(cont. from § 9) The organization of health and medical care (cont. SoU16)

Anders W Jonsson (C)

Mr. Speaker! In 1993, an interesting debate was held in the chamber which resulted in a legislative change. It concerned the LVM and LVU homes, which municipalities and regions were operating at the time. It was thought that it functioned so poorly, but this was to be resolved through a nationalization. The State Institution Board, Sis, was therefore formed in 1994. Now, 30 years later, we know that it was not so simple. Despite it being a state organization with as many as 4,000 employees, the Director General should make frequent visits to the Social Affairs Committee to explain the complete failure we see in Sis.

Now the Sweden Democrats believe that there is a crisis and catastrophe in Swedish healthcare, which I do not agree with. Swedish healthcare performs at an absolute world-class level, even though there are challenges in a number of areas. The Sweden Democrats claim that the problems the healthcare system has can be solved through what some call the big bang, namely a nationalization of the entire Swedish healthcare system. In that case, it is not about 4,000 employees but 400,000 and an immensely more complex operation than Sis, which is a relatively simple operation.

I therefore ask Carita Boulwén: What analysis has been conducted? We know, and agree, that Sis is a complete state failure after 30 years. But now it is not about 4,000 but 400,000 employees and a much more complex organization, and you believe that a nationalization will solve the problems that are being pointed out.

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

Carita Boulwén (SD)

Mr. Speaker! I thank Member Jonsson for the question.

This is a complex issue. We have a system that has not functioned for very many years. Different governments have tried to solve the problems with healthcare queues, competence shortages, and unequal care but have not succeeded. Different governments have introduced different measures and proposals on what should be done about the situation, but they have, as said, failed.

The Sweden Democrats have not sat in government but are now included in the government support, and now some proposals will come to make healthcare better for everyone in all of Sweden.

People have long tried to patch and repair the system, but as has been said, it has not worked. Money has leaked out, and more money has been pumped in without fixing the system itself, even though that is where it is failing. Regardless of how much the state has intervened and steered, the results one expected have not been achieved.

Now we begin by increasing state control in six areas, which is very good. It is, as said, a complex issue, but the Sweden Democrats believe that this is the right way to go to resolve the problems.

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

Anders W Jonsson (C)

Mr. Speaker! Regarding the six identified areas, eight out of eight parliamentary parties agree that more state governance is needed there. It is nothing new, but over the last 20 years we have received more and more state governance of Swedish healthcare – while at the same time patients have had more and more to say.

If it were so simple that a state responsibility for the entire healthcare system would solve the identified problems with lack of competence, lack of accessibility, lack of equality, and problems with financing, then the countries that have chosen this path, for example England, Norway, and to some extent Denmark, would not have these problems. But the lack of competence in England is significantly greater than in Sweden, and Norway, which undertook this journey more than 20 years ago, still has exactly the same problems with lack of equality. A nationalization has not solved the problems. On the other hand, one has succeeded in creating a long series of other problems.

If the Sverigedemokraterna member does not want to look at Sis as an example, she can look at three other and larger nationalizations in modern times: Arbetsförmedlingen, Försäkringskassan and the police – and the number of employees within the police is one-tenth of the number of employees within healthcare. Even though these are significantly simpler operations, nationalization has not been the general solution. Furthermore: While in the 90s we had an employment office, social insurance agency and police in every small town, after nationalization we hardly even have it in the regional centers. The result of a nationalization of healthcare will therefore, obviously, be a powerful centralization.

Mr. Speaker! I still do not understand the analysis. If it has failed with Sis and the other activities, why would healthcare become better if it is thrown into such a giant reorganization?

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

Carita Boulwén (SD)

Mr. Speaker! I thank Member Jonsson for his supplementary question.

We are painfully aware that Sis is not functioning, and much is being done here to rectify the enormous problems. I understand that the member takes Sis as an example, because it really does not function well there.

Sweden has 21 different regions and thus 21 different authorities, and different things are done in different regions, which results in unequal care. I come from Halland, and there the care is very good. But further up in the country, one does not have the same access to care. It is this inequality that we want to eliminate.

