Coun­ty Elec­tion Pro­gram­me 2022

The health and social services reform is a historic change in the organisation of wellbeing services in Finland. The reform is carried out in order to ensure faster access to care and more equal access to high quality services across Finland than at present. In the future, the responsibility for social and health care on the whole will lie with only one operator, the wellbeing services county.

With the reform, it is now possible to arrange social and health services within the same organisation. This will put an end to people needing to go from one queue to another. When designing services, the focus must be on employee retention and continuity in the relationships between care providers and clients. As a result of the reform, more resources can be allocated to preventive work and basic services provided by multiprofessional teams in social and health care centres. Staff will be trained to treat clients as individuals and to take into account the needs of different minorities. For the Left, the main goal of the whole reform is to put people at the heart of social and health care and to increase equality.

In regard to the wellbeing service counties, one of the most important goals of the Left Alliance is to strengthen local services. Social and health care services must be organised close to people, not concentrated in large units or large localities. The linguistic availability of services must be taken into account in accordance with the needs of the counties. The availability of services in different languages must be based on the needs of the residents in the counties. Bilingual counties will provide services in both national languages. In the Sámi homeland, services will be provided in the Sámi languages.

Local services that are important for everyday life, such as child health clinics, social and health care centres, and social welfare housing services, must continue to be available close to people. Services in sparsely populated areas must be strengthened, for example, with the help of itinerant professionals and by digital means. Similarly, specialised expertise and treatment of less common problems can be arranged with the help of rotating visits by experts. In this way, services that require specialised expertise can also be brought to locations where they do not currently exist. Such services include, for example, medical services or physiotherapists specialising in the treatment of people with disabilities, the chronically ill, or the elderly.

One of the key objectives of the social and health care reform must be to strengthen the role and status of social work. Social work services will be incorporated alongside health services into social and health care centres. This means that people will receive help and support for their problems quickly and at a low threshold. Social services must be accessible, barrier-free, and inclusive. The services must be easy to find and as simple and easy to access as possible. All services must ensure that sufficient competence and resources will be available to help and connect with victims of domestic violence, sexual violence and exploitation.

Finland is currently experiencing a labour crisis in the social and health care sector. The need for services will increase with the ageing of the population. At the same time, tens of thousands of social and health care professionals will retire. The labour shortage must be addressed by increasing the intake capacity of education in the fields of social and health care. However, the problems will not be solved without improving the working conditions and salaries of social and health care professionals. As an employer, every wellbeing services county must immediately draw up a programme of measures to identify recruitment needs and outline concrete measures to clarify the division of labour among professionals, develop work processes, and improve terms of employment and working conditions. This work must be carried out in cooperation with the trade unions in the sector.

The counties will be the largest employers in the regions, and it must be ensured that they are also the best employers. Competitive working conditions must be ensured. Involuntary intermittent and part-time employment must end. Running the social and health care sector on overtime must come to an end. Employees must be provided with evolving career paths and encouraged to maintain their competences and seek further training. Specialised expertise must be rewarded with proper salary increments. The substitute system must be developed in order to ensure an adequate number of staff in all circumstances.

Change requires a culture of good management. Resources must be used to reduce the mental and physical strain on staff. Occupational health care must be more closely involved in supporting employees’ coping at work.

Social and health care employees are burdened with unethical practices and violations occurring in the sector. It must be ensured that employees in the public, private, and third sectors have channels to report any grievances they come across without fear of losing their jobs or other negative consequences.

Mental health care needs more low-threshold services that can be provided quickly, even without a referral. Unrestricted access to care is simple for the patient and makes it easier for people to seek treatment before the situation becomes serious.

There are major shortcomings particularly in the mental health services for children, young people, and people not in the labour force. Mental health professionals must be present in schools and educational institutions. Schools must have sufficient services of a psychologist, welfare officer, and psychiatric nurse to provide low threshold help.

Expertise and services related to basic mental health care must be available in all social and health care centres. Basic mental health services will be implemented as proposed in the Therapy Guarantee initiative. In this way, the need for care is assessed immediately when a person seeks help, and psychosocial care and support begins within one month of the assessment of the need for care.

Services must be built from the point of view of those who need them, and transfers between services must be flexible and quick. The wellbeing services counties must draw up a mental health and substance abuse treatment plan, which also includes treatment of gambling-related harm. Substance use must not be an obstacle to accessing mental health services. Both rehabilitation and housing services must be available to everyone who needs them. A suicide prevention centre will be established in each wellbeing services county.

