this year, 71 out of 78 applications have been approved and we are on track to reach out to 100 companies by end of this year. Moving forward, HPB will encourage the uptake of the grant and women’s health programmes at the workplaces.

(E) Conclusion

34    Sir, our vision is to achieve graceful ageing in place in a community for all ages. We will realise an aged care system that is anchored by home and community care as well as strong community support from fellow Singaporeans. In the next 50 years, I am confident that Singapore will remain an inclusive and caring home for all.