Skills supply, e-health and preparedness

Thomas Ragnarsson (M)

Madam Speaker! Today we are debating the Social Affairs Committee's report SoU14 Competence Supply, e-health and Preparedness. I would like to begin by moving for the approval of the committee's proposal for a decision.

This report is quite diverse and covers several very large and completely different areas. I will concentrate on skills supply and preparedness.

Madam Speaker! After 35 years within Swedish health and medical care, I consider myself to have quite good knowledge of the Swedish healthcare system.

During the last decade, we have been able to see that it has become harder and harder to provide the necessary skills for operations. This becomes extra clear during holiday periods. In the Tidö Agreement, we have agreed that some national governance within this area is needed. This primarily concerns a national mapping of supply and demand where responsibility is also taken for creating the conditions for skill supply throughout the country. This does not, however, deprive the regions of their responsibility to ensure the long-term skill supply within their own area.

There is a dispute regarding the reason why staff choose to leave the profession. What I hear in my meetings with staff is that the primary reason is a form of hopelessness regarding the assignment. As staff, one experiences that one is not seen and heard. There is a long distance between the management level, and there are more managers than leaders.

A simple way to create participation is to let the staff be involved in scheduling, work methods, and development projects. I was on a study visit at a larger hospital where they had no healthcare developers. Their philosophy instead was that all staff were healthcare developers and that it was a part of their service. Here, it was quite clearly seen that staff well-being was high and that the need for hired staff was much lower than at many other hospitals.

Madam Speaker! I believe everyone in here agrees that we must solve the long-term supply of skills in Swedish health and medical care to address the availability issues and the queue situation that prevails today. It is not worthy of a welfare state like Sweden that we cannot deliver the healthcare that our citizens need.

Therefore, we need to optimize the healthcare we have today and let these hospitals work based on the conditions that prevail at each respective unit. Our hospitals have different conditions, both regarding the available staff and regarding the premises in which they operate, and therefore we cannot assume that everyone will work in the same way.

A final reason for the lack of competence is that Swedish healthcare is in the process of administering itself into ruin. Staff describe over-documentation while at the same time the systems cannot be used optimally.

If we look at the quality registers that are kept today, we see that authorized personnel spend several hours manually extracting data from medical records. This could be done completely automatically. The most expensive resource in a hospital – the doctor – sits and writes certificates for medical travel and the like. I usually talk about RAK, the right use of competence, and in my eyes, a surgeon should to the greatest extent possible meet patients and perform surgeries – not manage quality registers or other unnecessary administration that someone else could perform.

Madam Speaker! We face a new reality in the world: after decades of relaxation, we now have a war in Europe. It is now becoming very clear that we lack preparedness for supply within Swedish health and medical care. This work has begun, but I believe everyone realizes that it will be a tough task to solve. The establishment of a civil preparedness minister has been very important in this situation, and I know that work is now being done intensively between departments and agencies to, among other things, map out what needs exist.

The work to build up stocks has also been started very slowly. It is obviously easy to be wise in hindsight and think that we should not have decommissioned the stocks we had. And that is the case, but it is what it is – and now we still have the chance to create a modern stockholding with materials that can be used in major events, whether it concerns war, pandemics, or other disasters. Money has been set aside in the budget for this work.

The acute hospitals that exist in Sweden today are needed, and we need to ensure that they can maintain their competence so that they can function fully both in daily operations and during war, a pandemic, or another major event. In addition to medical material, we also need to ensure that one can manage all types of transports to and from the hospitals. This means that one needs to review helicopter landing sites, and one also needs to review decontamination reception centers for contaminated patients.

Madam Speaker! In addition to stocks, we need to be able to handle everyday problems, such as the washing of blankets and staff clothing. This must take place locally. We need to increase the amount of reusable material in healthcare, so that cleaning and sterilization can be carried out continuously and locally. The use of disposable materials works perfectly well in everyday care, but in the event of a major incident, the transport capacity will not be able to cope with this. Then there is an imminent risk that, due to a shortage of materials, we will not be able to manage the influx of patients.

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Anna Vikström (S)

Madam Speaker! I want to raise an important basic prerequisite for the possibility of increasing the proportion of inhabitants in the population with a fixed doctor contact in primary care with the right competence and conditions for the assignment.

The previous government tasked Socialstyrelsen to, together with the National Health Competence Council and in dialogue with other relevant parties, develop proposals aimed at strengthening the employees and securing the future supply of competence in primary care. The National Health Competence Council has already submitted its report on this. Compared to the need, there is currently a shortage of many doctors in general medicine.

The final report states that the shortage of general practitioners results in poorer accessibility for patients and negatively affects the working environment for employees in primary care. The report proposes a number of measures, including that models for supervision of students during work-based training should be developed and that clinical practice within municipal health and medical care should be added. It also proposes a national leadership program.

It is also written that the target value of 1,100 inhabitants per specialist doctor in primary care is an important measure for improved competence supply. More suggestions are also provided.

Therefore, my question to the member is: Will the government take measures based on the National Health Competence Council's proposal so that access to doctors with the right competence and the conditions in primary care can be secured?

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Thomas Ragnarsson (M)

Madam Speaker! I thank the member for the question.

We are in the middle of a paradigm shift in Swedish healthcare, at least in terms of thinking. There is talk about good and close care, and there is talk about moving more resources to primary care. In that case, it is quite reasonable that one also reviews the issue of competence supply. I know that there are regions that have worked actively with this issue and created opportunities, both financially and purely in terms of work, to make it more interesting to become a general practitioner. But it is a tough situation.

Of course, it is the regions that are responsible for the employment, but in order for us to reach the goals with the intentions that exist, we must also work with the issue of skills supply at a national level. This makes it clear that the government needs to look at what can be done in this work.

Some of it is the national management. Today we do not have a good picture of how it looks nationally. Locally there is good statistics, and one has a pretty good grip on it. However, there is no unified grasp when it comes to the national context.

Given that we are moving towards good and close care, we must solve the problem of competence supply. It is absolutely crucial for Swedish health and medical care to be able to function in the future.

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Anna Vikström (S)

Madam Speaker! Thank you, Thomas Ragnarsson, for the answer!

At the latest committee meeting, we received a report on primary care and, among other things, its competence supply. The report showed that things are going completely in the wrong direction when it comes to the staffing of several different occupational categories. This does not align at all with the goals that have been set. This also hinders the transition in care that the member spoke about, which ensures that patients – not least the most ill elderly – with a fixed doctor get continuity in care and can prevent unnecessary emergency visits and unnecessary admissions to hospitals.

When it comes to the supply of competence, we often hear references from the government to the National Healthcare Competence Council, which has been given a mandate to be finalized in about a year. In the area of primary care, however, they have already submitted a report – over half a year ago – that can be used. This is somewhat my point; the mapping is already done when it comes to primary care.

It is very practical recommendations that show that some things must be done by regions, locally and otherwise, but some recommendations are also directed at the state and the national level. Therefore, I wonder if the member can answer a bit more concretely on when measures will be taken to improve the supply of skills in primary care. What measures are in the works to solve this problem?

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Thomas Ragnarsson (M)

Madam Speaker! Thank you, member, for the question!

I cannot give any date for when this will happen. I believe we must pause here. We cannot look at one thing and believe that we have solved all the problems.

Healthcare is a large organization. We have primary care and hospital care. This must be coordinated.

We know that the number of doctors in Sweden today is, overall, larger than ever. Some have left the profession, but de facto we have a very large amount of trained personnel. We actually have more trained personnel today than we have ever had.

Then it is a matter of managing this staff in the right way. As I touched upon in my speech, I do not think it is reasonable that doctors who are highly competent in their areas of responsibility are sitting and writing transport certificates so that patients can get to care. We can achieve extremely much by ensuring that each staff category does the right thing. There we have a first step.