Substance abuse services must be accessible and easy to find. Access to them must be as simple and barrier-free as possible. The stigma surrounding the use and users of substance abuse services must be overcome by training all social and health care professionals. The families of people with mental health and substance abuse problems must also be offered help. Housing for people with substance abuse problems must be arranged in such a way that the substance abuse problem does not lead to homelessness and overcoming substance use is not a condition for obtaining housing. Preventive substance abuse work must be carried out in cooperation with municipalities.

Services for families with children must be developed in a direction that supports families in the long term. This is best achieved through the family centre model in which services for families with children are centralised in a single unit. In this way, parents can be supported from their child’s early childhood through their teenage years.

Home help and other practical help with everyday activities prevent parental fatigue. These services must be available free of charge to anyone who needs them. Free and timely services as well as preventive and supplementary income support are key tools in reducing poverty in families with children.

The wellbeing services counties must establish cooperation bodies with municipalities. This ensures seamless cooperation between services provided by the counties and municipalities respectively. Services for children and young people, such as student welfare, must continue to be provided in the everyday environment of children and young people, i.e. in daycare centres, schools, and educational institutions.

Expenditure on child welfare is best controlled when problems are prevented. This means investing in early-stage support, adult social work, substance abuse and mental health services, and prevention of domestic violence.

Child welfare services must be able to secure children’s rights. In order to ensure client safety, a child welfare social worker shall be responsible for the affairs of a maximum of 25 children.  The wellbeing services counties must invest sufficiently in working conditions and salaries in order to support the recruitment of permanent employees. The counties must invest in recruiting and supporting foster families and increase the number of their own child welfare units.

The threshold for access to family planning services will be lowered. The county must provide free contraception for people under the age of 25 and those who have given birth within one year as well as for clients of substance abuse services, regardless of age.

The shortcomings of elderly care are a serious human rights issue and a disgrace to Finnish society. Empty promises are not enough to secure decent care for the elderly.

The number of staff must correspond to the needs of the residents and the wellbeing of the employees, both in nursing homes and in home care. The wellbeing services counties must ensure that staffing requirements are fully met in 24-hour care units and that the quality of home care is improved. Home rehabilitation, recreational activities, outdoor activities, and, if necessary, a doctor’s home visit must be included in the range of care services. Home care must be arranged in such a way that nurses have time to genuinely interact with the elderly person and that the personal nurse principle is realised. The elderly must be able to decide for themselves when home care is no longer adequate and they need more services.

Elderly people on low incomes must be exempted from client fees that restrict access to health centre visits, oral health care, and home care.

Family caregivers take care of their loved ones due to an injury, illness, or other cause. In order to ensure the coping of family caregivers, the wellbeing services counties must invest in high-quality services that support family caregiving and informal care. By providing a wide range of substitute care arrangements, caregivers can be encouraged to take the time off that they are entitled to and support their own wellbeing. Substitute care can be provided, for example, in the care receiver’s own home. Budgetary constraints in the wellbeing services counties must not limit support for family caregivers; support must be provided whenever necessary. Support services must be implemented according to the needs of the family in the informal care situation.

The counties need to inform their residents about the possibilities of being a family caregiver so that everyone can access statutory support and services. The level of support for informal care must be raised and the criteria for granting allowance and the levels of benefits must be harmonised. The possibilities of family caregivers to hold municipal or regional positions of trust must be improved through substitute arrangements.

It is important that people with disabilities have access to social and health services intended for all residents. The facilities used by the wellbeing services counties and the services and support they provide must be inclusive, barrier-free, and accessible.

The right to self-determination should be the foundation for disability policies. People with disabilities must be able to decide for themselves about their treatment. The person with a disability and members of their family must be able to participate in the decision-making that affects them and they must also be consulted on matters and services that concern them. People with disabilities and their families must have access to comprehensive, plain language information on what kind of services are available. The counties must have separately appointed professionals who advise people with disabilities and their families.

Ensuring the adequacy and effectiveness of transport services and personal assistance is an important way of strengthening the autonomy and ability of people with disabilities to decide, for example, on how to use their own free time. The possibilities to hire personal assistants and occupational health care must be improved. The counties must not put lifelong services for people with disabilities out to tender. People with disabilities must be able to decide for themselves where and with whom they live. The counties should conduct disability impact assessments and cooperate with disability and patient associations.

People should be able to see a health centre doctor or other qualified professional within a week – free of charge. The wellbeing services counties must implement a seven-day care guarantee for the whole of primary health care. The resources of health centres need to be increased both in non-urgent care and emergency care, so that the joint emergency room services can focus on the treatment of patients who require urgent or emergency care. Undocumented and paperless people must be guaranteed access to non-urgent care.

