New structure and dynamics in the disability sector in Denmark
– early experiences and expectations of managers, employees and users
by Leif Olsen og Anna Charlotte Thorsted, April 2007
Summary
The local government responsibility and structural reform in Denmark has resulted in major changes to the structural, procedural and political framework of operations and development of specialised initiatives in the disability sector. Denmark’s 98 local authorities, 66 of which are new and amalgamated, get full authoritative and fiscal responsibility in the disability sector. They are also to establish disability councils, which will give people with disability new opportunities to influence disability policy in their local authorities. The five new regions are responsible for about one fifth of the previous 14 counties’ programmes in the disability sector (Danish Regions 2006). The state is responsible for operation of the National Knowledge and Specialist Consultancy Centre (VISO), which gives local authorities access to highly specialised knowledge, reports and advice. Further, a number of new management principles and tools have been introduced in relations between citizens, programmes, local authorities, regions and the state in the form of e.g. annual framework agreements, the Services Portal and disability councils.
What these changes will ultimately mean for people with disability and with a need for specialised assistance is an open-ended question. Will the changes improve the chances of being able to live a life with equal opportunities as close to »normal« as possible? Will the goal of establishing a more coherent effort for people with disability and vulnerable groups in Danish society be achieved? Is the financial and professional sustainability that is a prerequisite for high quality in highly specialised programmes and services in the disability sector future-oriented?
In this evaluation, which covers the period 2006-2010, we ask the question: What does the local government reform mean for citizens with disability who need specialised assistance and advice?
This evaluation has a user perspective and will therefore follow and document selected users’ experiences during the evaluation period. This will be done through visits and repeated interviews with users, ultimately resulting in comprehensive material that tells the stories of the selected users in relation to the specialised programmes they utilise. Regardless of whether the users’ situations improve, deteriorate or remain the same during the evaluation period, their experiences will be relevant when it comes to analysing and assessing the effect the local government reform has had on users of specialised services in the disability sector. We specifically ask the users about: life with a disability; choice and utilisation of programmes; importance of the programme; assessment of the programme; experiences with changes to the programme; use of other programmes and influence and options.
In order to analyse and assess the users’ experiences in relation to the local government reform, it is necessary to gain insight into how the specialised programmes are affected by and react to the reform, which sets new conditions for their operations. The evaluation therefore also emphasises developments and prerequisites regarding the production of services within the programmes the users utilise. This is done through visits and interviews with selected managers and employees in the programmes and through collection of documentation on the development of the programmes. In addition, the evaluation follows general developments in the disability sector in that the local government reform creates the prerequisites for entirely new dynamics in developments in this area. The local authorities may be at the centre of things, but they are also dependant on cooperation with other local authorities, regions and the state in order to carry out the specialised tasks in the disability sector.
At this early stage, we can say that the users have relatively few concrete expectations regarding what the reform may mean for them. The employees in the programmes utilised by the users have slightly higher expectations, but it is especially the managers, of course, who have the highest expectations and who already have early experiences in relation to the implementation of the local government reform. These early expectations and experiences are presented in Chapter 3.
The reform entails new uncertainties about future developments in the disability sector. The programmes that become the responsibility of the regions are subject to some uncertainty about where they belong and who is responsible for their operation, as conditions can, in principle, change from year to year. In the programmes that become the responsibility of the local authorities, uncertainty exists about whether the new local authority in which they must operate will understand the special characteristics of the programmes, and whether the new types of management and administration will allow for the programmes’ specialisation, which must match the users’ complex needs. The managers see some problems in this, but they also see positive opportunities, for instance in their proximity to the decision makers and new development dynamics in the local authorities.
The local authorities’ unambiguous fiscal responsibility and incentives for preventive efforts are assessed, in part, as a possible driver for development and, in part, as a stopper to the financing of specialised programmes. Some managers express concern that professionalism will be given lower priority at the expense of financial prioritisation of other local government tasks.
The relationship between the professional autonomy of the specialised programmes and the new local authorities that are responsible for operations is seen as a key theme for the managers. In their initial contacts with the local authority, some managers have experienced an understanding and inspiring atmosphere, giving rise to expectations that the specialised programmes will be developed even further. Other managers have found their initial contacts difficult in that they have been met by a lack of understanding and by demands for standardisation of their organisation and services. Such experiences give rise to frustration and very negative expectations for the future relations with the local authority.
