Speech by Mr Gan Kim Yong, Minister for Health, at the National Seminar on Productivity in Healthcare 2016, 20 October 2016

Colleagues and friends,
Distinguished guests,
Ladies and gentlemen,

Introduction

1.           It is my great pleasure to join you at the National Seminar on Productivity in Healthcare 2016.

2.           Today, we have a healthcare system that serves Singapore well. Our citizens are living longer, and also enjoying more healthy years.    

Health System Transformation

3.           Credit must go to the dedication, professionalism and ingenuity of our past and present generations of healthcare professionals and workers.  I want to thank each and every one of you for your contributions.

4.           The next 50 years will be no less challenging. Population ageing will challenge our healthcare system in three ways. First, needs for healthcare and aged care services will increase. Second, our local labour force will be more constrained as older Singaporeans retire and fewer younger Singaporeans enter the workforce. Third, families are getting smaller and thus require greater support in taking care of their loved ones who are sick or frail.

5.           To sustain a high quality and affordable healthcare system for everyone, we will need to make deep and fundamental changes to how we deliver care. Three major shifts are needed. First, we need to move beyond delivering healthcare to enabling health. It is not enough to focus on treating illnesses. We need to aggressively promote health and preventive health services to keep Singaporeans of all ages, healthy. Second, we need to move the centre of gravity of healthcare delivery, from the hospital to the home within the community. Third, we need to move beyond quality care, to also focus on bringing care that is efficient and appropriate for our patients.  

Investing In Our People

6.           Some people call healthcare a “high touch” industry. Indeed, the heart of a healthcare system lies in its people.  So to transform care, we must invest in our healthcare workforce.  Today, I am happy to launch the 2020 Healthcare Manpower Plan. It is a joint effort by the government, industry and the union to chart the strategies to build a future-ready healthcare workforce. 

Growing Future Skills

7.           There are three key strategies under the 2020 Healthcare Manpower Plan.  First, we need to build future skills. If we are shifting care beyond hospitals to the community and home, we will need to change the skills profile of our future workforce.

8.           We are putting more emphasis on our primary and community care in pre-employment clinical training.  For example, Nanyang Polytechnic and Ngee Ann Polytechnic have doubled the duration of clinical training in the community care setting from 80 hours to 160 hours for nursing students.  Physiotherapy and occupational therapy students at the Singapore Institute of Technology will undergo six to seven weeks of clinical placement in the community setting, in addition to new modules on community care with service and experiential learning.

9.           We are also training more doctors in broad-based specialty disciplines such as Family Medicine, Geriatric Medicine and Internal Medicine. They serve a critical role in bringing together in a holistic manner, care for the elderly, who are likely to have multiple needs.  

10.       We are deepening the skills of nurses.  From December 2016, a new SkillsFuture Earn and Learn programme in gerontology nursing will be introduced by Nanyang Polytechnic for new nursing graduates so as to better equip them to provide nursing care in the community. Pharmacists too can take on expanded roles by managing patients in pharmacist-led clinics providing medication therapy management services, therapeutic consultations and patient monitoring.  With a better trained workforce of nurses, pharmacists and therapists, we can expand their roles to make the best use of their training, in team-based care to provide better care and achieve better outcomes for patients. 

11.       One such example is Advanced Practice Nurse (APN) Ang Kim Wai who works at Tampines Polyclinic.  Kim Wai is a Master-level trained nurse.  With over 20 years of experience as a nurse in both acute and primary care, she runs an APN clinic to manage patients with chronic conditions such as diabetes and hypertension and complements doctors in chronic disease management.   Such active collaboration in an inter-professional team will provide better care for patients.

12.       The Ministry and our partners will also work to raise the skills level of support staff such as healthcare assistants, therapy assistants and patient service associates, to take on expanded roles in care delivery.  We will, at the same time, create jobs with higher value and improved career progression.  

Growing a strong local core

13.       The second prong of the 2020 Healthcare Manpower Plan is to build a strong local core of Singaporeans within the growing health and aged care sector.  Whether young or old, fresh school leavers, mid-career Singaporeans, or non-practising healthcare professionals, we will help you with training and development to take on meaningful and fulfilling careers in this sector.  We will enhance professional conversion programmes, re-design jobs and build good career pathways.  

14.       In the aged care sector for example, where the number of facilities and services is growing rapidly, we are nurturing a pool of senior management candidates with strong leadership and management skills under the Senior Management Associate Scheme (SMAS). Seven candidates were selected under the scheme in the first run this year.  After undergoing training by the Agency for Integrated Care (AIC), they are now working as centre managers and operations directors.

