The organization of health and medical care

Thomas Ragnarsson (M)

Mr. Speaker! Today we are debating the Social Affairs Committee's report SoU14 Organization of Health and Medical Care, and I would like to begin by moving for approval of the committee's proposed decision.

Mr. Speaker! The Swedish health and medical care is a complex operation to organize. We have 21 regions that are to solve this in the best way given the geographical differences that exist, while at the same time the number of citizens within each region differs significantly. When the operation does not function, it is easy to start looking at organizational changes, and a common trend is that one looks at centralizations. There is, however, nothing that indicates that this has any major effect. We can state that with the organization in which we conduct the operation today, we do not achieve the basic requirements in the Health and Medical Care Act, to offer the patients good and equal health.

Mr. Speaker! The regional and geographical differences are not something that has emerged now, but the knowledge of them has existed for a long time. The difference is that the Moderate-led government, together with our coalition party, has now taken the issue seriously and in the Tidö Agreement pointed out a number of areas where they are investigating how the state should actually take greater responsibility so that the patients involved can receive better and more equal care.

One area that is being looked at is a parliamentary inquiry where the conditions for a fully or partially state-governed ownership are examined. They are also looking at a national plan for skills supply, the establishment of a national healthcare brokerage, a national plan for how the shortage in the number of healthcare beds shall be eliminated, expansion of cooperation in the number of regional centers, reforming the digital infrastructure in healthcare, a national maternity plan, expansion of primary care, continued development of cancer and childhood cancer care and equal healthcare and research on women's diseases and health.

Mr. Speaker! These are examples of areas where the state could take a clearer responsibility for health and medical care. But from there to the state governing health and medical care entirely is a long step. The healthcare crisis that we see needs to be broken down and analyzed carefully, but there are some points that are already known today.

Close leadership is absolutely crucial for an organization to function. Unfortunately, over the years we have seen an increasingly centralized management structure in the regions, and this has had major consequences for how healthcare functions at the capillary level. This in itself suggests that further centralization of the management structure would have further negative consequences. The reason for this is that the demographic and geographical differences are very large in the country. The regions play a major role in the close governance of how healthcare is to be conducted in each respective area.

Mr. Speaker! In a situation where something is not working, it is easy to start looking at organizational changes. We as politicians, but also the civil servants, have an over-reliance on precisely organizational changes. But if one looks at other operations that have taken just these steps, one can see that the result is quite disappointing. What I often miss in the debate is the foundation: Where is the patient perspective? This is something that we should all reflect on.

Instead of building an organization that the patient should adapt to, we should look at the patients and build the organization from their needs. It is not reasonable that today there are patients who fall between the cracks or end up in care queues that lead to continued deteriorating health or, in the worst case, death. It is not reasonable that one is denied treatment that then turns out to be available in a neighboring region. These types of differences are completely unreasonable. It is here that I see the great benefit of increased state involvement and increased state governance.

Mr. Speaker! I am aware of the problems with providing equal healthcare in a country like Sweden. We are, on the surface, the fifth largest country in Europe with a population that roughly corresponds to London's. It then becomes clear that level structuring in highly specialized care is absolutely necessary and that the regional collaborations, such as the regional cancer centers that exist today, need to be increased.

Patients in general have no problem moving, but for them, the most important thing is to get help. This is made impossible today due to the regions' autonomy, administrative hurdles, and economic discussions – things that are completely uninteresting to the patient seeking care. Here, a national healthcare mediation plays a very large role.

Mr. Speaker! We have one of the world's best healthcare systems in this country, but it is hampered by organizational and structural problems that ultimately risk affecting the patient. This is not acceptable. Therefore, we need to make changes in organization and governance, while simultaneously increasing the follow-up on how care is provided and how state funds are used. But these changes need to focus on the patient, and we need to create a political consensus on how we can continue to develop Swedish healthcare and increase patient benefit. The most devastating thing would be to end up in organizational discussions every parliamentary term, as that would definitely not benefit our patients.

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Karin Rågsjö (V)

Mr. Speaker! I completely agree with Thomas Ragnarsson regarding organization and a total nationalization, but that is not what I am going to speak about now, rather I am going to raise three questions.

The first question concerns primary care. We have all stood behind how important primary care is and that we should increase the pace when it comes to the registration of patients, more employees, and so on. It is not going like a train - unfortunately, one can no longer use such an expression, Mr. Speaker. But it is, therefore, not going particularly well. My question is: From your position as the government, do you have any ideas about what you are going to do? As it stands now, we simply cannot fix primary care.

The second question concerns inequality in health. The greatest inequality, Mr. Speaker, is the class-based inequality, not the regional one. It is, for example, women with short education who have a significantly shorter lifespan and more and more diseases. In the Tidö Agreement, it is insanely difficult to find anything about class-based equality, but perhaps there is some point that I have missed.

The third question concerns the Mental Illness Inquiry. The previous Social Affairs Committee was completely in agreement that we should produce that inquiry. It is finished and has been referred for consultation. Everything is fixed and ready, but the bill seems to be insanely far away. Are there any prospects at all that we will produce policy in this area, with a bill during this parliamentary term?

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Thomas Ragnarsson (M)

Mr. Speaker! Thank you, Member Rågsjö, for the questions! Primary care has enormous problems. It is in many ways linked to the fact that the interest in becoming a general practitioner is quite low in society at the moment. The regions need to consider how to attract young doctors so that they actually want to become general practitioners.

At the same time, 21 regions are now trying to reinvent the wheel on how we are to achieve good and accessible care. I do not understand why people do not look at the good examples. I emphasize – as I have done previously – Västerbotten as a success story. There, via Glesbygdsmedicinskt centrum, together with the health centers, they have built up a system that actually works in rural areas. But it is not that which should be copied, but the way of thinking. I actually believe that we have great gains to make if the regions choose to copy this.

Class differences in health are a huge problem. We know that those who are highly educated seek care earlier. They may also sometimes live a slightly healthier life and have the prerequisites for it. But if one has a functioning primary care, the chance increases that one can reach out to the other groups as well. That is what good and close care is about, to be present where people are and, based on their prerequisites, provide as good care as possible.

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Karin Rågsjö (V)

Mr. Speaker! An answer was missing - the one concerning the Mental Illness Inquiry. Perhaps the member will return to it in the next round.

When it comes to primary care, it is primarily resources and structure that are lacking. I believe that the state must step in with a firmer grip and more long-term funding when it concerns primary care. I believe it is extremely important for us to be able to stand tall, those of us who stand behind this. It is, therefore, all parties that stand behind this primary care reform. I am very worried that it is going backwards instead of forward.

Unfortunately, class differences are growing. It can be seen in various documents that health in groups with short education and poorer finances has worsened. It is a matter of accessibility. In the Stockholm region, the flagrant mistake was made of placing an insane number of health centers and increasing accessibility in the inner city, where I myself live, while socially underprivileged areas had huge problems with their centers. Here, it was the market that ruled more than the thought of those who have the worst health, so to speak.

I am still unclear about the answer regarding the Comorbidity Investigation. We can see that mortality is increasing in that group. It is therefore about a group that is dependent and has mental ill-health. It is a very large group that suffers very badly. There are many out there—relatives, the dependents themselves, and the professionals—who ask: What is happening with the Comorbidity Investigation? Why is no bill being submitted? That is what I wonder as well.

