Abstract
Political accountability is fundamental in a democratic society. Societal changes such as the marketization of the public sector have, however, made accountability issues complex and negotiable. The question of who is to be held to account for policy failures is increasingly a subject of struggle within the media. The aim of this article is to examine how journalism does “accountability work” in a political setting marked by new public management. The empirical study focuses on an example of intensive news coverage of the mistreatment of elderly people in private health care, in Sweden, 2011. A corpus of 156 news items is analyzed. The analysis focuses on the use of accountability interviews, and how journalism constructs boundaries of political accountability by framing social problems. In general, the study shows that the political accountability work carried out was weak and restricted, the problems were constructed as a moral scandal instead of a policy failure.
The principle that public authorities should be answerable to the public and that politicians can be held to account for their actions is fundamental in a democratic society. Public accountability is, thus, a cornerstone of democracy (Bovens et al., 2008; Mulgan, 2000; Przeworski et al., 1999).
A number of studies have, however, identified several problems when it comes to enforcing political accountability in contemporary democracies. Most importantly, pervasive societal changes such as globalization, multilevel democracy and the marketization of the public sector (privatization, deregulation, new public management) have made accountability issues complex and negotiable rather than clear-cut and straightforward (Bovens, 2007; Bovens et al., 2008; Held and Koenig-Archibugi, 2004; Peters and Pierre, 2006; Przeworski et al., 1999).
Additionally, the ongoing mediatization of politics has made matters of political accountability a pertinent object for public debate and journalistic scrutiny. The question of who is responsible for causing (or resolving) social problems and who is to be held to account for political malfeasance and policy failures is thus increasingly a subject of struggle within the space of mediated visibility (Iyengar, 1991; Maia, 2009).
The aim of this article is to examine how journalism does accountability work in a political setting marked by new public management: that is, where the delivery of health care services has been relocated from local and regional government to private health care corporations by means of competitive tendering and contracting. Countries like Australia, Great Britain, Denmark, the Netherlands and Sweden have all witnessed similar, ideologically driven, shifts towards marketization of public sector services, such as health care and care of the elderly. Governments on different levels are still principally responsible for public services and private health care in for example Sweden is still publicly funded. The trends toward a depoliticized public sector (Bozeman, 2007; Peters and Pierre, 2006), the reduced space for political responsibilities and the shift in the distribution of responsibilities, however create new general challenges and problems for journalism when it comes to scrutinizing politics. The main question explored in this study is how political accountability is constructed and negotiated in the news media. To what extent, how and for what actions are different actors held accountable in journalism? More generally, the study discusses the preconditions for the watchdog role in journalism and from what legitimate positions journalism manages to scrutinize politics and policy regimes in a democracy transformed by the marketization of the public sector.
The study is designed as an explorative case analysis. We have strategically selected a case where problems and responsibilities in private health care have received considerable attention in public debates and intensive news coverage. This makes it possible to analyze how journalism deals with the political responsibilities in a situation where problems in the public sector is obviously understood as significant and given high priority in the news. The specific case in focus is the “Carema case” that occurred in Sweden in the fall of 2011, when the private health care corporation Carema was accused of mistreating the elderly in its nursing homes. The criticism was initially voiced in an article published by the dominant morning paper in Sweden, Dagens Nyheter, in October 2011. Several media followed suit and reported on similar and related cases, providing their own investigative reports on the conduct of Carema and other private health care providers. The disclosures evolved into a national scandal, where the news media exposure to a large extent came to deal with questions of responsibility and accountability. The empirical analysis examines the extent to which, and the ways in which practices, problems and failures in nursing homes owned by Carema are constructed as political problems in the news, and how political actors are held to account for the situation.
The article explores how journalism does accountability work, by drawing from two different research traditions within media studies. The first is framing analysis (Entman, 1993; Gamson and Modigliani, 1989), and the question is how journalism constructs definitions and boundaries of political accountability by framing social problems in terms of causes, solutions and responsibilities. The second builds on the tradition of analyzing journalistic practices and discourses, in this case the accountability interview (Clayman and Heritage, 2002; Montgomery, 2008). The question is how such interviews are used in positioning actors as responsible and asking politicians to justify their decisions and actions (or non-actions). By combining these two approaches the study provides both macro (framing) and micro (discursive practices) perspectives on the role of journalism in accountability processes.
