Wednesday, 30 November 2016

Yishun Community Hospital gives glimpse of future care

Such facilities are cheaper to run and build and can ease the crunch at acute hospitals
By Salma Khalik, Senior Health Correspondent, The Straits Times, 29 Nov 2016

The template for the future of Singapore's healthcare system was on display yesterday as the Yishun Community Hospital was officially opened to take the load off the neighbouring Khoo Teck Puat Hospital (KTPH).

Community hospitals will play a bigger role in caring for patients in the future and are part of the transformation under the Healthcare 2020 Masterplan to "shift the centre of gravity from acute hospitals to the community", said Health Minister Gan Kim Yong.

As he officially opened YCH, Mr Gan said: "Over time, we see community hospitals expanding their roles to provide more short-term inpatient care for geriatric, dementia and palliative patients."

YCH, which is linked to KTPH, has cared for more than 1,400 patients since it became operational in December last year.

YCH, which has opened 238 of its 428 beds so far, is currently 60 per cent full, while the adjacent KTPH faces a bed crunch, with occupancy hovering at around 90 per cent.

It is much cheaper to run a community hospital, where the nurse-to-patient ratio is one to 16, which means one nurse can look after four times the number of patients compared with a general hospital. This is largely because, while its patients still need care, their conditions are stable.

Community hospitals are also cheaper to build, at roughly half the cost of an acute hospital.

That is why all future acute hospitals in the public sector will have a community hospital next door to allow patients to "transit smoothly from the acute hospital to the community hospital and eventually back home".

Aside from KTPH, Tan Tock Seng Hospital, Changi General Hospital, and Ng Teng Fong General Hospital all have community hospitals next door. Outram Community Hospital, expected to open in 2020, is being built on the Singapore General Hospital campus.

Speaking to The Straits Times after the event, the minister said: "With an ageing population, community hospitals will play an increasingly important role in our healthcare system.

"Older patients tend to take longer to recover and are more likely to require a longer period of rehabilitation to return home."

The environment at a community hospital is more appropriate for extended rehabilitation and recuperation than that at acute hospitals, he added, "to help patients regain functionality and confidence so that they can return home safely".

Mr Gan said two in five hip fracture patients can benefit from a stay in a community hospital, as can patients with pneumonia or who need complex wound management.

He said: "The community hospital's focus is to help patients improve their functions and regain confidence such that they will be able to look after themselves when they eventually return home."

He praised the hospital for innovations such as its "modern tropical kampung" design, which provides a natural healing environment.

Mr Gan said community hospitals can, in the future, expand their role "to support seniors in the community in key areas such as dementia care and palliative care".

He also spoke of the addition of facilities in the north. Three wellness and care centres were launched in Yishun earlier this year that provide a whole range of aged care and active ageing services.

Next year, there will be a new medical centre in Admiralty and a new nursing home in Woodlands Crescent, and a bigger Yishun Polyclinic will be ready by 2018.

Active role for community at new Yishun hospital
By Salma Khalik, Senior Health Correspondent, The Straits Times, 29 Nov 2016

The 428-bed Yishun Community Hospital (YCH) lives up to its name by involving the community in getting its patients better. It has volunteers who tend rooftop gardens, teach patients crafts or bring books for them to read.

Among its volunteers are young children from The Little Skool-House, which provides nursery and kindergarten classes for children of staff as well as from the neighbourhood. These children spend an hour with patients every Tuesday, talking, playing or learning to cook alongside them.

Madam Oh Quee Eng, 80, moved to YCH 10 days ago after undergoing a knee operation at Khoo Teck Puat Hospital (KTPH). She said she enjoys interacting with the children.

Natalie Sim, six, said she, too, enjoys the sessions. "It is very fun," she said. "I make them happy, and we play fun games. They smile, they are not sad."

Madam Oh also appreciates the cleanliness, surrounding greenery and attentive staff at YCH.

Speaking at the official opening of YCH yesterday, its chief executive officer, Dr Pauline Tan, said: "KTPH is an acute care hospital designed to offer 'fast medicine' for ill patients with short episodic care.

"Treatment is prompt and precise. However, for patients who do require longer-term sub-acute care and rehabilitation, the acute hospital is not where they should remain."

At the community hospital, Dr Tan said, care was provided without any rush, and staff "have autonomy to individualise activities for patients".

A palliative patient with multiple medical problems suddenly decided he wanted to look good and wanted to colour his hair. His occupational therapist bought hair dye and helped him colour his hair in the ward. He died a few weeks later.

Health Minister Gan Kim Yong, who officiated at the opening, was given a drawing of the hospital done by a patient, Mr Heng Peng Swan, 65. He had studied art in his youth, but not practised it over the past 50 years. Recovering from multiple fractures in a road accident, "he rediscovered his talent in drawing, thanks to the supportive effort of the art therapy group", said Mr Gan.

Not to be outdone, Mr Gan gave the hospital a calligraphy he had personally done. Mr Gan said his calligraphy means "the way of healthy living".

Ensuring right level of care
By Salma Khalik, Senior Health Correspondent, The Straits Times, 1 Dec 2016

There really is no need to use an axe to kill an ant, but that was essentially what was happening in healthcare when the very sick, the not so sick, and the patients well on the way to recovery were all looked after in general hospitals.

The over-dependence on acute hospital care has resulted in a shortage of beds and higher healthcare costs. That's because it costs over $1 million per bed to build an acute or general hospital, which also requires many more trained staff to provide the round-the-clock care that the very sick need.

A community hospital, on the other hand, costs half that to build, and needs fewer employees, since patients there are usually undergoing rehabilitation and are well on the road to recovery.

But for a long time, community hospitals were under voluntary welfare organisations' purview, such as Ren Ci near Tan Tock Seng Hospital.

A few years ago, there were just not enough community hospital beds to take on all recovering patients. The Ministry of Health saw the important role they played, and moved in.

Last year, both the Jurong Community Hospital that adjoins the Ng Teng Fong General Hospital and the Yishun Community Hospital next to the Khoo Teck Puat Hospital opened their doors, adding hundreds of beds to the public sector.

In the pipeline are several more: the Outram Community Hospital near Singapore General Hospital and one in Sengkang being built together with a new acute hospital there. In fact, all future public acute hospitals will be built with a community hospital nearby, to give patients a smooth transition, said Health Minister Gan Kim Yong this week.

Community hospitals are now, rightly, a key piece in the healthcare jigsaw. This saves costs, gives patients time to recover without being "chased" out of an acute hospital to make way for more urgent cases, and makes the best use of the limited skilled manpower in healthcare.

New Yishun Community Hospital takes in its first patients

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