Speech by Mr Gan Kim Yong, Minister for Health, at Assisi Hospice’s Charity Dinner 2011, Pan Pacific Singapore, 7 November 2011

A very good evening to one and all. I am happy to be here tonight at Assisi Hospice’s 42nd anniversary and charity dinner 2011. I understand that many of you here are long-time supporters and donors of Assisi Hospice. Thank you for your generous and unwavering support for the cause of Assisi Hospice.

Refining end-of-life care to suit changing healthcare needs

2    Some of you may have read about the Primary Care Workplan Seminar organised by the Ministry of Health last month. We had shared during the Seminar how the demand for chronic care in Singapore has risen significantly due to an ageing population, longer life expectancy and changing lifestyles. With these evolving healthcare challenges we need to fine-tune the way primary care is delivered.

3    This changing healthcare landscape has similar consequences for end-of-life care as well. With longer life expectancy and the rise in chronic diseases, the medical care which people require at the end of life will change significantly. For example, while deaths in the past often occurred due to acute illnesses such as infections or heart attacks, deaths today increasingly come after a period of progressive disability due to an incurable condition, such as advanced cancer, progressive organ failure or advanced dementia. While the palliative care sector had historically focused on patients with advanced cancer, there is increasing recognition that patients with non-cancer conditions can also benefit from palliative care. Hence, we need to continuously modify our care model in order to respond to changing disease profiles and tackle new sets of medical complexities and challenges effectively.

Progress in the palliative care sector in Singapore

4    We have made good progress in developing palliative care services in Singapore. Improving accessibility is one. While palliative care services here began as home hospice services and inpatient hospices, such services are now also available in acute hospitals and piloted in a few nursing homes. We are enhancing home hospice services so that more patients can receive palliative care at home, in familiar surroundings with their loved ones around them. Today, we have seven inpatient and home hospice providers, serving about 5,000 palliative care patients yearly.

5    We will continue to invest in expanding and training our healthcare professionals in palliative care. For example, the number of nurses trained in palliative care has increased by about 14% over the past year, from 257 in 2010 to about 300 in 2011.

6    We are also doing more to ensure that Singaporeans continue to receive good quality palliative care. The Ministry of Health has commissioned the Lien Centre for Palliative Care to formulate a National Strategy for Palliative Care, in consultation with the palliative care community. The strategy will shape our local care delivery models based on the best clinical evidence available here and overseas, and will help determine the resources needed to realise this vision in our local context. MOH, together with Lien Centre and partners, will share more about the Strategy soon.

Making choices on end-of-life care

7    Even as we develop and put in place policies to address our society’s end-of-life care needs, we need to recognise that ultimately, death cannot be avoided.  However, while death is inevitable, it need not be filled with agony and helplessness. We can actively make choices on our care preferences at the end of life before the debilitating illness strikes us. By then, it is probably not the most ideal time to make such considerations. Through Advance Care Planning (ACP), we encourage patients, families and the healthcare professionals to engage in greater discussions on end-of-life care and treatment decisions before palliative care is required. This is already beginning to take place in some of our hospitals and nursing homes today. For example, under Project CARE#, seven nursing homes in the central region are collaborating with Tan Tock Seng Hospital to improve their palliative care and ACP capabilities. Preliminary results of this pilot have been encouraging and we intend to scale up such initiatives across the healthcare continuum in the coming few years.

Raising awareness of palliative care

8    We also need to improve the public and patient’s understanding of palliative care, in tandem with our initiatives to improve the sector. There are unfortunately still many misconceptions and taboos related to death and end-of-life issues. For example, some hospice care workers had shared with me that some patients and family members of patients referred for palliative care sometimes decline the referral as they see palliative care as ‘futile care’. I thought it was a lost opportunity for the patient and family to make the patient’s final journey as meaningful and comfortable as possible, and avoid inflicting unnecessary pain and suffering to the natural process of dying. My Ministry will continue to partner the palliative care community in raising awareness of end-of-life issues in Singapore.

Palliative care is as much an art as a science

9    In many ways, palliative care is as much an art as a science. Science, as we all know it, is the drugs and medical equipment that can help to relief the physical pain and suffering brought about by the patient’s medical ailments. At the same time, I see palliative care as an art which concerns how medical personnel, staff and volunteers interact with patients in a way that improves their care. This approach involves that special human touch and compassion delivered to patients at the end of life. It takes into consideration the humanity of the patient, and involves listening to and respecting the patient’s wishes on their care preferences. The integration of art and science is not easy. However, when done well, it will go a long way to improve the patient’s final journey.

10    Assisi Hospice has done well in delivering such personalised care. During my recent visit to the hospice, I was touched by the dedication of the care staff and volunteers in helping patients maximise the quality of life, in the face of terminal illness.  Besides caring for the patients, the staff paid much attention to the feelings and wishes of the patients. They also extended their support and care to the patients’ families, through family counselling, caregiver support and training, and even bereavement care after the patients pass on. The environment of the hospice also facilitated patient privacy and respect for patients from various religious backgrounds.

11     As earlier mentioned by Ronny in his speech, the Ministry of Health is working closely with Assisi Hospice on its proposed redevelopment plans. We envisage the new Assisi Hospice to have expanded inpatient, day care as well as home hospice care capacities to better meet the increasing palliative care needs of the community. We are also working with Assisi Hospice on setting aside spaces in the new hospice for the training and education of caregivers and other healthcare professionals. This will help Assisi Hospice to develop itself as a centre of excellence in research and training in palliative care. I am confident that with this redevelopment, coupled with continued commitment and effective leadership from the Board and management, Assisi Hospice will be well-positioned to continue delivering quality palliative care to the community.

12    Assisi Hospice will need the support of the community to fulfill its mission. Please contribute generously to tonight’s fund raising drive. Your contributions will go a long way to helping many patients at the end of life who require palliative care.

13    I wish all of you a pleasant and enjoyable evening.