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Thomas Ragnarsson (M)

Mr. Speaker! Thank you for the question, member! I have not missed the Samsjuklighetsutredningen. Time did not suffice, so I chose to skip it.

I am painfully aware of the problems that these patients live with. I have been in the homes of many of those patients. This is tragic to see. It is many times a misery. There is a cry for help. But in some way, we have this patient, who falls between the cracks.

The member of Parliament asked: Can we see a bill this parliamentary term? I cannot answer that, but it is my hope that the bill comes as soon as possible. This is, in fact, a huge problem in society. Just as the member describes, this is incredibly tragic for those who are affected, but also for family, friends, and so on.

My hope is that the bill will come as quickly as possible. I truly hope that during this parliamentary term we will reach the goal with this. There is actually no political dividing line in how we reason here.

There may be problems with accessibility, but I believe that what is the problem is that our primary care is still working ad hoc. They are putting out fires, and they have not entered into the work of good and close care. It is about working preventatively to a greater extent, and one must be close to one's patients to be able to feel them and be able to do this. Changes need to be made within primary care, but a very large amount lies on primary care to make those changes.

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Anders W Jonsson (C)

Mr. Speaker! One almost becomes a little drunk with laughter when listening to the Moderate member, who stands here describing all the positive things happening in Swedish healthcare. I wonder a bit: In what reality do the Moderates live, considering the total crisis we have in Swedish healthcare right now? In the previous exchange of remarks, when he was going to highlight something that is very positive, he went to the Social Democrat-governed Västerbotten to find an example.

I requested the floor because accessibility and the very long queues are one of the truly major problems we have in Swedish healthcare. It is completely unacceptable. During the last parliamentary term, there were two proposals on the table as to what could be done about this.

One was a bourgeois proposal from the old alliance parties that changes should be made to the Patient Act to give patients the right to seek inpatient care anywhere in the country. Furthermore, important information, namely information on how long the queues actually are, would be made available. Patients would be given the power to decide for themselves where they should seek care.

Against that stood the Social Democratic proposal, which the Accessibility Delegation had drawn up, namely that this should be solved by having an office in Stockholm that would mediate all available healthcare capacity that exists around the country.

I have raised this several times. I am surprised that as soon as one enters the Government Offices, one lets go of the proposal that could actually make a difference. Instead, you raise this with that an office on Kungsholmen in Stockholm could convey all the available healthcare capacity that exists and that it would be the way to tackle the queues. I requested a reply when I heard the member even say that precisely this healthcare office, with the healthcare mediation, would solve the problem. Then I wonder: Where is the available healthcare capacity that is supposed to solve the problem with the gigantic queues? It just gets worse day by day.

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Thomas Ragnarsson (M)

Mr. Speaker! Thank you, Anders W Jonsson, for the question! It is quite interesting how people perceive things. I do not think I stood there and spoke in superlatives about how well the Swedish healthcare system works. If there is anyone in this chamber who knows how poorly it functions in many respects, it is probably me. I work continuously in the field and see this. I think it is a tragedy. On that, we agree. It does not work.

Yes, Västerbotten has succeeded. I do not believe, however, that it is the politics in Västerbotten that has done this work, but it is the operations themselves - dedicated employees who have been given a great deal of trust. Investment has also been made in research. That is what has led to a very positive change.

I find it difficult to see that it would be the politics, regardless of whether it is blue, red, green, or any other color, that has made this big difference, and that is what I want to address with close leadership: to trust the staff. There is de facto available healthcare capacity, but the structures make it so that it does not work. We think that one can work in the same way at all hospitals within a county, but that is not possible, because there are different conditions. In that case, one must trust and have confidence in one's staff and let each respective hospital build up an organization for how one works most efficiently at that specific hospital.

There is available operating capacity, but work is proceeding quite slowly in many places, which leads to us not achieving any efficiency in this.

I will return to the last question.

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Anders W Jonsson (C)

Mr. Speaker! I understand that Thomas Ragnarsson chose not to answer my actual question, namely that we have problems with queues.

The queues are getting longer and longer every day, and there were two proposals on how one could handle some of this. One of them was the Social Democratic government's proposal from the Accessibility Delegation, namely that an office should be established in Stockholm to convey available healthcare capacity across the country.

The second proposal came from our parties and was about making a structural change where the patient would be given the power to decide for themselves where they want to seek care in the country. Furthermore, the patient would receive information not only about how long the expected waiting times are but also about the quality of the care they are then to receive.

But as soon as one entered the Government Offices, they dropped the proposal that both Vårdföretagarna, Svenskt Näringsliv, and very many who work in healthcare say could influence this, because one could then plan long-term. At one hospital, one could say that now we are building up the capacity here, because the long-term rules of the game mean that we can handle a larger volume of patients.

That proposal is dropped. Instead, one takes the Social Democratic proposal that an office in Kungsholmen in Stockholm shall convey available healthcare capacity. One does not give the patient the right to choose, one does not provide the conditions for long-term planning out in the healthcare system, but instead, one chooses an administrative solution.

For me, it is incomprehensible that the structural changes that our parties have previously made are being abandoned. We have introduced the choice of care and LOV, things that have truly changed people's everyday lives. But now, suddenly, that is not what matters. Here, the patient is not to have any power, but instead it is the regions' officials who are to call the care office and check if there is available capacity. But those who move around in the healthcare system know that there is no available capacity today. It is that simple.

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Thomas Ragnarsson (M)

Mr. Speaker! It is good if one can hold two thoughts in one's head at the same time. We are proposing a number of tightenings regarding the healthcare guarantee within certain areas, for example child psychiatry, and that is something that can continue.

I don't think anyone actually has anything against the patient having to search themselves. I am myself so lucky that I have never been seriously ill. But there can actually be a point to having a healthcare mediation that can help me as a patient when I am seriously ill, instead of me having to sit and work on searching for care myself. It is hardly the case that I, as a patient, care whether I receive care at Södersjukhuset in Stockholm or at Halmstads lasarett. That is usually not something one cares so much about as a patient. What one cares about is that one should receive help in a reasonable time, and that can happen by being able to call a place where there is a map of available healthcare capacity.

In Kronoberg County, we have had problems in certain areas. There, we purchase services from other counties, both from other regions and from private healthcare providers, and in that way, the patient can receive care in a reasonable time. This still indicates that there is available healthcare capacity. We need to work with all avenues.

Tightening the healthcare guarantee is one way. We start with child and adolescent psychiatry and go down to 30 days. That can be introduced in more areas. So there must also be somewhere where I can easily find out where there is available capacity.

(Applause)

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Yasmine Bladelius (S)

Mr. Speaker! It is not exactly common to stand in this rostrum on a Saturday. But despite the fact that the sun is shining nicely outside the Riksdag building today, I truly look forward to spending a few hours together in here today.

Today, Mr. Speaker, several important debates will be held in this chamber, and the debate on the Social Affairs Committee's report 14, The Organization of Health and Medical Care, is one of them. In the report, all motions written by members of the Riksdag during the general motion period in the autumn and which concern the area we are now debating are collected.

