Healthcare Services (Nursing Home Service) Regulations 2023

No. S 849

Healthcare Services Act 2020

Healthcare Services
(Nursing Home Service)
Regulations 2023

In exercise of the powers conferred by section 57 of the Healthcare Services Act 2020, the Minister for Health makes the following Regulations:

PART 1

PRELIMINARY

Citation and commencement

1.  These Regulations are the Healthcare Services (Nursing Home Service) Regulations 2023 and come into operation on 18 December 2023.

Definitions

2.  In these Regulations —

“allied health professional” has the meaning given by section 2 of the Allied Health Professions Act 2011;

“approved standards of nursing practice” means the standards established by the Singapore Nursing Board for the practice of nursing in Singapore;

“collaborative prescribing service” has the meaning given by regulation 2 of the Healthcare Services (Collaborative Prescribing Service) Regulations 2023 (G.N. No. S 398/2023);

“compound”, in relation to a therapeutic product, means to formulate, mix, assemble, package or label the therapeutic product, with the intention of dispensing or administering the therapeutic product to a patient in accordance with the written instructions of a qualified practitioner;

“dietetic service” means any of the following services that is provided to a patient for the purpose of optimising the patient’s health and nutrition:

(a) assessing and determining the patient’s nutritional needs;

(b) formulating and implementing a dietetic plan for the patient;

(c) monitoring the patient’s response to the dietetic plan and determining whether a change to the dietetic plan is necessary;

“duly qualified allied health professional” has the meaning given by section 3 of the Allied Health Professions Act 2011;

“emergency ambulance service” has the meaning given by paragraph 2 of the First Schedule to the Act;

“enrolled nurse” means a person who is an enrolled nurse within the meaning of the Nurses and Midwives Act 1999 and holds a valid practising certificate under that Act;

“essential life‑saving measure” means any basic emergency procedure that may be carried out on a person for the purpose of resuscitating the person;

“general anaesthesia” has the meaning given by paragraph 2 of the First Schedule to the Act;

“General Regulations” means the Healthcare Services (General) Regulations 2021 (G.N. No. S 1035/2021);

“head of nursing” means the individual appointed under regulation 8(1);

“health product” has the meaning given by section 2(1) of the Health Products Act 2007;

“healthcare professional” has the meaning given by regulation 2 of the General Regulations;

“hospice patient” means a patient who receives a hospice service;

“hospice service” means the provision of care, treatment or procedure to a patient who —

(a) suffers from an advanced and progressive disease which will result in the continued decline in the patient’s health and eventual death of the patient; and

(b) has a medical condition that requires specialist palliative care and nursing oversight,

for palliating any pain, suffering or discomfort of the patient;

“IPC programme” has the meaning given by regulation 37(1)(a);

“licensee” means a person who holds a licence to provide a nursing home service;

“medical transport service” has the meaning given by paragraph 2 of the First Schedule to the Act;

“medicinal product” has the meaning given by section 3 of the Medicines Act 1975;

“minor surgical procedure” has the meaning given by paragraph 2 of the First Schedule to the Act;

“nurse” means a registered nurse or an enrolled nurse;

“nursing home service” has the meaning given by paragraph 2 of the First Schedule to the Act;

“nursing personnel” means a nurse or any other person who assists a nurse in providing nursing care to patients;

“nursing service” means the provision of nursing care to a patient to assist the patient in attaining, maintaining or recovering his or her health;

“nursing supervisory function” means the function of supervising the provision of a nursing care by a person, and includes directing, managing and supervising the provision of nursing care;

“nutrition service” means the provision of food to any patient at any approved permanent premises;

“palliative medicine specialist” means a medical practitioner who is registered under section 22 of the Medical Registration Act 1997 as a specialist in palliative medicine;

“patient health record” means a record containing the personal data and medical information of a patient that is maintained by a licensee in relation to the provision of a nursing home service to the patient;

“personnel”, in relation to a licensee, means any individual employed or engaged by the licensee to assist the licensee in providing a nursing home service;

“pharmaceutical service” means —

(a) the procurement, storage and control, dispensing, distribution, supply and administration of medicinal products and health products stored at any approved permanent premises;

(b) the preparation of medicinal products or health products, other than the compounding of therapeutic products, at any approved permanent premises; and

(c) the counselling and monitoring of patient drug therapy;

