Dr Neo Han Yee, Chairman, Organising Committee, Singapore Palliative Care Conference
Dr Patricia Neo, Chairperson, Singapore Hospice Council
Distinguished Guests
Ladies and Gentlemen
1 It is my pleasure to join you here at the first virtual 7th Singapore Palliative Care Conference.
Palliative Care During COVID-19
2 COVID-19 has put our healthcare system and workforce under considerable stress. It has been all hands on-deck, and every part of the system contributed to our national response. While we expect future transmission waves to come, just like what other countries have experienced, I really hope the worst of the pandemic is behind us.
3 In this regard, I want to thank the palliative care sector for your contribution, resilience and adaptability over the past 22 months.
4 When ICU cases were rising, hospital palliative care teams rallied and supported your ICU colleagues. You worked tirelessly to alleviate the sufferings of patients who were very severely ill. You stepped forward and provided care and comfort to patients at home. Hospices pivoted to virtual platforms to conduct programmes, befriending services and tele-consultations to continue supporting patients’ well-being.
5 So thank you for stepping up so competently, in the nation’s hour of need.
Rising Importance of Palliative Care
6 Beyond COVID-19, we need to raise the awareness of the importance of palliative care. To do so, we need to address the mismatch of expectations and desires that exist today.
7 Let me explain. Given the typical decline in a patient’s health towards the end of life, a large part of our lifetime healthcare expenditure is actually incurred in the last 90 days of our lives. I raise this not as a financial issue, but for us to appreciate the amount of drugs we have to take, the surgeries we have to go through and the number of tubes attached to our bodies, as we approach the end of our lives. The question is whether this is truly what we want our journeys in life to end.
8 From the perspective of some many loved ones, we hold dear to values that emphasise filial piety, familial support and care. Many of us will do whatever we can to ensure that our family members, often our elders, receive the best possible care to recover from their illnesses, however slim the chances are.
9 But from the perspective of the elderly patient, many prefer to spend their last days in the comfort of their homes, in a familiar environment and in the presence of loved ones. Going through traumatic treatments and then dying alone in a hospital, is the last thing they want. Yet this is what many have to go through.
10 We need to reconcile these two desires and the answer lies in the advancement of palliative care and raising the awareness of its importance.
National Strategy for Palliative Care
11 The Ministry of Health (MOH) has developed a National Strategy for palliative care. This has allowed us to make good progress in enabling dignified, and for lack of a better word, good quality of death.
12 According to the Economist Intelligence Unit’s Quality of Death Index, Singapore improved from 18th to 12th out of 40 countries from 2010 to 2015 and we are now ranked 2nd in Asia.
13 We will continue to evolve and improve our National Strategy for palliative care, especially given our rapidly ageing population and the following are areas that we will continue to work on:
First, support caregivers. Caring for loved ones in their last days at home can be physically and emotionally draining. To reduce the risk of caregivers burn-out, MOH has since 2019 implemented a Home-Based Respite Care pilot to allow caregivers some rest while a trained caregiver steps in temporarily to care for their loved ones.
Feedback from the scheme has been promising, with close to 80% of caregivers indicating that they experienced a reduction in caregiving burden after using the service and based on this positive feedback, MOH is studying ways to extend the programme.
14 Second, expand palliative care capacity. MOH will ensure sufficient capacity to meet the growing demand for palliative care services. The number of day hospice places has increased steadily over the years as demand for care in the community grows, by over 60% since 2017, to about 160 places today.
15 In addition, MOH has launched the Inpatient Hospice Palliative Care Service in 2020. Recognising that many patients have complex care needs towards end of life, the Palliative Care Service consolidates care services offered in community hospitals and inpatient hospices, into a single service type. This minimises the need to transfer the patients to different care facilities. Today, there are about 250 inpatient hospice places, in addition to the 160 day hospice places I mentioned earlier. And we plan to have more of such beds in upcoming healthcare facilities over the next few years.
16 We are also expanding the number of home palliative care places. This will ensure that those who prefer to pass on at home would be able to do so. Patients would receive clinical, psychological, emotional and spiritual care during visits from the home palliative care team. The palliative care teams will also train caregivers in the family. As of 2020, there are around 3,100 home palliative care places at any one time and MOH is building the capability to support more families and this is really the area that will move the needle.
17 Third, raise palliative care capability. Healthcare, including palliative care, is highly dependent on competent and qualified workers. This is why we have invested significantly in palliative care training for healthcare workers. The Graduate Diploma in Palliative Medicine that was launched to encourage doctors in community settings to be equipped with the relevant skills and knowledge to deliver good quality palliative care. To date, it has trained more than 100 doctors.
18 Further, the National Guidelines for Palliative Care set standards to steer the sector towards provision of good quality clinical and psychosocial care. The Lien Centre for Palliative Care, and the Palliative Care Centre for Excellence in Research and Education are the key partners in educating and training healthcare workers. Together with the Singapore Hospice Council, almost 11,000 healthcare workers have been trained to provide palliative care.
19 And finally, last thing we need to do, and the more importantly, we need to discuss the sensitive issue of deaths more openly and more honestly. This is probably the most important thing we need to do. It has to happen within families, between patients and doctors, and amongst members of our society and healthcare fraternity. It is one way to bridge the mismatch of expectations and desires I spoke out about earlier between a dying patient and his loved ones.
20 This is why more people are realising the value of Advance Care Planning over the years as a tool to document their healthcare preferences in the event they lose mental capacity to speak for themselves. In the last 10 years, Advance Care Planning has been on the increase, with over 27,000 lodged nationally. To encourage more of such honest conversations with family and healthcare staff, there have been various efforts to normalise death and dying as a topic. A local arts company, Both Sides Now, has used immersive arts experiences to reach a wide variety of audiences. The responses to its programme has been encouraging. In the last run of the programme which ended in 2019, it engaged over 12,000 individuals and trained over 300 volunteers in Advanced Care Planning advocacy.
21 Since 2017, the Singapore Hospice Council has championed a “Live Well, Leave Well” public engagement campaign through TV commercials and social media. More student groups in tertiary institutions are also taking steps to raise awareness of end-of-life matters amongst their generation. One example is a project called Project Happy Apples by NUS medical school students.
22 What I have mentioned are just a handful of efforts, often ground up. But I think there is an increase in awareness of end-of-life issues. Family members must feel comfortable that putting their loved ones through palliative care fulfills the desire of the dying and is in fact an act of love. It is a social attitude, which requires time to shift. When it does, it will be for the better.
Conclusion
23 The theme of today’s conference is “Embrace. Engage. Envision.” I hope it marks the start of a more honest conversation on end-of-life matters in our society. By embracing the deeply personal concerns of patients and their loved ones, we can bridge the divide and recognise the importance of palliative care. We can then engage various stakeholders, in mobilising resources and building capabilities to develop the sector. Then we can envision a future where we can bring dignity, solace and comfort to the great majority of the dying.
24 Last but not least, the Singapore Hospice Council celebrated its 25th anniversary earlier this year, 2021. I would like to thank the Singapore Hospice Council and all practitioners for the good work over the past two and a half decades.
25 I wish everyone a fruitful conference.