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: Norwegian Board of Health Supervision (Norwegian: Statens helsetilsyn) and the county governors.
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.
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
- 2017: Countrywide supervision in 2017 of The Norwegian Directorate for Children, Youth and Family Affairs (Bufetat)
- 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 3000 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 cirka 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 430,000 people with Norwegian authorization as health personnel (2013).
Department for Operational Health Supervision: reports concerning serious incidents in the specialist health services
The specialist health services are obliged to notify the Norwegian Board of Health Supervision 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 Norwegian Board of Health Supervision, receives initial information, warnings, by e-mails addressed to firstname.lastname@example.org. The Department for Operational Health Supervision contacts those involved in and affected by the event within a couple of days. Unit staff collects relevant information and gains an understanding of the course of events. Information is collected about the patient's medical condition and illness progression, and about relevant organisational aspects of the health service provider in question. All reports are investigated and evaluated with a view to ascertaining if there is any reason to suspect any serious deficiencies in patient treatment. Jointly with the Office of the County Governor in the county where the hospital is situated, the Norwegian Board of Health Supervision 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 organisational department at the hospital was involved in patient treatment, and when there is a risk of the same problem recurring, be it in the same or other hospitals. When on-site inspections are carried out, the immediate family (and, if applicable, patients) are offered a chance to talk to a member of the supervision team so that they can share their version of events. In most cases, family members wish to talk to the supervision team. In the experience of the Department for Operational Health Supervision, they provide information that helps create a broader, more detailed and more accurate picture of events.
In other events, the hospital or the health trust in question is required to provide their own detailed review of events and a description of measures undertaken to prevent recurrence and ensure patient safety.
In the six year since the reporting scheme was set up in June 2010, the Norwegian Board of Health Supervision has received more than 2000 reports concerning adverse medical events, and has carried out more than 80 on-site inspections.
Further details on the 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 the central governmental child welfare authorities are responsible for child welfare services.
Several bodies make up the state child welfare services: the Ministry of Children, Equality and Social Inclusion; the Office for Children, Youth and Family Affairs (Bufetat) and the Offices of the County Governor. The Norwegian Board of Health Supervision 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, child welfare institutions, care centres for lone juvenile asylum seekers under 15, parent-and-child centres 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 supervisions of child welfare institutions and care centres for lone juveniles at a minimum of twice a year. Institutions that care for youth with behavioural difficulties and where the institution may use coercion, must be visited at a minimum of four times per year. In these supervisions the Office of the County Governor shall contact each child in order to learn what the child's views are on its stay in the institution. Parent-and-child centres shall be supervised at least once every other year.
Any appeals regarding administrative decisions made by the municipal child welfare services in pursuance of the Child Welfare Act are considered by the Office of the County Governor. Such 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 child welfare institutions and care centres for lone juvenile asylum seekers. Examples of such cases include coercion used in emergency and dangerous situations for the child and its surroundings, restrictions on freedom of movement, restrictions regarding the use of electronic communication devices, searching a child's room or property, and confiscating objects.
As the superior body for the Office of the County Governor, the Norwegian Board of Health Supervision 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 driven according to principles of sound and ethical child care. As the superior body the Norwegian Board of Health Supervision 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
- 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
Approximately 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 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.
The director general of the Norwegian Board of Health Supervision is Jan Fredrik Andresen.
The pages in English at helsetilsynet.no
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
Links to other web resources in English and other languages
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.
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.
The Office for Children, Youth and Family Affairs (Bufetat) is responsible for central government child welfare services, including the centres for lone 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).
The Norwegian System of Patient Injury Compensation (NPE) manages the legislation governing governmental compensation for any harm suffered by patients in the health service.
Radiation Protection Authority (Statens strålevern (NRPA))
Statistics Norway publishes statistics about health and social conditions, and health and social services.
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.
Postal address: Norwegian Board of Health Supervision, Postboks 231 Skøyen, 0213 Oslo
Street adress: Møllergata 24, 0179 Oslo
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: