Report of the audit of the Qualification Programme in the NAV NAV Søgne 2014 – Board of Health

Summary

1 Introduction

2 Business description – special conditions

3 Implementation

4 What audit included

5 Findings

6 Assessment of business management

7 Regulations

8 Document Substrates

9 Participants at the audit

This report describes the deviation and remarks were pointed out in the audited areas. System audit covered the following areas:

About the municipality ensures the proper allocation of the qualification program.

About the municipality ensures the proper execution of the qualification program.

was found two discrepancies in the audit:

1. Søgne municipality does not ensure proper allocation of qualification

 

2. Søgne municipality does not ensure a proper implementation of the qualification program

Date: 07/05/2014

Trond Sælør
audit manager

Birthe Guttormsen
auditor

report was prepared by system audit at NAV Parish / Søgne municipality in the period 16.01.2014 – 07.05.2014. The audit is part of the County Department planned audit activities in the current year and is part of a nationwide inspection, conducted on behalf of the State Board of Health.

Governor is authorized to supervise the NAV by the Social Services NAV § 9

purpose of system audit is to assess whether the business caters to different requirements of the legislation through its internal controls. The audit included examination of:

• which measures business has to identify, correct and prevent violations of the legislation on the subject audit includes

 

• measures implemented in practice it if necessary

 

• measures are sufficient to ensure that the legislation complied

A system audit carried out by scrutiny of documents, the interviews and other research.

report discusses discrepancies and Notices are identified during the audit and therefore provides no complete condition assessment of the work within the areas covered audit.

• Deviation is a lack of compliance with the requirements laid down in or pursuant to law or regulation

 

• Comments conditions which do not conflict with the requirements laid down in or pursuant to statute or regulation, but where the regulatory authority finds reason to point out the possibility of improvement

in the parish is approx. 10,000 inhabitants. NAV Søgne is organized as a “unity of social services Nav” under municipal chief of Health and Human Services. NAV office has a minimum solution and there is a clear distinction between municipal and state functions. Social service consists of 4.1 job legal basis for follow-up and 0.5 mercantile position relating to reception. All the monitoring department works with KVP in addition to other tasks NAV. There are different ways in which long experience as senior KVP has and how many cases the individual has experience with. There is a person in the follow-up, which has overall responsibility for KVP work at the office.

System audit covered the following activities:

Revision term was sent 16/01/2014. List of documents the company has submitted in connection with the audit is given in chapter Document Surface.

Pre-meeting was held on 21.02.2014. The meeting was conducted only with the contact person for the audit.

Opening Meeting was held 02.27.2014.

Interviews

6 people were interviewed.

Overview of documentation that was reviewed during the audit visit is given in chapter Document Surface.

were conducted inspection at the office in connection with the conduct of the audit.

Final Meeting was held 28.02.2014

were audited on Søgne municipality / NAV Søgne ensure proper allocation and implementation of the qualification program. Within the theme proper allocation audit examined further whether the municipality ensures availability of the service, proper identification processes, proper information about the right qualification program and whether the municipality ensures the proper mapping, assessment and decision making when awarding the qualification program. Within the proper conduct audit examined further whether deadlines for implementation of the program were met and whether the content and scope of services is appropriate and in accordance with law and regulation.

deviation:

1 Søgne municipality does not ensure proper allocation of qualification.

2 Søgne municipality does not ensure proper completion of the qualification program.

Deviations from the following statutory requirements:

Social Services Act NAV § 30 (qualification program content) Act on Social Services in NAV § 4 (requirement to soundness)

Social Services Act NAV § 5 (internal)

regulation on internal control for the municipality in NAV § § 4 and 5 Regulations on qualification program – and transfers § 1

1 Søgne municipality does not ensure proper allocation of qualification.

deviation based on the following:

• Upon review of five cases was the employability assessment in only two of cases.

 

• In the interviews was voiced that the self-assessment form is known, but there is no evidence in the cases showing that the forms used.

 

• There are no written procedures describing the supervisor to do, before they are granted KVP.

 

• There is no established structure, through meetings, events and written procedures, which captures the possible KVP participants.

 

• Through the interviews it emerges a need for education about KVP.

 

• cases contain little written documentation. Employees expressed a demanding work situation where they are not prepared the plans and notes required.

 
• municipality has a system of discrepancy reports. Alarm is not known and in use by the employees.

 
• When granting KVP is not written down what the basis of assessments, and how the user is ensured.

2 Søgne municipality does not ensure proper completion of the qualification program.

deviation based on the following:

• In the five cases that were reviewed, it appears no written note that underpin user participation in the preparation of the program.

 

• In three of five cases received KVP benefit without there being a program.

 

• missing stop decision / leave decisions when the participant has disappeared from the program.

 

• reduction in KVP performance by absence, be done by sending notice to the participant via SMS about the reduction in funding.

 

• missing fixed evaluation point in the program.

 

• It is not possible to determine whether the requirement of 37.5 hours is met, then there are no plans or notes in the cases. One can not plans or notes, see the work of KVP is in line with the requirement of work-related activity, job seeking and other measures that support and prepare the transition to work.

 
• There is no routine to issue a certificate of participation at the project’s end.

 

• Through interviews will be conveyed that where there are steps organizer, but where follow-up is added to the supervisor, are not made in accordance with the law. There is no capacity for close individual attention from the tutor.

 
• interviews confirms that where there used measures promoters, it is known that the NAV is responsible for follow up action. There are no written procedures describing the scope and nature of touch with measures organizer.

 
• There is no mapping of competencies and skills plan that describes measures to increase / maintain expertise for those who work with KVP.

 

• There are no established procedures for reporting work with KVP in content and scope. Reporting to the employer consists in financial reporting.

From 1.1.2010 was introduced duty of the municipality to establish internal controls in areas covered by the Social NAV. The requirement for internal means that municipal management is responsible for ensuring compliance with social legislation through systematic management and continuous improvement. In this audit, it exposed shortcomings in this area, failures that have led to legal requirements related to KVP is not adhered to.

municipality is responsible for the operations are arranged so that the implementation of KVP program followed up on properly. KVP is a one-off performance that can be up to two and a half years. It is therefore essential that the program has sufficient content throughout the period for achieving the goal of work and activity. It is a requirement that NAV can provide a close and coordinated follow-up.

