Speech by Dr Amy Khor, Senior Minister of State for Health, at the Ministry of Health Committee of Supply Debate 2020, on Thursday 5 March 2020

Chairman, ageing should not be regarded as a Silver Tsunami to be feared but rather as Silver Equity to be drawn upon.  Longevity is also not a disease! It is a gift to celebrate, so long as we stay healthy. With the gift of time and health, we can pursue the things we enjoy.

2.          Minister Gan shared that Singaporeans have a life expectancy of 84.8 years, of which 74.2 years are lived in full health. How could we seize the opportunities of at least 74 good years?

AGEING: SEIZING OPPORTUNITIES OF LONGEVITY

3.            Since we launched the Action Plan for Successful Ageing in 2015, we have made significant strides in building a caring and inclusive home, centred on 3 ‘C’s - care, contribution, and connectedness.

4.         From scaling up the Community Networks of Seniors nationwide, to promoting learning and volunteering opportunities, we have sought to enable seniors to age in a caring environment, pursue the activities they enjoy, and contribute to others in the way they wish. 

5.         We are also helping our seniors stay connected by capitalising on man’s best friend.  I don’t mean a pet dog or cat, but you might have guessed it – the smart phone.

6.        Together with Smart Nation and Digital Government Office and Public Service Division, we have developed the Active Ageing module in the Moments of Life (MOL) app.

7.             As one of the 250,000 Merdeka Generation members that the Silver Generation Ambassadors have reached out to date, I found it really easy to access information about the various active ageing programmes via the MOL app, and pick the one nearest home.

8.             From next month, not only can I browse information on the MOL app, I can also sign up and “chope” a spot for active ageing programmes by the Health Promotion Board (HPB), such as health talks, cooking demonstrations, and more!

9.             This January, we launched the Healthy Longevity Catalyst Awards in partnership with the United States National Academy of Medicine, to spur bold, innovative ideas and technology to extend healthy longevity. This could include assistive devices, smart-enabled homes, or job redesign solutions.

10.          We received more than 100 applications, and I look forward to leveraging these innovations to help seniors stay active and engaged.

11.         With all our efforts, I am glad to inform Ms Tin Pei Ling that the 2019 Ageing Survey showed that Singaporeans generally had a positive outlook towards ageing. Across all age groups, those who were still working or volunteering were also less likely to describe themselves as old. However, 96% of Singaporeans cited health as the top concern in old age, and three in four retirees wished they could have worked longer.

12.          As we plan for both seniors of today and tomorrow, we must respond to changing needs and aspirations. As part of the SG Together movement, the government will engage Singaporeans across all ages to refresh the Action Plan for Successful Ageing, so as to co-create a future where generations of seniors may thrive in. Health and employment will be key focus areas in the Action Plan, to address our seniors’ top concerns.

13.          Of course, while we strive to make the best of our golden years, most of us will eventually come face to face with creaky knees and back pain. But if we prepare ourselves and plan ahead early, we can better cope with the uncertainty, and lengthen the good years of life.

14.          To that end, we have partnered the Centre for Seniors (CFS) to pilot bite-sized life-stage conversations, with the aim to reach out to some 5,000 mature workers, especially those in their early 50s, through collaborations with companies, union leaders and community organisations over the next two years.

15.         The conversations will touch on a wide range of topics such as employment, health, and family, to help mature workers prepare themselves early for the transitions in their senior years. As of December, CFS had organised some 63 lunch-time talks for over 2,000 participants.

16.      Chairman, speaking from experience, I will now like to urge all younger Singaporeans in their 20s and even younger to prepare early for their golden years, which could so easily come upon us in the blink of an eye. Just like me, members of this House on the right side of 50 would surely understand.

17.        Bone health in particular, deserves our careful attention. With an ageing population, the number of hip fractures has nearly doubled, from 1,500 cases in year 2000 to nearly 3,000 in 2017. About 14% of those with hip fractures pass away within a year of fracture – a sobering statistic. Of the patients who survive, 20% require assistance with activities of daily living. Fractures can have a debilitating effect on our quality of life.

18.          To reduce the risk of fracture when we age, we must start ‘saving up’ calcium from young, before we reach maximum bone density at around 30 years old, after which, we can only maintain the density at best. To inculcate the importance of proper nutrition and a healthy lifestyle, HPB will be conducting a pilot outreach to ten schools on bone health.

19.          Besides ‘saving up’ calcium in our youth, we must also continually upkeep, and prevent depreciation of our assets. In this case, depreciation refers to bone loss.

