The Kaste programme’s client-oriented reforms

The National Development Plan for Social Welfare and Health Care (better known by its Finnish abbreviation Kaste) aims to encourage municipalities in Finland to reform their services to be more client-oriented.
 

"It is still surprisingly difficult to pinpoint the status of those in need or to genuinely listen to people when it comes to the reform of primary health care and social welfare. But I think that the trend is changing. For instance, experienced specialists are starting to be used in child welfare, and mental health and substance abuse service reform," explains Ministerial Advisor Salme Kallinen.

The Kaste programme is designed to reduce health and welfare inequalities, and to structure welfare and health services to be client-oriented and financially sustainable.

The government adopts a new Kaste programme every four years. The programme is based on legislation covering planning and government grants for social welfare and health, and defines various objectives for sectoral reform and how to carry it out.
It focuses on the reform needs raised by major stakeholders in social welfare and health care, and by the public. The Kaste programme is prepared and implemented by the Advisory Board for Social Welfare and Health care, the steering group under it and five regional steering groups.

The aims of the Kaste programme are achieved through cooperation by local authorities and joint municipal boards, different branches of government, NGOs, parishes, companies, educational units, and national and regional research and development units.
The programme aims to ensure the smooth running of work with clients and the occupational well being of social and health care personnel. In order to speed up the reform process, municipalities receive specialist guidance and state subsidies for development projects. Assistance is subject to new forms of collaboration across municipal, sectoral and administrative boundaries.

Requirements for real change

Development projects that will receive state subsidies in 2014 were publicised on 23 January. Grants have been awarded to 10 projects within the scope of the Kaste programme.

The grants are aimed at bringing improvements to primary health care, child and family services, and services for older people, in addition to facilitating structural reform. Also, 10 of the largest cities in Finland have received support to reduce long-term homelessness. The total of the grants runs to €13.3 million.

"All the projects awarded grants were well prepared entities required to achieve concrete and significant changes in their areas. I'm particularly glad that domestic and intimate partner violence and intervention in it has started to be talked about more publically. Ways are needed to help both victims and perpetrators. The project on this issue will begin as a collaboration between municipalities and organisations in the eastern and central region of Finland."

Taking root

It is essential for the success of the Kaste programme that the projects to have a lasting impact. It is also important that they really make it easier to obtain assistance, limit clients being shunted from one professional to another and lessen the need for institutional care.

"Therefore the projects must be structured so that both management and employees are committed to the reform process. When permanent employees are involved in it from the outset, the possibilities for changes to take root are greater than if you only had project workers carrying it out with project funding."

While the Kaste programme encourages inter-municipal cooperation, it is not necessarily possible to replicate or inculcate best practices directly from one locality to another. Salme Kallinen says that this is because the work involves very different kinds of people with different training.

"People don't function like machines that you programme to do things. Work communities also function differently from one another.

Results and hurdles

The most important outcomes of the Kaste programme have been improvements to primary health care processes, in developing child, youth and family services, and in improving the availability of mental health and substance abuse services.

Despite there being few development projects there is nevertheless precise information on how many people's working methods have changed, what such changes have meant in practical terms, and what they have meant to clients.

"If you consider all the assisted projects, you don't find that the results have been put together. Many of the projects' outputs, such as toolkits and instruction manuals, have been presented as separate publications. Our aim is to guide projects towards closer monitoring and presentation of results."

Kallinen explains that an important partner in this work and for those carrying out projects is the "Innovillage" initiative. This refers to an open resource and support space, which was created by a project that ran from 2009-2013, and which is used by public service providers, developers and NGOs for promoting health and welfare.

Changes underway

There are still two years remaining in the current phase of the Kaste programme. Applications for the new project funding have to be submitted by the end of September this year. The aim is also to plan new ways to carry out and disseminate best practices, alongside customary project activities.

Preparations for the next Kaste programme will start in 2015.

"We've an interesting two years ahead of us," says Salme Kallinen. "We're living in a time of diverse changes. Municipal managers and professional practitioners are having a tough time. Which is why you have to give credit to the chairs of the Kaste programme's regional management groups.
"They have had an uphill struggle, kept things in hand, and understood the importance of structural and operational reform. But everything starts from the fact that only someone who is healthy can do their work with passion and enthusiasm."

Kimmo Vainikainen and Mark Waller