JOURNAL
ISSUE 6
2002/2003
Helene Hanssen
and Mari-Anne Zahl, MSW, Dr.polit.
Norwegian
Governmental Policies of Decentralisation and Privatisation
and Consequences for Social Work
Introduction
Decentralisation and privatisation have been dominant issues
in the development of health and social policies in Norway
during the last 10–20 years. The relationship between
the central level and the regional/local level has gone through
major changes during this period. The main responsibility
for welfare services rests presently at the municipal and
county level. From running and controlling the services in
detail, the state now sets the external conditions through
legislation and regulations to ensure an equal service level
for everybody, regardless of where in the country they live.
It is mainly a municipal responsibility to bring about governmental
policies and goals (St.meld.nr.31 (2000 – 2001)).
This article presents
some examples of services that have been decentralised and
privatised during this period, either through radical reforms
or through more silent evolutions. The services that traditionally
have been decentralised, like public assistance, will not
be discussed. However, it can be mentioned that there is a
persistent discussion also within these areas on how to provide
an equal and just national level for services rendered.
Some statistics
Norway is a country with a relatively small population in
proportion to the geographical area. It is a mountainous country,
with a vast area that is not suitable for settlements. It
has four larger cities (population more than 100000) and many
smaller towns, villages and municipalities. The statistical
figures show (per 31.12.00):
Geographical area:
325000 km2
Total population: 4, 478, 497
Number of municipalities: 435
Urban municipalities
(population more than 100000) : 5
Larger municipalities (population 20000 – 100000) :
38
Medium municipalities (population 5000 – 20000) : 147
Small municipalities (population 1000 – 5000) : 224
Extremely small municipalities (population less than 1.000):
21
(Statistisk Sentralbyrå 2001)
The ideology of
supporting autonomous local government is prevalent in Norwegian
democracy. The above mentioned figures are therefore of importance
when focusing on decentralisation and privatisation of social
services in Norway, especially the fact that as many as 245
municipalities have less than 5000 inhabitants, and out of
these, 21 have less than 1000 inhabitants. This means that
many of the sovereign political and administrative units are
small and serve few people.
Traits in the decentralisation of health and social services
Historically, as many other countries, Norway has organised
the services for people with special needs in rather centralized
units and the legislation and regulation of the services were
authorised by a number of special laws (Seip 1984).
Since the early
1980s the development of health and social policy and the
delivery of services within these areas have moved in a clear
direction. In short these can be listed as follows, from:
• institutionalisation
to integration in society at large
• central institutions to locally-based services
• care in institutions to home-based care
• special laws/legal rights to general rights/legislation
• governmental responsibility and control to legal regulation
and municipal autonomy
• client to user to citizen – focus on user’s
involvement, individual plans and service (NOU 2001: 22).
This illustrates
that the decentralisation of health and social services in
Norway implies:
1. That the specialized
services are offered on a municipal (or county) level rather
than at the state level (from state to municipal level)
2. That even at the municipal level the services are offered
on an outpatient rather than on an institutional level (from
institutional to “private” level)
3. The rights of people with special needs are included in
the general legislation for health and social services rather
than being authorised by special laws (from legislative segregation
to integration)
4. Decentralisation is closely related to the discussion on
user’s rights and democratisation in the health and
social services
The transformation
of responsibility from the central to the local level was
followed by economic transferences. The municipalities receive
funding from the state to develop services at the local level.
In the early stages of the process, funding was earmarked
for specific areas only. Subsequently, funding has most often
been given as block grants. The municipality itself has the
responsibility to use this in a way that keeps the services
at a sufficient level. One major criticism of this policy
is that the transference of money from the state was relatively
high in the initial phase, but then reduced. The cut creates
problems in running and developing the services further. On
the other hand, the municipalities are being criticized for
using the funding for other tasks given high priority in the
municipality.
The decentralisation
of services leads to the necessity of comprehensive thinking,
crossing sector lines, agencies and political properties.
For instance, there is a need for close connection between
the housing policy and the care policy, between the educational
system and the social services, and between the mental health
care and the employment office (St.meld.nr. 35 (1994-95)).
Decentralisation
of health and social services in Norway are based on social
democratic ideology and values. Equal rights for all people,
regardless of personal ability, background or living conditions,
as stated in the UN Declaration on Human Rights (1948) and
the UN Convention on the Rights of the Child (1982), are the
major goals.
