Open
World Conference of Workers
In Defense of Trade Union Independence & Democratic Rights
Sweden
Answer to the Berlin Conference Invitation from Swedish social-democrats
Declaration against privatisations, from a conference on February 24, 2001, organised by social-democrats for the public sector (SOS)
Open letter to the social-democratic congress, from SOS (nov 2001
Contribution to the Berlin conference, by Bengt Silfverstrand, social-democratic deputy in the Swedish parliament
Swedish Social-democracy: Twenty years of staggering on deregulation and privatisation, by Peter Gustavsson, district secretary of the social-democratic youth organisation in Southern Sweden (Skåne)
How Neo-liberalism destroy human dignity, by Ingemar Körner and Helena Öhrfeldt, trade-unionists (Kommunal/LO)
Destruction of public transport in Stockholm, by Sixto Iturra, trade-unionist (SEKO/LO)
Privatisation of public water, by Jan-Erik Gustafsson, researcher at the Royal Institute of Technology (KTH), trade-unionist (ST/TCO)
Destruction of public health care in Stockholm, by Mirja Särkiniemi, trade-unionist (Kommunal/LO), member of the steering committee of the Social-democratic party in Stockholm
Privatisation of social assistance, by Annika Gyllfors, trade-unionist (SKTF/TCO)
"Balance record of social welfare for the 1990s" Extracts from an official governmental report
Discrimination of pregnant women Summary of a trade-union report on discrimination of pregnant women
Why I support the Berlin conference, by Bengt Silfverstrand
Support
statement of Berlin Conference from a meeting against privatisations, February 9, 2002
To the Preparatory Committee of the International Conference Against Deregulation,
to be held in Berlin, February 2002
We have received the invitation from you to the international conference against deregulation that you plan to hold next year, in Berlin. We welcome this initiative to an international counter-offensive from the worker's movement against deregulation and for a labour code for all.
We are social democrats and active in the trade-union movement, fighting against privatisation and the exposing to concurrence of the public sector. We have many experiences from how the politics of privatisations dismantles the public activities. Within the elderly-care the opening-up of public procurement* have led to scandals of negligence of care, within public transports the same politics have led to cancelled trains, weakening of the security, employees abandoning, and crisis of work environment. In the health care we can see a deepened segregation with the help of more and more private assurances. The hospitals in Stockholm will soon, by the bourgeois majority, be opened-up to the world's biggest public procurement. The politics of privatisation is the cause of segregation and deepened class-gaps. Profit-driven schools are promoted at the same time as public schools are decomposing.
Privatisation and the exposing to concurrence of the public sector puts the personnel and their working conditions - i.e. pensions, holidays, working time, forms of employment, the right of free speech at work etc - under systematic pressure. Undetermined employment is for many nothing but a memory and the dismantling of the contracts explains largely the fact that the personnel is abandoning their work and the crisis we now can see within the sectors of education, care and public transports.
In your invitation you tell us about the protests in Germany against putting the pensions on the capital market and the raising of the pension age. We have the same problem in Sweden, where the pension system already have been deregulated and an important part of the pensions have been made dependent on profits from the stock market, at the same time as a limitation of the public pensions and a rise of the pension age is prepared by the social democratic government.
From the party leadership we have also got a proposal for a new party program, risking to cut all the references to the workers movement and to become an instrument for continued privatisation. This proposal is, as far as we can see, on the line of what Gerard Schröder and Tony Blair have launched as the politics of the "Third Way", and it has to be opposed.
We wish to contribute to the building of the resistance on the international level and we hope to have an exchange with you during the preparations of the Berlin conference, to which we have the intention to send delegates.
Annika Gyllfors, local president within SKTF, editor Oberoende Socialdemokraten, SAP-Stockholm; Bengt Silfverstrand, deputy, SAP; Karin Gustavsson, president SSU-Stockholm; Jens Lundberg, international secretary, SSU-Stockholm; Peter Gustavsson, local leader within SSU-Uppsala; Staffan Örneland, local president within SAP-Örebro; Arne Nyström, EU-sceptic social democrats, SAP-Örebro; Marja-Lena Karlsson, city district councillor, SAP-Örebro; Kurt Jakobsson, SAP-Örebro
Yvonne Elkström, local president within SKTF, local president within SAP-Stockholm; Agnetha Falck-Rodriguez, trade union officer Kommunal, SAP-Stockholm; Sixto Iturra, local president within SEKO, SAP-Stockholm; Eero Carroll, member of the regional board, SAP-Stockholm; Rikard Erlandsson, SAP Sundbyberg; Eva Pauli Arkemo, vice local president within SKTF, SAP-Stockholm; Göran Larsson, member of the regional board, SEKO, SAP-Stockholm
_____________
SKTF = Union of Local Government Officers (TCO); SAP = Social Democratic Workers Party, "SPD"; SSU = Social Democratic Youth Organisation; Kommunal = Union of Municipal Workers (LO); SEKO = Union for Service and Communication (LO
Statement adopted at Social Democratic activists' meeting, Stockholm, February 24th 2001
STOP PRIVATIZATION!
Social democrats from the whole country, at all levels in the party, have met today to gather strength behind our demands for stopping privatization and profit interests within collectively financed sectors such as those of education, social services, and public transportation.
We have today heard many examples of how privatization policies are dissolving public sector programs. Within old age care, scandals have followed on the heels of contracting out to private entrepeneurs. Within public transportation, the same policies have led to cancelled train departures,
undermined job safety, personnel flight, and deteriorating work environments. Already today, an increasing share of access to medical services is becoming dependent on whether patients can afford to pay. In Stockholm, municipal hospitals will soon be involved in the biggest bidding wave ever seen in the world, in accordance with decisions made by the right-wing-dominated city council.
Privatization policies will lead to increasing segregation and class inequalities. When private schools are favoritized, at the same time as the resources available to public schools are increasingly depleted, children will be treated differently according to their background already in their first years at primary school. In many private schools, students are organized into groups by study results obtained, in so-called "fast track" and "slow track" classes. For the good of all children, a unified school system is necessary.
Privatization and competitive bidding are also effective instruments for setting working conditions and social benefits under systematic downward pressure. Pensions, vacation days, working hours, types of employment contracts offered, freedom of expression and speech on the job, personnel density, and many aspects of the work environment are all potentially affected for the worse. Permanent employment contracts are but a memory for many, and "contractual dumping" practices explain a considerable part of the personnel flight and repeated organizational crises which continually afflict the educational sector, social care services, and public transportation.
We are social democrats who have committed ourselves to political activism within the labor movement to further moves towards greater social justice, equality, and developed democracy. We are fighting for the chance to make collective social services work. In order to actualize the potential of workers in these jobs, it is necessary to bring the recurring threats of cutbacks, collective dismissals and worsening work conditions to a standstill. In order for genuine freedoms to be available to all, public management of social services must be maintained, developed and strengthened. Private profit interests must be excluded from publicly financed services. Marketizations and selling off of public services must cease, and re-democratization take place at the expense of international capital interests.
We can conclude that we are not alone-the same problems exist in all of Europe. International regulations and economic policy coordination within the European Union have not strengthened the hand of the public sector against the market. Further, the resistance to these trends is not limited to Sweden. Many social democrats over all of Europe are today fighting in order to bring back on to the policy agenda a genuinely social democratic politics, a strong public sector with sufficient resources, and protective work regulations for all.
We demand a stop to continued competitive bidding on public services, to privatization, and to deregulation.
We are of the opinion that there are basic problems with the recently presented new party program draft to be discussed at the next party congress in November of 2001. In the proposal, the public sector is not mentioned by name a single time, and the notion of collective responsibility is replaced by phrases like "a redistribution of life opportunities" and "equality in diversity". In practice, these phrases open the way for nothing less than continued privatization and competition. They are, however, useless for those of us who strive to realize the concrete steps towards greater social justice which a strong public sector gives possibilities to reach.
In addition, the new draft program runs the risk of critically weakening the labor movement in its entirety. The very possibility of a democratic and socialist society is excluded from the very possibility of discussion. The political goals to put power over economic production and distribution into the hands of the whole people are replaced by a ostensibly realist policy of pandering to the market, in a time when resistance to marketization is growing, in Sweden and throughout the world.
It is therefore necessary that the party congress of 2001 be made into a point of departure for re-capturing the confidence of all those who expect a politics of radical egalitarianism from us. Such a truly new politics of justice should aim to reduce the class inequalities which cut through Sweden of today, by taking a clear stand against the dissolution of the public sector.
We call upon all social democrats to rally to our cause, and to actively resist privatization policies at all levels where they are advanced, internationally, nationally as well as locally. We also declare our support for all party organizations, labor union organizations, and individual citizens who take initiatives to stop ongoing privatization.
Open letter to the delegates of the Swedish Social Democrats' Party Congress, Vaesteras, Fall 2001
A dramatic year is nearing its end. The only thing which seems certain is that social disparities, conflicts, fear and desperation are on the increase across the world. Behind the rioting and police shooting in Gothenburg, behind horrific acts of terror and bombings undertaken in the name of "justice," we can also see how deregulation and privatization is pursued further.
In the course of the Swedish presidency, the European Union adopted economic policy guidelines where we can read of the following goals: "create an effectively functioning internal market in services by removing regulatory and other constraints," "fully liberalise electricity and gas," "further open up the public procurement market and bring it on-line," "accelerate the liberalisation of the network industries (energy, railway, air transport and postal services sectors," "reduce the overall level of State aid," "more favorable environment for business," "ensuring that public and private entities compete on a level playing field," "raise private sector involvement contributing to a better commercialization of R&D ( research and development)" Two concrete commitments for Sweden's part in these guidelines are to "enhance compliance with regulations on public procurement" and "enhance competition in public services provision at all local levels."
These guidelines are in direct contradiction with many of the welcome statements that representatives of the government and of the Swedish Trade Union Confederation (LO) have made in recent times, against the privatization offensives taking place in the municipalities. They are also in direct contradiction with the future survival of welfare and of democracy.
Before the very eyes of the people who live and work in this country, the public sector is being cut apart into small pieces and distributed out to private enterprise, which demands profits-despite the fact that the services involved are tax-financed. These profits are created through inferior wage developments, the absence of determinate rules in collective agreements, worse arrangements of working hours, the absence of free speech and deteriorating employment protection. Citizens are discovering that health care services, public transport, education, housing and social care services include more and more black holes-collective goods are constituted by half-done services, or for some periods of time no services at all. Employees and citizens are being played out against each other in a downward spiral. The labor union movement is hamstrung and the confidence of members in their organizations decreases. Social disparities and residential segregation is on the rise, and women are once again expected to enter the non-paid labor force in their leisure time in order to perform central care services for our children, youth and elderly. Welfare, and democracy, are threatened at their core.
Thousands of workers and citizens are now resisting this development, on the basis of their own daily experiences, and the need for a vital and democratic labor movement which is capable of turning these trends around is acute. Many of us have been active in writing congress motions, op-ed pieces and public statements, organized meetings and networks. The contacts between us have been strengthened, but the work must go on.
Congress delegates of Vaesteras!
Many generations of the labor movement's sons and daughters have fought for a democratic society, for living better lives and to realize guarantees for a future for new generations. This is our historical legacy, and our future. It is not possible to declare oneself free of responsibility for the developments which we are affected by now!
