Mr Pritam Singh (Aljunied): Chairman, having to be hospitalised is physiologically and emotionally stressful in many ways. Fortunately, our health workers work hard to minimise the inconveniences of the experience as much as possible.
Even so, to know that you have to wait long hours for a bed in Singapore does not correspond with what many older Singaporeans in particular expect of our healthcare system. At their moment of need, many of our seniors and even citizens across various age groups did not believe that they would have to wait hours in a chair in an A&E department or be decamped to beds located at a temporary car park where the lights are never turned off at their moment of critical need.
MOH currently publishes the daily median waiting time at emergency departments on a delayed basis of two weeks. In some hospitals, even at the median, the waiting time for a bed can exceed 16 hours. This was the situation at the end of January at Khoo Teck Puat and Changi General Hospital. Imagine being ill and uncomfortable and having to wait 16 hours for a bed. This hospital experience is being narrated anecdotally to me by an increasing number of seniors.
In order to have a more accurate perspective of the problem, would the Ministry be prepared to publish the waiting time for an admission to a ward, not just at the median which it does now, but at the 75th and 90th percentiles as well, for a more holistic overview of the situation on the ground?
Secondly, in view of the situation today and in the short term, can the Ministry generate a publicly accessible or build within mobile health applications such as HealthHub, a resource that provides information on waiting times at A&E departments in our public hospitals, and details on bed occupancy in as close to real-time as possible, perhaps even on a two-hourly basis, so that patients and their caregivers can exercise the option of going to an A&E department that is less crowded? This would also relieve and better spread the patient load at hospitals where doctors and nurses, allied health workers and staff consistently see higher A&E admissions and bed utilisation.
Sir, the reality of our growing senior population has been on the radar for decades. I understand moves are underway to increase the number of hospitals and polyclinics. In fact, piling works have just begun last month for the Eastern Integrated Health Campus in my ward of Eunos in Aljunied Group Representation Constituency, the development of which is expected to take some patient load off Changi General Hospital. These developments should improve the situation, but it has to account for the rising number of seniors and Singaporeans who inevitably will have to tap onto the healthcare system in some shape or form, and also to account for the rising healthcare manpower needs.
Thirdly, there have been reports of patients preferring to stay in a hospital longer than they are supposed to, despite being medically fit for discharge. One report cited an expert as postulating, for example, that three out of 10 NUH patients or their family members have to contend with discharge issues. While each situation would have to be looked at on a case-by-case basis, such patients can exacerbate the problems faced by the primary healthcare system. How many patients were labelled as overstayers in our public hospitals in 2023, and how serious is this problem?
The Ministry has announced plans to increase beds over the next five years and the number is 1,900. Can the Ministry share its plans on how it intends to expand home care services over the next five years as well, to reduce patient load in hospitals, and so as to ensure that the load on our healthcare workers is not more than it needs to be?
The Minister for Health (Mr Ong Ye Kung): Mr Singh suggested that we provide dynamic waiting times of emergency departments (EDs) across hospitals publicly, in real time. It is possible, but we have been reluctant to do so, I think for a good reason. Ambulances today already have a process in place to ferry patients needing urgent care to the nearest appropriate hospital for priority treatment. However, at the EDs, 40% of cases are not life-threatening or urgent, but they ended up there anyway. So, our worry is that giving dynamic information may perversely drive more non-urgent cases to hospitals and worsen the overall situation.
I know it is very uncomfortable, very unsettling for a patient who is quite unwell to have to wait many hours for a bed. But please be assured that hospitals will triage patients quickly upon arrival and start treatment for urgent cases, even if the patient is waiting for a bed.
The Chairman: We have time for clarifications. Mr Pritam Singh.
Mr Pritam Singh (Aljunied): Thank you, Chairman. A question to the Minister on my cut. Emergencies can be defined by the patient and the medical professional differently depending on the sort of pain you are in. And to that end, the Minister shared that about 40% of cases at Accidents and Emergencies (A&Es) are not emergency cases. I would like to enquire whether that has been a stable number over the years because, if it has been, then it may be helpful to consider some sort of dynamic information to be shared with walk-in patients, because it will help them get attended to more quickly and also for the health workers and health staff in hospitals who may not be overloaded if these potential patients go to a hospital which is less crowded.
The second question pertains to my cut with regard to providing information beyond just the median vis-à-vis bed utilisation, and whether it can also be extended to bed utilisation at the 75th and 90th percentiles.
I have a final query on overstayers. Is this a significant problem in the hospitals? It would be helpful if the Minister could share some information on overstayers and whether there could be better coordination between medical social workers and the consultants and overseeing doctors, so that this problem can be abated somewhat.
The Chairman: Minister Ong.
Mr Ong Ye Kung: The definition of “urgent care” is actually standardised and practised. We have a nomenclature P1, P2 which are considered urgent; P3 onwards not so urgent and it goes up. So, therefore, this is based on a standard definition, and so P3 and above is 40%. I do not have the number whether it is stable. I am hoping it has come down over time. But we had a pandemic in between. So, even if it is tracked over time, it may not be representative. But we are doing what we can educating the public, having UCCs, having GPFirst programme to reduce this number.
So, our concerns still stand, that the worry is that with dynamic information, we are encouraging more P3s, non-urgent, from coming to EDs. Sometimes, when the ED has a breather, maybe we should just let the doctors and nurses have a breather. So, we remain to have a concern. But as I said, we are not rejecting the suggestion, but we always had this concern.
As for bed waiting time beyond median, whether we can indicate 75th, 90th percentile, the issue remains this: that if there is urgent care needed, it will be given almost immediately, without delay, at the ED if possible. But I take Mr Singh’s point that it is not the most comfortable place. The lights are on. There is a trolley bed, but it is not a proper ward. So, we will have to prioritise. Those who need urgent care in the ward, we will give them immediately. So, it is not just a matter of waiting time. The urgency and the clinical needs of the patient play a big part as well.
On overstayers, actually I have addressed that question. We used to have about 300 overstayers at any point in time. It has come down to 200, but there is still room for improvement.
Ministry of Health
5 March 2024 & 6 March 2024
https://sprs.parl.gov.sg/search/#/sprs3topic?reportid=budget-2378
https://sprs.parl.gov.sg/search/#/sprs3topic?reportid=budget-2389
Office of the Leader of the Opposition 