Committee of Supply – Head O (Ministry of Health)

Madam, women play a crucial role in the health of our Singaporean families. They are usually the central figure in families, taking charge of the cooking, health appointments, caregiving activities and childbearing as well. It is thus important to ensure our women stay healthy and happy. They are also the gender with the longer lifespan, which means they may also face the brunt of the complications of chronic illnesses.

For those who are working, there will be, of course, added responsibilities to prioritise their commitments. Can I ask MOH what is the role of the Women's Health Advisory Committee and also on the following issues which, hopefully, can be reviewed?

First, a more integrated package for women's health screening at subsidised rates and more publicity as well. Two, tracking and monitoring our Singaporean women's health statistics which can be shared openly. I hope that this can be a motivational element for our ladies to see the positive changes. Thirdly, more education and outreach for our ladies with diabetes since we are all on a war path against diabetes. The prevalence is high and even higher amongst some ethnic groups.

As mentioned, our women play important roles and we do not want them to be prematurely debilitated by the complications of diabetes. The other group to assist will be our women with gestational diabetes and a proportion of them, we know, do go on to become pre-diabetic or overt diabetic. Therefore, I think a proactive approach to handle this will be necessary.

Mdm Chair, primary healthcare at GP clinics should be seen as a form of preventive healthcare to arrest the development of illnesses before they escalate to the needs for costly hospitalisation. Costly, that is, to the public purse and the public, given universal hospitalisation insurance or MediShield Life.

The monthly household income per member capped to qualify for CHAS subsidies should be raised from $1,800 to the prevailing median monthly income from work for an individual which stands at $3,900 in 2015. This is so that retirees who live with their working children, who are themselves parents, are not excluded. This would also provide some relief for the children of the retirees, who belong to the sandwich middle-income group. Another benefit is that this would provide support for and promote multigenerational households, where the elderly would not be disincentivised to live with the children and grandchildren.

Madam, primary care has been on MOH's radar for a while and there are initiatives being planned. However, there are still some gaps that need to be addressed.

One area is the need for service and its siting. For example, in the eastern part of Singapore, the polyclinics are very heavy in terms of patient load. Bedok, Geylang East and the newly renovated and opened Marine Parade polyclinics are all very busy clinics, besides the Clementi one that I just heard about. The waiting times, too, are affected by this. I am sure we know.

Some seniors tell me they have to place an item or stand in line from as early as 6.30 in the morning. I tell them to make an appointment because we know that it is a lot easier and more efficient. Can MOH consider having another polyclinic in the Geylang, Eunos, Haig Road and Ubi vicinity to meet the needs of the patients there? The need and demand for Government primary care services will continue to rise, especially with the introduction of the PG Package, the CHAS programme and other subsidy schemes.

Mdm Chair, population ageing presents a unique opportunity for us to redefine ageing and make Singapore an icon of successful ageing. Ms Joan Pereira asked about our Ministry's detailed plans under the Action Plan for Successful Ageing. We have planned a suite of initiatives along two directions.

First, going beyond healthcare to health by investing more in health promotion and active ageing to help seniors live longer and live well. Second, going beyond hospital to home and community by building up a good system of home and community-based care that can provide person-centric care for our seniors. Let me elaborate on each of these.

Health is wealth. I always tell my seniors that they need to achieve three "wellness" for successful ageing: physical wellness, mental wellness and social wellness.

Under the Action Plan, we will step up efforts to promote seniors' health education at different levels: at the national level, in the community and at workplaces. At the national level, MOH and HPB will embark on a series of public education campaigns on seniors' health issues this year. HPB will roll out campaigns on topics, such as Seniors' Nutrition, Falls Prevention and Dementia, to raise awareness among seniors on how they can keep healthy.

We will launch a new National Seniors' Health Programme which is a set of "healthy ageing 101" programmes on health issues important to seniors, such as nutrition, exercise, mental wellness and chronic disease management. Seniors will be encouraged to go through this series of six basic health workshops as a start and then they can attend other additional workshops depending on their interest.

This set of programmes will be delivered in the community and that was elaborated earlier by Senior Minister of State Heng Chee How.

To enable seniors to be cognitively and socially active as well, MOH has worked with MOE to establish a new National Silver Academy to enable seniors to pursue learning in diverse areas according to their interest.

The Academy is not a physical campus, but made up of a network of education institutions and VWOs offering courses in various fields to seniors. I am pleased to announce that the National Silver Academy will offer over 10,000 learning places across 500 courses this year and that seniors aged 50 and above can start to register for courses from next month onwards. The Academy will offer new learning opportunities for seniors in three areas.

First, Singaporeans will be able to take selected courses offered by the Institute of Technical Education (ITEs), polytechnics and universities without taking exams. The post-secondary education institutions are making selected modules from their full qualification courses available for seniors to attend without being assessed, for a token fee. Seniors will be able to sit in the same classroom and learn together with the regular students attending the course.

Second, seniors can now receive subsidies for short courses offered by these post-secondary education institutions as well as VWOs that cover a whole range of topics. Today, such courses offered by the post-secondary education institutions are largely unsubsidised by the Government. Under the Academy, Singaporeans aged 50 and above will receive a subsidy of up to 50% off the course fee.

Third, seniors can look forward to a wider range of courses. The Academy will not only include courses from educational institutions, including the two art colleges LaSalle and NAFA, but also those from community-based organisations and other ad hoc learning opportunities as well. For instance, seniors can also attend intergenerational learning programmes conducted by students in school after school hours on topics, such as technology and music.

We hope that the Academy can not only fulfil seniors' aspirations to keep learning, but also help shape a new mindset regarding ageing. I think having seniors learn with younger students in the same classroom will foster intergenerational interactions and also, at the same time, inspire our younger generation that learning does not stop at any age.

Mdm Chair, together, we can give health and wellness to more seniors and extend the health span of Singaporeans even as their lifespan increases. But when our seniors grow frail eventually, we need a comprehensive range of care options to enable seniors to age in place. Assoc Prof Fatimah Lateef, Ms Tin Pei Ling and Ms Joan Pereira asked about ramp-up plans for eldercare services. In the past five years, as my Minister has noted earlier, we have expanded home and community care capacities to 6,900 home-care places and 3,500 day care places today.

We will continue to work hard to develop more infrastructure and manpower needed to grow our services and we are on track to meet the projected demand of 10,000 home care and 6,200 day care places by 2020.

I agree with Assoc Prof Fatimah Lateef that beyond capacity, we need to continually enhance the quality of care. We introduced the Guidelines for Home and Centre-based Care last year and are committed to supporting providers in working towards these Guidelines. In addition to training courses and capability building programmes, AIC is also developing a voluntary baseline assessment framework based on the Guidelines to help our providers understand how they can improve.

MOH and AIC regularly engage the sector on various fronts, such as in the development of these Guidelines and the Enhanced Nursing Home Standards, in our manpower and quality improvement councils for the sector, as well as through dialogues, such as with the Association of Private Nursing Home Operators.

We will study ways to further strengthen our tripartite partnerships, including the suggestion by Ms K Thanaletchimi to set up an ILTC association.

Dr Tan Wu Meng and Ms Joan Pereira also spoke about delivering home and community care in an integrated manner. Indeed, this is one of our key strategies going forward. MOH will pilot a number of new initiatives under a new Home and Community Care Masterplan this year to better support seniors to age at home.

First, we want to train and assess a new "corps" of domestic elder carers so that they can anchor good care for seniors at home. We have introduced a Foreign Domestic Worker Grant and lowered the concessionary levy so that it is more affordable for caregivers of frail seniors to hire foreign domestic helpers. But some caregivers still find it difficult to obtain domestic helpers who are proficient in eldercare.

MOH will launch a new "Eldercarer" pilot to provide comprehensive training to domestic helpers before they are deployed to the families' homes. The new training programme, developed in consultation with experienced nurses from nursing homes and community hospitals, includes four days of classroom learning and on-the-job training. Trainers will go to the homes to observe the domestic helpers at work and check that they can perform the required eldercare tasks competently. These pre-trained elder carers can then be deployed to families in need. Existing employers who want to send their domestic helpers for this in-depth training can also contact AIC.

Second, we will complement domestic maids with informal caregivers in the community. Dr Lily Neo and Ms Joan Pereira spoke about befriending and support for seniors at risk of isolation. MOH piloted a community befriending programme a year ago where seniors are paired with befrienders living in the neighbourhood who can visit them often, keep an eye on their condition and help them with their needs.

Since the start of the programme, some 15 communities have come on board with over 230 befriendees and almost 90 befrienders. These befrienders are given a small token to cover the costs of their befriending work. Our target under the Action Plan for Successful Ageing is to grow the befriending movement to 50 communities by 2020, which means more than 1,000 befrienders and some 3,000 befriendees.

Third, we will further strengthen our community-based home and day care services. To serve the needs of seniors more holistically, MOH has worked with some providers to pilot new Integrated Home and Day Care packages that bundle both home and centre-based care services together. Today, we have such a combination and that is the Singapore Programme for Integrated Care for the Elderly (SPICE) programme for frail seniors. We are now expanding the original SPICE package to pilot three or more new care packages which offer different combinations of care services to meet the needs of seniors with a wider range of frailty.

Let me illustrate this with an example. Mdm Lim Miau Chew has multiple health conditions, including Parkinson's disease, which makes it challenging for her to walk, perform activities of daily living as well as keep track of her multiple medications.

During the day, Mdm Lim attends the Peacehaven Bedok Multi-Service Centre, where she receives rehab and nursing care and does recreational activities. The centre will also help her pre-pack her medications. On days when she is feeling unwell, the centre's staff will check on her at home. They will also arrange for basic housekeeping services and meals delivery for her during the weekends, which are additional add-on services not included within the current SPICE. All these services will be conveniently bundled within a single, comprehensive care package for Mdm Lim.

Some three eldercare providers will be offering these packages with a capacity of over 300 places in the pilot phase. If successful and well received by caregivers, we will scale up the packages. We will also test a new tool to capture seniors' needs – functional, cognitive and social – holistically, for better matching with services.

Fourth, we will build more and better centres to support the new care services. Under the Action Plan for Successful Ageing, MOH is working with HDB to pre-build larger spaces within new Build-To-Order HDB developments to serve as "Active Ageing Hubs" or AAHs. These are one-stop centres for seniors that can serve a range of needs, from active ageing programmes for ambulant and healthy seniors, to day care and rehab services for frail seniors, to "assisted living" services, such as grocery delivery.

