Opening Address by Health Minister Gan Kim Yong, at the Healthcare Infrastructure Technology & Engineering Conference (HI•TEC) 2012, Wednesday, 12 September 2012, 8.35am at Resort World Sentosa

Mr. Goh Aik Guan, Managing Director, MOH Holdings

Distinguished Guests,

Ladies and Gentlemen,

1.            I am pleased to join you this morning at the inaugural Healthcare Infrastructure Technology & Engineering Conference (HI●TEC) organised by MOH Holdings.  I would like to begin by extending a warm welcome to all our overseas speakers and guests.  We are glad that you are able to be here with us to share your expertise and experiences at the Conference.

Global Healthcare Problems

2.            Many governments around the world are keenly aware that their healthcare systems must adapt and evolve in order to meet their peoples’ changing healthcare patterns and needs.  Governments are confronted with similar problems, such as ageing populations and the increasing burden of non-communicable diseases (NCDs) such as diabetes, cancers, cardiovascular diseases, and chronic respiratory diseases.  Many Governments also face the challenge of developing new and cost-effective infrastructure to make healthcare more accessible.  In addition, there is the perennial challenge of keeping healthcare affordable, in the face of resource constraints, rising costs and increasing patient expectations and demands. 

3.            At the global level, the World Health Organization (WHO) has recognized the importance of managing NCDs.  They are the leading cause of deaths, accounting for over 60% of deaths in the world in 2008.  At the 65th World Health Assembly in May 2012, delegates supported the development of a global monitoring system aimed at preventing and controlling NCDs, and agreed to adopt a global target of reducing premature deaths from NCDs by 25%.  Recognizing that ageing is one of the main factors contributing to the rise in NCDs, member states also agreed on the importance of implementing policies and programmes to promote healthy ageing, to address the needs of older persons, and to encourage their active participation in society.

4.            The issues of NCDs and ageing also featured prominently at the Global Health Policy Summit in London last month.  There, the participants presented a variety of innovative solutions aimed at addressing these two challenges.  These innovations ranged from micro-health insurance programmes in Bangladesh to help people manage healthcare costs in ageing societies, to community-based salt intake reduction programmes in China aimed at reducing the incidence of cardio-vascular disease, to technological platforms which enhance the collaboration between doctors and patients and improve the rate of adherence to medication schedules.  Such innovations and technological solutions will play an important role in enabling healthcare systems to more effectively address the healthcare needs of citizens.

Singapore’s Challenges

5.            Like the rest of the world, Singapore is also facing the challenges of an ageing population – and acutely so.  By 2030, about one-fifth of Singaporean residents will be 65 and older.  This alone will lead to a significant increase in healthcare demand, as the elderly are not only four times more likely than younger citizens to be hospitalized, they are also more likely to stay in the hospital longer.  However, Singapore also faces an additional challenge in that our population has also grown significantly in the last ten years, adding to healthcare demand. 

6.            Apart from the quantitative problem of increasing healthcare demand, the growing incidence of NCDs also requires a paradigm shift in the way that we deliver healthcare.  We need to increasingly alter our focus from once-off, episodic treatment in hospitals to the continuous management of chronic diseases in the community.  We also need to step up our efforts to encourage more people to lead healthy and active lifestyles so that they do not become ill so quickly. 

7.            As an added challenge, not only do we need to deliver more healthcare and new modes of healthcare, we must continue to ensure that healthcare remains affordable while maintaining and even raising already-high standards of quality.  As our society becomes more affluent, citizens will have increasing expectations of our healthcare system.  This includes not just clinical outcomes and physical comforts, but the way in which our healthcare institutions engage, communicate with, and address the emotional needs of patients and their loved ones.  At the same time, we must continue to ensure that basic healthcare remains affordable and within the means of all Singaporeans. 

8.            While the challenges above are shared by many Governments across the world, Singapore faces a unique constraint in the delivery of healthcare: scarcity of land.  Singapore is a tiny city-state of only around 700 square kilometres, with one of the highest population densities in the world.  There are many competing demands for land.  Hence, we must ensure that each parcel of land is efficiently and creatively utilized to mitigate our space constraints.

