Resignation rates among healthcare workers in Singapore up this year; MOH to increase ICU capacity
SINGAPORE: Resignation rates among healthcare workers are up this year amid a manpower crunch in hospitals, Senior Minister of State for Health Janil Puthucheary said in Parliament on Monday (Nov 1).
About 1,500 healthcare workers resigned in the first half of 2021, compared to about 2,000 annually pre-pandemic, he said.
Foreign healthcare workers have resigned in bigger numbers, he added. Close to 500 foreign doctors and nurses resigned in the first half of 2021, compared to around 500 in the whole of 2020 and around 600 in 2019.
These resignations were mostly tendered for personal reasons, for migration, or moving back to their home countries, he said.
He quoted messages he received from a senior member of a clinical team and a colleague on how healthcare workers are getting “increasingly stretched, overworked and fatigued” and how "what started as a 2.4km run became a marathon".
“Our people are exhausted physically, mentally, emotionally – whether they will admit it or not,” the message said.
“It is therefore not surprising to find resignation rates going up this year,” Dr Puthucheary said.
Dr Puthucheary was giving details on the state of healthcare workers in response to questions from Members of Parliament, who asked several questions on the topic, including the manpower crunch, amount of leave taken and whether they are discriminated against when they take sick leave.
A large proportion of healthcare workers have not had the opportunity to take leave since 2020, with more than 90 per cent unable to clear their accumulated leave for 2021, Dr Puthucheary said.
“This is a higher proportion compared to the past two years. Our healthcare workers have gone way beyond the call of duty to care for their patients,” he said.
He added that the hospitals are trying to minimise having staff members work overtime. For the month of September, nurses worked for an average of 160 to 175 hours per month, he said.
MOH is reaching out to more volunteers to join the SG Healthcare Corps and is also working with private hospitals to help ease the load on healthcare workers in public hospitals, Dr Puthucheary said, adding that the ministry is also stepping up recruitment of healthcare workers from overseas.
Workers' Party chief Pritam Singh asked for numbers on foreign healthcare workers being recruited. In response, Dr Puthucheary said that while he did not have numbers on hand, one of the challenges of recruiting such workers is that they would be new to the environment.
"While we are recruiting and we have been actively ... Operationally, I can't say that that is going to make a huge difference in the ICUs (intensive care units)," he said.
However, he said that the additional manpower will make a difference in other parts of the healthcare ecosystem.
"We hope that can displace a little bit of the manpower into some of the high activity areas and then release a few people to go and help in the ICU. But I think this is a bit more of a medium-term strategy rather than something that we can rely on as an urgent fix to our current problem," he said.
Dr Puthucheary also addressed a question by MP Tan Wu Meng (PAP-Jurong) about hospital departments factoring in sick leave as an indicator of work performance.
"There have previously been isolated incidents, but this practice has ceased," he said, adding that employees who are concerned about this may approach their union, MOH or the Manpower Ministry for assistance.
INCREASING CAPACITY OF ICU BEDS
Dr Puthucheary also responded to questions on ICU capacity, adding that there has been a need to increase the total number of ICU beds to 382 for both COVID-19 and non-COVID-19 patients over the past two months.
“The need to increase the capacity of our healthcare system is a heavy burden carried by the staff, our healthcare workers,” he said.
While the proportion of COVID-19 cases requiring ICU care is at about 0.3 per cent - a small proportion - it translates to a large absolute number of ICU patients when case numbers are high, and will place a serious strain on ICU capacity, Dr Puthucheary said.
There are currently 130 patients who need intensive care, Dr Puthucheary said, adding that some are intubated and require a mechanical ventilator.
They occupy around 60 per cent of the 219 ICU beds currently reserved for COVID-19 patients. These patients stay for an average of 11 to 15 days in the ICU, and some stay for up to a month, he said.
“All of these patients require the continuous care of an ICU team,” he said.
“Besides COVID-19 cases, there are also non-COVID-19 patients with life-threatening medical conditions who require ICU care, adding to the sustained load that our hospitals have to bear.”
He said that logistically, a key trade-off in increasing the number of ICU beds for COVID-19 patients is decreasing the number of of ICU beds for non-COVID-19 patients.
Public hospitals currently operate about 163 adult ICU beds for these patients, with an average occupancy of close to 80 per cent, he said. This number is down from the 298 adult ICU beds pre-pandemic, which had an average occupancy rate of 63 per cent.
MOH will expand Singapore’s ICU capacity further, in preparation for a potential rise in severe cases, he said.
“We are currently working with our hospitals to ramp up from 219 to 280 ICU beds for COVID-19 patients. These can be ready this week. If needed,” he said.
He added that the next expansion will be to 350 beds, adding that MOH has been repurposing existing hospital wards, such as single rooms and isolation rooms, into additional ICU beds.
"We are also asking the private hospitals to set aside ICU beds to assist in managing both COVID-19 and non-COVID-19 patients who are critically ill," he said.
Mr Singh (WP-Aljunied) asked if the "operating parameter" had changed from what had been previously said - that up to 1,000 ICU beds can be made available for critically ill COVID-19 patients if needed.
In response, Health Minister Ong Ye Kung said that the number was given as an illustration of how even at that kind of capacity, the system could become overwhelmed in a "matter of weeks" if infection numbers increased rapidly.
Mr Ong added that manpower will be a "serious constraint".
INCREASING MANPOWER IN TANDEM
Dr Puthucheary similarly said that that while logistically, Singapore can keep increasing the number of ICU beds, and there are ventilators, equipment, consumables, there are “not enough people”.
“As a result, when we increase beds, we stretch and stretch our healthcare workers. We will come to the point that they will no longer be able to provide that continuous excellent care,” he said.
He cautioned that each nurse will have to take care of more patients than they do today.
“While we may have plans to step up to certain number of ICU beds, the real situation on the ground, the operational considerations, are not straightforward. We do not want to go anywhere near the theoretical limit,” he said.
Any increase in ICU bed capacity must be supported by an increase in manpower, which has to be diverted from non-COVID-19 ICU duties, he said.
"Any redeployed staff or new hires would also have to undergo training to operate the specialised equipment and medical devices in the ICU to care for COVID-19 patients," he said.
Hospitals have been augmenting ICU manpower by deploying previously trained ICU staff members to help with patient care, Dr Puthucheary said. Non-ICU staff have also been brought in, and they work under the supervision of ICU trained staff.
The shift pattern of nurses may have to be adjusted in order to cater to these needs, and this has already started to happen in some hospitals, he noted.
Giving the example of a nurse from the orthopaedic department who was working in a COVID-19 intensive care unit, Dr Puthucheary said that many nurses, doctors, therapists, social workers have been re-deployed to do what is urgently needed.
While they have kept the clinical outcomes “excellent”, he said this was “taking a toll”, he said.
“They are getting tired. They are carrying a burden of care that is sometimes unimaginable,” he said.
“Having to hold a phone for a patient so their family can say their last goodbyes. Holding their patients’ hands, to keep them company, on behalf of the patient’s relatives. They need all the support we can give them."