Wellbeing services counties

The supervisory authorities are the National Supervisory Authority for Welfare and Health Valvira and the Regional State Administrative Agencies.

A Regional State Administrative Agency supervises the legality of the provision of social welfare and health care services and the services whose organisation is the responsibility of the wellbeing services counties in its area and provides guidance related to supervision. The Regional State Administrative Agency also supervises and steers the private social welfare and health care services that are not organised by a wellbeing services county.

Valvira steers the Regional State Administrative Agencies’ activities in the implementation, coordination and harmonisation of supervision and related guidance. In addition, Valvira supervises the legality of the provision of social welfare and health care services and the services whose organisation is the responsibility of the wellbeing services counties and provides guidance related to supervision in the case of

• vital or wide-reaching issues
• issues relevant to the operating areas of several Regional State Administrative Agencies or the entire country
• issues that are essentially related to an enforcement case handled by Valvira concerning social welfare or health care or a social welfare or health care professional.
• issues that the officials handling enforcement cases at the Regional State Administrative Agency are disqualified to process.

Valvira also supervises and steers the private social welfare and health care services that are not organised by a wellbeing services county.

Laki sosiaali- ja terveydenhuollon valvonnasta tuli voimaan 1.1.2024. Sen myötä hyvinvointialueen valvontavelvoite koskee nyt hyvinvointialueen järjestämisvastuulle kuuluvia palveluita joitakin poikkeuksia lukuun ottamatta. 

Since the beginning of 2023, the primary responsibility for supervision has been transferred to the organisers of social welfare and health care service, i.e. wellbeing services counties. The organisation of services means, among other things, that each wellbeing services county is responsible for the availability of social welfare and health care services in accordance with the service needs of its residents. In order to fulfil its organisational responsibility, a wellbeing services county has the option of producing social and health care services itself, obtaining them from a private social or health care service provider or organising the services with a service voucher. The wellbeing services counties monitor the organisation and implementation of their services with self-regulation. Although each wellbeing services county supervises the social welfare and health care services it organises, wellbeing services counties are not referred to as supervisory authorities.

If there are shortcomings or deficiencies in the operations of a private service provider or their subcontractor in a matter falling under the organisation responsibility of a wellbeing services county, the wellbeing services county must steer the private service provider or, if necessary, ask the private service provider and their subcontractor to provide information on the matter within a sufficient deadline set by the county. When shortcomings or deficiencies arise, the wellbeing services county must demand that they be rectified within a sufficient deadline set by the county. In the case of shortcomings or deficiencies that significantly endanger client or patient safety, the wellbeing services county must demand that they be rectified immediately.

If a private service provider or their subcontractor does not rectify shortcomings or deficiencies within the deadline set by the wellbeing services county, the county must, if necessary, take contractual measures to reduce or withhold compensation. If the violations are material or recurring, the wellbeing services county must take measures to terminate or cancel the contract.

A wellbeing services county must immediately notify the Regional State Administrative Agency supervising the services of any shortcomings and deficiencies in the operations of a service provider or their subcontractor that have materially endangered client and patient safety. Similarly, if a Regional State Administrative Agency is informed of any shortcomings or deficiencies in the activities of a service provider or their subcontractor that significantly endanger client and patient safety, the Regional State Administrative Agency must immediately notify the wellbeing services counties to which the service provider is providing services. In addition, the wellbeing services county and the Regional State Administrative Agency must send each other their prepared inspection reports concerning the activities of the service provider providing services to the wellbeing services county or its subcontractor.

The task of Regional State Administrative Agencies is to promote and ensure the self-regulation of wellbeing services counties and to intervene if the self-regulation of a wellbeing services county is not sufficient.

An enforcement case can be initiated at a Regional State Administrative Agency on the basis of a notification about shortcomings or on the basis of observations made by the Agency itself. 
 
When an enforcement case is brought to the supervisory authority, the authority takes the measures that it considers necessary for ensuring client or patient safety or compliance with the law. 

If a matter does not give rise to separate measures at a Regional State Administrative Agency, the Agency may conclude that the matter should be brought to the attention of the wellbeing services county and taken into account in self-regulation and supervision. 

Above all, Regional State Administrative Agencies’ supervision addresses suspected activities that are significant in terms of quality or scope and are illegal or endanger client safety. As a rule, a Regional State Administrative Agency will investigate a matter when a wellbeing services county’s self-regulation or supervision measures concerning deficiencies in its own operations or private service provision have not been sufficient or the matter is not within the county’s competence. 

