(cont. from § 7) Municipal and regional issues (cont. KU15)
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
I urge approval of the proposal because it is unwise to preempt ongoing preparations 1. KD considers that citizens have the right to equal welfare 2, is pleased that the government is investigating stronger state governance of healthcare 3 and argues that the government provides more money to regions and municipalities than ever before 4. MP wants regions and municipalities to be given increased responsibility and influence 5. MP is positively inclined towards pilot projects 5, sees asymmetrical distribution of responsibility as a desirable development 5 and wants to safeguard opportunities for development in rural areas 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Lars Johnsson (M)
Madam Speaker! As we heard here earlier this afternoon, there are 290 municipalities in Sweden and 20 regions, or 21 if one counts Gotland among both regions and municipalities.
At the last turn of the year, Dorotea municipality in Lappland, with just over 2,300 inhabitants, was the country's smallest municipality in terms of the number of inhabitants. Stockholm municipality is the largest with nearly 1 million inhabitants. In Dorotea, approximately 1 person lives per square kilometer, and in Stockholm, around 5,300 people live per square kilometer.
Despite the great differences, both municipalities have the same basic mandate. Both shall offer their residents good service in the form of, for example, school, elderly care and social services. They shall manage the maintenance of streets, perform environmental supervision and handle planning and building cases. For this, specialized competence in a number of areas is naturally required.
These are municipalities with 2,300 or almost 1 million inhabitants, which have the same mandate and the same competence needs but at the same time completely different conditions in most respects. In between are the country's other 288 municipalities, all of which have unique conditions to some extent.
When one simultaneously knows that it is the country's municipalities and regions that are responsible for the majority of all welfare, it is easy to understand that the commitment and interest in the country's municipalities and regions, their opportunities to carry out their mandate and how they should organize themselves, arouse great interest. It is precisely this that the report is about: a number of motions from the general motion period concerning municipal and regional issues.
I will very briefly touch upon some of the proposals in the report. One of the motions concerns so-called asymmetric responsibility distribution. In plain language, the proposal means that municipalities should be able, on a voluntary basis, to relinquish areas of activity that are strongly regulated by the state to another municipality or to a regional level. An example of such an area could be financial assistance. The motive for such a change would be that for some smaller municipalities, it is difficult or unreasonably expensive to recruit the specialist competence required for the activity.
The question of asymmetrical distribution of responsibility has been investigated by the so-called Municipal Inquiry, which submitted its final report in February 2020. The inquiry found that there are many difficulties with a model where certain municipalities take over tasks from other municipalities. This concerns, among other things, financing and the possibility of accountability.
The question has also been touched upon in the so-called Kommunperspektivutredningen, which submitted its report at the beginning of this year. This investigation points out another model for the distribution of tasks as an alternative. That model would instead mean that municipalities within a cooperation area distribute the tasks that require a larger population base among themselves, so that one municipality is responsible for a certain task in the entire cooperation area and another municipality is responsible for another task. Within the cooperation area, such a distribution of tasks can be based on local assessments and the actual resources of the municipalities concerned.
The same investigation also stated that interest is weak among the municipalities for voluntary mergers, but it is argued at the same time that it is important for the state to be prepared for the possibility that the attitude towards municipal mergers may change during the coming decade.
Another investigation that also concerns the municipalities is the so-called Försöksverksamhetskommittén, which submitted its report in December last year. The investigation's mandate was to promote pilot projects in municipalities and regions.
The investigation points to various areas where it is considered the time is ripe to proceed with pilot projects, which in some cases would require legislative changes. This includes, among other things, pilot projects within the health and medical care sector, cooperation within land survey activities, and state grants to small municipalities.
Madam Speaker! In summary, it can be stated that there are various investigations that have very recently addressed questions regarding the possibilities for municipalities and regions to meet tomorrow's challenges, as well as how they should best be organized to fulfill the mission. Within the Government Offices, the preparation of these investigations is currently underway. I mean, therefore, that it would be unwise to anticipate the result of the preparation. Therefore, I move for approval of the proposal in the report.
Gudrun Brunegård (KD)
Madam Speaker! In the municipalities, we build Sweden. So said Birger Ekstedt, who was the Christian Democrats' first party chairman. The party was formed on March 20, 1964, in the days of 60 years ago.
There is a lot in that statement, because in the municipalities we literally build our homes. Therefore, there needs to be housing planning there. In the municipalities, our children receive their childcare and their schooling, and it is in the municipalities that our elderly loved ones receive their care in the autumn of life. These areas are municipal responsibilities, even if the tasks in some cases can be performed by someone else.
The municipal sector also formally includes the regions, or the county councils as they were called until 2018, for more than 150 years. The regions are responsible for health and medical care and now also for public transport and regional development.
Furthermore, municipalities and regions are, in many places, the largest employers without competition. The more one thinks about it, the more one realizes how right Birger Ekstedt was: In the municipalities, we build Sweden.
