Government proposal on hospital network reform reviewed based on feedback from consultation round – Kouvola to retain possibility to maintain 24-hour emergency care services in primary healthcare

On 6 September 2024, the Ministry of Social Affairs and Health gave an account of the further preparation of the reform concerning the system of hospitals and emergency care services and the division of duties in specialised healthcare. The Ministry also gave an account of the more than 100 (around 140) comments that were received on the reform.

The proposal will be amended based on the comments received so that 24-hour emergency care services can be maintained not only in Ivalo, Kuusamo, Jakobstad and Raseborg as previously outlined but also in Kouvola. As for Kemi and Savonlinna, the proposal will be amended so that, as an alternative to 24-hour emergency care services in primary healthcare, it will be possible to maintain a limited range of 24-hour emergency care services in specialised healthcare. This will support the hospital inpatient wards in specialised healthcare and the care chains in the wellbeing services counties. However, this would not mean 24-hour emergency care services in several specialities, and the purpose is not to enable demanding surgical procedures in these hospitals. The concept of 24-hour services in acute medicine will be abandoned in legislation. Because of this, some changes would need to be made to the current operating model for emergency care services provided by Ratamokeskus in Kouvola.

The Government made most of the decisions on the network of hospitals and emergency care services in its spending limits session on 16 April 2024. During the session, the Government decided that each wellbeing services county would continue to have a central or university hospital equipped to provide childbirth services and perform surgical procedures in a comprehensive manner. The provision of 24-hour emergency care services in primary healthcare will be possible in fewer locations as specified by law, and the practice concerning derogations will be discontinued. The wellbeing services counties will be free to provide urgent appointment services during evenings and weekends. It is hoped that an increasing number of counties will do this, because it would reduce backlogs in emergency care services at hospitals. Changes will be made to 24-hour emergency care services in specialised healthcare in certain hospitals. HUS Group will decide on the arrangements concerning emergency care services in its hospitals. It will become possible to procure services from the private sector when it comes to outpatient surgeries and certain other procedures. The existing legislation does not allow the procurement of these surgeries and procedures.

In order to shorten the waiting times for access to care, the Government has also decided that primary hip and knee joint replacements performed on an outpatient basis may be procured from private service providers in cases where there is a risk that the maximum waiting time for access to care is not realised. During the transition period (until 30 June 2028), such surgical procedures may be performed temporarily in Kemi, Savonlinna, Oulainen, Salo and Valkeakoski.  

It is proposed that the amendments concerning emergency care services enter into force on 1 October 2025 instead of the previously agreed 1 January 2026. According to the proposal, the temporary act that enables certain outpatient surgical procedures, short-stay surgical procedures, outpatient joint replacements and certain other procedures in the specified public hospitals and the procurement of these procedures from private service providers would enter into force on 1 January 2025.

The proposal aims to achieve annual savings of EUR 26.5 million in central government finances. The proposal will next be submitted to the Finnish Council of Regulatory Impact Analysis for consideration, and it will be submitted to Parliament in the autumn. 

Inquiries: 

Nuutti Hyttinen, Special Adviser to Minister of Social Affairs and Health Kaisa Juuso, tel. +358 295 163 073

Sirkku Pikkujämsä, Senior Ministerial Adviser for Medical Affairs, Ministry of Social Affairs and Health, tel. +358 295 163 014 (content-related matters)

Merituuli Mähkä, Senior Ministerial Adviser, Ministry of Social Affairs and Health, tel. +358 295 163 575 (legislation)

[email protected]

• Minister Juuso’s press conference on the hospital network, 6 September 2024 (in Finnish)
• Press release of the Ministry of Social Affairs and Health, 16 April 2024: Government session on spending limits agrees on the future of hospital network 
• Press release of the Ministry of Social Affairs and Health, 21 May 2024: Government proposal on the network of hospitals and emergency care services circulated for comments (in Finnish)
• Press conference presentation material: Reform concerning the system of hospitals and emergency care services and the division of labour in specialised healthcare (in Finnish)