The healthcare system's preparedness

Christian Carlsson (KD)

Mr. Speaker! For nearly four years, Russia's full-scale war of aggression against Ukraine has been ongoing. With determination and great courage, the Ukrainians have bravely defended their country, despite ruthless Russian attacks against the civilian population. Since the outbreak of the war, over 2,000 attacks have been directed at Ukrainian healthcare facilities alone.

We in Sweden find ourselves in the most serious security policy situation since the Second World War and therefore need to upgrade both the civil and the military defense. We need to strengthen the healthcare's preparedness due to the threats we face. Today's report is a part of this work.

The proposals from the government that we are debating today mean that it is clarified what limited obligations municipalities, regions, and healthcare providers have to offer care in peacetime crisis situations, during heightened readiness, and during states of catastrophe. The purpose is that care in a very serious situation should be able to reprioritize and make certain deviations from the obligations that are otherwise regulated in the Health and Medical Services Act. During a state of catastrophe, municipalities and regions shall only be obliged to offer care that is necessary for life and health. It is also proposed that municipalities and regions shall be obliged to promptly provide assistance to other municipalities and regions where a state of catastrophe prevails in healthcare.

It is also clarified what obligations municipalities and regions have to plan for certain conditions, for example, to maintain preparedness for states of disaster or events resulting in a large number of injured and sick people. Among other things, an obligation is introduced for municipalities and regions to keep medical products in stock so that they can offer the care they are obliged to offer in a serious situation. The Government may issue regulations on the extent of the stockkeeping. Currently, it is assessed that a one-month turnover stock of such medical products that municipalities and regions use in everyday life is a reasonable level for normal conditions.

Something I particularly want to emphasize is that with what is proposed, we would also strengthen the state's governance of health and medical care. The government, or the authority that the government appoints, would namely, according to the proposal in the bill, be allowed to issue regulations on planning instructions for health and medical care before and during high alert. It can, for example, state that a certain municipality or region is expected to receive the primarily injured and have responsibility for aftercare or for certain staff reinforcements in, for example, a war situation. The instructions can also state that the municipality or region shall take certain specific measures regarding the dimensioning of the number of care beds.

This is a very good proposal, because the state's governance regarding the preparedness of health and medical care really needs to be strengthened.

We need more healthcare beds in Sweden to strengthen the healthcare system's preparedness. When Magdalena Andersson and the Socialdemokrater lost the election in 2022, they left behind a Swedish healthcare system with the fewest number of beds per capita in Europe, according to the OECD, and the fewest number of intensive care beds for adults. The National Board of Health and Welfare noted last year that thousands of beds were missing – specifically 2,300 beds.

Three years into the parliamentary term, we can state that the shortage of healthcare beds is less, according to the Swedish Health and Social Care Inspectorate's assessment. We must, however, note that Sweden still needs more healthcare beds, not fewer. The government has therefore allocated large sums to increase healthcare capacity and the number of healthcare beds across the country.

Despite this, and despite the fact that the regions are also responsible for Swedish healthcare and have the opportunity to levy taxes to ensure access to care, there are certain regions that do exactly the opposite. They shut down emergency care and reduce the number of care beds. Region Kronoberg is such an example. There, a red-blue alliance in the form of Social Democrats and Moderates are closing intensive care beds at Ljungby Hospital. Region Västernorrland's closures at Sollefteå Hospital is another example.

Mr. Speaker! I had the privilege of visiting Sollefteå as recently as last Monday and met several of the residents of Sollefteå and the healthcare staff who day in and day out fight to keep their hospital. I also visited the Swedish Armed Forces and Västernorrlands regemente. Sollefteå Hospital was once built as a preparedness hospital, and Sollefteå plays a strategic role in the investments in Västernorrlands regemente I 21 in connection with the NATO membership. The Host Nation Support Agreement implies that there is an expectation that Sweden will be able to receive troops and materiel from the west for further transport north to a planned eastern front in northern Norrland or in Finland. In this regard, Sollefteå is particularly important.

At the same time as the state invests large sums to renovate and strengthen the military readiness in Sollefteå, the regional management in Västernorrland has decided to close care beds and reduce emergency care, which causes the healthcare's readiness to deteriorate. This is, of course, irresponsible.

The fact that the state today cannot ensure that the civil rearmament keeps pace with the military rearmament is, however, significantly more than that. It is a systemic error. This is an example of how dysfunctional and inefficient today's system with 21 self-governing regions functions.

A vote for the Christian Democrats is a vote to abolish the regions and let the state take over full responsibility for Swedish health and medical care. The Christian Democrats have proposed that until then, there should be a national basic supply of strategically important care – a kind of guaranteed level of care that the regions shall provide, for the patients' sake but also so that we can manage Sweden's preparedness. The civil buildup shall be able to proceed in step with the military buildup. Before such a basic supply is in place, we want to see a stop to the closure of healthcare facilities.

The bill that is now on the table means that the state will have an increased opportunity to be involved in the work of planning and dimensioning Swedish healthcare. This is a big step in the right direction to secure a preparedness for Swedish health and medical care which means that we can defend Sweden together.

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

Karin Rågsjö (V)

Mr. Speaker! The member brings up Sollefteå, and I fully agree with that. But then it probably stops. I think it is strange that you who are responsible for healthcare, that is, the Kristdemokraterna, constantly place the entire responsibility on the municipalities and do not see their own responsibility. I think that if one has responsibility for an issue, then one takes it and does not constantly blame the regions, because that becomes very strange.

I sat myself in the Care Responsibility Committee, and it was not so long ago that we struck the gavel on the table and agreed that we shall not have a state-run healthcare system. This was six parties completely in agreement on, and yet the Christian Democrats are pushing the issue forward as if you had a large majority behind you. Enough on this, Mr. Speaker.

If we are to be able to pull together in war and crises, we must have a healthcare system that also works in peacetime, right? Then it is perhaps not entirely the regions' fault that Sweden has fewer intensive care beds now than before the pandemic – they need to increase by 11 percent. But Stockholm has actually broken this trend and increased the number of intensive care beds. The available care beds have also not increased nationally, which one might have thought they would have done with the Kristdemokraterna at the helm of healthcare.

