2 Perspective and summary

2.1 Innovation in the care services

The terms «innovation» and «care services» come from two different worlds. Many would think of these terms as complete antitheses, and be sceptical to using them together. However, the tension inherent in their pairing gives rise both to curiosity and to new ways of thinking. Innovation is a term that designates change and creation with relevance to all areas of life and society.

2.1.1 The care services sector as a historical innovation

From a historical perspective, the public care services sector, as developed in the Nordic countries, may be regarded as a major innovation in itself. It is just that the term «innovation» has not been applied to the strong growth of municipal homecare and institutional care services that occurred about 40 years ago. The expansion of these services was a response to some of the most crucial challenges that society faced at the time:

• the dramatic rise in the number of elderly;

• the lack of labour;

• the need for gender equality in the family and working life.

The innovative solution was to move part of the care arena out of the family and the private sphere by expanding the public welfare schemes. This means of transferring, or «outsourcing», caregiving tasks helped to enhance gender equality and freed up women to participate in the workforce. The proportion of women in the labour force in Norway is now one of the highest in the world. At the same time, this established the basis for a new distribution of caregiving tasks between the family and the public sector, making it possible to combine caregiving with employment and education. Thus, the new care services sector became a key component of the social value creation in society and the infrastructure for working life. Many were concerned about what this development would mean for birthrates and the family's ability to provide care. In retrospect, the Nordic welfare model has proven to have both economic and demographic sustainability. Birthrates in Norway are significantly higher than in countries where the women in the family are responsible for most of the caregiving tasks.

This does not mean that the solution developed 40 to 50 years ago will necessarily be robust enough to meet the challenges Norway will be facing in the coming decades. Most of the attempts to forecast trends by expanding on the current system with the same rate of growth experienced in recent years point to an impossible situation in a few decades. The successful innovation that the expansion of the care services represents from a historical perspective should provide inspiration for new ways of thinking in the future as well. If as many developments take place in the sector in the next 50 years as in the past 50 years, the situation may look entirely different.

On the other hand, the committee advises against entirely dismantling a model shown to be sustainable and capable of responding to the major societal changes that have occurred during this period. The committee has therefore chosen to retain the welfare model with local municipal responsibility for the caregiving tasks, and has been more concerned with identifying new adaptations and making changes to enable Norway to provide community-based solutions in the future as well, as stipulated in the mandate.

In the quest for areas of potential innovation, the committee wishes to point out that the most exciting renewal may occur in the interface between the public sector and civil society. Achieving such renewal may be contingent on proximity to the local administrative level. In this sense, the care services sector is strategically well-placed in the municipality. No major shifts are required. In most places it is an integral part of the local level and cooperates closely with users, families and the local community. In the coming years, the care services should better exploit the potential right in front of them to achieve innovation across the municipality as a public administrative level and the municipality as a local community.

The care services constitute one-third of all municipal activities. Consequently, what occurs in the care services sector has a crucial impact on the municipality as a whole. Innovation efforts in the care services sector should therefore be conducted as part of an integrated innovation initiative in the municipal sector, where solutions are sought in the interface between the health and social services and the other municipal sectors and between the municipality, the local community and the private sector.

2.1.2 New solutions for six future challenges

In Report No. 25 (2005-2006) to the Storting, «Long-term care – Future challenges, Care Plan 2015»», the Government identified five future challenges. Two of these address problems that will increase in the future:

• the number of new younger user groups;

• the number of elderly in need of assistance.

Three of the challenges address areas in which there are deficiencies:

• the shortage of volunteer care providers and health and social services personnel;

• the lack of coordination and medical follow-up;

• the lack of activities and coverage related to psycho-social needs.

