IT HAS BEEN SOME TWO YEARS SINCE COVID-19 REACHED SINGAPORE’S SHORES — AND WE HAVE COME A LONG WAY, AS A HEALTHCARE CLUSTER AND AS A NATION, SINCE THOSE HARROWING EARLY DAYS OF TRYING TO STAY A STEP AHEAD OF A THEN-UNKNOWN VIRUS.
Today, the picture looks very different. Singapore is one of the most vaccinated countries in the world, with eight in 10 residents fully inoculated with two doses of the COVID-19 vaccine. The number of severely ill cases remains stable despite the rise in total cases — a commendable feat in the face of an unyielding and evolving virus. In light of these new realities, the country has shifted from its “Zero Cases Approach” to one of living with the virus by becoming “COVID Resilient”, and the NHG Family has played a contributory role in getting Singapore to this stage in the management of this century’s most devastating health crisis.
The National Centre for Infectious Diseases (NCID) and Tan Tock Seng Hospital (TTSH) remain at the vanguard of understanding SARS-CoV-2 and the clinical management of critical COVID-19 cases in Singapore. Multiple wards at Khoo Teck Puat Hospital (KTPH) and Yishun Community Hospital (YCH) were converted into COVID-19-related and operationally ready Intensive Care Unit (ICU) wards to handle surging caseloads. Woodlands Health (WH) and the National Healthcare Group Polyclinics (NHGP) were at the forefront of the fight to manage the outbreak among migrant workers. The Institute of Mental Health (IMH) and the National Skin Centre (NSC) deployed staff to support the management of the pandemic, including in the dormitories, Swab Isolation Facilities (SIFs) and the Community Care Facilities (CCFs), in addition to providing mental health and skin care as national specialty centres. I commend and thank every member of the NHG Family for your commitment and sacrifice in the fight to contain the pandemic. We should stand ready and take on any unforeseen developments of the virus, especially when Singapore lifts more restrictions and opens up progressively.
FORGING AHEAD IN POPULATION HEALTH
Although much of the focus in FY2020 was on containing COVID-19, it was not at the expense of NHG’s mission to foster better management of population health; our mandate to transform care for over 2.2 million residents in the Central Region remains our priority. COVID-19 has only strengthened our commitment to creating coordinated and integrated health services by collaborating with the community to serve the population holistically. Towards this end, we have restructured the NHG organisation to support the next phase of our population health journey.
Our Group Accountable Care Division is responsible for the population health outcomes, whilst keeping healthcare sustainable. In support of this, it will work to align the various payers and providers by creating strong partnerships focused on shared value, and develop the strategy to roll out capitation funding and the NHG Health Plan for the enrolled population. Our Group Integrated Care Division, led by the acute hospitals, is responsible for activating patients for self-management and for providing integrated care and services through a network of providers targeted at the distinct needs of their local populations. It will drive this mission by supporting integrated care planning and programmes, and by collaborating closely with both health and social care providers, and with the patients and residents.
NHG will focus on five key areas to propel our care transformation journey: Partnership, Care, Finance, Workforce Transformation, and Digital Transformation. Digital innovation will be integral to advancing our population health efforts. It helped sustain productivity and operational readiness during the unprecedented disruptions caused by the COVID-19 pandemic and played a crucial role in our effective management of the crisis. Furthermore, the last year saw an exponential acceleration in the creation and adoption of digital solutions. We will capitalise on this trend to continue the enhancement of our care. NHG’s population health approach aims at addressing several challenges facing the public healthcare system in Singapore. An ageing population, with a concomitant rise in frailty and chronic illnesses, makes an institution-centric, fragmented, treatment-focused model of care unsustainable in the long run. We can future-proof our healthcare system by aggregating the different players, within NHG as well as in the community, aligning them around creating shared value for patients and residents, and anchoring them to forge a common focus on the population health aims — better health outcomes, better individual care experience, and lower cost per capita — undergirded by strategic partnerships and satisfied staff.
