This book grew out of a Nordic research network that initially focused on the recruitment crisis in care work. The collaboration took the shape of series of workshops, where we discussed con-cepts and interpretations and exchanged stories and informa-tion about trends and developments in the individual countries.
It is through these exchanges that the notion of crisis in care work fi rst took shape as a meaningful frame for a shared book.
By collecting the qualitative evidence about the value of socially-defi ned care and its current predicament, we the edi-tors wish to reclaim that specifi c Nordic ethos that made room for the rationality of caring. We do not make a claim for the reinstatement of some specifi c model to organise care, even though we share a view that key services should be publicly funded and provided on the basis of a social right. What we defend here is the specifi c humanistic Nordic ethos that gave impetus to a policy convergence underpinning care-friendly as well as care-worker friendly institutional developments in the welfare services.
The book covers developments in care work in four Nordic countries—Denmark, Finland, Norway and Sweden, building on a number of qualitative case studies that together provide so-called ‘thick description’ of the world of care. We believe that by bringing these insights together we can provide a rich-er and more dialogic account than would be possible, had we confi ned ourselves to more specifi cally defi ned themes and sought to redact the research materials into comparable fi g-ures.
Several chapters in this book examine the impact of the cul-tural shift associated with managerialist reforms. Some chap-ters examine the shaping of formal care work at the macro level but the majority of chapters focus on the grassroots level of care where the two competing rationalities create a ten-sion. Our shared view is that it is particularly important to help voices from the grassroots to be heard, to challenge the currently dominating discourse that often presents the struc-turing of the services as a ‘rational’ campaign of streamlining care in an effective way (Vabø 2003, 85).
The studies that form the foundation for the book have their separate, independent histories and do not advance a shared interpretation or agenda. The aims of the different chapters and authors vary: some of us seek to make the lived experience of care workers or those cared for somehow visible, while others focus more on uncovering how politics structure that experience. But even though interpretations may vary, these
analyses are shaped by a shared conviction about the value of the human experience, be it that of the person cared for, or the care worker.
In order to emphasise the aim of the book to offer cultur-ally and institutioncultur-ally embedded accounts, the book is or-ganised in four parts, one for each Nordic country. Hopefully, our decision to keep the countries separate helps the reader to grasp a more multifaceted understanding of the dynamics in the similar but not identical countries. The more detailed presentations of the chapters are given in the short introduc-tions found in the beginning of each part.
Each country section has an emphasis on some specifi c an-alytical dimension. In the Danish part, this broad perspective is learning, refl ecting the background of the authors in edu-cation studies. In the Finnish part, attention to welfare state restructuring underpins sociological analyses of the shaping of work and occupations in the context of service policy. The chapters in the Norwegian part are inspired by the modernisa-tion perspective and focus on long-term developments in care occupations. Finally, the Swedish part most consequently fo-cuses on elderly care as a social service, developing the analy-sis primarily from the point of view of social care research.
Notes
1 Finland was not included in Rauch’s study, but comparable data from other sources (Szebehely 2003, Kröger 2007) allows us to discuss it together with the other countries.
2 The concept ‘competition state’ was introduced by Philip Cerny (1990).
References
Ahnlund, P. & Johansson, S. (2006) Omvårdnadsutbildning som mål eller medel? Socialvetenskaplig tidskrift 13(3), 212–227.
Ahrenkiel, A. G. et al. (1996) Evaluering af de grundlæggende social- og sundhedsuddannelser. København. Amtsrådsforeningen:
Kommunernes landsforening og Undervisningsministeriet.
Allardt, E. (1975) Att ha, att älska, att vara. Om välfärd i Norden. Lund:
Argos.
Allardt, E., Andrén, N., Friis, E.J., Gíslason, G., Sparre Nilsson, S., Valen, H., Wendt, F & Wisti, F. (Eds) (1981) Nordic Democracy. Ideas, Issues, and Institutions in Politics, Economy, Education, Social and Cultural Affairs of Denmark, Finland, Iceland, Norway, and Sweden.
Copenhagen: Det danske selskab.
