CLOSING SPEECH FOR SECOND READING OF HEALTHCARE SERVICES (AMENDMENT) BILL BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, 6 MARCH 2023

(A) Introduction

1. I thank Members for their support of the Bill, as well as for their comments and
I will just address a few of the issues raised. 

(B) Better regulation of healthcare services

2. Ms Ng Ling Ling and Mr Yip Hon Weng asked about the administration of the approval framework for modes of service delivery, especially where healthcare services are becoming complex.

3. I point out that while HCSA is designed to cover a wide scope of healthcare services, including those that were mentioned by Mr Yip.  MOH takes a risk-based approach. This means that we only license healthcare service providers, and require them to comply with the relevant requirements, if there are patient safety or welfare risks that we need to control through legislation. We want to guard against over-doing this, and ensure that services remain affordable and accessible.

4. One concrete example, we are reviewing whether to regulate the community health screening services that may involve invasive procedures, such as the drawing of blood, but may not be provided by a medical practitioner or dentist, bearing in mind the general aim of making such services not only more accessible and convenient but also safe for patients. We are closely monitoring the community screening landscape to identify newer models or other types of services where they may pose a higher patient safety and welfare risk and then explore whether those need to be licensed. 

5. There were a number of questions on telemedicine-related requirements, including by Mr Louis Ng and if I may address some of those issues, we had consulted with our various licensees and communicated these to them over the past few months.

6. From a service provision standpoint, telemedicine or remote medical service providers must ensure that the service is provided is done so in a proper, effective and safe manner, similar to what we would expect of a medical service in a clinic. For example, we have to ensure the privacy and confidentiality of the medical consult, the integrity and security of patient health records, the timely escalation and referrals. Providers will also need to make sure that their doctors using the remote modality are trained and competent to do so.

7. Our prevailing professional codes, such as the Singapore Medical Council’s Ethical Code and Ethical Guidelines, will continue to apply. Doctors offering telemedicine will thus need to meet both professional practice and clinical service standards, which will provide more comprehensive protection for patients.

8. This applies to all healthcare professionals as Dr Tan Yia Swam has reiterated. It is important that all healthcare professionals are ourselves aware of the need to actively self-regulate and to participate in the process of self-regulation, including by complying by and with the professional codes of conduct as the ultimate objective is to ensure that the patient’s safety and welfare are not compromised.

(C) Helping patients make more informed choices

9. There were some questions about healthcare service advertising. Mr Yip has asked whether existing licensees whose business names contain the restricted terms of “Singapore” or “National” will be allowed to retain their business name. I had mentioned that they can continue to use these terms unless there is a change in the business name, or there is a change in the licensee. We understand that there is already some brand equity built up already, and rather than mandating that these licensees immediately remove these restricted terms, we will allow them to continue.

10. Mr Yip also asked about the licensees with specialty names. They may continue to use those names that they already have, but if they provide or purport to provide services within that specialty, we may impose regulatory requirements on such licensees to employ or engage a relevant specialist. Otherwise, we will work with the licensee to amend their business names. Otherwise, they will be giving the wrong impression to the public and that would not be in the patients’ interest.

11. I agree with Mr Yip about public education. It is important to complement our regulatory effort, especially around how the public engagement of advertising and business names. We will be publishing the intent and scope of these naming restrictions, so that the public can understand what is allowed, or what is not allowed, and they can have an easily accessible reference. More public education effort is needed to enable patients to be discerning in their consumption of healthcare services, in line with overall efforts on media literacy, we encourage the public to help one another and we ask the Members of the House to also within your communities in doing so.

12. We will also continue to encourage the public to perform due diligence and exercise some degree of discretion before engaging the services of any healthcare provider. A list of licensees with the modes of service delivery and specified services they are approved to provide will be published and also made accessible through HealthHub so that the public can check if the healthcare provider they wish to obtain services from has the necessary approvals to provide those services. We hope that the public will also participate and report errant institutions through our feedback channels, which we can then investigate and take the appropriate enforcement action.

13. Mr Louis Ng brought up some issues around healthcare service advertising that mislead by using visual imagery. I agree with Mr Ng that this risk exists and we have provided restrictions on the use of certain terms not just in the licensees’ names but also the use of those terms within the logo. However, the extension of the restrictions to the use of visual imagery completely may limit businesses’ ability to create a brand to distinguish themselves, and I think there is room to significantly over-step.  One example that I may provide for Mr Ng’s consideration, is the use of a heart shape. I think it is quite commonly in a variety of settings. I don’t think anybody would say that it is exclusively the purview of cardiologists. Especially if it is a simplified cartoon- shaped heart. We do need to be quite careful not to prevent more advertising. We will investigate any complaints however, on a case-by-case basis And the examples he had cited, if there is a non-licensed provider or someone purporting to treat when they should not be, and doing so through the use of visual imagery, we will suggest that these cases are reported. We will look at the visual imagery but we will also take into consideration the overall content and the intent of the advertisement, before we decide whether we take enforcement action. Now the intent is to make sure that those providing treatment and medical services are appropriately regulated for the safety of the public.

14. Now Mr Ng suggested the banning of the use of the term “Doctor” outright for healthcare service advertising, We try to have a balanced approach. The title “Doctor”, is something that is afforded not only to medical doctors. PhD holders will also have that title and having the title of “Doctor”, as a medical doctor, does not automatically mean that one is licensed if one does have a title. We are trying through our approach to achieve the right balance and make it clear that where you are advertising a healthcare service, the appropriate description is used including the description of your qualification, or lack thereof, for the provision of medical or dental services. So we don’t think it is tenable to the title of “Doctor” and prevent it completely from all healthcare service advertising. We think having these mandatory disclosures is a more balanced approach.