The committee has based its work on these five main challenges, and refers to the analyses presented in Report No. 25 (2005-2006) to the Storting. The Government has followed up efforts relating to these five challenges through the Care Plan 2015 and prepared a separate Coordination Reform on cooperation between the municipal health and care services and the specialist health care services. The committee has therefore decided to focus its efforts on those issues and needs that are not incorporated under the existing activities to the same degree. In keeping with the mandate and on this basis, the committee has put emphasis on investigating new action points and solutions for meeting the caregiving challenges in a time horizon that extends beyond the Government's Care Plan 2015, with special focus on technology, alternative housing and organisational solutions, research, innovation and business opportunities.

In its work, the committee has taken as its starting point three of the most common problems encountered by the care services:

• falls;

• loneliness;

• cognitive decline.

These three factors mutually affect one another and reach into most areas of the health and social services sector. The committee has chosen to use these as an illustration and practical point of departure for identifying and testing new solutions, work methods and approaches.

The sixth challenge

Additionally, the committee points to the challenges and opportunities inherent in these problems when viewed in an international context, where:

• the personnel market is becoming internationalised, and the care services workers are increasingly exported and imported;

• larger service providers operate in an international market, often in the form of multinational corporations;

• a growing number of patients and users are crossing national borders for treatment, recuperation and physical training.

The contours of the future must also be viewed in light of the vast changes occurring in the age composition of the population in both Europe and the world at large. There is reason to believe that this will affect all markets and social sectors throughout the world. In this context, Norway is more fortunate in that it is experiencing less dramatic changes in this regard than the other countries in Europe. However, Norway will be strongly affected by events elsewhere in the world, and should also be cognisant of the market-related opportunities this generates. Society will face major challenges relating to care services in the coming decades. These will be demanding enough without being made worse by dire predictions and worst-case scenarios. In the view of the committee, the future challenges for the care services cannot be dealt with by the health and social services sector alone. They must be addressed on the basis of a public responsibility involving most of the sectors in society and by supporting and developing new forms of involvement and participation by the families and local communities, organisations and enterprises. The issue at stake has just as much to do with the kind of society Norway seeks to build for the future as with how the health and care services sector will develop.

2.2 New policy

Care services for all

Treatment for a wide variety of problems, diagnoses and disabilities relating to the entire life course from childhood and adolescence to adulthood and old age are now encompassed under the municipal care services. The care services sector has experienced significant growth, incorporated many new user groups and assumed a number of new tasks over the past 20 years. It has become a sector that provides services to everyone who has a need for assistance and care.

A future-oriented care services policy requires a broad societal approach to future user groups. Therefore, the committee's recommendation is based on the assumption that the policy of dismantling disabling barriers in society will be continued and strengthened. The committee also recommends the formulation of a new active ageing policy for all areas of society and a modern policy for informal care that is framed on equality between men and women and partnership between users, close relatives or friends and the care services.

2.2.1 A policy that removes barriers for people with reduced functionality

Dismantling of disabling barriers in society, equality and participation comprise the main elements of the struggle waged by people with impairments in recent decades. There is still a need to combat discrimination and prevent segregation to ensure that all segments of the population achieve full participation in working life and society and can live a normal life in community with others.

It is primarily younger people with reduced functionality who are at the vanguard in the development of the care services sector. They play, and will continue to play, a leading role in:

• the adoption of new technology and technical aids to cope with daily life on their own and to be as independent as possible;

• the demand for universal design of housing and the surrounding areas;

• user-driven ownership of service provision organisations and housing options;

• implementation of reforms involving the closure of institutions and the development of local services, independent housing and the opportunity to lead as normal a life as possible.

If the welfare society is to realise values such as participation, independence, autonomy, dignity and normalisation, the users must have a high degree of influence and control over their own life situations.

The committee believes that this policy will be resilient enough to address the future challenges in a wide range of areas. It is reasonable to assume that the new elderly generation will follow the lead of the younger users of municipal services. New generations of elderly will meet their old age with a completely different set of resources and will not accept being placed on the sidelines. Parts of what is referred to today as institution-based elderly care are therefore ripe for reform with the same goals as similar reforms implemented in the past 20 years for various groups with reduced functionality.

