The last thirty years have witnessed a significant change in the ethos and organisation of public services. There has been a profound market shift in the provision of publicly funded services in different types of welfare states. This chapter looks at the avenues and mechanisms through which in the Nordic countries an increasing proportion of publicly funded care services for older people is being removed from the entirely public sphere of state and municipal provision and is increasingly shifted to private for-profit providers. There are clear signs of intensified marketisation developments, most particularly in Finland and Sweden. Marketisation refers to the growing presence of private for-profit providers and the increasing influence of market ideas, logics and mechanisms within public service delivery. In this chapter the concept of ‘marketisation from within’ is used to characterise the marketisation shift typical of the Nordic countries, as the state and municipalities are important actors in the marketisation process by regulating and financing services that are outsourced to for-profit providers through competitive bids and customer choice models.
Anneli Anttonen and Olli Karsio
Kateřina Kubalčíková, Gábor Szüdi, Jaroslava Szüdi and Jana Havlíková
The chapter focuses on the implementation of de-institutionalisation in care for older people in the Czech Republic and Slovakia. The principles of de-institutionalisation were incorporated in the national strategic documents of both countries after the 2004 accession to the European Union. First, the question of how this concept influenced the Czech and Slovak national strategies, legislation and organisation of social services for older people is tackled. Subsequently, the chapter looks at the ‘responses’ of regional and local authorities and providers of care services for older people. Two case studies are then presented, which illustrate the ambivalent nature of the de-institutionalisation process. Particular attention is paid to the new role played by domiciliary care since this service form takes a central role as a ‘substitute’ for outdated or expensive institutionalised care. The chapter highlights how, even though a de-institutionalisation strategy was introduced at the national level in both countries, it was implemented without guaranteeing a constant and steady flow of financial resources, and the transition of national policy priorities to a ‘new’ conception of care for older people at the regional and local levels has been rather slow. As the case studies suggest, the implementation of the national strategy can actually lead to the exact opposite outcome than originally intended, with significant policy implications.
Blanca Deusdad, Sagit Lev, Charles Pace and Sue Vella
De-institutionalisation of care for older people in Mediterranean countries has not been sufficiently analysed, in terms of policy discourse and implementation. The aim of this chapter is to study and compare both aspects within a cluster of three different Mediterranean countries: Israel, Malta and Spain. Although these countries differ in their historical, geographic and demographic features, they share a number of features. The traditional provision of care by the family has decreased as women’s employment rates have risen and family sizes have shrunk. Despite attempts to counter this through various ‘ageing in place’ policies, in none of the three countries have such attempts managed to fully offset undue institutionalisation due to the lack of family or financial resources, let alone enable the return of older persons from institutions to the community. Despite differences, enough similarities exist to propose a Mediterranean variant of LTC for older persons. This is characterised by ongoing reliance on family care even in the face of rising female employment; by underdeveloped or under-resourced community services; and by growth in private care services including recourse to migrant care labour. These features have implications for older adults who lack family support or financial means, and for the sustainability of care policies in the face of rapid demographic ageing.
Liisa Häikiö, Laurent Fraisse, Sofia Adam, Outi Jolanki and Marcus Knutagård
Social innovation in the context of social services is generally portrayed as a way of doing things better by directly involving individuals and communities in the design and co-production of such services. In this chapter, we argue that social innovation has an ambivalent character. We identify mainstream and radical policy discourses on social innovation that share the view that social innovation is a positive social phenomenon but differently outline the meaning of social innovation. Four case studies on local welfare initiatives for the provision of social and health services in Finland, France, Greece and Sweden highlight how the values and aims of social innovation that have been mobilized are flexible and vary according to the context in a pragmatic manner. In addition, the four cases show how institutionalization and up-scaling are a major challenge, with sustained societal change remaining partial and somewhat unreachable for local welfare initiatives. We conclude that social innovation can be differentiated on the basis of who the key actors are and what the role (and power) of citizens is in relation to institutional actors and the dominant social order.
Carla Weinzierl, Andreas Novy, Anikó Bernát, Florian Wukovitsch and Zsuzsanna Vercseg
Roma communities are among the most vulnerable and socially excluded groups in Europe. This chapter highlights the historical and institutional mechanisms of their discrimination and explores the potential of social innovation to combat such discrimination and social exclusion. Two case studies of socially innovative initiatives for the inclusion of Roma in Austria and Hungary are described and their potential for contributing to social cohesion is critically analysed. The authors highlight that path-dependencies in two welfare models with assimilationist tendencies have resulted in difficulties in striking a balance between diversity and equality. They conclude that while European policies have raised awareness on cultural discrimination, socio-economic and political exclusion cannot be addressed solely by local initiatives.
