(cont. from § 12) Certain issues regarding the healthcare system's preparedness for supply (cont. SoU11)

Johnny Svedin (SD)

Madam Speaker! From the end of 2019 onwards, the disease covid-19 with its after-effects has affected us all in one way or another. The pandemic seemingly took both the government at the time and the authorities by surprise.

During the year when the pandemic was most devastating, Sweden's various stocks of protective equipment were small or almost non-existent. This meant for a long period that the heavily strained staff working within health and medical care and elderly care did not have access to protective equipment to prevent further spread of covid-19.

The Corona Commission, which among other things has evaluated the government's and the authorities' measures to limit the spread of covid-19, gives the then S-led government stinging criticism for substandard crisis management. This meant, together with a number of other reasons, that many lives were very likely lost entirely unnecessarily.

In the proposition Certain issues regarding the healthcare system's preparedness, it is proposed that the Health and Social Services Act (2017:30) shall explicitly state that where any form of healthcare is provided, there shall also be medical products and other equipment required for good care to be able to be given. This is obviously fundamental, and we Sverigedemokrater agree with the government's proposal.

During the pandemic, there were deficiencies in areas including pharmaceuticals, and there were problems delivering several types of life-saving medicines. In a modern society well into the 2000s, such problems should not exist.

That the population of Sweden should be at the mercy of supply chains to gain access to the most basic medicines and equipment to survive a crisis is not worthy of a welfare country like Sweden. Unfortunately, that was what many Swedes had to experience during the most critical period of the pandemic.

In the proposition being debated today, it is proposed that the Medical Products Agency shall be entitled to levy a sanction fee for those who have been granted authorization for a medicinal product and have not notified that the sale has ceased permanently or temporarily. The minimum fee is 25,000 kronor and the maximum 100 million kronor.

That obligation already exists today. It is called good pharmacy practice, which the industry itself has developed. Unfortunately, it has not worked. At some point, it must be time for the Riksdag to give the authority a fair chance to rectify problems that are otherwise recurring, all so that we can achieve an effective care chain with functioning pharmaceutical management as much as possible in Sweden. This should be the desire of all Riksdag parties.

It is also proposed that outpatient pharmacies and the supply chain, that is, the wholesale trade, shall be required to stock the medicines for which there is the highest demand within the area. This may, for natural reasons, look different from pharmacy to pharmacy depending on the demographics.

It has also emerged that there are others who believe there should be a list of special medicines that pharmacies shall be obliged to stock. We believe, however, that it is best that the citizens are the ones who decide which medicines should be available at the pharmacies. But the Sverigedemokraterna can, on the other hand, see that this issue may become relevant at a later time.

Madam Speaker! We Sweden Democrats are concerned about the dismantling that has occurred in many places so that it is no longer possible to ensure a good stock of life-saving medicines, healthcare products, or medical products. We believe that previous governments' carelessness and lack of decisiveness have gone too far. We welcome proposals that address these deficiencies.

We also view it positively that the new right-wing government, in connection with the investigation on the healthcare's preparedness, has also decided to give more agencies further assignments to further strengthen Sweden's preparedness. Among other things, it can be mentioned that Socialstyrelsen has been tasked to identify and compile the most critical medicines and medical products. It shall also produce a basis for which healthcare products should be covered by the healthcare's supply preparedness, which we welcome.

Madam Speaker! In order to ensure that we in Sweden do not fall into a shortage of both supply and stockpiling of medicines, healthcare products, or medical products, the Riksdag needs to decide on important legislative changes required so that this does not happen again. I therefore move for the approval of the bill in its entirety.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! Sweden was not some isolated island, member. There was a shortage in the whole world of both medicines and protective equipment. It is perhaps good to remember that. Otherwise, one can end up in completely wrong corners.

Madam Speaker! I have a question for the member. It concerns how one views how this should be built up again. It is absolutely necessary. I also want to point out, Madam Speaker, that it was not the previous government that sold off Apoteket AB, but it was the alliance government. It can also be good to remember that. Consequently, the national stock for protective equipment, medicines, and whatever also disappeared. It was perhaps not so great, seen in hindsight.

When looking at what different referral bodies have said about the bill, one sees that many are calling for a more detailed roadmap forward. It is not about waiting or having a long-term plan.

Madam Speaker! I believe that it is necessary to have both a long-term plan and a more rapid plan. Unfortunately, the pandemic could return in a year. In that case, it is very good that we have the protective equipment in the regions, a national stockpile, and so on.

Wouldn't it be good to look at, for example, the referral responses from the Swedish Civil Contingencies Agency, which I think are very good? This also applies to the Swedish Work Environment Authority's responses regarding protective equipment. I will return to that later.