Shall the trade unions, and the political organizations, of the labor movement in Sweden act as a force for justice, or shall we go under? The question of the future party program, and of privatization policies, are at the focus of attention for this congress. It is time to take responsibility and to say no. Adopt a party program, and policy guidelines, which will bring continued privatization to a halt!
Privatization policies are a question of vital importance, and will be a central issue in the upcoming elections. In that arena, it will not do to say one thing and to do another. Workers and citizens will judge us on the basis of the practical work that we do. Let therefore the congress become the turning point that is needed for welfare, social justice and democracy to be
rewon.
The adopters of this statement are elected representatives and party organization activists-at this, the meeting of our network, Social Democrats for the Public Sector (SOS), conducted together with residents of the city of Stockholm, we say no to continued privatization and competitive tendering, for the sake of welfare, justice and democracy. We will not falter, but will continue our struggle to convince others. We will extend our cooperation for a future of security and freedom. In consonance with this work, we urge you to participate in the demonstration against privatization which is being arranged in Stockholm for the 17th of November.
Adopted on the 20th of October, 2001
Discussed at a public meeting in Stockholm
to raise the demand "Stop Privatization"
By Bengt Silfverstrand, Member of the Swedish Parliament and
its standing committee on Financial affairs
Contribution to the
International Conference Against Deregulation
at Berlin, 22nd-24th of February, 2002
Neoliberalism has replaced debate and ideas with advertisements, form and color. As Jacques
Seguela, a French advertising expert, puts it: "Selling politics is like selling toothpaste, but actually easier, since 60 to 70 percent of Frenchmen vote, while only 20 percent of them brush their teeth." This says something about the influence which markets and the media have over politics these days. The American economist Milton Friedman's message of marketist liberalism has gone out like wildfire over the world: deregulate, privatize and contract out public service, and you may achieve humanity's complete liberation and re-entry into paradise. Now we can see the results of this so-called liberation. In the cradle of globalization, it is not only income and assets differentials that are growing. Distances of space are also, actually, growing. The new elites have their own residential areas, their own social service programs, leisure time activities of their own, and are increasingly protecting their homes and lives with advanced security systems. We can see increasing slummification of many other residential areas. Insecure conditions for
childrens' coming of age, insufficient education, exclusion and rootlessness are also triggering mechanisms for increasing criminality, which right-wing politicians seem to think can only be fought by hiring more policemen.
The new Swedish employers' organization, the Confederation of Swedish Enterprise, has recently acquired an economist-in-chief whose name is Stefan
Fölster. Among other things, he has suggested that one way of combatting homelessness is to announce free places at homeless shelters on the Internet. The next suggestion from
Fölster, we can suppose, is that all homeless people are to be equipped with portable computers But the traces of deregulation and privatization during the 1990s are truly frightening. Let me illustrate with a few international examples:
One. In England, all municipal waterworks were privatized. The results were that fees charged for water increased by 60 percent. Profits constitute 35% of financial turnover, and the directors of the works have increased their wages by 300 percent.
Two. In England, Margaret Thatcher liberalized the housing market. It did not, however, take long before private construction entrepeneurs were running shuttleraces to the right-wing government to demand government intervention in urban planning, which was beginning to totally disintegrate.
Three. In New Zealand, large shares of the welfare state were dismantled or strongly delimited, and were replaced with pure competition and market mechanisms. The changes went perhaps longer, and were more consistent, than in any other Western countries. They were admired and praised by the European right. Schools were adapted to market principles wholesale. School reforms were based in ideological preconceptions, not public inquiries or social science. Free parental choice and competition between schools, together with a creeping tuition fees system, has made for increased polarization between schools.
This third example, though it will not be the last, deserves to be gone into in some detail. Obviously, it is in the very nature of the market system that a given school will have a vested interest in attracting well-to-do children from well-to-do families. The schools will not have any greater interest in taking on children who can be predicted to run into educational difficulties, or who come from problematic social backgrounds. The new Labour government of New Zealand under Helen Clark has started what could be described as a careful reassessment, attempts to once again create confidence in society's and in politicians' capabilities to affect peoples' life chances. Markets, voucher systems and free parental choice certainly do have potentially discriminatory consequences. This is supported by international research in considerable agreement-as an example, we can name the findings of Professor Martin Carnoy at Stanford University, who is a specialist on voucher systems and their effects.
Fourthly, and lastly: California, the United States of America. Here, the market for electric power was deregulated wholesale. Already the first-order consequences were destructive, with investment rates plunging. Instead, more effort was focused on stock values. And here, the valuation of stock prices in the last quarter of a fiscal year is often decisive. Entire metropolitan districts in San Francisco lost power. And in Silicon Valley, the center of the world's IT industry, the computers stopped. The only area in California which does not suffer from electricity shortages is Los Angeles, which has not deregulated locally.
One positive consequence of all this can be noted. Nativity rates are increasing. But it the deregulation of electricity in California was not exactly supposed to be a reform in family policy!
Also in Sweden, the priesthood of the corporate executives are singing the market's praises, and is using the concepts of flexibility, investment climate, logotypes, and entrepeneurial spirit as if they were holy sacraments. Stock market introductions are the christening, the quarterly report is the confession of sins, and penance is done by announcing mass redundancies.
"School companies are like airlines," the CEO of the private schooling company Kunskapsskolan says to the Swedish newspaper Dagens
Industri. "It's a matter of filling up the seats. It's the last two seats which give the profit margin." Yes, that's actually true. Under the newsstory title "Now you've become profitable, my little friend," another CEO for
Kunskapsskolan, Anders Hultin, also a former policy advisor to a Conservative Minister of Education, admits precisely what we would suspect to be true. It is the profit motive which is the ultimate driving force behind the establishment of private educational services companies underwritten by the common taxpayer. The logic of aerodynamics and of the squeeze mentality have now penetrated also the domain of schooling. Given all of this, can anyone really be surprised by the fact that resistance is now growing in the labor movement against marketist thinking and profit maximization within tax-financed public operations of schools and social services?
At a public policy debate on education which I participated in recently, in my hometown of Helsingborg in the south of Sweden, the situation was very aptly described by one school principal. In his own words: "Here at the Gustav Adolf school, we have children from the whole world, with the possible exception of
Helsingborg." It is in these words that the principal commented a situation where 95 percent of the children at his school have immigrant background. Despite the fact that the school in question offers education of recognized high quality, segregation is rampant, a stratification of children with different backgrounds, in ethnic, social and economic respects. In the book The New Face of the Welfare State, the political scientists Paula Blomqvist and Bo Rothstein show how segregation grows as a result of marketist regulation within the schools. One can speak of "creaming" and "white flight," in the sense that the well-educated and highly paid opt out of municipal schools and literally flee from schools in areas with high concentrations of immigrants.
Primary schooling in the Swedish tradition has entailed that children and youth gather within the ambit of the same institutions. It has contributed to strengthening equality and social justice in our country. It is by no means without its problems, and it will never become perfect. But its achievements cannot be denied.
Schools are not like airlines. Children are not customers, and they are not to compete on a market. Schooling should not be a place for competition, but certainly a place where voluntary initiative without pay can constitute important complements to municipal schooling. Schools run for profit should be completely excluded from the educational system. The time we spend in school is perhaps the only time in life where people encounter one another over all borders, as a natural matter of course. Impressions of our world, and of our fellow men and women, which are conveyed to people in their years of youth will affect people for the rest of their lives. In such times, children are not to be divided up against each other. They should be together for their start in life. That is when the foundations for equal starting conditions and integration are laid down.
The same way of thinking I have shared here can be applied to social services. Privatization of health care has been intended to give us all more care for our money. Instead, we have gotten less care for more money. Both more expensive and worse at the same time.
But wait a second, says someone: private profit interests don't threaten the principle of shared financing. That simply isn't true, however. If a for-profit company decides to use part of its resources to offer care services for holders of private insurance, moved to the top of the queue, shared financing will be undermined. More and more people are going to question whether they should be expected to pay for the same care services twice, both to the public till and to the private insurance companies.
At the tempo of the forced march, the current right-wing administrations of Stockholm's municipality and regional county council are continuing to implement market solutions within schools, health care and other social care services. In tandem with the increasing extremism of the measures pursued, the ideological motives for the new policy of de-communalizing core social services and of selling out public assets become more and more clear. It is, in other words, a clearly right-wing policy that is being pursued. Not of the new center, not of the center-right, not of the center-left, not of modernization, not of the third way. This is not anyone else's policy, nor should it ever be. This is the policy of the hard right wing-pure and simple.
Experience shows that when hospitals are increasingly administered by private actors, with obvious profit interests, the driving forces are strengthened behind letting in private care insurance plans as complements to tax financing. The same developments can now be seen in my own constituency in southern Sweden-in the region of Scania (or Skåne), run by a right-wing administration under the leadership of the Conservative Party. A concrete example is available from
Helsingborg, where a local hospital (run as a freestanding corporation) recently concluded an agreement with the insurance companies of Scandia and
Storebrand. The agreement specified that customers of these two companies would be offered hospital care before anyone else. Here, fast tracks are being created in health care for those who have the money to purchase care insurance. In such a situation, health care is no longer being distributed on the basis of need, but on the basis of purchasing power. Here, universalist welfare programs break down.
Hearteningly enough, the Social Democratic Party in the region of Scania has woken up. A month ago, the executive board for the Scania Social Democratic party district adopted a decision which means that we, if we attain majority power after the elections in September of this year, are going to oppose all privatization efforts directed at health care services in our region. We will insist that health care services shall be administered democratically, and that this administration will be based on cooperation, not competition. Therefore, we are going to abolish all divisions between service-ordering and service-tendering organizations, and reform the organization of health care to strengthen democratic influence, increase the possibilities of enforcing claims of responsibility on providers, and dismantle bureaucracy. In order to prevent future efforts to sell out emergency care hospitals, we are going to abolish the administration of hospitals in the form of free-standing corporations, and re-establish unified public administration of the hospitals.
Beautiful speeches about freedom of choice ignore at least three basic conflicts of interests, which I will now discuss each in turn before concluding.
Firstly, conflicts will always beset the extent of free choice to be allowed. It cannot be regarded as a self-evident right to limitlessly choose which old age care facility, health care center, or school one will have access to at taxpayer expense. Schools are an important example. Shall we really accept the operation of confessional schools, whose religious message can hardly be expected to be in consonance with national curricula? In a modern society, the schooling of children must be based on democractic values, science and rationality. Education should also have as its task to encourage critical thinking. It is questionable whether religiously based schools, regardless of whether they are Christian or Muslim, can enforce such standards, and it should thus be questioned whether public subsidies should be granted to schools of this kind.
