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Weaknesses in property management in health trusts and regional health authorities

In reality, the choice of development option is often made before the reports and analyses of the alternative solutions are available. Other options than the preferred one are not studied in as much detail. - The basis for decisions concerning new hospital buildings is not good enough to ensure that the best possible development options are chosen, says Auditor General Jørgen Kosmo.
Published 9/15/2011 12:05 PM

Document 3:11 (2010-2011) The Office of the Auditor General’s investigation into property management in health trusts and regional health authorities was submitted to the Storting on 15 September 2011.

Major investment projects are subject to an early-phase planning process. The guide to early-phase planning in hospital projects provides a good basis for a systematic and clear decision-making process, and the guide has been used as the basis for the planning of all the hospital developments included in this investigation. However, the investigation shows that, as a result of overriding guidelines from the board of the health trust or regional health authority, the regional health authorities and health trusts are tied to specific solutions, and their freedom to examine alternative development solutions is limited.

In several of the projects, there are weaknesses in the business economics analyses on which the preferred investment alternatives are based. In several of the developments, assumptions about factors such as savings on personnel and increased income as a result of an increase in patient treatment have been included without being sufficiently substantiated in the analyses. This results in uncertainty about whether the health trusts and regional health authorities will be able to handle the financial consequences of the investment.

The Office of the Auditor General's investigation of completed projects shows that the assumptions about gains resulting from new buildings being put into operation are often not fulfilled. This could be due to inadequate follow-up and/or support for the chosen option, as well as a lack of realism in the original estimates.

The Office of the Auditor General's investigation also shows an extensive need for the upgrading of buildings as a result of a failure to adequately prioritise maintenance. - Efficient utilisation of premises and efficient operation of buildings is challenging since some of the buildings are ill-suited for their current use, says Mr Kosmo.

Most health trusts and regional health authorities have prepared maintenance plans, and some work is under way in the health regions in relation to buildings and properties, among other things with a view to obtaining a better information and planning basis. Only half the health trusts and regional health authorities have long-term plans for their buildings, however. This entails a risk that the buildings may not be adequately adapted to new requirements and changes in the assumptions on which treatment is based.

The investigation also shows poor correspondence between maintenance plans and actual needs. Around half of the buildings show signs of being in a poor condition, and three of four health regions believe that the technical condition of a sizeable proportion of their buildings has deteriorated during the period 2003 to 2010.

The Ministry of Health and Social Care states that, until 2008, the allocations to regional health authorities only enabled them to replace and maintain approximately 60 per cent of the overall value of hospital buildings and equipment. Although a lot is new, it is not possible to repair everything at once. The health trusts and regional health authorities have extensive investment plans that will result in more modern hospital buildings being built in the time ahead.

The deferral of public access to documents prepared by or for the Office of the Auditor General in connection with Document No 3:11 (2010-2011), cf. the Act relating to the Office of the Auditor General section 18 second paragraph, is hereby set aside.

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