DPM Tharman Shanmugaratnam at KK Women's and Children's Hospital (KKH) 160th Anniversary Dinner

Senior Minister of State, Ministry of Health and Ministry of the Environment and Water Resources Amy Khor
Mr Peter Seah, Chairman, SingHealth,
Professor Ivy Ng, Group CEO, SingHealth,
Professor Alex Sia, CEO, KKH
Assoc Prof Ng Kee Chong, Chairman of Medical Board

KKH’s transformation over the years

KKH is a veritable Singapore institution. It is an important part of our history, the transformation of our society, and in fact an important reason why Singapore had the top rating in the World Bank’s Human Capital Index that was released two weeks ago. 

Founded in 1858, as a general hospital.

Became a maternity hospital on 1 October 1924.

In 1966, it entered the Guinness Book of Records for delivering the most number of births of any hospital in the world (39,856 then), a record it held for the next ten years.

Through the years, more than 1.2 million Singaporeans were born in KKH.

There were also many illustrious names who built up KKH – 

• Dr Benjamin Sheares, whom Prof Alex Sia mentioned, who served and indeed lived in KK during WW2, and who of course later served as our second President;

• Prof S. S. Ratnam, who delivered Asia’s first ‘test tube’ baby in KK in 1983; and

• Many others, and I would highlight the many trained midwives, who worked hard to bring down maternal and infant mortality rates in Singapore.

• That Singapore was able to reduce mortality rates at birth to one of the lowest rates in the world is in no small part the achievement of the generations of good people at KK. 

Today, KKH is the largest medical facility in Singapore for women and children, and an integrated one, offering a full range of services from antenatal to postnatal. It is among the world leaders in its field.

KKH has now embarked on its strategies for the future. It is taking forward the key shifts that we are making to our national healthcare system: going Beyond Healthcare to Health, Beyond Quality to Value, and Beyond Hospital to the Community. I will say a few words about KKH’s moves in this regard.

Shift 1: Beyond healthcare to health

Our healthcare institutions are going upstream, so that we go beyond treating patients when they are sick, to helping them stay healthy in the first place. KKH is focused on enhancing the long-term health outcomes of Singaporean mothers and children. It is a profoundly important effort.

This includes KKH’s important role in the national-level War on Diabetes.

Singapore has one of the highest incidences of gestational diabetes in the world.

Women diagnosed with gestational diabetes are at increased risk of developing diabetes in the future, and children born from such pregnancies are at higher risk of developing obesity and Type 2 diabetes later in life.

KKH has implemented universal screening for gestational diabetes mellitus (GDM) since Jan 2016, and is providing the necessary intervention and care for those who are at risk or who have been diagnosed with GDM. 

Around 27,000 expectant mothers have already been screened, and 15% of them (about 4,000) have been diagnosed with GDM and given follow-up advice and care where needed.

KKH is also engaging in anticipatory care nursing, to help patients stay well in the community once they are discharged from hospital.

KKH trains nurses to anticipate the needs of patients and families while in hospital, and the self-care skills that patients will require after returning home.

The nurses then educate parents and their families during their time in hospital, on how to stay healthy and manage chronic diseases – such as diabetes, epilepsy or asthma – so they can avoid relapse or complications.

Shift 2: Beyond quality to value: Keeping the healthcare system sustainable

We take pride in having a healthcare system which delivers a high standard of care and outcomes.  But we must also ensure that high quality care is affordable and sustainable. This is a key challenge for healthcare systems all over the world.

KKH has been at the forefront of innovations to deliver quality care in more effective and productive ways.

This includes technology-enabled solutions. 

An example is tele-consultation. Smart Health Video Consultation has also been implemented in KKH for patients in selected areas such as speech therapy, paediatric homecare and lactation consultation.

KKH is also using robotic solutions to automate more than 90 percent of workflows for medication dispensing, and using data for predictive modelling of clinic attendance patterns, so it can optimise manpower and minimise wait-times.

KKH has also been investing in continuous development of its people themselves, so they can deliver quality care to patients in the most efficient way.

For example, KKH introduced the first paediatric Advanced Practice Nurse (APN) role in Singapore, to expand the quality and scope of care nurses are trained to provide.

To date, there are 26 APNs and interns, with 6 more students soon to graduate from the Master of Nursing APN programme at National University of Singapore.

Shift 3: Beyond hospital to the community 

The third shift is also critical. We are moving care into the community, beyond the hospital setting. But KKH’s efforts in the community in fact go beyond our objectives in healthcare. It has been an integral part of our broader efforts to give every child a good start, so let me say a little more about this. 

