Health, social services and regional government reform should be reconsidered

The six largest cities of Finland – Helsinki, Espoo, Tampere, Vantaa, Oulu and Turku – propose in a joint statement that the national reform of social services, health care and regional government should be reconsidered by Finnish Parliament. This reform is under discussion in Parliament, and parts of it are still under preparation - reports City of Helsinki.

According to the statement, the large cities have been bypassed in the fragmentary preparation process, and the Finnish Government’s approach to the reform is narrow and schematic.

The statement was signed by the Mayors of Helsinki, Espoo, Tampere, Vantaa, Oulu and Turku.

Mayors’ statement

The relative importance of large cities and the surrounding urban regions has grown and will grow further as a result of urbanization. The populations of the six largest cities of Finland are larger than those of the majority of the current regions. The ongoing preparation for health, social services and regional government reform fails to assess the impacts of the reform on cities and city residents and thereby on the national competitiveness of Finland and the wellbeing of all Finns.

Legislation for the vast reform of social services, health care and regional government is currently under consideration by Parliament, but parts of it are still under preparation. Large cities have been bypassed in this fragmentary legislative process, and the legislation is becoming such an entity that is difficult to manage even by experts. The separation of actors who organize services from those who produce services as well as the multiple-provider model are about to result in a confusing outcome.

The six largest cities consider that the key to the reform of social services and health care is a successful outcome. This reform as it stands is such a large structural reorganization that its implementation must not be endangered by simultaneous changes related to other sectors. Instead, even the reform of social services and health care must be divided into realistic stages of execution over a sufficiently long transition period. The preparation of the execution of the reform must utilize the competences and experts of the municipal sector.

The principle of freedom of choice proposed by the Government has been justifiably criticized, and this principle should be reconsidered. On the basis of the Government proposals for legislation, it is not possible to draw a conclusion on how the Government’s goal to curb growth in expenses by three billion euros could be achieved. Instead, the costs of social services and health care are expected to grow in the short term. The legislative proposals fail to address the necessary adjustment of support services, which would be carried out by municipalities. Neither do the proposals address how the massive transfers of social-service and health-care personnel would be carried out reasonably and without endangering basic operations.

The cities consider that regional government based on self-government is justified only in terms of the reform of social services and health care. The legislative reform must secure possibilities for large cities to carry out other regional tasks proposed for municipal cooperation. When employment and economic development services, that is, so-called growth services, are reformed, it must be taken special care to avoid creation of overlapping, competing structures. The objective should be to create one actor responsible for organizing the services who is close to customers. It is justifiable to assign the responsibility for versatile employment services, integration of immigrants and customer-centered cooperation with enterprises to large cities and to municipal cooperation, which already now handle these tasks to a large extent.

Overall, the Government’s approach to the reform is narrow and, based solely on market-based operation, all too schematic. The planned transfers of authority to regions and dramatic narrowing of municipalities’ tax revenue base undermine the efforts by large cities to improve their competitiveness based on their strengths, as well as undermining the cities’ efforts to boost dynamism and to develop investments. A mechanic transfer of the current regional planning activities to new regions is not possible, as it would break municipal monopoly in planning. The strong roles of cities and urban regions in the steering of land use and transport and traffic planning must be secured.

Read other news on the city site of Helsinki.

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