Peer Review on Social Protection Information System Finland On the way from separate systems to the national service architecture Lithuania, 23 November 2017 DG Employment, Social Affairs and Inclusion Written by Sari Pitkänen November, 2017
EUROPEAN COMMISSION Directorate-General for Employment, Social Affairs and Inclusion Unit C1 European Commission B-1049 Brussels Contact: Dijana Ror and Bent-Ole Grooss E-mail: EMPL-SPSI-PEER-REVIEWS@ec.europa.eu Website: http://ec.europa.eu/social/main.jsp?catid=1024
EUROPEAN COMMISSION Peer Review on Social Protection Information System DG Employment, Social Affairs and Inclusion Directorate-General for Employment, Social Affairs and Inclusion Peer Review on Social protection information system Lithuania, 23 November 2017 November, 2017
Peer Review on Social protection information systems Europe Direct is a service to help you find answers to your questions about the European Union. Freephone number (*): 00 800 6 7 8 9 10 11 (*) The information given is free, as are most calls (though some operators, phone boxes or hotels may charge you). LEGAL NOTICE The information contained in this publication does not necessarily reflect the official position of the European Commission European Union, 2017 Reproduction is authorised provided the source is acknowledged.
Table of Contents 1 Situation in the peer country relative to the host country... 1 2 Assessment of the policy measure... 2 2.1 Similarities in the policy measures... 2 2.2 Differences in the policy measures... 3 3 Assessment of the success factors and transferability... 4 3.1 Assessment of the success factors... 4 3.2 Assessment of transferability... 4 4 Questions to the host country in the Peer Review... 5 Annex 1 Summary table... 6 Annex 2 Example of relevant practices... 8
1 Situation in the peer country relative to the host country In Finland, the social protection system is divided into social security and social welfare. According to the Constitution of Finland (731/1999) there is a right to social security for everyone who cannot obtain the means necessary for a life of dignity. Permanent residents have the right to basic subsistence in the event of unemployment, illness, disability, during old age, at the birth of a child and the loss of a provider. Social Welfare Act (1301/2014) defines organizing social and health care as duties of municipal authorities and stipulates the services that municipalities must produce. There is also special legislation for child welfare, child day care, treatment of substance abusers, special care of people with intellectual disabilities, disability services, informal care support, family care, rehabilitation and older people. Social assistance is provided by law (Act on Social Assistance 1412/1997, the new Social Welfare Act, the Act on the Status and Rights of Social Welfare Clients). Social protection in Finland is financed by employers (the share in 2015 amounted to 34.4%), state (26.5%), municipalities (20.8%), insured people (13.3%) and the returns on social protection funds (6%). Social assistance is a discretionary last-resort financial assistance determined by the household's income and expenses. Social assistance consists of basic social assistance, supplementary social assistance and preventive social assistance. Social assistance is the last-resort form of financial assistance. Until the end of 2016 social assistance was granted by municipalities. Since 2017, basic social assistance is granted by the Social Insurance Institution of Finland (KELA), while municipalities are responsible for granting supplementary and preventive social assistance. The supplementary social assistance covers special expenses such as housing costs arising from special needs or circumstances, e.g. long-term or serious illness, and children s leisure activities. Preventive social assistance functions as a means for independent coping and preventing social exclusion. The amount of basic social assistance is regulated by the law. In 2017 the basic amount for social assistance for persons living alone is EUR 485.50 per month, while in 2016 it was EUR 487.89. Social assistance recipients usually receive other types of allowances in addition to social assistance, such as housing allowance, unemployment security or sickness allowance. In 2015, 7.3% of the Finnish population received social assistance. The average duration for receipt of social assistance was 6.1 months. Total government expenditure on social assistance amounted to EUR 740.6 million. People receiving social assistance have legal right to discuss personally with social worker or social advisor. Unemployment funds are responsible for the earnings-related unemployment allowance, usually for members of a labour union. Unemployed persons who are not covered by an unemployment fund or who have exhausted their entitlement to fund-provided benefits, get basic unemployment benefits from KELA, such as the basic unemployment allowance and the means-tested labour market subsidy. In comparison to Lithuania, in Finland there is a strong legislative basis for access to social assistance and services to maintain an adequate standard of living of vulnerable citizens. On the other hand, there has been non-take up of social assistance (estimated 30-100 ME). Finnish social benefit system is complicated, and e.g. experimental study on a universal basic income aims to reshape the social security system in response to changes in the labour market. In Lithuania, municipalities are more independent in granting social assistance and social services. Also in Finland there has been variation of waiting times and code of conduct in granting social assistance. The application procedure of social benefit is not so complicated, because digital services are commonly used in applying for social benefits. In Finland too, each individual applicant is responsible for providing necessary documents for the proof of eligibility. November, 2017 1
