Toddler “Joe” (not his real name) and his family were suffering from HFMD. Joe came to KKH feverish and really dehydrated. The poor child was crying in pain due to his oral ulcers, and had an unusual florid presentation of HFMD blisters all over his body. We quickly rehydrated him and gave him pain and fever relief. It took several days before the pain and fever finally subsided and Joe regained his appetite. His elder brother had similar symptoms while his father had mild oral ulcers and blisters. While Joe’s condition was definitely “serious” to his parents, in medical terms, the outcome was excellent for Joe.

Close to 99% of all HFMD sufferers will eventually recover with no adverse long-term effects from the infection. Of this, the majority would have been infected without even knowing it (the so-called “silent infections”). Those who develop clinical disease may have a combination of the usual painful throat ulcers and blistering rashes on palms or soles (although in many children, the rashes often extend to the legs, buttocks, sometimes even the torso, rarely on the face, and almost never on the scalp). A few may require hospitalisation for rehydration therapy if they are unable to retain fluids at home.

A very small number (less than 1%) can develop more serious complications such as meningitis or encephalitis (inflammation of the brain), myocarditis (inflammation of the heart) or widespread disease, which may then be fatal. Unfortunately, medical science has not developed to a stage where we can predict which patient is likely to develop these severe manifestations, and there is currently no available effective “treatment” for HFMD – in most cases the patients develop immune cells and antibodies to kill off the virus in their bodies; current medical therapy mainly supports the body during this period (e.g. with fluids or antibodies) and prevent further complications.

Evidence reveals that out of the 70-odd strains of the family of Enteroviruses that cause HFMD, a few may be more deadly. The most notorious strain is EV71 which is a genetically diverse and rapidly evolving virus. Singapore saw large outbreaks of this strain in the past decade or so, with year 2000 being the worst. But besides EV71, many strains of HFMD are now well established in Singapore.

I would like to stress the importance of the old and tested mantra of teaching our children to practice good hand hygiene, cover our mouths and noses when we sneeze or cough, avoid contact with infected people, and avoid passing the infection to others. This will keep all of us safe not just from HFMD, but from many other deadly germs too.

In the past 2 to 3 months, I’ve noticed the attendance at the KKH Children’s Emergency Department with HFMD cases doubling before tripling, but the most reassuring piece of data is that the proportion of children requiring admission has consistently stayed at around 10% with no severe cases in intensive care (yet).

Data from National Public Health Laboratories’ surveillance cultures show that most of the HFMD strains are non-EV71. Hopefully, with good quarantine and control measures, a heightened sense of awareness, personal hygiene and social responsibility, we’ll see this epidemic plateau and pass.

Some final words of wisdom by one of my respected clinical mentors that you certainly won’t find in medical textbooks: we sometimes say that the more blisters you have on your body, the less likely you may have severe disease – better to have it in your skin than your brain or heart.

DR THOON KOH CHENG

Head and Consultant
Infectious Diseases Service
Department of Paediatrics
KK Women’s and Children’s Hospital

]]> http://mohsingapore.sg/2012/05/hfmd-battle-frontline/feed/ 0 http://mohsingapore.sg/2012/05/thoughts-healthcare-affordability/?utm_source=rss&utm_medium=rss&utm_campaign=thoughts-healthcare-affordability http://mohsingapore.sg/2012/05/thoughts-healthcare-affordability/#comments Thu, 10 May 2012 01:54:40 +0000 mohcontact http://mohsingapore.sg/?p=2790 It has been just about two months since we unveiled the Healthcare 2020 Masterplan. As many of you may recall, the Masterplan outlines a slew of measures to enhance the affordability, accessibility, and quality of healthcare, to better meet the needs of Singaporeans.

Since then, I have received encouraging feedback on many of our healthcare initiatives, especially via the REACH portal. Measures which many Singaporeans welcome include the enhanced subsidies for Intermediate and Long-term Care (ILTC) services, and the expanded scope of the Community Health Assist Scheme (CHAS).

