IS Lesley Riddoch absolutely certain it was Norway she was writing about last month (How tough love on healthcare pays off for Norwegians, The National, January 25)? I have lived in Scotland for 20 years, and Norway for seven. I have researched, worked in and used health and social care services in both countries. Some claims need correcting, and more context is needed to interpret others.
- In Norway you can’t visit A&E without a GP referral? I don’t understand where this is coming from. It does not apply to the ordinary A&E Legevakt, used by most people. In fact, Legevakt is where we go when our GP is closed.
- Norway manages demand for hospital services? Not as well as Scotland, in my experience and according to evidence. Visits to Legevakt circumvent referrals from GPs into hospital services. Most referrals to hospital beds come from Outpatients and Legevakt. GPs can do little to treat patients in the community, as they have no practice team around them for management of routine illness. They refer to Outpatients, who refer in to hospital beds. This is encouraged; hospitals are run as separate enterprises that need patients for income and to balance their budgets.
- Norway manages delayed discharges by charging municipalities for every 24 hours a patient remains in hospital after declared ready for discharge by a doctor? This claim needs serious modification. It is part of the Co-ordination Reform introduced in 2012 to improve co-ordination between the hospital sector and municipalities and reduce pressure on hospitals. The evaluation of the reform in 2015 suggested delayed discharges had gone down, but this was continuation of a trend that had started before the reform. More seriously, patients are moved out earlier (more income and less expense for hospitals, see above) and service bottlenecks were simply moved, with patients stuck in units outside of hospitals. Vulnerable older people’s journeys from hospital to home were more fragmented and risky. Admissions went up after the reform – small wonder perhaps. Municipalities were given more resources to manage increased demand, but this did not compensate for increased activity from more ill and more vulnerable patients.
- Fees for use of services limits demand? Possibly, but evidence suggests this also applies to patients with a low income who are more likely to suffer poor health and with greater need of services. Yes, there are poor people in Norway too, and the numbers are increasing due to government policies: cuts in benefits (including for disabled) to fund tax cuts is one reason.
In Norway, if you have a physical complaint that counts as urgent you will receive excellent care equal to none. If you are old, mentally ill, poor and or suffering from chronic illness that requires the co-ordination of health, social care and welfare services, you are up against a very unwieldy system. The increased use of private providers to get waiting lists down is part of the problem: the system becomes more and more fragmented and it is very easy to fall between the cracks.
I know the health service in Scotland is creaking. Austerity does not go well together with increased demand. But the Scottish system is vastly superior to the Norwegian in many respects. One reason is that health services are part of one publicly owned system where the separate parts are forced to work together to limit demand. And councils are made part of that collaboration. It’s not perfect, but a look south to England suggests it’s not the worst system.
If you live in Scotland you may well have reason to count your blessings. If you write about another country’s health policy you may do well to do some research beforehand.
Dr Guro Huby
Senior Researcher, University College Østfold
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