Ms Denise Phua, Mayor of Central Singapore District
Professor Joe Sim, Group CEO, National Healthcare Group
Associate Professor Jeremy Lim, Chairman, Dover Park Hospice
Professor Eugene Fidelis Soh, CEO, Tan Tock Seng Hospital
Dr Liew Li Lian, CEO, Dover Park Hospice
Colleagues and friends
During my last visit here in October, eight wards were opened. Today, 14 out of 18 wards are operational, and the remaining will be ready soon. It is my pleasure to be back here this afternoon to officially open the Integrated Care Hub.
2. This Hub complements the work of Tan Tock Seng Hospital (TTSH). I know there are three specialised care streams here, but I have summarised them to two scenarios under which a patient leaves an acute care hospital like TTSH. One, the patient is regaining his or her health and coming back into normal life. In which case, the Integrated Care Hub will help the patient regain their mobility and independence, and return to their normal lives faster and smoother.
3. Two is when a patient is unfortunately approaching the end of his or her life journey. Death and dying are an inevitable passage of life. Hence, Dover Park Hospice moved into this Hub, making palliative care a key stream of care here. When faced with the inevitability of death, many Singaporeans wish to pass on at home. The Hub will try to fulfill as many of our wishes as possible.
4. Two very different scenarios, but both will be given the best possible care and attention. Let me talk about each of them in turn.
Rehabilitation
5. First, rehabilitation and recovery. The TTSH Rehabilitation Centre recently marked 50 years of specialised rehabilitation care when the team moved from its temporary home in Ang Mo Kio-Thye Hua Kwan Hospital to this Hub.
6. There is a range of specialised rehabilitation interventions and research programmes here. One of them is called “RESTORES” — a research trial collaboration between TTSH and the National Neuroscience Institute to treat patients with complete spinal cord injury. By inserting electrodes into the spinal cords, the signals to the brain are boosted. This is followed by customised and intensive rehabilitation, so that patients could possibly achieve voluntary movement of their legs, and maybe even walk again with aid.
7. TTSH is also the first in Singapore to provide rehabilitation for patients on ventilators. The programme has helped shorten patients’ overall hospital length of stay by an average of 81 days, from 216 days to 135 days.
8. More effort is devoted to ensure that care continues beyond patients’ stay at this facility. Here, patients and families are engaged early, to help them make plans for the long-term care of their loved ones after discharge. Caregivers are also trained to increase their confidence and skills to meet patients’ long-term care needs at home.
Palliative Care
9. Let me now talk about the next important stream of care, which is palliative care.
10. We launched the National Strategy for Palliative Care in July 2023, and have made progress in its implementation. It is early days, but we are seeing some signs of more deaths shifting out of hospitals into palliative settings, either at home or inpatient hospices. But much more work remains to be done.
11. We are implementing several important initiatives. First, we have standardised and streamlined across all public hospitals, the process of transferring a dying patient out of a hospital to spend their final days at home. This includes standardising the name of the process by calling it “compassionate discharge”.
12. The practices used to be different across hospitals, and sometimes even different within hospitals, across departments. Now, they are consistent and clear, with better coordination amongst different hospital departments and home hospice teams, and more hospital staff trained to manage the entire process.
13. Second, since February this year, we have enhanced the support for palliative care in a significant way. This includes removing the lifetime MediSave withdrawal limit for all home palliative and day hospice patients and also raising the MediShield Life daily claim limits for inpatient palliative care. Soon, we will effect a step jump in the level of subsidy for palliative care.
14. We have been encouraging palliative care providers to expand their capacity. As a result, home palliative capacity has increased from around 2,000 in July last year when we made the announcements, to 2,400 now. This is a 20% increase. We expect a further expansion to 2,800 by end of this year, and to 3,600, by end of next year. By then, we would have almost doubled the home palliative care capacity from the point of announcing the new measures.
15. I know capacity expansion is not a simple matter. It is not just about having more funding, but also having adequate skilled manpower, equipment and effective management oversight. Nevertheless, the needs are rising, the work is urgent, and I hope our providers, especially those delivering home palliative care, can move as fast as you can to fulfill the wishes of as many patients as possible.
16. I can see that Dover Park Hospice (DPH) is working very hard. It is planning to expand its capacity by one third every year over the next few years. It has embarked on an integrated palliative care pilot project with TTSH and is also leveraging technology.
17. The use of telehealth has enabled more than 1,200 virtual telehealth palliative consultations for stable patients at DPH. It has also enabled DPH to remotely monitor patients after a change in treatment was made.
