"Finland will be a more equal and equitable country where everyone is valuable and where trust in others and society augments"

3.6 Fair, equal and inclusive Finland

Current situation

People in Finland largely share the principles and values that are the building blocks of our Nordic welfare model, created together over the years as a joint effort. The cornerstones of the model are non-discrimination and equality, services in health, wellbeing and education financed by means of tax revenue, high social mobility, and an active civil society. We have not invested in the wellbeing and inclusion of people solely because we have had the financial resources to do so; instead, we have also wanted to become a prosperous nation. The financing base of our welfare state is facing many challenges. Population ageing and low birth rate are leading to a weaker dependency ratio. The demographic changes together with cumulative disadvantage and slower economic growth warrant robust investment horizontally in preventive measures.

Working life is changing, and the present social security system is not responsive enough to all the changes in people’s life situations or to the transformation of work. Poverty exposes people to social exclusion, and people who depend on social assistance for their income are also less likely to find work.

The aim of the Finnish service system is to promote and maintain the health, wellbeing, functional capacity, work ability and social protection of the population and to reduce inequalities in health and wellbeing. While these objectives have been achieved for some, others do not get all the services they need or the services at their disposal do not meet their needs. Most Finns are doing well, but there are still significant inequalities in health and wellbeing in our society. People can experience deprivation not only during their lifetime but it can also be passed down from generation to generation.

Finnish family policy is up against new challenges in the form of new kinds of needs and more complexity in families with children. Non-traditional nuclear families already account for around one third of all families in Finland, and the number of blended families and rainbow families is increasing. Existing practices and benefits do not always meet the real needs in families. Our society has so far failed to find sufficiently effective ways to promote the reconciliation of work and family and to ensure more balanced sharing of care responsibilities. Poverty among families with children is most common in single-parent families and in families where children are under the age of three. Access to services, such as couples counselling or divorce counselling, that foster the wellbeing of families and support them when they experience parenting or relationship problems is not systematic or equal across the country.

Social inequality affects people in many ways. It is manifested in poverty and prolonged need for social assistance. Inequality is also reflected in the differences in health and social inclusion between population groups and in the percentage of young people who are not in education, employment or training.

There is strong evidence showing how not only poor health and wellbeing of individual people but also the national economy are linked with social problems, such as unemployment, low levels of education, difficult living conditions, poverty and an intergenerational cycle of disadvantage. Multidisciplinary competence and support is available in the Finnish service system, but despite sustained reform efforts the system is chequered, fragmented and confusing to service users.

The biggest challenges to a fair and equal service system where costs are held in check are associated with the strengthening of basic-level health and social services and the provision of preventive and rehabilitation services. The performance of health centres and social work, services for older people and people with disabilities, child protection services, the securing of linguistic rights, and the promotion of health and wellbeing are being hampered by the fragmented organisation of services, inadequate resources, changing service needs and associated skills shortages in basic-level health and social services.

The content of services is not the only problem; the structures and financing of healthcare and social welfare no longer stretch to securing equal services for all. A restructuring of health and social services is essential especially in terms of financial carrying capacity of the municipalities. Municipalities do not have sufficiently broad resources to fund and organise health and social services.

The restructuring of the Finnish health and social services system has been a long-term ambition. Major obstacles for successful reform efforts have included constitutional requirements, regional differences and the scale and schedule of reform. A successful restructuring of services needs a stronger climate of dialogue and trust between state, regional and local actors.

Objective 1

Promoting wellbeing and reducing inequalities

Finland will be a more equal and equitable country where everyone is valuable and where trust in others and society augments. Inequalities in health, wellbeing and income will be reduced, and social inclusion will be increased. Finland will promote human rights, the economy of wellbeing and people’s chances for a good life throughout their lifespan. People living in Finland will have the opportunity to make choices that foster their wellbeing.

Measures

Promoting non-discrimination

While the situation of persons with disabilities has improved in recent years, discrimination is still an issue. Services for persons with disabilities struggle to meet their clients’ individual service needs on time. The Government will reform the Act on Disability Services and Assistance to ensure better consideration of individual needs of persons with disabilities. We will also pilot personal budgets for persons with intellectual disabilities, at the same time evaluating the needs for legislative amendments. Disability services will be secured for Swedish speakers.

