Singapore Innovating Health Series | Roundtable 1 Summary Report

ROUNDTABLE 1 SUMMARY REPORTRaising the bar in delivering quality Aged Care:Convergence of Social Services and Healthcare

ABOUT THE SERIESAccenture, in partnership with TalentGrid Ventures, is pleased to announce SingaporeInnovating Health, an exciting new thought leadership series.By bringing together a diverse group of representatives from government agencies, acutecare providers, community hospitals and nursing homes, non-profit organisations andacademia to share different perspectives and best practices in the healthcare industry, weare poised to elevate the profile of digital health innovation agenda as we seek to transformthe healthcare sector in Singapore.The need to challenge the healthcare status quo has never been more imperative for bothsystem sustainability and improved population health, and we aim to address that withdisruptive perspectives, innovation and collaboration.The Singapore Innovating Health series comprises four roundtable sessions with to drivetargeted thought leadershipby provoking key industry leaders to share their aspirationsand fears as well as looking at the future through the lens of innovation. “Our aim is to select a group to talk about key challenges faced in Singapore healthcare. The Accenture model is to identify trends and bring it to the local healthcare sector by harnessing our global strength through small group discussions.” - Mark Tham, Managing Director, Health & Public Service ASEAN, AccentureSingapore Innovating Health Series | Roundtable 1 Summary Report 2

Roundtable 1 | 23rd November 2016 Raising the bar in delivering quality Aged Care: Convergence of Social Services and HealthcareOVERVIEWThe Singapore Innovating Health officially opened its 4-part roundtable series at theInternet of Things (IoT) Centre of Excellence with some of the most respected leaders andstakeholders in elderly care. This inaugural roundtable delved into the convergence ofsocial services and healthcare to raise the bar in the delivery of quality aged care.“There needs to be a better way to manage volunteers. They come from all over the island, and they are deployed to where new programmesare being initiated. The travel required from the volunteers contributes to some of them eventually dropping off. The more effective way may be to keep them around their neighbourhoods. There is also a need toprovide proper training to the volunteers so that they know what to look out for and how they can help. I feel that today we are too focused on institutional care rather than how to look after people at home.” - Mr TK Udairam, Chief Executive Officer, Sheares Healthcare ManagementThe discussion on the state of elderly care could not have come at a better time consideringSingapore’s status as a nation with one of the highest rates of ageing in the world. Andwhile efforts are underway to provide better holistic care to our elderly, there’s still work tobe done to improve the transition of care from hospital to the home, with social networksplaying a crucial role in the process.Better information sharing, policy, subsidy and business process review, better social andhealthcare services integration are only some of the things urgently required to improvethe future and social care needs of the elderly. There is also a need to look at the state ofhealthcare manpower and how best to optimise current and forthcoming challenges.To facilitate the inaugural roundtable, we had Dr Julian Sham and Dr Yoong Siew Lee fromAccenture, to take the participants through different workshop activities intended to bringabout a lively and engaging exchange of experiences and ideas among those present.The discussion was active, exploratory and informative with several views and positionsexpressed which revolved around the topic posed. It was the start of a conversation whichis poised to continue.Singapore Innovating Health Series | Roundtable 1 Summary Report 3

HIGHLIGHTS & KEY TAKE-AWAY POINTS1. A change in clinical mindset is required to focus on optimised discharge of all patientsDue to growing demand, the infrastructure response, i.e., increasing the number of hospitalbeds and building community hospitals, has been increasing though it is still beingoutpaced by the accelerating surge in ageing population. Commonly, doctors are ready tobe more aggressive in treatment of younger patients but are more conservative with theelderly. Given that the population above 65 is driving bed utilisation in hospitals, changingthe clinical mindset to push all patients out of the hospital as soon as possible can helpmanage the situation.2. Elderly care and social services are available but still fragmentedNotably, the converging trends of changing demographics, changing family size andchanging lifestyles are affecting the integration of health and social services. There was aproposed framework to segment elderly population with two axes of health status (good/poor health) against social status (good/poor social support) that could help stakeholdersunderstand better the specific needs of the elderly. • Elderly with poor health and poor social support tend to end up in institutions like nursing homes and aged sick • Elderly with poor health but living with family are supported at home with FDW (foreign domestic workers) • Elderly with good health but have no friends or good support system are still considered at risk • Elderly with good health and good social support are found to be living well and still workingThough there is now a proliferation of services targeted for each segment that are putin place by the government and VWOs (Voluntary Welfare Organisations), multiple touchpoints and re-registrations when patients transition between different levels of care arealso prevalent. “I feel that the psychological component is missing. There must be ownership by the patient and family as well.Primary care side is still weak and there is a need for some form of a ‘navigator’ to help families navigate through continual changes.” - Dr Ng Wai Chong, Medical Director, Tsao Foundation’s Hua Mei Centre for Successful AgeingSingapore Innovating Health Series | Roundtable 1 Summary Report 4