The second goal conflict is of economic character. The difference between production based on needs and on market demand is obvious. The most usual driving force for the market sector is the drive for profit. This is the case for companies, but especially for companies noted on the stock market, since they must be able to demonstrate high profits in order to keep up the sale value of their stock shares. Profit demands are not reconcilable with needs-based production, since the profit objective entails that every pupil or patient will be assessed by the school or the hospital with respect to how profitable the "customer" in question is. Thus, for-profit schools and hospitals will compete for the easy patients or pupils. The principles of customer choice and of market areas cannot find a home within the ambit of need-oriented and tax-financed services. Even the occasional Social Democrat in my home country sometimes claims that if we want freedom of choice within social services, this means that we also have to accept profit-driven companies. Naturally, we don't have to do this at all. At least not so long financing truly is collective and public committments are to be viewed as binding. We can certainly demand that operations of this kind are to be pursued in non-profit forms. Profits as a measure of demand? Sure, why not! Profits as a driving force? No!
The third goal conflict is one of democratic administration. The production of welfare services, if they are to be regarded as a social right, must also be democratically administered. Thus, free-standing corporate administration should be rejected also for reasons of democratic principle. We, as
labourists, socialists, and/or social democrats, should naturally be ready to ready to see non-profit and cooperative alternatives come up within child care, schooling, health care and old age care as complements to municipal organizations. However, the commercialization of such operations should be resisted with all our power.
The entire labor movement must now direct all its efforts to expand those domains of society which are not directed in accordance with market principles and capitalist interests. We must resist the development of society in a direction where capitalists and markets dominate society, and commercialize social, cultural and human relations. We must resist continued privatization and corporate organization of schools, health care, and social care services. We must dare to fight the fight to keep open public rights of way, in all domains of social service. The response of the labor movement to privatization and ideologically motivated alternatives to public administration must be to offer extensive personnel development within the public sphere. This must take place through wage development for public sector workers which are competitive with private sector standards. This must take place by expanding opportunity for public sector workers to improve their work environment, and much better opportunities to public sector worker education, both on and off the job.
In a speech made to administrative leaders in Malmö in 1986, the late Swedish Prime Minister Olof Palme expressed it thus: "Private profit-motivated systems are incapable of distributing social services in any way which is just, and takes needs into account." That was true then. And it is equally true today.
Swedish Social Democracy:
Twenty years of staggering on De-regulation and Privatisation
The Swedish Welfare State was built by a strong Labour Movement convinced upon its ability to step by step build a society based on solidarity and equality. It had its Golden Era in the 1960's and 70's, but in the time of right wing governments in 1976-82 much of the radical momentum was lost and the employers' propaganda succeeded to put the Labour Movement on the defensive. A dramatic change took place. It was only a few years between the 1976 LO (The Swedish Trade Union Congress) Congress when the decision was made on Employee's Funds taking some of the profits from the companies in stock to create an economy which in 25 years should be ruled by the unions and the 80's boom when the stockbrokers in costumes were invading the central areas of the capital city. The Swedish politicial history since the early 80's is a history of an almost constant Labour defensive.
The change of the Swedish political landscape had its roots in a change in the international economy. The West European Social Democracy had succeeded to increase Labour's part of the production results and to create big spheres of the economy free from profit interests. This had to be wiped away in order to satisfy Capitalism's need of new markets to conquer. An agenda was formulated that has been the standard formula of Structural Adjustment in both industrialised and developing countries: de-regulation of the markets, abolition of public monopolies, cuts in public welfare systems and privatisation of the public sector.
The resistance against this neo liberal agenda has formed within the grass roots of the Labour Movement, in many other popular movements and in the cultural sphere, but the Social Democratic party has not been able to a consequent struggle against these policies. On the contrary, the party has dwelled some of the loudest advocates for an adaptation to the neo liberal agenda. The so-called chancellery right-wingers [kanslihushögern] within the ministry of finance during the 80's de-regulated the currency market and the financial sector, resulting in a wild speculation that led Sweden into deep recession when entering the 90's. When the budget deficit was fought in the mid 90's, important welfare systems were brutally attacked. The continental doctors had written out hard medicine in order to qualify for the Single Currency. In the latest years, infra structure such as telecom, rail roads and energy production has been privatised by Social Democratic central and local governments.
The present main problem within Swedish Social Democracy is the lack of a deep discussion on the consequences of the politics of de-regulation and privatisation. On some areas the policy is sharp and clear - such as the opposition to private insurances within the public medical services. On other areas it is diffuse - such as the refusal of the party leadership to listen to local policians' demands on an upheaval of the legislation that force local governments to fund private schools. And on even other areas the party's politics is working directly in the interests of those who profit on de-regulation and privatisation - such as the decision to support a Swedish membership in third step of the EMU.
There is a need for an uproar against the profit interests that are destroying the basic structures of a welfare state thas has served as in instrument to free people from poverty and unequal power relations. Social Democracy has to take a clear stands for preserving and developing the Public Sector!
Peter Gustavsson
District Secretary of the Social Democratic Youth Organisation, SSU, in Skåne
How the new-liberalism destroy human
dignity
Since we have worked several years for the trade union for employees in the public sector, we have had a great possibility to observe the social development.
During the 90s the only thing which was discussed and was considered important was the economy and the shareholders´ value. All the time people heard that they have lived beyond one's means. The only thing the employees in the public sector heard was that they cost a lot of money, but nothing about our important job for the welfare state.
During this time society had only two "gods", the stock exchange and the powerful secret market. There's only one way to put things on the right side again, the politicians said all the time, and that was to fire many people in the public sector. The other part of the new-liberal medicine was to powerfully reduce taxes, and deregulation in all sectors of society. Furthermore, the politicians meant that all the problems depend on the fact that people had had it to good and that the social politic had been too generous.
The logical consequence of all this is
The people who are home for sickness increase like an avalanche. This development is particularly strong for women and low-paid people.
Many members we meet in our profession tell us that they have lost their empathy depending on a sense of fatigue.
The large problem with work environment has taken all the pleasure out of their work.
The class distinctions have grown fast in all parts of society.
Segregation starts the day children begin school.
Increased elitism thinking.
Reduced solidarity thinking.
Reduced civil courage in all sectors of society.
Much better medical care for people with a lot of money.
Psychical illness has grown very fast, especially among young people.
The number of homeless people grows quickly.
We mean that all these things are logical parts of the realization of a society which is based on New liberal assessments.
Bengtsfors the twelfth of February 2002.
Ingemar Körner Helena Öhrfeldt.
Destruction of Public Transport
by Sixto Iturra, trade-unionist public transport (SEKO/LO), Stockholm
I have worked as a repairman since 1977 and I have been employed by the old SL (Stockholm public transports). Now, we are called Tågia ("Trania") and I am trade-union leader for all the personal working with the maintenance of rail-traffic.
1990 there were 13 000 employed by SL, today there are 500. Ten years ago a coalition of social-democrats and conservatives in Stockholm decided to put public transport on the market (tendering). The goal with the tendering was to increase efficiency and quality. Has this been the case? No, interruptions in the traffic have grown. In 1999 we had two fires per week and 78 stops. The reason for this are cuts in the maintenance. With the tendering, the transport system was cut apart and the coordinating functions between trains, underground and bus disappeared.
We informed the users of public transport about this in 1997, but the employers said that we were wrong. Today they admit that we were right.
In 1998 SL decided to speed up the introduction of the new underground wagons, because the old wagons were worn out. They had to scrap the wagons in advance because of poor maintenance. 350 wagons that were supposed to run until 2010will be scraped now and 314 wagons that were supposed to run until 2005 have already been scraped. This is a pure destruction of capital.
Buying new wagons ahead of time also means loans and big interest costs, that goes directly into the pockets of the banks. The interest costs 200 million SEK each year and nobody can maintain that local transports now are cheaper than before! The costs for the users (for the monthly card) have increased with 125% in the last 8 years.
The private companies, Connex and Tågia, owned by Adtranz, made profits already 3months after their take-over. and are now investing these profits in obligations. The tax-payers have to pay more today and these costs will certainly increase, since Adtranz have a monopoly, both producing and maintaining the wagons.
At the same time they are pressing down costs for labour, by attacking the employment conditions (in the collective agreements). So, the tendering, and the chaos around it, was a preparation for privatisation. And now when private companies run the business we have to pay, when they want to make profits.
Resist the Stepwise Process of
Privatisation of Public Water Utilities in Sweden
Jan-Erik Gustafsson
Department of Land and Water Resources Engineering
KTH
SE-100 44 Stockholm, Sweden
janerik@aom.kth.se
Introduction
Public water and sanitation utilities (the VA service) have by tradition been managed by the municipality sector in Sweden. When urban water supply works began to be constructed at the end of the 19th century, it was considered as a municipal undertaking. Even small communities in rural areas have their own public water supply works. It is only big industrial companies that have been given permission to withdraw surface or groundwater for their own private water works. In the short period from 1965 to 1975 most of the 285 municipalities in Sweden were provided with treatment plants up to the highest international standard.
The Swedish VA model
According to the Swedish Water and Wastewater Association (VAV) there are some more than 2 000 municipal water supply works and 2 000 waste water plants. The waste water plants treat 1 500 million cubic meters of sewage water. All together some 6 000 staff are employed in the VA service sector.
The municipal water and sewerage works (MWSW) are separate accounting administrations, which are not allowed according to the law to be operated by a profit margin, only to be funded by connection fees and operation charges. Under the law it is stated that a MWSW is a societal concern. The municipality has the responsibility for health protection (prevention and control), and therefore also should provide for the MWSW. The responsibility includes that the municipality decides the geographical perimeter of the individual MWSW.
The strong belief in the welfare state has made private VA service not to be considered as a viable option until 1990s. Water supply and sanitation has basically been developed as a service to all citizens at a non-profit basis.
The Swedish municipal VA service is also confirmed to be very competitive by international comparison. According to statistics from IWSA (International Service Water Association) the average price or 200 cubic meter drinking water was less than half the price most other European cities, table 1.
Table 1. Average price for 200 m3 drinking water in some EU cities .
City Euro
Amsterdam 153
Brussels 306
Geneva 322
Hague 241
Helsinki 174
Liege 229
London 140
Lyon 268
Marseille 256
Newcastle 275
Odense 143
Paris suburbs 265
Turku 254
Gothenburg 80
Swedish average 105
The low Swedish VA charge is remarkable considering that drinking water is an important foodstuff with very high requirement to its preparation and quality. Sweden has also no scale advantages as the population is small in number and huge part of the country is sparsely populated.
In addition to economic efficiency there is a coherent linkage between the VA service and the concern for the environment. The basis for the public VA service is to supply good quality water and to protect the environment. The new Environmental Code from 1999 demands extensive environmental impact assessments reports as well as introduces environmental sanction fees. Thus in most Swedish cities nowadays the MWSW:s have a comprehensive responsibility for the complete water cycle from raw water to recipient water . Many MWSW have increased their process and energy efficiency. For instance some 150 000 households in Stockholm have their heating provided through heat-recovery from treated wastewater. Biogas production covers 40 to 45 percent of the sewage treatment plant internal electricity need and all the heating requirements of the Stockholm Water Company.
The public water and waste water utilities challenged by commercialisation and privatisation
Commercialisation of MWSW
Since the 1970s a limited number of Swedish MWSW have been corporatised like the Stockholm Water Company AB, Roslagsvatten AB, i.e. transferred into a full (100 per cent) municipal water and sewerage company (MWSC) under public ownership. In a situation of weakened municipal economy this restructuring has been considered as an advantage for borrowing to cover funds for additional investments needs not covered by the VA charge. The Stockholm Water Company has practised a depreciation time of 30 to 50 years for loans to investment in assets. This commercialisation will also give the MWSC the right to buy companies and run business outside of the municipal border.
