Healthcare 2020 road map unveiled: MOH Committee of Supply Debate 2012

Health Minister pledges affordable, good-quality, accessible treatment for all
By Salma Khalik, The Straits Times, 7 Mar 2012

A HEALTHCARE road map was unveiled yesterday, showing the path Singapore will take to tackle a growing and rapidly ageing population.

It sets out the extra infrastructure and manpower needed, as well as signals a change in the way healthcare will be delivered, with patients increasingly being treated in the community rather than in hospitals.

Called Healthcare 2020, it will focus on three goals, said Health Minister Gan Kim Yong when he rolled it out during the parliamentary debate on his ministry's budget. These are: Singaporeans will receive healthcare when they need it, it will be of good quality and effective, and it will be affordable.

Delivering this will call for ramping up the number of beds and manpower. By 2020, 3,700 hospital beds and 20,000 healthcare workers will be added.

To meet short-term demand, private hospitals will be roped in. Parkway East will lease some beds to be run by Changi General Hospital staff and Raffles Hospital will help to treat some subsidised patients.

Public and community hospitals will produce another 170 beds by next year.

The number of people to man the increase in beds - the doctors, nurses and allied health professionals - will go up by 50 per cent across the board. To recruit and retain the 20,000 more workers needed, the Health Ministry will increase salaries.

Workers will get about 20 per cent more in the next three years, starting with pay rises next month. This is expected to cost the Government an extra $200 million this year and Mr Gan promised that none of it will be passed on to patients.

Training will be intensified to produce 500 doctors, 2,700 nurses, 240 pharmacists and 80 dentists a year. But it will not be enough, said Mr Gan. Foreigners will need to be recruited, and Singaporeans working overseas lured back.

Giving an overview of the forces shaping healthcare needs in the years ahead, the minister noted that life expectancy has gone up by four years over the past decade. Premature deaths from cancer, heart diseases and stroke in people under the age of 65 have plummeted between 1990 and today. These changes put Singapore on a par with First World countries such as France and Sweden.

But they also mean the number of people aged 65 and older will triple from 350,000 today to 960,000 in 2030.

'The ageing population will be a strong driver for healthcare demand,' Mr Gan said, and 'requires changes to how we organise and deliver healthcare'.

Older people are four times more likely than younger people to end up in hospital, where they will need more intense care and stay longer. Their chronic conditions are more effectively managed in the community, he added.

Demand for hospital and nursing home care will rise. 'Already, we are seeing signs of capacity constraints across the system - from high bed occupancy rates to long waiting times for appointments,' he said.

Mr Gan also said he plans to adopt a new approach to stem the flow of doctors to the private sector.

He wants to reinforce 'a greater sense of public-sector ethos and values' by rewarding doctors for treating all patients, whether full-paying or subsidised.

Tie-ups with private hospitals to treat subsidised patients
By Melissa Pang, The Straits Times, 7 Mar 2012

SINGAPORE'S two major private hospital groups are tying up with public hospitals in a new move by the Government to solve the soaring demand for treatment and beds at public hospitals.

The new role for the private sector is part of the Government's effort to optimise capacity and capabilities in Singapore, as the occupancy rates in the private sector average around 55 per cent while that at public hospitals is 80 per cent to 90 per cent.

With spare capacity, the private hospitals can be tapped 'to serve our national health-care needs, not just for private patients, but also for subsidised patients', said Health Minister Gan Kim Yong yesterday when he announced the two new collaborations.

One is an in-principle agreement signed for Changi General Hospital (CGH) to lease some beds from Parkway Pantai group's Parkway East Hospital.

So, while staying at Parkway East, patients will continue to pay subsidised rates and be managed by CGH's doctors.

Another is an upcoming memorandum of understanding with Raffles Hospital, which will take on some subsidised patients.

Mr Gan said the hospital will sign the agreement with the Health Ministry.

He did not give further details and when contacted, a Raffles Medical Group spokesman said it is in talks with the ministry.

Similarly, a Health Ministry spokesman said talks with Raffles and Parkway East were ongoing, with more details to be released in due course.

She added: 'The overall aim is to better serve patients in a cost-efficient way.'

Parkway Pantai's executive vice-president of Singapore operations Lim Suet Wun noted that Parkway East, being the only private hospital in eastern Singapore, is well-placed to collaborate with CGH.

Dr Lim said the average occupancy of its hospitals is between 60 per cent and 70 per cent and the group hopes to explore with the ministry other ways to develop more partnerships.

Parkway Pantai is the largest private health-care provider in Singapore, owning Mount Elizabeth Hospital, Gleneagles Hospital and the upcoming Mount Elizabeth Novena Hospital.

Private-public sector collaborations, however, are not new. For instance, the National University Hospital has been renting 30 beds from West Point Hospital since 2009.

Mr Gan, during the debate on his ministry's budget, also announced the addition of about 3,700 beds to acute and community hospitals.

He said his ministry would monitor demand closely, and if necessary, start work on another new hospital before 2020.

In the meantime, the planned number of beds for the new Sengkang General Hospital and its sister community hospital, which are slated for completion in 2018, has more than doubled, from about 600 beds to 1,400.

A new community hospital will also be built in Outram, where Singapore General Hospital is.

Facilities for long-term care services will also be ramped up to include more nursing homes, day care, home care, and rehabilitation facilities.

Their details will be announced later.

New 250-bed building to ease crunch at CGH, St Andrew's
By Salma Khalik, The Straits Times, 7 Mar 2012

A NEW 10-storey building with 250 beds will come up between Changi General Hospital (CGH) and St Andrew's Community Hospital in 2014.

The $200 million building will be linked to both hospitals on the ground and third floors, and share a common underground carpark with CGH.

