(cont.) Response to interpellation 2023/24:301 on the funding of healthcare

Lena Bäckelin (S)

Madam Speaker! "'Robust health centers' shall support Östersund's hospital in the event of crisis or war" was a headline one could read in the newspaper at home in my region Jämtland Härjedalen at the beginning of the year. With only one hospital in the entire region, it becomes vulnerable, and in today's global situation with a need for strengthened preparedness for crisis and war, it links the ongoing work directly into the work with robust health centers.

This is more important than ever today in order to be able to support the hospitals both in peacetime, in a region where it is not uncommon for the citizen to have a distance to specialized care of 15-25 miles, and in crisis and war situations, when the care must function well in all parts of the region. But that requires sufficient resources, which have not existed in the SD government's budget on the healthcare side.

But with a relatively small population of about 130,000 inhabitants, spread over a large geographical area that constitutes about 12 percent of our country's total area, this poses significant challenges for Region Jämtland Härjedalen. For example, ambulance response times today are significantly above the national averages in many places in the region. To meet this challenge and for the care to be equal, more resources are needed.

Madam Speaker! Today, the cost crisis hits Region Jämtland Härjedalen very hard due to, among other things, continued inflation and the fact that covid measures are still ongoing. We have, for example, opened a new ward just for covid patients. We also, as one of our members mentioned earlier, still have a large vaccination program, and the pharmaceutical costs have increased, not to mention the staffing companies that are draining our finances.

In a situation where we must make a revolutionary structural change, which robust health centers are about, and to cope with the extra pressures that can arise during crisis and war, large additions were needed already today to manage to maintain the quality of healthcare in our region even at today's level and to manage the availability for our citizens in both war, crisis, and peacetime.

We also already have enormous needs for staff recruitment, which today is solved through expensive staffing agencies. In one department at the hospital, up to 80 percent of the staff come from staffing agencies. The consequence is a great pressure on regular staff and their working environment, and the money flows out of the region's budget straight into the staffing agencies' pockets.

Everyone understands that more resources are needed and that the efficiencies that the government points to absolutely cannot be the only solution.

(Applause)

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

Lena Hallengren (S)

Madam Speaker! Thank you, Marcus Wennerström, for the interpellation and the initiative! Thank you, Minister, for the answer and for sitting here and listening to all the testimonies that we now carry with us! Thank you to the healthcare staff who work and toil under increasingly tougher conditions!

Sweden is, we argue, in a healthcare crisis. We have already heard in the debate how all parts of the country are plagued by cuts, closed health centers, departments being moved, and staff numbers being reduced. We know that healthcare needs a larger suit, not a smaller one, that healthcare needs more colleagues, not fewer, and that healthcare needs to become more attractive, not scare away its employees.

With this said: I live in Kalmar and also intended to give a testimony. It is a fact that even if a region is well-managed and has saved in the barns, the crisis does not pass unnoticed, on the contrary. Kalmar is the region that, according to the patients, has Sweden's best care, but it remains to be seen how it will turn out with that matter. If one has saved in the barns for a long time and then uses the money in one sweep, how prepared is one then for the future? This is what is happening now. One is forced to empty in principle ten years of savings to manage the finances.

Patient fees are also being forced up. These are fees for healthcare visits, fees for missed visits, high-cost protection, and a new fee being introduced for ambulance dispatches where treatment is provided on-site. The fee paid for care in a hospital is increased. The subsidized inpatient care fee for persons who have sickness or activity compensation and have not reached the age of 40 is removed. The visit fee for vaccinations is increased, and furthermore, there is no longer any subsidy for the fee for vaccination against seasonal influenza. The time-based tariff for certificates is also increased. This is something that the individual will notice. The person seeking care may wonder if they really should do so.

Reductions are also being made in continuing education initiatives. I will not say that they disappear completely, but they are being reduced radically. The development work that is needed in healthcare must now be slowed down. Instead of developing the operations and continuing the important work for, for example, good and close care, one stands and treads water and perhaps takes steps backward. Healthcare cannot afford this.

It is also about long-term savings measures of approximately 200 million kronor. This can be translated into six health centers, just so we understand how much it actually is. This will not go unnoticed. As with many other parts of the welfare system, it is the case that once you have made a cut and worsened the operations, which can happen quite quickly – it takes a decision and then, admittedly, time for notice periods and so on – it takes much longer to rebuild the quality in the welfare system and lure back that employee who quit and found a new job somewhere else.

This is real, and it is very serious. We mean that the government must take responsibility and give the healthcare system the resources that are required. Several of us have testified to the possibility of prioritizing differently, of forgoing tax cuts for those who can afford to pay tax and ensuring that the healthcare system instead receives the resources that are absolutely necessary. It is possible if one only wants to.

(Applause)

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

Jennie Nilsson (S)

Madam Speaker! The testimonies regarding the serious and acute situation in healthcare are numerous. Care in Halland has during 2023 been palpably affected by vacancies, high staff turnover, sick leave, and a shortage of substitutes. This has resulted in reduced capacity in operating departments and inpatient wards. On average, care beds equivalent to slightly more than one major care ward have not been in operation since the beginning of 2023.

The difficulties in recruiting and retaining staff are, of course, not a problem that one solves solely with more money. It also requires a strategic, long-term, and purposeful effort to improve the working environment and conditions in general.

But it should be obvious to everyone, also to the SD government, that reduced resources, austerity measures and cuts hinder and exacerbate an already strained and serious situation.

