The Swedish Agency for Public Management

The establishment of the Health and Social Care Inspectorate. Interim Report (2014:13)

Statskontoret has been commissioned by the Government to follow up the establishment of the Health and Social Care Inspectorate (IVO). IVO was established on 1 June 2013, wherein it took over supervisory and certain licensing activities from the National Board of Health and Welfare. The agency's tasks consist primarily of supervision and license examination with regard to health and medical care, social services and services under the Act concerning Support and Service for Persons with Certain Functional Impairments.

This report is an interim report. Statskontoret will submit a final report by 31 March 2015.

Statskontoret's overall assessment of IVO's initial work is that the agency is working with those areas identified in the bill constituting the basis for the establishment of the agency. In order for IVO to establish a more effective supervision for the future, it is necessary, inter alia, for the agency to obtain control over the increasing caseload and establish an effective IT system for the monitoring of cases.

The operations have progressed without major disruptions

During the agency's first ten months, the operations have progressed without major disruptions. Statskontoret's assessment is that the change process initiated by the agency is in line with the justification behind IVO's establishment.

IVO needs to gain control of the caseload

IVO took over activities from the National Board of Health and Welfare which involve a high caseload. IVO is now reviewing its case processes, but it is too early to identify any clear effects of this work. Statskontoret can observe that the caseload has continued to increase since IVO was established. Currently there are over 10,000 open cases. The majority consist of individual complaints against health and medical care. Statskontoret's follow-up also shows that the processing times are longer. For nearly a quarter of complaints cases against health and medical care, the processing time exceeds one year. The age of the open cases indicates that processing times will remain long in the near future. According to Statskontoret's assessment, the lengthy processing times represent a legal problem for both patients and reported healthcare professionals.

IVO needs to develop the IT systems

IVO has taken over the National Board of Health and Welfare's IT systems for managing and monitoring activities. As part of the change process, the agency needs to develop these IT systems. However, Statskontoret can observe that the system deficiencies that existed in the past still remain. For example, it is not possible to use the systems to find out if a care provider has recurring deficiencies. Difficulties obtaining information mean that various compilations for analysis need to be done manually. There are also deficiencies in the data quality. For example, in some cases there are no clear definitions of the information that administrators need to register.

Statskontoret's assessment is that IVO has not sufficiently prioritised the development of an effective IT system. According to Statskontoret, such a system is necessary in order for IVO to exercise effective and uniform supervision. IVO needs, for example, to be able to analyse caseloads, compile the results of supervision at an aggregate level, and produce supporting data for risk analyses.

IVO needs to monitor the uniformity of the supervision

Statskontoret notes that IVO has initiated certain measures which could ultimately promote uniform supervision. For example, the conditions for raising fundamentally important issues within the agency have been improved. Statskontoret's follow-up shows that there are differences in how cases are handled within IVO. The administrators at the regional departments do not always receive clear support in their processing of cases. For example, there are still no assessment criteria for several areas. Furthermore, IVO currently lacks methods for monitoring the uniformity of the supervision. There is thus a long-term risk that supervision will not be conducted in a uniform manner.

Statskontoret believes that IVO needs to develop methods for monitoring the uniformity of its case administration and its decisions. Statskontoret would especially like to point out that there are good examples to be obtained from other agencies. For example, the Swedish Migration Board uses its IT support to monitor uniformity.

IVO needs to free resources for developing risk analyses

In order for supervision to become more effective, it is necessary, according to the Government, that the supervision is based on risk analyses. Although IVO has initiated development work within the area, the agency's supervision is currently not based on strategic risk analyses. According to Statskontoret, IVO needs to free resources in order to conduct supervision to a greater extent using strategic risk analyses as a basis. At the same time, Statskontoret notes that IVO allocates three-quarters of its resources to individual complaints, reports in accordance with lex Maria and lex Sarah, and the regular supervision of accommodation for children and young people. In the management of these tasks, the agency cannot and shall not base its work on strategic risk analyses.

One way to increase the scope for risk-based supervision is to implement the proposals regarding changes in complaint handling that Statskontoret presented in the report Patient complaints and patient safety. This applies both to the proposed amendments to the Swedish Patient Safety Act and to the proposals for changes in IVO's processing procedures. The proposals would provide IVO opportunities to shorten the processing time for complaints and transfer resources to risk-based supervision.

Statskontoret's proposal

Statskontoret proposes that the Government:

  • contemplate initiating the amendments to the Swedish Patient Safety Act as proposed by Statskontoret in the report Patient complaints and patient safety (2013:24).

Statskontoret proposes that IVO:

  • give top priority to the work with developing effective BPM systems and monitoring systems,
  • prioritise the development of methods for assessing the uniformity of its case administration and its decisions, and
  • implement the proposals regarding changing procedures for handling individual complaints which Statskontoret submitted in the report Patient complaints and patient safety (2013:24).