Senior Minister of State COS Speech 1: Building our Healthcare Manpower Capabilities

Mdm Chairman,

1.            MOH has put in place comprehensive plans under Healthcare 2020 to increase healthcare capacity across various care settings, so that we can adequately meet the needs of the population.

2.            Members like Dr Lam Pin Min and Ms Tin Pei Ling are right to highlight that the ability to attract talent and manpower into the healthcare sector will be key to our success in upscaling our healthcare capacity. As part of our Healthcare 2020 plans, we had projected that we would need about 20,000 more healthcare professionals including doctors, nurses, pharmacists and allied health professionals, between 2011 and 2020.  We have since made good progress. Between 2011 and 2013, the healthcare professional workforce grew by 6,000, an increase of 13%.

3.            Our doctor and nurse-to- population ratios have also improved as a result.  While they are lower than those in most OECD countries, they are comparable to developed regional economies such as Hong Kong and South Korea.  As we continue to expand healthcare manpower, we expect our ratios to increase further. We do not have ideal target ratios, as manpower ratios are also dependent on the structure of the local healthcare system and would shift over time with changes in technology, model of care, as well as demographic and disease profiles.

4.            Dr Lam Pin Min asked how we plan to further build up our manpower capability.  We will do so in three ways: by attracting young Singaporeans, growing new sources of manpower and topping up our workforce with foreign recruitment.

I.              Attracting Young Singaporeans

5.            First, to attract young Singaporeans into healthcare, we are expanding the intakes in our schools.  The health and aged care industries offer our young people good careers, which are meaningful and provide developmental and upgrading opportunities.  The Ministry wants to build and nurture a strong core of locals among healthcare professionals.

6.            With the opening of the new Lee Kong Chian School of Medicine at the Nanyang Technological University, our medical intake has increased by 17% to 413 last year. Our nursing intake has also increased by 9% to 1,682. We plan to continue growing the medical and nursing intakes to reach our targets of 500 and 2,750 respectively. This will be supported by our efforts to market nursing and allied health professions as fulfilling careers of choice through our “Care to Go Beyond” branding campaign.

II.            Growing New Sources of Manpower

7.            Second, we want to attract more mid-career professionals, those who have taken a break from their careers, housewives and retirees to join the healthcare sector.   Last year, 49 mid-career professionals received sponsorships for their training under the Healthcare Professional Conversion Programmes.

8.            Besides mid-career professionals, we are also reaching out to nurses who are keen to return to active practice. Many of them had taken leave from work to have children, study or look after elderly parents.  Last year, following an outreach exercise by MOH, more than 600 of them indicated interest to return to nursing.  A first batch of 27 has since re-joined the nursing workforce. Refresher courses and training allowances were provided to ease the re-entry of those who have left practice for some years. We will be engaging the remaining former nurses this year to attract more to come back and serve.

9.            As MOH aggressively expands the aged care sector with more nursing homes and eldercare centres in the community and more home-based care services, there will be ample new jobs that offer flexible work-hours close to home.  Singaporeans living in different parts of the island can walk to work if they work in these facilities. For example, Mdm Vivien Ow Wai Fong joined the Singapore Christian Home last month as a Health Attendant.  She helps the Home’s cook to whip up healthy meals for the residents.  The sprightly lady, who is 68 this year, walks to work every day.  According to Mdm Ow, “It is good to work here because it is nearby and I can save money and save time on transport.”

10.         This year, we will be working with aged care providers who are opening new facilities, to pro-actively reach out to residents living around them and offer them new jobs within the community.  Our Place and Train programme to train senior care workers has shown promising results. Under this programme, NTUC Eldercare re-designed the job functions of one full-time care worker into three distinct job roles which can be taken up by part-time workers. More than 100 Singaporeans have since been recruited by NTUC Eldercare, and trained to take up jobs in their day care and home care services.

11.         We need even more Singaporeans to step forward and contribute to the care and well-being of our elderly. We are working to extend the Place and Train programme to more providers. There will be a series of job fairs later this year and I urge Singaporeans to consider joining this meaningful sector. 

III.           Foreign Recruitment

12.         Third, even as we grow the local pipeline of healthcare workers, we still need to supplement our workforce with foreign-trained professionals.  In FY2012, we awarded pre-employment grants to 102 Singaporean medical and dental students studying overseas.  This is a 50% increase from the 68 students in FY2010.  We will continue to encourage overseas Singaporeans to return.

13.         We will also recruit qualified foreign professionals who can meet our registration requirements and help them adapt to our local working environment through language courses such as Mandarin, Chinese dialects and Malay courses, orientation and immersion programmes, as well as mentorship and supervision. This would help them to improve their communications with patients, a point raised by Ms Sylvia Lim.  There are also interpreters in our public healthcare institutions who can help to translate when necessary.

IV.          Enhancing Retention

14.         Besides stepping up recruitment, my Ministry has been working to better retain staff in the public healthcare sector, so as to maintain a strong Singaporean core of healthcare professionals, a point which Ms Sylvia Lim raised.  I have heard from many public sector doctors and nurses that they enjoy working alongside other healthcare professionals to provide patient-centric, team-based care, especially to patients with complex conditions in the public healthcare institutions.  Many also appreciate the opportunity to serve their fellow Singaporeans.  The public sector also offers our healthcare professionals the unique opportunity to undertake research and to nurture future generations of healthcare professionals. In fact, these are key reasons why many of our healthcare professionals choose to remain in the public sector. 