The article starts with a discussion on how the concept of public accountability can be understood and defined, and how it has been applied within the fields of journalism and media studies. The next part describes the analytical approach, method and data used, followed by a presentation of the results of the study. The framing analysis is described first, arguing that three major frames were employed in the Carema coverage and that each promoted certain interpretations of accountability. This is followed by the analysis of how accountability work is performed specifically through the use of journalistic interviews. A concluding section discusses the main findings of the article and its more general implications.
The media and accountability
In the research literature on accountability, which mostly emanates from political science or public administration, the media and journalism have received scant attention. Bovens observes that “in many countries, the media are fast gaining power as informal forums for political accountability” (2007: 455), and other studies mention the media as well (e.g. Bovens et al., 2008; Mulgan, 2000), but, when discussed, the accountability work performed by the media is rarely analyzed in any detail.
In media studies, however, the role of the media in accountability processes is indeed a key issue. The watchdog function of the media is fundamental in a democracy (Ettema and Glasser, 1998) and it is also a role-defining professional ideal among journalists to scrutinize those in power. Accountability issues are also highly relevant in research on political scandals, studying how the media define scandals, make them evolve, and what the consequences are for the political system (Allern and Pollack, 2012; Ekström and Johansson, 2008; Thompson, 2000; Tumber and Waisbord, 2004). Other fields of media research that to some extent discuss the problem of accountability are studies on the quality of election coverage (Asp, 2007; Esaiasson and Håkansson, 2000), crisis communication and blame avoidance (Bovens et al., 1999; Brändström and Kuipers, 2003; Hood, 2011), rhetorical criticism (Benoit, 1995; Kelley-Romano and Westgate, 2007) and framing analysis. In the latter vein, Iyengar (1991) studied the extent to which the media focus on causal responsibility (who caused the problem?) and treatment responsibility (who is responsible for solving it?).
Studies that specifically focus on the accountability work performed by journalism are, however, rare. Maia (2009) and Bonner (2009) both investigated the role of the news media in accountability processes in political crises in South America. Other scholars have explored accountability interviews as a particular journalistic practice: how accountability is achieved through the specific design of interview questions (Clayman, et al., 2006; Montgomery, 2008) and how politicians respond to accountability questions and related communicative conflicts (Clayman and Heritage, 2002; Ekström, 2009).
Although media scholars have demonstrated a prolific interest in the general function of the media as an informal “accountee” (Bovens, 2005: 184) in democratic politics, less consideration has been given to the theoretical concept of accountability. The concept is, on the other hand, widely discussed in the research literature in political science and public administration. When examined closely, however, it emerges as rather elusive; it is something no one can be against, like “democracy”, “transparency” and “justice”. This vagueness has led to an all-encompassing use of the concept (Mulgan, 2000). As pointed out by Bovens, accountability “resembles a dustbin filled with good intentions, loosely defined concepts and vague images of good governance” (2007: 449).
In the present study we choose a narrower conceptualization of accountability, recognizing it as a social relationship that is exercised through specific institutional arrangements. Furthermore, we focus on public accountability, where “public” refers to an account-giving that is done in public: that is, it is open or at least accessible to citizens (Bovens, 2005: 183). Following the work of Bovens, we understand public accountability as: a relationship between an actor and a forum, in which the actor has an obligation to explain and to justify his or her conduct, the forum can pose questions and pass judgment, and the actor may face consequences. (Bovens, 2007: 450)
The chosen definition is more precise than the wider notion of public accountability that incorporates almost everything that can be related to “good governance”. In another sense, though, the definition is considerably wider. In accountability research, much effort has been put into evaluating the function of formal accountability regimes, such as legal and political channels of public scrutiny (Mulgan, 2000). When public accountability is defined as a social relationship it allows for the inclusion not only of formal accountability regimes, but also of other institutionalized practices where accountability claims are articulated in a public forum, that is, journalistic practices such as press conferences or journalistic interviews. It also makes it possible to study accountability as a process, where the final outcome (who is held to account for what) depends on how responsibilities are defined, perceived and managed by actors within the specific public forum (Hood, 2011; Maia, 2009).
The accountability literature recognizes different types of accountability, where the political is distinguished from legal, administrative, professional and social accountability (Bovens, 2007; Maia, 2009). In these studies, the accountability work conducted by journalism and the media is sometimes classified as political (informal) and sometimes as social (related to non-governmental organizations, interest groups and civil society) accountability. Such typologies are constructed on generalized notions of what the actor is held responsible for and the type of forum to which the actor has to explain and justify their actions.
