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Agreement on a Structural Reform

 


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Titel: Agreement on a Structural Reform
Publisher: The Ministry of the Interior and Health
Responsible institution: The Ministry of the Interior and Health
Copyright: The Ministry of the Interior and Health
Keywords:
Resumé:
Language: English
Version: 1.0
URL: http://www.im.dk/
Date: 2004-08-27
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Translated by Bullet Translation.

The publication is available on the internet at the homepage of the Danish Ministry of the Interior and Health (www.im.dk).

 


Table of Contents

Chapter 1 — Agreement on a Structural Reforms

Chapter 2 — Health Care

Chapter 3 — Employment

Chapter 4 — Upper Secondary School and Higher Preparatory Examination Course

Chapter 5 — Adult Education Centres (VUC) and Preparatory Adult Education (FVU)

Chapter 6 — Nursing and Radiography Educations

Chapter 7 — Social and Health Educations (SOSU)

Chapter 8 — Social Services

Chapter 9 — Special Education

Chapter 10 — Trade and Industry

Chapter 11 — Collective Transport

Chapter 12 — Roads

Chapter 13 — Nature and Environment

Chapter 14 — Planning

Chapter 15 — Improved Citizen Service

Chapter 16 — Taxation

Chapter 17 — Culture

Chapter 18 — Location of other Tasks

 


1. Agreement on a Structural Reform

between the Danish government (the Liberal Party and the Conservative Party) and the Danish People’s Party.

 

Introduction

The government (the Liberal Party and the Conservative Party) and the Danish People’s Party are in agreement that there is a need for a reform of the framework for public tasks and public service.

The purpose of the reform is to maintain and develop a democratically governed public sector with a sound basis for continued development of the Danish welfare state.

Denmark has a long-standing tradition of taking care of the most vulnerable elements in the society and of investing in people and the future. The public sector should have even better possibilities of doing so in future.

Therefore, the decentralised public sector, which is a distinctive Danish feature, needs to be designed in such a way that it can meet future requirements by creating sustainable units with a clear responsibility to provide high quality welfare service to the Danish population.

Larger municipalities can provide the basis for improved task solution where more welfare tasks are solved locally, and democracy will be strengthened as more political decisions are made locally. Efforts should be made to expand democracy so that the citizens can be more actively involved in the decisions. The municipalities of the future should find new ways to involve citizens and users in local decisions.

The reform is based on comprehensive groundwork. The recommendation of the Commission on Administrative Structure, which was followed by a broad hearing and debate, has formed the basis for the political process that has now resulted in this agreement on the general principles for the future public sector. Implementation of the agreement requires extensive legislative work.

The reform defines a new public sector where municipalities, regions and the state each have their own identity in terms of tasks. The state establishes the general framework. The municipalities will be responsible for tasks that involve the citizens directly and therefore become the primary access point to the public sector for citizens and companies. Five new regions will be responsible for the health care service, the instigators of regional development and responsible for solving major operational tasks for the municipalities.

The agreement will result in a reduction of the taxation levels from three to two.

The conciliation parties find that the agreement on a structural reform creates a joint and binding framework for further development of the public sector.

The parties have agreed to prepare a plan for a more detailed legislative implementation of the agreement by the end of September 2004.

In this connection, the government (the Liberal Party and the Conservative Party) and the Danish People’s Party emphasize the importance of a broad majority for the implementation of the structural reform. The conciliation parties are therefore open to an expansion of the group of conciliation parties with parties who wish to accede to this agreement before the implementation plan is finalized at the end of September.

The government and the Danish People’s Party have proposed to the political parties, who have declined to accept the conciliation agreement, that they accede to those parts of the overall compromise that are acceptable (without the right of veto) and thereby to participate in the legislative implementation within the areas in question so that legislation in connection with implementation of the structural reform will have the broadest majority possible.

 

Distribution of tasks in the future public sector

With this agreement, a fundamental reform of the public sector will be implemented. The counties will be dissolved and five elected regions will be established. Larger and more sustainable municipalities will be given the responsibility to handle most of the citizen-related tasks. The following section is a general description of the distribution of tasks. Reference is also made to later chapters where the distribution of tasks and responsibilities is described for the individual sector areas.

Within the social sector where the regions basically have been assigned responsibility for a number of the existing county institutions, a discussion will take place during 2006 between the committees responsible for preparing the new regions and the municipalities/integration committees with a view to investigating whether it would be expedient to transfer county institutions to the local municipalities where they are located from the commencement of the reform in 2007. In situations where a local government wishes to take over an institution, but an agreement cannot be reached, the division councils will make a final decision according to the guidelines that apply in these situations.

In connection with the new distribution of tasks which form part of the structural reform, the conciliation parties also note that there has been a gradual decentralization of tasks to the municipalities over the years. The parties agree that this development should continue. For this purpose, the liaison committee to be established between the region and the municipalities should at least once during each election period discuss whether responsibility for any social institutions in the region should be transferred to the municipality where the institution is located.

 

Municipalities

The municipalities will be responsible for solving most of the welfare tasks. Consequently, there is consensus about transferring a number of tasks from the counties to the municipalities as their increased size will enable them to solve more tasks.

Creation of new, strong municipalities establishes the basis for them taking on a more substantial role in relation to development of the local area. Increased professional sustainability in the municipalities implies inde-pendent handling of more technical and environmental tasks, a better infrastructure and improved business development.