The employers - in this case often regions, but there are also private healthcare providers - must consider how they can attract staff who have chosen to leave the profession to return to the employers' operations. I do not think the Riksdag should dictate how this should happen, but it must be something that each respective region and healthcare provider must come to an agreement on.

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Karin Rågsjö (V)

Madam Speaker! I intended to ask Member Ragnarsson whether the government and SD - for it is they who are governing this now - will really deliver a better working environment. It is indeed very many who are talking about this within health and medical care.

I am deeply concerned, Madam Speaker, about the signals I am receiving from the different regions. It looks a bit different, of course, but 17 of 21 regions have a type of deficit that means they will have to make cuts. One then wonders how these cuts will hit, for example, patients.

For me, it is incomprehensible that the government and SD have not stepped in with a larger supplement regarding the general state grants. I believe that it is going to become very troublesome. That is what is being said already now, and it hasn't been so many months since the new government took office.

Madam Speaker! I want to hear a bit about the outlook. It is also about wanting long-term perspective within health and medical care. One wants to be able to see what one will do in 2024. Which ones should be removed? Can one hire?

I think we are in a rather tricky economic situation right now.

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Thomas Ragnarsson (M)

Madam Speaker! Thank you, Member, for the question!

We have heard several times that the regions and municipalities will receive less money in state grants with the budget that has been presented. This budget has been presented based on the situation we find ourselves in. In the best of worlds, our economy would have been somewhat like the pig Särimner in the old Viking saga, so that what we burn today stands in the path tomorrow. But that is not the reality.

Since then, it is actually the case that the economy is something that is dynamic. Almost every region and municipality has made enormous surpluses in recent years. That is very good, but the idea is that these funds should be able to be used in worse times.

You also mentioned the work environment, Karin Rågsjö. I agree with you, and I am not just listening. It actually happens that I also work, so I see this. One thing that I both see and hear about is the importance of close leadership. This does not need to cost any money, because these leaders and managers already exist today. It could very well be that it is the wrong person in the position, but these people are already budgeted for. I believe that we have a lot to do with simple means there.

It is about, as I mentioned, creating participation and about feeling that there is a value in what one does. If a nurse has a good idea, the person dares to test the idea, because the person is a healthcare developer. That would be fantastic, and it is doable. It doesn't cost any money either.

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Karin Rågsjö (V)

Madam Speaker! It is absolutely excellent to do so. However, there must then be time, and for time, resources are needed.

I think it is a bit strange: We are in an economic crisis, but now we have also ended up in a welfare crisis, I want to assert. It is about the government and about state responsibility.

Is an investment in welfare, i.e., school and health and medical care, inflation-driving? No, says the National Institute of Economic Research. Public investments have a very small effect on inflation. It is instead about rising food prices and so on, and it is clear that municipalities and regions are affected by it in different ways.

For Vänsterpartiet, it is extremely important that the regions are given long-term conditions. But we see none of that in the government's budget, instead, it continues to roll on.

Just as the member said, that is what happened with the stocks during the pandemic. It was due to the circumstances, and we cannot change that now. But we can ensure that the regions become responsible for having a stock for three months. Do we not need to legislate on that? There were, for example, three regions that had stocks for three days.

Does Member Ragnarsson believe that the regions will listen to the state and do as the state says, that is, keep stocks?

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Thomas Ragnarsson (M)

Madam Speaker! I will begin with the last question. Yes, I actually believe that the regions will listen, because they ended up in an extremely pressured situation during the pandemic. Everyone realized that it was a major failure that they were unable to maintain patient safety because they did not think a bit further ahead. I believe that most are working intensively on this issue without pressure.

It is complex. We have lived by just-in-time, where two trucks a week unloaded the material that the hospital will use during the week for the operations and the care that is to be carried out. So we cannot have that, and I believe most people realize that.

But it is an extremely tough task to create stocks for three months in each region, and I believe that one therefore needs to review a bit what material one needs. One cannot just prioritize disposable materials but must invest in reusable materials. One also needs to create things at a local level, for example a laundry, in order to be able to maintain hygiene.

One often gets the feeling that a cancer patient will not receive care because there is no money. But my perception is that there is quite a lot of money in the regions for care, but that one is quite good at saying that it is not possible to save and that it is not possible to make improvements and efficiencies. But now we are in an economic situation where we actually need to do so.

I am completely convinced that we will be able to deliver good care to all patients in Sweden with the budget that exists.

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Anna Vikström (S)

Madam Speaker! I stand behind all our reservations but move for approval only of reservation 1.

The foundation of our country's safe and high-quality healthcare is its staff. Healthcare's difficulties in retaining and recruiting staff lead to fewer care beds, longer waiting times, and a number of other consequences in care. In that way, the issues of competence supply are healthcare's most important and highest priority issues in the coming years.

But I will start at the other end and tell how fascinated I, as a young person, became by healthcare when I began my education and work within the field. To meet so many different patients, to experience that no day is like the other, to be able to develop and learn new things in a dynamic and changing environment, to be challenged, to be able to work closely with colleagues with different competencies, and to be able to work in a socially important activity is important, difficult, fun, and demanding.

There were deficiencies then as there are now. As a young, newly appointed safety representative, pointing out the problems with overcrowding at the medicine clinic to the operations managers who stood before me with disapproval was not entirely easy.

It is not easy today either. There are deficiencies in capacity. But the question is whether we have now reached a completely new level of competence shortage across the board. We know that today's Swedish health and medical care is under-dimensioned and that it is not sustainable. There is a shortage of staff with the right competence in large parts of health and medical care, which in turn affects the quality of care.

These deficiencies have also been described within scientific research as well as in a number of agency reports. A combination of measures at both state, regional, and municipal levels was needed, covering issues of a systemic nature as well as pure employer issues regarding conditions and the work environment.

The previous S-led government decided, within the framework of the January agreement, to establish a national healthcare competence council that would, in the long term, coordinate, map out, and work to streamline the supply of competence for personnel within healthcare. It is positive that the current government continues to give mandates to the National Healthcare Competence Council.

But against the background of the question's size and importance, we Social Democrats believe that the government should proceed and take the initiative for a national preparation for the welfare sector's competence supply. Models for similar cooperation structures exist, for example, in the defense area and the security area.

Through a preparation, forums are created for consultations between the government and representatives of the political parties in the Riksdag. Opportunities are also opened for a collective dialogue with stakeholders and actors in the field.

If we are to reverse the development regarding the attractiveness of welfare professions, a broad consensus and a common national initiative are required. As described above, it is precisely long-term investments in personnel and skills supply that are necessary to address all the major problems within healthcare.

The previous government invested in healthcare in several different areas, for example maternity care and good and close care, and through many general state grants.

An example of an initiative that should be long-term is the so-called Äldreomsorgslyftet, which finances competence development within elderly care. It is an area that faces great challenges ahead. Äldreomsorgslyftet can be used for different occupational categories and is, in broad terms, very useful. We hope that the government continues the initiative to enable staffing and competence within elderly care to be lifted.

It requires long-term work to address the issues concerning staffing, working conditions, and the work environment.

Madam Speaker! The questions regarding the digitalization of healthcare and effective access to health data are of central importance for the future of healthcare.

The Social Democratic-led government therefore prioritized these issues during previous terms through a large number of investigations and agency assignments. For example, it appointed two major investigations and gave a number of agency assignments on the use of health data, for example on the secondary use of health data for patient purposes and on national digital infrastructure. Vision e-health 2025 is ongoing, where state actors and the main employers in health and medical care cooperate on digitalization issues of national interest. There has also been a government assignment for a basic data domain for health, care, and service - to mention some of the assignments.

A new law on integrated health and social care documentation entered into force this year, which enables an efficient and secure exchange of information between health and social care providers.