The size of these AAHs will depend on the space available in the developments but can be up to twice as large as the eldercare centres today. We launched the first Request-For-Proposal (RFP) for operating two AAHs at Kallang-Whampoa last month. At least 10 future HDB housing developments will have these AAHs by 2020.

Fifth, to close the last mile, we need to improve the system of transportation to care services. In the past year, AIC piloted a programme with ComfortDelgro to engage taxi drivers to send seniors from home to their care centres. The effort is off to a promising start with 25 taxi drivers on the scheme. More than 130 seniors have benefited from the service, and we hope to expand the service to serve 200 more seniors this year.

Sixth, Regional Health Systems are piloting new programmes to strengthen their support for frail patients in the post-discharge period. For instance, SingHealth is piloting a new system of deploying its nurses to provide home nursing care to its patients living nearby, starting with Bukit Merah.

Finally, we are investing in research and innovation to pioneer new models of home and community care. We have set up a National Innovation Challenge (NIC) on Active and Confident Ageing to support research and innovation in ageing-related issues, including the use of technology. Last year, MOH made two grant calls under NIC to seek innovative ideas to improve manpower productivity of home-care services and enhance dementia care in the community. We received close to 100 proposals and we will select the best ideas to be implemented on the ground.

Ultimately, home and community care must work together with good residential care options to form a robust system of care for our seniors. Thus far, we have largely tendered out our aged care facilities individually or in pairs. Going forward, we need to better integrate different forms of aged care services so that seniors can receive continuous, seamless and person-centric care even as their care needs evolve. To give integration of care a bigger push, MOH will pilot a new Integrated Operator (IOP) scheme this year. MOH will launch Request for Proposals (RFPs) to appoint operators for bundles of "three-in-one" care facilities and services, comprising nursing homes, eldercare centres and home-care, within the same area. Under this new IOP scheme, the sector may see up to 500 nursing home beds, 240 day care places and 150 home-care places, within one tender.

There are a few objectives to this IOP scheme. First, we want to encourage a single operator to integrate residential and non-residential aged care services into patient-centric care options.

Second, we hope that these large tenders will enable us to grow bigger players with the economies of scale to provide better and more affordable care for our seniors.

Third, by packaging different care services in a region into a single tender, we hope to develop strategic partners who can then partner our Regional Health Systems to provide integrated and seamless care from the acute sector to community hospital to long term care, for Singaporeans.

IOPs will need to demonstrate that they are able to achieve higher standards of care. They are also expected to do more in terms of workforce development, that is, to train and build up the manpower capabilities in this sector. We will start with an RFP for one bundle – for the South region – later this year, but subject to market conditions.

I assure Members that even while we roll out IOP bundles, we will continue to call smaller tenders with individual facilities and services to cater to providers who may prefer to specialise in a particular care setting. Our eventual aim is to develop a sizeable, diverse and resilient sector. We will continue to support all players, both big and small, in developing their capabilities in this sector.

MOH and AIC have partnered SPRING Singapore to reach out to the private sector aged care providers and enable them to tap on the Capability Development Grant to embark on new manpower development or productivity initiatives.

Beyond individual services, we need to better integrate the programmes, services and resources within each community to build a strong "community of care". And it is for this reason that we are piloting community networks for seniors, as mentioned by Assoc Prof Fatimah Lateef and Ms Tin Pei Ling. Let me elaborate more on this new initiative and the Ministry's role in this.

The aim of the community network for seniors is to enable more systematic collaboration between Government agencies and community-based stakeholders, enabling them to leverage each other's strengths and resources to jointly support our seniors. A small group of staff from different agencies will work together to drive the development of this network and there are three objectives of this community network.

First, we want to expand outreach. The Government agencies will coordinate our efforts with local VWOs and grassroots so that we combine forces and collectively reach out to a bigger pool of seniors, rather than visit the same seniors a few times over. For instance, PGAs can inform the Pioneers of relevant active ageing and social activities in the community, as part of their current house visits to explain Government schemes.

Second, we want to link the programmes and services across Government agencies, VWOs and grassroots organisations together so that we can serve our seniors better. For instance, we can join up the healthcare services provided by Regional Health Systems with the social care provided by community-based organisations to support our vulnerable seniors better in the community.

Third, we want to engage stakeholders and recruit more resident volunteers in a particular community, to help their fellow elderly neighbours. As part of this pilot, MOH wants to work with different partners in the community to recruit and train more neighbour carers that can include the more able and active elderly, as suggested by some Members, who can be paired with the seniors living alone in the community.

With Community Networks for Seniors, we hope to build kampungs for all ages, where our seniors can age happily, healthily and actively in place, for as long as possible. If we build up strong community networks over time, caregivers will also have greater peace of mind that their elderly loved ones will have many caring neighbours and agencies on the ground looking out for them.

Assoc Prof Fatimah Lateef, Dr Chia Shi-Lu and Ms Tin Pei Ling asked about our plans to grow the healthcare workforce. In the midst of a more uncertain economic climate, the growth in the healthcare sector will provide good job opportunities and meaningful new careers for Singaporeans. MOH is stepping up efforts to attract fresh school leavers and mid-career professionals to join the healthcare industry. For instance, we are enhancing information and outreach through career talks and exhibitions, engaging the education and career guidance (ECG) counsellors to secondary school students.

We will also continue to support providers to recruit nurses, allied health professionals and care staff for the aged care sector. We launched the online ILTC Careers Portal in 2013 and a branding campaign earlier this year to raise awareness of opportunities in this sector. We have facilitated the recruitment of 107 locals through our job fairs over the past one year.

MOH has also provided funding support to enhance the pay competitiveness of healthcare workers in VWO providers, in tandem with the pay increases in the public healthcare sector. We will do even more this year, to enhance recruitment for the aged care sector.

Assoc Prof Daniel Goh suggested recruiting retired nurses to deliver home and community care. Today, some of our home-care providers are already doing so. To better attract non-practising local nurses back to work in the growing aged care sector, we have enhanced the Return-To-Nursing scheme in April this year. We have strengthened training in areas, such as geriatric and palliative care, in a three-month refresher course and enhanced the training allowances. There will also be a new one-time Community Care Placement Bonus at $3,000 for Enrolled Nurses and $5,000 for Registered Nurses who join the aged care sector.

There is also an increasing need for professionals, managers, executives and technicians (PMETs) who can take on management and supervisory positions in new aged care facilities. We have, therefore, launched a new Senior Management Associate Scheme to attract mid-career talents with supervisory or managerial experience, who are interested to explore a career switch to the aged care sector. We aim to recruit 10 mid-career talents per year. They will undergo three months of training with AIC to understand the sector before taking up senior positions like Centre Directors in the institutions. MOH will provide funding support to the institutions for the remuneration and benefits given to these mid-career talents.

Even as we explore more initiatives to grow local workforce participation in the sector, there is still a need to bring in foreign healthcare workers to augment our local supply. We will continue to help these workers adapt to our practices and working environment, so that they can be effective members of our teams. Assoc Prof Daniel Goh spoke about home nursing providers who bring in foreign nurses under foreign domestic worker permits.

Let me clarify that providers can only deploy nurses registered under the Singapore Nursing Board (SNB) to deliver home nursing services. The providers Assoc Prof Daniel Goh mentioned are employment agencies who bring in care aides to assist senior clients and they hold foreign domestic worker permits.

In parallel with efforts to grow the workforce are efforts to deepen skills and build new capabilities. To date, more than 7,000 ILTC staff have undergone various training, from care skills training to leadership programmes under the AIC Learning Institute.

Under the national SkillsFuture initiative, we will introduce the Healthcare Skills Future Study Awards to support skills upgrading of the healthcare workforce. The $5,000 study awards will support learning and development in the areas of aged care, healthcare IT, analytics and healthcare system design, organisation and delivery, and will benefit 50 healthcare staff this year. The awards will be opened for application from June this year.

MOH will also champion initiatives within the public healthcare sector to make our healthcare institutions age-friendly and enhance the longevity of our older experienced staff. Our healthcare institutions will be systematically introducing mechanisation to take away the physical strain of healthcare jobs. We will also redesign jobs, introduce FWAs and provide retraining to create more opportunities for older Singaporeans to work in the healthcare sector.

For instance, NUH has started a flexi-work pilot for Singaporeans to help ward nurses with basic care duties, so that the nurses can focus on clinical nursing work. NUH targets to have up to 50 of such Basic Care Assistants and has already hired 16 under the pilot phase.

Ms Thanaletchimi and Dr Chia Shi-Lu will also be pleased to note that all healthcare clusters today have FWAs in place to help workers balance work and personal demands. These include part-time employment, compressed work week, flexible work schedules and hours.

Last year, four hospitals piloted new FWAs for nurses in selected wards, where the timing of the afternoon shift was brought forward to allow the nurses to spend more time with their families and friends after work. MOH is currently working to facilitate electronic rostering systems, so that more FWAs for nurses can be scaled up to all public healthcare institutions.

Our healthcare institutions will also strengthen workplace health programmes and introduce new retirement planning programmes for their mature workers. These include pre- and post-retirement workshops, to guide older healthcare workers through career transition issues.

In short, despite the current economic uncertainty, the health and aged care sector is expanding and will be able to offer many different good jobs to Singaporeans of all ages.

Assoc Prof Fatimah Lateef and Ms Tin Pei Ling asked for an update on community mental health. Last year, I updated the House that we will systematically strengthen our community mental health efforts in a few ways and I am pleased to report that we are making steady progress.

First, to enhance the mental well-being of Singaporeans, HPB has rolled out initiatives to equip the public with knowledge and skills to keep mentally well and seek help early, if needed. For example, their "Working Minds" talks and workshops in workplaces impart skills on managing stress and developing resilience so that employees can perform at their best and 4,500 employees from 90 small and medium enterprises (SMEs) have participated in these workshops since they started in 2013.

Second, to help detect and support the treatment of mental health patients in the community, AIC has trained and partnered over 100 GPs and set up six specialist-led community-based teams to guide our primary care providers in managing patients with more complex issues. Six allied health-led community teams have also been set up to support GPs by providing counselling and psycho-education to clients and caregivers. This is an increase from the 70 GP partners and nine specialist and allied health-led teams last year. As at end-2015, these teams have seen over 7,000 clients, an increase from 4,700 in the previous year.