The conciliation parties are in agreement that the municipalities in future should undertake a number of additional tasks:

Furthermore, the local governments will have the opportunity to solve a number of citizen-related tasks on behalf of other authorities in local service centres.

 

Regions

New regions become responsible for the health care service, including hospitals and the entire national health insurance service, general prac-titioners and specialists.

Furthermore, the regions will be assigned a number of positively delimited tasks involving regional development and solution of a number of tasks that the individual municipality is unable to solve appropriately.

The conciliation parties are in agreement that the regions should undertake the following tasks:

Finally, subject to agreement with the local governments, the regions can be contractors on local tasks that are naturally related to regional tasks where they have special skills, e.g. in rehabilitation.

 

State

In order to ensure coherence in task solution, certain tasks will be transferred to the state. As a result, responsibility for upper secondary schools and higher preparatory examination courses will be placed in the state together with the other youth educations. The state will assume responsibility for the Adult Education Centres (VUC), Preparatory Adult Education (FVU), including education of dyslexics, nursing and radiography educations as well as social and health educations.

County knowledge centres, state knowledge and communication centres, The Danish Centre for Technical Aids for Rehabilitation and Special Education and the most specialised national and regional counselling services will organisationally be concentrated under one umbrella – a natio­nal knowledge and special counselling organisation – with an executive committee consisting of representatives from the state, regions, munici-palities and consumer organisations.

Responsibility for the general road network will be concentrated in central government who will also assume responsibility for those county railways that are not transferred to the transport companies.

Taxation and debt collection will be concentrated in the state, but the day-to-day service of the citizens regarding tax matters will still be carried out by the municipalities.

In future, the state will undertake general administration and payment of EU structural funds. Finally, the state will be assigned a number of the tasks currently residing in the counties in the areas of environment, planning and culture.     

 

Municipalities

Division of municipalities

The conciliation parties are in agreement that the ongoing transfer of tasks to municipalities since the last local government reform and the citizens’ increasing expectations to the quality and efficiency of local services have created a need for larger municipalities. The need for larger municipalities has been further intensified by the transfer of tasks to the municipalities that the conciliation parties have agreed upon.

Furthermore, there is consensus that the merger of municipalities will reduce the need for municipal partnerships and create the basis for a clearer distribution of responsibilities and therefore a more transparent admini-strative structure for the civil society. In addition, the conditions for democratic control and cross prioritization of tasks will be improved.

The conciliation parties therefore encourage the smaller municipalities to merge into new and larger municipalities.

The Commission on Administrative Structure was of the opinion that municipalities with a minimum size of 20,000 inhabitants would provide the framework for satisfactory, professional sustainability in the solution of the most important current tasks.

Based on the conditions of this agreement where the municipalities are given increased responsibility, the conciliation parties find that a population of minimum 30,000 will be a good aim for establishment of new sustainable local governments. Establishment of the new municipalities should take correlation between cultural and business activities into account, and efforts should be made to include both rural and urban areas.

Municipalities with less than 20,000 inhabitants, which are not interested in a merger which could increase the population to a level of approximately 20,000 inhabitants, must enter into binding partnerships with one or more municipalities with a view to ensuring professional sustainability in task performance.

 

Binding partnerships

Binding partnerships implies delegation so that the local government(s) that delegate(s) tasks to another local government will retain responsibility, also financially, for the tasks as the assignment only applies to the practical performance. As responsibility is maintained in the delegating municipality, it will not be possible to concentrate all the employees within the individual fields in one municipality. Therefore, a condition for entering into a binding partnership will be that the demographic basis is at least approx. 30,000 inhabitants to ensure the required professional sustainability in the municipality which has been assigned performance of the task in question.

Binding partnerships should as a minimum include: Employment, visitation within social services, special education in special classes, special education for adults, rehabilitation that does not take place during hospitalisation, and tasks within the area of nature and environment that the municipalities will be taking over from the existing counties. Binding partnerships for the above-mentioned tasks should include a permanent group of municipalities.

In order to facilitate one-tier performance of certain tasks, some of the current local tasks should also be included in the partnership. This applies to cash benefits for the unemployed, special education in special classes, visita­tion, etc.

A binding partnership can only be entered into with a geographically adjacent municipality.

The conciliation parties are in agreement that special considerations should be taken regarding the islands that currently constitute – or are in the process of establishing – one independent municipality and where the local council does not wish the municipality to be part of a merger. Consequently, these municipalities will be requested to submit proposals indicating how they will ensure sustainability through binding partnerships with municipalities on the mainland.

 

Feedback from the municipalities

The Danish Ministry of the Interior and Health will contact the local councils by 1 July 2004 requesting them to inform the ministry by 1 January 2005 how they propose to achieve the required sustainability.

Local councils in municipalities with less than 20,000 inhabitants should state which merger of municipalities they wish to participate in. If the local council does not wish to enter into a merger of municipalities, the council should state with which municipality or municipalities binding partnerships will be made.

Based on the wishes of the local councils, division of the municipalities will be determined by the Minister for the Interior and Health pursuant to the provisions in a new law about division. A motion for the minister is being discussed by the conciliation parties. The conciliation parties have to agree on all important questions relating to the division.

Based on the agreements made by the local councils, a decision will be made as to which municipalities should enter into binding partnerships with each other.

If a municipality of less than approx 20,000 inhabitants has not made any agreement with one or more municipalities about a merger or a binding partnership, the Minister for the Interior and Health will make a decision on a merger in consultation with the municipalities involved and upon agreement with the conciliation parties.

