5 Public sector renewal, better and more effective welfare, health and care services
High-quality public services are a mainstay in the Norwegian welfare society. We devote substantial public resources to these services, and just under every third employee in Norway works in the public sector. The public sector is responsible for delivering life-long services to the entire population. These services include supporting safe conditions for children and young people growing up, and providing a good education for each and every one of them. The services encompass assistance in finding employment, and ensuring that everyone has an income. The public sector is responsible for providing safe, effective and high-quality health and care services, for preventing crime and promoting safety and emergency planning. Public resources must be used efficiently to ensure that we can continue to provide good welfare services in the years to come. At the same time, the population has high and growing expectations regarding these services, and the authorities respond with high ambitions as to what they will offer. Therefore, the public sector must be a driver for innovation by adopting new knowledge and new forms of organisation.
The private sector plays an important role in renewing the public sector. The private sector will develop much of the technology and expertise that will be incorporated in future public services. These services will also be carried out in cooperation between the private and public sector. Therefore, there is a need for efficient research and development collaboration between the private and public sectors. There is also a need for information on how this collaboration should be organised so as to yield the best possible public services, the best use of resources and profitable business development.
The Government will step up appropriations to research and higher education that will revamp the private sector, and provide the population with better and more effective health, welfare and care services. The Government wants to achieve:
more knowledge-based production and development of services, with emphasis on research-weak and strategically significant cross-sector areas
a public sector that drives and utilises innovation
a knowledge system for better health and care services
5.2 Knowledge-based public services
Norway's commitment to knowledge about and for the public sector is lagging behind. The public sector is responsible for ensuring that the services provided are of high quality, and that they are effective. Public service development will be affected by major structural changes, such as changes in settlement patterns, demographic changes as a consequence of aging and immigration, vulnerability and security in the national infrastructure, and an altered health and illness pattern in the population.
Textbox 5.1 Good programmes to put more people to work
NAV (the Norwegian Labour and Welfare Administration) provides programmes aimed at giving the unemployed and those with reduced work capacity a greater chance of gaining or maintaining employment. NAV has many different measures that can be used. Some of the measures take place in a sheltered environment, others in normal workplaces or in ordinary education. The effects of the measures are varied and depend both on the individual's circumstances and on the labour market situation. The effects of the measures depend on both a varying labour market and on the challenges each individual has as regards their health and social situation.
Relatively advanced models have been developed in recent years to analyse the effects of measures. These methods have provided better tools for the authorities to learn which measures, or which elements of a measure, are effective for various groups. There is a potential here for obtaining information that can contribute to streamlining labour market and welfare policy. However, we do not know enough about what works and for whom for this to be a reliable tool for NAV officers and partners in the health and education sectors, as well as in working life.
Textbox 5.2 Better services to prevent alienation of children and young people
Norway spends about NOK 13 billion per year on child welfare. A more diverse population necessitates better, more targeted services. The children and families that are assisted by the child welfare service often face complex challenges. Research reveals that the help these children receive is not good enough to prevent negative development. In an overall lifecycle perspective, adults who have received child welfare services do not do as well as the rest of the population. Compared with the rest of the population of the same age, some of the traits characterising those of us who have been child welfare clients include poorer physical and mental health, lower education, weaker connections to working life and a greater need for health and social welfare services. Therefore, we need research-based knowledge and social science and child welfare personnel who can alter the application of child welfare measures towards actions that actually work, and that contribute to long-term positive change in the lives of children and young people. Good and targeted measures contribute to positive development for individual children, but also bring major socio-economic benefits.
The public services do not operate independently, but must cooperate and be coordinated in relation to users who often have very different and complex needs. These people may receive assistance from several different services in different sectors and at different levels. Good coordination between labour market measures, health services and education is particularly important. Research can contribute to mapping and evaluating cooperation, and contributing to develop the content of comprehensive services.
Complex contexts and the demand for high-quality services require knowledge and expertise. Several areas in the public sector can be characterised as “research-poor” in the sense that there is little research-based knowledge in these areas at present. Generally speaking, there is a need for more research on the effects of and content in the actual services, and the structures they are part of. This applies to both state and municipal services, and how these services function together. For example, there is little research on the care services, considering the fact that this is a sector that employs 130 000 people and accounts for annual public spending of NOK 95 billion. Several reforms have been initiated in the public sector in recent years, such as the cooperation reform, the pension reform and the NAV reform. The Government also plans to implement a municipal reform. We lack a good system for applying the available information, and we need more knowledge about the use and effect of measures and reforms that are initiated. New measures must be developed and tested. The effects of measures must be documented through relevant research, and followed up with implementation and consequence research. Accurate measures will provide the right assistance to help each individual, and while also benefitting society at large.