Strengthening the early years

The early years of life are as we know critical in enabling every individual to achieve their full potential through life. We want, in particular, to do more to help those who start off from a disadvantaged position to reduce early deficits, and to achieve their full potential in school and through life. Our early interventions will also help in our broader efforts to keep social mobility alive in Singapore.

The science behind these early interventions is compelling. The latest research tells us that a million new neural connections are formed every second in a child’s brain in the first few years of life. The connections develop most quickly through interactions with adults. They form the architecture of the brain, and the base upon which later learning, behaviour, and health depend.¹ 

Our efforts are aimed at the holistic development of the young child. 

It means shifting the balance in the early childhood years, which is still too focused on academic preparation for the school years.

Towards a greater emphasis on the right nutrition and eating habits and developing children’s physical abilities; and

Their social and emotional development.

This is in addition to developing their language abilities, including their bilingual abilities. 

• Language is particularly important in the early years as it enables the child to interact with others, express and understand feelings, and to think for themselves;

• And to developing their curiosity and other fundamental cognitive abilities that are set in the early years.

Nutrition and Outdoor Play

There is more to do on each of these fronts, starting with nutrition and outdoor play.

Here too, the research underlines why it is so important for children to play outdoors. It keeps them fit and healthy, and keeps myopia at bay. It helps them socialise better with other children. And it sparks creativity and appreciation of nature. 

ECDA is increasing gross motor development time for full-day preschools to an hour daily, up from 30 minutes today. 

Childcare centres today are hence also being designed with better access to parks, community gardens and other outdoor play spaces. 

Secondly, healthy eating habits start from young. And unhealthy eating habits also start from young. Unfortunately, our current situation, as can be seen among our primary school children, is not a pretty one.

8 years ago, about 10% of our primary school children were overweight.

Last year, this figure has increased to 13%.

That is a worrying increase and a worrying level.

Many of these children were already overweight when they turned 5.

We have to act much more decisively to change habits in the early years. 

Otherwise, the situation will only get worse – not only for our children, but with consequences for the health of our population later on in life.

70% of children who are overweight at age 7, remain overweight as adults.

This also has a direct impact on chronic diseases such as diabetes, and life expectancy.

At the preschool level, nutritional requirements have been enhanced since earlier this year.

Wholegrains, fruits and vegetables are served in our preschools, and water is provided throughout the day. 

Sugary drinks, such as syrup and cordial, and drinks without the Healthier Choice symbol (HCS) are not allowed. 

Fried, pre deep-fried and preserved food are not allowed.

We will do more. We are going to progressively tighten the requirements for nutritional content for preschool food – to ensure that the kids get nutritious, balanced and varied food. 

The preschool setting gives us the opportunity to shape the tastes and preferences of our children. But it is also critical for parents to cultivate healthy eating habits in their children.

HPB has been stepping up efforts to engage parents on health and nutrition for children.

But it is quite clear we will have to do more to help parents understand why this is important for their children’s future, and make changes to their own habits too, so they can be role models to their children.

We are studying how we can do this – how we can help shape or nudge behaviour within families. 

Giving a leg up to children from low-income families

One of our most important efforts is to provide children from low-income and vulnerable backgrounds with additional support, as early as possible. We have to do all we can to reduce their early deficits compared to other kids, and lay the foundations for them to achieve their full potential as they go through school and life. 

The KidSTART programme is a focal point for this effort. We want to intervene early and provide more wrap-around support for children from low-income families. It starts from pre-natal care to when the child turns 6 years old.

We know that the issues faced by low-income families are multi-faceted. Our approach has evolved from one that is programme-centric, to one that is child and family centric. We are building an ecosystem of support around each family in need. We are also paying special attention to children growing up in a stressful environment, such as when they are separated from a parent, or where there is some other family turmoil. And we will make sure that financial circumstances are no barrier to the kids getting quality attention.  

The KidSTART pilot was launched in July 2016. The feedback so far has been encouraging – parents feel better supported and are more confident in their parenting skills. But this will be a journey that we will stay on for the long term, with a lot of learning along the way on what works better and what doesn’t work so well. We will also learn from the most effective experiments abroad. 

KidSTART in fact built on the early efforts of KKH, which started the KIDS 0-3 programme in 2014. 
 
The KIDS 0-3 programme provided mothers and babies from vulnerable families with integrated health and social support, from pregnancy until the baby is three years old, so that the child will develop healthily, and the mother’s well-being was taken care of.

KKH and ECDA have since 2016 been working together on home visits to vulnerable homes. 

