Report finds flaws in wellbeing services county reform

An evaluation report showed various shortcomings of the wellbeing services county reform and made a series of recommendations for improvement of the situation.

An independent group of experts conducted a broad-based interim evaluation of the wellbeing services county reform, which was published on Wednesday, said a government press release.

It found significant differences between the counties when it comes to the availability and reform of individual services.

The wellbeing services county reform is progressing towards the set objectives throughout Finland, but there are still many issues left to address, said the report.

According to the evaluation, the availability and operational capability of rescue services have improved since the early years of the reform.

Nevertheless, there are regional differences particularly in growth centres where improvements in the availability of services have not fully met the needs of population growth and demographic change.

According to the expert group, leadership capacity varies by county. At the same time, it has been necessary to reform the network of health, social and rescue services, harmonise these services and adapt to a new funding model.

Many counties have succeeded in managing people and change. The counties with a clear strategic management model, a competent senior management team and investments in leadership have made faster progress in implementing the wellbeing services county reform than other counties.

The expert group was unanimous with regard to its summary and recommendations. Some of the proposed measures need to be launched immediately, while others will take more time to be developed further.

The experts see three alternative futures: counties with an even stronger self-governing status, an alternative based on the development of the current model, or stronger central government steering.

They consider it essential to strengthen a systematic approach to reforming the system of health, social and rescue services across parliamentary terms.

This can be done by increasing parliamentary cooperation. National steering and the structures of health and social services in the counties must be reformed boldly far into the future.

The expert group proposed that the number of counties be assessed as a whole at national level.

Before the government formation talks in spring 2027, clear operational and financial criteria need to be defined on how to reassess the structure and number of counties.

The interim evaluation states that the national steering of the wellbeing services counties must be strengthened and clarified.

According to the expert group, the problems identified in the funding model of the counties must be addressed. It is recommended that, in the first stage, counties that accumulate a new deficit in 2025 but that have a sufficiently detailed plan approved by the Government also be allowed to fulfil their deficit coverage obligation by 2028.

The expert group recommended addressing the technical issues related to the knowledge base for healthcare and social welfare and ensuring that all counties follow consistent and reliable practices for recording data (particularly entries concerning diagnoses and morbidity). The recording practices will be audited as necessary to ensure quality.

The group proposed that the funding model should provide more incentives to take preventive and cost-effective measures. Furthermore, it proposes creating a new incentive by extending the scope of the share of imputed funding allocated to the promotion of healthcare and social welfare.

As a long-term recommendation, the experts propose that the counties’ own responsibility for financial resources be increased. This would be done by introducing the right to levy taxes if a solution based on a stronger self-governing status was to be selected.

“The implementation of a major overhaul such as the wellbeing services county reform must be evaluated regularly. The reform is one of the most significant administrative reforms in Finland’s history, and it changed the ways in which publicly funded health and social services are organised, provided and funded,” said Permanent Secretary Veli-Mikko Niemi of the Ministry of Social Affairs and Health.