Severe bed crunch in hospitals

During Question Time in Parliament on 20 January 2014, several MPs asked the Health Minister what was being done to alleviate the severe bed crunch in public hospitals, which has forced some hospitals to house their patients in tents or on corridors. I asked the Minister if public hospitals had considered converting their higher class (A and B1) wards to C class wards. I also asked whether public hospitals were still marketing their international patient services to foreigners residing abroad.

During Question Time in Parliament on 20 January 2014, several MPs asked the Health Minister what was being done to alleviate the severe bed crunch in public hospitals, which has forced some hospitals to house their patients in tents or on corridors.

I asked the Minister if public hospitals had considered converting their higher class (A and B1) wards to C class wards. This was a suggestion I had made during the Committee of Supply debate in 2012. Back then, I had pointed out that 22% of beds in public hospitals were non-subsidised (i.e., A and B1 class). My assessment is that since A and B1 class wards use up more space per bed, if they can be converted (permanently) to C class wards, hospitals would be able to free up more bed space for patients and this will help alleviate the bed crunch.

The Minister responded that this could not be done because of the re-wiring and re-piping that would need to be done. I am not convinced. If hospitals are willing to permanently convert their A and B1 class wards to C-class wards to maximise space for more beds, the necessary renovation works can be done.

On a related issue, I asked whether public hospitals were still marketing their international patient services to foreigners. Note that this had nothing to do with public hospitals treating foreigners who are already living and working in Singapore. (Of course we cannot deny medical treatment to these foreigners.) I was asking if the hospitals are still pro-actively marketing their premium healthcare services to foreigners residing outside Singapore. The Minister’s response was that these patients “only” take up 2% of hospital beds. But with many hospitals hitting 100% capacity during certain peak periods, wouldn’t this 2% make a difference?

Below is the relevant section of the debate. The full transcript can be found here.

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Mr Gerald Giam Yean Song: I have two supplementary questions. First, have the hospitals considered converting the A and B1 class wards to C class wards, especially in this period of bed crunch so as to free up more space for the patients? And, secondly, are the public hospitals still marketing their international patient services to foreigners because these would naturally add to the bed crunch as well?

Mr Gan Kim Yong: Madam, first, let me explain that for the wards in the hospitals, the conversion has to take into account the infrastructure design. It also needs to take into account the manpower capacity as well. Some of the wards in B1 may not be able to be converted into C class wards by simply adding beds because we need to ensure that the pipes are there, the wiring is there, and the system is capable of accommodating more than the number of beds that are currently in B1. But in the hospitals, what they have done is they have taken a very practical approach for patients when the bed capacity is tight. When they need more hospital beds to cater to the demand of the patients, they would allow the patients to be uplodged. Even if they are C class patients, we allow them to be uplodged to B2 or B1 wards. So I think all the private wards are being used as a potential capacity to cater to the need of the patient when the bed demand is high.

On the second point of foreign patients, I think I have replied in one of the PQs earlier. Foreign visitors form a very small component of our hospital beds. Some of them come for day surgeries, some of them are in the emergency and treated as outpatients and they go off. From my recollection, I remember that foreign visitors in our hospitals take up less than 2% of our hospital beds and these are sometimes urgent cases and some of them are already here in the emergency department. From the hospital’s point of view, these foreign visitors do not pose a significant stress on our hospital beds. If you look at the historical trends, as I mentioned earlier, I think extension of the length of stay and rising of proportion of patients aged 65 and above are key drivers of hospital bed demand. Of course, hospital bed occupancy is also a very dynamic number. It varies from day to day as you can imagine. It also varies from hospital to hospital. It depends to a very large extent on the number of emergency admissions and the number of discharges the hospital is able to undertake on each day. So it depends on how many patients arrive at the A&E, how many patients we plan to discharge and, therefore, in certain days, when we plan for a certain number of discharges but there could be a significant number of emergency cases that arrive at the emergency departments, and we have to address them and we may have to hospitalise them. If that situation happens, you tend to see a high bed occupancy rate for that particular day of that particular hospital. Once you admit a patient into a hospital ward, it is not just for one day. Sometimes it takes two or three days. For an elderly, it may take a bit longer. So even for that particular day, the occupancy rate is high because of high admissions. It will take a few days for the occupancy rate to come down even if you have low admissions because the patients will take up the bed for a couple of days, or three-four days, depending on the situation. So it is not just a simple factor. That is why I explained in my answer that a combination of factors will contribute towards a high bed occupancy.

[Source: Singapore Parliament Reports]