According to the regulations the agency shall ensure that employees have sufficient knowledge and skills in the relevant field. Lack of training is especially vulnerable when the organization reorganized and staff to new matters, new ways of working and new technologies. Systematic work with training and skills are required in all levels of the organization, to ensure that the services are reasonable. NAV must have a system to evaluate, control and adjust their practices so as to safeguard the individual’s rights in accordance with law and regulation.

Social Services Act NAV of 18.12.2009 No. 131

regulation on internal control for the municipality of Labour and Welfare Administration Regulations on qualification program and qualification benefits

Administration Act of 10.02.1967

Regulations for Administration of 15.12.2006 No. 1456

organization’s own documentation relating to the daily operations and other significant matters that were submitted during the preparation of the audit:

documentation that was submitted before the County Authority:

• New organization chart

 

• List of employees working with the theme of Authority

 

• Routine Descriptions on case flow when it comes KVP

 

• Procedures related to KVP, such as mapping, needs assessment, delegation of subject matter

 

• five decisions where KVP is granted and 5 cases of refusal.

Documentation was reviewed prior to the audit visit:

• It was on 21 February undergone five dossiers on Nav Søgne. With assistance from employees of the NAV Søgne the case was pending in the various computer systems. This is to form the best possible impression of the job done with the qualification program.

 
• Survey in reception / Nav center

Correspondence between the business and the County:

• Notification Authority, dated 16.01.2014

 

• response from the municipality of contact

 

• Agreement on time for review of cases at NAV office

 

• Agenda for supervising day

 

• Sent preliminary report for comment 3/25/2014

The table below provides an overview of the participants at the opening meeting and final meeting, and of the persons interviewed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Participants at the audit

Name	Function / position	Opening Meeting	Interview	Final Meeting
Gustav Skretting	Local authority	X	X	X
Helge Andresen	Deputy Mayor	X
Grete E Hansen	Supervisor	X		X
Anette Berg	Supervisor	X	X	X
Lita Seland	Supervisor	X		X
Kristin H Streaming	supervisor / contact	X	X	X
Per Pedersen R	Supervisor reception	X		X
May Elin Salvesen	Supervisor	X	X	X
Ellen Marie Glad	Supervisor	X	X	X
Ann Torhild Mller		X		X
Kirsten Aaraas	receiving social	X	X	X
Elin Kristensen	auditor	X		X
Birthe Guttormsen	auditor	X		X
Trond Sælør	Audit Director	X		X

From supervisors attended:
Birthe Guttormsen, accountant
Elin Kristensen, accountant
Trond Sælør, audit manager

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Municipalities can end up with bus bill – Smaalenes Journal

It is a joint effort between Østfold county totaling NOK 2.5 million that could save the express bus. The county takes half the bill, the rest divided between Indre Østfold municipalities.

County Mayor Ole Haabeth (AP) register for a mayor meeting yesterday that municipalities Askim, Eidsberg, Hobøl and Spydeberg is on the slide, while the other is more lukewarm.

Splicing team will make it possible to maintain commuter services both morning and evening.

According Eidsberg Mayor Erik Unaas gives the region respite to devise alternative solutions, if they say yes.

idea is also that the county is considering announcing the route of a new competitive tender, while the work is being done to process potential actors that can conceivable route.

Askim takes the lion’s share?

At yesterday’s meeting was presented a memo showing that 60 percent of passengers get on or off in Askim, 15 percent Eidsberg, 15 percent Spydeberg and 10 percent in Hobøl.

This fraction can be one of the ways when the four municipalities to allocate their share of the splice at 1250000 local currency, although this would mean that Askim risk a bill of more than 700,000 kroner alone.

Local Politicians decide

Askim mayor Thor Hals (H) will not anticipate what local politicians agree on.

– First we must clarify the principle in each municipality if it is a municipal task to fund the bus. If the answer is yes, then we can certainly negotiate us forward to a mutually agreed solution in Indre Østfold, he said.

Should the bill apportioned by population in the region, this will more than halve the proportion of Askim.

Neck adding that the figures showing who is the region’s bus capital with 2,500 passengers annually, but many believe trøgstinger and spoon forces obviously traveling through Askim and consequently should help.

agreement is now the Indre Østfold municipalities will decide each one to the question of splicing.

• Facts
• Nettbuss has decided to close down express service between Mysen and Oslo.
• closure occurs from midsummer.
• commuters departures runs virtually with full buses.

Main Library in Bjørvika delayed by 19 months – Osloby

building should be finished in September 2016, but the new completion is expected to occur during the first half of 2018.

They were Only one offer because the work and erecting, which was laid out as a single tender. All they got was considerably above the municipality had budgeted for. Probably would not market large and complex work and execution time the municipality had planned was too short, according to an evaluation municipality has done in retrospect. Thus, the project is split up and sent out to tender into smaller parts.

Even with the delay municipality expects that they will remain within the financial envelope of nearly 2.6 billion, according to a memo from Commissioner Department for culture and industry. They still considering whether to cut the project.

– Have enough in reserve

Project Manager Vibeke Johnsen did not want to comment on the matter Wednesday night, but referred instead to the Communication Manager Haakon Berg Jensen.

– When you choose this form of contracts, it will always be so that you never get the right amount on the table before the project starts. There will always be some uncertainty related to the final sum. Then one must consider the cost, if you see that the project exceeds that which is the limit of the City Council, says Jensen.

– If you have enough in reserve to withstand a delay of 19 months

– How we assess the situation as. today it is the case, yes.

– Where will you possibly cut costs in such a project?

– I do not wish to comment now. Today it is not appropriate to make such drastic measures. But of course we have seen where the opportunities lie, unless I want to comment on it.

– In retrospect, their own evaluation demonstrated that the tender was too big and that it was not set enough time to carry out the groundwork. Have you done a poor preparation

– We have a project that controls what goes on technical advice. We rely on the information we get from there. It was the information we had then, this is the information we have now, says Jensen. It is pr. date not appropriate to ask for more money from the city council, he explains.

