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Gov't unveils 13-region social and healthcare reform model

Ex-PM Juha Sipilä tendered his government's resignation after its version of the reform package failed to pass.

Krista Kiuru
Family Affairs and Social Services Minister Krista Kiuru at Friday's press conference. Image: Pekka Tynell / Yle

Prime Minister Sanna Marin’s government has outlined a social and health care reform model that would provide services via 13 regional authorities in addition to Helsinki and five cooperating regions providing specialist services, according to a statement from the Ministry of Social Affairs and Health.

Funding for the model would come primarily from state coffers, while the regional authorities would also have the power to raise tax funding. Work is currently underway to empower the authorities accordingly, government representatives said at a press conference on Friday.

The new model should not, however, result in higher taxes, Family Affairs and Social Services Minister Krista Kiuru told reporters.

She said that the goal is to reduce welfare gaps, ensure equality of services, improve access to services, safeguard labour supplies and control costs.

Reform defeated previous government

Successive governments have struggled to reform Finland’s delivery of social and health care services and streamline a system that currently relies on nearly 300 municipalities to provide services.

Juha Sipilä’s Centre Party-led government envisioned an 18-authority model, but Sipilä tendered his administration’s resignation in March last year after failing to take the ambitious overhaul across the finish line.

That coalition government struggled to arrive on consensus on the number of regions required to deliver services, as the other major government partner, the National Coalition Party, favoured a more streamlined model with 12 regional authorities. The administration eventually settled on 18, while accommodating the NCP's push to have private providers play a bigger role in delivering services.

Kiuru said on Friday that one way the current plan differs from the previous effort is that the same operators will be responsible for organising and producing services.

"In other words, the entity that organises these services will also know how they are to be provided. It can then broaden [service] production to others," she explained.

Social Affairs and Health Ministry permanent secretary Päivi Salo said that the ministry had been working on the reform package despite the ongoing coronavirus crisis.

"The need for reform has been undeniable and many governments have been working on it," she noted.

"I believe many have suspected that because of the coronavirus crisis we would not finalise the reform during the government term," Kiuru added.

Emphasis on public sector

The Marin government’s reform proposal rejects the previous government's model of so-called freedom of choice, which essentially made more room for private providers in the system.

In the current scheme, the main responsibility for organising and providing services would lie with the public sector.

"The regional authorities can buy social and health care services from private sector providers although overall [services] will primarily be in public hands," Kiuru said, adding that conditions for using private providers are still being ironed out.

Ministry officials said that procurements should not include services related to organisational responsibility or the exercise of public power, social emergency services or emergency care, or the provision of round-the-clock health care.

Private providers can however perform tasks involving public authority, if other laws allow. For example, the proposed regional health authorities will be able to hire workers from private sector firms. However they will have to ensure that they retain responsibility for organising tasks.

The minister also noted that some current outsourcing contracts do not fulfil the criteria required by proposed new legislation associated with the reform package. She said that government will lay down criteria for voiding those agreements.

Regional elections in 2022?

The new reform proposal will be sent out for commenting from mid-June and government aims to bring a package of reform-related legislation to Parliament in December at the latest, the minister said.

"After that the timetable will be in the Parliament’s hands," she added.

Government will set up temporary arrangements before transitioning to the fully-empowered regional authority system, health officials said at the press conference. It could for example, nominate a special preparatory organ for the purpose.

According to the government’s plan, regional elections to appoint leaders of the new authorities could take place in early 2022, but Kiuru stressed that this schedule also depends on lawmakers.

If it does hold however, social and health care regional councils could begin their work in March 2022, while the authorities themselves would begin operating in early 2023.

Workers' status critical

The minister said that the reform package will result in major personnel changes. "It is the largest business handover in history. It will affect health care as well as emergency operations," she added.

She added that safeguarding the status and skills of workers in the sector is critical.

Kiuru said that government is no longer looking to save three billion euros so it would have more room to manoeuvre as it distributes 18 billion euros in funding.

Edit: Updated at 3:48pm to adjust the number of regional authorities from 21 to 13, according to the Ministry for Social Affairs and Health.

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