11 Health services and other services

11 Health services and other services

11.1 Health services

11.1.1 Introduction

The Mining Code for Spitsbergen (Svalbard) laid down by Royal Decree of 7 August 1925 and special regulations laid down pursuant to section 4 of the Svalbard Act have formed the basis for the establishment of health service facilities for the Svalbard population. The health legislation on the mainland has not been applied to Svalbard because it is not suitable for the special conditions prevailing on the archipelago.

The Mining Code places employers under a general obligation to provide for assistance in the event of illness. Other special regulations lay down supplementary provisions concerning health ser-vice facilities on Svalbard, while also regulating the relationship between the Mining Code and other regulations governing health service facilities.

In Report No. 39 (1974-75) concerning Svalbard, the Government proposed that the state should take over and organize the health services on Svalbard, replacing the services that had been the responsibility of Store Norske Spitsbergen Kulkompani AS (Store Norske). With effect from 1 January 1981, the central government administration assumed responsibility for running the hospital in Longyearbyen and its ancillary functions, in return for which Store Norske and its employees were to pay national insurance contributions along the same lines as other employers and employees. The Russian settlements at Barentsburg and Pyramiden were however to continue to have their own health services in accordance with the provisions of the Mining Code. In Report No. 40 (1985-86) to the Storting concerning Svalbard, it was established that Longyearbyen Hospital was primarily intended to serve as an emergency facility, with most of the treatment concentrated on emergency surgery. The qualifications required of its staff were determined in the light of this objective.

Due to changed health service needs and improved transport and communication possibilities with the Tromsø Regional Hospital, it was decided in 1998 to reorganize Longyearbyen Hospital. This has entailed a lowering of the level of surgical emergency preparedness in favour of increased general medical facilities and more attention to preventive medicine, especially for children and families. The main reason for this change in organization was the growing demand for general practice and other services following from the development of Longyearbyen into a family community whose needs are increasingly related to children and adolescents, including a need for mother and child clinics. There has also been a considerable reduction in the frequency of accidents in the Norwegian mines.

11.1.2 Current health service facilities

The overriding objective of Longyearbyen Hospital is to provide satisfactory health services to the Norwegian population on Svalbard and to all others travelling on the archipelago. The hospital provides primary and secondary services, i.e. services corresponding to those provided by a health centre on the mainland, as well as being prepared for accidents and emergencies. The services available comprise medical, nursing, mother and child clinic, school health, physiotherapy, occupational health and dental health services. However, in the event of major accidents in connection with mining or other industrial activity, air traffic, and traffic on the archipelago and in the waters around Svalbard, assistance must be summoned from the mainland.

According to its annual report for 1998, Longyearbyen Hospital undertook 4 074 out-patient consultations in 1998, and had waiting periods of two to three weeks. In comparison, there were 3 644 out-patient consultations in 1995. The hospital reports a steady increase in the number of patients in recent years, but this is believed to have peaked, so that the increase is now expected to level out. The number of out-patient consultations is high in proportion to the population. The hospital believes that this is due to the easy access to the hospital and availability of medical services, but also to the increasing tourist traffic. The number of ante-natal check-ups, examinations of babies and small children, and school consultations has risen. This is thought to be connected with the establishment of a full-time post for a midwife/public health nurse.

The central government meets the costs of medical assistance given on Svalbard to patients who are covered by the National Insurance Act and entitled to medical benefits and sickness allowances. The health services in Longyearbyen are funded directly by the central government or by the patient's home municipality on the mainland. If a patient who is covered by national insurance is sent to the mainland for treatment, the responsibility for meeting the need for necessary health ser-vices on his or her arrival are regulated by the Act relating to municipal health services and the Hospitals Act.

In 1993, a Super Puma rescue helicopter was stationed on Svalbard. Under the terms of their emergency preparedness scheme, hospital personnel also man the helicopter on rescue and ambulance missions.

The Social Services Act has not been made applicable to Svalbard. This means that residents on Svalbard whose situation prevents them from earning a living or caring for themselves are not entitled to financial support or social services on Svalbard. In principle, persons in need of assistance under the Social Services Act must move back to the mainland and apply to their municipality of residence for financial assistance or social ser-vices.

Although the National Insurance Act does not apply to Svalbard, it affects people there in that they retain their national insurance membership during their stay provided they were members prior to arrival or are taking up employment with a Norwegian employer on Svalbard. National insurance membership means that one earns benefit entitlements and receives national insurance benefits to the same extent as on the mainland. To improve services to national insurance members, a national insurance office was opened in Longyearbyen in 1980.

The Russian settlement at Barentsburg has its own health service, which is self-financed pursuant to the provisions of the Mining Code.

11.1.3 The development of health services

In the Government's view, the various needs and conditions on the archipelago must be weighed against each other when providing Svalbard with suitably adapted health and social services.

Although Longyearbyen has become increasingly like the mainland, the local community differs from those on the mainland not only geographically and climatically but also in the composition of the population. In view of the population mix and the short average periods of residence, future health and social service needs are difficult to estimate. The establishment of local bodies to administer and provide the same level of health and social services as on the mainland will moreover entail substantial costs. The Government therefore does not recommend the further expansion of facilities, but presupposes that such needs will continue to be met by the mainland municipality to which each individual is connected.

