Roosting Ahead (Part 2)

The biggest news in the past month is the reclustering of the reclustered 6 clusters into 3 clusters which is leaving just about everyone flustered. So flustered was one Group CEO that it was rumoured he quit stat, like a guy with anaphylactic shock.

If you ask this Hobbit, the 3 clusters formed in this latest exercise makes a lot more sense geographically and operationally. It certainly makes more sense to have this structure than the 6 clusters that was formed just a few years ago. The last cluster, Eastern Health Alliance (EHA) was just formed 6 years ago in 2011. Its formation was formally declared by Minister for Health, Mr Gan Kim Yong, who inherited this six-cluster idea from the previous administration. The other two clusters that are closing shop, Jurong and Alexandra Health are also less than 10 years old. In case you are wondering, the current health minister remains Mr Gan, and that underscores just how briefly this six-cluster gig lasted.

Any organisational structure than involves tens of thousands of people than cannot even last 10 years is a bad idea. For example, do you know how many hours, consultancy dollars it takes to design logos, uniforms, taglines, mission, vision and values when a cluster is formed? And how many more hours of meetings and trainings to get buy-in from the thousands of staff that each cluster employs? And all that investment is now down the drain, not to mention the emotional upheaval that comes along with these clustering exercises.

Take the guys in Changi General Hospital for example. If you ask the longer-serving staff, they were pretty OK with being part of SingHealth in the first place (not ecstatic, but OK). Then they were asked to become EHA because they had to join the movement of creating six regional health clusters. We needed six clusters because it was rumoured another two mega-huge personalities in another cluster couldn’t get along with each other and had to part ways by forming two clusters. And now, they are told EHA is no more and you are back in SingHealth again. Some wry old coot remarked, “Luckily I kept my SingHealth name-tag and employee handbook, maybe no need to issue new one”.

Seriously folks, you can just cry.

The problem is that we should not create organisational structures around personalities., unless you are talking about Christiano Ronaldo, Lionel Messi, Tom Brady or Donald Trump. By doing so, you are storing up problems for yourself and the chickens are now coming back to roost.

And then we have NNI. Just kidding. This Hobbit has absolutely NOTHING to say about NNI. I repeat, NOTHING.

Whew. Yeah, call me chicken-hearted. I am not a dumb cluck like many think this Hobbit is. Let’s move on to other stuff.

Just the other day, I was told of some terrible behaviour by GP locums that need to be addressed.

One GP was told by a locum that for a $100 an hour, he will only see 6 patients an hour. Any more and he needs to be paid more. If not, he will not work faster than see 6 patients per hour even if the waiting room is exploding.

Another locum was worse. He signed up for one week of locum slots with one clinic. After one day, he said he will not take $100/hr and demanded $120/hr instead, if not he wasn’t coming back the following day; effectively blackmailing the proprietor GP (who was already away on holiday).

Thankfully, I haven’t faced such unprofessional locums in my practice. In my opinion, once you accept a locum gig, you are COMMITTED to it at the pre-agreed price. In the first case, if there are less than 6 patients per hour, do you refund some money to the guy who hired you? Of course not! You are paid for your time, not the number of patients you see. True, it may be a tough and busy practice, and you are free to ask for more money the NEXT time they contact you for future slots. But for the current slots, you have to complete them because you have already agreed to. Your word is your bond.

If I may add, these cases are purportedly involving young locums. The general consensus (and I agree) is that decline in professionalism and even clinical standards involve the younger locums.

Maybe it’s the residency system where residents’ workloads are capped to a certain (low) number of patients an hour in the clinics that has led to this mindset of entitlement. SMC should consider adding a section on Unethical or Unprofessional Locum Behavior in the new Ethical Code and Ethical Guidelines. This is the real world, not the make-belief world of residency.

In last month’s column, we talked about the government now self-insuring all doctors in the public sector through MOHH. And how MPS handling of the OG’s indemnity coverage essentially led to the government stepping in for all of the public sector. Well, MPS is now conducting a seminar or forum of sorts called “Making The Right Choices”. This hobbit is confused. Is it meant for doctors or is it meant for MPS themselves? After all, if some geniuses running MPS did not make the choice of unilaterally and suddenly changing the nature of coverage for Singapore OGs, their monopolistic hold in the specialist sector would not have vanished overnight. Talk about hatching a bad idea and making the wrong choice. They are now left with only the private sector business. Board members of MPS should ask themselves if they had hired the right people to manage MPS after this debacle. They can call this the Fall of Singapore Part 2 and look for the MPS equivalent of General Percival. (Well, to be fair to the old boy, at least Percival didn’t self-destruct, he merely surrendered). Are the MPS OG chickens coming back to roost big time now.

It is now again approaching government budget time and it is again time to strut the numbers like how the Sin Ming Avenue cockerel struts his feathers. In FY 2002, Government Health Expenditure (GHE) was S$1,558M or about S$1.6B. In FY 2015, GHE was S$9,247M or ~S$9.2B. For FY 2016, the estimated GHE was S$10,999 or ~S11B. That is an increase of S$1,752M in FY2016 over FY2015. As you can see, the increase from FY2015 to 2016 alone was greater than the whole of what government spent on health 14 years ago. This is a very frightening number. Clearly, while we may have underspent on healthcare in our first 40 years of independence, the spending increases in the last 10 years have more than made up for lost time. Yes, the large increases in MOH spending have led to better working conditions and terms for healthcare staff and better outcomes for patients and all this is great. But still, are such increases sustainable? Or are we again storing up troubles for later?

This hobbit thinks we may have to cull healthcare spending like how NEA wants to cull the Sin Ming Avenue chickens….and it will be a very painful exercise because younger healthcare leaders, managers and staff who work in the public sector now have never experienced the kind of parsimony if not deprivation that older workers had lived with, especially those that have worked in the seventies and eighties.








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