Complex tasks and services requires stronger governance

In this report, the Norwegian Board of Health Supervision presents a summary of findings from countrywide supervision in 2010 of municipal health and social services for elderly people. Several municipal services and measures, which are essential for frail elderly people, were included:

• identification, assessment and follow up of elderly people with dementia living in their own homes
• administration of medication and treatment with medication
• prevention and treatment of malnutrition
• rehabilitation in nursing homes
• dealing with applications from relatives for respite care.

Supervision of service provision was carried out in the following areas: home nursing service and services providing practical assistance, nursing homes, units where applications are dealt with, general practice and cooperation between the different services.

Supervision was carried out in 232 municipalities. In about 2/3 of these, it was found that service provision did not meet the statutory requirements. For all the areas that were investigated, we found that many municipalities have a long way to go in order to ensure that:

• it is known who is responsible for the organisation and for providing the services
• there are clear guidelines for allocation and performance of tasks
• there are enough staff with necessary training and skills to carry out the tasks
• there are sound systems for documentation
• there is a system for reporting adverse events and preventing them from being repeated.

All this is necessary to ensure that frail elderly people with comprehensive needs for medical treatment and care receive the care they have the right to receive. This is a challenge that requires sustainable and proactive governance in the municipalities.