Objectives of the Future Health and Social Services Centres programme 4/5: Ensuring the multidisciplinarity and interoperability of services

The Future Health and Social Services Centres programme develops both basic social services and health services. The availability of services will be improved, and the services will be coordinated to meet people’s needs. The programme aims at reforming the operating methods of healthcare and social welfare and developing people-oriented service packages. Cooperation between healthcare and social welfare professionals will be strengthened, so that the client's situation can be assessed as a whole, and they will receive the necessary assistance or support with a single contact. The programme has five objectives: 

1. Improving equal access, timeliness, and continuity of services 
2. Shifting the focus of activities from heavy services to preventive and proactive work 
3. Improving the quality and effectiveness of services 
4. Ensuring the multidisciplinarity and interoperability of services 
5. Curbing cost increases 

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

The Government Programme emphasises the coordination of services, as well as the smooth flow of care pathways and service chains. Basic and special level services of social services and health care will be coordinated, and seamless cooperation between various professional groups will be ensured. From the residents' point of view, the issue is very much related to preventive and multidisciplinary service provision, which, if successful, streamlines access to care and safeguards the continuity of care. 

Jenna Meri, a student living in Kauniainen, is an expert by experience when talking about the interoperability of multidisciplinary services. Like many other young people, she has used school health care services and regularly visited meetings with a school social worker. In these meetings, however, the need for specialised medical care was not reflected to the professional, to prevent the situation from getting worse. "It felt like they (the social worker) were not able to really take my case forward even though the situation was serious," Meri recalls her experiences from a couple of years ago. 

In addition, the coordination of services between the school and specialised medical care has not been entirely smooth: "Important information, which the school should also know about, has not  reached to school. This makes things difficult, as I am then forced to explain the situation myself," Meri says. 

In specialised medical care, Meri has been satisfied with the level of service and especially with the fact that the nurse has been the same person for a long time. This makes the use of the service smoother, because there is no need to repeat the same things in each meeting. Yet, doctors do change almost every time, due to which one needs to start the conversation all the way from the beginning with the new person. "I have had a number of doctors and whenever I have to tell them the same things, it feels a bit heavy," Meri says. 

Johanna Jäppinen, living in Veikkola in Kirkkonummi, has been very satisfied with the interoperability of local health care and social services. As the mother of three children under the age of 10, the child health clinic services have become the most familiar, and through these services, her family has been provided with smooth assistance and a referral for further examinations or treatment.  

According to Jäppinen's experience, the staff of the child health clinic is extremely professional and also relies on the parent's feelings of the child's need for care and situation. "My youngest child has stuttered a little bit, and just last week I called the child health clinic about it: with one phone call we were guided to speech therapy," explains Jäppinen, as an example of quick everyday help.  

On the social services side, Jäppinen has experience of family work home services, which she has been particularly pleased with. “Family work home services visited us about once a week, for several years, and it is perhaps the best preventive service ever. Thanks to it, I have not gotten exhausted, even with many children", Jäppinen sums up. 

Hanna Koivisto, from Hanko, is very happy with the local child health clinic services, there is enough staff, and the services can be accessed almost immediately, if necessary. "You can send a text message directly to the public health nurse," Koivisto says. According to Koivisto's experience, a small municipality enables personal service and there seems to be enough time for discussion. Things were different in Helsinki, where Koivisto and his family lived before moving to Hanko.  

The Koivisto family, who has lived in Hanko only for a couple of years, has experienced the multidisciplinarity and interoperability of services through child health clinic services and school health care services. For example, cooperation between the daycare centre and the child health clinic is important in children's matters, and Koivisto has only good experiences of this.  

The sufficiency and stability of health and social services are a worry in Hanko, as services have been cut and it is challenging to find permanent staff in the area. Multidisciplinarity is difficult to implement if there is a lack of personnel. Koivisto has considered the matter from various perspectives: "Part of the problem may be housing or whether the spouse can find a suitable job," Koivisto says. In fact, the issue should be considered in the preparation of wellbeing services counties, when ensuring the human resources and multidisciplinary nature of the activities. 

Service Area Director for children, youth, and families, Mari Ahlström, describes the activities of her own service area as a highly multi-level combination of social and health care services. "At one end, the services include child health clinics, as well as school and student health care, which are purely health care, and at the other end there is child welfare, which is social welfare. And then there are different services in between, such as rehabilitation services, family and social work, family law services, and psychiatric services for children," Ahlström describes. 

Close cooperation between professionals is essential in ensuring the multidisciplinary nature and interoperability of services. Network-based cooperation with services remaining in municipalities is also significant, as early childhood education, schools and hobbies, for example, will continue to be a service provided by municipalities. 

