Committee of Supply debate: Ministry of Health
MOH to wage war on diabetes
Measures include promoting healthy living and getting more people to go for screening
By Salma Khalik, Senior Health Correspondent, The Straits Times, 14 Apr 2016
The Ministry of Health has declared war on diabetes, describing it as one of the biggest drains on the healthcare system here.
In outlining how the Government intends to battle the disease, Health Minister Gan Kim Yong revealed in Parliament that four Singaporeans lose a limb or appendage daily because of complications from diabetes.
Dealing with diabetes is already costing more than $1 billion a year, he said during the debate on his ministry's budget yesterday.
"Left undetected, untreated or poorly managed, diabetes can lead to heart disease, stroke, kidney failure, blindness and amputations," he warned.
Of the over 400,000 diabetics in Singapore today, one in three does not even know he has the disease.
Of those who do know, one in three has poor control over his blood sugar levels. If nothing is done, things will get worse, with one out of every three people here - more than a million - getting diabetes.
"Therefore, I am declaring war on diabetes," Mr Gan said.
"We want to help Singaporeans live life free from diabetes and, for those with the disease, to help them control their condition to prevent deterioration."
Mr Gan will co-chair a new Diabetes Prevention and Care Taskforce with Acting Education Minister Ng Chee Meng that will include people from the public and private sectors, as well as patient advocacy and caregiver groups.
This "war" will start with the young. Minister of State for Health Lam Pin Min said it is worrying that children and young people are getting increasingly overweight.
"Childhood obesity is likely to persist and progress into adulthood," he said. Such individuals are at higher risk of getting chronic diseases like diabetes and hypertension.
"It is important for us to work upstream to lay strong foundations for our young to lead healthier and more productive lives, starting from those as young as two years old," said Dr Lam.
He will jointly lead an inter-agency NurtureSG Taskforce with Minister of State for Education Janil Puthucheary in this effort.
Senior Minister of State for Health Amy Khor's Women's Health Committee will help women with gestational diabetes prevent birth complications and tackle higher risk of diabetes in the child.
Studies show four in five babies born to women with uncontrolled gestational diabetes will likely become obese or diabetic.
Minister of State for Health Chee Hong Tat will work with the community to promote healthy living and reduce the prevalence of diabetes.
He will try to get more people to screen for diabetes, and strengthen the follow-up treatment for those diagnosed with the disease.
Said Mr Gan: "The war on diabetes will not be a quick battle, but a long war requiring sustained effort."
Success will be far reaching as it will "curb not just diabetes but other related chronic diseases such as heart disease, and we will improve the lives of Singaporeans and reduce the burden on their families".
More effort to promote healthy living habits
NurtureSG task force set up to encourage people to live healthily from a young age
By Linette Lai, The Straits Times, 14 Apr 2016
To stay alert while on the night shift, taxi driver Wong Pang Koon would down an average of five cans of Red Bull - a sugary energy drink - every week. He had a sweet tooth, too, and would often have a bowl of dessert for supper.
But 20 years ago, a doctor told him he had diabetes. Recently, the 62-year-old developed kidney failure, and now has to undergo dialysis three times a week.
"My doctor told me that I was eating too many sweet things and did not exercise enough," recalled Mr Wong. "At the time, I would sleep in the day and at night, I would just go out to drive my taxi. I did not have time to exercise."
Mr Wong is one of more than 400,000 Singaporeans who have diabetes, a third of whom may not even be aware of the condition.
Health Minister Gan Kim Yong told Parliament during the debate on his ministry's budget yesterday that his ministry will wage war on the disease, which can lead to complications such as stroke, kidney failure, blindness and amputations. "In fact," said Mr Gan, "four Singaporeans a day lose a limb or appendage due to diabetic related complications."
To stem the rising diabetes numbers, the Ministry of Health will do more to encourage people to live a healthy lifestyle from a young age.
Minister of State for Health Lam Pin Min and Minister of State for Education Janil Puthucheary will lead a task force, NurtureSG, to this end.
The Health Ministry will also step up efforts to screen and identify diabetics, so interventions can take place earlier. And it will help those already diagnosed with the disease to avoid complications and better manage their condition.
"For those with diabetes, we need to do our best to help them have good quality of life, at all stages, by having good control over their disease," Mr Gan said.
NurtureSG will rope in parents, educators, caregivers and the community, and aims to get young people to maintain healthy habits after they leave school and as they enter the workforce.
The health and education ministries will consult the public to get ideas on how to get children and youth to adopt and maintain healthy lifestyles.
