SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES, AT THE 2025 NURSES’ MERIT AWARD

Senior Minister of State for Health Dr Koh Poh Koon

Minister of State for Health Mdm Rahayu Mahzam

Ms Paulin Koh, Chief Nursing Officer (CNO)

Chief Nurses, Nurses,

Distinguished guests, ladies and gentlemen,

1. A very good morning to everyone. I am happy to join you at this year’s Nurses’ Merit Award. Today we are honouring 141 nurses who have demonstrated outstanding knowledge, skills, heart and dedication.

2. Nursing is a profession that encompasses an unwavering commitment to bettering human lives, by easing a patient’s suffering, comforting their loved ones, mentoring younger healthcare professionals, or spearheading innovations that improve our system. Together, you collectively saw through challenging as well as triumphant moments in our history, and never wavered in your duty and dedication.

3. So as we celebrate both SG 60 and 140 years of nursing excellence in Singapore this year, we thank you for your immense contribution to Singapore healthcare, and to nation building! Thank you.

Transforming our System of Care

4. COVID-19 triggered a significant manpower challenge for healthcare systems around the world, because the demand for healthcare workers, especially nurses, shot up.

5. Post-COVID-19, we have therefore focused on tackling this challenge, and specifically, replenishing the nurses we lost during the pandemic, improving working conditions and strengthening retention. As a result, we had two consecutive bumper years of nursing recruitment, implemented the ANGEL long-term incentive system, rolled out the zero tolerance towards abuse in all our healthcare settings, operated dormitories for new foreign nurses who have just settled into Singapore, and I think we have about 2,000 beds by now. Hospitals like Tan Tock Seng Hospital offered more flexibility in working hours, and shortened handover time significantly. I hope it works well and at some point, it can be extended to other hospitals.

6. Today, I think we can put the COVID-19 manpower challenge behind us and look ahead. What is ahead of us is a challenge that is equally significant and more long-term, and that is to adapt our healthcare workforce to a new reality, requiring a different system of care.

7. This major shift is due to an ageing population. The logic is quite straightforward. Younger patients are generally healthy, and their hospital visits tend to be episodic when some organ is not working well, and you go to a hospital to get it fixed, and you are out and back to normal.

8. But when patients gets older, they are likely to have more complex, multiple needs. Say an elderly fell and fractured your hip. You will need one team to take care of your fractured hip. You knocked your head, so you need one team to look at your head injury. You need one to answer the question of why you felt dizzy leading to the fall, and then as this is a senior, chances are there is a chronic illness which complicates everything, and the chronic illness team will also come in. So there are four teams, and that is just a typical example of what you have seen in the hospitals. And after this patient is discharged from the hospital, he is likely to need continuous care near his home, in the neighbourhood.

9. The case mix between these two types of patients is evolving rapidly. We used to have a lot more of the first type and fewer of the second type. Now I think it is reversed. Our hospitals are treating many more of the latter, more complex category, and the numbers and proportion are rising down the road. This is driving change in our system of care, in the following significant ways:

10. First, there needs to be better coordinated and consolidated care in acute hospitals, to care for all patients with multiple conditions. To do so, we are transforming the way we structure our hospital medical care teams, comprising mainly doctors. This is a profound change but it is a story for another day, not today’s speech.

11. Second, more care will need to shift away from hospitals to the community. So we are now really living one of the “three beyonds” in a very concrete way we say from our hospitals to our community. Now we are really shifting to that, and there needs to be preventive care in the community to avoid triggering these multiple conditions simultaneously. There also needs to be continual care after the patient is discharged from the hospital. Both preventive and continual care will need to be delivered in a community setting.

12. I am seated next to the Group Chief Nurse of NUHS, Dr Catherine Koh. I asked her where her office is, and she said it used to be in the hospital but is now in the heartlands in Clementi. That is shifting the centre of gravity of care from acute hospitals. If community care is effective, how does that look like? I think we will be able to detect health concerns as early as possible. And if we can detect it early, the condition will be less severe, and intervention will be as simple as possible. Further, to reduce the barriers to care seeking, intervention needs to be delivered as close to the home of the patient as possible, with as few touchpoints as possible.

13. Early, simple and close to home. Three basic tenets of community care. To achieve this, we will need to prepare and transform not just the medical workforce, but the rest of the healthcare workforce, especially nurses. As I mentioned in an earlier speech this year, workforce transformation will be a key priority for MOH in the coming years.

