Danish public sector industrial relations and welfare services in times of trouble

Mikkel Mailand & Patricia Thor Larsen

1. Introduction

This chapter will analyze findings from Denmark related to the common themes of the project, which in our interpretation can be summarized to:

•What shape has public sector reform taken in the country in general and in the three sectors in particu-lar?

•To what extent and in what way have industrial relations actors (trade unions and employers and their organizations) influenced these reforms?

•What effect have reform policies had on the number and quality of jobs in the public sector?

•What effect have the changes in quantity and quality of jobs had on the availability and quality of pub-lic services?

The introduction presents Danish public sector IR in general. The following three sections includes the findings regarding the three subsectors in focus – the hospital sector, the school sector and the elder care sector. The fifth and final section compare the findings and draw the conclusions. Where nothing else is stated the source of the findings are the interviews listed in Annex A and referred to in footnote 8.

1.1 Introducing the Danish public sector and its IR system

Denmark has one of the largest public sectors in Europe both measured in share of the economy and share of employment. The public sector has employed between 28 and 31 % of all employees from 2000 to 2015 (29 % in 2015) (Statistik Årbog 2017). The number of employees in the three main areas of the public sector is 173.000 in the state area, 122.000 in the regional area and 416.000 in the municipal area (Statistics Den-mark 2017). As many as 38 % are working part time - and the large majority of these people are women. Moreover, 10 % are on temporary contracts (Mailand 2015).

Subcontracting of public services is possible in the majority of the public service areas. In the large munici-pal area, the share of public services legally possible to subcontract were exposed to competition (mean-ing that they should be contracted out, but that it would be possible for the municipality itself to make a bid) increased from 19.5 % in 2006 to 26.9 % in 2016 (KL 2015; 2016).

Whereas the formation of the IR-system in the private sector in Denmark is normally dated to 1899 and the so-called September Compromise, the IR-system in the public sector has a much shorter history. It was as late as 1969 that collective bargaining on wages and working conditions was formally recognized and the government became obliged to bargain with trade unions. The right and duty to negotiate cov-ered both the state employees and the increasing number of regional and municipal employees, but civil servants were still not allowed the right to strike (Due and Madsen 2009). In summary, the Danish public- sector IR-model is characterized by relatively limited legislation, bipartite collective agreements at all lev-els with high coverage rates, an extensive system for employee involvement, and relatively strong trade unions.

1.2 The social partners

The employer in the state sector is the Ministry of Finance (de facto, the Agency of Modernization, until 2011 the Personnel Agency (Moderniseringsstyrelsen). Hence, the state employer is not a separate unit. During the reconstruction of the Agency of Modernization in 2011, nearly all managers were replaced as part of a merger between this and another department. In some sectors, trade unions have since then experienced a tougher management approach, and they have understood the replacement of managers as a part of this development whereas in other subsectors, they have experienced a more cooperative approach (Mailand 2014). This issue will be discussed further in section 5 and section 6.

As for the municipalities, their employer is Local Governance Denmark, (Kommunernes Landsforening, KL). Its large number of responsibilities, the relative autonomy of the municipalities, and the high number of municipal employees means that KL is a relatively strong organization. This is true even though it may have lost power during recent decades due to the centralization of political power in the Ministry of Fi-nance. At the local level, individual municipalities and public institutions themselves are the employers. In the regional area, the employer is Danish Regions (Danske Regioner) with their bargaining unit being. At the local level, bargaining takes place between the individual regions and the unions, but public institu-tions (de facto, the hospitals) might be the most important employer units because of their size.

Whereas the employer structure in Denmark as described is generally straightforward, it is more complex on the trade union side. Of the three confederations the Danish Confederation of Trade Unions (Land-sorganisationen i Danmark, LO), the Confederation of Professionals in Denmark (FTF), and the Danish Confederation of Professional Associations (Akademikerne, AC), only the latter plays a direct role in col-lective bargaining. Put simply, one or two bargaining cartels exist in each of the three main bargaining areas .

There has been a decline in trade-union organizational density between 1996 and 2011, but less so in the public than in the private sector. For the sub-sectors where statistics exist for the whole period from 1996 to 2011 the decline has been between 91 and 89 % (public administration), 86 to 80 % (education) and 92 to 83 % (health) (Statistics Denmark, "tailor-made" figures).

1.3 Collective bargaining

Collective bargaining covers no less than 98 % of the employees in the state sector. The remaining 2 % covers employees who solely have individual contracts or whose pay and conditions are unilaterally regu-lated by legislation (Due & Madsen 2009: 360). No statistics exist for the regional and municipal sector, but the collective bargaining coverage is estimated to be at least as high as in the state sector.

However, these high percentages do not imply that collective bargaining is the sole important type of regulation of pay and conditions. Legislation plays a role, most importantly when it comes to employment conditions (terms of notice etc.), holiday regulation, leave of absence due to childbirth and working envi-ronment issues. Moreover, in the higher parts of the job hierarchy individual agreements often supple-ment collective agreements.

All three main bargaining areas - state, regions (health) and municipalities – have a three-tier structure, where the first two (highest) tiers are closely related (see table 2.1) (Hansen & Mailand 2013). The first tier is ‘cartel bargaining’, which normally takes place every second or third year. During these bargaining rounds, the state, the regional and the municipal employers respectively bargain with cartels (coalitions) made up of representatives of trade unions. The second tier is organizational bargaining (individual un-ions), which takes place more or less simultaneously with the sector-level bargaining. Here the individual trade unions conduct bargaining themselves on all occupation-specific parts of wages, pensions and work-ing conditions within an established economic frame. In times of tight budgets, there can be very little to bargain on at this level. The local level is the third bargaining level. This has gained in importance due to the partial decentralization mentioned above (Hansen 2012). As a rule, a trade union related shop stew-ard conducts the bargaining. Bargaining issues include wages, working time, training and policies for senior employees.

Tabel 1.1: Levels, bargaining tables and actors in the public sector IR-model

1.4 Public sector reforms and the role of the social partners

The New Public Management (NPM)-reforms have included, inter alia, privatization, contracting out, con-sumer choice, competitive tendering, performance related management and decentralization (of wage-setting and other issues) (Ibsen et al. 2011; Greve 2006; Hansen & Mailand 2013).

It is important to note that the trade union in most of the NPM- reforms presented below were involved through bargaining or at least consultation. Some are the social partners own initiatives agreed upon in the collective bargaining arena while others have a political origin. It is also noteworthy, that the basic features of the public-sector IR system have remained unchanged by the reforms. For this and other rea-sons some researchers find it more accurate to talk about ‘modernization’ rather than ‘marketization’, meaning that the reform-path taken in Denmark has mixed marketization with other types of reforms, and hence, NPM has been taken a moderate form (e.g. Ejersbo and Greve 2005; Ibsen et al. 2011).

The development of NPM in Denmark has gone through several phases. Firstly, in the 1980s, the Con-servative-led government initiated the first ‘Modernization-program’, which included NPM. However, privatization and contracting out was not achieved to any large extent, but consumer choice was intro-duced, and local wage determination in various forms was introduced from 1987 (Ibsen et al. 2011).

In the 1990s, a center-left government continued many of the NPM-oriented reforms, especially in the form of management by contract and large-scale privatizations of public utilities. Regarding wages, the trials from the 1980s were made permanent and formalized when social partners in 1998 agreed to de-centralize part of wage determination within the framework of the new wage-system ‘Ny Løn’ and allow deviations from central working time provisions (Ibsen et al. 2011).

In the 2000s, the Liberal–Conservative government strengthened NPM with free customer choice in wel-fare services and extended compulsory competitive tendering while maintaining strong central controls through performance and quality management (Ibsen et al. 2011). However, the government also intro-duced a number of reforms that were not NPM reforms in the strictest sense, although they included some NPM elements: Firstly, the Welfare Reform from 2006, whose aim was to redesign the public sector and its financing in order to meet the challenge of an aging population and other challenges. Secondly, the Quality Reform from 2007 that aimed to improve service levels and job satisfaction for public employ-ees; this reform promised to end detailed control systems and enhance the focus on skills development and local innovation. Social partners in the public sector followed up this reform by allocating financial resources when they made a tripartite agreement to support it in 2007 (Mailand 2006). Thirdly, and most important, the Structural Reform, which was implemented from 2007. NPM dimensions of this reform included central control of performance and the mandate that quality and budgets should also be in-creased (Ibsen et al. 2011). The Structural Reform implemented changed the responsibilities of the three main areas for public services – state, county/region and municipalities. Moreover, it amalgamated 273 municipalities to 99 and 14 counties were liquidated and replaced by five regions with a narrow range of responsibilities. The aim of reform was to create economies of scale and to improve welfare service by reshuffling the division of responsibilities between the three main areas. The municipalities (local gov-ernments) were a net-gainer of areas of responsibility from the reform.

