Objectives of the Future Health and Social Services Centre programme: Shifting the focus of operations from heavy services to preventative and predictive work

The programme for the Future Health and Social Services Centre develops both basic level social services and healthcare services. The accessibility of services will be improved and the services will be adapted based on people’s needs. The programme aims to reform the operations of social services and healthcare and develop people-oriented service units. The cooperation between professionals of social services and healthcare will be strengthened to allow a more comprehensive assessment of a client’s situation so that they can receive the necessary help or support through a single contact. The programme has five objectives: 

• improving the equal accessibility, timeliness and continuity of services 

• shifting the focus of operations from heavy services to preventative and predictive work 

• improving the quality and effectiveness of services 

• ensuring multidisciplinary, well-coordinated services 

• mitigating the growth of costs. 

(Source (in Finnish): https://soteuudistus.fi/tulevaisuuden-sosiaali-ja-terveyskeskus-ohjelma1(external link)) 

We asked residents in the Western Uusimaa Wellbeing Services County area what this objective means to them and what kinds of expectations and thoughts they have regarding the matter. The views naturally vary according to the stage of life a person is going through and the factors that form the need for services.  

Sani Helin, a student from Espoo, feels that the school world plays an important role in preventive work for children and young people. School staff should pay more attention to the pupils and create an operating model where children are regularly asked how they are feeling: “Some pupils have no one at home to ask them how they are doing,” Helin says.  

Regular meetings with a school welfare officer, for example, where a child or young person could talk about how they are doing, allowing for a professional to observe e.g. the need for early intervention, would be one way of preventing situations from getting worse. This is where Helin would like school welfare officers to be proactive. “When I was in school, a school welfare officer was just some person sitting downstairs next to the nurse’s office with their door always closed.”  

Helin also highlights the view that it would be important to use skilled staff with children and young people: “I feel that if e.g. a school psychologist or welfare officer is incompetent, the help that they give may be the wrong kind, which may actually be harmful, and the situation may deteriorate – this is something that has already happened,” Helin says. In Espoo, Helin has received help when needed, but feels that she has had to be very adamant in justifying her need for help. “No small-scale solutions can ever be tried, because there are so many people who need help and too few employees.” 

For young people, outreach youth work and cooperation with different actors, such as the parish, is important from the point of view of preventative and predictive work. This is where Helin feels that Espoo has improved wonderfully over the years. “I've seen e.g. parish cars going to places where young people party, and I think it's really good – they don't tell people not to drink, but they hang out with young people, which is a good thing.” 

Mother Kaisa Randström from Siuntio wants wellbeing services counties to have low-threshold services to make seeking treatment as easy as possible. She would also like to see a more in-depth approach on the first visit: “I want to be able to discuss things a little deeper and with a more preventive approach, before being prescribed medication as the first solution,” Randström says. According to her, team work between experts, for example, as soon as the customer contacts the services would enable a more wide-ranging and versatile diagnosis to be carried out.  

According to Randström, local specialised medical treatment is excellent, but access to treatment itself is difficult. As a mother, Randström is concerned about what this means for teenagers and young adults: “It might be good to be able to talk to a psychiatrist nurse, for example, without a doctor’s referral.” Digital remote services will also make it possible to lower the threshold in the future. “At least as far as young people are concerned; they may not be as suitable for older people,” says Randström. 

Randström sees great potential in becoming part of the wellbeing services county e.g. from the perspective of staff, because experts who would earlier work alone in small municipalities will now become part of a larger team and receive expert support. On the other hand, as a member of a family living in a sparsely populated area, she hopes that the local services will not be taken too far away – this could impede timely access to services. “I hope that comprehensive services will remain in Siuntio as well, so that we would continue to get laboratory tests and treatment locally. This would prevent hours-long trips to neighbouring municipalities – or further away,” Randström says. 

Sonja Rönkkö, an Elderly Council member from Kirkkonummi, thinks that the senior health centre (seniorineuvola) model is the key to shifting focus to prevention in services for the elderly, and she has, as a matter of fact, proposed this during the planning for the local elderly strategy as a member of the Elderly Council. The senior health centre would be able to obtain information on the client’s overall mental and physical health at an early stage. “People over a certain age (from the age of 65 onwards) should receive systematic health check-ups, and these check-ups should be made statutory in the same way as for children – which is probably being worked on right now,” says Rönkkö. 

According to Rönkkö, there are shortcomings in municipal health and social services in terms of customer orientation, and she would like to see developments in this area as the wellbeing services county is established. The health centre callback system and long waiting times at emergency services, for example, are things that should be developed – just to get people to seek treatment in time, if not for any other reason.  

