Municipalities in Finland Ms Hannele Häkkinen Director, Brussels Office Estonian Delegation 2.6.2010

Association of Finnish Local and Regional authorities: Competence to support change The way services are provided by municipalities will undergo radical changes over the next few years. The service needs of residents will also change. The Association of Finnish Local and Regional Authorities and its companies support municipalities in their efforts to bring about the change. The objective is a viable municipality that will ensure the wellbeing of its residents and their opportunities for participation also in the future. All municipalities are members of the Association by their own will. 2.6.2010

Short-term challenges for the Association’s operations Balance between local government functions and internal financing Basic services programme and budget Revision of the financing and central government transfer systems Secure the bases of tax revenues Functional local government and service structure Functional local government structure Effective service structure productivity, effectiveness, availability methods of provision and financing service strategies, information technology competitive tendering Functional democracy, opportunities for residents to exert influence, and management 2.6.2010

Suomen Kuntaliitto Group, FCG Ltd Association of Finnish Local and Regional Authorities and its affiliated companies in 2009 Association of Finnish Local and Regional Authorities Gustavelund Ltd Hotel and restaurant business Audiator Ltd auditing firm Suomen Kuntaliitto Finnish Consulting Group, FCG Ltd 58 % Association-owned (other owners: universities, central government, private comp) Consulting in: physical planning and the environment municipal infrastructure and administration training for local authorities share of international business 40 % turnover over 70 million €, personnel over 600 KL-Publications Ltd Publications e.g. Associations periodical and municipal trade fair KL-Hallintopalvelut Ltd Property investments 2.6.2010

Central figures Number of municipalities (cities, towns and municipalities) 342 on 1.1.2010 Number of joint municipalities now over 200, diminishing due to new models of co-operation and mergers of municipalities Total expenditure 36,5 billion € Municipalities share of public expenditure almost 2/3 Number of employees in municipal sector 424,000 (17% of all employees in Finland) 2.6.2010

Municipal revenue and expenditure* Expenditure (total 36,5 billion €): welfare and health care 52% education 25% infrastructure 19% financing and other exp 5% Revenues: tax income 52% of which income tax (varies 16,0–21,0%) 41% corporate tax, municipal share 4% property tax 2% Charges and fees 27% State subsidies 19% Other (loans and other) 7% * includes both municipalities and joint municipalities 2.6.2010

Municipal organisation COUNCIL Auditors MUNICIPAL EXECUTIVE BOARD MUNICIPAL COMMITTEES Main tasks: Education and culture Social welfare and health care Environment and technical infrastructure 2.6.2010

Municipal elections, 2008 Percentage of votes received by each party Election turnout 61,3 % 2.6.2010

Percentage of women in municipal councils 2.6.2010

Examples of differences between municipalities Average Smallest Largest Population 31.12.2007 5 300 484 (total) 116 568 531 Population density inh./km2 17,4 0,2 3 051,0 Area (net of water areas) km2 303 901 (total) 6,0 15 052 Economic structure Agriculture and forestry % 3,9 0,1 33,2 Manufacturing % 25,1 5,1 48,0 Services % 70,1 38,0 86,3 Age structure 0–14 year-olds % 16,9 9,6 34,6 15–64 year-olds % 66,6 54,2 72,1 65 and over % 16,5 7,4 35,6 Local tax rate 2009, % of taxable income 18,60 16,50 21,00 2.6.2010

Number of municipalities by size of population Inhabitants 7 17 31 45 66 134 48 100 000 and over 40 000–99 999 20 000–39 999 10 000–19 999 6 000–9 999 2 001–5 999 < 2 000 (Population 31.12.2007) 2.6.2010

Municipal employees in various branches Employees in total 424 000 2.6.2010

Finland’s regions and municipalities 19 regions and Åland 342 municipalities 2.6.2010

