Tackling our Challenges together

06 Feb 2009

By Ms Yong Ying-I

Good morning

Distinguished Guests and friends

INTRODUCTION

        I am very pleased that you are able to attend our inaugural 'MOH VWO Excellence Seminar’.  I’m very grateful, too, to our speakers and panelists for being here today to share their insights and their expertise with us.

CHALLENGES APLENTY

2        The charity sector has been the scene of some high profile controversies in the last few years.  This has increased public interest and government attention on the governance and management of charities and IPCs in Singapore.  Government has enhanced and re-organised its regulatory framework for better oversight of the charity sector.  The Commissioner of Charity (COC)’s role has been changed, to provide overall guidance and drive the direction of charity regulations.  The Charities Act and Regulations have been streamlined.  A new Charity Council now advises the COC. The charity sector faces far greater scrutiny than ever before.  

3        To many of you who have been doing sterling work in the charity sector for decades, some of this scrutiny and demands for improved corporate governance may well be distracting, if not downright irritating.  I think most people accept the need for some level of good governance but how much is necessary in a sector that is supported heavily by volunteers and driven by passion and the desire to do good?  Are the new regulatory requirements for documentation and reporting, for Board level responsibilities and accountabilities too onerous?  What level of scrutiny should the public expect for their donations? And now that we have entered into an economic recession that is making 2009 look very difficult, you may well ask whether the focus on good governance and organizational excellence is a bit passé at this time?  Getting donations will be a big problem in 2009.  For charities where donations are an important chunk of annual revenues and they do not have huge reserves to tap on, survival may be the most important thing on your minds this year.

4        MOH is the Sector Administrator for healthcare charities.  While we have delegated regulatory powers from COC, we also hope to play a more rounded role including being a promoter, facilitator and enabler for the sector.  In terms of good corporate governance, we intend not just to regulate, but wish to be able to work with you and help you step up your governance and management capabilities.  In terms of clinical governance, which is an issue peculiar to healthcare charities, different healthcare charities have different level of need for clinical capabilities.  We recognize that professional clinical capabilities may sometimes be in short supply in the charity sector, and for some of you, this can limit your ability to achieve your goals.  We hope to be helpful and work with you to address this.  Specifically for manpower, many charities have been struggling to find adequate manpower to staff their operations.  Last year, we were told about beds and services closing as there were more jobs available in the healthcare sector than qualified staff available.  You found it hard to compete with our restructuring hospitals in terms of compensation and job attractiveness.  We would also like to work with you on this, through more systematic support for training and recruitment.

5        Since funding matters critically in the recession, my Ministry is reviewing our funding formulas to see how we can be more helpful.  For our community hospitals which required significant budgets, we have already been talking to you about whether you can support subacute care.  If so, we will propose funding arrangements to support such patients. In line with this, RenCi Community Hospital signed a joint clinical governance MOU with TTSH recently.  Some of you may have read about this in the newspapers. Government had also announced a $15m VWO support fund in the recent 2009 Budget.  Our healthcare charities will get a share of this. We hope it will go some way to tiding you over this year.  MOH will announce details of how to apply for the fund very shortly.  

WHAT IS A GOOD MODEL FOR “GOOD GOVERNANCE” IN SINGAPORE?

6        Since we have 2 eminent speakers today, and experienced and knowledgeable panelists, I’m not going to expound at length on my theory or MOH’s theory of good governance in the charity sector.  Rather, I’d like to say that MOH will be quite practical in our approach to regulating and supporting our healthcare charities.  I have been reading and reflecting on Mr Willie Cheng’s book on “Doing Good Well”.  If you haven’t read it, I strongly recommend it to you!  He raises the issue of what is an appropriate model for regulating charities in Singapore.  Should external regulation be more intrusive or should it be less intrusive but with a corresponding high degree of transparency by the charity so that donors know what is being done with their gifts. 

7        I think our philosophy would tend towards the latter, of less intrusive external regulation and more transparency by the entities towards how they are using the money by donors.  This gels with the “many helping hands” philosophy of charity in Singapore.  However, I also think that where we are now, speaking very generally, is that our competencies in good governance is not particularly high.  It isn’t so much an issue of incompetence as it has been indifference or treating it as something not of the highest priority amidst the numerous, more pressing challenges of raising funds and providing good care.  The controversy and corresponding high profile this issue has received in recent years has had its uses in reminding us that good governance is a fundamental.  It is as important as the charitable work itself.  If a charity focuses only on building up the “heartware” but neglects to build the “hardware” as well, the organization will not be sustainable.  The desire to do good for the society and help the less fortunate and less privileged would be hampered by the lack of organization support. 