At the same time, the collective Tidögänget and the SD-dependent government have chosen to lower all taxes by 120 billion during their years. Then I wonder anxiously what will happen to the welfare. Will it get better? Does the health and medical care have the capacity to meet pandemics, crises, and wars? There are no reservations in this matter, but there are circumstances that make me extremely worried.

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

Christian Carlsson (KD)

Mr. Speaker! I am pleased that the Christian Democrats and the Left Party agree to oppose the closures at Sollefteå Hospital that are now being pushed through by a regional leadership consisting of Moderates and Social Democrats. It is good that we can join forces on this issue. And if we are to be completely honest, we are actually in agreement on more things, as the Left Party supports every single proposal the Christian Democrats put forward in today's bill. Let us therefore not paint large differences unnecessarily.

Do the Christian Democrats want to place all the responsibility on the regions? No, that is not what we want to do. We are prepared to let the state take responsibility. But in the current situation, it is the regions that bear the primary responsibility for how Swedish healthcare is to be organized and dimensioned, and they have full taxing rights to fulfill this task. Despite this, the state is injecting 18 billion into health and medical care just this year. Of these, 7.5 billion go to increased care capacity and more hospital beds.

We Christian Democrats would gladly have allocated more money. We would gladly have allocated all the money because we want the state to take full financing responsibility for Swedish health and medical care so that people can be offered fair and equal care regardless of where they live. But as Karin Rågsjö mentioned, Vänsterpartiet opposes such a solution where the state takes responsibility for the financing so that people throughout the country receive equal care. I regret this. It is quite true that six of the parties in the Riksdag oppose state responsibility for healthcare. But we Christian Democrats continue this work anyway, and we have a majority in the government support that now governs Sweden with us.

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

Karin Rågsjö (V)

Mr. Speaker! Sometimes one must realize that one has lost, and that is what the Christian Democrats should do now. Then one cannot, until the election, continue to talk about a whole-state care. That match you have already played, and you were knocked out.

So to another question. According to Article 3 of the NATO Regulation, we are obliged to manage our own healthcare in war. Large shipments from, for example, the USA or Finland will therefore not arrive. Foreign healthcare capabilities provided to Sweden in the event of a major war can therefore not be included in the planning assumptions; instead, we must have a national capability. War healthcare is by definition all healthcare conducted during wartime, and war can mean tens of thousands, perhaps hundreds of thousands, of casualties in addition to ordinary care that cannot be postponed. In that case, it becomes particularly problematic to, as is the current situation, have a healthcare system that does not function as it should. I therefore mean that the state has a responsibility to ensure that there are financial conditions for equal healthcare in all regions.

That Sweden has gone through a major crisis with sky-high inflation could not even have escaped the Christian Democrats. One could therefore index the state grants so that they follow the cost development, but that thought does not seem to have struck Member of Parliament Christian Carlsson.

My question is still: How are we going to be able to handle a coming pandemic, other crises, or in the worst case a war, with today's capacity? I am very worried.

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

Christian Carlsson (KD)

Mr. Speaker! I understand that the Left Party wants the Christian Democrats to believe that the battle over state-run healthcare is over, because the Left Party only has five other parliamentary parties with them on the issue of state governance. The fact is that seven out of ten Swedes support the Christian Democrats' proposal for state-run healthcare, as do eight out of ten doctors, so I understand that the Left Party wants us to drop the issue. But we do not. After the Healthcare Responsibility Committee's work, the Christian Democrats have indeed won over the Sweden Democrats, and at present, the Sweden Democrats and the Christian Democrats gather significantly greater support in the chamber than the Moderates and the Liberals do. Consequently, within the cooperation that governs Sweden right now, there is a majority for the state to take over the responsibility. The Christian Democrats are going to the election on this issue, and after the election, it will be a negotiation issue.

Let us focus on what we agree on: that the healthcare capacity needs to increase. If the Christian Democrats did not consider that the healthcare capacity and the staffed healthcare beds needed to be increased, we would not have agreed to submit budgets where the state, despite the regions' responsibility for healthcare, chips in as much as 7.5 billion solely to increase the healthcare capacity and the number of healthcare beds.

We are prepared to take full responsibility for the financing of Swedish healthcare, but then we also need to have the full possibility to plan, organize, and dimension the same.

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

Anders W Jonsson (C)

Mr. Speaker! It is pleasing to hear the Christian Democrats' newly awakened interest in healthcare in crisis and war. In the Defence Committee, this issue was handled, and it was not the Christian Democrats who drove it but the Liberals, through Anna Starbrink, who drove it very hard. What all parties in the Defence Committee agreed on is that Sweden has some very vulnerable areas, above all Gotland but also the inland of Norrland.

The Christian Democrats' solution is that the state should step in and manage the basic supply. I am familiar with Sollefteå, as I work there as a pediatrician. But Gotland is in an even more vulnerable position because it is an island in the middle of the Baltic Sea. One is forced to have a full-scale supply of emergency care. There is no alternative, because if there is a storm, neither helicopters, planes, nor boats can operate. Therefore, one must be able to handle all situations. They have had to cut back on elderly care, home care, and primary care in order to maintain the capacity at their emergency hospital. Time and again, they have tried with the government to bring up the need for a municipal tax equalization to get the island factor and be able to secure funding. Former Minister for Health Acko Ankarberg visited Gotland, received information about this, and said: You must write to the government about this, because we must act here.

What is it that has happened then? Well, the proposal regarding municipal tax equalization, which for Gotland's part would have meant an extra 100 million kronor, is still lying in a desk drawer. If Christian Carlsson and Kristdemokraterna had been serious about trying to support Gotland and the inland of Norrland, they would have presented proposals that involve securing the funding for healthcare in those vulnerable areas, but they do not do that. Instead, it is words and no money.

