This week, Norwegian hospitals must make cuts and savings in the billions range. Investments in new hospitals are put on hold across the country. Cut, cut, cut The budgets for next year are tight, and the accounting figures are so red that you can get into the Christmas spirit. But Christmas cheer is far from it. In Bergen, it is announced that “the doctors will have to say no more often”. The hospital management believes there will be “long and demanding days”. In Oslo, cuts in maternity services and psychiatry arouse resentment. In addition, there is an unexploded bomb in the hospitals in the form of a price increase that has not been taken into account. Although everyone knows that both electricity, medicine, food and equipment are becoming more expensive. The worst is standing in the north. A long-announced crisis Look north more often, wrote the poems Rolf Jacobsen. And that is exactly what the health experts are doing, with increasing concern. Because what happens there is often a pilot or a forewarning of what will eventually hit us. Every single day, the hospitals in our northernmost counties have used 2.3 million more than they have. This autumn, the health authority was expected to run with a deficit of a staggering NOK 850 million. However, the big concern is not about tight budgets and red numbers. If something dramatic does not happen with how we rig the healthcare system, experts fear that the whole system will collapse. Or as the health company’s new director Marit Lind stated when she got the job: If we continue to operate in the same way, it will eventually come to a standstill. She says what no one thought a manager in the public sector would say: Money is not the main problem for Helse nord. Temporary workers take over The reason for the overuse can be summed up in three words: Lack of people. Large sums of money are spent on overtime and the hiring of temporary workers because there is a lack of professionals to do the jobs. At the same time, Northern Norway is so spread out that there are not enough patients to have an efficient operation. Shift guards and emergency services devour health personnel. In the hospitals, at ambulance stations and at the local emergency room. According to the Norwegian Nurses’ Association, the hospitals have increased temporary staff costs by 62 per cent in three years. Last year, Helse Nord spent close to half a billion on temporary workers. Finnmarkssykehuset alone has spent 100 million on rent. The municipalities also spend large sums on hiring temporary workers for nursing homes and doctors’ offices. There is great variation, but particularly scattered municipalities in the districts struggle to obtain enough professionals. The paradox for these municipalities is that the young leave, while the old stay. But who will care for those who remain? Saving up to find It is a well-known fact that being poor can be expensive. Temp agencies earn good money by staffing Norwegian hospitals with foreign temps. With images of spectacular northern Norwegian nature, the mountains in Lofoten and high wages, for example, Danish doctors, nurses and midwives are tempted to take a “working adventure” in Norway. It is not made any easier by the fact that more and more healthcare workers prefer to work freelance or for a temp agency rather than being a permanent employee at the hospital. In many cases, this means both more income and greater flexibility. Tight rotations scare people away from permanent employment. And the temporary agencies are criticized for inappropriate recruitment methods. The great health mystery It is certainly tempting to point to the temp agencies as the root of the evil, but they are probably just as much a symptom that something is wrong. Therefore, the healthcare system was also exempted from the tightening of rent that the government has fought for. Why it is difficult to get enough hands may seem like a mystery. We are at the top of the world when it comes to doctor and nurse density. In addition, an increasingly large proportion of all working people work in the health and social care sector. So where do they go, all the doctors and nurses? Part of the picture is that we treat more, and that the healthcare system is becoming increasingly specialised. Where before you could manage with one doctor regardless of whether you had broken your leg, operated on your appendix or had a caesarean section, now three doctors with different skills are required. Today there are 43 different specializations for doctors. The advantage is that it makes the healthcare system even more sharp and professional, but the downside is that this has a centralizing effect. For example, much of the cancer surgery was collected in fewer hospitals when it turned out that there was considerable variation between the hospitals. Those cancer departments that treated the most patients also had the best results. It was about volume training. The elderly wave has been forewarned for a long time. Now it is here. More and more of us are getting older, and we are living longer. This also increases the need for health services. Today’s well-organized working life is another reason. It is no longer the case that a district doctor or an ambulance worker is more or less continuously on standby around the clock. Regular doctors work more normal working days. At the