The Swedish Agency for Public Management
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Increased staffing in elderly care. A follow-up of the Government’s temporary initiative 2015-2018. Final report (2019:5)

During the period 2015-2018, the Government invested a total of SEK 7 billion on increasing staffing in elderly care. The initiative was formulated as a targeted government grant where all municipalities could requisition a predetermined share of the funds every year. All municipalities have chosen to partake of the funds. The National Board of Health and Welfare administered the initiative and followed up the municipalities' work.

The Government wanted the funding to give the staff more time with the elderly and more opportunity to develop the activities. The initiative should also contribute to increasing the quality of elderly care, increase the security of the elderly, improve the work environment for the staff and improve the conditions for an elderly care that is equal in terms of gender and diversity.

The Swedish Agency for Public Management (Statskontoret) has had the Government's assignment to analyse if the governance, formulation and working methods have been suitable in relation to the Government's goal for the initiative. In December 2016, we presented an interim report and this report is our final report.

The initiative led to increased resources in elderly care

Statskontoret deems that the initiative has led to increased resources in elderly care and that they have also led to an increased staffing close to the elderly. We find that the activities that the municipalities have implemented using the extra resources have contributed to increasing the quality of the elderly care and to increasing security for the elderly, during the time that the initiative was under way. During this period, the initiative also had the conditions to contribute to a better working environment for the staff.

The initiative has also contributed to increasing the equivalency between municipalities, since municipalities with greater needs in elderly care were able to requisition more funding. The initiative has in itself some conditions to contribute to greater equality, but the preconditions for obtaining funding did not guide the municipalities to work to increase equality.

Initiative was suitably structured

Statskontoret finds that the initiative was suitably structured in relation to the outcome the Government wanted, meaning increased staffing. The funds were distributed based on a model that captures the needs in the various municipalities well. The model meant that the municipalities were able to predict how much funding they would receive each year, which facilitated their planning. But the predictability was deteriorated by the model changing between 2015 and 2016.

The initiative was relatively easy to administer for the municipalities. It was easy to requisition funding and the requirements on reporting were reasonable in relation to the scope of the initiative. The municipalities also had extensive freedom to decide how they would use the funds, which made it possible to formulate locally adapted efforts.

Short preparation time gave the municipalities worse preconditions in planning the efforts

The conditions for the municipalities' planning became worse than they could have been since the Government's decision on the initiative was made close to the start. The Government decided on the initiative at the end of June 2015 and the municipalities were able to use the funds for costs that arose as early as July. This meant that the municipalities had limited time to plan and prepare for the efforts. The focus the municipalities initially decided on in many cases also lasted for the entire initiative. The deficient preparations thereby affected the municipalities' work during the entire initiative.

National Board of Health and Welfare's work generally functioned well

The National Board of Health and Welfare's work to administer and follow up on the initiative generally functioned well. The authority also administered the initiative at a low cost. But in some cases, the National Board of Health and Welfare was not consistent in its assessments of how the municipalities may use the funds. The authority in some cases approved the municipality using funding in a way that conflicts with the Government's intentions and the authority's own instructions. Besides this leading to incorrect fund use in individual cases, it also led to it becoming unclear to the municipalities in terms of what the funds could have been used for.

Risk that results of the initiative are short term

There is a risk that the positive results in the elderly care become short term since the initiative is not formulated to provide lasting results and effects. The Government expressed a hope that the funds would provide the staff an opportunity to develop the activities, but there are no conditions or requirements in the fund use that guided towards learning or developing new working methods. Only a small portion of the municipalities prioritised such efforts. There was also no possibility to finance training of recruited staff through the initiative's funding, which could have strengthened the long-term nature of the initiative.

The Government did not assign the National Board of Health and Welfare to provide guidance to the municipalities to direct the initiative towards long-term operational development or new working methods. We nonetheless find that there was room for the National Board of Health and Welfare to provide more support to the municipalities when the initiative began. The initiative could have then been a way to promote development of the activities or of successful working methods around, for example, rehabilitation and a secure return home.

For many principals and implementers in elderly care, the end of the initiative was a difficult challenge to manage. Like when other targeted government grants end, the municipalities must handle a reduced staffing or themselves bear the higher costs that the initiative contributed to.