1. Five findings in the cross-Nordic welfare challenges
The mapping shows that the same challenges are repeated across the Nordic countries – regardless of the organisation and legislation in the different Nordic countries. The mapping has summarised the cross-Nordic challenges in these five headings:
The overall welfare needs of the individual citizen tend to receive insufficient attention
Competence strategies are often underdeveloped
Incentive structures provide limited support for prioritisation of coordinated services
Lack of responsibility and shared ownership can make coordination challenging
A guidance overload can create demanding conditions for (de)implementation
The overall welfare needs of the individual citizen tend to receive insufficient attention
The mapping shows that a lack of coordination and collaboration between service providers can lead to users experiencing a fragmented process and not having a coordinated service. This can lead to uncertainty among users about who are responsible for what, often meaning they must repeat their story several times to different services. In addition, a lack of user involvement creates a sense of unpredictability, and users experience services as standardised and do not take their specific situation into account.
The services are often rigid and diagnosis-centred, failing to recognise that users’ needs do not fit into clear diagnoses or categories. Actors in different sectors lack a common plan and therefore work independently of each other. This leads to inefficient use of resources and lack of coordination, which can mean that users receive contradictory or incomplete solutions.
Furthermore, how one talks about the different user groups has an impact on all system levels. This is expressed, for example, in the narrative of the social services compared to the health services. For example, one does not want to talk about cancer patients as a “burden on society”.
Competence strategies are often underdeveloped
The mapping shows that competence challenges are multifaced. It is hard to recruit the right skills, both for employees and managers. Keeping and developing these skills is also difficult. Using the full knowledge of the team can be a challenge too.
Challenges related to competence are multifaceted. It is not only difficult to recruit the necessary skills, both among employees and managers, but also to retain and further develop competence and to utilise the collective expertise effectively. This includes the need to consider both generalist and specialist skills. Increasing specialisation heightens the need for collaboration, yet service providers often avoid collaboration due to limited time and resources.
Furthermore, the mapping highlights a lack of comprehensive competence strategies across municipalities and services, as well as insufficient structures and capacity to support initiatives aimed at developing and implementing such strategies.
Incentive structures provide limited support for prioritisation of coordinated services
The mapping manifest that financial considerations and budget restrictions are often prioritised over professionalism, and that interdisciplinary collaboration is downgraded because each sector defends its own budget. In other words, there is no strong incentive to collaborate and share resources across organisations. Metaphorical spoken this is a “sow-and-reap problem”, where one sector has no strong incentive to make a given investment because the benefits cannot be reaped in the same sector.
In addition, politicians’ desire for visible results in the short term can conflict with the need for long term and strategic plans for development and implementation. This can lead to political decisions not always being in line with the actual needs, and therefore the measures become populist rather than necessary.
Lack of responsibility and shared ownership can make coordination challenging
The mapping points out that lack of management support and unclear goals leads to frustration, because the employees experience that they are solely responsible for the services. Furthermore do managers not have sufficient time to make the necessary decisions to coordinate. No one takes responsibility for the overall coordination need. The lack of ownership for coordination can lead to a "not my responsibility attitude”.
Furthermore, a lack of overview across local services as well as national authorities causes that the employees do not know who does what and which resources and competences are available. This prevents effective collaboration and holistic follow up, and it is not clear how services should be integrated to meet complex user needs.
Municipalities are often organised in several sectors that operate in silos with limited cross-disciplinary collaboration. When you stick to your own professionalism, it can be difficult to collaborate. It is difficult to commit to each other, and there is a lack of "chain responsibility". This applies both at the local level in the municipalities and at the national level. The sectors see their areas of responsibility as "isolated islands", and there is a lack of strategic leadership that coordinates across the sectors.
There are different governance mechanisms and sectoral logics, each with its own perspective, where legislation is aimed at different levels and not always coordinated. Also, there is political pressure within each sector and a desire to define solutions leading to uncoordinated solutions. The operations at the outermost level end up with the problem when the problems cannot be solved cross-sectoral at the national level.
A guidance overload can create demanding conditions for (de)implementation
The mapping shows that municipalities experience continuous pressure from new requirements and guidelines from national authorities that follow sector specific lines and can sometimes even appear contradictory. This leads to "change fatigue" and makes it difficult to collaborate across sectors. Conversely, it is a challenge at the national level to prepare guidelines, because it is difficult to “oblige municipalities with anything other than their good will”.
In addition, resource limitations make it difficult to meet all expectations at the same time, and therefore municipalities do have to prioritise what they can implement. It is rarely stated what needs to be de-implemented when a new guide is implemented.
Furthermore, it is difficult to find the right level in the guidelines. If they are too general, they become "fluffy", and if they are too specific, it may be difficult to apply them across sectors. In addition, different professional languages are used across national authorities and sectors, which further complicates cooperation.