Speech by Senior Minister of State for Health, Dr Amy Khor at the MOH Committee of Supply Debate 2017

Introduction

1.        Madam Chair, we need to grow our healthcare workforce to support increasing healthcare demand due to an ageing population and growing chronic disease burden. We also need to transform our healthcare workforce in order to support care transformation that Minister Gan spoke about, so that we can sustainably achieve better health and better care for all.

Growing our healthcare workforce

2.        The positive news is that growth in the healthcare sector will bring many good jobs, clinical and non-clinical, and at different levels, for Singaporeans. In the next 3 years, we estimate that about 9,000 additional staff will be needed for new facilities and services in the public healthcare and aged care settings. Approximately 50% of these jobs are PMET level roles. These include nurses, therapists, administrative executives and operations managers.

3.        Dr. Chia Shi-Lu and Mr Patrick Tay asked what the Ministry is doing to help Singaporeans access these jobs. We will support young school leavers to join healthcare. Over the past 5 years, the number of graduates for medical and allied health has generally increased while the number of graduates for nursing has decreased. However, we have made consistent efforts in the past few years to enhance nursing in terms of career progression, professional development and recognition. The positive news is that intakes have increased. MOH has attracted more students to join nursing programmes in ITE, polytechnics and NUS, from 1,500 in 2012 to over 1,800 in 2016. Overall, our intake for nursing has increased by 20%. We will continue to sustain efforts to enhance the attractiveness of nursing.

4.        Mr Christopher de Souza suggested that we develop our local allied health professional workforce. In 2016, MOH worked with the Singapore Institute of Technology (SIT) to introduce four degree-level Allied Health programmes in Physiotherapy, Occupational Therapy, Diagnostic Radiography and Radiation Therapy. 230 students were admitted in the first cohort. This year, SIT will be increasing the number of places for these AHP courses by 30% to 300 students for fresh school leavers and mid-career professionals.

5.        I agree with Mr Patrick Tay that we would like to attract more mid-career Singaporeans into healthcare. MOH will invest an additional $24m over the next three years to enhance our healthcare conversion and training programmes, to enable more mid-career Singaporeans to take up new careers in the sector.

6.        MOH and Workforce Singapore (WSG) have established Professional Conversion Programmes (PCPs) for mid-career Singaporeans to be trained as Registered and Enrolled Nurses, Physiotherapists, Occupational Therapists and Diagnostic Radiographers. The latest PCP for Dental Surgery Assistants (DSAs) was launched in November 2016. Since 2003, over 1,000 locals have participated in the Healthcare PCPs. 

7.        This year, MOH will further increase funding for nursing PCP training so that employers co-fund only 10% of the training cost, down from the current 20% to 50%. We will also provide new on-the-job training support of $12,000 per mid-career enrolled nurse and $16,000 per mid-career registered nurse to employers. The funding will encourage employers to admit more PCP-trained nurses and enable them to better support these nurses in their transition to a new career. We will also tap on MOM’s new Attach and Train scheme to enable more mid-career Singaporeans to take up PCP nursing training.

8.        Besides enhancing the local professional conversion programme, MOH will introduce a new overseas nursing scholarship under the Healthcare Graduate Studies Award (HGSA) for non-nursing degree graduates, including fresh graduates and those with prior work experience. Awardees can pursue an overseas Graduate Entry Masters (GEM) nursing programme and will join the nursing profession as registered nurses after their studies. They will be fully sponsored for their nursing course, including tuition fees and maintenance allowances. We target to give out 20 such nursing scholarships annually.

9.        There are also non-clinical roles for PMETs in the healthcare sector. Our public healthcare clusters will offer administrative and executive positions under WSG’s PCP for Professional Executives, in areas like human resource and hospital operations. The Regional Health Systems (RHSes) will be training more mid-career Singaporeans as Care Coordinator Associates, to coordinate the care services required by patients post-discharge and empower patients to manage their conditions well at home. Several public hospitals have created Basic Care Assistant positions to help nurses provide personal care to patients such as feeding and transferring. This will free up nurses’ time to concentrate on their clinical duties. MOH will be providing employers with on-the-job training support of $10,000 for each Basic Care Assistant hired. The public hospitals aim to recruit about 200 Singaporeans for these part-time positions over the next three years.

New jobs in aged care sector

10.       There are even more job opportunities in the aged care sector.  In the past 5 years, MOH has increased aged care capacity substantially and is on track to increase our nursing home capacity to 17,000 beds by 2020, an increase of 33% from 2016. We have also improved the designs of nursing homes to provide more greenery, and a cosier living environment. Since 2014, we have also put in place the Enhanced Nursing Home Standards (ENHS) which was developed in consultation with the sector to not only guide consistent, safe, and quality care in homes, but also to ensure that the psychosocial needs of residents are met. MOH conducts licensing checks to ensure that nursing homes uphold these standards. We impose measures, such as a shorter licensing period, on nursing homes with severe or repeated non-compliances. The licensing period of each nursing home is available online for the public’s reference. We will continue to support the sector in improving their quality of care, including sharing good practices beyond the enhanced standards amongst providers.