“pharmacist” means an individual who is registered as a pharmacist under the Pharmacists Registration Act 2007 and holds a valid practising certificate under that Act;

“psychosocial support” means the provision of emotional, social and practical support to a patient for the purpose of alleviating anxiety and depression to enhance the patient’s mental health;

“qualified practitioner” means —

(a) a medical practitioner; or

(b) a registered dentist under the Dental Registration Act 1999 whose name appears in the first division of the Register of Dentists maintained and kept under section 13(1)(a) of that Act;

“registered nurse” means a person who is a registered nurse within the meaning of the Nurses and Midwives Act 1999 and holds a valid practising certificate under that Act;

“rehabilitative service” —

(a) means assisting or facilitating a patient in slowing down the disabling effects of the patient’s health condition and functional abilities; and

(b) includes physiotherapy, occupational therapy and speech and language therapy;

“Singapore Nursing Board” means the Singapore Nursing Board established under section 3 of the Nurses and Midwives Act 1999;

“specimen” has the meaning given by regulation 2 of the General Regulations;

“therapeutic product” means a health product categorised as a therapeutic product in the First Schedule to the Health Products Act 2007.

Application of Regulations

3.  Unless otherwise expressly provided in these Regulations, the provisions of these Regulations —

(a) apply in addition to the provisions of the General Regulations; and

(b) prevail if, and to the extent that, there is any inconsistency between these Regulations and the General Regulations insofar as the matter relates to a licensee.

PART 2

LICENSING MATTERS

Specified service

4.  For the purposes of section 9A(1) of the Act, the services set out in paragraph 1 of the Schedule are specified services for a nursing home service.

Prohibited service delivery modes

5.  A licensee must not provide a nursing home service by any of the following service delivery modes:

(a) at any premises other than permanent premises;

(b) using a conveyance;

(c) by remote provision.

Prerequisites for application for approval of specified service

6.  A licensee may apply for approval to provide a blood transfusion service as a specified service for a nursing home service only if, in the course of providing the nursing home service, the licensee also provides a hospice service as a specified service.

PART 3

REQUIREMENTS RELATING TO PERSONNEL

Qualifications, skills and competencies of Clinical Governance Officer

7.—(1)  For the purposes of section 24(3)(b) of the Act, an individual is suitably qualified to be appointed as a Clinical Governance Officer for a nursing home service if the individual is —

(a) a medical practitioner who satisfies the requirements in paragraph (2); or

(b) a registered nurse who satisfies the requirements in paragraph (3).

(2)  For the purposes of paragraph (1)(a), the medical practitioner —

(a) must be registered under section 20(1) or (2) of the Medical Registration Act 1997 as a fully registered medical practitioner and hold a valid practising certificate under that Act; and

(b) must have one of the following:

(i) registration under section 22 of the Medical Registration Act 1997 as a specialist in any branch of medicine;

(ii) registration under section 22A of the Medical Registration Act 1997 as a family physician in the Register of Family Physicians;

(iii) full‑time work experience as a medical practitioner for a continuous period of at least 5 years or an aggregate period of at least 5 years during a continuous period of 10 years, in treating patients —

(A) in the provision of an outpatient medical service, outpatient renal dialysis service, acute hospital service or community hospital service provided in a private hospital, medical clinic or healthcare establishment (as the case may be) licensed under the repealed Act; or

(B) in the provision of an outpatient medical service, outpatient renal dialysis service, acute hospital service or community hospital service licensed under the Act.

(3)  For the purposes of paragraph (1)(b), the registered nurse —

(a) must not be subject to any condition imposed on his or her registration by the Singapore Nursing Board under section 17(2) of the Nurses and Midwives Act 1999;

(b) must either —

(i) hold a degree in nursing that is recognised by the Singapore Nursing Board; or

(ii) have obtained a qualification in any area of clinical nursing that is conferred by an institute of higher learning approved by the Director‑General, after he or she becomes a registered nurse; and

(c) must have full-time work experience —

(i) in providing nursing care; and

(ii) in a nursing supervisory function in respect of the provision of a nursing care,

at any inpatient ward of a hospital or nursing home, whether in or outside Singapore, for a continuous period of at least 5 years immediately before the registered nurse’s appointment as a Clinical Governance Officer.

