Demand and Attrition Rates for Allied Health Professionals

1 Mr Gerald Giam Yean Song asked the Minister for Health (a) whether the demand for Allied Health Professionals (AHPs) has increased between 2019 and 2023 and, if so, by how much; and (b) in each year from 2019 to 2023, what has the attrition rate of AHPs been in (i) public acute hospitals (ii) public community hospitals (iii) public long-term care facilities and (iv) polyclinics.

2 Mr Gerald Giam Yean Song asked the Minister for Health (a) how does the attrition rate of Allied Health Professionals (AHPs) in public acute hospitals, public community hospitals, public long-term care facilities and polyclinics compare with those of doctors and nurses; (b) what measures are being considered to address attrition rate of AHPs; and (c) whether such measures include an increase in remuneration.

The Senior Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam) (for the Minister for Health): Mr Speaker, may I have your permission to answer Question Nos 1 and 2 together in today's Order Paper?

Mr Speaker: Yes, please proceed.

Ms Rahayu Mahzam: Thank you. Due to our growing healthcare needs, the demand for Allied Health Professionals (AHPs) have been growing. The total number of registered diagnostic radiographers, occupational therapists, physiotherapists, radiation therapists and speech therapists increased by 25%, from about 6,000 in 2019 to 7,500 in 2023. Overall, the attrition of AHPs in the public healthcare sector increased slightly from 8.9% in 2018 to 11.6% in 2022. In the community care sector, the attrition of AHPs has fallen from 17.7% in 2018 to 11.3% in 2022.

The Ministry of Health (MOH) continues to work with our public healthcare clusters, community care organisations and our Institutes of Higher Learning (IHLs) to train, attract and retain AHPs. There need to be good career prospects and opportunities for professional development, a conducive workplace environment and salaries will have to be competitive.

In this regard, the public healthcare institutions (PHIs) had increased the starting salaries of AHPs in 2023. Since 2021, MOH has also supported salary enhancements in the community care sector, including for AHPs.

Mr Speaker: Mr Giam.

Mr Gerald Giam Yean Song (Aljunied): I thank the Senior Parliamentary Secretary for answering my questions. Is the attrition rate of AHPs higher or lower than doctors and nurses? I am not sure if the Senior Parliamentary Secretary answered my original question on that. Are the retention and career progression needs of AHPs being, in any way, prioritised behind those of doctors and nurses, despite them playing a very critical role in the recovery of patients?

Ms Rahayu Mahzam: I thank the Member for the question. Indeed, the attrition rates for the AHPs are higher than that for the doctors and nurses. The Member is right in that they play a very critical role. We have been engaging AHPs in developing a strategy because they are part of the healthcare ecosystem. And, as you know, we are transforming our healthcare sector – there will be Age Well SG and Healthier SG – and it is important for them to also play that role in this endeavour to have a common understanding of the focus areas and transformation of the allied health delivery that needs to meet these national strategies.

We have been working with them to future-proof the allied health workforce to handle future challenges of the ageing population and improving population health and outcomes. These are things that are already ongoing. They are definitely not left behind. They are part of the ecosystem, and we are working together to help us work that journey of transforming the healthcare system.

Mr Speaker: Mr Giam.

Mr Gerald Giam Yean Song: I thank the Senior Parliamentary Secretary again for that answer. What proportion of APHs in PHIs are foreigners and how does this compare to the proportion of nurses who are foreigners? And secondly, how is the Ministry encouraging more Singaporeans to take up careers as AHPs?

Ms Rahayu Mahzam: I do not have the data now on hand, as far as the numbers of foreign AHPs.

In respect of the second question on how we are working to enhance the AHP profession, we have been doing this on a few fronts. We have been working upstream. We are working with the IHLs to increase local training pipelines with healthcare employers to attract and retain quality manpower. Over the last 10 years, we have doubled intakes for AHP courses from around 270 to 500.

In respect of the foreign AHPs, we also value them. And if they demonstrate their commitment to Singapore, we are also prepared to grant them permanent resident (PR) status. So, that is one thing that is quite encouraging, I believe.

We also have healthcare career conversion programmes for mid-career locals to undergo relevant trainings through our IHLs for selected AHP professionals. These are some of the efforts that we have put in place to enhance the profession and to uplift the standing of the profession within the community.

Mr Speaker: Assoc Prof Jamus Lim.

Assoc Prof Jamus Jerome Lim (Sengkang): I note that the Senior Parliamentary Secretary mentioned that the community care AHPs had experienced a decline in the attrition rate, as opposed to the overall slight increase in attrition rate for the other sector. I am wondering whether the Ministry has given any consideration into what might account for this differential because understanding this might give us some insight into how to improve retention in the overall sector.

Ms Rahayu Mahzam: Just to clarify the point. AHPs are in the public healthcare sector as well as in the community care sector because they also support some of our roles in the public institutions. So, in terms of the decline, I think there are so many different factors, clearly, and we are looking at how we can improve this. Part of it is salaries and the standing of some of these professions within the community.

