We are preparing for our long-term future by strengthening our social safety nets. After food and shelter, I think good health is one of the most important basic requirements which human beings have. It is more important than money. Singaporeans know that we have good doctors, good hospitals. Their worry is whether they can afford it, especially in the future after they grow old and retire.

            We have done many things to mitigate this worry. We have a 3M (MediSave, MediShield, MediFund) system designed precisely to keep healthcare affordable to all, even and especially, the lower income group. And we have steadily improved and upgraded and extended the 3M system so MediSave now covers long term outpatient treatment, MediShield now provides higher insurance payouts, MediFund –we have increased the amounts, it is giving more help to the needy to settle their outstanding hospital bills.

            So as a result, MPs see fewer cases of residents unable to afford healthcare, and medical social workers report that the MediFund is adequate to cover hospital bills. We will continue to improve this and to widen the 3Ms progressively but we have to do it carefully because we want to keep the system working and there are pitfalls.

            But I know that Singaporeans are still concerned. We see medical science advancing, we see new technologies, new drugs, new procedures. People can live longer, but it costs more. And those who are in their 50s looking after aged parents, they feel the burden and they wonder “what will happen to me when my turn comes?”. They asked, “I am all right now, what about the future?” We need to gear up our healthcare systems to prepare for this ageing population and we are doing that.

            So today I would like to explain the implications of our ageing population and how we are preparing our healthcare system to cope. What does it mean when we say our population will be older? It means there will be more demand on healthcare because older people are sick more often.

            But this also means it is a different pattern of healthcare. Younger patients do not go to hospital so often. When they go to hospital it is an acute problem which can be treated within a few days and then they go home well. I remember I was admitted to hospital once as a teenager for an appendicitis operation and my doctor who was a wise old man said, “I am so happy to treat you because you are a young man, I treat you, you will go home well. When I treat my older patients, I see them, they get better, after a while they come back again and I have to treat them again. It is much more complicated.”

            But now we have many more older patients who are admitted more frequently with multiple complaints. After a few days in hospital their acute condition probably has stabilised, they no longer need intensive and complex treatment but they are still not well enough to go home. You may not need to have the heart monitor, you may not need to have the blood or oxygen monitor, you may not need to have the nurse look at your every two hours or the doctor look at you twice or three times a day but you are not quite ready to go home and you still need several weeks to recuperate and to get better before you can be discharged.

            After they go home they may still need continuing medication for underlying long-term conditions. Maybe they have diabetes, maybe they have heart disease, they may need aspirin, they may need statins. There are so many things which you have to take not just when you are sick but for the rest of your life. And even when you are at home, you may get sick again and you may have to come back again.

            So we have to respond to this by putting in more resources into our hospital system, building new hospitals. We got the Khoo Teck Puat Hospital coming up in Yishun, we have got Jurong General Hospital coming up in the west, and that is good. Well, the buildings are easy to do, but getting the people to man them, the doctors, nurses, specialists, physiotherapists, that takes more doing but we are in the process of doing that. It needs money. We are in the process of increasing the budget too. We need to improve our 3M system. We are doing that too.

            All these are necessary but by itself, more money is not the full solution to the problem. Because we also have to get the whole system to be structured properly so that it will be adapted to cater to the ageing population.  To structure it properly means we need step-down care. What is step-down care? I think Khaw Boon Wan has been talking about this for some time but let me explain it again because it is a vital idea and a crucial part of our solution. Step-down care means slow medicine: community hospitals, nursing homes, GPs doing more work, home care - people taking care of sick people at home. Organised properly all this can provide competent, appropriate care especially for the elderly patients. Step-down care today is provided mostly by VWOs. They do an excellent job but they will need government help to deal with more elderly patients.

            And one key thing we must do with this step-down care is to link up our acute hospitals - Tan Tock Seng, Khoo Teck Puat Hospital and so on with community hospitals, so that you can have the best of both worlds. Patients are sick can go to the acute hospitals, where they get “fast medicine” - ICU, MRI, surgery, all the intensive intervention and high-tech medicine. Then after they get better, they go to the community hospitals – Ren Ci, St Andrew’s Community Hospital where there are doctors and nurses who can look after the patients and you have physiotherapy and occupational therapy and rehab but they do not need the high-end medicine. The patients go there, they receive “slow medicine”, they take some time, get well enough to go home. If in the “slow medicine” place, you need “fast medicine”, you shift back to the acute hospital, and the doctor can see to you.

            
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            And that way you get appropriate care, you save money and we also free up beds in the acute hospitals for more cases which need to be admitted. This is all in principle but just to understand what it really meant, I decided to go and have a look for myself. So I went to visit the new Ren Ci Hospital which is co-located with Tan Tock Seng. And in this picture you can see Ren Ci on the left and Tan Tock Seng in the background, on the right hand side and behind. Ren Ci has a new management and they are working with Tan Tock Seng to realise this new arrangement. Tan Tock Seng will guide the medical care of patients at Ren Ci. The two hospitals will be connected together soon with a bridge so you can just wheel the patients across, without need for an ambulance.  Ren Ci will maintain its community outreach. It has got many volunteers and these volunteers do a very valuable job helping to keep patients active and happy. And here you see (in this picture) the volunteers helping the elderly lady to get her muscles control and built up again, practising fishing for something, and cheering her up.

            
            (Copyright Ministry of Health)

            So I think Tan Tock Seng - Ren Ci is a good model. Other acute hospitals should also tie up with community hospitals in the same way. Changi Hospital is already partnering St Andrew’s Community Hospital in the east. We will build similar sister community hospitals to match Khoo Teck Puat Hospital in the north and to match Jurong General Hospital in the west. And this arrangement will draw on the strengths of both parties - government professional teams delivering high quality care and VWOs, good at pastoral care and community outreach.

