SPEECH BY MS RAHAYU MAHZAM, SENIOR PARLIAMENTARY SECRETARY FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2023, ON FRIDAY 3 MARCH 2023

     My colleagues have spoken at length about the upcoming initiatives in healthcare. In order for those efforts to bear fruit, it is essential that we grow and retain our healthcare workforce. We often say that healthcare workers are the backbone or lifeblood of the healthcare sector. These medical metaphors are correct, because if the healthcare system were a body, none of it would function without healthcare workers. It is therefore important that we continue to recruit healthcare workers from diverse sources and ensure that the sector remains an attractive one.

Manpower

2.     Our manpower policies are designed to meet present and future needs. We regularly update our projections to ensure that we plan this well. We have increased local intakes of students over time, to ensure a stable supply of healthcare professionals. This increase will materialise in the workforce in the coming years. For example, the first batch of 230 allied health graduates from the Singapore Institute of Technology entered the workforce in 2020. After increasing the intake by around 85%, about 430 students from the 2022 batch will enter the workforce in 2026. As the demand for healthcare services grows and our care model evolves, we will continue to work with schools to review our intakes.

3.     We want to attract students from all pathways into suitable healthcare programmes. Take for example the Diploma in Nursing offered by Polytechnics. Besides N-Level, O-Level and A-Level pathways, students can also join from the Integrated and International Baccalaureate Programmes, whether at the 4th or 6th year of study. The other nursing schools like the Institute of Technical Education and National University of Singapore also offer multiple admission pathways. We are working towards making the entry criteria for each pathway more transparent. So I want to assure all students, while there are entry criteria, no student from any particular educational pathway is denied eligibility.

4.     Healthcare staff are also encouraged to continue upgrading their skills, and practise at the top of their licence. Healthcare is a multi-disciplinary team effort. Our nurses, pharmacists and allied health professionals work closely with doctors to step up to lead care initiatives in the community. By expanding and advancing their skill set, they can look forward to a long and fulfilling career in healthcare.

5.     However, the most important and urgent step we need to take is to beef up nursing manpower. In recent years, the global competition for healthcare workers has intensified, especially for nurses. The attrition rate for local nurses has remained stable over 2019 to 2022, but for foreign nurses, this has spiked from 9.5% to 14.5% over the same period. The loss of both local and foreign nurses to our competitor countries is a key reason for the stress and high workload for our nurses. We need to replace the manpower lost to other countries, safeguard the welfare of nurses, and meet increasing needs. Therefore, as Ms Mariam Jaafar has rightly pointed out, the most critical and practical thing to do is to increase manpower.

6.     To this end, we are ramping up recruitment of foreign nurses. We will go through a period of increased inflow of foreign nurses because of their higher attrition in recent years. Looking forward, we will continue to need foreign nurses to complement our local core. Because if our population has more and more seniors, and fewer young graduates joining the workforce, the numbers will not add up, and local nurses alone cannot meet our healthcare needs. We are glad that members share these concerns, such as Ms Sylvia Lim, who asked about our measures to retain experienced foreign staff. Some of these foreign healthcare workers may grow to become valued members of our healthcare community and demonstrate their commitment to Singapore. We should be prepared to grant them Permanent Residence (PR) status, because it means retaining a pool of manpower that is of critical value to Singapore.

7.     So I hope all members of this House will support our efforts to expand the manpower of the healthcare sector, including recruitment of foreign manpower. This allows us to deliver quality healthcare, and safeguard the welfare of our healthcare workers.

8.     After recruiting them, it is equally important that we retain the healthcare workers we have. To answer Mr Gerald Giam’s question, we review salaries regularly to ensure that healthcare workers are paid competitively. Last year, we announced an enhanced special payment package for nurses in both the public and community care sectors. Among the public healthcare institutions, they will also refresh and update pay components such as allowances for shifts and for work duties beyond regular hours.

9.     As Dr Tan Wu Meng has pointed out, other measures such as flexible work arrangements can help retain staff who might leave otherwise. For those who leave the sector, our healthcare institutions maintain contact to encourage them to return. Every year over the past five years, about 750 non-practising nurses return to practice, joining some 2,400 new nurses. In comparison, about 1,300 nurses do not renew their practicing certificates each year. We will continue with our efforts to retain the nursing workforce.

10.     Last but certainly not least, we will continue to ensure the well-being of our healthcare workers, and that starts with a healthy working culture and environment. I thank the several Members of Parliament (MPs) and Nominated MPs (NMPs) who have spoken up on this, such as Mr Abdul Samad, Dr Tan Yia Swam, Ms Ng Ling Ling and Mr Louis Ng. Those who have worked in a healthcare institution, will know that many of our healthcare workers work beyond their call of duty, skip meals and forego rest time. Their strong sense of duty keeps them going, but it is neither sustainable nor fair that they constantly sacrifice their well-being. In a profession where people come first, there must be more we can do to ensure their welfare.