It is quite obvious, Mr. Speaker, that there is a great interest among the members of the Riksdag to discuss these issues. The report deals with approximately one hundred different motions concerning everything from the organization and governance of health and medical care to privatization and choice of care, accessible and equal care, mental ill-health, and much more.

Mr. Speaker! Swedish healthcare is in many ways of absolute world-class standard. The absolutely outstanding doctors, nurses, and nursing assistants who work in healthcare do everything in their power to provide us with good care in a timely manner.

They are absolutely fantastic, but they are pressured. For decades, their working environment has deteriorated. They are expected to run faster, perform the important work in less time, eat faster, take shorter and fewer breaks, and receive more and more patients. They are given shorter and shorter recovery times, they have to forgo their statutory vacation, and they work overtime more as a rule than as an exception. They are going on their knees.

Mr. Speaker! Sweden is in the midst of a national healthcare crisis. Many of us have seen this crisis coming, a crisis that many of us have for a long time both warned against and pleaded with the government to curb. It is a crisis that could have been avoided, but now it is a fact.

In this situation, we shall now debate how healthcare should be organized. It is naturally not entirely simple in a crisis situation, but many of the questions and proposals addressed in this report could, if implemented, have a direct improving effect on healthcare and its organization.

Such a question and an important part in raising both the quality and the system efficiency within healthcare is precisely the implementation of the so-called primary care reform, that is to say that primary care shall be the very hub of the Swedish healthcare.

A better functioning and well-developed outpatient care and home healthcare has all the prerequisites to offer patients better care at the right level of care than today. This would, naturally, also reduce the pressure on hospital staff and inpatient care.

We Social Democrats initiated that important transition during our time in power. The current government has also signaled that they intend to continue with the important work, and that is, of course, a welcome message.

At the same time, it is clear that the transition has proceeded far too slowly so far. Much of the work for the transition has until now been carried out at a strategic level without any particularly visible effects in the operations. Therefore, we Social Democrats believe that the operations need to be given better conditions and – and this is important, Mr. Speaker – sufficient resources to drive forward the development work that the transition actually requires.

We also think that the government must increase the pace of the primary care reform and establish a special office for the transition within the Socialstyrelsen, with the mandate to continuously monitor the development and, above all, drive the transition forward. It is simply going too slowly, and the reform is absolutely necessary in our time's health and medical care.

Mr. Speaker! Another issue that has a great impact on Swedish healthcare is privatization and the right of free establishment. They have completely changed the forms of governance, and they have fragmented healthcare. Access to care has been concentrated in areas with high demand but relatively good public health, while areas with poorer public health have been depleted of healthcare resources. It is simply not profitable for healthcare companies to establish themselves in socioeconomically disadvantaged areas, or in the countryside for that matter, and therefore they have simply chosen not to do so. It is not good for either the patients or society.

That is why we Social Democrats believe that the government should analyze and investigate how the different market solutions within healthcare affect compliance with the portal paragraph in healthcare. The government shall, if necessary, propose changes to the regulatory framework so that care is provided based on need - nothing else.

There are also several cost-driving factors in today's health and medical care system. I am thinking, for example, of the costs for hired healthcare personnel and online doctor companies. It is about healthcare companies that target advertisements to patients to increase the consumption of care. It is about the LOV system, which means that the regions have the ultimate responsibility and therefore must constantly be prepared for if private actors wind down their operations or go bankrupt.

We believe that the government should conduct a review of the entire system to limit or abolish the cost-driving systems within healthcare, which we believe threaten the portal paragraph.

Mr. Speaker! Through the development of digital healthcare, new paths for establishment and financing have opened up for private healthcare providers, where providers can now offer care to patients from other regions and municipalities. This means, in practice, major challenges for the healthcare's principals, who must plan, dimension, manage, and finance the operations.

There are also several system-critical missions that the public healthcare providers perform but which the private healthcare providers do not have the same obligations to perform. This can, for example, concern research, education and work-based practice.

We want society to take back democratic control over the healthcare system. We want the government to stop the uncontrolled privatization within healthcare. We want the government to investigate a new stop law to prevent the sell-off of emergency hospitals. We want to set the same requirements for private actors as for public ones. We want measures to be taken so that private healthcare and care companies are covered by the principle of public access. We want to abolish the requirement for the choice system, LOV, in primary care. We want additional directives for the Healthcare Responsibility Committee to analyze and submit proposals to secure Swedish ownership of healthcare in Sweden.

Mr. Speaker! We want the government to introduce a ban on private health insurance within the publicly funded healthcare system. It is completely unreasonable that those with the deepest pockets go first in the care queue.

Even though much more can be said, I would finally like to say a few words about an important investigation that we Social Democrats want to see on the list of government bills in the near future; I am talking about the Co-morbidity Investigation.

It is an investigation that many long for, and we know that it will result in improved care and treatment of the group that has comorbidity in the form of substance abuse and psychiatric diagnoses. In our opinion, the government should promptly move forward with the investigation's proposals.

Mr. Speaker! I move for approval of reservation 6.

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Thomas Ragnarsson (M)

Mr. Speaker! I thank Yasmine Bladelius for her contribution.

There were a few things that I reflected on a bit. The member described a situation where the government is doing nothing. Then one gets the feeling that what we see today has arisen after the 2022 election. But that is not true.

From 2015 until 2022, a terrifyingly large number of healthcare beds disappeared in Sweden. From 2022 to 2024, another amount of healthcare beds has disappeared, but not at all to the same extent.

This is a healthcare crisis that has been ongoing for many years. In that case, it feels strange to say from the rostrum that the sitting government is paralyzed and that the sitting government is doing nothing. But we can look back in the rearview mirror and see that the previous government, over eight years, definitely did nothing. Fundamentally, I agree with the member that healthcare is in crisis. That is not what the discussion is about. But to place the blame for the crisis on the current political leadership now feels a bit strange.

It was the Social Democratic government that took the initiative for good and close care and pushed it through forcefully. There was no major reluctance from anyone to participate in this, but during those years, virtually no money was allocated to this; instead, it was to take place alongside the operations.

Today, 3 billion is being allocated, but it is too little. The transition will cost enormous amounts of money, and it is something that I have questioned for a long time. How has it been planned to finance this? There has not been a huge political discussion about this, and that is something I would like to see.

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Yasmine Bladelius (S)

Mr. Speaker! It was perhaps the member's own perception that I spoke about the government in my speech. I spoke very little about the government in my speech. On the other hand, I spoke a lot about what we Social Democrats want to do differently.

I listed examples of changes that we Social Democrats have proposed and that we want to see in order to curb the crisis and implement an improving change in the organization of health and medical care.

I turn to the member's opening question to me regarding whether I had said that the government is not capable of taking action. It is an opinion that I hold, I must say honestly, but it was not something that I spent time on in my speech.

I noted that the member, in their speech, highlighted the government's policy and the improvements the government is making to curb the crisis and improve the organization of healthcare.

I noted that what the member said does not fully correlate with what the member's party and the government have collectively presented in the budget. In at least the last three budgets, they have invested significantly more in lowering taxes for high-income earners and removing a plastic bag tax than in curbing the crisis that we see in healthcare today.

What is the member's answer to that?

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Thomas Ragnarsson (M)

Mr. Speaker! Thanks to the member for the question! Now, this is not a budget debate, but I can answer the question.

