Concept of Social Services Development - Implementation of social services development policy within the Region Trenčín

Why was this example implemented?

The process of long-term care services developed in Slovakia after 1989 was influenced by a non-existent pool of carers  brought about by a low demand, but conversely high increase of long-term care need. Added to this, financial resources and facilities from government as well as private sources was low, and there was a spontaneous increase of private providers. There was an obvious need to massively invest into regional LTC infrastructures, so involvement at the political level became necessary. The Slovak Parliament requires that all eight Regional parliaments coordinate regional activity with respect to developing and partly financing LTC according to their regional social service policies. Concepts are developed, where concrete investments are recommended. These investments are proposed by local governments and providers and approved by regional parliament. In general, the need for investment corresponds to the lack of LTC facilities and should complement the informal care sector and health care facilities, as well as addressing the low quality of social services provided. Concepts should be planned so that widening and enhancing  services in LTC facilities should unburden family caring commitments with the possibility of helping them to remain in employment.  In addition, hospital admissions for chronically ill old people should be reduced and coordination activities from the regional government level should demonstrate how they can use limited resources better. This example describes one of regional Concepts from the Trenčín region.

Description

The “Concept of Social Services Development” is a political document which was accredited by the self-governing Regional council of Trenčín Higher Territorial Unit (HTU) on 26 August 2009. This Concept was based on the new social services law (448/2008 Coll) and on national priorities of social services development (from the Ministry of Labour, Social Affairs and Family). Relevant groups of citizens, organisations and municipalities within the HTU Trenčín working groups were involved in the preparation of the document. The Concept analyses current social circumstances and the quality of social services (facilities and fieldwork) and proposes a developmental strategy for the period 2009 to 2013. Using comparative analysis between the potential demand and the current state of long-term care services, the proposals aim to address the main gaps in LTC provision in the region. The proposals that were developed include widening of ambulatory and residential social services in semi-residential care facilities, and enhancement of quality and humanisation of social services through reconstruction and modernisation of those facilities. In addition a range of support mechanisms are proposed for regional social counselling, training of carers, and for developing ‘new’ disease specific types of social services  for citizens with, for example, Parkinson´s disease, Alzheimer´s disease, multiple sclerosis, schizophrenia, and dementia. The Concept also includes support for public and for non-public providers of LTC and other social services.

A component of the Concept is the ‘Box of Project Intentions for cities and villages within HTU Trenčín’ – this is a list of investments recommended by municipalities and by social services providers (see here).  The list contains investments not only within the LTC sector but in other areas that come under the social service remit. On this list for example are: Reconstruction of care homes in the cities (eg. Myjava, Trenčín), rebuilding a maternity school at a senior home facility in the village of Dolná Maríková, and building a centre for social services within the city of Handlová.  

The Concept includes not only regional and municipal resources within HTU Trenčín region, but also resources from the Ministry of Labour, Social Affairs and Family of the Slovak Republic and grants such as the European Social Fund. The total items in Trenčín´s ‘Box of Projects’ is 85 with a calculated costs of €75 million. However, the annual available resources are only €1 million.

What are/were the effects?

The implementation of concepts as political and strategic tools for LTC development started in Slovakia in 2005 as a part of a wider aim for social services. The first aim was to establish LTC as a firm component of social services (with links between formal care, informal care and health care). Up to now only partial assessments of impact are available.

From accessible sources such as the way that budgets are accounted for (see references), we learned that Trenčín Regional County parliament adopted the Concept through a process of a Regional Budget (at the beginning of a year) and a Regional Closing Account (at the end of a year). This meant that it was possible to look at the figures and differences between the plan and the reality and investigate the financial (and other) possibilities to improve the social infrastructure. Data for last three years show decline of capital expenditure (from 100% in 2007 through 95.8% in 2008 to 75.5% in 2009) although the total spent was over €1 million in each year (€1.05 million in 2007, €1.63 million in 2008 and €1.19 million in 2009). Total capital expenditures – not only for building new facilities, but also for buying new technologies - are within those figures. For the following years (during the period 2011 – 2013) the plan aims to spend €1.19 million yearly on capital investment to improve the social infrastructure. So, the actual financial capacity of Trenčín HTI to improve social services is significantly lower than it was declared in the adopted Concept. This is partly due to the fact that the large 'Box of Projects' is dependent on the laborious process of finding relevant documents to acquire financial means from European structural funds. These delays in building a much needed social infrastructure are worsening the conditions for clients.

Meanwhile, a clear impact of the Concept on improving interfaces between formal and informal care and health care is not yet verifiable. But from a political viewpoint, using more resources to improve social service systems should potentially increase citizens' satisfaction in the region. It is envisaged that the final outcome of the Concept's implementation will result in:

• a higher number of community and residential social services,
• more social counselling and crisis intervention,
• better quality in LTC through modernisation of facilities,
• education of personnel, and
• support for new types of disease specific social services.

With the constant adaptations being made, the Concept seems to be sustainable. There is evidence of a widespread use of the ‘Box of Project Intentions' by cities and villages when planning the development of social services in the Trenčín region. A similar procedure has started to be implemented in other regions of Slovakia. The methodology for preparing these ‘Boxes’ might be used in other countries with a communist past.

What are the strengths and limitations?

Strengths

There is an explicit political will to support LTC development and enhanced interest of legal entities and political decision-makers to provide social services that is expressed by guaranteeing the use of financial resources for public providers of social services.

Weaknesses

The undeveloped system of community planning and the weak continuity of health and social care are negative preconditions for municipalities to assume the responsibility for providing social services. This includes the inadequate level of social services in cities and villages, bad technical conditions of buildings, a lack of information for users, etc.

Opportunities

• Targeting measures according to local and regional social services needs in LTC
• Increasing cooperation between self-government and non-public providers

Threats

• Increase of social services costs, limited financial capacity for social services, ageing process in rural regions, lack of professionals in the region, limited financial capacity for health care.
• The implementation of the planning process so far is not sufficiently developed to overcome barriers at the interfaces between health care and long-term care whilst other things have priority. However, the application of the ideas and strategies will show the need to join health and long-term care activities in favour of a better life for people in need of care. 

Credits

Author: Rastislav Bednárik, Institute for Labour and Family Research, Bratislava
Reviewer 1: Stephanie Carretero
Reviewer 2: Susanne Kümpers
Verified by:

External Links and References

• Koncepcia rozvoja sociálnych služieb Trenčianskeho samosprávneho kraja (Concept of social services development in Trenčín Self-government county), Office of TNSK, 2009
• http://www.tsk.sk/buxus/docs//socialne/krss/KRSS_TSK.pdf
• http://www.tsk.sk/buxus/docs//socialne/krss/KRSS_TSK-Pr4-SWOT.pdf
• http://www.tsk.sk/buxus/docs//socialne/krss/KRSS_TSK-Pr5A-Zasobnik_projektov.pdf
• http://www.tsk.sk/buxus/docs//socialne/krss/KRSS_TSK-Pr5B-Zasobnik_obce_mesta.pdf
• http://www.tsk.sk/buxus/lib/print_page/print_page.php
• Budget of Trencin HTI for the period of years 2011-2013
• Closing statement of Trencin HTI for the period of year 2009
• Bednárik, R. & K. Repková (2005) Národné priority rozvoja sociálnych služieb – teoreticko-metodologické východiská a komparácia (National priorities of social services development – theoretical-methodological basis and comparison). Bratislava: SŠPR.
• http://www.sspr.gov.sk/texty/File/pdf/2005/rodina/Narodne_priority.pdf