The Swedish Agency for Public Management

The establishment of the Swedish Health and Social Care Inspectorate. Final report (2015:8)

The Swedish Agency for Public Management (Statskontoret) has been commissioned by the Government to evaluate the establishment of the Swedish Health and Social Care Inspectorate (IVO). IVO was established on 1 June 2013, taking over supervisory and certain licensing activities from the National Board of Health and Welfare. The Inspectorate's role consists primarily of supervision and licensing of healthcare, social services and activities covered by the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS).

IVO's change process justifies its establishment

Statskontoret's overall assessment is that IVO's change process is consistent with the motivation behind its establishment; clear, coordinated and effective supervision. Statskontoret's evaluation also indicates that health and social care providers often implement measures on the basis of IVO's supervision.

Limited scope for risk-based supervision

One of the bases for the establishment of IVO was that its supervision would be risk-based to the greatest possible extent. So far, the Inspectorate has only been able to create marginal scope for risk-based supervision, primarily due to the volume of patient complaints. Dealing with patient complaints accounted for close to one third of IVO's costs in 2014. In total, close to 70 per cent of the Inspectorate's resources were devoted to supervision that is largely regulated by statutes and that neither can nor will be conducted based on risk: complaints, lex Maria and lex Sarah reports and the regular supervision of accommodation for children and young people.

IVO has developed several areas as expected

It has been just over a year and a half since the establishment of IVO. Statskontoret argues that in this time it can be expected that the Inspectorate will have drawn up plans for the change process for which there is a set schedule and budget, will have initiated activities and that these activities will have had some impact on operations. Statskontoret's assessment is that IVO has developed its operations in line with expectations in several areas. The Inspectorate has drawn up a supervision policy, a national risk analysis and has developed a system for feeding knowledge back to health and social care providers. However, there are other areas in which IVO has not developed to the same extent.

IVO needs to improve its internal communications and consistency

Statskontoret's assessment is that IVO needs to improve its internal communications in order to ensure that it makes the intentions of the change process a reality. Managers at all levels play a particularly important role in this. Statskontoret's assessment is also that IVO needs to improve its effort to achieve consistency when assessing similar supervision cases. For example, the Inspectorate's employees are demanding more practice and guidance before they assess cases.

Turnaround times are still long

The number of current cases decreased in 2014 in terms of complaints against the health service and social services and lex Maria reports. However, some of IVO's turnaround times are still very long, primarily those for individuals' complaints against the health service, but also those for licensing cases. The long turnaround times have detrimental consequences both for patients and service users and for health and social care providers. Statskontoret concludes that IVO's efforts to improve efficiency have not thus far reduced the turnaround times for complaints. 

Continued need to improve the case management system

IVO took over a case management system from the National Board of Health and Welfare that was not suited to the needs of the organisation. In the past year, IVO has taken a number of steps to improve the system. For example, it is now possible to obtain aggregated follow-up data from the system. However, the Inspectorate is still not able to ensure the quality of the input data and there are only limited opportunities to search the system to find similar licensing cases from other units and regional departments.­­ IVO has not yet drawn up a clear schedule and resource plan for the work of developing a case management system and tools that enable the organisation to be governed and monitored simply.

IVO's licensing activities face great challenges

The Commission of Inquiry into the Licensing of Owners has submitted proposals that would mean additional organisations, e.g. private home-help companies, will need to apply for licences from IVO. IVO will also require further expertise on top of what it currently has in order to conduct economic assessments of the companies applying for licences. In addition, the Swedish Migration Agency's prognoses indicate that the number of unaccompanied minors applying for asylum will remain at a high level, which will result in additional applications for the licensing of accommodation coming into IVO.

Long turnaround times for licensing applications, together with the increased external demands mean that IVI needs to streamline the administration process. Statskontoret conclude that IVO has now begun to revise the licensing process, but that such an overhaul has previously had a low priority.

Proposals for the Government and IVO

In order to give IVO the scope to conduct risk-based analysis, Statskontoret proposes that the Government implement the Commission of Inquiry into Complaints' proposal that care providers and the patients' commissions be the first port of call for patient complaints.

We also propose that the Government reduce the requirements for regular supervision of accommodation for children and young people in order to provide further scope for risk-based analysis. IVO has built up good knowledge of the organisations involved, which means that it should have the opportunity make the supervision of such accommodation more risk-based.

Statskontoret are also submitting several proposals to IVO. These include that it adopt a timetable for the improvement of its case management system and that it provide its senior legal officer with clear responsibility for ensuring consistency in decision-making. We also propose that the Inspectorate give greater priority to its efforts to streamline the licensing process.