Reaching out to children with developmental delays

There is also a more specific group of children that deserve our additional attention – those with developmental delays. For these children, early and appropriate intervention based on their needs, is key to maximising their potential. 

MSF works closely with its partners to enable the timely detection of children with developmental needs, provision of Early Intervention (EI) services, caregiver training and capability development.

KKH’s Child Development Unit has been a key partner in this area too for many years. 

In fact, a pilot by a group of KKH professionals that was started in 2009 paved the way for preschoolers with mild developmental needs to have family-focused learning support and therapy services to improve their readiness for mainstream education. 

This pilot was later adopted by MSF in 2013, and expanded into the Development Support (DS) and Learning Support (LS) programmes for children with mild-to-moderate needs, which run in some 550 preschools in Singapore today.

KKH continues to support these programmes today as consultants, and conducts training for the Learning Support Educators in the programmes.

Together with consultants from the National University Hospital, KKH consultants had also helped centres running the Early Intervention Programme for Infants and Children (EIPIC) build capabilities and enhance early intervention standards. 

We are continuing to develop the continuum of early intervention services, to better cater to the varying needs of these children with developmental delays. 

MSF plans to further increase the support for children with special needs within the mainstream preschool setting. It is exploring an enhanced Development Support programme, which will allow children who have made sufficient progress in an EIPIC centre to continue to receive support within their preschool. Early intervention professionals can then support and co-teach the child alongside the preschool teacher. 

MSF will also be setting out clearer guidelines for service delivery across our EIPIC providers, to introduce greater standardisation in the way children are identified for EI programmes and to track their progress over time. 

The interventions I have just described – whether they are for children from vulnerable families or children with specific developmental needs - are really part of a much broader journey.  They are part of how we invest in every child, and help every Singaporean develop through life. And how we keep social mobility going, and maximise our collective abilities as a people. 

Closing Remarks 

Let me reiterate how remarkable it is that 1.2 million Singaporeans started life in KKH, and even more would have benefitted from KKH’s expertise, and dedication. 

Let me also echo Prof Alex Sia in thanking the generous donors and partners who have contributed their money, time and expertise to help KKH in this journey.

Once again, congratulations on 160 years of rich heritage. May you have healthier and more fulfilling years ahead, as you continue to deliver excellent, holistic and compassionate care for generations of women and children to come.

[1]  Centre on the Developing Child, Harvard University. ‘Five numbers to remember about early childhood development.’

Senior Minister of State, Ministry of Health and Ministry of the Environment and Water Resources Amy Khor
Mr Peter Seah, Chairman, SingHealth,
Professor Ivy Ng, Group CEO, SingHealth,
Professor Alex Sia, CEO, KKH
Assoc Prof Ng Kee Chong, Chairman of Medical Board

KKH’s transformation over the years

KKH is a veritable Singapore institution. It is an important part of our history, the transformation of our society, and in fact an important reason why Singapore had the top rating in the World Bank’s Human Capital Index that was released two weeks ago. 

Founded in 1858, as a general hospital.

Became a maternity hospital on 1 October 1924.

In 1966, it entered the Guinness Book of Records for delivering the most number of births of any hospital in the world (39,856 then), a record it held for the next ten years.

Through the years, more than 1.2 million Singaporeans were born in KKH.

There were also many illustrious names who built up KKH – 

• Dr Benjamin Sheares, whom Prof Alex Sia mentioned, who served and indeed lived in KK during WW2, and who of course later served as our second President;

• Prof S. S. Ratnam, who delivered Asia’s first ‘test tube’ baby in KK in 1983; and

• Many others, and I would highlight the many trained midwives, who worked hard to bring down maternal and infant mortality rates in Singapore.

• That Singapore was able to reduce mortality rates at birth to one of the lowest rates in the world is in no small part the achievement of the generations of good people at KK. 

Today, KKH is the largest medical facility in Singapore for women and children, and an integrated one, offering a full range of services from antenatal to postnatal. It is among the world leaders in its field.

KKH has now embarked on its strategies for the future. It is taking forward the key shifts that we are making to our national healthcare system: going Beyond Healthcare to Health, Beyond Quality to Value, and Beyond Hospital to the Community. I will say a few words about KKH’s moves in this regard.

Shift 1: Beyond healthcare to health

Our healthcare institutions are going upstream, so that we go beyond treating patients when they are sick, to helping them stay healthy in the first place. KKH is focused on enhancing the long-term health outcomes of Singaporean mothers and children. It is a profoundly important effort.

This includes KKH’s important role in the national-level War on Diabetes.

Singapore has one of the highest incidences of gestational diabetes in the world.

