Introduction to the supervisory authorities and the supervision of child welfare services, social services and health and care services in Norway
This introductory section describes the basis for supervision, how supervision is carried out, areas and themes for supervision, and organization of the supervision authorities.
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. There is comprehensive legislation regarding child welfare, health and social services, that:
- lay down requirements about which services that shall be offered to the population
- lay down requirements about the quality of services
- regulate the services provided by health care personnel who have authorization
- give users of the services rights
The County Governors and the Norwegian Board of Health Supervision (the Board of Health) are supervision authorities. All statutory services are subject to supervision, irrespective of whether they are provided by municipalities, private providers, publicly owned hospitals and residential child care institutions or health care personnel who run their own practice.
The Board of Health is a national public institution organized under the Ministry of Health and Care Services. The politically adopted acts and regulations provide the framework for our supervision.
The supervision authorities work independently of political governance. The supervising authorities make the decisions about which topics and services should be supervised Priorities are determined mainly on information about risk and vulnerability.
The supervision authorities shall contribute to ensure that:
- the rights of the population for child welfare, social and health services are protected and their needs are met, services are provided in accordance with sound professional standards
- deficiencies in provision of services are prevented, identified and acted upon
- resources are used in an appropriate and effective way
- the population has confidence in the services and in health personnel
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 in Norwegian on this website. 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.
The supervisory authority provides a general picture of the quality of services. This involves collecting, organizing and interpreting information about child welfare, 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 meet the requirements laid down in the legislation?). Reports from area surveillance are distributed to the services and to the public.
Proactive or preventative 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 200 and 400 system audits are carried out each year. Supervision reports are available to the public on our website www.helsetilsynet.no.
Each year the Board of Health chooses two to three areas for countrywide supervision. The areas subject to countrywide supervision in the period 2013 - 2020 are:
- 2019–2020 Outlying patients in inappropriate wards
- 2019 Collaboration between Child Welfare Services and adult Social Welfare to ensure care for young adults
- 2019 Municipal supervision on environmental health in Kindergartens and Schools
- 2018 Residential child care institutions – sound professional practice
- 2017–2018 Municipal and specialized services to people with concomitant psychiatric disorder and drug addiction
- 2016–17: Diagnosis and treatment of sepsis in accident and emergency departments
- 2017: The Norwegian Directorate for Children, Youth and Family Affairs (Bufetat)
- 2016: Municipal health and care services for people with developmental disabilities
- 2015–16: Municipalities’ response and follow up of reports of concern to child welfare services 2015: Cooperation between services when patients are discharged from hospital and returned to the municipality
- 2014: Municipalities’ efforts to monitor the health status of the population and 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 centers for children aged 0–6 years
The supervision authorities work actively to ensure that organizations that provide, child welfare, health and social services use supervision reports in their efforts to develop management systems and improve the quality of services.
Individual cases of deficiencies in services
The Offices of the County Governors receive information about possible deficiencies in services from many sources (children, patients, relatives, employers, the police, and media). About 3000 to 4000 cases per year are investigated to see whether there has been a breach of acts or regulations. The majority of these cases concern health services, some are information on child welfare services or social services. This is called incident-related supervision.
If deficiencies are identified in health services, the Board of Health can give an administrative reaction against the organization in the form of instructions to correct the situation. Similarly, the Offices of the County Governors can instruct social services and child welfare services. The Board of Health 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 approximately 100 (mainly physicians and nurses) health care personnel have their authorization revoked. More than half of the revocations are due to drug abuse; other important reasons for loss of authorization are sexual abuse of a patient and other behavior incompatible with the profession. There are approximately 430,000 people with Norwegian authorization as health personnel (2013).
Reports concerning serious incidents in the specialist health services
The specialist health services are obliged to notify the Board of Health about serious and unexpected adverse events, cf. Section 3-3a of the Specialist Health Services Act. This reporting was introduced in the spring of 2010 following a number of serious incidents in the specialist health service causing considerable public attention. The objective is to enhance patient safety and promote improvements in the health services through the use of supervisions.
