Debated in Parliament on 4 Oct 2022.
Debate resumed.
Mr Xie Yao Quan.
Madam, in 2020, I said in my maiden speech in this House, during the thick of COVID-19, that while we worked on the immediate task at that time of flattening the epidemic curve, we also needed to keep our sight squarely on our longer-term health care challenges and bend our long-term healthcare cost curve.
Today, we are debating a new health and healthcare strategy for Singapore, laid out in the White Paper on Healthier SG.
The last time MOH published a White Paper was 30 years ago. That paper was on affordable health care and it was a landmark paper that went on to define the development of our healthcare system over the last 30 years.
Thirty years on, we have this White Paper on Healthier SG. And I believe it will be no less of a landmark paper, providing an additional strategy – a strategy reboot – for a vastly different population with very different needs and against the backdrop of a Government healthcare budget that has increased many times in the last 10 years.
This White Paper shows how urgent and important our challenge of bending the healthcare cost curve is. I stand in support of the Motion. I had two key considerations in mind as I prepared this speech.
First, because the challenge before us is so important and so urgent, we must take a thorough and critical look at every piece of the Healthier SG strategy and leave no stone unturned. In this regard, I will make quite a number of points in my speech. But second, I will focus only on the strategy – and the key strategic pieces – and set aside for now questions that are of a more operational nature, even if there are a number of these.
With this preamble, let me lay out my views on the White Paper on Healthier SG.
First, Healthier SG must be inclusive because it goes to the heart of our social compact, and our social compact must, in turn, be for all Singaporeans. On this point, I have three key questions.
How do we ensure Healthier SG is inclusive socio-economically? We know the lower-income segment has poorer health outcomes and a lower propensity for health-seeking behaviours for various reasons. Therefore, I wished the White Paper had included specific mention of how we plan to support our lower-income segment through additional, differentiated measures to remove the particular barriers to health-seeking behaviours that this segment faces.
For example, because travelling distance may be an especially salient barrier for this segment, do we need to be particularly deliberate in ensuring proximity of family doctors in both GP clinics and polyclinics to our rental communities?
How can we improve seemingly basic things like nutrition, sleep and smoking cessation through targeted interventions for this segment because these things may not be basic for them?
How can we help this segment find time and cognitive bandwidth to exercise, when time and cognitive bandwidth may be particularly scarce for this group?
Who will have primary responsibility to pull all the assets together to wrap around the enrolled person?
I wish the White Paper had provided some insights to these questions.
The second question that I have is how do we ensure Healthier SG is inclusive digitally? The Healthy 365 app will be the "digital front door" for citizens to enrol with a family doctor and Healthy 365 will also be the "digital front door" for capturing individual behaviour, for tracking progress and for generating healthpoints in exchange for rewards.
But we know that a number of seniors have dropped out of exercise groups when these groups went onto Healthy 365 for the sign-up and bidding of slots. They dropped out because they did not know how to do this on Healthy 365.
Seniors have also given lots of feedback about polyclinics and their recent shift towards more and more of an appointment-based system in lieu of walk-ins. Seniors wonder how they go about booking polyclinic appointments online or on mobile? If they call the hotline, what number should they call? How long do they have to wait for their calls to be answered? A "digital front door" in Healthier SG can well become a "digital gate" for some and we have to avoid that.
The White Paper further mentions HealthHub as the second "digital front door" for every individual's health action plan. But each of the three healthcare clusters also has its own app – its own "digital front door". So, put together, these could add convenience to users but they may also confuse them.
The point is: while digital is essential and we must have digital channels, we have to also preserve traditional touchpoints. In other words, we must provide optionality in the key touchpoints of Healthier SG. Optionality by providing both traditional and digital options rather than substituting the traditional with the digital. We need optionality as a core design principle of key Healthier SG touchpoints.
The third question I have is, how do we ensure Healthier SG is Inclusive for All Healthcare Professionals? I did a word count. The word "doctor" was mentioned more than 160 times in the White Paper, unsurprisingly. Compared to "nurse" and "nursing", which were mentioned 22 times, "pharmacist" was mentioned six times and "allied health", seven times. So, the doctor appears overwhelmingly to be the centre of gravity in the Healthier SG strategy, but what about the roles of a nurse, a pharmacist and an allied health professional?
Is there room for more equal roles, more co-leadership to shape preventive care in the community? Because, let us pin the flag squarely on the mast. The focus of Healthier SG is chronic diseases. Prevent chronic disease onset in the first instance and if disease is inevitable, manage these diseases well. So, it is not complex medicine per se, but medicine that is person-centred, relationship-driven and certainly high-value. And in this respect, nurses are very good at titrating medication and at engaging, motivating and cajoling. These are key activities in preventing chronic diseases and in managing chronic diseases, that nurses can be very good at.
And in comparison, what is more exclusive to doctors is the gestalt to diagnose diseases and to provide prognoses of disease trajectories. So, I wish we had a fuller articulation of the vision for nurses, pharmacists and allied health professionals, including medical social workers, in the overall Healthier SG strategy – all practicing at the top of their respective licenses in the community, alongside doctors, to prevent and manage chronic diseases across our population.
And I think we also need a mindset shift in our population, from a doctor-centric view to one that respects all healthcare professionals including nurses, pharmacists and allied health professionals, and what they can do.
In summary, my first broad point: our Healthier SG strategy needs to be inclusive socio-economically, inclusive digitally and inclusive for all healthcare professionals.
My second broad point is that manpower planning will be key in Healthier SG. The most natural question in this regard is how many family doctors, nurses and so on, would we need to fully realise the strategy, but I prefer to leave this to MOH's COS debate next year. I think that would be the best time to discuss manpower numbers.
Today, I would like to raise some other points about manpower planning.
First, for the public healthcare sector, we need stability to become a key principle in manpower planning. Family doctors and physicians in our public polyclinics will take on a significant portion of the Healthier SG workload even as we enable GPs to step up and to do more. So, within the polyclinics, I would like to ask what happens to enrolment arrangements when family doctors and physicians within these polyclinics move, get rotated or cross-deployed, as they routinely do. Do patients move with the doctors? Fundamentally, are Singaporeans going to be enrolled to a polyclinic or to a particular doctor within the polyclinic?
May I boldly suggest that we need less rotation and more stability in our manpower planning for all polyclinics across all three healthcare clusters in order for Healthier SG to work as it should?
On a related note, may I suggest even more boldly, that clinical manpower recruitment, posting and deployment in general across our three healthcare clusters, should be centralised at the Ministry level going forward? Currently, the healthcare clusters have principal responsibility for this strategic manpower function. Taking this responsibility off the clusters and moving it to the Ministry level will ensure a coherent manpower planning strategy nationwide in support of national desired outcomes, and as importantly, this would free up strategic bandwidth within the clusters for them to step up to their very important new roles and responsibilities as regional health managers under Healthier SG.
Besides clinical manpower planning, we would need equally robust manpower planning for our cybersecurity and healthcare IT talent. As the White Paper noted and many Members have noted, IT is a critical enabler and quite often a pain point. But the competition for tech talent has never been more intense and will probably intensify further. So, how does the Ministry plan to manage the competition and secure the healthcare IT and cybersecurity talent it needs to deliver on Healthier SG?
We need to get this right, because this is about securing public trust in the protection of their healthcare data, and it is also about securing the trust of professional users in the usability and inter-operability of our healthcare IT systems.
In summary, my second broad point about manpower planning for Healthier SG: we need this to enhance clinical manpower stability in polyclinics, we need to free up strategic bandwidth for healthcare clusters and we need to secure critical IT talent.
My third broad point is: let us remember to integrate downstream even as we look to integrate upstream. It is timely and apt that Healthier SG emphasises upstream interventions, primary care, preventive care, collaboration between GPs and community partners to promote health. All this is good, but we also need to pay an equal amount of attention to integrating much more downstream. In other words, strengthening the integration between GPs and specialists that are based largely in our hospitals.
GPs have spoken of the need to become more equal partners in care, vis-à-vis their specialist counterparts. GPs want to feel that after a referral is made to a specialist in a hospital, there is tight two-way communication and the loop is closed, and GPs do not feel like they are losing their patients to the system, and in the system. Of course, details about such integration between GPs and specialists ought to be worked out by the healthcare clusters but I wished the White Paper had made a stronger mention of our larger, strategic intent in this regard.
For Healthier SG to really tackle chronic diseases across our population, we need to integrate much more, both upstream and downstream, across the health and healthcare value chain and address all archetypes, including those with more advanced diseases and requiring more specialised care.
My fourth broad point: on healthcare financing, our reforms can go further to truly drive integration. Ideally, capitation funding to GPs should flow through the healthcare clusters rather than from MOH, as is currently proposed in the White Paper. Capitation funding to GPs through the clusters will drive fuller integrations between GPs and the clusters as regional health managers. We should aspire to – as many Members have mentioned – the UK model for example, where GPs can eventually refer patients for direct admission to a hospital within a healthcare cluster, without the need to go through an Emergency Department, for clinically appropriate cases.
I hope as we progress in this multi-year Healthier SG journey, we will keep pushing the boundaries on healthcare financing as a key lever to drive integration and what is currently described in the White Paper will not be become our eventual end-state.
My last broad point on Healthier SG: in certain aspects of the strategy, let us avoid optimising at the margins, only to blunt the tip of the spear. What do I mean? The Motion before us today has only three limbs and community-based programmes are one of the limbs. In fact, the White Paper also emphasised that, "good health is sustained through everyday choices and habits, which take place outside healthcare facilities" – outside the clinic. So, community-based, health-promoting programmes are a centre of gravity of Healthier SG.
These programmes in the community are what I would call "the tip of our Healthier SG spear" and as Minister mentioned in his opening speech, they occupy that space and the time between the visits to the clinic, to the GP, so they are really important. They are the tip of our spear and we must keep it sharp. Keeping it sharp means amongst other things, ensuring that there is adequate funding to this part of the strategy, and as importantly, we need to rethink how we measure effectiveness and efficiency of such funding.
For example, exercise groups by HPB had emerged with a vengeance since we opened up and residents have really welcomed this. But recently, there has been concerns amongst residents that some of the exercise groups by HPB could be cut or consolidated away because they are not hitting and maintaining a certain attendance rate. If the purpose of these exercise groups is simply community programming, then I would agree with this approach because we need to be prudent.