15. Ms Ng has some questions on the co-location of non-licensable healthcare services (such as a Traditional Chinese Medicine (“TCM”) practitioner) with licensable healthcare services, We have prescribed a list of services that can be co-located without needing to seek prior approval, and this includes TCM acupuncture services and services provided by registered allied health professionals such as physiotherapists. Beyond this list, service providers who wish to co-locate their services must seek MOH’s approval, and conditions will be imposed, including requirements to comply with for their advertising. In particular, the advertising must not result in a misperception by patients that the co-located non-licensable healthcare service is actually licensed by HCSA.

16. Where an advertisement covers both the licensable healthcare service and the co-located non-licensable service, it is the HCSA licensee is responsible for ensuring compliance with the Healthcare Services Regulations for the entire advertisement.

17. I would also like to address Dr Tan Yia Swam’s concern that the amendments already cover misleading claims made by non-HCSA licensees including beauty and wellness service providers. This means that any salon that purports to treat a medical condition will be in contravention. We continue to encourage the public to exercise discretion and if the public is aware of such misleading claims, please escalate this to the Ministry for further investigation.

(D) Balance and accountability in regulation 

18. Members have asked about the safeguards in the regulatory process. Mr Yip highlighted concerns that healthcare institutions may not have sufficient turn-around time given the 14-day notice period being removed. I would like to stress again we are only removing the 14-day notice period for a class of licensees, such as all licensees that provide an acute hospital service, And such a situation often have a significant impact on our healthcare worker safety and our public health safety as well. Members will remember exceptional circumstances that include the recent COVID-19 pandemic, and you can extend this to other public health emergencies are conceivable. And we would need to react to these in a relatively swift manner.

19. Based on our experience with COVID-19, the licensees can indeed meet the requirements, and can do so at a relatively short notice. I would like to assure Mr Yip and Mr Ng that the aim of this amendment is to provide the Ministry with the power to direct groups of licensees to take immediate action. The focus is on saving lives through the quick introduction of safety measures, and not on penalising licensees for not being able to comply with the Ministry’s direction despite their best efforts.

20. Ms Ng also asked if it was too onerous to place the burden of approvals on one authority. I would like to reassure her that the Ministry of Health and the agencies that are part of the family, we have a number of experts, committees and appeal advisory committees that are part of our normal processes. So when guidance is given by the Director of Medical Services, the decisions are made by Minister, it is informed by a wide group of experts, academics, practitioners and professionals from the associations and various bodies that represent healthcare workers, including the Academy of Medicine, the Singapore Medical Association, Singapore Dental Association, the College of Family Physicians Singapore and our various Expert Committees and appeals advisory groups. These are all very much of our ongoing process that is not going to change with the HCSA.

21. There were a number of questions by Associate Professor Jamus Lim. I will point out that several of his questions address healthcare manpower, the professional healthcare certifications of individuals, pastoral support for doctors and the healthcare workers who are from overseas, the universities, and medical schools, none of which is covered by this Bill before the House. I would suggest that he might want to either raise as PQs or take it up at an appropriate time. There are some issues that he raised that are indeed covered and I would like to go through. The first of all, is on this issue of TCM practitioners and other complementary and alternative medical practitioners. They are not prohibited from advertising, from describing what they do. What they are prohibited from is purporting to treat, diagnose medical conditions. I just want to make sure that we have a clear understanding that TCM practitioners themselves, have their own professional board that regulates them. And that is not something that this legislation will require them to state their qualifications.

22. Professor Lim also brought up the issue of the language around the premises. Now the intent is not to constrain premises. The intent is to regulate the service provisions. In describing premises, we have tried to cover indeed as many possible premises and models of service delivery. The intent is to look at the service, and then specifying and so hence, we do need the language to cover the various possibilities, how and where a service is provided. That addresses Professor Lim’s query on why we have the language around permanent, versus non-permanent, phrasing within the Bill. Indeed, the point he brought up around international providers around virtual teleconsultations is important. We cannot regulate what people have access through the Internet but we do want to educate members of the public to be discerning about where they get their healthcare information from and ideally, they should get it from an identified, locally registered, licensed healthcare providers. If they do get information online from healthcare providers overseas, then that is not something that this Bill is going to be, to regulate. However, if that advice requires them to have prescribed medication, consume medication, treatments and services and interventions, those are controlled by a variety of legislation and regulatory frameworks. And that is where we can assure more patient safety. Ultimately, the main thing is that when people look for information, they should be doing so ideally from a licensed, locally registered healthcare provider. He also brought up the issue of midwifery professionals and nursing professionals. This Bill does not regulate any of those. This Bill is a Bill to regulate the provisions of services. It is not a Bill to regulate professional certification of individuals and there are the legislation and regulations for it.

(E) Conclusion

23. Sir, in conclusion, this Bill introduces changes to future proof our regulatory framework for agility, to enhance the operational efficiency and clarity, as well as to strengthen safeguards for patient safety and welfare, to ensure that our regulatory regime remains robust, agile and responsive to provide better healthcare services to our population in Singapore.

24. I thank Members for the support of the Bill.

25. I would also like to take the opportunity here to thank our licensees, healthcare professionals, professional associations and members of public who have contributed throughout our stakeholder consultation exercises, including virtual sessions which have involved more than 1,000 attendees, helping with ideas and suggestions to jointly improve the healthcare services regulatory framework.

26. Mr Speaker, I beg to move.