Areas of strategic, cross-sectoral importance shall be prioritised. We must reinforce areas where there has been little research, but where more knowledge is required in order to deliver and develop better quality. The accuracy of the services must be improved. Here it will be important to involve the people who will use these services, to ensure that the research is beneficial for them. There is also a need for research on organisation and management as well as decision and control models in the public sector. Relevant, hands-on research should be prioritised as a basis for planning and for promoting professional and service development.
Educational institutions and the public sector must cooperate to train a sufficient number of expert personnel to meet the needs for public services. High-quality and relevant education of candidates for the social welfare professions is important. Developments within ICT and other technologies mean that the public sector needs different expertise than previously. In addition, continuing and post-qualifying education must ensure that expertise in the public sector is up-to-date and relevant. The interaction between research, education and work experience must be applied to a greater extent on the innovation and development work in the public sector. This necessitates cooperation between the educational institutions and the services.
5.3 Public sector as driver and user of innovation
The solutions of the future will come from both the private and public sectors. The public sector plays an important role in demanding innovation. It will be an important domestic market for Norwegian business and industry, and will contribute to the application of new knowledge.
These solutions must be developed through interaction between the users, the public sector, business and industry and the research communities. This means that the public sector shall be a good requisitioner of innovation, and shall be key in communicating to business and industry and research communities the challenges that can be solved through research and development. The public sector must also be a good partner, for example with other business organisations. Knowledge and innovation is put to use, both in individual enterprises and across sectors.
Public procurements and public-private cooperation are examples of collaboration that must be designed so they become instruments for addressing challenges that require research or innovation. Financial instruments can also support this interaction. Public support is needed for user-driven innovation projects which public enterprises can apply for, in cooperation with research and business communities. The public sector phd programme is another important instrument. The Research Council and the educational institutions can contribute a comprehensive approach to innovation in the public sector. This requires close cooperation with users and expertise centres in the national and municipal sectors.
Norway has what it takes to lead the way in applying new knowledge to produce public services and to facilitate appropriate infrastructure. We have a highly-educated population, along with good technology expertise and internet access. Norway also has well-developed public services combined with unique infrastructure in certain areas such as registry data and bio-banks. Norway already leads the world in promoting international use of public digital solutions such as Altinn and NAV's electronic service “Your pension”.
Production and development of services often takes place in smaller entities and in municipalities with little expertise and few resources to carry out innovation. The municipal reform will play an important role in achieving stronger and more innovative environments. Success in the changes that must be made in the future requires that the public sector masters and utilises innovation in technological and organisational solutions and in the services. While there are good examples of service innovation, we do not know enough about which mechanisms stimulate this in the organisations.
Textbox 5.3 Technological innovation in justice and preparedness
There are several examples of technological and organisational innovation within the field of justice and preparedness that have contributed to better and more efficient development of services. This includes the violence alarms for persons at risk of violence, electronic imprisonment, DNA tools for use in investigation, biometrics to confirm identity, as well as digital communication solutions for the police and emergency services. Over the longer term, drone technology can be used for a variety of purposes by the police and search and rescue operations. At the same time, several of these technologies also give rise to legal and ethical challenges.
5.4 A knowledge system for better health and care services
Good health is important for each individual. It is also important for sustainable social development and good access to labour. The need for health and care services to adapt and change is primarily driven by developments within medicine and medical technology. At the same time, people live longer than before and contract different illnesses than was the case just a few decades ago. More people live with chronic illnesses such as cancer, diabetes and COPD. At the same time, we note a worrying development where resistance to antibiotics is a growing threat. In Europe alone, 25 000 people die each year after being infested with multi-resistant microbes, e.g. via food, livestock or pets.
We lack knowledge about diagnosis and treatment in several areas, such as dementia, substance abuse treatment, cancer, rare diseases and patients afflicted with multiple diseases all at once. These challenges must be met with knowledge about factors that impact health and illness, how these services can best be offered, which treatments work and how we can apply new solutions in future health and care services.
Textbox 5.4 Desired objectives and priority areas in the Health&Care21 strategy
The desired objectives for Health&Care21 are three-fold: research and innovation shall contribute to good public health, ground-breaking research, business development and national economic development. Health&Care21 prioritises ten strategic efforts:
increased user involvement
the health care industry as an industrial policy priority
knowledge mobilisation for the municipalities
health data as national comparative advantage
improved clinical interventions
efficient and effective services
meeting global health challenges
increased, high-quality internationalisation
development of human resource
strategic and evidence-informedgovernance and management
The strategy also identifies some main priorities going forward. These are:
Knowledge mobilisation for the municipalities with substantial, sustainable R&D funding; establishment of a national registry of municipal health and care services; and universities, university colleges and a new research institute sector that specifically aim to meet municipal needs.
Health care as a focus area of industrial policy with sector-specific measures and greater interaction between the public and private sectors
Easier access to and increased utilisation of health data.
