SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF COMMUNICATIONS AND INFORMATION & MINISTRY OF HEALTH, AT THE SINGHEALTH COMMUNITY FORUM, ON 17 MAY 2024, 9.15AM, AT SENGKANG GENERAL HOSPITAL AUDITORIUM

Professor Lee Chien Earn, Deputy Group CEO (Regional Health System), SingHealth 

Professor Teo Eng Kiong, CEO, Sengkang General Hospital

Colleagues from the health and social sectors

Ladies and gentlemen

1. Good morning. It is with great pleasure that I join you here at the SingHealth Community Forum 2024. This has been a platform for celebrating progress and collaboration between our healthcare institutions and our community partners in bettering the well-being of our residents through the very important integration between social and health spheres.

2. The theme for this year is "Innovations to Improve Care Delivery and Quality of Life". Innovation can have a very significant and profound impact on what we do in the healthcare space. We have made remarkable strides in our healthcare system here in Singapore. By any measure, we have  world-class standards in health outcomes. We do relatively well in the world in ensuring accessibility and affordability. Although, in those spheres we can never do enough. However, the challenge of balancing cost, accessibility and quality, what commentators call the "iron triangle" of the healthcare system, remains a pressing concern. How we navigate this iron triangle is going to rest on our ability to be innovative. This has always been true within the healthcare and social spaces. 

3. I am going to speak a little bit about innovation within the healthcare space. Innovation in technology, innovation through partnerships and innovation through a resident-centric approach.  

Technological Innovation

4. Innovation in technology is critical. Despite our efforts in health promotion and active ageing, the ageing of our population will inevitably lead to an increase in healthcare demands. We are not going to be able to change that increase in demand and to tackle this, we are going to have to leverage technology to re-think what we do in care delivery, what we use as solutions and how we apply our processes.

5. For instance, the MOH Office for Healthcare Transformation started a sandbox for Mobile Inpatient Care @ Home (MIC@Home) in 2022. This is an option to receive what you would consider hospital-level care in your own home through technology or remote monitoring. Through a combination of teleconsultations and home visits, an appropriately skilled and sized care team can deliver more holistic care in your home. The team can  remotely monitor the patients’ conditions and escalate health conditions for timely interventions when needed. By March 2024, more than 2,700 patients benefited from this service and were able to receive treatment in the comfort of their own homes. At the same time, this enabled more than 12,000 hospital bed days to be avoided. With the support of all three healthcare clusters, the service has since been mainstreamed as part of acute care from April 2024. I think this is the approach we need to have. Find a small, defined set of patients and clients, work with a partner who is ready to go, develop a model, demonstrate its success and then when we see that it is working, how do we escalate and scale this across our entire healthcare system. We have to learn from each other. Take the innovations from partners, and make it work in the best interests of all our residents. 

6. Within our  hospitals, we are also exploring opportunities in Artificial Intelligence. An example is ATLAS, a new AI-assisted system co-developed by SingHealth Community Hospitals (SCH) and Rebee Health to enable seamless transition of rehabilitation from hospital to home. During their inpatient stay, ATLAS facilitates AI-assisted tele-rehabilitation for patients. This complements what they are getting on a day to day basis from the physiotherapy team. Upon discharge, patients can continue their rehabilitation remotely with their physiotherapists via ATLAS. This enables post-discharge patients from the community hospital to keep up with their rehabilitation. This is very important.  Anywhere you work within the social-healthcare space and the community hospital, we know that compliance with the treatment that you need is a big part of making it happen. Working out what to do is only part of the solution. Working out how to keep your client and patient doing it on a regular basis is a very important part of our implementation. 

7. Likewise, our community care organisations are also leveraging technology to enhance care for their clients. For example, the Lions Befrienders developed a one-stop LB Tech Care, which deploys remote monitoring, home-based technologies, and personalised ways of social engagement, to serve seniors more holistically. This includes leveraging of applications that are AI-driven to detect mild cognitive disorders and dementia in seniors, as well as to assess facial emotions to detect potential mental or emotional concerns. Additionally, the Lions Befrienders have piloted the use of autonomous mobile robots to deliver essential items such as meals, groceries, and medication directly to the homes of frail or homebound seniors.

Innovation through Partnerships

8. Other than digital innovations, it is not just about the technology. We  are embarking on a shift in the way we think of healthcare services. Traditional models of healthcare focus primarily on treatments and hospital setting. With the  rollout of Healthier SG and Age Well SG, we are stepping up preventive care and addressing social determinants of health upstream. Our health system must proactively promote good health, before our residents become patients. 

9. An illustration of this shift is evident in SingHealth’s Health Up! initiative, a preventive health programme that supports the objectives of Healthier SG. Through collaboration with community partners such as Sport Singapore (SportSG), the Health Promotion Board (HPB) and People’s Association (PA), Health Up! provides residents with enhanced access to a diverse range of tailored healthy living activities. Since the launch of the Health Up! pilot in Tampines in November 2021, the participation rates for chronic disease and cancer screening among pilot participants have increased to between 60 and 80 per cent. Additionally, 73 percent of the pilot participants who set at least one health goal have successfully achieved their objectives. Instinctively, we know the nature of this problem. You have a New Year’s resolution and you go to see a doctor or counsellor and say ‘yes, I will do this’ but it is difficult to follow through. It is hard because your lifestyle, social interactions and what you do on a day-to-day basis have to change. The interventions may not seem very technically advanced. This is not necessarily frontier science but it is a hard and knotty problem to shift behaviours. The application of frontier technology and changing business models to shifting behaviour in programmes like Health Up! actually make a big difference if we can get it right. 

