SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT THE INSTITUTE OF TECHNICAL EDUCATION WORK-STUDY DIPLOMA IN NURSING LAUNCH EVENT, 30 SEPTEMBER 2024, 3.00PM, AT THE COLLEGE OF MEDICINE BUILDING AUDITORIUM, MINISTRY OF HEALTH

Ms Low Khah Gek, CEO, Institute of Technical Education

Ms K Thanaletchimi, President, National Trades Union Congress and Healthcare Services Employees’ Union 

Ms Paulin Koh, Chief Nursing Officer, Ministry of Health

Nurses, Ladies and Gentlemen

1. Today we are launching the Work-Study Diploma (WSDip) in Nursing by the Institute of Technical Education (ITE). It is an especially happy occasion for me for two reasons. First, as a former Minister for Education, to know that the Work-Study Diploma programme continues to improve and grow. 

2. Second, as the current Minister for Health, that there are now more pathways to become a Registered Nurse. In fact, with this Work-Study Diploma, I think we may be finally offering the full range of training options for someone to become a qualified nurse. This could be the last jigsaw piece that completes the whole picture.

ITE’s Work-Study Diploma

3. In 2018, when I was the Minister for Education, we worked together with ITE to launch the Work-Study Diploma programme.  It was a bold move by ITE, because ITE was not established to offer diploma programmes. Behind the move was an audacious goal – we wanted ITE to position itself like a sixth Polytechnic in Singapore. But a different kind of Polytechnic, with a strong focus on learning by doing through work-study programmes, and by learning on the job. 

4. We recognised that at the stage of development of the Singapore economy, the great majority of our young people need at least a diploma to stay competitive in the workforce. However, we also recognise that students have different talents and interests, and the ways they respond to different training methods are different, and some students are just much better at learning by doing. 

5. For many, the ITE route with a hands-on, learning by doing approach works best for them. Hence, beyond NITEC and higher NITEC, ITE students should be able to attain diploma qualifications at ITE, without necessarily having been enrolled in a polytechnic course.

6. The ITE Work-Study Diploma was therefore born. As an idea, it is actually not new at all. Many countries have tried it, as learning by doing has historical roots in the guilds and apprenticeship programmes in many European countries. Over time, work-study should become a key pathway for NITEC and Higher NITEC graduates to upgrade to a diploma. 

7. We started off with about 100 trainees across four WSDip programmes. I remember I had to bargain very hard with ITE and finally I squeezed out four programmes. But each programme requires so much hard work, and I can see ITE staff put in a lot of effort. Today, instead of 100 trainees across four programmes, it has multiplied tenfold to more than 1,000 trainees across 40 WSDip programmes. Thank you and congratulations to ITE!

Work-Study for Nurses

8. The Work-Study Diploma in Nursing was designed in consultation with nursing leaders and the Healthcare Services Employees’ Union. It will upgrade Enrolled Nurses to Registered Nurses. It is particularly useful for in-service nurses, who need not disrupt their income and work while they upgrade to Registered Nurses. 

9. With this change, we now have a full range of pathways to become a nurse, and upgrade further.

10. First, from secondary schools, students can enrol in the ITE, Nanyang or Ngee Ann Polytechnic’s nursing programmes. 

11. Second, for ‘A’ level, International Baccalaureate and Polytechnic graduates in non-nursing programmes, they can join the National University of Singapore’s (NUS) nursing school to become a Registered Nurse. 

12. Third, for working adults in non-nursing fields, they can attend career conversion programmes to become nurses. 

13. Fourth, for Enrolled Nurses seeking to upgrade, they can attend the Polytechnic courses, or the ITE Work-Study Diploma Programme that we are launching today. 

14. Finally, existing Registered Nurses can attend the nursing courses at NUS or the Singapore Institute of Technology to attain their degrees. There are also several masters programmes for nurses at these universities. 

15. So wherever your station in life, whatever level of education qualifications you have, there is now a pathway for you to enter the nursing workforce, or to upgrade further. 

