Opening Address by Prof Tan Chorh Chuan, Executive Director, Office for Healthcare Transformation and Chief Health Scientist, Ministry of Health, at the Singapore Population Health Conversation & Workshop, 27 April 2018

Professor Ivy Ng, Group CEO, SingHealth 

Professor Philip Choo, Group CEO, National Healthcare Group 

Professor John Wong, Chief Executive, National University Health System 

Friends and colleagues from the health and social care sectors

Introduction

            It is my pleasure to be here this morning. I am heartened to see many familiar faces from the healthcare, social care, R&D and education sectors, gathered today.

2          I would like to commend the three healthcare clusters for coming together to co-organise today’s inaugural event. It provides a timely platform for health and social care providers and the research community to discuss population health trends, and propose solutions to improve the quality of care, cost effectiveness of treatment, and health outcomes. The aim of today’s event is to foster multi-disciplinary and cross-institution collaboration to address emerging and unmet healthcare needs of our population.

3        With an ageing population and rising incidence of chronic disease, healthcare needs in Singapore will increase in demand and complexity. These would require healthcare providers and the community to make decisive changes in our approach to health and healthcare.

4        In a paper in JAMA in 2016, Dr Eugene Washington, Chancellor for Health Affairs at Duke University, posited that academic health systems need to move their focus to a “third curve”. The first curve was directed at treating patients with disease. The second curve is population health management, that is, illness management and prevention in a defined population. He proposes a third curve which is population health improvement. The goal of population health improvement is to actively enhance the health of all individuals in a population in a defined geography. We need to move beyond just providing care for those with diseases, or those who seek care at health facilities, to improving the health of entire populations of Singaporeans. We need to focus on wellness, chronic disease prevention, and empowerment of individuals for better self-management.

5        This will require a significant paradigm shift in the way care is conceived and delivered. Compared with the status quo, investing in population health improvement will require us to move out of our institutions into the broader community, and building stronger links and partnerships with both citizens and non-health related organisations on the ground. It will require greater emphasis on factors and influences that are indirectly related to health care, for example exercise and diet, social and economic determinants of health, and social support services. There are various levels of planning and delivery required for effective population health, from systems to individuals. I am very heartened that our Clusters have already taken significant steps in this direction.

Beyond Hospital to Community

6        For example, the NUHS CareHub, which takes the form of a care and call centre, supports patients with multiple chronic conditions and complex care needs after discharge from the hospital. Patients and their families have easy access to professional help via a hotline manned by nurses and care coordinators if they need to seek medical advice. Where necessary, the care team will deploy or refer appropriate services to patients or caregivers to ensure they are well-supported in the community.

7        CareHub has helped to reduce the number of unplanned cardiac-related readmissions by 30 to 50 per cent, based on a randomised controlled trial on 270 heart failure patients enrolled from July to November 2016.

8        Similarly, SingHealth and National Healthcare Group have introduced telecare services to provide care coordination, health coaching, and medication reminders. Nurses and allied health professionals monitor patients with chronic conditions such as diabetes, Chronic Obstructive Pulmonary Disease (COPD), and heart failure via phone calls.

9        On the palliative care front, I am pleased to note that the National Healthcare Group rolled out its community palliative care programme last October, in partnership with Dover Park Hospice. A multi-disciplinary team comprising doctors, nurses and medical social workers from Tan Tock Seng Hospital and Dover Park Hospice provides palliative home care and psychosocial support to patients with end stage organ failure and advanced dementia. The team also empowers caregivers by training them to spot and manage symptoms such as breathlessness, pain and signs of distress. A 24/7 on-call service also offers round-the-clock support to caregivers, alleviating their anxiety and preventing unnecessary emergency attendances and hospital admissions for their loved ones. To date, 115 patients have benefited from the programme, of which 34 patients have since passed on at home, their preferred place of death.

10        As we strengthen care delivery in the community, it is important that we proactively engage and encourage Singaporeans who are well, to take charge of their health.

11        There are currently 400,000 individuals with diabetes in Singapore, and one in three Singaporeans has a risk of getting diabetes in their lifetime. As part of the War on Diabetes, MOH is looking at how to help the population take ownership to prevent the condition.

12        In 2017, the SingHealth Duke-NUS Diabetes Centre embarked on a three-year study to understand the effectiveness of a specially tailored diabetes prevention programme. Targeted at individuals with pre-diabetes, the programme consists of group exercises and health coaching classes conducted by Health Promotion Board. Where indicated, patients at high risk of developing diabetes despite lifestyle changes are started on metformin. The data gathered from this study will help us understand the impact of such interventions on our local population, and guide the continual review of ways to prevent the progression of diabetes in Singapore.

13        Similarly, a study launched by NUHS in 2016 to understand the factors which contribute to the progression of Type-2 Diabetes, could pave the way for better diabetes management for people here and in the region. Preliminary results have shown that the inability to produce enough insulin could be why Asians are more prone to Type 2 diabetes than their Western counterparts. These study findings can in future guide the delivery of more tailored dietary advice, the optimised use of existing drugs, as well as help researchers identify new pathways for drug development.

14        We also recognise that healthy lifestyle habits need to be inculcated from a young age, as this is the critical stage where lifelong habits take root.

15        Since 2014, Sengkang General Hospital (SKH) has been promoting healthy living to primary school students in the Northeast, equipping them with skills to be Healthy Living Advocates. To date, the Millennia Kids Programme has reached out to more than 12,000 students and their families through healthy living workshops, activities and family carnivals.

16        The team at SKH is also conducting a study of 10 and 11 year-old schoolchildren to understand if an experiential healthy eating curriculum incorporating self-control strategies would be effective. This study on behavioural change is funded by the National Medical Research Council, through SingHealth’s Population Health Centre Grant, “PULSES”.

Closing

17        These illustrative examples are very encouraging. Population health improvement has to become a crucial area of focus in Singapore. Dr Washington made four suggestions which are worth repeating here. First, add population health improvement to our missions. Second, practice at home by creating healthy campuses. Third, forge necessary partnerships. Fourth, leverage our strengths particularly as research and education play critical roles in advancing population health improvement.

18        As you may know, I am also the Executive Director of the MOH Office for Healthcare Transformation, with a vision to work with stakeholders and partners to reshape the healthcare system towards one that provides longitudinal, holistic care across a person’s life, with an emphasis on promoting wellness, prevention of chronic diseases and empowerment of individuals for more effective self-management. The Office works collaboratively with healthcare partners on transformative projects, with a view to scale these solutions across the public healthcare system if successful. I’m heartened to see some of our partners in this group here today and I look forward to partnering many more of you in our mission to bring about system-level changes for the benefit of Singaporeans.

19        Today’s conference is an important step forward in our journey towards population health improvement. I congratulate the organisers for putting together an excellent programme which will stimulate energising discussions and sharing of perspectives and practices. I wish you all a fruitful day ahead.

Thank you.