Women diagnosed with gestational diabetes are at increased risk of developing diabetes in the future, and children born from such pregnancies are at higher risk of developing obesity and Type 2 diabetes later in life.

KKH has implemented universal screening for gestational diabetes mellitus (GDM) since Jan 2016, and is providing the necessary intervention and care for those who are at risk or who have been diagnosed with GDM. 

Around 27,000 expectant mothers have already been screened, and 15% of them (about 4,000) have been diagnosed with GDM and given follow-up advice and care where needed.

KKH is also engaging in anticipatory care nursing, to help patients stay well in the community once they are discharged from hospital.

KKH trains nurses to anticipate the needs of patients and families while in hospital, and the self-care skills that patients will require after returning home.

The nurses then educate parents and their families during their time in hospital, on how to stay healthy and manage chronic diseases – such as diabetes, epilepsy or asthma – so they can avoid relapse or complications.

Shift 2: Beyond quality to value: Keeping the healthcare system sustainable

We take pride in having a healthcare system which delivers a high standard of care and outcomes.  But we must also ensure that high quality care is affordable and sustainable. This is a key challenge for healthcare systems all over the world.

KKH has been at the forefront of innovations to deliver quality care in more effective and productive ways.

This includes technology-enabled solutions. 

An example is tele-consultation. Smart Health Video Consultation has also been implemented in KKH for patients in selected areas such as speech therapy, paediatric homecare and lactation consultation.

KKH is also using robotic solutions to automate more than 90 percent of workflows for medication dispensing, and using data for predictive modelling of clinic attendance patterns, so it can optimise manpower and minimise wait-times.

KKH has also been investing in continuous development of its people themselves, so they can deliver quality care to patients in the most efficient way.

For example, KKH introduced the first paediatric Advanced Practice Nurse (APN) role in Singapore, to expand the quality and scope of care nurses are trained to provide.

To date, there are 26 APNs and interns, with 6 more students soon to graduate from the Master of Nursing APN programme at National University of Singapore.

Shift 3: Beyond hospital to the community 

The third shift is also critical. We are moving care into the community, beyond the hospital setting. But KKH’s efforts in the community in fact go beyond our objectives in healthcare. It has been an integral part of our broader efforts to give every child a good start, so let me say a little more about this. 

Strengthening the early years

The early years of life are as we know critical in enabling every individual to achieve their full potential through life. We want, in particular, to do more to help those who start off from a disadvantaged position to reduce early deficits, and to achieve their full potential in school and through life. Our early interventions will also help in our broader efforts to keep social mobility alive in Singapore.

The science behind these early interventions is compelling. The latest research tells us that a million new neural connections are formed every second in a child’s brain in the first few years of life. The connections develop most quickly through interactions with adults. They form the architecture of the brain, and the base upon which later learning, behaviour, and health depend.¹ 

Our efforts are aimed at the holistic development of the young child. 

It means shifting the balance in the early childhood years, which is still too focused on academic preparation for the school years.

Towards a greater emphasis on the right nutrition and eating habits and developing children’s physical abilities; and

Their social and emotional development.

This is in addition to developing their language abilities, including their bilingual abilities. 

• Language is particularly important in the early years as it enables the child to interact with others, express and understand feelings, and to think for themselves;

• And to developing their curiosity and other fundamental cognitive abilities that are set in the early years.

Nutrition and Outdoor Play

There is more to do on each of these fronts, starting with nutrition and outdoor play.

Here too, the research underlines why it is so important for children to play outdoors. It keeps them fit and healthy, and keeps myopia at bay. It helps them socialise better with other children. And it sparks creativity and appreciation of nature. 

ECDA is increasing gross motor development time for full-day preschools to an hour daily, up from 30 minutes today. 

Childcare centres today are hence also being designed with better access to parks, community gardens and other outdoor play spaces. 

Secondly, healthy eating habits start from young. And unhealthy eating habits also start from young. Unfortunately, our current situation, as can be seen among our primary school children, is not a pretty one.

8 years ago, about 10% of our primary school children were overweight.

Last year, this figure has increased to 13%.

That is a worrying increase and a worrying level.

Many of these children were already overweight when they turned 5.

We have to act much more decisively to change habits in the early years. 

Otherwise, the situation will only get worse – not only for our children, but with consequences for the health of our population later on in life.

70% of children who are overweight at age 7, remain overweight as adults.

This also has a direct impact on chronic diseases such as diabetes, and life expectancy.

At the preschool level, nutritional requirements have been enhanced since earlier this year.

Wholegrains, fruits and vegetables are served in our preschools, and water is provided throughout the day. 

