New national development programme

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments 11

Abstract

According to newly reformed legislation, the government draws up the National Development Programme for Social Welfare and Health Care after it has been appointed. In this document the general aims of health care policy and the measures that will be taken in order to fulfil these aims are adopted for the next four years. First such programme was adopted in January 2008 and the central theme of the programme is to strengthen the development activities of municipal services.

Purpose of health policy or idea

When a new government is appointed it draws up a social welfare and health care programme for next four years based on the Government Programme (see HPM report "The government programme for the years 2007-2010"). The general aims of health care policy and the measures that will be taken in order to fulfil these aims are adopted in this document. The intention is that the government, municipalities and other actors in the field of social welfare and health work towards the achievement of common targets based on the government programme. These targets and development recommendations apply primarily to the municipalities, but the programme includes also recommendations for measures for state administration (especially STAKES, National Public Health Institute and the National Occupational Health Institute).

Before 2007 this programme was called the Social Welfare and Health Care Target and Action Plan. In January 2007 the parliament reformed legislation in this respect and the plan was replaced by the "National Development Programme for Social Welfare and Health Care" (Finnish acronym KASTE). The objective of the reform was to strengthen the steering function of the programme, for example by integrating the state funding of local development projects into the programme.

Strengthening the development activities of municipal services

The current government was appointed in April 2007 after parliament elections and the first National Development Programme for Social Welfare and Health Care was adopted by the Government in January 2008. The central theme of the programme is to strengthen the development activities of municipal services.

The programme defines three main targets which were divided to measurable and more specific subtargets:

• to decrease marginalisation of the people;
• to increase health and well-being and to diminish differences between population groups in this respect; and
• to increase quality, effectiveness and accessibility of services and diminish geographical differences in this respect.

Defined subtargets related to health for the year 2011:

• consumption of alcohol will decrease to the level at which it was in 2003;
• proportion of overweight working-age people (BMI>25) will decrease to the level at which it was in 1998-2001;
• proportion of smokers from 16-18 year olds will decrease from 22% to 17%;
• functional capacity of elderly population improves;
• number of home and leisure-time accidents decreases by 10%;
• user satisfaction in health and social services measured by user feedback will improve;
• maximum waiting-times defined in legislation are not exceeded;
• physician and dentist shortage in primary health care will decrease; and
• geographical differences in effectiveness in secondary care decrease;

Main measures to reach those targets are for example:

• to strengthen structures for promotion of health and well-being;
• to improve the services for children and adolescents;
• to secure sufficient human resources for social and health services;
• to strengthen the competence of personnel;
• to improve management in the social and health sector;
• to strengthen the position of users of services (patient empowerment);
• to reform the organisation of municipal services (the Project to Restructure Municipalities and Services, see HPM 11/2008);
• to promote the integration of services (for example between primary and secondary care);
• to further develop electronic services; 
• to strengthen primary care;
• to create a Good Practices -network for distributing experiences from new service innovations; and
• to further develop national quality guidelines.

Main points

Main objectives

To define the implementation of the Government Programme in terms of social and health policy and to steer the development of municipal social and health services from the national level.

Type of incentives

The development programme is required by the law

Groups affected

Municipalities, state administration

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

The main targets and measures defined in the programme are rather traditional and consensual. The definition of explicit, measurable subtargets and the tight connection of the state funding for local development projects to the programme are fairly innovative. There has been very little public discussion on the programme.

Political and economic background

The current government was appointed in April 2007. Compared to the previous government, the most notable change was that after 12 years as a strong political party in the government the Social Democrats moved to opposition and after 4 years in opposition the National Coalition Party ascended to the government (the prime minister remained the same). As a consequence, in terms of traditional political divisions the new government moved the government power balance to the right. The development programme is based on the Government Programme (HPM 10/2007).

Change of government

The new Government was appointed in April 2007 after parliament elections

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

Main themes of the development programme are brought up also in the Government Programme. The Advisory Board of Social and Health Care directed the preparation of the programme. The board is chaired by the Minister of Health and Social Services. The Ministry of Social Affairs and Health, the Association of Finnish Local and Regional Authorities, the Ministry of Education and the Ministry of Employment and the Economy are represented in the board. Activities of the board are organised for three divisions: one for state administration, one for regional level and one for civil society. Additionally, five regional steering groups have responsibility of implementation and follow-up in regional level.

The programme was prepared by an extensive process in which a wide variety of actors were involved. For example five regional meetings were arranged to listen to the municipalities' views on the matter.

Initiators of idea/main actors

• Government

• Providers

Approach of idea

The approach of the idea is described as:
amended: The Government Programme

Stakeholder positions

The Ministry of Social Affairs and Health has the leading role in the programme. The programme is also accepted by the municipalities and municipal organisations which have a very important role in the implementation of the programme. The programme is not explicitly opposed by any stakeholder.

Actors and positions

Government
The Ministry of Social Affairs and Health	very supportive		strongly opposed
Providers
Municipalities	very supportive		strongly opposed
Hospital districts	very supportive		strongly opposed
The Association of Finnish Local and Regional Authorities	very supportive		strongly opposed

Influences in policy making and legislation

In January 2007 the parliament reformed legislation so that the Social Welfare and Health Care Target and Action Plan was replaced by the National Development Programme for Social Welfare and Health Care. The legislation change was passed unanimously.

Legislative outcome

success

Actors and influence

Government
The Ministry of Social Affairs and Health	very strong		none
Providers
Municipalities	very strong		none
Hospital districts	very strong		none
The Association of Finnish Local and Regional Authorities	very strong		none

Positions and Influences at a glance

Adoption and implementation

The implementation and follow-up of the programme is the responsibility of the Advisory Board of Social and Health Care and five regional steering groups. The measures identified in the programme will be more explicitly defined separately. The state funding for local development projects has an important role in the implementation of the programme (annually about 25 million euros). The programme also steers the activities of the National Public Health Institute, STAKES, the Occupational Health Institute and provincial administration.

Monitoring and evaluation

The activities of the programme are monitored annually and necessary further measures are taken based on that evaluation. Thorough external evaluation is conducted concurrently with the programme.

Review mechanisms

Mid-term review or evaluation, Final evaluation (external)

Dimensions of evaluation

Outcome

Expected outcome

The municipalities have a key role in the implementation, and outcome of the programme depends greatly on how seriously municipalities try to reach the defined targets and take measures identified in the programme. Municipalities cannot be fined though if they don't reach the targets. The new programme has better possibilities to succeed than previous Social Welfare and Health Care Target and Action Plans because state funding for local development projects is seamlessly integrated into the programme and the programme has stronger regional structures for implementation.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

Impact of the programme is difficult to estimate at this point.

References

Sources of Information

Programme web pages (in Finnish). www.stm.fi/Resource.phx/hankk/hankt/sote/index.htx 

Author/s and/or contributors to this survey

Vuorenkoski, Lauri

Suggested citation for this online article

Vuorenkoski, Lauri. "New national development programme". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/fi/a11/3