Building a Healthier SG

Mr Deputy Speaker, in Mandarin.

(In Mandarin): [Please refer to Vernacular Speech.] I thank MOH for further expanding the role that our clinics and family physicians can play in universal healthcare.

Years ago, some of my Parliamentary colleagues and I proposed to the Government to allow residents to visit neighbourhood clinics instead of polyclinics, while benefiting from the lower outpatient service fees charged by polyclinics. The Government then launched the CHAS scheme, allowing residents to visit their own GP clinics at the price of polyclinic fees. Since its implementation, the plan has been welcomed by residents. I also shared feedback from residents at that time. In many cases, residents often perceive that their family doctors were more cordial, reliable and trustworthy. So, recoveries were quick after the visits.

Sir, the recommendations of the White Paper are commendable.

Residents do not need to go to the polyclinics to queue for outpatient services. They can easily go to the family doctors in their neighbourhoods for treatment and follow-up consultations, hence prevent the deterioration of chronic illnesses. At the same time, they can obtain early and proper treatment.

In the last session of Parliament, I talked about "the best doctor", that is, prevention is still the best medicine. Therefore, this White Paper is the best form of medical practice. It is farsighted and looks to the future so that Singaporeans can age in place. I hope that under this scheme, residents will have more flexibility to change clinics or GP, if the GP has transferred to another clinic or has left.

(In English): Deputy Speaker, Sir, I fully support the excellent proposals in the White Paper on Healthier SG. This preventive care model is yet another step in our journey to help Singaporeans achieve and maintain their best health and live more good years.

The proposals in this White Paper will further strengthen the role of GPs in the national healthcare framework. It is a superior strategy and deserves our full support.

I have always believed that our family doctors play an essential role in this endeavour. Residents find it comfortable to have family doctors with whom they are familiar with to look after their healthcare issues.

I believe it can be technically done to have all GPs to have online access to patients' records. However, we must recognise that there is a need to balance patients' confidentiality and operational efficiency.

In addition, I would like to ask the Ministry how will the balance be maintained between need and demand for certain medications. Some patients may ask for more than necessary, as generic medications are generally more economical. Will patients be given a choice between new and generic medications? Patients may still find it a burden regarding the choices of new medicines.

I hope this plan can be expanded soon to allow residents to visit more than one GP at similarly subsidised rates for the management of diseases. Some GPs may be more experienced and skilled at managing certain diseases. This is because certain GPs may have individual competitive strengths or specialties. Thus, each patient may like to have a principal GP doctor in attendance and be assisted by such specialists upon referrals.

Next, may I ask what would happen to the doctors or clinics in the case of uncooperative patients with problems adhering to their healthcare plans? I am concerned because the White Paper has stated that this new model will be outcome-based. I hope that the Ministry will not penalise the doctors in charge as these patients should be the ones responsible for their own health.

Many GPs clinics, especially those in mature estates, are already overwhelmed with patients. For some popular clinics, the wait for the face-to-face onboarding health consultation may take days to weeks. If the enrolment for particular clinics is always too many for the doctors to cope, how will this be resolved?

Another concern is regarding the use of Healthhub to choose preferred clinics and enroll in Healthier SG. Will assisted support on-site and via helplines be available at the clinic itself or at CCs? As many seniors are non-IT savvy and some may be illiterate, they will not be able to use the apps after enrolment to monitor their health progress. They may require simple printed materials to do manual recording. This means that the GPs will have to manually key in the progress reports into the available system to enable monitoring. This is additional work for GPs if they have many of such senior patients.

For this group of seniors, they will not know how to use apps like Healthy 365, ActiveSG and OnePA to book and pay for activities. They may have to ask the doctors to teach them during their first consultations or even subsequent consultations and this will take up the doctors' time, which could be better used in treating patients.

Another concern is about patients who are not enrolled into Healthier SG at GP clinics. The clinic assistant will have to remember to charge correct prices for patients under the Healthier SG and non-Healthier SG schemes. For the popular clinics, the clinic assistants may be overwhelmed, resulting in longer waits for all patients.

For residents who do not have chronic diseases to follow up at the GPs, the face-to-face consultation after enrolment via Healthhub will probably be the first and only visit to the GPs under Healthier SG.

I doubt anyone with no sickness would want to see a doctor regularly. If a healthy person sees the GP for their first health consultation under Healthier SG or subsequent follow up, will they be given a medical certificate (MC) or memo to excuse them from their work? Will all employers recognise such "excuse sheet", the same as during COVID-19, when employers must recognise ART-positive results as proof?

For such residents, the doctor will advise them on appropriate preventive measures as part of their health plans, such as health screenings and vaccinations. The doctor may also make referrals to community programmes. I would like to ask if it is necessary for doctors to do social prescriptions for such patients? Will health coaches not be more suitable? With that, I support the Motion.

Mr Deputy Speaker, Sir, I support this bold initiative to promote preventive healthcare. This White Paper has naturally gotten a lot of attention amongst my senior residents and GPs in Yio Chu Kang, which is a mature estate. Having spoken with them, I would like to raise feedback on several areas.

First, Mr Deputy Speaker, Sir, I will discuss Healthier SG from my residents' point of view. My residents are generally happy with the Healthier SG benefits. Notwithstanding, there are a few concerns. First, can a patient, who has already enrolled with a family doctor, consult other GPs and still enjoy Healthier SG benefits? I would like to highlight. TCM treatments.

Many patients also like to get a combination of Western and TCM treatments for their ailments. Some elderly patients prefer to get regular acupuncture treatments at registered TCM clinics for their aches and pains, rather than to rely on pain medication. Will the Government take this opportunity to review how we involve TCM practitioners in community preventive healthcare, especially, since acupuncture is also offered in our restructured hospitals?

Second, how will compliance and success be measured? Measuring health is unlike exercise, where we can determine participation and progress through counting the number of steps taken, heart rate and so on. How does the GP and the wider healthcare system assess adherence and compliance? How do we measure the impact on the individual at the personal level?

For patients who refuse to follow the prescribed health plan, how can we then determine whether the overall programme is effective, or even whether the GP is proficient? Having a good number of sign-ups is a favourable start. However, this does not necessarily guarantee in-depth participation.

What is more important would be compliance to a single GP or the Primary Care Network (PCN). How do we discourage the practice of GP hopping? Will there be penalties for either the patient or GPs? Is this a key performance indicator and who is it directed to?

Third, can we speed up the implementation of Healthier SG to residents under 60 years old? I believe we should be more ambitious, especially considering that chronic illnesses can start in the 40s. One way to do this is by allowing family members to enroll in the programme together with the senior.

For example, if an individual is 60 years old and his wife is younger by a few years, can they both enrol at the same time? This ensures better compliance. They can motivate and accompany each other for consultations and screenings, and adhere with exercise plans.

Mr Deputy Speaker, Sir, I now move on to what Healthier SG means for GPs. Our GPs have been very helpful with our efforts to build a dementia-friendly community in Yio Chu Kang. They shared with me some useful insights on Healthier SG.

First, how adequately are our GPs trained in managing chronic diseases? A GP who wants to manage more complex health problems must begin their training from medical school. In big countries like Australia, there may only be one doctor serving one or even a few towns. The GPs there are trained through medical school and postgraduate courses, with the expectation that they will function as the only doctor in the town and would, therefore, be equipped as such, with skills spanning from common ailments to more complex chronic conditions. In Singapore, because of how accessible our tertiary healthcare institutions are, many of our GPs focus on common ailments and function as referrers for more complex and serious conditions.

Second, how many GPs are enrolled in our PCNs? This may give some insight on GPs' willingness to participate in Healthier SG. Do we have the majority of GPs on board the PCN initiative? What more can we do to get their buy-in to provide effective care in the neighbourhood?

Third, will the cost of ancillary services be subsidised by the Government so that it is on par with those provided by tertiary healthcare institutions?

The Government has gone to great lengths to reassure us that the drug cost parity between prescriptions from GPs and polyclinics is reduced. Will this be done through restricting the brands of drugs brought in? What happens if a patient opts for "branded medication"? As drug sales constitute a large part of GPs' incomes, how will drug cost parity affect a GP's willingness to sell generic drugs? Does this also extend to the cost of ancillary services, such as blood tests, X-rays and other related services provided by GPs?

The White Paper also mentions a team-based care approach. Will this be similar to the PCN where backend support for care coordination and other ancillary services are provided to the GP? Would GPs have to hire additional manpower or to pay for these services?

Fourth, how many more staff are required to deal with the additional administrative workload and to handle social prescription?

Under Healthier SG, we expect GPs to provide advice on lifestyle and dietary activities but such social prescriptions can involve a longer consultation session and probably over an extended duration of time. In the meantime, GPs still have other patients' ailments to tend to. Can the GP count on the care team to help out or will they have to hire additional staff if they are unable to manage? This is more so in solo practices and goes back to my previous point on getting more GPs to join PCNs.

In tertiary healthcare institutions, typically, you would have a nutritionist speak to a patient on diet and then there will be other healthcare professionals and programmes to deal with smoking cessation, weight loss and so on. With many GPs still practicing solo, would they have the time and resources to do so?

