Bed crunch

20 January 2014

Question No.: 1714

Name of person: Dr Lam Pin Min, MP for Sengkang West

Question

To ask the Minister for Health (a)if he can provide an update on the bed crunch situation in both the public and private sector hospitals; (b)what are the interim measures to alleviate the situation; and (c)what is the Ministry's assessment of the severity of the shortfall over the next few years.

Answer

1.   A combination of factors contributed to the high Bed Occupancy Rate of 87.2% early this year, higher on some days and in some hospitals. This was higher than the 85.8% in the same period last year. With an ageing population, there are now more old and frail patients who need hospitalisation. The proportion of public sector admissions from patients aged 65 years and above has increased from 28.6% in 2006 to 33.4% in 2013. Older patients also tend to stay longer in hospitals because it takes longer for their conditions to stabilise and for them to be eligible for discharge. The average length of stay for patients aged 65 and above has lengthened from 7.8 days in 2010 to 8.2 in 2013. In contrast, younger patients’ ALOS has actually shortened during this period. With shrinking family sizes and weaker family support over time, family members may not be ready to take the patients home in a timely manner and this also will result in a longer stay in the hospital.

2.   We address the capacity issue from both the short term and the long term perspectives. In the short term, we are actively managing the capacity in two ways. First, we are optimising capacity in each acute hospital by facilitating timely discharge of patients to appropriate care settings, including community hospitals and nursing homes, as well as the patients’ homes.

3.   To better support our patients and their families, our hospitals are going beyond the physical confines of the hospital to provide care. Hospitals such as Changi General Hospital, Khoo Teck Puat Hospital and Tan Tock Seng Hospital have formed transitional care teams to support patients in their homes initially after discharge if necessary. These multi-disciplinary teams, comprising doctors, nurses and allied health professionals, will continue to support the patients and ensure that care-givers are able to provide proper care for the patients. This helps to give the patients and their families greater assurance and facilitate timely discharge.

4.   Families who need time to make permanent care arrangements at home are able to tap on the Interim Caregiver Scheme at Changi General Hospital, Tan Tock Seng Hospital and several other hospitals and community hospitals. As of December 2013, about 300 patients have benefited from this scheme.

5.   In view of the growing healthcare needs, we have added more than 300 beds in our public hospitals over the past six months. This was done by adding more beds into existing wards, re-commissioning beds at the Communicable Disease Centre, and converting office and other non-clinical space into bed space. In addition, close to 1,000 more nursing home beds were added last year, which helped to take over from the hospitals lower acuity patients who need longer term care.

6.   Second, we are optimising national capacity by initiating transfers from acute hospitals with a tight bed situation to others with higher bed capacity. We are also tapping on spare capacity in the private sector. For example, public-private partnerships have been forged between Changi General Hospital and Parkway East Hospital; and also between National University Hospital and Westpoint Hospital. We now have almost 50 beds from these private hospitals. We are exploring further collaborations with the private hospitals.

7.   We will continue to monitor the situation closely and work with our hospitals on all fronts to ensure that patient safety and care is not compromised.

8.   Over the medium-term, the demand for acute care services is likely to continue to rise as our population ages. MOH has already put in place plans to build additional bed capacity across care settings under the Healthcare 2020 Masterplan. In 2014, 1,200 beds including community hospitals and nursing homes beds, will be added to the healthcare sector, and 10,000 more beds will be added by the end of 2020. Besides the upcoming Ng Teng Fong General Hospital and Jurong Community Hospital that will open in 2014 and 2015 respectively, Yishun Community Hospital will open in 2016, Sengkang General Hospital and Community Hospitals will open in 2018, and a new Community Hospital in Outram will open by 2020. In the intermediate and long-term care sector, we are building various eldercare facilities, including 12 new and replacement nursing homes by 2016.

9.   Even as we add capacity, we need to also transform the model of care because a hospital-centric system is not the best in meeting the care needs of an ageing population. We need to help our senior population stay healthy and manage their chronic conditions better so that they do not need to be hospitalised frequently. We also need to provide good support in the community to recuperate well after a hospitalisation episode.

10.   An example of a care transformation programme is Tan Tock Seng Hospital’s Virtual Hospital. This involves assigning a care manager to monitor frail patients who have a history of multiple admissions to hospital, and help them better manage their conditions so that they can stay healthy get better and not have to visit our hospitals.

11.   We also need to build up our primary care and intermediate and long term care sectors and integrate them better with our acute hospitals. These transformation efforts, together with planned increase in bed capacity, will allow us to better manage our healthcare needs in the decade ahead.