Closing Speech for Second Reading of Healthcare Services Bill by Mr Edwin Tong, Senior Minister of State, Ministry of Health, 6 January 2020

Introduction

1.      Mr Speaker, I thank Members for speaking in support of the Bill, as well as for their constructive comments.

2.      I will address the various issues raised by Members.

Scope of the Bill

3.      There have been several questions on the regulatory scope and the types of services that will be licensed.

4.      The Bill seeks to be clear and transparent in the scope of ‘healthcare services’ that can be regulated.

5.      Our primary focus as we implement the Bill is on services that provide clinical care for a condition or disease. Mr Murali Pillai has asked if community-led initiatives, including those provided by voluntary welfare organisations, will be in scope and be licensed under the Bill. These entities, such as Senior Activity Centres, provide services which are predominantly social in nature and, to that extent, will not be regulated under the proposed regime in the Bill. But sometimes these centres also provide services that are clinical in nature. For example, a doctor may be located in a senior activity centre, and if that doctor is engaged to provide medical services in that centre, then that doctor will require a medical clinic licence, or would have to be employed by a clinic licensee. 

6.      Ms Irene Quay, Prof Fatimah Lateef, Mr Christopher de Souza and Mr Melvin Yong asked for timelines on the licensing of allied health, mental health and traditional medicine services, as well as non-doctor-led home and community based services, so that the providers would have sufficient time to prepare for regulation. 

7.      Sir, let me be clear that, there will be sufficient time and notice. Indeed, the framework for any regulation, even for these services, will be as has been set out in the Bill, so that they will know the parameters and the landscape that they will have to deal with, even before it applies. Second, as to when these services will be included, MOH will be adopting a calibrated and risk-based approach to progressively license healthcare services. We do not at present have any plans to license these services and will closely monitor the landscape. If significant patient safety risks, for example, emerge in these services, we can then decide to license these services, but as I said on the outset, the broad framework will be as set out in this Bill.

8.      In addition, before we move to regulate any new services, I will like to assure Members that MOH will engage and consult the relevant stakeholders on proposed standards to ensure they are contextualised for that particular service. As is already the case now, MOH will also work with the providers in readying them for eventual regulation, in the lead-up period to licensing.

9.      Ms Quay has asked why Government entities like SCDF-owned ambulances and SAF medical centres are excluded from the Bill’s scope. These entities serve critical national functions and come under a separate internal governance structure and standards.

10.     I would add that Government entities providing healthcare services are subject to stringent internal standards that are, in some cases, more stringent than the ones that are being proposed by this Bill. Let me give a few examples. The SCDF serves highly-critical cases, and they hold their services to higher standards. SCDF mandates a six-monthly paramedic skills certification test, and quarterly Continual Professional Education sessions to improve and also broaden the knowledge, skills and competence of their emergency medical services crew.

11.     In contrast, the draft ambulance Regulations require Emergency Ambulance Service Crew to attend lectures, simulation, practical sessions or clinical discussions at least once every six months, and paramedics are required to be re-certified every two years.

12.     For SAF clinics, all personnel are qualified according to national requirements. Medical officers are trained to national standards, and are also Singapore Medical Council (SMC)-registered with working experience in the restructured hospitals. There are regular refresher courses for staff, as well as regular audits for the clinics.

13.     Dr Chia Shi-Lu asked for clarifications on how this new framework might deal with Third Party Administrators (TPAs) and medical concierges.

14.     The current scope is limited to regulating the providers of direct healthcare services. As TPAs and concierge services are principally an administrative coordinating service – they are agents of the principal medical providers – and are not engaged in direct patient care, so they will not be licensed under this framework.

15.     However, MOH is monitoring the patient safety risks and studying the landscape of these services further, before deciding on the appropriate framework, if any, to regulate these entities. If the licensing of TPAs and concierge services in some form is found to be needed, an amendment to the scope of this Bill can be made at the appropriate juncture to include them, again, with the proper contextualisation.

16.     In the meantime, professional guidelines, such as SMC’s Ethical Code and Ethical Guidelines (ECEG), provides guidance for medical practitioners contracting with TPAs to ensure the objectivity of the medical practitioner’s clinical judgement and the provision of the required standard of care. So, for members who are familiar with the ECEG, you would know that advertisements are prohibited, save for certain circumstances set out. If, at the end of the day, the judgment of the medical practitioner - how he looks at the patient, how he treats the patient -should be unimpaired and unaffected by any other third parties or agents. Medical practitioners are ultimately responsible for their agents, if any, and if TPAs advertise licensable healthcare services, they will be subject to Clause 31 of the Bill, and can only advertise on a licensee’s authorisation and must comply with all relevant advertising rules.

