Skills supply, health and preparedness

Thomas Ragnarsson (M)

Mr. Speaker! Today we are debating the Social Affairs Committee's report SoU22, Competence Supply, Health and Preparedness, and I would like to begin by moving for the approval of the committee's proposed decision.

It is a comprehensive report concerning a large number of areas, but one cannot escape the fact that one of the most important issues in the report is the future supply of skills. Healthcare is not alone in needing to handle this issue; it exists within most industries. Given the demographic development in Sweden, with simultaneously low birth rates, one quickly realizes that the equation will not add up.

We must, however, scrutinize the truths presented to us. According to the regions and municipalities, there has been a shortage of staff for a long time, but there are figures that show that this is not true in total. The employers must begin to consider how the staff is utilized. Medical development is progressing at a rapid pace and can often mean that the work around the patient is streamlined and reduced. We must simultaneously take advantage of the innovations that exist within medical technology and which facilitate the work for the staff.

One of the most expansive areas for technology is AI. The moderate-led government has decided to appoint a committee on enhanced AI capability in Sweden. This is a technology that needs to be considered from several different perspectives, not least from the medico-ethical perspective. But we still see that AI is used with great success in certain areas, for example for image review in mammography, which in the future will free up personnel resources for other tasks.

Mr. Speaker! The digital infrastructure within Swedish healthcare is, to say the least, deficient, and therefore this is a point in the Tidö Agreement. The Moderate-led government and the coalition partner Sverigedemokraterna are working to create a uniform and common digital infrastructure for Sweden's healthcare. It shall replace and complement existing structures.

The work is very important from several aspects, above all from a patient safety perspective. With functioning systems and infrastructure, the staff's work is also facilitated, which is of utmost importance given the future supply of competence. The advantage of such an infrastructure is that all primary stakeholders can share health data while it becomes easier to extract information and material for research and innovation.

Sweden today has a number of quality registers that are of world-class standard but which, in today's system structure, require an incredible amount of manual input, not infrequently from both doctors and nurses. This will be facilitated by a common infrastructure.

Madam Speaker! The world is in a difficult time, and a war of invasion is underway in Europe. Ukraine is under attack and has been for over three years. This reality has caused us in Sweden to wake up, and with all desirable clarity, we have become aware that our preparedness is not functioning.

Swedish healthcare has been centralized over decades, with increased specialization in all areas. It works in peacetime and in a normally functioning society, but it does not work in war or during major societal stresses. We are today completely dependent on functioning transport chains through which much material is delivered just in time. The stock levels at the hospitals are very small. War and other major events will, however, require more personnel.

The Government has taken the issue most seriously, and work is being carried out on a broad front to ensure stockpiling of materiel, medicines, and personnel supply. The Government has allocated funds for this purpose. Socialstyrelsen, Läkemedelsverket, and MSB have been tasked with increasing our robustness. Consideration is also being given to how civil servants could strengthen the operations.

Many lessons can be drawn from Ukraine regarding how we should build up our resilience. One thing is clear: healthcare is a priority target for a potential attacker, and it requires both that we can work in so-called "off-grid" conditions and that there are escalation plans for how we can scale up operations and utilize different locations to provide advanced healthcare.

A dysfunctional healthcare system in peacetime will definitely not function when the pressures increase. The training for the staff will largely take place in ordinary operations, which means that the things we do not do in everyday life will also not be able to be scaled up if the national situation so requires.

Madam Speaker! Our municipalities and regions have a great responsibility for the local development of the healthcare system's preparedness, but my view is that the issue is prioritized very differently across the country. A worrying trend is that functioning healthcare is still being shut down in Sweden today, and four emergency hospitals in different regions are seriously threatened. I see that as extremely noteworthy given that we only have around 60 emergency hospitals in Sweden.

At the same time, we know that half of the healthcare facilities in Ukraine have been precision-bombed. With that in mind, we should not shut down functioning operations; instead, we will need to scale up with additional operations, for example, emergency hospitals and reinforced primary care centers. These will need to be reinforced with personnel from facilities that perform surgery and advanced care in their daily work.

The question of the healthcare system's preparedness is something that interests me very much, and I have had the privilege of meeting many important stakeholders. The conclusion I draw is that this work must be carried out at the very ends of the capillaries, where staff, authorities, interest organizations, voluntary organizations, the business community, and the rest of civil society work side by side.

(Applause)

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

Karin Rågsjö (V)

Madam Speaker! Much is discussed about what will happen in the event of a crisis or in a war. There are things that make me wonder, and I hope that the member has very sharp answers to that.

