The organization of health and medical care

Christian Carlsson (KD)

Madam Speaker! Those who become ill deserve equal care without long queues. But healthcare in Sweden is not equal. The chance of quickly getting in contact with child and adolescent psychiatry when one's daughter is unwell and the probability of detecting severe cancer at an early stage when someone in the family is affected differ dramatically depending on where in the country one lives.

We Christian Democrats went to the election on a platform to abolish the regions and let the state take over the responsibility for Swedish healthcare, and we have the Swedish people with us. According to the SOM Institute, seven out of ten want to introduce a national responsibility for healthcare. The same is true for eight out of ten doctors and numerous experts. It is obvious that development has outpaced today's healthcare organization, with 21 self-governing regions. The healthcare model is no longer efficient or economically sustainable in the long term. It is not equitable. The regions also do not manage their mission to offer care in a timely manner.

During Magdalena Andersson's eight years in power, the healthcare queues, which were already record-long before the pandemic, doubled. The queues to BUP tripled. S handed over a healthcare system with the lowest number of care beds per person in Europe. This happened despite people paying high taxes and Sweden being one of the countries that spends the most tax money on healthcare.

We Christian Democrats stand firm in that the record-long healthcare queues that built up during the Social Democrats' time in power were a betrayal of the welfare state. The growing healthcare queues, which have persisted even during this mandate period, need to be countered on a broad front. The Christian Democrats have therefore, in a government position, invested in more healthcare beds and increased healthcare capacity. We have begun the work with a sharpened healthcare guarantee, so that the patient can more quickly receive care from another actor if their own region is unable to provide care in time. We are also establishing a national healthcare brokerage, so that one as a patient should be able to see where in the country there is available and accessible capacity.

But we also need to realize that today's regional boundaries constitute obstacles for patients to receive the care they have a right to. It is even so bad that there are regions that would rather place patients in the region's own care queue than turn to another region or healthcare provider so that the person who is ill can receive care in time. Therefore, state responsibility for healthcare is required.

Despite the fact that the government is investing 7.5 billion kronor this year to expand healthcare capacity and despite the fact that thousands of healthcare beds are missing in Sweden, there are regions that are now reducing the number of healthcare beds and closing down acute care. One example of this is Region Västernorrland. At the same time as the state strengthens the military readiness in Sollefteå, the region weakens the healthcare's readiness, while Sweden finds itself in the worst security policy situation since the Second World War.

The Corona Commission already showed that the regions' municipal self-government makes the state governance and Sweden's crisis management capability deficient. It is clear that the 21 self-governing regions constitute an obstacle when Sweden needs to upgrade the healthcare's preparedness to meet the military threat from Russia.

The dysfunctional governance is also evident in that the state has injected a total of 31 billion kronor through agreements with SKR to strengthen primary care without the regions' budgeting having increased significantly. The regions are not fulfilling their mandate, and Sveriges Kommuner och Regioner is therefore also not keeping its word.

We Christian Democrats no longer accept a model where the state provides a large part of the money but the regions do not keep what they promise. The healthcare staff make fantastic efforts in our country, but Sweden has an inefficient healthcare organization which means an unjustifiable waste of taxpayers' money. We spend more money on healthcare today than before, but the number of healthcare contacts is not increasing sufficiently. The healthcare queues are too long. Sweden has fewer healthcare beds and less healthcare staff than comparable countries. Instead, we have more administration and large differences in healthcare quality.

In that situation, it is not sufficient to desperately cling to a dysfunctional and inefficient healthcare organization from the middle of the 1800s. It is time to put the patients before the system. The state should be given full responsibility not only for governance and financing but also for the organization and dimensioning of Swedish healthcare.

It was against this background that it was an important day when the Healthcare Responsibility Committee presented its report last week. The Healthcare Responsibility Committee is the parliamentary investigation that has investigated the issue of state responsibility for healthcare. The investigation's underlying reports clearly show that a state ownership could have better conditions to solve many of healthcare's greatest challenges.

It is therefore positive that the representatives of the other parties in the Care Responsibility Committee have taken steps in the right direction. All parties now acknowledge that the state's governance of the regions' health and medical care needs to be strengthened and improved. There is an agreement that the state's accountability and control should be strengthened with the aim of securing patients' rights and guaranteeing that the health and medical care legislation achieves greater impact in practice.

It is specifically proposed that system and financing responsibility be increased within skills supply, pharmaceuticals, screening, and vaccinations. This also applies to airborne ambulance care and airborne medical transports as well as forensic psychiatric care. In addition, it is proposed that the state's governance, monitoring, and accountability be strengthened also within other parts of health and medical care.

It is good that the Healthcare Responsibility Committee has now completed its assignment, so that we can together increase state governance and take further steps towards giving the state the full responsibility and mandate to govern Swedish healthcare. Let me be clear: If we seriously want people to be able to receive care in time and receive a share of the best care, regardless of where in the country they live, we need to fully scrap Sweden's inefficient healthcare organization, abolish the regions, and let the state take over the full responsibility for Swedish healthcare.

State ownership is necessary to achieve more accessible and equal care, long-term funding, and better preparedness. The Christian Democrats stand on the side of the Swedish people in this issue, and we will continue to work to abolish the regions and let the state take responsibility for Swedish healthcare.

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

Anders W Jonsson (C)

Madam Speaker! It is interesting to hear the chairman of the Committee on Health standing in the Riksdag's rostrum and saying that we have a dysfunctional and poorly functioning healthcare system in Sweden. Swallow those words! There is no support at all for the idea that Sweden should have a dysfunctional and poorly functioning healthcare system. On the contrary, it is the case that we perform at an absolute world-class level.

Since then, we have a number of challenges. Christian Carlsson raises the queues. They are just as long now as when the Social Democrats lost power in 2022. Equality in healthcare is very important. Over the course of two years, we have had the chance to look more closely at these issues. If the state took over the entire principal responsibility, as in Norway and England, would one then have equal healthcare and shorter queues? There is pretty much nothing in the investigation's 800 pages that shows that would be the case. It is completely different measures that are required if one wants to shorten the queues and achieve more equal healthcare.

It is important to distinguish between increased state governance, which eight out of eight parties think is good, and a state principalship. We must clarify what that entails. That is where Christian Carlsson becomes answerable. He wants a director-general in Stockholm to be given the power over 400,000 employees in Swedish healthcare and from Kungsholmen direct exactly how it should be organized and how people should work. That would correspond to 30 percent of the state budget. It would require a transformation process of approximately ten years. In what way can Christian Carlsson find grounds in this report that speak for it solving any problem whatsoever?

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

Christian Carlsson (KD)

Madam Speaker! Let me first state that it is not a serious picture that Anders W Jonsson paints. It is a caricature of what state responsibility would entail. No one thinks that all decisions with state responsibility should be made by a director-general in Stockholm. The Christian Democrats have proposed that there should be six regional profession-led executive organizations within the framework of the state responsibility. We want to move the power from the regional politicians to the healthcare professionals. We advocate for state responsibility precisely to be able to cut regional bureaucracy and political greed.