11.       But the needs for aged care are not and should not be met by nursing homes alone. In fact, most Singaporeans prefer to age at home, so we should work towards making nursing home care an option of last resort. To achieve this, MOH is strengthening home and community care options to help seniors avoid institutionalisation, and age comfortably at home and in the community. Between 2016 and 2020, MOH aims to increase day and home care services by 40%. Today, many seniors are also cared for at home by foreign domestic workers and the government provides foreign domestic worker (FDW) grant to some 6,900 households caring for seniors. With home care, centre-based care, trained domestic workers and nursing home places, we can adequately support the needs of seniors in 2020 and beyond.

12.       The growth in the aged care sector means we have new job positions for care staff across the island, offering Singaporeans a chance to work closer to home. In 2016, AIC helped 400 locals find jobs in the aged care sector through four job fairs, with about 25 participating aged care providers.

13.       This year, AIC will enhance the Community Care Traineeship Programme (CCTP), which is a Place and Train programme, by including more structured bite-sized training under the Programme to help Singaporeans take up healthcare and therapy assistant roles. In addition, MOH will provide on-the-job training support of $10,000 to employers for each new care worker, to better facilitate mentoring, supervision and development of the new hires.

14.       Besides care staff, the aged care sector will need PMETs to join its workforce to lead the new institutions. Mid-career Singaporeans with managerial experience can tap on the Senior Management Associate Scheme (SMAS) to switch careers to the aged care sector.

15.       In addition, MOH will enhance our “Return to Nursing” programme to encourage non-practising local nurses to rejoin the healthcare sector, and in particular, to take up new positions in the aged care sector. Non-practicing nurses employed by aged care providers will receive support for their refresher training course fees, and draw full salaries now, instead of training allowances during their 3-month training. They will also be able to enjoy a bonus of between $3,000 and $5,000 for transiting into the aged care sector.

Building a Future-Ready Healthcare Workforce 

16.       Madam Chair, we need to nurture a future-ready healthcare workforce that can support our efforts to transform our healthcare delivery.

17.       Ms K Thanaletchmi asked about the Ministry’s efforts to further develop the nursing profession. MOH set up the National Nursing Taskforce in 2012 to strengthen the development of the nursing profession. We have since enhanced professional development, career advancement and recognition for nurses.

18.       Going forward, we will have to meet higher healthcare needs with a more constrained workforce. This challenge would be felt more acutely for the nursing profession as the over 34,000 practising nurses currently form the largest professional group of the healthcare workforce. Also, nurses are needed to anchor primary and aged care to lead care transformation.

19.       Therefore, MOH set up the Future Nursing Career Review Committee in April last year, comprising nursing leaders from across the different care settings. The Committee has identified three strategic areas of focus, namely Care, Community and Competency, to develop a future-ready nursing workforce.

20.       The first area of focus is job and process redesign to enable nurses to focus more on patient care. We encourage public healthcare institutions to undertake a comprehensive review of nurses’ roles so that they can spend more time on direct patient care and take on deeper nursing care roles. For example, SGH has introduced a digital nursing handover notes system to minimise the time spent handing over patients’ case notes between shifts. Experienced Enrolled Nurses (ENs) can be trained to take on more complex procedures such as wound care, administering oral medications and giving subcutaneous and intramuscular injections.

21.       The second area of focus is to develop community nursing. If we want to go beyond healthcare to health, we need nurses to deliver preventive health in the community. If we want to go beyond hospitals to the community and home, we need nurses to support patients with good day and home-based care. The Regional Health Systems will expand the existing pilot manpower partnership scheme, under which they hire and deploy nurses across their community care partners. RHSes will also pilot a community nursing team network comprising nurses and support care staff to provide seamless care for patients from hospital to home and help seniors age in place. The RHSes have started a network of community nursing teams providing preventive and transitional care in the northern and eastern regions, which have served over 3,000 clients to date.

22.       These RHS-level community services and partnerships with community providers will give nurses greater exposure to different aspects of community nursing for a more diverse career. MOH will work with the nursing profession to develop Community Nursing as a distinctive career track in its own right, with a comprehensive competency framework that covers the skills needed for different roles in the community. This will underpin a more holistic system of training and deployment of community nurses.