It is about, for example, a healthcare system that is somewhat in crisis. I mean that our healthcare partially is, given the enormous savings that were made in the regions in 2023 and 2024. Even this year, cuts are being made, for example in Skåne. You are the ones in power there. This year, cuts of 1 billion have been made, and 1,000 people are to be laid off. And the intensive care beds in Sweden have continued to decrease five years after the pandemic. Socialstyrelsen wants the intensive care beds to increase by 10–20 percent so that we can handle what might potentially happen – or rather, what is happening.

I wonder how you have thought about that. Is it the regions' responsibility, now that they have received such an extreme austerity proposal? They have simply had it a bit difficult. I think that the government and the Sweden Democrats often pass the responsibility over to the regions without seeing their own responsibility. That is one question.

This matter regarding AI is very interesting; I agree with that. It can facilitate a great deal. It is also the case that it looks very different – in some regions, an AI process has been initiated regarding mammography and other things, but it has not been done in the whole country. It results in an extreme inequality. I wonder what proposals the Moderaterna and the government have to facilitate so that it becomes equal in Sweden when it comes to AI.

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Thomas Ragnarsson (M)

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

It is not the first time we stand here in the speakers' chairs, Karin Rågsjö, and discuss how much money the regions and municipalities should have – what they should get according to you and what they should get according to me.

Yes, it has been a tough situation, but to say that funds have not been added to the regions, I think is a bit presumptuous. I can speak from experience: I have worked in healthcare for 37 years, and we have never stayed within budget. It becomes a bit of a paradox – you don't need to worry about the budget when you know that money will come anyway.

When it comes to the crisis that is being discussed, I mentioned in my speech that we actually have to scrutinize the figures a bit. Swedish healthcare has never had as many employed nurses and doctors as it does now, and it has also never produced so little. In my world, that indicates a systemic failure. To choose to inject more money in that situation is like burning money. It will not happen.

The chairman mentions Skåne and that large cuts are to be made there. Yes, it is also a quite large county with very many employees. But it is not said that cuts should be made on healthcare personnel. There is other personnel to cut. It is something we must start thinking about. It actually lies with the regional and municipal politicians to start steering and leading their operations, but today it is very much freely chosen work. That is my opinion.

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Karin Rågsjö (V)

Madam Speaker! It was interesting – I hope that someone from the regions listens to the sheer nonsense that the member is giving the regions. It was a bit interesting.

If you lead a country, as you do now, Thomas Ragnarsson, I still think one must take responsibility for what happens. I cannot see that you are taking that responsibility; instead, the responsibility is constantly passed on to the regions. It is said that they are sluggish, that they have too many staff members, and that they produce too little. It sounds like it is soap factories we are talking about.

To be honest: If you look at what has happened over the years, you see something else that has also happened, namely that we have a completely different demography, significantly more expensive medicines and so on. I think the member will be very angry when I say this and perhaps think that it is fabricated figures, but SKR has calculated that the general state grants would have been 27 billion higher if we had followed the cost development through an indexing of the state grants. The cost development has been so terribly harsh when it comes to, for example, medicines, that many more elderly people need the care's resources and so on.

I think it is very dangerous to say that today it is teeming with staff who are just wandering around. Because that is how it sounds to the member. Is it the case that the member means that there are a lot of loose cannons, so to speak, who work with communication or whatever? That is not really the case, as far as I know.

I am quite worried about what would happen if Sweden were to experience a pandemic tomorrow. We have, in fact, worse conditions than when the previous pandemic came to Sweden in 2020. I do not see the government parties, nor SD, taking responsibility for building this up in a reasonable way. It worries me immensely.

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Thomas Ragnarsson (M)

Madam Speaker! The big problem is the following: If on the one hand we have more employed staff than ever – and it is healthcare staff I am talking about – and on the other hand we produce less, then there is something skewed in the system.

I do not mean that people are walking around and complaining, but I am talking, for example, about the digital infrastructure. We over-document something incredible within Swedish health and medical care. We have surgeons who sit and write medical records instead of operating. It is completely crazy. We also have bad systems that cause the staff to be sucked into unnecessary work.

The regions wanted to handle this with the digital infrastructure themselves, and they have tried to do so for a number of years. I do not know how the member perceives it, but I must say that I do not think anything has happened. I do not think it should rest on the regions, SKR or the municipalities; it should rest on the state. It is we who should take the responsibility. But this is a way to streamline the operations.

