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Network of regional hospitals
At the Topping-out Ceremony at the Tan Tock Seng Hospital on 24th May 1997, Mr Yeo Cheow Tong, Minister for Health announced his Ministry’s plans in developing a network of regional hospitals and explained the relationship of these regional hospitals to the country’s tertiary hospitals. The new Tan Tock Seng Hospital will be the regional hospital serving the medical needs of the population in the central region of Singapore. It will be completed by the end of 1998 and operational in early 1999. The New Changi Hospital is the regional hospital that will serve the needs of the population in the eastern sector of Singapore. A regional hospital is being planned for the north-western part of Singapore. It is anticipated that this will take eight to nine years to plan, build and equip and will therefore be ready only by 2005 at the earliest.

He explained the role of the regional hospitals, “The government expects the regional hospitals to play an increasingly important role in the years ahead. The network of regional hospitals will be the hospitals of choice for residents living in their vicinity. The regional hospitals will have the appropriate level and mix of specialist, nursing and paramedical manpower, and be equipped with modern state-of-the-art medical facilities and equipment. This will enable them to manage most patients efficiently and effectively at the accident and emergency, specialist outpatient, day surgery and inpatient levels.”

“The regional hospitals will offer a broad base of general specialties and excel in 1 to 2, or more, sub-specialities. By offering excellent medical services and developing a strong reputation in several sub-specialities, the regional hospitals will be able to enhance their professional standing. It will attract patients to use them as the hospital of choice and help them to retain good doctors, nurses and other paramedical staff.”

Role of tertiary hospitals and national centres
On the role of the tertiary hospitals and national centres, he said, “We have 2 tertiary hospitals, SGH and NUH, which deal with complex cases in a broad range of specialities. We also have a separate specialist hospital, the KK Women’s and Children’s Hospital to look after the special needs of women and children. In addition, there are 3 national centres to cater to patients with heart, eye and skin diseases. Another 2 national centres are now being built to serve patients suffering from cancers and neurological problems.” 

“The tertiary hospitals and national centres have a clearly defined role and responsibility – they are to manage the more complicated and challenging medical cases, as well as co-ordinate national clinical service, training and research programmes. Specialists in the regional hospitals can have dual appointments to work in the national centres and tertiary hospitals. This will allow them to further hone their medical skills in some areas, and to share their special expertise with the doctors there in other areas. Similarly, it will also benefit specialists in the national centres to work in the regional hospitals to see the more common medical conditions, and to share their knowledge with the staff there.”

“Patients should therefore use these tertiary centres for the correct reasons; that is, only when they have complex medical conditions that cannot be adequately handled in the regional hospitals. I can assure Singaporeans that the regional hospitals are more than capable of looking after most of their medical needs, and that these hospitals will not hesitate to refer them to the tertiary hospitals and national centres if the need arises. This approach will ensure that our finite and expensive health manpower and equipment in the tertiary centres are better utilised. It will also help to slow down the increase in health care costs.”

See the family physician first
He reiterated the need for Singaporeans to use medical services properly, using headache as an illustrative problem. “A person who has a headache can take one of several alternative courses of action. At the one extreme, he can just take a painkiller and sleep it off.  At the other end, he may decide to play safe and go directly to a medical specialist, and insist on a whole range of tests, and throw in a MRI scan as well. If many people act in this ‘kiasu’ way, it will lead to excessive demand on our scarce medical resources, and compromise our ability to respond optimally to the health care needs of the population.”

“Hence it is far more appropriate for a patient who is worried about headaches, or any other medical condition, to see his family physician first. The family physician will provide him with the appropriate treatment, or refer him to specialist if, in his judgement, this is necessary. In this way, the right health care provider will give the patient the correct care in the most appropriate care setting. Equally important, it will also result in lower medical costs for patients.”
 
Three policy initiatives
Mr Koh Yong Guan, Permanent Secretary (Health), announced at the Opening ceremony of the 24th annual meeting of the International Society for the Study of the Lumbar Spine on 2 June 97, three policy initiatives which the Ministry of Health has introduced recently to further develop teaching and research activities in Singapore.

“The first is to review the present funding arrangements for hospitals. At present, a substantial share of the manpower required by public hospitals for teaching and research is funded indirectly through the government subvention for clinical services. This means that to the doctor, the income he receives is regarded as reimbursement for his clinical work, and he is not being directly recognised nor rewarded for his role in teaching and research. Doctors are therefore given no incentive to commit time and energy to those roles.”

“We are reviewing the present funding arrangements to establish separate budgets for service, teaching and research. This would allow us to safeguard and allocate resources much more effectively to support the development of teaching and research activities. Once there are separate budgets, the concept of “protected time” for doctors to carry out teaching and research activities can be implemented more effectively. We have just announced an increase in the intake of medical students from this year onwards. Part of the rationale for this increase is to provide for “protected time” for doctors to do research and teaching.”

“A second initiative we are working on is to appoint a clinical academic dean in each hospital. This will enhance the quality of undergraduate and postgraduate medical training given at the public hospitals. Currently, this training is undertaken by all senior doctors who are appointed as clinical teachers by the university. However, the roles and responsibilities of clinical teachers are not clearly defined, leading to a situation where medical students face varying standards of teaching and mentorship in the various hospital departments. The selection of teachers has also not been  rigorous, nor are these senior doctors given additional administrative support from the hospital or university for their teaching activities.

“The Ministry is therefore working towards appointing a clinical academic dean from among the senior doctors in each hospital. The dean takes charge of planning, co-ordinating and monitoring the teaching of medical undergraduates and postgraduates in his hospital. The dean would also maintain close ties with the university and help to ensure that the programs and standards are co-ordinated across the various hospitals.”

“In a small country like ours, we need to use  our limited human resources well, regardless of whether they work in the public sector, private sector or in academia, A third policy initiative is to open up the public sector hospitals to give greater access to the best doctors in the private sector to contribute to service, teaching and research. The terms offered to such doctors will be made more flexible and attractive so that those with expertise, knowledge and skills in a particular field, and who have the desire to contribute, will do so more readily. This we think is important if we want to grow as a regional centre of repute.”

“The initiatives I have just cited are among several my Ministry has been working on to strengthen the culture of medical teaching and research in Singapore in order to enhance our standing and reputation as a regional medical centre.”