SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2024, ON WEDNESDAY 6 MARCH 2024

               Mr Chair, our population is ageing rapidly. As we age, we become more susceptible to developing serious diseases. As a nation we have become less healthy in the past decade, with a general rise in the prevalence of chronic diseases, such as hypertension.

2.             Life expectancy in Singapore has improved over the last 10 years. Seniors are increasingly living alone, and this trend is expected to continue as our population ages and average household size decreases. For all these reasons, and others, the strain on individuals and their families, and the impact on our  healthcare system will increase significantly in the coming years.

3.             We need to strengthen our healthcare system to meet these challenges by proactively encouraging healthier lifestyles and preventing or delaying the onset of poor health. This involves strengthening healthcare services in the community, closer to individuals’ everyday environment, and leveraging our extensive network of family doctors and community partners as necessary. While we continue to invest in building new healthcare infrastructure and upgrading our existing infrastructure, we are also expanding our primary and community care services.

Better Health Outcomes By Bringing Care Closer to Individuals

Primary care as preventive and continuing care

4.             Studies have shown that individuals with a regular family doctor experience better health outcomes, including fewer hospitalisations and emergency department visits. Beyond managing our acute and chronic illnesses, the primary care team also plays a vital role in preventing the onset of serious illnesses.

5.             An on-going relationship with a regular doctor allows for deeper understanding and familiarity with patients’ medical conditions, sensitivities to medications and foods, and the day-to-day lives of the patient. This results ultimately in better care.

6.             Mr Ang Wei Neng asked about our plans to build more polyclinics to cater to the increasing demands of our ageing population, particularly in the Western region. There are 25 polyclinics and over 1,000 Healthier SG GP clinics today. By 2030, we will have 32 polyclinics, and we hope to have more Healthier SG GP clinics. There will be three new polyclinics in the western region; one in Tengah will be completed in  2025, another in Yew Tee by 2027, and the third in Taman Jurong by 2028. The existing Clementi Polyclinic and Jurong Polyclinic will also be redeveloped by 2030 to increase their capacities.

7.             I agree with Dr Tan Wu Meng on the need to ensure adequate accessibility between polyclinics and major transportation nodes. For the redeveloped Clementi Polyclinic, the Ministry of Health (MOH) has worked with the Land Transport Authority (LTA) to ensure that sheltered pedestrian access will be provided between the building and Clementi MRT’s nearest exit, save for the junction across Clementi Ave 3, where such shelters will not be practical because the junction is wide and there are double-decker buses passing through.

Mobilising community partnerships to support better health

8.             Sir, as our society ages, we need to ensure that seniors’ social and health needs are adequately supported in the community. Having strong social support networks have been shown to contribute to better health outcomes. This is particularly important for seniors who live alone and are at risk of social isolation. Active Ageing Centres (AACs) will collaborate with healthcare providers, including family doctors, as well as work with other community providers and government agencies for active ageing programmes.

9.             In addition to physical health, we also need to look after our mental health. At the Parliament Motion on advancing mental health last month, this House recognised the importance of mental health as a health, social, and economic issue, and affirmed the importance of a robust national mental health ecosystem to enhance mental health and well-being.

10.          Mr Keith Chua asked about key areas that the National Mental Health Office (NMHO) will be focusing on. The Office is expected to be fully established by 2025, comprising officers from MOH, Ministry of Social and Family Development (MSF), and Ministry of Education (MOE). It will oversee the implementation of various plans under the National Mental Health and Well-Being Strategy and shape the development of future mental health initiatives, building upon previous efforts such as the National Mental Health Blueprint and the Community Mental Health Masterplan. Under the Office, we will scale up mental health services in the primary and community care settings, and strengthen access to community-based care. Specifically, initial plans include building the competencies of professionals and frontline personnel. We will include staff in religious organisations, to support persons with mental health needs, to  address Dr Wan Rizal’s questions about involving religious organisations in community mental health support. Other plans include promoting early care access through publicising key mental health first-stop touchpoints, and ensuring better care coordination among service providers through the development of a Practice Guide. The Office will also track indicators to monitor the progress and outcomes of these plans, as reflected in the National Mental Health and Well-being Strategy Report.

11.          While persons with severe mental health conditions may seek psychiatric care at hospitals, those with mild to moderate mental health symptoms would benefit more from care delivered in the community, as compared  to being institutionalised for treatment or  being removed from their daily routines and social networks. Dr Syed Harun asked if mental health will be a focus of Healthier SG implementation plans. Let me elaborate on how we are scaling up mental health services in the primary and community care settings.