But if such community exercise programmes are so important in Healthier SG, if these programmes are the tip of our Healthier SG spear, then we need a different approach. We need to have K-pop classes available in the mornings and evenings on weekdays and on weekends. We need to have Zumba and Stretch Band and HIIT classes equally available, mornings or evenings, weekdays or weekends.
We need each and every local community to be abuzz and completely teeming with community exercise groups and health promoting activities catering to the entire range of needs and lifestyles within the community. This will really bring Healthier SG alive in the community and send a strong signal to residents that we want them on board, even if this may mean some redundancy or unused capacity at the margins.
Mdm Deputy Speaker : Mr Xie, you have one minute to round up.
Mr Xie Yao Quan : Indeed, we should welcome such redundancy and it could serve as a useful buffer. If we focus instead on optimising capacity and funding efficiency at the margins for these programmes, we will blunt the larger intended purpose of the programmes under the Healthier SG strategy.
I will make one last point about the community and that is eating and food choices in the community. Member Ms Hazel Poa suggested taxing unhealthy food to subsidise healthy food. And I would just like to ask her for clarifications about her specific ideas for taxing unhealthy food and in the larger spirit of Healthier SG, having heard the essence of the strategy, whether she feels that, an intervention like taxing unhealthy food would cohere with the overall spirit of the strategy and is still a good idea.
Madam, let me conclude. In the White Paper —
You have two seconds.
— one family doctor was quoted as describing Healthier SG as "our great leap forward for primary care and preventive care for chronic conditions." But a "great leap forward" may not end up in success. So, I prefer to see Healthier SG as a "moonshot" for SG Healthcare.
And when JF Kennedy resolved to send a man to the Moon, he said, "We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard." Indeed, Healthier SG entails hard work ahead for us in this decade, very hard work. But this is precisely why we must do it, and we will do it together to secure a better and healthier future for all Singaporeans.
Mr Abdul Samad.
Mdm Deputy Speaker, as a union leader and representative of fellow workers, I rise in support of this Motion to drive towards Healthier Singapore.
This Motion clearly emphasises the need for and the importance of living healthily to start at a young age. This will then pave the way for healthy daily living and mobility as we grow old to enjoy the fruits of our hard work during our early age. Furthermore, unions also want to ensure that our fellow workers can continue working beyond the retirement age, knowing that one of the criteria is about the medical condition of the worker.
My speech today will cover the role of unions in strongly focusing on preventive care and building strong partnerships with community partners to support our fellow workers who are taking care of their own health and wellness.
Madam, I am not sure how many in this House or members of the public know the complete suite of benefits our unions provide in supporting our fellow workers. While many may be aware of the workplace grievances handled and social benefits provided by our NTUC social enterprises and affiliated merchants, unions do so much more than that. Of the many cases that unions handle, only about 10% are on workplace grievances. Hence, we need to provide unique, value-added services to the remaining 90% of our members, one of which is to provide support and subsidies for our members in terms of health and wellness.
Unions continuously innovate to serve our members better because, for the unions, it is "Members First, Workers Always".
Allow me to enlighten the House on the three different ways that our unions and our leaders have supported members and workers in the preventive healthcare journey.
This role is not new to the unions. Minimally, we encourage our management partners to provide regular complimentary health screening for our members and workers. Regular health screening is critical to identify any symptoms of sickness that each worker has, and they could then be provided with the necessary early intervention measures before the sickness worsens.
While providing these complimentary health screenings looks simple, mobilising and encouraging workers to take part is never an easy task. There were times when some management partners wanted to discontinue this, due to the low take-up rates, but our union leaders rejected strongly and worked with management partners, to maximise outreach efforts to increase and optimise participation.
Allow me to share some examples of two unions that have gone beyond what their management partners do for their workers.
First, is the Union of Security Employees, in short, USE, which has set up a healthcare advisory booth provided by the HPB at their customer service centre for any member to walk in and request for assistance. These members take the opportunity to know and understand health advisories while waiting for their turn to be called up.
Another example is one of mine, the Union of Power and Gas Employees, in short, UPAGE. We started this movement many years ago with one of our management partners. Initially, our members were offered $50 if they chose not to take any medical leave for the year. We have replaced that with an annual health screening worth close to $150.
We are happy to share that most of our represented companies today provide basic complimentary health screening for our workers either at their workplace or at a designated healthcare or medical centre to provide that flexibility for the workers.
In addition to this, UPAGE started to provide additional subsidy since 2018 to encourage our members to go for additional testing during their health screening. This subsidy ranges from $50 to $100 per member, depending on the cost of additional tests that our members would like to take. We are pleased to share that we have supported more than 2,200 members with a total subsidy of more than $150,000 as of today and we intend to reach out to more members. We are only able to do this because of our close partners' strong support and generosity for workers in the power sector.
Please note that this subsidy applies to UPAGE members only, not for all. With so many support measures and subsidy provisions, I always believe that the union membership fee would be beneficial to all, if not many.
Hence, I would call on the Ministry to acknowledge and work together with the Labour Movement and our affiliated unions as one of your community partners to reach out, engage and encourage our fellow workers to strive for a healthy lifestyle. This will then align with the Government's vision of Healthier SG.
At this juncture, I would like to put forward four requests to the Ministry.
First, can the Ministry provide a guide on the kind of medical checks that everyone should prioritise for their own well-being at different age groups?
Next, can the Ministry provide more designated centres for our fellow Singaporeans to do their health screening?
Can the Ministry also allow an individual to use their MediSave for additional medical checks that they want to do for their own well-being?
Finally, can the Ministry provide an enhanced infographic that not only states the risk of poor health but one that instils the importance of starting a healthy lifestyle at a very young age? Madam, I will speak in Malay.
(In Malay): [Please refer to Vernacular Speech.] This Motion, that calls us to strive towards a healthier society, is the right move. It will help us to achieve a healthier life compared to a situation where we have to suffer in pain, regardless of whether we are young or old.
Among the challenges that our society faces are diabetes and being overweight, just like me, which can lead to various other diseases. However, this must be changed from early on. We must gradually change our eating habits that always crave for sugary drinks and fatty food, so that we will choose less sugary drinks and healthier food, as well as consume lesser portions.
I have personally witnessed family members, relatives and friends who had to live in pain at a young age, as early as their thirties, suffering from various diseases, such as diabetes, high blood pressure and so on. There is an Arabian proverb which says that every disease has its cure except death, but that does not mean that we should let ourselves go until we get sick, and then we start to get medication.
It is certainly very challenging to change our unhealthy habits into healthy ones. However, we must accept that this change is meant for our own good. We also do not want to trouble our children when we get old, whereby, they need to take care of their sick parents and have difficulty leading their own lives. Let our old age be full of healthy activities, such as playing with our grandchildren and taking care of them, being able to walk to the mosque and so on.
All these can be achieved by ensuring that we lead a healthy life from a young age. It is true that death can happen at any age, but a healthy and active body and mind will be more beneficial for us. Let us not leave our twilight years to chance, but instead, we ensure that we remain healthy for ourselves and for our loved ones.
(In English): Madam, many of us would acknowledge that good health is the real wealth. It is one where we can enjoy benefits of our hard work, instead of sacrificing our savings and wealth to pay for our medical costs.
Let us work together to eat healthier food and adopt a healthy lifestyle so that we can all achieve our mission towards a Healthier SG. In conclusion, I support this Motion.
Mr Edward Chia Bing Hui.
Mdm Deputy Speaker, the Healthier SG White Paper is timely and critical for all Singaporeans today and augurs well for our long-term sustainability. The White Paper has set a bold direction and has completely redesigned the way we deliver healthcare – from one that is reactively caring to one that is proactively preventive. This is a sea change.
As we are more user-led in solutions, we will be better able to identify patterns and similarities where solutions can be scaled up. Prioritising those above 55 is crucial, given that about one in four Singaporeans will be 65 years old and older in 2030.
This White Paper shows our ability to turn a potential adversity of the silver tsunami into a possible silver lining.
We cater to our seniors first and eventually scale this to a nationwide system for those above 40. In time, I hope this would be scaled up to all Singaporeans.
Most importantly, Singaporeans now know that this Government will co-design a preventive health plan with them. This partnership will require every Singaporean to play their part in co-solutioning. I rise in support of the White Paper on Healthier SG.
Gathered ground sentiments largely welcome this initiative. Many are pleased with the preventive measures in place. To enhance this White Paper, some came forward to share their opinions, which will be categorised into two main sections.
First, I will share concerns from the perspective of the individual Singaporean, following which, I will touch on ecosystem partnerships that are required to scale up Healthier SG.
I will now touch on the ground sentiment from residents I have interacted with. With regard to the national enrollment programme, it was stated that Singaporeans will be allowed up to four changes in the initial enrollment period but it was unclear how long the enrollment period would be. Furthermore, would there be a need for Singaporeans to indicate a reason for wanting to switch clinics?
Given the increasing levels of tech literacy, Singaporeans are also turning to virtual doctor appointments and companies are offering such services as part of their medical benefits. Would the Government consider this group of GPs in terms of medication subsidy and capitation funding?
Whether it is changing GPs or being able to access virtual clinician services, it will be very important for this programme to allow Singaporeans to make choices at key life stages.
Indeed, while the GP would be the critical first touchpoint in this relationship, it would be ideal for individual Singaporeans to have a fitness coach who can journey with him or her on a regular basis. A little exercise goes a long way and the new Singapore National Physical Activity Guidelines launched by national bodies Sport Singapore and the Health Promotion Board rationalise official guidance towards healthy activity.
Having access to fitness coaches would allow for a deeper collaboration between MOH with SportsSG, HPB and People's Association, especially with the vast range of community fitness centres that the Government has invested in for Singaporeans over the years.
By understanding that every Singaporean will need a fitness coach or ambassador or advisor nearer to where he or she lives to execute this preventive health plan, we keep our communities close to our Singaporeans. Much like the relationship between a resident and a GP is a personal one that takes into account individual preferences, so will the relationship be with a fitness coach.
To provide Singaporeans with greater choices, would MOH look into collaborating with private fitness service providers? As these service providers are all across the island in different fitness centres and gyms, they are well-placed to provide community care. MOH could also consider engaging self-employed persons (SEPs) with domain expertise as Healthier SG ambassadors and health coaches.
Such approaches will, in turn, encourage diversity of offerings to cater to different individuals and tap on expertise and knowledge in the private sector. It would be a missed opportunity if we do not harness the choice private sector and self-employed individuals provide to Singaporeans.
This will keep Healthier SG relevant to our citizens' preferences and also enable new innovative services like digital clinician services to participate.
At the systems level, designing this programme to have high inter-operability with innovative delivery models will enable Healthier SG to tap on the private sector's ability to discover leaner and effective models of preventive healthcare. This will ensure longer-term success, especially with the backdrop of manpower constraints and rising costs.
Next, I will touch on the ecosystem partnerships that are required to scale up Healthier SG.
As shared, employers are providing employees with medical care plans. Healthier SG's proactive, preventive approach needs to harmonise with employers. The strong support of the Singapore Business Federation and the Singapore National Employers Federation will be needed to help companies to remodel corporate health plans with this new approach.
One question for clarification will be how the Ministry intends to work with employers in assisting their employees to enrol in family doctor national enrolment programmes. Many Singaporeans rely on the provision of medical benefits from their employers and are restricted to a fixed panel of doctors. Also, in some cases, such services are provided by corporatised clinics where doctors are less rooted to a specific clinic or location. Another added complication is when an employer changes healthcare providers or when an employee moves to a new company.
While Singaporeans can choose to see the panel doctors for episodic care despite enrolling in the national programme, it derails from the core idea of keeping to one primary care doctor, limiting the true benefit of having a dedicated family doctor.
The area of interest of Singaporeans will be the co-payment or full payment by their employers under their existing employment contracts. Employers need to embrace Healthier SG so that every Singaporean feels assured that this is in line with their personal healthcare journey.
This is all part of an evolving workplace environment and, as such, MOM needs to work very closely with MOH for this initiative.
Another key ecosystem partner in the provision of healthcare is insurers. MOH and the monetary Authority of Singapore (MAS) should encourage the Life Insurance Association to find sustainable ways to integrate this to an individual's MediSave-related policies.
Such preventive efforts need to be rewarded and if our insurance actuaries can understand the percentage of population making serious efforts to live better, their calculations of risks need to take this into consideration. For example, those with committed healthier plans should not be paying as much when premiums increase with age. Such co-related pricing will make our Integrated Plans relevant and useful. This would provide another incentive for individuals to take charge of their preventive health plan.
Mdm Deputy Speaker, the business model enabling the provision of healthcare services is still largely based on reactive care. As we take the bold step to shift the model to one of preventive care, we will need to engage various aspects of society, including employers and insurers, to recalibrate various cost calculations and incentives.
Mdm Deputy Speaker, I have touched on two main sections in my speech.
First, on the micro level, let us place individual Singaporeans first in this journey by providing virtual doctors and fitness coaches by tapping on the private sector for more options.
Second, at the macro level, let us engage employers and insurers in recalibrating benefits, costs and incentivise them to better align with our model. The easier we make this to follow, the more we can guide Singaporeans to a society where we can all keep costs sustainable, maintain a comfortable standard of living and, most importantly, age well in the decades to come.
Ms Ng Ling Ling.
Mdm Deputy Speaker, I would like to first declare my role as an independent consultant in healthcare transformation projects.
Madam, I give apples to Jalan Kayu residents at every house visit from the start of this year. This gives me an opportunity to share with them about healthy living, a key theme that I promote in Jalan Kayu besides sustainability and intergenerational bonding. An apple a day keeps the doctor away – this 19th century proverb sounds simple, but it is not always easy to follow.
In my COS speech in March, I spoke about my concern for the increased prevalence of chronic diseases, such as high blood pressure, high blood sugar and high cholesterol in our population, not just amongst our seniors but also in some of our younger people.
I recognise that our national Budget for healthcare will inevitably have to increase in order to create better health and quality of life outcomes for our people. But I also suggested to manage the workload on our healthcare professionals by empowering Singaporeans to take more ownership of our own health and participate whenever possible with our healthcare professionals on our treatment or health plans.
I thus read the Healthier SG White Paper with great delight, that we are, indeed, embarking as a nation towards a much healthier way of living, with stronger emphasis on preventive care, building relationships and trust with our family doctors to maintain our health, supported by each of our own community, right in our neighbourhood. This is a transformative healthcare policy, in my view.
It will also require a transformative mindset from our people to fully reap the fruit of this healthcare policy breakthrough. But we can take heart that we will have our neighbours to walk the journey ahead with us together. For my Jalan Kayu residents, you have your Member of Parliament who will walk this journey with you.
All good policies can only be as good as how well they are implemented. That is when the tyres hit the road, so to speak.
I will focus my speech on clarifications with MOH on three implementation considerations. One, awareness of subsidised preventive health screening; two, enhance community partnership and participatory approach to collective health; and three, enabling seniors through simplifying healthcare technology.
Firstly, I would like to know how MOH will be tracking and reporting the usage of the enhanced subsidies provided under Healthier SG to encourage Singaporeans to adopt more preventive health behaviours. The White Paper outlined MOH's plan to fully subsidise nationally recommended vaccinations and screenings as well as an onboarding health consultation with their chosen family doctors upon enrolment.
I would like to clarify what types of vaccinations and screenings will be fully subsidised. Are they those that are under the existing Screen for Life programme or will there be more added under Healthier SG? What is the participation rate for Screen for Life for Singaporeans above 50 years old currently? And what improvement does MOH aim to achieve under Healthier SG?
From my Meet-the-People (MPS) experience, whenever I asked my residents in need about their awareness of Screen for Life programme, I will usually draw a blank look. For the handful who may be aware, they would admit to me their fears of finding out illnesses that will cost them more to treat and affect their jobs.