With these enhancements, even middle-income earners aged above 40 can now receive subsidised care for chronic outpatient treatment at private clinics near their homes. This is a win-win for all. Singaporeans can get regular consultations with doctors nearer their homes to control medical conditions earlier in life. This prevents more serious conditions from developing when they grow old.

But, I also detect continued worries among some Singaporeans over rising medical costs and affordablity. This is evident from concerns expressed by some REACH contributors.

One particular issue that has surfaced is the suggestion to remove, or significantly reduce, the individual’s co-payment in MediShield. I am sure many would welcome this. But it will inevitably lead to over-consumption, no different from human behaviour we observe in other facets of life, like over-eating at buffets!

If I pay less or not at all, someone else will need to pay. Who will that “someone else” be?

“Who pays” actually becomes a big issue. Dr Lim Meng Kin’s piece in Straits Times yesterday, cited Taiwan as an  example, where low co-payment has encouraged higher-than-usual utilisation of medical services. As expenditure outstripped the premiums collected, Taiwan’s National Health Insurance has run into a sizeable deficit. The working population and their employers bear the bulk of healthcare costs, but this may not be tenable in the long-term as its population ages, just like ours.

Experience elsewhere also suggests that there is no magic formula in healthcare financing. We hope that “someone else” will pay so that we can  enjoy lower or zero co-payment. But that “someone else” is inevitably you, me, or our children, often through higher taxes.

We need a carefully considered, and calibrated approach. Remember that after government subsidies, we have our 3Ms – Medisave, MediShield and Medifund, to help defray our medical expenses. The 3Ms allow us to first look after ourselves and our families through savings (Medisave). The second line of defence is the pooling of risks to pay for larger bills (MediShield). And if all else fails, to tap on the government-funded  Medifund.

This is a responsible yet compassionate approach. Sometimes, individuals end up with large medical bills despite their best efforts. This is when risk-pooling through MediShield and help from Medifund comes in.

On the cost side, Government has always come in to help, and in a big way too.  Last year, MOH spent more than $3 billion on direct patient subsidies, as well as indirect subsidies to expand capacity and upgrade professional capabilities, support research and develop new services.

Indeed, with the 3M system, most Singaporeans fork out little or no cash payment for hospitalisation. Moreover, since Medisave is our own money, available for use for oneself or one’s family, many would take care to ensure that it is spent wisely. This makes our healthcare financing model affordable and sustainable.  Of course, we will need to continue to refine  the system to meet changing needs and address gaps.

Spending more on medical services per se is not a measure of success. The best thing we can do for ourselves is to keep healthy and fit. As Chief Health Ambassador, this is especially close to my heart. Practising healthy eating habits and exercising regularly should be among every Singaporean’s priorities. While some risk factors – such as age, gender and heredity – cannot be changed, we can reduce the risks of chronic diseases or delay their onset, through regular exercise and eating more healthily. This not only saves money, but gives us a better quality of life. As the adage goes “a stitch in time saves nine”. Regular heath screenings can also help us take preventive action before it is too late.

Healthcare is too important to leave  to “someone else”. Join me and thousands of other Singaporeans to lead a more healthy lifestyle!

Take obesity for example. Experts believe that obesity is not just a lifestyle disease but also a lifestyle choice, since it has to do with what we eat and how we decide to live. Obesity leads to so many other health problems including diabetes and heart disease. In fact, a recent MOH study estimated that in Singapore, if nobody is overweight or obese, we can prevent almost 70% of the diabetes burden (this includes premature death and years spent in ill health), and almost 20% of cardiovascular disease burden in Singapore!