To further commercialisation the Swedish Municipal Law was reedited in 1991 in neo-liberal direction, giving the municipalities greater freedom to organise infrastructure services. Customer orientation, decentralisation and competition became buzz words. Public utilities like MWSW or MWSC were supposed to imitate private company behaviour, and then learn from each other.
Sweden has long and noted tradition of citizen's right to access to public sector documents. It also empowers a public servant to report to the press anonymously or openly about improprieties and misbehaviours in the public sector. This public right of transparency is lost with corporatisation. Also the political accountability is transferred from elected members in the municipal council to a restricted number of assigned politicians in the public company board. In addition to the good will of the MWSC, what will be left for the general public as the only source of information is the annual report to check the MWSC performance. Thus the influence of promoting competition and commercialisation gradually leads the municipal sector away from its original role of a transparent water supply and sanitation provider and facilitator.
High level privatisation
The next step in chain of achieving a higher degree of privatisation is to put MWSW or MWSC functions like operation and maintenance or even investments to bid or tender on the private market. This is a direction of restructuring the public sector in general, which is strongly promoted for example by the European Union (EU), the World Trade Organisation (WTO), the World Bank, the International Monetary Fund and the European industry groupings European Services Forum (ESF) and UNICE. After the Doha ministerial meeting in Qatar November 2001 WTO will negotiate the General Agreement on Trade and Service (GATS), which, if accepted by national politicians, will open up the entire public sector for global private competition. GATS means to harmonise national legislation by deregulation or minimum legislation in order to promote the free procurement, investment and trade of public sector activities, including the water supply and sanitation sector .
The ultimate privatisation is the sell out part of the public shares in the MWSC or the entire public assets (water supply work, treatment plants and network system). The most well-known example of the latter situation was when the Thatcherist government 1989 floated the water and sewerage functions of the river valley authorities into ten private water and sewerage companies (PWSC).
Commercialisation without corporatisation
It was first with the Thatcherist government privatisation policies that a debate was initiated to privatise infrastructure services in Sweden . One of the first cases occurred in Vaxholm municipality north-east of Stockholm. This town, run by a local conservative government, put its technical infrastructure services for tender in 1987. However, when the project was evaluated five years later it was surprisingly acknowledged that most municipal works/companies produced cheaper services than the private ones. As a consequence, the Vaxholm water and sewage service was transferred to Roslagsvatten AB, which is a MWSC operated jointly by several municipalities.
The first major attack for a broader privatisation took place in Malmö municipality before the local election in 1994. Sweden was at the time governed by the Carl Bildt conservative government at the national level and by a conservative local government in Malmö. This local government worked very actively in the beginning of the 1990s to privatise services. For instance the municipal waste service and local traffic were sold to private companies. Its MWSW was subjected to the largest operation and maintenance tender ever in Sweden. The case was considered as a test for the future development in other municipalities. It was in July 1993 that the Municipal Board commissioned the Road and Traffic Board to investigate the possibilities of an impartial tender competition by private companies to operate and maintain the Malmö MWSW. As many as 19 private companies participated in the bidding process, among them the big French PWSCs and some ten English PWSCs. Also the existing staff at the Malmö MWSC through a new "executive unit" were exhorted to present a bid. The president of the Road and Traffic Board, Eva Ollén, expressed her enthusiasm in the coming efficiency gains she anticipated by contracting the operation and maintenance to a big private company. After examining the proposals the Board tender group recommended the English transnational Anglian Waters through its subsidiary Nordvatten AB for the contract.
Anglian Waters, one of the new Thatcherist PWSCs, promised in the bid to reduce the running costs with 30 percent, claiming that this measure would reduce the VA charge nine percent or with 300 SEK per year for a normal Swedish family living in a villa. The company also applied the OFWAT price cap model, stating that the cost after the initial reduction would be increased by maximum the retail price index minus one percent per year over ten year contract period. The company also promised complete staff transfer, and work for initiating great research efforts at Nordvatten AB Head Office, which was to be placed in Malmö. It is apparent from these favourable terms that Anglian Waters wished to get a break through to the Swedish market.
The privatisation of Malmö MWSW became an important topic in the local election campaign. The conservative majority lost the election. The Malmö consumers were not seduced by the promised lowering of the VA charge. The new majority of social democrats had opposed any kind of privatisation, and argued that a regionalisation in the form of a collaboration of several municipalities might be a better alternative to develop the MWSWs. Thus the question of privatisation fell after the election. However, the resigning political councillor Joakim Ollén meant the cancellation of the tender process was a devastating act
for the credibility of future contract-by-tender-agreements.
It is obvious that the whole tender process was ideologically motivated, and inspired by the Thatcherist policies, even if the Malmö case did not involve the sell out of the assets. If the election results had been in favour of the conservatives one could have expected large scale consequences involving a big number of transnationals asking for commercialised contracts in Swedish municipalities.
Instead, during the rest of 1990s saw some Swedish companies involved in the commercialisation process of MWSW in a few Swedish municipalities. For instance PEAB contracted the operation of the Danderyd municipality MWSW including it pumping stations in 1995. Härnösand, a municipality in the middle of Sweden, contracted the operation of its MWSC and its roads to SKANSKA-Norrland for the period 1994-1998. In the new tender after 1998 MWSW was separated from the road service, and this time NCC won the MWSW contract. After the local election in 1998 the municipality initiated negotiations with NCC aiming at an eventual co-ordination with the electricity company HEMAB. For both these cases the commercialisation have been ideologically motivated, stating political goals like more freedom of choice, more competition, more businesslike performance, as well as increased efficiency, productivity and creativity. All these buzz words are cornerstones in the neo-liberal vocabulary.
The first public-private joint venture
In 1995 Karlskoga, a municipality in the western part of Sweden, corporatised its technical service into a municipality-owned company. Later in 1998 Karlskoga sold out 49 percent of its shares to the Finnish Fortum/IVO Group, and set up Karlskoga Energy & Environment AB, which is a so called multi-utility company. The Finnish state controls Fortum by owning 70 percent of the shares. Karlskoga Energy & Environment AB is under the concern company divided in three subsidiaries owned to 100 percent by the concern company; the Electricity Network, Central Heating and Environmental companies. The Environmental company is in its turn divided according to functions in the water supply and sewerage unit and the waste handling unit.
The shareholding contract says that consensus in decision-making is needed in the Board. The municipality has four seats and Fortum two seats. The president of the Board is also the chairman of the local social democrat party. The CEO of Karlskoga Energy & Environment AB has declared that the company was established as a result of the general economic cut downs in the public services. He argues that the new company has benefited from big-scale advantages, positive market response to the multi-utility concept and reduced cost by sharing the staff between the subsidiaries. Also Fortum, the CEO says, shows serious commitment, which has resulted in distinct goals and company plans. The Board has become more professional and market-orientated, which is claimed to have given new incentives to the activities. Thus, the activities it is said is distinguished by market proliferation and a customer perspective, and the VA charge has not been increased in three years.
However, the market orientation has implied a severe prioritisation of the investment needs in the municipality. The investment need has been reduced from 60 million SEK to 50 million SEK with reference to that loans and pay back otherwise would be to expensive. The investment need in water and sewerage is estimated at 8 - 10 million SEK. In addition, the company has substantially reduced the staff, especially in the water and sewerage unit. The prediction for the result in 1999 was over 30 million SEK of which 8 millions SEK were planned as dividends to the owners. Thus, the harsh economic conditions in the municipality allow a profit margin of 27 percent, which is at the same level as the English PWSC.
The first Thatcherist sell out of a MWSW/MWSC
In 1997 the Norrköping MWSW was corporatised and merged with the energy utiliy in Norrköping Environment & Energy Company (NME AB). In the general election campaign 1998 the local social democrats promised not to sell any shares in the NME. But later in June 1999 the energy company Sydkraft bought 49 percent of the shares. Sydkraft is together with Vattenfall and Birka Energy the three biggest energy companies in Sweden.
A political majority in Norrköping consisting of social democrats, conservatives, christian democrats and liberals were not satisfied with this public-private model of ownership, leading to an intense local debate. The chief local social democrat Gunnel Gennebäck declared that she saw no intrinsic value in the municipality ownership of the NME. Also she claimed that Norrköping was in need of money to pay for its hospital care, elderly care and school services. But in reality the municipality deficit of 70 million SEK was a minor problem compared to a turn over of 3 800 million SEK. Neither it did not matter that 7 300 inhabitants in Norrköping signed a petition for a local referendum. According to the Swedish Municipality Law local people can demand a referendum, and the Municipal Board must consider a request if more than five percent of the voters demand it. The municipality director of Norrköping, Björn Johansson, commented the voters request. "A referendum concerning the sell out of the rest of the municipality shares in the NME may be an expression of opinion. But a referendum is not estimated to bring up any unnoticed objective motives before a decision on the sell out will be taken".
The referendum was rejected by the Municipality Board in November 2000 by the votes 65 - 15. Only the Green and Left parties voted against it. Thus the first Thatcherist sell out of a complete MWSC became a fact, when Sydkraft acquired all shares in the NME. For the full acquisition Sydkraft paid 2 755 million SEK, and in addition it will invest 20 million SEK in a research fund in collaboration with the local University.
In its turn Sydkraft is controlled to 67 per cent by the global player and the second largest energy company in Europe (after the RWE group) the German-based Eon. This company was formed as recently as in early 2000 by the merger of the German energy companies Viag and Veba. With the acquisition of the multi-utility NME company the water and sewerage service included the ownership of assets is controlled and owned by the German international giant. Some people claim the Eon interest was to get a strategic hold of the well-operated energy part of the NME, situated in Sweden's eight biggest municipality by number of population. But still Eon has not indicated any wish to sell out the water and sewerage functions on the international market circus.
Vivendi gets a Swedish water contract
In 1990s the world leading water company Compagnie des Eaux was reconstructed. It transformed itself into a multi-utility company dealing with media, entertainment, IT, transports, real estates etc. In 2000 this huge multi-utility group was renamed Vivendi Universal. It owns subsidiares like the Hollywood companies Universal Studios and Universal Music, Seagram, Canal+, Cegetel, Onyx, Compagnie des Transport, Vivendi Environment. In Stockholm Vivendi is involved in operating the major part of the local transport by the companies Connex and Linjebuss. It also manages the real estates of the County of Stockholm by its company Dalkia.
The core business has always been water supply and sanitation, supported by the many French consumers paying their VA-charge in many of the French municipalities. Now this basic service, Vivendi Water, representing a turnover of some 100 billion SEK in 1997,
is a sub-activity of Vivendi Environment. In its turn Vivendi Environment with 215 000 employed all over the world had a turnover of 195 billion SEK in 1999. This is an income, which is more than 50 percent of the Vivendi Universal total figure.