In Australia, GP visits are by appointments. This gives them adequate time to holistically review a patient's clinical and lifestyle needs, including making adjustments. In Singapore, it is, generally, a numbers game. The more patients a GP sees, the more money a GP makes. It would only be natural that the GP would want to earn more by seeing more patients.

Fifth, will the annual fee for providing care for enrolled patients be extended beyond CDMP conditions? This could include frailty and mobility issues, which are common with old age. Delaying the onset of such problems is critical in preventive care and will greatly help to improve the quality of life.

Sixth, I hope that under Healthier SG, GPs can be incentivised to start end-of-life care planning with their patients. This includes encouraging them to do Advanced Care Planning, or LPAs, at the opportune time.

These conversations are best started by people like GPs who know the patient best and ideally understand the patient's family and social context. It is these meaningful conversations that may need to take place. It is not so much to "bend the cost curve", though it might, but it helps people prepare for the inevitable and for families to be at peace with their decisions.

Lastly, Mr Deputy Speaker, Sir, I will now talk about the role of community care providers in Healthier SG.

Can the Ministry clarify whether screenings under Healthier SG are primarily done by GPs or Eldercare Centres (ECs)? The White Paper mentions leveraging on physical spaces in ECs to conduct activities like health screening, early detection of dementia risk and other healthcare initiatives for seniors. Yet, GPs are also expected to conduct screenings. What is the envisioned eventual end state? Regular opportunistic screening systems may make screenings more widely accessible. However, they could be confusing and overlapping in intent, thus resulting in excess costs.

In conclusion, Mr Deputy Speaker, Sir, Healthier SG is a paradigm shift. The Government's Population in Brief report was released last week. It shows that Singapore continues to grapple with long-term issues, such as low total fertility rate and the ageing population.

The responsibility of caregiving for older family members will rest on fewer shoulders. If all of us can take better care of ourselves and be more independent in our silver years, we can help to reduce this caregiving responsibility for our loved ones.

At the systems level, this means reduced fiscal funding on healthcare so that the money can be better used in other areas.

But what matters most is for the individual. I recently spoke with Mdm C, a senior living alone in Yio Chu Kang. I often see her around in the neighbourhood. Most of the time, I see her at the weekly exercise class in the park or at the market after her exercise for her breakfast with her exercise kakis. I asked her what she thinks is a good life. She told me that, being in her 70s, she does not ask for much. She said as long as she can eat well, sleep early, exercise and meet up with her neighbours and her friends, she would have lived a fulfilling life.

With the benefits of Healthier SG, such as having an assigned GP who knows her well and having a proper health plan to keep healthy, I am certain she will be active and can enjoy her silver years for many more years to come.

The focus should rightly be on health and not on healthcare, and to stay healthy in the community for as long as possible and not in the hospital. As such, I would like to take this opportunity to encourage all eligible residents listening in to sign up with Healthier SG as soon as the opportunity avails.

Let us all do our part to take responsibility for our own health and build a healthier Singapore. I support the Motion.

Please do.

(In Malay): [Please refer to Vernacular Speech.] We have been working closely with the mosques for several years, to encourage congregants to lead an active lifestyle through the JKJU programme (Look After Your Health, Look After Your Community). HPB will continue to expand the JKJU network by involving more organisations apart from the mosques to develop healthy lifestyle programmes and culturally-nuanced healthy lifestyle messages for the Malay community.

Recently, we have also launched the "Saham Kesihatan" (Health Investment) initiative, a collaboration between HPB and community organisations, including M3@Towns, ActiveSG and the People's Association (PA). This initiative aims to encourage more Malay/Muslims to stay healthy through community-led interest groups.

These groups can design their own local health programmes by leveraging on the various healthcare facilities and services provided by community bodies and Whole-of-Government organisations. The pilot "Saham Kesihatan" programme was launched in M3@Jurong and M3@Tampines. We hope to nurture at least one community-led interest group in every M3@Town. We will also continue to enhance existing programmes and support the Malay community with various health programmes, to encourage them to lead a healthy lifestyle.

(In English): In her speech, Ms He Ting Ru touched on the gender health gap for women. The feminisation of ageing is a well-recognised phenomenon, where women face a greater risk and duration of loneliness as those who are married tend to live longer than their husbands. They also have greater financial insecurity than men and carry a greater budget of the challenges and stresses of caregiving.

MOH is cognisant of these concerns. In fact, I chair a Women's Health Committee which comprises community partners championing for women's health issues. Together with our partners, we will continue to increase the awareness of women's health issues and promote healthier lifestyle practices amongst women. Sustained education efforts and support for women is important in addressing this long-term phenomenon. The efforts of the Committee will complement Healthier SG in supporting women in their preventive health journey so that they may live longer, healthier.

I agree with Ms Ng Ling Ling's point on the importance of adopting a community participatory approach under Healthier SG and this is in line with our plans.

Under Healthier SG, we and our healthcare clusters will continue to work closely with agencies to explore these suggestions and we look forward to the support of all our partners to achieve the vision of Healthier SG.

Moving on, we have "L" which stands for looking out for caregivers. As we seek to empower fellow Singaporeans to stay healthy, we recognise that some of our seniors are already frail, living with dementia, or approaching end of life. These seniors and their caregivers also need our support. Second Minister for Health, Mr Masagos Zulkifli, will speak more about our commitment to enabling seniors to live and age well in the community.

Over the years, we have enhanced our support for caregivers, with a range of initiatives under the Caregiver Support Action Plan and the White Paper on Women's Development. If you are a caregiver, there are a range of care options to help ease your burden, such as the Dementia Day Care and the Night Respite Care pilot to help caregivers of persons living with dementia, and home-based respite care for caregivers of those approaching the end of life. We will also provide more help to ease caregiving costs, with an enhanced Home Caregiving Grant in 2023.

Ground-up community efforts can also let caregivers know that they are not alone in this journey. For example, peer support networks under the People's Association's WIN Caregivers Network and Project 3i empower caregivers to learn skills and receive social-emotional support.

We recognise that caregivers also need even more support as their loved ones approach the end of life. Palliative care comes in here to provide not just physical, but also emotional, psychosocial, and spiritual support to patients and their families. I would like to encourage caregivers to join and benefit from these initiatives.

In their speeches, Dr Wan Rizal and Ms Hany Soh touched on enabling caregivers to better support their loved ones. Currently, nominated caregivers can already conveniently access the health records and appointments of their loved ones in HealthHub. Next year, caregivers will also be able to use HealthHub to help their loved ones enrol to Healthier SG.

I would also like to acknowledge Ms Janet Ang's point on leveraging digital technology to engage caregivers and we will continue to work with partners to engage caregivers through various channels, including digital channels.

So far, I have covered how the Government and community can play a role in supporting our healthy living journey. For my last two points, I will cover how technology can be used to empower and motivate you to take charge of your own health journey. The letter "T" is for tracking of your health activities.

In between visits to your family doctor under Heathier SG, you can access relevant, up-to-date advice via the Healthy 365 app and the HealthHub app on your personal devices. Healthy 365 enables easy tracking of different lifestyle behaviours such as physical activity, healthier food purchase and consumption. You will also be able to share your lifestyle data by showing the app to your family doctor, enabling the doctor to have a holistic view of your progress and discuss what lifestyle goals and programmes can help you.

In addition to monitoring of physical activity, sleep and healthy food purchases, the Healthy 365 app will be enhanced with new features, such as diet logging. The diet logging tool will help you easily monitor and be aware of your daily caloric intake from food and drinks consumed, so that you can work towards achieving your daily recommended caloric intake.

This tool will have a photo recognition function, that Minister described, so that we can simply take a picture of our meal, which could comprise of local food and drinks, such as chicken rice and kopi-o, for the app to estimate the caloric intake.

There will also be ways to support those who are not digitally fluent, for example, by enabling patients’ caregivers or family to assist.

Finally, the last “H” refers to health-related lifestyle nudges, personalised recommendations and rewards to sustain healthy behaviours. At the heart of Healthier SG is empowering residents to choose health for themselves while the system supports them. We know that lifestyle behavioural change is a long-term journey requiring both strong motivation and regular participation.

While we may interact with our family doctors once every six to 12 months and participate in community activities a couple of times a week, personalised recommendations and nudges delivered via digital technology can be a constant support to help us stay engaged on our healthy journeys.

We will enhance Healthy 365 to deliver more personalised nudges, such as through recommending suitable lifestyle activities, achievement of health goals and improving adoption of healthy lifestyle behaviours.

Many private companies have been developing such technologies and some have built deep expertise in nudging health behaviour change. We will continue to explore collaborations with them to harness technology and insights to help us all take better ownership of our health.

We have also made healthy living rewarding with HPB Healthpoints. You can earn Healthpoints under programmes, such as the National Steps Challenge. You will also receive Healthpoints after enrolling and completing the first consultation with your enrolled family doctor. We will continue to improve on this and encourage all of us as we choose better health.

With Healthier SG, it will be easier for everyone to start and sustain healthy living. Let me share a fictional example of how your health journey can look like.

