(cont. from § 9) Next steps for good and close care (cont. SoU23)

Karin Rågsjö (V)

Madam Speaker! I have a greeting for Member Christian Carlsson regarding Stockholm and primary care. It is going very well in Stockholm. One has never had such a high increase in the number of doctors as now, one has a plan that one is working towards and one will double the number of general practitioners in ten years, which one is fully financing. One also, of course, has very good contact with the unions regarding this.

Madam Speaker! When it comes to close care, the Agency for Health and Social Care Analysis, Vårdanalys, says: "After several years of investment, none of the government's goals for the transition to good and close care have been achieved so far. The government, the regions, and the municipalities need to make a new effort to ensure coordinated governance."

The transition to good and close care has been a guiding principle within healthcare for nearly ten years. The concept echoes in the corridors of the Ministry of Health, but primary care has perhaps not been highlighted as much as it should have been during the mandate period. At the same time as a larger portion of the money bag must be allocated to the health centers, one cannot divest from the hospitals because the number of care beds has decreased over a number of years. The goal regarding the number of listed patients per doctor, which we all stand behind, is also quite distant. This is difficult material to handle, as it concerns health centers versus hospital care. One can, however, prioritize differently. Instead of lowering taxes by 70 billion, one can invest more in this issue.

Madam Speaker! During the pandemic and ahead of the 2022 election, the Christian Democrats often and willingly spoke about the needs of the healthcare system. But now the tone is different, and it is often about nationalizing and that everything is the regions' fault.

Vänsterpartiet wants to see increased state grants, not because we are wasteful, but because we see that if the region is to manage this, the state grants must be indexed. They must therefore be adjusted upwards every year so as not to fall behind when it comes to pensions, prices, and so on. I believe that the state must take a greater responsibility for the transition if it is to happen at all.

Vårdanalys, which follows this issue, also says that the transition has primarily resulted in various delimited projects that are in line with the transition's goals but do not move the issue forward. Vårdanalys concludes as follows: "We assess that the lack of goal fulfillment is largely due to the fact that the operations have not received improved financial or personnel resources, which are required to implement the changes."

We see today a rather unequal healthcare across the country, both in terms of class and region. We see a shortage of healthcare beds, a shortage of licensed staff and, in many instances, poor working conditions for healthcare staff. If the health centers are to be the base in the chain, quite extensive, planned changes must occur. This specifically concerns the work environment, because without staff, there will be nothing.

The first line of defense for mental health should be a self-evident matter almost everywhere, but that also requires staff with appropriate training within primary care. We think this is good, and it is nothing we are against in the bill. One must have psychologists and counselors who work with this, and one must intervene early in order to be able to prevent mental ill-health.

The proposition contains some steps to improve and strengthen the possibilities for good and close care. Vänsterpartiet has no objection to this but considers that much more is required to achieve a functioning primary care.

We want to raise two points in the bill. The first concerns how one views care in general. Physical and mental care should exist within all care, not just within primary care. This has also been raised by Vårdanalys and the Red Cross in their referral responses. But the government argues that this is not needed, which we think is a shallow argument. We therefore want the government to return with proposals on how this issue can be highlighted within healthcare in general.

We also want a deeper analysis of what economic consequences the proposals will have. If psychologists and counselors are to be hired, one must also have a thought about how it is to be financed. Both mental and physical care are to be strengthened.

The government argues that since the proposal is not considered to entail any new mandatory tasks or differences in ambition level, it is left to the heads of the agencies to analyze how they shall fix this. I think it is a bit twisted, and the Left Party thinks it is a bit contradictory of the government to on the one hand say that the proposal will make a difference, and on the other hand say that it will not entail any changes.

It raises the question of what one actually wants with this. Does the government have such a low level of ambition? Or does one believe that this is to be solved completely geschwint by having psychologists fly to the health centers without the health centers and the regions being affected financially?

We want to see a consequence analysis of the proposal and want the government to return with an in-depth analysis of what the proposal that primary care should meet both physical and mental care needs has for economic consequences.

I vote in favor of reservation 1.

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

Karin Sundin (S)

Madam Speaker! So it is finally time for the next step for good and close care. It is welcome, and I therefore begin my speech by moving for approval of the committee's proposal in the report. We Social Democrats have also submitted a special statement, which I will return to.

The transition to what we call good and close care has been ongoing for quite many years. During those years, the insight that primary care should be the hub for patient care has increased. We cannot organize healthcare in silos because most patients cannot be sorted into silos. Patients have different needs, different symptoms, and different diagnoses – sometimes several diagnoses – and they are at different places in life. Healthcare must, of course, be organized so that the best possible care can be given to each patient regardless.

The report we are debating today represents a number of steps in the right direction. Some of the steps are, frankly, not particularly large. That we in the legislation replace the term home care with the term health and medical care at home does not involve any major change in practice.

The proposal to clarify that regions and municipalities shall cooperate with each other in the planning and development of health and medical care is entirely in line with how regions and municipalities have worked for many years.

The proposal that primary care should meet both physical and mental healthcare needs is in itself no change, but an important reminder that primary care must plan for and deliver both.

That the information requirement in relation to the patients is strengthened is welcome. The patient should, of course, have the right to know who is the fixed point of contact and the medical contact, and how to get in touch with them.

Some of the changes involve larger steps on the way towards good and close care. The proposal that there should be a person medically responsible for rehabilitation in every municipality is important. Approximately half of Sweden's municipalities today have a person medically responsible for rehabilitation, what we call MAR. With today's consideration, all of Sweden's municipalities will need to appoint such a person, and it is important so that every patient shall receive equal care and rehabilitation that provides the opportunity for a healthy life for as long as possible.