Regarding the IR-system, the Welfare Reform and the Quality Reform have had consequences for the retirement age and further training whereas the Structural Reform has led to larger workplaces and larger areas being covered by collective bargaining and codetermination. Moreover, it has contributed to a de-cline in municipal employment.

In the 2010s, a new centre-left government continued the work on reforms with NPM features. One area where this can be seen is in the subcontracting of public services, which is possible in the majority of pub-lic service areas and is used to a large extent. KL agreed in 2007 that 25 % of municipal public services (of the services it is legally possible to subcontract) should be ‘exposed to competition’, as mentioned above. However, to some extent, the present decade has also seen a slowing down in the deepening of existing NPM initiatives and in the introduction of new ones. In the IR-system, this is reflected in the low and stagnating share of wages negotiated at local level. This wage-related development is partly crisis con-nected, but the slowdown of NPM is in some cases also a reaction to NPM itself. The so-called ‘trust- re-form’ launch by the centre-left government illustrates this. The reform aims at reducing control over pub-lic-sector employees and managers and reducing the time they spend on reporting in order to allow them more time for the core tasks of delivering quality welfare service (Mailand 2012). Furthermore, at least in some parts of the public sector, user involvement is now an important tool (Hansen & Mailand 2015).

Some observers see the reform trend from the 2000s onwards as a departure from NPM and into New Public Governance and other trends, with an emphasis on networks, partnerships, user involvement and digitalization rather than NPM focusing on marketization in various forms (e.g. Greve 2012). Such changes might have been real, but NPM certainly still plays a role in public- sector employment. New reform para-digms add to NPM rather than replace it.

Regarding the present decade, austerity measures have been included in the ‘reform picture’. One ex-ample is that in 2011, municipal budget cuts. Partly because of this plan 20 % of municipalities experienced cuts in their budget of 4 % or more between 2009 and 2011 (KL 2011). The center-left government that came into office in September 2011 continued the tight budget policy, but also introduced a stimulus package. The liberal-conservative government coming into office in 2015 also continued cutting spending in the public sector, for example with a demand of increasing productivity by 2 % each year.

2. The hospital sector

2.1 Introduction to the sector

The five regions have operational responsibility for the public hospitals in Denmark, whilst overall respon-sibility remains with the National Health Authority, which is part of the Ministry of Health (Sundheds- og ældreministeriet). There are currently 57 public hospitals, but the number is declining fast due to the de-cision to introduce a new hospitals structure where (nearly) all hospitals are so-called ‘super-hospitals’ covering at least 200.000 patients. When this new structure is fully implemented in 2020 the number of hospitals is reduced to 21 (Johansen 2014). Most hospitals will both be larger and more specialised than the existing ones.

The budgets for public hospitals has overall increased rather than decreased since the crisis. Figures from Danish Regions show that from 2009 to 2014 the budget has increased with 5 %. Measure as share of GDP the expenditure has increased as well. With 9,6 % the expenditure were just above the OECD average on 8,6 % in 2013 (Danske Regioner 2016).

The public hospitals employed in 2016 a staff of 117,000, divided into:

• 14 % doctors,

• 45 % nurses (incl. lead nurses),

• 7 % nurse assistants,

• 7 % doctors secretaries and

• 27 % other support staff, including administrative staff, psychologists, cleaning staff, technical staff, porters, etc. (DSR 2016).

Besides the public hospitals, there exist around 18 private hospitals and larger clinics, but the number is uncertain. The trade union for nurses (DSR) estimates that only around 1 % of their members’ works in private hospitals. The scale of the private hospitals and clinics are so limited in Denmark that this chapter will focus on the hospitals in the public sector.

2.2 The social partners and the collective agreements

Regarding social partner organizations, Danish Regions (Danske Regioner) represent employers’ interests. Danish Regions is the bargaining partner in the bi- or triannual collective bargaining rounds. At the admin-istrative level of the regions (five in all) there are councils for employee involvement (so-called Coopera-tion Councils), and the general guidelines for staff policy at the hospital are formulated here, but no col-lective bargaining takes place. At the hospitals themselves, collective bargaining takes place within the framework of the sector agreements (those with Danish Regions as the employers’ association).

The structure is somewhat more complex on the employee side. The Health Care Cartel (Sundhedskartellet) includes 11 trade unions, none of which is trade unions for doctors. The trade union for nurses (DSR) is by far the largest. The Health Care Cartel negotiated until recently general working conditions and some more occupation-specific conditions, whereas other occupation-specific conditions are negotiated by the individual trade unions. However, the Health Care Cartel became in mid-2014 part of a new broader cartel, The Danish Association of Local Government Employees Organisations (Forhan-dlingsfællesskabet), together with the former bargaining cartel for employees in the municipalities and the regions. This development was a reaction to the 2013 industrial conflict described above, which in-cluded an incentive for creating stronger organizations on the trade union side.

Among the trade unions in the cartel, the trade union for nurses - DSR – is the largest with 61.000 mem-bers. Their precise organizational density is unknown, but is estimated to be around 85–90 %. Fagligt Fælles Forbund (3F) organises hospital porters, cleaning assistants and skilled service assistants. Trade and Labour (Fag og Arbejde, FOA) is also a member of LO and represents occupations with short education such as care workers, hospital assistants and skilled service assistants. Other unions organizing hospital employees include, e.g., The Danish Association of Biomedical Laboratory Scientists (Danske Bioana-lytikere, Dbio) and The Danish Association of Midwives (Jordmoderforeningen).

In the public sector, the collective agreements create a complex web. The hospitals are no exception, and there is a plethora of collective agreements covering the hospitals. Areas that have been partly privatized – for instance, cleaning – are covered by private sector collective agreements and will not be covered in the present chapter. Collective bargaining coverage is close to 100 %.

2.3 Reforms and the role of social partners

Reforms in the Danish public sector are decided upon either in the political system or in the collective bar-gaining system.

The collective bargaining rounds

Industrial relations in the hospital related areas has been relatively conflictual, with industrial conflicts involving the nurses in 1995 and again 1999. The first bargain round to be included here is the 2008 bar-gaining round - completed months before the first signs of the crisis - was also included industrial conflict. It was the members of the Health Care Cartel and FOA who ended up in an industrial conflict. The favour-able economic context – and maybe the political pressures - made the three public employers - the state, regions and municipalities - accept a 12.8 % wage-increase over a three-year period. However, The Health Care Cartel and FOA requested a 15 % pay increase and were for a long period not open for compromises, even with the with the help of the National Arbitrator it was not possible to strike an agreement (Due & Madsen 2009). Unlike earlier sector-wide public sector industrial strikes, the Government - a Liberal-Conservative government - did show no intention to intervene. In early May 2008, the parties agreed to a pay increase of 13.3 %, which due to internal distribution among FOAs members – implied a 14 % wage increase for nurse assistants. The Health Care Cartel, however, only reached a compromise in mid-June, after planned lockouts had been added to the industrial conflict. Also in this case, the compromise was a 13.3 % wage increase (Due & Madsen 2009). However, the strike was so expensive especially for DSR, that they had to increase membership fee substantially for a long period and lost more than 3 % of their members (DSR 2016).

The following 2011 bargaining round was less dramatic in the hospital area and included few changes and no or limited increases in wages. The 2013 bargaining ran relatively smooth too in the hospital-related areas. The agreed wage-increases were again very modest, and further decentralization of decision-making power with regard to the Cooperation Councils was agreed. Most importantly, however, was that the flexibilization of some types of hospital doctors’ working time. This was a strong and long-lasting wish from the employers, who wanted a better utilization of hospitals equipment beyond normal working hours (Mailand 2014). The 2015 bargaining round included for the first time since the economic crisis more than marginal wage-increases and further working time flexibility for the hospital doctors, but no major changes for the hospital employees (Hansen & Mailand 2015).

Summing-up, industrial relations in the hospital-related areas has taken an interesting development in the present decade, so that it not anymore represent a part of the public sector with a high conflict-level, but rather a lower conflict level than the state bargaining area and the municipal bargaining area. Time will show if this is a lasting trend.

The involvement of social partners in public policy reforms

The Structural Reform (implemented 2005-07) was ‘high politics’ and the social partners in the hospital areas were not among the most influential organizations. The reform was important for the regional em-ployers in that it restructured their interest-organization from one with focused on counties, several poli-cies areas and public authority roles as well as employer role to one focused on regions, one policy area (health) and the employer role mainly . Apart from that, however, the interviews did not highlight this as one of the most important initiatives for the hospitals.

