Speech by Mr Gan Kim Yong, Minister for Health, at the Ministry of Health Committee of Supply Debate 2020, on Thursday 5 March 2020

Mr Chairman, several MPs have asked about COVID-19. Let me provide an update on the situation.

2.         As of 4 March 2020, we have 112 confirmed cases. 79 have been discharged while 33 patients remain in hospital. Of these seven are in critical condition. Contact tracing is ongoing. Dr Chia asked about contact tracing, we are indeed strengthening our capabilities on contact tracing efforts. I want to thank Singaporeans for their cooperation and support for the measures we implemented, without which our efforts will not be effective.

3.      Globally, the number of cases outside mainland China continues to grow at an alarming rate across continents and regions. This is worrying as they pose a high risk of importation of cases into Singapore. Therefore we must expect to see significantly higher numbers of new cases in time to come.

4.        In line with our risk assessment of the situation, we have implemented precautionary measures including travel advisories and restrictions, temperature screening, contact tracing and quarantine, amongst others.

5.         Ms Sylvia Lim and Mr Christopher de Souza asked about the effectiveness of our current strategy and how we can better prepare for the future. We have to appreciate that every outbreak is different. COVID-19 is different from SARS and different from H1N1. Even as we do our best to learn from each outbreak and prepare for the next, we must always expect the unexpected. To mount a swift and effective response, we have to adopt a whole of government approach and mobilise the resources of all the relevant agencies. This will allow us to assess, decide and execute our response quickly. It is important to be transparent too, and share the information we know as soon as possible. This will help to preserve the trust between the people and the government so that we can have the support of the public as we work together to fight COVID-19. It is also crucial to counter and respond decisively to fake news to avoid diversion of our resources and prevent disruption to our efforts.

6.         The international scientific community has been working hard to study the virus, share new findings and develop solutions. We are sharing our best practices, research and knowledge on COVID-19 with other countries. For example, scientists from China published the genetic sequence of the COVID-19 virus quite early on, on 12 January 2020. Within just over a week, Singapore’s National Public Health Laboratory (NPHL) developed a specific Polymerase Chain Reaction (PCR) diagnostic test. Shortly after, A*STAR produced a PCR test kit, which has been used locally and shared with international partners to help identify patients and contain the disease. Our scientists are also participating in international clinical trials for treatment and vaccines.

7.         Ms Sylvia Lim asked about using blood plasma for treatment. We are indeed planning to do so and NCID is collecting blood plasma from patients, but there are limitations and constraints. It may take some time before effective treatments and vaccines become available. As the global situation evolves, many countries may become infected. It will become increasingly difficult to stop the virus at our borders as we cannot ban visitors from every country and shut ourselves out from the world.

8.         Even amongst our closest neighbours, the situation is also evolving. Therefore, it is likely that we will continue to see new cases, and this disease will stay with us for quite a long time. We will have to continuously adjust and finetune our measures to deal with the disease so that life can go on while appropriate precautions are put in place.

9.         I am glad to see the SG Clean campaign picking up momentum and I would like to thank Minister Masagos for leading this important effort. More initiatives will be announced later. All of us have a role to play and we must continue the good practices that have proven effective in reducing the spread of infectious diseases, such as staying home when unwell, and practising good personal hygiene. We should also maintain high public hygiene standards in our food centres and public toilets. This will strengthen our collective resilience against COVID-19 as well as other infectious diseases, while allowing us to go about our daily lives as normally as possible.

10.      Our healthcare workers are critical in our efforts in managing and containing this outbreak. I want to assure Dr Chia Shi-Lu that they are well-trained on infection prevention and control measures, and are provided with appropriate personal protective equipment (PPE) for their safety. I would like to take this opportunity to thank them for their contributions and their dedication. As DPM announced, we will be giving them a token of appreciation through a special bonus for healthcare workers in our public hospitals and institutions who are directly involved with treating COVID-19 patients. The senior management of our three healthcare clusters have informed me that as a gesture of solidarity with our healthcare workers, they will donate their own Special Bonuses to the staff welfare fund of their respective clusters. The details of the special bonus for our healthcare workers will be released in due course, but for now our focus is to keep up our fight to contain the spread of COVID-19.

UPDATE ON HEALTHCARE 2020

11.      Mr Chairman, even as we tackle the COVID-19 outbreak, we need to continue to plan forward and build our healthcare system. MOH first introduced Healthcare 2020 in 2012 to increase accessibility, raise quality and enhance the affordability of healthcare services.

12.      We are now in 2020. Dr Chia Shi-Lu, Mr Christopher de Souza, and Ms Tin Pei Ling have all asked how we have fared with regard to Healthcare 2020. Mr Chairman, I am happy to share that MOH has delivered on what we promised.

13.      We have invested significantly in infrastructure to add capacity. In 2019 alone, we opened the National University Centre for Oral Health Singapore, and Outram Community Hospital. Sengkang General and Community Hospitals, which first began seeing patients in 2018, were also officially opened in 2019. Of course, we also opened the National Centre for Infectious Diseases (NCID) in time for the COVID-19 outbreak. We stepped up the building of long-term care facilities too like nursing homes and day care centres to meet the needs of our ageing population.

