Palliative care for ageing population

18 Oct 2010

Question No:  564   

Question

Name of the Person: Mr Laurence Wee Yoke Thong

To ask the Minister for Health in view of our rapidly ageing population (a) what further challenges and issues are faced in palliative care; and (b) what is being done to increase community support services in the end-of-life care sector.

Reply

Reply From MOH

1. End-of-life care is a delicate and complex issue.  The challenges it throws up are many; addressing them is a preoccupation among healthcare providers in many societies. 

2. In Singapore, we have made a lot of progress, particularly in recent years and are now much better prepared.  But much more still needs to be done.

3. Supply side constraints are real, in terms of availability of skilled resources.  We are expanding capacity and raising capabilities through greater investment in this area.  My Ministry is committed to this.  I have shared our plans on this before in this House and I will not repeat them.  At the end of the day, resource constraints are easier to fix. 

4. More difficult to fix are attitudinal constraints: both of the patients, their family members, as well as of the doctors.  Acknowledging the limits of medical science and human mortality is easier said than done, especially when it involves ourselves and our loved ones.  Changing attitudes takes time and we should be patient. The key is greater dialogue, more sharing of experiences, raising awareness and empathy. 

5. Within the healthcare sector, we are promoting advance care planning (ACP), to facilitate greater dialogue between patients, families and the healthcare professionals on end-of-life care and treatment decisions. The aim is to empower patients and families to participate in decision making and express their wishes for treatment and care preferences, through facilitated discussions. My Ministry is also working to reinforce ACP to doctors, nurses and other healthcare professionals, through targeted training and awareness sessions.

6. We know that many terminally-ill patients prefer to spend their last days at home, in familiar surroundings accompanied by their loved ones. We should support these preferences as far as practicable by growing community support services for home palliative care.

7. This is not just in medical and nursing care, but also in psychosocial support. This is particularly important for patients with young children or complicated family relationships as it helps the surviving family members come to terms with the patient’s impending passing. We are working to support the efforts of the hospice care community in providing this vital service. We are also working with the hospice community to have more day facilities to meet the care needs of these patients.

8. Some terminally ill patients end up in nursing homes.  Tan Tock Seng Hospital and Dover Park Hospice have started a pilot programme to improve end-of-life care in nursing homes. As the outcomes are promising, we are expanding the programme progressively across more regions in Singapore.