Public dental care resources need to be increased to shorten queues. It is also necessary to ensure that people have smoother access to the specialised medical care when they need it.

Despite maximum limits, client fees in social and health care services are a burden particularly for people on low incomes. More than 400,000 client fees end up in distraint proceedings each year. The wellbeing services counties must lower the client fees and, in addition, apply the possibility provided by legislation to reduce or waive client fees when charging for them is unreasonable in view of the client’s financial situation. Health centre fees must be removed altogether. Private collection agencies must not be used to collect client fees.

The wellbeing services counties have an obligation to guarantee the services for their residents under all circumstances. The large-scale outsourcing undertaken in municipalities and hospital districts in elderly care and disability and mental health services, for example, must be addressed by increasing public service production.

Outsourcing and the corporatisation of services have led to a deterioration of employees’ terms of employment and salaries. Outsourcing agreements create additional costs that go into preparing and monitoring of contracts and profits paid to the owners of the companies. Many companies have repatriated health care profits through tax havens.

The wellbeing services counties may need to complement their own services with services provided by organisations, cooperatives, or private companies, for example. Particularly in the field of organisations and in cooperatives, many operators have such expertise in services intended for special groups that may not exist in the wellbeing services counties. This expertise must be identified and utilised.

Help must be available without delay in times of emergency. The service level and quick response time of emergency and rescue services must be ensured in all wellbeing services counties. In addition, cooperation between emergency care and hospitals must be effective. Particular attention must be paid to the ability of paramedics and rescuers to cope with work throughout their working lives as well as to their safety at work.

The operating conditions of contractual fire brigades must be sufficient and cooperation between them and rescue services must be developed. Decisions on the service level must be based on a thorough risk assessment. In addition to the climate crisis, the ageing of the population will also increase the challenges of emergency and rescue services, and it is necessary to prepare for these challenges in the operations of the wellbeing services county. The focus of emergency and rescue services should also be shifted to risk management and prevention.

One of the most important tasks of the new wellbeing services counties is to ensure that the residents, NGOs, and municipalities can participate in the decision-making and preparation of matters in the county. People in need of services and their families must be given the opportunity to influence the development of services, and they must be consulted during the preparation of decisions. In addition to statutory disability, elderly, and youth councils, there is a need for participatory leadership, resident councils, experts by experience, digital platforms and other tools for resident participation. These must be implemented in an accessible way.

Social and health care services in the counties have many intersections with municipal early childhood education, education, youth work, employment-enhancing activities, housing planning, and promotion of wellbeing and health. These intersections must be identified from the beginning, and effective forms of cooperation must be established. Cooperation with NGOs is also key. The voluntary work carried out by organisations is valuable and its importance as a complement to the services is also recognised by supporting the organisations’ activities financially.

In the future, the promotion of wellbeing and health will be a joint task of municipalities, organisations, the wellbeing services counties, and the state. The counties will coordinate cooperation. Cooperation and the county’s own activities must be properly resourced, both in terms of staff and funding. Preventive action must be considered an investment that reduces future morbidity and social problems.

Social, emergency and rescue, and health services must be secured to prepare for climate and environmental crises. The counties can combat climate change, pollution and nature loss through their own activities: through environmentally responsible procurement, avoiding waste of materials, using low-emission energy and electricity solutions, reducing the concentration of services and thus travel, efficient waste management and recycling, and training of staff.

Social and health care services in the counties will introduce the percent for art principle, according to which a certain percentage of the budget of a project is used for cultural and art purchases. Local operators are favoured in procurement. The presence of culture in social and health care services is also systematically promoted in cooperation with municipalities.

Social and health care services that meet the needs of residents require the state to assume its own responsibilities. The operating conditions in the counties must be sufficient. The state must secure adequate financial resources, the availability of trained staff, and legislation that protects the rights of residents. In addition, the state must ensure the uniformity, quality and security of information systems. The autonomy of the wellbeing services counties must not be restricted or undermined by overly detailed state regulation.

The parliament will decide later on the introduction of a county tax. Collecting a county tax in the wellbeing services counties is necessary in order to ensure that the decision-making power does not escape the residents of the counties and their elected representatives. Without the right to tax, the counties are fully under the control of the Ministry of Finance and the Ministry of Social Affairs and Health. In this case, the decision-making power and scope for action of the decision-makers elected in the county elections are very limited. Nevertheless, the main responsibility for financing social and health care services must remain with the state.