Many of the innovative solutions and action points that should be implemented in the municipal care services may simply be a matter of transferring the experience from the responsibility reform for mentally impaired persons carried out in the 1990s to the area of elderly care.

2.2.2 An active ageing policy

The committee also believes that Norway must develop a new policy for senior citizens that encompasses more than retirement pensions and elderly care. An active ageing policy for all areas of society must be developed.

The new generation of senior citizens will be large. Its members will enter old age with a higher level of education, better health, longer life span, better housing conditions and more resources. More than ever before in history, an elderly population with substantial resources and purchasing power will have an impact on all markets, all societal institutions, trade and the economy, demand and consumption – all over the world. On the one hand, they will have a better foundation for taking care of themselves than any other generation before them. On the other hand, they will place high demands on the global community.

An active ageing policy invites and expects participation in society and politics, in education and cultural life, in the family and volunteer work, and for those who have the opportunity: in business and working life.

An active ageing policy builds bridges between the generations and counteracts segregation and age discrimination.

An active ageing policy in the health and care services area puts emphasis on prevention and provides a framework so that people can take responsibility for their own lives as they wish by:

• making adaptations to their own housing conditions and nearby surroundings;

• taking part in physical, social and cultural activities;

• participating in education, physical training and rehabilitation.

An active ageing policy is based on the principles of autonomy, independence and influence over one's life, in spite of illness and reduced functionality.

The EU has decided that 2012 will be the European year of «Active Ageing and Solidarity between Generations», in which all of Europe will prepare and plan for the demographic changes that will affect all the countries in the coming decades.

The committee recommends that Norway take active part in this forward-looking work and formulate a senior citizen policy for all areas of society. Senior citizen policy will be so central to the development of society that the Government should consider giving it a higher profile and a more prominent role on the agenda.

2.2.3 A modern policy for informal care

Due to the future shortage of both volunteer care providers and care services workers, it will be necessary to combine work and caregiving in a different, more flexible way than today.

The new policy for informal care must first and foremost direct attention towards, and establish the value of, the contribution of family members, friends and neighbours. It must then ease the time crunch many experience by providing greater flexibility in working life, and integrate close cooperation with the municipal care services as a means of lightening caregiving burdens.

The committee therefore recommends a new policy for informal care incorporating six components:

• visibility;

• gender equality;

• flexibility;

• guidance;

• relief;

• value.

Family-based caretaking activity does not show up anywhere. It remains essentially unregistered in case management files, statistics and public reports, despite its magnitude in terms of man-years, which equals that of the public care services sector.

The committee therefore recommends that the care provided by families is given greater emphasis in research and evaluation activities, that stronger political focus is directed toward family members and volunteers as a resource, and that an integrated policy is drawn up in this area.

The individual’s efforts should be given much greater attention and recognition by the municipal authorities. Agreements made with family members and volunteers should be recorded in the case files and individual plans, both in order to coordinate these efforts with the public care services and to assess relevant measures relating to training, guidance, relief from the caregiving burden and finances vis-á-vis the family members.

A modern policy for informal care must be framed on equality between men and women. It would not be desirable to have a care services policy that sets back gender equality efforts many years. It is therefore satisfying to see that according to the health and living conditions survey (Statistics Norway 2008), almost as many sons as daughters are providing help or supervision to their elderly parents on a regular basis. In this context, it is important to expand the focus on men's role as father to include focus on men's caregiving functions as sons and spouses.

An integrated, more cohesive policy for informal care will facilitate the introduction of new rights and welfare schemes that ensure:

• training, support and guidance for family members and volunteers;

• relief for those who have heavy caregiving burdens;

• financial security so that family members do not also find themselves in a difficult financial situation;

• necessary leaves of absence so that family members do not lose their right to work or have to take sick leave to care for their close relatives.

The committee believes that the future shortage of labour as well as volunteer care providers will require solutions that make it easier to combine employment with caregiving, and on this basis proposes that consideration be given to extending the leave of absence permissible in connection with caring for close relatives to one year.