9.            All of the above challenges – the need to deliver more healthcare, the need to deliver healthcare in new ways, the need to deliver even higher quality but affordable healthcare, and the need to make efficient use of space in the delivery of healthcare – mean that it will not be business as usual in the healthcare sector.  There is a need for innovation and to creatively leverage on new technologies to find solutions to the many challenges present today and to better prepare ourselves for future needs.

The Government’s Response: Healthcare 2020

10.         The Singapore Government has already taken steps to address many of the challenges faced by our healthcare system.  Through our Healthcare 2020 Masterplan, we aim to continue to deliver accessible, quality, and affordable care for Singaporeans.  In other words, Singaporeans will be able to receive healthcare when they need it, our healthcare services will be of good quality and effective, and Singaporeans will be able to afford such services.

11.         We are expanding the capacity of our healthcare system to meet the increase in demand.  First on manpower, we will be increasing the intake of doctors, dentists, nurses, allied health professionals and pharmacists, with the aim of growing the healthcare professional workforce by 20,000 by 2020.  Next on physical infrastructure.  Many of the participants of this conference are in the business of delivering healthcare infrastructure, and would likely already be aware that by 2020, we are planning to add 1,900 acute beds, 1,800 community hospital beds and 6,600 nursing home beds.  Some of the key developments include the Changi General Hospital-Saint Andrews Community Hospital Integrated Block (CGH-SACH IB) in the east, the Ng Teng Fong General Hospital and Jurong Community Hospital in the west, the Yishun Community Hospital in the North, the Outram Community Hospital in the central region, and the Sengkang General Hospital and Community Hospital in the north-east.

12.         We are changing the way in which we deliver healthcare in order to meet the challenges of ageing and NCDs.  First, we are attempting to tackle the issue at its root by increasing our focus upstream, on prevention.  The Health Promotion Board (HPB) is taking the lead on this, and is going beyond awareness campaigns to the creation of social movements that encourage healthy living.  HPB intends to recruit a volunteer army of 10,000 health ambassadors to get more Singaporeans to lead healthy lifestyles and have already signed up 3,000 health ambassadors.  They are working together with other partners in the public and private sectors to develop health promoting solutions.

13.          Separately, to tap on the private sector to better manage chronic diseases, we are encouraging GPs to set up Family Medicine Clinics to provide team-based care for patients, and we are developing Community Health Centres to support GPs and provide allied health services for their patients. 

14.         To improve the quality of care, we are reorganizing our healthcare system into Regional Health Systems to strengthen regional collaboration and partnership. Acute hospitals, community hospitals, nursing homes, home care and day rehab providers, polyclinics and private GPs will work together to provide seamless and patient-centric care across the entire healthcare delivery process from health promotion, diagnosis and treatment to post-discharge follow-up.

15.         To make healthcare more affordable, we have relaxed the income criteria for the Community Health Assist Scheme so that middle-class families can now benefit from the scheme.  In addition, we have extended the coverage of subsidies for long-term care services and have raised subsidy rates.  For example, our subsidies for home and community-based care have been raised to as much as 80%, and our subsidy levels for residential long-term care services have increased by up to 50%.  We have recently also announced our intention to enhance Medishield to provide basic insurance coverage to more Singaporeans.

Innovations in Healthcare

16.         Many of these strategies represent innovations in how healthcare will be delivered in Singapore.  But we have still much to learn from others, including other industries.  The Institute of Medicine (IOM) in the US recently looked at what the healthcare sector can learn from other industries.  For example, healthcare could learn from the banking sector how to give clinicians and patients real-time access to their medical records.  Or, from the aviation industry, on how to learn from past performance and experience to reduce errors and harm.

17.         Within Singapore, we are working hard to improve the flow of information across the healthcare sector, through the continued development of the National Electronic Health Record System.  Public sector hospitals have also been monitoring key patient safety indicators and tackling areas for further improvement.  This is a continuing journey, which leads to better and safer care for patients. 