2 Assessment of the policy measure 2.1 Similarities in the policy measures Similarity between Lithuanian and Finnish policy measures is the focus on ensuring equal provision of social support for citizens. In Finland there has been a trend to transfer responsibility and delivery of social benefits from municipalities to the state, e.g. child maintenance allowance is now administered by KELA. Also, in Finland the provision of social benefits varied a lot before moving the administration of basic social benefit to KELA. Even though Act on Social Assistance applies to all municipalities in the same way, the interpretation and application of legislation has varied across municipalities. Some municipalities had long queues in the application of social assistance. Also, the economic situation of the municipality affected the provision of social assistance and caused unequal possibilities to get it. In Finland there is no system comparable to SPIS, which integrates data from public institutions on social assistance or other social benefits or services. As in Lithuania, also in Finland there has been a trend to integrate social protection systems. Nowadays a problem of Finnish system are fragmented databases without access for public officers. People in most vulnerable situations use many benefits and services and thus use many systems. The system is complicated, esp. for unemployed people with lowest income levels. If one has to apply for basic social benefit from KELA, the unemployed person must usually contact public employment services (PES) and apply for supplementary social benefits from the municipality. There are separate calculators for different types of social benefits, but not for calculation of total amount of benefits. Also in Finland the use of several client databases has been problematic. Similar to Lithuania, the health care and social welfare data are dispersed in a number of different information systems managed by different authorities. There are only few databases for multi-professional work. TYPPI-system is used in the Multisectoral joint service promoting employment, which is a service point for long-term unemployed. TYPPIsystem is a client register, which combines information of three clientele databases: of the public employment service (PES), municipal databases (social and health) and KELA. The reason for problems in using clientele registers is that there are restrictions on using clientele data and public officials don t have access to all information they need. Even in one organisation there are various roles and user rights for viewing and using client information, not to mention the multisectoral client processes and data systems. Kanta service 1 (which is the national data system services for public and private healthcare services, pharmacies and citizens) has similar features as SPIS. Kanta Service is a statutory service concept including the electronic prescription, Pharmaceutical Database, My Kanta pages, and Patient Data Repository. Kanta Service has been developed in phases during 2010-2016. For the period of 2016-2022 a solution architecture is under construction for national information system services in social welfare, Kanta service for Social care, which includes client information management and nationwide IT services. Kanta service for Social care is developed by Ministry of Health and Social Affairs, The National Institute for Health and Welfare (THL) and KELA. The goal is to improve the information management and document management in social welfare and develop national information system solutions. The final aim is to develop the client data systems in social welfare in such a way that the client details are easier to utilize in client work for social welfare professionals nationally. 1 http://www.kanta.fi/kanta-palvelut November, 2017 2
2.2 Differences in the policy measures In comparison to Lithuania, in Finland social support and maintaining social information systems is regulated by statutory law. The Ministry of Social Affairs and Health is responsible for the legislation, planning, steering and implementation of social and health policy. In the Ministry of Social Affairs and Health, the Department for Insurance and Social Security directs and steers insurance policy and is responsible for drafting social insurance (pensions, health insurance and unemployment benefits) and other insurance legislation. THL is responsible by law (668/2008, 1227/2010) for the operational guidance of the information management in social welfare and health care, maintenance and development of the statistical and register repositories and national classifications. THL maintains the register of social assistance, which has been collected since 1985 through surveys. The register includes data on social service clients who have claimed social assistance. THL provides open data statistical information of social assistance receivers and funding from every municipality. National Pension Institution Act (731/2001) defines that KELA has to