sou · H6B377 · 2018-11-01 00:00:00 — The Inquiry’s assessment is that, despite agreement among stakeholders on the shortages and their consequences in - terms of ward closures and cancelled operations, care providers lack management systems to help produce sustainable forecasts of skills requirements in their skills supply planning. Other factors that make it to assess access to and the need for specialists include the lack of requirements placed on care providers when it comes to monitoring and mapping skills, the lack of services for specialist nurses and the lack of work duty definitions in the work identify- cation system, as well as the fact that only a few work duties within health care require specific training in order to be carried out. Over- all, the Inquiry is of the opinion that these factors have led to the current shortage and to the specialist nursing profession not being seen as attractive. However, there are measures that can be taken to rectify the problem. The recruitment of specialist nurses is one area that can be improved by stating which specialisation is sought for advertised positions in job adverts. adverts are often drawn up in such a flexible that it is not clear whether or not specialist knowl- edge is required. The majority of adverts state that a nurse with basic training is required, and that specialist knowledge would be an advantage. It is not clear to applicants whether specialist knowledge would make a difference. It is also hard to know anything about the difficulty of the work duties and whether there is any salary scope for specialist knowledge when the advert suggests that basic training would be enough. Against this background, the Inquiry proposes that health and care’s requirements for quality within health and operations should be systematically and continuously developed and ensured, that they should refer specifically to operational skills supply and skills development in relation to advanced clinical specialist nurses, midwives, radiographers and specialist nurses, and that good quality care should be provided by health and staff who have the right skills for the job. The Inquiry’s assessment is that care pro- viders should use the prescribed management system as a tool for inventorying, identifying and planning for healthcare’s skills supply and skills development in both the long and short terms. Measures required to improve the attractiveness of the specialist nursing profession Good examples that care providers can adopt The Inquiry has identified a number of good examples of measures that can be taken by care providers to improve the attractiveness of the specialist nursing profession. Care providers should define the duties of specialist nurses so that these duties are seen and valued correctly within the work identification system. This would also allow for a higher degree of salary differentiation than is currently the case, as the work duties carried out by specialist nurses would be recognised. Care providers should create specific positions for specialist nurses based on the relevant specialisation, to both clarify and highlight the need for these and thus increase the incentives for nurses to carry out specialist training. At the same time, the creation of positions will represent a tool for care providers in their skills supply planning. Care providers should also carry out the necessary measures to improve the working environments for nurses and specialist nurses in the form of plans and routines to ensure systematic further training, models for reducing working hours and mapping action plans for workloads and stress-related sick leave. Care pro- viders should also work systematically to improve managers’ leader- ship, for example through training and other skills improvement initiatives. Measures that the state can carry out The Inquiry reports on three different measures that the state can carry out to increase the attractiveness of and access to trained specialist nurses. The first proposal, on management system requirements for systematic operational development for skills provision, has been described above. The second proposal involves placing demands for systematic and ongoing further training in order for to meet the requirements of the Directive on the recognition of professional qualifications (2013/55/EU) and to improve patient safety. Despite the legislation requiring health and care staff to carry out their work in compliance with science and proven experience, the Inquiry is of the opinion that the updating of existing training is currently almost non-existent. The requirement for member states to ensure that the conditions are in place for health and care staff to carry out further training is not covered in Swedish law. The Inquiry’s