The Health Ministry is also reaching out to different groups of workers. It has organised health screenings and deployed health coaches to taxi service centres, so cabbies can check their health when they send their vehicles for servicing every month.
Meanwhile, Mr Wong has managed to take charge of his condition by eating right and trying to lead a more active lifestyle.
He has stopped working the night shift, and his diabetes is under good control and only requires insulin jabs to keep it in check.
"I try my best not to eat too many sweet things now - if I order tea, I will ask for less sugar," he said. "I also do a lot more brisk walking now."
What seniors need, care providers seek to meet
Customised home care and daycare package among measures to support the elderly as population ages
By Tan Weizhen, The Straits Times, 14 Apr 2016
There is often a lot of logistics involved in ensuring that frail seniors get the care they need.
Some of them need transportation to daycare centres or meals to be delivered. Others may need help in managing their medication and making medical appointments.
The Ministry of Health (MOH) is working with care providers on a trial to offer these services, tailored to the specific needs of a senior, under the Integrated Home and Day Care package. It was among measures announced during the debate on the ministry's budget yesterday, aimed at supporting seniors as the population ages.
Ageing was on the mind of MPs, who spoke about issues such as standards of daycare services and ensuring the elderly age actively.
Fees for the Integrated Home and Day Care package can range from $1,100 to $2,200 per month, depending on the services needed, said MOH. But subsidies of up to 80 per cent are available to those who qualify.
Ms Low Mui Lang, executive director of Peacehaven Nursing Home, which is involved in the trial, said the scheme will simplify things for seniors, who sometimes do not get the help they need because they want to avoid hassles.
The MOH will also be piloting an Integrated Operator Scheme this year to ensure that care is delivered seamlessly to the elderly even as their needs change.
Under this scheme, it will appoint operators that will offer all three services commonly needed by the elderly: nursing homes, eldercare centres and home care.
Senior Minister of State (Health) Amy Khor said this could lead to economies of scale and result in more affordable care.
In a bid to ensure that seniors can get services they need within their own neighbourhoods, the MOH is also working with the Housing Board to build "Active Ageing Hubs" within new Build-to-Order developments.
These one-stop centres can serve a range of needs. For instance, they can provide active ageing programmes, daycare and rehabilitation services, or grocery delivery.
The ministry also hopes to encourage learning among seniors so they can age actively.
A new National Silver Academy will offer more than 10,000 learning places across 500 courses this year. Singaporeans aged 50 and above can start to register for courses from next month.
They will be able to take selected courses offered by the Institute of Technical Education, polytechnics and universities for a token fee, and will attend classes together with existing students.
"We hope (this) can not only fulfil seniors' aspirations to keep learning, but also help shape a new mindset regarding ageing,"said Dr Khor.
"I think having seniors learn with younger students in the same classroom will foster inter-generational interactions and... inspire our younger generation that learning does not stop at any age."
Turning to mental health issues, Dr Khor said the focus for her ministry will be on dementia.
Currently, the rate of dementia is about 10 per cent among seniors aged 60 and above.
With the number of those suffering from the condition likely to grow as the population ages, the Government has moved to increase the capacity of dementia care services in the community, she said.
By 2020, there will be 3,000 daycare places and 1,970 nursing home beds for those with dementia. There will be 160 elder-sitters.
There are also plans to help communities in towns such as MacPherson, Queenstown and Bedok become more dementia-friendly. Residents in these towns will be trained to provide assistance to people with dementia.
A "safe return" system for lost seniors will be piloted.
Said Dr Khor: "We need to rally the whole Singapore kampung to play a part in supporting seniors with dementia and their caregivers within our communities."
Maids can get training on caring for the elderly
By Linette Lai, The Straits Times, 14 Apr 2016
Foreign maid Rusmini is no novice when it comes to caring for the elderly. In the eight years since arriving in Singapore from Indonesia, the 37-year-old has looked after two elderly couples.
Her current ward, Madam Lee Ah Moy, is 74 years old and suffered a stroke four years ago.
Yet, when she attended a training course on how to care for the elderly that is administered by the Agency for Integrated Care (AIC), she learnt some new skills.
"They taught me how to properly transfer her from the bed to the chair, because she cannot walk," said Ms Rusmini, who goes by one name. "They also taught me how to give her a shower, and how to dress her. Before this, I didn't always know what was considered safe or unsafe."
The course will be offered to more foreign maids like Ms Rusmini this year, under a new pilot programme by the Health Ministry to train them to give specialised care to seniors.