Now, people also often blame each other. The regions blame the state and the state blames the regions. I believe that an important part of resolving the problems is that one has the responsibility and can be held accountable when things do not go well.

We think it is time to leave the fragmented system, and I do not believe the member advocates for unequal care. I do not know what the member means would deteriorate if state ownership were introduced. One can compare with other countries, but different countries obviously have different conditions. In some countries, it has worked very well when state governance has increased or when state ownership has been introduced.

The Sweden Democrats believe that it is this path Sweden needs to take to address the skills shortage and the inequality in healthcare. But much needs to be done and adjusted for this to work. It is a complex problem for which good solutions need to be found so that it becomes as good as possible for all patients, and regions as well.

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

Lina Nordquist (L)

Mr. Speaker! The very best care is the one that one never even needs, I think.

For very many years, the Liberals have pushed for a broad national strategy for health that spans the entire society. The government we formed after the 2022 election has now launched such a strategy for mental health and also pushed forward the work for more preventive care.

Mr. Speaker! Since January 1 of last year, it has been clear in the health and medical care legislation that rehabilitation must be part of primary care's mandate. I believe we agree here that it should have been so for a long time, and now it finally is. Prevention covers everything from the work of child health care to home visit programs, physical activity on prescription, and health consultations for the elderly and so on.

Then most of us still get sick, and when a person becomes ill, the care must function, Mr. Speaker, no matter where we live and regardless of whether we are patients or relatives or if we work in healthcare. For many years now, we see the opposite instead: long care queues and different rules and medicines depending on place of residence. We see a lack of cohesion that affects those who are most vulnerable. It is completely obvious that healthcare needs to become more accessible, more equal, and more human.

Work is underway on a strengthened healthcare guarantee, the possibility to choose where one wants to receive care when one's own region falls short, increased continuity in all care and, of course, a family doctor but also a fixed doctor contact within specialized care, when one needs such for a long period.

Care needs to be managed more intelligently and more strategically. The Liberals want to introduce common guidelines. It should not be a list of tips, but there must be mandatory requirements when it comes to the guidelines. We want to introduce equal access to medicines throughout the country, and it is the same with screening. We want to see better protection during crises and pandemics and journal systems that talk to each other. When we move across the country, our information should follow us. If we ourselves want it to be shareable, this must be possible. The state simply needs to take greater responsibility in strategic issues.

With this said, we do not believe in a single giant authority. What works fantastically in a large city can simply be bad in rural areas. The forms of healthcare may need to look completely different. What is digital care in one part of the country may perhaps need to be a mobile clinic, specialist care outside the hospital, or a traditional ward or clinic in a building in another place.

Care needs to be able to be provided in different ways, depending on the circumstances. However, a disease and the body obviously require the same medication regardless of where we live. The body is the same regardless of whether one moves to Ljusdal, Malå, or Skinnskatteberg. We want tomorrow's care to be provided based on our bodies' needs, and there, a clearer state steering was needed. Care should also be provided based on our possibilities to best receive it, but there it is about the regions' possibilities to design the care so that it truly helps every person where she is located.

To replace today's healthcare structure with a heavy state agency machinery is something completely different from saying that the body is the same when you move. To replace today's healthcare system with a giant agency, Mr. Speaker, is the same as saying: "If I change the drafting table, the houses I draw will become better." It does not result in more care. It does not result in more wise, caring people. It does not result in shorter queues.

On the other hand, we have somewhat too many regions. In those regions that have a close cooperation, the state needs to help them merge. Where there are already close contacts, the state should be helpful in ensuring that we get fewer and fewer regions, but the care must still be designed according to the possibilities that exist in each location.

With this said, Mr. Speaker, we Liberals are not finished here. We intend to continue to strengthen continuity, strengthen people's self-determination even when they are ill, increase support for relatives, improve working conditions and introduce more development paths for employees, including that more professionals should be able to provide small-scale care. This helps both the professionals in care and the people who live in places where there is currently too little care: suburbs, industrial towns and rural areas.