Clarification that a medical assessment can be made by a doctor and nurse regardless of the time of day is also important to ensure that the large group of frail patients covered by municipal care will be entitled to help where they are also on evenings and weekends.

Madam Speaker! We Social Democrats stand behind these proposals, because there is a large and broad consensus that the transition towards good and local care is important and necessary. We are in agreement across party lines and at all political levels. We are in agreement in municipal healthcare and in regional healthcare. It is good for the patients, who can avoid being sent like pinballs between the different silos of care. It is good that the resources in healthcare can be used as effectively as possible. We also agree that good and local care requires new ways of working. It requires a redistribution of resources, and it requires decisions in all areas of healthcare.

But despite this broad agreement on the necessity of the ongoing transition, the proposal we are debating here today is one of few steps in the transition work that has been taken by the government during this mandate period and during the years when it has been the Moderates and Christian Democrats who have conducted the operations at the Ministry of Social Affairs. It is moving too slowly.

In our special statement, we note that there is still a long way to go until Swedish primary care can fulfill the role of being the hub of healthcare. Far too few patients have a fixed doctor contact. Almost all regions are far from the Socialstyrelsen recommendation of 1,100 listed patients per specialist doctor in primary care.

Swedish healthcare is struggling today with its supply of competence at all levels. We must not delude ourselves into thinking that we solve the problem of how all patients shall get access to good rehabilitation through a decision that there shall be a person medically responsible for rehabilitation in every municipality, because there is a great shortage of both physiotherapists and occupational therapists in Sweden today. We do not legislate that away with these proposals. There is a shortage of specialist doctors in general medicine, and there is a shortage of nurses in many municipalities. We do not legislate that away. There are great deficiencies in the working environment in health and medical care. We do not legislate that away either with what we are debating today.

The Minister for Health and Social Affairs has just announced that she wants to appoint a crisis commission to address precisely the poor working environment in healthcare. It is truly in the eleventh hour of the mandate period after we have lived with a healthcare crisis for years. But we welcome that crisis awareness and that the Minister for Health and Social Affairs is now ready to take a national responsibility. That is good.

As we Social Democrats write in our special statement, more resources are needed for Swedish healthcare if we are to succeed with the transition to good and close care. More resources are needed for the training of healthcare personnel. Resources are needed to create a better working environment. Regions and municipalities need a larger budget if they are to manage their healthcare mandate and with it also the continued transition to a good and close care where primary care can be the hub.

We Social Democrats have, during this parliamentary term, presented shadow budgets which each would have meant that Sweden's municipalities and regions had significantly more money for welfare and for healthcare than they have today. We would also have given Sweden's regions and municipalities information regarding the long-term conditions ahead.

We want the general state grants to be adjusted in line with inflation, just as the Left Party pointed out here earlier. This would give healthcare completely different planning conditions and the long-term perspective required to be able to recruit, invest in staff, and improve the work environment. It would also mean that regions and municipalities would have a completely different power in the transition work towards good and close care.

With all this said, Madam Speaker, it is good that we are now finally taking some steps forward in the process towards good and close care. I move to approve the committee's proposal.

(Applause)

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

Nils Seye Larsen (MP)

Madam Speaker! Miljöpartiet fully supports the direction of the transition to a good and local care. Therefore, the proposals in the bill Next steps for a good and local care are very welcome.

I agree with previous speakers that it is one of the few steps the government has taken to concretely move forward in the important transition for good and close care.

Strengthening primary care, improving cooperation between primary care, the municipality, and other specialized care, and being able to work more preventatively regarding both physical and mental health and creating greater continuity for patients is absolutely necessary if the healthcare system is to meet both today's needs and the challenges that await ahead. It is about people getting help in time, about the care being connected, and about those living with long-term illness being spared from having to start over every time they come into contact with healthcare. For this very reason, we also need to create long-term sustainable conditions for the implementation of the transition for good and close care.

We stand behind many of the proposals contained in this bill. But what we from Miljöpartiet return to and want to highlight specifically is what is found in the referral responses: not primarily a criticism of the bill's proposals, but a concern regarding the feasibility and that the requirements will increase faster than the prerequisites.

Primary care should take greater responsibility and be a clearer hub in healthcare. At the same time, the underfunding of Swedish healthcare and the shortage of healthcare personnel, including general practitioners, psychologists, and district nurses, are real problems that are already hindering the transition towards good and close care. In that situation, proceeding with a government bill and proposals for the next steps for good and close care without concrete solutions to the two major problems, underfunding and the competence shortage, which already today hinder the transition, increases the risk that it will become a reform that sounds good on paper but which does not make much of a difference in practice.

There is a great risk that we force the same staff, the same organization and the same structure to do more in a shorter time and with greater responsibility. In that case, there is a risk that the reform will not lead to the increased continuity and better accessibility that we hope for, but rather to an even more pressured primary care.

That is why Miljöpartiet argues that the transition must be combined with long-term stable funding. Regions and municipalities need the conditions to plan over time and provide staff with reasonable working conditions. In order not to have to manage healthcare in the short term through temporary solutions from year to year, they need long-term continuity and stability in both governance and funding.

Madam Speaker! A central part of primary care is continuity – that patients meet the same healthcare contact over time and that the care is connected. But continuity is not just an organizational issue but also a staffing issue. The shortage of specialists in general medicine is already great, and it is difficult to recruit district nurses and psychologists.

