Important details to know about the counties’ new duties, decision-making and services.
This section includes information on what the new counties will do and how decision-making will be carried out in practice in the counties. These have been provided on in the Government’s legislative proposal. New legislation is currently being reviewed by Parliament, and the Parliament will make decisions on them in autumn 2018. The reform is due to enter into force on 1 January 2021.
Click on the heading:
- 1. What is the regional government, health and social services reform?
- 2. Why is the reform being implemented?
- 3. Who will make decisions in counties and on what matters?
- 4. How can counties improve participation by residents?
- 5. Where will the counties funding come from?
- 6. How will the reform affect personnel?
- 7. Planned timetable
- 8. What will the counties do and in what manner will services be reformed?
- 8.1. The county as an organiser
- 8.2. Health and social services
- 8.3. Growth services
- 8.4. Rescue services
- 8.5. Environmental duties
- 8.6. Food and natural resources services
- 8.7. Transport tasks
- 8.8. Agricultural entrepreneurs and replacement services
- 8.9. Environmental healthcare and alcohol administration
- 9. Linguistic rights
- 10. Glossary
1. WHAT IS THE REGIONAL GOVERNMENT, HEALTH AND SOCIAL SERVICES REFORM?
The purpose of the regional government, health and social services reform is to strengthen services by centring their organisation with the counties starting on 1 January 2021. Parliament is currently reviewing the new laws that apply to the reform. Parliament will decide on how the reform will move forward in autumn 2018.
The reform aims to improve the quality and accessibility of services throughout Finland, to curb the growth of costs and to clarify public administration. The responsibility for organising services will be transferred from nearly 400 different responsible authorities to 18 autonomous counties. The new counties will be formed on the basis of the current regional division, but they will be responsible for completely different duties than today’s regions.
Thus, it has been proposed that Finland’s public administration will in future be organised on three levels, which are the state, the county and the municipality.
According to legislative proposals the counties will be multi-sectoral, meaning that starting from 1 January 2021 they will be responsible for:
- social welfare and healthcare
- tasks promoting employment and economic development
- rescue services
- environmental healthcare
- control of retail sale and serving of alcoholic beverages
- regional planning
- certain transport, environment and natural resources tasks
- promoting the county’s identity and own culture as well as
- other regional services that are provided to the counties by legislation.
The most extensive change will entail transferring responsibility for the organisation of health and social services from municipalities to the counties. The majority of the counties’ activities will comprise health and social services. Approximately 225,000 public sector employees will be transferred to positions within county administration of who 220,000 work in health and social services.
The counties will also take over some other tasks from the ELY Centres, TE Offices, Regional State Administrative Agencies, regional councils, joint municipal authorities and municipalities.
Additionally, a new permit and supervisory agency (Luova) is due to be established on 1 January 2021, which will take over tasks from numerous agencies and institutions.
Cooperation between counties, municipalities and organisations is important
Municipalities will no longer be permitted to provide health and social services after the reform. Municipalities will also no longer provide growth services (employment and economic development services) except in the Helsinki metropolitan area. Municipalities will remain responsible for early childhood education and care, education, land use planning, the promotion of residents’ welfare and health as well as for preventive intoxicant education.
Close cooperation between counties, municipalities and the organisations that operate within them will continue to be of great importance in the future. In the new counties, organisations can be non-profit actors, service providers or both.
For example, contract fire brigades participate in daily rescue operations around Finland and volunteers coordinated by organisations play a fundamental role in catastrophes and preparing for them. Organisations also have good preconditions for acting as providers of health and social services provided with health and social services vouchers or personal budgets.
2. WHY IS THE REGIONAL GOVERNMENT, HEALTH AND SOCIAL SERVICES REFORM BEING IMPLEMENTED?
The reform is necessary because people do not have equal access to public health and social services. There are massive differences in the availability, quality and costs of services between municipalities and regions. Another aim is to create a more harmonious regional administration than at present, which will provide multiple services for people.
Why can’t we continue with the present system?
Finns are ageing and the need for care is increasing (the number of people who are 75 and older will grow by 60 percent in 13 years). In the future there will be fewer people of working age. This equation will bring in a smaller amount of tax revenue each year. Even at present, the Government increases its debt each year to fund services.
Without reforms to operating practices it will be impossible to even retain the current level of services.
The aim of the regional government, health and social services reform is to offer people more equal services, reduce well-being and health gaps and curb rising expenses.
Costs will not be cut from what they are at present, but their future rate of growth must be curbed. This will help in narrowing the public finances sustainability gap meaning it will help in reducing the debt burden of future generations. Of the Government’s target 10 billion euro savings, 3 billion in cuts are to be implemented as part of the regional government, health and social services reform by 2029. In order for this to be possible, health and social service expenses can only be allowed to grow by 0.9% per year, whereas at present they increase by 2.4% annually. The counties will have limited budgets meaning that they will not be permitted to increase their income for example by raising taxes, as their funding will come from the State.
Introduction of best operating models and digitalisation
The growth of expenses can be curbed when the benefits afforded by digitalisation and technology are effectively and systematically implemented in the counties. Digital services that are better than at present, which provide flexibility in services and daily life must be built for clients
Digital services that correspond with the needs of clients can be used to decrease demand for services. Clients will be provided digital tools for monitoring and maintaining their own well-being and health e.g. web services omaolo.fi, omakanta.fi and terveyskyla.fi as well as personal measuring devices).
The condition for well-functioning services is that client data is transferred between actors in a manner that is timely and takes into account information security. In the beginning the digitalisation of activities will require investments but will produce savings in long term. The State will support the construction of interoperable information systems.
At present, the level of services and availability of services vary between municipalities and good practices have not spread throughout the country. Due to their large size, the counties will be able to ensure that the most effective operating models are introduced in all services.
The profitability and impact of activities can be improved merely by developing customer-oriented service packages and care pathways. For example, it will be possible to coordinate employment services and health and social services more closely than at present and this will make it easier to promote the work ability and employment of jobseekers. Health and social services must focus on pre-emptive measures and outpatient services as well as cut back on expensive institutional care.
By increasing freedom of choice, we are looking to increase the speed at which people have access to care. Although this will increase the cost of primary healthcare, it can also reduce the need for expensive specialist treatment in the long term. Competition between providers also may also improve the efficiency of activities and the quality of services.
Digital transformation programme: https://alueuudistus.fi/en/digital-transformation-programme
How will the reform be implemented in practice?
- The backbone for the regional government, health and social services reform will be built with legislation. More than ten new laws related to the reform are in the process of being enacted. The most important of these are the Counties Act, the Act on the Financing of the Counties, the Act on Organising Health and Social Services, the Act on Freedom of Choice, the Growth Services Act and the Rescue Act. At the same time, acts related to the taxation and central government transfers to counties are undergoing reforms and hundreds of pieces of legislation are undergoing amendments. Fact sheets: https://alueuudistus.fi/en/fact-sheets
- The regional government, health and social services reform is being prepared in numerous preparation groups under the leadership of the Ministry of Finance and the Ministry of Social Affairs and Health. The Ministry of Economic Affairs and Employment, the Ministry of Agriculture and Forestry, the Ministry of the Environment, the Ministry of the Interior, the Ministry of Education and Culture as well as representatives of numerous stakeholders have taken part in the preparation of the reform.
- The reform will be implemented in the future counties. Municipalities and joint municipal authorities have set up regional preparation groups for this purpose and responsible persons have been employed in the transition administration. The State has granted regions funding for various experimental schemes, in which services geared for families with children, senior citizens and persons with partial work ability are reformed and the more broad-scoped freedom of choice for clients is trialled. The objective is to introduce the best practices throughout the country.
- Supervision of health and social services Social welfare and healthcare organised by the counties is supervised not only by the counties, but also by the State’s permit and supervisory agency Luova. The State permit and supervisory agency would also be tasked with supervising that the organisation and provision of rescue services and the preparedness of the counties comply with legislation.
3. WHO WILL MAKE DECISIONS IN COUNTIES AND ON WHAT MATTERS?
To guarantee democracy the future counties will be led by county councils that residents vote for in elections. According to the proposal for the Counties Act, each county will have its own county council, which will be responsible for the county’s activities and economy, and will have the highest power of decision in the county. Representative and deputy representatives will be elected in county elections once every four years.
The tasks of the county council will be provided in the Counties Act, which is currently being reviewed by Parliament.
The county council, county executive and county governor are the representatives of the county as an organiser. Their task is to lead the county are a entity and in accordance with all its residents’ interests.
The council monitors whether the county’s residents receive the services they need in an equal manner and whether the activities are economical. Broad policies in land use, transport infrastructure and many of the area’s other structural matters are decided on by the county council.
