Draft law (496 SE) for amending the Social Welfare Act and the Act Regulating the Provision of Health Care Services (regarding the provision of independent nursing care in 24-hour special care services) - First Reading
Session: Fifteenth Riigikogu, Fourth Session, Plenary Session.
Date: 2024-10-09 17:07
Participating Politicians:
Total Speeches: 26
Membership: 15
Agenda Duration: 32m
AI Summaries: 26/26 Speeches (100.0%)
Analysis: Structured Analysis
Politicians Speaking Time
Politicians
Analysis
Summary
The Riigikogu discussed in the first reading draft law 496 initiated by the Republic of Estonia’s Government, amending the Social Welfare Act and the Act on the Organisation of Healthcare Services. The draft concerns the organisation of independent nursing care when providing round-the-clock special care services. Minister of Social Protection Signe Riisalo presented the draft, whose main objective is to transfer the financing of independent nursing care provided in special care to the Health Insurance Fund (HIF), from the Social Insurance Administration (SKA), similarly to the reform carried out in general care in 2020. The aim of the change is to ensure a more uniform quality of the service and more flexible organisation according to the need for assistance, by creating a nationwide service description.
The Minister pointed out that the component spent on nursing care within the service price by the SKA has previously been 1.2 million euros. The Health Insurance Fund will add 1.65 million euros from its own funds, increasing the total cost of the service to 2.85 million euros per year starting from January 1, 2025. Riisalo acknowledged that special care remains underfunded (covered only 60% of the actual price) and that there are long waiting lists for the service. She also announced that co-payments (which cover living conditions and catering) will increase by 10% by agreement with the parties involved. During the debate, questions were raised about the accessibility of the service, the direction of home care, and the transparency of financing, particularly concerning the use of HIF reserves to cover fixed costs.
Decisions Made 4
The steering committee was designated the social committee, with Madis Timpson as representative.
A proposal was made to include the draft on the agenda of the plenary session on October 9, 2024.
Bill 496 has completed its first reading.
The deadline for submitting amendments was set for October 23rd at 5:15 PM.
Most Active Speaker
Rain Epler (superior) was an active questioner, focusing on the bill's financial implications. He demanded clarification regarding the elimination of minimum service volume requirements and the transparency of the new funding model (1.2 million versus 2.85 million euros), suspecting a genuine reduction in service.
Aseesimees Toomas Kivimägi
AI Summary
The Riigikogu is debating the first reading of Draft Act 496, initiated by the Government of the Republic, which amends the Social Welfare and Health Services Organization Act. The purpose of the bill is to enable the provision of independent 24-hour special care services, and the rapporteur is Minister of Social Protection Signe Riisalo.
Sotsiaalkaitseminister Signe Riisalo
AI Summary
According to Riisalo, the funding for the 24/7 special care service will move under the Health Insurance Fund in the future. Furthermore, starting January 1, 2025, the costs of providing this service will begin to be covered by the Health Insurance Fund's resources, totaling 2.85 million euros (1.2 million previously from the Social Insurance Board and 1.65 million added). This is intended to improve the availability and quality of the service, but resources remain scarce and waiting lists persist, which is why a comprehensive reform cannot be implemented immediately.
Aseesimees Toomas Kivimägi
AI Summary
Thank you. The members of the Riigikogu are ready to ask their questions and invite Andres Metsoja to respond.
Andres Metsoja
Profiling Isamaa fraktsioonAI Summary
Andres Metsoja asks how to ensure service accessibility across Estonia's various regions, why the Nordic trend is leaning more towards home care, what steps have been taken to find service providers, and how the 60/40 co-payment ratio would financially impact things.
Sotsiaalkaitseminister Signe Riisalo
AI Summary
Riisalo pointed out that special welfare services are available in 283 locations across Estonia, and old buildings have been replaced with new family homes, focusing on expanding opportunities for living at home and integrated services, and minimizing the need for 24-hour assistance. However, in some cases, institutional placement and the requirement for intensive supervision are unavoidable, and the availability of nursing care services is also expanding within institutions through a partnership with the Health Insurance Fund (Tervisekassa). The ongoing goal of deinstitutionalization remains increasing the possibilities for living at home or creating a home-like environment for individuals residing in institutions.
Rain Epler
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
Rain Epler stated that while the draft legislation allows for flexibility in the organization of special care services, the removal of minimum requirements could potentially decrease the scope of the service and compromise its quality. He further inquired how these changes would impact both accessibility and quality once they take effect.
Aseesimees Toomas Kivimägi
AI Summary
Toomas Kivimägi asks Rain Epler.
Sotsiaalkaitseminister Signe Riisalo
AI Summary
Riisalo said that the substantive service descriptions will bring clarity regarding exactly what activities must be performed and how the need for assistance should be monitored and met, which improves the availability and quality of the service. Furthermore, funding will increase by 1.6 million euros in the future. Previously, the Social Insurance Board supported the special care service with 1.2 million, and the Health Insurance Fund (Tervisekassa) will add an additional 1.65 million euros from its own resources to ensure nursing care is guaranteed for people living at home.
Aseesimees Toomas Kivimägi
AI Summary
Deputy Speaker Toomas Kivimägi asks that Kert Kingo be called up.
