Monday 25 April 2022

Trust is most precious resource in Singapore's COVID-19 response: PM Lee Hsien Loong at the SGH Lecture and Formal Dinner 2022

Singapore cannot let valuable lessons from COVID-19, 'for which we have paid dearly', go to waste: PM Lee
By Timothy Goh, Health Correspondent, The Straits Times, 24 Apr 2022

Trust has probably been the most critical factor in Singapore's pandemic response - and the nation must learn from Covid-19 and not let lessons from it go to waste, said Prime Minister Lee Hsien Loong on Sunday (April 24).

These include upholding Singapore's standards of medical excellence and further developing its expertise in public health.

He was speaking at the Singapore General Hospital's (SGH) Lecture and Formal Dinner 2022, which was held at Shangri-La Singapore.

Addressing about 300 guests on site, as well as about another 1,000 gathered online, PM Lee cited a study in The Lancet which found that higher levels of trust in the government and among the population were associated with greater compliance with Covid-19 restrictions and higher vaccination rates.

"In fact, by this measure, trust levels mattered much more even than the quality of healthcare and access to universal healthcare.

I do not believe this means a good healthcare system makes no difference – it is absolutely necessary. But it does show how crucial trust levels in the society are to public health and healthcare outcomes," he said, adding that Singapore is fortunate to be a high-trust society.

He said that the strong public trust built up over the decades between Singaporeans and the Government, and in one another, sets the Republic apart from many other countries.

This involves trust that the Government has the best interest of Singapore and Singaporeans at heart, that the Government is competent and will make the right decisions on behalf of Singaporeans, and that every citizen will play their part - not just for themselves and their loved ones, but for others as well.

"This trust is a most precious resource. It is the fundamental reason why Singaporeans were able to come together during the pandemic, instead of working against each other," said PM Lee.

He cited four examples of this: People here abiding by "burdensome" safe management measures, patiently enduring repeated rounds of easing and tightening, going for vaccinations and booster jabs, and exercising personal and social responsibility.

"In other countries, a precaution as simple and essential as wearing a mask became a heated point of contention between citizens... Fortunately, in Singapore the opposite happened," he noted.

3 key thrusts of trust: Competency, commitment, transparency

PM Lee said that a big part of this was due to the public's trust in the healthcare system here, which in turn was based on three things.

First, trust that healthcare workers here are professional, and know their job well.

Second, that they are dedicated and selfless, committed to the care, treatment and well-being of their patients.

Third, that the healthcare system is open and honest with the public, even when things fail to go as intended.

For instance, said PM Lee, during the vaccination campaign, the Health Ministry regularly reported statistics on serious adverse events.

He said: "Some may be tempted to think that it would have been easier to keep things quiet, and avoid causing unnecessary alarm with bad news. It would have been expedient and convenient, but it would have been very unwise.

"If we kept quiet, it might work once, or twice. But rumours will spread, people will gradually lose faith in the system, and we will eventually pay a high price - the loss of public trust.

"We should always be upfront when we encounter problems and setbacks, and address them honestly and transparently. If we make a mistake - own up, take responsibility, and strive to put things right.

He noted that this is not easy to do, but is absolutely essential to strengthening public trust, especially during crises when stakes are high.

PM Lee said that there is a need to continue nurturing trust in the healthcare system during normal times, by always maintaining high standards of competency, commitment and transparency in the system.

In the next crisis, there will then be a "deep reservoir of trust" that can be drawn upon, he added.

"And, of course, even when the going gets tough, and especially when the going gets tough, we must continue to live by these cardinal values, and continue to strengthen the trust that we depend on to stay together and pull through," he said.

"We cannot thoughtlessly revert to the status quo ante after this crisis."

PM Lee also said that Singapore should make the most of the changes forced on it by Covid-19 to improve the way it does things.

"We cannot thoughtlessly revert to the status quo ante after this crisis. Or let valuable lessons, for which we have paid dearly, go to waste," he said, adding that this means two things for the nation's healthcare system.