Anttonen, A., Henriksson, L. & Nätkin, R. (1994) Naisten hyvinvointivaltio. Tampere: vastapaino.
Anttonen, A., Baldock, J. & Sipilä, J. (Eds) (2003) The Young, the Old and the State. Social Care Systems in Five Industrial Nations. Cheltenham:
Edward Elgar.
Bergh, A. & Erlingsson, G. (2006) Resilience through Restructuring:
Swedish Policy-Making Style and the Consensus on Liberalizations 1980–2000. Ratio Working Paper 110. The Ratio Institute: Stockholm.
Campbell, P. & Pedersen, O. (Eds) (2001) The Rise of Neoliberalism and Institutional Analysis. Princeton: Princeton University Press.
Cerny, P. (1990) The Changing Architecture of Politics. Sage Publications:
London and Newbury Park.
Christiansen, N.F. & Markkola, P. (2006) Introduction. In Christiansen, N. F., Petersen, K. Edling, N. & Haave, P. (Eds) (2006) The Nordic Model of Welfare. A Historical Reappraisal. Copenhagen: Museum Tusculanum Press.
Copus, A. (Ed.) (2007) Continuity or Transformation? Perspectives on Rural Development in the Nordic Countries. Stockholm: NordRegio.
Dahl, H.M. (2000) Fra kitler til eget tøj: Diskurser om professionalisme, omsorg og køn. Århus: Politica.
Dahl, H.M. (2004) A View from the Inside: Recognition and Redistribution in the Nordic Welfare State from a Gender Perspective. Acta Sociologica 47(4), 325–337.
Dahl, H. M. (2005). A changing ideal of care in Denmark: A different form of retrenchment? In Dahl, H. M., & Eriksen, T. R. (Eds) Dilemmas of Care in the Nordic Welfare State. Aldershot: Ahsgate.
Dahle, R. (2003) Shifting boundaries and negotiations on knowledge:
interprofessional confl icts between nurses and nursing assistants in Norway. International Journal of Sociology and Social Policy 23(4/5), 139–158.
Davies, C. (1992) Gender, history and management style in nursing:
towards a theoretical synthesis. In M. Savage and A.Witz (Eds) Gender and Bureaucracy, Oxford: Blackwell Publishers.
Eliasson, R.-M. & M. Szebehely (1991) Äldreomsorgens särart och särbehandling. Socialmedicinsk tidskrift 68(2–3), 69–77.
Esping-Andersen, G. (1990) The Three Worlds of Welfare Capitalism.
Cambridge: Polity Press.
Evertsson, L. (2000) The Swedish Welfare State and the Emergence of Female Welfare State Occupations. Gender, Work and Organization 7(4), 230–241.
Gough R. (1987) Hemhjälp till gamla. Arbetslivscentrum: Stockholm.
Hega, G. & Hokenmaier, K. (2002) The welfare state and education: A comparison of social and educational policy in advanced industrial societies. German Policy Studies 2(1), 2002.
Heinonen, J. (1999) Kohti yksilöllistä pirstoutumista vai demokraattista yhteisöllisyyttä? Yhteiskuntapolitiikka 65(3), 270–278.
Henriksson, L. (1998) Naisten terveystyö ja ammatillistumisen poltitiikka.
Tutkimuksia 88. Helsinki: Stakes.
Henriksson, L., Wrede, S. & Burau, V. (2006) Understanding professional projects in welfare service work: Revival of old professionalism?
Gender, Work & Organization 13(2), 174–192.
Hernes H. (1987) Welfare State and Woman Power. Universitetsforlaget:
Oslo.
Hernes, H. (1988) Scandinavian citizenship. Acta Sociologica 31(3), 199–215.
Hugemark A. (1994) Den fängslande marknaden. Ekonomiska experter om välfärdsstaten. Lund: Arkiv förlag.
Høst, H. (2006) Kunnskapsstatus vedrørende rekruttering og utdanning til pleie- og omsorgstjenestene i nordiske land. Notat 4–2006.
Rokkansenteret: Universitetet i Bergen.
Johansson S. (1997) Hälsoprofessioner i välfärdsstatens omvandling In E. Sundin (Ed.) Om makt och kön i spåren av offentliga organisationers omvandling (pp. 69–102) SOU 1997:83. Stockholm: Fritzes.
