Ensuring Seniors' Access to Polyclinic Care

1 Dr Tan Wu Meng asked the Minister for Health what safeguards exist to ensure access to polyclinic care for seniors aged 65 years and above who (i) cannot go online to book appointments and (ii) repeatedly find that online slots are already fully booked.

2 Ms He Ting Ru asked the Minister for Health whether it is possible to release polyclinic next-day appointment slots in a few fixed tranches each day rather than have a single release of time slots at 10.00 pm.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mdm Deputy Speaker, may I have your permission to answer Question Nos 1 and 2 on today's Order Paper?

Mdm Deputy Speaker: Please go ahead.

Dr Janil Puthucheary: My response will also cover the matters raised in the written questions by Dr Tan Wu Meng.

Our healthcare system is facing increasing demands, as our people age and need more healthcare, including primary care. At the same time, the completion of new polyclinics that were planned had been delayed due to the pandemic.

As a result, some polyclinics have greater demand and less easy availability of appointments. Pending the development of new polyclinics, they are putting in place short-term measures to address this.

The polyclinics will set aside some slots for walk-in patients with urgent medical needs, as well as for elderly patients, particularly those who are frail and who have mobility issues. To do so, non-urgent cases may be given an appointment for another day or advised to seek treatment at a nearby Community Health Assist Scheme (CHAS) general practitioner (GP) clinic. Polyclinics will also try to leverage telemedicine as much as possible and contract private GPs to help deliver the service.

Some polyclinics already adopted the practice of releasing polyclinic appointments in tranches. However, this does not solve the issue of capacity constraint and in fact may frustrate patients more if they are repeatedly unable to book appointments.

The Ministry of Health (MOH) does not have the data requested by Member Dr Tan Wu Meng.

Mdm Deputy Speaker: Dr Tan Wu Meng.

Dr Tan Wu Meng (Jurong): I thank the Senior Minister of State for his answer. I have two supplementary questions. I have Clementi residents, especially seniors who are worried about the experience of the polyclinic booking system. One resident tried to make an online booking for her elderly mother – four days in a row, logged in at the booking time, could not get a slot. Another senior, not IT-savvy, cannot go online, went to a polyclinic, was told to book online. He cannot go online.

Can I ask the Senior Minister of State two supplementary questions? Firstly, can the Ministry and the polyclinics explore the role of a hotline, so that seniors who cannot log in with smart phones and computers can still have a chance at the online booking process? Secondly, can we try to further improve the subsidy for consultations at CHAS GP clinics so that a visit to a CHAS GP clinic can receive comparable subsidy to a visit at a polyclinic?

Dr Janil Puthucheary: Madam, I thank Dr Tan for the questions. We will continue to explore the role of things like hotlines and other ways to improve our processes so that the appointments and the services available at the polyclinics are indeed more accessible and more user-friendly, especially to seniors. I thank him for his suggestion and I will take that up with the teams that our running our polyclinic systems.

The question of subsidies at the CHAS GP clinics and how they relate to the charges and the costs at the polyclinics is an important one. As Dr Tan knows and as Members know, this is something we are constantly reviewing, on an ongoing basis. We will have to constantly review the conditions as well as the level of subsidy that we provide for the CHAS GP clinics and indeed, taking into account the relationship with what happens on the polyclinics. I thank him for the reminder that we have to keep doing this.

Mdm Deputy Speaker: Mr Liang Eng Hwa.

Mr Liang Eng Hwa (Bukit Panjang): Thank you, Madam. I want to echo what Dr Tan Wu Meng has said. I do continue to receive feedback from our seniors who have said it is almost impossible to make an online appointment at the polyclinic run by National University Health System (NUHS) at Bukit Panjang. Can I ask the Senior Minister of State whether we are able to set aside some walk-in appointment slots, especially for the seniors so that they do not have to go through that online booking? Not everyone is able to do that.

Secondly, I feel it is puzzling. Notwithstanding MOH having built new polyclinics with increased capacity, why is it the case that we are still not able to meet the demand?

Dr Janil Puthucheary: Madam, I thank Mr Liang for his questions. We do indeed set aside a proportion of the slots for walk-in appointments. So, not all the appointment slots at a given polyclinic, on a given day, are only for online appointments. There are slots that are set aside for walk-in patients. The potential walk-in patients are assessed and so, sometimes, they will be given advice to come back on another day or to seek help at a GP clinic, depending on what it is they present with.

Sorry, I did not quite catch the second question. Oh, the capacity. Indeed, the capacity is constrained. There is a combination of factors: there has been a delay in the building and operationalisation of polyclinics as a result of the COVID-19 pandemic; some of them delayed by up to two years. Recently, in the news, we had the Khatib and Sembawang Polyclinics' timings talked about. But there is also an increasing demand as our population ages and the aged have increasing frailty and co-morbidities that will require further care. So, it is a combination of growing demand and the projected supply having been constrained by the pandemic. We are trying our best to catch up and provide more services to increase our capacity.

Mdm Deputy Speaker: Leader of the Opposition.

Mr Pritam Singh (Aljunied): Thank you, Deputy Speaker. Just to the Senior Minister of State on this point again, is it possible to increase the number of walk-in slots at the polyclinics in view of the feedback that many Members of this House are receiving from seniors who have difficulties in accessing the online system and making a booking? Can the Senior Minister of State also give us an indication of the percentage of these slots which are walk-in slots?

The other supplementary question pertains to the number of feedback MOH has received on complaints of not being able to book a slot through the online system. Does the Senior Minister of State have some numbers for us, so we can understand the extent of the problem?

Dr Janil Puthucheary: Madam, I thank Mr Pritam Singh for the questions. I do not have the data to answer his second question; that was not part of the Parliamentary Question that was filed. For his first question, yes, there is the possibility to increase the proportion of walk-in slots. I would point out that that does not change the overall capacity available at the polyclinics. That is actually the heart of the issue.

I understand there is frustration with the online system for seniors, but there are also people who are able to use the online system and as a result, the availability of the resources and the capacity for the services at the polyclinics are better matched to those patients. It means that the clinical notes are available ahead of time, preparations can be made ahead of time for investigations, tests and the allied health services that support, given the instance of someone coming down to the polyclinic.

So, I think we have to have a balance. If we went to a fully walk-in system, that would have an implication on the ability for the care teams to deliver the service that they are used to delivering. If we went to a fully online system, indeed, the frustrations that Members in this House have highlighted will become worse.

So, we need a balance: we need some walk-in slots and some pre-booked slots. The question then is, what is the best way of determining that balance. This is left to the operational teams running the polyclinic to take into account their capacity, the services that they deliver, the demographics of their population. And it can vary over time.

So, I take the feedback from the Leader of the Opposition and other Members of the House, and will continue to work with our cluster management and operational teams that run the polyclinics and see how we can optimise the correct balance of online appointments made ahead of time, same-day appointments and walk-ins.

Mdm Deputy Speaker: Mr Yip Hon Weng.

Mr Yip Hon Weng (Yio Chu Kang): I thank the Senior Minister of State for his reply. I have two supplementary questions. As a result of the difficulties in booking polyclinic slots, how many senior patients have gone to the Accident and Emergency (A&E) Departments at the hospitals for non-emergency cases?

Secondly, will MOH consider training Active Ageing Centre (AAC) staff to help seniors book polyclinic appointments, since AACs are located within the community and the neighbourhood?

Dr Janil Puthucheary: Madam, I thank Mr Yip for his questions. I do not have the data for the first question that he has asked. It is possible that we are unable to get the data because what he is asking for is those who have not booked, how to track them. I would be happy to try and fulfil but I do not have the data with me today.

The second question is a good suggestion. We are happy to explore how we can leverage on other types of resources to be able to help people have better access and utilisation of services. I will work with the teams to explore the use of that suggestion.

Mdm Deputy Speaker: Assoc Prof Jamus Lim.

