Challenges of Rehabilitation: Inclusion and Working Life Hanna Nyfors, Senior Officer Ministry of Social Affairs and Health

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1 Challenges of Rehabilitation: Inclusion and Working Life Hanna Nyfors, Senior Officer Ministry of Social Affairs and Health National Insurance Institute, Helsinki 12 th March 2014

2 Socially Sustainable Finland 2020 Strategy for social and health policy A strong foundation for welfare Health and welfare in all policies Longer working careers through wellbeing at work Sustainable social protection financing Access to welfare for all Reduce differentials in welfare and health Customer-oriented services New service structures and operating practices Strong sense of social inclusion A healthy and safe living environment etc. 2

3 Finland? Population 5,4 million GDP per capita $ (US $) Life expectancy M 77 / F 83 years Total fertility rate 1.85 Infant mortality 2.4/100 (US 6,5) 38% have tertiary education (US 41%) OECD Hannu Hämäläinen

4 in Finland The age of retirement has risen Work careers longer than before The number of persons retiring on disability pensions for mental health reasons now lower than before Finns are healthier than ever, the number of people dying of cardiovascular diseases lower than 20 years ago

5 Development of the Rehabilitation System in Finland 1/2 Started during and after the Second World War During the 1950 s and 1960 s the welfare services relied on the Nordic principles of normalization and integration of health care, social welfare, social security, employment and education services

6 Development of the Rehabilitation System in Finland 2/2 Legislation completely revised in 1991 to introduce improvement: the vocational rehabilitation of the young medical and vocational rehabilitation of working-aged rehabilitation of the severely disabled Partly new legislation in 2005 (threat of disability) Latest changes in 2014 (social rehabilitation) Government bill (draft 2015) in the Act of Client Cooperation in Rehabilitation

7 A way to develope the system? Legislatory, funding or informational means to promote the rehabilitee s inclusion and ability to cope with everyday life, studies, work and at home? No use of legislation if it is not known or observed Money does not guide if its use is not supervised Information has no effect if it does not reach the right people

8 The present Rehabilitation System The rehabilitation of municipal health, social welfare and educational services (Basic social and health care) (Functional capacity, medical) The rehabilitation of Social Insurance Institution (Medical, vocational) 274M Employment services (Vocational, educational) Rehabilitation of insurance companies (Vocational, educational), 12M Third sector rehabilitation (NGO) mostly patient organisations Rehabilitation of war veterans Obligatory accident- and traffic-insurance rehabilitation (Vocational, educational, medical) Non-obligatory accident-insurance

9

10 Challenges of service structures in Finland Relatively small units (municipalities) responsible Smallest municipalities inhabitants Fragmented service delivery and financing parallel systems for providing health services: the municipal, the private and the occupational health system Poorly integrated health and social care especially mental health/alcohol and drug use, the elderly and families/children at risk Poorly integrated primary and secondary (hospital) care

11 Rehabilitation services criticised of lack of nation-wide coordination The Audit Committee of Parliament: The Advisory Board for Rehabilitation has not succeeded in managing its statutory duties The rehabilitation paths of clients in need of multiprofessional disciplinary rehabilitation not uninterrupted. The actors of the system favour partial optimizing. A need to set paths for the next Government Programme to clarify the rehabilitation provision between the four main actors

12 Objectives of the Government Programme for a multidisciplinary Rehabilitation Review Develop the service structure and process models for rehabilitation based on client-orientation aim at proper timing, availability support longer careers and a comprehensive work ability and functional capacity Clarify the responsibilities for provision and funding Strengthen the cooperation between primary health care, specialised medical care, occupational health care, the social welfare system and the Social Insurance Institution

13 Review of Multidisciplinary Rehabilitation Influencing competence in providing rehabilitation by means of instructions, trials 5. Survey of gaps in competence in providing rehabilitation and of development needs 1. Description of money flows in rehabilitation and allocation of money to services 2. Work ability Description of jäsenet: HTO, STO, VAO, Kela, and functional TEM, TTL ja THL monitoring systems for rehabilitation asiantuntijakuulemisia: Kuntaliitto, capacity Soste ja muut etujärjestöt services. Instructions Needs to amend legislation 4. Updating the division of responsibilities in vocational rehabilitation services 2007 and development needs 3. Coordination and integration of rehabilitation services in the reform of social welfare and health care Legislation basis, funding sources and distribution of costs Spread the effective models, instructions Trials, e.g.. rehabilitation of older persons, multidisciplinary rehabilitation centres. National guidance and coordination of rehabilitation Multi-channel funding investigation to be started Develop the monitoring system

14 Coordination and integration of rehabilitation services in the social welfare and health care reform What should be changed to facilitate the rehabilitation service processes for different client groups? -In what kind of packages rehabilitation services should be organised, which of them horizontally and which vertically? -Effective service process for different client groups? - Home and institutional rehabilitation of the elderly - Social rehabilitation of adolescents - Rehabilitation of unemployed -A need for an assessment by a physician/others or multidisciplinary planning? -The social reasons as criteria for access to rehabilitation? -Effectiveness of the present rehabilitation plans? -When is a contact person for rehabilitation needed?

15 The division of responsibilities and development needs in vocational rehabilitation services Objective To obtain information on how the division of responsibilities in vocational rehabilitation is implemented between -the employee pension institutions -the vocational rehabilitation organised by the Social Insurance Institution -the vocational rehabilitation services provided by the employment administration

16 Competence gaps in providing rehabilitation How to improve both client-orientation and knowledge of the system? -Increase the competence of physicians and social and health care professionals (home care) -Influence the provision of basic, further and continuing education - A virtual university and a multidisciplinary rehabilitation module with opportunity for studies in multidisciplinary rehabilitation?

17 Concept: implementation of all methods! Disability allowance Rehabilitation allowance Compensation of rehabilitation costs Allowances for self-motivated studies Suspended pension Partial disability pension Social security Partial sickness allowance Accessibility Workplace Arrangements at the workplace Community Work arrangements Occupational safety Job seeking and career coaching Training and work trials Employmentpromoting training Wage support Start-up allowance Support for spec. arrangements at work Compensation of travel costs Employment service Vocational guidance Vocational basic education and education for a degree Employment promoting training Employment services Job coaching Career coach Vocational rehabilitation Education Training trial Job trial Other on-the-job training Apprenticesship training Rehabilitation Social Health care and social services Medical Vocational Occupational health care Primary health care Specialised medical care Social services

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