An evidence-informed health and care system based on user involvement and competence, with greater emphasis on developing new interventions and documenting the impact of these, both at the clinical level and at the organisational and system levels
A strong commitment to internationalisation and increased participation in the competitive European research system.
Research, education and innovation are important criteria for developing sound, high-quality health and care services. A knowledge system for improved health and care services must include cooperation arenas for user participation. The system must also be equipped to assess needs for trained personnel and expertise in these services, such as health workers, natural scientists or technologists, as well as schemes for assessing the quality of health and social science programmes. We need outstanding professional and research communities in the fields of prevention, treatment, care and service development. We also need good cooperation between these services, the professional clusters, the users and the business community in order to develop and apply the results of this innovation.
In June 2014, the Government received “Health&Care21”, the first cross-sectoral, comprehensive research and innovation strategy for health and care services. This strategy forms the basis for long-term, comprehensive development of research, development and innovation for public health, and the health and care services. The strategy points to a pent-up potential for international research cooperation and business development in the health field. There are also areas with major knowledge gaps, for example within municipal health and care services. Second only to the petroleum industry, the health industry is the sector that invests most in research and development. The Government has great ambitions for exploiting the potential that lies in business development in the health sector, and therefore wants to establish health and care services as an industry policy commitment area, with appropriate policy instruments.
In Norway, we have expert communities that are world leaders in certain aspects of health, health research and innovation. We also have unique research tools through our stores of health data and samples from patients and healthy individuals. These samples are stored in large bio-banks and represent tools that give us a good starting point for developing our basis of knowledge, which is attractive for international partners and forms the basis for cooperation with business and industry.
Norway also plays a prominent role in clinical research, but this remains an area with major knowledge gaps. We lack information that can contribute to better prevention and treatment of both major widespread diseases such as dementia and musculoskeletal ailments, as well as more rare diseases such as chronic fatigue syndrome (also called ME). Not least, there is a huge need for knowledge in the municipal health and care services. The Government believes that HelseOmsorg21 provides a good description of the challenges faced in the municipal health and care services, and wants to enhance its commitment to a knowledge system that can contribute to better health and care services in the municipalities. The Ministry of Health and Care Services will develop a municipal health and care services register to further objectives such as development of infrastructure for research in the municipal health and care services. The Government will revert to the Storting as regards a plan for how to follow up the HelseOmsorg21 strategy.
There is also a great international demand for better and more effective public services. The development within e-health and welfare technology is important to address user needs for more home-based and adapted treatment and care services. A large part of the research funding in the European research programme Horizon 2020 is earmarked for research in health, demographic change and welfare. The Government is working to ensure that many Norwegian expert communities take part in the Horizon 2020 health programme.
A knowledge system for better health and care services depends on developing good arenas for cooperation which allow us to assess the need for expertise, user needs and the need for knowledge in the health and care services. In other words, closer cooperation must be achieved between the educational and research institutions and the local and regional authorities that are responsible for developing and delivering the services. The knowledge system must involve the users to a far greater extent throughout the entire course of research and innovation. Both the health enterprises and the Research Council have already embarked upon this.
There is a particular need for intensified efforts targeting the municipal health and care services, and services in the interfaces between the hospitals and the municipal health and care services. Increasing demands are placed on developing, testing and documenting the effects of measures through clinical studies, implementation and effect research. This requires research infrastructure such as clinical test units and medical quality registers. The professional, medical and technological development requires a broader understanding of how illnesses develop, and the development of new, effective and more individually adapted and gentle treatment methods and diagnostics. The development of more tailored treatments based in part on genetic data and development of new medical technology is expected to have a major positive impact for individuals by reducing potential side effects. One example of new technology is new types of radiation treatment for cancer patients. Such treatments are currently being established in many countries.
Textbox 5.5 Progressive medical equipment means opportunities for leading expert groups
Rapid development is taking place in technical solutions for radiation treatment of cancer. Two new techniques are radiation therapy with protons and radiation therapy with carbon ions. Both have significant curative effect and result in less radiation damage to adjacent organs and tissue, compared with the current treatment. Establishing this type of treatment in Norway will require substantial investment in buildings, equipment and expertise. The expert communities claim that Norway could become the world leader in research on radiation physics, particle physics and radiation biology if Norway invests both in radiation therapy with carbon ions and treatment with protons. This could form the basis for a Nordic and European research collaboration with Norway taking the lead. At the same time, we can offer patients a gentler radiation treatment.
Existing health data must be utilised more efficiently, and better data must be developed for the health and care services in the municipalities, as well as better data for measuring that the services offered are safe and of high quality.
We need more knowledge about special needs and social problems, prevention and effective nutrition and lifestyle-based strategies to optimise health and reduce risk, or to delay early onset of nutrition-related diseases. New technology and new organisation models must address the needs of the users and requirements for effective, high-quality and safe services. To achieve this, we must train and update personnel and experts who can use these new technologies and who can work in a public health service which constantly adapts to new types of services.