Before we know what future fate the long-announced Health Personnel Commission will have, it has managed at least two feats. The seriousness has sunk in. Submission of a commission often becomes an exercise in duty that ends up in the deep desk drawers. Even with a rare sleep-inducing name, they have managed to create attention and debate. For that, they have received good help from the news: In large parts of the country there is a crying need for professionals. Even if you pay well and the use of temporary workers is high, you struggle to get people in important positions. Both news Brennpunkt’s revelations about outrageous failures in elderly care and the criticism of Ullern health center have actualized the problem. The elderly wave we have talked about will come for as long as people can remember. Now it is here. Employees say they break the law at work and relatives fear gross negligence. How is it in Norwegian nursing homes? Agree on the description of reality With a selection that spreads in all directions and that represents a number of strong special interests, they have managed to unite on a common description of reality, which is not a message of joy. After many years of talk about more and better health services, they recognize that growth in the health care system is not sustainable. We cannot expect a very large increase in resources or personnel for health purposes. There is a consensus on this: We will lack professionals, and the fringes will be affected first We are getting more and more elderly and needing care This is not something we can just train, hire or grant our way out of. There is an upper limit to how large a proportion of the population can work with health. There will be fewer employees per patient We must do things smarter than today and use technology where we can This is a problem that the whole of Europe is experiencing and that can hardly be solved with immigration Even if you agree with the description of reality, everything else is simple to agree on the measures. There is a major restructuring of society that the current government and Minister of Health Ingvild Kjerkol Ap) has on his watch. These are some of the main obstacles. Battle between professional groups For many years, the trend has been towards more and more education and competence, and the healthcare system also has its version of “master’s disease”. Now the experts believe we must stop using overqualified health personnel, and push more responsibility and tasks down the line. A group that is particularly highlighted are healthcare workers, who have a secondary education. We would hardly have had such a large nursing shortage if healthcare workers did more of their tasks. Nor would the shortage of doctors have been as precarious if nurses, midwives and other health workers did tasks that only doctors can do. When it has not happened to more than a limited extent, it is due to something that is often called professional competition. Most occupational groups will almost on autopilot think they are best suited to carry out a task. It is of course about professional pride, but considerations such as salary, contractual agreements and exclusivity are hardly unimportant. We also see that in the preliminary reactions to the commission. The trade union, which organizes healthcare workers who can get more status and tasks, is very positive. Both the Nurses’ Association and the Medical Association have appeared more measured. Struggle for (free) time Another hard nut to crack is how to get healthcare workers to work more evenings and weekends. While most people want normal working days, the healthcare system is open 24 hours a day. Although many people work in shifts, it is almost enough to meet the needs. This is one reason for the many small vacancies that abound in nursing homes and hospitals. The employers have long wanted tighter rotations, but the unions have opposed this. There is of course also a question of salary. Among other things, it is proposed here that more people who currently work regular day positions must contribute more to rotations in other departments. We also see that other ways of organizing the working day are being experimented with, for example the North Sea shift (working for longer periods with subsequent days off). Struggle for localization Norway stands out in one important area. We have many hospitals, and there are relatively few patients who visit each hospital. Still, many have a long way to the hospital. A look at the map of Norway explains why. Simply put, it requires the same amount of basic staff to keep an emergency department or a delivery room running, regardless of whether it concerns 10 or 100 patients. Therefore, discussions about structure will continue. The need is reinforced by the fact that the healthcare system is becoming increasingly specialised, and will require more specialist expertise. Healthcare professionals also need practice to become a master. All this points towards centralizing more of the highly competent services to fewer hospitals. At the same time, more elderly people will need frequent health care. It is then an advantage to have health services close to where people live. Today, there is little between a hospital and a nursing home. It will therefore be recommended that there be more “super-nursing homes”, with more hospital services. And fewer hospitals. But who will voluntarily let go of their local hospital? There is nothing that arouses as much emotion as moving and closing a hospital. Struggle between state and municipality Today, the state is responsible for the hospitals, while the municipalities are responsible for, among other things, care for the elderly, medical services and health centres. The teeth are the only thing you have to go to the county council to get fixed. It might have been easy if there was a clear line between these levels. But in practice, there are many patients who flow between them. Who are too healthy to be in hospital, but too ill to cope with home-based care or in a nursing home. It is not made easier by the fact that the eye of the needle has become narrower to be admitted to hospital. A lot happened when admissions were largely replaced by day treatment (in outpatient clinics). Many elderly and frail patients in particular have experienced becoming a kind of toss-up between hospital and municipal health services. It is neither good care, health promotion nor sensible use of resources. But since the money comes from different pockets and there are different politicians who decide, it is easier said than done to solve this. It is expensive, opens up opportunities for blackmail and creates gray areas. Opinions differ here, but the commission will investigate bringing all health services together on one level. The maligned, but so far irreplaceable health care company model will certainly be debated. Others will think that the state should be given more responsibility for care for the elderly. But such a proposal will surely meet with opposition from those concerned with local democracy. Fight between politicians Politicians must stop outbidding each other, is the clear message from the commission. And they have a point. Health policy has in many ways become the opposition’s arena. We see that all parties that are in government and are actually in charge tend to lose credibility in care for the elderly. It is easier to point out what is wrong than the solutions. And that’s enough misery to take off. Although we have known for many years that the wave of older people is coming, (too) little has been done to meet it. The answer has usually been more money and better arrangements, not other ways of doing things. This week, for example, SV came up with a proposal for staffing standards in care for the elderly. When the commission, like health leaders, says that the answer cannot be more money, it is unfamiliar food for the politicians. How will they face a debate that is actually about priorities? Fighting against our expectations Ultimately, this is also about our expectations. Because for many years we have received increasingly better health services and treatment, without necessarily feeling healthier or happier. Now the new signals are that the healthcare system must prioritize harder, say no more and say that this is good enough. Not everything can be world class. But will it be good enough for us? And who should really prioritize what is unnecessary and what is overtreatment? It looks great and sensible on paper, but so difficult in practice. It is not only politicians and health personnel who will be put to the test. We all will be.
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Agree on the problem. The solution creates noise – Speech