third proposal involves an increase in the number of independent higher education courses within subject areas of relevance to advanced clinical specialist nurses, midwives, radio- graphers and specialist nurses. In order for higher education’s research and scientific developments to benefit healthcare, further training at higher education institutions must be made possible to a greater extent than is currently the case. Higher education instituteions should therefore provide a broad, flexible and predictable offering of independent courses for the purposes of continuing and further education. The content of these courses should be adapted to follow developments within healthcare. The remit to educational institu- tions should be given over consecutive four-year periods, for which earmarked funding should be provided. The total funding for this remit is estimated at million per year. Introducing advanced clinical specialist nurses as a new regulated profession the course of the last 20 years, Swedish health and care –within which specialist nurses will work – has undergone many changes. In general, healthcare has become more complex in both and technological terms while the number of hospital beds has fallen, and a large proportion of healthcare is now provided outside hospitals. Healthcare also faces challenges involving the fragmentation of healthcare management with an unclear distribution of roles and a lack of coordination between in-patient and out-patient care, with a large number of actors working within both forms of care. This requires access to highly trained nurses who can coordinate healthcare and provide accurate information about patients’ conditions so that patients can decide for themselves how to promote good health, manage their diseases and know when they need to ask for help with their conditions. In order to meet the needs of the health and care of the future and its changing requirements, an additional specialist level should be introduced over and above the current Postgraduate Diploma in Specialist . The Inquiry proposes that a new higher education professional qualification be introduced at second- cycle level. The Advanced Clinical Postgraduate Diploma in Specialist should form the basis for qualification as an advanced clinical specialist nurse. This two-year programme should reflect the needs in the Swedish healthcare context and represent a new professional role that leads to increased quality of care for patients through in-depth knowledge within both science and care science, giving nurses the tools needed to take overall responsibility for the patient within the chosen specialisation. The advanced clinical specialist nurse should act both autonomously and in cooperation with other professions, and should diagnose disease and ill-health, refer patients if necessary, provide self-care advice, teach and supervise colleagues and students, and coordinate care interventions. In practice, advanced clinical specialist nurses can – to a greater extent than specialist nurses – run their own clinics, as a result of their authorities and their in-depth knowledge, in e.g. rural areas for older patients with multiple diagnoses and a significant need for continuity within the care chain, thereby promoting equality. The professional role will also increase attractiveness for nurses by offering an additional career path for nurses who want to carry out specialist training. An amended Postgraduate Diploma in Specialist Ongoing developments within health and care create a continuous need for new education programmes and changes to existing programmes to ensure that they keep abreast of healthcare needs and developments. The Inquiry proposes that the Post- graduate Diploma in Specialist should continue to be a professional qualification at second-cycle level that is achieved on completing course requirements worth 60 higher education credits. The qualification should have four specialisations: three set specialisa- tions and a fourth different specialisation. The three set specialisa- tions should be anaesthesia care, intensive care and operating theatre care. These specialisations should be regarded as beginner professions that aim to maintain the necessary skills needed in society within the fields of emergency care, operating theatre care and intensive care. The design of specialist nurse training makes it sustainable in the long term in accordance with the principles that apply for the qualification descriptors. Different content structure can lead to the same objectives, and the educational institutions should have both freedom and responsibility for the choice of different paths that lead to these objectives. The Inquiry’s proposed Postgraduate Diploma in Specialist also reduces lock-in