20.         HPB will be working with Osteoporosis Society Singapore to train 300 Bone Health Ambassadors to reach out to more Singaporeans on the importance of a healthy lifestyle and diet, starting in the second half of this year. These ambassadors will help to run public educational sessions, particularly in the area of fall prevention.

21.          Dr Lily Neo, Ms Tin Pei Ling, and Ms Joan Pereira asked about our progress in supporting seniors to age-in-place. Since 2015, MOH has expanded the number of home and day care places by 70%, to support seniors to age-in-place. For nursing homes, we have expanded bed capacity by 30%. We now have sufficient capacity nationwide.

22.         Besides expanding capacity, we are also enhancing the scope of services, to better address the spectrum of care needs.

23.          I announced last year that we will enhance the scope of eldercare centres, to go beyond aged care to social support and preventive health. Currently, MOH funds 82 Senior Activity Centres to provide wellness programmes and social support to residents in rental flats. In the next four years, we will progressively level up and fund at least double the number of eldercare centres to provide an expanded suite of baseline support services for all seniors nationwide, and not just those living in rental blocks.

24.          Services include active ageing programmes for the well, befriending services for the lonely, and information and referral for care services for our frail seniors.

25.          In addition, about half of the eldercare centres will also provide higher level care services, such as day care and community rehabilitation services, to cater to those who are more frail.

26.         We also echo Ms Irene Quay’s view that community pharmacists play an important role in ensuring medication adherence in the community. In 2017, of some 517,000 seniors, more than 43% were prescribed five or more regular medications, and seen by three or more healthcare providers.  Seniors who have multiple co-morbidities often struggle with making sense of many medications from many clinics, and the risk of medication error then increases.

27.          Thus, MOH conducted a small proof-of-concept for a pharmaceutical care service for 150 seniors at eight eldercare centres last year. Community pharmacists from both private and public healthcare institutions worked with the centres’ care teams to optimise seniors’ medications. Through one-to-one sessions with their pharmacists, seniors and their caregivers received tips on managing their medications, including medication packing and management of side effects, so that they may take their medications safely and independently at home. Feedback from participants of the pilot has been positive.  Hence, over the next three years, we will be extending the pharmaceutical care service to another 2,500 seniors, at more eldercare centres. This will allow us to establish scalable solutions to help seniors manage their medications safely.

28.          Besides pharmacists, community nurses pounding the ground complement the role of eldercare partners. To Ms Joan Pereira’s question, we have expanded the number of community nursing posts from about 70 a year ago, to about 120 community nursing posts today. These are sited at senior activity centres, community centres, and religious sites, just to name a few. We now have a pool of 245 community nurses, exceeding our target to recruit 200 community nurses by end 2019. As feedback has been positive, we target to expand our pool to 300 community nurses by 2021. Kudos to our nurses from the Regional Health Clusters, who have attended to 86,000 residents in the community, up from 33,000 just a year ago. I am glad that not only do our residents cherish our community nurses, but nurses likewise found their job meaningful, and nearly all of them have stayed on the team since the pilot started. In fact, only one left.

29.         This year, as earlier announced by Minister Lawrence Wong, we will also be rolling out another HDB housing type – assisted living flats – to expand the housing options for seniors. The first one, announced by Minister Wong, will be launched in Bukit Batok. These new assisted living flats are meant to provide seniors with a housing option for independent living, with care available if needed, and a gotong royong spirit amongst neighbours.

30.       We co-designed the flats with Singaporeans. In the past year, MOH and MND conducted 14 Focus Group Discussions (FGDs) with seniors, service providers, and healthcare professionals.

31.          Chairman, may I display a few slides please?

32.     The FGDs were conducted at these specially constructed mock-up flats and communal living room to help participants better imagine the assisted living experience. It was helpful as participants could give us very specific feedback: a moveable partition between kitchen and sleeping areas, room for a full-sized fridge, and more. We took in all the feedback, and improved the design of the housing units, communal living room, and basic service package. We are also exploring additional care service options to support frail seniors, such as after-hours care.

33.         So, what is the difference between assisted living flats, and the range of senior housing options today, such as two-room flexi-flats? Unlike two-room flexi-flats, these assisted living flats will be sold, twinned with a service package. Elderly residents will benefit from 24/7 emergency response, as well as the assistance of an on-site community manager.

34.          The community manager will monitor the health status of residents, and link them up with relevant care services according to their needs. The community manager will also curate programmes to foster a strong sense of neighbourliness, and residents can look forward to mingling at the communal spaces on every floor – much like the good old kampong days.

35.          The first Assisted Living flats in Bukit Batok will be reserved for seniors aged 65 and above. In addition, we will set aside some units where priority will be given to seniors with care needs. More details will be shared in the coming weeks. Planning for a private assisted living pilot is also underway. MND and MOH have consulted developers and care operators on this, and will announce details later.