Rosa Mas Giralt and Antonella Sarlo
Existing research from migration studies and comparative social policy has highlighted the need to develop better understandings of immigrants’ social rights and their inclusion/exclusion from welfare systems. This chapter contributes to this literature by exploring to what extent the UK and Italy, two countries very different in terms of immigration histories, management of integration and structure of their welfare states, have come to converge in the last 15 years in relation to the social inclusion of (documented) immigrants. To fully understand the social rights of immigrants we need to consider the intersection of the policies which regulate immigrants’ social rights (welfare, immigration and immigrant policies) with the systems of governance (national, regional and local actors, both statutory and non-statutory) that implement these policies and mediate access to social services. The chapter analyses the trajectories of immigrant and immigration policy in the UK and Italy while paying attention to the ‘vertical’ and ‘horizontal’ divisions of labour within the two states and the role of non-governmental organisations in complementing or substituting for retrenching public provision in this area. We argue that there are important similarities between the two countries: (1) national governments concern themselves largely with immigration policies (quotas and restrictions on newcomers’ social rights) while transferring responsibility (but not resources) for immigrant integration to local governments; (2) actors from the third sector ‘compensate’ for insufficient public provision at the local level while facing a lack of funding and institutional support. In both countries these features lead to a growing territorial differentiation in services for the social inclusion of immigrants.
Peter Brokking, Marisol García, Dina Vaiou and Serena Vicari Haddock
The chapter addresses the impact of market-oriented reforms, the financial crisis of 2008 and the resulting austerity measures on housing and neighbourhood services within the already changing trajectories of welfare states. We discuss the shifting boundaries of social groups whose needs remain unanswered and the resulting patterns of exclusion. The focus of the chapter then shifts to the response to these changes, in the form of local initiatives that attempt to address these needs and to further social inclusion. These initiatives highlight the increasingly important role of neighbourhoods and civil society actors in filling the gaps when the welfare state no longer provides basic services or when households can no longer afford to pay for services at market prices. In the final section, challenges for governance are identified and discussed. They include the definition of flexible arrangements between civil society, local public institutions and market actors and a new role of the central state in supporting the social right of access to housing.
Social services are a social policy field with a rapidly growing political and theoretical importance in Europe. These services enhance human welfare and the overall well-being of people, but in different ways and through different mechanisms. In this chapter, social services – with specific attention to care for older people – are evaluated from three perspectives. First, social services are examined in connection to risks people meet during their life course. Becoming old and fragile is one of such risks. However, there is a large variety in the ways life-cycle risks are taken into account by national care service policies. Second, the universality of service provision – or lack of it – is considered. From this perspective, a general weakening of universalism is observed throughout Europe. Finally, there is a distinctiveness in social service provision related to the complexity and complementarity of these services. Complexity and complementarity are at the same time strengths and weaknesses in social services provision and might explain the low status these services exhibit even today.
This chapter reflects on major trends in social service design, as identified and described in the previous chapters. All these chapters underscore significant changes in the role of the public sector in social service provision, and they are all keenly attentive to the potential drawbacks and problematic aspects of the changing outlook of public policy engagement. This concluding chapter seeks to understand the reasons why the contributors to this volume lean towards critical conclusions about the developments they have observed and have a hard time conceiving of potentially positive aspects and opportunities that come with ongoing social service developments. The chapter argues that trajectories of social service innovation are often measured against the yardstick of an ideal-typical model of citizenship-based rights and privileges, which has left its mark on the assessment of the trends identified. In this social citizenship-based perspective on social services, public involvement plays a major role in securing inclusive access to social services, a more or less even distribution in terms of their qualitative aspects and the scope of services available, and an orientation of social services as tools for supporting self-determination and empowerment of citizens making use of social services. When appraising the role of the state in social services, it is then important to consider the details of implementation, the specific institutional settings and the contextual factors of social service design.
Despite the great diversity observed in the restructuring of different social services, across countries and regions throughout the book, a number of common trends do emerge, which in turn point to a set of similar consequences, albeit with different intensities depending on context. Drawing on the wealth of empirical evidence and critical assessments presented in the preceding contributions, this last chapter summarises some key findings. First, the main changes experienced in the public provision of social services in Europe over the last thirty years are recapitulated, stressing continuities and discontinuities in national trajectories, as well as convergence and divergence among countries and regions. Subsequently, the main impacts of such changes and their ‘disruptive’ features are highlighted. Finally, different policy ‘options’ are examined, critically assessing their implications and challenges for the goal of a prosperous and socially inclusive Europe.