HUS Annual Report 2010
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
CONTENTS
HUS IN BRIEF
Chair’s Review 4
The Hospital District of Helsinki and Uusimaa (HUS) is the largest hospital district and the fourth largest employer in Finland. HUS provides specialist medical care services for the nearly 1.5 million residents of its 26 member municipalities. In addition, HUS is responsible for providing certain types of expert-level medical care for the entire population of Finland.
Chief Executive Officer’s Review 5 2010 Was a Good Year 6 A New Hospital for the Future 14 Vacation of Meilahti Tower Hospital Commenced 17 New Pancreas Transplant Programme 20 Outpatient Care Instead of Hospitalisation 22 Years of Turmoil in HUCH Child Psychiatry Department 25 In Hyvinkää, Children’s Appointments with Paediatric Neurologist take place in the Family Centre 26 Every Day Is a Birthday in HUS 29
In addition to the HUS Joint Authority, there are also independent limited companies in the HUS Group.
Nearly half a million patients are treated each year at the 21 HUS hospitals. Employing about 21,000 health care professionals, the HUS Joint Authority has a turnover in excess of EUR 1.5 billion.
Hyvinkää Hospital Area
Extension of Children’s Hospital Completed 31
Porvoo Hospital Area
Kellokoski Hospital
HUSLAB Cooperated More Closely with Finnish Municipalities 33
Hyvinkää Hospital Mäntsälä
Towards More Individualised Cancer Care 34 Organisation and Representative Bodies 35
Lohja Hospital Area Paloniemi Hospital
Executive Board Members 2010 39 Joint Authority Profit and Loss Account 2010 40 Joint Authority Financial Statement 2010 41
Karkkila Nummi-Pusula
Council Members 2010 38
Tuusula Kerava
Vihti
Vantaa
Lohja
Askola
Järvenpää
Nurmijärvi
Lohja Hospital
Länsi-Uusimaa Hospital Area
Lapinjärvi
Hyvinkää
Pornainen
Loviisa Porvoo
Sipoo
Espoo
Karjalohja
Kauniainen
Joint Authority Balance Sheet 2010 42
Siuntio
Karjaa
Consolidated Profit and Loss Account 2010 44 Raasepori
Consolidated Financial Statement 2010 45
Kirkkonummi Inkoo
Jorvi Hospital
HUCS Hospital Area
Consolidated Balance Sheet 2010 46 Hanko
Tammiharju Hospital Länsi-Uusimaa Hospital
Porvoo Hospital Peijas Hospital Skin and Allergy Hospital Surgical Hospital Kätilöopisto Maternity Hospital Children’s Hospital Children’s Castle Meilahti Tower Hospital Meilahti Triangle Hospital Women’s Hospital Psychiatry Centre Eye and Ear Hospital Department of Oncology Töölö Hospital
HUS also operates in the following hospitals: Aurora Hospital Herttoniemi Hospital
Texts: Niina Kauppinen, Johanna Kojola, Katri Laukkanen, Riitta Lehtonen, Merja Mäkitalo, Leena Räisänen, Johanna Saukkomaa, Johanna Sirén, Tiina Syvälahti. Pictures: Mikko Hinkkanen, Timo Löfgren, Jarmo Nummenpää.
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
A YEAR OF GOOD RESULTS
STRONG OWNERSHIP STEERING IN HUS In 2010, the HUS Executive Board was in its second year, continuing its work enthusiastically and doing its best. It was a year of many events. Among the most important were the amendments to the new Health Care Act, the decision to preserve HUS as a single entity, the discontinuation of obstetric services in Tammisaari Hospital in summer, and the default fine imposed by Valvira, the National Supervisory Authority for Welfare and Health, due to waiting lines that exceeded the limits set for them in the Care Guarantee. A comprehensive plan for the provision of psychiatric services in the HUS area was finally approved, and the plan is already moving ahead. HUS facilities have also received attention. Both the new Surgery and Intensive Care Unit at the Children’s Hospital and the Meilahti Triangle Hospital, the most modern hospital in Finland, opened their doors in 2010. Additionally, decisions were made on the refurbishment and extension of the Women’s Hospital Annex, a new building for the Jorvi Hospital Emergency Department, and a new building for the Psychiatry, Physiatry and Rehabilitation Departments at Lohja Hospital. The aim of the Executive Board has been to secure good patient care within the framework of a predictable budget. The development of the finances of HUS in recent years has shown that combined with cost discipline, the economies of scale have had beneficial effects both in terms of the economy and the quality of care. In HUS, the costs of specialised health care services per capita were lower than in other Finnish hospital districts on average. The rise in costs has been slower than elsewhere. This would not have been possible without the good work and commitment of our staff. There have been plenty of applicants and candidates for HUS tenures. The cooperation between HUS and the University of Helsinki creates a solid basis for the University Hospital. We now have a dedicated team to facilitate
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this cooperation. The Meilahti Campus boasts European expertise in its research activities, but we need to be wary of a downward trend in terms of results. The existing intellectual capital must not be lost through brain drain. We have paid special attention to research work, and the very first Research Strategy in the history of HUS/HUCH was approved in 2010. We will not be able to develop fast enough unless we provide additional support for specialised health care training and research. Knowledge and training are the cornerstones that allow us to keep up to date, and in medicine, we can only rely on researched knowledge. Two reports were commissioned to assess the organisation and activities of HUS. One of them focused on the operations and status of the business enterprises, while the other concentrated on the management and operation of various facilities and properties. The completed reports were discussed both in the Board meetings of the business enterprises and in official proposals. Any changes to the organisation of the functions and administration of the business enterprises are dependent not only on HUS, but also on new competition neutrality legislation currently in preparation. Municipal enterprises are constantly under close external scrutiny. Even after the parliamentary elections and the ratification of the new Health Care Act, it should be borne in
mind that HUS operations are based on strong ownership steering. According to municipal laws, the Joint Authority is managed by the Council. The members of the Executive Board, all of whom are representatives of their respective municipalities, were appointed by the Council. All five hospital areas and the University of Helsinki are represented in the Executive Board. To secure equal care for the entire population, the cooperation between HUS and the municipalities within the HUS area has been enhanced. HUS supports the joint development of social welfare and health care services in these municipalities. HUS also aims to ensure the availability of those specialised health care services which are best provided in municipal primary health care, provided that these activities are not in contradiction with the equal opportunities of the inhabitants. It was truly amazing how we managed to shorten the waiting line of thousands of patients under penalty of the default fine imposed by Valvira. Both our staff and facilities proved extremely flexible, and private-sector services were also utilised to reduce the delays in patient care. Inquisitiveness and a questioning mind are necessary qualities for all elected officials: How is patient care organised? Why is it organised so differently in different hospitals? How do we productise the most common forms of treatment from a patient’s first visit to the last control visit? How do we create a well-functioning specialised health care consultation model for primary health care units? A great deal of work remains to be done. Ulla-Marja Urho Chairman of the Executive Board
2010 was a successful year for the Hospital District of Helsinki and Uusimaa. We managed to shorten waiting lists that had become too long. The work atmosphere improved significantly. The public debate around HUS calmed down. With regard to our owners, the municipalities, our financial result was good. The provision of acute or urgent care is the primary function of all hospitals, with 50–60% of the resources of HUS hospitals being spent on this. In acute care, the delay between the appearance of the need for treatment and its provision can be anything from a few seconds to a few hours. In 2010, we managed to provide urgent care at a consistently high level. Owing to the holiday season, the occasional shortage of substitutes, and the increased need for certain types of treatment, the summer season presents a particular challenge. Last year we faced this challenge successfully. In May 2010, on my second day as Chief Executive, Valvira imposed a twomillion-euro default fine to have the waiting lists for non-urgent care shortened to comply with Finnish legislation. The waiting lists were shortened through more efficient operations, overtime work and purchased services. A single figure is hardly sufficient to describe the production volume of a large hospital organisation, but the weighted volume of our care services should serve to illustrate the point here: in 2010, it increased by 4.2 per cent, while our costs rose by only 2.3 per cent. So, there is no denying the increased profitability of our operations. Invoicing from the member municipalities increased by 1.7 per cent. The factors behind this phenomenon are cost discipline, well-planned and well-implemented acquisition processes, general cost awareness, sufficient monitoring and reporting, good personnel management, the further development of fluent production processes, and the close interaction between top management and direct superiors. It is all about systematic, painstaking work.
The close cooperation between HUS, HUCH and the University of Helsinki continued in 2010. Extensive scientific research was carried out despite cuts in state subsidies. Approved by the Executive Board in 2010, the new Research Strategy outlines the key areas in research activities for the next few years. There was also extensive cooperation with other educational institutions and institutions of higher education, with regard to the organisation of studies in HUS hospitals in particular. The Meilahti Triangle Hospital and the new operating theatres and Intensive Care Unit at the Children’s and Adolescents’ Hospital started operations in autumn 2010. Temporary facilities necessary for the refurbishment of the Tower Hospital were being built in Meilahti. The plan for the temporary relocation of the Tower Hospital was been drawn up carefully, and it includes significant relocation of functions to various HUCH hospitals. HUS hospitals were again beneficiaries of substantial donations in 2010. The fully automatic surgical system donated by the Erkko Foundation merits special mention here as HUCH now has two such systems, which is believed to be sufficient for the next few years. Based on an extensive staff survey, the annual working life barometer was conducted in September 2010. Both participation and the response rate were high. The results were carefully studied
after they became available in late autumn. Compared to the barometer conducted in 2008, the results were clearly better. The negative feedback submitted was also recorded carefully and will be utilised in development activities. All units have been instructed in the perusal and utilisation of the working life barometer, and they were also encouraged to publish the results in their entirety. For HUS staff, one of the most significant things in 2010 was undoubtedly the steady continuation of HUS operations without any threat of large-scale lay-offs or other threats. There was a slight increase in average work input, but this was partially caused by the reduction in the use of rented labour. In November, the Executive Board approved the principles and development policy for the HUS pay policy, which will be utilised in the drawing up of concrete models based on performance-based compensation and other forms of incentive pay. The media has followed the activities of HUS and its hospitals with interest. A critical approach is naturally part of their role, but there was also a lot of positive coverage in the papers, on TV and on the radio. The overall image of HUS in the media was definitely positive. It is extremely important that the public gets a truthful picture of the basic function of HUS, which is specialised health care. We have also invested heavily in communications and PR activities, both within the organisation and to the general public. One of the channels for this is the Chief Executive and President’s weekly blog. Towards the end of 2010, the Executive Board made a decision concerning a large-scale reform of HUS strategy, which will be carried out by HUS civil servants in cooperation with staff and decisionmakers in spring 2011. The new strategy will particularly emphasise support for primary health care, quality management, and the enhancement of patients’ rights within the service system. Aki Lindén Chief Executive Officer
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
2010 WAS A GOOD YEAR 2010 was an excellent year for HUS. We succeeded in getting under control the waiting lines for patients who had been waiting for treatment for more than six months. Urgent acute care was provided without disruptions throughout the year. With regard to our owners, the municipalities, our financial result was good. There was a distinct improvement in work atmosphere. Negotiations were conducted with HUS municipalities in spring and autumn 2010 as the financial situation of the municipalities was becoming tighter. The outcome was a service plan for the municipalities that was EUR 47 million (3.8%) lower than the amount of realised services in 2009. Accordingly, significant action on behalf of HUS was necessary to make its operations more effective. Considering the ageing population and the corresponding increase in morbidity, this was not an easy task. Furthermore, the budget included the requirement for a profitability target of two per cent, which we did manage to reach in the end. In 2010, the sales of services to HUS municipalities reached a level that was some EUR 20 million, or 1.7 per cent, higher than in 2009. The aim of the Joint Authority was a balanced economy. The next few years will be burdened by significant financial investments, however. The financial situation remained better than expected in the budget, so there was no need for the Joint Authority to take out the EUR 90-million loan earmarked in the budget. The interest rates remained low throughout the year. The average inter-
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est rate for the loan portfolio was approximately 2.1 per cent (2.8 per cent in 2009). The loan portfolio is currently a well-balanced combination of variable and fixed rates of interest. In the Financial Statements, the proportions of longterm liabilities (EUR 177.1 million) were as follows: fixed-rate loans 43% and variable-rate loans 57%. The financial result in 2010 was positive. The fact that the result exceeded the projected result in the budget was due to increased demand and reduced costs. The result for the financial period exceeded the projected result in the budget by EUR 40.3 million. There was a surplus of EUR 21.5 million in the result before hospital area-specific returns of the surplus. Some EUR 22.3 million was returned to the member municipalities, resulting in a deficit of EUR 0.8 million for the Joint Authority in 2010. Compared to 2009, the operating income in 2010 increased by 2.4 per cent. Most of this (79.3%) consisted of member municipalities’ service plans. The percentage of sales of services provided for other municipalities and patients covered by insurance policies accounted for 12.3 per cent of the income. The percentage of the income of state subsidies for tuition, research and doctor training was 2.1. Of the rest, 3.6 per cent came from customer fees, while other operating income formed 2.7 per cent of the total.
