Frequently asked questions about the health and social services reform

 

Frequently asked questions about the health and social services reform

  • What are public health and social services?

    Health and social services are services the state (central government) finances through tax revenue. They include, among others,

    • outpatient services (which usually means health centre appointments and, for example, preventive services provided by maternity and child health clinics)
    • hospital services
    • oral health services
    • mental health and substance abuse services
    • child protection
    • services for people with disabilities
    • housing services to older people
    • home care
  • What are the goals of the regional government, health and social services reform?

    The regional government, health and social services reform will give the public administration in Finland a clear three-tier structure: state, counties and municipalities.  The aim is to modernise administration and services to respond better to client needs and to make the administration function cost-effectively. The objective of the regional government reform is to coordinate regional state administration and county government and to create an appropriate division of responsibilities between the regional state administration, the counties and the municipalities.

    The objective of the health and social services reform is to improve the availability of health and social services and reduce disparities in citizens’ wellbeing and health. The reform aims at giving everyone equal opportunities to choose and use services and at creating services that would have a better impact on people. The reform also aims at curbing costs.

    The reform is due to come into force on 1 January 2021.

  • How will the administration model outlined by the Government help bridge the sustainability gap?

    Resources, such as personnel, premises and funding, can be used more effectively when health and social services are organised by 18 counties instead of the current municipalities and joint municipal authorities. Bridging the sustainability gap also requires a smooth integration of primary and specialised health and social services. This means in practice that clients receive the services they need in a smooth manner and without unnecessary intermediaries. These changes will help to reduce institutional care and reinforce preventive work, which in turn will postpone older persons' need for services. Counties will be larger and stronger operators than municipalities, enabling a better division of responsibilities and more efficient use of new service forms.

    Significant savings will be made when health and social services in future utilise digital services more widely that today. In addition, interoperable information systems will guarantee that information flows well between different operators. Central government steering must be strong enough to spread good practices and to allocate funding and models in the right way to right places in order to implement the services.

  • Why should the health and social services reform also curb rising costs?

    The population is ageing, which means that more and more people need health and care services. It has been estimated that by 2035 the ageing of the population leads to an increase of 70% in the need for older persons' services and an increase of 20% in the need for healthcare.

    The costs of services have also increased, and they are expected to rise faster than the overall price level. The increase of tax revenue is limited, however, and therefore the services must be produced more economically than today.

    It is necessary to reform the system if we simultaneously want to ensure that everyone can get care and treatment of high quality and to keep public finances balanced.

    A major part of health and social services are financed by tax revenue, but since the total tax ratio is already high in Finland there is little scope for increasing the revenue.

  • How will transfers of personnel be carried out, and will they influence employee benefits?

    The healthcare and social welfare personnel and some support service employees currently employed by municipalities and joint municipal authorities will be transferred to the employment of the counties in line with the principles relating to a transfer of undertakings. In addition, approximately 5,000 employees will be transferred to the counties from the state regional government. Over 220,000 persons from municipalities, joint municipal authorities and central government will become employees of the counties and their companies as of 1 January 2021.

    In future, the legislation on local government officials, collective agreements legislation and legislation on collective agreements for public servants will be applied to the counties' personnel. Statutes will be amended to apply also to the counties’ personnel.  The counties will become members of Keva (former Local Government Pensions Institution) and the counties’ personnel will be covered by the municipal pension system. Local Government Employers KT will also act as the counties’ employer representative. The costs of personnel transfers and pay harmonisation will be kept to a minimum.

    In the new employer organisation, the counties’ status will correspond with their personnel numbers and economic weight. County representatives will join the central organisation for municipal employers. The organisation has two so-called departments. One of them will promote the interests of municipal employers and the other one the interests of county employers. County-owned companies may choose whether to join the local government pension scheme and to observe the local government and county collective agreements.

  • Will the buildings owned by municipalities be transferred to the counties?

    The ownership of the facilities of municipal health and social services will not be transferred to the counties; instead, the counties will rent the facilities for a fixed period of 3 years. However, the movable property related to organising health and social services will be transferred from municipalities to counties.

    Follow-up preparations will seek to ensure that individual municipalities will not be burdened by empty facilities and renovation liabilities.