We often get stuck in this rut that it is money that is the sole savior. If we look at the investments that have been made, we see that the regions have received a lot of money. But if there is an opportunity to get more, one naturally would like to have it.

The Social Democratic government during the pandemic did not hold tight to the purse strings. That can be right and proper in a situation such as a pandemic. But it feels a bit odd that we had regions, for example my own, that could set aside 450 million in the treasury over two years. It was money that one didn't even need but that one received.

I think we need to have a relevant discussion when it comes to the economy and those issues. But my experience is that the regions have received money but have not actually made any major prioritization changes in the operations given the staffing situation that prevails.

They have removed "rent," but I have not seen that they have made structural changes where they actually say: "We are not going to do this now. Now we need to take staff from that side and move them to that side, because we must be able to take care of our patients." It is a painful journey, and that one has not really been made.

I agree that we cannot conduct ordinary operations with hyr, but hyr is very good when there are care peaks and acute illness. That is how hyr should be used, but unfortunately, the regions have lost sight of that. In that way, one has ended up in a situation where one conducts ordinary operations with hyr activities, and that is fatal.

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Yasmine Bladelius (S)

Mr. Speaker! I would like to thank the member for the commitment he has in these issues. I believe many see that shining through here in the speaker's chairs. Unfortunately, it is not enough to have a commitment, even though I believe many would often have liked it.

Like the member from Centerpartiet in a previous exchange, I would like to ask the M-member in what reality the Moderates and the government are living in, because it is not the case that we have a hell of a lot of people in the Swedish health and medical care system in the Swedish hospitals who have nothing to do or who are working with completely wrong tasks and who could be removed in a time of crisis. That is not the case.

It is at least not the case in all of the county hospitals and hospitals that today are forced to make large cuts and large staff layoffs. In a healthcare system that is already stretched thin, and among healthcare staff who are already stretched thin, there are no people who are idling around and who can be used for something else. There are no resources to spare.

There were resources after the Social Democratic-led government's time in power, when extra resources were added to manage that crisis. Those funds have been used to make up for the fact that we now have a government that chooses not to prioritize healthcare. Therefore, they have been picked out of those coffers. They are now exhausted, and now one sits in fearsome situations as regional politicians in all parts of Sweden where one is forced to lay off healthcare personnel in an already strained healthcare system. I do not think that is reasonable. I and the Social Democrats would have prioritized differently.

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Camilla Rinaldo Miller (KD)

Mr. Speaker! The Christian Democrats support the committee's proposal for a decision in the report SoU14 Organization of Health and Medical Care.

The report addresses the issues I just mentioned, the organization of healthcare, but also governance, privatization, choice of care, accessible and equal care, and mental health.

We move for the rejection of all motions. We do so, among other reasons, due to the intensive and ongoing work that the government is currently engaged in within this area.

Mr. Speaker! The Christian Democrats want the state to take greater responsibility for healthcare in order to make healthcare more equitable regardless of where one lives in Sweden.

The government has now appointed an inquiry to analyze and highlight the advantages and disadvantages of full or partial state ownership of healthcare. The assignment is to be reported in June 2025.

This is a major reform that we in Kristdemokraterna have pushed for for a long time, and we are glad that we have gained support for it in the government cooperation.

From the introductory provisions of the Health and Medical Services Act, the following appears: "The goal of health and medical care is good health and care on equal terms for the entire population. Care shall be provided with respect for all people's equal value and for the individual person's dignity. The person who has the greatest need for health and medical care shall be given priority to care."

Healthcare in Sweden has and faces major challenges in meeting the goals in the Health and Medical Services Act. A number of investigations over the years have pointed out the need to review how healthcare is organized.

For example, the Corona Commission concluded that the experiences from the pandemic demonstrate the importance of an administrative reform at the regional level and clearer state governance.

That is why it is good and important that the Care Responsibility Committee has now received the government's mandate to shed light on the issue of the ownership of health and medical care and to provide proposals that ensure a more efficient system based on the patients – exactly as the Health and Medical Care Act stipulates.

Mr. Speaker! In today's Sweden, we do not have equal healthcare. Where you live determines how long you need to queue for an operation, what treatment you receive, and how good the care you receive is. The unequal healthcare in the country is not due to the healthcare in Sweden being bad. On the contrary, Sweden's healthcare is fantastic. But unfortunately, it is difficult to access for far too many, and today's organization with 21 regions cannot fulfill the mission of providing equal healthcare.

We need to work for a more efficient utilization of the gathered healthcare resources for the patients' sake.

The Christian Democrats are now working actively in a government position to realize the healthcare policy we went to the election on in 2022.

Through a national healthcare coordination, waiting patients will be offered care at another healthcare provider with shorter waiting times, regardless of where in the country this healthcare provider is located.

Through a national maternity plan, the regional differences in maternity care shall be reduced so that all pregnant and birthing women and their partners shall receive more person-centered, safe, accessible, and equal care.

These were only two examples.

In connection with the presentation of the spring budget this year, the government also added 6 billion kronor to healthcare via the regions - an important supplement that corresponds to the cost of 7,000 nurses.

Mr. Speaker! For the Christian Democrats, it is important that people have good opportunities to influence their own living conditions, for example, to be able to choose school, healthcare, and elderly care themselves. At the same time, other parties are pursuing a policy that wants to stop freedom of choice. Patients should not be prevented from choosing which health center they should go to, by strangling the choice of care and removing the conditions for other alternatives.

That companies within the welfare sector must be allowed to make a profit is a self-evident matter for us Christian Democrats. Who else would dare to start and operate companies within this sector?

From an equality perspective, this is something that must be monitored so that the opportunity to operate profitably continues to exist, for the simple reason that a large part of these companies are run or led by women. This gives women a greater chance to strengthen their private finances and become more independent. If the choice systems and LOV are abolished, the idea-based activities will also be affected.

Mr. Speaker! All the work that is now being done aims to ensure that everyone receives accessible and equal care so that you can trust that you will receive the care you need, when you need it.

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Karin Rågsjö (V)

Mr. Speaker! The reality is different in my eyes than in the member's - it is obvious.

Firstly, we have a national healthcare crisis right now. There are 5,000 people who have been laid off across Sweden, and I wonder what evidence you have from each region regarding how many are to be employed of the 7,000 nurses who were to be hired for the money you have sent out. I would like to see this; I am getting completely different signals.

It is always interesting to discuss profits in welfare, which is now also being raised by very many actors. It is not about small, nice companies run by women, but about large companies in large chains. It is they who take care of a large part of the healthcare today – they are large, large companies. In their boards of directors, it does not exactly teem with women. It is not about small, small companies.

This has hardly increased equality within healthcare. One only has to look at Stockholm, which previously was the bourgeoisie's great shop window when it came to profits in welfare and private companies. It turned out in a completely obvious way that it was we who lived in the city center, the middle class, who received access to healthcare. Stockholm had a 40 percent higher consumption of healthcare than other regions. One can worryingly wonder if we were sicker here. I do not think so, rather it is about the fact that this was a system that targeted the healthiest.

When it comes to equality in healthcare and access to healthcare, all surveys today show that the class difference is increasing flagrantly throughout Sweden. I wonder, Mr. Speaker, how the Tidö parties have intended to ensure that we get more equal healthcare in terms of class.