18. Currently, 10% of all DPH home care consultations have pivoted to telehealth, with dedicated home care nurses manning teleconsultation clinics. DPH aims to increase this to 20% by the end of this year and is looking into setting up a dedicated telemedicine operations centre to further accelerate the expansion of home-based palliative care.
19. Palliative care has evolved over the years and the use of technology will be a further key development, to complement physical consultations with teleconsultations and also remote monitoring.
20. As our palliative care providers embrace technology, they will need to balance the increased access to home palliative care made possible by telehealth, with the quality of care. I think they can be achieved together. With a rapidly ageing population and clear wishes of our patients towards end-of-life care, we should be prepared to take bolder steps, leverage technology to the fullest to serve and benefit as many patients as possible.
Support Beyond Money
21. On the Ministry of Health’s (MOH) part, besides cheering you on and providing more budget and resources, we will continue to enhance our support for palliative care.
22. One of the key challenges in ealizing our plans is to secure sufficient skilled manpower and talent. In palliative care, one needs a strong clinical acumen, combined with sensitivity to the patient’s often complex home environment and dynamics.
23. I hope that more doctors, nurses, and healthcare professionals can be trained in palliative care and can consider joining palliative care. Dying is a natural process, not a disease. It takes different skillsets to manage this process, in a way that minimises pain and maximises quality of life, by bringing comfort in the face of suffering, dignity in the midst of vulnerability, and compassion during life’s most delicate moments.
24. As Dr Tricia Yung, head of Dover Park Hospice Home Care Service, said “Death is not a failure, but dying in pain is.” We need more willing hearts and hands like Dr Yung to join in the care for terminally ill patients. It is a noble career, but admittedly, also a challenging and emotionally draining one.
25. MOH will continue to support the development of palliative care as a career, by ensuring that training is relevant and available, and remuneration for palliative care professionals is competitive.
26. On remuneration, MOH has recently published salary guidelines for the community care sector, which will also apply to healthcare workers in palliative care services. This is the first time we have published salary guidelines for the sector. MOH is providing funding to community care organisations to align their salaries to the guidelines. We understand that organisations will need some time to do this, but I have no doubt it will be completed soon.
27. Another impediment to patients and their families accepting home palliative care is the availability and cost of setting up medical equipment at home. This can make the transition to home palliative care stressful and unsettling. For many families, they end up buying these equipment to be installed at home.
28. To help smoothen this, we are rolling out the new Equipment Rental Scheme. Under the scheme, public hospitals will facilitate the renting of home equipment instead of having families deal with the rental companies themselves. This will provide families with timely and easier access to equipment, at more affordable rates, for patients with a prognosis of one year or less.
29. With this scheme, a compassionate discharged patient receiving maximum subsidies may pay about $100 to rent two pieces of equipment – say a hospital bed plus an oxygen concentrator for a week – instead of purchasing them at over $2,000 now.
30. MOH has set aside $23 million over three years from 2024 to 2027 to implement this scheme. More than 12,000 patients are expected to benefit. We will monitor utilisation and study how best to continue providing such support in the long run.
Taking Bold Steps
31. The TTSH Integrated Care Hub is made possible with the support of many agencies and partners. I want to recognise some of them here today – Asia Infrastructure Solutions, CIAP Architects, CPG Corporation, Dover Park Hospice Building and Development Committee, Kajima Overseas Asia (Singapore), Meinhardt (Singapore), MOH Holdings, Lam Soon Group, Edible Gardens City, Sing’Theatre, volunteers coordinated by the Centre for Health Activation, and many more. Thank you all for making this facility a reality. Shall we have a round of applause for all of them?
32. The Integrated Health Hub is not just a significant facility in our healthcare landscape. It is important because of the activities that happen here, and the way it makes us do things differently in healthcare, by integrating acute, rehabilitation, recovery and palliative care into one premise, meeting the needs of patients during various phases of a disease episode.
33. To make the Hub successful, we need to bring all our skills, technology, passion and conviction to bear. We need to take bold steps together to better serve our patients.
34. If you take a more philosophical approach, life is full of options. But for those who are clearer minded, life’s options often boil down to a fork. At the point of the pandemic, as the Co-Chairs of the Multi-Ministry Taskforce, do we continue to close up and protect ourselves, or do we take a bold step and open up? At MOH, do we continue to expand acute care, or do we also try to make the population healthier? Sometimes in life, the options are taken from us. Often, it happens to seniors who are getting sick. They either take one road which is to recover and get back to their normal lives, or unfortunately it is the end of their journey.
35. But when options are taken out of them, for us as MOH, TTSH and DPH, we must be there to say that whatever life dishes out to you, whatever fork you are facing, we are there for you to give the best possible care. Let’s take those bold steps together. Thank you.