Skills supply, e-health and preparedness

Thomas Ragnarsson (M)

Madam Speaker! Finally, we are debating the Social Affairs Committee's report SoU21 Competence Supply, e-health and Preparedness. I would like to begin by moving for approval of the committee's proposal for a decision.

Madam Speaker! Competence supply is something that has been talked about since I began my career in Swedish healthcare in the late 80s. The needs have fluctuated over time, and we can observe that the discussion has accelerated over the last decade and that the pandemic threw the entire healthcare system into turmoil.

This time has left its mark, and we have seen a number of employees leave the profession after this. But the number who have left the profession has been quite constant for a long time, and what is heard in the debate is that it is the wages that are the problem. Of course, the wage situation is a partial factor, but I do not recognize the picture that it is the reason why one chooses to leave the profession. What I encounter is the discussion about poor leadership, participation, and the possibility of influencing one's work environment. After that, the wage discussion can come. There is also a professional pride that makes it so that one ultimately cannot stand behind the care that is currently being delivered.

Competence supply, e-health and preparedness

Madam Speaker! We face great challenges when it comes to providing competence for Swedish health and medical care. Given that we continue to work as we do now, my own county will need to recruit the entire year group leaving school in Kronoberg County in 2030 for work within health and medical care. That figure is obtained by comparing the demographics and the calculated need that exists to replace departing staff.

Will it be like that? The answer is obviously no. We must find new ways of working. Good and close care is absolutely crucial for us to meet the health challenges and competence needs of the future. Healthcare needs to work more preventatively and not so reactively as is done today. This is something that the government has entered into an agreement with SKR to implement. At the same time, money has been allocated for the purpose, 3.2 billion for 2023 and an additional 1.2 billion for 2024 and 2025. In the healthcare reform budget, an additional 6 billion has also been added to the regions in sector grants to mitigate the effects that inflation and pension costs have had on these operations.

We also need to discuss the healthcare administration that burdens the operations, where it is not uncommon to have double and even triple documentation in the same case. It is not sustainable that our employees spend more time on documentation than on patient-facing work.

Madam Speaker! There are already good examples today of where the agreement on good and close care has been implemented. Here, I want to highlight the work that has been done in Västerbotten with the expansion of their health centers, where Glesbygdsmedicinskt centrum has been a major contributing part. This development has led to a great interest in working within the operations, and through patient knowledge, the preventive work increases automatically. The content of the work has grown, and the staff is a driving factor for this development to continue.

Madam Speaker! The use of welfare technology needs to be developed and increased, while the digital infrastructure needs to be improved and coordinated, which is a task that has been investigated and final reports submitted during the month of April.

Through functioning digital infrastructure, we increase patient safety, but we also significantly facilitate the work for the employees. It frees up time for patient-facing work. Technology can never replace the personal meeting, but technology should be used where it is possible, all to free up personnel resources for precisely that personal meeting.

Madam Speaker! When one reads and listens to everything that is said about the Swedish healthcare crisis, one easily gets the impression that we are standing on the brink of ruin. But that is not the case, in my opinion.

We need to talk about how we use our personnel resources. Our municipalities and regions have actually never had as many employed nurses and doctors as they do right now. Despite that, we produce less. Political courage is needed here to prioritize which activities should be carried out and which things we should not be doing.

If we simply continue to pump money into a system without following up on how it is used, the situation will only get worse. One example is the phasing out of hired personnel, which SKR is working on. It is absolutely necessary that this phasing out occurs. Regular operations should not be built on hired personnel. Hired personnel should be used during acute vacancies and care peaks for which regular operations are not staffed.

It is, however, important that, in parallel with the phasing out, priorities are also made regarding what the already employed staff shall work with. Otherwise, the skills shortage will increase and become even deeper. And then more will quit.

Madam Speaker! I know that politics should not interfere in the settlement between the parties in the labor market, but the new working hours agreement that has been concluded has not had any positive effects on the issue of skills supply. On the contrary, we now see that more and more people choose to change industries. This means many times higher wages, better working hours and, above all, less or no weekend service.

This is not value-creating for anyone. Participation, being able to influence one's schedule and working hours, has been important for the staff. That one chooses to overinterpret an EU directive in that situation is extremely concerning. The intention of the directive is good, but it complicates the scheduling within our 24/7 operations. This, in turn, leads to schedules that have the completely opposite effect. Many employees experience feeling more tired and more worn out, while at the same time the recovery periods have been compressed.

It is human to make mistakes. Sometimes one does not see the whole picture when making decisions. But with the consequences that are now being clarified, it would be decent if the parties sat down and reformulated the agreement based on the reality that prevails.

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Karin Rågsjö (V)

Madam Speaker! I mean that we have a national healthcare crisis in Sweden. We also have a major crisis regarding the working environment for healthcare staff. We have had that for a long time. The overcrowding at the country's hospitals is also increasing. The intensive care beds are decreasing and are fewer than before the pandemic. That is not particularly fortunate. The unions - Kommunal, Vårdförbundet and Sveriges läkarförbund - are sounding the alarm.

You are placing a lot of the responsibility on the regions, Thomas Ragnarsson. And the regions are responsible. But it is an economic crisis caused by inflation and various things. Still, approximately 16 billion is missing within healthcare.

It also has other consequences. Healthcare is lagging in its work to increase preparedness for war and serious crises. It is not Vänsterpartiet but the Defense Preparation Board that states this. That means our ability to handle a crisis, a war, or a pandemic is very limited, less than before I must say.

Last year, the Total Defence Research Institute, FOI, warned in another report about the risks of private ownership in healthcare. FOI pointed out, among other things, that the authorities lack direct control over large parts of the healthcare sector, which makes it somewhat difficult to ensure operations in a crisis and to deploy personnel for war. I believe that the government and SD have ignored this.

I want to ask the member: Are there any ways forward? What do we do in an operation that is currently very drained if—God forbid—a pandemic occurs?

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Thomas Ragnarsson (M)

Madam Speaker! I thank you for the question.

We are in complete agreement that the Swedish healthcare system's preparedness to handle war and crises is substandard. But this is nothing that has been created with this government. It has occurred over a long period. We must all take responsibility for it. We have been naive in this country. The experience when the wall fell in 1989 was that there were no threats left. It was then that the disarmament began. And it has continued with different governments. Even Vänsterpartiet has been involved in the disarmament.

We can therefore state that we are anorectic today when it comes to preparedness. But the work has begun, and now work is being done on a broad front regarding the issue. But it is not done in a heartbeat.

We can look at the medicine preparedness. Our Minister for Health and Social Affairs has described that if we were to fill up our stocks, we would create an acute medicine crisis right now. As a diabetic, I found out that my long-acting insulin is backordered until 24/12. I haven't seen any war here today and not any crisis either, actually. We have huge problems with our supply chains.

I agree. We have huge problems with the preparedness. But given that we have received a minister who is actually dedicated when it comes to working on those issues, they are still on the agenda now, and they are high up on the agenda.

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Karin Rågsjö (V)

Madam Speaker! That is not quite my view. With 16 billion less in the treasury, it certainly won't get better. We are currently living in a time when, for example, the intensive care beds are fewer than before the pandemic. Then it is perhaps not at its peak.

Another thing I am worried about is primary care. You know that we all concluded an agreement that primary care would step up. That is not what we see now. Rather, we see that primary care is being slowed down due to a lack of resources. It is completely obvious.