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

Camilla Rinaldo Miller (KD)

Mr. Speaker! Thank you, Member Rågsjö, for the questions! I will try to catch all of them.

When it comes to the extra 6 billion and the hiring of nurses - or healthcare personnel in general, but equivalent to 7,000 nurses; that was how we tried to explain pedagogically how much money this government added to the regions - there is also a competence shortage.

We have just heard from the speaker before me that the situation has worsened for decades. In that case, it is quite interesting that one has such high confidence in the current government that one believes we could have solved what the Social Democratic government had eight years to solve. They began the work but failed to complete it. We in this government would therefore have solved this in one and a half years – I am very grateful that one has such high confidence in this government. We will solve it, but the important thing regarding all these investigations is now that it does not become fast and wrong, but correct and good, and that one can get this in order.

I still want to assert that there are many women who run companies within the welfare sector. If we were to remove the freedom of choice and LOV, many women would lose the independence that it means to be able to run a company, and I therefore think that from a gender equality perspective, it is very important that we continue to have this possibility.

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

Karin Rågsjö (V)

Mr. Speaker! There is currently a shortage of approximately 15 billion within healthcare. We can see that the number of intensive care beds is decreasing to levels that are much lower than before the pandemic. We can see that the overcrowding in the country's hospitals is increasing. It is not exactly a success for the Tidögänget when it comes to healthcare; that is hardly what one can say.

It is also about how the situation for the healthcare workers has been for a long time, just as the member says in any case. But during these years, the conditions for those working in healthcare have hardly improved within the regional healthcare system; instead, the whole idea is based on overtime for, for example, nurses – it is completely senseless.

It is clear that it is about resources. It has been an enormous crisis. During the pandemic, the previous government snatched up resources for healthcare to manage the situation. You are not doing that now during the inflation, on the contrary. This has created large rifts in healthcare. The reality, therefore, looks quite bad.

When it comes to private profits, we believe it is the patients who should choose. We are completely against the freedom of establishment, as it has been shown to a very large extent that the incentive is simply to make money. The incentive is not to make the world better, but to get as much money as possible for those who have invested. In that case, one naturally utilizes their staff in various ways.

There are not many small companies within healthcare; rather, it concerns large corporations, often global.

I have a specific question for the representative; it concerns the Co-morbidity Investigation. Where is it?

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

Camilla Rinaldo Miller (KD)

Mr. Speaker! In order not to be suspected of not wanting to answer, I will begin with the last question. When it comes to the Samsjuklighetsutredningen, we are all equally eager for it to result in a government bill that we can make decisions on here in the Riksdag. However, I cannot say more today than what we know. The investigation's final report was presented, as we know, in January 2023, and I know that the government and my minister Jakob Forssmed, with their officials, are doing what can be done to expedite and produce the bill as soon as possible. Unfortunately, I cannot say more. We are broadly in agreement that it needs to be produced. I wanted to start by saying this.

This government had to take over regions and a healthcare system that was in crisis. The crisis did not arise after the government took office. Sure, we had a pandemic behind us, for which the previous government obviously had to take great responsibility. But again: It was not because of the pandemic that it began.

When my party Kristdemokraterna sat in a previous government, a "queue billion" was introduced, because even then the healthcare queues were irresponsibly long. At that time, we reduced the healthcare queues. Then we got a new government, and the healthcare queues increased again.

I can promise and guarantee that this government will do everything so that we get good and equal care throughout the country, regardless of where one lives.

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

Yasmine Bladelius (S)

Mr. Speaker! The Member from the Christian Democrats says in her speech that she, her party, and the government have allocated resources equivalent to 7,000 nurses in Swedish healthcare. I noted that even the Christian Democrats' party leader said the same thing during the press conference, also in response to direct questions from journalists.

I would therefore like to ask the member: Is it really the member's, the Christian Democrats' party leader's and the minister's intention to explain the 6 billion pedagogically by claiming that 7,000 can be employed in Swedish health and medical care, or is it rather the case that the intention is to mislead Sweden's healthcare personnel, regional politicians and others?

Everyone who has some knowledge and insight into how the resources allocated in government grants are distributed knows that no 7,000 nurses will be hired or saved in Swedish healthcare.

We have 5,000 who have been given notice in the Swedish health and medical care today. We have a health and medical care crisis. The Government and the Christian Democrats have invested twice as much in tax cuts for high-income earners as on the healthcare staff. What could the 12 billion in tax cuts for high-income earners have done in the Swedish health and medical care? Why, Camilla Rinaldo Miller, do you invest half as much in the nurses as you invest in me, who receive a thousand more per month?

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

Camilla Rinaldo Miller (KD)

Mr. Speaker! Thank you, Yasmine Bladelius, for the reply, which gives me the opportunity to again address what the member herself said in her speech, namely that healthcare and the conditions for the staff have deteriorated over decades.

Once again, just as I pointed out in my previous turn: It is fantastic that one has such high expectations that the current government, in a year and a half, will be able to solve what has deteriorated over decades. But I thank you for the trust, and I promise that the government will manage it in the absolute best way.

Yes, we thought we were being pedagogical when we said that 6 billion kronor corresponds to 7,000 nurses. I thought people would understand that it was a pedagogical image, but it does not seem so. Competence within healthcare is also very important, but the government cannot find and train 7,000 nurses. All aids are needed here.

We need more nurses, and above all, we need nurses who go back to working as they did before. Could it be that women are fleeing care professions? Could it have to do with the Social Democratic hysteria about that one should work full-time and do a full-time journey? Not all women and men perhaps want to work full-time but have chosen to do so because they feel a pressure from society. Then comes mental illness as a receipt that they are not working as they should.

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

Yasmine Bladelius (S)

Mr. Speaker! During one and a half years, the Christian Democrats and the government have managed to present three budgets where they have invested twice as much on tax cuts for high-income earners as they have invested in healthcare. It is a fact.

One can try to present it as if one is making investments in Swedish health and medical care when one de facto is not doing so, for example by saying that one will explain one's investments pedagogically. The fact is, Mr. Speaker, that we are in the middle of a national healthcare crisis.

In three budgets in a row, the Social Democrats have presented budgets where we have doubled the government's investments in health and medical care because we have seen that there is once again a crisis in Swedish health and medical care and because, similar to the last time we had a crisis in health and medical care, we want to invest in getting healthcare out of the crisis, unlike the government, which would rather invest in tax cuts for high-income earners like myself and the member than in the care and the healthcare staff, who are on their knees.

We have regional politicians all over Sweden who are making incredibly difficult decisions right now. We see hospitals and healthcare staff who are not functioning and are on their knees, but who nevertheless must make cuts and lay off healthcare staff, even though the member and the responsible minister in the government have said that the money – 6 billion kronor – that is being invested will save 7,000 nurses. That is the reality.

Mr. Speaker! I have another question for the member from Kristdemokraterna. It concerns the Samsjuklighetsutredningen, which I raised in my speech. I know that the member has received questions about it and said that she cannot answer them. I wonder why. Why can the member, who is a representative of the party that leads these issues in the government, not answer when a completed report from the investigation can be tabled in the Riksdag? Furthermore, there is not particularly great disagreement between our parties.

