Prime Minister Juha Sipilä Prime Minister's announcement about deferral of the regional government, health and social services reform’s entry into force until 1 January 2021
On Wednesday 27 June, Prime Minister Juha Sipilä presented to Parliament his announcement on the deferral of the entry into force of the regional government, health and social services reform.
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the regional government, health and social services reform is the biggest and most important of this Government’s reforms and is the biggest and most important reform for the country as a whole. This is why the deferral of its entry into force by 12 months is of great significance and requires not only the commitment of the ministerial groups but also a Plenary Hall debate.
The Government wishes first to remind everyone of the purpose of the reform. The reasons behind it have not changed at all. On the contrary, the reform is more necessary than ever.
people have a right to equal and non-discriminatory health and social services throughout the country. High quality services must be secured despite the accelerated ageing of the population.
The reform is being carried out to ensure that people can still have services of at least today’s standard in ten years’ time and beyond.
The reform is being carried out to ensure that wherever it currently seems hard to get treated, the queues will be shortened as a result of different alternatives becoming available in primary healthcare and social services with the introduction of freedom of choice. Freedom of choice will strengthen health and social services in particular and will ensure that there is equal access to treatment and care more quickly than at present.
The reform is being carried out to ensure that health gaps can be reduced and expenditure curbed.
The reform is being carried out so that the service organisers will, in future, have broader shoulders. Thanks to the reform, the current total of about 400 organisations seeing to the various statutory duties will be replaced by 18 service organisers. These broader shoulders will allow uninterrupted chains of services.
The reform is also being carried out so that we can at last guarantee uniform and compatible information systems for Finnish health and social services, supporting the idea of uninterrupted service chains. This will ensure that client information is complete and can be transferred conveniently. Compatible information systems are also an absolute requirement for building digital services and making full use of them.
the reform will have a significant impact on the sustainability gap in general government finances. The proportion of the Government's EUR 10 billion target that is to come from health and social services is EUR 3 billion. Bringing costs down by EUR 3 billion means that, in practice, future spending can grow by an annual 0.9 per cent in real terms, whereas now spending would otherwise be growing at an annual rate of 2.4 per cent.
The regional government, health and social services reform will establish the new counties and reform the structure, services and funding of healthcare and social welfare, bringing with it freedom of choice and also transferring new duties to the counties. The duties transferred to the counties will include rescue services and the employment and business services transferred from the state regional administration. This reform will enable better management of services as a regionally balanced whole. The reform was to have entered into force in full on 1 January 2020.
before us now is a situation where a historically significant and innovative reform requires more time in terms of parliamentary work than had been anticipated. Although the Government submitted its legislative proposals to Parliament within the time promised, the schedule has proven too tight for the counties to be fully up and running in 2020.
According to the statement from the Office of the Chancellor of Justice, there must be a period of about six months between the legislation’s entry into force and the holding of county elections.
Officials estimate that a minimum of 10 months is needed for the counties to be fully operating after the county councils have begun to function. The counties and the county councils will have a lot to do in implementing the reforms prior to the start of operations. With the start of the county councils being transferred to next summer, the schedule can no longer be met.
Therefore, by this announcement, the Government wishes to bring to the attention of Parliament and to inform the staff of organisations involved in the reform, as well as those involved in making preparations for the reform and the general public, that the starting date for the new counties must be deferred until the beginning of 2021. Freedom of choice will, correspondingly, begin a year later than the dates given in the reply last week.
The Government has also decided to secure sufficient additional funding for 2020 needed for the reform as a whole. The Government’s aim is that the first county elections could be held in May 2019. The legislation should then be in force about six months prior to this.
The Government will return in more detail to the other changes required by this schedule during August.
a further 12 months for the preparations also brings with it a number of challenges. Additional funding for the preparations is needed. The current estimate is that the additional funding needed is approximately EUR 200 million, but a more accurate figure will emerge before the government budget session. The additional cost pressures due to the phasing will be assessed together with the regions.
The unclear situation regarding organisational responsibilities will be further drawn out, too. Unfortunately, this may mean that organisations giving up responsibilities might decide on a separate course of action and engage in outsourcing that does not tie in with the bigger picture regarding the overall interests of the future county. The Government hopes that the municipalities and joint municipal authorities will still work cohesively, so that the additional 12-month period does not become an arena for market forces. The state of limbo affecting the operational development of health and social services within some of the organisations that will be giving up responsibilities is to continue for still a further year. As Prime Minister, I fervently hope that the hearts of those involved do not harden at the slowness of national decision-making.
On the other hand, an additional year provides more time to prepare the county and national ICT solutions. The readiness to start up county activities still varies from one county area to the next. An extra year will also allow those regions that have made slower progress to make sufficient preparations for the reform. With the extra time, the readiness of the slower regions to function as strong service organisers will improve significantly.
In the preparations for the reform we can also benefit in full in all county areas from the experiences of the freedom of choice pilot schemes beginning straight after the legislation’s entry into force. The Government has reserved a total of EUR 200 million for these pilots. The readiness of the counties to introduce freedom of choice in the health and social services centres straight away during 2021 will therefore be considerably enhanced.
the Government has resolved to see this reform through to completion. The reform is one of the greatest equal treatment reforms in Finnish history.
It is essential at this point that the work on the reform continues. This is why the Government wishes to strongly convey the message that the goal remains clear and that we shall be implementing Finland’s biggest reform of services and administration.
The reform involves numerous associated acts of legislation, and time must be found to deal with these during the present Parliament. The general public must also soon be informed of when the historical first county elections are to be held.
The timetable for the reform is now in the hands of Parliament. The Government hopes that Parliament will debate the reform in a thorough, expeditious and responsible manner. The regions’ uncertainty over the reform timetable should be brought to an end. Similarly, thousands of employees in all regions need an idea of when everything will be ready. The changes will affect hundreds of thousands of employees: public sector employees transferring to the counties; private sector employees serving in the future health and social services centres; and also, for example, the self-employed individuals and small business employees who will supply services to residents of Finland via the health and social services voucher system. They all deserve certainty at last over when the reform will take effect.
the reform process will not stop here, which is why Finland and its political system must do better. Public confidence in democracy and politics is on the decline, according to various indicators. This should be of concern to every one of us in this hall. We must strive to do better in future.