Johansson S. (2002) Den sociala omsorgens akademisering. Liber:
Stockholm.
Johansson U. (1997) Den offentliga sektorns paradoxala
maskuliniseringstendenser. In Sundin, E. (Ed.) Om makt och kön—i spåren av offentliga organisationers omvandling. SOU 1997:83.
Kvinnomaktutredningen. Stockholm: Fritzes.
Julkunen, R. (1991) Hoiva ja professionalismi. Sosiologia 28(2), 75–83.
Julkunen, R. (1994) Hyvinvointivaltiollisten professioprojektien katkos.
Tiede & Edistys 19(3), 200–212.
Julkunen, R. (2001) Suunnanmuutos. 1990-luvun sosiaalipoliittinen reformi Suomessa. Vastapaino: Tampere.
Kettunen, P. (2006) The power of international comparison. A perspective on the making and challenging of the Nordic welfare state. In Christiansen, N. F., Petersen, K. Edling, N. & Haave, P. (Eds) The Nordic Model of Welfare. A Historical Reappraisal. Copenhagen:
Museum Tusculanum Press.
Klemelä, K. (1999) Ammattikunnista ammatillisiin oppilaitoksiin.
Ammatillisen koulutuksen muotoutuminen Suomessa 1800-luvun alusta 1990-luvulle. Turku: University of Turku.
Korpi, W. & Palme, J. (2003) New politics and class politics in the context of austerity and globalization: welfare state regress in 18 countries, 1975–1995. American Political Science Review 97(3), 425–446.
Kröger, T. (2007) Vanhuus, hoivatyö ja hoivaköyhyys. Presentation at Vanhuus, hoiva ja sosiaalityö –meeting, Verso, Lahti, 30/3/2007.
verso.palmenia.helsinki.fi /asp/datastore/download.asp?ds_
id=115&Krger+070330.pdf Retrieved January 23, 2008.
Leira, A. (1993) Mothers, markets and the state: A Scandinavian ’model’?
Journal of Social Policy 22(3), 329–347.
Lilja Mósesdóttir (2001) The Interplay Between Gender, Markets and the State in Sweden, Germany and the United States. Aldershot: Ashgate.
Mydske, P.K., Claes, D.H. & Lie; A. (Eds) Nyliberalisme—ideer og politisk virkelighet. Oslo: Universitetsforlaget.
Nannestad, P. (2007) Immigration and welfare states: a survey of 15 years of research. European Journal of Political Economy 23(2), 512–532.
Neil, C. & Tykkyläinen, M. (Eds) (1998) Local Economic Development. A Geographical Comparison of Rural Community Restructuring. Tokyo:
United Nations University Press.
Nordberg, G. (2007) Formal and Informal Care in an Urban and a Rural Elderly Population. Who? When? What? Stockholm: Karolinska institutet.
Pfau-Effi nger, B. (2004) Development of Culture, Welfare States and Women’s Employment in Europe. Aldershot: Ashgate.
Population Reference Burau (2007) 2007 World Population Data Sheet.
Washington D.C: Population Reference Bureau.
Rauch, D. (2007) Is there really a Scandinavian social service model? A comparison of childcare and elderlycare in six European countries.
Acta Sociologica 50(3), 249–269.
Saari, J. (Ed.) (2006) Suomen malli—murroksesta menestykseen. Helsinki:
Yliopistopaino.
Sainsbury, D. (1996) Gender Equality and Welfare States. Oxford: Oxford University Press.
Schienstock, G. (2007) From path dependency to path creation: Finland on its way to the knowledge-based economy. Current Sociology 55(1), 92–109.
Simonen, L. (1990) Contradictions of the Welfare State, Women and Caring.
Municipal Homemaking in Finland. Acta Universitatis Tamperensis ser A vol 295. Tampere: University of Tampere.
Sipilä, J. (2005) Minkä instituutioiden varaan uskallamme turvamme rakentaa? Sosiaaliturva 93(9), 14–16.
Stein, J.G. (2001) The Cult of Effi ciency. Toronto: Anansi.
