SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES AT THE LAUNCH OF THE DIGITAL ADVANCE CARE PLANNING TOOL

Mr Tan Chee Wee, CEO, Agency for Integrated Care

Ms Lim Sze Ling, CEO, ServiceSG

Partners

Families and friends

I am very happy to join everyone here at the ‘Plan Your Legacy Today!’ roadshow. I am here for a very important initiative, which is to launch the digital Advance Care Planning (ACP) tool.

National Strategy for Palliative Care

2.             We are an ageing population. End-of-life issues have become more important. One key issue is palliative care. Last year, the Lien Foundation survey affirmed what we know, which is that most of our seniors, in fact two-thirds of them, prefer to pass on peacefully in their home, in a familiar environment surrounded by loved ones, and without pain, if possible. This is the wish of most Singaporeans, based on our surveys, yet many are not able to do so.

3.             Hence, in 2023, we launched the National Strategy for Palliative Care. Under the Strategy, we did the following:

4.             First, we made palliative care much more affordable for Singaporeans. We raised subsidies and MediShield Life claim limits, and removed limits to MediSave withdrawal for palliative care patients. That helped many end-of-life patients.

5.             Second, we strengthened the palliative care capabilities in our community. Among our nursing homes, 62 (or around two thirds)  of them have now established partnerships with hospitals to develop their own palliative care capabilities. This means that when an old person in a nursing home is approaching end of life, we no longer need to shuttle them between hospital and nursing home to care for them. The nursing home will take care of them until their end of life, where they pass away peacefully in the nursing homes, often surrounded by family members.

6.             Third, we continue to expand palliative care capacity. When we launched the Strategy in 2023, home palliative care capacity was at 2,400 places. Capacity is totally dependent on manpower and our manpower can support 2,400 places. Inpatient hospice palliative care had about 260 beds. Now, from 2,400 home places, we have 3,000 places. For inpatient palliative care we now have about 300 beds, up from 260. This is about 25% increase for home palliative care and 15% increase for hospice beds. By end of this year, we are on track to reach 3,600 home palliative care places.

7.             Fourth, we smoothened the whole process from hospital-to-home transitions for palliative care patients. Across our public hospitals, we harmonised Compassionate Discharge protocols, making the process simpler for terminally ill patients to transit from hospitals to their home. We implemented the Equipment Rental Scheme, so that families can rent the equipment and place them at home at a very subsidised rate. The scheme has already benefitted more than 1,000 patients since we launched it in October last year.

8.             Our work has shown results after two years. For two consecutive years – 2022 and 2023 – 62.5% of deaths in Singapore happened in hospitals. In 2024, this has dropped to 59.8%. So it dropped slightly, by almost three percentage points.

9.             This appears to be a small improvement, but this small improvement happened only over two years. And more importantly, it translates into thousands of end-of-life patients being able to fulfil their wishes. Attitudes will take time to change, but we are encouraged that we are heading in the right direction.

Making Advance Care Plans More Accessible

10.          One area that we can still do better is to encourage more Singaporeans to plan ahead. Some may be aware of palliative care, and they have a preference for how their end-of-life care should be. But while they are healthy and well, most do not want to broach the subject with their parents and children.

11.          But it will be too late to do so when we have fallen very sick, and sometimes so sick that we cannot communicate what we want to our loved ones. At that time, our loved ones will be placed in a very difficult position to decide what the best care approach is. My loved one is sick in bed and suffering, but I do not know what the best way to care for them is, because I cannot ask what they prefer, and they are too sick to tell us by then. Family members will be in a difficult position, and so will the doctors. Sometimes they cannot agree, and that is when family disputes also happen. Many of our loved ones will feel guilty in making any decisions, asking themselves whether are they doing the best thing for their loved ones.

12.          We need more open and early conversations about future care needs. Don’t be pantang, but be open and honest. That way, we prepare ourselves emotionally and mentally for the future, together with our loved ones. Normalise the discussions. When we plan ahead, we not only safeguard our own preferences, we also make things easier and clearer for our families, doctors and healthcare teams later on.

