11 may 2012

Prime Minister Dmitry Medvedev holds a meeting in Tambov on improving social services

"The social services system should be much more modern, it should be more focused on the needs of our people."


Dmitry Medvedev: Good afternoon colleagues, please take your seats.

You have found the right place for our current meeting – there couldn’t have been a better venue.

Our meeting is devoted to a very sensitive issue – social services to the population. It is at the centre of attention of all authorities in this country, including the government. It is about our attitude to elderly and disabled people, and to families with children in difficult circumstances. By standard criteria, this category amounts to about 20 million people.

Today we have about 5,000 regional social institutions. Importantly, in recent time our authorities have been building elderly care centres in addition to traditional boarding houses. We are now in one of these average boarding houses – it is quite ordinary and nothing has been done here for our visit because we decided to come here at the last moment. Mr Betin (governor of the Tambov Region) would have been unable to do anything even if he wanted to.

We’ve just been to one of these centres and, of course, this is an institution of a different level, with good medical treatment capabilities and opportunities for communication, rest and recreation. Now we also have recreation and retreat places, crisis centres for families with children and other similar institutions.

In 2011, 35 social institutions (am I correct?) have been built, some of them under the programmes co-financed by our Pension Fund. Both standard and new projects are being used for this purpose. Modern methods of social care for elderly people at home are also being introduced.

Needless to say, we must study and promote the positive experience that many regions have accumulated after social services were transferred to their responsibility. However, there are also serious issues that must be resolved at the federal level.

The first issue I’d like to highlight is the differing regional regulatory frameworks. This is true – and here we see the governors of some regions, some territories who can confirm this – currently the residents of even neighbouring regions are getting an absolutely different range of services. Of course, the higher and broader this range the better; there is no limit to perfection. However, we must create a certain set of minimal standards for these services, because otherwise there will be permanent differences between different regions, too wide of a gap between them. The problem is that the relations forming in this area are currently governed by two federal laws that are outdated. I mean the 1995 law, On the Foundations of Social Services for the Population of the Russian Federation, and the law adopted in the same period, On Social Services for the Elderly and People with Disabilities. These are two basic documents.         

To eliminate this duality and create a more modern regulatory act, I issued instructions 18 months ago to develop a new law, On the Foundations of Social Services for the Population, a new law meeting modern realities and, most importantly, meeting the needs of our citizens. The law will provide for uniform standards of social services across this country with the use of regional experience, including in cooperation with non-profit organisations and businesses. This work is concluding, and Ms Golikova will brief us on the results of this work. The draft law is a large, solid document, and our meeting should result in a decision to introduce it in the short-term to the State Duma. And so it is nice to see our colleagues from the State Duma here.

The second point that I’d like to make is this: We all realise that regions have differing resources and capabilities. The system of social services in some regions suffers from chronic shortage of funding. As a result, there are growing queues of patients that need to be taken to hospitals; there are growing queues of those in need of social services at home. Currently about 20,000 people are queuing for hospitals, and over 35,000 people are queuing for social services at home. There are other problems, too. The inspections showed that a large number of institutions fail to comply with sanitary standards. There are social institutions that are beyond repairs; and staying in them can be dangerous to one’s life. This is the situation that requires federal intervention and adequate solutions.     

The social services system should be much more modern, it should be more focused on the needs of our people. Truth be told, these needs are rather modest. Our people never demand anything special, they are often thankful for a basic set of services, for an absolutely basic set of services.

We need to develop the material and technical base of the social institutions. We need to continue to build new hospitals where there is no other way to tackle the problem of large queues at hospitals. Meanwhile, the requirements of the federal law, On the Security of Buildings and Structures, should be observed most strictly. This concerns both new and old facilities, of course. We all remember the tragedies in a number of regions, unfortunately; I mean the Republic of Komi in 2009 and the tragedies in the Krasnodar Territory and in the Tula Region. These are extremely serious events, and our task is to prevent such events in the future. Naturally, this will require additional resources. Let’s discuss what sources of funding can be used here. There are a number of problems involved along with proposals.

Naturally, we should keep in mind that even state-of-the-art infrastructure is no substitute for simple, warm, humane treatment. Our people are very sympathetic and responsive. We have visited several social facilities where we saw that simple care and attention produce a good emotional response – everybody should provide care and attention at every level. Therefore we should focus on training and encouraging social workers. I met with them some time ago, and we discussed creating adequate conditions for their challenging work. This is close to pure altruism, but we are in a position to remedy the situation. The issue is not only about raising salaries, but also about provision of motor transport, mobile communications and, certainly, attracting young specialists to this fairly challenging industry. This is what we are going to discuss at today’s meeting. I give the floor to Ms Golikova. Please go ahead.

