OPENING ADDRESS BY MR EDWIN TONG, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE SINGAPORE HEALTHCARE MANAGEMENT CONGRESS 2019, ON TUESDAY 20 AUGUST 2019, 9.20AM, AT THE MARINA BAY SANDS CONVENTION CENTRE

Professor Ivy Ng, Group CEO, SingHealth

Mr Tan Jack Thian, Organising Chairman, Singapore Healthcare Management Congress 2019

Delegates

Distinguished speakers

Colleagues and friends

    I am delighted to join you this morning in what I think will be a marvelous experience, a great platform to exchange ideas and certainly one where you can not only gain knowhow, but also gain a few friends. This session and congress promise to bring thought leaders together, and I think it is opportune and timely, not just learning from within the healthcare sector, but also learning from experiences outside the healthcare sector. After all, there is no monopoly of good ideas, and what might be workable outside the healthcare sector can certainly be deployed within healthcare.  

2    All of you are here today because in one way or another we contribute to the healthcare landscape. Some of you would be frontline healthcare professionals, others are sited within the backend team, playing a behind-the-scenes, but no less important and critical, support role. Both groups make serious, meaningful contributions to our healthcare landscape. We all care about good, efficient delivery of care and that is why we are here to pick up ideas, to learn best practices and to exchange knowhow.

3    We are operating in an ecosystem where healthcare cost is rising. I think it almost goes without saying that healthcare cost and an ageing population are the twin challenges that we face in our environment today. Rising cost, low Total Fertility Rate, giving rise to smaller families so the pool of caregivers for care recipients will only shrink as the years progress. Our population demographic, in terms of our ageing profile, is steeply rising. About 420,000 Singaporeans are 65 years old today, and in about 10 to 12 years, that number will more than double to 900,000.

4    It is a sharp incline and a very steep acceleration of the demographic profile and with it, healthcare cost as well, as the healthcare burden on healthcare caregivers will rise. It is not sustainable for the healthcare budget. It is one of the highest components of the budget and it has been sharply rising over the last couple of years. So there is a pressing need to look into healthcare transformation, specifically how we can deliver care outcomes that matter to patients. We have to remember this – whatever we do in terms of care delivery and care transformation, the patient remains at the heart of what we do, and so with that caveat, we have to make sure that we deliver care in a more cost effective and, in the long term, sustainable manner.

5    You will cover a range of different topics in the course of the next three days, such as A.I. data analytics, cybersecurity, risk management, leadership and talent management, a wide spectrum of skillsets matter directly in how we manage ourselves better in healthcare. All are very important, but let me say something in the next few minutes about how we can transform care delivery.

 ENABLERS IN TRANSFORMING CARE DELIVERY

6    The demand for healthcare continues to grow with rising incidence of chronic diseases and more complex medical conditions. We have started intervening upstream, go up as far as we can to treat patients even when they are well, to look after their diet, to make sure they are encouraged to have a good healthy diet and active lifestyle, and of course to take proactive steps to screen and pick up diseases early. We are starting along that, making a big push, but it will take some time for this to have some effect on the health demographics of our population. So we still need to meet the here and now of healthcare demands, and with tightening resident labour force growth, it will be unsustainable to keep growing manpower at the same pace.

7    Against this backdrop, we have started our healthcare transformation journey to develop new ideas and innovation to meet future demand. We try to cater ahead of the demand and build resources ahead of what we expect we might need in the immediate future, and with that, we always cast the line on the population and demographic profile. Increasingly, technology can play a bigger and bigger role. Technology not only has the potential to revolutionise how care is delivered, but also make incremental yet important improvements to our healthcare system.

8    All of you, as administrators, whether frontline or backend, deal with the issues hands on, day in and day out. You are all well-placed to identify appropriate tools and process changes necessary to improve productivity, step-by-step, to develop better systems, to improve workflows and work processes, and also to gel them and moderate the manpower needs. You all play an important role in effecting and facilitating change to ensure that healthcare services remains affordable and sustainable in Singapore.

AUTOMATION TRANSFORMS CARE DELIVERY TO PATIENTS

9    Sometimes we hear that people are resistant to technology because it is often seen as the one big cloud that takes over the jobs. I challenge you to think differently, to look at how we can use technology. Technology does not replace healthcare workers because there is care in healthcare workers. That is irreplaceable by technology. But artificial intelligence and technology can help to leverage upwards in terms of the manpower needs. If we learn to integrate technology into the work processes and system flows, that will free up our healthcare workers for more important and more direct patient management needs. Let me share with you some examples of how technology has played a part in transforming care delivery.

