From Official Supervision to Self‐monitoring: Privatizing Supervision of Private Social Care Services in Finland

In October 2011, a new Act on Private Social Care Services came into force in Finland. The Act included a provision on a ‘self‐monitoring plan’. According to the provision, providers of private social care services are required to draw up a self‐monitoring plan and to follow its realization. The plan must be kept publicly on view so that clients and their relatives can also keep an eye on the realization of self‐monitoring. In this article, self‐monitoring is first explained and then briefly analyzed against the background of a wider theoretical discussion on accountability. It is argued that the introduction of client involvement in the supervision of private social care services represents a new mechanism of accountability that is typical of the Post‐Keynesian welfare state. Because public authorities are no longer able to supervise the growing number of private social care service providers, the responsibility has been partly shifted to service providers themselves as well as to clients. However, it is argued that the idea of self‐monitoring lends itself poorly to ‘delegated’ private social care services, i.e. to services that are outsourced to private service suppliers. Supervision of private social care service providers should not be too eagerly delegated to service providers themselves, or to clients, because we are here dealing with the constitutional right to adequate social care services. Client involvement also involves numerous practical problems, as shown at the end of the article.     

The gap in social care provision for older people in China

Because of its unprecedented sociodemographic changes, particularly rapid population aging, China faces huge challenges in social care. Using data from the 2012 Chinese Longitudinal Healthy Longevity Survey (n = 9,765), this article examines the need for social care, as well as the major sources of provision. The findings indicate that the majority of older people face some restriction in their daily living activities. From their perspective, however, the most urgent social protection services are related to health care and legal aid rather than services supporting daily living. Although Chinese Government policy since the 1990s has been a strategy of social welfare socialization, the role of government, both as provider and funder, is limited and focuses only on the most deprived and on urban areas. The result is a massive “care gap” between the need for social care and its supply. The primary responsibility for care provision is borne by the family. The direction of social policy in the future should focus on shared care between the family and the state, giving priority to expanding the coverage of social care services, especially in rural areas.     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Comparative Political Economy of Long‐Term Care for Elderly People: Political Logic of Universalistic Social Care Policy Development

Despite there being common socio‐demographic pressures across advanced industrialized countries, the public elder care programmes therein tend to vary. While the current literature on social care devotes itself to describing the care arrangements of each country and pigeonholing welfare/gender regime types, it does not sufficiently address this empirical puzzle. This study looks to specify the causal relationship between political institutions and public long‐term care programmes. It argues that countries with personal‐vote‐oriented electoral systems and/or fragmented party systems have difficulties in developing universalistic public elder care programmes, whereas countries with party‐vote‐oriented electoral systems and cohesive party systems are likely to develop generous elder care programmes. For whilst the former types of political institutions prioritize patronage‐based, particularistic benefits, the latter types encourage political actors to appeal to broader constituencies through universalistic welfare programmes. This study tests this claim by examining pooled time‐series and cross‐section data of advanced democracies, from 1980 until 2001. The empirical results suggest that politicians' reliance on personal votes and the fragmentation of ruling coalitions impede the expansion of public spending for elder care.     

Micro‐provision of Social Care Support for Marginalized Communities – Filling the Gap or Building Bridges to the Mainstream?

As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro‐providers – very small community‐based organizations, which can work directly with individuals. These micro‐providers are assumed to be able to cater for the ‘seldom heard’ groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer‐reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small‐scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self‐organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community‐based micro‐providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization.     

The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?

Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi‐market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across public and private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “new normal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.     

Implementing Consumer Choice in Long‐term Care: The Impact of Individual Budgets on Social Care Providers in England

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.     

What makes hybrid insourcing successful: A new public–private partnership model for social welfare services

Outsourcing has been a key policy tool for delivering a range of social services, and regarded as more effective than insourcing or direct government provision. At the same time, it has also caused many delivery issues such as principal‐agent problems, a lack of policy coordination, and poor‐quality welfare services. While the pendulum continues to swing between insourcing and outsourcing, we aim to propose a new public–private partnership model called the “hybrid insourcing model” and examine which factors influence the performance of the model. In South Korea, around 2010, the local government in Namyangju City was the first to implement the “Hope Care Center model,” a kind of hybrid insourcing model, which has been praised for its innovation and widely emulated by central and local governments. Our analysis utilizes data collected between December 2017 and January 2018 from public sector employees and civilian staff in Namyangju and a comparable city, A. From this, we draw a number of implications, both for theory and for policy. We argue that, for public–private partnerships, active cooperation and equality are the biggest factors in contributing to positive performance. These work alongside leaders with a clear vision and with employees' positive attitude.     