23.       We will start building a pipeline for nurses to enter the community care sector. MOH plans to introduce a Community Nursing Scholarship later this year to attract ‘O’ and ‘A’ level students into nursing with specialisation in community nursing. The Community Nursing Scholarship will support students who choose to undergo the nursing diploma or degree courses, and offer them clinical attachments with community institutions and work in the community care setting after graduation. They will be further supported to undergo the Advanced Diploma in Community Nursing to gain deeper skills in community nursing. The scholarship will also support in-service nurses who are keen to join community nursing to deepen their skills via local and overseas programmes. We are targeting 20 community nursing scholars annually. This exposure to community nursing will also become part of the leadership development of nursing leaders so that they will gain competencies across both acute and community care.

24.       The third area of focus is on developing competencies to prepare nurses for the future. A more fundamental review of our nursing training system is needed so that we can better support nurses in developing deeper, future-ready skills in their nursing career. For instance, we will need to enhance the recognition of the skills and competencies that ENs have acquired at work to facilitate experienced ENs to undertake an accelerated diploma upgrading course to become RNs. For RNs, the Advanced Diploma courses will be reviewed to support more flexible, modularised ways of learning so that more can upgrade themselves. MOH has convened a Nursing Education Executive Committee (NEEC) comprising nursing leaders and will complete its review by 2018. 

25.       Over the next few months, MOH will work with the Healthcare Services Employees’ Union and healthcare institutions to engage nurses through focus group discussions to hear more ideas to implement the Committee's recommendations.

26.       With these three shifts, nurses can look forward to more meaningful and dynamic careers across the acute and community care sectors. With more time dedicated to direct patient care, nurses can better focus on what they are trained for and what they are passionate about. Patients can look forward to more integrated care and care within the community.

27.       Beyond nursing, we are working to build a future-ready healthcare workforce across all healthcare professions. MOH is collaborating with SkillsFuture Singapore (SSG) to develop a Skills Framework for the healthcare sector to support healthcare workers in their professional and career development. For a start, we will focus on developing the Skills Framework for nurses, physiotherapists, occupational therapists, speech therapists, pharmacy technicians and support care staff. This is targeted for launch in end-2018. MOH is working closely with MSF to ensure that the Skills Framework is applicable to their counterparts in the social service sector.

28.       We will further develop the capabilities of our pharmacy workforce. Last year, we implemented the National Pharmacy Residency Programmes to train specialist pharmacists, with a total of 15 residents enrolled to-date. In addition, we are developing advanced pharmacy practitioners through the Advanced Practice Competency Framework for Pharmacists. This framework serves as a developmental tool for pharmacists to gear towards advanced level competencies. To up-skill our pharmacy technicians, we developed the SkillsFuture Earn and Learn Programme leading to an Advanced Diploma in Pharmaceutical Sciences in collaboration with Nanyang Polytechnic. This 18-month structured work-learn programme aims to enhance core competencies of pharmacy technicians so they can take on bigger roles. Training for the first batch is slated to start in April this year.

29.       Even as we grow and develop our healthcare workforce to meet current and future needs, we recognise that with a shrinking local labour workforce, we will need to supplement our core local healthcare workforce with foreign manpower. Currently, foreign doctors and nurses make up 16% and 33% of our total medical and nursing workforce respectively. The proportion of foreign doctors has decreased from 18% in 2012. We will work to help our foreign workforce assimilate to the local environment to meet our healthcare needs.

30.       As Dr Chia Shih Lu mentioned, it is also important to ensure that good staff are retained. Through various efforts, we have reduced public healthcare staff attrition rate from 10.1% to 8.4% between 2012 and 2016. Attrition for nurses has decreased from 8.4% in 2012 to 6.5% in 2016.

Caring for Our Seniors

31.       But the formal workforce is only one part of our care system. Caregivers play just as, if not a more important role in our healthcare ecosystem. A/Prof Daniel Goh asked about our plans to support caregivers of seniors. We have expanded home and centre-based care services as well as respite care services, including weekend respite at our Senior Care Centres (SCCs,) where caregivers can place their loved ones to be cared for, while they run errands or take a short break. The Agency for Integrated Care (AIC) also started a three-year pilot since September 2015 to embed more comprehensive caregiver support services within 5 SCCs. These include supporting caregivers’ emotional and psycho-social needs, and assisting them with information and referral services. For caregivers requiring further assistance, the SCCs will also link them to a central pool of social work support. AIC has also rolled out AICareLinks centres at five hospitals and at its office at Maxwell Road. These are one-stop counters where caregivers can receive advice on services and schemes. Caregivers can also call AIC’s Singapore Silver Line to receive assistance over the phone.

32.       The government has also supported households who need to hire foreign domestic workers (FDWs) to care for seniors and disabled persons, with a reduced Foreign Domestic Worker levy of $60 per month, and a Foreign Domestic Worker Grant of $120 per month. We also provide an annual training grant of $200 for caregivers of seniors and persons with disabilities.

