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

2. 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.

3. 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

4. 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

5. Central figures
Number of municipalities (cities, towns and municipalities) 342 on
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)

6. 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

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

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

9. Percentage of women in municipal councils

10. Examples of differences between municipalities
Average Smallest Largest
Population (total)
Population density inh./km2 17,4 0, ,0
Area (net of water areas) km (total) 6,
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

11. Number of municipalities by size of population
Inhabitants 7 17 31 45 66
134 48
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 )

12. Municipal employees in various branches
Employees in total

13. Finland’s regions and municipalities
19 regions and Åland
342 municipalities

14. 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.

15. 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.

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

17. 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.

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

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

20. Background Finland 5,3 million people
342 municipalities in 2010 (415 in 2008)
Population varies from 116 inhabitants to (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)

21. 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

22. 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

23. 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 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

24. 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

25. 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)

26. - Services for the Elderly - …. Basic Team
Regional Cooperation
( 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

27. 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 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.

28. 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.

29. 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
2005
Access to care
Treatment guarantee
2007
Restructuring
Restructuring of municipalities and services
2009
Partnership areas ( 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)

30. 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

31. 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

32. 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

33. Communication
The office has contact with the specialists of the Association and partners in Finland and in other countries
The office has contact via 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)

34. 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

35. 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

36. Thank you for listening!
Further information:
Ms Hannele Häkkinen
Director, Brussels Office
The Association of Finnish Local and Regional Authorities
Square de Meeûs 1
1000 Brussels, Belgium
Phone: