The aim of the audit was to determine whether the actions of the Ministry of Social Affairs and Health have promoted the development of the division of labour. This document contains a summary of the main results of the audit. The entire audit report is available only in Finnish.
Conclusions and recommendations of the National Audit Office
The aim of the audit was to determine whether the actions of the Ministry of Social Affairs and Health have promoted the development of the division of labour. The audit was based on an assumption that ensuring the adequacy of social welfare and health care personnel in a situation where the Finnish population is ageing requires improvements in the division of labour. Another aim of the improvements is to increase the efficiency and productivity of the social welfare and health care services.
The social welfare and health care sector is the largest provider of employment in Finland. A total of 16 per cent of all employed people work in the sector. As the working-age population is decreasing and the ageing population needs more social welfare and health care services, the sustainability of general government finances increasingly depends on the efficiency and productivity of the social welfare and health care personnel. Personnel expenses in local government social welfare and health care total about 10 billion euros each year. The Ministry of Social Affairs and Health is responsible for the national steering of the social welfare and health care personnel and the development and adequacy of the personnel resources.
According to the audit findings, the Ministry of Social Affairs and Health has facilitated the development of the division of labour by means of legislative and information steering. The ministry has promoted the development of the division of labour by issuing a recommendation on the task structure of the social welfare professionals, by giving nurses the right to prescribe drugs and by means of project steering. About 20 million euros of Kaste project funding has been allocated to projects supporting the development of the division of labour.
The project steering has helped to develop the division of labour. Projects that have generated discussion on professional structures in municipalities where such issues have not been examined before have been particularly important. However, according to the audit findings, at national level Kaste projects have only played a minor role in the development of the division of labour. Converting the work into practical results and persuading other municipalities to adopt good practices have been the main challenges in the projects. The efforts to disseminate good practices have also been hampered by weak local government finances and delays in the social welfare and health care reform.
According to the audit findings, the fact that the efforts to improve the division of labour have proceeded at different speeds in different municipalities has made nationwide steering more difficult. The reasons for developing the division of labour have also varied. Municipalities are of the view that the development work should be on the basis of client needs. In practice, the work has been prompted by a lack of resources and the need for more efficiency. Progress has been slowed down by differences in work culture between localities and employee groups.
Except for a small number of measures and projects, the Ministry of Social Affairs and Health has played a passive role in the efforts to develop the division of labour. The municipalities covered by the audit were also of the view that the ministry should steer the work more extensively.
According to the audit findings, more extensive steering by the Ministry of Social Affairs and Health would be needed so that the national savings targets concerning the division of labour can be achieved. The Ministry of Social Affairs and Health should have a clearer opinion on such issues as the qualification of persons holding a Bachelor of Social Services degree for different tasks. The recommendation on the task structure of social welfare professionals does not provide sufficiently clear guidelines for the division of labour between social counsellors and social workers. It seems that the new social welfare legislation does not provide clear guidance in this respect either.
The new Social Welfare Act (1301/2014) entered into force in April 2015. The act contains definitions for such concepts as social work and social counselling. The new act is expected to increase the number of Bachelors of Social Services among the social welfare personnel. However, the qualification of a person with a Bachelor of Social Services degree for different tasks is not clearly defined in the act.
The Act on Social Welfare Professionals also impacts the efforts to develop the division of labour. The act is expected to enter into force on 1 March 2016 and it is partially based on the Structural Policy Programme. One aim of the programme is to introduce more flexible qualification and measuring criteria for social welfare and health care personnel so that the sustainability of local government finances and the supply of personnel can be ensured. The lower qualification requirements laid out in the Structural Policy Programme should generate savings of 39 million euros in the health care sector and 14 million euros in the social welfare sector by the year 2019. The savings are expected to be achieved by steering municipalities and joint municipal authorities in the development of new task structures and the division of labour. The social welfare and health care reform will also have a major impact on the overhaul of task structures and the development of the division of labour.
According to the audit findings, improvements in task structures and the division of labour may result in more efficient operations and savings in personnel expenses. However, the audit findings suggest that achieving the savings targets is not realistic. This is because there is little steering by the Ministry of Social Affairs and Health, while in many areas the efforts to develop the division of labour have made little progress. Achieving the target by the year 2019 would require substantial changes in the division of labour, especially in the health care sector. It seems that there is more willingness to develop the division labour in the social welfare sector where the shortage of social workers is forcing munici-palities to transfer tasks to social counsellors. Meeting the savings targets would also require substantially better cooperation between social welfare and health care professionals.
The social welfare and health care legislation provides a basis for an appropriate and flexible personnel structure and division of labour. However, according to the audit findings, the problem is that especially in social services, employers are not necessarily aware of the flexibility allowed under the legislation.
The most topical issue concerning the flexibility of tasks in social welfare and health care concerns the division of labour between social workers and social counsellors. About 170 social workers and about 2,000 Bachelors of Social Services graduate from Finnish higher education institutions each year. This has led to a situation where Bachelors of Social Services are employed as temporary social workers even though they lack the formal qualifications for the task. According to the Ministry of Social Affairs and Health, social counselling should become the most important service form in the social welfare sector. According to the audit findings, developing the division of labour by providing more social counselling is the right approach from the perspective of client service and productivity. However, at the same time, it should also be ensured that social workers can continue to engage in professional development and that there will not be any shortage of this group of professionals. Social workers will also be needed in the future as decision-makers and as employees responsible for the planning and coordination of services for clients in need of special support.
Smooth cooperation between professionals is part of a smooth division of labour. According to the audit findings, adoption and development of a multi-professional approach to work is essential from the perspective of the adequacy of the personnel resources and efficient provision of services. However, both in the cooperation between social welfare and health care and in the team work within the sectors, there is still a great deal of work to do. The fact that the social welfare and health services legislation treats the two sectors as separate entities has discouraged cooperation between them. Moreover, merging of social welfare and health care services has not necessarily led to smooth cooperation in day-to-day client and patient work. Problems in cooperation have their greatest impact on the coordination of the treatment of clients with extensive service needs.
The expertise and experience of the clients and patients should be used in the development of the task structures and the division of labour. Only a small number of municipalities collects regular feedback from social welfare clients. The view was that in social services, there is so little client feedback that it is impossible to use it as a basis for any broader conclusions or strategies steering the work. In health care, clients provide more active feedback and the conclusion was that the client feedback has steered the development of the division of labour.
According to the audit findings, development of the division of labour has not had any substantial impacts on client or patient safety. The risks concerning client and patient safety are mainly connected with the problems of determining the necessary medical care and the assessment of urgency in outpatient care. In this respect, there is a need for steering in the definition of the tasks and responsibilities of practical nurses, other nurses and doctors. Client safety may also be at risk in services where service providers must use a large number of unqualified substitutes and where the personnel turnover rate is high.
Recommendations of the National Audit Office
The National Audit Office recommends that the Ministry of Social Affairs and Health
should strengthen steering in matters concerning the division of labour. Especially in social services, municipalities and employers need more information about qualification requirements for different tasks
should determine the content of and need for social counselling and social work with the accuracy supporting the division of tasks
should assess trends in personnel expenses and how the savings targets can be achieved
should promote the nationwide dissemination of the good practices developed in the projects in a more systematic manner
should encourage municipalities to collect client feedback and to make better use of it in the efforts to develop the division of labour.
Additional information
Attachments
