The Transformation of Care in European Societies

Margarita Leon

• Publisher: Palgrave Macmillan
• Year: 2016
• Print ISBN: 9781137326508
• eBook ISBN: 9781137326515
• Topic: Politics & International Relations
• Subtopic: Education General
• Index: Politics & International Relations

This book aims to explore the nature and extent of the 'care deficit' problem in European societies and how effective the different care systems are in dealing with these problems through policy innovation. It combines theoretical and conceptual debates, cross-national comparisons and analytically-driven case studies.

Part I

Contextualising the Transformation of Care Across Europe

1

Pressures towards and within Universalism: Conceptualising Change in Care Policy and Discourse

Margarita León, Costanzo Ranci and Tine Rostgaard

Introduction

Within Europe, care policies for children and older people have been, over the last two decades, one of the most dynamic policy areas of welfare state development. Both long-term care (LTC) and early childhood education and care (ECEC) respond to changing needs and demands for care. Ageing populations, labour market participation of women, decline in fertility and changes in family dynamics put pressure on national care systems. Although all countries that are analysed in depth in Part II (Austria, Denmark, England, Germany, Italy, Poland and Spain) experience these changes in needs and demands, albeit with different degrees, their responses vary depending on a number of factors ranging from their institutional history of welfare evolution, industrial relations and migratory regime to political discourses and social norms and values. This chapter will look at discourses and policy agenda setting, framing developments in care for the two extremes of the life cycle, children and older people, at both supranational and national levels and since the 1990s until today.

While most of the institutional changes taking place in LTC and ECEC since the early 1990s have been already described and critically discussed (see, for instance, Ranci and Pavolini, 2013; Pfau-Effinger and Rostgaard, 2011), only a few analyses have comprehensively considered the role played by ideas about care and their relations with reforms and policy change. And yet, the manner in which the ideational foundation for the care policies is framed has many different implications as decisions about care responsibility, needs and what constitutes good care imply normative assumptions regarding family obligations, gender relationships, professionalism, and the role of the state, the market, the third sector and local communities. In this sense, Schmidt’s (2008) advocacy for incorporating the role of ideas and discourse within analysis of institutional change becomes particularly relevant.¹

In an attempt to fill in this gap, our focus will be on paradigmatic changes. Drawing on Hall (1993), an analytical framework for the understanding of paradigmatic change includes looking at the changes in principles, logics and institutional instruments of the welfare state. We can thus differentiate between three orders of policy change. A change of the setting of instruments (benefit levels) makes up a first order change. A second order change occurs when the instruments of policy such as mode of access (for instance, labour market or citizenship-based entitlement), the benefit structure (service or cash-based) or financing (state/user contributions) are modified along with the settings. Third order change refers to a transformation in the overarching goals (the epitome of equality, citizenship and solidarity) that simultaneously affects also the other two components – settings and instruments – and represents, according to Hall, a paradigmatic shift introducing radical discontinuity in policy.

Paradigms have been mainly considered in policy analysis as a coherent, homogeneous corpus of ideas and normative orientations that establish the cognitive and value frame within which policy is usually developed (Howlett and Ramesh, 1995). In this perspective, only in exceptional circumstances are existing paradigms subjected to a radical change implying a strong, path-breaking re-orientation of policy according to a new policy model. The case of care policy, however, does not completely fit into this analytical model: in most European countries, the 1990s coincided with a time of paradigmatic change in the care policy field and yet, third order changes were not so coherent and homogeneous as is assumed in the analytical model, and gave way to various interpretations of the same paradigmatic change. New ideas and normative concepts about care became dominant in the public discourse in many countries and inspired institutional reforms through which new social rights were introduced. Care policy became a ground for harsh conflicts between contrasting ideas about what should be the best way to solve the care deficit problem, investing in people and preserving the financial sustainability of public care programmes at the same time. The final change in most of these countries was the result of compromises and blurring of different ideas and concepts, which were subsumed within the paradigm of universalism, albeit with varying degrees and interpretations.

This chapter will firstly reflect on understandings of universalism paying attention to what it implies at an analytical as well as theoretical level when applied to the care policy field. Secondly, the chapter will look at the main tensions and dilemmas, namely, marketisation and re-familisation trends, within the paradigm of universalism and how these trends have evolved in LTC and ECEC, respectively. Following from here, the chapter finally describes how austerity has affected the development of these two policy fields in recent years, giving way to new dilemmas and discourses in the policy agendas, including the emergence of a new tentative paradigm based on the ‘social investment’ idea.

We argue in this chapter that universalism has generally been the dominant paradigm for the two policy fields considered here (ECEC and LTC) since the beginning of the 1990s up until the beginning of the economic crisis. Changes in care policies (especially the introduction of universalistic entitlements in many continental countries) were possible in the 1990s and early 2000s on the basis of a loose understanding of universalism where both marketisation and/or familisation were not considered as antithetic logics to the dominant paradigm and consequently more hybrid care regulations were set up in many countries. The pressures created by opposed problems (increased demand for care versus higher financial constraints for social expenditures) plus contrasting ideas about what should be the best way to organise care provision have certainly created tensions within universalism (public provision and funding versus more market-led or family-led externalisation). These tensions led to a re-interpretation of universalism, although within first and second order changes in Hall’s terms. Since 2007 the financial crisis has reinforced tensions and conflicts within the universalism paradigm, giving way to a phase of partial retrenchment and more ‘selective’ universalism. It is argued in this chapter that the embracing of a ‘social investment’ logic might be preventing, or at least softening, cutbacks in LTC and ECEC in the current austerity context – although this is certainly not an across the board trend.