By far the most important political initiative was according to the interviewees the abovementioned plan to introduce a new hospital structure with ‘super-hospitals’. This was prepared in the ‘Expert panel re-garding investment in hospital’, which was established after an agreement between government and Danish Regions in 2007. Regarding the role of the social partners, Danish Regions was one of the initiators of the panel, but not represented in it. Neither was any of the trade unions in the areas. However, it was possible to influence the decision-making through hearings.

Other initiatives emphasized in the interviews includes ‘Eight goals for health care authorities’, which was agreed by the Ministry of Health, Danish Regions and KL in 2016. The new eight goals is a way to improve the quality by setting broad goals and having fewer indicators and fewer demands on processes and less registration. The introduction of a simpler model should be seen in the light of the political aim of ‘de-bureaucratization’ and development of alternatives to NPM, which has been supported by most actors in the Danish health care sector, but which nevertheless still mainly are intentions rather than initiatives.

Finally, the ‘annual economic agreements’ should be mentioned. These agreements are bargained on an annual basis between Danish Regions and the government, and spell out the spending in different cate-gories, which during the last few years have become less detailed compared to previous agreements. These agreements have not included cutbacks in total, but have framed the development towards higher productivity, which at 2.4 % annually has increased more in the hospitals than anywhere else in the public sector. The trade unions are not involved in the annual economic agreements.

Evaluation their overall political influence, DSR finds that they – when they are involved in the political decision making processes at all – are involved late and/or are involved in so-called ‘following groups’ in distance from the key decision making processes. Furthermore, are accordingly most often involved when problems have to be solved in connection to, for instance, cutbacks, work environment issues and working issues. The weak government’s limited initiatives to involve DSR implies that often seeks ‘to in-vite’ themselves’ in order to seek influence. The Union of Specialized Doctors (Foreningen af Spe-ciallæger, FAS), on the other hand, give a picture of a stronger influence and earlier involvement, illustrat-ing the higher status and stronger power-position of the doctors than of the nurses and the support staff.

2.4 Quantity and quality of jobs and the effect of reforms on these

This section and the following sections will focus primarily, but not exclusively, on the employee groups with lower education (the support staff) and medium level education (the nurses), whereas the situation of employees with longer education (the doctors) will only be touched on briefly. Services that have been outsourced are mainly cleaning and ambulance-service. These could be argued to belong to other sectors than the hospital sector and will not be covered here.

Quantity of employment and overview of employment types

Tabel 2.1 shows, that the number of employees increased until 2010 (but has started to decrease again already from 2012, which the table does no show). Secondly, as expected, part-time work is very high.

Table 2.1: Employees by employment type in the hospital sector, 2007–2013

NB: The figures are numbers of employees, not full-time equivalents. Both private and public hospitals and clinics are included. Source: Statistics Denmark, tailored calculation, AKU. * = 15 hours or below, de facto working hours. Numbers below 2,000 not reported by Statistics Denmark (= n.a.).

However, it is more important that the number of marginal part-timers is below the national average, because they have an increased risk of precariousness. Danish Regions has formulated a ‘policy for full-time positions’, which took force in January 2014. The policy implies that new positions in the regions in general should be full-time positions and includes targets for full-time employees in the regions (64 % in 2015 and 80 % in 2021) but also a number of possibilities for exemptions, which could be a barrier for reaching the targets (Danske Regioner, 2013). However, the interviewees stated that the policy was seri-ous and genuine. The reason for the regional employers to formulate such a policy was not to improve the employment situation for part-timers, but due to foreseen labour shortages.

Thirdly, fixed-term contracts are relatively widespread too. Fourthly, although TAW has attracted quite some attention, the numbers are quite low. Fifthly, self-employment is nearly non-existing.

However, table 2.1 hides interesting differences between the occupations. Most importantly, while near-ly all categories of employees has increased in numbers, the category ‘support staff with short education’ has decreased since 2010. Of the occupations that has grown, doctors has had the largest relative increase (esundhed.dk). Hence, one of the most important challenges for at the support staff is related not so much to wages and working conditions but to job security and employment security. The main explana-tion given for this development by the interviewees is that the periods the patients are hospitalised has shortened substantially in recent years, leading to less near for support/care and more need for ‘cure’.

The quality of employment for nurses – contract types and health & safety

As seen from table 2.1, the majority of nurses are employed on open-ended contracts, and self-employed nurses are nearly non-existing. Part-time contracts and (less so) fixed-term contracts and TAW are widely used. Since 2008, the part-timers have had the right to be upgraded to full-time employees, but very few have exploited this opportunity (dr.dk, 16.06.11). Indeed, part-time work among nurses is predominantly voluntary. Apart from being paid according to working hours, part-timers have the same wages and the same employment and working conditions as full-timers, and the social benefits are the same. As a result, precariousness does not seem to be a problem for part-time nurses.

The nurses working as temps often hold a full-time or a part-time open-ended contract and are therefore mainly temping as a secondary job. Both before and after 2010, the large majority of nurses signing up for external or internal temp work were on open-ended contracts in the hospitals, as mentioned earlier.

Fixed-term contracts are relatively widespread in hospitals, and the figures are a bit higher than the na-tional average for all sectors. However, the use is not very widespread among nurses or among the sup-port staff, according to the interviewees. Unfortunately, it has not been possible to provide figures for this type of employment.

The nurses face health and safety problems due to work intensification/excessive workloads. The prob-lems seems to have increased during last years. There is now less doubt on the trade unions side that the problems are severe. In a large-scale independent survey of all Danish employees including the work en-vironment issues, members of DSR score on all dimensions their work environment as clearly more prob-lematic than the average Danish employee, including psychological burdens, time pressure and work load. Also with regard to ‘increasing demand for documentation in recent years’, the difference is substantial: 90 % of DSR members agree on this statement compared to 63 % of all employees (Caraker et al. 2015). According to DSR, the most important explanation is that although the number employees at the public hospitals (and the number of nurses) has increased rather than decreased the last 15 years, the workload has increased substantially. The reasons for this increase include also that each patient is hospitalised for shorter periods then previously and therefor is in worse shape and demands more care. Moreover, each health employee has to do more tasks now than before. On the background of this, DSR finds the cuts have now reached the bone. As a professional organization for leading doctors FAS is less outspoken in their critic than DSR in their critic, but regarding the 2 % productivity demand they agree with DSR. Danish Regions recognises that problems exists in certain department in hospitals, but is of the opinion that the right type of work organization is able to solve large parts of the problems.

The intense critique of the 2 % productivity demand seems to have had an effect. In late September 2017, the government announced – under pressure from the largest opposition party and their own supporting party – that the demand will be abandoned, but no additional funding was promised.

Quality of employment for other health care staff and support staff

Hospitals employ a large number of other health care staff and support staff. These occupations appear not to be precarious to any notable extent. The positions are, in general, full-time open-ended contracts or long part-time contracts that tend to be voluntary. For the abovementioned groups organised by FOA, 58 % were on full-time contracts (FOA 2012). However, with regard to part-time employment, so-called ‘hourly employees’ have less favorable access to some social benefits compared to their colleagues on open-ended contracts, although the problem has been reduced by lowering employment period thresh-olds to benefits in the collective agreements. Similar challenges exists for a special category of fixed-term employees labelled ‘employees on occurrence of a special event’, the event being sick leave, materni-ty/paternity leave or another kind of leave) and ‘call temps’ (which is a type of zero-hour contract). The extent of the use of these contracts for the occupations in focus is, however, according to the interview-ees limited in the hospitals, whereas they are much more widespread in other parts of the health care sector. The same pattern exist regarding the use of marginal part-time employees (FOA 2017).

Work intensification/excessive workload has increasingly become an issue of concern, as indicated in the section on nurses. For several of the support groups with lower level of qualifications the problems is according to trade union interviewees, that the staff reductions has not been accompanied by a propor-tional reduction in the volume of work tasks.

2.5 Effect of the job changes for quantity and quality of the service

As shown above, the total number of employees has increased, but the number of patients has increased more and some degree of work intensification has taken place. The extent to which this has ’spill-over’ to work environment problem is a matter of controversy. Is there seen an effect on quantity and quality of services too?

By far the majority of the main goals and indicators of the hospitals show a positive development. Since 2009, overall activity, productivity and patients’ satisfaction has increased, whereas waiting time and mor-tality has been reduced (Danish Regions 2016). Hence, the effect of the work intensification on service quantity and quality does not (yet) show in the statistics. One interpretation of this is that the lack of ‘real’ cuts in budget and number of employees rescue the quality of service despite of work intensification. Another interpretation comes from the DSR – the most outspoken organization regarding work intensifi-cation. A DSR interviewee, who acknowledge the positive development in the main indicators, but never-theless argue that an increasing share of their members find their work situation ‘professionally indefen-sible’ and that the risk of making mistakes, including serious ones, has increased due to the work intensi-fication.