Suomessa on pitkät välimatkat, maa on pisimmillään 1420 kilometriä pitkä. Ei ole harvinaista, että lääkäripalveluja saadakseen joutuu matkustamaan 70 – 100 kilometriä. Pohjoisessa, Lapissa, matka päivystävälle lääkärille voi olla jopa 230 kilometriä. Suomalainen väestö vanhenee. Se on Euroopan nopeimmin vanheneva yhteiskunta. Maailmassa Japani vanhenee Suomeakin nopeammin. 2.6.2010

People over 65 years Yli 65-vuotaiden määrä nousee. Ihmiset elävät pidempään, onneksi myös hyväkuntoisina. Mutta koska palvelujen tarve kasvaa 80 ikävuoden jälkeen, aiheuttaa tämä vanhusten määrän lisäys paineita terveyspalvelujen saatavuudelle. 2.6.2010

Elatussuhde Huoltosuhde eri maissa, työttömien ja työvoiman ulkopuolella olevien määrä jaetaan työllisten määrällä. Suomi on selkeästi EU:n keskiarvon yläpuolella. 2.6.2010

Maan sisäinen muuttoliike on voimakasta Maan sisäinen muuttoliike on voimakasta. Kansalaiset muuttavat työn perässä maaseudulta kaupunkikeskuksiin. Maaseudun palvelujen tuottaminen vaikeutuu, koska kunnissa on yhä vähemmän asukkaita ja näin ollen myös työntekijöitä. 2.6.2010

Population Density in Europe (person/ km ² ) Population in Finland 5,3 million Density 15/km 2.6.2010

Työikäisten määrä vähenee Työikäisten määrä vähenee. Kuten muissakin Euroopan maissa Suomessa tarvitaan lisää työvoimaa. Meillä on työperäinen maahanmuuttopolitiikka, mutta taistelemme muiden maiden kanssa työvoimasta. 2.6.2010

Background Finland 5,3 million people 342 municipalities in 2010 (415 in 2008) Population varies from 116 inhabitants to 560 000 (Helsinki) Decision-making power lies within the municipal council Elected in every four years by general elections Appoints executive board and different committees (social and health committee, basic services committee etc.) Municipalities have the right to levy tax (income tax and real estate tax) 2.6.2010

Responsibility for basic welfare services The municipalities are responsible authorities for arranging of basic welfare services The way these services are arranged is decided by the municipality: it can produce services self have joint service provision with neighbouring municipalities buy services from other municipalities, joint councils or private service providers (Local Government Act 1995) use service voucher 2.6.2010

Reform to restructuring of municipalities and services 2005-2012 Objectives of the Reform A sound structural and financial basis for the services that municipalities are currently responsible for In order to secure the organisation and provision of such services in the future With due regards to the required standard of quality, effectiveness, availability, efficiency, and technological advancement Municipalities themselves lead the process of change within the limits of the framework legislation 2.6.2010

Reform to restructuring of municipalities and services Social welfare and health services play a key role in the modernisation of the entire services structure Results Primary health care and social services 260 municipalities plan to achieve the 20 000 population base by establishing a partnership area (responsible for primary health care and social services) > 66 partnership areas 20 would administratively be joint municipal boards, and 35 have chosen “host-municipality-model” (joint municipal organ) > 36 of the areas function already, others will start in 2010-2013 2.6.2010

Reform to restructuring of municipalities and services Results Integration of social and health care 25 municipalities plan to give all primary health care and social services to the partnership areas 90 plan to give all other above mentioned services excluding children day care Rather many (67 municipalities) plan to give only some separate services, 10 none of these services and 68 haven’t made decisions 2.6.2010

Levels of Structural Reform State Strategy and Guidelines (legislation, municipalities policies, financing, restructuring state administration) Managing the change within Municipalities (strategy, management, expertise, resources, evaluations) Administrative Structures (basic municipality, service districts, regional municipalities) Service Production (companies, enterprises, Inter-communal cooperation, purchasing) Service processes (expertise and know-how, technologies, productivity) 2.6.2010