15.       In line with our objective to move care beyond the hospital into the community, we will further develop community nursing as a career option for nurses.  Community nurses provide nursing care to elderly patients through home visits, facilitate the organisation of services to meet the needs of our patients, and share with patients and their families knowledge of health promotion and disease prevention. 19 local nurses who had stopped working for various reasons have returned to nursing and joined the aged care sector under the enhanced Return-to-Nursing (RTN) scheme since April this year.  With their previous nursing experience, they are valuable assets and contribute to caring for patients and residents and helping them to stay well in the home and community environment.

Improving Productivity Through Care Redesign, Technology and Workforce Transformation

16.       With a smaller local workforce going forward, we cannot achieve accessible and quality care by simply adding more and more staff.  So the third prong of the 2020 Healthcare Manpower Plan is to improve productivity by changing the way we work and using technology as multipliers.  Only then can we meet the expected growth in health and aged care demand, and sustain good pay for our workers.  MOH has been working with the public and community healthcare institutions, as well as the Healthcare Services Employees’ Union (HSEU) to encourage and support innovations in a few areas.  Let me give some examples.

(i)           Care Redesign

17.       The innovation with the greatest impact will be in new care models that better integrate care according to the patient’s needs.  An example is how the National University Hospital (NUH) and St Luke’s Hospital (SLH) came together to provide better integrated care for patients who needed total knee replacement and total hip replacement. They took steps to improve the awareness amongst patients and their families on post-operative care, including holistic financial counselling on care in the community. Strong integration of care across the two institutions helped shorten the length of stay for 295 patients over two years.  The reduction in transfer time from NUH to SLH also enabled patients to start rehabilitation at SLH earlier, leading to better functional recovery.  This will save costs not only for the institutions, but also for the patients.

18.       Another example of integrating care better for patients is between acute hospitals and nursing homes.  There are stable patients who require nursing care after their acute condition has been stabilised and treated.  Five hospitals and 11 nursing homes came together to jointly map out and improve the care transition process.  Through this workflow re-design, the time from referral to admission was reduced by more than 50%, from 28 working days to 13 working days, without needing any additional resources.

(ii)         Automation and Robotics Innovation

19.       We also need to push for practical technology use that can be scaled across the whole system and achieve significant manpower effectiveness.  We are seeing some early results. Combined medication pre-packaging has been automated in many public healthcare institutions and more than 35 nursing homes since 2011. Through procurement of pre-packaged medication instead, we are now able to reduce the time needed by nursing home staff for medication preparation and checking.   

20.       In addition, ten nursing homes have also automated vital signs documentation. Vital signs monitoring devices are integrated with the nursing homes’ clinical IT systems to automatically document vital signs readings, so that nurses no longer have to manually record this data.  This in turn frees up time for nurses to focus more on the care of our patients. 

(iii)        Workforce Transformation

21.       We can also innovate by re-imagining and redefining the practice of healthcare workers, and patients and their caregivers, so that we can achieve better healthcare outcomes more effectively, together.  I urge healthcare leaders and clinical leaders to actively review the roles of staff in different disciplines and allow them to perform at the top of their competencies.  At the Tan Tock Seng Hospital (TTSH) Medical Ambulatory Centre, nurses lead the care of patients. The MAC is a short-stay facility that caters to patients undergoing procedures and treatments that can be completed within one day.  The nurses there can discharge patients after the procedure following a standardised approach, unless a doctor’s review is ordered.  This approach of nurse-led care has helped to reduce the patients’ length of stay in the hospital from 48 hours to 17 hours, reducing overall system and patient cost.   

22.       Innovation and productivity improvements are driven by people, often in the frontline.  This year, we are launching the National Healthcare Innovation and Productivity (HIP) Medals to recognise teams of healthcare professionals and workers who have excelled.  They serve as an inspiration that even as we address the patient needs of today, we are also creating the new healthcare of tomorrow.  

Conclusion

23.       Ladies and Gentlemen, the transformation of our healthcare workforce is a journey. It is a journey that we need to take together – as leaders, as healthcare workers, as patients and caregivers and as individuals.  Only if we all share the same vision of what a good healthcare system is for tomorrow, and what the important skills and career choices are, can we build a healthcare system that will serve Singaporeans well for many more years to come.

24.       Thank you.