Tatyana Golikova: Thank you. Mr Medvedev, colleagues, I will continue on the subject raised by Mr Medvedev in his opening remarks, specifically, the instructions issued to the government 18 months ago regarding updating of social services regulations. The initial deadline was tighter than the current one. We may have protracted, but for a reason: this is a very sensitive law that needs to be discussed with all stakeholders and consumers of social services. Mr Medvedev, we now have about 1,100 permanent reviewers after 18 months of work on this draft law. It’s been posted on the internet all this time, and we’ve received over 1,130 comments. The original draft has undergone major changes, including conceptual ones. The current text is a result of work of many people. The draft was discussed with the participation of members of parliament right before May holidays, since, as you have rightly noted, it will be submitted to the parliament very soon.

Before we go on to discuss its main provisions, I’d like to give a brief presentation and call your attention to several important figures that describe social services in Russia. You can see on the first slide that around 19 million people are covered by social services annually. Fixed-site institutions provide services to about 370,000 recipients; the rest are serviced by mobile or semi-mobile social services institutions, including 1.4 million people who receive home-based services.

In all, we have 11,640 social services institutions, of which 5,000 are fixed-site facilities and the rest are mobile or semi-mobile institutions of various types.

Slide 3 shows the structure of paid social services: 30% of recipients whose retirement benefits were lower than the subsistence minimum were entitled to free social services in 2011. Fifty-two percent of recipients whose retirement benefits were within 100%-150% of the subsistence minimum covered a portion of the cost of social services provided to them. Eighteen percent, whose income was upward of 200% of the subsistence minimum, paid for the services in full.

The next slide shows that about 515,000 people are currently employed in the social care system. There’s need for 33,550 more staff members, including 14,200 mid- and entry-level medical personnel. These shortages are mostly due to relatively low salaries and inadequate training, since our higher education system doesn’t focus properly on training social workers. This slide shows average salaries ranging from 5,100 roubles a month in the Penza Region to 23,800 roubles in the Kamchatka Territory. In conjunction with the local authorities, we will raise these salaries once we get relevant instructions. Clearly, such raises depend on regional budgets, but we will need to tackle this issue no matter what. As for the costs involved in the provision of social services at different levels, fixed-site social services cost 7.4 times more than home-based services in 2011. Fixed-site expenses average 193,000 roubles per person per year across Russia. Home-based services cost around 26,100 roubles per person per year. The most expensive regions include Moscow, the Yamalo-Nenets, Khanty-Mansi and Chukotka Autonomous Areas, which makes sense due to high income levels and high regional wage premiums. As you can see, the average cost at fixed-site institutions in the regions such as the Karachayevo-Circassian Republic, the Penza Region, the Republic of Chuvashia or the Kabardino-Balkarian Republic amounts anywhere from 14,200 roubles to 73,000 roubles a year. Of course, this is not enough for a fixed-site institution.

In your opening remarks, you described the current situation in terms of the 1995 legislation. This legislation has undergone some cosmetic changes only in 2004. They were related to the delimitation of authority that didn’t imply any major changes in regulating social services.

Perhaps, the lack of an exhaustive list of specific grounds for receiving social services is the main problem today. The citizens’ rights are determined not by specific social services, but rather by the description of certain types of social services. Some regulations are inconsistent with the law on socially oriented non-profit organisations. We often talk about the need for their involvement in the work, but this hasn’t been included in legislation yet. As a result, we have what you mentioned: a high level of differentiation across regions in terms of the standard and quality of social services.  

The new draft law sets forth legal, organisational and economic grounds for providing social services, specifies related constitutional rights of individuals and clearly defines regulatory powers of the federal and regional authorities.

In addition, it is also important that five social services concepts, such as the supplier and the recipient of social services, personal assistance, difficult life situation and individual need for social services, have been enshrined in law.

In addition, this draft law includes legislative changes that have occurred in the budgetary institutions related to the government contracting system, non-profit institutions and so on.

Today, we have seven categories of people who are eligible for social services. The draft law adds four more categories, including individuals or families recognised as low-income ones by virtue of the law on state and social care, even families with adults or children with disabilities, families with HIV-positive family members and family members with drug and alcohol addiction and families at high social risk.

Importantly, the existing principles of social services organisation are complemented by what we believe is an absolutely essential principle, namely, the focus on keeping the recipients in their customary environment for as long as possible, i.e. providing home-based social care. Unfortunately, this form of social services ... It seems to be popular, but it is poorly organised in Russian regions for obvious reasons, such as long distances, lack of financial support and so on.

Last year you issued an instruction during the State Council meeting to the effect that, in addition to improving the material status of institutions, the money from the Pension Fund should be used for the acquisition of mobile posts. In 2011, 62 regions purchased 632 motor vehicles.

As for the distribution of powers, I would like to begin with Slide 9. On the left, you can see six powers available at the federal level that have been established by applicable legislation on social services.

Today, we will specify these federal powers based on the discussions that were held across the nation. They have to do with more than just regulations. They also include standard applications for the provision of social services, standard certificates of social services institutions and other methodological foundations that establish a common organisational approach with regard to Russian regions.

Slide 11 also has to do with the powers of public authorities. Today there are only four, but their number will increase after we specify them. You can see them on Slide 11.