Evolving the Roles of Nurses

14. So where do we start? Having discussed this matter with various colleagues, and especially with CNO Ms Paulin Koh, I suggest we focus on specific nursing roles outside of hospitals, where the healthcare system will need most, and where we think there will be a huge demand.

15. There are three immediate roles that need to be redesigned or scaled up, and we need to prepare more nurses for. They are as follows:

16. First, community nursing care. We have implemented a major national active programme for active ageing, called Age Well SG. Under Age Well SG, we now have well over 220 Active Ageing Centres (AACs) throughout Singapore. The AACs, which are out in the public, engage more seniors living around the area - seniors who are healthy, not so healthy, not healthy but think they are healthy, and not healthy and know that they are not healthy.

17. 90% of the AACs incorporate a Community Health Post (CHP), where nurses will operate on a weekly basis. We need to leverage this extensive outreach of the AACs for preventive or continual care to reach the seniors through the CHPs. It will complement hospital acute care. It will strengthen Healthier SG and the work of our family doctors. CHPs must be able to help uncover chronic disease patients who are latent in the community, either unaware of their condition or aware but reluctant to do anything about it.

18. This is a very significant segment, contributing to the six kidney failure patients and 60 heart attack and stroke patients that we see every day. We cannot reduce the number and the late interventions without effective preventive care in the community. Nurses in these CHPs will need to establish yourselves as the first point of contact for residents with chronic conditions, preventive health needs, or emerging symptoms.

19. In these care settings, our nurses need to be able to conduct assessments for a fairly large patient group that turns up at the AACs every day or every week, provide health counselling to the patients, and ensure that patients are adhering to their Health Plans prescribed by their Healthier SG doctor. They see their Healthier SG doctors once or twice a year and in between, they can see our nurses at CHPs.

20. With training and defined protocols, CHP nurses can also conduct social prescribing and referrals, and manage patients with stable mental health conditions. We will need to develop a system to provide community nurses with the relevant support from the backend, providing information and advice to them so that they can operate independently, and with as much autonomy as possible.

21. The second role is in long-term care. Our nurses are the mainstay and frontline of medical care in nursing homes and that is already happening. The residents in nursing homes are often frail, already sick, and their numbers are growing very quickly. We are building more nursing homes. We are anchoring more care in nursing homes itself, so as to minimise to-ing and fro-ing between nursing homes and acute hospitals.

22. We can strengthen this process through Nurse Clinicians who can lead care in the long-term residential care setting. This will require more empowerment to the Nurse Clinicians, and especially Advanced Practice Nurses (APNs) who are practising at the apex of the profession.

23. This is a proven concept in other countries that have aged before us, where studies have shown that having onsite Nurse Clinicians improve the quality of care in nursing homes.

24. For example, in a nursing home in New Brunswick, Canada, APNs form a key component of the care team, where they diagnose, manage, order interventions, and prescribe medication in collaboration with the facility physician. They conduct rounds regularly and guide staff in recognising early signs of illness. As a result, hospital transfers dropped, chronic conditions were better managed, and families felt more confident and more involved.

25. MOH is already driving this effort to further develop nursing competencies, practices and leadership to bring about what I just described in Singapore. We are working towards allowing Nurse Clinicians, starting with APNs, to assess and initiate first line treatments or medications, and to conduct six-monthly chronic reviews within defined protocols in nursing homes. This will help to minimise hospital admissions and emergency department visits, resulting in fewer transitions, and improving quality of care.

26. The development and deployment of Nurse Clinicians and APNs to long-term residential care settings will be one of our significant manpower transformation initiatives.

27. Third role, palliative care. Nurses have always played a crucial role by providing comfort and care to patients in their last moments, and journeyed alongside patients and their loved ones during difficult times. It is a well-established nursing role which we will need to scale up, and we can scale up, so that we can better deliver this vital service to our community, ensuring better end-of-life care for all.

28. These three transformations in nursing roles are just the beginning. We are also talking about practising at the top of their licence, ensuring better career progression. To allow better career progression for nurses, roles need to evolve and to be enriched. We are in a sector where patient growth is rising, and more work needs to be done. We have plenty of opportunities to enrich the roles and progression pathway of nurses. It is imperative that we do this. We need to extend similar role transformation to allied health professionals and pharmacists as well. But to achieve this, we need all hands on deck, as this is a system-wide effort that requires everyone to be aligned and committed.

