SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT HMI INSTITUTE’S 20TH ANNIVERSARY AND GRADUATION CEREMONY, ON 31 OCTOBER 2022, 4.00PM AT KHOO TECK PUAT HOSPITAL LEARNING CENTRE

Dr Gan See Khem

Executive Chairman & Group Managing Director, Health Management International Pte Ltd

Ms Chin Wei Jia

Group CEO, Health Management International Pte Ltd

Graduands

Ladies and gentlemen

Distinguished guests

1.     Good afternoon. I am delighted to join HMI Institute once again.

2.     I have been associated with HMI Institute and your work for many years, since I was the CEO of Workforce Development Agency (WDA) in 2005. At that time, we already knew that the healthcare sector provides meaningful jobs with good careers and that the sector was short on manpower. We wanted to develop training programes, and developed the Workforce Skills Qualifications (WSQ) system to support that. The purpose was to help mid-career workers to gain the skills to enter the healthcare sector.

3.     Our argument was that there are only so many babies a year and every sector is chasing for those 35,000 babies. It is therefore not possible to rely on new cohorts of students to meet the needs of the healthcare sector. But there is a big existing reservoir of workers who, with the right incentives and help, can convert and enter a sector where the demand is high.

4.     So we were looking for partners. In those days, SkillsFuture Singapore was not part of the Ministry of Education, which means we could not go to ITE or the polytechnics  as it was not their mission yet. WDA was part of the Ministry of Manpower, so we looked towards the private sector and training partners to help us train mid-career entrants to enter the healthcare sector. We went around looking for partners and found that HMI Institute was a ready partner, as Dr Gan had been working on this even before we formulated our national Continuing Education and Training (CET) manpower policy.

5.     I am heartened that after so many years, HMI Institute continues to recruit, train and hold graduation ceremonies for its graduates. I want to thank Dr Gan and Ms Chin, and whole team at HMI Institute, for your important contribution to the healthcare sector.

XBB Wave

6.     I want to dial back a bit and talk about the pandemic. We are still in the middle of the COVID-19 pandemic, and I thought I will give a brief update today.

7.     The situation has stabilised, and life has gone back to normal. There is in fact much fatigue dealing with the pandemic and many people do not even want to think about COVID-19 anymore. Indeed, we are in a new phase of the pandemic, but not just in terms of people’s mentality and our safe management measures (SMMs), but in two other important aspects.

8.     The first aspect signifying a new phase of the pandemic is the evolution of the virus. In every society, there are now multiple sub-variants circulating. In Singapore, for example, we have BA.1, BA.2, BA.4, BA.5, BA.2.175, BA.2.10 and a few cases of BQ.1. In such a situation, where so many sub-variants are circulating, there is always the possibility that two of them meet and combine to become something new, what we call a recombinant subvariant such as XBB which is a combination of BA.2.175 and BA.2.10.

9.     But there is no reason for recombinants to be always more transmissible but less severe. It is a random process of nature, and a new recombinant variant could always take on characteristics of a parent variant that can lead to more severe illnesses. Fortunately, XBB was not like that.

10.     The second aspect of being a new phase of the pandemic, is that life in Singapore is now practically back to pre-COVID normalcy, and we have once again re-established ourselves as an international hub and open economy. Singaporeans travel a lot, and we are hosting many conferences and events that create opportunities and jobs for our people. This also makes us vulnerable because whenever there is a new sub-variant which is very transmissible, we can be one of the first cities in the world to experience it, just as we were one of the first cities in the world to have a wave that is dominated by XBB.

11.     So if you put the two together, we can have a recombinant that can be more dangerous and we can also be one of the first cities in the world to experience it. Therefore while there is a lot of fatigue, we cannot be complacent. We, at least for the Ministry of Health (MOH), and all our hospitals and all of us in healthcare, cannot be complacent. Singaporeans do depend on us. So we need to be prepared in case there is a nasty infection wave, and we need to have our contingency plans in place.

12.     A key response is our vaccine strategy. That is why we rolled out the bivalent vaccines to those aged 50 and above. It is very important for older individuals to keep your vaccinations up to date, because it is more likely that you may develop severe illnesses when infected with COVID-19. Even in the last month, two out of 100 infected persons aged 70 or above and not fully vaccinated either died or ended up in the ICU. Once you get vaccinated, that probability drops by fivefold at least.

13.     So far, about 53,000 individuals have taken the bivalent vaccine, including myself. Many are waiting to be eligible or due, and I hope more will come forward. In a few weeks, we expect to roll out the bivalent vaccines to the younger age groups below 50.

14.     In the meantime, the wave driven by the XBB recombinant variant is clearly coming down and that has also relieved some of the pressure on our hospitals. I believe we have most likely ridden through this wave successfully. This is another first, because we dealt with the XBB wave with practically no SMM restrictions, and had removed indoor masking requirements and vaccination-differentiated SMMs (VDS). We practically had no rules and yet we went through the wave quite safely and successfully. It shows that our resilience has gone up by another notch.

15.     For the XBB wave, the Multi-Ministry Taskforce (MTF) was very ready to reimpose indoor masking and perhaps targeted VDS should the situation worsen. Fortunately, the infection numbers peaked and declined much earlier than we modelled, and we can stand down this contingency plan, at least for now.

16.     I thought that it is important that if we were seriously thinking about it because we were uncertain what would happen, it was better to inform the public that we might do it. Now that we think things are better and we do not need to do, we should be honest that we are no longer thinking about it – until the next wave comes. It is important to always be very open with the public, what we are thinking of, what we might have to do, but only when absolutely necessary.

