Rakenteet muuttuvat – mihin suuntaan?

16
Children and families have quite varied service needs nowadays. The proportion
of children under 18 in non-institutional care as well as the proportion of outplaced
children were generally highest in big ARTTU municipalities. The high key figures
of child welfare often reflect multiprofessional cooperation and increased professional
skills in social work and an ability to intervene in the problems of children living in
harmful conditions. The figures may, on the other hand, also reflect increasing problems
in families with children, deficiencies in non-institutional early support, increasing
social problems in the area or a growing uncertainty in the economy and in working
life. Thus a decline in the number of children does not automatically mean reduced
costs.
Service profiles describing services for the elderly showed a great variety in the way
services had been arranged in each municipality. In 2006 most of the elderly lived at
home. They did not use locally provided elderly services. The service system for people
over 75 was assessed as a whole, from home care to heavy institutional care. There
were considerable variations in the proportions of institutional care and informal care
in each local authority. In 2006, people over 75 still were in institutional care much
more often than recommended in the national objectives. The costs for institutional
care varied quite a lot from one municipality to another. The strategies for elderly
services underlined service integrity and a user-oriented approach, but according to
assessment reports drawn up by auditing committees in the ARTTU municipalities,
the picture of the elderly services was somewhat fragmented.
The actual possibilities for local authorities to affect service use and costs is very
often a question of how to allocate services in the initial stage of service needs. As far
as services for families with children are concerned the main issues are early support
and an accurate timing of services. The costs for elderly services are affected by the
coverage of and criteria for home care, the structure of institutional care and the entire
service network available for the elderly. For instance primary care medical services are
mainly targeted at children and the elderly.
In 2006–2009, some major structural and functional reforms were carried out
in social and health services. In the ARTTU municipalities new service forms were
established. They were innovative, customer oriented and they bridged established
organisational sectors. In the initial stage of the PARAS reform, changes in the functional
structures were most easily observed. Initially one could also observe a certain
fragmentation especially in social services and a fear of a cooperation break down in
social and health services. When the transformation phase has passed, the reshaped
services may, on the other hand, be more appropriate for the clients compared to the
situation in 2006. This applies in particular to services for children and families.
Since health services are organized in various different ways, the crucial question is
who is in charge of the local health policy. The tendency towards bigger municipal and
organisational entities results in more versatile services, but possibly also in problems
regarding accessibility. In sparsely populated areas this may manifest itself in difficulties
concerning service use and customer admittance.
In decisions regarding the structures of social and health services it is important
to indicate clearly the problems that you wish to solve through a reform. You have to
ACTA