The chief executive of Helse Nord, Marit Lind, believes they have to cut maternity and emergency services – news Nordland

Helse Nord receives harsh criticism from several quarters because of the process of changing hospital services. An internal working document that was leaked to news this week shows that a working group is considering closing the emergency and maternity services at several local hospitals in northern Norway. Emergency and maternity services in danger Marit Lind, the head of the hospitals in northern Norway, tells news that there are likely to be major changes. – Do you think there will be some local hospitals that lose emergency and maternity services in the end? – I think we have to get a good total. It is a very puzzle game. She refers to the assignment they have been given to assess some hospitals for only planned activity. – So the changes will be big, there is no question of there being a little tinkering here and there? – I think major changes are needed if we are to manage to operate in the future and deliver good services. And she hastens to add: – But what those changes will be is too early to say. Mayors consider boycott It is the Minister of Health who has given Helse Nord the task of reorganizing hospital services in the north. The background is poor economics and a major shortage of professionals. Now the secret document has fueled the hospital debate in the north. It shows where the group envisages that it will be cut down and where it will be built up. Here are the alternatives that are being assessed by Helse Nord: The 0 alternative is the current distribution of functions. Finnmark: Kirkenes 0-alternative: Emergency hospital Option 1-new: Emergency hospital without emergency surgery, orthopedics and delivery (delivery room) Option 2-new: DMS (district medical center) Hammerfest 0-alternative: Emergency hospital Option 1-new: Emergency hospital – increased volume Option 2 -new: Large emergency hospital Alta: 0-option: Clinic/DMS with 24-hour function and delivery room Option 1-new: Clinic/DMS with/24-hour function and delivery room Option 2-new: Delivery room discontinued UNN: DMS Nord-Troms 0-option: DMS w/ 24-hour function and delivery room Option 1-new: Delivery room discontinued Option 2-new: 24-hour function and delivery room discontinued Tromsø: 0-option: Regional and university hospital Option 1-new: Regional and university hospital Option 2-new: Regional and university hospital Harstad : 0-alternative: Emergency hospital Alternative 1-new: Emergency hospital – increased volume Alternative 2-new: Large emergency hospital Narvik: 0-alternative: Emergency hospital Alternative 1-new: Emergency hospital without emergency surgery, orthopedics and obstetrics+elective gy/orth Alternative 2-new : Elective hospital DMS Midt-Troms 0-option: DMS w/ delivery room Option 1-new: DMS w/ delivery room Option 2-new: Delivery room discontinued Longyearbyen: 0-option: Emergency medical emergency hospital Option 1-new: Emergency medical emergency hospital Option 2-new : Emergency medical emergency hospital Nordlandssykehuset: Vesterålen 0-option: Emergency hospital Option 1-new: Emergency hospital – increased volume Option 2-new: Emergency hospital – increased volume Lofoten 0-option: Emergency hospital Option 1-new: Emergency hospital without emergency surgery, orthopedics and delivery (delivery room) Option 2-new: DMS Bodø 0-option: Large emergency hospital Option 1-new: Large emergency hospital Option 2-new: Large emergency hospital Helgelandssykehuset: (Here, Helse Nord does not mention the hospitals by name (ed. note)). X 0-option: Emergency hospital Option 1-new: Emergency hospital without emergency surgery, orthopedics and maternity Option 2-new: Large emergency hospital Y 0-option: Emergency hospital Option 1-new: DMS Option 2-new: Elective hospital Z 0-option: Emergency hospital Alternative 1-new: Emergency hospital – increased volume Alternative 2-new: DMS Brønnøysund 0-alternative: DMS w/ maternity ward Alternative 1-new: Maternity ward discontinued Alternative 2-new: Maternity ward discontinued The reactions have been strong. “Ordinary” people have become involved and said that they feel insecure. Mayors and other prominent politicians in the north are considering boycotting Helse Nord. They are calling for more transparency about the work of Helse Nord. – We wonder what else lies there that we don’t know. It is clear that you should be allowed to have good processes, but good processes mean that everyone can be involved, says group leader for the Labor Party in Bodø Ann-Kristin Moldjord. Ann-Kristin Moldjord, group leader Ap Bodø Photo: Sondre Skjelvik / news – Are you even talking about boycotting Helse Nord? – It is clear that we have to use strong words to get through. When there is a process that is public and one that is hidden, we have to use strong words to reach the Helse Nord board, she says. Senior doctor: – Choose those you think cause the least noise. There are 11 emergency hospitals in Northern Norway, but there are many indications that it will not be like this in the future, according to the Helse-Nord chief. Many critics question why only some hospitals have been selected to investigate decommissioning. The hospital in Narvik is one of them which is at risk and may lose emergency and maternity services. – People say you should turn over all stones, I certainly don’t feel that you do. People like to choose the stones that are furthest away, the ones that you think make the least noise, says department chief Jon Harr at the hospital in Narvik. The Helse Nord manager is adamant that she cannot go out and explain the background for why these options have been listed, including for Narvik. But she says we will get more answers in a couple of weeks. Below you can see how the planned timeline for division of functions and tasks is laid out. Source: Helse Nord The Ministry of