I believe for preventive health behaviours to improve significantly in Singapore, MOH must invest more in creating the right awareness and assurance of benefits of preventive health screening and a follow-through care that Singaporeans can expect. This should be done in more mass media and vernacular languages, including even some dialects, to correct the misinformation that screenings will lead to more problems.
Secondly, I would like to propose strengthening the community participatory approach so that our busy family doctors, whether they are practising in the GP clinics or polyclinics, would know and have quick ways of connecting with their community, sports and social service counterparts when they see patients that need support beyond medical treatments.
The White Paper proposed to rally a group of community care partners to support residents in leading healthier lives. The White Paper mentioned the People's Association (PA), SportsSG and Agency for Integrated Care (AIC)'s Silver Generation Office (SGO) to help organise healthy living programmes for residents. It also mentioned plans to tap on the eldercare centres to serve as the community care connectors for seniors, to help them follow through the recommended lifestyle interventions prescribed by their family doctors.
Although I am fully supportive of this approach after speaking with a few GPs in my Jalan Kayu constituency since the release of the White Paper, I noted their concerns on the bandwidth to activate such community partnership to care for their patients who are my residents. There were also questions on seniors who are living in the private estates, such as those who are living in the Seletar Hills East and Jalan Kayu private estates where some of my older residents live. The existing eldercare centres are usually located nearer to rental blocks of each constituency. I would like to ask how MOH will also support the social prescriptions by family doctors for the senior residents living further from eldercare centres, including those living in the private estates.
Lastly, I understand that enrolment will start next June, beginning with our older residents aged 60 and above first. This is good as we should always prioritise the health of our seniors first, given their higher risk of developing health challenges.
The White Paper proposed the HealthHub app and Healthy 365 app as the digital front doors of Healthier SG to encourage and nudge residents to adopt healthier lifestyles. I understand that the HealthHub app will have a digitally enabled health plan where residents can access and check their health outcomes. This will be complemented by the Healthy 365 app which allows tracking of physical activities and diets, as well as supports their access to community activities.
Like fellow hon Member Dr Tan Wu Meng, several studies that were published between 2020 and 2021 shared that there is lower interest in adopting mobile health applications and digital health services amongst seniors despite the convenience that it presented during the COVID-19 lockdown.
Thus, I would like to clarify with MOH on the current adoption rates for these two apps by the senior population above 60 years old. And if the take-up rates have been low, similar to my fellow hon Member, Ms Denise Phua, I would like to ask how MOH intends to help our seniors utilise these two apps after they have enrolled with their family doctors under Healthier SG. Mdm Deputy Speaker, please allow me to say some words in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Prevention is better than cure. Not only does this phrase demonstrates our understanding of preventive care, but it is also the core concept of the Healthier SG White Paper.
Through preventive care, we can help every Singaporean improve their health and quality of life. In our ageing society, preventive care can also reduce the cost and burden on the healthcare system and individuals. If you want everyone to be healthier, we must empower them.
Therefore, I strongly support the initiatives put forward in the White Paper.
At the same time, I would like to make three suggestions to the implementation of Healthier SG to help residents better accept preventive care measures to improve their health.
Firstly, I hope that MOH will provide more public education and information on benefits of preventive screening to encourage residents to undergo screening.
MOH currently has the Screen for Life programme which covers chronic illnesses and some common cancers, for example, colorectal cancer. I hope that MOH will further strengthen public education under Healthier SG, and even use Malay, Tamil or even dialects to reach out so that more Singaporeans, especially the seniors, will understand the benefits of preventive health checks.
Secondly, I also hope that MOH will work with the GPs and the community partners to empower residents to complete their own health plans, using more of the Community Participatory Approach.
In the community, we should also have the regional health system to help identify common illnesses in each local constituency through the coordination of the three regional healthcare clusters, and work with Government agencies such as the People's Association and SGOs, as well as the residents, to organise healthy activities that benefit the residents. In this way, residents will be able to take ownership of their own health, making it easier for them to accept preventive care. This will also help to strengthen the Healthier SG ecosystem.
Finally, I hope that MOH will be able to improve the HealthHub and Healthy 365 mobile apps to make them more accessible for the seniors under Healthier SG. I also hope that MOH will work with IMDA to promote HealthHub and Healthy365 apps through the IMDA's Senior Go-Digital Scheme and teach the seniors how to use these two apps and introduce their main functions. I hope that when the seniors experience the benefits of using these apps, they will help promote Healthier SG through word of mouth.
[Mr Speaker in the Chair]
(In English): In closing, I would like to speak up for a group of healthcare professionals who have become my friends in my four-and-a-half years of involvement in the healthcare sector. They are the family doctors working both in GP clinics and public polyclinics. They are a group of highly intelligent, motivated and committed healers in our community.
The falling ill of one family doctor in a busy polyclinic can mean the rest taking up a much higher patient load for the day, sacrificing lunchtime or even any breaks in that day.
I hope that MOH will continually invest in helping them reduce unnecessary administrative workload.
To the Minister for Health Mr Ong Ye Kung, I agree that administrative work that is required for claims is very necessary, but I think we should study some of the areas in which we can maybe reduce for the professionals. This can include doing away with the need for issuing medical certificates (MCs) for mild acute illnesses, like coughs and colds, which my fellow hon Member Ms Mariam Jaafar has raised earlier in the Parliamentary speech she made.
