7.8 Current debates and reforms
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The long-planned Health and Social Services reform has been one of the most crucial governmental reforms in Finnish history and by January 2023 the reform will be fully adapted. In 2023 there will be 22 Health, social and rescue services counties, and additionally a separate Hospital district in Helsinki and Uusimaa, instead of the previous 195 health and social services, and 22 rescue departments. The state is responsible for funding the Health, social and rescue services counties and giving needed guidance for the implementation of planned actions. Private and third sector health care institutions will continue to complement public health and social care services.
In the first phase of Health and Social Services reform, the counties will not have the right to levy taxes. The funding of the wellbeing services counties will be based on imputed universal central government funding and revenue from fees and sales. In 2023, the national level of central government transfers for wellbeing services counties will be based on the 2022 health, social and rescue services costs transferred from municipalities. The funding will be adjusted retrospectively to correspond to the actual costs at national level. The health and social services reform aims to curb the growth of costs, with due consideration for the preconditions set earlier by the Constitutional Law Committee for the sufficient funding of services. The Government would confirm the national and fiscal policy strategic objectives for health, social and rescue services for a four-year period. The counties’ activities and funding would be assessed annually in negotiations to provide guidance and direction.
County councils are in charge of exerting influence in well-being services counties, and the first elections were held on 23 January 2022. The actual responsibility for organising services will be transferred to the counties’ well-being services on 1 January 2023. Starting in 2025, the county elections will be held in conjunction with the local elections. County elections will be held in all areas except Helsinki, where the city council work as the responsible body. For more information, visit: Youth Wiki/Finland: 7.2 Administration and governance.
The Finnish Government has submitted a proposal to Parliament on reducing the maximum waiting times for access to care. The proposal would shorten the maximum waiting times for access to primary healthcare under the Health Care Act. The Treatment Guarantee would apply to both physical and mental health problems. Regarding outpatient care in primary healthcare, the maximum waiting times for access to non-urgent examinations or care would be shortened from three months to seven days. The waiting time would be calculated from the date on which the need for care is assessed. The maximum waiting time for access to oral healthcare would be shortened from six months to three months. If the well-being services counties are unable to provide the services themselves, they will need to acquire the services from other service providers.
SOSTE Finnish Federation for Social Affairs and Health is a Finnish umbrella organisation of 200 social affairs and health NGO members and dozens of partner members. During the current governmental term, SOSTE has monitored in particular development indicators for well-being, that describe the state of well-being, competence, perceived health and participation of younger age groups. Younger age groups (under 40 years old) have been selected as the monitored age group because they have a period of active social participation ahead of them as well as a potentially long-working career. Based on the monitoring work (more information in Finnish), it seems that the well-being of younger age groups has not developed favourably in recent years. On the contrary, the longer-term negative trends seem to continue and the corona crisis has possibly further reinforced these trends.
The welfare economy indicators monitored by SOSTE show rather worrying signs about the state of well-being of younger age groups. In particular, the deterioration of the perceived health of young people and the continuous increase in the number of people on disability pensions for mental health reasons show that there is still reason to make welfare investments in society. According to SOSTE, “in the future, greater attention must be paid to the well-being of young people. It is also necessary to start thinking more seriously about ways to interrupt this development and change the direction of the trends described by the indicators”. SOSTE has proposed to Parliament, among other things, the rapid introduction of the Therapy Guarantee, increasing child protection resources, better resourcing and implementation of need-based labour services, and increasing the amount of training for social and healthcare professionals.
The mentioned Therapy Guarantee started as a citizen initiative in 2019 and it has collected more than the needed 50 000 signatures in order to proceed to the parliamentary hearing. The initiative was supported by eight parliamentary parties and has received exceptionally broad political support across party lines. In the government proposal regarding the aforementioned Treatment Guarantee), psychotherapies and other psychosocial treatments not included in the seven-day treatment guarantee described in the treatment plan. In the government's presentation on the forms of mental health work, so far only treatments that can be easily and quickly obtained in primary care are covered by the Treatment Guarantee.
According to Sari Aalto-Matturi, the executive director of MIELI Mental Health Finland, “the government's presentation on the treatment guarantee only partially fulfils the goals of the Therapy Guarantee citizens' initiative”. She considers it unfortunate that not all of the goals of the Therapy Guarantee have been included in the Treatment Guarantee. "The Treatment Guarantee remains half way from the perspective of Therapy Guarantee. The presentation does not directly respond to the citizens' initiative's demand for timely treatment of mental health disorders. However, the positive thing is that, according to the proposal, the availability of psychosocial interventions in primary healthcare can possibly be promoted," she commented on the article of Mielenterveyspooli (in Finnish, published in 13.5.2022).
The ongoing debate concerning mental health issues has also highlighted the need for action, while also creating new operating models, and has launched national campaigns. In the Therapies to the Frontline operating model, which is operated by HUS Helsinki University Hospital, the availability and processes of basic mental health services are improving thanks to their collaboration with the future welfare areas and university hospitals. The operating model, which enables the implementation of the therapy guarantee in welfare areas, is part of the national mental health strategy and supports the social security reform.