Cabinet and Parliamentary colleagues, Minister Masagos, SMS Janil Puthucheary, SPS Rahayu Mahzam
Permanent Secretaries
Chief Nursing Officer, Ms Paulin Koh
Chief Nurses, Nurses,
Distinguished Guests,
Ladies and Gentlemen,
1. A very good afternoon to all of you. It brings me great joy to join you today to celebrate our nurses’ achievements at the annual Nurses’ Merit Award 2023, in the way we did before the pandemic.
2. Everyone in this room knows that nursing is more than a job or a profession. It is a calling. Some of you here were called to this probably at a fairly young age, as you chose the course and set your mind to complete your nursing diplomas or your nursing degrees. Some of you felt the pull of nursing at a later age and chose to convert your skills and join the profession.
3. The motivations vary greatly. Some of you are inspired by parents who were nurses; others cared for a close family member which then ignited your resolve to join nursing; still others entered nursing maybe by chance or by fate, and then grew to be committed.
4. The underlying common thread almost always comes down to the understanding that at some point in our lives – from the beginning of a person’s life at birth in the neonatal wards, to the last moments in palliative care – we will need care. And nurses want to be there, to guide us through our recovery, celebrate with us in our times of joy, and help bring comfort and peace in the most difficult moments.
5. Whichever path you took, whatever reasons drove you, I thank you. For without you, Singapore’s healthcare system would not be what it is today. The COVID-19 pandemic story for Singapore would have turned out very differently, if not for you.
6. Indeed, COVID-19 thrust all of our healthcare workforce into the spotlight. We call it a crisis of a generation. When a system is put under such immense pressure for a prolonged period, it morphs and goes through a qualitative change. Like carbon subject to strong pressure for a long time, it becomes diamond. Hence healthcare systems around the world are waking up from the COVID-19 pandemic to a new world, all at an inflexion point.
DORSCON Green Didn’t Arrive
7. Today, I wish to address the specific question: What is the state of nursing post COVID-19 pandemic?
8. I think things are now much better compared to the height of the pandemic. We are no longer worried that there would a huge wave of infections that causes our wards to overflow seriously and our healthcare system to collapse. That is a thing of the past. We are no longer guarding multiple fronts at the hospitals, foreign worker dormitories, community treatment facilities and home recovery.
9. However, even as things become better, healthcare is not the same as before the pandemic crisis. When we announced DORSCON Green, the world outside of the hospitals says life is back to normal. Within the hospitals and MOH, it felt as if DORSCON Green did not come for us. In fact, the more we opened up to the rest of the world, the more work we get in order to gain freedom for the rest outside the hospitals.
10. Workload is discernibly heavier than before the pandemic, even though we see very few COVID-19 patients who require hospitalisation. Instead, we are seeing more people sick with other illnesses. There are more seniors, more complex cases, more with co-morbidity issues.
11. All these translate to more long-staying patients. Over the pandemic, and I have mentioned this publicly before, the average length of stay has gone up from 6.1 days to 7 days. That is a huge jump. This contributes to a significant 15% increase in occupancy. Our hospital wards are therefore often full; Emergency Departments feel it very strongly; at KK Women's and Children's Hospital now, every day feels like Chinese New Year.
12. Singapore is not alone. It is a new world of healthcare that the world woke up to from the pandemic. Our experience is shared throughout OECD countries. In countries such as the United Kingdom where investment in healthcare could not keep up with demands, the situation is quite grave. There are seven million patients on the waiting list in the UK to get diagnostics in UK hospitals, and they wait an average of 16 months.
13. I thought it was a problem faced by OECD or developed countries. Then I met the Malaysian Minister of Health, Dr Zaliha Mustafa, last week. I asked her the same thing. She said that in urban areas in Malaysia like Kuala Lumpur, there is also a hospital capacity crunch. She said they are not seeing many COVID-19 patients, but many more patients with non-communicable diseases such as diabetes and cardiac problems, include fairly young patients. So they too, are feeling the same problem.
14. I am sure in good time researchers will figure out what is causing this post-pandemic hospital crunch. But there are some strong hypotheses, from what healthcare professionals can observe.
15. First, there is an immunity debt, because during the past three years, we were so well-protected against all infections, and they make a strong comeback post-crisis.
16. Second, the pandemic has resulted in many people missing their health screening, not complying with their medication, and generally neglected taking care of their chronic diseases.
17. Third, COVID-19 led to delays in completion of healthcare infrastructure projects, which means supply cannot keep up with the demand.
18. Finally, and I think this is a serious one, many seniors hid away and kept themselves in their own home for a prolonged period during COVID-19. Over time, it became habit. I meet many of these seniors during my home visits.
