SM Goh Chok Tong at the NUH 25th Anniversary Gala Dinner

More and better Healthcare Professionals

Time has indeed flown before our eyes. Twenty-four years ago (1986), I was the Guest-of-Honour at NUH’s official inauguration. It was a significant milestone then, as NUH was our first restructured hospital. NUH was expected to demonstrate how a hospital, freed from civil service norms and regulations, could be more responsive and cost-effective in delivering health care to Singaporeans. The experience of NUH was positive and all our government hospitals have since been restructured.

NUH has grown rapidly. It now has about 1,000 beds and employs 5,500 staff. I congratulate NUH, as it commemorates its 25th Anniversary, on fulfilling its mission of providing excellent health care, producing pioneering clinical research and educating a whole generation of healthcare professionals.

Transforming Healthcare Education

Worldwide, governments face the challenge of providing affordable, timely and good quality healthcare to their citizens. The demand for health care in developed countries will rise exponentially with ageing population, advances in medical technology and knowledge, and rising expectations. Many developed economies will have difficulties catching up with demand, given their budget deficits.

Fortunately, because of our fiscal prudence over the years, our healthcare payments system and emphasis on individual responsibility, we are less constrained than most developed countries in addressing the supply side of the healthcare equation. Here, I would like to commend MOH on providing our population good medical care. But the job is never done and MOH has to ensure that the supply side of medical care does not lag behind the increasing demand.

We have just opened the new Khoo Teck Puat Hospital in Yishun. Within the next 4 years, another general hospital will be ready in Jurong. NUH itself is also constructing a new 20-storey Medical Centre comprising specialist outpatient clinics. Such increases in physical capacity will require more doctors, nurses, pharmacists, physiotherapists, occupational therapists and other healthcare professionals. Tonight, I shall focus on how MOH will produce more and better healthcare manpower.

We have been steadily increasing the intakes for Medicine, Nursing, Pharmacy and Allied Health in NUS and the polytechnics. But beyond numbers, quality is paramount. Our healthcare professionals will need to learn new techniques and technologies, and work in multi-disciplinary teams to treat and manage increasingly complex conditions.

New Medical School

Over the weekend, Prime Minister Lee Hsien Loong announced that Singapore will be setting up a third medical school, a joint partnership between NTU and Imperial College, London. The new medical school will do more than just supplement the local pipeline of doctors from the existing two medical schools. The new medical school will also build on NTU’s and Imperial College’s strengths in science and technology to generate new knowledge and innovations to help in the diagnosis and treatment of diseases, for example, in studying the application of robotics to surgery, and in developing new devices that act as extensions of a surgeon’s eyes and hands.

Emphasis on holistic care

While each of the three medical schools will develop its unique education philosophy, all three serve the same higher purpose, which is to equip doctors with the necessary medical skills and ethical values to deliver holistic care. What do I mean by holistic care?

From a layman’s point of view, I see at least two important elements – prevention and integrated care. Holistic care starts well before a disease is even diagnosed. I would like to see the doctors of tomorrow playing a bigger part in educating patients on maintaining health, and to partner them effectively in managing their conditions.

Next, holistic care involves delivering integrated care. I have heard comments that our doctors are sometimes too specialised and do not look at patients as a whole, but only the specific problem that they are treating. This is not holistic care. Tomorrow’s doctors must take a holistic view of the patient and his or her problem, and be even more comfortable stepping beyond their own area of expertise to work with other members of the healthcare system, across organisational and professional boundaries, in order to deliver integrated care.

I asked, and MOH gave me the example of a diabetic patient who develops eye and foot problems. He would not want to be cared for by his endocrinologist, ophthalmologist and podiatrist, as if he had three unrelated problems. He will also need a pharmacist to explain to him the dosage, effects and how to manage his medication. He will need advice from a diabetes nurse clinician to educate him on the likely complications and health implications, and learn to monitor his blood glucose levels and self-administer insulin injections. From a dietician, he will need advice on how to manage his diet. He would not want these healthcare professionals to work in isolation in caring for him. Rather the patient would want the healthcare professionals to work as a team with his care manager, to ensure that the patient is able to bring his condition under control. This requires far more than technical competency. It requires a strong sense of ethics, an understanding of the patient as a total human being with anxiety needing empathy and support, and the ability to work as a team, acting always in the best interests of the patient.