Enforcement cases are, as a rule, more extensive than complaints and handled at a more general level, i.e. organisational supervision. Organisational supervision processes cases related to the arrangement and organisation of activities, for example concerning the amount and structure of personnel, the quality and content of care and services, and the implementation of pharmacotherapy.

We usually start investigating an enforcement case by hearing the operator the case concerns. In connection with the hearing, we will, as a rule, provide the operator with all the documents that have been submitted to us alongside the notification about shortcomings, after which we request a clarification from the operator. 

If an enforcement case concerns a private service provider, we may also request a statement from the party responsible for organising the service, i.e. the wellbeing services county. 

We usually process enforcement cases on the basis of documents, but the processing may also involve an inspection visit.

As a rule, the documents related to an enforcement case are made public at the latest when a decision on the case has been made. The documents may however contain some confidential information.

A complaint refers to a notification to the supervisory authority of suspected negligence or misconduct. Several different authorities investigate complaints in addition to the Regional State Administrative Agencies.

Most of the complaints we process concern individuals, i.e. the care, service or treatment of a particular client or patient, which distinguishes complaints from more extensive enforcement cases.

The Regional State Administrative Agency assesses the measures it will take as a result of a complaint. If a complaint does not give the Regional State Administrative Agency reason to take measures, the complainant is usually notified by letter.

Sometimes it is most appropriate to process a complaint by a client or patient as an objection. In these cases, we can transfer the matter to the operating unit or wellbeing services county. The unit or county has to respond to the objection in writing within a reasonable time and also send the response to the Regional State Administrative Agency.

If a complaint is taken on by the Regional State Administrative Agency for investigation, the process can for example start by obtaining documents or hearing the subject of the complaint. In connection with the hearing, we will, as a rule, provide the subject of the complaint with all the documents that have been submitted to us with the complaint and request clarification from the subject of the complaint. The Regional State Administrative Agency can also get an expert opinion.

Once we have received the necessary clarifications, we will assess whether the subject of the complaint has acted as required by law and issue a decision on the matter.

Complaints are confidential even after the matter has been resolved.

A reply letter is usually sent if the Regional State Administrative Agency has assessed a matter and finds that the complaint or enforcement case does not reveal any unlawful conduct or negligence falling within the scope of the Regional State Administrative Agency’s competence that would give rise to measures by the Regional State Administrative Agency.

No consequence means that investigation has revealed that the matter is in order or that the shortcoming is so minor that the supervisory authority considers the guidance given in the decision to be sufficient for the procedure laid down in the law.

If the Regional State Administrative Agency finds deficiencies in the operations of a wellbeing services county or private service provider either on the basis of an inspection visit or reports received, it may issue administrative guidance for future operations in its decision. The different forms of administrative guidance are expressing an opinion, drawing attention, and the strictest one is a warning. In other words, the supervisory authority may inform the subject of supervision of the authority’s understanding of the lawful procedure or draw the attention of the subject of supervision to the appropriate organisation of activities and the requirements of good governance. If these means are not sufficient, we can issue a warning to the subject of supervision.

The supervisory authority may also issue an improvement notice for the subject of supervision to rectify the identified deficiency or other shortcoming.

For example, the Regional State Administrative Agency may also provide oral guidance during an inspection visit with the purpose of guiding the service provider to correcting deficiencies or shortcomings without delay. Guidance can also be provided for identifying risks in the client service processes to prevent the endangerment of client safety.

As a last resort, we can issue a binding order to the organisation to rectify deficiencies or eliminate shortcomings. When we issue an order, we set a deadline for taking the necessary measures. An order can be enforced with a conditional fine, for example. To ensure client or patient safety, the Regional State Administrative Agency may also suspend operations, prohibit the use of a service unit or a part thereof immediately or cancel the registration of a service provider or a service unit.

Proactive supervision means the registration procedure for the providers of social welfare and healthcare services in which we assess a service provider’s operating conditions already before it starts operations. In the assessment of the operating conditions, we take into account factors such as the facilities where the operations are to be carried out, the amount and structure of personnel, the mission statement and the target group of the operations. 

Reactive supervision means that we receive a notification or complaint about a mistake or neglect by a social or health care service provider, i.e. there may have already been a shortcoming and we are investigating it after the fact. The Regional State Administrative Agency may also take on a reactive enforcement case on its own initiative, for example on the basis of a shortcoming brought to its attention through the media. This is also referred to as own-initiative supervision.

Planned supervision refers to supervision that we for example carry out on the basis of a risk assessment or a plan that is founded on our statutory obligations. We also carry out planned supervision that is based on the social welfare and health care supervision programme prepared jointly by the Regional State Administrative Agencies and Valvira. We can also carry out guidance and assessment visits.