    However, the counties will receive the assets and liabilities of hospital districts and special care districts and regional councils as well as all related real estate and facilities.

  • How will health and social services be financed?

    The state (central government) will finance the operations of counties. In addition, counties will collect client charges and other user charges.

    The counties will have no right to levy taxes. The main principle is that counties' funding from the central government depends on which services the clients living in the county area need. Certain factors will be taken into account, such as age structure, morbidity and socio-economic factors (for example factors related to employment, level of education and subsistence). The financing is not earmarked; the counties decide themselves how they use the funds in health and social services.

  • Will client charges go up?

    The aim is that client charges will not change significantly. Legislation on client charges is currently being updated. The drafting of this legislation started in spring 2017. Different charges can change in relation to each other. In future, some charges may be higher than today while others may be lower.

  • Will the health and social services reform weaken the prehospital emergency medical services?

    No. Prehospital emergency medical services are being developed continuously. The aim is that the services respond to changing needs, are focused as appropriately as possible and concentrate on their central duty to help patients in emergencies. Prehospital emergency medical services are scaled taking into account the need for services in the county area and the extent of the needed services.

    In future, counties will organise the prehospital emergency medical services, Thanks to this reorganisation, the current resources of hospital districts and rescue services can be used in a more flexible manner, as they will belong to the same county. In addition, counties will be able to supplement their services by purchasing some services from the private sector.   

    The quality of prehospital emergency medical services are being studied and developed. In future, there will be two new IT-systems, the new emergency response centre system (ERICA) and the command and control system (KEJO) of the security authorities, and they will provide data on prehospital emergency medical services. The systems enable the collection and use of data nationally in a uniform and reliable way. This will be a significant support for planning and developing the services.

    A new health and social services helpline, Non-Emergency Advice 116117, will allow the prehospital emergency medical services and the Emergency Response Centre Administration to concentrate on their essential tasks. The 24-hour helpline 116 117 will be a national service but provided regionally.  Residents can call the helpline for advice on health and social services. Some hospital districts are already piloting Non-Emergency Advice 116117. The aim is that the service will be taken into use in the whole country during 2019.

  • How will the language rights of clients and patients be ensured in the health and social services reform?

    Law will guarantee people’s language rights in health and social services even in future. Clients and patients 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. Language rights are laid down in the current Language Act, Sámi Language Act and Sign Language Act as well as in the forthcoming Act on Organising Health and Social Services and Freedom of Choice Act. According to the Act on Organising Health and Social Services, health and social services will be organised in both national languages – Finnish and Swedish – in counties where there are both Finnish and Swedish-speaking municipalities or bilingual municipalities If all municipalities in a county are monolingual, services and related administration will be provided in that language.

    Of the proposed counties, five will be bilingual, with Swedish as the minority language in all except Ostrobothnia. The right to use the Saami language applies to the Saami homeland and some parts of the Lapland County.

    According to the Language Act, a public authority must ensure, on its own initiative, that an individual’s language rights are fulfilled in practice. When services are organised, compliance with the Language Act must be ensured.

    Services to clients and patients must also be safeguarded in situations where a client or patient and personnel do not have a common language or an individual cannot be understood due to a sensory or speech disability or other reason. Such language groups include those that use Finnish and Finnish-Swedish sign language. If it is not possible to provide an interpreter, understanding must be ensured in other ways.

  • How will counties take deaf people who use sign language into account in their services?

    Under the Act on Organising Health and Social Services, services for clients and patients must also be safeguarded in situations where a client or patient and personnel do not have a common language or an individual cannot be understood due to a sensory or speech disability or other reason. Such language groups include those that use Finnish and Finnish-Swedish sign language. If the client or patient and personnel do not have a common language, care must be taken to ensure that the person has sufficient understanding of the matter and is able to express his or her opinion. If it is not possible to provide an interpreter, understanding must be ensured in other ways.

  • How will counties organise advice and support for people with disabilities? What measures will be taken to identify what services people with disabilities will need and how will the services be designed?

