1 00:00:00,150 --> 00:00:02,490 Speaker 1: You're listening to AC N A podcast. 2 00:00:03,609 --> 00:00:06,119 Speaker 1: Hello, everybody and a warm welcome back to the Heart 3 00:00:06,130 --> 00:00:08,299 Speaker 1: of the Matter. It is me or Telly Edwards. I'm 4 00:00:08,310 --> 00:00:10,739 Speaker 1: standing in for Steven Chia and that he will be 5 00:00:10,750 --> 00:00:13,529 Speaker 1: back next week. Now. You may have read or seen 6 00:00:13,539 --> 00:00:17,439 Speaker 1: videos of people complaining about waiting hours for a hospital 7 00:00:17,450 --> 00:00:21,510 Speaker 1: bed and some of you may even have experienced this yourself. 8 00:00:21,620 --> 00:00:22,350 Speaker 1: It's not ideal, 9 00:00:22,440 --> 00:00:25,860 Speaker 1: especially not when you're feeling ill. But over the years, 10 00:00:25,870 --> 00:00:29,340 Speaker 1: this has become more of a reality for many who 11 00:00:29,350 --> 00:00:32,439 Speaker 1: show up at the hospital. So today we want to 12 00:00:32,450 --> 00:00:37,259 Speaker 1: dive a bit deeper into the bed crunch situation in Singapore. 13 00:00:37,270 --> 00:00:40,779 Speaker 1: So what's causing this? Why now? And what is being 14 00:00:40,790 --> 00:00:44,259 Speaker 1: done and joining me online for this discussion, 15 00:00:44,700 --> 00:00:48,598 Speaker 1: Dr Jeremy Lim Public Health Specialist and CEO of the 16 00:00:48,610 --> 00:00:53,000 Speaker 1: Asian Microbiome Library. We have Professor David Macha from Duke 17 00:00:53,009 --> 00:00:57,180 Speaker 1: Nus Medical School and Mr Jeremy Lee, the assistant co 18 00:00:57,189 --> 00:01:01,439 Speaker 1: o overseeing central operations at the National University Hospital. And 19 00:01:01,450 --> 00:01:04,599 Speaker 1: Mr Lee also spearheaded the bed management system there 20 00:01:05,360 --> 00:01:08,819 Speaker 1: just to share some steps with you and our viewers 21 00:01:08,830 --> 00:01:13,809 Speaker 1: between January to September last year 2023 the media waiting 22 00:01:13,819 --> 00:01:18,089 Speaker 1: time for a bed in public hospitals was about 7.5 hours. 23 00:01:18,099 --> 00:01:20,559 Speaker 1: But some people are saying it's even longer, they can 24 00:01:20,569 --> 00:01:22,809 Speaker 1: wait up to two days. So what we did was 25 00:01:22,819 --> 00:01:25,470 Speaker 1: our team ran a poll on CN A's Instagram account, 26 00:01:25,790 --> 00:01:29,169 Speaker 1: basically asking for people's experience waiting for a bed at 27 00:01:29,180 --> 00:01:32,440 Speaker 1: a Singapore public hospital. And we had more than 800 28 00:01:32,449 --> 00:01:35,250 Speaker 1: people who answered. And one third of them said that 29 00:01:35,260 --> 00:01:38,768 Speaker 1: they waited for more than 10 hours and one reader 30 00:01:38,779 --> 00:01:41,059 Speaker 1: said that she was admitted for heart problem and had 31 00:01:41,069 --> 00:01:44,139 Speaker 1: to wait over 10 hours in the A&E corridor. And 32 00:01:44,150 --> 00:01:46,129 Speaker 1: I'm sure these are complaints that you're 33 00:01:46,220 --> 00:01:49,800 Speaker 1: not unfamiliar with. But based on these accounts, the situation 34 00:01:49,809 --> 00:01:52,959 Speaker 1: sounds pretty bad. Perhaps a professor or doctor Lim, you 35 00:01:52,970 --> 00:01:55,360 Speaker 1: would like to jump in and share with us your thoughts. 36 00:01:56,089 --> 00:01:59,720 Speaker 1: Please go ahead. Well, thank you for putting me in 37 00:01:59,730 --> 00:02:02,379 Speaker 1: that position. Yeah, I think that, uh, waiting for a 38 00:02:02,389 --> 00:02:04,809 Speaker 1: long time for a hospital bed is a really uncomfortable, 39 00:02:04,819 --> 00:02:06,500 Speaker 1: unpleasant situation to be in. 40 00:02:06,839 --> 00:02:09,860 Speaker 1: And I've, I've been in that situation myself waiting in 41 00:02:10,029 --> 00:02:13,850 Speaker 1: emergency rooms. Uh, even as a patient, certainly as a 42 00:02:13,860 --> 00:02:18,538 Speaker 1: physician watching, waiting for bed control to get a bed 43 00:02:18,550 --> 00:02:20,710 Speaker 1: for a patient who needs to be in the hospital. 44 00:02:20,940 --> 00:02:23,660 Speaker 1: And then sometimes trying to manipulate things by trying to 45 00:02:23,669 --> 00:02:27,100 Speaker 1: swap beds with other units and, you know, maybe admitting 46 00:02:27,110 --> 00:02:31,360 Speaker 1: them inappropriately to a higher intensity bed service. So it's 47 00:02:31,369 --> 00:02:34,339 Speaker 1: a bad situation. The question of what to do about 48 00:02:34,350 --> 00:02:35,978 Speaker 1: it is a bit more complicated. 49 00:02:36,199 --> 00:02:38,750 Speaker 1: And I think maybe that's what we'll get into as 50 00:02:38,758 --> 00:02:41,339 Speaker 1: we have this conversation. But I think to a large extent, 51 00:02:41,350 --> 00:02:44,220 Speaker 1: we have probably enough beds, maybe we do need a 52 00:02:44,229 --> 00:02:46,580 Speaker 1: few more here and there. Uh But I think it's 53 00:02:46,589 --> 00:02:50,769 Speaker 1: really how beds are used. It's the balance between inpatient 54 00:02:50,779 --> 00:02:53,830 Speaker 1: and outpatient services that I think is the key issue here. 55 00:02:54,029 --> 00:02:57,479 Speaker 1: So when it comes to dealing with inpatient incoming patients, 56 00:02:57,490 --> 00:02:59,649 Speaker 1: that is something that you cannot predict we have a 57 00:02:59,660 --> 00:03:00,160 Speaker 1: fixed 58 00:03:00,490 --> 00:03:03,309 Speaker 1: a number of beds. So how are we going to 59 00:03:03,320 --> 00:03:06,270 Speaker 1: resolve it or how do you decide who gets what 60 00:03:06,600 --> 00:03:10,880 Speaker 1: on an aggregate, the number of admissions, the number of 61 00:03:10,889 --> 00:03:13,549 Speaker 1: attendances in the emergency departments, 62 00:03:13,860 --> 00:03:18,740 Speaker 1: they are actually reasonably predictable. I mean, these things ebb 63 00:03:18,750 --> 00:03:22,960 Speaker 1: and flow with a certain consistency and therefore we can 64 00:03:22,970 --> 00:03:27,910 Speaker 1: plan for these surges. And it's almost akin to knowing 65 00:03:27,919 --> 00:03:31,759 Speaker 1: that hotel rooms during the f one season, it will 66 00:03:31,770 --> 00:03:34,399 Speaker 1: be higher price supply will be much more constrained. 