The right to self-determination for users of healthcare and social welfare services will be strengthened by legislation. We will improve the system of patient ombudspersons and social services ombudspersons. Linguistic rights will be secured in practice, especially for Swedish speakers, Saami speakers and sign language users. Current Care guidelines will be translated into Swedish.

Reducing poverty and exclusion

More people are now at risk of poverty and exclusion. The Government will take decisive action to reduce poverty and exclusion especially among pensioners and families with children. We will also reduce poverty by developing benefits and services as a package. Our goal is to make sure that everyone in Finland enjoys the benefits of higher living standards and more equal distribution of income. We will focus more on risk factors for social disadvantage and the intergenerational cycle of disadvantage and target effective services at risk groups by revamping adult social work.

The Act on Client Charges in Health and Social Services will be reformed to remove barriers to treatment and to increase equality in health by introducing more free services and by making client charges more equitable.

Promoting health and wellbeing

The Government will boost the economy of wellbeing by investing in measures that foster people’s health and wellbeing and reduce their need for services.

We will assess the health and wellbeing impacts of decisions comprehensively, and make prevention and treatment of chronic diseases more effective. New low-threshold services in lifestyle counselling and prevention will be introduced.

Addictions will be reduced. To foster preventive work and to harmonise substance abuse services, the Government will update the substance abuse strategy. We will continue working systematically to reduce smoking and the overall consumption of alcoholic beverages. A cross-sectoral Government resolution on drug policy will be prepared to increase the efficiency of services for drug users and to reduce the harmful effects of drug use. Moreover, problem gambling will be tackled as part of an action plan on gambling.

Drawing on earlier work, the Government will prepare a mental health strategy with a focus on mental health as a resource. The strategy will secure people’s mental health rights and mental health services, incorporating them into existing structures. It will also prevent suicides and strengthen the competence of mental health professionals. The legislation on mental health and substance abuse services will reformed at the same time.

To foster prevention and strengthen public health, the Government will extend the scope of the national vaccination programme (e.g. HVP for boys) and the national screening programme (e.g. colorectal cancer) in controlled ways.

We will modernise the Farm Relief Services Act and ensure continued application of the ‘Välitä viljelijästä’ model for supporting the coping and wellbeing of farmers. Making the model a permanent practice will be reviewed at the end of the electoral term.

Adequate resources will be secured for prisoners’ healthcare services.

We will reinforce the operating conditions of third-sector providers of health and social services, and they will be supported in their efforts to renew and diversify their work and services.

The criteria and practices regarding the funding granted by the Ministry of Social Affairs and Health from national lottery proceeds will be reformed so that the new system will be in force in 2021. The aim is to increase democracy in the allocation process, foster autonomy, reduce bureaucracy and transfer resources from administration to funding grants.

Linguistic rights will be secured in practice in the health and social services system.

Health and social services professionals will be given guidance on the special needs of members of minorities and on how to deal with them in a sensitive manner.

The Government will appoint a broad-based advisory board on sign language matters to assess the implementation of the Sign Language Act and the realisation of the fundamental rights and non-discrimination of sign language users (Ministry of Justice).

Objective 2

Promoting a child and family-friendly society

Finland will be a more child and family-friendly country that is also more inclusive and more equal. The wellbeing of children and young people is paramount. We will support people in their endeavours to reach the family size they aspire to, keeping in mind that there are different ways of forming families and that all family forms are equally valuable. Every child has the right to have a safe adult in their lives.

Measures

Strengthening wellbeing

Towards an equal and child and family-friendly Finland with a strategy for children

Our society is faced with the challenges of low birth rate, population ageing, poverty among families with children and the intergenerational cycle of social exclusion. To respond to these challenges, a parliamentary committee will be appointed to prepare a national strategy for children based on the UN Convention on the Rights of the Child. Its task will be to formulate a vision for a child and family-friendly Finland that spans government terms and crosses administrative boundaries.