11.     We work closely with public healthcare clusters on this. In recent years, the public healthcare clusters have appointed Chief Wellness Officers to develop system changes to improve staff well-being, and also support measures like counselling and peer support networks. The clusters also regularly survey staff on whether they feel able to cope with the demands at work, and whether they know how to seek help when faced with stress or workplace bullying.

12.     To ensure healthcare workers have enough rest between and during shifts, the clusters regularly review administrative processes, and remove them if not needed. We are also reviewing the working hours of junior doctors, but it is a complex issue that will take time to work out. At present, the hospitals use methods like electronic logging and surveys to monitor junior doctors’ working hours and well-being.

13.     That said, hospitals are operational environments which have to address patient needs on a day-to-day basis. When planning rosters, hospitals take into account the skill mix of staff on each shift and each staff’s preferred shift pattern. Healthcare workers have also covered for each other occasionally where there is an operational need.

14.     In addition, Singaporeans can show their support by lightening the workload on healthcare workers. Each of us can avoid bogging nurses down with admin and basic tasks that do not require nursing expertise to address. We seek the public’s understanding on this. Family members can do their part in assisting their loved ones in the hospitals with basic care, such as feeding and moving around. It is also reassuring for patients to be attended to by their loved ones. Your support in such activities will allow nurses to focus on complex care tasks such as medication administration and wound care. We are grateful to those who already do their best to support healthcare workers.

Supporting Healthcare Workers Against Abuse and Harassment

15.     Last year, the Ministry announced that we were forming a Tripartite Workgroup to look into the rising number of cases where healthcare workers had been abused and harassed. Since then, we have extensively engaged healthcare workers and members of the public on this issue.

16.     Based on our findings, abuse has become a more common occurrence that healthcare workers face. Almost 1 in 3 healthcare workers witnessed or experienced abuse at least once a week.

17.     We need to take decisive steps to ensure the safety and well-being of our healthcare workers. This includes enhancing protection for healthcare workers by improving and standardising how public healthcare institutions deal with abuse and harassment. We need to have a clear and common definition of abuse across healthcare workers and members of the public. It also means taking steps to prevent potentially abusive situations, as well as promoting trust and respect between patients, caregivers, and healthcare workers. We appreciate that members of this House have raised various questions on this important issue. As shared by Minister earlier, we have completed the first phase of our work. We will share more details of the Workgroup’s engagement findings and a progress update on the Ministry of Health’s plans later this month.

Promoting Healthier Living and Supporting Ethnic Minority Groups

18.     Now I would like to talk about healthier living through increased physical activity and balanced diets.

19.     Last year, I spoke about our efforts to reach out to ethnic minority groups, including the formation of the Malay Community Outreach, or MCO, Workgroup. I also shared on the Health Promotion Board’s (HPB) efforts to use culturally significant events for public education on healthier lifestyles. We have kept up the momentum of these efforts. In the past year or so, over 29,000 Malay residents and over 32,000 Indian residents have participated in healthy living programmes like exercise and mental well-being workshops. To engage the Indian community, we promoted healthy eating messages during Deepavali, such as the need to reduce sugar consumption in desserts. The public may have seen last year’s Deepavali music video with Mediacorp’s Vasantham. HPB also held exercise sessions and health screenings in places of worship such as the Central Sikh Temple.

20.     Mr Chairman, please allow me to say a few words in Malay.

21.     Bagi menggalakkan orang ramai supaya bertanggungjawab terhadap kesihatan mereka, kami telah memudahkan masyarakat untuk menganjurkan dan menjalankan program mereka tersendiri. Salah satu inisiatif daripada kumpulan kerja Jangkauan Masyarakat Melayu ataupun MCO Workgroup adalah Saham Kesihatan, yang telah dipelopori di M³@Bandar atau M³@Towns di Tampines dan Jurong. Ia bertujuan untuk menumbuhkan sekumpulan pemimpin sebaya di dalam masyarakat yang menganjurkan program-program dan kelompok minat bagi mengalakkan penduduk Melayu Islam hidup dengan gaya hidup yang sihat.

