The world is facing a severe manpower crunch in health and social care. The CEO of the International Council of Nurses (ICN) said last year that “the scale of the worldwide nursing shortage is one of the greatest threats to health globally.” The ICN estimates that due to existing nursing shortages, the ageing of the nursing workforce and the effect of COVID-19, up to 13 million nurses will be needed to fill the global nurse shortage gap in the future. The Southeast Asia region alone is facing a shortfall of 1.9 million nurses, according to the World Health Organization.
Singapore needs another 24,000 nurses, allied health professionals and support care staff to operate hospitals, clinics and eldercare centres by 2030. Our rapidly ageing population is causing demand for health and social care to increase dramatically. Yet Singapore is facing a high attrition rate of nurses. One of the reasons why nurses in Singapore have reported to be resigning is because of their heavy workload and stress, which is caused in large part by the manpower shortage.
Boosting local healthcare manpower
Urgent measures are needed to address this manpower shortage. There are no quick fix solutions. We need to encourage more Singaporeans to choose health and social care as a career so as to boost the pipeline of future professionals in this field.
I highlighted in my speech on Singapore’s COVID-19 response in March that nurses in Singapore are often still seen as the assistants to doctors instead of being professionals in their own right. We need to boost the image of the profession and enhance societal esteem for nurses and allied healthcare workers. Nurses should be granted more autonomy and entrusted with higher level responsibilities.
Schools should highlight careers in health and social care early to students. Professional associations should come up with materials and videos highlighting the careers in this field and share these with schools to disseminate to their students. I agree with Dr Tan Yia Swam’s call just now for a repository of articles on navigating the healthcare system — and I hope she starts her blog again so that we can continue to tap on her knowledge. Career guidance should start early in secondary one. This is so that students’ interest in health and social care careers can be sparked early and they can start working towards choosing suitable subjects as they move up to secondary three.
As I mentioned in my speech on the education system in April, schools should move away from sorting students according to their grades and towards allowing students to take subject combinations based on their interests. This is how we can continue to raise up a generation of future healthcare professionals who love what they do and are passionate about their work.
IHLs (institutes of higher learning) could develop guidebooks to help local students prepare themselves for their eventual applications to these institutions. These guidebooks could include information on the subjects they need to take in school, the grades they need to obtain, and the co-curricular and extracurricular activities they need to get involved in to best prepare themselves to get admitted to the institution and major of their choice. For example, this guide could recommend that students take certain subject combinations, join the science club, find opportunities to conduct scientific research, write and publish research papers, or work as an intern in a health or social care institution during their school holidays.
It should provide guidance on how to search out these opportunities and work with professional health and social care associations to create these opportunities for students. These could all help our students focus early on pursuing their area of interest in health and social care and better prepare them for their eventual careers in this exciting field. It is too late to attempt to put together a portfolio just before applying for university or polytechnic. Yet this is often what many students do, because they go through secondary school with little idea of what they are interested in, and do not participate in activities that prepare them for their future careers.
Students from more well-resourced families, on the other hand, often obtain this guidance from their parents and are provided with opportunities for hands-on experience through their parents’ professional connections. In order to level up our society and capture a wider pool of talent in our population, we need to make this information available to every student.
However, changing public perceptions and increasing public awareness about health and social care careers takes time and requires a concerted effort from various stakeholders, including the government, the media, schools and parents. We must continue to develop targeted initiatives to address the concerns of healthcare workers, such as work-life balance, remuneration and career progression.
Technology as a force multiplier in healthcare
Having said all this, it is simply not sustainable to rely on increasing manpower supply alone to meet the health and social care needs of our nation. Considering our own ageing population in Singapore, which will require greater care needs, if we are to staff all our health and social care institutions with the doctors, nurses, allied health professionals and care workers to meet the ideal healthcare worker-to-patient ratios, the health and social care sector will likely take up a disproportionate share of Singapore’s manpower and will starve other sectors of the economy of skills and talent.
Technology can play an important role in boosting productivity and augmenting manpower. In my adjournment motion in this House in 2013 on easing the cost of healthcare, I said that technology should be used as a force multiplier in the face of limited manpower in our healthcare system. This is even more so now than it was a decade ago.
Healthcare technology — or HealthTech — is a fast-growing and promising field which must be developed further in Singapore. Transformational technologies are being developed now which will revolutionise the way healthcare is delivered in the future. These include artificial intelligence-driven diagnostics that can detect diseases early and make more accurate diagnoses more quickly than conventional means. For example, researchers at MIT have developed an AI model called Sybil that can predict a patient’s risk of lung cancer within six years using low-dose CT scans.