Madam Speaker! Does the member think it is sufficient to have the long-term planning? That can happen very far off. We need to speed up a bit and press the gas pedal. You can do that now when you have the chance, because you are the prerequisite for the formation of the government.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johnny Svedin (SD)

Madam Speaker! Thank you for the question, Karin Rågsjö!

Long-term perspective is obviously always good. That is also something we stand for. I see no obstacles to us looking at things from a long-term perspective.

This is a long-term measure. It is the beginning of something where we make legislative changes that require one to fulfill their obligations as an entrepreneur. I think that is long-term.

Regarding the obligation to provide access to protective equipment, that is included in the Swedish Work Environment Authority's (Arbetsmiljöverket) mandate. It is the employer's duty to ensure when something happens.

Unfortunately, that was not done during the pandemic. But I hope that a lesson has been learned and taken to heart. I believe that most regions are working on the issue quite a bit at the moment in any case.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! Of course we should have long-term plans. It would be very good if we also had a quick plan to establish a national stockpile. I believe that could be important.

I would prefer that the regions were legally obligated to build up stocks. It was a catastrophe situation we had. It is not every day that one sees the chief physician at Södersjukhuset with a cyclops instead of a visor. It is my hope that we never need to see it again.

Madam Speaker! I would have preferred that the government and its support party Sverigedemokraterna perhaps had looked more at the slightly more quick-fire items. It is important to get the work started quite quickly.

We do not know what we are facing after the pandemic. The day after the Corona Commission had presented its report, the war machine in Russia was pressed.

Then it is good to be prepared. One never knows what will happen. We shall have the stocks filled the day we need them.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johnny Svedin (SD)

Madam Speaker! I agree with the member that it is important that we build up our stocks quickly. As I said before, I am completely convinced that the regions are working on that issue. I do not believe there is a region in Sweden that does not take what has happened and what is still ongoing to some extent very seriously. It is, however, not at all in the same format as it was a couple of years ago.

With that said, I think the bill that we are debating today is incredibly important for making any progress on the issue at all. Then I know that Vänsterpartiet has some views on the implementation. At the same time, it is a big step in the right direction.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! Member Johnny Svedin accuses in his speech the previous government in a routine manner of having been passive and having done far too little.

I well remember the previous parliamentary term when representatives for Sverigedemokraterna stood in the chamber, though not Johnny Svedin, and said that you are acting far too slowly and too little.

Now Johnny Svedin and the Sverigedemokraterna have the prerequisites to act quickly. Then one can wonder why one should wait with a good deal of the investigation's proposals.

There are some proposals in the report being discussed today that I think are good, Madam Speaker. But one can reflect on the Sweden Democrats' rhetoric. Does it not apply when they are a supporting party to the government? That is my first question, Johnny Svedin.

The second question concerns the fact that the Sweden Democrats often say they are the workers' party. Now the Sweden Democrats have the chance to support the Social Democrats' bill regarding what the Work Environment Authority considers. They have stated in their referral response that they want an addition to the Health and Medical Services Act regarding protecting the health and safety of healthcare personnel. The addition shall apply to protective equipment.

But the Sweden Democrats voted no to our proposal. My question to Johnny Svedin is therefore: Why do you not stand behind the workers' situation?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johnny Svedin (SD)

Madam Speaker! Thank you, Mikael Dahlqvist, for the question! In response to question number two, there are, as I also said in my speech, requirements in the bill for healthcare products and other equipment to protect healthcare personnel. It is proposed that the Healthcare Act 2017:30 shall explicitly state that where any form of health and medical care is provided, there shall also be healthcare products and other equipment required for good care to be able to be provided. I consider that to be a sufficiently good answer.

In response to your question: Yes, we take the employees into account. I happen to be an employee within healthcare myself, so I think this is extremely important. I also think that this wording accommodates this.

However, I unfortunately did not quite understand question number one, so I must ask to come back with the answer to that. I therefore have no answer now.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! My first question to Johnny Svedin was: Why does SD not act more actively and promptly present more proposals when it comes to the healthcare system's crisis preparedness?

Your party colleagues and representatives for SD came with this criticism against us, the previous social democrat-led government, during the last parliamentary term. They thought that we acted far too slowly and too little. Now Johnny Svedin and his colleagues have the chance to speed up the process. My question was therefore: Why do you not act on more points that the investigation proposes?

It is obvious, Madam Speaker, that regions and municipalities shall have a stock - a disaster stock. That is how it stood previously, and that is how it stands today as well. One region had it, and four municipalities had it. It lasted for four weeks at most. This is an acute point. It is very good that we are building pharmaceutical stocks and that the state takes responsibility for it. It is good that we secure how healthcare shall be conducted and so on. But we have the basic problem remaining; we still have the regions and the municipalities.

