Despite recent social welfare cuts, few would be surprised to learn that Sweden is leading the way when it comes to assistive technology. Two Isabel Schwarz Award winners, both Lambeth Council professionals, recently travelled there to find out more. Corin Williams reports
Many of us here in the UK, particularly those with centre-left leanings, have often held up Sweden as a beacon of hope a country whose rational, well-funded education, benefits and social services systems appear embedded in its liberal tradition. However, since the social democrats lost power to conservatives in 2006, benefits have been cut, as have taxes. Conservative leader David Cameron welcomed Swedish prime minister Fredrik Reinfeldt to London recently by saying that the Swedish were on the same page as the centre right elsewhere and confronting the issues of “how to make bold and lasting change, how to reform welfare in health how to put the consumer in control, in education how to put parents in control”.
But Sweden has a long history of commitment to social justice that won’t just evaporate. Its philosophy of inclusion for all disabled people, developed in the 1950s, and a political commitment to provide assistive technology drew UK social workers Greg Brown and occupational therapist Hoa Nguyen to visit Stockholm. As their local authority, Lambeth in south London, is in the early stages of implementing an assistive technology and telecare programme for its adult clients, Brown believes there is a lot to be learned from the smorgasbord of equipment available to Sweden’s disabled and older citizens.
“Their system of assessing and prescribing care could be put in place here,” he says. “It’s a much broader system than we have in the UK. For instance a wheelchair can only be prescribed within our borough by the primary care trust, but over there it would be possible for an occupational therapist within a hospital or even within a local authority to prescribe a chair to a client.”
Like the UK, Sweden has an ageing population. “Sweden is now called the ‘land of the four-wheel walking frame’,” Brown says. “Everyone aged over 80 has basically been provided with one free. They worked out that a walking frame is about 1% of the cost of a hip replacement operation, plus the level of support over the months after that.”
This sort of cost-effective solution has been made possible in Sweden by a long-term enthusiasm for assistive technology. “There’s not the same stigma of using equipment as in the UK – it’s just another way of getting around.”
There are a vast array of assistive technology products in Sweden produced by 250 firms. Brown and Nguyen visited the government-funded Swedish Assistive Technology Centre to find out more. “It’s the major player in devising and researching assistive technology across Sweden,” says Brown.
“They have quite an international focus, people visit from as far afield as Japan or China. Videos, libraries, [on assistive technology] you name it, it’s all there.”
But it was not just the range of equipment that impressed Brown, it was the way that equipment was prescribed. “Because their principle is built on looking at the vocational, educational or recreational goals for a client, they provide things like bicycles for children with disabilities – a difficult thing for us to do within our work. The things that stood out for us were wheelchairs for toddlers. There was also the possibility that a person could be given four wheelchairs because they had different needs within different environments. That would be very difficult if you were in the UK.”
Brown has brought many ideas back with him that could help Lambeth improve its service, particularly around training for social workers. “Most of the professionals we spoke to there were quite surprised when I explained to them that social workers in Lambeth were doing assessments for grab rails and things like that. It raises big issues for the level of ongoing training and support we need.”
Lambeth has recently appointed an occupational therapist manager to lead a telecare/assistive technology pilot project, which is why Nguyen joined Brown on his nine-day fact-finding mission. She shares his commitment to independent living and was similarly impressed by what she saw. “The Swedish have a strong model looking at prevention and improving an individual’s function,” she adds.
Nguyen found that the range of people she met gave her a useful overview. “The visit was dominated by occupational therapy. Equipment was prescribed mainly by occupational therapists and physiotherapists – in contrast to the UK where social workers play a key role. It was interesting to see how our interpretation of assistive technology differs so much from theirs, and how occupational therapists over there are recognised in their own right for taking a lead.”
Free care packages
However, Nguyen and Brown both question whether providing free care packages is a sustainable proposition. “Equipment is currently not means-tested and you don’t pay a contribution towards it,” says Brown. “There’s no real limit to what you can get. There’s concern that Sweden can’t continue to afford a model like that.”
Under its current government, it could be that Sweden adopts a more client-focused system where the user has more of a say in the kind of equipment they are given. While this may benefit those clients who are overly dependent on a prescriber, it may bewilder many of those unable to cope with the sheer level of choice on offer. Brown met one prescriber who had not offered telecare in over five years as he was not up-to-date with the latest practices. But whatever glitches appear in the Swedish model, Lambeth can learn a lot from a country that has been one of Europe’s leading lights in the care of older and disabled people.
ABOUT THE FELLOWSHIPS
The IS Travel Fellowships are bursaries which enable social workers to travel abroad and examine good practice, with the aim for the experience to inform their own practice in the UK. The fellowships commemorate the life of Isabel Schwarz, a social worker in Bexley, Kent, killed by a mental health client in 1984.
This article appeared in the 17 April issue under the headline “Swedish techno”