 

Process for establishment of new municipalities

Elections for the local councils in the new merged municipalities and for the local councils in the other municipalities in the country will be held in November 2005.

The new, elected local councils in municipalities that are not included in a merger of municipalities will perform in accordance with the provisions of the Local Government Act and the Local Government Election Act effective from 1 January 2006 as local councils for the present municipalities.

In 2006 the elected local councils for the new, merged municipalities will have the role of integration committees with the authority to make preparations for the merger of municipalities.

Tenure for the local councils in the municipalities included in the merger of municipalities will be prolonged by statute by one year till the end of 2006.

The powers of the integration committees will be determined based on the authority bestowed on the integration committee in connection with the merger of municipalities on Bornholm.

In addition, it will be stipulated that some of the financial transactions of the current local councils, including large construction investments and supple-mentary appropriations, should be approved by the integration committees.

Consequently, the integration committees should be informed of the financial development, including liquidity in the merged municipalities.

The integration committees’ administration expenditure, etc. in 2006 will be paid by the participating municipalities. Payment will be distributed according to the tax base.

The new division of municipalities comes into force on 1 January 2007.

 

Governmental issues

The number of members of the local councils for the new merged municipalities will be determined as requested by the local councils in the municipalities included in the merger if agreement can be reached about an uneven number of members of 25 to 31. In case of disagreement, the number of members will be fixed at 25 to 31 members for the first term of office of the local councils as follows:

-         25 members in municipalities with 20-40,000 inhabitants

-         27 members in municipalities with 40-60,000 inhabitants

-         29 members in municipalities with 60-80,000 inhabitants

-         31 members in municipalities with more than 80,000 inhabitants

For future terms of office (effective from 1 January 2010), the members of the local councils in all municipalities with at least 20,000 inhabitants should be an uneven number between 19 and 31 as prescribed in the bylaw, however max. 55 in the City of Copenhagen.

In municipalities with less than 20,000 inhabitants, the number of members will be the same as before.

 

Participatory democracy

Transfer of new tasks to the municipalities will create the basis for strengthening participatory democracy. Larger and more sustainable municipalities will also facilitate central government initiatives being based on specification of goals, framework and performance requirements rather than detailed government. This will provide more freedom to organise task performance locally.

The conciliation parties agree that the possibilities of the structural reform creating the basis for strengthening local democracy through increased citizen participation should be investigated. In collaboration with representatives from the local government, village associations and representatives from other associations, activities will be initiated to facilitate involvement of citizens and consumers in local decisions.

In this connection a further investigation will be made as to whether consumer organisations could be given more authority and whether the rules for appointment of community groups provide the required possibilities of involvement of local areas in the new and larger municipalities.

The conciliation parties agree that the voluntary organisations in Denmark promote that people with different qualifications become involved in binding communities and activities. Voluntary organisations in Denmark promote interest in collectiveness and are of crucial importance for a live democracy. Public authorities can set aside funds for strengthening and initiation of joint initiatives between the state and voluntary organisations or target funds for special tasks that these voluntary organisations can undertake. Public authorities have an obligation to try to avoid that it becomes unnecessarily difficult to perform a voluntary task.

 

Local financing sources

In addition to the financing sources available to the municipalities today, financing will be provided as follows:

In connection with the assumption of these financing sources, the local block grant will be adjusted in order to balance local economy.

Local income tax will be imposed on the basis of the same levels of income as before. Local budgeting of the basis of income and equalisation may be simplified so that it becomes obligatory to use a government guaranteed tax base in budgeting. As a result of transfer of tax assessment to the state, equalisation will be based on the assessed income.

The structural reform will include implementation of an equalisation reform which will contribute to evening out the resulting shifts in the burden as much as possible. The size of the future municipalities, the type of municipalities to be merged, and the exact distribution of tasks will affect the equalisation. Division of municipalities is expected to be finalized during the first half of 2005. The exact distribution of tasks will be determined in connection with the reading of the bill during the session of the Danish parliament in 2004/2005, and a final decision on the distribution of tasks is therefore not to be expected until the actual division of municipalities.

In continuation of the committee’s Recommendation no. 1437, it has been agreed to request the financing committee of the Ministry of the Interior and Health to make a proposal for modifications of the local grant and equalisation system, etc. taking into account the final distribution of tasks and the division of municipalities. On this basis, the government will submit a specific proposal to be discussed by the conciliation parties with a view to presenting a bill.

In the deliberations of the financing committee, cf. the committee’s Recommendation No. 1437, a number of possibilities could be considered to obtain a more satisfactory distribution of the burden, including:

The equalisation reform will be prepared on the basis of a municipality of min. 20,000 inhabitants. The basic bonus in equalisation of expenditure needs will be abolished and replaced by other criteria. For island municipalities, however, supplementary subsidies will be maintained.

In order to even out the distortion of the sharing of costs involved in implementation of the reform and to avoid sudden impacts on the economy of the individual municipality, the conciliation parties are prepared to ensure that the same kind of transitional schemes apply as was the case during the last equalisation reform in 1996. This means that compared to the tax percentage to be calculated for the merged municipalities in 2007, the annual loss due to the restructuring of tasks and financing will only be 0.2 per cent of the tax base.

Preparation of the financing system has taken into account especially costly, individual cases within the social sector. Consequently, a state reimburse-ment scheme for this type of large expenditures will be introduced. The financing committee has been requested to submit concrete proposals accordingly. Reference is made to chapter 8 about social services. A final decision regarding the reimbursement schemes will be made in connection with decisions on modifications in the grant and equalisation system.

