NOU 2011: 11

Innovation in the Care Services

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1 Appointment, mandate and activities of the committee

1.1 Appointment

In Report No. 7 (2008-2009) to the Storting, An innovative and sustainable Norway, the Government recommended that a committee be appointed to explore new innovative solutions for meeting future challenges in the care services.

The committee was appointed in Council on 26 June 2009 and comprised the following members:

  • Kåre Hagen, Oslo (chair)

  • Siv Iren Stormo Andersson, Bjugn

  • Glenn Kenneth Bruun, Oslo

  • Siri Bjørvig, Tromsø

  • Annichen Hauan, Oslo

  • Karin Høyland, Trondheim

  • Shahzad Rana, Oslo

  • Bente Skansgård, Oslo

  • Per Gammelsæther, Fræna

  • Tove Johanna Fagertun, Bodø

  • Ivar Leveraas, Oslo

Committee member Shahzad Rana took part in the first meeting only.

The secretariat has consisted of the following members:

  • Steinar Barstad, Policy Director, Ministry of Health and Care Services (chair of secretariat)

  • Astri Myhrvang, Senior Adviser, from the secretariat for the National Council for Senior Citizens until 1 february 2010

  • Allis Granberg, Senior Executive Officer, Ministry of Health and Care Services from 1 february 2010

  • Åshild Willersrud, Strategic Adviser, Division for Innovation and Development of the Norwegian Association of Local and Regional Authorities (KS)

  • Espen H. Aspnes, Innovation Adviser, InnoMed

  • Geir Petterson, Adviser, Ministry of Trade and Industry, has followed the committee’s activities.

In addition, Siv Svardal, Senior Adviser at the Ministry of Health and Care Services, and Une Tangen, Adviser at KS Konsulent, have assisted with the writing of this document.

1.2 Mandate

Presentation

«Society is facing demanding challenges in the care services in the coming decades related to an increasing number of elderly, new user groups and a shortage of health and social services personnel and volunteer care providers, cf. Report No. 25 (2005-2006) to the Storting, «Long-term care – Future challenges, Care Plan 2015.»

The municipal care services consist of extensive, round-the-clock activities that are carried out by a small number of managers, a large number of personnel, a high percentage of employees without professional training, many part-time workers, a very high percentage of women and often simple technical aids. Furthermore, care services involving daily life, meals, activities, and social and cultural factors are identified in most studies as among the weakest services today. There is therefore both a tremendous need and a vast potential to take innovative steps and find new solutions for meeting future challenges in the care services.

The municipal care services have gross operational expenses of roughly NOK 70 billion, divided more or less equally between about 40 000 nursing home residents and some 160 000 recipients of home care services. Despite its size, this sector has been the subject of very little systematic research and development activity.

Consequently, there is much to be gained by focusing attention and effort on a sector in which a great deal can be achieved with relatively limited resources. The municipal care services have great potential to implement innovative, creative measures in relation to:

  • new technology in a conservative sector that has shown limited capacity to make use of new technical aids, new care services technology, Smart House solutions and new communications technology;

  • new architecture in a sector that is not adequately prepared to address the future preferences, demands and challenges of new user groups and new generations of elderly;

  • organisational development in large enterprises that have broad-based cooperation with families, local communities and the specialist health care services and where the users should be challenged and given greater influence;

  • research on a sector that has been the object of virtually no research activity and where hard-won research funding still comprises only a tiny proportion of the overall budget.

This is some of the background for why the Government chose to focus on the care services sector in its white paper on innovation policy (Report No. 7 (2008-2009) to the Storting, An innovative and sustainable Norway) when considering innovation in the public sector. The white paper recommended that a public committee be established to address these issues and laid down some guiding principles which are now more closely defined and specified in the attached mandate for the committee.

The mandate specifies in particular that the committee is to focus on the following:

  • new technology

  • architecture and new types of living arrangements

  • user influence and skill mastery

  • research and development activity

On this basis, the committee has been charged with the task of assessing new solutions and making recommendations for the design of future nursing homes, types of living arrangements and services to ensure that these will meet the needs of future users and make the most of their resources.

In its efforts, the committee is to emphasise that the services offered must, in keeping with the Care Plan 2015, have a more active profile that encourages greater user influence, user skill mastery and active participation by the individuals, their families and social networks. New types of living arrangements, forms of organisation and the use of new technology must first and foremost promote this objective. The committee is to assess the potential for developing new forms of ownership and operation and new types of cooperatives based on expanded collaboration with user organisations and idealistic enterprises.

The committee is also to assess the potential for developing care services products through cooperation between the public and private sectors, focusing in particular on the development of architecture and new technology.