PURSUING HOLISTIC CARE IN THE COMMUNITY
The COVID-19 pandemic has impacted every aspect of life — including the mental well-being of our population. According to preliminary findings from a study by IMH, about 13 per cent of over 1,000 participants, who were polled between May 2020 and June 2021, reported symptoms of anxiety and depression during the pandemic. This study is supplemented by real world data from IMH that showed a 50 per cent rise in the number of calls made to its Mental Health Helpline in 2020, as compared to 2019
To manage the psycho-social effects of the pandemic, an inter-agency taskforce, the COVID-19 Mental Wellness Taskforce (CoMWT), was set up in October 2020, with NHG’s Deputy Group CEO (Strategy & Transformation), and CEO, KTPH & Yishun Health, Professor Chua Hong Choon as the chairman. The Taskforce made three recommendations that will be progressively implemented by the Ministry of Health (MOH) — developing a national mental health and well-being strategy to align and guide the work of various agencies in the area; creating a national mental health resources online portal to increase access to useful and accurate information; and establishing a national mental health competency training framework to align and standardise training curricula on mental health in the community. IMH will lead multiple agencies in the development of this framework, which will include a national curriculum for the management of mental health issues among frontline workers, and more training among General Practitioners (GPs) to handle mental health issues.
In addition to these policy-level efforts, IMH has played a significant part on the ground in safeguarding Singapore residents’ mental well-being during this crisis. In April 2020, the National CARE Hotline was launched to offer psychological first aid to people who felt stressed and anxious about the COVID-19 pandemic. Associate Professor Lee Cheng, Clinical Director, Population Health, IMH and Associate Professor Clare Yeo, Senior Principal Clinical Psychologist, IMH, were activated as Chief, CARE and MOH Head, CARE, respectively. 105 staff volunteers took on eight-hour shifts as Duty Care Officers. The hotline managed some 30,000 calls five months after it was introduced. In June 2020, IMH was part of a multidisciplinary team, which included clinicians, social and data scientists from the MOH Office for Healthcare Transformation (MOHT), the Ministry of Social and Family Development (MSF), and the National Council of Social Service (NCSS), that launched mindline.sg. This online tool facilitated the health and emotional wellness of Singaporeans by providing users convenient access to a wide range of help and support resources. A key feature of mindline.sg is a clinically-validated self-assessment tool designed by IMH, which matches local help resources to users’ needs. The pandemic brought mental health issues to the foreground of the collective conscience. Looking ahead, IMH, as the only tertiary psychiatric hospital in Singapore, will play a key role in turning this crisis into an opportunity to push mental wellness and psychological resilience as a priority for both providers and the population through public education, prevention, and infrastructure development.
PURSUING HOLISTIC CARE IN THE COMMUNITY
Primary care is the heart of our nation’s health and serves as the frontline of healthcare. For many of our residents, it is the first point of contact with the healthcare system. To ensure healthcare remains robust and sustainable in the long run, we have to effectively manage chronic diseases, detect and intervene early to prevent severe illness and hospitalisation, and seek to achieve holistic health for our population. This is attained through developing a sustained relationship with our patients, championing coordinated, shared care, where possible, with our partners such as GPs, and moving upstream to advocate active lifestyles and health ownership among families and with the community.
In NHG’s Central Zone and Yishun Zone, TTSH and KTPH respectively, have deployed health coaches to run community wellness programmes which help residents manage their chronic conditions better through targeted interventions. To nurture a pipeline of professionals with appropriate coaching skills, NHGP and the Singapore University of Social Sciences (SUSS) signed a Master Collaboration Agreement in January 2021 to equip undergraduates in health and wellness coaching, a first between a primary care organisation and an academic institution in Singapore. Students will be trained on health and behavioural modification strategies. They will also learn to engage patients, including those with low health literacy on health and wellness goals.
We have also made inroads into bridging acute and primary care across the cluster. To tackle the increasing burden of diabetes, the Diabetic Foot in Primary and Tertiary (DEFINITE) Care project was launched in June 2020. The DEFINITE Care team comprises collaborators across our Institutions. The project aims to integrate and coordinate multidisciplinary care across primary and tertiary sectors for patients with diabetic foot ulcers (DFU) to prevent DFU-related amputations, and help lower the economic and disease burden of DFU. It will eventually harmonise DFU-related services across all NHG polyclinics, TTSH, KTPH and WH. Preliminary six-month data showed that nearly 2,000 patients with DFU have benefitted from the joined-up care.
ACHIEVING EXCELLENCE AMID A PANDEMIC
Amid such challenging times, I would like to acknowledge the many accomplishments of the NHG Family in the past year. Over 139 Senior Management and Staff from across NHG and our Institutions were honoured at the National Day Awards 2021, in recognition of their service to Singapore. My heartfelt congratulations to them for exemplifying the spirit of public service integral to our work at NHG.
