SGH Pathology Building Groundbreaking Ceremony

25 Sep 2007

By Mr Khaw Boon Wan

Venue: Singapore General Hospital

"Building Hardware, Software and Heartware”

Distinguished guests

Ladies and Gentlemen

In the last 10 years, our total population increased by 813,000 or 22%. This was mainly due to immigration rather than local births. For the next 10 years, we can expect a similar increase as our total population shoots towards 5.5 million, with a high probability of overshooting.

This has major implications for the health sector.  In most countries, the healthcare system only needs to prepare for gradual organic growth and ageing of the population.   In Singapore where immigration is significant, our burden is more severe as it is harder to predict such trends.  While organic growth is easier to project, immigration rate depends on a host of factors, including the prevailing economic growth rate.  When we couple this with the long lead time in putting up a hospital or training a medical specialist, it is a real challenge for my Ministry to get our healthcare infrastructure and healthcare manpower projections right.  When we underestimate demand, the result is over-crowding at hospitals as we now experience at the Tan Tock Seng Hospital.  If we overestimate demand and oversupply, we end up with under-utilized assets, a costly outcome.  Between the two, I prefer to slightly under-supply than to over-supply as this will put pressure on ourselves to intensify usage and minimize over-consumption.

This morning I want to share my Ministry’s projection of our healthcare infrastructure needs over the next 10 years.  A 10-year capital development plan will inevitably be tentative, requiring regular reviews and updates in the light of new information.  A rolling ten-year plan is an important part of healthcare planning.

There are 7 key elements in our current 10-year plan.

(1) General Hospitals

First, general hospitals.  The new Khoo Teck Puat Hospital with about 557 beds is under construction and will open in 2010.  We are looking beyond 2010 and have started planning a new general hospital in the west.  Alternative sites are being evaluated.  Now that we have decided to retain Alexandra Hospital until this new hospital is open, we can take some time on this project.  In any case, we should not add to the current construction boom and pay unnecessarily for higher tender prices.  But we will have the new hospital in the west open before 2015.  It is likely to have 500 to 600 beds.

(2) National Specialty Centres

Second, national specialty centres.  As I explained last week, we will support a second heart centre and a second cancer centre at NUH, to meet the rising burden of these two top killers.  Some infrastructure expansion will be required and we are currently studying the requirements.

Separately, we will rebuild the National Heart Centre which is bursting at its seams.  Since its inception, its outpatient attendances have more than doubled, far exceeding the capacity that the building was originally projected to serve.  Over at TTSH, we will redevelop the Communicable Diseases Centre (CDC) by consolidating existing CDC1 and CDC2 facilities. Learning from the SARS experience, we consider this an urgent piece of infrastructure against the backdrop of the risk of bioterrorism and the very real threat of a global flu pandemic. The new CDC will strengthen our capabilities and will house a National Public Health Laboratory and an Infectious Diseases Research Centre. 

We are studying what new national specialty centre(s) Singapore will need by 2015 so that we can keep moving up the medical specialization value chain and meet Singaporeans’ rising needs for better healthcare.

(3) Support Facilities

Third, support facilities, like the SGH Pathology Building that we will shortly ground-break. The pathology laboratory provides critical information for doctors in the clinics and wards to accurately diagnose patients’ conditions and monitor progress in the treatment.  Demand for pathology laboratory services has grown significantly and we expect this trend to continue.  Meanwhile, the emerging field of molecular medicine is going to revolutionize diagnosis and treatment.  The new pathology laboratory will allow our doctors and scientists to participate in the research and development in this exciting area and to provide new test services for our patients.

Besides, the new SGH Pathology building will consolidate several laboratory service sites at one location. In so doing, it will enhance integration, enable effective deployment of equipment and manpower, and raise workflow efficiency.  This will improve turnaround times and service delivery for the benefit of the patients.

(4) Teaching and Research Facilities

Fourth, teaching and research facilities. We need to invest in new academic and research facilities to grow our medical capabilities. The second medical school, a joint venture with Duke Medical School, is being built across the road.  It should open in 2009. 

Additional research infrastructure including laboratories will be needed to support the next lap of biomedical science development.  We are adding a Tower Block to the new SGH Pathology Building for our clinician-scientists to conduct their research. The co-location of research labs with the Pathology Building in an integrated complex of twin towers is to facilitate closer interaction and collaboration between researchers and pathologists. This could potentially translate research findings to preventive therapies, better diagnostic capabilities, innovative cures and treatment modalities.  This will directly benefit our patients.

(5) Primary and Step-Down Care

Fifth, primary and step-down care facilities, such as polyclinics, community hospitals and nursing homes, will have to expand to meet the needs of a rapidly ageing population. Queenstown Polyclinic is being rebuilt, with more capacity to better meet the needs of our patients.  Other polyclinics will be enhanced in due course.   New nursing homes will also have to be built when demand increases.

Technology improvement is also allowing us to provide many of the diagnostic and treatment services that previously had to be located in the hospitals in the community.  We have set up the Jurong Medical Centre in Jurong West to provide a wide range of diagnostic and specialist services to residents there.  This is more convenient for the residents and relieves some of the load from the overcrowded hospital facilities.  We will learn from the Jurong Medical Centre experience and build more of such facilities.  

Meanwhile, the Renci Community Hospital next to Tan Tock Seng Hospital is being built with 124 beds for convalescent care and about 150 beds for the chronic sick.  I encourage the management and professional staff of both TTSH and Renci to collaborate closely so that their patients can move seamlessly between them to be treated at where it is most appropriate and cost-effective.  Co-location is an advantage for both facilities as we have learnt from the Changi General Hospital-St Andrew’s experience.  Recognising these benefits, we have reserved adjacent plots of land for community hospitals whenever we develop new hospitals. We have done so for KTPH and will do the same for the proposed hospital in the west.  