19. They did not realise that while the COVID-19 enemy had come and gone, the biggest enemy for seniors remains. And that is social isolation. When seniors distance themselves from social circles and activities, they become lonely and their health can deteriorate quite rapidly.
Tackling Capacity Crunch
20. Fortunately, driven by the challenges of an ageing population, we have been anticipating higher patient loads. We did not expect it to come so fast post-pandemic, but at least the plans are there, which we can activate and accelerate where possible.
21. For example, Woodlands Health Campus had been delayed for quite a while, but will start opening at the end of this year after a lengthy COVID-19 induced delay. This will provide much needed relief to Khoo Teck Puat Hospital, which is one of our busiest hospitals after Changi General Hospital.
22. Beyond that, we have plans to build the Eastern Integrated Health Campus, and redevelop Alexandra Hospital. We can also procure beds from the private hospitals, if possible, to serve as subsidised public hospital wards.
23. We also hope that in a few years, Healthier SG will start to deliver results in keeping people healthier, and chronic illnesses at bay.
24. All these are for the medium to long-term, and it will take a few years. I know for most nurses and doctors, what is on your mind is what can we do immediately in the short term, by the end of this year at least, to provide relief to our hospitals and healthcare workers. This is what we will be doing:
25. First, we will add 280 more acute beds by the end of this year. This is after exploring various means with every public hospital. 120 beds will come from the Integrated Care Hub which will open at Novena this year. It is designed for community care, but we will step up some beds to deliver acute care.
26. Other hospitals scoured through their premises to find space to set up new beds. Khoo Teck Puat Hospital will set up 100 beds, Sengkang General Hospital 40 beds, and Alexandra Hospital 20 beds.
27. Second, we will also be expanding Mobile Inpatient Care@Home (MIC@Home). By setting up hospital equipment at home and having visiting healthcare workers, MIC@Home allows acute patients to be cared for at their home instead of the hospital.
28. The scheme has been deployed extensively in many countries and it works. We have also done so, and it has seen positive outcomes in terms of patient recovery and discharge. We will therefore double the capacity of MIC@Home, from 100 to 200 beds. And rest assured, when we do that, they can claim MediSave and MediShield Life.
29. The combined additional capacity of new acute beds and MIC@Home is 380. This is equivalent to about half a regional hospital, to be opened by the end of this year.
30. Third, we will expand step-down and rehabilitation care. This is an important initiative, because we continue to have many patients staying in hospitals, not for clinical reasons, but for social reasons. Usually, this means that they do not have family support to take care of them at home, or they are waiting for admission to a nursing home, and in the meantime, they stay in our acute hospitals.
31. We will be opening 280 more community hospital beds at the Integrated Care Hub (150), Woodlands Health (40), Sengkang Community Hospital (35), Outram Community Hospital (30) and Jurong Community Hospital (25).
32. We will also expand Transitional Care Facilities (TCFs). These are developed during the COVID-19 pandemic, to care for patients who are stable and awaiting their final discharge destination. It is also a useful step-down care facility, especially when operationally integrated with acute hospitals. We will open 200 TCF beds near Ng Teng Fong General Hospital and another 140 beds in the central region.
33. We will also augment nursing home capacity by another 310 beds by the end of this year. These beds will come from the opening of a new nursing home and the expansion of two existing nursing homes.
34. All of these add up to about 800 step-down or rehabilitative care beds. If we can successfully transfer acute patients who do not need acute care to these new and more appropriate settings, it is equivalent to adding one new regional hospital to our system, by the end of this year.
Strengthening Nursing Manpower
35. Healthcare capacity is necessary but you know it is insufficient. They will need healthcare manpower, in particular nurses, to put them to good use. However during and after the pandemic, there is intense international competition for nurses. Development, recruitment and retention of nursing talent must therefore be a key priority.
36. I have announced earlier this year that we are aiming to bring on board about 4,000 nurses nationally this year. This covers both public and private nursing hires. It is 40% more than the pre-pandemic levels, because we are catering both for replacement of nurses that we lost during the pandemic, plus expansion.
37. In the first half of this year, the public healthcare institutions have intensified local and overseas recruitment and have collectively hired 2,000 new nurses, and that is just public institutions alone. If we add the private sector hires, and if all goes according to plan, we are most likely able to exceed our 4,000 target, to replace as well as expand our nursing workforce to be able to run all the new facilities I mentioned.
38. New nurses will need to be guided and inducted. So I seek the help of our experienced nurses to assist new nurses to integrate into the family. It will add more to your plate of responsibilities, but I think it is a necessary process to go through, to improve the situation.
39. This leads to our fourth measure, which is to strengthen hiring of nurses. I have spoken about the hiring of foreign nurses in earlier speeches – how we are diversifying our sources, stepping up our efforts, and being prepared to grant the committed nurses Permanent Residence status. Ms Paulin Koh mentioned we are also reviewing the process of hiring foreign nurses. We are re-engineering the whole thing, and many of the plans and changes have already been put in place, so that the time between selection and landing in Singapore is much shorter, without compromising quality control. I believe we can do that. But today, let me focus on our efforts to intensify hiring of local nurses.