8        MOH will be practical.  Our workplan for the next few years is to build the capabilities in individual entities to put in the processes to account well for monies spent and to improve the transparency of reporting.  This is why we are organising this seminar today.  It is part of a bigger framework to provide support to the charities to strengthen your corporate governance capabilities.  We recognize that the larger charities with more complex accounts will naturally need more capabilities than the smaller entities with simpler operations.  On the regulatory front, MOH will not be going around shining a torch into every corner, checking through each and every set of accounts to find mistakes.  We will focus on helping entities raise corporate governance standards.  It’s the spirit of good governance that matters.  Of course, we will not look kindly on findings of fraud or blatant efforts to cheat donors.  But these are the aberrations.  We are working on the assumption that people in this room today want to “do good well”, and we would like to support you to realize this goal.  Indeed, many of you in the room are passionate veterans in the charity sector and I thank you for your tireless efforts to help the less privileged in our society.   

RE-FOCUSING ON INTEGRATED CARE FOR THE ELDERLY

9        I would like to take today’s opportunity to also speak briefly about MOH’s efforts to develop a stronger framework of integrated healthcare for the elderly.  As Singapore’s population ages, the healthcare system needs to prepare for their needs now and into the future.  In particular, intermediate and long-term care (ILTC) services play a crucial role in serving the care needs of the elderly.  This is largely provided by charities today, and VWOs will continue to play the dominant role in future.  It is the nature of such services that care, help, and emotional support play an important role in the recovery and well-being of the beneficiaries of services, and VWOs are especially well placed to fulfill that role.  Many health sector VWOs are also special interest groups which cater to the needs of people with very specific medical conditions. 

10        My Ministry wants to ensure that there are sufficient capacity and capabilities to meet increasing demands and that the scope of services remain relevant.  Where we are short of capacity such as community hospital and nursing home beds, we will invest in new infrastructure.  The current Budget provides for the development of 2 new nursing homes, including one for psychiatric patients, and another 1 or 2 if needed.  Land has been safeguarded for some new community hospital facilities and we are also looking for more suitable nursing home land.  Government does not see ourselves directly running nursing home or rehabilitation facilities so please don’t think we are going to compete with you.  We hope to find VWO organizations which will be willing to operate the new nursing home facilities but we recognize that the capital outlay must come from us, and we decided to invest in the infrastructure as there is a critical need for the beds.

11        For other entities like hospices and day rehabilitation centres, we have been discussing their needs withyou.  There may not be an acute shortage of facilities per se but there are other issues.  For everyone in the eco-system, there is also a shortage of trained personnel such as allied health professionals and support staff such as nursing aides and therapy aides.  While these staff may be employed by the charity sector, Government recognises that we have the national responsibility to provide for their training, and we will be expanding our training pipelines accordingly.  The recession means that there may also be mid-career people who would like to switch into working in the healthcare sector, and we will place emphasis on having suitable conversion courses and schemes in place for them.

12        We would ideally like the elderly who are able to, to live at home rather than be institutionalized.  Families want to look after their elderly to the extent possible.  But the support could be improved whether it’s family education, caregiver training, visits by GPs or palliative specialists or nurses as needed, or home nursing aide.  We will be contacting some of you to discuss the possibility of expanding services.

13        I should reiterate, before closing, that just because Government is doing more, we do not see the VWOs as having less to do.  We see VWOs continuing to play a major role in the provision of care for the elderly in Singapore.  We have been studying the experiences of other countries which have more developed elder care systems than ours, and VWOs play major roles there.  In Hong Kong, for example, large charities groups like Tung Wah and “Yan Chai” operate many nursing homes.  In Canada, its VWOs run almost every aspect of elderly care, on par with private providers.  Indeed, there is a big job ahead in this sector, and we hope to see VWOs growing to fill the larger role.  Apart from building capabilities and capacity, the future could require you to work differently from today.  I had earlier mentioned much closer collaboration between our community hospitals and our restructured hospitals.  Likewise, there is potential for stronger collaboration between VWOs and using shared services to get the job done effectively.  I gather that some of our nusing homes are piloting a shared service scheme to procure commonly used medical supplies through bulk purchasing.  This is a good example of collaboration being win-win. There are other possibilities including IT. I would encourage other VWOs to think in this direction.

CONCLUSION

14        In conclusion, the Ministry of Health is keen to strengthen our partnership with you.  We have stepped up on our engagement and interactions with you recently, and will continue to do so going forward.  We have been listening to feedback and responding to them, and your feedback is driving some of our policy changes and new strategies.  A good example is the recent changes introduced to the HMDP-ILTC to enhance the scheme so that it can better fulfill your training needs.  We encourage you to continue providing us with your views and suggestions on how we can improve governance in the sector, so that we can regularly adjust our policies accordingly.

15        Today’s inaugural seminar is one more new platform that we hope is useful to you.  It is part of our plans to provide more avenues for sharing, learning, and networking.  I am delighted that so many of you were able to be here today, I thank you for coming and do hope you will find the morning fruitful.

16        Thank you.