    The right of people with disabilities to receive services will be based on the Act on Services and Assistance for People with Disabilities, just as before. In future, the same Act will cover matters concerning both people with intellectual disabilities and people with other disabilities. Counties may grant people who require multiple services a personal budget. The content of such a budget is defined in the client care plan, and it is based on the assessment of service needs. People with disabilities and people close to them will together plan the services to be covered from the personal budget. If necessary, people with disabilities will get help from the county’s personnel when choosing a service provider.

  • What does the public service pledge mean?

    The purpose of the public service pledge is to inform the county residents how the county intends to organise its health and social services. A public service pledge gives the county residents the opportunity to monitor and assess how the services are implemented. Clients can also give feedback and make suggestions on how to improve services. Clients’ views and needs will be taken into consideration. The public service pledge may not reduce the current scope of statutory services. All the changes will be written in the law.

    The purpose of the service pledge is also to increase the transparency of activities and thereby improve the quality and effectiveness of services and to make the services more cost-effective.

  • What does the integration of health and social services mean?

    The integration of health and social services means that all services will be under the management of a single structure, that is, the county. It will be the responsibility of the counties to combine the services into a seamless package responding to clients' needs in the best way possible. Clients will be able to move from one service to another without unnecessary intermediaries. This applies to public health and social services both at the primary and specialised level. In addition, all financing will flow through the counties to the service providers. The counties will also be responsible for making sure that the public, private and third-sector services within the scope of the client’s freedom of choice work seamlessly together, that information flows smoothly and that the services meet quality criteria.

  • How will counties organise advice and support for people with disabilities? What measures will be taken to identify what services people with disabilities will need and how will the services be designed?

    The right of people with disabilities to receive services will be based on the Act on Services and Assistance for People with Disabilities, just as before. In future, the same Act will cover matters concerning both people with intellectual disabilities and people with other disabilities. Counties may grant people who require multiple services a personal budget. The content of such a budget is defined in the client care plan, and it is based on the assessment of service needs. People with disabilities and people close to them will together plan the services to be covered from the personal budget. If necessary, people with disabilities will get help from the county’s personnel when choosing a service provider.

  • How will service organisation and provision be separated in the counties?

    Counties will assign the organisation and provision of services to separate organisations. Counties must separate their own health and social services from their other operations, such as administration related to elected officials. In other words, counties' health and social services must not operate under the county council, the county executive or the healthcare and social welfare board of the county. Each county will therefore establish an unincorporated county enterprise that has its own separate executive board, director and administration.

    As the organiser, each county will be responsible for public authority functions and ensure that their services work and people's fundamental rights are observed. Public authority will be exercised under liability for acts in office. In other words, only public officials of public officeholders in public-service employment relationship may use public authority.

  • How will the diversity of services be ensured in all counties?

    The Act on Organising Health and Social Services and the new Freedom of Choice Act aim to ensure a sufficiently extensive supply of private and third sector services in addition to publicly provided health and social services. This guarantees that the conditions for a genuine multi-provider model and freedom of choice will be effectively in place across the country. Then the clients can choose in a versatile manner between services offered by multiple providers.

  • What are collaborative catchment areas?

    Counties will have five collaborative catchment areas. Counties shall plan how they can together organise services within their collaborative catchment area and carry out research and development work relating to the services. There will be a university hospital in each of the five collaborative catchment areas (Helsinki, Turku, Tampere, Oulu and Kuopio). The collaborative catchment areas will be formed based on the current catchment areas for highly specialised medical care. The counties of each collaborative catchment area will draw up a cooperation agreement for healthcare and social welfare, where matters such as inter-county services and investment in healthcare and social welfare in the collaborative catchment area are settled.

  • Which services will be centralised and provided regionally or nationally?

    Services and procedures that require a broad population base, large number of clients and a high degree of specialisation or that are less common and more expensive will be brought together at either a national or regional level. In practice, either university hospitals or other hospital units operating on a broad basis around the clock will supply these services. This will be ensured through cooperation obligations that apply to all counties. Expertise in specialised level social services may also be gathered to larger clusters. The main rule is, however, to deliver the services close to the clients.

