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Hospital beds crunch due to COVID or just poor planning by Singapore authorities?

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In an opinion piece by Salma Khalik, Straits Times’ health correspondent, it is highlighted that the delay in securing a bed recently has been exceptionally long, with some patients having to wait several days before being moved from the emergency department (ED) to a hospital ward.

She noted that there had been a 35.8-hour median wait on 10 Oct, a Monday and questioned if it may be a record for Singapore.

Ms Salma wrote, “It is never good for patients to spend long hours – or even days – in a place specifically meant for emergency treatment and not long-term care. There are no shower facilities in the ED, for one thing, or even enough toilets when patient numbers soar to beyond capacity.”

She pointed out that doctors and nurses at the ED should also not have to provide day-to-day care for patients. But instead, they should only be focusing on emergency cases.

“Anecdotally, it seems patients sometimes remain in an ED for three or four days before being moved to a ward.”

One would wonder if there has been a new spike of COVID infections among the Singapore population causing the bed crunch at the hospitals.

Referring to the Ministry of Health (MOH)’s data, we do see a spike in admissions as a result of COVID infections.

But if we look closely, we can see that the spike resulted in 186 beds being occupied. This leads to the question of how many beds we have as buffers in the public healthcare system.

According to government data, there were 15,564 beds at hospitals in 2020. During that period, there were a recorded number of 5.69 million residents, which gives us a ratio of 2.74 (2.74 beds per 1000 pax).

Based on the information from MOH, we see that the occupancy rate for Singapore’s public hospitals is mostly at above 90 per cent occupancy.

According to United Kingdom’s National Audit Office, the bed occupancy rate is deemed efficient at 85% and recommended not to exceed 90%.

Its evidence suggested that, in general, any increase in occupancy leads to an increased risk of adverse patient outcomes including mortality (in-hospital, 7-day and 30 day), avoidable adverse events reported as hospital-acquired infections (Clostridium difficile infection), length of stay, 30-day readmission and delays in admission for patients waiting in ED.

What is suggested by the UK institute, seems to comply with the reality in Singapore’s hospitals as described by Ms Salma in her opinion piece.

At a ratio of 2.74 in 2020, Singapore fares slightly better than its neighbouring countries, Malaysia (2.01, 2020) and Indonesia (1.49, 2021) but it fares considerably worse than other Asian countries such as Japan (12.63, 2021), South Korea (12.65, 2020) and Taiwan (7.3, 2021).

It bears noting that World Health Organisation (WHO) in India highlights that global standards recommend 5 hospital beds for every 1000 people. This standard is said to be meant for district hospitals — India had 5 beds per 10,000 in 2020. At the same time, the OECD average was 5 beds per 1000 in 2018.

While there has been a mad rush to build new hospitals over the past couple of years such as Ng Teng Feng Hospital, Sengkang Hospital and Jurong Community Hospitals and others, we can see that most were built after 2011.

Hospital Opened Beds Ownership
Mount Elizabeth Novena Hospital 2012 333 Private
Ng Teng Fong 2015 700 Public
Yishun Community Hospital 2015 224 Public
Jurong Community Hospital 2015 400 Public
Farrer Park Hospital 2016 121 Private
Sengkang General Hospital 2018 799 Public
Sengkang Community Hospital 2018 400 Public
Outram Community Hospital 2019 550 Public

 

Priority to that, we even had hospitals such as Toa Payoh Hospital being merged to form the current Changi Hospital in 1997.

In fact, if we were to look even deeper, we will see that the ramp in hospitals (in turn beds) came after 2011 when the People’s Action Party lost its first Group Representation  Constituency (GRC) in Aljunied at the General Election. (Note that the increase in 2013 was due to a private hospital and not a public one.)

In the aftermath of the election, it is reported that voters were unhappy over the influx of immigrants, causing overcrowding in public transport and other amenities alongside the rising cost of living.

