Finland's left-centre coalition government on Monday took another step in what has been a drawn out and contentious battle over reforming the nation's system of social and healthcare services.
The Ministry of Social Affairs and Health, the Ministry of Finance and the Ministry of the Interior on Monday jointly began circulating the government's draft proposal concerning its plan for reforms. Experts and stakeholders invited to comment have until 25 September to file their feedback.
Under the draft proposal, 21 health and social services "counties" would be established in Finland and entrusted with the health, social and rescue service duties that are currently the responsibility of municipalities.
In Uusimaa, the responsibility for organising healthcare, social welfare and rescue services would differ from elsewhere in Finland so that in addition to the four health and social services counties in Uusimaa, the City of Helsinki would be responsible for organising services.
Some shared tasks
Promoting health and wellbeing would continue to be the responsibility of municipalities, but work in this field would be carried out in cooperation with the counties. Meanwhile, environmental healthcare would continue to be the responsibility of municipalities. The tasks of school social workers and school psychologists in student welfare would be transferred to the health and social services counties.
The county units that would be set up would provide social services and healthcare, dental care, home care, mental health and substance abuse services, outpatient therapy, as well as pre- and post-natal care.
"All services will be available from one place and with a low threshold," Minister of Family Affairs and Social Services Krista Kiuru told the media on Monday.
Shifting resources
The failure of its own flagship social and health care reform package led to the resignation of the government by PM Juha Sipilä in March of 2019.
One major difference between this draft proposal and the failed reform package put forward by the government is that this time there is no inclusion of transfers of administrative responsibility in matter such as agricultural and water management.
Also, unlike the Sipilä government's vision, this proposal is firmly committed to placing the main responsibility for organizing and providing services on the public sector. It includes provisions for enabling the annulment of outsourcing contracts with private service providers.
A proportion of the municipalities’ revenue and costs, amounting to an estimated 19.1 billion euros at the 2020 level, would be transferred from the municipalities to finance the newly-established counties’ activities.
To make this happen, the government's proposal includes bills for amending legislation on central government financial transfers to municipalities and tax legislation.
In general, the personnel of municipal health, social and rescue services, apart from the personnel of the City of Helsinki, would be transferred to the employment of the health and social services counties. School social workers and school psychologists in municipalities would also be transferred to the employment of the counties. The personnel of the Hospital District of Helsinki and Uusimaa would be transferred to the employment of a joint county authority.