National services have been established to ensure a coherent approach to prioritisation, rational use of resources at national level, and equitable access to expertise and highly specialised, high-quality treatment for patients.

National and multi-regional treatment services

National and multi-regional treatment services provide assessment and treatment, primarily for a small group of patients who require highly specialised expertise or the use of specialised medical equipment.

A national treatment service must be established at only one health trust in the country. A multi-regional treatment service is a single service located at two health trusts in two different health regions.

National treatment services in the specialist health service must be equally accessible regardless of where the patient lives in the country.

National centres of competence

National centres of competence shall ensure national competence-building and dissemination of expertise within their specified field to a defined target group in the health service.

The purpose is to ensure equitable access to competence-building so that service providers throughout the country can make use of the expertise.

National centres of competence shall not provide patient treatment. A national centre of competence may have either the function of training with a duration of five years, or the function of competence-building with a duration of ten years.

The governance system for national services

The governance system for national services has been established to follow up the establishment, operation and discontinuation of national services. Service provision within the specialist health service is constantly changing, due in part to medical and technological developments.

The governance system for national services must therefore be dynamic and ensure national services in areas where this is considered professionally necessary in order to ensure patients equitable access to specialised, high-quality patient treatment.

The Ministry of Health and Care Services makes decisions on the establishment of, or changes to/discontinuation of, national services following applications from the Regional Health Authorities. The Norwegian Directorate of Health is the ministry’s professional advisory body.

Guidance for national services

National services are regulated by a separate regulation pursuant to the Specialist Health Services Act. The regulatory framework provides for the establishment, amendment and discontinuation of national services, and sets requirements for the tasks and reporting of the national services.

The Ministry has prepared guidance concerning the provisions in Chapter 4 of Regulation No. 1706 of 17 December 2010 on the approval of hospitals, use of the designation “university hospital”, and national services in the specialist health service.

The guidance was published in December 2023 and replaces previously issued guidance documents.

Updated edition in 2023

The guidance issued in December 2023 has been updated because the Ministry of Health and Care Services has repealed the regulation that delegated authority to the Norwegian Directorate of Health to approve national services.

The Ministry of Health and Care Services have approved national services since 2024. In addition, the regional health authorities will take over the task previously carried out by the Norwegian Directorate of Health of assessing the annual reports of the national services.

Since 2021, the regional health authorities have strengthened their responsibility for the establishment and operation of national services by establishing the Regional health authorities' support unit for national services, networks and centres.

The support unit also provides support to national centres of competence which, upon expiry of their period of operation, are reorganised as a national quality and competence network or centre.

The guidance provides supplementary comments on the provisions of the regulation and is aimed at those responsible for operating and following up national services in the specialist health service, and those who will use the regulation.

This includes the Norwegian Directorate of Health, the regional health authorities, health trusts and the national services. The guidance also contains an overview of roles and responsibilities in the governance of national services.

Overview of national services

You can find an overview of national services in the specialist health service on the Norwegian Directorate of Health’s website (helsedirektoratet.no, in Norwegian).

Each service prepares annual reports available at the website of the national services (nasjonaletjenester.no, in Norwegian). 

For further information on application processes, operation, reporting, etc., please refer to the regional health authorities’ support unit for national services, networks and centres (helse-vest.no, in Norwegian).

Background – five-year comprehensive review of national services

The Ministry of Health and Care Services assigned the regional health authorities and the Norwegian Directorate of Health to evaluate national treatment services in 2017 and national centres of competence in 2018, in line with the guidance’s requirements for a comprehensive review.

On the basis of the review of national centres of competence, the Ministry of Health and Care Services identified a need to introduce changes to ensure a more dynamic system in line with the intention.

The process of implementing the changes has taken several years and has been described in the annual budget proposals from 2021 (chapter 732, item 78).