National Healthcare Group Health Manpower Development Plan (HMDP) Award Ceremony

05 Jul 2007

By Ms Yong Ying-I

Venue: National University Hospital

I am pleased to be here at the NHG HMDP Award Ceremony 2007.  The HMDP is one of the most important and impactful programmes in healthcare.  Since its introduction almost 30 years ago, HMDP has funded generations of our doctors, nurses, pharmacists and other allied health professionals to go for training attachments to internationally renowned healthcare institutions. We have been able to import many new and novel skills and processes this way.  Many new clinical services, patient education programmes, work process improvements and medical advances in our public and private sector hospitals today are a result of skills built through the HMDP programme.

When I asked NHG for an example of a new service that had been started as a result of a HMDP training award, you told me about Dr Malcolm Mahadevan, a Senior Consultant at the Emergency Department, NUH who received an HMDP fellowship to the Yale / Hartford Medical School, Connecticut, USA. On his return, he established an Extended Diagnostic Treatment Unit in the Emergency Department (EMD) so that patient with selected diagnosis would be observed in the EMD rather than admitted. The project took off in 2005 and has saved NUH 8,000 bed days or about eight admissions a day.  Eight a day is significant, because it is 10 per cent of the usual admission load of 80 per day.

MORE HMDP AWARDS

The number of awards offered by the two clusters this year has almost doubled from the number five years ago.  I am happy to note that there are 108 of you who are receiving an award this year.  NHG has increased its contribution from the NHG endowment fund this year to more than $2 million, co-funding the awards with MOH which has contributed $2m. NHG’s increased funding shows its strong commitment and support towards the professional development and training of its staff.  The greater number of awards is very important, because there are rapid advances in medicine that we want our people to be able to keep up with, and we have a larger base of manpower to train.   

First, plan

Let me share a few thoughts of mine on the directions we should take in manpower training. The training awards were devolved to the clusters a few years ago. The process is decentralised and is heavily bottom-up.  NHG tells me that Clinical Heads of departments typically discuss with their staff possibIe traineeship options, and these get translated into applications.  The HMDP Selection Panel scrutinises applications for its value in starting up a new services or replenishes or builds up more clinical experts in an existing critical service.

This is good but going forward, we can complement this by some top-down strategising as to the areas of growing clinical needs in Singapore and our strategy for developing future peaks of medical excellence in Singapore.  In some cases, it may not be adequate to train only one person in an area of subspecialisation; we may need to send a number of people if we are to build depth of capability in that area.  We also need to train nurses and other support staff in these same areas or the consultant who comes back may not be adequately supported to offer the new procedure or treatment.  Or the funding for the requisite posts or equipment for his department may be inadequate.

Essentially, I would like to see us doing some strategic thinking and developing a clearer consensus about the areas of capability we are going to build in the public sector going forward, the next five years, the next 10 years.  Where do we go from here?  Which are the new specialty centres to develop?  At projected growth in patient volumes, is it time to have two specialty centres in some areas?  Do we need to expand the number of institutions across the public sector offering some treatments because of the growing number of patients with these diseases?  Being clearer about our development strategies will allow us to better organise the funding, the infrastructure development, and of course, the manpower training. 

Clinical research manpower

An important new area that MOH will be directing funding towards is the training of clinician scientists and researchers.  Government has decided that we should continue with our biomedical sciences research thrust, and that the next phase is to develop translational and clinical research capabilities for which MOH must play a major role.  Clinical research is now part of MOH’s official mandate.  To catalyse translational and clinical research, we must build a critical mass of clinician scientists and researchers which we have very few of today.  In line with this, the Specialists Accreditation Board (SAB) appointed the SAB Research Committee this year, to facilitate research training for specialist trainees with a keen interest in research.

Of course we know that training manpower is not enough.  We also have to create a more supportive environment to stimulate research, including having more manpower overall so that individual clinicians are not worked off their feet just trying to cope with the very heavy service load.  They need time to catch their breath, to think, to have protected time to do research.  There needs to be the requisite lab space, the academic environment that supports inquiry and debate and so on.  This is all work in progress. 

Manpower to meet the needs of the Elderly

Another important area of manpower to develop are the healthcare workers we will need to better cater to the growing number of elderly.  This theme has a number of different dimensions.  The first is a stronger emphasis on integrated and holistic care, both within institutions and across healthcare institutions.  Indeed, Minister Khaw and MOS Heng spent a lot of their time in this year’s budget debate in Parliament talking about this whole area.  For hospitals, there is a growing realisation that we need to have more general internists rather than have patients referred from one highly specialised consultant to another to yet another.  We have to rethink our approach to care coordination in hospitals and compensation for different specialties.  For instance, we should make it more attractive for people to choose to be general internists and to become geriatricians.  I know that various parts of NHG have done much thinking and work on care for the elderly and that geriatric units had their historical starting point in hospitals like TTSH.

