SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE 24th SGH ANNUAL SCIENTIFIC MEETING, 7 OCTOBER 2022, 8.35AM, SGH ACADEMIA “'CALL TO ACTION: FUTURE PROOF HEALTHCARE”

Professor Ivy Ng, Group CEO, SingHealth,

Professor Kenneth Kwek, CEO, SGH,

Associate Professor Ruban Poopalalingam, Chairman, Medical Board, SGH

Distinguished Guests,

Ladies and Gentlemen,

Introduction

1.     Good morning, I am glad to be with you at the 24^th SGH Annual Scientific Meeting. We have progressed, Singapore as a whole has progressed much over the years achieving a world-class healthcare system. We have one of the highest life expectancies at 83.5 years and one of the lowest infant mortality rates at 1.8 per 1,000 life-births.

2.     But as has been several times but it bears repeating our ageing demographic presents challenges for population health and sustainability of care. The proportion of Singaporeans aged 65 years and above is rising quite rapidly. About one in five today, by 2030, it will become one in four.  We want and we need for Singaporeans not to just live longer, but also to live well, intervening to ensure that that life expectancy is healthy.

3.     We have talked about Healthier SG just had a debate in Parliament. We have to refresh our healthcare system to enable current and future generations of Singaporeans to proactively intervene to achieve that better health and that improved quality of life. You will have a much deeper exposition about Healthier SG from DMS Kenneth Mak’s plenary lecture later on. today, I would talk about how we can leverage technology for change, promote some change and innovation and then seize the opportunities we have in front of us, transform healthcare for the future.  

Seizing Opportunities to Transform Healthcare

4.     COVID-19 indeed has sowed many of these seeds for the transformation of our healthcare system.

5.     We have come a long way since our first local COVID-19 case in 2020. One of the core things that Singapore as a whole has done, like highlighted by the work of our healthcare professionals is that we have done, we have achieved what we have achieved in COVID-19 by focusing on scientific evidence every step of the way. We looked at the data, the science and rationale about what we needed to do. That is not a given in healthcare systems in countries.  We carefully navigated the course of the pandemic, continuously reviewing emerging scientific evidence and using that to inform policy changes using that scientific evidence to translate into practice meeting our ground needs, our priorities and our realities.

6.     That approach has also required a fair amount of nimbleness, agility, adaptability or taking that science and moving it into a critical and swift response. When COVID-19 placed a tremendous strain on our healthcare resources pushed our people and our systems to the limit, we had to consider how to change our model of care to look after our people, to cope with the pressures of our system and allow us to continue to deliver the services that we need to.

7.     At the start of the pandemic, you know we relied on very stringent hospital-based isolation and quarantine measures trying to contain the disease as we grappled with the uncertainties. We tried to cope with the absence of the key tool which is vaccinations, which we do not have earlier on in the pandemic. As time progressed, we understood the disease better, we understood the science better and we kept up with the knowledge available throughout the world even as the virus mutated. We learnt about effective vaccines, therapeutics, testing technologies we made those tools available and made a concerted effort to educate our public on the science behind the matter, explaining the rationale behind our policies. Then as a result when we had to shift our COVID-19 management strategies, the people were with us, the healthcare professionals and the population.  

8.     When we realised that the concerns about the pandemic changed, we altered our interventions, we altered the model of care when it was clear that most people from most age groups have mild symptoms were not good to be severely ill, our healthcare language the way in which we talked about it changed, we stopped talking so much about “Treatment” towards “Facilitating Recovery”; moving from hospitals to Community Care Facilities, Home Recovery Programmes. Our language changed our mindset, changed the way in which we engaged people on these issues. The paradigm for healthcare provision shifted towards a more empowering participatory relationship with our patient.

9.     This was enabled and transformed through technology such as virtual wards, the Mobile Inpatient Care @ Home (MIC@Home) scheme, which was something that benefitted not just COVID-19 patients but also our non-COVID-19 patients. We had to continue servicing all our population shifting physical healthcare away from institution-based setting.