14.      We continued to improve the quality of care, with significant expansion in medical schools and nursing intakes to ensure sufficient healthcare manpower. We expanded our polyclinic and GP networks, and further integrated patient care through the introduction of team-based care, and strengthened referral pathways to our Specialist Outpatient Clinics.

15.      We have made healthcare more affordable for all. Over the years, we have progressively enhanced and expanded the Community Health Assist Scheme (CHAS), to make primary care more affordable, and for all Singaporeans. We also introduced the Pioneer and Merdeka Generation Packages in 2014 and 2019 to help our senior generations. Since then, almost one million Pioneer and Merdeka Generation seniors have received over $2.5 billion in benefits. We rolled out MediShield Life and will be launching CareShield Life (CSHL) later this year together with other changes to make MediSave usage more flexible which many MPs have asked. SMS Tong will go into greater details later on.

16.      Most importantly, our overall healthcare outcomes have improved, with longer life expectancy and Health Adjusted Life Expectancy (HALE). This means that Singaporeans are not only living longer, but living longer in good health.

UPDATE ON WAR ON DIABETES

17.      However, there is still room for improvement. Singaporeans are still living about 10 years in ill health. Several factors have contributed to this – based on National Population Health Survey 2017 for example, approximately one in three of residents aged 40 to 69 has hypertension, one in seven has diabetes, and two in five have hyperlipidaemia. To combat chronic diseases, we declared War on Diabetes in 2016. Let me give an update on the War on Diabetes that Mr Chen Show Mao has asked for.

18.      To overcome this fearsome adversary, we have to start at the ground level to build a strong foundation by shaping an ecosystem that encourages healthier choices like living healthy lives and staying physically active. While healthier lives for Singaporeans will take many years of effort to realise, some of our efforts have yielded early progress. For example, we have created more options for healthier meals. As of 2019, one in two stalls across hawker centres and coffee shops listed at least one healthier option on their menu, as part of the Healthier Dining Programme (HDP). The number of healthier meals sold also grew to 205 million in 2019, up from 158 million in 2018. The prevalence of regular leisure-time exercise has also increased by about six percentage points from 29% to 35% between 2017 and 2019.

19.      We will be launching a public campaign later this year to increase awareness on regular diabetic foot and eye screening. With greater awareness, we hope to reduce the incidence of lower limb amputation and give our patients better quality of life. These are just some of the many efforts we are taking on preventive healthcare that Ms Tin Pei Ling has asked about. SPS Amrin will be sharing more on our efforts later.

20.      Besides prevention, we are also providing greater support for individuals living with diabetes. Under our Patient Empowerment for Self-care Framework, we have developed the National Diabetes Reference Materials on HealthHub, as a comprehensive resource for patients and their caregivers. This is helpful for patients and families as they can “self-help” themselves to information about their condition and what they can do for better disease management. For example, patients who wish to start exercising can learn simple, safe and practical ways to do so. These materials can also be customised by healthcare professionals for their own patients.

21.      Our healthcare clusters will also be commencing pilot programmes from the second half of 2020 to increase patients’ ownership of their care journeys. For example, one of the programmes will empower newly diagnosed patients with diabetes to initiate and sustain lifestyle changes through group health coaching and greater peer support.

22.      To win the War on Diabetes , we will need concerted, multi-year efforts, and many of these efforts will only bear fruit in the long-term. We will continue to monitor the intermediate outcomes, like physical activity and dietary practices to better track the progress of our various initiatives.

SIGNIFICANT INVESTMENTS WILL CONTINUE

23.      Going forward, I would like to assure Dr Chia Shi-Lu and Mr Christopher de Souza that we will continue to invest in new healthcare infrastructure and facilities, to ensure care continues to be accessible and to meet the needs of the ageing population.

24.      We will be opening four more new polyclinics over the next two years. SMS Lam will share more about the expansion plans for our polyclinics later on. Woodlands Health Campus is scheduled to open progressively from 2022. We had experienced some challenges during the construction due to soil conditions, but we have mostly caught up. Now with COVID-19, we are discussing with our contractors and suppliers to assess the impact and we hope to minimise delays.

25.      Other upcoming facilities include a new community hospital in Novena, and the redevelopment of two national specialist centres, the new National Cancer Centre and the National Skin Centre).

26.      MOH had previously announced that NUHS would develop new and innovative care models, and test them at Alexandra Hospital (AH) as part of AH’s future development. The master planning exercise of AH was completed in 2019 and we will be calling a tender soon for Medical Planners for this project. The first phase of the development is scheduled to be completed by 2030.

27.      Ms Tin Pei Ling has asked about healthcare capacity in the East. Changi General Hospital (CGH) is currently the only hospital in the east. While we have added significant capacity in CGH through expansion over the years, the healthcare demand has grown substantially as a result of population growth and ageing. Ms Tin will be pleased to know that we have commenced the planning of a new integrated acute and community hospital in the East, targeted to be ready around 2030. Whilst the hospital will include the usual range of hospital services, we also want to hear what the community would like to see in this new hospital.  As such, SingHealth, which will be operating this new hospital, will be engaging the community to co-create ideas to better meet the needs of the residents there. SingHealth will reach out to the community leaders when they are ready to do so.