Assoc Prof Jamus Jerome Lim (Sengkang): Thank you, Mdm Deputy Speaker. Like many others who have shared in this House, Sengkang residents have had significant difficulties getting online. To a Parliamentary Question that was filed in March earlier this year, some of our residents are waiting as much as 2.5 hours on the long tail. One question that I wonder in terms of increasing the number of walk-in slots – what the Leader of the Opposition said earlier – is if we could channel more of those that are currently booking online toward telemedicine options. The reason behind that is, of course, those who are sophisticated enough to book online, may be also much more comfortable with addressing a telemedicine option.

Related to this, one reason why many younger and more Internet-savvy patients tend to go toward the polyclinics is because there is still a discrepancy between for some employers what is recognised to be a valid medical certificate (MC) – whether you need a polyclinic MC versus a regular GP MC. I understand this falls a little bit beyond the remit of the MOH and more on the Ministry of Manpower (MOM). Nevertheless, I wonder if this is something that can be explored a little further in terms of guidelines that the Government offers toward allowing for MCs that are across a wider range of providers.

Dr Janil Puthucheary: Madam, I thank Assoc Prof Lim for his suggestions and questions, and the acknowledgement that I am not going to comment on MOM's remit.

Indeed, we are exploring the use of telemedicine to improve the delivery of services from the polyclinics. I think we leave it to the professional teams in terms of how they assess the referral information, the patient demographic, as well as the presenting problems as to which patients can be dealt with an online consultation and which patients will need an in-person appointment. I think that is something for a clinical judgement, rather than a policy position. But we will support the teams so that we can optimise the use of telemedicine and make sure that we improve the capacity available at the polyclinics.

Mdm Deputy Speaker: Dr Tan Wu Meng.

Dr Tan Wu Meng: Mdm Deputy Speaker, just two more supplementary questions to the Senior Minister of State. I also declare that I am a medical doctor at a public hospital. My first additional supplementary question relates to Mr Yip Hon Weng's query about patients who could not make a booking but later on sought A&E care. May I suggest to the Senior Minister of State that my written Parliamentary Question filed yesterday may provide a way to analyse this by looking at persons who logged in the day before a next day appointment, but did not eventually make a booking? It is not the full data set but that could be a way to analyse this.

Secondly, can I also ask the Senior Minister of State what is being done to support our healthcare workers, doctors, nurses, allied health professionals working at our polyclinics? Because the polyclinics are very busy, our healthcare brothers and sisters are at the front lines; and we have to support them to do their best as well, for the patients and for the community.

Dr Janil Puthucheary: Madam, I thank Dr Tan for his suggestions and his questions. Indeed, we will continue to explore how we can track the data to inform our decisions on resourcing the polyclinics and have a balance between online appointments, walk-in appointments, and the behavourial incentives for patients to choose between them. But as I have explained, I do not have that data with me.

Dr Tan's question about supporting healthcare workers in polyclinics is important. They have been working very hard. They continue to deal with an increase in demand, both through the COVID-19 pandemic and beyond, and I do want to record our thanks for the work that our primary care practitioners and the teams that they work with, have put in to support our residents and citizens and we are trying to make sure that they are as much as possible provided with access to the resources within primary care. We continue to try to support them by expanding the role of GPs, by expanding the role of CHAS clinics, by helping to make sure that we right site care within the primary care space, by providing training and staff and resources to be able to support the very important role that primary care plays in our health ecosystem. And we will continue to do so.

Mdm Deputy Speaker: Mr Melvin Yong.

The Minister for Manpower (Dr Tan See Leng): Madam Speaker, can I just take this opportunity because I raised my hand? I wanted to answer Assoc Prof Jamus Lim's point.

Mdm Deputy Speaker: Oh, I am so sorry. I did not see it.

Dr Tan See Leng: All medical certificates, medical leave of absence, so long as they are issued by a licensed medical practitioner in Singapore, will be recognised. So, I hope that answers the Member's earlier point. I will move on to answer the hon Member of Parliament Mr Melvin Yong's question.

Mdm Deputy Speaker: Parliamentary Question No 3?

Dr Tan See Leng: Yes.