17.     Ms Quay also raised an issue on possible overlaps between the different Acts, and cited an example of hospital pharmacies being subject to both the current Private Hospitals and Medical Clinics Act (PHMCA) and in future this Bill, as well as the Health Products Act (HPA).

18.     The HPA governs the position when a pharmacy serves walk-in customers or walk-in patients. In such a situation, where the patient is not coming from the hospital where he would have had a prescription and had been seen by doctors, different standards would apply. In fact, we would expect that different standards should apply. If a pharmacy is part of a hospital and only serves in-hospital patients, then its licence will be part of the hospital’s (as the primary licensee) and it need not have a separate one.

19.     Hence, I should clarify that the scenario Ms Quay contemplates occurs only when a hospital pharmacy also chooses to also serve walk-in customers in addition to serving the hospital’s own patients. This being the case, the pharmacy would be expected to abide by the retail pharmacy standards set out under the HPA.

20.    That said, I have taken onboard Ms Quay’s comments about the rationalisation, and MOH and HSA have and will continue to streamline our processes to avoid duplicative work by licensees to comply with the requirements of this Bill and HPA, including for tele-pharmacy services, and will no doubt consult with Ms Quay and the Society further on this point. For example, the 2019 Singapore Standard for Supply and Delivery of Medication is a common national standard for all healthcare providers and retail pharmacies if they want to supply and deliver medications.

Newly licensed services

21.      Dr Chia, Mr Yong, and Ms Joan Pereira have asked about services that will be regulated for the first time under the Bill - in other words, not previously or hitherto regulated, but introduced for the first time under this Bill - and these include services like telemedicine and ambulance services, and asked how these services will be regulated prior to the roll-out and implementation of this Bill.

22.     To Dr Chia and Ms Pereira’s questions on telemedicine – we should view telemedicine as an extension of the practice of medicine, provided through a platform different from the traditional clinic setting. Nonetheless, this is a practice of medicine, and it remains regulated by existing standards such as, for instance, SMC’s ECEG. In addition, the National Telemedicine Guidelines, set out specific guidelines relevant to telemedicine that registered doctors and healthcare professionals would have to abide by.

23.     I would reiterate that the broad principle is that doctors are expected to provide the same quality and standard of care as in-person medical care. The fact that there is now, or there could be a more convenient way, in which care is delivered or the patient is communicated with, should not in itself be a reason to lower standards. The doctor should clearly indicate the limitations of his telemedicine services at the start of the consultation, and refer the patient for an in-person consultation when he is unable to form a sufficient judgment in order to discharge the expected standard of care.

24.     Moving forward, we will continue to refine the telemedicine regulations, have them tested, looked at, and assessed in the context of the industry as well, to make sure that they are as appropriate and as relevant to the ground practice as possible. MOH has set up the Regulatory Sandbox to work closely with telemedicine providers to co-develop service-specific regulations. This will ensure that patient safety and welfare are adequately safeguarded.

25.     Some Members have asked about cross-border healthcare services including the use of telemedicine. Let me clarify that the Bill does not have extraterritorial powers.

26.     However, if the telemedicine provider provides services (from wherever he might be) where such services are received in Singapore, then these services must be licensed under the Bill and all foreign doctors working for the provider must be registered with SMC.

27.     Of course, there is the question on how you would enforce and how you would deal with potentially errant providers who exist outside of Singapore. MOH will continue to improve patient engagement and education on the benefits and some of the limitations of telemedicine, including consuming healthcare services provided from abroad where, as I said, oversight and regulatory enforcement is not as readily available, so that patients will know and can make an informed decision as to which healthcare services to use and consume when seeking treatment.

28.     Mr Yong raised questions on licensing for new healthcare services, such as through the use of artificial intelligence (AI). MOH is aware of the increasing role and importance of AI in healthcare. It is an evolving area, and we are monitoring this space closely and also engaging the relevant stakeholders, those who develop the AI and use the AI to try to find the best possible guidelines and also to develop them in tandem to the industry to assure patient safety.

29.     Mr Yong made valid suggestions on the prospect of extending the regulatory sandbox to these cutting-edge areas, to explore and test boundaries, and to see what works and what does not work in the safe context of the sandbox. And we will do so, so that we can introduce these new services, if they are found to be workable and, most importantly, safe for the patient.

