SINGAPORE: The Ministry of Health (MOH) will be empowered to take over the operations of certain healthcare service providers who are in serious financial trouble, under the Healthcare Services Bill that was passed in Parliament on Monday (Jan 6).
The step-in provisions will apply only to residential healthcare entities like nursing homes, hospitals and inpatient palliative care centres.
MOH or an appointed "step-in" operator can also take over if the service provider flouts regulations under the Bill, or is operating in a way that is detrimental to the interests of its patients or customers, Senior Minister of State for Health Edwin Tong said during the second reading of the Bill.
The Healthcare Services Bill replaces the Private Hospitals and Medical Clinics Act (PHMCA), which was enacted in 1980 and last amended in 1999.
Under the Bill, there will be a services-based licensing regime, instead of a premises-based one under the Act. Private ambulance operators and telemedicine service providers will also be regulated for the first time.
However, some services such as traditional medicine and complementary and alternative medicine will not be licensed at the moment, MOH said.
The Bill will be implemented in three phases from early 2021 to end 2022.
The new provisions will first apply to PHMCA clinical laboratory licensees, followed by clinic licensees and private ambulance operators, and finally to hospitals and licensees providing other new services.
"The primary purpose is to protect patients’ safety and welfare against a recalcitrant provider endangering them or from abrupt discontinuation of residential healthcare services,” Mr Tong said.
Stepping in will be a temporary arrangement until the service has been stabilised and patient safety and welfare are no longer compromised, Mr Tong added.
Step-in powers are not unique to the Healthcare Services Bill, Mr Tong said. Such powers also exist in regulatory frameworks for “essential services” like the transport sector and financial services sector.
"The case with this is perhaps even more compelling in the healthcare setting given that lives as well as the continued delivery of care to patients, whose welfare and interests are at risk, remain at stake," he said.
MPs ASK FOR CIRCUMSTANCES REQUIRING STEP IN POWERS
However, several Members of Parliament (MPs) asked for assurance that the powers will be used only when needed.
Holland-Bukit Timah GRC MP Christopher de Souza asked: “As the powers are intrusive and the threat of a step-in being invoked preemptively can cause uncertainty for all involved, would the minister provide some examples to illustrate the severity involved in circumstances of public interest? Essentially, what is the threshold required?”
Similarly, Nee Soon GRC MP Louis Ng also wanted to know how and when the step-in powers will be exercised.
“They (the powers) will be triggered when it is in the patients' interest to do so. Ultimately, that, of course requires a multi-faceted and dynamic assessment of the facts in each case. We would like to assure the house that step-in powers will be activated sparingly and really as a measure of last resort," Mr Tong said in response.
Where appropriate, other measures, like penalties, warnings or the appointment of a new management team to rectify the issues will be used, within reason, before a step-in order is made, Mr Tong said.
Under the existing PHMCA, MOH can only take regulatory action such as revoking or suspending the licence. This was "not feasible" given that this would interrupt continuity of care for the resident patients, Mr Tong said.
Step-in powers will now enable MOH to intervene in the operations to address the problems and improve continuity of care for patients.
"These powers can make a real difference in protecting patient safety and the continuity of care," Mr Tong said. He gave the example of specified service providers with financial difficulties that were unable to afford to continue its services, which may endanger the safety and welfare of its patients.
MPs QUESTION LICENSING OF OTHER SERVICES, CO-LOCATION RESTRICTIONS
MPs also asked when services such as allied health, mental health, traditional medicine and non-doctor-led home and community-based services will be licensed, so that providers will have sufficient time to prepare for regulation.
Mr Tong said that there are no current plans to license such services, and that MOH will closely monitor the landscape.
“If significant patient safety risks emerge, we can then decide to license these services,” he said.
There were also questions about the co-location of licensed and unlicensed services. Under the Bill, unrelated, unlicensed services will not be allowed to co-locate with or within a licensed service, unless MOH approves.
Marine Parade GRC MP Fatimah Lateef asked if guidelines in this area can be made clear and succinct, as there is the potential for abuse and misinterpretation.
For instance, while the beauty and wellness industry, as well as the traditional medicine and complementary medicine, do not come under the scope of this Bill, these are some of the services that may co-exist on the same premises as a licensed service.
Asking what would be permitted to co-exist, Dr Chia Shi Lu, who is MP for Tanjong Pagar GRC, said: “With the continuing push from healthcare to health, I think the demarcation between health and wellness services continue to be blurred. What about beauty and aesthetic services?
“Since we are talking about new paradigms in healthcare, what about digital providers, for example, if you provide a tele-medicine platform? How do we regulate how the services co-exist in the digital sphere?”
Mr Tong said in response that the intent behind this is to prevent public misperception that such unlicensed services, such as wellness and spa services, are endorsed and licensed because of their close physical proximity and association with licensed healthcare services.
Where services are complementary to the licensed healthcare service, this concern is mitigated, he added.
“For example, a physiotherapist can co-locate with an orthopaedic clinic so that a more holistic service can be provided ... In other circumstances, we will review on a case-by-case basis,” he said.
MPS ASK FOR UPDATE ON NEHR
Mandatory contribution to the National Electronic Health Record (NEHR) has been deferred until improvements to the system have been completed, and the Government is satisfied that the system is sufficiently robust, Mr Tong said in response to MPs' questions.
Various cybersecurity reviews for NEHR have been commissioned and enhancements are being made to the NEHR, Mr Tong said, adding that it is an important large-scale national system.
When MOH announced details of the Bill in January last year, it prescribed that all healthcare providers are to contribute to the national database.
However, following a cyberattack on Singhealth in July last year, which resulted in the biggest data breach in Singapore, Health Minister Gan Kim Yong said the system will be put through a “rigorous independent external review” before contribution of electronic health records is made mandatory.
On Monday, Mr Tong said: “MOH will want to ensure that all necessary safeguards are in place to handle an evolving cybersecurity threat landscape.”
Mr Tong was responding to questions on the NEHR from Members of Parliament during the second reading of the Healthcare Services Bill, including one from chairman of the Government Parliamentary Committee for Health Dr Chia and Worker's Party's Sylvia Lim.
Dr Chia said that setting out of the legal framework for NEHR was the "elephant in the room".
“The hacking of the SingHealth computer system has understandably led to a pause in this regard, but it should not inflict a mortal blow to our efforts to have a robust and comprehensive digital health record system, which will have many benefits for all Singaporeans, both in sickness and in health,” Dr Chia said.
On that note, he asked for an update on the measures MOH will implement to ensure that licensees protect health information in medical records.
“MOH will want to ensure that all necessary safeguards are in place to handle an evolving cybersecurity threat landscape," Mr Tong said, adding that his Ministry will make further announcements when appropriate.