It is therefore deeply concerning that Region Halland's budget for 2024 is underbalanced by almost 620 million kronor with reference to special reasons. To this should be added that all Halland health and medical care boards begin 2024 with a deficit they carry over from 2023 totaling 236 million kronor. These deficits also must be managed during the year in order to achieve a balanced budget. The result is poorer accessibility with growing healthcare queues, cancelled operations, a staff that continues to go to their knees until they collapse, further worsened working environment and even harder to recruit and retain staff, and it becomes a hopeless and unsustainable spiral.

Ultimately, this means poorer healthcare. It is an unacceptable development, and I expect the responsible minister and the SD government to now show that they have both the will and the ability to handle the crisis that the healthcare system is in.

(Applause)

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

Lars Isacsson (S)

Madam Speaker! I would like to begin by thanking the interpellator Marcus Wennerström and the Minister for this debate.

In my home county of Dalarna, the annual conference Folk och Försvar took place a few weeks ago. It was very much about the importance of a strong total defense and the strong society that we need, not least in light of a threat of war. But this costs money, and it requires a political steering beyond juridification and silos. And for this, the SD government must take responsibility, not least for the welfare. Regions and municipalities are on their knees, and now further savings will be required.

How can our welfare contribute to safety and security when the budgets are tight for teachers and nurses? A strong and jointly funded welfare is the foundation for people in Sweden to manage the challenges.

I asked the chairman of the regional council in Dalarna, Elin Norén, about what savings they are facing and how she views the Minister's answer that it is a matter of prioritizing.

She replied: "We are prioritizing fully. We are trying to prioritize not making cuts to the health centers. We are trying to prioritize that children and young people with mental ill health receive care in time. But if we prioritize that, we must prioritize away something else. Now our queues for surgery are growing, after a long period of reduction. The patients and the healthcare staff pay the price when the government forces us into those types of prioritizations."

When the minister says that we must prioritize, I want to say this: We take our responsibility. When will the government take its?

Region Dalarna is to save approximately 500 million kronor, of which the largest portion is in health and medical care. This includes, among other things, a saving of 20-30 million on close-to-care services, with the consequence that healthcare staff will have less time to provide care.

There will be mergers of operations with the consequence that patient safety may be affected. And the staff experience a worse working environment.

Public transport will be scaled back. The consequence will be an increased divide between city and country, a greater environmental impact, and that fewer people can commute.

Patient fees will be increased, and the consequence will be that people experience a mistrust of the tax system and find it difficult to pay for their hospital visits.

Assistive technology stores will be closed, and people will find it more difficult to receive support and service.

There will be reduced scholarship payments, which will have consequences primarily for cultural workers who will not be given the opportunity to develop.

There will be delays in necessary renovations and new constructions, and the consequence will be capital destruction and a worse working environment.

One is also reducing staff at the administrative level, and the consequence is that healthcare staff will have to deal with more administrative tasks.

It is almost provocative to receive the message from the Minister that it is a matter of prioritizing. What should be prioritized and how? Should one not perform life-saving operations? Should one prioritize away staff? Should one prioritize away an ambulance in northern Dalarna so that one can afford to treat MS patients in Falun?

Madam Speaker! My question to the Minister is: Will the government take initiative to avoid regions being forced to lay off healthcare personnel, or will the government take a walkover and let municipal and regional politicians face unreasonable choices and priorities?

(Applause)

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

Johan Hultberg (M)

Madam Speaker! Let me begin by praising the Social Democratic Party. The Social Democrats are skilled at political communication. But the Social Democrats are also completely shameless when they blame everyone's problems on the sitting government. Now, one mobilizes their party organization to blame all of the healthcare's problems and challenges on the government. In this debate, one mobilizes their parliamentary group to try to shift the responsibility from Sweden's 21 self-governing regions to the government. One Social Democratic Member of Parliament after another has now asserted that the crisis within Swedish health and medical care arose when the Social Democrats lost the election and lost power.

But, Madam Speaker, it is not that simple. The crisis within Swedish health and medical care did not arise in September 2022. The challenges within Swedish health and medical care have grown and become increasingly deep and increasingly serious over many years, not least during the Social Democratic government's tenure.

Before the 2014 election, the Social Democrats, led by Stefan Löfven and Lena Hallengren, promised that everyone with a cancer diagnosis would receive care within four weeks. But S betrayed its promise. With Hallengren as Social Minister, fewer than half of all women with breast cancer received care in time, and not even one in three men with prostate cancer did.

Madam Speaker! When I and others highlighted this breach of promise and this serious problem during the previous parliamentary term, the then minister shrugged off all responsibility. It is the regions that are responsible for healthcare, was the message from S.

Now that the Social Democrats are in opposition, it is a completely different tune. Now they blame everything on the government.

For me, the Moderates and the government, it is crystal clear that the challenges in healthcare require leadership and accountability at all levels. The crisis is fundamentally about many employees in healthcare having grown tired of difficult conditions, poor working conditions, too low wages, heavy workloads, messy work schedules, and cumbersome IT systems.

The crisis in healthcare cannot be solved with anything less than all those who have responsibility for healthcare becoming better employers and ensuring that healthcare staff have good working conditions and wages that reflect their commitment and important work contributions.

Madam Speaker! For me, the Moderates and the government, it is crystal clear that the state needs to take greater responsibility for Swedish health and medical care, not least in order to reduce regional differences. What care one is given should be governed by need and not be decided in a postcode lottery.

