Illustrasjon

Nei til koordinering!

Likeverdsreformen er KrF sin baby. Regjeringen har startet arbeidet med å utforme reformen. Det er en mulighet vi må gripe. Vi må legge til rette for at reformen skal kunne gi et bidrag. Makter vi ikke det, vil reformen ende opp med en samling svulstige ord.

Vi vil ha likestilling, ikke likeverd

Likestilling er likeverd, like muligheter og like rettigheter. En får ikke likestilling uten like muligheter og like rettigheter. Likeverd har gjennom historien vært myndighetenes ord på diskriminering. Slik var det under raseskille i USA. Hvite elever gikk på skoler for hvite og elever av afrikansk opprinnelse gikk på skoler for afroamerikanere. Skolemyndighetene hevdet at skoletilbudet var likeverdig for alle elever. I 1954 sa amerikansk høyesterett enstemmig at "Seperat is not equal".

Likeverd kan være det motsatte av likestilling. Uten like muligheter og like rettigheter, får en aldri likestilling!

Tomsnakk om koordinering

Folk flest tar av seg skoene før de går inn i andres hjem. Dette til tross for at det ikke er regulert i et eget lovverk. Det er snakk om det selvsagte. Slik er det også med koordinering av tjenester.

"Samarbeid mellom tjenestene på tvers av ulike sektorer og nivåer er en forutsetning for et godt hjelpe­apparat og et så selvfølgelig mål at det ikke er regulert særskilt i et eget regelverk", kan en lese fra rundskriv I-3/2004.

Problemet var bare at verken staten, fylkene eller kommunene ikke oppfylte sin selvfølgelige plikt til å koordinere tjenestene på tvers av sektorer og forvaltningsnivå. På slutten av 1990-tallet ble det stadig mer snakk om å innføre rettigheter og plikter til koordinering av tjenestene. Tiltaket var dels individuell plan (IP), dels rett og plikt til koordinator. Etter årtusenskiftet har kravet om individuell plan og koordinator spredt seg som en epedemi. Vi finner hjemling blant annet i:

  1. NAV-lovens § 15
  2. Forskrift om individuell plan i arbeids- og velferdsforvaltningen
  3. Spesialisthelsetjenestelovens § 2-5
  4. Barnevernloven § 3-2a
  5. Helsepersonelloven § 38a
  6. Helse- og omsorgstjenesteloven, kapittel 7
  7. Pasient- og brukerrettighetsloven § 2-5
  8. Psykisk helsevernlov § 4-1
  9. Forskrift om habilitering og rehabilitering, individuell plan og koordinator
  10. Sosialtjenesteloven kap. 4
  11. Introduksjonsloven § 6
  12. Opplæringsloven § 15-5
  13. Krisesenterloven § 4
  14. Friskoleloven § 3-6a
  15. LAR-forskriften § 6
  16. Forskrift om narkotikaprogram med domstolskontroll § 9
  17. Forskrift om funksjons- og kvalitetskrav for fysioterapeuter med kommunal driftsavtale § 12
  18. Forskrift om kommunens helsefremmende og forebyggende arbeid i helsestasjons- og skolehelsetjenesten § 5
  19. Forskrift om private virksomheters adgang til å yte spesialisthelsetjenester mot betaling fra staten § 3
  20. Forskrift om kvalitet i pleie- og omsorgstjenestene for tjenesteyting etter lov av 19. november 1982 nr. 66 om helsetjenesten i kommunene og etter lov av 13. desember 1991 nr. 81 om sosiale tjenester m.v. § 3
  21. Forskrift om fastlegeordning i kommunene § 19
  22. Psykisk helsevernforskriften
  23. Forskrift om kommunalt pasient- og brukerregister (KPR) § 2-1
  24. Forskrift om rettigheter og bruk av tvang under opphold i institusjon for behandling, omsorg og rehabilitering av personer med rusmiddelproblemer § 14
  25. Forskrift om nasjonal retningslinje for sosionomutdanning § 10
  26. Forskrift om nasjonal retningslinje for fysioterapeututdanning § 13
  27. Forskrift om pseudonymt register for individbasert helse- og omsorgsstatistikk § 1-8
  28. Forskrift om stønad til dekning av utgifter til fysioterapi m.m.
  29. Norsk pasientregisterforskriften
  30. Forskrift om stønad til dekning av utgifter til undersøkelse og behandling hos lege

En skulle altså tro at kravet om koordinering av tjenester var rimelig godt lovfestet.