Report No. 7 (2008-2009) to the Storting, An innovative and sustainable Norway, states:

«The committee must be composed in a way that ensures it can view the care services sector with new eyes, with representatives of the business sector and professional circles as well as development-oriented representatives from the municipal sector, the care services and the users of the services.»

In keeping with the mandate, the committee comprised 11 members from the areas of business, technology, innovation, architecture, and health and social care as well as key representatives for the users. The chair of the committee has held positions as research director at the Institute for Labour and Social Research (Fafo), departmental head at BI Norwegian Business School and chair of the programme board of the Programme for Welfare Research. He has also participated in many future-oriented research and development projects.

There are six women and five men on the committee.

The committee is to submit its final evaluation and recommendation in the first half of 2011.

Mandate

On the basis of Report No. 7 (2008-2009) to the Storting, An innovative and sustainable Norway, and in cooperation between the public and private sectors, the committee is to assess the potential and make recommendations for new innovative measures and solutions designed to meet the future challenges of the care services, with special focus on:

  • new technology

  • architecture and new types of living arrangements

  • user influence and skill mastery

  • research and development activities

On this basis, the committee has been charged with the task of assessing new solutions and making recommendations for the design of future nursing homes, types of living arrangements and services to ensure that they meet the needs of future users and make the most of their resources. The committee is to emphasise that the services offered must, in keeping with the Care Plan 2015, have a more active profile that encourages greater user influence, the users’ own skill mastery and active participation by the individuals, their families and social networks. New types of living arrangements, forms of organisation and the use of new technology must first and foremost promote this objective. The committee is to assess the potential for developing new forms of ownership and operation as well as new types of cooperatives based on expanded cooperation with user organisations and idealistic enterprises.

The committee is to view its endeavours in a light of long-term thinking and development trends, and view its task in the context of prevention. At the same time, the committee’s activities must be directed towards ensuring that the local care services are made capable of assuming new, professionally demanding tasks, as stipulated in the Coordination Reform. With a view to planning the care services of the future, the committee is to identify specific research needs and submit proposals that can strengthen research and development activities in the municipal care services. The committee may also take the initiative to raise questions and propose measures aimed at enhancing innovation and research in the care services sector.

The committee is to assess the potential for product development, business development and export activity arising from cooperation between the private and public sectors in the field of care services, focusing in particular on the development of architecture and new technology.

Smart House solutions and new technology for care services create new opportunities for the users to master their own daily lives, and can help to promote independence and autonomy. Telemedicine and new communications technology make it possible for the health and care services to improve, simplify and enhance the efficiency of their activities. The committee is to assess the ethical aspects of its proposals and the impact of these proposals on the individual’s personal privacy, especially in relation to the use of new notification and monitoring technology.

Over the years, various institutional solutions and living arrangements featuring a wide array of names, designations and schemes have been developed in the municipal health and care services. The committee is therefore charged with reviewing and systematising the various institutional forms and living arrangements used for caregiving purposes with a view to standardising the terms used and simplifying the statistics and regulatory framework.

The committee’s activities are to be based on the assumption that the care services of the future are rooted in publicly-funded schemes and a dynamic, humane civil society. Such community-oriented care services encompass the municipal care services, family-based caretaking, local communities, and user-driven and volunteer organisations working in close cooperation with the specialist health care services and other sectors. The committee's recommendations are to be formulated on the assumption that the collective resources of civil society and the public and private sectors are utilised in an economically beneficial way for society.

The committee is to submit its final report and recommendations within the first half of 2011. The ministry stipulates that the committee must employ an open work method and remain available to receive input and discuss key topics with various professional groups, government councils and special interest organisations, including identifying an effective means of coordinating its efforts with the activities of the technical aids committee (Hjelpemiddelutvalget).

1.3 The committee's activities

The activities of the committee are planned to be carried out in three phases:

  1. Autumn 2009: Brainstorming

  2. Spring/autumn 2010: Compilation and systematisation of knowledge

  3. Winter/spring 2011: Writing and completion of the report

A total of 12 committee meetings were held: one three-day meeting, four two-day meetings and seven one-day meetings in Oslo, Drammen, Gardermoen, Drøbak, Trondheim and Arendal.

At the start of its work, the committee ordered three state-of-the-art overviews and reports from the Norwegian Knowledge Centre for the Health Services:

  • Holte, Hilde H., Kirkehei, Ingvild and Gunn E Vist: Omsorgsforskning i Norge («Care Services Research in Norway»)

  • Bakke, Toril and Hilde H. Holte: Kartlegging av nye eier- og driftsformer i omsorgssektoren basert på samvirke, brukerstyring og kooperasjon («Overview of new forms of ownership and operation in the care services sector based on interaction, user control and cooperation»)

  • Hofmann, Bjørn: Etiske utfordringer med velferdsteknologi («Ethical challenges related to welfare technology»)

In addition, researcher Ivar Brevik of the Norwegian Institute for Urban and Regional Research (NIBR) prepared an historical account of the development of various types of institutions and living arrangements used for caregiving purposes, which served as the basis for the committee’s work with future types of living arrangements (Brevik 2011).