The committee also proposes the establishment of more comprehensive, flexible schemes that provide relief to caregivers in their own homes, as a daytime activity programme and as short-term stays outside the home.

Furthermore, the committee takes note of the potential of measures using the new social media and new communications technology to reduce worry and provide security, guidance, establish contact and provide follow-up in relation to users, family members and the care services.

2.3 The committee's five proposals

2.3.1 «Close caregiving» – the second Coordination Reform

The first Coordination Reform has focused primarily on improving the utilisation of resources in the collaboration between the municipal health and care services and the specialist health services on health-related and medical issues. The «second Coordination Reform» revolves to an equal degree around mobilisation of resources, focusing on cooperation between the family, the social network and the local community.

Being a responsible citizen entails more than the consumption of public services. For community-oriented solutions to work, people must also take responsibility for the development and design of the services offered, and play a role as both producer and consumer. Caregiving should be an integral part of a thriving, dynamic society and this should be manifested in interpersonal relations in the family and local community, organisations and institutions, and in informal contexts where people meet, work and live together.

What is needed is to think along new lines regarding the interplay between the public schemes and civil society, to explore the new forms of volunteerism, and to put focus on alternative work methods, forms of operation and organisation that encourage participation of the citizenry. The committee has decided to call this project the «second Coordination Reform», which targets the family and local community. This reform will be based on close caregiving, responsible citizenship and co-production, and includes:

• a national agreement and local contracts for partnership between public and volunteer enterprises in the care services area;

• new forms of ownership and operation, such as cooperatives, user-driven schemes and social entrepreneurship;

• new work methods and professional approaches that give higher priority to active caregiving, ordinary rehabilitation, group methodology, culture and well-being;

• a new, modern policy for informal care;

• care services that are organised with the family and local community in mind and that emphasise homecare services, open institutions and networking activities.

The committee wishes to emphasise the importance of seeking new solutions and patterns of cooperation through dialogue and negotiations between public and volunteer enterprises in the care services. It is in the interface between the public sector and civil society that new community solutions can be developed.

Idealistic measures and enterprises in the form of NGOs and user-driven cooperatives should be given a much larger role in the development of the future care services. The committee believes that this will strengthen innovation and development activities in the care services and encourage active participation and co-creation of the new forms of ownership and models of operation needed to meet the exponential growth in caregiving needs expected after 2025. Ambitious targets should be set. The committee proposes that one target should be to allow 25 per cent of all the activities in the care services sector to be organised and operated as idealistic enterprises by 2025.

2.3.2 «Technoplan 2015» – technological support for the care services

The care services have an enormous unexploited potential to utilise available technology and develop new technology. This applies to welfare technology that can give the users greater security and a better ability to take care of themselves in daily life, telemedicine solutions to help in treatment, supervision and care, and technical support for communication, administration and management that frees up care workers to spend more time on direct user contact.

The committee has submitted a three-phase plan for the expansion and practical application of welfare technology, and proposes its inclusion as part of the Government's Care Plan 2015:

Phase 1 further develops the security alarm concept into a security package which includes an adaptation for Smart House dwellings.

Phase 2 uses modern communications technology and social media to enable users to contact the health and social services, moderate loneliness, maintain contact with family and friends, and participate in user forums.

Phase 3 uses technology that stimulates, entertains, activates and structures daily life for the elderly.

The plan gives priority to training and competency measures, organisational development, and the establishment of cooperative arenas for innovative municipalities and professional circles.

The committee proposes that the specifications for new or renovated buildings financed through the Norwegian State Housing Bank’s investment grant for nursing homes and residential care homes must include adaptation for the connection of alarms, sensors and Smart House technology. In this context, the committee also notes the need to develop a standardised communications platform in the home with services that can be adapted to the individual user's needs over time.

The committee also recommends more direct regulation of the use of tracking and warning devices (e.g. with GPS) in the statutory framework for health and social services. This will provide clearer rules, simplify case management and clarify which considerations must be weighed when employing technical aids that clearly will result in greater independence and freedom for many users.