My question is therefore: Why do you not want to move forward with concrete proposals even in this area?

When it comes to the staff's protective equipment, the Socialdemokraterna and the Sverigedemokraterna do not share the same opinion. Obviously, our expert authority Arbetsmiljöverket has made a different assessment. They consider that this needs to be written in for the staff's safety and security.

Madam Speaker! During the pandemic, for example, it was the same occupational environment responsibility for the employers. But it was not fully followed. Many testified to insufficient protective equipment and danger in their work environment.

I hope, as I said, that the Sweden Democrats will change their minds about our proposal.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johnny Svedin (SD)

Madam Speaker! Thank you again for the question, Mikael Dahlqvist! I have full understanding that previous Sverigedemokrater have stood here and been critical of how the Socialdemokrater have acted. I also raised this in my speech. And it was not routine, but it was a feeling that I believe many besides me - also out in Sweden's regions and municipalities - shared. But enough about that; it was not what we were going to talk about today.

The question today concerns what the bill will generate. What I feel and what we believe is that it will generate exactly what we are talking about. We will get increased stockpiling. Pharmacies, for example, will be required to have certain medicines that are in circulation. Regarding the staff's equipment out at residential facilities, in home care, in elderly care, and so on, the employer is already today obliged to have stocks even for a potential crisis.

Looking ahead, I think we should let this mature and let the bill pass. Then we can have a new debate, perhaps in a year, and see how things look then. It is to be followed up on as well, so I think we stay with this.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! For a long time, Sweden's preparedness for pandemics, crises, and war has been significantly weakened. It is about the commercialization of healthcare and pharmaceuticals that has made access to this extremely vulnerable. Just in time has been the motto for this.

In the late autumn of 2019, I submitted a proposal for a committee initiative regarding precisely preparedness. On October 1, it was the case that five regions changed suppliers of hospital materials. This concerned disposable items, syringe tips, dialysis materials, and so on. They had conducted a catastrophically bad procurement. The affected regions were Dalarna, Sörmland, Uppsala, Västmanland, and Örebro. The new supplier, Apotekstjänst AB, did not fulfill its assignment.

The hospitals went into emergency mode, and it was quite catastrophic. There was, therefore, no longer any medical supplies - none were arriving! It affected patients, and 489 operations were cancelled at these hospitals. Emergency mode was thus in effect during a period.

Then Vänsterpartiet proposed that a national preparedness plan for important medical products should be developed and that the products should be available both nationally and in the regions. We also proposed that conditions for a state-owned company focusing on medical products should be developed.

No one had a crystal ball, but one might ask if there was any outcry from the other parties? No, of course there wasn't. And three months later, the pandemic was here.

The staff in elderly care testify that the early period of the pandemic was characterized by great uncertainty and anxiety. The fear of being infected and of infecting others was very great, and at the same time, approved protective equipment, for example visors, was lacking.

To secure access to necessary health and medical equipment, there must be a completely different level of preparedness. When the crisis actually hits, there is no time to carry out the fantastic high-quality procurements. There is no chance, especially not when the whole world is making the same type of procurements.

Vänsterpartiet has in previous motions proposed a national responsibility for stocks of protective equipment and a domestic production of such. We saw that things happened during these two years that I absolutely never would have thought could happen. We still managed to get through it all very well, I think, considering how it started.

Madam Speaker! The Government now assesses that the work to strengthen the healthcare's supply preparedness must be conducted with a long-term perspective. At the same time, the investigation, SOU 2021:19, presents a more detailed roadmap for how to handle the healthcare's supply preparedness. They elaborate a bit more on how they have envisioned this.

The Swedish Civil Contingencies Agency, MSB, highlights in its consultation response that the reforms identified by the investigation should be implemented successively as soon as possible. MSB has extensive experience given what developed during the two years of the pandemic. MSB points out that the needs within the area are great and that the development of preparedness needs to maintain a much higher tempo based on the threats and risks seen in the global environment.

Madam Speaker! Vänsterpartiet shares MSB's opinion and does not consider the description that the work shall be carried out with a long-term perspective and be done in several steps to be sufficient. Long-term perspective is very important, but now the healthcare system's supply preparedness must be strengthened quickly. It feels very urgent, if I may express it that way.

Let me then return to the staff. Vänsterpartiet wants to reform the personnel policy so that more people want to start working in health care and elderly care, while at the same time those who already work there want to and are able to stay. One of very many steps is to ensure the availability of medical products and other equipment for the staff. They should not feel that there are no visors, there is no that and there is no that. So it simply should not be in a welfare state. There must be a completely different supply readiness than what exists today.

