SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE MOTION DEBATE ON SUPPORTING HEALTHCARE ON 10 MAY 2023

Introduction

Mr Deputy Speaker, Sir, I rise in support of the motion, standing in the name of Dr Tan Yia Swam, Dr Shahira Abdullah and Mr Abdul Samad. Sir, all of us play a key role in ensuring good health and well-being of the population. As individuals, we need to take active steps to live healthier and minimise the risk of falling ill, even as the Government builds a supportive environment to help us do this. I will speak about  mental health, oral health and the healthcare IT infrastructure and digital tools to support individuals on healthy living. 

Mental Health 

2. Good mental health is essential and it lies along a spectrum and is multi-faceted. Mental health issues can arise from a range of factors including physical health and social determinants. Addressing these issues will require a collaborative and integrated approach that involves multiple stakeholders from the health, social, education, workplace and community sectors. 

3. This is already happening. For example, under the Community Mental Health Masterplan, the Ministry of Health (MOH), the Agency for Integrated Care and social service agencies have worked together to establish community mental health teams across Singapore. These teams provide mental health education to residents, and bring care such as mental health screening, assessment and therapy, closer to home, where there is less stigma and individuals feel safe to seek help. 

4. Professor Koh Lian Pin spoke about mental health in academic settings. The Health Promotion Board (HPB) has worked with Institutes of Higher Learning (IHLs) to establish peer support structures. Training is provided in empathetic listening and basic mental health first-aid skills, to support one’s peers who show signs of emotional distress. In addition, those who wish to learn about mental health and self-care tips can access MindSG, a portal for mental health and well-being resources that is curated by mental health experts. 

5. It is important to address mental health issues that affect us at work, whether at workplaces, academic settings or otherwise. The Tripartite Advisory on Mental Well-being at Workplaces was jointly launched in 2020 by the Ministry of Manpower (MOM), National Trades Union Congress (NTUC) and the Singapore National Employers Federation (SNEF) to support employees’ mental well-being and provide resources for employers, employees and self-employed persons. 

6. Dr Tan Yia Swam shared her experience as a junior doctor where there were occasions when she worked for more than 24 hours a day when she was on call. The Ministry is reviewing the total working hours of junior doctors, including hours worked while on call. The public healthcare clusters have been piloting shorter call hours for junior doctors in selected departments, as well as using electronic logging and surveys to monitor junior doctors’ working hours. This is a complex subject which requires a fundamental relook at manpower deployment and the sharing of responsibilities between senior and junior doctors. This will take some time to study and work out and we are engaged in this matter.

7. Dr Tan Yia Swam and Professor Koh Lian Pin shared about the importance of mental health education and de-stigmatisation. HPB launched the ‘It’s OKAY to Reach Out’ campaign in October 2021 to normalise the topic of mental health by building awareness and encouraging conversations. The campaign in 2022 was focused on youths to help them overcome their hesitation to seek support and address their concerns about seeking help. Activities such as teacher-guided class discussions were brought to mainstream schools and IHLs. Outreach efforts to promote mental health awareness and literacy among Singaporeans have continued through online efforts and in-person programmes. 

8. In addition, the National Council of Social Service’s (NCSS) Beyond the Label (BTL) movement was launched in 2018. In the next phase, BTL 2.0 moves to inspire action. NCSS has brought together 26 partners across the People, Public and Private sectors to promote and enable help-seeking and help-giving behaviours in schools, workplaces and the community.

9. The Interagency Taskforce on Mental Health and Well-being was established in July 2021 to oversee and coordinate mental health efforts across different sectors, focusing on cross-cutting issues that require interagency collaborations.

10. The Taskforce had identified 12 preliminary recommendations and sought the public’s views in a consultation process last year. There were over 950 responses, with feedback from groups such as youths, parents, persons with mental health conditions, service providers, employers and community agencies.

11. The respondents were supportive of all the recommendations, and the Taskforce will be releasing a short report of the consultation’s findings soon, even as we commence the implementation plans for these recommendations. 

12. One of the recommendations is to implement a tiered care model for mental healthcare delivery. This is a framework that matches the level of care to the degree of the mental health need, allowing for a more effective allocation of mental health services based on the severity and complexity of an individual’s needs.

13. As part of the public consultation, we received very useful feedback on implementation.

14. One example would be that for the tiered care model to work well, service providers need to be sufficiently competent to fulfil their roles and responsibilities. We completely agree that for this tiered care model to be implemented effectively, an important aspect is to ensure adequate competencies and standards amongst all mental health practitioners. We have the National Mental Health Competency Training Framework Workgroup. The framework that they are developing will guide mental health practitioners on the knowledge, skills and competencies necessary to deliver quality and effective care. It will apply to all practitioners, from lay responders such as peer supporters, to mental health professionals including nurses, social workers, and counsellors, amongst others. I thank Dr Wan Rizal for highlighting the importance of this. 

15. In addition, there are already systems in place to safeguard professional practice today. Mental health professionals are regulated through professional boards and councils or set practice standards through professional associations. For example, psychiatrists, nurses and occupational therapists are regulated by the Singapore Medical Council, Singapore Nursing Board, and Allied Health Professions Council respectively. Professional associations such as the Singapore Association for Counselling and Singapore Psychological Society provide guidance on the professional and ethical conduct for counsellors and psychologists respectively. 

16. There is also the need to help individuals with mental health needs access the appropriate services in a timely manner. One recommendation from the Taskforce is to designate a few first-stop touchpoints to provide individuals with easy access to mental health support and advice.

