Staff Adequacy at Public and Private Hospitals

While indicators like the doctor-to-patient ratio and healthcare staff-to-patient ratio are useful in providing a broad comparison across time and across countries, we need to be mindful of the differences in clinical practices and operating environments across different institutions and countries.

Between 2007 and 2012, Singapore's doctor-to-population ratio improved from 1:620 to 1:520. Similarly, our nurse-to-population ratio also improved from 1:205 to 1:154.

To meet the needs of a growing and ageing population, my Ministry has worked with the public healthcare clusters to expand our pool of public sector healthcare professionals. The number of doctors in the public sector has increased by more than 50% since 2007 to around 6,200 in 2012, while the number of nurses has increased by about 70% to 21,000 over the same period. The pay of healthcare professionals has also been enhanced in 2012 to be more competitive against the market, to better attract and retain healthcare professionals in the public healthcare sector.

At the upstream training level, we are expanding intakes to meet the projected additional 20,000 more healthcare professionals needed by 2020. The medical intake will further increase this year by another 50 students with the opening of Singapore's third medical school, the Lee Kong Chian School of Medicine at NTU, bringing the total medical intake to around 400. This will further increase to 500 over time. Likewise, we will increase the nursing intake to 2,700 eventually.

We are also working with the public healthcare clusters to optimise the use of our public healthcare workforce through productivity measures. These continuous efforts to improve workflow, redesign jobs and better utilise technology will not only drive efficiency gains and savings in operating costs, but will also provide higher job satisfaction for the healthcare workers.

We agree with Mr Gan Thiam Poh that there should be an increase in emphasis and investment in preventive healthcare in the face of our ageing population. In view of this, we are investing in the promotion of healthy lifestyles, including the adoption and maintenance of good dietary habits and regular physical activity, as well as leading a smoke-free life. We are also

Page: 30

encouraging regular health screenings to facilitate early detection and management of chronic diseases. The Integrated Screening Programme (ISP) was introduced in 2008 to encourage Singaporeans aged 40 and above to screen for chronic conditions, including diabetes, high blood pressure and high blood cholesterol. To improve the health of our adult population, who will become the next generation of elderly Singaporeans in time to come, we have implemented the Workplace Health Promotion (WHP) programme to provide a comprehensive support infrastructure for companies to introduce health promotion policies, activities, and programmes for their workforce.

In addition to health promotion, we are investing in good primary healthcare. The Chronic Disease Management Programme (CDMP) available at enrolled GP clinics works in conjunction with the Community Health Assist Scheme (CHAS) to ensure the accessibility and affordability of medical treatment for persons with chronic conditions in the community. These help improve individuals' health outcomes as well as prevent the deterioration of the chronic conditions and the development of complications later in life.

As part of the public consultation on the Healthy Living Master Plan that was announced at the recent Committee of Supply Debate, my Ministry will get feedback and suggestions on how we can make healthy living, including preventive care, a part of our everyday fabric. The on-going review of our healthcare financing framework will also cover our funding framework for preventive health to ensure that it remains affordable and accessible to all Singaporeans.

I thank the Minister of State for the comprehensive reply. I just want to find out how the current ratio compares with those of other countries, both developed and developing. Will MOH also look into contingency plans should there be a sharp increase in demand, such as an outbreak of bird flu, and whether the current strength is sufficient enough to meet the challenges? Will MOH also consider planning for extra manpower in case there is a sudden rise in demand? Will MOH think about looking into improving the ratio further from the current level?

For the healthcare manpower ratios, as I have noted in my reply earlier, these basically provide a broad level comparison of the adequacy of healthcare manpower across time and countries. We need to be mindful that we need to take into account differences in demographic and epidemiological profiles, healthcare systems and legislations in order to make the

Page: 31

comparisons more informative and useful.

As regards our current healthcare manpower ratio, the common ratio used is the healthcare manpower-to-population ratio. Thus, doctor-to-population, and nurse-to-population ratios. For these ratios, they are comparable to those of developed regional economies which have a similar proportion of elderly, such as South Korea, Hong Kong and Taiwan.

As I have noted, we expect to expand our healthcare professional workforce by about another 20,000 by 2020 to take into account the growing and ageing population. By 2030, we expect to expand our healthcare professional workforce by about 32,000 staff, as well as about 9,000 support care staff. With this expansion, our doctor-to-population and nurse-to-population ratios are likely to remain broadly comparable internationally with economies with similar economic development and ageing demographics.