In another referral response, Arbetsmiljöverket has pointed out that a completely different approach is needed to protect the health and safety of healthcare personnel. We think this would be very relevant. The staff must be given the conditions required to be able to provide good care, and that includes ensuring that healthcare products and equipment are on site to ensure that they can take care of the patients.

We would like this regarding the staff to also be introduced in the Health and Medical Services Act. We think it is important.

The lack of protective equipment during the corona pandemic led to major occupational environment problems and difficulties for the staff to provide good care. To disregard the healthcare workers' occupational environment in the Health and Medical Services Act risks also worsening it in various ways, which leads to an intolerable situation for the staff and results in poorer care for the patients.

We never want again - I have said this before - to see staff with temporary items over their faces to protect the patients. For example, a senior physician at Södersjukhuset had a cyclops for a period because there were no visors available. There was no protective equipment in the Stockholm region. It was exhausted, and then one had to take what was available.

We believe that the government should return with proposals in the Health and Medical Services Act that explicitly state that medical products and other equipment shall also be available to protect the health and safety of healthcare personnel. Therefore, I move for approval of reservation 2.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Madam Speaker! The new Moderate-led government has not come to a set table. Long healthcare queues, too few staffed healthcare beds, and unequal healthcare are three major problems that deserve the attention of politics and a will for reform. Now is the time to get the healthcare system in order, both for the patients' and for the employees' sake.

Madam Speaker! In recent years, crises have succeeded one another - first a global pandemic that put pressure on healthcare, followed by a war in Europe that has both cost many people their lives and created major disruptions in companies' value chains. Parallel to this, it has been a tough time for international trade, which has created a very difficult situation for pharmaceutical developers who want to get products into the hands of patients.

With Sweden's new problem-solving government, the defense has received increased supplements. We are tightening the legislation to go head-to-head against the criminals who challenge the validity of the social contract. We have also placed the fight against inflation at the top of the agenda. That is good. But we must, while patching and repairing what is broken, also account for upcoming crises. This applies to Sweden in general and, today, the healthcare system's supply preparedness in particular.

Madam Speaker! It is important that patients have access to the care and the medicines needed to alleviate and cure, both in peacetime, in crisis, and during high alert. For this to be possible, it is required that those who operate healthcare activities also have, in addition to staff and premises, the medical products and the other equipment needed for good care to be provided. That requirement is clarified in the government's bill, while at the same time the government states that Ivo's control shall be facilitated. We cannot be satisfied that the basic stockpiling is deficient. It is associated with very large risks.

Madam Speaker! The report also proposes a number of changes to the pharmacy market to ensure access to both medicines and information. It concerns introducing a stockholding obligation for outpatient pharmacies, a delivery obligation for wholesalers to hospital pharmacies, and a possibility to impose a sanction fee on companies that do not inform Läkemedelsverket that the sale of a medicine ceases temporarily or permanently.

The reasons for this are several. It is about ensuring that good pharmacy practice is followed, which means that the pharmacies' stock shall be adapted based on the consumers' needs in the market where the pharmacy operates. It is about increasing stock levels so as not to have empty shelves in a crisis. It is also about the fact that medicine shortages can pose a risk to people's health.

In Sweden, it is the authority Läkemedelsverket that is responsible for producing national situation reports on critical or potentially critical shortage situations. If that work is to be effective and purposeful, or even possible, information needs to flow freely to Läkemedelsverket. That is not always the case today. Therefore, a possibility is also proposed to impose sanction fees on those companies that do not meet the requirements to provide information regarding the medicine shortages.

Madam Speaker! This is new. As a Moderate, I am rarely inspired to make interventions in the economy or place new burdens on companies. We already have an all too non-free economy in Sweden, which leads to low growth and makes impossible the elevated standard of living that we otherwise could have. The pharmaceutical market, however, is not like other markets. Our responsibility for Sweden must trump in this case, when we see that there are deficiencies in the distribution of information about necessary medicines.

Since it is undoubtedly so that sanction fees should be decided with regard to the severity of the violation and the circumstances otherwise. Our goal is to increase the exchange of information so that crises can be mitigated and avoided, not to scare pharmaceutical developers away from the country, companies that we undeniably need more of if we are to take the next steps towards the healthcare of the future.

That is why the lowest level of sanction fee has been lowered based on the proposal that was worked out during the previous government. It would also be reasonable to make delimitations that make the situation competition-neutral for companies operating in an international market and not just in Sweden. I believe we can give the government that confidence, even though the committee is, of course, completely united on the issue that this system shall be followed up and evaluated like other reforms.