The county council’s tasks include:
- appointing a county executive and other county bodies and selecting a governor. In practice, the appointed county executive will lead the county’s activities, administration and economy. The county governor, in turn, will head administration, the management of finances and other activities as a subordinate of the county executive.
- making decisions on matters such as the county strategy, the county’s administrative regulations as well as the county’s budget and financial plan
- making decisions on the principles for ownership steering and the consolidated county guideline
- making decisions on the terms for consolidated county enterprise activities (objectives, bunding income and expense items, investment plan, confirmation of the financial statement, discharge from liability and other statutory matters)
- making decisions on the counties’ cooperation agreement
- making decisions on the methods for residents to participate and exert their influence.
The council elected into office in the first county elections will make significant decisions on for example the county’s management system, bodies and leading public officials.
- The exact timing of the first county elections will be determined when Parliament has decided on legislation related to the regional government, health and social services reform. County elections are provided for in the Election Act.
- In future, county elections will be held in April simultaneously with municipal elections.
- Each county will be its own electoral distract in the elections. County election boards will be established as a new election authority.
- County elections will be held as a direct, secret and relative election. All people who have the right to vote will have equal suffrage.
- The number of representatives will depend on the number of residents in the county with a minimum of 59 representatives in the smallest counties and 99 in the largest counties. However, the county council may also independently decide a higher number of representatives.
- According to the proposal, the election financing limit for county elections will be the same as for parliamentary elections. A candidate in county elections may not accept more than 6,000 euros in financial backing from a single supporter.
4. HOW CAN COUNTIES IMPROVE PARTICIPATION BY RESIDENTS?
The regional government, health and social services reform improves the ability of residents to have an impact on their own living environment and on decision-making.
Legislation that applies to counties includes the premise that residents must be heard in matters that impact their lives and daily surroundings. Residents must have versatile and effective opportunities for participation and influence. These can include for example discussion and hearing events, resident panels, digital methods as well as the opportunity to participate in the planning of the county’s strategy and economy, etc.
Residents can stand as candidates and vote in municipal elections, and they also have the right to vote in any county referendums. Residents of all ages can also submit direct initiatives on the activities of their home county.
The county executive must appoint the county’s youth council or a similar impact group for youths as well as a seniors’ council and council for the disabled. These bodies act as the channels for hearing the groups they represent and for promoting their interests.
The county executive for bilingual counties (Central Ostrobothnia, Kymenlaakso, Ostrobothnia, Uusimaa and Southwest Finland) must appoint an impact committee for the language minority. In Lapland, a Language Minority Committee for the Sámi language must be appointed.
Participation by clients in health and social services
In order for client participation in health and social services to improve, municipalities and counties will have to coordinate their activities. The participation of clients and their sense of community have been strengthened in service provision by steering peer coordinating peer support activities and offering social rehabilitation and guided group activities in the services of the counties and municipalities.
Cooperation with organisations is an important resource. For example, authorities can do very little to deter loneliness. Support persons from organisations and volunteer work should be incorporated into the county’s service packages.
Some clients are unable to independently seek the use of services. A greater variety of forms of reach out work must be implemented and the clients on the outer fringes or completely outside of services must be identified. The prevention of social exclusion will increase everyone’s wellbeing and safety.
How do we build an inclusive operating culture?
An operating model for the inclusion of clients has been drawn up to support the counties. The operating model includes suggestions on how clients can become equal partners in the planning, development, provision and assessment of health and social services. The model has been built through experimental schemes carried out at the regional level.
5. HOW WILL THE ACTIVITIES OF THE COUNTIES BE FINANCED?
Counties will receive the majority of their funds as central government funding. The counties will not have the right to levy taxes. Legislation requires counties to budget their expenditure according to the available funding.
According to the proposal for the Act on the Financing of the Counties, the government would finance the activities of the counties with tax income and steer the financial management of the counties. Because the counties do not have the right to levy taxes, their income sources are central government funding and client and user charges as well as sales income.
According to the proposal for the Act on the Financing of the Counties, the Government will grant counties so-called universal funding. This means that the county council will decide independently within the confines of the law how the funds are used. The council also supervises that the county’s activities are economically solid and cost-efficient.
Differences between counties such as the varying service needs of their residents and conditions for organising services will be taken into account in central government funding to the counties. Any possible amendments in legislation to the tasks of the counties will also be taken into account in central government funding. In this way, it can be ensured that each county has the adequate preconditions to organise services for its residents.
In addition to universal funding, the counties will also be given separate funding for certain tasks. Far-reaching investments, funds used for the payment of aid to agriculture, the EU and national assets linked to EU funds as well as appropriations for the basic maintenance of transport routes are all within the scope of separate funding.
Counties can when necessary be granted short-term loans to help with liquidity issues or state securities, discretionary government transfers as well as discretionary additional funding,
Coefficient for the promotion of welfare and health
Central government transfers for counties and municipalities will in future also be influenced by how their activities promote the welfare and health of their residents. In counties the size of the coefficient will be approximately 1 percent of the share of the counties’ funding in total (170 billion euros ). This will be applied for the first time as the basis for county funding in 2023.
Steering of the county economy
The county must strive to use its resources as efficiently as possible in all its activities. The largest expenditure item in a county’s economy will be health and social services. As part of the reform, a county finances steering model will be created, which will aim to curb the growth of health and social service costs and other county expenses. This will mean that the central government will monitor the implementation and cost of services in counties each year.
Read more on funding for counties and their asset arrangements: https://alueuudistus.fi/en/government-policy-outlines
6. HOW WILL THE REFORM AFFECT PERSONNEL?
Approximately 225,000 employees would transfer from the municipalities, joint municipal authorities and the regional state administration to the employment of the counties. They will be transferred as old employees.
Approximately 220,000 employees will be transferred to the employment of the counties that will be established as part of the regional government, health and social services reform in accordance with the transfer-of-business principles. Additionally, some 5,000 employees from regional state administration will be transferred to the counties.
The reform sets off with the premise that personnel will be transferred to the new organisation’s employment as so-called old employees. The rights and obligations related to each person’s employment relationship or public service employment relationship will remain as they are at the time of the transfer. Fixed-term employees will be transferred to the county until the end of their employment. The employment and public service employment relationship rights and obligations as well as the related benefits valid at the time of the former employer hands over the employees will be transferred to the new employer.
It has been proposed that it be separately entered into legislation that the personnel transferred to corporations established by 31 December 2021 when incorporation takes place would be viewed as transfer of business. The provision would secure the personnel’s position and set a practical transition timetable for incorporation.
In connection with the reform, the wages of employees will be harmonised between counties. At the moment the cost of wage harmonisation cannot be precisely estimated as the transferred personnel can only be surveyed after all legislation enters into force. The obligation to harmonise does not apply to employees transferred to corporations.
Regulations governing the counties’ personnel will be affected by expanding the scope of local government employment legislation. The obligation to guarantee that supplementary pension provisions will continue to be available when incorporation takes place will be provided on in the regional government, health and social services Implementation Act.
Local Government Employers will act as representatives for county employers, and the name will be altered to Local Government and County Employers KT. The status of each county in this new body, Local Government and County Employers KT will be determined on the basis of their personnel numbers and economic weight.
Additionally, the counties will become member organisations of the Local Government Pensions Institution (Keva). Corporations owned by the counties can also become member of Keva. Keva will see to the pension security of county personnel.
The average age of public sector personnel is high, and by 2026 approximately one third of current health and social services personnel will have retired. It is important to ensure that a large amount of new professionals graduate yearly in the field and that immigrants are also employed,
Read more on the personnel’s position: https://alueuudistus.fi/en/personnel
Primary healthcare staff to private employers
A larger share of publicly funded health and social services provision than at present and thus part of the personnel will be transitioned in coming years to private companies, as clients can freely choose their health and social services centre and dental surgery. The largest transitions are likely to happen in healthcare where there are approximately 45,0000 employees. The role of private service providers will also be improved in growth services.
In addition to this, there are 15,000 employees in the municipalities’ support services, some of whose employer would change to a private one.
The premise is that the restructuring of tasks will be carried out in a way that will minimise the transfer of personnel from one area to another.
Changes brought about by the new service structure, new operating methods and digitalisation will require new competence from personnel. The regional government, health and social services reform offers personnel the opportunity to develop their own competence and expertise.
Digitalisation and health technology will influence the health and social services sector in the same way they will other sectors. Technology is utilised especially in helping to curb costs. In spite of this, the need for human resources will remain significant in health and social services also in the future.
The competence of personnel must be focused more precisely than previously regardless of employer, so that overlapping work can be minimised and productivity optimised.
Digital remote services, mobile work, and services provided at home will become more common in health and social services. The best practices must be introduced across the board regardless of employer. The profitability and impact of activities could be improved merely by developing client-oriented and seamless care pathways.
