Final day in Finland

I met with the Development Manager at 8 am. He outlined the programme of development planned to the year 2020. It was very impressive that they had such a clear vision of their overall strategy and direction as well as a quite detailed programme. There were 7 general projects and about 18 sub-projects for individual departments. The general projects included an e-service delivery service for replacing medications on the wards; IT plans to go paperless, sending patient letters via an e-letter system to the Finnish mail service who then print these out, put them in an envelope and post them out (did wonder where this fitted with patient confidentiality!); developing the concept of the patient hotel; combining services. alongside this is the buildings programme. We discussed the need for change and ways of managing resistance to change.

After this I met with Katja who was driving me to visit two hospitals. It was really great to meet Katja as she has worked in the UK for 10 years and so has a rally good understanding of the two healthcare systems and was able to answer many of my questions and clarify lots of points for me.She is the acting head nurse of the psychiatric hospital in Kaivanto where we were to visit in the afternoon. Our first visit was to Valkeakoski hospital where we met with the Head of Nursing and the Medical Director.

Valkeakoski Hospital

They confirmed the coming changes to the municipality system and that they will be moving to 5 university areas covering the whole of Finland.  They recognise that this will have a major impact on  their future but were confident that they are large enough to be viable. They work with the 6 health care centres in their area. They too are a not for profit organisation but for them this means at the end of the year any surplus goes to the municipality (so I asked if this then meant that they spent the money to ensure there wasn't any and they agreed it probably did). They provide general medicine, mainly elective surgery, gynae and out-patient services. The medical wards have 35 beds including 4 Cardiac Care, 5 dialysis and 22 surgical beds. 

CCU (there were not patients)

The endoscopy theatre - after the morning list

Although they had a similar size budget (40 million euros) to our own CityCare, their expenditure was very different as they have many more overheads and many less staff (458). I discovered that over half of their staff are on temporary contracts. This is largely due to the maternity system. Women are paid for 9 months maternity leave but can then take unpaid leave until their youngest child is 3 years old. during this time their post must be kept open for their return. It also transpired that if temporary staff remained in continuous employment for over 2 years they had to be employed if a vacancy arose.

The length of stay of patients is quite short as many come for day surgery and others move to the primary health centre beds once they are stable. The demand for these beds is such that they are building a new unit of 96 beds which will be joint funded by the municipalities and private funding for primary care patients and supported housing. It will have 24 hour care available.

The new primary care / supported housing building

We visited the m ain areas of the hospital including their emergency department. Like the others this only takes patients referred from the primary care health centres Monday to Friday 8-4 but after this accepts direct referrals. They too had one room for drunk / violent patients. It was interesting to hear Katja's views on this as a psychiatric nurse. She thought it was really good as it provided a safe environment for both staff and patients but recognised in the UK this would probably be seen as a violation of human rights! The emergency department also shared with the primary care but here the nurses would work across both areas, especially at night and weekends.They managed to separate the budgetary costs of this. Here the nurses were working more autonomously and often in more specialist roles. Katja and Paivi explained that because of the relatively small numbers of nurses specialising most of their training was done "on the job" but there were often courses they could access and some of the universities were now offering joint training opportunities. They also provided a rationale as to why nursing seems to behind compared to England. The nursing unions are very strong in Finland. They have opposed nurses taking on extended roles without additional pay. Because there is no general pay structure such as our banding system nurses have been actively discouraged from taking on more skills!

By the  main reception there was an area with a blood pressure machine. There has been a move to set up health kiosks and to encourage people to check their blood pressures, blood glucose, BMI and in some places offer vaccinations and health promotion advice.

They took me to the "Polyclinic". This actually turned out to be the out patient department and where they carried out investigations and some day surgery. Their psychiatric services are all based at Kaivanto, although all of the health centres should have a nurse specialising in depression and a substance misuse worker.

After lunch Katja drove me to Kaivanto Psychiatric Hospital. This is 35km away. It has 116 in-patient beds with an assessment polyclinc and rehabilitation support. It has an acute admissions ward (30 beds), longstay ward (20), rehabilitation (28), psychogeriatric (26) and substance misuse ward (12). 

Front of hospital

Back of hospital

Like many of the district hospitals it too was set in a peaceful and beautiful environment.

Leading down to the lake and sauna

The Frisbee Golf area!

Katja told me that there had been a decision to close the hospital 2 years ago but there had been a major fight to keep it open and last September they were saved. However, they are going to have some major management restructuring which will include reducing the nurse ward managers from 6 plus a lead nurse to 2. They try to work closely with the community services but this has been blocked by the municipalities who do not think that patients want treatment in the community to be provided by the psychiatric services. There are often many "projects" which receive funding for short-term but do not then continue. This often leaves patients adrift having had extra support and then this stops as soon as the funding ends. A major initiative in Finland for nursing is the development of evidence based practice. This has not been widespread but is being driven forward now. It does not have central government backing as in the UK with NICE and Katja explained that the duodecim chains are very medically driven, focusing on medication management.

The hospital provides support services for the patients which are seen as key elements in developing self-esteem and helping to improve patients' social skills. They offer textile therapy, carpentry, sports, occupational therapy, outdoor work and physiotherapy. As a parting gift I was given a beautiful piece of embroidery.

The woodwork on sale

The embroidery

The looms

The support worker asked me if we had equipment like the looms in England but I had to confess I had only seen such things in a museum!

Katja then drove me back to TAYS. I met with Pirjo and then came back to the flat to write up my blog and start my packing - which I am dreading! TAYS had really kindly given me a gift of some towels as Tampere is famous for its linen. I am not sure where they will go in my luggage but they are a lovely gift! 

Goodbye to TAYS where I have spent the last 4 weeks

Tonight I am going to the cinema with Pirjo to see "Snow White" and then she will kindly take me to the railway station to go to Helsinki and the airport. It was strange to think that this is my last time here having been here for these 4 weeks. I have learnt so much and experienced such an amazing vareity of both work and social activities. I am not sure how much time I will get in Berlin to write my blog but this has been the focus of my time here anyway.