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

Christian Carlsson (KD)

Mr. Speaker! What Anders W Jonsson points out here is not correct. The Government is preparing the issue of the tax equalization system, and the Christian Democrats are ready to provide funds here and now to strengthen the regions. We want to take full responsibility regarding the financing of healthcare from the state's side. This is opposed by Anders W Jonsson, even though he himself has sat on the healthcare responsibility committee which has completely condemned today's healthcare model and the conditions to be financially sustainable.

Today's healthcare organization with 21 self-governing regions is not economically sustainable in the long term. One of the reasons why we should let the state take over full responsibility for healthcare is that healthcare should be able to be given the economic muscles that the state has to offer.

The Christian Democrats are absolutely willing to strengthen the regions' conditions and the healthcare's conditions to make their finances sustainable so that one can offer people equal care throughout the country and care in a timely manner.

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

Anders W Jonsson (C)

Mr. Speaker! It will not help people in Västernorrland, in the inland of Norrland, or on Gotland in the slightest that the Christian Democrats and some official in Stockholm sit and say: "You are obliged to have a basic provision regarding healthcare." This is already known.

The weakness in today's system is that the regions have the right to tax only one thing, namely people's income, but that is not sufficient in a situation where healthcare is to be financed. Therefore, the Healthcare Responsibility Committee has pointed out that there are a number of opportunities where the state can step in and take a greater financing responsibility.

It is therefore false when the Christian Democrats say that they are indeed prepared to take the full financing responsibility for health and medical care, approximately 500 billion kronor, but that they are not prepared to ensure that one can, today, in an emergency situation, secure access to emergency medical care whether on Gotland or in the inland of Norrland.

The Christian Democrats believe that the problem can be solved by the wise men here in Stockholm simply telling the people of Gotland that they are obligated to maintain a basic level of healthcare. Every decision-maker on Gotland knows that is the case, and they have solved it in a very tragic way, namely by cutting back on elderly care and primary care. They have done this in order to be able to maintain a full-scale emergency hospital.

The Christian Democratic healthcare minister was informed in detail about this at the beginning of the mandate period, but nothing has happened despite the people of Gotland doing exactly what she suggested, namely writing to the government that this was something that had to be dealt with.

One is actually doing exactly the opposite. There is a ready-made proposal for a new system for municipal tax equalization that would compensate the people of Gotland with on the order of 100 million kronor and make it easier for them to maintain a basic supply regarding home care and primary care, but that proposal is, therefore, sitting in a bureaucratic drawer. Instead, one is to point a finger at the people of Gotland and say: "This is what you have to solve! We in Stockholm shall decide that you must fix it."

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Christian Carlsson (KD)

Mr. Speaker! I agree that the regions' funding is not sustainable in the long term. That is why we say that today's healthcare organization with 21 self-governing regions, which are to manage the future funding of healthcare by taxing their own regional residents, will not hold. We need to let the state take over the responsibility for Swedish healthcare so that we can ensure that the state bears the full funding responsibility. That is our policy.

Anders W Jonsson supports the proposals that we are now presenting. This means that the state should be able to indicate the dimensioning of healthcare places throughout the regions, specifically for each respective region. If Anders W Jonsson and Centerpartiet have such great objections to the state being able to point out society-critical, strategically important healthcare that needs to exist in the regions and that the regions need to prioritize, I do not quite understand why one gives its full support to the bill, which is about strengthening Sweden's crisis preparedness when it comes to health and medical care. Anders W Jonsson is currently arguing against the proposal that is on the table and which Centerpartiet has chosen to support.

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Mona Olin (SD)

Mr. Speaker! I want to begin by expressing my support for the Sweden Democrats' reservation.

Today we are debating the healthcare system's crisis preparedness and the dynamics that exist in this context primarily between the state and the regions.

Let me begin by stating that Sweden's geopolitical position has changed drastically due to circumstances in our global environment that we could not have predicted or influenced from here. As we can note, with some varying degree of enthusiasm from left to right, this has paved the way for a Swedish NATO membership, which we now observe is a fact.

War in Sweden's immediate vicinity could never actually be ruled out, but we see from the increased defense appropriations, which all parties stand behind, that we see Sweden's security differently today compared to a few years ago.

With the exception of Gotland, Sweden is likely not in the front line in a military confrontation between Nato and Russia, but we are not far from it. Finland and the Baltic states are our allies, and they are geographically exposed. This is something our military and experts are very well aware of.

Mr. Speaker! From our Ukrainian contacts, we have learned the following: What we do not plan for in peacetime, we do not have on the day war breaks out. There is much that we wish today we had thought about ten years ago, but back then, military and civil crisis preparedness was something of a budget regulator. Today we know better.

War in our geographical vicinity could mean that we, on short notice, need to take care of both civilians and military personnel who urgently need intensive care, while our own country finds itself in a so-called twilight state. At the same time, we know that the regions face great economic challenges and that many hospitals have large budget deficits ahead of them that are growing like snowballs. They wouldn't hesitate if national politics reached out and asked them to build operating rooms underground.

A robust total defense presupposes that both civil and military preparedness are developed and coordinated. This entire situation calls for national preparedness hospitals, given that individual regions cannot on their own plan for matters concerning the kingdom as a whole.

There are synergies here. One can argue that national preparedness hospitals should be located outside major cities and thereby contribute to investments and development in smaller localities. Not least, one can look for sites with a military presence and planning for increased military presence.

Mr. Speaker! Some become upset when specific locations are highlighted, and therefore I do not do so. But if I say that I am thinking of a location that starts with S and ends with ollefteå, we have at least one example of a location with great potential synergy between the military's and the healthcare's needs. This is an example of how the total defense could be coordinated with the planning of health and healthcare. This is in the interest of healthcare and the military, and also in the interest of society. Of course, we do not exclude other locations here today.

Mr. Speaker! It is not a journey to Mars or even a moon landing we are discussing now, but it is about a commitment to healthcare that to some extent takes into account unexpected events. That commitment is needed here and now, when we have the opportunity to plan, not later. Then it may be too late.