– Amazing sin

Culture and Education Committee was informed of the delay in a letter Wednesday night.

– This is first and foremost incredibly sorry for anyone who has looked forward to the new main library, and there are many people, says Andreas Halse (Ap), Deputy Chairman of the Culture and Education Committee.

– Is it done a poor preparation

– It amazes me that the pilot project showed something completely different than what we see now. There are huge amounts of money and important things we are talking about here, so we should take the time to sit properly into the case until we have very strong opinions one way or the other, says Halse.

– Could it be possible to inject more money into the project?

– It’s one of the things we need to discuss. When I asked the committee today I got the impression that this is not just about money, but what practical manage to get to the assumptions. We must dig more in. If it is such that it is possible to get the library ready earlier if we put more money on the table, we will consider it.

– Where to cut costs of a building that been drawn and designed

– I’m very excited. It will be incredible shame and a huge mistake if we end up cutting the important interior which will help to make the service good, because we are going to build an expensive building. It is primarily the content that will be essential for this library.

Osloby coming back for more.

Published: May 14. 2014 8:08 p.m.

Highway to Os exposed again – Bergens Tidende

When the National Transportation was presented in the spring of 2013, most people thought that a parliamentary decision on E39 Svegatjørn-Rådal was just around the corner.

– Finally we are there. Now it boot for winter, cheered Os mayor Soviknes to BT.

NTP stated that the government aimed to put a bompengesak presented to Parliament in autumn 2013. It never happened. New people took office and decided to defer the matter. Now it turns out that Transport Minister Ketil Solvik Olsen also not able to present our case. It is clear from a note Bergens Tidende has accessed the Norwegian Public Roads Administration. It says that the case will first make a decision in Parliament at the end of the year.

– This government has made a name for rising action force and ability. I am disappointed that this matter does not come, says Magne Rommetveit (AP), a member of the transport committee in Parliament.

– examined and investigated

stortingstingsvetak the fall means that a first come started bidding process winter 2015, while the spade probably can be put in the earth after the summer holidays.

BT was last in contact with Os-mayor Soviknes and State Secretary Bard Hoksrud the Ministry of Transport. None of them had any answers when the toll bill will be presented in Parliament. Hoksrud showed that for a couple of months ago had come to new figures on the table that had made the project more expensive which again had complicated the process.

in costs Hoksrud points caused by the BT experience not the project has become more expensive but the government has seen new financing methods. Among other things, the government is working on a new interest compensation for new bomprosjekter. There have also been calls to have prevented it set up tolls on existing roads in the five years Peripherique built, such as the existing plan advocates.

leads to the plans now one years delayed compared with the previous government’s plans.

– The bourgeois parties believed the previous government only studied and investigated. The fact is we who have investigated this matter fully. I call well they could set in motion, says Rommetveit.

Opening in 2021

As a result of the many delays will there be requirements for new quality assurance cost estimate and financing plan because it is delivered will be over one year old when the bill is presented.

According to the note from the Norwegian Public Roads Administration will construction start will be after the summer holidays in 2015, while there will be opening in 2021.

– I can not understand that there must be some uncertainty about this. If one should arrive at something more affordable financing solutions along the way, so one can take it as it comes. It’s been a long road to the is completed, says Rommetveit.

E39 Svegatjørn-Rådal the planned highway between Os and Bergen. The development started at Svegatjørn Os and continues to Rådalen in Bergen. The road will be 16.3 km long and is kostnadsbereknet 6.2 billion (2012), of which approximately 2.6 billion bomfinansiert.

Cancelling European concerts – AP

More of Miley Cyrus’ (21) scheduled European concerts to be moved due to illness. But the concert in Norway should not be in danger.

Initially the concerts in Amsterdam and Antwerp 2 May 4 May moved to the end of June.

Thus, the concert in London on May 6, the first concert of Miley Cyrus in Europe.

appears on the singer’s website.

“After a period of progress, then disease symptoms come back. Doctors her will not give her permission to travel “, according to the press release.

Cyrus has struggled with illness, after she April 15, was taken to hospital because of a sharp allergic reaction to antibiotics.

She also had to cancel concerts in several American cities because of hospitalization.

According to Cyrus’ doctors may take up to 27 days to recover from allergy reaction.

Concert Promoter Live Nation stresses to VG that the concert in Norway must go as planned.

– We have not received any indications that the concert in Oslo are danger, says marketing director Kristin Svendsen Live Nation.

Many have speculated why the pop star has had allergy problems, but Miley Cyrus even like bad reputation flood.

In a Twitter message that she shared with fans in April, she wrote the following: “Shut up and let me get well,” before she presents a further note about the disease.

You are here: Home> Audit> Audit Reports> Gol and Hemsedal Nav … – Board of Health

County Governor of Buskerud

Introduction

Theme and background Authority

About Nav Gol and Hemsedal and implementation of audit

County Department of discovery

Further follow-up of audit

Appendix Document Substrates

the County has the 2014 audited Gol Municipality v / Nav Gol and Hemsedal work with handling of applications for financial support. It will firstly say Nav Gol and Hemsedal effort to map the user’s situation and needs help, and secondly the work of assessment and granting of financial support.

Authority provided the basis for establishing one deviation:

In some situations curtailed benefits to cover the bare essentials for a longer period than regulations allow, and without documented evaluation of the individual user’s situation.

The report discusses both the realized variance and the parts of the service were examined without uncovered discrepancies or made comments.

Date: 24/04/2014

Gisle Skaaden
audit manager

Anne Cathrine Dahl
auditor

This document is electronically approved and transmitted without signature

Supervision is legality. The purpose of the audit is to enhance service and legal certainty for users. Governor is in the law of social services in Nav § 9 given the authority to oversee social service in the employment and welfare administration.

This report was prepared by system audit of Gol Municipality v / Nav Gol and Hemsedal Municipality during the period from 14 January to 6 March 2014. System audit consisted of a review of documents and case files and interviews with employees and managers. The purpose of the system audit is to assess whether services are reasonable and in accordance with legal requirements, and if the municipality operates its own adequate planning and control of the services they provide. The local authority has a statutory duty to engage in such internal controls. ^[1]

During the audit, we examined whether it is compiled routines in the areas audit included. We also checked whether these are available and known to the employees. Next, we assessed whether procedures are in accordance with the regulations. We controlled what is practiced, whether this is in accordance with internal procedures, and whether practices are well enough documented in the material presented.