30.     Moving on to the private ambulance sector. Dr Chia and Mr Yong raised questions about this. As Mr Yong mentioned, it is an area that was not previously regulated. As such, progressive efforts have been made to ensure that private ambulance operators will be able to ramp up and be regulated under this Bill. Let me elaborate on a few measures.

31.     In 2017, we issued standards for emergency ambulance and medical transport services, so that operators will have clarity on the regulatory requirements that they must meet. This process that we expect to see come into force in the second phase in fact started some years ago to socialise these requirements to them, to acclimatise them to the standards they will have to adhere to.

32.     MOH recognises that private operators will require support to ramp up their capabilities and to meet the standards. Hence, a year later in 2018, a Voluntary Accreditation Scheme (VAS), which Ms Lim referred to in her speech, was launched to help familiarise private operators with the applicable standards for clinical governance, personnel, and vehicles early, so that steps can be taken to raise clinical service standards, and they know what the benchmark and the bar would be. Further, training schemes have also been introduced and facilitated by MOH, to upskill the existing manpower to meet the new requirements for paramedics and emergency medical technicians.

33.     Presently, more than 50% of private ambulances have come on-board the VAS. MOH will continue to work with other operators to prepare their vehicles, as well as scale up their manpower. As such, ambulance services will be licensed in the second phase of implementation and ambulance operators under VAS will be seamlessly ported over as licensees under the HCS Bill.

34.     Dr Chia also asked about the costs and fees of private ambulance providers. MOH shares these concerns. MOH will be also working with the VAS ambulance operators to develop and publish an appropriate range of fees charged, so that consumers are able to make better informed choice of the providers to use. We intend to publish those fees before these ambulance operators are phased under the second phase, and in fact we target to do so in the course of this year.

Governance requirements on licensees

35.     Prof Lateef, Mr de Souza and Mr Yong have asked how the Bill impacts existing PHMCA licensees, and whether its various requirements to enhance governance will place unnecessary burden on licensees.

36.     Members will know of course that this is not the intention. But at the same time, healthcare services must be properly regulated. The rationale for introducing the enhanced governance requirements is to ensure the licensees are well managed, so that they can effectively and safely serve their patients’ needs. At the same time, we recognise that the scale and complexity of licensees, and the kind of services that they may offer, the scale of their operations and set-up, may differ. The requirements will therefore be attenuated to take into account the nature of the licensee’s business, so as not to unnecessarily increase regulatory burden on all of them, in equal proportions.

37.     Let me first address queries from Mr Yong and Mr de Souza about the officeholders under this Bill. The Bill requires all licensees to appoint a Principal Officer (PO), and certain licensees providing more complex and technical services must also appoint a Clinical Governance Officer (CGO). The PO is akin to the manager appointed by the licensee under the present PHMCA regime and is responsible to assist the licensee in ensuring compliance with the requirements of this Bill. The PO ought to have sufficient organisational authority and management skill to adjust operations and make decisions, while the CGO will oversee the technical and clinical aspects of the service.

38.     MOH will be satisfied as long as the PO and CGOs are able to discharge their duties appropriately, and we will not require specific personnel, such as the CEO, for instance, to be the PO or CGO in each case. Similarly, for small GP clinics that likely do not provide any complex specialised services, one individual can fill the role of the licensee and PO, and a separate CGO will also not be required in those cases.

39.     Mr Pillai queried on whether there are objective criteria to determine the suitability of key appointment holders. Mr Pillai would have seen Clause 2(3) of the Bill, which sets out key factors that will be considered in deciding whether a person is suitable to be appointed as a key appointment holder, PO or CGO. It provides what is required, the broader outliers, financial suitability, prior conviction, and so on. But at the same time, we do not want to be overly restrictive in the quality of the candidate who comes forward. So, to that extent, that is a kind of interplay between the criteria that are set up here and what the Director of Medical Services might subjectively determine as suitability in each case.

40.     We also intend to provide clear guidance of instances where persons will be found unsuitable, so that licensees will be apprised of the applicable criteria. This might be done through regulations, and as Members know. Should a licensee appeal to the Minister against any decision to reject the appointment of his key appointment holders, PO or CGO, the Minister will consider each case based on its own facts.

41.     Mr Pillai raised the point about the appeal and how the Minister would consider it. Clause 48 of the Bill allows the Minister to vary, substitute the decision of the Director as to what is appropriate at the point of the appeal. As for Mr Pillai’s point on ensuring that the key appointment holders are competent in corporate governance and financial management, we agree, and that is the reason to ensure that there is a PO and CGO that deals with the clinical and technical aspects of the practice. MOH plans to include such requirements in a Code of Practice under Clause 38 of the Bill, which will guide licensees with a bit more specificity on the levels of skill and competencies required, but at the same time, not being overly prescriptive. That is not the intention.