If difficulties arise in connection with preparation of a financing scheme regarding social services, the conciliation parties agree to discuss the possibility of maintaining a basic rate system.

 

Regions

Establishment of regions

Five new regions will be established to be regulated by their own law. The law will prescribe the general framework for government of the regions and which tasks the regions should undertake.

The existing counties will be dissolved and the same applies to the Greater Copenhagen Authority (HUR) and the Copenhagen Hospital Corporation (H:S).

The following five regions will be established:

A region covering North Jutland which provisionally will be called "Region Nordjylland"

A region covering Mid Jutland which will be called "Region Midtjylland"

A region covering South Jutland/Funen which will be called "Region Syddanmark"

A region covering the capital and Bornholm which will be called "Region Hovedstaden"

A region covering the rest of Zealand, etc. which will be called "Region Sjælland".

The regional division will be prescribed by statute. The government proposal forms the basis for the division.

The conciliation parties have considered whether the regional division in North Jutland should be changed.

The parties are of the opinion that the region covering North Jutland according to the government’s proposal will be sustainable considering the tasks assigned to the region, including the health care service. Therefore, the conciliation parties find that the government’s delimitation of the regions in North and Mid Jutland can be the final solution. However, they are aware that the region in terms of population is smaller than the other regions.

Upon evaluation of the matter, the conciliation parties can point at a solution for a possible expansion where all the areas in North and West Jutland become one region around Limfjorden. However, the parties are of the opinion that such a solution should not be finalised before the affected areas have had an opportunity to submit their comments. Consequently, general and positive backup from the municipalities in the area is required if the previously specified delimitation of the region in Mid and North Jutland is to be changed.

In addition to the areas in Region Nordjylland indicated in the government proposal, such a combined region would consist of the municipalities Sallingsund, Sundsøre, Spøttrup, Skive, Fjends, Vinderup, Holstebro, Ulfborg-Vemb, Thyholm, Struer, Lemvig and Thyborøn-Harboøre.

The parties will consider the comments received about regional boundaries in September in connection with the discussion of the implementation plan. Decision on the division will follow the political procedure mentioned in connection with division of municipalities.

Regarding regional affiliation in the area around Vejle, the conciliation parties have noted that a referendum has been held in Vejle which indicated that Vejle should belong to the region of Mid Jutland.

However, for a number of reasons, the conciliation parties have decided to maintain the boundaries indicated in the government proposal.

Firstly, for professional health care reasons. Vejle Sygehus is an important factor in terms of medical education, offers of treatment and dissemination of professional health care skills in the entire region of southern Denmark and thus a prerequisite for maintenance and development of the faculty for health care science at the University of Southern Denmark. Secondly, there is a joint business development effort in the area called the triangle which Vejle is a part of. Finally, the parties find that Vejle could be the natural administrative centre for a region in Southern Denmark, cf. below.

If, in spite of these reasons, there is still a local wish to change the regional affiliation, the parties will be prepared to accede to local wishes. The final decision on this matter will also be made in connection with the implementation plan in September.

Nevertheless, there is general agreement that the exact delimitation of all the regions should be adjusted according to local wishes regarding mergers across the regional borders indicated.

Regarding location of the central administrations of the five regions, the parties agree that they should use the existing county administration facilities to avoid construction of new buildings. Central administrations should also be placed geographically to allow reasonable accessibility from all parts of the region.

Therefore, location of the central administrations of the new regions will be prescribed by statute in the same way as the current legislation regarding counties.

Central administrations for the new regions will be located as follows:

Furthermore, the parties agree that the interests of those towns that loose status as head office for the county administration in connection with the reform will be considered with the location of the following new decentralised state administrations:

There is general agreement that Born­holm in Region Hovedstaden should be given own responsibility for regional development tasks.

 

Process for establishment of new regions

In November 2005 elections will be held for the governmental bodies of the new regions.

Tenure for the county councils will be prolonged by statute by one year till the end of 2006.

In 2006 the new, elected governmental bodies will act as preparation committees with the powers to make preparations for establishment of the new regions. The committees will be responsible for adoption of the bylaws of the new regions, the procedures of the regional councils, the first budget of the regional councils, structure of the regions’ administration, and any other decisions required to prepare establishment of the new regions. It will also be stipulated that some of the financial measures of the existing county councils, including large investments in construction and supplementary appropriations should be approved by the preparation committees of the new regions. Consequently, the county councils should keep the preparation committees informed of the financial development, including liquidity in the counties.

The county councils pay any costs involved in the administration of the preparation committees in 2006.

The new regions will be in operation on 1 January 2007.

 

Governmental issues

The number of members of the governmental body for the regions is fixed at 41.

Establishment of the regions and other governmental issues, including government system will be prescribed in the legislation about regions.

The governmental body for the region will be called the regional council and the chairman of the regional council will be called the chairman of the regional council.

In order to promote a good and ongoing collaboration between the region and the municipalities in the region, a liaison committee will be appointed consisting of the chairman of the regional council and the mayors who will meet twice a year.

 

Regional financing sources

The economy of the regions will be divided into two separate parts: Health care and other tasks. Financing of these two areas will consist partly of grants from the state, partly of contributions from the municipalities in the region.

 

Health care

The majority of the regions (approx. 75%) will receive a block grant from the statefor health care services. In order to give the regions equal opportunities to run the health care service, the grant will be distributed according to a number of objective distribution criteria reflecting the expenditure needs. These criteria will partly take into account the age composition of the population in the individual regions, partly the social structure that may have an influence on the need for health care services. The new distribution model will be introduced gradually over a five year period.

