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Statens undersøkelseskommisjon for helse- og omsorgstjenesten

Statens undersøkelseskommisjon for helse- og omsorgstjenesten (Ukom) har som oppgave å granske svært alvorlige hendelser i helse- og omsorgstjenestene, dra lærdom fra slike hendelser slik at en for fremtiden kan unngå at slike hendelser gjentar seg.

Under det lange navnet Statens undersøkelseskommisjon for helse- og omsorgstjenesten, finner vi en ny offentlig instans som skal granske alvorlige hendelser i helse- og omsorgsvirksomheten. Fordi navnet er så langt, så vil nok de fleste angi instansen som Ukom, forkortelsen av navnet.

Ukom har egen nettside som viser hva Ukom skal gjøre, hva de har gjort og hvem de er. Men de er ikke bare nettsiden som forteller hva Ukom skal gjøre. Det er faktisk en egen lov som fortelle hva de skal gjøre.

For bedre å forstå hva Ukom er og hvordan de kan være av interesse for mennesker med utviklingshemming, så ble Ukoms direktør, Pål Iden, stilt noen spørsmål:

Pål Iden

Ukoms direktør Pål Iden som selv har en bred bakgrunn som praktiserende lege, fylkeslege og assisterende fagdirektør i Helse Vest (Foto: Elisabeth Tønnessen)

Undersøkelseskomisjonen for helse- og omsorgsvirksomheten skal granske alvorlige hendelser i helse- og omsorgsvirksomheten. Mye alvorlig skjer hele tiden. Noe er alvorlig og annet er veldig alvorlig. Hvor alvorlig må en hendelse være hvis det skal være aktuelt for Ukom å gjennomgå hendelsen?

Vi går først og fremst inn i saker som dreier seg om dødsfall eller svært alvorlig pasientskade. Det er slike hendelser vi skal bidra til å forebygge. Ukom ønsker å plukke ut hendelser som kunne skjedd hvor som helst og hvor alle kan ha noe å lære, sier Pål Iden.

Vi har allerede mange instanser som har ansvaret for at omsorgstjenestene skal være gode slik at vi ikke får alvorlige hendelser. Både kommunene og sykehusene har et ansvar for å sikre gode tjenester og god behandling. Fylkesmannen og Helsetilsynet har et ansvar. I alvorlige tilfeller kan også politiet komme inn med etterforskning og eventuell tiltale. Hvorfor trenger vi Ukom?

Ukom har som oppdrag å gå dypere inn i de alvorligste hendelsene og se disse hendelsene i sammenheng med hverandre. Vi skal ikke bare se på hva som skjedde der og da, men vurdere bakgrunnsfaktorer. Bakgrunnsfaktorer som påvirker helsehjelpen kan være lovverk, fagkunnskap, organisering, prioritering, kontrollsystemer eller ressurser. Ukom-undersøkelser vil også gå mye tettere inn på pasientens og de pårørendes historie for å ta lærdom av denne.

Det er mange pasienter. Eldreomsorgen er omfattende og svært mange mottar kommunale omsorgstjenester. Mennesker med utviklingshemming er en lite gruppe som ofte er svært avhengig av tjenester gjennom hele livet. Vi er en såpass liten gruppe at vi ofte glemmes ut. Hvordan vil Ukom sikre at tjenestene til mennesker med utviklingshemming er i fokus?

Ukom vil ha særlig oppmerksomhet på tjenester til pasienter som trenger hjelp mest, og som er avhengig av trygg og tilrettelagt helsehjelp. Mennesker med utviklingshemming er spesielt avhengig av godt planlagte og koordinerte helse- og omsorgstjenester. Dette gjør at tjenester rettet mot mennesker med utviklingshemming vil være særlig aktuelt for Ukom å se på.

Hvorfor er det viktig å gjennomgå alvorlige hendelser?

Det er alltid noe å lære av det som går galt. Ved å gå i dypet på disse hendelsene, og lære av dem, kan vi forebygge nye hendelser og gjøre tjenestene tryggere. Dessuten har pasienter og pårørende også et behov for å få vite hva som har gått galt.

Hvordan kan en komme i kontakt med Ukom og varsle om alvorlige hendelser?

Både kommuner og sykehus er pålagt å varsle myndighetene om alvorlige pasientskader og hendelser. Ukom mottar disse varslene. I tillegg kan hvem som helst gå inn på vår hjemmeside og varsle oss gjennom en trygg kanal.

Hvem henvender seg til Ukom og hvordan fanger dere opp sakene som dere gransker?

Vi får henvendelser fra pårørende, pasienter og helsepersonell fra hele landet. Vi fanger også opp viktige tema fra media og bekymringer som formidles gjennom dialog med fagmiljø eller brukerorganisasjoner.

Hvor mange alvorlige hendelser har Ukom kapasitet til å gjennomgå per år?

Vi gjennomgår flere hundre varsler hvert år for å finne viktige tema eller spørsmål som vi skal gå inn i med en undersøkelse. Bare et fåtall av hendelsene blir brukt i selve rapportene for å belyse et bestemt tema for læring. Alle varslene vi mottar, går likevel inn i den kunnskapen som vi bruker i våre rapporter. Ofte vil rapportene våre bygge på flere hendelser og gjentatte varsler rundt liknende problem.

Den første rapporten fra Ukom omhandlet en ung kvinne med utviklingshemming og psykiske lidelser som døde mens hun var under behandling for sine psykiske lidelser. Hva kan en lære fra den saken og hvem bør lære noe av den saken?

Saken retter seg først og fremst mot institusjoner innen psykisk helsevern. Rapporten inneholder mange læringspunkter, og jeg vil mene at de fleste av disse kan ha stor verdi også for andre tjenesteområder som gir hjelp til særlig sårbare mennesker. Noen av læringspunktene er:

  • det er viktig med individuell tilpassing av behandlingen, særlig hos personer som er spesielt sårbare, eller som er i en særlig sårbar fase
  • lokalene må være egnet for sårbare mennesker med stort behov for trygghet og som er spesielt følsomme for støy, uforutsigbarhet og uro. Lokalene i seg selv bidrar til om behandlingen er omsorgsfull og verdig
  • avdelinger bør jevnlig invitere pårørende eller tidligere pasienter på befaring i lokalene med spørsmålet: Er dette et godt sted å være?
  • somatisk kompetanse må være på plass også på avdelinger som behandler pasienter med psykisk lidelse. Fysisk og mental helse henger sammen.
  • det er viktig med somatisk overvåking av pasienter som behandles med sterke medisiner i kombinasjon, også i psykisk helsevern
  • ulike yrkesgrupper må samarbeide tett om felles mål det er viktig å styre bemanningen slik at behandlere og miljøpersonale blir stabile rundt den enkelte pasient
  • det er viktig å styre bemanningen slik at behandlere og miljøpersonale blir stabile rundt den enkelte pasient
  • ledere må involvere seg og sørge for refleksjon rundt behandlingstiltak og lokal behandlingskultur

 

Direktør Pål Iden synes også å ha fulgt prinsippet om ulike yrkesgrupper som må jobbe tett om felles mål i Ukoms rekruteringspolitikk. Blant dem som jobber i Ukom, finner vi et bredt spekter av fagfolk, blant annet leger og sykepleiere med ulik spesialitet, vernepleier, sosiolog, psykolog, statsviter, jurist.

Det å unngå alvorlige hendelser er et viktig kjennetegn med gode tjenester. Rapportene fra Ukom vil kunne gi et godt faglig grunnlag for å bidre til gode tjenester også for mennesker med utviklingshemming.

Jens Petter Gitlesen

2 september 2020

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