MENTAL HEALTH

36.          MOH continuously seeks to wrap care and support around Singaporeans. Dr Lily Neo, Ms Anthea Ong, Mr Daniel Goh, and Mr Murali Pillai highlighted the importance of taking this approach for not just physical health, but also mental health. I agree and we are embracing this approach. For instance, the HPB promotes both physical and mental health in its preventive health programmes organised in the community and at workplaces. 

37.          Like a migraine or backache, we should seek help for mental health issues early, so as to avoid problems that are more challenging to address later on. To that end, we have set up 43 community outreach teams and trained over 24,000 frontline staff from government agencies and community partners across Singapore, to identify persons with mental health needs in the community and refer them for appropriate support. As of December 2019, we have reached out to over 300,000 persons, and provided assistance to more than 23,000 persons who were at risk of developing mental health conditions or dementia.

38.          The Institute of Mental Health (IMH) and the National Council on Social Service (NCSS) have also been driving the “Beyond the Label” national campaign to facilitate more conversations about mental health. This way, we hope to chip away at the stigma associated with mental health, and encourage those with mental health issues to seek help promptly.

39.          Ms Anthea Ong should also be assured that physicians are bound by duty and ethics to protect patient confidentiality, and to ensure data sharing and use for patient care purposes only – for all medical conditions, not just mental health.  Healthcare institutions are also required by licensing conditions to safeguard confidentiality of medical records.  Specifically, our public healthcare institutions have implemented safeguards to ensure access by authorised users on a need-to-know basis. Severe disciplinary and enforcement actions are taken against users who wilfully breach patient confidentiality. Organisations must also comply with the Personal Data Protection Act.

40.          Chairman, over the years, we have expanded our network of partners, to ensure that persons with mental health issues can access the support they need.

41.          For example, IMH operates a 24-hour Mental Health Helpline. NCSS also recently launched a Helpbot named ‘Belle’, to provide 24/7 access to consolidated information about helplines and mental health resources, according to what the users are looking for. To date, Belle has supported 1,000 users.

42.          Community intervention teams have also been established to support partner General Practitioners (GPs) and service providers with allied health services such as psychotherapy and counselling. Over 26,000 persons have been supported by these teams. In addition, persons with mental health issues who face social and family issues may approach Family Service Centres for counselling support.

43.          To date, more than half of our polyclinics provide mental health and dementia services. In addition, over 210 GP partners have been trained to diagnose and support persons with mental health conditions.

44.          These services are available to all Singaporeans, irrespective of their specific risk factors such as disabilities or gender identity. However, we agree with Ms Yip Pin Xiu and Ms Anthea Ong that care providers need to take into account specific care needs, and risk factors.

45.          For example, for persons with hearing loss, sign language translators will provide counsellors with the necessary support. The Singapore Association for the Deaf also provides counselling services.

46.        Over the next year or so, MOH and the Agency for Integrated Care will be engaging our stakeholders, including disability associations, to identify ways to improve mental health support.

47.         As highlighted by Ms Anthea Ong and Mr Daniel Goh, Singaporeans can tap multi-layers of financial support, such as government subsidies and Community Health Assist Scheme (CHAS), MediShield Life, MediSave and MediFund, for treatment of mental health conditions.

48.          MOH reviews the amount of financial support regularly, to ensure that they are adequate. For example, the MediSave and MediShield Life claim limits differ across inpatient treatments, to reflect different bill sizes. As the bill sizes of inpatient psychiatric treatments are comparatively lower than other inpatient treatments, the MediShield Life and MediSave limits are also correspondingly lower, to cater to different treatment types.

49.          Based on the latest available data, fewer than one in 10 subsidised patients exceeded the MediSave yearly withdrawal limit for inpatient psychiatric stays, while fewer than three in 10 subsidised bills exceeded the MediSave daily withdrawal limit. As for MediShield Life, we are reviewing the claim limits, and more details will be announced later this year.

50.          For outpatient treatments of mental health conditions under the Chronic Disease Management Programme (CDMP) – which includes depression, anxiety including Obsessive Compulsive Disorder (OCD), bipolar disorder, and schizophrenia – CHAS cardholders may tap on subsidies of up to $500 per year for treatments at CHAS GPs, and more for Pioneer and Merdeka Generation cardholders. Patients can also withdraw up to $500 per year from their MediSave for outpatient treatment for conditions under the CDMP. In 2018, only about two in 10 patients who withdrew MediSave for their outpatient mental health treatment reached the yearly withdrawal limit.  To further defray the costs for patients with complex chronic conditions, say, a patient with both OCD and osteoporosis, we will be raising their MediSave withdrawal limit. Further details on this will be given by SMS Tong. Singaporeans who still require financial support after tapping these schemes can apply for MediFund from our public healthcare institutions.

