3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
Hospitals were advised to start reopening for elective care from 14 April.
According to the assessment of risk and responses to the COVID-19 pandemic of the Norwegian Institute of Public Health (NIPH) from the 5th of May, hospitals must be prepared for the full onset (stage 3) of the pandemic. The current situation in Norway on the whole is classified as stage 2 of the pandemic, whereas some areas of Norway are classified as stage 1. Municipalities and hospitals should continue to prepare for a pandemic situation that will last about a year and in stage 3 may have 1700-4500 patients hospitalised, with 600-1200 of them in intensive care units.
On 15 May the Directorate of Health (DoH) issued advice to the municipalities to maintain or reopen School Health Services and Maternity and Child Health Care Centres.
From 19 May dental care services could reopen if adherence to the guidelines for infection control in dental care is maintained. For patient with COVID-19 or with suspected infection, treatment should be postponed or referred to specific clinics with preparedness measures in place.
On 26 May the Parliament approved a temporary legislation amending the Health Preparedness Act. The stated aim of this Act was to ensure control of resources but meant limiting patient rights to choose hospital and to waiting time guarantees. Through the amendment, the Ministry has reinstated patient rights to be informed about whether they are eligible for elective care within 10 days of referral as well as the right to choose hospital for elective treatment. The legislation is valid until January 1, 2021 and supersedes previous restrictions, i.e. restrictions imposed by the Act on the control of communicable diseases and further restrictions introduced by the Coronavirus Act, which were valid until 27 May. Temporary suspension of patient rights is detailed in regulations valid until 1 October 2020. Currently there are no legally binding rights relating to the limitation of waiting time.
The Government has proposed to prolong the temporary legislation amending the Health Preparedness Act. The stated aim of this Act was to ensure control of resources but meant limiting patient rights to choose hospital and to waiting time guarantees. The temporary amendment is to be valid until the 1st of June 2021.
To ensure safe and sufficient access to health services a series of measures has been taken. Patients with symptoms were advised not to report at their GP office directly, but to call first. If necessary, they will be referred to a test offered in the community, outside the GP office. Follow up by the local health services has varied, with some patients being called on a daily basis, while others not receiving any follow up and calling emergency services after becoming severely ill and needing acute hospitalization. People in long-term care nursing homes were advised to be treated there and avoid being admitted to hospitals.
If hospitalization is considered necessary patients should as far as this is possible receive treatment at their local hospital. People requiring more specialist care should be referred to the appropriate level of care. A process of so-called reverse triage started on initiated 12 March. Elective care (in- and outpatient) has been reduced to an absolute minimum:
- only necessary treatment, including acute and emergency care, treatment for cancer or other conditions for which it is not considered advisable to postpone treatment, can be offered;
- elective treatment involving respiratory equipment or treatment that might require intensive care should be reconsidered and only performed if necessary;
- all cancer screenings has been postponed;
- access to intensive care must be planned locally.
Patients’ right to choose hospital has been suspended from 27 March until 27 May, with the exemption of psychiatric care, substance abuse as well as intensive rehabilitation care for children and patients already undergoing treatment in private hospitals.