The specialist health service

In Norway, we have four regional healthcare organizations that are responsible for ensuring the population's access to the necessary specialist healthcare services.

The four health organizations are

• Health South-East RHF: Those who are responsible for the population in Agder, Vestfold and Telemark, Viken, Oslo and Innlandet.
• Health Vest RHF: They are responsible for the population in Rogaland and Vestland.
• Health Central Norway RHF: They are responsible for the population in Møre og Romsdal and Trøndelag.
• Health Nord RHF: They are responsible for the population in Nordland, Svalbard and Troms and Finnmark

The specialist health service includes

• Somatic and psychiatric hospitals 
• Outpatient clinics
• Treatment centers
• Training and rehabilitation institutions
• Prehospital services
• Institution for interdisciplinary specialized treatment for drug use
• Specialists in private practice
• Laboratory activities
• X-ray business

Referral

In order to receive treatment for somatic or mental disorders that require specialized treatment, the patient must be referred from the primary healthcare service. In essence, this will be your GP. Everyone has a legal right to healthcare in the specialist healthcare service.

When children and young people are referred, this must be assessed within 10 days!

If it is assessed that the child needs health care in the specialist health service, it must be determined what type of help/treatment the child will receive, and a deadline set for when it is at the latest justifiable for the child to receive this. This means that a date must be set for when the health care will be up and running at the latest. If the hospital is unable to provide treatment by this date, the hospital must, if you wish, contact HELFO so that HELFO can offer the child healthcare elsewhere, either in Norway or abroad.

Responsibility

The specialist health service is responsible for making a diagnosis, providing treatment and then following up the patients who come to the services with acute, serious and chronic diseases and health complaints.

Children with a long-term need for follow-up and treatment in the specialist health service have the following rights:

• Contact doctor
  According to the law, children and young people have the right to a contact doctor at the hospital. The contact doctor must be involved in the treatment or follow-up of the child and ensure that the patient's course goes as planned.
• Coordinator
  “The task of coordinator in the specialist health service involves coordinating internally during the stay, and externally with those who will follow up after discharge. If the need for continuity and coherence in the process dictates it, the coordinator must interact with personnel and bodies outside the institution who have or will be given treatment or follow-up responsibility for the patient. Examples of this are a GP, coordinator in the municipality, coordinating unit, home nursing care or specialists in other health organisations.
  Read more about the coordinator here.
• User participation
  Children and young people/their parents have the right to be heard by the healthcare system. This is laid down in the Patient and User Rights Act.
  "The right to user participation is enshrined in law, among other things in Section 3–1 of the Patient and User Rights Act. This means that children and/or their parents have the right to participate in the selection, design and use of offers, both during planning and implementation. The background for the right to participate is respect for the individual's right to self-determination. The right must be seen in the context of the fact that, as a general rule, health care must be carried out on the basis of consent from the patient himself. In order for the right to user participation to become real, it is crucial that the child/parents receive sufficient and adapted information, so that they can, as far as possible, gain insight into their own state of health, the content of the health care and their rights as a patient or service recipient."
• Children have the right to be heard, especially children over the age of 12
  "If the patient is under 16 years of age, both the patient and the parents or others with parental responsibility must be informed.
  If the patient is between 12 and 16 years of age, the information must not be given to the parents or others who have parental responsibility when the patient, for reasons that should be respected, does not want this.
  Regardless of the patient's age, information must not be given to the parents or others who have parental responsibility, if weighty considerations for the patient speak against it.
  Information that is necessary to fulfill parental responsibility must nevertheless be given to the parents or others who have parental responsibility, when the patient is under 18 years of age. The patient must be informed that the information is provided."

§ 6-5. Children's party rights
"A child can act as a party in a case and assert party rights if he has reached the age of 12 and understands what the case is about."

When a child is hospitalized 

When a child is admitted to hospital, he and his relatives have a number of rights which are regulated in Regulations on children's stay in a health institution.

