The SingHealth HMDP Reception 2007

20 Jun 2007

By Ms Yong Ying-I, Permanent Secretary

Venue: National Dental Centre

It gives me great pleasure to join all of you here today at the SingHealth Health Manpower Development Plan (HMDP) Reception 2007.

Background

The Health Manpower Development Plan (HMDP) is MOH’s key manpower development programme for the public healthcare sector.  Its objective has been to systematically develop the clinical capabilities of our healthcare professionals so as to improve the overall level of care and health of all Singaporeans.  Since its introduction almost 30 years ago in 1980, it has funded the training of entire generations of our clinicians at numerous centres of excellence around the world.  Visiting experts also come to share their expertise. Through these, the programme has shaped not only healthcare capabilities in the public sector, but indeed the quality and approach to care by clinicians across the whole of Singapore.

Need to invest in line with national priorities

The HMDP programme will remain a lynchpin of our manpower development efforts.  However, as we continue to develop the healthcare sector to reach new peaks of medical excellence, as we innovate the way we deliver care, we will need to ensure that the HMDP programme also evolves to support our broader strategic thrusts.

As many of you would know, the HMDP programme was devolved to the clusters and statutory boards some 6 years ago so that institutions would be better able to manage training scholarships in line with the needs and strengths of each individual, department and hospital.  Today, MOH and the clusters co-fund the HMDP, drawing on government funds as well as the clusters’ own reserves.  I am heartened that SingHealth is supporting a record of 120 HMDP awards this year – this scale of awards is a powerful signal of SingHealth commitment to developing our human capital.  It is contributing $2.7m of funds from the SingHealth Foundation, to top up the $2m fund from MOH.

The approach today is heavily bottom-up.  Individual clinicians decide where they want to go for training and what training to get.  The selection committee determines whether this would be valuable to the applicant and to meeting Singapore’s needs. While a bottom-up perspective to granting HMDP fellowships remains important, we should complement this with a top-down sense of how the overall allocation of fellowships can strategically support the development of the healthcare system in Singapore. Are we training people to meet the changing disease patterns of Singaporeans?  Which are the next peaks of excellences that we hope to grow?  Today, I would like to talk briefly about 3 key developments in our healthcare landscape and how the HMDP programme can better prepare our workforce for these changes.

Growing healthcare demands

The first concerns the need for more healthcare manpower. With an aging population, work in our hospitals has become more complex. Patients are older and hence more ill, requiring more attention and skilled care.  Traditional staff ratios may no longer hold true with these changes.  Couple this with the development of Singapore Medicine, the Biomedical Sciences and Research initiatives as well as the opening of new hospitals - and it becomes clear that there is a need to increase our pool of doctors, nurses, pharmacists and other allied health professionals. We must train more locally, we must also bring in more from overseas.

This year, the ministry secured more funds from the Treasury, notably to raise the number of nurses in our system. Moving forward, our number of doctors and allied health professionals will also need to expand in tandem. The number of foreign schools whose degrees we recognise has been expanded significantly, paving the way for us to attract more international medical graduates to come and work in Singapore.

It is essential for us to beef up our manpower numbers but quality must accompany quantity.  HMDP and other training funds are therefore critical complements to ensure that we continue to raise quality of our manpower so that we can remain on the cutting edge of medicine.

National System of Integrated Healthcare

The second area I’d like to mention is the ministry’s push to integrate care across the tertiary, step-down, primary and community care sectors. Historically, our healthcare system has been very hospital focused.  This made sense for a young population where people might require a critical episode of care and hospitalisation but will recover fully again.  With an ageing population, however, the long-term management of chronic diseases becomes more important.  Old people may be well, able to live high quality lives but they need on-going medical care, advice and rehabilitative support.  They will certainly need stronger GP and nursing support in the community.  MOH made a start last year by allowing usage of Medisave to pay for the management of some major chronic diseases, in exchange for the documentation and tracking of the patient’s clinical condition.  This year, our Minister has announced that we will try to integrate our care delivery system, linking tertiary care with step-down care and care in the community.  This will be supported by national electronic medical records.

This change in care delivery has implications for manpower development.  Historically, we have focused our manpower training on hospital-based staff, to handle acute episodes.  Moving forward, we are trying to link tertiary care more closely to step-down and community care so that discharges can be planned more effectively and hospital stays reduced where possible.  Changi General Hospital is likely to lead the way in strengthening its collaboration with St Andrews’ Community Hospital.  This effort will require us to train many more nurses and allied health professionals, as well as social workers and case coordinators in the hospitals and in the community care setting.  We will need to strengthen the professionalism and the training of staff in the step-down care institutions.