The strategy will be based on information and research evidence, and it will promote the implementation of the Convention on the Rights of the Child. Common goals will be reached through cross-sectoral measures promoting child rights-based governance and decision-making and fostering a child and family-friendly society. The Government will pledge to assess the child impacts of its decisions, improve child budgeting, strengthen knowledge about child wellbeing and foster the inclusion of children and young people.

There will be broad-based commitment to the goals of the strategy, ranging from the central government to private and third-sector operators, the church, and other public operators, such as municipalities, joint municipal authorities, higher education institutions and education providers. Preparations for the strategy will utilise earlier work, including the report “Child’s Time – Towards a National Strategy for Children 2040”.

Most families are doing well, but every family needs some support from their social network or society. In our policy making, we will take into account the wide range of families and the complexity of circumstances. Involuntarily childless families will be offered different kinds of support in their aspirations to have children, and equal access to infertility treatments will be ensured. The Government will advance the proposals for measures put forward by the working group on alternating residence.

Every child and young person has the right to physical integrity. The Government will strengthen sex education. and prepare an action plan against bullying and loneliness.

Improving services for families with children and securing their income

The Government will support families with children by introducing ways to foster families’ wellbeing and measures to prevent and address problems. We will lower the threshold for mental health services for children and young people and improve the timing and availability of services within the scope of basic-level health and social services. We will reinforce the links between mental health services and existing services for children and families and other service structures. We will secure preventive substance abuse services for minors in both regional and linguistic terms.We will step up cooperation across administrative branches and ensure free flow of information.

The Government will continue the programme to address child and family services. We will bring the family centre model into wider use, and the role of maternity and child health clinics will be developed. We will reinforce couples counselling and parenting support services, and child guidance and family counselling services will be improved. Preventive services for families under the Social Welfare Act will be strengthened, and the eligibility criteria for families to qualify for home services will be eased.

While ensuring each child a good life is a broadly accepted social goal, services or support do not always reach children, young persons and families on time. Child protection services are under-resourced in our country in relation to demand. To secure the rights and wellbeing of the most vulnerable children, a gradually tightening minimum staffing level will be introduced in child protection services, starting from 35 clients per professional in 2022 and reaching 30 clients per professional in 2024. Child protection services alone will not be able to meet the needs of children, young people and families who need a lot of support. To this end, we will secure multidisciplinary services for people with special needs and distribute across the country the team model based on collaboration between professionals from different fields.

After-care services in child protection will be developed. Young people will be provided sufficient support on their road to adulthood.

The availability of shelter services for victims of domestic violence and intimate partner violence will be raised to the level provided in the Istanbul Convention. We will secure sufficient services and rehabilitation for mothers and families with substance abuse problems. Finnish children do not get the recommended amount of physical activity, and wellbeing indicators show growing degrees of polarisation. We will promote on a broad basis physical activity, weight control, healthy diets and alcohol and drug-free lifestyles among children and young people.

Gender minority members and their families will be provided individualised services when they need them.

There will be a national experiment on free contraceptives to everyone under the age of 25. Making the experiment a permanent practices will be decided at the end of the electoral term, taking into account the outcomes of the experiment. Positive attitudes towards vaccination will be endorsed, and vaccination coverage will be improved.

Linguistic rights will be secured in practice.

Objective 3

Fostering an age-friendly society

Finland will be a more age-friendly society that recognises and prepares for the social effects of its ageing population. Older people are not only service users; they are also an important resource in society. The aim is to raise the number of healthy years, improve people’s functional capacity and secure efficient and timely services.

Measures

Reinforcing wellbeing and functional capacity

The Government will prepare a horizontal programme on ageing in collaboration with ministries, municipalities, third sector organisations and other actors. We will bring the preventive measures against memory disorders in step with the prevention of other chronic diseases.

An office of an ombudsperson on older people’s rights will be established. We will improve lifestyle counselling, guidance and support services. We will also introduce ‘wellbeing checks’ and better assistance to clients. Special attention will be paid to those who will be retiring soon. We will monitor and improve the quality and availability of nutrition services and the potential for social eating both for older people living at home and for those living in care units.