Vital objectives
for decentralisation of services can be outlined as follows:
• include every human being in ordinary society and
its systems
• reduce the stigmatisation related to different problem
groups
• understand and find solutions to difficulties in accordance
with to people’s natural contexts
• design the services for each client according to individual
needs and local resources
• facilitate an access to service – make the services
more user-friendly (NOU 2001: 22).
Decentralisation as a strategy – examples from relevant
areas
Decentralisation as a strategy in health and social policy
affects most areas of social work. To illustrate the changes
brought about by this strategy and paint a picture of the
challenges for professionals and local communities, examples
will be given from two relevant areas: Care for Mentally Disabled
and Mental Health Care.
The Care for Mentally
Disabled
Historically, the disabled have mainly been cared for in rather
big central institutions by Norwegian standards. In 1969,
there were 109 such institutions with a total of 5500 beds.
Some families chose to keep their disabled children and adults
at home, but there were practically no services offered to
neither the children nor the families. Generally speaking,
the public care for intellectually disabled was institutionally
based (NOU 2001: 22).
In the 1970s a
very critical debate was raised about care and protection
in these institutions. Cases of rather severe neglect and
abuse were exposed. The human rights of the intellectually
disabled were put on the agenda. In 1982, a public committee
(Lossius-utvalget) was appointed to explore conditions in
institutions. The committee concluded that the living conditions
in institutions were inhuman and not acceptable to modern
society and proposed that the institutions should be closed
(NOU 2001: 22).
In short, this
led to a total reform in the care for mentally disabled implemented
1 January 1991. A nationwide registration of disabled (those
who lived in institutions as well as those who lived with
their families) and their needs was accomplished. The institutions
were supposed to close down by 31 December 1995 at the latest,
and each municipality was obliged to provide suitable housing
and care for their disabled. The disabled children were to
be integrated in ordinary classrooms in the schools and kindergartens.
The disabled adults were supposed to be integrated in the
ordinary neighbourhoods and social systems (NOU 2001: 22).
Consequently,
during a period of 5 years, 5100 individuals were sheduled
to move from the central institutions to their municipality
of origin. Most of them needed some kind of sheltered accommodation,
care, practical assistance, occupational therapy, transport,
etc. In addition to the ones who lived in institutions, the
registration showed that 8000 disabled lived with their families.
About 4000 of these were adults. The reform was supposed to
also include them, but highest priority was given to the ones
who lived in institutions. The local communities were faced
with extensive challenges.
The reform has
been under constant evaluation administrated by the Norwegian
Council of Research. We will draw attention to the fact that
a minority of the next of kin were positive to the reform
in advance; though in 1996, in retrospect, 75% considered
that the reform had led to a positive change for their disabled
family member. Regarding the housing conditions, the evaluation
studies show that one year after the institutions were closed
down, 96% of the people who had moved out lived in some kind
of shared housing, care homes, etc. while only 6% lived in
their own separate flat (Tøssebro 1996).
Today, it is common
for the disabled to live with their families until the age
of 16–20 and then move into some kind of care accommodation.
Yet, it is a fact that the waiting lists for such housing
are rather long. The local communities have still not fully
managed to build services according to needs and expectations
of the public.
It is further
initiated that the Department of Social Services is responsible
for composing individually-based core groups and work out
personal plans for habilitation to promote users involvement,
and to secure a sufficient level of service to achieve individual
goals. (St.meld. nr. 21 (1998–1999)). Some municipalities
have already started this process and to a certain degree
this work is forcing an inter-agency coordination. However,
there is still a long way to go to formulate these plans and
not least to put them into effect.
The Mental Health Care
The Mental Health Care Reform was initiated in 1996 (St.meld.
nr. 25 (1996-1997)) and implemented in 1997. This reform has
been stated as the most extensive and important change within
the health and social sector in Norway (St.prop. nr. 63 (1997-98)).
Historically,
institutionalisation was the main solution to mental illness.
The care and therapy for people with severe and/or chronic
psychological dysfunctions were organised in rather large
centralised hospitals. One of the primary goals in this reform
is to integrate people with psychological dysfunctions in
the local communities. This involves that centralised hospitals
will gradually be closed and every municipality has the responsibility
to offer sufficient outpatient therapy and care, even to people
with severe and chronic dysfunctions, and also to provide
suitable living conditions in general, such as care accommodation,
education, work or occupational therapy, etc. Hospitalisation
is to be used only in very severe, life threatening and acute
situations and, in principle, only for shorter periods. This
has led to a decrease in number of hospital beds and the mushrooming
of outpatient services (Robberstad 2002).