It is important for the counties to develop effective models for how social welfare can be integrated with health services to form service packages, how social services and specialised medical care can be mobilised at health and social services centres, how multiprofessional teams can be brought together to help the client, and how service management and guidance for clients can be carried out when there are public sector, private sector and third sector service providers.
When well-implemented the reforms will also improve the personnel’s wellbeing at work and commitment to their work.
According to studies, factors that influence the commitment of personnel the most include the possibility of influencing one’s own work – for example working times and the content of work – as well as the functionality of the work community and the organisation of work. For these reasons, it is important that more systematic efforts are made to improve wellbeing at work and good management also in the public sector.
7. PLANNED TIMETABLE
Parliament will decide on legislation related to the regional government, health and social services reform in autumn 2018. The exact timing of the county elections will be determined after this. At the moment, the target timing for the elections is May 2019 in which case the counties’ elected officials could start in their new positions in August 2019. Responsibility for the organisation of multisectoral services would be transferred to the counties at the beginning of 2021.
The Counties Act, the Act on the Financing of the Counties, the Act on Organising Health and Social Services, the Act on Freedom of Choice, the Rescue Services Act, the Growth Services Act and numerous other laws related to the reform are being reviewed by Parliament simultaneously in autumn 2018.
8. WHAT WILL THE COUNTIES DO AND IN WHAT MANNER WILL SERVICES BE REFORMED?
8.1. THE COUNTY AS AN ORGANISER
The regional government, health and social services reform would separate the organisation and provision of services. Below is a list of tasks counties will be responsible for as organisers.
Today, the municipalities organise and provide many services. In the future, municipalities will no longer organise or provide health and social services or rescue services. Municipalities will also no longer organise growth services except in the Helsinki metropolitan area.
The premise of the reform is that counties are organisers. Services provided by a county must be structured so they are separate unincorporated county enterprises and county-owned companies. The organiser and providers must have different management.
The county as an organiser heads the county as a whole and is responsible for the funding of its activities and for supervising that activities function as intended. Providers will provide services according to the terms outlined by the county.
What do organisation and provision mean?
A service organiser bears overall responsibility for the implementation and funding of services. The organiser determines where services will be provided as well as how funding will be targeted regionally to various services and service providers. In the new social welfare and healthcare model, the service organiser i.e. the county will not provide services itself.
Service provision will mean that the service provider and its staff will tangibly provide services to people. The service provider will be responsible for seeing to it that clients are given statutory services in the manner determined by the organiser. In addition to its own personnel, the service provider can use subcontractors in the provision of services.
Tasks pursuant to the Counties Act
Parliament is currently reviewing the Counties Act, which will include the tasks of the counties as an organiser. The county would be responsible for carrying out the tasks determined for it in legislation for example in the following areas:
- social welfare and healthcare
- expert support to counties for the promotion of welfare and health
- rescue services
- environmental healthcare
- control of retail sale and serving of alcoholic beverages
- agriculture and rural development, fishing industry and water economy, organisation of substitution services for farmers
- development and funding of the area’s business and innovation environment
- growth services and promotion of integration
- foresight of regional education needs
- county planning and regional land use planning
- promoting the protection of biodiversity and management of the cultural environment
- functionality of the transport system and regional road maintenance
- promoting the county’s identity and culture
- environmental duties
- coordination of county preparedness and regional preparedness
- regional Roma issues
- the county may also be responsible for other tasks separately provided for it in legislation.
Organisation of health and social services
Parliament is also currently reviewing the Act on Organising Health and Social Services, which will provide on the availability of county services. The content of health and social services will in future be determined according to the special laws that apply to the services. These special laws include the Social Welfare Act, the Act on Services for the Disabled, the Healthcare Act, the Mental Health Act and other laws that apply to services. Pursuant to these laws, the content, scope and quality of services must meet with the needs of clients.
The county’s tasks as the organiser of health and social services are the following:
- Service pledge and service strategy. The service pledge is a declaration of intent by the county to its residents on how it will implement the social and health services in the scope of its duty to organise in a manner that will take into account the needs and views of its residents. The county’s service pledge is a part of the service strategy the county council decides on.
- Service provision can be brought together into larger packages within one or more counties, when the availability of services and ensuring their quality require specialised expertise or expensive investments. This can be done when the appropriate, cost-effective and efficient implementation of services so requires.
- There will be five cooperation areas for cooperation between counties. The health and social services of the counties in each cooperation area will be coordinated with cooperation agreements. The cooperation agreement includes an investment programme, which the Government will approve.
- The implementation of health and social services must promote accessibility.
- Social welfare and healthcare must be organised in Finnish and Swedish when the county has both Finnish and Swedish speaking municipalities or at least one bilingual municipality.
- The county must monitor the welfare and health of its area’s residents, the quality and impact, cost and profitability of the health and social services it organises, as well as how the coordination of client services has been realised.
- The county must promote the participation and influence of its residents.
- Counties must set objectives and measures for the promotion of welfare and health.
- The county must ensure the integration of health and social services i.e. coordination. The obligation applied to both services for client groups and those for individual clients.
- At the client group level, the county determines service packages and service chains. All providers must comply with these. The specified service packages and chains steer the content and implementation of an individual client’s customer plan.
- The county must see to it that it can identify the client groups and clients that need extensively coordinated services.
- The county sees to it that the individual client’ service needs are assessed and where necessary a client plan is drawn up.
- The county is responsible for information flow between different providers.
- The county will see to it that information is provided on the client’s rights and benefits and that guidance is provided on the use of services.
- The county will be a controller of the client and patient information register.
8.2. HEALTH AND SOCIAL SERVICES
The responsibility for organising public health and social services is to be transferred from the municipalities and joint municipal authorities to the 18 new counties on 1 January 2021. Parliament will decide on the laws related to the health and social services reform in autumn 2018.
On the new health and social services model, the county as an organiser will head its area’s health and social services as a whole. In its service strategy, the county council will decide on the scope of its service network and the targeting of its funding on services. The council will monitor whether the county’s residents receive the services they need in an equal manner and whether the activities are economically solid.
Legislation will provide certain conditions for what the services must be like. The council will nevertheless hold a great deal of power in deciding on how much he county will invest in preventive services, digital and mobile service, services for families with children, the elderly and the disabled, mental health and substance abuse services, and how extensively health and social services vouchers will be used in the county and what requirements will be set for service providers.
The county council will make ultimate decisions on the implementation of the best practices and most effective operating methods in county services, which will benefit the entire county.
Similarly, the council monitors the population’s welfare and health, the quality and impact of services, as well as how the coordination of client services has been realised.
Importance of management by information to grow
Information based decisions must be made in the planning and decision-making processes in order to realise the objectives set for health and social services.
The county needs information for the planning and management of its activities. Service providers must produce information for the county on for example client numbers, waiting times and costs. Also clients need information on the quality of and waiting times for health and social services so they can make choices. Read more on management with information: https://alueuudistus.fi/en/knowledge-management
Also supervisory authorities will in future need information from the new counties. Social welfare and healthcare organised by the counties is supervised not only by the counties, but also by the State’s permit and supervisory authority Luova.
Read more on supervision of services https://alueuudistus.fi/en/supervision-of-health-and-social-services
County responsible for the determination and coordination of service packages
In today’s healthcare and social welfare services have been provided for the most part by the same provision organisation, i.e. the municipality or joint municipal authority. Municipalities and joint municipal authorities supplement their services ´by purchasing some of their services from private providers and organisations. The social welfare sector already purchases a large number of housing and institutional services.
When the primary provider is one municipality or joint municipal authority, its organisation will generally determine service packages. This provision method does not facilitate extensive, flexible, client-centred tailoring of services and the client’s ability to choose is very limited.
In the new health and social services model, the municipalities and joint municipal authorities do not organise or provide health and social services. The county organises health and social services and can provide services themselves or in cooperation with other counties or purchase them on the basis of a procurement agreement from another service provider.
Another new aspect of the new model is that certain health and social services will be provided primarily by service providers the client chooses pursuant to the Act on Freedom of Choice. The provider can be either public or private. The client can have a direct impact on ensuring that he or she gets services from the service provider that is best suited for him or her.
This means that health and social services will be provided by many organisations, which can be in the public, private or third sector. This means that new methods must be introduced for seeing to the integration or coordination or services. The county must determine client-centred service packages for various client groups as well as the key care and service pathways for clients.
All service providers must commit to complying with the service packages and service chains determined by the county. In this way the health and social service provided by the unincorporated county enterprise and other service providers will function seamlessly together and the client will receive services in a timely manner.