In addition, the draft law defines the rights and obligations of social services recipients and the rights and obligations of social services providers. The draft law also sets forth appropriate mechanisms (you will see them in the slides later), which allow us to track social services providers. In addition, the draft law defines the conditions and types of social services and defines a list of reasons for recognising an individual or a family as eligible for social services.

Perhaps I should list some of them: partial or complete loss of the ability to take care of oneself, disability, orphanhood, neglect and homelessness of minors, family problems, family members with disabilities, recognition of low-income status (I have already mentioned it) and several others. In addition, the individual need for social services has been established as well. Clearly, an assessment must be made to identify individual needs. Individual needs shown on Slide 15 include such criteria as health, the need for permanent or temporary help, family status, housing conditions, material security, the risk of getting into a socially dangerous situation, psychological condition and several others.

The draft law currently includes a provision about a customised social services programme, which is an integral part of the social services agreement. Many experts suggest looking into the need to introduce personal cards once we decide to go ahead with the social contract.  Perhaps, there is need to discuss this further, because this applies more to fixed-site institutions than to home-based social care.

In addition, the draft law defines a list of social services that should be provided at fixed-site and semi-mobile institutions and, of course, at home, and also lists all the relevant services. Together with experts, we tried to make legal provisions as straightforward as possible to avoid many by-laws in the future. We won’t be able to do without them at the federal or regional level, because clearly if these powers belong to them, then they should exercise the bulk of regulatory oversight.

I would like to draw your attention to an important innovation in the draft law shown on Slide 17. In the previous versions of the law on social services, social services were to be carried out only by state social services agencies located in Russian regions. The new draft law proposes to add four more categories: individuals engaged in business activities, socially oriented non-profit organisations, non-public social services organisations, philanthropists, volunteers and so on. However, I would like to point out something that is not related to this draft law, but is related to real life. Today, such organisations can participate only if social services are provided based on competitive tenders. This field is still regulated by Law No. 94 and the law on federal contract system. This area of application is extremely sensitive, so Law No. 94 and the future federal law on the contract system should be applied with caution.

Since we have agreed with the Duma and the Federation Council that the law on the federal contract system will be finalised by the State Duma, it would be appropriate to pay special attention to this area because, clearly, individuals, socially-oriented non-profit organisations and non-public social services organisations will tend to provide home-based services. Obviously, the Russian regions should charge certain fees for providing social services, and winners will provide such services, but one other thing is clear as well: we should understand what these organisations that provide services are all about. Perhaps we shouldn’t award contracts to the lowest bidder. Most importantly, these services should reach all the people who need them. So, we need a clear and transparent register of providers of such services.

As I mentioned earlier, the draft law sets forth mechanisms for providing social services and organising related information systems, lists of recipients and providers, and - importantly – the procedures and standards for providing social services, as well as all the regulations governing interagency cooperation that support the need for electronic provision of information and receipt of social services. I believe that we will need to delimit the provision of paid and free social services. This subject has also been discussed in depth, and is shown on Slide 19. We have identified absolutely clearly the categories of recipients entitled to free services. They include people who are not capable of self-care due to old age, illness or disability and have no relatives. These are people in difficult situations due to family problems, minors in distress, retirees aged 80 years and up. Current legislation and the current draft law stipulate social services that are provided on the basis of partial payment or full payment. Perhaps, the draft law should be even more specific about services and terms of their provision.

Unlike the previous law, the draft law sets different levels of oversight in the area of social services, including the state, departmental, internal and public oversight.

To conclude, I would like to say that after we had a meeting with representatives of the parliament and the working group, we summarised and discussed all comments that we had received as a result of the public debate. After that, we sent the amended draft law to Russian regions on May 5. I believe it is very important that they pay attention to the key points you mentioned in your opening remarks, before they send their final comments on this draft law to us.

The updated version of the draft law – the one that you have in front of you – is posted on the official website and is still being discussed by the public.

Dmitry Medvedev: Which website is that?

Tatyana Golikova: The website of the Ministry of Healthcare and Social Development. We would like the regions and non-governmental organisations to get back to us with their feedback as soon as possible. The Public Chamber is actively working on this and has provided spoken comments on the draft law. We plan to submit the draft law for consideration by the Duma during its autumn session. That way, we would be able to adopt it by the end of 2012 and enact the main part of the law on January 1, 2013. Other regulations that require by-laws to be adopted by the regions could be enacted six months later, as is done in similar cases. Thank you.

Dmitry Medvedev: Thank you, Ms Golikova. The draft of the decision that we are about to adopt today says that we have discussed and finalised the draft law, which should be submitted for consideration by the government before July 1. After a brief discussion by the government, it should be submitted to the Duma and passed by the end of 2012. I believe that this is a realistic timeframe, so we should stick to it. Thank you.

Who would like to take the floor? Please go ahead, Mr Isayev.