 

Theme and background Authority

Theme for the audit was handling applications for financial support under the Social Services Act in Nav. It will firstly say Nav Gol and Hemsedal effort to map the user’s situation and needs help, and secondly the work of assessment and granting of financial support.

Financial support is one of five services by law Social Services in Nav. The report is not an overall assessment of the social services at Nav Gol and Hemsedal. The report also only based on what was the office’s practice at the time of completion of the audit.

the County adds at the start of plans for the Nav office shall be supervised and what should be the theme. For some of the system audits is the theme adopted by the State Board of Health, as part of the nationwide audit. In 2013 and 2014 the award and performance of the qualification program nationwide theme for the supervision of the municipal services in Nav.

the County shall also determine the topic of supervision based on knowledge of the services in their own county, and reviews of how it risk of failure in service. Supervision of Nav Gol and Hemsedal was decided in particular for two reasons. Firstly Nav Gol and Hemsedal were merged into one office from 1 January 2013. Secondly, that the County in 2013 experienced a marked increase in received complaints from both municipalities, and that the proportion of converted and canceled the decision of the appeal proceedings were over average for the county.

the County supervised the Nav Gol in 2010 and Nav Hemsedal in 2012. Results from these audits were respectively a note and one deviation. The deviation at Nav Hemsedal were corrected, and the audit completed in autumn 2012. Reports are available on www.helsetilsynet.no.

Gol Municipality and Hemsedal municipality is located north of Hallingdal, with respectively about 4600 and 2200 residents . From 1 January 2013 the municipalities entered into collaboration on joint Nav office. Gol Municipality is host by the Local Government Act, Chapter 5 A.

Nav Gol and Hemsedal is headquartered in Gol, but some of the staff are also present at the town hall in Hemsedal few days a week, and it is possible to make conversation with the supervisor also there. Bear Lac Seth was the former head of Nav Gol, and is now head of Nav Gol and Hemsedal. He reports to the chief administrative officer of Gol Municipality of municipal services and the county director of Nav Buskerud about government services. Team leader for the reception with special focus on audience reception, the law on social services in Nav, refugee services and monitoring of jobseekers with standard and specific efforts. Personal responsibility lies with the Nav-chairman, who is responsible is the municipal services in both Gol Municipality and Hemsedal Municipality.

In addition to being locally Nav office for Gol and Hemsedal, the office is also a resource unit perform state functions for Nav in Hallingdal.

Six coaches have financial support as one of its tasks, including team leader for about half position. Some more employees have duties that include managing inquiries from the public concerning financial support. Received applications and inquiries added directly to the supervisor, considering how the matter should be followed up on.

Simply by Nav Gol and Hemsedal is a weekly technical meetings where individual cases are discussed. Here attends all supervisors working with social services, as well as team leader reception. Are to be kept. Supervisors have delegated decision-making authority. The office routine manual states that the team leader will conduct random checks, and copies of all decisions together in one binder. Team Leader participates in weekly management meetings in the office.

Statistics (KOSTRA figures) shows that Gol Municipality in 2012 had 148 people who received financial support, that is, 3.2 percent of the population. Of these, 66 persons received benefits for more than six months, and 42.6 percent had financial support as the main. Mean length of benefit was 5.7 months. Hemsedal Municipality had in 2012 37 people who received financial support, of which 14 people long-term recipients, and the proportion of financial support as the main income was 75.7 percent. Under supervision visit, it was stated that the office estimated approached by 2-4 new users of the social services every month.

the County audit notice sent on 8 January 2014. Summary of business documents has been submitted in advance of the supervision visit is given in the appendix to this report. The opening meeting was held on 5 March 2014. Seven people were interviewed, among them chairman and team leader. Overview of documentation were reviewed during supervision visit is given in the appendix. The final meeting was held on 6 March 2014, audit manager had telephone conversation with Chief Administrative Officer Hege Dark Gol Municipality same day. From the County participated Deputy Anne Cathrine Dahl and senior advisors Lena K. Hjelle and Gisle Skaaden, with the latter as an audit manager. Adviser Dag Kjetil Strandbo participated as an observer.

 

County Department of discovery

the County examined both Nav Gol and Hemsedal effort to map the user’s situation and needs help, and the work of assessment and granting of financial support.

In considering mapping work labeled the County that it is not in use survey form, checklist or other written aid as a tool of tracking the user’s situation. County Governor also noted that the quality of notes taken after discussions with users was variable.

Nevertheless County Department conclusion that Nav Gol and Hemsedal effort to map users’ circumstances and needs, in line with statutory requirements. The workforce is stable and follows their users over time. The impression from the interviews was that the staff have a good knowledge of their users and their situation. This impression was confirmed by review of case files. Many decisions about the allocation of the benefit in itself shows that the user’s and the family’s situation is well known for Nav Gol and Hemsedal and the processing time is usually so short that the specific needs of the case concerns, are addressed.

County Department concluded therefore that Nav Gol and Hemsedal effort to map users’ circumstances and needs, in line with statutory requirements.

the County assessed the Agency’s work with allocation of financial support under the Social Services Act § 18 and transfers in special cases under § 19

Like everything mentioned, experienced the County in 2013, a marked increase in received complaints from Nav Gol and Hemsedal and proportion of changed and canceled the decision was above the average for Buskerud. Upon review of the submitted resolutions supervise the visit, the County formed in a different impression than what was possible to read out the complaint statistics for 2013 alone. Among these 379 submitted resolutions were few cases where the decision alone indicate improper understanding of the law. County Department review showed that the office has the correct understanding of the costs of living man, as a starting point, you assume covered by current subsistence allowance and the expenses that must be evaluated and awarded separately.

document review and interviews during inspections showed that taking account of the expenses necessary to ensure social participation of children. Both Gol and Hemsedal is typical ski resorts, where children in low-income families may fall outside of fellowship with peers, as some activities are costly. County Governor noted that Nav Gol and Hemsedal cover expenses for these and other activities, where necessary. Individual attention is taken.

weekly technical meetings is the venue for discussion of individual cases and general issues that arise based on these. The printed abstracts in which the conclusion about the outcome of the discussion going forward. Team leader is with all these meetings, and then have the opportunity to follow the technical discussions in the office. Technical meetings are not an appropriate venue for the quality of work done with the decisions, because supervisors are delegated decision-making authority, and thus do not need immediate superior recognition of individual decisions. But as copies of all resolutions put in a binder, the team leader able to follow the decisions.