analyse social security systems and make statistics and prognoses. Statistics Finland is responsible by law (48/1992) to combine collected data to statistics and information services. In comparison to Lithuania, in Finland individuals have a lot of influence for exchange of information between public officials: one can choose, if client information is available in other clientele databases. Also, legislation has been strict in using client data in social services. Personal Data Act (523/1999) applies to the automatic processing of personal data and establishing a personal data file. The processing of sensitive data has been prohibited and data have been classified as sensitive, if they are related to the social welfare needs of a person or the benefits, support or other social welfare assistance received by the person. In order to ensure flexible and secure use of data, the Government has proposed a new act on the secondary use of health and social data. The aim is to establish a centralized electronic license service and a licensing authority for the secondary use of health and social data. The new act would streamline the processing of data requests and allow faster access to data for research and innovation activities. The Government proposal is included in the 2018 draft budget. The new law will unify Finnish legislation in accordance with EU general data protection regulation (2016/679). In addition, the Ministry of Social Affairs and Health has, together with stakeholders, drawn up a strategy for Information Management in healthcare and social welfare (ehealth and esocial Strategy 2020). The central idea of the strategy is to put information related to social welfare and health care services into effective use to support well-being and to enhance the services. The objective is also to support the active role of citizens in maintaining their own well-being by improving information management and increasing the provision of online services. There are also differences in scope of digitalization of public services and benefit systems in Finland. There is an Act of common digital services in public services (571/2016). Digitalization is a cross-cutting theme also in the present government program. There have been several programs for digitalization of public services. There is an ongoing National Service Architecture Programme (KaPA 2014 2017) and a Digital municipality trial. KaPA aims to facilitate transactions by citizens, companies and organisations with the authorities and to promote corporate opportunities for leveraging public administration databases and services. In Finland digitalisation of health care began in the 1980s, but active efforts to standardize the content and technology of information management in the social welfare sector started only in the mid-2000s. November, 2017 3
3 Assessment of the success factors and transferability 3.1 Assessment of the success factors One success factor of the Lithuanian model is that it has been developed systematically. Digitalisation of the social sector, data collection and creation of online social assistance services has been planned for a long time, but then implemented during a rather short period. Lithuania succeeded at combining 70 social benefit systems into one database. In Lithuania, the state succeeded in getting all municipalities into the system, even though they have been various procedures and practices for providing social support. Lithuanian example shows that it s easier to build totally new system and enterprise architecture to databases than try to make some parts of them compatible. In Lithuania, there are probably no such sectoral and segmented online databases as in Finland, where in a small municipality there can be 70 data systems for special purposes and statutory systems in addition to it. In Lithuania, there has been a strategic partnership between municipalities and SADM since 2005. In Finland, the partnership agreements are rare and in practice it is always the legislation what is needed for co-operational processes between state and municipalities. In Lithuania, a success factor has been that municipalities have been included in the development and gained benefits for citizens and public officers from SPIS. Another success factor is that the lack of digital skills of citizens and public officials) has been noticed and measures taken to improve the situation. Video instructions for people applying for social security are good in getting citizens as users of SPIS. SPIS had good features that help to use and get benefit from the use of online-service based model. Also, if the plans to use E-file are put into practice, they will be a success factor for citizens to use SPIS. The overall success factor of SPIS will be in the future combining SPIS into Lithuanian judicial information system, LITEKO and e-health -systems. A rather similar process which has been under construction in Finland is the development of National service architecture. The aim is to create a national data exchange layer, taking into account the shared service views required by citizens, companies and authorities, a new national e-identification model and national solutions for the administration of roles and authorisations for organisations and individuals. There has been e.g. established Suomi.fi Services, a platform which is used with single sign-on. 2 3.2 Assessment of transferability One factor improving possibilities for having a system as SPIS is in Finland is the