The health and social service centres provide certain health services and social guidance. The proposal for the Act on Freedom of Choice provides alternative methods for bringing other county services in a broad-scoped manner alongside services already provided at health and social services centres. The counties can apply these methods to their services in the manner that they choose. For example, mental health and substance abuse services can be brought to health and social services centres in numerous different ways.
Integration of health and social services: https://alueuudistus.fi/en/integration-of-social-and-health-services
Coordination of mental health and substance abuse services: https://alueuudistus.fi/en/mental-health-and-substance-abuse-services
Networking of child and family services https://alueuudistus.fi/en/child-and-family-services
Service package for the elderly: https://alueuudistus.fi/en/home-care-and-informal-care
Services in the client-based model are formed around the client
From the perspective of the individual client, client-centredness refers to for example the fact that he or she can access all services with one phone contact.
Services are built for a client according to his or her needs. The client’s life situation is viewed in its entirety, and when needed he or she will be given more personalised services that at present. The client can choose where he or she will procure the appropriate services. However, this requires that the area has a service range to choose from. In county services, the client can choose the service unit and place whose services he or she uses.
If the client does not need health or social services, they can be steered to health management groups, peer support services provided by organisations or the municipality’s cultural and sports activities.
Local services will remain, digital services will increase in number
The county council will decide on the scope of the county’s service network. The service network and local services do not only refer to offices. Some local health and social services are provided as digital, mobile or home services. Services provided at home can include home care, family work or child welfare. For example, dental care and vaccinations can be provided as mobile services.
Well-functioning digital services make people’s daily lives easier and decrease the need for travel. In the future, remote appointments will become more common. Especially people who live in sparsely populated areas, the physically challenged and people who go to work and have busy timetables will benefit from these,
When necessary, the county can provide services in cooperation with other counties. Services that require specialised expertise can be centred and situated in certain locations. For example, certain services for the disabled or some child welfare services that require specialist knowledge can be centred. Even in these cases, the client must be able to access these services primarily in their own living environment.
Division of work at hospitals has also undergone a reform. In the future, people will only receive the more demanding care in hospitals with extensive emergency services. This will ensure competent and high quality care. Read more on the hospital network reform which entered in force at the beginning of 2018: https://alueuudistus.fi/en/emergency-services-and-specialised-medical-care
Urgent access to care will not change
The right to seek urgent care regardless of one’s home municipality and place of residence will remain unchanged. In emergencies you can call 112 or go to the closest emergency care unit.
Unincorporated county enterprises and service units
The county unincorporated enterprise for health and social services will organise social services and the majority of specialised medical care for residents. The u8nincorporated enterprise is county-owned and part of the county’s official organisation. The unincorporated enterprise has its own management and budget.
If a client needs more broad-scoped services or their service requires a decision by an authority, the client is steered from a health and social services centre to the unincorporated county enterprise. The unincorporated country enterprise’s service unit can be for example a unit that provides services to the elderly or disabled. The service unit may have numerous regional service points. Service points include for example hospitals, social welfare offices and clinics.
The client need not know what an unincorporated enterprise is. The client uses the “county’s services” such as clinics, social welfare offices or hospitals.
The client can independently contact any service point of the unincorporated county enterprise, such as a clinic. The exception is non-urgent hospital care. This will require a referral from a doctor, just as it does now.
The client can get the agreed upon services directly from the county. The alternative is that the client is given a health and social services voucher or a personal budget with which the client procures the services he or she needs. This will necessitate that there are private service providers in the area to choose from.
The county must guarantee the adequate availability of services in all situations. The unincorporated county enterprise will provide all health and social service centre and dental care services for residents, if these are not available otherwise. This can be the case for example when a sparsely populated area does not have any private health and social services centres and dental surgeries.
School healthcare and secondary school student healthcare as well as the related dental healthcare will be organised by the counties. Pupils and students will not have freedom of choice in this. The municipalities would be left with responsibility for organising student welfare psychologist and school social worker services.
In the future Kela will see to the organisation of health services for higher education students and YTHS will be responsible for providing these services. However, pupils and students will all have the same freedom of choice in other county services as all other residents.
Read more on the unincorporated county enterprise: https://alueuudistus.fi/en/service-providers/unincorporated-county-enterprises
Read more on social services: https://alueuudistus.fi/en/social-services
Mental health and substance abuse services
Mental health and substance abuse services apply to a large part of the population either directly or through a family member. Treatment for mental health problems and substance abuse is an important part of the services provided at future health and social services centres.
Counties will be given the opportunity in connection with the health and social services reform to build seamless packages for those client groups that the county’s decision-makers consider a priority in their service strategy.
The proposal for the Act on Freedom of Choice provides alternative methods for bringing other unincorporated county enterprise services in a broad-scoped manner alongside services already provided at health and social services centres. These methods can be applied to various services such as mental health and substance abuse services.
- The county can mobilise the specialised hospital care it provides to health and social services centres. This means that the county’s psychiatric nurse and attending psychiatrist could treat the client in cooperation with the doctor at the health and social services centre.
- Or the county can decide that the health and social services centre’s own services should include psychiatric services. In this case, the health and social services centre could have its own psychiatrist or psychiatric nurse carrying our treatment under the management of the county’s psychiatrist.
- The county can also choose to use health and social services vouchers in mental health and substance abuse services. Health and social services vouchers could be used for example in short-term counselling and psychiatric home visit group services. The county’s specialised medical care could in turn provide for example electronic self-care programs, online psychotherapy and mobilised services.
The most important thing is to ensure that the client receives the needed services in a timely manner and unnecessary separate appointments are avoided. This objective is also supported in the overall reform of mental health and substance abuse legislation, which will be sent out for comments this spring.
County pilots are to be initiated to test the possibility of the county organising Kela-compensated rehabilitative psychotherapy and demanding medical rehabilitation. An act on experimentation is being prepared for these pilots.
Read more on the coordination of mental health and substance abuse services: https://alueuudistus.fi/en/mental-health-and-substance-abuse-services
Rehabilitation service packages are being developed as part of the health and social services reform. Supporting functional capacity and work ability will improve the welfare of the county’s residents, their coping with everyday life, living at home, and participation in education and working life and in the activities of various communities.
The county is responsible for seeing to it that there is a rehabilitation operating model in place in the area and many service managements for clients who need various different services.
Rehabilitation must be based on an operating model the principles of which are the same for all clients of all ages. The operating model includes the identification of rehabilitation needs, the assessment of functional capacity, work ability and rehabilitation needs, decisions concerning services, implementation of services, measures that apply to the rehabilitation client’s surroundings, monitoring and assessment of the rehabilitation process as well as the changes that must be made on the basis of these. Rehabilitation activities will be entered in the client plan.
In its report the rehabilitation committee recommended that the county should introduce a model for responsible case management model in order to manage the rehabilitative pathway of clients who need multiple services. Where necessary, the client is appointed a responsible person, who will coordinate the client’s rehabilitation service package.
By offering its residents the necessary, effective and cost-effective rehabilitation services, the county can significantly decrease expenses for demanding health and social services and social assistance. By supporting work ability, the county prevents incapacity to work among its residents, improves its employment rate, increases its tax revenue and strengthens the county’s economy.
The responsibility for organising medical rehabilitation in health services and social rehabilitation in social services is due to shift from the municipalities and joint municipal authorities to the counties from the beginning of 2020.
Services for people with disabilities
The health and social services reform will improve the right of self-determination in services for disabled people. Disabled people will have a wider range in choices on where they procure their health and social services than previously.
The health and social services reform will see responsibility for the organisation of services for the disabled shift from the municipalities to the counties. The county and the unincorporated county enterprise are responsible for providing guidance and advice to clients when they have choices to make.
People with disabilities who require multiple services can receive either health and social services vouchers or a personal budget from the unincorporated county enterprise for the procurement of services. The content for these will be determined in the client plan as will the services needed by the person. Service vouchers can be given for a specific service such as home care or physiotherapy.
A personal budget can be used to purchase the services that are entered into an official decision and client plan and to which the client has a statutory right. A disabled person plans – if necessary with the help of a family member – the more detailed content of the services that will be purchased with their personal budget and will select service providers. A personal budget can be used for example for housing services or daily activities.
The client is responsible for covering the costs of the services, which are not provided as public services or to which the client does not have a statutory right.
The new Act on Services for the Disabled is also in preparation and this will replace both the present Disability Services Act and the Act on Special Care for People with Intellectual Disabilities. The act is due to enter into force during 2020. The premise of the reform is to improve the participation and equality of people with disabilities as well as to ensure adequate services that are of high quality also in the future.
a. HOW WILL THE CLIENT’S FREEDOM OF CHOICE BECOME MORE BROAD-SCOPED?
