Government outlines basis for health and social services reform

The Government has finalised the policy outlines for the health and social services reform, on the basis of which preparations for the reform will continue. The aim is to circulate the draft bills on the restructuring of health and social services for comments in June.

The reform is progressing both as a structural reform and as a service reform. Health and social services will be developed as part of the Future Health and Social Services Centres programme. The call for applications for funding from the programme closed at the end of May. The results of the call will be published at the end of June.

Division into regions and integration of services

The division into regions would be implemented in a way that, after the reform, there would be one joint Act on the Division into Counties. The division into counties would provide an area of operation not only for health and social services counties but also for regional councils and forms the basis for the regional divisions of regional state administration. The act implementing the reform would lay down provisions on the division into counties as the reform enters into force.

The responsibility for organising services would be integrated so that there would be one organiser responsible for both basic-level and specialised services in healthcare and social welfare. The services would be gathered under one decision-making body, one management and one budget, and the service organiser would have the possibility to employ new ways to organise services as a balanced whole. In this way, it would be possible to improve the availability, quality and equality of services and their cost-effectiveness. 

Some of the services and duties in healthcare and social welfare would be integrated into larger packages for one or more counties. A total of 12 counties and HUS would be responsible for providing extensive 24-hour services in healthcare and social welfare. There would be five collaborative catchment areas for the regional coordination, development and cooperation of healthcare and social welfare organised by the counties.

A basic solution based on the health and social services counties would be applied to the Uusimaa region, apart from the City of Helsinki and the joint county authority for the Hospital District of Helsinki and Uusimaa. As a city, Helsinki would be responsible for organising health and social services as well as rescue services, and the joint county authority for the Hospital District of Helsinki and Uusimaa would perform the statutory duties assigned to it. During the consultation round, comments are requested on two options for the counties of North Savo and South Savo regarding the placement of the municipalities within the East Savo Hospital District either as part of the county of North Savo or as part the county of South Savo in accordance with the current division into regions. The decisions will be made after the consultation round.

Responsibility for organising services

The health and social services counties would be responsible for their statutory duties and the equal availability of services, and they would define the need, quantity and quality of services and determine the way services are provided. They would be responsible for exercising the powers assigned to them as public authorities (exercise of public authority) and supervising the provision of services.

In addition to the services, the health and social services counties would assume responsibility for preventive healthcare and social welfare services, training and research, preparedness for incidents and emergencies, security of supply and duties related to the prevention of communicable diseases, for example.

The services of school social workers and school psychologists would be organised in the future health and social services counties but they would be a locally accessible service in the same way as before.

Organisation of rescue services

The responsibility for organising rescue services would rest with 21 health and social services counties and the City of Helsinki. Because the health and social services counties would be responsible for organising both health and social services and rescue services in their areas, the rescue departments could, in addition to their rescue service duties, continue to provide prehospital emergency medical services and first response services. Rescue services would continue to be a separate sector working in parallel with the healthcare and social welfare sector.

Organisation responsibility and purchased services

The health and social services counties could purchase health and social services from private service providers if that is necessary to ensure the sufficiency and equal provision of services and to perform their duties appropriately.

However, it would not be permitted to purchase services relating to duties fulfilling the responsibility for organising services or the exercise of public powers, 24-hour social services, primary and specialised 24-hour health services, and services related to the organisation of prehospital emergency medical services. Under similar conditions, it would be possible to use temporary agency labour.

Municipal funding

A proportion of the municipalities’ revenue and costs, amounting to an estimated EUR 19.1 billion at the 2020 level, would be transferred from the municipalities to finance the counties’ activities. This would be achieved by decreasing central government transfers, compensations for tax losses, municipalities’ share of corporation tax revenue, and municipal income tax. Taxation would account for approximately EUR 13 billion. A proportion of the municipal income tax would be transferred to finance the counties’ activities by lowering the municipal income tax percentages equally among the municipalities. A current estimate of the cut is 12.63 percentage points.