Third, we have reached out to 36 constituencies; 16 in the past one year alone. Over 800 grassroots leaders, volunteers and community partners have been trained in basic mental health knowledge and symptoms of mental illness, which allows them to identify, respond and support residents with mental health challenges. Again, this is an increase from the 400 trained in 2014. AIC has also trained over 500 staff from the ground agencies, such as HDB, Town Councils, the Singapore Police Force (SPF) and Family Service Centres.

In addition, advisors in all 89 divisions have been given a single AIC contact point for easier referral to assist residents with suspected mental health issues. AIC will be the first responder and lead in coordinating further assessment and care. To address Dr Lily Neo's suggestion, SSOs today can refer persons with suspected mental health issues to AIC for assessment, as well as help provide the necessary support if needed, as part of the overall care plan.

Fourth, IMH is strengthening its after-care services to better support clients post-discharge, so that they could be better managed and supported to continue to live in the community. Together with AIC, IMH is piloting an integrated model of after-care case management for clients with moderate to complex social and healthcare needs. Case managers assigned to these clients will assist in their transitional care upon discharge and link them to community support partners. These after-care teams have reached out to over 150 clients since 2015.

IMH is also enhancing its capability to monitor higher risk patients post-discharge and ensure that they comply with follow-up treatment. If a patient refuses or defaults on treatment, IMH will work closely with family members, caregivers and other community partners to engage the patients. Currently, the Mental Health (Care and Treatment) Act does not provide for enforced treatment of psychiatric patients in an outpatient setting. We can study Dr Lily Neo's suggestion on whether to compel outpatient mental health treatment, taking reference from overseas models, such as Scotland, England and Australia.

Nonetheless, the experience of these countries is mixed so far, and there is no robust evidence to show that community treatment orders are effective in achieving key outcomes, such as reduced hospital re-admissions, improved medication adherence and patients' quality of life. Even as we study such an approach, it is important that we continue to enhance access to mental health services and continuity of care.

We share Mr Low Thia Kiang's concern about funding for mental health, and take a calibrated approach in ensuring comparability in coverage. Patients requiring inpatient treatment can enjoy Government subsidies similar to other medical treatments.

The MediShield Life claim limit and MediSave withdrawal limit for psychiatric treatments are lower, as Mr Low has said, because its bill size is generally lower as well. The median post-subsidy bill per day in 2014 was $60 for psychiatric treatment, compared to $350 for non-psychiatric treatment.

Taken together, the MediShield Life and MediSave limits were sufficient to cover seven in 10 subsidised inpatient psychiatric bills. MediFund assistance is also available for those who are unable to afford treatment, even after subsidies and MediSave and MediShield. Patients requiring outpatient mental health treatment can receive Government subsidies at our SOCs and polyclinics, which were recently enhanced for lower- to middle-income patients, who also enjoy CHAS subsidies at CHAS GP clinics.

Pioneers can receive special subsidies at SOCs, polyclinics and CHAS GPs. All patients can also use MediSave for psychiatric conditions under the Chronic Disease Management Programme (CDMP) and our seniors can further tap on Flexi-MediSave.

We recognise the stresses of caregiving, as highlighted by Miss Cheng Li Hui and Ms Kuik Shiao-Yin, and have enhanced support for caregivers to make it easier for them to navigate our care system.

Caregivers can approach AIC's AICarelinks at AIC's office and our hospitals. These are one-stop points to get information and advice on the appropriate services for their loved ones. They can also contact AIC's Singapore Silver Line for support on all matters relating to mental health and eldercare services. Besides the four major languages, there are dialect-speaking agents available for seniors who are more comfortable speaking in their native dialects. We have also put in place programmes to help patients and their caregivers transit more smoothly from the hospital to home.

Since 2008, AIC has care coordinators who helped patients look for services required after discharge and follow up with them to provide further support post-discharge through phone calls, home visits or both. To ensure their well-being, we have also made respite care more accessible for caregivers and enhanced subsidies to help defray the costs of caregiving. AIC also works closely with community touch points to look out for caregivers who may be stressed and render assistance where needed.

As noted by Mr Low Thia Kiang, Miss Cheng Li Hui and Dr Tan Wu Meng, the focus for our community mental health efforts going forward will be on dementia. With a fast-ageing population and a dementia prevalence rate of about 10% amongst seniors aged 60 and above, we can expect the number of seniors with dementia in Singapore to grow with time.

We are strengthening community-based support for persons with dementia and their caregivers. We have three home intervention teams to support caregivers in managing challenging behaviours of their loved ones with dementia at home, which have reached out to close to 200 clients and caregivers to date. The 10 outreach CREST teams have also reached out to more than 39,000 seniors at risk islandwide. We are also expanding capacity of dementia care services in the community. By 2020, we will have 3,000 dementia day care places, 1,970 dementia nursing home beds and 160 eldercare sitters.

Mdm Chair, we need to rally the whole Singapore kampung to play a part in supporting seniors with dementia and their care-givers within our communities. Last month, I launched an effort to build a Dementia-Friendly Community in Hong Kah North, after the first such community was launched at Chong Pang. We are working with other divisions, such as MacPherson, Queenstown and Bedok, to embark upon this initiative, too.

Under this initiative, we will build up networks of Dementia Friends who are trained to recognise and provide assistance where necessary to persons with dementia. We will also pilot a safe return system for lost seniors and step up efforts to raise public awareness, such as through AIC's dementia toolkit. We hope to encourage more communities to come together to build a dementia-friendly Singapore.

Moving on to women's health issues, I am pleased to update that I will be chairing a revamped Women's Health Committee to focus on three key health issues among women. These are increasing cancer screening uptake, promoting bone health and, of course, women cannot be left out of the war on diabetes. So, the third focus will be on fighting diabetes, particularly diabetes linked to obesity and gestational diabetes, which Ms Tin Pei Ling and Assoc Prof Fatimah Lateef asked about.

Specifically for gestational diabetes, the Committee will complement the work of the diabetes task force and look into providing support for women with gestational diabetes to reduce the risk of complications during pregnancy and risk of Type 2 diabetes and cardiovascular disease for the child.

Promoting bone health is also important for women who are at higher risk of osteoporosis than men. The Committee will also encourage women to promote good health in our families, such as by breastfeeding our infants, which may reduce the risk of obesity and, hence, diabetes for them later in life, provide them with the best possible nutrition and protect them against illnesses and allergies.

Mdm Chair, the Action Plan for Successful Ageing is our blueprint to prepare for rapid population ageing. A Nation for "All Ages" has to be built by all Singaporeans together. With many hands and many hearts, I am positive that we can face population ageing confidently and successfully.

Madam, childhood obesity has been described by WHO as "one of the most serious public health challenges of the 21st century". It is also on the rise in Singapore. A major concern is that obese children are more at risk of suffering from chronic diseases and stroke later on in life.

However, this can be prevented if intervention is done right and early. We must keep our young healthy and fit, for their own sake and for the sake of a healthy Singapore. Hence, what is the MOH's plan to address childhood obesity? What is the Ministry's plan also in promoting and supporting our young to stay healthy?

Mdm Chair, I would like to speak on the mental well-being of youths. Mdm Chair, young students today face many different challenges.

First, they have to deal with the pressures of school. Assessment and homework are followed by more assessment and homework. Then, you have enrichment classes and tuition and everything culminates in examinations at the end of primary and secondary school.

They are also increasingly exposed to the digital world. While infocommunication technology can be a great learning tool if employed correctly, this digital world also presents its own set of challenges, such as the exposure to too much unfiltered knowledge. And the pervasiveness of social media also means that these young students sometimes find themselves the victims of cyber-bullying.

Such issues used to be typically associated with teenagers, but we have to acknowledge that pre-teen students are facing these challenges as well. I have personally spoken to a few parents of children from this age group who are seeing psychologists to help their children deal with the stress. In fact, some parents feel that they should see a psychologist as well.

On the risk of falling into mental health problems, it is usually precipitated by experiencing simultaneous multiple stressors in life. In addition to those stressors mentioned above, these could also arise from problems in their family and personal relationships.

I would like to ask what the Ministry is doing to help students build up their mental resilience and mental well-being to better prepare them to cope with these stressors in life. Also, would the Ministry consider having a decentralised community-based mental wellness facility not just for students, but for others, too?

Madam, the rise in dengue cases in recent years and the spread of Zika in other parts of the world are worrying. While the Government is proactively working to prevent mosquito breeding, it is not foolproof. Singapore is an international hub. The risk of an infection brought in by an unsuspecting foreign carrier is always present. We, therefore, need to look at other prevention methods.

Could the Ministry share whether there are plans to integrate dengue vaccination with other dengue control and healthcare strategies in Singapore? Could the Ministry also share whether it will invest in research into Zika, its treatment and vaccination?

Yes, Mdm Chair. While we are understandably concerned about the impact of chronic diseases on the population, such as diabetes, which we have been hearing about, we must remain vigilant to the continued threat of infectious diseases, in particular, new and emerging ones.

Our experience with severe acute respiratory syndrome (SARS) at the turn of the millennium has shown us the devastating impact of a previously unrecognised infectious disease and the immense human, social and economic cost.

More than a decade later, the world continues to be besieged by the threat of emerging infectious pathogens: bird flu, swine flu, Middle East respiratory syndrome (MERS), Ebola and, more recently, the Zika virus. MERS remains a threat in the Middle East and had a devastating though fortunately limited outbreak in South Korea last year. Ebola cut through entire populations in West Africa and infected close to 30,000 people worldwide and claimed over 11,000 lives worldwide.

Now, we face the spectre of Zika, which is not fatal but behaves in a far more sinister fashion, affecting unborn babies and potentially condemning them to a lifetime of mental disability. I commend the Ministry on how it has increased our preparedness to deal with such threats since the SARS epidemic, and Singapore has thus far been spared similar crises, through a combination of vigilance, border controls and perhaps through a measure of good fortune.

I would like to ask the Ministry to provide an update on its plans to protect Singapore from the threat of infectious diseases, such as the new and emerging ones which I have just mentioned, and also persistent ones like dengue and resurgent ones like tuberculosis.

Madam, I am glad that, over the years, the Ministry has been actively pursuing greater transparency with regard to issues related to healthcare and healthcare delivery. Results of quality-of-care reviews, patient satisfaction surveys, average costs of hospitalisation for common procedures are readily available, and patients can now access their personal health information online.

I would like to ask what further steps the Ministry is taking to allow even better transparency across the whole chain of healthcare delivery. Can this added transparency be harnessed to improve healthcare delivery, in terms of efficiency, quality and also cost containment?

