In her annual speech to the hospitals, Health Minister Ingvild Kjerkol (Ap) said that she wished she was standing here with promises of more money and better times. In reality, she will be a minister for worse times – which we have long known had to come. It has been muttered about for a long time, but the big challenges have to drown in what we have on the plate today. The hospitals are already struggling with a kind of fake covid, with significant backlogs in patient treatment and sick leave. Now they find that everything they buy in medicine, equipment, electricity and food has become more expensive without this being compensated. In reality, cuts, even if the politicians refuse to use that word. Nevertheless, the health minister’s underlying message is that this is just a foretaste. Because the big questions in the hospitals will not be about this year’s budget, but about the “who, what and where” of the future. The clear message to the hospitals is that they must prioritize. It’s a nice word, but in practice it means that we have to do less of something. At what this “something” is, the agreement also stops. Who will do which tasks in the hospitals? Who will receive health care? What should they get help for? And where should they get help? Bigger needs, fewer hands The description of reality is widely agreed upon. Many arrows point in the same direction. We live longer, medical development makes frequent progress and we treat more and more diseases and conditions. The healthcare system is also becoming more specialised. A doctor is no longer a doctor. You need far more employees to carry out the same tasks. The long-announced elderly wave is here. We are getting fewer and fewer working people behind each pensioner. It is becoming increasingly difficult to recruit professionals who want to work in the healthcare system. Even if we vacuum the neighboring countries for nurses and doctors who want to take well-paid shifts in Norwegian hospitals. Although a well-organized working life is a good thing, it is no longer the case that a district doctor or an ambulance worker is more or less continuously on standby around the clock. This also requires far more professionals for the same job. And it is worth remembering that this does not only apply to hospitals. Municipalities, nursing homes, ambulance stations and district psychiatric centers are also in the same position. The big threat to our healthcare system is simply a lack of people to do the jobs. Treat the symptoms, not the problems The Minister of Health has given a clear marching order to the hospitals to tighten the use of substitutes. Much of the overspending in hospitals is linked to overtime and the hiring of substitutes. Temporary agency expenses are said to have increased by 62 per cent in three years. The further north, the bigger the problem. Last year, Helse Nord spent close to half a billion on temporary workers. 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 it will hardly be easier if the permanent employees now have to work more instead of hiring temporary workers. Here are good opportunities for a vicious circle. But the temp agencies, which specialize in recruiting doctors and nurses, are hardly at the heart of the problem. They are a symptom of a severe imbalance in the need for healthcare professionals. Meeting themselves at the door When the Red-Greens tightened the use of temporary agencies and temporary agencies, they made an exception for the health sector. But when it comes to private service providers, the tone is different. While they strongly oppose private nursing homes and welfare services, they have no problems with private individuals making money from, for example, cleaning, plowing, municipal buildings and IT services. The argument then is that health and welfare are core tasks of the welfare state. At the same time, the healthcare system can freely hire from private temporary agencies, while construction sites, shops and other businesses have been given strict restrictions. It is probably mostly about the fact that the Norwegian healthcare system would not be able to function without substitutes. And that you are closest to yourself. Commission with explosive power For many years, the answer has been that we need to educate more people. Nevertheless, Norway is at the top of the world both when it comes to the density of doctors and nurses. And there has been a large increase in the proportion of all working people who work within the health and social services. It does not seem realistic that the answer should always be that more people have to work with health. What remains is whether we have to do something different. If something dramatic does not happen with how we rig the healthcare system, experts fear that the whole system will collapse. If we continue to operate in the same way, it will eventually come to a standstill, stated the new head of Helse Nord. The first 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. It sounds uncomplicated on paper, but it has enough explosive power to trigger professional fights and a lot of opposition. One such example is that many health centers have employed midwives to follow up pregnant women. Is it the right use of the scarce midwifery resources? Many of these challenges are expected to be addressed in the Health Personnel Commission, which will be presented on 2 February. An eternal minefield Hospital structure is another inevitable question, even if the politicians are reluctant to enter that minefield. There is still no getting away from the fact that Norway is a long, scattered country. Many people have a long way to the hospital, while in many hospitals a disproportionately large part of the time and the employees are spent on call. It is also not perceived as meaningful for healthcare personnel. Most people want exciting tasks together with colleagues. The government has asked the hospitals in Northern Norway to consider “changes in the division of functions and tasks”. Which in practice means that professional environments and treatment services must be gathered in fewer places. This does not necessarily mean that everything should be centralised, but everyone cannot keep up with everything. And for the patients, it means that you have to travel further to get help. The third thing that will force itself to the fore is a debate about what we should stop with. For example, Kjerkol asks to reduce the use of laboratory and X-rays. As many people ask because we want to find out what/if anything is wrong with us. And the more we are tested and examined, the more we find that can be repaired. Little help For many years, people have called for a debate on priorities in the healthcare system, but it always fails. Because who would voluntarily have less health care? Just as certain as the debate about what we should do less of, it is that Kjerkol and the government will get little help. FRP calls the hospital speech “a slap in the face to patients in the health queue”, while SV uses words like “madness”. The Conservative Party is concerned about the patients, the Red Party is concerned about the employees, while the KrF is concerned about everything and everyone. The Conservative Party probably did not feel that they were getting much help from Kjerkol and her fellow party members when they governed the health policy. The health policy debate has long been the domain of the opposition. Add all the trade unions, patient organizations and mayors who speak their case. In this way, there are not many priorities. But now comes the debate. Whether the politicians want it or not.
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The silent crisis cannot continue much longer – Statement