That is why I am proud that the government, with Minister for Health and Social Affairs Acko Ankarberg Johansson at the helm, has tackled important reforms in Swedish health and medical care, is taking initiatives for a national competence supply plan, and is ensuring that a national responsibility is taken to clear out the jungle of complicated IT systems and create a national platform.

For me and the Moderates, it is also crystal clear that the regions have a tough economic situation. Inflation hits welfare hard. And in this situation, it is important to pursue a responsible economic policy that pushes down inflation, restores the work principle, and supports municipalities and regions. And, Madam Speaker, that is exactly what this government is doing.

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

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! I thank Marcus Wennerström for the interpellation and all others who have participated in the debate.

What is the situation for Swedish health and medical care? A lot of good results are achieved every day when people seek care and receive fantastic care, good support, and coordinated care - and the health and medical care becomes just as person-centered as we want it to be. This also applies in difficult situations when people receive help with a severe illness or a chronic and lifelong illness. There are a lot of things that work well.

At the same time, there are very long queues, which as mentioned did not arise the other day but have been ongoing for a very long time. It concerns people who need an operation or an intervention but still do not receive it.

It is thus double images of the situation in Swedish health and medical care, which is operated by both municipalities and regions. They have a shared responsibility. And one of the things that is connected to the situation is precisely a lack of working environment. There are so many employees who experience that they do not have the best working situation. They have a working situation that makes them not stay. They leave the profession and do not even work with care in any form but go to a completely different sector.

There really are things to do, both those that the government has taken the initiative on and those that many others are doing - not least the regions themselves, of course, as well as the municipalities. Some things have been attempted, and they are breaking through on a broad front this year. It is good, but it is really tough right now.

For example, one is trying to reduce the large use of hired staff. This was exemplary raised by one of the members; was it possibly Peter Hedberg who raised it? Thank you for that! Being constantly dependent on hired staff is not good. Hired staff are for peaks and troughs - to be added when needed - but we have heard about many departments that are completely dependent on hired staff or where it is so commonly occurring that one loses continuity. In that case, it affects both quality and economy.

The regions have tried in many different ways, I want to say, but they have now gathered together in a common framework agreement and are making a major push this year to reduce the use of agency staff. I support that, but I see the consequences right now when one simultaneously decides on hiring freezes. If you remove staffing companies and introduce hiring freezes, it becomes quite tough.

This is a challenge that the regions are working with. Work is being done to find a good balance so that one can actually still provide the care that every patient has a right to, but there are things that complicate it. This applies in particular to the working time directive, which is indeed protective legislation but which entails challenges for large parts of the sector. There, work is being done to find reasonable valves and such things that still allow the operations to function.

To this, we shall add the effects of inflation. It is therefore many things at once that make it really difficult for every employee. We see that the consequences affect the patients but of course also the regional politicians, who perhaps are our strong focus here today.

Is inflation then a big issue? Yes, Sveriges Kommuner och Regioner still assess that it is; in their economic report from October, it is stated in the summary conclusions: "When and how much the inflation is dampened is crucial for the economic development and the possibility of reaching balance again in the future. SKR assesses that the results begin to recover after 2024, but for the regions, an overall deficit is projected even in 2025."

SKR is therefore pointing straight out that the government's stance regarding inflation must be maintained, that is, to have a restrained budget that ensures that inflation goes down. It is the consequences of inflation that plague the regions throughout 2024, and I will return in the next contribution with what the government has done. The Riksdag did, in fact, make a decision on measures in December, and I would like to return to those.

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

Marcus Wennerström (S)

Madam Speaker! First and foremost, I would like to thank all my colleagues who have stood at the rostrum and advocated for the regions.

Let me then remind you of what I began my previous post with. When the Social Democratic-led government four years ago faced the uncertainty and the threat from a pandemic, the message was clear: costs would not stand in the way of saving lives. We took responsibility.

Madam Speaker! During the afternoon, 21 Social Democrats have shared stories from reality in our regions. It is a selection from the healthcare crisis we now face. It is also a reality that is here and now. These are stories of how the regions' politicians take an enormous responsibility to manage an impossible situation. It is about healthcare staff who, despite threats of resignation, do everything in their power so that patients receive the care they need.

Madam Speaker! In that situation, it is not enough for the government to shift all responsibility onto someone else. Yes, the situation is complex, but it is not enough to repeatedly make claims that savings can be made on some undefined non-core activity. The ball is now in the government's court to act. Now is the time for action. It is precisely now that there is an opportunity to save healthcare before it is too late – or perhaps that opportunity even existed the day before yesterday.

That is why it is so incredibly sad to see the government's passivity in the face of the seriousness of the situation. It is not possible to duck this. It is reported how healthcare facilities are being closed and that thousands of healthcare workers risk being laid off, which will have consequences for accessibility and patient safety. We hear about increased patient fees and that care is being moved more and more from smaller towns into the cities, which goes against the objective of good and local care. Despite all this, the government remains deaf to it.

Madam Speaker! I have so far not heard anything in the government's statement that points towards more measures for regional healthcare in Sweden. The situation is extraordinary, and I look forward to hopefully hearing something about this in the government's next entry.

(Applause)

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

Anna Vikström (S)

Madam Speaker! What we see is that the government has allowed the inflation crisis to become a national healthcare crisis. It is not possible to abdicate responsibility for this. Other things than healthcare have been prioritized; that is the fact. For example, snus, plastic bags, and increased rut and rot have been prioritized, which, according to the National Audit Office, are not used effectively or reach their goals.