There is no long-term guarantee for primary care in Sweden. The idea itself for several years has been that the local care would step up, and it would become great. Now it is not becoming so. Right now, there are fewer specialist doctors and ST-doctors in general medicine than in 2017. There is also no plan from SD or the government to do anything about primary care. I do not see that.

The reports we receive in various ways, for example from Vårdanalys, point out exactly that it is getting worse and worse instead of better and better. I must say that it is a major failure for the government and for SD that they have not succeeded in capturing primary care. It is therefore clear that there is a crisis within primary care as well. This means that people who need continuity in their care and so on have to be sidelined.

The idea was that primary care should move forward; instead, it has moved backward. You should, after all, take responsibility for that. It is perhaps not possible to pass the entire responsibility onto the regions. With 16 billion less in healthcare, it is clear that there will be damage far out in the healthcare system and within primary care.

My question is: Are there any ideas and thoughts about what you, SD and the government, are going to do with primary care?

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Thomas Ragnarsson (M)

Madam Speaker! Primary care has had major problems for quite a long time. Interest in working within primary care has been rather lukewarm. A temperature check was conducted at the University of Linköping some time ago. At that time, no one who took the medical program had a thought of becoming a general practitioner. This is a problem.

Why is that? I believe that the limitations in the operations in the form of what one should do and somewhat unclear directives have led to the feeling that the workload is too great given the staffing that exists. To change the entire direction for our primary care - it could, for example, be about good and close care - so that one gets a greater overall responsibility can be a way to awaken interest.

It is not about money. I come from a county that directly pays money if one chooses ST or takes a service within primary care, but that is not interesting. This is a huge problem.

I believe it is about the content of the work. That is why I mentioned the health centers in Västerbotten. They are fantastic, and they do so much. What is interesting is that they do not feel they have any major shortage of staff. They are developing and are given the opportunity to develop the operations. You perform X-rays and perform minor surgeries and all sorts of things at a health center. You have an inpatient department. That makes the interest in the work increase.

This is not something that is new, but it has been discussed for a long time. I am the first to say that it is a disappointment that we have not moved further together when it comes to good and close care.

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Anna Vikström (S)

Madam Speaker! We stand by all our reservations, but I would like to move for approval of reservation 5.

The foundation of our country's safe and high-quality healthcare is its staff. We are now in an absurd situation: At the same time as healthcare and care have great staffing needs, healthcare staff are being laid off and reduced by the thousands in many regions, despite being needed in healthcare. This healthcare crisis could have been stopped by the current government, but what has been done by the government is not at all sufficient. The consequences of the healthcare crisis will affect patients, healthcare, and employees throughout Sweden.

Arbetsförmedlingens statistics on layoffs in health and social care, both last year and this year, is a frightening read. So far this year, 2,785 people have been laid off within healthcare, of which 268 just this month up to May 10. We can state that the Prime Minister's statement in February that the government and SD would present a budget that would ensure that people are not laid off in the Swedish healthcare system was not correct. The budget that was presented did not stop the layoffs.

The Social Democrats make a different prioritization of healthcare. Our three most recent budgets contained a doubled investment in healthcare and welfare. Our assessment is that Sweden would not have been in this healthcare crisis if these investments had been made. During the previous parliamentary term, our government also took the initiative for a targeted investment in healthcare personnel with the aim of creating better conditions and circumstances for them to do their jobs. The new government has now concluded this investment, which we see as a mistake.

Madam Speaker! Even before these warnings, we knew that the Swedish health and medical care today is under-dimensioned. Fewer healthcare workers lead to fewer care beds and longer waiting times, and it is not possible to live up to the citizens' needs for care.

It has long been a challenge for regions and municipalities to provide the necessary skills for their operations. The attractiveness of welfare professions and workplaces has decreased. Working conditions, wages, and workload are perceived as less competitive in comparison with other industries than before. The gap has thus increased.

The number of sick leaves for women in healthcare professions is very large. The situation that prevails now, where healthcare staff in the regions are not replaced when they leave and where large-scale notices have been issued, will have serious consequences both in the short and long term, not only for the patients but also for the healthcare staff's health, the attractiveness of healthcare professions and the possibilities to recruit in the future.

The previous government took the initiative for the National Healthcare Competence Council. In a couple of weeks, they are to submit their final report, which concerns developing proposals for a national plan for the healthcare system's competence supply. We look forward to this report, but we want to move forward and see a preparation for the welfare sector's personnel supply. Models for similar collaborative structures for preparations exist, for example, in the defense and security areas. If the development regarding the attractiveness of welfare professions is to be reversed in the long term, a broad consensus and a joint national initiative are required.

In several reports, the negative impact resulting from the growing administration is recurring. This means that many of the welfare employees, against what they themselves wish, spend more of their working time on administration instead of on meetings with patients. Reporting to authorities, management, or others responsible for following up on care takes a lot of time. One example is that quality registers often require manual entry, contrary to the intentions.

An investigation titled Shared health data - double benefit was recently released, which was commissioned by the previous S-government. In that, proposals have been presented with the primary purpose that patients should receive good and safe care. But the proposals also aim to streamline care through reduced administration for healthcare providers and by ensuring that unnecessary double documentation and double work are avoided. This is an important focus that we politicians must also have, even when it concerns decisions on digital infrastructure. Will the decisions we make provide patients with better care, and will the administration decrease? All decisions that increase administration should be carefully considered, even when it concerns digitalization.

Madam Speaker! Currently, a number of government assignments and investigations are underway in the area of national digital infrastructure. The Government has also appointed a coordinator and an entirely new council. Something that is actually ongoing, so to speak, is the introduction of the national pharmaceutical list, even though it is significantly delayed. But otherwise, there is not much work being done in this area, but mostly investigations.

If it is to become a national digital infrastructure, a number of decisions are needed, including a position on financing. It is not free to get municipalities, regions and private operators to adapt to state governance within the area of digital infrastructure. This is also not something that happens by itself; we know this after many years of voluntariness and recommendations within the e-health area. It also requires very good coordination from the state's side with public and private operators. It is not only desirable but necessary that this happens if a national digital infrastructure is to become a reality.

(Applause)

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Liza-Maria Norlin (KD)

Madam Speaker! I begin by moving to approve the committee's proposal.

We are now debating several important and current issues concerning healthcare, for example, questions regarding the staff's conditions and good competence supply. Other matters addressed in the report are occupational health care, the work environment, life science, healthcare in rural areas, and the very current issue of the healthcare system's preparedness. Kristdemokraterna agrees with the committee in the assessment that the motions should be dismissed, among other things with reference to ongoing work within the government.

Madam Speaker! For us Christian Democrats, it is important that more people educate themselves to work within health and medical care, but also that already trained healthcare personnel feel supported and have a good working environment that enables them to have the strength to stay working within healthcare. All too many feel today that it is heavy to go to work and experience an anxiety over their workload. That is not how it should be.

Despite the ongoing conflict, where Vårdförbundet does not agree with the employers, we are pleased that most who work in healthcare now have valid agreements and that an agreement has been reached. Regarding the remaining conflict, we believe it is important that Vårdförbundet and the employers agree on an agreement that both parties consider acceptable.