Madam Speaker! The Moderates and the Tidö parties have delivered on several central areas in a short time, after eight years with a passive and reform-weary government. Together we have secured budget investments to shorten queues and staff more healthcare beds, we have delivered sharp mandates to responsible authorities to increase equality in healthcare and we have prioritized the issue of civil defense so highly that it now entails its own ministerial portfolio. But we are not satisfied. We want more.

In the agreement we have concluded between four parties, we establish that the role of pharmacies in the care chain needs to be developed with health screenings and pharmaceutical assortments. We work to establish a national healthcare brokerage to cut the queues, produce a national plan for the competence supply, and reform the digital infrastructure in healthcare. Strengthening healthcare is prioritized and mentioned first of all in the Tidö Agreement.

The work to ensure available medicines and care for people who need cure and relief continues with undiminished force, both regarding peacetime and regarding times of high alert, as we speak of today.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! There were huge problems during the beginning of the pandemic with the regions not having any stocks at all. Most had stocks for three days. How will you ensure that the regions have stocks? How will you follow up on that? It is quite important to do it, I believe, this time.

Then I wonder a bit in the context of the economy in the regions. I have met a number of regional politicians, staff, and so on in various regions. It is not exactly "the heels in the ceiling" [doing great], even though one might think so from the member's description of the situation: All flowers are blooming and it is fantastic! But within healthcare, there is great concern that the state grants will not be enough. One will have a major crisis. How is it possible, in the type of crisis that many regions are now entering—which concerns staff and perhaps purchases and deliveries as well—to live up to the goal of having a crisis preparedness within healthcare that can accommodate large crises?

If the regions need to cut back, there is a risk that they will not be able to live up to what they are supposed to do when it comes to health and medical care. How does the member view this?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Mr. Speaker! Member Karin Rågsjö is asking many questions. I will do my best to answer them in the usual order.

First, there is a question in the air regarding Arbetsmiljöverket's proposal concerning personal protective equipment, something we believe is included in the wording that the government has placed before the Riksdag. Furthermore, one can wonder if the referral response is a sufficient preparatory basis for it to be able to become legislative text. I am not sure that the constitution agrees with that assessment.

Furthermore, we want a business sector regarding both pharmaceuticals and medical technology products in Sweden and abroad. When a crisis comes, you cannot just have one leg to stand on, you need to have several legs. I do not believe that central planning with hard lines drawn from Stockholm would lead to better crisis preparedness, rather the opposite.

We need a dynamic business sector that can pivot and do new things. We also saw many examples of this during the pandemic. Companies that did not otherwise manufacture protective equipment were able to pivot quickly. There were also municipalities, often those led by Moderaterna, where people living on social welfare were engaged and manufactured protective materials.

Then there is a question from the member regarding how we will work further to strengthen the civil preparedness in Sweden. There are investigations ongoing. We passed a decision on the society's crisis preparedness just half an hour ago, and we see how the Minister for Civil Defence is working diligently to bring up these issues across many departments.

I am convinced that more will be done during this mandate period than during the previous one, and it is very welcome.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Mr. Speaker! It would be strange if one did not do very much since we have lived with a pandemic for two years. If one does not lift a finger, then it is very strange, so I really expect that this is followed up in different ways.

I believe it is extremely important to follow up on what happens in the regions given the poor economy many regions will have precisely depending on the state grants.

This with the market is very good. It was, for example, thanks to the pharmaceutical companies that we got access to vaccines. It was fantastic! It also went quickly. It did cost some money, in fact.

But letting the market loose completely may not have been tipptopp either. That can be seen within the pharmacy world. For example, it is not tipptopp that one cannot stock medicine. It is not tipptopp that there are 50 meters between pharmacies for those who live in the inner city. It cannot be tipptopp that in sparsely populated regions, one cannot get hold of one's medicine. It will be interesting to follow this. I think it is extremely important that one has access to medicine in the way that one should have in a welfare state.

Then I want to comment on this with a dynamic business sector and a dynamic market within healthcare. It can become so dynamic that it also becomes very unequal. That has been seen, for example, in Stockholm.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Mr. Speaker! I agree with Member Karin Rågsjö that the market truly is a force of nature. I would perhaps even say that it is the world's eighth wonder. It is incredible what free and sound competition can lead to in a world where we are constantly trying to make things better and better and create utility and value for one another. That is how it is in liberal democracies, where one can only earn money by actually creating a utility for someone else, so that transactions arise.

But it is also as the member says that a force of nature cannot just flow freely like the river; sometimes one needs to regulate and adjust it because one wants to reach certain goals and certain political ambitions. This is what is being done in the pharmaceutical market.

We see that there are problems with information not flowing freely. Therefore, we introduce the possibility of sanction fees because we see that the market will not always arrive as quickly as we see is necessary at the conclusion in all parts.