No new loans taken out by HUS
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
Member municipalities’ proportion of service income EUR 823.10/inhabitant
Profit and Loss Account Financial EUR 1,000 Statements 2006
Financial Statements 2007
Financial Statements 2008
Financial Statements 2009
Budget 2010
Financial Statements 2010
Operating income 1,349,444 total Sales proceeds 1,285 674 Payments income 50,068 Subsidies and grants 8,531 Other operating 5,171 income Operating expenses 1,262,618 total Personnel expenses 819,690 Purchased services 160,404 Materials, supplies 244,398 and consumables Subsidies 509 Other operating 37,617 expenses Operating margin 86,826 Financial income 10,473 and expenses 76,353 Result before depreciation and extraordinary items Depreciation and 62,129 reductions in value Annual result 14,224
1,404,447
1,490,522
1,547,869
1,512,536
1,584,430
4.8 %
2.4 %
1,334 307 50,240 7,671 12,229
1,425,532 49,328 7,028 8,634
1,479,476 52,874 6,256 9,263
1,443,445 54,765 5,433 8,893
1,512,931 56,916 5,873 8,710
4.8 % 3.9 % 8.1 % -2.1 %
2.3 % 7.6 % -6.1 % -6.0 %
1,320,542
1,405,882
1,451,925
1,447,305
1,485,920
2.7 %
2.3 %
849,036 174,607 256,950
893,934 195,499 274,248
922,647 201,406 285,544
939,976 188,334 277,660
953,389 202,978 287,606
1.4 % 7.8 % 3.6 %
3.3 % 0.8 % 0.7 %
540 39,409
546 41,655
553 41,775
589 40,746
443 41,504
1.9 %
-19.9 % -0.6 %
83,905 10,152
84,640 11,831
95,944 13,759
65,231 15,618
98,510 13,599
51.0 %
2.7 % -1,2 %
73,753
72,809
82,186
49,614
84,911
71.1 %
3.3 %
65,894
75,521
82,181
90,716
85,711
-5.5 %
4.3 %
7,859
-2,712
5
-41,102
-800
1,386,436
1,481,403
1,534,106
1,538,021
1,571,631
2.2 %
2.4 %
Total operating expens- 1,324,747 es and depreciation
Change, % Change, % Financial Financial Statements Statements 2010/ 2010/ Budget 2010 Budget 2010
2 000
1 500
1 000
474
500
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The operating costs exceeded the budget by EUR 38.6 million (2.7%). The increase in costs was 2.3 per cent from 2009.
21,171 EUR 1,584.4 million EUR 1,485.9 million 1.5 million
2 500
962
Number of staff Operating income Operating expenses Population (HUS area)
HUS successfully fulfilled the obligations of the Care Guarantee and reduced the number of patients who had had to wait for treatment for more than six months to only 14 at the end of the year. As late as in October 2010, the number was still close to 3,000. The number of physicians in HUS was significantly reduced during the period from autumn 2009 to spring 2010. Accordingly, the situation was the most difficult for patients waiting for cataract surgery. The waiting lines were reduced during autumn through overtime work and purchased services. In the summer, Valvira imposed a 2-million-euro default fine on HUS with the purpose of expediting HUS in its efforts to bring the assessment of the need for treatment and availability of treatment to the level prescribed in the Act on Specialised Medical Care. HUS intends to fulfil the obligations of the Care Guarantee also in future and keep the waiting lines under control.
1997
578,737 279,778 1,556,074 approx. 2.4 million 86,155 18,652 462,964 3,128
2393
NordDRG products Inpatient day products Visit products Invoiced patient events Operations Births Number of individuals using HUS services Hospital beds
Moderate growth in operating costs
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Waiting lines under control
Key indicators in 2010
2494
The most common forms of treatment provided were dialysis, pregnancy treatment, radiotherapy for breast cancer, radiotherapy for genitourinary cancer, diagnostics involving the musculoskeletal system, treatment of digestive diseases, and diagnostics involving the head or the central nervous system. These forms of treatment accounted for 31 per cent of the productised medical procedures. Deflated by the hospital cost index, the average costs of the products were reduced by 1.5 per cent over the previous year.
0 July
August
September
October
November December
Number of patients on the waiting line for more than six months, July–December 2010.
Doctor Tea Nieminen and Nurse Ulla Mari Lyytinen prepare a patient for the administration of intravenous arthritic medication in Ward K2 of the Children’s Castle.
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
HUS-kuntayhtymän toimintatuottojen HUS-kuntayhtymän toimintatuottojen jakauma jakauma vuonna 2010 vuonna 2010
availability of care, municipal customers, The single largest investment is the and the enhancement of municipal ownMeilahti hospital area. The lobby and main entrance to the Meilahti hospitals was ership steering. The total investments for 2010 amounted to EUR 113 million. The completed first in 2010, followed by the deteriorating finances of the member new extension to the Children’s Hospital municipalities were taken into account in and the new Meilahti Triangle Hospital. the preparation of the investment plan. Work is currently in progress on the The large-scale building and informaextension of the tunnel network, the tion system projects already started were building of the temporary inpatient ward, nevertheless continued. and the planning of the refurbishment Investoinnit ja poistot 2000 - 2010 120 113
40
64,2 %
15,9 %
0
64,2 %
9,9 %
3,8 %
TP2007
TP2008
Investments and depreciation 2006–2010
Key figures
Distribution of the operating expenses of Jäsenkuntien Jäsenkuntien palvelusuunnitelmien HUS Joint Authoritypalvelusuunnitelmien in 2010 %-jakauma %-jakauma
9,1 %
3,4 %
% % 1,3 % 4,0 % 1,34,0 9,1 %
4,7 %
77,6 %
77,6 %
3,4 %
HUCH Hospital HUCH Area Hospital Area Länsi-Uusimaa Länsi-Uusimaa Hospital Area Hospital Area Lohja Hospital Lohja Area Hospital Area Hyvinkää Hospital Hyvinkää Area Hospital Area Porvoo Hospital Porvoo Area Hospital Area Group Administration Group Administration
Percentage distribution of service plans for member municipalities.
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TP2009
TP2010
TP2006
Poistot
TP2009
TP2010
Vähimmäistavoite
Toteuma
Adequacy of cash flow (days)
3,8 %
Personnel Personnel expenses expenses Purchase medical care services Purchase of medicalofcare services Purchase of other services Purchase of other services andequipment medical equipment MedicinesMedicines and medical Other materials, supplies and consumables Other materials, supplies and consumables Other operating income and subsidies Other operating income and subsidies
4,7 %
TP2008
0 TP2006
Investoinnit 9,9 %
TP2007
10
3,4%% 2,8 % 3,4 % 2,8 15,9 %
25,4
20
27,6
30 86
80
82
Milj. euroa
Distribution of the operating income of HUS-kuntayhtymän toimintakulujen HUS-kuntayhtymän toimintakulujen HUS Joint Authority in 2010 vuonna 2010 jakauma jakauma vuonna 2010
109
110
40
21,6
Service income from member Service income frommunicipalities member municipalities Other salesOther income sales income Special State subsidies Special State subsidies Payments Payments income income Other operating income and subsidies Other operating income and subsidies
of the Meilahti Tower Hospital and the extension and refurbishment of the Women’s Hospital Annex. In addition to the projects in the Meilahti area, the extension and refurbishment projects in Hyvinkää, Kellokoski, Lohja and Jorvi Hospitals were being prepared and evaluated. The Meilahti Tower Hospital was preparing for a thorough renovation Kassan riittävyys (pv.)
27,2
79,3 %
82 76
79,3 %
89
14,1 %
25,4
0,9 %
66
14,1 %
3,6 % 0,9 3,6% % 2,1 %
61
2,1 %
The largest increase was in personnel costs (3.3% compared to 2009). Paid wages and salaries including secondary expenses amounted to EUR 953.4 million in 2010, exceeding the budget by EUR 13.4 million (1.4%). The increase in expenses was caused by anticipated incremental pay rises, changes in personnel structure and the shortening of waiting lines. The total number of HUS personnel stood at 21,171 on 31 December 2010. Compared to 2009, there was an increase of 262 persons. 79.1 per cent of personnel were permanent staff, which can be considered quite a high percentage. The number of work years totalled
16,694, which is 0.7 per cent less than in 2009. EUR 13.5 million was spent on temporary agency work, which is equivalent to 225 person-years. A working life barometer survey was conducted on HUS staff in October–November 2010. The response rate was 65, which can be considered a satisfactory achievement. The results were also more positive than in the previous survey conducted in 2008. The surveys clearly show that in many units the work atmosphere has improved. An extensive investment programme In the preparation of the investment programme special attention was paid to the
2010
2009
2008
2007
2006
Number of personnel 21,171 20,909 20,956 21,202 20,927 Permanent 16,742 16,757 16,749 16,917 16,560 Temporary, of whom 4,429 4,152 4,207 4,285 4,367 Substitutes 2,792 2,641 2,675 2,652 2,687 Acting/interim appointments 1,481 1,439 1,465 1,404 1,538 Short-term employees (1 to 12 days) 156 72 67 229 142 Personnel by personnel group 21,171 20,909 20,956 21,202 20,927 Nursing staff 11,854 11,725 11,658 11,999 11,798 Physicians 2,649 2,571 2,551 2,519 2,451 Other personnel 5,678 5,603 5,768 5,734 5,742 Special personnel 990 1,010 979 950 936 Average age 43.4 43.3 43.1 42.9 42.7 Women 43.5 43.5 43.3 43.0 42.8 Men 42.4 42.3 42.3 42.1 42.0 Permanent 45.5 45.3 45.1 44.9 44.8 Temporary/fixed-term 35.5 35.2 35.2 35.0 34.8 Gender distribution women/men, % 85.9/14.1% 85.8/14.2% 85.7/14.3% 85.7/14.3% 85.6/14.4 % Turnover of permanent personnel 5.8 % 6 % 7 % 7 % 6% Training days per person 3.7 3.4 3.5 3.4 3.7 Proportion of wages and salaries (excluding social security costs) of operating expenses 52.4 % 51.5 % 52.0 % 52.3 % 52.7 % Temporary agency work In EUR 13.5 16.7 16.0 11.7 7.5 In work years 225 278 288 210 169
Personnel key figures 2006–2010
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
Henkilöstö henkilöstöryhmittäin 2010 4,7%
26,8% 56%
12,5% Nursing staff Physicians Other personnel Special employees
Personnel by personnel group 2010
New Chief Executive and President for HUS
Kaavio Kaavio 7.7. Vuotuisen Vuotuisen työajan työajan jakauma jakauma 2010 2010 7,97,9 %%
3,83,8 %%
4,14,1 %% 10,8 10,8 %% 70,7 70,7 %% 2,7% 2,7%
Regular Regular hours hours Extra Extra hours/Overtime hours/Overtime Annual Annual leave leave Absence Absence due due toto illness illness Statutory Statutory leave leave ofof absence absence Other Other absence absence
Division of working hours per year 2010
Työajan rakenne, palkkamenot prosentteina 0,8 0,8 % % 1,0 1,0 % % 2,6 2,6 % % 9,2 9,2 % % 5,9 5,9 % %
80,5 80,5 % %
Regular Regular hours hours Extra Extra hours/Overtime hours/Overtime Annual Annual leave leave Absence Absence due due to to illness illness Statutory Statutory leave leave of of absence absence Other Other absence absence
Composition of working hours, cost of labour (%)
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scheduled for autumn 2011. This meant that the hospital had to be vacated, and the relocations to other HUCH hospitals commenced as early as in autumn 2010. A temporary inpatient ward building, scheduled to open its doors in the summer of 2011 as the renovation of the Tower Hospital begins, will be erected next to the Tower Hospital to allow it to be vacated. The large-scale construction sites did not have a detrimental effect on the care of patients in other hospitals in the Meilahti area.