In July 2021, two nurses from NHGP and TTSH were bestowed the President’s Award for Nurses 2021, the nation’s highest accolade in the nursing profession. Ms Lim Voon Hooi, Chief Nurse, NHGP, and Mr Christopher Soh, Assistant Director of Nursing, TTSH, were among seven nurses presented with the award by President Halimah Yacob in a virtual ceremony. Ms Lim and Mr Soh made critical contributions toward NHG’s collective COVID-19 response. Ms Lim was instrumental in the set-up of medical posts at the migrant worker dormitories. She not only managed the nursing support team, but also undertook the responsibility of designing clinical processes and planning logistics deployment. Mr Soh has built his career over 20 years in the TTSH Emergency Department, and led staff to implement workflows to ensure the smooth operation of the NCID Screening Centre during the height of the COVID-19 pandemic. Ms Lim and Mr Soh epitomise the Collective Leadership NHG inspires and aspires to be.
In September 2020, NCID and the Ng Teng Fong Centre for Healthcare Innovation (CHI) received international acclaim at the European Healthcare Design (EHD) Awards 2020 and the Design & Health International Academy Awards, for their innovative healthcare design which enabled the effective delivery of complex services during the COVID-19 crisis. Both buildings received the Healthcare Design Award, Design for Adaptation and Transformation, and the International Health Project — High Commendation Award. In addition, NCID’s Executive Director, Professor Leo Yee Sin, was lauded by The Lancet and BBC (100 Women list) for her steadfast leadership during the COVID-19 pandemic.
NHG and our Institutions also clinched seven awards across multiple categories at the APEX 2021, an annual US-based competition which recognises excellence in publishing. This year, APEX 2021 received some 1,200 entries from professional communicators worldwide. We thank the NHG team and applaud your efforts to cascade population health messages across Singapore, and globally.
ADVANCING INTO A NEW ERA
As we stand on the cusp of a new phase in our care transformation journey, I would like to express my gratitude to those who have contributed immensely to how far we have come. We thank Mr Gabriel Lim, who stepped down from the NHG Board in October 2021, for his commitment and contributions during his tenure. In April 2021, Professor James Best, NHG Board Member and Dean of the Lee Kong Chian School of Medicine (LKCMedicine), retired after seven years of guiding the medical school, and stepped down from the NHG Board. Prof Best steered the growth of education and research at LKCMedicine, and was bestowed the Imperial College Medal in recognition of his exceptional leadership. We thank Prof Best for his dedication and wish him the best in his future endeavours. Professor Joseph Sung succeeds Prof Best as the new Dean of LKCMedicine. I welcome Prof Sung, as well as Mr Augustin Lee, Chief Executive Officer of the CPF Board, and Mr Patrick Tay, Assistant Secretary-General of NTUC, to the NHG Board. We look forward to working with all our NHG Board Directors as we forge ahead into this new era of change and transformation.
On behalf of the NHG Family, I would also like to extend my deepest appreciation to my predecessor, Madam Kay Kuok, for helming the NHG Board for the past 12 years. During her tenure, Mdm Kuok played an integral role in NHG’s care transformation journey towards population health through its River of Life framework.
She oversaw NHG’s efforts in strengthening its primary care and mental health infrastructure and capabilities, including the initiation of the National Mental Health Blueprint in 2006. Under her stewardship, NHG implemented numerous successful care innovations, including the development of three Family Medicine Clinics, NHGP’s patient empanelment and the “teamlet” care model, telehealth initiatives for chronic disease management, as well as mental health programmes in the community.
Mdm Kuok also oversaw the expansion of our institutions, including KTPH and YCH following the amalgamation of the former Alexandra Health System with NHG, as well as new developments such as HealthCity Novena, NCID, CHI, WH, and the new NSC Campus. All these milestones have strengthened NHG’s foundation, and we thank Mdm Kuok with much gratitude for her invaluable contributions and impactful leadership.
NHG turned 21 this year. To commemorate this “coming of age”, we launched the NHG21 Logo, designed by Group Corporate Communications, a homage to the enduring spirit of service alive in the people of NHG that will push us to ever greater heights in our relentless pursuit of better health outcomes for our patients and the population. As the nation opens up and rallies to become “COVID Resilient”, it is the dawn of a new era — not just for NHG but for public healthcare as a whole, and indeed for Singapore. I would like to thank every one of you for going above and beyond in the nation-wide efforts to keep Singapore safe. As we embark on the next phase of our journey, let us uphold the NHG values of People-Centredness, Integrity, Compassion, and Stewardship to deliver our vision of “Adding Years of Healthy Life” for our fellow Singaporeans.