THE COVID-19 PANDEMIC IS FAR FROM OVER BUT SINGAPORE IS LESS IN THE GRIPS OF IT WITH MORE PEOPLE VACCINATED AND BECOMING ACCUSTOMED TO THE DISEASE.
Even amid a highly contagious Delta variant of the coronavirus and the sudden surge of community cases, the nation is better placed, having fought the pandemic relentlessly for nearly two years. On-going defences include ready access to vaccines, calibrated lockdowns, emergency public health and hygiene protocols, safe management measures, and repeated calls for social responsibility. These have kept COVID-19 in Singapore contained. Despite these moves, COVID-19 will be with us for the foreseeable future as an endemic disease.
MOUNTING VACCINATION EFFORTS AND THE NEW NORMAL
In an endemic COVID-19 world, mass vaccination of our population is key to curbing transmission to induce herd immunity, and, NHG with our Institutions are at the forefront to support our nation.
As part of the National Vaccination Programme, National Healthcare Group Polyclinics (NHGP) began administering vaccination for the public at its Ang Mo Kio Polyclinic in January 2021, starting with seniors aged 70 and above, and by February, the Programme was expanded to its remaining five polyclinics. As of 31 March 2021, NHGP had administered 56,000 doses of COVID-19 vaccinations to members of the public and staff.
As the epicentre of the national COVID-19 response, Tan Tock Seng Hospital (TTSH) and the National Centre for Infectious Diseases (NCID) continue to provide care for the majority of critical patients. Woodlands Health (WH), Yishun Health (YH), National Skin Centre (NSC), Institute of Mental Health (IMH), NHG Pharmacy (NHGPh), NHG Diagnostics (NHGD), and NHG HQ have tirelessly worked as one team to build up COVID-19 resilience in the community.
With Singapore’s adoption of a vaccination-differentiated approach to COVID-19, our Institutions have also adjusted their healthcare and safe management protocols for visitors and patients. Plans are being rolled out to support the Vaccinate or Regular Test (VoRT) regime when it is implemented from 1 October 2021. Under this regime, unvaccinated individuals from several settings including healthcare must be tested twice a week using Antigen Rapid Tests (ART) to enable early detection of possible infections to keep the community safe.
The pandemic has accelerated the adoption of technologies to bring care to patients in the new normal. Telehealth is increasingly used in clinical consultations. Community Health Teams from Central Health and Yishun Health use it to screen and determine if additional home visits are necessary for vulnerable and at-risk patients. The TTSH Home Ventilation and Respiratory Support Service leverages on teleconsultations to assess the need and frequency for visiting home-based patients on ventilators.
At IMH and NSC, clinicians and nurses provide tele-psychiatry and tele-nursing services, respectively to residents of nursing homes. Patients consult TTSH pharmacists on certain high-risk medication remotely from home.
NHGP monitors patients with chronic diseases, including hypertension through the use of tele-sensors for vital signs, paired with video and telephone clinical reviews. These telemedicine services are complemented by home delivery for medication, and community-based blood tests and laboratories.
COVID-19 has indeed disrupted the way we live and work. Our staff have adapted to new digital learning platforms and tools to attend meetings, e-learning classes, conferences, and webinars during Work From Home (WFH). Even as our workplace practices continue to evolve, NHG is committed to empowering our staff and creating a sustainable, high-performing and collaborative environment for them to carry out their duties, no matter where they might be. Change has brought uncertainty and anxiety. To engage staff and boost employee resilience and promote Joy in Work, the NHG Staff Well-Being Committee (NHG-SWC) introduced a Co-Funding Scheme for Staff Mental Well-Being. New workplace health initiatives such as NHG’s Zest For Life continue to be rolled out to improve employees’ physical, emotional, and psychosocial well-being. I am proud of how the NHG Family has adapted to the evolving COVID-19 situation, and embraced collective leadership to steer our people well.
BREAKING THE CHAIN OF TRANSMISSION
The COVID-19 cluster which emerged in TTSH in April 2021 was a solemn reminder of the need to stay vigilant. It also demonstrated great teamwork, strong leadership and staff dedication. The hospital, supported by the Ministry of Health (MOH) and NCID, was quick to Contain, Control and Cast a wide net to ring-fence the coronavirus transmission and secure the safety and well-being of patients and staff. Although the outbreak affected the operations of other public healthcare institutions (PHIs) including those from NHG, they readily stepped up to help manage the spill over of patient workloads diverted from TTSH. Staff across NHG even came together to show support in an uplifting video — NHG Voices to Support TTSH: Count on Me — produced by Group Corporate Communications. I would like to commend our TTSH colleagues for their professionalism, and quick and decisive response, as well as our Institutions who stood in solidarity with TTSH.
