MENTAL WELL-BEING OF HEALTHCARE PROFESSIONALS.

Mr Murali Pillai asked the Minister for Health (a) what steps are being taken by the Ministry to deal with the burnout, anxiety and psychological issues on the part of healthcare workers involved in the fight against the COVID-19 pandemic; and (b) how are barriers such as stigma and impairment to practise when diagnosed with mental conditions are being addressed.

Dr Janil Puthucheary: From today’s Order Paper I will address Oral Questions Nos 1 to 10 and Written Question No 40, as well as questions filed by Ms He Ting Ru, Assoc Prof Jamus Lim, Mr Liang Eng Hwa, Mr Leong Mun Wai, Ms Mariam Jaafar as well as Mr Murali Pillai for future Sittings…

…[T]he need to increase the capacity of our healthcare system is a heavy burden carried by the staff, our healthcare workers.

Already, our hospitals are feeling the manpower crunch. Signs of fatigue can be seen amongst our healthcare workers. It has been over 20 months of continuous daily battle against the pandemic. A large proportion of our healthcare workers have not had the opportunity to take leave since 2020 and over 90% of them will not be able to clear their accumulated leave for 2021. This is clearly a much higher proportion compared to the past two years. Our healthcare workers have gone and continued to go way beyond the call of duty to care for their patients. The hospitals are trying to minimise having staff work overtime. For the month of September, our nurses worked for an average of 160 to 175 hours per month.

I received a WhatsApp message from a senior member of the clinical teams. It says, “We are getting increasingly stretched, overworked and fatigued… We are uncertain how long we can keep this up. Morale is slipping.” Another colleague sent me a WhatsApp message and it goes: “It feels like what started as a 2.4k run became a marathon, and just as we are reaching the finishing line, we have to run a second marathon. Our people are exhausted physically, mentally, emotionally — whether they will admit it or not.” I know this person as a professional colleague. I know both of them. Their roles to look after ICU patients also extend to looking after their staff, managing their teams, making sure that people are in a position and have the ability to perform at their best. When people like them say words like these, “exhausted physically, mentally, emotionally — whether they will admit it or not”, I take it very, very seriously.

It is therefore not surprising to find resignation rates going up this year. About 1,500 healthcare workers have resigned in the first half of 2021–1,500 in the first half of 2021 — compared to about 2,000 annually pre-pandemic. Foreign healthcare workers have also resigned in bigger numbers, especially when they are unable to travel to see their families back home. Close to 500 foreign doctors and nurses, healthcare workers, have resigned in the first half of 2021, as compared to around 500 in the whole of 2020 and around 600 in 2019, about double the usual rate. These resignations were mostly tendered for personal reasons, for migration, or moving back to their home countries.

But it is also in such trying circumstances that we find stories of inspiration, stories of commitment to public service. On a recent visit to a COVID-19 ICU, I met a nurse who had been redeployed from her usual job in the Orthopaedic Department into the COVID-19 ICU. In the Orthopaedic Department, they look after bones, joints, muscles. She was now redeployed into a COVID-19 ICU. She had had a short training and orientation course, and then subsequently on-the-job training from her ICU colleagues. She is senior, she is a Nurse Clinician and an Advanced Practice Nurse, with many, many decades in public service. And although it is a challenge to work in a new environment and with a new set of equipment, drugs and protocols, because of her excellent fundamentals and her experience and resolve, she demonstrated confidence and competence in delivering care that the ICU patients need.

On the day I visited, she was looking after her first ever obstetric patient. After many years, this is her first ever obstetric patient, a young lady who had to have her baby delivered prematurely because of COVID-19 and was now needing treatment in the COVID-19 ICU, not in a post-natal ward. An orthopaedic nurse, deployed to a COVID-19 ICU, now looking after an obstetric patient. And there are many others like her, doctors, nurses, therapists, social workers — re-deployed to do what is urgently needed. And despite having to do difficult work in unfamiliar environments they have kept the clinical outcomes excellent, through hard work, professionalism, dedication and resilience.

But this is taking a toll. They are getting tired. They are carrying a burden of care that is sometimes unimaginable. Having to hold a phone for a patient so that the family can say their last goodbyes. Holding their patient’s hand, to keep them company, on behalf of the relatives. They need all the support we can give them.

At MOH, we are redeploying manpower, to serve as healthcare or patient care assistants at our institutions. We are reaching out to more volunteers to join the SG Healthcare Corps and support this important work. We are collaborating with private hospitals to ease some of the load on our healthcare workers in our public hospitals. We are stepping up the recruitment of healthcare workers from overseas.

Our public healthcare institutions have also stepped up their outreach to staff to support them through measures that will safeguard their well-being, including counselling services, staff helplines and peer support programmes.

…That we got to this point, where after nearly two years of fighting a pandemic I can explain our hope to maintain one of the lowest case fatality rates in the world, is a small miracle. It did not happen by chance. It happened because Singaporeans stood together, looked out for each other, did their duty and put the interests of others ahead of their own. And the healthcare workers of Singapore have done all this and much, much, more, caring for us all.

I receive another message from a colleague: “we are one of the few countries in the world where ICU teams don’t have to worry about resources and equipment — very grateful for that. Healthcare workers have given everything in the last two years, we have held ourselves up to the highest standards; we have the lowest mortality in the world; our people are still pushing on”. Our people are still pushing on!

The healthcare workers we are worried about are also the same healthcare workers who are committed to doing what is needed to look after all their patients. They will do their duty, do their best and try their hardest. Words will never be enough, but I express our gratitude on behalf of this House.