Norwegian Perspectives on Communalisation of Service Provision
This content explores the shift from ideology to governance in service provision in Norway, focusing on principles of organization, long-term trends, closure of institutions for intellectually disabled individuals, and post-reform developments. It examines changes in responsibilities between levels of government, the push for community-based care over institutional care, and the impact on quality of living conditions.
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Presentation Transcript
Communalisation of service provision: From ideology to governance. Norwegian perspectives Jan T ssebro NTNU/ NTNU Social Research 1
Basic principles for organisation of services The division of labour I: - National responsibility for benefits (Law on social security) - Local responsibility for services Exception: assistive technology as part of the social security system The division of labour II: - The sector responsibility principle: Each sector responsible for all citizens for tasks within the sector - The LEON principle: Services should be provided by the Lowest Efficient Level of Government General services: the local governments/ municipalities Specialised services: County or state provision Diverging trend: More is seen as general services, whereas specialised services are becoming more centralised (state run) 2
Long term trends Communalisation: Reforming the division of labour between levels of government - Special education the 1970s - Elderly with care needs 1980s - Intellectual disability 1990s - Mental health 1990s?? Linked to Normalisation v1.0 - The generic system should provide for more special needs Example special education Linked to deinstitutionalisation and Normalisation v2.0 - Institutions were specialised health services that provided general care services: Close them - In some cases, a rather practical debate about division of labour between levels of government - In other cases, a pervasive reaction to the segregation of citizen groups and the living conditions provided in institutions 3
Closing institutions for intellectually disabled people: 1991-1995 A case in point The division of labour between and within levels of government: - General care is to be provided by local governments - Normalisation v1.0 applies: each sector responsible for all citizens A new system of care: - Home-based care, farewell to institutions, goodbye to governmentally planned segregation Rising ambitions concerning living conditions/ level of living: - The general welfare state principle of acceptable living conditions for all - A future development of living conditions in line with other people - Housing conditions in keeping with the general standards of the National Housing Bank (social accommodation directorate) - Normalisation V2.0 social role valorisation Strong ideological drivers of change, in alliance with practical changes in level of government 4
Post reform developments diverging trends Deteriorations: - Re-institutionalisation? Size of group homes from 3-4 to 9+ Reasons for lack of self-determination back to the days of institutions - Personal economy renting costs, renting support, additional benefits Expected long term developments that never took place - Employment/day time activities - Leisure and cultural participation - Self-determination Benefits - Community presence - New forms of support personal assistance 5
Why an analytical approach Three interacting streams defining problems , toolbox of solutions , actors and choice opportunities - The organisation and governance of the sector From division of labour to management of resources - Normalisation V1.0 becoming a part of the general local health and care system - Ideology and the welfare state Disappearing after the 1990s? Replaced by a quality focus? 6
Drivers illustrated Governance reforms financial control Governance -decentralisation Normalisation V1.0 From disability group to local health and care Living conditions, Normalisation V2.0 Disappearing/ Quality of care 7
So what, quality? Quality measurement Motivation - Factsbasedand transparent governance - Management of the sector supporting budget decisions Expectationmanagement (benchmarking) - Qualitydevelopment Choice of indicators - Input and process factors(backdoorto theadm. system), not outcomes for user The doing of indicators - The race to the bottom? - Expectation management - Qualityor tickingoffcompletedtasks? 8
In brief From a complex but ideologically driven development - Parental associations - Scandals - Professionals(some) - Social policy(acceptablelivingconditions) To a governance driven development - Budget prioritiesin a largeand expensivesector - Budget control - New public management 9