Since the municipal reform of 1971, Sweden has had a uniform concept of the municipality, with common legislation and responsibility for the same tasks throughout the country.
When we yesterday solemnized the 50th anniversary of the Riksdag's decision on the Instrument of Government, I asked questions about the constitutionally protected local self-government, because precisely the fact that municipalities and regions are responsible for the same tasks means that citizens rightly have an expectation of receiving good and equal quality in school, health and medical care, and elderly care, regardless of where one lives in the country. But with different external challenges and with changed demographics, the ability to meet these expectations and demands has changed.
If a municipality today cannot recruit native language teachers itself, it can, for example, solve this via digital aids with distance teaching from another municipality. If the region has too few radiologists, the X-ray images can be read with the help of radiologists as far away as Australia. And municipalities can form different types of municipal federations or joint boards to manage meeting the need for experts in areas such as the environment and construction.
An important principle in politics is the citizens' opportunity every four years to hold the elected representatives accountable. It is, of course, more difficult with the forms of cooperation. But there are areas where responsible municipal and regional politicians have not succeeded in finding solutions to their challenges. Governments have used both the stick and the carrot to try to stimulate creative solutions on how the regions can shorten healthcare queues or how treatment of specific diseases through national guidelines should be carried out according to best practice, regardless of where in the country the patient lives.
Right now, different ways to meet the challenges are being investigated, both the possibility for municipalities to voluntarily join together to better fulfill their tasks and the possibility of introducing stronger state governance of healthcare, for example. It is a difficult and important balancing act between municipal self-government and the citizens' right to equal welfare.
A number of investigations and reports, which are currently being processed in the Government Offices and which previous speakers have pointed out, show that the government is well aware of the issues and is actively working to find solutions.
Madam Speaker! With these reflections, I move for approval of the committee's proposal in the report.
Christofer Bergenblock (C)
Madam Speaker! In the municipalities, we build Sweden, regardless of whether we are talking about the primary municipalities or the secondary municipalities, that is to say the municipalities or the regions.
Member of the Board Brunegård states that the regions manage healthcare, public transport, and regional development. But it is common knowledge that the Christian Democrats' position regarding the regions is actually to completely remove healthcare from the regions' responsibility.
The Care Responsibility Committee has two assignments. One is to look at the whole, whether the entire health and medical care area should be nationalized, and subsequently, if it is concluded that this is not the case, whether there are other parts that need more state governance. But the first question is entirely dictated by the Christian Democrats, as one of their election promises was to nationalize health and medical care. If one were to do that, the regions would be left with only the responsibility for public transport and regional development. It will not amount to much of a region, we can state, if other major changes are not to take place, which I have not perceived.
In the municipalities, we build Sweden. But what I understand applies, from the Christian Democrats' perspective, not to the secondary municipalities.
Madam Speaker! My reflection and question to the Christian Democrats is: In what way will it help the Swedish health and medical care, strengthen democracy in Sweden, and ensure that citizens get a closer opportunity for accountability if the entire health and medical care sector is moved to the state level?
Gudrun Brunegård (KD)
Madam Speaker! Thank you for the question, Christofer Bergenblock!
This is a hypothetical question. It is probably quite far off in the future. We are in a cooperation with other parties. It was Olof Palme who said that politics is the art of the possible. One has to find ways to implement what is possible in the way that is possible. We are pleased that we are now investigating if and how a stronger state governance can be achieved.
We have, as I mentioned, seen that 21 different regions are unable to meet the citizens' rightful need for equal care today. One region may have years-long queues for a certain procedure while other regions can manage it in a few weeks. That is not equal care. During the covid-19 pandemic, we could also see how very differently the regions managed it. I am therefore pleased that the government, with the support party, has found at least the lowest common denominator: stronger state governance.
There are different ways to govern at the state level, for example through common national guidelines for how different diseases should be treated, according to best practice. But despite having them, not all regions manage to provide the care that has been established.
We must make trade-offs. What are the citizens' needs? And what is politically possible?
Christofer Bergenblock (C)
Madam Speaker! There is no doubt that Swedish healthcare faces many challenges. And it sometimes looks different in different regions, in a way that is not justifiable. So yes, there is reason to look at stronger national guidelines in various parts.
But one should, above all, provide the regions with good conditions to carry out their activities. I believe that is one of the important parts. We must look at both. It may look different in the country when it comes to how one organizes and manages their activities, but as a patient, one should naturally be able to expect the same quality.
Today, the regions find themselves in a steep economic downhill. A deficit of 24 billion kronor is estimated for the current year. The answer to that was 6 billion from the government. Despite the Prime Minister having sat in the TV sofa and promised that there would be no layoffs in Swedish healthcare, the government returned with 6 billion kronor, which is to say a quarter of what the regions actually need.
Almost more interesting than the quarter of the money to the regions is the efficiency delegation that the government appoints. It shall take over the responsibility and look at how the regions can streamline their operations. For some reason, the government does not have confidence that the regions can manage it themselves.