We know that state responsibility for healthcare could reduce unnecessary bureaucracy, and healthcare workers could be given increased responsibility. Healthcare could become more equitable and more accessible. Above all, it is stated in the underlying reports that today's system is not financially sustainable.

That is why we have drawn the conclusion from the Care Responsibility Committee's basis that what is right is not only to let the state take responsibility for systems and financing but also for the provision. We can then dimension the care in a way that creates conditions for equal care and accessible care for all people in Sweden.

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

Anders W Jonsson (C)

Madam Speaker! It is one thing to have increased state control. All parties are in favor of that. There we have had a gradual transition over a number of years. In the investigation, they are now pointing to an additional six areas where it would be needed.

It is something completely different to let the state become the principal for the entire Swedish healthcare system. It means de facto that it becomes a state agency, let's say with deputy directors in six regions and sub-deputy directors who decide in 21 regions. But it is nonetheless a state agency. It would have 400,000 employees, ten times as many as the largest state agency we have today.

We can go through how it is in the corresponding countries. One only has to look at Norway and England. It is not the case that equality there has become better or is better than it is in Sweden. It is not the case that the queues are shorter in those countries because one has a state agency that manages the entire healthcare system.

I will give Christian Carlsson the point on one issue. One thing where it would make a difference if you had a state agency that handled 30 percent of the state budget is the financing. It is a fundamental problem we have in Sweden with our 21 regions. One region, the Stockholm region, has an income development that none of the other 20 regions have.

That is why the gap is gradually increasing between the finances one has in Stockholm to provide healthcare and what one has in the country's other 20 regions. With a fully state agency handling it, one would take money from Stockholm and send it out into the country.

If you seriously want to do something about it, Christian Carlsson, there is another possibility. It is to present the proposal that is in the drawer at the Government Offices regarding a sharper municipal tax equalization. It is a considerably simpler path to take if one wants to solve part of the financing problem.

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

Christian Carlsson (KD)

Madam Speaker! I am the first to welcome that all parties in the Riksdag want to move towards increased state control when it comes to financing and system responsibility. But what the member claims about us being in complete agreement on this is not true. After all, it is only a few areas that most parties point out where they want the increased financing responsibility. The Christian Democrats want the state to have the full responsibility and mandate when it comes to both system and financing.

Let me also mention something about dysfunctional governance. Member Anders W Jonsson claims that there are no signs of it at all. Taxpayers via the state provide 31 billion kronor to strengthen primary care. But the state cannot ensure that those funds reach primary care, as everything is based on agreements with SKR regarding how the money should be distributed. If they then do not keep what they promise, it means that 31 billion kronor are thrown into the sea. That is naturally not functional, it is dysfunctional.

It is the same thing when we agree that there are thousands of healthcare beds missing in Sweden. We are now strengthening the military preparedness in a town like Sollefteå. Then it is regional politicians who cut back on acute care there. Is that effective governance? Does it hang together? No, it is naturally completely unacceptable that the state does not have the full mandate in those matters.

In many ways, we have a dysfunctional governance. We are asking for an increased mandate from the state. We do this primarily so that we can offer people equal care and care in a timely manner.

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

Karin Rågsjö (V)

Madam Speaker! The member continues with state care. We have just concluded the work in our committee, the Care Responsibility Committee, and have submitted our proposal. Six of the eight parties are against what the member has proposed and continues to propose.

It might perhaps be more effective for the Christian Democrats, who have full responsibility regarding healthcare, to be a bit more here and now. It is not only politicians but also expert committees and researchers who have looked at this.

It is sad to hear that the member is dragging the entire Swedish healthcare system into the mud when the member again presents their demands for state-run healthcare. You are very alone in that matter.

You say that we should acknowledge this, and that we have acknowledged that the state should take greater responsibility. The politicians who sat in the committee brought proposals from their parties. It is not KD that has whipped forward our analysis, but we have done it together in very great consensus.

It is very good that eight parties are prepared to do things together for this. It is regrettable that the Christian Democrats, who are actually not in opposition but in a government position, do not take responsibility for here and now.

There is very much within healthcare that is not functioning due to various things. For example, the regions have had an extreme economic crisis due to inflation. Unfortunately, the member's party, along with the other parties, forgot this when the budget for 2023 and 2024 was presented.

It is still the case that there is simply a lack of money in the pot. Things have become more expensive. We want to index. Is that something the member is interested in?

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

Christian Carlsson (KD)

Madam Speaker! It is true that the Christian Democrats take responsibility for the here and now. We have already taken several initiatives during the current parliamentary term to increase the state's governance of health and medical care. This is in areas such as competence supply, increased care capacity, digital infrastructure, and preparedness. We are also now working for a sharpened care guarantee and a national care mediation aimed at reducing the regions' power, strengthening the patient, and putting the patient in focus.

I have also noted that Minister for Health Acko Ankarberg Johansson has welcomed the fact that there is a certain consensus that we need to move towards increased state control. Work is already underway to investigate the possibility of proceeding with this as soon as possible within the framework of the government cooperation. Surely the Kristdemokraterna are taking responsibility here and now.

That it did not become a majority for the Christian Democrats' proposal in the committee is naturally not a reason for us to stop pursuing the issue. Hardly anyone would have expected that such a majority would be achieved. It was rather beyond expectations that so many steps in the right direction have nevertheless been taken.

One also forgets the majority that we have. We have seven out of ten of the Swedish people with us for the Christian Democrats' proposal and eight out of ten doctors. It may be that support is currently lacking among the other parties, but the popular support for our proposal is massive.

We ourselves were about ten years ago where most parties were. Hopefully, more will be able to come in the future.

I understand that Vänsterpartiet wants us to stop pushing this issue. It is an issue where we have great popular support. We stand on the side of the Swedish people, and we will continue to push the issue that the state should take over the responsibility for healthcare.

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

Karin Rågsjö (V)

Madam Speaker! It is somewhat surprising that on the very same day we hand over the report to the Minister, campaign number two on the same theme is launched. The member mentions figures for all doctors and so on who are behind it. There are other questions that people have been asked to comment on. For example: Do you believe that healthcare needs more resources? Probably nine out of ten do. One can ask questions in somewhat different ways.

I mean that a healthcare policy must contain a bit more than a goal that will not be reached. A healthcare policy should also mean that one should have had more oversight of the regions when it concerns, for example, how it looked in their budgets in 2023 and 2024, when they were forced to lay off 4,000 people. It would have been fantastic if the Christian Democrats, who have nevertheless had the responsibility for health and medical care during this mandate period, had looked a bit more at what they could have done for the staff and for the patients.

It sounds as if money would be flowing into the regions, and it doesn't – that is what I want to say. With the extreme inflation we have had and in the situation that now prevails, the regions are still financially tight.