10.     At the same time, we had in parallel many public health responses to limit the spread of the virus reduce the risk of severe disease in our population.  We learnt the importance of communication strategies. As a healthcare professional, we are always taught about the importance of communication, but in the midst of a crisis with changing scientific evidence, changing models of care, changing anxieties in our population, communication becomes not just necessary but a rate limiting step up of what we can do. We had to not just provide the service, provide the public healthcare measures but effectively communicate at all levels explaining safe distancing, mask wearing, shifting entrenched beliefs about vaccines.

11.     But there is a very important upside to this, just doing it well then translates later to informed ownership of one’s wellbeing, one’s health. The population has shifted their views about what they can do to keep themselves safe and healthy. Even with relaxation of measures. You now have an increasing sense that as individuals we can decide when to wear a mask, when to take the appropriate action, when to be a bit cautious stay at home do things by Zoom, by phone, rather than risking exposing others in our population.  The empowerment and the motivation I think in our society has changed and we have the opportunity to play a part collectively as a nation on healthcare, not just for COVID-19.

12.     It is a great start in shifting our mindset and our behavior towards health and healthcare and away from illness. The initial success gives us confidence to further empower Singaporeans to take greater charge of their health and wellness, with support from the community.

13.     We have to continue to ride on this momentum to drive change for a sustainable and resilient healthcare system for all of us.

Leveraging Technology for Change

14.     Technology is going to be a key part of that. The pandemic significantly accelerated the adoption of technology for use in healthcare. Prof Ruban talked about how the population had been sensitised to the developments in technology and that made the adoption of technology in healthcare easier for the healthcare professionals. Now segments of our population that under adopted technology has become much more familiar about using their phone, using web portals. We work together on this, both the healthcare and non-healthcare parts of our ecosystem. We have shifted our entire population’s mindset on the use of technology. Across the globe, technology was employed to provide near real-time data and feedback to health agencies, improving access to healthcare, augmenting models of care.

15.     If used well, technology enables healthcare professionals to devote more attention to the patients who need it, while ensuring accessibility to healthcare services for all.

Mobile Inpatient Care @ Home (MIC@Home)

16.     One example of this good use is Mobile Inpatient Care @ Home (MIC@Home) initiative. This was an effort by MOH Office for Healthcare Transformation, SGH, NUHS and Yishun Health are currently running the MIC@Home programmes as a large scale pilot, providing patients the option of being cared for in the comfort of their own home.          

17.     And through technology they have access to a multidisciplinary team, teleconsultations, home visits, remote monitoring of vital signs and very important the tools to escalate for further attention when necessary, and they can even receive intravenous medications at home as part of this.

18.     Technology is an enabler of this programme. Care providers using technology can make clinical decisions on the basis of the data and data that they wouldn’t otherwise have about patient’s lifestyle their home habits allowing them to personalise and customise treatment plans. For a patient they can maintain a certain quality of life, avoiding hospital admissions, avoiding hospital-acquired infections and having the same level of intervention that they previously would not have. The studies so far have demonstrated this type of approach can be efficacious. It can be safe for selected patient segments and we should explore how to deploy these types of approaches for more patients and more settings.

19.     Together with the 3D Printing Centre that Professor Ruban mentioned earlier, these are just some of the examples of how you as healthcare professionals have leveraged technology to augment ‘how’ we deliver healthcare, ‘where’ we deliver healthcare ‘when’ we deliver healthcare.

Driving Change and Innovation

20.     You will continue to face changes and challenges in the post-COVID world. We have to play our part to reshape our healthcare system and to deal with these challenges. 

21.     Changes, innovations and innovative solutions for the healthcare, for our future are going to be important. And how do we empower all the stakeholders in order be able to own and drive this type innovative change?

22.     At the system level, we have to analyse the healthcare trends translate them into action plans for our national context.  We have shifted our healthcare licensing approach to one which prioritises business flexibility and is outcome-based. The new Healthcare Services Act better safeguards patient safety and well-being while ensuring new and innovative healthcare services can be offered. 

