SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT THE 16th TAN CHIN TUAN NURSING AWARD FOR ENROLLED NURSES 2022 CEREMONY, 21 NOVEMBER 2022, 4.30PM, AT THE LEE KONG CHIAN SCHOOL OF MEDICINE

Ms Chew Gek Kim, Deputy Chairman of Tan Chin Tuan Foundation

Mr Sebastian Tan, CEO and Director of D.S. Lee Foundation

Ms Paulin Koh, Chief Nursing Officer, Ministry of Health

Ms Samantha Ong, President of Singapore Nurses Association

Ms Lilian Yew, Chairperson of the award ceremony

Distinguished Guests

Award Recipients

Ladies and Gentlemen

     It gives me great pleasure to be here at today’s ceremony to show our appreciation to all our award-receiving nurses. Congratulations to all recipients of this year’s Tan Chin Tuan Nursing Award for Enrolled Nurses.

2.     Today, about 16% of our nursing workforce are Enrolled Nurses. Enrolled nurses play a very critical role in our healthcare system, with varied and very heavy responsibilities. These include monitoring patients’ vital signs; providing dressing and hygiene assistance; and assisting with rehabilitation programmes. Some of you take on enhanced roles, such as administering medication and even subcutaneous insulin injections, venepuncture, intravenous cannulation, and performing complex wound dressings.

Enhancing manpower capacity

3.     I want to take this opportunity today to also provide an update on two issues close to the hearts of many of our nurses, including our Enrolled Nurses. Firstly, the crowded situation in our hospitals, especially the Emergency Departments (EDs), which has been a significant burden on our healthcare workers, especially our nurses, over the past year.

4.     I have explained in Parliament recently, the main public health responses to a pandemic crisis are (1) social restrictions; (2) vaccinations; and (3) the healthcare system, when all else fail. The COVID-19 pandemic is not over. However we are in a new phase of our fight against the virus. In this phase, we have removed almost all Safe Management Measures (SMMs), adopted an endemic posture in the community, and life has largely reverted to pre-COVID-19 normalcy.

5.     At the same time, our vaccination coverage is very high, over 90% if you consider the basic first two shots of mRNA vaccine, or three shots of Sinovac vaccine. Whatever we administer today is to maintain our population resilience and strengthen it only at the margins, such as to infants and very young children, which means we are not going to make a huge difference in vaccination coverage and resilience of society against the virus.

6.     This means that the burden of endemicity and any new wave of COVID-19 will fall disproportionately on our healthcare system. Singaporeans are now able to resume normalcy in their daily lives because our healthcare workers are fully dedicated to taking on heavy caseloads, caring for patients, pulling long shifts, and rapidly adapting to the changing situations. 

7.     But this pace of work in our hospitals is not sustainable either. It also affects the level of service to other business-as-usual (BAU) patients. The EDs are crowded, because in a pandemic, the supply of available hospital beds has become very tight, which has resulted in some patients at the EDs having to wait quite a long time for admission. We must therefore find ways to mitigate and resolve the problem.

8.     Fortunately, bed occupancies, ED attendances, and bed wait times have improved as the XBB wave has subsided. Hospitals have feedbacked to me that the number of non-urgent ED patients waiting for beds is now about half, compared to the peak of the XBB wave. Patients who require urgent care have always been admitted immediately. The median wait times at EDs have fallen from about 7 hours two weeks ago, to about 4 hours now. It has come down quite significantly.

9.     However, we are still working hard to further reduce bed occupancies by a couple of measures – first, is to expand Transitional Care Facilities (TCFs) and second is to remove the ringfencing of beds for COVID-19 patients.

10.     TCFs admit medically stable patients from public hospitals, while they wait for their transfers to intermediate and long-term care facilities or for their discharge plans to be finalised.

11.     A few days ago, I visited our latest TCF – Crawfurd Hospital – which opened earlier this month on 4 November. It has 43 beds for transitional patients, of which about 15 are now occupied. While it is not a big number, it has helped relieve the inpatient load for its partner public healthcare institution, namely Tan Tock Seng Hospital. At the same time, we are actively working with Ang Mo Kio-Thye Hua Kwan Hospital to be a partner TCF in the north for Khoo Teck Puat Hospital.

12.     Let me now talk about the second measure, which is the ringfencing of beds just for COVID-19 patients. Hospitals are progressively standing down ringfencing of COVID-19 beds. The concept of treating COVID-19 as an endemic disease should rightfully be extended to hospitals, as it is applied in the community. Hospitals have various precautionary and isolation measures for patients with infectious diseases, and there is no longer a need for separate premises and separate hospital wards just for COVID-19 patients, and holding them to a different standard. These practices of segregation and ringfencing are adding significant work burden to healthcare workers, and sub-optimises the use of hospital bed resources in our hospitals.