Healthcare costs are on the rise. Does MOH have any plans to enhance transparency of healthcare fees or to introduce fee guidelines to help contain healthcare inflation?

MediShield Life now provides comprehensive and universal hospitalisation coverage, but about two-thirds of Singaporeans still have integrated insurance plans (IPs) that cover them for medical services by private healthcare providers.

Many are concerned about the cost of private healthcare and also of IP premiums, notwithstanding the recently announced Standard B1 plans that aim to provide a reasonable benchmark for IPs. What is the Government doing to manage rising charges in the private healthcare sector?

Thank you. MOH remains committed to reinforcing the core pillars of a quality healthcare system for our population. This encompasses taking a closer look at the fundamentals of our healthcare system, including developing better preventive health services for our young and strengthening primary care.

There is a rising prevalence of chronic diseases amongst our population. One in four Singaporeans aged 40 and above has at least one chronic disease. We are concerned about this increasing prevalence, as these conditions can lead to serious complications if not well-managed. For example, complications faced by poorly-controlled diabetic patients include kidney failure, stroke, heart attack, blindness and even lower limb amputations.

The risk of chronic diseases in general can be lowered through simple lifestyle changes. Choosing to live healthily is a habit that we should inculcate from a young age. As pointed out by Ms Tin Pei Ling, it is vital that we go upstream and enhance preventive health services that encourage the formation of healthy habits in our children and youths, even as we continue to step up our efforts in promoting health screening among older adults. All of us have a role to play in keeping our young healthy and fit, especially parents and caregivers. They role-model healthy living, nurture a healthy home environment, influence and guide children to form healthy habits, which, hopefully, will continue through adulthood.

In Singapore, we have had a comprehensive school health service since 1921, which underpins the good public health achieved today. The HPB's current strategies and close collaboration with the schools in encouraging students to adopt a healthy lifestyle have served us well. For example, trained professional nurses are stationed full-time in selected secondary schools and post-secondary institutions under the Student Health Advisor (SHA) programme, to provide advice on weight management and smoking cessation.

One successful story is that of Ms Tan Su Kheng. For many years, Su Kheng put up with jokes and comments about her weight, which affected her self-esteem. Last year, she joined her school's weight management intervention programme, which helped to kick-start her journey towards a healthier life. On top of receiving many practical tips on healthy living, Su Kheng found additional support through her SHA, who taught her how to incorporate exercise into her busy student life. Apart from exercising thrice a week, she walks home and takes the stairs every day, instead of taking the bus and using the lift respectively.

The journey to staying healthy can be challenging. However, I am inspired by what Su Kheng relates to us about her experience. And I quote, "Whenever I feel like giving up, I will tell myself that although I may not be there yet, I am one step closer to success than yesterday." I am happy to share that with her perseverance and encouragement from her SHA, Su Kheng has lost over 20 kilogrammes in just one year. I hear that family and friends have even started approaching her for tips on healthy living. My heartiest congratulations to Su Kheng!

Despite these efforts, it worries me that we still see the proportion of overweight children and youths increasing over the past five years. Studies have shown that childhood obesity is likely to persist and progress into adulthood. This results in individuals being at higher risks of developing chronic diseases, such as diabetes and hypertension. An overseas study revealed that those with childhood obesity are four times more likely to be at risk of developing hypertension in adulthood when compared to their non-obese peers. It is, therefore, critical that we curb the rising rates of childhood obesity.

A local survey showed that most students are engaging in less physical activities and becoming more sedentary. More than 80% of the students surveyed exceeded the recommended screen time of no more than two hours a day. This is exacerbated by inadequate physical activity. Based on past surveys, only about 10% of mainstream or ITE students and 20% of polytechnic students had sufficient physical activity.

In addition, the prevalence of myopia in our children is one of the highest in the world. More than 60% of our Primary 6 students have myopia today. This is undesirable as poor eyesight from myopia can impact learning. And as the condition progresses, it may result in sight-threatening complications as well.

We have also found that about half of all our Primary 1 students have dental caries. Poor oral health affects the nutrition, growth and development of our children. We are concerned and are keen to tackle the pervasion of these trends among our young. Apart from their physical growth and development, we will also further strengthen our efforts to help our young to build up their mental resilience to better cope with the stressors of life.

Mr Darryl David raised concerns on the mental resilience and well-being of our youths. To comprehensively address the multifaceted aspects of student mental health concerns, we have adopted a three-pronged approach, comprising knowledge and skills-building, facilitating access and referral to mental health services, and parental engagement.

MOE and HPB have introduced programmes to provide educators with basic knowledge on common issues faced by our youths. Educators are also equipped with the ability to detect early warning signs and skills to provide appropriate support and referrals to services and resources in the school setting. These programmes have also groomed youth opinion leaders on health, by arming them with knowledge on health and well-being, mental health concerns and youth advocacy.

Mr Darryl David also suggested having community-based mental wellness facilities. As Senior Minister of State Amy Khor mentioned earlier, we are steadily building up our mental health services and support networks within the community to identify and help persons with mental health concerns.

It is important for us to work upstream to lay strong foundations for our young to lead healthier and more productive lives, starting from those as young as two years old. To this end, I will lead an inter-agency NurtureSG Taskforce with Minister of State for Education Dr Janil Puthucheary. The task force comprises representatives from various Ministries, HPB, Sport Singapore and the ECDA, as well as medical professionals and academics. It will guide the development of the NurtureSG Plan to enhance the health outcomes among our young.

The NurtureSG Taskforce will focus on three main areas. First, we will look into developing new strategies and strengthening existing programmes to address salient health issues and negative trends among children and youths. Next, we want to reinforce health promotion efforts at the tertiary institutions so that young Singaporeans will maintain healthy habits beyond the school-going age and well after entering the workforce. Last but not least, we aim to bring health promotion for the young beyond the school and into their families and the community.

We will launch a public consultation later this month to seek ideas on how we can encourage and enable our young to adopt and maintain healthy lifestyles. In particular, we will engage students, educators, parents, caregivers and even the private sector, such as food establishments, to create a healthier environment for our children.

To Miss Cheng Li Hui's comments, children are referred to the hospitals for both developmental and mental health conditions by polyclinics, GPs, paediatricians, primary schools and REACH, which stands for Response, Early Assessment and intervention in Community mental Health teams. Besides the Child Guidance clinics at Buangkok View and Outram Road, mental health services for children and youths are also available in other hospitals, such as NUH, Singapore General Hospital (SGH) and KK Hospital.

These services typically include assessment, diagnosis and multidisciplinary management of patients up to the age of 18, but may continue to follow up with them beyond this, where appropriate. The subsidies for these services are in line with existing SOC subsidies. From 2013 to 2015, there were about 50,000 psychiatric SOC attendances for patients up to 18 years old, of which two-thirds were seen in IMH.

Empowering and teaching our young to lead healthier lives are only one part of the equation. As our population ages and healthcare needs continue to rise, we must reshape the way we approach healthcare.

Primary care is the foundation of any healthcare system. We aim to strengthen its place in our healthcare system, to be the first and continuous line of care. Dr Tan Wu Meng asked about the role of the family doctor. My response is encapsulated in our vision "One Singaporean, One Family Doctor".

Overseas studies have shown that care continuity by a regular family doctor results in better care outcomes for patients. These include decreased hospitalisations and emergency department visits. Our family doctor can be our partner in helping us stay healthy and in providing us with good and affordable care close to us. Many Singaporeans see a doctor when we come down with an illness, such as a bad cold. With a regular family doctor, such visits can develop into a strong doctor-patient relationship over time. As our family doctor develops a holistic understanding of our family's medical profile and health needs, they will become our health advocate in identifying risk factors and can offer more targeted, timely and individualised advice and plans to manage our health.

For those with chronic diseases, we can manage our condition better by having a family doctor who understands our condition well and supports us with quality management and treatment. Our family doctor must also have some understanding of our family, social and work situation to advise us on making lifestyle changes and adhering to treatment. They can also refer us appropriately if we require more specialised medical attention and help coordinate our care with other providers.

I would like to share a story of a family doctor being one's trusted health partner. Mr Tan Heok Lim has been seeing his family doctor, Dr Leong Choon Kit, for the past 14 years. He feels comfortable with Dr Leong's care and has continued seeing him for his medical needs. This enables Dr Leong to care for Mr Tan holistically – from health screening to diagnosis and management of chronic conditions, such as hypertension.

With deeper understanding of the family, Dr Leong has recommended suitable health screening for Mr Tan's wife, who has a strong family history of diabetes. Mrs Tan was found to be borderline diabetic and Dr Leong was able to intervene early through advice on lifestyle modifications, to prevent the progression of diabetes. Currently, Dr Leong manages the chronic conditions of Mr Tan, his wife and his son. And I am happy to hear that both Mr Tan and his son have also successfully quit smoking, with encouragement from their family members and Dr Leong.

I believe that there are many such positive stories to illustrate the benefits of having a regular family doctor. However, only two in five Singapore residents aged 18 to 69 have a regular family doctor today. We want to call on Singaporeans, especially those with chronic conditions, to take the first step in identifying and sticking with a regular family doctor.

To facilitate this, we will review our policies to help strengthen doctor-patient relationships in primary care. As we progress on the journey to realise our vision of "One Singaporean, One Family Doctor", we will continue to engage our GP and polyclinic colleagues to co-create the future primary care landscape, in particular, to achieve better chronic disease management in the community.

We are mindful to ensure sufficient primary care capacity with the ageing of the population and a growing chronic disease burden. Our polyclinics will continue to play a key role, especially in the management of complex chronic diseases. In recent years, we have announced the development of new polyclinics and redevelopment of existing ones.

Since 2012, we have also strengthened partnerships with private GPs to provide subsidised care to Singaporeans. Today, the CHAS provides lower- to middle-income Singaporeans and all Pioneers access to subsidised care at private GP and dental clinics, and 900 GP clinics and 650 dental clinics islandwide have signed up for CHAS. We value their partnership.

We have also developed new models of primary care, such as the Family Medicine Clinics or FMCs, since 2013. The FMCs are multi-doctor practices, with onsite nurses and other allied health professionals, delivering comprehensive team-based care, especially for chronic disease management.

As part of our continual efforts to better serve our residents, we have been redeveloping existing polyclinics. The new polyclinics in Punggol and Jurong West will open in 2017. I am pleased to announce that we will build another polyclinic in Eunos, in response to Assoc Prof Fatimah Lateef's query on new primary care facilities. The new polyclinic is expected to be operational by 2020 and will be designed to cater for future primary care needs.