Region Stockholm intends not to lay off staff. Instead, they want to protect healthcare as much as possible. That is good, because it risks becoming very negative for the long-term supply of competence to lay off healthcare staff. This crisis must be ridden out, but it must be done with more support from the national level. Furthermore, many voices are now being raised that healthcare today has too small margins for the civil preparedness. What we see in healthcare right now is a reduction instead of an upgrade.

Another aspect of preparedness that I want to mention is that the marketization of healthcare, at least in Stockholm, has led to a lack of availability of resources, which could be seen during the pandemic when hospitals struggled for the patients' survival under very strained conditions while private healthcare clinics calmly operated simpler ailments with resources that had been needed elsewhere. Even in a crisis, the principle of care based on need must be prioritized.

It looks like Region Stockholm and other regions are using every tool in the box to manage this crisis, but the government is not doing its part. In fact, not enough is being done. The consequences are affecting patients and relatives.

(Applause)

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

Sofia Amloh (S)

Madam Speaker! The government went in hard: They started by, in their first budget, not even being anywhere near the state grants that SKR, that is, municipalities and regions, had sent sharp and clear signals about being in need of. Region Sörmland burned through its entire savings account, and the government's party comrades in Region Sörmland's leadership – Moderates and Christian Democrats – pleaded, begged, and prayed for more money. They needed help to survive. The government and the State Council refused to listen to the cries for help that came from so many sides.

The government chooses again, in the budget for 2024, not to give the regions even anywhere near what healthcare is in need of. The descriptions and testimonies that we are messengers for today are the reality. It is a reality that the bourgeois governments are incapable of handling.

The consequences will not stop at what we describe today. When the cuts are implemented during the year, every person in Södermanland will be affected in some way.

Madam Speaker! The banks are making profits of an estimated 90 billion. This government thinks this is reasonable – they do not want to do anything about it and let it pass. Region Sörmland's deficit is 1,200 million kronor, which corresponds to 4,000 kronor per Sörmlänning. It is difficult to defend the banks' profits in front of the people of Sörmland.

What does the government intend to do? Does one intend to leave the regions alone?

(Applause)

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

Lena Johansson (S)

Madam Speaker! Many of us have now conveyed what the situation looks like in Sweden's regions today. The Minister has surely received a good picture of how the health and medical care in Sweden is doing. Now one only needs to make the right diagnosis, and it should be easy for the Minister to do that.

Once a diagnosis has been made, it is also quite easy to medicate. Here, we are all authorized by the Swedish people to make diagnoses and medicate. My hope is that the government takes the time to make the right diagnosis and prescribes enough medicine. This issue must not be left waiting in the waiting room but must be solved quickly. It is an acute issue not only for the people of Köping and Västmanland but for all of Sweden and all its inhabitants.

The Minister says that one needs to have a restrained budget. That is absolutely true, and one needs to make priorities. But this government has prioritized tax cuts and luxury-rot. Does the Minister intend to continue to make the wrong diagnosis, or does she intend to make the right diagnosis and medicate incorrectly?

(Applause)

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

Hanna Westerén (S)

Madam Speaker! It is hardly surprising that I will continue to speak about healthcare in Gotland.

In addition to what I have described earlier – that equal care is seriously jeopardized when healthcare is so severely underfunded – an additional challenge arises for my constituency, as it does for many others, namely civil defense.

The Swedish civil defense must be upgraded; on that, we agree. We do not, however, agree on who should bear the cost. Gotland has a stated strategic position in the defense of Sweden; this is evidenced, not least by the Armed Forces' ongoing upgrade on Gotland. It will, however, be up to the regions to upgrade the civil healthcare capacity.

Think about that for a moment. In a situation where Gotland's healthcare is running at a deficit of 400 million kronor, Region Gotland is also expected to deliver healthcare capacity in the event of crisis or war. This burden is distributed among 61,000 Gotlanders. It is astounding.

The government has allocated "coffee money" for the regions to share in order to manage civil defense in a situation where the regions are bleeding, while the Minister for Civil Defense complains that the civil defense buildup is proceeding too slowly, and when Gotland is expected to build up capacity for crisis or war.

I am fully positive about joint preparedness and a stronger civil defense, but for my life I cannot comprehend how the regions, in addition to their current challenges, can deliver capacity in the event of a crisis or war. I therefore want to emphasize my question to the Minister regarding her assessment of the municipalities' and regions' capacity for Swedish health and medical care.

(Applause)

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

Heléne Björklund (S)

Madam Speaker! I continue to describe how we have it in Blekinge.

To the Minister for Health and Social Affairs, I want to say that this debate is a cry for help. We still have a hope that the government will help all of Sweden's regions. The reason that so many of us are in this debate is that we want to show how urgent this is.

In my previous post, I mentioned that for the small province of Blekinge, it is 600 million that is to be cut. This corresponds to 14 percent or a 2 kronor tax increase. It is system-threatening if this cut is to be carried out; it is actually quite serious.

I agree with what has been said here about crisis preparedness and how important the entire healthcare system is, but what I see ahead of me is that small children and their families suffer. We have heard several testimonies about BUP activities that are threatened and long queues to child and adolescent psychiatry. Everyone in here knows what happens when children do not receive help in time. It is not just about human suffering, but great tragedies can be waiting if help is not provided in time. Of all the misery that I and many colleagues have described here, it is still these children and their families that I see ahead of me.

I pose the question to the Minister for Health and Social Affairs once again: How does the Minister for Health and Social Affairs assess that the government's budget will affect health and medical care? The follow-up question is: Will the Minister help us with this?