No wonder that Vivendi Environment sooner or later would enter the Swedish water and sanitation market. In February 1999 Norrtälje Municipality Board, located to the north of Stockholm, announced that it would leave out its MWSW for market testing and tender. The bid included the operation and maintenance of 13 water works, 3 water towers, 6 water supply pumping stations, 19 sewage treatment works, 73 sewerage pumping stations, 310 km water supply network, 230 km sewers and 150 km surface drainage network. Also some investment and the customer service might be included in the offer. The total contract value was estimated to 300 million SEK for a period of ten years.
In summer 2001 the conservative-dominated Muncipality Board chose Vivendi as the contractor from January 2002. Vivendi promised to run the service for 23 million SEK per year for a ten years period with an option for a two years prolongation. A trade unionist from the Swedish Municipal Trade Union expressed his relief. He and his colleagues had got tired on the municipality as the employer, and now he looked forward for higher pay. Vivendi, by a representative of its Dalkia company, conveyed "the ambition not to impair the existing collective bargain contract" .
A notable affair in the tender process occurred when the Swedish Water and Wastewater Association (VAV) became involved in the bidding process as co-owner of the Swedish Water Development AB (SWD). SWD was a partner in a consortium also consisting of the Swedish companies NCC, Kemira and Sweco. This consortium was pre-qualified for preparing a bid. Thus the association of the Swedish MWSW:s and MWSC:s was involved in a tender of one of its own members!
When it was revealed that the SWD was a part of consortium acting for a bid at the commercial market in Sweden it came as a complete surprise for the representatives at the VAV annual meeting in May 2001, and it aroused much criticism. The CEO of VAV, Roger Bergström, has defended the involvement in the consortium by saying that Sweden can not silently watch how foreign companies take over the municipal VA service in the country. It is a positive component in this argument to protect from foreign take-over, but the counter measure by the SWD to try to compete with the foreign companies on commercial terms seem rather pathetic. As said before the SWD was set up in 1996 with the objective of structuring, optimizing and developing the portfolio of international projects of the Swedish water utility model in the Baltic and developing countries. It is questionable, if the SWD:s involvement in the bid follows the company charter. It states that SWD shall "support municipal and state-owned organisations, especially in the Baltic States but also in countries receiving Swedish development assistance, in VA service and water management with the aim of transfer knowledge, so that the receiving organisation as soon as possible can act independently".
Limited public debate and transparency
Up to now there has been no public debate of the experiences of the commercialisation and corporatisation of the Swedish public water utilities. At a seminar arranged by VAV in December 1999 staff involved in market testing from the municipalities of Danderyd and Härnösand claimed that eventual efficiency gains expressed as lower costs for operation and maintenance were counteracted by increasing procurement and transactions costs. Applying market testing municipalities must set up new procurement, accounting and documentation administrations. Both municipalities had also experienced increasing difficulties in keeping or finding competent staff. Many professionals in the sector admit that the long-term provision of competent staff is a major problem, which will be aggravated by foreign company take over.
At this seminar it was also questioned if there exists a market of competent company/contractors, which have the ability to understand the municipal utility sector with its many anonymous customers. It could be challenged if such an ability can combine with the contractors profit interest. It is also a complication that the contractor should represent the municipality in front of the customer. Both municipalities had experienced deteriorating customer service, creating confusion when the customer wished to make complaints.
The principal Thatcherist take over of the Norrköping energy and VA utilities was never debated in the parliament or the national media. It simply seems to have been considered as a local issue. It was first after the take over that five prominent local politicians from the social democrat party in a debate article in a main Swedish newspaper warned against private purchase of VA service by energy companies. The article was never responded to.
A plausible explanation to the lack of debate and transparency is that the social democrat party since the end of the 1980s step by step has promoted private alternatives . This process started in the 1980s with a discussion inside the minister of interior of how to make the public sector more consumer-friendly and democratic. But at the end of the decade, when Bengt K Johansson became the new minister of the interior, a paradigm shift occurred according to a researcher from the Stockholm School of Economics. From now on efficiency and market testing became more important than democracy and user involvement. Market testing of municipal waste collection and park maintenance was considered as a way of getting more out the municipal money purse. It became more controversial to initiate commercialisation of the elderly and hospital care. At the end of 1988 leading social democrats intensively debated the public sector. Lars Engqvist, who is the minister of social affairs in the present government, wrote in the periodical Liberal Debatt 1988: "One should go the whole length and release the production of services from the political decision-making bodies". In 1991 the minister of finance Kjell-Olof Feldt and his close collaborator Klas Eklund in a report from 1991 wrote that all but the core activities of the public sector could be market tested and contracted out. Thus, the social democrats paved away for intensified privatisation attacks by the conservative government during the 1991-1994 reign period.
The social democrat governments and the locally controlled governments at the counties and municipal levels did not challenge the privatisations policies for the rest of the 1990s. On the contrary, after Sweden becoming a member of the European Union in 1994, the social democrats like the Blair labour government in power after the conservative defeat in 1997, have amplified the privatisation policies. The social democrats have not opposed the Maastricht Treaty enforcing budget ceilings on municipal, county and state budgets, leading many local politicians see market testing and privatisation as the only way out of reducing budget deficits. In addition with the monetary union the stability pact prevents governments from using national budgets to stimulate their economies, which enforces the policies of deregulation and privatisation even more. The increased pace of merging of private multi-utility companies and contacting out or buying public utility services is an expression of implementing the monetary union.
Thus the heads of the EU governments in the so-called Lisbon process expressed during the European Council meeting in 2000 that EU should develop into the worlds most "competitive and dynamic knowledge-based economy". The deregulation should be achieved by the mean that the heads of governments make the highest priority of developing effective functioning markets for services. The Public-Private-Partnership model (PPP) was declared a tool for promoting increased commercialisation and privatisation. The PPP implies that companies, authorities, professional organisations (like trade unions) and civil society (like the Salvation Army, Sport clubs) at the expense of political elected bodies should take a joint responsibility in corporate structures to develop and fund e.g. health care, education and infrastructure services. And during the Swedish chairmanship 2001 the Lisbon process was further confirmed and emphasised with the Prime minister of Sweden Göran Persson playing a pusher role. For instance in the guidelines from the chairmanship, Sweden committed itself to "increase market testing of public services" and "deepening competition on all local levels".
Growing awareness in favour of the public sector
It waited until the autumn 2000, when genuine social democrats formed the network Social democrats in favour of the public sector (SOS) . Today this network consists of some 300 party members including some 30 parliamentarians and many with connection in the trade unions and social democrat youth organisation. At the social democrat congress in November 2001 deregulation and privatisation became a hot issue. In an open letter to the congress SOS challenged the party leadership demolition of the welfare state and its uncritical adoption of EU:s deregulation and privatisation policies. The open letter says: "Before the eyes of us living and working in this country the public sector is crushed into pieces and given to profit-claiming private companies - in spite of the fact that the services are funded by taxes. These profits are created by repressed salary increases, no compelling claims on collective bargain contracts, worse conditions of working hours, lost freedom of contacting media and deteriorating job security".
At last after the Norrköping and Norrtälje utility cases were concluded some media coverage has appeared in the national and trade union press from this summer and onwards. LO-tidningen, which is the weekly periodical of the Swedish Trade Union Confederation (LO), wrote 7 September about growing corporate interest to run the Swedish VA service. Next day the daily Aftonbladet reported that some 12 -15 municipalities had plans to change its VA service organisation within three year. In the same article the minister of municipalities Lars-Erik Lövden expressed that he was very critical to run the VA service under private management adding "The development in England and Wales has not been good. Water is a basic right, which is not for sell" ..
Conclusion
The Swedish VA model based on public ownership and control of water and wastewater utilities has been proved to be both economically and ecologically efficient. It is founded on long traditions and a firm legislation, the latter considering the water and wastewater delivery as a service to all citizens at a non-profit basis. The model relies on high quality plants, networks, equipment and professional staff. By international comparison the water price is low.
From the beginning of the 1990s the VA service like many other services has come under influence of neo-liberal international organisations and the EU claiming increased competition and market testing in the public sector. Gradually the public VA sector has been put under external stress, resulting in the first Thatcherist sell out of Norrköping water and wastewater utility to Eon/Sydkraft in 2000 and the first long-term concession of the operation and maintenance of Norrtälje water and wastewater utility to Vivendi in 2001.
There are no economic arguments within the VA sector to find that support these deviations from the public VA model. On the contrary the Swedish public VA model is well functioning and Sweden has the competence to independently take care of its VA service. The Swedish VA service is a general interest for water supply and wastewater treatment, public health, environmental protection and social cohesion. It shall not be privatised. It is encouraging that in the recent year the awareness of keeping the VA service and other public services under public regime has grown among an every day increasing number of parliamentarians and trade unionists, the youth and people in general.
Destruction of the Health Care in Stockholm
by Mirja
Särkiniemi, trade-unionist (Kommunal/LO)
at the Karolinska Hospital in Stockholm, social-democrat.
I am a junior (staff) nurse and I have been employed by the county council, at he Womens clinic at the Karolinska Hospital, since 1981. I have altered this work with trade-union tasks. In my spare time I am vice president of the city-district committee of Kista (Stockholm).
() After the elections of 1994, the social-democrats took over the county council. There was at that time a huge deficit, and they launched a so called "development plan". It showed out to be a plan of liquidation. They shut down two urgency hospitals in Stockholm, two well functioning hospitals. The result is that the maternity care has entered a catastrophic state. The deficit was so big that we were not allowed to increase the number of maternity beds, despite the fact that the numbers of births were drastically increasing. We got 1 500 more births per year, but we didn't get a single new bed. We now have to redirect women to Västerås and Uppsala [at 100km and 70km respectively from Stockholm].
While the social-democrats were in power, the bourgeois parties planned how to massacre a whole county council, and that's what they are doing now. Since their take over in 1998, the bourgeois parties have transformed all the urgency hospitals into companies. They sold off the St: Göran hospital to
Bure. And in the very agreement with Bure the bourgeois parties promise that they will put all the hospitals on tender before the end of their mandate. I got this agreement in my trade-union office. It's hard to understand that this is the way things are run, but it's true!
() The transformation into companies [owned by the county council] is not a goal, but a means for a future sell out of the hospitals. If we lose the general elections we will also soon see an assurance financed health care in Sweden. Erik
Langby, from the Conservative party, said before the last elections: "We want private, obligatory sick-assurances. You should be able to choose the premium yourself. If you have a small wallet you have to stay in a 4-bed room, if you have a big wallet you get a single room." That what's on the agenda if we get a bourgeois majority in parliament after the next elections. I am critical towards my own party and my own trade union regarding these questions, since they have been too silent too long.
The bourgeoisie regional government in Stockholm have decided to put all hospital care on the market, no matter private or public run, through the largest competitive tendering process ever in the world. Health care valued to _ 7000 million will be put on the market the next coming five years. Multinationals, private companies and public companies will all compete and make their offers to take over whole hospitals or parts of the hospitals, and run them for profit.
There is a great risk that the hospitals now will be converted into malls where different companies run different parts and that the patients will be reduced to pure customers.
The trade unions now see into a future where the hospital management will be replaced by, up to, 15 company bosses. The individualisation of the working conditions will of course escalate.
The politicians say to us that the hospitals still will be public financed and all they want is "diversity". But, since competitiveness and profitability will be the main force, we fear that patients with a private insurance will be priority number one for these companies. We also fear that the knowledge how to run hospitals will be destroyed. Just as we heard from the British railways, where the knowledge how to run safe railways were destroyed.