Furthermore, part of the state financing of the regions will be paid as a state, activity-related grant. The activity pool will be determined annually, but basically it only constitutes max. five per cent of the health care expenditure in the regions. The pool will strengthen the regions’ incentives to create increased activity in the hospital sector.

In addition there will be a local contribution to financing of the health care service. With this local co-financing, the municipalities will be assigned a larger role in the health care service. Due to the co-financing, the municipalities will become more interested in initiating prevention and encouraged to relieve the pressure on health care service.

Local financing consists of a basic contribution, amounting to max. DKK 1,500 per inhabitant, and an activity-related contribution. The basic contribution will be determined by the regions according to a detailed procedure, see below, and this contribution is expected to correspond to just under a tenth of the health care expenditure. The activity-related contribution is based on the citizens’ use of the health care service and will primarily depend on the number of people discharged from the hospitals. The activity-related contribution is also expected to finance approximately one tenth of the total regional health care expenditure. The contribution is described in further detail in chapter 2 about health care.

In order to finance the main part of the regional and local health care expenditure, the state imposes a health care contribution. The health care contribution partially replaces county income tax and the remaining part of the county income tax goes to the municipalities. The health care contribution, which is based on the local tax base, amounts to 8%, and the proceeds are paid to the state which distributes the funds to the regions and the municipalities.

 

Other tasks

For financing of tasks involving development of the regions, the outlying areas and the rural districts, the regions will receive a block grant from the state based on criteria corresponding to the tasks, and they will also be allowed to charge a development contribution per inhabitant in the municipalities. The development contribution can amount to max. DKK 200 per inhabitant. This contribution together with the block grant can be used for development tasks at the regions’ own discretion.

Finally, some tasks within social services and special education will be undertaken by the regions against payment of local rates.

 

Procedure for the regions’ specification of contributions from the municipalities

Limits for the basic contribution to the health care expenditure and for the development contribution, respectively, will be prescribed by statute and regulated annually based on the rate regulation percentage. Contribution per inhabitant within these limits will be specified in the annual financial agreements. The government can establish a netting mechanism that ensures neutralisation of proceeds in excess of what has been agreed.

If the individual region wishes to increase the contribution in relation to the basis stipulated, the region must give notice accordingly in due time to allow for a dialogue between region and municipalities before a final decision is made in the region in question. The dialogue will be anchored in the liaison committee to be established between the region and the municipalities of the region. Two thirds of the municipalities of the region can veto increases of the contribution that exceed the regulated rate. The process will be planned so that the local basic contribution is known so far in advance that it can be allowed for in the local budgets. Furthermore, the time of the decision should be coordinated with the budgeting schedule of the municipalities.

The local basic contribution to the health care service is initially fixed at DKK 1.000 per inhabitant. The development contribution will initially be fixed at DKK 100 per inhabitant.

In connection with preparation of alterations in the local grant and equalisation system, these amounts will be used as a starting point.

A more detailed plan of the future financing schemes for the regions will be discussed in the financing committee of the Ministry of the Interior and Health before the legislation is implemented.

Credit facilities for the regions will be determined annually.

 

Management of expenditure in the regions

Financing will be predictable for the regional councils given the financing sources mentioned and with clear rules about financial management and economic balance, the regions can take measures to avoid deficits. If there is still a risk of a deficit, the regions shall promptly take remedial action. The regions can be put under administration by the Ministry of the Interior and Health if the deficit continues to build up in the same way as municipalities and counties today. This requires preparation of a financial restoration plan, possibly supplemented by a short-term access to loans. In this connection the Minister for the Interior and Health can decide on a temporary deviation from the fixed maximum for the local contribution to the region.

Increases in the local contribution as a result hereof cannot be vetoed by the municipalities in the region.

 

Transfer of staff and division of assets and liabilities in connection with transfer of tasks

Staff

There is general agreement to establish the most secure framework possible for the staff during the restructuring.

The employees will basically follow the task, i.e. employees involved in tasks that are transferred to another authority should be transferred to the same authority.

Furthermore, it will be prescribed by statute that all employees under a collective agreement, etc. will be covered by the Company Transfer Act. Basically, employees have to accept a new employer, and they cannot consider a change of employer as a dismissal. On the other hand, they have the right to continue employment with the new employer on the same terms as before.

The conciliation parties have noted that the Minister of Finance has informed the employees’ organisations of the government’s proposal for a structural reform and the consequences to the staff. They have also been informed that meetings will be held as required during implementation of the reform.

The conciliation parties emphasize that the involved MED-committees in the municipalities and counties as well as consultative committees in the state will be involved in accordance with the agreements to this effect in order to ensure that staff representatives will get the opportunity to discuss legal, financial and social consequences for employees affected by the reform. The conciliation parties encourage the parties on the public labour market to create the framework for joint discussions between the MED-committees in the municipalities and counties regarding questions relating to the time after the merger of the municipalities and the transfer of tasks.

Furthermore, provisions will be made so that local authority officials get employment with the new authority on terms and conditions that are equivalent to those they had previously.

The specific distribution of staff will be agreed upon between the authority that releases staff and the authority that takes in staff. The integration and the preparation committees constitute the receiving authorities in connection with the new merged municipalities and regions, respectively.