One can also reflect on what it looks like for the private actors when one hears that it costs 25 billion kronor every year just to follow up on profits in welfare across the entire base: health and medical care, school and so on. 25 billion – you understand how much money we could instead pour into the patients and the staff!

This is also a question that is included. Healthcare does not consist only of the will to nationalize. We all now stand behind increased state control. We in Vänsterpartiet are very happy about this, because this is what we have included in our motions and so on.

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

Christian Carlsson (KD)

Madam Speaker! No, not everything within Swedish healthcare is, of course, about the desire to let the state take over the responsibility. We do not believe either that a state responsibility for healthcare would fully solve all of healthcare's problems overnight. On the other hand, it would create significantly better conditions for us to solve healthcare's problems.

The reason why we advocate for a state responsibility and also continue towards step two, now that we have come as far as we have, is the desire that all those patients who have to wait far too long to receive their care should be able to receive care in time. We shall settle accounts with those regions that would rather place people in a care queue than send them to another region or, for that matter, to a private healthcare provider.

It is about the fact that we think it is unfair that there can be a difference of over a decade between the regions when it comes to who gets access to a certain cancer screening program. The colorectal cancer screening program was an example of this.

It is about us wanting to put a stop to the waste of taxpayers' money in the regions that the regional politicians, as it stands today, contribute to.

It is about wanting to be able to ensure that the state has the possibility to take full responsibility for the organization and dimensioning of healthcare in a very serious security policy situation where we need to ensure that we equip and strengthen Sweden's crisis and war preparedness.

That is why we continue to push the issue. It is also because we realize that more money will not solve the healthcare system's problems without structural changes also being required.

It is positive that Vänsterpartiet wants to be part of the first step, and we are already working to take the next step.

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

Karin Sundin (S)

Madam Speaker! An organization is never as good as the day before it is launched, before the neat schedule in an organizational sketch has been tested against a much more complex reality.

It also applies to health and medical care, even though it was a long time ago that the organization was new. Today's debate concerns the organization of healthcare based on the processing of 160 proposals that were written in the autumn motions. These are issues that do not obviously lend themselves to being sorted into an organizational sketch.

In view of the exchange of remarks just now, it should probably be said that it is a bit strange to debate last autumn's proposal on the organization of health and medical care the week after the Vårdansvarskommittén has presented its report on how healthcare should be organized in Sweden. There, the question is also raised as to whether it should not be operated under state management instead.

The answer to that question is, despite what we have just heard here in the chamber, a clear no. Six of the eight parties in the Riksdag do not consider that the solution to today's problems and challenges in healthcare lies in moving the decision-making from the regional level to the state level.

Anders W Jonsson exemplary explained what the consequences of moving healthcare to the state level could be thought to have. We Social Democrats do not believe either that the state is better suited to manage all healthcare. A reorganization would likely paralyze the development of healthcare for a long period and in turn, of course, give rise to new boundary-setting problems.

We do, however, share the committee's conclusions that there are areas where the state needs to take greater responsibility, not least when it comes to the financing of healthcare and in order to increase equality across the country.

These are areas that we Social Democrats include in our proposals on how healthcare should be organized. We propose that the general state grants are indexed, i.e., increased automatically. In this way, the state grants are protected against inflation and provide municipalities and regions with better and clearer planning conditions. We call it laying a foundation for the welfare, and it means that in our budget for this year, we had 6 billion kronor more in general state grants to municipalities and regions than the government did.

The Care Responsibility Committee also points out the need for greater state responsibility for, among other things, skills supply, pharmaceuticals, vaccinations, and screening. This is in line with proposals that we Social Democrats have put forward. Among others, we have proposed larger investments in healthcare personnel. In our budget motions for both 2024 and 2025, we have allocated 3 billion more than the government for personnel investments. We believe that it is needed to meet the challenges of the healthcare system.

We also believe that much of the solution to today's challenges lies in better interaction between the state, the regions, and the municipalities. We therefore welcome that the government has now taken an initiative for the continued development of good and close care in the transition currently underway so that primary care shall be the patients' hub in health and medical care.

The referral to the Council on Legislation that the government presented last week highlights some of the areas that require continued work: focus on rehabilitation, focus on access to the right medical expertise at all hours of the day, and focus on both physical and mental health in primary care. It is important and welcome.

But much more than that is required for the organization of healthcare to improve. If we are to reach the goal of good and close care, we must clear up the mess and the market failures that exist in Swedish healthcare today. The starting point must be that healthcare shall be available where it is needed and that the patient with the greatest need shall go first. But today, in large parts of Swedish healthcare, private healthcare providers have the greatest opportunities to make a profit.

We Social Democrats believe that the regions should have greater powers to govern the establishment of new health centers to ensure that the entire region's population has access to good care. Therefore, we want to abolish the legislation that means that anyone who wants to start a health center can do so and also receives funding from the regions to do so.

We have seen far too many examples of how the law on choice systems in primary care has resulted in new establishments of health centers in areas where there are already plenty of health centers and where access to care is good. This occurs at the expense of investments that would be needed in other areas in a region or in other parts of the healthcare system.

We also mean that private actors who are funded with public funds should take a larger share of the collective responsibility that healthcare entails. We want private actors to have the same obligations as public ones to contribute to the development of healthcare, for example regarding crisis preparedness, research and development, and to offer students work-based education. It is not reasonable that public care should take all that responsibility while private actors can focus entirely on more short-term profits.

In recent years, we have seen hair-raising examples of how private actors can put profit before good welfare. In Dagens Nyheter, 19 women have testified about deficiencies in gynecological care and aftercare in Stockholm. Several women have come close to dying.

The latest article was about Catharina, who died as a result of a so-called healthcare-related accident. She was not discovered by the healthcare provider who had operated on her. Despite the fact that she was not well at all, she was sent home. When she arrived at the emergency room a few days later, it was too late.

The article in Dagens Nyheter is about a family's grief over a lost daughter and frustration over the healthcare system's failure. But it is also about a private healthcare choice system that has capsized. We cannot have it this way in Sweden.

We need to clean up the mess. But a sharpened state control was also needed to address the problems. In that work, the Health and Social Care Inspectorate has an immensely important role to ensure that both regions and municipalities as well as private providers follow current laws and regulations. Ivo must have the right conditions to be able to do his work in a good way. Therefore, we Social Democrats say that we must invest extra resources so that Ivo can do just that.

It is no longer just about Ivo having the competence to ensure that healthcare maintains the right quality. That is extremely important, but today Ivo must have the competence to see through business arrangements from organized crime. Ivo must be able to audit operations run by criminal actors for purely criminal purposes. That is, in fact, how the Swedish healthcare market looks today.

It is not sensible. We cannot have it this way. Patients are not customers in a market. They are people with different needs for care but with an equal right to have their needs met. The patient with the greatest need should always go first, regardless of where in the country the patient happens to live.

Madam Speaker! I stand behind all the Social Democrats' reservations, but I would like here to specifically call for approval of reservation 7.