We intend to give all regions a responsibility to contribute to tomorrow's healthcare, a responsibility to contribute to research, education and innovation in healthcare.

I vote in favor of the committee's proposal.

We want the state to support but not stifle – hint, hint to some parties here. We want the state to lead but not remote-control – hint, hint to some other parties here. We do not intend to give up until the patient's and the relatives' perspectives are always more important than the organization's boundaries and the system guardians' own interests.

Healthcare must be safe, local and equal. This is something the state and the regions need to create together.

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

Karin Rågsjö (V)

Mr. Speaker! Six of the eight parties are against a complete nationalization of healthcare. It became a bit strange when we listened here today to the Christian Democrats' view on Swedish healthcare and its problems. After the Healthcare Responsibility Committee, where all our parties have sat, submitted its report, you in KD still say that we should abolish the regions and nationalize healthcare.

This seems to be the universal solution that you can come up with. You say this even though the issue has now been investigated for two years and partially dismantled by experts and a broad political majority. You do not have the majority with you either, and in that case, it would perhaps be good if you looked at your entire government. It is, after all, you who are responsible for the healthcare issue.

When it comes to unequal care, we see great differences in health – class-based and regional. The conditions for equal care differ depending on where in the country you live, who you are, and where you come from. The care you are offered should not depend on your social class, your gender, your origin, or your geographical location. That is how it is. Here, increased state influence over the economic distribution is required, i.e., how we should distribute money across the country.

Mr. Speaker! When it comes to the poor working environment within health and medical care, it is the staff who are the gold. But a functioning healthcare system should not presuppose that one has to become a hero – it is about qualified and society-sustaining work that requires great competence and should be treated accordingly, that is to say, the staff need to be given good working conditions and good working hours. In our budget motion, proposals were therefore presented for significantly increased general state grants. We want to index the state grants. The Social Democrats now also want this, which pleases me.

One can ask whose needs should rule. It is the needs that should govern healthcare. Those who are the sickest should come first, but that is not quite where we are. The online doctor companies and other private providers prioritize the healthiest patients, who require the least intervention but provide high compensation and are therefore profitable.

This means that public healthcare will have to take responsibility to a greater extent for people with large and very large care needs, which is resource-intensive and affects public healthcare. I spoke about this, among other things, when I was down in Helsingborg and traveled around among different health centers and met healthcare staff. It was very clear there.

It is the profit opportunities that determine how healthcare resources are distributed, instead of letting needs guide them. We believe that the Swedish health and medical care should return to being governed based on exactly healthcare needs and long-term planning possibilities for the regions.

We have talked about primary care for quite a long time. Excuse me, but it feels far away. In 2022, Socialstyrelsen established 1,100 inhabitants per doctor as a national target value. We all think that is good; no one is against it. But what is happening? The latest mapping from Myndigheten för vård och omsorgsanalys shows that around 30 percent of the population has a fixed doctor contact. That is a figure that varies between 18 and 95 percent. Vårdförbundet and Läkarförbundet believe that this must be prioritized higher, and I assume everyone agrees. It is also about the resource shortage within healthcare, which Vårdanalys has written about in its reports. It is therefore high time to prioritize primary care – now.

Mr. Speaker! When it comes to the mafia within the welfare system, I do not want, when I enter one of the countless vaccination centers that we see, at least in this region, for Bandidos or any other mafia activity to wash money there and manage the operations. Now I am talking about the mafia, not about welfare crime, because it is clear that the mafia has found its way into the body of society and gained access to power over our lives and power over our health. And the previous bourgeois government and now the SD-dependent government have given the mafia the conditions to operate within the welfare system.

Free choice of care and freedom of establishment may sound nice, but with money as an incentive – that is, profits in welfare – a sick culture is created.

