Speech by Minister for Health Mr Gan Kim Yong at the Singapore Palliative Care Conference, Saturday 14 July 2012, The Matrix @ Biopolis

1     Good morning everyone. To our distinguished delegates from overseas, welcome to Singapore.

2     It is a pleasure for me to join you this morning at the fifth Singapore Palliative Care Conference 2012. I understand that this conference is one of the key events on Singapore Hospice Council’s calendar this year. I am glad to see many local and international experts within the field coming together to share experiences and best practices.

3     The theme for this year’s conference is aptly titled ‘A Tapestry of Care – Engaging Minds, Reaching Hearts’. Indeed, like a colourful piece of tapestry carefully woven together by different threads, good palliative care is achievable only through the close collaboration of various healthcare professionals in delivering holistic and personal care to the patient suffering from advanced illness. As our population ages and healthcare needs change in tandem, we also need to continually engage our healthcare professionals and reach out to the larger community to promote a wider understanding of end-of-life care and explore ways to serve our patients better.

National Strategy for Palliative Care and Implementation Committee

4     In January this year, I had shared how the development of a National Strategy for Palliative Care is a milestone in strengthening palliative care services in Singapore. A committee has been set up to study how we can implement some of the recommendations made in the strategy. This committee, headed by Associate Professor Pang Weng Sun and Associate Professor Cynthia Goh, comprises key representatives from primary care, hospitals and the intermediate and long term care sector. The committee will be supported by three subgroups which will look in-depth into each of the three thrusts of the national strategy, namely (a) service development; (b) education and training; and (c) standards of palliative care.

5     I have shared previously the good progress made in developing palliative care services over the years. We are building up the capacity of our inpatient hospices and increasing the capability of our providers to deliver sub-acute and non-cancer palliative care, such as for patients with end-stage heart, lung and kidney failure. As we continue to enhance services across the healthcare continuum to improve the accessibility of palliative care, we need to ensure that there is strong integration of care, so that our patients can be assured of continued, hassle-free care across settings and over time. This integration is important as palliative care patients sometimes transit across different care settings as the level of needs vary over the course of their illness. It is timely that the committee is looking at how care can be better coordinated amongst different providers so that seamless and timely care can be provided to patients in the most appropriate setting.

6     Under the national strategy, we envisage to have all healthcare professionals equipped with basic knowledge and skills to care for patients with life-limiting illnesses. Today, basic palliative care modules are available in our medical and nursing curriculums and palliative care training courses. The committee will continue to look into ways to further building up the basic palliative care knowledge among health care professionals, including both undergraduate and postgraduate doctors, nurses and allied health professionals. At the same time, MOH is also committed to expand and train our healthcare workers to ensure an adequate supply of quality manpower to support palliative care developments now and in the longer term.

7     Another area which the committee will look into is the development of sector-wide standards for palliative care. In healthcare systems worldwide, there has been a growing focus in standards and accreditation to improve the delivery and quality of care. In my interactions with the various palliative care organisations and groups over the past year, I could sense the deep commitment that our healthcare professionals had in upholding high standards of care within their institutions. This conviction to deliver the best possible care for patients nearing the end of their lives is heartening. I am confident that the development of a clear and consistent set of standards will benefit the palliative care sector as a whole.

8     Many of you here today who are involved in developing palliative care services in Singapore or back in your home country will know that the implementation of any strategy or plan is often a long and challenging process. However, this journey will be a worthwhile one, to help us achieve better care for our patients.

Strengthening Palliative Care in the Community

9     What is considered better care in palliative care? For many patients, better care is that which addresses their needs and maximises their quality of life. The majority of patients would also prefer to be cared for at home, near to their loved ones, and be accorded as much independence as possible, even towards the last phase of their lives. Families sometimes misconceive that palliative care patients can only be adequately cared for in hospitals or inpatient hospices. This is not true. Even when the disease is advanced, it is still possible to look after patients very well at home if the necessary expertise and services are made available.

10     Today, we have five MOH-subvented home hospice providers, serving about 3,900 patients across the island each year. We will continue to explore ways to extend the scope of our home palliative care services to more patients. For example, with the increasing prevalence of chronic diseases, we are extending palliative care beyond traditional cancer care to benefit more non-cancer patients. Under the Agency for Integrated Care’s Holistic Care for Medically Advanced Patients Programme, patients with end-organ failure receive structured home palliative care to meet the diverse medical, nursing and psychosocial needs of the patients, thereby reducing crisis admissions to the hospitals. This programme targets to benefit over 3,000 end-organ failure patients over a five-year period, at a cost of about $12M funded by MOH.

11     Earlier in my speech, I touched on how patients sometimes transfer across different settings due to exacerbations that cannot be adequately managed in their current care setting. For these patients, coordination is important, as services are currently offered by different providers. MOH and the Tote Board Community Healthcare Fund are supporting Dover Park Hospice to pilot an integrated palliative home care model within the central region of Singapore. Dover Park Hospice is well positioned to pilot this model, as it has both inpatient hospice and home palliative care capabilities. It also works closely with Tan Tock Seng Hospital and surrounding nursing homes. Under this project, palliative home care patients can be directly admitted to the hospital or inpatient hospice if they are assessed to require higher-intensity care. This arrangement helps to smoothen the transition of patients across care settings, minimise visits to the emergency departments and facilitates timely care. This new integrated care model will also include case management, advance care planning and possibly the use of information technology, to enhance operational efficiency and quality of care for patients living in the community.

Supporting Caregivers

12     Adequate caregiver support is critical in supporting the patient to continue staying in the community. Caring for a loved one who is inflicted with life-limiting illnesses is tremendously distressing, both physically and mentally. Access to a strong network of support services would empower caregivers to better manage stress and become more effective caregivers to their loved ones.

13     Recognizing this importance of caregiver support, HCA Hospice Care was appointed by the National Council of Social Service in 2004 to be the national agency providing palliative caregivers training in Singapore. In 2011, these training sessions benefitted more than 500 caregivers. HCA Hospice Care will be enhancing their training curriculum and standardizing their training methods to maximise the effectiveness and outreach of their programmes.

Better Bereavement Support in the Community

14     The journey of care continues even after the patient passes on. For most people, the loss of a loved one brings grief and often triggers a multitude of feelings including sadness and anxiety. Although grief is a natural response to loss, bereaved individuals should be adequately supported to help them come to terms with their loss. I understand that Assisi Hospice and the Lien Centre for Palliative Care have piloted a project under the Tote Board Community Healthcare Fund initiative to look into research, education and clinical services for bereavement care in Singapore. This project, known as Project REBUILD, aims to raise awareness of grief and
bereavement care amongst both healthcare professionals and the public. This is done through a series of educational forums and training workshops. Through this project, I hope we can gain more insights on the needs of these families, and how we can enhance bereavement care in Singapore.

Closing

15     With better palliative home care services, caregiver training and bereavement care, we hope to strengthen palliative care in the community to enable more patients to be cared for in the comfort of their homes. In closing, let me thank the organizing committee once again for your hard work in hosting this platform for us to learn and network with one another. I wish everyone here a meaningful and fruitful time at this conference.

Thank you.