(Applause)

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

Karin Sundin (S)

Madam Speaker! The Minister for Health and Social Affairs speaks beautifully about the importance of a good working environment, but it is not always so good. The staff are working hard but it is not enough. Let me therefore also repeat Marcus Wennerström's question about how the government's budget will affect health and medical care and the staff's working environment.

I previously mentioned the thesis that Anna Hertting wrote about the healthcare crisis in the 1990s. I spoke about Region Örebro län's organizational memory after the large-scale layoff, but the effects of the layoff were also measurable in physiological terms. We know that unemployment can affect people's health both physically and mentally, but the layoff in Örebro also affected those who were not laid off. The blood tests conducted on the staff who remained at the regional hospital showed a clearly increased stress level in their bodies. Then, long-term sick leaves also increased - between 1996 and 2001, they increased from 3 to 6 percent.

Madam Speaker! I wonder how Minister for Health Acko Ankarberg Johansson believes the government's budget affects the working environment, the stress, and the working situation for the employees in healthcare. What are her thoughts regarding the risk of more sick leaves?

It should not have to be like this. Let me remind you that the Social Democrats, within the same budget space that the government has proposed, have suggested 10 billion more for welfare. Even this would not be enough, but if one did not lower the tax for high-income earners, it could mean 300 million more for the region and for the municipalities in Örebro län. This would be much, much better than the situation we have today.

(Applause)

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

Peter Hedberg (S)

Madam Speaker! I must thank the Minister and for the fact that some moderate company joined the debate; we were so few before.

I was somewhat fascinated by the almost dreamlike state the Moderates painted, where the regions can apparently calmly focus on improving the working conditions for the staff. The Moderates completely ignore what we have said throughout the entire debate: The regions are bleeding! Lars Isacsson testified that in northern Dalarna, one has to choose between having ambulance services and keeping primary care open at certain times. To face that choice is not a normal state of affairs.

This does not mean, however, that we are saying there have not been problems within healthcare for a long time. But now the problems are acute with deficits of several hundred million kronor; in some regions, they have even breached the billion mark. To then talk about a situation where unions and employers can calmly discuss how to best develop competence is absurd. It is clear that the regions are trying to invest in competence development, but it is also many times a desperate attempt to retain staff because one knows what a battle it is for the right competence.

It is good that the Minister for Health and Social Affairs supports the regions' initiatives regarding the staffing situation, but I repeat the question we have asked: Will there be any initiatives from the government with extra resources for healthcare so that people do not have to be laid off? If the Christian Democrats are to nationalize healthcare, it is very good if there is anything left when the state eventually takes over, because as we have just heard, what is happening now is system-threatening.

(Applause)

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

Yasmine Bladelius (S)

Madam Speaker! Let me begin by addressing Moderate Johan Hultberg's contribution. Talk about insolence! In the previous crisis Sweden went through, admittedly not the same as this one but also a crisis that hit healthcare hard, the Socialdemokraterna were in government. Then we were there, stepped up and provided the resources required by the regions several times over. In this crisis, we are not in power, but the Moderaterna are, together with among others the Kristdemokraterna and the Sverigedemokraterna. This time the government is not there for Sweden's regions, and in this healthcare crisis, the government does not step up.

Madam Speaker! Let me return to Region Skåne. The region is being indebted now as never before. Over three years, the Tidö parties in Skåne, that is, the minister's friends, want to increase the net debt by 56 percent. This has never happened before. Investments can absolutely be partially financed by loans, but the principle should always be that the operations and the wages are covered by ongoing revenues.

Madam Speaker! The Minister for Health and Social Affairs does not govern Region Skåne. But the government is responsible for the crisis we see in Skåne. The government could have, in fact, chosen to invest in healthcare in the two most recent state budgets instead of in reduced taxes for us high-income earners. I appeal to the minister to do so.

(Applause)

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

Mikael Dahlqvist (S)

Madam Speaker! I thank the Minister for Health and Care for her contribution.

In the 2000s, I was the chairman of the municipal executive board in Hagfors municipality, a small municipality in the middle of Värmland. At that time, we had a financial crisis, and Sweden was governed by the Alliance government. The recipe then was no compensation to either municipalities or regions. In my municipality, we had to cut by about 25 percent; you understand yourselves. At that time, it was not about prioritizing core activities, but about the slaughter of core activities.

Why do I bring this up? Well, because we are now in precisely the same situation, an extraordinary event. I do not blame Acko Ankarberg Johansson and the government for the fact that we are in this economic crisis, because there are more factors. But I believe that the minister and the government are responsible for the crisis potentially becoming permanent by not seeing that more resources are needed.

During the pandemic, the S-led government added more than what was actually needed so that no one would be affected by the negative effects. At that time, we were quite in agreement in the Committee on Health and Welfare regarding the measures, but still, during many debates, we heard that it was the government's responsibility. Now I am surprised that Member of Parliament Johan Hultberg has completely suddenly switched sides. Throughout the entire last parliamentary term, he scolded the government for the healthcare crisis but did not say a word about the regions, but now it is suddenly the regions' responsibility. Well, examine yourself a bit, Johan Hultberg!

(Applause)

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

Björn Wiechel (S)

Madam Speaker! We heard that it is about economic responsibility, and in that regard, there are a few things that are important to state. One is that the reduction in inflation is not primarily a consequence of the government having taken responsibility while the employees have not taken responsibility in the wage movement and thus lost ten years of real wage increases.