The Government considers the present scale of the health service to be appropriate to the population in terms of the latter's size and composition, and considers it to be well organized. Longyearbyen is well provided with doctors in relation to the size and composition by age of its population, is well supplied with qualified health personnel, and has short waiting periods for appointments. However, the special situation of the hospital as an emergency preparedness hospital for the treatment of acute cases calls for a higher staffing level than on the mainland. Cooperation with Tromsø Regional Hospital is good, and further cooperation, for instance in surgery, is under discussion. The question of making Longyearbyen Hospital part of Tromsø Regional Hospital does not arise, owing to the unique character of Longyearbyen Hospital, where the emphasis on general health services makes closeness to the population important. There has been some discussion locally of whether the changes the hospital underwent in 1998 were to the purpose. An evaluation will accordingly be carried out by an independent body, during which the population at large as well as particular groups will be asked for their views. The relevant alternatives will be either to keep up the present duty roster and preparedness level, with a staff of two general practitioners and one surgeon, or to revert to an earlier scheme in which the main emphasis was on surgical preparedness.

Where facilities at Svea and Ny-Ålesund are concerned, the Government sees no obvious need to set up special health services at these settlements. It is assumed that the need for health ser-vices at Svea and Ny-Ålesund can be met by Longyearbyen Hospital. The owners and those responsible for the infrastructure at the places in question must, however, ensure that there is sufficient medical first-aid preparedness. It is assumed that the foreign settlements will continue as before to organize and finance their own health service facilities in accordance with the Mining Code.

According to the Governor of Svalbard and the Ministry of Health and Social Affairs, the current regulations governing health services are not well adapted to the present local community. In connection with the adoption of new health legislation for the mainland, the Government will consider whether these statutes ought in part to be made applicable to Svalbard, and will undertake a review of the regulations currently in force relating to the health services on Svalbard.

Food and drinking water are regulated by the Regulations of 1928 relating to physicians and health conditions on Svalbard. Little has been done to update the Regulations scientifically, and they contain few guidelines concerning necessary hy-gienic measures or principles to be observed by industry or by supervisory authorities. The Government has initiated a review of the rules so that they can be updated.

11.2 Housing in Longyearbyen

11.2.1 The present system

Ownership of dwellings in Longyearbyen differs considerably from the structure on the mainland. The largest owners of housing are Svalbard Samfunnsdrift AS, Store Norskes Boligstiftelse (Store Norskes housing foundation), and the state. Over the years, housing construction has generally speaking been financed through the fiscal budget. Only 10 per cent of the dwellings are privately owned, mainly by enterprises.

With few exceptions, the provision of housing in Longyearbyen is connected with employment, with the employer owning the dwelling. Dwellings are allocated by employers according to several criteria relating to length of service, need, and position held. In principle, and with very few exceptions, dwellings have not been let to persons without regular employment in Longyearbyen.

The central government authorities have subsidized housing by supporting the development and operation of infrastructure. In addition, the bulk of the investment and operating costs have been met by the state either directly or through state-owned companies. Employees of Svalbard Samfunnsdrift, Store Norske and the state have had their rents subsidized.

In 1997 the residential properties belonging to Store Norske were transferred to a foundation, Store Norskes Boligstiftelse. For the employees of Svalbard Samfunnsdrift and Store Norske, the terms of leases were changed in 1998 so as to introduce the payment of rent. The rents were to meet the costs of managing and running the housing. In addition, residents pay for electricity, district heating, maintenance, supplementary furnishings and fittings, and white goods. Capital backing has been introduced to a modest extent. When rents began being charged, employees of Svalbard Samfunnsdrift and Store Norske negotiated compensatory wage increases. The pay rises applied to all employees, whether they actually incurred rental expenses or not. In addition, the employees were allowed to buy the furniture and fittings in the dwellings at reasonable prices.

The state housing is managed by the Director-ate of Public Construction and Property. The dwellings are at the disposal of a total of sixteen employers. The allocation of dwellings is left to each service, for which a certain number of apartments are earmarked. The criteria for allocations vary from service to service. Most allocate housing according to need, but others apply length of residence in Longyearbyen as an important criterion. State employees pay no rent, but are taxed on the benefit of living in free housing.

The private companies own or rent a certain number of dwellings for rent to their own employees. The rents vary, but are usually subsidized by the employers.

Most enterprises in Longyearbyen regard housing as an important incentive when recruiting key personnel. But the present housing arrangements have led to a distribution of housing which is in some cases regarded as unfair, with some large apartments occupied by single people and small ones occupied by families. It has also been claimed that there are not enough family dwellings. The links between dwellings and employment have moreover caused difficulties for some residents who changed jobs locally, or for family members when there are changes in family status.

