Doctor and postdoctoral fellow, Center for Medical Ethics, UiO
Ingvild Kjerkol (Labor Party) puts the quality of hospital treatment above other interests, such as culture, catering and students’ social lives.
This is a debate post. Opinions in the text are at the writer’s expense.
In this pandemic, the capacity of the health service puts a lid on the freedom and unfoldment of the rest of society. If the health service in the coming weeks can step up capacity more, especially the hospital capacity, it can be kept more open.
In this connection, there has been uncertainty about the ability to scale up the intensive capacity of the hospitals. This is partly because the quality of the health care that is then provided can be somewhat poorer.
But after the New Year, the regional health authorities came up with a new figure for how many intensive care units they can muster in a pandemic peak: 647, against 289 to normal. This number includes significantly more intensive care units with respirators, but also 73 intermediate places in Health Southeast without respirator. These can be useful used on those who are not very sick.
In VG 7 January, Minister of Health Ingvild Kjerkol (Labor Party) says something about how willing she is to use this capacity:
“Recently, they have informed that it is realistic to be able to step up to 647 beds in the short term, but a proportion of these will be so-called intermediate places with a simpler facility and lower staffing than full-fledged intensive care units. Higher number of beds will lead to a lower standard than we have today. It is a situation we do not want to end up in. “
In plain text: The Minister of Health seems reluctant to use the capacity we actually have, to keep society open to a greater extent. Then she (obviously) would rather intervene in other areas of society that get into big trouble. And her reasoning is that the quality of health care can then be somewhat lower. It then seems unlikely that the capacity we actually have will be used.
With the omicron variant, it seems that the intensive capacity can be less pressured. But it is reasonable to assume that the Minister of Health’s thinking also applies to capacity in hospitals more generally and elsewhere in the health care system.
This is sensational. Here, the Minister of Health – if we are to believe what she is quoted – comes up with an explicit choice of values: She puts the quality of hospital treatment above other interests, such as culture, catering and students’ social lives.
Who are these “we”?
One important question that arises: Who are these “we” that the Minister of Health is talking about, who do not want an upscaling with a possibly worse standard?
As the new Minister of Health, she has hardly come to this alone, and it is hardly the bare owners she has talked to.
Behind it, we must expect that there are influential suppliers of premises in the Ministry of Health, the Norwegian Directorate of Health, in the hospitals’ managements and representatives of the health professions, doctors and nurses. With its values and standards.
Director of Health Bjørn Guldvog stated as an example of the NRK Debate on 13 January that «all our purpose is that we do not overload so much that we provide a poorer service to our patients ».
Assistant Director of Health Espen Rostrup Nakstad said on 20 December to Dagbladet that “that is exactly what we have been concerned about in Norway, that we should have a health care system that can function as normally as possible through the pandemic”.
The intensive care physicians’ association leader Jon Laake has as one important professional premise suppliers both previously and now expressed a negative view of the possibilities for upscaling capacity.
What is “too bad a standard”?
Here we are facing a situation where all other considerations in society are measured against the perception of good enough quality in hospital treatment. Another important question that arises is therefore what the Minister of Health actually means by “too poor a standard”. This is vague, but at the Debate on 13 January, she says: “If too many people become ill at the same time, it will lead to weaknesses in the health service, and then some will be affected.”
The Minister of Health must be happy to correct. But in her statements, compared with Guldvog’s and Nakstad’s above, it seems the closest any deterioration in quality – any deviation from the norm – in the health services is considered worse than large and serious quality losses in other areas of society.
I would also like to question the extent to which the Minister of Health and the Norwegian Directorate of Health should make these valuations alone
I believe we must be able to tolerate a certain, temporary deterioration in the quality of health services as long as they remain sound, and this enables an upscaling of capacity that entails significant benefits by safeguarding other interests in society.
It was striking to hear the Minister of Health’s statement on NRK Debatten on 13 January when she spoke to Tommy Åsheim, the après-ski owner who represented dining and nightlife: “The pandemic is fundamentally unfair,” she said.
Imagine if the Minister of Health had said the same thing to tired nurses or doctors when they appear in the media. The leader of the Nurses’ Association called it as an example before Christmas «Whipping» that nurses did not get a Christmas holiday and time off as usual – in the middle of a pandemic peak and national crisis. Think about the Minister of Health to this replied: “I understand you are having a hard time, but the pandemic is fundamentally unfair.”
Imagine if she had said: “If schools, nightlife or cultural institutions can not be run with top quality, there are some who are affected, so then the hospitals unfortunately have to step up as much straps and clothes can hold.”
This illustrates value choices in our people and among politicians. Regardless of whether I am right in my tentative diagnosis regarding her value assessment here, the Minister of Health should clarify these assessments more for the people. And she can reconsider.
I would also like to question the extent to which the Minister of Health and the Norwegian Directorate of Health should make these valuations alone. They have significant conflicts of interest in that their area and interest is the health field. They will primarily over time deal with and cover interest groups within this sphere of society.
Therefore, the Prime Minister also has an important overall responsibility. Other ministers should safeguard the values of their fields, and the media have a responsibility to get other voices into the debate.