The government stated in the budget bill that a national and unified digital infrastructure that puts the patient at the center will enable health data to become accessible throughout the entire care chain, regardless of the form of care or the primary provider. It is a promise that we Social Democrats will closely monitor during the mandate period.

When it comes to 1177, we believe that for reasons of quality and information security, it should be operated in the public sector. I come from Region Stockholm, where the Swedish Authority for Privacy Protection issued sanction fees against private subcontractors and the region due to deficient personal data management after data had lain unprotected with subcontractors in Thailand.

New digital healthcare providers have used marketing in their work in a completely new way. The marketing aims to drive consumption of the companies' services. In June 2022, the then S-government commissioned an investigator to review how digital healthcare providers can become part of a more cohesive primary care where all actors work together to meet patients' needs for care.

Madam Speaker! I am as trapped now as then by the health and medical care after a long professional life in different roles. But I am also frustrated that the investments in welfare now seem to be slowing down. It is evident in the current situation that additional funds are needed for regions and municipalities, even to maintain care and nursing at the current level. Otherwise, those who will be squeezed, as they always are, will be squeezed: the patients, the elderly within elderly care, and the women in care and nursing who most often bear the brunt when resources are too small, squeezed between their will to provide the best possible care and nursing and the resources available.

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Thomas Ragnarsson (M)

Madam Speaker! I thank the member for the speech. There were a few things therein that I felt I needed to comment on.

The Speaker mentions the state's role in developing Swedish healthcare. As I recall, the Social Democrats have been in government for eight years, and when one looks at how healthcare has changed, I have not seen much of those investments leading anywhere.

The member mentions maternity care. It is of course that we should invest in maternity care, but even there it has become worse in many places despite the fact that we have made large investments. I do not quite believe in the correlation that more funds all the time is a solution to the problems that exist in the operations. I would like to hear how the member views the eight years that have passed - what she takes away as successful investments that have led to us actually having a better situation.

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Anna Vikström (S)

Madam Speaker! I thank the member for the question. I can begin by describing how I felt in 2015 when the government at the time invested in maternity care - the first time a government has ever invested in maternity care with state grants. I thought it was fantastic!

I have followed the use of these state grants. Even the current government has continued with them, so you must think that they have had some kind of effect or that there is reason to provide them. I have followed this very closely. I cannot go into it in detail, but I can say that the care that has been able to be provided has become significantly better. When it comes to birth injuries, for example, it has been demonstrated that the funds have had an effect. And there are a number of follow-ups - three of them at the Agency for Health and Social Care Analysis - which in detail show what improvements have occurred.

In some area, success has not been achieved regarding maternity care: aftercare, for example. One needs to do significantly more of that. I can agree with the member of Parliament there. An initiative to improve aftercare - which is a neglected area that I also hope the current government will look at - will also not cost anything in particular. On the contrary, it will mean that one can move money from acute operations to slightly earlier interventions without it having any negative effect on the economy.

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Thomas Ragnarsson (M)

Madam Speaker! I thank the member for the answer. I do not actually believe that the member and I have any shared opinion on the matter. I can only state that we have invested a great deal in maternity care.

I can briefly describe something I experienced this summer. I had the privilege of delivering a child at a hospital that had no maternity ward. It went well; all the staff helped each other—ambulance personnel, nurses, a doctor, and nursing assistants. Everyone did their best, and it went well. The child was obviously to be moved on afterwards. We called five hospitals in four counties and received a no from all of them, as they had no space. That is not something I am proud of. That is when I feel that we have failed here. It is probably a recurring problem—the competence supply at our maternity wards is a huge problem.

I was up in Lycksele and looked at the hospital there. It is a fantastic little hospital, but one has enormous problems qualifying the maternity unit. Of course, it is an incredibly frustrating feeling for the women who live in that area - and there we can actually talk about distances - to wonder what happens if the water breaks quickly and it becomes an emergency birth.

I do not think we have a difference of opinion on the issue. I think that we as a party and I as a person safeguard these issues just as you do and are passionate about. That should be a good basis for us to actually be able to have good maternity care in the future.

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Anna Vikström (S)

Madam Speaker! What did not work with the money that came in targeted government grants, among other things to maternity care, was that one did not invest in staffing despite it being included in the agreement between Sveriges Kommuner och Regioner and the state.

I perceived it as that the previous majority and also the opposition in the committee had quite a lot of views on this, how the state grant was used. In that case, I can only state that in 17 of 21 regions, our party was not involved in governing. We can perhaps say that we do not think that the majorities that existed in the regions during the previous mandate period really used the money for staffing and competence supply as they could have done.

I also note that the current government is extending some other state grants. We do not only need to talk about maternity care, but also that for mental health is something that you are extending which we started. You also continue with state grants for good and close care, even if it is halved funds compared to what we left. But in the big picture, and with the crisis we are in with all the cost increases, care and nursing are now underfunded. I do not need to calculate this myself, but Sveriges Kommuner och Regioner now say that they need quite a few billions just to maintain the operations at the current level.

I also want to agree on one thing that Thomas Ragnarsson says: that one also must work with the work environment at a local level and that there is much to do when it comes to local leadership, administration and so on. But more money is also needed.

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Dan Hovskär (KD)

Madam Speaker! I would like to begin by expressing my support for the committee's proposal.

Where one lives in the country should not determine what care one receives. Many wait too long for specialized care or surgery, while there are available slots in other parts of the country. Care queues are not a law of nature, we in the Christian Democrats believe.

We mean that a state ownership for healthcare would be good and that we would then get a common organization instead of 21 different ones, so that high-quality, efficient and more equal care can be provided on equal terms to the entire population.

In a first step, we want to introduce a national healthcare brokerage that matches the healthcare need with the healthcare capacity that exists in the country and not just in the region where the person lives. There may, for example, be space in Lund but not in Stockholm, and a national healthcare brokerage can then broker available healthcare capacity so that the patient can receive care without waiting unnecessarily long. It will be better for everyone, we in Kristdemokraterna believe.

Madam Speaker! The Social Committee's report on competence supply, e-health and preparedness covers a number of different issues, approximately 110 different motions, from the motions during the general motion period. We will not have time to debate all of them here today, but I will make some points in my speech.

In the budget bill for 2023, the government notes, among other things, that the staff is healthcare's most important resource. At the same time, the supply of competence has long been one of healthcare's major challenges. It remains difficult to recruit staff, not least to rural areas. In order to meet healthcare's needs in the whole country in the long term, the national commitment for the supply of competence needs to be strengthened.

The shortage of staff with the right competence can have serious consequences for patients. It can result in medical errors, lack of care beds, misplacements, and long waiting times. The Government therefore intends to develop a national plan to improve the supply of competence. The mapping shall show what measures for existing and new healthcare staff may be needed to improve the staffing supply within health and medical care.

In January 2023, the government commissioned Socialstyrelsen to prepare a proposal for a national plan to improve the healthcare system's competence supply. The proposal for the plan shall be developed by the Nationella vårdkompetensrådet.

The plan shall, among other things, contain measures that may be needed to improve the supply of skills, for example measures to develop, motivate and retain the employees who already today work within health and medical care, to lure back healthcare personnel who have left the profession, as well as to attract new employees.

The plan shall also contain a national mapping of the need for health and medical personnel now and in the future. The mapping shall contain an account of the distribution of responsibility in competence supply issues between the primary healthcare providers and the state.

Madam Speaker! A positive piece of news is that the title assistant nurse will become a protected professional title this summer. In just over two months, on July 1, it will be possible to apply to the National Board of Health and Welfare for the evidence that will subsequently be required to call oneself an assistant nurse.

In 2020, there were hardly 180,000 people working as nursing assistants in Sweden. Additionally, there are another couple of hundred thousand people in related occupations, for example treatment assistants and healthcare assistants, who may come to apply for the protected professional title.