During the period
1994–2000, 18387 care homes were built in Norway (NOU
2001: 22). This includes care homes for people with different
kind of problems. The numbers illustrate that the decentralisation
of services has a great influence on the local communities
and affect a large number of people. In the period 1999–2006,
3400 care homes are to be built mainly for people with psychological
dysfunctions. Institutionalisation as a way of living shall
be brought to an end (Plan of Action for the Mental Health
Care 1999–2006). Looking critically at the plan it might
be asked whether the reform brings institutionalisation to
an end – or if care homes represent the institutions
of today.
Yet, decentralisation
of this type of care does not only include housing. It also
comprises providing a wide spectre of services needed to create
a good quality of life. Last, but not least, it deals with
changing attitudes in society at large and our thinking as
professionals. According to preliminary research, the differences
between municipalities in providing general and specialised
services are major, and there is still a long way to go to
fill the gap between ideals and reality (NOU 2001: 22).
Traits in privatisation
Privatisation is not a new idea. For the time being, 40% of
day-care facilities in Norway are run by private parties.
Even so, the discussions of privatisation of social services
have triggered heated discussions. In the Norwegian political
system we find attitudes along a socialistic – conservative
axis. The Socialists have public control as their aim, whereas
the conservatives are aiming at reducing public control. However,
they will not escape governmental control-mechanisms such
as subsidies and by law-making setting limits.
Since we are using
a terminology that appears in everyday language as well as
in research and in the social services, we will give our understanding
of some of the important concepts:
• Privatisation
indicates that the public hands over the responsibilities
for a certain task, or area to private enterprises or private
organisations (privatisering)
• Outsourcing includes letting others do the work while
the public plans, covers the expenses and keeps the main responsibilities.
At this level, negotiations as well as competition might enter
the scene (utsetting av driftsoppgaver)
• Tender and competitive tendering or bidding cover
the expenses. The public can also be a tenderer for the task
at stake. Different parties compete to secure a contract for
public services (anbuds- og konkuranseutsetting av kommunale
tjenester)
We might puzzle
over which elements lend themselves to privatization. Areas
like responsibilities, market, costs, contracting out, and
central- and local governmental administration fall into this
category (Lorentzen 1987). This indicates that when we start
discussing privatization, a whole range of political and ideological
issues are at stake. These matters touch upon fundamental
convictions. Promoting the scheme that privatization will
harm the welfare state will irritate some; promoting the opposite,
saying privatization will make the welfare state more effective,
will aggravate others. Exploring this phenomenon from a rather
value free stand seems complicated. Over time, political parties
have worked for moving from private to public. At this point
it seems as though politics are reversing. However, during
the period of public dominance laws prescribing public responsibilities
are adopted. They provide guidelines for potential “reversing
processes” or obstacles for such a move.
For both profit
and no-profit organizations, private represents supplements
and alternatives to what the public offers. The profit dimension
is a central concern in the discussion about privatization
of care functions. Privatization in the sense of leaving all
responsibilities to cover the needs of citizens in an area – for example child care – to private enterprise,
has not been the way chosen in Norway. Private competition
might come along with public alternatives. Discussions regarding
public–private include covering costs. In Norway, ‘private’ does not mean no public funding by subsidy. Approved private
schools receive from 85 to 100% funding from the government.
Another trend is to let users pay part of the cost directly,
to reduce expenses for the public. Converting technical entities
into companies/corporations is also a trend. This might be
part of providing an opportunity for these establishments
to compete with tendering by private firms.
The idea of reducing costs – cost effectiveness – is prevalent in the reasoning leading to competition and tendering.
Estimating cost is a complicated matter with many hidden factors.
This covers for example, time to prepare the tendering, to
keep control of quality of work done and decide on qualifications
to be required from the workers. Are some professionals to
be replaced by paraprofessionals or by others for on-the-job
training? Does a person with three years of education serve
clients better than one with five years or only one year of
training? Will education be part of the cost-effectiveness
calculation? Education might be considered of value to society
at large even if it cannot be proven effective in all settings.
In the health
sector, some services are provided by private enterprise.