In several parts of the country, not least in rural areas and in northern Sweden, the situation is particularly strained. There, a single vacancy can have a direct impact on accessibility, on the work environment, and in the long run on the possibility of keeping a health center well-functioning and accessible for the patients.

The transition to close care therefore presupposes that primary care is given the opportunity to expand its capacity. This is the background to why Miljöpartiet, in addition to the sector contribution to health and medical care that we have budgeted for, also proposes a special initiative, a primary care lift, to strengthen good and close care throughout the country.

Madam Speaker! Competence supply is not just about educational places and funding. It is also about what conditions Sweden provides for people to work and remain in healthcare.

Here I want to specifically highlight something that has become even more pressing in today's debate and which primarily affects primary care in different parts of the country, namely that Swedish health and medical care today is to a large extent dependent on foreign-born staff. In many operations, their competence is absolutely crucial for everyday life to function. At the same time, a migration policy is now being pursued that in several parts goes in the opposite direction of the healthcare's needs. When healthcare staff are deported despite working and being needed, when regulations are tightened in a way that hinders recruitment, and when the security for those who want to establish themselves in Sweden decreases, it also affects the healthcare's long-term competence supply.

General practitioners, dentists, specialist nurses and researchers, the highly qualified professions we want to attract, are deterred from coming to Sweden when there are proposals to revoke permanent residence permits. One also does not want to move here as a doctor if one has a 15-year-old child who risks being deported because of a regulatory framework that leads to the teenage deportations we see today.

It is therefore not just that we deport healthcare personnel that we need today, but we also deter healthcare personnel from coming to Sweden – healthcare personnel that we will need. We are also shooting ourselves in the foot when it comes to future competence supply because a large proportion of those who train for healthcare professions and want to work in healthcare are foreign-born.

One cannot say that primary care should be expanded and continuity strengthened while simultaneously pursuing a policy that makes it harder to recruit and retain staff. It does not add up.

Madam Speaker! Miljöpartiet has not submitted any motion of its own in this matter. We stand, as said, largely behind the government bill and the proposals that are on the table. We have, however, really wanted to highlight the criticism that has come from all referral bodies, and we also share the criticism that Vänsterpartiet presents in its motion regarding the reform's economic and organizational prerequisites. Therefore, we choose to support requests 2 and 3 in Vänsterpartiet's motion, that is to say, reservation 2. We do this because we want the transition to succeed, not just in intention but also in practice.

In the end, close care is not determined by what is written in the legal text, but by whether there is enough staff, enough time, and enough stable resources. Only then can care become more cohesive, more accessible, and actually close – in the whole country.

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

Carita Boulwén (SD)

Madam Speaker! Today we are debating the Social Affairs Committee's report 23 Next steps for good and close care. I would like to begin by moving to approve the committee's proposal for a decision.

A well-functioning healthcare system is a fundamental part of a welfare society. When people become ill, the care must be there. It must be accessible, it must be coherent, and it must function throughout the entire country, from the first breath to the end of life. For us in the Sverigedemokraterna, this is a central issue.

Healthcare is organized through 21 regions and 290 municipalities. This means different decisions, different priorities, and different conditions. But when people become ill, the care must function at the same basic level throughout the country. It must not be decisive where one happens to live. It requires clearer national requirements and frameworks.

Madam Speaker! This report is a step in the work to create clearer responsibilities and better cooperation in Swedish health and medical care. It is about ensuring that people receive the care they need in a timely manner and without falling between different principals.

The transition towards a more cohesive and close care has been discussed for many years, as many have previously said. It is a view shared by many, both in this chamber and out in the country, that the development has gone far too slowly. Strategies have been formulated and plans have been drawn up, but the reality in municipalities and regions has looked different. Elderly people have been sent between levels of care. Municipal care has lacked clear medical involvement. Primary care has been overburdened and unclear in its mandate. Many have been forced to seek care at emergency departments for ailments that should have been able to be managed in primary care.

Madam Speaker! Now we take the next step by having responsibilities and mandates written more clearly into law.

On July 1, several legislative amendments are proposed to enter into force in the Health and Medical Services Act, the Patient Act, and the Dental Care Act, in accordance with the bill. The legislative amendments clarify the primary care's mission and responsibility, strengthen continuity and accessibility, and clarify the regions' responsibility for the management and follow-up of primary care.

The primary care's mandate is clarified so that both physical and mental common healthcare needs are covered. This means that the first line receives a more clearly nationally defined responsibility.

We know that the management of mental illness today varies greatly between regions. In some parts of the country, the first line of care functions well, while in others, sufficient resources or clear structures are lacking. This leads to patients being passed around, waiting times increasing, and responsibility becoming unclear.

When the primary care's mandate is now clarified, the conditions are strengthened to take a clearer responsibility for commonly occurring mental health issues. It is crucial for young people with anxiety and depression, for adults with stress-related ill health, and for those who otherwise risk falling between primary care and specialist psychiatry.

Regions and municipalities will simultaneously receive a clearer statutory responsibility to cooperate in the planning and development of healthcare. This is crucial for elderly people with complex needs, for people who are discharged from hospitals, and for those who are dependent on municipal health and medical care.

In municipal care, requirements are also introduced for medical responsibility for rehabilitation. That, Madam Speaker, strengthens the medical responsibility surrounding frail patients, especially after hospital stays. It is also clarified that medical assessment by a doctor or nurse shall be able to be offered when needs arise, regardless of the time of day. If the region does not fulfill its responsibility for physician involvement, the municipality shall have the opportunity to hire doctors and request compensation for it. Responsibility shall be clear, and there shall be consequences when it fails.