Understandings of (and challenges to) universalism

As has been thoroughly explored in Anttonen et al.’s (2013b) recent volume, universalism is both a contested and a context-specific concept and social policy principle. In its pure form, universalism is rather ‘an ideal type that is always beyond reach’ (Anttonen et al., 2013b: 187). In its more mundane application, universalism is subject to multiple meanings and different interpretations depending on academic disciplines, political ascriptions and social milieus. Hence we agree with Stefánsson (2013: 65) when he claims that ‘rather than trying to impose one standard definition of the term, it seems more fruitful to accept the polysemic nature of universalism and come to terms with the diverse meanings attributed to it’. From an analytical perspective, we understand in this chapter the idea of universalism as a loose social policy principle that aims at an equal distribution of services and/or benefits among individuals belonging to the same group. Thus, when we claim that universalism has been the dominant paradigm in LTC and ECEC in Europe since the 1990s, what we are referring to is that social rights to care have been recognised or substantially confirmed in most of the European countries, though cross-national variation in levels of access, quality and coverage is still very high.²

Besides the difficulty in coming to terms with a precise and once-and-for-all definition, universalism is a difficult process to follow in the case of care policy for a number of reasons. Firstly, following from the ambiguous and contested nature of the concept of care itself (see Daly and Lewis’s 2000 influential article), care policy in general is characterised by a weak definition of rights and responsibilities. This often means that universality rests on some conditionality criteria that vary from country to country as well as from region to region, and may rest on varied criteria, such as the principle of need, family resources and means, citizenship status and local standards, always open to different interpretations. What rights should be given and what should be the obligations over the care needs of infants or the elderly are highly dependent on norms and social values, much prone to chronological and geographical variation. Secondly, social entitlements to be cared for, even if universally conceived, are not always automatically linked to provisions and clear responsibility for delivering and/or paying. Social rights to care for are equally blurred (Knijn and Kremer, 1997). The mixed economy of welfare in this field is quite more complex than in other welfare domains such as pensions, health or education. Also, entitlements are often dependent on the benefit structure, with more formal and explicit conditionality requirements to cash benefits than is the case when care is organised as a service benefit. Thirdly, the definition of the quality criteria and/or standards for care is often unclear and subjective; professional requirements for care workers are poorly defined in respect of other more consolidated welfare policy fields (such as health or education). This is partly due to the fact that the status of care work as a standard formal profession is in many countries still weakly delineated (see Chapter 2). The implication again is the existence of very diverse scenarios in terms of what citizens might expect for the provision of a universal right. Finally, the understanding of universalism as a dominant paradigm in care policy is further complicated by the fact that the two main groups (child care and eldercare) are not always, and as we will argue increasingly less so, synchronised in a coherent and comprehensive policy path. On the contrary, there might well be contradictions and opposing trends between these two care fields. This is despite the fact that one of the driving agendas is the reconciliation of work and family life, where families caring for children versus the elderly are very differently situated.

Assuming this complexity in grasping ways to define and measure universalism, we argue in this chapter that while the scope for universalism might have been questioned in other policy fields, it is quite clear that the need for greater coverage and expansion in the fields of child care and eldercare has gained presence in the political agenda at supranational (EU and OECD in particular) and national levels at least since the beginning of the 1990s (see OECD 2001, 2005, 2011). On the one hand, public expenditure and coverage of social care needs as well as take-up of services have been increasing in the countries that were previously characterised by a more residual approach. On the other hand, universalism is still the founding principle in countries where universalistic social rights to care were already established, especially in regards to ECEC, whereas LTC services have become more targeted (see Chapter 2). There has therefore been a more or less generalised trend towards universalism, although the justification behind policy intervention has differed greatly whether we refer to child care or LTC of dependents and also across countries.

In all cases, however, universalism has increasingly been confronted with the challenges of diversity and autonomy on the part of care recipients. As Anttonen et al. (2013b: 10) point out ‘diversity raises the question of whether universal allocation of social services can promote adequate social policy solutions for citizens with different needs, lifestyles and values, and whether social services should be more customised’. Moreover, a new idea of care as capability (Nussbaum, 2003) was increasingly supported by the mobilisation of groups of care users (for example, disabled adults) starting to claim for more autonomy and empowerment. In practice, these challenges of diversity and autonomy have translated into a clear externalisation trend that has so far taken two main forms – and with varying degrees across the countries: marketisation on the one hand and re-familisation on the other. While the former puts the emphasis on market principles such as competition of suppliers (including for-profit) and freedom of choice for users, the latter recasts family care in a variety of ways. As a result, the traditional boundaries between public/formal and private/informal care provision have been subjected to blurring and hybridisation (Pfau-Effinger et al., 2011; Pfau-Effinger and Rostgaard, 2011).

Though these notions have been clearly opposing each other in ideological terms (universalism vs. marketisation, universalism vs. re-familisation), with some resonance in the academic discussion, policy change taking place in Europe in the fields of care has actually been characterised more by compromises and mutual adjustments than by conflicts and normative battles. The positive fiscal trends in many countries during the 1990s have enabled policy strategies aimed at finding new balances between universalism and cost-containment that were based on the extension (or continuation as in the case of the Nordic countries) of social entitlements to be cared on the one hand, and new forms of public-private mix in the actual provision of care services on the other. Used to justify what we have called the ‘externalisation trend’, freedom of choice is importantly embedded within universalism for both eldercare and child care. The idea of freedom of choice might lead to social and economic inequalities (because of differentiated access to resources, financial as well as capacity for making choices) but this does not need to be necessarily the case. Quite on the contrary it might serve to strengthen universalism as when parallel social policy programmes serving the same function are put in pla...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Figures and Tables
• Acknowledgements
• Notes on Contributors
• Introduction
• Part I Contextualising the Transformation of Care Across Europe
• Part II National case-studies
• Index