28 November 2019
The Healthcare Services Bill (“Bill”) was introduced in Parliament on 4 November 2019. The Bill seeks to regulate the provision of healthcare services (other than those provided by the government), including the premises and conveyances used for that purpose, so as to ensure the safety and welfare of, and the general continuity of healthcare provided to, people in Singapore. It is also intended to repeal the Private Hospitals and Medical Clinics Act.
The Ministry of Health had consulted on a draft version of the Bill in January 2018 and issued its response to feedback received on 24 May 2018.
Scope of “healthcare service” and “licensable healthcare services”
Under the Bill, the “healthcare service” means any of the following services, whether or not provided for reward:
- assessment, diagnosis, treatment, prevention or alleviation of an ailment, a condition, disability, disease, disorder or an injury affecting any part of the human body or mind;
- nursing or rehabilitative care of an individual suffering from an ailment, a condition, disability, disease, disorder or an injury mentioned above;
- conduct of any clinical procedure to change, or that is intended to change, the appearance or anatomy of an individual;
- assessment of the health of an individual;
- any other service of a medical or healthcare nature that is prescribed.
The “licensable healthcare services” that are regulated by the Bill are clinical laboratory services, tissue banking services, blood banking services, radiological laboratory services, and nuclear medicine imaging and assay services.
Strengthening safeguards for safety and welfare of patients who receive healthcare services
The Bill sets out particular duties, requirements and restrictions that licensees must comply with, including:
- referring patients to clinical ethics committees for ethics review in relation to the provision of medical treatment of a prescribed category or description;
- record-keeping obligations;
- restrictions on the usage of the terms “Singapore” or “National” (and their abbreviations / derivatives) in a licensee’s name or logo;
- obligations concerning the use of licensed premises and conveyances; and
- requirements relating to advertisements of licensable healthcare services.
Improving governance requirements for providers of healthcare services
Under the Bill, a licensee must ensure that every key appointment holder of a licensee is a suitable person to act in that capacity, and at least one of whom must possess the skills and competencies for the functions and duties that may be prescribed or specified in any code of practice issued by the Director of Medical Services (“Director”).
Every licensee is required to appoint a suitably qualified individual as its Principal Officer who must be involved in the day-to-day management of the provision of authorised licensable healthcare services. The Principal Officer must have the capacity to influence the compliance of the licensee’s officers and employees with the requirements under the Bill.
Licensees are also required to appoint one or more Clinical Governance Officers who are suitably qualified individuals. Clinical Governance Officers are responsible for the clinical and technical matters relating to the respective prescribed licensable healthcare services, and performing the prescribed functions in relation to the licensee.
The Director will be empowered to direct a licensee to remove a key appointment holder, Principal Officer or Clinical Governance Officer if the Director is satisfied that the person in question is not suitable to act in that capacity, or does not possess any of the requisite skills and competencies.
Licensees of prescribed categories are required to appoint one or more specified committees as may be prescribed in relation to, among other things, any licensable healthcare service that is provided by that licensee. Such specified committees refer to quality assurance committees, service review committees and clinical ethics committees.
Enhancing regulatory powers in relation to providers of healthcare services
The Bill, by providing for step-in arrangements, ensures the continuity of the provision of licensable healthcare services by certain licensees. This is done through empowering the Minister for Health to make step-in orders or expedited step-in orders when necessary to ensure the continued safety and welfare of, and the continuing provision of licensable healthcare services to, a licensee’s patients or customers. These measures avoid disruption to the provision of licensable healthcare services which would follow if a licence was revoked or suspended instead.
A step-in order or expedited step-in order can cover a wide range of matters to ensure continuity of services, including the following orders or specifications:
- designated licensee to remove and replace any of the designated licensee’s key appointment holders, Principal Officer or Clinical Governance Officers;
- Director to take over, directly or through the appointment of a step-in operator, the operations of the designated licensee or a specified part of the operations;
- designated licensee stop providing healthcare services to specified patients or customers on and from a specified date;
- designated licensee to transfer its patients or customers to the care or treatment of another licensee;
- giving step-in operator access to, and authority to take control and management of, the designated licensee’s premises or other assets and other property (including intellectual property), licences and employees used or required by the designated licensee for the purposes of carrying out the order.
The Bill also contains, among other things, provisions that would allow the Director to publish information about non-compliant healthcare providers and unlicensed providers.