The National Board of Health and Welfare has now issued regulations for when one may call oneself a nursing assistant. A protected professional title will serve as a guarantee of competence and contribute to increased safety for patients, users, and relatives. We in the Christian Democrats think this is good.

In January 2023, the government and Sveriges Kommuner och Regioner, SKR, concluded an agreement on good and close care - a transformation of health and medical care with primary care as the hub. The agreement consists of four different development areas, all of which aim to support the development of health and medical care with a special focus on close care.

One of these areas is good conditions for the healthcare workers. This part of the agreement covers health and medical care conducted in both municipalities and regions, and for this development area, just over 3 billion kronor are allocated during 2023, which shall go to overarching measures that shall contribute to strengthening the primary managers' planning of their competence needs in order to develop the healthcare operations for good and close care.

The funds for the development area may be used for a purpose-driven supply of competence within the area of close care, improved conditions in the workplace, and training of the healthcare's future employees. In addition, 400 million kronor are allocated to the regions and 100 million kronor to the municipalities for the further education of specialist nurses.

Madam Speaker! In the government's budget for 2023, it is also highlighted that the work with civil defense shall be increased. The grants for public health and healthcare shall be increased by 100 million kronor in 2023 for this purpose. The government also states that the total defense shall be strengthened and that the reconstruction of the civil defense shall be increased.

At the beginning of the year, an agreement was concluded between the state and SKR regarding the healthcare's work with civil defense 2023. The purpose of the agreement is to provide the regions with long-term conditions for the healthcare's work with civil defense. The agreement shall create conditions for the regions to conduct a long-term, sustainable and effective work, among other things in terms of the employment of staff who are adequate for the work.

The regions have been allocated 400 million kronor in 2023 to work with, among other things, war organization and its staffing, cooperation and management, training and exercise, care for many injured, as well as supply readiness. It is important that we in Sweden prepare ourselves and step up in these areas, given the deteriorated security situation around us.

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Anna Vikström (S)

Madam Speaker! I want to start by saying that I agree with Dan Hovskär that it is good that it has become a protected professional title for nursing assistant, something that our government pushed forward.

Now the next step is underway. The parties, i.e., unions and employers, have reached an agreement on a training ladder. For it to be realized, Äldreomsorgslyftet must remain, so I sincerely hope that the government will continue with it.

My question concerns this: In the Tidö Agreement, it is stated that a uniform and common digital infrastructure for Swedish healthcare shall be implemented. In interviews, the responsible minister has spoken about roads, traffic rules, and road signs that ensure data ends up in the right place, and that we have not fully succeeded with this.

In this matter, the government and the Social Democrats have somewhat similar interests. As I mentioned earlier, several different investigations are underway that we have commissioned, including an investigation into the secondary use of health data. It is to submit its final report in September but has already submitted a memorandum to the government where they list proposals in three areas that need to be addressed immediately. There is a lack of national coordination, national governance, and building blocks for infrastructure for health data. Many other investigations are ongoing, but by reason of what is currently happening within secondary and digital infrastructure, my question is: For which actors should the digital infrastructure in this area be uniform and common when it comes to regions, municipalities, and private operators?

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Dan Hovskär (KD)

Madam Speaker! There are many important issues, but just when it comes to the digital infrastructure in healthcare, there is very much to be done. What can be stated is that we, so to speak, need to have more of the same inputs.

Several of us have worked in healthcare and know that one can end up working with very many different systems. To complete essentially one and the same issue, one may have to use up to three or four, perhaps even five or six different systems. We must try to find a digital infrastructure for this.

It is a coordination effort that is currently underway. It is an important part of healthcare, and we are talking about competence and also resources. If we can then make it possible to have a system and simpler ways into the healthcare work, we will also free up time for the patient-facing work.

Several investigations are therefore underway. I do not have a direct answer to the member's question as I understood it, i.e., which different titles should use this. It is about the healthcare as a whole; that is what I perceive they are doing and working on.

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

Anna Vikström (S)

Madam Speaker! Thank you, Member, for the answer!

We can understand from the statements made by the Inquiry on the secondary use of health data, which is to submit its report in September, where they list proposals in these three areas that need to be addressed immediately, that decisions are needed as soon as possible in important issues surrounding the national coordination, the national governance, and the building blocks for an infrastructure for health data. This also has a connection to something called EHDS, the European Health Data Space, a regulation which implies that health data should be able to be shared both more efficiently and more securely for the benefit of the individual, healthcare and care, academia and business, as well as for Sweden as a knowledge nation.

The work to nationally attempt to unify the digital infrastructure has been ongoing for a long time, and by that I mean that at the state level, work has been done on this for a long time. It appears to a large extent that one of the challenges is that it is voluntary for operators, and by that I mean more of various types of healthcare employers, to choose to use standards, tools, products, and services within the digital infrastructure.

Therefore, it would be interesting to know if the government has made any progress in the question of which actors – not titles but principals – are to be included in the digital national infrastructure and how it is to be done to include everyone, which is my question to the member. If that is not the intention, who then are those who are to be left out of this infrastructure?

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Dan Hovskär (KD)

Madam Speaker! I can state that digital care is important in the development of healthcare. What is underway is a common standard for a national platform for accessible information on quality, waiting times, and the range of care. That is what is being worked on right now, i.e., several parts of what Anna Vikström raises in her question.

The digital infrastructure is important and will also be included, among other things, within the framework of Vision e-health 2025. An agreement to establish more secure data communication is also something that is being linked into Good and Close Care. These issues are being prepared.

In order for us to achieve the whole, one needs to find structures that make it attractive even for the private healthcare providers to be part of this, and my hope is that we will see a whole within the entire healthcare sector.

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Karin Rågsjö (V)

Madam Speaker! When it comes to state-run care, it must be investigated completely and fully, for which we are grateful, so that you do not just bang the gavel on the table. It is indeed difficult to see how it could benefit everything, so to speak. State control, on the other hand, was needed in a number of areas. I shall not go into that here.

When it comes to the inequality regarding which care one receives, one can simply go to the Stockholm region and look. It is very interesting. There, one can see that there is a difference of 18 years in average life expectancy between a highly educated man in Danderyd and a lowly educated man in Vårby - 18 years. There, one can talk about a difference, and then one can wonder why it has become so. But that must be another debate.

It is clear that it matters where one lives. This is also about how we are to ensure that we get healthcare that works in rural areas. It is something that one must collectively ensure works.

I am quite worried about healthcare in the future when it comes to the economy. I am not alone in that; it is also 17 of 21 regions. Then one can always say that one can run faster, think better or whatever. But I simply believe that it will become a crisis, and I think it is very sad. We are in an economic crisis when it comes to housing, food and so on, and now the government, together with SD, is also causing a welfare crisis in the whole of it.

That is why I wonder how you have envisioned the long-term perspective in health and medical care. Now, people are sitting in the regions and do not really know what to cut back on, what they can do, and how patient-unsafe it can become. Does Member Hovskär have any ideas about that?

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

Dan Hovskär (KD)

Madam Speaker! I am relatively new as a member here in the Riksdag and have worked in the municipal management in Falköping Municipality and in the Västra Götaland Region with health and medical care. One can state that we in both Municipality and Region Sweden have made large surpluses during recent years, and there is money there that can now be used.

We have landed in a tough economic crisis, and it is not always just the money that determines how one should work. Many of the best projects are about how one develops things and how one can work in new ways. Shoveling in money is not always the big solution, even though one should not turn a blind eye to the economic crisis that Sweden is nevertheless in.

If we look ahead, we see that there are many different parts that can be done to work with development. The government has also provided municipalities and regions with a portion of money, 12 billion, during 2023, so they have received quite a lot. Then it is the economic situation in Sweden that affects this.