Madam Speaker! My final question to the Christian Democrats is: Why do the Christian Democrats lack confidence in their own regional politicians when it comes to managing the operations with the economic support they receive from the state?
Gudrun Brunegård (KD)
Madam Speaker! I thank you for the follow-up question.
It is not that the Christian Democrats lack confidence in our own municipal and regional politicians, but we must see how it looks on the ground. For example, during the Alliance's years, the then Social Minister Göran Hägglund created a motivating system to shorten the healthcare queues. Some regions, or county councils as they were called at the time, managed it very well, while others did not. We see, therefore, that there are differences even when the conditions are provided.
The 6 billion that was announced yesterday shall be added to what the budget was also expanded by. Most of the entire reform space is spent on strengthening welfare. It is not the case that the government is holding back. This government gives more money to regions and municipalities than has ever been done, except during the pandemic years, when there were extraordinary circumstances.
We see that the regions are having difficulty fulfilling their mission. In that case, we need to review other models to solve it. Our ultimate mission as elected representatives is, as said, to provide good and equal health and medical care across the entire country. One should receive the care one needs; it should not depend on which address or which zip code one has. A small child should not have to move to another region to get an insulin pump, which was the case a few years ago.
Jan Riise (MP)
Madam Speaker! Miljöpartiet has a decentralist basic view. This is expressed, among other things, in that we want regions and municipalities to be given increased responsibility for and influence over political decisions that affect the region and the municipality. Decisions should simply be taken as close to the citizens as possible.
Social functions such as the police, the public employment service, and the social insurance agency shall be for all of Sweden's inhabitants and be available throughout the country. State regulations shall function equally well for small municipalities as for large growth municipalities. A well-functioning tax system shall provide equivalent economic conditions to provide municipal services throughout the country.
The members of the Green Party are engaged in issues concerning municipalities and regions, and our attitude towards pilot projects is generally positive. Such activities can provide important opportunities for citizen influence and creativity. We would like to see greater attention for these areas.
A few months ago, the investigation report Change through Trial was presented, which, among other things, offers a welcome and informative overview of a number of different examples of collaborative projects between municipalities and regions. The municipalities face challenges for many reasons: demographic changes with more and more elderly people, climate challenges with more and more necessary adaptation measures, and problems with welfare crime increasingly.
The investigation finds that pilot projects require political will and cooperation but that they can at the same time function as a lever for change. The investigation establishes that one must be careful with the design of the evaluation of pilots, and it also points out that evaluation should take place in time in connection with the pilots.
This aligns with my own experiences from the university world; for a few years I had the opportunity to participate in a Mistra-funded project for sustainable urban development. There, so-called follow-up research was a common and valuable tool.
Madam Speaker! Sweden's municipalities are interested in cooperation but are not as interested in mergers. This means that the conditions for a favorable development are strengthened by us finding forms of cooperation across borders without necessarily merging two or more municipalities in different locations.
The committee proposes that a motion on so-called asymmetric responsibility distribution be dismissed with reference to ongoing preparatory work within the Government Offices. For a municipality, asymmetric responsibility distribution means that areas of responsibility that are clearly state-regulated under certain conditions could be moved to another municipality. From the perspective that it should be possible to live and work in the entire country, such a development is of course desirable to both follow and discuss - locally, regionally and nationally - as an alternative to mergers or as something that can facilitate discussions on future such.
It is a context that, on one hand, is partly about access to public activities and services regardless of where one lives, and on the other hand, about available competence. In both cases, development is facilitated by a view of work regions that can be made larger through good and fast train connections in combination with local and regional transport that does not necessarily end at the nearest administrative border. Opportunities to travel to work or for public services need to be developed in parallel with any distribution and relocation of activities to other municipalities and/or regions.
Madam Speaker! The committee also rejects a motion on the sale of municipal companies to the extent that it is possible - not so much for ideological reasons as because questions of that nature are currently being prepared within the Government Offices.
In my party, we safeguard, above all else, the opportunities for development in the countryside. This naturally includes the conditions for starting companies around business ideas of all kinds, not least those that have a connection to the local area. It could be tourism or local products or services. It would naturally be unfortunate if competition became impossible because there is a municipal activity of the same kind.
At the same time, it is of course equally unfortunate if municipal residents are not granted access to the public services they are entitled to because activities have been outsourced to private actors for policy reasons. In my home municipality, this has occurred on repeated occasions, and agreements on, for example, care have had to be terminated prematurely. It is therefore extremely important that such a review is conducted with a fundamental discussion about what constitutes genuine and basic municipal service and what can or should be put out to tender.
Lastly, Madam Speaker, I want to advocate for the state service centers that have been established in a large number of municipalities and which in an excellent way create conditions and accessibility for residents, entrepreneurs, retirees and everyone else, even in places and in municipalities that are located somewhat further away.
I vote in favor of the committee's proposal.
The deliberation was hereby concluded.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.