Called Eldercarer, it was announced in Parliament by Senior Minister of State for Health Amy Khor yesterday, during the debate on her ministry's budget.
She was replying to Dr Tan Wu Meng (Jurong GRC) and Ms Joan Pereira (Tanjong Pagar GRC), who had called for more care to be provided for seniors at home.
Dr Khor acknowledged that despite steps taken to make employing foreign maids more affordable, some people still find it difficult to get helpers who are experienced in caring for seniors.
Under the programme, the helpers will be trained before they start working with families.
"Trainers will go to the homes to observe the domestic helpers at work, and check that they can perform the required eldercare tasks competently," Dr Khor said.
The programme comprises four days of classroom learning and on-the-job training - similar to that attended by Ms Rusmini.
Helpers will learn techniques such as how to prevent falls, as well as soft skills such as communicating with seniors.
Those who wish to send their maids for the training can call AIC on 1800-650-6060 or visit AIC's website at https://www.silverpages.sg/
Healthcare costs cause concern
Minister cites 'buffet syndrome' as one of the areas to be looked into
By Salma Khalik, Senior Health Correspondent, The Straits Times, 14 Apr 2016
Singapore's Healthcare Masterplan 2020 is on track, and people here rank behind only Japan and Andorra in terms of leading the longest healthy lives in the world.
But there are some worrying trends, said Health Minister Gan Kim Yong yesterday, including the ability to sustain the current level of service as the population ages. Costs are of particular concern.
"Many developed countries with ageing populations are facing similar challenges as us," he said. "One important lesson we can learn from their experience is that doing more of the same cannot be the solution."
The Government has already more than doubled its healthcare spending from $4.7 billion in FY2012 to $11 billion this year.
The launch of MediShield Life to cover everyone from birth till death last year has also helped people pay for their healthcare cost. Between December and February, this new scheme has paid out $136 million to cover 95,000 claims. This is 29 per cent more a month compared to payouts last year, he said.
But more needs to be done and he suggested three paradigm shifts:
One of these deals with choosing appropriate care. Some insurance policies for private care provided by Integrated Shield plans pay according to what doctors and hospitals charge. Some people also buy "riders" that do away with the need for the patient to pay anything for major medical treatment.
These could lead to a "buffet syndrome" since the cost is paid by someone else, said Mr Gan. "This contributes to rising healthcare costs for everyone and eventually pushes up premiums."
This system will have to be studied, he said.
Meanwhile, the ministry has set up an Agency for Care Effectiveness (Ace) to look into the use of high-cost treatments and technologies "to ensure that the outcomes from these technologies are commensurate with these costs".
Not all medical tests and treatments are necessary or useful, he said.
Countries like the United States, Britain and Japan have launched "Choose Wisely" campaigns to educate people on low-value tests and treatments.
These countries have identified 400 such treatments.
Ace will do the same for Singapore. It will also encourage healthcare providers to manage costs while providing quality care.
He said: "This will help patients, caregivers and physicians make more informed treatment decisions and avoid over-provision of services that will drive up costs."
Another shift involves moving beyond the hospital to the community. This requires a comprehensive system of primary, intermediate, long-term and home care to support hospital treatments.
It should centre on the patient's desire to recover quickly with as much functional ability as possible. By streamlining care, the stay in hospital can be shorter and rehabilitation, if needed, started earlier.
The third push is to increase the years of healthy life for people here, which stood at 70.8 years for men and 73.4 years for women in 2013.
Unfortunately, with longer lives, the number of years people here live in ill health has also gone up, and in 2013 stood at 8.9 years for men and 10.6 years for women.
Dr Lily Neo (Jalan Besar GRC) and Dr Chia Shi Lu (Tanjong Pagar GRC) had asked about what Singapore is doing about diabetes, which is fast becoming a major global healthcare burden.
To them, Mr Gan said his ministry will be waging a multi-year war against diabetes, a disease which costs Singapore more than $1 billion a year.
Closing big gap between a model and an actual ageing society
By Lydia Lim, Associate Opinion Editor, The Straits Times, 14 Apr 2016
Singapore may want to adopt, as a motto, the phrase "You're never too old to..."
It has the potential to fire people's imagination, as Nike's tagline "Just Do It" has, and fits a fast-ageing society.
Health Minister Gan Kim Yong used it when he announced the Government's War on Diabetes yesterday, citing a United States study published in the New England Journal of Medicine which found that changes to diet, exercise regimes and other behaviours worked especially well in reducing the risk of diabetes among participants aged 60 and older.