(Applause)

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

Anders W Jonsson (C)

Madam Speaker! Karin Sundin expressed disappointment and surprise that the Christian Democrats did not stop pursuing their demand. It rings a bell. It is much like when John Cleese in 1969 was dissatisfied and surprised that Michael Palin could not realize that the parrot was actually dead.

But that was not why I requested the floor. It was because of what happened at the Social Democratic congress. A central theme in the welfare discussion there was to regain control, for example over primary care.

I am so old that I remember the time when one belonged to a certain health center and did not have the possibility to choose. I remember several younger colleagues who very much wanted to start primary care units but absolutely were not allowed to. Then we got LOV and Vårdval Sverige, which has resulted in that we today have a fantastic development regarding primary care in Sweden.

There is no patient who would want to return to the situation where it is the politicians who have control over which health center or medical center one belongs to. I believe the surprise would be great if you told younger doctors and nurses: Even if you want to start your own unit, you are not allowed to, because the politicians want the control.

I heard Karin Sundin say in her speech that if you just start a health center, you get the funding from the public sector. I must correct Karin Sundin there. It is only when a number of patients say that it is specifically this health center they want to go to that the public sector pays. No money is paid out in advance.

I find it a bit difficult to understand the Social Democrats' enthusiasm for politicians reclaiming control from patients who want to make choices and from proactive doctors and nurses who want to work in primary care.

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

Karin Sundin (S)

Madam Speaker! Thank you for the question, Anders W Jonsson!

I am the first to say that we have excellent private alternatives in this country. We have well-functioning health centers operated both in the public sector and in the private sector. We have that across the entire country, also in my home region of Örebro län. There are an enormous number of healthcare providers who do an enormous good job.

It is not the patients' control that we are looking for. We want patients to have the opportunity to choose for themselves and be their own hub in cooperation with primary care. We also do not want to take control away from the healthcare professions. On the other hand, we argue that it is our responsibility as representatives of the state to have control over how public funds are used, and they are to a large extent not being used in the right way today. We need to ensure that the crowns intended to be used for health and medical care are also used for health and medical care and not for profit distribution or investments that are not for the benefit of the patients or for the professions that are to do the work.

That is what we mean by reclaiming control. Today, an entirely too large part of the control is outside of our power. Nor do our public oversight bodies, such as the Health and Social Welfare Inspection and the National Board of Health and Welfare, have the possibility to see through what is happening with public funds without standing powerless in the face of serious organized crime. This is what we mean by taking back control.

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

Anders W Jonsson (C)

Madam Speaker! To say that one wants patients to have the right to choose which health center they want to go to and at the same time want to limit the private sector's opportunities is a bit like saying: I would very much like to have a new car, but we can ignore those four wheels. If one is to have a number of alternatives in primary care, Madam Speaker, it is based on opening up for, encouraging and providing the conditions for enterprising companies, doctors and nurses who want to start their own clinics.

Apparently, one should be able to start companies in primary care, but one should not be able to take out profits. What private companies would survive at all without having a plus on the bottom line?

If one seriously wants to maintain the freedom of choice in primary care – today it is 45–50 percent of the Swedish people who appreciate it and choose a private healthcare provider – it is based on the fact that we have good conditions for the private healthcare providers who want to establish themselves and want to run operations. The money does not go to these clinics either if it is not a number of thousands of patients who say that they would very much like to go to this newly opened clinic instead of the old one that they are dissatisfied with.

I am the first to say that we must have control over public funds to the extent that there must be extremely sharp quality controls. There we can certainly do much more – especially when it concerns organized crime which in some places has managed to nestle itself even into primary care. There, there should be no pardon. There, society must strike hard. But when one lifts those few such examples that exist and, based on them, is prepared to pull the rug out from under all the private, very skilled healthcare providers we have in primary care, I do not understand how the Socialdemokraterni think.

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

Karin Sundin (S)

Madam Speaker! We shall not pull the rug out from under anyone who contributes to Swedish healthcare in a constructive, good, and quality-assured way. On the other hand, we shall pull the rug out from under those who primarily do so for the purpose of making money and exploiting our public welfare systems for their own gain.

We mean that we should have good conditions for the actors in health and medical care. However, it does not have to mean that one can make as much profit as one wants. There are many ways to regulate how large a profit withdrawal one is allowed to make and in what way the profit may be used. Let us look at that!

I do not believe that the Social Democrats and the Centre Party necessarily need to stand so far apart on these issues. It is about ensuring that every tax crown is used in the right way – for the best possible care for the patients, the best possible working environment for the staff who are to perform the care, and the best possible conditions to develop healthcare to be good also in the future.

We need to get better at this in Sweden today. What we see, the alarm reports we are receiving now, show a healthcare system that actually does not function. We see how our public welfare systems, including healthcare, are being looted by criminal actors. So we cannot have that.

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

Johan Hultberg (M)

Madam Speaker! The organization of health and medical care is the heading of the committee report we are now debating. It may be a not particularly exciting heading, but the report actually contains both important and ideological issues.

Will freedom of choice and diversity increase or decrease? Shall the patient's position be strengthened? Or is it instead the politicians' power that is to increase? Shall we have a centrally controlled healthcare system or a healthcare system shaped regionally close to patients and employees?

These are questions that are answered very differently by the parties in the Riksdag. The answers shape the parties' policies and, consequently, the design of Swedish health and medical care.

On behalf of the Moderates, I will attempt to answer these questions and describe how we Moderates want to develop the organization and governance of Swedish healthcare for the benefit of the individual patient. It is precisely the individual patient who is the starting point for the Moderate healthcare policy. The patient must always be put first, and the care queues must be shortened. Therefore, freedom of choice and diversity are important. We are convinced that diversity is better than uniformity. Both patients and staff need to have the right and the opportunity to choose and to opt out. We are convinced that the competition that arises between different actors contributes to innovation and development, and it makes care better and more efficient.

Madam Speaker! Healthcare must become more efficient. Measuring productivity within healthcare is admittedly difficult, but it is clear that costs are increasing faster than production. It is unsustainable. We must get more care for the money. Therefore, the government's establishment of a special efficiency delegation is important. It shall be a delegation that supports the regions in their endeavor to work smarter. It is also important and smart to strengthen preventive and health-promoting work.

An incredible amount of suffering and enormous costs can, in fact, be avoided and prevented. Therefore, I am pleased that the Tidö parties and the Moderate-led government prioritize early and preventive measures and also drive innovative models in the form of, among other things, social outcome contracts to meet the public health challenges.

Madam Speaker! I have had the privilege of being part of the Care Responsibility Committee, which is the government inquiry that since the autumn of 2023 has been tasked with analyzing the pros and cons of a full or partial state ownership of care. After a solid and ambitious analysis and investigation work, it is clear for the Moderaterna, as well as for a further five of the Riksdag's parties, that care shall not be nationalized.

