SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2021, ON FRIDAY 5 MARCH 2021

Mr Chairman, Singapore is fortunate to have a workforce in the healthcare family driven by professionalism and dedication. Our people answered the call of duty, they have carried us far in this fight against COVID19 and have contributed to keeping Singapore safe during the pandemic.

2. Our infectious disease experts and staff at the National Centre for Infectious Diseases (NCID) and other public healthcare institutions have worked to provide clinical guidance to and support for our public health operations. Laboratory specialists at the National Public Health Laboratory provided guidance for COVID-19 tests, and conducted genomic analysis to support cluster investigations and surveillance for variants. The staff at the public and private healthcare institutions do their duty, putting themselves in harm’s way. They undertake healthcare operations in high-risk locations like the foreign workers’ dormitories, emergencies departments, hospital wards and intensive care units across our healthcare system. I echo the sentiments of many in the house to express our deep appreciation for colleagues in many, many different roles.

3. The work continues, and members will know that we started our national vaccination operations at NCID on the 30th of December 2020. NCID was one of several initiatives and projects that came out from the lessons we learnt from SARs. In the test of that crisis, we identified vulnerabilities, and in our response, we developed capabilities and institutions that persist to this day, like NCID, helping us with COVID-19. And in this crisis, we are learning new lessons, and responding to different vulnerabilities. We need to institutionalise the capabilities that we are developing, we have needed to deal with the pandemic and continue the usual clinical services and now stand up a massive national vaccination exercise. Many of these skills, tools, processes and systems we have developed are distributed across our healthcare network and the care providers. But centrally at MOH, we have had to also develop and improve our organisational capability to manage the response to this crisis and hopefully be better prepared for the next. 

4. At MOH we have set up a new Crisis Strategy & Operations Group. They have worked hard, in collaboration with other ministries and other agencies, to coordinate COVID-related operations. This is a capability and a team that we will need in order to be better prepared for the next pandemic. We are heartened by the appreciation demonstrated by the public for our healthcare workers.

5. However, today, there are still cases of harassment and abuse against our staff. This has affected their well-being and their safety. To Dr Wan Rizal’s question, we take abuse and harassment against our healthcare workers very seriously and will not hesitate to take appropriate action when necessary. The enhancements to the Protection from Harassment Act in November 2014 gave additional protection against harassment to public sector healthcare professionals and support care staff.

6. Public healthcare institutions also have policies in place to handle abuse cases. The institutions conduct training for healthcare staff including on de-escalation measures during potential conflict and abuse. In addition, we will work with the clusters and the Healthcare Services Employees’ Union (HSEU) on a tripartite effort to strengthen messages against abuse and harassment of our public healthcare sector staff.

7. During the Budget debate, Mr Darryl David asked about staff benefits. Dr Wan Rizal also asked about this just recently. Our public healthcare institutions do pay close attention to staff leave, and make time for sufficient rest. These are all planned to ensure sufficient staffing for patient safety. There are also rostered breaks and staff rotations to ensure sufficient rest during and between shifts. To better support our healthcare staff, a cross-cluster Staff Well-being Committee with representatives from our public healthcare institutions and MOH had been set up. The Committee will share best practices and provide feedback to MOH on possible enhancements to improve staff well-being. 

8. Besides healthcare workers, our Health Technology engineers have also played an important role. They rapidly developed systems to support new operational demands, including the ongoing vaccination operations. These are also important capabilities that we need within our system, and thus to grow our HealthTech workforce, we have worked closely with the Integrated Health Information Systems (IHiS) to redesign jobs and actively recruit people into new roles, including software engineers, systems analysts and cybersecurity professionals. 

9. To facilitate mid-career switches into HealthTech, IHiS and theInfocomm Media Development Authority (IMDA) and SkillsFuture have curated specific training programmes. One such example of a mid-career switch was a gentleman by the name of  Mr Daniel Ong, whom I spoke to recently. He was a copywriter, and his formal education was in English Literature. He couldn’t write code before joining IMDA’s Tech Immersion and Placement Programme, which is part of the Techskills Accelerator. In March last year, Daniel began work at IHiS as a front-end developer, and he has contributed to two IT projects supporting the fight against COVID-19. Now he is developing the user-facing components of the system supporting the One-Rehab framework, which I will speak a little more about later. We hope that more people will see opportunities in this HealthTech space, and embrace the possibility that with some training they can join the healthcare family,  not necessarily as a clinician, but contributing to the success of our public healthcare ecosystem.