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

Anders W Jonsson (C)

Mr. Speaker! The Sweden Democrats have, as the only party of the Riksdag's eight parties, chosen to reserve themselves against the committee's proposal in this matter – a matter where we are actually codifying something that already works in Sweden. Much of the bill describes how one worked already during the pandemic, with a few exceptions.

What the Sweden Democrats are highlighting are emergency hospitals. This is an issue that has been discussed very much in the Defense Preparation Board, even if the Sweden Democrats perhaps were not the most driving force there regarding the emergency hospitals.

The Defense Preparation Committee was in agreement that we must develop a planning for preparedness hospitals, especially for Gotland and the inland of Norrland. That is not just about Sollefteå, it is about Lycksele and Gällivare. It is also about Östersund and Torsby.

What I do not understand is what it is in the Defense Committee's unanimous report and unanimous proposal that the Sweden Democrats are now opposing. This is nothing other than us repeating what is contained there.

My second question is this. If you had thought that this was very important, you would have ensured that money was allocated for what the member describes, such as digging bunkers under the hospitals. You are not doing that. Despite having sat and negotiated the budget, you have not even ensured that the new proposal for municipal tax equalization is brought forward, where precisely those regions affected here would be winners. If you are serious about thinking that precisely preparedness hospitals are very important, what was wrong with what was agreed upon in the Defense Committee since you now choose to reserve yourselves? And why have you then not ensured that this issue is brought into the budget negotiations? Just as the member said: What is needed is money to in that case be able to renovate and ensure that these hospitals have redundancy in relation to a war situation.

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

Mona Olin (SD)

Mr. Speaker! I thank Anders W Jonsson for the questions.

I want to start by saying that we are not discussing the Committee on Foreign Affairs' report here, but we are discussing the healthcare system's crisis preparedness, so I do not intend to address that question.

I want to say that we have no problems with the bill being submitted in the Social Affairs Committee, but we want to highlight the importance of having emergency hospitals. It is very important that investments are made in hospitals and the military in parallel to build up preparedness for crisis situations.

The proposition regulates obligations between municipalities and regions during peacetime crisis situations and high alert in states of catastrophe, as well as obligations to plan for difficult conditions with a large number of sick people. We would, however, like to emphasize that in order to be able to fulfill these obligations, one must consider whether to choose to set up emergency hospitals in order to be able to meet crisis times.

It is also very important that one builds up the entire healthcare system so that it functions in a satisfactory way in peacetime, because as I said: What one does not do when it is peacetime, one cannot do when times of great problems arise.

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

Anders W Jonsson (C)

Mr. Speaker! I do not quite understand how the Committee on Foreign Affairs ended up here.

The issue of preparedness hospitals has been discussed in detail in the Defence Preparation Board because it is directly linked to Sweden's civil defense and our capabilities to defend ourselves in times of war. If the Sweden Democrats were in agreement with other parties that this is important, that this should be moved forward, why does this question suddenly appear in the form of a reservation in a report that actually deals with something completely different?

The members of the board are aware that this is fundamentally an economic issue. The hospitals that will be able to be decisive as preparedness hospitals are also located in regions where things are extremely tough economically. It concerns Gotland in that it is an island in the middle of the Baltic Sea, but it also concerns the inland of Norrland.

If one is to strengthen the economy for healthcare, there is a very quick way to do it, and that is to launch the proposal for a new municipal tax equalization system that exists. In that case, Gotland, Norrbotten, Västerbotten, Jämtland and Västernorrland would be winners. They would receive more money for healthcare, not only because it is rural area but also from the perspective that, purely from a defense policy standpoint, they may come to be in a very vulnerable position.

So, the Sweden Democrats choose, in a very strange way, to reserve themselves against something that the parties are already in agreement on. At the same time, one chooses not to present the proposal for new municipal tax equalization. If one is serious about what the member is talking about here, one should have ensured that there were funds available in the regions to strengthen health and medical care in the more sparsely populated areas and on Gotland here and now, but one chooses not to do that. That is the equation I cannot make work, Mr. Speaker.

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Mona Olin (SD)

Mr. Speaker! I mean, of course, the Defence Preparation, and nothing else.

The regions have a very difficult time making the finances balance. That is why we are also interested in partially taking over the state's responsibility for healthcare, just as Christian Carlsson mentioned earlier. It would provide better conditions for healthcare to function equally across the entire country.

I also want to point out that the regions sometimes might think backwards when they want to save money. One example is Sollefteå, where the military is now investing a huge amount of money in building up the military readiness and also military service, while the region with the Socialdemokraterna and Moderaterna together with Centern chooses to shut down parts of the hospital to save 45 million. Quite soon after the decision, it was realized that the saving might instead be 22 million. I think those are strange priorities from the region's side.

I can only maintain that if there had been decisions regarding emergency hospitals, Sollefteå Hospital would not have been affected as it is now. Other hospitals as well, for example on Gotland and in Lycksele with several locations that the member mentioned, would have had much better conditions to remain and be prepared for difficult situations.

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Nils Seye Larsen (MP)

Mr. Speaker! I would like to begin by saying that I am pleased that the Sweden Democrats have also been engaged in the issue regarding Sollefteå and the closure of the acute hospital.

I will return in my speech with more on the proposition itself regarding the healthcare's preparedness. But I have a number of questions that I would like to take the opportunity to ask.

There are several challenges for the Swedish health and medical care system to be able to stand ready during times of crisis and, ultimately, war. Socialstyrelsen produced a major report where they looked at the preparedness capacity and concluded that one of the absolute biggest bottlenecks is the supply of competence – that there is a shortage of staff. As someone who lives in northern Sweden, I am well aware of the very difficult situation that the northernmost counties find themselves in. It is also a partial explanation for the decisions that were felt necessary to make in Västernorrland – even though we in Miljöpartiet have also been engaged in safeguarding Sollefteå hospital.