In May 2010, HUS announced the appointment of a new Chief Executive Officer as Aki Lindén left his former post as the CEO of the Hospital District of Southwest Finland to take the reins in HUS. The new Chief Executive and President has received a lot of publicity as a prominent representative of HUS and an active contributor to public debate. Mr Lindén has played an active role in public discussion on the future of health care, not only in HUS, but in the whole of Finland as well. Lively debate over HUS Early in 2010, lively public discussion started on how specialised health care and primary health care should be organised and funded in Finland. With regard to HUS, the consensus was that HUS should remain a single entity. The new Health Care Act was passed in the Finnish Parliament late in 2010. It places several new duties and obligations on the Hospital District of Helsinki and Uusimaa. HUS will be well prepared for these reforms when the new act enters into force in May 2011. Cooperation with member municipalities was enhanced. It was agreed that HUS and Jorvi Hospital would be responsible for primary health care emergency duties outside office hours as of 1 January 2011. Another agreement concerned the merging of the Espoo Pharmaceutical Centre with the HUS Pharmacy. Pharmaceutical care services in Espoo were taken over by the HUS Pharmacy as of 1 January 2011.
Preparations for the introduction of vouchers underway In May 2010, the HUS Executive Board approved the introduction of vouchers. The act concerning vouchers became effective in 2009. The voucher is a new form of service aimed at increasing patients’ freedom of choice. The voucher system was first tested in conjunction with cataract surgery. Quality criteria were set for private service providers, and cooperation with service providers who met these criteria started in March 2011. Vouchers are available for HUS patients who are in the waiting line for cataract surgery. Having received a voucher, the patients can choose where to have surgery from among the list of approved service providers. Patients may also refuse vouchers and remain in the HUS waiting line. The value of the voucher is EUR 660, and the price ceiling for cataract surgery performed by private service providers is EUR 750. The patient’s deductible is EUR 90 at most. HUS invested in training and research In 2010, HUS invested in training and research. More than 700 students received basic training in medicine and dentistry. Furthermore, 141 medical specialists and five dental specialists graduated from the medical specialist programme. Some 4,000 health care students received practical training in HUS. The total number of students was 300 higher than in the previous year. HUS also entered negotiations concerning the re-introduction of the Master of Science (Health Care) Programme into the University of Helsinki. The HUS Research Strategy was completed in 2010. The Faculty of Medicine at the University of Helsinki was also heavily involved in the planning of the strategy. HUS utilises scientific research in the diagnosis and treatment of diseases. One of the aims of HUS is to be an internationally renowned developer and utiliser of new technologies.
Saving millions through centralised purchases In 2010, significant savings were achieved through centralised purchases both in HUS Pharmacy and HUS Logistics. These savings played a part in the positive financial result of the Joint Authority. The HUS Pharmacy savings in cancer drugs were significant. The savings for a single product were more than half a million euros per year. The savings were most significant in anti-infection drugs, where they amounted to some EUR 3 million. Compared to the previous purchasing period, savings created for the HUS Joint Authority by jointly
organised competitive bidding amounted to approximately EUR 17 million in 2010–2011. All framework agreement purchases made by HUS Logistics were recorded, and the costs were compared to existing
agreements. The average price level of the agreements decreased by five per cent. In terms of the purchasing volume of HUS, the savings are in the region of EUR 5–10 million, which can be considered significant. Savings were achieved in all hospital areas. The purchasing costs of clinical units – the most significant users – decreased the most. Of individual jointly organised competitive biddings, the greatest savings were achieved in orthopaedic and cardiology products. In both of these, the total annual savings amounted to more than EUR 1 million.
Nurse appointments on the increase Compared to 2005, the number of specialised health care nurse appointments in HUS had more than doubled in spring 2010. Where the number six years ago was 170, by spring 2010 it had risen to 460. Early in 2010, the first nurse trained in the follow-up of testicular cancer treatment in Finland started receiving patients at the Department of Oncology. The follow-up period of testicular cancer is long, lasting from five to nine years. The first and last appointments are always with a physician, as is the one halfway through the follow-up period. If the disease remains in remission, the remainder of the visits are to a nurse. At the Department of Oncology, nurses have been performing some of the physicians’ duties in the follow-up of breast cancer treatment since as early as 1997. There is a long tradition of nurse appointments in HUS. For example, foetal screenings have been performed there as early as in the 1960’s. The number of nurse appointments in HUS is the largest in the Department of Psychiatry, with around 200 nurses receiving patients in outpatient care.
After her practical training period, Radiographer Ellinoora Haapaniemi was offered a job in the X-ray department at the Children’s Castle.
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HUS Annual Report 2010
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Department of Haematology Head Nurse Susanna Tiililä acted as relocation coordinator in the move to the Triangle Hospital.
A NEW HOSPITAL FOR THE FUTURE The Meilahti Triangle Hospital, the newest and most modern hospital in Finland, opened its doors in November. The planning of the Triangle Hospital was based on a modern hospital concept, according to which patients are treated with new methods and processes. One of the visions was a paperless hospital. This could not be achieved entirely, however, as the introduction of the digital dictation system had to be postponed until spring 2011. The hospital employs an electronic case history system, where entries are made via wireless workstations during physicians’ rounds. Additionally, some of the patients have a personal multi-function device at their disposal, allowing them to call the nurse, watch TV, access the Internet, and also access their own case histories. The inpatient rooms are for 1–3 persons. Compared to older hospitals, the most significant difference is in the operation of the day hospital. The operational model for day hospital activities had been developed for some years at the Meilahti Tower Hospital and the Surgical Hospital, but it was only at the Triangle Hospital that the activities got into full swing. The underlying principle of day hospital is that the patient is discharged on the same day. In the course of the day, a single bed can be used by more than one patient. The number of annual visitors to the Triangle Hospital day hospital is estimated at 18,500. “With experience, we keep discovering new groups of patients that can be treated in the day hospital instead of a traditional inpatient ward,” says Perttu Arkkila, Head of Department. For the patients, the initial installation of a pacemaker, for example, used to mean a couple of days in the inpatient
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ward. Now the same procedure can be performed in the day hospital, and the patient can go home on the same day. The day hospital also performs follow-up for medical procedures. The patients have received the day hospital well, and they find it convenient that they do not need to wear hospital clothing there. The fact that the day hospital also has evening appointments is an advantage to patients who go to work. The day hospital is open from 7 a.m. to 8 p.m. on weekdays. Next to the day hospital is the outpatient clinic area, with which the day hospital cooperates on a regular basis. Some of the medical procedures that used to be carried out at the outpatient clinics are now performed at the day hospital. Cortisone injections, for example, are nowadays administered at the day hospital.
Helena Kallinen, Head Nurse of the new joint outpatient clinic, is excited about her new job. “The processes have been carefully thought out and described, and we aim at making them as clearly defined as possible. The idea behind this is to allow the nurses to focus on one task at a time, such as processing referrals, for example.” Each outpatient clinic has its own consulting rooms, but they can also be used by other clinics if necessary. This is team work in the truest meaning of the word. Traditional doctor-nurse teams are a thing of the past. In the new model, each six-doctor team is assisted by two or three nurses. The annual number of patients treated in the Triangle Hospital outpatient clinic area is estimated at 45,000.
The staff of the new Triangle Hospital met for the first time at a coffee reception in the new toplighted atrium in November.
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Nurses take a new approach to their work The number of staff involved in nursing care at the new Triangle Hospital is approximately 250. For many, their job description has undergone some changes since they moved to the new hospital. “For the staff, the move to the Triangle Hospital has certainly been the greatest challenge in their careers so far. They are a courageous lot,” says Riitta Vuorinen, Head of Ward Group, acknowledging the forerunners’ efforts. In the inpatient wards, every effort has been made to allow the nurses to dedicate as much of their time as possible to the care of patients. To ensure this, the orders for hospital supplies and the re-stocking of the storage facilities have been left to employees of the
business enterprises. Additionally, some of the nurses’ previous duties have now been taken over by departmental secretaries. The nursing staff focuses on providing care for so-called ‘real’ inpatients, that is, those who require careful monitoring and maintenance of vital signs, or those in an acute stage of a disease or who have not been diagnosed yet. The patients in the inpatient wards can call a nurse using the new mobile nurse call system. There are new and demanding duties for the nursing staff, particularly in the day hospital. It is no wonder then that the unit is mainly run by nurses. The nurses receive the patients and in-
dependently start the medical procedure ordered by one of the clinics. This operational model is made possible by the fact that the treatment processes of day hospital patients are welldefined, and the patients’ service needs are to a great extent predictable. The experienced nurses have also received special training to help them to identify situations that deviate from care standards and require the opinion of the specialist who referred the patient. Nurse appointments could not be started at the Triangle Hospital in 2010, but there are plans to use them for follow-up visits, injection training and memory examinations for some patient groups.
MRI Unit the first to move in The first unit to move to the Triangle Hospital was the MRI Unit of HUS Medical Imaging Centre in October 2010. There are three MRI scanners at the unit, two of which were transferred from the Meilahti Tower Hospital. Additionally, a new 3-tesla unit was acquired to replace an outdated machine. A useful additional resource for the unit is the mobile MRI truck at the Meilahti outpatient clinic. The facilities of the MRI unit follow the outlines of the triangular plan of the Triangle Hospital. In the new hospital, all medical equipment is located in spacious, dedicated facilities. Spaciousness is essential because the extremely sensitive MRI machines require an extensive magnetically compatible zone around them without electronic equipment or metallic objects. The underground floor is free of any other activity in the immediate vicinity, and is therefore an ideal and disturbance-free environment for MRI equipment. It also brings the additional advantage of being easily accessible from other hospitals in
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the Meilahti area via the tunnel network. Due to high demand, the MRI machines are in heavy use. Imaging is performed in two shifts, and the equipment is on call around the clock. Approximately 15,000 examinations are performed every year. During night-time, the examination units are often used for research purposes.
Several buildings in the Meilahti Campus are awaiting refurbishment. Initially planned as a temporary solution, the inpatient ward wing will remain in use even after the completion of the refurbishment of the Tower Hospital.
VACATION OF MEILAHTI TOWER HOSPITAL COMMENCED
The new 3-tesla MRI unit has performed as well as expected. It allows more accurate imaging of the heart, abdominal and back areas, which are extremely challenging areas for MRI. The new unit improves the quality of examinations in these areas, making diagnosis faster and easier.
Scheduled for autumn 2011, the refurbishment of the Meilahti Tower Hospital has required a huge amount of work in the form of planning and coordination. It was necessary to create a plan for the relocation of inpatient wards into other hospitals in the HUCH area for the duration of the renovation. The operation is unique in the history of HUCH. “Surgical functions will be dispersed to four different hospitals while the hospital remains fully operational. Emergency services and demanding surgical functions will continue uninterrupted,” says Reijo Haapiainen, Head of the Department of Surgery. Planning for relocation has been going on for two years, and during 2010
the final shape of the plan began to emerge. “Working conditions will be difficult in many ways during the relocation years, and occasionally it will be necessary to transfer patients between hospitals,” Reijo Haapiainen continues. The vacation of the Tower Hospital commenced in November with the relocation of medical inpatient wards to the Triangle Hospital, while Urology Ward 132 relocated to Peijas Hospital. Temporary facilities had to be found also for gastric surgery, cardiovascular surgery, cardiac and thoracic surgery, neurology, and pulmonary diseases inpatient wards. Finding sufficient office space for the Meilahti Tower Hospital staff turned out to be a major challenge. Building work started on the inpatient ward wing Building work on the inpatient ward wing adjacent to the operating unit wing of the Meilahti Tower Hospital started in June 2010. The building will house 120 beds on two floors with the necessary office,
storage and technical facilities. The hospital beds will be allotted to patients from gastroenterologic emergency surgery, cardiac and thoracic surgery, cardiovascular surgery, and neurology departments. In addition to the inpatient ward wing, some of the surgical functions will be relocated to Surgical, Jorvi and Peijas Hospitals. The pulmonary diseases inpatient ward will be relocated to the Ear and Eye Hospital. The relocations will change the daily activities in the operating units in many ways. Personnel transfers, the orientation of nursing staff into the functions to be relocated, moving the equipment, and new acquisitions have placed a huge burden on ward managers in the operating units as well as other personnel involved in the planning. In this ‘relocation jigsaw’, the distribution of duties between the various HUCH units was designed with minute precision to allow patients to be treated and examined within the time limit prescribed by the law.