Andrei Isayev (Chairman of the State Duma Committee on Labour and Social Policy): Thank you. Mr Medvedev, esteemed colleagues, we support the government’s stance that this bill is needed, that it should be passed before the year is out, and we can confirm that the majority of the work in preparing and examining this bill has been done. We are pleased to note that parliamentary representatives were included in the working group. Representing us in the working group was Galina Karelova, probably the highest authority on this issue in the State Duma, and therefore most of the comments we made were taken into consideration during the finalisation of the bill. We still have some comments. For instance, article 11 of the bill prioritises social security provision for minors who find themselves in difficult situations. The overall sense of the article implies that the specifics of minors should be taken into account, however the word “prioritise” implies a sense of precedence, in other words there is some top high-priority category, which comes first, and all other categories come second, after the problems of this top-priority category have been solved. This runs counter to article 5 of the bill, which specifies equal rights for all people in obtaining social assistance, regardless of their age, social background, etc. Consequently, we believe that this bill can be modified still further. Nevertheless, it is our opinion that there are no conceptual points of criticism, and that the document can be finalised by the government working group and later during preparations for its second reading in the State Duma.

In this connection, there is another important point I would like to make. Mr Medvedev, when we met at a meeting of the parliamentary party prior to your approval as prime minister, you came up with the important idea that the bylaws for some bills should be finalised pending their examination in the third reading. As I see it, this bill falls into this category, and its bylaws should be drafted pending approval of the bill. Seeing as the Russian regions have been granted numerous rights, it would be good if as well as the bylaws, the government could draft standard model regulatory documents for the Russian regions as part of the elaboration of this bill. As a result, we would get real minimum social standards and benchmarks in the form of standard documents, which the government could recommend to the Russian regions.

In conclusion, I would like to say that of course, I support Ms Golikova in her opinion that, while preparing the law on the federal contract system, it is crucial to stipulate that the price should not serve as the main criterion for winning tenders to provide social services to the population. You see, we realise that we often encounter situations of price dumping, cutting prices, but without actually providing people with any real services.

Thank you very much, Mr Medvedev.  

Dmitry Medvedev: Thank you, Mr Isayev. 

Anatoly Artamonov (Kaluga Region Governor): Mr Medvedev, esteemed colleagues, I would like to say that everyone agrees that the bill has been examined down to the smallest detail. This is a timely and up-to-date regulatory document. It has been widely discussed; we for instance, also submitted amendments that were taken into account, so if we continue modifying it, it might get worse.

Dmitry Medvedev: That sometimes happens.

Anatoly Artamonov: What provisions can be added, so that they don’t change the essence of the law? For example, we could add some clearer standards regarding the provision of these services because standardisation is essential … We’ve been saying for many years that a common nationwide social infrastructure should be established. Today, we can see that it’s not so bad when the regions are able to provide a certain volume of services in their respective territories using their greater potential. But if we take, for example, Moscow, the Moscow Region and surrounding regions, some disproportions have become pronounced, which in some cases leads to heightened social tensions. In this respect, some things might need to be spelled out.

Today the federal legislation practically does not regulate the issuing of licenses to organisations which provide social services to the population. To be honest, we could have made more use of public–private partnerships in this area. In our region, for example, this is standard practice. There is the danger of seeing unscrupulous providers of these services. This is a very delicate and sensitive area. In my opinion, we should be able to get rid of such organisations by issuing licenses.

Next. By law, payments for accommodation and social services for elderly people with disabilities in nursing homes cannot exceed 75% of their retirement and social pensions. At the same time, the actual costs are considerably higher, and we have to make the additional payments out of the regional budgets. I believe that it’s high time… Considering that we are witnessing a certain lumpenisation of the population, we need to introduce measures to keep these processes in check. We could pass legislation obliging the families of residents in nursing homes to bear a proportion of the costs of the medical and social services for their parents or spouses. Incidentally, article 88 of the Family Code of the Russian Federation makes it incumbent on adult children to make a contribution towards their parents’ maintenance expenses.

And lastly I would like to make one small point. We are launching a large-scale campaign to build rental housing, which will include various provisions for  opportunities for the simplified renting of such housing by different categories of individuals. Perhaps it would be inappropriate to place some individuals in retirement homes. Maybe they are not mentally ready for such a step. Perhaps there could be some state support measures for these people, so that they could easily rent a flat somewhere in a decent building on condition that a specific set of services is provided to this category of people.

I think that would be good. By the way, we are now opening many of these institutions, and we are trying to equip them with good furniture, we are creating the right conditions. Many senior citizens are quite shy and don’t want to move into retirement homes. So rental housing could help solve the problem. Thank you.

Dmitry Medvedev: Thank you, Mr Artamonov.

Oleg Betin (Governor of the Tambov Region): Mr Medvedev, I agree with Ms Golikova and the colleague who said that this is a very good law. Its main attractions are a strong logic and a solid structure. We must definitely adopt it, but some amendments will certainly be made to it during discussion. What worries me here? I believe that the law will be adopted, but I fear that when implementing it we may find it impossible to honour some of its provisions and requirements.