(4)  For the purposes of section 24(3)(b) of the Act, an individual is suitably qualified to be appointed as a Clinical Governance Officer for a hospice service if the individual is a medical practitioner who —

(a) is registered under section 20(1) or (2) of the Medical Registration Act 1997 as a fully registered medical practitioner and holds a valid practising certificate under that Act;

(b) is a palliative medicine specialist; and

(c) has full‑time work experience as a medical practitioner for a continuous period of at least 5 years or an aggregate period of at least 5 years during a continuous period of 10 years, in treating patients —

(i) in a private hospital, medical clinic or healthcare establishment (as the case may be) licensed under the repealed Act; or

(ii) in the provision of a healthcare service licensed under the Act,

where at least 3 years of the full-time work experience is in treating patients requiring palliative care, as a palliative medicine specialist.

(5)  In this regulation, “acute hospital service”, “community hospital service”, “outpatient medical service” and “outpatient renal dialysis service” have the meanings given by paragraph 2 of the First Schedule to the Act.

Head of nursing

8.—(1)  A licensee must appoint as the head of nursing for every approved permanent premises, an individual who —

(a) is a registered nurse;

(b) either —

(i) holds a degree in nursing that is recognised by the Singapore Nursing Board; or

(ii) has obtained a qualification in any area of clinical nursing that is conferred by an institute of higher learning approved by the Director‑General, after he or she becomes a registered nurse; and

(c) has full-time work experience —

(i) in providing nursing care; and

(ii) in a nursing supervisory function in respect of the provision of nursing care,

at any inpatient ward of a hospital or nursing home, whether in or outside Singapore, for an aggregate period of at least 5 years.

(2)  A licensee must ensure that the head of nursing of any approved permanent premises performs all the following functions:

(a) supervising the provision of a nursing service to patients at the approved permanent premises;

(b) overseeing the induction, training and development of every nursing personnel;

(c) supervising the work processes, conduct and activities of the licensee’s nursing personnel in providing a nursing service;

(d) supervising the deployment of nursing personnel at the approved permanent premises so as to ensure the assignment of a suitable nurse who possesses the appropriate qualifications, experience, competency and skills, to provide nursing care to a patient, taking into account the patient’s medical needs and condition;

(e) assisting the licensee in —

(i) establishing, implementing and regularly reviewing written policies and procedures to provide guidance for the provision of any nursing service;

(ii) ensuring that the provision of any nursing service at the approved permanent premises is in accordance with those policies and procedures and the approved standards of nursing practice; and

(iii) conducting any audit of the provision of the nursing home service at the approved permanent premises so as to evaluate and monitor the quality of the nursing service provided by the licensee to patients;

(f) ensuring that in providing a nursing service to any patient at the approved permanent premises, the licensee complies with the IPC programme.

QAC supervisor

9.—(1)  In addition to regulation 22(1) of the General Regulations, a licensee must appoint, as the licensee’s QAC supervisor, an individual who is the licensee’s employee.

(2)  In this regulation, “QAC supervisor” means the QAC supervisor who is appointed under regulation 22(1) of the General Regulations.

General requirements relating to personnel

10.  A licensee must —

(a) establish, implement and regularly review policies and the appropriate processes for the training and competency assessment of the licensee’s personnel to ensure that the personnel are able to perform their work effectively, safely and in compliance with the applicable laws, guidelines, policies, processes, procedures and protocols; and

(b) monitor and regularly review the work performance of the licensee’s personnel to ensure compliance by the personnel with the applicable laws, guidelines, policies, processes, procedures and protocols.

PART 4

APPROVED PERMANENT PREMISES, EQUIPMENT, ETC.

Standards for approved permanent premises

11.  A licensee must —

(a) ensure that every approved permanent premises is operating at all times;

(b) ensure that every approved permanent premises is sufficiently spacious and appropriately equipped to enable the nursing home service (including any essential life‑saving measure) to be provided to patients in a proper, effective and safe manner;

(c) ensure that there is sufficient lighting and ventilation at every approved permanent premises;

(d) ensure that every approved permanent premises is designed, built and equipped to enable and facilitate —

(i) access to and from the approved permanent premises by elderly patients or patients with physical disability or mobility impairment; and

(ii) movement within the approved permanent premises by elderly patients or patients with physical disability or mobility impairment;

(e) ensure that every approved permanent premises have wide passageways to enable and facilitate the movement of personnel, patients and bulky equipment including trolley beds, shower trolleys and wheel‑chairs;

