Singapore - MOH to strengthen efforts to provide palliative care to more patients

SINGAPORE: The health ministry is beefing up efforts to provide home care for patients going through the last stages of their lives.

Speaking at the Singapore Palliative Care Conference on Saturday, Health Minister Gan Kim Yong said this means expanding palliative home care services and improving caregiver training.

Stakeholders in palliative care said most patients prefer to be cared for at home towards the last stages of their illness.

Mr Gan said: "The majority of patients would also prefer to be cared for at home, near to their loved ones, and be accorded as much independence as possible, even towards the last phase of their lives.

"Families sometimes misconceive that palliative care patients can only be adequately cared for in hospitals or inpatient hospices. This is not true. Even when the disease is advanced, it is still possible to look after patients very well at home if the necessary expertise and services are made available."

But achieving this means strong integrated care across different settings.

A three-year pilot project for integrated home palliative care was set up last year with Dover Park Hospice and Tan Tock Seng Hospital.

As patients' records are shared, home care patients can be directly admitted to the hospital if they require higher-intensity care.

The project costs S$3 million and is funded by the Tote Board Community Healthcare Fund.

It has seen more than 100 patients.

The new integrated care model will also include case management, advance care planning and possibly the use of information technology to enhance operational efficiency.

If successful, such a project could be seen in other hospices, nursing homes and hospitals.

To provide more support for structured home palliative care, the government is funding a S$12 million programme for over 3,000 end-organ failure patients.

The five year programme started in 2011.

Dr R Akhileswaran, Chairman, Singapore Hospice Council, said:"90 per cent of our patients are cancer patients. 10 per cent are non-cancer. So I think now the focus is now shifting to support those who have end-stage organ failures, like kidney, lung, heart, neurological illnesses and how do we improve the support of this care. This is also going to strengthen more patients to be looked after at home, rather than in the hospitals or inpatient setting."

Another area that needs strengthening is caregiver training. To do this, HCA Hospice said it is improving its curriculum so that the delivery of training is more standardised.

HCA Hospice Care was appointed by the National Council of Social Service in 2004 to be the national agency providing palliative caregivers training in Singapore.

More than 500 caregivers were trained in 2011.

Dr Chong Poh Heng, Deputy Medical Director, HCA Hospice Care, said: "As part of the training, the family caregivers will taught, for example, how to transfer patients from the bed to the chair, the chair to the bed. So a simple process like this can be broken down into many, many steps. And some of these steps can come first, before another one. So if we are able to standardise the steps from one to ten, how this should be done among different trainers then at least we ensure that all our caregivers are given the right, specific and most accurate instructions to do this in a very safe manner."

The Singapore Hospice Council is hoping to expand the pool of caregivers by inviting the general public to come for caregiver training.

In January this year, a committee was set up to study the recommendations for a National Strategy for Palliative Care.

The committee is looking at service development, education and training and standards of palliative care.

- CNA/wm/ck