Among the examples that have been noted is the suspected white-collar crime web that led to the Västra Götalandsregionen deciding to terminate the agreements with three health centers. Recently, Ekot also reported that Region Stockholm terminated an agreement with a healthcare group that had links to Bandidos and the health centers suspected of crimes in Västra Götalandsregionen.

Ivo describes that their mission has become much more complex and has moved from focusing on the quality of care and nursing to also auditing corporate structures, front-man setups, the presence of drugs and weapons, and gang recruitment. It is as if Ivo has become the FBI. Something is very dysfunctional.

The current government often talks about how much over-administration the regions engage in and about the inefficient healthcare. But with this policy, which gives the mafia the conditions to make money from welfare, the regions will need to build up units to stop the worst of the crime, large control units that take money from healthcare. Then we can talk about over-administration.

We want a three-year moratorium on the establishment of new companies in the health, school, and care sectors to clear out criminal activities, abolish the systems that allow for profit-seeking within healthcare, and establish a special unit at the Economic Crime Authority for the purpose of investigating private companies that engage in welfare crime.

I move for approval of reservation 8. The Government should investigate what significance the law on choice systems has had for the increased welfare crime.

Cancer survival is a clear class issue. It has increased in all socioeconomic groups over the last 20 years, but the gap between the different groups remains and has not been affected. If the survival rate had been as high for everyone as it was in the groups with the most survivors, approximately 3,000 lives could have been saved. It truly is a class issue. Here, one must have completely different preventive measures and be active at an early stage in a completely different way to close these gaps.

Mental health is constantly in focus. A major reason for the sharply increased prescription of psychopharmaceuticals, also specifically to children and young people, we believe is that other methods to meet the growing mental ill-health are not available to a sufficiently high degree.

In addition to psychopharmaceuticals, short-term manual-based psychological treatment, often based on cognitive behavioral therapy, is usually offered. It is very popular. Longer psychotherapy treatment and psychotherapies with other orientations are rarely offered within public care. It costs a lot to go to private therapy, which many do. It becomes a class issue.

We believe that more opportunities for care and treatment for mental ill-health could yield better results. We therefore want to see an investigation into the possibilities of offering therapy within primary care by trained, licensed therapists, with the requirement that they shall not be profit-driven.

My last question, Mr. Speaker, concerns the bill on comorbidity that we are waiting for.

There must be conditions for persons with addiction problems to receive treatment for psychiatric conditions within the regions' psychiatry. Research results show that nine out of ten persons with substance abuse or addiction would prefer to seek help within health and medical care. Only 5 percent would prefer to seek care within social services.

In most comparable countries, healthcare is organized differently than in Sweden. They also have lower mortality rates.

This issue was addressed by the Comorbidity Investigation. Now the government has appointed a comorbidity delegation. It may be a step in the right direction. We hope so. But not much is happening.

In view of that, I move for the approval of reservation 19.

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

Anders W Jonsson (C)

Mr. Speaker! Karin Rågsjö often takes me to Stockholm in the debate to describe how healthcare functions here.

I intended to take Karin Rågsjö to Gävleborg, my home county. There, we have had very large problems with primary care, which has struggled with staffing. The patients have not been particularly satisfied. After we were given the opportunity for choice, we are today up to 50 percent who have chosen a private healthcare provider, one of the many that we have all around the county.

A couple of years ago, an investigation was commissioned to look into why our primary care is among the country's most expensive. We have fallen behind by half a billion during the last five-year period. That investigation came with some quite interesting results.

All private health centers have turned a profit. Of those operated by the region itself, only one has turned a profit. All others have run at a loss. Looking at what the patients prefer, one sees that eight of the ten most popular healthcare providers are privately run. The most interesting thing is that we often hear what Karin Rågsjö said in the rostrum: The private sector prioritizes the healthy. But in Gävleborg, that was not the case. When the patient burden was compared, it was seen that it was rather the private units that had the heaviest patients.

When you ask patients and those who work, they say it is obvious if the public healthcare does not function. Those who then move over to the private sector are not those who never need to go to the health center, but it is, of course, those who have very great needs.

