COS Speech By Minister for Health Gan Kim Yong - Better Health for All (Part 1 of 2), 12 March 2013

Madam Chair, I would like to thank Members for their comments and questions.  As Mr Sitoh and Mr Cedric Foo reminded us, ten years ago, Singapore faced our first major health crisis as an independent nation, when SARS, or Severe Acute Respiratory Syndrome, broke out in March 2003.  The outbreak dealt a significant blow to our economy, and severely affected our community and social life .  Singaporeans rallied together during this trying time, and we emerged stronger from the experience.  Speaker, with your permission, I would like to  share with you a video clip made on SARS. We will be holding a series of commemorative events later in the year. Mr Foo asked about Courage Fund. We will also be reviewing Courage Fund to make it more effective for healthcare workers later this year. In the meantime, I would like to recognize the contributions and sacrifices of everyone who was involved, in particular my colleagues in the healthcare sector, some of whom fell ill and some lost their lives as they cared for their patients.  We will and we must remember them.

2.         Over the years, our healthcare system has grown from strength to strength, achieving good outcomes and delivering good care for our people.  The Global Burden of Disease Study 2010 ranked Singaporean men and women as having the second and fourth highest healthy life expectancy at birth in the world.  We were also happy to find out last year that Bloomberg ranked Singapore the world’s healthiest country.

3.         Premature deaths from cancer, heart disease and stroke have also  steadily fallen over the years.  However, it is not time to celebrate yet as there remain several key challenges ahead of us, which my colleagues and I will be talking about .

4.         Our National Health Expenditure in 2011 amounted to four percent of Gross Domestic Product.  It is lower than the OECD average of 9.5 percent.  But we must bear in mind that several OECD countries have older populations than we do, and our expenditure on healthcare is likely to grow as our population ages.

Our Challenges Ahead

5.         Ageing will be a key driver of demand for healthcare services.  An older population means a higher incidence of admission to hospital, and for each admission, a longer stay.

6.         Lifestyle changes are another driver.  Many of us have sedentary lifestyles, and do not exercise enough.  More young people are taking up smoking, and becoming obese.  Non-communicable diseases – especially cancer, heart disease, and stroke – account for 60 percent of deaths in Singapore each year. Therefore I agree with Mr Laurence Lien that we need to do more and be innovative to keep Singaporeans healthy.

Delivering Healthcare 2020 to Meet Future Needs of Singaporeans

7.         Last year, I announced my Ministry’s Healthcare 2020 Masterplan, to build an inclusive healthcare system for the future – one that will provide Singaporeans with affordable, effective, and good quality healthcare.  Dr Lam Pin Min asked about the progress on Healthcare 2020.

8.         First, on capacity, to meet the needs of our patients. Over the past five years, resident bed-days rose by about four percent each year, from roughly 1.5 million to 1.8 million bed-days in total.  A significant proportion of this increase was contributed by an ageing population.   Over the years, foreign patients have remained about 2 percent of the public sector’s total patient load, the question that Mr Low asked.

9.         Our hospitals adopt various strategies to actively manage the increasing patient load.  For instance, they deploy inpatient medical teams to the Emergency Department, to ensure that prompt medical assessment and definitive care can be provided at the ED, even before patients are warded.

10.       In the short term, we will increase our capacity by adding beds in existing facilities.  NUH’s current renovation project will make available an additional 79 beds by December.  Ang Mo Kio Thye Hua Kwan Hospital has just added 50 beds, and St Luke’s will add a similar number by year end.

11.       We will also be opening two new facilities this year. The new Medical Centre at NUH will open by July 2013.  This will allow NUH to expand its Specialist Outpatient Clinics and day surgery operating theatres.  The building will also house the National University Cancer Institute.  The new National Heart Centre on the other hand will allow for expansions in our cardiac services.

12.       We are on track with our infrastructure plans in the medium term.  The Ng Teng Fong General Hospital will begin to serve patients from end-2014.  Let me show you how the hospital looks like. So that is our next upcoming acute hospital. Jurong and Yishun Community Hospitals will be ready by end-2015.  Sengkang General and Community Hospitals are scheduled for completion by 2018.  In the central region, Outram Community Hospital will be ready by 2020.  Altogether, we will add 4,100 more acute and community hospital beds.  This is 400 more than what we announced in Healthcare 2020.

13.       Dr Lily Neo spoke about planning for our future healthcare needs.  Beyond 2020, we are planning for new hospitals in new population centres, and in areas where demand is likely to grow.  We anticipate that we may need to build four new acute hospitals between  2020 and 2030.  We are currently studying regional demographic profiles to identify the potential  locations of these new hospitals, and we will review our infrastructure plans nearer 2020.

