30.11.2010 Alpo Jokelainen 1

Kainuu Region and Its Self-Government Experiment

Congress of local and regional authorities, Helsinki 30.11.2010

30.11.2010 Alpo Jokelainen 2

Population of the municipalities of Kainuu 2009 total 82 626

3 128

9 332

3 401 3 918

38 208 10 6979 632

1 5212 789

Turku

Helsinki

Tampere

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Tilastokeskuksen väestöennuste 2006-2040

2006 2007 2008 2009 2010 2015 2020 2025 2030 2035 2040KAINUU 84 350 83642 82992 82379 81 809 79 399 77 756 76 661 75 679 74 657 73 527Hyrynsalmi 3 015 2962 2911 2862 2 814 2 619 2 500 2 421 2 360 2 303 2 245Kajaani 38 027 37882 37753 37639 37 535 37 118 36 830 36 637 36 389 36 089 35 720Kuhmo 10 072 9902 9747 9599 9 454 8 842 8 374 8 000 7 684 7 393 7 104Paltamo 4 093 4062 4033 4005 3 982 3 877 3 821 3 798 3 778 3 757 3 730Puolanka 3 337 3270 3211 3152 3 097 2 865 2 702 2 591 2 499 2 412 2 334Ristijärvi 1 608 1590 1571 1555 1 541 1 481 1 462 1 464 1 477 1 483 1 483Sotkamo 10 738 10733 10732 10731 10 732 10 727 10 767 10 837 10 872 10 869 10 840Suomussalmi 9 848 9709 9578 9449 9 329 8 792 8 371 8 064 7 822 7 601 7 372Vaala 3 612 3532 3456 3387 3 325 3 078 2 929 2 849 2 798 2 750 2 699

Kainuu population projections (Statistics)

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The law of Kainuu governance experiment Regional functions (§ 4):

Region planning Regional development Healthcare Social services (except for children´s day-care) Secondary education = upper secondary schools and vocational schools General economic development Cooperation with other regional developers Supervision of the region´s interests Control of state budget funds for Kainuu Law + municipal decisions

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A centralised arrangement of basic public services enables securing the service quality, availability and economy in Kainuu in the long term, despite the threatening population forecasts.

At the same time, the citizens living in the eight Kainuu municipalities will have equal opportunity to receive basic public services.

The purpose of the experiment

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The Joint Authority of Kainuu Region(in parentheses is the numbers of employees in 2008,

total 3785) REGIONAL COUNCILREGIONAL COUNCIL

Inspection boardInspection board

REGIONAL BOARDREGIONAL BOARD Executive directorExecutive director

Steering CommitteeSteering Committee

Planning and Development Planning and Development Division (25)Division (25)

Social and Social and Healthcare Healthcare

BoardBoard

Education Education boardboard

Social and Social and Healthcare DivisionHealthcare Division

(2885)(2885)

EducationalEducationalDivisionDivision

(642)(642)

General services (233)General services (233)

Board of KainuuBoard of KainuuVocational Vocational

Institute,Institute,a municipal a municipal enterpriseenterprise

Board of Board of KainuuKainuu

OccupationalOccupationalHealtcareHealtcareenterpriseenterprise

IndividualIndividualCare Care

DivisionDivision

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Regional Board I- Chairman is executive director Alpo Jokelainen- The regional council appoints for term - 10 other member / municipal law- Vaala`s representative in matters relating to the provincial union tasks - decides internal tasks of the Joint Authority of Kainuu Region

Regional Board II (16 members)- Regional Board I and leaders of local state authorities- decides of the use of development funds => state authorities, “operating budgets”

Regional Board III (34 members + about15 other participants)- MYR assembly (go-operation group)- Regional strategic plan, programme and operational programme, decisions of projects over 500 000 €

Regional Board

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Municipal contributions to the Joint Authority of Kainuu Region is defined as a percentage of deferred tax.

Deferred tax funding includes revenues (local taxes (19.25%), community taxes and property taxes (2009)) general funding of social and health from the state, additional funding based of sparsely populated area, tax revenue based on the alignment of the state tax and compensations.

Education state grants are paid for the education provider.