First, it must keep up its high standards of medical excellence by continually investing in its healthcare workers, and supporting them with good medical facilities and healthcare infrastructure.

At the same time, this also means building up Singapore's scientific and biomedical capabilities, and collaborating with researchers in other countries.

Second, there is a need to further develop an emphasis on public health.

Public health, he pointed out, focuses on the health of the overall population and not of individuals. The priority is to benefit as many people as possible.

That is why, even though the polymerase chain reaction tests are more sensitive, Singapore replaced them with the antigen rapid tests for most cases, to pick up and isolate infectious cases faster and more cheaply.

This made a bigger impact on disease transmission.

Noting that in normal times, many other "popular" medical specialisations are more sought after, PM Lee pointed out that in a pandemic, public health expertise is crucial.

This is because the nation must be able to understand how a new disease is spreading, make sense of disease trends, and devise models to assess and predict them, evaluate alternative public health measures, and devise non-medical interventions that can help bring the outbreak under control.

So there is a need to strengthen skills in these areas, and ensure high-quality public health inputs inform policymaking, said PM Lee.

He added: "Singapore must continue to grow in maturity and resilience, learning from our experiences and those of others, and so must our healthcare system."

PM Lee thanks healthcare workers 'constantly on front lines' in Singapore's COVID-19 battle
By Clement Yong, The Straits Times, 24 Apr 2022

The professionalism and commitment of healthcare workers in Singapore was a key reason that the country retained a degree of normalcy during the two extraordinary Covid-19 years, said Prime Minister Lee Hsien Loong on Sunday (April 24).

Speaking at the Singapore General Hospital's Lecture and Formal Dinner 2022, PM Lee paid tribute to the more than 62,000 healthcare workers who bore the brunt of the pandemic.

"They were stretched to the limit but maintained the highest standards," PM Lee said at the event held at Shangri-La Singapore. "They were constantly on the front lines, determined and resilient, even at the start when we understood little of the virus.

He added that doctors, nurses and other volunteers were "fearless" in executing their duties in the early days of the pandemic when outbreaks occurred in many migrant worker dormitories.

Healthcare workers were also among the first to brook the wearing of full personal protective equipment for entire days and among the last to cease rostered routine Covid-19 testing.

"These two years have been challenging for them, and such a pace is clearly unsustainable in normal times. So we must continue our efforts across the board - at the institutions, clusters, ministry and also in the community - to prevent fatigue and burnout among our healthcare workers," PM Lee said.

In the past two years, many healthcare workers were unable to take leave and worked long hours every day, often redeployed at short notice to new roles.

Studies of healthcare workers showed signs of increased burnout and psychological distress. Resignation rates went up, with 1,500 people quitting in the first half of last year compared with a pre-pandemic annual average of 2,000.

With the coronavirus now abating, staff have begun to be rostered for leave.

PM Lee said the authorities have done their best to give healthcare workers some respite and breaks from their duties to recover and recharge.

He added: "We must take good care of their welfare and well-being, if we expect them to continue doing their best for all of us."

Shifting healthcare focus to preventive care is difficult but right thing to do, says PM Lee
By Clement Yong, The Straits Times, 24 Apr 2022

Shifting the healthcare system's focus from the reactive treatment of diseases when they surface to a more preventive one that relies on regular screenings will be a huge challenge but is the right direction to take, Prime Minister Lee Hsien Loong said on Sunday (April 24).

"It will demand considerable commitment and effort from many stakeholders - not just from the Government," he said at the Singapore General Hospital's Lecture and Formal Dinner 2022, which was held at Shangri-La Singapore.

"It calls for a mindset shift and a fundamental reorientation of how our whole system works," he added of the overhaul.

As Singapore assesses its healthcare system post-Covid-19, the Government has said that it wants everyone to enrol with a family physician from next year, so that each person has a doctor who is familiar with his healthcare risk factors.