In the present study we have opted for another approach, choosing to make the specific type of accountability put forward by the media an empirical question for investigation. The focus is on political accountability and how it is constructed in the news media, but we also consider the way that other forms of accountability (legal, professional, administrative) may be emphasized in the media reports. The extent to which a problem is politicized is a matter of debate, and political accountability is defined and established in relation to other forms of accountability; that is, a critical issue in implementing new public management regimes is to do with the diminishing role of politics in favor of market mechanisms (Peters and Pierre, 2006). A key question for the analysis is thus to examine to what extent political accountability is emphasized in the news media in relation to other types of accountability as the Carema case develops.
The institutional arrangements for the implementation of public accountability – including formal constitutional arrangements as well as journalistic practices in which political leaders are held to account – are based on legitimate practices and expected obligations to justify actions and decisions in relation to a forum (Bovens, 2007). Normative expectations are reproduced but also negotiated and even challenged in concrete practices, such as when a politician refuses to answer questions in a news interview. Institutionalized practices of public accountability are also typically based on relations to principles. When journalists do accountability work they represent media institutions. In their professional role, journalists take on the role of “ombudsman” of the citizens, asking questions on behalf of the general public (Clayman, 2007), and the forum consists of the audiences addressed in the news media reports. Actors asked to justify also act on behalf of principles. Politicians are asked to defend not only their own conduct but also their party’s opinions and policies.
The analytical approach, method and data
The analytical approach employed in the study combines framing analysis and analyses of journalistic interviewing, representing the most concrete practice in which actors are held accountable and asked to justify themselves in the media.
The perspective on framing departs from the culturalist-constructionist conception (Chong and Druckman, 2007; D’Angelo and Kuypers, 2010; Entman, 2010; Gamson and Modigliani, 1989; van Gorp, 2010), seeing frames as “organizing principles socially shared and persistent over time, that work symbolically to meaningfully structure the social world” (Reese, 2001). Framing, therefore, involves selecting and promoting certain definitions, interpretations and perspectives on an issue; frames define problems, diagnose causes, make moral judgments, and suggest remedies to problems (Entman, 1993).
Frames work ideologically and express social power relations (van Gorp, 2010); each frame is part of and derives from an ideologically imbued social discourse relating to social, political and economic power. Frames are used, reproduced and renegotiated in social interaction, and as Vliegenthart and van Zoonen (2011) suggest, frames are part of a struggle for meaning between different actors who have unequal material and symbolic resources.
When applied to the Carema case, the framing analysis examines how the news reports define the “problem” with Carema, that is, how the causes and possible solutions of the problem are constructed in the news. Who is blamed for being responsible for causing the problem, who is expected to act and to provide solutions, and what kind of actions/solutions are called for?
The analysis of the journalistic practices puts the accountability interview at the center of attention. The interview is an institutionalized discourse, based on the asymmetrical roles of one asking questions that the other is supposed to answer, which is particularly well suited to accountability work (Clayman and Heritage, 2002). It is no coincidence that interviews are also used in other accountability arrangements, such as courts, constitutional committees and audits. It is a legitimate and productive form of holding actors accountable, producing justifications and treating justifications as satisfactory or not. In the media these practices are performed in front of an overhearing audience. Responsible actors and actions of justifications are displayed and thus possible for the audience to evaluate.
In journalism, the accountability interview is one among a number of specialized interview activities (Ekström and Patrona, 2011; Montgomery, 2008). The specialization is manifested in the organization of the interview and the role and identities of the interviewees. Questions in accountability interviews, expert interviews and experience interviews are designed for different purposes. Accountable actors are discursively constructed by journalists using various techniques in the construction of questions, in quoting and in the overall construction of news stories. The media discourse is thus a critical site not only for accountability interrogation, but also for deciding who should be held to account in the first place. This is particularly the case in situations of disputable and negotiable accountability relationships.