There is also much more we can do across institutions in the name of integrated care. One area that your senior management is working closely with HQ on is strengthening the collaboration with our community hospitals.  If we can raise the capability of the community hospitals like Ang Mo Kio and RenCi, and work more closely with them, this will help the tertiary hospitals discharge patients more smoothly to them.  This can have a significant impact on the length of stay and bed occupancy in our tertiary hospitals, which is very valuable when we are often full-house or close to full-house. 

Includes nurses, allied health professionals across the spectrum

The optimal team mix to take care of the elderly and many of those with chronic diseases on an on-going basis may involve less doctors than for acute episodes.  Rather, we need more nurses and allied health professionals, with expanded roles and higher skills.  We have done a lot in the last few years to develop the career ladder of nurses, including the development of Advanced Practice Nurses.  The undergraduate nursing programme at NUS has also started.  We need to continue to develop nurses with specialist skills in complex treatments, and in step-down care and community care.  We will need many more allied health professionals across the spectrum.  We are presently developing a clearer strategy towards rehabilitation – its benefits, its limitations, where it is most valuably deployed.  Indeed, we will need more medical social workers and case managers, to support a vision of elderly and chronic sick patients being cared for by a wider variety of care offerings in the community.   We will support training for these healthcare workers more aggressively, with diploma programmes at NYP being upgraded to degree programmes, and new degree programmes for selected areas such as Dietetics and Podiatry being explored. We should use HMDP to provide continuing and advanced training to the leaders of these groups.

And staff in supporting areas too

Let me also talk about the training of staff in non-clinical areas.    Historically, HMDP has supported the development of clinical capabilities.  But hospitals are complex, giant service operations, which has to smoothly handle thousands of patients flowing through each day.  And patient expectations are high.  We should grow the skills of our people in customer service management and public relations, financial management and hospital management.  They are a crucial part of the whole team enterprise.  Think about the systems skills needed to run general hospitals well, especially when they are close to full-house.  I think that we would benefit from building skills in areas like managing flow-through of patients from admission to discharge with a view to speeding up discharges while ensuring patient safety, and management of OT scheduling, managing emergency loads at the national level so that we contain the need for bypasses, and so on.

I am glad to note that in the last few years, many of your staff have been sent to programmes in hospital management and medical informatics in areas such as management of set-ups for day surgery and radiotherapy centres, robotics and pharmacy automation amongst others. Support areas like health services research and medical informatics are indeed important too.  I have worked with several of our clinical leaders in both clusters on healthcare IT, as we are trying to make a big push forward in EMRX. It is patently obvious to me that healthcare IT requires clinician involvement as the IT has to be designed to meet clinical needs. The IT guys cannot succeed if we do not have intensive contributions from clinicians. But we do not have enough clinicians involved today or knowledgeable about the subject. It is a technically complex area which requires investment in time and energy to learn.  Acronyms like HL7 and SNOMED are not easy to develop deep understanding on.  Worse, it is not as if we can simply copy what other countries have done – everyone seems to be exploring together.  The IT vendors offering expensive solutions are not necessarily much wiser than the people who run the hospitals.  Because healthcare IT is complex, the saying that “a little knowledge is a dangerous thing” is particularly true here.  But with its enormous potential to impact service delivery, it is important that we have many more clinicians take a deeper interest in this area.      

GOING FORWARD

Everything I have said shows that manpower development will be a top priority for MOH.  Medicine is a talent intensive business, and whether we are able to deliver quality care and continue to meet Singaporeans’ expectations depends on the quality and quantity of human resources.  MOH is therefore putting in much effort on manpower, whether it is policies and standards regulations, bringing in foreign manpower, developing our own people to their potential or identifying and building new skills.  HMDP will continue to be the lynchpin of our manpower development efforts. 

Some of you listening to this speech may worry that the many other priorities in our manpower development efforts will cannibalise the funds for training for clinicians.  I would like to assure you that the funding for clinical training will not fall; indeed, it is fairly obvious to me that it must go up and that MOH will work hard to expand funding to manpower development.

Let me conclude by offering my congratulations and best wishes to each of the award recipients.  I hope you will have a fruitful learning experience.  However, the experience of going overseas is not just about work and learning.  Do not forget to have an enjoyable time and make new friends.  Climb some mountains, listen to the opera, take up wine-tasting, go horse-riding and try skiing……I hope this year overseas will leave you with memorable experiences that you will treasure.

Thank you.