Norwegian Board of Health
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The Norwegian Board of Health is a national government institution under the Ministry of Health and Care Services. The Norwegian Board of Health (Norwegian name: Statens helsetilsyn. Short name: Helsetilsynet) is an independent supervision authority, with responsibility for general supervision of health and social services in the country. The Norwegian Board of Health directs the supervision authorities at the county level: the offices of the county governors, which have responsibility for supervision of social services, and the Norwegian Board of Health in the Counties, which have responsibility for supervision of health services and health care personnel.
[edit] Supervision of health and social services in Norway means ensuring that legislation is complied with
In Norway there are many acts relating to health and social services that:
- lay down requirements for the quality of services
- regulate the practice of health care personnel who have professional authorization
- give users of health and social services rights, for example those laid down in the Patients’ Rights Act.
Supervision is carried out for all statutory services, including services that are provided by publicly owned hospitals, municipalities, private organizations, and health care personnel who run their own practice.
However, the supervision authorities are independent of political direction, and to a large extent decide themselves about priorities for which services to supervise and which areas supervision shall include. Priorities are decided, among other things, on the basis of information about risk and vulnerability.
The supervision authorities contribute to ensuring that:
- the needs of the population for health and social services are met
- services are run in accordance with statutory requirements and acceptable professional standards
- deficiencies in provision of services are prevented
- resources are used effectively and efficiently.
[edit] Methods used by the supervision authorities
[edit] General supervision
General supervision is supervision with an overall perspective, and involves collecting, organizing and interpreting information about health and social services from the perspective of supervision. This information forms the basis for evaluating supply and quality of services.
[edit] Planned supervision of health and social care institutions
System audits are used for supervision of health and social care institutions (municipalities, nursing homes, hospitals etc.), based on internationally accepted methodology. The institutions are investigated by reviewing documents, carrying out interviews, inspecting premises, and carrying out random checks. Conditions that are in breach of laws or regulations (nonconformities) are documented in supervision reports. The supervision authorities follow up nonconformities with the owners and management until the conditions meet the statutory requirements. Each year, the Norwegian Board of Health designates between two and four areas for countrywide supervision.
[edit] Individual cases concerning deficiencies in services
The Norwegian Board of Health in the Counties receive information about possible deficiencies in services from many sources (patients, relatives, employers, the police, the mass media). About 2 000 cases are investigated each year to determine whether there has been a breach of laws or regulations. If a breach has occurred, the Norwegian Board of Health can give an administrative reaction against the institution, in the form of instructions to correct the conditions, or an administrative reaction against health care personnel with authorization, in the form of a warning, revocation of the right to requisition medicinal products, or withdrawal of authorization.
The way the Board of Health manages these cases has however been criticized, as the health provider under investigation has few of the civil rights he would have in a proper court of law. It is not mandatory to hear the accused person's version of the story, little actual investigation takes place. It is quite possible to be under investigation and even sentenced without being notified that a case against you has been raised. The decisions are based on the perceived credibility of the complaint, and have been seen as heavily biased against the accused. Hearings and sentencing takes place in closed sessions without the scrutiny of either the public, the accused or the politicians. The proceedings are thus quite different from the US. Medical Boards, where the accused doctor or nurse have the same civil rights as in a regular court of law. Furthermore, it seems impossible to be completely acquitted once the Board of Health has opened an investigation. Even if the case is baseless and recognized as such, it is filed, and if several equally groundless complaints should occur in the future, they can be pooled and justify a sanction from the Board of Health.
[edit] Reports of events that have led to, or could have led to serious injury to patients
The Norwegian Board of Health has responsibility for MedEvent – the reporting system for adverse events in specialized health services, in which reports of events that have led to, or could have led to, serious injury to patients, are collected. Hospitals have a statutory duty to report such events.
This system does however not function, the paramount reason for this failure being the behavior of the Board of Health itself. From time to time, the Board of Health leaks grossly distorted information from the MedEvent system into the tabloid press, with headlines that at best are misleading, at other times so removed from the underlying facts as to be outright travesties of the truth.
[edit] Complaints about health and social services and failure to meet statutory rights
The Patients’ Rights Act gives the population many rights regarding health services. The Act covers the following:
- the right to essential health care
- assessment by a specialist physician within 30 days
- free choice of hospital
- access to medical records and corrections to records
- patient participation
- information
- special rights for children
- consent to medical treatment
- individual plans for people who require several different services.
The Social Services Act covers the duty of the municipalities to provide services for the population, such as:
- information, advice and counselling that can help to solve or prevent social problems
- practical help and instruction for people who have special needs for assistance because of illness, functional disabilities, age etc.
- relief for carers and salary for families and people who care for a person with extensive need for care
- support persons and families
- places in institutions and sheltered accommodation
- accommodation for people with special needs.
Each year, the supervision authorities deal with 6000 to 8000 complaints about these services and rights.
[edit] Use of the findings and experience gained from supervision
The supervision authorities work actively to ensure that agencies that provide health and social services use available sources of information in their work with developing management systems and with improving the quality of services. These sources include: supervision reports, decisions made in individual cases, reports about adverse events, and publications of the Norwegian Board of Health.
The findings and experience gained from supervision, other sources of information and supervision methodology are available to the public. Most of this information is available on the web site www.helsetilsynet.no.
[edit] Organization
The supervision authorities are the Norwegian Board of Health (the central office), the Norwegian Board of Health in the Counties, and the Offices of the County Governor.
The Norwegian Board of Health is the national supervision authority, with about 85 employees, of which 25 are lawyers, about 20 are doctors, 10-15 are other types of health care personnel, 5 to 10 are social care personnel and about 10 are social scientists.
Supervision is carried out in the counties by the Norwegian Board of Health in the Counties (supervision of health services and health care personnel) and by the Offices of the County Governor (supervision of social services).
The leader of the supervision authorities is Director General Lars E. Hanssen (Ph.D., prof.).
