These are just some of the ingredients when the board of Helse Nord will on Tuesday consider the proposal to centralize and collect more of the hospital provision in Northern Norway. And anyone who thinks that it is only on the football field that Bodø and Tromsø are fierce rivals has not seen the dispute that is now flaring up in the health region. More on that later. Because factually speaking, the case is about finding a balance between quality, proximity and resource use in the health service. But there are few who consider this with a sober eye. While people fear for their hospital, others are worried about the signal effect if the politicians give in to the torch trains. The healthcare system could eventually collapse, is the scenario being drawn up. Because the really bad news is that the unpopular proposals being debated in the north are just a drop in the bucket to solve the challenges that the health authorities themselves believe they have. And it’s not just on the football field An especially special mission The message from Helse Nord’s chief executive is something to lose sleep at night: It is not possible to maintain the overall health service without making significant changes. Today’s situation is unsustainable, and if we do not make changes, the crisis will quickly become even deeper, writes CEO Marit Lind. That is why the health organization received a very special assignment from the government. They had to consider changes in the division of tasks between the hospitals in order to be able to solve their mission in the long term. An important cause of the problems is a lack of health personnel. Large sums are spent on overtime and the hiring of temporary workers. It creates unpredictability, and now even the private recruitment agencies report that they are running out of people. A frequent diagnosis is that the professionals are spread too thin. Norway is no longer as attractive a country to work in, and it is not only in this country that there is a shortage of professionals. Few believe that this will improve. On the contrary, there are more of us needing care, and fewer hands to provide care. Surrounded by enemies Although the Helse-Nord management uses strong words about the seriousness, they have “doubted their way” to a compromise that seems somewhat half-hearted. It will neither cause much cheer nor solve any fundamental problems. It is nevertheless understandable. The pressure is massive, and health management has a thankless job. Behind every rock and line there pop up senior doctors, municipal doctors and others who believe that what they are proposing is the wrong medicine. The local politicians rage. Those who support the health company hide it well. Or know how to sit quietly in the boat. Nothing arouses such strong emotions as closing hospital services. The entire Aps local team signed up in protest in the hospital municipality of Vestvågøy, and Aps is virtually wiped out in the local polls. Only torch sellers and debate editors have had good times. Torchlight procession at Stokmarknes in solidarity with the proposal by Helse Nord to cut emergency and maternity services in Lofoten and Narvik. Photo: Vilde Bratland Erikstad / news The core of the struggle There were big waves when a working group proposed to close the emergency services at the hospitals in Narvik and Lofoten. Instead, the hospitals should carry out more planned treatments, which are a large part of the activity at a hospital. The difference is that there is no 24-hour on-call service and therefore cannot accept emergency cases. It obviously goes beyond the perceived security. It also means that more patients have to travel further and puts greater pressure on the municipal health service. But emergency preparedness requires many professionals, who often spend a large part of their working time on call rather than treating patients. The upside is that this is a smarter use of badly needed health personnel. Now the health management proposes that Lofoten and Narvik should retain internal medicine emergency services, but emergency surgery should be moved to the larger hospitals Bodø and Harstad. It hardly removes the noise, and is far from sufficient to have the necessary effect on staffing and finances. Even if the most far-reaching proposals are adopted, there will be a need for further, very extensive changes, it says in black and white. It is still completely out of the blue whether the board of Helse Nord will get together to send this proposal out for consultation. On with the bunade? Another proposal is that the maternity services should be scaled down in several places. Today, there are maternity services at 14 different locations in Northern Norway. The number is synonymous with the number of annual births in the two smallest birthplaces, which had 14 and 15 births respectively in 2022. A consequence of the region’s depopulation and aging population is that the number of child births is falling. Paradoxically, an ever-improving offer for pregnant women, such as the NIPT test, early ultrasound and better maternity care in the municipalities, contributes to an even greater shortage of specially trained doctors and midwives to staff the maternity wards. Health Minister Ingvild Kjerkol has stood quite alone in the