Kert Kingo
AI Summary
Kert Kingo noted that the bill is part of the care reform and that money is being transferred from the Social Insurance Board to the Health Insurance Fund, and she asked whether the fees for special welfare services would be raised.
Sotsiaalkaitseminister Signe Riisalo
AI Summary
Within the context of the national care reform, long-term care is central, encompassing elderly care, general welfare services, and home services. However, special care clients are working-age individuals aged 18 and over, representing an additional burden on families and informal caregivers. We will increase the participation share for this group by 10%, subject to the agreement of all parties, primarily to enhance catering and living conditions, thereby improving the overall quality of the service.
Rain Epler
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
Rain Epler stressed the need to clarify the figures: why the cost increase was stated as 1.65 million when the explanatory memorandum indicates 2.85 million, how the 2.8 million is calculated, and what the current service cost is, so that the new institution can be properly compared.
Aseesimees Toomas Kivimägi
AI Summary
This address is merely a plea directed at Rain Epler.
Sotsiaalkaitseminister Signe Riisalo
AI Summary
Riisalo explained that the nursing component of the special welfare service amounts to 1.2 million euros, the price of which depends on the individual's level of severity and the volume of round-the-clock care. Furthermore, although the total budget stands at 57 million euros, only one specific part is currently being addressed, and no growth is anticipated for the next year.
AI Summary
Rene Kokk points out that the special care service has become significantly more expensive in recent years, and the shortage of care workers combined with low salaries makes providing the service very difficult. He then asks what ideas and proposals are currently being developed regarding how to value and fairly compensate these employees so that young people would be encouraged to study the profession and work in the sector.
Aseesimees Toomas Kivimägi
AI Summary
The Deputy Chairman invited Rene Kokk to take the floor.
Sotsiaalkaitseminister Signe Riisalo
AI Summary
Riisalo emphasized that it is crucial to clearly distinguish between the roles of nursing service providers, carers, and activity supervisors, and that the increase in care workers' salaries and the growth in job positions resulting from the care reform is solid progress (400 new general care workers and 800 additional spots). However, there has been a setback in special welfare, and the 15% increase was necessary to maintain competition. Meanwhile, 45 special care service providers have received operating licenses and can begin their partnership with the Health Insurance Fund (Tervisekassa) next year. Furthermore, OSKA data shows that although there are many qualified people in social work, few remain in the field due to the heavy workload and low pay. We are attempting to mitigate this through European funding and cooperation with the Estonian Social Work Association to make social work more attractive and ensure workers are better supported, although this remains a difficult task.
Aseesimees Toomas Kivimägi
AI Summary
Deputy Speaker Toomas Kivimägi calls upon Martin Helme to speak.
Martin Helme
Profiling Eesti Konservatiivse Rahvaerakonna fraktsioonAI Summary
Martin Helme claims that although the total sum is 57 million and it is stated that it will not increase, a portion of the money is being transferred to the Health Insurance Fund (Tervisekassa), and the additional funding will come from its resources, not the state budget. He argues that this move might lower the prices of special welfare services and place a burden on local municipalities. He then poses the question of what the response to this criticism is and what obligations or additional costs local governments will incur.
Sotsiaalkaitseminister Signe Riisalo
AI Summary
Riisalo said that the role of local governments does not extend to managing the 24/7 special welfare service, and while municipalities may act as guardians for private individuals if a person lacks a close relative to fill that role, this does not mean that service payments should be covered by the local government budget. Furthermore, the calculations made by the Association of Providers of Special Welfare Services for transferring money from the Social Insurance Board to the Health Insurance Fund were based exactly on the volume of nursing services indicated in their reports, and there is no objective dispute on this matter.
Aseesimees Toomas Kivimägi
AI Summary
Toomas Kivimägi thanked the Minister, acknowledged his thorough knowledge and factual accuracy, and invited Madis Timpson, the Chairman of the Social Affairs Committee, to the Riigikogu rostrum as a co-rapporteur and the representative of the leading committee.
Madis Timpson
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
The Social Affairs Committee discussed the bill scheduled for its first reading, covering the funding of care and healthcare services and salary issues. They then unanimously decided to appoint Madis Timpson as the representative in the lead committee, to add the bill to the plenary session agenda on October 9, 2024, and to conclude the first reading.
Aseesimees Toomas Kivimägi
AI Summary
The Chairman thanked the audience and invited questions, subsequently turning to Anti Haugas.
Anti Haugas
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
Anti Haugas highlighted that the provision of nursing services is a significant problem, which manifests through state funding in general welfare institutions, where ambulance workers are being used as nurses and often work multiple consecutive 24-hour shifts. He questioned whether this is sustainable given the shortage of nurses and whether these 24-hour shifts had been discussed by the committee.
Madis Timpson
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
Madis Timpson stated that there had been no discussion about this in the commission, and he would only share his personal opinion after leaving the stage; until then, he might treat you differently as a fellow party member, and you should ask after the speech, because he is only presenting what was debated in the commission.
Aseesimees Toomas Kivimägi
AI Summary
Toomas Kivimägi expressed his thanks and informed the assembly that the negotiations had been opened and closed, the first reading of Bill 496 has been concluded, the deadline for submitting amendments is 5:15 PM on October 23rd of the current year, and the proceedings regarding the second item on the agenda have been completed.