I usually take an example: In the 80s, a surgeon operated on about 700 patients in a year. Today, a surgeon operates on 150 patients in a year. I am aware that in the 80s, people opened patients to look for errors and that we do not need to do that today, but the question I usually ask when I am out in the regions is what today's surgeons do given that the old surgeons operated on 600 or 650 more patients. The answer I get is that they have clinics, but they had that at that time too.

We therefore have a system failure, and we need to reflect on that.

(Applause)

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

Anna Vikström (S)

Madam Speaker! We support all reservations, but I move for approval of reservation 1 only.

The foundation of our country's safe and high-quality health and medical care is its staff. We are now in the absurd situation that healthcare staff in many regions and municipalities are being laid off and reduced despite being needed in healthcare, and at the same time as healthcare and nursing have large staffing needs. This healthcare crisis could have been stopped by the current government. But the government has not done enough, and the consequences of the healthcare crisis are now affecting healthcare – the patients and the employees – all over Sweden.

The healthcare crisis is still a fact. The Minister for Health's statements that brighter economic times await healthcare across Sweden now that inflation has gone down and that the feared healthcare crisis was averted could not be more misleading. Two weeks after the statement, 940 people had been laid off within healthcare and elderly care in three weeks. The number of layoffs in healthcare and elderly care amounted to a total of 1,016 in March this year, and in 2024 it amounted to 6,098.

The number of employees is also decreasing in other ways, even if the layoffs do not correspond to the number of those given notice. People who leave are not replaced, substitute positions are terminated, and so on. Notices, reductions, and layoffs affect people who are actually needed in healthcare, which affects healthcare and the patients.

Just saying that not as many are laid off as are given notice, and thereby waving away the problem, shows that one has no idea about the long-term consequences for the competence supply of these notices and closures. Other questions must be asked, such as how the trust in the employer is damaged in the long term and whether notices and reductions give a push to trained healthcare personnel to permanently leave the profession.

Not being able to provide the care that one wants to be able to provide and that one sees patients need can cause stress. This has been clarified in letters to the editor and protests from staff and trade unions. For example, fifty doctors in Region Östergötland recently protested against the cuts within psychiatric care. They gave very serious examples of how the reductions worsened various areas of care within psychiatry.

Working in a situation where one risks losing their job involuntarily is definitely not a good working environment – something that is a prerequisite for a good supply of skills. To even issue notices and reduce staff when the long-term supply of skills shows major problems with recruiting staff to health and social care is absurd. Notices and reductions of staff must be stopped. That is the first thing that must happen.

The government must see reality as it is and act accordingly. It is an abnormal situation for Swedish health and care that resignations and notices of termination occur in this manner. We believe that the entire health and care sector must be strengthened, also from a preparedness perspective, so that there is a better ability to handle major crises and wars. We believe that healthcare needs to be upgraded and that the staff's working conditions need to be improved.

Madam Speaker! Other measures for the government, in addition to acting to stop warnings and cuts, are to use the tools that exist. For example, there are measures in the national plan for skills supply, which is finished. This has come from the National Health Competence Council. These are measures that are also directed at the government.

The completed investigation on activity-based education and that which is called VULF, which concerns education, the government can also proceed with. It is referred and finished. The investigations have quite similar proposals, that is to say, the investigators and stakeholders have a fairly large consensus. It is time to move from words to action.

We also want to move forward and see a preparation for the staffing of the welfare sector. Models for similar cooperation structures exist, for example, in the defense and security areas. If we are to reverse the development regarding the attractiveness of welfare professions, a broad consensus and a common national initiative are required in the long term.

Madam Speaker! Currently, there are many investigations and government assignments regarding a national digital infrastructure within health and medical care, including a proposal for a roadmap. Many assignments are complete. For example, the previous S-government produced several investigations, and the government appointed new investigations. These are all now at the Government Offices. But something that is actually being implemented for real is the national pharmaceutical list, even though it is significantly delayed. But otherwise, there is not much workshop, but mostly investigations.

If a national digital infrastructure is to be established, a number of decisions are needed. It is not something that happens by itself. We know that after many years of voluntariness and recommendations within the healthcare sector. Good coordination is also required for the state and for the public and private providers. A position on financing is also needed.

It is not free to get municipalities, regions and private operators to adapt to state governance within the area of digital infrastructure. Regional representatives recently noted, regarding the European Health Data Space EHDS, that it will require extensive and costly measures in all member states and that the Swedish government's approval of EHDS means that the government needs to take responsibility for the financing. The so-called financing principle means that no new mandatory tasks may be introduced without accompanying financing to municipalities and regions.

