The Swedish Agency for Public Management
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Evidence-based practice in social services Follow-up of the agreement between the Government and Swedish Association of Local Authorities and Regions. Interim Report 3 (2013:17)

The Swedish Agency for Public Management (Statskontoret) has been commissioned by the Swedish Government to, over several years, follow up on the agreement between the government and the Swedish Association of Local Authorities and Regions (SALAR) concerning evidence-based practice in social services. The aim is to improve the full range of social services. The aim is also to improve social services' use of information technology using various initiatives that go by the name eHälsa (eHealth). The government have allocated about SEK 228 million for this intervention in 2013.

This report constitutes Statskontoret's third interim report. Statskontoret will submit a final report in 2014.

The SALAR project management is now better defined

Statskontoret makes the assessment that SALAR's internal work is now easier to monitor. This year, SALAR has altered its project management structure and developed its governance documents. The management of this project has also become more clearly defined and more coordinated than it was in the past.

On the other hand, SALAR's coordination of the various interventions within the social sector is insufficient. The organisations involved sometimes find it hard to see the connection between SALAR's different initiatives. SALAR has many parallel networks and support groups in which the health and social care organisations participate. The key individuals from the counties, who participate in various activities at the national level, have limited time and resources, and there is a risk that the initiatives in national networks take power away from local efforts. Statskontoret is of the opinion that the regional representatives risk being burdened unnecessarily hard and that the legitimacy of the networks may be undermined.

SALAR has not analysed the conditions of the major cities

The counties containing major cities have specific prerequisites for the creation of regional support structures, as they consist of many municipalities and sub-regions.

Change processes may take longer in these counties as there are so many different stakeholders involved. Statskontoret's follow-up shows that SALAR has found it hard to reach the counties containing major cities with its initiatives within the scope of this agreement. Furthermore, SALAR has not analysed in greater detail whether the major cities need some other type of support than what is provided by SALAR to the other counties.

Support structures have been established, but do not reach all target groups

In the agreement, the expansion of the regional support structures are highlighted as a key factor in achieving a more evidence-based practice within social services. These support structures consist of networks of people who are active within various research environments, R&D units, social welfare services and healthcare units, as well as platform and development managers.

The work to build up these support structures has taken a big step forward this year. In the counties that Statskontoret has investigated, the support structures have a clear position in the regional political organisation. Furthermore, the municipalities we have investigated use the support structures and have contacts in several of areas within social services. Municipalities have received support to develop individual and family care, care of the elderly, the field of disability and with implementing leadership development for managers. The support structures have also supported the municipalities in evaluating social services and working on improving quality.

However, Statskontoret has noted that the eHälsa initiatives, which are meant to develop the use and accessibility of information within the health and social care sector, have not been completely integrated with either the support structures or the organisational development within social services. Nor have the support structures reached out to all the target groups in a satisfactory way. There is a lack of systematic contact pathways to private providers. Furthermore, the link to research needs to be developed.

The requirements in the agreement promote longevity

Statskontoret has ascertained that the well-defined plan for phasing out the support from central government, which was presented in this year's agreement, has intensified the work to draw out regional funding for the support structures. Our follow-up indicates that that organisations involved in the counties studied will be partly financing the support structures and deciding making a decision on a long-term action plan.

Public authorities do not use the support structures

The agreement states that the support structures will function as dialogue partners between the public authorities concerned in matters related to knowledge development. However, Statskontoret's follow-up indicates that the public authorities that in some way work with knowledge feedback within this area are not, to any great extent, collecting experiences or disseminating information via the support structures. Several of the public authorities within the care sector state that these support structures are not appropriate to them. This is in spite of the fact that the county council activities are well in line with the direction of the support structures.

The connection to healthcare should be strengthened

In general, the county councils and municipalities need to reinforce their collaboration on initiatives for people who need the help of both health services and social services. Statskontoret's follow-up indicates that there are deficiencies in the collaboration between the county councils and the support structures that have been built up in the counties. This is despite the fact that the county councils are clearly highlighted as the areas that the support structures are meant to support. The areas in which the collaboration with the support structures could be developed include care of the elderly, substance abuse care and psychiatry.

Risk of parallel support structures

Statskontoret makes the assessment that there is a risk of parallel support structures being built for the dissemination of knowledge within the social services. Within this area there are also national knowledge centres. As with the support structures, these knowledge centres have the task of compiling existing knowledge, supporting implementation and collaborating with regional R&D environments. These are roles that partly overlap with the goals of the support structures.

Proposals

Statskontoret proposes that the government, in advance of the continued collaboration on this agreement:

  • clarify, in collaboration with SALAR, the aim of the national knowledge centres, and structure the roles of these centres and the regional support structures so that parallel structures are not created,
  • place demands on SALAR to follow up on whether the aim of the agreement has been achieved in the counties containing major cities, even if they have chosen to organise parts of their work in different ways,
  • place demands on the people responsible for the regional support structures to draw up strategies for reaching the private providers, strengthen the connection with research and clearly show their link to eHälsa, and
  • notify public authorities that work with knowledge feedback within health and social services of the fact that that they should consider possible ways to disseminate information and collect experiences via the support structures.