Multi-level Coordination Bodies of Democratic Nexus Governance for the Frail and Elderly in Sweden

Many groups of citizens’ complex needs require increased coordination as the welfare state's responsible agencies belong to different levels and forms of authority – often governed by separate laws and regulations – and are democratically accountable for the performance of both public and private service providers. This challenge constitutes a new and emerging pressure on cities and regions where they must increasingly co-operate through multilevel governance nexuses in a growing number of policy areas. In Sweden, such multi-level bodies for strategic coordination for the frail elderly for getting both elder care from the city and health care from the region rests on a complex, geographical belonging, sometimes determined by partnership through local-regional government associations, or residing within the borders of a single county. The purpose of this paper is to analyze such multi-level democratic governance coordination nexus bodies as a new and emerging phenomenon; hence the aim is to answer three questions: How are they staffed? How do its members regard their governance roles, representation, activity, mission, influence and decision-making? How are they held accountable? The paper takes its theoretical basis in the framework and research on democratic network governance and transparency-accountability-representation nexuses. Information about these multilevel local-regional governance bodies for strategic elder care coordination in Sweden was gathered in two steps. First, in 2014 an initial survey directed to local government social service managers responsible for elder care was performed in a randomized stratified sample which covered one third of the 290 Swedish local governments at municipal level. From this first survey, we got information from about 60 local governments’ social service/elder care managers on their representation in such bodies and all its members. Based on this information, in a second step we selected 73 multilevel governance bodies for a new survey performed in 2015, directed to all members (local and regional politicians and administrators, public and private service providers and professionals) in each sampled multilevel governance nexus or network. The sample of relevant representatives from these bodies in the survey came to include 870 persons, with a response rate of 63 percent (n=545) and participation from all 73 sampled multilevel governance bodies. The analysis shows how these coordination nexus bodies are staffed, and what its members are doing as representatives and decision-makers. Regarding the coordination bodies´ assignments, the perceptions between the different nexuses vary, where the most common perceptions are to create common values and to create rules. It is less common to perceive the role of resolving conflict. Its members consider themselves to have varying influence over the operations, and the various members are attributed as having fairly great power. However, power and accountability do not seem to accompany each other, and the coordination nexus bodies and its members are not held accountable in a clear manner of their principals, which must be regarded as problematic from a democratic perspective. In the end, we discuss the implications of our findings in relation to theoretical issues related to democratic network governance and transparency-accountability-representation nexuses in a broader sense.