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The Office of the Auditor General’s investigation into follow-up and quality in private institutions in interdisciplinary specialist treatment for drug addicts and alcoholics

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Summary

Background and goals of the investigation

The regional health authorities were assigned responsibility for interdisciplinary specialist treatment for drug addicts and alcoholics (IST) through the reform of treatment for drug addicts and alcoholics that entered into force on 1 January 2004. The Storting’s primary goal for this reform is for drug addicts and alcoholics with complex problems to receive good services and for treatment results to improve. In 2008, the regional health authorities allocated approximately NOK 927 million for the purchase of IST services from private institutions. A total of 931 private in-patient places were purchased from private institutions with contracts. In 2008, the regional health authorities had signed contracts with 35 private institutions in IST, which accounted for 58.3 per cent of the total treatment capacity. The Government’s action plan for combating drug addiction and alcoholism 2003-2005 points out that it is problematic that the public authorities’ purchase of treatment places does not ensure adequate quality of treatment.

The purpose of the Office of the Auditor General’s investigation is to establish whether the Ministry of Health and Care Services and the regional health authorities have established an expedient system for follow-up of the IST services provided in private institutions, and to evaluate whether the private IST institutions meet the quality requirements relating to internal control and individual plans.

Method

The lines of inquiry in the investigation were pursued through interviews, questionnaire surveys, case file reviews and document analysis.

Results

The investigation shows that there are no national guidelines or other guides that provide the regional health authorities with information about how IST services should be designed. The Ministry has stated that guidelines and guides will not be available for all areas of IST until 2015.

The investigation also shows that the design of IST services is only to a limited extent based on documented knowledge about the need for such services. This could result in the treatment services that are established not being the most expedient ones. Since IST was established in 2004, the Ministry of Health and Care Services has initiated measures to improve management information, but this work has taken a long time. In 2006, a system was introduced for the reporting of waiting lists to the Norwegian Patient Register (NPR), and with effect from 2009 all IST institutions are expected to report activity data to NPR. The investigation also shows that the regional health authorities do not carry out systematic reviews of individual institutions’ quality systems. Moreover, the investigation shows that there are shortcomings in internal control systems in several institutions, and that some institutions do not check compliance with their own systems. The investigation also reveals that a high percentage of patients admitted to institutions had not had an individual plan prepared for them, despite their wish for such a plan. Information from the regional health authorities shows that between 69 and 79 per cent of patients admitted to private institutions had not had individual plans prepared for them. In addition, the review of individual plans identified a number of shortcomings in relation to the requirements stipulated by the regulations relating to individual plans. Examples include cases where patients’ goals, resources and service needs have not been documented in the plans, and cases where information is lacking about the planning of and preparations for the discharge of patients. The investigation also shows that the institutions experience problems in their cooperation with municipalities on the planning of aftercare. The investigation indicates that there are problems because individual plans as a tool for achieving better cooperation is not an integrated, functioning system in the municipalities.

Ministry/ministries:

Riksrevisjonen, Storgata 16, P.O. Box 8130 Dep, 0032 Oslo, Norway

Phone: +47 22 24 10 00

Org.nr: 974 760 843