• Relief for parents
  Parents are entitled to relief when the child is admitted to hospital. The health personnel at the ward where the child is admitted is responsible for clarifying with the parents what tasks the parents must do and what the health personnel must do during the stay. A guideline could be that parents do the same tasks as they would have done at home. They should not do things that are frightening or painful for the child, but rather be the children's safe haven. When the parents have a need, they must also receive relief during their stay at a health institution. This is laid down in the regulations on children's stay in a health institution, chapter 2 §6.
• Suitable living spaces
  According to the regulations, parents must have access to suitable living spaces where they must be able to retreat when they need to. Not all healthcare institutions have such living spaces, but ask the staff and report the need.
• Parents have the right to contact a social worker, psychologist and/or other support staff while the child is admitted. The health institution must offer parents this, but about help and guidance if you need it. If the child has a disease picture that is changing, it may be a good idea to talk to the social worker more than once.
• The health institution must inform parents about relevant interest organisations. Ask for this if the health institution itself does not take the initiative to do so. 
• Children with a need for assistance and/or a need for a night watch
  If the child has BPA (regardless of the number of hours and time of day) and/or needs continuous supervision at night (night watch), the hospital must ensure that this is covered. If the hospital cannot itself provide personnel/night guards, or it is considered that it is best for the child to use personnel known to the child, the hospital must contact the child's home municipality to clarify this. The hospital and the municipality must then provide night guards from the child's own night guard scheme or BPA scheme in the municipality. This right can be found in the cooperation agreements between health organizations and municipalities, and parents can refer to the cooperation agreement if the hospital or the municipality claims that the child does not receive their usual health and care services during admission.
• Information for parents and siblings
  The Healthcare Personnel Act and the Patient and User Rights Act require healthcare personnel to ensure that children, siblings and parents receive sufficient, correct and necessary information about their own state of health, various options, treatment, side effects and rights.
• Offer for siblings as relatives
  On 1 January 2018, it was decided that siblings as relatives and children as survivors should be equated with children as relatives in the Health Personnel Act §10 ab. Health personnel are now obliged to find out what information and follow-up needs these children have, and to follow this up.
• Activation of the hospitalized child
  Children have a statutory right to be activated when admitted to hospital. Examples of this could be access to toys, watching films, music therapy, gaming, drawing and painting. Children must be given the opportunity for activities adapted to their age and development. In most large hospitals, there are departments with special educators whose job it is to activate the children. Children who, for various reasons, cannot make use of these offers, still have the right to be activated. Ask for a visit from a special education teacher in the room if the health personnel do not offer this on their own initiative. The regulations set requirements for a suitable area for the activation and teaching of the child. Neither the corridor nor the room where there are other sick people who need rest is a suitable area. 
• Teaching the hospitalized child
  Children have a statutory right to education and special educational help when admitted to hospital. Special educational help also applies to pre-school children who are entitled to this, and should preferably be provided by a pre-school teacher. This also applies to children who do not have the opportunity to stay at the physical hospital school. A teacher from the hospital school can teach the child in the room the child is in. The regulations do not say anything about the fact that some time may pass before a school child is offered hospital school. Please note that some hospitals do not have the practice of offering school if the child is admitted for only a few days. If the child is often hospitalized, one therefore risks many days without teaching.
• Preschool children who need special educational help must receive it when they are admitted to a health institution
  In some health institutions, the hospital school is supposed to provide preschool children with this help. The hospital school is dependent on the ward the child is in reports that they have a child who needs such education. 

Here You can find information about genetic testing in the specialist health service.

Free treatment center

As a patient, you have the right to choose the hospital you want. Large hospitals may be more specialized in rare conditions, while the smaller hospitals have a more general medical service. Therefore, it may be that there is a different hospital than your nearest one that specializes in the disease or syndrome you have. 

Prize

Children must always receive a prize regardless of age and functional variation!
Unfortunately, we constantly experience and hear about healthcare personnel who do not give prizes to the very youngest children, children who have significant cognitive and communicative challenges, who cannot see, or who for various reasons they assume do not enjoy prizes. Parents should be notified of this if they are exposed to it, so that the practice does not become the norm. Children must always be offered a prize!