At the committee's request, the Data Inspectorate has carried out a new assessment of personal privacy issues related to the use of welfare technology, which the committee finds clarifying. The Data Inspectorate’s letter of 9 May 2011 is therefore attached to this report.

2.3.3 «New rooms» – future housing solutions and neighbourhoods

An important part of the planning of tomorrow’s society will deal with making dwellings and surrounding areas good to grow old in. Most of the housing and institutions in which people will live and receive health and social services in the coming decades have already been built. This concerns primarily the ordinary building stock such as single-family homes, row houses and apartments, but also the more than 40 000 beds in retirement and nursing homes and the almost 50 000 dwellings built for caregiving purposes.

The large-scale renovation project

The committee is concerned that too much attention on new building may lead to neglect of renovation, and recommends strengthening the instruments used in housing policy to encourage renovation and renewal of the homes that already exist. Given the challenges that society is facing with regard to health and social services, it will be crucial to dismantle barriers and adapt homes and surrounding areas so they can function throughout the entire life of an individual. The committee seeks to promote a general line of thinking in which it is just as common to prepare a home for one's old age as it is to adapt it in other life phases. Thus the committee proposes that an advisory service for housing adaptation be established as a cooperative effort between the Norwegian State Housing Bank, the municipalities and the technical aid centres of the Norwegian Labour and Welfare Administration. The committee also proposes a system for classifying various types of homes based on the specifications for universal design.

New concept

An exciting development is underway in the municipal care services, as two different traditions are in the process of merging into one. On the one hand, the rooms in nursing homes are becoming more and more similar to rooms in full-fledged residential care homes. On the other hand, today's residential care homes are being built together and used both as a supplement and alternative to nursing homes. The committee envisions a solution in which the best of each of the two different traditions is combined rapidly and constructively.

The new concept proposed by the committee entails a «fusion» in which a high standard of housing and services can be combined in various ways, prompting the development of a range of solutions based on six fundamental principles:

• a division between municipal housing policies and the municipal service policies in the area of health and social services so that the services and resources are linked to the individual’s needs, regardless of type of living arrangements;

• a clear physical and legal division between private areas, common areas, public areas and service areas in all buildings used for health and social service purposes;

• a professional and organisational division between health services on the one hand and food service, cultural activities and other services on the other;

• housing solutions that provide access to all necessary living functions (bath/toilet, kitchen, sleeping area and general living area) within the private area, adapted for both residents and family members;

• the adaptation of the infrastructure of homes for the use of new welfare technology;

• a joint scheme for rent and self payment regardless of living arrangements, with an equal right to housing allowances from the Norwegian State Housing Bank, the same payment for services and same coverage of pharmaceuticals and technical aids under the Norwegian National Insurance Scheme.

The committee finds that the time of the large institutions has passed, and is of the opinion that the care services should include homes and premises that are an integrated part of the local community in towns and urban areas where the public common areas are shared by the rest of the population. A hub where a welfare centre and various types of housing are located must therefore be a component in the municipality’s overall planning.

The committee wishes to incorporate these principles into the basis for the expansion of tomorrow's municipal housing solutions for people in need of health and social services. In this connection, the committee notes that the Care Plan 2015 estimates a need for the renovation and expansion of 12 000 24-hour care spaces in the period up to 2015.

The need for dramatically increased capacity will arise in 10 to 15 years. Therefore, importance should be attached to modernising, replacing and renovating existing nursing homes and residential care homes. Almost half of Norway's 90 000 spaces in institutions and residential care homes will soon be in need of renovation and replacement. The location and design of some of this building stock make it poorly suited to future user needs. The committee is concerned with ensuring that the renovation of the older building stock is completed well in advance of 2025, when the need for services hits the sector. It is also important to actively use this period to plan the expansion that will then take place.