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

Camilla Rinaldo Miller (KD)

Mr. Speaker! Thank you, member, for the question! I will begin with the Mental Illness Inquiry. I believe that all parties that have ever been part of a government know that when a matter is being prepared in the Government Offices, one cannot state an exact time. Therefore, I will not be able to say that today. The only thing I can say is that there is no motive to delay or linger in completing the inquiry. I want you to know that, Yasmine Bladelius. Work is being done as much as possible, but we have 400 inquiries ongoing.

The Speaker has reminded of tax cuts of 12 billion kronor, but I want to remind those listening to the debate this Saturday morning that the government in the budget for 2024 allocated approximately 40 percent of the budget space to welfare. That is 10 billion in permanent increase of the general state grant and almost 6 billion more in targeted grants compared to what was previously calculated for 2024. There is also a sector grant of 3 billion specifically for the regions' healthcare so that they can manage the situation.

When I add this up quickly, I get well over 12 billion. I want those listening now to know that the government is making major investments, is taking the healthcare crisis we have seriously, and wants to support the regions as much as possible.

(Applause)

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

Lina Nordquist (L)

Mr. Speaker! Those who become ill, regardless of whether it is in the body or in the soul, should of course be able to receive their care within a reasonable time and be able to maintain their self-determination. There should be no strangeness about that. It is sad, I think, that we cannot say that we are there today. People do not have their self-determination, and the care takes too long to receive.

Mr. Speaker! Most people want to receive their care as close as possible when they become ill, but there may be those who have relatives elsewhere, those who have to wait too long in their own region, or those who have a great trust in care somewhere other than where they themselves live.

I am therefore very proud that the government has taken a first step so that, if the region where one lives cannot provide the care one needs within a reasonable time, one shall be allowed to choose for oneself. We Liberals naturally want that one should be allowed to choose regardless of how long one otherwise would have had to wait. It should be self-evident that one owns one's own life, regardless of whether one is a patient or healthy.

Mr. Speaker! When it comes to the fact that most people want care close to home, most care needs to be provided closer than it is today, and it needs to be shaped according to us humans. We must achieve continuity in care. We Liberals have fought for a long time for a fixed doctor, and we are very proud that this is now underway thanks to the government. This also applies to specialized care where long-term contacts may be needed, for example psychiatry and oncology. More care is needed in suburbs, industrial towns, and rural areas. Work is ongoing for this in the Government Offices. I think it is very important and truly hope that we will soon see these changes where people live.

Advanced, more unusual care, however, cannot be provided locally. It must be concentrated at fewer locations so that patients are truly met with expertise. This applies, for example, to highly specialized care and care for rare conditions. I am also pleased with the government's work on a strategy for just rare conditions. It is long-awaited, and I am very grateful that it is on its way.

Then we have this matter regarding the governance of healthcare. We in the Liberals do not believe that the form of operation in itself is important, but instead, we believe in a diversity where every person or organization that provides healthcare has the same quality requirements imposed on them. There must be the same high requirements for continuity and other things. The patient shall have the right to choose and manage their life - but must also have an obvious possibility to refrain from choosing. One must be secure regardless.

We Liberals do not believe either that the principal is decisive, Mr. Speaker. On the other hand, we think it is completely fundamental that there is a clear strategy for Swedish healthcare and that we know who it is that governs and who governs what. Clearer state governance is needed in the long-term, overarching issues and when it comes to strategic healthcare issues. This concerns things such as national healthcare coordination and the right to self-determination for the patient, as well as the right to receive support in what one can choose and where the care is located. It is also about a strengthened work environment within healthcare and the right to continuing education throughout one's professional life.

We have a long way to go, but much is happening. There is also much happening that we have had to wait for far too long for, but where we are now finally taking important steps forward. I therefore wish to vote in favor of the committee's proposal, Mr. Speaker.

I also want to thank you for the work we do in the committee every week and for the work the government is now driving forward so that every person shall have a good life, regardless of whether they are healthy or sick.

(Applause)

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

Karin Rågsjö (V)

Mr. Speaker! We have a fantastic health and medical care in Sweden thanks to everyone who works within health and medical care. They toil every day. That is the fact.

Right now, however, we also have a national healthcare crisis in Sweden, and it has hit staff and patients very hard. Now, 5,000 people have also been laid off within healthcare around the whole of Sweden. It feels completely insane considering how we had it during the pandemic. It feels like it lies very far down in Tidögänget's way of behaving.

I believe that the SD-dependent government is draining regional healthcare by simply not providing enough resources in a very difficult time. We can see that the overcrowding at the country's hospitals is increasing. The number of intensive care beds is decreasing and is now fewer than during the pandemic, which should wake many up.

The share of general government grants in the financing of health and medical care has decreased from 16 percent to 11.5 percent between 2010 and 2022. This is, as it were, in direct contradiction to various governments' recurring descriptions of historical healthcare investments in recent years.

I will speak about primary care and local care. It feels like a mirage right now that it should be a foundation for all care, so to speak. Primary care should be the base in the care chain, but that requires muscles. The government does not seem to have those muscles, and neither does SD. Primarily, there is a lack of resources to manage the entire mission, which is gigantic.

Without staff who have good working conditions and a good working environment, it will not be possible to realize the goal of good and close care, Mr. Speaker. Follow-ups show that primary care's financial resources during the last five-year period have only increased marginally. In the regions' action plans for the transition, it is also unclear whether the regions intend to strengthen primary care's resources going forward and, if so, how. It can be said to be alarming.

Vänsterpartiet believes that primary care should be guaranteed long-term funding to manage this transition. One must be able to look very far ahead to improve the working environment and increase staffing throughout the entire primary care chain. It is actually the government's and SD's responsibility that something happens within primary care. We want to see a national primary care reform that guarantees the long-term sustainability of primary care.

We also want to see the government and the Sweden Democrats, together with the regions, develop regional action plans to reach the target value we have for listed residents, as well as that the preventive work in primary care is developed in cooperation with the regions. I therefore move for approval of reservation 4. It should not just be talk about primary care but also workshop, and that is what we are waiting for.

I am moving on to talk about that market, you know. The belief in the market within the welfare sector has been boundlessly naive, one must say. The entry of market logic into Swedish healthcare has primarily meant that healthy, well-off individuals are given the opportunity to over-consume care - we can see this in Stockholm, for example - while patients with poorer finances and poorer health, as well as elderly people with great care needs, have been deprioritized.

The really large healthcare needs are not inside the cities, for example in Stockholm's inner city, but in suburbs, residential areas on the outskirts of cities and in rural areas. There, it is not teeming with private actors, which of course means that profit interest has nothing to gain there. For example, in Storuman, that driving force does not work.

This path leads away from the content of the Health and Medical Services Act, that is, the principle of equal care and the sickest first. Vänsterpartiet believes that freedom of choice should apply to those who need care and nursing, not for private companies. We therefore want to abolish the right of free establishment within care and nursing, as it has not turned out well. We want to see a national plan for how equality within health and medical services can be improved.