The conflict, but also the warnings across the country, show that there is fundamentally a major problem and that it will not disappear in the short term but requires more measures. The Christian Democrats want the state to take greater responsibility for health and medical care, and the government has now appointed an inquiry that will look into a full or partial nationalization of healthcare. It is a major reform that we Christian Democrats have pushed for for a long time and which is crucial for good and equal care in the long term.

But what is the government doing about the challenges in healthcare that we see here and now? In January 2023, the government tasked Socialstyrelsen with developing proposals for a national plan to improve the healthcare system's competence supply. The final report is to be submitted no later than May 31.

In connection with the presentation of the spring budget this year, the government announced that it is adding 6 billion kronor to healthcare via the regions. It is a large and important addition, which corresponds to the cost of 7,000 nurses. The healthcare package contains not only money but also structural measures, such as an efficiency delegation.

We Christian Democrats are also proud that the government has chosen to invest in a national healthcare brokerage to increase the use of available capacity. It shall be possible for a person who does not receive care in time within their region to easily seek care in another region. More patients shall receive care in time, and the queues shall be shortened.

Madam Speaker! Things are being done here and now by the government, but we are also strengthening healthcare over time. Part of strengthening care is the work with e-health. Being able to share health data between healthcare providers in a secure and smooth way is important to increase patient safety and reduce the administrative burden for staff in healthcare. The government is therefore working for a uniform and common digital infrastructure for Swedish healthcare that replaces and complements the existing infrastructure of the 21 regions. Health data shall be accessible throughout the entire care chain.

Recently, the Public Health Agency presented a roadmap describing what this infrastructure should look like and when it should be in place. The infrastructure shall create better conditions for residents to access and have control over their own health data and streamline the working methods for the operations. Data shall be better utilized to develop healthcare, conduct research, and improve decision-making. Furthermore, the infrastructure shall, through increased data access, provide conditions for, for example, precision medicine and training of AI models.

This development gives healthcare staff more time to provide care. It also provides increased security to the patient, who will be able to trust that the correct information is available when it is needed. Ehälsa strengthens healthcare.

Madam Speaker! In the restless times we live in, it is also important that the government makes investments in civil defense and cybersecurity. In April 2024, the government presented a package to strengthen these areas totaling 385 million kronor. The investments include such things as the upgrading of shelters, increased stockpiling of medical products, increased capacity regarding drinking water supply, and strengthened cybersecurity.

The lack of availability of healthcare products that are crucial for certain healthcare services constitutes a serious threat, especially in the event of a crisis or war. The Government is therefore making an investment to increase the stockpiling of healthcare products and to ensure the procurement of strategic goods and services to strengthen the healthcare system's preparedness.

There are many important issues to discuss, but I choose to stop here. For us Christian Democrats, the goal is clear: Sweden shall offer good care in a timely manner and equal care throughout the country.

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Karin Rågsjö (V)

Madam Speaker! Yes, there is an inquiry into nationalizing healthcare, or rather about who should be responsible for healthcare, and I am sitting here in the chamber with a few others. It is far from clear what will become of it, but the government and SD have the opportunity to step in with money and save healthcare already now. 16 billion are missing in the sector, healthcare is bleeding, and 5,000 people have been laid off. Obviously, this will affect the patients. That it becomes patient-unsafe is evidenced, among other places, at Sahlgrenska and in Linköping - yes, everywhere they say it no longer works. The staff are on their knees. Right now, a conflict is ongoing, and it concerns a work environment that is completely inadequate where nurses have to run back and forth and do not know whether they are free or not.

Madam Speaker! It would have been sensible to provide the resources needed to at least have a healthcare system in balance and without deterioration. But here and now we see that the healthcare beds and intensive care beds are decreasing. It has not happened previously, but it is happening now.

The member is part of the Christian Democrats, which is the major healthcare party. What is this draining of healthcare supposed to lead to? How have you planned for when 5,000 are laid off in the regions? It is your responsibility, just as it was the previous government's responsibility, to ensure that healthcare functioned during the pandemic. But you are backing down. It concerns all types of care, which is currently in a very bad state. All the unions, Kommunal, Läkarförbundet, and Vårdförbundet, are extremely concerned. Does the member have any proposal?

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Liza-Maria Norlin (KD)

Madam Speaker! I do not only have proposals, but active work is now being carried out by the government. We Christian Democrats wish that this work had been started a long time ago. It was over ten years ago that we pointed out that the system of 21 regions is obsolete when it comes to running healthcare in Sweden and that a greater national responsibility needs to be taken. It is not the solution to everything, but money is also not the entire solution to today's challenges. Money exists in the system, but it is also about organization, governance, and management.

It looks very different in the regions, so when we direct money from the state to what is the regions' responsibility, it is difficult to be accurate in the distribution. Some regions say: We do not want any money. Do not ruin the work we have already started! Other regions have received loans to pay wages. This is first and foremost the principals', that is to say the regions', responsibility. But the government is truly doing its best to support. Karin Rågsjö says that 5,000 are pledged, and the government's 6 billion is enough for 7,000 nurses.

I really do not agree that the government is doing nothing. Work is being done on a broad front, and the government fortunately has several years left to do even more because not much was done during the eight years before.

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Karin Rågsjö (V)

Madam Speaker! I think that one should take responsibility for what is happening now and not shift the blame. I think that is a self-evident matter for the responsible government with SD in tow, or rather in the driver's seat.

The chairman says that the regions do not want money, but that is hardly my view. I mean that the unions that exist, namely Läkarförbundet, Vårdförbundet, and Kommunal, and the regions I have met are in a very bad situation. They report that it is patient-unsafe. This is not one region, but it is 21 regions. Which regions do not want resources? Which gold region is it? That is what I am very interested in.

This does have an impact. What the government is doing now is refusing to provide resources to the regions. 5,000 are laid off. Shouldn't that ring some alarm bells? I have traveled around Sweden and met with laid-off nurses and so on, and I see that this is real.

One can talk about an investigation underway regarding the nationalization of healthcare and that everything will become fantastic, but the reality looks like this here and now. I must say that the state responsibility is non-existent from the government and SD, and it shows.

Primary care is also retreating right now. We have a national healthcare crisis. If cancer queues are increasing, it is clear that it is a national healthcare crisis. If newborns do not receive the care they need due to staff shortages, it is a healthcare crisis. It is very serious all over Sweden.

Responsibility, I believe, is a self-evident matter when one sits in a government. In that case, one cannot talk about an investigation further ahead, but it is about here and now, I believe.

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Liza-Maria Norlin (KD)

Madam Speaker! Responsibility is a given. For us Christian Democrats, healthcare is one of the most important issues, which we have worked on for as long as we have existed as a party. Now that we also have the position of Minister for Health, there is full activity in that area, both to manage what is happening here and now and to build for the future. For that, it cannot be that we are not to take responsibility for future generations but only act on what is happening here and now?

We see and we hear that there are great challenges. It is partly, of course, about the supply of skills, which is linked to what the working conditions look like. Here, our Minister for Health and Social Affairs has for several years, long before she became minister, pressed that it is primarily about the policy pursued for the employees within healthcare. Here the focus is placed. Here the government is doing work here and now.

One cannot say that the government is not taking responsibility today. We are allocating extra resources in the budget for this year and adding an extra 6 billion kronor now in the spring budget, and that is taking a financial responsibility. In addition to that, the government is addressing the structural measures. It is about how we can streamline and how we can support the regions in reorganizing their work so that it becomes even more efficient. I mentioned in my speech how we can work with e-health and health data. All those investments are also important.