We have been encouraging Singaporeans to exercise regularly and eat more healthily, but making these changes is not so simple. It is hard work to lose weight. Anyone who has tried to do so will agree. Healthy lifestyle habits therefore need to be developed from young; they are so difficult to change later in life. But the obesity epidemic is already affecting Singapore’s young: In 2010, about 6000 (or 10.8%) of our youth (aged 18) entered adulthood already obese based on our National Health Survey findings. Compare this to 1998 when the figure was only about 2500 (or 6.0%). Statistics show that obese people will spend at least 20% more on healthcare over their lifetime. It is therefore important that we inculcate the right healthy lifestyle habits from young.

It took celebrity Chef Jamie Oliver’s reality TV show to really show just how bad things have become: children getting pizzas for breakfast and flavoured milk with more sugar than a can of soft drink. In the aftermath of the “Feed me Better” campaign in the UK, former Prime Minister Tony Blair set up a School Food Trust to get schools to pledge their commitment to providing healthier meals. To that end, I’m glad that our schools place great importance on this, working closely with the Health Promotion Board (HPB) to promote healthy lifestyle habits to their students. During my visit to Wellington Primary School last year, I was impressed to find student set meals that provided a balanced diet, complete with fruits and vegetables. Our next step now, is to move “up-stream” and target pre-schools to build an environment that encourages healthy living among our younger children.

Set meals provides a balanced diet, complete with fruits and vegetables

Besides schools, parents and caregivers have a critical role to play in making sure our children develop the right habits. As a mother of three children, I can attest to the important role that we as parents play. I make sure that my children have a healthy diet during their growing up years. In fact, I still cook healthy dishes for the family whenever I have the time! It will not be effective if our schools promote healthy lifestyle habits, only for the child to go home and immediately open a bag of chips and a can of soda, and spend the rest of the day on the sofa in front of the TV. Parents and caregivers not only help to establish a healthy home environment, they also act as role models for their children.

While establishing a firm foundation of healthy lifestyle habits from young is important, it is never too late to change our habits later in life for better health. Changing our lifestyle habits is a process, and processes take time, and a fair amount of discipline and hard work. Unfortunately, there is no short cut. If we spend the first 30 years of our lives living sedentary lifestyles and “living to eat” as the old Chinese saying goes, it will take some effort to start exercising and eating healthily.

Take physical activity as an example. Many of us find it difficult to find time to exercise regularly due to our busy schedules. In fact, about 40% of Singaporeans (18-69 years old) do not exercise enough to meet minimum guidelines for good health. But some physical activity is better than none at all. There are actually small steps we can take towards living a more active lifestyle. Using the staircase instead of the escalator or lift, walking out for lunch instead of driving, going down to the park to play as family time instead of staying in front of the television, are some changes we can easily make to our daily routines. Seemingly small, it’s steps like these that help start us on our journey to a healthier lifestyle, and reap the long term benefits when sustained over time.

With Singaporeans living longer, it is important that Singaporeans take control of our health. The recent National Health Survey showed that half of people suffering from diabetes do not know they have the condition. Similarly, there are findings to suggest that an obese person or one living an unhealthy lifestyle might have other chronic conditions such as diabetes or high cholesterol. While we step up our public engagement to raise awareness on the various health promotion programmes in the community, Singaporeans need to come forward to participate in these programmes.

If health is wealth, let’s all be proactive and work towards a healthy and wealthy Singapore population! It starts with you and I.

Last December, I came across an article in Zaobao titled “Old Man Living Alone Has Lingering Concerns” (独居老伯 心有牵挂). It describes an old man, Mr Huang Ji Fu (黄吉富), who lives alone after his wife had a stroke. She had to be admitted to a nursing home because he was unable to take care of her at home. His thoughts were however never far from her.

As our population ages, the demands on aged care will increase. However, aged care involves not just responding to the functional or health related issues of our seniors but their social and emotional needs as well. Ultimately, what matters is the quality of life they have as our seniors age. We can all empathise with Mr Huang. Even as we all age or become frail, we will want to be cared for at home and be together with our loved ones, just like Mr Huang.

