Speech by Ms Yong Ying-I, Permanent Secretary (Health) at the Inaugural Educating Pharmacists (Asia) 2010 Symposium,

15 Apr 2010

By Ms Yong Ying-I, Permanent Secretary (Health)

Venue: Inaugural Educating Pharmacists (Asia) 2010 Symposium, University Hall, NUS

SPEECH BY MS YONG YING-I, PERMANENT SECRETARY (HEALTH),

AT THE INAUGURAL EDUCATING PHARMACISTS (ASIA) 2010 SYMPOSIUM,

15 APRIL 2010 (THURS), 9.00AM

Professor Tan Eng Chye, Provost, National University of Singapore;

Distinguished Guests;

Ladies and Gentlemen,

1. Good morning and a warm welcome to our overseas speakers and participants.

2. I am pleased to be here at the Inaugural Educating Pharmacists (Asia) 2010 Symposium.

Developments in the Healthcare Landscape

3. Healthcare reform has emerged at the forefront of public policy discourse globally.  Governments across the globe have to juggle the needs of an ageing population and a burgeoning healthcare budget, amidst tight fiscal resources.  At the same time, rapid advances in medicine and technology are continuously reshaping the delivery of healthcare and outcomes for patients.  With these advances, it is not surprising that patients’ demand for quality and choice continue to rise.  The most famous of these reform efforts is President Obama’s in the United States.  But in reality, the US is not alone.  The same month as the US healthcare reform bill was passed, the Australian Government released a proposal to fundamentally restructure the funding and governance of its public hospitals.  I understand Hong Kong will be publishing its reform proposals shortly.  Many European countries are also working on major changes.  Some are coming to Singapore to study what we are doing, I’ve hosted delegations from Germany, Russia; and Qatar is coming later this month. 

4. Singapore itself is in the midst of remaking our own healthcare system.  With a growing elderly population, we have been building new hospital facilities and expanding professional manpower to meet rising demand.  Our public sector staffing for patient care has risen 44% since 2007.  We have been revising our healthcare financing frameworks to better provide for the care that the elderly and disabled need.  But the nature of healthcare delivery will change too with chronic diseases and elderly health needs.  Singapore is therefore also making a big push in developing the primary care sector and the intermediate and long-term care sectors.  Some of the biggest healthcare issues of today – post-stroke rehabilitation, chronic disease management and palliative care – are best handled outside the acute care settings. The key is to integrate care by providers across the acute, long-term and primary care settings, and to redesign care to be delivered by multidisciplinary teams in an integrated way, not just doctors and nurses.

5. These changes amount to a fundamental reshaping of Singapore’s healthcare system, just like the transformations other countries’ healthcare systems are going through.  These raise basic questions about the roles of different groups of healthcare professionals now and going forward, including pharmacists.  As the role of pharmacists evolves, what expertise will be needed in future?  And how does this affect their education?

Development of Pharmacy Manpower in Singapore

6. In Singapore, the past few decades have seen a major shift in focus in pharmacy.  The profession has progressed from one engaged solely in dispensing pills behind the counter to one spanning a broad scope from the discovery, design, development and manufacture of new drugs in various dosage forms, to the safe and cost-effective use of medicines to achieve optimal, therapeutic outcomes and quality of life for patients.  The growing use of technology and reliance on pharmacy technicians has enabled pharmacists to move more towards the provision of patient care, with direct impact on patient outcomes.  Demand for pharmacists has grown, similar to the other healthcare professions.  In the last five years, the number of registered Pharmacists in Singapore has grown from 1,300 to 1,600.  We have expanded the Pharmacy intake at the National University of Singapore from 90 to 130 over the same period. To meet the future demand for pharmacist services, including in the community, in long-term care, and in home care, we will need to increase the intake even further.  We hope to grow the pharmacist to population ratio from 1:3,000 now to 1:2,650 within the next five years. 

7. As healthcare evolves, so will the role of pharmacists.  In line with this, we have already moved to enhance the attractiveness of Pharmacy as a career within the public healthcare sector.  With a new career pathway framework outlining three career tracks – Administrative, Specialisation / Clinical, and Research, we hope to provide structured career advancement and development opportunities for pharmacists across all tracks, and develop pharmacy specialisation and research further.