The problems and challenges that Swedish healthcare struggles with are not explained by today's ownership. Thus, the solution to the healthcare's problems and challenges is also not to initiate the greatest organizational change of all time. What the gains of such a change would be is highly unclear. It is clear, however, that the risks of such a reorganization are great and that the implementation costs would become very high.

Instead of spending the coming decades on carrying out a massive reorganization, we need to strengthen the patient's position here and now and tackle the concrete problems we see within healthcare. We Moderates want that as a patient, one should have access to good and close care, but also that one should have the right to seek care throughout the entire country. Healthcare needs to be humanized – not nationalized.

That healthcare should not be nationalized does not mean that the state can lean back. The state needs to take greater responsibility as well as develop and improve its governance in order to create a better and more equal healthcare. That is something I and the Moderates have pointed out and pushed for for a long time. And it is now also clearly expressed through the policy of the Moderate-led government.

One of the government's most important reform efforts concerns creating a national digital infrastructure and clearing away the many obstacles that exist for utilizing health data and the possibilities of digitalization to a greater extent and in a smarter way. Specifically, it is about the state needing to take a strategic responsibility for the healthcare infrastructure and ensuring that Sweden is an attractive country for research and development of new medicines and treatments.

I am also very pleased that all eight parties in the Care Responsibility Committee agree that the state needs to take greater responsibility in an additional six areas. In the Care Responsibility Committee's final report, it is proposed that the state should take greater responsibility for competence supply, pharmaceuticals, vaccinations, screening, forensic psychiatric care, as well as airborne ambulance care and airborne medical transports.

The time, Madam Speaker, is not sufficient for me to develop the reasoning behind every area, but let me specifically highlight the competence supply.

A good supply of competence is absolutely crucial to making healthcare better and to being able to address the problems and deficiencies we see within Swedish healthcare, namely lack of accessibility with long care queues and geographical differences. The root cause of poor accessibility or geographical differences is often a lack of competence supply. To improve the competence supply, more people must want to both seek out and remain within healthcare's many professions. Therefore, the working environment must become better. It is nothing that can be easily commanded from the Riksdag, government, or agencies in Stockholm; instead, it requires regional and local work and, not least, good leadership. What the state, however, needs to secure is a national coordination and dimensioning in the education of healthcare personnel. 21 individual regions simply do not have the national perspective, and that must be taken by the state.

Madam Speaker! What is crystal clear for me and the Moderaterna is that the state does not only need to increase its accountability, the state also needs to develop and improve its governance. We know that the state's governance of health and medical care today functions poorly. But the solution is then not just to increase the governance. On the contrary, the way forward in many and much is to reduce the governance but to govern better.

Today, the regions are hit by a large swarm of steering signals coming from the national level. Ultimately, the regions are governed by the laws we enact here in the Swedish Riksdag, but then a multitude of other steering signals are added. These are steering signals that many times are far too detailed and too short-sighted. The state steers with ordinances and regulations, through agency mandates and agreements with Sveriges Kommuner och Regioner, and not least through budget appropriations. The appropriations consist largely of targeted state grants that rarely function particularly well. The state's steering needs to become narrower but sharper. So, I would like to summarize the Care Responsibility Committee's proposal on how the state's steering needs to be improved.

Specifically, we in the committee point to the need to provide the regions with long-term conditions and that the state's governance should to a greater extent be about norming as well as control, follow-up, and accountability. As a Moderate, I am pleased that the committee is clear that targeted state grants should only be used in exceptional cases, as well as that the patient's position should be strengthened and that it may mean new sanction possibilities. For the Moderates, it is clear that the state needs to step forward to strengthen the patient's position. As a patient, one should receive care in a timely manner.

Madam Speaker! Unless anything unforeseen occurs, tonight's debate is my last before I leave my mandate as a Member of Parliament to instead use my drive and my strength as a municipal official to try to develop my own home municipality, Tanum.

I have had the privilege of shouldering the very finest of trusts, namely to be a member of the Riksdag for 15 years. It has been 15 incredibly exciting, developing, and challenging years.

During these years, the political landscape has been redrawn. And we as a country and we elected representatives have had to handle major challenges and crises. The climate challenge, Brexit, the refugee crisis of 2015, terrorism, the corona pandemic and not least Russia's illegal war of aggression against Ukraine are things that have characterized my time here in the Riksdag.

Madam Speaker! I understand that there is no time and probably also no interest for me to give a long review of everything that has happened during my time in the Riksdag. But let me still, before I leave this rostrum, say a few words about the Riksdag, or the democracy factory as I sometimes call this fantastic institution and workplace.

The central production method in the democracy factory is to let different ideas, opinions, and proposals clash against one another. After debates, negotiations, and investigations, decisions eventually fall out. These are decisions on legislation, on the state budget, on the shaping of our foreign policy, or on the work at the EU level. The decisions are intended to make Sweden better.

The first and most important provision of the Instrument of Government is that all public power derives from the people. It is the Riksdag, we 349 members, who are the people's primary representatives, but we grant the power to govern the realm to the government. That the government and its agencies administer that power in the best possible way is something we must control. I want to emphasize that this task is important for the Riksdag.

Madam Speaker! I am immensely grateful for the wonderful trust that I have been given. To serve here in the democracy factory for four terms is a rare privilege. Even though the democracy factory's machinery grinds a bit slowly, I can still, now as I look back, state that much has happened during this time. I have been involved in making the difference that all of us who are politically engaged want. It has been an honor and a pleasure, but it has also involved many sacrifices and hard work.

In conclusion, I would like to extend a warm and heartfelt thanks to all members from all parties. I would also like to extend a warm and heartfelt thanks to all officials in the Riksdag Administration, in the party and committee offices, all caretakers, service technicians, IT technicians, janitors, assistants, property technicians, recording notaries, investigators, chamber secretaries, and other fantastic colleagues who hold various roles but who collectively ensure that the democracy factory functions and is well-oiled.

Thank you to you all and thank you for me!

(Applause)

In this speech, Thomas Ragnarsson and Jesper Skalberg Karlsson (both M) agreed.

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

Anders W Jonsson (C)

Madam Speaker! It is difficult to take a point from Johan Hultberg and the Moderaterna given that the Centerpartiet and the Moderaterna have largely identical views when it comes to exactly the healthcare policy.

The reason I requested the floor now is actually that I want to do exactly the same thing as I have done once before in the Riksdag. During the corresponding debate three years ago, I used the opportunity to speak to express my great respect for and my thanks to Barbro Westerholm. I would now like to do exactly the same thing for Johan Hultberg, Madam Speaker.

Johan Hultberg has in fact meant a great deal as a member of Parliament and has actually made a personal difference in a number of issues where we would not be where we are today if it were not for his efforts. I want to mention two issues in particular.

One is the addiction diseases and how we treat them. There, Johan has had a very great significance for the shift in position that has been made within the Moderaterna. Without it, we would not have the broad support we have today regarding a policy that actually leads to people with addiction diseases receiving a much better care.