Investing More in Primary Care to Deliver Better Care for Singaporeans

14.       Madam, we are also improving our delivery of primary care to Singaporeans, which Dr Lam Pin Min asked about.  As more Singaporeans develop chronic diseases, a good GP in the neighbourhood who is familiar with our family’s medical history will be well placed to advise us on how to manage our health. This is also a point raised by Mr Lien as well.

15.       We have taken steps to make primary care more accessible and affordable for patients.  We introduced the Community Health Assist Scheme, or CHAS, to help lower- to middle-income patients receive subsidised treatment at GP clinics, as well as for dental care, which Mr Patrick Tay asked about.  Last year, we enhanced CHAS significantly.  More Singaporeans have benefited as a result.  The number of CHAS cardholders has grown from 35,000 to about 250,000 since we made these changes – more than seven-fold increase.  We will monitor the scheme for a while more before reviewing it again, but I note Dr Lam’s appeal to review the age criteria.

16.       Participating GPs can already refer CHAS patients to public sector Specialist Outpatient Clinics at subsidised rates, as Ms Tin Pei Ling and Mr Low Thia Khiang asked about.  They do not need to visit a polyclinic anymore so long as they are a CHAS patient.

17.       During the Budget debate, Dr Fatimah Lateef asked about the progress on Community Health Centres (CHCs) and Family Medicine Centres (FMCs).  There is growing support from the GP community for the idea of CHCs, which provide allied health and other support services to GPs and patients. To provide more patients with convenient access to such support services, we will set up three more CHCs this year, in addition to Tampines.  The next CHC will open in mid-2013, in the Bedok area, while centres in Jurong East and Tiong Bahru will open by year end.

18.       We will pilot four Family Medicine Clinics (FMCs) this year.  This is a group practice managed by private GPs, in collaboration with other healthcare professionals, with the support of ancillary services.  Here, patients will be looked after by a regular care team, and will receive comprehensive care. Our first four FMCs in Clementi, Lakeside, Ang Mo Kio, and Bedok will  come on-stream later this year.  We will continue to work with GPs to explore different  models that will best suit their needs and those of their patients.

19.       We will also need to build more polyclinic capacity to meet the growing needs of our population.  We have refurbished Geylang polyclinic to increase its capacity and incorporate age-friendly features such as barrier-free access throughout its premises.  Similar improvements are being made to Tampines polyclinic, and we will also be redeveloping Ang Mo Kio and Bedok polyclinics.

20.       In regions where there may be gaps in coverage, building a new polyclinic will be necessary.  I am happy to let Mr Cedric Foo know that we will be constructing a new polyclinic in the Jurong West area, near Pioneer.  This new polyclinic, along with the new Punggol polyclinic which Ms Penny Low asked about, will open by 2017.  I anticipate that we will need another 4 new polyclinics by 2020, and another 6 to 8 more polyclinics by 2030.

21.       All our polyclinics are equipped to handle basic emergencies, a point which Dr Teo Ho Pin raised.  However, for serious emergencies, patients will be triaged and referred to the Emergency Departments of our hospitals.  Polyclinics continue to play an important role in our primary care sector.  Our polyclinics, together with a wide network of GPs, and CHAS, provide the public with good access to primary healthcare services.

Regional Health Systems

22.       Mr Low Thia Khiang asked for an update on the Regional Health Systems, or RHS.  Developing the RHS is an ongoing effort.  I can share with Members the example of the Eastern Health Alliance, which Mr Low mentioned.  It is collaborating with HPB on the Eastern Community Health Outreach programme, or ECHO.  This combines community-based screening with appropriate follow-up care, as well as lifestyle advice such as diet plans and workshops to help patients control their chronic conditions such as diabetes and high blood pressure.

23.       Strong and lasting RHS partnerships will take time to build.  One of the lessons that we have learned from this Eastern Health Alliance is that trust and understanding among providers from various sectors – public, private, and the community – are critical to forge strong partnership and deliver coordinated, holistic care to our patients.  While each region has its unique needs, and will therefore develop quite differently, I am confident that we can share lessons from our experience in Eastern Health Alliance, and forge strong partnerships in these other regions as well.

