Minister COS Speech 1: Together Towards Better Health

I.             State of our Health

1.           Madam Chairman, I would like to thank Members for all their comments and suggestions. With your permission, Madam Chairman, may I display some slides on the LED screens to facilitate the debate.

2.           Overall, Singaporeans are enjoying longer and healthier lives. This can be attributed not just to better access to quality medical care and improvements in health technology, but also the efforts of individuals and the community in leading and promoting healthier lifestyles. Going ahead, we will need to work together to address the challenges of demographic and lifestyle changes so as to continue to improve the health of all Singaporeans.

II.           Update on HC2020

3.           Two years ago, I shared with Parliament our “Healthcare2020” (HC2020) Master Plan - the Master Plan to guide us in our preparation for the future. Focusing on three strategic objectives of Enhancing (1) Accessibility, (2) Quality and (3) Affordability of Healthcare for our people, HC2020 provides the roadmap to a better and more inclusive healthcare system to cater to future needs and challenges, as mentioned by Dr Lam. Let me update the House on the progress of HC2020 thus far. 

Accessibility

Capacity

4.           First, on accessibility. As our population grows and ages, demand for healthcare services will rise. Our hospitals are indeed seeing an increase in the number of older and frailer patients. These elderly patients tend to require longer stays in our hospitals as it takes more time to stabilise their conditions and prepare them for discharge.

5.           Our family size is also becoming smaller over time. With less family support, family members may find it increasingly difficult to take the patients home in a timely manner. These factors contribute to an overall higher demand for healthcare services. In addition, as I have explained earlier in the House, our hospitals have to manage periodic surges in demand, accentuated by outbreaks of diseases like dengue.

6.           Mr Low Thia Khiang asked about capacity planning. Building capacity has been a key focus of our healthcare policy. Over the last ten years between 2003 and 2013, we have increased public acute and community hospital as well as nursing home beds by over 30%. This includes the building of Khoo Teck Puat Hospital (KTPH). We also started planning for the new Ng Teng Fong General Hospital (NTFGH) even when KTPH was still under development.

7.           As part of HC2020, we have put in place plans to add more capacity to meet the long term demand for healthcare services. A point raised by Mr Dhinakaran.  At the end of this year, we can look forward to the opening of the new NTFGH and the new Integrated Building at Changi General Hospital. Sengkang General Hospital will also be ready in 2018. 

8.           We have also been our expanding Specialist Outpatient Clinics (SOC) capacities. A point raised by Dr Lily Neo. We have recently completed the NUH medical centre last year and the new National Heart Centre (NHC) building has just taken in its first patient a few days ago.

Managing Increased Demand

9.           While these facilities and services are being built, in the short term, our hospitals are actively managing demand for hospital services. In 2013, we have added more than 300 beds to existing facilities. In addition, we have tapped into the capacity in the private sector. Mr Dhinakaran will be happy to note that we have some 50 beds from Parkway East Hospital and Westpoint Hospital and are exploring further collaborations with other private hospitals.

10.       We have also put in place programmes to facilitate the discharge of medically-fit patients such as the Interim Caregiver Services (ICS), under which patients who are fit to go home are provided with temporary subsidised help while their family members work out their long-term care arrangements.

11.         Take Mrs Annah Lee for example. When her 77-year-old mother was first discharged from Changi General Hospital (CGH), Thye Hua Kwan interim caregiver service helped to take care of her and Mrs Lee was able to leave home with peace of mind to work while she worked out the permanent care arrangement.

12.       In parallel, protocols are in place to take care of the patients at the A&E. Patients are prioritised based on the severity of their presenting conditions when they arrive at the A&E. I can assure Mr Dhinakaran that the A&E team attends immediately to urgent cases. As elderly patients can present with symptoms which are less obvious compared to the general adult population, the A&E doctors do spend more time with them.

13.       Our hospitals also deploy inpatient medical teams to initiate prompt medical assessment and definitive care at the A&E, even before patients are admitted, so that care will not be compromised.

14.       However, I would like to urge Singaporeans to visit GPs for non-emergency conditions, so that our Emergency Departments resources can be focused on those who really need emergency services. 