The versatility of service providers in the field will be taken into account, and different forms of care services, including family care and other intermediate solutions, will be further developed.

The number of war veterans and war invalids is diminishing. As they grow older, they and their families will need more support. The Government will secure the support and services for our war veterans and ensure quality services across the country.

Improving services

We will reinstate trust in the quality, timeliness and availability of services for older people. An evidence-based increase in resources and reorganisation of practices based on the roadmap will be implemented according to plan and in such a way that the correct allocation of resources and measures is ensured.

Longer life expectancy means that the number of pensioners will grow sharply. People will stay healthy and maintain their functional capacity longer, but the need for services will grow nevertheless. The Act on Care Services for Older Persons will be updated, and the scope, quality and effectiveness of services for older people will be improved.

We will enact a statutory minimum staffing level of 0.7 for care personnel in units providing 24-hour care. Care intensity will be used as the main criterion for determining appropriate staffing levels. We will review the division of work in support services, among others. The increase in staff levels will be implemented in stages by launching a goal-oriented development programme that will be used to finance the path towards a plausible staffing level securing sufficient care for older people.

Since most older people will live at home, the quality and resourcing of home care will be developed alongside 24-hour care provision. We will also develop informal care. 

In addition to more resources and updated legislation, the service system must be developed as well. We will strive to find solutions to the challenges of today and tomorrow by bearing in mind the importance of competent and wellbeing staff and the possibilities of a goal-oriented human resources policy and integration of operating cultures.

New methods and technologies will be introduced in the field, and we will reinforce managerial skills in services for older people. Moreover, we will ensure the appeal of the sector, and secure the availability and skills of personnel.

We will also improve both self-supervision of service providers and local and national supervision. Linguistic rights will be secured in all services for older people. The Government will continue to promote rational pharmacotherapy.

Objective 4

Improving healthcare and social welfare services

Finland will be a country where everyone has equal access to care and treatment when they need them. Health and social services will be efficient and cost-effective, and will be based on people’s needs and life situations in flexible and comprehensive ways. Better services will strengthen trust among service users and professionals.

Measures

Improving access to basic-level health and social services in health and social services centres of the future

Everyone will have access to quality primary healthcare and basic social services when they need them. The variety of service providers and the availability of locally accessible services will be taken into account. The Government will launch a development programme for health and social services centres of the future, and it will be closely linked to the preparations and implementation of the restructuring of health and social services. The purpose of the development programme is also to strengthen people’s trust in public healthcare and social welfare services.

The maximum waiting times for access to primary healthcare will be shortened so that access to non-emergency care must be arranged within a week (7 days) of the assessment of need for care. The National Institute for Health and Welfare (THL) has estimated that in the present system the seven-day cap on waiting times would mean that health centres would have to recruit from 1,600 to 2,600 new doctors. However, a lot can be achieved by improving the system and the field in general through various broad-based measures.

We can bring down the maximum waiting times for access to primary healthcare by recruiting approximately 1,000 new general practitioners by creating multidisciplinary health and social services centres that harness the possibilities of digitalisation and modernise division of work to make better use of different professionals’ skills and of specialist consultations. Of the estimated 1,000 new GPs, around 300 GPs can be recruited by the filling of long-term vacant posts and by hiring new in-house doctors to replace temporary outsourcing arrangements. This requires that the health and social services centres across the country are made into more attractive workplaces than the current basic-level services.

With these measures, the focus of healthcare services will be shifted from specialised healthcare to primary healthcare.

Health and social services centres will provide both social services and primary healthcare services close to people, and their selection of services will include at least primary healthcare, oral health, social work and home care as locally accessible services, at-home hospital care, basic-level mental health and substance abuse services, outpatient rehabilitation services, chronic disease prevention, maternity and child health clinics and other preventive services.

We will reorganise the practices and division of work of professionals in the field of healthcare and social welfare. Tasks will be divided among a larger group of different professionals. Multidisciplinary teams and better division of work will guarantee the continuity and effectiveness of care, smoothly running services, and effective cost management. The Government will prepare a development programme for social welfare and make social welfare services better available in the health and social services centres of the future.

