Opening Address by Dr Amy Khor, Senior Minister of State for Health, at the SingHealth Integrated Care Symposium, 10 Jan 2018

OPENING ADDRESS BY DR AMY KHOR, SENIOR MINISTER OF STATE FOR HEALTH & THE ENVIRONMENT AND WATER RESOURCES, AT THE SINGHEALTH INTEGRATED CARE SYMPOSIUM, 10 JANUARY 2018 

Prof Eric Coleman, Director of the Care Transitions Program, University of Colorado

Distinguished guests from the primary care, intermediate and long-term care (ILTC), and social service sectors

Friends and colleagues

Introduction

1.        It is my pleasure to be here this morning.  I am heartened to see representatives from various healthcare institutions, social service agencies and grassroots organisations gathered at this Symposium.

2.        The healthcare landscape in Singapore is undergoing an exciting phase of transformation. This inaugural symposium provides a timely platform for different care providers to exchange ideas and pioneer solutions to move the focus of healthcare beyond the hospital to the community.

The Way Forward: Care Integration

3.        In 2016, the Ministry of Health (MOH) outlined three major shifts that will shape our healthcare system to meet the changing needs of our population i.e. Beyond Hospital to Community; Beyond Quality to Value; and Beyond Healthcare to Health. These three shifts are critical in preparing us to meet our long-term healthcare needs in a sustainable manner.

4.        Every care provider – whether in primary care, acute care, intermediate and long-term care, or in the social sector – has a part to play in integrating care. When we work together to link up various parts of the system through seamless processes and workflows, we can provide a smooth and holistic experience for patients.

5.        It was for this key reason that the Ministry developed the Regional Health Systems several years ago.  More recently, they were reorganised into three clusters to enhance their capabilities and efficiencies and to better coordinate care services across a range of providers from both the public and private sectors.

6.        Caregivers are also key partners of the care team. As we develop links between inter-professional teams across care settings, we are mindful that linking in and providing adequate resources and support for caregivers is vital for care integration that is personalised and can be anchored closer to home.

7.        The aim is for these partners to work more closely together to deliver person-centred care, so that patients can move across care settings with ease and be assured of receiving timely and appropriate care.

Integrating Primary and Acute Care

8.        Over the past few years, the clusters have established new partnerships to deepen integration across care settings. As with the other clusters, SingHealth has actively reached out to do the same.

9.        Integrating primary and acute care is important in order for us to move healthcare beyond the hospital to the community. One good example is the SingHealth Delivering on Target or “DOT” programme, which right-sites patients with stable chronic conditions from our public hospital specialist outpatient clinics (SOCs) to partnering General Practitioners (GPs). Since the programme started in 2007, about 6,000 patients have been right-sited, with over 150 GPs on board.

10.        Currently, GPs islandwide look after 80% of our primary care needs. As we ramp up efforts to strengthen support for GPs, the Ministry has also enhanced the process for referrals from the polyclinics to SOCs. In 2014, MOH commissioned the polyclinic-SOC workgroups to streamline Orthopaedic Surgery, Gastroenterology, and Cardiology referrals. Since then, the workgroups have made good headway to develop standardised protocols to enhance referrals to SOCs. For example, patients with conditions like back pain can now be directly referred by their polyclinic doctors for subsidised physiotherapy services, without having to go through a specialist. This has helped patients to receive appropriate care in the community, reduced unnecessary referrals and delay, and allowed the specialists to focus on other patients with more complex conditions. 

Integrating Acute and Intermediate and Long-Term Care

11.        Community hospitals have an increasingly important role to play in the care continuum too. Patients who suffer from major illnesses requiring rehabilitation, such as hip fractures and stroke, benefit from smoother and early transfers from acute to community hospitals. The strong focus on rehabilitation at community hospitals’ helps patients with functional recovery so as to prepare them to return to their daily life at home, in the workplace and the community.

12.        Patients who needed surgery for hip fracture at Changi General Hospital (CGH) had their overall length of acute and community hospital stay reduced by about eight days, through an entire workflow process review, including through close collaboration with their partner, St. Andrew’s Community Hospital (SACH). CGH and SACH had developed an integrated pathway across both settings to ensure quality rehabilitation services for hip fracture patients transferring from CGH to SACH, resulting in the reduction on the length of stay and improvement of the quality of life for such patients. More than half the hip fracture patients had regained their pre-fracture self-care status at one year follow-up.