National Electronic Health Record System

24.       Mr Low Thia Khiang also asked about the progress of the National Electronic Health Records, or NEHR.  This is a multi-year, long term project, which aims to facilitate information flow to improve care delivery.  The system has been rolled out to almost 5000 clinical users in the public healthcare sector, including 8 hospitals, 6 specialty centres, and all our polyclinics.  Access to NEHR has also been provided to the Agency for Integrated Care, some GPs, and long term care providers, with more nursing homes to follow.  To help our healthcare providers understand how to use the system, our teams conduct on-site training, and provide comprehensive information packages to all clinical users.  Providers can share information such as patient diagnosis, lab results, medications, and discharge summaries.  We will next work towards enriching the system’s functionalities, including case management and shared care plans.  With information shared across providers, we will have a system that is better connected, better coordinated, and better able to provide good care to each and every patient.

Better Care for our Seniors – Enhancing Quality, Providing More Options

25.       Let me update the House on our progress on initiatives under the Ministerial Committee on Ageing, to take care of our seniors.  We have moved decisively to enhance the access and affordability of aged care.  Last year, we announced that the government will invest $500m to build 10 new nursing homes, 39 senior care centres, and 56 seniors’ activity centres by 2016.

26.       Some of the new capacity is already  on stream.  This year, three existing nursing home providers will begin their operations at new sites.  Bright Hill Evergreen and Singapore Christian Home are slated to start within the first quarter of FY2013, followed by Villa Francis. By the end of 2013, we will add more than 500 new beds to our nursing home capacity.  Three senior care centres providing day rehab and day care will also open this year.

27.       We raised the subsidies for community hospitals, nursing homes, centre-based care, and home care last year.  Let me also clarify a point raised by Mr Gerald Giam.  We have simplified the means-testing process and criteria in the ILTC sector, to reduce hassle to patients and their families. They will only need to give consent for us to access their information from CPF and IRAS  similar to what is done for CHAS and in hospitals. This has been implemented since last year.

28.       One beneficiary of our subsidy enhancements was Mr Tan Cheng Lim, who needed rehabilitation for his spinal cord injury.  Mr Tan also has other chronic conditions, including high blood pressure.  With the changes to our subsidies, Mr Tan now receives an 80 percent subsidy, as compared to 50 percent previously, at St. Andrew's Community Hospital's Day Rehabilitation Centre.  Mr Tan is happy to have his total healthcare bill reduced.

29.       This year, we will pay greater attention on two areas: first, enhancing the quality of aged care.  We have started workgroups comprising service providers as well as relevant agencies to look at care standards in nursing homes and centre-based care. The nursing home workgroup has proposed a new set of guidelines and standards, and we will be launching an industry consultation on this shortly.  Dr Amy Khor will provide more details later.

30.       Second, we will enhance the access and affordability of services to help the elderly be cared for in their own homes and in the community.  We are making significant efforts to expand home nursing, home medical and en suite home personal care services.  MOH will convene an industry-led committee comprising professionals and home care providers, to chart new strategies and set new standards to develop the home care sector, so that home care can provide a viable alternative to nursing homes.

31.       To make care more affordable, DPM has announced that the Seniors’ Mobility and Enabling Fund will be expanded from $10m to $50m to subsidise more devices and consumables needed by frail seniors. We will also provide transport subsidies to a wider population of wheelchair ambulant seniors who need to travel to day centres to receive care.  Dr Amy Khor will provide more details on this in her speech.

Integrate to Provide Aged Care Services

32.       Madam Chairman, seniors who need care often have complex care needs spanning social, medical and sometimes financial needs.  In order to provide more holistic and person-centred care to our seniors, we will merge the aged care functions of the Centre for Enabled Living, with those of the Agency for Integrated Care, under one roof, at AIC.

Developing a Quality Healthcare Workforce

33.       Let me move on to talk about how we are developing our healthcare workforce.  In the past year, our healthcare professional workforce grew by 3,700, or about 8 percent.  We are on track to growing our professional workforce to meet the healthcare needs of our population, as outlined in Healthcare 2020.  Our priority continues to be to grow our local healthcare manpower supply.

34.       We will continue to invest in the training of our healthcare professionals.  In addition to classroom training within educational institutions, healthcare professionals also undergo supervised training in the public healthcare institutions.  MOH will provide an additional $50 million to our institutions in FY2013, to enhance their capacity to deliver good quality clinical training, in view of the increasing number of students.