However, a newer reform follows the principle of every person
having a "primary" doctor. We might call it an updated
form of family doctor. We were all asked to suggest the doctor
we wanted and ended on her/his list. The doctor receives a
certain amount of money from the public for each name on the
list. Due to the system of socialized medicine, taxes are
paid for potential services, and a set fee is paid when using
the services. This amount has a fixed upper limit for each
year.
Examples of privatisation
When planning for cutting costs, finding good comparisons
is essential. Using the same tools in Norway as in Sweden,
for example, does not automatically lead to the same results.
Since institutions in Sweden in general had a higher employee
rate than in Norway (Bogen & Nyen 1998), reducing costs
by cutting staff can be better tolerated in one system than
in another. The same goes for seemingly similar institutions.
When some municipalities
wanted to “lease out” care for the elderly to
an international company, voices were heard. The municipality
of Asker – close to Oslo – negotiated a five-year
contract from 1996 with an international company, ISS, and
with no competition from other companies, whereas Moss –
also a municipality in the Oslo vicinity – in 1997 signed
a four-year contract with the international company, Partena
Care, to run a nursing home. This move is said to be ideologically
based and not as a result of sound considerations (Nesheim
& Vathne 2001: viii). The contract came about in competition
with another company (Eikås 2001). The offer from Partena
Care was 2.1 million Norwegian kroner below what the municipality
had estimated. The calculations showed to be too low and after
adjustments came quite close to the other figure (NOU 2000:
19, 91). This is an example that illustrates forth the question
of who is to take responsibility for services when crises
arrive. Since then, Oslo and Trondheim have opened up for
private companies in the care for the elderly. Prior to this,
renovation and cleaning had been handled by other companies
– including the cleaning for institutions for the elderly.
In order to prepare
for tendering or negotiations, the municipality has to set
standards. They have to specify what services they intend
to buy. In fact this includes everything that is supposed
to take place in, for example, a nursing-home, such as food,
care, medical treatment, activities, hygiene, staff ratio,
and reports. This is a document that will be used when evaluation
is to take place. Written documents of this kind open up for
comparisons between municipalities, and also set a standard
for requirements used in the nursing homes run by the municipalities
themselves. The planning work sets new tasks for the public
servants and these take time to learn. However, their new
skills will be valid if the privatisation and outsourcing
waves continuous or if they come to a stop. Paying for this
training, however, might be part of the cost-effectiveness
calculations.
We can give an
example from the city of Kristiansand, where a set of criteria
was used when evaluating if a service could be part of tendering
(Nesheim & Vathne 2001: 54-55). This applies to all their
municipal services:
• no legal hinder
• the services must have a certain financial importance
and potentials for cutting cost
• start with rather simple surveyable/well organized
services to boost possibilities of success
• the service must lend itself to specification
• the service must lend itself to precise description
• there must be real competition between service providers
(suppliers)
On the other hand,
a few ”ifs” to be aware of are mentioned, including:
• if the
service has important effects for the municipal organization,
it should not be exposed to tendering
• if the service can develop and be offered on the private
market this might initiate growth and new products that results
in good contract agreements for the municipality
• if the municipality operates in a competing market
it is important to master tendering techniques, contract control,
and the writing of agreements.
Quality of services
has been a central issue in discussing giving room for private
and commercial organizations in services for the elderly and
for children. This opens up for a debate of how to define
quality for people served, and make quality concrete enough
to be observed, evaluated and corrected or if below the standard
in line with the specifications mentioned above.
A drawback is,
however, if the municipalities cut down special services and
terminate positions for professionals needed to run certain
programs. Municipalities might become unable to undertake
the tasks themselves if they turn out to be dissatisfied with
the quality of work purchased from companies. They will be
disqualifying themselves. Companies on the other hand, can
raise the prices if they have few to compete against. Such
a situation is more likely to come about if negotiations with
a chosen party have been used instead of competition. These
processes might open a path leading from public monopoly to
private monopoly.
Research focussing
on attitudes indicates that citizens have become more sceptical
towards public services and less sceptical towards private
solutions. Research also indicates that those receiving public
services are more satisfied than the general public. What
seems to be most criticised is the lack of available services
leading to long waiting lists (Moland & Bogen 2001: 11).
The Norwegian
welfare state has financed most services through taxation.