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Robot-assisted surgery spreads In December 2010, HUCH received its second Da Vinci robotic surgery unit. The acquisition was made possible by a donation from the Jane and Aatos Erkko Foundation. The new robotic surgery unit was located in the operating unit at the Meilahti Tower Hospital. In 2011, the proportion of robot-assisted surgery will grow, particularly in gynaecology and thoracic surgery. The new method will be phased in, and it will also be used in certain cardiac surgical procedures and pancreatic surgery. There are also plans to extend its use into pulmonary and oesophageal surgery. Commissioned in 2009, the first HUCH robotic surgery unit is currently placed in Peijas Hospital, where as many as two thirds of radical prostatectomies are already performed as robot-assisted surgery. There are also plans to extend the application of the unit to other areas of urology.
December 2010: Head of the Department of Surgery Reijo Haapiainen and Nurse Tiina Tuomipuu giving a demonstration of the robotic surgery unit to Heli Rahka and Marja Leskinen, representatives of the Jane and Aatos Erkko Foundation.
“The ‘swimming pool lanes’ in Opera allow the situation in operating theatres to be monitored in real time,” explains Irma Jousela, Chief Physician.
Organ transplants concentrated on the Meilahti Campus The concentration of organ transplants in the Meilahti Campus, a longterm objective, took a step forward late in 2010 with the relocation of Liver Surgery Ward 5 from the Surgical Hospital to the Triangle Hospital. This was the first part of the twostage relocation of the HUCH Department of Transplant and Liver Surgery to the Meilahti Campus. Later, in February 2011, it was the turn of Kidney Transplant Ward 9, whose inpatient ward will operate at the Triangle Hospital and the Eye and Ear Hospital during the refurbishment of the Meilahti Tower Hospital. All organ transplant surgery operations in Finland are now concentrated in the Meilahti Campus. The relocation of liver and kidney transplant surgery has
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significantly increased the emergency activities in the Meilahti Tower Hospital operating unit. It also means that even more expertise and knowledge of new operating procedures is required of the staff – as well as more hours on call. In 2010, a total of 273 organ transplants were performed in HUCH, the majority of them liver transplants. Along with the amendment to the Organ Donation Act, the number of organ transplants is believed to increase somewhat, even though the real effects of the act will be seen only in 1–2 years.
Opera to cover all HUCH operating units The operating room management system Opera is now in use in all twenty operating units in HUS hospitals. The system is also operational in the cardiac wards at Jorvi and Peijas Hospitals as well as the Meilahti Tower Hospital. Opera is simultaneously a tool for both the real-time management and scheduling of daily activities in operating units and the recording, analysis and management of surgical operations. It is now possible to have real-time information on the number of operations to be performed, the use of operating theatres
at various times of the day, and how well emergency operations remain on schedule. It even allows the users to check the top 10 operations in each operating unit, or how well the units adhere to checklists recommended by WHO. “We intend to monitor the operating theatres and the changes in the spectrum of medical procedures performed there more closely than before. We hope that each operating unit will monitor their own activities and allocate their resources in the best possible way. One the most important development targets
is the reduction of night work, so that only those medical procedures that are absolutely necessary are performed during the night,” says Chief Physician Irma Jousela. Unlike previously, Opera makes it possible to monitor the use of anaesthesiologic resources at so-called virtual access points – e.g. in radiology departments, during medical procedures in outpatient clinics, and in obstetric theatres.
In addition to liver transplants, Surgeon Heikki Mäkisalo also performs liver resections, most of which in Finland are performed at HUCH.
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NEW PANCREAS TRANSPLANT PROGRAMME In March 2010, the first pancreas transplant in Finland was performed at the HUCH Transplant and Liver Surgery Department. Combined with a kidney transplant, the transplant was performed on a patient with Type 1 diabetes. Both transplants began functioning immediately, and the patient made a quick recovery.
In the Triangle Hospital, pancreas transplant patients are treated at the Transplant and Liver Surgery Department 4b.
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Active preparations for pancreas transplants had been made for several years. Surgeons Marko Lempinen and Arno Nordin had studied surgical techniques in pancreas transplant centres abroad. They performed both the donor’s removal operation and the actual transplant. Agneta Ekstrand, Head of the Department of Nephrology, was responsible for the pre-surgery examinations and treatment of the diabetic patient. A simultaneous pancreas and kidney transplant is suitable for those patients with type 1 diabetes who also suffer from renal failure. Most of the pancreas transplants worldwide are indeed performed combined with a kidney transplant. The operation improves the patients’ sugar balance and the prognosis of the kidney transplant. A pancreas transplant restores insulin production, and after a combined pancreas and kidney transplant, the patients no longer require dialysis or insulin. As many patients suffer from other diabetes-related conditions, such as cardiovascular diseases, careful pre-surgery examinations and balanced treatment of other illnesses are a necessary precondition for a pancreas transplant.
1960s. They have been rather slow in gaining popularity due to various technical difficulties relating to surgery technique, for example. Compared to other organ transplants, it is in pancreas transplants that the techniques have developed the most radically. As a result of improved immunosuppressive drugs and advanced surgical techniques, the results have improved steadily since the early 1990s. International research has shown that a pancreas transplant slows down the organ damage caused by diabetes, and may actually even repair it. Nowadays the longterm results of pancreas transplants are good. Five years after the operation, 80 per cent of pancreas transplants function well and the patient does not need insulin. Every year some 2,500 pancreas transplants are performed worldwide, 700–800 of them in Europe.
Good long-term results The first pancreas transplants were performed in the United States in the late
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OUTPATIENT CARE INSTEAD OF HOSPITALISATION In October 2010, the HUS Executive Board approved the Psychiatry Action Plan for 2010–2015. The plans outlined in the plan will bring about large-scale reforms in operational models and the operational culture. “The next breakthroughs in psychiatry will arise from a change in the system. The closer to people’s everyday lives psychiatric services get, the better. Without a significant reduction in hospital resources and their re-allocation to outpatient care we are facing a dead end, however,” says Grigori Joffe, Head of Psychiatry Department at HUCH. Together with HUS and the municipalities, institutionalised psychiatric care is being stepped down at the same time as the resources of primary health care for dealing with mental disorders are increasing, which allows them to invest in the service housing of patients suffering from severe disorders. In 2010, a new operational model for outpatient care was introduced in adult and adolescent psychiatry in the Jorvi and Peijas areas. In the new model, the activities of several decentralised outpatient units were concentrated in four units. This has made access to treatment and consultation faster. Additionally, the City of Espoo increased the number of its outpatient
The HUCH Psychiatry Centre in Helsinki houses the Acute Psychiatry Clinic, the Addiction Psychiatry Clinic and the Eating Disorder Clinic.
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service housing places by 18, which will reduce the need for psychiatric hospital care. Instead of Tammiharju Hospital, Espoo residents in need of hospital treatment will be treated at Kellokoski Hospital in future. At Peijas and Jorvi, psychiatric care is divided into three different units: the Acute Diseases Unit, the Affective Syndrome Unit, and the Psychotic Diseases Unit. In each of them, the staff specialises in research and care services that are known to be effective within their specialty area. In addition to fluent and economical processes, the purpose of these changes is to improve the availability of the services for the patients. The process has already yielded positive results. “The number of treatments available is significantly larger in the centralised outpatient clinics, and because there is more staff, the operations are less vulnerable,” says Matti Holi, Director of the Peijas Clinic Group. In acute psychiatry, all referrals are now processed at the same point, from where the patients are referred forward to either the Psychosis Unit or the Affective Syndrome Unit. This has improved the quality of care of psychotic patients, and they now have faster access to treatment. In Vantaa and Kerava, a new kind of cooperation was initiated in the treatment of patients who live in service flats and require long-term care. Instead of traditional appointments, psychiatrists are now more mobile and provide outpa-
tient care, while nurses are able to make house calls to the patients’ service flats. “Our aim is to monitor schizophrenic patients also in the stable stage. Earlier on, health centres assumed responsibility for providing the patients with housing services. There is a risk that a health centre physician is unable to manage the medication of a patient using several types of psychosis drugs simultaneously. The correct dosage may have been arrived at through a long period of trial and error, and incorrect medication may lead to institutionalisation for many years,” says Holi. Psychiatric hospital – rehabilitation for outpatient care The current emphasis on outpatient care will change the traditional hospitaloutpatient care dichotomy and bring about a decrease in hospital activities. At the end of 2010, activities at Tammiharju Hospital were significantly reduced with the decision to concentrate all patients from the Espoo area in Kellokoski Hospital, and to offer them more outpatient care services. From now on, Tammiharju Hospital will focus on providing for patients in the Länsi-Uusimaa area in need of acute psychiatric treatment. The hospital will also provide psychiatric care for Swedishspeaking children and youth in the entire HUS area. “We are investing heavily in outpatient care, and there are several projects under way for the development of outpatient care and home clinic activities,”
Psychiatric hospital beds
Hospital beds in the HUS area
Compared to the situation worldwide, the psychiatric care system in Finland is still predominantly hospital-based. The number of beds in psychiatric institutions is 4,600. If the national Mieli 2009 Project reaches its objectives, there will be 1,500 hospital beds fewer in Finland by 2015. The downsizing of institutional care is an international trend, aiming primarily at rehabilitation in familiar surroundings.
HUCH Psychiatry 351 Kellokoski 285 Tammiharju 136 Lohja 64 Porvoo 40 City of Helsinki 308
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says Henno Ligi, Head of Psychiatry Department, Länsi-Uusimaa Hospital Area. In future, all demanding psychiatric rehabilitation activities in the HUS area will be concentrated in Kellokoski Hospital. The hospital specialises in forensic and rehabilitation psychiatry, in addition to which there are also youth and acute psychiatry wards.
HUS Annual Report 2010
“In psychiatric rehabilitation we are at the cutting edge in Finland. Our rehabilitation methods are state-of-the-art, and we are constantly developing new methods, such as neuro-cognitive rehabilitation and social cognition rehabilitation,” says Risto Vataja, Chief Physician at Kellokoski Hospital.
Institutionalised psychiatric care is downsized through joint efforts
Internet therapy a cure for anxiety? Psychiatric services are brought to where the people are – and that includes the Internet. Online at HUS Mental Health Centre, patients can enter their symptoms into the symptom navigator, which will help them identify their possible need for treatment and provide more information on mental health services. Complementing more traditional forms of therapy, online therapy is currently being developed at HUS. The accessibility of online therapy will increase
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patients’ chances of getting treatment because the waiting lines for face-to-face therapy are long. Cognitive-behavioural online therapy is well-suited at least for mild and intermediate-level disorders without complications. There is convincing evidence of its effectiveness from all over the world, and it has been shown to be approximately as effective as traditional therapy. In online therapy the patient works independently, while the psychologist
monitors the sessions as he/she would a temperature curve, discussing the situation with the patient at regular intervals. The first section of the programme, focusing on social anxiety disorder, is set to come online in spring 2011. The next section will deal with depression, and the programme should be ready for more extensive application in two to three years. Online therapy is many times more economical than face-to-face therapy.