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Karin Rågsjö (V)

Madam Speaker! You have used this issue of inflation and implied roughly that if we invest in welfare, inflation will increase a great deal. But that is not the case. Even the National Institute of Economic Research has stated that there is a small inflation effect from public investments.

We are in an economic crisis. We all know that, those of us who pay more for food, more for loans and so on. Furthermore, you see to it – precisely that is what I think you do – that municipalities and regions have to cut back on their activities. One can have very clever ideas about what to do and not do, about developing this and that. But then there must also be staff on site, right?

17 of 21 regions say that it will become a crisis, because they also pay more for rents, goods and so on. They are in a rather precarious position. What I mean is that it is strange that, in the midst of the economic crisis we are already in, you also ensure that it becomes a welfare crisis.

It sometimes sounds like SKR, different regions and municipalities, are making up that it is a crisis. But one can clearly see that it is going to become a crisis. If one does not have enough resources, one will not be able to hire based on the needs one has, because there are enormous needs for recruitment. One will also not be able to recruit, for example, administrative staff who can take over the work from the healthcare personnel, as we want, when it comes to documenting and so on.

I am, to say the least, worried about this. There was also no hope that it would get better when one received your spring budget in hand. I believe that very many out in the regions and those who work within healthcare are seriously nervous.

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

Dan Hovskär (KD)

Madam Speaker! I thank Member Karin Rågsjö for the question.

We are facing one of the larger economic crises that our country has seen in very many years. Inflation is one of the most important parts to push down, because if inflation were to continue to stay at a very high level, all our money would become less valuable. What we earn becomes worth less, so one can buy less. The same thing applies to our municipalities and regions. Therefore, one of the most important parts is about getting down the inflation. We must take responsibility for the economy. When inflation hopefully slows down, we can step on the gas with more money.

Karin Rågsjö speaks about a welfare crisis. We see the economic crisis, but municipalities and regions in Sweden have a stable economy.

I believe that many understand that we must take these steps to bring down inflation in order to then be able to take the next step. If anything, I think people see it as a hope that we have responsible politicians who are not just flooring it right now. But hopefully, we can do it moving forward.

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

Johnny Svedin (SD)

Madam Speaker! Sweden is in a crisis situation within the health and medical care. The care beds decreased during the previous Alliance government, but the major collapse came after 2014 when the Social Democrats governed together with the Green Party. One-fifth of all healthcare beds disappeared during this period. But the question is whether it would have made any difference at all if there had been 5,000 more beds today. Would the healthcare system and the healthcare staff have been able to manage these beds? The answer is no.

The Swedish healthcare system has been backed into a corner by naive politicians where, on one hand, there are not enough beds, and on the other hand, there is no staff to man them. Already today, hospitals are forced to close departments due to understaffing, while in other cases, hospitals are forced to provide satellite care for patients in other departments due to too few beds. It is an incredibly difficult balancing act for all hospital managements to address and a devastating and chaotic situation that is unworthy of a welfare country like Sweden.

Madam Speaker! The Swedish health and medical care shall offer the latest knowledge, proven and advanced treatment methods, the latest technology, and well-functioning medicines. All of this is needed in order to best be able to cure, alleviate, and prevent disease and ill health. It is also important that healthcare is continuously developed and renewed, that both physical and mental illnesses are treated, and that patients receive qualified and patient-safe care throughout their lives. Patients shall receive the right care, at the right time, in the right place, and according to their specific needs. The tax-funded healthcare only has legitimacy if it can live up to the ambitions of health and medical care. Good accessibility is a matter of patient safety, and here we in Sverigedemokraterna believe that we need to take action together. A Swedish healthcare system that achieves good medical results is worth being proud of.

To achieve the goal of world-class healthcare, it is also required that accessibility and equality are secured across the entire country, throughout the entire care chain, and within all operational departments. The current devastating situation with a large variation in accessibility, both between different regions and municipalities and between different care areas, creates injustices and a lack of trust.

The Sweden Democrats argue that Swedish healthcare should be equal for those who seek it. Cohesive and high-quality care contributes to a strong trust in healthcare and increases the overall legitimacy of healthcare among the population. The consequence of this, Madam Speaker, is increased patient safety and a strong healthcare system. And that is, in some way, the goal.

The Sweden Democrats, in cooperation with the government parties, have jointly negotiated the Tidö Agreement. The agreement contains an ambitious section on Swedish healthcare, where we also see several of the Sweden Democrats' long-presented measures and proposals, incentives for the healthcare organization and the strive towards equality. The Sweden Democrats make a difference for Sweden and Swedish healthcare, and that is something I, as a member, am very proud of.

One of the larger reforms in the Tidö Agreement concerns the organization of health and medical care. The Sweden Democrats have long advocated for increased state governance with the goal of achieving greater equality, efficiency, and quality improvement across the country. We are also open to investigating the issue, which is currently being done, regarding the ownership of Swedish healthcare. At the same time, we see major challenges in today's governance of Swedish health and medical care, why a broad investigation is absolutely necessary to take a position on an immensely large and decisive issue for the future of health and medical care.

Already in 2018, the Sweden Democrats presented the following: In 1862, Sweden was divided into county councils as part of a thorough decentralization and democratization. It is also at this regional level that responsibility for health and medical care has been distributed. Unfortunately, the equality of care is at risk, as accessibility and treatment results vary too much between different regions. To ensure equal and accessible healthcare of high quality, the Sweden Democrats believe that the state should have a clear responsibility for governance and financing. The historical role of the county councils and regions as commissioners and financiers regarding care should largely lie at the state level. At the same time, every responsibility model should be well-anchored and strive for the right balance between necessary national coordination and local adaptation. No system should be locked, with respect for the complexity that applies when an entire care chain is to hold together.

In the Tidö Agreement, the issue of national healthcare mediation, which we in Sverigedemokraterna have previously called the healthcare guarantee office, is also raised. We have pushed the issue for many years and then stated that Sweden needs a national function that takes the overall coordination responsibility for the available healthcare capacity in the country. The proposal has been developed and now exists as a part of the agreement. It was initiated through the joint budget proposal in the autumn of 2021 which came from Sverigedemokraterna, Moderaterna, Kristdemokraterna, and Liberalerna.

Another area that is prioritized in the Tidö Agreement is the healthcare sector's competence supply. It is important to address the competence supply and, not least, the staff's working environment, which is central to that work. The staff's commitment, working environment, and mental health at work are, in some sense, the cornerstone of the entire healthcare system and fundamental for Sweden to be able to deliver both care and nursing as well as research and quality development.

The agreement also mentions, among other things, that the need for medically trained personnel now and in the future is being mapped nationally. The mapping shall show what measures for existing and new healthcare personnel may be needed to improve the staffing supply. The distribution of responsibility for personnel issues between the healthcare provider and the state shall also be accounted for.

The Government, together with the Sweden Democrats, has tasked the National Board of Health and Welfare with developing a national plan to improve the healthcare system's competence supply and has entered into an agreement on good and close care 2023 between the Government and SKR, which shall make primary care a so-called hub for healthcare - just to mention a few examples of measures that we Sweden Democrats welcome.

Madam Speaker! In order for healthcare to at all have a chance at recovery and be a basis for health and care on equal terms, we within the Sverigedemokraterna will work for increased national coordination. We will work to minimize the administrative burden for frontline healthcare staff. We will also work to increase the pace of the reforming of the digital infrastructure within healthcare.

We believe that digitalization can enable a large proportion of healthcare meetings to be conducted digitally. Increased use of digital technology can facilitate self-monitoring at home. The patient can therefore take a more active role in their own care, which is also requested by the patients.

Digitalization can also reduce unnecessary bureaucracy, which we believe must happen, and thereby give employees more time to create increased patient participation. Not least, a unified medical record is one of the most important tools for succeeding with a patient-safe care.

Swedish healthcare shall become good again, and I look hopefully towards the future with a new right-wing government with the Tidö Agreement as its basis.