It is the case that Västernorrland today stands with the largest proportion of agency staff and has major challenges regarding both personnel and financing. I therefore have two questions for Mona Olin. One concerns, of course, the financing and why one has not been more active in providing greater economic resources to the regions. The other question concerns how one views that healthcare personnel all over Sweden are being deported while we sit in this situation. It concerns personnel in both municipal operations and hospital operations – which are needed in times of crisis and, ultimately, war.

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Mona Olin (SD)

Mr. Speaker! I thank Nils Seye Larsen for the question!

As you know, we have fought a lot for Sollefteå hospital. You notice that, and we appreciate it. There are great challenges when it comes to how healthcare should be equipped for war and crisis.

You mention that Västernorrland has one of the highest figures regarding hired personnel. However, it is the case that the hospital in Sollefteå has almost no hired personnel at all. On the contrary, it is a very loyal staff who have worked there for many years. They want to continue working there and be employed by the hospital. Sollefteå hospital does not, therefore, suffer from this problem, and that is perhaps one of the reasons why it is unfortunate that one chooses to cut back just there.

We would like the hospitals to remain and for them to be renovated and take in more patients than today to be prepared when that day comes.

Just as Nils Seye Larsen points out, we need to have competence within healthcare. It is something that needs to be worked on, and it will certainly go very well in connection with us setting activity requirements for social assistance, as more people will then enter education and hopefully actively choose healthcare.

That people without residence permits or work permits in Sweden should not work in Sweden should be easy to understand.

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FÖRSTE VICE TALMANNEN

I remind the member that we do not use the word "you" as a form of address in the chamber.

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Nils Seye Larsen (MP)

Mr. Speaker! Such mistakes can even I make.

What the member says is true, and I want to return to Sollefteå because I have been very moved by this. They have fantastic healthcare staff there. It is also a preparedness hospital – it was built as such once upon a time.

The problem persists, particularly in northern Sweden, on a broader basis. We are talking about regions where the median incomes are many times 10,000 kronor below the national average.

Healthcare personnel are being deported already. If we take elderly care in Boden as an example, entire healthcare departments in Harads are being deported. We have problems all around, and we lack people who can work within healthcare and who are trained to work within healthcare. These are people who have had permits. Everyone is needed, especially in times of crisis.

We are lacking employees. Just as was said in the Social Affairs Committee when the National Board of Health and Welfare was there: Northern Sweden should actually have an overcapacity. Partly because of our security situation, where northern Sweden constitutes an important cornerstone in our common defense, partly because we have very large regions, where we must be able to ensure care in our entire region. Västerbotten is, for example, one and a half times the size of Belgium, and 280,000 inhabitants live there.

Funding is required for this. I lack that funding in your budget. I also lack measures to ensure the supply of competence. In that respect, it is extremely remarkable that healthcare personnel, whom we are entirely dependent on, are being deported.

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Mona Olin (SD)

Mr. Speaker! I thank Nils Seye Larsen for the question! It is true that Sollefteå Hospital was originally a preparedness hospital, and it should reasonably continue to be that.

When we turn to elderly care in Norrland, we hear that this is a major problem, but at the same time, we have many people in Sweden who are without work and who have the opportunity to educate themselves, move, change residence, and take jobs in a location other than where they live today.

I also think that one should see opportunities to attract younger people to become interested in healthcare professions through more visits to healthcare and work experience (prao) in healthcare already when they are in upper secondary school. The vast majority of those who work in healthcare stumbled into it on a banana peel. They were only going to work over the summer and then discovered that they liked it. We need to open up the opportunity for more to discover that it might be pleasant to work there. We should help more people stumble into that industry. It is a way to meet the competence problems within health and care.

A lot of money is needed for the regions to manage and cope with undertaking these obligations. The question of whether one can invest in emergency hospitals is also something that should be raised in cooperation with the upgrading of the military. Military upgrading is not just about operations. It is also about preparedness within healthcare.

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Fredrik Lundh Sammeli (S)

Mr. Speaker! Sweden is in a serious security policy situation. We see a new Europe emerging, where the line between peace, crisis, and war is becoming increasingly blurred. In that situation, the basic functions of society – not least healthcare – must be strong, coordinated, and resilient.

We Social Democrats share the government's view that the healthcare system's preparedness must be strengthened, and we move for approval of the bill. The proposals for clearer responsibilities, better reporting, and the possibility to set specific requirements in a crisis are important steps. But, Mr. Speaker, the government is not taking the comprehensive approach that the situation requires.

It is more important than ever that society's basic functions are robust and strong, but despite that, the government and the Sweden Democrats have starved welfare. They refuse to tackle the challenges Sweden faces, and their policy makes healthcare weaker, the staff more stressed, and the waiting times longer. This hits hard in peacetime, but it is also a direct threat to our civil preparedness. If society does not function in peace, it will not function in crisis and war either.

As an officer, I know that preparedness is about endurance, clear responsibility, and coordination. Civil preparedness is not an annex to the defense. It is a part of the total defense, and it must function when the pressure is at its greatest.

However, for healthcare to function in a crisis, clear leadership is required. Here, the government still leaves important questions unanswered: What will the national leadership look like when several regions are affected simultaneously? Who makes decisions when civilian and military actors need to be coordinated quickly? It is precisely that leadership that Sweden lacks today.

Preparedness is not just about documents and plans. It is also about people, about the nurse who stays on their shift when a colleague is ill and about the nursing assistant who takes an extra shift when the crisis comes. Without the staff's knowledge, commitment, and perseverance, we have no preparedness at all. Therefore, the government must also secure their conditions, working environment, and opportunities to remain in the profession. Without staff, we have no preparedness.

Strong preparedness requires long-term perspective, investments, and accountability – not cuts. But the government's underfunding means that regions and municipalities cannot manage to invest in their preparedness. They cannot afford to build warehouses, train staff, or secure their resilience.

Central parts of a strong preparedness involve developing preparedness hospitals, being able to operate in alternative premises, securing the pharmaceutical supply, and building a long-term personnel supply as part of the total defense.

