Grounding worker conditions in the procurement of social welfare services

This article examines ways in which Swedish municipalities steer the selection of providers when procuring welfare services in the areas of homecare and personal assistance. It focuses particularly on issues related to working conditions and occupational health and safety.1 In accordance with Sweden’s Freedom of Choice Act (Lag [2008:962] om valfrihetssystem, LOV), municipal authorities and regional county boards may choose to outsource their welfare services through public procurement to private competition by allowing individual users to choose their own providers of health care and social services. Those municipalities and counties that implement freedom of choice systems must do so under the legal requirements set out in LOV. For municipal governments, implementing a system of choice is optional, while for county governments, a choice system in primary health care is mandatory under chapter 5 of the Health and Medical Services Act (Hälso- och sjukvårdslagen |2017:30]). The LOV regulates the procurement process by which contracting authorities outsource services through procurements to competition, by allowing individual users to choose their own providers. The government, however, retains overall responsibility for the services provided, and users pay the same price no matter what provider they choose. Private providers are remunerated by municipalities at a flat rate for services rendered (LOV, chapter 4, sections 1–2). This means that while the public sector assumes all the financial risk, it no longer has any “direct” insight into the operations of homecare and/or personal assistance service providers. The Public Procurement Act (Lag [2016:1145] om offentlig upphandling, LOU), which entered into force on January 1, 2017, applies in parallel with the LOV. Sweden’s supervisory body for public procurement, the Competition Authority (Konkurrensverket), recently stated that “there are good opportunities for doing good business while also contributing to sustainable development and ensuring robust competition in the marketplace.”2 The LOU stipulates that contracting authorities “shall treat suppliers equally and without discrimination and shall conduct procurements in a transparent manner. Further, procurements shall be conducted in accordance withthe principles of mutual recognition and proportionality” (chapter 4, section 1). The LOU further states that although no supplier may be intentionally either “unduly favored or disadvantaged” (chapter 4, section 2), it should nonetheless be possible for public procurements to “take environmental considerations, and social and labor law considerations into account...if the nature of the procurement so justifies” (chapter 4, section 3).