Madam Anna, a 60-year-old resident in Jurong, meets her family doctor to discuss her health plan after getting her screening results. As Madam Anna is overweight and has high blood pressure and pre-diabetes, her family doctor recommends that she attends the “Live Well Age Well” programme to stay active and pick up nutrition tips to avert diabetes.

Madam Anna can scroll through the Healthy 365 app to find the “Live Well Age Well” programme nearest to her friend, so that they can attend together. She is also automatically registered for the “National Steps Challenge” and “Eat Drink Shop Healthy Challenge” where her daily healthy lifestyle activities help her earn Healthpoints to exchange for vouchers. The Healthy 365 app will also remind her to clock more steps, complete more moderate to vigorous physical activity (MVPA) minutes and offer other suitable activities to add variety.

During Madam Anna’s next half-yearly check in with her family doctor, she proudly shares that she has become more active and has reduced her caloric intake by using the Healthy 365 diet logging tool to monitor her meals. The family doctor notes that Madam Anna has lost two kilogrammes in the past six months. Her high blood pressure is also under control. If Madam Anna continues to sustain her healthy lifestyle and manage her chronic condition well, the family doctor may consider reducing her regular medication at her next health consult.

Although Madam Anna is a fictional character, as demonstrated by Mr Loh and Madam Rahimah in my earlier example, it is possible to start and sustain a healthy lifestyle and Healthier SG would make it easier for you to do so.

Enrolment for Healthier SG will start in the second half of 2023 for those aged 60 and above. In the meantime, you may download and explore HealthHub and Healthy 365 to access a wide range of preventive health resources and programmes.

Healthy living starts with you and me. Thus, as the Government strengthens support for preventive health under Healthier SG, I would also like to urge all of us to make a conscious decision to invest in our health. Let us strive towards living healthier and better lives.

Mr Deputy Speaker, in Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.] As the saying goes, "prevention is better than cure". This wise and well-known quote is apt to describe the Healthier SG White Paper. It also represents a major turning point in our public healthcare policy. Singapore's public healthcare system has always placed a greater emphasis on treatment. From the allocation of Government funds to services provided by civic organisations, there is a clear bias towards the treatment of patients. This is a passive model. Even in the eyes of the general public, to be a specialist is better than a general practitioner. This attitude inadvertently affects the choice of students when they choose their course of study, hence has an impact on our talent supply. It also affects the perception of the public with regard to public healthcare.

Of course, when people are sick, we have to treat and take care of them. Like a parent, the Government should not only provide quality medical care for Singaporeans, but also give subsidies to reduce the financial burden from medical expenses. Against the backdrop of an ageing population, it is even more important for the Government to provide quality and affordable healthcare. However, when people fall ill in their twilight years, they may find it hard to enjoy life even if they own a mountain of wealth. Hence it is often said that health is wealth. Because if you are healthy, you will have the energy to travel around, play with your grandchildren, pursue unfulfilled dreams and scale new heights in life. In this way, seniors will not be counting down to the end of their lives, but will be anticipating every new day.

Of course, from a long-term point of view, preventive public healthcare will only bring benefits. First, although we are a rapidly ageing population, the increase in public healthcare expenditure can be slowed down and the burden on future generations will also be lightened. Second, good health helps to improve our quality of life, and a good quality of life helps to improve our happiness index. Third, a healthy and strong population means a prosperous country. With good health, one need not fear about the future.

Earlier, I heard Assoc Prof Jamus Lim's speech and I have some doubts. I would like to take this opportunity to seek clarifications from him. He talked about listing out consultation fees at private clinics. I believe benchmarking fees against market standards and listing out consultation fees at private clinics are already in practice. Is he looking for greater transparency or better consistency of consultation fees? Second, he talked about MediShield Life. From what I heard he seemed to suggest that more medical services be included in MediShield Life. Can he elaborate on what additional medical services he is thinking of? Today, we are debating the White Paper, does he expect that certain preventive care services be included in MediShield Life? If so, how will that affect the premiums of MediShield Life? How do we help Singaporeans deal with the increase in premiums? Can Assoc Prof Jamus Lim clarify on these points?

My general feeling after listening to Assoc Prof Lim's speech is that he still plays a greater emphasis on treatment, but the Healthier SG White Paper is focusing on preventive care. I would like to seek his clarification. Does he also agree that the preventive medicine is better than curative medicine? In the long term, I feel that preventive care is a better option.

Now, I would like to return to my original speech. To move Singapore's health focus from treatment to prevention is necessary. However, in my view, the key to realising the vision of the White Paper lies in getting the people's genuine buy in. Bai Juyi once said, "feel how other people would feel with your own body and heart". When we rollout Healthier SG, we must pay attention to both the body and mind. Policies play a facilitating role. At present, if we ask Singaporeans whether they should live healthy lives and take preventive care, the answer must be "yes". Ask if they support it, the answer will surely be "yes" as well. But how important is it to them? And whether they will translate it into action, the answers are not so clear. In fact, unless we are sick, we tend to have the mindset that "it will not be me". Health checks or healthy dietary habits are often not on the agenda. Hence, in the White Paper, it is right to emphasise the role of GPs in inculcating good habits among Singaporeans. Building on the existing CHAS network, I hope that all GPs will heed the call and join the Healthier SG initiative to benefit more Singaporeans.

For these reasons, I support the Healthier SG White Paper. The White Paper's analysis is meticulous and the measures put forward are suitable. But I have two questions. First, as the existing recreational facilities, community partners and health activities in each estate are not uniform, how does the Government intend to work with various Government agencies and social organisations to ensure that each estate has a basic package with sufficient space and budget, customised according to the needs of the estate? For example, in some mature estates, there may be more elderly people living alone who are old, frail and financially disadvantaged. What they need is not just recreational activities, but also social and financial support. How can the Government ensure that every community, whether it is old or new, rich or poor, provides equal services? After all, one can get chronic illnesses regardless of one's status. But one's financial ability affects one's choice in life.

Second, I am happy to see that the Government agrees with the importance of mental health. In the White Paper, care protocols are mentioned to enhance the consistency of GPs in the care of chronic illnesses. I hope that the Government will also step up its efforts in the mental health area. Singapore is a high stress environment and mental health cannot be ignored. During the pandemic, many older Singaporeans have become accustomed to staying at home or avoiding the crowds because they have lived at home for a long time. This inevitably aggravates the psychological challenges that they face. So, I think mental health is an issue that we have to deal with sooner rather than later. Can the Government introduce mental health care with the "three highs" care protocols?

Overall, the intention of the Healthier SG White Paper is clear and should be supported.

Thank you, Mr Deputy Speaker. I stand in support of the Motion, which seeks to empower individuals to take charge of our own health and wellness and help Singaporeans live longer and healthier lives.

The strategies proposed within the White Paper on Building a Healthier SG provide significant steps in the right direction to provide better quality healthcare in a more affordable and convenient manner.

In my speech, I will talk about how Healthier SG will benefit our workers who work hard, work long hours and more often than not, also work in stressful environments and offer suggestions on areas where we can and should do more.

Let me start by talking about the healthcare challenges that our workers face and how employers can play their part to help foster a healthier workplace.

During the NTUC's recent #EveryWorkerMatters Conversation, many workers raised concerns about the steady creep in healthcare costs. Concerns were understandably more pronounced among our mature workers, who are deeply worried about being able to afford treatments for their chronic illnesses such as diabetes, high blood pressure and high cholesterol.

Employers too are affected by the rise in healthcare costs for their ageing workforce as they have to spend more for their employees' medical benefits. An unhealthy workforce also reduces workplace productivity.

According to the United States' Centre for Disease Control and Prevention, some job roles can result in workers becoming more susceptible to chronic illnesses. For example, four out of the 10 most costly health conditions for US employers, which include chest pains, high blood pressure, diabetes and heart attack, could be attributed to work stress and physical inactivity caused by prolonged hours of sitting at the work desk. This relationship between certain job roles and chronic health conditions is unlikely to be unique to the United States.

The Labour Movement is therefore heartened that Healthier SG will help to make healthcare more affordable through: one, subsidies on health screenings and vaccinations; two, waiver of the co-payment requirement when using MediSave for chronic care management; and three, introduction of the new Community Health Assist Scheme (CHAS) drug subsidy tier for a whitelist of chronic disease management drugs to ensure that medications for chronic illnesses are made affordable.

Beyond general chronic illnesses that Singaporeans are susceptible to, we should also consider whether certain types of work predispose us to certain chronic illnesses.

As I have alluded to earlier, spending long hours sitting in front of the computer or in a driver's seat, among many other repetitive job tasks, can result in various forms of chronic illnesses. Examples include arthritis, carpal tunnel syndrome and hypertension. What can we do about this?

Mr Deputy Speaker, we spend most of our adult lives at work and research has shown a strong correlation between our work and overall well-being. Employers therefore must do their part to mitigate job-specific chronic illnesses faced by their workers.

They can do so in three ways: one, design the work environment to prevent chronic illnesses from forming; two, provide structured health screenings at the workplace, targeting job-specific chronic illnesses; and three, provide healthier eating options within the workplace. Let me elaborate.