Hospital and health care equal and accessible for all citizens, as Swedish law states, can soon be history in Stockholm.
Privatisation of social assistance
by Annika Gyllfors
The local bourgeoisie government in Stockholm has decided last November to, step by step, put all social workers and all their investigations to find solutions for citizens in need of help, on the market.
Instead of employing social workers the local government want them to compete with each other and work, either on individual contract basis with no right to union organisation and collective bargaining at all, or been hired from staffing companies like ManPower where union rights are not as good as in the public sector.
This decision from November is a real attack on social workers right to decent working conditions an their right to organise collectively. It is also a fundamental attack on the law stating that all citizens have a right to equal protection from society in times of economic or social problems.
Since the decision from November is an attack on the rights of unemployed and homeless, to demand as citizens, help to solve their problems, it is an attack on the whole idea of a society based on equal citizenship.
Chapter 1.5, "Changes in institutions: Welfare services," in
"Balance
Record of Social Welfare for the 1990s:
Final Report, Balance Record of Social Welfare Commission
(Välfärdsbokslutet för 1990-talet:
Slutbetänkande, Kommitén Välfärdsbokslut). SOU 2001:79. Stockholm: Fritzes (Partial direct translation). (pp. 95-114)
()
The ways in which child care services, schools, health care, old age care services, and other social services work is important for most peoples' welfare and everyday life. This is not only the case for those who, at various stages of their life, make direct use of these services themselves. Well-functioning social services are an important resource also for people who are not currently in need of these services, which can instead be seen as a sort of insurance for possible future needs. Besides, welfare services can also constitute resources for citizens who do not need these themselves; thus, for example, well-functioning old age care services are a resource for all people with relatives in need of care, and a school system where youth become equipped for the demands of adult life constitute a resource for all citizens. Central concepts for assessing the extent to which welfare services actually constitute collective resources for people's welfare are accessibility and quality-are services accessible to those citizens who need them, and does their design and quality correspond to citizens' needs?
In the following sections (1.5.1-1.5.7) , we aim to give a description of how resource allocation has developed in different areas of welfare services, and to the best of our ability situate this development with respect to concurrently observable developments in needs. The committee has also aimed to describe how resources are allocated within each area. Since welfare services are all characterized by being created through interaction between those offering and those using the services, the personnel involved here constitute a central human resource. We thus aim to describe resources development not only in economic terms, but also with the help of indicators on personnel-for example, the number of employees, employee density (in relation to the amount of those served), and levels of education and/or training. We also describe changes in systems of regulation and other conditions affecting accessibility and content of services. The focus in this description is on the extent of services as well as on the organization and content of activities provided for the users. The description thus aims, in the last analysis, at an assessment of welfare services as a resource for all citizens.
1.5.1 Child care services
Since some time back, Swedish child care policies have had two major goals: firstly, to stimulate
children's' development through pedagogical intervention as well as through equalizing life chances for children in different population groups, and secondly to make it easier for parents to combine parenthood with gainful employment and/or studies.
Child care service development in the 1990's can be described both in terms of expansion and contraction. Public commitments were broadened, in that [Swedish] municipalities became decisively more obliged (starting in 1995) to provide a childcare position without unreasonable delay for every child between the ages of 1 and 12 whose parents were employed or pursuing a course of study. Decisions made in the child care sector were also followed up in other sectors in 1998. Provisions from the social assistance act were transferred over to the primary and secondary education act, the concept of the "day nursery"
(daghem) was replaced by that of preschool, and educational activities offered were integrated within a national curriculum. The increased emphases on the pedagogical content of childcare services can be seen as steps to make child care accessible to all children, regardless of whether their parents are working or not. Further steps in the same direction were taken in November of 2000, when the Parliament took the decision to mandate offers of at least three hours of preschool activity per day to children of parents who were unemployed or on parental leave.
Also with regard to the number of children included, it is reasonable to speak of an expansion in the course of the 1990s. The number of children registered in some form of child care program (preschools/nurseries, family-based paid daytime care, or so-called "leisure hours facilities"/school-based child care) increased from 532 000 to 720 000 between 1990 and 1999. Annual variations in birth rates naturally affect this development, but coverage rates for preschool and leisure hours services increased as well. The share of children aged 3 to 6 in child care increased during the 1990s from 64 to 82 percent-among children aged 7 to 9, the share increased from 49 to 63 percent () Child care services have progressed towards increased universalism during the 1990s.
At the same time, an institutional shift has taken place within child care services, insofar as the share of children in publicly financed but privately administered day nurseries/preschools has increased from 5 percent in 1990 to 15 percent in 1999. Within privately administered child care, non-profit organizations still dominate, mainly in the form of parental cooperatives. But the share of profit-oriented organizations, in the form of corporations, increased most rapidly during the 1990s (see Trydegård 2001). Highly educated and otherwise well-off groups of parents make use of privately administered child care considerably more often than do other groups, whereas (for example) children to parents born outside of Sweden are clearly underrepresented in Swedish private preschools. A conflict can thus exist between, on one hand, the goal of increasing parental choice through extension of privately administered child care, and the ambition that childcare services contribute to creating "meeting places for children with different ethnic, cultural and socioeconomic backgrounds" (Government White Paper 1999/2000:129, p. 8).
In the course of the past decade, the financing of child care services has also undergone a sea change in the direction of greater privatization. Child care user fees were increased, and the share of the child care sector's total financing obtained from parents increased from 10 to 18 percent. In the course of this period, most municipalities also ended up relating the size of the fees charged to parental income levels and the time duration which children spent in care, at the same time as inter-municipal differences in fees levied underwent increase. With the recent enactment of a national maximum ceiling on child care user fees, this will change, and most parents will end up paying lower fees for child care.
As seen from parents' and
children's' point of view, the question of child care service quality is of course crucial, but not entirely easy to answer. Measured as the level of economic resources set aside for child care services, retrenchment and cutbacks have been characteristic of developments in the 1990´s. The overall level of public expenditure decreased, but the increases in parental user fees meant that the total amount of resources available to finance care was about as big in 1999 as it had been in 1990, about 40 billion Swedish crowns annually. Costs per preschool child decreased during the first half of the 1990s-despite a renewed rally over the second half of the 1990s, the final level of per-head expenditure was lower in 1999 than it had been in 1990. Resource cutbacks for the leisure hours facilities were even more violent, and this trend continued also into the second half of the decade (see National Agency for Education
(Skolverket) 2001c).
The size of classroom groups increased by 20 percent in the preschools, and by 65 percent in the leisure hours programs. Personnel density varies greatly between municipalities, and intermunicipal differences in this respect increased throughout the 1990s
(Bergmark 2001). In the country as a whole, the amount of children per full-time full-year worker increased from 4,2 to 5,4 in the preschools, and from 8,3 to 17,5 in the leisure hours facilities. In the preschools, this trend turned in 1998, whereas personnel dilution within the leisure hours facilities instead accelerated in the last year of the decade (in connection with the rapid increase in the amount of children registered).
The dilution of resources, decreasing personnel density and the increased sizes of classroom groups can in themselves be seen as indirect indicators of decreasing child care service quality. Another often-used indicator of quality is the level of personnel education. This has increased rapidly throughout the decade, for preschool and leisure time facility workers as well as for family-based
daycarers. Within leisure time programs, the share of workers with pedagogical qualifications has however once again declined after 1998 (National Agency for Education 2001c). Insofar as the work environment of child care service workers has potential repercussions for service quality, it is thus noteworthy that also the work environment seems to have deteriorated. For example, the share of workers reporting symptoms of distress and work-related sleeping problems has doubled in the course of the decade
(Bäckman 2001). A summary assessment of what all these changes have meant more directly for the children involved is, however, not possible to make here.
1.5.2 Schooling
Mandatory primary schooling aims to, among other things, give pupils the knowledge, aptitudes and training which is needed to participate in social life. According to the primary and secondary education act, all children are to be guaranteed access to education of equitable value, without regard to gender, class or domicile.
As institutions, Swedish schools were
thoroughly transformed in the course of the 1990s, with regard to both type of administrative mandate (public or private authority) and such aspects as grading systems and curricula. Schools have become progressively "de-nationalized" and "municipalized", with municipalities today being responsible both for overall administration and financing. Another institutional shift within the world of schooling has to do with the relationship between public and private. Different parliamentary decisions taken in the course of the decade made possible the expansion of so-called "free-standing schools," privately administered but with public financing. The share of primary school pupils in "free-standing schools" increased between 1990 and 1999 from 0,9 to 3,4 percent (Statistics Sweden
(SCB) 2000b)). A corresponding trend could also be noted within secondary education, where the share of pupils in "free-standing schools" increased from 1,5 to 3,8 percent between 1995 and 1999 (National Agency for Education 2000c). The majority of the free schools was not profit-oriented, but profit-driven companies, as well as large companies as such, are those which are expanding most rapidly. Free schools are more usual in the biggest cities, as well as in municipalities where population shares of those with low educational attainment are at their lowest. Children in free schools had, more often than children in municipal schools, parents with high educational attainment and high income levels (National Agency for Education 2000b).
Departing from a resource-oriented perspective on welfare services, schooling can be assessed with a number of different approaches. In line with the schools' own goal setting, one first question is to what extent schools provide pupils with knowledge and competence that has a positive impact on their future life chances. A more direct answer on what developments in this respect have taken place during the 1990s is however not possible to give, since there is considerable shortage of comparable knowledge and competence measurements in the domain of primary schooling. Given recent changes in the grading system, it is also not possible to follow the development of final grade point averages over time, and it is also difficult to assess how many reach eligibility for the next level in the educational system. Available information does however indicate that the number of students without a complete set of final grades from primary school increased between 1990 and 1997, and that the number of students lacking eligibility for high school studies
continued to grow between 1998 and 2000 (Gustafsson, Andersson & Hansen 2000).
A traditional, but indirect, indicator on the resource-constituting character of the school system for citizens is the distribution of economic resources to the system. The total costs of primary schooling decreased by 15 percent during the first half of the 1990s (as measured in fixed prices)-after increases in spending by the end of the decade, most recent levels were somewhat higher than in 1990 (56 billion crowns for 1999). For demographic reasons, the number of primary school pupils increased at the same time by all of 17 percent-by the year 1999, there were somewhat more than 1 million in Swedish primary schools.
[Regarding] the development of primary school expenditures per pupil, as well as the number of teachers per 100 pupils, it is mainly the endpoints of these trends that are most interesting from a balance record perspective. Figures here indicate that the total level of expenditure per pupil about 5 percent lower by 1999 than in 1991. Teaching-related expenditure however decreased more significantly, by 12 percent, despite increased gross resource allocation to the schools at the end of the decade. Teacher density has declined by even more, or by almost 20 percent. The number of teachers per 100
pupils was 7,6 in 1999, which can be compared to 9,4 in the year of 1991 (National Agency for Education 2001c). Despite the fact that the number of pupils with another home language than Swedish increased over the 1990s, the number of teacher hours allocated to second-language education and to Swedish as a second language decreased radically (Public Inquire Commission report 2000:3). The share of teachers with pedagogically oriented higher educational qualifications has also decreased. The share of teachers without such qualifications increased from 8 to 13 percent between the beginning and the end of the decade (Statistics Sweden 2000b), and increased further to 17 percent by the year 2000 (National Agency for Education 2001e). In about 70 percent of all municipalities, primary schoolteacher shortages prevailed at the end of the decade (Swedish Association of Local Authorities 2001a). To the extent that teachers' work environment may have repercussions for the quality of services, it is important to note that the share of teachers who hold the opinion that they have too much to do and who experience problems with sleeping and distress increased strongly over this period
(Bäckman 2001).
