2014 Round Table Caserta

Service Delivery Balance between Central and local levels

• To what extent should local self-governance units make their own priorities on services, and

• When should national government step-in and and equalize services nationwide?

Clashing perspectives?

Recent poll made by the Swedish Association of Local Authorities and Regions (SALAR): • Swedish citizens want nationwide conformity in

service provision but …at the same time they prefer proximity through local self governance

• …and they also want to have a say as individuals (66 %)on key areas of service delivery

• …but only 5 % do think that they have

Ambivalence among citizens to local and central governance

• Public choice/New Public Management – has reduced the sphere of services run by government

• Move towards individualized services e.g.up to citizen’s to choose supplier of eduction, health care and it has created new markets largely driven by profit

• Transparent systems for comparisons triggers harmonization of services (access and quality)

• Political parties have lost attraction – to promote more complex and comprehensive solutions – sector perspectives tend to dominate

Why this ambivalence to diversity?

• SALAR position: Differencies are acceptable as long as they reflect local priorities anchored among citizens, but they are NOT acceptable:

• If they affect conditions that might be life threateining for individuals or if they cause significant difference in access and quality of services

Are solutions modelled at the center a smarter way to move forward – or not?

• Effeciency: Lokal and regional adjustments to local and regional needs/specifics

• Innovation: There’s a need for local and regional champions

• Participation: Local adjustments and decisions closer to citizens

The positive angle of local ”command” on service delivery

• Regulations that provides for uniform service provision might reduce efficiency (less adjusted to local conditions) and become roadblocks for local initiatives/creativity in providing services in more dynamic manners.

• In Sweden it’s rarely the differences between local governments that provides the challenges but the levels (quality and numbers) of services that can be unsufficient.

Argument against uniform service provision

• Access to expensive drugs • Tariffs• Acccess to certain health care • Waiting time for surgery• Number of staff in elderly care centers and

services provided at home to elderly

Problematic services – differencies between regions in the the health sector

• Care dealing with life threatening situations• Big share of pupils in schools not

prepared/accepted for upper secondary studies• Lacking continuity in care of elderly

Problematic service results

• Cost for expensive drugs and access to certain health care – Proposal: voluntary coordination of practices at national level through SALAR and other stakeholders

• Tariffs – upper treshold for treatment and drugs – but not yet for equipment

• Waiting time – state pressure on regions through national quality register including financial carrots (subsidies) maximum waiting time for care 3 months – then a right to go outside your home region for health care

Different examples on how challenges are confronted

Life threatening care • quality: joint agreements with University

hospitals for specialists• waiting time: might be harmonized legally• control: option to appeal waiting time:

coordinationShare of pupils not prepared for upper seconday school • subsidies by national government to local

governments with high share of immigrants

Different examples on how problems are dealt with

• Career opportunity introduced for teachers• Smaller classes and assistant teachers• Tax reduction for tutorial teaching on leasure

time• Review of contents of education more

mathematics, sports etc.

Examples

Lacking continuity in elderly care–• The individual needs more focussed in

reorganizations • Harmonized treatment –through training of staff• IT applications to make life more safe for elderly

– can live at home longer• Procurement with improved quality parameters

Examples

• Establish a reasonable balance between the interest of national equalization and local self-governance

• Regulations and evaluations but also ”softer” initiatives like incentives

• Governing through standards

The role of national government

• Detailed interventions: The right for local government to organize itself for delivery of services is key for our decentralized system

• Detailed regulations can hamper local initiatitives

What the role of national government should not be

Sectors:• Business climate• Public transport• Health Care• Social care• Education• SafetyObjective: To stimulate service providers to analyse its activities through take-up from others

Open comparisons

• The quality municipality of the year• Database (jointly developed SALAR and national

agency for statistics with key figures in two version one for specialists and another one for elected

Other incentives to service improvements

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