Prioritizing Care: emerging dilemmas in the Norwegian care service landscape (PriCare)

In the PriCare project, the main goal was to develop new knowledge and insight into the (re)design of the health and care service in Norwegian municipalities, with a particular focus on dilemmas, consequences, and prioritization challenges for the entire care chain. The project developed from two overarching research questions: 1. What characterizes municipal health and care services today? 2. How is prioritization carried out in the services when the resources are to be distributed? The project has illuminated these issues in a quantitative and a qualitative study. With the help of a questionnaire and register data, we have analyzed what the service offer looks like in Norwegian municipalities today and further how the organization of services depends on the characteristics of the municipality, and how the organization has an impact on the allocation of services and service quality. Through observation in the home care service and interviews with managers at various levels and politicians in three municipalities, we have taken a closer look at how priorities are set, what is prioritised, what is behind the choices that are made and what reflections the actors have about the priorities they make. Key findings: • The services are specialized • The municipalities offer services in various models • Which model the municipality has does not seem to have any effect on the quality of the services • Functional level matters most for the allocation of services • The municipalities experienced increased financial pressure • Increased central management through regulations from ministries and directorates • Responsibility for challenging priorities is pushed down the system • Medical tasks and somatic care are prioritized over other types of tasks • People with "rehabilitation potential" are given priority

Prosjektet har frembrakt ny kunnskap om organisering og utviklingstrekk i de kommunale helse - og omsorgstjenestene. Prosjektet har også sett nærmere på tildeling av tjenester og hvilke faktorer som har betydning for tjenestene som tildeles. Denne kunnskapen er nyttige innspill i debatten om variasjon i kommunale helse- og omsorgstjenester og som grunnlag for videre politikkutvikling og planlegging for disse tjenestene. I den kvalitative delen har prosjektet løftet frem stemmen til informanter som ikke er så frampå eller kritiske og gitt dem mulighet til å uttrykke seg uten å måtte frykte konsekvenser (anonymisering). Kvalitative data gir innsyn gjennom «thick descriptions» av hva prioriteringspraksiser i kommunal eldreomsorg innebærer, og hvordan nyere tids regulering av disse påvirker rolleforståelser og skjønnsutøvelse hos de (u)faglærte ansatte. Resultater fra prosjektet er aktivt formidlet til relevante aktører, deriblant Blankholm utvalget og arbeidsgruppen i Helsedirektoratet som nå jobber med en prosessveileder for prioritering i de kommunale helse og omsorgstjenestene. De kommunale helse- og omsorgstjenestene, og eldreomsorgen i særdeleshet, står foran store utfordringer. Hvordan vi skal løse dette i fremtiden er en viktig samfunnsdebatt. Funn fra PriCare bidrar med kunnskap og innsikt som har direkte relevans for denne samfunnsdebatten.

Over the past decade, there have been shifts in the care service responsibilities, tasks, focus and organization, creating a new care service landscape. The municipalities have considerable autonomy in designing their services, leading to heterogeneous care service provision models. To develop services within budget limits, municipal leaders and local politicians are facing tough priorities. This project will produce novel insight into the (re)design of Norwegian municipal care services by exploring the care service landscape, the inherent prioritizing dilemmas and consequences for the service chain. The care services have steadily expanded; most of this growth has taken place in the home care services. At the same time, there has been an increased focus on short-term stays in nursing homes. In the home care services, there has also been increased focus on the reorganisation of services. Moreover, there is an increased focus on new types of services delivery, such as home care reablement and use of welfare technology. In this landscape of services in change, we lack knowledge of how service development unfolds in different municipalities, how municipalities prioritize giving rise to new service provision models, altered distribution and desirable and undesirable consequences for service delivery. In this project, we will explore these questions. The empirical analyses will build on a combination of data sources including register data (IPLOS and KOSTRA), a survey among Norwegian municipalities and a case study in a selection of municipalities representing different care service delivery models. In the case study, we will draw on field observations, document analysis and interviews with municipal managers, politicians, healthcare professionals, and users as well as their next of kind. The project will build a database and methodology suitable for continuous analysis of service trends in the municipal care service landscape.