Healthcare Services Bill – Speech by Sylvia Lim

(Delivered in Parliament on 6 January 2020)

Deputy Speaker, Sir, I note that MOH has proceeded cautiously in presenting this Bill. According to the MOH website, it started consulting on this matter in 2016 and published a draft Bill two years ago for scrutiny and feedback.

The Bill today is quite different from the draft Bill in some respects, which the Senior Minister of State explained briefly earlier.

While I agree that Government oversight of healthcare services is necessary to protect patient welfare, I have some queries and concerns about the Bill. These concerns relate to the Bill’s phased coverage, price transparency, quality assurance and the National Electronic Health Records System (NEHR).

First, the Bill’s phased coverage. Clause 5 states that the Bill does not apply to any healthcare service provided by the Government. And earlier, the Senior Minister of State did explain that Government-provided services included those under the Singapore Armed Forces and the Singapore Civil Defence Force. So, I take it that restructured hospitals, polyclinics and also primary care providers will be covered under the Bill. It is a question of at which phase they are included.

Again, related to the issue of coverage, I was originally a little puzzled by the First Schedule because it stated only certain specific types of healthcare services which will be required to licensable, particularly clinical support services and some specialised laboratory-type services. I was puzzled because I had previously raised concerns about the private ambulance services used by consumers and also the feedback from residents about poor quality service and also hidden charges not being feasible at the time of booking. But I believe that, if I heard the Senior Minister of State correctly, he mentioned that this would come under phase 2 of the implementation. So, I would like him to confirm that emergency ambulance services and such related conveyance services would be actually included for regulation under phase 2.

Related to that, in last year’s Committee of Supply when I raised this issue, the Senior Minister of State mentioned about price transparency that the Healthcare Services Bill would include this issue in its regulation and it would mandate the publication of common fees charged, as well as give more transparency to the bill components to be paid by consumers so that they would know upfront what those costs would be. So, do I take it then that with regard to private ambulance services, this would be actually done under phase 2? If that is the case, then when would that be done? And in the meantime, would there be anything put in place to protect consumers? For example, are we still relying on the Voluntary Accreditation Scheme to try to get some standards into that industry?

Next, Sir, I move on to the important issue of quality assurance for consumers. The Bill states upfront in the explanatory statement and the Minister also mentioned earlier that one of the Bill’s aims is to strengthen safeguards for the safety and welfare of patients who receive healthcare services.

Since the day I became an elected Member of Parliament nine years ago, I have, from time to time, come across families who have been devastated by unsuccessful medical procedures. Some of their family members died unexpectedly while others sustained permanent disability in their prime and have been lying in rehabilitation hospitals for years. Of course, it must be said that the cause of such tragic outcomes may not be the inadequacy of healthcare services but other causes, such as the nature of the illness itself or inherent risks of certain medical procedures. Nevertheless, healthcare is an area where there is asymmetry of knowledge, with patients placing high trust in professionals. It is critical that the public must be assured that investigations into complaints are fair to the consumer and independent of professional and institutional interests. At the same time, professionals need justice as well. And we recall the High Court’s decision in July last year to reverse the conviction on an orthopaedic specialist by the Singapore Medical Council. To this end, can the Senior Minister of State elaborate on how this Bill will enhance confidence in the fairness of the quality assurance processes for all parties?

My final point, Sir, concerns the implementation of the NEHR system. I note that during the public consultation on the Bill, a lot of time was spent dealing with the issue of potential data leaks. This is understandable in view of recent incidents.

In responding to the feedback, the Ministry stated that patients concerned about the confidentiality of their medical data could possibly opt out of having their data inputed into the NEHR by healthcare service providers. Could the Ministry please update the House on the status of this opt-out option.

Sir, I look forward to the clarifications from the Ministry on the points I have raised.