GREETINGS from Tromso where the sun should finally rise over the horizon for the first time this winter later today.

The Arctic Frontiers conference is held in the Norwegian Arctic capital every year, with three thousand delegates from countries across the globe. That in itself is impressive. A city a thousand miles further north than Inverness has almost twice the Highland capital’s population, a university issuing its own degrees since 1972 and a clutch of hotels with auditoriums large enough to seat several thousand people. Some of the biggest delegations here are from China, Russia and Japan. They want to be involved in the move from oil to renewables and think Norway is at the cutting edge. They’re right. Norway has cannily (some might say cynically) backed both sides of the “green shift”. The country is home to one in 10 of the world’s electric cars, the first electric ferry and by 2040 all electric internal flights, as well as six new oil and gas projects in the Barents Sea over the next decade.

But there are other equally important social changes happening in Norway too, like the shift of older patients from hospitals to more appropriate care settings.

It may not be as headline-grabbing, but delayed discharge is a direct cause of human misery and an indirect cause of the queues and long waits that led most hospitals in England (and some in Scotland) to cancel scheduled operations and miss Accident and Emergency admissions targets this winter.

Tory MSP Miles Briggs raised eyebrows before Christmas when he suggested Scotland should copy the Norwegian system for tackling overcrowded hospitals and “bed-blocking”. Anyone might wonder why the Scottish Tories would ever embrace the social democratic Nordic Model? But of course there is a reason. Despite their cuddly appearance, the Norwegians actually use a tough-sounding combination of cash payments and penalties to manage hospital admissions.

They make patients pay to see GPs, don’t let patients walk into Accident and Emergency without a GP referral and make councils pay every day someone isn’t discharged from hospital when they could be. These weren’t recent Conservative Government measures, but were brought in by Labour Governments in the 80s and noughties. Iceland, Sweden and Denmark do much the same.

But does charging councils produce more home adaptations and nursing home beds to cut delayed discharge — or just penalise councils for being too cash-strapped to really try?

First, a wee bit of background.

The news that Norway had once again bagged top spot in the World Economic Forum’s Inclusive Development Index this week didn’t even make the front pages here. Despite having a Conservative-led coalition government for the past five years, the equity embedded in its welfare state means Norway still scores highly on all pillars of inclusion; intergenerational equity, sustainability, growth and development. Essentially Norwegian Conservatives are not like our Conservatives. Explain the bedroom tax, benefit sanctions, six-week waits for Universal Credit, disability car cuts and high childcare costs to any Norwegian and they are astonished and appalled. The spectacle of patients stacked up in corridors and stuck in ambulances outside hospitals in England made TV bulletins here. But in their worst years, (and flu had a huge impact here this winter) Norwegians have seen nothing like it.

That’s mostly because their health service spending is amongst the highest in the world (only partly explained by their stronger currency) which helps finance the highest proportion of nurses and midwives per head in Europe. It’s partly because their hyper-fit population has better baseline health than Scots with a far better diet, a longer life expectancy and a smaller gap between overall life expectancy and healthy life years.

But there is another factor progressive Scots will find hard to accept.

It’s also partly because the Norwegians are managing demand — not waiting for it to come crashing through the doors of A&E departments

All patients pay to see the doctor and get hospital treatment or prescriptions. But there are exemptions for those on low incomes and total annual payments are capped at around £230. Patients with more serious conditions also pay but get a tax rebate. That figure may still look high, but Norway is prosperous and has a much more egalitarian distribution of income, and a fairer tax system than Britain. So no major party has plans to change the system — not even Labour.

These “co-payments” by the public came in during the 1980s to boost doctors’ income, screen out people with trivial complaints and encourage the creation of more GP practices at a time of financial crisis. Co-payments by councils began in 2012 to end “bed blocking” by charging councils for patients who should be at home or another care location. And Accident and Emergency departments don’t accept random visitors — patients must be referred by a GP or an ambulance paramedic first. If that sounds extremely tough, bear in mind there is a 113 emergency phone service that connects with a local GP available day and night to make important triage decisions and a fleet of ambulances and emergency helicopters with staff equipped to decide if less seriously injured patients should go direct to their GP instead of hospital.

Now, none of this fits with the Scots idea of inclusion — I ken.

Aneurin Bevan’s founding principle for the NHS was that healthcare should be free to all at the point of delivery. But Norway has as small a private health sector as Scotland (8.5 per cent of the population with private health insurance) and recent Norwegian Conservative Government attempts to tender out nursing home care went nowhere because private firms couldn’t make a profit with the high pay and standards insisted upon. So high-quality nursing home places are financed and provided free (or with small co-payments) by councils, not private companies, and as part of their health service.

Some on the left admire the Scottish health system with its free service provision, and almost twice as many Norwegians as Brits don’t access the health service because of cost. But there’s very little public dissatisfaction with the system because it seems to manage demand.

Crucially, too, the Norwegians didn’t bring payments into their health system to create a market in healthcare or provide opportunities for the private sector, but to fund an expansion of GPs, deter patients with trivial complaints turning up at A&E and to tackle “bed-blocking”.

So before the Scottish Tories start jumping with delight at the idea that Norwegians prove charging works — there are a few caveats.

Firstly, unlike the present UK Government which only uses the stick, the Norwegian government introduced co-payments as a carrot in disguise. Councils have actually been given extra money by central government every year to compensate them for these payments — the point is not that “failing” councils are punished but that successful councils get extra money to spend on other things. Can you imagine Jeremy Hunt or the Scottish Tories coming up with a plan like that? Me neither.

Secondly, in some parts of Norway — like Tromso particularly — the council co-payment system didn’t end delayed discharges because of political party pettiness. Co-payments were brought in by a Labour Government, so it seems Conservative councillors running Tromso council opted to spend the extra money on other services, not “step down” provision. Finally, public pressure and bad headlines made them toe the line — the first of several new nursing homes will open next year.

Thirdly and perhaps most importantly, next to no-one is stuck in a Norwegian hospital because they are waiting for minor adaptions to their homes. Norwegian society is too humane and councils too well-funded for that to happen. Delayed discharge happens in Norway for bigger reasons — like not enough nursing home beds or convalescent homes locally for recuperation after hospital and before going home (in the UK these were axed by Margaret Thatcher in the 90s). Shamefully, there are still Scottish patients stuck in hospital for the want of £1000 to fit new rails and a walk-in shower for an elderly hip fracture patient. Despite the extra layer of bureaucracy represented by Scotland’s new Health and Social Care partnerships, such chronic failures of joint planning still happen in Scotland every day.

So should we introduce the Norwegian system? It’s an academic question because the Scottish Government doesn’t have the spare cash to finance a Norwegian-style bung so that council payments for delayed discharge can be introduced. Furthermore, inequality is too pronounced for all Scots to pay even a little for healthcare and our welfare system is so precarious after years of Tory control that introducing any system of payments could rapidly form the thin end of a privatising wedge. Finally, the systems change needed to stop the public walking into A&E without a GP referral would be enormous.

But it makes you think.

If the Norwegians, Swedes, Icelanders and Danes — the most inclusive societies on Earth — are using techniques like these to manage demand on their health and care services, how is the Scottish NHS going to achieve better long-term outcomes with none?

I merely ask.