(6) New And Less Developed Services

Sixth, there are new and less developed services which will become necessary with a shifting social context and particularly an ageing population. For instance, mental health is a growing concern, hence the theme for the National Healthy Lifestyle Campaign.  We need to ramp up capabilities to manage dementia and treat addictions, such as problem gambling, which may grow, and synthetic drugs.  We are working towards setting up a National Addiction Management Centre to provide a more holistic approach to help people overcome their addictions.

Hospices, and support facilities for home palliative care to facilitate ageing in place are other areas that we will look into. There are many tentative ideas being studied. Fortunately, these facilities will only require a shorter lead time to realize and execute after we have determined their feasibility.

(7) IT Infrastructure

Seventh, IT infrastructure.  It is the key to enabling patient-centric, integrated care, and seamless service provision.  A national Electronic Medical Records Exchange (EMRX) is necessary to support healthcare delivery that is integrated nationally, between the different sectors and among the diverse providers. We are now piloting the extension of EMRX beyond the public sector hospitals and clinics to the community hospitals.  Our public hospitals have started to innovate at the forefront of healthcare IT.  Early results indicate significant reduction of preventable medication errors and allow us to gain new insights on our diabetic population in the case of disease management.  Such IT exploitation will require major investments both in IT infrastructure, and clinical change management.

Capital Development Budget

These are the major pieces of healthcare infrastructure that we are putting in over the next 10 years.  They are all big ticket-items.  Together, they will cost us more than $ 2 billion and will position our healthcare sector for 2015.  The expansion in infrastructure will in turn push up our operating budget which will have to be jointly funded by all the major stakeholders: government, employers and patients. 

Patients who are well off can and should shoulder a higher burden.  If they choose subsidized services, they should get lower subsidy than those who are less well-off.  That is why we need means-testing.  Government will remain the largest payor for the subsidized facilities.  Government subsidy at 80% for Class C and 65% for Class B2 remains unchanged.  But as the total cost goes up to support a higher level of care, the patient’s co-payment in dollar quantum will inevitably go up too.  A 15-minute consultation costs more than a 10-minute consultation as more doctors will need to be employed to handle the same patient load.  That is why it is necessary for public hospitals and clinics to periodically adjust their fees.  But we are mindful to keep the adjustments moderate and total fees affordable.  The key is to remain prudent in our healthcare spending and ensure that we only spend on what is necessary. This is our commitment to Singaporeans.

Beyond 2015 

Beyond 2015, we will have to consider the upgrading of old facilities.  SGH was newly open when I started working.  In 10 years’ time, it will be 40 years old.  Indeed SGH doctors tried to persuade me to rebuild it now. NUH too wants to rebuild to intensify land use.  I told both of them to wait as we have other urgent priorities such as this one.   Their rebuilding projects will have to be after 2015 and spread over several years.  But we need to do masterplanning for the sites now so that any short-term additions or changes, like this SGH Pathology Building, will fit nicely into the longer-term plan for the campuses.

As the population grows beyond 5.5 million, we will also need new general hospitals and other facilities. Hence sites are being reserved now at places like Woodlands and Sengkang, to meet such future development needs.

More Than Hardware

In healthcare, hardware is important and we need it, but they play only a minor part.  What is more important than hardware is our software that will enable us to use our resources efficiently and effectively. We have to find a more creative way to maximize the use of expensive resources.  We have to find more innovative ways to meet patients’ needs in a cheaper way.  All over the world, medical inflation exceeds general inflation.  Some countries are worse than others.  We are among the better performers but even then, it is the same story of growing health expenditure as a percentage of GDP. 

Ours is 4% now, the best among developed countries.  But 10 years ago, it was only 3%.  10 years from now, it will surely be higher but how much higher?  5%, 7% or worse?  Japan is now at 8% and rising.  I discussed this with the Japanese Health Ministry.  They said that they would be satisfied if it stays within 10% of GDP forever.  But they did not give me clear ideas on how they propose to ensure this.  I also discussed with the Korean Health Ministry.  They too worried about the rising trend and the absence of a clear proven strategy to rein in rising healthcare cost.  All of us lament at the US’ rate of 16% and despair at the fact that it is still accelerating.  Serious economists are now projecting a rate of 20% or even higher.

Actually, the principles to arrest rising healthcare costs are well established.  First, we need everyone to stay healthy by embracing a healthy lifestyle.  Second, we need the patient to co-pay so as to discourage over-consumption.  Third, we need to discourage over-servicing by doctors and hospitals through a better reimbursement model that will push them to aggressively look for better, safer and cheaper ways to treat the patients.  Fourth, we need good information to reach our patients so that they can rationally choose and consult such doctors and hospitals which provide better and cheaper care.  Fifth, our doctors, patients and families need to realize the limits of medical science and that at some stage, it is futile to pursue aggressive treatment and simply postpone death with no quality of life. 

But these principles are not easy to implement and execute nation-wide.  Challenging as they are, we must put our minds to getting them firmly established and incorporated in our healthcare system.  Our public hospitals must take the lead in this effort to transform healthcare.  We already have some of the ingredients in our system and we are better off than practically every other country in this regard.  But we need to do more.  It will require a major mindset change among us all.  More important than hardware and software, it is this heartware of our healthcare professionals, their care, concern, passion, ambition and the guts to aim high and be the best, which will determine if we succeed in this endeavour. Please join me to transform healthcare and make Singaporeans live long, live well and with peace of mind.