Alpo Jokelainen1 Kainuu Region and Its Self- Government Experiment Congress of local and regional authorities, Helsinki

Alpo Jokelainen2 Population of the municipalities of Kainuu 2009 total Turku Helsinki Tampere

Alpo Jokelainen3 Kainuu population projections (Statistics)

Alpo Jokelainen4 The law of Kainuu governance experiment Regional functions (§ 4):  Region planning  Regional development  Healthcare  Social services (except for children´s day-care)  Secondary education = upper secondary schools and vocational schools  General economic development  Cooperation with other regional developers  Supervision of the region´s interests  Control of state budget funds for Kainuu  Law + municipal decisions

Alpo Jokelainen5 A centralised arrangement of basic public services enables securing the service quality, availability and economy in Kainuu in the long term, despite the threatening population forecasts. At the same time, the citizens living in the eight Kainuu municipalities will have equal opportunity to receive basic public services. The purpose of the experiment

Alpo Jokelainen6 The Joint Authority of Kainuu Region ( in parentheses is the numbers of employees in 2008, total 3785) REGIONAL COUNCIL Inspection board REGIONAL BOARD Executive director Executive director Steering Committee Planning and Development Division (25) Social and HealthcareBoardEducationboard Healthcare Division (2885)EducationalDivision(642) General services (233) Board of Kainuu VocationalInstitute, a municipal enterprise Board of KainuuOccupationalHealtcareenterpriseIndividualCareDivision

Alpo Jokelainen7 Regional Board I - Chairman is executive director Alpo Jokelainen - The regional council appoints for term - 10 other member / municipal law - Vaala`s representative in matters relating to the provincial union tasks - decides internal tasks of the Joint Authority of Kainuu Region Regional Board II (16 members) - Regional Board I and leaders of local state authorities - decides of the use of development funds => state authorities, “operating budgets” Regional Board III ( 34 members + about15 other participants) - MYR assembly (go-operation group) - Regional strategic plan, programme and operational programme, decisions of projects over € Regional Board

Alpo Jokelainen8 Municipal contributions to the Joint Authority of Kainuu Region is defined as a percentage of deferred tax. Deferred tax funding includes revenues (local taxes (19.25%), community taxes and property taxes (2009)) general funding of social and health from the state, additional funding based of sparsely populated area, tax revenue based on the alignment of the state tax and compensations. Education state grants are paid for the education provider. Municipal financing for the Joint Authority of Kainuu Region is determined as follows:

Alpo Jokelainen9 Kainuu finances (2009) Total expenditure 315 meur Social and health care 237 meur ( 75 %) Education 48 meur ( 15 %) Administaration, development and services 22 meur ( 7 %) Financial expenditure and investments 8 meur ( 3 %) Total income 315 meur Municipal payment222 meur ( 70 %) Customer and patient charges 38 meur ( 12 %) State subsidies and sales revenues 52 meur ( 17 %) Operating revenues from other services 3 meur ( 1 %)

Alpo Jokelainen10 Growth rate of expenditures, % / year

Alpo Jokelainen11 Annual margins and depreciation € / resident

Alpo Jokelainen12 KAINUU DEVELOPEMENT FUND, V TOTAL € mill. / DIVISION AND UTILIZATIONS

Alpo Jokelainen13 Environmental Health SOCIAL- AND HEALTH DIRECTOR Health and disease management services Family services Senior ziticens services Families with children. social services Families with children health services Adult social services Disability Services Senior Citizens Service Region I (Kajaani Region) Senior Citizens Service Region II (Sotkamo, Kuhmo) Senior Citizens Service Region III (Ylä-Kainuu) Shared Services Health Monitoring Veterinary services Enviromental´s Healtcare laboratory Adult mental health Services and addiction treatment Reception and Health Centre, Action Dental healthcare services Operational treatment Conservative treatment Emergency room Services Laboratory and pathology Radiology Pharmaceutical Service Equipment Service Paramedic; Anesthesia and intensive care Manage- ment, Delelope- ment and Planning Management support Medical services Kainuu Health SOCIAL AND HEALTHCARE BOARD EXECUTIVE BOARD full-time in addition of own work the specialty of corresponding Division Level: appropriate higher education sector and experience in management. ORGANIZATION OF SOSIAL AND HEALTH DIVISION