The government could have taken responsibility by supporting households financially, but in that regard, they have done the bare minimum. One-third of all adults have difficulty paying ongoing expenses; that is how reality looks today. What the government has done instead is to lower taxes for those with the highest incomes. The consumption of high earners has been prioritized and inflation-protected, not that of ordinary households and welfare.

The government could have supported the welfare state in this situation, specifically the regions and healthcare. Inflation is a problem, but giving the regions the funds they need to be able to have a welfare consumption is not inflation-driving. This has been stated by economist after economist.

The situation is exceptional. It is not a common situation that has rolled on for many years or that arose after the election as some tactical choice. This is a real economic situation. That the government does not see the problem and does not take it seriously shows that we have two problems. The first problem is that it is extremely harsh and exhausting in the regions, that every krona is being turned over, and that there are cuts. The second problem is that the government neither sees this, acknowledges it, nor takes it seriously.

(Applause)

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Sanna Backeskog (S)

Madam Speaker! I mentioned earlier examples of the healthcare crisis in Gävleborg. Long outdoor queues in snowstorms at the emergency room are neither worthy of Swedish healthcare, the patients, nor the healthcare staff. I see two alternative explanations for what is happening in healthcare in Sweden. Either the government has failed due to incompetence; they have not understood how difficult the situation in the regions is. Or the government has succeeded with exactly its policy: to prioritize tax cuts over welfare. I do not know which is worse, but in any case, a collapse of Swedish healthcare cannot be ruled out. Necessary healthcare activities, such as health centers, are disappearing, accessibility is deteriorating, and the staff's working environment is being damaged. This will have consequences for a long time to come.

In my region, Gävleborg, the situation becomes extra serious: a combination of a passive government with all too much trust in the market, a capitalization of Swedish healthcare, and a regional leadership with the Sverigedemokraterna at the helm that is more concerned about who gets to be Lucia or what art should hang in the county museum than securing high-quality, safe, and equal care for the county's residents.

The health center in Ljusne is a clear example – the one that is closed because it is not profitable. As usual, it is the people in industrial towns – or in suburbs – who are hit hardest by bourgeois politics. It is they and the women of the welfare system, who are already today going on their knees in a region that is running at a deficit of 700 million.

I agree with previous questions and pleas to see the regions and to allocate more funds.

(Applause)

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Dzenan Cisija (S)

Madam Speaker! I will continue to speak about the challenge that Västra Götalandsregionen, to which my home city of Göteborg belongs, faces due to cost increases of 3.4 billion kronor.

In a situation where we need to build up our civil defense, Västra Götalandsregionen is forced to discuss cuts within the ambulance services. The region is raising patient fees. Healthcare clinics are being merged, with a risk that accessibility in rural areas will deteriorate. Important investments in competence-enhancing initiatives for staff are being postponed. The work to shorten the healthcare queues that were built up during the pandemic is being slowed down because the money has run out. The effect is that the healthcare queues are growing.

Madam Speaker! It is difficult to ensure sustainable and effective healthcare if the resources do not match the actual needs. The government's modest addition to general and targeted state grants does not go far in the operations. In real terms, it becomes a reduction of resources, which will lead to diminished care capacity, longer waiting times, and staff cuts.

(Applause)

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Fredrik Lundh Sammeli (S)

Madam Speaker! If it had only been about Norrbotten and some other region, or only about S-led regions around the country, or about regional politicians not taking their responsibility and not prioritizing core activities, it might have been easy for us as an SD government to think and argue that this is not something to worry about. But now all regions in the entire country, regardless of government, are crying out for help.

I can understand if the Minister for Health and Social Affairs, the Minister for Finance, and the Prime Minister do not want to listen to me or my Social Democratic colleagues here in the chamber. But if you do not want to receive our testimonies from the regions we represent around the country, then for God's sake, listen to your own party comrades around the entire country!

It is unacceptable that the government allows this to continue without taking powerful measures. It is inexplicable that one just stands by and watches and shakes out some old talking point about efficiency or prioritization when we see this healthcare crisis striking across the entire country.

In a short time, the conditions at home in my region have deteriorated by over 400 million. This corresponds to 30 percent of the entire primary care budget, in a region that is a quarter of the area of this country. It will have enormous effects, and the government needs to take responsibility for it.

(Applause)

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Eva Lindh (S)

Madam Speaker! I want to extend a thank you and a greeting to the healthcare staff in Östergötland. I know how hard they worked during the pandemic, and now they are truly struggling against the wind.

I have met some of them. They feel a great deal of concern. People talk about natural attrition, but now people are leaving their departments without anyone new being hired. They see how this affects things, and the concern for how this will end is truly great. They are worried about the patients they are employed to care for.

In Östergötland, it is about a deficit of 1.6 billion. That is almost the entire primary care. Everyone understands that it has an impact.

The debate today has sometimes been about whether it is the responsibility of the municipalities and regions or the state, but we obviously have a shared responsibility: The state sets the conditions for the healthcare that the region operates. Can we not just agree on that?

I have also visited the home care services. They are also beginning to notice how this affects things. All the elderly people out in the municipalities are being held back. This will therefore affect the staff, the municipalities, and all of us who are patients and need care in Östergötland.

I also just want to state that although inflation has indeed affected municipalities and regions, investments in welfare do not drive inflation. One can invest in welfare. That is what we Social Democrats have shown in our budget alternative. I appeal to the SD-led government to invest in healthcare. It is important.

