Economic downturn, inflexible legislation and a labour shortage to steer reform of services provided by wellbeing services counties

Publication date 24 Oct 2023

Expert assessments published today by the Finnish Institute for Health and Welfare on the organisation of health and social services indicate that the dire economic situation, inflexible legislation and the growing shortage of social welfare and health care professionals are hampering the provision of necessary and timely services to the residents of the wellbeing services counties, which launched their activities at the beginning of this year.

The greatest challenges in the provision of health and social services are related to basic and specialist services of children, young people and families as well as services for older people. Problems related to the mental welfare of children and young people have continued even after the Covid-19 pandemic, and the need for corrective services has remained high. There is a great need to strengthen low-threshold services close to children and young people thus reducing the need for expensive corrective services.

The growing need for services for the rapidly ageing population and a shortage of health and social services personnel increase the pressure to reform the structures of services for older people. The majority of wellbeing services counties have succeeded relatively well in assessing the service needs of older people, but organising services that meet their needs has been a challenge. In the coming years, there will be a particular need for services for communal housing for older people.

The increased labour shortage in wellbeing services counties has also had a negative impact on the availability of non-urgent specialised medical care. The share of those who have awaited treatment for more than six months varies greatly in different wellbeing services counties.

The wellbeing services counties strive to respond to the increase in the need for care and services by improving efforts to guide their clients to services that meet their needs and by supporting their self-care. Services will be diversified by increasing the use of mobile services and by further expanding the use of electronic services. An effort will be made to strengthen multiprofessional cooperation to help clients who need a large amount of different services.

Plans for balancing operations and finances are being drawn up across the country 

According to THL Director of Assessment Nina Knape, the shortage of professional personnel and the poor financial situation of the wellbeing services counties are currently accelerating the reform of health and social services. Several wellbeing services counties are planning to centralise operations into larger units and to coordinate basic and specialised services better with one another.

"In addition to service network planning, wellbeing services counties must also diversify their services so that they are able to secure the services their residents need," Knape says.

"A factor that is essential in improving and reconciling health and social services is the utilisation of the good practices developed so far and rooting these the activities of the wellbeing services county as a whole," emphasises Anu Niemi, Service System Director the Finnish Institute for Health and Welfare.

The funding granted to wellbeing services counties for this year 2023 has not fully covered the additional costs caused by inflation and the national labour market solution. Considerable unforeseen additional costs have been caused by an increase in outsourced services, price increases and an increase in the amount of hired labour.

THL's preliminary data also show that wellbeing services counties are also struggling with the requirements of organically increased normative legislation - binding regulations have been drawn up over the years without the management of the whole, which leads to inappropriate prioritisation and binds the hands of the regions. In fact, the normative legislation would require rapid reform so that the new model could meet its promises.

According to the wellbeing services counties' own estimates, their combined budget deficit will grow by more than one billion euros this year. By October, approximately half of the wellbeing services counties have prepared a plan for balancing their finances and operations.

According to Jutta Nieminen, Senior Specialist at the Finnish Institute for Health and Welfare, wellbeing services counties are in danger of falling within an evaluation procedure by the Ministry of Finance if they fail to balance their finances by the end of 2026.

According to Nina Knape, a few years is a very short time for balancing operations and finances, as the starting point of the wellbeing services counties was difficult and the planning, decision-making and implementation of the measures requires time.

THL annually assesses the organisation of health and social services both nationally and by wellbeing services county. In autumn 2023, THL will publish a national expert assessment and wellbeing services county-specific assessments at the same time. The national expert assessment is based on observations made during the wellbeing services county-specific expert assessments and other current regional and national reports and studies. 

Source: Assessment on the organisation of health care and social welfare at (in Finnish)

Further information:

Nina Knape                                                                
Director of Assessment, THL                                               
tel. +358 29 524 7683                                                  

Anu Niemi
Service System Director, THL
tel. +358 29 524 7296

Jutta Nieminen (costs, financing, investments)
Senior Specialist, THL 
tel. +358 29 524 7157

Vesa Syrjä
Development Manager, THL
tel. +358 29 524 7240

[email protected] 

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