15.       Mr Low asked if private beds can be converted into subsidised beds. I have previously explained in this House the constraints of this approach. In fact, National University Hospital (NUH) has converted some of its private beds into subsidised beds in 2013. It was not a straightforward process. NUH had to reconfigure the space and carry out renovations such as re-wiring and piping works for the addition of medical gas points, nurse substations and other supporting infrastructure. We actually lost the use of the wards for more than three months during the renovation.

16.       As a government, we must also ensure that our hospitals can meet the needs of all Singaporeans, both private and subsidised patients and we need to strike a careful balance. When the subsidised beds are filled up, the hospitals will allow patients to be up-lodged into a higher bed class, if necessary. Hence, these private beds are already acting as potential capacity for subsidised patients when bed demand is high.

17.       More importantly, we need to move beyond acute beds and provide appropriate care to patients in the right setting, especially in the Intermediate and Long Term Care (ILTC) sector, as well as the home care sector as Mr Low Thia Khiang has pointed out. We are already doing this by increasing the number of community hospital (CH) and nursing home beds.

18.       We agree with Dr Teo that community hospitals play an important role in step-down care and we are planning more community hospitals islandwide, including in the heartlands.  These include Jurong Community Hospital in the West, Yishun Community Hospital in the North, Sengkang Community Hospital in the Northeast, and Outram Community Hospital in the central part of Singapore.

19.       Altogether, from now until the end of 2020, we will add over 11,000 more acute hospital, community hospital and nursing home beds.  Beyond 2020, we announced last year, plans for four additional new acute hospitals. One of these will be the new integrated hospital development in Woodlands that Minister Khaw Boon Wan recently announced. Comprising an acute hospital, community hospital and, a nursing home, this development will have about 1,800 beds in all and will open progressively from 2022.

20.       We are also expanding capacity and capability in community and home care services to complement efforts in adding beds. This includes introducing new care models, which allow our elders to age in place and live their golden years with or close to their families.

21.       I agree with Dr Lily Neo that home care is important and it will be a priority area for the Ministry of Health (MOH) in the coming years. I visited Japan last September to understand better how they cope with the ageing challenge, and what we learnt reaffirmed our strategy to strengthen community and home care. With an ageing profile that is about 15 years ahead, Japan officials told me at the beginning of the meetings that they wished Japan had started building home care capacity earlier.  This reinforced our decision to build up our home care capacity. This will allow us to support the different needs of our seniors and caregivers. Dr Amy Khor, SMS for Health, will be talking more about our plans to develop our home care services later on.

Enhancing Capability for Healthcare Sector

22.       Madam, as we develop our hardware infrastructure by building new facilities and adding beds, it is ultimately our healthcare professionals who are at the heart of our healthcare delivery system. We will continue to invest and grow our healthcare manpower pool and raise the capabilities of healthcare professionals. Dr Amy Khor will also be sharing more of our plans in this area.

Quality

23.        To meet our evolving healthcare needs, we cannot just continue to do more of the same. Increasing capacity alone cannot be sustainable in the longer term. If left unchecked, demand will keep increasing and we will run up against the physical limits of space and manpower. A hospital-centric system is also not the best in meeting the needs of an ageing population as patients’ needs become more complex and require longer term care.

24.        As highlighted by Dr Lam Pin Min, reforms and restructuring of the healthcare sector are needed to cater to the future healthcare needs of Singaporeans. Therefore, Healthcare2020 is not just about building capacity, but also about transforming our delivery of care and raising the quality of care for Singaporeans. 

Transforming our Delivery of Care through Regional Health Systems

25.       The key to this strategy is the development of Regional Health Systems or RHS to transform our model of care to be less reliant on acute hospitals, more integrated with primary care and more centred on the patient in the community and at home as mentioned by Dr Lam. Our healthcare delivery should allow patients to receive care that is more effective, less costly and in more appropriate settings.

26.       Our healthcare clusters are already embarking on some of these new programmes. One good example is Khoo Teck Puat Hospital’s (KTPH) Ageing-in-Place Programme, which focusses on patients with 3 or more hospital admissions within a 6-month period.