About 60 per cent of the beds will be used by CGH, with St Andrew's taking the rest, but this could change according to varying needs, said Mr T.K. Udairam. He heads the Eastern Health Alliance, which includes both hospitals.

The two hospitals are now linked by an overhead bridge that allows patients to be moved between them on mobile beds, if necessary.

Patients who are no longer in acute danger, but require longer-term care, are transferred to St Andrew's.

Dr Loh Yik Hin, St Andrew's chief executive officer, said the community hospital is facing full occupancy, and people who are 90 per cent rehabilitated are urged to go home and continue their treatment at day rehabilitation centres.

'Some prefer to stay on, while others, who are aware of the bed crunch, are willing to go,' he said. The last 10 per cent of rehabilitation would typically take two to three weeks.

Work on the new building will start around September and should be completed in 22 months.

CGH is also facing almost full occupancy on some days, and has been forced to postpone some non-urgent surgical operations owing to the shortage of beds.

Until the new building is up, Mr Udairam, who is also the chief executive officer of CGH, said the hospital will squeeze out 40 more beds 'from all over the place' by next month.

Half will come from converting 20 B1 private wards with four beds in each room to B2 subsidised wards with five beds in a room. The rest will come from rehabilitation spaces at the end of wards.

It will still not be enough to meet short-term demand, so the hospital will lease some beds from private Parkway East Hospital, 10 minutes away by car.

These measures to alleviate the shortage of hospital beds were announced by Health Minister Gan Kim Yong yesterday. The warding of CGH patients at Parkway East is expected to start as soon as a formal agreement is signed.

Mr Udairam said the 250 beds in the new building should see the hospital through till 2018, when a public hospital in Sengkang opens.

About 1,000 more people will be needed to man the new wards.

Public workers in health care to get pay rise
Doctors' salaries up by 20%; nurses and other staff get up to 17% more
By Poon Chian Hui, The Straits Times, 7 Mar 2012

PUBLIC-SECTOR doctors will get an average pay rise of about 20 per cent, under a new pay framework that will better capture the ethos of working in public health care.

Nurses and other public health-care staff, too, will get a pay hike of up to 17 per cent, starting next month.

The increases will not be passed on to patients, as the Government will foot the bill, which comes up to $200 million this year.

Announcing the pay hikes in Parliament during his ministry's Budget debate, Health Minister Gan Kim Yong said that they were made after a year of gathering feedback from doctors.

Doctors wanted a pay system that reinforced a greater sense of public-sector ethos and values, he told the House.

They also wanted greater clarity around their diverse roles of clinical work, education, research and leadership, and hence the new pay formula, he added.

'The framework will better recognise public-sector doctors for the complexity of their clinical work, quality outcomes and workload, regardless of patient class.

'It will also strengthen the recognition for doctors who play crucial roles in education, administration, leadership and research,' he said.

And with two more public hospitals coming up in the next six years, as well as more community hospitals and nursing homes, the public sector will be growing its workforce by 50 per cent - or about 20,000 - by 2020.

The pool will be expanded by first growing the intake at local schools. For example, the Lee Kong Chian School of Medicine at Nanyang Technological University will open next year with an initial batch of 50 students, which will be raised eventually to 150. Together with the other two medical schools, Singapore will train about 500 new doctors every year.

Yearly intakes of dental students will also go up from 48 to 80. Annual intakes of nurses will be ramped up from 1,700 to 2,700, and pharmacists, from 160 to 240.

The ministry will also extend the pre-employment grant for medical students to dentistry students overseas, in a bid to attract them to return here to work when they graduate.

In recent years, more doctors have quit the public sector. In the first half of last year, 150 doctors left public hospitals and polyclinics.

The chairman of the Government Parliamentary Committee for Health, Dr Lam Pin Min, said local talents are being lured by better salaries and prospects overseas, not just by private-sector opportunities at home.

The pay rise aims to stem the exodus.

From April, doctors will receive more pay based on their job level. For example, most associate consultants at a public hospital will get an increase equivalent to 20 per cent of their base salary, while consultant family physicians at polyclinics will get 10 per cent.

Junior-level doctors, such as house officers and medical officers, will similarly get 20 per cent more.

When the new pay framework is fully implemented by 2014, doctors will receive further increases. Dentists' pay will be similarly adjusted.

Trainee doctors can get paid around $3,000 a month, while consultant doctors can get $10,000 and upwards.

Mr Gan said that the ministry will also look into ensuring better work-life balance, including a five-day work week.

The Singapore Medical Association, which represents doctors in Singapore, said it is happy with the changes, with its president Chong Yeh Woei saying the pay rise is in line with the group's expectations.

'We are also encouraged that the pay framework will be revamped to reward doctors for looking after all kinds of patients, regardless of whether they are subsidised or full-paying,' he said. 'The next steps would be to look at factors other than salary that have an impact on the retention of doctors in the public sector.'

These would include the rising administrative and patient workload, as well as medico-legal risks, he added.

Meanwhile, nurses, pharmacists and allied health workers will also get a one-time pay hike ranging from 4 per cent to 17 per cent starting next month.

Senior staff, especially, will be recognised for their roles in leadership and training the younger generation. For example, a nurse manager can expect 8 per cent to 13 per cent more base pay.

The starting pay for nurses ranges from about $1,200 to $2,500, depending on the strength of their qualifications. Allied health workers earn between $1,500 and $2,800.

Nurse Tan Siok Bee, 48, who has been working at the Singapore General Hospital for more than 20 years, said the pay revision will help workers feel more valued.

But ensuring job satisfaction remains the key to retaining staff, said the assistant director of nursing.

She added: 'The important thing is that you are being appreciated for your efforts.'