16. As a result, the intake of our nursing cohort has expanded considerably, by about 30% over the past ten years. To put it into perspective, about one in 20 Singaporean students will go on to study nursing. In a Primary one class of 40 students, you will find on average about two nurses eventually. So never say that Singaporeans do not want to join nursing. Many people want to join nursing.

17. This uptake is important in continually expanding and refreshing our nursing talent pool, and making sure that nursing is an attractive career option for Singaporeans. This also provides the ballast for us to continue to be able to recruit foreign nurses, to complement and supplement the local talent pool and our local core. 

A Decisive Shift to Care in the Community

18. Beyond recruitment, we need to keep remuneration competitive, and the work of nurses challenging, with career growth opportunities. In this regard, I believe the roles and responsibilities of nurses are evolving quite rapidly in the near future. 

19. This is because as our population ages, the profile of our patients is changing. Hospitals are more accustomed to attending to patients who have major health episodes – it can be something sudden and unexpected like a heart attack or discovery of a serious disease, or a planned surgery that requires hospital stay. That is what hospitals do.

20. However, moving forward, the fastest growth in healthcare demand is unlikely to be these big health episodes, but about older patients who are progressively and steadily deteriorating due to age. 

21. What they need most is preventive care, an active social life, good living habits, rehabilitation, and assisted living. These are delivered in the home and community settings, and much less in hospitals and clinics. 

22. Nurses, as well as pharmacists and allied health professionals, will be the backbone of such a community care system. I believe they will find themselves at the frontline, leading the delivery of care, taking on much broader responsibilities for the long-term well-being of large segments of our population. 

23. MOH has therefore been investing heavily in community care. This includes building up capacity of Mobile Inpatient Care at Home, community hospitals, and also nursing homes.

24. We are mounting a big national effort in supporting Singaporeans to stay healthy. This includes mobilising almost all our family physicians to roll out Healthier SG, deliver preventive care to Singaporeans, and to expand and better resource our network of Active Ageing Centres to support healthy living for our seniors. We are making huge efforts to build up our community care system.

Significant Package of Funding Measures

25. One aspect is financing incentives and financial schemes. We are redressing the subsidy levels of community care versus acute hospital care. Let me explain what this is about. We have an old paradigm, which is that acute hospital care is more expensive, so we should subsidise more – at least in percentage terms – compared to community care, where bills are less expensive, and the demands on clinical intervention is lower. 

26. But this has unintended consequences. When we fund hospitals more, and fund community hospitals less, patients or their loved ones sometimes prefer that patients to stay in acute hospitals where there is greater assurance of government financial support. Patients therefore are sometimes reluctant to move to community care settings, including community hospitals. 

27. This paradigm has now shifted. It is not in debate; it has shifted. We should subsidise community care at least at the same level as hospital care, if not more. That way, we encourage the right siting of patients. 

28. In fact, it is often in the interest of patients to quickly move to community settings where they can get the right rehabilitation and social support, which is what they need most, at that stage of their recovery. 

29. By prolonging their stay in acute hospitals, they are at higher risk of either catching an infection from other patients in the hospitals, or they may ‘decondition’, which means becoming weaker because rehabilitation is not the natural focus of acute hospitals. 

30. Hence, over the past year or two, we have announced several adjustments to our subsidy policies for community-based care. For community hospitals, earlier this year, I announced that we will further enhance the subsidy framework. 

31. As we know, many subsidy schemes in Singapore are means-tested, which means we differentiate the subsidy levels between those with higher and lower incomes, to ensure that those with greater needs receive more support. Hence, there are different tiers of subsidies based on different income.

32. The means-tested subsidy rates of community hospitals will be raised to match those at acute hospitals. I announced this earlier this year. It is a significant step. To illustrate, the current subsidy range of 30% to 80%, depending on income, will be raised to 50% to 80%, same as acute hospitals. 

33. Advanced diagnostic services, such as CT and MRI scans, are currently not subsidised at community hospitals. This has also led to delays in the transfer of suitable patients from acute hospitals to community hospitals, because once you go there, you would not be subsidised for your scans. We will therefore be subsidising these scans at community hospitals too.