Therefore, a key focus of the Ministerial Committee on Ageing is to expand the scope of intermediate and long-term care in Singapore, to facilitate ageing-in-place. We plan to expand and enhance home-based care to better support caregivers to care for their loved ones within their homes, rather than in an institution.

We also intend to expand and develop a wider network of day care centres within the heartlands so that care can be brought closer to home. We plan to build new centres that may be bigger and provide integrated services for seniors who are functional and healthy, as well as seniors with healthcare needs. These centres will not only provide a place for them to socialise, but also access services such as nursing, rehabilitative services and dementia management programmes. Seniors living with their children who are working can then be supported by these centres, while their children have the peace of mind that their parents are being cared for by professional staff in the day.

An example of this is the Touch Home Care centre which recently opened in Jurong. A team of nurses and occupational therapists are stationed at a satellite centre in a void deck from which they deliver home-based nursing care to bed-ridden patients in the west. They also tap on local housewives to provide housekeeping and local GPs to provide medical care to clients that they help.

Another centre is the Bedok Multi Service Centre operated by the Salvation Army which I visited. They provide day care services as well as day dementia, day rehabilitative services and nursing care for seniors living in the nearby HDB blocks, while their caregivers go to work. Demand for their services is overwhelming! Instead of expanding their Bedok centre to cater to the demand, I suggested that they consider using the centre as a platform to stage services to their clients at their homes. This will provide holistic care to their clients and complement the care that they provide at the centre.

The government will continue to invest in building more of such centres in the community. We will also work with aged care providers on manpower and financing initiatives that can help build up their capabilities. This will in turn make home and community-based care a more viable option for Singaporeans. We will also study how to enhance the care for patients who are discharged from hospitals, in their homes, in the immediate few months post discharge. This would enable caregivers to better cope with the transition and pre-empt potential re-admissions into hospitals which can be traumatising for both our seniors and their caregivers.

However, for patients who are very frail and have little or no care support, institutional care will still be necessary at some point. In view of our significant senior population post 2020, we still need to invest in building more nursing homes to ensure that our seniors who require institutional care will have access to the right care. Based on past utilisation and future demographics, we project that we will need up to 15,600 nursing home beds by 2020. Beyond the current capacity of some 9,000 nursing home beds, we have some 1,800 additional beds in the pipeline from our replacement and new nursing home projects which are already being planned and developed.

In developing new nursing homes, we will study how the rehabilitative services within these homes can also cater to other seniors living in the neighbourhood as well. We will look at how nursing homes can provide respite care options for caregivers living within the community.

The intermediate and long-term care sector will be a key focus for my Ministry in the next few years. My Ministry will be working hand in hand with partners within this sector to scale and improve the quality of care, so that we will be ready to provide holistic, accessible and quality care for a larger senior population in the years to come.

A reporter asked me whether being the Minister-in-Charge of Ageing Issues was an additional ECA (Extra Curricular Activity) for me. I said that it was not an “ECA” but a “CCA” (Co Curricular Activity)!

Indeed, an ageing population will be a major force shaping our society over the next one or two decades. We will see about 400,000 Baby Boomers turn 65 years old between now and 2020. However, the bulk of Baby Boomers, or about 600,000 people, will turn 65 years old between 2020 and 2030. 600,000 people today is equivalent to about the size of Ang Mo Kio, Choa Chu Kang, Toa Payoh, and Yishun taken together!

Over the past few years, we have been promoting active ageing. However, increasingly, we will also have to think about caring for our seniors who fall ill or may end up with functional disabilities.  An ageing population will mean a higher need for both acute care in hospitals, as well as longer term care in nursing homes and other community facilities.  Many of the voluntary welfare organisations I meet tell me that they have to move from providing social day care for seniors to providing rehabilitative and other healthcare-related services because our seniors have aged over the past decade or so, and are getting more frail.