YEARS OF TURMOIL IN HUCH CHILD PSYCHIATRY DEPARTMENT During the past few years, all HUCH child psychiatry functions have undergone a thorough reform. This has resulted in shorter waiting lists that are now in accordance with current regulations, fewer inpatient hospital beds and appointments, a substantial increase in the number of patients treated, and better control of therapy waiting lines and therapy costs. The reorganisation of the Child Psychiatry Department started in 2007 when the City of Helsinki confirmed that it would establish new child psychiatry clinics. This meant substantially increased resources for outpatient care, which in turn made it possible to review the entire child psychiatry care system. In 2007, child psychiatric activities were to a large extent putting out fires; waiting lines for examinations and treatment were long, and in many cases the children had to wait in line at many different levels of care. The key factors in the reform were the establishment of regional child psychiatry clinics in Helsinki, the reorganisation of the clinics in Espoo and Vantaa, and the streamlining of the activities in all clinics. Important factors also included the concentration of acute care in one unit, the merging of intensive outreach outpatient care with inpatient care, and the centralised provision of psychotherapy. As a result of the latter, there is no longer a waiting line for psychotherapy, while the costs of purchased therapy services in 2010 decreased by EUR 600,000 compared to the previous year. Intensive outreach outpatient care refers to care that takes place in children’s
natural environment. Tailored to meet the child’s needs, it is carried out at home, at school or in day care, paying attention to the needs of the child and his or her environment. It provides the parents and other important people in the life of a child with psychological symptoms with guidance on how to support and understand the child better. The results have been good. In 2007, 22 per cent of child psychiatric patients received treatment in less than three months, which is the time limit prescribed by the Care Guarantee. In 2010, the corresponding figure was 99 per cent.
Likewise, in 2007 18 per cent of the patients were admitted into inpatient care in less than three months, while at the end of 2010 the percentage was one hundred. Simultaneously, the number of inpatient beds was reduced from 76 to 55. The number of children in inpatient care has not been reduced significantly, but the average treatment period is now much shorter. The number of bed days has been reduced from 14,620 to 11,797 in 2007– 2010. Conversely, the number of outpatient care visits has increased from 25,114 to 42,103 during the same period.
Providing intensive outreach care, Child Psychiatrist Laura Rautio and Nurse Anne Virtanen visit patients at home, at school and in day care.
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HUS Annual Report 2010
IN HYVINKÄÄ, CHILDREN’S APPOINTMENTS WITH THE PAEDIATRIC NEUROLOGIST TAKE PLACE AT THE FAMILY CENTRE The threshold for visiting a paediatric neurologist is significantly lower if the visit can be arranged at the patient’s own family centre.
Chief Physician Sanna-Leena Vanhanen (centre) and Paediatric Neurologist Tuula Kosonen meet their little patients at family centres.
This practice has already been in use in the Hyvinkää Hospital Area for 13 years; that is, ever since Sanna-Leena Vanhanen was appointed Chief Physician at the Department of Paediatric Neurology. Sanna-Leena Vanhanen has many years’ experience working as a doctor in health centres, family centres and schools, and it did not take her long to realise that there was often a great deal of overlap in the treatment of children’s developmental disorders.
She soon launched paediatric neurologist’s consultation visits to health centres, family centres and schools in the area. Currently she pays regular visits to three of the municipalities in the hospital area, while her colleague, Paediatric Neurologist Tuula Kosonen, visits the remaining two. On average, there are three consultation days for each municipality in autumn and in spring, with three consultations per day.
Learning from each other Each visit lasts between an hour and a half and two hours, the neurologist first meeting the child and parents together. Ideally, the child’s family centre doctor or health centre doctor is present at the meeting. Around half an hour is reserved for the meeting with the child and parents. The doctor examines the child and discusses the diagnosis with the parents. This is followed by a network meeting, which is attended by the parents and by the medical staff treating the child, including, for example, a speech therapist, a psychologist, an occupational therapist and/ or physiotherapist, a family centre nurse, a doctor, a nursery school teacher or schoolteacher, and a family centre or child welfare worker where necessary. “A large group of people, who are all trying to help the child,” says Sanna-Leena Vanhanen. “It is also a learning situation. For example, there was this health centre doctor who said that during the twohour consultation he had learned more about paediatric neurology than during his entire training programme. And once we know the services and resources available in the municipality, we can draw up a realistic rehabilitation plan, so that we won’t be recommending music therapy, for instance, if it can’t be provided,” Sanna-Leena Vanhanen continues.
New TV sets donated to dialysis patients at Lohja At the end of 2010, there were some 30 HUS patients receiving dialysis treatment at Lohja Hospital. The haemodialysis unit, launched early in 2007, has expanded in a controlled manner. In addition to patients from the Lohja Hospital Area, there are patients from other parts of Finland and abroad, especially during the summer. Lohja Hospital has also been able to help out by admitting patients from the HUCH area. On average, the patients spend 15 hours a week in dialysis treatment, extending over several years. This can be quite boring at times, even though the hospital provides radio headphones, magazines and books. The building of the dialysis unit coincided with the transition of TV broadcasts from analogue to digital. It turned out that there were no digital TV sets available for the patients at the time of the completion of the unit. The long wait was finally over in 2010 when the unit received the longawaited TV sets, funded by the Uusimaa Kidney Association and a donation. Along with an Internet connection accessible via the digital sets, sports, news and entertainment now enrich the lives of the patients and make the time spent in dialysis less exhausting. The patients bring their own DVDs for everybody to watch.
Efficient time management One consultation is usually enough for agreeing on further measures covering a longer period. This is normally the case for children who have not reached school age, the plan drawn up during the consultation covering the years up until the child starts school. For the parents, this means that they can be sure that things are being taken care of and that there is a definite plan. “It could come as a shock to the parents that their child may be suffering from a developmental disorder. Meeting the paediatric neurologist in the familiar surroundings of the family centre may also lower that threshold a little. And as the parents and the entire team are present at the same time, everybody knows exactly what has been agreed on.”
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TV and an Internet connections keep the dialysis patients entertained at Lohja.
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HUS Annual Report 2010
All medical appliances from a single address in Länsi-Uusimaa
EVERY DAY IS A BIRTHDAY AT HUS
In 2010, a new regional Medical Appliance Centre was completed in the grounds of Tammiharju Hospital. The centre is responsible for medical appliance services for Raasepori and Hanko primary health care and for medical rehabilitation in the Länsi-Uusimaa Hospital Area. Opened in March 2010, the Medical Appliance Centre is located in the former occupational therapy facilities at Tammiharju Hospital that were renovated for this purpose. The centre employs three physiotherapists, three equipment technicians and a maintenance technician. The Medical Appliance Centre aims to support its customers’ ability to function, allowing them to manage in domestic surroundings and in different situations. This
2010 was a busy year for HUS maternity hospitals: the Labour Ward at Tammisaari Hospital was closed down, the Women’s Hospital building project was approved, and Kätilöopisto Maternity Hospital received an award for its baby-friendly approach.
will promote their social interaction skills and help them cope in their daily lives. The activities include the identification of the need for a medical appliance, assessment of this need, the acquisition, transfer and commissioning of the appliance, and training in the use of the appliance. Medical appliances come in all shapes and sizes: various appliances for physical activity, housework, home equipment and personal hygiene. People who use medical appliances come to the centre when they need a new appliance, or when the one they have is in need of repair or maintenance. A doctor’s referral or a statement by a physiotherapist is required for customised appliances, such as a wig, prosthesis or orthopaedic footwear.
The purchasing and maintenance of medical appliances is concentrated at the Medical Appliance Centre, located in the grounds of Tammiharju Hospital.
Active municipal cooperation in Porvoo Several development projects were carried out in cooperation with the municipalities and other HUS operators in the Porvoo Hospital Area. Supervised by the Group Development Team, the Department of Medicine conducted a small-scale pilot study (SUTJAKE) on the fluent transition into continuing care of certain patient groups. As a result of close municipal cooperation, the number of advance reports on patients to be transferred into continuing care increased significantly, which in turn made it easier for the municipalities to provide the necessary care, and facilitated the patients’ transition into primary health care. Utilising the PoliHoi dependency classification programme created specifically for clinics, the emergency clinic was the first Finnish clinic to incorporate dependency classification in its operations.
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The Department of Pulmonary Medicine carried out two experimental projects with a view to reducing the number of clinic visits. In one of them, electronically generated messages were sent in reply to elective referrals, while the other focused on research into sleep apnoea and feedback on the results. During the experiment, the patients were referred directly to an examination, and feedback on research results was given by phone. Not once did the patients visit a specialised health care doctor. Both projects were successful. In child psychiatry, the activities also focused on close and well-functioning cooperation with primary health care, social services and educational services in the member municipalities. Similarly, there was extensive and fluent cooperation between various psychiatry specialties. Cooperation in the work with
families with babies involved not only family centres but also adult psychiatry, paediatric diseases and obstetrics units. Cooperation was also the common denominator in paediatric neurology. A paediatric psychiatrist and a paediatric neurologist study referrals together and also decide on the unit which is to provide the necessary treatment. To make the distribution of duties more clear-cut, a steering group for paediatric rehabilitation, with representatives from the member municipalities, was established at the Department of Gynaecology and Paediatrics. Together with primary health care, the Paediatric Unit participated in an international allergy programme.
In 2010, there were 18,649 deliveries and 18,972 babies born at HUS maternity hospitals. Compared to 2009, the number of deliveries had increased by 197 and the number of babies by 259. The increase in deliveries was largest at Lohja Hospital (+237), Kätilöopisto Maternity Hospital (+204), and the Women’s Hospital (+187). The number of deliveries at Kätilöopisto Maternity Hospital, the largest maternity hospital in Finland, was 5,881. The number of deliveries (5,624) was only marginally smaller at the Women’s Hospital. There were 3,486 deliveries at Jorvi Hospital, 1,637 at Hyvinkää Hospital, 930 at Lohja Hospital, and 831 at Porvoo Hospital. The number of deliveries at Tammisaari Hospital stood at 260 on 31 May 2010, when the maternity ward was closed down. Approximately 18 per cent of HUS deliveries were performed via Caesarean section, and of these, approximately two thirds were emergency cases. Epidural analgesia or spinal anaesthesia was used in about two thirds of all deliveries. The rate of stillbirths and deaths in the first week of life (perinatal mortality rate) was once again very low at HUS, only 0.37 per cent.
hospitals in the HUS area, and expectant mothers were free to decide at which hospital they wanted to give birth. After the closure of the Tammisaari maternity ward, most parturients in the Länsi-Uusimaa Hospital Area chose to give birth at Lohja Hospital, with some 68 per cent of them giving birth there. Approximately 30 per cent chose to give birth at HUCH maternity hospitals. After the reorganisation of various functions, an on-call paediatrician service was launched at Lohja Hospital on 1 July 2010. This means that all HUS maternity hospitals now have round-the-clock oncall paediatrician services. The resources at HUS maternity hospitals are therefore
Tammisaari parturients opted for Lohja The maternity ward at Tammisaari Hospital was closed down on 1 June 2010. After this, there were six maternity
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and it was made possible by close crossdisciplinary teamwork. Women’s Hospital building project obtains HUS Council approval In June 2010, the HUS Council approved the Women’s Hospital refurbishment and extension project for 2012–14. Under the project, the Neonatal Intensive Care Unit, responsible for intensive care for neonates in the entire HUS area, will obtain the new facilities it sorely needs. The Obstetrics and Emergency Department and the Surgery and Anaesthesia Department will also be thoroughly renovated to meet current requirements.
A relocation plan has been drawn up for patient care during the building project, and the care of patients during building work will be as safe and as high-quality as under normal circumstances. After the completion of the project, the Women’s Hospital will be a modern and familyoriented hospital, providing demanding specialised health care for mothers and neonates.
EXTENSION OF CHILDREN’S HOSPITAL COMPLETED The new facilities at the Children’s Hospital have made it possible to introduce new methods for performing complicated, planned operations requiring intensive care, free of the threat of cancellation, and for giving greater consideration to parents’ needs.