Furthermore, it can be mentioned that the vaccine developed by the pharmaceutical companies was not only based on a year of research into mRNA but on 50 years of accumulated knowledge from various actors combined into something new. It is incredible and cool, and I hope that we in this chamber can agree not to adopt the American cultural debate that all pharmaceutical companies are evil, because that is not the case in Europe. Here, the pharmaceutical companies exist to put new products into the hands of patients, and we shall let them do that if they meet the requirements we set regarding control.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Mr. Speaker! Since Member Jesper Skalberg Karlsson, in his speech, took the liberty of speaking about much other than today's topic, I also intend to take the liberty of repeating a bit from the Member's speech.

The new government delivers, says the member. Yes, well, it is fortunate that the previous government has produced so many inquiries that the current government has something to deliver. One can be a bit humble. I note that today's report has been made possible thanks to the social democratically led government, among other things.

I think one should have a humble attitude towards the market. I believe in a society where we have both market and state control. The market is good in many parts; for example, this with the development of vaccines is a fantastic journey. But at the same time, we know that the market is not our best servant.

Jesper Skalberg Karlsson's former government colleagues were involved in deregulating the pharmacy market. It was supposed to become so fantastically good, they said. Yes, some things have improved. The member is right about that, but now a new iteration of the same government, with the support of the Sverigedemokraterna, gets to come back and say: Oh dear, we must reintroduce the obligation to hold stock! This was precisely what disappeared when market forces were introduced.

My question to Jesper Skalberg Karlsson is: How is the government going to be able to deliver such fantastic welfare and healthcare as you said in your speech when you do not provide economic resources?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Mr. Speaker! Thank you, Mikael Dahlqvist, for the question!

I can also venture to be humble. The previous government - that is, the single-party government led by the Social Democrats - was incredibly skilled at appointing many inquiries, especially during the last three months of its government period.

Now, it is being said from the Social Democrats' side that Arbetsmiljöverket's referral response must be implemented. Why then was it not written into the investigator's directive that this was what was wanted? One can wonder about that when one is so skilled at appointing new investigations.

Mr. Speaker! Furthermore, one can reflect on how large the resources of the Government Offices are to carry out many investigations. My impression is that many resources are tied up in the previous government's investigations, which continue all the time because many were appointed late. But when I look at the opposition parties' budgets, which they placed on the floor of the Riksdag during the autumn, I see that they want to cut the appropriation to the Government Offices. Then there will be fewer investigations that can be carried out and less policy that can become reality. For I do not believe that they wanted to cancel the Swedish EU presidency.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Mr. Speaker! Thank you very much, Member, for your answer! I do not know if it is investigations that the new government needs to conduct. I will tell the Member that it is money that is missing, and therefore we Social Democrats in our budget motion had twice as much money for welfare. We see now that, among other things, health and medical care is starting to cry out for resources. We gave enormous resources to welfare - historical resources.

My reflection is perhaps more about what the pace of reform will be with the new government. I look forward to seeing it.

Then I can inform the members that the investigation which forms the basis for the bill today did not come in the last three months. It arrived already before the pandemic, in 2018. So the Social Democratic government has indeed been forward-thinking at times.

Mr. Speaker! I would like to ask the question that I did not quite get an answer to: How does the member imagine that one is to quickly gain control and order over Swedish health and medical care when it comes to lack of space, lack of staff and so on, when one does not provide the resources that are needed?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Mr. Speaker! First and foremost, it can be stated that the temporary supports that were introduced during the pandemic were indeed temporary. Now we have put large parts of the pandemic behind us, largely thanks to successful vaccination. Therefore, many of these supports should end, because they were temporary.

Furthermore, it is worth mentioning that Swedish inflation, and perhaps above all core inflation, has stuck. Inflation can be a theoretical concept in economics. But for ordinary people, people who go to work, it is a very harsh reality when the money covers less and less. It does not only concern discretionary consumption but also shoes for the children, leisure activities, food, and other things.

Fighting inflation is at the top of the agenda for this government. It is not appropriate in this situation to do as some of the opposition parties are doing: promising new billions to various projects. I know of one opposition party that has overdrawn the Swedish reform space more than twice since the budget was laid on the table of the Riksdag. Such proposals, which admittedly do not come from Mikael Dahlqvist's party but from the coalition parties, would contribute to higher inflation and a higher national debt and, in the long term, make us all much poorer.

This government will prioritize. It will not be easy. It will be difficult, but it will be absolutely necessary if we are to leave inflation behind us.

With this, I would like to thank you for the debate.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Mr. Speaker! It was with a certain fascination that I listened to the exchange just now and heard how a debate in the chamber about certain issues regarding the healthcare system's preparedness for supply shortages ended up in inflation and what problems that causes for Swedish society. I think those issues are so important that they are worthy of their own discussion.

