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.

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.

On 28 February 2023, Parliament adopted the Act on the Supervision of Social Welfare and Health Care. The Act is expected to enter into force on 1 January 2024. With the Act, wellbeing services counties’ obligation to supervise will apply to the services that the county is responsible for organising, with some exceptions.

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 refers to the permit and notification procedure of private social welfare and health care service providers where we assess a service provider’s operating conditions before the start of 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.

If you are dissatisfied with the service or treatment given to you, take the issue up first with the person who gave the treatment or made the decision, or their supervisor. It may be possible to resolve the matter through discussion. The party responsible for the operations is obliged to remedy any deficiencies. In addition, there may be some misunderstandings related to the situations that have caused dissatisfaction, and these can be cleared most rapidly through discussion.

When social services staff report a shortcoming or a threat of a shortcoming they have detected to their supervisors, the supervisor is obliged to react to the report without delay. The supervisor shall report the matter to the party arranging the service, which in the case of private service providers is the wellbeing services county. If the supervisor fails to react to the shortcoming or take action to remedy it, the staff should report the matter to the Regional State Administrative Agency.

If you are dissatisfied with the way you were treated or the quality of service, you may file a written objection about the matter directly with the service unit. The service unit may be a day care centre, health centre, health clinic, social welfare office, nursing home, etc. This will bring the shortcoming immediately to the attention of the person in charge, and it can be addressed promptly. They must provide a written response to your objection within about four weeks. 

You may file the objection using the service unit’s own form or as a freeform document. If you write a freeform document, enter ‘Objection’ as the heading. Send the objection directly to the director of the service unit or to the person responsible for the branch in question at the wellbeing services county.

The patient ombudsman or social ombudsman can assist you with preparing an objection.  

You may file an objection on behalf of a family member if they are unable to do so themselves.

If you remain dissatisfied after receiving a response to your objection, you may file a complaint with us. If you have not filed an objection before filing a complaint, we can forward your complaint to the service unit in question as an objection.

Before you file a complaint, however, we recommend that you engage the service unit in discussion and then, if necessary, file an objection.

You may file a complaint with the Regional State Administrative Agency. We will notify you as soon as possible if your complaint will not lead to an enforcement matter being opened. 

Read more about filing a complaint.

Cases where there is a suspicion of malpractice leading to the death or severe permanent injury of a patient are handled by the National Supervisory Authority for Welfare and Health (Valvira).

Social care

The status and rights of social welfare customers are provided for by law, in the Act on the Status and Rights of Social Welfare Clients (in Finnish). You can read a brief description of the status and rights of customers on our website.

Health care 

The status and rights of patients in health care are provided for by law, in the Act on the Status and Rights of Patients (in Finnish). You can read a brief description of the status and rights of patients on our website.

The tasks of the social ombudsman and the patient ombudsman are to:

• offer advice on questions about legal protection in health care, social welfare and early childhood education and care
• offer advice and, if necessary, assist in submitting an objection
• offer information about customers’ and patients’ rights
• collect information on customer and patient contacts and monitor the development of customers’ and patients’ rights and status.

The ombudsmen will not comment on the content of a customer’s service or the content of a patient’s treatment or diagnosis. Their contact information is available from the wellbeing services county.

If you are dissatisfied with entries made in your customer documents or patient documents, please contact the service unit where those entries were made. The Regional State Administrative Agency cannot change entries in health care patient records or social welfare customer records.

In case of problems, contact the Data Protection Ombudsman

The Patient Insurance Centre manages compensation for personal injury caused in health care services.

Service providers are responsible for ensuring that their services comply with the requirements imposed in their operating licence. Nursing home service providers are expected to self-regulate, this being the principal form of enforcement. The self-regulation plan must be publicly available, and it must be monitored. Care services for the elderly are secondarily enforced by local authorities, Regional State Administrative Agencies and the National Supervisory Authority for Welfare and Health (Valvira).

Wellbeing services counties are responsible for arranging the services and for enforcement of both its own and outsources services.

At the Regional State Administrative Agency, we enforce the arranging of services by wellbeing services counties and the operations of other public-sector and private-sector service providers.

The National Supervisory Authority for Welfare and Health (Valvira) is responsible for enforcement in cases that are of major importance in terms of scope or principle. We will forward a case to Valvira if necessary, according to the agreed division of duties.

The supreme overseers of legality in Finland are the Parliamentary Ombudsman and the Chancellor of Justice. If all legal avenues in Finland have been exhausted, official decisions may be appealed to the European Court of Human Rights.

• Social Welfare Act (1301/2014)
• Social Welfare Decree (607/1983)
• Act on the Status and Rights of Social Welfare Clients (812/2000)
• Act on Private Social Services (922/2011)
• Decree on Private Social Services (1053/2011)
• Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons (980/2012); also referred to as the Act for Elderly Care and Services

Local authorities are responsible for arranging services for the elderly. Local authorities are also responsible for enforcement of their own services and of outsourced services.