22.     Bagi sesiapa yang menjalani gaya hidup yang kurang aktif, ia memang sukar untuk membiasakan diri untuk bersenam. Mujurlah, ia tidak pernah terlambat untuk kita mulakan semula. Seseorang yang telah mencontohi sifat ini ialah Puan Haslina Aziz, yang merupakan seorang sukarelawan dan pemimpin aktif di Siri Gems Empowering Me. Gems adalah sebuah usaha sosial yang telah menganjurkan aktiviti-aktiviti untuk mengalakkan wanita menjalani gaya hidup yang sihat. Sejak bergabung dengan Gems hampir sepuluh tahun yang lalu, Puan Haslina telah mengambil bahagian dalam aktiviti-aktiviti seperti perlumbaan Spartan, ekspedisi lautan serta berperahu naga. Dia juga mempunyai sijil panjat tembok. Inilah seseorang wanita yang berada di puncak kehebatan fisikalnya, dan anda mungkin menyangka bahawa saya telah menggambarkan seseorang yang berusia dua puluhan tahun. Tetapi sebenarnya, Puan Haslina adalah nenek kepada lima orang cucu. Dia mempunyai  penyakit kencing manis namun tetap mengawal kondisinya dengan sering berusaha untuk menjaga kesihatan. Puan Haslina telah membuktikan bahawa usia dan penyakit kronik bukan penghalang bagi menjalani gaya hidup yang aktif.

23.     Kita sentiasa menganggap bahawa mengambil bahagian dalam kegiatan olahraga akan membuat kita lebih aktif dan sihat. Cubalah kita berfikir sebaliknya: Kalau kita kekal aktif dan sihat, kita akan sentiasa dapat menikmati kegiatan tersebut sampai ke hari tua kita. Dan itulah yang akan membuat hidup kita lebih bermakna.

24.     Di kesempatan ini, saya ingin menggalakkan orang ramai untuk menyertai kami di Festival Saham Kesihatan Sekeluarga di Our Tampines Hub pada pagi Ahad, 12 March. Kita akan bermula pada pukul lapan setengah pagi dengan acara senaman beramai-ramai, diikuti dengan acara sukaneka seperti kuiz dan kegiatan fizikal. Kemudian, anda boleh meneroka festival itu untuk mempelajari tentang pemakanan sihat dan pemeriksaan kesihatan. Terdapat juga zon kesihatan di mana para penduduk boleh mempelajari tentang kepentingan berhenti merokok dan program “Saya Berhenti” ataupun “I Quit” oleh Lembaga Penggalakan Kesihatan (HPB). Jikalau sesiapa di antara golongan keluarga anda merokok, mari kita ambil kesempatan ini untuk menggalakan mereka supaya berhenti tabiat ini.

25.     Kita semua memainkan peranan dalam mendorong keluarga dan rakan-rakan kita untuk mengamalkan gaya hidup yang sihat. Masyarakat Melayu-Islam kita juga perlu mainkan peranan. Jika anda berminat untuk menganjurkan aktiviti yang menyebarkan gaya hidup yang sihat untuk masyarakat, karnival ini mempunyai ruang di mana anda boleh mendaftarkan diri bersama rakan-rakan Kerjasama M³@Bandar. Ini adalah peluang yang menyeronokkan bagi masyarakat kita berkumpul dan belajar mengamalkan kehidupan yang sihat. Saya harap dapat berjumpa anda di sana.

(In English)

26.     To encourage people to take charge of their own health, we are making it easier for the community to organise and run their own programmes. One example is a new initiative by the MCO Workgroup, called Saham Kesihatan, which was piloted at M³@Towns at Tampines and Jurong. It is aimed at nurturing a group of peer leaders in the community who organise community-led interest groups for Malay Muslim residents to live healthily.

27.     For people who lead sedentary lifestyles, it can feel challenging to get into the habit of exercising. Luckily, it’s never too late to start. Someone who illustrates that perfectly is Madam Haslina Aziz, who is an active volunteer and leader in Gems Empowering Me Series. Gems is a social enterprise that organises activities for women to lead healthy lifestyles. Since joining Gems almost ten years ago, Madam Haslina has participated in activities such as Spartan Races, sea expeditions, and dragon boating. She also earned her rock climbing certification. This is a woman at the peak of her physical prowess, and you might assume I am describing someone in her twenties. In fact, Madam Haslina is a grandmother of five. She has diabetes, but keeps that in check by making a sustained effort to live healthily. She shows us that age and medical conditions should not deter us from pursuing an active lifestyle.

28.     We often think that participating in sports activities helps to keep us active and healthy. Let us think of it this way instead: it is by staying active and healthy that we are able to continue enjoying these activities well into our golden years. And that is what makes for a fulfilling life.

29.     On that note, I encourage everyone to join us at the Saham Kesihatan Family Festival at Our Tampines Hub next Sunday morning on 12 March. We will be starting at 8.30am with a mass workout, followed by a team tele-match with quizzes and physical activities. Afterwards, you can explore the festival to learn about nutrition and health screening. There is also a health zone where residents can learn about the importance of quitting smoking and HPB’s “I Quit” programme. If anyone in your family is a smoker, please take this chance to speak to them seriously about quitting smoking.