3. In optimising use of limited elderly care manpower, opportunities lie in volunteerism,promoting self-care, as well as trainingWhile technology and robotics may be some of the more obvious ways to optimise,volunteerism and promoting self-care can also be used to augment lack in manpower.Furthermore, assisted living should also be considered as some of those currently innursing homes do not really need that type of care.There is also a need for meaningful employment opportunities and not just volunteeropportunities, given the high drop-off rate from volunteers. Proper training must also beprovided not only for volunteers but also for family members so they would know how toproperly handle their elderly after hospitalisation. “There is opportunity for self-help training and not always rely on healthcare professionals alone. Trainings on how to use technology so that families know that their elderly loved ones are well are also important.” - Dr Tan Weng Mooi, Chief Community Mental Health Division, Agency for Integrated Care “More discussion needs to take place between all concerned parties with respect to finding the ‘sweet spot’ or nexus between the Health and Social Service regulators (MOH/MSF) and Enablers (NCSS/AIC) , and the various players in both the social service and health arenas - VWOs. Charities, civic and community organisations to facilitate the Prime Minister’s call for a more inclusive society and ensure that ‘no one falls through the cracks’.” - Mr S. Devendran, Chief Executive Officer, Sree Narayana Mission HomeSingapore Innovating Health Series | Roundtable 1 Summary Report 5

4. Primary care needs to be engaged in supporting elderly care and the incentivisation orfunding models should be used to drive better continuity of care at the primary care leveland not reduce GPs to technicians merely performing tasksThe ‘fee for service’ model is not ideal as it may drive up visits for minor conditions suchas cough and colds. Similarly, if hospitals are incentivised based on occupancy, then theremay be a reluctance to discharge to avoid empty beds. “Primary care needs to be empowered and the primary care physician is at the heart of the whole system.” - Ms Adrienne Mendenhall, Country Lead, ACCESS Health International5. Technology is an enabler in the future of elderly care in SingaporeParticipants shared best practices in certain countries like in Finland where a single caserecord for the citizens is already being developed in Helsinki. Remote monitoring and virtualconsultations using technology will also reduce visits and waiting time. Robots coupledwith artificial intelligence can perform repetitive tasks in hospitals and nursing homes,thus, leaving the staff more energy to deal with issues that require human decision-makingskills and empathy.But beyond technology, other key focus areas of healthcare in the future are: • Individual health empowerment • Linking up the community from individual – family – community – hospital • Job redesigns and increased productivityIn conclusion, the participants highlighted the need for education and training, especiallyin the use of technology and available information, among patients, to family members,to foreign domestic workers caring for the elderly. They collectively feel that multiplegovernment agencies coming together to address this will help things move forward. “I feel that there is the case for nursing homes with remote patient care. We are seeing a of developments in medical devices to facilitate patient monitoring at home.” - Mr Sajit Baskaran, Chief Executive Officer, Ack3 BioneticsSingapore Innovating Health Series | Roundtable 1 Summary Report 6

TalentGrid Ventures’ Reflection on the RoundtableCONCLUSIONWe were duly impressed and encouraged by the level of discussion and sharing of ideasof the participants to the inaugural Singapore Innovating Health roundtable. Picking upon the different perspectives of our participants on healthcare (in general) and elderlycare (in particular), was an inordinate learning experience for us as observers. We thankMark Tham, Dr Julian Sham and Dr Yoong Siew Lee for facilitating the workshops andgroup presentations, as well as, sharing their thoughts on some of the topics that werediscussed.Our key take-away as participants and observers at the event were: • Look at changing the clinical mindset to focus on optimised discharge of patients • Leverage integration of healthcare and social services to provide better care quality • Optimise use of limited elderly care manpower by considering effective volunteerism, training and self-care • Empower primary care and re-look at the incentivisation or funding models currently in place • The future of elderly care in Singapore will be mostly technology-driven but there are other equally important areas of focus such as education, job redesign, individual health empowerment, etc.We look forward to our next instalment in the Singapore Innovating Health series in 2017.Health Leaders in attendance: • Ms The Shi-Hua, Deputy Head, Smart Nation Programme Office • Mr Low Yew Jern, Assistant Head, Smart Nation Programme Office • Dr Eugene Shum, Chief Corporate Development Officer, Eastern Health Alliance • Mr TK Udairam, Chief Executive Officer, Sheares Healthcare Management • Ms Adrienne Mendenhall, Country Lead, ACCESS Health International • Dr Tan Weng Mooi, Chief Community Mental Health Division, Agency for Integrated Care • Mr Sajit Bhaskaran, Chief Executive Officer, Ack3 Bionetics • Mr S. Devendran, Chief Executive Officer, Sree Narayana Mission Home • D. Michelle Thai MD, Professor, University of California Irvine, Medical Director, PMR, Providence-St Joseph Health System Skilled Nursing Facility Consultant • Dr Ng Wai Chong, Medical Director, Tsao Foundation’s Hua Mei Centre for Successful Ageing • Assistant Professor Rahul Malhotra, Programme in Health Services and Systems Research, Head of Research, Centre for Ageing Research and Education, Duke-NUS Medical School • Mr Ang Chip Hong, Senior Associate Director, SMU-TCS iCity LabSingapore Innovating Health Series | Roundtable 1 Summary Report 7