We are doing concrete things here and now, but we must also have the strength to maintain the structural reforms and strengthen Swedish healthcare in the long run, otherwise nothing is won.

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Anna Vikström (S)

Madam Speaker! I thank Member Liza-Maria Norlin for the contribution. I have a question for the Member, because it is the Christian Democrats who are responsible for the health area and this concerns the national digital infrastructure.

It is absolutely a great idea with a national digital infrastructure, but there is a great deal that is to be accomplished with it. It is to result in more time for the healthcare staff and it is to be better care and so on. My question is: How?

I want to provide some background information. Most regions are now in full swing with procuring and introducing very costly new, large patient record systems. Additionally, they have very many systems that are already operational. Furthermore, the regions pay Inera AB, which has national e-health services that have existed for something like fifteen to twenty years. They have been developed over time and are used by the entire population and also by a good number of healthcare providers. There is, therefore, already a kind of infrastructure, even if it is between regions and municipalities.

In the investigation report Shared Health Data - double benefit, there are proposals regarding an obligation for healthcare providers to make certain tasks available to other healthcare providers. This brings the financing principle in the investigation into focus. I therefore wonder: Do you in the government speak about the fact that this could cost the state money, and are there any plans for state funding at all? We have neither heard nor seen that in this debate.

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Liza-Maria Norlin (KD)

Madam Speaker! I am glad that the member and I nevertheless share the view that a digital infrastructure is important for healthcare.

One of the challenges we have with 21 regions is precisely the problem that the member highlights, that it is individual procurements and individual systems that do not communicate with each other. Here, SKR has had, and has, an important role in its work to coordinate. It has, therefore, in many ways become better. One also pays for different services that are used jointly. Working with a common digital infrastructure is also about setting requirements and standards for how the different systems should communicate with each other so that one can transfer and utilize this data.

There has been some back and forth here regarding investigations, but somewhere it is the way forward to find exactly in what way we best do things. The financing principle applies, and that is what we usually use. I have no information today regarding that.

Of course, we need to help each other here. The Christian Democrats are a party that says we need greater national governance of healthcare. Let us then perhaps begin with these different systems that are so important for patients and staff, both when it comes to being able to work with health data here and now, to have access to the data needed when providing care, and for research and development.

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Anna Vikström (S)

Madam Speaker! I thank the member for the answer. Perhaps there is some mockery regarding the investigations, and I do not think that it is necessary to do that either.

There are many investigations and assignments. Our government also appointed quite a few, including one that dealt with the secondary use of health data. One has arrived very recently.

My question, however, is where they are going. There are several different investigations that have not been handled. So far, there has been no progress more than when it concerns the old proposition that we were involved in preparing, which concerned pharmaceutical information. We have not heard particularly much about what has happened during this parliamentary term more than that investigations have been commissioned. The question then is: Will there be concrete government proposals in this area? It has been talked about in silence for a very long time.

I can, however, say that a debate article from the government was actually published in Läkartidningen today, but it did not provide any roadmap information or any assurances that there are any plans to finance regions and municipalities to participate in this national infrastructure. It will be needed, because as it stands right now, it is voluntary work, and very many providers—not least private providers, but also some others—can choose not to hand over the information. In that case, there will be an information shortage, and patients and healthcare personnel cannot rely on the information being complete. Therefore, requirements need to be set. The question then is: Is there a roadmap that realizes these proposals? Is the member aware of it?

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Liza-Maria Norlin (KD)

Madam Speaker! I do not have a roadmap with me today that I am presenting in connection with this debate. Let me, however, make it clear that all focus is, of course, on this becoming concrete measures and concrete plans for how this shall be implemented. That was why this government started its first period by conducting investigations – to obtain the correct basis.

When it comes to the issues of digitalization and data, we have an incredibly rapid development. One would wish that it were possible to speed this up, because otherwise, the technology is, so to speak, ahead of us. It is also complicated when it comes to ownership, where there are 21 regions that need to reach an agreement and where we do not control it from a national level.

What I can promise here today is that there is full activity in this work, which I hope will soon be able to be presented to more.

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Linda Lindberg (SD)

Madam Speaker! Today we are debating, as my colleagues have said earlier, the Committee on Social Affairs' report number 21: Competence supply, e-health and preparedness. The Sweden Democrats naturally stand behind all our reservations and large parts of the report and also have some of our own motions, but here I move for approval only of reservation number 15.

Madam Speaker! In the report, we address motions concerning, among other things, the training of staff in occupational health care. We talk about skills supply and qualification. We talk about the work environment, issues regarding life science, care in rural areas, the healthcare system's preparedness, but also the healthcare system's documentation.

Our reservation today concerns precisely the healthcare's documentation, where we specifically highlight the question of how an individual's gender identity is designated within healthcare. Here we see a value in not deviating from the designations man, woman, boy and girl and in not calling ourselves, for example, womb-bearers. We mean that in no form of healthcare documentation should one deviate from the designation of biological sex and that this is fundamental.

But the consideration is about much more than that, Madam Speaker. The very biggest question is probably still the healthcare sector's competence supply. I know that everyone here in the chamber today is very engaged in precisely this issue. We also know that healthcare constitutes one of the most fundamental parts of our welfare society. A well-functioning and accessible healthcare is not only a basic right for all citizens but also a decisive factor for our country's well-being and our development.

To ensure a well-functioning and accessible healthcare system, good competence supply and a well-educated and strong workforce are required. We need to have effective processes and continuous development, but also good cooperation across the entire country. We all know that the healthcare staff play an absolutely crucial role in this work, for the healthcare to function effectively and safely. They are key players and do an incredibly important job. This is worth pointing out.

Madam Speaker! Sweden has one of the world's highest tax rates and is one of the countries in Europe that invests the most resources in healthcare, measured as a share of GDP. Nevertheless, for far too long we have been confronted with a reality where people die in care queues, where staff choose to leave their jobs within healthcare, and where patient safety is threatened by insufficient care capacity across the country. The Sweden Democrats and several of the Tidö parties have warned against this for a long time and have also presented a number of concrete proposals for improvement.

The healthcare crisis is not news, even if it sounds that way today and the opposition would like to make it so. We have discussed this for at least ten years. Already in 2014, and earlier for that matter, there were reports of problems with competence supply, the work environment, the design of the healthcare guarantee, staff shortages, and healthcare queues. Now we stand here ten years later, and it is the same discussions in the chamber and the same situation that we see across the country when it comes to Swedish healthcare.

We have a pandemic and unrest in the world, not least in our immediate vicinity. Inflation and thus increased pension contributions in combination with a recession have clearly exposed the deficiencies that already existed, amplified them, and also hit the regions' economies hard. I am therefore pleased, Madam Speaker, that the Sweden Democrats, together with the other government parties within the framework of the Tidö Agreement, have agreed on a number of decisive and extremely important reforms to address the many and serious deficiencies that we have in our country. These deficiencies have not arisen in just over a year and a half.

We have the ambition that Swedish healthcare shall be at the forefront and maintain a high international quality. Patients shall be treated with evidence-based and effective treatment methods. The waiting times within the framework of the Swedish guarantee shall be complied with, and we shall have good and patient-safe care throughout the country. It should not matter where in the country one lives, Madam Speaker, but the inhabitants shall be offered good and equal care throughout the country.