27.       Under this initiative, community nurses visit these patients regularly and develop holistic individual care plans to manage patients’ health in their homes. During these visits, the nurses not only help to monitor the patients’ medical conditions, they also conduct a home and social assessment to understand and manage the needs of the patients at home. In addition, the nurses help to advise the caregiver on how to provide proper care for the patient. By getting to know the patient better, the community nurses are also able to better motivate the patient to make lifestyle changes and reduce readmission rates for the patients.

28.       Take Mr Quek Chiu Boy for example. Mr Quek is 86 years old and has a long history of diabetes, high blood pressure, high cholesterol and heart problems. After three admissions into hospital within five months, he was placed on the AIP programme. When community nurses visited, they found that Mr Quek did not take his medication regularly and preferred food that tended to be quite salty and oily, and not suitable for a diabetic. Through regular visits and calls, the nurses guided him to a healthier diet and to take his medication regularly. They also worked with the doctors to reduce his medications from nineteen different types to seven types when his conditions improved.

29.       To prevent him from falling, the community nurses helped to arrange for grab bars and ramps to be installed at his home and applied for a motorised scooter to help him move around more easily. Mr Quek has since been doing very well on the programme. He now can go out and meet his friends daily and his blood sugar level is also under control through a healthier diet and medication. He has not been readmitted to the hospital for more than a year now.  We wish him well.

30.       More work has also been done upstream, to keep our population healthy by providing preventive health services for early detection and disease management where needed.

31.       For example, through Eastern Health Alliance’s ECHO screening programme, one of our residents, Mr Liang found he had extremely high blood pressure. After some persuasion by Mrs Liang, he went to see a GP and realised that the reading had in fact gone even higher. I am sure this was not caused by the GP. He was immediately put on medication for hypertension. If not for ECHO programme, his condition would have gone unnoticed and could have resulted in serious complications later on.

Telehealth

32.       We all need to think innovatively and find ways to do things better, safer, cheaper, faster, as my colleague Mr Lim Swee Say will say. But in our case, not just cheaper, better, faster but also safer, including through telehealth initiatives as mentioned by Mr Giam.

33.       Telehealth is a promising mode of care and if done correctly, will improve outcomes and possibly reduce costs. For telehealth to work well in the long run, two key conditions must be in place. First, we will need to adjust the way care delivery is organized and second, there must be a sustainable model to ensure that the service is affordable to patients.

34.       Already, we have a few telehealth projects in development. For example, Eastern Health Alliance Health Management Unit has been expanding their telecare system to monitor the progress of certain chronic and long term disease patients.

35.       Starting out with diabetic patients from CGH in 2010, the programme was expanded to patients discharged from St Andrew’s Community hospital in 2011. In 2012, it was further expanded to include patients with chronic obstructive pulmonary disease (COPD) and heart failures. The programme has enabled its nurses to monitor over 3,200 patients today.

36.       This programme triggers telecarers to follow-up if a patient’s test results show a worsening condition, when the patient visits the A&E, or misses a medical appointment. It also identifies needs and coordinate support services for the patient as part of his overall care management.

37.       Acute stroke patients who are presented at CGH’s and KTPH’s A&E Department are also provided with timely diagnosis and treatment, where appropriate, by off-site neurologists at National Neuroscience Institute (NNI) via real-time video-conferencing and review of the patient’s CT scan.

38.       We will continue to pilot new telehealth models and share successful experiences among our institutions.

Primary Care

39.       One critical piece in healthcare delivery is primary care. We need to further strengthen primary care so that residents can be better cared for in the community. To add onto the existing 18 polyclinics, we are constructing 2 new polyclinics in Pioneer and Punggol which will be ready by 2017. Beyond these, we have made plans to develop a further four new polyclinics by 2020 and another 6 to 8 more by 2030. We will also develop new models to improve access to services by co-locating polyclinics with compatible community facilities where feasible. For instance, the redeveloped Bedok polyclinic will be situated within an integrated Community Hub.