67 00:03:34,660 --> 00:03:38,020 Speaker 1: So while it's true that there's a certain dynamism, many 68 00:03:38,029 --> 00:03:42,259 Speaker 1: of the uh much of the background variability is actually 69 00:03:42,270 --> 00:03:46,160 Speaker 1: predictable and it can be planned for, right? And what 70 00:03:46,169 --> 00:03:49,220 Speaker 1: the system then needs to figure out better is how 71 00:03:49,229 --> 00:03:51,520 Speaker 1: then do we ensure the flow 72 00:03:51,850 --> 00:03:55,580 Speaker 1: and I will take flow at really three different levels. 73 00:03:55,589 --> 00:04:00,440 Speaker 1: One is flow into the hospital and here clearly there 74 00:04:00,449 --> 00:04:04,330 Speaker 1: are still cases that don't actually need to be hospitalized 75 00:04:04,339 --> 00:04:08,110 Speaker 1: but due to social circumstances or, or the lack of 76 00:04:08,119 --> 00:04:11,699 Speaker 1: confidence on the part of the home situation. Therefore, patients 77 00:04:11,729 --> 00:04:15,070 Speaker 1: prefer to be admitted. The second flow is the flow 78 00:04:15,080 --> 00:04:18,230 Speaker 1: within the hospital. And how do we keep the 79 00:04:18,980 --> 00:04:21,959 Speaker 1: length of stay as short as is possible? And here, 80 00:04:21,970 --> 00:04:24,859 Speaker 1: I think the hospitals in the public system have done 81 00:04:24,869 --> 00:04:28,279 Speaker 1: a really good job in really compressing this. And then 82 00:04:28,290 --> 00:04:31,799 Speaker 1: the third piece is once the patients are medically fit 83 00:04:31,809 --> 00:04:35,089 Speaker 1: to be discharged, how then do we flow them out 84 00:04:35,100 --> 00:04:38,500 Speaker 1: into the community? And this is an area that I 85 00:04:38,510 --> 00:04:41,760 Speaker 1: think David Jeremy, I would personally argue that the Singapore 86 00:04:41,769 --> 00:04:44,540 Speaker 1: Health health care system needs to do much more work 87 00:04:44,549 --> 00:04:46,440 Speaker 1: in making sure that when patients 88 00:04:46,630 --> 00:04:50,238 Speaker 1: go out of the hospital, that they flow into safe hands, 89 00:04:50,250 --> 00:04:53,920 Speaker 1: whether it's in a rehabilitation facility, whether it is in 90 00:04:53,928 --> 00:04:57,690 Speaker 1: the home setting. And there are multiple initiatives that we 91 00:04:57,700 --> 00:05:01,049 Speaker 1: can talk about that seek to ameliorate this doctor Li, 92 00:05:01,059 --> 00:05:03,260 Speaker 1: you said that they've done a pretty good job. But 93 00:05:03,269 --> 00:05:05,880 Speaker 1: the benchmark in the UK and us, for instance, the 94 00:05:05,890 --> 00:05:08,549 Speaker 1: waiting time is four hours, Jeremy. I just want to 95 00:05:08,559 --> 00:05:09,769 Speaker 1: bring you in here because you 96 00:05:10,279 --> 00:05:12,829 Speaker 1: are normally in the thick of things, you are on 97 00:05:12,839 --> 00:05:15,149 Speaker 1: the ground, on the floor, you know, dealing with all 98 00:05:15,160 --> 00:05:18,109 Speaker 1: of this. So this bed crunch problem is the problem 99 00:05:18,119 --> 00:05:21,420 Speaker 1: that we've had. I mean, even before COVID, so help 100 00:05:21,428 --> 00:05:25,429 Speaker 1: us understand that. Why is this overcrowding issue? It's sticky. 101 00:05:25,440 --> 00:05:28,428 Speaker 1: It's stubborn. It's not going away. Why haven't things improved? 102 00:05:28,440 --> 00:05:32,089 Speaker 1: I think this problem of be crunch started almost about 103 00:05:32,100 --> 00:05:35,510 Speaker 1: 10 years ago. I still remember about during that time 104 00:05:35,519 --> 00:05:38,399 Speaker 1: I was managing the emergency department as well of the 105 00:05:38,410 --> 00:05:39,600 Speaker 1: executives there. 106 00:05:40,170 --> 00:05:42,609 Speaker 1: And I can remember every morning I turn up in 107 00:05:42,619 --> 00:05:45,329 Speaker 1: the department, I see about 70 to 80 patients waiting 108 00:05:45,339 --> 00:05:45,940 Speaker 1: for bids, 109 00:05:46,720 --> 00:05:50,010 Speaker 1: but as the government starts to build more hospitals, so 110 00:05:50,220 --> 00:05:53,760 Speaker 1: from comes on stream KTP, comes on stream, then we 111 00:05:53,769 --> 00:05:57,200 Speaker 1: managed to see some relief in the system. But like 112 00:05:57,209 --> 00:06:00,480 Speaker 1: what my colleagues have mentioned over here with the increasing 113 00:06:00,488 --> 00:06:05,130 Speaker 1: aging population as well as patients having more comorbidities, they 114 00:06:05,140 --> 00:06:07,738 Speaker 1: are actually staying longer in the hospital as a result 115 00:06:07,750 --> 00:06:09,428 Speaker 1: of that with longer length of stay 116 00:06:10,000 --> 00:06:15,209 Speaker 1: aging population as well as the social issues or challenges 117 00:06:15,220 --> 00:06:18,350 Speaker 1: that we face out in the community. For example, lack 118 00:06:18,359 --> 00:06:22,529 Speaker 1: of caregiver options, social support patients do stay a little 119 00:06:22,540 --> 00:06:24,989 Speaker 1: bit longer in the hospital. So these are just some 120 00:06:25,000 --> 00:06:28,570 Speaker 1: of the factors that's causing the big crunch. And I 121 00:06:28,579 --> 00:06:31,750 Speaker 1: believe that the government is doing a lot to work 122 00:06:31,760 --> 00:06:36,010 Speaker 1: on this and with woodlands coming on stream and hopefully 123 00:06:36,500 --> 00:06:38,678 Speaker 1: Alexandra Hospital as well as the redevelopment of N 124 00:06:39,570 --> 00:06:42,040 Speaker 1: we will be able to write this through at least 125 00:06:42,049 --> 00:06:45,760 Speaker 1: for the near term. We've been doing some interviews and 126 00:06:45,769 --> 00:06:48,950 Speaker 1: our producers actually spoke to Eunice. She wants to share 127 00:06:48,959 --> 00:06:52,690 Speaker 1: her experience. And let's listen in on the two recent occasions, 128 00:06:52,700 --> 00:06:55,250 Speaker 1: my mom had to be warded that was in May. 129 00:06:55,260 --> 00:06:59,029 Speaker 1: And in August 2023 we waited at least two full 130 00:06:59,040 --> 00:07:01,589 Speaker 1: days before she was sent to a hospital ward. 131 00:07:02,019 --> 00:07:04,489 Speaker 1: In the interim, she was placed at the