31 January 2018
From 5 January 2018 to 15 February 2018, the Ministry of Health (“MOH”) issued a consultation paper (“Consultation Paper”) inviting feedback on the draft Healthcare Services Bill (“draft Bill”). The draft Bill seeks to provide for the regulation of healthcare and healthcare-related services and will repeal the current Private Hospitals and Medical Clinics Act (“PHMCA”).
Some of the key features of the Bill are set out below.
Draft Bill covers healthcare services, allied health and nursing services, traditional medicine, and complementary and alternative medicine
Healthcare services, allied health and nursing services, traditional medicine, and complementary and alternative medicine will be covered under the draft Bill, but beauty and wellness services will not as they do not involve the assessment, diagnosis, prevention, alleviation or treatment of a medical condition or disorder.
Allied health and nursing services, traditional medicine, and complementary and alternative medicine are within the scope of the Bill but will not be licensed at the moment. These services will remain under the purview of existing legislation.
Healthcare providers to be licensed based on type of service provided
Healthcare providers will be licensed based on the type of service they provide. Currently, under the PHMCA, providers are licensed based on their physical premises. The healthcare services to be licensed will be grouped into six broad categories including hospital service, ambulatory care service and long-term residential care service.
Further regulation of governing bodies
The governing body of a healthcare service must possess the competence and skills to carry out its role. The Consultation Paper notes that, in the case of Boards that comprise different individuals, this requirement can be met collectively by different members of the Board. The draft Bill provides that every key appointment holder of the licensed healthcare provider must have the appropriate character and fitness to act in that capacity. The healthcare provider must also ensure that there is one or more key appointment holders who possess skills and competencies for such duties which may be prescribed under codes of practice which may be issued pursuant to the draft Bill.
Enhancement of role of Principal Officer and introduction of role of Clinical Governance Officer
The role of the Principal Officer (“PO”) of a healthcare provider will be enhanced and the appointment of a Clinical Governance Officer (“CGO”) for selected services introduced in order to strengthen governance and oversight of healthcare services. The Consultation Paper notes that the same individual can function as the licensee, the PO and CGO for different service licences, as long as the individual can fulfill all relevant requirements and can perform all roles adequately
Introduction of new committees for clinical quality and medical ethics
The current PHMCA requirement for Quality Assurance Committees (“QACs”) for selected licensed healthcare providers will remain, with the Bill mandating the creation of new service committees. The Consultation Paper also notes the introduction of a requirement that a suitably qualified and competent individual will be designated to oversee quality assurance processes in a licensed service.
The draft Bill also seeks to introduce Service Review Committees (“SRCs”) for selected services or programmes that are deemed higher-risk, more complex or of greater public interest. The SRCs will review utilisation patterns, effectiveness, risks and the benefits of these services. In addition, Service Ethics Committees (“SECs”) will be mandatory for selected licensed healthcare providers to ensure that patients are treated in an ethical manner before certain complex and high-risk medical treatment can be conducted. The list of medical treatment that will require SEC referral and review will be determined based on advice from the Academy of Medicine and the National Medical Ethics Committee, and will be stipulated in regulations.
MOH empowered to “step-in” where residential care services fail
MOH will be empowered to “step-in” and assist in the operations of failing healthcare services. This provision seeks to protect patients against abrupt discontinuation of residential care services and would be a transitional measure until patients can be transferred to other service providers.
Requirement to contribute to National Electronic Health Record
Healthcare providers will be required to contribute to the National Electronic Health Record (“NEHR”). Contribution to the NEHR will be implemented in phases. The NEHR enables patients to have their health record follow them regardless of where they seek treatment, supporting better assessment and decision making among healthcare professionals through access to a patients’ medical history. The Consultation Paper notes that safeguards will be put in place to ensure that patients’ NEHR records are kept confidential. Measures, including the provision of access logs to patients and regular audits on NEHR access, will be instituted to protect against illegitimate access. Penalties will be imposed for unauthorised access.
Whilst all patients will by default have their specified health data contributed to the NEHR, it is possible to opt-out. Patients who have opted out will continue to have their information uploaded to the NEHR, but with access blocked, to allow for the possibility of the patient opting in at a later point in time. Those who have opted out and prefer not to have their information uploaded to the NEHR at all can make this preference known. Whether this will be acceded to will be determined on a case-by-case basis, as the impact of incomplete NEHR records is irreversible.
Enhancement of MOH powers to obtain and publish information
Existing PHMCA powers will be enhanced to enable MOH to gather data for purposes of patient safety, care and welfare, as well as public health interest. MOH will also be authorised to publish information about non-compliant healthcare providers and unlicensed providers.
MOH to prohibit unsafe practices, services and employment restrictions
MOH will explicitly prohibit the provision of medical practices and services that has caused or may cause harm to patients. In addition to powers to direct a specific service or practice to cease, the specific practices and services that are prohibited will be listed in a Schedule.
Introduction of measures to minimise public misperception
Explicit approval from the Director of Medical Services will be required for healthcare providers to be able to use terms that connote a national body, such as “National” or “Singapore”. Restrictions on naming will be imposed on new business entities. For instance, healthcare providers will be prohibited from using names of services that they are not licensed for. Existing entities will not be affected.
The following materials are available from the REACH website www.reach.gov.sg:
- Consultation Paper on the Draft Healthcare Services (HCS) Bill
- Definition of Healthcare Services under the HCS Bill - Annex A
- Draft Healthcare Services Bill