A pragmatic reformer of social and healthcare services

Joanna Sinclair

Finland’s health, social services and regional government reform is a change of historic proportions that touches each and every Finn. Chief physician Andreas Blanco Sequeiros has been closely involved in building Soite, Central Ostrobothnia’s Joint Municipal Authority for Social and Health. He is also active in LAPE, a program to address child and family services, which is one of the Finnish government’s key initiatives.

Blanco Sequeiros is no stranger to working on numerous projects at the same time. Five years ago he was drawn to Central Ostrobothnia, when he was offered a unique opportunity to build a brand new children’s hospital from modest beginnings. Today the hospital is Finland’s tenth largest maternity hospital and one of the country’s most operationally integrated hospitals in pediatrics.

On a national level Blanco Sequeiros is particularly influential in acute issues, such as developing children’s on-call-services.

“Disruption in healthcare has been ongoing for ages. Preparation for the current social and healthcare reform started in the 1990s. The transformation has been prolonged, and at first even small changes took years. In the 2000s plans have boomeranged back to the drawing board time and again. In the 2010s governments have each in their turn attempted to carry out rapid reform, without success,” Blanco Sequeiros describes.

“In the midst of the latest social and healthcare reform, many people have a hard time judging what is necessary and what is not to drive this longwinded change forward,” he summarizes.

“Finding the core of complex issues, strategic thinking, and implementing necessary change are usually my strengths. The latest social and healthcare reform, however, has involved simultaneous changes on so many levels that it has been challenging to determine just how I could best be of service,” he continues.

LAPE drives child and family services renewal in counties

“I strongly feel that my job is my vocation. I strive to be useful in numerous ways.  This disposition is very typical for healthcare professionals, as is its consequence: we often have a sundry of projects in the works simultaneously,” Blanco Sequeiros smiles.

Currently, Blanco Sequeiros is particularly enthusiastic about his opportunity to renew child and family services in the LAPE program, in which he acts as Central Ostrobothnia’s project manager.

“LAPE is beyond doubt the Finnish government’s most important key initiative in the social and healthcare reform. LAPE aims to renew child and family services in the future counties,” Blanco Sequeiros says.

“There is much more to LAPE than merely developing social and healthcare public actor operations. LAPE will renew county child and family services on a broad scale, creating an integrated whole together with service providers, children, families, associations, parishes and other third sector actors. The aspiration is to strengthen the wellbeing of children, youth and families,” he lists.

The potential of freedom of choice

In May 2017, the Finnish government submitted a proposal on the legislation on freedom of choice as a part of the social and healthcare reform.

Freedom of choice refers to the peoples’ right to choose their own social and healthcare providers. The most radical change to the current system would be an obligation for counties to privatize all social and healthcare services in which freedom of choice would apply.

Publicly funded social and healthcare services in the new health and social services centers could be produced by public, private and third-sector operators, and client fees for all service providers would be the same. The county would compensate service providers for the services they produce based on a previously set calculation method.

In the proposed model, service providers are expected to compete for clients with services that are both higher quality and easier to access, thus creating greater impact. The public sector’s new independent level of government, the county, would act as service manager and primarily concentrate on financing, combining, and monitoring services, as well as producing the most challenging social and healthcare services in the county’s public enterprise.

“Freedom of choice has potential, albeit as a professional I see that public sector services are often the most cost effective and impactful method for creating wellbeing,” Blanco Sequeiros affirms.

Maternity and child health guidance outside freedom of choice?

Like the majority of professionals in his field, Blanco Sequeiros is especially determined on one issue: Finland’s maternity and child health guidance is globally unique in its accessibility and scope, and therefore freedom of choice should not be extended to this service.

In April 2017 Blanco Sequeiros actively participated in creating a joint statement in which the Finnish Pediatric Society, the Finnish Society of Obstetrics and Gynecology, the Finnish Perinatal Association, the Finnish Association of Pediatric Neurology, the Finnish Society for Child and Adolescent Psychiatry, the Professors of Pediatrics, Chief Physicians of  Gynecology and Obstetrics, and the Chief Physicians of Pediatrics in every county together appealed to decision makers to keep Finland’s maternity and child health guidance outside freedom of choice.

“Together we questioned if for example the program to reform child and family services, LAPE, could achieve its goals, if some counties decided to extend freedom of choice to maternity and child health guidance, and privatize this service,” Blanco Sequeiros explains.

“Change is necessary, but not on the expense of impact. Maternity and child health guidance is already a well-functioning local service. With LAPE, the aim is to build even more impactful services around it. Just like school and student healthcare, maternity and child health guidance should unequivocally be left outside freedom of choice,” he emphasizes.

In early July 2017 news came out that that the government’s freedom of choice proposal shall be redrafted.

Service must have impact

Blanco Sequeiros says he steers clear from ideological questions in the social and healthcare reform. Above all, he concentrates on impact.

“I have a very pragmatic approach to things. No ideology guides me in developing social and healthcare services. I think development work should be open to all solutions that can bring the desired outcome,” he underlines.  

“The most important goal for tax-funded social and healthcare services is to create health and wellbeing for people. It does not necessarily matter very much whether the service is produced by a private or public service provider, as long as the service is ethical, impactful, cost-effective and it can be transparently evaluated,” he adds.

In his work as a children’s hospitals Chief Physician Blanco Sequeiros sees how good, high quality service Finland’s public sector produces daily. Alongside the high professional ethics of healthcare professionals, liability for acts in office is also a major driver of public service quality.

Blanco Sequeiros admits that public healthcare is rigid compared to private healthcare, because public officials diligently follow law, regulations, guidelines from authorities, and other rules.  He emphasizes, however, that liability for acts in office is an important factor ensuring the good quality and impact of public services.

”The social and healthcare reform will create structures in Finland - and perhaps with time a working market - which calls for ethically and morally conscientious actors in both the public and private sector. We need people who are passionate about doing their jobs well and creating wellbeing. We also need clear, mutually agreed upon and continuously evaluated ground rules,” Blanco Sequeiros states.

Andreas Blanco Sequeiros has participated in the Management in Healthcare (Johtaminen terveydenhuollossa) and Aalto Executive MBA programs at Aalto EE. The programs he attended brought indisputable benefits. Thanks to them, he has been able to save his employer millions of euro annually. Read more about his experiences »

 

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