Speech by Dr Lam Pin Min, Senior Minister of State for Health, at the 12th Singapore Public Health and Occupational Medicine Conference, 21 July 2017

Mr S R E Sayampanathan, Master of the Academy of Medicine, Singapore;

Associate Professor Vernon Lee, President of the College of Public Health and Occupational Physicians;

Distinguished guests, ladies and gentlemen.

    A very good morning and thank you for inviting me to the opening ceremony of the 12^th Singapore Public Health and Occupational Medicine Conference. This year’s event is unique because it is held in conjunction with the 51^st Singapore-Malaysia Congress of Medicine, and highlights the strong synergies between public health and clinical care. I can attest to that as a Fellow of both the Colleges of Public Health and Occupational Medicine, and Ophthalmology, as well as through my work in the Ministry of Health.

2    The theme “Moving Forward, Staying Ahead” embodies the need for all of us to be future-ready and responsive to a constantly evolving world. Health systems are dynamic and open to external influence, hence we have to constantly think ahead and improve, or risk falling behind. This is particularly pertinent for the public health and occupational medicine. Singapore needs to be prepared to respond, and in this regard the Ministry of Health has rolled out the “Beyond Healthcare 2020 Masterplan” which outlined three key shifts for our healthcare system moving forward: (i) Beyond Hospital to Community, (ii) Beyond Quality to Value, and (iii) Beyond Healthcare to Health. As we move on this journey together, it is vital that we do so as a single and cohesive healthcare system.

Strengthening primary and community care

3    Singapore faces a rapidly ageing population, with the concomitant increased prevalence of chronic diseases and complex care needs. World-class specialist care alone is not a suitable nor sustainable model. Acute inpatient care is labour intensive and often renders clinical care prone to fragmentation. Such care is not holistic and tends to downplay the importance of what is more important post discharge.

4    Therefore there is a pressing need to move ‘beyond hospital to community’, and strengthen primary and community healthcare services. For example, there are new family medicine clinics and polyclinics in the pipeline to meet the expected increase in service demands. New models of care, such as the primary care network, are also being explored. This was conceptualised by a group of general practitioners, with the aim of improving chronic disease management through team-based care. To encourage more GP clinics to work in networks, we ran an inaugural application call for new PCN proposals from April to May this year. The response has been positive and MOH is currently evaluating the applications.

5    Community care needs to extend beyond solely addressing physical health concerns. Many people in Singapore with mental health issues still refuse to seek help due to a fear of social stigma. Many are also not aware of the avenues of help available to them. We need to encourage such difficult conversations. The government has invested an additional 160 million dollars over the next five years to enhance capabilities and improve access to community mental health services.   

Ensuring value in healthcare

6    Healthcare technologies continue to advance at breakneck speed, further catalysing sub-specialisations that offer a buffet of possible diagnostic and treatment options. While we reap some of these benefits, we must cast a critical eye towards clinical costs and cost-effectiveness to ensure that our patients receive “valued-based care”. This entails services that are of high standard yet affordable and sustainable. The pursuit of value is increasingly important in an era of escalating healthcare costs.

7    How do we go about achieving this? The Agency for Care Effectiveness, or ACE for short, was established in August 2015 to run health technology assessments to inform MOH’s policies regarding the subsidy of treatments, including drugs, medical devices and services. ACE also produces guidance on the appropriate use of treatment modalities for public hospitals and institutions in Singapore. By bringing together the best available evidence and contextualising them to our local needs, ACE’s work would help both physicians and policymakers alike to make better-informed decisions.

8    We also have to find ways to improve productivity amidst manpower constraints. Where possible, we should tap on innovative and new technologies, such as automation and telemedicine, to explore efficient care delivery models. Equally important is for us to optimize our processes and remove wasteful activities. By doing so, our professionals can focus on tasks such as spending quality face-time with patients to better address their needs.

Encouraging a healthy population

9    To achieve a healthy population, we need to start young and look to prevention programs. Many of us speak fondly about the central role which public health initiatives played in advancing preventive and population health when Singapore was still a young and developing nation. The focus then was on improving sanitation, hygiene, maternal and child health. We are now entering an era where preventive medicine and public health are again taking centre stage. Issues such as obesity and diabetes require a whole of approaches to tackle the underlying causes – unhealthy lifestyles. This means we need the public and patients to be actively involved.

10    NurtureSG is an example of one of our national efforts to foster healthier habits from young to address worrying trends such as rising obesity among our children. This is a worthy investment, since they are the country’s future and a healthy childhood lays the foundation for an active, healthy and successful life ahead. The Health Promotion Board’s National Steps Challenge, Healthier Dining programmes, and Healthy Workplace Ecosystems also promote Healthy Living Anywhere, Anytime. These are key pieces in our ongoing “War against Diabetes”. Needless to say, the public health and occupational medicine community, embedded across our healthcare system, play critical roles.

Keeping up with a changing healthcare landscape

11    Indeed, our healthcare landscape will be evolving on many fronts. Over time, Singaporeans would likely benefit from new models of care, advanced technologies, and improved community-based services. In the midst of these, the safety of our patients and ensuring continuity in their care pathway must remain a top priority. The current regulations governing healthcare providers under the Private Hospitals and Medical Clinics Act, or PHMCA, are based on the traditional brick and mortar concept of healthcare delivery. This means that regulations and licenses have been traditionally tied to premises. To remain relevant and stay ahead of industry, the PHMCA is currently being reviewed in consultation with our stakeholders. The aim of the review is to ensure that as healthcare changes and advances, our regulatory system remains relevant and future-ready.

Cross-Disciplinary Collaboration

12    Successfully implementing these three key shifts in our healthcare system requires our combined efforts. Some issues, in particular emerging public health challenges, demand that we adopt a holistic cross-disciplinary approach. For instance, instead of each focusing on sector-specific initiatives, experts from the health, environment as well as agri-food and veterinary agencies are working together to strengthen Singapore’s National Antimicrobial Resistance Strategic Plan that will encompass a “One Health” perspective.

13    The Academy of Medicine in Singapore, which celebrates 60 years this year, is another good example of cross-disciplinary collaboration. By bringing together specialists from across its various Colleges and Chapters, the Academy has been providing a strong foundation for specialist competency, professional education and platforms for exchange of ideas. I trust that the Academy will continue to do so for many more years to come.

Conclusion

14    In conclusion, as we face new and sometimes daunting challenges, there are opportunities for us to adapt and strengthen our healthcare system further. I hope that the next three days will be fruitful in bringing about more effective solutions to address the public health issues that we face both today and in the future. I wish you all a successful conference ahead.

Thank you.