Selvityshenkilöt: Sosiaali- ja terveyspalvelujen järjestämisvastuu 34 sote-alue

The working group of evaluators who considered the arrangement of social welfare and health care submitted their proposal to Minister of Health and Social Services Maria Guzenina-Richardson on Tuesday 19 March. The evaluators' suggestions were based on policies of the Government Programme and the Ministerial Working Group as well as several hearings arranged in five regions.

Currently, responsibility for the arrangement lies with approximately 140 municipalities or inter-municipal cooperation areas. A reform is needed because there are problems in the availability of health centre and social welfare services, and inequality among the population has continued to grow. Also, municipalities find it increasingly difficult to cope witharranging such services with an ageing population and a decrease in the number of people of working age.

Local services will be secured and the availability of services will be improved

In future, the population will need an ever greater number of services that make many kinds of competence available concurrently. In many cases, small municipalities are unable to provide such a range of services locally; instead, local residents must obtain their services from many different places which leads to longer queues for treatment.

Compared with the present situation, the regions proposed by the evaluators will be better placed to secure the social welfare and health care services people need. Arranging such services in larger regions larger with a significantly stronger financial standing will also balance regional differences and improves the equality of the local residents. Primary services can be increased and enhanced when such services are arranged and funded by broader shoulders than today.

It will also help ensure there is a sufficient number of personnel. Within these larger areas, employees' competence can be developed and their skills maintained, and staff can be used in more flexible manner.

The evaluators also emphasise that local services must be secured even though a larger area would assume responsibility for the arrangements. A region with a stronger financial position is better poised to arrange a versatile provision of services, so people can get the services they need frequently or every day close to home.

SOTE regions offer equal services to all

All SOTE regions must have uniform grounds when arranging their services. The municipality or SOTE region in charge of the arrangement is responsible for ensuring that people receive all high-quality services they need everywhere within the region. The party responsible for the arrangement may have several providers offering services to the local residents.

In line with the Government's policies, most of the SOTE regions would employ a model of "municipalities with primary responsibility" whereby municipalities jointly agree that one municipality will be responsible for the arrangement of social welfare and health care services on behalf of the region's other municipalities. In other SOTE regions, arrangement of the services would be the responsibility of a joint municipal authority formed by the municipalities in the region.

According to the working group, the impact of these proposals on the vitality of growth centres, costs incurred by them and the models for financing services will have to be assessed in more detail during further preparation.

SOTE regions should be organised according to the size of the population, sufficient financial standing and special features

The proposed model secures the availability of services for people and the sufficiency of staff all over Finland in a human, socially and financially sustainable manner. The proposal takes into consideration the municipality-based approach emphasised in the Government Programme and the assignment as well as preconditions for implementing the solutions at the regional level.

The model drafted by the working group of evaluators eschews partial optimisation, overlapping services and regions with incapable of providing sufficient services.
Five specific catchment areas will be responsible for coordination in social welfare and health care

In addition to the SOTE regions, the evaluators propose five specific catchment areas on social welfare and health care with duties, research and education that support and coordinate the extensive primary level. University hospitals will still be responsible for provision and competence concerning the most demanding care in the five areas.

Establishment of joint specific catchment areas in social welfare and health care will improve the situation of special services in social welfare, in particular. Currently, the arrangement of special services in social welfare is primarily the municipalities' responsibility, and availability of services is a big problem.

How to proceed from here?

The service structure reform is the most significant reform in social welfare and health care in decades, and the proposal made by the working group of evaluators entails a significant improvement of the current situation.

The evaluators' suggestion will be discussed this week by the Ministerial Working Group on Social Welfare and Health and by the Ministers during a Government meeting. Municipalities will be provided an opportunity to express their views on the proposal during this spring.

The Finnish Ministry of Social Affairs and Health will set up a committee to prepare an act on the arrangement and support the implementation of the reform. The aim is to submit the Government Bill to Parliament in spring 2014, and the Act is scheduled to enter into force in 2015. The act would include a transition period, and implementation of the act would be specifically supported.

For further information, please contact

Working Group Chair, Director-General Päivi Sillanaukee, tel. +358 2951 63356

Related topics

Service structure reform as part of the local government reform