First, employers must put in place a work environment that prevents job-specific chronic illnesses from forming and to adapt the workplace and work processes to help workers who are suffering from chronic illnesses, in particular, our mature workers.

According to a 2017 Swedish study, which examined the challenges involved in encouraging an ageing workforce to continue working productively, the researchers found that workers with chronic conditions can continue to work meaningfully by changing tasks and having proper physical aids to assist them. However, the study also observed that these changes often come at the workers' initiative, rather than the employer proactively doing so.

As our population and workforce ages, employers must be cognisant on how to adapt the work environment to help their workers remain productive.

Sir, as we shift away from transactional and episodic care, employers should also shift away from requiring medical certificates and provide workers some sick leave without MC. This will reduce the need to visit the doctor just to get an MC and reduce medical bills too. While some employers are already doing this – for example, workers in our healthcare clusters are given up to three days of non-MC sick leave – I urge all employers to do the same.

Second, all employers should work with their insurers and third-party administrators to include more Healthier SG clinics on their panels and offer structured health screenings and vaccinations for their workers. This benefit should also be provided to all workers, including those in the gig economy.

The Labour Movement has been pushing for this as early detection and intervention can help prevent chronic illnesses and infection of diseases.

For example, the National Taxi Association, the National Private Hire Vehicles Association and the NTUC's Freelancers and Self-Employed Unit have been working with the Health Promotion Board (HPB) to encourage gig economy workers to go for quarterly health screening and health coaching sessions, to get active and to stay in shape.

Third, companies with staff canteens can promote healthier eating options. The canteens operated by the National Transport Workers' Union have been offering brown rice at subsidised rates, to encourage our public transport workers to take up this healthier option. Since the campaign started, more than 100,000 plates have been taken up by our public transport workers.

Instead of a sugar tax, the canteens rolled out promotional discounted prices for our kopi o kosong and teh o kosong to encourage workers to cut down on their sugar intake. We are working with HPB next on a low salt campaign for our public transport workers. I hope that all companies with staff canteens can follow suit and nudge their workers towards a healthier diet.

Mr Deputy Speaker, in addition to better physical health outcomes, today's debate would not be complete if we do not consider the need for better mental health outcomes too. According to a 2021 study by the Institute of Mental Health, the COVID-19 pandemic has led to a rise in mental health issues in Singapore. Our workers are feeling the stress acutely.

A 2021 survey by software company Oracle found that nearly seven in 10 residents in Singapore said that 2021 was the most stressful year at work. More than half of respondents said that they were struggling with their workplace mental health.

I therefore fully agree with the White Paper that taking a preventative approach in mental health is aligned with the objectives of Healthier SG and I note that the scope of Healthier SG will eventually widen and include other complex chronic conditions such as mental health conditions. I would just like to ask the Minister when that will be.

Could we consider improving access to mental healthcare support to all Singaporeans by increasing the current psychiatrist-to-population ratio to 10 per 100,000 residents, similar to other countries such as the United States and Australia?

We should also encourage Singaporeans to have a dedicated counsellor or psychologist, similar to how we are encouraging everyone to have a regular family doctor, to serve as their first point of contact for their mental health.

The bottom line is that mental health conditions should be given the same priority as all other chronic illnesses and it is in everyone's interest – employers, workers and the Government – to ensure that we have a mentally healthy workforce.

I hope that MOH and the Inter-agency Taskforce on Mental Health and Well-being can prioritise the roll-out of preventative mental healthcare for the next review of Healthier SG.

Sir, to conclude, it is no secret that our health affects the way we work and our work affects our health. While the strategies outlined in the White Paper on Building a Healthier SG will help us achieve a higher quality, affordable and convenient healthcare ecosystem, we can all lean in and do more.

I encourage employers to play their part in tackling job-specific chronic illnesses at the workplace and putting in place a structured healthy workplace programme for their workers. Workers too should also do their part to go for regular health screenings, partake in regular exercise and eat healthily so as to remain healthy, productive and employable. Lastly, I hope that the next review of Healthier SG will include a strong focus on preventative mental healthcare. With that, I support the Motion.

Mr Deputy Speaker, we have reached a critical point in Singapore's demographic history. One in four citizens are expected to be aged 65 and above by 2030, up from one in six today. While our life expectancy is one of the highest in the world at 85 years, our health-adjusted life expectancy is 75 years. This means that on average, we spend about 10 years in ill health. Our chronic disease prevalence rate has also risen. The proportion of population with high blood pressure has increased, from 20% in 2010 to 32% in 2020, and 26% to 37% for high blood cholesterol.

We want to reverse these trends and empower residents to lead active and healthy lives, surrounded by people whom they love and can support them in their journey towards better health. We must not let our health be determined by medical care alone, even if there are plentiful experts who can provide it. In fact, the way we live, work and play, and the environment we put ourselves in are as important, if not, more so.

We are already familiar with keeping healthy. From young, Singaporeans participate in activities in schools, such as physical education (PE), and go on to participate in programmes and activities in their workplaces and in the community. During our engagements, residents have told us that they are better able to sustain healthy behaviours if it is social. Much like in school – among friends.

For example, some find joy in going brisk walking with their friends. Others are motivated to stay healthy so that they do not burden their family members. One resident said "Exercise and sports, I do a lot of that. I play pickleball. If I am not playing games, I am going for walks with my friends." Another resident said "If a doctor recommends for me to do something, I would convince him that I rather do it with my friends." Like both residents, we are more motivated to exercise if our friends and family encourages us to do so or better yet, to do it with us.

Healthier SG acknowledges the importance that we place on participating in activities we enjoy, with our loved ones and friends. In support of this, community partners will provide a range of lifestyle programmes and activities to attract different profiles, and bring them closer to residents' homes, especially for our seniors. Senior Parliamentary Secretary Rahayu Mahzam has touched on HPB's support for this.

People's Association also has a wide array of health and wellness lifestyle activities, interest groups and courses catering to a broad range of preferences and interests. Those who prefer more structured support can start with Sport Singapore's network of Active Health Labs and Coaches. Active Health Labs will help residents get started and stay on their health regime. Residents will receive regular health and wellness coaching and advice on exercise customised to them, in order to meet health goals. This includes residents who are at risk of developing chronic conditions.

Even before Healthier SG, we are and will continue to be inclusive in promoting health to all. Ms Denise Phua and Mr Mark Chay asked about MOH's plan for persons with disabilities. The Enabling Masterplan 2030, which was just published in August, sets out our approach to enable persons with disabilities to live healthier lives, supported by quality healthcare.

Mr Gerald Giam asked about MOH's upstream efforts on child and maternal health. Child and maternal health is critical. We have already started on this, in parallel with planning for Healthier SG. The inter-agency Child and Maternal Health and Well-being Taskforce that I chair focuses on improving health outcomes for our women and children, starting from as early as the pre-conception stage and during pregnancy, to give every child a good start. Expecting and postpartum women can access educational information and resources on Parent Hub, which can be found on HealthHub.

Ms Denise Phua also asked about upstream interventions. We will continue to inculcate healthy habits from young by making health more prominent in schools and preschools and have started a review with MOE and MSF on this so that we can better support the health and development of our children. I have heard your concern for care and outreach to seniors participating, including males.

Ms Ng Ling Ling suggested to partner family doctor with community partners. These suggestions are important as we shape Healthier SG. We will need to ensure family doctors are plugged into relevant community level information so that they are familiar and can refer residents to these programmes. But more importantly, we hope their doctors can help them follow through on their health plans and show how these can achieve good health outcomes. Therefore, we will strengthen coordination and support across partners.

First, Healthy 365 as the entry way for all residents to easily access lifestyle programmes offered by community partners. Ms Ng Ling Ling suggested making it easy for more seniors to use Healthy 365 and HealthHub. I would like to assure her and other Members that seniors who need help navigating the app and enrolment need not worry. Help is available at our community centres, eldercare centres or through our Silver Generation Ambassadors. Already, out of those 50 years old and above, 280,000 participate in National Steps Challenge on Healthy 365. There are also about 230,000 seniors above 55 who are using HealthHub. We will reach out to more seniors and ensure they will be able to easily navigate the apps and locate the information they want.

Second, our healthcare clusters, as regional health managers, will step up. Ms Denise Phua and Mr Sharael Taha asked about the role of regional health managers. They will build relationships, coordinate activities and support across community partners and tailor programmes specific to the needs of the population in their regions. Over time, healthcare clusters will gain in-depth understanding of their residents’ needs. They will work with partners to strengthen the environmental and social support for our residents. The Agency for Integrated Care, a trusted partner of many community partners, will support this effort, integrating care across partners to better support residents.

Mr Yip Hon Weng expressed concern that there may be duplicative efforts in screening by community partners and primary care. We understand the concern. Senior Minister of State Janil Puthucheary will be sharing the care protocols that will guide screening done by family doctors and their care team. In addition, our healthcare clusters will guide supporting initiatives in the community. Over time, we hope to minimise duplication and target population segments that need more help. These partnerships will make it easy for residents to live healthily in their day-to-day lives and help connect residents to relevant programmes and services.

