SPEECH BY MR EDWIN TONG, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, AT THE 29TH SINGAPORE PHARMACY CONGRESS, 5 OCTOBER 2019

Ms Amanda Lee, Chairperson, 29th Singapore Pharmacy Congress Organising Committee,

Ms Irene Quay, President, Pharmaceutical Society of Singapore,

Associate Professor Lita Chew, Chief Pharmacist,

Distinguished guests and speakers,

Ladies and gentlemen,

1.     A very good morning to all of you. I am delighted to join you at the 29th Singapore Pharmacy Congress. For those who come from abroad, welcome to Singapore, and for those who are from Singapore, enjoy the weekend. Thank you for giving me the opportunity to be part of the pharmacy community.

2.     I am very glad that this congress is being organised to not just broaden knowledge, share good ideas, but also to foster camaraderie and fellowship. This is what keeps societies like you strong, sustainable and also builds up a deeper knowledge base which we can exchange with people we know.

Meeting evolving needs amidst Singapore’s changing healthcare landscape3.    Like many countries, Singapore has a rapidly ageing population. We have a number of citizens who are 65 years old and above. What is stark about Singapore is that this number is not just growing, but it is growing at a rate that is faster than almost any other country in the world. So we not just have an ageing population – we have a quickly ageing population.

4.    When you marry that out with two other statistics – one is the lifespan, we are living longer, and the other statistic is that our Total Fertility Rate is very low, we are looking at a situation in which we have to support an ageing population, healthcare needs, societal support and so on, but faced with an increasing care burden, because society, the number of children in each family has grown smaller, and the care burden now falls on a smaller group of people. That is the landscape that we are operating in, and it is something that is increasingly challenging. This in turn has necessitated the transformation of our healthcare system. It has moved into the Three Beyonds, and has required a transformation of our healthcare system, to something that is sustainable, value-based and value-added. I believe that pharmacists in this ecosystem play a crucial role in that transformation.

5.    This year’s theme is very timely: “Educate, Engage and Empower for a Future Ready Pharmacy”. It is not just in line with the Ministry of Health (MOH)’s efforts to reach out to and strive towards a progressive and engaged pharmacy workforce. It is also something that is opportune, because it is not just in the pharmacy area. It is really across a broad spectrum of healthcare professionals that we must empower, educate, re-educate, learn and re-learn so that we are ready for the future. Pharmacists must embrace change and equip themselves with new skills, new mindsets and new attitudes. The last value is particularly important. It is the ability to adapt, and that calls for having a new mindset and new attitude to how you embrace changes around us.

6.      In line with MOH’s Beyond Hospital to Community strategic thrust, MOH has been working with our public healthcare institutions and partners for healthcare services to be available closer to home to enhance accessibility and convenience for patients. That is particularly important, the last mile in how we deliver healthcare. It is well and good to have a very good healthcare system, but if it is not so accessible, it stands far away. So we have to bridge that gap, find that last mile of connection to, in some ways, as far as we can, personalise the delivery of healthcare services to those who need it.

7.     In 2003, our public healthcare institutions and polyclinics started the Medication Delivery Service which offers patients greater convenience compared to collecting their prescribed medicines and also reduces the amount of time they had to spend at healthcare institutions. Not that we do not welcome patients being there, but I think spending less time having to wait around to collect the medication improves the overall efficiency and improves the patient experience at our healthcare institutions. We are seeing an encouraging increase in the adoption of the service over the years.

8.     In this regard, I am very pleased to note that the Singapore Standards Council, Pharmaceutical Society of Singapore (PSS), Enterprise Singapore (ESG), and partners in the healthcare, regulatory and logistics sectors have come together to formulate the Singapore Standard 644 (SS 644). It is refreshed and enhanced, and I think it fits in very nicely with the theme that we have for the Congress, which is to be future-ready. The SS 644 which was released in August 2019 replaces the earlier PSS Guidelines for Supply and Delivery of Medications to Customers, and will provide guidance to healthcare and logistics service providers on the supply and delivery of medication. This includes ensuring proper storage, which is important to ensure the efficacy of the medication is not diminished, security, traceability and safety of medication, and also in the dispensation and delivery of medication to patients, as well as the provision of the right type of information to patients about the medication and the effects of the medication, so that they can consume the medication safely.

9.     This effort, spearheaded by PSS, and developed by SSC’s Biomedical and Health Standards Committee, is an industry-led and industry-wide effort, with representatives from the public sector, private sector, regulatory, logistics, MOH, the Health Sciences Authority (HSA), ESG, and also the Singapore Manufacturing Federation (SMF). The guidelines cover the whole supply chain to ensure that we look after the delivery of medication properly, efficiently and, most importantly, safely to patients.

10.    SS 644 is an important step in maintaining a high quality of healthcare services and products. It provides patients with new modes of convenient medication delivery from retailers and third party delivery operators, which can be delivered to preferred locations, be it the home, sometimes the office, designated collection points, sometimes the children or family members collect it at day-care centres and also nursing homes, where the patient might be. So it is a lot more curated, a lot more customised to the patients’ needs, while maintaining professional standards and, of course, the quality of medication during last mile medication delivery. With SS 644, both patients and caregivers can also be more assured of continued care beyond just the hospital environment.

