"The focus of the healthcare and social welfare system will be shifted towards basic-level services and prevention"

3.6.1 Restructuring of health and social services

The central objectives of the health and social services reform will be to reduce inequalities in health and wellbeing, safeguard equal and quality health and social services for all, improve the availability and accessibility of services, ensure the availability of skilled labour, respond to the challenges of changes in society, and curb the growth of costs.

The challenges in the service system vary across the country. Areas affected by population decline and ageing are experiencing problems in the availability of health and social services. In other areas, such as the Greater Helsinki region, health and social services are dealing with pressure from population growth and a growing number of migrants.

The Government will start preparations for restructuring health and social services, taking into account the work done during previous electoral terms and making sure that relevant constitutional requirements are met. The restructuring will be carried out in a controlled manner and in stages.

The focus of the healthcare and social welfare system will be shifted towards basic-level services and prevention. Services will be integrated, care chains will run smoothly and people will get sufficient and effective services when they need them.

The health and social services reform will transfer the responsibility for organising health and social services to self-governing regions (counties) that are larger than municipalities. The responsibility for organising rescue services, too, will be transferred to the counties. There will be altogether 18 autonomous counties. Separate legislation will be enacted on the functioning, finances and governance of the counties. Decision-making power in the regions will rest with directly elected councillors, and we will strengthen participation of county residents and reinforce user democracy.

People will be allowed to use services across county boundaries. Counties will carry out some of their tasks in cooperation with other counties. Five collaboration areas for specialised services will be created. They will be based on the existing catchment areas for highly specialised healthcare.

The public sector will be the primary service provider in the counties, with the private and third sectors serving as supplementary service providers. The role of municipalities as service providers will be resolved on the basis of a separate analysis by the end of 2019. Third-sector organisations will be given a stronger role in the promotion of health and wellbeing and their possibilities to provide services will be safeguarded.

The Government aims to secure equal access to smoothly running services and reinforce service users’ right to self-determination. With this objective in mind, we will prepare an amendment of the Service Voucher Act and draw up guidelines to introduce personal budgets as part of the health and social services reform.

We will make health and social services more effective and better performing, and growth in costs will be curbed and the service system will be made more open and transparent.

The counties will receive most of their funding from the central government. We will reform the system for financing health and social services so that it is structured on needs-based criteria. The Government will immediately start preparations to introduce county income taxation. On their entry into force, the changes to the tax structure must not result in tax increases. The counties will be able to collect client fees stipulated in legislation.

Separate from other preparations, a parliamentary committee will conduct preparatory work on the right of counties to collect taxes and the dismantling of multisource financing by the end of 2020.

We will enhance real estate management in health and social services and in rescue services to create a comprehensive real-estate specialist and owner, either by making use of regional real-estate managers or by creating a national operator co-owned by the counties. The Government will assess the need for further measures in the early stages of preparations. It should be possible for the counties to genuinely have a say in the administration and use of the facilities in their use.

We will need well-functioning information systems and data management systems, comprehensive knowledge-base and a uniform reporting system for the restructuring of health and social services. During the transition phase, we will safeguard the integration of information systems, preparations of ICT solutions and funding of other work to develop health and social services.

The health and social services reform and the future organisation of services will take into account regional characteristics where possible. The Government will conduct a study by the end of the year on special arrangements for Uusimaa, the Greater Helsinki region or Helsinki, in cooperation with the cities and municipalities located in the area.

Synergies from the close links between rescue services and prehospital emergency medical services will be secured in the restructuring of health and social services. As part of the restructuring, the Government will review the organisation of environmental healthcare.

The health and social services reform will safeguard quality, client-oriented services on an equal basis for Finnish speakers and Swedish speakers. In practice this may involve special arrangements for language reasons.

To develop services and management in healthcare and social welfare, we need evidence-based information and knowledge-based management. Healthcare and social welfare professionals will be closely involved in preparing the reform and in developing services.

Full service integration in terms of healthcare and social services and basic-level and specialised services and seamless cooperation between different professions will ensure that services are not fragmented and that all counties have the conditions and incentives to plan their services as packages. The aim of service integration is to create coherent service chains and ensure better care and treatment for people who are frequent users of services.

Basic-level health and social services will be provided close to people. To increase the supply of home-delivered services and to make services more readily accessible, we will develop new digital and remote services. Moreover, to develop and improve the quality of services, we will harmonise the knowledge-base in healthcare and social welfare.

We will foster the wellbeing of children, young people, older people, vulnerable people and people who need multiple services by means of collaboration between counties and municipalities. Services will be designed to strengthen the abilities of people of all ages to look after their own health and wellbeing.

We will raise separate central government funding to reinforce research and competence in social work. Research into service integration in healthcare and social welfare will be boosted with more funding.

A parliamentary study will review the tasks of the National Supervisory Authority for Welfare and Health (Valvira) and the regional state administrative agencies with regard to the supervision, licensing and guidance of health and social services as well as the reorganisation of other tasks of regional state administration.

The autonomous regions will enable a gradual transition to multi-sectoral counties. This will be prepared in a parliamentary process by the end of 2020. A study will examine which duties of municipalities, joint municipal authorities and the state are to be transferred to counties. The Government will prepare the necessary legislation once the parliamentary work has been completed.