Madam Speaker! During the pandemic, the deficiencies in responsibility and medical presence in elderly care became painfully clear. The Corona Commission directed sharp criticism at how society protected the elderly and pointed out structural weaknesses in responsibility and cooperation. Those experiences must not be repeated. When we now clarify responsibility and strengthen the medical requirements in municipal care, we reduce the risk of similar deficiencies arising again.

Continuity is one of healthcare's greatest challenges. Many patients experience meeting new people every time and that no one really holds the care together. It creates insecurity and diminishes the quality.

But continuity is also about something more. When the same doctor or healthcare contact follows the patient over time, the possibility of detecting changes early, initiating the right treatment in time, and preventing simpler issues from developing into severe illness increases. When we strengthen the requirements for information on fixed healthcare contact and fixed doctor contact, we therefore take an important step towards better continuity, better quality, and better preventive care.

Madam Speaker! This report is part of the broader reform work that the government is carrying out with the support of the Sverigedemokraterna within the framework of the Tidö Agreement. In parallel, we are working to shorten healthcare queues through national healthcare mediation so that available capacity can be better utilized across the country. This strengthens accessibility and reduces differences between regions. We are also implementing a national skills supply plan and strengthening the digital infrastructure, which is crucial for the healthcare system to function cohesively and efficiently.

Furthermore, within psychiatry, a broad reform is underway with a focus on more care beds, better management of comorbidity, and strengthened forensic psychiatry. This is particularly important as primary care's responsibility for mental illness is now being clarified. Without staff, no continuity. Without competence, no quality.

Madam Speaker! The next step for good and close care involves clearer primary care mandates, sharpened cooperation between region and municipality, strengthened medical competence in municipal care, and better conditions for continuity. These are concrete changes that strengthen security for the elderly, for persons with chronic diseases, and for those seeking help for mental ill-health. It also strengthens the preventive work and reduces the risk of illness worsening unnecessarily.

For us in Sverigedemokraterna, it is about ensuring a healthcare system that works in everyday life, for patients and staff, in the entire country. This is a step in the right direction, Madam Speaker, but the work to strengthen Swedish health and medical care continues. For us in Sverigedemokraterna, it is crucial that care becomes more cohesive, more accessible, and more equal across the whole country. We take this step today, and we continue the reform work.

(Applause)

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

Christofer Bergenblock (C)

Madam Speaker! I thank Member Carita Boulwén for her speech.

I was a bit worried for a while that staff would not be mentioned in the speech at all, but then it did appear: Without staff, no continuity. It shows that even the Sweden Democrats consider staff to be an important prerequisite for good and close care in Sweden.

Looking at the staff in Swedish health and medical care, it appears that a third of the doctors were born abroad, that half of the dentists were born abroad, that a fifth of the nurses were born abroad, that a third of the assistant nurses were born abroad, that a third of all biomedical analysts were born abroad and that half of all healthcare assistants were born abroad. Without these people, Swedish care would collapse. I believe that even the Sverigedemokraterna understand that we would not manage the mission within health and medical care without all the staff who have come from other countries and who are now helping out in the Swedish welfare.

Similarly, we see an unparalleled deportation policy from the government and the Sweden Democrats. Day by day, we can read how healthcare personnel are forced to leave the country, how healthcare students are forced to leave the country, how parents whose children have received a deportation decision choose to leave the country because they cannot stay without their children.

How does this rhyme with all the beautiful words about good and close care and the words that without staff, there is no continuity? Is not the foreign-born staff that we have in our care today a part of that continuity that the Sverigedemokraterna claim to safeguard?

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

Carita Boulwén (SD)

Madam Speaker! I thank Member Bergenblock for the questions.

The staff is, of course, the most important thing we have for a functioning health and medical care. In that regard, the work environment is important so that we can get staff who want to work within health and medical care.

Sweden naturally needs competent staff in healthcare, regardless of background. But work permits must be based on clear requirements, and they must be followed up. We cannot have special rules for special people; instead, we must have order and clarity in the migration policy. Regardless of where you work, you must follow the rules. Then it is regrettable that it affects people who work in healthcare, support themselves, and have integrated. It is naturally regrettable. It is sad with all the individual cases that one can relate to.

This is rooted in a problem that the Center Party has championed in recent years, namely the irresponsible migration policy. That is why it needs to be tightened. The policy has subjected society to great strains. There has been a lack of control, and the consequences have been devastating, with growing exclusion, gang crime, and a welfare state under hard pressure. It is important to have order and clarity in the migration policy.

Several parties, and also our party leader, have opened up to review whether the policy is hitting the wrong targets. This primarily concerns children who are studying here and have received a deportation decision.

Many parties have been involved in driving the line, not just the Sweden Democrats or the current government, but also previous governments. It was staged by the Social Democrats and the Green Party.

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

Christofer Bergenblock (C)

Madam Speaker! The member is demanding order and clarity in the migration policy. I do not believe we have ever seen greater disorder in the migration policy than with the ongoing deportations. I believe that both the spectators in the stands and those in the chamber share that image, namely that it is a completely unacceptable situation.

At the same time, the member says that the most important thing we have in Swedish healthcare is the staff. There should be continuity in the staff. On the other hand, one is prepared to kick out staff who provide the continuity that we really need, not least in the countryside and in rural areas. Although I know that the Sweden Democrats have forgotten them along the way since they came to power via the Tidö government.

