TALLINN, 12 December 2024 – In Estonia, the arrangement for detecting and responding to problematic activities by health care professionals has been cumbersome and slow, the National Audit Office finds in a review published today. The Ministry of Social Affairs and the Health Board should therefore strengthen the supervision of health care professionals, including by reviewing the roles of the different institutions and the rules on restriction of the right to practise.

The National Audit Office emphasises that although problematic practices are rare in the sector as a whole, the risks to patients must be comprehensively managed. “Fortunately, severe and recurrent medical errors, the promotion of medicine that is not evidence-based and unethical or illegal behaviour are relatively rare in Estonian medicine,” commented Rauno Vinni, Audit Manager at the National Audit Office. “However, this is a small consolation for the patients who’ve had to experience this. The means for stopping problematic activities should be more effective.”

In the opinion of the National Audit Office, some of the issues will probably never get raised, because the arrangement for filing a complaint has been relatively complicated for people. As a result, a reaction is more likely to occur when a serious violation has already occurred.

Although state supervision in the field is carried out by the Health Board, it has so far focused its attention more on verifying compliance with formal requirements. For example, the Board checks whether the staff of a health service provider are properly trained, or whether the premises and equipment comply with legislation. Unfortunately, the Health Board gives less attention to addressing substantive problems, such as cases where a health care professional promotes treatment that is not evidence-based, or behaves unethically, for example by prescribing medication without justification.

According to professional associations, public authorities have not always been forthcoming in investigating the suspicions and resolving the concerns they have raised, even though, as experts in the field, they believe this is necessary to ensure the quality of health services and patient safety.

The associations find that in the current legal space, public authorities are almost powerless to call to order problematic health care professionals who promote medicine that is not evidence-based and treat patients according to the respective principles. In Estonia, a health care professional’s right to practise can only be suspended, if necessary, for up to three years on the basis of a court ruling, or for up to one year in the event of failure to comply with a precept issued by the Health Board. However, not all cases that need attention end up in court, because it is a complex and costly process for the patient.

From 2018 to 2024, the court restricted a health care professional’s right to practise on three occasions, the reason being disciplinary issues such as illegal mediation of narcotic drugs and psychotropic substances, etc. The Health Board did not impose any restrictions on the right to practise during the same period.

The National Audit Office is of the opinion that the Health Board could be more active in controlling the activities of health care professionals and solving problems related to them also within the limits of its current tasks and rights. However, clarifying the rights of the Health Board is necessary and their possible extension is worth considering.

The roles of the authorities carrying out supervision can be confusing for people who notice problems and want to report them. It is also unclear to the agencies themselves which quality aspects should be checked by the Health Board and which ones by the Health Insurance Fund, and how exactly the agencies should react. At the moment, there is some duplication of roles, but due to the dispersal of responsibilities, there is no certainty that everything that needs to be done will get done.

The analysis “Organisation of the quality and supervision of health services in Estonia – analysis and proposals” planned by the Ministry of Social Affairs is necessary to establish a basis for restricting the activities of health care professionals that is clear and transparent for all parties involved. It is important that the analysis is not carried out just for the sake of it, but that it will lead to real changes in the system.

The Health Board has not kept the information that foreign countries have sent to Estonia about health care professionals who have been banned from practising there, but an overview of the persons who have been banned from practising in foreign countries would be necessary. Although the restrictions imposed on health care professionals in a foreign country are only valid in the respective country, it is necessary that the information on the problematic activities of health care professionals registered in the Estonian Health Organisation Information System is available for the purposes of the monitoring and/or supervision carried out by the Health Board.

The National Audit Office finds that the whole system of noticing problematic activities of health care professionals and responding to violations needs to change, and agrees that the mandatory systematic collection of patient safety cases, implemented from November 2024, creates good preconditions for this. For example, one of the objectives of the reform is to ensure that concerns about the quality of care are identified, recorded, addressed and resolved appropriately.

However, the National Audit Office notes that the new system does not deal with all problematic situations, such as the promotion of treatment that is not evidence-based and unethical behaviour. The Ministry of Social Affairs should undertake a review of the legislation and clarify the tasks of the authorities. It must be clear to all parties involved where to turn in the case of suspicions in order to get help in justified cases. The starting point for changes is the need to build trust in the system, as patients and other stakeholders need reassurance that the concerns they report will be taken seriously.

Background

Supervision of health care professionals is one aspect of ensuring the quality of health services. The National Audit Office addressed other issues of ensuring the quality of healthcare services in its report “The role of state institutions in ensuring the quality of healthcare services” published in March 2024 and the assessment of the competence of health care professionals in the report “Assessment of the competency of health professionals”, which was published in October 2024. The purpose of this review was to provide an overview of the current situation in restricting the right to practise and supervision of health care professionals, and to highlight the bottlenecks in this area.

Priit Simson
Communication Manager of the National Audit Office
+372 640 0777
+372 5615 0280

[email protected]
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http://www.riigikontroll.ee/

• Posted: 12/12/2024 10:00 AM
• Last Update: 12/12/2024 10:17 AM
• Last Review: 12/12/2024 10:17 AM