IVO is also responsible for issuing certain permits in these areas. Its supervision remit covers the processing of complaints concerning, for example, the reporting of irregularities in health care and social care (called lex Sarah and lex Maria reports) and the municipal obligation to report non-enforced decisions.
IVO conducts supervision of services in the area of social services, in health care and for people with disabilities, activities under the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS), and supervision of health care professionals in their professional activities.
Health care and social services affect everyone, directly or as a close relative, in different ways in different phases of life.
Under the Health and Medical Services Act all citizens shall be given good care on equal terms irrespective of where in the country they live. The individual patient, care receiver or relative must be able to be sure that the Act is followed and that their interests are safeguarded. It is important to be able to count on the rules concerning processing, safety, equal treatment and the right to a particular service actually being complied with. Supervision means an independent and free-standing examination that laws and other regulations are followed.
Health care, LSS activities and social services often require well-coordinated and integrated interventions by service providers. This is equally applicable to elderly care, rehabilitation and the area of functional impairments and to psychiatry and dependency care. The dividing lines between the responsibilities of various providers are sometimes unclear. This means that at IVO we do not just examine individual services but that we also look at how the whole care chain functions and whether and how collaboration takes place between different providers.
In social care we conduct supervision of, for example, elderly housing, residential care homes for children, young people and adults, dependency care, SSA activities and individual and family care in the social services. We can also examine how a municipality has gone about placing a child or young person in an emergency or family home, but we cannot examine the homes as such.
In health care we conduct supervision of, for example, primary care, home health care, psychiatric and somatic specialist care and pre-hospital care, including ambulance services. We also have supervisory responsibility for medical care in the Prison and Probation Service and school health care.
IVO also examines health care professionals and licensed pharmacy professionals – pharmacists and dispensers. If we identify any deficiencies in their professional practice that represent a threat to the patient, we can propose various actions such as, for example, withdrawing the right to prescribe narcotic substances, further advanced training or guidance by another professional. If the deficiencies are extensive, serious or recurring, IVO can propose that the person be delicensed and lose the right to practice their profession. It is the Medical Responsibility Board (HSAN) that takes decisions in all authorisation matters concerning licensed health care professionals.
Scope of supervision
In the area of health care IVO conducts supervision of both services and licensed health care professionals. In the case of the social services and LSS activities IVO only supervises the services.
Apart from when there are special instructions in statutes or specific assignments from the government, IVO’s supervision shall mainly look at:
- services where quality and safety are assessed as low and where this may have serious consequences for the population or the individual
- services that do not have a functioning management system for quality and safety (for systematic quality work)
- licensed health care professionals where there are suspicions that the professionals are not practising their profession in a satisfactory way.
The area of health care
In the area of health care IVO’s supervision covers:
- public and private health care units such as hospitals, health centres, dental clinics, care homes, school health units and tissue banks
- licensed health care professionals (about 265 000 licensed individuals spread across 21 professional groups)
- occupational health services
- units for forensic psychiatric examinations and units where care is provided under the Compulsory Mental Care Act and the Forensic Psychiatric Care Act as regards safety for patients and staff
- the compliance of government agencies, county councils and municipalities with the Act on Protection against International Threats to Public Health
- protection against the spread of communicable diseases.
IVO’s supervision also covers medical technology.
Social services and LSS activities
In the case of the social services and LSS activities IVO’s supervision covers:
- municipal social services such as non-institutional care, social service departments (exercise of government authority), home care services, day activities, special housing and housing with special services
- services for the care and treatment of children, young people, families and adult substance misusers that are run by municipalities or private providers, and residential care homes and special residential homes for young people (run by the National Board of Institutional Care) have to be inspected twice a year.
- institutions for the care and treatment of young and adult substance misusers that are run by the National Board of Institutional Care
- the compliance of the municipalities in executing decisions favourable to individuals.
About permits and registers
IVO examines applications for permits for private services under the Social Services Act, the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS) and the Health and Medical Services Act.
We are also responsible for the registers linked to these services. Providing a service that requires a permit without holding a permit is illegal and can lead to prosecution.