- Services for the Elderly - …. Basic Team Regional Cooperation (20 - 30 000 population) Private Producers and Third Sector (NGOs) - Occupational Health - Services for the Elderly - …. Basic Team Basic Team Population Responsibility - Basic Services Basic Team Regional Cooperation Basic Team Basic Team Services with special expertise as regional services - digital Imaging - Specialists - Special services - Psychiatrics - …… - Qualitative and Cost effective Services Regional Cooperation Cooperation in Hospital District - Electronic Patient Record - Laboratory - Imaging - Emergency Services (Telemedicine, call centre) - Medicine - Specialized Health Services Source: Talja 2003 2.6.2010

Solutions in Finland Reform to restructure municipalities and services Long-distance consultations, TeleHealth Joint emergency services Labour division between medical doctor and nurse, between dentist and dental assistant Mobile services (medical doctor, specialists, rehabilitation) Call Centres Health Promotion / Prevention Mitä ratkaisuja Suomessa on tehty? Kunta- ja palvelurakenneuudistus Terveyspalvelut tulee järjestää 20 000 henkilön väestöpohjalle. Tavoitteena on turvata peruspalvelut väestölle. Isommissa yksiköissä pystytään tukemaan toisia työntekijöitä, erikoistumaan ja paikkaamaan jonkun sairastumista. Kunnat ovat tehneet vapaaehtoisia kuntaliitoksia tai järjestäneet yhteistoiminta-alueita. Etäkonsultaatiot, tietotekniikka - esim. videon välityksellä. Muut sähköisen terveydenhuollon ratkaisut: internetin käyttö terveysinformaation saamiseksi. Kotihoidossa television käyttö yhteydenpitona. Erilaiset turvajärjestelyt: hälytysnapit, joilla yhteys kotihoitoon tai omaisille. Yhteiset päivystysjärjestelyt Kunnat järjestävät ilta-, yö- ja viikonloppupäivystyksen yhdessä. Matkat päivystyksiin voivat olla pitkät, mutta näin saadaan palvelut turvattua ympäri maata. Työnjako Työnjako lääkäreiden ja hoitajien välillä sekä hammaslääkäreiden ja hammashuoltajien välillä takaa sen, että potilas pääsee nopeammin hoitoon. Työnjakomalleja on useita, mutta toimivin näyttää olevan vaihtoehto, jossa lääkäri ja hoitaja toimivat työparina, he hoitavat tietyn alueen kuntalaisia pitämällä molemmat omaa vastaanottoa ja takaamalla hoidon jatkuvuuden. Joissakin terveyskeskuksissa hoitajat pitävät omaa vastaanottoa ja konsultoivat tarvittaessa lääkäriä sähköpostin tai kännykän välityksellä. Mobiilit/ liikkuvat palvelut Palvelut tuodaan asiakkaan luokse esim. kerran viikossa. Linja-auto tuo palvelut eli lääkärin tai hoitajan konsultoimaan, kuntoutuspalvelut ym. Kimppataksit kyläperukoilta keskustaan kulkevat kerran viikossa. Puhelinpalvelu Suomeen on järjestetty puhelinpalvelua eri toimipaikkoihin, joissa sairaanhoitajat vastaavat soittajien kysymyksiin. Näin voidaan vähentää vastaanotolle tulevien määrää. Ennalteehkäisy / terveyden edistäminen Väestön liikunnan ja ravitsemuksen parantaminen, ehkäisevät kotikäynnit vanhuksille, Terveys 2015, itsehoitopisteet (asiakkaat mittaavat itse verenpaineensa) kauppakeskusten yhteyteen. Terveyden edistämisen politiikkaohjelma tähtää myös kansan terveyserojen kaventamiseen. 2.6.2010