23.     At the institutional level, the MOH has established a regulatory environment for healthcare businesses and innovators to test new care models and services that have the potential to improve cost and care for patients.

24.     One example was the regulatory sandbox for telemedicine under the License Experimentation and Adaptation Programme, this allowed the testing of different service delivery models over a time-limited period, but maintaining essential safeguards for patient safety, allowing us to better understand risks, co-create effective mitigations. And at the same time, support innovations, which we hope can subsequently be scaled out of the regulatory sandbox, to improve service delivery.

25.     At the individual level, it can be overwhelming if you are hit with a buzzword of “digitalisation”, “value driven care” having to learn about AI and machine learning ut the truth is that each of us as healthcare professionals we need to enhance our health technology skills. We cannot expect the entire population to move along with technology, adopt technology, to augment their healthcare, and we as healthcare professionals do not play our part as individuals. It becomes a core competency, a skill that all of us need to be able to engage with and develop. The use of large volumes of data, how do you translate that into clinical practice. The use of video conferencing and remote tele-medicine, how do you deliver the very important traditional skills of empathy and patient consultation using these platforms. SGH has set up a unit called the “Office of Future Healthcare Systems” to specifically support this area of need and better prepare its workforce for the future.

26     It is important to remember that even as we tap on emerging technology and innovation, we do so in a sustainable manner to provide good quality and affordable healthcare.

Value-Based Healthcare (VBH)

27.     And as we do so we have to strengthen our focus in enhancing the value of our healthcare system, as part of our transition towards a Value-Based Healthcare model.  

28.     At its core, Value-Based Healthcare is a collection of initiatives undertaken throughout our healthcare system to raise the value of care provided. This includes the Value-Driven Care programme, benchmarking clinical and cost performance across providers for selected high-impact conditions. This benchmarking process is essential to allow the identification for opportunities for improvement, otherwise you do not know which are the models of innovations and pilots in a regulatory sandbox that you have to then justify and apply funds and resources to scale across our whole nation to benefit as many people as possible. Sometimes this work has a significant impact on the kind of healthcare service that we have to do for our whole population.

29.     We have to share innovations in care models and best practices in order for the system to improve. And SGH has optimised through the VDC programme the use of bed resources by scaling up the use of Day Surgery, Short Stay Ward for selected patients, patients undergoing keyhole surgery. These types of care innovations were tried in small numbers in selected locations under very tight conditions. And now, they have become widespread and well adopted.  These types of care innovations will become critical to the progress that has been made in bending the cost curve, maintaining the focus on quality and safety improvement at the same time.

30.     Future proofing our healthcare requires us to collectively look at the changes at the system, institution, and individual levels. We have to update our regulatory framework, promote innovation and nurture the capabilities of our healthcare workforce, looking after the people who drive what we do, and in doing so increase the value of care that we can provide. It is by no means an easy feat. The silent calm approach to what would otherwise be an overwhelming challenge, and in the pictures, we saw not individuals, we saw teams of people, we saw groups of healthcare professions, people playing different roles coming together, putting themselves together for a common cause. And that is the marker of how we behave as a healthcare community, looking not just at the immediate challenges, but also for the future of our healthcare landscape, future proofing this important set of work that we do collectively.

Conclusion

31.     Academic Medical Centres, SGH, the collaboration that is represented by the participants at your annual scientific meeting, this type of community plays an important role in driving innovative solutions, developing a deep understanding of the challenges we face, the new technologies that we can leverage on and the opportunities that are presented to us to transform healthcare to benefit all our patients.

32.     Having platforms like this and restarting platforms like this, after the challenges that we have been through over the last 2 years, are going to be essential to drive that change, promote further knowledge sharing and collaboration.

33.     Thank you once again for inviting me to join you here today, I wish you all a fruitful conference ahead.

34.     Thank you.