Such renovation will pave the way for new structures and surrounding areas both for those who need services and for those who will provide care services in the future. This will generate opportunities for industrial development and a higher demand for construction and technology specialists. The committee recommends that municipalities, professional circles and companies view this as a call to innovate, in which the need is to find new solutions that both are adapted to the needs of future generations and the preferences of tomorrow’s local communities.

2.3.4 A national programme for municipal innovation in the care services

Innovation in the care services will occur primarily at the local level in the individual municipality, close to the users and the publicly elected officials responsible for the services. The central government’s role will be to establish an incentive structure that promotes innovation within the sector and to develop an infrastructure for research, development and innovation in the care services that takes the initiative and responsibility for coordination, network-building and the dissemination of results at the national level.

Activities within the care services sector are also crucial to municipal development. In the view of the committee, it is therefore necessary to give the municipalities access to instruments designed to alleviate some of their risk and protected financial schemes that enhance their ability to innovate, test new work methods and find new ways of performing caregiving tasks. The development of the care services sector is closely linked to other segments of municipal activity, and would benefit from the allocation of similar contributions from other ministries to other municipal sectors in the municipality.

A municipal school for innovation

The committee proposes that, in cooperation with the Norwegian Association of Local and Regional Authorities (KS), a national training programme in innovation be established for high-level municipal administrators and others who carry out key functions in or for the care services, or if appropriate other parts of the municipal sector.

One per cent of the budget to research, development and innovation (RDI)

The committee believes it is irresponsible to operate a public care services sector with an annual operating budget of some NOK 80 billion while allocating less than .002 of this amount to knowledge development and research, innovation and development activities. The major challenges relating to care services that society faces will require:

• more research-based knowledge in order to plan future services at the local as well as the national level;

• the willingness to take risk and ability to innovate in order to test new professional approaches and find new ways of performing caregiving tasks;

• long-term development activities in order to prepare and implement the necessary changes and restructuring.

The committee recommends the allocation of additional funding from the central government through an escalation plan in the period up until 2020, so that one per cent of the total care services budget is used to develop the knowledge base for these services. The financing scheme should be used primarily to test and disseminate new ways of performing the caregiving tasks, i.e. through the use of technology, work methods or forms of organisation that help people to take care of themselves longer or that frees up care services workers so they can spend more time with the individual users. The allocation of additional funding assumes a three-way collaboration between a service provider, a municipality and a third party comprised of civil society, the business sector or the research community.

NISO – An overall national responsibility for knowledge dissemination and innovation in the care services

The committee proposes that the Ministry of Health and Care Services and the Ministry of Local Government and Regional Development, in cooperation with the Norwegian Association of Local and Regional Authorities (KS), establish a secretariat for municipal innovation, which will initially focus on the care services sector with links to the regional centres for care research for the health and care services and the county centres for development of institutional and home care services. The main task of the secretariat will be:

• advise the service providers regarding the testing and development of new solutions;

• allocate and manage innovation grants, including evaluation, documentation and dissemination of results;

• coordinate and further develop local and regional innovation networks.

NORAGE – An event-history study

The committee proposes the establishment of a national database (NORAGE) and an extensive research project that follows a large number of individuals through the last third of their lives to obtain knowledge for use in the planning of the care services and society’s senior citizen policy in a wide range of different areas. A database of this type will provide a good framework for the design and investigation of questions for researchers with a background in the social sciences, medicine and other fields.

2.3.5 The care services as an industry

The committee sees great potential for developing a Norwegian-based industry for deliveries to the care services. The demand for appropriate housing solutions, activities and welfare technology tools will increase from households and the municipal care services sector alike. This means that the care services will become increasingly more open, and like other industries, will be more exposed to import and export.

An overall knowledge and industrial development policy

In the care services today, cooperation with other industries occurs mainly through the municipal procurement of sub-contracted goods or services. With regard to housing, this comprises a crucial part of the service provision, with large investments in nursing homes and residential care homes. Growth in the procurement of welfare technology solutions is also anticipated. It is important that this procurement power is strengthened, developed and managed so that it promotes innovation among the suppliers of services. In this way, clearer signals will be given to players in the business sector and other suppliers about what the care services sector requires in order to carry out its responsibilities in a better way in the future.

