This paper deals with “national agreements” within health care in Sweden, a country where responsibility for health care is decentralized to the 21 regions. The agreements are reached between the central government and the Swedish Association of Local Authorities and Regions (SALAR). National agreements have been a prominent feature of central-local government relations in Sweden in recent years, especially during Covid when agreements regulated, for example, vaccinations as well as infection tracking. The literature on governance categorizes agreements of this kind as “soft” policy instruments depending on factors such as voluntariness and the absence of sanctions. Another important factor is the participatory process behind the development of soft policy instruments. However, there is currently little knowledge on exactly how the national agreements develop and about the participation and influence of the association representing the regions at the central level - SALAR.

In this paper, we analyse the process behind agreements in Swedish health care with an emphasis on the participation and influence of SALAR. The following research questions are addressed: (i) How is the process behind the development of the agreements designed? (ii) what are the possibilities for participation and influence of SALAR in different stages of this process? (iii) are national agreements really a case of soft policy instruments considering the process in which they are developed?

Our empirical material mainly consists of interviews with politicians and civil servants representing SALAR and the Ministry of Health and Social Affairs. The findings suggest that the agreements are developed in a participatory process. However, differences can be noticed during various stages of the process. In the preparatory phase, SALAR has limited possibilities of influencing the overall topics for the agreements as well as the grants devoted. The overall topics for the agreements, as well as the grants devoted, are presented in the state budget each autumn. It is first thereafter that negotiations take place between SALAR and the government on the specific content of the agreements. These negotiations are intense during autumn in preparing the agreements for next year. In this process, interviewees at SALAR consider there to be possibilities to influence the content of the agreements. Even though the main conclusion is that the agreements are being constructed in a participatory process, it is not participatory in all aspects. This finding raises concerns about an uneven power-relationship between the state and SALAR. Further, it suggests that there is a need for a more structured negotiation order at the central level between central and local government.

Background: Digital transformation has lowered the threshold for communication. It is easier than ever to provide stakeholders with different types of information by publishing reports, statistics and the ability to daily use social media to keep stakeholders informed about current events. This holds true also for public sector organizations. We can also see how in the wake of NPM, there has been as Power (1997, p. 42) puts it: an audit explosion. NPM has resulted in an increased focus on ensuring compliance, reporting results and a focus on quality management and value for money.

To disclose information is often considered to increase transparency and in the extension of this the ability for stakeholders to hold elected officials and civil servants accountable. This is however not necessarily the case. For example, if the information disclosed is too technical and thus difficult to understand without specific knowledge. Hopwood (1987) argues that the use of numbers can lead to a ”technicization of politics” meaning that technical expertise is needed to gather and interpret the numbers. Also Rose (1991) points to the need for citizens to be able to understand numbers to hold politicians accountable. Organizations have an interest of their own in how they want to be portrayed, reports and statistics are thus not objective, but rather the result of political judgment as politicians not only decide what to measure, but also how to measure (Rose, 1991, p. 675).

From a democratic perspective, more information is thus not necessarily a good thing. How information is provided and in what format it is published is also important. The question is if the digital transformation has changed not only what public sector organizations communicate, but also how public sector organizations communicate.

Purpose: The aim of this study is to investigate the use of Annual Reports in municipalities. More specifically, the purpose of this study is to investigate i) how municipalities use the annual report to inform stakeholders about the financial status of the municipality and ii) what an alternative annual report that is less technical and more accessible could look like.

Theory: To investigate the use of the annual report and how it can be improved, the point of departure is theories on accountability and calculative practices and prior research on value for money in a local government context.

Method and empirical material: This study is based on a case study of how a Swedish city works with the annual report but also how they perceive an alternative annual report. The empirical material is mainly gathered through interviews and document studies. A smaller survey is performed of how other municipalities in the same region (in total 33) use the annual report to inform stakeholders about the municipality.