40.       I note Mr Liang’s suggestion to speed up these polyclinic developments. MOH assesses primary care needs based on demographic trends and we will bear in mind Mr Liang’s comments. Meanwhile, MOH has been introducing other initiatives to improve access to primary care.

41.       First and foremost, we have been continuing our efforts to tap on the capacity and capability of our GPs, in line with my Ministry’s vision of one family physician for every Singaporean. Through the Community Health Assist Scheme or CHAS, over half a million Singaporeans are now able to receive subsidised care at about 1,000 GP and dental CHAS clinics around Singapore.

42.       Our clusters have been actively building their partnerships with GPs as well.  Under the GPFirst initiative for instance, Eastern Health Alliance works with GPs in the east to educate and encourage the public to tap on GPs to manage non-emergency cases.

43.       SingHealth also transfers stable chronic disease patients from SOC to their network GPs for continued management in the community, under the D.O.T (Delivering on Target) programme. We will continue to work with GPs to explore different models and collaborations to provide good care for our patients in the community.

44.       Secondly, MOH has been working with GPs and the private sector on introducing Community Health Centres (CHCs) and Family Medicine Clinics (FMCs). 4 FMCs have since been set up in partnership with private GPs: in Clementi, Ang Mo Kio, Jurong and Chinatown. At these clinics, Singaporeans enjoy a subsidy through CHAS, and they can look forward to seeing the same family physicians for each visit. These clinics are well equipped and staffed by nurses and health care professionals to care for the chronic diseases holistically.

45.       2 more FMCs will be ready in Jun this year and we will continue to bring more on board over time. 

46.       Beyond FMCs, our GPs are also doing good work in chronic disease management, supported by nearby Community Health Centres which provide allied health and nursing services for patients referred by the GPs. 3 Community Health Centres will be opened this year, one in Bedok, another in Tiong Bahru and the third will be a mobile one, which enables it to cover a wider area, in Ang Mo Kio, Toa Payoh and Hougang.

47.       We are also encouraging our primary care physicians to continue to improve and upgrade themselves. With the establishment of the Register of Family Physicians in 2011, the majority of our GPs have upgraded themselves to be on the Register.

48.       A good family physician can help to manage patients’ conditions within their community. Take Mr Lim for example. He is 79 years old and suffered from complications as a result of years of diabetes, and frequently visited his five different specialists at TTSH as a result. Now, with a family physician, who focuses on his overall health and who co-ordinates his care amongst the various specialists, Mr Lim now only needs to see two specialists in TTSH and his frequency of seeing them has also decreased. His diabetes control has also improved.

49.       Beyond supporting and developing new ways to work with GPs, we will also be working with the College of Family Physicians to celebrate the role of our family doctors at the World Family Doctor Day in May 2014. This is an important tribute to the role of these critical medical professionals which we hope will raise the profile of GPs in Singapore, and raise awareness of their capabilities. 

Healthy Living

50.        Mdm Chair, I have outlined my Ministry’s efforts to improve our healthcare delivery system to meet future needs. Improving healthcare is, however, only part of the strategy for better health. More importantly, we have to keep ourselves healthy so that we can continue to contribute positively to our community and families and enjoy a good quality of life, even as we age. 

51.       With the twin drivers of ageing and lifestyle changes, Singapore, like many other countries, is seeing an increasing number of people with chronic conditions and related diseases such as heart disease, diabetes, stroke and cancer. These are major contributors to ill health and premature deaths in Singapore and will likely continue to grow, if current trends continue. However, as these diseases are highly influenced by lifestyle risk factors, including obesity, cigarette smoking, and physical inactivity, we can reduce the impact of these risk factors by adopting healthier lifestyles. 

52.       Healthy living starts with each one of us and we have to be responsible for our own health. To help Singaporeans adopt healthy living, my Ministry and Health Promotion Board (HPB) will work to help individuals and families to better take charge of their health and nudge all of us to make healthier lifestyle choices.

53.       In particular, we will focus on 2 key priorities, namely, obesity prevention and tobacco control and target our strategies in 3 settings; in school, at the workplace and within the community. These efforts will be complemented by preventive health initiatives to encourage early screening, detection and treatment of chronic diseases. My Parliamentary Secretary A/P Faishal will be sharing more of our plans later on. 

