SPEECH BY MS LAI WEI LIN, PERMANENT SECRETARY (POLICY & DEVELOPMENT), MINISTRY OF HEALTH, AT THE NUHS QUALITY DAY, 9 FEBRUARY 2026

Dr Lim Yean Teng, National University Health System (NUHS) Board Member

Professor Yeoh Khay Guan, Chief Executive, NUHS

Professor Thomas Loh, Group Chairman, Medical Board (CMB)

Dr Quek Lit Sin, Assistant Chief Executive, Clinical Quality and Patient-Centred Care

Professor Quek Swee Chye, Executive Director, NUHS Institute of Clinical Quality

Ladies and gentlemen, friends and colleagues

1.          Good morning

2.          It is my pleasure to join you today at the NUHS Quality Day, with the theme "Bridging Quality Across Boundaries. For Better and Safer Care."

3.          Being from the Ministry and not a clinician, I am actually far from the frontline of delivering care and dealing directly with patient safety and clinical quality matters. 

a.    Infection control, medication safety and quality improvement – these have been well anchored deep in our public healthcare institutions. 

4.          Indeed, with our public healthcare system having matured, with many peaks of excellence, much of the Ministry HQ’s preoccupation in this century has been on two of the three legs of the healthcare trilemma – that is access and affordability. 

a.    So, we often discuss and fret - are our SOC (Specialist Outpatient Clinic) and admission waiting times too long?  

b.    Do we have enough capacity? When do we need the next hospital? Are our training intakes and foreign recruitment adequate?

c.     Is care affordable for patients?  Fiscally, can our tax base sustain the growing government healthcare spending? Is our nation’s total healthcare bill affordable for our economy and society? 

5.          In contrast, we always regard quality as core; without it, there is no point worrying about access and affordability. 

a.    So, we typically seek to achieve quality as a clear unyielding baseline, then we consider how to balance access and affordability. 

b.    With this, MOH’s focus is on monitoring specific quality and safety indicators, such as readmission rates or incidence of hospital-acquired conditions. 

c.     We then trust our public healthcare leadership – CEOs, CMBs, Chief Nurses and many more, all of you – to drive the efforts. 

6.          But our understanding has evolved over the years. 

7.          MOH and the Clusters’ mission, to steward a healthcare system that delivers quality care, remains accessible and is affordable, not only now, but into the longer term, has not changed. 

a.    But increasingly, we see how these three trade-offs in the ‘healthcare trilemma’ need not be a zero-sum game.

b.    Especially as we focus on pursuing Value.

c.     And especially if we work together, across boundaries.

Value-Driven Care (VDC)

8.          More than a decade ago, we started a major thrust in value-driven care. We scrutinised certain inpatient clinical pathways and zealously measured many things. Minimising variations not only reduces risks in patient care and improves safety, it also improves quality and reduces resource take. And when quality and safety improve, we get better value in return.

9.          So, value-driven care was a key milestone as we sought to bring together quality and safety, as well as value, in an integrative way, not as competing priorities, but as mutually reinforcing ones.

10.      NUHS has been a most committed partner in these efforts –

a.    You were the first Cluster to adopt Value-Driven Outcomes in 2015. This led the Ministry to adopt Value-Driven Care at the national level in 2017.

b.    Since then, you have also expanded your efforts to more than 70 conditions.

11.      And looking ahead, we are now working with the Clusters to progressively expand episode-based Value-Driven Care to cover end-to-end pathways.

a.    Examples include the expanded ischaemic stroke and chronic heart failure VDC programmes, with the Ministry playing a facilitator and convenor role wherever needed.

Health Technology Assessment

12.      In the last decade, MOH has also accelerated our efforts to drive clinically- and cost-effective care, building health technology assessment capabilities, in our Agency for Care Effectiveness, or ACE. 

