The study analyses what factors policy-makers, researchers and teachers find most influential for the development of the social welfare and health services in the Helsinki Metropolitan Area and what kind of developments these services are expected to and preferred to undergo by 2015.

The publication presents the multitude of changes that are influencing and expected to influence social and health services - their development and internal relationships. The publication partly applies the same structure as Balanced Scorecard, a classification used for grouping the strategic goals of organizations. 

The results of this study implicate that demand for public social services is growing faster than supply: social problems, mental health problems and intoxicant abuse among children will have increased by 2015, and the need for child protection accordingly. The health of the working population is deteriorated by problems relating to urbanized life styles, i.e. pressures for success, social and mental problems, and increased use of intoxicants. People with a lower income exercise less. The need for supporting service for the elderly grows with the growing number of elderly people. The link between age and ability to work is getting weaker. The period when elderly people are unable to cope gets shorter and shorter, which means the need for care for the elderly grows slower than the number of elderly people. Instead, alcohol-related dementia and mental problems among the elderly will become more common. Due to increasing chronic diseases, the need for special nursing increases. Developments in technology, medicine and services create new demand for expert services requiring evidence, medical care based on belief, and therapies that improve your looks. Clients demand better quality than today in social and health services. Those who have a good income do not feel they get service from the public health care.

This study on the future of social welfare and health services in the Helsinki Metropolitan Area is part of Metropoliluotain ("the Metropolis Sounder "), a project conducted by the Stadia Helsinki Polyctechnic and receiving economic support from the European Social Fund. The project has also included an expert group that has convened three times for scenario workshops, whose findings will be published separately at a later stage.

The population studied were 56 people representing the social welfare and health authorities and various firms and associations in the social and health sector in the Helsinki Metropolitan Area, i.e. the cities of Helsinki, Espoo and Vantaa. These people were first interviewed, and drawing on their responses, which were classified and compressed, three structured questionnaires were made that they, eventually, answered over the Internet. Response rates were 34 % with the first structured questionnaire, 76 % with the second and 70 % with the third.

Economic support from the European Social Fund

In future the provision of social and health services is steered by demand, but with developments in the information technology the assessment of needs is becoming more planned. Services are becoming more individual and varied, and clients are more clearly than today divided between the private and the public sector. More active responsibility for one's own health is required from those who go to work. Unemployed people under 30 have to accept whatever work they are offered by the authorities, and early interventions in alcohol and drug abuse are becoming more common at public health stations. New care models based on health sciences are introduced in basic health care. When elderly people fall ill, therapies based on technology-assisted intervention are applied, and the elderly are increasingly given rehabilitation therapy instead of conventional nursing. Polypharmacy among the elderly decreases. Old people suffering from serious dementia are not kept alive through intravenous nourishment.

The public sector remains the main service producer, but it applies a multi-producer strategy. The private sector provides services to those clients and patients that have the means for it, and the third sector to special groups that would not otherwise get any service because the service is new or there is no evidence of its effects. The private professional health sector helps those who go to work while those outside the workforce receive health care at the public health stations. Private care for the elderly increases, and so do third sector volunteering and care of relatives. Bigger and bigger units of the public sector put their services to tender in the Helsinki Met. Companies merge to upgrade their own functions. The public sector is responsible for safeguarding cooperation within social and health services. Cooperation with the private sector develops along with increasing experience and mutual confidence. Public indemnities for health costs will require more evidence of the effects of the therapy. Within social welfare services, indemnities will require both scientific evidence and political consensus. To reduce risks and investments caused by staff, municipalities produce only the basic services themselves, putting services that require special skills to tender. Spreading the service producers over several sectors implies a growing need for coordination, and the tendering of services increases the need for rules and creates a demand for skills in tendering. The need for raised efficiency and a growing element of entrepreneurship imply a growing need for entrepreneurial skills among staff.

Resource allocation for public social and health care will not increase proportionally compared with today. Tax revenue will remain the foremost resource, but client fees will increasingly be imposed depending on the means of the client. In the care of the elderly, the means of the client will influence the fee for all-day long term care. Private health insurances are becoming more common. The public sector improves its productivity and saves by upgrading its service processes, applying new models for service production and increase the use of information technology, whereby overlapping is reduced. The responsibility for priorities within health care is increasingly shifted over from health care professionals to politicians. The competition for staff between companies and the public sector grows. The care sector receives a growing element of untrained employees, immigrants and workers changing fields. The salaries of staff do not rise faster than salaries in general, but differences in salary between basic and special health care grow. The average retirement age within the social and health sectors rises only slightly.

The skills that staff in the social welfare and health care sector in the Helsinki Metropolitan Area are expected to need are going to be dictated by the changes we just saw and by growing cooperation in multi-professional teams, a need to coordinate services, the increasing use of the consumer-producer model, increasing entrepreneurship and a need for cultural skills. In health care, some tasks are moved downwards in the hierarchy. Besides special professional skills, employees will need increasing skills and knowledge about the social welfare and health care system - and skills in networking. Professional leaders are increasingly entering the scene in the health care sector.

Stadia Helsinki Polytechnic
Finland
Mr. Juha Nyman (Researcher), tel. +358 50 341 6284

18/05/2006

Juha Nyman

research

Urban Policy > Social inclusion & integration > Quality of life

Health, Social services