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Tripartite workgroup recommends zero-tolerance policy against abuse and harassment of healthcare workers

The Tripartite Workgroup, comprising the Ministry of Health (MOH), healthcare institutions, and healthcare unions, has recommended adopting a standardised zero-tolerance policy against abuse and harassment of healthcare workers in any form.

The recommendations came after an extensive engagement with more than 3,000 healthcare workers and over 1,500 members of the public.

The workgroup found that more than two in three healthcare workers had witnessed or experienced abuse or harassment in the past year. The most common forms of abuse and harassment include shouting, threats by patients and/or caregivers, and demeaning comments.

Minister for Health, Mr Ong Ye Kung, fully supports the recommendations and says that abusive behaviour towards healthcare workers is not acceptable.

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SINGAPORE — The Tripartite Workgroup, consisting of representatives from the Ministry of Health, the National Trades Union Congress, and the Singapore Health Services, has completed an extensive engagement with over 3,000 healthcare workers and more than 1,500 members of the public, through surveys and focus group discussions.

The engagement findings revealed that more than two in three healthcare workers said they had witnessed or personally experienced abuse or harassment in the past year.

Half of them, or a third of all healthcare workers, witnessed or experienced abuse or harassment at least once a week. Frontline healthcare workers such as pharmacists, patient service associates, and nurses are more likely to experience abuse and harassment.

The most common forms of abuse and harassment are shouting, threats by patients and/or caregivers to file complaints or take legal action against the healthcare workers, and demeaning comments.

On average, healthcare workers reported that abuse or harassment they witnessed or experienced came from patients / clients most of the time (41%), followed by caregivers / visitors (28%), colleagues / peers (18%) and supervisors / managers (13%)

Healthcare workers experiencing abuse and harassment sometimes rationalize these as being part of their job. Healthcare workers often empathize with patients’ circumstances and do not take action against them.

Among incidents of abuse and harassment recounted by healthcare workers, only a small proportion were officially reported to the institution (24%) or to the Police (4%), as healthcare workers often had to recount incidents of abuse or harassment to multiple supervisors, which could be emotionally challenging.

Filling up incident reports outside of working hours added to their workload, while taking time off for interviews at police stations disrupted their schedules. Moreover, there was uncertainty among healthcare workers regarding what constituted abuse or harassment, leading to situations where incidents were not reported, or supervisors failed to take action due to lack of clarity on legal thresholds and advice.

Furthermore, healthcare workers are concerned about how reporting abuse and harassment will be perceived by their supervisors and colleagues, and some are worried about losing their jobs.

As a result, abuse and harassment are often under-reported.

Standardized zero-tolerance policy

In response to these findings, the Workgroup recommends adopting a standardized zero-tolerance policy against the abuse and harassment of healthcare workers in any form, using a three-pronged framework of Protect, Prevent, and Promote.

The framework includes measures such as protecting healthcare workers who face abuse and harassment, preventing situations that lead to abuse and harassment, and promoting positive relationships between healthcare workers and patients/caregivers.

To protect healthcare workers from abuse and harassment and build a supportive culture where they feel safe to work and confident to report abuse and harassment, the Workgroup suggests establishing a clear and common definition of abuse and harassment, which includes any inappropriate behavior or communication that causes a healthcare worker to experience distress, harassment, threat, or discrimination, regardless of intention.

Additionally, an effective reporting and escalation protocol and a supportive culture of reporting are crucial, along with clear consequences that are implemented and enforced.

The Workgroup also recommends that institutions train their staff to prevent potential abusive situations by equipping them with the skills and knowledge to manage and de-escalate challenging situations and deterring potential offenders through the enforcement of consequences.

The public healthcare sector will lead by example, and the public healthcare institutions have agreed to strengthen their existing processes and implement this standardized zero-tolerance policy.

Private healthcare institutions and community care organizations will be encouraged to refer to the parameters of this policy when it is ready and adapt it to their processes and operating models where feasible.

The Ministry of Health Holdings will launch a national public education campaign in the second half of 2023 to promote positive relationships of trust and respect between healthcare workers, patients, and their caregivers.

“Support their recommendations fully”, Health Minister

Minister for Health, Mr Ong Ye Kung, expressed his support for the Workgroup’s recommendations, stating that abusive behaviour towards healthcare workers is not acceptable.

Speaking at the Ng Teng Fong centre for Healthcare Innovation on Friday, Mr Ong noted that while many healthcare workers find ways to cope, it is wearying and demoralizing to experience this on a regular basis.

He called for the implementation of these recommendations to create a safe and conducive working environment for healthcare workers to carry out their duties effectively.

Mr Ong noted that the Ministry of Health will be working closely with public healthcare institutions to implement the recommendations made by the Tripartite Workgroup to Prevent Abuse and Harassment of Healthcare Workers.