(Applause)

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Lena Bäckelin (S)

Madam Speaker! I know that my colleagues back home in Region Jämtland Härjedalen have worked and are working extremely hard to cut the queues. The work of securing access to care by shortening the queues risks coming to a standstill in our region when the important work is now threatened because the government does not respond with the state grants we need.

Madam Speaker! The government is inexcusably passive. It is clearly visible by the fact that the government does not protect the most vulnerable population from the cost crisis, and here we also see how the government also does not see the healthcare crisis. It is inconceivable. It is simply far from the reality that so many today are struggling with in our elongated country. People are struggling both with their own household budgets and as patients when the queues become longer in this healthcare crisis.

We in Region Jämtland Härjedalen are budgeting for a deficit of 300 million kronor in 2024. It is a choice we have made. We cannot close the door because of too few state grants. People have a right to care.

This is a choice between postponing the payment to the future in order to be able to provide care here and now to those who need it, and laying off staff and then letting the remaining staff go on their knees after a pandemic and a healthcare debt. It is not the way to go.

Madam Speaker! Finally, I want to ask: Does the Minister not see the healthcare crisis in Region Jämtland Härjedalen?

(Applause)

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Lena Hallengren (S)

Madam Speaker! I think it has emerged with all desired clarity throughout this entire afternoon that there is a healthcare crisis in Sweden. No one is saying that the crisis is fundamentally the fault of the Moderate-led SD government, but when one sees the consequences of the economic crisis and does nothing about it, one becomes partially responsible.

Health and medical care is complicated. We could have many different debates here about primary care, research, pharmaceuticals, preparedness, competence supply, demographics, safety, equality, SVF and so on, but now we are talking about the fact that the money is not enough. The regions are doing their absolute best, but it results in cuts, savings, increased fees, tax increases and worse care.

What is the government doing then? Well, they consider themselves able to afford tax cuts. It was just recently that the Minister for Finance, to whom the question was actually addressed but who passed it on to the Minister for Health and Social Affairs, said that now it is time for some tax cuts. It is still important for a Moderate-led government. I will not add many new questions here, but I am a bit curious about whether the Minister for Health and Social Affairs really shares that priority.

It is a matter of scraping out some reform space, which we Social Democrats have shown in two opposition budgets can be done. One can forgo tax cuts for those with high incomes. One can forgo the luxury tax. One could even imagine keeping the plastic bag tax, but I think it is quite small in the context. One can have a bank tax.

There are ways to increase the reform space. But if one uses the reform space already available for tax cuts, it does not bode well for welfare and healthcare.

I add that question: Does the Minister for Health share the Minister for Finance's view that it is now tax cuts that are the priority moving forward? That makes me very concerned.

(Applause)

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Jennie Nilsson (S)

Madam Speaker! I want to begin by stating, by reason of Johan Hultberg's contribution to the debate, that holding the government accountable is not something shameful but an opposition's responsibility. If one, as a government, is furthermore not prepared to take responsibility, one should perhaps not aspire to form a government.

With that said, I can agree with Johan Hultberg that the current healthcare crisis requires leadership and responsibility at all levels. That is why we all stand here today, 21 representatives for 21 regions, and say that the SD government must also show leadership and responsibility.

I appreciate that Minister Acko Ankarberg Johansson still addresses the challenge of recruiting competent staff. She shows that she sees how it looks out there and what it means for both the staff and the healthcare. But the question that remains is: If one sees this and can express it so well, does one believe that the regions can handle this challenge at the same time as they are to save, cut back, issue redundancy notices, and lay off people?

What responsibility and what prioritization does the Council of State consider that the SD-led government should now take and do? Is this seen? Does one intend to do something? Does one intend not to do anything? Does one intend to lower the tax?

(Applause)

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Johan Hultberg (M)

Madam Speaker! It is late, and I respect that the concentration of one or another member may be wavering. I was misunderstood on quite a few points.

One of my main messages was that the crisis that the health and medical care system finds itself in must be solved precisely through a shared responsibility. My firm opinion is that the government is taking a very large responsibility in the crisis we are currently in. Despite the fact that the room for reform is scarce, large resources are being allocated to support the regions and municipalities in this difficult situation. The government succeeds with perhaps the most important task, namely to combat the inflation that is the root cause of why the regions are having it so incredibly tough right now. That is perhaps the most important thing in the long term to create better economic conditions for the regions.

Madam Speaker! What is also incredibly important to give the regions better conditions to provide good health and medical care is to secure the long-term financing of health and medical care. This is done by re-establishing the work line and ensuring that we get more hours worked and that more people enter the workforce. Therefore, it is important that we in the government's budget also make it more profitable to work.

If Sweden had had the same development as the EU average regarding unemployment during the S eight years, we would now have 40 billion more for welfare - 40 billion, Madam Speaker! This should be compared with the 6 billion that the Social Democrats say they want to add to the regions in general and targeted state grants - 40 billion through a strengthened work line or 6 billion.

The 6 billion that the Social Democrats want to add is also built on a castle in the air, a financing model with the introduction of a bank tax just like that. It is not credible, Madam Speaker. I think it is important that it stands clear for the voters.

A strong work line is the foundation for a strong welfare, and that is what this government ensures to deliver.

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, members, for your contributions!

The one who removed the wealth tax that the very richest paid was the previous government. The former Minister for Social Affairs sat in the government at that time. My party voted against it.

Today, all parties have slightly different orientations. I noted in Agenda that we took different positions regarding how we should handle surplus goals or enabling borrowing for investments to get the country moving. We have slightly different starting points. In the government, we meet and agree on a policy.