County Department concluded therefore that the office’s practice of granting of financial support was essentially in line with statutory requirements.

We still did some observations of illegal practices:

1. grant restricted in some situations to the most appropriate (“emergency”) for periods of up to 14-16 days. It happens both in normal and emergency applications in response to breaches of conditions.

 
2. granted in these cases, benefits for children 50 NOK. day for all children between 0 and 18, with no differentiation because of the child’s age or specific assessment of the child’s needs during the period the decision applies.

 

3. Where such benefits are enforced in response to breaches of conditions, it is not documented in the decision or otherwise being made an assessment of the consequences of the reaction before it is implemented.

Total seen this constituted the County’s evaluation practices that involve deviation from the statutory requirements for service. The County formulated discrepancy as follows:

In some situations curtailed benefits to cover the bare essentials for longer periods than regulations allow, and without documented evaluation of the individual user’s situation.

This is the deviation from the law on social services Nav § § 18 and 20

Comment

That benefit may be limited to the bare essentials, the first mainly on the grounds that in some cases it is important that the matter be dealt with quickly than that done the same mapping and proceedings otherwise. Nav Gol and Hemsedal operates, like other Nav offices, with dagsatser for such cases. The rates are £ 100 per. day for couples / partners, kr75 date. day for singles and kr50 date. day for children. Under current guidelines ^[2]

will benefit the most appropriate, in practice only referred to as “emergencies” only be prudent in “some few days “. A period of 14 days can not be characterized as a few days and practice at this point in violation of the law.

People between 0 and 18 are children, but have very different needs. A baby needs diapers, while a youth of 17 years happily eats like an adult. An emergency kit at $ 50 per. per day. children, regardless of age, does not capture these differences. In combination with periods of using the emergency level of up to 14-16 days, entails the risk that the child’s needs during the period not covered.

steel. § 20 as conditions for granting of financial support, with the aim of making the recipient financially self-reliant. Decomposed condition without reasonable cause, it can have consequences such as reduced benefits, even down to so-called emergency level. But even in these cases the benefit to the bare essentials is limited to a few days. Alternatively, the reduction in benefits will be less, but for a longer period. In all cases it is required that there be an assessment before reaction to violation of terms taken, where it is to be emphasized that the cause of the condition has not been fulfilled, and the significance of the consequences reaction is allowed to use and user family. ^[3]

Such considerations did not documented in the County’s decision or otherwise.

particularly relating to benefits for large families

During the final meeting said the County Office’s special procedures for the assessment of benefits for large families. From the beginning of 2013/2014 was introduced a scheme whereby it as a base to calculate so-called economies of scale benefits to families with more than five members. The idea behind this is partly to reflect the economic reality set in savings, for example through inheritance of clothing and food purchases in larger quantities. And partly because the benefit may otherwise be so high that it becomes difficult to find work that will provide the same or higher income.

office routine manual states that it shall be a deduction of 20 percent of total family subsistence support when the family has six or more members. The starting point is the state’s recommended rates for subsistence support ^[4]

Routine Manual also stipulates that there should be an assessment of each case. For families with five or fewer members, made no reduction in benefit.

Taken literally means routine that a family with two adults and four children can get lower benefit than if the family still only had three children. This was the reason why the Governor sought to obtain through past cases in which it was granted support to large families. During the interviews, it quickly emerged that Nav Gol and Hemsedal had seen the impact that routine, read literally, can get. It was also clear that such matters are always discussed in the academic meeting. The County did not find that the new routine had been reflected in practice in a way that made it the basis for saying that the practice was contrary to law. And because the office had seen the possible consequences, it was our opinion no basis for saying that the risk of failure of the service was so great that this alone was reason to point out a discrepancy. Nav Gol and Hemsedal stated themselves that they saw reason to revise the handbook routine at this point.

 

Further follow-up of audit

the County asks that Gol Municipality v / Nav Gol and Hemsedal before 1 June 2014 the County sends a plan where the following is shown:

• What measures are planned implemented to correct deviations.

 

• How management will monitor and ensure that measures are taken.

 

• How management will ensure that the measures have worked as planned, after they have been in operation for a while.

 

• What limits the municipality has taken to ensure progress is being rightly deviations.

the County will terminate supervision when the municipality has corrected the discrepancy.

 

Appendix Document Surface

organization’s own documentation relating to the daily operations and other significant matters that were submitted during the preparation:

• Organization for Nav Gol and Hemsedal, including overview the meeting structure.

 

• Cooperation agreement between Gol Municipality and Nav Buskerud on operating joint local office.

 

• Cooperation agreement on joint Nav services in Gol and Hemsedal

 

• Delegations of authority under the Act on Social Services in Nav.

 

• Overview of managers and supervisors who take care of inquiries, surveys and makes decisions concerning economic benefit.

 

• Introduction Plan for new employees at Nav Gol and Hemsedal.

 

• Procedure manual for processing applications for financial support, revised 1/30/14.

 

• Minutes of weekly technical meetings.

 

• Procedures for evaluation of the services provided by the Social Services in Nav Nav Gol and Hemsedal.

 

• Template for quarterly reporting.

 

• Application for financial support.

 

• simplified application form for financial support.

 

• Results from local user survey, conducted in 2013.

 

• List of users with dependents who received financial support from Nav Gol and Hemsedal date. 1.2.14.

 
• 379 decisions on financial support from the period from 10/01/13 to 31/01/14.

In addition, information materials and municipal annual reports available on the municipal website.

following documentation requested the County that were presented supervised visit:

• Complete dossiers for 20 users, according to the list.

