Singapore Hospitals to Standardize Ward Designs, Aim for Six-Bed Maximum
New national standards promise faster, more cost-effective hospital construction and a potential streamlining of subsidized ward options for patients.
Singaporean patients opting for subsidized care in public hospitals will likely find themselves in wards with a maximum of six beds in the future, a shift from current arrangements that can accommodate eight or more. This change is driven by the launch of the Healthcare Facility Design Standards (HFDS) on December 9th by the Ministry of Health (MOH), a new national framework designed to standardize hospital layouts and features – including plumbing and lift systems – across the nation.
The HFDS initiative aims to accelerate hospital construction and potentially reduce costs, while also paving the way for a possible consolidation of the existing B2 and C ward classes. According to statements made in 2021, the MOH noted that the physical distinctions between these two ward types “are no longer so obvious.”
Several major projects are already incorporating the new standards, including the new Tengah General and Community Hospital (TGCH), the Tan Tock Seng Hospital Medical Tower, and the ongoing redevelopment of the National University Hospital (NUH). Ward layouts under the HFDS utilize standardized grids measuring 8.4m by 8.4m, allowing for “easy reconfiguration of internal spaces without major structural changes while supporting future renovations, expansions or technology upgrades.”
The framework establishes three standardized general ward classes: A, offering single-bed occupancy; B1, with four beds; and B2 or C, capped at six beds. Currently, B2 wards range from five to six beds, while C wards can accommodate anywhere from five to twelve patients.
The HFDS was a collaborative effort, developed by MOH Holdings alongside all three public healthcare clusters, drawing on lessons learned from past projects and best practices. While TGCH, as the first project utilizing the HFDS, is “still in the planning and exploration stage,” according to its pro tem chief executive, Associate Professor Victor Koh, the framework signals a potential future where public hospitals operate with a more uniform ward structure.
This move towards standardization builds on earlier discussions regarding the convergence of B2 and C wards. In a 2021 parliamentary debate on the MOH budget, Senior Minister of State for Health Dr. Koh Poh Koon explained that improvements in infrastructure had diminished the noticeable differences between the two classes, particularly concerning bed numbers, ventilation, and access to attached toilets. This led to a decision to unify subsidies for both ward types, ranging from 50% to 80% for Singaporean citizens, as more refined means testing reduced the need to differentiate based on ward choice.
Financial considerations also support the shift. Online comparisons reveal minimal cost differences between B2 and C wards at many hospitals. For example, a subsidized stay at Ng Teng Fong General Hospital’s 12-bed C ward costs $51 per day, just $4 less than a six-bed B2 ward. NUH’s eight-bed C ward is priced at $52.40, while its six-bed B2 wards cost $57. However, discrepancies exist at other institutions, such as KK Women’s and Children’s Hospital (KKH) and Singapore General Hospital (SGH). KKH’s B2 wards cost $75.60 daily, significantly more than its C wards at $43.10, while SGH’s C wards are $19.10 cheaper than B2 wards.
Beyond cost, subtle differences in amenities also distinguish the ward classes. Sengkang General Hospital, for instance, provides separate shower and toilet facilities in B2 wards, while C wards combine them. At Woodlands Health, patients in both B2 and C wards may share the same physical space, with B2 patients receiving a complimentary toiletry set and a wider selection of meal options – up to 14 choices compared to 10 for C ward patients.
A director at the MOHH’s healthcare infrastructure projects division, Mr. Joseph Toh, emphasized the importance of fiscal prudence, noting that projects already underway may not be immediately adaptable to the HFDS to avoid unnecessary disruption. However, he added that the standards likely reflect best practices already incorporated into many hospital designs. Existing hospitals can adopt the HFDS during refurbishment or renewal projects, and the framework allows for operational flexibility, enabling ward conversions as needed.
The 1993 White Paper on Affordable Health Care established a baseline requiring at least 65% of public hospital beds to be B2 or C class, with A class beds limited to 13%. The current HFDS initiative represents a significant step towards modernizing hospital infrastructure and optimizing patient care within a sustainable and efficient healthcare system.