I am referring, in particular, to a transitional norm in Article 46, under which the authorities of all Russian regions must organise the provision of social services in accordance with the procedures elaborated in compliance with this Federal Law starting in 2014.

And these provisions will be… For example, Mr Topilin (Maxim Topilin, Acting Deputy Minister of Healthcare and Social Development) will write the law but it will be for the regions to implement it, and they will be called to account for failing to do it. In the past, we adopted a law on state guarantees. But we still cannot finance it, although the prosecutor’s office calls us to task, making an official request when we draft the budget and appealing for a responsible attitude.

Dmitry Medvedev: I don’t quite understand. Mr Betin, do you think you will be unable to draft the transitional provisions or do you expect the federal-level team to fail?

Oleg Betin: I believe we will be unable to finance the provisions that could be stipulated in the law.

Tatyana Golikova: Not even the provisions, but the procedures that will be …

Dmitry Medvedev: This is exactly what I am trying to understand: Do you question the procedure stipulated in Article 46?

Oleg Betin: Not the procedure, but our ability to finance its application.

Dmitry Medvedev: So, the procedure will be stipulated but there will be no money? Or there will be no procedure either?

Oleg Betin: There will be the procedure but no funds.

Tatyana Golikova: I just want to draw your attention to the formula according to which the executive agencies have the right to “approve the procedures for the provision of social services in Russian regions.” This means that a standard procedure will be approved at the federal level, but the financing of its implementation in the region will depend on the region’s budget. This is why it is written in the law, or rather in an appendix, that there will be no need for extra funds.

Dmitry Medvedev: In other words, no one will force any particular standards on anyone?

Tatyana Golikova: We have no right to do so, because the issue concerns competences.

Oleg Betin: The law does not say so directly, but the issue will be clarified in the enactments that are to be approved later. Besides, even the current procedure can be disregarded. You said in your opening remarks that not enough funds are allocated for many projects. We have considered additional spending under the new law. To date, 17,500 people receive assistance at home, 2,400 people in hospitals, 2,980 people in outlying cities and towns because we lack the staff to provide services there, 1,500 children with special needs, who should be covered by this law, and 15,000 people with disabilities who live with their families but still need social assistance.

First, we will need to double our social staff, who currently number 6,178 people, not to mention the material resources about which it could be said tomorrow that they do not meet the norms, requirements or standards. This alone would cost an additional billion roubles, or more precisely 906 million roubles in our region, and therefore we need to adopt the law. There is one thing to which I’d like to draw your attention: We have an education and healthcare modernisation programme, which will need comparable funds in the future. Therefore, if we adopt the law, the sequence of introducing provisions should depend on the actual capabilities of the federal and regional budgets.

There is one more element that could be used here, even though the financial sources will be the same. The gerontology centre you have visited was built with allocations from the region and the Pension Fund. And the construction of this building was co-financed too, which is why it is managed in the same way. Therefore, the participation of funds and interdepartmental interaction could be specified more clearly in the law, including the participation of the Pension Fund or any other state funds as co-financing agents. A lending mechanism could also be stipulated, so that loans would be issued for specific targets. The trouble is that [good] decisions may be taken but their implementation leads to a contrary result.

This may be quite a different issue, but the problem of commuter trains, of railways has not been resolved, and we cannot seem to find a solution although we have met more than once, in different groups, to discuss it. I’m afraid that if we adopt this law, the day of reckoning will come – and I don’t want us to fail. It is very important… You have seen how warmly the veterans welcomed you – we must not fail them and the hopes they have pinned on you today. Thank you.

Dmitry Medvedev: Thank you. You are right about it being impossible to deceive them.  If we reach some agreement, it should be fully guaranteed by various ways of raising funds. Let us also discuss them today. Go ahead please, Mr Kovalyov.

Oleg Kovalyov (Ryazan Region Governor): I agree with my colleagues: even preliminary estimates show that in order to fulfill the law’s requirements at the minimum level, the industry will need an additional investment of 250 million roubles, while the current budget for social programmes is 1.5 billion roubles. This is a relatively small increase and it will be spent on raising salaries as well as on other purposes. So I would like to draw your attention to one aspect that Anatoly Artamonov has mentioned. The situation is as follows: apart from the Family Code, there are no laws that support relations between generations. War veterans living in our retirement homes can suffer because it is difficult for them to accept the fact that they are obliged to live there, while they have children who are quite well-to-do. Unfortunately there is no law that requires providing for one’s parents, even in part. I have often witnessed situations where people living in Moscow, who have good jobs, send their parents to live in retirement homes. These senior citizens suffer more psychologically than physically. They do not need much. But I think it would be good to add some requirements to the Family Code along with adopting this law, because excessive paternalism isn’t good either.

Dmitry Medvedev: Go ahead please.