Alpo Jokelainen14 ORGANIZATION OF EDUCATION DIVISION BOARD OF EDUCATION EDUCATION DIVISION DIRECTOR VOCATIONAL EDUCATION VOCATIONAL EDUCATION UPPER SECONDARY SCHOOL EDUCATION SCHOOL EDUCATION Vocational education services Welfare sector Culture (Director of Education Business and industry Natural Resources Tourism and Catering Technology and Transport Sector Kuusamo unit / Tourism KAO = Kainuu Vocational College Units: Units: Kajaani High School Kuhmo High School Kajaani High School Kuhmo High School Sotkamo High School Filiaal High School Hyrynsalmi High School Paltamo High School Puolanka High School Suomussalmi High School Sotkamo High School Filiaal High School Hyrynsalmi High School Paltamo High School Puolanka High School Suomussalmi High School

Alpo Jokelainen15 REGIONAL BOARD GENERAL SERVICES Payroll Well-being and collaboration Personnel-Service and service and serviceRelationship matters matters SalesActivities Accounting Centralwarehouse TheprocurementofficeBuildingsystems Engineering NutritionServices Administrative Services IT -services Material Services Financial Services Personnel Services Transportation Services Nutrition Services Technical Services Generalservices Economic- and debtCounseling services services Archive- and data dataProtectionservices ORGANIZATION OF GENERAL SERVICES

Alpo Jokelainen16  Regional decision-making works fine Enlargement of collaboration, productivity increase by 20% Payroll ”Accountancy services” IT -service  Clear synergies Health services and care for the elderly: a single administrative No overlapping Treatment processes are designed, functional Elderly housing and residential care are in the same unit Municipality billing is fixed in advance => predictable Homecare has been increased  Social welfare Improved legal status of customers Better quality due to expertize of personnel Harmonized actions in Field work Experiences 1

Alpo Jokelainen17 Combining of small high school administration and teaching adiministrative costs; nearly half off municipality costs – 50% wider choice for students Vocational and secondary education for synergies Student welfare services Finance Student services Harmonized operational practices, (quality management system) IT-systems Sharing of facilities and equipment Adult education co-operation Joint development projects Experiences 2

Alpo Jokelainen18 Experiences 3 - Municipalities finances have been strengthened in 4 years more than EUR - State provincial operations management capabilities is fierce - The service changes are justified and there is no return to old system - Support services (catering, cleaning, techical services) need for the gathering = productivity, increasing possibilities for better productivity - By strengthening of small municipality economy, the current structure of the municipalities has been able to maintain

Alpo Jokelainen19 Summary of social and health services 1 Focus on health promotion Investment in research and development to ensure all time improvement Success criteria Deep integration and cohesion Financing modell Own research and development increased Staff commitment

Alpo Jokelainen20 Preventive work and the developement of services has been possible In the last year people have got services more than in the past People has been little dissatisfied because it has been necessary to limit doctor´s action desk because of the lack of doctors There has also been difficulties in access to dental care Initial assessment of the need for care is well realized Customer feedback is good, imago is not Summary of social and health services 2

Alpo Jokelainen21 How long is the waiting time for doctor´s in non-hazardious cases? (average) Kainuu: Less than 2 weeks

Alpo Jokelainen22 Standardized expenditures of social-, health- and elderly care in Finland / Year 2008 (€/people, index=100)

Alpo Jokelainen23 We have succeeded in: expenditure growth has been restrained availability of services in Kainuu is secured citizen equality has been improved Kainuu model transferability and innovations : social care, basic and specialized health care are combinated no overlapping (laboratory, logistics and maintenance of equipment) unbroken service chain, specialist consultations economy and funding is fixed in advance, no single action invoicing for municipalities reducing exces plant locations ensuring excellence = acute hospital only there, where experts is => dissatisfaction with the smaller municipalities Summary of social and health services 3

Alpo Jokelainen24 Contacts: Alpo Jokelainen Region Mayor, Chairman of the Board Puh ,