By Cheryl Wu and Soh Tze Min
The confluence of economic and demographic trends and changing public expectations in Singapore has given rise to growing and more diverse social needs. To meet these needs, Singapore has expanded its social security measures and social safety nets since the new millennium. This has raised questions for policy makers: How can the expansion be accomplished in a sustainable way? What are the underlying philosophies that must continue to anchor Singapore’s social security system, even as policies and programmes evolve? How do we organise service delivery for better effectiveness and resource optimisation?
(I) Singapore’s Social Safety Nets in Different Time Periods
Post Independence: A Rising Tide Lifted All Boats
In Singapore’s first three decades following independence, the Government focussed on meeting Singaporean’s most essential social needs - opportunities to education and jobs, access to basic healthcare, as well as the chance to own a home. The Government provided a basic social safety net - social transfers were limited and there was little explicit financial support for the poor.
Instead, there was a strong emphasis on self-reliance and individual responsibility. Where individuals needed help, families were to provide the first line of support. The community was encouraged to supplement such efforts with their many helping hands. Organisations such as the Singapore Council of Social Service (later renamed as the National Council of Social Service ) and Voluntary Welfare Organisations (VWOs) were urged to play an active role to help the poor and vulnerable. The Community Chest was formally established in 1983 to marshal support and raise funds for this purpose.
For many years, the Public Assistance scheme was the most recognisable Government financial assistance scheme. It provided support to the poorest and unemployable Singaporeans with no family support, and its numbers were kept small. In healthcare, the self-funded Medisave (1984) and MediShield (1990) schemes were introduced. These schemes were supplemented by a limited Government-funded Medifund (1994) to help Singaporeans whose Medisave and MediShield monies are insufficient for their healthcare expenses.
During this period, Singapore saw excellent economic growth, strong job creation and favourable demographics. As a result, most Singaporeans and their families enjoyed rising household incomes and living standards. They were able to own homes, which grew steadily in value.
Turn of the Century: Structural Socio-Economic Changes
Starting from the late 1990s, socio-economic trends prompted a re-examination of Singapore’s social security and social safety net policies. Linked to global markets, Singapore’s economy and labour market became more volatile, and recessions became commonplace. Income growth also became increasingly uneven. While lower educated and less skilled Singaporeans grappled with wage stagnation, highly educated and skilled citizens experienced rapid growth in wages. Income inequality widened, with Singapore’s Gini coefficient trending up from 2000. At the same time, Singapore’s demographics turned increasingly unfavourable as it met with the challenges of a falling fertility rate and a rapidly ageing population.
Helping individuals tide over unemployment and regain employment emerged as a key priority. Following the Asian Financial Crisis of 1998, several government schemes, including the Skills Redevelopment Programme, Interim Financial Assistance Scheme and Reemployment Assistance Programme, were piloted. These focussed primarily on temporary financial assistance for the unemployed and support for skills upgrading, job search and employment.
2005-2010: Decisive Shifts Begin
Recognising that the socio-economic trends were structural rather than temporal, the Government began to ponder more long-term policy shifts. Starting in the mid-2000s, a series of new and significant policies and programmes were introduced.
In 2005, the ComCare endowment fund was established. This institutionalised the provision of government financial assistance to needy Singaporeans, beyond the small number of Singaporeans covered under Public Assistance. ComCare beneficiaries included the unemployed, temporary unemployable (due to health or family reasons) and later, lowwage workers who had difficulties making ends meet.
In 2006, a Workfare Bonus scheme was piloted. This became the ongoing Workfare Income Supplement in 2007. The CPF Life scheme was subsequently introduced in 2009. In the same year, means-testing in hospitals introduced for more progressive targeting of healthcare subsidies.
Post 2011: A Comprehensive Reinvention
2011 provided another milestone in social security and safety nets in Singapore. In the lead up to the 2011 General Elections, many Singaporeans voiced concerns and unhappiness over various issues, including the widening income gap, inadequacy of social support and challenges faced by the low income. Many criticised the Government’s social policies and its delivery of social services, which fell short of policy intent.
Following the 2011 elections, a Social Policy Review Committee (SPRC) was established to address prevailing concerns over social issues amongst Singaporeans. Chaired by Deputy Prime Minister Tharman Shanmugaratnam, the committee was tasked to comprehensively review all social policies. Discussions moved beyond merely increasing government support at a greater urgency. Issues related to the study of deeper social concerns, design of social service delivery, organisation of resources and capability, and public communications were regularly discussed. A large reinvention of Singapore’s social security system and social safety net started taking shape.
(II) Redesigning Singapore’s Social Security System and Social Safety Net
2.1 Rebalancing Responsibilities among Individuals, Families, Community & Government
Shifts that had begun in the mid 2000s took on greater urgency. The coverage of existing government subsidies was extended to the middle income in many areas, including preschool education, healthcare, eldercare, disability care and housing. Government support for lower income groups was increased significantly.
