Speech by Mr Gan Kim Yong, Minister for Health, at the opening of the Asia Pacific Hospice Conference, 27 July 2017

Dr R Akhileswaran and A/Prof Cynthia Goh, Co-Chairs, APHC 2017 Organising Committee

Dr Angel Lee, Chair, Singapore Hospice Council

Distinguished Guests

Ladies and gentlemen

1          Good morning. It gives me great pleasure to join you at the 12^th Asia Pacific Hospice Conference. I would like to extend a warm welcome to our overseas friends and distinguished speakers.

2          50 years ago, Dame Cicely Saunders founded St Christopher’s Hospice in London, marking the start of the modern hospice movement. She introduced a system of pain management and provided dignity, compassion and respect in caring for the dying. Following these principles, St Joseph’s Home started a 16-bed hospice in 1985 to bring better end-of-life care to Singapore. Over the past three decades, hospice or palliative care have become an integral part of Singapore’s healthcare system. This is due in no small part to the hard work and dedication of all those in the sector, and particularly the many pioneers who spearheaded this movement. I understand a number of them are here with us this morning. 

3          Palliative care will continue to increase in importance not only in Singapore but also around the world. This is especially so in Asia which faces the challenges of a rapidly ageing population. Therefore, there is urgency in planning care delivery for our aged, including palliative care. 

PALLIATIVE CARE PLAN

4          Over the past 3 years, Singapore has invested significantly in developing palliative care services as part of our efforts to cater to the needs of our ageing population. We announced a palliative care plan three years ago to systematically develop the palliative care sector along four thrusts. We have made good progress.

5          First, we are improving accessibility to services. We have doubled the number of inpatient palliative care beds from 118 in 2011 to about 230 beds today. We have increased the number of home palliative care places from 3,800 in 2011 to 5,500 in 2016. We are also working to ramp up day hospice capacity nationally. 

6          Second, we are enhancing quality. The Singapore Hospice Council, or SHC, developed the National Guidelines for Palliative Care with industry support in 2014. SHC is working with the providers to encourage adoption of these guidelines to improve care. We have also worked to better equip our doctors through courses such as the Graduate Diploma in Palliative Medicine (GDPM), launched three years ago. To date, about 40 doctors have graduated with a GDPM and 20 more are undergoing training. 

7          Third, we are increasing affordability. Over the past few years, we have increased subsidies as well as Medisave withdrawal limits for inpatient hospice and home palliative care. We will be extending subsidies to paediatric home palliative care from next month to better support children with life limiting conditions and their families. 

8          Fourth, we are strengthening public awareness. In many Asian societies like ours, death is a sensitive topic and we tend to avoid talking about it. Hence, we worked with community partners to bring end-of-life conversations to the community in a relevant yet sensitive manner. For example, the “Both Sides Now” puppetry show conducted at 30 Senior Centres by arts groups ArtsWok and Dramabox last year allowed our seniors to reflect and talk about end-of-life issues frankly and meaningfully. 

9          We are also encouraging Advance Care Planning, or ACP, which involves having ongoing conversations with our loved ones about one’s own care preferences towards the end of life. Since 2011, MOH has invested in the training to build ACP-related capabilities within our public healthcare institutions. To date, the Agency for Integrated Care (AIC) has trained over 2,000 ACP facilitators and advocates. These efforts have benefited more than 10,000 Singaporeans. 

BUILDING ON OUR PROGRESS 

10        But we can still do more.  As individuals, many of us equate healthcare with extending longevity. Yet, there will come a time when medical interventions may no longer make us better, and may not reduce our pain and suffering. We can think about and communicate early our care preferences at end-of-life. This will spare our loved ones the stress of making decisions on our behalf when they are not aware of our preferences. Medical professionals need to be ready to start conversations on what is appropriate care for the patients they look after. 

11        The Eastern Heath Alliance and National Healthcare Group will design and pilot integrated home palliative care programmes to better care for patients with non-cancer conditions. This area is still relatively new compared to palliative care for cancer conditions. These new programmes aim to enable our patients requiring palliative care to be cared for at home through a comprehensive care package that includes both social support and medical care. Over the next 5 years, NHG and EHA hope to serve about 3,000 patients collectively and honour their care preferences. 

12        At the national level, MOH is establishing a strategic partnership with the Singapore Hospice Council (SHC) to further raise public awareness and improve the quality of palliative care. 

13        First, we will work with SHC to introduce a 3-year quality improvement (QI) programme for the sector. The programme will address existing service gaps and seek to upskill providers to meet the national guidelines. It will train at least 60 staff from SHC member organisations to entrench a quality improvement culture.

14        Second, we will expand efforts to foster greater conversations about end-of-life care in the community and encourage earlier conversations. Over the next four years, we will work with our community partners, the Regional Healthcare Systems and AIC to raise awareness of ACP and initiate ACP conversations earlier at more touch points in the community, such as primary care and specialist outpatient clinics. We aim to reach out to 100,000 Singaporeans over the next 4 years. 

15        Third, we will continue our efforts to reach out to more Singaporeans to raise public awareness on palliative care through different channels. The SHC will be developing community engagement kits, an easy to use information pack featuring information on various topics related to end-of-life issues, including hospice and palliative care services, ACP, Lasting Power of Attorney (LPA) and Advance Medical Directive (AMD) to help patients and their caregivers better plan for care at end-of-life. Caregivers play an important role in caring for palliative care patients. SHC will also look into the needs of caregivers and devise better ways to support them during this difficult period. With better awareness, more will be encouraged to ‘Talk, Plan, Live’ on the issues that really matter to them. 

CONCLUSION 

16        On this note, I am encouraged by the theme of today’s conference - “Greater than the Sum of Its Parts”. This highlights the many helping hands approach that we have taken to make palliative care more accessible, affordable and of good quality for Singaporeans. I look forward to closer collaboration among our partners and stakeholders. 

17        In closing, I would like to thank the Singapore Hospice Council and the Asia Pacific Hospice Palliative Care Network (APHN) for putting together this conference. I trust that the discussions over the next 3 days will both challenge and inspire us to advance palliative care in the region. I wish you a fruitful conference. Thank you.