National Medical Excellence Awards winners, and their families,
Colleagues, guests, ladies and gentlemen,
1. It gives me great pleasure to join you at the 14th National Medical Excellence Awards (NMEA) Ceremony.
2. The annual National Medical Excellence Awards recognise clinicians and healthcare professionals who have made outstanding contributions to the advancement of healthcare.
3. This year, we recognise five individuals and two teams who have shown passion, commitment and resilience in their relentless pursuit of medical excellence, and ultimately improving people’s lives.
Harnessing the strengths of healthcare clusters
4. Tonight’s award recipients hail from all three of our healthcare clusters – it was not deliberately desined to be so, but because our research and clinical excellence spans the entire healthcare sector. Over the years, each cluster has developed its own unique strengths and characteristics, upon which innovation and excellence can thrive.
5. For example, SingHealth has built a network of national centres of excellence. This could be traced back to the history of Singapore General Hospital, which housed from its early days a number of medical specialties such as neurosurgery and cardiothoracic surgery – which later became the genesis of the five national centres under SingHealth. Today SingHealth boasts a strong culture of clinical excellence, on par with many world-class healthcare institutions.
6. The National University Health System’s (NUHS) uniqueness lies in its co-location with the National University of Singapore and the Yong Loo Lin School of Medicine on the Kent Ridge campus. This has endowed it with a strong culture and tradition in research – both foundational and translational. Its close links with the medical schools promote strong collaborations and synergy between research and clinical practice.
7. The National Healthcare Group is a passionate proponent of population health, through integrated care. They set out to form community nodes all over the island to connect residents and create a care ecosystem. Last week, I visited the Wellness Kampung in Yishun, supported by Khoo Teck Puat Hospital, where residents, many of whom are seniors, come together not just to receive help, but be part of the solution for other vulnerable seniors. They cook, sing, do art and craft, and socialise – important non-clinical interventions for healthy longevity.
8. I cite these examples not just to show that our clusters are doing an outstanding job in pursuit of medical excellence – which they are – but to also highlight that each cluster has its strengths and expertise in varied areas, honed over decades. Together they offer a diverse set of capabilities to help our healthcare system chart new directions, achieve further breakthroughs in knowhow and further improve lives.
The Role of Regional Health Manager
9. We recently published our Healthier SG White Paper, which will be debated in Parliament next month. Healthier SG is a fundamental re-orientation and significant transformation of our healthcare system. It requires us to take bold moves, over many years, and some moves will be quite difficult. It requires us to go back to the fundamentals and rethink what health and sickness mean, and why we need to shift the centre of gravity of healthcare away from acute hospitals to the community.
10. For our healthcare clusters, this opens up even greater scope for innovation and medical excellence. Many of the award winners’ projects are about the community, not the hospital. Not just to cure sickness but to prevent diseases and keep a population healthy through a range of both medical and social interventions.
11. Under Healthier SG, our healthcare clusters will therefore step up as Regional Health Managers to care for their residents under their charge, about 1.5 to 1.6 milion per cluster. We have not elaborated on this very much in the White Paper, but it is a significant redefinition of a healthcare cluster’s role.
12. As a Regional Health Manager, the mission of a cluster is to look after the health of the geographical segment of population it is looking after. It goes far beyond running hospitals and polyclinics. Clusters are already implementing health interventions in the community today, but this role will need to expand in the coming years, from a relatively small proportion of clusters’ efforts now to quite a significant proportion in the future.
13. Because we all know that health is not just about doctors and hospitals, but how we live, our daily habits and our social circle. The Ministry of Health (MOH) will need to work with our clusters to take this strategic, holistic and system-level perspective to improve population health.
14. This means identifying the social determinants of health, that is, the various factors in our lives that affect our physical, emotional and mental wellbeing. This can include our physical living environment, education, employment and jobs, and food choices. We need a far better grasp of available information as well, to link point of care data with community health data. We need to use research to connect datasets and draw insights on which social interventions drive better health or overcome poorer health.
15. MOH and the clusters will then have to engage and coordinate the efforts of various community partners, to go upstream to guide the development of population health and shape the path towards a healthier Singapore.
16. These concepts are not new to the clusters, nor the hospitals, because you have been doing it. But we are formalising and expanding it. This includes evolving your KPIs, to feature population health and preventive care much more strongly. In my discussion with the Board of Directors and senior management of clusters, there are plans for these KPIs to be cascaded to various departments and institutions of the clusters.
17. As stated in the White Paper, we are also moving in the direction of capitation funding. I should acknowledge that the depth of understanding of how capitation funding can work for us, is still insufficient. The understanding also varies between institutions and people. But it is probably useful for all of us to have the following common understanding as a start:
18. First, capitation funding supports the focus on population health and preventive care. Because instead of budgeting clusters based on the services it provides and their workloads – how many admissions, surgeries, inpatient bed days etc., which tend to be acute in nature, we will fund clusters mostly based on the size of the population it is looking after. The inherent incentive is to keep the population healthy to avoid costly care episodes.