During 2017, political mobilisation to abandon or at least change the Government demand for a 2 % yearly increase in productivity has increased and so has the media coverage of the negative consequences of it. As described, DSR and other stakeholders see the demand as one of the main courses of the problems with work intensification and service quality. In late September, just two weeks prior to the publication of this report, the Government announced that they would abandon the demand. The question is what will replace it and if the new regulation will reduced the work load overall.

It is also notable, that the use of outsourcing – apart from cleaning and ambulance service - has been lim-ited at the hospitals, again with dissimilarity with the municipal health care sector. Outsourcing in these two areas have a longer history, but it is still occasionally debated if the service has been reduced here, most often in connection with specific problematic cases in individual regions.

3. Primary and lower secondary public education

3.1 Introduction

In 2013, Denmark had 1.312 public schools for the age group 6-15 and 548 private schools for the same age group. Less than a fifth of all students attended private schools, though the tendency has been growing in recent years. In the remainder of this section, the focus is on the public schools.

The Danish Folkeskole (‘Peoples School’) covers both (public) primary and lower secondary education, i.e. grade 0–6 and grade 7–9/10 (pupils traditionally from age 6 to 15). The Folkeskole is regulated through the Folkeskole Act, which sets the over-all framework for the schools’ activities. According to the act, it is the municipal local council, which is responsible for the running of the school. The Structural Reform has re-sulted in the merging of a number of schools locally in order to create larger, more specialized school units. Many schools today cover two or more school units, with one shared management. Moreover, the number of children has decreased in recent years.

Regarding the job level, figures show a 7.2 % decrease in the total number of employed teachers from the school year 2008/09 to the school year 2011/12 (UNI.C 2012). According to KL, there were 51.453 full-time teaching positions within Folkeskolen in December 2013. However, this number will probably further decrease as 35.000 fewer schoolchildren are expected to enter the public school system in 2025 (KL 2013).

Regarding expenditure, expenditure in Folkeskolen per pupil decreased 10 % (adjusted for price- and wage development) 2007-13. Increased expenditure in connections with the 2013/14-reform reduced the decrease to 4 % (Økonomi- og indenrigsministeriet 2017).

3.2 The social partners

A number of organizations are involved in the traditional social dialogue in the basic school sector, includ-ing KL, which is also the interest group and member authority of all Danish municipalities. The Danish Un-ion of Teachers (DLF) organises teachers of public and private schools and counts 91.000 members. How-ever, another and an increasingly significant employee group in the Folkeskole is the early childhood and youth educators, represented by the trade union BUPL. School principals are represented by their own organization. Thus, KL, BUPL, DLF and the Association of School Leaders are the main collective bargaining partners in the school sector. These organizations are also represented in the social dialogue on the gen-eral development of the school.

3.3 The collective agreements

This section focuses on collective agreements for the teachers.

Working time has always been a controversial issue in industrial relations in the teaching filed, and since the 1990s the regulation of it has gradually been decentralized and made more flexible, although DLF managed to maintain a strong influence over the issue (Hansen 2012). In the Folkeskole area, steps to-wards a more flexible and decentralised and less bureaucratic working time regulation had been agreed upon during the 2008 collective bargaining round. KL recognised this as a step in the right direction, but found it insufficient. In the case of the gymnasiums, an agreement had almost been reached with the Danish National Union of Upper Secondary School Teachers (GL) during the 2011 bargain round, but failed at the last minute, causing considerable frustration in the Ministry of Finance.

At the collective bargaining round 2013, working time was removed from the collective bargaining arena. The new working time regulation resulting from this should be seen in connection with the 2013 Folke-skole reform (see below), in that the changes made during the collective bargaining round 2013 contrib-uted to the financing of the reform.

The public employers’ aim was a winding–up of all existing local agreements on working time for teachers in the Folkeskole (municipal employers’ demands) and in most post-15 education institutions (state em-ployers’ demands) in order to strengthen management prerogative. In the case of the Folkeskole, the aim was also to facilitate and finance the implementation of a large-scale reform (see below). According to employers, the aim was not to make the teachers work longer, but to enable them to spend more time in the classroom with the pupils. DLF contested the employers' claims arguing, that, on the contrary, re-duced hours in preparation would reduce the quality of education.

The bargaining process in the gymnasium area ended in early February. After a long standstill in the ne-gotiations, GL agreed to waive their claim for the right to bargain on working time, and for the phasing out of the special senior conditions, which was also one of the employers’ demands. In return, they received a substantial wage increase and a (limited) fixed framework (‘fence’) to secure planning and avoid an excess teaching workload. In justifying the decision to strike an agreement, GL’s general secretary ex-plained that GL would have lost their bargaining right in any case, because the Ministry of Finance would have been willing to initiate an industrial conflict on the issue, which GL could not have won. By accepting ‘the unacceptable’ during the bargaining phase, GL obtained a substantial economic compensation.

However, DLF made it clear that they needed a compromise for the Folkeskole teachers, and not only compensation as the offer to GL included. In the end of February, the attempt to strike an agreement therefore continued under the leadership of the National Arbitrator, who had to give up after just two weeks. A lockout of nearly all Folkeskole teachers came into force. However, neither DLF, nor KL and the Ministry of Finance, changed their positions during the lockout. After three and half weeks, the Govern-ment decided that it was time to intervene to prevent the lockout from having too great an effect on the final examinations of both the Folkeskole and the vocational education sector. The Government had, well in advance, secured its backing from large parts of the opposition. Hence, after a speedy two-day process in Parliament, the legislative intervention came into force in May 2013. In sum, the intervention met the employers’ main demands, and the compensation was limited and mainly related to wage. Calculated per teacher, it was substantially lower than the sum the gymnasium teachers received.

Because of the abovementioned government intervention, the teachers working time is now regulated by legislation. However, during the collective bargaining round 2015 KL and DLF (and KL and Ministry of Finance in the state bargaining area) agreed on a ‘common understanding’ in order to improve relations between the parties and facilitate the implementation of the new working time regulation regime locally. The common understanding add to, rather than replaces, the law (Hansen & Mailand 2015).

3.4 Reforms

During the last 15- 20 years, the main developments in the Folkeskole have been to: Differentiate be-tween the educational needs of pupils with different learning capacity; strengthen basic skills in maths, reading and writing; introduce English at an earlier stage; use more national tests and common goals; in-troduce individual ‘learning plans’; and deal with increased competition from private schools.

The latest reform prior to the ‘big reform’ agreed in 2013 was the new Folkeskole Act from 2009. One of the main elements of the 2009 reform is that the nine years in Folkeskolen should no longer be seen as a closed process ending with the final exam, but as a process that prepares for further education. Worries about the approximate 20 % of the youth cohort who never completes a further education is clearly re-flected in the reform (Aarhus Universitet 2017).

The main elements of the school reform 2013 was:

•A longer school day

•More lessons in Danish and Maths for level 4–9, because the two core subjects are seen as fun-damental to be able to learn other subjects

•Earlier foreign language learning: English from level 1, a second foreign language (Ger-man/French) from level 5 and an opportunity to choose an optional third foreign language in level 7

•Homework assistance at the school

•Exercise and movement integrated in all students' school days for an average of 45 minutes each day in order to enhance students' motivation, learning and health

•Continuing education of principals (Undervisningsministeriet 2013).

3.5 Quantity and quality of jobs and the effects of reforms on these

Quantity of jobs and employment types

The number of employed teachers in Folkeskolen has decreased by 4.7% from 2010 to 2015. However, in the same period the number of pupils decreased by 4.4%, indicating that the demographic development might be the most important driver. Teachers with open-ended contracts decreased by 7 % during the same period, while fixed-term employed teachers in Folkeskolen more than doubled from 2200 to 5500 in the period from 2013-2016. KL find that the increased use of hourly paid employees is a consequence of the reform’s qualification requirements, which send teachers and pedagogues through further training and thereby create a need for replacements, but point also to the increasing teaching time as part of the explanation (Pedersen 2015). By contrast, DLF points to the shortage of teachers as the main reason for the increasing use of hourly-paid teachers. The teachers must work faster, and according to DLF this has created a negative spiral and makes it less attractive to be a teacher (Hansen 2015).

An increased number of teachers have found a job in another profession after the new reform and new regulations. More specifically, 3.6 % of the teachers employed in 2014, had by the following year found a new job in another profession. This compare with teachers employed in 2012, only 2.2 % had found of whom new job in another profession (Drescher et al. 2016).