For example, subsidies for preschool and intermediate and long-term care are now extended to 67th percentile of monthly household incomes, while the Community Health Assist Scheme (CHAS) is extended up to the 50th percentile. Alongside enhanced medication subsidies at polyclinics and Specialist Outpatient Clinics (SOCs) of public hospitals, subsidies for treatments at SOCs have also been increased from 50% to 70% and 60% for lower and middle income Singaporeans respectively . In the area of pre-school education, additional childcare subsidies were enhanced to “help make infant and childcare services more affordable for lower- and middle-income families”. The coverage of ComCare and Workfare was broadened and level of support increased. For example, the monthly income cap for the Workfare Income Supplement was raised from $1,700 to $1,900 in 2013, while ComCare now supports Singaporeans in a range of challenging circumstances through short- and medium- term assistance. Such assistance is coupled with other forms of interventions (e.g. employment assistance and social support) with the aim of providing more holistic help to these families.
The rebalancing of responsibilities among individuals, families, community and government took centre stage in the Prime Minister’s National Day Rally speech in 2013. The direction was clear -the Government will do more to support individuals and families. In the years immediately following the speech, new broad-based policies and programmes were announced. These included the Pioneer Generation package (2014), Medishield Life (2015) and Silver Support scheme (to take effect in 2016).
Notably, social transfers from the higher to the lower income were increased and made explicit. Property tax was increased in 2013, while personal income tax rates for the higher income earners will be raised in 2017. These not only provided additional revenue for assistance programmes, but signalled a clear intent to address the widening income gap.
2.2 Redesigning Services Delivery
While most of the public attention is focussed on the rebalancing of responsibilities, other significant shifts were taking place. Major efforts were made towards the redesign of services delivery to the last mile. The Government became more involved in both service delivery and resourcing models at VWOs, especially those delivering services that are cofunded by the Government.
2.2 (a) Increasing Presence on the Ground
To improve access to help services and outreach to target groups, the Government increased its presence on the ground. For example, a new network of Social Service Offices (SSOs) were launched across Singapore from 2013, and served as new touch points on the ground to reach out to needy Singaporeans. By bringing assistance services closer to potential beneficiaries within the housing estates, the SSOs are better positioned to provide assistance to Singaporeans within their communities. Furthermore, SSOs can take advantage of its presence in the community to identify new needs and service gaps, and help coordinate community and VWO resources to meet these needs.
2.2 (b) Striving at Better Coordination
A common criticism of government ministries and agencies managing social-related issues was the silo approach towards policy-making and services delivery despite Singaporeans’ cross-cutting needs in different areas. This led to greater efforts to improve co-ordination between help agencies delivering different types of social services ranging from healthcare, pre-school education to social assistance more seamlessly.
Regional healthcare clusters for example, each of which includes acute and community hospitals, were established to plan and provide more integrated healthcare services. The model is premised on close cooperation between healthcare partners within the community (e.g. general practitioners, rehabilitation and care providers, nursing homes and community hospitals) to support the citizens at different stages of their healthcare journey. Upon discharge from the hospital, patients can more easily access follow-up treatment and rehabilitative therapy within their community.
New IT initiatives were launched as solutions to facilitate information sharing and case management. On the healthcare front, a National Electronic Health Record (NEHR) was implemented to enable the sharing of medical records across healthcare establishments. In the same way, a Social Service Net was developed to serve as a centralised case management database within the social services sector to help deliver more coordinated assistance to needy Singaporeans across different agencies, and reduce the need for citizens to repeat their stories.
2.2 (c) Redrawing Government Boundaries
The commitment to improve policy planning and service delivery in the social sphere is further reflected in the willingness to redraw long-standing boundaries between government agencies.
In late 2012, the Ministry of Community Development, Youth and Sports (MCYS) was split into the Ministry of Social and Family Development (MSF) and Ministry of Culture, Community and Youth (MCCY). Such a move was intended to provide a sharper focus on social and community development issues. As part of the restructuring, eldercare policies were streamlined under the Ministry of Health (MOH), with the eldercare portfolio transferred from MSF to MOH. Close to 300 social assistance officers were also transferred from the People’s Association’s Community Development Councils to MSF’s new network of Social Service Offices.
Similarly, MSF’s Childcare Division was merged with the Ministry of Education’s (MOE) Kindergarten Division in 2013 to form the Early Childhood Development Agency (ECDA). The agency was tasked to improve the accessibility, affordability and quality of preschool education in Singapore, and reports to both ministries - a rare arrangement in the Government.
