Public supervision in Norway is about ensuring that health and social services are provided in accordance with national acts and regulations.
In Norway, there is comprehensive legislation regarding child welfare, health and social services, that:
- lay down requirements about the services that shall be offered to the population
- lay down requirements about the quality of services
- regulate the work of health care personnel who have authorization
- give users of the services rights, for example, according to the Patients’ Rights Act
Supervision applies to all statutory services, irrespective of whether they are provided by municipalities, private businesses, publicly owned hospitals or health care personnel who run their own practice.
The Norwegian Board of Health Supervision is a national public institution organized under the Ministry of Health and Care Services. The politically adopted acts and regulations provide the framework for the services that shall be supervised.
However, the supervision authorities work independently of political management. To a large extent, they decide themselves which services to give priority to with regard to supervision, and which areas supervision shall include. Among other things, priorities are determined on the basis of information about risk and vulnerability.
The supervision authorities shall help to ensure that:
- the needs of the population for child welfare, social and health services are met
- services are provided in accordance with sound professional standards
- deficiencies in provision of services are prevented
- resources are used in an appropriate and effective way
The Norwegian Board of Health Supervision became a purely supervisory body in 2002 when the functions of the Directorate (professional development, regulatory development and policy performance) were transferred to the Norwegian Directorate of Health and other bodies. From 2009 the National Board of Health Supervision has been responsible for supervising medical and health related research, and from 2010 it has been responsible for child welfare services, social assistance and health services for the Norwegian Armed Forces’ foreign operations.
The way the supervision authorities work – findings and experience from supervision
Supervision reports, results and experience from supervision, information about supervision methods, and other types of information, are available to the public on this website, in Norwegian. We have a lot of contact with the mass media and professional organizations. Our policy of transparency is necessary, so that the findings of supervision can be used by the services as a basis for learning and quality improvement. In order for people to have confidence in supervision, it is necessary for the professions, consumer organizations and the public to be able to criticize our knowledge base, our methods and our results.
Area surveillance is supervision with an overall perspective. It involves collecting, organizing and interpreting information about health and social services. Such information provides the basis for evaluating whether needs are met (are people offered the services they require?) and whether the quality of services is adequate (do the services that are provided meet the requirements laid down in the legislation?). Reports from area surveillance are distributed to the services and to the public.
Planned supervision of services
System audits is the method that is used to supervise services (municipalities, children’s and youth homes, nursing homes, hospitals etc.). This method is internationally recognized. The organization is investigated by examining documents, carrying out interviews, reviewing the organization and carrying out sample tests. The report of the supervision includes a description of conditions or factors that are not in accordance with acts and regulations. These deficiencies are called nonconformities. The supervision authority follows up nonconformities until the requirements laid down in acts and regulations are met. Follow-up involves the management of the organization, and if necessary the owner (the municipality, the board of directors etc.).
Between 700 and 900 system audits of activities are carried out each year. Supervision reports are available to the public, and are looked at more than one million times each year on www.helsetilsynet.no.
About half of all the supervision activities in two to four areas are carried as countrywide supervision each year. The Norwegian Board of Health Supervision chooses the areas for countrywide supervision. The areas for countrywide supervision in 2009, 2010 and 2011 are:
- municipal health services: compulsory treatment in accordance with the Patients’ Rights Act chap. 4A (applies to people without the capacity to give consent for treatment)
- municipal social and health services for frail, elderly patients
- municipal child welfare
- specialist health services’ treatment and rehabilitation of elderly stroke patients
- specialist health services (subjects selected in the five regions)
- financial support in accordance with the new act on social services in the Norwegian Labour and Welfare Administration (Nav)
- social services in Nav
- psychiatric specialist health services for adults (district psychiatric centres)
- municipal social and health services for children in palliative care homes and auxiliary housing
The supervision authorites work actively to ensure that organizations that provide health and social services use supervision reports in their work with developing management systems and with improving the quality of services.
Individual cases of deficiencies in services
The Norwegian Board of Health Supervision in the Counties receive information about possible deficiences in the health services from many sources (patients, relatives, employers, the police, the mass media). About 2000 cases per year are investigated to see whether there has been a breach of acts or regulations. This is called incident-related supervision.
If deficiencies are identified, the Norwegian Board of Health Supervision can give an administrative reaction against the organization in the form of instructions to correct the situation, or an administrative reaction against health care personnel who have authorization. This can be a warning, withdrawal of the right to prescribe addictive drugs, or withdrawal of authorization. Each year about 50 health care personnel loose their authorization. Most of these are nurses. Each year between 50 and 100 health care personnel loose their authorization. The majority of these are doctors and nurses. More than half are due to drug abuse; other important reasons for loss of authorization are sexual abuse of a patient and behaviour incompatible with the profession. There are approximately 390,000 people with Norwegian authorization as health personnel (2010).
