22 January 2020
The Healthcare Services Bill (“Bill”) was passed in Parliament on 6 January 2020 after its introduction 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 (“PHMCA”).
The Ministry of Health (“MOH”) 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”
The regulatory framework under the Bill introduces a services-based licensing framework which would allow healthcare service provides to obtain licences based on the services they wish to provide. There will be more vertical and horizontal integration across traditional healthcare settings with the services-based licensing framework. For example, nursing homes may now be able to provide dementia care and geriatric clinical services within one location.
Under the Bill, “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 as stated 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 and require licensing 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
With the aim of strengthening safeguards for the safety and welfare of patients, 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 all of its key appointment holders are suitable persons 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.
Restrictions on employment of healthcare workers
In order to ensure that healthcare workers are properly managed, especially those who deal with vulnerable patient groups who may be at risk of abuse, the Bill imposes employment restrictions on certain licensees. Such restrictions include (a) prohibitions on employing any individual convicted of prescribed egregious criminal offences involving violent acts, and (b) a requirement for licensees to provide information of prospective staff to the MOH for screening with the Criminal Records Office. Licensees who wish to employ past offenders of prescribed offences may seek the approval of the Director, who will consider each such case on its merits.
Employment restrictions will be limited only to settings such as nursing homes, inpatient palliative care services, and the Institute of Mental Health where patients are at higher risk if they require substantially long term stays or are mentally and physically vulnerable.
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 key appointment holder, Principal Officer or Clinical Governance Officer;
- 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 to 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.
MOH intends to implement the regime under the Bill in phases from early 2021 to end 2022 as follows:
- The first phase will bring PHMCA laboratory licensees under the Bill’s regulatory regime;
- The second phase will impact medical clinics and other ambulatory care services, as well as ambulance services;
- The final phase will bring hospital and long term care services, as well as other new licensable services, under the regime.
The following materials are available on the MOH website www.moh.gov.sg:
- Opening speech for second reading of Healthcare Services Bill by Mr Edwin Tong, Senior Minister of State, Ministry of Health, 6 January 2020
- Closing speech for second reading of Healthcare Services Bill by Mr Edwin Tong, Senior Minister of State, Ministry of Health, 6 January 2020