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Occupational rehabilitation – organised anarchy?

| Text: Knut Fossestøl, Research Director, Norwegian Work Research Institute

Everyone struggles to increase the labour participation rate among people with reduced work ability. Could the actual support system be the greatest obstacle?

When trying to explain low labour participation rates, the focus is often on the individual job seeker’s skills or motivation or on employers’ drive for profitability and productivity. But could it be that the actual system which should be supporting the individual by offering occupational rehabilitation in itself represents an obstacle to this goal?

Proper management means a clear link between stated aims and the tools needed to reach them. If the aim is to increase the users’ labour participation rate, and the authorities and the social support system are the tools needed to reach this goal, there has to be a link between what happens here and what you want to achieve. Based on this model you would think there was a clear division of roles and responsibilities between the different players who take part in the assignment chain, based on knowledge about what works for whom, and which could be controlled and measured after the event.   

That’s not the case, however.

Firstly, the rules for measures and income security have to cover several different issues simultaneously. The reasons behind providing occupational measures must focus on the individual’s opportunities and resources, while the reasons behind providing income security must be linked to the sickness criteria. Assessing whether someone can work and assessing whether they have a right to income security represent two very different tasks. As people need something to live off, it is easy to focus more on the money than on work opportunities, especially if the advisor has a lot on his or her plate.

Secondly, the division of labour between the commissioner and the service provider can be unclear. Assessing and following up the users is usually the main responsibility of the Norwegian Labour and Welfare Administration (NAV) offices. But due to heavy workloads the offices have to a large degree taken the opportunity to purchase these services from elsewhere. One result of this has been that those who deliver the measures often end up knowing more about the user than the NAV office in question does. The service providers end up being the ones that often have the competence to order services.

Thirdly, there is the question of the quality of the work delivered by both NAV offices and the service providers. For the service providers it might look as if advisors at NAV offices assess someone’s ability to work without having mapped that ability, and that the needs assessment is poorly documented – which results in poor quality referrals and commissions. Due to heavy workloads the advisors will carry out referrals in order to “be rid of users for a period of time”, and poor quality referrals “makes where the user ends up a lottery”, as knowledgeable players put it. For the service providers this means a lot of invisible extra work, especially because they will be measured by how long the applicants remain in the system, and by the number of referrals. For NAV, on the other hand, it might look like the service providers are “stretching the measures‘ duration”, they run them to the maximum limit which can lead to lock-ins and a loss of focus. This is amplified by the fact that the measures should both provide long-term sheltered work, they should include work training and they should get people into work.

Finally, there is no agreement between professionals in the field or politicians on what type of organisation is best suited to organise relations between the state authorities and the service providers. Should you increase competition or should you increase cooperation and network control, or should the NAV offices themselves deliver these services? Today all these strategies are pursued at once. Clarification measures and follow-up services are put out to tender, while already approved companies are given the chance to deliver these services at the same time as trials are taking place for the insourcing of the same services.

Thus what happens in the real world differs from the model for efficient management illustrated in the introduction: there are multiple and contradictory goals. There is no clear division of labour between commissioner and service provider. The quality of work varies, and many other conditions than quality – for instance the need to get cases out of the system – form the basis for the decisions that are made. There are also several and contradictory management models at work; the public sector is producing services itself, services are put out to tender or they are bought from the sheltered sector. There is no clear, targeted thinking, with close connections between the different players within this system. It is more organised anarchy than a clear, formalised structure. There is uncertainty over who takes part in the decision-making processes, what is considered the most important challenges and what is considered to be good solutions. The result is increased complexity and a diffuse, ambiguous and unpredictable situation where those who should be managing, advising and using the system understand only a fragment of what is going on, where the self-interests of the different players become prominent. 

In this way the support system itself can become an obstacle to achieving its own goals. The question is how it is possible to design a system which is a tool for problem solution more than a tool for arbitrariness and self-interest? And while we consider this, it can be of comfort, or deeply unsettling depending on where you stand, that almost regardless of the economic cycle and organisation, four in ten people end up on support without a job, four end up in jobs while two disappear out of the registers. 

The comment is based on the report ‘Necessary differentiation or overlapping measures?’

Evaluation of clarification and follow-up measures in NAV by Knut Fossestøl, Pål Børing and Ingebjørg Skarpaas. AFI report 13/2012

FACTS about the Norwegian Labour and Welfare Administration (NAV)

The NAV reform is the largest administrative reform which has ever been carried out in Norway. It saw the merging of the Labour Market Agency and the National Insurance Service, the introduction of mandatory partnerships with municipalities and NAV offices were established in all of Norway’s municipalities. The aim was to strengthen the assessment and follow-up of users, and to get more people into work and off benefits. Where there used to be three doors in, there would now be only one. The NAV reform was more than an organisational reform – it was also a content reform. The benefit system and regulations of labour market measures would be simplified for the users, and free up time for the administration to spend on assessment and follow-up work, focusing on individual plans tailored to individual users. New tools and work methods were also developed. Today NAV procure services worth nearly eight billion kroner (€1bn) annually. 

Knut Fossestøl

Knut Fossestøl

is Research Director for the research group The Organisation of the Welfare State at the Work Research Institute in Oslo.


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