OPENING SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE DUKE-NUS CENTRE OF REGULATORY EXCELLENCE 2022, SCIENTIFIC CONFERENCE, 5 OCTOBER 2022

Professor John Skerritt, Chair of the Conference Scientific Committee

Adjunct Professor, University of Sydney

Deputy Secretary, Health Products Regulation, Australian Department of Health

Special Advisor, Duke-NUS Centre of Regulatory Excellence (or CoRE)

Dr Lembit Rago, Vice Chair of the Conference Scientific Committee

Secretary-General, Council for International Organizations of Medical Sciences (CIOMS) – (pronounced as “cee-yoms”)

Professor John Lim, Executive Director, CoRE

Senior Advisor, Ministry of Health

Distinguished Speakers and Guests

Good morning

2.             It is my pleasure to open the Duke-NUS Centre of Regulatory Excellence (CoRE) 2022 Scientific Conference on the theme of “Patients as Partners for Health: Co-creating Equitable Access to Health Products and Services”. A very warm welcome to our delegates and speakers from around the world, especially those who have travelled to Singapore for the conference. We appreciate your strong commitment to patient engagement.

Importance of Partnering with Patients

3.             Today’s programme is a comprehensive one which includes an open dialogue on centering patients and caregivers in the healthcare system. Healthcare services and products are developed to ultimately benefit patient care. Understanding the holistic needs of consumers which include patients and caregivers can help better design solutions to achieve the desired outcomes of health and safety. Consumers can also help to identify acceptable risks when new medicinal products such as medicines and vaccines are developed and introduced. Furthermore, patient engagement is important to raise consumer awareness and empowerment so that patients and the public stay away from unsafe services and products. Instead, they will report such products and services to the authorities to better safeguard society. Thus, it is critical for governments and regulators to engage consumers when developing and reviewing healthcare and regulatory policies.

Singapore's Efforts to Educate & Engage Patients: Establishment of the Agency for Care

4.             Singapore has been embarking on patient engagement on many fronts in recent years.

5.             The Agency for Care Effectiveness (ACE) was established by the Ministry of Health (MOH) in 2015 to support providers, patients, and payers in making better-informed decisions about patient care. In 2021, ACE launched a new Consumer Engagement and Education (CEE) workstream to support patient involvement in health technology assessment and to develop educational resources to enhance consumer understanding of health conditions.

6.             Together with global experts and healthcare professionals in scientific advisory bodies, ACE established a Consumer Panel comprising experts from patient and volunteer organisations. And just this year, ACE launched a new initiative for members from local patient and voluntary organisations to share their lived experiences of different health conditions and treatments. Their views and experiences, together with the technical evaluations, helped to inform MOH’s Drug Advisory Committee in its recommendations on funding decisions for health technologies. These initiatives have been well-received by local patient organisations who said that being able to share their patients’ testimonials was a meaningful and important activity for their patient groups.

Launch of Consumer Education Campaigns and HealthWatch Website

7.             In recent years, the free flow of health information online as well as the growth of new modalities of care have also led to increasing consumerism in healthcare. This led MOH to embark on a series of consumer education campaigns in 2019 to improve consumer discernment on unlicensed healthcare professionals, and unsafe healthcare products and services. We also wanted to educate the public on making smart decisions regarding new and emerging healthcare services. This included the online purchase of direct-to-consumer (DTC) genetic test kits, online sales of eyewear, and other unlicensed healthcare services such as injections offered by unlicensed persons. As a result of our campaigning efforts, we saw an overall increase in the number of website visits to our consumer education website. 

Raising health product safety awareness in patients through strategic communications

8.             Separately, the Health Sciences Authority (HSA) regularly educates consumers to raise their awareness on health product safety through public education and media releases. For example, in 2020, HSA conducted a six-week campaign featuring HSA’s advertisements to educate consumers on the dangers of buying health products from dubious and unknown online sources. HSA also collaborates with other agencies to conduct targeted educational campaigns to specific groups such as foreign domestic workers, migrant workers and students.

9.             HSA has been participating in the annual #Medsafety week campaign organised by the Uppsala (pronounced as Oop-sala) Monitoring Centre since 2019. This is a global social media campaign where regulators simultaneously share campaign materials on their social media channels to raise public awareness on the importance of recognising and reporting adverse effects from their medicines.

Patient engagement efforts by healthcare clusters to ensure better access to health services

10.         At the public healthcare cluster level, there are also efforts to enhance patients’ access and experiences of health services. The SingHealth Patient Advocacy Network (SPAN) was established in March 2017 by the SingHealth Duke-NUS Institute for Patient Safety and Quality (IPSQ). It is a self-driven network of patients and caregivers that represents the collective voice of patients within the SingHealth cluster and is committed to designing a healthcare system together with patients.

11.         Tan Tock Seng Hospital organises the Singapore Patient Conference (SPC), a dedicated event where patients, caregivers, volunteers, community partners, health and social care professionals come together to share their care journeys and brainstorm new ideas in co-creating a better health and social care system for all.

12.         The National University Health System (NUHS) conducts various focus group discussions to garner perspectives from patients, caregivers and partners, on their experiences of being cared for by the respective NUHS institutions. For example, focus groups were organised at various stages of the Alexandra Hospital Campus development to seek feedback and ensure that patient perspectives were incorporated into the development.

Importance of Public Engagement in Singapore’s Fight Against COVID-19

13.         Public engagement has also been important in the fight against COVID-19. Through proactive communications, the Government ensured that the public was well informed and kept up to date with national policies and the latest developments on COVID-19.