Contributions: This study contributes to our understanding of how the annual report, in the light of the current digital transformation, can be used to increase transparency and in the extension of this strengthen accountability and improve local democracy. The focus is thus on how an alternative annual report, independent and with a critical eye, can be used as a tool to bring the citizens back in.

References:

Hopwood, A. 1987. The Archaeology of accounting systems, Accounting, Organization and Society, Vol. 12 (3), pp. 207-234.

Power, M. 1997. The Audit Society: Rituals of verification, Oxford: Oxford University Press.

Rose, N. 1991. Figuring out democracy, Accounting, Organization and Society, Vol, 16(7), pp. 673-692.

Citizens’ trust in government is generally considered an essential component – and indicator – of well-functioning societies. It represents ‘the subjective probability of a citizen believing that the political system, or parts of it, will produce preferred outcomes even if this citizen takes no part in its production’ (Klingemann & Fuchs 1995: 22). In increasingly polarized societies, trust serves as a glue that binds individuals and government together. When citizens trust their government, they are more likely to actively participate in civic activities, engage in public discourse, and abide by the laws and regulations (Marien & Hooghe, 2011; Rudolph & Evans, 2005; Scholz & Lubell, 1998). Trust also fosters social cohesion, as it promotes a sense of collective identity and shared responsibility. Moreover, trust in government is closely linked to the legitimacy of political institutions.

Previous research has put forth the crucial relationship between citizens’ levels of political trust on the one hand and government performance and citizens’ evaluation of the incumbent government’s actions on the other hand (Hetherington, 1998; Finkel et al. 1989; Foster & Frieden, 2017; Keele 2007; Rothstein, 2011). A second strand of literature argues that trust originates outside the political sphere: cultural norms and early-life socialization (Almond & Verba, 2015; Inglehart, 1997; Mishler & Rose, 2001; Putnam, 2001), as well as interpersonal trust (Dellmuth & Tallberg, 2020) shape political trust. Third, trust in government is often explained by political and electoral variables (Listhaug, 1995; Miller & Listhaug, 1990; Newton & Norris, 2000) and external events such as crises (Schraff, 2020).

This study seeks to contribute to the literature by theorizing and testing the role of distance to central government on political trust. Until today, research on the relationship between spatial aspects of political systems and trust has mainly been limited to control variables related to the urban-rural divide and the scale of communities (e.g., Delhey & Newton, 2005; Denters 2002; Hooghe, Marien, & de Vroome, 2012; Mouritzen 1989). Adding to the limited body of studies that have taken a spatial perspective (Stein, Buck & Bjorna 2021), we conceptualize distance to central government as a multidimensional construct that consists of physical distance (measured as the number of kilometers from the capital), temporal distance (measured as the travel time to the capital through diverse transportation means) and public service distance (measured by the – lack of – public services in the locality). Each of these dimensions of distance is theorized to impact citizen trust in central government in particular ways. Therefore, studying different dimensions of distance between citizens and government provides insights into the factors that shape trust, enabling policymakers to identify strategies to bridge this gap and strengthen citizens' trust in central government.

This study explores the explanatory power of distance to central government on 1) citizens’ trust in central government and 2) the relative differences in trust between central and local government in the federal context of Belgium. In federal countries, the division of power between the central government and regional or state governments creates a delicate balance where citizen trust becomes crucial in maintaining stability and ensuring effective governance. As such, trust is essential for the central government to successfully navigate the complexities of federalism. Nevertheless, the complexity of the federal state structure poses a challenge to achieve trust.

The empirical context concerns 300 municipalities in Flanders (region of Belgium). For the dependent variables on citizen trust in government, we use data from the Flemish ‘Municipality and City Monitor’, which contains data on trust in government (next to a range of control characteristics) from a sample of 139.470 citizens that is representative for the population (response rate 36.9%). For the main independent variables on distance, we use travel times and distances to Brussels from 28 000 addresses in 280 municipalities. We retrieved data from the google API.