Anton Siluanov: Thank you Mr Medvedev. I have two ideas, one of them already voiced by Mr Kovalyov. I must say that this law essentially regulates the authority of the regions. Some of its clauses clearly stipulate the responsibilities of the regional governments. For example, article 12 of this law says that federal approval is required for various standards, such as diet and equipment at social institutions, as well as the list of sources of income used while estimating the average per capita income, and so on. But this means we interfere with the regional governments’ authority. Do we really need to interfere? And if we do, in what capacity? We must certainly pave the way, make recommendations and provide information on procedures. But what happens in reality? This is not the first law of this type we are discussing. We have been saying that regions must be given greater authority in regulating the functions stipulated by the federal law. What happens if a region has financial difficulties and is short of funds to perform the functions determined by the federal law? The judicial authorities, the Constitutional Court in this case, says the federal law sets a certain standard and the region does not have enough money to meet that standard, therefore, the federal government should provide financial assistance. I think this law here also contains similar clauses, which need to be corrected so as to include support on procedures and recommendations from the federal government rather than direct financial standards.

My second idea concerns the co-financing of social programmes. Research material for this meeting suggest allocating federal funds to co-finance regional social programmes aimed at boosting the material resources of institutions which provide social services. The current federal spending for this purpose is in the region of 1 billion roubles, or about 10 million roubles for each region: for example, 5 million roubles for the Kaluga Region, 8 million roubles for the Ryazan region. I mean, these are not large amounts and I don’t belief they have great effect. Therefore, I believe our task is not to introduce new subsidies to replace the old ones for the next year, or the next three years. It is not our goal to introduce a new subsidy or increase the money flow. Our goal is to integrate all subsidies within the framework of existing and planned systems – state programmes – and list clear conditions a region needs to meet in order to be entitled to it. These conditions should include efforts to implement the requirements of the bill we are discussing now. We do not need to introduce a separate subsidy for each specific purpose. I think this can be done as part of state programmes. Thank you.

Dmitry Medvedev: Thank you. Go ahead please.

Anton Drozdov (Chairman of the Pension Fund Board): I would also like to speak about an existing state programme, the co-financing of the regional governments’ social obligations, including, in particular, funds spent on maintaining the material resources of institutions providing social services. The problem is that social services are often funded on leftovers. Any governor can tell you that. But for the co-financing provided by the Pension Fund, social institutions would have been built and renovated at a far slower pace. We have contributed 22 billion roubles over a decade which has helped renovate and modernise a large number of institutions, in collaboration with regional governments. We provided these funds as subsidies. However, if co-financing will continue as part of a targeted programme, the process will be accelerated even further. And we are also determined to expand this programme and extend it to three years, because this year, for example, we have a billion roubles, but we have no more for 2013-2014.

At the same time, I would like to add that this law and this programme are going in two different directions, because the law does not provide for the subsidy we are talking about, but the money is allocated via a different programme. The law says that the federal funds are transferred to an authorised federal body, which we aren’t, and are then channeled on further to fulfill federal obligations. The money that we contribute is included in the Social Support programme (the Modernisation of Social Services subprogramme). Therefore, I think we should keep to co-financing for the time being, while there are still problems in this area and the regional governments cannot cope with this on their own.

We also have a remark on the law: it envisages a good many registers and rosters at various levels with electronic interaction or the exchange of information between them. In accordance with normative documents this should be based on SNILS, or an individual personal account insurance number. Therefore we suggest that Article 33 include the insurance number on the register’s data because now, for example, we interact with the social security agencies based on this number. It takes place in electronic form. We make the register of persons entitled to benefits at the federal and regional levels every month, determine the level of their income and then pick the group that is entitled to additional federal benefits. This process is working smoothly and it could be included in the law.

Dmitry Medvedev: Thank you. Galina Karelova, please.

Galina Karelova: Mr.Medvedev, esteemed colleagues. Honestly, Andrei Isayev has presented the State Duma position, but I thought I should react to the remarks by Anton Siluanov. All of us who have taken part in drafting this bill believe that the adoption of the bill marks the beginning of a qualitative renewal of social services. We think the bill is the first step in creating a legal space that will really kick-start the modernisation of this area. Modernisation is necessary: not only are the buildings and the equipment old, but also the paradigm of personnel training must be changed. Only 5% of the social higher education institution graduates choose to work in the speciality for which they have been trained. In other words, there are a lot of problems. They will not work in this area until we’ve changed and created new approaches in this sector. I think a modest sum could be allocated at the first stage to stimulate innovative technology or different approaches in the regions, a contest could be organised to send a strong message to the regions that the sector is beginning to change qualitatively. Thank you.

Dmitry Medvedev: Thank you. Valery Ryazansky, please.

Valery Ryazansky (Chairman of the Federation Council Social Policy Committee): Mr Medvedev, the Federation Council was also involved in the working group and we have seen, as successive variants were proposed, that the draft changed and that the changes complemented each other and the overall quality was improving. We believe that new conditions in our country must include a more modern legal framework for the processes ongoing in the social sphere. Social services is not simply a collection of disparate forms, but a sector that serves people. The role of the state here must be very pronounced. I think the draft law encourages the use of forms of social services that are not capital-intensive. That’s right because we should look for new approaches that won’t involve great outlays of capital, but will nevertheless be effective.