The managers and employees heavily emphasise the importance of strong professional networks for cooperation and knowledge sharing in relation to the specialised programmes. Regardless of whether they are formal or informal, networks appear to be a highly relevant factor for continual development of the specialised programmes. Managers and employees express a hope that the local authorities will understand the need for professional networks and will support their maintenance and expansion. Because of the reform, some networks have been dissolved while others have, for now, been strong enough to survive even though the professionals have been assigned new jobs.
The interviews with managers make clear that coherence in the programmes for users is an important theme for development after the local government reform. They also emphasise that there are many challenges associated with creating coherent user action plans, which are now the responsibility of the local authorities. The proximity of the local authorities to residents and users is mentioned as a factor that can help the achievement of goals pertaining to coherent initiatives for users.
For a minor proportion of the users in this study, the local government reform has meant that, like managers and employees, they have considerations and hopes or concerns about the future. However, the largest proportion of the users whom we have spoken to have not yet considered specifically how the reform will affect their situations.
With complete authoritative and fiscal responsibility, the local authorities take over a key role for the users. The local authorities now represent the only access to public service in the disability sector, regardless of whether this service can be provided by the local authority itself or whether the local authority needs to refer to private providers in other local authorities or regions. Consequently, the local authorities are not only the fulcrum for the individual users, but also for the dynamics in relation to external providers of knowledge, advice, reports and services that the local authorities need to draw on in order to meet the needs for specialised programmes and advice.
The National Knowledge and Specialist Consultancy Centre (VISO) is one of the external sources of knowledge, advice and reports designed to ensure that the local authorities can carry out specialised tasks in the disability sector. One goal of VISO is, thus, to counter the criticism that the reform will lead to despecialisation. Another goal is to establish a knowledge organisation that can “keep in step and at level with global knowledge developments in the disability sector.” In order to achieve these goals, however, local authorities and users have to seek out and use VISO, which must render its services available to local authorities and users as well as ensure the foundation of relevant and useable services.
The objective of the Services Portal is to make public tenders in the disability sector more visible and comparable, both in terms of the elements of their content and in terms of their price. On the one hand, this results in public information that can be used in the dialogue between users and local authorities. On the other, it results in a marketplace that acts as a foundation for competition among providers in the area. The requirement that the initiatives must be presented on the portal has initiated a dynamic process where the initiatives have to describe their characteristics and their prices. This then forms the basis, in theory, for more choices and better opportunities to match the users’ needs with the programmes available within the local authority referral process. However, there are many challenges and there is a need for constructive development dynamics in the relations between the Services Portal, providers, local authorities and users.
The new disability councils have the chance to establish new local policy dynamics in the disability sector. Surprisingly many politicians have chosen to become members of these councils, which shows that this is an interesting and important political platform. With widespread information activities via Internet portals operated by the Danish Council of Organisations of Disabled People (DSI) and the Equal Opportunities Centre for Disabled Persons (CLH), the ground has been prepared for intermunicipal dialogue and experience exchange with regard to developing local disability policies.
Local authorities and regions are required to enter into annual framework agreements, which are a new tool for coordinated policy planning in the area. The object is to ensure a reliable supply and to clarify the division of responsibilities between local authorities and regions when it comes to supply of and demand for programmes and services. In addition, the framework agreements are to underpin the ongoing professional development. The first framework agreements have been entered into under time constraints and out of consideration for intermunicipal agreements on maintaining status quo in the first couple of years after the reform. Thus, it will not be possible to see whether the framework agreements create new dynamics until the next generations of agreements.
Integrating the specialised programmes and services into the local authority referral process, which has not previously had to include these initiatives, may give rise to several entirely different dynamics. At one end, new initiatives and services may be expected to be adjusted to the existing referral practices. At the other end, new challenges may result in the foundation for the referral practices being reconsidered and fundamentally revised. We have seen examples of both extremities.
Development councils are to be established in every region with the remit of continuous monitoring and evaluation of developments in the disability sector for the first four years of the reform period. In addition to regular information aimed at the development councils, the Services Portal, once fully implemented, will provide the current status of the entire collection of initiatives offered throughout the country. Another ‘piece of the puzzle’ for creating an overall view of developments is annual framework agreements. The information and assessments that result from these efforts will be useful to the Minister, local authorities, regions, user organisations and professional organisations when discussing developments and proposing changes.
The new dynamics for developments in the disability sector can result in changes and outcomes that point in very different directions. The evaluation’s interview material suggests that there are both positive opportunities and negative pitfalls associated with these developments. It is therefore worth considering how these opportunities can be put into practice and how the pitfalls can be avoided. We hope that this report can be a constructive contribution to this discussion.
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