Social Services in Sweden


Legislation

The municipal social services form a central part of the Swedish welfare system together with the health and medical care provided by the county councils and the state social insurance system. Objectives for municipalities‘ social activities are laid down in the Social Services Act (SSA). It constitutes a „frame law“ by which the municipalities are granted to form their services according to unique local needs and prerequisites.

The social services are universal in that they comprise all persons in the population. One part concerns a responsibility for the municipalities to perform and to participate in efforts that aim to improve living conditions for the population as a whole and for various subgroups, e.g. by anti-drug information in schools or in the process of planning for new residential areas and means of public transportation. The other part concerns individually orientated measures in which the need of each individual underlies the municipal decision on what service should be provided. This latter concern forms an almost totally predominant part of the social services. Depending on the kind of need and the severity of it, there is a substantial amplitude among those who are entitled to get the social services, e. g. from an „ordinary“ old age pensioner with a need of home help service to a heavy alcoholic with a need of detoxification and treatment.

Aside the SSA two special laws define certain measures which are compulsory to the individual, and the circumstances when the measures should be applied. These concern children and young persons growing up in a hazardous environment or showing a severe anti-social behaviour, and alcohol and drug abusers. Another special law stipulates the rights for functionally impaired (physically or mentally) to receive social services and support.

Areas of activity

The Swedish social services operate in two main areas - care for individuals and the family and care and nursing for the elderly and those with impairments. The official statistics of the social services (http://www.socialstyrelsen.se) refer to:

• Social child care, i.e. individual measures to children and young persons, and sometimes their parents. (Commonly available pre-school activities belong to the education sector in Sweden.)

• Social assistance („Economic aid“)

• Family law and family counselling

• Measures for adult alcohol and drug abusers

• Care and nursing of the elderly

• Support and service to functionally impaired

The measures may be advice, support and encouragement, home help service, care and treatment, social assistance, family law or family counselling. Special forms of accommodation are arranged for care and nursing of elderly in need of special support. Housing must be arranged for people who for physical or mental reasons encounter considerable difficulties in their daily lives and hence need special accommodation. People with impairments are entitled to support and service which provide for e.g. personal assistance, escort service, contact persons and organised daily activities.

The service affecting most people in 2001 was social assistance. Around 470.000 people (5 per cent of the population) received such support at some time during the year. The home help and special housing measures affected 240.000 old-age pensioners (16 per cent of the age-group) and 47.000 people with impairment received support and service at a certain day of measure in the autumn 2001.

Costs and financing

The social services form the largest sector of action in the 290 municipalities and it corresponded to 36 per cent of both the number of employees and the total municipal operating costs in 2001. On a national level the social services‘ part of the GDP in 2001 was 5.8 per cent, whereas the total costs of health and medical care amounted to 8.0 per cent.

The social services are almost exclusively financed by the municipal income taxes. A minor fraction is covered by fees paid by the users, mainly in the care of the elderly. The municipalities‘ taxation power varies a lot due to different average income level and the proportion of employed among the local population. To neutralise differences in the financial ability to offer social services a national system for tax equalization is operated by the state. This means that „rich“ municipalities are contributing and „poor“ are gaining economic support, involving that the system is occasionally a hot topic on the political agenda.

Contracting of services

Some 13 per cent of all municipal social costs in 2001 refer to contracting of services provided by private companies or non-profit organisations. This is most common in social child care and measures for adult abusers; one third of the total costs. It usually concerns accommodation in family homes and care institutions. In the care of elderly, which represent half of all contracting costs, and services to impaired persons the proportion is about one tenth, respectively. A slight but steady increase in the amount of contracted social services is seen in recent years.

In the early 2000s the non-profit organisations working in the social area gained greater attention and significance than formerly, both as partners to the municipal social services and as direct contracted providers. Both ideological and economic considerations underlie this, and a desire for diversity and freedom of choice.

Some challenges and problems

Extensive reforms in the 199Os entailed largely increased social services responsibility towards impaired persons and the elderly. Through amendments to the Social Services Act, more tasks have been added and the lines of responsibility have been further defined. An ageing population will probably increase the need for care and nursing while a (national, regional and local) imbalance may arise between the gainfully employed and those who have left the labour market for reasons of age. The financing of the social welfare services may thus be affected, as may public ability to meet the need for care and nursing.

The most acute problem affecting the social services‘ work for old people - as well as for impaired persons - concerns the provision of staff and competence. The municipalities are experiencing great difficulty in recruiting nurses, paramedical staff and nursing assistants. The recruiting problems are compounded by increased sickness absence, and this has repercussions on care quality. At the same time social services are compelled to meet needs and demands for care of a more complex kind than previously. To manage this, well-functioning liaison with county councils is required about participation by doctors in municipal care, rehabilitation and medical measures.

The system of social assistance has increasingly taken the form of maintenance for unemployed refugees and other people who, born outside Sweden, have lived here for a fairly short time. Significantly more people on maintenance are unemployed or seeking work than others are, and the proportion of people on maintenance among youngsters bom abroad is high.

Especially in the field ot social child care and measures for abusers the lack of systematic knowledge about the treatment effects is pronounced. This creates difficulties in choosing the right intervention type.

The supervision of the municipalities‘ social services performed by The National Board of Health and Welfare (Socialstyrelsen) and the county administrative boards reveals various shortcomings. The number of complaints and identified errors in the municipal social sector however affect less than 1 out of 1.000 performed measures. This may indicate that the public social services‘ sector in Sweden still attains a reasonable standard, taken in consideration though, that considerable challenges and urgent needs are at hand.

Gunnarson, Thomas, Social Services in Sweden, in: Newsletter Observatory for the Development of Social Services in Europe 2/2003, p.5f.