Within hospitals, one of the new emphases is team-based care and hence team-based training. This is because care delivery increasingly requires integrated care across specialties and across professions – doctors and nurses in different specialisations, medical social workers and other allied health professionals must all work cohesively as a team to deliver holistic care to patients.  Specialists also need to work closely with family physicians so that care can be seamlessly continued into the community.  This integration between specialists and family physicians is something that Prof Ng Han Seong and Prof Tay Boon Keng have played strong leadership roles in driving in SGH.  This year, I am glad to hear that SingHealth is also introducing team-based awards for subjects such as multi-disciplinary chronic pain management. In 2004, I understand that Dr Tan Yah Yuen, a General Surgeon was awarded an HMDP fellowship to the University of California, San Francisco. On her return, she was able (first in TTSH, then in KKWCH) to bring together nuclear physicians, pathologists, surgeons and operating theatre staff for the new procedure – sentinel lymph node biopsy – which helped shorten the recovery time for breast cancer patients & reduce functional morbidity of the arm after curative surgery, with no reduction in relapse rates. With team-based training awards, I hope that more people will learn and adapt novel, team-based approaches to healthcare for our system.

Another area to fund is Healthcare Management and Administration. Historically, HMDP has been used to support the development of clinical capabilities.  Today, as we push for national integration of care and are increasingly confronted by rising patient expectations, managing hospitals is a complex service business that requires a multi-disciplinary team with the requisite range of skills.

Let me mention 2 sets of skills briefly.  The first is obvious areas like customer service management and public relations.  There are less obvious areas but important areas like customer credit counselling and cross-institution case management.  To help Singaporeans get the best care, we must not only be able to deliver the best care but also help patients connect to the right care they need. We have paid relatively less attention in the past to these and we should build capabilities in them.

The second area is training in areas like health services research and medical informatics, which would benefit greatly from having people with clinical foundations driving them.  Likewise, systems management of hospital operations.  In the name of cost-efficiency, we have chosen to run our general hospitals at or close to full-house. Managing this successfully requires an extra layer of managerial skills by people who have a deep understanding of clinical practice.  These include managing emergency loads and bypasses at the national level, a more sophisticated management of flow-through of patients from admission to discharge with a view to speeding up discharges while ensuring patient safety, and management of OT scheduling.  Issues like the development of more sophisticated algorithms for admission of patients has huge implications on bed utilization, hospital budgets and manpower resources.  This sort of work must be undertaken by clinicians, but with a managerial perspective.

I am glad to see that some clinicians and nurses have been sent on executive and MBA programmes. Today, many top Schools of Public Health deliver good programmes covering healthcare policy, hospital management and health sciences research, and we should also consider these programmes.  I would welcome more healthcare professionals leveraging our HMDP funds to build capabilities in these not-strictly-clinical areas that I’ve highlighted.

Medical Excellence

I’ve spoken about more manpower, the different skills required to deliver integrated care and a systems approach to running our very busy hospitals.  Let me now switch to something closer to many of your hearts which is pursuing new peaks in clinical excellence.

We must continue to develop our clinical capabilities systematically.   Medical advancement – in knowledge, in treatments, in drugs – is happening rapidly, and if Singapore wants to continue to be a medical hub and provide improved care for our people, we must continue to invest in clinical development.  MOH wants to support you in pursuing your individual interests and ambitions, but I believe we can better leverage your skill on your return when we know how this fits into a hospital-level or indeed national development strategy for individual specialties.  Where are we going in cardiology, or in muscular-skeletal disorders, or in cancer? The national-level strategising is necessary so that we are coordinated between our specialist training committees, our budget planning which determines the number of establishment posts at any point in time, and our HMDP selection panels which give training awards.

One of the new areas of skills that I’d like to speak about is Clinical and Translational Research.  The Singapore Government has decided that it will expand and extend its push in biomedical research.  Clinical research is now part of MOH’s mandate.  On our part, we must build up a critical mass of clinician scientists and researchers through aggressive investment in human capital development.

In line with this, the Specialists Accreditation Board (SAB) appointed the SAB Research Committee in Feb this year, to facilitate research training for specialist trainees who have a keen interest in research. This committee comprises well-known clinician scientists and researchers from among you. Together with this effort, the ministry will also look at increasing the training support for clinicians who, for example, are interested in pursuing a Masters in Clinical Investigation or PhD related to their specialty.

Conclusion

Let me just end by saying that the Ministry regards manpower development as perhaps the lynchpin of all our strategies to move healthcare forward.  Ultimately, whether we succeed in our various strategies depends on the quality and skills of our human capital.  MOH will therefore continue to support and expand the HMDP programme which is a key pillar of our manpower development strategy.  It will indeed grow in importance in the years ahead.

I congratulate all recipients of the HMDP award.  This opportunity for you to study in a top institution overseas will not only broaden your individual experience but enrich Singapore and Singaporeans with the new ideas, techniques and systems that you will bring home.  I offer all of you my best wishes in your studies and career ahead.