SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT THE ST LUKE’S HOSPITAL’S 28TH ANNIVERSARY CHARITY DINNER “CELEBRATION SILVER: SYMPHONY OF HOPE”, 13 SEPTEMBER 2024, 7PM, AT ONE FARRER HOTEL

Mr Khoo Teng Cheong, Chairman, St Luke’s Hospital

Dr Tan Boon Yeow, Chief Executive Officer, St Luke’s Hospital

Ladies and Gentlemen

1.     It is with great pleasure that I join you in celebrating St Luke’s Hospital’s 28th Anniversary. 

St Luke Over 28 Years

2.     28 years ago, in 1996, the hospital was established and named St Luke’s Hospital for the Elderly. The name reflected its unwavering mission. Since then, St Luke’s has expanded its scope of services, spanning inpatient care, community clinic, day rehabilitation centre and home care services. It attends to conditions from general medical and nursing services, to dementia, wound and palliative care. 

3.     Today, St Luke’s meets the diverse healthcare needs of more than 7,000 patients every year. Other than its physical location in Bukit Batok, St Luke’s has established a prominent presence in almost the whole western part of Singapore, through collaborations with various community care partners. 

4.     The work of a community hospital like St Luke’s is going to grow in importance. This is because we are undertaking a major healthcare reform exercise, to move towards preventive care, building better health in the community instead of just treating illnesses in acute hospitals. 

5.     There are powerful reasons to make this very decisive shift. One, if we want to build health, instead of just treating diseases, it has to be done while a person is healthy or relatively healthy, in the community and in their homes. 

6.     Two, it does not follow that it is always better for the patient to be sent to hospitals or emergency departments whenever there is a medical condition. I can understand why this is a habit because loved ones do that, because we are assured that should the worst happen, medical support is available in a hospital or an emergency department. 

7.     However, there are also inherent risks in a hospital or emergency departments, such as infections from other patients, or less focus on rehabilitation and recovery, which is what many patients need most to restore health. As our population gets older, these considerations become increasingly salient for many patients. 

8.     There is a spectrum of community care – from community hospitals and nursing homes to mobile inpatient care, home nursing, day care and rehabilitation. In the coming few years we need to integrate these services as seamlessly as possible, within community care and also between community care and hospital care.  

Future of Community Hospital Sector

9.     In this major transformation, community hospitals will need to evolve. It is traditionally conceptualised as stepdown care. So you take in patients referred to by acute hospitals. This concept will need to be updated, when community hospitals become a dynamic and integral part of the healthcare ecosystem that is anchored in the community. 

10.     We will need to evolve the sector in at least the following three directions: 

11.     First, expand their range of services beyond stepdown inpatient care. Indeed, we see that our community hospitals have been doing just that. St Luke’s for example, now has a comprehensive and accessible ecosystem of care within the community. It has been offering rehabilitation services to help patients bounce back on their feet faster and stronger. 

12.     Today, we just witnessed the launch of the Integrated Rehabilitation Exercise Programme (iReX) which is another step in this direction.  

13.     Besides rehabilitation, St Luke’s also delivers specialised areas of care such as dementia, wound and palliative care. Palliative care, in particular, is an area we feel strongly about at MOH, and I feel strongly about it. It is the wish of the great majority of Singaporeans to be able to pass on at home when the time comes, in the comfort of home, surrounded by loved ones. However, about 60% of Singaporeans still pass on in hospitals. 

14.     Delivering palliative care should therefore not be the sole responsibility of our hospices, such as Assisi and Dover Park, which are doing a tremendous job. The closer a care organisation is to the community, the more it needs to develop capabilities in palliative care. Hence, community hospitals, transition care facilities and nursing homes, must all be able to offer palliative care eventually. 

15.     Second, we can improve how we right-site patients in community care facilities. The objective is to ensure that the most appropriate care is given to the patients. We don’t want to be too conservative because we worry the patients’ condition may worsen and hence prolong their stay in acute hospitals. That is being too conservative. Neither do we want to be so liberal that even patients who are well and should recover at home end up in a community hospital. So you have got to be like Goldilocks, do it just right.

16.     Recently, I encountered a good example of appropriate care when I visited Ng Teng Fong General Hospital (NTFGH) and Jurong Community Hospital (JCH). They are two hospitals that are integrated in the same development. 

17.     The healthcare workers of JCH will actively visit patients in the Ng Teng Fong acute hospital wards, to identify those suitable to be transferred to the community hospital, and then make the transfers. This is in contrast to past practices where community hospitals wait passively, sometimes eagerly, for the acute hospital to make the patient referrals. 

18.     By doing this, the combined average length of stay for acute plus community hospital stays at NTFGH and JCH has dropped by 20 days, from about 43 days to now 23 days. This is quite unintuitive. You persuade the patient to quickly move from an acute hospital to a community hospital and the total length of stay drops by 20 days. Why? It is because with an earlier transfer to the community hospital, the patient benefits from early physiotherapy and rehabilitation, and avoids deconditioning due to the lack of activity in an acute hospital setting. 

19.     We should therefore try to make admissions to community hospitals more flexible, yet appropriate. There needs to be adequate governance and gatekeeping to ensure appropriate care and utilisation of resources.

20.     We are making steady progress in expanding the referral pathways to community hospitals. Emergency departments of hospitals are able to make direct referrals to community hospitals. They have been able to do for some time but I think  community hospitals and acute hospitals need to collaborate more closely to better make use of this referral route. MOH is also reviewing other referral sources to community hospitals, such as from nursing homes. 

21.     Third, the community care sector will also need to step up its efforts to develop manpower. We will need to equip many more people with the appropriate healthcare skills, so that they can deliver care in the community. This can include new skills for existing healthcare professionals, training potential employees in the community sector, or simply preparing laypersons to perform basic caregiving tasks in the community or for their loved ones. 

22.     If prompt and appropriate care can be delivered at home and in the community, we can often avoid a trip to the emergency department or into the hospital wards.  

23.     I visited an Active Ageing Centre (AAC) recently and saw that they have their own gym. Several seniors were doing their weights and exercise while some were doing rehab, and there were a few people supervising them. I asked the people supervising if they were certified coaches. They said: “No, we are not. But we are trained, not as certified coaches, but good enough to supervise the seniors doing weights and some rehab.” We are supposed to do rehab on your own anyway, but when you go to a gym in the AAC, at least there is somebody to supervise you. The gym room was filled with chatter, laughter and warmth. This was a community effort in building health in both body and mind. 

24.     As a Learning Institute appointed by the Agency for Integrated Care, St Luke’s provides training in areas such as rehabilitation and wound care. It collaborates with professional bodies and academic institutions such as the College of Family Physicians and National University of Singapore. To date, over 2,000 healthcare professionals and students have benefited from these training programmes by St Luke’s. This includes 600 community care staff trained at the St Luke’s Community Wound Centre over the past three years and I hope that your training footprint can enlarge over time so that more people in the community benefit from your training. 

Closing

25.     I thank St Luke’s for your efforts in community care all these years, and being part of our healthcare transformation process. 

26.     Tonight, we are gathered here not just to celebrate 28 years of good work by St Luke’s to also to raise funds to support the continuation of your good work. We have many donors present today, and on behalf of St Luke’s, I thank you for your support and seek your continued support. The target tonight is $1,000,000 to ensure that St Luke’s beneficiaries have access to the quality healthcare services essential for their recovery and re-integration into society. They are quite close to reaching their target.

27.     So have an enjoyable evening, and get yourself into a generous mood. Congratulations to St Luke’s on your 28th anniversary and we look forward to an exciting transformation in healthcare! Thank you.