Naturally, order and discipline are needed. The Centre Party stands for a strict migration policy. But that does not mean that we should throw out those who are already in the country, who work, pay taxes, have established themselves and behave correctly – or their children. In just the last ten years, 4,000 people have come to Sweden who today work as doctors in Swedish healthcare. In the last ten years, 2,000 people have come who work as nurses. 33,000 people who work as nursing assistants or healthcare assistants have come here, in just the last ten years. We need them all.

This does not rhyme well, and it is not correct, because the Sweden Democrats on one hand say that they safeguard continuity, want to see good and close care and that the staff is the most important, but on the other hand are prepared to throw out the staff who happen to have the wrong skin color, wrong ethnicity, wrong religion, wrong culture or wrong background. It is actually shameful.

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

Carita Boulwén (SD)

Madam Speaker! I thank the member for the questions.

I do not believe that anyone here in the chamber, or anyone else who has listened, believes that Centerpartiet stands here and tries to pretend that they want a strict migration policy. We cannot build a welfare society on constantly bringing in new people. We already have high unemployment in the country, if not Centerpartiet and the member know that.

We can start there. We need to educate those who do not have education or jobs so that they can start in, for example, healthcare. We cannot continue to fill from other countries.

That we should be targeting healthcare personnel specifically is misleading. According to Migrationsverket's statistics, only this year have 87 doctors received new work permits and almost 400 doctors had their permits extended. That is, 87 doctors, 15 nurses, 30 assistant nurses, 26 healthcare assistants and 14 dentists who have received first-time permits. Regarding extensions, it is 392 doctors, 130 nurses, 78 assistant nurses, 83 healthcare assistants and 54 dentists. That we deport and hunt healthcare personnel are pure lies.

Those who meet the requirements may stay. That there has been an irresponsible migration policy where people have lived in uncertainty for so many years is not something we can take responsibility for; rather, you must take responsibility for it. The Center Party, the Social Democrats, and others who have governed previously have created this mess. It is now we are cleaning up, and unfortunately, it affects individuals. It is regrettable when it affects precisely those who truly behave themselves, have a job to go to, and are trying to be a part of our country.

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

Thomas Ragnarsson (M)

Madam Speaker! Today we are debating the report SoU23 and the bill Next steps for good and close care. I would like to begin by moving for approval of the committee's proposal for a decision.

Madam Speaker! The idea of good and close care is good. There is probably no one who is against us moving in that direction. But unfortunately, the process has gone slowly and been extremely costly. It is said that society has spent around 31.5 billion on the reform, and the result has been quite meager. There are good examples all around the country, but at best they are run under the auspices of individual regions and not infrequently in some form of project activity.

It is clear that new, additional legislation is needed in this area. That is what the Moderate-led government is now presenting. These are amendments to the Dental Care Act, the Patient Act, and the Health and Medical Services Act to clarify the direction for the continued work with good and close care.

Madam Speaker! Primary care needs to be the hub in the work surrounding the patient, partly to create continuity, partly to relieve hospital care. There is no doubt today about what is the mission of primary care, but unfortunately, these requirements are not being met. It has been many years since primary care was given the mission to handle first-line psychiatry. But it is clear that this mission has not been fulfilled. A clarification in the legislation was needed.

Good and close care means that the patient is at the center and that needs, accessibility, and integrated care are central. Municipalities and regions need to work seamlessly. For that, cooperation is required and there must be routines in place.

The bill means that the information requirement in relation to the patient is strengthened. All patients shall know who is the fixed care contact and who is the fixed doctor contact and, above all, how to reach these. It is an issue that has been on the agenda for many years but has never functioned fully.

Madam Speaker! A few weeks ago, we debated public health and agreed on the importance of preventive work. It can be stated that we unfortunately are still in a system that works reactively and not proactively. This, in turn, leads to the fact that preventive work is quite absent. Here, the regions need to reprioritize, when it comes to both competence and economic resources.

I am aware that primary care is struggling in many places. There is a shortage of staff, and accessibility is failing. But the transition will require that ways of working change. Here, digitalization will play a major role. All healthcare providers must be able to access the patient record and medication list, regardless of where the patient lives. Here, it is a matter of ensuring that the systems can talk to each other.

Madam Speaker! Municipal health and medical care is affected to the highest degree by the legislative changes, especially regarding the requirement for a person medically responsible for the rehabilitation activities in the municipalities and that, if needed, medical assessment by a nurse and a doctor shall be provided around the clock. The solution will look different depending on where in the country one is located. So it must be. But the goal is that we shall provide our citizens with better service and equal care and minimize the number of patients being sent to hospitals unnecessarily.

In a previous debate, I have raised the good example of the health centers in Västerbotten. It is a fantastic operation where primary care is elevated to a completely new level. There is a learning to be made here for many regions all over Sweden.

Madam Speaker! There is no level of care other than primary care that is capable of working fully person-centered. The possibility of seeing the whole human being and being able to meet the individual based on symptoms, unique needs, circumstances, will, and culture creates the foundation for a care that provides great health gains in both the short and long term. This, in turn, is a major step towards working proactively.

In conclusion, I want to highlight the need for cooperation between different social actors. I have already raised the cooperation between primary care and municipal health and medical care. But there is one additional actor who should be highlighted. It is the pre-hospital healthcare, which has high competence and good equipment for care outside of healthcare facilities. Ambulance healthcare is represented in almost all of our 290 municipalities and could make a real difference with fairly small resource reinforcements.

