The aging wave hits Northern Norway first and hardest. The handling here will be an important touchstone for the rest of the country. It is therefore particularly worrying that Helse Nord’s restructuring runs counter to what society as a whole needs. Two apparently unstoppable forces are united in Helse Nord’s cut proposals for hospitals in northern Norway: The first: More multi-ill elderly and fewer young people. The second: A constant centralization and specialization within the health professions which makes it more difficult to get hold of the “right” personnel. We can’t do anything about the first one. It is all the more important to do something with the other. Centralization and excessive specialization put the healthcare system on the opposite path to what we need. It is precarious to turn this around in time. The approach in Helse Nord reduces the sustainability of the healthcare system and at the same time affects the weakest. The co-operation reform provides for treatment at the lowest possible level, as close as possible to the patient. This is something the local hospitals do best, in collaboration with the municipalities. Elderly and vulnerable patients will not be able to use treatment facilities that are far away. It will be more expensive and cumbersome, and will raise the threshold for seeking out and receiving the necessary help. The consequences are a worsening of the condition, prolonged treatment time and a poorer prognosis. In addition, the local hospital plays on the team with volunteerism and a strengthened relative role. An image is often created that the local hospitals have low activity and that most patients are sent on. The reality could not be more different. The local hospitals complete over 90 per cent of their emergency admissions themselves. At the same time, the large hospitals are already filled to bursting point and have an occupancy rate well above what is reasonable. This alone shows that further centralization is not justifiable, neither in northern Norway nor in other parts of the country. Firstly, there is no plan for how overcrowded central hospitals with overworked staff will cope with another large increase in patients coming from the scaled-down local hospitals. Secondly, the increased number of emergency patients from the rural areas will displace precisely the very important and specialized treatment for which the large hospitals are really needed; such as cancer treatment and complicated operations. Because hospitals without an emergency function cannot provide the necessary training, Helse Nord’s cut proposals will also reduce the number of training positions, and ensure that the young doctors never see anything other than the inside of a large specialist hospital. This is in sharp contrast to the societal need for more generalist competence. Downscaling of local hospitals makes such expertise increasingly threatened with extinction. The trend is exacerbated by rigid rules and square bureaucracy for doctors in specialisation, who have to work for a period in large hospitals to learn everything they need to know. Simple adjustments to the rotation that, for example, enable weekly commuting are routinely rejected. Thus, relocation is the result. Moving several times in a few years with a whole family is harrowing, especially for the children, and then of course there will be no return to the local hospital afterwards. The health organizations have their specific mission, and do not take into account overall societal considerations such as total preparedness and public health. This becomes particularly clear in Helse Nord’s ongoing investigation and the cut proposals that have come forward. Community medical and socio-economic consequences have been assessed to a small extent. The risk analyzes are carried out at an approximate level, where the entire region is seen as a whole. We therefore do not know anything about the concrete risk of a lack of emergency surgery for Kirkenes, Narvik, Lofoten or parts of Helgeland. Centralization of hospital functions is in practice a massive transfer of tasks to the municipalities. It is no easier for them to get hold of health personnel than it is for the hospitals. The difference is that municipalities cannot opt out of patient responsibility. The municipalities are the last refuge. Midwives and emergency room doctors will have to accompany laborers and patients into hospital to a greater extent, and be awake for longer periods, which increases the duty load in the municipalities. All in all, the burden on the healthcare system is not eased, but the patients still get worse. Finally: The district political effect of downsizing the most central welfare services we have is of course massive. The municipalities and the specialist health services that remain will experience far greater challenges in relation to recruitment. Centralizing basic services will not only have consequences for people’s lives and health, but also for the development of entire local communities. The healthcare system needs changes. It needs major changes. But the changes must be based on the reality that Norwegian society now finds itself in and will get more and more of. It cannot, to put it bluntly, be based on subject-specific wishful thinking from professors at the university hospitals. This is not intended as a criticism of hospital colleagues who are passionate about their profession. It is also not intended as an argument for all new development within specialized healthcare services to stop. But it is a very necessary and completely unavoidable reminder that the road we are on now is not passable much longer. It is easy to wish that all types of conditions could receive increasingly specialized and sophisticated treatment in large national centres. This is simply not possible in a small country like Norway, neither in the north, south, east or west. We have known for a long time that this crossroads would come. Now it is upon us. If the healthcare system is to survive, if the welfare state is to survive, we need a decentralised, more generalist healthcare system. The following doctors/community doctors have signed the chronicle: (as of 20 November) Ingebjørn Bleidvin municipal chief physician in Hadsel, Jan Håkon Juul municipal chief physician in Vågan, Eli-Anne Emblem Skaug chief physician Climate, environment and public health, Trondheim, Arild Iversen assistant municipal chief physician in Bergen . , Ingrid Kristiansen municipal supervisor Frøya, Trøndelag, Siri E. Hansson Kristiansen municipal supervisor in Karmøy, Rogaland, Guro Hafnor Røstvig municipal supervisor in Sandnes, Rogaland, Anne Ruth Syrtveit Mikalsen municipal supervisor Froland, Agder, Kathrine Kristoffersen municipal supervisor in Tromsø, Preben Aavitsland professor of community medicine and physician , Anne Helen Hansen associate professor UiT, senior 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 specialist unit for primary medicine, May-Lill Johansen head of the General Medicine Research Unit in Tromsø, Arnfinn Seim municipal supervisor Indre Fosen and professor emeritus in general medicine, NTNU, Sigrid Vikjord physician St. Olav’s hospital and researcher, NTNU, Ernst Horgen Brage Ulvmoen coordinating consulting senior physician, NAV Nordland, Sverre Litleskare senior researcher at NORCE UiB, Balpreet Kaur Sandhu municipality supervisor, Sandnes, Astrid B. Holm municipality supervisor Andøy, Drude Bratlien Municipal Supervisor Sør-Varanger, Britt Larsen Mehmi 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 manager Levanger, Trøndelag, Nina Ihle Hadland municipal manager Gjesdal, Rogaland, Anne Herefoss Davidsen municipal manager Alta, Jonas Holte community medicine and general practitioner, Harstad, Daniela Brühl municipal manager Ullensvang, Vestland, Kristin Vik Hagerupsen municipal manager Harstad, Thomas Bakkeid municipal manager Kvæfjord, Marie Helene Jørgensen municipal chief physician Tjeldsund and Evenes Paul Olav Røsbø
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The health service is kneeling – Speech