Til tross for et hav av lovhjemler er foreldre, funksjonshemmede og partilederne bekymret over manglende koordinering av tjenestene.

- Foreldre må få bruke tiden sin på å være foreldre i stedet for å kjempe mot systemet. Målet vårt er at folk skal møte offentlige tjenester som henger sammen, og at de ikke skal oppleve tjenesteapparatet som vanskelig, sa Frp-leder Siv Jensen på regjeringens nettsider.

- Vi skal ha et samfunn med rom for alle. Foreldre som venter barn med sammensatte behov trenger ekstra hjelp og støtte i en sårbar tid. Derfor vil vi gi dem en lovfestet rett til koordinator allerede under svangerskapet, sa KrF-leder Kjell Ingolf Ropstad.

- Et viktig mål med reformen er å styrke likestillingen. Alle skal ha like muligheter til å leve et selvstendig liv og delta i samfunnet, uavhengig av funksjonsnivå, sa Venstre-leder Trine Skei Grande.

- Regjeringen har gjort mye for å gjøre livet enklere for disse familiene. Likevel vet vi at det fortsatt er utfordringer. Vi ønsker et samfunn som stiller opp og som har bruk for alle, sa statsminister Erna Solberg (H).

Siv Jensen, Kjell Ingolf Ropstad, Trine Skei Grande og Erna Solberg har utvilsomt rett. Mange kjemper endeløse kamper mot systemer som verken er koordinerte eller lette å hanskes med. Men før en innfører enda et lovkrav om koordingering, bør en spørre om hvorfor eksisterende lovhjemling av koordinering ikke funger. Vi trenger ikke flere virkningsløse lover.

Det var koordinering før lovkravene. Koordineringen er ikke blitt bedre av lovkravene. Det er pengene som råder, ikke loven. Loven er mer som en anmodning. Jeg møtte en PPT-rådgiver som skulle skrive drøyt 100 sakkyndigvurderinger i løpet av noen vårmånder. Det er forståelig at rådgiveren ikke kunne drive så mye samordning. PPT-kontoret hadde ikke budsjett til å utøve sin eneste lovpålagte oppgave.

Kommunenes evne, vilje og mulighet til å utøve de lovpålagte oppgavene står ikke i stil med pliktene og budsjettvedtakene. Helse- og sosialsektoren er kommunens største sektor med drøyt 30 prosent av driftsutgiftene. Når det ikke bevilges nok penger til å oppfylle loven, så blir loven verken interessant eller effektiv.

Det er heller ingen grunn til å etterleve et lovverk hvor det knapt er kontroll. I takt med stadig flere lovhjemler om koordinering av tjenester, er klageorganet blitt vingeklippet. Når det gjelder omsorgstjenester har fylkesmannen heller aldri hatt sanksjonmidler. Nettopp derfor viser nasjonale tilsyn på området at rettsikkerheten var elendig, er elendig og at det ikke er tegn til bedring.

Tiltak som virker

Fylkesmannen må kunne utøve en bedre kontroll med kommunale tjenester og gis sanksjonsmuligheter overfor kommuner ved alvorlige lovbrudd eller kommuner som ikke retter opp påpekte lovbrudd.

Skal likeverdsreformen få en verdi større enn papiret den blir trykket på, må barnehage, skole og overgangen fra videregående skole til arbeidsliv få hovedfokus. Opplæringssektoren er den dominerende sektoren både når det gjelder foreldrefokus og barnets tidsfordeling på ulike sektorer. For de fleste små barn med større funksjonsnedsettelser, er tjenestetilbudet stort sett begrenset til barnehage og skole, selv om det også er mange som sliter med tilleggskomplikasjoner. De øvrige tjenestene tiltar med barnets alder.

Regjeringen arrangerer fire innspillskonferanser til likeverdsreformen. Opplæringssektoren inngår ikke som tema i noen av dem. Konferansedeltakerne bør vite at snakket om lovregulering av koordinering, ikke har vært spesielt suksessrikt de siste 20 årene. Opplæringssektoren bør absolutt trekkes frem, spilles inn og presses på.

Vi har mer enn nok av politiske festtaler om betydningen av en helhetlig koordinering som er samordnet til pasienten og brukerens beste. Pass på at det kommer kjøtt på beinet!

Jens Petter Gitlesen

15 februar 2020

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