SPEECH BY MR LIM HNG KIANG, MINISTER FOR HEALTH AND SECOND MINISTER FOR FINANCE AT THE OFFICIAL OPENING OF THE NATIONAL NEUROSCIENCE INSTITUTE (NNI) ON TUESDAY 25 JULY 2000 AT 10.30 AM

Distinguished guests, ladies and gentlemen.

It gives me great pleasure to be here today at the official opening of the National Neuroscience Institute. NNI is the newest of our national specialty centres, joining the distinguished ranks of the National Cancer Centre, National Heart Centre, National Skin Centre, Singapore National Eye Centre and National Dental Centre.

Neurological disorders constitute one of the major disease groups afflicting many Singaporeans. For example, stroke is the 3^rd most common cause of death. As a national specialty centre, NNI will be responsible for the following:

• provide professional leadership in the development of clinical neuroscience services;
• serve as the centre for managing complex neurological diseases, which includes performing sophisticated treatments and procedures;
• spearhead neuroscience research; and
• co-ordinate the training and teaching in neuroscience.

Our goal is to develop NNI into a centre of excellence for the management and study of major neurological diseases. To achieve this, NNI needs to develop its capabilities as well as synergise the strengths of all our hospitals. After all, the brain and the nerves must function together with the other organs to give a body life. Each hospital will therefore continue to manage its own patients and conduct its own research. NNI’s role is to act as the focal point for the development of neuroscience throughout our healthcare system. NNI will do this by helping each hospital to upgrade its neuroscience capabilities where necessary. And the technical expertise and specialised facilities at NNI will be made available as a common resource to all healthcare providers who are involved in treating neurological disorders.

NNI will also set up partnerships with the appropriate supporting specialties in the various hospitals so that it can manage complex cases that require multi-disciplinary care. The result of this professional collaboration will be a higher standard of care for all patients with neurological disorders in Singapore.

Through this arrangement, we can concentrate a critical mass of the complex cases in NNI so that it can perform the more sophisticated treatments and procedures. This will also prevent the duplication of resources and optimise the use of high-tech facilities and equipment. MOH has been working with the National Committee on Neuroscience and other professional bodies to identify appropriate conditions for centralised management. Examples of those already identified include neurosurgery for movement disorders, epilepsy surgery, and nerve and muscle biopsy studies.

I will now focus on a more specific topic - stroke – to illustrate NNI’s role in the coordination and implementation of our national stroke management plan. Stroke is the most important neurological disorder in Singapore. It is the 3^rd most common cause of death. Those who survive it requires a major rehabilitation and adjustment effort from both the patients and their families.

Stroke is usually regarded as an elderly person’s disease. However, among Singaporeans aged between 35 to 64 years (i.e. the economically active segment of our population), the death rate from stroke is 38 per 100,000. This is very high. My Ministry has made it one of our priorities to lower the national mortality from stroke by 30% by the year 2010.

To achieve this reduction, we need concerted efforts at several fronts. First, to reduce the incidence of stroke through primary prevention programmes. These will draw upon our ongoing efforts for the early detection and good control of hypertension and diabetes. We will also strengthen our public education programme to encourage and help Singaporeans adopt a healthy lifestyle, especially eating healthily and exercising regularly. When a stroke is developing, it is important that the patient receive treatment as soon as possible so as to reduce severity of illness and prevent death. Our health education programme will help Singaporeans learn to recognise the early symptoms of stroke so that they will not delay seeking medical treatment.

Second, we will ensure a consistent standard of stroke care in all our hospitals through the use of clinical pathways and the setting up of stroke units. Third, we will integrate the clinical and rehabilitation aspects of stroke management so that the stroke patient experiences a seamless transfer from acute to chronic care.

NNI will play a leading role in coordinating the implementation of all these strategies by providing stroke treatment and stroke rehabilitation, training health professionals in stroke management and conducting research into new treatments for stroke patients.

A key element of our strategy is the setting up of dedicated stroke service units in hospitals to manage acute strokes. These units allow stroke patients to be treated in one place by a multi-disciplinary team experienced in the care of such patients. Each unit is led by a coordinator who is usually a physician that has been specially trained in stroke management. The rest of the team is made up of nurses, therapists, social workers, dieticians and patient educators.

Studies have shown that these units can significantly reduce mortality and morbidity, as well as improve functional outcome, among stroke patients. Stroke units are already in place at NNI, SGH and NUH. The NNI stroke programme currently caters to about 2000 cases a year. The other acute hospitals are in process of setting up similar units with NNI’s assistance.

Stroke is not only a major cause of death; it is a major cause of disability. About half of all stroke survivors require continued rehabilitation and assistance. The provision of step-down care is therefore a crucial component of stroke management.

I am pleased to note that one of the first stroke clubs in Singapore is being set up here at NNI; the other two will be at CGH and SGH. Established by the Singapore National Stroke Association (SNSA), the stroke club functions both as a support group and a resource centre; it assists both survivors and caregivers with the physical, mental, social, emotional and financial aspects of post-stroke care. Their objective is to help stroke survivors overcome depression, return to work and contribute actively to their family and society. I would like to commend both SNSA and NNI on this worthy collaboration.

NNI has also been active in educating and training professionals and the public in stroke management. Such activities include organising the Inaugural Stroke Conference for healthcare professionals and the Stroke Nurse Course as well as the publication of "My Stroke Book – A Guide for Patients and Carers".

In the field of research, NNI is one of the few centres in Asia that has established its ability to participate in international clinical trials for new medications in stroke. Involvement in these trials allows the latest treatments to be brought into Singapore, contributes to the global body of knowledge (especially by providing insight into the response of Asian patients to these new treatments) as well as boosting our standing in the international medical community. Studies are currently underway to look at agents that will protect the brain during acute stroke, new drugs to enhance recovery from stroke and unusual causes of stroke in young patients.

NNI has a very important role to play as the national speciality centre for clinical neuroscience services, research and training. But I believe that NNI’s leadership of national stroke management plan will prove to be NNI’s more significant and enduring achievements directly impacting on the health of all Singaporeans.

NNI has seen full operation for about a year. It has fulfilled all our expectations. This is a tribute to everyone who has contributed to the setting up of NNI, especially Prof Richard Johnson, the founding Director of NNI. Prof Johnson has attended to the conception, development and nurturing of NNI. Because of his other commitments, he could not accept a full-time appointment here as Director NNI. We are indeed sorry to see a good friend leave.

During his term of office, Prof Johnson served as the Chairman of the National Committee on Neuroscience, which provided valuable advice to my Ministry on various programmes such as the Stroke Programme, Movement Disorders Programme, Neuro-oncology Programme and Spinal Injury Programme. Prof Johnson also spearheaded neuroscience research and established the Neuro-muscular and Neuro-pathology Laboratories in NNI. He has given NNI a firm foundation for future growth.

Today, I am pleased to announce that Prof Simon Shorvon will succeed Prof Johnson as NNI’s Director with effect from 1 December 2000. Prof shorvon is a world-renowned expert in epilepsy and is currently Head of Clinical Neurology at University College London and Consultant Neurologist with the National Hospital Queens Square in London. We are very fortunate to have Prof Shorvon lead NNI in the next phase of its development.

I am confident that Prof Shorvon and his team will establish NNI as an international renowned centre in neuroscience.

It now gives me great pleasure to declare the National Neuroscience Institute officially open.

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