As part of the health and social services reform clients be given more broad-scoped rights to independently choose where he or she will access health and social services. More extensive freedom of choice will improve people’s right of self-determination.
For example, the elderly and disabled people will be able to impact the services they receive better than at present. The goal is to also to ensure that people who need multiple services such as the elderly and children will be able to access services more quickly that at present as the number of services available to choose from increase.
Publicly funded health and social services could in future be offered to clients by unincorporated county enterprises, companies owned by the county, private companies and third sector actors and foundations.
In practice, more extensive freedom of choice would mean that the client can choose:
- the county in which he or she accesses services as well as the service unit for the unincorporated county enterprise and the service point where he or she uses services
- a health and social services centre and dental surgery, which can be either public or private
- a service provider when given a health a social services voucher
- service providers when using a personal budget
- a healthcare service provider in another EU country (Act on Cross-Border Healthcare).
If the client does not want to choose, the county will appoint a service provider, such as the health and social services centre. A client can also always select the county service, meaning that clients need not user service vouchers or a personal budget.
No freedom of choice is given in child protection services, involuntary care as well as school and secondary education healthcare.
Frequently asked questions on freedom of choice https://alueuudistus.fi/en/frequently-asked-questions-about-freedom-of-choice
Client examples on freedom of choice: https://alueuudistus.fi/en/freedom-of-choice-for-customers/examples
The proposal for the expansion of freedom of choice is currently being reviewed by Parliament.
Parliament will decide on this in autumn 2018. According to the legislative proposal freedom of choice would expand in stages starting in 2021. In areas that are participating in freedom of choice pilot, freedom of choice will expand earlier than this, if the health and social services reform moves forward according to the timetable provided in the legislative proposal. A more specific timetable and phasing will be confirmed after the legislation is reviewed by Parliament.
Health and social services centre
Health and social services centres pursuant to the new health and social services model will begin their operations on 1 January 2023. Freedom of choice could be extended already as of 2019 in areas taking part in the piloting of health and social services centres and as of 2021-2022 should a county apply for exception. Counties can even apply for postponement so that the extension would enter into force on 1 January 2024 at the latest.
According to the legislative proposal, a resident chooses the health and social services centre and dental surgery they want to frequent. Service providers must have an agreement with the county, and it must comply with terms laid down in legislation and by the county. These terms may apply to for example the range of available services, the quality of activities and the provider’s solvency.
In practice, the client signs up as the client of a health and social services centre of their choice. The selection is made online or in writing. Residents can start to sign up as clients of health and social services centres at latest from October 2023 onward.
The client will receive primary health services and social welfare guidance from their health and social services centre. Services offered by health and social services centres will include doctor’s check-ups, appointments with general physicians, assessment of functional capacity and work ability as well as guidance and advice provided by a social worker or Bachelor of Social Services. The client would also in the future be able to choose the place for specialised medical care together with the referring doctor in cases of non-urgent care.
Health and social services centre would also offer the services of professionals in at least two different fields of specialised medical care. The county could decide which fields these are. The county can for example offer mental health and substance abuse services at it health and social services centre. The overall responsibility for the client’s care will remain with the general physician at the health and social services centre and there will be no gaps in the client’s care.
If the client does not choose a health and social services centre themselves, he or she will initially be signed up as a client of the unincorporated county enterprise health and social services centre. The client will be notified of the public health and social services centre to which he or she has been assigned as a client on the basis of where he or she resides. The same client will also be notified that he or she has the right to immediately change the health and social services centre he or she is signed up with if he or she so wishes.
If s county’s resident has not chosen a health and social service centre by the end of 2023, the county must assign him or her permanently as a client of one, which is in the county’s area and is easiest for the client to access (public or private).
A client has the right to change their health and social services centre once every 6 months or earlier for example if their place of residence changes. A client can also change their health and social services centre temporarily, if he or she lives in another area for part of the year.
If the health and social services centre has service point throughout Finland, the client can use the services of any of these centres.
Social welfare to be present in health and social services centres
According to the proposal for the Act on Freedom of Choice, clients can get social welfare guidance and advice at the health and social services centre. Additionally, the unincorporated county enterprise’s social welfare professionals, such as social workers, substance abuse workers and geronoms, could when necessary be present at health and social services centres. They would offer social services and carry out service needs assessments at health and social services centres.
This would mean that the client would not need to seek services from the unincorporated county enterprise service unit when needing social services. Digital services can also be utilised in service needs assessments, which would help in cutting down on unnecessary travel.
According to the proposal for the Act on Freedom of Choice, the unincorporated county enterprise must have a multi-professional team that operates in a mobile manner within the county in connection with its health and social services centres. The team includes health care and social welfare professionals. The purpose of this team is to provide consultation services relating to social welfare, to assess clients service needs and, if necessary, to direct clients to services provided by the unincorporated county enterprise. If a client needs more broad-scoped services or their service requires a decision by an authority, which cannot be carried out in a health and social services centre, the client is directed to the unincorporated county enterprise. The unincorporated country enterprise’s unit can be for example a unit that provides services to the elderly or disabled.
If a client need many health and social services, a client plan will be drawn up for him or her. This includes information on services their providers. The client plan is drawn up with according to the needs of the client at the health and social services centre, the unincorporated county enterprise or together by the two.
Oral health and dental care
Starting on 1 January 2023, a client can choose a county funded public or private dental surgery. All service providers will charge the same client fees. However, service providers much be approved by the county meaning the client cannot randomly choose any dental care facility.
The services of a county-funded oral health unit meaning a dental surgery include the prevention of oral diseases and guidance, oral health checks and care plans, oral and dental procedures for gum diseases, filling of cavities, infections, surgery, imaging services and dental prosthetic repairs.
The majority of specialised care and all demanding specialised care is given at the unincorporated county enterprise meaning a public oral health unit or a hospital. This kind of treatment including for example demanding oral surgeries.
The unincorporated county enterprise can also give a health and social services voucher with which the client can independently choose a service provider (e.g. orthodontics and dental prosthetic).
Health and social services voucher
According to the proposal for the Act on Freedom of Choice, the unincorporated county enterprise must grant health and social services vouchers for certain services. The client uses the service voucher to procure a single service from a service provider.
Starting on 1 January 2022, service vouchers should be offered for example for home care, housing services and medical rehabilitation. Additionally, a service voucher should be granted if the time limit for the statutory treatment guarantee is exceeded.
The county can, if it so wishes, use the health and social services vouchers more extensively than this. However, it may not interfere with the county’s final responsibility for guaranteeing the functionality of the services provided by the unincorporated county enterprise. The service provider whose services are procured with a service voucher must be a provider approved by the county and registered in the service provider register.
If the client wants to use a service voucher or adopt use of a personal budget, the client must choose a provider other than the unincorporated county enterprise. However, the unincorporated enterprise can provide the same services for clients who do not want to use service vouchers or a personal budget.
Starting on 1 January 2022, a person with extensive and long-term needs can be granted a personal budget under certain conditions. The budget is intended especially for the elderly and the disabled.
The person given a personal budget could select a service provider and influence the content of their services. The unincorporated county enterprise will reimburse the costs of the services to the service provider up to a predetermined amount. A service provider must be registered in the service provider register. See also services for the disabled:
The client charge for county residents is always the same regardless of whether the service is provided by a public or private service provider. Therefore, for example the charges for the county’s health and social services centre may be the same as those for a health and social services centre run by a private company. However, charges may differ between counties.
The county has the right to decide that a fee that is lower than what the law stipulates at the maximum fee will be charged for services or that no fee will be charged at all.
The charge for services that are needed over a longer period of time can be determined according to the quantity of the services and the client’s income (e.g. home services) or solely on the basis of the client’s income (e.g. long-term institutional care). However, a fee charged on the basis of income cannot be higher than what the service costs the county.
Provisions on the maximum amount for client charges are currently being provided on in the Client Charges Act, which is in preparation. The premise will be that client charges are as equal and reasonable as possible and they do not prevent people from using services. Read more on the reform to client charge legislation: https://alueuudistus.fi/en/reform-of-the-act-on-client-fees
County-paid compensation to service providers
The county will pay compensation directly to service providers for the provision of health and social services. Kela will see to the payments. The compensation paid to service providers must act as an incentive for effective services, must promote the welfare and health of the population as well as the maintenance of functional capacity.
The county can pay service providers fixed compensation, performance-based compensation or incentive-based compensation. Additionally, the service provider can receive additional compensation for example on the basis of its remote location.
The premise is that providers are expected to compete with the quality of their services. For this reason, each county as a rule pays the same sum to all providers for the same services.
