Speech by Mr. Louis Ng Kok Kwang, MP for Nee Soon GRC at the Second Reading of the Healthcare Services Bill 2019 (Bill No. 37/2019)
Sir, I stand in support of the Bill.
The update is timely. In the 39 years since the Private Hospitals and Medical Clinics Act was enacted, the healthcare landscape has seen significant changes, including a shift toward digital and online services.
At the same time, Singapore faces an ageing population and an increased prevalence of chronic diseases. The demand for healthcare services is set to increase.
Furthermore, there is a growing need for alternative models of care beyond face-to-face consultations or healthcare provision at physical, brick-and-mortar locations.
We cannot take for granted Singapore’s high quality healthcare infrastructure. The service-based licensing model will help ensure that people in Singapore continue to have access to safe and well-regulated healthcare services, even as the services take on alternative forms.
The mandatory nationwide healthcare records database will also ensure continuity of care for patients across service providers.
Sir, I have four clarifications.
Data privacy and protection
First, plans to mandate the contribution of data to NEHR have been in the news as early as 2017. However, these plans were deferred in the wake of the SingHealth cyber attack in 2018, which highlighted the risks posed by weak spots in the system.
Since then, disciplinary action has been taken against top management and key individuals, the NEHR has been subject to reviews, and Minister Gan has assured this House that the Ministry is “taking many precautions” to ensure that the system is “robust before everyone is required to submit (data)”.
Under the Bill, NEHR data can only be accessed for the provision of healthcare services, or with the approval of the government. Third parties such as employers and insurance providers cannot access the data unless the patient permits.
The Ministry has also said it will implement safeguards to ensure the confidentiality of patients’ NEHR records. These include the provision of access logs to patients, regular audits on NEHR access, and penalties for unauthorised access.
However, as with all electronic databases, the NEHR faces a risk of data breach. From a national security perspective, it would also be dire should NEHR data fall into the wrong hands. This was demonstrated by the Singhealth cyber attack.
On an individual level, patients may fear having their sensitive medical information leaked since that could have repercussions on their employment prospects or social lives.
Can the Minister clarify how the use, access and transfer of patient data will be monitored by the system? Furthermore, how will the Ministry seek to prevent abuse of authority by healthcare professionals who have access to the system?
Can the Minister share what recourse is available for a patient who suspects that there was unauthorised access to their records?
If that patient subsequently suffers perceived injustice at his or her workplace or discrimination by his or her insurer, what recourse is available then and on whom does the burden of proof fall? Who would bear the costs of any follow-up action?
Finally, would a patient be responsible for probing or proving any alleged system abuse, or will the Ministry be actively monitoring the system and taking enforcement steps against breaches identified?
Opt out process
Second, given the concerns with data privacy and protection, there are understandable reasons why certain patients may not want their data uploaded onto the NEHR.
These patients must submit a request to the Ministry, and requests will be assessed on a case-by-case basis.
Can the Minister share the criteria for assessing these requests? Would it be possible for Minister to decline a patient’s request and if so, on what grounds?
I understand that a balance must be struck between encouraging participation in the NEHR and upholding patient choice and confidentiality.
Can the Minister provide assurance that the opt out process will not be unduly difficult for patients? Can the Minister share what measures are in place to ensure that the opt out process is relatively quick and easy for patients?
Can the Minister also provide an estimate of how long the review and opt-out process might take?
Costs of transition
Third, under the Bill, the licensing regime for healthcare service providers will transition from a premise-based to service-based one. As such, an establishment might require multiple licenses depending on the services provided.
Can the Minister provide some details about the projected costs for this transition? Would establishments who offer more than one type of healthcare service now have to foot higher administrative costs because they will need to hold more licenses?
If there are any increases in costs, can the Minister clarify the proportion of the burden that will be borne by the end-user, the service provider, and the Ministry?
Can the Minister also clarify whether there will be efforts to streamline the license application process for establishments that might require multiple licenses?
Lastly, the Bill has step-in provisions relating to residential care services such as hospitals, nursing homes and in-patient palliative care services.
The step-in provisions allow the Ministry to take over the operations of providers at risk of insolvency, or who are unable to resolve systemic patient safety or welfare issues.
In particular, Section 33 provides that the Minister has the power to issue a step-in order.
Can the Minister clarify how and when will this power be exercised? Will the Minister have access to a committee of industry experts who may be able to advise him on such matters?
Sir, I stand in support of the Bill. It is a necessary move to adapt our legal framework to the rapidly evolving healthcare landscape, so as to continue ensuring the well-being and care of people in Singapore. Moreover, it places us in a better position to embrace even more novel models of care.
I hope the above queries will aid in sharpening Singapore’s approach to the provision of healthcare services, thus securing Singapore’s continued leadership in healthcare globally.
Watch the speech here
Watch MOH’s response here