Infrastructure was simply not sufficient or built fast enough to cope with the mass increase in the population where there had been a jump of 1 million residents from 2000 to 2010.

Historically, it may also be interesting to note that the total number of hospital beds (public & private) dropped from 11,936 in 2001 to 11,394 in 2011 (Dept. of Statistics) – whilst the number of hospital admissions increased from 384,054 to 469,445 – medical tourists increased to 850,000 a year.

In 2011, the ratio was just at 2 beds per 1000.

Given that there has been an additional increase of over 600k population from 2010 to 2020, rather than building more hospitals to increase its capacity for comfort and buffer, it can be said that Singapore is catching up with its backlog due to its lack of planning.

But it is fortunate that the Singapore government seems to have learnt its lesson and has been aggressively building new hospitals to cater for its population, particularly so in light of its ageing population.

However, while hospitals can be built so long you have the money but it is a different challenge when it comes to staffing them with experienced healthcare professionals.

While this can be solved with short-term solutions by hiring foreign doctors from countries such as India, many have argued and questioned why Singapore is not bringing its citizens who have studied medicine back as doctors.

True enough, Singapore is indeed ramping up its recruitment of Singaporean medical students who are studying abroad after a high turnover of healthcare staff following the COVID pandemic.

But whether would it persist in this trajectory, resolves challenges in attracting the students back or lose its way as it did in its foreign talent policy for other industries in Singapore, is something to be examined in the future to come.

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Editorial

Undying Phoenix: TOC navigates regulatory restrictions with a revamped approach

Despite new regulations hindering operations, The Online Citizen Asia (TOC) views this as a chance to return to its roots, launching Gutzy Asia for Greater Asian news, while refocusing on Singapore. Inviting volunteer support, TOC’s commitment to truth and transparency remains unshakeable amidst these constraints.

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On 21 July 2023, the Ministry of Communications and Information, under the leadership of Minister Josephine Teo, declared The Online Citizen Asia’s (TOC) website and social media platforms as Declared Online Locations (DOL) according to the Protection from Online Falsehoods and Manipulation Act 2019 (POFMA).

This decision follows a series of alleged false statements propagated by TOC, with the most recent incident reported on 2 May.

Amidst a politically charged environment characterized by scandals involving the People’s Action Party and increasing public mistrust towards the ruling government, TOC will continue to operate, albeit under significant constraints, despite the regulatory restrictions imposed.

The DOL declaration mandates that TOC must carry a public notice on its online platforms, which indicates its alleged history of disseminating misinformation.

The POFMA Office, however, clarified that TOC can continue its operations, retaining its website and social media pages under stringent regulations, particularly concerning monetization.

According to Part 5 of the POFMA, TOC is prohibited from gaining financial or material benefits from its operations. Additionally, offering financial support to TOC is equally unlawful. For the next two years, TOC will be compelled to self-sustain, relying solely on its resources without any public backing.

It strikes TOC as notably ironic that the Singapore government, eager to stymie our operations to prevent the spread of “fake news”, simultaneously demonstrates a fervour to invest S$900 million of taxpayer funds into the SPH Media Trust, currently embroiled in a data misrepresentation scandal. This dichotomy indeed presents a masterclass in cognitive dissonance.

Despite these significant constraints, TOC views this as an opportunity to revert to its roots, replicating the enthusiasm and drive that characterized our operation following our establishment in 2006.

Our existing staff will transition to a new publication, Gutzy Asia, focusing on news from Greater Asia, while TOC will refocus on its primary subject, Singapore, hence dropping the Asia subtext.

In this transition, we invite volunteers passionate about journalism and holding power to account to join us in our mission. We also welcome contributions from Singapore’s political parties, offering them a platform to express their perspectives and provide updates.

While this change may result in a decrease in content volume and frequency, we assure our supporters that our commitment to truth and transparency remains steadfast. We are legally obliged not to seek financial aid, but we hope our supporters will provide us with manpower and information support.

