MOH 'right' to ensure undisrupted palliative care

B.J. Miller, an amputee, is a hospice and palliative medicine physician who sees patients and families at the University of California, San Francisco’s Helen Diller Family Comprehensive Cancer Center, where he also teaches.
B.J. Miller, an amputee, is a hospice and palliative medicine physician who sees patients and families at the University of California, San Francisco’s Helen Diller Family Comprehensive Cancer Center, where he also teaches. PHOTO: RAHIMAH RASHITH

US expert: Patients won't need to turn to costly hospitals if operators cannot continue

A government proposal to ensure palliative care for patients in nursing homes is not disrupted is in the right direction and a financially sound move, according to a prominent American palliative care expert who was in town recently.

The proposal, if it gets adopted, means that patients do not have to turn to the most expensive options - acute care hospitals - in the event something happens to the original palliative care provider, said Dr B.J. Miller, an assistant clinical professor of medicine at the University of California, San Francisco.

So, ensuring that continued care is not disrupted "is the wise thing to do", said Dr Miller, who was in Singapore earlier this month to present on palliative care at the Global Conference on Integrated Care, organised by the Agency for Integrated Care (AIC).

The 46-year-old's passion for palliative care stemmed from an accident when he was a Princeton undergraduate that cost him his legs and left arm, and nearly killed him.

His 2015 TED Talk - "What really matters at the end of life" - has been viewed over six million times.

Speaking to The Straits Times, Dr Miller was weighing in on the Ministry of Health's intention to appoint a temporary operator for residential care services, such as palliative care in nursing homes, as a stop-gap measure if operators cannot continue to function due to factors such as bankruptcy.

The temporary operator will ensure all patients are cared for until they can be transferred elsewhere.

The proposal for continued residential care services was one of several set out in the Healthcare Services Bill, which was unveiled last month. The draft Bill is set to replace the current Private Hospitals and Medical Clinics Act, which was last amended substantially in 1999.

Dr Miller said that the proposal to step in and catch those who fall through the cracks due to a disruption in care services is a "financially smart move".

While the hospital is the most expensive place to receive care, it is also the backbone of care. "So, if you are going to fall through the cracks because of a lack of care services or because there are not enough facilities where you can live safely, you are going to find your way back to the hospital," added Dr Miller.

He acknowledged the need to extend the skill sets of palliative management beyond palliative specialists, and to the wider community.

"We need to drive the basics of palliative management across disciplines," he said. "These are good skill sets for any good specialist and physician."

Minister for Health Gan Kim Yong said in a speech at the conference that Singapore has already been deepening its manpower capabilities to support care integration.

General practitioners (GPs), who are closest to the community and easily accessible, can help provide palliative care during a patient's end-of-life journey through the Community Care Manpower Development Award, which provides training support to GPs who want to provide care services for seniors.

The AIC has distributed 25 such awards since last year.

A version of this article appeared in the print edition of The Straits Times on February 20, 2018, with the headline 'MOH 'right' to ensure undisrupted palliative care'. Print Edition | Subscribe