Both the framing analysis and the analysis of accountability interviews are primarily conducted by means of qualitative analyses of the media coverage of the “Carema case” in the Swedish news media in the fall of 2011. The analysis examines the main national coverage, including news, editorials and opinion pieces, in the daily “prestige” newspaper Dagens Nyheter (political affiliation: liberal) and the daily tabloid Aftonbladet (political affiliation: social democratic), stories in the national daily news show on public service television (Rapport) and on commercial television (Nyheterna). All stories that treated the “Carema case” as a main subject were included in the study. The final corpus of news items consisted of articles from Dagens Nyheter (86 articles) and Aftonbladet (32 articles), and news stories from Rapport (21 reports) and Nyheterna (17 reports), published between 1 October and 31 December 2011.
The framing of political accountability: new public management, anti-marketization and greed
The overall pattern of the media coverage of the Carema case displays the typical pattern of a news wave (Wien and Elmelund-Præstekær, 2009) or attention cycle, where mediated actions and reactions cause a “social amplification” of social problems in the public sphere. News stories about the Carema case were initiated by one critical case that brought attention to a common problem and new disclosures led to further allegations and criticism (Thompson, 2000). As in similar situations when the media covers a scandal, the news media attention to Carema transformed over time, both with regard to volume and in the way the Carema problem was framed.
The trigger event of the news wave was an article published in Dagens Nyheter on 11 October 2011, in which severe problems at one of the nursing homes run by Carema – Koppargården – were exposed. The article was initiated by an email sent from a group of nurses working at Koppargården: “We are crying out for help. Please listen! Please help us!”
The framing of the problem in this opening article was to become typical of most of the news reports published in the first phase of the scandal. Carema was accused of mismanaging its nursing homes, and employees and relatives of the elderly living in the nursing homes came forward and talked about offences and misconduct. In the report, the staff and the elderly were portrayed as innocent victims, and the problems were blamed on the operating management of the nursing home, and on the corporate culture (the heavy emphasis on cost-cutting and the downsizing of staff) of Carema.
The management of Carema, however, either refused to comment on the allegations or, when they did, blamed others such as the local medical team. Local politicians appeared in the news, expressing a deep moral indignation over the conditions at the nursing homes, but they too blamed the management and expressed a clear intent to terminate the contracts with Carema. Similar stories were found in all the news media: morning press, tabloids, radio and TV news.
From the beginning of November the focus in the news shifted from the local to the national level and from individual nursing homes to the corporations that make profits from producing publicly funded health care; that is, the fact that the nursing homes were run by venture capital corporations. This was the overarching theme in a documentary on Carema that was aired on Swedish public service television on 6 November (Dokument Inifrån). The documentary had a big impact on the discussion on Carema, and also led to a wider public debate about privatization, but less so in the news and more in opinion pieces (and blogs).
With the shift to the national level, the ministers of the Conservative-led coalition government and other national politicians also became more visible in the news reports. When government ministers began to make public statements about Carema, they avoided accepting any political responsibility for the problems. Instead they targeted local government, blaming them for lacking competence and proficiency in handling the competitive tendering for government contracts with private corporations. They also made clear that it is the obligation of the authorities – such as the National Board of Health and Welfare – to inspect and control the quality of the health and elderly care.
The new focus on the owners and on corporate management made Carema initiate a more active “crisis communication”. The CEO, Carl Gyllfors, was invited to appear on the morning show on public service television on 7 November. He admitted that there had indeed been some mistakes and flaws, and that these had been taken care of and corrected, but he also stressed that the mistakes were not related to the fact that Carema is a privately owned company.
Taken together, it is evident that issues of responsibility and accountability were constantly highlighted in the news reports, but the discussion targeted the administrative and professional responsibilities of the management of Carema at the level of individual nursing homes and/or the CEO and board of Carema. Thus managerial and professional accountability, not political accountability, was placed at the forefront of the news. When accountability was discussed in the news it was done in the context of three very different news frames: the new public management frame, the anti-marketization frame and the greed frame.
The new public management frame
In the new public management frame, the shortcomings exposed at Carema were not due to private health care as such; mistakes and flaws can be found in publicly administered health care as well. The main problem with Carema, identified in this frame, is that local politicians perform poorly when it comes to competitive tendering; that is, they lack the competence to be purchasers in a new public management-administered health care system. The solution to the problem is to increase the professionalization of the system, and to strengthen the agencies’ capacities to control the quality.