Wage earners pay high taxes on a progressive scale. This means
direct payment for social services are rare. Most social workers
work for public offices and institutions. More than 50% of
them work for the social welfare department. Some are selling
their services to the public, for example, by running child
care facilities. It is a new challenge for social workers
to offer their services on an open market and not be closely
tied to social policies.
Challenges for social work
One of the main tasks for social services and social workers
in the Norwegian welfare state is to implement governmental
social policies. The national goals related to decentralisation
(and privatisation) processes and the expectations to services
offered will effect social work in all its contexts: social
work practice, social work research, social work education
and the organisation of social services. We will discuss some
of the challenges arising from this.
Competence
As initially illustrated, Norway is a country with many small
municipalities, 245 in rural areas with less than 5000 inhabitants.
Each municipality is an autonomous administrative and political
unit, with its own health and social services. Firstly, it
is a problem for a number of these municipalities to recruit
professional and experienced health and social workers. Secondly,
they have a problem in encouraging the professionals to stay.
Professionals often consider these jobs as temporary, jobs
were new graduates can gain experience to get positions in
more attractive areas, both professionally and geographically.
Thirdly, the possibility to maintain and further develop specialized
competence is often quite limited, mainly because of the very
limited professional/specialist environment, a small number
of cases, and the necessity to function as a generalist. So,
if we consider decentralisation as a transfer of specialized
services from the central to the local level, it represents
a challenge to the quality of services provided. One way of
dealing with this has been to concentrate on formalized inter-municipal
coordination, and inter-agency and inter-professional collaboration.
These are actions which, in turn, challenge the professional
roles and the organisation of services.
Integration – inclusion – exclusion
The idea that a society is able to include all citizens is
outstanding. Few would disagree with this as a principle.
The important issue is how to make it happen. Several questions
can be asked according to the present policy of integration:
• What does
“integrating people with disabilities and special needs”
mean? Is there any significance between “non-segregation”
and “inclusion”?
• Does building care homes for people with psychological
dysfunctions lead to inclusion of them on an individual level
into the neighbourhoods?
• Does the fact that an disabled pupil attends a regular
class at school imply that she is looked upon as an equal
and finds friends among her schoolmates?
Based upon research
and experience, our answer to these questions is, "no"
(Tøssebro 1999). Placing people together physically
can in the long run create some changes in attitudes towards
one another, but the process is slow, the costs are high and
the results are uncertain. This is also intensified by a certain
duality in values in western societies: on the one hand, the
statement of equal rights and value of every citizen; and
on the other hand a society where youth, beauty, effectiveness
and success are outstanding ideals, and intellectual and physical
ability is more and more valued in the school systems, labour
market, etc. As a term, integration focuses on the individual
to fit into the established social systems, while inclusion
focuses on changing the social systems to fit the variety
of individuals (Oliver 1996, Skrtic 1991). Integration might
lead to exclusion and loneliness for the people who are “integrated”.
They are looked upon as “different” and do not
have access to the more informal socializing. Some might even
feel more excluded than before, because compared to “institutional
life” they have less opportunity for contact with people
who share their own characteristics.
Traditionally,
social workers in Norway have neither been very visible within
the school system and nor in the care for disabled. The majority
of professionals within these areas have been, and still are,
teachers and social educators. Even if the need for inter-professional
competence is clearly stated, the decentralisation of services
has only to a very small extent lead to an increase in the
number of social workers within these areas.
In the hospitals
for people with psychological dysfunctions, social work traditionally
has had a rather strong position. However, the transfer from
institutions to a municipally-based outpatient service has
led to an increasing number of psychiatric nurses in the municipal
mental health care system and very few social workers.
We might question
whether the absence of social workers within these services
also implies that the priority is on learning (or teaching)
in the schools, health (in a narrow sense) in the municipal
health care and practical assistance to the disabled, and
that the social consequences, such as loneliness and exclusion,
social functioning, have been less in focus. Even if we consider
social work to represent important perspectives, values, understandings
and methods, it is a great challenge to promote the professional
competence as an indispensable contribution in all service
areas, and to enter new arenas as well.
Unfortunately,
entering a new arena also brings up conflict of interests
between different professions. Professions that have had a
dominant position within a specific area will not easily open
up “their domain” for other professions, even
if the tasks have changed and new competence is needed. It
seems to be a general challenge for professionals to concentrate
on the client’s needs rather than their own interests
as professionals and to use their competence in an inter-professional
context (Barr 2002).