The new facilities for the Intensive Care Unit, the Surgery and Anaesthesia Department, and the MRI Unit were commissioned in October–November 2010. Along with the new facilities, the number of operating theatres at the Children’s Hospital was increased by one, and the number of intensive care beds by six. Most of the equipment was also modernised and personnel resources increased significantly. The number of staff at the Surgery and Anaesthesia Department
was increased by eight fixed-term nurses, and 20 new positions for nurses were created at the Intensive Care Unit. More attention to parents’ and children’s needs The cancellation of planned surgical operations due to the lack of intensive care beds at the Children’s Hospital has been a burden primarily for the families of the children arriving for heart surgery. With the completion of the new facili-
in accordance with the Current Care recommendation for the resuscitation of neonates and the recommendations of the Ministry of Social Affairs and Health’s Uniform Criteria for Emergency Care. Kätilöopisto Maternity Hospital receives recognition for baby-friendly approach 2010 was a year of celebration for Kätilöopisto Maternity Hospital: the hospital building celebrated its 50th anniversary, and in November, the National Institute for Health and Welfare awarded the hospital a certificate for its baby-friendly approach in recognition of excellent support for the promotion of breastfeeding. For Kätilöopisto Maternity Hospital to receive the certificate, its obstetric operations were audited in accordance with the instructions of WHO and UNICEF. The international Baby Friendly Hospital Initiative is an action programme launched by WHO and UNICEF in 1991, aimed at the promotion of breastfeeding in all maternity units. According to research, the motivation to breastfeed is clearly higher in mothers who gave birth at a baby-friendly hospital, and exclusive breastfeeding is more common among them than on average. In Finland, the Baby-Friendly Hospital Certificate has previously been awarded to four smaller maternity hospitals. Being awarded the Baby-Friendly Hospital Certificate is a major achievement for a large maternity hospital such as Kätilöopisto,
30
The intensive care resources of the Children’s Castle were significantly enhanced with the completion of the new Intensive Care Unit.
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
Children process things through play, which is why a Kitten scanner was placed in the waiting room of the MRI Unit. The children can place an animal figure in the toy MRI scanner themselves and see how the imaging takes place. There is also a lightshow system in the examination room, which makes it possible to change the atmosphere in the room with the help of variable shades of light and video images, making the room more tranquil and less frightening for the child. New methods
Children’s Hospital extension project
Cost approx. EUR 25.5 million Extent approx. 6,936 gross sq.m. Net floor area approx. 3,322 sq.m. Design AW2-arkkitehdit Oy Main contractor YIT Rakennus Oy 6 operating theatres, 14 recovery room beds 16 intensive care beds 1.5-tesla MRI scanner
ties and additional personnel resources, the cancellation of surgical operations at the hospital has been brought down to a minimum. Early in 2010, more than 50 heart operations were cancelled because of the lack of beds in the Intensive Care Unit. After the completion of the new facilities, operations in November and December only had to be cancelled on one especially busy day. During the commissioning of the new facilities, the elective surgical operations at the Children’s Hospital were momentarily at their minimum, and it was feared that this would show in surgery waiting lines. However, through increased efforts, the staff managed to shorten the waiting lines to more or less Care Guarantee standards by the end of October. Despite the momentary downsizing of elective surgical operations as a result of relocation, the waiting lines remained under control, and by the turn of the year were
32
within the limits prescribed in the Care Guarantee. One of the underlying principles in planning the new facilities was the significance of the family in the care of a sick child. The presence of parents, and a parent holding the child in his or her arms, increase the child’s feeling of safety in a new, and often frightening, situation. Parents were not previously allowed into the operating theatre area owing to the cramped conditions. The new facilities have made it possible to better cater to their needs. The inpatient rooms in the Intensive Care Unit are more spacious than before, which further facilitates the parents’ involvement in the care of their child. There is now enough room around the patient’s bed for the parents and staff as well as the necessary equipment. The new Intensive Care Unit boasts two dedicated rooms for family members.
Even though the number of operating theatres was only increased by one, the use of the actual theatres will be more efficient through the introduction of an induction room and a waiting room, or pre-operative holding area. The operating theatres are substantially larger than before, making it possible to perform several surgical procedures during the same operation, which will be more economical in terms of resources, and also less stressful for the patient. For example, in hybrid cardiac surgery, the surgical and interventional cardiologic procedures are performed simultaneously. The treatment of infection epidemics is typical of paediatric intensive care. Six of the sixteen intensive care beds in the new department can be isolated if necessary. Now that infection patients have their own care facilities, the vulnerability of the treatment of elective patients is reduced. Paediatric surgery training has also benefited from the new facilities. There is both a video and audio connection between the operating theatres and the new Matti Sulamaa Hall. The operating surgeon is able to describe the procedure to an audience that are following the operation in the auditorium. The audience can also put questions to the operating theatre staff.
HUSLAB COOPERATED MORE CLOSELY WITH FINNISH MUNICIPALITIES During 2010, the cooperation between HUSLAB and the member municipalities became closer. On 1 January 2010, the Järvenpää Health Centre became a HUSLAB customer, followed on 1 March by the Nurmijärvi Health Centre. Late in 2010 an agreement was signed with the municipality of Mäntsälä concerning the integration of laboratory functions into HUSLAB.
sample collection and transport services, laboratory analyses, specialist consultations, and IT solutions. As a result of systematic integration work, all laboratories in the HUCH area are now part of HUSLAB, including those at Jorvi and Peijas hospitals, as well as nearly all laboratories at Uusimaa hospitals and primary health care units. Improved profitability for HUSLAB Early 2010 was challenging for HUSLAB: In 2009 the company made a loss, and prices were cut by some 0.6 per cent. Costs had risen, and the demand for laboratory services was falling. During 2010, the profitability of HUS improved significantly, however, and the result for 2010 showed a deficit of only EUR 0.1 million.
The reasons behind the improved profitability of HUSLAB can be found in the reorganisation process, which made the use of staff, facilities and shared processes more efficient. The changes were particularly significant at the Department of Pathology. The operations of the Peijas Pathology Laboratory were transferred to the Meilahti Central Laboratory and the Pathology Laboratory at Hyvinkää Hospital. The laboratories for molecular genetics, molecular pathology and cytogenetics were combined. The Emergency Laboratory at Meilahti Hospital was integrated into the main laboratory. Some rearrangement took place in protein analytics and immunoanalytics, while some primary health care sample collection points were also combined.
Despite its active expansion policy, HUSLAB has managed to keep its services at a satisfactory level. In many units, access to laboratory services has actually improved: thanks to the integration process, HUS laboratories are open to all patients in the HUS area regardless of their municipality of residence. The development of the primary health care service concept has progressed in leaps and bounds. Municipalities may choose between three different service models: sample collection without appointment in laboratories, a mobile sample collection service, or quick tests for emergency patients at health centres. Services, especially in the Helsinki metropolitan area, are often provided in the form of a combination of these models. In such cases, mobile collection services and wider use of quick tests guarantee that the level of services remains high, even though the number of fixed laboratories is reduced. The automated production system, customer-orientedness and wide range of products of HUSLAB have convinced the municipal customers: it pays to be a partner of HUSLAB. HUSLAB provides its customers with effortless and comprehensive laboratory services, including
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H US A n nu al R ep ort 20 1 0
TOWARDS MORE INDIVIDUALISED CANCER CARE
ORGANISATION AND REPRESENTATIVE BODIES
“Cancer is a result of the collapse of the immune response system. If we could find a highly specific drug to awaken the sleeping white blood cells in the immune system, we would have an excellent treatment for cancer,” says Kimmo Porkka, Chief Physician of the Haematology Outpatient Clinic at Meilahti Triangle Hospital.
In addition to the Joint Authority, the HUS Group also includes the independent affiliates and real estate companies, as well as subsidiaries and business enterprises.
34
The Executive Board is responsible for administration and finances
HUS Group 2010 COUNCIL EXTERNAL AUDIT EXECUTIVE BOARD INTERNAL AUDIT CHIEF EXECUTIVE OFFICER strategy, ownership steering and finances
NURSING COMMUNICATIONS
MEDICAL SERVICE PROVISION and Research and Development
BUSINESS
HUS Pharmacy
PERSONNEL
Porvoo Hospital Area
FINANCES
Länsi-Uusimaa Hospital Area
ADMINISTRATION Lohja Hospital Area
The Lutetium and SIRT treatments administered to patients at the HUCH Department of Oncology at the turn of the year were among the first in Finland. Prior to this, Finnish patients were sent to Uppsala, Sweden. The Lutetium treatment is a tailored form of treatment for small groups of patients, and in Europe is given in a few large centres. The number of Finnish patients in need of this form of treatment is estimated at 5–10 patients annually. The Lutetium-Octreotate treatment is indicated for tumours containing somatostatin receptors. The isotopic drug containing Lutetium (Lu-177) is carried in the blood circulation and adheres to the receptors. The short-range beta radiation emitted by it kills the cells. This form of treatment is used to treat rare metastasised or progressing neuroendocrine tumours. Another isotopic form of treatment introduced recently at the Department of Oncology is radioembolisation treatment, or SIRT. SIRT is indicated for cancer patients with metastases confined to the liver. The
treatment is based on the fact that circulation in tumours is dependent on the hepatic artery, whereas in healthy liver tissue circulation takes place via the portal vein. Radioactive granules are infused via catheter directly into the hepatic artery, where they block the blood vessels feeding the tumour, thus destroying it. The treatment is indicated for an otherwise healthy patient with numerous small metastases in the liver, where the liver still functions adequately. The original, metastasising cancer may have been, for example, a treated retinal melanoma or colorectal cancer. It is estimated that there are approximately a dozen patients a year in need of this form of treatment. The introduction of both Lutetium and SIRT treatment is complicated by a problem that is typical of rare tumours: there is no comparative research data available because it is extremely difficult to carry out randomised studies. The results have been good, however, and there are dedicated teams of experts at the Department of Oncology for the provision and development of these forms of treatment.
Hyvinkää Hospital Area
Control of metastases with new isotopic treatment
HUCH Hospital Area
It was for haematologic diseases that the first specific cancer treatments were developed. Effective forms of treatment against malignant haematologic diseases are developed with the help of biobanks, for example. It is often possible to follow the progress of a haematologic disease very closely, and as a result of intensive research work, blood cancers have become model diseases for other cancers. Much progress has been made in the treatment of chronic leukaemias, and now the search is on for a cure for aggressive acute leukaemia. In this type of leukaemia, it is essential to start the treatment as early as possible because the disease progresses rapidly. Kimmo Porkka emphasises that we need to develop better forms of treatment, as the current treatments are exhausting for patients, and also too expensive and inefficient. High-dose cytostatic treatment and stem cell transfusions are the most toxic forms of treatment that can be given to a human being. “We have made good progress with the treatment of chronic myeloic leukaemia. Most patients lead a normal life, apart from possibly having to use medication for the rest of their lives. However, the aim is definitely to find a cure for these patients.”
The HUS Joint Authority comprises five hospital areas that are similar in organisational structure: the Hospital Areas of HUCH, Hyvinkää, Lohja, Länsi-Uusimaa and Porvoo. The group also includes two
profit areas: Group Administration and HUS Facilities Centre. Additionally, the HUS Joint Authority includes four business enterprises providing medical services and five business enterprises providing general support services. The HUS Joint Authority owns 100 per cent of the following companies: HUS-Kiinteistöt Oy, Kiinteistö Oy Jorvi, Kiinteistö Oy Asolanrinne, VN Fastigheter, Asunto Oy Laurinkatu 24, Kiinteistö Oy Kangasjyvä and Asunto Oy Pilvenmäki. The HUS Joint Authority also owns 69.93 per cent of Uudenmaan Sairaalapesula Oy.
Department of Medicine Department of Gynaecology and Paediatrics Department of Surgery Department of Psychiatry
HUSLAB
HUS Medical Imaging Centre HUS Desiko
Ravioli
HUS Logistics
HUS Servis
HUS Medical Engineering
HUS ICT
HUS Facilities Centre (Profit area) Uudenmaan Sairaalapesula Oy
HUS Real Estate Ltd.