Health and Care (HOD) commissions Helse Nord to look at measures that involve changes in the division of functions and tasks to ensure sustainability The board of Helse Nord adopts the framework for further work The board of Helse Nord adopts specific areas to be investigated further The board i Helse Nord adopts a mandate for the investigation work and how the investigation work is to be organised. They decide, among other things, that five working groups are to be set up to investigate different areas. A joint kick-off meeting for the five working groups that are to investigate different sub-areas for the division of functions and tasks in Helse Nord is established and the work starts. During the investigation period, the working group must present one report in its area. The five interim reports must be brought together in one joint, comprehensive plan. Individual kick-off meetings for the working groups. The working groups’ recommendations, including risk and vulnerability analysis, are delivered to the coordination group in Helse Nord RHF. The overall plan for division of functions and tasks, including ROS analysis, is finalized. The board adopts a consultation draft of the overall plan with proposals for functional and division of tasks in Helse Nord. The plan is sent out for consultation for eight weeks. 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. We reserve the right to change the timeline. Show more How can a working group consider cutting the emergency services in a struggling new hospital, such as in Narvik. – We will get the justification for that when they submit their proposals. They haven’t finished discussing. They have not reached the point in the group where they are ready to deliver. But they must have discussed quite a lot to arrive at those options? – They certainly have. But it has not been presented yet, neither to me nor to the management group. We’ll get there. Believes the document creates insecurity The Helse Nord manager says she had not seen the internal document before it was published in the media. – I had not seen that document. According to the timetable laid out, the Helse Nord board will decide the future of the hospitals at its meeting in April. If there are major changes, the Minister of Health must have the last word. Photo: Barbro Andersen / news She admits that it is unfortunate that what she calls an unfinished document came out. – The worst thing about it is that it creates insecurity in the population. The document as it came out is a solitary document without any justification, which can be read and interpreted in many different ways. I understand that it causes anxiety when you read what is written there. Why isn’t it public? – We have had many discussions internally, and we want to have a transparent and open process. But there are many “touchy” topics that need to be discussed in order for us to arrive at proposals for alternatives. Therefore, we decided not to publish unfinished documents. – Doesn’t it look like an unfinished document? – We are not at the point where we have been presented with the final options that the group will deliver. Kjerkhol: – A large and inclusive process Health Minister Ingvild Kjerkol is the one who has given the task of investigating changes for the hospitals in Northern Norway. – What does she think about the fact that there is now great unrest in the north about the process to cut emergency and maternity services? Minister of Health Ingvild Kjerkol (Ap) Photo: Tariq Alisubh / news – Now Helse Nord is working on a large and inclusive process. The challenges are known. You have to get control over the economy and you have to get professionals in the positions so that the quality is also good in Northern Norway. – Mayors are considering a boycott of Helse Nord because they believe it is an undemocratic and closed process. They want you to put a stop to the process. What do you answer them? – I would encourage the mayors to participate in the process. I have given this assignment because Helse Nord has too many hires and too few permanent employees. She adds: – You have no control over the economy. And one thousand man-years with hire and overtime and that is not sustainable. – Do you have control that this will not be a harmful process? – Now I think it is important that a process is carried out, it must be open and inclusive. And then there will be many proposals on the table in such a long and demanding process that we are working on now. – I think it is important that a process is carried out, it must be open and inclusive, says Helse Nord director, Marit Lind. Photo: Synnøve Sundby Fallmyr / news Lind will not postpone the decision Marit Lind says that it is important not to postpone the work that is underway. – Having such processes going on for a long time, we see, is very unfortunate. Lind refers to what department head Jon Harr said at a general meeting she had with the employees in Narvik. – He said something like “now rip off the plaster, we need to get an explanation.” Because people wonder if they should dare to buy an apartment. Is it safe to apply for a job at the hospital if we don’t know what the future holds?” So when we have major recruitment challenges and live with uncertainty, it is not good to stay in it for too long. – Mayors raise questions about whether those affected should boycott the further work? – I think it’s broken. But I understand that it creates reactions when such a document comes out in that way. I think we have involved them well and in the way we should involve them. She says it is not only in the hearings that the mayors should be able to give feedback. – We will have dialogue conferences with the municipalities, and have set dates at the end of October and the beginning of November, in Tromsø and Bodø. Then we will get input on these things.



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