The Tidö Agreement contains, among other things, an ambitious section on Swedish health and medical care, which includes several measures and proposals that the Sweden Democrats have presented for a long time. The government, together with us, has agreed on reforms that shall, among other things, reduce care queues, increase accessibility, improve efficiency and equality in health and medical care, and also improve the working environment and the supply of skills for employees within the healthcare sector.

One of the larger and more important reforms in the agreement concerns the organization of health and medical care. We have for a long time as a party advocated for increased state governance, with the aim of achieving increased equality, increased efficiency, and an improvement in quality across the entire country.

The Tidö Agreement also raises the issue of national healthcare coordination, which we have previously called the healthcare guarantee office. We have pushed this issue for many years and asserted that Sweden needs to have a national function that coordinates the available healthcare capacity in the country. The proposal has been developed and is now included as part of the agreement. The purpose is quite simply to make the entire country's healthcare capacity available on one arena so that patients in need of care can receive it faster and so that we simply increase efficiency. We are now allocating further funds to this. We are accelerating this work, because it is urgent.

Socialstyrelsen and E-hälsomyndigheten have also been tasked with developing methods to measure availability and capacity and proposing different solutions that utilize available staff in a more efficient way from a national perspective. They are also allocated funds for this.

We are actually united in this chamber, but perhaps not on exactly how we should proceed. At the same time as we know that the number of healthcare beds needs to increase to ensure safe and secure care, we have problems with staffing. We believe that the regions, among other things, need to have performance-based compensation from Socialstyrelsen in order to be able to expand the number of healthcare beds. We are therefore doing a number of things to really try to work out this as quickly as possible.

Madam Speaker! Another priority area in the Tidö Agreement is the healthcare sector's competence supply. We have talked about this several times, and it is perhaps so important to return to that question again. It is about the key personnel in the entire situation we find ourselves in. Not least, we see that the challenges are particularly great in rural and countryside areas.

Madam Speaker! The government is therefore, together with the Sweden Democrats, making major investments and important reforms to address the serious deficiencies we see within the Swedish health and medical care. Reforms take time, and investigations are needed. We have requirements for investigations in Sweden.

Trust us – we feel that we need to move forward, but it must be allowed to take its time. It must be allowed to do that, because when we do this now, we shall do it properly and at the right pace in order to truly, in the long term, get the Swedish health and medical care right. This is something that, unfortunately, has been failed at for many years in Swedish politics.

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

Karin Rågsjö (V)

Madam Speaker! The Sweden Democrats are one hundred percent responsible for the national healthcare crisis we have. 5,000 people are to be laid off across the regions. There is no region that will emerge unscathed from this, and it will also affect patients.

Despite all the troll accounts, I must say that it is quite crystal clear that the healthcare system is, if I may put it that way, a bit on dekis, as we say in Stockholm.

Sweden stands out in the international statistics when it comes to healthcare beds. It is not the case that the number of healthcare beds is increasing. According to the National Board of Health and Welfare, the probability of a healthcare injury is 60 percent higher for a patient who is cared for at an outsourced location, for example. A strategic approach regarding healthcare beds throughout Sweden is required, but right now we see that the numbers are decreasing. They are decreasing, of course, because resources are lacking in the regions. It is very good that one has some kind of foresight, but it is also usually very good if one does things here and now when things happen that cause it to turn out exactly the opposite of what one wishes and says.

When it comes to care beds and intensive care beds, I am very concerned, because a shortage of such beds hits patients extremely hard. Given the national healthcare crisis we have, I want to ask how the Sverigedemokraterna intend to act. They do not directly support the welfare and have also not supported the healthcare since they took office in 2022 as a support party to the government. I am very concerned, I must say.

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

Linda Lindberg (SD)

Madam Speaker! I have been incredibly worried about the Swedish health and medical care for at least ten years. Not much has happened, and we also do not see that the care queues have decreased or that the supply of competence has been strengthened. The working environment has not directly improved. This is no news for Member Rågsjö. I have stood in this chamber and debated with the Member previously, and it is the same arguments that are being put forward now.

I can agree that there is still a certain frustration that it is going slowly. We have a challenging situation in Sweden, not least due to inflation, the increased pension contributions and obviously that many regions are having an extremely tough time. The whole country has a tough situation.

In Swedish politics for several years, the Social Democrats' only measure has been to provide more funds. It is obvious that that tactic does not work, because we are still in the same boat with the same challenges and deficiencies in Swedish health and medical care.

Sweden has a fantastic health and medical care, so we should not stand here and say that everything is very bad. But there are different challenges. It is in many and much Social Democratic-led regions that the very most difficult situation exists. It is also interesting to include that in the calculation.

I agree that it is alarming and that it is a tough situation out in the country. The Sweden Democrats take welfare very seriously. We take the Swedish health and medical care very seriously. I think it is unnecessary to complain that we would not do so.

It is also interesting to see how Vänsterpartiet handles this and what solutions they have. It is more taxes that are supposed to solve the problems in the Swedish health and medical care, according to them. It would have been very interesting if Vänsterpartiet had sat in government and had a majority. God forbid, however!

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

Karin Rågsjö (V)

Madam Speaker! If we had been responsible, we would have taken responsibility. I think it is good to take responsibility for one's own policy and not refer to other parties that have sat in other governments.

It is right now that 5,000 people within healthcare are to be laid off. I have met them myself.

It is right now that the number of healthcare beds is decreasing.

It is right now that the number of intensive care beds is decreasing.

It is now, in this specific situation, that 16 billion is missing in the regions due to inflation. It is here and now that you could have taken responsibility.

I am thinking about the pandemic. It was a different sound in the hall! Then the government and other parties took responsibility. I think it is a fine thing to take responsibility for the policy that is pursued. That can be done.

Another thing that is absolutely not working right now, Madam Speaker, is primary care. Everyone's fine goal was that primary care would step up, but that is not how it looks now. Instead, we hear from Vårdanalys, other organizations and workplaces, and the Socialstyrelsen that primary care has huge problems. It is also because resources are lacking. It is difficult to hire people and to get anything started if there are no resources. It is difficult to hire if one does not have the money for it.

We have a good health and medical care. If you are seriously ill, you get help. But now we are backing off in a worrying way. In Västra Götaland, they say at the neonatal department at Sahlgrenska that tiny, tiny children risk dying every day because resources are lacking. Then it is a matter of taking responsibility for the politics you actually pursue and for the cooperation you have with the government.

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

Linda Lindberg (SD)

Madam Speaker! We take responsibility. We take great responsibility. There is much that needs to be done and that we need to tackle. We have a high speed at the Ministry. We also have four ministers who are now working broadly within the Ministry of Health and Social Affairs to truly get a grip and catch up with what has been neglected within the Ministry of Health and Social Affairs and the Swedish health and medical care.

We take responsibility. We are investing money here and now. We have good investments within the entire healthcare area, and the members know that.

We are also working long-term to get the competence supply in order and to strengthen the working environment so that one can both recruit new staff and get back the staff who have instead chosen to work at, for example, an Icalager. There is nothing wrong with doing that, but they are needed in Swedish health and medical care. They have chosen to leave the profession because it is an unsustainable working situation, and that is what we are working on. We are reviewing the efficiency and how we can use the money and the staff in the best possible way to extract the capacity that exists in healthcare to meet the need.

