The Malmi social and health care centre in Pietarsaari on 18 June 2023. According to STT, 13 of Finland’s well-being services counties have launched or are planning to launch consultative negotiations to reduce costs and meet the financial requirements imposed by the central administration. (Timo Jaakonaho – Lehtikuva)


A BIT OF A REBELLION against the spending cuts the government has forced on well-being services counties is brewing in Vantaa and Kerava.

Timo Aronkytö, the director of the well-being services county of Vantaa and Kerava, told Helsingin Sanomat on Monday that the county intends to devise a budget with a deficit of tens of millions of euros for next year.

Its budget for this year shows a deficit of 62 million euros.

Decision-makers in the county are scheduled discuss a reform programme later this autumn that is expected to reduce the deficit slightly. Aronkytö underscored to the newspaper, though, that the programme is not a series of spending cuts but a genuine development programme the effects of which will not be evident until years from now – too late for the budgetary targets imposed on the well-being counties.

The Finnish government has declared that the counties should eradicate their budget deficits by the end of 2026. Calculations by the Ministry of Finance indicate that the counties will have a combined deficit of 1.2 billion euros in 2023.

“There’s nothing to discontinue. You can’t cut something that’s already lean,” retorted Aronkytö. “For instance, we only have nine health care centres, three facilities with inpatient wards and too little nursing capacity for the elderly.”

Pirkanmaa, the largest well-being services county in Finland, announced recently that it will reduce its headcount by 500 person years to create cost savings. STT has reported that 13 of the 21 well-being services counties have launched or are planning to launch consultative negotiations in pursuit of cost savings.

Established in 2021 to take over the responsibility for organising social and health care services from municipalities, joint municipal authorities and hospital districts, the well-being services counties are all in economic trouble, Helsingin Sanomat reminded on Friday. Several county directors told the newspaper that they are helplessly underfunded, possibly facing a ministry assessment of their ability to perform their statutory duties.

Such an assessment inevitably involves a probe of the merits of consolidations.

The notion of consolidations was shot down by county directors on Friday.

“The possible consolidation of counties won’t create any savings. We’ve just carried out a major administrative reform that created the systems for the current structures. If counties were consolidated, billions of euros would be spent on new patient systems, investments and wage harmonisation,” Santeri Seppälä, the county director in Southern Savonia, stated to Helsingin Sanomat.

“The funding base has been insufficient in all regions, and the difficulties were more or less given. Even a county that succeeds may face the assessment because the catching up we have to do to balance finances is absurd,” said Sally Leskinen, the county director in South Karelia.

“You should have a cool head now. Consolidating two or three poor well-being services counties won’t create a single rich one, but one that’s even poorer,” predicted Tero Järvinen from South Ostrobothnia.

The central administration will initially fund the well-being services counties based on how much the municipalities, joint municipal authorities and hospital districts that were previously responsible for organising social and health care services spent on the services in 2022, the last year before the responsibility was transferred to the counties.

In the coming years, the criteria will be gradually shifted toward service needs, as determined by factors such as the age structure and morbidity of the county population.

The City of Vantaa managed its facility and staff costs carefully last year despite the obvious incentive to spend heavily, leaving the county with more catching up to do than others, according to Aronkytö.

“We’ve harmonised wages, but we’ve also raised them because we’re competing with our neighbours for the same professionals. This has already started to have an effect on our reputation as an employer,” he said.

The shift to needs-based funding has been criticised as unfair in the capital region: it fails to take into account the actual need for child welfare services, for example, explained Aronkytö.

Liina-Kaisa Tynkkynen, a research director at the Finnish Institute for Health and Welfare (THL), said to Helsingin Sanomat on Tuesday that she is not surprised by the cost-cutting plans of well-being services counties.

“That’s the whole point of the reform, to do things in a new way.”

The reform, she reminded, was expected to force social and health care providers to shutter facilities especially in small localities in the face of strained economic and human resources.

“This is precisely what many previous governments have wanted from the social and health care reform: that the rise in costs is slowed down.”

Aleksi Teivainen – HT