Local working time regulation and types of working time

The implementation of teachers working time regulation at municipal and local level varies. A framework agreement between the main social partners in the municipalities have since 1999 made it possible for all personnel groups in local government to sign local agreements on working time. This possibility also in-cludes teachers before as well as after 2013.

In the immediate aftermath of the 2013 conflict, KL advised local municipalities to refrain from entering into new local agreements on working time. Nevertheless, some municipalities engaged early on in forms of social dialogue with the local branches of DLF. Over time KL have softened their stance on local social dialogue, though they still warn municipalities of entering into agreements that tie up resources.

For the school year 2015/2016, 54 local municipalities out of the 98 Danish municipalities reached an agreement or mutual understanding with the local branch of DLF. In addition, 12 municipalities formulated an administrative paper (Hansen 2017) . A newly published memo from DLF indicates that the number of local agreements by March 2017 had increased to 69 (DLF 2017).

The reform resulted in a higher numbers of hours for class lessons. The regulation on teachers working time distinguishes between teaching time and remaining time. The remaining time includes all other work assignments apart from class lessons. Survey data indicates that finding time for preparation and evalua-tion of teaching is the biggest challenge after The School Reform (Bjørnholt et al. 2015:6).

Another significant change following the regulation on the teachers working time is the principle regard-ing presence at the workplace during the workday. According to this principle, all work-tasks – including individual preparation – should take place at the school. For some teachers, the sharper division between workday and time for leisure this has been a positive experience. For others, it is a negative experiences challenging their professional norms with not enough time for preparation and creativity (Hansen 2017).Teachers are found to be more positive about the regulations in municipalities with the new local agreements/common understandings, if these resemble earlier agreements (Bjørnholt et al. 2015).

Sickness leave and benefits

The proportion of teachers on sick leave was below 3% during the period from 2010 to the mid- 2013. Af-ter the reform, the number increased to about 4 %. However, it decreased slightly in the fourth quarter of 2015 (Drescher et al. 2016:9). Furthermore, absence due to illness rose from 11.1 days in 2013 to 13.9 in 2015 in Folkeskolen (Drescher et al. 2016). The increase seen in the school sector might be ascribable to the changes in relation to the reform and the working hour regulation, but it could also be based on other factors. Local budgetary difficulties, municipal austerity, and restructuring of local school systems are fac-tors of huge importance for the pressures experienced at school level (Hansen 2017).

In general, the teachers give a more positive reaction to the working hour regulations if the new local agreement have a closer resemblance to earlier regulations. Moreover, around 4 % of the teachers em-ployed in municipalities without local agreements in 2014 changed job to another municipality. This num-ber is 1%-point higher than in municipalities with a local agreement (Ibid.).

Summary: The effect of the school reform on job quantity and job quality

Indicators here shortly after the implementation of the reform show in many cases only small changes:

The decline in the number of teachers has been matched by a decline in the number of students, so the decline cannot be seen as an expression of austerity. Whatever the explanation for this, there has been a decrease in open-ended contracts and an increase in the use of atypical employees, representing a de-clining job quality. Whether this change will be permanent is difficult to judge. As planned, the principal’s decision-making power has increased and the teachers’ voice regarding working time has been reduced, but the local agreements reflect variation in this reduction. There are some (vague) indications of a posi-tive effect of the presence of local agreements on work environment dimensions. Regarding working environment, there are some positive indications after the implementation of the reform (such as less use of leisure time for work, the feeling of still having some autonomy and being motivated), but most indications are negative (reduced motivation, reduced job satisfaction, slight increase in sickness absence, preparation outside normal working hours).

3.6 Effect of the job changes for quantity and quality of the service

Due to the early stage of the implementation of the reform, it is difficult to make solid conclusions regard-ing the effect on the quality of services i.e. quality of teaching. One of the latest large-scale surveys com-pares the pupils’ experiences in early 2016 with the situation before the reform in early 2014. The pattern is more or less similar to those regarding the quantity and quality of employment from the previous sec-tions: Either no change has taken place, or the changes are small and mainly in a negative direction. The former is the case concerning the support from parents and teacher-parent relations, the latter is the case concerning the overall satisfaction, the content of the lessons, and the extent to which there are clear goals with the teaching. The only main indicator which shows a change of more than a few percent-age-point change is the share of the pupils that is of the opinion that the school day is too long. The share increased from 46 % in 2014 to 82 % in 2016 (Nielsen et al. 2016).

Another recent official evaluation has analysed six elements of the school reform also only point to mar-ginal marginal changes, with the exception of the reform element increased physical activities, which had led to an increase in motivation and well-being (Jacobsen et al. 2017).

The social partners’ readings of these and other official evaluations differs – maybe not surprisingly. KL emphasises in their summary of the reform: That the share of pupils with ‘high participation’ in teaching has increased by 3.5 % 2014-16, that the increases is largest among girls, pupils from homes with weak educational tradition and ethnic minorities, and that 95 % of the parents still have an overall positive eval-uation of Folkeskolen. However, KL also emphasise that the share of parents that report on disturbing noise in teaching is no less than 30 % and that the share of parents who take part in school related activi-ties has dropped from 58 to 38 % (KL 2017). DLF has a less positive view of the effect of the reform. Their own evaluation show that only 13 % of their members in 2015 found that the reform worked well, and that this number had dropped to 12 % in 2016. Moreover, DLF point to the general lack of effect found in Jacobsen et al.’s evaluation (Folkeskolen June 9, 2016; Folkeskolen January 24, 2017). Also in relation to the long- term development of Folkeskolen DLF is critical. Although DLF admits, that the increase in aver-age size of the class from 20.4 pupils in 2009 to 21.7 in 2017 is not that dramatic, the same period also show that the number of pupils in classes with more than 25 pupils has increased in the same period from 17 to 27 %. The class size has not changed since 2013 (DLF 2015).

4. Eldercare

4.1 Introduction to the sector

Eldercare in Denmark is provided free of charge and consists of a wide range of services such as residen-tial care, home help, personal care and various forms of health care. Danish municipalities are responsible for eldercare provision and it is one of their core services. Eldercare accounts for a significant share of the municipalities’ annual expenditures and amounted to 4.5 % of the Danish GDP in 2015 (Rostgaard & Mat-thiessen 2016).

The eldercare sector employs overall 105.000 employees, which roughly is equal to a quarter of all munici-pal employees. In the period from 2010 to 2015 the number of employees within eldercare decreased by 2 % (FOA 2016a). During the same period, the number of elderly citizens over the age of 80 increased by 6 % to 241.000 persons (Statistical Denmark).

Comparing the situation in 2017 with 2007, expenditure on eldercare has increased. However, when the number of users (elder persons) are taken into account, the adjusted for price and wage development spending has been reduced by 25 % per elder person (Økonomi- og indenrigsministeriet 2017). The budg-et for eldercare is decided by the individual municipalities within the framework of the annual economic agreement signed by KL and the Government.

The eldercare is divided into two main parts. One part includes traditional nursing homes where the el-derly live in housing facilities with small apartments or rooms for each person and provision of full time nursing. In several cases, the nursing homes have additional living facilities, so-called ‘protected accom-modation’ (‘beskyttede boliger’) where the elderly can stay in e.g. an apartment with extra help and as-sistance, but still have to manage on their own. The second type is nursing care at home (aka home help services). It is a public provided service including cleaning, cooking and personal care to the dependent older people, who are approved by the municipalities to receive help. The fact that home help is free of charge and primarily publicly funded is unique in a Scandinavian context (Rostgaard 2015).

Occupations

The eldercare sector employs a wide range of health and social care staff, which can roughly be divided into the following groups:

•Social and health care assistants, who work in nursing homes as well as provide home help and per-sonal care. The education of this group ranges from 3 years and 10 months to 4 years and 7 months

•Social and health care helpers, who have completed a 2 years and 2 months course and perform simi-lar care-related tasks within the eldercare sector as the social and health care assistants.

•Nutrition assistants who ensure that older people receive proper nutrition. These nutrition assistants have completed an education of between 2 years and 4 years and 2 months of duration.

•Other occupations such as nurses and doctors are as also present in the sector, but the aforemen-tioned groups are the most widespread.

Since 2005, the eldercare sector has overall experienced an improved skills level (Rostgaard & Matthies-sen 2016.

4.2 The social partners and the collective agreements

KL has the employer role in collective bargaining and other forms of labour market regulation. FOA is the largest trade union in the eldercare sector. It mostly organises public employed workers with shorter ed-ucation within cleaning, cooking, childcare, and social and health services.

The Danish eldercare sector is characterized by high union density estimated to be around 90 % and al-most full collective agreement coverage (Larsen et al. 2010:268). Results from a survey among leaders and care institutions in 2010 describe that 88 % of self-governed or independent institutions are covered by collective agreements (Ibid.). The collective agreements will affect the working conditions and terms of employment of none-covered areas of the private sector as a spill over impact on the expectations and demands from the employees (Larsen et al. 2010). It should be added that most of the employees in the sector are covered by the Salaried Workers Act in addition to the collective bargaining.