(Applause)

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

Karin Rågsjö (V)

Madam Speaker! Members of the Committee! We are in very much agreement on the fundamentals of this reform. We have chewed over it regarding primary care for a long time. But I wonder a bit how the regions are to prioritize at the same time as there is a shortage of care beds.

Last week I met with Sjukhusläkarna, a professional association within Sveriges läkarförbund. A number of doctors working across the country pointed out their stress regarding how things look in the various regions. The situation for doctors and other healthcare staff is extreme.

At the same time, the member says that the regions must prioritize, because it is incredibly important that we get this primary care reform started, with the number of patients per doctor and so on. It must take hold. But it is a bit much to handle. It becomes like a large ball pit. Which balls should one choose? One could ask that.

That is why I ask the member: How should the regions think if the shortage of care beds continues and it costs money to employ, for example, psychologists and counselors for primary care? It would be wonderful if there were a psychologist or a counselor that people with different mental health problems could meet.

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

Thomas Ragnarsson (M)

Madam Speaker! Thank you, Member Rågsjö, for the question! It is always equally pleasant to stand here in the rostrum and debate.

As I said in my speech, it has been many years since primary care was given the task of handling first-line psychiatry. When that transition was made, psychiatry was moved from psychiatry to primary care. It freed up some staff, and many followed to the health centers to work with just this part.

I know that in some places in Sweden there is a shortage of, for example, psychologists. It is a tough challenge. I am fully aware of that.

I often become very worried when we paint a picture of Swedish health and medical care as merely one large crisis area. This has been my life for 38 years. I have loved my work every day. There is an incredible potential in Swedish health and medical care.

The personnel crisis has most recently been investigated in the form of research at Linköping University, which shows that Swedish health and medical care has never had as many employed nurses and doctors as today. We have a system failure, and we need to talk about that. We should not paint a picture of a shortage all the time. In this case, there is no shortage, but our staff are doing the wrong things. That is what I mean. But we here in the chamber cannot tell the regions who should work with what. One must prioritize the important core activities, and that is the regions' responsibility.

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

Karin Rågsjö (V)

Madam Speaker! When one meets the staff or Vårdförbundet and Läkarförbundet, it sounds a bit different. They do not say: Oh, we don't know what to do!

We fundamentally have a fantastic health and medical care in Sweden. But we also have very large problems. One must still say that. Arbetsmiljöverket's large investigation shows extreme stress among the staff. It cannot just be about the regions being sluggish and having a strange personnel policy. When one talks to others within healthcare, they describe their work environment as quite unsatisfactory. I do not think one solves it by saying that too much is being done. What is it that is "too much" of what is being done?

We also have a completely changed demography in Sweden. My God – we are all getting older and older and living longer and longer, and that is very good. But it also means that healthcare receives a different burden. One might perhaps reorganize a bit and see if, instead, geriatric clinics or whatever are needed.

But to get what is needed in place, for example a first point of entry for mental ill-health, one must equip in a completely different way than we do today. It is also about psychiatric care as a whole. But we shall not speak about that here today, rather it is about the point of entry. That should mean that one employs psychologists and social workers. Then the money must come from somewhere.

The chairman and I can stand and talk for many rounds about what this is due to. But I think it is a problem that healthcare personnel sound the alarm but receive very little attention from politicians at the national level. That there will be a shortage of 27 billion to the regions in 2030 is a problem.

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

Thomas Ragnarsson (M)

Madam Speaker! I thank Member Rågsjö for the input and the question.

I will take a simple example. A department needs 20 nurses to care for the patients admitted there. On the department, there are 3 section leaders. I do not know if you have heard that term, but section leaders usually have administrative tasks. Are they then counted as administrators in the PA system? No. For me, it therefore becomes quite simple to understand why the staff feel that they are exhausted. It is actually the case that 17 people are doing 20 people's jobs, because 3 people are engaged in administrative activities.

We have a stealth administration that is enormous. Between 2010 and 2022, the costs for Swedish health and medical care increased by 18 percent per inhabitant in this country. The increase of staff within health and medical care was 7 percent. The larger part was accounted for by administrators. The healthcare provision increased by barely 2 percent.

I want to assert that many of the problems we experience today are due to the fact that we have too poor governance and management out in the operations. When you ask staff who are leaving healthcare for the reasons why, it is not primarily about the salary, as Vårdförbundet says it is. No, it is primarily due to poor leadership, poor participation, and a poor working environment. Then comes the salary. Just this with participation – by letting the staff be involved in structuring the work and so on, we would go as far as we could, and it costs nothing.

(Applause)

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

Christofer Bergenblock (C)

Madam Speaker! The core of Swedish healthcare is an accessible and patient-oriented primary care throughout the country, where the patient is put at the center and receives continuity, proximity, and security. This is summarized in the concept of good and close care, which is the subject we are now debating. The consideration is titled Next steps for good and close care and highlights important measures that the Center Party fully stands behind. It is primarily about municipal health and medical care in relation to primary care.

Centerpartiet has for several years raised the need to set clearer requirements on cooperation agreements between municipalities and regions to avoid problems with unclear patient responsibility, which causes patients to risk falling between the cracks. This is now being clarified, which is very good.

Centerpartiet has also raised the issue of strengthening the patient perspective in healthcare. It is still all too easy to put structures ahead of patients' needs for contact, understanding, and influence. Now a small step is taken in that direction by clarifying the patient's right to receive information. It is a good step forward, but there is still a long way to go.