42.     Mr de Souza and Prof Lateef have also asked for details on specified committees for quality assurance and clinical ethics. I believe they also raised questions on the quality assurance committees (QACs). QACs are already an existing requirement under the current PHMCA. They provide a protected environment for healthcare professionals to identify, learn, and correct errors made, without fear of being sued based on materials shared or their candid discussions. Through the learning environment that QACs foster, proper root-cause analysis can be conducted, and professionals can come up with solutions that will prevent the recurrence of such errors. That, after all, is the intention.

43.     Over the years, QACs have served their functions well in reviewing adverse clinical events and recommending initiatives to improve the quality and standard of care. Ms Lim asked specifically about the function of the QACs, and whether ultimately they will provide total oversight over the way in which procedures are handled. I believe she also mentioned a recent case. The QAC’s function is really to review adverse events and to recommend initiatives to improve the standard of care. That is quite different, and it does not affect other procedures, or, should the need arise, civil compensation under the civil courts. This still exists and nothing prejudices that or changes the options available to a patient. Therefore, the oversight over a case or over professional misconduct of a medical professional still falls with the SMC, and the regime that is there still exists. The QACs exist separately, and as I explained, really for a different purpose and outcome.

44.     Clinical ethics committees (CECs) review ethically challenging cases and ensure that ethical care and treatment is provided. There will be a list of prescribed medical treatments that require CEC review, where the care management of patients is likely to be complex; where societal values may be undermined; and where values of the medical practitioners may be challenged. For instance, when there are treatments for surgical separation of conjoined twins, that is something that the CEC should review. Or for example, in the creation of saviour siblings, that should also be considered by the CEC. Those are relevant matters that fall within the ambit of clinical as well as ethical considerations that the CEC would be well-placed to review.

Protecting patient safety, welfare and enhancing continuity of care

45.     Next, let me talk about the second mechanisms, and also some restrictions which various Members have raised. As I mentioned from the outset, the rationale for these powers is to ensure that patients not only receive appropriate but also continual care from their healthcare service provider.

46.     Prof Lateef, Mr Louis Ng, and Mr de Souza raised queries as to when step-in powers could be triggered. They will be triggered when it is in the patient’s interests to do so. Ultimately, that is of course a multi-faceted and dynamic assessment of the facts of each case. We would like to, however, assure the House that the step-in powers have to be activated sparingly, and as a measure of last resort, for the specified licensees. Other alternative measures as may be appropriate in the circumstances, like penalties, warnings, or the appointment of a new management team to rectify the issues – these are measures that could be considered before step-in. Licensees will be given an opportunity to make written representations before the step-in order is activated, unless it is an extreme case where an expedited or urgent step-in order is required.

47.      These powers can make a real difference in protecting patient safety and ensuring the continuity of care. For example, there may be cases of certain specified service providers with financial difficulties who may find it difficult to afford to continue its services and patient care. This in turn translates into undermining the safety and welfare of its patients.

48.      Under the existing PHMCA, MOH can only take regulatory actions such as revoking or suspending the licence, which was not feasible given that this would interrupt continuity of care for the resident patients. Under the Bill, step-in powers will now enable MOH to intervene in the operations instead to address the problems and improve continuity of care for patients. MOH will also ‘step-out’ once the service is stabilised and patient safety is assured.

49.     On Mr Yong and Ms Quay’s queries regarding the restriction on employment of certain individuals in long-stay settings, the mandated background checks are to be conducted by licensees on all prospective staff, and existing employees will not be affected. The objective of the check is to prevent individuals who have committed egregious crimes, such as rape, from being employed and potentially harming vulnerable patients in these settings. For foreigners, the background check has to be on a best-efforts basis, as and when information arises.

50.     Dr Chia, Mr Ng and Mr Gan have asked for an update on measures, including cybersecurity ones, to assist licensees in protecting health information in their electronic medical records. Ms Quay also asked when MOH would be mandating contribution of patient health information to the National Electronic Health Record (NEHR). I think the Members have called it the elephant in the room that is not actually in the Bill, and indeed, it is not in the Bill. Let me, however, take some time to assure Members and address some of these concerns nonetheless.

