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Are S'pore public hospitals on track to meet future healthcare needs?

By 2020, there will be six new public hospitals, which are part of the Health Ministry's plan to boost infrastructure to deal with the rise in demand for healthcare services.

SINGAPORE: By 2020, there will be six new public hospitals, which are part of the Health Ministry's plan to boost infrastructure to deal with the rise in demand for healthcare services.

But with Singapore currently experiencing a bed crunch at hospitals, are the ministry's plans on track to meet future healthcare needs?

Construction of the new Ng Teng Fong General Hospital and the adjacent community hospital has been ongoing since 2009.

The new general hospital in Jurong is gearing up for its opening in December.

Preparations include having numerous meetings on matters like patient management, infection control, and on-site visits to oversee safety issues.

The new hospital hopes to give patients an integrated healthcare experience, combining critical care service with the streamlining of bills.

Foo Hee Jug, CEO of Jurong Health Services at Ng Teng Fong General Hospital said: "The successful smooth opening of a hospital actually requires us to not only envision the big picture.

"Now it's about getting into all the details, ensuring that we take note of the specifics about the patient experience, the systems that need to come out, the instruments that need to be there."

Over in Queenstown, about 2,000 nurses are being trained for the new hospital.

The Health Ministry says training of manpower starts between six months and two years prior to the opening of a new hospital.

Other than familiarising themselves with the hospital's new electronic systems, nurses will also be trained to deal with cases specific to the Ng Teng Fong General Hospital.

Kuttiammal Sundarasan, director of nursing at JurongHealth, said: "Being in the centre of the industrial area, we have a lot of factories and shipyards... so we expect to see certain type of problems more while in NTFG.

"For example, we may see a lot of traffic accident patients or industrial accident patients and therefore we are actually gearing up, in anticipation of all this. We are gearing up our nurses' training to be able to handle more complex cases."

Ng Teng Fong General Hospital has also set aside 6 to 12 percent of hospital space to cope with possible surges in demand. These "white spaces" are typically non-clinical areas, used for administration work, for example. If emergencies occur, these "white spaces" can be used for extra beds or operating rooms.

In Singapore, healthcare infrastructure has been ramped up to meet the demands of an ageing population.

There are currently six acute general hospitals in Singapore.

Ng Teng Fong General Hospital will add 700 beds by the end of 2014, and the general and community hospitals in Sengkang in 2018 will add about 1,400 beds.

Between 2020 and 2030, the government plans to build four new acute hospitals, with Woodlands as a possible site.

The Health Ministry says the entire planning process from conceptualising a new hospital to its opening can take an estimated 8 to 10 years, depending on the size and complexity of the development.

The ministry works with agencies, such as URA, to select appropriate sites. The eventual size and capacity of a proposed hospital development is finalised after factors like demographics and site accessibility are taken into consideration.

However, some have raised concerns about how hospitals are planned, especially when the beginning of this year saw bed occupancy rates at some public hospitals rise above 90 percent.

Academic Paulin Tay Straughan was appalled when her husband had to wait over eight hours before being given a hospital bed.

She said: "When it happens so frequently then it's no longer a glitch, it's the new norm. So the question is what happened in the planning, the master plans for hospital beds 5 to 10 years ago?"

Health economist Associate Professor Phua Kai Hong has said it comes down to demand and supply.

While the total number of hospital beds has kept pace with population growth, he said the growth of the elderly population is not being responded to.

Assoc Prof Phua of Health Policy & Management said: "The hospital bed supply has been growing at about 1 percent a year for the last 10 years, and some of the newer hospitals have only been commissioned and are due to open in the coming years.

But if you actually look at the population demand in terms of ageing and the population -- baby boomers will retire from 2010 onwards.

"We have done projections in the past to show that this increase is going to go from 10 percent of population to more than 20 percent within the next 20 years... So you would expect lots more chronic degenerative conditions."

Singapore residents aged 65 years and above made up close to 11 percent of the population in 2013, rising from 9.9 percent the year before.

A higher proportion of the elderly were staying in older estates such as Toa Payoh, Marine Parade and Queenstown, and less than 15 percent in areas such as Ang Mo Kio, Jurong East and Bedok.

Not everyone agrees though that the bed crunch was due to a lack of proper planning. Rather, it is the area of home care which needs to be looked into.

Dr Lam Pin Min, chairman of the Government Parliamentary Committee for Health, said: "The truth of the matter is that it is quite difficult to plan the bed situation as well as the requirements to pinpoint accuracy.

"There needs to be a support system to support both the caregivers and the patient. I think there is this condition called 'caregiver syndrome' whereby after a certain number of years the caregivers get stressed looking after the loved ones at home."

Several hospitals have started transitional care services to provide such support.

80-year old Madam Lim spent three weeks at Khoo Teck Puat Hospital after having a stroke. When she was released, a doctor and nurse visited her at home for three months.

Her caregiver was also trained on how to take care of her, such as how to tube feed.

Elaine Chua, daughter of Madam Lim, said: "It makes a difference because there is some very basic care which we can provide to the patient.

"It's not necessarily that every time there is something, that we take out the phone and call 995. Sometimes we just have to discern what to do."

In the short term, the Health Ministry is planning to tap spare capacity in the private sector. It currently has 50 beds from private hospitals like Parkway East Hospital and Westpoint Hospital.

Assoc Prof Phua said: "Most Singaporeans would perceive if they go into that system, at least, not only the quality, but the prices will be monitored very carefully. And so if that is the public perception, perhaps if you bring in the private sector, the private sector would also have to play by the same rules."

Associate Professor Phua also weighed in on long stays at hospitals, saying occupancy rates are higher in subsidised wards.

He suggested the healthcare financing schemes -- such as MediShield, Medisave and Medifund -- be tweaked so that instead of being geared towards acute hospital based care, they can be used towards preventive care and primary care.

Piling work on the upcoming Sengkang General Hospital and Community Hospital is about halfway through.

The 1,400-bed integrated hospital will include 200 "swing beds" for either acute care or intermediate wards.

Professor Christopher Cheng, pro tem CEO of Sengkang Health, said: "These bed numbers are arrived at by calculating the projected population needs in the northeast.

"This is based on the current utilisation of hospital beds from the citizens around the area, projected to grow in the future -- 2025 and 2030 -- to close to 1 million.

"These are very young families with young children so the services that we plan will be geared towards their needs."

While the hospital's building is on track, experts say its opening cannot be rushed.

One of the biggest challenges it faces is recruiting 5,000 staff.

Dr Chia Shi-Lu has been involved in the medical manpower planning for the hospital since 2010.

He says hiring senior doctors will be the toughest part for the hospital that will open in 2018.

Dr Chia said: "Sometimes it is very difficult to commit doctors six or seven years down the road. The problem would be -- probably when we look at staff who are a bit more senior because some of them might want to retire, they might want to branch off into other aspects of hospital work."

The overall sentiment is that a hospital-centric system is not the most optimum way to meet the needs of an ageing population. Rather, the model of healthcare needs to evolve so that more is built up in the primary care sector.

It is hoped that such efforts, together with the planned increase in bed capacity, will allow future healthcare needs to be better met. 

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