effects for specialist nurses, and can ensure that nurses – with their broad expertise and in-depth knowledge bases – can work within each specialisation area to a greater extent than is currently the case. Entry requirements for the Postgraduate Diploma in Specialist The Inquiry’s assessment is that specific eligibility requirements for specialist nurse training may present an obstacle to the supply of specialist nurses. If higher education institutions set specific eligibility requirements in the form of professional experience, those individuals who do not have professional experience cannot be accepted for the programme. It is probably reasonable to assume that without specific eligibility requirements, more students would be accepted for specialist nurse training. It should still be up to each educational institution to decide on specific eligibility requirements for specialist nurse training. The Inquiry would particularly like to emphasise that, according to the legislation, the specific eligibility requirements imposed must be necessary for the student to be able to assimilate the education successfully. Continued state responsibility for specialist nurse training The Inquiry’s assessment is that the state should continue to be responsible for specialist nurse training, and that this training should be provided in the form of higher education and by individual education providers. This is to ensure that work duties can continue to be carried out on the basis of science and proven experience. Proposals to strengthen cooperation between educational institutions and care providers training and research agreements should be entered into between the state care providers In order to strengthen quality and provide the necessary number of work-based training places, educational institutions and care providers should enter into a work-based training and research agreement, similar to the national training and research agreements for doctors. The Inquiry is of the opinion that an agreement will improve the conditions for planning the work-based training for the parties to the agreement, by ensuring access to the necessary number of work- based training places, improving the quality and monitoring of operations, creating equivalent payment levels and reducing the administrative burden on educational institutions and care providers. The agreement will also contribute towards an important strengthening of care science research through the provision of million per year. This funding should be allocated within the framework of the agreement’s regional cooperation, and aims to both encourage more combined employment for specialist nurses and increase the quality of care through care science research findings reaching out to patients and being put into practice to a greater extent than is currently the case. A council within the Government Offices for cooperation at national level There is a need to further formalise the cooperation on training and skills supply issues for advanced clinical specialist nurses, midwives, radiographers and specialist nurses. The Inquiry therefore proposes that a council should be established within the Government Offices to deal with strategic issues on cooperation between the state and authorities. The council will allow the Government to obtain infor- mation on an ongoing basis on issues relating to the skills supply for these professional groups, and on various training issues such as dimensioning and course offering based on access and need fore- casts, as well as how more effective use can be made of existing skills. The council shall consist of the programmes’ stakeholders in the form of representatives from e.g. professional associations and trade unions, specialist associations, educational institutions, care providers (county councils, municipalities, private actors, etc.) and certain ministries and government agencies. A need to change the qualification descriptor for midwife training The Inquiry is of the opinion that changes need to be made to the qualification descriptor for the Postgraduate Diploma in Midwifery, but does not propose making changes to the programme itself. It is stated in the Inquiry’s directive that the scope of the qualification should remain the same, in other words 90 higher education credits, and that the requirement to issue authorisation as a midwife should also remain. The and all the educational institutions that train midwives have requested direct training to become a midwife, or alternatively an extension to the current training. These stakeholders are of the opinion that the current training does not include all the knowledge deemed necessary for professional practice as a midwife. In January 2018, the Inquiry appointed a reference group consisting