            
            (Copyright Home Nursing Foundation)

            But the community hospitals cannot be the end of the story because you cannot stay in the hospital forever, you must go home. You want to go home. And patients are best discharged home as soon as possible so that they can be with their families, so that they can be in familiar surroundings. They will be more comfortable, happier; much better and cheaper than leaving them in the hospital. I think families want this too but at the same time, families tell us they need some help and support at home. Very often they need caregivers and maids. And the caregivers and maids may need some professional training to look after the seniors. They could require nurses to visit them more frequently, check on the patient's condition and refer back to doctors in the hospital if necessary.

            Nowadays nurses can do many things: the nurse comes, attaches the sensors, reads an ECG, emails back to the doctor, the doctor can make a reading and then adjust the prescription or if need be, call the patient back. Home Nursing Foundation is doing good work in this respect and I think they need to ramp up, as we need more of this. GPs need to do more things with patients at home, monitoring and supervising their care.

            So we want people at home. We would like to help you to have your patients at home and we are working on upgrading home care. It is one of Ministry of Health’s priorities. This is not sexy, glamorous medicine but this is how we can help Singaporeans look after their elderly, look after ourselves when we are elderly, look after our healthcare costs. We have to think about the whole system, provide the right treatment at the right place to patients with different needs. So I hope that doctors will give full support to this. I hope the step-down care providers and VWOs will also work together with this because they are crucial.

            And we also need the patients' cooperation and support. Please do not insist on being in the high acute hospital, getting high-tech fast medicine. If the doctor advises you that you would be ok, go to the community hospital. It is more suitable, you get better and more appropriate treatment. We need everybody to cooperate so that we can deliver good, affordable healthcare and benefit all our patients. This is what the doctors and the hospitals can do.

            But I think one important business in medicine, in healthcare is what we ourselves can do to stay healthy - by maintaining healthy lifestyles. I think you know what to do because every teacher tells children in school, and we tell you this all the time: eat more fruits and vegetables, exercise regularly, do not smoke, keep your weight down. It is easy to say but very hard to do. I was reading one doctor lamenting how difficult it is to persuade people to lose weight in America where they have a big problem. And she said, “I advise my patients to lose weight. Then my patients look at me. And I said: Yes, I know but please try”.

            So please try. It is a change in attitude. You need lifestyle changes. It requires discipline, perseverance. So lectures and speeches would not work, necessary but would not be enough. The best way is to harness social links and interests to help individuals to stick to their good habits. So we have community programmes which combine fitness with fun, with social activities, brisk walking clubs, I think Northwest CDC has got a very popular activity going. Or qigong groups, this [picture] is one group, and all races participate.

            
             (Copyright Ministry of Health)

            One innovative scheme which encapsulates neatly what we need to do is the Wellness programme which Lim Boon Heng has been promoting and piloting in Jurong as well as a few other constituencies, with three components: Medical check-ups, regular exercise and social networking. So it becomes fun. And here [see picture below] you see the seniors are the ones who are dancing, not the ones who are looking. I think they are enjoying themselves. I went to visit the one in Jurong, and what really struck me was that all the seniors were cheerful and enjoying themselves, happy. So we will progressively expand this to cover the whole island. And we will reach out to more seniors so that we will help them to stay well and stay healthy.

            
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            Before I leave healthcare, let me just talk briefly about H1N1. That was at the beginning. It has been a big challenge for us these four months. I am very glad that Singaporeans have responded well to this unexpected virus. We were very worried when the news first broke in April of Swine Flu in Mexico. We knew it would reach us very soon but we knew very little else. How dangerous was it? How treatable was it? How badly would we be affected?

            
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            So at the onset we reacted strongly. We raised our alert status to orange. We did temperature scanning at entry points [see picture below], masks and gowns in hospitals and clinics, home quarantine for suspects. And many people home quarantined themselves after they came back from overseas. Very soon it became clear that H1N1 was different from SARS - more contagious, fortunately less deadly. So we stepped down, orange to yellow, but we kept up our efforts to block the virus, to delay community spread, to buy time so we would not be overwhelmed by a huge spike of cases overnight.

               
                 (Copyright Singapore Press Holdings)

            The whole of Government responded. The whole of the population responded. We had learnt our lessons from Sars. And we succeeded in delaying community spread, and slowing the impact on us. Perhaps we were lucky but I think what we did made a difference. I would like to thank everyone who was involved in this - the doctors and nurses, the hospital staff and GPs, those taking temperatures at the entry points, teachers and principals in our schools and kindergartens, health officials and so many more. You worked under a lot of stress, there must have been some worry, concern over what the dangers might have been, but you did not shirk from your responsibilities, you continued to perform under pressure. There was even one case where neurosurgery had to be carried out and the surgeon carried out the neurosurgery fully garbed up in PPE -Personal Protective Equipment: gown, N95 mask and did brain surgery. I think Singapore owes this team and all of them a debt of gratitude.

            This is how our healthcare system should work, not just against flu but all the time and for our long-term well-being. We have a good healthcare system, universally available and affordable to all. It is the envy of many countries. The Americans spend five or six times as much as us, their outcomes are worse, the British spend maybe double or three times what we do, their outcomes also not as good, and when they analyse their systems, they tell their people: the closest model to what they want to be is what Singapore is, with the 3Ms. So we have a good system, we must improve it but do not upset it and discard it because we are doing right and good by our people. 

            We will be ready for an ageing population. Each of us will also play our part to stay healthy and well and that is the way for Singaporeans to enjoy not just long life but good health and active golden years.


(Part 1 - Economy)
(Part 3 - Racial & Religious Harmony)
(Part 4 - Shaping Singapore Together)

Malay Translation