At the same time, emergency planning must not be limited to only acute care. Care that is necessary for life and health also includes assistive devices, rehabilitation, and habilitation. It is an important part of the entire care flow. Without a holistic perspective in the planning, the interventions risk cracking when the pressure increases, and the ability to manage the consequences after the acute phase is undermined. Preparedness must involve the entire care chain.

The government must take a clearer national responsibility here. One must guide, prioritize and support the regions, not leave them alone in this situation.

We in politics must learn from the pandemic. It became clear then; when the crisis came, there was no system for, for example, how private operators should contribute. It is unsustainable. In a crisis situation, everyone must contribute. Private operators who have contracts with municipalities and regions shall be obliged to, on the same terms as the public sector, make their resources, their staff, and their premises available.

Mr. Speaker! Preparedness is fundamentally about responsibility, about leadership, and about building a society that holds together and stands firm even when the wind blows. For us Social Democrats, preparedness is about security in everyday life and in crisis. It is about a society that holds when it is tested and where the state takes responsibility, where welfare receives resources, and where people can trust that healthcare is there when the situation demands it.

Sweden must stand strong when it really matters. For that, it requires accountability and leadership. Unfortunately, that is not what the Kristersson government is delivering. Sweden needs a new direction. We look forward to hard work during the coming months to make it possible.

(Applause)

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

Noria Manouchi (M)

Mr. Speaker! Sweden must stand strong in peace, in crisis, and in war. The recent years have shown us how quickly the situation can change. The pandemic hit healthcare hard, and Russia's war of aggression against Ukraine changed the security situation. The vulnerabilities in our society became clear.

When everyday life is tested, the preparedness must hold. This applies actually to our entire society. But few areas are as crucial as health and medical care. Therefore, this bill, on the preparedness of health and medical care, is both necessary and long-awaited.

The proposition is fundamentally about responsibility. Municipalities and regions must know what applies, and the state must be able to follow up. In the proposition, the responsibility for planning and preparations during peacetime crises, during high alert, and during war is clarified.

Regions and municipalities shall have the preparedness to quickly scale up when the situation requires it. There shall be plans to be able to care for many injured or sick people in a short time. There shall be stocks of healthcare products, medicines, protective equipment, and materiel so that care does not come to a standstill when supply chains are broken.

These are lessons, dearly bought lessons, that we have drawn from the pandemic. Back then, the healthcare system barely managed to cope, thanks to the employees' enormous efforts and sacrifices. But it became apparent how vulnerable our system is. We saw that a shortage of protective equipment and medicines could jeopardize both healthcare and security. And we saw that unclear responsibility caused measures to be delayed.

Our hope is that that time will be over now. With this bill, we establish that responsibility, planning and preparations are not optional issues and should not be crisis issues. These are obligations that we need to fulfill now.

Mr. Speaker! A functioning healthcare system in everyday life is a prerequisite for a functioning healthcare system in crisis or war. It is the same healthcare staff, the same organization, and the same leadership that must be there when the unexpected happens. Therefore, the government is building up preparedness, not only with new legislation but also with a long-term reform agenda for Swedish healthcare. We know that the healthcare that functions in peacetime, with order, structure, and quality, also withstands difficult tests. Therefore, this bill is only part of something larger.

The Government and the Moderates are implementing several important reforms and initiatives to strengthen healthcare both in everyday life and during a crisis. A new and strengthened healthcare guarantee shall ensure that no one is forgotten in long healthcare queues. You shall receive care where care is available. A strengthened primary care with more permanent doctor contacts will also be central during a crisis. The relief of the emergency hospitals that a strong primary care can provide, we will be grateful for when the crisis or the war comes.

We are introducing a national follow-up of the healthcare's results to see where the healthcare works and where it may need to be strengthened. We are also investing heavily in civil preparedness and total defense. The Government has doubled the investments in civil defense, with healthcare as a key component.

All of this is, of course, connected. When healthcare works in everyday life, we also manage the crisis. When the responsibility is clear, the management works. And when the preparedness is real, Sweden stands stronger.

Mr. Speaker! We know that safety does not come of itself. It must be planned, it must be built, and it must be followed up. This bill is an important step in that work. It gives Sweden a more robust health and medical care where the responsibility becomes clearer, the planning becomes sharper, and the preparedness becomes real. It gives the healthcare staff better conditions to act when it is needed. And it gives the Swedish people the security that one has the right to expect, also in crisis and war.

Mr. Speaker! With this, I move for the approval of the proposal in the committee report and in the government bill.

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Karin Rågsjö (V)

Mr. Speaker! The SD-dependent government sometimes seems to have forgotten the pandemic and what did not work then, in a major crisis. For a long time, Sweden's preparedness for pandemics, crises, and wars has been weakened. Commercialization of health and medical care has made the availability of medicines and medical supplies vulnerable. Just in time has long been the motto.

The single most important measure for society's preparedness is robust and equal welfare and health and medical care in peacetime. The focus in the preparedness work should therefore lie on strengthening health and medical care and welfare in general. Health and medical care that is well-resourced under normal conditions naturally has better conditions to handle peacetime crisis situations, crises, and war.

However, it cannot be said that intensive care is well-resourced, as it has fewer beds now than before the pandemic. The National Board of Health and Welfare assesses that intensive care needs to be strengthened by approximately 11 percent, calculated on today's capacity. Some regions, for example Stockholm, have broken the trend by increasing the number of beds. In March 2025, however, it was reported that even the number of available care beds has not increased as desired since 2022, but has rather decreased slightly.

Now, let's have a bit of history here: In the late autumn of 2019, I proposed a committee initiative regarding precisely preparedness. On October 1, 2019, five regions changed suppliers of hospital equipment, for example disposable items, needles, dialysis material, heart valves, tubes for ventilators and so on, and already on Thursday, October 3, Akademiska sjukhuset went into crisis mode. The reason was a shortage of healthcare equipment. Nothing arrived from the supplier.

Hospitals in all five affected regions were affected by delayed deliveries, and 489 operations were cancelled in these regions. A number of hospitals went into emergency mode.

