Joint UK-Singapore Conference On Independence And Care For Older Persons

19 Oct 2001

By Mr Lim Hng Kiang

Lord Filkin

Government Spokesman on Health, House of Lords,

United Kingdom

Sir Stephen Brown

British High Commissioner to Singapore

Distinguished speakers, guests,

Ladies and gentlemen,

I am very pleased to join you this morning at this Joint UK-Singapore Conference on Independence and Care for Older Persons. This is a follow up to a similar seminar held 2 years ago.

I understand that in addition to local delegates and delegates from the United Kingdom, we have representatives from surrounding Asean countries in the audience. Let me extend a warm welcome to all our overseas participants to Singapore.

The Planning Committee has put together a programme focusing on promoting independence and long term care for older persons. The speakers at this Conference are experts in their fields and we can all look forward to a stimulating Conference.

Evolution In Health Care For The Elderly In Singapore

Since the last Seminar, a number of developments have taken place in healthcare for the elderly in Singapore. Similarly in the United Kingdom too, major developments in healthcare for the elderly have occurred and Lord Filkin and the speakers will be speaking on these. Let me highlight 3 key areas in healthcare for the elderly over the last 2 years in Singapore - namely, the development of a framework for integrated services, implementation of community support programmes and the establishment of financing schemes for long term care of the elderly.

Integrated Health Services For The Elderly

Currently, 7% of our population is 65 years and older. By 2030, it will be 18%, close to the level in the United Kingdom today. A fairly comprehensive range of health services are available for the elderly. However, there is a need to better integrate the various levels of care and to raise the standards of clinical service delivery. In June last year, my Ministry announced a framework for integrated health services for the elderly. Under this framework, 3 regional acute hospitals were each linked with a number of community hospitals and nursing homes. Each regional hospital provides professional guidance and support to the step-down facilities affiliated to it, to improve the quality of clinical care and to assist in clinical service development. The scope of services at these community hospitals and nursing homes were expanded to include day rehabilitation, home medical and home nursing services. A centralised agency was also set up, since May this year, to co-ordinate the placement of patients from the hospitals and the public into nursing homes.

We are expanding our step-down facilities in line with expected demand. Today, we have 4,200 VWO nursing home beds and 430 community hospital beds. By 2010, there will be an additional 1,000 VWO nursing home beds and 750 community hospitals beds, and expanded community and home care services. In tandem with this increase, it is projected that in 2010, the overall quantum of funds for step-down facilities supported by the Ministry will be about $100m, which is double today's expenditure.

My Ministry is currently working on the phased introduction of more structured and effective clinical quality assurance systems in step-down facilities. Through this and the integrated step-down care framework, we are confident that the quality of care delivered by these providers will be high and continue to improve. In this regard, the United Kingdom has managed these issues well over many years, and I am sure that we can learn a great deal from your experience and expertise in these areas.

Community based Programmes For The Elderly

We recognise the importance of keeping the elderly independent and living in the community with their family members for as long as appropriate. This is one of the principles guiding our planning of healthcare services for the elderly. It is also strongly advocated in the UK and forms the theme for this conference.

A key pre-requisite for the elderly remaining with their families and the community is the availability of home medical, home nursing and other supporting services. With such services in place, families would be more confident of looking after the elderly at home. This is an area that we need to build up substantially and we can expect such services to expand over the next few years.

To complement home medical and home nursing services, we need programmes to train home carers in skills for caring for the elderly. Such programmes were started at community centres and complements training of home carers provided at hospitals and other step-down care institutions. We also need to educate the elderly, and their family members, on how to keep fit and healthy and to prevent illnesses and disability eg through fall prevention. The Health Promotion Board also works with employers to advise on programmes to maintain the health of workers.

A national community health screening programme was also implemented last year to screen persons aged 50 years and above for hypertension, diabetes and blood cholesterol levels. At the polyclinics, a Comprehensive Chronic Care Programme was launched last year which provides a structured care package to ensure good control of blood pressure, diabetes and blood cholesterol. Good care of diabetes, hypertension and high cholesterol levels will reduce complications of these diseases which cause severe disability, like stroke, blindness, limb amputations and renal failure.

Financing Healthcare For The Elderly

As the population of the elderly increases, we can expect more financial resources to be needed.

In 2000, we set up the Eldercare Fund. This is an endowment fund for sustained financing for eldercare. The Government has so far provided $750m from budget surpluses for the Fund, and the sum is targeted to reach $2.5b by 2010. Only the interest income of the Fund will be used to fund step down care for the elderly, and this sum is planned to be about $100m by 2010, which should be adequate to fund all step-down care services at that time. In other words, the Eldercare fund will reduce the need to further tax the shrinking number of economically active persons to fund elderly care services in the future.

As Medisave covers only hospitalisation care, we considered the need for long term care insurance and we are launching the Eldershield scheme next year. Eldershield will provide cash payouts for those certified to have severe disability and are unable to perform three or more activities of daily living. I have already announced the Eldershield Scheme, but to recap, I will briefly mention its key features. It is an actuarial scheme which provides lifetime coverage. It has low annual premiums which can be paid from Medisave, starting from the age of 40 years to 65 years. The cash payout is $300 per month up to a maximum of 60 months for the severely disabled, to defray expenses of home care or nursing home care.

Means Testing

In July 2000, we implemented means testing and a 3-tier subsidy for nursing homes. The subsidy rate is pegged to the per capita income, with a higher subsidy given to those in greater financial need. The subsidy is 75% for those with per capita income of less $300, 50% for $301 to $500, and 25% for incomes between $501 to $700. As a result of the means testing, there was a 20% increase in subvention to the 16 MOH funded nursing homes, and we note that the additional subsidy was due mainly to the increase in the proportion of patients who qualify for the maximum subsidy of 75%.

Revised means testing

We monitored the implementation of means testing in the nursing homes and I am pleased to announce that we will be making changes to the means test quantum. The change will allow more to qualify for government subsidy. The per capita income cutoff to be eligible for 50% subsidy will be raised from $500 to $700. To be eligible for 25% subsidy, the per capita income cutoff will be raised from $700 to $1000. This means that those with per capita income of between $700 to $1000 who did not qualify for subsidy previously will now be able to receive 25% subsidy, and the subsidy for those with per capita income of between $500 to $700 will be increased by 25%, from 25% subsidy to 50% subsidy. Government subsidy for stepdown care will therefore be provided for half the population.

Hand-in-hand with the cash payouts from ElderShield, this revision in means testing will improve affordability and increase the sustainability of long term care, particularly so for the lower 50% of Singaporeans. The revised means testing framework will be applied to all VWO services under MOH's purview. It will be implemented in nursing homes and hospices from 1 Oct 2001 and in community hospitals by 1 Jan 2002.

It leaves me now to convey my best wishes for a successful Conference. I am sure we will all benefit from the stimulating exchange of our different experience. I am pleased to declare the Joint UK-Singapore Conference on Independence and Care for the Older Persons open.