    Provisions on the coordination of health and social services organised by the counties are now contained in the Health Care Act and the Social Welfare Act. Later, the Act on Organising Health and Social Services will also contain provisions on this. In accordance with the Government Programme, the implementation of the reform will begin in healthcare even before the health, social services and regional government reform package enters into force on 1 January 2021. A reform of the system of urgent and emergency care services in healthcare and social welfare began in the beginning of 2017. 

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  • What happens to local services? Will they disappear?

    The county's responsibility will be to make sure that health and social services are available for everyone and offered within a reasonable distance of people's homes. New practices will be introduced to ensure this. In sparsely populated rural areas, for example, electronic and mobile services can also be used. The counties will also have the responsibility to provide services themselves. This will ensure that there are enough services available and the services are financially cost-effective. The counties will also provide public health and social services when no one else provides the services. This could happen in some rural areas where people are not able to choose between several service providers.

     

  • What steps will be taken to guarantee low-threshold services for families with children so that they can easily get in touch with members of personnel who they already know and who work close to them? Will family workers be transferred to the payrolls of counties?

    Low-threshold services for children and families will in future be provided by family centres. Family work is a social service designed for families with children, so the employees are on the county’s payroll.
     

  • What is a family centre?

    Family centres provide services for children in all age groups and their parents. A family centre can mean a joint physical service facility or a seamless network of services. Family centres will bring together the following services into a network: maternity and child health clinics, other health services for families with children, home services, family work, services related to the rights of children, early childhood education and care, and the work conducted by NGOs and parishes.  The core of family centres is maternity and child health clinics. They are part of counties’ own services and fall under the responsibility of unincorporated county enterprises. Counties may also decide to grant health and social services vouchers for maternity and child health clinic services. Family centres also bring together special services organised by unincorporated county enterprises and low-threshold services, such as family cafes, provided by third-sector operators. Each family centre offers open meeting places for children and families.

  • What measures will be taken to safeguard face-to-face advice and support for older people? Who are these client advisers, for example in health and social services centres?

    As part of the health social services reform, older people and informal caregivers and family carers will be provided with better coordinated services on a more equal basis than before. Service packages will be introduced for older people, integrating all the services designed for them. Many counties are currently carrying out a pilot to better coordinate services for clients.

    Client advisers may be social welfare and healthcare professionals who provide advice on health and social welfare and tell clients how to use their freedom of choice. They can be practical nurses, public health nurses, nurses, elderly care professionals, professionals with a degree in social services from a university of applied sciences, and social workers. Members of the office personnel may also give advice on practical matters which do not require any health or social welfare expertise.

  • Can family members have a say in whether they wish the elderly person to be cared for in the closest possible facility?

    As a result of the health and social services reform, counties will be responsible for organising all health and social services for older people. Counties may provide the services for older people themselves or purchase them from private service providers. Family members may take part in deciding where the elderly person should be cared for, but in the end the location is decided on the basis of the services that the person needs. If, for example, the person needs service housing with 24-hour assistance, the appropriate facility could be located further away.  When in future clients have more freedom of choice, older people and their family members will have a wider range of opportunities from which to choose their service providers for housing services. However, older people’s personal situation and service needs determine whether they will be entitled to service housing with 24-hour assistance, for example.

  • How significant is digitalisation in the reform?

    Digitalisation and electronic services will play a major role in the reform. According to productivity studies, around half of the operational efficiency and productivity gains will derive from the use of electronic services, information systems and digitalisation. Digital and electronic services also encourage people to assume more responsibility for their personal health and wellbeing. In addition, digitalisation will facilitate new kinds of business related to wellness technology and gene technology.

  • What acts will be laid down as part of the health, social services and regional government reform package?

    The most central acts governing the reform are the Counties Act, the Act on Organising Health and Social Services, the Implementation Act, the Act on the Financing of the Counties and the Freedom of Choice Act.  In addition, several acts need to be amended due to the reform. The changes concern for example tax legislation, the act on central government transfers to local government for basic public services, legislation on the status of employees, election legislation and general administration legislation. The acts on the provision of health and social services will also be reformed.

    These acts are related to the establishing of the new counties and to health and social services. The Government issued a proposal to Parliament regarding the amendments in March 2017. The Freedom of Choice Act is under preparation.