Within secondary education, changes in resource allocation have been less dramatic. As in many other domains of welfare services, resources allocated declined at the beginning of the decade, followed by an increase during the last years of the 1990s. In the year 1999, combined expenditure amounted to 22 billion crowns. By the end of the decade, expenditures per student were 10 percent higher compared to 1991, whereas teacher density was back at the same level as at the beginning of the decade (National Agency for Education 2001d). Also within the high schools [gymnasium in Swedish, probably also in German? Translator's Note], the share of teachers without pedagogical higher education increased during the 1990s, from 7 to 18 percent (Statistics Sweden 2000b).
The biggest changes within secondary education are otherwise that all degree programs are now three years long, and give formal eligibility for higher education, as well as the emergence of the new so-called individualized degree program. This course of study is mainly intended for students who lack formal eligibility, or who have not been accepted for studies within the high schools' so-called national programs. The number of students in the individual program has increased during the 1990s-during 1999, 14 percent of all first-year students in the high schools were enrolled within this program (National Agency for Education 2001c). Severe criticism has been expressed that the individual program does not seem to yield the intended effects and only a minority of those enrolled end up leaving high school with a degree (see, for example, Broady et al 2000). In accordance with what has been said about the primary schools, it is difficult to judge whether students are generally leaving the high schools better or worse equipped with knowledge at the end of the 1990s than they did at the beginning of the decade. It should, however, be noted that the share of students who have received a final certificate within four years of starting high school has decreased in each year between 1998 and 2000.
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1.5.4 Health care
According to the introductory paragraph of the Health and Health Care Act, the health care sector in Sweden has the goal of guaranteeing good health and health care under the same conditions for the whole population
(SFS 1982:763, §2). The text of the law further stipulates that health care shall be provided in the spirit of respect for the equal value of all human beings, and that those with the greatest need of care shall be given priority.
How health care should be financed, organized and administered have all been central questions in the welfare policy debate of the last few decades. Today, health care is administered by 18 so-called county councils (landsting, or regional parliaments), 2 newer regional administrations, and one local authority not incorporated in any county council (the Baltic island of
Gotland). In the course of the 1990s, many changes have taken place in the delimitation of health care services vis-ā-vis the municipal care service sector, which has also made for major attendant changes in financing. The so-called
Ädel-reform, which was mainly implemented by 1992, is the biggest of these transformations, but the psychiatric care reform of 1995 has also been significant. All told, the changed division of labor between local authorities and the regional-level county councils has entailed a growing focus on emergency health care within the county councils, whereas the local authorities have taken over a great part of the more long-range primary care services. Health care services have also been substantially reorganized during the 1990s with respect to type of administrative mandate (public or private) as well as ownership. A number of county councils have enacted divisions of labor between order-placing authorities and executing units which services are ordered from. Services ordered are then paid for through internal performance-related compensation. Private tenderers performing services have also become more common, not least within primary care. The combined consequences of these organizational changes for service quality and accessibility are, however, not currently possible to quantify.
It is difficult to get a unified overview of health care costs from the available sources, not least due to changes in type of administrative mandate, but also due to shifting delimitations and definitions of e.g. services performed. Generally, it can however be concluded that public expenditure on health care services increased during the 1990s overall, above all between 1998 and 1999. The increase consisted to a great degree of markedly increased costs for medicines. Overall, public financial commitments to health care services amounted to about 120 billion crowns in 1999 (Statistics Sweden 2001c).
Also those costs of health care which are paid for directly by households increased during the 1990s, amounting to 23 billion crowns in 1999. Among other things, this trend depended on marked increases in the user fees paid by patients for visits to doctors and dentists, as well as for medicines (National Board of Health and Welfare 2000c). In 1990, a visit to the doctor cost 60 crowns both within primary care and at hospitals. By 1999, the fee had increased to 100 crowns on average, whereas fees for specialist visits had increased to an average of 200 crowns. Variations between the county councils in this respect were substantial by the end of the 1990s. If the level of fees had since 1990 increased only by the same increments as consumer prices generally, the average patient fee would have been about 75 crowns in 1999. For children and youth, user fees were abolished in 1998 for non-institutional primary care, but in some county councils this decision has later been circumvented. Higher user fees have in the 1990s partly been motivated as ways of cutting back "over consumption" of health care services, but also run the risk of cutting back utilization of health care which really would have been needed
(Granqvist 2000).
The system for charging user fees upon purchase of prescribed medicines has been thoroughly changed on a few occasions during the 1990s, with increasing costs for individuals as a tangible consequence. Until the beginning of the 1990s, increases in user fees for medicine stayed mainly in line with consumer price increases-thereafter, user fees have increased much more rapidly than prices (National Board of Health and Welfare 2000c).
Also dental care has undergone a number of user fee changes during the 1990s. Roughly speaking, we may say that these changes have made for increased costs for individuals, as well as that fewer and fewer people are receiving insurance compensation for visits to the dentist or the dental hygienist. In connection with the enactment of a new compensation system in 1999, free price setting was also introduced, which has led to major price increases within the public "people's dental care" system as well as among privately practicing dentists. The fee increases also appear to have decreased the likelihood of people seeking dental care, also among those who are experiencing problems (National Social Insurance Board 2001g). However, private dental insurance has not been successfully established as an alternative, despite the fact that the 1990s have entailed significantly increased user fees for individuals.
For the health care sector as a whole, the 1990s have entailed significant decreases in personnel strength. Even if different data sources give varying pictures of the exact numbers involved, at least 60 000 employees have disappeared from the health care services, above and beyond the number of those affected by changes in administrative mandate (public or private authority). The decrease has mainly occurred among junior nurses (undersköterskor) and aides-that is, personnel whose work duties are mainly oriented to caring duties as such. As far as doctors are concerned, the development has been rather the opposite.
An increase in the total number of doctors in Sweden does not need to mean increased access to doctors for the individual citizen. Neither does increased access necessarily follow from the fact that the amount of county council-employed doctors per 1000 residents has increased from 2,2 in 1990 to 2,6 in 1999 (Ministry of Social Affairs 2001). Here we find, among other things, considerable regional variation, both regarding the number of positions and (more importantly) the number of positions which are actually occupied. A situation survey which the committee has had done indicates that the staffing situation for specialist-trained doctors varies both within and between the county councils. Local authorities and health care centers in socially disadvantaged areas often have fewer occupied general physician's positions. For the three county councils situated furthest north (those of
Jämtland, Västerbotten and Norrbotten), staffing has worsened since 1998 compared with that in the nation as a whole.
The number of beds within institutionalized health care was almost halved in the course of the 1990s, above and beyond the number of places affected by transfer of responsibility to the local authorities of geriatric services and nursing homes which the
Ädel-reform brought with it. At the same time, the number of visits to the doctor increased slightly, as did the number of operations performed-the overall number of visits received and/or treatments performed only decreased marginally, mainly within surgery. This apparently contradictory development has to do with the average duration of care decreasing substantially within institutionalized care, as well as with the increasing number of treatments executed within non-institutional health care.
An overall
judgment of how health care works as a common resource for all citizens is difficult to do on the basis of currently available knowledge. The shortening of care durations, as well as decreases in the number of beds within institutional care, are trends which in themselves cannot be
interpreted either as welfare losses or welfare gains-rather, it is the accessibility and the quality of care received which is of significance here. Here we find a number of examples of how improved methods of care have contributed to increased quality of caring services, both in terms of survival rates and the life situation for those with different kinds of illnesses. Improvement in health care for patients with circulatory disorders has prevented about 3 000 deaths in the course of the 1990s, and health care services can reasonably be held to also have cut mortality related to strokes and different forms of cancer (National Board of Health and Welfare 2001c). Measures improving life quality and ability to function for patients have also been increasingly conducted during the 1990s. For example, the amount of balloon-driven pulmonary blood vessel dilations performed increased from some 2000 to almost 7000 between 1991 and 1998, whereas the amount of anti-glaucoma eye operations increased from c:a 28 000 in 1990 to 60 000 in 1999 (National Board of Health and Welfare 2001c).
Developments within health care with, among other things, new methods of care have meant that more people can be treated, at the same time as the number of people potentially eligible for treatment increases. This means, for example, that the number of people in queues to undergo balloon-dilation of blood vessels has not decreased despite increases in the number of treatments, and that the number of those in queue to undergo anti-glaucoma operations has increased from about 16 000 at the end of 1991 to almost 24 000 by the end of 1997 (National Board of Health and Welfare 2001b). Increased treatment capacity thus does not necessarily lead to decreasing queues, and using health care queues as the only indicator of service accessibility is thus less than appropriate.
Public debate on queues for services have however conceivably contributed to the number of individually held private health care insurance policies increasing by almost fivefold during the 1990s, from 23 000 in 1990 to about 115 000 in the year 2000 (Grip 2001). These insurance policies should mainly be regarded as a way of increasing accessibility [for some of us! Translator's notice], since they guarantee that policyholders receive fast and unhindered access to care upon becoming sick. This type of insurance does not, however, constitute an alternative for those who are often sick, since they are non-insurable-also for others, these individual insurance policies will probably not work too well if too many people have them.
Besides technology-driven changes in quality, also changes in staffing and in the work environment should be factored in a more comprehensive assessment of health care services quality. Even if there are not ways of quantifying the consequences of deteriorating work environments for security, as well as for the quality of care (see Bäckman 2001; le Grand, Szulkin and Tåhlin 2001a), it is a reasonable hypothesis that highly burdened health care workers run the risk of doing a worse job. We can here note that the amount of reported incidents of workplace accidents and mistakes in health care more than doubled in the course of the 1990s. This increase can, however, depend on increased reporting propensity as well as on an actual increase in the number of accidents, and it can be noted that a constant share of reports resulted in some kind of formal sanctions (National Board of Health and Welfare 2001b).
The accessibility of health care is also affected by the personnel situation, not least by unfilled vacancies within socially disadvantaged areas where care needs are also greater. Increases in user fees for doctor visits and medicine run the risk of decreasing care utilization among economically disadvantaged groups. There is, however, still no proof for the claim that the share of people refraining from going to the doctor despite present need has increased over the 1990s.
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1.5.6 Old age care
According to the national action plan for old age policies adopted by the Swedish parliament in 1998 (Government White Paper 1997/1998:113), the basic principles for old age care remain the same as in the course of the preceding decade: the elderly should be able to age in security, with retained independence and with access to high-quality service and care. The action plan also maintains that old age care should be publicly financed and accessible in relation to need, not purchasing power. Despite the unchanged goal statements, the 1990s was a very turbulent period for old age care, both organizationally and in terms of resources. What these changes have meant for old age care as a welfare resource for the elderly and their families has not, however, been possible to clarify.