In home care, the current outsourcing of emergency telephone services is not necessarily a good way to serve customers: “A friend of mine from Raseborg pressed this emergency button, and the person at the other end did not speak Swedish, and this elderly person did not speak Finnish,” Rönkkö tells us. A person’s condition can deteriorate quickly and require a longer treatment period if treatment is not available in time. 

The things that Rönkkö would definitely keep as the move to the wellbeing services county is made are high-quality care – once you actually receive it – and excellent ambulance/emergency care. For these, she would like to thank the professionals in the region.  

The national objective is to move from heavy services to preventative and predictive work, which means shifting the focus of health care from specialised medical care to basic care and to early support and low-threshold services in social services. The aim is to address issues in time and reduce the need for heavy services, which will also curb the rise in costs over time.  

Western Uusimaa Wellbeing Services County is preparing for the safe joint transition of ten municipalities, and the preparation work must take a wide range of perspectives into account – those of customers, services and personnel, and cost issues naturally play an important role.  

The Service Area Director for Elderly Services Tuula Suominen sees the timeliness of the need for care as the key to health and social services: “Problems deteriorate if they are not detected at an early stage, allowing for addressing them – it creates bigger challenges in people's lives and diversifies the need for services,” Suominen says. 

Health and social services are the responsibility of municipalities until the turn of the year, and municipalities must also provide them until then. Coordination of activities and e.g. harmonisation of work tasks will take place in the preparatory project at both ends of the transition period.  

Several projects concerning the development of preventive and proactive work are under way in the preparation of the Western Uusimaa Wellbeing Services County. New operating model experiments are ongoing and the processes aim to take the finding for individual solutions into account. As an example, Suominen mentions the ‘Terapiat etulinjaan’ (therapy first) operating model, which is being implemented in the Western Uusimaa Wellbeing Services County. The operating model will improve access to basic mental health services and processes in cooperation with future wellbeing services counties and university hospitals. The model aims to ensure that customers have access to services as soon as possible, which can prevent the possible accumulation of future mental health challenges for young people, for example. 

In terms of services for elderly people, Suominen sees preventive work as a major pre-emptive activity that includes e.g. advice, service guidance, various day centre activities and rehabilitation. “Perhaps it is not possible to avoid heavy services, but we can postpone the need for them,” Suominen says. 

Important services for elderly people include nutrition advice and services. “Nutrition is recognised as a factor that often improves when a person moves into housing services, which in turn improves their functional capacity – this begs the question whether nutrition-related issues could be solved already at home.” In the Western Uusimaa region, for example, a nutrition pilot has been implemented to strengthen the nutritional skills of professionals by organising training in cooperation with the Finnish Food Safety Agency and providing advice on nutrition for informal care families, among other things.  

Regional cooperation plays a key role in developing service provision. Suominen sees great potential in the transition to the wellbeing services county in terms of the focus areas of the operations: “Cooperation with municipalities and other stakeholders is important on the whole – preventive action will require a great deal of other actors and interfaces,” Suominen says.  

The wellbeing services county will cooperate with other authorities and actors and, as services develop, many challenges will be solved – such as the timely organisation of services, which prevents the need to move on to heavy services. This means examining the entire service chain, also from the perspective of personnel – continuous training is needed in the sector. As the focus of operations shifts, it may be possible to allocate more work tasks and resources to preventative and predictive work. On the other hand, the availability of personnel is currently a challenge throughout the region, and prioritisation will probably have to be carried out even after the wellbeing services county is established. 

From the perspective of service provision, it is possible to develop activities in the wellbeing services county in a different way than in smaller or medium-sized municipalities. “A large wellbeing services county enables us to consider how to provide services in our own way, in a new way or with a new procurement model that could improve service quality,” Suominen says. She mentions medical services for the elderly as an example, which could in the future be provided using a uniform model for home and housing services. 

From the perspective of personnel, the transition provides many opportunities in terms of careers and new work tasks. Instances where good practices should be shared or old processes opened up and re-examined can already be found in the project groups of the preparation of the wellbeing services county. “Although we have worked together before, the municipal boundaries have been rather strict, and it has not even been possible to know how well things have been done in different places,” Suominen says. Developing services in cooperation with different actors increases competence and understanding as well as opportunities for different experiments and pilots in the wellbeing services county. 

“A great deal of this is about multi-professional coordination, cooperation and, indeed, finding effective means.” 

For further information, please contact Tuula Suominen, Service Area Director for Elderly Services in the Western Uusimaa Wellbeing Services County, tuula.suominen@luvn.fi  

  

Read the first part of the article series: Improving the equality, accessibility, timeliness and continuity of services