Emergency services and specialised medical care structure reform
As part of the social welfare and health care reform, the hospital network and joint emergency services are being reformed.
In addition to the joint emergency services, work division in hospitals and social emergency services will be reformed. In its Government Programme, Prime Minister Juha Sipilä’s Government has agreed on a regional reform of specialised medical care, which will support the social welfare and health care reform and the implementation of the regional government reform as from the beginning of 2020. The execution of the reform is based on the current structures and legislation.
According to the policies drawn by the Government in November 2015 and the Government Programme, the ministerial reform group has outlined that the hospital network and the joint emergency services will be reformed. The most demanding specialist emergency services will be concentrated in to 12 hospitals, which will maintain extensive round-the-clock emergency service units. Social welfare emergency services will also be offered in connection with these units. All five university hospitals in Helsinki, Turku, Tampere, Kuopio and Oulu would offer the most demanding treatment. The seven other central hospitals offering extensive emergency services would be located in Lahti, Lappeenranta, Pori, Seinäjoki, Jyväskylä, Joensuu and Rovaniemi.
Round-the-clock basic health care and specialised medical care joint emergency services would be arranged in other central hospitals located in Kotka, Mikkeli, Savonlinna, Hämeenlinna, Vaasa, Kokkola, Kajaani and Kemi. These round-the-clock joint emergency services arranged in the other central hospitals would include emergency services for the most commonly needed specialities and social welfare emergency services, in addition to oral health care emergency services according to need. Specific demanding surgeries would be concentrated to the hospitals offering extensive emergency services. Some operations would be ended in smaller health care units such as regional hospitals.
The reform aims to insure the equal availability of services, adequate competence in the treating unit and customer and patient safety as well as curb the growth of costs. In addition, the objective is that people can get into emergency care easier than at the moment. Health centre service points would arrange emergency reception work on week nights and weekends during the daytime. The need for local emergency medical services in connection with changes to the emergency services is only emphasised. When planning an entity that meets the population’s needs, also other social welfare and health care local services in the area must be taken into account.
Social welfare services alongside health care
The reform also aims to promote the equal availability and accessibility of social welfare alongside health care both during business hours and outside business hours. The reform would strengthen the availability of social welfare services also in hospitals and expedite the direction of customers from health care to the services of social welfare and vice versa. After the reform, the needs of people could be met in a more customer friendly manner and more comprehensively by supporting them in their own everyday life surroundings.
To guarantee customer safety and the quality and efficiency of social services, these services could be centralised and arranged nationally or regionally in connection with health services or other services according to need. In order to implement seamless service in connection with non-emergency and emergency care, possible need for social welfare must be assessed.
Patient safety as the starting point - local services will be secured
A key goal of the reform is to improve patient safety. For this reason, specialised medical care tasks requiring specialist skills are concentrated to larger units without compromising high-quality local services. When the same unit performs a lot of surgeries, the competence based on practical experience of the team of professionals needed for surgeries increases, which in turn improves patient safety.
The work division of specialised medical care between the five university central hospitals will be reformed so that specific specialised medical care tasks would not be handled in all five places in the future. According to the work division, some of the university hospitals would handle specific specialised medical care tasks nationally. For example, organ transplants and severe burns would be such specialised medical care tasks in the future too.
Local services of the residents would be secured and they would be offered in a variety of ways in the future. According to the proposal, emergency reception services would be available as a local service for example at the health centre also at night time and during weekends. Distances in different parts of the country and other regional special features will be taken into account in arranging the local services.
Emergency medical services will continue to be a local service in the future. For their part, emergency medical services secure the assessment of the patient’s need for care and the beginning of emergency treatment.
Centralisation of demanding emergency services would improve patient safety
Exhaustive round-the-clock specialised emergency services would be centralised into 12 hospitals of which five are university hospitals offering the most demanding treatment. Each of these hospitals would have physicians from at least ten different specialities and emergency social services professionals. Thus, the readiness for the high-quality and safe care of demanding situations would always be available. In addition to patient safety, the solution would improve equality: demanding specialised services would be available to people equally in different parts of Finland.
For half of the Finnish population, the travel time to the closest extensive emergency unit hospital would be less than 30 minutes and for 80 %, less than 50 minutes.
Other current central hospitals would continue their basic health care and specialised medical care emergency services and they would also offer social welfare emergency services. In addition, they would maintain the competence of the most commonly needed specialities. If the distance to the emergency clinic of a larger hospital would otherwise be too long, the smallest hospitals and some health centres would also offer round-the-clock emergency treatment. In this way, emergency care could best be secured for the entire population irrespective of the place of residence.
Social and health services will be better harmonised
Emergency social services should be arranged in connection with extensive round-the-clock health care emergency units and specialised medical care joint emergency services. The obligation to arrange psychosocial support through co-operation between social welfare and health care as part of emergency treatment would be clarified. All units implementing emergency services would have to have adequate resources and competence.
The proposal would not require transfer of the entire social welfare emergency services as part of the hospitals but services could still be offered in their own unit or, for example, in a joint unit with the police. Since the majority of emergency service work is performed elsewhere than in a fixed office, it must be ensured that there is adequate readiness for this.
Attachments in Finnish:
- National survey on the operation of emergency medical services: Mid-term report 2 (Reports and memorandums of the Ministry of Social Affairs and Health 2016:40)
- Statement documents, 19 May 2016 (stm.fi)
- Frequently asked questions regarding the structural reform of 24-hour services and specialised medical care in the Social Welfare Act and Healthcare Act, pdf
- The 24-hour services reform would link social welfare and healthcare services closer together – proposal sent for comments (Press release, 19 May 2016)
Materials from consultation events:
- Reform of 24-hour services and specialised medical care, consultation in Turku on 23 February 2016, pdf
- Reform of 24-hour services and specialised medical care, consultation in Oulu on 12 February 2016, pdf
- Differentiation of urgent care in the reform of specialised medical care, 5 February 2016, pdf
- Future hospital network and 24-hour services, memorandum of the Ministry of Social Affairs and Health, 3 February 2016, pdf
- Structural reform of specialised medical care and 24-hour services - Statutes, 5 February 2016, pdf
Liisa-Maria Voipio-Pulkki, Director, Ministry of Social Affairs and Health, tel. +358 2951 63382 (structural reform)
Timo Keistinen, Ministerial Counsellor for Health/Medical Affairs, Ministry of Social Affairs and Health, tel. +358 2951 63385 (specialised medical care)
Lotta Hämeen-Anttila, Ministerial Counsellor for Legal Affairs, Ministry of Social Affairs and Health, tel. +358 2951 63406 (24-hour social services)
Lasse Ilkka, Senior Specialist, Ministry of Social Affairs and Health, tel. +358 2951 63995 (emergency medical services)
Anne Nordblad, Ministerial Counsellor for Health/Medical Affairs, Ministry of Social Affairs and Health, tel. +358 2951 63387 (oral health services)