 
• the past ten notes for the first time calls / survey calls.

 

• the last ten decisions on the allocation of financial support to households with more than five members.

 

• dossiers in the past ten cases in which it had been reacted to the breach of conditions (for steel § 20) with stopped or reduced financial support.

---

[1] Statutory obligation to establish a management system was introduced on 1 January 2010, see § 5 of the Act on Social Services in the Labour and Welfare Administration. Regulations on internal control for the municipality in the labor and welfare administration was granted 19 November 2010.

[2] Labour and Welfare Directorate circular H35 paragraph 4.18.1.6.

[3] See Labour and Welfare Directorate circular H35 paragraph 4.20.2.8.

[4] See the Work Ministry circular A-1/2013.

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Consultation – proposal booking possibility for GPs – Board of Health

Fra:	Statens helsetilsyn
Dato:	25. april 2014
Vår ref:	2014/232 2 JKT

Tillitsforholdet mellom fastlegen og pasienten

Reservasjonsspørsmålet i historisk perspektiv

Forholdet til abortloven og helsepersonelloven

Tilsynsmessig oppfølging av forslaget om en reservasjonsmulighet

Konkret merknad til ordlyden i lovforslaget

Administrative utfordringer

Konklusjon

Helse- og omsorgsdepartementet (HOD) har lagt fram et lovforslag som gir fastleger en mulighet til å reservere seg mot henvisning og behandling ved alvorlige samvittighetskonflikter knyttet til liv og død. Videre foreslås det en endring i fastlegeforskriften slik at kommunen og fastlegen kan inngå avtale om at fastlegen kan reservere seg mot å henvise til abort.

Høringsnotatet tar opp en tematikk som er kompleks, og lovforslaget søker å finne en hensiktsmessig løsning på en krevende problemstilling. Statens helsetilsyn er av den oppfatning at foreslått reservasjonsmulighet for fastleger vil kunne svekke tillitsforholdet mellom pasienten og legen. Vi mener at hensynet til kvinnens rett til forsvarlig og omsorgsfull hjelp må veie tyngre enn fastlegens personlige overbevisning. Statens helsetilsyn støtter derfor ikke forslaget.

Tillitsforholdet mellom fastlegen og pasienten

Departementet skriver på side 10, kap. 4.2.1 i høringsnotatet: “Den klare hovedregelen bør være at pasienter kan regne med åfå tilbud om alle de allmennlegetjenester som de har behov for hos sin faste lege. Fastlegene skal ivareta det offentliges interesse av at alle innbyggere får tilbud om enfast lege som gir allmennlegetjenester, iriformasjon og veiledning og somfyller rollen som hjelper og veiviser for pasientene inn mot den øvrige helsetjenesten”. Statens helsetilsyn slutter seg fullt til denne beskrivelsen.

For å kunne ivareta oppgaven med å yte forsvarlige allmennmedisinske tjenester og omsorgsfull hjelp må det være etablert et tillitsforhold mellom pasient og lege. En forutsetning for et slikt forhold er at legen opptrer profesjonelt og fremstår som fordomsfri overfor alle pasienter, uavhengig av hvilke problemer og behov de måtte ha. Som følge av forslaget vil fastlegens avtale om reservasjonsmulighet bli kjent for pasientene, noe som vil gjøre fastlegens verdisyn på dette området offentlig kjent.

Statens helsetilsyn mener at det å åpne opp for at legenes verdisyn skal tematiseres i pasient-legerelasjonen, vil kunne utfordre tillitsforholdet. En forutsetning for å kunne få forsvarlig helsehjelp er at legen får tilgang til all nødvendig informasjon om pasientens tilstand. Forhold som kan bidra til å svekke tillitsforholdet mellom pasient og lege vil kunne hindre en nødvendig informasjonsutveksling. Dersom pasienten er kjent med at fastlegen har reservert seg mot å henvise til abort, kan det oppleves som vanskelig å ta opp og være åpen overfor fastlegen om andre forhold av privat og intim karakter som har betydning for helsen og helsehjelpen. Dersom ordningen innføres innebærer det at det ikke er tilstrekkelig at kommunen vet at andre leger i kommunen vil henvise til abort når det trengs. Kommunen må ha fastlegekapasitet nok til at langt flere pasienter enn de som kan oppleve uønskede svangerskap kan få bytte/velge annen fastlege.

Prinsipielt mener vi det er riktig at pasienter informeres om at deres fastlege har reservert seg mot henvisning til abort, men samtidig viser dette noen dilemmaer. Noen av legene som i praksis har reservert seg mot å henvise til abort, har bestrebet seg på å håndtere disse situasjonene på en slik måte at pasienten ikke har blitt konfrontert med legens verdisyn og holdninger. Legene har uttrykt at de ikke ønsker å la egne holdninger og overbevisninger være et tema overfor pasientene fordi de mener det er lege/pasientforholdet uvedkommende. Dersom ordningen innføres som foreslått tvinges disse legene til å gå offentlig ut med sine holdninger og overbevisninger, noe som åpenbart kan påvirke langt flere pasientrelasjoner enn de som er knyttet til uønskede svangerskap.

Statens helsetilsyn savner en mer utdypende drøfting av forslagets mulige konsekvenser for tillitsforholdet mellom alle pasienter og fastlegene.

Reservasjonsspørsmålet i historisk perspektiv

Reservasjon etter abortloven omfatter bare helsepersonell som utfører eller assisterer ved selve inngrepet, jf. abortloven § 14. Loven gir ingen hjemmel for å nekte forskrivning, utlevering av prevensjonsmidler, eller for at fastleger kan nekte å henvise til svangerskapsavbrudd.

Spørsmål om reservasjonsrett for spesifikke helsefaggrupper til å yte bestemte typer helsehjelp har tidligere vært drøftet blant annet i forbindelse med, og som oppfølging av abortmeldingen, St meld nr 16 (1995-96) Om erfaringer med lov om svangerskapsavbrudd mv.