The working group has taken into account our remarks about including socially-oriented nonprofit organisations in this segment. We appreciate the drafters for including our amendment. The draft law updated the item on housing for orphans. In between readings of the bill I saw one more positive change related to the strengthening of oversight and interagency interaction. Why? In the intervening period I came upon an article about an accident in Vladivostok, where a misdirected mother, if indeed she can be called a mother, starved her two daughters, aged three and four, to death. I think if there existed interagency oversight of the services that deal with these matters, surely someone would have been alerted to the problems of that family and prevented the disaster. So the subject of oversight must be written up, and we have that in the draft law; the drafters are to be given credit. Of course, we support the draft law and we believe it can be submitted for discussion.

Dmitry Medvedev: Thank you very much. You please.

Svetlana Verzhbitskaya (Deputy Governor of Tver Region): Thank you. I too represent a region and I would like to say that the latest draft of the law that I have read differs substantially from the early drafts that we saw and that had put the regions on their guard when they saw the early rough drafts. Now we see that the remarks of the non-government organisations and the deputies have been taken into account and the regions are also pitching in. The draft law was mailed to us on the 5th. Although a huge amount of work lies ahead, the draft law takes social security to a different level, a more up to date level. I think we should move on from social security to a different kind of services, new forms. This law implies a change of mentality among the recipients of these services, and let’s face it, the mentality of the social security workers who are used to working the old way. Introducing new forms that assess the quality of the service, and that are also mentioned in the law, calls for further effort. I think that certain parts of the law could be polished to make them more clear. For instance, today we were discussing average per capita income and what it would include: only the pension or salary or also property, a car and so on. Certain concepts need to be more precisely defined. But the law does fill a need and elevates these matters to a higher level, and it will force us, the regions, to take a new look at social security services.

I would like to say that social security has some untapped reserves of its own. For example, over the last six months we in our region developed model staff charts for retirement homes which made it possible for us to use our internal reserves to raise the pay for medical personnel attending to bed-ridden patients. Their pay is very low, but no additional allocations were required, just the introduction of these model staff charts was enough.

At the same time I agree with my colleagues from the regions that the time has come for the government and the federal authorities to pay closer attention to social protection. All the updates in the education and healthcare systems throw up the problem of keeping personnel. The social security area is manned by older personnel and practically no young workers are joining these agencies. One option could be to support the regions by allocating lump-sum allowances to be offered to social service personnel, like those offered to doctors who go to work in rural areas and so on. Perhaps some bylaws could renew not only the service, but the pool of personnel that deliver that service. I agree that this draft law gradually moves us away from the free-ride attitude to our social security sphere…

The law should be introduced carefully and by stages without undue haste and without creating social tension. But I think this law is absolutely necessary.

Dmitry Medvedev: Thank you.

Anatoly Artamonov: I’m sorry for sidetracking the discussion but could we devote some time specifically to taking stock of the requirements for the creation of various institutions, for example, kindergartens, retirement homes, etc.? You know, when you go there, it’s like a feast during a plague. For example, if a nursing home for the elderly has 29 patients, you will find at least 30 personnel of whom five will be medical workers. And this despite the fact that they are in the adjoining room, in the same building, they have been given part of the regional hospital because we are reforming all of them. Separated from them by just a wall there are doctors, nurses, everything. However, if we don’t have five nurses on our staff we won’t be able to obtain a license. Or take the size of a toilet room in a kindergarten, I think it is 24 square metres, or perhaps 16 square metres.

Dmitry Medvedev: The anthological example was not a toilet but a kitchen. According to Soviet standards, it was the size of a restaurant. A kindergarten cannot be registered if it does not have such a kitchen.

Anatoly Artamonov: I promised you that there would be no waiting list for kindergarten this year; we are building 23 new kindergartens. My heart is bleeding when I see this nonsense: we are pouring money into it. But in fact nobody needs it, neither the kids nor their parents. Only Onishchenko needs it (Gennady Onishchenko is the Head of the Federal Service for Supervision of Consumer Protection and Welfare).

Dmitry Medvedev: And Onishchenko too…

Anatoly Artamonov: This is a 1930s attitude.

Dmitry Medvedev: But he was already working in the ‘30s. Onishchenko is eternal.

Anatoly Artamonov: Let’s take a closer look at this matter, Mr Medvedev, it is very important.

Dmitry Medvedev: People come and go, but Onishchenko stays. I hear you. Thank you.

I think it’s time to wrap it up. There is no doubt that the new law is necessary and we must create a modern foundation for social services. The 15 years that have passed since 1995 (17 years actually) is a considerable period of time. Since then our country has changed and we have new opportunities, so upgrading legislation in this sphere is an overdue task. In the last year and a half a good deal of work has been done, although, as Tatyana Golikova said, it took more time than originally planned, but this proved to be a blessing in disguise: I hope that as a result we have a more or less agreed text in spite of the details mentioned today. We can use this to move it forward to the government and then to submit it to the parliament. We will finalise it. I would go along with what Andrei Isayev said about preparing the bylaws that will allow the main law on social services to be adopted. I would like to remind you that some time ago I issued instructions on this matter and on some other issues that were contained in my annual address.