Active Ageing

54.    Let me now move on to ageing. Madam, as we continue to work hard to ready ourselves and our healthcare system to meet the needs of an ageing population, we need to be careful that we do not inadvertently associate ageing with decline and obsolescence, nor sickness or disability. This is not the case today. Seniors today contribute actively in various ways -- they are caregivers to their grandchildren at home, they are valued employees at the workplace or active volunteers in our community. As Mr Lien mentioned, they could also be bungee - jumpers today.

55.    Ageing can be a happy and fulfilling journey. As a society, we can come together to celebrate longevity and encourage seniors to continue staying physically, socially and mentally active. Even at their golden age, seniors can continue to grow as individuals, pick up new skills, and pursue new interests that they did not have the time for when they were younger.

56.    Mr. Yap Yee Tham is one such example. He retired from the Building Construction Authority at the age of fifty-five. Drawn by the opportunities to pick up new skills in a fun environment and expand his social circle, he signed up for YAH!’s or Young at Heart’s Transformation Course and graduated in 2006. But, he did not stop there.  Several years later, he signed up for a Bachelor of Science programme in Construction Project Management. Mr Yap, completed his programme in 2011, and now armed with a degree, he has since returned to the workforce and started a new career at sixty-five. He works full time at a Construction Consultancy firm as a Resident Technical Officer and is looking to contribute for many more years to come.

57.    Mr Yap demonstrates how we can continue to develop ourselves and contribute as we age. We want to enable more seniors to age positively like Mr Yap and we have put in place programmes to support seniors in doing so. Senior Minister of State Heng Chee How will elaborate more on ageing issues.

58.       We can celebrate ageing together as a nation.  As announced by DPM Tharman, the Ministerial Committee on Ageing (MCA) will reach out to businesses, organizations to coordinate an effort to celebrate and honour our seniors in the run up to our 50^th national day celebration next year. In particular, we hope that through this “SG50 – Seniors” initiative  we can engage businesses, organisations and the community to contribute programmes and privileges for seniors, such as by giving seniors discounts for entry to places of recreation and leisure and also to participate in sports and other learning activities. We hope that the special privileges will encourage seniors to go out with their families and friends and live life to the fullest. MOH as the secretariat for MCA will coordinate this effort.

Outreach

59.       I agree with Dr Lam that we need to engage the public for many of our key initiatives and new changes, including this SG50 senior’s programme, PG Package as well as Medishield Life which I will be talking about later on. Many of these are significant changes that require an extensive outreach effort to Singaporeans to help them understand the benefits available to them and more importantly, how they can access these benefits. I welcome the community to help in the outreach – grassroots leaders, neighbours, voluntary organisations and employers – to help to spread the message.

60.       We will be forming an inter-ministry taskforce, led by Senior Minister of State Josephine Teo and Dr Amy Khor, to take a whole-of-government approach in communicating and reaching out to Singaporeans to help them understand these benefits.I thank Dr Lam for his suggestion to engage professional experts to help in the outreach. The Government will certainly consider his idea. 

61.       Madam Chairman, all of us, will grow old, but in the process, we should keep ourselves healthy, and active. By doing so, ageing need not be a burden and can be a positive experience. I want to particularly thanks Dr Lam for the beautiful poem that he has cited and let me just respond in mandarin.

62.       蓝先生说：家有一老，如有一宝。 我也说：国有一老，更是国宝。 我们当中的老长辈们不单是家中之宝，也都是国家人民宝贵的资产，都是值得珍惜的。

63.       Collectively, we can shape societal mindsets about ageing. Through SG50-Seniors as well as many other programmes, I hope all of us can each play our part in our own way to celebrate ageing with our seniors and tell them that they are not a burden, tell them that they matter to us.  Together, we can work to build Singapore to be a place where all of us, myself included, can look forward to our happy golden years, leading active, healthy and fulfilling lives and together We can make Singapore a Nation for All Ages. 

64.       Thank you.