Madam Speaker! The Sweden Democrats naturally stand behind all our reservations, but we choose to move for approval of reservation 6 in the chamber.

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Karin Rågsjö (V)

Madam Speaker! Sweden has a fantastic health and medical care. That is due to the staff, the research, and the fact that the care is largely public. We do not have a care system that, in its entirety, is based on people's wallets.

But we have a healthcare system that has become more unequal. Those with the greatest needs risk ending up last in the healthcare queue, and specifically in our large cities, there are gigantic gaps. Between the terminal stations of the Stockholm metro, there are several years' differences in average life expectancy. For example, a highly educated man in Danderyd lives, on average, 18 years longer than a low-educated man in Vårby.

The conditions for equal healthcare differ depending on where in the country you live, and therefore increased state influence over economic redistribution and increased resources for healthcare are required. Regional autonomy is an asset in preventive work and in public health work, but an equal platform must also be created across the country. The care you are offered should not depend on your social class, your gender, your origin, or where you live.

Vänsterpartiet wants to create the working environment that healthcare staff deserve. In Vänsterpartiet's budget motion, there are proposals for significantly increased general state grants for, among other things, increased staffing levels, higher wages, and an improved working environment across the entire welfare sector. We simply have different priorities than Tidögänget.

Inflation is largely due to energy prices and food prices, but the government and the Sweden Democrats refer to the high inflation and the fiscal space to explain away the lack of progressive policy, that is to say, they are creating a welfare crisis. The National Institute of Economic Research has looked at this, and it is simply a very small inflation effect of public investments.

I have met several representatives for the regions, and I have been out in the regions and spoken with staff. The regions will unfortunately experience a kind of meltdown because the state grants are at a minimalist level, and it will hit healthcare hard. Those responsible for this are the Sverigedemokraterna and the government.

It is completely obvious that more trained colleagues are needed within healthcare, better schedules with opportunities for recovery, and reduced working hours with maintained salary. The administrative secretaries shall help the healthcare staff so that they can avoid sitting at desks. Furthermore, there shall be research opportunities, good salary, and good working hours.

How do you do that then? We have developed different types of working time models that involve shorter working hours with maintained salary.

Hired personnel is not a long-term solution, but rather a desperate short-term solution. It is expensive. The personnel who are on-site receive a significantly lower salary than those who come in from the side, and furthermore, those who come in from the side from the hiring laws are to receive extra training from the personnel who are on-site.

These are funds that instead should have been spent on the staff's wages. It is extremely important that we try in every way to get rid of agency staff, and I think SKR could have done more in the matter during the years that have passed. Not so much has happened.

All healthcare personnel shall be able to live a bearable life on their wages; even those with the lowest wages in the regions. This applies to all who toil in heavy jobs in the welfare sector's kitchens, facility maintenance, janitorial work, and laundry, but also to the nursing assistants, who are actually low-paid today. They must be able to put together an income so that it is possible to live in a reasonable way. We must change this. The single mother who is a nursing assistant shall be able to manage on one job and not need to have two jobs.

We believe that the government should create the conditions to improve the working environment, strengthen competence, and improve the conditions for employees within health and medical care. I move for approval of reservation 7.

It has long been requested that nursing assistants should be able to further their education to become nurses, and it is a certain process. Many argue that the competence exists and that they should be given a fast track in. Even if it were to open up the possibility for more people to train as nurses, Vänsterpartiet wants to be clear that it is not in itself the solution to the shortage of nurses. There, better working environments and higher wages are what matter. We still want to develop a national plan for nursing assistants' opportunities to train as nurses.

Welfare resources must be managed according to a principle of need, where the greatest need comes first. That sounds reasonable - doesn't it? The sickest first. For the online doctor companies and other private healthcare providers, the healthiest patients are the most profitable. Various surveys show that the freedom of establishment means that health centers locate themselves in areas where people are not so very sick. I often speak about Stockholm. There, one can compare the number of health centers in Östermalm with Botkyrka, and there are twice as many health centers in Östermalm.

Online doctors are an interesting issue. Do online doctors relieve the healthcare system? Who makes contact? Is it those in Kalix who call or those at Karlaplan? Is it the sickest who call? Is it the needs that drive it, or is it the commercial side that drives it? What happens to the continuous care? Or will it become a fragmented care? These are interesting questions. For example, Vårdanalys has looked at them.

Since there is a free market today regarding health and medical care, different types of deviations can also be created. We have seen a number of online doctors open special digital clinics for overweight. They have prescribed diabetes medication, which has a fantastic ability to make people lose weight quickly. And this has occurred without follow-up.

We believe that certain types of counseling and simpler healthcare via video calls should work in regional healthcare. It is strange that it is not a self-evident matter. And therefore, that care must be prioritized.

As you understand, we want to abolish the right of free establishment, but it is extremely important that we also safeguard the patients' freedom of choice.

It has been a pandemic, and we have learned a lot from it. It is the regions that are responsible for providing medical care. In all too many cases, the regions have not cared to work in accordance with what the authorities have said. This means that there have been no stockpiles, but instead, it has been a question of the just-in-time model. The long-haul truck has functioned as a warehouse on the way to the hospital.

In Sweden's three largest regions, which were then right-wing governed, there were insufficient stocks when the pandemic broke out. Therefore, we believe that legislation must be enacted in this matter. The regions shall have pandemic stocks.

We also believe that publicly funded private healthcare units should be covered by the state's crisis preparedness and be subject to the same requirements as public operations when a crisis arises. We want all private healthcare companies with agreements from the region to be included in the regions' and the state's crisis preparedness by law.

An equitable healthcare must be the goal, not a growing healthcare market where those with the greatest needs end up last.

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Johnny Svedin (SD)

Madam Speaker! I have a question for Member Karin Rågsjö.

Vänsterpartiet often talks about injecting a lot of money into healthcare. There is a lot of talk about injecting a lot of money all the time. It feels as if there were a hidden bag of money somewhere that one could take out and give to healthcare to administer this themselves.

I have a rather short question: If one does not have that bag of money, how does one solve the healthcare instead?

I mean that today there is an incredible capacity in our regions that is totally underutilized. We have an administrative colossus within the regions that has been formed over the last ten years.

We can look at my county, Kalmar län. I do not have exact figures, but I estimate that there are approximately 200 administrative employees, who are licensed personnel but are thus working with something completely different.

How can this happen, and what is being done about it? Are there no solutions to such things? Can one not look at what exists here and now and see how one can utilize the resources that are available? What does the member say about that?

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Karin Rågsjö (V)

Madam Speaker! This is about how one prioritizes.

We begin with the economy. We want, for example, to borrow for climate investments because we think that the climate is important and think that we are facing an unpleasant development. It is not something you are so keen on, so to speak. That is the first thing.

Then sometimes some platitudes may come from the right side about the left having some kind of hidden sack that we are to use the money from. That is not the case. We prioritize differently. We do not have tax cuts for the richest. We would have removed the money that those who have 50,000 and more have received in tax cuts and so on. That is exactly what it is about.

I believe that one has to do very many things at the same time within health and medical care.

I believe, for example, that it is extremely important to bring in administrative staff who facilitate work for doctors and nurses so that they can avoid sitting at their computers.

I think it is strange - macabre, I would venture to say - that we today do not have a link, a platform to stand on, when it comes to digitality between the regions. It is a failure, and I mean that it is a failure for all parties. This could have been put into the lake quite a long time ago, but one is still going on and wondering how and where and why. I find that frightening.

I am, quite frankly, very worried about the health and medical care right now.

More people are needed working in health and medical care to open the care beds. A care bed is not just a bed, it means that there must be staff. Then you need to hire more, and in order to be able to hire more, you must have more SEK. Isn't that right? They will not work for free, even if some might have wanted to. I believe it is extremely important to look at the whole.