The second question concerns the legislation that enters into force now on July 1 regarding the possibility of changing legal gender. Many of us had great respect for Johan Hultberg's hard work and persistence when he pushed that issue forward.

There are surely additional questions. But one actually cannot point at all members who leave the Swedish Riksdag and say: Here, the individual has made a difference.

I have great respect for the fact that Johan Hultberg has made the decision to, for a period, work close to his family on the west coast in Bohuslän. But given his ability, Madam Speaker, I would not be surprised if he reappears in a heavy position within national politics.

(Applause)

In this speech, Gustaf Lantz (S) agreed.

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

Johan Hultberg (M)

Madam Speaker! Thank you for the floor and above all thank you for the words, Anders W Jonsson! It warms me enormously that you express yourself in the way that you do. I have truly appreciated the fine cooperation that we have had in our roles in our respective parties.

It is important to emphasize to the audience. Sometimes when one follows the Riksdag and Swedish politics, it appears as if it is only conflict and a high tone. But there is also a lot of constructive work to jointly move Sweden forward and try to solve difficult problems. In those cases, it is often a good cooperation across party and bloc boundaries. I have had that with Member Jonsson, and I have appreciated it very much.

I know that Member Jonsson will also be leaving the Riksdag, though under more orderly circumstances when the parliamentary term has expired. I think that Member Jonsson also deserves a big thank you and great appreciation for the fine work he has done, not least in the matters where he expressed praise for me.

The two questions are the kind of questions where it has been required that people have stepped forward within their own parties, engaged in internal debates, and had the strength to stand firm when it has been difficult. I know that Member Jonsson has done that and has had that persistence. There are probably few members in this chamber who have driven the specific question of better addiction care as stubbornly and long-term as Member Jonsson has. A warm and heartfelt thank you for that!

(Applause)

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

Karin Rågsjö (V)

Madam Speaker! As a gift, I intend to give the members a small ideological debate here at the final stretch.

Free choice of care and freedom of establishment have opened the doors for welfare crimes. There is no doubt about that. It has created a rather sick culture. Money as an incentive often creates a special culture.

Ivo also describes that their mission has become much more complex. It has shifted from focusing on the quality of care and nursing to also auditing corporate structures, front-man arrangements, the presence of drugs and weapons, and gang recruitment. Ivo is becoming something of an FBI in the dysfunctional situation we have.

The previous government often speaks about how much over-administration the regions engage in. This actually creates over-administration in a number of places. For example, the regions now have to build up their own small units to monitor what is happening. It becomes very costly.

I wonder if the member here in the final debate has any sharp proposals regarding that specific question.

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

Johan Hultberg (M)

Madam Speaker! Of course, Member Hultberg has that. The Moderates are a full-range party that has policies for most societal challenges.

It is absolutely true that welfare crime is a serious societal problem. It is something that the Tidö parties and the Moderate-led government have truly addressed and dealt with, not least through the establishment of the special Payment Authority. It is important for stopping incorrect payments of various compensations and social insurance benefits. These are benefits that we must ensure land with those who are entitled to them, so that we can maintain the systems in the long term as well as the trust in the systems.

I think it is somewhat serious that Member Rågsjö and the Left Party refuse to see that the criminals' ugly face is making its way everywhere in society. It does not only manifest through private actors, but the criminals are also making their way into the municipalities' social offices and into the courts – everywhere.

Solving the problem of welfare crime is therefore not as simple as realizing the Left Party's wet dream, namely to kill everything called private execution, diversity, and freedom of choice. The challenge is more complex than that. It is about doing exactly what my government is doing, namely tearing down secrecy barriers, pushing for increased agency cooperation, and ensuring that we have strong supervisory authorities that are resourced and can meet the challenges of the new era.

The answer is not to kill freedom of choice. Instead, we shall cut off the head of welfare crime when it shows its ugly face.

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

Karin Rågsjö (V)

Madam Speaker! It is exactly as Johan Hultberg says: This exists in a few places and is system-threatening.

But now I will release this – the debate, that is, not the questions – and move on to something completely different, Madam Speaker. The member and I have worked together quite a bit, on various issues.

Covid was not an easy match. One could make a film about it. A series will surely come soon, I think, about exactly that and what happened in the Social Affairs Committee.

I am also thinking about the issues of addiction, where you have really pushed your own party forward. It has, just as MP Anders W Jonsson said, meant very much. We have also moved closer to each other in the Social Affairs Committee regarding the view on addiction.

The Speaker also fought for the legal gender. That type of energy and courage is important; one must have it if one sits in the Riksdag, I think. One must be able to take the fight even internally, within one's own party. I think we have all done that.

I just want to thank the member for a fantastic cooperation, says Vänstern, in the issues I have mentioned. Thank you!

(Applause)

In this speech, Gustaf Lantz (S) concurred.

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

Johan Hultberg (M)

Mr. Speaker! I have very much appreciated Member Rågsjö. We have had many spirited debates and exchanges of remarks, such as the most recent one. I think it is important that we have these ideological, value-based debates in Sweden's Riksdag – that not everything is just about technicalities and small adjustments in the machinery, but that we also go back to values and ideological starting points. It is important for democracy. I have had many spirited debates of that type with Member Rågsjö, and I have appreciated them and had a lot of fun.

I have also had fun when we have been able to join forces on important issues, such as the problem of addiction and how we can ensure that we try to fill the serious gaps that we know many with co-morbidity and addiction fall into. I greatly appreciate the constructive cooperation that the two of us have had as members, but which we have also had in the entire Social Affairs Committee. There is a good spirit of cooperation in the Social Affairs Committee, and it is my wish that it should endure when I leave the Riksdag.

Hold on to that, and hold on to the robust debates here in the chamber! Warm thanks, Karin Rågsjö!

(Applause)

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

Karin Sundin (S)

Mr. Speaker! Much can be said about the organization of health and medical care, but I do not have much to say in reply today either. I would instead, Mr. Speaker, also take the opportunity to thank Member Hultberg for the debates.

Fifteen years is a long time. Member Hultberg has been a member for significantly longer than I have and has also sat on the Social Affairs Committee significantly longer than I have. But during my years in the Riksdag, I have come to know the member as a sharp debater. We have also had some harsh exchanges of words here in the chamber. But we have also had good cooperation when it has been needed, and that is well and truly how it should be.

I speak for the Social Democrats as the large, governing party when I say that we are glad that, from time to time, we can join forces with the other, almost equally large – or well, half as large, but still – governing party. Many thanks for the fact that we have been able to do so in a constructive manner when it has been necessary!

Several questions have already been mentioned here in the debate. I also want to highlight the hard and responsible work that the members did when it came to producing a new gender identity law. It was necessary to change the lives of a number of people in a very important way, even if they are not so many.

I also want to particularly thank Member Hultberg for the cooperation we have had regarding drug policy issues and for the contribution that the Member, who has been mentioned here, has made in the drug policy issues. Together we have carried a number of them in the cross-party drug policy network here in the Riksdag. This is something I will take with me in my continued work.

So thank you for the work, Member Hultberg, and good luck with continuing to make a difference!

(Applause)

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

Johan Hultberg (M)

Mr. Speaker! These are the most difficult exchanges; one is not used to receiving so many encouraging and praising words. I appreciate them enormously, and I also truly appreciate the cooperation that I and Member Sundin have had, in the committee but also a bit on the side of the committee. It concerns, for example, the narcotics policy network, where we jointly try to increase knowledge and commitment in our parties and here in the Riksdag regarding these important issues and also get more members from other committees than the Social Affairs Committee to understand that they also have an important role in ensuring that persons with addiction get better care and support and better conditions in life. A warm and heartfelt thank you for that!

Thank you also for the spirited debates we have had! I have appreciated them very much. I am sure that Sundin's wonderful debating style will continue to create energy here in the chamber. Continue on the path you are on, and a warm thank you for these years together!

(Applause)

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

Nils Seye Larsen (MP)

Mr. Speaker! After these exchanges with very fine thank-you speeches, I am almost a little ashamed that I actually had a political point of order. But it has been incredibly pleasant to work with you during the short time I have been in the Committee on Social Affairs. I wish you all the best.

I just wanted to link back to something the member said. I agree that funding alone does not solve everything; one must also be able to make priorities. When I read the report How is healthcare doing? from Kunskapsverket, I was struck by the fact that the absolute largest cost increases within healthcare concern the purchase of services from private healthcare providers. Another thing I noted in the report was that the personnel categories that have increased most proportionally are the groups central administration and managers, while healthcare staff have remained somewhat more stationary.

When Minister for Health Acko Ankarberg visited us in the committee to talk a bit about welfare crime at some health centers, I thought about how she was clear that the government will never ever back down from total market freedom and the right of free establishment. But she expects the regions to ensure that they tighten control and follow-up and write better contracts, which means, as she herself confirms, more administration. I just wanted to hear how the member views this.

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

Johan Hultberg (M)

Mr. Speaker! We must do an enormous amount to reduce the bureaucracy within healthcare. Getting more care for the money is one of the most important ways to ensure that healthcare staff get more time with the patient and need to spend less time on administration and documentation. Therefore, for example, the work to create a national digital infrastructure, which I raised in my speech, is incredibly important. For example, a doctor should not have to document information in a medical record system, a medication system, and a national quality register. It must, of course, be possible to enter a piece of information once so that it is available in different ways and in different systems.

When it comes to welfare crime, it is important that we ensure that the state and the regions do not duplicate work. There is a lot of such work today. We need to ensure that the roles between the region and the state are clarified.

I believe it is incredibly important that we ensure that confidentiality barriers are removed in order to achieve better follow-up and better control.

Welfare crime and the unscrupulous actors are skilled at exploiting weaknesses in the system. One such weakness is that confidentiality barriers prevent different authorities and actors from obtaining a coordinated picture. This tears apart the Moderate-led government. We ensure that we can, in that way, tackle the unscrupulous actors in a good way.

But if the question was whether the Moderaterna do not want to kick out all private actors to stop welfare crime, the answer is the same as to Member Rågsjö: We shall guard diversity. We shall guard the freedom of choice for the sake of the patients, for the sake of the employees, and because this also drives innovation and contributes to a more efficient healthcare. But yes, we must ensure that we get better control and better follow-up, so that no unserious actors can make money from healthcare.

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

Nils Seye Larsen (MP)

Mr. Speaker! A large part of the cost increase is not necessarily about money spent on private welfare-criminal companies. But a major challenge when we have health legislation that says we should have good and equal access to care throughout the country and that care should be based on needs is that a large market experiment has been built up, which results in a healthcare consumption that is unequal. I agree that there are many private providers who do a good job.

Here we can look at the online doctor companies. One might think that where it is absolutely furthest to the nearest health center, in the northern parts, the consumption of online doctor services would be highest, but it is precisely the opposite. Consumption is highest in the densely populated areas – the more densely populated, the higher the consumption. Is the health status for Stockholmers, Gothenburgers, and Malmöites really that much worse? I am doubtful of that. But it is, therefore, driving up the cost.

When one appoints an efficiency delegation, there is only one person who has medical expertise, and that person is simultaneously the CEO of one of these online doctor companies. My follow-up question is: Can the member see a problem in this, that it comes into conflict with the intention of making healthcare more efficient? Does one realize that there are challenges with the completely free right of establishment when it comes to healthcare?

Thank you, Johan Hultberg, and good luck in the future! It has been great fun to debate with you.

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

Johan Hultberg (M)

Mr. Speaker! Thank you, Member Seye Larsen, for those words! I greatly appreciate our cooperation and warmly wish Member Larsen good luck in the continued role in the Social Affairs Committee and in the Riksdag.

When it comes to the private actors, it is a very incorrect description to say that there is total freedom of establishment. There are quite high thresholds to establish oneself within healthcare and, for example, to become a provider within primary care. This has, I would say, become a real problem. If we take primary care as an example, I can say that the thresholds for starting a health center today are incredibly high. This causes health centers to become staff-driven to an entirely too small extent. It becomes difficult for smaller actors to compete and establish themselves.

There is every reason, not least for the regions, to review their specifications and see if it is also possible for smaller actors to offer care to the people of Västerbotten, Bohuslän, or whoever it may be.

Then I also believe it is an incorrect conclusion to say that just because the costs for digital care increase, the costs for healthcare in general also increase. The fact is that digital healthcare visits are generally cheaper and more cost-effective than physical ones.

Then there are absolutely major problems with the reimbursement systems we have. Hardly anyone thinks that today's model with out-of-county reimbursements is a good arrangement. It needs to be developed. But fundamentally, we must understand what these companies contribute. They contribute an opportunity for us as patients to receive care where and when we need it. That flexibility is something the healthcare system has previously struggled to live up to.

I am pleased that the regions are also now developing their digital services. It is necessary for healthcare to become more accessible and more cost-effective.

The efficiency delegation is still in its early stages. We will evaluate it later.

(Applause)

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

Carita Boulwén (SD)

Mr. Speaker! Today we are debating the Social Affairs Committee's report 16 Health and Medical Care's Organization. We in the Sweden Democrats naturally stand behind all our reservations, but I move here for approval only of reservation 17.

Mr. Speaker! A strong and functioning healthcare system is a cornerstone of a well-functioning society. Every citizen should feel secure that care is there when it is needed, regardless of where in the country one lives or what illness one has. But for this to be possible, more than just ambitions are required: structure, long-term perspective, and above all, that the healthcare staff are given the right conditions to perform their life-saving work.

The Sweden Democrats see the healthcare staff as the heart of the entire system. It is their knowledge, commitment, and perseverance that make healthcare function – from the health center in the rural areas to the highly specialized unit at the university hospital. Therefore, we are pleased that the government, in line with what we Sweden Democrats have long demanded, has now received a national plan for the healthcare sector's competence supply.