We are reviewing the organization of the Swedish health and medical care, because there must be some kind of systemic error when we constantly put more money into it but still do not fully receive the care we expect. You cannot just add more money when it actually does not have an effect for the patient who needs it.

There are many parts we need to review and that we are also working on, here in the Riksdag and especially at the ministries and agencies, in order to truly address the challenges within the Swedish health and medical care. The situation is alarming, absolutely - but it has not happened overnight. I think one should take that into account when having this type of discussion. We are actively working on this in the short term and especially in the long term. We will not try to solve it in the same way as has been done for many, many years.

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

Lina Nordquist (L)

Madam Speaker! Everything within healthcare that works or does not work ultimately boils down to the supply of competence. Regardless of what improvement we want to achieve in healthcare, it will always require skilled professionals who enjoy their work. This applies if we want to reduce healthcare injuries, strengthen Sweden's civil preparedness, and shorten waiting times for surgery or for child and adolescent psychiatry or for any other type of care. This applies if we want more care in suburbs, in industrial towns, and in rural areas. This applies if we want to staff more and increase the number of care beds. It has decreased by 20 percent since 2012. It also applies, by the way, if we want to improve the work environment. The shortage of important colleagues is likely healthcare's greatest work environment problem.

It is therefore significant when the government invests state funds in the work environment, even though the responsibility for healthcare lies with the regions. Those funds are crucial to get extra momentum when it comes to retaining staff, so that more people can manage to work full-time, and so that leadership can be strengthened. It is significant with the national plan for better competence supply. The government has added more than 1 billion just this year.

It is also significant with continuous continuing education. I am thinking of the announcement here a few years ago. It must become a self-evident matter in healthcare to receive continuing education throughout one's entire professional life.

It is also important that we as a country consider that research and innovation must be fundamental parts of healthcare. It is very important that the government wants to make it easier to combine clinical work with research, but it does not stop there, of course. For all these things, there must also be time. There must be time for patient meetings. Regardless of how much knowledge one has, a lack of time will still ruin the patient meeting and much of what could become good in healthcare. There must also be time for continuing education and research, but less time must be spent on administration.

Madam Speaker! Swedish doctors today spend the equivalent of one day a week on administration. They manage to meet significantly fewer patients and spend less time with each patient they meet than their European colleagues do. At the same time as there is a shortage of nurses, nurses in our country are forced to spend time on documentation, peripheral tasks, and searching for care beds instead of on nursing care. This is completely unreasonable.

We must give back the healthcare professionals' time to the patients. We must free up time for supervision, healthcare development, and continuing education. The Government is working structurally to achieve all of this.

The government is also working focusedly for better digital infrastructure as work tools for healthcare and research. This applies to everything from medical records to certificate management and quality registers. Digitally, healthcare is still in many ways a journey back to the 90s today, and we cannot have that. People should enjoy working in healthcare. They should be able to use their time wisely. That requires really good digital infrastructure.

All this work must maintain a marching pace. I therefore move for approval of the committee's proposal and of the government's work. Through this, the healthcare sector's shortage occupations can become dream jobs. This, in turn, will reduce healthcare injuries, strengthen Sweden's preparedness, and shorten the wait for surgery or the queue for child and adolescent psychiatry and other care. It will provide more care in suburbs, industrial towns, and rural areas. It will also make it possible to open the healthcare beds that have been gradually closed over the last 13 years because people have not wanted to apply for positions, even though the healthcare sector has cried out for competence.

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

Karin Rågsjö (V)

Madam Speaker! How is the healthcare system doing? During the pandemic, we applauded the health and medical care. We all did that. Now, instead, 5,000 are being laid off. Despite increased needs, the number of care beds is decreasing, and the primary reason for that is the shortage of staff and resources.

The SD-dependent government is currently draining healthcare by not providing enough resources in a very difficult time. We have a national healthcare crisis in Sweden. We really don't need to have that.

The overcrowding in the country's hospitals is increasing. The number of intensive care beds is decreasing. They are fewer than before the pandemic. Kommunal, Vårdförbundet, and Läkarförbundet are sounding the alarm about the serious situation. I have respect for Vårdförbundet for taking the fight.

In the Left Party's proposal for the spring budget, we showed, among other things, how one can put a stop to the acute care crisis and ensure that no one is laid off within healthcare. We thought that was obvious. The staff is the gold.

We want to remove the market from healthcare. It is not entirely unfamiliar. We also want to remove the freedom of establishment so that one can get rid of the healthcare mafia, which can now open health centers and vaccination clinics almost anywhere to launder their money.

The Right has opened the door for this mafia, and now one must close the door that has been opened through the freedom of establishment. This applies to health centers, vaccination clinics, and other things throughout the welfare system.

Increased costs have eroded the regional budgets enormously. At the same time, we have an increasing population, an increasing elderly population, which demands more. It would perhaps be good to keep that in mind.

The staffing levels and the quality of care will fall to such low levels that patient safety will be threatened. It is being threatened right now because of too few resources. That is what the unions say. One has to decide whether to trust the unions or not.

As I mentioned earlier, the situation in the neonatal department at Sahlgrenska University Hospital is so strained that staff are warning that patient safety is threatened every day.

The share of general government grants in the funding of health and medical care has decreased from 16 percent to 11.5 percent between 2010 and 2022. It might be good to remember that. It runs contrary to various governments' recurring descriptions in recent years of historical healthcare investments.

All regions except three increased their costs for hired personnel within healthcare last year by 1.4 billion kronor. In total, the bill for hired personnel across the entire country landed at 9.3 billion kronor. This is due to a shortage of other staff rooted in poor working conditions, and it has been that way for quite some time.

The Left has presented a ten-point program to phase out hired personnel. We think it is extremely important.

Vårdförbundet is now reporting that their members have 3 million overtime hours. We must do something about it. This is due to the work environment. The situation is that one is called in immediately and all the time. People are having difficulty taking their leave. This is a crisis.

More than 90 percent of employers have a shortage of basic-trained nurses, district nurses, and X-ray nurses. 90 percent - that is serious.

Something that worries me and which permeated the work in the Committee on Health and Welfare during the pandemic is that the health and medical care system is lagging behind in its work to increase preparedness for war and serious crises. We do not have the capacity to receive a large number of injured. This is the responsibility of the SD-dependent government.

Last year, the Total Defence Research Institute, FOI, warned in a report about the risks of private ownership in healthcare. FOI pointed out, among other things, that the authorities lack direct control over large parts of the healthcare sector, which makes it difficult to ensure operations in a crisis and to deploy personnel for war. This is ignored by the parties on the right to a considerable extent, I believe.

The government's argument right now is that care must be made more efficient. That might sound good. There are studies from the USA where a research group has looked generally at care and concluded that the productivity development is underestimated by 3.1 percent per year. This is also about quality improvements being made within care. Care is not a car company; care is supposed to save people. Of course, it costs more and perhaps requires more staff.

When it comes to good and close care, primary care would step up. The scarce resources mean that instead, it has been braked. Follow-ups show that primary care's financial resources during the last five-year period have only increased marginally. The state must therefore take greater responsibility for the entire area. It is currently SD's and the government's responsibility to ensure that something comes of this reform.

Vänsterpartiet considers that there must be long-term funding to manage the transition that has begun within primary care.

The development of the competence supply within primary care is going completely in the wrong direction. Not least, the proportion of specialist physicians in general medicine and the proportion of district nurses have decreased over time. Today, there are fewer specialist physicians and ST-physicians in general medicine than in 2017 in relation to the number of listed patients.