I would like to ask a question to Karin Rågsjö. Vänsterpartiet's policy is that we should not have any private healthcare providers and that we should not have any profits in welfare. How then does one intend to solve the challenges we have in Gävleborg, where 50 percent of the patients today are very satisfied with going to a private healthcare provider, which also generates profit?

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

Karin Rågsjö (V)

Mr. Speaker! The Centre Party is a party that truly supports the private sector within the healthcare sector. You have really boosted that which we are currently sitting in.

As far as I know – I also have some contacts in Gävleborg – a lot of things that are negative are also happening there, but I will not dwell on that.

I am not against the private [providers] generally. I am completely against the extreme profits that some extract from this, and I am definitely against the fact that choice of care and freedom of establishment create a mafia across all of Sweden.

We see that now. We see that in Stockholm. We might see that in Gävleborg as well. We see that all around the country. Suddenly, the health center is owned by a family or whatever that has connections to, for example, Bandidos. We have seen that, unfortunately. It is very sad. I do not want to go to health centers that are potentially run by criminal forces.

This is a general problem. Then one can consider what to do – whether to run after it or try to think a bit smartly. Even with the freedom of establishment, I believe that politicians should have some influence over where health centers should be located. Should they, for example, be located in areas where only the rich live? Isn't it good that one has health centers in other places? There must be another thought behind the freedom of establishment. It cannot be the private actors who drive the healthcare forward. There must be some kind of counterforce, if the member understands what I mean, from politicians who think wisely.

Sweden also looks very different. The Member usually often, when he talks about the private sector specifically, lands in Gävleborg. I land in Stockholm. There, they have had 40 different healthcare choices, parts of which they are now taking back because they have noticed irregularities to a very high extent.

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Anders W Jonsson (C)

Mr. Speaker! I may quote one of the founding fathers of the movement to which Karin Rågsjö belongs, Deng Xiaoping: It doesn't matter if the cat is black or white as long as it catches mice.

It shows quite well how the Center Party views this. It is not that we love private healthcare providers, but we see that the patients are very satisfied.

When it comes to extreme profits, it is the case that at least in the choice of care in Gävleborg, the publicly run health centers receive exactly the same compensation as the private ones. But the public ones have difficulty retaining patients. They are running at a loss of hundreds of millions of kronor, while the private ones rather have heavier patients and also manage to make the finances balance. They are also more popular to work at among healthcare staff, so I do not understand the problem.

Then it is often pointed out that it was some patient who had gone to a private clinic who died afterwards.

Karin Rågsjö raises what I see as a major problem, namely that there are criminal interests. Of course, we must do everything we can to maintain high quality and also ensure that we smoke out the criminal elements. But it is still one-sided: the quality doesn't matter, what the patients want doesn't matter, that the staff want to work there doesn't matter, and that they do not demand extra supplements from the region doesn't matter. It is about the fact that they absolutely must not make a profit – and if you have a company that does not make a profit, that company does not remain.

In 2004, an interesting scientific study was published where they looked at the social inequality of doctor visits. Sweden at that time had, in principle, an entirely publicly produced outpatient care. We were one of the countries that had the absolutely most skewed distribution. With us, if one were to be sarcastic, it was the upper class that ran to the doctor, while in other countries there was a significantly more even distribution.

It is not as simple as that it is just a matter of us solving all the problems in healthcare if we get rid of the private ones.

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

Karin Rågsjö (V)

Mr. Speaker! We have never said that we are against all private care. We are against the incredible profits being made. We are against the dysfunctional things that are happening. In this discussion, we can also talk about the online doctors. Who is it that seeks online doctors? It is not the sickest person in Gävleborg, who needs to talk to someone, but unfortunately, it is those in the city center of Stockholm. This has been seen in various measurements.

I absolutely think it would be very good if, for example, more foundations operated health centers. It would be good if there were a limit on profit extraction. I also think it would be very good if the public healthcare were better. I do, however, think that the public healthcare I encounter is quite good.