13.     The transition will be done progressively. All hospitals are working on it, and I hope that in time, their full impact will be felt in mitigating the crowded situation in our hospitals, especially in our EDs.

14.     In the meantime, we are constantly looking to lighten our nurses’ very heavy workload, by tackling the problem of manpower shortage. During the pandemic, the competition for nurses by different countries has been intense, and we lost many of our good and experienced foreign nurses to other countries.

15.     We will need to replace the nurses we lost, and further expand our nursing workforce by building up both local and foreign manpower pipelines. Over the past months, we have been working on various efforts. We expect to progressively bring on board close to 4,000 new nurses by the end of next year. This is a significant number, about 10% of our current nursing workforce, and if you compare to 2021, it is 700 more additional nurses. The increase is somewhat backloaded, starting from around the middle of next year. You will see the ramp-up in the middle of next year, and all the way to the end of next year, to an estimated additional 4,000 local and foreign nurses.

16.     Of this number, there will be a higher proportion of foreign to local nurses, a split of about 60:40, to make up for the slowdown in foreign nurse recruitment due to COVID-19 border restrictions over the past two years, so there is some catching up to do. Even whilst we ramp up foreign recruitment to bolster our nursing workforce, the large majority of our nursing workforce, let me assure everyone, will continue to be local and contributed through our nursing school intakes and mid-career training programmes. Many thanks to Ngee Ann Polytechnic, Nanyang Polytechnic, the Institute of Technical Education (ITE), as well as our NUS Nursing School and Singapore Institute of Technology (SIT).

The role of nurses in Healthier SG

17.     The second issue is a longer term one, and has to do with the future roles of Enrolled Nurses. With Singapore’s ageing population and transformation of the healthcare system brought about by the Healthier SG initiative, we are shifting the focus of healthcare from curative to preventive, from hospitals to the community. This means that the role of Enrolled Nurses will evolve further, with new opportunities in preventive and primary care.

18.     Enrolled Nurses can play a key role in supporting patients to improve and maintain their mental, physical, and behavioural health in the community. You can educate patients on their recommended health screenings and lifestyle adjustments prescribed within care protocols. These are changes currently under deliberation and discussion. We will engage you in our conversations, and look forward to your continued contribution in transforming our healthcare system.

19.     This also means that we need to enhance the skills of our Enrolled Nurses to better prepare you for future healthcare needs. Your responsibilities will expand to be more fulfilling and exciting. For new nurses, as announced by the Ministry of Education (MOE) and ITE in April last year, ITE is enhancing its curriculum structure to enable all students to attain a Higher Nitec qualification directly. This will equip ITE students with deeper industry-relevant skills for employment and provide a stronger foundation for their future skills upgrading.

20.     The Nitec in Nursing programme will also be reviewed as part of this wider shift. The Ministry of Health (MOH) is working with ITE, the Singapore Nursing Board and MOE to review the Enrolled Nurse training, along with enhancements to the Enrolled Nurses’ scope of practice.

21.     As for existing nurses, we will work with the hospitals, training providers and also the Union, to enhance training support for you. That way, you will have the skills and confidence to take up new and meaningful roles and responsibilities under Healthier SG.

Recognising the efforts of nurses

22.     Our nurses deserve recognition for the tireless effort they have put in for their patients. I thank the D.S. Lee Foundation and Tan Chin Tuan Foundation for supporting this Award for the past 16 years. The award is the pinnacle of recognition for Enrolled Nurses who have displayed excellence and dedication in patient care and contributed to raising the profile of the nursing profession.

23.     Beyond serving as a tangible recognition of the excellent work of our Enrolled Nurses, it reaffirms our regard and appreciation towards our nurses and the work that you do. It is important to do so in a pandemic, especially at this phase of the pandemic when our three levers are down to one, and it really depends on our healthcare workers and healthcare system to carry us through the pandemic. You are the one who have earned the rest of society our freedom and our ability to lead normal lives again.

24.     Today, we recognise 10 outstanding nurses from both public and private healthcare institutions, including those in the community care sector. They are truly passionate about their work, always seeking to improve their work, always learning for tomorrow, and making a difference in their patients’ lives. They are also representative of the larger contribution and sense of purpose of the Enrolled Nursing workforce.

25.     To all recipients, my heartiest congratulations to you. May your stories continue to inspire many others. I wish you all the best for your future endeavours. And to the Foundations that have supported this award, I know you are supporting many worthy philanthropic causes, but I want to assure you that this one means a lot to the Ministry and our healthcare workers. Thank you very much.