Today, there are seven FMCs in operation. By early 2017, we will develop two more FMCs: one in Tampines and another one in Keat Hong. We will continue to review and evaluate FMC development as part of our efforts to strengthen and improve primary care.

With these range of developments, we have tried to support the growing needs in primary care. To address Dr Tan Wu Meng's concerns, residents in the West can look forward to three new facilities – the new polyclinics in Jurong West and Bukit Panjang, as well as a new FMC in Keat Hong. These will help to relieve the load in existing polyclinics in the West, such as Clementi Polyclinic.

We will continue to review the regional primary care needs of our population and work closely with the Urban Redevelopment Authority (URA) and HDB to review and ensure the adequacy of the space needed for primary care facilities in HDB estates.

A good primary care system can help to reduce costly interventions in the hospital setting. To keep primary care affordable, CHAS and PG cardholders at the FMCs and CHAS clinics receive Government subsidies for their care. Dr Tan Wu Meng and Assoc Prof Daniel Goh commented on enhancing subsidies for primary care. Since 2012, we have significantly enhanced CHAS so that more Singaporeans can benefit. In 2013, we raised the income criterion from per capita monthly household income of $1,500 to $1,800. In 2014, the age floor of 40 years was also removed. These changes have helped more Singaporean households to benefit from CHAS.

I thank Assoc Prof Daniel Goh for his suggestion to change the qualifying criteria for CHAS. Assoc Prof Goh suggested that we change the per capita household income criterion of $1,800 to an individual's prevailing median monthly income of $3,900. The current CHAS income criterion of $1,800 ensures that lower- to middle-income Singaporeans, or Singaporeans in about half of all resident households, can qualify. This means that a household of four, with the breadwinner earning $7,200, is eligible.

A household-based approach ensures that subsidies are equitably distributed to extend more benefits to individuals with more dependants. In determining our income criterion, we will need to strike a balance, bearing in mind the need to target subsidies at those who need it most and Government budget availability. We will review CHAS regularly and enhance the scheme where needed to ensure that care remains affordable.

Dr Chia Shi-Lu asked for measures to improve transparency in the charging of healthcare services. We have implemented various measures to this end. Hospitals are required to provide financial counselling to patients to ensure that they are informed of the charges likely to be incurred for their treatment. For outpatient care, patients are also provided with information on estimated charges for consultation.

Since 2013, hospital bill sizes for common conditions and procedures at both public and private hospitals have been progressively published on the MOH website. In 2014, the publication of "Total Operation Fees" for common procedures in public hospitals was introduced.

I am pleased to announce that the publication will be expanded to cover "Total Operation Fees" for private hospitals later this year. There will be further breakdown of the "Total Operation Fees" into "Surgeon Fees", "Anaesthetist Fees" as well as "Facility Fees". The expanded publication will provide added transparency on the private hospital bill components attributed to performing the procedure and serve as a point of reference for both healthcare professionals and the general public.

Safeguarding public health is another fundamental aspect of maintaining population health. Even as we tackle the increasing prevalence of chronic diseases, we need to remain cognisant of our external environment.

In line with the Minister's call for us to remain vigilant, we need to constantly improve our public health system to promote health, prevent diseases and prolong life among our population. Dr Chia Shi-Lu asked about the measures that we are taking to protect Singapore against emerging diseases. We have adopted a three-pronged approach to external public health threats, namely, reducing the risk of importation, early detection and containment.

We perform local and global surveillance to ensure situational awareness for endemic diseases, such as tuberculosis and influenza, and emerging diseases overseas, such as MERS and Zika. We also fund research to evaluate the effectiveness of surveillance and response plans to infectious diseases. These include looking at potential areas for collaboration with the relevant institutions on Zika virus diagnostics, transmission and its association with microcephaly and Guillain-Barre Syndrome. We conduct regular preparedness exercises to practise our responses and identify potential areas for improvements. We also maintain a surge capacity for isolation beds and a national stockpile of personal protective equipment.

In the community, we work with about 640 GP clinics which have volunteered as Public Health Preparedness Clinics, or PHPCs, to help manage public health emergencies, such as haze and influenza pandemics. While all GPs play important roles to provide care in such situations, PHPCs take on additional roles, such as providing subsidised care for conditions related to the public health emergencies.

Coordinated efforts across multiple Government agencies, as well as with other countries and international organisations, are also vital in protecting Singapore against external public health threats.

In relation to Ms Tin Pei Ling's query regarding dengue vaccination, HSA has received the regulatory filing for Sanofi's dengue vaccine in March 2016 and is expediting the review, given the dengue situation in Singapore and recognising that this is the first dengue vaccine available.

The key focus in the Health Sciences Authority's (HSA's) review is to ensure that the vaccine is safe, of good quality and is effective for use in our local population, taking into consideration the local prevalent strains of dengue and its potential risks and adverse effects. Nonetheless, there is currently no vaccine that confers 100% protection against all known strains of the dengue virus.

If it is found to be efficacious locally and subsequently introduced, dengue vaccination should be coupled with other dengue control and healthcare strategies in Singapore, such as having a strong disease surveillance system and maintaining effective vector control measures, to keep the mosquito population low. All of us still have a part to play in staying alert and fighting dengue.

Mdm Chair, we see an increasing need to shift the focus from healthcare to health. However, we cannot do this alone. Let us encourage one another, including our children and youths, to adopt a healthy and active lifestyle to keep chronic diseases at bay. Our regular family doctor shall be our trusted health partner throughout the different stages of our lives.

At the same time, we introduce further measures for greater fee transparency at the hospitals. Not forgetting our vulnerabilities in an increasingly connected global community, we will remain vigilant in responding to public health emergencies. On this note, I urge Singaporeans to partner us in building strong foundations for better care and better health.

Madam, with increased cost of living and added healthcare cost, I am concerned that the poor and vulnerable elders in Singapore will fall through the cracks. While MediShield Life is a good measure to cover all Singaporeans, it does not help with their living expenses when they are in recovery or out of the hospital.

This is where ElderShield comes in. However, there are some improvements that I would like to suggest. The premium costs are high for the lower-income families and the process to file claims may be overly burdensome, especially for the elderly. Does the Ministry have plans to review the premiums and also simplify the claim process? Can the Ministry also tap on the PG Office (PGO) to reach out to the other 35% of the resident population who are currently not covered by ElderShield?

Lastly, while the payout period has been extended to 72 months, will the Ministry consider extending the payout period for ElderShield to end of life instead, since there is no reason to assume that care needs would decrease after 72 months?

May I declare first that I am a doctor who has served in the public and private sectors.

Medical records are essential to good patient care. Better information means better quality diagnosis, more timely treatment and better patient safety. Yet, today, when patients move around across public hospitals, private hospitals, polyclinics and their local GP clinics, it can take time to get a full picture of the patients' medical records. Even within the same public or private hospital, information can be spread between paper and digital, sometimes in multiple digital databases, and not all databases are in the National Electronic Health Record (NEHR). Sometimes, it can be almost like opening a different web browser app to view each different website.

We should look at ways to enhance the use and user-friendliness of information technology (IT) in healthcare to improve productivity and patient safety everywhere.

Mdm Chair, with an ageing population, it is not feasible for Singapore to meet future healthcare demand by simply building more and more hospitals, hiring more and more healthcare workers and providing more and more subsidies. We must also focus on developing a sustainable healthcare system. If we shift too far to the right, we will not be doing right by our fellow Singaporeans. If we overspend and shift too far to the left, our children will have nothing left in the future.

Today, I shall talk about three areas to develop a sustainable healthcare system. First, promoting healthy living. Second, transforming our care models by bringing care beyond hospitals into the community. Third, enhancing value through innovation and productivity improvements.

Let me start with initiatives to promote healthy living and to reduce diabetes prevalence. To fight diabetes, we need a supportive environment to encourage Singaporeans to eat healthily and exercise regularly. Under the Healthy Living Master Plan, we introduced healthier dining options and provided more exercise options in the community, workplaces and schools.

One such initiative is the Healthy Community Ecosystem, which has been implemented in six neighbourhoods since 2014, including my own Group Representation Constituency (GRC) in Bishan-Toa Payoh. Group exercises are held in 40 community spaces, with an average of 1,000 residents participating each week. Lifestyle modification programmes have reached 14,000 residents in these neighbourhoods.

To benefit more Singaporeans, we will be extending the Healthy Community Ecosystem programme to nine more neighbourhoods this year, including Jalan Besar, Pasir-Ris Punggol and West Coast.

Eating right is key to fighting diabetes. Excessive consumption of sugar and refined carbohydrates can lead to weight gain and cause spikes in blood sugar levels. Such spikes increase the risk of developing Type 2 diabetes, if they happen frequently over time.

Dr Chia Shi-Lu asked about measures to discourage consumption of unhealthy food products. Assoc Prof Daniel Goh asked if we could introduce colour-coded labels for sugar content in processed food and drinks. I thank Dr Chia and Assoc Prof Goh for their useful suggestions. We will study their proposals as part of the fight against diabetes.

Many food manufacturers already practise back-of-pack nutritional labelling. HPB's Healthier Choice Symbol (HCS) helps consumers make healthier purchases, through an identifiable front-of-pack symbol. There are currently 2,500 HCS products across 70 food categories. These products contain less sugar, saturated fat or salt. A 2015 consumer survey showed a high level of awareness of HCS products. Nine in 10 said they recognised these products as healthier options and eight in 10 said they use HCS to guide their food purchases.

HPB has worked with close to 240 supermarkets on in-store promotions, such as lucky draws, food sampling and cooking demonstrations. I am glad to know that HCS products are gaining market share. Sales of HCS products are growing at 9% annually. Our target is to increase the total market share for HCS products to 25% by 2020, up from the current 17%.

Some Members are concerned that healthier food may be more expensive. I understand these concerns. We need to work together with industry partners to provide affordable healthy options for Singaporeans. As of March this year, we have 52 food and beverage partners participating in the Healthier Dining Programme involving nearly 1,600 food stalls. Under the programme, we collaborated with restaurants to offer lower calorie meal options and to incorporate healthier ingredients, such as whole grains, fruits and vegetables, as part of their core menu offerings. Major food court chains, including Kopitiam, Koufu and NTUC Foodfare, offer at least one dish below 500 calories at each stall. They also promote reduced-sugar drinks. The number of lower calorie meals sold has doubled from 7.5 million in 2014 to 15 million last year.

