Tackle bed crunch now

This story was first published in The Straits Times on Jan 14, 2014

SINGAPORE is experiencing its worst bed crunch ever.

Asked what the Ministry of Health (MOH) is doing about it, Health Minister Gan Kim Yong told The Straits Times that he is "cognisant" of the problem, and the Government will add 3,700 beds by 2020.

He added: "In the short term, Ng Teng Fong General Hospital is scheduled to open in 2014, and community hospitals in Yishun and Jurong will be ready by 2015."

There is a Chinese saying that distant water cannot put out a nearby fire.

Yes, there should be relief for the bed crunch by the end of this year. But what is going to happen to patients between January and December?

National University of Singapore sociologist Paulin Straughan was quoted recently as saying that the current situation has reached "crisis level".

That may or may not be overstating it. But the fact is that several public hospitals are resorting to extreme measures to cope with the deluge of patients. Patients sick enough to need hospitalisation are being put up in beds at temporary tents or along hospital corridors .

What is needed are immediate, even if temporary, solutions.

As it is, Changi General Hospital, which has put up patients in a tented shelter, is not the only hospital facing such a severe bed crunch.

Associate Professor Straughan said her husband had to wait 12 hours for a bed at the National University Hospital last week. He had to sit in a chair with a drip in his arm for several of those hours.

Over at Singapore's newest public hospital, Khoo Teck Puat Hospital (KTPH) in Yishun, the situation was just as bad.

Its emergency department has 18 cubicles for patients waiting for a bed. Each cubicle is meant to house one bed. But early last week, the hospital had to squeeze two more beds into each cubicle.

Yet even that was not enough to cope with the non-stop flood of patients needing hospital care. Another 20 to 30 patients ended up lying head-to-toe on trolley beds along three corridors near the emergency department.

Tan Tock Seng Hospital was equally stretched. But it was able to cope by having up to 49 temporary beds along its ward corridors, and taking over and opening two 13-bed wards from the nearby Communicable Diseases Centre last week.

All these hospitals are experiencing average weekly occupancies of well over 90 per cent. The bed count is taken at midnight, and some of these "spare" beds are occupied within hours as more patients pour in.

Hospital heads are saying that on some days, their real occupancy exceeds 100 per cent.

All this means that even as Singapore looks forward to the long Chinese New Year weekend at the end of this month, the hospitals are dreading it, as the post Chinese New Year period is a traditional peak period.

How much above 100 per cent can these hospitals go in terms of occupancy, before there is a real negative effect on patient care?

Hospitals are already discharging "less sick" patients - who may not have fully recovered - to make way for those needing a bed more urgently. They have to do this. They have no choice, whether patients like it or not.

The hospitals cannot be faulted for the current situation. They have done their best over the years to cope with a bad situation as best they can.

They have tried to provide care in patients' homes to keep them healthy and out of hospital.

They have introduced same- day surgery. Instead of requiring patients to spend a night at the hospital before surgery, patients go from home straight to the operating theatre. This has saved more than 17,000 bed days each year at the six public hospitals.

More operations are now done as day surgery, where patients are discharged the same day after their operation. Today, day surgery makes up 70 per cent of operations, up from half 10 years ago. This has cut demand for hospital beds - but not fast enough.

With a population that is both growing and ageing, the increased call on hospital services is a given. Proper planning and timely intervention could have prevented the severe bed crunch hospitals are struggling with.

In fact, bed shortage is a chronic problem in Singapore hospitals that flares up into an acute crunch every now and then.

Many people are asking how the bed crunch got to this serious state. That question needs to be answered - but the priority right now must be to find solutions to the problem.

Mount Elizabeth Novena, which has not fully opened all its wards, has offered to rent out up to two of its 30-bed wards for use as public hospital wards. It has also offered to help provide manpower to service the wards if needed. For a start, MOH should take up this offer. But even those 60 beds might not be enough.

MOH could also do what it did during Sars in 2003, when it took over the six-storey building meant for Ren Ci Community Hospital and turned it into a second communicable diseases centre. It could, for example, take over the premises of a new nursing home and use them to house patients who are stable and recovering, but still not well enough to go home.

Or MOH can put up temporary buildings to house patients. After all, the country is able to put up temporary buildings at top speed every year for an event like the Formula One night race and take them down quickly. A temporary hospital may be a more complex operation, but should not be beyond Singapore's capability.

It can also step up the home- care services that have been talked about for some time, but appear slow in building up. This frees hospital beds by having stable patients looked after by professionals in their homes.

To expand home care, the government has to look into providing home-care subsidies that are as attractive as that for hospitalisation, which is up to 85 per cent subsidised.

Efforts to boost manpower supply must also be stepped up.

MOH also needs to recognise that given the current state of affairs, urgent action is called for.

It should also not regard the 700-bed Ng Teng Fong Hospital in Jurong as a panacea. The relief public hospitals got with the opening of the 550-bed KTPH in 2010 lasted barely a year.

MOH should seriously consider bringing forward the opening of the Sengkang hospital from 2018.

It is better to have a slight oversupply than the shortage now afflicting the public health-care system.

This story was first published in The Straits Times on Jan 14, 2014

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