The details of the recommendations will be translated into practices on the ground, with operating guidelines to be published once ready.

“Healthcare workers deserve to be treated with respect, like anyone else. We are grateful to those who have stood up for them and expressed appreciation and understanding,” said Mr Ong.

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Civil Society

TWC2 launches fundraising initiative for at-risk migrant workers

Transient Workers Count Too (TWC2) has launched a fundraising campaign to assist those facing challenges such as work injuries, wrongful termination or financial hardship due to underpayment disputes. The campaign, hosted on Give.asia, aims to raise S$36,000 to provide crucial support during these workers’ most difficult times.

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SINGAPORE: Transient Workers Count Too (TWC2), an advocacy group for migrant workers, has launched a fundraising campaign to support those facing difficulties, including work injuries, termination for requesting rightful salaries, or financial hardship due to disputes over underpayment.

The campaign, hosted on the Give.asia platform, aims to raise S$36,000 to provide a lifeline for these workers during their darkest hours.

The group stated that the funds will offer support to low-wage migrant workers in distress through various means, including meal assistance, phone top-ups, travel allowances, emergency shelter, and more.

TWC2 highlighted five types of workers in distress. For example, one cook was forced to perform unpaid work late into the night and was coerced into signing blank payslips.

He received less than half of his official salary, with his employer creating false timecards and payslips.

TWC2 specified the resources needed to assist migrant workers facing financial challenges over six months, including S$1,322 per month for an online helpdesk, S$876 for meal support, S$120 for phone top-ups, and S$80 for EZ-Link credit to attend Ministry of Manpower (MOM) appointments.

Worker Left Vulnerable After Company Closure: Loss of Housing and Belongings Leads to Months of Hardship

Another worker is struggling after his company closed down, leaving him without coverage for his injury.

Furthermore, his employer allegedly failed to pay his housing rent, resulting in the worker losing all his belongings, including his passport, cash, and clothes. He was left to beg and borrow clothes for nearly a month.

TWC2 stated that the funds will help him replace his passport, which costs around S$200, as well as cover S$2,228 for his monthly rent at the TWC2 shelter, S$480 for EZ-Link credit for travel to hospital appointments, and S$240 for phone top-ups.

The third case involves a migrant worker who was denied necessary surgery after suffering a finger injury from heavy machinery. Instead of being taken to the hospital immediately, he was brought to a small clinic, leading to an infection in his open fracture.

He was also pressured to return to his home country for treatment. Urgent surgery was delayed for 33 days because his employer withheld the necessary documents.

TWC2 is appealing for S$1,322 per month for online helpdesk support for this worker, S$1,898 for meal support, S$240 for phone top-ups, and S$480 for EZ-Link credit for travel to hospital appointments.

The fourth case involves a worker who was underpaid for overtime and rest day work.

He was fired after discussing information related to the Employment Act with his colleagues. His employer later contacted a potential future employer to disparage him.

This worker will require S$1,073 monthly to fund online information campaigns, S$120 for phone top-ups, and S$80 for EZ-Link credit to attend MOM appointments.

The fifth case concerns a worker who injured his back while lifting 50kg of cement. Although he was granted 300 days of medical leave, his employer did not report the incident to MOM, and the insurance company took over a year to investigate and accept his claim. The doctor instructed him to avoid catered food for health reasons.

TWC2 is seeking S$160 monthly for his groceries, S$120 for phone top-ups, and S$80 for EZ-Link credit to attend MOM appointments.

Part of this annual fundraising campaign commemorates International Migrants Day in December, which includes a luncheon, “Lunch With Heart,” for migrant workers to thank them for their contributions to Singapore.

TWC2 Highlights Ongoing Exploitation: Employers Bypass Laws to Undermine Workers’ Earnings

TWC2 noted that, according to Singapore’s Employment Act (Section 96), all workers should receive payslips detailing how their salaries are calculated and paid.

However, some employers still find ways to circumvent these laws, cheating workers out of their already low salaries. In 2023 alone, salary disputes rose by 55% according to MOM’s Employment Standards Report.

TWC2 emphasized that migrant workers who experience workplace accidents can be denied treatment by unscrupulous employers, despite being covered under the Work Injury Compensation Act. Even with medical insurance, they often lack access to it and may be sent back home with untreated injuries. The recovery process can be long and isolating, contributing to significant stress and mental health challenges for injured workers.

For these workers, a significant source of daily stress is financial insecurity.

“They are constantly thinking about providing for their family back home, ensuring loans are paid and sick family members have money for medical treatment. Essentially they are like us in every way.”

TWC2 highlighted that workers often take on overtime and forgo days off, even on public holidays, to earn higher wages. They should not be deprived of the wages they have rightfully earned or left with untreated injuries.