This perspective was, predictably, emphasized in editorials in Dagens Nyheter (liberal), where the editorial stance is clearly pro-marketization. An example is the editorial on 13 November, in which the editor writes: “The welfare vandals destroy for everyone.” The rhetoric tells us that freedom to choose in social services is something good per se and that Carema is a single bad apple whose conduct puts the efforts of all other private health care providers at risk. This was also a recurring frame in the news, where news journalism focused on Carema as a single case, and the actors discussed the flaws as a problem of quality and control, and not a problem with private health care as such.
Another political accountability claim addressed in this frame was voiced in relation to national politics. These accountability relations were confined to the system level, where national politicians argue that they are only responsible for providing the “rules of the game” for the health and elderly care sector, meaning that they are not to be held to account for individual cases of misconduct or failure. If someone is to blame, it is not the government.
The new public management frame derives from a neoliberal discourse, where freedom of choice is an overriding value and where health care produced for profit is seen as inherently good. From this perspective, politics is the problem. Politicians should keep at arm’s length to allow quality to be attained by letting the customers (users, the market) choose from a variety of health care providers. Dagens Nyheter (13 October) reported from a debate in Parliament in which the prime minister, Reinfeldt, responded to criticism voiced by the left party (Lars Ohly) arguing that it is wrong for private corporations to make “profits on the elderly”. Reinfeldt responded that Ohly used: heavy leftist rhetoric: everything public is good, everything private is bad. The important thing is that we should know that both private and public welfare services can be mismanaged. I believe that citizens are nurtured when they are allowed to choose schools or elderly care.
The anti-marketization frame
The second frame – the anti-marketization frame – is rooted in a capitalism-critical discourse where the main problem concerning Carema is associated with the absence of politics. The market orientation, privatization and deregulation of the public sector is said to be the main cause of quality deficiencies in health care. However, the critical perspective is not necessarily a derivative of a socialist ideology, where private health care for profit should be banned altogether. Instead it is the limited democratic control of health care that is emphasized as the main problem. Likewise, privatization is also understood as resulting in a struggle between quality and profit.
The anti-marketization frame is absent from the news, but appears on a few occasions in editorials in Aftonbladet and in opinion pieces such as one published in Dagens Nyheter and signed by six social democratic politicians on 25 October. They argue that the privatization of too many nursing homes has made political control of elderly care unachievable. “It is not clear who is responsible for the health-care scandals, but it is clear that the government cannot handle the situation.” The argument continues: “As social democrats we are not against private health care providers. On the contrary, we believe that certain not-for-profit organizations can provide a valuable complement to public health care.”
In the anti-marketization frame the cause of the problem with Carema is clearly identified as the ongoing privatization and deregulation of the public sector. The political accountability claims that can be found within this frame are directed towards the coalition government, and national politicians. The Conservative-led government is the prime target of criticism, partly because of its strong support for the present marketization of social services, but also the Social Democrats, who approved of the market orientation of the public sector when they were in government in the 1990s.
Since this frame was absent from news journalism, any discussion on the lack of democratic control that is possibly associated with privatized public services has been hard to find. An embryo of this argument was, however, voiced in the one-hour-long documentary on Carema (Dokument Inifrån). The documentary discussed the imbalance between international health care corporations and local politicians/municipalities when it comes to resources and power. This perspective, however, never became a key theme in the further discussion on Carema.
The greed frame
The greed frame derives from an anti-establishment populist discourse that locates the power distance between “ordinary citizens” and the elite as the root of societal problems. In the Carema case the criticism is focused on the greed of top-level managers in Carema and the corporations behind it (Ambea, Triton, KKR). According to this frame, the main problem is not private health care as such, but the selfishness and voracity shown by its management and owners.
In the news reports, Carema was accused of cutting costs wherever they could. Purchases of necessary equipment were restricted, adult diapers were weighed after use (to see whether they were used to their fullest capacity) and employees were encouraged to compete against each other in saving money on food and utensils. Carema had also implemented a performance-based bonus system that generously rewarded the managers who provided the highest profits.
The greed frame is commonly found in all of the news media. In Dagens Nyheter, the headline “They make a profit out of mistreating the old and the ill” was published in an article scrutinizing the venture capitalists who own Carema and who make huge profits from avoiding paying taxes in Sweden (12 November). In the public service news (Rapport, 6 December), the earnings of top management were illustrated by managers appearing as flying paper dolls, holding balloons showing their (huge) income. The real cause of the problems at Carema is the personal greed among top-level managers, and the solution (albeit not stated clearly) is public condemnation of such immoral behavior, thus effectively de-politicizing the problem.