short stay 132 00:07:04,500 --> 00:07:08,160 Speaker 1: unit where only one visitor is allowed. When the doctor 133 00:07:08,170 --> 00:07:10,679 Speaker 1: told me that my mom needs to be admitted. I 134 00:07:10,690 --> 00:07:13,679 Speaker 1: somehow knew that there would be a wait for hospital bed. 135 00:07:13,989 --> 00:07:15,929 Speaker 1: So I didn't make a fuss about how long my 136 00:07:15,940 --> 00:07:18,399 Speaker 1: mom had to wait to be warded. She was taken 137 00:07:18,410 --> 00:07:21,200 Speaker 1: care of at the short stay unit. So you've heard 138 00:07:21,209 --> 00:07:24,239 Speaker 1: the Unice sound by basically, they had to wait for 139 00:07:24,250 --> 00:07:26,459 Speaker 1: two full days. I just want to direct my next 140 00:07:26,470 --> 00:07:28,519 Speaker 1: question to doctor Li and Doctor Mara 141 00:07:28,890 --> 00:07:31,790 Speaker 1: bearing in mind that aging population. That's one. But that's 142 00:07:31,799 --> 00:07:34,239 Speaker 1: something that we've known for a time now. And already 143 00:07:34,250 --> 00:07:36,730 Speaker 1: in 2014, the issue of a bed crunch that was 144 00:07:36,739 --> 00:07:40,980 Speaker 1: discussed in parliament. So with Unice experience does kind of 145 00:07:40,989 --> 00:07:43,549 Speaker 1: show that interim measures are quite important. Um But do 146 00:07:43,559 --> 00:07:46,410 Speaker 1: you think that we have enough of this? I assume 147 00:07:46,420 --> 00:07:48,420 Speaker 1: that you're asking about, do we have enough beds? And 148 00:07:48,429 --> 00:07:48,790 Speaker 1: I think 149 00:07:49,049 --> 00:07:51,369 Speaker 1: the answer to that is as far as I can 150 00:07:51,380 --> 00:07:53,970 Speaker 1: tell is that the number of beds you actually need 151 00:07:53,980 --> 00:07:56,679 Speaker 1: are quite malleable. It's, you know, you, if you look 152 00:07:56,690 --> 00:07:59,559 Speaker 1: around the world, the number of beds per capita is 153 00:07:59,570 --> 00:08:03,079 Speaker 1: twice as many say in Japan or twice as many 154 00:08:03,089 --> 00:08:05,140 Speaker 1: as say in the US or a little bit above 155 00:08:05,149 --> 00:08:07,739 Speaker 1: the US or around the same as the US, you know, 156 00:08:07,750 --> 00:08:10,040 Speaker 1: a little bit higher than some other countries. But you 157 00:08:10,049 --> 00:08:13,989 Speaker 1: can have an adequate hospital system and have a fairly 158 00:08:14,000 --> 00:08:16,109 Speaker 1: uh variable number of beds. 159 00:08:16,390 --> 00:08:18,549 Speaker 1: The issue is how do you use those beds and 160 00:08:18,559 --> 00:08:20,450 Speaker 1: how do you bring people in and out of the beds? 161 00:08:20,459 --> 00:08:24,209 Speaker 1: And this really gets into what Jeremy Lin was saying earlier, 162 00:08:24,220 --> 00:08:24,880 Speaker 1: which is that, 163 00:08:25,119 --> 00:08:27,660 Speaker 1: you know, it's about that flow and what's driving that 164 00:08:27,670 --> 00:08:31,920 Speaker 1: flow clearly, you know, we can't diminish the importance of 165 00:08:31,929 --> 00:08:36,098 Speaker 1: the aging population. When you look over time, the likelihood 166 00:08:36,109 --> 00:08:38,460 Speaker 1: of an older person being admitted to the hospital is 167 00:08:38,469 --> 00:08:42,130 Speaker 1: dramatically higher than a younger person and that rate has 168 00:08:42,140 --> 00:08:46,450 Speaker 1: actually been increasing more than for younger people. Now, what 169 00:08:46,460 --> 00:08:48,718 Speaker 1: does that suggest to me? Well, what suggests to me 170 00:08:48,729 --> 00:08:49,419 Speaker 1: is yes, 171 00:08:49,590 --> 00:08:51,849 Speaker 1: but as our population ages, we're going to need more 172 00:08:51,859 --> 00:08:55,799 Speaker 1: hospital beds per capita. But also that somehow as the 173 00:08:55,809 --> 00:08:59,250 Speaker 1: population is aging, we're not doing as good a job 174 00:08:59,260 --> 00:09:02,729 Speaker 1: taking care of those people outside the hospital as we 175 00:09:02,739 --> 00:09:06,010 Speaker 1: might be able to. And the problem is visited on 176 00:09:06,020 --> 00:09:08,969 Speaker 1: the hospital. I mean, so the hospital is where the 177 00:09:08,979 --> 00:09:12,890 Speaker 1: pain point appears. We're here talking about waiting times for 178 00:09:12,900 --> 00:09:13,960 Speaker 1: hospital beds 179 00:09:14,210 --> 00:09:17,479 Speaker 1: because of a whole series of other things that are 180 00:09:17,489 --> 00:09:20,390 Speaker 1: not happening and why is that? Why, why are we 181 00:09:20,400 --> 00:09:23,760 Speaker 1: falling short in that area, for example? And I'm just 182 00:09:23,770 --> 00:09:27,309 Speaker 1: talking in my experience as a doctor, as a clinician, 183 00:09:27,320 --> 00:09:29,729 Speaker 1: you talk about who's going to get admitted? Why are 184 00:09:29,739 --> 00:09:32,500 Speaker 1: they going to get admitted under some circumstances? When the 185 00:09:32,510 --> 00:09:35,309 Speaker 1: hospital beds are available? You'd say, well, why not admit? 186 00:09:35,549 --> 00:09:38,260 Speaker 1: And when the hospital beds were very full, you'd say, well, 187 00:09:38,270 --> 00:09:41,539 Speaker 1: oh my goodness. Why admit when I was a trainee, 188 00:09:41,609 --> 00:09:44,280 Speaker 1: we used to call the admitting officer who was letting 189 00:09:44,289 --> 00:09:46,630 Speaker 1: everybody into the hospital, we'd call him a sieve and 190 00:09:46,640 --> 00:09:50,299 Speaker 1: we'd call the person who kept everybody out a rock. 191 00:09:50,309 --> 00:09:53,440 Speaker 1: So it was a well understood phenomenon that the number 192 00:09:53,450 --> 00:09:55,460 Speaker 1: of people who came into the hospital, the rate at 193 00:09:55,469 --> 00:09:58,489 Speaker 1: which they came into the hospital was quite variable and 194 00:09:58,500 --> 00:10:01,369 Speaker 1: it depended on the threshold for admitting. 