13.        Similarly, Singapore General Hospital (SGH) has been working with Bright Vision Hospital (BVH) on a Fast Track Admission (FTA) Programme since June 2015. This has resulted in closer collaborations between the clinical teams in SGH and BVH. For instance, the clinical teams work together to identify patients who require intensive rehabilitation or post-acute care early and expedite their referral, assessment and acceptance to BVH. Through this programme, the waiting time for admission to BVH has been reduced from about seven days to four and a half days 

Bridging Medical and Social Care

14.        Beyond medical issues, it is important for healthcare professionals to work with social care agencies to ensure that patients’ health and social needs are also effectively met.

15.        At the SingHealth Regional Health System, the SGH care team works closely with community partners such as NTUC Health, Thye Hua Kwan Moral Charities, and the Tsao Foundation to provide post-discharge care for elderly patients with complex medical and social needs to reduce their risk of readmission. I am encouraged to note that since its launch in April last year, the programme has benefitted about 3,000 patients in five Communities of Care located at Chinatown, Tiong Bahru, Bukit Merah, Katong and Telok Blangah. By end 2018, the programme will be extended to a total of 5,000 patients.

16.        This strong partnership is proof that many helping hands in the community can deliver person-centred care that ensures that patients, especially the vulnerable elderly, are well-supported in the community so that they can recuperate in the comfort of their own homes.

17.        Another programme which has made good headway is the Neighbours for Active Living programme, which matches trained volunteers in the community to elderly residents living near them. The volunteers help to keep a close eye on the elderly’s well-being and provide emotional support. If the volunteers spot any health issues, they will inform the community care team at CGH, so that timely intervention can take place. The close coordination between the care team and volunteers has halved the overall number of hospital admissions among residents with various conditions in the programme over a six-month period. The average length of hospital stay has also reduced from about seven days to four days.

18.        This programme started in the Eastern part of Singapore with only 50 volunteers, and has now extended to 18 communities, with more than 500 trained volunteers. It will be expanded to more neighbourhoods with the integration of SingHealth and Eastern Health Alliance.

19.        All these efforts help to build the capabilities and linkages within the Regional Health System for better care integration, with social care and grassroots entities playing equally important roles.

Nurturing a Healthy Nation

20.        As we scale up efforts to strengthen care delivery in the community, this may entail a greater strain on our healthcare resources if we do not have accompanying measures to mitigate healthcare demand. It is therefore also important that we continue investing in efforts that encourage Singaporeans to take care of their health and require less healthcare. As part of the War on Diabetes, MOH is looking at how patients with diabetes can be better supported to take greater ownership and participate more actively in managing their condition.

21.        For example, MOH is funding a three-year study conducted by SingHealth, to understand the effectiveness of a diabetes prevention programme. Targeted at pre-diabetic individuals, it consists of group exercises and health coaching classes, as well as cash incentives for those who lose weight. Patients at high risk of developing diabetes despite lifestyle changes may be started on metformin. Data gathered from this study will help us understand the impact of such interventions on our local population, and guide our continual review of the standard of care to prevent diabetes in Singapore.

22.        We recognise that health promotion efforts should not be limited to the elderly or individuals with ill health. Since 2013, Sengkang General Hospital has been promoting healthy living to primary school students in the Northeast, equipping them with skills to be Healthy Living Advocates. To date, the Millennia Kids Programme has reached out to more than 12,000 students and their families through healthy living workshops, activities and family carnivals. It pays to start early and I commend the team for coming up with this novel and fun idea to engage our young.

Conclusion

23.        This morning, all of us are here because of our mutual commitment to co-operation in achieving an integrated national healthcare system that will allow patients to receive care that is more effective, less costly and in more appropriate settings. I am confident that the lectures by Prof Eric Coleman and the sharing of ideas and best practices will lead to new synergies and partnerships. The Ministry will continue to support these efforts and foster meaningful partnerships towards better health, better care and a better life for all Singaporeans.

24.        I encourage you to seek out like-minded partners and start conversations on how you can leverage collective strengths to deliver care that matters most to patients. I wish you a fruitful time at this symposium. Thank you.