Municipal financing for the Joint Authority of Kainuu Region is determined as follows:

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Kainuu finances (2009)• Total expenditure 315 meur

• Social and health care 237 meur ( 75 %)• Education 48 meur ( 15 %)• Administaration, development and services 22 meur ( 7 %)• Financial expenditure and investments 8 meur ( 3 %)

• Total income 315 meur• Municipal payment 222 meur ( 70 %)• Customer and patient charges 38 meur ( 12 %)• State subsidies and sales revenues 52 meur ( 17 %)• Operating revenues from other services 3 meur ( 1 %)

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6,46,8

7,67,4

2,2

5,3

4,4

5,8

6,3

5,3

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

10,0

2002

2003

2004

2002-2004vuosikeskiarvo

2005

2006

2007

2008

2009

2005-2009vuosikeskiarvo

men

ojen

kas

vu, p

rose

nttia

Sosiaali-jaterveydenhuollontoimintamenojenkasvukokomaassa

Kainuun kuntien sote-menojen keskimääräinen kasvu(asukasluvulla painotettu)

Kainuu maakunnan menojen kasvu (ilman liikelaitoksia)

Growth rate of expenditures, % / year

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Vuosikatteet ja poistot €/as Kainuu: kunnat + maakunta

0

50

100

150

200

250

300

350

400

450

1995 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Vuosikate, kunnat Vuosikate, kunnat+maakunta Poistot €/as Vuosikate, kunnat (6000-10000)

Annual margins and depreciation € / resident

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KAINUU DEVELOPEMENT FUND, V. 2010 TOTAL 61.324 € mill. / DIVISION AND UTILIZATIONS

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Environmental Health

SOCIAL- AND HEALTH DIRECTOR

Health and disease

management services Family services Senior ziticens services

Families withchildren.social servicesFamilies withchildrenhealth servicesAdult social servicesDisability Services

Senior CitizensServiceRegion I(Kajaani Region)Senior CitizensServiceRegion II(Sotkamo, Kuhmo)Senior Citizens ServiceRegion III(Ylä-Kainuu)Shared Services

Health MonitoringVeterinaryservicesEnviromental´sHealtcarelaboratory

Adult mental healthServicesand addiction treatmentReception andHealth Centre,ActionDental healthcare servicesOperational treatmentConservative treatmentEmergency room Services

Laboratory andpathologyRadiologyPharmaceutical ServiceEquipment ServiceParamedic;Anesthesia andintensive care

Manage-ment,Delelope-mentandPlanning

Management support

Medical services

Kainuu Health

SOCIAL AND HEALTHCARE BOARD

EXECUTIVE EXECUTIVE BOARDBOARD

full-time

in addition of own work

the specialty of corresponding

Division Level: appropriate higher education sector and experience in management.

ORGANIZATION OF SOSIAL AND HEALTH ORGANIZATION OF SOSIAL AND HEALTH DIVISIONDIVISION

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ORGANIZATION OF EDUCATION DIVISIONORGANIZATION OF EDUCATION DIVISION

BOARD OF EDUCATIONBOARD OF EDUCATION

BOARD OF EDUCATIONBOARD OF EDUCATION

EDUCATION DIVISION DIRECTOREDUCATION DIVISION DIRECTOR

VOCATIONAL EDUCATIONVOCATIONAL EDUCATION UPPER SECONDARYUPPER SECONDARY SCHOOL EDUCATIONSCHOOL EDUCATION

Vocational education servicesVocational education servicesWelfare sectorWelfare sectorCulture (Director of EducationCulture (Director of EducationBusiness and industryBusiness and industryNatural ResourcesNatural ResourcesTourism and CateringTourism and CateringTechnology and Transport SectorTechnology and Transport SectorKuusamo unit / Tourism Kuusamo unit / Tourism

KAO = Kainuu Vocational CollegeKAO = Kainuu Vocational College

Units:Units: Kajaani High SchoolKajaani High School Kuhmo High School Kuhmo High School  Sotkamo High SchoolSotkamo High School Filiaal High School Filiaal High School Hyrynsalmi High School Hyrynsalmi High School Paltamo High School Paltamo High School Puolanka High School Puolanka High School Suomussalmi High School Suomussalmi High School

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REGIONAL BOARD

GENERAL SERVICES

PayrollPayroll

Well-being Well-being and collaborationand collaboration

Personnel-Personnel-ServiceService

and service and service RelationshipRelationship

mattersmatters

SalesSalesActivitiesActivities

AccountingAccounting

CentralCentralwarehousewarehouse

The The procurementprocurement

officeoffice

BuildingBuildingsystemssystems

EngineeringEngineering

Nutrition Nutrition ServicesServices

AdministrativeServices

IT -services Material

ServicesFinancialServices

PersonnelServices

TransportationServices

NutritionServices

TechnicalServices

GeneralGeneralservicesservices

Economic- and Economic- and debt debt

CounselingCounseling servicesservices

Archive- andArchive- and datadata

Protection Protection servicesservices

ORGANIZATION OF GENERAL SERVICESORGANIZATION OF GENERAL SERVICES

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Regional decision-making works fine• Enlargement of collaboration, productivity increase by 20% • Payroll • ”Accountancy services” • IT -service