We estimate that by 2030, there will be 117,000 seniors who are semi-ambulant or non-ambulant, more than 2.5 times that of today.  And the impact goes beyond healthcare. We could see more than 80,000 seniors living alone, some of whom could also have health needs. How do we care for and engage our seniors? How do we make sure that the living environment within our city is one that encourages our seniors to be part of the community and not apart?

In my mind, there are three immediate challenges:

• First, we need to ensure that the capacity of our aged care infrastructure is able to meet the needs by 2020 and beyond.
• Second, we need to enhance the quality of care services, both in terms of increasing the care options that seniors have, as well as enhancing the level of care services.
• Third, we need to ensure that seniors and their caregivers can afford these care services.

The ramp up in aged care services is more easily said than done. We need a concerted effort across the aged care sector and beyond. We will need additional resources, not just financial, but manpower with the right skills and in the right numbers. We will also need to tap on the expertise of social service professionals and healthcare professionals to create and deliver better and new forms of care, that not only address the functional, but the psycho-emotional and social needs of our seniors. Singaporeans must accept the need for more aged care facilities to be developed across the island, and in locations within our HDB heartlands so that they are easily accessible.

The challenges are huge but not insurmountable. In the past months, I have visited many seniors activity centres, rehabilitative centres, nursing homes and hospitals. The passion among staff and volunteers within the aged care sector is our most valuable asset.

Together with my colleagues from the Ministerial Committee on Ageing, I hosted a dialogue session today with the leaders of the various organisations providing aged care. We wanted to share our plans to scale up aged care services, and hear their views on what we can do to achieve an expansion in aged care services and how we can enhance the quality of care for seniors. There was no lack of bold and innovative thinking among professionals within our aged care sector. During the dialogue, many useful comments and ideas were raised as to how we can work together to address the issues of manpower, financing, and care integration. Some also shared with us their thoughts on how best practices in other countries can be applied here. We will study the suggestions that were raised very seriously. Their views, ideas and suggestions will form a critical part of the plans and policies that the government will put in place to prepare Singapore to meet the needs of an ageing population in the years ahead.

Our seniors today and tomorrow should be able to age gracefully and with dignity as an integral part of our society. They should have the option to be cared for with love from their families and the community. That, I think, is the purpose we all share.

Of the three new ideas, the proposal to set up Community Health Centres (CHCs) received the strongest and broadest support from the GP community. Naturally so, as many of our physicians recognise that with more ancillary support services available in the community, they will be better able to deliver good primary care, especially for older Singaporeans with chronic illnesses. Some suggested that CHCs can provide administrative support, such as claims and data submissions, and relieve the doctors from such chores to focus more on patient care. There was also a suggestion to include a pharmacy within these CHCs for the convenience of patients. These are useful feedback and we will study them carefully. The configuration of the CHCs must meet the needs of our patients and GPs.

I also discussed with GPs the possibility of bringing together private sectors doctors, nurses and allied health professionals to create Family Medicine Clinics (FMCs) in the community. This way, we can offer holistic team-based care which many of our chronic and elderly patients will need and appreciate. The reaction was more mixed.  Some solo GPs were understandably concerned about the possible competition FMCs may pose to them. A few GPs also expressed reservations over team-based care. But there were also GPs who were keen to collaborate under this model. Our Regional Health Systems are currently in preliminary discussions with GPs who have come forward to explore setting up FMCs. Some have come as a group to operate a FMC, while others are thinking of running clinic sessions in FMCs even as they continue to run their own clinics.

The third idea that I have asked for feedback is the provision of specialist services in Medical Centres (MCs) sited within the community. With the support of specialists in these MCs, GPs can co-manage patients with more complex but stable conditions in the community as part of shared care programmes. GPs can also refer their patients for selected surgical procedures that can be safely managed in the community. Many of the GPs whom I have spoken to are supportive of this idea. Singaporean will also find this more convenient compared to going to hospital Specialist Outpatient Clinics.

