About public supervision of child welfare, health and social services in Norway

The overall aim of public supervision in Norway is to ensure 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 are 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 services 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 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 extensive contact with the mass media, NGOs representing patients and users of the various services as well as with professional organizations. 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, NGOs and the public to be able to criticize our knowledge base, our methods and our results.

Area surveillance

The supervisory authority provides a general picture of the quality of services. This 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 most frequently used to supervise services (municipalities, children’s and youth homes, nursing homes, hospitals etc.). This method is internationally recognized. A service 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.  

Each year the Norwegian Board of Health Supervision chooses two to three areas for countrywide supervision. The areas for countrywide supervision in 2013 - 2017 are: 

  • 2016–17: Diagnosis and treatment of sepsis in accident and emergency departments
  • 2016: Municipal health and care services for people with developmental disabilities
  • 2015–16: Work of the municipalities regarding reports to child welfare services and feedback to the person (or organization) who reported
  • 2015: Cooperation between services when patients are discharged from hospital and returned to the municipality
  • 2014: Work of the municipalities to have an overview of the health status of the population and of factors that influence public health, in accordance with the Public Health Act
  • 2013–14: Mental health care for children and adolescents
  • 2013–14: Following up of children living in foster homes
  • 2013: Health services provided in health centres for children aged 0–6 years

These countrywide supervisions account for approximately half of all supervising activity each year. The supervision authorities 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 Offices of the County Governors receive information about possible deficiences in 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 in health services, the Norwegian Board of Health Supervision can give an administrative reaction against the organization in the form of instructions to correct the situation. Similary the Offices of the County Governors can instruct social services and child welfare services. The Board of Health Supervision can also give 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 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).

Complaints about services and failure to meet individual 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
  • information
  • the special rights of children
  • consent to health care
  • individual plans for people who require several different types of services

Approxemately 3000 complaints about health services are dealt with by the Offices of the County Governors 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, issues 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 organization

The supervision authorities are the Norwegian Board of Health Supervision (the central office), and the Offices of the County Governors.

The Norwegian Board of Health Supervision is the superior, national supervision authority. The office has approximately 125 employees in 2016, including lawyers, medical doctors, other health care personnel, professionals within the fields of child welfare, social work and social scientists.

At the level of the counties, supervision is carried out by the Offices of the County Governors.

From 2013 the director general of the Norwegian Board of Health Supervision is Jan Fredrik Andresen.

The pages in English at helsetilsynet.no

These pages include:

  • legislation
  • 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

Links to other web resources in English and other languages

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 and Equality (BLD) has responsibility for child welfare services and measures to support families in difficulty.

Ministry of Labour and Social Affairs (ASD) 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 directorate deals with applications for authorization to practice as a health personnel in Norway.

The Norwegian Institute of Public Health (NIPH) is a national centre organized into the domains mental and physical Health, infection control and environmental health, emergency preparedness, health surveillance, vaccines and immunisation, health data and digitalisation and forensic sciences. 

Nav The Norwegian Labour and Welfare Administration 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 website for the Nordic Welfare DataBASE.

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.

Contact information

Postal address: Norwegian Board of Health Supervision, P.O. Box 8128 Dep, NO-0032 Oslo, Norway

Street address: Calmeyers gate 1, Oslo

Office hours:
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: postmottak@helsetilsynet.no
E-mail to the editor of the web site:  nettredaksjon@helsetilsynet.no
Internet: www.helsetilsynet.no

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