The case in summary Over 50 community doctors criticize the process surrounding Helse Nord’s work in assessing the hospital structure in Northern Norway, and fear consequences for the rest of the country. The critics believe that the process is based on incorrect premises and that many important aspects are not taken into account in the work. Among other things, they point to increased specialization in the health service and think there should be more generalization in the hospitals. The critics also believe that the capacity of the largest hospitals in the region can become a challenge, and that there is a need to keep the hospitals in the districts. Minister of Health and Care Ingvild Kjerkol welcomes all input regarding the process. The summary is made by an AI service from OpenAi. The content is quality assured by news’s journalists before publication. – We believe that the process Helse Nord is currently in is based on the wrong premises, and that there are a great many elements that are not taken into account in the work, says Jan Håkon Juul, chief municipal physician in Vågan municipality in Nordland. Helse Nord is currently looking at what can be changed to make the hospitals in Northern Norway more efficient. An assignment they have received from the Ministry of Health and Care. – Helse Nord is in a serious situation. If we do not take action, we will lack professionals in the future to provide as good a health service in the north as in the rest of the country, writes Health and Care Minister Ingvild Kjerkol in an email to news. – That is why the government has commissioned Helse Nord to assess the need for measures and changes that can solve that challenge and create a sustainable specialist health service in the north. But Labor has received a lot of criticism, and a number of politicians have protested loudly. Now the process has been postponed for three weeks to carry out more analyses. At the same time, more than 50 municipal chief doctors and other community doctors across the country have signed a chronicle in which they come out strongly against the whole process. These have signed the chronicle Ingebjørn Bleidvin Municipal supervisor in Hadsel Jan Håkon Juul Municipal supervisor in Vågan Eli-Anne Emblem Skaug Supervisor Climate, environment and public health, Trondheim Arild Iversen Assistant municipal supervisor in Bergen Inger Hilde Trandem Municipal supervisor in Tromsø Guro Steine Letting Municipal supervisor in Fredrikstad Raymond Dokmo Municipal supervisor in Bodø Øystein Furnes Municipal supervisor in Sunnfjord, Vestland Leif Edvard Muruvik Vonen Municipal supervisor in the Værnes region and member of the board of the Medical Association Terese Folgerø Municipal supervisor in Alver, Vestland Ingrid Kristiansen Municipal supervisor in Frøya, Trøndelag Siri E. Hansson Kristiansen Municipal supervisor in Karmøy, Rogaland Guro Hafnor Røstvig Municipal supervisor in Sandnes, Rogaland Anne Ruth Syrtveit Mikalsen Municipal chief Froland, Agder Kathrine Kristoffersen Municipal chief Tromsø Preben Aavitsland Professor of community medicine and physician Anne Helen Hansen Associate professor UiT, Chief physician UNN, Specialist in general medicine and community medicine Annette Fosse Head of the National Center for District Medicine Anders Bærheim Professor emeritus, General Medicine, UiB Edvin Schei Professor, Department of Global Health and Community Medicine, UiB Svein Zander Bratland Researcher, Specialist in General Medicine and Community Medicine, UiB Knut Eirik Eliassen Associate Professor, University of Bergen, Specialist in General Medicine Kjell Haug Professor Emeritus in Community Medicine at UiB Stefán Hjörleifsson Associate Professor at the Department of Global Health and Community Medicine, UiB Anne Kveim Lie Professor, Department of Health and Society, UiO Kirsti Malterud, professor emerita, Bergen Professor emerita, UiB Peder A. Halvorsen Professor at the department of primary medicine May-Lill Johansen Head of the General Medicine Research Unit in Tromsø Arnfinn Seim Municipal chief physician Indre Fosen and professor emeritus of general medicine, NTNU Sigrid Vikjord Physician St. Olav’s hospital and researcher, NTNU Ernst Horgen Brage Ulvmoen Coordinating consulting chief physician, NAV Nordland Sverre Litleskare Senior researcher at NORCE UiB Balpreet Kaur Sandhu Municipal chief physician, Sandnes Astrid B. Holm Municipal supervisor Andøy Drude Bratlien Municipal supervisor Sør-Varanger Britt Larsen Mehmi, Vadsø Municipal supervisor Vadsø Sonni Schumacher Municipal supervisor Hammerfest Elisabeth Dalgård Municipal supervisor Sørreisa Ingunn Heggheim Municipal supervisor Alta Aud Marie Tandberg Municipal supervisor Hammerfest Mette Røkenes Municipal supervisor Sortland Kenneth Johansen Municipal supervisor Kvænangen Frode Berg Municipal supervisor Rana Anders Svensson Municipal supervisor Bø Tommy Aune Rehn Municipal supervisor Levanger, Trøndelag Nina Ihle Hadland Municipal supervisor Gjesdal, Rogaland Anne Herefoss Davidsen Municipal supervisor