On Tuesday, shock waves went through northern Norway. Among other things, there was a proposal to turn the emergency hospital in Lofoten into a district medical centre. In addition, the emergency services at the hospital in Narvik will be removed and moved to Harstad. And in Helgeland it is recommended to go from three to one hospital. The background Helse Nord lacks people in the hospitals, and has been commissioned to look at a new organization of the hospitals in the region. Five working groups were to come up with new alternatives. Most attention was given to group 1, which looked at emergency and planned treatments. But the recommendation was far from unanimous. Five of the members dissented from the decision. Now, for the first time, one of the members tells why. Two and a half months – There are probably several conditions that I am pointing to, says Bjørn Bremer to news. Bremer believes that the working group has had far too little time to assess the content of the hospitals throughout northern Norway, and the consequences of making drastic changes. – It has been a very bad time for the process. A proposal for a new structure for the specialist health service in Northern Norway must be made in two and a half months. And then it goes without saying that it will be a very demanding exercise to do it properly. Bremer believes that, among other things, the investigation has lacked a good overview of where Helse Nord’s approximately 1,000 vacant positions are located. – So, which hospital has the major staffing challenges and in relation to which types of positions? We have not received that overview. It is an important part of the decision-making basis. Another element that Bremer points to is the pre-hospital services – i.e. ambulance, boat, plane and helicopter. This part of the hospitals will have an increased burden if the recommendation to reduce or remove emergency preparedness at several hospitals is adopted. – There will be major consequences and we have not dug into them well enough. This means that I believe the consequences of a change have not been explained well enough, and then it will be very difficult. These are the most important points from the report: In Nordlandssykehuset, it is proposed to change the current function at Lofoten Hospital to a DMS (district medical centre) with outpatient functions, 24-hour function and delivery room. The hospital in Bodø will be a large emergency hospital like today, and no changes are proposed. A majority of the working group proposes that the hospital in Narvik be developed to operate with planned treatment. (cut from emergency surgery) It is nevertheless proposed to retain a 24-hour service within maternity care in the form of a delivery room. A majority of the working group recommends option 2 with a large emergency hospital in Helgeland. Today there are three emergency hospitals in Helgeland, where the hospital in Mosjøen has already been decided to be closed. The group does not specify where a large hospital will be located. A majority of the working group recommends that UNN Harstad gathers emergency and 24-hour activity from UNN Narvik’s admission area. No changes are proposed in emergency functions for Tromsø. No changes are proposed in emergency functions in Finnmark. The majority in the working group recommends alternative 2, which corresponds to the current organisation, Consequences for the municipalities The municipalities in northern Norway have been represented in the working groups. Bremer represented Narvik in the group, and he is critical of how precisely the municipalities have become involved in the process. – Helse Nord has tried to set up a collaboration with the municipalities, but with such a time factor as we have had here, it has not been possible to give the set up a content that makes you sit with the experience of having been involved. Because a change to the hospitals will also entail changes for the municipal health service. – For the municipalities, a change will have major consequences for municipal health services, he says and continues: – That is why it is extremely important to have the cooperation in place, and not least to ensure good involvement. But it has been extremely demanding and completely impossible to achieve in practice. news has been in contact with the leader of working group 1, Fredrik Sund, for a comment. He refers to the media guard in Helse Nord. Demanding group work Working group 1 started its work on 23 August. For almost a month, the group worked without much attention from the outside world. That changed abruptly on September 20. Then news and Avisa Nordland were able to reveal content from an internal working note, which showed that the group proposed to remove the emergency functions at several hospitals in northern Norway. The reactions from patients, politicians and entire local communities were not long in coming. Not long after, Helse Nord began to publish the meeting minutes from the working groups on its website. This gave the public even more insight into how the groups had thought about the various hospitals. Bremer describes the work in the group as demanding. – There has been a lot of focus in the media, there have been many points of view. It has sometimes been very demanding, so there is no hiding it. Was contacted by people along the way – But when you say very demanding, what does that mean? – In practice, this means that you have been contacted by people and environments who want to promote their views, he says and continues: – But when you sit in such a working group, you are loyal to the process internal to the group. So it has been listening and hearing, but not being able to say much. They have taken the input into the group and tried to let it be part of the decision-making process. – What do you think is the solution to Helse Nord’s challenges, as described? – No, I just want to say that there are challenges, we completely agree on that. He adds: – We in the minority believe that more time is needed to prepare the necessary basis for decision-making in order to find the right medicine for the diagnosis made at Helse Nord. These are the members of the group that works with the hospital structure Working group 1 consists of the following members: Fredrik Sund, Helse Nord RHF (leader) Siri Solheim, Helse Nord RHF (secretariat) Gunnhild Berglen, Regional user committee Sissel Alterskjær, group union representative Jørgen Nilsen, Finnmarkshykehuset David Johansen, University Hospital of Northern Norway Snorre Sollid, University Hospital of Northern Norway Gro-Marith Karlsen, Nordland Hospital Monica Storkjørren, Helgeland Hospital Bjørn Bremer, Narvik Municipality* Raymond Dokmo, Bodø Municipality* Anne H. Davidsen, Alta Municipality* Geir Tollåli, Helse Nord RHF Bente Mietinen, Helse Nord RHF Randi Spørck, Helse Nord RHF * The participants from the municipal health service are appointed by the municipalities themselves through an established municipal coordination body for Northern Norway’s 80 municipalities. (source: Helse Nord) – As there has been such strong criticism that some areas have been too poorly lit, we have to see if we agree, says Helse Nord director Marit Lind. Photo: Lars-Bjørn Martinsen / news Helse Nord: Must see if they agree Director of Helse Nord, Marit Lind, says in an interview with news today that if the investigations are insufficient, she will consider asking the board for an extended deadline. Lind says she has personally only had time to skim through the reports, which came yesterday. When that is done, and they have put together a comprehensive plan, new risk assessments will be made, says the Helse Nord director. – Then it may happen that we have to adjust based on that, if we see that there are areas that are becoming too vulnerable or similar. What happens next? It is still some time until Helse Nord decides what happens. This is the planned progress plan: 14 November 2023: The working groups’ recommendations, including risk and vulnerability analysis, are delivered to the coordination group in Helse Nord RHF. 1 December 2023: Draft of the overall plan for the division of functions and tasks, including ROS analysis, is finalised. 4 to 12 December: Discussion and dialogue. 20 December 2023: The board adopts a consultation draft of the comprehensive plan with proposals for division of functions and tasks in Helse Nord. 2 December–1 March: The overall plan is sent out for a broad and open consultation. 25 April 2024: The plan must be adopted by the board of Helse Nord before, if necessary, it is presented to the owner, the Ministry of Health and Care. Lind says she believes they have drawn up a structure which means that the involvement of municipalities and professionals in the investigation work has been greater than is usually the case. She disagrees that the involvement has not been good. – When we have received criticism from employees and the media that it is too risky a schedule, I have always said that now we will wait and see what we get from the groups. Then I’ll decide on that. In the course of a few days now, I have to look at it so that this is sufficient to make a comprehensive plan, or whether we need a little more time. – It sounds as if you now see that this may have to be postponed? – I will not say. As there has been such strong criticism that some areas have been too poorly lit, we have to see if we agree.
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Bjørn helped decide the future of hospitals in the north – believes they had far too little time – news Nordland