The framing analysis shows the three major frames in the Carema coverage and how each provides a specific understanding of the actual problem, its causes and solutions. The three dominant frames derive their basic rhetoric from different ideological discourses: the neoliberal, the left and the populist. In the making of news, journalism primarily operated within the new public management frame, complemented by the greed frame. In the next section we will analyze in more detail the accountability work carried out in news journalism, focusing on the accountability interview as a concrete and specialized method available for journalists in this context.
Journalistic interviewing and the discursive construction of (non-)political accountability
The overall aim of this analysis is to explore how interviews are used as resources when news journalism deals with the recognized problems in elderly care and, in particular, the questions of political accountability. What characterizes the accountability work carried out? How are frames articulated in the practices of interviewing, that is, in the selection and positioning of interviewees, and in the use of quotes in news stories? While most research on accountability interviews has focused on live interviews (Clayman and Heritage 2002; Ekström and Patrona, 2011), the news data analyzed in this article mainly consists of edited news reports, in which interviews are represented in the form of quotes and sound bites.
In the newspapers, 77 percent of the articles in Dagens Nyheter and 31 percent in Aftonbladet, included quotes from interviews. The articles without interviews were mainly commentaries and short news items. In the two news programs, sound bites from interviews were used in 90 and 70 percent respectively of the news reports.
Politicians were frequently interviewed in the news about Carema (about one-third of all news items). The journalists obviously understood the Carema case as partly related to institutional politics. Other actors frequently interviewed were officials, managers of Carema, staff in elderly care and relatives of the elderly. The politicians were not primarily addressed as accountable, however. Three recurring participant roles can be identified when politicians appear as interviewees in the news reports: politicians who express opinions (without being questioned); politicians who talk about and represent actions taken; politicians held accountable and who seek to justify either their own actions or the institution they represent. Participant role refers to the role given and/or taken by the interviewee in the particular news story, that is, what the politicians are entitled to do in the interviews and in the quotes presented.
Politicians express opinions
Several of the news reports are based on stories about individuals who have suffered from the abuse in the nursing homes. In one example (Dagens Nyheter, 31 Dec. 2011), this is expressed in the following headline: “Carema care covers up severe fall accident in elderly care – resident had serious brain damage”. In the article there is one quote from an interview with a local politician who is described as being very critical of Carema: “The contract obligations have not been met and I regard this as very serious.” In another article (Dagens Nyheter, 11 October), two local politicians comment on a report describing poor conditions in a nursing home located in their area. In the headline and news text, the politicians are quoted expressing anger and saying that the situation is totally unacceptable. What characterizes the role of the politicians in these examples, and in several similar cases, is that the political opinion articulated is not questioned. The politicians are not explicitly asked to justify their opinion or policy. The thematic structure of the articles is organized in relation to politicians’ reactions and not political accountability.
Politicians entitled to talk about actions taken
The news also reports on actions taken by the politicians. This is the headline in one example: “All new contracts for elderly care stopped in Stockholm” (Dagens Nyheter, 15 November). The lead paragraph starts as follows: “The city of Stockholm immediately stops all procurements of elderly care …” In the news text the plan to stop the contracts is expressed in interview quotes from the politician in charge. In several of the television news reports the politicians are also invited to demonstrate the capacity to act, for example initiatives to terminate existing contracts, without being questioned by the journalists or asked to justify the actions taken.
Politicians held accountable
Accountability interviews are here defined as interviews and quotes/sound bites in which the interviewee is discursively constructed as an actor who justifies or is expected to justify the policy he represents, his action or non-action. This role can be articulated in the general news story, concrete questions and in the answers quoted. This is one example of what we define as an accountability question asked to a government minister: “How many more cases of this must happen before you do something?” (Rapport, 16 November).
In the 35 news items in which politicians were interviewed, in most cases they appeared in the roles of expressing opinions or presenting actions taken (28 items), while accountability interviews were represented in only seven cases. It should also be noted that we have used a permissive categorization, in which the accountability category includes all interviews which articulate any form of justifying discourse, even though the interviews mainly present the politician in another role.
If the journalists did not ask the politicians to justify themselves, other than in a few exceptional cases, did they use the accountability interview at all in the news reports? The answer is yes. Managers on different levels in Carema were repeatedly held accountable (26 news items). There are also other differences – not only in terms of frequency – in how politicians and Carema managers were treated as accountable. Most importantly, when politicians were held to account this was a side issue in the news reports, while it was often the main issue, structuring the news narrative, when Carema managers were targeted.