13.      ACE rigorously assess treatments, drugs, devices and implants. And if they are proven to be clinically- and cost effective, MOH then extends the key financing levers, whether subsidy, MediShield Life or MediSave.  

a.    Before, we used to think of this as a zero-sum game. Extending subsidies to some drugs meant that others had to be deprioritised.

b.       But now increasingly, we are seeing how we can tell the pharma company when there is an opportunity to do so: meet our threshold for effectiveness, and we will extend subsidy, because this will increase take-up. And with higher sales volume, you will still be able to meet your revenue goals, even if you lower the price. And with this lower price, if they agree to do so, we're actually able to consider more drugs for subsidy.

14.      This is an example of how we have integrated quality and a resource lens to drive a win-win in value.  And that was actually the approach that we took for shingles and that we are able to put it under the subsidised list.

Patient-Reported Outcomes

15.      More than a year ago, we looked across our thrusts in safety, quality and value and crystallised it into a key MOH priority, Appropriate and Value-Based Care or AVBC.

16.      AVBC efforts include the elements that I have spoken about, such as value-based financing, adoption of clinically- and cost-effective interventions, addressing unwarranted variations and reducing waste.  It also includes a focus on outcomes measurement, not only clinical but also patient-centred outcomes.

17.      Patient-Reported Outcome Measures, or PROMs, are an important aspect of quality and value as well, because the impact of our interventions on patients’ immediate to longer-term quality of life is just as important as clinical outcome measures. 

a.    But our efforts in PROMs are still in development.

b.    Current efforts remain fragmented, with suboptimal collection of data, and underdeveloped and inconsistent adoption. 

c.     I would like to commend NUHS, for being one of the pioneers in the use of PROMs for selected conditions, helping to shift attention towards outcomes that matter to patients. And this is important as we learn how to do this better and together, and this journey of quality, safety and value can then continue.

Quality, Safety and Value as a Unified Imperative

18.      So, it is NUHS’ Quality Day, and I have intentionally shared about MOH’s thinking and priorities – not only on quality, but encapsulating patient safety and value-based care as well because these cannot be separate considerations.

19.      Quality cannot exist without safety, and neither quality nor safety can be sustained over time without attention to value.

20.      From a system perspective, healthcare organisations – even leading ones – often treat quality, safety, and value-based care as distinct, parallel efforts.

21.      However, from the patients’ perspective, these distinctions do not exist. They expect care to be better and safe. And they do not experience quality separately from safety, nor do they consider these aspects separately from value.

22.      So, what is increasingly needed across the system is a more deliberate effort to integrate these perspectives. 

a.    This entails designing care with quality, safety, and value in mind from the outset, and not as afterthoughts.

b.    This is also about shaping mindset and driving alignment. We need to help our staff make sense of how these multiple initiatives and requirements integrate and not see them purely as new disparate structures or reporting requirements.

c.     This also requires us to break down silos across departments, institutions, clinical and operational teams.

NUHS’ Role

23.      NUHS occupies an important position within our healthcare system, producing many innovations in quality treatment and value-based care.

24.      We have leveraged digital and data-enabled solutions to enhance patient care, improve operational efficiency, and support clinical decision-making. For example, conversational AI tools to help access clinical guidelines and support evidence-based practice. And AI-driven solutions that reduce repeat procedures and complications for patients with digestive conditions. This will be scaled to other specialties and VDC conditions.

25.      What you practise for better care has implications that extend beyond your walls.

a.    Your practices influence practice norms.

b.    Your data shapes understanding.

c.     And your improvement efforts contribute to national learning.

26.      Looking ahead, NUHS’ ability to integrate across safety, quality and value, and across organisational teams, will also be increasingly important, as healthcare demand continues to rise and care becomes more complex. 

Closing

27.      Quality Day is an opportunity to pause, reflect and examine how we can do better for our patients.

28.      It is not just a showcase of good technical programmes. It is a reminder of our shared responsibility to improve processes, reduce harm, and refine care models, across work teams, and across Clusters, and as part of a broader national effort to ensure that healthcare remains appropriate, trusted and sustainable.

29.      Quality, safety, and value-based care are expressions of what we believe healthcare should be. When they are integrated, they create systems that are resilient, trustworthy, and capable of learning. This is what Bridging Boundaries is about.

30.      Thank you for the opportunity to be part of your important day. I wish you a very meaningful and productive discussion.