legislation. The Government s proposal for a new act on the secondary use of health and social data will help to use the extensive data resources in social and healthcare. One problem in the digitalization of services has been identification of citizens. The most common way to log into digital services of private and public sector is through an individuals e-bank identification. However, not everyone could get an e-bank identification, e.g. persons with debt and payment problems were not eligible. Since 2017 there were changes in the legislation of payment services and it facilitated everyone to get e-bank identification. Through the transferability of systems as SPIS, citizens common usage of and the ability to use digital programs is positively affected. One reason, which caused problems in transferring basic social assistance from municipalities to KELA, was that the new ICTsystem was under construction and not tested enough, e.g. some procedures had to be 2 https://esuomi.fi/?lang=en November, 2017 4
made manually. The use of online applications varies a lot: only about 10% of pensioners, but 90% of students apply for benefits online. In the beginning the capacity of the system was not sufficient, while usage of online system was on unexpectedly high level for persons applying for social assistance (about 55-60%). A major factor, affecting the transferability of Lithuanian SPIS, is the ongoing health, social services and regional government reform in Finland. In the future it s not the municipalities, but the counties, that will be responsible for healthcare and social welfare. For the structural change, a digital transformation program was established. The aim of the program is to implement digitalisation of the government and public services as a single service platform and launch 2 or 3 nationally available patient and customer information systems as part of it. State owned company (SoteDigi Oy) begins to develop national client and patient information systems and other digital solutions for social and health care. Many development programmes have been initiated for unification and integration of different databases in Finland. There is a program for the development of information of cost-effectiveness data (2017-2018), which is implemented by Ministry of Health and Social Affairs and THL. The goal of the program is to promote health, social services and regional government reform by producing national indicators and pilot data materials. Data materials and indicators can be used in national planning and monitoring of health and social affairs and at local level at service production level in the counties. There are 11 projects developing social and health data system for state of welfare and welfare services, receipt and usage of services, resources and expenses of services, and quality and efficacy or services. At moment there are 406 present indicators for these themes and 215 new indicators were suggested to be produced. Another programme, affecting the possibilities to enhance the systems as SPIS in Finland, is STePS 2.0 program for Monitoring Social and Health Care Information Systems and Services (2016-2019). It s a co-funded project by the Ministry of Social Affairs and Health and research institutes. In the preceding STePS-programme (2013-2015) data collection was undertaken prior to the introduction of national Kantaservices. In 2017, data collection reporting focuses on monitoring and information relevant to social and health care-reform decisions 3. 4 Questions to the host country in the Peer Review Lithuania is advanced in developing SPIS-system that combines various databases. Where did the SPIS idea originate from and what was the original incentive for this kind of solution? (e.g. political decision, technical advice) In comparison to Finland, citizens of Lithuania do not commonly use digital services. Are there any other measures in Lithuania similar to the videos in the SPIS which aim at enhancing use of SPIS when applying for social support? In Finland, in the organisations there is a lot of variation in the number of personnel working with the ICT systems. The number of staff working with the SPIS at the national level in Lithuania seems to be rather small. How is this kind of efficiency in terms of human resources and results achieved and are the resources in balance with future plans to develop the system? In Finland, the digitalisation of social and health care services and information is supported by the legislation, strategies and governmental programmes. Are there any strategies and policy programmes that support launching data system as SPIS? 3 https://www.thl.fi/en/web/information-management-in-social-welfare-and-health-care/what-isinformation-management-/follow-up-of-the-information-system-services-in-social-welfare-and-health-care November, 2017 5