195 00:10:01,729 --> 00:10:04,229 Speaker 1: Now, one of the things that makes it easy or 196 00:10:04,239 --> 00:10:08,689 Speaker 1: easier for you to not admit someone to the hospital 197 00:10:08,700 --> 00:10:12,549 Speaker 1: is if you feel comfortable as the physician or who's 198 00:10:12,559 --> 00:10:15,429 Speaker 1: seeing the patient in the emergency room, if you're comfortable 199 00:10:15,440 --> 00:10:18,419 Speaker 1: that they're going to be taken care of perfectly well, 200 00:10:18,429 --> 00:10:21,710 Speaker 1: when they see their primary care doctor on the next day, 201 00:10:22,010 --> 00:10:24,140 Speaker 1: and you can say, look, you know, your sugar is 202 00:10:24,150 --> 00:10:26,590 Speaker 1: a little bit high or a little bit low or whatever, 203 00:10:26,599 --> 00:10:28,750 Speaker 1: instead of having to admit to the hospital, which is 204 00:10:28,859 --> 00:10:33,140 Speaker 1: actually a surprisingly common phenomena in Singapore. You say you 205 00:10:33,150 --> 00:10:35,859 Speaker 1: get their sugar under control and then send them out. 206 00:10:36,010 --> 00:10:39,150 Speaker 1: That's a decision that can be made only if you 207 00:10:39,159 --> 00:10:42,000 Speaker 1: have a level of comfort that that person is going 208 00:10:42,010 --> 00:10:44,260 Speaker 1: to be taken care of. Otherwise you bring them into 209 00:10:44,270 --> 00:10:47,179 Speaker 1: the hospital because what's a hospital for, it's to watch 210 00:10:47,190 --> 00:10:48,580 Speaker 1: people really closely 211 00:10:48,869 --> 00:10:51,469 Speaker 1: so that if they start to look bad, then you're 212 00:10:51,479 --> 00:10:53,770 Speaker 1: right there so that you can take care of them. 213 00:10:53,890 --> 00:10:55,590 Speaker 1: But if you don't feel comfortable that that's going to 214 00:10:55,599 --> 00:11:00,189 Speaker 1: happen on the outpatients side, then you feel obligated to admit. 215 00:11:00,400 --> 00:11:03,690 Speaker 1: So you become a sieve, you were talking about threshold 216 00:11:03,700 --> 00:11:06,858 Speaker 1: earlier and the recommended threshold for a bed occupancy rate 217 00:11:06,869 --> 00:11:09,409 Speaker 1: at public hospitals is around 85%. 218 00:11:09,659 --> 00:11:12,590 Speaker 1: But over the Christmas period just last year, some hospitals 219 00:11:12,599 --> 00:11:16,729 Speaker 1: even hit 99%. So there is a sense that, you know, 220 00:11:16,739 --> 00:11:18,369 Speaker 1: things can turn. I mean, especially if you're in a 221 00:11:18,380 --> 00:11:21,020 Speaker 1: COVID wave to both the Jeremy. I mean, is this 222 00:11:21,330 --> 00:11:24,539 Speaker 1: situation unique to Singapore. And I guess what is the 223 00:11:24,549 --> 00:11:27,739 Speaker 1: worst case scenario? I mean, are we prepared for that? Well, 224 00:11:27,750 --> 00:11:30,539 Speaker 1: maybe I'll tell you the right way to think about 225 00:11:30,549 --> 00:11:34,599 Speaker 1: this is, is patient care adversely affected, 226 00:11:35,140 --> 00:11:37,960 Speaker 1: right. And I think if we think back to the 227 00:11:37,969 --> 00:11:41,489 Speaker 1: first COVID waves in 2020 Singapore has been very, very 228 00:11:41,500 --> 00:11:45,669 Speaker 1: fortunate that our health system was not significantly overwhelmed to 229 00:11:45,679 --> 00:11:48,299 Speaker 1: the extent that we had patients dying out in the 230 00:11:48,309 --> 00:11:51,468 Speaker 1: streets because they didn't have beds as what we saw 231 00:11:51,479 --> 00:11:54,968 Speaker 1: happening in some other countries. So I do think Singapore 232 00:11:54,979 --> 00:11:56,580 Speaker 1: dodged the bullet there 233 00:11:56,929 --> 00:11:59,929 Speaker 1: and to your question, um I, I want to go 234 00:11:59,940 --> 00:12:04,309 Speaker 1: back to David's point around practice behavior between the rock 235 00:12:04,320 --> 00:12:07,840 Speaker 1: and the sea and clearly clinicians decision making has a 236 00:12:07,849 --> 00:12:10,869 Speaker 1: lot to bear on this. But there are two other 237 00:12:10,880 --> 00:12:14,130 Speaker 1: factors that I want to highlight. One is the patient 238 00:12:14,140 --> 00:12:17,598 Speaker 1: and the family and their confidence in in being looked 239 00:12:17,609 --> 00:12:21,960 Speaker 1: after outside the hospital. And that's partly the doctor's confidence 240 00:12:21,969 --> 00:12:24,349 Speaker 1: and also the patient and the family's confidence. 241 00:12:24,640 --> 00:12:28,750 Speaker 1: And the third factor is really the financial gradient. If 242 00:12:28,760 --> 00:12:31,900 Speaker 1: we think about it, the hospital is safe 243 00:12:32,239 --> 00:12:34,020 Speaker 1: as what David says, that's the whole point of the 244 00:12:34,030 --> 00:12:38,320 Speaker 1: hospital is to very closely monitor patients. And if insurance 245 00:12:38,330 --> 00:12:42,530 Speaker 1: fully funds the hospital and I as the caregiver can 246 00:12:42,539 --> 00:12:44,820 Speaker 1: go to work the next day, I don't need to 247 00:12:44,830 --> 00:12:48,619 Speaker 1: worry about caregiving about food and everything and it's not 248 00:12:48,630 --> 00:12:52,229 Speaker 1: going to cost me anything then really why not? We 249 00:12:52,239 --> 00:12:56,699 Speaker 1: do need to change provider behavior, we need to change 250 00:12:56,849 --> 00:12:57,840 Speaker 1: the patient and the 251 00:12:57,992 --> 00:13:02,453 Speaker 1: family expectations, the financial gradients need to shift and we 252 00:13:02,463 --> 00:13:05,532 Speaker 1: really have to turbocharge what we do outside in the 253 00:13:05,543 --> 00:13:09,643 Speaker 1: community so that both providers, the doctors, the nurses, as 254 00:13:09,653 --> 00:13:12,703 Speaker 1: well as the patients and their families, feel very reassured 255 00:13:12,713 --> 00:13:15,532 Speaker 1: and feel very confident that they don't need to be 256 00:13:15,543 --> 00:13:17,811 Speaker 1: in the hospital and they will still be well taken 257 00:13:17,822 --> 00:13:20,442 Speaker 1: care of Jeremy Lee perhaps. So you can just jump 258 00:13:20,453 --> 00:13:22,562 Speaker 1: in here, your experience, you know, talking to some of 259 00:13:22,572 --> 00:13:23,653 Speaker 1: these patients, 260 00:13:23,745 --> 00:13:26,385 Speaker 1: there are also a lot of elderly people who live 261 00:13:26,395 --> 00:13:29,286 Speaker 1: by themselves or, you know, whether they have family, they 262 00:13:29,296 --> 00:13:31,295 Speaker 1: don't have that immediate care. And obviously there is an 263 00:13:31,306 --> 00:13:34,135 Speaker 1: insecurity of like, if I'm by myself, my kids are 264 00:13:34,145 --> 00:13:37,495 Speaker 1: at work. There's nobody overseeing the situation that mindset shift 265 00:13:37,505 --> 00:13:40,866 Speaker 1: is quite difficult, isn't it? Exactly. So we do have, 266 00:13:40,875 --> 00:13:43,645 Speaker 1: I would say a handful of patients that are actually 267 00:13:43,905 --> 00:13:47,245 Speaker 1: still in the hospital because of the lack of social 268 00:13:47,255 --> 00:13:49,395 Speaker 1: support or family support back home. 269 00:13:49,700 --> 00:13:52,809 Speaker 1: And like what Dr Jeremy mentioned earlier is also about 270 00:13:52,820 --> 00:13:54,940 Speaker 1: the financial gradient. So for example, if they were to 271 00:13:54,950 --> 00:13:57,919 Speaker 1: be moved to a step down facilities, maybe their out 272 00:13:57,929 --> 00:14:00,679 Speaker 1: of pocket will have to be higher. So there in 273 00:14:00,690 --> 00:14:03,859 Speaker 1: lies the problem, there's no real incentives for people to 274 00:14:03,869 --> 00:14:08,070 Speaker 1: actually move out of the hospital in such circumstances. 275 00:14:08,580 --> 00:14:10,559 Speaker 1: I believe that a lot of these things can be 276 00:14:10,570 --> 00:14:15,239 Speaker 1: better managed if there are enough social support back home, 277 00:14:15,250 --> 00:14:19,239 Speaker 1: caregiver support as well as the level of confidence of 278 00:14:19,250 --> 00:14:22,299 Speaker 1: the caregivers. Like what Doctor Jeremy mentioned and with all 279 00:14:22,309 --> 00:14:25,159 Speaker 1: this in place, then I think that the patients will 280 00:14:25,169 --> 00:14:29,200 Speaker 1: be more comfortable to be discharged and the patients families 281 00:14:29,210 --> 00:14:32,059 Speaker 1: will be more receptive of them coming back home if 282 00:14:32,070 --> 00:14:34,200 Speaker 1: there's a sufficient support back home. 283 00:14:34,460 --> 00:14:37,539 Speaker 1: So I think these are areas whereby the government have 284 00:14:37,549 --> 00:14:39,520 Speaker 1: to do maybe a little bit more to see how 285 00:14:39,530 --> 00:14:42,789 Speaker 1: we can help such families with more support at home. 286 00:14:42,799 --> 00:14:46,190 Speaker 1: Have there been any sort of suggestions being put up 287 00:14:46,200 --> 00:14:50,059 Speaker 1: to get around this issue? Firstly, the National University Hospital 288 00:14:50,070 --> 00:14:53,080 Speaker 1: is doing really good work with the M I or 289 00:14:53,090 --> 00:14:57,090 Speaker 1: the hospital at home to predict colloquially, there are start 290 00:14:57,099 --> 00:14:59,080 Speaker 1: up companies like Speed Dog and 291 00:14:59,179 --> 00:15:03,340 Speaker 1: so on that, I'm essentially augmenting the home ecosystem that 292 00:15:03,349 --> 00:15:07,419 Speaker 1: allows patients to have that confidence. And of course, if 293 00:15:07,429 --> 00:15:10,460 Speaker 1: the patient is cared for in the home setting, then 294 00:15:10,469 --> 00:15:12,830 Speaker 1: they are not in the hospital bed and this really 295 00:15:12,840 --> 00:15:16,549 Speaker 1: helps to drive the flow. I do think that we 296 00:15:16,559 --> 00:15:22,229 Speaker 1: are not utilizing enough technology for remote monitoring to really 297 00:15:22,239 --> 00:15:23,799 Speaker 1: provide that lifeline 298 00:15:24,070 --> 00:15:28,500 Speaker 1: because patients and their families don't just want to know 299 00:15:28,510 --> 00:15:30,679 Speaker 1: that they will be OK at home. They want to 300 00:15:30,690 --> 00:15:34,200 Speaker 1: know that if anything happens, they can be responded to 301 00:15:34,210 --> 00:15:37,469 Speaker 1: very quickly and there is a very proactive way of 302 00:15:37,479 --> 00:15:41,210 Speaker 1: looking at it. So if we toggle the manpower situation 303 00:15:41,219 --> 00:15:44,840 Speaker 1: and augment our home care with home nursing, with home 304 00:15:44,849 --> 00:15:46,349 Speaker 1: physicians as well as use tax, 305 00:15:47,255 --> 00:15:50,166 Speaker 1: I do think we can improve the flow from the 306 00:15:50,176 --> 00:15:53,776 Speaker 1: hospital into the community better. But doctor li, what sort 307 00:15:53,786 --> 00:15:56,806 Speaker 1: of timeline are we looking at? Because we are not there. 308 00:15:56,815 --> 00:15:58,755 Speaker 1: I mean, in the sense that we have telemedicine, we're 309 00:15:58,765 --> 00:16:01,385 Speaker 1: trying to expand that. So I'm trying to find out, 310 00:16:01,395 --> 00:16:03,755 Speaker 1: you know, Singapore also is supposed to be the smart nation. Right. 311 00:16:03,765 --> 00:16:06,596 Speaker 1: How far are we from that? I think that you 312 00:16:06,606 --> 00:16:08,765 Speaker 1: are spot on that the individual pieces 313 00:16:08,872 --> 00:16:13,052 Speaker 1: do exist. We have home care providers. We have the technology, 314 00:16:13,211 --> 00:16:17,711 Speaker 1: what's not working out as well as probably should would 315 00:16:17,721 --> 00:16:20,791 Speaker 1: be the education of the patients as well as the providers. 316 00:16:20,802 --> 00:16:23,572 Speaker 1: And as what both Jeremy Lee and myself had mentioned 317 00:16:23,581 --> 00:16:27,081 Speaker 1: the financial gradient. In fact, last year, I think Steve 318 00:16:27,091 --> 00:16:29,632 Speaker 1: and I had a chat about whether we should actually 319 00:16:29,642 --> 00:16:31,171 Speaker 1: pay patients to go home, 320 00:16:31,429 --> 00:16:35,099 Speaker 1: right. So that their families can use the money to 321 00:16:35,109 --> 00:16:39,119 Speaker 1: pay for meals to really pay for transport services and 322 00:16:39,130 --> 00:16:42,159 Speaker 1: all of these, right? And I do think that we 323 00:16:42,169 --> 00:16:44,630 Speaker 1: can do more. And the good thing is that because 324 00:16:44,640 --> 00:16:49,559 Speaker 1: the individual ingredients are in place once the right chef 325 00:16:49,570 --> 00:16:52,280 Speaker 1: with the right recipe comes along, I think we can 326 00:16:52,289 --> 00:16:55,520 Speaker 1: get started relatively quickly. So I wanna expand on this 327 00:16:55,530 --> 00:16:58,119 Speaker 1: just a little bit because I think you're asking how 328 00:16:58,130 --> 00:16:59,830 Speaker 1: quickly can this all happen? 