51.     First, Clause 27 of the Bill requires licensees to implement measures to protect their medical records and also to ensure the records are accurate and remain up to date. As MOH encourages more licensees to digitalise their medical records, we will also be working closely with healthcare licensees to study further ways to safeguard the collection, storage, access, use and sharing of health information. This will no doubt include developing cybersecurity guidelines specific and customised to the various healthcare services, and exploring efforts to better support the smaller healthcare providers as they take steps to improve their cyber and data security positions. We will be engaging the licensees on this effort, and will be releasing more details on this in the first half of 2020.

52.     As for NEHR, Dr Chia asked if this would be a mortal blow to the NEHR. It does not. But nonetheless, MOH will want to ensure that all necessary safeguards are in place to handle the evolving cybersecurity threats and also ensure that where various cybersecurity reviews for NEHR have been commissioned, the appropriate enhancements will be made to the system.

53.     As such, as I have announced previously, mandatory contribution to the NEHR has been deferred until all the enhancements have been completed, and we are satisfied that the system is assessed to be sufficiently robust. MOH will make further announcements on this at the appropriate juncture.

Helping patients make informed decisions

54.     Next, let me turn to the queries from Prof Lateef and Ms Quay who have also raised queries on co-location between licensed and unlicensed services.

55.     As I have explained in the opening speech, the prohibition on co-location is to prevent patients from being misled into consuming the unlicensed services, under the impression that it is part and parcel and adjunct to the licensed services. This is no different from the current position under the present PHMCA.

56.     However, where services are complementary to each other, between the licensed and the unlicensed services, which I have mentioned earlier, this concern is allayed. And in these circumstances, we will be prepared to make an exception for certain healthcare professionals to co-locate with licensees. 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.

57.     The Bill also contains other measures which will assist patients in making informed decisions when selecting healthcare services.

58.     Ms Quay cited the register of licensees in Clause 22 of the Bill. This register will be accessible by the public, making it easy to check and determine if a provider is in fact licensed by the MOH or not.

59.     Dr Lee Bee Wah and Mr Yong also asked how we can prevent patients from being misled by unqualified providers and into thinking that they are qualified when they are not, and go and seek their services. First of all, the licensee is responsible for ensuring that their personnel are appropriately qualified and competent. If a licensee permits unqualified personnel to provide healthcare services, MOH can investigate and take the appropriate regulatory actions. Secondly, Clause 31 plays a part by limiting advertising of licensable healthcare services to licensees only and as I have mentioned at the start, to persons acting on the authority of a licensee. Thirdly, Clause 37 allows MOH to publish information to ensure patient welfare, or for public interest, and this includes publishing a list of unlicensed providers.

60.     That said, ultimately public education will play an important role to prevent or reduce as far as possible, or to remove all such mis-impressions. MOH has and will be enhancing efforts as we implement the Bill and in public education. When in doubt, I would advise patients to check the registers maintained by the professional boards, such as the SMC. Mr Yong raised a query on the regulation of mental health professionals. Professional associations such as the Singapore Psychological Society and the Singapore Association for Counselling also provide advice on trained professionals in their respective fields, so the scenario that Mr Yong is trying to avoid is where there is doubt as to whether someone is a counsellor or not, whether he is a psychologist or not, which the association will provide further evidence for.

61.     Ms Pereira and Prof Lateef have given useful comments on other Bill requirements, such as naming restrictions and point-of-care tests. We will consider these carefully in implementing the Bill. And I would add to Ms Pereira’s point that should an entity today be using one of these otherwise prohibited names, the licensee does not change, its ownership does not change and it will carry on where it is. It will be allowed to continue using the name. But of course that will have to be revisited if they either sell the business or change the ownership materially.

Healthcare costs

62.     Next, let me turn to healthcare costs, which several members including Dr Chia, Mr Perera, Dr Chia, Dr Lee and Mr de Souza had raised. Concerns regarding the impact of the Bill on healthcare costs and the costs of passing on these costs to the patients, were raised. And I think those were valid concerns. Let me start by saying no single measure can tackle the issue of healthcare affordability, and I take onboard Mr Perera’s various suggestions, and I will address them in a moment.

63.     But for now, let me very quickly outline the various initiatives that we have done to keep healthcare costs low and sustainable for all Singaporeans. As I mentioned, we adopt a multi-tiered, multi-pronged and multi-faceted approach to controlling costs, with the basic assurance that no Singaporean will be denied access to basic healthcare due to financial difficulties. That is the assurance that we give, and the multi-tiered approach that we take will include enhancing the 3Ms, which we have done in various stages and will continue to – MediSave, MediShield Life and MediFund; and also extending significant subsidies, including the CHAS scheme. Looking ahead, we are also enhancing the role of insurance in long term care, such as with the launch of CareShield Life from mid-2020.