A long-term plan for the primary care's competence supply in cooperation with the regions is needed. A long-term national economic plan for basic education, further education, and continuing education is also needed in order to ensure the need for doctors and nurses, and not only within primary care.

We believe that the government, together with the regions, should develop national action plans to reach the target value of 1,100 listed inhabitants per doctor contact. We shall achieve this by 2030.

Healthcare has been under very great pressure in Sweden for a longer period and is in crisis after the pandemic - a clear staffing crisis. Not least, it has led to the fact that the shortage of care beds is acute, which has been pointed out by the National Board of Health and Welfare. Within the coming years, 2,300 more care beds were needed within somatic healthcare. This is not about a shortage of beds but about a shortage of staff.

The crisis is a direct consequence of the cuts in healthcare that have been ongoing not only during this year but also previously. To meet the crisis that exists within healthcare, Vänsterpartiet wants to appoint a national crisis commission for a better working environment for staff within health and social care. It is necessary to renew the commitment to ensure a good working environment for all employees within healthcare. I therefore move for approval of reservation 8.

When I traveled around Västerbotten a few months ago, I naturally noted that it was sometimes very difficult for people to receive care. It is one thing to live on Kungsholmen, where there is an abundance of healthcare facilities, another thing to live in Sorsele. It is more difficult and more expensive in rural areas to build up units to be able to offer residents reasonable travel times. People in rural municipalities also have significantly poorer health than the average and compared to residents in wealthier municipalities. Curiously, it is the case that the access to and use of care is greatest where the most and healthiest people are. We can reflect on that.

Primary care in rural areas has a particularly resource-intensive operation, because the proportion of elderly people with large care needs is greater in the rural population. Working in rural areas requires not only medical knowledge but also accessibility. One must be able to see the entire care as a cluster. Here, the government, in cooperation with the relevant region, should ensure that there becomes a better rural medicine. We can do better, quite simply. It doesn't matter how many troll accounts provide a skewed perception of reality. That the care is in crisis is crystal clear, and the responsibility lies with the sitting government and the Sverigedemokraterna.

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

Thomas Ragnarsson (M)

Madam Speaker! I think it is fantastic to hear the member describe the failure that has occurred with the health and medical care since the 2022 election. It is astounding that we have been able to neglect it in that manner.

I dared to sit and look a bit online while the member held their speech. I pulled out some quite interesting figures regarding the number of healthcare beds. The large loss of healthcare beds has not occurred now but successively between 2010 and 2018.

When it comes to the number of healthcare beds, we are in complete agreement. We have 2.0 healthcare beds per 1,000 inhabitants in Sweden. The corresponding figure in Europe on average is 5.3 healthcare beds per 1,000 inhabitants. Germany and Austria are at the top with 9 and 10 healthcare beds per 1,000 inhabitants respectively.

Online it is stated that one explanation could be that the healthcare reform in the 90s caused care places to be moved from healthcare to municipal home healthcare. But that is a truth with modifications. I can think that one should be able to have a bit of self-respect and admit that one perhaps hasn't done this so well either. Member Karin Rågsjö has sat in government or been in a leading position during the recent years and sat as part of a government basis. Surely you also have a part in this, Karin.

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

Karin Rågsjö (V)

Madam Speaker! Certainly – everyone has a responsibility. But I have never sat in the government. And it is now that we have this crisis. It is now that 5,000 people have been laid off. It is now that one can see fresh figures from Socialstyrelsen that 2,000 more care beds are needed solely within somatic healthcare. There has been a shortage for a long time, but it is now that one risks losing even more care beds. It is also now that the intensive care beds seem to be decreasing. It is now that one can see from FOI, the Total Defence Research Institute, that there is a danger that the healthcare is trembling. It is now that we have had this inflation, and it is just now that healthcare is retreating. It is just now that we can see from, for example, Vårdanalys that all bars show red and point downwards when it comes to primary care. It is happening right now. That is how it is.

I have never sat in a government. It is very sad. I have, however, been part of a government basis. As far as I know, we took responsibility for what we did. I think that one should do that.

When the unions - Vårdförbundet, Läkarförbundet, Kommunal - say that this is a healthcare crisis affecting patient safety, I think it is obvious that one should take it seriously. But I don't quite think that this government, including SD, has done so. Then you would have ensured that during this crisis period with the high pension contributions and so on, you would have managed the year without having to lay off 5,000 people within healthcare. That cannot benefit healthcare facilities, intensive care, primary care, or whatsoever.

Yes, I am concerned. I must say that. I do not know which accounts the members have gone in and looked at. Nowadays, I am very worried about all the accounts that are circulating.

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

Thomas Ragnarsson (M)

Madam Speaker! I am not so worried about SCB's figures, nor am I worried about SKR's figures. But perhaps one should be - I do not know.

In my main speech, I mentioned – there are figures on that as well – that our municipalities and regions have never ever had so many employed healthcare personnel. Yet we produce less. Doesn't that still ring a bell that something is skewed?

I have looked a bit and tried to recapitulate my own working life to see when it went wrong. It was somewhere around 2010. That was when one started looking at county-wide clinics. Things were to be clustered together. In 2014, an investigation was released regarding level structuring within highly specialized care. It was a very good investigation, but unfortunately, I would like to claim, it was interpreted and read in a rather skewed way by many regional politicians; suddenly, one was down to ordinary gall surgeries and ordinary primary healthcare. Somewhere there, something happened.

We still have to look at productivity. A surgeon in the 80s operated on nearly 800 patients. A surgeon today operates on approximately 130 patients. Now, I also know that diagnosis was performed through surgery in the 80s. But the time in the operating room was there. So my question is: What do our doctors do during the time that the old surgeons operated on 650 patients? It is not a question of outpatient activity. I want to assert that they are sitting and administering in absurdum.

Things can be changed. 5,000 people are being laid off, but who has said that it is healthcare personnel who need to be laid off? There is never any talk about any other specialties – HR, communications departments, managers, and healthcare strategists. Who says it must be healthcare personnel?

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

Karin Rågsjö (V)

Madam Speaker! They are also being laid off. This specifically concerns healthcare personnel.

This matter of the healthcare system needing to be made more efficient is a rather interesting thing that you are now coming up with. What do you do? One thing that one does is something I am very baffled by. It concerns doctors and medical certificates. One has to sit and write very long certificates for Försäkringskassan, who wonder whether people are sick or not. It takes a great deal of time. But you want to speed it up even more. It will take even more time with your proposals, which you have in the filing cabinet - no, not in the filing cabinet; they are in the "file" here.

This issue of efficiency has been looked at in the USA, and I think it is quite interesting. Over there, they are very good at looking at things. It is a fairly large research group that has determined that the underestimation has been 3.1 percent regarding efficiency. It is about quality improvements. One handles difficult diagnoses that require a bit more. It is not a manufacturing industry we are talking about. It is not Volvo that we are talking about right now, but the entire health and medical care. I find it interesting that you always bring up this thing with efficiency - how many can one operate on, how can it be done in the shortest time, and so on.

Since then, it is the case that we have significantly more elderly people today, and they need a different type of care. It also takes time. Or maybe it is young, agile 40-year-olds. There is much that must be looked at, but right now I think this government and Sverigedemokraterna should look at the crisis that prevails and manage it. It is clear that the dismissal of 5,000 people will affect patient safety. It is your responsibility, I mean—the government's and Sverigedemokraternas. That is how I see reality, right now.