Serious incidents are deaths or significant harm to the patient, where the outcome – given the foreseeable risk – is unexpected.
The Department for Operational Health Supervision in the Board of Health receives initial information, warnings, by e-mails addressed to firstname.lastname@example.org. The Board of Health contacts those involved in and affected by the event within a couple of days. Unit staff collects relevant information and gain an understanding of the course of events. Information is collected about the patient's medical condition and illness progression, and about relevant organizational aspects of the health service provider in question. All reports are investigated and evaluated with a view to ascertaining if there are any reasons to suspect serious deficiencies in patient treatment. In cooperation with the Office of the County Governor in the county where the hospital is situated, the Board of Health determines whether there are any grounds for further supervisory activity in the case, and what steps to take.
If necessary in order to gain an understanding of what has happened, the Department for Operational Health Supervision sometimes performs on-site inspections. This is done in serious and complex cases; if more than one organizational department at the hospital was involved in treating the patient, and when there is a risk of the same problem recurring in the same or other hospitals. When on-site inspections are carried out, the immediate family (and, if applicable, patients) are invited to talk to a member of the supervision team and share their version of events. In most cases, family members wish to talk to the supervision team. Relatives and patients provide information that helps create a broader, more detailed and more accurate picture of events.
From the reporting scheme was set up in June 2010 until the end of 2018, the Board of Health has received 3636 reports concerning adverse medical events, and has carried out 117 on-site inspections.
Supervision of Child Welfare Services
The purpose of the Child Welfare Act is to ensure that children and youth who live in conditions that may be detrimental to their health and development receive the necessary assistance and care at the right time, and to help ensure that children and youth grow up in a secure environment. The municipalities and governmental child welfare authorities are responsible for child welfare services.
Several bodies make up the state child welfare services: the Ministry of Children and Family, the Directorate and the Offices for Children, Youth and Family Affairs (Bufetat) and the Offices of the County Governor. The Board of Health is responsible for the overall professional supervision of child welfare services in Norway.
The Office of the County Governor supervises the municipal child welfare services, residential child care institutions, care centers for unaccompanied juvenile asylum seekers under 15, parent-and-child centers and other governmental services and measures provided by the Office for Children, Youth and Family Affairs (Bufetat). The Office of the County Governor also supervises private service providers delivering services and measures in pursuance of the Child Welfare Act.
The Office of the County Governor carries out supervision of residential child care institutions and care centers for unaccompanied juvenile asylum seekers at a minimum of twice a year. Residential institutions that care for youth with behavioral difficulties and where the institution may use coercion are visited at a minimum of four times per year. In these supervisions, the supervision staff must contact each child in order to learn what their views are on the way they are treated in the institution. Parent-and-child centers shall be supervised at least once every other year.
The Office of the County governor handles appeals regarding administrative decisions made by the municipal Child Welfare Services in pursuance of the Child Welfare Act. Administrative decisions include services to assist the child, such as providing a support person, a visiting home, leisure activities and support measures in the home.
The Office of the County Governor is also the administrative appeal body for decisions made by municipalities or institutions regarding any use of coercion and restrictions in residential child care institutions and care centers for unaccompanied juvenile asylum seekers. The Child Welfare Act and regulations specify how and when coercion may be used; Coercion may be used if the child is in danger of serious harm or places others in such danger. Coercion can also be used when it is found to be necessary to restrict freedom of movement, restrict the use of electronic communication devices, to search a child's room or property, or to confiscate objects.
A variety of methods are used to supervise child welfare services. The Board of Health is responsible for continuous quality improvement of all supervision.
As the superior body for the Office of the County Governor, the Board of Health processes complaints regarding the Office of the County Governor's administrative decisions on orders and fines, and any decisions to shut down institutions that are not run in accordance with principles of sound and ethical child care. As the superior body, the Board of Health also processes complaints regarding supervisions conducted by the Office of the County Governor.