I think, over time, we have learnt, and we have also been engaging these professions to understand what are some of the challenges and the workplace issues they may be facing. And so, these are the things that will inform us as we have these discussions, moving forward, with the AHPs in enhancing the profession, in making them also part of the larger ecosystem, as we transform our healthcare sector.

Mr Speaker: Assoc Prof Lim.

Assoc Prof Jamus Jerome Lim: Just a quick point. I acknowledge what the Senior Parliamentary Secretary mentioned about how salaries. As an economist, that is an intuitive explanation. But my understanding is that in the community care sector, if anything, salaries are slightly lower than compared to overall. So, I would truly urge the Ministry to look much more carefully into why attrition rates seem to be lower in the community care sector compared to overall.

Ms Rahayu Mahzam: I thank the Member for the points made. Indeed, we have been working with the community care sector. You have heard announcements recently about Award for Nurses' Grace, Excellence and Loyalty (ANGEL) and we are also working with the community sector, to make sure that it is also something that can translate into that sector.

As I mentioned earlier, since 2011, we have been supporting salary enhancements in the community care sector, including for AHPs. So, this is something we will continue to review, look at and enhance when appropriate.

Mr Speaker: Dr Tan Wu Meng.

Dr Tan Wu Meng (Jurong): Mr Speaker, I thank the Senior Parliamentary Secretary for her answers to the various questions on our AHP colleagues. I should start by declaring that I am a medical doctor practising at a PHI and I look after cancer patients as part of that journey.

Can I put it to MOH, is there a role to take a detailed look at the evolving landscape of skills across our AHPs, a skills-based assessment and analysis, to see how we can better retain and develop our AHPs? We recognise today that in healthcare, for medical professionals and nursing professionals, deep skills are involved. And it is likewise the case for AHPs, whether these are the therapists, occupational therapists or speech therapists.

Secondly, can I also ask MOH, has there been attention given to emerging domains of deep skills in new areas of allied health? For example, in the care of patients who have cancer running in multiple family members, there is a group of experts called genetic counsellors who provide very important support for the medical care team as well. And so, if we look at the emerging role across all these AHPs as having deep skills, skills that can be deepened, best in class in Singapore and across the world, would MOH consider that as a way of refreshing or relooking at how we recognise AHPs as an important and key part of our healthcare system?

Ms Rahayu Mahzam: I thank the Member for his inputs. Indeed, he makes very relevant points. In response, I will just highlight a few things. I think, firstly, indeed, this is the direction that we are going in terms of enhancing skills and making sure that there are sufficient manpower and resources within each domain. As you know, the AHPs are a mixed bag; there are many different types of specialties. Indeed, I think it is a good suggestion for us to deep dive and look as to how we can enhance these specific domains within that sector.

So, definitely, as I mentioned earlier, we have already been in engagements with the AHPs. So, this suggestion that is raised will be something that we can take back and look at, and see how we can enhance that profession, while improving the services to the people as well as enhancing the stature of the profession within the community.

Mr Speaker: Dr Tan.

Dr Tan Wu Meng: I have got one more question to the Senior Parliamentary Secretary. As part of this review which the Senior Parliamentary Secretary has mentioned, will MOH also look at best-in-class jurisdictions around the world and learn from the experience of how AHPs' career journeys, retention, skills and all these have been developed, in jurisdictions such as the United Kingdom (UK), in Europe or in the United States (US)? Will MOH consider looking at that as well as part of this overall landscape review?

Ms Rahayu Mahzam: I think that is a brilliant suggestion from my fellow Jurong Group Representation Constituency mate. We will definitely take that into account.

Mr Speaker: Ms Yeo Wan Ling.

Ms Yeo Wan Ling (Pasir Ris-Punggol): I note that the Ministry had published salary guidelines for the community care sector and the Senior Parliamentary Secretary talked about it just now. I would say I have received much positive feedback from healthcare professionals and their managers; in particular, from the larger private sector community care and age care groups, on this guidance. They found it very useful in attracting and retaining staff.

However, in my union and constituency work, I continue to receive wage and welfare grievances from employees of smaller clinics. And salaries can be stagnated for years; sometimes, at levels lower than the Progressive Wage Model (PWM).

While I appreciate that private sector salaries are best left to market forces, for this group of workers, what more can MOH do to engage the owners of small health businesses and to ensure that our workers have dignified livelihoods?

Mr Speaker: Before I come Senior Parliamentary Secretary Rahayu, I remind Members to seek clarifications and not make speeches here.

Ms Rahayu Mahzam: Thank you, Mr Speaker. I thank the Member for raising this issue. We do not have any plans currently to develop salary guidelines for the private sector, the general practitioner and specialist clinics at this juncture. From our experience, the assessment or the complaint or feedback that we have gotten is there is a move from the public sector into the private healthcare sector. Because of the competitive nature of the competitive salary, we take that into account as we think about whether to have a salary guideline for this space.

But I note that the Member was probably referring to those who are in the lower-income bracket within that sector. I will have to take this back and then, we will see and consider whether this is something that we would need to review and look at in the future.