Pharmacists’ Roles

8. But in terms of roles that pharmacists can play, the changes we have made so far are just the beginning.  I can only speak about Singapore, but I envisage that pharmacists will play growing roles in the clinical care of patients.  Today, the number of drug options has exploded compared to a few decades ago.  This has raised the complexity of therapies.  Within the team of healthcare professionals, pharmacists would have the greatest knowledge and skills to prevent, detect, monitor, and resolve drug-related problems.  They can support doctors and other healthcare professionals with advice on drug efficacy and their use in care plans.  They have a unique role to play in managing patients’ drug regimens, evaluating medication therapies, conducting medication reconciliation, and titrating individual doses.  Roles for specialised pharmacy knowledge in areas such as oncology, infectious diseases and critical care will become more important.  And unfortunately, because drug costs is a core issue in affordability and sustainability of healthcare, pharmacists will not be able to avoid working on cost-effective options vs theoretically optimal solutions.  This makes the work enormously challenging.

9. The growing emphasis on integrated care, including in the community, means that the physical work setting for pharmacists will change. They may take on expanded practice roles in the community, long-term care, and home care settings in support of this.  They could manage ambulatory clinics, for example, heart failure or asthma clinics, providing therapeutic consultations and prescribing drugs where appropriate.  As the public demands more information on drugs and their effects to make more informed decisions, pharmacists are also likely to take on a more active role in patient education. 

Opportunities in the Biomedical Science Industry

10. Aside from clinical practice, the expansion of the pharmaceutical and biomedical research sectors in recent years has also created many opportunities for pharmacists in manufacturing and drug research and design.  There are new roles in regulation as pharmaceutical and biotechnology companies look for ways to boost manufacturing and R&D productivity globally.  Advances in areas such as pharmacogenomics and tailored drug therapy also present opportunities for high-impact research.

11. Within Asia, clinical research activities are growing due to the region’s growing demand for cost-effective and efficacious medicines.  Singapore is making a big push in Biomedical Sciences.  The effort is bearing fruit, with biomedical manufacturing output more than tripled in ten years from $6.3 billion in 2000 to $20.7 billion in 2009.  We now have more than 4,300 researchers from a variety of backgrounds carrying out more than $1 billion worth of biomedical R&D activities across 50 companies and 30 public sector institutes.   These developments in industry have opened up a new array of career opportunities for pharmacists.  About 19% of pharmacists in Singapore have chosen to work in the industry, contributing to high-value research and development work directly and indirectly.

The Need for New approaches to Education

12. This leads me to our education needs.  It clearly cannot be status quo.  For Singapore, a good pharmacy education should train well-rounded pharmacists who are flexible and nimble enough to contribute to developments in both the healthcare and biomedical sectors.  They should be comfortable with tackling challenging questions in complex environments.  Students will need to be equipped not just with theoretical knowledge, but also clinical experience, cross-disciplinary skills, soft skills, critical thinking and problem-solving skills.  Professional ethics and values are also key. 

13. Having been involved in some of the thinking on new developments recently in medical, nursing and allied health education, I can safely say that changing the education of pharmacists will be challenging.  Educators need to consider what the local and international healthcare landscape will look like 10 years, 20 years from now, and educate our students today for tomorrow’s world.  Because the global business and scientific environment is changing very fast, the future can be fuzzy, and it is human to be concerned about tackling uncertainty.  Educators need to embrace the need for change, and accept that complexity and uncertainty is the reality.  We must take the attitude that we will not fear change, but learn quickly, adapt and modify as we go along.  Educators will also need to create an environment and develop a culture conducive to inquiry and research, because so much in medicine and pharmacy is yet to be discovered.  

14. Practice, Research and Education are closely linked and interdependent.  Practice fuels Research, Research supports Education, and Education feeds Practice.  Consequently, for education to be an effective driver for the profession’s growth and development, educators must engage the various stakeholders – healthcare practitioners, academic and clinical researchers, and the wider pharmaceutical and biomedical community – to keep pace with both practice and research, and ensure curriculum relevance.  Effective collaboration between educators and the practitioners will be particularly important to improve experiential education and develop patient-centred practice.  Likewise, blurring the lines between practice and education is helpful, so that more practitioners also teach and mentor the next generation.  Through teaching, practitioners will also have to remain at the cutting edge of new discoveries and new knowledge, and ensure that their own education continues lifelong.  

Conclusion

15. A challenging but exciting future for healthcare lies ahead.  Educators like yourselves play a pivotal role in grooming the future generation of healthcare professionals.

16. I congratulate the Department of Pharmacy, National University of Singapore on providing 105 years of providing quality pharmacy education in Singapore and Malaysia.  I also congratulate the organising committee of this symposium for planning a very comprehensive programme which spans curriculum design and delivery, teaching and learning methodologies, experiential training, education technology, staff development, and continuing education.

17. I am confident that this symposium will provide an excellent platform for educationists from around the region and the world to share your insights and to learn from one another.  For our guests to Singapore, I hope that this will support you to enhance your pharmacy programmes back home.  I wish you an exciting and fruitful symposium, and may you forge friendships and collaborations here that will move all our healthcare systems forward together.