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
- regular general practitioner
- assessment by a specialist within 30 days
- the right to a second opinion
- choice of hospital
- patient transportation funding
- the right of access to and the right to correct patient records
- participation and information
- the special rights of children
- consent to health care
- individual plan for people who over a protracted period require coordination of several different types of services
The Municipal Health and Care Services Act list statutory municipal services:
- information and advice to promote wellbeing and prevent social problems
- practical assistance and training for people with special needs caused by disease, disabilities, age or other factors
- respite care and salaries for families with heavy burdens of care
- support persons for individuals and families
- residential care
The Office of the County Governor handles complaints on rights to health and care services. Nationally there are approximately 3500 such complaints annually.
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
- subsistence support for people who are unable to provide for themselves through employment or rights based incomes (i.e. pensions etc)
- intermediary housing for people unable to provide housing for themselves
- individual plan for people who over a protracted period require coordination of several different types of services
- qualifying programme activities for adults with significantly reduced employment or income ability
- immediate assistance and support following natural or other disasters or accidents
- assistance in procuring housing for persons unable to operate in the open housing marked
The Offices of the County Governors handle complaints concerning municipal decisions on statutory services. Annually there are approximately 3500 complaints, the majority concern financial subsistence support. In approximately 20% of these cases, the decision is in favor of the person who complains.
The Board of Health 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 Board of Health.
The supervision authorities are the Norwegian Board of Health Supervision and the Offices of the County Governors (Norw.: statsforvalterne).
The Board of Health Supervision is the superior, national supervision authority. The office has approximately 115 employees in 2018, including lawyers (35-40), medical doctors (20), other health care personnel (15), social workers including experts in child welfare (10), and social scientists. The four departments are: Department for Supervision of Child Protection, Social and Health Services; Department for Complaints and Assessment of Health and Care Services; Department for Operational Supervision; and Department for Planning and Administration.
At the level of the counties, supervision is carried out by the Offices of the County Governors.
The director general of the Norwegian Board of Health Supervision is Jan Fredrik Andresen.
Links to other web resources in English and other languages
The Storting (Stortinget, the Norwegian Parliament)
The Norwegian Biotechnology Advisory Board (Bioteknologinemnda)
Norwegian Food Safety Authority (Mattilsynet)
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.
Ministry of Children and Families (BFD) has responsibility for child welfare services and measures to support families in difficulty.
Ministry of Labour and Social Inclusion (AID) has responsibility for social security, pensions and social assistance.
The Office for Children, Youth and Family Affairs (Bufetat) is responsible for central government child welfare services, including the centres for unaccompanied juvenile asylum seekers and refugees, the family counselling service and adoption.
Nav The Norwegian Labour and Welfare Administration has responsibility for pensions, social security benefits, qualification programmes and other employment measures and social assistance.
The National Health Services Complaints Body (Helseklage) is a joint secretariat for all bodies that deal with complaints about health services, for example complaints about administrative decisions to withdraw authorization from health personnel.
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 competence institution for governmental authorities, the health service, the judiciary, prosecuting authorities, politicians, the media and the general public on issues related to forensic medicine, physical and mental health, prevention of communicable diseases and prevention of harmful environmental influences.
The Norwegian Medicines Agency (SLV) is responsible for supervising production of medicines and their supply chain (to the health services).
Norwegian Radiation and Nuclear Safety Authority (Direktoratet for strålevern og atomsikkerhet (DSA))
The Norwegian System of Patient Injury Compensation (NPE) manages the legislation governing governmental compensation for any harm suffered by patients in the health service.
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 Health and Welfare Statistics.
WHO (The World Health Organization) has a website with pages for each country. See “Countries” in the menu.
OECD has well-organized statistics and other information about its member countries.
Links to relevant reports in English
- Revocation of Medical Licences in the UK and Norway A comparative investigation Mears A, Hem HE. London and Vestfold: Høgskolen i Buskerud og Vestfold, London South Bank University, 2014.
- National health preparedness plan 2018
- An external peer evaluation of the Norwegian Board of Health Supervision by the European Partnership of Supervisory Organisations in Health Services and Social Care (EPSO)
- Offshore Health Services. Publications and Forms. The County Governor of Rogaland has a nationwide role in the regulation of health and hygiene in Norway's offshore oil and gas sector.