10    Before the Pneumatic Tube system at the Singapore General Hospital (SGH) was introduced in 2008, more than 8,000 specimen cases were delivered manually by SGH porters from the inpatient wards to the laboratories each month. 8,000 work flow, on average every day, you see the porters going up and down. Not only is that a use of time but it is also use of physical space that demands the use of corridors that are already tight, and demands the use of lifts. By 2017, the Pneumatic Tube system had reduced the quantity of specimens delivered manually by 80%. It was a sharp use of technology resulting in a sharp decline of manual delivery. This frees up the porters, not to take over their jobs but it frees up the porters to do a different job, to support more critical areas such as transferring patients from ward to ward, location to location, and delivering medications to the wards. This has resulted in more than 40,000 man hours saved. No jobs were lost and staff continued, in some cases retrained but continued, to be gainfully employed in areas where it matters most – helping to deliver good quality care to the patient.

11    By automating manual processes, SGH staff are empowered to put the “care” back into healthcare, and I think ultimately that is the goal of today’s discussion, that is the goal of a good healthcare management system. And this is the part that technology cannot replace – to devote more time interacting with patients, understanding their needs, trying to create programmes that best nurture the recuperation and recovery that is best suited for their needs. I am pleased to note that SGH is now looking to use the pneumatic tubes to further reduce the time needed to transfer medication from the inpatient pharmacy to the wards. I have seen some demonstration and it looks pretty amazing.

INNOVATIONS IN SUPPLY CHAIN MANAGEMENT DRIVES IMPROVED OUTCOMES WITH LOWER COSTS

12    Beyond the use of technology in transforming the way care is delivered to patients, another important aspect of healthcare transformation is the transition to value-based care. To put this simply, it means driving improved patient outcomes at lower cost. That is really quite the Singapore way of doing things – same output at lower cost and if you can manage it, better output at lower cost. But in order to do this, I think managers need to have a deep appreciation and deep understanding of the processes that are important. It is only then that they can identify systemic and process changes, take advantages of economies of scale, harness resources and then pull them together to deliver better outcome at lower cost.

13    Earlier Mr Tan mentioned ALPS, transforming the way in which the numbers of posters that we see here and also the number of exhibitors. In 2018, ALPS was set up. The purpose was to pool procurement and supply chain management so that the resourcing and procurement functionalities of the three healthcare clusters can be better organised. The aim is to achieve greater economies of scale, create synergy, develop new capabilities and evolve innovative supply chain solutions across public healthcare spectrum. Through the economies of scale achieved by bulk procurement, public healthcare institutions are able to lower their purchase cost and in turn, pass on the savings to patients. Ultimately, that is what matters most – that we procure all these stuff, harness all these economies of scale so that patients get to benefit from them.

14    For example, a box of 50 diabetes strips sold at outpatient pharmacies in public healthcare institutions which was previously sold at around $70 is now available to patients at around $20, less than half the price. That means about 70% savings for patients. When the drug Losartan had to be taken off the market, ALPS played a critical role in sourcing for alternative drugs for our public healthcare institutions, as well as securing sufficient supply for the patients who were affected.These examples demonstrate the positive impact of being able to look at it not just from the perspective of one or two large clusters, but across a spectrum of healthcare industry as a whole, to look at supply chain management solutions that apply across the board. I encourage you as you engage in discussions over the next few days, to continue to explore such innovative solutions, such economies of scale in other areas as well..

 CLOSING

15    Healthcare transformation is a constant evolution. I think the phrase by definition means that you have got to keep transforming. And you can only do it better if you understand the processes of healthcare, and are prepared to be bold and innovative in our work, to learn and to adopt the best practices from others. As I had said, no one has a monopoly of good ideas. If you think there is a good idea, share it. If someone has a good idea, copy it and adapt it. But all of these must always be aligned with one question and one question only – what is in the best interest of the patient?

16    Ultimately, we hope that the front and centre of what we are trying to achieve, what we want to do, how we want to transform, and to what we want to transform, will be guided by the interest of our patients. So I wish you three days of bonus and innovation, three days of fresh ideas and also borrowed ones, as you exchange knowhow and experiences. I hope you will not just leave this forum and congress with more ideas, more innovation, more bonus, but also with some new friends and new contacts because sharing, especially across industries, is what makes learning vibrant and lifelong.

17    On this note, thank you very much for your contributions to healthcare sector and I wish all of you have a fruitful and engaging meeting. Thank you.