51.       We must also not forget that the well-being of persons with mental health conditions often rests on the caregivers, and they are at risk of burnout.

52.         Hence, we will be piloting a structured system of support for caregivers of persons with mental health conditions. Under this system, upon first diagnosis of their loved ones, hospitals and community partners will provide caregivers with information such as disease progression and expected care needs, and link them up with the necessary health, financial and social support services. With this, we hope that caregivers will know upfront that they are not alone, that there is an entire network of support for them.

53.          Even as we expand our suite of care services for persons with mental health, we must strengthen our multi-pronged strategy to better address mental health, and this extends beyond medical care. Hence, in the coming months, we will be undertaking a whole-of-government review of our mental health strategy, to identify gaps and strengthen existing inter-agency efforts. Besides enhancing support for the mental wellbeing of seniors, we will also focus on youth mental wellbeing, which SMS Lam will elaborate on.

STAFF APPRECIATION

54.          Chairman, in recent months, our healthcare workers are at the frontline, battling against the spread of Coronavirus Disease 2019 (COVID-19).

55.          I will also like to take this opportunity to thank all our healthcare workers who have gone above and beyond their duty to keep us safe. We are grateful, and we will do our utmost to support you.

56.          I share Mr Daniel Goh’s pride in our nurses. It is unfortunate that some of our nurses were shunned, and even berated, for wearing their uniforms in public recently. Our nurses wear their uniforms with pride, and I hope members of the public can appreciate and trust their professionalism, and affirm their efforts.

57.          The work of our healthcare workers is not any easier in ‘peace time’. Healthcare workers sometimes, inadvertently, bear the brunt of patients’ and their families’ emotions. Under the Protection from Harassment Act, the Government adopts a zero-tolerance policy against the harassment of public healthcare workers performing their official duties. The same act also protects them as private citizens if they are harassed when off-duty. All our public healthcare clusters also have counselling services and hotlines for our healthcare workers if they need help.

58.          But the best way to support our healthcare workers is not to react after harm is done, but to refrain from taking out our stress on them. I urge Singaporeans to take a moment to recognise their efforts, and am heartened by those who have rallied behind them.

MEANINGFUL OPPORTUNITIES

59.        Chairman, our healthcare workers are truly the backbone of our healthcare system. Battling COVID-19 is but the latest example. Their role will only continue to grow in importance. As care needs increase in our ageing population, we will need a steady pipeline of dedicated healthcare workers. Manpower is a perennial challenge, but on the flipside, it is also an opportunity for Singaporeans who seek a meaningful career.

60.          We have made some headway in growing the number of healthcare workers. For instance, the number of practising nurses has grown by 3.3% per annum in the past five years. In comparison, Singapore’s total employment grew by 1.1% per annum, over the same period.

61.          With the expansion of services, we could see up to around 6,000 additional jobs in the healthcare sector in the next two years. This is on top of hiring to replace attrition. We will continue our efforts to attract and recruit Singaporeans to build a strong local core in our workforce.

62.          However, with shrinking birth cohorts, the labour market will become much tighter in the decade beyond 2020. To meet our growing manpower needs, we must rethink our current approach, and find creative ways to attract and retain people in the sector, particularly in the growing community care sector.

63.          First, we need to diversify our hiring sources. Besides attracting fresh graduates, we will continue our efforts to bring mid-careerists into healthcare. Mid-careerists play a valuable role, as they bring with them unique expertise and fresh perspectives from their previous careers. In the last two years, about 2,000 local mid-career PMETs transited into the healthcare sector. About one-third of them are mature workers aged 40 and above.

64.          Besides healthcare staff, there are many administrative positions available in the healthcare sector too.

65.          Take for example Ms Noraini, who joined Ren Ci Hospital after spending more than 20 years as a special needs educator, and then as a business executive. Ms Noraini’s experience placed her in good stead for her role as a resident care manager in Ren Ci.

66.          Nevertheless, to support her transition into the Community Care sector, Ren Ci placed Ms Noraini under the Senior Management Associate Scheme (SMAS). When she completes her induction programme this year, Ms Noraini can continue to attend leadership programmes to support her development.

67.          Second, we must invest in our people, especially in the community care sector, to enable the shift of care beyond hospital to community.

