Singapore enhancing palliative services 'to end our walk with dignity, peace and comfort'

SINGAPORE - The number of people receiving community palliative care in Singapore increased by 30 per cent over the past five years, with about 8,800 terminally ill people receiving such care in 2022.

This was announced in Parliament by Senior Parliamentary Secretary for Health Rahayu Mahzam on Tuesday (May 9), as she spoke of the Government’s efforts to enhance end-of-life care.

She was responding to an adjournment motion by MPs Ng Ling Ling (Ang Mo Kio GRC) and Yip Hon Weng (Yio Chu Kang).

Community-based palliative care is also referred to as hospice care. 

Ms Rahayu said that as Singapore’s population continues to age, more people will need palliative care. 

Hence, the Republic will be expanding such services and reviewing its financing frameworks to improve access to palliative care.

Palliative care should be entrenched as a basic skill set for all healthcare professionals across disciplines and settings, she said.

Ms Rahayu said her ministry is working with the Agency for Integrated Care and care providers to equip clinicians with the necessary skills and tools in nursing and home care.

In her adjournment motion on enhancing the end of life with choices and dignity, Ms Ng said that while a 2014 Lien Foundation survey found that 77 per cent of Singaporeans wanted to die at home, only 30 per cent did. The latter figure rose to 39 per cent in 2022. 

She referred to a Straits Times report on May 1 on a pilot effort by Ng Teng Fong General Hospital (NTFGH) to safely transfer patients who no longer wanted intensive care and wanted to be allowed to die at home.

Commending the medical teams at NTFGH for starting its IAmGoingHome programme in October 2022, she asked if such initiatives could be centralised across public and private hospitals, as well as hospices.

Family doctors could be included in line with the Healthier SG initiative, allowing more people the choice to “end our walk” in the world “with dignity, peace and comfort”, Ms Ng said.

Ms Rahayu replied that the Government is working with hospitals and palliative care providers to implement workflows that would allow more patients to get a “compassionate discharge” to go home.

“This involves, for instance, providing appropriate training and resources, and implementing handover checklists to ensure continuity of care,” she said.

Mr Yip asked how palliative care could be kept affordable, noting that healthcare costs “can be a huge burden on families, especially when dealing with end-of-life care”.

Ms Rahayu said the overall financing framework for palliative care is being reviewed to ensure that it remains affordable.

She added that Dover Park Hospice and Tan Tock Seng Hospital will co-pilot a single bundled funding rate starting in the second half of 2023, which will empower hospice care providers to decide whether inpatient, day or home hospice settings are most suitable for patients.

This may be progressively expanded should the trial prove successful, and there will be “appropriate safeguards to ensure continued quality of care”.

Noting that caregivers of end-of-life patients often come under tremendous stress, Ms Rahayu said that as of January this year, hospitals can refer patients to a home-based respite care service, which provides the patients with palliative-trained care staff.

This allows caregivers to rest or tend to other matters while their loved ones are cared for.

A three-year campaign will be launched later in 2023 to increase awareness and the adoption of tools such as the lasting power of attorney (LPA) and advance care planning, Ms Rahayu added.

An LPA allows a person to appoint someone to make key decisions for him should he lose his mental capacity, while advance care planning lets him document his medical treatment preferences in advance and designate someone to decide on medical care for him in the event that he becomes mentally incapacitated.

This article was first published in The Straits Times. Permission required for reproduction.