Mental health support, getting elderly on digital platform among MPs’ concerns about healthcare reform plan

SINGAPORE: Improving access to mental health support and helping patients who are less IT-savvy enrol in a voluntary national healthcare programme were among the suggestions raised during a debate on a parliamentary motion on Tuesday (Oct 4).

Led by Health Minister Ong Ye Kung, the motion seeks to endorse a White Paper on Singapore’s new health strategy - also known as the Healthier SG initiative - and to form the basis of transforming Singapore’s healthcare system.

The new strategy aims to have citizens enrol with a single family doctor who knows their medical history well and can work with them to better manage their health needs.

It puts a stronger focus on preventive care, as Singapore tackles the challenges of an ageing population and the rising impact of chronic disease.

First announced during the Ministry of Health’s (MOH) Committee of Supply Debate in March, Healthier SG will be open for enrolment to those aged 60 and above in the second half of 2023.

It will gradually be made available to those between 40 and 59 years old in the next two years. 

IMPROVING ACCESS TO MENTAL HEALTH

Nineteen Members of Parliament (MPs) from both sides of the House rose to speak on the issue on Tuesday. Several of them asked how mental health would fit in Singapore’s new healthcare strategy, with growing awareness about the importance of mental well-being.

Noting that the White Paper did not include mental health as part of the first 12 care protocols being rolled out to family doctors, MP He Ting Ru (WP-Sengkang) said there is a need to ensure that doctors and their staff members are adequately trained and supported to deal with patients who suffer from mental health.

She added that the referral system must also not be overly complicated, and healthcare workers need to have easily accessible references to know what resources are available to their patients.

“Not having adequate treatment or support, while suffering from mental health conditions, has an impact on all aspects of life ranging from economic output to physical health,” she said. 

MP Wan Rizal (PAP-Jalan Besar) raised concerns about whether general practitioners would be able to manage consultation time when it comes to patients who require mental health support, as it might require deeper attention.

SUPPORT FOR THE ELDERLY 

Other MPs raised possible challenges in getting seniors, who are less digitally savvy and mobile, to enrol and follow up with Healthier SG. 

Dr Wan Rizal asked if there are enough resources to support the elderly, who may live in older neighbourhoods with fewer GP clinics. 

"For the elderly who are less mobile or immobile, regular visits to the doctor may be challenging. How does MOH intend to engage and support them?" Dr Wan Rizal said, suggesting that ground efforts - similar to those mooted during the COVID-19 pandemic - may be helpful to seniors.

He added that the elderly would need a longer consultation time, thus increasing the daily workload of doctors.

MP Tan Wu Meng (PAP-Jurong) asked how the Government would engage seniors who do not use smartphones. 

Those participating in Healthier SG will have a health plan on the digital platform HealthHub, which will record key points of discussions with doctors and track health outcomes. They will also be able to use the mobile application Healthy 365 to track physical activities and diets and get access to community activities.

However, Dr Tan said some seniors would not be comfortable with such technologies.

"There must be careful attention to ease of use, understanding what our seniors and elderly need and find easy to use. Technology must serve, adapt and bend to the person, rather than getting people to bend to the technology. Seniors who feel left behind by digital change should not be treated as having fallen by the wayside, or not able to adapt," he said. 

The plan to use technology to help implement the Healthier SG programme is “laudable” and should be explored, said Nominated Member of Parliament Janet Ang. 

The IT system, health communications network and the National Electronic Health Records systems are critical for the successful implementation of the initiative, she added. 

“MOH has done very well ... in this space but will need to continue to invest as more still needs to be done to ensure system up-time, efficient sharing and update of the patient’s health records while ensuring data is secure and personal data duly protected,” said Ms Ang. 

Doctors, nurses and staff will also need to be trained to educate and support patients in the enrolment and transition, she added. 

“What help and support will MOH provide to help the GPs and clinics transition to the level of digital that will enable them to perform their role in this healthcare model?” 

Ms Ang also expressed concern for elderly citizens who may be less familiar with technology, noting that there is a large group of seniors who may not be digitally savvy.

“How will MOH onboard this segment of citizens who are digitally naive and who are likely to be from lower-income households?” 

MP Dennis Tan (WP-Hougang) stressed the need to improve outreach efforts to engage elderly patients. 

He noted that under the White Paper, the number of eldercare centres will increase from 119 to 220 by 2025. Eldercare centres will connect seniors with community programmes, offer community-based monitoring of vital signs such as blood pressure, in between visits to the doctor, as well as help to roll out other healthcare initiatives. 

However some elderly keep to themselves, while others live alone. In such cases, MOH can study how to improve outreach efforts so that all seniors can benefit from programmes under Healthier SG, said Mr Tan. 

TRANSITION AND MANPOWER PLANNING  

Several MPs expressed concerns about the transition to the Healthier SG strategy, noting that manpower planning would be crucial. They also asked about the number of family doctors and nurses that would be needed to fully realise the Healthier SG strategy. 

The White Paper states that a fifth of Singapore's doctors and nurses are in primary and community care. To support the implementation of the strategy, the proportion will need to be increased to at least a quarter by 2030.

“While MOH and its various partners will undoubtedly put in much effort to ensure that more will start choosing family medicine as a vocation, efforts are also hampered by what is traditionally seen to be a ‘lesser status’ of family doctors,” she added. 

Family doctors and physicians in the public polyclinics will take on a significant portion of the Healthier SG workload, even as GPs can step up and do more, said MP Xie Yao Quan (PAP-Jurong). 

“For the public healthcare sector, we need stability to become a key principle in manpower planning,” he added. 

“So within the polyclinics, I would like to ask what happens to enrolment arrangements when family doctors and physicians within these polyclinics move, get rotated, or cross-deployed, as they routinely do? Do patients move with the doctors?

The debate on the White Paper continues on Wednesday.

“Fundamentally, are Singaporeans going to be enrolled with a polyclinic, or to a particular doctor within the polyclinic?” 

Mr Xie suggested that there be less rotation and more stability in manpower planning for all polyclinics across all three healthcare clusters. 

He also suggested that clinical manpower recruitment, posting and deployment across the three healthcare clusters be centralised at the ministry level going forward. 

Manpower issues may not be solved just by hiring more healthcare workers, as the experience of each staff member is also important, said NMP Dr Tan Yia Swam, who is also president of the Singapore Medical Association. 

“Losing a nurse with 10 years of experience and intensive care unit training - can she be replaced by five new nurses?” 

Dr Tan urged the Health Ministry to look at retaining staff - for senior and trained doctors to stay in the public sectors, and experienced nurses and allied healthcare workers to want to stay in Singapore. 

“It is good that there's more training and new hires for Singaporeans and for foreigners, but how do we actually retain them?”