of experts within midwife training to discuss the design of an amended training programme. Unfortunately, the participants in the reference group stated that they did not intend to support the Inquiry in the work involved with an amended training programme. The Inquiry believes that there is a lack of support for a reform process in relation to an amended midwife training programme within the scope of the Inquiry’s remit, and the Inquiry has not therefore been able to carry out this aspect of the remit. A Postgraduate Diploma in Specialist should not be introduced within higher education The Inquiry is of the opinion that a Postgraduate Diploma in Specialist should not be introduced within higher education. The Inquiry’s perception is that the scope of each specialist area does not currently correspond to a professional qualification worth 60 higher education credits. The Inquiry’s analysis and assessment should be seen in the light of the limited time made available to the Inquiry. The Inquiry therefore proposes that the Government should com- mission the Swedish Higher Education Authority with investigating further the existing conditions for those educational institutions with degree-awarding powers for a Bachelor of Science in Diagnostic Radiology Nursing to provide a Postgraduate Diploma in Specialist . The Inquiry is of the opinion that there are rapid developments within the field of radiology in both technological and terms, placing significant demands on access to continuing and further training for radiographers. The Inquiry wishes to em- phasise the educational institutions’ opportunities to offer general qualifications, meaning that several institutions already offer both education programmes and independent courses for radiographers at second-cycle level. Independent courses for radiographers at second-cycle level are currently largely lacking. The current course offering is too narrow to meet healthcare’s skills development needs. Against this background, the Inquiry proposes a greater number of independent higher education courses, as described previously. 1.1Förslag till lag om ändring av hälso- och sjukvårdslagen (2017:30) Härigenom föreskrivs att 5 kap. 1 och 4 §§ hälso- och sjukvårdslagen (2017:30) ska ha följande lydelse. samheten ska bedrivas så att samheten ska bedrivas så att kraven på en god vård uppfylls. kraven på en god vård uppfylls. Det innebär att vården särskilt Det innebär att vården särskilt 1. vara av god kvalitet med 1. vara av god kvalitet med god hygienisk standard, god hygienisk standard, 2. tillgodose patientens behov 2. tillgodose patientens behov av trygg het, kontinuitet och 4. främja goda kontakter mel- 4. främja goda kontakter mel- lan patienten och hälso- och lan patienten och hälso- och 5. vara lätt tillgänglig 5. vara lätt tillgänglig, och 6. utföras av hälso- och sjuk- vårdspersonal som har kompetens Kvaliteten i verksamheten ska systematiskt och fortlöpande utvecklas och säkras och särskilt avse verksamhetens kompetens- försörjning avseende avancerade kliniska specialistsjuksköterskor, barnmorskor, röntgensjuksköter- skor och specialistsjuksköterskor. Kvaliteten i verksamheten ska systematiskt och fortlöpande utvecklas och säkras. Denna lag träder i kraft . 1.2Förslag till förordning om ändring av hälso- och sjukvårdsförordningen (2017:80) Härigenom föreskrivs att 5 kap. 5 § hälso- och sjukvårdsförord- ningen (2017:80) ska ha följande lydelse. Behörig för anställning som barnmorska, fysioterapeut, psy- kolog, psykoterapeut, sjukhus- fysiker eller sjuksköterska är den som har legitimation för sådant yrke och, vad gäller psykolog, även den som genomgår före- skriven praktisk tjänstgöring. Denna förordning träder i kraft . 1.3Förslag till lag om ändring av patientsäkerhetslagen (2010:659) Härigenom föreskrivs i fråga om patientsäkerhetslagen (2010:659) dels att 4 kap. 1 och 4 §§ och 6 kap. 1 och 2 §§ ska ha följande dels att det ska införas en ny paragraf, 6 kap 18 §, av följande lydelse. Den som i enlighet med vad som anges i nedanstående tabell har avlagt högskoleexamen eller har gått igenom utbildning och som, i förekommande fall, fullgjort praktisk tjänstgöring ska efter ansökan få legitimation för yrket. Legitimation får inte meddelas om förhållandena är sådana att legitimationen skulle ha återkallats enligt bestämmelserna i 8 kap. om sökanden hade varit legitimerad. En legitimerad psykoterapeut ska i samband med sin yrkesut- övning ange sin grundutbildning. Regeringen eller den myndighet som regeringen bestämmer får i de fall som anges i tabellen meddela föreskrifter om vilken utbild- ning och praktisk tjänstgöring som krävs för att få legitimation. 