While this will require the support of the Ministry of Defense (MINDEF), the Ministry of Education (MOE) and MOM, countries like the United Kingdom that have practised doing away with MCs for absence from school and work due to common colds and coughs have not seen students or employees abusing such a move.
Also, more use of telehealth, that can augment and take away some of the family doctors' repetitive tasks, should continue to be invested in and subsidised by MOH.
There is no doubt that Healthier SG will take time – I think at least a decade – before we can see a healthier population coming to fruition. Nevertheless, as a strong advocate of healthy living and active ageing, I commend MOH for taking this bold step towards reshaping Singapore's population health.
With the collective and united efforts of all Singaporeans, we will get there. Notwithstanding my considerations raised, I strongly support the White Paper on Healthier SG.
Ms Joan Pereira.
Mr Speaker, Sir, I support the Healthier SG initiatives and look forward to the expected benefits as this new healthcare model nudges Singaporeans to focus more on active self-care.
All of us as individuals need to consciously take steps on a daily basis to minimise the risks of illnesses and diseases, with care and guidance from our doctors and their teams of support professionals. Many of the things we can do are quite achievable, though not always easy for some of us, such as taking the necessary medications on time, watching our diets and exercising. Following up with doctors familiar with our health histories regularly will help to introduce some discipline into our lives, as we have to be accountable to them too.
One of my concerns is regarding the funding model that will be partly based on health outcomes.
The White Paper states that service fee payments for family doctors will be partially based on "the progress made in terms of preventive care or chronic diseases management". While I understand the intent of this clause, the reality is that there will be some patients who have difficulties being compliant and it is not reasonable to expect the doctors to control their patients.
I would like to know how the Ministry will help such patients. Will there be situations where doctors may choose not to continue with the management of very challenging patients?
Another question is regarding the additional administrative and IT set-up and maintenance requirements necessary for this scheme. The White Paper states that in the initial phase, the Ministry will provide a one-off IT support grant. Going forward, inputting data and maintaining the IT system in a clinic will need more manpower and IT knowledge, particularly to ensure a high level of cybersecurity. While MOH has stated that it will support the GPs in this aspect, what will happen if a patient's preferred GP chooses not to join the network due to the clinic's constraints?
Yes, patients can select another doctor but it is not so easy, especially when a strong relationship has been built and, more importantly, the doctor's medicine works well for the patients. This would then mean that patients have to doctor hop before finding the right one that suits them.
Some residents are also concerned that more costs for the GPs will be involved and they worry as a result, the medical costs will be higher for residents who see GPs under this Healthier SG initiative. How would the Ministry ensure that costs will be kept in check?
I applaud the decision to narrow the difference in drug subsidies across polyclinics and private clinics through a combination of enhanced drug subsidies and drug price limits. However, there may be some non-generic drugs which will continue to be priced above the limits. Will patients be given a choice to opt for such drugs via personal top-ups and MOH to provide greater subsidies because these drugs work well for them?
Last, I would like to ask about the role of TCMPs in the Healthier SG model. TCMPs have been playing a significant role in helping residents, particularly the elderly, to better manage their health over the long term. Traditional Chinese Medicine (TCM) methods often emphasise holistic care and can be complementary to our current system.
If the Ministry is concerned about the standard and consistent TCM healthcare delivery, how about setting up a system similar to our present Western medical framework and ensure its integration into our healthcare system? Sir, in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Last, I would like to ask about the role of Traditional Chinese Medicine Practitioners (TCMPs) in the Healthier SG model.
TCMPs have been playing a significant role in helping residents, particularly the elderly, to better manage their health over the long term. TCM methods often emphasise holistic care and can be complementary to our current system.
If the Ministry is concerned about the standard and consistency of TCM healthcare delivery, how about setting up a system, similar to our present western medical framework, and ensure its integration into our healthcare system?
Ms Hany Soh.
Mr Speaker, I speak in support of this Motion. I concur that prevention is undoubtedly better than cure, not only because the former can be easier and more affordable as compared to the latter but also because individuals and their loved ones can minimise the risk of experiencing a lower quality of life that comes with chronic diseases.
It is well understood that prevention of chronic diseases is achieved by addressing risk factors before falling sick whether through healthy living, better dieting or exercising regularly. Although doing so seems simple and straightforward, these actions are easier said than done.
Many of us are used to long working hours, a sedentary work life, late nights and, for better or worse, various cuisines within easy reach whether day or night – all of which contributes to a less than healthy lifestyle.
With that said, it is possible to return to good healthy habits, but it will take some time, effort and some encouragement.
Similar to the Singapore Green Plan, I view the Government's initiations of Healthier SG as a whole-of-nation movement which seeks to rally bold and collective actions, to transform our healthcare system and to encourage all Singaporeans to come together and take steps towards better health.
The funding support from the Government and community partners will come in vital to kickstart this project and steer it towards the right direction.
Similar to the concept of SG Eco Fund, I hope that the Ministry can consider setting up a SG healthy fund to support projects that champion healthy living and involve the community. A steering committee can be set up comprising representatives from the 3P sectors, retired grassroots advisors, sports athletes as well as healthy lifestyle experts to manage this fund and monitor the progress of such projects.