Sugary drinks, such as syrup and cordial, and drinks without the Healthier Choice symbol (HCS) are not allowed. 

Fried, pre deep-fried and preserved food are not allowed.

We will do more. We are going to progressively tighten the requirements for nutritional content for preschool food – to ensure that the kids get nutritious, balanced and varied food. 

The preschool setting gives us the opportunity to shape the tastes and preferences of our children. But it is also critical for parents to cultivate healthy eating habits in their children.

HPB has been stepping up efforts to engage parents on health and nutrition for children.

But it is quite clear we will have to do more to help parents understand why this is important for their children’s future, and make changes to their own habits too, so they can be role models to their children.

We are studying how we can do this – how we can help shape or nudge behaviour within families. 

Giving a leg up to children from low-income families

One of our most important efforts is to provide children from low-income and vulnerable backgrounds with additional support, as early as possible. We have to do all we can to reduce their early deficits compared to other kids, and lay the foundations for them to achieve their full potential as they go through school and life. 

The KidSTART programme is a focal point for this effort. We want to intervene early and provide more wrap-around support for children from low-income families. It starts from pre-natal care to when the child turns 6 years old.

We know that the issues faced by low-income families are multi-faceted. Our approach has evolved from one that is programme-centric, to one that is child and family centric. We are building an ecosystem of support around each family in need. We are also paying special attention to children growing up in a stressful environment, such as when they are separated from a parent, or where there is some other family turmoil. And we will make sure that financial circumstances are no barrier to the kids getting quality attention.  

The KidSTART pilot was launched in July 2016. The feedback so far has been encouraging – parents feel better supported and are more confident in their parenting skills. But this will be a journey that we will stay on for the long term, with a lot of learning along the way on what works better and what doesn’t work so well. We will also learn from the most effective experiments abroad. 

KidSTART in fact built on the early efforts of KKH, which started the KIDS 0-3 programme in 2014. 
 
The KIDS 0-3 programme provided mothers and babies from vulnerable families with integrated health and social support, from pregnancy until the baby is three years old, so that the child will develop healthily, and the mother’s well-being was taken care of.

KKH and ECDA have since 2016 been working together on home visits to vulnerable homes. 

Reaching out to children with developmental delays

There is also a more specific group of children that deserve our additional attention – those with developmental delays. For these children, early and appropriate intervention based on their needs, is key to maximising their potential. 

MSF works closely with its partners to enable the timely detection of children with developmental needs, provision of Early Intervention (EI) services, caregiver training and capability development.

KKH’s Child Development Unit has been a key partner in this area too for many years. 

In fact, a pilot by a group of KKH professionals that was started in 2009 paved the way for preschoolers with mild developmental needs to have family-focused learning support and therapy services to improve their readiness for mainstream education. 

This pilot was later adopted by MSF in 2013, and expanded into the Development Support (DS) and Learning Support (LS) programmes for children with mild-to-moderate needs, which run in some 550 preschools in Singapore today.

KKH continues to support these programmes today as consultants, and conducts training for the Learning Support Educators in the programmes.

Together with consultants from the National University Hospital, KKH consultants had also helped centres running the Early Intervention Programme for Infants and Children (EIPIC) build capabilities and enhance early intervention standards. 

We are continuing to develop the continuum of early intervention services, to better cater to the varying needs of these children with developmental delays. 

MSF plans to further increase the support for children with special needs within the mainstream preschool setting. It is exploring an enhanced Development Support programme, which will allow children who have made sufficient progress in an EIPIC centre to continue to receive support within their preschool. Early intervention professionals can then support and co-teach the child alongside the preschool teacher. 

MSF will also be setting out clearer guidelines for service delivery across our EIPIC providers, to introduce greater standardisation in the way children are identified for EI programmes and to track their progress over time. 

The interventions I have just described – whether they are for children from vulnerable families or children with specific developmental needs - are really part of a much broader journey.  They are part of how we invest in every child, and help every Singaporean develop through life. And how we keep social mobility going, and maximise our collective abilities as a people. 

Closing Remarks 

Let me reiterate how remarkable it is that 1.2 million Singaporeans started life in KKH, and even more would have benefitted from KKH’s expertise, and dedication. 

Let me also echo Prof Alex Sia in thanking the generous donors and partners who have contributed their money, time and expertise to help KKH in this journey.

Once again, congratulations on 160 years of rich heritage. May you have healthier and more fulfilling years ahead, as you continue to deliver excellent, holistic and compassionate care for generations of women and children to come.

[1]  Centre on the Developing Child, Harvard University. ‘Five numbers to remember about early childhood development.’

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