40. Today, one in 25 students who enrol in the Institute of Technical Education (ITE), polytechnics or the autonomous universities, take up nursing. It is not bad at all, and we are getting our fair share of talent locally. But enrolment into nursing programmes is not enough. They must, upon graduation, join the nursing profession.
41. Today, two-thirds of the available pool of nursing graduates enter the sector. It is not a bad figure but there is still one-third that we can go for.
42. The other one-third join other sectors. If we are faster in encouraging our nursing graduates to join the healthcare workforce, it will help address our manpower needs significantly.
43. The public healthcare clusters have therefore recently enhanced their sponsorship packages for in-flight nursing students, to encourage more of them to make an early decision to join the sector before graduation.
44. The package now covers at least half of a student’s tuition fees and include allowances during their training. It is a good move and I encourage all our nursing students to seriously consider joining nursing early.
45. But this being an exceptional post COVID-19 crisis year, we should try harder and encourage more of our fresh local nursing graduates to take up a nursing career without delay. Hence for 2023, we will introduce a sign-on bonus for nursing.
46. This will be for the 2023 graduating batch from our polytechnics and university nursing programmes, and for the December 2022 ITE nursing programme, as they are also joining in 2023.
47. The sign-on bonus is set at $15,000. It will be paid out over two years. The first tranche of $5,000 will be paid out upon joining, and the second and third $5,000 are provided at the end of the first and second year of service respectively.
48. The sign-on bonus will apply to all fresh local nursing graduates who have not already taken up a sponsorship or scholarship package, and who take up a nursing job this year in the public healthcare sector, or in a publicly funded residential community care organisation, such as nursing homes and hospices.
49. We will also backdate the sign-on bonus to those who entered from January 2023.
50. To our fresh graduates, I know many of you want to take some time to decide on your careers after graduating. That is understandable. But you have been trained for nursing, a very fulfilling career, and the nursing workforce needs you now. So if you are weighing your options, I hope the sign-on bonus will tilt the balance and help you firm up your decision to join us now.
51. Fifth, we need do more to retain existing nurses. Pre-COVID-19, attrition of nurses was about 5% to 7% a year. During COVID-19, it shot up to about 10%, mostly due to foreign nurses being poached by other countries. In the first half of 2023, attrition has so far reverted to pre-COVID-19 levels, which is a big relief for us.
52. We can do more to retain our good nurses. Strengthening recruitment, including through sign-on bonuses, will help indirectly because it relieves the heavy workload of existing nurses. But I know remuneration matters too. MOH will continue to work with the healthcare clusters to review the salary packages of nurses on a regular basis.
53. But remuneration can also be enhanced in ways other than a salary revision which comes every several years. We have public service professional services, such as the Singapore Armed Forces (SAF) and the Education Service, which offer quite attractive retention schemes. The SAF has the SAVER Scheme while the Education Service has the CONNECT Scheme.
54. They serve two purposes – one, they enhance the remuneration package of the service, and two, they encourage officers to stay long enough in service to build a career.
55. MOH is therefore working on a long-term retention scheme for our nurses in our public healthcare sector – schemes that are similar to the SAVER scheme for the SAF officers and education officers. We will share more details when ready in the coming few months.
Closing
56. The package of measures I just announced – increasing acute care beds,increasing MIC@Home, expanding step-down and rehabilitative beds, strengthening recruitment of nurses, and introducing a retention scheme – are significant changes that will address the capacity constraints faced by many healthcare systems around the world now.
57. We are determined to do our best to stay ahead of the challenge, especially in light of our rapidly ageing population. All these can only be done with the contribution of nurses.
58. Today, we are honoring some of our best nurses. I know every recipient understands that he or she is receiving the award for himself or herself, but also for everyone around them, because you work as a team.
59. More importantly, through the Nurses’ Merit Awards, we come together to honour the idea and spirit of being a nurse – recognising your dedication, celebrating your achievements, and thanking you for your contributions in changing the trajectories of countless lives.
60. This year, as Paulin has mentioned, we have a total of 125 award recipients. Every recipient has consistently shown outstanding performance and contribution to the nursing profession, some with more than thirty years of experience. I salute and congratulate all of you.
61. We have always implemented sound and effective policies to support healthcare workers to do your jobs well. It is the only way for us to succeed. You doing your best and MOH implementing policies that support you to do your best. We demonstrated that during the COVID-19 crisis, and will continue to do so as we tackle the challenges of a super-aged Singapore.
62. I wish all of you a Happy Nurses Day! Thank you.