The review of the National Audit Office uses the example of employment trends in the four job groups with the core functions for the state - general practitioners (GPs), general education teachers, police officers and rescuers - to show that we have reached a point in time in Estonia where we should truthfully admit that the provision of public services equally and of consistent quality throughout the country is beyond our power. The reason for this is not only the lack of money, but also the lack of people.

• Of the areas covered, general practice is the most problematic, as there are more GPs retiring than candidates who might fill vacancies. Almost half of GPs are 60 years of age or older, i.e. they are already of retirement age or can retire soon if they wish. It is becoming increasingly difficult to find new doctors for the general practice lists - the number of failed competitions on vacant positions has quadrupled in the last five years. There are practice lists where there has been a temporary substitute instead of a GP for 7 years. There have been few graduates of the residency for a long time, and less than half of them immediately take up the practice list. Residency graduates often do not want to work away from Tallinn or Tartu.
• The distinctive feature of the general education schoolteachers’ group is that there are still enough class teachers, but there is a scarcity of subject teachers (primarily natural science and STEM disciplines teachers). In ten years’ time, the number of students in general education schools is declining, but there is a concern that teachers do not want to go outside the larger centres to teach. More than a third of Estonian teachers are over 55 years of age, i.e. they will reach retirement age within the next ten years or are already of retirement age. At the same time, the share of teachers under the age of 30 has remained at the same level for ten years, i.e. less than 10%.

• There are still more or less enough of police officers, but there is already a scarcity of rescuers. In five or ten years' time, however, the scarcity of both will be acute, because, firstly, there will be a surge in the retirement of police officers and rescuers, and secondly, there will be too few suitable candidates who want to do the job. 

   

  According to the estimates of the Police and Border Guard Board, approximately 350–400 additional police officers will leave the service by 2030 than will be graduated from the National Defence Academy. Due to the turnover of the labour force, it will soon be necessary to find more than 100 rescuers a year, but there are half less of the suitable people on the labour market who want to be rescuers, i.e. about 50-55 people a year. In total, in the following 10 years 500 more rescuers will leave the service than, if the current trends continue, there would be young people who would want to be rescuers.

Thus, the provision of primary services is facing ground-breaking changes that may have a significant impact on the availability of public services, especially in areas that are not close to Tallinn or Tartu. The reason for the problem is both the aging of the population, i.e. fewer young people, and the fact that these few young people do not have primary service occupations among their vocational preferences.

The availability of services is problematic everywhere in Estonia, except in Harju and Tartu counties

The National Audit Office mapped out information in which region and in which occupational group employees will have the right to retire within the next 5–10 years (see Figure 1). 

The overview shows that the whole of Estonia outside Harju and Tartu counties is peripheral. By periphery, we mean an area where the provision of several primary services is at risk at the same time. The picture is not quite the same by counties and occupational groups, but in general it can be said that the resilient provision of essential services is in question everywhere except in these two counties. The reason is the large share of pensioners in several occupational groups at the same time, as well as poor situation with future generations of frontline workers. 

The highest percentage of GPs, teachers, police officers and rescuers of retirement age or soon to be reaching the retirement age is in Hiiu, Saare and Lääne counties, as well as in Lääne-Virumaa. The situation is better in Ida-Virumaa and the already mentioned Harju and Tartu counties.

A situation has arisen where GPs and teachers do not even want to go to work in county centres. This trend affects the development of the whole region as a domino effect. 

Solving problems by patching does not create certainty for the future

Although the concerns of primary services providers and the risks to the resilience of services have been widely discussed in the public, they have not yet so far exceeded the tolerance of people, as primary care providers have tried in various ways to alleviate problems in an emergency, either within their institution or sector.

However, narrow measures driven by urgency also make the whole system more bureaucratic and costly. For example, concluding temporary contracts with substitute doctors may be a suitable solution in the short term, but in the long run it is burdensome - and most importantly - does not provide the necessary stability.

Consequently, the level of primary services depends a lot on the ingenuity, management skills of the managers of the institutions, the possibilities of meeting the employees needs, etc. Chance is also important - for example, a worker who wants to return to a former place of birth for nostalgic reasons or who has another personal reason to go to the periphery may come to a sparsely populated area.

By operating in this way, holes in the system can only be patched urgently and temporarily. Often, a new problem may arise in the same region or area of life before something can be done with the old one.

Figure 1.

There are no easy or quick solutions to the labour problem

It is exceedingly difficult to overcome labour scarcities because training is usually years-long. It is also not enough to increase the number of training orders, staff salaries and recruitments, because there are no people to replace those who gradually leave the labour market due to age.

One of the solutions to the labour problem is the popularization of the profession, incentives for students to start their professional work, flexible organization of working and study time, retraining of experienced people, etc. However, competition is largely for the same people, and other sectors also need skilled labour.

Certainly, there are many benefits to be gained from further increasing the contribution of voluntary service providers in alleviating labour scarcities. However, there is the same concern: when there are few people, there are not enough volunteers to provide all the basic services at any level. Although volunteers have some role to play in internal security, education and medicine, one of the factors limiting their potential is training - not all volunteers have the necessary qualifications to contribute on an equal footing with professionals, so for example it is not possible to use the services of an amateur GP.

Advancement in technology and service delivery offers relief, but it is more important to prepare people for the inevitable changes

One of the directions in the development of public services is the introduction of e-solutions. Some current temporary (e-)practices may need to be made permanent, such as distance counselling in general practice, the replacement of absent teachers in small schools with distance learning support from large schools, and greater involvement of the third sector in providing public tasks.

The state can also increase the efficiency of the employees of the core service providers with smart machines and computer programs, but equipment and technology cannot completely or sufficiently replace the frontline staff - they must be physically present. These workers also play a crucial role in how people perceive the state and its governance.

Therefore, changes are inevitable and the criteria of the required minimum level of service need to be renegotiated and agreed. In the future, the availability of primary services will be determined by the state's ability to make informed decisions. Future trends in population and labor are relatively well known, so there is a need to reform the entire public service policy.

The main question is how to maintain an optimal balance between the government's opportunities and people's expectations in a country with a small and a regionally uneven population such as Estonia.

This raises many further questions: how, where and in which cases to provide services non-contact and remotely? Where and how to drive a so-called state bus or state taxi that will take service providers to people, or needs-based social transport that will take people to the service provider? Who takes children to school and the elderly to the doctor? Is the organization of public services viable in small administrative units or even within the borders of the county, or should we talk about forms of cooperation in larger areas? How can we create a reserve of resources in primary services (e.g. trained people to continue, modern tools) to help withstand the surprises that hit the operating environment as painlessly as possible? These are just some of the questions that require the intervention of the legislator to move forward.

What can the state do?

• To create new incentives to attract young or career-changing workers and to train future generations.
• To keep existing employees in employment longer, develop their qualifications and, if possible, offer them jobs in other positions within the public service.
• To introduce a variety of innovations offered by technological and social advance to reduce labour demand.
• To set realistic standards for the quality and availability of services.

Most likely, all of these solutions need to be combined in some way. In any case, it is necessary to start making decisions now, because it will take years for decisions to have an impact.

Janar Holm
Auditor General