Unfortunately, most government agencies are having a lukewarm reaction to this theme because it calls for a concentration of resources and a lot of work. But I have promised to the United Russia parliamentary party and other colleagues that we would revisit the issue and compile at least an approximate register of bills that require a prior preparation of bylaws. This register should not just be created but it should form the basis of the future government’s activities. The law should be enforced if it is backed by the related enabling legislation – bylaws, otherwise it should not go before the government at all, if we want to have order in that department. As for the law we are discussing, this is a legitimate requirement.

Concerning the issue of licensing raised by Anatoly Artamonov. As I see it, the model embedded in the draft law is… there is no licensing, but there are the register and the specified grounds for being included in or dropped from the register based on the compliance of the services to the accepted standards that the social institutions must live up to, so it is a structure very similar to licensing.

The issue of the so-called responsibility of children to support their parents: this topic is not as simple as it may appear. Some time ago I made a special study of this issue. Of course, one can establish harsh rules, including a liability of the children for the debts of their parents, but life can be tricky and our family legislation proclaims the approach whereby children are not liable for the debt of their parents and parents are not liable for the debt of their children because they are independent civil actors in family legal relations, and this is in fact the approach everywhere in the world.

At the same time it is of course not only a legal, but to a large extent a moral problem, and the examples you are citing are all too frequent when children can well afford to support their parents but do nothing. But one also encounters the reverse situation when able-bodied parents do not help their sick children. But family support duties in our family legislation refer above all to parents supporting their underage children and in some cases, it is true, the duty of children to support their disabled parents. All this goes to show that it is not such a straightforward situation as it might seem, but still we can take another look at the matter and see if we should not discuss these obligations of mutual support based on family legislation and perhaps make some adjustments. Although in my opinion they should not be changed radically because that would contradict the principles of any society, and the legal approach to the way a family is organised.

Now as regards of the review of requirements to social institutions, I would support it 100%. Some of the requirements are grossly outdated. I think we have implemented them with regard to kindergartens and pre-school childcare. I’m not sure if they are adequate, perhaps they are too demanding or obsolete. We could take another look at them. I am ready to issue a directive and even conduct a meeting devoted to the inventory of requirements to social institutions. Let’s think about when to hold it and perhaps the government could review the entire situation in this sphere to see what has been done and what changes need to be made.

Clearly, the cost of implementing this law will be considerable. I don’t know if it will be as high as that of modernising healthcare and education, as Oleg Betin claims. But it will be considerable. In this respect I would by and large support the idea of making maximum use of financial tools to address the goals set in this law. I’m referring to the resources of the Pension Fund, credit mechanisms and some other schemes which could be applied, including some sub-programmes in existing government programmes, for example, the social support of citizens programme. But let’s be mindful of what we can afford now. As regards financing, I think that’s a possible approach that makes sense for some major tasks.

On the remarks made by Anton Siluanov. I agree that we should lay down the legal structure of the law in a way that would not give rise to obligations we did not envisage when drafting this law. We should be honest with the regions and in turn the federal budget should be secure. I think we should pay attention to the proposals made here. Regarding co-financing, the suggestions made by Anton Siluanov could be useful.

Bringing order to the training of skilled personnel in this field (Galina Karelova and other colleagues spoke about it), training specialists who are not interested in moving all over the country is of course an obvious challenge. That said, we understand that it is hard to lure a new specialist to a 5,000-rouble-a-month job. The women who are engaged in this business are truly great women who provide social services for very little money, but as a rule they are not young specialists. There are however, some notable exceptions. In any case the training of personnel in this respect must be improved. I don’t know how many universities work in this field, I am not sure that they all make the grade; there has been a proliferation of major areas of study and institutions. Perhaps they should be instructed to get organised.

Anatoly Artamonov: Actually, there is also a need for rebuilding and major repairs. There are so many buildings owned by various state corporations and defence enterprises and the like that are not being used, it is simply mind-boggling. We could take their inventory if you trust us with the job…

Dmitry Medvedev: I know you don’t like the Defence Ministry, we have discussed this with you more than once. We’ll take an inventory and take away what needs to be taken away and leave what they are entitled to.

Finally about the resolution, as I said, it will be signed. We’ll draw attention to some important issues, including rules for interagency interaction, the introduction of information systems at social service agencies, the registration of suppliers, the registration of social service recipients and a range of other issues raised here today. On the draft resolution, you have until May 20, 2012, a very short time, to introduce your remarks on the draft (we have discussed them today). I invite all those present here today to commit these remarks to paper and send them to the Ministry of Healthcare and Social Development. But we must review this draft law at a government meeting before July 1, 2012.

Thank you very much and goodbye until our next meeting.