4.3 Reforms and the role of the social partners

Due to an ageing population and a political request for effectiveness, the Danish eldercare sector has ex-perienced a series of changes. NPM reforms have to a large extent affected the Danish eldercare sector with the adoption of NPM-measures such as time registration, documentation and use of private provid-ers to ensure productivity and effectivity (Kamp et al. 2013).

In the late 1990s, quality standards and the initiative ‘Mutual Language’ (Fælles Sprog) was developed to streamline the provided service and the time spend on care for each elderly person. In 2003, the divide between purchaser and provider was introduced. Requests by public authorities for increased documen-tation is also an important development. From 2005 to 2015, the number of employees working with doc-umentation and administrative tasks has increased from 10 % to 44 %. In addition, the eldercare sector employees experienced an increasing amount of more practical services regarding cleaning and a de-crease in the volume of care-related services in the period from 2005 to 2015. For example 69 % of em-ployees in 2005 described coffee drinking with the elderly as a part of their job description – this share had decreased to 36 % in 2015 (Rostgaard & Matthiessen 2016).

Marketization through contracting-out and free client choice are also important NPM-tools in Danish eldercare. Free client choice means that the municipalities are obliged to provide different options of providers for cleaning and eldercare services to older people entitled to home help (The National Board of Social Services 2016). Especially regarding the delivery of home help to older people living in their own homes, the share of private contractors has increased from 26 % in 2008 to 38 % in 2014 (KRL 2016). Re-garding nursing homes the use of private providers are less widespread, but different types of ownership have become more widespread due to recent modernization reforms in the public sector.

Public tendering is used to insure the free consumer choice. Approximately 38 private providers of home help have faced bankruptcy since 2013, which may indicate financial conditions too narrow to compete and fulfil the contract agreed. According to a trade union interviewee, the tendency of bankruptcies has led to the necessity of municipal backup teams to ensure and maintain the nursing care.

Regarding the large-scale reforms covering the entire public sector, the eldercare sector was only briefly mentioned in the policy papers of the Structural Reform 2007, but the sector was nevertheless affected by the reform. As a method to enhance the effectivity of the health sector - including eldercare - a com-pulsive collaboration between the municipalities with responsibility for eldercare and the regions with responsibility of the hospitals was agreed in 2007. The agreement compelled municipalities to create new solutions within prevention and rehabilitation to prevent hospitalization and through that retrench the financial support from the municipalities to the regions (Dahl 2008). To support this, a joint coordination committee was set-up with the aim to implement the so-called ‘Agreements on health’ (part of the Struc-tural Reform) to ensure the coordination between hospital and the municipalities.

The most important reforms since the economic crisis has been the aforementioned annual economy agreements between the Government, KL and Danish Region and the Recovery Plan, which caused that 20 % of the 98 Danish municipalities experienced budget cuts of 4 % in the period 2009-11 (KL 2011). In the post-crisis era, focus on rights of clients has also been prioritized. The ‘Commission of the Elderly’ was set up as a part of the agreement regarding the annual budget in 2011 and aimed to enhance focus on the individual’s quality of life and self-determination (The Commission of the Elderly 2012). According to a trade union interviewed, the economic crisis has legitimated these budget cuts and the increased focus on efficiency and further modernization of the eldercare sector.

Additional earmarked funds have been part of the annual budget for 2014 and 2016, respectively with the aim to ensure the ‘dignity’ of the Danish elderly’. This illustrates, along with the recent appointment of a Minister for the Elderly in 2016, that eldercare is high on the political agenda. However, the expenditure per elderly continues to decline.

The role of the social partners

The trade union interviewees representing the eldercare sector emphasized nearly exclusively their role in the collective bargaining arena, indicating that this is there arena where they have by far the greatest influence. Thus, this section will not include the role of the social partners in the political (reform) arena to any great extent.

The collective bargaining round in the public sector 2008 diverged from the moderate level of conflict. Relevant also for the negotiations in 2008 were the increased focus on employees, the so-called ‘warm hands’, to insure the quality of care prior to and during the bargaining round at sectoral level. Another key trade union demand was equal pay. These issues became the focal points in the negotiations and were brought forward as a struggle for equal pay in a sector traditionally occupied by women (Due & Madsen 2009). It was the members of the Health Care Cartel and FOA (with nurse assistance working at the hospi-tals as one of the largest groups), who ended up in an industrial conflict, which was all about the money (see section 2.3).

The collective bargaining round 2011, 2013 and 2015 was less dramatic, and included only few changes – and limited wage growth – in the sector. However, the interviewees from the social part-ners representing the eldercare sector emphasized the change in power relations.

Around the same time, FOA tried to influence the political agenda regarding the physical and psychologi-cal work environment in the eldercare sector. They pointed to the shorter life expectancy for the social care workers compared to e.g. academics and pointed the possibilities of differentiated retirement age. These attempts was a joint attempt with other relevant trade unions.

As a part of the cartel-level bargaining in at the collective bargaining round in 2015 was the set-up of fund aimed to ensure education possibilities for unskilled employees and further training for employees with short education. The target group was employees above the age of 25 with more than 5 years of experi-ence in the Danish municipalities. This training initiative may have affected the formerly mentioned en-hanced skill-level of the eldercare sector in Denmark.

4.4 Quantity and quality of jobs

As previously mentioned, the number of employees within eldercare has decreased by 2 % in the period from 2010 to 2015 (FOA 2016a) and four percentage-points decline in employee per elderly person in the period from 2010 to 2015 (Rostgaard & Matthiesen 2016). According to representatives from FOA, the way the economic crises has affected the quantity of employment in the eldercare sector by increasing the number of employees with longer education, such as legal advisors and economic consultants. This may alienate the care professions from the decision-making and consequently reduce the professional autonomy. According to FOA, the unemployment rate for their members stands at 2.7 %, compared to the average of 3.4 % for the remaining members (FOA 2016b).

Non-standard employment: The sector register a growing number of employees working part-time (un-der 35 hours a week). In 2015, only 21 % of the employees providing home help and 23 % of the employ-ees in nursing homes worked 35 hours or more per week. Moreover, FOA has also experienced an a rapid increase in the number of members in marginal part-time positions in the municipalities working 7 hours a per week or less (FOA 2017). Finally, a study from 2009 showed that eldercare is one of the areas within the public sector that uses most temporary employees – the share at that time were 21 % of all employ-ees (Larsen 2008).

Work satisfaction, health and safety: 75 % of the employees in the Danish eldercare sector perceive their work as interesting and meaningful. This level has not changed much since 2005. However, 33 % of the employees providing home help describe their working day as too stressful (Rostgaard & Matthiesen 2016), and 67 % agreed or partly agreed that the employees where compelled to work faster than previ-ously (Larsen & Navrbjerg 2010).

Regarding work satisfaction, there seems to be a tension between the new market-oriented rationality in the sector and the high level of professionalism and occupational identity of the employees. With the introduction of time registration and documentation demands a perception of degraded quality of the service is widespread by the eldercare workers, of which the majority has experienced increasing work-loads (Kamp et al. 2013).

Job- and employment security: The profound organizational changes around 2007 created insecurity among workers due to transformed work places and tasks (Dahl 2008). Moreover, the number of suppli-ers who have experienced insolvency leaving many elderly citizens without the help needed. Therefore, an increasing number of employees in the eldercare sector are worried about their job and employment security due to repeated rounds organizational changes. The number has increased from 11 % in 2005 to 32 % in 2015 (Rostgaard & Matthiesen 2016).

4.5 The effect of changes in job quantity and quality on the service

Media and politicians are highly interested in measuring the quality of eldercare services, but it is a com-plicated task and it is difficult to formulate true and fair definitions of quality care. Moreover, it is difficult to ensure comparability in a Danish context with standards of quality, because the standards are deter-mined by the individual municipality. This may also be the very reason why the quality of eldercare has only to a limited extent been researched in Denmark (Hjelmar et al. 2016). The Danish Health Authorities’ conduct national inspections on health related issues. However, these do not include the quality of the social interaction between staff and the elderly (procedural quality).

The only encompassing large-scale study to date of the quality of eldercare builds on a survey among di-rectors of Danish nursing homes and the coding of inspection reports (Hjelmar et al. 2016). According to this study, the quality of services provided has only to a limited extent been affected negatively by the marketization reforms and increased use of private providers.

