WAITING TIME FOR BEDS IN PUBLIC HOSPITALS

WAITING TIME FOR BEDS IN PUBLIC HOSPITALS: 2. Mdm Halimah Yacob asked the Minister for Health (a) what is the average waiting time for beds in the public hospitals for both emergency and non-emergency cases; (b) what measures are being taken to address the problem of bed shortage; and (c) whether the bed crunch in public hospitals has affected the quality of care for patients.

Mr Khaw Boon Wan: Sir, our Emergency Departments attend to all life-threatening cases immediately. There is no waiting for such patients.

For non-emergency cases which require admission, their waiting time for a bed will depend on the hospital they visit. Overall, we have sufficient beds but there are mismatches on certain days, like Mondays and Tuesdays, resulting in some patients having to wait for a bed longer than we desire. I can explain why if you ask me a supplementary question later on.

To address the problem, we have added new hospital beds over the years, while building the new Khoo Teck Puat Hospital and planning the new Jurong General Hospital. This has provided some relief.

This January, for example, the average bed occupancy rate was 82%, ranging from 74% at Alexandra Hospital, 81% at Singapore General Hospital to 89% at Tan Tock Seng Hospital (TTSH). The average bed occupancy rate went down to 77% in February as patients avoided hospitalisation during the Lunar New Year. With the end of the festivity,

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elective admissions have returned. So last week we were heavily stressed.

Among the hospitals, TTSH has the highest number of admissions from its Emergency Department. This is because it serves a large population catchment, both from the north and the central part of Singapore.

Nonetheless, most patients do not have to wait long. At TTSH, half of the emergency department admissions in January were admitted to their assigned wards within two hours. Another 35% of patients waited two to four hours. But 5% of patients had to wait more than eight hours.

In order to relieve the overcrowding in TTSH, the other hospitals have chipped in, to handle the overflows of ambulance cases and admissions. This has, in turn, spread the problem to them, especially to CGH which had a bed occupancy rate of 91% last week. So we are all eagerly awaiting the opening of the Khoo Teck Puat Hospital later this year. That will add 555 beds to our capacity.

The shortage of beds on certain days of the week has a significant impact on customer service. Patients, naturally, would like to be admitted to and be able to get settled down in their preferred ward immediately. Our failure to do so for some patients who have to wait a few hours for this to happen is unsatisfactory. I am sorry for this lapse in service level.

However, the clinical care for such patients is never compromised. When patients are waiting to be admitted, they continue to receive the appropriate care. Their doctors would assess the patients, order the necessary tests and initiate the appropriate treatment immediately.

Mdm Halimah Yacob: Sir, supplementary questions. Of course, since the Minister has indicated I should ask the

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question, my first question is why is there a problem on Mondays and Tuesdays. The second question is related to the perception on the ground that seems quite prevalent, that foreigners are depriving Singaporeans of beds and are crowding them out. Is this a true perception, particularly in the subsidised wards?

Mr Khaw Boon Wan: In hospitals, we handle both, what we call electives – non-emergencies and of course emergencies. Public hospitals typically handle a huge share of emergency workload because we are the only ones with true emergency departments. Private hospitals generally handle elective cases. Elective cases have the advantage of predictability; you plan for it. So if you need something, it can be done this week or next week or next month – it does not really matter. Your health is not affected by it, and you can choose the date. Of course, hospitals and doctors prefer electives because life is simpler, whereas emergencies are so unpredictable. In public hospitals, all emergency workloads are heavy. But some hospitals have heavy electives, too. SGH, for example. Of all the admissions into SGH, I would say about 40% to 45% are electives and 55% are emergencies. Whereas other hospitals like Tan Tock Seng or Changi, the emergency workload is about 90%, so electives make up less than 10%. As electives are scheduled events, doctors generally make the request for the hospitals to schedule elective admissions on Sunday so that the surgery can be done on Monday or Tuesday. The emergency work is still there, but on Mondays and Tuesdays, we superimpose the electives on the emergency workload. That is why Mondays and Tuesdays become extra heavy days. And because patients stay a few days, it all accumulates. So for subsequent days of the week, we will cut down the elective numbers in order to accommodate the number of patients in our available beds. That explains this peak pattern on Mondays and Tuesdays.

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Over the years, we try to manage but the bottomline is, yes, we are at the moment a bit short of beds. And the correct solution is to delay electives. In fact, in many countries electives take months. But we have been spoilt to be able to respond to electives within a few weeks. When my visitors come in from Europe or US, they express surprise. They said, "why do you do that?". For them, to wait a few months for elective surgery is no big deal. But because we have now reached this standard, it is very hard to reduce it. So I plead for some patience, if we have to delay the electives a little in order to cope with this immediate shortage of beds for the next few months, until we fully open Khoo Teck Puat Hospital.

Do foreigners crowd out locals? The statistics do not show that because we know that foreigners, including PRs, make up maybe one-third or 35% of the total resident population here. But in subsidised wards, they only make up about 15% of the total in-patient load. 85% are Singaporeans. Why foreigners make up 35% of the population but 15% of in-patient load can be explained because the foreigners, the people working here, are generally young, as compared to locals staying here. Older people do get hospitalised more often.