Wellbeing services counties can strengthen decision-making by reducing governing bodies and increasing resident participation

Wellbeing services counties can streamline decision-making by reducing the number of governing bodies and clarifying their roles. Resident participation can also be significantly strengthened through new methods such as citizen panels and Polis, the digital participation platform.

These findings are based on a study (summary in English) commissioned by the Finnish Innovation Fund Sitra in collaboration with the Ministry of Finance, which is responsible for coordinating the government steering of wellbeing services counties. The study was conducted by the Nordic Healthcare Group (NHG), a consultancy specialising in social welfare and healthcare.

The study reveals that the number of governing bodies involved in decision-making varies significantly across wellbeing services counties. On average, each county has 15 decision-making bodies, approximately half of which are statutory. The statutory bodies include the county council and county executive.

“Many wellbeing services counties would benefit from streamlining their governance structures. According to the study, decision-making is perceived as most effective in counties with fewer than 15 administrative bodies. Counties should also ensure that each body has a clearly defined role and responsibility in both the preparation and implementation of decisions,” says Antti Rissanen, Senior Manager at the NHG.

Since the beginning of 2023, the wellbeing services counties have been responsible for organising healthcare, social welfare and rescue services. Most counties are currently considering reforms to their decision-making and governance structures. This spring, county elections will also be held to elect new officials for the wellbeing services counties.

Investing in resident participation strengthens trust

Wellbeing services counties are under immense pressure. They must ensure that essential services are available to citizens while cutting costs as part of general government adjustment measures. At the same time, they need to develop decision-making processes in a way that ensures that services are governed as democratically as possible. 

Hannu-Pekka Ikäheimo, Director of Sitra’s Democratic Innovations programme, highlights that while citizens want to influence healthcare and elderly care services, their belief in their ability to make a difference remains low.

“Trust in democratic governance is being tested at a time when it is needed most to provide balance and security amidst crises, fear and uncertainty. If Finland intends to continue using its democratic strengths, it must boldly enhance citizens’ opportunities to participate in decision-making between elections. Social stability, governmental transparency and the predictability of decision-making are also crucial to Finland’s economic competitiveness,” Ikäheimo emphasises.

Many wellbeing services counties have attempted to introduce various participation methods and have laid the foundations for regional democracy while the new governance model is still evolving. However, the development of participation has been fragmented, and the assessment of its impact remains insufficient.

According to the study, wellbeing services counties should establish a clearer framework for resident participation methods and set clear and measurable targets for participation.

There are tangible solutions for increasing resident participation. Several wellbeing services counties have piloted deliberative citizen panels and the Polis participation platform in 2023 and 2024 with financial and expert support from Sitra. The work to expand and institutionalise these methods continues.

These experiments (summary in English) demonstrated that wellbeing services counties successfully enhanced both resident and staff participation through citizen panels and the Polis platform. Decision-makers received a more solid foundation for their decisions, as residents’ views on issues such as service networks and digital and mental health services became clearer.

Democracy costs account for a fraction of wellbeing services counties’ expenditure

The study also examined the amount of money wellbeing services counties have allocated to democracy-related expenses, including elected officials’ meeting fees and annual allowances, as well as political parties’ group funding.

The findings indicate that cutting democracy-related expenses will not resolve the financial difficulties faced by wellbeing services counties. On average, counties spent EUR 9.50 per resident on democracy-related costs between January 2023 and June 2024. This amount accounted for approximately 0.18% of the total operating expenses of the wellbeing services counties during the same period.

“Self-governance is a crucial element of the health and social services reform and its constitutional legitimacy. Open and effective decision-making is essential for local acceptance and for considering regional differences. It is important to discuss the relationship between services, finances and democracy in wellbeing services counties. This study provides a solid foundation for future county councils and administrative leadership to support decision-making and develop participation,” says Director General of Department Ville-Veikko Ahonen at the Ministry of Finance.

Read more:

Mitä demokratia maksaa hyvinvointialueilla? Välitarkastelu kustannuksista ja päätöksenteon rakenteista (summary in English)

Asukaspaneeli- ja Polis-kokeilut hyvinvointialueilla 2023–2024 – Oppeja ja suosituksia demokratian kehittäjille (summary in English)