SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES, AT THE 9TH SINGAPORE PALLIATIVE CARE CONFERENCE, 18 APRIL 2026

Mr Robert Chew, Chairman, Singapore Hospice Council

Dr Jennifer Guan, Chairman, Organising Committee of the 9th Singapore Palliative Care Conference (SPCC)

Distinguished guests

Ladies and gentlemen

1.            I am happy to join you today at the 9th SPCC.

Taking Stock of Progress

2.            The majority of Singaporeans – two-thirds – say they prefer to pass on peacefully at home, in a familiar environment, surrounded by loved ones and preferably without pain. Yet in 2023, the opposite was happening – almost two-thirds of Singapore residents died in hospitals.

3.            That was the year MOH launched the refreshed National Strategy for Palliative Care.  We instituted a compassionate discharge procedure in all our public hospitals, we trained the medical teams in nursing homes in palliative care, so that nursing home residents pass on in the nursing home, as opposed to going to the hospitals. We have also been increasing funding support for hospices, so that they can expand their service capacity.

4.            Over the two years, we have made progress. Two years ago, 46% of those who died in Singapore received palliative care in their last year of life.  Now, 46% has increased to 51%.

5.            In 2023, our home-based palliative care capacity was about 2,400, Robert mentioned this. Now, it is more than 3,600 places – a 50% increase. Inpatient hospice capacity increased also by about a third, to currently 330 beds.

6.            Many nursing homes are also building palliative care capabilities through partnerships with hospitals, so that patients need not be transferred back to hospitals at the end of life.

7.            And so, all these reflect a gradual but important shift in how our society approaches end-of-life care. We are moving from asking what more treatment we can provide, to what care is appropriate, and what truly serves the patient's best interests.

8.            But a lot more needs to be done. The imperative is best illustrated by the percentage of Singapore residents who died in hospitals. It fell, 2023 was  62.5% and then in 2024 it was about 60%, but it has remained about the same level since 2025. So we were very happy, in the first two years it dropped, dropped, dropped, almost a three-percentage point drop and after that, it got stuck.  So, it will appear that we have hit a limit.  

9.            And this outcome is consistent with our observation on the ground. While more patients are receiving palliative care, many of them do so in acute hospitals. If they are not discharged to receive palliative care in community settings such as at home or in hospices, it is natural that they will pass on in hospitals. And for many of them, actually that’s not their preference.    

10.         Indeed, the proportion of patients receiving palliative care in acute hospitals has grown by about 17% annually on average, which is significant. Even for patients already referred to community palliative care, we see more of them returning to hospitals, where they ultimately pass away. 

11.         We know that most Singaporeans wish to pass on peacefully and comfortably at home. Through palliative care in the acute hospital setting, we are fulfilling only half of their dying wish.

Strengthening Care in the Community

12.         We believe the key constraint to home palliative care today, is that families and caregivers do not feel ready or confident to carry out the care tasks, especially when procedures can be complex or unexpected. Further, patients and families may still seek active treatment for their loved ones, even though they are already on palliative care. 

13.         To better anchor palliative care in the community, we have to do a few things. We first need to make palliative care skills ubiquitous in our healthcare system. It is not just for palliative care professionals; it becomes quite a basic skill throughout the system. We have developed and implemented the Palliative Nursing Competency Framework across public healthcare clusters, that’s in 2022, and this is a structured way to develop palliative care skills in nurses.  But we need to deliver the training more flexibly, more broadly. 

14.         Not everyone needs to acquire full qualifications before they can practise palliative care. They can pick up the basics, practise alongside more experienced palliative care practitioners, and then stack up more advanced skills later on. 

15.         Standards of practice and training are therefore not compromised. But instead of treating palliative care as specialised skills for a small group of healthcare workers, it is about upgrading core skills for as many healthcare workers as possible.

16.         Our local polytechnics are therefore restructuring their Advanced Diploma in Palliative Care to a standardised six-month duration, only six months, comprising stackable modules with 70% of the time dedicated to on-the-job training. The Lee Kong Chian School of Medicine also offers a stackable Master’s programme in holistic palliative care. 

17.         We should set an ambitious target to make palliative care training widespread. Every time I push the officers they will say, how about a few hundred. I say by 2030, let’s train 10,000 nurses, healthcare workers, in generalist palliative care competencies. And 10,000 is over one-fifth of our national nursing workforce. And this will empower our nurses to manage physical needs, while also supporting patients’ emotional and spiritual well-being at the end of life. 

18.         We should also go beyond nurses, to equip family physicians, allied health practitioners, and community care workers with the same skills. In doing so, we can better support patients seamlessly through every stage of their journey.

