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Velferdsstaten forskrever seg

Til tross for økende rikdom, blir det stadig vanskeligere å finansiere velferdstjenestene. Velferdsstaten forskrever seg, men få registrerer spagaten.

"Statens helsetilsyn mener at samlet sett gir funn fra dette landsomfattende tilsynet gode holdepunkter for å konkludere med at de fleste av kommunene som er undersøkt, ikke sikrer at tjenestemottakere med langvarige og sammensatte behov får et forsvarlig tilbud om kommunale helse- og sosialtjenester. Tilsynsmyndigheten har avdekket svikt på flere nivåer og flere områder i kommunenes arbeid med å gi disse tjenestemottakerne et helhetlig, koordinert tjenestetilbud over tid."

Sitatet er hentet fra helsetilsynets rapport nr. 3, 2006: "Et stykkevis og delt tjenestetilbud", da var det allerede gått 16 år siden Stortinget sluttet seg til st.meld. 47 (1989-90) "Om gjennomføring av reformen for mennesker med psykisk utviklingshemming". Etter den tid har det kommet rapporter på rekke og rad som alle sier at rettigheter brytes og at utviklingen er i strid med nasjonale politiske målsetninger. Men verken offentlige rapporter, innstillinger fra Stortinget eller offentlige utredninger synes å ha ført til noe som helst. 

Velferdsstaten forskrever seg, – vi er taperne

Velferdsstaten vokste frem gjennom en gradvis utvidelse av 1800-tallets fattiglover. Et lovverk som gikk over til å bli et trygdesystem for stadig flere grupper av befolkningen. Trygdesystemet er regelstyrt. Rettsikkerheten er høy med en to trinns klageordning hvor Trygderetten fungerer etter en domstolmodell. Trygdesystemet finansieres av staten gjennom overslagsbevilgninger i statsbudsjettet.

De som ikke ble omfattet av trygdesystemet, kom inn under sosialhjelp, et langt mer skjønnsmessig system med lav rettsikkerhet og en finansiering som er overlatt til kommunene. Med tiden kom omsorgstjenestene inn i sosiallovgivningen, uten at det fikk prinsipiell betydning verken for rettsikkerheten eller finansieringen. I dette bildet er mennesker med bistandsbehov den lavest prioriterte gruppen, blant de siste som ble omfattet av statens velferdsordninger. En gruppe hvor likestillingsfokuset først og fremst anvendes i festtalene.

Rettsikkerheten var svak og er blitt svekket gjennom vingeklipping av fylkesmannen både ved innføringen av helse- og omsorgstjenesteloven og nyere endringer av fylkesmannens kompetanse.

Hvorfor galt blir verre

Tall fra SSB viser at i 2006 var gjennomsnittsinntekten til norske husholdninger 379.800 kroner. I 2016 var tilsvarende tall 571.600 kroner. I samme periode økte brutto nasjonalprodukt fra 2215 milliarder kroner til 3117 milliarder kroner. Inntektene har økt omtrent med 50 prosent siden 2006.

Utgiftsveksten har imidlertid vært vel så stor og den burde ha vært større for å dekke allerede eksisterende forpliktelser. Pengene til velferdsgoder renner i hovedsak ut gjennom sykehusene, NAV og kommunene. Nye velferdsordninger har kommet til. Eldrebølgen har økt antallet pensjonister med 50 prosent siden 2006, noe som gjenspeiles i økte utgifter både for spesialisthelsetjenesten, NAV og kommunenes helse- og omsorgsbudsjetter. Stadige medisinske fremskritt bidrar til å øke antallet personer som kan behandles på sykehusene. Kravene fra kommunens innbyggere og ønskene fra kommunepolitikerne om større kulturhus, bedre veier og flere sykehjemsplasser er også med å bringe utgiftene oppover.

Selv om de økonomiske mulighetene for å sikre likestilling har vært tilstede, så har funksjonshemmedes rettigheter blitt svekket. Andre grupper har blitt prioritert. Nå styres tjenestene til mennesker med funksjonsnedsettelser av en eldreminister. Det er det fare for at vi drukner i eldrebølgen.

Inkonsistensen som fører til at spillet får sin løsning

For å sikre at innbyggerne får sin rett, har staten utviklet en rekke kontrollmekanismer. Utgifter til trygdesystemet har statlige myndigheter liten kontroll med. Det er overslagsbevilgninger og de individuelle rettighetene er gitt ved lov. Men staten har sterk kontroll med den kommunale pengebruken. Kommunene har ikke andre inntekter enn dem de får fra staten:

  • Det er staten som har rett til å skattlegge. Staten bestemmer hvor mye skatt kommunene kan kreve av sine innbyggere.
  • Staten bevilger hvert år et rammetilskudd til kommunene, et tilskudd omtrent like stort som kommunenes skatteinntekter.
  • Staten bevilger tilskudd til bestemte formål i kommunene, det en kaller for øremerkede tilskudd.
  • Staten bestemmer hva kommunene kan kreve egenbetaling for og rammene for egenbetaling.

Samtidig med at staten styrer kommunenes inntekter, så gir de kommunen plikter og innbyggerne rettigheter overfor kommunen. Kommunenes inntekter og plikter er frikoblet. Når Stortinget gjør vedtak om rammtilskuddet til kommunene, så ser de ikke på kommunens evne til å utøve sine plikter.

Tabell: Fordeling av kommunenes brutto driftsutgifter for 2017 (Kilde: SSB)

  Prosentandel av totale utgifter i kommunene
Helse- og omsorg 30,2
Grunnskole 19,0
Barnehage 11,5
Eiendomsforvaltning 6,7
Sosialsektoren samlet 5,3
Administrasjon, kommune 5,3
Vann, avløp, renovasjon, avfall 4,7
Kultursektoren 3,7
Barnevern 3,2
Samferdsel 2,1
Kommunale boliger 2,0
Fysisk planlegging, kulturminner, natur, nærmiljø 1,6
Brann- og ulykkesvern 1,3
Næringsforvaltning 1,2
Kirke 0,8
Politisk styring og kontrollvirksomhet 0,6
Fellesutgifter -0,2

 
Den ulykksalige skjebnen til mennesker med store bistandsbehov, er at de både tilhører et område med omtrentlig lovgivning og svak rettsikkerhet samtidig med at de inngår i kommunenes største utgiftspost, –helse- og omsorgsektoren.

De andre store utgiftspostene er vanskelige å gjøre vesentlige kutt i. Kostnadene med skole og barnehage er stort sett gitte på grunn av stramme rammer knyttet til timetall og bemanningsnormer. Blir utgiftene til vei, vann og renovasjon for små, så merkes det på en slik måte at kommunen må finne ekstramidler umiddelbart. Når det gjelder omsorgstjenestene, så har en imidlertid det som økonomene kaller for handlingsrom. En trenger kort og godt ikke utøve kommunens plikter. De som rammes er de som fra før er gjemt bort i kommunens bofellesskap.

Det finnes løsninger på problemet. En kan koble kommunens inntekter med kommunens plikter, en kan styrke tjenestemottakers rettsikkerhet, sanksjonsmidler kan innføres. Ulempene med løsningene er at de til syvende og sist vil koste penger, mye penger. Når tjenestene til personer med utviklingshemming ikke er kommet på plass etter 27 år, så kommer det enten av at ingen politiske flertall har vært villige til å betale prisen for forslagene som et samlet Storting gikk innfor i st.meld. 47 (1989-90) eller at styrerne ikke er klar over stryringssystemet og tilstanden i sektoren.

Jens Petter Gitlesen

17 desember 2018

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