The plan, which has been developed by the National Health Competence Council on behalf of the National Board of Health and Welfare, contains 25 concrete proposals for measures to secure access to healthcare personnel throughout the country, not least in rural areas and in smaller municipalities. They focus on better matching between training places and the actual needs of healthcare, continuous competence development, clearer career paths, and an improved work environment.

For us Sverigedemokrater, it is crucial that healthcare personnel not only have the strength but also want to remain in the profession. Therefore, this is a very welcome step in the right direction. It is an important direction to stop the flight of competence, improve continuity in healthcare, and ensure that resources are used where they do the most good. The plan also builds in a systematic follow-up with annual reporting to ensure that the proposed measures are actually implemented and have an effect.

Mr. Speaker! No one should have to wait, turn, or fight to get care. Healthcare should be there when it is needed, secure, close, and designed based on the patient's needs and life situation.

The concept of "near care" has long been associated with primary care. It is an important perspective, but it is not sufficient. We mean that it is now high time to also include highly specialized care in this work.

The government has recently taken further steps by submitting a referral to the Council on Legislation to strengthen the transition to good and close care. The proposal clarifies primary care's responsibility and covers both physical and mental needs, strengthens cooperation between region and municipality, and secures medical competence around the clock. It is an important step to increase accessibility and safety for the patients.

Close care must also mean that care is provided where it does the most good for the patient, regardless of the level of care. There are good opportunities today to offer advanced cancer care at home, for example by administering chemotherapy at home and monitoring the side effects remotely. This provides security for patients, reduces the burden on hospitals, and frees up resources.

We in the Sweden Democrats also believe that the state must take greater responsibility for access to modern radiotherapy. The differences in infrastructure are too great. It is not acceptable that the healthcare outcome should depend on which region one happens to belong to.

We also see a great need to improve cardiac care. Today's care chains are not sufficiently cohesive. There are large differences in quality of care. Therefore, we propose a national heart strategy with the goal of creating an unbroken care chain from emergency care to rehabilitation. Furthermore, resources for advanced cardiac care must be ensured throughout the country.

Mr. Speaker! We in the Sweden Democrats have long been clear. Swedish healthcare needs more cohesive governance. The current division between 21 different regions leads to unequal care, double work, and a lack of accountability. The patient is caught in the crossfire when the system fails.

Therefore, Mr. Speaker, we welcome that the government, through the Vårdansvarskommitténs report, now points out concrete areas where the state should take greater responsibility. This concerns six central parts of the healthcare system: competence supply, pharmaceutical supply, vaccinations, national screening programs, forensic psychiatric care, as well as airborne ambulance care and medical transports.

That these areas are being highlighted is wise. They require national coordination to function effectively and equally across the entire country. We in the Sverigedemokraterna see this as a step in the right direction. It is not about removing what works locally, but about building a more equitable, transparent, and accountable healthcare structure. The state must take a clearer grip for the sake of the patient.

Mr. Speaker! It is impossible for me to stand here in this chamber and speak about the future of healthcare without raising psychiatry.

We have for a long time lived with serious deficiencies within psychiatric care. Too few care beds, lack of cooperation between responsible actors, and significant competence gaps lead to patients not receiving the support and treatment they need when they need it. The consequences do not only affect those who have been affected by mental ill-health or illness. This also affects the families around them, the entire care chain, and in the long run, the security in society.

It is not acceptable that people with serious mental illness are bounced between different authorities, go without help, or are forced to wait for weeks or months for interventions that are crucial for their life situation.

Within the framework of the Tidö Agreement, important investments are now being made in psychiatric care. The work focuses on strengthening forensic psychiatry, improving the continuity of care chains, increasing the number of care beds, and meeting the needs of individuals with comorbidity, where mental illness and substance abuse often are interconnected.

It is important steps to re-establish a safe, cohesive, and accessible psychiatric care. But it also requires a clearer focus on quality and the patient's rights, not least for children and young people. Many children who are cared for within child and adolescent psychiatry report that they do not receive sufficient information or participation in their treatment. It is not acceptable.

Children should have the opportunity to understand the care they receive and be able to influence it. The Government should therefore work towards a systematic effort where children, to the extent possible, are given influence over their psychiatric care and access to information adapted to their age and maturity.

Mr. Speaker! We also see a need to modernize the psychiatric treatment methods. Older, traditional methods should be replaced if there is evidence that newer treatments yield better results. The Government should therefore task Socialstyrelsen with carrying out a broad review of evidence-based methods in the treatment of mental illness and depression.

The Sweden Democrats have also highlighted the need to broaden the view of what psychiatric care can be. We believe it is time for psychiatry to be both broadened and modernized. Not all patients fit into a model where medication is automatically the first choice. Psychopharmaceuticals fulfill an important function in some cases. But today's over-prescription, not least among young people, clearly shows that care needs more tools, more choices, and greater responsiveness to the patient's needs. The extensive prescription of psychopharmaceuticals, especially to children and young people, is worrying and requires a new direction.

The Sweden Democrats argue that more complementary and integrative forms of treatment should be available within psychiatry. Green rehabilitation and nature-supported care are examples of interventions that have shown good results, particularly regarding exhaustion syndrome and anxiety issues.

Other evidence-based non-pharmacological methods, where conversational support is combined with physical activity and body-oriented treatment, should be integrated as natural parts of the healthcare offering. It is time that these alternatives are given the place they deserve, for the benefit of both patients and the healthcare system.

We also want to emphasize the importance of freedom of choice. All patients should have the right to psychiatric care without medication if it is medically possible and the patient themselves wish it. The Government should therefore return to the Riksdag with proposals for a clear wording in the Patient Act that strengthens the right to medication-free treatment.

Mr. Speaker! For us Sweden Democrats, it is clear what is required to build a sustainable healthcare system for the future: primary care that functions as the hub of the system, accessible and equal care across the entire country, and a modern organization where even highly specialized care can be provided close to the patient.

Mr. Speaker! When we in the Sweden Democrats are involved in shaping health policy, we put the patient's safety and needs first. We prioritize functioning care chains, accessible and equal care throughout the country, and better conditions for healthcare staff to endure, develop, and stay. Our ambition is about a healthcare system that maintains high quality, not just today but also for future generations. That is how we build a healthcare system to trust – for the patients and for the staff. It is about the future of healthcare for all of Sweden.

In conclusion, Mr. Speaker, I would like to extend a warm thank you to all of you who work in healthcare – in tough environments, with heavy responsibility and often under great pressure. It is your efforts that make a difference every day. Our policy aims for you to be able to do your job with pride – with correct staffing, reasonable working conditions, and opportunities for development. I truly hope that you all have a very nice summer and that you get a chance for rest and recovery.

I would like to take this opportunity now to wish the Speaker, the Presidium, my committee colleagues and not least our administrative staff a very fine and happy summer.

(Applause)

(cont. § 13)

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