The health and social services centres of the future will provide client-centred services and foster good management and safeguard skills development and wellbeing at work for all personnel. Research and development activities will become a broader extension of basic work. Services will be made more client-centred by increasing the availability of services during weekends and evenings and by establishing new low-threshold service points. We will also introduce digital and mobile service solutions. Moreover, we will ensure more efficient use of information resources and further develop information systems.

Additionally, better availability and quality of oral health services and mental health services play a central role in the overall restructuring of health and social services. Prevention and effective treatment of chronic diseases will be improved.

All undocumented migrants will be secured necessary care and treatment. 

Vaasa Central Hospital will be turned into a hospital providing extensive emergency care services.

In addition to the focus on primary healthcare, the Government will review the overall system of healthcare and social welfare services. We will safeguard the provision of emergency care services in central hospitals and secure the availability of skilled labour without jeopardising patient safety or the functioning of the service system. If there are special reasons, we can decide to depart from the provisions on the division and centralisation of tasks in specialised healthcare. The Government will decide how tasks will be divided and collaboration developed, taking into account the common position of catchment areas for highly specialised healthcare.

We will restructure the service system.

Developing the service system and launching new reform projects

We will redesign rehabilitation services based on the work of the rehabilitation committee. The system of rehabilitation services will function seamlessly and it will improve and support people’s functional capacity.

By means of legislative provisions, we will implement a development programme to secure end-of-life care, palliative care and pain relief that respect human dignity for all. The effectiveness of cancer treatments will be improved.

Registers on the quality of treatment will be created, client satisfaction will be enhanced, and care and treatment practices will be improved in cooperation with service users.

We will ensure long-term resources for research and development in healthcare and social services (including nursing care and the central government funding for university-level research in healthcare units). We will create a research and development structure for social welfare. The Government will continue and tighten the temporary restrictions on legal transactions by municipalities with regard to investments and outsourcing, designed to secure equal access to services pending the health and social services reform. The Government will secure cost-effective availability of emergency medical helicopter services across the country.

The governance of the Social Insurance Institution of Finland (Kela) and the functioning of its services will be reviewed. We will examine the possibilities of introducing a registration procedure for some of Kela’s services subject to competitive tendering. We will make an ex post review of the functioning of the transport services provided by Kela and local authorities since the entry into force of the new Act on Transport Services and propose amendments where necessary.

The ownership steering of Alko Inc. will be retained at the Ministry of Social Affairs and Health, and its current exclusive right to retail trade will be safeguarded.

We will examine the possibilities to regulate complementary and alternative medicine.

Based on a unanimous report of the Social Affairs and Health Committee in 2018, flaws in the system of authorised doctors specialised in insurance policies will be remedied.

Active collaboration across ministries will be continued to develop a research and development ecosystem in the health and social services sector. We will ensure that the measures proposed in the Health Sector Growth Strategy for Research and Innovation Activities from 2014 are implemented without delay. The Government will promote the establishment and start of operations of new national centres of excellence.

New legislation on genomic databases and biobanks will be enacted. We will review the possibilities to deploy healthcare and social welfare data in health R&D, while guaranteeing a high level of data protection.

The Government will examine the necessity of reimbursement for foods for special dietary use.

Pharmaceutical services will be reformed on a long-term basis, taking into account the roadmap presented by the Ministry of Social Affairs and Health in 2019. The objectives are to make pharmaceutical services more cost-effective, safeguard pharmaceutical safety and guidance, and secure the availability, accessibility and smooth running of services.

The Government will finalise the government proposals to reform the pharmacies sector, which lapsed during the previous government term after prolonged preparations, and re-submit them to Parliament as soon as possible. A review will be carried early on during the government term to establish comprehensive picture of retail distribution and formation of retail prices of medicines. This will serve as a foundation for overhauling the pharmacies sector. The Government will use the review as a basis when examining the possibilities of expanding the ownership base of pharmacies.