Mr Deputy Speaker, Sir, let me now elaborate on how we are supporting our seniors. We are committed to enabling seniors to age and live to their fullest potential in the community.

The Ministerial Committee on Ageing (MCA) adopts a whole-of-society approach towards making Singapore a better community to age in. This is one instance of a whole-of-society approach in health which Member Sylvia Lim said we should have. In 2015, MCA launched the Action Plan for Successful Ageing, covering 70 initiatives across 12 areas. I am glad to share some key achievements from the Action Plan and the latest initiatives on how we have built communities of care around our seniors.

Today, active ageing programmes exist in every neighbourhood. Our seniors have opportunities to learn new things and meet new people close to their homes. We provide targeted outreach to those who need it through the Silver Generation Office (SGO) and with intermediate and long-term care (ILTC) partners. Since April 2022, in their door-to-door preventive health visits to seniors, SGO looks out for seniors’ frailty status and level of social support. They will intensify outreach to seniors identified to have higher health and social risks so that they can be referred to the right services.

Dr Wan Rizal will be glad to know that we have been enhancing our care infrastructure and capacity to support the growing needs of our population, helping seniors to age in community, including those that are less mobile or immobile. Between 2012 and 2020, we added around 6,000 day care places and 5,500 home care places to cater to seniors with a range of care needs. Transport is provided to seniors who need it.

Healthier SG will extend to all seniors, including those who are lower-income earners. I appreciate Mr Xie Yao Quan for raising concerns about the lower-income in Healthier SG. Preventive care is not only for those who can afford personal trainers and coaches. With Healthier SG, we are making preventive care accessible to everyone. We are collaborating with GPs and polyclinics to help residents stay healthier. We are activating community partners to support them to live healthier lifestyles. Healthcare clusters have been working with SSAs and MSF’s social services offices (SSOs) in their regions to jointly address the health and social needs of the residents, particularly those from the lower-income households. For example, there are community nursing posts co-located with many SSAs and SSOs to make health services more accessible at these community touchpoints.

With Healthier SG, we will facilitate partnership and shared care of individuals across health and social agencies. We will also work through PCNs to strengthen the collaborations with Healthier SG GPs.

All hands must be on deck to enable our seniors to remain physically, cognitively and socially engaged, as well as maintain and improve their health. The MCA is refreshing the Action Plan for Successful Ageing. MCA ran a series of engagements with more than 5,000 residents. We found that many seniors continue to have aspirations even as they age, whether it is to volunteer in the community, care for their grandchildren or even start a business.

We have concluded our recommendations and are finalising the report which will be launched early next year. The Action Plan Refresh will be anchored on Care, Contribution and Connectedness, or what we call the 3Cs.

For the Care thrust, seniors will be supported through preventive health, active ageing programmes and care services.

On Contribution, seniors will have opportunities to contribute their knowledge and expertise to the community by volunteering, continuous learning and employment. Through our Citizens’ Panel on Contribution, many seniors have told us that they also wish to contribute to society by mentoring our youths. I am heartened to see such enthusiasm.

Finally, for Connectedness, seniors will age-in-community within an inclusive built environment while staying connected to their loved ones and society through digital platforms and support networks.

As suggested by Ms Hany Soh and Mr Sharael Taha, we will increase opportunities for families to provide the support system to help our seniors live healthier lives, strengthening intergenerational relationships within the family.

The Action Plan Refresh will focus on interventions in the community. The Infocomm Media Development Authority (IMDA) and SGO help seniors to be more confident in using technology to stay healthy. For example, our eldercare centres have been collaborating with IMDA to hold digital literacy workshops for seniors. The Seniors Go Digital programme also helps introduce use of Healthy 365 and HealthHub.

MOH has been working closely with MND to develop new housing-cum-care options to support seniors to age in community. We launched our first Community Care Apartments –which are senior-friendly housing integrated with care services – in Bukit Batok last year. And we will be launching our second in Queenstown in the November 2022 BTO exercise. Housing monetisation options like the Lease Buyback Scheme are also available to support seniors to age in community while boosting their retirement savings.

Eldercare Centres will be further strengthened as the key node for seniors. ECs will be the go-to points for all seniors’ health-social needs, including connecting them to social and lifestyle activities and monitoring simple vitals.

I would like to thank Ms Ng Ling Ling for her suggestion of reaching out to seniors living in private estates. Today, ECs provide support for seniors from different ethnicities and backgrounds and many of them participate regularly in activities and programmes at ECs. When we double our ECs by 2025, we expect eight in 10 seniors to be able to access these activities near their homes.

We welcome more stakeholders and community partners to come together in this endeavour to build a society that empowers seniors to contribute, be socially engaged and achieve their aspirations. All these efforts, together with Healthier SG’s emphasis on preventive care, lay a strong foundation for seniors to age in community, a major reform of our aged care ecosystem. Before I conclude, let me summarise my speech in Malay.

(In Malay): [Please refer to Vernacular Speech.] Healthier SG aims to empower all of us to take care of our own health. Family doctors will work with residents to improve our health. But beyond healthcare, we acknowledge that social and environmental factors are also important.

Under Healthier SG, community organisations will also be involved to provide various programmes close to homes to facilitate participation in programmes and activities to stay healthy. We will help seniors age in place and live to their fullest potential within the community. Ultimately, every individual must be responsible for their own health and therefore take active steps to stay healthy. Let us all make use of the resources available to live a healthier life and support one another to do the same.

(In English): In closing, the shift to leveraging community support for better health is a significant move. Everyone – families, individuals, community partners and the Government – must and will do their part, I hope.

Together, we can help one another sustain healthier lifestyles, live and age well and be a Healthier Singapore. [Applause.]

Mr Deputy Speaker, it is timely that Singapore is going to shift away from illness-based hospital care to a more sustainable way of patient-centred preventive care. This a good move but there will be challenges during the implementation stage.

The general practitioners or GPs are critical to the success of Healthier SG. After the release of the Healthier SG White Paper, I managed to communicate with a few GPs, including GPs who are practising in the Nanyang division. In general, the GPs are very supportive of Healthier SG.

While some GPs operate in residential areas and in clearly family clinics, others practise at the workplace. Those GPS who practise at the workplace are concerned that some residents or many residents would not appoint them as the primary family doctor, especially those residents above 60 years old, who are not working. How would MOH address this perceived inequality?

On the other hand, some popular GPs may be overwhelmed if too many patients want them to be their primary family doctor and they have to turn people away. Minister Ong alluded to this in his opening speech. For Singaporeans, securing a family doctor should not be a competition.

As such, I would like to ask what is maximum number of patients each family doctor can accept? What is the set of criteria which doctors can use to decide whether to accept or reject existing and new patients under Healthier SG? For instance, would they take into account factors like whether the patient had visited the clinic before, or how far away the patient lives from the clinic, or on a first-come-first-served basis? What exactly are the factors they would have to take into account and is that a priority?

Meanwhile, one GP, who is an owner-doctor running his own clinic has requested me to ask if it is compulsory for all family doctors to join the Primary Care Network (PCN). Such GPs also have questions on the need to be qualified as a family physician. Referring to page 42 of the Healthier SG White Paper, it states that each GP clinic must have at least one family doctor to be registered as a family physician within seven years of the launch of Healthier SG. Thus, I would like to ask, does it mean that the family clinic with only doctor, the sole doctor would have to be qualified as a family physician? If so, this may have profound implications for family clinics run by solo doctors.

If GPs are to oversee the end-to-end journey of caring for a patient, it would be helpful if they can work with partners to deliver this care.

According to an article from the Harvard Medical School, such GPs, who are also called primary care physicians, work in teams to keep patients at the centre of all diagnostic and treatment activities. These teams often comprise medical assistants, nurses, pharmacists and social workers.

Likewise, in the Netherlands where the GP is the central figure in Dutch primary care, GPs employ salaried nurses and primary care psychologists, who can even provide mental health services. The typical practice size is approximately 2,200 patients per full-time working GP and over 95% of the citizens are registered with one GP that they have chosen. Chronic care management is coordinated through care groups, which are mostly GP networks. These care groups coordinate care from multiple service providers for certain chronic diseases, such as diabetes and cardiovascular conditions.

Would MOH envisage the formation of such GP networks in Singapore? If so, would such networks be coordinated by the respective three health clusters?

Outside of the clinic, there are many touch points and community engagement opportunities with members of the public. I heard from Minister Masagos that the healthcare cluster will coordinate with community partners and GPs to provide healthy activities for the residents. And to this end, as a Member of Parliament taking care of the Nanyang Division of West Coast GRC, I would be happy to leverage on my community partners to work with the healthcare clusters and the GPs in Nanyang to provide healthy lifestyle activities for the residents.

As with any change, it would take time for residents to embrace Healthier SG. Preventive care requires more commitment from people to live more healthily, commit to advice from their doctors and spend time on regular health screenings. Many Nanyang residents I met and have spoken to after the release of the Healthier SG White Paper are very supportive of Healthier SG but they have also raised some concerns. Let me continue in Mandarin.

