Speech by Dr Amy Khor, Senior Minister of State, Ministry of Health, at the National University of Singapore, Yong Loo Lin School of Medicine Commencement Ceremony, 15 July 2018

Dr Noeleen Heyzer, NUS Trustee

Professor John Wong, Senior Vice President (Health Affairs) NUS and Chief Executive, NUHS

Associate Professor Yeoh Khay Guan, Dean, NUS Yong Loo Lin School of Medicine

Distinguished Guests, Parents, Graduands,

1.    Good morning. I am glad to join you today in celebrating this important milestone in your lives. My congratulations to all graduates and your loved ones here today. A lot of hard work has gone into these past few years, and you and your loved ones should feel very proud of your achievements.

SINGAPORE’S EVOLVING HEALTHCARE LANDSCAPE AND CHALLENGES

2.    As you take time to reflect and celebrate your journey over the past few years, I ask you to also look towards what lies ahead and appreciate the evolving landscape of healthcare which you are about to join. You are graduating in an era of change in healthcare, where we are facing a new set of challenges.

3.    Our population is ageing rapidly. By 2030, the number of Singaporeans aged 65 and above is projected to almost double from 500,000 to 900,000. As our population ages, there will be a shift in disease patterns. Patient care will become more complex, with multiple chronic diseases that require multi-disciplinary approaches. This has resulted in a higher National Health Expenditure (NHE) over the years. To date, healthcare spending stands at 4.6% of GDP. We expect this to continue to rise as our population ages. A fundamental rethink of how we deliver healthcare is needed if we want our current healthcare system to remain sustainable. As future healthcare providers, you have an important role in the transformation of healthcare to one that is effective, efficient and fit for purpose. 

MEETING THE CHANGING HEALTHCARE NEEDS – THE ‘THREE BEYONDS’

4.    The Ministry of Health (MOH) has already begun work on transforming healthcare. In 2012, we announced the Healthcare 2020 Master Plan, which outlined our plans to add capacity, improve affordability, and enhance care quality. We have made good progress, but more still needs to be done.

5.    More recently, in 2016, we highlighted the key paradigm shifts we need to make in order to prepare our healthcare system for beyond 2020. These three shifts are encapsulated in the ‘Three Beyonds’- Beyond Hospital to Community, Beyond Healthcare to Health, and Beyond Quality to Value.

6.    ‘Beyond Hospital to Community’ describes a shift in our emphasis away from hospital-based, specialist provided care, to community-based care. We also want to move upstream and focus on aspects of preventive health, to help our population stay as healthy as possible and to reduce the incidence of chronic diseases. This is encapsulated in ‘Beyond Healthcare to Health’. The last ‘Beyond’ – ‘Beyond Quality to Value’ - describes our journey towards developing a value-based healthcare model, with greater emphasis on making cost-effective choices for medical investigations, technologies and treatments.

7.    In order to achieve the ‘Three Beyonds’, a new model of healthcare delivery needs to be developed. Given that patients require different levels of care over their lifetime, a key consideration is to make the patient experience seamless and better integrated across different care settings. In 2017, we took the major step of reorganising our healthcare system to integrate care more effectively. With the reorganisation, each of the three integrated clusters has a broader range of healthcare facilities, including its own group of polyclinics. This move to strengthen vertical integration within each cluster reflects our commitment to better care coordination. The era of any doctor working in isolation has passed and effective care is now team-based. This team is inter-professional and the doctor is but one member and may or may not be the leader depending on the situation.

ALIGNING MEDICAL EDUCATION AND TRAINING WITH NEEDS

8.    It is imperative that our doctors in training are equipped with the relevant skills and competencies to function in this transformed healthcare landscape. MOH is actively steering medical education and training towards supporting the ‘Three Beyonds’. We will launch the National Standards for Basic Medical Education and National Outcomes Framework for Medical Graduates by the end of the year. These twin documents, together with our National Postgraduate Year One (PGY1) Training and Assessment Framework, prescribe a more generalist and competency-based approach to learning during these formative stages of medical education. It also prescribes exposure in the care for the elderly, patient safety, value-based care, health promotion, and to our unique health system.

9.    I am happy to hear that the Yong Loo Lin School of Medicine has taken steps to prepare their graduates for Singapore’s evolving healthcare landscape. Among other things, the school’s redesigned curriculum gives greater emphasis on team work and being a part of the multidisciplinary team. As part of their Family Medicine posting, students are rotated to community hospitals, nursing homes and polyclinics.  Furthermore, from this year, first year NUS Medicine students will be introduced to Caregiver Training where they are taught basic caregiving skills. I hope that through such training, students will gain insight into the practical difficulties faced by patients and their families, and how these difficulties translate into obstacles for achieving smooth transitions of care.

10.    As the first and continuous line of care, primary care is the bedrock to support this integrated model of care and the shift beyond hospitals into the community. Training more Family Physicians is one of the Ministry’s key commitments because of the central role Family Physicians play in community-based care. For those who pursue Family Medicine as a career, you will have many opportunities to be personally involved as a key enabler in Singapore’s healthcare transformation. Besides traditional outpatient primary care settings such as polyclinics and GP clinics, there are various settings where Family Physicians can practice and lead care, such as in community hospitals.

11.    For those training to be specialists, there will be a shift in emphasis towards developing the more generalist disciplines, as well as those with greater roles in the community, such as internal medicine, geriatric medicine and rehabilitation medicine. Core broad competencies will also be assimilated into specialty training, in order to help trainees retain proficiency in generalist care despite their very specialised field of interest. This will allow them to better provide consistent and planned long-term care.

NOT FORGETTING YOUR ROOTS

12.    No matter which career path you choose, I hope that all graduates here today will remember the fundamentals of your practice. First, to conduct yourselves professionally and ethically, keeping the best interests of the population at heart, and secondly, to engage in lifelong learning so that you are well-equipped to serve the changing needs of Singaporeans.

13.    In closing, I would again like to congratulate all graduates here today. I wish all of you exciting and fulfilling careers ahead, and I look forward to working with you to deliver better care and to contribute to a better life for all Singaporeans.

Thank you.