We have come to a rapid awakening, I would say, during the recent years in Sweden regarding the fact that we have problems in this area. And there, all parties are equally responsible. It is not such that one can cast the blame on one, then the other.

The pharmacy reform was very successful. One of the parts that was not addressed was precisely the storage of medicines. There were proposals from the Reinfeldt government, but the Löfven government chose not to proceed with them. There was not a large discussion about it, which was because it was not seen as a major problem.

It was several regions that made poor procurements. It was decided that by using just-in-time, which has been up for discussion several times, economic resources could be freed from inventory holding and used to actually provide healthcare. It was not particularly debated. Most thought it was quite wise until reality caught up with us in Sweden.

The pandemic has been mentioned. The catastrophe in procurement has been mentioned. This made almost all parties realize that this must be changed. That is why we see the proposal being discussed today and which we will decide on tomorrow. It is a proposal that was developed by the previous Social Democratic government – there I must give Mikael Dahlqvist credit. And it has been handled by the current government.

There are not many controversial parts in this. But a problem that we in Centerpartiet see is that the new government has used a bit too much copy and paste when it comes to the Socialdemokraternas proposals. That is what risks becoming counterproductive.

There are, Mr. Speaker, two very sharp parts in this bill. It concerns inventory holding, and it concerns stricter requirements on delivery. Everyone thinks that is good. All parties also agree that damages can be required in a situation where one does not live up to this. But the level at which the damages are set risks having a purely counterproductive effect.

Here we are talking about amounts of up to 100 million kronor that one will then have to pay. In that case, it is clear that the companies will reason in a business-economic way. Instead of only reporting when one actually sees that one gets a delivery problem, they will start reporting a large number of additional medicines where one might potentially get delivery problems. A fine amount in the 100-million class means that any CEO will have to make that type of decision.

The second thing is what we have seen in both France and the Netherlands. It is not only Sweden that has this problem, and it is not only Sweden that has introduced this type of regulation. In the Netherlands, it has been seen that exactly this regulatory framework, but with significantly lower damage levels than the 100 million that the right-wing government is now proposing, resulted in the number of medicines on the Dutch market decreasing by 5 percent. Let us say that a company sells a medicine that generates 100,000 kronor in Sweden - approximately 5 percent of the medicines on the Swedish market are at that level. Then it is clear that it will be natural for one to say: If we risk damages in the multi-million range, we must make a decision to withdraw this from the Swedish market and sell it on other markets instead.

We from Centerpartiet have also in our motion - nota bene - raised a warning finger and said that it is an obvious risk that this does not lead to increased access to medicines but to the opposite and that one must give an authority a mandate to very carefully monitor this.

We have also had other views, which I believe most parties can agree on. And even the Minister for Health has addressed it. It is about the fact that the proposals in this bill will not solve the problems. They will contribute to a solution for a part of the problems. But these are problems that virtually all countries within the OECD area face, because it is a globalized market. These are not things that one can simply handle nationally.

One could have requested further proposals in these areas. It is about, for example, that exchange rules for patients when they do not receive their medication could be simplified. There are also many other concrete proposals on what could be done. The hope is, of course, that the government proceeds with that type of proposal.

I would like to move for approval of reservation 3. It concerns the fact that an authority must follow this very carefully because it risks leading to fewer medicines, not more.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Lina Nordquist (L)

Mr. Speaker! Now I just want to begin by reassuring everyone who has talked about how all the parties were caught off guard and how no one could have predicted this, and say that the liberal crystal ball worked even this time.

We actually submitted several of these proposals before the pandemic. The S-investigation appointed at that time said: Nix pix, it wasn't needed; we just need to have proposals for high readiness. Then people woke up and added supplementary assignments once, and then again, and then it actually became a quite good investigation.

With that said, it is the case, Mr. Speaker, that preparedness in many ways is about being prepared for the unexpected. But it is also about being prepared for that which is very expected. It is not strange that medicine shortages arise when we need many, many manufacturers in a global market. It is not strange that shortages of protective equipment can arise when we have many, many manufacturers all around in different countries. Our responsibility is to regulate that market, because it concerns public funds and vulnerable people. But we do not want to oppose the fact that we have a market.

In that way, I think that many of the proposals became very good in the end, and I am glad that we can make these decisions. I am sure that it is very good for Sweden's patients, and I also say, Mr. Speaker, that it is very good for the people who work with preparedness in Sweden, in white, in green, but not in camouflage. They all need good conditions, and to these conditions naturally belongs that one has medicines and protective equipment.

