Step-in powers are meant to be activated as a measure of last resort. These powers are necessary to ensure patient safety, welfare and continuity of care. Failure of continued operations is detrimental to the interest of the patient.

These powers are similar to other legislation involving critical services, such as the Banking Act 1970, Insurance Act 1966 and the Bus Services Industry Act 2015, which allow the Minister or a Public Authority to step-in and take over a licensee’s operations.

Whilst this power may appear intrusive, experience from other legislations shows that even though these powers exist, they are used very sparingly in very exceptional circumstances. For example, MAS has far-reaching powers to take over financial institutions under its purview, and ‘step-in’ will only be used in a very dire situation where it is necessary to prevent systemic risks to the financial markets.

In Section 32 of the HCSA, step-in orders has been circumscribed to certain “designated” licensees. These are residential care licensees such as nursing homes and hospitals

MOH can only exercise these powers in certain circumstances (e.g., licence is revoked, suspended or surrendered or in cases of insolvency) and if it is necessary to take over the designated licensee to ensure the designated licensee’s patients and customers receive safe, appropriate healthcare services or an adequate provision of healthcare services.

Step-in measures are temporary, and used to ensure patient safety, welfare and continuity of care, and for the stabilisation of operations. Once continuity of care for patient is assured, MOH will ‘step out’.

To ensure fairness to businesses, Section 33(2) mandates that Minister must give the relevant designated licensee concerned a reasonable opportunity to make written representation in respect of the proposed step-in order.

The exception to this is when step-in is urgent (such as in life and death situations) where an expedited step-in order is necessary because patient safety is jeopardised.