From Vision to Reality? An Evaluation of the Swedish National Action Plan for Disability Policy (2009:21 )

The assignment

The Swedish National Action Plan for Disability Policy (Government Bill 1999/2000:79), From Patient to Citizen, was adopted by the Riksdag (Swedish Parliament) in 2000. This Action Plan, covering the period up to 2010, represents a clear shift from a perspective of healthcare and social care to the citizen’s point of view. The aim is to mould society so that people with disabilities can enjoy the same rights as others, but also have equal opportunities and obligations to contribute to the development of society.

In November 2008, the Swedish Government decided to commission the Swedish Agency for Public Management to follow up the National Action Plan for Disability Policy. The overall purpose of this assignment is to assess the impact exerted by the Government’s control instruments to date on implementation of the Action Plan.

Fourteen government agencies (1)  were given special sectoral responsibility for implementing the general objectives of disability policy. This special sectoral responsibility has been described as a cornerstone in the implementation of the National Action Plan for Disability Policy. The Swedish Agency for Disability Policy Coordination (Handisam), set up in 2006, was charged with supporting the central government agencies in their implementation of the National Action Plan.

In carrying out its assignment, the Agency for Public Management has dealt with the following questions:

• What bearing does special sectoral responsibility have on scope for achieving the aims of the National Plan for Disability Policy?
• Does the Government control Handisam in such a way as to promote efficient implementation of the National Action Plan for Disability Policy?

Observations

Special sectoral responsibility
Over the past ten-year period, the Government has not carried out any reassessment of which government agencies should be sectoral agencies in the area of disability policy. Accordingly, it is difficult to assess the grounds on which the 14 sectoral agencies possess their sectoral responsibility, and the grounds on which other agencies with substantial responsibility in their respective sectors of society have not been appointed as sectoral agencies.

Different sectoral agencies vary widely in terms of how they interpret and define their ‘sectoral responsibility’. Since this term has not been defined precisely in the Action Plan, the agencies’ instructions or any other steering documents, the agencies have had to work out their own versions. This has meant that certain agencies have interpreted their responsibility very narrowly, for example by stating that the agency is its own sector. Other agencies describe their sectors very broadly, making them almost impossible to demarcate. In several cases, the sectoral agencies have difficulty in clearly specifying which other stakeholders are included in the sectors concerned. The stakeholders may, for example, be other central government agencies, cultural or interest organisations and companies.

Sectoral responsibility has included the sectoral agencies’ duty to draw up interim targets that could be followed up. The sectoral agencies have had problems in breaking down the general objectives of the Action Plan into their own interim targets to govern their activities. These targets have proved unworkable as means of controlling the sectors concerned. The monitorable targets have therefore been successively replaced by more generally worded directional targets that lack clear connections with the Action Plan. These generally worded targets are difficult to use as a basis for follow-up and evaluation. The follow-up studies and evaluations carried out therefore afford no clear answers to questions about outcomes and effects in relation to the overall objectives in the Action Plan. This means that the documentation for assessing the target fulfilment of the Action Plan has major shortcomings.

Special sectoral responsibility is an unclear means of control. The sectoral agencies’ work on disability issues is controlled in several dimensions. Agencies’ work on disability issues is governed by directives, laws and other regulations relating to their own spheres of responsibility; and they are also governed by the objectives in the National Action Plan. This multidimensional governance makes it difficult to isolate effects and results of the governance through laws and regulations, on the one hand, and governance by means of objectives in the National Action Plan on the other.

The Government’s control of Handisam
The Government’s purpose in forming Handisam was to create a body at central level with responsibility for overall coordination of the implementation of disability policy.

The following figure (from written communication 2004/05:86) summarises roles and functions for the agency.

The objectives in the National Action Plan are overall directional aims. The Government’s performance management of Handisam is not directly linked to the overall objectives in the Action Plan. This is one reason why it is not possible to carry out a comprehensive assessment, based on Handisam’s annual report, of this agency’s performance and the effects of its work in relation to the objective that the Action Plan should be implemented by 2010.

The governance of Handisam has substantial features of special government assignments. Excessively far-reaching task management may impair the efficiency of Handisam’s activities. The risk is that it may result in short-term, fragmented work, split up among too many different tasks. It also makes it difficult for Handisam to develop its work, on its own, by means of a long-term, coherent strategy with deliberate, clear priorities, for example to concert its strength in a few work areas for a while.

Handisam’s remit includes several roles that are partially hard to reconcile. Handisam is intended to be supportive towards, and promote, agencies responsible and other stakeholders, while simultaneously performing the role of evaluator of these stakeholders for the Government. This makes its role and remit unclear, weakening Handisam’s legitimacy vis-à-vis the stakeholders concerned. This dual role also contributes to lack of clarity on what responsibility can be laid on the sectoral agency for implementation of the Action Plan and target fulfilment.

The Agency’s conclusions

The overall purpose of the task assigned to the Agency for Public Management was to judge what impact the Government’s control instruments had had in the implementation of the National Action Plan for Disability Policy. In its implementation of the Plan, the Government has used parallel means of control. In the view of the Agency for Public Management, this has made governance unclear and adversely affected the impact of the Action Plan.