(f) ensure that adequate toilet and bathing facilities that are suitable for the use by elderly patients or patients with physical disability or mobility impairment, are available at the approved permanent premises or (where the approved permanent premises comprises 2 or more storeys) at each storey of the approved permanent premises where any patient is accommodated;

(g) ensure that there are sufficient beds, mattresses, pillows, chairs and lockers at every approved permanent premises so as to enable the allocation of a suitable bed with mattress, pillow, chair and locker to every patient;

(h) ensure that there are sufficient bed screens to safeguard every patient’s privacy;

(i) establish and implement a patient-to-nurse communication system at every approved permanent premises to facilitate communication between a patient and any nurse at the nursing station, including when a patient is at his or her bed or in any toilet and bathing facilities;

(j) ensure that any care or treatment (other than an essential life‑saving measure) is provided to a patient only in an area at the approved permanent premises that is sufficiently spacious, appropriately equipped and, if necessary, partitioned (whether on a permanent or temporary basis) from the other parts of the approved permanent premises to ensure the patient’s comfort, safety and privacy;

(k) where the approved permanent premises consists of one or more storeys, ensure that at each storey where any patient is accommodated, there is —

(i) at least one nursing station; and

(ii) at least one sluice room;

(l) designate at least one area at every approved permanent premises where patients can have their meals or carry out recreational activities;

(m) designate at least one area at every approved permanent premises where patients can receive rehabilitative service;

(n) designate at least one area in every approved permanent premises for the accommodation of patients suffering or suspected to be suffering from an infectious disease specified in the First Schedule to the Infectious Diseases Act 1976, and ensure that the area is equipped with hand‑washing facilities;

(o) ensure that the area mentioned in paragraph (n) is —

(i) separate and isolated from the area at which all other patients are accommodated; and

(ii) designed, built and equipped to minimise the risk of the transmission of any infectious disease among the patients staying in that area, or from a patient staying in that area to any individual outside that area;

(p) ensure that any room or equipment that has been used by a patient suffering or suspected to be suffering from any infectious disease is not used by any other patient unless it is adequately disinfected; and

(q) implement measures to prevent unauthorised access to every approved permanent premises.

Equipment, materials and supplies

12.—(1)  A licensee must ensure that there is a process to facilitate prompt access to adequate supplies of equipment, materials and other supplies which are necessary for the provision of any nursing home service in a proper, effective and safe manner.

(2)  A licensee must not use any equipment, facility or supply that is not adequate, functional, effective or fit for use to provide any care or treatment to a patient.

Environment cleaning

13.  A licensee must —

(a) establish and implement measures and processes for regular cleaning and additional ad hoc cleaning to minimise the spread of pathogenic organisms; and

(b) ensure that every structure, facility, equipment or device provided by the licensee for a patient’s use is sanitary and safe for the patient’s use.

Backup utilities

14.—(1)  A licensee must ensure that there is access to emergency power and lighting in every approved permanent premises to ensure the provision of a nursing home service in a proper, effective and safe manner.

(2)  Without limiting paragraph (1), the licensee must ensure that —

(a) the emergency power and lighting are sufficient to ensure —

(i) any procedure that has commenced may be safely completed; and

(ii) at all times, the approved permanent premises is sufficiently lit to ensure —

(A) the safe movement of patients into, out of or within the approved permanent premises; and

(B) the timely and safe access to fire‑fighting equipment; and

(b) where any life support equipment is used, the life support equipment is connected to an emergency power supply at all times during its use.

Notification of addition or removal of beds, etc.

15.—(1)  A licensee who intends to add or remove a bed at any approved permanent premises used for the provision of a nursing home service must, no later than 2 months before the bed is added or removed, notify the Director‑General of the intended addition or removal.

(2)  Before adding any bed at any approved permanent premises, the licensee must ensure that —

(a) there is sufficient space at the approved permanent premises to accommodate the bed; and

(b) there is sufficient personnel at the approved permanent premises to provide care and treatment to all the patients at the approved permanent premises after the patient capacity is increased due to the addition of the bed at the approved permanent premises.

 

Made on 13 December 2023.

CHAN YENG KIT

Permanent Secretary,
Ministry of Health,
Singapore.

[MOH 78:44/1; AG/LEGIS/SL/122E/2020/44 Vol. 1]