The county as an organiser
From 1 January 2020, all publicly funded health and social services will be organised by the county. It means that the county will plan, steer and finance the health and social services in its area. This is what the Government has outlined it its draft proposal for the health and social services reform.
Each county will be responsible for ensuring that clients are provided with efficient service packages as well as service and care chains. Municipalities will no longer organise or finance health and social services. They will, however, continue to have the responsibility to promote health and welfare.
The Counties Act lays down general provisions on organising services:
- The draft bill for the Counties Act contains general provisions on the organisation of the administration and the finances of the county.
- The county will be responsible for the realisation of the resident's rights laid down in the Act. The county will also be responsible for ensuring that residents have equal access to statutory services.
- The county will determine the need, quantity and quality of the services and the way they are produced, unless otherwise prescribed in another law. In addition, it will be responsible for steering and supervising the production of the services and for exercising official authority.
- The county may provide services itself or in cooperation with other counties, or outsource them under a contract to some other service provider.
- The county will finance the tasks and services it is responsible for mainly with the funding it receives from central government and a small part of them with the revenue from collected fees.
- The county may only assign a public administrative duty to a party other than a public authority if this has been separately permitted under law.
The Act on Organising Health and Social Services lays down provisions on health and social services:
- The Act on Organising Health and Social Services lays down provisions on the availability of services. The content, scope and quality of health and social services must meet with the needs of clients. The services must form integrated packages and they must be delivered close to clients in accordance with the population’s needs.
- 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 social and health 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 counties that will be responsible for extensive 24-hour social welfare and health care emergency services are South Karelia, South Ostrobothnia, Central Finland, Lapland, Päijät-Häme, Pirkanmaa, North Karelia, North Ostrobothnia, Pohjois-Savo, Satakunta, Uusimaa and Varsinais-Suomi. All the other counties will also organise 24-hour emergency care services, but their emergency services units will have more restricted competence in specialised medical care. This reform will begin during 2017.
- The implementation of social and health 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. (see Language rights)
- If the municipality of residence of a person receiving family care, institutional care or housing services changes and the person moves to the area of another county, he or she will already be able to apply to the new county for the same services before moving.
- Local authorities will continue to be responsible for promoting the health and welfare of their residents. This will also be the task of the county. Furthermore, it will be the task of the counties to support with their expertise the promotion of health and welfare carried out in municipalities.
- The county must organise the health and social services in such a manner that it will be possible for the client to choose the service provider according to what legislation on the freedom of choice separately provides on this.
- The county will draw up a service strategy and make a service pledge (see Steering and Public service pledge).
- The county must draft a self-monitoring programme to ensure the implementation of the responsibility for organising services.
- The county must monitor the health and welfare of its population, the quality and impact, costs and productivity of the healthcare and social welfare it organises, and how the integration of the services for clients has been realised.
- The county must promote the participation and influence of its residents. Residents' views must be taken into account when the county prepares the service pledge, the cooperation agreement of counties and the cooperation area's proposal for the national targets to the Ministry of Social Affairs and Health.
- The county will be responsible for the development of health and social services in its area. The cooperation areas will agree on shared development principles and mutual coordination of development activities.
- The financing of the healthcare and social welfare organised by the county will be determined on the basis of the Act on the Financing of the Counties.
- The social welfare and healthcare organised by the counties will be supervised by the national supervisory authority.
- The county must in cooperation with the municipalities in its area prepare for disruptions and emergency conditions.
Liisa-Maria Voipio-Pulkki, Director, Ministry of Social Affairs and Health, tel. +358 295 163 382
Pekka Järvinen, Senior Ministerial Advisor, Ministry of Social Affairs and Health, tel. +358 295 163 367
Riitta-Maija Jouttimäki, Senior Ministerial Advisor, Ministry of Social Affairs and Health, tel. +358 295 163 383
Kirsi Varhila, Director-General, Ministry of Social Affairs and Health, tel. +358 295 163 338