According to the proposal for the Act on Freedom of Choice, the county pays health and social services centres a fixed monthly payment for each client who has signed up for the centre in question (capitation). The compensation sum is based on national needs factors, which include the age, gender, rate of illness, employment rate of the county’s residents as well as other socio-economic factors.
The value of the service voucher must be determined in a way that allows the client to have an real opportunity to choose a service provider from among those approved by the county. The value of the service voucher cannot exceed the county’s own provision costs, but it must allow the client to get services required by law. When determining the size of a personal budget, the client’s service use needs and the cost of providing the services at the unincorporated county enterprise must be taken into account.
Read more on compensation paid to service providers: https://alueuudistus.fi/en/private-service-provision
Supervision of service providers
The county will be tasked with supervising that service providers comply with the law. If it is observed that a service provider acts in a manner that is contrary to the law, the county is responsible for informing the provider that their actions violate the law and must require that they immediately terminate their illegal activities. If the provider does not correct their methods, the provider’s contract can be terminated.
The client has the right to notify the county if the client observes any shortcomings, defects or illegalities in the activities of a service provider. National permit and supervisory authority Luova is the senior supervisory authority in matters concerning health and social services.
b. CHILDREN, YOUNG PEOPLE AND FAMILIES
Child and family services to undergo reforms All counties will introduce the family centre operating model. Additionally, the operational culture is being reformed so that it is based on the child’s rights and on information.
When the responsibility for organising health and social services is transferred to the counties in 2021, municipalities will remain responsible for many services that are important from the perspective of children and young people. These services include for example early childhood education and care and basic education, free-time services as well as cultural and sports services.
Families with children will be afforded more extensive freedom of choice in health and social services. In the future, families with children can choose which health and social services centre or dental surgery they frequent. A child’s guardian selects a health and social services centre for a child under the age of 15.
There is no freedom of choice in child welfare services or school and student healthcare. School healthcare and secondary school student healthcare as well as the related dental healthcare will be organised by the counties.
Services for children, young people and families to undergo reforms
All the counties are currently carrying out child and family services development, which will create new regional models for services.
The best results and practices of development work carried out in the regions can be introduced in any county.
The currently ongoing reform of services for children and families (LAPE Programme) will guarantee that children, young people and families receive the support and services they need. When the correct support is given at the correct time, the focus point shifts from corrective services to preventive. This will also help rein in expenses.
The objective is for authorities to work together with one another ensuring that the child and the child’s family no longer need to seek services in so many separate locations. Additionally, the services are easy to access and nearby. Services can partly also be digital services and services provided at home.
- Services for children, young people and families will be reformed https://alueuudistus.fi/en/child-and-family-services
All family services available in one place at family centres
The family centre will create a network for currently fragmented services such as maternity and child health clinics and other health services for families with children, home services, family work, children’s legal services, as well as work by organisations and parishes.
The family centre model can either mean that numerous services have been brought together under the same roof or that services are based on network-like cooperation.
The family centre offers services to children of all ages and their parents. Many counties are also developing services for young people.
Every family centre has open meeting areas for children and families, which make it possible for parents to provide support to one another and offer activities, which have been planned together with families.
The development of the regional family centre model is underway in all counties.
Specialised services closer to primary services
Specialised services and services of the most demanding level will be coordinated so that children and young people living in difficult situations will receive the best possible help and services.
Specialist social welfare and healthcare services will be provided as often as possible near the family’s primary services or in the child’s or young person’s immediate communities such as early childhood education and care, school or educational institutions.
Additionally, five centres of excellence and support for the most demanding services will be established in Finland. These will be located in Oulu, Tampere, Turku, Kuopio and Helsinki.
Services that will be brought to the centres of excellence and support or services networked to these include:
- some of the most demanding specialised medical care for children and young people including forensic psychiatry for children and young people.
- demanding child protection. including state residential schools.
- demanding services for disable people and services for immigrants, which often require expertise from numerous fields.
Early childhood education, the school and the educational institution provide support for well-being
Municipalities will still maintain responsibility for early childhood education and care, schools and educational institutions as well as student welfare (school social workers and school psychologists), and these will strengthen their role as promoters of pupil and student welfare.
The regional government, health and social services reform will alter the responsibilities and tasks of organisations, which will lead to the creation of interfaces and networks. The interface foe health and social services provided by the municipalities’ education departments and the counties refers to the services the organisation of which require close cooperation.
Work to develop activities in early childhood education and care, schools and educational institutions related to the LAPE Programme is currently being carried out in 11 counties and in the Helsinki metropolitan area. For example, new operating practices are being created for pupil welfare, so that children and young people will in the future receive correctly-timed and needs-based support in municipalities and counties.
Operational culture to be transformed so it is based on the rights of the child
A child’s rights must be taken into account in administration and decision-making at the county and municipal levels, as must the impacts of administration and decision-making on children.
In addition to the assessment of impacts on children, child-centred budgeting must be introduced. This means that the county or state budget must be examined from the perspective of a child’s rights.
At the moment, six counties are piloting the Child-friendly county operating model with UNICEF’s support, and on the basis of this piloting guidelines will be drawn up, which all the counties will introduce.
Municipal and county actors and decision-makers will in future be offered training and tools for the assessment of impacts on children, the determination of the opinions of children and young people and for monitoring the welfare of children from various backgrounds and of various ages and reporting on these.
c. YOUNG ADULTS AND PEOPLE OF WORKING AGE
Young adults and people of working age will select their health and social services centre and their dental surgery themselves. Occupational healthcare will remain as it is now. Students at universities of applied sciences will in future be in the scope of YTHS services.
The freedom of choice enjoyed by young adults and other people of working age in health and social services will expand from what it is at present. A county resident will able to freely choose a public or private health and social services centre and dental surgery, as long as they are county-approved service providers. An individual can also choose an unincorporated county enterprise or its service unit. When necessary, a client can be given a health and social services voucher or be issued a personal budget.
Occupational healthcare to remain unchanged
Occupational healthcare paid for by an employer will remain an option in the future, Many people of working age use these services. Even so, they have the same right to freedom of choice in healthcare services as all other residents. Similarly, there will still be private health and social services, which the client pays for themselves for example with private health insurance.
Urgent care will not change
Urgent care will remain unchanged from what it is now – you can always seek care from the nearest emergency care unit or call 112 in emergencies.
In the future Kela will see to the organisation of health services for higher education students and YTHS will be responsible for providing these services. Starting from 2021, these services will undergo expansion, so they are also available to students at universities of applied sciences. Higher education students are charged a mandatory healthcare fee for these services akin to a tax.
Upper secondary school and vocational institution students will receive healthcare and dental services from the county.
However, students will all have the same freedom of choice in county services as all other residents. Students can also go to a health and social services centre, another service organised by the county or any emergency services unit.
Employment services for persons with partial work ability and support for work ability
In 2021, the responsibility for current TE Services and ELY Centre business services will be transferred to the counties.
To ensure that the range of health and social services and TE services methods intended to support the structurally unemployed in gaining employment can be used as effectively and productively as possible, the services must be coordinated with one another so that the employment of persons with partial work ability and their continued employment are made easier.
Service chains work seamlessly and in a timely manner, overlapping actions have decreased and people receive the help they need. In this way, weakened work ability will not lead to a person being left completely outside of working life or a person who has lost part of their work ability can return to their job.
A completely new service package will be created for supporting work ability. where the county’s services that support work ability have been incorporated into existing treatment and rehabilitation practices. The objective is for the client to receive timely, seamless and appropriate support services as part of their treatment and rehabilitation so that they can continue their work or return to their job in a timely manner.
In the future, every county will also have work ability coordinators working for example in health and social services and TE services, in municipalities, educational institutions and in organisations.
The employment of persons with partial work ability has a significant impact on the county’s economy: it will increase the employment rate and bring more workforce to the county’s use. For persons with partial work ability themselves, the opportunity to take part in working life signifies equality and an improvement to their economic situation.
Read more on Support for work capacity and employment https://alueuudistus.fi/en/support-for-work-capacity-and-employment
d. THE ELDERLY
The reform of home and informal care aims to ensure that the elderly and families that provide informal care receive equal services throughout Finland. The elderly can live at home for as long as possible because daily tasks at home are supported adequately.
Home care and informal care
The local government, health and social services reform will see responsibility of the organisation of home and informal care services transferred to the county. The organisation of housing services for the elderly will also be transferred to the county. One’s home municipality will still be responsible for daily surroundings as well as cultural and sports services.
Although services will henceforth be organised by the county, the client will continue to receive home and informal care related services from their local area.
All counties are currently preparing a coordinated service package for the elderly, part of which will comprise case and service management for the elderly. This will make it possible to guide the elderly to appropriate and harmonised services, which in turn will allow the elderly to safely live at home for as long as possible.