Research fellow Eline S. Lorentzen Ingstad submitted a memorandum to the committee which was used in the committee’s discussion of social entrepreneurship.

In the phase of compilation and systematisation of knowledge, various presenters were invited to speak on relevant topics at all of the meetings held in 2010.

The committee received assistance from various departments in the Ministry of Health and Care Services and from the Research and Innovation Department in the Ministry of Trade and Industry.

A meeting was held with the chair of the technical aids committee, Arnt Holte, in which issues were discussed and boundaries for the work of the respective committees defined in relation to technical aids and welfare technology (see Norwegian Official Report 2010:5 Aktiv deltakelse, likeverd og inkludering («Active participation, equality and inclusion»).

A meeting was also held with the chair of the official committee on benefits for providers of informal care who replace municipal services, Karen Kaasa, in order to find an expedient means of coordinating and distributing the tasks related to issues of pay for family caretakers and the policy for informal care.

The committee’s chair and secretariat held meetings with various players in Scotland, Sweden and Denmark for the purpose of gathering knowledge and learning from the experience of others.

In keeping with the committee’s mandate, an open work method was employed which entailed contact and meetings with a number of companies, organisations and professional circles. The committee practiced an «open door policy», meaning that those who wished to communicate with the committee were given the opportunity to meet with the committee’s chair and secretariat. The committee’s chair held talks and presentations at several large conferences in Norway. At two of these, the committee was responsible for workshops in which the participants were invited to take part in the work on the future challenges in the care services.

In June 2010, the entire committee held a joint meeting with the members of the innovation alliance for the municipal sector under the Norwegian Association of Local and Regional Authorities (KS). During this meeting, work groups discussed the main issues set out in the committee’s mandate.

In connection with the annual InnoMed conference in 2010, professional organisations, user organisations, municipalities, companies, etc. were invited to attend a seminar where information about the committee’s activities was presented and participants were invited give their input and responses. The seminar was organised in cooperation between Innovation Norway and InnoMed.

The committee’s chair gave 48 presentations and lectures at conferences, seminars, meetings and events at the national, regional and local levels. Together with the secretariat, the committee’s chair held separate meetings with the Norwegian Association of Pensioners, the State Council of Equality for the Disabled, the Norwegian Association of Local and Regional Authorities (KS), the Confederation of Norwegian Enterprise (NHO), Innovation Norway, a number of professional organisations, associations, user organisations, municipalities, industries, companies, university colleges and professional circles. Input was also received from several organisations and enterprises.

During the committee’s work, KS administered two questionnaires to its members about the use of welfare technology and local partnership agreements with NGOs in the municipalities. Statistics Norway participated in a Nordic study of innovation in public sector activities, and the committee had the opportunity to pose questions to Norwegian municipalities.

On its own initiative, Abelia, a trade and employers’ association associated with NHO, conducted a survey of its members which provides an overview of the number of people involved in the production of services and products for the care services sector. Abelia has followed up these efforts by establishing an arena for safe care.

The committee also established a dialogue with the Data Inspectorate to achieve further clarification and obtain advice related to personal privacy and tracking technology.

1.4 To the mandate

While carrying out its activities, the committee has seen a dramatic rise in interest in the issues that are central to the committee's mandate. The committee has therefore considered it a key task to encourage this interest and to generate a common movement by bringing together different professional circles and linking care services in the municipalities to knowledge circles that understand the significance of the care services sector for value creation in society.

In the course of its activities, the committee has determined that it is especially crucial to highlight the distinctive character of the care services and to strengthen their identity and pride by giving the care services the opportunity to develop their own knowledge base. Thus, the committee is pleased that the mandate has been so clearly defined and does not open the door for addressing larger medical and health-related issues and topics. A health services and treatment dimension will always be present. The care services probably often view themselves as a «second-rate health service» when they compare themselves with the specialist health care services. The committee has therefore focused on other key aspects of the care services and touches in particular on the interaction with families and civil society. These services find their own distinctiveness in their relation to and interaction with families and local communities, which no specialist health care services can match. This is «close caregiving».

The mandate given to the committee is quite broad and addresses future-oriented topics, each of which deserves an entire report. The committee has attempted to carry out its task primarily by restricting itself to the main themes and then selecting a few issues for more thorough assessment. By the same token, the committee has chosen to pass on and communicate some of the ideas it has discovered along the way, not least in its encounter with many committed users and professionals in the sector or players in research and business that have now turned their attention towards the care services. These are ideas that need further consideration and study.

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