We are resolute in our decision to continue TOC’s operations, standing in defiance against attempts to silence dissent through lawsuits and intimidating regulations. We are here to serve the people, and we will continue our mission with determination and resilience.

To keep up to date with the publication: Follow The Online Citizen via telegram (Gutzy Asia’s posts are included)

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Editorial

Shanmugam, Balakrishnan, and the Code of Conduct: A Demand for Straight Answers

Editorial: Amid the recent controversy involving Singaporean ministers K Shanmugam and Vivian Balakrishnan regarding the tenancy of two state properties, serious questions have surfaced about potential breaches of the Ministerial Code of Conduct.

Despite being renowned for high standards of governance, the lack of a clear response from the ministers themselves and the decision to pass the issue to a review committee chaired by a fellow party member has raised eyebrows. The crucial question remains: does leasing property from the Singapore Land Authority, an organization overseen by the minister in question, breach the Code of Conduct?

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In a country renowned for its high standards of governance, the recent controversy surrounding the tenancy of two state properties by Minister K Shanmugam and Foreign Minister Vivian Balakrishnan has raised some perplexing questions.

Both ministers, tasked with the important responsibility of upholding the integrity of Singapore’s laws and foreign affairs, respectively, find themselves under scrutiny following allegations of a potential breach of the Ministerial Code of Conduct.

Mr Shanmugam claimed in his statement on Tuesday (23 May) to have “nothing to hide” and encouraged questions.

However, the irony is palpable when we consider the simple question that remains unanswered: Does leasing from the Singapore Land Authority (SLA), an organization he oversees, breach the Ministerial Code of Conduct?

Prime Minister Lee Hsien Loong’s decision to initiate a review is commendable and necessary to maintain the high standards of integrity that are a cornerstone of the Singapore government.

However, having a fellow People’s Action Party Senior Minister, Teo Chee Hean, chair the review does raise some questions. Furthermore, it remains puzzling why a straightforward answer isn’t forthcoming from the ministers implicated in this issue.

Under Section 3 of the Ministerial Code of Conduct, it’s stipulated that a Minister must avoid any actual or perceived conflict of interest between his office and his private financial interests.

While we should refrain from jumping to conclusions before the review concludes, the public certainly has the right to question whether a Minister leasing public property could conceivably conflict with his public duty.

This predicament reflects an unprecedented evasion of responsibility, particularly from Mr Shanmugam, who has been vocal in demanding clear and direct responses from political opponents.

Now that the tables have turned, the nation awaits his clear and direct answer – does leasing the property at 26 Ridout Road contravene the Code of Conduct for ministers?

Instead of a straightforward response, we see the matter deferred to a review committee and promises of addressing the issue in Parliament, where the ruling People’s Action Party holds a supermajority. This is far from the accountability and directness we expect from a Minister, especially one overseeing Law and Home Affairs.

The question is simple and direct, yet the absence of a clear answer has inevitably raised eyebrows and triggered skepticism about our leaders’ transparency and accountability. It is incumbent upon Mr Shanmugam and Mr Balakrishnan to clear the air and restore public confidence by providing a simple “Yes” or “No” answer.

Do the two ministers not think that the average person will likely perceive a conflict of interest when ministers rent from a government agency under the Law Minister’s purview? Once such a perception exists, how can there be no breach of Clause 3 of the Ministerial Code?

Clause 3, analogous to the maxim that justice must not only be done but seen to be done, requires a Minister to avoid actual conflict of interest and apparent or perceived conflict of interest.

Parliamentary privilege and safe environments shouldn’t be an excuse for evading direct answers. Singaporeans deserve more than opaque explanations and bureaucratic deferrals; they deserve straightforward, honest responses from their public servants. This is a matter of trust, transparency, and, above all, integrity.

If there’s anything the public can perceive from the actions of the ministers so far, it’s how out of touch they appear to be with common folks – both in the matter of principle and the need for accountability – from atop their massive ivory towers on Ridout Road.

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