Furthermore, it is good that requirements are now being set for there to be a person medically responsible for rehabilitation in municipal health and medical care, a so-called MAR, because the need for rehabilitation after cancer, stroke, hip surgery, etc., is often completely decisive for the patient's continued quality of life when they return from treatment.

From the Center Party's side, we have also been critical of how inaccessible psychiatric care is for many patients, not least children and young people. It is therefore good that we are now clarifying that primary care has a responsibility for both mental and physical care. This is admittedly no news, but it is now being further clarified.

It is also good that it is now clarified that medical assessment by doctors and nurses should be able to be offered around the clock within municipal health and medical care. That is also something that should actually already be a given but which has now been clarified.

Madam Speaker! These are, therefore, good changes and a step in the right direction towards good and local care. Does that mean we are satisfied now? No, not at all. There is much left to change and improve so that everyone in Sweden experiences that they truly receive good and local care. Therefore, I now intend to outline some of the additional steps that we in Centerpartiet see need to be taken moving forward.

First and foremost, we can state that accessibility to care differs across the country today. In our rural and sparsely populated areas, only one in five patients has access to a regular doctor contact, compared to one in three patients in the country as a whole. This is, of course, completely unacceptable. Furthermore, among patients who die in conditions considered to have been treatable, we see that the frequency is twice as high in our sparsely populated areas as in our metropolitan areas. It is more than unacceptable.

At its core, this is about how accessible healthcare is, that is, how easy it is to get in contact with healthcare and how far one has to travel to the nearest health center. It is indeed the accessibility that becomes decisive, for example, for how quickly a cancer is detected and thus for the possibility of survival.

Increased accessibility to primary care does not, however, have to mean that everything looks the same. Our starting point in Centerpartiet is rather the opposite. It must be allowed to look different, and we must utilize all the opportunities that exist to increase accessibility and in this way create the conditions for equal care throughout the country.

We see that the existing structure of health centers needs to be supplemented in our rural areas with smaller doctor-led units, which we have chosen to call rural doctors but which involve a minimum of one doctor and one nurse. In that way, one could ensure that the coverage rate within primary care becomes significantly higher and greater than it is today.

We also see that there are other resources that need to be available to increase accessibility. It is about technical and digital solutions with own monitoring and digital doctor visits to avoid longer journeys when it is not necessary. Here we also believe that pharmacies in the future can play an essential role and function as an additional link between patient and primary care.

Madam Speaker! The foundation for good and close care is, of course, the staff. Therefore, it is with sadness and concern that we have been able to observe the Tidö parties' and the Social Democrats' deportation policy over the past months.

It is about healthcare workers like Zahra and Afshad, who are well-integrated, work and pay taxes, who received a deportation decision despite the need for them at Södersjukhuset.

It is about nursing students, such as the sisters Donya and Darya who are studying to become nurses at Högskolan Väst, who have been deported to the dictatorship in Iran despite the fact that Sweden has invested seven years in their education and future.

It is about high school students like Jomana, who planned for a future in Swedish welfare, who were deported alone to Egypt.

It is about researchers and doctors who are forced to leave Sweden because their children are receiving deportation decisions, and where Sweden is seen as an increasingly unattractive place even for highly qualified labor.

This is the result of a policy that does not care in the slightest about good and close care but instead sees the deportation of people as a priority. It is a shame for Sweden, but it is also a hard blow to Swedish healthcare.

Now, some may wonder how dependent we are on immigrant labor in Swedish healthcare. I can tell you that. One in three doctors in Swedish healthcare is born abroad. One in three biomedical analysts in Swedish healthcare is born abroad. One in three nursing assistants is born abroad, and as many as one in two healthcare assistants and one in two dentists is born abroad. Without our foreign-born workforce, Swedish healthcare would collapse.

Madam Speaker! Swedish health and medical care must be both accessible and equitable. Investing in good and local care with primary care at the center is the most important part of reaching that goal. Therefore, it is good that we take another step in that direction today, but more needs to be done. Above all, the unjust deportations of healthcare personnel must be stopped.

(Applause)

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

Carita Boulwén (SD)

Madam Speaker! Thank you, Member Bergenblock, for the speech!

Much of what the Center Party advocates regarding healthcare policy, we can agree with. What the Center Party constantly returns to is continued large-scale immigration. It is not strict immigration, despite the fact that we see the terrible situations we have across the country with increased crime and a welfare state that has been on its knees for a very long time.

We have an imported care need. Shall we continue to fill up with more with care needs from other countries, to then continue with an irresponsible migration policy?

As I said earlier, Sweden obviously needs competent staff in healthcare regardless of background. But if it is such that one does not have the right to stay in the country, one should leave it. Stricter requirements within labor migration are not about stopping healthcare staff from working here. It is not about hunting healthcare staff. It is about stopping abuse and wage dumping.

Those who fulfill the conditions shall be able to work in Sweden. Those who do not fulfill them cannot expect to stay in Sweden.

That is why I ask Christofer Bergenblock: Doesn't the Center Party see this? Do you not see what the migration policy that you have driven for so many years has caused in terms of deficiencies in the welfare system? The Center Party wants to continue the irresponsible migration policy and just keep adding more.

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

Christofer Bergenblock (C)

Madam Speaker! Now I believe we must clarify a few things here. There are two parts to the migration policy. One part concerns how many people enter Sweden. The Centre Party stands behind the fact that we should have a strict migration policy moving forward and that it shall remain that way.