Annex 1 Summary table Situation in the peer country relative to the host country Social protection system is divided into social security and social welfare. Social security is mainly granted by the state and social welfare services are in the responsibility of municipalities. Social assistance is a legally regulated right of citizens. In the legislation, there are regulations on eligibility for social assistance, timetable of decision making of granting social assistance and amount of basic social assistance. Since 2017, the administration of basic social assistance has been the duty of the Social Insurance Institution (KELA), while municipalities are still responsible for granting supplementary and preventive social assistance. Assessment of the policy measure Similar feature in Finland is that citizens and public officials need to use various databases. Different kind of user rights make receiving data about clients difficult at the organisational level and especially in the context of multisectoral work. There is no system in Finland similar to SPIS in Lithuania. There have been efforts to develop such a system for private and public service providers and citizens, e.g. Kanta-service in health care (developed in 2010-2016) and Kanta service for Social care (developed in 2016-2022). In both countries the aim is to ensure equal provision of social security to citizens. Due to differences in granting social assistance in the municipalities, granting of basic social assistance was transferred to KELA. In Finland, collection and delivery of statistical information about social security and social services is regulated by law. The Ministry of Social Affairs and Health, KELA, THL and Statistics of Finland have all roles in collecting information and maintaining the data system of social assistance. Digitalisation of public services has been promoted via governmental programs, projects and new legislation. Digitalisation and using digital service is more common in Finland. Assessment of success factors and transferability A success factor of SPIS is the systematic development of it, making partnership agreements and showing benefits of system to municipalities and citizens. Features that make use of SPIS easier, such as calculators and guiding videos, are positively reflected in the number of users. Future plans of developing SPIS to combine other data systems with it and to use E-file will improve the usability of SPIS. In Finland there s ongoing enhancement of digitalisation of public service and reform of health, social services and regional government. These require unified data systems and thus would benefit greatly from transferring a system such as SPIS to Finland. ehealth and esocial Strategy 2020 and development programs as STEPS 2.0 will help the implementation of digitalisation in social services. For possibilities to use data of people in social services and receiving social assistance, the new act on the secondary use of health and social data will bring improvements. Questions to the host country in the Peer Review Where did the idea originate and what was the incentive for that kind of solution? (e.g. political decision, technical advice) November, 2017 6
Are there any other measures in Lithuania such as the videos in SPIS which aim at enhancing the use of SPIS when applying for social support? Are there any strategies and policy programmes that supported the launching data system such as the SPIS? November, 2017 7
Annex 2 Example of relevant practices Name of the practice: Year of implementation: Coordinating authority: Objectives: Main activities: Results so far: Transformation of basic social assistance from the municipalities to Social Insurance Institution of Finland (KELA) 2015 legislation 2017 into operation Social Insurance Institution of Finland (KELA) To unify nationally processes and delivery of basic social assistance Launching a new data system and process of granting In the beginning the new data system didn t work properly due to the large number of new applicants and the high usage of e- services. Process was evaluated due to difficulties and the main lessons to be learned were to launch systems and process by piloting first and taking risk into account more profoundly. Nowadays KELA receives over 55% of basic income applications online and over 60% of extended applications. It was known that people don t apply social benefit due to stigma. Threshold of applying basic social assistance is lower e.g. due to online application. The number of applicants and receivers of basis social assistance is a bit higher, but lower than predicted. Unlike municipalities, KELA receives information from tax administration which makes data of persons income little bit reliable. In 2019 the national income register will be launched and after that information is received also from pension institutions, employment official and the Population Register Centre. Statistics of social assistance is available in few days. Name of the practice: Year of implementation: Coordinating authority: Objectives: Main activities: Results so far: Monitoring Social and Health Care Information Systems and Services project First stage 2014-2016, second 2016-2019 Ministry of Health and Social Affairs Collect data on the availability and use of e-health in Finland, utilization of national Kanta-services citizens views of e-health and e- welfare services availability and use of e-welfare in Finland and physicians and nurses use and usability of health information systems In 2017 data collection forms the next data collection point, reporting focuses on monitoring implementation of the strategy, implementation of national Kanta-services, the production of information to support social and health care reform regarding status of horizontal and vertical information exchange /impacts in different regions The database reports that offer a flexible way to view data e.g. results on required level of detail (by region, by time, by service, by user group), sort results and, view results graphically and export results map, time series, diagrams (www.thl.fi/tikuinstructions) November, 2017 8