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HUS Annual Report 2010
H US A n nu al R ep ort 20 1 0
HUS Representative Bodies 2010
COUNCIL AUDIT BOARD EXECUTIVE BOARD PSYCHIATRIC BOARD BUSINESS DIVISION MINORITY LANGUAGE BOARD
HOSPITAL AREA BOARDS
BUSINESS ENTERPRISE BOARDS
HUCH Hospital Area Hyvinkää Hospital Area Lohja Hospital Area Länsi-Uusimaa Hospital Area Porvoo Hospital Area
HUS Pharmacy HUSLAB HUS Medical Imaging Centre HUS Desiko HUS Logistics HUS Medical Engineering HUS ICT Ravioli HUS Servis
The HUS management model is based on a so-called ‘sole manager’ model. Each management member always carries operative, personnel and financial responsibility. Representative bodies The Council is the highest decisionmaking body in the HUS Joint Authority. Reporting to the Council, the Executive Board is responsible for the administration and finances of HUS. Directed by the Executive Board, the hospital area boards manage the operations of their own hospital areas. The Executive Board and the Business Division that reports to it steer the Executive Boards of HUS business enterprises and HUS affiliates. Elected officials in 2010 According to the Charter of the Joint Authority, the Council of each member
36
municipality appoints 2–5 Joint Authority Council members and their personal deputies. The term of the representatives is the same as that of municipal council members. The number of Council members is determined in proportion to the core capital ratio of each member municipality. A municipality whose core capital ratio is less than 8 % of the core capital is entitled to appoint no more than three Council members. A municipality whose core capital ratio is no less than 25% of the core capital is entitled to appoint up to five Council members. Moreover, the University of Helsinki is entitled to appoint two Council members and their personal deputies. On 1 January 2010, the number of member municipalities changed with the merging of Pernaja and Liljendal with the City of Loviisa. Similarly, Ruotsinpyhtää (excluding the areas of Haavisto and
The lobby and main entrance to the Meilahti hospitals were opened in a ceremony held in May 2010.
Vastila) in the Hospital Area of Kymenlaakso was merged with Loviisa. HUS is managed by a 17-member Executive Board appointed by and reporting to the Council. The University of Helsinki appoints two Board members. While managing the administration and finances of the Hospital District, the Executive Board focuses particularly on the implementation of the strategic operative targets of the Hospital District, the maintenance of a balanced economy, increasing the efficacy of operations and the implementation of structural arrangements necessary for this, the coordination of various activities, the implementation of national duties and duties specific to special areas of responsibility, the organisation of health care training and research activities at university level, employer activities, and the steering of administration.
In addition to this, the Executive Board discusses the follow-up reports concerning the Joint Authority’s operations and finance, and decides on eventual measures arising from these. The Executive Board held 20 meetings in 2010. On 17 December 2009, the Executive Board decided to appoint a 6-member Business Division to steer and supervise business operations for the duration of the Board’s term. Each municipal enterprise has a Board of Directors appointed by the HUS Executive Board. The duties and powers of the boards are provided for in the regulations of each enterprise. Each of the five HUS hospital areas has an Area Board, appointed by the Council for the duration of its term and responsible for the management of operations. The duties of the Area Boards are: to implement the Group strategy
and financial management; supervised by the Executive Board, to manage the operations of the hospital area in accordance with the Charter of the Joint Authority; to prepare matters concerning the Hospital Area for Council and Executive Board meetings and to implement the decisions; and to cooperate with primary health care services in the municipalities in their area. Additionally, the Area Boards submit initiatives concerning the development of operations within their areas, discuss reports on the operations and finances in their areas, and make decisions on measures to be taken on the basis of these. In accordance with Section 18 of the Act on Specialised Medical Care, HUS has a Minority Language Board appointed by the Council for the duration of its term. According to the Charter of the Joint Authority, the Board ensures that within
the HUS area, each patient receives specialised health care services in their own language (Finnish or Swedish). There are corresponding Minority Language Divisions in the HUCH Hospital Area and the minority-language hospital areas. Appointed by the Council for the duration of its term, the Psychiatric Board assists the Executive Board in the development and coordination of psychiatric health care. The Audit Board is supervised by the Council; the Board prepares issues concerning the administration and finances for the Council, and estimates how well the operational and financial targets set by the Council have been reached.
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HUS Annual Report 2010
Council members 2009–2012
Votes Deputies
University of Helsinki Kari Suokko 96 Erkki Vuori
Executive Board members 2010
Mirka Järvinen Kari Kyttälä
Psychiatric Board 2010
Votes Deputies
Lapinjärvi Anna-Maija Lukkari Harri Sintonen
Karl-Erik Stenvall 2 Aino Villikka
Marjatta Smeds Mika Sistola
Askola
Lohja
Juhani Korkatti 3 Maritta Helin
Tuula Jämsén 33 Paul Packalén
Jarno Lundberg Eeva Oksanen
Espoo
Kristiina Lundell Petteri Åström
Loviisa
Kari T. Nukala 175 Jarkko Korpi Katja Koivumäki
Leena Rehn Tarja Tallqvist Matti Metsäranta
Hanko Jouko Veikanmaa 7 Sture Söderholm
Ulf Lindström Anja Roos
Helsinki Maija Anttila 362 Aatos Hallipelto Seija Muurinen Kalle Könkkölä Sirkku Ingervo
Anita Vihervaara Katja Ivanitskiy Ville Väärälä Aki Hyödynmaa Tiina Turkia
Olof Gren Anja Järvinen
9
Johanna Koivuniemi 12 Anna Helin Aulis Mattila Jyri Mela
6
Nurmijärvi Minna Aittakallio 23 Petri Kalmi
Antti Rantalainen 34 Irma Pahlman
Risto Kuisma 2 Ulla Rainio
Irma Kulmala Timo Ojamäki Liljan-Kukka Runolinna Matti Kalsola
Porvoo
Inkoo Barbro Viljanen 4 Marie Bergman-Auvinen
Heimo Hakala Erik Holmberg
Berndt Långvik 33 Tapani Eskola
Järvenpää
Raasepori
Ulla-Mari Karhu Christer Brännkärr
Ulla Dönsberg 24 Bertel Sundman
27
Pekka Luuk Kaarina Wilskman
2
Susanne Ahlqvist Christer Björkstrand Ritva Uhlbäck Jaana Tasanko
Sipoo
Karjalohja Jorma Roine Tero Eskola
Hans Blomberg 13 Ari Oksanen
Monika Zakowski Anna Hyrske
Karkkila
Siuntio
Maritta Salo Raino Velin
Rabbe Dahlqvist 4 Janne Laakkonen
8
Sirkku Hopeavirta-Hanhinen Hannele Stenberg
Börje Grotell Tuula Elo
Tuusula
Kauniainen Gunnel Carlberg 6 Heikki Kurkela
Boris Kock Marianne Kivelä
Arto Lindberg 23 Salla Heinänen
Merja Kuusisto Harto Palén
Kerava
Vantaa
Markku Pyykkölä 19 Tuula Lind
Raimo Huvila 119 Mari Niemi-Saari Varpu-Leena Aalto
Jüri Linros Auli Lehikoinen
Kirkkonummi Marjatta Savilahti Johan Karlsson
21
Kielo Leimi Ari Harinen
Deputies Tuomas Nurmela (Kok), HeIsinki Sirpa Asko-Seljavaara (Kok), Helsinki Reijo Vuorento (SDP), Helsinki Johanna Nuorteva (Vihr), Helsinki Hans Blomberg (RKP), Sipoo Anja Roos (Kok), Hanko Rolf Paqvalin (SDP), Kerava Tony Hagerlund (Vihr), Espoo Ari Oksanen (Kok), Sipoo Eija Grönfors (SDP), Vantaa Timo Auvinen (PS, sit.), Vantaa Karel McLeod Smith (Kok), Hyvinkää Anna Cantell-Forsbom (Vihr), Vantaa Satu Manner (Vas, sit.), Lohja Marja-Leena Laine (Kesk), Hyvinkää Elina Ikonen, university representative Pekka Karma, university representative
Nummi-Pusula
Pornainen
Karel McLeod Smith Sari Tani
Pia Hydén Sinikka Heikkinen
Mäntsälä
Hyvinkää
Kari Lehtola Rolf Oinonen
Kalevi Heinonen Harri Krakau
Ordinary members Ulla-Marja Urho (Kok), Helsinki, Chair Seppo K.J. Helminen (Kok), Helsinki Ilkka Taipale (SDP), Helsinki Suzan Ikävalko (Vihr), Helsinki Henrika Zilliacus-Tikkanen (RKP), Helsinki Sanna Lauslahti (Kok), Espoo Veikko Simpanen (SDP), Espoo, Vice-Chair Kirsi Aropaltio (Vihr), Espoo Johanna Tuuli (Kok), Vantaa Säde Tahvanainen (SDP), Vantaa Pietari Jääskeläinen (PS), Vantaa Irene Äyräväinen (Kok), Lohja Jari Oksanen (Vihr), Porvoo Harry Yltävä (Vas), Raasepori Jukka Pihko (Kesk), Nurmijärvi Mikko Salaspuro, university representative Jaakko Karvonen, university representative
Teemu Räty Tarja Pesonen Marjo Varsa
Vihti Tiina Noro 19 Raimo Pilvi
Pekka Viljanen Anu Rajajärvi
Ordinary members Kaarina Pärssinen (SDP), Tuusula, Vice-Chair Antti Karila (SDP), Helsinki Aira Suvio-Samulin (Kok), Helsinki Sirpa Peura (Kok), Vantaa, Chair Jouni Vilkki (Kok), Askola Kai Järvisalo (Vihr), Espoo Pirkko Telaranta (Vihr), Helsinki Tuula Sjölund (RKP), Kirkkonummi Jouko Lönnqvist, university representative Kirsi Aropaltio, Board representative
Deputies Hilkka Pokki (SDP), Vantaa Heidi Hertell (SDP), Helsinki Jaakko Ojala (Kok), Helsinki Pertti Airikainen (Kok), Espoo Eeva Huikko (Kok), Järvenpää Eero Untamala (Vihr), Vantaa Eija Lönnroth (Vihr), Helsinki Lisbeth Konttinen (RKP), Espoo Kristian Wahlbeck, university representative Jari Oksanen, Board representative
Audit Board 2010 Ordinary members Maija Anttila (SDP) Helsinki, Vice-Chair Tuula Lind (SDP), Kerava Markku Pyykkölä (Kok), Kerava, Chair Aatos Hallipelto (Kok), Helsinki Kari T. Nukala (Kok, Espoo Varpu-Leena Aalto (Vihr), Vantaa Ulla Dönsberg (RKP), Raasepori
Deputies Kari Lehtola (SDP), Karjalohja Auli Lehikoinen (SDP), Kerava Raimo Huvila (Kok), Vantaa Seija Muurinen (Kok), Helsinki Anna Helin (Kok), Mäntsälä Marjo Varsa (Vihr), Vantaa Olof Gren (RKP), Loviisa
Minority Language Board 2010 Ordinary members Inger Östergård (SDP), Helsinki, Vice-Chair Viveca Lahti (SDP), Kirkkonummi Sunniva Strömnes (Kok), Helsinki Roger Weintraub (Kok), Lohja Jan-Erik Eklöf (RKP), Vantaa, Chair Werner Orre (RKP), Raasepori Klaus Kojo (Vihr), Vantaa Marjatta Donner (Vihr), Helsinki Christer Holmberg, university representative Henrika Zilliacus-Tikkanen, Board representative
Deputies Hildur Boldt (SDP), Helsinki Kjell Grönqvist (SDP), Sipoo Philip Relander (Kok), Helsinki Marianne Rosvall (Kok), Porvoo Monica Avellan (RKP), Tuusula Bodil Lund (RKP), Porvoo Anniina Kostilainen (Vihr), Vantaa Jon Lindström (Vihr), Helsinki Carl Gustaf Nilsson, university representative Hans Blomberg, Board representative
The Finnish abbreviations used: Kok = The National Coalition party, SDP = Finnish Social Democratic Party, Vihr. = Finnish Green League, RKP = Swedish People´s Party, Kesk. = The Centre Party, PS = The Finns Party
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H US A n nu al R ep ort 20 1 0
HUS Annual Report 2010
Joint Authority Profit and Loss Account (EUR 1,000)
Joint Authority Financial Statement
1.1.–31.12.2010 1.1.–31.12.2009