A source of momentum in the intensive news coverage of Carema was the stories about individual elderly people suffering from abuse in the nursing homes. The focus was on Carema’s mistreatment of the elderly and Carema was explicitly or implicitly accused of immoral conduct. Day after day new cases appeared. These reports were based on what has been described in the literature as witness or experience interviews (Montgomery, 2008). Relatives of elderly people, but also staff (or former staff) in the criticized nursing homes, stepped forward and told their stories. The thematic structures of the news stories were organized in relation to one or two interviewees who describe what happened, their experiences, but who also express feelings of sadness and anger. The interviewees and their knowledge were typically not questioned in this type of interview, but treated as a self-evident point of departure for the blaming of Carema. In the press, quotes from the interviewees were also often used in the headlines and the lead paragraphs: “I cried when I got home from work” (former staff member, headline in Dagens Nyheter, 13 October).
In many cases the witness interviews were the main (or the only) source of information published when evidence of the mistreatment of elderly people was put forward and related to Carema’s misconduct. It reflects an epistemic orientation in which statistical evidence and reports from inspections and so on are marginalized, while extended quotations from single interviewees play a significant role. The choice to make witness interviews the main source of knowledge in news reports, and the concrete practices of interviewing and quoting, reflect an emotional news discourse which appeals to empathy but also outrage and indignation. It was in relation to these stories that people representing Carema were held to account.
In a few cases politicians were also held to account in interviews. These were exceptions, but as such they illustrate how far the journalists are prepared to go in asking politicians to justify their policies and actions. These moments were also typically embedded as sub-topics in news reports; the news is clearly not about the accountability as such. This is illustrated in an example from Rapport (16 November). The news report focused on a single case of mistreatment in elderly care and in the final part of the story, the Minister of Health Göran Hägglund was interviewed. As is often the case in news reports, the sound bite started in an answer and not a question (Ekström, 2001):
It is also true that we at the national level have to tighten the control so that the inspections become more effective and that, ultimately, the nursing homes that do not work can be shut down.
How many more cases of this must happen before you do something?
Yes, of course I want no more cases to happen. I am determined that we shall handle these questions. I do not want to experience this again.
In his first answer the minister treats himself as partly responsible. He relates to the discourse of new public management and an understanding of political responsibility as restricted to inspections and quality control. In this case the journalist also asks a follow-up question. It is a question (“How many …”) to which one cannot reasonably expect a direct answer. It rather invites the politician to comment on the presupposition that he, as the minister in charge, should do something and relates to a common understanding of politicians who talk a lot without doing anything. It does not question the minister’s justifications in his previous answer, however. On the contrary, the question invites the politician to comment within the same framework. The rather restricted understanding of political responsibility is thus indirectly accepted.
The minister responsible for elderly care, Maria Larsson, was also interviewed in a few news stories. One overall theme in these interviews related to what measures the government was prepared to take in order to safeguard quality in elderly care. In one of the articles (Dagens Nyheter, 12 November), the minister was quoted in the headline and in the lead paragraph: “The local government must take a greater responsibility.” The article was organized as an edited dialogue with interview questions and answers. In the opening it says that the minister is “very upset about the mistreatment revealed by DN”. And then the first question follows: “How should control be improved so that this will be avoided in future?” In her answer the minister says that the government has made significant economic investments in “quality improvements in elderly care”, and that a much more powerful control and inspection system has been developed. The minister is also asked if profit requirements can have a detrimental effect on the quality of health care. In her answer the minister refers to a new government bill that will prevent this from happening, and she also claims that the local government can choose to contract the companies that provide the best quality in elderly care. What characterizes the news interview in the report is that while the minister is asked to justify the policy, her answers are not questioned in follow-ups. The interview operates mainly within the new public management frame.
