Changes in the Doctor- and Nurse-to-Population Ratios

22 Mr Leon Perera asked the Minister for Health (a) what are the current projections in the rate of change in doctor-to-population and nurse-to-population ratios over the next five years; (b) what targets are in place to improve the doctor-to-population and nurse-to-population ratios over the next five years; (c) how does the Ministry intend to meet these targets; and (d) what are the fallback options should the Ministry be unable to meet these targets.

The Minister of State for Health (Mr Chee Hong Tat) (for the Minister for Health): Mdm Speaker, at the last Parliament Sitting in January, I informed Mr Leon Perera that Singapore's doctor-to-population ratio in 2014 was 21 doctors per 10,000 population, compared to 18 in Hong Kong and Taiwan. For nurses, we have 69 nurses per 10,000 population compared to 66 in Hong Kong and 60 in Taiwan. I also explained that these ratios could only offer a broad comparison and we need to be mindful about differences in healthcare demand, clinical practices and operating environments. A higher staffing ratio does not necessarily equate better quality healthcare or better health outcomes.

MOH has been expanding the capacity of our healthcare and aged care services in Singapore under the Healthcare 2020 Masterplan. We are on track to growing the healthcare workforce by 20,000 between 2011 and 2020. So, our staffing ratios will go up. In addition, the Government has introduced policy measures like Pioneer Generation Package and MediShield Life to improve healthcare affordability and give Singaporeans greater peace of mind.

Looking beyond 2020, Singapore will face an increase in projected healthcare demand and also a smaller local workforce due to our ageing population. To keep our healthcare system sustainable, we must step up efforts to help Singaporeans to stay healthy and enable our seniors to age well. MOH is also working in close collaboration with healthcare institutions, unions and community partners to develop new care models and improve productivity, so that we can continue to provide high quality of care for Singaporeans and a good working environment for our healthcare workers. We are adopting this tripartite partnership approach to attract and train more Singaporeans to join the healthcare sector, improve productivity in our healthcare institutions and enable our healthcare workers to continue working till a later age.

As I explained at the last Sitting, another important area is for all of us to show appreciation and support for our healthcare workers. This will go a long way to motivate our healthcare workers to continue putting in their best efforts to serve with care and commitment.

Mr Leon Perera (Non-Constituency Member): Madam, I thank the Minister of State for his helpful reply. I have a few supplementary questions. In regard to the assurance from the Minister of State that our staffing numbers will improve in future, which is a welcomed assurance, my question would be: does he feel that the doctor-to-population and nurse-to-population ratios right now are not really where they should be? And if so, what are the mitigation measures that the Ministry is considering to deal with that current situation? That is the first question.

The second question is: would the Ministry consider evaluating the feasibility to set a target for doctor-to-population and nurse-to-population ratios? The reason I ask that question is because I think that, looking at where Singapore stands versus other OECD countries, we are quite close to Hong Kong and Taiwan. But there is a considerable body of expert opinion that there is a doctor and nurse shortage in Hong Kong and Taiwan. There are various reports, for example, the Brookings Institution, Taiwan National Institute of Health, Hong Kong University, Hong Kong Hospital Authority and so on, which have acknowledged that there is a situation of doctor and nurse shortage in those countries. So, it concerns me that we are closer to those countries on the OECD spectrum. Would the Ministry consider setting a target or an ideal zone that we want to move towards in future?

Mr Chee Hong Tat: Mdm Speaker, the assurance that I have given earlier about the staffing ratios going up is not a new assurance. This is something that the Ministry of Health (MOH) had previously already provided. The figures are in the public domain. We will be increasing the number of healthcare workers between 2011 and 2020. This is not something that is because of what is happening now and, therefore, we are hiring more workers. It is in recognition that our population is ageing and we expect healthcare demand to go up. So, we are building more hospitals and hiring more healthcare workers not only to take care of the current situation but in preparation for what is going to come in the future.

This is something which the Government does in all areas, not just in healthcare. We always plan ahead, we always anticipate, we build ahead of demand and we deal with the situation before the problem emerges. This is something which we will continue to do.