10. I commend all the partners for engaging in this and I think it does indeed require partnerships because you may have the problem detected by one set of professionals. You may have the solution decided upon by another professional in another setting. Then, you have to live your life in the community. Bringing together partnerships across these different settings for you, residents and the clients is very important.

11. I hope that SingHealth will assess and share the findings from the pilot. The rest of us will then think how best to deploy such programmes and also how to embed such support for our residents across partners and partnerships. 

12. We observe such service innovations in the community care sector regularly. For instance, Montfort Care has developed five of their Active Ageing Centres into Goodlife Studios. These studios offer programmes and activities based on different themes to draw in younger and more educated seniors. Two of their five studios are currently operational: A Tea Bar at Bedok Reservoir and a Carpentry Studio at Bukit Purmei. In addition, Montfort and SingHealth has also collaborated to set up Community Health Posts at Goodlife Studios to bring health and medical services to residents in community settings. For instance, SGH occupational therapists helped to design carpentry work at Bukit Purmei, to enhance the motor skills of participants.

13. These examples highlight the positive impact of service innovations, made possible by partnerships among health and community care providers. Together, we can reimagine and improve the support and care for our residents in their individual health journeys.

Resident-Centric Innovation

14. This brings me to my final point – innovation and what we do – changing our business, operational and technology models should be anchored on the first principles of empowering residents to effectively address their needs. To ensure that innovation is purposeful, we have to begin by taking on a resident-centric lens.

15. For instance, an initiative by Medical Social Workers (MSW) at the National Heart Centre Singapore (NHCS) prompts their heart-failure patients along their health journey with simple yet essential questions as part of their Local Area Coordination-Empowerment (LACE) programme: 

a) What is a “Good Life” to you? 

b) How can you use your strengths and skills to meet your goals? 

c) How can your family, friends and community support you in meeting your goals?

16. These are relatively simple questions on the face of it. But these are not the questions as a client or patient walking in to see a professional will be usually asked. We usually report technical things like ‘what drugs have you run out of’ or lifestyle things like ‘what have I eaten. What is my weight today? Have I been compliant with my health programmes’. This is turning the questions around and getting the professionals to think and ask the resident – what do all these mean to you? We want the residents to take ownership of their health and lifestyle changes that they make. They are  encouraged to reflect on their personal needs and strengths – what is it they can do to change the trajectory of their health and lifestyle, strengthen the social capital and think about the support structures that they need to strengthen.  

17. The results of the pilot programme are encouraging. Patients report feeling more in control of their lives, with a reduction in unplanned admissions and average length of stay. Training workshops on "Good Life" conversations with LACE principles were also well-received by 208 community partners, community nurses and cardiac doctors. Over 90% found the training useful and reported an increased in providing cardiac community care.

18. One beneficiary of the programme is Steven, who is a 65-year-old single elderly without family support. Steven was navigating his health journey alone and had recurrent hospital admissions due to challenges in complying to medical advice. Despite receiving a comprehensive array of community services such as medications packing and  day care, Steven remained relatively disengaged. Applying LACE, the NHCS team built trust and fostered relationship by delving into Steven’s life story and engaging in "Good Life" conversations to understand his envisioned “Good Life” and his goals using the structured questionnaire. 

19. Through the dialogue, the team uncovered Steven’s desire for meaningful conversations and genuine friendships, and his talent for singing. The team partnered with his day care team to co-create a personalised plan and encouraged his participation in karaoke sessions at his day care centre. The team also introduced a companion from his day care centre, which deepened Steven’s social connections with the community. In the subsequent six months, Steven grew increasingly engaged and motivated to achieve what he had defined as a  “Good Life”. He developed more discipline to self-manage his health which reduced his frequent readmissions. Steven also began to volunteer in his day care by developing ways to encourage his peers to participate in day care activities and became a positive influence for his peers.

20. One story, one patient. But it illustrates the importance of anchoring what we do in innovation, pushing the boundaries in resident-centric care. Beyond leveraging technology and partnerships, what is best can vary very significantly from situation to situation and resident to resident. We need a little humility about understanding what works best in the context of individuals’ lives. Sometimes, it seems like a very simple shift, but if you can engage in such a way that the resident, client or the patient feels that they have ownership and they are empowered to make a difference in their own life, that difference will stick and social differences can often transform a patient's outlook and give access to many other types of interventions from the professionals, peers and community supporters. 

21. If we co-wrote an academic paper on the influence of karaoke singing on cardiac care, it may be a stretch to find a peer reviewed journal to accept it. But that is not the point. That is not what we should be aiming for. The point is, it made a difference in Steven’s life. We know it worked for him. We extract the correct lessons of our partnerships, the use of social interventions and its impact on the health and social space. We take those lessons in and we share them across. We have to find more day care centers and think about how we get more people singing. More importantly, the friendships and the networks that are built around us. 

Closing

22. I would like to commend SingHealth and all the community partners for your hard work and heart work. The examples show that when we have like-minded organisations, we have partnerships and we can push the boundaries through innovation and technology, partnerships and resident-centric care. We can achieve a lot to  address the needs, health and social aspirations of our residents. Today’s Community Forum is yet another opportunity to share insights and practices, and to learn and encourage each other in dealing with some rather challenging and difficult problems. 

23. I look forward to hearing more about the impact of these collaborations in the years to come, and to witness how they can enable our population to improve their quality of life, as together we build a healthier Singapore. Thank you very much.