THANKING OUR FRONTLINERS
To commemorate the first year of the COVID-19 response, TTSH and NCID held a Stronger Together, Better Together — Staff Appreciation event in January 2021. It saw the unveiling and dedication of five unique wire sculptures by artist Victor Tan to TTSH and NCID. This work depicts the Coming Together of minds, body and hearts of all healthcare workers and the community to fight COVID-19 with valour and resilience.
In March 2021, NHG and the Singapore Art Society (SAS) co-organised the Heroes Of Our Time art exhibition as a tribute to COVID-19 frontliners. Held at the sponsored venue — ION Art Gallery, the exhibition featured more than 200 artworks by children, migrant workers, and professional artists, capturing their individual experiences and perspectives of the pandemic. The central artwork, titled Heroes of Our Time, has images of Singapore’s battle against COVID-19. It was created by 18 artists from SAS, and presented to NCID, in recognition of NHG’s and its significant contributions towards our pandemic response.
WHAT’S NEXT IN OUR CARE TRANSFORMATION JOURNEY
Developing A New Model Of Care
2021 marked the 21st anniversary of NHG. The Health Ministry announced the appointment of Mr Tan Tee How as the new Chairman of NHG. Mr Tan who succeeded Madam Kay Kuok in April, brings extensive expertise in leading public entities to NHG. In the coming years, he will further advance our population health efforts through actualising the River of Life (ROL) framework of care, and enhance the shared value between payers and providers through tighter collaboration and better integration of care. This will help maximise health for patients, taking into account distinct demographics and health status over their lifespan and healthcare costs. To accomplish this, NHG has aligned its population health efforts and clinical care delivery into the Accountable Care Organisation (ACO) and Integrated Care Organisations (ICO) — ACO-ICO model.
Expanding Care In The Community
Although COVID-19 occupied much of our time and resources in 2020 and 2021, our vision of Adding Years Of Healthy Life for Singaporeans remains unchanged. Since 2017, NHG has moved upstream to drive health ownership, modify lifestyle habits, prevent disease or slow down the progression of chronic illnesses. We have made wellness education and activities within easier reach of the community and encouraged more individuals to make informed choices and take charge of their health.
NHG has also gained more ground with children and youth through our Living Well@School initiative, with the Ministry of Education (MOE) and schools as partners to coach and empower students and their parents, and teachers, to lead healthy lifestyles. We are co-developing curriculum and activities that emphasise behavioural-based nutrition and a “growth mindset” for Primary Schools and MOE Kindergartens. In addition, a three-year pilot to train about 1,000 teachers from more than 300 schools to be health coaches will be launched in seven Primary Schools in 2021. Beyond schools, NHG is partnering SportSG and ActiveSG to develop community initiatives that advocate and enhance health and physical activity across different platforms.
A key driver of population health in NHG is Primary Care with almost 80 per cent of the 2.2 million residents in Central region accessing its services. As General Practitioners (GPs) remain the first point of care for some 60 per cent of our residents, NHG and Institutions collaborate closely with GPs and care providers in different zones to right-site patients. In September 2020, Woodlands Health (WH) launched its GPFirst Programme in the North to encourage residents to first seek care for non-emergency conditions from their family doctor. To-date, WH in partnership with Yishun Health has engaged 139 GPs in Woodlands, Sembawang and Yishun, and recruited 81 for the programme as of June 2021. Between September 2020 and February 2021, some 1,205 GPFirst referrals were made to the Urgent Care Centre@Admiralty (UCC@Admiralty) and the KTPH A&E department. The UCC has seen close to 4,000 patients as of April 2021.
Nestled in Central Zone, the Ang Mo Kio Specialist Centre (AMKSC), set up by TTSH in close collaboration with Primary Care and community partners, opened in December 2019. AMKSC provides holistic specialist care that includes:
- An eye clinic that accepts referrals from GPs for patients with stable chronic eye conditions;
- Additional diagnostic hearing tests for residents who have abnormal hearing results, following basic functional screening;
- Integrated musculoskeletal services where patients from polyclinics or GPs are triaged to consult occupational therapists/physiotherapists for timely treatment before their Specialist Outpatient Clinic (SOC) appointment;
- Trans-disciplinary care where clinical diabetes educators, as well as GPs, collaborate to support patients with Diabetes Mellitus (DM); and
- Co-located integrated health and social care services.
Strengthening Mental Health
The COVID-19 pandemic has accelerated the need for mental health with more people reporting symptoms of anxiety and depression.
Under the leadership of its new CEO, Associate Professor Daniel Fung since February 2021, IMH will support individuals across all dimensions of mental health by focusing on three strategic goals: recovery, hope and independence for patients; wellness, resilience and happiness for the people of Singapore; and meaningful, rewarding and joyful work for staff and partners. These goals will be carried out through more person-centred programmes that holistically assess needs of patients, with shared decision-making and greater ownership with the patients, caregivers, and partners in the development of care plans and supporting initiatives.
Establishing Group Nursing
Maintaining a robust nursing workforce is essential to meeting the needs of diverse patients and advancing population health. I am excited that we have established the NHG Group Nursing (GN) Department in October 2020. Led by Group Chief Nurse, Associate Professor Yong Keng Kwang, GN serves as the administrative arm of the NHG Nursing Council, NHG Nursing Strategic Map, and NHG Community Nursing. In the coming years, it will help elevate the nursing profession by facilitating best practices and attaining excellence in patient care across NHG.
NHG Community Nursing, a key pillar of our population health strategy, has made good progress in recent years. Clinical workflows to guide the delivery of care to patients with chronic conditions such as dementia and diabetes, and their caregivers in the community have been developed. They enable individuals-at-risk timely access to health services and interventions, an important goal for preventive health. As at December 2020, our Community Nursing teams have served more than 15,000 clients in the Central Zone, and some 13,000 clients collectively in Yishun Zone and Woodlands Zone.
ADVANCING DIGITAL TRANSFORMATION
As part of our digital transformation journey, we have set our sights on developing our people as thought leaders in digital health, and to raise mobility-enabled productivity by implementing sustainable and connected capabilities, and building digital portals, relationship management systems and analytics platforms.
We have data scientists to analyse trends across the population spectrum — Living Well, Living with Illness, Crisis and Complex Care, Living with Frailty and Leaving Well — to capture and provide evidence-based information for clinical strategies and programmes to strengthen health and avert medical complications. NHG is also building common data definitions, and a population health and risk registry for the future, to enable the use of analytics capabilities across these ROL five segments of care. Enabled by technology, we firmly believe we can enhance patient self-efficacy and empowerment.
We achieved a milestone with the successful “GO-LIVE” of the Next-Generation Electronic Medical Record (NGEMR) at NHGP’s Geylang Polyclinic on 27 February 2021. NGEMR was implemented in the remaining five polyclinics. As more NHG Institutions adopt NGEMR, this IT platform will provide more integrated, timely aggregated patient data for patient care.
Redesigning Education
While the COVID-19 pandemic has disrupted the training and education of medical students, residents, and healthcare professionals, it presented opportunities for growth in the way we teach and learn, digitally. New tech tools for learning were rolled out and will remain mainstream.
CELEBRATING NHG21
To mark NHG’s 21st anniversary, Group Corporate Communications designed the NHG21 Logo, which pays homage to the bright, enduring spirit of service displayed by the NHG Family. The slogan — Blazing Beyond Boundaries with Better People and Better Care — heralds the next phase in NHG’s care transformation journey. The logo and slogan are a rallying call to apply our core values — People-Centredness, Integrity, Compassion, and Stewardship (PICS) — in the pursuit of NHG’s vision of Adding Years of Healthy Life.
Reflecting on how far NHG has come, I would like to express my deep gratitude to our former Chairman, Madam Kay Kuok for her wisdom and great leadership in charting the course of NHG for more than a decade. Under her chairmanship, NHG achieved several milestones of care delivery — from championing disease management programmes, to laying the groundwork for population health management, laying the foundation of the National Mental Health Blueprint, and, encouraging an on-going culture of continuous improvement in collaborative and team-based care in our ROL framework.
Let us continue to remain focused, vigilant, adaptable as one NHG Family, and stay grounded in our core values to serve our nation.