Social service permits
A permit from IVO is required for private providers of services under the Social Services Act and the LSS. When the permit application is considered, an assessment is made of whether the service can be run with good quality and safety before a permit is granted. In a service looking after people who are vulnerable and at risk, the competence of the staff and the person who is responsible for the service are very important. This is part of what we assess when we consider a permit application, along with the service’s quality and management system, premises and other features.
Health care permits
IVO examines applications for permits for:
- blood services
- tissue banks
- services for the circumcision of boys (which must follow certain laws and regulations – IVO is also responsible for supervision of the service)
- syringe exchange services for injecting drug abusers, whose objective is to prevent the spread of blood-borne pathogens such as HIV, hepatitis and other blood-borne infections among injecting susbstance misuers.
In the course of one year work at IVO results in:
About 20 000 supervision decisions
- Complaint cases from individual patients or relatives
- Report cases under lex Sarah and lex Maria
- IVO-initiated cases and government assignments
About 3 300 inspections
The inspections are either pre-announced or unannounced and are conducted both in IVO-initiated cases and in connection with investigations of reports or complaints received by IVO. In addition to inspections, visits are also made to care providers to present the overall results of supervision activities in order to foster broad and systematic learning.
About 2 500 decision concerning the issuing of permits
In addition to supervision IVO is also responsible for issuing permits. Permits are required for certain privately provided services such as companies whose operations include personal assistance and residential care homes for children and young people.
A regionalised service
The approximately 450 inspectors at six regional divisions around the country conduct inspections and investigate reports and complaints. Programme officers at the Analysis and Development Division in Stockholm work on analysis and on feeding back the results of supervision work.
Brief facts about the Health and Social Care Inspectorate (IVO)
- IVO is a government agency under the Government (Ministry of Health and Social Affairs).
- IVO has a staff of about 700.
- Its supervision activities are carried out at six regional offices around the country. Permit division is located in Stockholm, as the three agency-wide divisions in Stockholm.
IVO’s mission statement
We are there for care receivers and our role is to contribute – by conducting supervision and issuing permits – to health and social care that is safe, is of good quality and is provided in compliance with laws and other regulations.
Here is how IVO’s supervision contributes to better care:
- Inspections and handling of reports and complaints
- Analysis and guidance
- Feed-back from supervision and guidance for services
- Risk-based supervision.
The Health and Social Care Inspectorate (IVO) is a director-general-led agency and Gunilla Hult Backlund is its Director-General. The agency has a staff of 700 and its operations are financed by appropriations (annual budget is about SEK 635 million). Operations are carried out at three agency-wide divisions in Stockholm and six regional offices around the country and: Umeå (North), Örebro (Central), Stockholm (East), Jönköping (Southeast), Gothenburg (Southwest) and Malmö (South). All regional divisions are responsible for:
- Supervision of services in health care and in social services
- Supervision of licensed professionals, including reports to the Medical Responsibility Board (HSAN) regarding the withdrawal of licenses and other authorisations
- Complaints by individuals about health care and social services.
The Permit division
Permit division is located in Stockholm.The Permit division examines applications for permits for private services under the Social Services Act, the Act concerning Support and Service for Persons with Certain Functional Impairments and the Health and Medical Services Act. Permits are required for, for example, certain privately provided services such as companies whose operations include personal assistance, residential care homes (HVB) for children and young people and some health care.
Centralised activities at the regional divisions
The following areas are centralised and are handled by the Division in Stockholm (East) on behalf of the whole agency.
- Supervision and other work linked to blood and tissue services
- Coordination concerning medical technology products and pharmacy supervision
- Handling of all cases concerning destruction of patient records.
The Regional Division in Örebro has a central responsibility for the transfer of cases between municipalities under the Social Services Act.
The Director-General and the three agency-wide divisions are based in Stockholm. The agency-wide divisions are the Director-General’s Office, the Support and Management Division and the Analysis and Development Division.
The Director-General’s Office provides support for the Director-General regarding the work of the agency’s management team and the external contacts of agency management.
The Support and Management Division works on strategic matters concerning finance, IT, communication, human resources and business development. There is also a central legal unit including the agency’s main registry.
The Analysis and Development Division has the main responsibility for risk analysis and analysis of the results of the supervision conducted by IVO. That Division also has the main responsibility for the development of supervision methods. The Division also houses IVO’s register operations.