Alta Jonas Holte Community medicine and general practitioner, Harstad Daniela Brühl Municipal supervisor Ullensvang, Vestland Kristin Vik Hagerupsen Municipal supervisor Harstad Thomas Bakkeid Municipal supervisor Kvæfjord Marie Helene Jørgensen Municipal supervisor Tjeldsund and Evenes Paul Olav Røsb Et natural commitment, according to Ingebjørn Bleidvin, municipal chief physician in Hadsel. – These challenges hit Northern Norway first. As a result, many of the guidelines that are laid here can also apply elsewhere in the country, he says. In the chronicle, they point to several things that should have been done differently. – Ineffective proposals – We want to start the process again. We agree that we need to rethink our hospitals, but we need to think together, says head of the National Center for District Medicine (NSDM) Anette Fosse, one of those who have signed the chronicle. – But isn’t it too late to start again? – No, it’s not too late. At least what’s bad is if they initiate big changes that turn out to be stupid to do. One of the challenges mentioned in the chronicle is the increased specialization in the health service. SIMILAR CHALLENGE IN SEVERAL COUNTRIES: According to Anette Fosse, countries such as Scotland, England, the USA and Canada are struggling with a lack of generalists in their hospitals. Photo: Frank Nygård / news – Many patients find that they have to be sent to more different doctors for examinations and treatment now than before, says Jan Håkon Juul in Vågan. In the chronicle, they write that the local hospitals today fully treat 9 out of 10 patients themselves. – Then it is of course the case that we need specialist expertise in some cases, and we must also develop this. But it cannot be the case that it comes at the expense of the service to the most common patients. The doctors behind the chronicle fear that the structural changes proposed so far in the work of Helse Nord will lead to even more specialisation. They believe that it would have been better to open up more generalization in the hospitals. Fears increased pressure on the large hospitals – In Northern Norway, we are quite sparsely populated and we have many hospitals for geographical reasons. As the hospitals have relatively few patients, we do not need all the various specialists every day. With more generalists, efficiency would increase significantly, and it would be easier to staff the hospitals, says Juul. In the chronicle, the doctors also indicate that the capacity of the largest hospitals in the region can be a challenge. – The main challenge for Helse Nord lies, as we see it, in the two largest hospitals, UNN in Tromsø and Nordlandssykehuset. We do not solve the staffing challenges by taking away the first line locally, says Juul. – Presumably this process will not result in very many more employees in Bodø and Tromsø, but they will receive many more patients. Contrary to the signals from Helse Nord’s investigations, the doctors behind the petition believe that there is a need to keep the hospitals in the districts. For several reasons. Proximity to relatives – The obvious disadvantage is that there will be a lot of transport. This is particularly true in northern Norway and parts of the country where there are long distances. It is inappropriate, especially for those patients who are already frail, says Anette Fosse. – Then it is also the case that the specialists who are eventually centralized do not necessarily move to the nearest big city. They move south. So for us in Northern Norway, centralization is a bad idea. Another argument for offering the most possible treatment where people live is the proximity to relatives, according to Ingebjørn Bleidvin in Hadsel. – Relatives are an important resource for us in the healthcare system. We gradually become more dependent on them and then we have to organize ourselves so that it is possible for them to contribute, says Bleidvin. – That is why it is important that we listen to the patients and their relatives in the planning of the future healthcare system. And what is important to them? Proximity to the hospital. INCREASING CHALLENGE: Ingebjørn Bleidvin, municipal chief physician in Hadsel, believes the challenges we now see in northern Norway will become even greater as the wave of elderly people grows. Photo: Bent Lindsetmo / news The doctors hope that everyone who will now make a plan for how the hospitals in northern Norway will be structured will listen to those who work outside the big hospitals. As they write in the chronicle: Health Minister Kjerkol welcomes all input regarding the process. – There will be many different opinions and proposals about which solutions will provide the best health services. Therefore, I hope that as many people as possible participate in the debate and send consultation input in the new year, so that the final proposal that is sent for political decision is as well informed as possible.
ttn-69
Municipal superintendents across the country strongly against the process in Helse Nord – news Nordland