Mr. Speaker! The bills that we will make decisions on the next time we vote, I want to stand behind today and I just want to clarify that the proposals are about the Health and Medical Services Act becoming clearer when it comes to the availability of medical products and equipment and when it comes to tougher requirements on companies that they must inform before a medicine runs out and before the stocks begin to empty.

It is also about a stock-holding obligation for outpatient pharmacies and an obligation to ensure that wholesalers actually deliver to hospital pharmacies. These are important and good things.

It is the same thing regarding an amendment to the Public Access to Information and Secrecy Act so that it is ensured that secrecy can be transferred from the Medical Products Agency when needed. It is also high time that Apotek Produktion & Laboratorier AB receives an expanded social mandate so that we get safety and security for patients.

I will not drag out the debate, because I do not believe this is a sharp issue ideologically. I do not believe that this is something that solves everything, but I believe that it solves some important issues. I just want to conclude by saying that even though these are important steps, Mr. Speaker, we must not forget that more will be needed ahead when the government that has now taken office and begun to change will take more steps to ensure that everyday working conditions, when it comes to the equipment one needs but also other things one needs in one's everyday life, are sufficient and really good. A higher load during a crisis, increased readiness, or special events will, of course, be easier to manage if everyday life itself is not a strain, but rather it is fun to go to work and fun to go home after a shift.

We continue to work, but this is a good step along the way!

The speech at riksdagen.se, in Swedish (opens in a new tab)

Amanda Lind (MP)

Mr. Speaker! It is a pleasure to participate in this debate, for the sake of the unusual, on an important issue - the healthcare system's preparedness for supply!

Healthcare needs to be planned so that situations with many injured can be managed while we have large disease outbreaks or pandemics. Here, Miljöpartiet sees that we need both a general strengthening of care and an increased capacity throughout the entire care chain. A resilient healthcare system in everyday life gives us a better crisis preparedness also during serious events.

Securing access to healthcare products and other equipment that protect the health and safety of staff is an extremely important aspect of improving working conditions and encouraging more people to want to stay in their jobs. To secure access to necessary healthcare equipment, there must be a completely different level of supply preparedness than what exists today. If that is the case, we seem to be in agreement.

The shortage of protective equipment during the corona pandemic led to major work environment problems and difficulties for staff to provide good care. The Government should return with proposals that mean that it is explicitly stated in the Health and Medical Services Act that medical products and other equipment shall be available to protect the health of healthcare personnel.

Mr. Speaker! Miljöpartiet believes that the state should take responsibility for building up emergency stockpiles and, together with the business sector, municipalities and regions, ensure that the storage in critical supply chains is sufficient to withstand crises and war.

Food, medical supplies, medicines, spare parts and fuel are examples of goods that need to be in stock so that society has time for transition in the event of trade disruptions. Current stockpiling is not sufficiently extensive, and the responsibilities are unclear. Stockpiling therefore needs to be improved step by step over several decades and constantly adapted to the needs that exist in society.

Some warehousing needs to take place centrally under state authority, but warehouses also need to be located near people and operations. Therefore, the public sector needs to cooperate with the business sector regarding the warehousing of goods that are critical for supply. It should also be investigated which goods it is possible to start or expand domestic production of. That Sweden has its own production capacity for certain materiel and certain basic components within medicine is necessary moving forward.

The Government should ensure that the work to strengthen the healthcare system's preparedness is carried out progressively as soon as possible and report to the Riksdag how the remaining proposals from the Inquiry on the healthcare system's preparedness are intended to be addressed.

Mr. Speaker! The Covid pandemic has shown Sweden and other countries in a tangible way that a stable supply of pharmaceuticals is central to healthcare and public health during a societal crisis. In accordance with the investigation and the government's assessment, we in Miljöpartiet believe that the possibility of sanction fees should be introduced to ensure that information regarding upcoming shortages of a pharmaceutical product reaches the relevant actors in time.

Intellectual property issues

At the same time, the proposal on sanction fees involves risks. It is important that the fees can be used in a flexible way in relation to the actors' size and economic situation, while at the same time the fees are large enough to achieve the intended effect. It is an obvious risk that some companies may attempt to protect themselves from the risk of being hit by sanctions by simply offering a smaller assortment.

Mr. Speaker! Healthcare needs to become better at adopting and implementing the knowledge and research results that have been developed within disaster medicine centers to strengthen preparedness throughout the entire care chain. We also take a positive stance toward increasing knowledge within disaster medicine by making it a mandatory part of the basic education for healthcare personnel.

I support all of the Green Party's reservations, but for the sake of time, I move for approval of only reservation 4.

Certain questions regarding the healthcare system's preparedness for supply and logistics

The deliberation was hereby concluded.

(A decision was to be taken on 13 April.)

The speech at riksdagen.se, in Swedish (opens in a new tab)