Childcare policies and services in Hong Kong after the handover: Beyond a feminist critique

This article reviews the development of childcare policies and services in Hong Kong after the handover, gauging it with two standards: promoting the equal development of children and gender equality in our society. Statistics derived from data taken from multiple sources show that the government has been sticking to a “positive non‐intervention approach” to welfare development and that the male breadwinner/female carer model prevalent in this region was shaped and strengthened by current childcare policies and services. The current provision of childcare services is insufficient to guarantee the equal use of childcare among children of different socioeconomic backgrounds, or to ease the tension between the needs of childcare and job requirements in a family, or to emancipate married women from the domestic sphere. A “generative welfare approach” that collects fiscal resources and redistributes them strategically with a systemic mind‐set has been suggested for social policy and service planning, including spending the money in the right place, launching smart and practical policies that can achieve both pragmatic effects and ideological improvement in the area of gender equality, providing financial support or subsidies to a company for the provision of parental leave, and increasing the provision of quality childcare services.     

The retrenchment of public pension provision in the liberal world of welfare during the age of austerity—and its unexpected reversal, 1980–2017

Pension system adaption during the “age of austerity” since 1980 is expected to vary between industrialized countries broadly in line with their membership of conservative, liberal, or social democratic worlds of welfare. Empirical testing on the liberal world focuses on the later period and differs in its conclusions. This paper is based on a systematic study of the scale, nature, and trajectory of change in six liberal pension systems between 1980 and 2017 using expenditure, economic, demographic, and social rights data. These data are analysed using a framework developed through critical engagement with Pierson's three welfare state change criteria and the welfare state “dependent variable problem.” The paper finds a significant retrenchment of public pension provision in most liberal welfare states after 1980 but largely during the first half of the period. This has been partly reversed in most countries since the mid‐1990s, though the scale of this reversal varies between countries. The recent rise of the state in liberal systems has been noted by some commentators, but to be properly understood, the paper argues, it must be considered in the context of the significant retrenchment, which preceded it. There is a scope especially for research on the broader social context of recent reforms, particularly how middle‐income groups were affected by retrenchment and how recent reforms have mitigated this.     

Social Inequality under a New Social Contract: Long-term Care in Japan

The 1990s saw the beginning of new developments in the social policy agenda of Japan. A combination of further cuts in social expenditure and increases in financial resources through various means has become inevitable in response to the increasing cost burden of an ageing society, the prolonged recession and changes in the Japanese family. In this context, “kaigo hoken” (long‐term care insurance) was introduced in 2000 to increase revenue and fill the gap vacated by the family. The scheme introduced a different concept to the public: that long‐term care was no longer “expected’’ from the family or “allocated” by the state, but has become part of a “social contract” based upon a system of mandatory contributions, uniform entitlements and consumer choice. This paper first explores the role of the new scheme in creating social inequalities among individuals (and families). A panel survey is used to highlight different patterns of care provision and the varying degree of financial pressure among different income groups. Second, based on qualitative research, the paper examines how the new scheme has transformed the relationship between older people and their families who have played a central role in this arena. The scheme has consequently divided “traditional” families and their liberal counterparts, as a result of care work being “commodified”. It is apparent that this scheme has not only responded to fill the existing care gap but may also help accelerate the changes that have been taking place for the last two decades.     

