Speech by Mr Gan Kim Yong, Minister for Health, official opening of new facilities at Dover Park Hospice

1. Good morning and thank you for inviting me to be here with you today. It gives me great pleasure to join you for not just one but two events this morning – the official opening of Dover Park Hospice’s (or DPH’s) new facilities, and the unveiling of Singapore Hospice Council’s new logo together with the launch of its Community Outreach Programme.

2. In my speech at Assisi Hospice’s charity dinner two months ago, I mentioned that we have made good progress in developing palliative care services in Singapore. Nevertheless, it is important to recognise that much more needs to be done as the demand for palliative care is expected to increase in coming years. To prepare for this, we need to expand our hospice care services and workforce to make end-of-life care more accessible to Singaporeans.

Higher level of palliative care

3. With the rise of chronic conditions and as disease profiles evolve, the palliative care needs of our patients will change. For instance, while hospices have traditionally catered to cancer patients, they have in recent years, witnessed a growing demand from those who have non-cancer terminal illnesses such as end stage heart, lung and kidney failure. Patients at end-of-life would also increasingly require interventions such as intravenous antibiotics, blood transfusions or other procedures for pain relief or other treatment during the course of their illness. Today, patients who require such care may have to be transferred to an acute hospital. This is not ideal as patients are inconvenienced and such transfers could be avoided.

Building capabilities at Dover Park Hospice

4. Recognising the need for this higher level of sub-acute palliative care, DPH has as part of their philosophy of delivering patient-centric, holistic care for their patients, embarked on not only renewing its physical facilities but also  concurrently developing relevant capabilities to support this higher level of palliative care. MOH and the Tote Board had supported DPH in this initiative by committing close to S$1M over the past two years. With this funding, the hospice expanded its inpatient capacity by 25%¹ , upgraded its equipment and increased the number of care staff. Care staff have also been equipped with the requisite knowledge and skills to provide sub-acute nursing and psychosocial care.

5. With the expansion of its capabilities, DPH aims to reduce unnecessary patient admissions to the acute hospitals and allow their home palliative patients who require sub-acute palliative care to be admitted to the hospice directly from home. Patients in acute hospitals can also be transferred to a hospice earlier for interventions and resolution of other care issues.

6. I am glad to hear that DPH will be starting an integrated home palliative care service that will provide a comprehensive suite of services ranging from nursing and medical care to caregiver education and psychosocial care. This is in line with the MOH’s home-centric approach to care, where patients are cared for in familiar environments and in the company of their loved ones.

7. I commend DPH on your initiatives to expand capabilities in sub-acute and home palliative care which will go a long way to provide seamless, coordinated care to meet the needs of patients at the end-of-life.

8. There are other palliative care providers who, like DPH, want to do more and are ready to do more to serve patients at the end-of-life. To better respond to this, an overarching strategy at the national level has been developed to coordinate and provide the framework for the development of this sector.

National Strategy for Palliative Care

9. The Ministry of Health had in February 2011, commissioned the Lien Centre for Palliative Care at the Duke-NUS Graduate Medical School to formulate the National Strategy for Palliative Care, in consultation with the key stakeholders in the healthcare sector. A workgroup was formed, consisting of health professionals from the restructured hospitals, hospices, home care providers as well as representatives from public sector. The workgroup discussed and formulated its recommendations over a period of eight months and has since submitted its report to the Ministry of Health.

10.  The recommendations in the report can be broadly grouped under three key areas, namely: (a) service development; (b) training and research; and (c) public education and awareness. The Ministry of Health accepts the workgroup’s recommendations. Let me share a bit more about them.
11. One of the key recommendations under the service development thrust in the National Strategy is to organise the provision of palliative care based on the Regional Health System model. This is in line with the broader direction for our overall healthcare organisation and service development. An integrated system for the delivery of palliative care will ensure that patients are cared for in the most appropriate setting, and allow for seamless care as patients move from one setting to another. To achieve this, there needs to be effective collaboration and coordination among the palliative care providers in the public, private and VWO sectors.

12. The National Strategy workgroup also recommended developing capabilities across the health care system to care for patients at the end- of-life. To encourage the integration of palliative care into mainstream healthcare delivery, health care professionals ranging from specialists to family physicians, nurses and allied health care professionals should be equipped with the wherewithal to care for patients with life-limiting illnesses. To this end, we will work with the Lien Centre for Palliative Care, the universities and polytechnics to incorporate palliative care training in relevant undergraduate and diploma courses. At the same time, we also encourage continual research in palliative care service models that can be adapted to suit the unique Singapore context, in terms of our culture and values, as well as our healthcare system and financing.

13. The National Strategy also highlighted the importance of public education initiatives to raise awareness of end-of-life issues and palliative care services in Singapore. The report emphasised the need for a coordinated and concerted outreach effort in promoting palliative care. I note that the Community Outreach Programme that the Singapore Hospice Council is launching this morning is in line with this recommendation. Through grassroots activities such as constituency events and talks, the Council aims to raise public awareness of palliative care services and promote greater discussions on end-of-life issues amongst the community.

14. In short, this three-pronged approach of service development, training and research, and raising public awareness of the National Strategy will impact positively on the quality of life for patients and their families. My Ministry will be appointing an Implementation Taskforce over the next few weeks to study the suggestions in greater detail before implementing the strategies at a national level.

15. Our palliative care partners will continue to play a key role in implementing this National Strategy. For example, the implementation taskforce will collaborate closely with the Lien Centre on training and research in palliative care. MOH will also continue to work with non-government organisations such as the Lien Foundation and Singapore Hospice Council to promote greater understanding of palliative care.

16. I would like to take this opportunity to acknowledge the Lien Centre for Palliative Care and the workgroup for the commitment and hard work in developing the National Strategy. The report will be made available on MOH’s website and I encourage the public to provide feedback on the strategy.

17. Once again, I congratulate DPH on the official opening of your new wing and facilities and I wish all of you a pleasant and enjoyable morning.

_{¹ Increase by 10 beds from 40 to 50 beds.}