This will nip illnesses in the bud and keep more people healthy and out of the hospital, which is particularly important as Singapore confronts issues related to an ageing population and a possible increase of chronic diseases.

PM Lee said it will also lighten the burden on hospitals, making healthcare expenditure more sustainable, adding that it is "clearly the right strategic direction to take".

"(It) will shift decisively from hospital-centric care to a patient-centred preventive care. Focus on healthcare outcomes, starting early while the person is still healthy and tackling illness at its root, before it progresses to the point of needing treatment," he said.

The Ministry of Health (MOH) is due to release in the second half of the year a White Paper on what has been called the Healthier SG initiative.

The broad-based major strategy shift was announced earlier this year during the Budget debate, with MOH saying that Singapore needed to now turn its attention to a far more challenging pandemic of longer-term, chronic illnesses.

One of these is diabetes.

Singapore leads the world in diabetes-induced kidney failure, with 5.7 new patients diagnosed with the condition daily and more than 8,500 dialysis patients here.

A greater focus on preventive care would enable hospitals here to focus on complex conditions and emergency cases, while reducing healthcare expenditure, which is already expected to triple in the coming decade to almost $27 billion in 2030, MOH said.

'I didn't want any of my guys to die': COVID-19 stories of SGH healthcare workers told in new book
By Timothy Goh, Health Correspondent, The Straits Times, 24 Apr 2022

When he was first told to prepare for a new virus from Wuhan in early 2020, Associate Professor Kenneth Tan, then newly minted head of Singapore General Hospital's (SGH) Department of Emergency Medicine, felt a mixture of excitement and pride.

"We were finally going to show the world what our Emergency Department (ED) was all about. I was going to be the head of department during this pandemic and the ED would do very well," said Prof Tan.

But the new coronavirus, or Sars-CoV-2, as it later came to be known, did not turn out the way many believed it would - and neither did the situation on the ground.

"We didn't anticipate that the number of tourists who would come in from China to our department would be tremendous, and it overwhelmed our facilities," he told The Straits Times.

The situation rapidly worsened. More people turned up, and staff struggled to manage the situation even as their colleagues who treated Singapore's first patient at the hospital began to come down with fever and other symptoms.

"It really was very heartbreaking," said Prof Tan on Friday (April 22), recounting the case of a young, newly married doctor who had a high fever after seeing the first patient.

His is just one of many stories told in Purpose With Passion: Our Covid-19 Stories, a book chronicling the experiences and perspectives of SGH's healthcare workers during the Covid-19 pandemic.

The 10-chapter book was launched by Prime Minister Lee Hsien Loong on Sunday at SGH's Lecture and Formal Dinner 2022, which was held at Shangri-La Singapore.

In the book, Prof Tan recounted: "I called (the young doctor) and he told me, 'I am very scared. I can't see my family. I can't see my wife, I don't know what's going on.'

"I didn't want any of my guys to die, I wanted them to be safe. There was this dread of losing someone on my watch. If they died, how would I face their family?"

SGH chief executive Kenneth Kwek wrote in the book's foreword: "The many first-hand accounts in this book speak to our humanity - our fears and anxieties, our despair when it seemed there was no end in sight, as well as the symbiosis of our actions."

The book was put together by an editorial committee led by Professor Tan Ban Hock, senior consultant in SGH's Department of Infectious Diseases, who was also the book's chief editor.

In another account in the book, Associate Professor Phua Ghee Chee, a senior consultant in the Department of Respiratory and Critical Care Medicine, which he headed till April 1 this year, shared the important roles that both veteran and junior healthcare staff played during the crisis.

"We were never short of volunteers for the isolation wards. It was heartening that the newer generation of clinicians were as dedicated, committed and courageous as their seniors were. I am really proud of the new generation of healthcare workers. The future shines bright," he said.

Prof Tan said: "I think the book is going to be a very important piece of history for SGH, also about what Singapore went through, to share with future generations.

"I think it's important that the book captures… all these emotions and thoughts and processes, which can be shared with the next generation when they have to tackle the next disease."


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