Opening Of The 11th Congress Of The Western Pacific Association Of Critical Care Medicine (WPACCM)

29 Nov 2000

By Mr Lim Hng Kiang

Distinguished delegates and guests, ladies and gentlemen,

It is my pleasure to be here this evening to address the delegates tothis 11^thCongress of the Western Pacific Association of Critical Care Medicine.I would like to extend a warm welcome to all delegates andparticipants, particularly those of you who are in Singapore for thefirst time.

The role of the WPACC

I understand that your Association has undergone major changes to keeppace with the rapid development in the science and the practice ofcritical care medicine in the Western Pacific region.

The Western Pacific Association of Critical Care Medicine has changedfrom being an individual membership organisation to one with nationalsociety-based membership. This recognises the important role that thenational societies can play in developing critical care medicine. TheAssociation has been very proactive in its aim of stimulating theexchange of information and knowledge among its members. It has adoptedthe journal, yyyCritical Care and Shockyyy as the Associationyyysofficial journal, and launched its own website on the internet in 1999.

Through its biennial Congress, the Association has facilitated thesharing of information and ideas among intensivists and contributed tothe development of this area of medical practice through bilateralexchanges of staff and training programmes. The Congress is now a keyregional scientific meeting for doctors and researchers from the regionand beyond, to present and discuss their work, and to learn of the workof others.

Changes in the practice of Critical Care Medicine

In the Western Pacific region, the practice of critical care medicinehas advanced rapidly over the past twenty years in response to theincreased demand for critical care services. Several factors accountfor this, including changing disease patterns, an aging population,medical advances and higher affluence levels. With improvements intechnology, management options have also expanded and it is not only aquestion of what can be done, but also one of whether it should bedone. Critical care medicine often involves life or death situationsand this can lead to emotionally-charged settings in which doctors,patients and their families have to choose between difficult treatmentoptions.

End-of-life issues and questions of when further treatment may befutile are ethical matters that face every critical care practitioner.These are difficult areas, which require not only medical judgement butsensitivity, compassion and a good understanding of socio-culturalfactors. It is therefore appropriate that this conference features asymposium at which ethical topics like the advanced medical directivesand withdrawal of care will be considered and discussed.

Critical care medicine has also developed in Singapore. Over the last10 years, some 20 doctors have gone on fellowship programmes incritical care medicine in renowned centres in North America, Europe andAustralia. Today, almost all our restructured hospitals have at leastone physician trained specially in critical care medicine. At present,specialists in respiratory medicine and anaesthesiology are the maingroups receiving specialised training in critical care medicine.However the interest in critical care medicine is developing in manyother disciplines. Singaporeyyys own Society of Intensive Care Medicinewas formed in 1995 with the aim of organising training and educationalactivities for critical care practitioners. The Society organises andconducts scientific meetings, workshops and lectures relevant to thepractice of critical care medicine. Last month, the Society started thefirst Fundamental Critical Care Support Course for doctors and nurseswho do not have formal critical care medicine training.

Health Service Development Programme

The theme for this 11th Congress is yyyCritical Care yyy Challenges ina New Erayyy. I commend the organisers for drawing up a scientificprogramme that not only updates practitioners on the latest medicaltechnologies and practices in the field, but also includes sessions oninformation technology, training & education, ethics and financialissues, and how these issues impact on critical care medicine. Forexample, we all realise that financial resources will always be finiteand ways must be found to put effective new medical technology intoservice.

In Singapore, we recognise that the development of new medicalcapabilities in our healthcare institutions is necessary to maintainand improve the standards of our public healthcare system and to attainmedical excellence. We already have several streams of funding for newcapability development, these include the Health Manpower DevelopmentProgramme which funds medical professional training, and funding fromthe National Medical Research Council which provides for medicalresearch.

To augment these existing mechanisms, I am pleased to inform you thatfrom next year, my Ministry will be instituting a new Health ServiceDevelopment Programme (or HSDP). The HSDP will have an initial annualbudget of $20 million and will provide another source of funds for thehospitals to develop new medical capabilities or services. We intendthat the HSDP should fund 3 major categories of capabilities on a pilotprogramme basis.

I am pleased to inform you that from next year, my Ministry will beinstituting a new Health Service Development Programme (or HSDP). TheHSDP will have an initial annual budget of $20 million and will provideanother source of finance for innovative and creative new medicalcapabilities or services. We intend that the HSDP should fund 3 majorcategories of capabilities on a pilot programme basis:

(a) Introduction of new medical technologies

These will be new medical technologies that have shown great promise inclinical trails or some areas of established practice. They may becutting-edge treatments for the time being but shows the potential tobe important, established procedures in the future.

(b) Advanced or experimental treatments which require aperiod of evaluation

These are advanced treatments which are either still experimental orbeneficial for only selected patient groups, are very costly and havesubstantial adverse effects. Examples would be heart and livertransplant.

And,

(c)   Major augmentations of existingmanagement capabilities for key diseases

Hospitals are already providing clinical services for major diseaseslike stroke, heart attacks and kidney disease. For these key diseases,my Ministry is initiating programmes aimed at substantially reducingthe long-term burden of these diseases for Singapore. This may requiresubstantial augmentation and reorganisation of clinical services in thehospitals, which the HSDP could fund.

Each programme funded under the HSDP will be closely monitored andcontinued support after the pilot period will be determined following adetailed evaluation of the programme. If the programme is successfulafter the pilot period, it may qualify to be part of the standardpackage of services to be provided by our hospitals.

In closing, let me make an invitation to our overseas guests to takethe time to enjoy the many attractions that Singapore has. I hope youenjoy both the Congress and our country.

I am pleased to declare this 11^thCongress of the Western Pacific Association of Critical Care Medicine,open.