Speech by Senior Minister of State for Health, Dr Amy Khor, at SingHealth Nursing Conference, 2 Oct 2015

Prof Ivy Ng,
Group CEO of SingHealth

Ms Tan Soh Chin,
Chief Nursing Officer, Ministry of Health

Dr Tracy Carol Ayre,
Group Chief Nurse of SingHealth &
Chief Nurse of Singapore General Hospital

Ms Foo Wee Ching,
Organising Chairman of the SingHealth Nursing Conference,

Distinguished Guests and Colleagues,

Ladies and Gentlemen,

1.            A very good morning to all of you. I am happy to join you here today at the SingHealth Nursing Conference.

2.            The theme of this year’s conference, Chronic Diseases: Partners in Health, is one that is close to my heart. In rolling out the Pioneer Generation Package this past year, I have often heard our elderly citizens talk about their concerns over long-term illnesses, which worry them more than the prospect of dying. How to stay well and how to pay for their care are their top concerns. With the expansion of Medisave to include more chronic conditions and the rollout of Medishield Life from next month, we have, I trust, fully addressed their concerns on how to pay for their care.

3.            The key focus now is to ensure that our seniors receive the care they need, in order to live well. Nurses are our key partners in this endeavour, especially in the management of chronic diseases, because our seniors are at a higher risk of chronic diseases as they age. But the process of managing chronic diseases is not a one-off event but a long journey that the care team takes with the patient. It requires sustained effort from all levels of the healthcare system, and especially our nurses.

4.            The goals of chronic disease management are several fold – the prevention of disease through management of risk factors, early detection, treatment, and control, so that the associated complications can be avoided or delayed. With their close proximity and level of involvement in patient care, nurses play an important role in helping and educating these patients to achieve the optimal outcome. With the evolving scope and practice of nursing, nurses are increasingly taking on greater roles and heavier responsibilities in the management and prevention of chronic diseases.

Hospitals: Patient Navigators

5.            A good example of this is the Patient Navigators, a role SingHealth introduced in 2014. Since our seniors often have multiple health conditions, they may find it confusing to navigate the healthcare system to receive the care they require. Coordination is therefore critical in ensuring that our seniors receive the care they need to live well. Patient Navigators are our important partners in this.

6.            In a study done last year, among patients enrolled in the programme at Singapore General Hospital, Patient Navigators succeeded in reducing Emergency Department attendances by up to 56%.  This shows that SingHealth is heading in the right direction.  SingHealth aims to have 400 patient navigators by 2018, with each navigator targeted to look after around 100 patients. Going forward, we need to have more of such innovative approaches to healthcare delivery, in order to manage chronic diseases.

Polyclinics: Advanced Practice Nurses and Nurse Practitioners

7.            At a broader level, we are transforming our model of care to better manage chronic diseases. We are evolving from our current hospital-centric, short-term management of acute diseases, to a person-centered model that is better integrated into the community.

8.            Situated at the heart of our communities are our polyclinics. And within our polyclinics, there are two key groups of nurses: the Nurse Clinicians and the Advanced Practice Nurses, or APNs. Our polyclinic Nurse Clinicians perform key roles in patient health education, self-management skills and partnering with primary care physicians to optimise outcomes for patients with chronic diseases. Our primary care APNs, likewise, are trained in chronic disease speciality tracks and run clinics independently – ordering and interpreting laboratory tests and managing patients with chronic diseases.  In addition, they review patients’ treatment and collaborate closely with doctors on developing care management plans for their patients. Being in primary care brings APNs even closer to patients and their caregivers, making them well-placed to influence patients’ behaviour and lifestyle choices.

Patient and caregiver education and empowerment

9.            Finally, a holistic healthcare system has to look beyond the provision of treatment and care, to focus on patient and caregiver education and empowerment to help patients manage their chronic conditions well.  As the saying goes, “Give a man a fish and you can feed him for a day; teach him to fish and you feed him for a lifetime.”  Empowering our patients and their caregivers with the knowledge and means to manage their chronic conditions, will enable them to maintain a good quality of life. I am happy to note that SingHealth nurses have developed educational tools and support materials to motivate patients and their families, to take responsibility for their own health and to make relevant changes to their lifestyles. I am also glad to learn of the twice-weekly caregiver training programme at Academia, started by SGH in 2000.

NNT Recommendations

10.         In the provision of healthcare and the management of chronic diseases, nurses are our key partners. We fully recognise this and we will support you to meet the challenges that lie ahead. We are in the midst of implementing recommendations by the National Nursing Taskforce, which we call the CARE package because it covers the four areas of Career development, Autonomy, Recognition, and Education. As part of the CARE package, we have introduced the Assistant Nurse Clinician role this year to improve your career progression prospects. We are also offering more opportunities for professional upgrading. To better recognise the value that you bring to the healthcare system, we have introduced the Nurse Special Payment (NSP) in December last year. More than 20,000 nurses in public healthcare institutions have also benefited from a pay raise of 3% to 10% in October last year and you can look forward to another round of salary increases this month.

11.         Beyond increased salaries and improved progression pathways in the CARE package, we will continue to grow and develop the nursing profession because we know that you, our nurses, are integral members of every team of healthcare professionals.

12.         With an ageing population and new public healthcare institutions being built each year, we need more nurses as you form the backbone of our healthcare sector. We will therefore continue with our efforts to enhance nursing and we hope that more Singaporeans will choose this meaningful and rewarding career.

Conclusion

13.         In the battle against chronic diseases, you are the care managers, system navigators and communicators. You are also the teachers and influencers, in educating both patients and the public to take proactive early interventions for chronic diseases.

14.         Seek to learn best practices during your time at the Conference and continue to push the boundaries in our approach to managing chronic diseases. I wish you a fruitful time.

15.         Thank you.