It is important for us to look beyond the numbers and I need to re-emphasise this point to Mr Perera, that we should not be overly fixated on one particular number, the staffing ratio, because it only represents one dimension of quality healthcare.

Mr Perera mentioned that some of the OECD countries have higher ratios than Singapore. But if you also check their health outcomes, they do not necessarily have better health outcomes than Singapore. So, if we look at the issue from only a single dimension, we may end up with the wrong conclusions. Higher staffing ratios do not necessarily mean better health outcomes.

It is important for us to bear in mind that there are many different aspects of what constitute good health outcomes: the efforts to encourage Singaporeans to stay healthy, how we run our healthcare institutions, improving productivity, how we review our processes and how we transform our care model.

Dr Tan Wu Meng (Jurong): I thank the Minister of State for his answers. One thing that many patients and, indeed, many of my residents tell me is that the care relationship in healthcare is very much local: local language, local culture, understanding local nuances for local medical practice. Would the Minister of State be able to share what measures MOH is looking at to help maintain a strong Singaporean Core in our healthcare system?

Mr Chee Hong Tat: Mdm Speaker, I thank Dr Tan for his question. Indeed, it is a very important area for us to look at, to increase the number of healthcare workers and the number of Singaporean healthcare workers. We do this in a number of ways.

First, it is to make sure that we have a good working environment for our healthcare workers, and this includes not just our younger workers but also our older workers. So, part of the effort that we have been working on and we will continue to do, is to work closely with the hospitals, the healthcare institutions and also our unions to look at how we can improve the work environment to allow our healthcare workers to work till a later age.

We are also looking at supporting mid-career professionals who are interested to become healthcare workers. We will fund the cost of their training and provide them with training allowances during their studies to help defray their living expenses. And upon completing their training, they will receive a career transition bonus.

We are also looking at how we can increase the pool of healthcare workers by bringing back Singaporeans who are studying overseas. We do this through the pre-employment grants which we offer to Singaporeans studying Medicine and Dentistry overseas. As of March 2015, we have awarded 630 of such grants.

Very importantly, it is also about how we can make good use of the number of workers that we have by improving productivity, providing a good working environment and making sure that they can focus on providing good quality care for their patients.

Mr Low Thia Khiang (Aljunied): Madam, I am happy to note that the Minister of State has said that MOH, and even the whole of Government, is always building ahead to prepare for demand. Perhaps the Minister of State would like to give us some examples as to how MOH has been building ahead in terms of hospitals, in terms of step-down care facilities, in terms of healthcare workers, so that residents or patients can be better served. Would he give us some examples or some statistics to prove what he said, that MOH is always building ahead of demand?

Mr Chee Hong Tat: Mdm Speaker, if Mr Low is interested to know more about the statistics, I am happy to provide these statistics to him. But just to assure Mr Low, we do look at the future demand. As I had said, the ageing population is one of these trends that we need to prepare for. We are building more hospitals. Recently, we opened Ng Teng Fong Hospital in the west; in the north, we added Yishun Community Hospital; and there will be new hospitals coming up subsequently in Sengkang and in Woodlands.

So, we do plan ahead and build ahead, and there are definitely areas which we will continue to work not just from within Government but in close partnership with the community. Many of these step-down care facilities, for example, are done in close collaboration with VWOs and with the community.

Mr Darryl David (Ang Mo Kio): I thank the Minister of State for his answers earlier on. It is good to know all that is being done to increase the local core of the healthcare system here. I have a question, and that is to ask whether MOH would consider working with MOE perhaps, to allow for more discretionary admission into tertiary programmes, like nursing programmes, for example, and explore possibilities for more bursaries, more scholarships, to entice and enhance more Singaporean students to take up nursing in these institutions as a career and also to develop a career path for such students. Perhaps, even in areas such as mentorship and internship, to holistically develop these future healthcare professionals.

Mr Chee Hong Tat: I thank Mr Darryl David for his question. Mdm Speaker, indeed, working closely with MOE, our ITE, Polytechnics and Universities, is an important area for MOH. We will continue to look at what are the different options we have to attract more Singaporeans join the healthcare sector, whether it is to become doctors, nurses or allied health professionals.