Under revisjon av abortloven i 1994/95 kom det flere henvendelser fra helsefaggrupper, som leger, sykepleiere, jordmødre og farmasøyter som av samvittighetsgrunner ønsket en reservasjonsrett for det de oppfattet å være abortrelaterte handlinger. Daværende Helse- og sosialdepartementet fant imidlertid ikke grunnlag for å foreslå endringer av gjeldende bestemmelse.

I 1999 konkretiserte det daværende Sosial- og helsedepartementet i samarbeid med Statens helsetilsyn de gjeldende lovbestemmelsene i abortloven. Målet var å opplyse om hva som skjer og kan forventes å skje i prosessen fra kvinnens begjæring frem til det endelige inngrepet. I brukerinformasjonen om legens oppgaver i forbindelse med håndtering av kvinners begjæring om svangerskapsavbrudd ble det understreket at
“dette er en oppgave leger ikke kan reservere seg mot”.

I rundskriv I-4/2011 fastslo Helse- og omsorgsdepartementet igjen at fastlegen ikke kan reservere seg.

I høringsnotatet fra HOD side 8 kap. 4.1.4.1 viser departementet til et rundskriv fra Statens helsetilsyn (IK 24/95). Videre henviser departementet til praksis fra enkelte tilsynssaker og skriver at Statens helsetilsyn har lagt til grunn at det er anledning for leger til å reservere seg mot å henvise til abort m.v. av samvittighetsgrunner dersom helsetilbudet til pasientene ivaretas tilstrekkelig. Statens helsetilsyn finner ikke grunnlag for en slik konklusjon på bakgrunn av vår tilsynspraksis. Vi har i en tilsynssak gitt en lege kritikk for ikke å ha henvist til abort samt nektet å sette inn spiral og foreskrive minipiller. Statens helsetilsyn påpekte at legen, til tross for personlig overbevisning, hadde ansvar for å sikre at pasientene fikk den helsehjelpen de hadde behov for. I det omtalte rundskrivet uttalte vi at nødvendig helsehjelp innbefatter henvisning til abort og et fullverdig prevensjonstilbud.

I forbindelse med Helsedirektoratets kartlegging av omfanget av samvittighets­begrunnede reservasjoner mot å utføre ovennevnte oppgaver i helsetjenesten i 2012, gikk Statens helsetilsyn gjennom tilsynssakene fra 2001, altså etter at fastlege­ ordningen ble innført. Fram til 2012 har vi behandlet kun to konkrete tilsynssaker. I begge sakene var saksforholdet at legen hadde nektet, og dermed bidro til å forsinke henvisingen til svangerskapsavbrudd. I den ene saken konstaterte vi brudd på kravet til omsorgsfull hjelp i helsepersonelloven § 4, og ga samtidig veiledning om hva som er å anse som god praksis. I den andre saken fikk legen advarsel.

I NOU 2013:1 Det livssynsåpne samfunnet, ble reservasjonsmulighet mot å henvise til abort og assistert befruktning og til å forskrive eller sette inn prevensjon, drøftet av Stålsett-utvalget. Flertallet (11 av 15) ville ikke tilrå å gi fastleger rett til å reservere seg mot å henvise til abort, assistert befruktning eller til å forskrive eller sette inn prevensjon.

Denne kortfattede historiske oversikten tydeliggjør etter Statens helsetilsyn sin oppfatning at helsepersonells adgang og mulighet til å kunne reservere seg fra å yte ulike former for helsehjelp ikke er en ny problemstilling og at den er kompleks. Det ble funnet en svært begrenset løsning i abortloven § 14 knyttet til gjennomføring og assistanse til selve inngrepet. At lovgiver og departement ikke tidligere har funnet grunn til å åpne opp for reservasjon av flere personellgrupper og mot annen type helsehjelp, er først og fremst fordi man har satt pasientenes rett til forsvarlige og omsorgsfulle tjenester foran hensynet til helsepersonellets samvittighetsgrunner.

Helsepersonells grunner for å reservere seg kan være flere og dreie seg om ulike former for helsehjelp, og det er vanskelig å veie den enes grunnlag opp mot andres og finne naturlige avgrensninger. Helsepersonell i offentlig helsetjeneste må forventes å yte den tjenesten det offentlige anser som forsvarlig.

Forholdet til abortloven og helsepersonelloven

Forslaget til lov- og forskriftsendringer grenser opp mot dagens abortlov. Vi savner en uttømmende drøfting av forholdet mellom gjeldende reservasjonsrett etter abortloven og den foreslåtte reservasjonsmuligheten for fastleger.

Helsepersonelloven regulerer helsepersonells plikter og rettigheter, herunder kravet til faglig forsvarlig og omsorgsfull hjelp i § 4. Slik vi vurderer det, vil det særlig være pasientens rett til omsorgsfull hjelp som utfordres ved at legen gis en reservasjonsmulighet. Dette forholdet drøftes ikke i høringsnotatet. I notatet vises det kort til helsepersonellovens kap. 11 om administrative reaksjoner uten at bestemmelser og vilkår gjennomgås og drøftes. Etter Statens helsetilsyns oppfatning er det helt nødvendig å vurdere disse virkemidlenes egnethet før det kan konkluderes med at bruk av dem i denne sammenhengen er hensiktsmessig.

Tilsynsmessig oppfølging av forslaget om en reservasjonsmulighet

Statens helsetilsyn stiller spørsmål ved om bruk av tilsynsmyndighetens virkemidler er hensiktsmessige når det gjelder å sikre etterlevelse av det foreslåtte regelverket.

Departementet viser i høringsnotatet til pålegg mot kommunene og bruk av administrative reaksjoner overfor den enkelte fastlege som mulige virkemidler for å sikre gjennomføringen av foreslåtte ordningen med reservasjonsmulighet.

Tilsynsmyndigheten kan følge opp og vurdere om kommunen gjennom sine avtaler har lagt til rette for at pasienter som er blitt uønsket gravide får et forsvarlig helsetilbud, og eventuelt anvende de virkemidlene vi har, blant annet pålegg.