15.         However, there are those who choose to leave for other reasons, such as the flexibility to choose their working hours and patient cases, the desire to own and manage their own clinical practices, and the opportunity to earn more.  While we may not be able to fulfil all these aspirations in the public healthcare sector, we can do more to recognise the important roles that our healthcare professionals play, by paying them competitively, fairly, as suggested by Mr Patrick Tay and Mrs Lina Chiam for nursing, and supporting their professional development.

16.         In 2012, we implemented salary increases for 45,000 healthcare workers in the public healthcare sector.  Come April this year, we will complete the implementation of the new remuneration framework for 4,000 senior public sector doctors.

17.         The new framework aims to reinforce the public healthcare mission and ethos.  It recognises doctors not only for excellence in clinical care but also for excellence in their roles in education, research and administration.

18.         The link between pay and performance for specialists and family physicians as measured by the outcomes in clinical care, education, research and administration will also be strengthened. For example, a surgeon who treats patients and also teaches specialist trainees can now be further rewarded for good outcomes if he has low unscheduled returns to the operating theatre, and if the specialist trainees he taught gave him good feedback. 

19.         To keep pace with the market, to pay our doctors fairly for their tireless, selfless efforts, the base salary of senior public sector doctors will be adjusted upwards by 9% from April this year.   This increase will be over and above the pay increment given in April 2012. Senior public sector dentists will also be covered under the new remuneration framework and receive the same pay adjustments as doctors.

20.         Nurses, as Mrs Lina Chiam has noted earlier, also play a vital role in our healthcare system.  They touch the lives of many individuals, and increasingly, nurses are also leading the change in healthcare and taking on new roles such as Advanced Practice Nurses or APNs. The National Nursing Taskforce, comprising representatives from the nursing profession, public healthcare institutions and my Ministry, was convened in end 2012 to chart the future direction of nursing.  This Taskforce is working on several fronts – enhancing nurses’ roles, improving nursing education and professional development, facilitating career progression and increasing recognition and rewards. The Taskforce expects to complete its review and submit its recommendations in the second half of this year.

21.         Allied health professionals are another integral part of healthcare. To equip our allied health professionals with greater in-depth knowledge and stronger skills to manage the increasing number of patients with complex conditions, we have been working with our tertiary institutions to open up good quality degree upgrading pathways for our diploma-trained professionals. In 2012, the Singapore Institute of Technology or SIT launched degree programmes in physiotherapy and occupational therapy. Later this year, SIT will also introduce degree programmes in diagnostic radiography and radiation therapy.  This is in addition to the existing part-time degree programmes offered by the Singapore General Hospital’s Postgraduate Allied Health Institute.

22.         Over the past two years, we have also rolled out several initiatives to enhance the attractiveness of lifelong careers in the ILTC sector. These included funding to subvented providers to hire more staff and to raise pay, enhanced subsidies to support continuous training and development of staff, as well as a centralised employment scheme for therapists. From April this year, the Agency for Integrated Care or AIC will be raising the maximum subsidy level for training courses offered by the AIC Learning Institute from the current 80% to 90%. This will enable providers to send even more staff for training, in tandem with the sector’s desire to further raise the quality of care provided to patients.

V.           Driving Innovation and Productivity

23.         Let me now move on to the issue of productivity.  Ms Tin Pei Ling and Mr Low Thia Kiang spoke about the need to drive innovation and reduce the need for manpower in healthcare.  We are mindful that healthcare is a labour intensive industry and we can never do away with the personal touch.  But we agree that we can use technology and LEAN management practices to simplify workflow processes, so that our healthcare workers can focus on what is most important, and that is, caring for the patients. 

24.         For example, through the use of a mobile app called Nurses Pal, nurses in SingHealth’s hospitals can now more quickly identify patients who are at risk of developing pressure ulcers, and carry out early interventions to prevent their conditions from deteriorating.  This is designed by the SingHealth nurses themselves. The app provides a reference guide that nurses can use readily without having to leave a patient’s bedside. Nurses only need to enter into their smartphones the patient’s conditions such as the state of alertness of the patient.  The app then calculates the risk level of the patient developing pressure ulcers, and recommends the appropriate interventions such as changing the patient’s lying position every two hours. 

25.         The National Healthcare Group Pharmacy also introduced a Multi-dose Medication Management System which uses robot machines to pack patients’ medicines into individual sachets according to the prescribed dosages and the time they need to be taken.  This is especially useful to patients with multiple chronic illnesses who have to take several different medicines a day.  About 3,200 patients in 16 nursing homes are currently receiving medicines in these individual sachets.  This has reduced the time spent by nurses in managing the medication.  At the NHG Pharmacy, a two-week supply of medication for residents in a 200-bed nursing home can now be packed in one and a half man-days instead of twenty man-days previously. 

26.         The examples I have just quoted illustrate an enduring culture of continuous improvement and innovation that we strive to build in the healthcare sector. 

VI.          Conclusion

Mdm Chairman, a well-trained and adequate healthcare workforce is key to the success of our healthcare system. MOH is actively building up our manpower capabilities and driving innovation and productivity, in order to adequately meet the healthcare needs of our population. Thank you.