(In Mandarin): [Please refer to Vernacular Speech.] Many residents in Nanyang support Healthyier SG, but they also have some questions. Let me share an example. Mdm Tan, who is in her sixties, has been seeing a doctor at the Teo clinic near her home since young. She has just changed her job, and the clinic is not on the company's list of designated clinics. Hence, Mdm Tan cannot claim medical fees from the company for the cost of seeing the doctor at the Teo Clinic. Mdm Tan was glad to hear about Healthier SG, and wanted to appoint Dr Teo from the Teo clinic as her designated doctor, so that she could receive free vaccinations and highly subsidised pills for the "three highs". For a common cold, Mdm Tan still needs to go to company-designated clinics. This situation is just like what the White Paper has described on page 24. If Mdm Tan has a choice, she would prefer to go to the Teo Clinic which she is familiar with whenever she falls ill, just like what the White Paper has recommended. I hope MOH can solve this dilemma.

Another important aspect of Healthier SG is to encourage Singaporeans to take part in more activities that are good for their health, such as Zumba, brisk walking in parks and gardening. To date, most of these activities are only attractive to women. Many men prefer to drink in coffee shops, eat and chitchat for a long time. It seems that we need to mobilise our men and entice them to move from drinking tables to table tennis and from eating to growing vegetables. While this is not MOH's strength, it is an important factor in Healthier SG. I hope the Minister will think about it and invest more in this area.

(In English): Next, I would like to touch on another very important topic, which is the funding. Minister Ong had indicated that it would cost about $1 billion over the next three to four years for IT support and other one-off costs to bring the GPs on board Healthier SG. At the same time, the recurring cost of running Healthier SG will amount to $400 million a year, including the service fee for the GPs.

As mentioned earlier, healthy activities for the residents as coordinated by the respective health clusters are a very important component of Healthier SG. I would like to ask Minister Ong, how much of the $400 million budget will be allocated for organising healthy activities and nudging residents to engage in such activities?

Earlier, I heard from Senior Parliamentary Secretary Rahayu Mahzam that they will make Healthy 365 as a very key component of the entire Healthier SG. But we know that there are many other apps that are very popular with the residents. For example, there is LumiHealth. So, how would Healthy 365 interface with those apps that are very popular right now, like LumiHealth, so that they can be more coordinated and benefit more residents?

Ultimately, we can take inspiration from what is being done in other countries for preventive healthcare.

A research study of primary care physicians in 10 countries including Australia, Norway, United Kingdom and Switzerland showed how patients that are managed by one primary care physician are able to view information from their medical records, and can even e-mail their doctors. While this could prove quite onerous for our GPs, it would certainly go a long way in building trust between patients and their doctors.

In conclusion, I would like to quote an advice by Dr Chuang Wei Ping, an elected member of the Singapore Medical Council and a popular GP in the Nanyang division. Dr Chuang said, “People want to live a fuller live, rather than a longer life.” “People want to live a fuller live, rather than a longer life.”

Currently, Singaporeans' life expectancy is close to 85 years but they spend more than 10 years in ill health. With Healthier SG, we hope to reduce the number of years spent in ill health. This is possible if all Singaporeans, all GPs, all Government officials and all community partners are ready to make Healthier SG as a priority for a better Singapore. I support the Motion. [Applause.]

Sir, the Workers' Party Members of Parliament have raised points which cover the main prongs of the Healthier SG White Paper. These include concerns on capitation funding, manpower issues across the healthcare landscape and the future evolution of the family medicine ecosystem as envisaged, amongst other points.

The upcoming changes to the healthcare system underwritten by the White Paper are significant, and in the main, the Workers' Party supports the Government's strategic shift towards preventive healthcare, important aspects of which were pre-emptively raised by Workers' Party Member of Parliament Leon Pereira in his Adjournment Motion on reviewing strategies towards preventive healthcare in February this year.

My contribution to this Motion will be short and it covers an important but sometimes understated stakeholder in the public health care ecosystem, and that stakeholder are the Traditional Chinese Medicine (TCM) practitioners and others who are practitioners of alternative or complementary medicine. In the course of the debate, I have heard hon Members Ms Joan Pereira, Ms Hany Soh and Mr Yip Hon Weng also speak on TCM and how it interfaces with the Healthier SG White Paper. In my speech today, I will make three suggestions to bridge TCM and complementary or alternative medicine as important community partners of a healthier SG.

In July this year, I asked the Minister for Health in a written Parliamentary Question how TCM practitioners would be integrated into the Ministry's Healthier SG plans. Minister Ong replied and I quote: "Traditional Chinese Medicine practitioners are important stakeholders, especially given their emphasis on holistic and long-term care. However, unlike Western doctors, Traditional Chinese Medicine practitioners are not tightly regulated by MOH. The standard of care delivery varies widely and we will therefore not be able to take the same approach as we have taken for Western doctors."

This reply is nonetheless not inconsistent with the Minister's public comments in December 2021 where Minister was quoted as recognising the benefits of TCM in fighting chronic diseases. In fact, successive health Ministers have raised hopes of alternative approaches to healthcare like TCM, which complement and integrate Western medicine.

Some almost 30 years ago, in 1995, the Health Ministry accepted the recommendations of the Committee on Traditional Chinese Medicine and moved to begin regulating TCM. Globally, under the Beijing Declaration adopted by the World Health Organization (WHO) in November 2008, Traditional Chinese Medicine was recognised as having an important role in the improvement of public health. Acupuncture has in fact, been scientifically proven through trials recognised by WHO to be an effective treatment for more than 20 diseases and disorders.

Today, TCM practitioners in Singapore are governed by the Traditional Chinese Medicine Practitioners Act and physicians are expected to abide by the ethical code and ethical guidelines for TCM practitioners issued by the TCM Practitioners Board which also comes under MOH.

In 2019, legislative changes were made to further professionalise the TCM industry. These included the introduction of continuing professional education and raising the maximum fines on errant practitioners from $10,000 to $50,000. This hike in fines brought the TCM Practitioners Board's disciplinary powers in line with those in the dental, pharmaceutical and allied healthcare boards.

Sir, TCM and other alternative treatments such as ayurveda and other alternative therapies have a long tradition of acceptance in various Asian cultures. Singapore is no different with non-Chinese Singaporeans resorting to TCM and alternative medicine as well. To this end, some TCM products have even been halal certified.

In fact, as early as 2005, MOH allowed licensed hospitals and nursing homes to have full service TCM clinics, including acupuncture, tuina and herbal medicine services to be co-located on their premises on the condition that the TCM clinic was clearly distinct from conventional medical services.

In 2018, an acupuncturist at Khoo Teck Phuat Hospital was quoted in the newspapers as saying that around 40% of her patients who sought acupuncture were non-Chinese and under the age of 25.

The Government, for its part, has previously allocated $3 million for the TCM Clinical Research Grant from fiscal years 2013 to 2018 to support research into chronic diseases.

A further $10 million in research and development grants was also announced in 2017 as part of efforts to modernise the industry. Then Senior Minister for Health, Mr Chee Hong Tat, was quoted as saying: "After you come out of hospital, how do you help a person to get back as quickly as possible to good health? I think things like therapeutic massage actually play a very useful role."

On 29 December 2020, in a significant move, MOH announced that it was extending means-tested subsidies and MediSave coverage under a pilot arrangement to support acupuncture for lower back pain and neck pain at specialist outpatient clinics in public healthcare institutions. The pilot did not cover acupuncture used to treat other pain indications and other forms of traditional complementary and alternative medicine offered at public healthcare institutions. However, the Ministry stated that it would review the expansion of the pilot to other settings in the longer term, taking into account learnings and data from this pilot. Healthier SG may well provide the opportune platform and impetus to expand this pilot.

Suggestion one – extending use of MediSave to more procedures and allow TCM practitioners who offer them.

To this end, Sir, my first suggestion is for the Government to consider extending the use of MediSave for more TCM procedures and alternative therapies that have a proven role in the management of one's general health and, more pertinently, in the prevention of chronic diseases. This expansion should also see the inclusion of certified TCM practitioners who can be allowed to offer such approved procedures in their TCM clinics outside public healthcare institutions. In order to prevent abuse, a fixed and audited list of procedures and caps to limit the fees that can be charged for such procedures ought to be considered. Additional subsidies can also be extended to Pioneer and Merdeka card holders for these procedures, many of whom resort to TCM as an important source of primary care.

Suggestion two – consider alternative and complementary medicine to lower costs.

Second, MOH should look into the cost of alternative medicine that substantively produces the same clinical outcomes as medicines and drugs disbursed by our public healthcare institutions. For example, Fybogel, which is commonly dispensed for constipation, can cost around $20 on the shelf without subsidies, whereas psyllium husk, which confers similar, if not identical, benefits, can be purchased from Little India and even NTUC supermarkets at under $3.

In 2015, the then Head of the Traditional and Complementary Medicine Branch of the Primary and Community Care Division at MOH confirmed and I quote, "MOH constantly reviews the regulations and policies on TCM, taking into consideration the scientific advancements and rising standards of TCM." In similar vein and with a view to better manage costs, a review of commonly prescribed medicine which substantially produces the same clinical outcomes as complementary medicine should be undertaken on a longer-term basis. It would be useful to understand if the Ministry or a relevant body like the Health Sciences Authority currently carries out such comparisons of clinical outcomes between Western and alternative medicine with the view to lower overall healthcare costs.