1Senaste lydelse 2013:1149. Regeringen får meddela föreskrifter om att även andra utbild- ningar än dem som anges i tabellen ska ge rätt till legitimation. Den som i enlighet med vad som anges i nedanstående tabell har avlagt högskoleexamen eller har gått igenom utbildning och som, i förekommande fall, fullgjort praktisk tjänstgöring ska efter ansökan få legitimation för yrket. Legitimation får inte meddelas om förhållandena är sådana att legitimationen skulle ha återkallats enligt bestämmelserna i 8 kap. om sökanden hade varit legitimerad. En legitimerad psykoterapeut ska i samband med sin yrkesutöv- ning ange sin grundutbildning. Regeringen eller den myndighet som regeringen bestämmer får i de fall som anges i tabellen meddela föreskrifter om vilken utbild- ning och praktisk tjänstgöring som krävs för att få legitimation. 4. avancerad klinisk Regeringen får meddela föreskrifter om att även andra utbild- ningar än dem som anges i tabellen ska ge rätt till legitimation. Behörig att utöva yrke som Behörig att utöva yrke som barnmorska, läkare, apotekare, avancerad klinisk spe- cialistsjuksköterska, barnmorska, endast den som har legitimation läkare, receptarie och tandläkare för yrket eller som särskilt är endast den som har legi- förordnats att utöva det. timation för yrket eller som sär- skilt förordnats att utöva det. nalen ska utföra sitt arbete i nalen ska utföra sitt arbete i skap och beprövad erfarenhet. och avancerade kliniska specia- sin kompetens systematiskt och En patient ska ges sakkunnig En patient ska ges sakkunnig och omsorgsfull hälso- och sjuk- och omsorgsfull hälso- och sjuk- vård som uppfyller dessa krav. vård som uppfyller dessa krav. Vården ska så långt som möjligt Vården ska så långt som möjligt utformas och genomföras i samråd med patienten. samråd med patienten. ska visas omtanke och respekt. ska visas omtanke och respekt. Den som tillhör hälso- och sjukvårdspersonalen får endast fullgöra uppgifter som han eller hon har kompetens för och bär själv ansvaret för hur han eller hon fullgör sina arbetsuppgifter. Den som tillhör hälso- och sjukvårdspersonalen bär själv ansvaret för hur han eller hon fullgör sina arbetsuppgifter. Regeringen eller den myn- dighet som regeringen bestämmer får meddela föreskrifter om krav på fortbildning för avancerade kliniska specialistsjuksköterskor, barnmorskor, röntgensjuksköter- skor och specialistsjuksköterskor i enlighet med 6 kap. 1 §. Denna lag träder i kraft . 1.4Förslag till förordning om ändring av patientsäkerhetsförordningen (2010:1369) Härigenom föreskrivs att 7 kap. 4 § och 8 kap. 1 och 5 §§ patient- säkerhetsförordningen (2010:1369) ska ha följande lydelse. får meddela ytterligare föreskrifter om skyl- digheter för hälso- och sjuk- vårdspersonalen som behövs till skydd för människors liv, per- sonliga säkerhet eller hälsa. Avgift tas ut för prövning av ansökan enligt patientsäkerhets- lagen (2010:65) eller enligt denna förordning i de fall som anges i tabellen. För ansökningsavgiftens storlek m.m. gäller 10–14 §§ avgiftsför- ordningen (1992:191), varvid följande avgiftsklasser ska tillämpas: 1Senaste lydelse 2016:161. Legitimation (ej tidsbegränsad) Kiropraktor, läkare, naprapat, psykolog, Apotekare, arbetsterapeut, audionom, barnmorska, biomedicinsk analytiker, dietist, fysioterapeut, logoped, optiker, ortopedingenjör, receptarie, röntgensjuksköterska, sjukhusfysiker, sjuksköterska, tandhygienist eller Bevis om specialistkompetens (ej tidsbegränsad) Bevis om rätt att kalla sig specialistsjuksköterska Avgift tas ut för prövning av ansökan enligt patientsäkerhets- lagen (2010:65) eller enligt denna förordning i de fall som anges i tabellen. För ansökningsavgiftens storlek m.m. gäller 10–14 §§ avgifts- förordningen (1992:191), varvid följande avgiftsklasser ska tilläm- pas: Legitimation (ej tidsbegränsad) Kiropraktor, läkare, naprapat, psykolog Apotekare, arbetsterapeut, audionom, avancerad klinisk specialistsjuksköterska, barnmorska, biomedicinsk analytiker, dietist, fysioterapeut, logoped, optiker, ortopedingenjör, receptarie, röntgensjuksköterska, sjukhusfysiker, sjuksköterska, tandhygienist eller Bevis om specialistkompetens (ej tidsbegränsad) Bevis om rätt att kalla sig specialistsjuksköterska 1. vilka moment som ska ingå i 1. vilka moment som ska ingå i patientsäkerhetslagen (2010:659), patientsäkerhetslagen (2010:659), 2. hur information ska ges till 2. hur information ska ges till ingå i en patientsäkerhetsberät- ingå i en patientsäkerhetsberät- 4. vilka åtgärder eller villkor 4. vilka åtgärder eller villkor som får ingå i en prövotidsplan som får ingå i en prövotidsplan och för att optiker ska få rekvi- och för att optiker ska få rekvi- 1Senaste lydelse 2017:94. förskriva läkemedel och om den förskriva läkemedel och om den behörighet som sådan kompe- behörighet som sådan kompe- morskor för att de ska få för- morskor för att de ska få för-