Reports of events that have led to, or could have led to, serious injury to a patient
The Norwegian Board of Health Supervision has responsibility for MedEvent – the reporting system for adverse events in specialized health services. This system collects reports of incidents that have occurred in specialized health services that have led to, or could have led to, serious injury to patients. Hospitals have a statutory duty to report such events.
These events shall be a source of information for the organizations to learn from, both information from incidents that have happened in their own organization, and information published in the annual reports from MedEvent.
Complaints about services and failure to meet patients’ rights
The Patients’ Rights Act gives the population many rights relating to health services.
The Act contains provisions about:
- essential health care
- assessment by a specialist within 30 days
- choice of hospital
- the right of access to and the right to correct patient records
- client participation
- the special rights of children
- consent to health care
- individual plans for people who require several different types of services
Complaints about these services are dealt with by the Offices of the County Governors. Between 500 and 1000 such complaints are submitted each year.
The Social Services Act contains provisions about the duty of the municipalities to provide services to the population, such as providing:
- information, advice and guidance that can contribute to solving or preventing social problems
- practical assistance and training for people with special needs for care because of illness, physical disability, age or other reasons
- respite care and salaries for people and families who care for clients who need a high level of care
- support persons for individuals and families
- places in institutions, sheltered housing and
- accommodation for people with special problems
Complaints about these services are dealt with by the Offices of the County Governors. Between 3000 and 5000 such complaints are submitted each year.
The Norwegian Board of Health Supervision is the superior authority for dealing with complaints, and isues guidelines, provides training, and carries out other measures to ensure that complaints are dealt with correctly and in a similar way in all the counties. Individual decisions about complaints cannot be appealed against to the Norwegian Board of Health Supervision.
The supervision authorities are the Norwegian Board of Health Supervision (the central office), the Norwegian Board of Health Supervision in the Counties, and the Offices of the County Governors.
The Norwegian Board of Health Supervision (the central office) is the superior, national supervision authority. The office has about 95 employees, of which about 30 are lawyers, about 15 are doctors, 10-15 are other health care personnel, about 10 are professionals within the field of social work and about 10 are social scientists.
At the level of the counties, supervision is carried out by the Norwegian Board of Health Supervision in the Counties (supervision of health services and health care personnel) and the Offices of the County Governors (supervision of child welfare and social services).
The leader of the supervision services is the director general of the Norwegian Board of Health Supervision.
These pages include:
- a description of Norwegian health and social services
- a description of public administration of health and social services
- the annual supervision report with articles and statistics in full text
- summaries of all the publications of the Norwegian Board of Health Supervision
- summaries of certain resolutions in individual cases concerning deficiencies in the health service
- links to other useful websites
The Ministry of Health and Care Services (HOD) has responsibility for all health and social policy, apart from social security benefits. The Norwegian Board of Health Supervision is organized under this ministry.
The Ministry of Children, Equality and Social Inclusion (BLD) has responsibility for child welfare services and measures to support families in difficulty.
The Ministry of Labour (AD) has responsibility for social security, pensions and social assistance.
Norwegian Directorate of Health (Hdir) (Hdir) is the National Directorate for Health Services. Its responsibilities include health services and measures to prevent illness and social problems.
The Norwegian Registration Authority for Health Personnel deals with applications for authorization to practice as a health care personnel in Norway. Their website also contains links regarding work permits etc.
The Norwegian Institute of Public Health is a national centre of excellence in the areas of epidemiology, mental health, control of infectious diseases, environmental medicine, forensic toxicology and drug abuse.
The Norwegian Knowledge Centre for the Health Services gathers and disseminates evidence about the effect and quality of methods and interventions within all parts of the health services. The uptake of this evidence by the health services is also an important goal for the Centre’s activities. The Centre measures and analyses the quality of selected health services in the light of the experiences of patients and clients.
Nav The Norwegian Labour and Welfare Organisation has responsibility for pensions, social security benefits, qualification programmes and other employment measures and social assistance.
Statistics Norway publishes statistics about health and social conditions, and health and social services.
The Nordic Council has a website with a lot of useful information in English. See also the websites for the Nordic Medico-Statistical Committee and the Nordic Socio-Statistical Committee.
WHO (The World Health Organization) has a website with pages for each country. See “Countries” in the menu on the left-hand side.
OECD has well-organized statistics and other information about its member countries.
Postal address: Norwegian Board of Health Supervision, P.O. Box 8128 Dep, NO-0032 Oslo, Norway
Street address: Calmeyers gate 1, Oslo, Norway
From 15 May to 14 September: 0800-1500 CET
From 15 September to 14 May: 0800-1545 CET
Telephone: (+47) 21 52 99 00
Telefax: (+47) 21 52 99 99
E-mail to the editor of the web site: firstname.lastname@example.org