17.     As we recover from each wave, and we have had three waves this year, we removed more rules until we reached where we are today. But when we have no more rules to remove, like now, we have reached a new steady state. From here, we should expect that if we encounter an infection wave driven by a nasty variant, we must be prepared to reinstate some SMMs, such as targeted VDS or indoor masking. We will prioritise measures which will not disrupt our normal lives and work.

Role of Support Staff

18.     Let me talk about the people at the centre of the pandemic, who are our healthcare workers. The COVID-19 pandemic has called into sharp focus the men and women who form the backbone of our healthcare sector. Our healthcare workers have been very busy throughout the pandemic. In particular, since the start of this year with the advent of the Omicron wave, healthcare workers staffing the Emergency Departments (EDs) have to handle a large volume of patients. During the Delta wave, it was ICU that was very busy.

19.     Part of this is due to increase in COVID-19 patients. More significantly are the business-as-usual patients, which have increased in numbers. This could be because the pandemic has disrupted care for their chronic illnesses, they might have stopped taking their medications, and their conditions have worsened to the extent that one day, they don’t feel well and they come to the ED. Two, it could also be because COVID-19 infections have triggered a deterioration of their chronic illnesses several weeks later.

20.     Our clusters have explained the various steps they have been taking to reduce the workload at the EDs. They are working with MOH closely and we are doing whatever we can to ease the workload. The measures include encouraging non-emergency cases to go to GP clinics or Urgent Care Centres instead of EDs, discharging patients who do not need hospital care to a stepped-down care facility, and providing more care to patients who remain in the ED for four hours or more.

21.     We can all do our part to help our healthcare workers, by attending ED only during emergencies and taking our COVID-19 vaccines. Once we take our vaccines, if we are infected, we are much less likely to be severely ill and requiring ED services.

Building Up Manpower

22.     In the medium term, i.e. one to three years, we will need to further build up healthcare manpower. This will include strengthening the pipeline of care support staff, who play a critical role in our healthcare institutions. This will have to include new local entrants, foreign recruitment, and also mid-career conversions.

23.     Over the years, we have demonstrated mid-career conversions into the healthcare sector to be very feasible if we have good training providers such as HMI Institute. During the pandemic, many staff in service sectors such as airline cabin crew and retail sales assistants took up roles in healthcare support, which was a big help to our hospitals. When the economy recovered, we lost them with a lot of mixed feelings. On one hand, we are happy they can go back to their old jobs. On the other, we lost many valuable colleagues who despite their relatively short stay, became an integral part of the healthcare workforce. This whole episode demonstrated that it is possible for us to bring in mid-career entrants who can play a big part in contributing to the healthcare sector.

24.     Support care roles are also varied and interesting. They range from healthcare assistants who help nurses in attending to patients’ needs; therapy assistants who support our therapists in performing rehabilitation and treatment; emergency medical technicians who provide care before and during the journey to the hospitals, and patient service associates who play a critical role in our hospitals’ admissions processes.

25.     Our graduates today are from the SG United Skills (SGUS) programme. I hope you will soon take up one of the roles in our healthcare settings. I know that everyone has taken a big leap of faith to undergo the training at HMI Institute for the last two years, and you are now ready to start work in the healthcare sector.

26.     Having been involved in skills conversion programmes for many years, I know it is not easy to disrupt your life to take up a skills conversion programme mid-career. It takes courage, determination and sacrifice. To all our graduands today, congratulations on completing this milestone and I wish you a fruitful career in healthcare for many years to come. We will need you. In a big decision like this, nobody takes it alone. I know you have a lot of support from your family and loved ones, so I also want to thank your families for supporting you to take this courageous step.

HMI Institute

27.     Today is not just your graduation but also the 20^th Anniversary of HMI Institute. The format of your 20^th Anniversary celebration reflects the character of the HMI Institute that I know. Most companies will have a gala dinner for their 20^th anniversary, but you did none of that. Instead, you had a very dignified graduation ceremony for your graduands this years. I hope HMI Institute will always stay mission-focused, responsible, selfless and serious in making your contribution to the sector.

28.     During the pandemic, we needed to quickly train large numbers of swabbers. HMI Institute responded swiftly, as you did in 2005 when I asked for CET partners, by mounting and scaling up courses, and trained over 87,000 people to handle swabbing operations.

29.     In peacetime, HMI Institute partners the Agency for Integrated Care to train support care staff, incorporating both classroom training and on-the-job attachment into the formal training. HMI Institute has since offered close to 90 courses ranging from basic care and first aid, to leadership and people management.

30.     Today, HMI Institute is our only CET centre for healthcare, and has trained more than 6,000 graduates for a variety of healthcare roles over the years.

31.     Listening to Wei Jia speak just now, when I was in my former role in WDA and we needed a CET centre to partner us for mid-career training, we found a natural partner in HMI Institute and you already knew what was needed for the sector.

32.     And likewise, today, our challenge moving forward is an ageing workforce which I spoke at length in Parliament. We used to be able to get by with one healthcare system, which is the acute care system. If you fall very sick, come to hospital, we will treat you. As the population gets older, we need to fire up all three healthcare systems. The acute care system, the preventive care system, which is what Healthier SG aims to do, and lastly, the aged care system.

33.     The aged care system is really not about nursing homes. Once an old folk goes to a nursing home, they stand the risk of losing their sense of independence. They lose friends and their normal activities, and they can deteriorate very quickly. The way for us to keep our population healthy and manage our ageing profile is to take care of our seniors in the community, and bring healthcare out of the hospital and nursing home into the community. That is our biggest challenge when we confront the ageing demographic, but I am glad once again, without much persuasion, we have a natural partner in HMI Institute.

34.     20 years is a remarkable milestone. I wish HMI Institute all the best in your growth and development as a pillar of our CET and healthcare landscape. With your good work, you will change the lives of many workers, who can go on to make contributions in the healthcare sector, and in turn improve the lives of many patients. Congratulations.