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With the reform in 2002 principles from New Public Management were implemented in the managment of the hospitals in Norway. The need for reform was partly due to the hospitals inability to solve problems with regards to expenses, resource allocation, geographical variability in availability and quality and unresolved questions about unclear managerial responsabilities. NPM offered solutions to problems with accountability, trancparency and quality control. But this also ushered in a system where the professional is expected to account for one’s actions through performance measures rather than the traditional system of responsability under the trust of authorization. This transition challenges the clinicians professional autonomy and possibility to exert clinical expertise. Yet it remains critical for the welfare state to secure distribution of the patients’ right to social security and health services as an individual right. Clinical expertise without accountability is vulnerable to unintended variation and arbitrariness in service delivery, and thus represents a judiciary and democratic problem in the core of the welfare-state. Some areas of psychological practice remain outside the realm of output measures, and must remain within the clinician’s autonomous discretion. There is, however, a need to identify systems of accountability outside the "hard" data of performance measures which allow clinicians to acount for one’s actions and thus be a source of transparency and legitimacy.

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