Another study evaluates the service quality is the national inspection reports and find that the number of serious remarks have remained fairly stable 2009 to 2015, fluctuating between 5 % and 9 % of the inspec-tions. Also the number of nursing homes without any remarks continues to be relatively unchanged at 3 – 4 % during that period (The Danish Health Authorities 2011; The Danish Patient Safety Authorities 2015). Hence, no change over time in service quality using this source either.

Whereas there is a lack of evidence in the research community for a negative impact on the quality of eldercare of outsourcing, most stakeholders seems to agree that problems exists. The former responsible minister for eldercare found that the municipalities look to much at the price and too little at the quality when eldercare is outsourced (dr.dk February 24, 2017). FOA asks for mechanisms that could force the municipalities not to accept the lowest bid, if this is unrealistically low. FOA sees furthermore a connection with the unrealistically low bids and the continuously high level of bankruptcy among the private elder-care providers (FOA February 20, 2017). Also the organization Danish Industries (DI), representing the service providers, has warned against always choosing the cheapest offer from their member companies, because this might lead to insufficient quality and bankruptcy. KL, as the main responsible actor, find that the municipalities already have an eye for the price-quality balance and refers to KL’s guidelines for out-sourcing (Politiken October 10, 2015).

5. Comparison and conclusions

In the following, we will relate the projects six sub-questions - mentioned under the two overall research questions - to the findings. The answers will as far as possible first use the cross-sector sections of the report to address the six questions, and then address each of the six questions with regard to the three sectors in focus. Finally, similarities and differences between the three sectors will be discussed.

5.1 Changes with regard to the social partner organizations

The first sub-question concerned changes within the last 15 years with regards to ‘the social partners’ structure and organizational capacity, ideologies and strategies, relationships (consensual or conflictive) and the coverage of collective bargaining, social dialogue and other relevant processes’. Because of the questions very broad scope, it is nearly impossible to answer generally for the public sector within the limits of this national report. However, a focus on the three selected sectors might also provide some information that can contribute to a general picture.

Regarding ideology in the public sector as a whole, it is worth to mention that a sort of NPM-agenda – that some observers prefer to label ‘modernization’ in its Nordic version – has developed under government and employer leadership. It is a version that in general has not excluded the public sector trade unions and the role of collective bargaining. The trade unions have gradually, but only partly, accepted the NPM-agenda.

Another overall development might be partly related to this, but has only been visible in the present dec-ade: that the public employers have become the most pro-active part in collective bargaining, often leav-ing the trade unions with a reactive role.

In the hospital sector collective bargaining coverage is still close to 100 %. Some organizational change has taken place, in that the employers’ organization has developed from a mixed employer/ public authority organization to a more ‘pure’ employer organization. On the employee side, the trade unions in the Health cartel were in the beginning of the 15-year period part of the wider collective bargaining cartel, before leaving and the coming back to it recently. Hence, their strategy with regard to ‘alone or together’ seems to vary. Also the balance between consensus and conflict has varied throughout the years, with 2008 being a peak on the conflict side. The organizations’ organizational capacities have declined due to declining membership, but only marginally so. The organizational capacity - and strike capacity - of the nurses’ union (DSR) was however seriously reduced for a couple of years after 2008.

5.2 The reasons for these changes

The changes described above, as well as in the following sections, is unlikely to be explained by just one or two factors. It is more likely that the developments are explained by a more complex web of inter-connected factors. At least six of these are worth pointing out:

First, the economic cycles (including economic crisis) have been of importance. The economic cycles were very favorable in the first half of the 15 years period in focus, and much less favorable in the second half – especially until 2013. The business cycles have directly and indirectly impacted on the relations between the social partner, the quality and quantity of jobs as well on the public services themselves.

Second, the evaluation of the economic crisis - which in many countries was a game-changer for the pub-lic sector and for public sector IR – is in a Danish context challenged by the fact that the implementation of a major political reform of administrative structures and welfare service institutions - the Structural Re-form - took place more or less simultaneously with the economic crisis in the years following 2007. Hence, what is due to the effect of the crisis and what is the effect of the Structural Reform is often not clear (see also Hansen & Mailand 2013).

Third, demographic change has been a driver. The ageing of the population in the form of more elderly people has impacted, e. g., the hospital sector and eldercare sector, whereas the – at least temporary – decline in school age children has affected the school sector.

Fourth, technological development affects in several ways. One of these impacts is that it in some sectors seems to be possible to reduce staff and/or spending per user without damaging the service quality – but also, that there might be limit to this effect.

Fifth, although less marked than in the private sector, there seems to be a change in power-relation to the benefit of the public employers – a change that cannot only be explained by the business cycles. This change has impacted on other changes, especially with regards to IR.

Finally, the change of ideologies, especially on the employer side, that include some variation of NPM and learning from the private sector. It could, however, also be seen as a cause of several of the changes de-scribed above and below.

5.3 What shape has public sector reforms taken?

Although there has been a reduction in public sector employment from 2010 to 2017 on 4.7 %, Denmark has one of the largest public sectors in Europe both measured in share of BFI and share of employment, This was the case 15 years ago and it is still the case today. The public sector’s share of BFI has been be-tween 26 and 28 % since 2000 (27 % in 2015), and the public sector has employed between 28 and 31 % of all employees in the same period (29 % in 2015).

Nevertheless, a number of NPM-inspired reforms, as well as a restructuring of administrative and organi-zational units towards larger ones, have changed the public sector. Contracting out, privatisations, free consumer choice, local wage determination, contract management and widespread use of targets and registration of activities have been introduced from the late 1980s and onwards. However, only 25 % of the municipalities’ services are exposed to competition and only 11 % of the wage sum in the public sec-tor is set at the local level. Moreover, a reaction to the NPM reforms - especially to the control and regis-tration aspects of it- has slowly developed in the present decade, but it is still too early to judge what the real impact of this reaction will be.

Although the 15 year-picture show certain stability, the economic crisis starting in 2008 has been followed by some (comparatively mild) austerity policies. Although, as mentioned above, it is difficult to separate the effects of the austerity initiatives from other factors, such as the demographic development and the Structural Reform, the austerity policies have no doubt contributed to the abovementioned decline in the number of public sector employees, which has been seen since 2010.

In the hospital sector there has been an increase rather than a decline in the financial resources allocated to the sector. However, the activities have - due to the ageing population and medical and technological development making new treatment possible – increased much more than the budgetary increase. Hence, the hospital sector has shown substantial productivity increases. Most of the NPM reforms men-tioned above have been seen in this sector.

In the school sector (public primary and lower secondary school) key issues of the reforms during the last 15 years (and a decade before that) have been to: Differentiate more between the educational needs of pupils with different learning capacity; focus more on basic skills in math, reading and writing; introduce English at an earlier stage; use more national tests and common goals and introduce individual ‘learning plans’; face increased competition from private schools. Elements of NPM are seen here, but not to the same extent as in the hospital sector. Compared with the situation before the crisis and the Structural Reform (2007), expenditure had in 2013 decreased by 10 % (adjusted for price- and wage development). Increased expenditure in connections with the 2013 reform reduced the decrease to 4 %.

In the eldercare sector, NPM reforms have very much been on the agenda for the past 15 years and even longer and have in this sector especially led to increasing documentation demands, standardisation of services, free client choice and use of private providers. The number of employees has decreased and the number of care-demanding elderly has increased. Compared to the situation before the Structural Reform and the economic crisis 2007 expenditure has without adjustments increased in the sector, but adjusted for price and wage development spending has been reduced by 25 % per older person (without the adjustment by 8 %).

5.4 The industrial relations actors’ involvement in the reforms

The overall picture of the influence of the industrial relations actors on the public sector is varied, but generally speaking they have had strong influence through the collective bargaining arena - and varied, but much weaker influence through the political arena.

Since legislation regarding wages is close to non-existent and limited regarding employment and working conditions, the collective bargaining arena is of major importance for regulation of these issues and the reforms covering these, such as decentralization of wages and working time flexibility. Public sector in-dustrial relations have traditionally been relatively consensual, but large scale industrial conflicts in rela-tion to the bi- or triennial bargaining rounds have taken place two times during the last 15 years, in 2008 and 2013.

The role of the social partners in the main cross-sector reforms on the political arena takes place ad hoc either through lobbying, hearings/consultations or – more rarely – tripartite negotiations. In general, the social partners’ role on the austerity policies have been limited.

In the hospital sector, the social partners have contributed to the development of the reform policies – NPM reforms as well as non-NPM – themselves in the collective bargaining arena. A largescale wage-related conflict took place in 2008. In recent years, the hospital (regional) has seemed less conflictual than the two other main public sectors areas, the state areas and the municipal area. Regarding the political arena, the influence of the social partners is ad hoc and uneven –not only between employer and trade unions, but also between the trade unions in that the doctors’ trade unions seem to have the best access to the political system. In general, involvement of the trade unions – when it takes place –takes place late in the decision-making processes.