2.2 (d) Reviewing Government’s Role and Level of Involvement
The Government’s relationship with VWOs providing key social services and assistance also began to evolve as it moved beyond its role as a co-funder of services. Ministries such as MOH and MSF started to assume greater responsibilities, such as builder and owner of facilities (e.g. nursing homes, family service centres and disability facilities) and regulator of standards. These steps were seen as important levers to increasing capacity and raising standards of services for which the Government were held accountable for, even if it was not the service provider.
New government initiatives were also introduced to meet the resourcing needs of VWOs, particularly in manpower. Given their small scale and limited resources, many VWOs often find it difficult to attract and retain manpower. To address such challenges, schemes to attract talent and groom leaders were introduced by NCSS and MOH Holdings for the social service and healthcare sectors respectively. Other attempts with similar objectives include government-funded specialised skills hubs such as a community psychology hub, as well as therapy hubs , to centrally hire and deploy psychologists and therapists for the social service sector. To “grow stronger hands”, increased efforts went into resourcing and developing “anchor operators” rather than “seeding more smallish helping hands”. At MSF for example, this approach was deployed for the pre-school and disability sectors.
2.3. Reassuring, Communicating and Engaging Citizens
Outreach and assurance to individuals are as important as the actual policies and services. In healthcare for example, where needs are inherently more emotive, the high variability of conditions and costs make the work of reassuring citizens especially challenging. Support therefore “need[s] to be reassuring at the right juncture — where it matters and to whom it matters”. Considerable effort went into engagements with the general public in the formulation of policies (e.g. MediShield LIFE and CPF LIFE). Communications were also made more citizencentric and localised to maximise outreach to the citizens on the ground. New channels and modes of communications were deployed, as evident in the media outreach for the Pioneer Generation Package through dialects, advertisements reflecting cultural norms that the elderly are familiar with, local Pioneer Generation ambassadors and dialogues.
(II) Tensions and Challenges
The shifts in Singapore’s social safety nets are not without tensions, dilemmas and difficulties for both policy makers and frontline public servants. While the direction is clear, the challenge lies in finding a point of new balance.
3.1 Where is the New Balancing point?
Achieving the objectives of meeting expanding social needs and increasing public expectations versus preserving the fundamentals of self-reliance and ensuring fiscal sustainability is not without trade-offs. Some have in fact questioned whether the articulated approach of active government support for self-reliance is in fact attainable. The rapid expansion and improvement in services may also have the unintended outcomes of fuelling citizens’ expectations . The need for a delicate trade-off between an imperative for reassurance and the fundamental of self-reliance will therefore need to be carefully considered.
In particular, can Government intervention really be effective in supporting rather than take over personal responsibility? Where should it draw the line in extending more support to the middle class? What can be done to better meet and manage existing expectations, rather than constantly chasing after ever-escalating ones?
3.2 Active Government vs Caring Community — Aspiration or Contradiction?
Greater government involvement in various capacities in social and healthcare services, as well as help for the poor and vulnerable has led to immediate improvements in scale, capacity and standards of services. However, this comes with trade-offs and risks for the longer term.
How does the Government resist the pressure to assume more roles as direct service providers, and ensure that it does not crowd out the ownership and roles of VWOs, community organisations, and volunteers? More importantly, how should the Government avoid squeezing out partners from the people and private sector to support the innovations that come with diversity, particularly in areas such as healthcare?
3.3 Band Aid or Trampoline?
The reinvention of Singapore’s social safety net may necessitate an even more fundamental review of existing policy and service delivery approaches.
Even as the Government does more, are its programmes really effective in getting the poor and vulnerable out of the poverty cycle? Can there be further integration within the Government so that interventions may be designed more holistically at the upstream? Rethinking is also needed on programme design to enable vulnerable individuals and families to improve their longer term prospect beyond their immediate needs - do Government programmes therefore need to adopt longer range time horizons and objectives?.
In this aspect, international examples such as the Australian Department of Human Services serve as an interesting contrast. Systems-level interventions outside of social policy domains may also be necessary. For example, do prevailing bankruptcy laws, which tend to favour the rights of creditors to recover a debt rather than an insolvent individual’s need to secure employment or obtain credit, need to be reviewed? Does the Government need to rethink its role as the largest employer to give individuals, such as persons with disabilities and those recovering from a conviction, an opportunity to get back on track?
(IV) The Future of Singapore’s Safety Net
Singapore’s social needs will become more complex as it continues to evolve in the economic, social and political spheres. Its social security system and social safety nets must continue to adapt in tandem with these to provide social support to needy Singaporeans and preserve its social compact. Beyond the hardware of policy design and services delivery, the emotive elements of reassurance, empathy and heart are essential to engender a greater sense of support, assurance and trust among citizens. There will be few easy answers as Singapore continues to chart its own path.
Yours
Something Small Thinking Big
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