Local authorities must always notify the Regional State Administrative Agency for their region of any shortcomings or abuses found. Local authorities are also obliged to guide and advise service providers so as to cause any shortcomings to be rectified. Certain enforcement measures specified by law, such as suspending operations, can only be undertaken by the Regional State Administrative Agency or the National Supervisory Authority for Welfare and Health (Valvira). These measures are provided for in the Act on Private Social Services.

When a local authority acquires services from a private service provider, the local authority or joint municipal authority must ensure that the services outsourced are consistent with the level of quality required from an equivalent municipal operator.

A local authority is also responsible for enforcement in respect of any service unit of a private care service provider located in its municipality, regardless of whether the local authority is purchasing services from that unit or not. A municipal body (e.g. the social and health services board) shall direct and enforce private social services located in its municipality. What this means is that the local authority has the power to inspect a service unit in its municipality when there is justified cause for doing so. Such cause may be a written or verbal notification of a shortcoming found at that unit. A local authority may conduct unannounced inspections.

The Regional State Administrative Agency is responsible for enforcement of social services in its region. The National Supervisory Authority for Welfare and Health (Valvira) directs us in the management of our duties. The purpose of this direction is to harmonise the operating principles, procedures and decision-making practices of the Regional State Administrative Agencies.

Individual cases of enforcement come under the jurisdiction of Valvira when a case is of major importance in terms of scope or principle, or when a case concerns the domains of several Regional State Administrative Agencies or the entire country.

In the supervision of social welfare and health care professionals, Valvira handles cases where the right of a professional to practice may have to be suspended or removed. Valvira also investigates cases where treatment or neglect of treatment is suspected to have caused the death or serious injury of a patient. Some cases may be referred to Valvira simply because of a conflict of interest in investigating a matter in our region.

It is our responsibility to enforce the operations of providers of care services for the elderly. In some cases, if we consider it necessary or if a case is of national significance, we may refer the case to the National Supervisory Authority for Welfare and Health (Valvira) for enforcement.

Local authorities are responsible for arranging care services for the elderly. They may provide these services themselves or outsource the services from a private-sector or third-sector service provider. In both cases, we enforce the operations of local authorities.

We engage in systematic enforcement according to the social welfare and health care enforcement programme that we have devised jointly with the National Supervisory Authority for Welfare and Health (Valvira) and the related regional implementation plans.

Enforcement is based on data collected from wellbeing services counties and social welfare service units. We may also, for instance, draw on studies conducted jointly by Valvira and the National Institute for Health and Welfare (THL) in enforcement. Regional characteristics such as individual care institutions are taken into account in the plans.

We direct wellbeing services counties in our areas of enforcement through means such as letters of instruction, dialogue, visits for steering and evaluation, and agreed inspections of nursing homes. We also conduct unannounced inspections. Some of our inspections are based on notifications that we receive.

Our enforcement practice is exactly the same for both private and municipal care institutions. However, the licensing procedure is different for private and municipal care institutions. We are the licensing authority for private service providers. Local authority units do not need to obtain a licence in this field.

In 2021, the most common reasons for complaints regarding care services for the elderly were:

• the service provider had insufficient care personnel
• personnel was lacking in professional competence
• shortcomings in personnel structure
• inappropriate behaviour by staff or poor treatment of clients
• shortcomings in the implementation of pharmacotherapy
• shortcomings in service availability
• procedural errors related to decision-making or administrative procedures
• self-regulation failings. 

Our information service may be busy at times due to a large number of contacts, the scope of the matters being handled, or other reasons. We aim to process requests for documents and information as fast as possible; in the case of publicly available information, this should never be later than two weeks after we receive the request. If a matter requires special measures or involves an unusual amount of work (because of the large number of documents involved, because of having to redact confidential information, or because of other equivalent reasons), then a response concerning a publicly available document should be given no later than one month after we receive the request.

In certain separately specified circumstances, we may charge a fee for the time spent in retrieving information and redacting confidential information before delivering documents. If your request is subject to a fee, we will give you a price estimate in advance.

In respect of the media, the aim is that questions from media representatives will be responded to by those officials who are the best informed in the matter at hand. Matters with high media interest often overload the relevant officials, and they must prioritise their enforcement duties above publicity demands.

Inspection visits generally involve a central government enforcement official and also local government enforcement officials.

It is the responsibility of the wellbeing services county to provide medical services for residents at assisted living units for the elderly. In the case of a private service provider, the wellbeing services county or joint municipal authority must agree with the service provider on how to arrange for medical services.

The need for providing medical services at assisted living units is always assessed on the basis of the needs of the residents. Medical services must be available whenever a customer needs them. Providing medical services as a remote consultation only is not sufficient in view of the rights of the patient.