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Healthcare sector must align with SkillsFuture movement, say industry players

The Multi-dose Medication Management (MMM) system designed by the National Healthcare Group (NHG) Pharmacy and the Health Ministry’s Integrated Health Information Systems (IHiS) packs medicine in sachets by what needs to be taken per dose instead of by type.


AS Singapore moves towards becoming a Smart Nation, the country's healthcare sector will need to respond by providing training and development programmes aligned with the SkillsFuture movement, that is, tailored to give healthcare-sector workers opportunities to go farthest, wherever they stand in terms of educational qualifications or work experience, industry players and observers have said.

This is so that they can deliver affordable, quality healthcare to a rapidly greying population, plagued by chronic conditions amid rising healthcare and social care costs.

Already, the escalating demand for efficient and cost-effective care has pushed Asian governments to explore the use of health-information technology, analytics, medical technology and wearable monitoring devices, among other things.

Health economist Phua Kai Hong from the Lee Kuan Yew School of Public Policy outlined three areas in which the sector needs to respond in an integrated manner:

  • supply of appropriate technology;
  • "right-siting", or the managing of stable, chronic-disease patients in primary-care instead of specialist settings; and
  • relevant workforce education.

He said: "Health workforce training and education should be aligned with these national goals at all levels - from specialist and technical training down to support services - and not just hardware and physical infrastructure, but also software, such as personnel or human-resource development and incentives."

Yong Chern Chet, Deloitte South-east Asia's healthcare sector leader, noted that there are now 345 healthcare courses listed on the Workforce Development Agency (WDA) website; these range from higher-certificate courses in "ophthalmic dispensing" to those including training in mundane tasks such as helping patients with trimming their nails.

Viewed collectively, these offerings are designed to boost proficiency and to broadly serve areas of needs within the healthcare ecosystem, said Dr Yong. By 2020, he noted, the number of elderly people with chronic ailments such as Type 2 diabetes, obesity and cardiovascular diseases will be much higher, triggering a shift in emphasis and demand for health care from acute to intermediate and long-term care.

Chia Shi-Lu, who chairs the government parliamentary committee for health, said that as this happens, a lot of work traditionally associated with doctors will be moved to specialised paramedical staff. Programmes must thus be developed to address these needs.

Already, in many countries, health care is delivered by adjunct medical staff, not full-fledged doctors.

Abhijit Ghosh, pharmaceutical and healthcare leader at PwC Singapore, said that medical specialists, nurses and some related technical professionals would require training modules that should factor in practical, on-the-job training and involvement of mentors where possible.

And as healthcare services become more patient-centric, demand for more specialised medical skills which support integrated-care management will rise.

Mr Ghosh said: "The use of technology will be extensive and staff at different skill levels must be equipped to guide the patients through the system. Moreover, as is done in Austria, we could consider developing a pool of staff in the hospitals and clinics who will be after-care managers or after-care planners."

Industry observers also identified hospice and palliative care as an area needing attention; basic medical and nursing education will need to include this aspect of health care.

Dr Phua said that, over and above providing training for geriatricians, rehabilitative-medicine specialists and physiotherapists, there needs to be greater public-private participation, which would require integrative practical training in the right settings, aligned with the right incentives.

Research and development of practical eldercare assistive technologies in home and community environments would have to be scaled up and improved to achieve cost-effective long-term care at home; this know-how could also be exported to external markets.

The future healthcare model will demand accountability and control, so healthcare staff will find more administrative tasks on their hands than they did before, said Mr Ghosh.

"For example, treatments need to be specified and labelled with different codes before they are invoiced, costs need to be specified according to different accounting systems, referral management for specialised or follow-up treatments are now more complicated, and archiving and filing of records for future use must be carefully handled."

The National Healthcare Group (NHG) trains about a third of all specialists and 20 per cent of all other students of health professions in Singapore. NHG group chief education officer Nicholas Chew said that they would need to be equipped with thinking skills and be more "future-oriented" and professional.

Calling for a re-think of the role of a healthcare worker, he said: "In a world where epidemics loom large and descend swiftly, 'future-sensing' skills and adaptability are a must. The patient-centred care of the future will need more than instilling soft skills such as empathy and communication; it will require working with patients to build a long-term relationship of solidarity, partnership and collaboration."

SingHealth, Singapore's largest healthcare group, when asked for its views, said that the Ministry of Health (MOH) "would be better placed to answer the questions on SkillsFuture".

In March, Health Minister Gan Kim Yong said that his ministry would place more emphasis on developing capabilities in new health technologies, including devices and drugs that are clinically and cost-effective.

He said that MOH's long-term healthcare strategy involved developing community care and setting up the regional health systems. By the end of the year, MOH will launch the Community Hospital Common System (CHCS), which will link the IT systems of all community hospitals with partnering public healthcare institutions. This is to enable healthcare professionals in acute and community hospitals to share patient information and improve the care experience.

Dr Yong said: "We need to develop a system where the critical clinical functions and decision making are carried out by the core medical team efficiently and effectively. This system also allows the healthcare support team to step in and manage the equally important but differentiated patient care function - the key concept here being 'right-siting' of care and medical capability."

Another concern comes from supply side-induced demand and other market distortions as a result of subsidies.

Dr Chia said: "There are concerns that in Singapore, we may be over-servicing certain aspects of health care, and under-servicing others. But until the system is calibrated to truly reflect where the needs are, healthcare manpower planning will remain problematic as one could end up chasing one's tail."

He cited another concern - that of the loss of manpower from the public to the private sector. Attrition will remain a point of tension in the near to medium-term, he said.

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