The emerging field of precision medicine has the potential to transform healthcare and is being used in the treatment of diseases like cancer, cardiovascular diseases and genetic disorders. It can potentially improve patient outcomes by providing more targeted and effective treatments, reducing adverse reactions to medications, and optimising disease prevention strategies. I note that there is now a Singapore Precision Medicine initiative aiming to generate precision medicine data of up to one million individuals, integrating genomic, lifestyle, health, social and environmental data. This is a very positive development.
There are also other healthcare technologies that are not as “deep tech” as what I mentioned earlier but are already in the market and can provide a boost to the productivity of healthcare workers, enhance the patient experience and improve health outcomes.
The National Electronic Health Records (NEHR) system is a major, multi-year HealthTech initiative. According to the MOH website, there are 2,231 healthcare institutions participating in the NEHR as of 5 May 2023. This list appears to be growing every day and I note there has been a marked increase in the number of participating healthcare providers since the start of this year.
The Straits Times reported on 2 May that the “private sector has been slow to participate in the NEHR since it was launched in 2011”. According to a PQ reply by Minister Ong Ye Kung to Mr Leon Perera in March 2023, only about 30% of licensed private ambulatory care institutions have view-access to the NEHR and less than 4% are contributing data.
A 2020 survey and paper by Clinical Asst Prof See Qin Yong of Changi General Hospital entitled “Attitudes and Perceptions of General Practitioners towards the NEHR in Singapore” found that solo-practising GPs who were more than 40 years old and who had practised for more than 15 years were less likely to view and contribute data onto NEHR. Doctors who regarded themselves as less computer savvy and those who perceived that an inadequate level of technical or financial support was available were also less likely to use the NEHR.
The Health Information Bill was supposed to be tabled in Parliament in 2018 to make the contribution of data to the NEHR mandatory for licensed healthcare groups after a grace period. However, this was deferred in the wake of the cyberattack and data breach of SingHealth systems in July that year, in order for technical and process enhancements to improve the security posture of the NEHR to be implemented first. Most of these security enhancements were supposed to be completed by last year, according to SMS (Health) Janil Puthucheary.
Can I ask the SMS if all the security enhancements to the NEHR have now been implemented? I understand that MOH aims to table the Health Information Bill in the second half of this year. Is MOH reaching out to doctors to address concerns they might have about the security of the patient data they will be required to contribute to the NEHR? How is MOH assisting the remaining GPs and dentists to get on board the NEHR?
Former Health Minister Gan Kim Yong said in 2017 that “patients can realise the full potential of the NEHR only if the data is comprehensive”. He added that “for NEHR data to be comprehensive, every provider and healthcare professional needs to contribute relevant data to it.”
Given the NEHR’s goals and the fact that $660 million has been spent on the system so far, it is imperative that the full roll-out is implemented without undue delay, while addressing the valid concerns of doctors.
We need to tap on the knowledge and experience of GPs who have been practising for many years, especially as we move forward into the Healthier SG initiative, which will see GPs playing a key role in promoting healthy lifestyles and providing preventive healthcare.
Technology can be used to help GPs focus on what they do best. Many private clinics find it a challenge to manage the dizzying array of IT systems that they need to manage their clinics, and connect to CHAS (Community Health Assist Scheme), Healthier SG and the NEHR. I note that there is a technology subsidy scheme available to help GPs to implement Clinic Management Systems that are compatible with Healthier SG. However, implementing these systems still requires a lot of time and effort on the part of GPs and their clinic assistants — time which they simply do not have, if they want to focus on direct patient care.
MOH should explore the possibility of offering and financing an “IT manager-as-a-service” to GPs and dental clinics. This would enable them to benefit from the expertise of IT professionals, who can assist them in resolving their healthcare IT-related issues. By providing a point of contact for IT matters, GPs and their clinic assistants can then concentrate on delivering high-quality clinical care to their patients. This solution would not only enhance the efficiency and productivity of GP clinics but also help them stay current with the latest technological advancements.
Conclusion
Urgent action is needed to tackle the shortage of manpower in health and social care institutions and grow the pipeline of Singaporeans entering this field. I have proposed some ways in my speech on how we can do so and I hope that MOH and MOE will consider them.
To boost productivity and augment manpower in the health and social care sector, we need to double down on the use of technology as a force multiplier, and assist providers to implement and use these technologies.
The world celebrates International Nurses Day this Friday May 12, which is the anniversary of Florence Nightingale’s birth. I would like to take the opportunity to say a huge thank you to all our nurses in both public and private healthcare institutions in Singapore. We appreciate your selfless service, sacrifice and care for our people!
Madam, I support the motion.