When it comes to priorities and economy, even the National Institute of Economic Research says that inflation is not rising because of investments in welfare, but rather it is due to completely other things. Welfare is exempt in that regard.

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Johnny Svedin (SD)

Madam Speaker! Thank you for the answer, member!

The Speaker touches slightly on the fact that within Swedish healthcare today, for example, we have full access to physician capacity. The shortage is nurses, for the most part. Then it is up to each region to decide how to utilize these resources, distribute work tasks, and so on. But it is something that this government, together with Sverigedemokraterna, is looking at to perhaps get a better picture of how it actually looks.

What I mean is that there should be sufficient resources within the regions today that can be utilized in the right way. What is it that makes Vänsterpartiet not see this?

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Karin Rågsjö (V)

Madam Speaker! Now, the situation is that we have met with Läkarförbundet, Vårdförbundet, and Kommunal and spoken with them. They see this crisis coming.

One has to do a lot of different things, but what they have talked about for a very long time is the work environment. That is the big thing within health and medical care: the work environment.

Who wants to work on a schedule that is completely unbearable, which makes it so that, for example, you cannot meet your children because it doesn't work?

Who wants to run around in an emergency department where there are incredibly many people, where it looks as if there has been a war? That is how it looks because it is so overloaded. You can walk into any emergency department at a major hospital today and be horrified by what has happened.

Then one must consider all sorts of things - recruitment, how it should become better for the staff and how to get people to stay.

How can we ensure that we phase out hired doctors, hired nurses and hired nursing assistants who have cost a huge amount of money? Perhaps it is a political project that we would all think was good. Isn't that right?

There are a lot of things that must be done. But I believe that one should trust the welfare workers. I believe that one should trust the health and medical care, the doctors and the nurses and the nursing assistants who describe their work environment as very difficult. And it has not happened in the last six months, but it has been like that for so long. Then we must ensure that we get a health and medical care where those who work there are satisfied and stay, and that we can hire more. I believe that is the foundation.

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Thomas Ragnarsson (M)

Madam Speaker! Thank you, the member, for the speech!

It seems that the member has close contacts with the National Institute of Economic Research. She has on several occasions said that the welfare state does not drive inflation.

That may be so, but given that the member and her party submitted a budget that was underfunded by 200 million, my question is what the National Institute of Economic Research says about that. Would it have driven inflation?

I may be a simple person, but for me, economy is very much about not spending other people's money however one pleases.

The member speaks about priorities. Yes, the member and I are in complete agreement there. In difficult times, one must make priorities. But when the prioritization solution is that one goes to the bank and borrows money, then I do not know if it can be called prioritization. The risk is that we end up in a situation that tends to lead this country into TV3's program Lyxfällan.

I ask the question again. Would the Left Party's budget have driven inflation, according to the National Institute of Economic Research? Or is it the same as with welfare?

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Karin Rågsjö (V)

Madam Speaker! This tends to become an economic discussion. I may have to blame myself.

I don't follow the National Institute of Economic Research very much. I follow Ali Esbati a lot. I also follow our economists a lot, who are highly competent, and I read their papers.

We have borrowed, absolutely. What have we borrowed for? We have borrowed for the climate. We thought it was a bit urgent to do it. Then large investments were needed to transition Sweden, large investments, and they are not in your budget. I find that frightening.

Furthermore, we have borrowed for the trains, you know, so that there is track to travel on and the trains are there.

When it comes to whose money, perhaps now, when it really is a crisis and we want to do something about that crisis, we should look at the rut subsidies, for example. What can we do with them? One could use the rut subsidies to increase the child allowance. There is a lot that can be done. One can be very creative to ensure that those people who have it worst in society can get a little, little better during this crisis so that they do not go under completely.

The luxury trap is not something we in Vänsterpartiet are responsible for, I must say, but it is the loans that have been given by the banks. If anyone is happy right now, it seems to be the banks. They are doing very well.

I think we should invest in health and medical care, and there are masses of different interventions we must make. It is not just financial interventions, but we must also ensure that this is there, as we all talk about – the digitalization and so on as people have talked about for so long and which must exist within health and medical care, including the regional one. There, one has sort of lost out, and I think that is sad. There we must do something radical.

I think it would be good if the government and SD had more long-term perspective in the financing of health and medical care so that health and medical care could see what lay ahead of it.

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Thomas Ragnarsson (M)

Madam Speaker! Thank you, member, for the answer! It was nevertheless pleasing to actually hear some ideas about priorities somewhere in the middle instead of that money should be fetched from somewhere else, for example by borrowing. We are currently in an economic crisis, not just in Sweden but across the whole world. It is one of perhaps the deepest crises we have been in in a very long time. I decline to borrow money. If we at the other end choose to prioritize when it comes to how we use the money we have, that is a completely different matter.

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Karin Rågsjö (V)

Madam Speaker! We are not only facing an economic crisis but also a climate crisis. Either one takes it seriously and says that we must transition and do certain things, or else my children, and above all my grandchildren, will have a rather dull life.

One can also borrow from what Joe Biden did in the USA, with the massive package to get people into work. We have a railway that is not at its peak – I believe very many members agree with that. You stand there and have missed the train and hope that the next one comes quite quickly.

But when it comes to health and medical care, one absolutely must have lots of creative ideas. And those creative ideas might not come from here but from the staff. Then one must listen more.

I belong to those who think that, for example, nurses and also doctors should be given more room to maneuver when it comes to building up the operations. They are the ones who know exactly what is best for them, in their department. Not even the politicians in the region know that. One must absolutely give the staff within health and medical care that freedom.

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Anders W Jonsson (C)

Madam Speaker! I stand again in the speaker's chair after having listened to what I thought would be a debate about healthcare – and not just healthcare in general but competence supply, e-health, and preparedness – but heard how it has degenerated into a debate about whether we should borrow more and about Lyxfällan and inflation. So it is unfortunately often when we are to discuss healthcare: It very easily ends up in something else, economic policy or completely other things.

I intended to stick to what the report is about, namely three important areas: skills supply, e-health, and preparedness. In two of these areas, e-health and preparedness, I think very much positive things have happened.

When it comes to e-health, the previous government took a number of initiatives, and we see how the current government has also appointed and supplemented investigations. I believe, therefore, that significantly greater progress will occur during this mandate period – perhaps not only depending on the government currently in power but also depending on what has happened previously.

Even regarding preparedness, which we had a debate about here in the chamber a few weeks ago, steps forward are being taken. The concerns we ended up in because we did not think we could end up in a crisis are not about to be solved, but nevertheless, very rapid steps forward are being taken.

But something that is not on its way to being solved, Madam Speaker, is the question one always ends up in when discussing various problems in Swedish healthcare, namely the lack of competence and the lack of staff who can provide healthcare.

I do not become much more reassured when I hear representatives of the new government saying that what is needed now is a mapping. We know exactly which personnel categories are missing. One could add that what is needed is more national governance. The sizing of certain educations is an issue owned by the state. But the sizing of the education of specialist doctors and specialist nurses lies with the regions today. It is clear that much more national governance is required here.

But to do something about this very large problem, a number of concrete proposals are also required. One cannot wave a magic wand and solve inflation or anything else, and so one does not solve this either. One does not solve it either through a mapping. Instead, it is required that one systematically goes through and looks at what can be done, and it is many different decisions that are required.

Firstly, we must ensure that people can have a longer working life and ensure that we invest in skills development for those in healthcare who are 60 plus. Today, it is rather the case that if you have turned 60, you no longer receive skills development from your employer.

Läkarförbundet and Vårdförbundet have warned that the pension rules need to be reviewed. We were saved during the pandemic, not least in connection with the vaccinations, by the fact that very many retirees came back and worked. But it turned out then that the pension rules make it very difficult. Once you have decided to go into retirement, we have systems that counteract you taking a break in your retirement and coming back. Do something about this!

