Debate, Northern Health | Helse Nord needs more money, better recruitment and stable services. The proposed closures in Northern Norway do not solve any of these problems

The consultation note proposes the centralization of 24-hour places in the largest cities in northern Norway. In the current proposal, 32 DPS overnight places in the district are moved from local hospitals close to the patients to regional hospitals (only in UNN and Nordlandssykehuset HF). The total number of inpatient places that are centralized in Northern Norway is 58. This is completely out of step with the management signals from the Hurdal Platform, the Task Document, the Escalation Plan for mental health and Helse Nord’s own Regional Development Plan, all of which state that you must have a decentralized health service close to where people lives. The risk assessments that are used as a basis for advice are overall, imprecise and leave out a number of significant risk areas that should have been thoroughly elucidated. They lack legitimacy.

Finances – small amounts and unknown costs

The total effect of all the proposals for closure and relocation only constitutes a small part of Helse Nord’s estimated deficit in 2027. In addition, this saving is “exclusive of investment needs”. Nordlandssykehuset has indicated that the psychiatry in Bodø in the current building mass cannot “establish sound, efficient and modern operations”, and investments are desired there for close to 1.3 billion ref. board case 007/2021. Even with minor rehabilitations, it is difficult to see that Helse Nord can with any degree of certainty predict a net saving through the proposed changes.

Recruitment and education

Helse Nord goes against its own knowledge and strategy Local education and practice are particularly important for recruiting and retaining health personnel, both for municipalities and hospitals. The departments threatened with closure in Vesterålen are used for the education and specialization of speech therapists, occupational therapists, physiotherapists, psychologists, nurses and at the medical school. The medical education in Tromsø and the decentralized Bodø package have largely been developed based on a recognition of how important local connections are for recruitment. The personnel situation at Lofoten and Vesterålen DPS is better than it has been for a very long time, and the department is one of the few in the region that has a full-fledged, functioning on-call system. It is not possible to find evidence in either the working group’s work or the consultation in general that closure in Vesterålen will strengthen recruitment in Bodø.

Service offer – Continues downsizing of psychiatry

Already 12 out of 20 24-hour places have been closed in Vesterålen in recent times. In addition, the reception area of ​​the remaining beds has been extended to Lofoten. Before the current situation, there has thus been an extensive downsizing of psychiatric services in the region. Patients with long journeys find it more difficult to benefit from outpatient treatment. It is therefore quite natural that the number of admissions is higher in district regions. The fact that Helse Nord RHF chooses to compare the number of beds per inhabitant in Northern Norway with that of the most urban and densely populated area (AHUS and OUS) in the whole country does not appear to be expedient.

Consultation input from Nordlandssykehuset HF

On 23 April, a divided board of Nordlandssykehuset HF adopted a consultation opinion for Helse Nord RHF, which we in the Vesterål Council do not stand behind. The discussion in the board meeting that led to the adoption of the consultation opinion was characterized by uncertainty about figures. Practical, financial and structural consequences of the decision were not explained to the extent that it can be said that the majority of the board has made a well-founded decision.

Mental health care and TSB

The cut proposals from Helse Nord challenge the comprehensive service offering within mental health care in several areas. Pronounced geographical skewed distribution: With 55,000 inhabitants, Lofoten/Vesterålen has more inhabitants than Bodø, and around the equivalent of ¾ of the whole of Finnmark. Helse Nord portrays this as a small and vulnerable area where it is not possible to operate responsibly. This is in stark contrast to other healthcare facilities, which operate with 24-hour services with a smaller population base (Kongsberg: 45,000, Flekkefjord: 40,000, Elverum hospital: 58,000, etc.) when both Helse south-east, Helse West and Helse Midt consider this to be reasonable and feasible, it seems strange that Helse Nord has completely different assessments.

Nordlandssykehuset HF proposes in its consultation response to operate the bed post at LVDPS “on termination”, pending a build-up in Bodø for which there are no plans. This is a recipe for losing professionals and destroying the department.

The connection between a strong primary health care service and good mental health care is clearly shown along several axes. There is less use of coercion where there is good capacity on the GP side, for example. The interaction between the patient, relatives, municipal services and the specialist health service is therefore central to good patient outcomes. Offers such as FACT and the Acute Ambulant Team and the somatic offers at the local hospital contribute to proximity to both patients and municipal partners. The synergistic effects of the proximity to the local community (relatives, volunteering, proximity to home, etc.) disappear if the bed post at LVDPS is closed.

Lofoten and Vesterålen are also in a special position due to the need to use aircraft to get to Bodø. This is significantly more difficult for patients and their relatives to achieve, and it is much more expensive. For children as relatives, and relatives with small children, this is completely devastating for being able to be present. The ROS analyzes from the working groups are completely overarching, without going into concrete conditions and making simulations of the various consequences. This is particularly evident in the fact that one does not look thoroughly enough at overall societal consequences. For example, the number of assignments where the police assist health with assignments within mental health has increased from 37,000 to 53,000 between 2017–2022. This is an increase of 43 per cent. Helse Nord’s consultation proposal appears to be disconnected from this type of dependence on cooperating social institutions.

Research is clear over several decades: Increased distance to mental health services results in less use. Removing beds for voluntary admission from Vesterålen will make it even more difficult to provide a voluntary 24-hour service for the population of Vesterålen. It becomes more difficult to prevent the course of the disease from developing into an acute phase. There were 268 emergency admissions from Lofoten/Vesterålen in 2023. As little as a 10% increase will require large resources and entail large burdens for patients and relatives. It is difficult to see how closing the inpatient unit at LVDPS will not generate more forced admissions.

There is no plan for how overcrowded services at central hospitals will cope with an increase in patients coming from scaled-down local hospitals. The increased amount of (acute) patients from the rural areas displaces precisely the very important and specialized treatment for which the large hospitals are really needed.

As the consultation proposals cannot prove either financial savings, better recruitment or better patient treatment, they appear mainly as a desire to strengthen the environments in Bodø and Tromsø. Helse Nord must realize that patient-friendly treatment is not a district political platitude: it is effective health care. If Helse Nord RHF chooses not to take this into account, and strives for an organization according to the BEON principle, it will end up with the social contract between the residents outside Bodø and Tromsø being perceived as broken. Loyalty to the central hospitals will then wane. And once you have boarded the plane, many patients will not care much if they fly 40 minutes to Tromsø / Bodø or just over an hour to Trondheim.