MOH's Addendum to the President's Address

1. The Ministry of Health (MOH) will continue to deliver good health outcomes for Singaporeans, while keeping costs affordable for individuals and sustainable for Singapore. We have been able to achieve these objectives through the delivery of high-quality care, supported by a dedicated healthcare workforce and resilient infrastructure built up over the years, and a S+3M (subsidies, MediSave, MediShield Life, and MediFund) system that instils financial discipline while providing a safety net for patients who need it.

2. The COVID-19 crisis has given us new perspectives on our pandemic preparedness plans and public health capabilities. Furthermore, our population is ageing rapidly. Medical advancements are not only opening up new possibilities but also major challenges and dilemmas. Singapore’s healthcare system is therefore at a pivotal phase of its transformation journey.

Preparing better for future pandemics

3. MOH will strengthen our capabilities and structures by setting up a Communicable Diseases Agency to oversee disease preparedness, prevention and control, surveillance, risk assessment, and outbreak response. MOH will set up a permanent Crisis Strategy and Operations Group, to maintain surge readiness for mid-sized outbreaks and other health emergencies, and to prepare healthcare institutions to be crisis-ready. We will also maintain a healthcare reserve force, to expand surge capacity if necessary.

4. MOH will continue to make progress on PREPARE, the Programme for Research in Epidemic Preparedness and Response, to develop our capabilities in global surveillance so we may better understand new and dangerous pathogens. We will implement our vaccine strategy, to secure an early supply of efficacious vaccines when another pandemic breaks out.

5. We will also review the Infectious Diseases Act (IDA) to deal with a wider range of public health situations, and better manage crisis communications.

Enhancing infrastructure and manpower

6. We will continue to invest in healthcare infrastructure and expand our care capacity. This includes the Woodlands Health Campus, the Tan Tock Seng Hospital Integrated Care Hub, the Eastern Integrated Health Campus, and the redevelopment of Alexandra Hospital. In the next few years, we will add 1,900 (or about 20%) more public hospital beds, from 11,000 beds today. By 2030, we will build 10 more polyclinics, making a total of 32 polyclinics. We will also expand the capacity of our nursing homes from 16,000 beds in 2020 to more than 31,000 beds in 2030.

7. We will invest heavily in IT, focusing on mission-critical national systems for hospital billing, drug ordering and dispensation, and the maintenance of national medical databases.

8. We will continue to develop our healthcare workforce. We plan to increase our nursing and support care manpower by 40%, from 49,000 now to 69,000 by 2030, by building a stronger local pipeline through pre-employment training and mid-career conversions, and complementing our local core with foreign healthcare workers. With good training opportunities and career prospects, Singapore will remain competitive in attracting foreign healthcare manpower.

9. More opportunities will be made available for doctors to become Family Physicians and develop their competencies, such as through postgraduate family medicine training. We will continue to upgrade the skills and knowledge of nurses and Allied Health Professionals, so that they can assume greater responsibilities, including in leading more clinical community care initiatives.

Becoming healthier

10. While ageing and changes to our demography are inexorable, we can improve the health of our population through effective preventive care that spans the entire life of an individual. This will be a major focus in the coming years.

11. Good health starts from the womb. We will enhance mental health screening and psycho-emotional support for pregnant women and their spouses, and support families in cultivating healthy lifestyle habits from young. As the child gets older, schools and preschools are important platforms to foster and sustain healthy habits. We will partner MOE and MSF closely, to incorporate health education in the school experience, and lay a strong foundation of health for our younger generation.

12. For adults, Healthier SG will be the key strategy to encourage healthy living and deliver preventive care. Enrolment into Healthier SG will start in July 2023, and this will kickstart the development of strong and dedicated patient-doctor relationships throughout society. Family doctors play an integral role in inculcating and strengthening good health habits, such a good diet, regular exercise, and routine health screenings and vaccinations.

13. To support this effort, we are marshalling community resources and partners to organise physical activities in the community, and to reach out to residents and encourage them to enrol. Through the Health Promotion Board, we will continue to drive efforts to reduce sugar and sodium intake, equip consumers with information to make healthier eating choices, manage the consumption of tobacco and nicotine, and promote smoking cessation.

14. By emphasising preventive care, Healthier SG brings healthcare out of hospitals and clinics, and into the community. We are therefore updating the Healthcare Services Act, to make regulations services-centric, instead of focusing on the premise where care is delivered. Similarly, we need to review our healthcare financing policies to make them more premise-neutral, and ensure support is available regardless of where care is sought.

15. For our seniors we need to make ageing in community the default, because it is the best way for them to stay socially engaged and active, and hence healthy. As part of the Forward Singapore exercise, we are studying the specific measures to enable this. Broadly, our built environment must be made more senior-friendly, with new housing options such as Community Care Apartments, and existing common spaces such as void decks, parks, and coffee shops transformed into conducive environments for seniors. Our network of Active Ageing Centres will need to be expanded, and their operations remodelled, so that they can become nodes for seniors to make friends, volunteer, participate in active ageing programmes, and receive support for maintaining good health.

16. As seniors approach end-of-life, we will seek to fulfil the wishes of the great majority to pass on in the comfort of their homes, surrounded by their loved ones. We will therefore strengthen support for palliative care by enhancing clinical protocols in hospitals to enable more seamless care transitions, upskilling healthcare workers, and engaging Singaporeans in conversations on their preferences. We will also enhance financial support for palliative care and ensure sufficient capacity across all settings to meet growing needs.

Harnessing medical advancement

17. We are in a period of major breakthroughs in medical science, especially in areas like precision medicine, gene editing, and artificial intelligence. For instance, with precision medicine, we can consider individual variations in genetic, environmental, and lifestyle factors when predicting the health risks of individuals, and determine the most effective prevention and treatment strategies for them. At the same time, there will likely be a proliferation of experimental treatments, such as genetic therapies.

18. We need to support and embrace technological advances but remain aware of the risks and pitfalls. Experimental treatments tend to work only on a small minority, so mass deployment of new treatments must be subject to evidence-based clinical development and evaluation of cost and medical effectiveness. Even as new medical technology becomes established, it will likely be costly and deployed only in specific circumstances. This would require a rethink of our healthcare financing policies, especially the role of medical insurance and MediShield Life. We may also need new legislation to safeguard moral and ethical standards in the practice of new medical technology such as precision medicine.

19. MOH will undertake this long-term effort in partnership with researchers, physicians, economists, bioethicists, regulatory bodies, and the public, to reap the benefits of these new solutions.