SPEECH BY MDM RAHAYU MAHZAM, MINISTER OF STATE, MINISTRY OF DIGITAL DEVELOPMENT AND INFORMATION & MINISTRY OF HEALTH, AT THE 2ND SINGAPORE PALLIATIVE CARE QUALITY IMPROVEMENT CONFERENCE OPENING CEREMONY, 29 AUGUST 2024

Dr Chong Poh Heng, Vice Chairman, Singapore Hospice Council 

Dr Yee Choon Meng, Organising Chairman, Singapore Palliative Care Quality Improvement Conference

Ms Sim Bee Hia, Executive Director, Singapore Hospice Council 

Speakers, delegates, ladies and gentlemen

Good morning. It is my pleasure to be here at the opening ceremony of the second Singapore Palliative Care Quality Improvement Conference. The theme of this year’s conference, “Transforming Palliative Care Through QI Lenses”, resonates deeply with our shared mission to enhance the quality of palliative care for patients who are at the most vulnerable stages of their lives.

Importance of Palliative Care

2. Palliative care goes beyond providing relief from the symptoms of life-limiting illnesses. It is a holistic and compassionate approach that caters to the emotional and psychosocial needs of both patients and their caregivers. 

3. While we discuss national-level quality improvement efforts for palliative care at today’s conference, we must remember how our efforts benefit the individual patients and their loved ones.

National Strategy for Palliative Care 2023 Framework

4. Last year, the Ministry of Health (MOH) launched the refreshed National Strategy for Palliative Care framework, focusing on three main areas to advance palliative care nationally.

5. First, enhance access to affordable palliative care services for patients. To address the future demand for palliative care in a rapidly ageing Singapore, we plan to significantly increase home palliative care capacity by 50% to 3,600 places, inpatient hospice capacity by 15% to 300 beds, and day hospice capacity by 12% to 140 places by the end of 2025, from 2023. 

6. Second, build a supportive and compassionate palliative care environment that spans hospitals and the community, to improve death literacy and provide more comprehensive support for palliative care patients and their caregivers. MOH, together with the Ministry of Social and Family Development, Public Service Division and Agency for Integrated Care, launched a nationwide Pre-Planning Campaign to raise awareness of the importance of pre-planning and end-of-life matters. Since July 2023, we have successfully conducted seven roadshows and run 12 mobile clinics offering pro bono Advance Care Planning (ACP) facilitation and Lasting Power of Attorney (LPA) certification to eligible seniors. More than 10,000 ACPs have also been completed since then.

7. At the same time, the Singapore Hospice Council (SHC) also runs the “Live Well, Leave Well” campaign with talks and workshops that encourage open conversations about death and dying, and the making of informed decisions about end-of-life care preferences through ACP. 

8. And last but not least, we will raise the quality of palliative care by enhancing our National Guidelines for Palliative Care and tracking the sector’s performance to continuously improve care. MOH will continue to work with SHC, who is a close partner, in driving these efforts.

Existing Efforts for Quality Improvement in Palliative Care 

9. The coordinated efforts of MOH, SHC, public healthcare institutions providing specialist palliative care, and community palliative care providers, have enhanced the quality of Singapore’s palliative care significantly.  

10. Since 2017, SHC has been collecting data from palliative care providers through the National Palliative Care Minimum Data Set. The data so far indicates that palliative care is initiated earlier for cancer patients with a median of 33 days before death compared to nine days before death for non-cancer patients. Findings such as this have helped identify where we can improve. 

11. One other useful measure of how we are doing is the Caregiver Response Survey which is conducted annually. The 2023 Caregiver Response Survey showed an overall improvement in caregiver feedback compared to the preceding year, reflecting the continued commitment and efforts of the palliative care community. At the same time, the survey findings also highlighted areas that require improvement, such as the provision of psychosocial support and caregiver training. These findings will prove useful as we continue to refine the services at every stage of the palliative care journey.

12. A key strategy for quality improvement is performance benchmarking. In this regard, SHC has been instrumental in the development of national benchmarking measures for the palliative care sector, which is on track to be implemented next year.  It is encouraging to see that benchmarks for generalist and paediatric palliative care are currently being developed to help achieve comprehensive quality enhancement across various care specialties. When rolled out, this will further drive sector-wide improvements in palliative care quality.

13. As the capacity of our palliative care sector expands over the next few years, it is important that we continue to monitor and improve the quality of palliative care.

Moving Palliative Care Upstream

14. While palliative care specialists play an important role, the wider community, including general practitioners, family physicians, and other non-palliative care specialists, has much to contribute. Many of them already have long-standing relationships with patients and their families, making them well-positioned to deliver palliative care earlier in the disease trajectory. 

15. Some of you, here with us this morning, have already started playing an active role in palliative care. For instance, through your advocacy for Advance Care Planning, you are helping your patients ensure that their preferences for end-of-life care are documented. 

16. I am heartened to see that about 50% of the delegates here today are friends from outside the palliative care sector. It is our hope to bring palliative care upstream by integrating it more deeply in the community, building on existing relationships that patients already have with their primary physicians. This conference is an excellent opportunity for healthcare professionals across disciplines and sectors to work together and contribute to the generalist palliative care guidelines.

Next Steps in Quality Improvement 

17. Sustaining quality improvement in palliative care will require a multipronged approach. Besides putting in place the hardware, such as data, guidelines and benchmarks, we also need to develop the software by cultivating a culture of continuous excellence and partnerships among our healthcare providers.    

Closing

18. Today’s conference is an important platform for sharing knowledge, inspiring new ideas, fostering meaningful connections, and driving significant improvements in palliative care. I would like to extend my heartfelt gratitude to the Singapore Hospice Council, its member organisations, and the conference organising committee for your work.

19. To the multidisciplinary team of healthcare professionals, including doctors, nurses, social workers and counsellors, thank you for your contribution towards patients’ palliative care journey and for making all of us proud to be part of this palliative care fraternity. I look forward to the continuous collaboration among MOH, SHC, the palliative care community, and delegates here today, as we strive towards achieving excellence in palliative care.

20. Thank you and I wish everyone a fruitful conference ahead.

[1] As of 5 September 2024, Paragraph 10 has been amended for factual accuracy.