Conclusions
This study examines how journalism constructs political accountability in a case of mismanagement in private health care services. In the “Carema case”, we have recognized both limitations and opportunities for journalism when it comes to reporting contemporary political issues in a political setting marked by the marketization of the public sector. The study shows that journalism does accountability work, and thus contributes to political accountability processes, in at least three different ways: by (1) suggesting meanings and boundaries of political accountability by framing social problems in terms of causes, solutions and responsibility, (2) organizing arenas, such as debates, questionings and opinion pieces, in which actors can hold others to public account, often in front of overhearing audiences, (3) employing journalistic practices such as accountability interviews, asking politicians to justify their policies and actions (or non-actions) in different media settings. In the specific case of Carema, the general conclusion is that the critical scrutiny of the political system in many ways failed. Even if journalism did do some accountability work, the in-depth analysis of the structural premises of the elderly care system was missing from the news as the reporting on Carema told the story of a moral scandal instead of a potential policy failure.
Three major frames were used in the Carema coverage, each providing a specific understanding of the actual problem, its causes and solutions. The different frames derive their basic rhetoric from specific ideological discourses: the neoliberal, the left and the populist. In doing so they also construct different frameworks for locating and discussing political accountability and different positions from which journalists can hold politicians to account. In the making of news on Carema, journalism primarily operated within the new public management frame, supplemented by the greed frame. In the new public management frame the political accountability relations were de facto muddled or obscured and in the greed frame the political implications of the issue were lost altogether, making it a moral issue instead of a political problem.
The analysis of the journalistic interviewing showed that, despite the many interviews with politicians in news reports, the journalists had incredible difficulties in finding a position from which they could hold politicians to account. There was news reporting on political debates in which the government was criticized for not taking responsibility. The marketization of health care was also criticized in opinion pieces and some editorials. Still, in the news reports and news interviews the responsibility of the politicians was narrowed down to their role as purchasers of services (managers of bids and contracts) and as suppliers of the regulatory framework for agencies doing the quality control. In relation to these functions, politicians were invited to describe actions taken (such as the termination of contracts), but in the interviews published no critical questions were asked about the general workings of the system; for example, if it is reasonable to expect local politicians to have the purchasing know-how, the resources and capacity to handle complex bids, and if the existing quality-control arrangements are effective enough to monitor the providers (and at what cost it is achieved) – questions frequently discussed in the literature on new public management and political accountability. When politicians were held to account, the journalists typically treated the answers given as satisfactory, even when they were vague or just referred to the responsibility of others. The political accountability work carried out in the Carema case can thus be characterized as weak, vague and restricted.
The case study design raises the question as to what extent the results relate to specificities of the particular case or reflects practices and preconditions of journalism more generally. This is of course a question for future research to explore. However, a number of factors indicate that there are several implications of the study that transcend the particular case and national setting.
First, the observed news framing and positions of journalism in political accountability applied to both commercial and public service media and to media with different political affiliations, thus indicating that the identified frames and positions constitute a general stance in news journalism.
Second, the marketization of the public service sector constitutes a transformation of democracy that indeed is not unique to Sweden. Since the problems for journalism in targeting the critical accountability issues in the Carema case were largely predicated on the transformed political setting, the results have broader implications. Accountability relations are far from obvious in a situation where social services are carried out in an interface between the private and the public sector. A reasonable hypothesis is thus that the news frames observed in this study also apply, more or less, to news about similar problems in many other countries.
Finally, other general political factors added to the difficulties of journalists effectively scrutinizing politics and holding politicians to account in the Carema case. Most of all, there was a general consensus among the major parties in Parliament on the development of market-oriented models for providing public services, allowing privately owned companies to make a profit in publicly financed health and elderly care. Hence, the hegemony of the neoliberal ideology was a key factor in explaining the way reporting came to be dominated by the new public management frame in the news media. Situational factors exacerbated the situation; at the time the political opposition was crippled by internal conflicts, and the party leader of the Social Democrats was in the midst of a scandal, with opinion polls showing a declining support. Taken together, the lack of a tangible and vocal opposition created a sphere of consensus (Hallin, 1986), where journalism largely came to reproduce the views of the dominant political elite; thus providing a perfect example of the indexing theory (Bennett, 1990).
Even within a consensus-oriented public sphere, journalism strives to fulfil its professional role in scrutinizing those in power. Evidently, the only way for professional journalism to assume a critical position when the traditional legitimate controversy between government and opposition is unavailable, is to make use of an alternative critical stance by employing a populist discourse. This is how we should understand the prevalent use of the greed frame in the Carema case. This study thus contributes to the broader understanding of how professional journalism carries out its scrutinizing tasks when faced with neoliberal hegemony and elite consensus.
Footnotes
Acknowledgements
The study was supported by The Swedish Research Council.