While a proportion of the municipalities’ revenue and costs would be transferred in equal measure when examined for the country as a whole, there could be great differences among municipalities. Changes in local government finances would be made more equitable among municipalities by introducing different kinds of equalisation elements to the system of central government transfers to local government.

Funding for the health and social services counties

The funding for the health and social services counties would be based to a large part on state funding as well as on client and user charges. In the first phase, the counties would not have the right to levy taxes.

This funding base would be raised annually based on estimated service needs and growth in the level of costs. Moreover, the national level of county funding would be adjusted retrospectively so that imputed costs would not diverge from the actual costs. This adjustment would include an element curbing the growth of costs.

The funding for the health and social services counties would be universal. It would be divided among the counties based on imputed factors related to service needs and circumstances, covering healthcare and social welfare and rescue services. Some of the funding would be based on population numbers and some would be determined by the criteria for health and wellbeing performance. The transition of the health and social services counties to a calculated finance model would be facilitated with transitional funding.

The health and social services counties would also be eligible for additional funding to secure health, social and rescue services if the level of funding allocated to them jeopardised the organisation of services.

The finance model will be reviewed on the basis of the comments received during the consultation round.
 

• Presentation material from the press conference
• Factsheet: Prime Minister Marin’s Government decides basis for health and social services reform

Inquiries:

Health and social services reform:
Requests to interview Minister Kiuru: Laura Lindeberg, Special Adviser, tel. +358 2951 63109, laura.lindeberg(at)stm.fi
Eila Mäkipää, State Secretary,  tel. +358 2951 63632, eila.makipaa(at)stm.fi
Päivi Salo, General Secretary, tel. +358 2951 63113, paivi.salo(at)stm.fi
Kari Hakari, Director General, tel. +358 2951 63642, kari.hakari(at)stm.fi
Auli Valli-Lintu, Senior Ministerial Adviser, tel. +358 2951 63463, auli.valli-lintu(at)stm.fi

Establishment and administration of counties, and division into counties:
Erkki Papunen, Ministerial Adviser, Ministry of Finance, tel. +358 2955 30167, erkki.papunen(at)vm.fi
Funding:
Markku Nissinen, Senior Ministerial Adviser, Ministry of Finance, tel. +358 2955 30314, markku.nissinen(at)vm.fi
Ville Salonen, Ministerial Adviser, Ministry of Finance, tel. +358 2955 30388, ville.salonen(at)vm.fi
Funding for counties:
Miikka Vähänen, Ministerial Adviser, Ministry of Finance, tel. +358 2955 30341, miikka.vahanen(at)vm.fi
Asset arrangements:
Pasi Leppänen, Ministerial Adviser, Ministry of Finance, tel. +358 2955 30564, pasi.leppanen(at)vm.fi
Mervi Kuittinen, Senior Ministerial Adviser, Ministry of Finance, tel. +358 2955 30445, mervi.kuittinen(at)vm.fi
Personnel:
Sari Ojanen, Chief of Negotiations, Ministry of Finance, tel. +358 2955 30109, sari.ojanen(at)vm.fi (only on 5 June 2020)
Marja Isomäki, Senior Ministerial Adviser, Ministry of Finance, tel. +358 2955 30414, marja.isomaki(at)vm.fi
Anu Hernesmaa, Ministerial Adviser, Ministry of Finance, tel. +358 2955 30027, anu.hernesmaa(at)vm.fi
Taxation:
Timo Annala, Ministerial Adviser, Ministry of Finance, tel. +358 2955 30318, timo.annala(at)vm.fi
Value-added tax: Marja Niiranen, Ministerial Adviser, Ministry of Finance, tel. +358 2955 30238, marja.niiranen(at)vm.fi

Rescue services reform:
Kimmo Kohvakka, Director General for Rescue Services, Ministry of the Interior, tel. +358 2954 88400, kimmo.kohvakka(at)intermin.fi
Ilpo Helismaa, Senior Ministerial Adviser, Ministry of the Interior, tel. +358 295488422, ilpo.helismaa(at)intermin.fi