329 00:17:00,390 --> 00:17:03,200 Speaker 1: Certainly, some of what is required is going to be 330 00:17:03,210 --> 00:17:07,449 Speaker 1: some technological changes, improving the electronic record system so that 331 00:17:07,459 --> 00:17:11,188 Speaker 1: people can share records from inpatient to outpatient side more readily. 332 00:17:11,670 --> 00:17:14,709 Speaker 1: But I think that the issue of transitional care going 333 00:17:14,719 --> 00:17:17,849 Speaker 1: from hospital to home is not a trivial problem. 334 00:17:18,069 --> 00:17:19,869 Speaker 1: I mean, we talk about it as though, well, if 335 00:17:19,880 --> 00:17:21,770 Speaker 1: we just sort of set up a hospital in your 336 00:17:21,780 --> 00:17:24,399 Speaker 1: house or something equivalent then you don't have to be 337 00:17:24,410 --> 00:17:27,170 Speaker 1: in the hospital. But the truth is, it's a complex 338 00:17:27,180 --> 00:17:31,089 Speaker 1: transition because a lot of information has to go from 339 00:17:31,099 --> 00:17:34,209 Speaker 1: the hospital to the people who are accountable in the 340 00:17:34,219 --> 00:17:37,209 Speaker 1: hospital for care to the people who are going to 341 00:17:37,219 --> 00:17:39,969 Speaker 1: be taking care of that person at home. And then 342 00:17:39,979 --> 00:17:42,419 Speaker 1: it actually gets to be more complicated because the people 343 00:17:42,430 --> 00:17:44,448 Speaker 1: who might be involved in care at home 344 00:17:44,750 --> 00:17:49,709 Speaker 1: could be in different locations and be under different administrative entities. 345 00:17:49,900 --> 00:17:54,060 Speaker 1: The creation of transitional care plans that really can serve 346 00:17:54,069 --> 00:17:56,810 Speaker 1: the purpose of, you know, getting someone out of the hospital. 347 00:17:56,819 --> 00:17:59,489 Speaker 1: So they don't have to be in there unnecessarily, don't 348 00:17:59,500 --> 00:18:03,089 Speaker 1: have to be subject to the unpleasantness of hospitals. But 349 00:18:03,099 --> 00:18:06,339 Speaker 1: to make that happen, you've got to have some plan 350 00:18:06,349 --> 00:18:09,219 Speaker 1: a program in place. Now there are several efforts on 351 00:18:09,239 --> 00:18:11,770 Speaker 1: pers I'm aware of and that we're working with various 352 00:18:12,020 --> 00:18:15,810 Speaker 1: the regional clusters that are involved in developing transition or 353 00:18:15,819 --> 00:18:20,239 Speaker 1: have developed transitional care programs and are indeed discovering how 354 00:18:20,250 --> 00:18:24,079 Speaker 1: difficult it is. And one of it is manpower issues getting, 355 00:18:24,089 --> 00:18:27,679 Speaker 1: making sure that the people who see the patient at home, 356 00:18:27,689 --> 00:18:28,959 Speaker 1: see them very quickly, 357 00:18:29,310 --> 00:18:33,589 Speaker 1: that they really understand what functionally you're trying to accomplish 358 00:18:33,599 --> 00:18:37,239 Speaker 1: in the outpatient side. So saying, I want a home 359 00:18:37,250 --> 00:18:39,448 Speaker 1: nurse is not enough. I know I'm kind of making 360 00:18:39,459 --> 00:18:40,930 Speaker 1: a big deal out of this, but this is I 361 00:18:40,939 --> 00:18:43,530 Speaker 1: think where a lot of the action is is that 362 00:18:43,800 --> 00:18:48,290 Speaker 1: having an accountable entity that understands how to create that 363 00:18:48,300 --> 00:18:49,050 Speaker 1: transition 364 00:18:49,280 --> 00:18:52,199 Speaker 1: and to monitor the transition, to make sure that everything 365 00:18:52,209 --> 00:18:55,550 Speaker 1: that needs to happen happens. That's something that I think 366 00:18:55,560 --> 00:18:57,800 Speaker 1: we have had a lot of difficulty with and, and 367 00:18:57,810 --> 00:18:59,829 Speaker 1: it's not unique to Singapore. By the way, I want 368 00:18:59,839 --> 00:19:02,540 Speaker 1: to get into just why they're spending more days there. 369 00:19:02,550 --> 00:19:04,540 Speaker 1: But before that, let's just listen to 370 00:19:04,939 --> 00:19:07,359 Speaker 1: experience, Edwin had a seizure and he went to tan 371 00:19:07,380 --> 00:19:09,239 Speaker 1: to sing hospital to get checked and he had to 372 00:19:09,250 --> 00:19:12,650 Speaker 1: wait eight hours for a bed. So let's let's listen 373 00:19:12,660 --> 00:19:13,449 Speaker 1: to what he has to say. 374 00:19:13,729 --> 00:19:16,449 Speaker 2: What they told me is that they don't really have 375 00:19:16,459 --> 00:19:19,839 Speaker 2: enough beds and then it is really based on severity. 376 00:19:19,849 --> 00:19:20,209 Speaker 2: And then 377 00:19:20,810 --> 00:19:22,760 Speaker 2: the only way that I can have a bit is 378 00:19:22,770 --> 00:19:25,959 Speaker 2: if someone checks out of the hospital and then that's 379 00:19:25,969 --> 00:19:28,800 Speaker 2: when I can have a place to stay in. So 380 00:19:28,810 --> 00:19:32,020 Speaker 1: you've heard there Edwin sound bite, just give us a sense. 381 00:19:32,030 --> 00:19:36,170 Speaker 1: Jeremy Lee here that whether you know somebody, how long 382 00:19:36,180 --> 00:19:39,510 Speaker 1: they want to stay in a hospital, some patients actually refuse, right? 383 00:19:39,520 --> 00:19:42,929 Speaker 1: Even when the hospital decides it's time to discharge, what 384 00:19:42,939 --> 00:19:46,030 Speaker 1: normally are some of their reasons? And can the hospitals 385 00:19:46,040 --> 00:19:48,708 Speaker 1: force a patient to leave? Maybe before I go into that, 386 00:19:48,719 --> 00:19:50,010 Speaker 1: I just want to address the 387 00:19:50,280 --> 00:19:53,458 Speaker 1: his earlier point about whether or not he can be 388 00:19:53,469 --> 00:19:56,770 Speaker 1: admitted and because of the condition that he's presenting, so 389 00:19:56,780 --> 00:19:58,939 Speaker 1: at least for us in any way, every admission is 390 00:19:58,949 --> 00:20:00,819 Speaker 1: screened by the senior doctor. So we make it a 391 00:20:00,829 --> 00:20:04,899 Speaker 1: point that every admissions, we get screen screen and whoever 392 00:20:04,910 --> 00:20:07,569 Speaker 1: needs admission and care, we will ensure that they have 393 00:20:07,579 --> 00:20:11,319 Speaker 1: the appropriate care in. And secondly, while they are waiting 394 00:20:11,329 --> 00:20:15,179 Speaker 1: for base in any, we actually get our inpatient teams 395 00:20:15,189 --> 00:20:18,540 Speaker 1: to come down to the emergency department to start treatment. 