There are still outstanding issues that need to be studied. For example, several GPs shared that the much cheaper drugs provided by polyclinics and public hospitals are preventing patients from seeking care at GP clinics. We are exploring possible solutions, including lowering the cost of drugs provided by GPs for patients under the Primary Care Partnership Scheme (PCPS).

I would like to thank the public hospitals for hosting the engagement sessions and the GPs who have contributed constructive feedback. While the engagement will continue, we will proceed to incorporate some of the suggestions into our master plan. I hope our GPs will continue to offer useful feedback and co-create the master plan with us.

On several occasions, MPs, the media and Singaporeans I met have asked me whether we can ease the current squeeze on the capacity of our restructured hospitals and whether our new hospitals and other healthcare infrastructure can be built faster. We have indeed accelerated our hospital building programme over the past few years, to keep pace with the rising healthcare needs of the population. Ng Teng Fong General Hospital and Jurong Community Hospital, and Yishun Community Hospital, will open in 2014-2015. We are also building a number of nursing homes, which will be opening over the next few years.

I had indicated earlier that MOH is studying whether we can bring forward the opening of Sengkang Hospital, scheduled for 2020. The planning team has completed their review and I am happy to share that we would be targeting to bring forward the building completion date to 2018, and to open the hospital thereafter in phases to serve the residents living in north-eastern Singapore.

However, adding more beds to the system is only part of the solution. We also need to find more innovative and cost effective ways to deliver health-care services and to optimise the use of our healthcare capacity. That is why the Sengkang hospital, when it is ready, will need to work closely with other healthcare partners (e.g. nursing homes, GPs and home healthcare providers) in the same region to provide coordinated and seamless care.

Over the past two months, we shared with our stakeholders the draft Primary Care Masterplan and we have received valuable feedback and suggestions. We hope to finalise it by early next year. MOH is also working on a master plan for intermediate and long-term care to address the challenges of our aging population. I will share more of this later.

As we build more healthcare facilities, we will need the continued support and understanding of Singaporeans, especially those who live in the vicinity of these facilities, so that we can meet Singapore’s immediate and future healthcare needs.

It required officers looking after drug subsidies, the Primary Care Partnership Scheme (PCPS), Medisave400 and Medifund to work together to find the most meaningful ways to bring bill sizes down to a reasonable level for all Singaporeans. There was a very conscious effort to look at things from the patients’ point of view, and define what is truly affordable for them. We debated long and hard, but ultimately agreed collectively that what mattered most to patients was the out-of-pocket payment they had to make, not for a single visit to the doctors but cumulatively over a period of time, and relative to their household disposable income. We had a clear affordability target to work towards, and while our longer term ability to sustain healthcare subsidies was still an important consideration, there was a tacit understanding that helping patients afford the care they need was the priority. It felt like a step in the right direction.

We certainly couldn’t have done it without the invaluable inputs from various stakeholders. We met clinicians, administrators, GPs and medical social workers (MSWs) in the public healthcare institutions to test our ideas and get their reactions on the proposed changes. They helped us to better understand some of the issues they faced on the ground and fine-tune our recommendations. Indeed they were our anchor to the ground.

The MSWs are a really passionate lot. They welcomed extending subsidies to cover the middle-income group, so that discretionary aid and more of their time can be channelled towards more needy cases. Ultimately more chronic patients will be able to afford the care they need. We were heartened by their feedback. The administrators helped us to think through the implementation challenges, the scale of means-testing necessary and lead-time for IT system and process changes. And the GPs gave us a good sense of the real impact on chronic patients that could now benefit from the enhanced PCPS. None of them complained when some of the meetings had to take place over lunch, dinner or even the weekends. I was glad to have these passionate health care partners aiding us tirelessly behind the scene. Their passion to help their patients was clear and their suggestions/feedback were instrumental in helping us improve and finalise these policies to bring benefits to patients as soon as possible. They galvanised my colleagues and I to work even harder.