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

Anders W Jonsson (C)

Madam Speaker! There are three important areas discussed in the motion's report. Perhaps the greatest of them is the supply of competence. It is one of the fundamental problems we have not only in Swedish healthcare but in healthcare in most other countries. In the contacts that one has as a Member of Parliament with colleagues in other countries, it is precisely that which they describe.

It is a concern that, aside from the fact that we have the same problems as those in other countries regarding skills supply, we are ensuring that the problems in Sweden are exacerbated through our own measures. Take something like what is now affecting healthcare with the EU's working time directive. It did not have to be the case that it is Brussels that makes the decisions regarding working hours in Swedish healthcare.

Madam Speaker! It was by a few votes' majority that we here in the chamber made the decision to give that mandate to the EU. That train has now left the station. But one must remember that the decision was made in this chamber. We could have had a different course of action from the government's side as well in that matter, even if it is ultimately a matter for the parties in the labor market. But it was here in the Riksdag that we made that decision.

The second thing is that we have the National Health Competence Council. It comes with some quite interesting conclusions. It was, among other things, from there that it was said: We probably don't actually have a shortage of midwives in Sweden. We have the midwives we would need. The problem is just that they do not want to work with births within healthcare, but they work with a number of other things.

Madam Speaker! It will not become more popular to work in Swedish healthcare if one does as the government and the Sweden Democrats do. They say: We shall now investigate whether one should not be forbidden from having an additional task in healthcare, namely to identify those who do not have a full personal identity number. Or for that matter, which could affect maternity wards, to remove the possibility of using interpreters.

Another thing that exacerbates the problems regarding the skills shortage is the fact that the government, together with the Sweden Democrats, has put a brake on labor immigration. This creates acute problems both in healthcare and not least in elderly care.

One of the most prominent cases is from Norrbotten. Norrbotten's municipalities and region appeal to the government: Let us be spared increased maintenance requirements for labor immigration.

In a situation where there is a shortage of staff in elderly care, one can be forced to deport a number of people who function very well and can work, such as in Harads up in Boden Municipality. Those problems will then propagate into healthcare.

These are problems that we, or rather the government with the support of the Sweden Democrats, are creating for Swedish healthcare. It is something that we really did not need, given the seriousness we have in the lack of competence.

We have the National Health Competence Council. The remarkable thing about the Swedish system is that the volume of training for, for example, specialist nurses but also specialist doctors is something that each region decides on itself.

It was certainly good in another time. If you were educated in Jämtland, you stayed in Jämtland until you died. But that is not the case today. Young people who get educated in healthcare get their education in Halland, and then they want to move to another part of the country.

Then one must have a national healthcare competence council that is not just advisory but that actually has the mandate to make the type of decisions that concern this.

There is also this matter of e-health. It is one of the most exciting areas now. I can only agree with my Social Democratic colleague who said that there is a high pace in appointing investigations. But for it to become a workshop, it is also a matter of providing the economic resources.

I see, in particular, what development it could offer for the more sparsely populated parts of the country. That is strange about the situation we have in Sweden. It concerns the regions that have it absolutely toughest when it comes to healthcare and the economy. I am thinking of Norrbotten, Västerbotten, Västernorrland and Jämtland. There, one needs to make very large investments in digital healthcare. But there, the state is not prepared to provide resources.

Madam Speaker! I therefore wish to move for the approval of reservation number 11.

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

Ulrika Westerlund (MP)

Madam Speaker! Today we are debating one of the most central issues for our committee and for our entire society. How are we to ensure the supply of competence within healthcare and elderly care? This is significant both for how we can guarantee that everyone receives the care they need, of good quality and in a reasonable timeframe, and for how the staff's good working conditions shall be ensured.

To solve this, investments in the work environment and wages are necessary. We must address the work environment in health and social care, industries that are also often female-dominated, and where many women are now wearing themselves out and working involuntary part-time. According to a report from Kommunalarbetareförbundet, seven out of ten of their members in elderly care and childcare feel an anxiety that their pension will not be sufficient or that they will not be able to manage to work until retirement age.

Vårdförbundet announced on April 11 an overtime, extra time, and new hiring blockade for all regions. The blockade took effect, as we remember, on April 25 and covers 63,000 midwives, biomedical analysts, X-ray nurses, and nurses.

Since the blockade took effect, no negotiations have occurred, Vårdförbundet reports on its website, and they have now, on May 6, announced that they are extending the blockade to municipal health and medical care in 29 municipalities. The blockade takes effect on May 20 and covers an additional more than 5,000 members. Municipal health and medical care includes, among other things, school health and home healthcare.

This is, of course, a matter for the parties in the labor market to resolve. But one of the reasons for the conflict is reasonably a lack of resources at the employer SKR. Our fully reasonable demand is that we want sustainable full-time positions so that our members can manage to work full-time and for an entire professional life, says the chairman of Vårdförbundet. I assume that is something most can agree is a reasonable demand.

Madam Speaker! Sick leave is topped by women, and this applies particularly to stress-related sick leaves. It is primarily women who work within healthcare. To address this, more colleagues are a fundamental prerequisite, but also otherwise better conditions and higher wages.

Miljöpartiet argues that there should be a right to full-time and an opportunity for part-time. But the right to full-time must also be about the right to the energy for full-time. Miljöpartiet wants publicly funded employers to take the lead and offer full-time as the norm and part-time as an option for all their employees.

Miljöpartiets most important healthcare issue is to improve working conditions and the work environment for staff in health and medical care and municipal health and social care. Right now, it is about the state should help to finance municipalities and regions so that we avoid seeing large cuts.

But in the long run, we also see that it is necessary with a state-funded major investment to enable more employees and higher wages in health and medical care and elderly care. This would, if it became a reality, make a big difference for women's working conditions and reduce the risk of stress-related ill health, and it would make a big difference for the supply of skills.

We also want to retain the recovery bonus that Miljöpartiet pushed through in government and which goes towards improving the working environment, for example through different working time models or other innovative ways of working that staff groups want to try.

Madam Speaker! In our spring budget motion, we are allocating 7 billion more than the government to healthcare, which means a total supplement of 13 billion. We also want the state grants to municipalities and regions to be indexed so that they increase with cost developments. This puts a stop to automatic cuts and gives municipalities and regions better conditions to plan their operations in a good way.

In our budget motion last autumn, we proposed 14 billion more than the government in general state grants to municipalities and regions. In addition, we invested 1 billion to maintain the recovery bonus.

We understand that not all challenges can be solved with just more money. But we still mean that money is a large part of the puzzle. The regions need general grants, not performance-based ones, so that they can decide for themselves where the money does the most good.

There is also a shortage of staff with the right competence in both health and medical care as well as elderly care, dental care and social services. The staff shortage is expected to grow and in several areas become acute during the parliamentary term.

The reasons behind the growing staff shortage are several. A broad consensus and a common national initiative are therefore needed to reverse the development. Dividing the issue through a number of different government assignments is not sufficient in this context. A preparation for the welfare sector's staffing should be established, and the government should take action.

I naturally stand behind all of the Green Party's reservations, but I move for approval of reservation 6.

The deliberation was hereby concluded.

(A decision was to be taken on 16 May.)

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