Clear synergies • Health services and care for the elderly: a single administrative • No overlapping• Treatment processes are designed, functional • Elderly housing and residential care are in the same unit • Municipality billing is fixed in advance => predictable • Homecare has been increased

Social welfare•Improved legal status of customers•Better quality due to expertize of personnel•Harmonized actions in Field work

Experiences 1

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Combining of small high school administration and teaching

• adiministrative costs; nearly half off• municipality costs – 50%• wider choice for students

Vocational and secondary education for synergies

• Student welfare services• Finance • Student services • Harmonized operational practices, (quality management system)• IT-systems • Sharing of facilities and equipment • Adult education co-operation • Joint development projects

Experiences 2

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Experiences 3

- Municipalities finances have been strengthened in 4 years more than 70 000 000 EUR- State provincial operations management capabilities is fierce- The service changes are justified and there is no return to old system - Support services (catering, cleaning, techical services) need for the gathering = productivity, increasing possibilities for better productivity- By strengthening of small municipality economy, the current structure of the municipalities has been able to maintain

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Summary of social and health services 1

• Focus on health promotion • Investment in research and development to ensure all time improvement

Success criteria

• Deep integration and cohesion• Financing modell• Own research and development increased• Staff commitment

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• Preventive work and the developement of services has been possible• In the last year people have got services more than in the past • People has been little dissatisfied because it has been necessary to limit doctor´s action desk because of the lack of doctors • There has also been difficulties in access to dental care• Initial assessment of the need for care is well realized • Customer feedback is good, imago is not

Summary of social and health services 2

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How long is the waiting time for doctor´s in non-hazardious cases? (average)

Kainuu:

Less than 2

weeks

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Standardized expenditures of social-, health- and elderly care in Finland / Year 2008 (€/people, index=100)Terveyden- ja vanhustenhuollon tarvevakioidut menot sairaanhoitopiireittäin 2008Timo Hujanen, Unto Häkkinen, Mikko Peltola, Terveys- ja sosiaalitalouden yksikkö CHESS, Terveyden ja hyvinvoinnin laitos THL 24.2.2010http://groups.stakes.fi/CHESS/FI/tilastotuotteet/index.htm

Nettomenot Nettomenot, indeksi Tarvekerroin Tarvevakioidut menot, indeksi

Sairaanhoitopiiri Euroa/asukas Koko maa=100 Koko maa=1,00 Koko maa=100Helsinki ja Uusimaa 1738 92 0,84 110Varsinais-Suomi 1927 102 1,01 101Satakunta 1984 105 1,09 97Kanta-Häme 1892 100 1,04 96Pirkanmaa 1871 99 0,99 101Päijät-Häme 1780 94 1,05 90Kymenlaakso 2012 107 1,12 96Etelä-Karjala 1980 105 1,10 95Etelä-Savo 2154 114 1,22 94Itä-Savo 2367 126 1,22 103Pohjois-Karjala 2021 107 1,15 93Pohjois-Savo 2004 106 1,14 93Keski-Suomi 1890 100 1,05 95Etelä-Pohjanmaa 1997 106 1,15 92Vaasa 2060 109 1,04 105Keski-Pohjanmaa 2006 107 1,06 100Pohjois-Pohjanmaa 1802 96 0,98 97Kainuu 1953 104 1,16 89Länsi-Pohja 2063 110 1,10 100Lappi 2015 107 1,05 102

HYKS sha 1744 93 0,83 112Hyvinkään sha 1582 84 0,82 102Lohjan sha 1741 92 0,88 105Länsi-Uudenmaan sha 2213 117 1,03 114Porvoon sha 1740 92 0,89 103

Terveyden- ja vanhustenhuollon tarvevakioidut menot 2008

HUS jaettuna sairaanhoitoalueisiin

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We have succeeded in:

• expenditure growth has been restrained • availability of services in Kainuu is secured • citizen equality has been improved

Kainuu model transferability and innovations:

• social care, basic and specialized health care are combinated• no overlapping (laboratory, logistics and maintenance of equipment)• unbroken service chain, specialist consultations • economy and funding is fixed in advance, no single action invoicing for municipalities • reducing exces plant locations • ensuring excellence = acute hospital only there, where experts is => dissatisfaction with the smaller municipalities

Summary of social and health services 3

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Contacts:

Alpo Jokelainen

Region Mayor, Chairman of the Board

Puh. 044 336 6700, alpo.jokelainen@kainuu.fi