I am encouraged by the industry's efforts to produce versions of staple foods, like bread and noodles, which are healthier and taste just as good. Gardenia, for example, uses finely textured wholemeal flour to retain the health benefits of whole grains, while keeping its bread soft and easy to chew.

Besides eating right, we need to encourage Singaporeans to exercise regularly. The recommendation is to have at least 150 minutes of physical activity per week. These 150 minutes can be achieved through simple daily activities like walking to the bus stop, using the stairs instead of the lift, doing household chores or taking a brisk walk at the park.

In 2013, one in four Singaporeans between the ages of 18 and 69 did not meet the 150 minutes per week target, and this was an increase from one in five in 2007. We need to reverse this trend. Leading an active lifestyle can be simple and inexpensive. It is also something we can enjoy with our family and friends.

Mdm Jessie Jee is a Pioneer and one of HPB's Health Ambassadors. She is a regular participant at our Sundays at the Park programme. Every Sunday morning, she joins others in workout classes at the Firefly Park near her home in Clementi. We hope to encourage more Singaporeans, including our seniors, to adopt active lifestyles like Mdm Jee. To support this, HPB will double the number of exercise sessions available in the community and workplaces from the current 100 to 200 by the end of this year.

Another initiative is the National Steps Challenge. Through the use of wearable technology and simple data analytics, users can receive feedback on their daily progress and also receive rewards when they reach certain milestones.

The National Steps Challenge has been well-received since its launch in November 2015. One in three participants have clocked 10,000 steps a day on average. In addition, 70% of previously inactive participants now average more than 7,000 steps per day.

This is a good start, as studies have shown that walking at least 7,500 steps a day can contribute to lower blood pressure and cholesterol levels and help those with diabetes keep their blood sugar levels in check.

Mr Mohd Aidil Bin Sufyan found the Steps Tracker easy to use and a good way to motivate him to stay healthy. He now takes the stairs more often and alights one bus stop earlier to walk home. He also brings his children for weekend walks. Praising the National Steps Challenge as a good initiative, Mr Aidil said he hopes this programme can be extended to more Singaporeans. Thank you, Mr Aidil, for your support and active participation. We are preparing for a second season of the National Steps Challenge. So, akan datang.

Apart from eating right and exercising more, it is important for Singaporeans to go for evidence-based health screening at recommended intervals. Under HPB's Screen for Life programme, Singaporeans 40 and above are recommended to be screened for diabetes once every three years and, very importantly, to follow up with their family doctors after the screening.

Early detection and treatment are important in the fight against diabetes, to keep the disease under control and prevent serious complications. Individuals with diabetes can benefit from lifestyle changes to prevent their condition from worsening. In addition, pre-diabetics could lower their risk of getting diabetes if they detect the problem early and improve their diet and lifestyle.

We plan to reach out to certain groups of Singaporeans below 40. For example, those who are obese and those whose immediate family members have diabetes. They face a higher risk of getting diabetes and may need to start the screening at an earlier age.

We will extend our screening outreach at the workplaces to bring diabetes screening to more workers. These include those who may find it difficult to schedule screening appointments due to the nature of their jobs. We will also review ways to strengthen post-screening follow-up to initiate early treatment and care when needed.

Next, I will touch on efforts to move care beyond hospitals into the community. MOH has co-located several community hospitals with acute hospitals to facilitate care integration for patients. We are helping patients to shorten their stays at community hospitals and return home earlier. For example, by allowing them to do their rehabilitation follow-ups at day rehabilitation centres. This is what many of our patients prefer. They do not want to stay in the hospitals longer than necessary.

As our population ages, it is inevitable that some of us will become frail and disabled and require support in activities of daily living. For some, this may be a few years before they pass on. For others, the duration could be longer, as Dr Lily Neo and Mr Louis Ng highlighted.

I thank Dr Lily Neo, Mr Low Thia Khiang and Mr Louis Ng for their suggestions on ElderShield. There were also earlier proposals from the People's Action Party (PAP) Seniors Group. MOH will study these suggestions carefully, as part of our ElderShield review.

Mdm Chair, one point I wish to highlight is that increasing the payouts and coverage of ElderShield will require, in the end, higher premiums for the scheme to remain viable. So, this higher cost will, ultimately, be borne by everyone, whether directly through ElderShield premiums or indirectly through tax-funded subsidies.

Hence, there is a need to balance enhancements in ElderShield with the potential cost increases, so that the scheme can remain affordable for all Singaporeans. ElderShield payout is one important source of payment but it is not the only source. Pioneers, for example, can receive Pioneer Generation Disability Assistance Scheme (PioneerDAS) on top of ElderShield. So, we will look at different ways of helping our seniors, especially those who are disabled.

Other important issues for the review include whether ElderShield should be made mandatory for every Singaporean. It is now an opt-out scheme, as some Members have pointed out, and how do we provide coverage for older cohorts of Singaporeans who, today, may not have ElderShield?

Similar to how we enhanced MediShield into MediShield Life, MOH will need to carefully review ElderShield in consultation with experts and key stakeholders. Our end in mind is to provide Singaporeans with peace of mind when we grow old, while keeping the scheme affordable for all.

Mdm Chair, ageing well also means having access to affordable end-of-life care. MOH is working in partnership with the palliative care sector under the National Strategy for Palliative Care. Since 2014, we have ramped up capacity and improved the quality of palliative care in Singapore.

Dr Lily Neo asked for better provision of hospice care, including training of hospice care personnel. We have introduced guidelines for the palliative care sector and will work with the Singapore Hospice Council to encourage industry players to adopt these guidelines.

Dr Lily Neo and Mr Low Thia Khiang asked about the financing framework for hospices. MOH regularly reviews funding for the palliative care sector to ensure end-of-life remains affordable for patients and sustainable for providers.

In July 2012, we raised the threshold for per capita household monthly income to cover up to two-thirds of Singaporean households, up from half previously. This has benefited more than 1,000 additional patients. We will continue to review and adjust the income threshold, like what we have done before.

We have also enhanced financial support for hospice care services. In 2014, we improved funding for home palliative care providers. Last year, we increased the MediSave withdrawal limit for inpatient hospice and home palliative care. Just last month, we increased subsidies for eligible inpatient hospice patients and introduced subsidies for day hospice care.

Overall, with coverage from Government subsidies, charity assistance and MediSave, most patients do not face out-of-pocket payments for hospice and palliative care. Let me share some data for FY2011 to 2015 on the length of stay. For inpatient hospice, the median length of stay is 15 days. For home palliative care, the median care period is around two months. And in terms of affordability, for inpatient hospice, eight in 10 patients have zero out-of-pocket payments and for home palliative patients, nine in 10 did not have to make out-of-pocket payments. Last year, MOH received three appeals on hospice care costs.

Later this year, MOH will further enhance financial support for palliative care by extending the $2,500 MediSave lifetime withdrawal limit for home palliative care to include day hospice services. Similar to home palliative patients, day hospice patients diagnosed with terminal cancer or end-stage organ failure will not be subject to this withdrawal limit if the claim is made from the patient's own MediSave account.

I agree with Ms Kuik Shiao-Yin that it is important for end-of-life care to be provided with empathy. We do have training for our healthcare professionals in this area and will look at ways to further improve and do better. In addition, MOH is supportive of other efforts to improve the quality of our end-of-life care, for example, Assisi Hospice's new facility, where the design of wards resembles a home rather than an institution. Outdoor gardens and green spaces are also included as part of the development.

VWOs play an invaluable role in the end-of-life care sector to provide quality and affordable care. We want to preserve this strong community support and involvement.

Programmes by volunteers also help patients to live their last days fully. This includes befriending and psycho-social support for patients and their families. We will support innovations in palliative care and will continue to work with providers, like Assisi Hospice and others, to pilot new ideas that can benefit patients and caregivers.

Mdm Chair, allow me to now respond to cuts from Mr Dennis Tan and Mr Pritam Singh. Mr Tan asked whether existing private patients in SOCs are allowed to switch to subsidised care without a polyclinic referral. Let me explain what our policy is.

If a private SOC patient wants to switch to subsidised care, a medical social worker will assess his request. These assessments are done on a case-by-case basis. This is to ensure that we target our subsidies at patients with the greatest financial need.

For new patients seeking subsidised specialist care, they will first go through a primary care doctor to assess if they need specialist care services. This can be done at a polyclinic or CHAS GP clinic, if he is a CHAS or PG card holder.

We know there are some private SOC patients who choose to be discharged from private SOC and go through this route to switch to subsidised SOC, instead of going through a medical social worker at the hospital. Strictly speaking, this is not part of the policy for patients to downgrade from private to subsidised SOC. This is perhaps why Mr Tan pointed out that the arrangement is not very neat and tidy. However, our hospitals want to be flexible and they have accommodated these private patients, so that they are not treated differently from new patients who go through the polyclinic.

Taking a broader view, our priority is to transform the way we care for patients, by bringing it beyond the hospital into the community. I shared about how we are integrating care between acute and community hospitals. In addition, MOH is piloting new models where specialists work closely with polyclinics and GPs to co-manage patients who have chronic conditions and need ongoing care. We are also building up primary care so that more SOC patients who are stable can be discharged and cared for by the polyclinics or GPs. This is a more impactful and sustainable way to have a win-win arrangement for everyone.

Mr Pritam Singh asked about Integrated Shield Plans, or IPs. These are private insurance plans which work together with MediShield Life.

IP premiums have two components: there is a MediShield Life component, which is sufficient for basic, subsidised healthcare services, and there is an additional private insurance component. MOH sets the premiums for the MediShield Life component and we will keep MediShield Life premiums affordable for all Singaporeans.

The private insurance premiums are decided by insurers based on commercial and actuarial considerations. They will review and adjust these premiums based on factors, such as claims experience. If claims were to increase significantly over time, the insurers will likely increase their premiums, as some have recently done so with the premiums for riders. Singaporeans who want to keep their insurance premiums affordable, including at older ages when premiums tend to go up, should carefully consider if you want to purchase private insurance like IPs and riders. Some of my residents in Bishan-Toa Payoh told me that they think MediShield Life is adequate to provide them with good quality subsidised care. It is an individual choice.

I agree with Mr Pritam Singh that it is important to guard against over-consumption and over-charging. These will exert upward pressure on healthcare costs and insurance premiums over time, a concern that was shared by Dr Chia Shi-Lu. This is why MediShield Life and all IPs have co-payment features. We will work with insurers to review existing features in private insurance schemes to mitigate the risk of over-consumption and over-charging, while providing sufficient coverage and peace of mind for policyholders.

Other important initiatives to keep healthcare costs and premiums affordable include: promoting healthy living and active ageing because we know prevention is better than cure; finding ways to improve productivity in the healthcare sector; encouraging appropriate care to reduce over-treatment or over-prescription; and, providing more information on fees and charges to help patients decide which hospital and doctor they want to visit.

Mr Pritam Singh also asked to increase the MediSave Additional Withdrawal Limits, or AWLs, to be sufficient for Standard IP premiums at all ages.

MediSave is sized for basic healthcare expenses. MediShield Life premiums can be fully paid for by MediSave. Singaporeans who wish to purchase private insurance can use their MediSave to pay for the additional private insurance component, up to the AWL. We need to set a limit for the use of MediSave for private insurance, including the Standard IP, so that Singaporeans will have sufficient MediSave balances to support their healthcare needs when they grow old.

Mdm Chair, let me now touch on the final area of enhancing value in healthcare through innovation. MOH will work closely with our healthcare institutions and the Healthcare Services Employees' Union to encourage and support ideas that can enhance patient care and service quality, improve the work environment for our healthcare workers and make our healthcare system more productive and sustainable.

Dr Tan Wu Meng asked about enhancing the use of information technology, particularly in the sharing of medical records. I agree with Dr Tan that this will help to improve productivity and patient care.

We rolled out NEHR in 2012 for participating healthcare institutions to view their patients' events and summary health records. As at March 2016, there are more than 900 healthcare institutions with access to NEHR and we would like to include more healthcare institutions over time.

Technology is a key enabler to improve the work environment for healthcare workers. When I visited NUH, I saw their pilot project to remotely monitor patients' vital signs. With this system, the time nurses spend monitoring patients' vital signs has reduced by half.

I am also very happy to know that there are other areas where we can support such technology, including a chair that I saw. It is a portable toilet from Japan. It looks like a normal chair but when you use it, and if you press a button, it will automatically wrap and seal the waste products. So, this makes it easier for the nurses and caregivers, as there is no unpleasant smell and the waste disposal can be done more conveniently.

Ms Thanaletchimi asked about the training for healthcare workers as we implement automation and robotics. The public healthcare employers are committed to redesigning jobs and supporting our workers to gain new skills so that they can stay employable. In fact, through technology and productivity improvements, we want to enable healthcare workers to remain longer in service by making the work less physically demanding for them. This is a win-win arrangement – workers can continue working for more years, while patients can benefit from their service and experience.

Jamiyah Nursing Home is a good example. They partnered the AIC to do a job redesign and, through the various changes they have made, the staff were able to save up to 20% of their time. They also introduced FWAs so as to allow staff more flexibility in managing their work hours.

Our healthcare workers play a pivotal role in supporting productivity initiatives and we appreciate and recognise their efforts.

Ms Thanaletchimi suggested extending the Progressive Wage Model which we currently have in the healthcare system to other groups of healthcare workers. I fully support her proposal. MOH will work with the union on this. We want to retain our healthcare workers and upskill them to provide quality care for our patients.

Mdm Chair, we have made steady progress over the years to provide quality healthcare for all Singaporeans. This is reflected in the improvements in our life expectancy and health outcomes. Credit must go to our committed healthcare workers, who have put in a lot of dedication and hard work to care for their patients. They do it with a caring heart. We must continue to show appreciation for their efforts, support them in their work and also stand by our healthcare workers during difficult times.

For future generations of Singaporeans to continue having affordable, accessible and quality healthcare, we need to transform our care models and keep our healthcare system sustainable.

To succeed, it will require the involvement of all Singaporeans − from individuals, families and the community. It will require changes in habits and behaviours. And, most importantly, it will require all stakeholders to work together in close collaboration and partnership.

Mdm Chair, I have three clarifications. The first concerns the Health Products Act. As I understand it, it now regulates medical devices and cosmetic products and I also understand there have been some public consultations on this about whether it is possible to transfer the control of other pharmaceutical products under this Act. Could I ask the Minister for an update on the status of this transfer and whether it is likely that we will see an amendment to the Act in the near future?

The second clarification concerns this threat of infectious diseases, and it is directed to Minister of State Dr Lam Pin Min. In view of the potential cost of an epidemic, should it occur, do we have provision for a fund to deal with the cost of tackling the epidemic and also the resultant economic cost?

If we look at the US, for instance, they set up a fund to combat Ebola. Now that the threat has passed, they are porting some money over to combat the threat of Zika and expanding on that fund. So, I am just wondering whether we have a provision for a fund to tackle such public health crises.

The final clarification is with regard to my cut on transparency. I thank the Minister of State for his answer.

Yes. Could I just ask if there are any more concrete steps that we can take to, perhaps modulate the cost of private healthcare?

Madam, let me just address the first clarification on the Health Product Act. Dr Chia is right that we are looking at health product regulations and looking at the pharmaceutical products that are currently regulated under the Medicines Act.

Pharmaceutical products will be ported over to the Health Products Act to be regulated under the Health Products Act as therapeutic products, in addition to the medical devices and cosmetic products that are already under the Health Products Act. This is in line with our plan to update our legislation and to consolidate the regulation of health-related products in one Act for greater clarity.

We have conducted extensive stakeholder engagement. We held two rounds of public consultation recently. The feedback has been supportive and we hope to be able to finalise the review shortly and to bring over the therapeutic products into the Health Products Act by the end of this year.

I would like to thank Dr Chia Shi-Lu for the two clarifications. I would like to say that we do not have a big war chest fund like in the US. Having said that, MOH does build in contingency requirements into our service contracts to respond to health emergencies. And in the event of a disease outbreak, MOH will reprioritise our budget to ensure that we are able to implement all these control measures.

In addition to that, like I have mentioned in my reply, we do stockpile medical equipment and supplies like our personal protective equipment, anti-microbials and even vaccines, if necessary. I would like to reassure Dr Chia that we take a whole-of-Government approach to tackle disease outbreaks and, if additional funds are needed, we will definitely work with MOF to ensure that there will be sufficient funding support to implement our efforts.

With regard to the second clarification on the control of costs in the private sector, in my speech, I did mention that we have published the professional fees on our MOH website which include total hospitalisation fees both in the public and private sector, the total operation fees in the public sector. And most recently, like I have just announced, we will be publishing the total operation fees of the private hospitals, and this will actually serve as a point of reference for both the healthcare professionals as well as the general public, so that they can make an informed decision.

Minister Gan Kim Yong has also announced the setting up of ACE, and this agency will evaluate the clinical and cost effectiveness of health technologies and all the different expensive treatment modalities.

Thirdly, our healthcare insurance financing features like co-payment and deductibles are built into our MediShield Life as well as some private healthcare plans and this will, hopefully, discourage the "buffet syndrome".

Last but not least, which is the most important, is that I would like to remind all doctors that we are bound by the Singapore Medical Council and Singapore Dental Council's ethical code and ethical guidelines and that we should not abuse the doctor-patient relationship for our own personal gains.

I would like to ask the Minister whether he will require hospitals to publish on their website waiting times for SOCs by medical speciality.

Madam, we will take onboard the suggestion and study what are the implications. There are pros and cons. From the patients' point of view, whether the data is meaningful or not, is something we need to consider. From the patients' point of view, what we do for SOC services is to prioritise their needs and fix their schedule according to the seriousness of their conditions. For those who have more serious and time-sensitive conditions, we will give them priority.

The published wait time may not mean a lot to them and may create more confusion, because some of them may have to wait longer than the median wait time because their conditions are less critical, and some may have earlier appointments because of their serious conditions. From the patients' point of view, we have to be careful with the data we publish. But we do monitor the wait times at our SOCs for our hospitals. Whether they are published or not, it is a performance indicator that we keep track of.

Madam, I have four clarifications. The first one, just now, Senior Minister of State Amy Khor had mentioned and provided some explanation about the community networks for seniors. I would like to register my very strong interest to have it piloted in MacPherson and, if yes – please say yes – I hope, I would like to ask if there is any room for the local grassroots to be involved in the set up so that we can provide the local context to customise the scope of work for the community network.

At the same time, I am just wondering if the Ministry will also consider establishing something like an eldercare relationship management system so that there is a more systematic way for the different stakeholders to integrate our efforts and to synchronise in how we can reach and better care for our elderly.

Second, I would like to ask whether there is any plan to leverage more on technology to enable ageing-in-place so that our elders in their retirement can live in a more independent manner.

The third query is on the Trim and Fit (TAF) programme. I understand that, in the past, in the schools, there is the TAF programme to encourage the young to be healthier. So, just wondering why this has been discontinued and what is the reason for that.

Lastly, on Zika, just yesterday, there was news from the US that it is worse than it has been previously thought. It affects the entire pregnancy period and so this is quite worrying. I would like to ask what are the measures in place to better protect pregnant women in Singapore. Also, I fear that awareness about Zika in Singapore is still very much lagging, especially compared to dengue.

I will take the first two. Firstly, on community networks, I would just like to explain that we will be piloting this in about three areas across the island, different regions and also looking at slightly different demographic profiles as well as socio-economic status so that we can learn from the pilots before scaling up. We will try and look at what the gaps are and so on.

With regard to the Member's suggestion about getting grassroots involved, indeed, community networks will involve all stakeholders in the community. It is just that it will be facilitated by a small team of staff together with the various Government agencies, the VWOs, community-based organisations and, of course, including grassroots.

Because we are piloting the project, we will certainly take into account the Member's strong interest in setting up a community network. Let us pilot it and learn from it before we can scale up.

Regarding eldercare relationships, in fact, this is what we have been doing under the Action Plan for Successful Ageing. After learning from implementing the many ground-up ideas, we have put it into a guide and sent it to all the divisions. When we learn through the community networks, we can also put up some of these as guiding principles for use.

Technology for eldercare, certainly. That is why I have said in my speech earlier that there is a National Innovation Challenge where we have made two grant calls and we will be calling for more. The first two are on new models of home-care and enhancing care for dementia.

Along with these, we will be looking at technology, too. In fact, there are some pilots, with regard to technology, say in Marine Parade, where they are piloting a home-monitoring system to monitor the health as well as the lives of the elderly to make sure they are taken care of. If something happens, they can actually alert the senior care centres.