19.         Second thing we must do, if we succeed in training more manpower in palliative care, next thing we should do is strengthen support around patients and caregivers – put those skills into use. That way, patients and families have greater confidence to undergo palliative care at home. You just imagine, if GPs are trained in palliative care, a palliative care patient at home, when an emergency arises, they have someone to call. They can call their Healthier SG GP, who can also provide palliative care services. They can call the community nurse nearby at the AAC (Active Ageing Centre), who can also provide palliative care services. That is the flexibility and the ubiquitous skills that we want to achieve. Family members and caregivers are learning constantly, boosting their confidence. Should there be an emergency, someone whether the GP or a community nurse can turn up at short notice to provide the necessary support.

20.         In this regard, the Singapore Hospice Council has been leading the Compassionate Communities Singapore movement since November 2025, by bringing together organisations, workplaces, schools, religious groups and grassroots partners. And I hope you continue that effort.    

21.         Third thing, we need to help patients make their preferences known to their caregivers and their doctors. But the topic of death is seldom raised in family discussions.  To some, in Malay in Chinese, we say pantang, it is unlucky to talk about it. To many family members, to suggest palliative care may be seen as a lack of filial piety.  

22.         We can help make the preferences of patients known, through tools such as the Advance Care Planning (ACP). ACP normalises discussions about end-of-life care preferences and enables individuals to plan them. To encourage ACP uptake, we launched the digital myACP tool in July 2025. I was the first one to file my ACP, for beta testing. And individuals can self-document care preferences for free, and it’s so much easier to do than an AMD (Advance Medical Directive).

23.         Earlier this year, we also launched the ACP Care Protocol under Healthier SG, to support GPs to facilitate earlier conversations with their patients on their future care needs. So with these efforts, ACP completion rates have increased steadily. More than 30,000 ACPs were completed in 2025 – doubled from 2024. The increase is significant and impressive, but from a low base, so let’s all recognise that I think more can be done for people to file their ACPs.

24.         Final point, we should continue to make palliative care very affordable. In 2024, we increased subsidies for all community palliative care services, and we raised MediShield Life claim limits for inpatient palliative care. We also removed the lifetime withdrawal limit for patients tapping on their own MediSave savings for day hospice and home palliative care. And this has helped many patients defray medical costs at their end of life. In fact, we should create a situation where end-of-life patients know that it’s practically free. The Government will cover most of it through subsidies, through MediShield Life, MediSave, remainder donors will cover. And actually, that is a very good assurance for our patients. We should not have a situation where they don’t know how to navigate. They should in fact be the opposite, palliative care we know is almost free. Somehow, we will make it almost free.  

25.         However, patients may still face considerable residual expenses, such as non-medical costs like transport expenses and adult diapers, rental of hospital beds sometimes, hiring of caregivers and potential income loss due to caregiving responsibilities by family members.  

26.         Recognising this, we have the Reduced Life Expectancy Scheme in place. So under this CPF scheme, patients medically certified to be approaching their end of life can withdraw their CPF savings. 

27.         But not everyone needs or wants to tap on the scheme. However, for those who do, we will help make it easier for them to do so. We will explore ways to improve awareness of the scheme for eligible patients. We will also streamline the referral and approval processes, so that we avoid multiple clinical assessments where feasible in the future.

The Hardest Part: Decision-making at the End of Life

28.         We can do our best to overcome the constraints, whether it is logistical, whether it is financial, to better fulfil the wishes of patients, but ultimately, the strongest determining factor in accepting palliative care is to reconcile the difficult dilemmas. Patients, their families and their doctors navigate complex emotions like hope, fear and uncertainty when confronted with the decision.

29.         For a patient, when we are young and healthy, many of us would say we would prefer comfort care over aggressive treatment or suffering. So, the survey results we’ve been getting is not surprising at all. We might even specify that in our ACPs, like me. But when the illness becomes real, perspectives sometimes can change. Some patients may wish to continue to pursue treatment, driven by hope, by unfulfilled wishes, and the instinct to fight on, even when medical options are limited.

30.         Doctors also face significant tension. The instinct to “do more” is strong, up to the point when treatment is no longer beneficial for the patient. It takes experience and wisdom, calmness, to know when that point has arrived.

31.         Families carry a heavy burden. Primary caregivers may struggle with guilt – whether they have done enough or could have done more, whether decisions made were right, and whether accepting palliative care means forgoing responsibility. Other family members may step in later, with different views. This can place additional pressures on those already bearing the responsibility of care.

32.         And these are the realities of end-of-life care. The journey is never linear, because emotions, perspectives and circumstances evolve. And as we continue to strengthen our system, we must also support patients, families and healthcare professionals to find balance across all these contrasting perspectives.

33.         This means always respecting what is in the patient’s best interest; giving medical care a fair run, while respecting patients’ wishes; and helping families come to terms with the difficult reality that more treatment may not always equate to better care.

34.         And this is a balance that needs to be struck for every patient. Beyond funding, support systems and trained healthcare workers, the most important work that needs to be done for palliative care is in its humanistic acceptance. That caring for a person does not necessarily always mean treating the disease, and that the value and dignity of a human being transcend his or her physical health.     

35.         I wish you a successful and meaningful conference. Thank you.