10. As Mr Ang Wei Neng pointed out, we can and should learn many things from our fight against COVID-19. For example, our early, comprehensive and persistent contact tracing and quarantine efforts have played a key role in our COVID-19 response. Besides the vigilance and skill of our healthcare workforce, our digital tools such as SafeEntry and TraceTogether continue to be central to the speed and efficiency of our contact tracing. Coupled with our aggressive testing strategies, these measures have contributed to our success in keeping the number of our community cases under control for now. To swiftly identify COVID-19 cases and contain the outbreak, we have built up our testing capacity and our community testing operations. Through targeted operations as well as routine surveillance testing, such as the testing of our hawker centre workers, we have so far been able to detect cases and quickly prevent spread. 

11. As a repository of patient records, the National Electronic Health Records (NEHR) has also been a key enabler in facilitating this provision of care during the pandemic. Healthcare professionals can access NEHR for their patients’ COVID-19 test results and existing medical conditions before their vaccination. The NEHR has also been enhanced this year to meet the requirements for COVID-19 vaccination, displaying alerts and reporting prompts. 

12. And as we do this, data security remains a key priority. We have been taking steps to improve the security of our NEHR through technical and process enhancements, in response to the security reviews that we conducted in 2018. We expect to complete most of this within the year, and onboard more healthcare institutions to contribute to NEHR more securely.

13. Beyond COVID-19, we must continue to be ready to respond to future public health crises by having the right systems and capabilities. We will do so in four ways. First, we will enhance our surveillance and response capabilities through the use of new technologies, to enable us to more effectively consolidate, analyse and generate insights from large amounts of data.

14. Second, we will augment our human capabilities to prepare Singapore against future threats. Skilled clinical teams will always play an important role in detecting and managing new diseases and outbreaks, and we also need other experts such as epidemiologists, data scientists and statisticians, and software engineers like Daniel. We need teams to investigate and perform advance analytics, for example to determine the likelihood of spread and inform our response to an outbreak.

15. Third, while we remain in DORSCON Orange for now (DORSCON stands for Disease Outbreak Response System Condition), we will look into strengthening our DORSCON framework, incorporating lessons learnt from the pandemic, so that we can better communicate public health risk and to help us more effectively respond as a whole society when “Disease X” strikes, the next serious pandemic crisis.

16. Finally, we will develop a national Research and Development (R&D) Programme for Research in Epidemic Preparedness And Response (PREPARE) to strengthen our R&D capabilities to prevent, prepare for and respond to future public health crises. It will include: 
• Strengthening infectious disease collaboration networks locally and regionally; 
• Strengthening capabilities for the accelerated development of diagnostics, therapeutics and vaccines; and 
• Establishing a national infectious disease repository and database for research and data analysis.

17. To further address Mr Ang’s question, MOH regularly reviews our national response and is conducting an interim review. It will include other ministries and agencies. We will share more details when it is completed.

18. Beyond pandemics, we must ensure that the healthcare needs of our general population are met. The work continues. Our polyclinics are a vital element in our public health primary response. Built in 1980, Clementi Polyclinic is one of our oldest and smaller polyclinics. Its central location has served residents well, with about 850 patients seen per day. We will be redeveloping the polyclinic by 2027 to better serve residents in the region. 

19. Dr Tan Wu Meng asked whether we have considered patients’ comfort and staff’s performance in our design of healthcare facilities. The answer is yes. When designing new healthcare facilities, the design team will engage stakeholders including the care team, patients and carers, and the facility management team.

20. The redeveloped Clementi Polyclinic will undergo the same process. It will be more spacious with more elderly-friendly and accessibility features. Residents can also look forward to a comprehensive range of primary care services, including medical treatment for acute conditions, chronic disease management, women’s and children’s health services, as well as radiological, laboratory and pharmacy services.

21. Another example of the ongoing work to improve routine clinical care services despite the pandemic is to ensure that our population has timely access to the right level of rehabilitation care. We have developed the National One-Rehab framework. Under this framework, patients will have improved access to community-based rehabilitation and benefit from expanded capacity and capabilities in the care providers. Our hospitals, polyclinics and community providers will embark on a multi-year pilot to validate this new care model. Our  hope is for patients with stable musculoskeletal conditions such as lower back pain who do not require surgery or complex interventions to receive this rehabilitation care in the community, instead of only at specialist clinics or hospitals. 

22. During last week’s budget debate, we heard Dr Shahira Abdullah, Ms Carrie Tan, Dr Wan Rizal, Ms Mariam Jaafar and Mr Eric Chua speak about mental health. Since the launch of the Community Mental Health Masterplan in 2012, and its enhancement in 2017, we have increased the capacity of community mental health services. We are on track to meeting our targets by end-2021. 