Svensson, E.-M., Pylkkänen, A. & Niemi-Kiesiläinen, J. (Eds) (2004) Nordic Equality at a Crossroads: Feminist Legal Studies Coping with Difference. Aldershot: Ashgate.
Szebehely, M. (2003) Den nordiska hemtjänsten—bakgrund och omfattning. In M. Szebehely (Ed.) Hemhjälp i Norden. Illustrationer och refl ektioner. Lund: Studentlitteratur.
Taylor-Gooby, P. (2002) The silver age of the welfare state: perspectives on resilience. Journal of Social Policy 31(4), 597–621.
Tedre, S (1999) Hoivan sanattomat sopimukset. Tutkimus vanhusten kotipalvelun työntekijöiden työstä. Joensuu: Joensuun yliopiston yhteiskuntatieteellisiä julkaisuja 40.
Törnquist, A. (2004) Vad man ska kunna och hur man ska vara. Diss.
Lärarhögskolan i Stockholm: HLS Förlag.
Vabø, M. (2003) Mellan traditioner och trender. In M. Szebehely (Ed.) Hemhjälp i Norden. Illustrationer och refl ektioner. Lund:
Studentlitteratur.
Vabø, M. (2005) New Public Management i nordisk eldreomsorg—hva forskes det på? In: M. Szebehely (Ed.) Äldreomsorgsforskning i Norden.
En kunskapsöversikt (pp. 73–111). TemaNord 2005:508.
Wærness, K. (1980) Omsorgen som lönearbete—en begreppsdiskussion.
Kvinnovetenskaplig tidskrift 1(3), 6–17.
Wærness, K. (1984) The rationality of caring. Economic and Industrial Democracy 5(2), 185–211.
Wærness, K. (2005) Social research, political theory and the ethics of care in a global perspective. In H.M. Dahl and T. R. Eriksen (Eds) Dilemmas of Care in the Nordic Welfare State. Continuity and Change (pp. 15–32). London: Ashgate.
Widding-Isakssen, L. (1994) Den tabubelagte kroppen. Kropp, kjøog tabuer i dagens omsorgsarbeid. Bergen: Universtiy of Bergen.
Wrede, S. (2008) Educating generalists: fl exibility and identity in auxiliary nursing in Finland. In E. Kuhlmann and M. Saks (Eds) (2008) Rethinking professional governance. International directions in health care (pp. 127–140). Bristol: Policy Press.
Wrede, S. & Henriksson, L. (2005) The changing terms of welfare service work: Finnish home care in transition, in H.M. Dahl & T. R. Eriksen (Eds) Dilemmas of Care in the Nordic Welfare State. Continuity and Change (pp. 62–79). London: Ashgate.
DENMARK
PART I
Crisis of Care in A Learning Perspective
Betina Dybbroe
Denmark presents some special features of the Nordic experi-ences of crisis of care. The crisis is profoundly shaped by the interrelatedness of: deteriorating quality in and of care; the lack of political strategies for the provision of care; and the lack of ability to attract and preserve qualifi ed occupational groups in social and health care. The ethos of care has tradi-tionally been that of equal access to and equal quality of pub-lic services. There has been a resistance to privatisation as well as to leaving responsibility for caring to families and to civil society. Since 2002–2003 this approach to care has been un-dergoing change. However, health care workers still remain strongly identifi ed with the welfare state in Denmark.
In the following, I point out some of the contradictory and paradoxical developments unfolding in the fi eld of social and health care in Denmark. Social and health care services and the caring sectors (in relation to the ill, disabled, and elderly, and to rehabilitation, reproduction etc.) have been expand-ing since the end of the 1990s (Pedersen 2005). Elderly care remains a major activity, amounting to 15 % of public ser-vice expenditures, with a yearly net increase of 1.6 % since 1995 (Bødtker 2005). In the year 2007, 203,000 persons re-ceived elderly care, amounting to an increase of 2.2 % per year since 1977. It is estimated that this fi gure will rise dramatical-ly in the coming years due to the ‘ageing society’ (Strategiske Forskningsråd 2006, Meijer 2004).