Training the pharmacy workforce

11.     Another theme that is relevant is, of course, the future of education. It involves having the mindset that we discussed earlier, to evolve, adopt, learn and re-learn. That is important. We need to continually upgrade our ongoing efforts in developing a skilled and future-ready pharmacy workforce. A critical skill for the future is the ability to work across services and organisations to meet the growing needs of people with complex medical conditions and those who may require care and support from different institutions. Patients come with a spectrum of increasingly diverse and complex treatment needs. The ability to work across the different departments, and to be a little bit out of your comfort zone, to be working with a colleague from another area is really what we need to also inculcate and develop. This skill requires collective leadership within our healthcare system to overcome the sometimes organisational and bureaucratic obstacles. This bureaucracy and regulations are there for good reason, but sometimes we can transpose and overcome them, and seek ways to work together in a different environment. Ultimately, it is to deliver better care and better value for Singaporeans in a safe manner that should drive and motivate all these efforts.

12.    To enhance the specialist training of pharmacists, MOH introduced new training and accreditation standards for the National Pharmacy Residency Programmes in April 2019, and conducted the inaugural portfolio-based exit assessment of Residents in August 2019. In addition to the existing five specialties recognised by the Pharmacy Specialists Accreditation Board, MOH introduced two new pharmacy specialties in Critical Care and Paediatric Pharmacy in February this year to raise professional standards and serve the complex healthcare needs of different patient populations. Structured residency programmes are being developed for these two new specialties and are expected to be launched by around mid-2020.

13.     To facilitate the continuing professional development of pharmacists, we launched a portfolio building toolkit in June 2019 to guide pharmacists as they prepare a practice portfolio in line with the competency standards. In March 2019, the Skills Framework for Healthcare was launched by SkillsFuture Singapore and MOH, which included three career tracks developed for our pharmacy support workforce. For pharmacy technicians, this serves as useful guide for their career planning and also in their own personal professional development. I think it is important to ensure that not only are we looking at developing the workforce in this holistic fashion, but to also give the individual person something to build a career track, to have something to be motivated about, and to aspire towards.

Expanding the pharmacist’s role in the community14.     As more patients receive care across healthcare settings, some, especially seniors, are also taking multiple medications, known as “polypharmacy”. This increases the risk of non-compliance and medication errors, which then result in repeat trips, having to come back and deal with the problem. All of that not only is adverse to the patient, it is a strain on our already limited healthcare resources. In 2018, MOH launched a community-based Pharmaceutical Care Services pilot, deploying community pharmacists at Senior Care Centres to help seniors and caregivers self-manage their medications, so it is de-centralised and posted out to the community. It is very much following the ethos of what I believe is the newer care model, to not just focus on care at hospitals, whether acute or community hospitals, but to be able to de-centralise it into the community.

15.     During one-to-one sessions with pharmacists, seniors and their caregivers will receive a Pharmaceutical Care Plan with instructions including how to take medications correctly and on time at home, how to sort, store and dispose of their medications as well as safety instructions and information. Seniors, their caregivers and home and community care service providers will have a contact point for queries related to their medications. The Care Plan will help to inform other healthcare professionals of the patient’s medication needs and, also importantly, their medication history, because the history sometimes guides you as to how to attenuate and adjust medications. To ensure that patients receive consistent structured care across settings, MOH introduced the Pharmaceutical Care Services Guidelines in April 2019 for pharmacists and pharmacy staff providing these services. It seeks to set a benchmark, a baseline, and with this provide recommendations on required service components, harmonisation of documentation and their roles and responsibilities.

16.     I am very pleased to note PSS’ efforts in expanding the pharmacist’s role in the community as well, in line with what I just said about making sure that we do not just operate in the hospitals but to be in the community. For example, under its Community Pharmacist Health Champion Programme, community pharmacists continuously engage members of the public to manage chronic conditions such as diabetes and hypertension. In recent years, they have also extended their outreach to those who are pre-diabetic and pre-hypertensive to stem the progression of these conditions. We do want, at MOH, to now focus on treating not just the ill, but also the well, so we go upstream and try to provide as much resources and opportunities as possible so that the well can start looking after themselves before they become ill.

17.   Collaboration with other partners also contributes to the expansion of the community practice. This year, the PSS ILTC Pharmacists Workgroup is working with the National Kidney Foundation to enhance its operational efficiency and safety in medication administration and optimise and streamline their procurement and distribution processes. They are also reviewing the medication management processes including procurement, administration, storage and monitoring, and implementing a medication safety framework.

18.     To better capture the impact of their interventions in the ILTC sector, the ILTC Pharmacists workgroup developed a Drug-Related Problem (DRP) classification system tailored to their practice. The DRP classification system was validated to be suitable and reliable for use by pharmacists to document and report DRPs in the ILTC setting. The results were published in 2018 and the standardised list used to harmonise ILTC pharmacists' efforts across various institutions in the workgroup. I am happy to see the spirit of continuous improvement and cooperation and the gung-ho ability to try to push the envelop a little bit more to see how we can enhance current practices and develop new ones, all to ensure that the delivery of patient services and medication can be optimised, and the safety enhanced.There have been many creative solutions and creative ideas along the way, and occasions like this, where there are so many thought leaders across the pharmacy spectrum, so many of you are operating in the environment itself, can come together, share ideas, exchange notes and really leverage on one another’s best practices.

Closing19.     The pharmacy profession in Singapore has grown over the years, and I think the PSS has played a significant role in enhancing it. We will continue to develop the pharmacy workforce as we address the challenges of a changing healthcare landscape. Collaboration between healthcare professionals, stakeholders and patients is key to ensure the sustainable and long-term reliability in the delivery of high quality healthcare services in Singapore. MOH and the PSS will continue to work together to collaborate, share ideas and find solutions, and chart the path forward in our healthcare transformation journey.

20.      In closing, let me thank Amanda and the organising committee in organising the Congress. I am sure everyone will benefit from this Congress. Take the opportunity to make new friends, have fresh learning and perspectives, take some time to tour the booths and also the research posters. I wish everyone here a successful and fruitful Congress.

Thank you.