Central Steering And Local Networks: Old‐Age Care In Sweden

Abstract

Recently, some European social scientists have claimed that the old legal‐bureau‐cratic model of administration has been replaced by a new paradigm in public administration, characterized by a strong emphasis on collaboration in local inter‐organizational networks. The proponents of this policy network approach take a clearly voluntaristic view on policy implementation; network actors build consensus in negotiation processes, and the role of central government is restricted to that of goal‐setter, facilitator and mediator. Thereby, phenomena like power and steering are overlooked. This paper gives an account of a major Swedish reform in the area of old‐age care, whereby the boundaries between regional and local areas of responsibility for care of the elderly were displaced. By using a variety of control methods, central government was able to structure and steer the old‐age implementation networks. The consequences of this central steering were different on different administrative levels: for the county councils, the reform has resulted in a specialization for the core areas of primary health care and hospital treatment, whereas the municipalities have had to diversify their areas of activity. Thus, to understand the effects of the reform, implementation networks must be viewed as both hierarchical and horizontal power structures, where national government, from a hierarchically superior position, can affect formally horizontal relations between actors by creating patterns of interdependence. Central government’s steering has taken on less direct forms than the traditional ones, but indirect forms of steering can certainly be efficient, especially when several mutually reinforcing control methods are combined.

Older People's “Voices”—On Paper: Obstacles to Influence in Welfare States—A Case Study of Sweden

“…Globally, these policy statements are found, for example, in United Nations documents such as the Madrid International Plan of Action on Ageing (United Nations, 2002). Little is known, however, about the outcomes of these national policies, especially at local levels, where they are supposed to be enacted (Cook & Klein, 2005;Johansson & Borell, 1999). In Sweden, as in many welfare systems, there is a lack of empirical data about older people's actual use of formal channels of influence (Braye, 2000;Cook & Klein, 2005;Janlöv, Hallberg, & Petersson, 2006).…”

Multi‐level governance in Norway: universalism in elderly and mental health care services

“…The cooperative turn in the central-local relationship has been observed in many European countries over the last few decades (Och, 2008;Røiseland and Vabo, 2008;Kelly, 2006;Bache and Flinders, 2004;Hill and Hupe, 2002;Johansson and Borell, 1999). The cooperative turn indicates that centralised leadership is no longer carried out through a hierarchical command and control-system of hard regulations by legal and economic means, but increasingly is conducted as indirect or soft regulations of self-regulating actors (Gjelstrup and Sørensen, 2007, p. 23).…”

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