The emerging role of Financial Counsellors in supporting Older Persons in financial hardship and with management of Consumer‐directed Care packages within Australia

The role of financial counsellors as providers of information, support and advocacy for those in financial difficulty is a well established mechanism in the mainstream welfare landscape in Australia. In general, the role of financial counsellors is in helping people alleviate or resolve their financial difficulties through improvement of their financial literacy. It is recognised as an important component of policy responses to assist low‐income households and individuals in financial stress. The use of financial counsellors for older persons (i.e., those aged 65+ years), however, appears to be underutilised. Financial hardship and abuse of older persons within our community are becoming key issues as the population of Australia “ages”. Existing evidence also suggests that service providers alone do not have adequate skills to address these issues. This paper firstly examines the development of financial counselling in Australia. It then examines the newly emerging role of financial counselling in supporting older persons in addressing barriers to financial literacy and then in navigating the complex landscape of aged care service provision. The current financialisation, marketisation and complexities of consumer‐directed care are identified as key contextual factors. The paper will then discuss an evaluation study of the provision of financial counselling to the older person population designed to support financial hardship and navigation of the complex aged care services system. The findings of the paper are based on an evaluation of the Financial Consumer Rights Council (FCRC), Victoria: Dignity and Debt Financial Difficulty and Getting Older initiative. This pilot initiative included older persons from both community‐based and aged care residential facilities in one regional area of Victoria. The initiative, conducted over 2016, was designed to assess the effectiveness of one‐on‐one financial counselling sessions with older persons that provided consumer advocacy and information about support services and entitlements (including hardship protections) associated with ageing. The evaluation found that the provision of financial counselling to the older person population could be a key mechanism in improving overall financial literacy, avoiding periods of financial hardship and in maintaining financial well‐being, quality of life and positive ageing. Findings also demonstrated a need for an expanded outreach financial counselling model to better service older persons in more isolated living environments and/or with mobility impairments living in the community, and the potential to situate offices of financial counsellors within medical centres (a space often visited by the ageing population), to co‐situate financial health check‐ups as an overall element of health and well‐being. As such, financial counselling was viewed as well placed to support older persons in improvement of financial literacy and in supporting navigation of the increasingly complex marketised and consumer‐directed care (CDC) landscape of aged care service provision in Australia.     

Local Voices in an Internal Market: The Case of Community Health Services*

This paper presents findings from a study of contract specification and implementation in community health services (CHS). In this paper, we focus on one aspect of that study: the role of local people in informing the assessment of health needs and in determining the provision of community health services in the context of the NHS “internal market”. The paper is based on fieldwork undertaken in three districts within one region. Analysis of data obtained from these localities suggests that while there appears to be a genuine commitment to the principle of local involvement, ideas about how that involvement can be built into the activities of either purchasers or providers are less transparent.     

Querulous Citizens: Welfare Knowledge and the Limits to Welfare Reform

Governments face pressures to improve services and (at the same time) to contain taxes and to ensure that their decisions are accountable to increasingly well‐informed and challenging citizens. The dilemma of “squaring the welfare circle” confronts New Labour in a particularly acute form, since the party has set ambitious targets for improvements in the NHS, education and elsewhere, and is also committed to economic prudence and transparency. This article uses new data from a major national survey to investigate knowledge and beliefs in the main policy areas. It shows that most people are generally strikingly well‐informed in some areas and ill‐informed in others. A government which wishes to pursue a progressive direction in redistribution, increasing taxation of the better‐off, or expanding provision for those on low incomes, faces real difficulties because many people hold inaccurate beliefs about policy impact and the policy context in these areas. However, NHS costs are more accurately perceived across the population, and the proposed expansion is likely to create less controversy. Current high‐profile policies appear to follow the contours of public knowledge reasonably accurately, but further policy development will require positive efforts to lead debates and improve public knowledge.     

Social investment effects of public education,health care,and welfare service expenditures on economic growth

The purpose of this study is to theoretically and empirically examine whether public spending in education, health care, and welfare service operates as a fruitful investment in welfare states, which has been implied in the literature of social investment arguments. Based on comprehensive review of existing literature, this study suggested a tripartite mechanism of social investment effect of such spending, that is “enhancement of human capital,” “support for labor force participation,” and “job creation.” To find the empirical evidence, a pooled time‐series cross‐section analysis was conducted with the data of 15 advanced welfare states from 1980 to 2015 using estimation technique of fixed‐effect model. The results confirmed that public spending in education, health care, and welfare service had a positive medium‐term as well as long‐term effect on economic performance, while cash‐type welfare spending had an obscure or no visible effect on economy. Government consumption that is a proxy and control variable of size of the welfare state showed a positive effect on real GDP in the medium term but a negative effect in the long run. In conclusion, this study suggests that reinforcing social services should be recognized and dealt with as essence of social investment strategy.     