That this government has done this has led to us prioritizing welfare in the budget that was laid in the autumn and which the Riksdag decided on shortly before Christmas. 40 percent of the reform space went to households to compensate for and manage the consequences of inflation. 40 percent went to welfare.

Now Niklas Sigvardsson has left the chamber, but I noted that he characterized tax cuts as a massive support. Since 40 percent went to households with a good deal of tax cuts, then 40 percent to welfare must also be a massive support. No other logic exists. It is a massive support from the restrained budget that was adopted.

But there is certainly a great need in the operations. Therefore, the government follows the developments. However, we will not be able to make decisions if regions and municipalities are not allowed to lay off staff. According to the law, that responsibility lies with the regions and municipalities, and it would be a major interference in the autonomy if we were to make such decisions.

However, just as the members have pointed out, the government also has a mandate to support the regions. Therefore, a decision was also made regarding special sector support with the label to manage the economy right now. We did not demand any performance for that, but it was to manage the pension costs we are currently in the middle of - money straight out to the regions to manage the situation.

Is the government doing enough? Marcus Wennerström asks in practice. We are not, in the sense that we compensate for everything that is a deficit. 24 billion is projected as a deficit. I wonder if you Social Democrats yourselves think that the 6 billion you give more than the government covers that deficit by far. I note that several members themselves state that they do not.

If one argues that the 6 billion that you are giving is the difference between not laying off at all and laying off, which has been suggested in some places today, that is not correct. 6 billion is not enough at all given the large deficit that exists, which points out that there is very much to be done by both the government as well as regions and municipalities so that we can manage the welfare in the long term.

We must manage the temporary strain that inflation entails. The regions' assessment is that it is temporary, and I fully support that because we are working to ensure that it is temporary. But there are also structural problems in the sector that need to be addressed.

Several members have been involved in this: It is about both a temporary burden on the budget that leads to unwanted savings and structural problems in the budgets. It shows that we have a job to do together: How do we achieve a balanced economy that can sustain welfare in the long term and that makes the staff feel optimistic about the future and know that "here is where I want to work"?

I was so happy that Peter Hedberg - now I have mentioned him twice, so he gets extra pluses, but it might be a minus for the party - also mentioned that investing in continuing education is core activity. That is completely correct. Continuing education is truly core activity. When one feels forced to reduce it, it has gone very far.

I believe that we need to carry out the reform work for the entire healthcare system jointly, in order to manage both the temporary inflation crisis and that which is structural and has existed for a very long time.

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Marcus Wennerström (S)

Madam Speaker! We are beginning to approach the end of a rather long debate. I note that it is easy to say the right thing but harder to deliver. For even though the Minister for Civil Defence stands in Sälen and says that it is serious, and even though the Prime Minister says to have the readiness to not betray the welfare, it has become clear today that the government is not planning for any real measures. That makes me worried.

Instead, there are promises of tax cuts. Instead, there are calls for efficiencies. And instead, there are tips that the regions can borrow money, all to manage the fact that the state is not delivering its part. Then it is not possible to try to claim that one is arming. It does not add up. It is to betray a responsibility. It is true that the regions should do their part. But the state must also do its part.

Even though the main task of healthcare is not to defend the country in crisis or war, it simply will not be possible without healthcare. In that case, the shifting of responsibility onto regions and municipalities appears as a PR trick so that the Finance Minister can talk about tax cuts.

Where the government does not take responsibility, the regions are forced to compensate. The consequences of the pursued policy will, as stated, be poorer patient safety. It will lead to warnings. And it will result in a poorer welfare.

I want to conclude the debate by pointing out that we have now ensured that the Minister has received a picture of what is happening in Sweden here and now. What the government chooses to do with that picture is up to the government.

I want to thank you for the debate. Please, hear the healthcare's cry for help!

(Applause)

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you again, Member, for your question and for the debate that the Member and all other Members here have been part of!

The government is truly following the developments. It is not something we are saying. It is not a PR trick. It is truly so. We have close contacts with patients and with representatives of the profession and can see the importance of making long-term changes. One such thing, which improves things for the patients and for the economy, is to invest in primary care. If one does not do that, one will in the future face much higher costs and poorer care for patients.

Jämtland Härjedalen is an example where they have actually dared to stick out their chin and do it in a good way. I hope they have the strength to keep it up! We are also part of the leadership there.

It is necessary to do the right things when facing great challenges. But there is no doubt that the state's support must be there. That is why we introduced a special support in the autumn.

I have noted the claim that the targeted state grants have been halved. Yes, if you count all special temporary state grants during the pandemic, that is absolutely correct. But not to continue with special targeted state grants linked to the pandemic when the pandemic no longer exists is obvious. Furthermore, it has stood at zero in the years since, both when the Social Democrats were in power and when we took over. Those funds did not continue to come in. One part, the recovery bonus, we kept for a while because we judged that it was necessary.

People are pretending that state subsidies in general have been halved. That is not true. It was specific targeted state subsidies, which we all stood behind collectively, but which were not used by the regions to a particularly large extent because they were precisely temporary. But they have enjoyed them – which I am happy about – in order to smooth out the economy.

The year 2024 is a tough year. Therefore, the government will do its utmost to support the regions and municipalities in the work. We will return when the time is right. But I do not believe that the 6 billion that the Social Democrats have will go far when it comes to the regions' crisis. We need to think better than that together.

Thank you for the debate and for your commitment!

(Applause)

The interpellations debate was hereby concluded.

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