storm. Before Christmas, she met new parents and activists at the hospital in Gravdal in Lofoten. Photo: Vilde Bratland Erikstad In addition, a significant centralization of drug and psychiatric services and X-ray and support services in the region is proposed, but that part of the proposal has not broken the sound barrier. In the same way that no one goes in a torchlight procession for the whole, few raise their voice for psychiatry. And lurking behind the scenes… two undetonated bombs As if this is not demanding enough, the most difficult cases lie ahead on the trail. The health authority proposes that in the future there should only be one large hospital in Helgeland. Anyone who has followed the year-long battle for hospitals between Sandnessjøen, Mosjøen and Mo i Rana has an idea of what lies ahead. It is not without reason that Helgeland has been nicknamed Norway’s Balkans. The real elephant in the room is nevertheless the latent dispute between the two large hospitals in the region, Tromsø and Bodø. More noise than on the football pitch Because it has not been agreed on who should have what, you have double functions in two hospitals for which there is not really a patient base. These are highly specialized services that cost a lot and require a lot of personnel. Now it is said outright that this cannot continue. In Tromsø, they will fight to strengthen and preserve the university hospital, which already has a vulnerable position. In Bodø, they will fight tooth and nail to keep their offers. Local people are already fighting to get their people into the new health boards, which will be appointed in mid-January. Northern Norway is not at all one kingdom in terms of health policy. It is more like a battle of all against all. Avisa Nordland’s commentator believes Tromsø is firing the guns and fears Bodø will be left with “torch processions, curses and despair”. The commentator in the newspaper Nordlys accuses Bodø of an attempted coup and believes it will throw the region into “50 years of misfortune”. The health organizations count, the politicians decide Ultimately, it is the politicians who decide. It is the government that gave Helse-Nord the task of looking at its tasks. Although you’d have to be blind and deaf not to know what’s coming, they don’t seem to like the answer. At least not the whole government. The Center Party was quick to make statements that can hardly be interpreted as anything other than a torpedoing of the process. Finance Minister Trygve Slagsvold Vedums made no concrete promises when he preempted the Minister of Health with his visit to Lofoten, but you’d have to be quite tone-deaf not to understand what SP is saying between the lines. Trygve Slagsvold Vedum said little, but signaled a lot when he came before the health minister to visit the hospital in Gravdal before Christmas. Photo: Vilde Bratland Erikstad / news The Center Party was badly burned on Melkøya, and is unlikely to find itself involved in more cases that could destroy its frayed credibility in the north. Health Minister Ingvild Kjerkol (Ap) has stood quite alone in the storm. There has not been much help from the opposition. This is a type of case where the Liberal Party and the Conservative Party could traditionally come together, but the Conservative Party has been conspicuously dismissive of the process. When SP has so clearly shown its cards, it is unlikely that the Conservative Party or anyone else in the opposition wants to burn their fingers. The question is how much will be put at the head of the government. Sources have long predicted that the hospital structure could become the real suicide bomb in this government. Because it is not without reason that the Minister of Health and the Prime Minister have not shot down the process in the north. They have responsibility for the whole, and are under great pressure from managers in the healthcare system in particular. In those circles, the consequences of the staffing crisis have long been feared. Therefore, this concerns the whole country. They claim a lot is at stake if changes are not made now. The consequences of a structure that cannot be staffed are that the healthcare queues grow and that there are large differences in the healthcare services people receive. People are getting sicker and have to wait longer. In the long term, they fear that the healthcare system may collapse. This is also the warning in the Health Personnel Commission, which came last winter. What is happening in the north is described as a foretaste of what will hit the rest of the country. Therefore, the politicians’ handling of the challenges in Helse Nord will also say something about how this will be resolved in the future. The pressure to collect health services will come in several places. One issue the government will soon have on its table is the decision by Helse Sør-East to close down the delivery service at Elverum hospital. Health economists have questioned whether it is right for Helse Nord to be rewarded with increased funding for what they call poor financial management. Unlike most crises, this one is unlikely to go away on its own or be solved with money alone. And there is always a torch train.
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There is always a torch train – Ytring