In addition, this committee, with extensive community experience and networks from its members, can also provide useful guidance for healthy lifestyle clubs, thus further advancing the objectives of Healthier SG.
One example of how such funds can be utilised would be to encourage GPs to organise community outreach events to foster lasting relationships between residents and their family doctors. The GPs can be the first line of support for many Singaporeans living in our heartlands. Many of these neighbourhood GPs have served the community for years or even decades and earned the trust and reputation of being the resident experts in all health-related matters.
As such, to foster more of such GP-patient relationships, with trust being built up and utilised to deliver the message from Healthier SG, one suggestion would be to consider providing funding support for GPs to conduct health awareness talks for the community, educating our residents about the benefits of preserving one's health with good habits.
Additional funding support can also be considered to encourage organising the follow-ups on the health awareness talks, such as one-time complimentary health screening and consultation sessions for attendees at their neighbourhood GP.
Other funding support can go towards encouraging more community organisations to set up healthy lifestyle interest groups and for its champions to form strong, sustainable partnerships with the community to promote healthy lifestyle activities.
Over the years, in my capacity as a community volunteer and subsequently as advisor, I have witnessed many inspiring examples of how healthy living has been promoted among residents through health awareness and wellness programmes initiated by the grassroots, such as the Northwest CDC's qigong, dance fit and brisk walking clubs.
The provisions for support for these interest groups and their events will empower them to further enrich the lives of many of my residents in Woodgrove by providing a wider range of healthy activities to choose from.
In addition to that, allocating funding support for passionate and committed healthy lifestyle champions, such as instructors and coordinators would also help grant a renewed sense of purpose for retirees looking to making a positive effect.
These individuals are more than just active participants in their programmes of choice. They also serve as the glue within their own communities. Through them, I have seen many friendships forged among the members and their trainers. Even outside training, they will gather to organise potluck sessions, sharing healthy cooking tips.
In Woodgrove, our active dance fit club members often help to bring more joy to events organised by the Residents' Committees, such as by choreographing a dance performance with them donned in special handsewn costumes.
Mr Speaker, while there is much we can do to ensure that Healthier SG can further encourage more Singaporeans to lead a healthier lifestyle, we should also capitalise on its ability to provide additional benefits outside of its main scope of objectives.
Picking up healthy living tips and sports can be interesting and enable the creation of more family bonding opportunities.
One such example is the Woodgrove Badminton Clinic, which was jointly organised by our Woodgrove Community Sports Club and the Singapore Badminton Association, with support from Horlicks. During the event, apart from inviting our national team's shuttlers Crystal Wong and Jing Yujia to coach our little ones and their parents on badminton strokes, a health talk was also carried out by Horlicks, sharing tips on possible diets to follow before and after exercising.
Next month, Woodgrove will also be collaborating with ActiveSG to organise a community sports day at the Woodland Stadium, encouraging families to participate in various sporting activities such as air badminton, table tennis, Zumba and K-cardio.
In our Marsiling-Yew Tee GRC, the recent launch of the Healthy Living card game in Marsiling's "Living The Life Carnival" was also received positively by elderly residents and their families. In this game, players are supposed to collect cards depicting good health habits in order to win. Through playing the game, these cards will serve to inculcate players with these healthy living habits.
Good health habits begin at a young age. As a community effort, Woodgrove is working on expanding the reach of this Healthy Living card game by encouraging our youngest residents to play with their families, hopefully inspiring them to a healthier lifestyle while promoting family bonding opportunities at the same time.
For a start, the nine PCF Sparkletots centres across Woodgrove will be procuring additional sets of these playing cards and distributing them to all of our K2 students in 2023.
One way to encourage healthier eating is to educate the public about new healthier alternatives. One good example of this would be the recent introduction of the lower sodium salt campaign. I believe that the public may find it useful to learn more about the science behind these healthier options from credible sources, such as HPB, so that they may be better informed about the food choices to make.
Disseminating the information through mass media will be very helpful in this regard. Although we can achieve much by encouraging residents to pay more attention to their health, more help can be provided by influencing their dietary habits, such as reducing the cost of healthier food items, which have a reputation for being more expensive than the standard options.
As such, in order to make the Healthier SG movement of success, there is a need to call for a mindset shift. Not just among the ordinary residents, but businesses that serve the community as a whole. This includes calling on fast food chains, film theatres and supermarkets, to just to name a few, to explore ways to incentivise offering of healthier options. In Mandarin please, Mr Speaker.
(In Mandarin): [Please refer to Vernacular Speech.] Last month, Woodgrove division, in collaboration with Sian Chay Medical Institution, organised a free health talk, sharing with seniors tips on healthy living and post-recovery from COVID-19. Many participants shared with me that they prefer to see a TCM doctor first when they are not feeling well. The reasons vary, including cheaper consultation fees, for example, Sian Chay and Chung Hwa Medical Institution provide free or low-priced consultation and treatment.
Generally, seniors tend to prefer opting for TCM to improve their vitality and address underlying root causes of health concerns in a holistic manner. I believe, we should look into combining Western and TCM medicine in terms of treatment as well as increasing awareness.
To me, both Chinese and Western medicine offer benefits, integrating both would bring a win-win situation. In conclusion, I support the Healthier SG Motion.
Leader.
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