Separately, I suspect more than a few in this House would have encountered cervical episodes for which traction and other specific thoracic mobility stretches are commonly prescribed through physiotherapy. Similarly, TCM also advances traction and certain stretching and mobility exercises as rehabilitative procedures.

In this light, would the Ministry consider whether there is scope for such rehabilitation or physiotherapy to be undertaken at TCM clinics by TCM practitioners? Such rehabilitation is not usually just more affordable than physiotherapy sessions at many private and public healthcare facilities, but the convenience of having such options for Singaporeans within one's neighbourhood and perhaps right under one's block can ensure that patients complete their rehabilitation and live healthier and more mobile lives.

Suggestion three – leverage on TCM practitioners to achieve Healthier SG.

Mr Deputy Speaker, late last year, a Straits Times article reported that the Government's feedback channel, REACH, discovered that many seniors were reluctant to get their COVID-19 vaccines due to and I quote, "advice from their doctors, mostly traditional Chinese medicine (TCM) practitioners who are unsure of what advice to give". In response to this, MOH arranged to meet all TCM practitioners to explain why vaccination was critical.

Sir, while TCM and other alternative therapies have not been covered in any substantive detail in the White Paper, it is clear that TCM practitioners do not have a small footprint in the mindshare of Singaporeans when it comes to our health, particularly in the heartlands. Like Healthier SG, prevention of long-term diseases is a core belief of TCM and complementary medicine. And this does not start in one's senior years. Their treatment philosophy places an acute focus on prevention before a disease arises. They advance the view that one's lifestyle is intimately related to health, which can be improved through effective mental health management, rest, a good diet and interventions based on a person's specific physical conditions, amongst others. By watching such indicators, one is well on his or her way to good health, regardless which economic strata of society one belongs to.

Indeed, the White Paper lists a number of community partners, such as AIC, Sport Singapore, the People's Association (PA) and the National Parks Board (NPB), that will empower residents to chart their own journey towards healthy and active lives. In our journey to live more healthy lives, I would suggest that we should not underestimate the wide reach of the local sinsehs in our neighbourhoods. MOH should tap on them to help share healthy living tips and preventive healthcare strategies, not just to our seniors. And MOH should not rule out subsidising TCM practitioners in this endeavour, subject to their contributions towards objective criteria under Healthier SG. Such an approach would also be consistent with the aim of successive Ministers of Health who had hoped to integrate Western medicine and TCM and alternative medicine as far as practicable, even as both branches of medicine operate in different cultural and professional milieus. While progress in this regard appears to have been fitful so far, Healthier SG provides a new-found opportunity for TCM and alternative medicine to play a more active role in the primary healthcare space and in preventive healthcare.

In conclusion, Sir, just like family doctors, many Singaporeans have been going to the same TCM practitioners for decades. For some, the reasons behind this may well be behavioural, peace of mind and more comfort dealing with a TCM practitioner. The Government is on record to say that TCM practitioners are an important stakeholder in Healthier SG. The Ministry should consider concrete plans and strategies to include them in the country's strategic shift towards preventive healthcare as Healthier SG is fleshed out and operationalised in the months and years ahead.

The Ministry will not be starting from ground zero. With decades of regulatory experience and periodic reviews of the TCM landscape undertaken by the TCM Practitioners Board, a dedicated effort must be undertaken, driven by the Ministry to draw on the treasure trove of alternative and complementary medicine that has been relied on by generations of Singaporeans for their well-being. This is an opportunity that should not be missed.

Mr Deputy Speaker, Sir, the Healthier SG strategy focuses on GPs and residents, as we encourage them to develop closer, longstanding relationships to better enable preventive care. Family doctors, General Practitioners (GPs) will play an important role. MOH is supporting GPs to help them on board to Healthier SG. We have consulted GPs extensively about this and I thank them for their time and valuable feedback.

GPs are supportive of Healthier SG and agree with the focus on health, not illness. They have raised some concerns and suggestions on how this will be implemented. Several Members of this House have also raised similar concerns and provided suggestions.

GPs require support for their enhanced role. We have worked with primary care teams to develop 12 care protocols. These will provide clarity and consistent processes for the GPs and the clusters who will support them. The protocols are on providing screening and vaccination, and managing common chronic conditions like diabetes, hypertension and lipid disorders. This will be a multi-year effort and we will continue to develop more care protocols, such as for mental and dental health.

Mr Xie Yao Quan suggested we strengthen the integration between GPs and the healthcare clusters. Our clusters will work closely with the Primary Care Networks (PCNs) to do this, developing clinical programmes for shared care.

Ms Janet Ang and Mr Ang Wei Neng asked about the enrolment process. Enrolment is tagged to the clinic, to enable service delivery even when a specific doctor is away or unavailable. After enrolment, residents can still visit other clinics if needed. Residents can also choose to change their enrolled clinic. For example, if your doctor leaves the clinic to join another group, you have the option to switch and enrol with your doctor's new clinic. Others may prefer the convenience of staying with the same clinic in the same location. Ms Ang also asked if three generations could enroll to the same doctor as well. This is ideal. But for now, we have to consider the capacity of GPs for the enrolment process, especially early in the roll out of Healthier SG. And we will consider this approach that Ms Ang described as we open up to other age groups.

Ms Denise Phua and Mr Gerald Giam also asked about enrolment to polyclinics. They will assign enrolled patients to a regular care team, so that there is one team looking after the resident for continuity of care.

Ms Joan Pereira asked if enrolled patients can use branded drugs at their own cost. They can. However, the enhanced CHAS chronic drug subsidies will not apply. The enhanced subsidy tier applies to a targeted list of clinically effective and cost-effective chronic drugs, which will be reviewed regularly. For drugs outside of this list, the current CHAS subsidies will still apply. MOH will announce more details next year, including standard safeguards and reviews to guard against excessive purchases as raised by Mr Gan Thiam Poh.

GPs have questions about their remuneration, the design of the annual service fee, will they be penalised if patients refuse to adhere to their health plan and would some GPs be incentivised to cherry-pick patients. They are also concerned about the impact on their business when drug prices are made more comparable with those at the polyclinics. These points were also raised by Dr Lim Wee Kiak and Mr Gan Thiam Poh.

Let me first explain how the annual service fee will work. There will be a base rate that will differ for enrolled patients with and without chronic conditions. This is regardless of whether the enrollees, the residents, are compliant with the health plans. On top of this base rate, additional payouts will be provided upon the completion of critical care components recommended in the GPs' care protocols and the residents' Health Plan. For example, have patients with diabetes gone for their annual eye and foot screening?

So, at the start, doctors will be paid not on the basis of whether the blood pressure or the blood sugar levels have come down, but whether the patient has engaged with the interventions that will help bring down the blood pressure and the blood sugar levels – at the start.

GPs have shared that educating and encouraging Singaporeans to turn up for screening requires dedicated time and effort, and the design of the service fee addresses this and minimises the impact of cherry-picking. This new annual service fee is on top of the existing Government subsidies and the patient revenue that GPs already receive for services rendered.

GPs can also expect more revenue from these patients with the increased uptake of recommended preventive care services which will be fully subsidised. And more comparable drug prices will help patients, who may have otherwise visited polyclinics, to see their GPs instead. Taken together, all of these means that GPs will be fairly remunerated for the care that they deliver under Healthier SG.

Ms Denise Phua highlighted the plight of busy GPs. We hope this set of changes will also help them gradually evolve from a volume-driven model to one with more opportunities to connect with and empower their residents for health.

To Ms Hazel Poa and Mr Gerald Giam's comments on MediSave, we have limits on the use of MediSave to ensure Singaporeans have sufficient savings to meet their various healthcare needs throughout their lifetime. We will continue to review the adequacy of each Medisave limit. MOH also reviews the list of conditions on the Chronic Disease Management Programme (CDMP) regularly and has recently expanded the list to include three new conditions such as gout, allergic rhinitis and chronic hepatitis B, bringing the total to 23 conditions.

To Mr Xie Yao Quan and Ms He Ting Ru's questions on personnel and overseas Singaporeans who are healthcare workers, we are actively growing our pool of family physicians to meet our target of 3,500 by 2030. The annual intake for family medicine has been increasing and we will continue to review the training numbers. MOH has been working with the Family Medicine Training Advisory Committee and the College of Family Physicians Singapore on expanding the number of training places. We are also increasing exposure to family medicine in the undergraduate curriculum and have incorporated preventive care in all clinical modules.

We conduct regular recruitment and retention efforts to reach out to overseas Singaporean medical students studying in medical schools recognised by us. We provide them with details on applying for jobs in Singapore and offer them Pre-Employment Grants to help with their school fees, in return for being bonded to work in our public sector healthcare institutions. We also offer, as appropriate, housemanship training positions or more senior jobs. Our aim is to facilitate as many of them as possible to return home. Overall, about 200 overseas trained Singaporean doctors come back every year.