The functional policies of the services for children, young people and families provide guidelines for the service area, in the transition phase of the wellbeing services county, as well as for future development.  

Functional policies include:  

• Smooth access to services and the continuity of the services in the event of change is ensured. 
• The services for children, young people and families together form a functional entity of the family centre, which is supported by a systemic approach to work. 
• The service for becoming a customer, as well as low-threshold guidance and counselling are developed, for example, through a well-functioning first-line service.  
• Cooperation between student welfare actors is strengthened.  
• The mental health of children and young people is supported by developing and implementing uniform service paths, strengthening the basic level. 
• Family law services are centralised and developed at regional level.  
• Existing services for child welfare clients are secured, and client guidance is gradually expanded to cover the entire area.   
• Child welfare reception services' own production is intensified to meet the demand of the entire wellbeing services county. The service structure of foster care is lightened by strengthening family care.   
• The structures and content of welfare and other interface work is developed in cooperation with municipalities.  
• The work of the personnel is supported by streamlined processes and business coaching is strengthened. 

The work is already well underway, but still a lot remains to be done. “We are still learning to become Western Uusimaa, and this is very human because the services we offer to our clients are often local. Therefore, it is natural to think about “our own town” and, in the transition, we do not want to break anything that functions well,” says Ahlström. The wellbeing services county also offers a lot of opportunities, for example, special services can be utilised throughout the region, even where they may have been difficult to obtain before.  

In social services, for instance, finding and training support and foster families in a large area provides flexibility. From the procurement perspective, operating in the wellbeing services county offers alternatives: at times, it makes sense to use local service providers, while sometimes combining larger entities brings clear financial benefits. 

"And then there are instances, where even a wellbeing services county of this size is not large enough. In this case, we cooperate with, for example, the wellbeing services counties of Uusimaa and Helsinki," Ahlström says.  

During various phases of the preparation process, the personnel has been wondering, what is the future position of individual persons in the new organisation, and whether the job descriptions will be modified. "The transition phase relies on the fact that local municipalities have considered the provision of services that meet their needs. Therefore, to ensure a safe transition, it would not be wise to make changes, at this point in time. Possible changes will be considered more carefully in the following year,” says Ahlström. 

In the transition to the wellbeing services county, it is important to develop network-based cooperation between the personnel, across municipal and professional boundaries. Services for children, young people and families together form a so-called family centre, where the services are adapted to the client's needs. The Family Centre operating model enables cooperation between various actors, whether it is a shared physical location or a network-based working method. When another professional's possibilities of helping a shared client are known, it is easy to adapt one’s own activities for the benefit of the family. The aid will then be targeted correctly.   

The size of the Western Uusimaa region also enables a more extensive utilisation of resources. While it also offers opportunities, from the career perspective, for expanding one's own competence and work area. "Services will become services of the wellbeing services county, and no longer services of a municipality: the aim of this reform is to enable the utilisation of resources within the entire area. It is essential that clients receive the care and services they need,“ Ahlström says. 

Digital services are developing at a fast pace, and the Western Uusimaa Wellbeing Services County wants to keep up with this development. Digital services can serve a growing number of residents today, although, it must be remembered that digital and remote services are not suitable for everyone. Several ways of contacting a professional are necessary, for organising the services. The wellbeing services county enables joint development and procurement; thus each municipality or professional group does not have to weigh different alternatives on their own.  

Part of the success of the wellbeing services county is determined by, how we can target services to those who need them or benefit from them the most. This is where we must develop in knowledge management. In a large area, we are also able to try alternative ways of implementing services and compare successes. "With knowledge management, we may be able to see more clearly, which of our activities genuinely have an impact and adjust them accordingly," Ahlström says. 

The greatest challenge, in terms of preparation, has been the lack of time.  "There may be a small-scale drop in content development and services here, which we will quickly overcome. Perhaps, it will be emphasised right now, at this time," Ahlström says. The transition of the wellbeing services county involves an enormous amount of administrative work, in the construction of the entire organisation. This obviously will affect the content development work, especially as the people making the change are often the same, whose task is also to run the service production.  

The future wellbeing services county will be challenged by the national shortage of social and health care sector employees. There is no clear-cut answer to the question, how to build an attractive employer image. "As a rule, people entering the sector have chosen it because they want to do meaningful work. It is our job, as an organisation, to help them do their job as well as possible," Ahlström sums up.   

More information: Service Area Director for children, youth, and families at the Western Uusimaa Wellbeing Services County Mari Ahlström, mari.ahlstrom@luvn.fi