Tryggvi Þórhallsson The Icelandic Association of Local Authorities

Definitions of disability services in the Icelandic system

Seminar 27 August 2014

Services transferred on 1 January 2011Negotiated between the State and the municipalitiesA number of premises

(1) As few changes as possible in the legal frameworkResult: Services are defined in the same manner as before being transferredInnovation and development lacks backup in laws and regulations

(2) Agreed funding 2011 – 2014 Result: Cuts in other sectors have moved expenditureGray zones: Health services, elderly, children

(3) Local application of services Result: Municipalities have moved the boundaries between basic social services rendered to alland the more specific services for disabled peopleVery difficult to have oversight

(4) Comparisons between 2011 and 2014 Result: Paradox between integration of all services and keeping everything apart „in the books“

Other factors: (5) Rapid advances in ideology

Result: New concepts – paradigm shiftThe old definitions focus more on what the individualcould not do instead of supporting his abilities

(6) The decision-making is closer to the users Result: High expectations create pressure on the decision-makersThe municipalities cannot maintain wait-lists in the same manner as the state did before the services were transferred

Do the definitions reflect reality as perceived: by municipalities as service providers? by users?

The answer is probably „no“Discrepancies and variancesin data from the municipalitiesBlurred answers from users

Basic personal support was in the hands of the municipalities before the transfer

„félagsleg liðveisla“Specialized services were delivered by the state

„frekari liðveisla“Introduction of NPA / BPA

Much wider range of services Personal support in schools Healthcare Transport

The „specialized“ part: Marked the division of tasks between state and the municipalities Did not reflect how the user experienced the difference

Definition: In special circumstances disabled people shall be given further personal support, consisting of various kinds ofassistance concerning the multiple functions of daily lifeif such assistance is needed to prevent institutionalization...

Act no 59/1992, §25

This definition is clearly outdated

The current definitions are a mix of: Services in the home Housing solutions

The mix has a reason but to the future the question has to be asked:

Are housing solutions part of the affairs of disabled people or Part of the overall housing strategy in society?

A core issueWhen is employment support a labour market measure and when part of social services?

Unresolved when the services were transferredOngoing dispute since

A new definition of employmentsupport must include a wide range of activation measures

A broad spectrum of services Development to integrate habilitation into all functions of daily life Some service regions do not have habilitation and rehabilitation centres

Close links with phsycologial and vocational helpA new definition must focus on what the individual can do but not his shortcomings

Defined as a service to children Research indicates that this service should not be limited to an age group

A new definition should assist users and decision-makers to choose this form of service

The same goes for short-term residence

A task of the municipalities before the transferThe definition is clearly obsolete Should municipalities have an overall strategy for transport encompassing all citizens (children, elderly, disabled)?

We have to rethink the definitionsPersonal assistance

Must reflect how the user experiences the services NOT the division of tasks between various service providers

Employment support Focus on activation and integration

Habilitation Focus on what the individual can do - not his shortcomings

Thank you.

The new definitions should guide how data on the services is collected

Decision makers can monitor the demand for services and make allocations The views of users are clear when asked about the services