Further Challenges in Finland Availability of professional labour force More input in primary health care Haasteita riittää: Ammattitaitoisen työvoiman saanti nyt on jo pula terveyskeskuslääkäreistä, n. 10 prosenttia viroista on täyttämättä. kunnat ulkoistavat toimintojaan, yksityiset työvoiman vuokrausfirmat tarjoavat enenevästi palvelujaan. Valitettavasti lääkärit siirtyvät yksityiselle palveluntuottajalle, koska tämä tarjoaa joustavammat työehdot. Suomessa on pula myös sairaanhoitajista, varsinkin syrjäisemmät alueet ja pääkaupunkiseutu tarvitsisivat lisää ammattitaitoista työvoimaa. Perusterveydenhuollon kehittäminen on tärkeää, koska se takaa palvelut kansalaisille. Perusterveydenhuolto on edullisempaa kuin sairaalahoito. On tärkeää myös kannustaa ihmisiä ottamaan vastuuta omasta terveydestään. Terveydenhuollon lainsäädännön uudistaminen eli perusterveydenhuollon ja erikoissairaanhoidon saaminen tiiviimmin yhteen on käynnissä. Lakityöryhmä istuu, mutta lain sisällöstä ei vielä ole selvyyttä. Sosiaali- ja terveydenhuollon kehittämisohjelma - Sähköinen potilaskertomus, sähköiset reseptit, palveluketjujen jatkuvuus ja terveyden edistäminen ovat jo käytössä. Tärkeää on kehittää perusterveydenhuoltoa. 2.6.2010

Summary: Health care reforms Year Focus Reforms 1972 Structure Primary Health Care Act: Implementation of health care centres 1979 Occupational Health Care Act: prevention 1984 Joint planning for social and health care services 1993 Reform of state subsidies: Local Planning Specialized Health Care Act Act on the status und rights of the patients 2002 Structure, Financing Health care reform project 2002-2007 2005 Access to care Treatment guarantee 2007 Restructuring Restructuring of municipalities and services 2009 Partnership areas (20 000 base population) 2010 Reforming the laws of primary and secondary health care into one law New proposal expected for structuring the primary and secondary health care (more concentration) 2.6.2010

Brussels Office of the Association of Finnish Local and Regional Authorities since 1992 The Brussels Office of the Association of Finnish Local and Regional Authorities is a centre for lobbying towards the European Union for the Association and the Finnish local and regional authorities In March 2007 the office moved to the House of Municipalities, Cities and Regions in Brussels In the fourth floor there are 8 national offices: Denmark, Estonia, Finland, Iceland, Latvia, Norway, Scotland and Sweden In the house there are about 30 offices of national associations and of cities, and CEMR (Council of European Municipalities and Regions) and EUROCITIES 2.6.2010

Brussels Office It acts as a channel of communication towards the EU institutions and other partners and stakeholders in Brussels The office maintains contacts with EU institutions, Finnish opinion leaders and representatives of other countries It builds co-operational relationships and participates to the work of different networks relevant to the local and regional level It keeps the association, Finnish Municipalities and other stakeholders posted on initiatives of EU institutions and the drafting of regulatory acts and makes Finnish regional and local government known to the EU 2.6.2010

Brussels Office The office arranges training, meetings, and visits in the premises of the House The office also serves as a base for the members and experts of the Finnish delegation of the Committee of the Regions 2.6.2010

Communication The office has contact with the specialists of the Association and partners in Finland and in other countries The office has contact via e-mail and phone, meetings and conferences in Brussels are important for the dialogue and exchange of views with other European actors The office has visiting groups from Finland and other countries EU-newsletter (in Finnish) 2.6.2010

Networking In Brussels, there are about 300 offices which represent local and regional administration Different networks are precondition to have your voice heard The office has a close cooperation with other European sister organisations offices in Brussels and with CEMR (Council of European Municipalities and Regions) In networks it is possible to change information and experiences and work together for common opinions 2.6.2010

Influencing Influencing through the Association of Finnish Local and Regional Authorities in Finland and in Brussels the networks: shared interests, common opinions the Committee of the Regions: the Association holds the technical secretary for the Finnish delegation The office has contacts with officials and politicians in EU and with experts of the Finnish permanent representation to EU The office works in different networks and mediates through them the views of Finnish regional and local government The office is a link between Helsinki and networks in Brussels 2.6.2010

Thank you for listening! Further information: hannele.hakkinen@aflra.fi Ms Hannele Häkkinen Director, Brussels Office The Association of Finnish Local and Regional Authorities Square de Meeûs 1 1000 Brussels, Belgium Phone: +32 478 338 322 2.6.2010