17. Some respondents from the consultation felt that there was value in having more than one way to deliver a service, to take into account user preference. We are developing a number of service modalities such as hotlines, text messaging, in-person services and digital resources to ensure that there are sufficient and different ways for people to access these first-stop touchpoints for mental health. 

Oral Health

18. Sir, if I may now shift to oral healthcare for older adults, persons with special needs, and migrant workers in Singapore in response to Dr Shahira Abdullah. The Government has introduced initiatives to ensure the access to affordable and quality healthcare for Singaporeans, such as through the Community Health Assist Scheme (CHAS). Most oral health needs of these population groups can be met by general dentists at the polyclinics, CHAS clinics and private dental clinics. Individuals with complex needs and those with medical conditions or multiple morbidities that require a higher level of care are cared for and can be cared for by specialists at our national specialty dental centres and hospital dental clinics.

19. To facilitate access, MOH has worked with MSF to list the details of dentists and private dental clinics providing special care dentistry services so as to raise awareness regarding the availability of services for persons with disabilities. Additionally, public-private partnerships, in addition to existing ones like Enabling Village, Agape Village, HealthServe and Saint Andrews’ Mission Hospital, will be further explored to better serve the primary medical and dental care needs of underserved communities, including migrant workers.

20. For our migrant workers, MOM will also continue to explore working with key partners such as NGOs, to facilitate accessible dental care for migrant workers and provide oral health education through Project MOCCA (Management of Oral and Chronic Conditions and Ailments). Project MOCCA was launched by MOM last year and is a preventive health framework to enhance the care of oral and chronic diseases among migrant workers where MOM works closely with partners such as MigrantWell Singapore.

21. We recognise the efforts of independent volunteer initiatives that provide dental services within the community, intermediate and long-term care settings, and in special needs organisations. To improve the coordination of these services, we will be encouraging larger volunteer associations to help provide a platform for communication, sharing of resources and coordination.

22. As the practice of dentistry constantly evolves with changes in population demographics, advances in technology and shifts in care approaches, the local dental landscape will shift accordingly. To better support dental professionals and other healthcare and non-healthcare professionals providing care for older adults and persons with special needs, we will look into the development of clinical practice guidelines and appropriate care guides to help establish standards of care and promote better health outcomes. Additionally, we will continue to review our subsidy framework and award scholarships for residency training programmes in the various disciplines of dentistry so as to ensure that our dental workforce can continue to meet the oral health needs across all ages and care settings. 

IT and Data Sharing

23. Next, I would like to highlight the importance of having a well-integrated and reliable IT system to connect the healthcare providers, community partners and residents. Members of the House have raised this in past Parliamentary sessions such as the White Paper for Healthier SG and the Committee of Supply (COS) 2023 debates. I thank both Dr Tan Yia Swam and Mr Yip Hon Weng for emphasising its importance. 

24. One key system will be the National Electronic Health Record System (NEHR), which is a common platform that captures selected patient health information from various healthcare providers and allows providers to view these health records for patient care. Mr Gerald Giam asked about the implementation of security enhancements for NEHR. The NEHR has been subjected to cybersecurity reviews, infrastructure vulnerability scans and application penetration tests. MOH and the Integrated Health Information Systems (IHiS) have reviewed the findings and most of the key enhancements to NEHR have been completed, with one further to be completed tentatively by 2025.

25. On the matter of IT support for GP clinics that Mr Gerald Giam also raised, we do want GPs to use the Clinic Management System (CMS) that supports their daily operations well and connects to key IT systems, to save them time on administration. We have been working closely with the CMS vendors to improve their products and strengthen their backend services to support the GP clinics. We are bringing onboard more healthcare providers to contribute to the NEHR, by extending the Early Contribution Incentive scheme to GPs, private hospitals, radiological laboratories and clinical laboratories to support them in data contribution. With the Health Information Bill (HIB), it will become mandatory for them to contribute patients’ data to NEHR.
 
26. We have been extensively consulting stakeholders such as our licensees and healthcare professionals, on issues surrounding data privacy and sharing related to the HIB. We had intended to table the HIB to Parliament sometime this year. But this is quite a significant Bill, and we felt more time is needed to engage our stakeholders and members of the public. We thus expect to introduce the Bill in this House in the first half of 2024. I would also like to thank Mr Yip Hon Weng for raising the need to enable data sharing between the health and social sectors. This is indeed one of our aims under the HIB to support more integrated care and reduce administrative work, while ensuring data security. 

27. Ms Ng Ling Ling and Mr Yip Hon Weng also raised the need to empower Singaporeans with more knowledge and support to manage their health better. We will do this through tools such as the HealthHub and Healthy 365 applications. For example, residents and their authorised caregivers can view health information from NEHR, such as discharge summaries, selected blood test and radiology results, via HealthHub. We will explore how we can reflect more results on these platforms. Residents and their authorised caregivers can also use HealthHub to book and manage their medical appointments across all public healthcare institutions, as well as to enrol in Healthier SG and view their Health Plan. 

28. Residents can use Healthy 365 to sign up for nearby healthy lifestyle programmes, track their physical activity, and collect Healthpoints from clocking steps and making healthier food choices. We will continue to enhance such digital tools to help residents sustain good health and well-being.

29. In summary, with increased accessibility to trusted platforms for appropriate health information and interventions, and support from healthcare providers and community partners, we hope individuals can make informed choices to enable better mental and oral health for themselves and their loved ones.

Closing

30. Mr Deputy Speaker, Sir, I support the motion. Thank you.