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Valinnanvapaus mullistaa työmarkkinat

Lausunnolla oleva uusi valinnanvapausesitys johtaa toteutuessaan merkittäviin henkilöstö- ja työmarkkinavaikutuksiin.

Arviolta noin kolmannes eli 60 000 kuntien ja kuntayhtymien sosiaali- ja terveyspalveluiden henkilöstöstä siirtyisi uusien valinnanvapausjärjestelmien, henkilökohtaisen budjetin, suoran valinnan sekä asiakassetelin yhteisvaikutuksesta yksityisen sektorin palvelukseen. Siirtyminen yksityiselle puolelle koskee erityisesti perusterveydenhuollon ja sosiaalitoimen henkilöstöä.

Suomalaisessa työmarkkinajärjestelmässä ei ole koskaan aiemmin muutettu lainsäädännöllä eri työmarkkinasektoreiden välisiä suhteita näin laajalti, vaikka sote-palvelut on tarkoitus rahoittaa jatkossakin pääosin julkisista verovaroista. Henkilöstö siirtyisi nykyisen kunnallisen sopimusjärjestelmän ulkopuolelle ja heidän työehtonsa määräytyisivät yksityisen sektorin työehtosopimusten mukaan.

Jotta kokonaiskustannukset eivät kasvaisi, julkista sosiaali- ja terveydenhuoltoa pitäisi sopeuttaa vähintään yksityisen palvelutuotannon kasvavan osuuden verran. Työvoimakustannusten osuus kaikista kustannuksista on noin puolet, jolloin käytännössä sopeuttamista voi tapahtua lähinnä henkilöstökustannuksia supistamalla. Tukipalveluihin voi kohdistua vielä suurempi suhteellinen leikkaustarve.

Työvoimakustannusten sopeuttamisen tarvetta lieventää jonkin verran uudistuksen asteittainen voimaantulo useamman vuoden aikana.

Asiakassetelin ulottaminen erikoissairaanhoitoon voi johtaa vakavaan työvoimapulaan erityisesti kriittisissä päivystyksen avaintehtävissä ja uhata tulevien maakuntien kykyä suoriutua tehtävistään. Julkisen sektorin päivystysvelvoite merkitse sitä, että valmiutta on pidettävä yllä jatkuvasti. Tämä varautuminen edellyttää myös sitä, että kapasiteettiä on jonkin verran ylimääräistä.

Markku Jalonen

Markku Jalonen on kunta-alan työmarkkinajohtaja

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