Mdm Chair, I would like to thank Ms Tin Pei Ling for the two clarifications. On the issue of the TAF programme, it was implemented in 1992 and discontinued in 2007. Ms Tin is probably young enough to have either personally experienced the TAF programme or have witnessed her classmates going through it. The objective of the TAF programme is to enable all our overweight and obese students to achieve a healthy weight and while it showed success in reducing obesity rate from 14% to about 9.8% in 2002, MOE did receive quite a number of feedback, both from parents as well as students, that some of the students felt stigmatised by this programme.

Since it was discontinued in 2007, MOE replaced it with a different programme called the Holistic Health Framework (HHF) which is a more holistic approach towards health, rather than just focusing on weight alone. It addresses other aspects of physical health as well as mental and social health. So, that is the reason and the answer to the Member's first clarification.

For the second one on Zika, just like any emerging diseases, including Zika, MOH adopts a three-pronged approach which I have mentioned in my reply. One, to reduce the risk of importation; two, early detection; and three, containment. In reducing the risk of importation, MOH issues travel advisories on affected countries for Singaporeans who are travelling out of Singapore. Even for women who may get pregnant, they are advised strongly not to travel to these affected countries unless there is a strong reason to do so.

To enhance early detection, we have enhanced vigilance amongst our healthcare providers as well as public healthcare institutions. We also have to step up public education amongst the general public about this disease.

If we do have a first case of positive Zika infection, then isolation will be necessary to prevent its spread through the bites on this infected person by the Aedes mosquito. So, we try to contain it. But, of course, not forgetting the good old effective vector control. I think all of us have a part to play in performing the 5-step Mozzie Wipeout routine.

To manage pregnant patients who may be affected by Zika, MOH has also set up a clinical advisory group on Zika virus infection and pregnancy and it comprises obstetricians, public health specialists as well as infectious disease specialists who advise MOH on the different aspects of management of a pregnant patient who may be suspected of being infected with Zika.

So, I want to reassure Ms Tin Pei Ling that MOH will closely monitor the development of Zika infection overseas as well as the development of other potential treatment modalities including vaccines.

Sure, Madam. On healthy living and preventive health, could I check with the Minister if there are any plans to roll out the holistic electronic health record of a Singaporean from birth to school, work and through retirement in a holistic way?

The second clarification is on promoting healthy eating habits. How can we help low-wage and vulnerable workers eat healthily, to have better healthy options for choice, if the cost of healthy choice options is rather high at workplaces or in industry sectors?

The third clarification is whether the Minister would consider reviewing the MediSave withdrawal limit, especially on flexi-MediSave capped at $200, so that those affected patients who are seeking specialist treatment can better manage their chronic disease or illness.

Lastly, would MOH revive or further explore the possibility of a portable medical benefits scheme which employers can offer workers in the early stage of employment so that workers can carry with them the medical benefit plan even if they were to be retrenched or lose their jobs?

Madam, yes, I will try to keep it short. I had been working with the unions and the employers' group when I was in the Ministry of Manpower, to look at the portable medical benefits, and I continue to do so after I have moved over to MOH. I am very supportive of these portable medical benefits and I think it is a great thing. The most portable medical benefit is really MediShield Life. I would encourage employers to think about helping their employees with their MediShield Life, either by topping up their MediSave so that they can use their MediSave top-up to pay for the MediShield Life premiums, or purchase IPs for their employees. These are possibilities, and we do have tax incentives for them. They can claim up to 2% tax deductions for the cost of the portable medical benefits.

I will now ask my colleague, Minister of State Chee Hong Tat, to talk about MediSave withdrawal limits that the Member has asked about, as well as healthy eating habits, how to help the low-wage workers.

On the health records from birth to school, adult and retirement, we have introduced an app called "My Health Hub" which draws data from your personal health records, including your screening and vaccination records from birth to the end of life. So, I would encourage you to download this app which you can carry in your handphone and it is available to you 24/7 all the time. It is something that we are working on and we will continue to enhance this app. This is just a pilot application and it is still at the beta stage. We encourage you to download it, use it and let us have your feedback on how it is working and we will continue to enhance its features to make it useful for individuals. We want to use this to empower our individuals to lead a healthy lifestyle.

Mdm Chair, I will answer the question on how to encourage our workers to eat healthily, especially our low-wage workers, and also the other question about MediSave.

First, on eating habits. Indeed, we have to find ways to make healthier food options affordable. There are different ways of doing this. In some of the institutions and companies, in their cafeteria or canteen, they do offer healthier options. When I visited Khoo Teck Puat Hospital, they were showing me the food court. They do a few things. First is pricing. If you eat brown rice, it is cheaper than if you eat white rice. It Is not the case in all places, but at the food court in Khoo Teck Puat Hospital, that is the pricing incentive that they give to encourage people to eat healthily. They also give a discount if you order drinks with less sugar. If you order kopi-C, it is more expensive than if you order kopi-C xiu dai, and it is more expensive than if you order kopi-C kosong. So, they try to find different ways to nudge people to eat healthily.

They also use design to try and place the different food items. So, this is not just pricing. It is also about how you encourage good behaviours, eating habits. The economic rice stall, for example, they will put the healthier options at the beginning of the queue, so that when you choose these options, by the end of the queue where some of the less healthy foods are, your plate would be full and, therefore, you may not have as much incentive, desire or temptation to order the less healthy food.

Through this combination of ways, they are trying to help the visitors, patrons and also their own staff to eat more healthily. We need to work with employers. We also need the help of the unions and our Labour Movement to help us to work together to try and encourage all Singaporeans, including our workers, to eat healthily.

Ms Thanaletchimi also asked about MediSave. Today, we have a withdrawal limit of $400 per person for management of chronic diseases. In 2014, when we looked at the amount, it was sufficient for the majority of patients. For eight in 10 patients, this amount was sufficient. But in certain cases where the need may be greater, they can actually share with their spouse. So, it is not just your own individual account. You can use it to help your spouse. This also gives greater flexibility in cases where they need a little bit more.

Very importantly, while we look at ways to provide more flexibility through the use of MediSave, we must also bear in mind that MediSave, at the end, is also used for long-term healthcare needs when we grow old. It is used to pay for our healthcare costs and to pay for our insurance premiums, including MediShield Life premiums. So, there is a need to strike a balance. But we will look at ways to try and make it flexible for people to use and to keep the cost affordable for chronic disease management.

Madam, just two brief clarifications and I will keep it short. One, for the Minister, is whether the Ministry will consider the suggestion I made to publish the waiting times separately for walk-in versus appointment for polyclinics, and to lower the key performance indicator from 100 minutes to 45 minutes.

My second clarification point is to Minister of State Chee Hong Tat regarding the outreach efforts to companies through health talks and healthy living promotion. One of the best ways to reach out to adults is through their employers. I know HPB does programmes, such as screening and talks, with large employers. But the SMEs often get left out. What more will HPB be doing to reach out to SMEs to conduct this kind of programmes, perhaps working together with the trade associations and chambers?

Madam, I may take a little bit longer. Usually, I try not to reject ideas and suggestions, so we will consider Mr Leon Perera's suggestion carefully and see whether we could enhance our indicators and publish the wait times for both appointments and walk-ins.

In saying that, I should also clarify that in the primary sector, such as polyclinics that the Member was referring to, we have more critical issues at hand because we are in the process of restructuring the whole primary care sector, as Dr Lam has outlined. Over time, we should look at primary care not just between polyclinics and GPs. In primary care, polyclinics and private GPs should work together. We have also introduced Family Medicine Clinics which are still in the pilot phase. We have six or seven of them and we hope to expand and have more. They play a very important role.

We are in the process of restructuring and revamping the primary care sector. Our indicators and performance targets have to be in line with the new model that we are evolving. We will take on board the Member's suggestion and study very carefully but, at the same time, bear in mind that the sector is going through a transformation.

This is not just between polyclinic and GPs. We are also trying to integrate SOCs with primary care, so that we minimise the need to refer cases to the SOCs and to also facilitate discharge of SOC patients to primary care, so that they can be taken care of in a primary care setting.

One example is orthopaedics. In orthopaedics today − I think Dr Chia Shi-Lu would be very familiar with − primary care and polyclinic patients cannot have direct access to physiotherapy without being referred to orthopaedic specialists because we are concerned about the missed-diagnosis. But we have developed protocols to facilitate primary care doctors to make a preliminary diagnosis and, in many cases, you do not require the services of a specialist and you can refer patients directly to a physiotherapist.

This is still at the pilot stage. We want to try it out to see whether this works well for us. If it does, we will encourage more in the primary sector to take on this responsibility.

In doing so, you will find that between GPs and polyclinic, between primary care and specialist care, it is going to be more and more integrated. The indicators that we use will also have to take that into account. How do we measure the outcome, not in a segmented way, each individual department's or setting's performance, but an integrated performance measurement? It is something that is evolving, and we will consider the Member's suggestions and incorporate some of them.

Mdm Chair, one clarification, please. Madam, may I first declare that my two children are doctors with MOH.

My clarification is on the expansion of healthcare demand which the Minister spoke about earlier. May I ask the Minister whether he will prioritise the traineeship of Singapore Core doctors? Are there sufficient resources given to this area? For long-term benefits and future needs, will the Minister not curtail, for whatever reasons, the specialist training of local doctors? May I also ask how many private specialist doctors are being employed in our public hospitals and is it not better to train our local doctors to fill these positions rather than employing foreign specialist doctors in our public hospitals?

Madam, I will keep it short. Our priority is to train our own doctors, to provide them with opportunities to go into specialist training if they are able to. But we do also want to ensure that there are sufficient numbers of local doctors that go into family medicine because family medicine is going to play an increasingly important role. As I explained just now, family medicine will play a very important role in our review of primary care. Therefore, we want to encourage our doctors to pursue further education, both in specialist as well as family medicine training.

Having said that, despite the expansion in the pipeline, expansion in our training capacity, we will still need to look at the need of supplementing our local manpower with foreign trained manpower. The first part of foreign trained manpower is our own Singaporeans who are trained overseas. We have a lot of programmes to reach out to them, including our Pre-employment Grant (PEG), where we work with our students who are receiving training overseas to attract them back to Singapore to serve in our public sector.

Our greatest allies are the parents because the parents do want their children to return. So, we work with them to bring them back. I have one parent who came to me to say, "Can you please give my son the PEG? I will fund you, but make sure he signs the contract to come back." We do go out of our way to reach out to them, engage them, provide them with the opportunity to return. In between their studies, if there are opportunities, we will also want to bring them back for internship, training and so on, so that they remain connected to Singapore. We hope to be able to do more of this, going forward.