11.2.2 Housing administration in the future

The Government will not provide for any further privatization of housing in Longyearbyen. Investment in housing in Longyearbyen entails a high degree of financial risk. Relatively small changes in the local business sector or the existing steering parameters can quickly lead to large changes in the housing market. There is therefore little basis for a private housing market in Longyearbyen. A greater number of privately owned homes could also in the longer run mean the establishment of a cradle-to-grave community in Longyearbyen, an undesirable development in the Government's view, cf. section 14.5.1 Community development in Longyearbyen. The arrangement must accordingly be retained whereby most people's housing is linked to their employment.

The Government wishes to see a just distribution of housing in Longyearbyen which at the same time permits more efficient utilization of central government resources. Where dwellings at the disposal of central government services are concerned, the Government will examine the possibility of coordinated allocations. The assignment could be given to the Directorate of Public Construction and Property. This would make it possible to relieve the heads of the various services of the responsibility for allocating and reallocating housing, which has proved difficult in practice. Housing would be allocated to central government emloyees according to need and irrespective of which service they were employed by. The Directorate would be empowered to require lessees to move to other housing if their needs changed.

The introduction of rents for central government housing will also be considered. Free housing has traditionally been linked to fixed-term contracts. Usually, central government personnel spend a few years on Svalbard, during which time they need to keep their mainland dwellings. Free housing has accordingly been a strong incentive for the recruitment of qualified personnel to central government posts on Svalbard. On the other hand, it seems clear that the introduction of housing rents on Svalbard would improve the distribution of dwellings between families and single persons. Initially, therefore, the Government will consider introducing the payment of rents by the respective central government services in Longyearbyen. Whether or not central government employees should be instructed to pay rents at a later date will depend on an overall assessment of the considerations on which the arrangements have been based, and of the question of financial compensation.

The specific conditions under which the Longyearbyen Community Council will administer the housing for which it assumes responsibility when it takes over Svalbard Samfunnsdrift AS will be considered in connection with the transfer of the company to Longyearbyen Community Council, cf. 14.5.2 The introduction of local democracy in Longyearbyen.

Should the Directorate of Public Construction and Property, the state-owned enterprises and as the case may be the Longyearbyen Council have surplus housing available, they will be able to let it to others.

The supply of family housing is expected to improve in the relatively near future. The newly-appointed mining company employees appear to number more single persons than before. The drop in the number of Store Norske employees will also release more family housing.

This arrangement will not solve the problems that arise when family situations change and spouses are not in employment which confers a housing entitlement. Such situations are relatively rare, and solutions need to be found in each particular case. This has so far been successful. The Government believes that flexibility should continue to be the policy in this connection.

11.3 Facilities for children and young people

11.3.1 Daycare facilities

There are at present three daycare facilities in Longyearbyen. In January 1999, 125 children under school age were registered in Longyearbyen.

Two of these daycare institutions are owned and run by Svalbard Samfunnsdrift AS. The first one was opened by the women's institute (subsequently the Women's Association) in 1964, but was taken over by Svalbard Samfunnsdrift AS in 1989. It offers places to 43 children aged 1 to 5. The second daycare institution was established in 1996 and provides daycare for 36 children aged 1 to 5. In addition to these, a family-based daycare facility was established in 1996. It comprises four homes and has facilities for 14 children aged 0 to 3. The homes receive educational guidance from a preschool teacher employed by Svalbard Samfunnsdrift AS.

The Daycare Institutions Act has not been made applicable to Svalbard. Operation of the daycare institutions on Svalbard is currently regulated through the conditions imposed by the Ministry of Children and Family Affairs when allocating operating grants to the daycare institutions on Svalbard. Where appropriate, these conditions are based on the requirements in the Daycare Institutions Act. The conditions for operating grants include educationally qualified staff, priority for disabled children, etc. Inspections and supervision of the daycare institutions in Longyearbyen are carried out by the Governor and other relevant authorities by agreement with the Ministry of Child-ren and Family Affairs. In addition, the Governor exercises control through the annual report forms, pays the grants to each daycare institution, and forwards applications for grants from the daycare institutions to the Ministry of Children and Family Affairs. For 1999, the central government operating grants to the daycare institutions in Longyearbyen will amount to about NOK 2.1 million.

As the highest supervisory authority for the country's daycare institutions, the Ministry of Child-ren and Family Affairs has every confidence in the present management of the daycare institutions on Svalbard. The Government nevertheless believes that the administration of daycare institutions on Svalbard ought to be formalized. The administrative work connected with the management of daycare institutions in Longyearbyen is a task which it would be natural to transfer from the Governor to the Longyearbyen Community Council.

In the autumn of 1999, for the first time since 1994, Trust Arktikugol has allowed employees to bring children to Barentsburg. In this connection a new daycare institution is being built. There are no children who need such facilities in the other settlements.

11.3.2 Youth club

The Longyearbyen youth club was founded in 1974. Since 1994 it has been owned and run by Svalbard Samfunnsdrift AS. It is open about 20 hours a week, and has a full-time staff of two, plus six extra staff/stand-ins. In 1998, 2 702 visitors to the club were registered. Its main activities are alcohol- and drug-free music and discotheque evenings, but various courses and craft activities are also offered.