33.       MOH is also leveraging on technology to care for seniors. We have started several pilots on senior monitoring using technology, in Yuhua, Bedok and Marine Parade. Under the Community Network for Seniors pilot in Tampines, Eastern Health Alliance is piloting a call centre service called “Careline” to support seniors living alone. Seniors enrolled in the service can call the Careline should they need help. Careline will also make regular calls to seniors and provide them with useful health information. In line with Dr Lily Neo’s suggestion, we are also working with MND and HDB to study new forms of housing and care options for seniors to age-in-place.

Community Mental Health

34.       Prof Fatimah Lateef, Ms Tin Pei Ling, Mr Dennis Tan, and Ms Joan Pereira asked about support for mental health. MOH will further strengthen care in the community over the next 5 years in five ways.

35.       First, to improve the early identification of mental health symptoms, frontline staff of selected government agencies such as HDB, SPF, NEA, community partners, and social service agencies, will receive basic training on mental health conditions. They will be trained to identify and respond to persons with mental health issues in the community, such as referring these persons to AIC for help. We will also continue to create more Dementia-Friendly Communities (DFCs), where residents, businesses and other partners are trained to identify and assist seniors with dementia.

36.       Second, we will strengthen our response to mental health needs in the community. AIC will act as a “first responder” to mental health needs identified in the community, and coordinate care across the health and social sectors. Community partners and caregivers looking after persons with mental health needs may call the Singapore Silver Line (SSL) or email for assistance and support. By 2021, we target to respond and support about 1,000 cases a year, up from the current 500.

37.       Third, we will expand mental health and dementia services in polyclinics, to make care more accessible. Our target is for one in two polyclinics to implement mental health clinics by 2021.

38.       Fourth, MOH and MSF will work together to strengthen integrated health and social care services in the community. AIC will partner and support social service agencies, so that they can support clients with stable mental health conditions. We will also expand our network of community outreach teams from the current 18 to 50 by 2021, to educate the public on mental health, and reach out to vulnerable and at-risk individuals. MOH will increase the number of allied health community intervention teams from 14 to 18 by FY2021, to support GPs, community and grassroot organisations in caring for persons with mental health conditions.

39.       Finally, we will strengthen IMH’s post-discharge “after-care” support. MOH will resource IMH to widen their case management support so that more IMH patients would be supported in the post discharge period and transit well back home. IMH expects to be able to support an additional 3,000 patients over the next 5 years, on top of the current 8,000 patients.

Enhancement of Tobacco Control Measures

40.       As we move beyond healthcare to health, we need to do more to tackle factors that contribute to ill health and diseases. Tobacco use is one such major contributor in Singapore. HPB has a programme called “I Quit” that supports smokers to quit. It will extend the programme’s outreach though roadshows at various community and workplace settings this year.  

41.       We want to protect our young from the harms of tobacco, and lay the foundation for good health. In Singapore, nearly half (45%) of smokers become regular smokers between the ages of 18 and 21 years.  According to a report by the World Health Organization, persons who do not start smoking before the age of 21 “are unlikely to ever begin”. Findings from Needham, Massachusetts, the first US town to increase its Minimum Legal Age (MLA) for sale of tobacco from 18 to 21 years, are promising – youth smoking rates have fallen more rapidly here compared to neighbouring areas. At least 215 localities in the US, including New York City and the states of Hawaii and California, have since increased their MLA to 21 years. Between December 2015 to March 2016, HPB conducted public consultation on further tobacco control measures. The feedback showed considerable support for raising the MLA in Singapore.

42.       MOH will take further steps to reduce, if not eliminate the opportunities for our young to be tempted and take up smoking before 21.  We will propose legislative changes to Parliament within a year to raise the Minimum Legal Age for sale of tobacco products to minors, from 18 to 21 years.  The change will be phased in over a few years.

43.       We are taking steps towards standardising tobacco packaging. Australia, France, and the UK have all implemented standardised packaging. We have closely studied the experience of these countries, and see significant value in moving in this direction, so as to reduce the appeal of tobacco products, particularly to youths, and raise the visibility and effectiveness of health warnings. We will conduct a further public consultation on standardised packaging this year to seek additional and more detailed views on possible standardised packaging measures. We will carefully review relevant considerations including public health, intellectual property and international law perspectives and ensure that any measures taken are consistent with our domestic law and international obligations.

44.       We will continue to monitor international best practices in tobacco control and will adopt appropriate measures to control tobacco use.

Conclusion

45.       In conclusion, as healthcare needs continue to increase, we need to make bold changes in our healthcare delivery and workforce, so that we can achieve our vision of better health and better care for all Singaporeans now and in the future.