12.          Today, 19 out of the existing 25 polyclinics provide mental health services. In addition, over 450 GPs have been trained to support persons with mental health needs under the Mental Health General Practitioner Partnership (MHGPP). To bring mental health services closer to where individuals live, we will expand mental health support in all polyclinics and Healthier SG clinics by 2030. MOH will also be developing mental health protocols and incorporating mental health care and support as part of the scope of practice for GPs in Healthier SG clinics.

13.          We will also be strengthening mental health outreach and intervention in the community. Today, we have 73 Community Outreach Teams (CREST) that detect and help individuals with mental health needs. By 2030, we will expand the number of outreach teams to 90. For those who require more intensive mental health support, they can be referred to any of our 29 Community Intervention Teams (COMIT), which will be expanded to 50 teams by 2030. These teams support GPs in the provision of psychosocial interventions for persons with mental health needs in the community. This also addresses Dr Wan Rizal’s question on what is being done to enhance the accessibility and integration of mental health services within the community.  

Support for Primary and Community Care Providers  

14.          Sir, there are critical structures and policies to support the effective delivery of preventive healthcare. Our primary care teams need to be suitably sized and equipped with the right skills. They also need to be adequately supported to provide team-based and integrated care through primary care networks and consultations with specialists, and by leveraging on technology.  

Enhancing training for family doctors and supporting care professionals  

15.          Mr Yip Hon Weng highlighted the need to ensure GPs in participating Healthier SG GP clinics have the necessary resources and expertise to effectively manage chronic conditions. Ms Ng Ling Ling also asked how the Government intends to support the professional development of GPs, especially in areas that they may be increasingly involved in, such as social prescriptions to influence patients’ lifestyle choices for better health outcomes and treatment of common mental health conditions. Dr Syed Harun asked about retention plans for healthcare professionals to support Healthier SG and the shift towards preventive health.

16.          MOH is working closely with Institutes of Higher Learning (IHLs) to increase local training pipelines. We are also committed to the development of family doctors in primary and community care, and have placed a stronger emphasis on family medicine training, such as encouraging more doctors to take up post-graduate Family Medicine training like the Graduate Diploma in Family Medicine (GDFM) and the Masters of Medicine in Family Medicine. Post-graduate training in Family Medicine has  also been strengthened to help family doctors be more equipped to manage a wider range of complex conditions across different age groups. Training is delivered through modalities such as  video conferencing and webinars  allowing GPs some  flexibility as they keep up to date  with the latest developments in family medicine.

17.          At the same time, we are increasing  the number of nurses, pharmacists and other allied health professionals in the community, and are providing inter-disciplinary training to empower them to practise at the highest level of their licences. We will also expand the role of community pharmacists and other allied health professionals in primary and community care to improve care delivery in the community. We will also train more ‘lay extenders’. These  are non-medically trained persons who can undertake tasks such as arranging the initial health screening, and coordinating referrals to community programmes. Healthcare professionals can then focus on clinical care.

18.          Primary care teams will be supported with Healthier SG Care Protocols to ensure consistent, quality care for patients. These Care Protocols lay out clear processes, referrals and data flows to guide GPs in managing each health condition. 12 care protocols were released during the launch of Healthier SG on the management of common chronic conditions such as diabetes and high cholesterol, and preventive health such as smoking cessation and weight management. More care protocols will be developed to cover more chronic diseases in the future. We recognise that some GPs may have more experience in managing certain chronic conditions than others. Therefore, we will work closely with the College of Family Physicians Singapore (CFPS), Agency for Integrated Care (AIC) and healthcare clusters to roll out training for GPs and their care teams for each care protocol. We will also support GPs in the provision of holistic care for patients with mental health needs by strengthening links to Community Intervention Teams (COMIT) for non-pharmacological mental health support. 

Strengthening team-based care

19.          Sir, Dr Tan Wu Meng asked if MOH is reviewing the time required by GP clinics to deliver holistic care. As we mobilise family doctors to co-develop health plans with their patients, which can include adjustments to lifestyles and regular health screening, we expect the percentage of patients requiring longer clinic consultations to increase. This has been taken into account when planning for future primary care capacity. To allow family doctors to focus on optimising clinical care, we have adopted a team-based care approach in polyclinics and private GP clinics. In polyclinics, patients with chronic conditions are assigned to multi-disciplinary care teams comprising family physicians, nurse care managers and care coordinators. In private GP clinics, Primary Care Networks (PCNs) anchor and strengthen team-based care for chronic diseases by pooling resources to organise core ancillary services provided by nurses and care coordinators who work with GPs to jointly manage the patients’ conditions. The number of clinics participating in a PCN has grown from 340 clinics in 2018 to more than 1,000 clinics today.