Make sure it remains as it has been previously so that medical students can come in and work as nursing assistants. There are a number of things that can be done to ensure that those who actually exist in the system are utilized.

We must also, Madam Speaker, consider who in healthcare should do what. We have several times submitted proposals to use the nursing assistants' competence in a completely different way by also giving them the opportunity for career positions and specialist training. Then they can take over a number of work tasks that are currently performed by nurses, for which there is a significantly greater shortage.

We must ensure that we establish a systematic approach when it comes to training service assistants. It does not have to be competent nursing assistants who perform all tasks around patients; instead, one could use service assistants significantly more.

There are also problems with leadership in healthcare. It is not all units that have problems getting staff, and here leadership is extremely important. We have proposed that in healthcare, just as in schools, there should be mandatory management training. Those who are to be managers in healthcare must also receive proper management training.

We must also ensure that the areas of responsibility are reasonable. There are no workplaces outside of health and care where a manager can have responsibility for 50, 60, 70, 80, or 90 employees. Thank goodness that one then can neither work with the work environment, have development talks, or stimulate the individual worker. It was not by chance that Jesus chose to have twelve disciples. It would be significantly better if every manager, even in healthcare, also had substantially fewer employees under them.

It is also about ensuring that we can use foreign labor. I move for the approval of our reservation 9, which is about exactly that. Today, 25-30 percent of those who work in healthcare have a foreign background. One could at least ensure that those who come from countries outside the EU and EEA area can validate their competence faster.

It is, Madam Speaker, tragic to see how the Tidö parties have agreed on the exact opposite, namely to limit labor immigration and ensure that only high-income earners, who are possibly fully qualified doctors who speak Swedish, are welcome; they set a wage floor at 33,000. One should do exactly the opposite: ensure that we can be an attractive place for healthcare personnel, even from countries outside the EU and EEA, so that they want to come here and work.

Finally, it is also about the attractiveness of working in healthcare. There, I am also dismayed by the healthcare policy that the Tidö parties have presented. There are two proposals that definitely will not make it more attractive to work in healthcare.

The first thing, Madam Speaker, is about how everyone who works in healthcare should not only have the task of caring for the sick, but they should also check the personal identity number – and woe to those who do not have the last four digits! Then one should immediately contact the border police. I believe that all employees in Swedish health and medical care will stand up as one and say that they will refuse to do this. It can never be a task for health and medical care personnel. One is not being honest about wanting to increase the attractiveness of healthcare when one says that the nursing assistant at the emergency room should also have this task.

The second point, Madam Speaker, is of course about wanting to limit the possibility of using interpreters in healthcare. It will definitely not be something that makes it more attractive to work in healthcare, but quite the opposite.

Madam Speaker! I stand behind all of our reservations. I would have wished that we could have more of a concrete discussion about which measures were needed, but I move, as I have said, for the approval of our reservation number 9.

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

Ulrika Westerlund (MP)

Madam Speaker! The competence supply in health and medical care is one of the areas that we in Miljöpartiet prioritized the highest in last year's election campaign and subsequently also highlighted in our budget proposal. I have spoken about this many times before in the debates here, but I still want to return to some of the central points today as well. We have also submitted a special statement regarding our initiative from the budget and the election campaign in the report being debated today.

We in Miljöpartiet wanted to see a new construction where the state takes a permanent and large responsibility to contribute to better conditions for the staff in health and medical care and in municipal care and elderly care. For this, we wanted to allocate 9.5 billion kronor during 2023 and then gradually expand the whole thing so that from 2026 we would see a permanent state investment of 40 billion kronor annually.

More people should want to apply for healthcare, and more people should want to and be able to stay without reducing their hours. We wanted this initiative to go to more employees and to increased wages within both the regions' health and medical care as well as municipal health and social care.

In this context, I also want to mention the recovery bonus. It is an initiative that Miljöpartiet has pushed through and which means that there are funds at Socialstyrelsen available to be applied for by working groups within healthcare and elderly care that want to try to develop new ways of working for an improved work environment, including working time models. The purpose is to take advantage of staff groups' own development ideas and give them opportunities to test these.

The recovery bonus was introduced in the summer of 2021 with 300 million kronor in funds and was then applied for by 190 municipalities and 16 regions. From 2022, 1 billion kronor has been allocated annually. In addition to this, 300 million kronor has been added to reduce or remove so-called shared turns.

The recovery bonus, with its possibilities for change from within, is very important. Miljöpartiet believes that the government should work to make the model better known and strengthen the bonus with an additional 1 billion.

Madam Speaker! In the, as mentioned, rather diverse report that we are debating today, several motions are addressed concerning the national quality registers. They are important tools for strengthening the quality of care. I would like to specifically mention some of them.

There is a national quality register for gynecological surgery. This includes operations that have been performed due to endometriosis. However, there is no register that covers the entire endometriosis-related care, which we believe would be needed.

There is also a gender dysphoria register, which concerns gender-affirming care. For a long time, access to gender-affirming care has been eroded, and as a result of lack of funding, the national quality register for gender-affirming care has not been given sufficiently good opportunities to follow up on either the effects of the care or the waiting times. The funding of the quality register for gender dysphoria must be ensured.

The last register I would like to mention is one that does not exist yet. It concerns abortion care. Since abortion care is undergoing change, in a positive way, a quality register would also need to be established for this care. The knowledge area surrounding abortion care in Sweden needs to be followed and developed. Furthermore, the regulatory framework needs to be changed regarding which professions should be able to provide information to quality registers as well as regarding which data it should concern.

The Government should review all these issues.

Madam Speaker! That some healthcare contacts can take place digitally has had both positive and negative effects. The increased accessibility can be positive, and there is still great potential for development with more services that could be linked to 1177. Unfortunately, the increased accessibility has also entailed increased costs. There is a very great reason to follow this entire area closely in order to ensure that the tax money spent on healthcare is used in the best and most efficient way and that it is those with the greatest need for care who get access to it.

During several of my study visits within healthcare, the question of the compensation to online doctor companies and how they erode certain regions' budgets has been raised. Part of the explanation for the increased costs we see now is that the digital healthcare providers are using marketing in a completely new way.

Care is not just any service. We therefore consider that the marketing of healthcare services should be regulated. We want to see stricter legislation regarding the marketing of health and medical care and that the marketing is characterized by moderation. We hope that the government wants to investigate this.

It is also important to strengthen the democratic control over digital healthcare and to strengthen the link between digital and physical care to promote increased continuity and accessibility. In June 2022, the previous government gave an investigator a mandate to review how digital healthcare providers can become part of a more cohesive primary care where all actors work together to meet patients' healthcare needs. The mandate is to be completed by August 15 of this year at the latest. It is important that the investigation is allowed to continue its work and that the government subsequently follows up on the issue.

Madam Speaker! Health and medical care needs to be planned so that situations with many injured can be managed simultaneously with large disease outbreaks or pandemics. There are a number of measures that should particularly be taken.

The work to climate-adapt healthcare facilities needs to be accelerated ahead of heatwaves. The number of healthcare beds also needs to be able to increase significantly even in peacetime crises, with increased capacity throughout the entire healthcare chain.

Medical transports, stocks of medical supplies and the distribution of healthcare facilities should be planned so that healthcare that cannot be delayed can be provided throughout the country even during disruptions.

A national responsibility for stocks of medical equipment and relevant medicines is needed as part of the crisis preparedness. Furthermore, the government should investigate the need for legislation requiring the regions to have pandemic stocks for at least three months of consumption.

For the sake of time, I move for approval of only reservation 22. It was a difficult choice, as this is such a diverse report. I, however, naturally stand behind all of Miljöpartiets reservations.

The deliberation was hereby concluded.

(A decision was to be taken on 3 May.)

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