30.     We all have a part to play in nudging our family and friends towards adopting a healthy lifestyle. This extends to the community as well. If you have a passion for organising healthy lifestyle activities for the community, the carnival will have booths where you can sign up with our M³ @ Towns partners. This is a fun opportunity for the community to get together and make the switch to a healthy lifestyle. I hope to see you there.

31.     Mr Chairman, in English. As we embark on the Healthier SG strategy, the public can expect to see more of such programmes for ethnic minority groups, as well as for the rest of Singaporeans. As Mr Xie Yao Quan has pointed out, it is important that we make it easy to join these activities. HPB conducts physical activity programmes such as weekly exercise sessions, and these are accessible regardless of which neighbourhood you live in. You can sign up conveniently through the Healthy 365 app. Seniors who are unfamiliar with a smartphone can ask their relatives to sign up on their behalf, or simply walk in with their ID.

32.     Community involvement is key to ensuring that health promotion efforts are sustained for the long term. We believe in supporting and encouraging more ground-up initiatives to meet the needs of the community. Last year, I shared that HPB is partnering the Ministry of Culture, Community and Youth to establish a $1.5 million Our Healthy Singapore Fund. This fund empowers community volunteers and organisations to kickstart ground-up health promotion initiatives. I am pleased to share that between April and December last year, we received almost 50 proposals. We are in the midst of evaluation and have awarded 7 proposals so far. We are heartened by how these Singaporeans have dedicated their time and skills to improve the health of their community.

33.     I would like to encourage members of the public to participate whole-heartedly in our health promotion programmes. Small lifestyle changes can go a long way towards lasting habits and better health outcomes. This is especially true for those with chronic medical conditions like diabetes. To provide diabetes patients with health information to manage their condition, we worked with more than 40 expert members and patient champions to develop Tier 2 of the National Diabetes Reference Materials. This will be published next month. It will contain easy-to-understand information on diabetic care, like reading nutrition labels and monitoring glycaemic index. We hope that this will empower diabetic patients and their caregivers to “be aware, be healthy and be proactive” to manage and live with diabetes.

Enhancing the Tobacco Control Strategy

34.     As we talk about healthy lifestyles, a major area of concern is smoking. Tobacco use is the single greatest cause of preventable death globally. Based on the latest National Population Health Survey 2022, the prevalence of daily smoking remains stable at 9.2%. We remain committed to our long-term goal to bring the overall smoking rate to a level that is as low as possible, and ultimately to pursue a nicotine-free Singapore.

35.     Another concern to address is vaping. To answer Mr Ang Wei Neng’s question on anti-vaping measures, we take a multi-pronged approach to address the issue of vaping including enforcement and education measures. At Singapore’s borders, the Immigration and Checkpoints Authority works with the Health Sciences Authority (HSA) for detection and enforcement of illegal imports of e-vaporisers. HSA monitors and targets the illicit sales of e-vaporisers on social media and messaging platforms to curb online access. HSA and the National Environment Agency (NEA) are working together on a cross-enforcement pilot for NEA’s enforcement officers to also act against vaping offences. Lastly, HPB has rolled out a digital campaign to raise awareness on the illegality and negative health effects of vaping, as well as how it leads to nicotine addiction.

36.     Vaping among youths is a worrying problem. In schools, we are raising awareness among students about the benefits of leading a nicotine-free lifestyle. MOE takes a firm stand against vaping. When students are caught using or possessing e-vaporisers, it will be confiscated and their parents informed. School-based disciplinary action is taken, including suspension, or caning for boys. They are referred to counsellors who will guide them through their cessation journey to effect long-term behavioural change. Recalcitrant offenders may be referred to HSA which may issue them a fine.

37.     Youths might also have misconceptions about smoking and vaping. It is important that we dispel these misconceptions and equip youths with knowledge and life skills to say no to cigarettes and e-vaporisers. Parents have a part to play as well, and they can refer to relevant information and resources through online articles on Parent Hub. We hope that parents can have a serious conversation with their children about smoking and vaping, and do it soon, before it becomes a life-long habit.

38.     We will continue to work towards a nicotine-free Singapore by exploring next-bound efforts of the tobacco control strategy. We will also continue to enhance our strategy to address the issue of vaping, including reviewing legislated penalties, enhancing enforcement, deterrence and education.

Closing

39.     Preventive health forms the foundation for better health, and the Ministry continues to strengthen upstream preventive health efforts. But Singaporeans must do their part to make healthier choices and lead healthier lifestyles. We are heartened that many have participated in our programmes and made a lasting switch to a healthy lifestyle. Programmes may come with incentives like Healthpoints, and that’s useful to help us get started. But we must be self-motivated in order to sustain these lifestyle changes. At the end of the day, what we are nudging Singaporeans towards, the real reward that matters, are the positive health outcomes of embracing a healthy lifestyle. Singaporeans have it within them to take charge of their health, and to create the health outcomes they want to have. Thank you.