19. Second, there is no reduction in the funding of clusters, at least for now. In fact, we are beefing the funding slightly, to cater for more preventive care initiatives. What will change is just the basis of calculation. Clusters continue to be adequately funded to deliver quality healthcare. What we are trying to do is to prevent costs and budgets running away uncontrollably in the coming ten years as our population ages.
20. Third, we are aware that residents may already have established relationships with their doctors in clusters and hospitals that are outside their residential region. For such cases, MOH will do budget transfers between healthcare clusters at the backend at the end of every year to account for residents’ different usage patterns. Residents therefore do not need to be limited to hospitals under the cluster that looks after the geographic area they live in.
21. Fourth, MOH will work with the clusters to study how best to take the next steps, to instill the discipline of capitation funding throughout our healthcare system. We will take it step by step, carefully, starting with cascading KPIs that reflect the objectives of Healthier SG.
22. If we are successful, we will progressively reshape the operations of and focus of our healthcare system, just as we try to influence the lifestyles and habits of the population. This will include the motivation to conduct research, gain insights, achieve breakthroughs and accomplish excellence.
Recognising Medical Excellence
23. Significant transformation lies ahead, and it is an exciting time to be in healthcare. Tonight’s award winners are all exemplary role models of excellence and transformation. Many of them have also demonstrated a spirit of working across institutions, clusters and disciplines. Let me highlight their achievements very briefly.
24. Associate Professors Lim Poh Lian and Ng Kee Chong are receiving this year’s National Outstanding Clinician Award.
25. Professor Lim has more than two decades of expertise in managing disease outbreaks. She currently heads the Travellers’ Health and Vaccination Centre in Tan Tock Seng Hospital, serves on the Expert Committee on COVID-19 Vaccination, and chairs the National Antimicrobial Resistance Control Committee. Congratulations, Professor Lim.
26. Professor Ng is a pioneer in paediatric emergency medicine and was instrumental in establishing Singapore’s first Children’s Emergency service at KK Women’s and Children’s Hospital. He helped establish the SingHealth Duke-NUS Maternal and Child Health Research Institute. To Professor Ng, health should not be “medicalised”. We should take a life course approach in advancing the health of the mother and child, starting from the womb, all the way to adulthood.
27. Next, is this year’s National Outstanding Clinician Scientist Award winner, Professor Marcus Ong from Singapore General Hospital (SGH). Professor Ong is a pioneer clinician scientist in Singapore and leads the Health Services and Systems research programme in Duke-NUS. He played a key role in shaping the national policy in pre-hospital emergency care. His contribution has helped bring about a ten-fold improvement in the survival rate – from 2% to 26% – for out-of-hospital cardiac arrest over the last 20 years.
28. Associate Professor Daniel Goh from National University Hospital and Clinical Professor Chan Choong Meng from SGH are the recipients of this year’s National Outstanding Clinician Mentor and National Outstanding Clinician Educator Award respectively.
29. Professor Goh is a champion for better healthcare for children and has been mentoring generations of pediatricians for almost 30 years. Professor Chan is the Group Chief Education Officer of SingHealth, and has been working hard to optimise clinical training to build up the competencies of the future generations of clinicians.
30. There are two National Clinical Excellence Team Award winners this year.
31. The Community Health Assessment Team (CHAT) from the Institute of Mental Health was formed in 2009 to improve youth mental health literacy at a national level. It provides free and confidential mental health assessments for distressed youths and in close collaboration with various ministries and organisations.
32. CareLine is a 24/7 personal care telephone service pioneered by Changi General Hospital to provide health and social support to vulnerable seniors who may be living alone or are frail. Using a remote telecare model, the CareLine team provides tele-befriending services and 24/7 emergency response to give seniors peace of mind. I thank all of you for your excellence in healthcare and congratulations to all.
Closing
33. Doctors, clinicians, allied health workers, nurses, policy planners, administrators – every member of the healthcare community – have contributed to a good and robust healthcare system in Singapore built on strong foundations.
34. COVID-19 stressed our system severely, but it did not collapse. Patients needing urgent care were not left to demise. Doctors did not have to choose who gets the oxygen to live, and who did not. These things happened in many countries overwhelmed by the pandemic. Here, we were able to still do our best to attend to every patient who needed urgent care.
35. But this may well be a rehearsal for a much larger challenge coming our way, which is an ageing population of deteriorating health. It is not an epidemic curve lasting several weeks that we can ride through, but an inevitable trend of health deterioration lasting a couple of decades.
36. We will need to build on our strong foundation to be ready for the challenges ahead. Starting with a fundamental change process through Healthier SG, focused on preventive care, supported by organisational adjustments, propelled by excellent practices, research and innovation, and driven by a strong sense of mission and passion of the people of the healthcare community.
37. My warmest congratulations to all the award winners and my deepest appreciation to their families and loved ones who supported them, as well as the broader healthcare family, who have supported them in their journey.
38. Thank you.