396 00:20:18,949 --> 00:20:20,139 Speaker 1: So actually they are not 397 00:20:20,500 --> 00:20:23,819 Speaker 1: in essence waiting for it. The treatment has already started 398 00:20:24,079 --> 00:20:27,349 Speaker 1: and appropriate care has already been administered while the patients 399 00:20:27,359 --> 00:20:29,800 Speaker 1: are waiting for their beds in the emergency department. 400 00:20:30,199 --> 00:20:32,739 Speaker 1: So this is something that I think is important because 401 00:20:33,069 --> 00:20:36,859 Speaker 1: timeliness of care appropriateness of care will help also shorten 402 00:20:36,869 --> 00:20:39,750 Speaker 1: the length of stay in the hospital. How do we 403 00:20:39,760 --> 00:20:45,099 Speaker 1: avoid having seniors, elderly people basically over staying in a hospital. 404 00:20:45,109 --> 00:20:47,290 Speaker 1: What needs to change? How do other countries deal with 405 00:20:47,300 --> 00:20:50,680 Speaker 1: this problem? We did a study of hospital occupancy and 406 00:20:50,689 --> 00:20:52,500 Speaker 1: its relationship to discharge rate. 407 00:20:52,900 --> 00:20:57,560 Speaker 1: And what we discovered interestingly was that when occupancy is 408 00:20:57,569 --> 00:21:01,810 Speaker 1: very high, well, maybe not surprisingly discharge rate went up. 409 00:21:01,819 --> 00:21:04,708 Speaker 1: So people were more readily discharged from the hospital. So 410 00:21:04,810 --> 00:21:07,979 Speaker 1: something was going on when the hospital got crowded that 411 00:21:07,989 --> 00:21:11,199 Speaker 1: caused patients to be discharged more rapidly. 412 00:21:11,689 --> 00:21:15,959 Speaker 1: Whatever happened, the patients were the same but somehow behaviors 413 00:21:15,969 --> 00:21:19,510 Speaker 1: were different. We also looked at at 90 day readmissions 414 00:21:19,520 --> 00:21:22,609 Speaker 1: or 30 day readmissions and found that even during times 415 00:21:22,619 --> 00:21:26,079 Speaker 1: when the discharges were more rapid, the readmission rate was 416 00:21:26,089 --> 00:21:28,589 Speaker 1: not higher. And that was an indication to us that 417 00:21:28,780 --> 00:21:31,209 Speaker 1: really the people who are being discharged didn't need to 418 00:21:31,219 --> 00:21:33,599 Speaker 1: be in the hospital in the first place. The people 419 00:21:33,609 --> 00:21:35,429 Speaker 1: who were in the hospital who don't really need to 420 00:21:35,439 --> 00:21:36,909 Speaker 1: be in the acute care setting, 421 00:21:37,469 --> 00:21:41,489 Speaker 1: they can be discharged. But it requires an effort and 422 00:21:41,500 --> 00:21:45,180 Speaker 1: it requires the physicians talking to the family, you know, 423 00:21:45,189 --> 00:21:48,329 Speaker 1: reinforcing how important it is for them to be discharged. 424 00:21:48,589 --> 00:21:52,410 Speaker 1: And it also probably involves I'm guessing Jeremy Lee, uh 425 00:21:52,699 --> 00:21:54,449 Speaker 1: uh people on your staff 426 00:21:54,770 --> 00:21:58,920 Speaker 1: going down to the wards and telling the docs start discharging. 427 00:21:58,930 --> 00:22:02,699 Speaker 1: And indeed, they find the people that discharge who don't 428 00:22:02,709 --> 00:22:04,959 Speaker 1: really need to be in the hospital. Yeah, we do 429 00:22:04,969 --> 00:22:07,208 Speaker 1: that every other day, but at least for us or 430 00:22:07,219 --> 00:22:09,849 Speaker 1: what we have, at least structurally we have come up 431 00:22:09,859 --> 00:22:13,469 Speaker 1: with is to have a structure that bit management is 432 00:22:13,479 --> 00:22:14,530 Speaker 1: a collective effort. 433 00:22:14,959 --> 00:22:19,550 Speaker 1: So previously many years ago, it is a bit management responsibility. 434 00:22:19,770 --> 00:22:21,760 Speaker 1: But as we move along, we realize that we need 435 00:22:21,770 --> 00:22:24,060 Speaker 1: to partner with the doctors and nurses that are like 436 00:22:24,069 --> 00:22:27,560 Speaker 1: health in order for us to better manage to be efficiently. 437 00:22:27,569 --> 00:22:29,979 Speaker 1: So in any, we structure ourselves, such that 438 00:22:30,229 --> 00:22:34,630 Speaker 1: b management becomes a collective effort and every department will 439 00:22:34,640 --> 00:22:38,329 Speaker 1: be responsible for their bit compliments. And we have seen 440 00:22:38,339 --> 00:22:42,410 Speaker 1: a very good improvements and the effectiveness of a collective 441 00:22:42,420 --> 00:22:45,739 Speaker 1: management of the bit. So, for example, as the National 442 00:22:45,750 --> 00:22:47,959 Speaker 1: a loss has been creeping up over the years. We 443 00:22:47,969 --> 00:22:51,479 Speaker 1: are still managing to hover about 5.5 days which is 444 00:22:51,489 --> 00:22:55,530 Speaker 1: actually quite remarkable for hospital managing very complex patients. 445 00:22:55,819 --> 00:22:59,589 Speaker 1: Now, Singapore has a five year plan to add 1900 446 00:22:59,599 --> 00:23:04,699 Speaker 1: public hospital beds. Is it enough? There is a saying 447 00:23:04,839 --> 00:23:07,939 Speaker 1: in the health economics world that a bed built is 448 00:23:07,949 --> 00:23:10,939 Speaker 1: a bed filled and with the caveat that someone else 449 00:23:10,949 --> 00:23:15,160 Speaker 1: pays for it. So we will never have enough beds 450 00:23:15,170 --> 00:23:19,229 Speaker 1: if we don't align the financial gradients and we improve 451 00:23:19,239 --> 00:23:20,869 Speaker 1: the out of hospital care, 452 00:23:21,380 --> 00:23:24,899 Speaker 1: right? To really David and really Jeremy's point about nudging 453 00:23:24,910 --> 00:23:28,099 Speaker 1: patients to go home, right? They must have some place 454 00:23:28,109 --> 00:23:31,959 Speaker 1: that they are comfortable enough to be, right? And hence 455 00:23:31,969 --> 00:23:36,010 Speaker 1: a lot of the grassroots efforts around building active aging centers, 456 00:23:36,020 --> 00:23:40,130 