64.     We have also put in place other measures to curb the increase in healthcare costs. These include requirements under the Integrated Shield Plan insurers for new rider plans. We have also developed and published fee benchmarks, as Mr Perera quoted, for private sector professional fees for common surgical procedures. Finally, the Agency for Care Effectiveness also publishes guidances on clinically and cost-effective patient care.

65.     Mr Perera has no doubt cited a number of studies. I think that at various junctures, as he mentioned, studies from various places, published from different sources, some experts speaking at a conference and delivered a paper, and some results, programmes and studies, where we are not prepared at this stage to agree with the conclusion because we need to contextualise, we need to look at the details, we need to look at who have studied and what their study findings might be. If Mr Perera would be happy to share with us these studies, and the other details that he had mentioned in his speech with us, we can do a more careful study and look at all the options in adopting some of these suggestions in Singapore. But I think we have common ground, which is the need to promote price transparency. The Bill supports this drive by:

a) improving price transparency, such as requiring licensees to display common charges;

b) mandating financial counselling and itemisation of bills for certain settings, such as procedures conducted by hospitals or specialist clinics; and also

c) establishing Service Review Committees to monitor utilisation and clinical outcomes of certain high-cost and more complex services, such as proton beam therapy, for example, to ensure that not just the care provided is appropriate, but also cost-effective.

To take into account and to assuage Mr Perera’s concerns, not all high cost procedures are good quality procedures and that not all good quality procedures are also at the same cost effective level. So all of these factors will operate dynamically and they will all have to be taken into account, depending on the nature of the service delivered and of course, patient safety and the requirements of each individual patient as well.

Implementation and rollout

66.     So the points that the Members raised about costs and that it will ultimately be transferred to the patient, is a point that we are indeed concerned about. As one example, to reduce the administrative workload for all existing providers as we implement the Bill, MOH conducted extensive stakeholder engagements, part of what we did in the two years, to understand and guide their own licensing needs and map these as far as possible to the new Bill licences.

67.     On Dr Chia and Mr de Souza’s query on how we will help the providers, specifically the smaller ones, transition from the current PHMCA to the future HCS Bill, I will like to assure the House that MOH will support and guide all licensees to ensure a seamless transition to the new licensing regime. This will be done at each implementation phase, where PHMCA licences will be swapped out for equivalent licences under this Bill, without the need for existing licensees to file any applications or pay additional fees.

68.     MOH will continue to provide clear instructions and appropriate channels for stakeholders to ask questions or clarify their doubts, or come and seek assistance from us on the conditions of the new regime

69.     Various Members - Dr Chia, Prof Lateef, Mr de Souza, Ms Quay, Mr Pillai, Mr Yong, and Dr Lee - have asked how this Bill impacts operating costs and in particular whether licensees will pay more fees as a result of the new landscape. Again, let me assure the House that the Bill is not intended as a revenue generating mechanism. It is necessary because of what we have outlined in the speech. The new regulatory landscape is necessary. MOH would not indiscriminately be collecting more licensing fees on an aggregate basis, compared to the position today.

70.     The general principle is that licence fees are pegged at a level that commensurate with the cost of manpower and resources incurred from the expected inspections and the audits to be done. MOH has and will continue to streamline our licensing processes to keep our regulatory costs down, as well as to reduce excessive regulatory burden on licensees.

71.     In fact, based on our preliminary assessment as we mapped the services across to the new HCS Bill requirements, more than 95% of existing providers today will either see no change or in fact see a decrease in the amount of fees to be paid. So there is no reasonable basis for the providers to pass on these costs to patients. The remaining providers who will see an increase are mainly providers that will be providing new licensable services regulated under the Bill.

72.     For existing providers facing higher fees, MOH will put in mitigation measures to support the transition, and this will include implementing the increase gradually over three licensing renewal cycles. So we will space this out as far as possible, the increase, and spread it out over three renewal cycles.

Conclusion

73.     Let me conclude. The Bill introduces a regulatory regime that is sufficiently nimble and flexible to protect patient safety and welfare, and at the same time take on board rapidly evolving changes to the healthcare landscape. At the same time, it will accommodate new healthcare services, new healthcare models and also nurture innovation. This will ensure that healthcare services provided in Singapore will be able to address the existing and also the future needs of our population. Sir, I beg to move.