29. In particular, we need the support of two groups. One is our Institutes of Higher Learning (IHLs), and second, our regulators, especially the Professional Boards who set the standards for the professions.

SkillsFuture in Healthcare

30. Let me start with the IHLs. To support healthcare workforce transformation, we need a robust training strategy. We have a traditional approach of manpower upgrading that is typically for pre-employment and tertiary students who want to be healthcare professionals. This traditional approach typically comprises training programmes that are quite long – couple of years or even longer – dominated by academic components, leading to higher qualifications such as Masters or Advanced Diplomas. And you apply this traditional approach to our existing professionals who are seeking to upgrade as well.

31. These programmes are rigorous, with high standards – no doubt about it. But as a tool for workforce transformation, they are neither adequate nor totally suitable. We need programmes that are modular, lasting a few weeks or a couple of months, with a strong emphasis on imparting skills that can be applied at the workplace immediately, leading at the end to a skills certificate.

32. The reason again, is straightforward. Adult workers are busy, we need to juggle multiple responsibilities, so training delivery must as efficient, relevant and practical as possible. This does not mean compromising rigour and standards of training. It is just a different way of training, and it is actually a very well-established alternate pathway. Instead of a big buffet, you are now serving dish by dish. At the end, you are still full. There is a good interval in between each dish. In many countries, such competency-based training can also stack over time into a Masters or Advance Diploma qualification.

33. This has in fact been the core design principle of the Continuous Education and Training (CET) programmes which today we refer to as SkillsFuture programmes. We need now a SkillsFuture strategy in healthcare.

34. We are already making some inroads into competency-based training in healthcare. We introduced the ITE Work-Study Diploma in Nursing last year, for in-service Enrolled Nurses to upgrade to Registered Nurses. We now have two Polytechnics delivering three advanced and specialist diploma programmes in palliative nursing, in both part-time and full-time formats. We are making preparations to shift these programmes to a more competency-based, work-study format in 2027.

35. But we will need to make a much stronger push on many more fronts, starting with the three nursing roles I just mentioned. MOH will work with our IHLs to achieve this. They have many years of experience in training adult workers, and they are key pillars of the SkillsFuture movement. They are not here in this room today, but they will read about it in the papers tomorrow, and I look forward to engaging them and seeking their support for this important change.

A More Flexible Regulatory Approach

36. Workforce transformation also requires a shift in our regulatory approach. Professional standards and health regulations are established for good reasons, but amid major changes, they cannot remain static and we all know that.

37. A regulatory framework should be a living system, constantly adapting to or even staying ahead of the changing landscape. We cannot sit still, and we cannot let reality run ahead of us, otherwise our system will become outdated and obsolete. By evolving ourselves constantly, we can fulfil our mission of safeguarding the safety of our patients and delivering good quality care to our patients.

38. For example, if our vision is to enhance the role of community nurses to provide more comprehensive care that is as early, as simple and as close to home as possible, then we need to review their scope of practice, equip them with advanced skills, and create clear guidelines for collaborative care.

39. If as regulators we disallow this evolution of practice, then the needs of an ageing population will not be met. Then we cannot profess that we can deliver a high standard of care in this kind of way

40. Whether we are MOH, HSA, HPB, Professional Boards and Councils or even our healthcare clusters – we are all regulators. We often see ourselves as gatekeepers of risks and disasters. We keep these disasters away, that is a noble mission. But this also creates a certain wariness and suspicion to changes amongst the regulators, which is very natural. But now, I would say there is tremendous potential for us to unlock our roles as enablers as well, on top of being gatekeepers, so that our system can evolve into something better and that we can be proud of, while still providing the necessary safeguards.

Closing

41. In closing, important work lies ahead, and I hope we can work actively together, towards transforming the healthcare workforce, driven by our common mission to deliver quality care to our population. I believe we will succeed, and when we do, the nursing profession will be even better. And when we gather again to observe 150 years of nursing, there will be a lot more to celebrate.

42. Finally, let me congratulate our award recipients. Do continue to uphold the ethos and dedication of nursing. Not only does your work benefit patients, I believe it is an inspiration to all Singaporeans. We are all very proud of what our nurses are doing. Thank you.