Class and health go together. People with only pre-gymnasium education, for example, have shorter life expectancy, increased risk of early death, and poorer self-reported health and mental health. The connection is particularly clear for women with only pre-gymnasium education. It is important to point out that these are linked, that is, unfavorable conditions for receiving care is a major contributing cause of poorer health for the group with low socioeconomic position. Equal living conditions lead to better health, and better health leads to equal living conditions.

I must say, however, that the interest in equality and class is quite marginal when it comes to the Tidögänget, Mr. Speaker. "More inequality!" seems to be the battle cry instead – rich and healthy keeps recurring. The government should instead task the regions with prioritizing areas with low public health figures in order to increase equality in health.

This area is quite large, and I am now moving on to talk about mental health among children and young people. Children and young people who have different types of mental ill-health can have it for different reasons. It can be about difficulties in the home environment, for example parents who are dependent on alcohol or who themselves are mentally unwell. It can be about the school environment - we know that the school has an enormous impact on children and young people's conditions to feel well. To complete primary school and upper secondary school with grades is a very large protective factor for children and young people.

It can also be about neuropsychiatric issues, and in those cases, different interventions are required. Who is responsible for ensuring the right intervention is given at the right time can sometimes be quite unclear. Experiences further show that children and young people with the greatest needs are very much affected by the fact that the care is so fragmented.

The mental ill-health among children and young people is so serious that it needs to be handled as a major public health problem. The demand for child and adolescent psychiatry has increased steadily. Bup needs more resources – that is obvious – but we must also find other points of entry for children and young people, Mr. Speaker. Bup cannot accommodate all children who, for various reasons and to varying degrees, suffer from mental ill-health. We want to see an investigation with a mandate to produce proposals on how more points of entry to support can be created for children and young people with mental ill-health.

It was the merit of the previous Social Affairs Committee that the Mental Illness Inquiry was carried out in the first place. Now, the inquiry's report has been processed through consultations. It is a fantastically good inquiry. We now ask: Where is the bill based on this enormously important inquiry? It is the government's and SD's responsibility that it is submitted, and it is urgent. With every passing day, the mortality increases.

I now have the audacity to move for approval of an additional reservation, namely reservation 24.

I will now move on to speaking about private health insurance. Not only can they be unfair and lead to errors – they can also lead to a culture of demands among those who have insurance. One might not only ask for a second opinion but also for a third opinion.

At the same time, the private healthcare providers have an interest in selling as much healthcare as possible; there are huge economic incentives in this. It is a problem when private healthcare providers that have agreements with the regions have two doors in – one for those of us who do not have insurance and another for those who do have insurance. It is the same premises and the same staff. This is a form of mega-club sandwich for the healthcare companies, who cash in from the regions and the insurance companies. The sickest first is hardly the rule here.

Today, the legal situation is extremely unclear regarding what the regions themselves can do. We believe that regions that are willing to live up to what is stated in the Health and Medical Services Act and prohibit private health insurance within private operations that have agreements with the regions should be able to do so. Due to the unclear legal situation, it is required that the issue be clarified nationally.

I would like to take this opportunity to wish everyone in this chamber and everyone else a pleasant summer. I believe this is the last thing I will say from this rostrum during this parliamentary session.

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

Anders W Jonsson (C)

Mr. Speaker! How we organize Swedish healthcare is an important issue. More than 20 years ago, it was investigated quite thoroughly.

Within the OECD area, there are different ways to organize tax-funded healthcare. In Sweden, we have chosen to place it with the regions, while other countries have chosen a state model. Others have mandatory insurance. When this issue was last investigated, it was concluded that the Swedish model favored Sweden, and therefore no change was made.

Now a new investigation is looking into this. I think it is very interesting that one chooses to highlight this again, because quite a few things have happened.

One of the main arguments for making a change is the unequal healthcare in Sweden. One receives different care depending on where one lives, what socioeconomic position one has in society, and how much education one has, as well as depending on whether one is born in Sweden or not. I raised an eyebrow in surprise when I heard the simple explanatory models in connection with this – as if it were because the regions have made decisions that healthcare should be different. That is not the case.

If one is affected by prostate cancer and lives in Dalarna, the risk is very high that it will only be discovered the day one develops metastases. If one instead lives here in western Stockholm, it will be discovered through one of the screening programs that exist in Stockholm. This is not due to the fact that the politicians in Dalarna have made decisions that they should have worse care for patients with prostate cancer, but it is about completely different factors.

I believe that one is under an illusion if one thinks that the problems with the concerning regional differences we have would be solved if healthcare were simply managed entirely from Stockholm. There may be other reasons to make changes, but this will not be the most significant one.

It is unfortunate if one looks at the other major difference in Swedish healthcare, namely the differences between different socioeconomic groups, and thinks that it is simply a matter of economics—that people have different amounts of money and therefore receive different healthcare. That is not the case. A typical example of this is dental care for children. It is free throughout Sweden, but there are still very large differences depending on which socioeconomic group people belong to. It is not about ensuring that healthcare becomes free and removing the private alternatives, but it is significantly more complex problems that lie behind this.

Nevertheless, I look forward to the work in the Care Responsibility Committee, because I believe there will be interesting things that can be turned over and examined. It is not, however, as simple as making a "coup de grace" and nationalizing the entire Swedish healthcare system; this would likely create significantly greater problems than it might possibly solve.

The second major change to take place in Sweden concerns what we call good and close care, that is to say that healthcare shall come closer to people. That which is done in hospitals today should be able to be done out in primary care. I and the Center Party are very disappointed that the government is sitting with its arms crossed in a situation where nothing is happening. Here, there has been political agreement both in the Riksdag and around the country that changes must occur – if we are to be able to handle the needs of the future, we must ensure that more of the care can be performed close to the patients.

The big problem is that primary care cannot cope. Above all, primary care has very difficulty recruiting doctors. If you do not have a regular doctor in primary care, you do not turn to it, but instead, you turn to somewhere else.

Let me highlight the difficulties in primary care, perhaps without starting from the Stockholm example. In my home county, Gävleborg, a major review of primary care was recently conducted. Gävleborg has some of the highest tariffs, or reimbursements, for primary care, so there is fundamentally no lack of money. All private health centers are running with a profit, and they have fewer problems retaining staff. They have slightly heavier patients than the regionally run health centers have. On the other hand, all except one of the regionally run health centers are running at a loss.

This, Mr. Speaker, shows the problems we have in healthcare. Therefore, it is counterproductive to point out the private alternatives as the major problem. Regarding primary care, it is actually the opposite. We must use the drive and the innovative thinking that exists in much of the privately run healthcare to ensure that we can renew Swedish healthcare.

The third thing I want to bring up has been taken up by several others earlier. It concerns the Investigation on Co-morbidity.

This is truly an organizational issue. When it comes to one of all diagnoses in healthcare, namely addiction diseases, it is not the healthcare provider in Sweden that has primary responsibility, but rather it is the municipalities and social services. No wonder we have one of Europe's highest mortality rates among people with addiction diseases and intravenous drug use.

The parties in the Riksdag agree that this should be changed, and an investigation has produced an absolutely excellent proposal. But from the government side, nothing is happening. Unfortunately, I am starting to get a bit used to this. When it comes to changes in primary responsibility within personal assistance, all parties agree. There is also an investigation proposal, but nothing is happening from the government side. Even when it comes to the unreasonably long queues, all parties agree, but the queues are getting longer and longer. Nothing is happening from the government side.