The social partners in the eldercare sector were also involved in the 2008 industrial conflict, and have since then experienced bargaining rounds with relatively few changes (such as the ‘security funds’ for persons facing lay-off), no or limited wage-increases and a strengthening of the power of the employers. The trade unions role on policy-making has been limited.

The social partners’ role in the school sector show another pattern. In the collective bargaining arena, an agreement to restructure working time regulation was made in 2008, but employers and politicians never-theless made a withdrawal of the working time from the bargaining agenda an essential demand in 2013. This demand was realized only after industrial conflict and government intervention. Involvement in polit-ical initiatives have traditionally been widespread in the sector, but in relation to initiatives around the 2013 reform the trade unions were by and large excluded.

5.5 The reform policies effects on the number and quality of jobs

As mentioned above, a decline in the number of employees in the public sector has taken place since 2010, but employment is still at the same level as in 2008. The national labour force survey shows that atypical employment in the form of temporary employees, part-time employees and self-employed without employees has been more or less stable since 2009.

In the hospital sector the total number of jobs has remained stable, but focussing on occupations, it is only the number of nurses that has not shown notable change: The number of doctors has increased and the number of support staff (with lower education) has decreased. This reflects a development towards shorter periods of hospitalisations and higher number of patients. Voluntary (long) part-time is wide-spread in the sector, whereas the employment types associated with precariousness are at the same level or lower than on the Danish labour market on average. The main job quality related problem seems to be work intensification, and the problem is – according to the trade unions – huge.

The eldercare sector shares with the hospital sector a situation where an increasing number of citizens needs the service of the sector. However, in the eldercare sector the number of employees has de-creased (at least since 2010). Regarding the job quality, part-time work generally and marginal part-time work has been increasing. The NPM reforms and decreasing time per elder persons have created a situa-tion where a fair share of the employees fair losing their job, feel that the professionalism of their occu-pation is under pressure, and that they have to work faster than previously. However, the majority of the employees still find their job interesting and meaningful.

In the school sector most major changes have taken place in connection with the collective bargaining round 2013 and the related school reform 2014. Contrary to the two other sectors, the citizens covered by the service (the pupils in the case of schools) has declined recently (after 2010), and the number of jobs has declined proportionally. However, changes are seen in employment types, where full-time employ-ment is in decline and fixed-term employment is raising. Whether this is a permanent or a temporary de-velopment, connected to the implementation of the school reform 2014, is a matter of controversy. Re-garding working environment, there are some positive indications after the implementation of the re-form (such as less use of leisure time for work, the feeling of still having some autonomy and being moti-vated), but most indications are negative (reduced motivation, reduced job satisfaction, slight increase in sickness absence, and preparation outside normal working hours).

5.6 Effect of the job changes for quantity and quality of the service

For none of the three sectors is it possible to say anything conclusive about changes in the quantity and quality of the service.

Regarding the hospital sector no clear conclusions can be drawn as to whether the work intensification - which without any doubt has taken place - has spilled over to problems in the quantity and especially quality of the service provided. The trade union for nurses, DSR, sees a connection between work intensi-fication and declining quality of services, including declining safety of patients. Those who do not see such a connection, including the hospital employers in Danish Regions, point to the fact that nearly all main service indicators point in the right direction.

The picture is not much clearer in the school sector. Conclusions with regards to the effects of the 2014 school reform are uncertain both because the reform is very recent and because the high political priority of the reforms implies that several alternative evaluations exists as well as several alternative readings of the evaluations. Using the most official evaluation as a source, the pattern in the dimensions analysed is either that no change has taken place, or that the changes are small and mainly in a negative direction. The former is the case in terms of the support from parents and the relations with teachers, the latter is the case with overall satisfaction, the content of the lessons, and the extent to which there are clear goals with the teaching. The only main indicator which shows more than a few percentage-points change is the share of the pupils that is of the opinion that the school day is too long.

In the eldercare sector the effect from the changes in job quantity and quality on the quality of the service provided is difficult to measures and there is no clear evidence with regard to direction of this change and the few available source point to stability rather than change.

5.7 Comparing the sectors and perspectives

Table 5.1 below show a brief formulated attempt to compare the findings from the three sectors. There are several commonalities. All three sectors:

•show no major changes with regard to the social partner organization, to their organizational den-sities or to the coverage of the relevant collective agreements

•have seen a development towards ‘tougher’ and more active employers (although not to the same extent)

•have been affected by the same drivers for change (although not to the same extent)

•have been affected by NPM reforms (although not to the same extent)

•show stronger social partner influence through the collective bargaining arena than the political arena

•have experienced work-intensification

•have been subject to intense discussions of the quality of services, though without leading to any clear picture of this quality, and without any clear link to the development in quality and quantity of jobs has been established.

Variation is seen with regard to:

•the relations between the social partners (most conflictual in the school sector (since 2013))

•the scope of NPM reforms (least extensive in the school sector)

•the shape of NPM reforms (most widespread use of outsourcing in the eldercare sector)

•the overall number of jobs (changed the least in the hospital sector)

•the use of atypical employment (least widespread in the school sector)

A number of observations can be drawn from this pattern and the sector-analyses.

Table 5.1: Comparing findings from the three sectors

Note: SP = social partners. CB = collective bargaining. TU = trade unions. Org = organization or organizational.

A number of observations can be drawn from this pattern and the sector-analyses.

Firstly, although three quite different - in terms of services - parts of the public sector are covered and there the presence of challenges specific to each of the three sectors, challenges and developments are to a large extent the same as it has been described above. Moreover, it is not possible to conclude that any one of the three sectors are facing more challenges from crisis, reforms and other drivers than the others. This said, however, it might be that the eldercare sector in the 15 years period has changed the most in the 15 year period in terms of organizational structure and work-organization (due to e.g. the widespread use of out-souring). It might also be the sector where the trade union has been least able to influence reforms and have the weakest power-position. The dominant union in the sector - FOA - is basi-cally a general workers union (of employees with no or low formal education) and they have never had the strong occupational identity, organizational capacity and history of (occasional) trade union militancy to use, as for instance the nurses’ and the teachers’ trade unions have. However, that the presence of these feature on the other hand is no guarantee for influence illustrated by the industrial conflict 2013 and the following school reform.

Secondly, one of the common challenges that shows most clearly in the sector analyses is work intensifi-cation. Whereas solid conclusions on the effect on quality and quantity of employment on the quality of service could not be drawn, there is no doubt that work-intensification – and the related challenges for the psychological working environment – in recent years has become a major issue across sectors.

Thirdly, interestingly, a high intensity of NPM-reform does or a high level of budgetary reductions does not seem necessarily to lead to more conflictual relations. Table 6.1 and the sector-analyses indicate that other factors plays a role. One is the level of involvement of social partners, especially the trade unions. Involvement of these in NPM reforms (though one of the two arenas or both) in formulation and imple-mentation of these seems in many cases to prevent conflicts. But also the power of the trade unions might play a role, in that more powerful trade unions are able to be more vocal and efficient in their com-plains, if they are bypassed, than weaker ones.

Fourthly, although change has taken place there are also a great deal of stability. The reforms, the Great Recession and the other drivers have impacted on the public sector, but fundamentally IR institutions are the same and the social partner organizations show a high level of stability in the 15 years period. Like-wise, although employment has been reduced in the most recent years, the job-level in 2017 is the same as in 2008 and the public sector is still in terms of resources and in terms of employment among the abso-lute largest in the Europe when compared to the private sector.

The short-term perspectives for the social dialogue in the public sector looks conflictual. 2018 is the first year with a collective bargaining round since 2015. The ‘trust-crisis’ between the social partners in the state sector is still present at the time of writing. Moreover, it seems that the teachers working time will again be a conflictual issue during the coming round. Maybe less conflictual will be bargaining regarding the conditions of atypical employees, where KL has signaled that whey want to further reduce, or totally eliminate, remaining thresholds. Moreover, psychological work environment and work intensification seems also to be an important part of the agenda.

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List of interviews

Marianne Brinch-Fischer, Head of General Collective Agreements, Local Government Denmark (KL).

Jakob Oluf-Bang, Head of Collective Bargaining Department, FOA.

Grete Christensen, Secretary General and Helle Warming, Head of Collective Bargaining Department, Danish Nurses Organization (DSR).

Ole Lund Jensen, Head of Center for Negotiations and Collective Agreements, Danish Regions.

Kasper Axel Nielsen, Director, The Union of Specialized Doctors (Foreningen af Speciallæger, FAS).

Anders Damm-Frydenberg, Consultant, Collective Bargaining Department, FOA.