UPCOMING CHALLENGES FOR HEALTHCARE

28.      Expanding our healthcare system will also mean that expenditure on healthcare will grow – both in the development cost of building new facilities, and later on as the cost of operating these facilities.

29.      Overall, our National Health Expenditure increased from $13 billion in 2012 to $22 billion in 2017, or about 11% per annum.

30.      On this 11%, about five percentage points of this 11% increase was due to increased utilisation. Let me explain. As our population ages and grows, demand for healthcare services also increases, as some MPs observed earlier.

31.      We are also utilising more healthcare than in the past, even after accounting for ageing and population growth. This is partly the result of making care more accessible and affordable to all, and partly due to earlier diagnosis, closer monitoring and follow-ups for medical conditions, that means more frequent consultations and treatment. The range of treatment options has also expanded as the frontiers of medicine advance, increasing utilisation, but at the same time improving life spans and the quality of life.

32.      Approximately another four percentage points of the growth in national health expenditure can be attributed to higher manpower costs. On one hand, our healthcare workforce expanded significantly between 2012 and 2017. On the other hand, our healthcare workers’ salaries also increased as we implemented pay adjustments to attract and retain our healthcare workers.

33.      The remaining two percentage points were largely due to increases in the costs of drugs, medical devices, and other overheads.

34.      As DPM highlighted in his Budget 2020 round-up speech, we can expect that the overall national health expenditure will continue to increase as our population ages and we step up our investments in facilities and services. But we must continue to be prudent in our healthcare expenditure to ensure it is directed towards where it gives us the best outcomes. Therefore to answer Dr Chia Shi-Lu’s and Ms Tin Pei Ling’s questions on what our strategy is going forward, we must continue on our transformation journey for healthcare to ensure that we have a good and sustainable system. We must press on with our efforts to go Beyond Healthcare to Health, Beyond Hospital to Community and Beyond Quality to Value.

35.      Patients too can play a role. We can make wise decisions and choices, and have a trusted family physician to turn to for advice. Only then can we ensure that our healthcare system is sustainable and remains affordable for our patients.

36.      Information Technology (IT) will continue to be an essential enabler for our healthcare system, and we will continue to strengthen our governance and safeguards on our data as this will be essential to maintain the public’s trust.

37.      Over the past year, we have been taking concrete steps to implement the recommendations of the Committee of Inquiry (COI) on the SingHealth cyberattack. These steps will help to raise the cybersecurity posture of the public healthcare system. Close to 80% of the control measures recommended have been implemented or mitigated. The more complex measures require careful implementation to avoid disrupting essential healthcare services and impacting patient safety. These will be progressively completed by 2022.

38.      Various enhancements have also been made to strengthen the security of the National Electronic Health Record (NEHR). Work is still ongoing, and the enhancements are being implemented. Mandatory contribution to the NEHR will be deferred until all enhancements are completed, and we are satisfied that the system is assessed to be sufficiently robust. We will provide further updates at the appropriate juncture.

39.      While we secure our systems, we continue to explore how new technology such as telemedicine, and how they can improve care. To date, 25 public healthcare institutions and 39 community care partners have started video consultation pilot services. We will also leverage technologies such as Artificial Intelligence, machine learning and robotics to support the work in public healthcare, which Dr Chia has asked about in his cut.

40.      One example we are already deploying is the Singapore Eye Lesion Analyser Plus (SELENA+). This is a deep-learning artificial intelligence software system which can detect three major eye conditions: diabetic eye disease, glaucoma and age-related macular degeneration. SELENA+ highlights areas with potential vision threatening eye disease and refers abnormal cases to human graders, allowing them to focus on the more complex cases. SELENA+ has proven to be more efficient in delivering fast and accurate results. Building on SELENA+’s capabilities, a predictive risk assessment model for cardiovascular disease will be developed to help doctors accurately identify high-risk patients and conduct more timely interventions to save lives and achieve better outcomes.

CONCLUSION: HEALTHIER TOGETHER

41.      To conclude, shaping better healthcare in Singapore is not something that MOH and our healthcare providers can do alone. Everyone will have a role to play.

42.      We can start by taking care of our own health. By taking responsibility to keep ourselves healthy, we can live better, longer and healthier lives this way.

43.        Mr Chairman, if I may, let me speak in Mandarin.

44.        对抗冠状病毒，我们必须沉着应对，不需要惊慌。只要大家能采取正确的防范措施，注意个人卫生，我们依然能够维持日常的生活。我也希望借此机会呼吁国人继续多运动，保持身心健康。我很高兴看到许多社区活动在停办一段时间后，采取了适当的防范措施，已经开始恢复。上个星期天，我很荣幸能与马善高部长和几位同僚，一同到蔡厝港德惠公园参加他们刚刚开始的社区晨运。我很高兴看到居民如此注重健康，并且积极地参与活动，我也感到非常欣慰。

45.        Keeping everyone healthy is a team effort, and we are all part of the team. So let us all play our part to keep Singapore and Singaporeans in good health.