This paper seeks to draw attention to the historical and institutional context of Norwegian home care and to the way in which care agencies have been pressed to reconcile…
Abstract
Purpose
This paper seeks to draw attention to the historical and institutional context of Norwegian home care and to the way in which care agencies have been pressed to reconcile competing demands caused by conflicting policy aims and administrative values. The paper also aims to explore how ideas of contractual management have been interpreted and put into practice in this field of tension.
Design/methodology/approach
The study draws on policy documents, historical and social research reports, and personal interviews with managers and home care staff from three different case studies representing different eras of management ideas. From this micro perspective the study examines professional work as the intersection between new public management and the health care state.
Findings
The findings demonstrate how contractual management is highly influenced by competing drivers of change. Reforms, stressing cost reduction, do not act as a unidirectional reform programme. Instead, they are infused with administrative arguments linked to previous reform ideas aiming to create legitimacy both from “above” and from “below”. The dynamic of change often has unintended consequences which in turn prompt further reform efforts.
Originality/value
The paper provides insights into the complexity of change following on from New Public Management (NPM). More specifically, change is characterised by tensions originating in competing normative drivers as well as the co‐existence of old and new forms of organising.
Details
Keywords
The paper seeks to explore how universal welfare arrangements based on needs testing may change and assume different institutional forms. Drawing attention to Norwegian home care…
Abstract
Purpose
The paper seeks to explore how universal welfare arrangements based on needs testing may change and assume different institutional forms. Drawing attention to Norwegian home care, the paper explores how established interpretations of needs and associated notions of equity among needs have been challenged by shifting modes of governance.
Design/methodology/approach
The study draws on policy documents, interviews and observation from three different case studies undertaken at different points in time representing different eras of governance. From this perspective, the study examines the role of professionals taking part in needs assessment.
Findings
The studies indicate that routines for needs assessment in home care are contingent on shifting logics of governance. A shift in policy of needs testing may be described as a shift from a personal situated approach encouraging “creative justice” towards a detached and impartial approach better equipped to ensure “proportional justice”. The latter approach has become more dominant as heightened attention has been paid to citizens' rights. It is, however, questionable to what extent it will improve the preconditions for treating citizens with equal concern and respect.
Research limitations/implications
The case study approach underlying the study is incapable of providing generalised conclusions about the development in all Norwegian municipalities.
Originality/value
Universalism is often talked about as a stable feature of the Nordic welfare system. Drawing attention to the underlying and elusive notions of needs, the study makes explicit some unstable aspects of universalism.
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Keywords
Viola Burau and Signy Irene Vabo
The purpose of this paper is to introduce the papers included in this special issue and discuss the theme – shifts in Nordic welfare governance.
Abstract
Purpose
The purpose of this paper is to introduce the papers included in this special issue and discuss the theme – shifts in Nordic welfare governance.
Design/methodology/approach
The paper discusses the major themes and sets out the structure of the special issue.
Findings
The picture emerging is mixed and there is evidence for strong decentralisation where policy instruments allow for considerable local room to manoeuvre. Organisational arrangements for governance are also highly localised, but (over time) oscillate between decentralisation and centralisation. As for the consequences for universalism, the contributions point to three contrasting scenarios. The first, relatively optimistic assessment suggests that while decentralisation challenges territorial equality, in some Nordic countries there seems to be inbuilt self‐correcting mechanisms pulling in the opposite direction. The second scenario is more critical and here it is argued that shifts in welfare governance, such as decentralisation and the introduction of elements of self and market governance, challenge universalism; universalism has become highly contingent on local circumstances and the practice of welfare delivery mixes different types of justice. The final scenario is rather pessimistic about the prospects of universalism and suggests that the shifts in welfare governance challenge universalism on all counts and lead to a wide range of new inequalities among citizens. This echoes the analysis of non‐Nordic countries in Europe where the scope for universalism remains limited.
Originality/value
The contribution of this special issue is twofold. First, using elderly care as a case study, the special issue analyses the complexity of welfare governance by looking at changes in both the vertical and the horizontal dimensions of governing. Second, focusing on Nordic countries, it assesses the substantive implications of shifts in welfare governance, notably in terms of universalism.