Official Norwegian Reports NOU 2011: 11 Chapter 1, 2 and 3 Published by: Norwegian Ministry of Health and Care Services Innovation in the Care Services Internet address: www.government.no Cover illustration: «Bakkerekord» by Kristian Finborud Printed by: Government Administration Services 08/2012 Official Norwegian Reports NOU 2011: 11 Chapter 1, 2 and 3 Innovation in the Care Services Report by the Committee appointed on 26. June 2009 Submitted to the Ministry Health and Care Services on 16. June 2011 Translation from the Norwegian. For information only. Contents 1 Appointment, mandate and 2.3.4 A national programme for activities of the committee ....... 5 municipal innovation in the 1.1 Appointment .................................. 5 care services .................................. 16 1.2 Mandate ......................................... 5 2.3.5 The care services as an industry . 17 1.3 The committee's activities ........... 7 1.4 To the mandate .............................. 9 3 Myths about care services and themes for the future ......... 20 2 Perspective and summary ....... 10 3.1 Future challenges for the 2.1 Innovation in the care services .... 10 care services ................................... 20 2.1.1 The care services sector as 3.2 Five myths about care services .... 21 a historical innovation .................. 10 3.2.1 The myth about elderly care ........ 21 2.1.2 New solutions for six future 3.2.2 Myth about the «elderly boom» .... 24 challenges ...................................... 11 3.2.3 The 25 per cent myth .................... 25 2.2 New policy ..................................... 12 3.2.4 The myth about informal care ..... 25 2.2.1 A policy that removes barriers 3.2.5 The illness myth ............................ 27 for people with reduced 3.3 Falls, loneliness and cognitive functionality ................................... 12 decline ............................................. 28 2.2.2 An active ageing policy ................. 12 3.3.1 Falls ................................................ 28 2.2.3 A modern policy for 3.3.2 Loneliness ...................................... 29 informal care ................................. 13 3.3.3 Cognitive decline ........................... 29 2.3 The committee's five proposals ... 14 3.4 Borderless care services ............... 31 2.3.1 «Close caregiving» – the second 3.4.1 Patients and users without Coordination Reform .................... 14 borders ........................................... 31 2.3.2 «Technoplan 2015» – technological 3.4.2 International labour market ......... 31 support for the care services ....... 15 3.4.3 International providers ................. 32 2.3.3 «New rooms» – future housing solutions and neighbourhoods .... 15 Reference ......................................................... 33 Official Norwegian Reports NOU 2011: 11 Chapter 1, 2 and 3 4 Innovation in the Care Services Official Norwegian Reports NOU 2011: 11 Chapter 1, 2 and 3 5 Innovation in the Care Services Chapter 1 Chapter 1 Appointment, mandate and activities of the committee 1.1 Appointment gen, Adviser at KS Konsulent, have assisted with the writing of this document. In Report No. 7 (2008-2009) to the Storting, An innovative and sustainable Norway, the Govern- ment recommended that a committee be 1.2 Mandate appointed to explore new innovative solutions for meeting future challenges in the care services. Presentation «Society is facing demanding challenges in the The committee was appointed in Council on 26 care services in the coming decades related to an June 2009 and comprised the following members: increasing number of elderly, new user groups Kåre Hagen, Oslo (chair) and a shortage of health and social services per- Siv Iren Stormo Andersson, Bjugn sonnel and volunteer care providers, cf. Report Glenn Kenneth Bruun, Oslo No. 25 (2005-2006) to the Storting, «Long-term Siri Bjørvig, Tromsø care – Future challenges, Care Plan 2015.» Annichen Hauan, Oslo The municipal care services consist of exten- Karin Høyland, Trondheim sive, round-the-clock activities that are carried out Shahzad Rana, Oslo by a small number of managers, a large number of Bente Skansgård, Oslo personnel, a high percentage of employees with- Per Gammelsæther, Fræna out professional training, many part-time workers, Tove Johanna Fagertun, Bodø a very high percentage of women and often sim- Ivar Leveraas, Oslo ple technical aids. Furthermore, care services involving daily life, meals, activities, and social Committee member Shahzad Rana took part in and cultural factors are identified in most studies the first meeting only. as among the weakest services today. There is therefore both a tremendous need and a vast The secretariat has consisted of the following potential to take innovative