There are different types of private ownership. It can be doctors who have cooperatives – I go to one such health center. It can be foundations. But these large corporations that own so much – I will not name them – are not small operations, but they are gigantic operations. The United Arab Emirates have looked at these and want to take over such entities. There are enormous interests.

Right now, it costs the regions a total of 25 billion per year to keep track of all private contractors in healthcare, schools, and for example LSS. Could we not use these funds a bit better? We must stop the mafia and the infiltration in society in some way, and then one must look over the forms that exist. It does not seem that the Centerpartiet is prepared to do so. I find that sad. But more to follow.

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

Anders W Jonsson (C)

Mr. Speaker! Debating a committee report on the organization of healthcare is still one of the more interesting political debates. That is because within this area, there are two of the issues that are party-dividing within healthcare policy. Otherwise, there is a great deal of consensus, and we find common ground in these debates.

The exchange of remarks that I had the privilege of having with Karin Rågsjö shows one of the ideological issues. There are some who claim that regardless of which problem we have in the Swedish healthcare system, we will be able to solve it if we just see to it that we get rid of the private companies and get rid of the profit-driven ones. Then there will be plenty of money for everything else. The Center Party does not have that view.

Just as I said earlier, we see that it doesn't matter so much whether the cat is black or white, as long as it catches rats. Many of the private providers bring an enormous amount of positive for Swedish healthcare. Regardless of whether it concerns the hairdresser, a football team, healthcare or LSS, well, it is never something anyone can defend that criminals are behind it, that pure crime is being committed, or for that matter, that what is being conducted is of poor quality – they have no business in healthcare.

The second question, which is also politically interesting, is how we organize healthcare – whether we are to conduct a huge experiment in Sweden and simply nationalize the entire healthcare system. When it comes to this, we have had one party – now two – that sees this as the solution to precisely all problems in healthcare. Regardless of what is raised in the debate, one can always get as an answer that the problem would indeed be solved if we could just fire the regional politicians and if only the state took over the operations.

It has therefore been a privilege, Mr. Speaker, to be able to devote quite a lot of time over two years to really digging into this issue. It has been incredibly stimulating and a very good discussion. Not least, we in the commission – I am speaking, of course, about the Care Responsibility Committee – have had access to all of Sweden's leading experts.

In the committee, we agreed that Swedish healthcare is fantastically good, but we have a number of problems that we must find solutions for. We have then sat and turned the question over as to whether a changed ownership is the solution to the competence shortage, lack of equality, lack of accessibility, problems with the financing, and a few more areas that we have focused on. We have been able to order any documents we wanted.

There is only one area where we have seen that nationalization could solve the problem. It concerns the inequality regarding finances. Healthcare is financed by 70 percent of the income tax that the regions can collect. It is clear that the Stockholm region has a completely different income development than all the other 20 regions have.

In Stockholm, incomes are increasing very rapidly. That is what causes us to see the gaps between Stockholm's healthcare on one hand and the rest of the country on the other. If we had a completely state-run healthcare, we could de facto take money from the Stockholm region and send it out to the rest of the country. We would achieve increased equality regarding the finances.

With that said, there is a significantly simpler way to do this, Mr. Speaker, and that is to proceed with the proposal for municipal tax equalization that is currently there, as it is based on leveling the economic differences. But it has probably disappeared deep down in the Government Offices' filing cabinets, for we have not seen a glimpse of it.

When it comes to all the other areas – geographical equality and queues – despite having turned over every stone, we have not been able to find evidence for this in research or in comparative studies where we compare ourselves with other countries that have tried other paths.

Norway carried out a nationalization during the early 2000s. They still have very large problems with inequality. It is perhaps not so difficult to understand given that the inequality stems from political decisions made in a regional leadership to a very small extent. The person who makes the effort to read the 800 pages in the background will therefore see that there is no evidence that one would solve the major problems with competence shortages and so on by turning everything upside down and shaking and hoping that it gets better.