18.         But the IOM report also points out ways in which we can innovate, to support our key strategic initiatives.  For example, with the reorganization of our healthcare system into Regional Health Systems, we need to strengthen capabilities for better teamwork and communication, within and across different health settings.  These include not only the development of care protocols and enabling IT systems, but the greater use of information and analytics across the system to identify specific areas for improvement and support decision-making with the best available data and evidence.

19.         Today’s conference is a timely platform. I believe that there is considerable scope to innovate in the area of healthcare infrastructure development.  For example, even as we address the issue of increased healthcare demand today, we also want to ensure that our healthcare infrastructure can support healthcare demand growth in the future.  When it comes to healthcare infrastructure, we have always been careful to avoid over-building, which could be wasteful and could increase healthcare costs unnecessarily.  When demand grows, we adapt and add capacity.  For example, the National University Hospital Medical Centre, the new National Heart Centre, and the Academia are being constructed on existing campuses.  We are thankful that patients and staff understand the importance of our enhancing capacity in the long-term by patiently putting up with the temporary inconveniences.  We are planning carefully for future expansion, and building this flexibility into the design of our new healthcare facilities so that when necessary, they can be expanded quickly.  In a land-scarce country like Singapore, the challenge is indeed to develop buildings that will not only meet today’s needs without excessive wastage or inefficiency, but which will also stand the test of time by being able to cater for future increases in demand.

20.         Another example is the process innovations we have been engaged in to ensure that our new buildings are known for their functional, patient-centric design.  We do not want to build expensive “iconic” structures, which have fancy expensive features.  Rather, we want healthcare facilities which put patients’ needs first – facilities which are functional and efficient but also open, friendly, welcoming and easy for patients to navigate.  We want services to be sensibly co-located, so that patients do not need to walk too far as they go for laboratory tests, doctor consultations, collection of medication, etc.  in their visits to the hospital.  We want designs which support healing, and allow for the introduction of new models of care. 

21.         For example, the CGH-SACH Integrated Block, which I mentioned earlier, is being built next to both SACH and CGH.  This is the first building which is purpose-built to support integrated care between an acute hospital and a community hospital, so that the patients can transit smoothly between two different levels of care. 

22.         Over the weekend, I also had the pleasure of witnessing the signing of the superstructure contract for Ng Teng Fong General Hospital and Jurong Community Hospital, which are currently being built.  A major consideration was how to incorporate the needs of elderly and sick patients.  I was impressed by the thought which had gone into every detail, down to providing softer lighting in the ED for the elderly patients.  The ICU and High Dependency beds will be co-located to reduce the need for transfers and allow for the same care team to look after the patient.  It will even have an outdoor terrace for stabilised patients to enjoy some prescribed sunshine and fresh air.  These innovations will add up to improving patient experience and patient care, and facilitate their recovery. 

23.         Innovation can also be applied to directly lowering the cost of healthcare.  For example, we can design buildings which are cost-effective to manage and operate.  The initial construction of a healthcare facility may be a significant capital investment, but it is a one-time investment.  The subsequent operation and maintenance of the building on the other hand, will take place over many years.  High operating and maintenance costs mean higher healthcare costs and less affordable healthcare.  Hence, we should seek to capitalize on design and technology to keep such costs low, for example, by designing healthcare facilities to make as much use as possible of natural lighting and ventilation, and leveraging on “green” features and technology to realize energy savings.

The Challenge To Innovate

24.         In conclusion, given the many challenges that face healthcare systems around the world today, there is an urgent need for innovation.  The challenge to the conference today is to consider what infrastructural innovations can be made to deal with the problems of growing healthcare demand, ageing populations, and the burden of NCDs? How can we innovatively leverage on infrastructure, technology and engineering to increase accessibility to healthcare, improve the quality of healthcare, and make healthcare more affordable? These are important questions for which I hope conference participants will be able to share their perspectives, and generate fresh ideas and innovations.

25.         I wish all of you a fruitful and valuable conference.  Thank you.