Furthermore, five temporary division councils will be established with three members each who will have the authority to make a final decision on distribution of staff in case of disputes between the affected authorities. The chairman will be appointed by the Minister for the Interior and Health. In addition, one member will be appointed by the Minister of Finance to participate in discussions about division where the state is involved. Two members will be appointed upon recommendation by the municipalities. In cases where the state is involved, the council consists of the chairman, a representative from the Ministry of Finance and a representative from the local sector involved in the division. When the case concerns issues between the state and the municipality, the council will consist of the chairman and representatives from these sectors. The state provides secretarial assistance required by the division councils.

Time limits will be stipulated in the legislation to ensure that all the employees will be advised of their new place of employment in due time before the transfer of tasks/merger of municipalities takes place.

 

Distribution of assets and liabilities

In connection with changes in the distribution of tasks, assets/liabilities related to task performance will be transferred from the ceding authority to the receiving authority. It will be necessary to define which assets/liabilities and rights/obligations are to be transferred to which authority.

The specific distribution of assets/liabilities and rights/obligations will be agreed upon between the ceding and the receiving authorities.

The temporary division councils mentioned above will be given the powers to make a final decision on distribution of assets/liabilities and rights/ obligations in case of disputes between the affected authorities.

Time limits will be stipulated in the legislation as to when the final statements of assets/liabilities and rights/obligations should be ready so that the receiving authorities will have time to take appropriate action regarding contracts etc. that they will be entering into. The division councils will operate until the end of 2007 in order to make decisions in questions of doubt that may arise after commencement of the reform.

Transfer of tasks between the state and the municipalities before 1 January 2007 will be treated as normal transfers of tasks with the usual negotiations based on the expanded total balance principle.

 

Further initiatives related to the reform

Local service centres

Legislation will be implemented to facilitate establishment of local service centres to handle tasks involving citizen service across the state, regions and municipalities.

Barriers in the legislation that are inappropriate for the performance of tasks for the citizens in the local service centres will be removed. In this connection, exchange of information between relevant authorities will be facilitated. Please see chapter 15.

 

Reform of the regional governmental administration – including the supervisory and appeals structure

The current provisions regarding state counties and state county directors will be repealed. As a result of the agreed changes of structure and distribution of tasks, five new regional government offices will be established under the Ministry of the Interior and Health to handle tasks involving family and personal rights, free legal aid, appeals, etc. cf. chapter 18. The name and location of the offices will be determined in connection with the implementation.

The new regional government offices will have the same geographic borders as the regions. Each of the five new regional government offices will be headed by a director who will be responsible for the day-to-day management and for ensuring availability of the required skills to handle the tasks assigned to the office.

In order to simplify the citizen service, a number of adjustments of the distribution of tasks will be made in the area of family law. Establishment of the new regional government offices will be made gradually as the state counties are finally closed down by the end of 2006, cf. chapter 18.

The parties attach importance to a regional balance in the location of public workplaces. Therefore, location of the regional government offices will be related to the location of the central administration of the new elected regions. Branch offices will be established where the distance between the regional government office and the citizen makes it necessary.

Location of these and the new general tax administration in 25-30 tax centres will be coordinated with the location of other public workplaces, cf. the goal regarding a regional balance in the location of public workplaces

 

Establishment of an evaluation institute

The parties agree that the potential of the new structure for the public sector should be fully utilised. An independent evaluation institute will be established to systematically follow up on decentralised, public task performance and to publish comparisons of the results.

The institute should provide a joint anchoring of knowledge about solution of public tasks and improved comparisons across the municipalities and thereby create more openness and transparency in the public sector.

It is a prerequisite that the institute works closely together with other relevant knowledge and research institutions.

The purpose of the institute’s evaluations and analyses is to compare and assess decentralised task performance in the public sector and to support local efforts to enhance efficiency and utilisation of resources in task performance through improved financial management. In this way politicians will have the best possible basis for decision making, and the citizens will receive the best possible quality in the public service for their taxes.

The evaluation institute will be established by statute under the Ministry of the Interior and Health following discussions with the municipalities. The institute will have a consultative committee, an executive committee and a day-to-day management. By 1 July 2005 at the latest, an executive committee will be appointed in order for the evaluation institute to be operational from 1 January 2006.

 

The German minority in North Schleswig

The German minority in North Schleswig is a national minority in Denmark. The historical status of the minority implies that special considerations need to be taken.

The current financial grant that supports the cultural and social activities, etc. of the German minority will be maintained.

The government and the German minority will discuss how to facilitate the minority’s continued, local, political involvement. The discussion will be based on a model where it will become statutory for the future Region Syd­danmark and for future municipalities in North Schleswig to appoint a special committee with representatives from the minority to protect the interests of the German minority similar to the committees appointed according to section 17, 4, in the Danish Local Government Act.

 

Transitional schemes — in general

For each sector, cf. the individual chapters, transitional schemes have been made to ensure reasonable time to plan the future takeover of tasks.

It is to be expected that it will be possible to reap financial gain from the merger of municipalities and establishment of the new regions that will benefit the merged municipalities. However, the transition will also involve non-recurrent costs.

As a result of the fact that there is no time correlation between non-recurrent costs and lasting financial gain, the following special financing options will be made available upon submission of an application:

 

Other organisational or financial issues regarding the restructuring

In connection with decisions on transfer of tasks, the financing system and division of municipalities, it will be possible to calculate the new tax percentages that will ensure balance in relation to continued financing of an unchanged average expenditure level in the merged municipalities. In order to avoid unintentional slides in the tax and expenditure levels in connection with the reform, the parties are prepared to set an upper limit for local taxes corresponding to the calculated level during the transitional period. This will ensure that all taxes remain stable during the restructuring.