20.          Our clusters will also step up as regional health managers, working with family doctors and other partners to address health and social needs of residents in their region and anchor care in the community. Family doctors may work with specialists or hospital doctors in the management of patients with more complex needs for example. Upon discharge, hospitals would refer patients to the family doctor they are enrolled with, to ensure continuity of care between the hospital space and primary care space

IT enablers to facilitate integrated care

21.      Dr Syed Harun asked about systems integration plans to support Healthier SG. To facilitate holistic, integrated, and coordinated care provided by multiple healthcare providers across hospital-based and community care settings, we need to simplify how our healthcare providers access and share data. The importance of a well-integrated and reliable IT system to connect healthcare providers has been highlighted by many GPs.

22.      The National Electronic Health Record (NEHR) is a key tool for supporting holistic and integrated care. It serves as a centralised repository of key health information that healthcare professionals can access and can contribute to. Its capabilities will be enhanced to cater to a wider spectrum of care providers in a safe and secure manner, enabling healthcare providers in different care settings to make better decisions when caring for their patients.  

23.      The upcoming Health Information Bill will also establish the framework to govern the collection, access, use and sharing of selected health information across various settings to facilitate the continuity of care.

24.      Specific to primary care, we have supported GP clinics and their IT vendors to upgrade their IT systems, to simplify administrative processes and improve data flows, while ensuring data sharing is secure. For example, under Healthier SG, we have rolled out the Clinic Management System (CMS) Tiering Framework for Primary Care to ensure that IT systems used by private GP clinics are integrated with national programmes, for a more seamless delivery of care.

25.      We have also enhanced our national digital health app, HealthHub, to empower residents to manage their own health. Through HealthHub, residents can enrol in Healthier SG, view their personalised health plans, manage medical appointments, and view their health screening results and vaccination records. We plan to expand the type of health records available through HealthHub in the future.  

26.      Dr Lim Wee Kiak and Ms Mariam Jaafar suggested making use of technology and Artificial Intelligence (AI) to optimise healthcare delivery for cost effectiveness and improved patient outcomes. Our healthcare institutions use proven, cost-effective technology extensively to automate manual tasks and augment clinical decision making. For example, the Outpatient Pharmacy Automation System (OPAS) helps to automate the packing and dispensing of pharmacy medication. Patients can also utilise HealthHub to  arrange for medicine refills and manage their medical appointments. This all  helps to reduce waiting times and enhance the patient experience. MOH is also exploring the use of AI-assisted radiology diagnosis systems for pathology detection, to automate the analysis of medical images, support clinicians to identify patients with urgent care needs, and help radiologists to generate radiology reports.

27.      Dr Wan Rizal suggested utilising AI to improve the accessibility of mental health care. Currently, Mindline employs an AI-enabled chatbot that allows people to share their emotional struggles anonymously and guides them to self-help resources such as psychotherapy exercises and counselling services where needed. While we embrace innovation and leverage technology, patient safety remains of paramount importance. MOH will continue to evaluate these new technologies for clinical and cost effectiveness, and assess their safety and suitability for various uses in our healthcare system.

28.      Ms Mariam Jaafar asked for an update on value-based care initiatives that have been piloted, and whether these initiatives have been scaled up across the healthcare system. MOH has been placing an increasing emphasis on value-based care efforts since 2015. These efforts aim to improve health outcomes while simultaneously managing the attendant cost increases in a sustainable way. These initiatives range from national system initiatives to programmes that target individual doctors and specific procedures. Since the implementation of the Cancer Drug List (CDL), which focused MediShield Life and Integrated Shield Plan coverage on clinically proven and cost-effective cancer drug treatments, CDL drug prices in the public sector have been brought down by an average of 30%, and over 60% for some drugs. This has  allowed us to subsidise more drugs and improve affordability. In the long run, we expect this to moderate the costs of cancer drugs. We are shifting our focus more upstream, and are applying value-based care to payment models like capitation and preventive  efforts through Healthier SG.

Closing

29.      Sir, it will be a long-term, multi-year effort to work towards a healthier population. The Government and healthcare providers will provide quality healthcare to residents, but individual responsibility is crucial. Each of us  must take charge of our  own health, adopt healthier behaviours, build relationships with our  family doctors, and proactively manage any  chronic diseases. Concurrently, healthcare providers will re-orientate towards preventive care, while the Government sets up systems, programmes and incentives to support healthcare providers in delivering care to residents in the community.

30.      In the future, through the Government’s efforts in strengthening preventive care and a shift in residents’ health-seeking behaviour, the aim is for all of us to visit a regular family doctor as a first point-of-contact and for ongoing support to holistically manage our own  health. Consistent and evidence-based care will be delivered across the diverse primary care landscape, and all of us  can take proactive steps to keep  to a personalised health plan. Together, everyone can play a part in improving our  health. Thank you, Sir.