SPEECH BY CHAN HENG KEE, PERMANENT SECRETARY, MINISTRY OF HEALTH, AT THE LAUNCH OF THE TEMASEK FOUNDATION - iMOVE PROGRAMME, 6 MAY 2019, AT ALEXANDRA HOSPITAL

Professor John Wong, Chief Executive, National University Health System

Mr Richard Magnus, Chairman, Temasek Foundation

Mr Low Sek Fun, Adviser, Trailblazer Foundation

Mrs Teo Poh-Yim, Chairman, Stroke Support Station System

Colleagues and Friends

Ladies and Gentlemen

1.   Good morning. I am delighted to join you this morning for the launch of the Temasek Foundation – iMOVE Programme.

2.   Rehabilitation, or rehab for short, is integral to the management of conditions such as stroke, spinal cord injury or hip fracture. And the needs for rehabilitation in Singapore will grow as our population ages. Take for example stroke. Over the last decade, the number of new stroke cases has risen from 5,500 cases each year to about 7,400 cases each year today.After the acute medical issues are addressed,about a quarter of stroke patients would undergo rehab in acute and community hospitals. Among the rest, many would undertake rehab on their own or with the support of community based services.

3.   We should strive to better support the rehab needs of Singaporeans. This is so that they can better regain their functionality and independence, return to work or other meaningful pursuits. And help them resume their normal family and community lives.

4.   This morning, I would like to touch briefly about three aspects which I think are worth considering and emphasising as we work towards the goal of better supportingthe rehab needs of Singaporeans, especially our elderly. These are(I) Technology Enablement; (II) Evidence-based Adoption; and finally (III) Community Involvement.

TECHNOLOGY ENABLEMENT

5.   First, technology enablement. Rehab has been traditionally a manpower and labour intensive activity. It is also physically demanding for those providing rehab services. I think we are familiar with the image of a rehab patient being closely supervised and supported by therapist; sometimes more than one, if the rehab patient is of a heavier weight or the activity is a lot more load bearing. Given our shrinking labour force cohorts and ageing workforce, this presents a real challenge for us – how then do we continue to support the rehab needs of a larger group of Singaporeans, given our ageing population.

6.   This is where technology can play a role. From innovative gym equipment to tele-rehab technologies; from new exer-games (a new term I learnt!) to virtual reality; and from robots to exoskeletons, technology can be a “force multiplier” that raises productivity, lighten the physical load on therapists and lower our manpower needs. But more important than that, when properly deployed, technology can make rehab more accessible and fun, hence improving patient compliance. It also has the potential to improve diagnosis, monitoring and therapy effectiveness.

7.   Some of these technologies may start out being cumbersome.Take exoskeletons for example. Earlier versions used to be heavy and unwieldly. But today’s newer models are a lot lighter and more agile, and allow graded assistance to be provided during movement So technology can advance and this is why application of technology in rehab, or tech-enabled rehab, is something we should keep a close attention to and experiment with.

EVIDENCE BASED ADOPTION

8.   The second point I would like to make is that in our journey to make rehab better and more supportive of patients in Singapore, we need to emphasise evidence-based adoption. It is good to get excited but we also need to gather hardnose, concrete evidence that it works.A few years ago, there was a report in the MIT Technology Review titled “The Costly Paradox of Health-Care Technology”. In the article, the author argued that “in every industry but one, technology makes things better and cheaper. Why is it that innovation increases the cost of health care?”

9.   The statement may be an over-generalisation and exaggeration because we do have technologies and innovations in healthcare that made innovation accessible to a large number of patients. But I think there is a grain of truth. And the larger point remains an important one, and that is we must never adopt new technology for technology sake, or adopt an innovation just because it looks cool. Before adopting or scaling up a new technology or innovation, we must have evidence that they create real value which means bringing about better patient outcomes and system benefits in a cost effective way. Don’t get me wrong - they do not always have to be cheaper. But we should be confident that they create greater value overall for our patients and for our systems before we mainstream them. Evidence-based adoption is just as important as technology and innovation.

COMMUNITY INVOLVEMENT

11.   My third point community involvement. The delivery of rehab services should not take place only in acute hospitals or the public sector. We can better segment the rehab needs of patients and structure more integrated rehab journeys across different providers in the care continuum. This is so that rehab care can be delivered at the most appropriate care setting and anchored within the community and closer to patients’ homes.

12.   To achieve this, we will need the participation of community partners. These include non-governmental rehab service providers, from which we can draw energies, networks and complementary strengths. They also include other community partners who can extend support in other ways. Be it providing funding support to experiment with new care models and technologies, like whatTemasek Foundation and Trailblazer Foundation have kindly done.Or convening special interest groups and communities of practice to advance knowledge and skills, like what the Society of Rehabilitation Medicine Singapore is doing.

TODAY’S LAUNCHES

13.   This morning, I am pleased to join you for this launch the Temasek Foundation – iMOVE programme. Based on what I see, I believe that the programme encompasses all 3 elements I spoke about - technology enablement, evidence-based adoption and community involvement. I understand that the programme will be experimenting with new exoskeleton technology that can improve rehab outcomes and productivity. I understand that as part of the programme, it will be carrying out a study toevaluate clinical effectiveness, patient outcomes as well as the cost effectiveness of scaling up the technology and adopting it, compared to what we do today.And the programme is drawing on the strengths and participation of many community partners including St Luke’s Eldercare, St Luke’s Hospital,NTUC Health and Stroke Support Station. And of course Temasek Foundation and Trailblazer Foundation.

14.   I am also pleased that we will be launching the Advance Rehabilitation Technology Special Interest Group today. By bringing together professionals inrehab medicine, including doctors, therapists, engineers, nurses and the care teams, thiscan be a platform for healthy and robust exchange of ideas and best practices, and the seeding of public, private and community sector collaborations in the space of rehab technology.

CONCLUSION

15.   I thank all of you for making both initiatives possible. I wish both iMOVE and ARTSIG the best. And I look forward to hearing more about your progress and findings. Thank you.