Social work education and practice
Finally, we want to raise the question of whether we need
a change in social work education and practice to face the
challenges following from decentralisation, and also to link
this to the organisation of services and privatisation.
The expectations
of social services today are rising, as the general public
are increasingly better informed of their rights as users
of public services and general levels of trust in professionals
are eroding (Nolan, Davies & Grant 2001). Studies on users,
involvement in the delivery of social care services show that
there is a gap between how social workers themselves consider
service is given and their cooperation with users, and how
the users report servicis received and their own influence
in the decision making (Sandbæk 2000, Croft & Beresford
2002)
Even though social work was founded on democratic ideals and
respect for every human being, this is not the way clients
feel professionals meet them, generally speaking. This might
relate to the possibility of social workers being forced into
certain roles by inhuman organisations and procedures; or
maybe they have too much work to do; or maybe clients misunderstand?
Perhaps social
work practice, as a part of the public services, does not
have to make an effort to serve people? Maybe social work
education focuses too much on client problems based on professional
assumptions and roles, and too little on clients’ resources
and capability. Maybe the education programmes creates paternal
(or maternal) social workers, who perform as experts on problems
rather than as experts to guide, assist and support people
in finding their own solutions. A person’s desires and
requests does not necessarily coincide with their needs as
defined by outsiders.
Decentralisation
and democratisation of services implies the reconsideration
of social work education as well as social work practice and
the organisation of services. Inter-professional and inter-agency
cooperation are acknowledged as important measures, but in
the “real life” this often means a lot of meetings
with rather poor results. In Norway, the health and social
services have more or less been under constant reorganisation
for the last 10–15 years, with many projects to develop
new “inter-professional” and “cross-agency” organisations of services, but it seems to be very difficult
to break down the boundaries between the specialised services,
and we have still not found any good answers. The users still
experience that the communication between services is insufficient
and that they have to muddle through the service jungle.
The new objectives
for rehabilitation services challenge the service jungle by
stating that the individual user’s needs should be in
focus for inter-agency collaboration, rather than the agencies
need for organising, and are also establishing the user himself
as an important and authoritative partner in this collaboration.
This implies a maximum of flexibility, where collaboration
groups are to be formed from case to case, rather than a fixed
forum for communication and collaboration (NOU 2001: 22).
It will be of interest to follow how these ideas can be realized,
since they challenge professional roles and the relationship
between professionals and clients as well as inter-professional
relationships.
Reflections about decentralisation and privatisation
The Norwegian Welfare State is ideologically based on equality
for all citizens regarding rights to, access to and levels
of education, health and social services. Decentralisation
and privatisation of services challenge this ideal. In spite
of the fact that Norway is one of the richest nations in the
world with a high standard of living in general, the welfare
state is under hard pressure and questions are raised as to
whether the country suffers from public poverty.
Decentralisation
transfers responsibility from central to local authorities
and leads to complicated discussions regarding prioritising
public funds where conflict of interests between different
political parties and pressure groups are visible. Within
the health and social sector we can observe a tendency to
reduce non-statutory provided services, like most of the social
services, in favour of statutory-provisioned service such
as essential health services.
Quality of services
is central when discussing both decentralisation and privatisation
of health and social services, including access to and standard
of services, and also the consequences for developing professional
competency. On the one hand, privatisation has many faces.
It might drain the public sector of competence and quality
services as well as lead to a friendly and service-minded
public sector, providing quality products in competition with
private service providers and become excellent overseers of
private supply. On the other hand, privatisation of services
might impoverish the public sector and make it dependent on
commercial firms. This development might harm less privileged
groups.
Any change in
social policy influences some group of citizens somehow – social workers included. Social work is in interaction with
society at large and therefore, social workers have a role
to play on behalf of clients when major changes are taking
place. Social workers are expected to render quality services
to clients regardless of structural arrangements and to develop
practice knowledge continuously. We might ask if there is
evidence that services provided by the public sector are superior
to services provided by private enterprises. Do public services
reach target groups better and cheaper than private parties?
Or, might privatisation be one of the answers to promote democratisation
in decentralised services? Questions of this kind will be
posed as part of the agenda when evaluating and developing
social services in a changing society. On such an occasion
social work might again discuss what it has to offer and the
future developments to promote problem reduction and social
functioning.
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(2001). Kommunal tenesteproduksjon på kontrakt? Om bruk
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