S’pore ranked Asia’s 2nd best city in provision of end—of—life care

SINGAPORE : Singapore is second best in Asia in the provision of "end—of—life" care, according to the first—ever global Quality of Death Index.

It ranked 18th after Taiwan, which occupied 14th spot in the index of 40 countries and territories.

Coming in close to Singapore is Hong Kong, which takes up 20th place, with Japan in 23rd spot, South Korea at 32nd and Malaysia in 33rd.

Experts believe Singapore could have fared better, if it had a national strategy in place, like in the United Kingdom (UK)— the country that topped the index.

Striving for a good quality of life is something that is often discussed. But it is different when it comes to a good "quality of death".

So to advocate better care for the dying, the Lien Foundation commissioned the Economist Intelligence Unit to compile the index.

Countries are rated on four categories — quality, availability, basic health care environment, and cost of end—of—life care.

"Quality" is given the largest weighting of 40 per cent. "Availability" accounts for 25 per cent, "Basic End—of—Life Healthcare Environment" 20 per cent, and "Cost" 15 per cent.

Lee Poh Wah, CEO, Lien Foundation, said: "For an important topic like mortality, we cannot be navel—gazing, or to be content with the current state of end—of—life care, so we see the index as a tool for us to analyse the country’s total environment of end—of—life care. And it is also a powerful tool to start ’die—logues’ in the community. We want the policy makers, the intelligensia, the community leaders to talk about this issue and hopefully to drive public awareness on this very important part — neglected issues."

Singapore is strongest on quality (11th place) but weakest in basic end—of—life healthcare environment (30th place).

In the areas of Availability of End—of—Life Care and Cost of End—of—Life Care, Singapore ranked 16th and 20th respectively.

Tony Nash, global director, Client Research, Economist Intelligence Unit, said: "Singapore did well in areas of end—of—life care policies — in recognition, training and accreditation of end—of—life care practitioners and availability of volunteers in end—of—life care field.

"Where Singapore did not rank so well was in the availability of end—of—life care facilities. There are only 127 hospices are beds in Singapore. And this is something that will improve over time and increase over time. And healthcare spending on a hospice care.

"Singapore also does well with the fact that CPF and Medisave can be used in both inpatient and outpatient — say, home care, hospice care. And the government has been quite innovative in allowing patients to pursue both curative and palliative treatments at the same time."

The Singapore Hospice Council said more still needs to be done. One area is the shortage of health care professionals. It said hospices also need more support in terms of contributions from donors, sponsors and volunteers.

Experts believe Singapore can climb up the ranks if capabilities get a boost through a national strategy.

Associate Professor Cynthia Goh, director, Lien Centre for Palliative Care, said: "We have not got round to doing it for a start, and I hope very much that in the next one or two years, serious efforts will be made to formulate a national strategy for Singapore.

"The sort of elements that will need to go into it...well, it includes the estimation of the need. How many people need the care and capabilities and how we are going to provide the care for the demand.

"This includes benchmarking and standards to make sure that...the quality is also good. But it also includes engaging the public in debate. For example, one of the things that we are trying to encourage is for people to take part in advanced health planning. Many (people) are now growing older and having chronic diseases. By not talking about death and dying, you can’t really talk about your plans on how you would like to be cared for in the future.

"And this kind of discussion needs to take place, not just once, but as an ongoing discussion between patients and their families and their healthcare givers. And this kind of thing needs to be documented...this information needs to be passed from the hospital to the community. So we need to start this kind of work, and a national strategy on end—of—life would include these kind of programmes."

That is because the study also revealed that countries with a national palliative care strategy — such as UK, Australia and New Zealand — tended to fare better in their care for the dying. The findings also showed that the prosperity of a country does not have a direct bearing on the quality of end—of—life care.

The Lien Foundation hopes the index will act as a catalyst for Singapore to present new ideas to improve care for the dying.

It will be seeking views from leading healthcare professionals, academics and community leaders moving forward.

The UK topped the table, followed by Australia and New Zealand, while the US ties with Canada at ninth place.

Experts involved in the study said UK’s top rank comes despite the country having "a far—from—perfect healthcare system".

It gained high marks when it came to indicators such as public awareness, training availability, access to pain killers and doctor—patient transparency.

These indicators make up the most important category — quality — which accounts for 40 per cent of the overall score.

The bottom—ranked countries include Brazil, India and Uganda. — CNA/ir/ms