Mr Edward Chia asked about telehealth providers. Telehealth will be an important enabler. In line with this, we will also consider how remote providers, without standard in-person clinic facilities, can be included. We will share more on how GPs can leverage telemedicine to offer regular check-ins for their residents under Healthier SG in future.

Let me also address Mr Ang Wei Neng and Ms Denise Phua's queries about doctors on company panels. We need to ensure that as many GPs as possible who are on employer panels join Healthier SG. The Singapore National Employers Federation (SNEF) and NTUC, employers and union leaders agree that they will need to get more of their panel GPs to join the Healthier SG programme.

What does this mean for an employee? If most panel clinics are on Healthier SG, the employee can benefit from Healthier SG benefits and employer medical benefits when they enrol with a Healthier SG provider that is on their employer's panel. If and when they change employers or retire, they can stay with the same clinic and continue to enjoy the Healthier SG benefits. These Healthier SG benefits will build on top of the employer medical benefits.

Regardless of the coverage of the employer medical benefits, employees on Healthier SG will receive a free consultation on their health plan and will be encouraged to complete the free nationally recommended screening and vaccinations.

With effective preventive health, some employers may see savings in employer medical benefits. SNEF has been urged to plough back these savings into other health and wellness programmes to enhance the health of employees and SNEF is supportive.

Mr Ang Wei Neng asked about the family physician requirements and how it will impact solo clinics. The intent is for all participating clinics to have at least one family physician per clinic. There is a seven-year runway to achieve this. PCNs support clinics in their network to achieve the requirements for Healthier SG and AIC can also provide support to clinics. We will find ways to facilitate the participation of solo GPs in Healthier SG.

Dr Tan Wu Meng and Ms Joan Pereira raised concerns about the administrative burden of data submission and whether the IT systems would adequately support the work of GPs. Many GPs we engaged also highlighted the importance of IT and that the systems need to be improved. We will work closely with GPs and their IT vendors, this work has already started with GPs and their IT vendors, to support the enhancement of IT systems, to simplify administrative processes, improve data flows and sharing – all while ensuring data security.

The indicators that will need to be submitted for outcome tracking and remuneration have been streamlined, taking reference from existing clinical indicators that doctors would routinely document and track, in their own records, to deliver good care. We want GPs to use a Clinic Management System (CMS) that supports their daily operations well and connects to all the key public health IT systems. And this then, will save them time on administration so that they can focus on the patients. We are working closely with the commercial CMS vendors to improve their products and strengthen their backend services.

Some GPs today continue to use pen and paper services, we will provide them an interim web portal, for them or their staff to enter the essential information while they adopt a CMS and we have given them some time to do so.

We know that it is not easy for GPs to upgrade to an IT system that is Healthier SG compatible, and they will have one year from the launch of Healthier SG to adjust. We will also provide a one-off IT support grant to support this transition. MOH and AIC will continue to support GPs in this process. We want them to come on board Healthier SG.

Our plans will require a close collaboration among family doctors, the healthcare clusters and a wide range of service providers. However, the use of IT and record-sharing differs widely, hindering coordination and communication across partners today. Going forward, to deliver Healthier SG, we must transform how we communicate and share data for more holistic, integrated and coordinated care. Ms Mariam Jaafar and Dr Tan Yia Swam spoke about this.

One key tool will be the National Electronic Health Record (NEHR). NEHR will capture summaries of patient medical records in one platform. Those healthcare workers who need it to support the clinical care that they are delivering, such as family doctors, will be able to draw from, and contribute to, a common platform.

We have put in place controls to restrict the access to sensitive health information to selected user groups only. There are also additional authentication processes for the sensitive health information and we audit the access to this set of information. We will continue to implement safeguards to balance patients' need for privacy and to ensure that the correct healthcare providers are able to access critical information necessary to provide care to patients.

We will introduce new legislation, the Health Information Bill, in 2023. This Bill will facilitate the proper collection, use and sharing of health data among healthcare providers in a safe and secure manner. This includes our healthcare clusters who will serve our residents as regional health managers. Only authorised personnel will be allowed to access the data, which will be limited to what is necessary for their work. MOH will be seeking feedback on the Bill later this year and we look forward to hearing your views.

Ms Mariam also highlighted the importance of data analytics. Data-driven intervention is indeed our intent. We will continue to work with clusters and partners to share data and deploy such capabilities to help our residents. It is important therefore that we set up the NEHR, with the safeguards and obligations spelled out in the proposed Health Information Bill.

We are strengthening the IT platforms, the services and the connections across all the partners: family doctors and healthcare clusters. I thank the many IT teams, public and private, who are collaborating on this. It is with their help that we will improve the flow of data, impact health outcomes and optimise the user experience for residents and our healthcare providers.

I am glad that Mr Xie Yao Quan has also highlighted the importance of having sufficient IT and cybersecurity talent. While we have built up expertise, a key challenge remains to attract and retain skilled IT professionals in a competitive market. We will continue to remunerate competitively. We also hope that healthcare IT colleagues see the contribution they make and the fulfilling career they can have in transforming our system, caring for our society.

Ms Ng Ling Ling suggested that more comprehensive health screening is needed as we move towards preventive health and Mr Abdul Samad further suggested more MediSave utilisation for this. We take guidance from the recommendations of the Screening Test Review Committee. This guidance is based on scientific evidence to ensure that screening tests are safe, effective and suitable for population level screening, means it applies to everyone across the population. We need to strike a balance, to balance the practice good preventive care, but consider what the test involves, without going overboard. In some cases, some of the tests, some of the screening tools, are better applied to targeted population. It may be better for some cases to take a calculated, risk-based approach, to offer tests that are effective and easy to administer to high-risk groups. One example is what we are doing for those aged 50 and above, such as with the 2-day Faecal Immunochemical Test (FIT) which is for colorectal cancer.

So, there are some tests which the science suggests we should apply it to the entire population and there are some tests which the science suggests we should apply to targeted population. We will continue to review emerging scientific evidence on these screening tests as well as the effectiveness of our financing models. Fundamentally, access will not be denied to those who need it.

Ms Janet Ang asked about regular eye and dental screening. These are important, we must look after our teeth and have our eyes checked, and most of us do so. The screening processes and tools are less appropriate as a mass exercise for all under the population approach for Healthier SG and again, are more suitable as targeted effort for certain groups of Singaporeans.

Healthier SG is a multi-year effort, we will continue to review and include other necessary care protocols in future. Meanwhile, to reassure Members of the House, regular oral health and eye screening programmes are already easily and readily available as a routine service in many settings, and we will continue to offer these. For example, Project Silver Screen conducts check-ups for seniors at community locations for age-related decline in vision, oral health and hearing, so that they do not have to visit a clinic or hospital, and so that timely interventions can be provided. Likewise, we would like to assure Mr Dennis Tan that there are already similar preventive dental health programmes in place.

To Mr Abdul Samad's comment, there are nationally recommended health screening tests widely available at CHAS GP clinics, polyclinics and participating community providers. In future, Singaporeans should go to their enrolled clinic to enjoy free screening.

Finally, let me address mental health and well-being, a topic important to many we engaged during our public consultation. Several members such as Ms Tin Pei Ling, Ms He Ting Ru, Dr Wan Rizal, Mr Melvin Yong and Mr Dennis Tan have also raised this. Good health is also about good mental health. The current planned interventions under the first phase of Healthier SG will support mental well-being. People have asked when will we start to look at mental well-being? Yesterday – actually, years ago! The interventions we already planned under Healthier SG, starting with our initial emphasis on eating well and regular exercise, will have a positive effect on mental health. But allow me to also highlight what we have put in place over the last few years to promote mental health and well-being, even before Healthier SG.

To raise mental health awareness, we have developed MindSG, a trusted online resource portal that provides comprehensive and current information on mental health. To improve access to community mental health services, we developed Community Outreach Teams (CREST). We have the redeveloped Alexandra Hospital coming up, which will provide psychiatric services. The National Addictions Management Service at IMH will be extended to other hospitals, including Changi General Hospital and National University Hospital, to make the services more accessible.

We have been working closely with AIC and GP partners to have more GPs provide mental health support. As of March 2022, there were over 390 GP partners trained to care for persons with mental health conditions in the community.

We have convened the Interagency Taskforce on Mental Health & Well-being with members from over 30 organisations. The task force has reviewed our mental health needs and identified four focus areas. First, to strengthen services and family support for parents and youths. Second, to provide and improve access to quality and affordable mental health care by integrating health and social services. Third, to provide employment support for persons with mental health conditions. And four, to improve mental health literacy among the citizens and create an inclusive society for persons with mental health conditions.

We have completed our public consultation on the issue of Mental Health Strategy in August. Members of the public and key stakeholders have shared their feedback, and we are now refining the recommendations. The task force will share its findings soon.

Mr Deputy Speaker, Sir, a Healthier Singapore requires a whole-of- society approach. We need the support of all healthcare professionals, the healthcare clusters, community partners and many more. We need to, and will, put in place systemic enablers for this challenging set of reform to succeed. Ultimately all of us need to also play our part in taking some responsibility for own health and change our behaviours. By working together, we can improve health for all of us. [Applause.]