steps and find new members: solutions for meeting future challenges in the care Steinar Barstad, Policy Director, Ministry of services. Health and Care Services (chair of secretariat) The municipal care services have gross opera- Astri Myhrvang, Senior Adviser, from the secretar- tional expenses of roughly NOK 70 billion, divided iat for the National Council for Senior Citizens until more or less equally between about 40 000 nurs- 1 february 2010 ing home residents and some 160 000 recipients Allis Granberg, Senior Executive Officer, Ministry of home care services. Despite its size, this sector of Health and Care Services from 1 february 2010 has been the subject of very little systematic Åshild Willersrud, Strategic Adviser, Division for research and development activity. Innovation and Development of the Norwegian Consequently, there is much to be gained by Association of Local and Regional Authorities (KS) focusing attention and effort on a sector in which Espen H. Aspnes, Innovation Adviser, InnoMed a great deal can be achieved with relatively limited Geir Petterson, Adviser, Ministry of Trade and resources. The municipal care services have great Industry, has followed the committee’s activities. potential to implement innovative, creative mea- sures in relation to: In addition, Siv Svardal, Senior Adviser at the Min- – new technology in a conservative sector that istry of Health and Care Services, and Une Tan- has shown limited capacity to make use of new technical aids, new care services technology, 6 Official Norwegian Reports NOU 2011: 11 Chapter 1, 2 and 3 Chapter 1 Innovation in the Care Services Smart House solutions and new communica- based on expanded collaboration with user organ- tions technology; isations and idealistic enterprises. – new architecture in a sector that is not ade- The committee is also to assess the potential quately prepared to address the future prefer- for developing care services products through ences, demands and challenges of new user cooperation between the public and private sec- groups and new generations of elderly; tors, focusing in particular on the development of – organisational development in large enter- architecture and new technology. prises that have broad-based cooperation with Report No. 7 (2008-2009) to the Storting, An families, local communities and the specialist innovative and sustainable Norway, states: health care services and where the users should be challenged and given greater influ- «The committee must be composed in a way ence; that ensures it can view the care services sec- – research on a sector that has been the object of tor with new eyes, with representatives of the virtually no research activity and where hard- business sector and professional circles as well won research funding still comprises only a as development-oriented representatives from tiny proportion of the overall budget. the municipal sector, the care services and the users of the services.» This is some of the background for why the Gov- ernment chose to focus on the care services sec- In keeping with the mandate, the committee com- tor in its white paper on innovation policy (Report prised 11 members from the areas of business, No. 7 (2008-2009) to the Storting, An innovative technology, innovation, architecture, and health and sustainable Norway) when considering inno- and social care as well as key representatives for vation in the public sector. The white paper rec- the users. The chair of the committee has held ommended that a public committee be established positions as research director at the Institute for to address these issues and laid down some guid- Labour and Social Research (Fafo), departmental ing principles which are now more closely defined head at BI Norwegian Business School and chair and specified in the attached mandate for the com- of the programme board of the Programme for mittee. Welfare Research. He has also participated in The mandate specifies in particular that the many future-oriented research and development committee is to focus on the following: projects. – new technology There are six women and five men on the com- – architecture and new types of living arrange- mittee. ments The committee is to submit its final evaluation – user influence and skill mastery and recommendation in the first half of 2011. – research and development activity On this basis, the committee has been charged Mandate with the task of assessing new solutions and mak- On the basis of Report No. 7 (2008-2009) to the ing recommendations for the design of future Storting, An innovative and sustainable Norway, nursing homes, types of living arrangements and and in cooperation between the public and private services to ensure that these will meet the needs sectors, the