The Minister for the Interior and Health will also be able to decide on a differentiation of tax payment in the new merged municipalities during an interim period based on the rates of the original municipalities if any inappropriate financial measures have been taken in one or more of the merging municipalities or if other arguments justify such a differentiation.

For the first years after a municipal merger, the Minister for the Interior and Health will be able to make dispensations so that the service level in the merged municipalities for a transitional period can vary in the different parts of the municipality if there are any practical difficulties involved in harmonization.

In order to avoid unintentional effects of the local government reform, a mayor, who has only been in office during this election period – and is still a mayor during the period from 1 January 2006 to 31 December 2006 – but has been elected to the local council in a merged municipality during the first election period, will be entitled to pension at the expiry of the election period on the same terms as those mayors with an 8-year term of office.

 

Legal implementation of the agreement

General framework

The legal implementation of the agreement should create a new framework for public task performance. The parties agree that the reform should not result in higher taxes or increased public expenditure. Changes in distribution of tasks will be made based on the principle that the reform is neutral when it comes to expenditure and the funds follow the tasks. This should ensure that the authorities taking on new tasks will be compensated by the authorities giving up the tasks. The distribution is made on the basis of the annual accounts for 2003/2004, adjusted for price and wage inflation, any new legislation, changed demography, etc., cf. the normal expanded total balance principles.

 

Time schedule

Implementation of the agreement requires a large amount of legislative work including comprehensive coordination across the ministries. Bills regarding the agreement on a structural reform will be introduced to the conciliation parties by the Minister for the Interior and Health before they are submitted for a hearing and presented to the Danish parliament.

The required bills about distribution of tasks and division will be submitted to the Danish parliament in January or February 2005 at the latest when the government has received information from the local councils about specific wishes regarding mergers and binding partnerships to be adopted by the Danish parliament before the end of the session in 2004/2005. If required, the conciliation parties are prepared to try to postpone the start of the period where the parliament has no meetings.

Regional division and the new act on division of municipalities will be included in this legislation. Local division and any resulting changes of the regional borders will be determined administratively by 1 July 2005 at the latest. The conciliation parties will be involved in the decision about the final local and regional division, see above.

The entire reform will be implemented as a gradual transition from the existing structure and distribution of tasks to the new structure. However, the new geographic structure should be in place by 1 January 2007.

The time schedule for the restructuring in general is as follows:

The reform applies until it has been implemented in the individual sectors. Subsequently, the parties are at liberty to make changes in public task performance.

 

Constituency

Implementation of the structural reform creates a need to look at the current division of constituencies. After a discussion with the parties of the Danish parliament, the Minister for the Interior and Health will therefore take the initiative to appoint a constituency commission, who in the light of the new division of municipalities should consider the need for changes of the current division of constituencies and make proposals accordingly.

 


2. Health Care

The conciliation parties wish to support and promote a strong, public health care service that offers patients unrestricted, equal and free access to prevention, examination, treatment and care at a high professional level. Furthermore, the health care service should provide high quality and high level education and research.

Therefore, the conciliation parties agree on the following distribution of tasks and responsibility:

Larger regions are better equipped professionally and financially to take on the responsibility for the hospitals in accordance with the recommendations from the government’s consultative health care committee and the Commission on Administrative Structure, and a combined Copenhagen region will be better equipped to provide efficient coordination of the efforts in the entire Copenhagen area.

Fewer regions will provide a better basis for concentrating more treatments, exploiting the benefits of specialisation, and ensuring better utilisation of the limited staff resources. Furthermore, it will be easier to fulfil the common, national quality standards. The possibilities of establishing electronic case records to ensure exchange of accessible information about the patients will be improved. The new regions will also have sufficient professional and financial sustainability for high level research and education.

Research is an integral part of task performance in the health care service. Therefore, all the regions should be obliged to support high quality and high level research. The distribution of research funds should strengthen the research environments and provide the opportunity for the individual regions to develop their core competences.

Competence and responsibility to plan the health care efforts in the individual regions lie with the elected councils in the regions. The elected councils will be responsible for making a large number of decisions about regional health care services, e.g. prioritisation between treatment areas, physical organisation of the services, management principles for the hospitals, collaboration between the hospital service and the general practice sector, etc. It is also important that there is a general coordination of larger investments and expansions in the hospital service.

Focus should be placed on promotion of health and prevention. The municipalities should be able to find new solutions especially within prevention and rehabilitation, e.g. in the form of health care centres.

If the regions close hospitals, it should be considered whether available capacity could be used to establish and develop new local solutions within care, prevention and rehabilitation, e.g. as health care centres to be established in partnership with the health care regions. It will be specified exactly how to give the municipalities the opportunity and the time to react on decisions about closure of hospitals enabling them to coordinate local services with performance of other tasks in the health care service.

 

National coordination of specialty planning and quality

It is important that treatments originate from the highly specialised departments concurrently with development of the necessary routine on the basic level in the hospital service or in the primary sector. It is also important that there is coordinated use of highly specialised resources in the health care service and that the treatments offered meet the same high quality standards.

Suggestions from the central health care authorities regarding highly specialised types of treatment, e.g. location of treatment facilities for cancer and heart patients, will therefore be binding for the regions. Based on the recommendations from the government’s consultative committee and the Commission on Administrative Structure, the central health care authorities will specify certain standards for quality and application of IT in the regions.