Speaker 1: putting nurses into the communities, these are belated efforts, but 457 00:23:40,140 --> 00:23:46,109 Speaker 1: absolutely necessary. And hopefully through a conglomeration of all these 458 00:23:46,119 --> 00:23:49,930 Speaker 1: individual initiatives, uh we can move the boulder, 459 00:23:50,430 --> 00:23:53,540 Speaker 1: right? But certainly to the point David made at the 460 00:23:53,550 --> 00:23:57,380 Speaker 1: start of this conversation that Singapore at the macro level 461 00:23:57,390 --> 00:24:01,459 Speaker 1: probably has sufficient or just slightly short of bids is 462 00:24:01,469 --> 00:24:04,310 Speaker 1: how we make the best of what we have and 463 00:24:04,319 --> 00:24:07,260 Speaker 1: to think about it, not just as a hospital bed issue, 464 00:24:07,270 --> 00:24:10,920 Speaker 1: but the healthcare ecosystem issue, I should quote what Doctor 465 00:24:10,930 --> 00:24:13,579 Speaker 1: Jeremy mentioned because I think we can increase the number 466 00:24:13,589 --> 00:24:15,739 Speaker 1: of bits. But if the system is inefficient, 467 00:24:16,530 --> 00:24:18,969 Speaker 1: increasing the number of base is just going to amplify 468 00:24:18,979 --> 00:24:22,139 Speaker 1: the problems. We need to think out of the box 469 00:24:22,150 --> 00:24:25,489 Speaker 1: to have more innovative care models, be more efficient in 470 00:24:25,500 --> 00:24:30,489 Speaker 1: our care coordinations. And that is the more sustainable effort 471 00:24:30,500 --> 00:24:33,329 Speaker 1: compared to building more bits and with more bids, we 472 00:24:33,339 --> 00:24:34,459 Speaker 1: need more manpower. 473 00:24:35,020 --> 00:24:37,139 Speaker 1: Even if we can find this, we may not be 474 00:24:37,150 --> 00:24:39,649 Speaker 1: able to find manpower. It looks like this whole bed 475 00:24:39,660 --> 00:24:43,160 Speaker 1: shortage issue is not likely to go away anytime soon, 476 00:24:43,170 --> 00:24:46,800 Speaker 1: but perhaps just to wrap up this conversation, what would 477 00:24:46,810 --> 00:24:49,649 Speaker 1: each of you suggest? Everybody does? I mean, just at 478 00:24:49,660 --> 00:24:52,520 Speaker 1: least in the interim until you know, the entire healthcare 479 00:24:52,530 --> 00:24:55,180 Speaker 1: system sort of gets into place. One of the first 480 00:24:55,189 --> 00:24:56,640 Speaker 1: thing people can do is to really think 481 00:24:56,790 --> 00:24:59,699 Speaker 1: twice before going into the hospital for people who are 482 00:24:59,709 --> 00:25:03,849 Speaker 1: having an acute event. If they're having symptoms of chest 483 00:25:03,859 --> 00:25:07,359 Speaker 1: pain or facial weakness, difficulty speaking, you know, stroke kinds 484 00:25:07,369 --> 00:25:10,930 Speaker 1: of things, things that really require emergency care, those are 485 00:25:10,939 --> 00:25:13,449 Speaker 1: things you absolutely have to go to the emergency room 486 00:25:13,459 --> 00:25:15,520 Speaker 1: for a lot of the reasons people have been going 487 00:25:15,530 --> 00:25:18,369 Speaker 1: to the emergency room, it's not entirely necessary. 488 00:25:19,069 --> 00:25:22,280 Speaker 1: Then they should have a primary care doctor. As both 489 00:25:22,300 --> 00:25:25,540 Speaker 1: Jeremy said, I think healthier SG is, is a healthy 490 00:25:25,550 --> 00:25:29,319 Speaker 1: move for Singapore in terms of rebalancing the structure of 491 00:25:29,329 --> 00:25:33,770 Speaker 1: the system. Thank you David. And really for me, uh 492 00:25:34,400 --> 00:25:37,359 Speaker 1: I would make it easier for patients and their families 493 00:25:37,369 --> 00:25:38,530 Speaker 1: to do the right thing. 494 00:25:38,910 --> 00:25:42,000 Speaker 1: I agree with David that the transition care can be 495 00:25:42,010 --> 00:25:45,629 Speaker 1: very complex, but there is a subpopulation of patients. If 496 00:25:45,640 --> 00:25:49,688 Speaker 1: we carefully select them, they can be incentivized to go home. 497 00:25:49,859 --> 00:25:53,119 Speaker 1: And I wouldn't close the door to cash payments, providing 498 00:25:53,130 --> 00:25:55,810 Speaker 1: meals at home and all of this to 499 00:25:56,015 --> 00:26:01,525 Speaker 1: encourage patients to leave and leave safely. Because ultimately, the 500 00:26:01,535 --> 00:26:04,354 Speaker 1: hospital that we did not have to build is the 501 00:26:04,364 --> 00:26:09,135 Speaker 1: biggest cost saving. I break my response into 21, I 502 00:26:09,145 --> 00:26:12,844 Speaker 1: think for the near term, we can look at increasing capacity. 503 00:26:13,145 --> 00:26:16,614 Speaker 1: But what's more important is to tighten care coordinations 504 00:26:16,959 --> 00:26:20,599 Speaker 1: as well as to improve the operational efficiencies, not just 505 00:26:20,609 --> 00:26:24,739 Speaker 1: within the hospital, but maybe in the community hospitals and 506 00:26:24,750 --> 00:26:27,410 Speaker 1: the nursing home as well. But the longer term, I 507 00:26:27,420 --> 00:26:30,530 Speaker 1: think there's a need for us to strengthen social networks, 508 00:26:30,540 --> 00:26:34,680 Speaker 1: embrace LT SG and also to review the overall ecosystem 509 00:26:34,689 --> 00:26:39,670 Speaker 1: like housing, transport financing and even community spaces. These are 510 00:26:39,680 --> 00:26:43,060 Speaker 1: all important elements to help us embrace health care. 511 00:26:43,380 --> 00:26:45,520 Speaker 1: So in a nutshell, think twice, whether you need to 512 00:26:45,530 --> 00:26:49,050 Speaker 1: go to a hospital or not embrace healthier SG and 513 00:26:49,060 --> 00:26:51,560 Speaker 1: we have to be more proactive in driving this shift 514 00:26:51,569 --> 00:26:55,810 Speaker 1: from hospital care to home care. Thank you very much, gentlemen, 515 00:26:55,819 --> 00:26:59,458 Speaker 1: for your time and thoughts, uh lots of insights that 516 00:26:59,469 --> 00:27:01,280 Speaker 1: there and also a big thank you to our CN 517 00:27:01,290 --> 00:27:04,750 Speaker 1: A podcast team, Joanne Chan Sai, we Christina Robert and 518 00:27:04,760 --> 00:27:07,649 Speaker 1: Tiffany Ang. I'm with you Edwards. Till next time. Thanks 519 00:27:07,660 --> 00:27:08,160 Speaker 1: for listening.