In the investigation, we have also gained a great deal of respect for what a massive reorganization this would entail. It is, therefore, a matter of moving 400,000 employees to a single state agency that will have sub-departments and so on in almost every municipality. This agency should then cooperate with the municipal home healthcare. This would, over a ten-year period, which is how long such a reorganization takes to complete, cause problems.

We can just look at the police, where one went from 21 regions to a single state agency. The police themselves say it took ten years before the operations were organized. My hope was, perhaps a bit naively, that the investigation would produce a basis showing whether this is the right way to go or not.

I have today participated in a seminar, and everyone who has read this will also see that someone said that this was well the final nail in the coffin for those who believe it would be good to throw Swedish healthcare into a giant reorganization. It will surely also in upcoming election campaigns be those who have this as the answer to all challenges in healthcare, just as there will probably be those who point out that if we only get rid of the private alternatives, we have solved everything.

I would like to move for approval of reservation 19, Mr. Speaker, just as Karin Rågsjö did. It concerns the co-morbidity. It is a very small reorganization in relation to the other things we are discussing. It is about the primary treatment responsibility for people with addiction diseases being transferred from the municipalities' social services – it is completely apart that they have the responsibility to treat a group of diseases – to the regions.

It may seem like a small change, but I respect that the government is taking the issue seriously and realizes that even this relatively small change is extremely complex to implement in Swedish healthcare. A comorbidity delegation has been appointed, and I respect that you choose to go that way. It is important that it is done correctly from the start, because this very vulnerable group must not be subjected to any experiments.

I nevertheless want to move for approval of the reservation because I think it would be good if we in the Riksdag showed the government that we have our eyes on it in this matter. We do not want the government to drag this out, because a quick solution is required, even though it must be correct from the very beginning.

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

Nils Seye Larsen (MP)

Mr. Speaker! I would like to begin by, in line with Anders and Karin, move for the adoption of reservation 19.

I remember a study visit to a needle exchange clinic that I took part in at the beginning of the spring. It is actually one of the more moving study visits I have made.

We arrived there early in the morning to be there before those who need the needle exchange's help arrived. There, we met the staff and accompanied the walk that those who come there in need of help take. We started by walking in through a small door, and then we saw the different needles the visitors could get. There, they also had to leave the needles they had used. They were also allowed to take with them, and received instructions on how to use, a specific type of nasal spray used to save lives in the event of an overdose.

The interesting thing was that for many of the most vulnerable in society, those who live with an addiction and who are usually regular visitors, this is the first trust-building contact they have with public authorities. Slowly but surely, when they return, one can take the next step – talk to them, check their health status, and ask if they might like help trying to get out of their addiction.

It can be a difficult process, as several of these people, for example, have been deregistered from Skatteverket and no longer have a permanent registered address. Trying to get such a person into the healthcare system again is a major challenge.

The first time I heard about the concept of comorbidity was when I entered local politics in Umeå and knew that one of the major societal challenges we have is problems with drugs and crime. I tried to delve deeper into the underlying factors. Something that recurred very often is precisely the problem of comorbidity, where persons with different mental diagnoses or issues tend to self-medicate with the help of drugs – and where drug problems in turn can cause problems with mental issues.

It is extremely important that we move forward with this. That is why we, just like the previous speaker, want to put extra pressure on moving forward with the proposals that the Comorbidity Inquiry has presented and work to achieve better and more coordinated support for persons with comorbidity. I believe that this is something that is important for societal development and for the individuals who are affected. The consequences of living with this type of comorbidity issues are, in fact, devastating both for the individual and for society.

Healthcare is an issue that affects many residents, or actually all of us. It is not so strange, because in some way healthcare follows us through our entire lives, in all its stages – from the moment we are born until we take our last breath here on earth.

It is healthcare that constitutes the safety net if an accident suddenly occurs. It is healthcare that saves lives – or does its utmost to try to do so – if we or any of our relatives are affected by serious medical conditions. Healthcare is also part of our everyday lives when we need help with minor ailments, such as urinary tract infections or allergies, when we need help with the children, or when the ailments of old begin to take hold in the body.