But our work is not done. My team will continue to review the new changes and see where else can we improve. We will also need to extend the same patient-centric approach to systematically look at other areas of concern for healthcare affordability, such as long-term care for the elderly. The holy grail will always be to make healthcare and long-term care truly affordable for everybody no matter their circumstances, and also to sustain this for future generations as well. The latter means we have to constantly rethink about who deserves more help within the society, given that healthcare resources are ultimately finite. This is not a decision that the government can make on its own, but rather one that we should make collectively as a society.

So we certainly hope to hear more great ideas from you. We may not always move as fast as the Internet, but yes we are listening, and will strive to do our best. After all, we could also be patients one day.

Scott Tan
Deputy Director, Healthcare Finance Division
Ministry of Health

We are at the brink of a Silver Tsunami, with the first cohort of Baby Boomers turning 65 years old next year. And many more people will turn 65 over the next 10 years. In my dual roles as MP of Hong Kah North and Mayor of South West District, I have received a lot of feedback on elderly residents’ concerns over healthcare costs, managing chronic conditions, coping with diseases that limit mobility and affect their independent living, and financial security. I have also come across younger residents who are faced with the financial and emotional burden of caring for an elderly person in the family, which is often made more challenging with the onset of dementia. Over time, we will also see more elderly who are single or who are married but on average, have fewer children who can care for them, compared to the elderly of today.

I believe that we need a whole-of-government approach to reviewing policies and putting in place measures to help the elderly age-in-place. Beyond healthcare policies, we need to address family and social support, as well as enhance our existing programmes to encourage the elderly to live active lives. I am thus excited to be part of the Ministerial Committee on Ageing (MCA), which is chaired by Minister Gan in his capacity as the Minister-in-charge of Ageing Issues. Given the complexity of ageing-related issues, the MCA comprises four inter-agency subcommittees to address issues such as encouraging active ageing and employability, ramping up institutional long-term care and home-care capacity, and developing a pool of care-giving staff.

Under the leadership of former Minister Lim Boon Heng, the previous MCA has had success in achieving barrier-free access in our neighbourhood. This has not only benefited the less mobile elderly residents, but families with young children as well.

Nonetheless, I believe we can do more to build a more elderly-friendly environment. In his Committee of Supply speech on Ageing Issues this year, Minister Lim outlined his vision for a “City for All Ages”. Given my personal interest and background in real estate and land management, I look forward to building upon Minister Lim’s vision and realising it under the new MCA. The design of a liveable environment has to take into account the elderly person’s sense of security, well-being and familiarity with the surroundings. It should also facilitate ageing-in-place. By that, I mean that we should allow the elderly to age gracefully and receive the care that they require within the community itself. To achieve this, we may need to intentionally provide for interaction spaces for social activities, and increase eldercare services that serve both medical and social needs in the neighbourhood. These measures will allow our elderly to continue to live in, and be engaged within the community, amongst their families and friends, such that their golden years will be rich and meaningful ones.

Even as we come up with ideas to do this, we recognise the need to engage local communities to understand the needs of an ageing society. The Marine Parade Pilot, which was announced by ESM Goh in Dec 2010, allows us to consult and engage our elderly residents on this issue. The Marine Parade estate has more than 20 percent of its total population aged 65 years old and above, making it an ideal town for an in-depth study of the local elderly population. The first phase of the pilot, which focused on assessing the implications and needs of an ageing community, has just been completed. We are currently looking at the detailed findings and thinking through possible interventions.

I firmly believe in the value of public consultation and engagement towards shaping effective government policies and initiatives. Throughout the course of the Marine Parade Pilot, we will actively seek the opinions and participation from the local community, grassroot leaders, and members of the general public, and I would like to encourage you to come forward if you have suggestions on how we can better serve the needs of an ageing society.