23. In primary care, we have over 220 GP partners and 14 polyclinics providing mental health and/or dementia services. We have set up 50 community outreach teams, and reached out to over 350,000 persons with mental health or dementia needs. In addition, 21 community intervention teams were established to provide mental health interventions such as psycho-social therapeutic interventions and counselling. We have met our targets of 50 community outreach teams and 18 community intervention teams ahead of our end-2021 timeline.

24. To Dr Wan Rizal’s question on support for youth and their families, we have piloted the Integrated Youth Service (IYS) with the Agency for Integrated Care (AIC), the Institute of Mental Health (IMH) and Care Corner, which is one of our community partners in the North. Since April 2020, Care Corner has begun community outreach using online platforms, and has reached out to over 2,600 users. In November 2020, the Care Corner team moved into the new Woods Square Community Space, to provide face-to-face mental health screening and basic emotional support sessions for persons with mental health challenges, and to conduct experiential resilience or mental well-being events. MOH and AIC have also worked with other community partners to set up youth community outreach teams to reach out to young people in mental distress to provide basic emotional support and resources.

25. The team would also engage the family to understand the stressors and the home environment. Links to the social and healthcare services are also provided. Through the Youth Mental Well-being Network, we have heard from the mental health and social sector professionals, parents and caregivers, on how we could improve the mental well-being of our young people.

26. Minister of State Sun Xueling earlier shared on how the Network has initiated ideas for over 30 potential ground-up projects. Parliamentary Secretary Eric Chua will also be sharing about an initiative to provide positive peer support during his MSF speech. The three of us are working together, just as MOE, MSF and MOH are working together on this important area.

27. To look into the psycho-social impact on the COVID-19 pandemic on the population, we set up the COVID-19 Mental Wellness Taskforce in October 2020. The Taskforce has reviewed and recommended three areas to work on, namely, to develop:

• A national mental health and well-being strategy, 
• A national mental health resources page, and 
• A national mental health competency training framework. 

28. Beyond COVID-19, we will evolve the Taskforce into an inter-agency platform on mental health and well-being, by mid-2021. The platform will oversee mental health and well-being efforts, focusing on cross-cutting issues that require multi- and inter-agencies collaborations. We are working out the details of the platform, and will share more when ready.

29. Dr Tan Yia Swam asked about the support for other vulnerable groups such as our seniors and building a more inclusive society. The Government recognises that those who suffer from mental health conditions may face discrimination. We have been working with partners to roll out initiatives to address this issue. It will take a whole-of-society approach to tackle this issue effectively.

30. The National Council of Social Service launched the “Beyond the Label” movement in 2018 to fight the stigma of mental health conditions and encourage social inclusion, positive attitudes and support towards persons living with mental health conditions. The movement also provides a platform for more conversations about mental health and promotes greater awareness and the acceptance of mental health conditions among the public.

31. To reach out to persons with or at-risk of mental health conditions or dementia, including seniors, community teams also reach out to residents and their caregivers to provide mental health or dementia information, basic emotional support, and links to  appropriate services, health or social as necessary. For seniors at risk of social isolation, the Active Ageing Centres (AACs), Silver Generation Office and the local grassroots organisations connect them to befrienders who will reach out on a regular basis, provide companionship and encourage them to participate in social activities, keeping active and keeping connected with the local community. Seniors can also sign up with CareLine, which is a 24/7 social support hotline providing tele-befriending services as well as emergency response to seniors in distress.

32. While we do all this to build up the capability in our community partners, we will make sure that our main psychiatric sector, IMH is updated. Since 2018, IMH has been undergoing refurbishment and improvement works to facilitate the care and improve operational efficiency and safety for patients and staff. These works are expected to be completed by the end of 2022.

33. Mr Chairman, to fight COVID-19 we have had to rely on the skill, dedication and professionalism of our people. We have had to develop and deploy technology, and we have had to scale up clinical services, all the while looking after the many healthcare issues that are unrelated to the pandemic, but essential to our health. We have had to be agile, steadfast and determined. We are all a bit tired and fatigued, but also hopeful and confident that we can find our way forward. Our ability to get this far was the result of many years of investing in our people, our facilities, systems, research and capabilities. We must learn the lessons from this experience. The preparations for the next crisis, whatever it is, are underway and require that we keep ourselves and our healthcare system in good health. Prevention is best, preparation is also necessary. Thank you.