Activities have been initiated to establish a Danish model for quality development in the health care service which will set standards for quality and ensure accreditation of the health care service. These activities should be maintained in a close collaboration between the central health care authorities, the regions and the municipalities. The National Board of Health will define specific requirements to standards, etc.

The central health care authorities define requirements for IT application standards in the health care service with a view to ensuring quick implementation of electronic case records in order to establish coherence in the systems across the regions. This will contribute to a positive patient process all the way through the health care system and ensure the best possible quality of the records of the health care service.

 

Local responsibility for rehabilitation

The municipalities assume responsibility for and financing of any training and rehabilitation that do not take place during hospitalisation. This task can be performed in own institutions, in private establishments or, upon agreement, in public hospitals. The specific framework for rehabilitation should be stipulated in the statutory health care agreement between the region and the municipalities see below.

The hospitals will continue to prepare plans for rehabilitation to define which type of rehabilitation the individual patient is entitled to. The plan is the patient’s security that a targeted effort will be made after the patient has been discharged from the hospital. The plans for rehabilitation will include a professional assessment of the functional level of the individual patient before and after rehabilitation.

In order to create financial neutrality between rehabilitation during and after hospitalisation and to avoid cash considerations, the municipalities will contribute to the financing of rehabilitation during hospitalisation through a basic rate model based on relatively few rates. Financing of rehabilitation is not included in the rate for hospitalisation of DKK 3,000, see below.

 

Increased cooperation between regions and municipalities

It is crucial for a positive and coherent patient process that cooperation between the hospitals, the general practitioners and the municipalities is efficient and stable.

Therefore, a statutory cooperation between municipalities and regions will be established in the form of obligatory, regional health care agreements to support the required coherence between treatment, prevention and care.

The obligatory health care agreements should include agreements on discharge from the hospital for weak and elderly patients, agreements on the social service for people with mental disorders, and agreements on prevention and rehabilitation.

The health care agreements will be anchored in the regional consultative committees consisting of representatives from the region, the municipalities in the region and private practices. The regional consultative committees can be used to resolve disputes, for example about the service level, professional indications and visitation criteria in the area of training, and create the basis for a continuous dialogue about planning of the effort.

The health care agreements should live up to requirements defined by central government, and service goals for the joint effort should be published.

Membership of the Negotiating Committee of the National Health Insurance Service will enable the municipalities to influence the collective agreement system and thereby ensure that more services are targeted at local needs, e.g. within social medicine.

 

A financing system that supports quality and coherence

The state pays a block grant to the regions based on objective criteria for the expenditure need. This gives the regions uniform financial conditions for tasks solution within the area of health care. Financing of the regions primarily originates from the block grant which gives the regions the freedom to prioritise and plan the effort. Part of the financing is reserved for a state activity pool that is paid on account to the regions and reduced according to fixed rates if the regions do not perform an agreed activity.

Systematic and publicly available productivity analyses at regional, hospital, department or any other relevant level should clarify the ability to provide value for money. The productivity analyses will become an important management tool ensuring that the best methods become known quickly. Furthermore, service declarations will create full openness about quality, services and facilities at the hospital wards.

In order to improve coherence between the health care service and local tasks, the municipalities will have a partial payment responsibility for the health care service.

Local contribution to financing of the health care service will consist of a basic contribution per inhabitant and an activity-related contribution. The scheme has been described in detail in the section about financing of the regions.

A partial payment responsibility for treatment of their own citizens, which depends on how much the citizens use the health care service, will give the municipalities the incentive to make an extra effort within the area of prevention, training and care.

The activity-related local payment goes to the region and includes:

Those municipalities that manage to reduce the need for hospital treatment through an efficient effort within prevention and care will be rewarded by having to pay less for hospitalisation of their citizens. The citizens will benefit from more needs being fulfilled properly in the immediate environment close to their own home and their own doctor.

Reducing unnecessary hospitalisation and ensuring that treated patients are discharged as quickly as possible will be accomplished by making the current care rate, which the counties today charge the municipalities for treated patients, obligatory both for somatic and for psychiatric patients.

Local co-financing of health insurance services and local representation in the Negotiating Committee of the National Health Insurance Service support the correlation between the private practice sector and the municipal effort, e.g. a closer interaction between general practitioners and the municipalities (in the area of sickness benefits, in home care, etc.).

 

Transitional schemes

In order to ensure a gradual and flexible equalisation of the existing differences in the financial situation in the regions, the new subsidy model will be introduced gradually on the basis of objective criteria over a period of five years.

 


3. Employment

The future employment system will be organised with local job centres so that citizens and companies have one access point to employment activities.

There is general agreement about the following central elements:

 

Everything under one roof: Cooperation between the Danish Employment Service and the municipalities about the entire employment effort

A cooperation between the Danish Employment Service and the municipalities about joint job centres will be established throughout the country so that citizens and companies have one access point to the employment effort. One access point for everyone - for the unemployed who need a job, for the citizens who would like another job, and for the companies who need employees or those who want to retain employees.

Close to 1.2 million citizens are currently in contact with the local government or the employment service every year. Therefore, it is important that the employment effort in future takes place close to the citizens and the companies. The strong unemployed should have jobs and not become clients. The unemployed with good qualifications should only have limited contact with the job centre. The unemployed on the edge of the labour market should be offered jobs combined with a social subsidy if required. No one should be left unattended.

 

Cooperation between the Danish Employment Service and the municipalities will be based on the following model:

There is general agreement about the following:

 

Joint job centres all over the country

 

Up to 40 job centres with special responsibilities