Hospital Children Foundation supplies the country's hospitals and children's wards with prizes of all varieties and sizes, as well as Easter eggs and Christmas gifts.

Coercion against children

Active efforts must be made to avoid the use of coercion against children in order to carry out examinations and medical procedures. We have made an overview of good solutions (such as nitrous oxide, preparations, use of ASK and hospital clowns, etc. Read more about it here.

Complain

If you believe that your child is not receiving proper help or treatment, or you are not satisfied or agree with the follow-up and treatment the child is receiving, you should complain.

If you need advice and/or help making a complaint, you can contact us The patient and user ombudsman. They can guide you in the rights you have and assist you in dealing with those responsible.

Should the child be exposed to incorrect treatment, complications or an injury, this can be reported/complained to The State Administrator, The Norwegian Health Authority, Health complaint or Norwegian patient compensation.

Legislation and guidelines

The Norwegian Directorate of Health's supervisor 

Guide on contact doctor

Regulations on habilitation and rehabilitation, individual plan and coordinator

§ 22 Coordinator in the specialist health service

"For patients with a need for complex or long-term and coordinated services according to the Specialist Health Services Act, a coordinator must be offered, cf. Specialist Health Services Act § 2-5a. This applies regardless of whether the patient wants an individual plan.

The coordinator must ensure the necessary follow-up of the individual patient. The coordinator must also ensure coordination of the service offer in connection with institutional stays and towards other service providers and ensure progress in the work with the individual plan.

The coordinator must be healthcare personnel.”

The Patient and User Rights Act

§ 2-3. Right to renewed assessment

"Following a referral from a general practitioner, the patient has the right to a renewed assessment of his state of health by the specialist health service. The right only applies once for the same condition.”

Section 2-5 a. Right to contact doctor

"A patient who has a serious illness, injury or disorder, and who needs treatment or follow-up by the specialist healthcare service for a certain duration, has the right to have a contact doctor appointed in accordance with the Specialist Healthcare Services Act § 2-5 c."

Section 3-2. The patient's and user's right to information

"The patient must have the information necessary to gain insight into their state of health and the content of the health care. The patient must also be informed about possible risks and side effects.

If the patient or user suffers damage or serious complications, the patient or user must be informed of this. At the same time, information must be given about the right to seek compensation from Norwegian Patient Injury Compensation, to turn to the patient and user ombudsman and the right to request the supervisory authority to assess any breach of duty pursuant to Section 7-4."

Children's special rights

Section 6-3. Children's right to activity in a health institution

"Children have the right to be activated and stimulated during their stay in a health institution, as far as this is justifiable based on the child's state of health."

Section 6-4. Children's right to education in a health institution

"Children of compulsory school age have the right to education during their stay in a health institution, to the extent that this follows from the Education Act.

Young people have the right to education during their stay in a health institution, to the extent that this follows from the Education Act.

Pre-school children have the right to special educational help during their stay in a health institution, to the extent that this follows from the Education Act."

Regulations on children's stay in a health institution 

§ 2-6 Visitation with parents

"The staff are obliged to clarify with the parents which tasks the parents want and can carry out while they are with the child"

"Parents who are with the child during the institutional stay must receive relief as needed"

§ 4- 12- 14 Activation/teaching

"Children must be activated and stimulated as far as their state of health allows. A suitable area and sufficient equipment must be set aside for teaching, activating and stimulating children at different age levels"

"Pedagogical activities for pre-school children should preferably take place under the leadership of a pre-school teacher"

"Children of compulsory school age have the right to education during their stay in the institution"

Act on healthcare personnel

§ 10 a Health personnel's duty to contribute to looking after minor children who are relatives of parents and siblings.

"Healthcare personnel must contribute to looking after the need for information and necessary follow-up that minor children may have as a result of the child's parent or sibling being a patient with a mental illness, drug addiction or serious somatic illness"

"When it is necessary to take care of the needs of the patient's underage siblings, the health personnel must, among other things, offer information and guidance on relevant measures. As far as possible, this must be done in consultation with parents or others who have care for the sibling"