Centred client and service management will make it possible to manage client flow and to target services to various client groups on the basis of service needs assessments. At the same time, it will be possible to make all benefits and services transparent as well as the criteria on the basis of which services are given. It will also be possible to verify and monitor these services.
Digitalisation is also being utilised in the development of home and informal care. Digitalisation will offer new options such as electronica and remote services as well as tools for monitoring one’s own health.
The right of self-determination will be strengthened in services for the elderly. In the future, also the elderly will be able to choose from a broader range of service providers. An elderly person may choose an unincorporated county enterprise and the service unit as well as a public or private health and social services centre and dental surgery. When necessary, an elderly person can be given a health and social services voucher or a personal budget. which he or she can use to procure for example housing services or home care.
Here’s how home and informal care will be reformed (I&O key project) https://alueuudistus.fi/en/home-care-and-informal-care
8.3. GROWTH SERVICES
Growth services include services for jobseekers, employers and companies in the municipalities. The purpose of growth services is to guarantee a well-functioning labour market and the availability of competent labour force as well as to promote the integration of immigrants.
Currently, these tasks are managed by the regional state administration’s TE Services and the ELY Centres separate from one another. The counties’ growth services will promote new entrepreneurship and the growth, reformation and internationalisation of companies and respond to changes in the labour market.
The county council has an important role in supporting regional vitality and entrepreneurship with its decisions. Better conditions will be created for entrepreneurship as employment services are firmly linked to services in the counties that support the growth of companies.
The age structure, geographical characteristics as well as profession and job structures in counties will differ from one another. In the future, counties will be better able to coordinate services so they meet with the specific county’s needs. The counties can independently determine how their growth services are organised on the basis of their strategies. Legislation will determine the minimum services organised.
In practice, growth services include public recruitment services and services that develop the competence of jobseekers. Additionally, counties will grant various subsidies and offer expert services for the development of companies’ business and innovations as well as to promote employment. The structurally unemployed need special help, and health and social services can be utilised more effectively to support these people after the reform.
Growth services can be provided in various ways
The counties can provide growth services themselves or procure services from service providers. The so-called alliance model can also be utilised in the service provision.
An agreement between counties, municipalities and service providers acts as the foundation of alliance. The parties are together responsible for the planning and implementation of growth services and the services related to tasks that promote the vitality of the municipality within its general field of operation. The parties will share both the benefits and the risks related to the project and will comply with the principles for transparency of data.
During the reform, around 2,800 employees will be transferred to the employment of the counties. Before implementing change, the ELY Centres and TE Offices will pilot new types of operating models that will make it possible to introduce both private and third sector service providers in a more extensive manner in the provision of services.
The pilots aim to utilise new service provision models such as the alliance model. The objective is to build new types of client centred service packages. The counties can utilise the results of the pilots in the planning of their own services.
County services for jobseekers
A jobseeker registers as the client of recruitment services in some county. In addition to advice and guidance on job seeking, a jobseeker can receive career guidance as well as training to increase their professional competence and skills, entrepreneurship training and integration training.
The county or service provider must when necessary give the jobseeker information on other services that can promote his or her employment, on how to apply for unemployment benefits as well as the obligations related to receiving an unemployment benefit.
The county must see to it that there are an adequate number of service points, where jobseekers can begin their job search and receive advice and guidance on employment. The county or the service provider must direct the client to the services appropriate for their service needs and provide advice on how to choose a service provider.
If a company terminates the employment of some of its personnel, the county will see to the implementation of change security together with the employer and representatives of the personnel.
How will the structurally unemployed be helped?
The county will organise multisectoral joint services that promote employment, where growth services are coordinated with health and social services and when necessary with Kela’s rehabilitation services and activities with organisations.
There is a need for the coordination of services when the jobseeker has work ability or functional capacity limitations or experiences problems with life management. These will not be resolved solely through consultations with authorities but will require close cooperation. In addition to the possibility to use digital services, people must always be given the right to face-to-face personalised services.
County services for companies
The county organises services for corporate clients in the scope determined in its service strategy. Service packages/contents intended for companies can be related to for example establishing a company, being an employer, leadership, financial management, product and service development and expansion of business.
National growth services for companies
In addition to county-organised growth services there are also national growth services. They offer services to companies regardless of where the company is based in matters related to internationalisation, innovation funding, international investments and travel.
National service providers (e.g. Business Finland, Finnvera and Finnish Industry Investment Ltd) and the counties must work together to ensure that the service packages and service chains offered to corporate clients are efficient, supplement one another and do not overlap. The objective is that services are offered to corporate clients with the one contact principle. This means that it is important to share corporate client data between public service providers. In future, digital services will facilitate more and more extensive client benefits and cost-efficient service provision.
8.4. RESCUE SERVICES AND PREPAREDNESS
Counties will be responsible in the future for organising rescue services. From the beginning of 2021, every county will have its own rescue department.
Rescue services are undergoing a reform as part of the regional government reform. The objective is to guarantee a cost-effective, harmonious and high quality rescue service throughout the country without jeopardising its preparedness. The purpose of the reform is to strengthen the national management and planning of rescue services and preparedness.
In practice, the reform will mean that all 18 counties will have its own rescue department from the beginning of 2021 in place of the current 22 regional rescue departments. The Ministry of the Interior has been preparing coming legislation for the organisation of rescue services.
The rescue services reform is linked to the emergency medical care solutions specified in the health and social services reform. The Government has decided that all 18 counties will organise emergency medical care. This will ensure that rescue departments continue to produce emergency medical care for healthcare services. At the moment, rescue departments handle around 400,000 emergency medical care assignments a year.
The reform will reinforce central government steering in rescue services. Strong steering will be carried out as follows: The Government will approve the national objectives for rescue services and the Ministry of the Interior will see to the direct steering of rescue services in the 18 counties. The Government will also be able to decide on the centralisation of some special tasks carried out by rescue services so that these are handled by one or more counties.
According to the Government Rules of Procedure, the Ministry of the Interior is responsible for the regional governments’ preparedness for emergency conditions and disruptive situations. It has been intended during the regional government reform that this task will stay with the Ministry of the Interior. In other words, the ministry will be responsible for the coordination joint preparedness nationally. This will mean that the county is responsible for its own area’s preparedness and the counties’ preparedness as a whole will be a national function.
The Ministry of the Interior will in future assess and supervise the service level of rescue services. The state permit and supervisory agency which is due to be established would also be tasked with supervising that the organisation and provision of rescue services and the preparedness of the counties comply with legislation.
8.5. ENVIRONMENT-RELATED TASKS
The high quality performance of environmental tasks will ensure that the counties can effectively influence the quality of their area’s environment and the wellbeing of their residents.
Environmental tasks will in future be performed by the municipality, county and the State. Municipalities will be responsible for environmental tasks that support local participation and vitality and smaller environmental permits, the counties will responsible for development and promotion work in their own areas, the State permit and supervisory agency (Luova) holds legal discretion for legal protection, permits and supervision as well as for supervising public interest.
The key environmental tasks carried out by counties will include county planning and zoning, the planning of land use in municipalities and promoting the organisation of building regulation, management of waters and the marine environment, marine area planning, promoting nature conservation, management of the cultural environment and production of environmental data. The high-quality performance of these tasks will ensure that the counties can effectively influence the quality of their area’s environment and the wellbeing of their residents.
As a multisectoral actor, the county has vast possibilities for effectively promoting sustainable development, low carbon strategy, energy and material-efficiency, climate goals and the circular economy. The county’s tasks include the coordination of climate and energy efficiency work and related guidance. as well as the promotion of the circular economy.
Tying in environmental aspects into the performance of all the county’s tasks and the county’s strategic objectives is important for the utilisation of synergy benefits. For example, it has been shown in studies that the quality of the environment has a positive effect on the quality of people’s lives and their health. The county can significantly benefit from this in the performance of health and social services tasks. Read more on the various environment-related tasks that the county is responsible for at alueuudistus.fi/ymparistotehtavat.
Many environmental issues and the development needs of areas cross county borders. Counties can work in cooperation with one another to add to the impact of their activities and to increase expertise. The use of resources can be optimised with cooperation and the division of work.
8.6. FOOD AND NATURAL RESOURCES SERVICES
The counties are tasked with promoting the diverse production of food and the sustainable use of natural resources.
Food and natural resources sector tasks form the counties’ third largest task entity covering around 2,000 person-years. These tasks are divided into three groups, agriculture and food economy and rural development, food safety and animal welfare under environmental healthcare as well as fisheries economics, water resources management and other natural resources services.
About 70% of Finland’s EU aids are made up of direct aid for agriculture from the EU and the rural development funds. This is approximately 864 billion euros a year. EU aid and national aid to the Ministry of Agriculture and Forestry’s sector totals approximately 2 billion euros a year.
