Sote integration – working for clients

Because new legislation on the organisation of social and health care (known in Finnish as Sote) was not ready within the current government term of office, there has been some public discussion questioning the significance of this service integration. However, strengthening basic services and their integration at all levels remain key goals.

"The incentive for increasing social and health care integration is to ensure clients have a more cohesive service package. The importance of integration is highlighted in situations where assisting people requires the expertise of both sectors," explains Director at the MSAH Päivi Voutilainen.

Changes to the organization of the Finnish social and health care system seeks to safeguard equal, client-centred and high-quality social welfare and health care services throughout the country.

A key issue is that of integrating the two areas of social and health care to strengthen their service interface and to create smooth service and care chains. This aims to generate new ways of providing services efficiently and cost-effectively in ways that focus foremost on what benefits the clients and patients.

The majority of social and welfare expenses accrue from only about 10 per cent of the population, so the effective coordination and prevention of piling-up of problems concerning the services used by this client group are particularly important.

Two thirds of this 10 per cent primarily comprise social service clients who also require health services. They include older persons with multifaceted service needs as well as clients using mental health and disability services. Some child welfare clients also belong to this group.

Voutilainen says that integration will particularly improve the situation of such people. There is less of a need for remedial work as long as clients get help before problems become acute. In many cases, there is a need for the specialisation and services of both social and health care sectors, which is why having a single package makes sense. Integration is one method in the process of facilitating an ethically, socially and economically sustainable social and health care system.

Creating a new operating culture

Structural and operational integration is, in Voutilainen's view, an instrument for attaining welfare and health equality. Health and functional capacity are socially selective in that when both are impaired they are associated with weaker socio-economic status. Within the process of change, it is important to give priority to the viewpoint of service users and to bringing them added value. Creating such added value by integrating social care requirements extends not only to health care but encompasses such things as basic education, vocational training and labour administration.

"It doesn't matter to the client or patient what sector services are placed in administratively. What's important to them is that they get the assistance they need."

Creating a new operational culture is a challenge for all those involved in social and health care. Voutilainen emphasises that the issue is not only one of increasing cooperation across the sectors but also of operating in a wholly new way. Instilling this in practical ways requires structures that support operational change, systematic implementation and a change of attitude. Integration also requires systematic knowledge-based generation of research projects that promote the integration process.

"Both sectors must learn to see what added value can be obtained from one another's sphere of expertise to assist clients. Attaining a more versatile understanding of the situation together helps develop more effective services, which in turn generate better health and welfare, and thus better social and economic sustainability."

Social and health care will clearly continue to be the only social and health sector areas covered by development needs. In many cases, though, there is a need for joint work so that the added value for the client from integration can be realised. Voutilainen gives the example of an elderly person having hip surgery.

"While the operation itself may go well, that in itself wouldn't guarantee a good end result in the life of an older person. Rehabilitation and other services needed after discharge have to be timely so that they support the return of functional capacity without hold-ups. Otherwise the benefits of the operation will be lost."

Crossing the threshold

The different developmental backgrounds of social and health care have given each of them their own structures, operational cultures and identities. Breaking with what is familiar requires learning and reflection. Voutilainen says that this succeeds best when you keep the objective of what is in the best interests of the client or patient clearly in mind.

"Realising the benefits of integration depends on those working in the sector and requires the support not only from changes in attitude but also from a vigorous management of change."

Paula Mannonen and Mark Waller