Integration of social and health services
The integration of healthcare and social welfare services means that all services will be under the management of a single structure, the county.
The counties will be responsible for coordinating the services and forming effective service and care chains. This will apply to all public healthcare and social welfare services, both at primary and specialised level. All financing will also go through the county to service providers. The county has the duty to ensure that public, private and third sector services within the scope of the clients' freedom of choice work together, information flows smoothly, and the services meet quality criteria.
Why is the integration of social and health services important?
Integration of healthcare and social welfare services based on the client’s needs is a key method for improving the equality of services and organising them effectively and cost-effectively. The basic principle is that the client's needs are assessed as a whole and that information flows smoothly between the actors. Clients are not sent from one expert to another, none of whom has a general picture, wasting time and money by waiting in queues and repeating the same steps several times. The aim is that the competence, services and interventions of different healthcare and social welfare professionals are combined flexibly, delivering services that are as timely and effective as possible for the client and ensuring that the services are organised effectively and economically.
County will be responsible for a client’s services as a whole
According to the draft Freedom of Choice Act, counties must ensure that their clients receive services in accordance with the Freedom of Choice Act, guidance and advice on freedom of choice and support to use their freedom of choice. Health and social services centres and dental clinics will also be obliged to give their clients guidance, advice and support. It is necessary to pay particular attention to clients who need a wide range of integrated services, who are frequent users of services or who need special support.
Counties must ensure the integration of healthcare and social welfare and secure adequate expertise in social welfare. An unincorporated county enterprise must therefore have a multi-professional group working in connection with health and social services centres. This group must include a social worker, other social welfare professionals and even healthcare professionals, when necessary. County staff working at health and social services centres would offer social services and make needs assessments. Clients would not need to separately visit a service unit of the unincorporated county enterprise in order to get social services.
Counties may decide to provide even other services in connection with health and social services centres. These services provided by the unincorporated county enterprise may be given by county staff working at health and social services centres or by a county working group moving between different locations in the county area. Services can also be given as e-services or in other suitable ways.
The county will define which conditions the service providers must meet and the county must also conclude contracts with service providers. The contracts can define in more detail how cooperation between different service providers must be organised, in order to strengthen the integration between the various services as necessary.
Client care plan collates the services to be given to the client
According to the draft Freedom of Choice Act, a client care plan will be the central tool for integrating the services for the client. The client care plan will include all health and social services for the client, irrespective of service provider. One operator (the unincorporated county enterprise or the health and social services centre) will be responsible for drawing up the plan in accordance with the client’s need for services. The plan will be drawn up in cooperation with the client’s other service providers. All service providers would have to follow the client care plan.
Service packages for client groups
Counties can determine service packages to be offered for certain client groups. These packages would integrate services for population groups needing similar services.
For example a family centre network could collate services for families with children into a well-functioning services package. Similarly, special services and most demanding services for children, young people and families will form a coherent network and be brought closer to basic services. Older people will also be referred to services tailored for them, which will be easier than at present. Regional centres of informal and family care will plan services for older people, integrating their services to other services offered in the region. Mental health and substance abuse services and rehabilitation services will also be integrated into service packages.
The goal of the legislation on the healthcare and social welfare reform and its implementation is to meet the following conditions, which are a prerequisite for service integration:
- integration of organisation: a single strong organiser responsible for the service provision structure and its steering, official activities, evaluation of regional impact, cost-effectiveness and quality of healthcare and social welfare services as well as supporting the users’ freedom of choice
- integration of financing: all financing goes through the organiser, who has an overall view of the financing (a single budget and single financial management)
- integration of information: in a client/care relationship and the related analysis, information flows between different providers through national registers and fully interoperable information systems
- integration of service chains: care and service packages are organised ensuring that different services and service providers can effortlessly liaise with each other. A prerequisite for this is agreements concluded under centralised guidance on referrals and the linkage of individual services to the packages
- integration of provision, where services are offered as cost-effective, clear-cut service packages. Integration of provision will take place in a network-based structure that consists of several service providers. It will also be implemented in individual service units.
Kirsi Varhila, Director-General, Ministry of Social Affairs and Health, tel. +358 295 163338
Liisa-Maria Voipio-Pulkki, Director, Ministry of Social Affairs and Health, tel. +358 295 163382 (health services)