same time, rotations and on-call arrangements tie up a lot of healthcare personnel. It is particularly a challenge in rural areas. Many spend a disproportionately large part of their time on duty at local hospitals, ambulance stations and in psychiatry. When you are at work you treat patients. On duty, you wait for something (preferably nothing) to happen. Such a job is not perceived as meaningful for healthcare personnel either. Most people want exciting tasks together with colleagues. Money is not the main problem Therefore they did not succeed in maintaining the maternity ward in Kristiansund, even though the Storting had both allocated money and specifically asked to keep the maternity service open. The hospital management believed they were unable to recruit enough professionals to provide a reasonable offer. The Bunads guerrilla and local campaigners, on the other hand, believe that it is the will that matters. We also see this pattern among GPs. In pig-ridden areas, doctors spend a disproportionately large part of their working time on call. In the big cities, the challenge is long lists of doctors. It is a dilemma that is difficult to steer clear of. Large parts of the country are sparsely populated and people are far apart. This is most obvious in the north. Now Health Minister Ingvild Kjerkol (Ap) has put the knife to the throat of the health company. They must gain control over the finances, and there is a clear expectation that they must consider “changes in the division of functions and tasks”. Health Minister Ingvild Kjerkol (Ap) is among those of Støre’s ministers who have a formidable challenge in their laps. Here from a visit to the maternity ward in Kristiansund. Photo: Marius André Jenssen Stenberg / news Which is bureaucratic language for professional environments and treatment services to be gathered in fewer places. This does not necessarily mean that everything must be centralised. But not everyone can keep up with everything. Boils Northern Norway, like the other health regions, has its boilers. The competition between the hospitals in Tromsø and Bodø has led to them having twice as many treatment options for which there is no patient basis. This increases costs, but also weakens the overall offer. For example, there is concern that Tromsø will not be able to maintain the standard of a university hospital, and that the sickest will have to be flown south. The health authority was unable to agree on a new emergency hospital in Helgeland. Now they are arguing about functions, and many fear the decision on hospitals in both Mo i Rana and Sandnessjøen hangs in the balance. Among mayors and local politicians there is widespread concern about the emergency services at the smallest hospitals, such as Narvik, Gravdal and Stokmarknes. The shops expect increased sales of torches. At the same time, it has been proposed to close maternity wards in the summer, but the health politicians refuse and push the decision ahead of them. Many fear that it is a first step in losing maternity services. The dilemmas are in the queue It’s a difficult question for the politicians. In the healthcare system, you always have to find a balance between quality and distance. There’s little use in a hospital in the neighborhood if they can’t provide the help you need, but it also doesn’t help the world’s best hospital if the patient dies on the way there. In the far less caricatured reality, some people experience having a long way to the hospital. But a question that will force itself to the fore is whether many people who have a long journey anyway will have to put up with it being even longer if it provides a better offer in the region. Incidentally, a case with enough power to blow up the current government. Another question is how to use healthcare professionals. During the pandemic, it emerged that Norway has a higher proportion of specialized personnel than our neighboring countries, for example in the intensive care units. A debate that will force its way is whether nurses can do jobs that doctors do, and whether healthcare workers can do nursing jobs. A case with explosive power enough to trigger a full professional match. Shortage of midwives also in Oslo A current example is that hospitals are struggling to recruit midwives because many prefer to work with maternity care in the municipalities. A tough rotation must be an important reason. There is now a debate going on about whether it is the right use of important key personnel. Even at Oslo University Hospital, operating theaters sometimes have to close because they struggle to recruit specialist nurses. Many of these challenges are expected to be addressed in the Health Personnel Commission, which committee leader Gunnar Bovim will present this winter. The essence of the Interaction Reform, the right treatment in the right place, will be dusted off. A patient must not be sent to hospital if he can receive treatment in his municipality. Perhaps the most difficult is the question of whether the level we have today is good enough. Can we expect Norway to continue pumping money and people into the health care system? The politicians have known the answer for a long time, but it is only now that the consequences have become so clear. Because this country is far. Most of it is north.
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