The Swedish Agency for Public Management

Increased staffing levels in elderly care. A follow-up of the Government’s temporary initiative. Interim report (2016:27)

In the period 2015–2018, the Government is investing a total of SEK 7 billion to increase staffing levels in elderly care. The goal of this is to increase the quality of care, increase security for older women and men and to improve the conditions for gender-equal, equivalent and equal elderly care throughout Sweden. The initiative is designed as a targeted state subsidy whereby municipalities can request a predetermined share of the total funds every year. The National Board of Health and Welfare manages the initiative and conducts follow-up of municipal work.

Statskontoret (the Swedish Agency for Public Management) has been commissioned by the Government to analyse the design, steering and working methods of the initiative. In this interim report, we point mainly to the initiative’s strengths and weaknesses in order to support the continued work of the Government, the National Board of Health and Welfare and the municipalities.

Statskontoret assesses the initiative’s design to be appropriate in accordance with its aim. The funds are allocated to all municipalities based on criteria that capture the needs of the municipalities well. This provides conditions for a general strengthening of staffing levels in elderly care.

The initiative has been relatively simple to manage. The conditions of municipalities to plan activities have also been good, even though they were weakened by the Government adopting the initiative close to the time at which the funds could begin to be used.

Statskontoret’s overall assessment is that the activities conducted by the municipalities support the initiative’s goal of increased quality and security for the elderly. Since some municipalities have found it difficult to recruit staff, this limits their opportunities to achieve results. The municipalities have to a high degree involved private providers of elderly care in the initiative.

The Government added a new goal for the initiative through a decision in the 2016 Budget Bill. This goal for the initiative is also to improve the conditions for gender-equal, equivalent and equal elderly care throughout Sweden. Statskontoret notes firstly that this goal has not been communicated to the municipalities. Secondly, the Government’s allocation criteria mean that the funds in principle give all municipalities equal opportunities to improve elderly care. This means that the criteria do not steer in the direction of greater equivalence between the municipalities.

Our investigation also shows that the initiative is associated with certain risks. The most significant risks are that it does not lead to long-term effects and that the municipalities reduce their own funding for elderly care. To counteract these risks, we propose measures to promote strategic and long-term work by municipalities during the remainder of the initiative.

Statskontoret’s assessment is that the National Board of Health and Welfare’s work to manage and follow up the initiative is effective on the whole. At the same time, we have identified certain problems in the National Board of Health and Welfare’s interpretation of which staff the funds may be used for. We also assess that the National Board of Health and Welfare needs to develop its follow-up in order to facilitate the assessments of performance and outcomes requested by the Government.