68.         To support the attraction and retention of manpower in this sector, MOH previously funded a total of $350 million between 2012 and 2017, to community care institutions to raise salaries for their staff. Around 90% of MOH-funded institutions participated in this exercise.

69.          Over the next three years, MOH will set aside another $150 million to support community care institutions to further improve the competitiveness of salaries. We project that this will benefit up to 4,000 local nurses and support care staff, if it is fully taken up. After these three years, MOH will factor in the higher salary levels in our funding to community care providers.

70.          We strongly encourage employers to take the opportunity to enhance salaries of nurses and support care staff, and continue to improve career prospects of our care staff in the community.

71.          We are also eager to bring non-practising nurses back to our healthcare family. Over the past four years, about 500 local nurses have returned to practice annually. Returning nurses may undergo a refresher course under the Return to Nursing scheme, and those who return to the community care sector are eligible for a retention bonus of up to $5,000. In response to Mr Melvin Yong, MOH has been actively working with the Union and employers on the retention and development of our healthcare workforce.

72.          I also echo Ms Joan Pereira, and Mr Christopher de Souza’s call to continue supporting professional growth and development for nurses and Allied Health professionals.

73.          Last year, we launched the skills frameworks for allied health workers, and medical social workers, just to name a few. This year, I am pleased to launch the Community Nursing Competency Framework, which can be used by community nurses and employers as a guide to identify skills gaps and pursue development opportunities.

74.          From this year onwards, fresh school leavers and in-service staff may apply for the new Community Care Scholarship to take up programmes relevant for the community care sector, such as in the disciplines of Occupational Therapy and Social Work.

75.          Besides training, we must also create opportunities for healthcare workers to take on leadership positions in the sector.

76.          Nurses, in particular, play a leading role in care delivery in the community care sector, and we must nurture those with strong clinical skills and leadership potential.

77.          Let me share the story of Associate Professor Edward Poon. He started as a staff nurse at Singapore General Hospital before joining the community care sector early in his career. Overtime, he took on various leadership positions, and he is now Director of Nursing at St Luke’s Eldercare, or SLEC.

78.          Now, Associate Professor Poon’s impact extends beyond SLEC. In addition to upholding and maintaining the quality of care at SLEC, he also conducts training for the sector, and collaborates with public hospitals on geriatric research.

79.          We hope there will be more budding professionals who will go on to take on nursing leadership roles in the community care sector, like Associate Professor Poon. Hence, we will be introducing a new Community Care Nursing Leadership Programme this year, to groom the next generation of nursing leaders for the sector. Regardless of their current place of practice, all experienced Registered Nurses who want to take on leadership roles in the community care sector are welcome to apply.

80.        The programme will provide nurses with opportunities in clinical training, leadership development, attachments and mentorship.

81.          Lastly, all of us must find ways to eliminate unnecessary workload, and adopt best practices to work smarter. This would include process and role redesign as pointed out by Ms Irene Quay.

82.          Collaborative prescribing is one example. Since 2019, 34 advanced practice nurses and 31 clinical pharmacists in 11 healthcare institutions have been trained and empowered to prescribe drugs to their patients. We hope more institutions and professionals will come on board in the near future. 

83.          In response to Ms Irene Quay, employers may already choose to accept medical certificates or time chits issued by allied health professionals, or Traditional and Complementary Medicine practitioners.

84.          In response to Mr Faisal Manap, the regulatory scope of the new Healthcare Services Act (HCSA) includes Traditional and Complementary Medicine services. MOH will monitor the prevalence of use, and risks to patient safety, before considering whether to license these services under the HCSA. Nonetheless, Traditional and Complementary Medicine practitioners are already subject to relevant provisions under the Medicines Act, and Sales of Drugs Act, just to name a few.

85.          Chairman, even as we face shrinking birth cohorts, we are also presented with the gift of longer health-adjusted life expectancy, which we can capitalise. Singaporeans are living longer and healthier, and we should allow them to continue contributing, if they wish to.

86.          This is a win-win scenario for both employers and employees. In 2019, around 99% of public healthcare workers aged 62 and beyond were offered re-employment, and 95% of them accepted the offer. To support our mature healthcare workers who are able and willing to continue working, MOH has worked with the Healthcare Services Employees’ Union and public healthcare institutions to raise the retirement age to 63, and re-employment age to 68 from July 2021 onwards – one year ahead of the national schedule. Those who wish to retire or stop working at 62 may still do so, while those who want to keep working, now have the choice to work even longer.

CONCLUSION

87.          In closing, it is our unending pursuit to find ways for each of us to age healthier, happier, and in a fulfilling manner. I urge all Singaporeans – young and old – to help us achieve this.

Thank you.