As regards the need to address pandemic outbreaks, such as SARS or H1N1, we have learnt from our experience with SARS and H1N1 and also with the surge in dengue cases previously, so we have put various processes and measures in place to deal with such a surge in cases due to, say, H1N1 or SARS. In the event of an outbreak of a pandemic, the public healthcare institutions would temporarily cut back on elective surgeries, outsource certain services where possible, bring back temporary healthcare support staff where appropriate, and redeploy the staff to tackle the higher load due to the pandemic. So, by cutting back, say, for instance, the electives, we will be able to redeploy some of these staff. Manpower could also be deployed across various healthcare systems, depending on where the loading and the need is. These are some of the measures that we will put into place in the event of a surge in cases.

A supplementary question, Madam. I am very happy to hear from the Minister of State about the recruitment increase in nurses and allied health workers. But is the Minister of State aware about the difficulty to recruit students into the nursing courses and the allied courses like physiotherapy, occupational therapy and radiography? These are areas where workers are really in demand and in need in Singapore. I hope we will look also into ways of how to promote such occupations and the ways to encourage our younger generation to consider such careers in the healthcare industry.

I thank Mr Zainudin for the question. Indeed, it is a challenge to recruit, especially upstream in terms of attracting school

Page: 32

leavers into the various healthcare courses.

Recently, in the COS, the Minister has also said that we have gone on a campaign to promote these various healthcare professions, such as nursing and the allied healthcare professionals (AHPs), particularly the school leavers, with the intention of attracting more into the courses at ITE, Polytechnics as well as at the Universities. The response so far to this campaign in terms of advertisements on TV, radio, online and so on has been positive. We will continue to do what we can to promote this in terms of showcasing the good work done by the nursing profession, the AHPs and so on. They are very noble professions and we should continue to promote these professions and create awareness among the school leavers.

Of course, as I have noted earlier also, we have reviewed the pay of the healthcare professionals and we have also put in place career pathways and development for the various healthcare professionals, such as nurses, AHPs and doctors, and we hope that that will also help to attract and retain healthcare professionals.

I would like to thank the Minister of State for reassuring us that the doctor-to-patient ratio in Singapore is relatively healthy compared to other developed countries. I would like the Ministry to look in detail at the number of specialists in areas, such as geriatrics as well as rehab medicine, since these specialties are more relevant in looking after the elderly population. I would also like to know whether MOH has plans to encourage more doctors to take up specialty training in these areas.

The short answer would be "yes". In addition to projecting our healthcare manpower needs based on population demographic profile, as well as on the epidemiological profile, we would also need to look specifically at the different specialties required among the doctors. One of the areas that we need to look at is to promote or encourage doctors to go into specialties that will be increasingly in demand, for instance, in geriatric care.

Thank you, Madam. I would like to ask the Minister of State two supplementary questions. I noticed that there has been quite widespread use of medical officers from non-traditional sources (NTS MOs) in the medical institutions. My first supplementary question is whether there will likely be further significant increases in the use of NTS MOs to supplement shortages in the hospitals,

Page: 33

especially to fill up these 20,000 places. And what would be the likely ratio to doctors from traditional sources.

My second supplementary question is: what are the measures to ensure that these NTS MOs are sufficiently equipped, both in medical skills as well as the ability to converse in local dialects and languages with our patients, especially since our elderly patients may not speak English.

Our key objective is to build up a core of Singaporean healthcare workforce. So, in addition to increasing our upstream intake of doctors to the medical schools – and I have noted that we are increasing the placements or number of places in our medical schools, especially with the addition of a third medical school – we are also increasing the number of places for our pre-employment grant for doctors, that is, foreign-trained Singaporean doctors. We are trying to attract them from the various countries, of course, from accredited institutions.

In addition to that, there is definitely a need to supplement our healthcare manpower with foreign manpower and we have said that a number of times. Whilst we will take in foreign manpower, say for doctors and so on, they must also be from recognised institutions. If they are not, they will not be registered. They will be working as support staff and there will be requirements for them to undergo further training and registration. I do not have the ratio at this point in time. If the Member wishes, he can submit another question.