Bruk av advarsel eller tilbakekall/begrensning i autorisasjonen forutsetter at helsepersonellovens bestemmelser er brutt. Det vil kunne forekomme tilfeller der en lege ikke vil henvise til abort (uten avtalt reservasjonsmulighet), men medvirker til at en kollega overtar denne oppgaven uten at det oppstår tidsforsinkelse av betydning og på en måte som sikrer pasienten omsorgsfull hjelp. I slike tilfeller vil ikke avviket fra god praksis bli vurdert som så stort at tilsynsmyndigheten finner helsehjelpen uforsvarlig og at det dermed ikke vil være grunnlag for administrative reaksjoner fra Statens helsetilsyn. Dersom departementet vil endre grunnlaget for bruk av administrative reaksjoner må dette drøftes og beskrives i forarbeidene, og det må foretas nødvendige lovendringer i helsepersonelloven.

Formålet med å ilegge administrative reaksjoner er å bidra til at pliktbrudd ikke gjentar seg og at praksis i fremtiden blir i henhold til kravene. Statens helsetilsyn er i tvil om at en advarsel til en fastlege som reserverer seg mot å henvise til abort av samvittighetsgrunner, til tross for at vedkommende lege ikke har denne adgangen, vil medføre at legen vil endre personlig overbevisning og innrette seg etter vårt vedtak.

Dersom en lege til tross for advarsel unnlater å innrette seg, kan det foreligge grunnlag for å tilbakekalle autorisasjonen. Om tilbakekall av autorisasjon er en hensiktsmessig reaksjon overfor enkelte fastlegers samvittighetsgrunner og personlige overbevisning, bør vurderes grundig. Dette er særlig problematisk dersom kollegaer med tilsvarende verdisyn og praksis “slipper fri” fordi de har fått en avtale med sin kommune om at de kan reservere seg.

Departementet foreslår at fylkesmannen skal få tilsendt alle avtaler som er inngått mellom kommuner og fastleger om reservasjon. Etter vår oppfatning må forslaget innebære at departementet mener at fylkesmennene løpende skal vurdere denne typen driftsmessig informasjon uten at det er holdepunkter for svikt. Statens helsetilsyn vil understreke at det er tjenesteyter som har ansvaret for å yte forsvarlige tjenester. De begrensede tilsynsressursene hos fylkesmennene må innrettes mot tjenesteområder der det er stor risiko for svikt og der tilsyn vil kunne bidra til forsvarlige tjenester. Å pålegge fylkesmennene en løpende tilsynsmessig overvåking av avtalene som kommunene inngår, er etter Statens helsetilsyns vurdering ikke hensiktsmessig ressursbruk. Fylkesmennene vil imidlertid innhente den/de aktuelle avtalene ved behandlingen av eventuelle tilsynssaker.

Konkret merknad til ordlyden i lovforslaget

Forslaget til ny bestemmelse i helse- og omsorgstjenesteloven § 3-2 tredje ledd lyder: “Departementet kan gi forskrift om nærmere bestemmelser omfastlegeordningen, herunder om kvalitets- og funksjonskrav, om adgangen til suspensjon av fastlegeordningen og omfastlegers mulighet til å reservere seg mot henvisning eller behandling når reservasjonen er begrunnet i alvorlige samvittighetskonflikter knyttet til liv og død. “

En slik vid hjemmel åpner for at det i fremtiden kan forskriftsfestes at fastleger kan gis en generell mulighet til å reservere seg mot å henvise eller behandle pasienter begrunnet i alvorlige samvittighetskonflikter på flere områder. Det fremgår av høringsnotatet at det med alvorlige samvittighetskonflikter knyttet til liv og død, først og fremst menes abort. Det åpnes imidlertid for at hjemmelen også skal kunne omfatte reservasjon mot aktiv dødshjelp dersom dette skulle bli tillatt.

Statens helsetilsyn vil sterkt tilråde at en eventuell bestemmelse formuleres klart og avgrenset, slik at det fremkommer i selve lovteksten at det kun gjelder mulighet til å reservere seg mot å henvise til abort. Innføring av aktiv dødshjelp og eventuell reservasjonsadgang i den forbindelse, vil være problemstillinger som uansett må underlegges egen grunnleggende debatt og behandling.

Administrative utfordringer

Høringsforslaget medfører omfattende detaljregulering av vilkår og innhold i en avtale mellom kommune og fastlege om reservasjonsmulighet. Det kan bli en utfordring for kommunene å måtte vurdere alvorlighetsgraden av samvittighetsgrunner dersom det er flere fastleger som ønsker reservasjon. Det blir også vanskelig for kommunen å ha en kvalifisert oppfatning av hvor mange pasienter som ikke ønsker å ha en fastlege hvis personlige overbevisning og verdisyn er offentlig kjent og som dermed enten vil bytte fastlege eller ikke velge vedkommende fastlege. Den foreslåtte ordningen vil kunne medføre administrativt merarbeid for kommunene. Avtaler om reservasjonsmulighet vil også kunne medføre en belastning for de fastleger som reservasjonsleger henviser kvinnen til.

Uavhengig av ovennevnte mener Statens helsetilsyn, at dersom foreslått ordning innføres, må det være den enkelte kommune som inngår avtale med fastleger om reservasjonsmulighet. Da kommunene er ansvarlige for å sikre tilstrekkelige og forsvarlige helsetjenester ser vi det ikke som hensiktsmessig å pålegge kommunene å innføre en slik ordning.

Konklusjon

Statens helsetilsyn er av den oppfatning at en reservasjonsmulighet for fastleger kan bidra til å svekke tillitsforholdet mellom pasienten og legen. Spørsmålet om en reservasjonsmulighet for fastleger dreier seg om en avveining mellom hensynet til legenes overbevisning og retten til lovbestemte helsetjenester. I denne avveiningen finner Statens helsetilsyn at retten til lovbestemte helsetjenester må veie tyngre enn fastlegens personlige overbevisning. Vi støtter derfor ikke forslaget til endringer i helse- og omsorgstjenesteloven og i pasient- og brukerrettighetsloven.

Med hilsen

Jan Fredrik Andresen
direktør

Kristina Totlandsdal
seniorrådgiver

Helsefaglig saksbehandler: seniorrådgiver Kristina Totlandsdal, tlf. 21 52 99 21

Juridisk saksbehandler: seniorrådgiver Lisbeth Raastad, tlf. 21 52 99 65

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