28 June 2018
The Ministry of Health (“MOH”) has recently released a summary of key feedback received on the public consultation on the draft Healthcare Services Bill (“draft Bill”) and its responses thereto. The public consultation was conducted between
5 January 2018 to 15 February 2018. 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”).
The feedback received indicates a broad recognition for the need to update the current PHMCA, given the evolving healthcare landscape with the introduction of new technologies and healthcare delivery models. Most issues raised concerned the implementation of the draft Bill (e.g. port-over and operational details) which MOH will address through regulations. The regulations, to be issued under the new Healthcare Services Act (“HCSA”), will outline the requisite standards (including personnel, premises and service requirements) that licensees will need to fulfil in order to obtain and retain service licences under the proposed new legislation. These will include responsibilities of key personnel, the listing of Point of Care Tests allowed in clinics, and the scope and roles of the various committees required under the HCSA. MOH will be seeking feedback on draft versions of all the regulations with the relevant affected licensees from early 2019.
In terms of implementation period, most respondents supported the proposed
18-month phased approach starting a year after enactment of the HSCA. MOH will continue to actively reach out to licensees through briefings and regulatory visits.
Set out in summary below are the other key feedback and MOH’s response:
- Reduce regulatory cost and administrative burden when transitioning licensees from PHMCA to HCSA: Under the draft Bill, MOH proposed for healthcare providers to be licensed based on the type of service they provide. Currently, under the PHMCA, providers are licensed based on their physical premises. Respondents were generally positive about the move from “premises-based” to “services-based” licensing although concerns were raised about possible increase in regulatory burden and cost. MOH will take this feedback into account when developing the new licence fee framework (e.g. exploring the option of bundling licences as a package), so that the regulatory cost impact to the existing licensees will be minimised at the point of port over.
In terms of transitioning licensees from PHMCA to HCSA, MOH will focus on reducing administrative burden on the licensees and enabling a smooth port-over. To do this, MOH recently conducted a service mapping exercise for the existing licensees to match their PHMCA and potential service licences under the HSCA. To ensure the validity of the mapping, MOH will ask licensees to confirm their mapping of services closer to the implementation date of the HSCA.
- Clarifications on HSCA service definitions: There were queries raised on some of the definitions for new services that will be licenced under the HSCA in relation to telemedicine, specialised interventional procedures and radiology which MOH has sought to clarify in its response.
- Co-location of licensed and unlicensed services: There were a number of questions on section 82 of the draft Bill regarding the use of licensed premises or licensed conveyances for other purposes. This provision is intended to prevent the co-location of unlicensed healthcare services with MOH-licensed healthcare services (e.g. a beauty spa co-locating with a general medical/dental clinic). Responding to feedback, MOH proposes to allow co-location for a list of health-related services with specific HCSA service licensees. MOH will review the operational details of this policy, and update service providers when the review has been completed. Licensees who wish to seek further clarification on the type of unlicensed services they can co-locate with may write to MOH.
- Stipulated qualifications for Principal Officers: Under the draft Bill, the role of the Principal Officer (“PO”) of a healthcare provider will be enhanced and a requirement for the appointment of a Clinical Governance Officer (“CGO”) for selected services will be introduced in order to strengthen governance and oversight of healthcare services. For better clarity, the role of the current Manager under the current PHMCA would be clearly delineated between the PO and CGO. With this delineation, the PO would not require stipulated qualifications under HCSA. Generally, even if the PO is not a medical professional, all decisions relating to patient’s clinical care must take into account healthcare practitioners’ views, to ensure patient safety and welfare.
- Concerns with the National Electronic Health Records: Mandatory data contribution to the National Electronic Health Records (“NEHR”) by all HCS licensees drew considerable comments and feedback. There was general agreement from both licensees and the public that mandatory NEHR data contribution would improve continuity of care for patients. However, there were concerns about the lack of technical knowhow and cost of acquiring and maintaining an electronic medical record system, relevance of NEHR to foreign patients, data security, medico-legal implications and confidentiality of patients’ medical data. Use of the NEHR for insurance and employment checks was debated widely during consultations. There were also concerns relating to the penalties for non-contribution to NEHR.
In the coming months, MOH will work with providers to support NEHR adoption through various means. These include a phased implementation to allow time for sectoral adoption of information technology (“IT”) and digitalisation grants to support licensees in the transition. MOH, through the Integrated Health Information Systems (“IHiS”), will be working with IT vendors to explore the feasibility of developing simpler systems for licensees who are less familiar with electronic records.
To address medico-legal concerns, MOH and IHiS will collaborate with medico-legal professionals and licensees to develop a set of guidelines for proper contribution, access and use of NEHR. This will be done through a series of educational workshops for licensees, which MOH will be planning to roll out in the second half of 2018.
MOH will also explore if additional provisions are required to be introduced into the draft HCS Bill to legally prohibit licensee access and use of the NEHR for insurance and employment purposes. MOH will also consider whether more clarity is necessary and feasible with regard to penalties for non-contribution to NEHR in the legislation.
- Patients’ records in HealthHub: MOH will consider patients’ suggestions for their summary record to be made available in HealthHub and will continue to develop technical solutions for safe access. MOH will also take in feedback on opt-out options and review how these options can be operationalised.