Then we have the Comorbidity Investigation. I perceived a clear message from the Christian Democratic member today that this bill will be submitted. One must believe what people say, Mr. Speaker, so I assume that a bill from the Ministry of Social Affairs on comorbidity and how care should be reorganized there will be included in the list of bills for the coming years when the Riksdag convenes in September. Anything else would be shameful.

I stand behind all our reservations, but so that the voting will not become all too long, I choose, like Karin Rågsjö, to move for approval of reservation 24.

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

Ulrika Westerlund (MP)

Mr. Speaker! Now some themes have started to recur in the various speeches. So also in this speech - I would like to begin by drawing attention to the important Co-morbidity Inquiry. It is now almost one and a half years since the inquiry presented its final report. Already in 2021, a partial report was issued. There, it was proposed that all treatment of harmful use and addiction should be the responsibility of the regions' health and medical care.

Part of the intended reform, which we have talked a great deal about here today, is that compulsory care for harmful use or addiction shall be provided in coordination with other psychiatric care and constitute part of a coherent and person-centered care chain. Through the investigation's proposals, the different mandates of the state, the regions, and the municipalities are clarified. This is, of course, aimed at reducing the risk of patients falling between the cracks and enabling improved care and treatment of the group with comorbidity in the form of substance abuse and psychiatric diagnoses.

It is extremely important that the commission's proposals are taken forward by the government. Now we have, as we said, received almost a promise regarding this, so we will of course monitor this closely.

The fact that substance abuse and addiction have for so long been seen as a separate area has made it very difficult for people with substance abuse problems. A person should not have to wait to receive support for mental health issues until they have gotten rid of their substance abuse. If one does not receive help, the risk of attempts at self-medication with drugs increases, which entails great risks. Sweden ranks high in the statistics on drug-related mortality, and this is something we are trying to rectify. It is evident that access to care and support can contribute to people getting help to get out of difficult situations, with reduced risk and reduced feelings of hopelessness as a result.

Mr. Speaker! It is not possible to debate the organization of healthcare without touching upon the financing, and I will also mention that it is absolutely necessary that the general state grant to regions and municipalities is increased.

In Miljöpartiet's spring budget motion, we added 7 billion more than the government for healthcare, which means a total supplement of 13 billion. I haven't calculated exactly how many nurses can be hired for this money, but it will therefore be more, if we are to continue with that comparison. In our budget motion last autumn, we proposed 14 billion more than the government in general state grants to municipalities and regions. We also want these state grants to be indexed so that they increase with cost developments. This puts a stop to automatic cuts and gives municipalities and regions better conditions to plan their operations in a good way.

I also want to specifically mention the recovery bonus, which I have mentioned many times before. It was an initiative from Miljöpartiet, which we would have gladly seen remain. In our budget motion this autumn, we allocated 1 billion to keep it because we believe it is an important tool in the work to improve the working environment for staff within healthcare. We want the recovery bonus to be made permanent and expanded and regret that the government has removed it.

Mr. Speaker! I will also say something about a subject that has been raised several times earlier. It concerns the democratic control over the healthcare system and the use of the common tax funds.

The extensive privatization has, according to the Green Party, entailed major problems, and several measures would need to be taken to improve the situation. Like previous speakers, I would particularly like to mention the system of private health insurance and what it means when private healthcare providers offer care on behalf of insurance companies. Insurance patients receive a shorter waiting time than that which follows from the statutory healthcare guarantee, and if the healthcare provider also accepts publicly funded patients on behalf of a region, these patients are not guaranteed the same waiting times. We believe this violates the legislation's principle of human dignity.

Mr. Speaker! In conclusion: Mental illness is one of our time's greatest challenges. An increase in mental illness among young people can be seen in all strata of society, but it is more common among children in vulnerable areas. Unequal mental health is, like much else, due to socioeconomic factors.

There is also a strong correlation between mental illness and ADHD. For some people, depression and ADHD coexist, but for others, depression is a result of ADHD, as a consequence of low self-esteem and a poor self-image. Research also shows that there is an overlap between ADHD symptoms and trauma symptoms. It is not uncommon to misdiagnose trauma as ADHD, so in this case, both increased competence and increased resources are required.

There are several measures that should be taken so that everyone receives the support they are entitled to. To improve the work regarding children's and young people's mental health, the most important measures are early detection and care, and a well-functioning cooperation between actors and levels of care. The Government should take measures to develop cooperation between school, social services, and health and medical care, as well as shorten the queues to child and adolescent psychiatry. One should also ensure that new national knowledge supports are developed for the entire care chain regarding children's and young people's mental health.

I support all of the Green Party's reservations but move for approval of reservation 23.

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

Mona Olin (SD)

Mr. Speaker! We are now debating the Social Affairs Committee's report 14 Health and Medical Care's Organization. I naturally stand behind all our reservations but move for approval of reservation 21.

One of the most decisive issues for our society is the Swedish health and medical care. The Sweden Democrats are determined to work for a healthcare system that is for everyone, regardless of where in the country one lives. For us, healthcare issues are among the highest priorities.

Swedish healthcare maintains high quality on many levels, which can also be seen in international comparisons. But it also faces several challenges, for example long care queues, lack of accessibility, and large regional differences. The number of care beds has decreased, and overcrowding is a problem. This is, however, nothing new but has been a growing problem for decades. Sverigedemokraterna works to ensure that high-quality care exists throughout the country, and we want to improve accessibility and reduce waiting times.

Competence supply within healthcare is important. It needs to be ensured that there is sufficient permanent staff with the right competence throughout the entire care chain and within all operational departments across the country.

The Sweden Democrats believe that the current organization of health and medical care needs a comprehensive review to ensure that resources are used effectively where they are most needed. We strive for a healthcare system that maintains high quality and is accessible and equal for all residents.

Patients who have access to a well-functioning primary care report higher levels of satisfaction with the care. Fast and easily accessible help is appreciated, as is having a long-term care relationship with one's doctor.

Primary care can also play an important role in identifying and treating mental illness. By offering early intervention, counseling, and treatment for mental problems, primary care can contribute to improving the mental health of the population.

Mr. Speaker! We see a great need for a comprehensive investment in mental health and an increased focus on early and preventive measures. We believe that increased competence and more resources are needed in primary care and that psychiatric care needs to be better integrated into other health and medical care to ensure a holistic view of the patients' needs.

Within the framework of the Tidö Agreement, there are a number of measures to improve care and shorten waiting times, not least when it concerns children and young people with mental ill-health.

Mr. Speaker! The Sweden Democrats and the other government parties have, within the framework of the Tidö Agreement, agreed on a number of decisive reforms to address the many serious deficiencies we have in our country, and this also includes health and healthcare issues. The Tidö Agreement contains an ambitious section on Swedish healthcare where several of the Sweden Democrats' long-presented measures and proposals are included. A national healthcare brokerage shall make the entire country's healthcare capacity available, something we have previously called a healthcare guarantee office. We have pushed this issue for many years and assert that Sweden needs a national function that coordinates the available healthcare capacity in the country. The proposal has been developed and is now included as part of the Tidö Agreement.

The deliberation was hereby concluded.

(A decision was to be taken on 18 June.)

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