The second part concerns people who are in Sweden, who have established themselves, learned the language and studied, who work and pay taxes and who have rooted themselves with their families in Sweden – it is them we are debating today. It is not the second immigration. The member may gladly discuss that in a migration policy debate. But now we are talking about those who risk having to leave the country.

We can observe that Swedish healthcare is entirely dependent on immigrant labor. It may look different if one has come here for asylum reasons or if one has come with a work permit. But we are completely dependent on people who are foreign-born to fulfill the welfare mandate within Swedish health and medical care.

It must be very difficult even for the Sweden Democrats, who do not particularly want to see our immigrants contribute anything positive to society, to deny it, not least considering that we have all the figures in black and white on how many come from other countries.

The member of the government speaks about how we should kick people out because we do not want to see wage dumping. Now, a wage demand of approximately 33,500 kronor per month is presented here. Does the member seriously mean that all those nursing assistants, healthcare assistants, and nurses who enter at the starting salary even in Kungsbacka municipality, where the member comes from, are wage-dumped when they live on wages below 90 percent of the median wage?

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

Carita Boulwén (SD)

Madam Speaker! I realize that we do not have the same view at all regarding migration policy. The Member claims repeatedly that we are hunting for healthcare personnel. That is not true.

Centerpartiet is trying to weigh the need for healthcare staff against the need for order in migration. It is not serious. It is completely unserious, I would like to say.

Since 2025, the requirement is around 80 percent of the median wage in Sweden. That corresponds to approximately 29,000 kronor. It is not entirely unreasonable that one could earn that.

As I said earlier in my speech, it is about that if you have the right to stay, you shall be allowed to stay. But that does not apply if you are here on incorrect grounds or if you have not behaved correctly.

We have had unclear rules from the beginning, which the Center Party has been involved in and contributed to. Then it ends up like this. It affects individual people. I can do nothing but regret, as I have said before, when it affects those who actually behave themselves. But we must have order and clarity.

I would like to ask another question to the member. The Centre Party speaks very often about the rural areas and that we should have healthcare throughout the country. That is something that we in the Sweden Democrats support fully. It is very important for us in the Sweden Democrats.

That is why we want to see a state ownership so that we can get it in order. We cannot have 21 different regions that decide differently and prioritize differently.

We have an example in Sollefteå, where the hospital is being closed down. For several years, they have cut back more and more, and eventually, there will be nothing left at all. In that case, the Center Party has been involved and contributed to the closure.

What does the member of the Center Party say here about wanting healthcare throughout the entire country?

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

Christofer Bergenblock (C)

Madam Speaker! I note that the member regrets that we are throwing out healthcare personnel from Sweden today. To be honest, I do not believe for one second in this regret, but it is a statement that it is that way. We are completely dependent on the immigrated healthcare personnel.

Much has been said about the migration policy that has been pursued over the last ten years. We can then state that of our doctors in Sweden, 4,000 have come from other countries during the last ten years. Of our nurses, 2,000 have come from other countries during the last ten years, and among our assistant nurses and healthcare assistants, 33,000 have come to Sweden from other countries during the last ten years.

It can only be stated that we are not reaching each other on this, and that is simply because our views on people differ completely. We see completely differently on the need for their services and skills and on the conditions when people have established themselves in Sweden.

I now return to speaking about the countryside and rural areas, where the Sweden Democrats envision that a centralization of the entire Swedish healthcare system will solve the countryside's problems.

Who seriously believes that it will be so? When a director general in Stockholm has taken charge of 350,000 healthcare workers and is going to set a norm for how a Swedish emergency hospital should look, we will see a wave of closures of Swedish hospitals of never-before-seen proportions. Then there will be no room for either Sollefteå hospital, Ljungby hospital, or other smaller emergency hospitals.

The belief that centralization and concrete politics will solve the rural areas' conditions and challenges is merely a chimera.

(Applause)

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

Lina Nordquist (L)

Madam Speaker! It is now my turn to strongly urge approval for another step towards good and close care.

This is one of the greatest issues of freedom, I would like to say: to be safe and to be able to steer one's own life even when one oneself or someone who means very much to one is affected by illness. Care in a timely manner is of course completely crucial. That care is nearby and with continuity is a pure patient safety issue and a safety issue. We must be allowed to be involved. It must still be our lives, no matter what happens to us.

That is why the Liberals have since the 70s pushed for really good primary care, for a family doctor reform, and for the right to a personal doctor in primary care for every inhabitant in this country. That legislation was actually also introduced during the bourgeois government in the 90s, but the Social Democrats immediately revoked it when they came to power again. We received decades of delay, but now this work is underway. I am very happy about that, Madam Speaker.

After this debate, we will vote through yet another reinforcement of the Dental Care Act, the Patient Act, and the Health and Medical Services Act. From this summer, care will become closer, and it will become safer. Yet another freedom reform will be completed. Primary care's mission and responsibility for both physical and spiritual care needs will become clearer.

The most important thing is that those people who receive care in their own homes, those who are the most fragile and those who most need the best support from healthcare, from this summer will know that there is a person medically responsible for rehabilitation in their municipality, regardless of what postal address they have and regardless of where in the country they live. They shall know that from this summer they can receive a medical assessment from a nurse or doctor regardless of the time of day. They will not be forced to be healthier after office hours.

These are important matters. It is truly a freedom reform that is taking place here and now. This makes healthcare closer, it makes it safer, and it makes it absolutely more secure for the people who really need it the most.

The deliberation was hereby concluded.

(A decision was to be taken on 25 February.)

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