No Horse Run……

Welcome to the Year of the Horse. The Year of the Horse sees a new Director of Medical Services in the saddle. This Hobbit recommends that he wears a horseshoe ornament for luck. He will need it since there is so much horse dung lying around that is waiting for him to clean up. In fact, this Hobbit can predict with some accuracy that after the Year of the Horse, he will still be cleaning Goat-poo next year and uncovering heck of a lot of Monkey business in the year after that. And we are not even going to talk about the big pile of Chicken shit…..

Anyway, expectations are high about this year’s Budget and what goodies the government is going to roll out for the much talked-about and revered Pioneer Generation.

The first thing about Pioneer Generation is to define who qualifies for Pioneer Generation club membership. This Hobbit thinks anyone who

·     Has actually dialed a phone number (not press buttons) and remembers having a 5-digit phone number

·     Has ever worked with Sir Arthur Ransome

·     Has brought an egg to the char kway teow/chye tow kway hawker

·     Has bought a new HDB flat near SGH for less than $20,000

·     Had hot dates in Sky, Odeon and Capitol cinemas and then made out in the old Houseman quarters (i.e. now occupied by the Academia in SGH)

·     Remembers that hypodermic needles used for injections could be re-used after sterilization and it was the nurse’s job to sharpen them

·     Still owes money to Ah Ling from old KEVII Hall.

-Should automatically qualify as a member of the Pioneer Generation.

Having qualified as an esteemed member of this club, what benefits should be bestowed on them? Here are a few suggestions:

·     They are given priority to be hired in critical positions; e.g. hawker centre cleaners, hospital attendants and part-time helpers in Seventh Month banquets.

·     They can jump queues at polyclinics and be served first by foreign doctors who will communicate with them by any method from sign language to telepathy, as long as it is NOT in their language or dialect of choice.

·     Should they require specialist care, they will be given quick access to the general hospitals’ specialist outpatient clinics. By way of “quick access”, we actually mean a first appointment before the next lunar eclipse or when consultants who are “core faculty” have time to do some real work, whichever comes first. On the day of the appointment, these Pioneer Generation will spend about half the day finding their way around our mammoth hospitals which are equipped with signage mainly in the English language. These Pioneer Generation are also supposed to understand what terms like“otorhinolaryngology department” and “non-invasive cardiac investigations”mean. Assuming they are able to find their way there, they will again be treated by some foreign doctor or resident and be given two minutes of real attention while the remaining 8 minutes are reserved for doctor-EMR interface time.

·     Should they fall very ill and need long-term care, they will automatically qualify for a 50% discount in our new state-subsidised nursing homes where they will spend their final days lying in open halls of eight beds with seven other persons with practically zero privacy and near-zero dignity. To top it off, these nursing home beds will actually cost more than a C-Class bed in an acute hospital.

With these potential awesome membership benefits, is it any wonder the Pioneer Generation feels they are very important in the large scheme of things?

We move on to yet another hot topic of the day – the hospital bed crunch. Actually there is nothing new to the bed crunch. This is not the first bed crunch and it certainly is not going to be the last. What we need is to create more capacity quickly while also trying to manage demand. Building a new general hospital from scratch takes too much time. We need quick fixes instead. Here are a few completely politically unacceptable but workable solutions:

  • Fill up the huge lake in KTPH and build a new block there. Limiting KTPH to only 550 acute beds was obviously a mistake. It needs to be bigger really quick.
  • Don’t just lease wards – Merge Mount Elizabeth Novena Hospital with TTSH and we have the Mount Elizabeth Tan Tock Seng Hospital. Demand for beds will automatically drop as people will now think TTSH is an expensive hospital. However, with an acronym like METTSH, we should avoid setting up a very big oncology department there. Just a small one would do.
  • There is a lot of empty shelf space in the huge new block called Academia in SGH. Convert the space into sub-acute beds. All this research and training space is academic if you cannot even have enough beds to house the acutely sick.
  • The new shopping mall near the NUH MRT Station is largely still unoccupied. NUS/NUH is rumoured to own it. Move all the outpatient clinics from NUH there instead and convert existing clinic space into wards. Trust this Hobbit, we have enough shopping malls and retail space now for even the upper population planning limit of 6.9M people
  • Kick Land Transport Authority (LTA) out of the old KKH buildings and re-convert them back into wards. After all, at the rate things are going with the LTA, they should be housed next to the famous Central Boulevard so that they can see for themselves what a bad idea this MCE is.

The other big issue that is on people’s minds is what will the new Medishield Life cost and cover? The Minister has already let a whole litter of cats out of the bag when he said there would be a new subsidy framework for the Pioneer Generation and those who turn 90 will still be covered pending the findings of the Medishield Review Committee. Speaking of this Review Committee, it is very interesting to note that the MOH announced the formation of Medishield Review Life Committee on 9 Nov 2013. Since then, we have been informed of who the members are, what the Terms of Reference are and as of a few days ago in its first public update, this Review Committee is already into the second phase of work and focusing on three key areas, namely: benefits,coverage and integrated shield plans. Obviously, these guys mean business and they appear to at least know what they are doing. We may not agree with all of the Committee’s recommendations in the end, but one cannot accuse it of not working quickly and transparently.

Now compare this to the Singapore Medical Council (SMC) Review Committee. Its formation was first announced in October 2012. In February last year, it was announced in Parliament no less, that it was expected that the SMC Review Committee’s work would be completed in 6 months’ time (i.e. ~August 2013). To-date, after 16 months, we still do not know who is on the Committee, its terms of reference, and much less its findings and recommendations. And those guys heading SMC who scolded SMA last year repeatedly for questioning the running of the SMC expect the medical profession at-large to believe everything is OK? Do they take us for fools? By the way, does this SMC Review Committee even still exist?

Is the SMC more complicated than Medishield Life? How many people are affected by Medishield Life compared to SMC? This really makes a fascinating tale of two review committees.

Hmm, come to think of it, maybe the new boss needs many, many horseshoe ornaments….

OK, enough horsing around this month. Bye for now.

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