34. Another major move we have announced is in palliative care. The subsidy rate today ranges from 0% to 75% for inpatient palliative care. and 0% to 80% for home palliative and day hospice care. We will also align the subsidy rates for palliative care to that of acute hospitals, with a minimum of 50%, and up to 80%. 

35. With more funding, palliative care capacity in the community will expand, and help fulfil the wishes of many terminal patients to leave with dignity and comfort, and preferably at home. 

36. During Budget 2024, the Finance Minister and current Prime Minister announced that the government is adjusting the Per Capita Household Income (PCHI) thresholds for all means-tested healthcare schemes. With adjustments to the PCHI thresholds, more people will benefit from higher rates of subsidies. For healthcare, this is very significant. 

37. For example, the qualifying PCHI for Community Health Assist Scheme (CHAS) Blue card will be raised from $1,200 to $1,500; the PCHI to qualify for the highest MediShield Life health insurance premium subsidy will also be raised from $1,200 to $1,500; and the PCHI to qualify for the highest subsidy in acute hospitals will be raised from $1,800 to $2,100.

38. Similar adjustments will be done across many schemes, for example CareShield Life premium subsidy, drugs and medication subsidies, nursing homes subsidy, and Seniors’ Mobility and Enabling Fund support, and all these will benefit more people. 

39. Palliative care worth a special mention. It will see a very significant jump in support. I just talked about funding each palliative care patient more. Beyond that, we are also enabling more patients to qualify for the top tier of support. The qualifying PCHI for palliative care will undergo a big step jump from $800 to $2,100.

40. We expect up to 1.1 million Singapore Residents to benefit from higher subsidies due to the PCHI threshold adjustments. No action is required by the patients. The higher subsidy rate will automatically apply when a patient incurs subsidised healthcare expenses. The great majority of CHAS cardholders who are eligible will also not need to apply, and most of them can just wait for the new card to be sent to them. 

41. However, while we have announced all these policy changes, they have not been implemented. This is because much preparation work, especially IT system changes, is required. 

42. The good news is, we are now ready to implement them. They will be implemented from tomorrow, 1 October 2024. I have been wanting to make this speech for a long time. Finally, it is 30 September and we have this event. The only exception is the subsidy of advanced diagnostic scans in community hospitals which will still take a while more, I suspect due to IT changes, and will be implemented progressively from the end of this year. 

43. With all these changes, plus the expansion of community care capacity, and the rollout of Healthier SG and Age Well SG, we are making a very significant shift in the centre of gravity of healthcare, from hospitals to community and home settings. It starts tomorrow, in a big way.

Closing – The Pioneer Cohort

44. Let me come back to the Work-Study Diploma. Today, we are joined by the pioneer cohort of 33 trainees. All of them are in-service Enrolled Nurses, and two have just graduated from ITE. All of them are working in public hospitals. We also have a reasonable mix of men and women. 

45. We have Mr Lee Tian Zhi, who graduated from ITE in 2006, has 16 years of clinical work experience and is now a Principal Enrolled Nurse at Changi General Hospital. He has been a very good performer, winning the First Prize of the Tan Chin Tuan Award in 2021, which is the highest award for Enrolled Nurses. 

46. We also have Senior Enrolled Nurse Ms Nur Shahirah from Khoo Teck Puat Hospital. She graduated with a NITEC in Nursing in 2019, always wanted to pursue a diploma but was unable to do so because of family commitments, and I think also the hospital is very busy. Now Woodlands Health is open, I hope you have a bit more time.. In June this year, she learnt about the WSDip in Nursing and her supervisors encouraged her to go for it. 

47. I thank ITE and the Singapore Nursing Board for making this Work-Study Diploma a reality. I am also thankful for the support and commitment from our three healthcare clusters. It is not easy to set aside resources to meet both service and training demands, while managing the heavy patient load at the same time. Fortunately, in healthcare, the sense of camaraderie is very strong, and we are always working together, sacrificing for others, sacrificing for each other, in order to strengthen our healthcare system.

48. I wish our students all the best in your academic and career endeavours. May we see even more Work-Study Diplomas from ITE in the years to come. Thank you.