“We are appealing to you to offer a helping hand to these filial sons, devoted husbands, responsible mothers and dedicated workers, in their hour of dire need. ”

“We sincerely hope you can chip in so that these workers can have a lifeline in their darkest hours.”

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Labour

19 workplace fatalities in first half of 2024, MOM reports

Singapore’s Workplace Safety and Health report, issued on 9 October, revealed 19 workplace fatalities in the first half of 2024, up from 14 in 2023. Vehicular incidents were the leading cause, followed by falls from heights and equipment breakdowns. With five more deaths reported by September, the total fatalities for 2024 have reached at least 24. In comparison, 36 deaths were recorded in 2023.

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SINGAPORE: Nineteen workers died from workplace injuries in the first half of 2024, an increase from 14 fatalities during the same period in 2023, according to Singapore’s Workplace Safety and Health (WSH) performance report released by the Ministry of Manpower (MOM) on Wednesday (9 October).

Vehicular incidents were the leading cause of death, followed by falls from a height and the collapse or breakdown of structures and equipment.

These causes accounted for 11 of the fatalities – 58 per cent of the total deaths.

The construction, marine, transportation and storage, and manufacturing industries were responsible for 63 per cent of the 19 fatalities.

In the construction sector alone, five workers lost their lives, down from seven fatalities in the first half of 2023 and 11 in the second half of that year.

The marine industry saw four deaths in the first six months of 2024, despite no fatalities being recorded in 2023.

The transportation and storage sector had two fatalities, down from five in the same period last year. One fatality occurred in the manufacturing sector, mirroring the number from the first half of 2023.

In the water supply, sewerage, and waste management sector, three workers died, including two who inhaled poisonous fumes while cleaning tanks at PUB’s Choa Chu Kang Waterworks. There were no fatalities in this sector in 2023.

As of September 2024, five more deaths were reported, bringing the total workplace fatalities for the year to at least 24.

In comparison, 36 deaths were recorded in 2023.

The most recent workplace fatality occurred on 29 September, when a 44-year-old Bangladeshi worker tragically lost his life in an accident at a construction site within Resorts World Sentosa (RWS).

The worker was fatally struck by a collapsing steel structure during lifting operations.

Two workers tragically lost their lives on 17 September following a heavy machinery accident at a North-South Corridor construction site along Lentor Avenue.

The incident occurred while a group of workers was assembling a winch drum on two concrete blocks. The winch slipped, causing injuries to four workers.

Singapore’s Workplace Fatality Rate Rises Slightly, Now Fifth Among OECD Countries

The latest WSH report noted that Singapore’s workplace fatality rate from January to June 2024 was one death per 100,000 workers, slightly up from 0.8 in the first half of 2023 and 0.99 in the latter half of that year.

Singapore ranks fifth among Organisation for Economic Cooperation and Development (OECD) countries, with a three-year average of 1.1 deaths per 100,000 workers.

The Netherlands and United Kingdom lead with 0.4, followed by Sweden at 0.7 and Germany at 0.8.

Major Injuries Decline

There were 293 major injuries in the first half of 2024, down from 316 in the same period of 2023.

These injuries, which include amputations, blindness, and paralysis, predominantly occurred in the construction and manufacturing industries. The main causes were slips, trips and falls; machinery incidents; and falls from a height.

The manufacturing sector saw a significant 35 per cent reduction in fatalities and major injuries, with 60 incidents recorded in the first half of 2024 compared to 92 in the same period last year.

The number of fatal and major injuries from metalworking also fell sharply, from 40 in 2023 to 22 in 2024.

In the construction sector, fatalities and major injuries from smaller-scale works, such as renovations, decreased by 22 per cent, from 59 in 2023 to 46 in 2024.

Senior Minister of State for Manpower Zaqy Mohamad attributed these improvements to the expanded demerit point system and increased surveillance.

The system, introduced to the manufacturing sector in October 2023 after years of use in construction, penalises companies for safety violations, potentially barring them from hiring foreign workers for up to two years.

Minor Injuries and Occupational Diseases

In the first half of 2024, there were 10,379 minor injuries, a 4.8 per cent reduction from 10,897 in the same period of 2023.

Slips, trips, falls, and machinery incidents were the leading causes. Meanwhile, the number of occupational diseases continued to drop, with 473 cases reported, down from 653 in 2023.

MOM also reported 11 dangerous occurrences in the first half of 2024, fewer than the 12 in the same period last year. These incidents included the collapse of structures and equipment, as well as fires and explosions.

MOM conducted over 3,000 inspections in various industries and took enforcement actions against more than 7,000 breaches, issuing 717 fines totalling more than $1.4 million and 22 stop-work orders.

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