Sectoral responsibility
The special sectoral responsibility has not become the effective means of control that it was intended to be when the National Action Plan was adopted. Still, after almost a decade, there is uncertainty among the majority of the sectoral agencies concerning their own sectors’ external boundaries and which stakeholders they should collaborate with, on the one hand, and how specifically to implement their exercise of their sectoral responsibilities on the other. In the view of the Agency for Public Management, the sectoral agencies have received too little support to be able to develop their special sectoral responsibilities.

The sectoral agencies have manifest problems in applying performance management to their implementation of the Action Plan. In its evaluation, the Agency for Public Management has found that one reason for this is that it has been very difficult to break down the general objectives of the Action Plan into specific targets to govern activities in the sector concerned. Special sectoral responsibility in disability policy is thus hard to reconcile with the model of performance management applied in Swedish public administration.

Special sectoral responsibility impedes accountability. When the agencies’ own interpretations govern the definition of, first, their own spheres of responsibility and, second, the content of their responsibilities, their accountability for fulfilling the aims of national disability policy is also obstructed. In the Agency’s estimation, this is a serious objection to the model of governance chosen.

Governance of Handisam
Handisam has many roles, and they are sometimes contradictory. This has adversely affected its work of supporting the implementation of the Action Plan.

The growing practice of task management of Handisam makes it harder to adopt a long-term strategy for the agency’s promoting role. Scope for concerting its forces and accumulating knowledge for activities initiated by Handisam itself is thwarted by an extended, resource-intensive staff role for the Government.

Handisam’s promoting role, that of supporting and coordinating the sectoral agencies’ work, is unclear. The specific content of Handisam’s coordination remit is insufficiently developed in relation to the functions, responsibilities and powers of the other central government agencies.

The Agency for Public Management judges that there is a lack of clarity concerning the remit of being in charge of coordinating disability policy. There are, broadly speaking, two issues that need to be clarified. First, can an agency coordinate and support the work of achieving aims that other central government agencies are expected to implement? Second, what is Handisam expected to coordinate? Moreover, Handisam’s task, remit and function as a cooperation partner is unclear in relation to other stakeholders with implementation responsibility at various levels of society, such as municipalities and county councils.

Handisam’s roles of both promoting other agencies’ work and, at the same time, serving as an evaluating staff body for the Government are not readily reconciled. Handisam takes part in, and is partially responsible for, the implementation of the National Action Plan through its functions of supporting and promoting the sectoral agencies’ work. Simultaneously, as a staff body for the Government, Handisam has the function of scrutinising and evaluating their work. Thus, it is difficult both for sectoral agencies and for other stakeholders to determine which role Handisam is playing in its pursuit of the aims of disability policy.

Recommendations

The following proposals refer to the period after 2010, when the present Action Plan has expired. The Agency’s purpose in putting forward these recommendations is to enhance the scope for achieving a real impact for the national objectives.

Apply disability policy in a simple, clear way without regulatory duplication
The Agency for Public Management recommends that the Government, in its governance of future disability policy, should apply a simple, clear control model and avoid regulatory duplication. An ordinance is a sufficient control instrument for specifying all the agencies’ responsibilities.

Phase out special sectoral responsibility in disability policy
The evaluation showed that there are a range of problems associated with the application of sectoral responsibility in disability policy. The Agency for Public Management has weighed up the scope for precisely defining ‘special sectoral responsibility’ in disability policy, but judges that this is not feasible. The Agency therefore recommends the Government to phase out special sectoral responsibility in disability policy with effect from 2011, when the current Action Plan has expired.

Supplement performance management with special assignments
The Agency for Public Management recommends the Government to develop its overall governance and coordination of the aims of disability policy by supplementing its performance management with focused assignments vis-à-vis agencies responsible for areas where there are problems.

Will Handisam be needed after 2010?
Supporting the implementation of the National Action Plan and application of the aims of disability policy have been a key function for Handisam. The Agency for Public Management proposes in this report that special sectoral responsibility in disability policy should be phased out. In addition, the Agency recommends that the Swedish Government Offices should, to a greater extent, govern through special assignments based on a well-developed strategic analysis. These recommendations affect the fundamental scope for Handisam’s pursuit of the aims of disability policy.

The Agency for Public Management therefore recommends the Government to carry out an overview of Handisam’s future role and functions. The main options that the Agency perceives, assuming that the Government otherwise follows the recommendations provided in this report, are twofold. First, Handisam could be given a new role that is more clear-cut and better developed than its present role. A future role of this kind may involve focusing Handisam’s role on serving as a staff body, with the function of supplying the Government with the documentation it needs to govern disability policy. Second, there is the option of phasing out Handisam, starting in 2011, and of strengthening and developing, in terms of resources, coordination of disability policy in the Government Offices.

1. The Swedish Work Environment Authority, Swedish National Labour Market Administration, Swedish Rail Administration, Swedish National Board of Housing, Building and Planning, Swedish Social Insurance Agency, Swedish Consumer Agency, Swedish Civil Aviation Authority, Swedish National Post and Telecom Agency, National Heritage Board, Swedish Maritime Administration, National Agency for Education, National Board of Health and Welfare, Swedish National Council for Cultural Affairs and Swedish Road Administration.