Mr Gan's conclusion? "You're never too old to make the change and take back your health."
That was the thrust, too, of Senior Minister of State for Health Amy Khor's speech, in which she gave details of courses available to seniors aged 50 and older at a new National Silver Academy.
They will be able to take selected modules offered by the Institute of Technical Education, polytechnics and universities - without sitting exams.
They will also receive subsidies for short courses offered by post-secondary institutes and voluntary welfare organisations.
They will be eligible for courses at the two art colleges - Lasalle and the Nanyang Academy of Fine Arts - and inter-generational learning programmes conducted by students on topics such as technology and music.
There will be 10,000 learning places across 500 courses this year and seniors can start signing up next month.
"We hope that the National Silver Academy can not only fulfil seniors' aspirations to keep learning, but also help shape a new mindset regarding ageing," Dr Khor said. "I think having seniors learn with younger students in the same classroom will foster inter-generational interactions and inspire our younger generation that learning does not stop at any age."
The academy attests to Singapore's intent to not just age well but also become a role model in the field. Indeed, Dr Khor kicked off her speech by declaring this ambition. She told the House that "population ageing presents a unique opportunity for us to redefine ageing, and make Singapore an icon of successful ageing".
That the Government has set itself such an ambitious target is good news for citizens, provided the reality on the ground matches the rhetoric.
For now, though, issues of under-capacity remain, and MPs highlighted several during the debate on the budget for the Health Ministry, including long waiting times at polyclinics and specialist outpatient clinics, and the shortfall in community-based home care and daycare services.
Dr Lily Neo (Jalan Besar GRC) even went so far as to say that "our home care services are almost non-existent at present".
She was "repeating" her call, she said, to make home care services available quickly so as to lessen the need for high-cost stays in acute hospitals.
Ms Joan Pereira (Tanjong Pagar GRC) wanted to know "if we will have enough eldercare centres, step-down community hospitals and hospices to cope with the increasing number of seniors".
"How will we recruit, train and retain enough volunteer carers, volunteer guides, nurses, nursing assistants, professional caregivers and therapists? What kind of support or resources can we provide their families and caregivers, especially if they have long-term patients or challenges like dementia?" she asked.
Ms Tin Pei Ling (MacPherson) worried about an "epidemic of dementia" and asked what lessons could be learnt from countries like Japan that have already had to meet this challenge.
Nominated MP Kuik Shiao-Yin cited a Lien Foundation survey which found that two in three people do not understand what palliative care is, and many doctors and nurses themselves feel unprepared to talk to patients about life-threatening illnesses.
She also spoke up for caregivers, this time citing a Ministry of Social and Family Development survey which found that those who cared for spouses or were of lower socio-economic status were more likely to suffer ill effects from caregiving.
"If we believe 'family should be the first line of support', we must keep finding how to better support the very people trying their utmost to live out that value - especially those who are less financially privileged," she said.
Responding, Dr Khor mapped out how the Health Ministry plans to meet these challenges in turn.
On home care, for instance, "we will continue to work hard to develop more infrastructure and manpower... and are on track to meet the projected demand of 10,000 home care and 6,200 daycare places by 2020", she said.
The Health Ministry is also piloting new packages that bundle home and centre-based care services together.
On dementia, that is now the focus of the ministry's community mental health efforts. There are three home intervention teams to support those who care for loved ones with dementia at home.
By 2020, it plans to have 3,000 dementia daycare places, 1,970 dementia nursing home beds and 160 elder-sitters. Indeed, Dr Khor's speech was replete with targets that the ministry has set for itself in the years ahead, to raise caregiving capacity.
At the same time, she appealed to the public to play their part: "We need to rally the whole Singapore kampung to play a part in supporting seniors with dementia and their caregivers within our communities."
Similarly, the ministry wants to raise befriending communities in different parts of the island to counter social isolation among the elderly. As Dr Khor acknowledged, Singapore can become an icon of ageing only if people come together to build "a nation for all ages".
For now though, there remains a big gap between ambition and reality.
Committee of Supply debate: Prime Minister's Office
More leave for new dads from next year
By Charissa Yong, The Straits Times, 14 Apr 2016
From next year, fathers will get a second week of compulsory paid leave to spend time with their baby and a bigger share of their wives' maternity leave.
These changes, when combined with the existing baby leave they get, could give a new father a total of eight weeks of leave. But they have to use the new perks before their child turns one year old.