14.         Regulatory information on COVID-19 related health products and advisories on their safe use were published on the HSA website and a consumer adverse event reporting channel was established to allow vaccine recipients to report adverse events following COVID-19 vaccination to HSA. To promote transparency in safety signals detected from the COVID-19 vaccines and to maintain public confidence in the national vaccination programme, HSA has also published regular safety updates on COVID-19 vaccines since May 2021. 

15.           During the COVID-19 pandemic, we also saw an uptake of telemedicine. Given that telemedicine was a relatively new service to many Singaporeans, MOH launched a social media campaign to raise awareness on how telemedicine should be used safely and appropriately. In our campaigns, we took effort to inform our consumers that telemedicine does have its own limitations. For example, not all medical conditions can be properly diagnosed via a telemedicine consultation and thus it was important that such awareness was raised among the public.

Singapore’s Future Approach to Health - Healthier SG

16.           As we look into the future approach of healthcare in Singapore, MOH has presented a White Paper on our Healthier SG strategy in Parliament.  In the paper, we outlined our increased focus on preventive health, with an emphasis on empowering individuals to choose health for themselves. The Government will help them, working with their local family doctor to engage individuals on improving their health and how community partners such as the People’s Association, Health Promotion Board and Sport Singapore will support them. The paper is currently being debated in Parliament, and if passed, will be launched in 2023.

17.         We engaged over 6,000 members of public and healthcare professionals while preparing for the White Paper. Many shared that they do not want to be forced. They acknowledged that intrinsic motivation was more powerful. Many highlighted that it is about having strong reasons to choose health, such as enjoying time with their families, being able to go to work to provide for their children. At the same time, they appreciated having support to improve their health at their own pace, such as from their doctors, family and community partners. We will continue to work with our partners to build on these insights and strengthen the support for healthier lifestyles.   

Improving Regulatory Processes & Outcomes through Patient Engagement

18.         In addition, patient engagement is also important in health regulation. Today, regulators face multiple challenges, including finite regulatory resources and the emergence of new service models due to advancements in science and the rise of new advancements, including disruptive technologies such as telemedicine or AI. To ensure that citizens continue to receive good quality healthcare in a safe manner, there needs to be a more effective way to enhance regulators’ overall audit and surveillance efforts.

19.         We are introducing the Health Information Bill in 2023 to support care continuity by facilitating proactive data sharing between healthcare providers. MOH is already in the midst of engaging stakeholders on key policies under the Bill. We intend to seek further feedback from the public later this year. The views shared during these consultations will help us to refine key policies and regulatory processes under the bill.

Other Areas of Improvement to Singapore’s Healthcare System

20.         While much work has been done in Singapore to engage patients, more can still be done. Globally, there has been increasing emphasis on the importance of real-world data for a product-life cycle approach in assessing effectiveness and safety of health products. Sources of such real-world data can include electronic health records, insurance claims, billing records, patient registries and wearable devices. Singapore has been successful in partnering the population to collect general health data through the Healthy 365 and LumiHealth app. That said, more can be achieved through collaborations among patients, regulators, academia and the industry to gather real-time data on the use of health products. An increase in consumer reporting could facilitate safety signal detection and allow timely risk mitigation actions.

21.         On this front, Singapore can learn from other regions of the world on how we could possibly improve our healthcare system through patient partnership. For example, the European Commission launched the European Health Data Space to empower patients to control and utilise their health data in their home country or in other Member States. With this, patients will have immediate and easy access to data and can easily share these data with other health professionals in and across Member States to improve health care delivery. Patients will be in full control of their data and will be able to add information, rectify wrong data, restrict access to others and obtain information on how their data are used and for which purpose. By learning from the successes experienced in other countries, Singapore will be able to refine its strategy to improve its healthcare system for all Singaporeans.

CoRE’s Role in Achieving Better Health Outcomes

22.         As we explore the possibility of engaging and partnering with patients for health, much work and coordination needs to be done. Capabilities need to be built to support wide-scale patient engagement.

23.         The Duke-NUS Medical School’s Centre of Regulatory Excellence (CoRE) was established in 2014 as the first Asian Centre dedicated to addressing the capacity development and policy innovation needs of stakeholders within the healthcare products regulatory ecosystem, and has since expanded its scope to cover health services and global health.

24.         CoRE provides a neutral, academic platform to raise awareness of best practices, add to the evidence base through mapping the patient engagement landscape in Asia, and bring together stakeholders who do not often engage with one another. Convening relevant stakeholders gives them the opportunity to co-create solutions and approaches relevant to the context in Singapore and the wider region. There are also opportunities for CoRE to facilitate education and training for stakeholders involved in patient engagement, including patients themselves.

Conclusion

25.         On this note, I would like to congratulate the organisers in assembling an international coalition of patient engagement experts and advocates for this important dialogue, appropriately themed “Patients are Partners for Health”. The CoRE 2022 Scientific Conference provides us with an opportunity to focus on patients and caregivers as the core of the healthcare system and listen to practical ideas and insights from patient advocates, regulators, policy makers, healthcare professionals, academics, researchers and industry. As consumers are increasingly engaged as collaborators and partners, we can look forward to increasingly positive patient-centered health outcomes.

26.         Thank you in advance to all our speakers, panelists and delegates from over 18 economies who will be sharing your insights throughout this conference. We look forward to more of such discussions in the future.

I wish you all a pleasant and fruitful meeting ahead. Thank you