To enhance the ability of the care services sector to perform its function as a visible, competent and demanding procurer of services, the committee recommends three types of measures:

• Systematic training of municipal players to improve the performance of their role as procurers of services with innovation potential and to increase their expertise in managing supplier development and innovation processes in cooperation with players outside of the care services sector.

• A financing scheme for innovation projects in the care services sector, organised through a national secretariat for innovation in the care services sector.

• A national programme for the spread of welfare technology that will both increase the municipal players’ knowledge of and interest in welfare technology, and develop municipal expertise as procurers in this market.

Senior citizens’ market

The committee notes in particular that the individual senior citizens’ market will likely see strong growth in the future, both domestically and internationally. A large generation of senior citizens with considerable buying power will have an impact on demand. Many services and products that were previously channelled through needs-based public schemes will become available «off-the-shelf». The senior citizens’ market is vast. Therefore, Norwegian care services companies should cultivate an interest in, and focus their efforts on, market segments other than just the domestic public sector. This applies especially to the individual senior citizens’ market and to the potential for exports to other countries’ public procurement of services. In order to highlight and increase demand from the individual senior citizens’ market, the committee recommends measures to:

• raise the awareness of and strengthen the individual consumer in the markets for adapted housing solutions and welfare technology;

• increase demand for housing renovations to achieve more appropriate overall design and home interior elements.

In a business context, the committee also wishes to mention the advantages in renovating and upgrading today's homes and residential areas, and the need to replace or renovate up to half of Norway's 90 000 residential care homes and spaces in institutions in the next decade. The committee appeals to both the construction industry and the municipalities to find future-oriented solutions to this based on knowledge about the preferences and needs of new generations and user groups.

Cooperation among companies

Cooperation among private companies is critical to the development of products in demand within the care services. It is especially important that the housing industry and technology circles cooperate in viewing housing solutions and welfare technology as part of the same whole. Industrial cooperation with the involvement of research and development groups should be encouraged, regardless of the municipal dimension in the care services. In the view of the committee, three key conditions must be in place to promote such development:

• the need for industrial technical standards must be elucidated and clarified so that Norwegian products are developed according to standards that are future-oriented;

• the general system of public instruments must be used to boost interest in opportunities in the care services, and to encourage and finance development projects with relevance and commercial potential for individual senior citizens’ markets and for export;

• Norwegian export of care services products and solutions must be promoted, and the committee proposes establishing a special foundation for this purpose.

«NORCARE» – care services as an export product

Many countries have shown an interest in the Nordic model with well-developed public welfare schemes, gender equality and a high level of employment. With this as a trademark, a 50-year tradition of care services as a professional field and a more favourable demographic trend than in the rest of Europe, it is reasonable to consider exporting Norwegian care services to a rapidly growing international market in close cooperation with other Nordic countries.

With this in mind, the committee recommends that the Ministry of Health and Care Services and the Ministry of Trade and Industry establish an export foundation for care services modelled after the Swedish foundation SWECARE, and in so doing lay the foundation for Nordic cooperation in this area.

INN scheme

The committee also sees the potential for great economic gains by involving other sectors of society as suppliers to the care services sector. This can both revitalise the content of these services and evolve into a new, alternative source of income for these enterprises.

«Inn på tunet» is an initiative under the Agricultural Agreement that uses farms for municipal daytime activities for people who need special resources. The committee recommends that the INN scheme not be limited to agriculture, but be expanded to include a variety of industries, workplaces and enterprises that can provide interesting environments for a daytime programme adapted for activity, learning and skills mastering.

In this way, individuals can find activities suited to their own histories, backgrounds and interests, and companies and enterprises can make use of their particular surroundings and expertise to develop a supplementary product that is lacking in the health and social services.