Vänsterpartiet then proposed a national preparedness plan for important medical products so that the products would be available both nationally and regionally. We also proposed that the conditions for a state-owned company focused on medical products should be reviewed. The interest in the committee initiative was minimal, so to speak – but three months later the pandemic was here, and then the conditions changed completely.

When the crisis finally hits, it is too late to start planning high-quality procurements. We have from the Left Party's side previously motioned that a national responsibility for stocks of protective equipment was needed, which is very good, and for a domestic production of protective equipment and consumables for health and care.

If one ignores the working environment of healthcare staff in the current state of healthcare, one also risks worsening the preparedness. Everyone can understand that. It can lead to very difficult situations, and Vänsterpartiet therefore works in all situations to ensure that the working environment for healthcare staff is strengthened. I never want to see a senior physician at Södersjukhuset in Stockholm wearing goggles instead of a visor, as during the beginning of the pandemic. I felt a very deep shame over Sweden's lack of protective equipment. It was shameful. Now we have come a bit further, which is good, Mr. Speaker.

The government has lowered taxes by a total of 120 billion kronor during the mandate period. This means, of course, that the room to invest in welfare becomes somewhat smaller. Will it be better because of that? Can we meet war and crises better within health and medical care? I am skeptical. It is the sick who have to take the hit, also in a war or a crisis.

The Armed Forces currently lack, and in its plans for the future lack, a functioning healthcare capability. The responsibility for wounded soldiers has been completely transferred to civilian healthcare without prior preparation or legislative change, and this despite the fact that civilian healthcare lacks the prerequisites and capability to provide military healthcare.

Reserve capacity, emergency stockpiles, and emergency and war hospitals are missing. Unlike the previous total defense, funding, planning, coordination, and war organization are missing in all essentials, write a number of reserve officers and majors, as well as chief physicians in anesthesia and intensive care, to the Defense Committee. This must be looked at.

According to Article 3 of the NATO Ordinance, we are obliged to manage our own healthcare in war; that foreign healthcare capabilities are provided to Sweden in the event of a major war cannot be included in the planning, but perhaps everyone here in the chamber knows that. A separate, national capability is required. Therefore, one must have good healthcare in peacetime, right?

The majors and reserve officers further write that the planning for war on Swedish soil from a healthcare perspective is non-existent. During the pandemic, neighboring countries and many NATO countries closed their borders, interrupted healthcare deliveries, and prioritized their own populations. This was done despite agreements and promises to help one another. It seems that this has been completely forgotten in Sweden. In Finland, they do not have this naive planning, but instead rely on, for example, large emergency stockpiles.

The existing healthcare system must be able to withstand a crisis. If it fails to do so due to a lack of resources, we will be in a very bad position. Strengthen healthcare in peacetime, and account for crises and war!

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

Anders W Jonsson (C)

Mr. Speaker! This is a good bill from the government. The Centre Party supports it, and I want to move for approval of the Social Affairs Committee's proposal.

I do not think, however, that those who work in healthcare and read the legislative proposals think this is some trivial matter, directly. Quite concretely, it is four different major proposals that are raised, and the first proposal is that the regions shall help each other in the event of a crisis. At the beginning of the pandemic, it was not quite like that everywhere, but quite quickly it was realized that not all regions were equally hard hit. They stepped up and helped each other, and the airborne transports ran in shuttle traffic around the country. This way of working is very common today in Swedish healthcare, but it is good that it is also codified in legislation.

The second proposal is that the regions shall be required to plan based on disaster scenarios. But of the regions I have visited, I do not believe there is any that says they do not have that type of planning. Furthermore, there are recurring exercises in everything from large gas accidents, large traffic accidents with mass casualty scenarios, pandemics, and more. So, this is also not something new for the Swedish healthcare system, even though it is good that it is codified in the legislation.

The third proposal is actually about what we saw during the pandemic, namely that the Health and Medical Services Act was partially sidelined. The prioritization principle of health and medical services does not apply when one receives a large number of very seriously ill patients; instead, a great deal is pushed aside and simply cannot be carried out because there are other things that are more important.

Furthermore, an inverse prioritization principle is used, which is not included in the bill. One is forced to allocate resources to those patients who have the best prospects for survival and may not always be able to allocate them to those patients who have the greatest needs. This is now clarified in the legislation so that no individual decision-maker, authorized personnel, or anyone else within healthcare shall be held accountable for making that type of decision in the event of a new corresponding situation.

The fourth proposal in this is the one that Karin Rågsjö raises, namely an obligation for the regions not to, as was done a long time ago, work according to the just-in-time principle. It turned out to work quite poorly in the event of a crisis. Instead, one must have stockpiling. But with your hand on your heart: I do not believe that today there is a single region that works based on the just-in-time principle regarding the type of equipment that may be needed in a crisis situation.

This is, therefore, a good proposal from the government, and I am pleased that a unanimous committee stands behind the bill even though the Sweden Democrats have a reservation about something completely different. I move for approval of the committee's proposal.

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Nils Seye Larsen (MP)

Mr. Speaker! We have had dramatic years behind us, and we find ourselves in a rapidly changing time. In recent years, much has happened that has pushed things to the limit. The Covid-19 pandemic, which hit us, was very difficult and tough for the healthcare system and society to manage. Russia's illegal and despicable invasion of Ukraine showed that the long period of peace in Europe was over. We have much to work with. Suddenly we understand how important it is to prepare a society in the event of crisis and war.

Other things that have happened around Europe have also taught us the importance of being ready when a crisis suddenly occurs. I am thinking of the extreme weather conditions that have hit Europe during the last five years. During the extreme floods in Germany and Belgium, over 200 people lost their lives. The same happened in Spain in 2024. The extreme heatwaves cause large forest fires, and thousands of people die because of the heat. All of this is factors that make us realize that we must build a much more resilient and robust society.

We in Miljöpartiet naturally welcome the bill in that regard as it clarifies the healthcare's preparedness. It is about how we can cooperate better between state, municipality, and region when it comes to competence, preparedness laws, and other matters. But we also have some concerns and other points that I would like to highlight. That is also why we have written a specific statement.

