HOSPICE AND PALLIATIVE SERVICES

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HOSPICE AND PALLIATIVE SERVICES:

(Accessibility and affordability): 7.

Dr Lam Pin Min asked the Minister for Health (a) if he will provide an update on the utilisation pattern of hospice and palliative services in Singapore; and (b) how will his Ministry make such services more accessible and affordable for terminally ill patients, especially those from low-income families.

The Minister for Health (Mr Khaw Boon Wan): Sir, last year, about 5,400 patients received hospice and palliative care services. Of these, about 4,200 patients were cared for at home, while 1,200 stayed at inpatient hospices.

Hospice care is affordable as it is subsidised by up to 75% of cost for low-income patients. Inpatients are able to tap on Medisave to pay for their bills. Medifund is also available for those with additional financial needs. Care is accessible, and no patient who needs hospice care will be turned away.

The main obstacle to access is awareness. There is a need for more discussions about death between patients, their families and their doctors. As death is inevitable, everyone should have an end-of-life care plan, including the kind of care that is preferred and share it with the family. For some, this may include signing the Advance Medical Directive.

Dr Lam Pin Min: I would like to ask the Minister what is the projection for the demand for hospice and palliative services with our rapidly ageing population and whether we are able to meet this demand in the short term and, if not, are there temporary or alternative measures in place to tackle this growing need.

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Mr Khaw Boon Wan: Sir, clearly, the demand for this will grow for two reasons, one is because of ageing, and second, is because I do intend to promote greater awareness of this need. I feel strongly about it. They are part and parcel of what end-of-life care requires. In many cases of the terminally ill, a good level of palliative care is available. As for the current supply, I think we are able to meet that demand. When I look at the inpatient hospice figures, the occupancy rate is not too high; we still have vacancies to take patients in. Hence, for the short term, we are all right, but for the medium to long term, I would like to see growth in this sector. I would say that all the terminally ill cancer patients ought to have a good level of palliative care. Today, I think more than half, maybe 60%, have access to that. What about the other 40%? Is it because of ignorance or what is it? We will try to find out why. But beyond terminally ill cancer patients, there are also other terminal illnesses which can benefit from palliative care – organ failure is just one of them. So I think it is a topic which I would like to encourage greater awareness among the patients as well as the carers.

Mdm Halimah Yacob: Palliative care services and support for palliative care services are found in hospices. Could the Ministry of Health look into how to provide subsidies and more resources for palliative care in non-hospice setting?

For the non-inpatient, ie, outpatient services for palliative care services, how are patients supported in accessing such care?

Mr Khaw Boon Wan: If cost is a major constraint towards access, I would look into it. But, off-hand, my feedback is that because of heavy subsidies that we provide to inpatient hospices, as well as through VWOs to home hospices, cost may not be a major obstacle but lack of awareness is. I think there is lack of

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understanding of what palliative care is all about and how it can benefit the patient and the family. There is that lack of awareness in the marketplace which we must try to overcome.

Dr Fatimah Lateef: Sir, can I ask the Minister if there are any plans to increase the number of training places for palliative care? Currently, we only have a handful of palliative care medicine specialists and with the ageing population, the needs are going to increase.

Also, if we cannot meet the needs for palliative care specialists, can we consider running some courses for general practitioners who would be more suited to provide home care and palliative care, and it will be more on an ambulatory basis as well?

Mr Khaw Boon Wan: Sir, the lack of well-trained doctors and nurses in this area is a constraint globally. We are aware of this limitation and we certainly would ramp up training of such specialists and nurses. The problem, sometimes, is a lack of interest. It is a specialty that does not make a lot of money and, unfortunately, some trainees are motivated by that, and it is not unique to Singapore.

I have just read the US Institute of Medicine Report (IOM) on geriatric and palliative care and it describes this whole ageing of US as a "silver tsunami" – I supposed they were inspired by the current financial tsunami from Wall Street – and their conclusion is that in the US, they can see this tsunami coming but the US is not prepared to deal with it. That is a good summation of this huge problem that the whole world would be facing in the next one or two decades.

I think we have to take practical approaches which are: exposing as many doctors and nurses to different aspects of

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geriatric care and palliative care so that along the way whichever department, or specialty they are in, that extra knowledge that they have picked up will be useful and be translated into better care for their patients. And GPs certainly play a big role, and so long as they are interested, we are ever-ready to train them up so that they can bring benefit to their patients.