Behind everything I mention are the hundreds of thousands of people I call the heroes of everyday life. These are people who have chosen to devote their entire professional lives to working in healthcare and helping us with that which is most sacred, namely our own health. There are great challenges with the Swedish health and medical care, but it is conducted day and night. Day and night, healthcare saves lives. Day and night, surgeries that go well actually take place, and day and night there are people who receive treatment and recover. This must not be forgotten.

What is the best thing we as decision-makers can do? Yes, it is to ensure that the healthcare workers are given the best possible conditions to work and enjoy their work. They must be able to have influence and participation and enough colleagues so that they do not become burnt out.

The worst thing we can do is the opposite – to continue to worsen the situation regarding the staff shortage. This situation is unequal in the country, and in our northern regions, it is already extremely strained. The worst thing we can do is to make the work environment worse so that the employees we have burn out and do not hold out or have the strength to stay for their entire professional lives, so that those who have trained to work in health and care choose something else, and so that people who would like to work in health and care perhaps even choose not to start their education at all.

It is absolutely crucial that we invest in the employees' conditions and in getting more people to work in healthcare, but we have a major fundamental problem, namely the underfunding of Swedish healthcare. This puts a spoke in the wheel, and it worries me enormously. It makes it difficult for the regions to do the transition work they need to do. There are several transition works that need to be done in parallel. It is also about the availability and the transition to good and close care. It is a matter of being able to strengthen and improve it and to work so that we as patients can get a fixed, continuous care contact, so that it feels secure for us and so that the care becomes efficient.

For example, in my region, Region Västerbotten, it is however very difficult to sit and work with the difficult transition work regarding the skills supply and the transition work for good and close care when one has a projected deficit of almost 1 billion. The underfunding is a major problem in Swedish health and medical care.

Care is not equal. Despite us saying that it should be equal and provided based on need, that is not quite the case. I return to the fact that there are many in the northern regions who have very long distances to health centers. Here in Stockholm's inner city, on the other hand, it swarms with health centers. It is a challenge.

One could imagine, just as I mentioned, that people use online doctors most where the distances are large, but it is exactly the opposite. Online doctors are used most where it is most densely populated. It is quite interesting. In Stockholm, one consumes 40 percent more care than in other parts. That makes me think of a person I know, who is a doctor and works at a health center in northern Sweden owned by one of the large healthcare groups. This person is frustrated that the doctors there cannot quite meet the patient volumes that are desired. He tries to explain that people there are truly sick. It is tougher, and it concerns other ailments.

So it is not just a question of priorities, but it is actually also about where one places the money. As I touched upon in the exchange of remarks I had with Johan Hultberg, we see that the largest cost increases concern the purchase of services from private healthcare providers.

We have a challenge with today's system and with the market that has been built up. Miljöpartiet sees this as a problem and therefore wants us to ensure that we remove the nationally imposed law on freedom of choice – i.e., the right of establishment – within primary care.

I think it is a bit strange with the Christian Democrats. I just saw a campaign on the bus about investing in healthcare and scrapping the regions. I have a very hard time with that type of simple populism. As many speakers here have pointed out, we see that the reorganization they want to do would be the largest of all time. There is no support for the idea that this would provide better and more equal healthcare.

At the same time, there is a complete unwillingness to tackle problems that contribute to unequal care. Just as when we had Minister for Health Acko Ankarberg visiting and spoke about the health centers that have been reported to the Economic Crime Authority, they do not want to touch the freedom of establishment. Instead, they want to invest more in administration, control, and follow-up in the regions. I cannot interpret that as anything other than a desire for more administration and less care. We naturally find that regrettable.

In conclusion, we from Miljöpartiet want to focus on securing more resources for healthcare, focus on ensuring that the primary care reform can actually take place and provide the regions with the necessary conditions for it, and focus on all those things, for example the recovery bonus, that could contribute to making the working situation more bearable for all invaluable employees.

The deliberation was hereby concluded.

(A decision was to be taken on 11 June.)

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