13.          This is the purpose of an Advance Care Plan (ACP). It empowers you, while you are alert and healthy, to make informed decisions about your future healthcare preferences and let your loved ones know about it. In an ACP, you can state your personal values, care preferences and wishes. When you fall very sick and lose the capacity to make decisions, what you have made earlier will guide your family to act in your best interests.

14.          Today, only about 77,000 people have completed their ACPs. This is 40% higher than the national figure compared to last year, but it is still a very small number. The common reasons for not doing an ACPs are: One, they do not know it exists. I think many here do not know what an ACP is, and how to go about doing it. Two, those who know there is ACP, but find the process too troublesome because you have to make an appointment with an ACP facilitator, which may involve a fee and is time-consuming. Three, the forms are quite difficult to fill, with many sections to fill up. For all these reasons, people do not do their ACPs.

15.          We are tackling all three issues at the same time, by launching the new digital Advance Care Planning tool, called ‘myACP’, today.

16.          myACP is developed jointly by the Ministry of Health (MOH), Agency for Integrated Care (AIC) and Government Technology Agency (GovTech). It is an online, easy-to-use, guided tool. You can find it on the My Legacy@LifeSG platform. With myACP, there is no need to meet an ACP facilitator in person. You can do it online, and it is free. At no time will the ACP tool ask you to key in your bank account. If it is, it is a scam. The ACP tool is free. For someone generally healthy and aged 21 and above, you can self-document your care preferences and submit it online, and it will be in the system.

17.          However, if you have an existing serious illness, such as cancer or heart failure, you will need to reach out to your healthcare team or a certified ACP facilitator. For those who are generally healthy, we can file it ourselves online, and it is free. If you are sick, you will meet the facilitator, and they will help you fill up your ACP, taking into account your illness and condition.

18.          I am one of the first users of the online ACP tool. Before it was launched, I went in to test it out and filled up my ACP. I am 56 years old, but it is not too early for me to fill in my ACP. I can still change it, if my preferences change next year. But at least, based on my preferences, it is now recorded in myACP. It took me about 30 minutes to do it. I was asked some simple questions, such as how I want to be cared for should I become so sick that I cannot make decisions for myself. Therefore, what do you want your loved ones to do for you at that point of time? I was asked to indicate my preferences on hygiene, companionship (who do I want to be around with), and any religious requirements, which I stated I am a free-thinker. All these are straightforward. The most difficult question is quite sensitive. They asked me how I prefer to be cared for, if I am terminally ill – whether the doctor should prioritise managing my pain and letting me pass peacefully, or sustain my life with whatever it takes. I had to state those preferences.

19.          After filling everything up, myACP asked me to nominate two spokespersons. I nominated my wife and my elder daughter. Then I showed my ACP to all my family members. They may or may not agree with what I stated, but they all respected my wish. And when the time comes, which I hope it never comes, but if it ever comes, they will be in the position to carry out my wishes.

Plan Your Legacy

20.          With the myACP online tool, I hope more Singaporeans will plan your legacy today, which is also the theme of today’s roadshow. Other than ACP, the public can also learn about other legacy planning tools such as Lasting Power of Attorney (LPA), CPF nomination and wills. It stands for CLAW – CPF nomination, LPA, ACP and wills. I thank the various agencies and partners for organising today’s roadshow.

21.          Sometimes we ask ourselves the question “If I only have one day to live, what would I do?” The best answer I have come across is “I will live it like any other day. Because I have had a full life, with no regrets. I have done all the things I wish to do, and have told all my loved ones that I love them, and they have told me they love me. So I will live my last day just like any other day.” That is a good line.

22.          But that answer now is incomplete. We should add one more line to that answer, which is that I have also completed my CPF nomination, LPA, ACP and a will. That, I think will leave you a bright legacy.

23.          I hope everyone will find today’s roadshow meaningful. Thank you.