Placing these tasks in the counties will bring significant benefits including that the tasks will be performed together by all counties and will be managed as an entity. It is of utmost importance to also utilise the areas’ own needs and possibilities in these tasks.
Agriculture, food economy and rural development
All counties will be responsible for these tasks unless they agree otherwise. According to a decision by the Government, nearly all rural and agriculture administration tasks currently handled by ELY Centres and municipalities will be transferred to the counties. The majority of these tasks and duties are so-called paying agency tasks. Their performance will be steered by detailed EU instruments. Paying agency tasks must be carried out as official duties. These cannot be transferred to the unincorporated county enterprise or third parties.
Food control as well as animal health and supervision of wellbeing
The management of these tasks will be centred at the Food Agency, which is to be established on 1 January 2019. However, inspections and implementation will be transferred to the counties with the exception of the supervision of veterinary practices, as well as the control of the welfare of animals used for scientific and teaching purposes, which will be centred at the Food Agency. The purpose is to reduce bureaucracy in the control of foods and animal welfare, as well as to do away with overlapping in the steering of food control. At the same time, closer cooperation than at present will be facilitated with the other functions that will be transferred to counties, such as alcohol licence administration, land use planning and environmental healthcare.
Fishery economics and water resources management
The county will bear responsibility for the majority of these natural resources tasks. The real challenge is to ensure that all counties have the expertise needed for the provision of equal services. For this reason, the counties decide on the performance of these tasks together. Collaboration also ensures that tasks will be carried out in bodies of water that are located in two or more counties.
The fishery economics tasks that will be transferred to the counties, including management of fisheries’ resources, supervision of the interests of the overall fishery economy, promotion of fishing, as well as promotion of livelihoods in the fishery industry and the administration of European Maritime and Fisheries Fund-paid subsidies as well as supervision of Europe’s joint fishing policy and fishing.
The counties will handle all their water resources management tasks in collaboration, but each county will be responsible for the related decision making in their own area. The water resources management tasks the responsibility for which will be transferred to the counties include: management of flood risks, regulations of waters, production of regional water status data, supervision of dam safety, (supervision of dam safety and expert tasks will be centred in Kainuu County), the management and repair of man-built bodies of water, basic drying and as well as water supply tasks.
The official duties pursuant to the Water Act handled by the current ELY Centres will be divided as follows: the supervision of compliance with the Water Act will be transferred to the State permit and supervision agency, while development and expert tasks in the area of water resources management will be transferred to the counties. The counties and the State permit and supervision agency would have equal powers in the supervision of public interest in accordance with the Water Ace.
The regional government reform will also impact transport tasks, road maintenance funding and the Government’s transport administration’s agencies. The State will retain ownership and responsibility for the road network even after the reform.
ELY Centres, the Finnish Transport Agency and the Finnish Transport Safety Agency currently hold primary responsibility for transport tasks.
Transport tasks that will be transferred to the counties on 1 January 2021:
- the functionality of the transport system
- transport safety
- road and transport conditions
- regional road maintenance
- cooperation in land use
- production of information on the operating environment for the planning of the national transport system and
- discretionary government transfer tasks related to private roads and mobility management.
The counties can, if they so wish, also take on the organisation of public transport and archipelago traffic. Also the personnel presently responsible for road maintenance at the present ELY Centres will be transferred for the most part to the employment of the counties.
Tasks that will stay with the Government:
- The State will retain ownership of roads.
- National transport tasks will be centred to the Finnish Transport Agency and the Finnish Transport Safety Agency.
- The Finnish Transport Agency will in future handle for example road maintenance permits and the Finnish Transport Safety Agency will handle business licences.
- The State will continue to be responsible for the maintenance and development of railroads and waterways.
- The State will also be responsible for seeing to the issuing of discretionary government transfers to certain municipal and regional authorities (e.g. subsidies to public transport in large and medium-sized cities).
After the regional government reform, the organisation of regional road maintenance, private road ferries and subsidies for ferry vessels, archipelago traffic and flight purchases Savonlinna-Helsinki would be funded in counties with separate funding provided from the Ministry of Transport and Communications’ budget.
Some tasks related to transport would be organised with universal state funding: purchase and development of public transport services, steering of mobility, the construction and maintenance of some flight locations and government aid for private roads. The county could independently decide on how to target this money.
8.8. AGRICULTURAL ENTREPRENEURS AND REPLACEMENT SERVICES
The daily life of entrepreneurs will also be simplified in rural areas, when public administration services are all available in one place. The regional government reform will bring together all rural entrepreneur services from ELY Centres, TE Offices, regional state administrative agencies, joint municipal authorities and municipalities. The county will provide guidance on matters such as farming subsidies, investments by farming entrepreneurs and the development of farming enterprise.
The Food Agency, which will be established in 2019, will be responsible for the payment of farming subsidies. The county will handle the applications and supervise the use of subsidies.
In accordance with the transfer-of-business principles, also responsibility for veterinary services and farming replacement workers will be transferred to the counties, which will be established as part of the regional government, health and social services reform. In the future, counties will thus be responsible for organising tasks that are provided on in legislation concerning agricultural entrepreneurs’ replacement services, such as the management of replacement and replacement services, the making of decisions concerning replacements, task packages related to financial management, various tasks related to human resources as well as the tasks of farming replacement workers.
8.9. ENVIRONMETAL HEALTHCARE AND ALCOHOL ADMINISTRATION
In future, counties would be responsible for environmental healthcare and for the control of retail sale and serving of alcoholic beverages.
Municipalities are currently responsible for organising environmental healthcare but it is organised by 62 co-operation areas consisting of municipalities. The control of retail sale and serving of alcoholic beverages is the responsibility of the Regional State Administrative Agency.
Environmental healthcare covers health protection, tobacco control, food security and animal wellbeing (veterinary services). Food security and veterinary services are presented more closely under paragraph 8.6 (Food and natural resources services). Tobacco control includes the control of sale of tobacco products and the enforcement of smoking bans.
Health protection covers extensively the assessment and control of health risks caused by the environment (for example, housing health, monitoring the quality of drinking water and bathing water, health conditions in public spaces).
Transferring environmental healthcare duties to counties is a natural step to take in current development towards the organisation of environmental healthcare by areas larger than municipalities. The transfer of duties to counties allows public officials, for example, to specialise in their own themes better than today. This will improve the quality and effectiveness of services provided to entrepreneurs and residents.
9. LINGUISTIC RIGHTS
The linguistic rights of county residents will not change from what they are at present. Clients will have the right to use a national language, i.e. Finnish or Swedish, as well as to be heard and receive documents in administrative matters in Finnish or Swedish.
- Health and social services will be organised in Finnish and Swedish, in a county that consists of Finnish and Swedish-speaking municipalities or bilingual municipalities. Language legislation also applies to other county services such as growth services.
- If all the municipalities in a county are monolingual, services in the county will be provided and the administration associated with them will organised in the language used in the municipalities of the administrative area.
- A private health and social services centre or dental surgery service provider must provide services in the county’s official language.
- Services provided on the basis of a health and social services voucher or a personal budget are provided in Finnish or Swedish or both languages. The service provider must state which language(s) they provide services in.
- The linguistic rights of the Sámi are more extensive in the Sámi homeland (the municipalities of Enontekiö, Inari and Utsjoki as well as part of the Sodankylä area). Sámi speakers also have a statutory right to use the Sámi language outside of their homeland in Lapland county in health and social services that are compiled into larger packages (i.e. specialised medical care). If a trained professional, who speaks Sámi, is not available an interpreter can be provided to meet the legal requirements.
- The inclusion of the client and the patient must also be safeguarded in situations where the client or patient and the personnel do not have a common language or if the patient cannot be understood because of a sensory handicap or speech defect, or for some other reason. Such language groups include those that use Finnish and Finnish-Swedish sign language. In a situation where the client or patient and the personnel do not have a common language, it must be ensured that the client is sufficiently informed of their issue and its significance and that they can express their opinion. If it is not possible to provide an interpreter, understanding must be ensured in other ways.
- Nordic citizens have the right to use their own language; Finnish, Icelandic, Norwegian, Swedish or Danish. In this case the county must, as far as possible, ensure that Nordic citizens receive the required interpretation and translation services.
- The need for other people who speak other languages including foreigners to have the right to use their own language will also be taken into account.
What is an unincorporated enterprise? What is a personal budget? What is capitation reimbursement? What are growth services?
The Ministry of Social Affairs and Health is drawing up a glossary on the key terminology related to the health and social services reform in cooperation with the Finnish Terminology Centre TSK.
The completed key health and social service glossary for experts can be found here: https://alueuudistus.fi/en/terminology