35.       We also aim to raise the attractiveness of careers in healthcare.  Last year, we increased the salaries for all healthcare staff in both the public and VWO long term care sectors.  This includes specialists, which Mr Low Thia Khiang asked about.  The salaries of our specialists take into account their contributions in all areas – patient care, education, research, and leadership.  Their skills are especially valuable in our public hospitals where patients are cared for by a team; we need experienced specialists to supervise the team, and ensure that we deliver good quality care.  We allow our specialists to see private patients – but within certain guidelines – as this helps to retain them within the public sector. We will be introducing a new remuneration framework in 2014 and we intend to pool part of the professional fees - a point that was made by Mr Low

36.       MOH has also started a campaign to increase the awareness of the diverse and fulfilling work that nurses and allied health professionals do, to attract more Singaporeans to join healthcare.  Here is a snippet of our nursing campaign, which by the way is a real story. This is one of the campaign that we will be running, to raise awareness on what our nurses do.

37.       Beyond our local training pipelines, we will continue to supplement our healthcare workforce with overseas-trained professionals, especially overseas Singaporeans.  The pre-employment grant for Singaporean medical and dental students studying overseas has proven to be successful, with 189 grants given out since 2010.

38.       Foreign healthcare workers also help us meet our healthcare service needs, add diversity to the sector, and help develop our capabilities in various clinical specialities.  Public healthcare institutions have put in place various initiatives to help them adapt to our practices and working environment, so that they can be effective members of our teams in serving our patients.

Towards Better Health – Transforming Singapore into a Healthier Nation

39.       Madam Chairman, I have outlined MOH’s efforts to ensure that our healthcare system provides for the care needs of Singaporeans.  But better healthcare is only part of our strategy.  More importantly, we should all aim to achieve better health by living healthily.  Ageing need not be a burden if we stay healthy.  Instead, ageing can be fulfilling and meaningful.  If we stay healthy as we age, we can continue to live good quality lives and contribute positively to society and family in many ways.

40.       Each of us is responsible for our own health.  The first thing we need to tackle is our own behaviour.  And I agree with Dr Lam  that we should start as early as possible, targeting our youth and young adults, so that healthy habits are inculcated early in life.  Let me outline two key ideas.

Food Advertising Guidelines for Children

41.       MOH and Health Promotion Board are looking into introducing a set of food advertising guidelines for children.  There is growing evidence that advertising affects children’s food choices and dietary habits.  As such, we will strengthen the standards for advertising to children, for food and drink products which are high in fat, sugar or salt.

42.       We conducted a broad-based consultation process on this issue last year. Responses from the public were overwhelmingly supportive for restrictions on food advertising to children to be introduced.  MOH and HPB, together with the Advertising Standards Authority of Singapore, an Advisory Council to the Consumer Association of Singapore (CASE), will jointly work out the details for implementation, to be announced later.

Tobacco Control

43.       Today, our smoking prevalence is relatively low, at 14.3 percent, compared to about 20 percent in New Zealand, 21 percent in the UK, and even higher in some other developed countries. But it is on the rise, especially among our young adults.  Smoking prevalence among young adults aged 18 to 29 years has risen at a faster pace than that of the general population – from 12.3 percent in 2004, to 16.3 percent in 2010.

44.       An effective way of discouraging individuals from smoking, or picking up smoking, is through a ban on point-of-sale display.  This means that when you go to the retail shops, they will not have these products on display.  Customers will have to ask for tobacco products specifically.  Vendors can store these products in areas that are not visible to the public, such as in closed drawers.  In the coming months, MOH will seek the views of the public on the point-of-sale display ban.

Healthy Living Master Plan for a Healthier Singapore

45.       Finally, let me share with the House  our broader vision for healthy living.  We aim to catalyse a whole-of-Singapore effort, in which healthy living becomes a shared vision.

46.       To lead this effort, we have formed a Healthy Living Master Plan Taskforce, chaired by Parliamentary Secretary Associate Professor Muhammad Faishal Ibrahim.  This Taskforce will develop a plan on how we can change our current landscape to encourage healthier living.  But such change must come from within. We want this plan to be created and owned by the people, and to enable Singaporeans to make decisions for themselves that favour healthier living.  The Taskforce has done a lot of preliminary work and developed a 3P approach: Place, People, and Price, and it will consult extensively before finalising its recommendations.  A/Prof Faishal will elaborate on this later.

Conclusion

47.       Madam Chairman, I have outlined the progress on the Healthcare 2020 Masterplan.  We are on track to enhancing access to healthcare services.  We are also making good headway in building up our capabilities to provide these vital services.  I have laid out our vision for a healthier Singapore – one in which individuals, organisations, and the community must work together to change the way we think about health.  The conversation on healthy living must go beyond the boundaries of the healthcare sector.  We need a whole-of-Singapore approach in order to keep Singaporeans healthy and give them greater peace of mind.

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