The emergence of new forms of supervision and operations within old age care constitute organizational changes for which there is very limited knowledge of these changes' possible consequences for elderly peoples' welfare. The founding of so-called results-responsible sub-units, as well as of performance-related financing systems, has been widespread, and more than half of the nation's municipalities have implemented models of organization which mean that responsibility for financing decisions are separated from services performance or "execution." The volume of old age care on tender-that is, publicly financed and regulated old age care which is actually executed by actors other than the municipalities themselves-increased by fourfold in the course of the decade, and by the year 2000 constituted eleven percent of the available special residential placements and nine percent of hours of service work performed for elderly living in their own homes (so-called home help services). The rate of increase was particularly big between 1999 and 2000 (National Board of Health and Welfare 2001e). The for-profit services are most extensive and are increasing most rapidly-of all the employees within privately administered old age services, three-fourths worked in for-profit companies in the year 2000 (as compared to 28 percent in 1993). Privately administed old-age care is most common in the big cities and in municipalities where population shares of those with low educational attainment are at their lowest
(Trydegård 2001). An increasing share of such old age care services is run by a small amount of bigger companies-in 1999, the four biggest firms stood for half of the privately tendered service (National Board of Health and Welfare 1999b).
As far as resources are concerned, the bigger part of the decade was characterized by retrenchment-public financial resources available for old age care did not increase in tandem with increases in the number of old people. During the latter half of the decade, real levels of resources did increase, also in relation to the increase in the number of elderly in the population. The overall resources spent for old age care amounted to some 55 billion crowns in 1999. This corresponds to an increase (at fixed prices) by about 20 percent by 1999 as compared to 1993, while the population share of those aged 80 and above increased by 10 percentage points during the same period. The biggest single cost item in services for the elderly (accounting for 73 percent of all expenditure in 1999) is constituted by expenditure on special residential institutions-that is to say, nursing homes, old peoples' homes, group apartments for senile persons, so-called service homes, and so on. Compared to 1993, the costs for special residential facilities have increased by 22 percent, whereas the costs of health care and other services offered in private homes have increased by 7 percent (Statistics Sweden 2001c). In contrast to what has been the case for services to the handicapped, a resource shift has taken place in old age care services from help offered in the home, in the direction of more institutionally based forms of service.
Old age care services cannot be regarded separately from health care. Old people have extensive need of health and medical care, and changes within the health care sector affect the need for municipal old age care. Increased resources channelled to municipal old age care must thus be seen in the light of the fact that the number of employees in the health care sector decreased significantly during the 1990s, and that the number of hospital beds was almost halved at the same time as durations of care were radically shortened, especially for elderly patients (see section 1.5.4 above). Old people with great needs of care, which were previously catered to within the health care sector, now take up an increasing part of the municipal old age service sector's resources. In consequence, the work of home-based old age care has increasingly been concentrated to a smaller and all the more help-demanding group of elderly persons-services such as cleaning, washing, purchases and accompanied walks have increasingly fallen outside of the municipal ambit of responsibility.
The share of elderly receiving old age services began to decrease radically more than 20 years ago, and the decrease continued also throughout the 1990s, although not as rapidly as before. The share of the very old (80 years or more of age) with placements within special residential facilities was about the same in 1999 as it had been in 1990 (22 percent), while the share of those receiving health care or other services offered in the home decreased from about 25 to about 21 percent. The gender distribution of municipal old age care services is uneven, in that services are received more often by men living alone than to women in the same situation. Among married elderly couples, it is instead more likely that municipal services are received more often when the woman in the household is in need of care, which means that an older woman taking care of her husband is usually more alone in her caring responsibilities than is a married man in the same situation
(Szebehely, Fritzell and Lundberg 2001).
During the 1990s, a certain increase in the amount of care services executed within the voluntary sector is likely to have taken place-the state of knowledge here is, however, unclear (see Svedberg 2001). As was shown in section 1.3.5, the decrease in municipal services has coincided with an increase in family members' care work, as well as increases in the care work done by private firms and financed with the elderly peoples' own money. It was shown that these shifts, which can be characterized as constituting both informalization and marketization of old age care, are unevenly distributed also by social class. The elderly with higher educational attainment tend to replace the decreases in municipal home-based services with help purchased on the market, whereas elderly with lower educational attainment tend to fall back on help by family members. The transformations in patterns of help and assistance thus tend to reinforce stratification in old age care. From a welfare perspective, it is important to direct attention to consequences of such change both for givers and receivers of help. It is here important to note that those family members which have realized an increase in helping responsibilities are most often women-mainly elderly wives and middle-aged daughters.
The shift from publicly financed old age care to family member care and privately purchased care is in all likelihood a consequence both of stricter criteria for care service eligibility on one hand and, on the other hand, of user fee increases and changes in organization as well as content of home-based help services. The risk is that the elderly will refrain from seeking help for economic reasons has been noted, not least in that the family members of less well-off elderly persons have been forced to take on more caring responsibilities than what could be seen as desirable. A proposal to implement protections against high user fees in old age care services is up for consideration in the parliament (Government White Paper 2000/01:149).
The extent to which old age care is a resource for the elderly in need of help and for their families naturally depends to a great degree on the quality of the activities and services offered. The possibility of following trends in this respect for the 1990s is however very limited, but in an initial evaluation study following up the national action plan for old age policies the National Board of Health and Welfare (2001f) has noted that a number of problems remain, despite the resource increments devoted to such service in the course of the most recent years. One problem is that there is insufficient coordination and cooperation between institutional health care, non-institutional health care, and municipal old age care service, which makes for big problems for the increasing number of old people with extensive medical and social needs being cared for in private homes or in municipal old age residences. Another problem is the personnel recruitment situation, which is very troublesome in the majority of Sweden's municipalities. This is partly a consequence of increased competition for labor, but the National Board also relates problems to rationalization, reorganization and expansion of competitive tendering, which in its turn seems to have led to negative consequences for "the possibilities to recruit, train and keep personnel, and ultimately, for the possibility to offer the elderly good and secure care" (National Board of Health and Welfare 2001f:9).
ARE PARENTS ALLOWED IN WORKING LIFE?
If they are, it should be possible to combine parentship and working life without to many difficulties. The situation at work should not affect the choice of point of time for having children, the conflicts of interests between work and parentship should be few and employees should not be discriminated because of their choice to be parents.
The above serve as the starting point to an investigation made by the Swedish Gallup, commissioned by HTF (trade- civil servant -union?) The investigation has asked HTF members, age 19-39, about their opinion about parentship and work, and 1000 telephone interviews has been carried out in the period march 2-22, 2001. The answers showed, among other things, that:
33% state that their situation at work affects the point of time for having children. 40% of the women, and 29% of the men feel this way.
Many of the asked feel that they have a need for a better security before it is pos-sible for them to have children. This may be related to the fact that 75% of these women do not have a permanent job.
16%, of the women who have children experience that they have been discriminated because of their pregnancy.
By those who claim to have been discriminated 20% state that they have been dismissed. Most of the employers stated shortage of work or reorganization as the reason. The remaining employers did not state any reason at all.
Most of the women who have felt discriminated tells that their probationary
employment did not change into a permanent employment due to their pregnancy.
When the child is born 37% tell it to be very or quite difficult to combine work and parentship. Women experience this to a greater extent than men, 43% of the women and 31% of the men.
38% of the asked who have children experience that there is very or quite often
conflicts of interests between work and parentship, women to a greater extent than men. Only 22% state that there are never any conflicts of interests.
50% feel it to be most difficult that work takes so much time, but women also feel that problems come up in relation to child care.
33% of the women, but only 10% of the men, have attended at least one
employment interview were they have been asked whether they are planning to have
children or not.
7% of the women and 1% of the men state that they have experience from an
employment interview where they have felt forced to promise not to have children in the immediate future.
12% of the asked women has hesitated or refrained to apply for work because of a pregnancy or a planned pregnancy.
By this, one can make the conclusion that working life is hardly allowed for parents and that women experience this to a greater extent than men. Many of the asked do see
difficulties in combining parentship and work, the situation at work do affect the point of time for having children and many, mostly women, do get discriminated when they choose to be parents. Their opportunities to make a career deteriorates and some women even lose their job.
To set these things right HTF suggest, among other things, a stronger legislation
respecting labour, re-established protective rules against arbitrary notice of dismissal, since this influences parents of small children, and that the employment security for parents at parental leave strengthens. Temporary employment's shall also in reality be an exception to the basic rule; permanent employment.
HTF calls attention to the need for a change of attitude in working life. Pregnancy and parentship are positive, developing and valuable, both to the parents themselves but also to the employers and to the society.
WHY I SUPPORT THE BERLIN CONFERENCE
Alarming examples
The outcomes of deregulation and privatisation in the 1990s alarm. Some international cases are worth to be mentioned;
England and Wales All public water utilities were privatised in 1989. The result has been a 60 per cent increase in the water tariffs. Profits makes up 30 per cent of the turn over in the private water companies and the managing directors have increased their salaries by 300 per cent.
England The Margret Thatcher government liberalises the property market. However, it was not long before the private contractors started running to the doorstep of the conservative government, requesting the government to come to rescue and regulate the planning process, which was on the point of derailing.
New
Zealand Major components of the welfare society were dismantled or drastically constrained , and has been replaced by simple competition and market society. School reforms were based on ideology, not on comprehensive investigations and social science.
Market, voucher money allocations based on enrolled students and free parent choice turned out to get discriminatory repercussions. This impact is supported by very unequivocal research , for instance by professor Martin Carnoy at the Stanford University. Professor Carnoy is a specialist on voucher systems and its impacts.
Social needs for sale
Market solutions reduce citizens to customers. Our social needs are put for sale. Sweden has together with England moved further than most other European countries concerning market testing and privatisation of public funded activities. It is obvious that privatised hospital care, schools and elderly care will imply increased social differentiation. Private insurance solutions will unavoidably press on. At the moment the political strife is tense about such "cream" systems in my Scania Region of Sweden.
Steps towards a co-ordinated resistance
The need for collaboration and co-operation above the national borders between progressive forces and movements, which realises the danger with deregulation and privatisation, has never been more urgent. This is why I look upon the Berlin Conference as an important step towards a more co-ordinated trade union and political resistance against the dismantling of our public funded welfare activities. Our common struggle must result in a strong support for a rebuilding of the public sector, and most important by emphasising the most valuable resource - all the people working in this sector.
Bengt Silfverstrand
Social democrat member of the Swedish Parliament
Statement in support of the Berlin Conference
We are gathered to a public meeting in Gothenburg February 9th 2002, to discuss
Privatisations, deregulation, undermined labour codes,companies closing down, the Euro, trade union rights.
Are there connections?!
How do we turn the development in a new direction?!
We who are gathered at this meeting states that there are connections between the policies of privatisation and deregulation we have seen in Sweden, and the policies dictated by the international institutions like WTO, IMF and EU.
We see therefore the need of building the resistance against the policies of privatisation and deregulation on an international scale ..We welcome the International Conference against deregulation, for workers rights in Berlin, February 22-24th 2002. We support the invitation to Berlin:
(quotes).
Adopted, February 9, 2002