The Third Way and Social Welfare: The Myth of Post-emotionalism

The “passive” welfare state was accused of promoting a dependency culture. “Active” welfare and the “what works?” approach of Britain's New Labour government is allegedly implicated in an age of post‐emotionalism, in which people are largely indifferent to the needs of others and committed primarily to their personal well‐being. This article, first, seeks to extend recent debates about agency and motivation in social policy and relate them to the notion of post‐emotionalism. Second, it draws on a recent empirical study of popular and welfare provider discourses, which suggests that popular opinion can accommodate an appreciation of human interdependency, while welfare providers remain committed to a public service ethos. None the less, Third Way thinking is associated with a narrowing of solidaristic responsibilities. The problem for the future of health, social care and state welfare policies lies not with the imagined consequences of post‐emotionalism, so much as with an ideological context that perpetuates a distorted ethic of responsibility.     

Vulnerable children's rights to participation,protection, and provision: The process of defining the problem in Swedish child and family welfare

This study addresses the relationship between children's participation and the protection and provision offered to them by social services in Sweden. It applies a theoretical framework for analysing child welfare that is anchored in the United Nations Convention on the Rights of the Child. How child participation may affect child protection and provision is examined empirically using case documentation from 2 municipalities. The main finding is that when children are not given voice or opportunity to influence the framing of what “the problem” is, the design of protection and care tends to be poorly matched to the actual problems documented in the child investigation and vice versa; when children can influence framing, this is associated with well‐matched protection and care. This suggests that traditional child welfare ethos, to the effect that protection should be of such overriding concern that children even should be protected from participation, is misguided. The study further illustrates the intrinsic problems with the family orientation of Swedish social services and its reliance on partnership with parents, which makes it difficult to live up to the Convention on the Rights of the Child. Incorporating child participation into existing service models can transform Swedish social services to an augmented child‐focused system that by ensuring participation also promotes protection and provision.     

Children against parents? The politics of intergenerational recalibration in Southern Europe

Traditionally, Southern European countries displayed remarkably elderly biased social policy arrangements. This article introduces the notion of intergenerational recalibration to capture reforms aimed at rebalancing the generational profile of Southern European welfare states via the expansion of family policy and social assistance schemes—both monetary benefits and care services—and retrenchment in the field of pensions. Then, it elaborates theoretically on the political dimension of this policy strategy, focusing on the implications of the peculiar combination of expansionary and retrenchment reforms, to advance the hypotheses that domestic politics would prevent the realization of such an agenda, whereas the latter would be favored by a major role of supranational actors, especially the European Union. To test these hypotheses, we systematically analyze policy trajectories in the field of pensions and social assistance in Italy and Spain between the mid‐1990s and 2016. This allows, first, to argue that investment in “pro‐children” measures has not adequately balanced the reduction of pro‐parents expenditure and, second, to question the idea that domestic political incentives to expand “pro‐children” policies are necessarily too weak as well as the “enabling” role of external pressures in pursuing intergenerational recalibration.     

Networks,case managers,and the job-search experiences of unemployed people

Employment services are commonly provided in network settings, but it is rare to find social policy analyses of how unemployed people search for jobs through networks. In a germinal analysis of social networks and employment, Mark Granovetter argued that “weak ties” (less familiar contacts) are more important to finding employment than are “strong ties” (family and friends). This is because weak ties provide more novel job-relevant information. Scholarship since Granovetter has predominantly supported the opposite argument, namely, that strong ties are more important for the unemployed, because they are more plentiful and thus provide more information in aggregate. Findings are also generally coloured by the focus being on “informal” networks or personal contacts. “Formal” networks, as represented most cogently by employment service providers, are absent or underestimated in most social network studies. On the basis of a qualitative study of 80 long-term unemployed people in Australia, incorporating analysis of both informal and formal networks, we argue that although “strong informal” ties are vital to job search, it is also important to consider “weak formal” ties, which can be complementary if and where service organizations are able to supply positive case management experiences.