It primarily concerns the situation we have in northern Sweden. I have returned to this several times just so that people can keep up. Northern Sweden – the four northernmost counties – account for half of Sweden's area and 8 percent of Sweden's population. It is, therefore, an enormous healthcare responsibility that is needed in the northern regions where I live.

I visited Sollefteå at the hospital threatened with closure, which was once built as a contingency hospital. To provide a little perspective: I 21, Västernorrlands regemente, spans from the Jämtland mountains all the way out to the coast at Härnösand and plays a decisive role for the defense line should Sweden end up in a situation of war. In Sollefteå, they have gone from approximately 40 full-time employees and conscripts in 2020 to now approximately 450, and they have as a goal to reach up to 1,000 at some point around 2030. This is a municipality where 9,000 inhabitants live in the urban area. It is a quite considerable increase of the war personnel. It is also one of the bases that should be able to receive foreign soldiers through our NATO cooperation, which places high demands on the healthcare capacity.

But now one sits there with a preparedness hospital where acute care is to be shut down. We in Miljöpartiet have engaged against this and think it is deeply unfortunate. One of the arguments for the shutdown is that money needs to be saved. Furthermore, it is the case that Västernorrland is in a situation where there is a lack of healthcare personnel. Västernorrland is in a tough situation financially. The region is forced to save. In January, Sundsvalls sjukhus went into emergency status due to overcrowding and a shortage of care beds.

In October, Norrland University Hospital went into an increased state of alert due to overcrowding, capacity shortages, and staff shortages. Recently, it was decided in Västerbotten that they would raise the tax by 50 öre due to the extremely strained economic situation. In Norrbotten, they are heading towards a large deficit this year, one of the five largest in Region Sverige. When it comes to hired staff, the list is topped, not surprisingly, by Västernorrland followed by Norrbotten and Jämtland.

The reason I am raising this now is that the best way to equip the Swedish healthcare preparedness in the event of crisis, disasters, or war is to ensure that it is well-equipped and functioning well in times of peace. But that is not the case today. That is where we would need to work much more broadly and comprehensively. We need to secure the financing of the Swedish health and medical care, especially in northern Sweden, and solve the great challenge of the skills crisis, which is obviously even more serious in northern Sweden, where we lack labor.

When it comes to the supply of skills, I want to emphasize, taking Umeå as an example, that it is actually thanks to the refugee crisis 2015–2016 that we have been able to ensure that we have enough staff to manage the situation. It is staff that we have trained. I think it is utterly tragic that we are currently deporting healthcare personnel whom we actually need in a situation where we lack the competence to equip the healthcare system so that it functions well in times of peace but, above all, functions in times of crisis.

With this, I and Miljöpartiet naturally approve of the proposition.

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

Jakob Olofsgård (L)

Mr. Speaker! Swedish healthcare is one of our most fundamental securities. It carries us through life, through vulnerable moments, from the first breath to the last. It alleviates pain. It saves lives. It creates trust between people and society. It is precisely this trust, Mr. Speaker, the trust between the individual and the state and between the patient and the care, that is the core of a democratic society. That trust must function even when society is tested the most.

The core mission of healthcare is clear. It is to prevent, investigate, and treat illness and injury. But in times of crisis and, in the worst case, war, everything changes. Then, many people may need help at the same time. Then, healthcare must stand firm, even when much is wavering. Municipalities and regions are also affected by other serious events, such as power outages, cyberattacks, communication disruptions, or shortages of healthcare products. In such a time, healthcare must not only react but also be prepared to act.

Healthcare is a major part of our total defense, but until now, the Health and Care Act has not provided municipalities and regions with the tools to be able to adapt their responsibilities when a crisis strikes. There has been a lack of a clear framework for how care should act when resources are insufficient. This is what is changing now. The proposal we are debating today establishes something that for most may feel like a given: In times of crisis and war, municipalities and regions are obliged to provide the care that is necessary for health and life.

Mr. Speaker! It is equally important that we have an obligation to help one another. If a region does not manage its mission, other regions shall provide assistance. It is also a community in a democratic society. It is accountability in practice.

We often speak of states of disaster – situations where many people are injured or become ill or where the conditions for healthcare are seriously disrupted. In such situations, the government can now decide on qualified states of disaster when municipalities and regions can no longer manage to provide the help that is required. When that occurs, the duty of care is further limited so that resources can be used to save the most lives.

But laws alone are not enough. We must build a culture of preparedness. When the crisis comes and the emergency room is suddenly filled with the injured and the sick, the preparedness must already be in place – the routines, the resources, and the leadership. That which was once self-evident in our Sweden must become so again.

Mr. Speaker! We must build our stocks. Our shortage of healthcare products is not just a logistical issue but is a threat to people's lives and health. Therefore, a duty to stock healthcare products is now being introduced. The Government will specify what must be stocked and how much. One month's turnover under normal conditions is a wise, reasonable, and responsible benchmark.

I also want to mention another change, that healthcare personnel during high alert will be required to provide information to the Armed Forces. Usually, there is confidentiality regarding who is being treated at a hospital, and that is correct. Integrity is an important part of our freedom. But when soldiers with severe injuries are taken to a civilian hospital, the Armed Forces must receive the information required to save lives and protect our country. It is not about restricting the individual's freedom, on the contrary. It is about safeguarding it by safeguarding life itself.

Mr. Speaker! This bill is not about bureaucracy. It is about the conditions for freedom. For without security there is no freedom, and without trust there is no strong society. Much of this should have been obvious already, one might think. But now, thanks to the government and the Liberals, it is becoming a reality.

We stand for a society that plans in peace in order to stand strong in crisis and war. There are few questions in politics that are more important than this: Every human being, regardless of where they live, has a right to care that is necessary for life and health. It is security. It is freedom. It is liberalism in practice.

The deliberation was hereby concluded.

(A decision was to be taken on 19 November.)

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