Improving postgraduate medical training

At the postgraduate level, we took the first step this year to transform the way doctors are trained, with the introduction of the residency programme. Our public sector hospitals already have a strong legacy of teaching and nurturing generations of good doctors. With the residency programme, our goal is to build on this strong foundation, so that all doctors working in Singapore will eventually have access to quality postgraduate training.

Beyond hard science, patients expect their doctors to help them make informed choices on treatment options. Patients expect doctors to be reassuring, to empathise with their predicament and yet motivate them to make the necessary changes in lifestyle and habits to improve their own health. Therefore, under the new residency programme, emphasis will be placed not just on the development of medical knowledge and skills in patient care, but also on other qualities such as interpersonal & communication skills, commitment to continuous learning and improvement, and systems-based practice. The impact of this transformation will be significant, as it will anchor the training of all specialists and family physicians in Singapore.

I welcome in particular MOH’s renewed focus on Family Medicine. Family Physicians manage complex chronic diseases and enable patients to be cared for within the community, outside of acute hospitals. This not only benefits patients, but also reduces overall healthcare costs. When patients require the attention of a specialist, their Family Physician can help them manage the interface with the acute hospital. This is why MOH is launching the Family Medicine residency programme, which aims to build a corps of well-trained family physicians. This will strengthen the primary care sector as a vital component of our healthcare system.

Nursing & Allied Health Professionals

A well-trained healthcare workforce extends beyond doctors. Across the world, there is a shift towards team-based care, where nurses and allied health professionals play an important role in deciding the treatment of patients, and help drive improvements in the model of care delivery. These professionals are the backbone of our healthcare system but are generally not given the same pride of place as doctors. I am glad that MOH is paying more attention to the training of nurses and allied health professionals, and giving them a longer and more satisfying career path.

The last few years saw the introduction of the NUS nursing Bachelor’s, Master’s and PhD degree programmes as well as the development of Advanced Practice Nurses, or APNs. APNs are equipped with postgraduate qualifications and are able to work as independent partners to doctors in their areas of expertise. For example, APNs in Cardiology help to review the suitability of patients for cardiac rehabilitation, initiate pre-treatment investigations and work with patients to develop health management plans. APNs who specialise in Diabetes Care, can independently review patients. With these highly trained APNs running clinic consultations, we can free up doctors to focus on the more complex cases, and reduce clinic waiting times.

Similarly, allied health professionals will be playing a key role in assessing patients’ conditions, and devising effective therapy plans. We need to better equip them with the skills and knowledge to perform a wider range of work, and to manage the increasingly complex technologies applied in health care today. We have increased the number of overseas scholarships for allied health professionals and will continue to send our good students abroad for such training. We are also looking at raising the local training of physiotherapy and occupational therapy to degree level by linking up with a good foreign university.

As the role of allied health professionals in health care grows, we also plan to introduce legislation to regulate the allied health professions. This will raise standards and improve consistency of service. As with nurses, allied health professionals can play a role in transforming the way health care is delivered.

The Next Lap – Advancing the Mission of an Academic Medical Centre

As a university hospital, what is NUH’s role and responsibility in this capacity and capability building? NUH, being part of the National University Health System Academic Medical Centre, has to achieve excellence in all three parts of its mission: providing quality, affordable clinical care to patients, advancing translational clinical research and educating our future healthcare professionals. NUH is in a unique position to tap on the close synergies between clinical service, education and research. Each of these elements exists not in and of itself, but because it plays a vital role in the system to enhance healthcare standards for our people. A good healthcare education should equip our healthcare professionals with the skills and perspectives to lead service innovations. And the goal of research is to develop better, more cost-effective diagnosis and treatments for patients.

NUH must therefore build on its achievements, and lead the way in analysing and measuring the clinical and cost effectiveness of treatments. Also, NUH should track and compare its clinical outcomes with those of other world-class institutions. In areas where we are not among the best in the world, NUH should assess why we are behind and find ways to improve. As an educator, NUH must develop more effective ways of nurturing future generations of healthcare professionals, as well as strengthening the culture of mentoring and public service ethos among them. It is my hope that just as NUH has blazed the trail as the first restructured hospital, it will do so again in showing how we can bring about real health benefits to our people.

Conclusion

Once again, I congratulate all members of the NUH family, past and present, for their contribution to the excellence of NUH and for providing high quality care to Singaporeans and others. NUH has achieved much but it has more to achieve.

Thank you.