The additions, announced by Senior Minister of State Josephine Teo in Parliament yesterday, are part of an official effort to encourage couples to have more babies by getting fathers more involved in parenting.
To spur fathers to do more, those whose children are born from Jan 1 next year will get two weeks of mandatory paid paternity leave. Only one week is now compulsory. The second week is up to companies.
The Government will pay for the extra week of leave, capped at $2,500 per week, including Central Provident Fund contributions.
Working mothers can share up to four weeks of their paid maternity leave with their husbands from July next year. Now, they can share only one out of the 16 weeks they get.
Together with one week of childcare leave and one week of unpaid infant care, fathers can get a total of eight weeks off work. Mrs Teo acknowledged businesses may be concerned about the extra leave affecting their manpower needs. But the changes are being announced eight months before they take effect, to give employers time to plan their staffing schedules, she said.
To qualify for the paternity leave and shared parental leave, fathers must be married to the child's mother, and the child must be a Singapore citizen.
In another change, mothers who adopt will get 12 weeks of paid leave to look after their adopted child, up from the current four weeks. The adopted child must be a Singapore citizen below 12 months of age and adopted on or after July 1 next year.
Mr Kurt Wee, president of the Association of Small and Medium Enterprises, said given the gloomy economic outlook, employers would have preferred 18 to 24 months' notice. "We understand that male employees don't have kids every year.
"But in the years that they do, they may take quite a lot of time off from work. Can they be given automatic approval to defer their reservist training that year?" he asked.
More parents abroad register babies as citizens
Increase is a result of more Singaporeans living overseas for extended periods
By Rachel Au-Yong, The Straits Times, 14 Apr 2016
More Singaporean parents living abroad are registering their children as citizens.
There were 1,600 children born overseas to at least one Singaporean parent who were registered as citizens last year. They made up 8 per cent of the 20,815 total citizenships registered last year.
This is up from the 1,200 such children registered on average each year from 2006 to 2010, and the 1,400 registered on average each year from 2011 to 2015.
The increase is a result of more Singaporeans living, working or studying overseas for extended periods, Senior Minister of State in the Prime Minister's Office Josephine Teo said yesterday.
There are 210,000 such citizens now, a 30 per cent rise compared with 160,000 a decade ago. "This shows how Singaporeans are increasingly mobile and welcomed by employers and educational institutions internationally," she said during the debate on spending plans of the Prime Minister's Office.
Mrs Teo, who oversees population matters, said the Government has kept a "calibrated pace of immigration" to prevent the citizen population from shrinking.
Apart from the new citizenships granted last year, there were 29,955 others given permanent residency.
Mrs Teo said more should be done to help new citizens deepen their sense of belonging here. She suggested they get involved in all aspects of local life, including learning to speak local languages and taking an interest in issues that concern fellow Singaporeans. "Most important of all, they must understand our roots as a multiracial and multicultural society," she said.
Agreeing with MPs Darryl David (Ang Mo Kio GRC) and Rahayu Mahzam (Jurong GRC), she encouraged Singaporeans to remain open to people of diverse backgrounds.
Mrs Teo said immigration measures will not fully meet the country's growing workforce needs. But rather than grow the population more quickly through immigration, "we have decided to press on with the restructuring of our economy towards one that is less dependent on manpower for growth", she said.
As such, the growth of the foreign workforce has slowed considerably, she noted. The Government is also trying to equip Singaporeans with more skills so they can remain relevant through measures like SkillsFuture, she added.
"Our vision must be a Singapore that is cohesive and open, where Singaporeans feel a sense of connectedness wherever they are in the world... and at the same time, have the capacity to welcome new additions to our family whether for a period of time or for good."
It takes the 'whole of society' to help Singaporeans have more babies
By Charissa Yong, The Straits Times, 14 Apr 2016
When his twin sons were born in March last year, Mr Eugene Tan, 31, took two weeks off work to help out at home.
The investment analyst changed diapers and bought groceries.
Said his wife Rachel Lee, 27, a human resources professional: "As first-time parents with twins, the learning curve was very steep. So I very much appreciated my husband's presence."
Mr Tan had taken a week of paternity leave and a week of Ms Lee's 16-week maternity leave under a scheme that lets her share the leave with him.
This was possible because his supervisor was supportive, added Ms Lee.
Support like this is crucial if more Singaporeans are to have children, said Senior Minister of State Josephine Teo during the debate on the spending plans of the Prime Minister's Office yesterday.
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