Operating income Sales proceeds 1 512 931 Payments income 56 916 Subsidies and grants 5 873 Other operating income 8 710 Operating expenses Personnel expenses Wages and salaries -777 845 Social security expenses Pension expenses -131 315 Other social security expenses -44 229 Purchased services -202 978 Materials, supplies and consumables -287 606 Subsidies -443 Other operating expenses -41 504 Operating margin Financial income and expenses Interest income 1 762 Other financial income 321 Interest expenses -3 919 Other financial expenses -11 764 Result before depreciation and extraordinary items Depreciation and reduction in value Depreciation according to plan -85 711 Surplus/Deficit for financial year
1 479 476 52 874 6 256 1 584 430 9 263 -747 266 -127 389 -47 992 -201 406 -285 544 -553 -1 485 920 -41 775 98 510 2 409 130 -4 438 -13 599 -11 861 84 911 -85 711 -82 181 -800
(EUR 1,000) 2010 2009
1 547 869
-1 451 925 95 945
-13 759 82 186 -82 181 5
FINANCIAL INDICATORS FOR THE PROFIT AND LOSS ACCOUNT 2010 2009 Operating profit/Operating loss, % 106,6 106,6 = 100*Operating profit/Operating loss Result before depreciation and extraordinary items/depreciation, % 99,1 100,0 = 100*Result before depreciation and extraordinary items/Depreciation and reduction in value
FINANCIAL INDICATORS FOR THE PROFIT AND LOSS ACCOUNT Operating profit/Operating loss, % Result before depreciation and extraordinary items / Depreciation %
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2010 2009 2008 2007 2006 106,6 % 99,1 %
106,6 % 106,0 % 106,4 % 106,9 % 100,0 %
96,4 % 111,9 % 122,9 %
Operating cash flow Result before depreciation and extraordinary items 84 911 82 186 Adjusting items for cash flow financing -1 782 524 Investment cash flow Investment expenses -113 104 -109 213 Investment expenses financing shares 1 411 275 Capital gains for fixed asset items 1 388 354 Operating and investment cash flow -27 177 -25 874 Financing cash flow Changes in loans Increases in loan receivables -6 500 -2 800 Decreases in loan receivables 504 439 Changes in loan portfolio Increase in long-term loans 0 60 000 Decrease in long-term loans -12 434 -9 190 Other changes in liquidity Changes in inventories -3 634 -165 Change in receivables 24 600 -9 075 Change in interest-free debts 17 929 1 152 Financing cash flow 20 465 40 361 Change in liquid assets -6 712 14 486 Change in liquid assets Liquid assets at 31 Dec 113 561 120 273 Liquid assets at 1 Jan -120 273 -105 786 -6 712 14 486 FINANCIAL INDICATORS FOR THE FINANCIAL STATEMENT 2010 2009 Investment cash flow financing, % 76,0 75,4 = 100*Result before depreciation and extraordinary items /Investment self-acquisition expenses Capital expenditure cash flow financing, % 65,3 68,2 = 100*Result before depreciation and extraordinary items /(Investment self-acquisition expenses + loans net increase + loan amortisations) Debt coverage ratio 5,4 6,4 = (Result before depreciation and extraordinary items +Interest expenses) /(Interest expenses+Loan amortisations) Cash disbursements, EUR million 1 634 1 589 Adequacy of cash flow (days) 25,4 27,6 = 365 days x Liquid assets 31 Dec/Cash disbursements during financial year
FINANCIAL INDICATORS FOR THE FINANCIAL STATEMENT 2010 2009 2008 2007 2006 Investment cash flow financing, % 76,0 % 75,4 % 88,3 % 82,8 % 69,6 % Capital expenditure cash flow financing, % 65,3 % 68,2 % 75,6 % 73,2 % 62,6 % Debt coverage ratio 5,4 6,4 5,0 4,8 5,1 Cash disbursements, EUR million 1 634 1 589 1 521 1 438 1 400 Adequacy of cash flow, days 25,4 27,6 25,4 21,6 27,2
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HUS Annual Report 2010
Joint Authority Balance Sheet (EUR 1,000) 31.12.2010 31.12.2009 ASSETS NON-CURRENT ASSETS 711 484 679 890 Intangible assets 37 002 35 285 Other long-term expenses 37 002 35 285 Tangible assets 640 160 616 162 Land and water 11 003 10 962 Buildings 488 868 412 031 Immovable structures and equipment 13 711 13 720 Machinery and equipment 85 809 79 296 Other tangible assets 138 138 Advance payments and purchases in process 40 631 100 014 Investments 34 322 28 443 Shares and similar rights of ownership 20 532 20 649 Other loan receivables 13 547 7 551 Other receivables 243 243 CONTRACT-RESTRICTED ASSETS 3 833 4 526 Special margins of gift funds 3 833 4 526 CURRENT ASSETS 196 532 224 211 Inventories 19 432 15 798 Materials and consumables 19 432 15 798 Receivables 63 539 88 140 Non-current receivables 11 11 Other receivables 11 11 Current receivables 63 528 88 128 Sales receivables 38 971 65 466 Loan receivables 150 200 Other receivables 16 526 15 652 Prepayments and accrued income 7 881 6 810 Investments 26 926 59 794 Shares and similar rights of ownership 0 0 Investments in money market instruments 26 926 59 794 Cash in hand and at banks 86 635 60 479 TOTAL ASSETS 911 849 908 626
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(EUR 1,000) 31.12.2010 31.12.2009 LIABILITIES CAPITAL AND RESERVES 433 100 433 901 Subscribed capital 391 253 391 253 Retained earning/loss 42 648 42 643 Surplus/deficit for financial year -800 5 PROVISIONS 36 206 36 985 Provisions for pensions 3 264 3 563 Other provisions 32 942 33 421 CONTRACT-RESTRICTED CAPITAL 3 833 4 526 Gift fund capitals 3 833 4 526 LIABILITIES 438 710 433 215 Non-current 164 696 177 121 Loans from financial and insurance institutions 164 696 177 121 Current 274 014 256 094 Loans from financial and insurance institutions 12 425 12 434 Advances received 6 148 6 612 Trade creditors 70 509 56 236 Membership fees and other creditors 24 235 25 121 Accruals and deferred items 160 696 155 690 TOTAL ASSETS 911 849 908 626
FINANCIAL INDICATORS FOR THE BALANCE SHEET Gearing ratio, % Relative indebtedness, % Loan portfolio 31.12. (EUR 1,000) Loan receivables 31.12 (EUR 1,000)
2010 2009 2008 2007 2006 47,8 27,3 177 122 13 547
48,1 27,6 189 556 7 551
51,2 25,1 138 746 5 190
54,0 23,8 118 724 1 344
55,2 24,2 80 518 1 344
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H US A n nu al R ep ort 20 1 0
HUS Annual Report 2010
Consolidated Profit and Loss Account (EUR 1,000) Operating income Operating expenses Share of business enterprises’ profit/loss Operating margin Financial income and expenses Interest income Other financial income Interest expenses Other financial expenses Result before depreciation and extraordinary items Depreciation and reduction in value Depreciation according to plan Below and over par values for financial year Depreciation and reductions in value Extraordinary items Annual result Tax reserves Minority share Surplus/deficit for financial year
Consolidated Financial Statement 2010 2009 1 595 464 -1 493 281 114 102 297
1 561 332 -1 462 263 196 99 265
1 637 326 -4 083 -11 934 88 243
2 323 135 -5 022 -11 863 84 839
-88 284 0 -88 284
-84 752 877 -83 875
140 99 -647 -1 -549
55 1 019 299 -42 1 277
FINANCIAL INDICATORS FOR THE PROFIT AND LOSS ACCOUNT 2010 2009 2008 2007 Operating income/Operating expenses, % Result before depreciation and extraordinary items/Depreciation %
106,8 % 100,0 %
106,8 % 101,1 %
106,2 % 96,0 %
106,6 % 111,4 %
(EUR 1,000) 2010 2009 Operating cash flow Result before depreciation and extraordinary items Extraordinary items Adjusting items for cash flow financing Investment cash flow Investment expenses Investment expenses financing shares Capital gains for fixed asset items Operating and investment cash flow Financing cash flow Changes in loans Decreases in loan receivables Changes in loan portfolio Increase in long-term loans Decrease in long-term loans Change in short-term loans Changes in minority share Other changes in liquidity Changes in inventories Change in receivables Change in interest-free debts Financing cash flow Change in liquid assets Liquid assets at 31 Dec Liquid assets at 1 Jan Change in liquid assets
FINANCIAL INDICATORS FOR THE FINANCIAL STATEMENT Investment cash flow financing, % Capital expenditure cash flow financing, % Debt coverage ratio
Cash disbursements, EUR million Adequacy of cash flow, days
44
88 243 140 -2 071 86 313
84 839 55 328 85 222
-121 914 1 409 1 732 -118 774
-112 550 275 418 -111 8575
-32 461
-26 635
3
3
273 -13 454 0 0
60 172 -10 964 0 2 434
-3 617 24 636 18 529 26 369
-194 -9 637 -1 043 40 769
-6 092
14 135
115 401 121 493 -6 092
121 493 107 358 14 135
2010 2009 2008 2007 73,2 % 65,9 % 5,3
75,6 % 68,8 % 5,6
89,3 % 77,1 % 4,2
83,4 % 71,9 % 4,2
1 645 25,6
1 603 27,7
1 531 25,6
1 447 21,8
45
H US A n nu al R ep ort 20 1 0
HUS Annual Report 2010
Consolidated Balance Sheet (EUR 1,000) 2010 2009
(EUR 1,000) 2010 2009
ASSETS NON-CURRENT ASSETS Intangible assets Intangible rights Other long-term expenses Intangible assets Tangible assets Land and water Buildings Immovable structures and equipment Machinery and equipment Other tangible assets Advance payments and purchases in process Tangible assets Investments Business enterprise shares and similar rights of ownership Other shares and similar rights of ownership and revaluation reserve Other loan receivables Other receivables Investments NON-CURRENT ASSETS CONTRACT-RESTRICTED ASSETS CURRENT ASSETS Inventories Receivables Non-current receivables Current receivables Receivables Investments Cash in hand and at banks CURRENT ASSETS TOTAL ASSETS
LIABILITIES CAPITAL AND RESERVES Subscribed capital Other own reserves Surplus (deficit) from previous financial years Surplus/deficit for financial year CAPITAL AND RESERVES MINORITY SHARES DEPRECIATION AND UNTAXED RESERVES Depreciation reserve Untaxed reserves DEPRECIATION AND UNTAXED RESERVES PROVISIONS Provisions for pensions Other provisions PROVISIONS CONTRACT-RESTRICTED CAPITAL LIABILITIES Long-term interest-bearing liabilities Long-term interest-free liabilities Short-term interest-bearing liabilities Short-term interest-free liabilities LIABILITIES TOTAL LIABILITIES FINANCIAL INDICATORS FOR THE BALANCE SHEET
173 37 152 37 325
170 35 479 35 650
12 516 508 921 13 711 88 290 913 49 584 673 936
12 475 433 433 13 720 81 605 854 102 222 644 309
14 661 3 278 623 243 18 805
14 456 2 960 626 243 18 285
730 066
698 243
3 833
4 526
19 611
15 994
11 64 341 64 352
11 88 976 88 988
26 935
59 804
88 466
61 689
199 364
226 474
933 263
929 244
391 253 1 031 43 875 -549 435 610
391 253 1 031 42 598 1 277 436 158
2 613
2 612
950 2 034 2 984
976 1 336 2 312
3 264 32 961 36 225
3 563 33 421 36 985
3 833
4 526
180 052 1 13 480 258 465 451 998
193 316 3 13 397 239 935 446 651
933 263
929 244
Gearing ratio, % = 100*Capital and reserves/(Capital and reserves total-Advances received)
47,6
47,8
Relative indebtedness, % = 100*(Liabilities - Advances received)/Operating income
27,9
28,2
Loan portfolio 31 Dec 193 532 = Liabilities-(Advances received+Trade creditors+Accruals and deferred items+Other creditors)
206 713
Loan receivables 31.12 = Other loan receivables in investments
626
FINANCIAL INDICATORS FOR THE BALANCE SHEET Gearing ratio, % Relative indebtedness, % Loan portfolio 31.12 (EUR 1,000) Loan receivables 31.12 (EUR 1,000)
46
623
2010 2009 2008 2007 47,6 27,9 193 532 623
47,8 28,2 206 713 626
50,4 26,1 157 505 629
52,8 25,3 140 300 633
47
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