It is not only desirable but also necessary that decisions are made if a national digital infrastructure is to become a reality. We therefore want the government to present a roadmap on the national digital infrastructure to the Riksdag.

We also want to allow regions to request and review private providers' patient records. Sveriges Kommuner och Regioner has, in a petition to the government, requested to receive clear legal support when it comes to the right to request and review patient records as part of a contract follow-up or to prevent and counteract welfare crime. The Social Democrats share SKR's view: The government should as soon as possible return with a proposal that gives the regions this possibility.

The government must take measures to stop warnings and cuts. That is the first thing that must happen. The government must put the national plan for skills supply and other similar national proposals in the area into practice. They exist. Use them!

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Mathias Bengtsson (KD)

Madam Speaker! I am replacing Dan Hovskär today, who has fallen ill. I have not had too many hours to read up on the committee report. But I would like to vote in favor of the committee's proposal and try to describe the Christian Democrats' policy in this area as well as I can.

We are well aware of a healthcare organization in Sweden that was established during the 1800s and which is now trying to manage the problems that exist in the 2000s. It is not holding up. The chance of surviving colon cancer should never depend on which zip code you have. An alarming test result must be taken with equal seriousness regardless of whether it is in Stockholm or in Blekinge. When the doctor calls and says that you have cancer, it should not matter which region you live in. But today, unfortunately, it does.

In a small country like Sweden, it is not reasonable to have 21 different healthcare organizations, where where one lives determines to an excessive extent which care one actually receives. Under the leadership of the Christian Democrats, the government is now implementing some of the largest healthcare reforms in decades. We are strengthening state governance and coordination in areas such as preparedness, digital infrastructure, and healthcare capacity. But that is not enough.

To continue leaving the future of healthcare in the hands of 21 different regions is a bit like expecting a broken engine to repair itself. Seven out of ten Swedes want the state to take over the responsibility for healthcare, and eight out of ten of the Läkarförbundet's members believe that the state has better conditions to achieve good and equal care. The Kristdemokraterna agree.

We need a modern and nationally coordinated governance. A holistic approach is required regarding issues concerning healthcare capacity and competence supply and patients' access to care in a timely manner. We want the state to take over the responsibility for healthcare, so that it becomes an equal care throughout the country.

Madam Speaker! The staff is the healthcare system's absolute most important resource. Many times they do not just carry stethoscopes around their necks, they actually carry the entire healthcare system on their shoulders. They are there when life is strained, when children are born, when accidents happen, and when the news comes that it is cancer. Healthcare staff are present throughout life as an incredibly valuable asset in society. If one wants to achieve increased healthcare capacity, it is naturally important to improve the working environment, so that the conditions for a good supply of competence increase.

In this work, the regions need to improve their governance of care so that the working environment and conditions are improved. There are actually many who are healthcare-trained in our country but do not work in health and medical care. We need to lure them back to the profession. Not least from a preparedness perspective, it is important to take advantage of the competence that exists but is not used in healthcare today.

We actually cannot afford to have a work environment and working conditions in the regions that drive experienced nursing assistants and doctors to other jobs. The government has therefore taken greater responsibility for exactly this regarding the supply of competence through the ordinance on good and close care, where it is now required that the regions show that they are improving the work environment and strengthening the supply of competence in order to receive the funds. It is a clear signal: One simply cannot continue as before and at the same time expect the state to make up the difference. It is a clear example of how the state needs to take greater responsibility for the steering.

The Government has also developed a national plan for the supply of skills. The National Healthcare Skills Council has developed 25 concrete proposals which, among other things, concern creating better opportunities for skills development and career paths within healthcare. These are measures that both strengthen quality and make the profession more attractive. The Government is now working on those proposals in the Government Offices. We have also ensured that the plan is anchored and adapted to the reality of healthcare.

Madam Speaker! Modern care naturally also requires a modern infrastructure and, not least, a digital one. An important part of strengthening healthcare is therefore about building up a secure, common and efficient digital infrastructure throughout the country.

Today, it looks very different between the regions. This creates problems, not least for the patients. If the information does not follow between healthcare providers, it can lead to incorrect treatments, double work, and uncertainty. At the same time, healthcare staff are forced to spend an unreasonable amount of time on administration when they should actually be able to focus on what is absolutely most important, namely providing care.

The government is now working to change this. Our objective is very clear. Health data must be able to be shared smoothly and securely throughout the entire care chain, whether it concerns municipal care, regional healthcare, or for that matter, dental care. The patient should not have to notice who is the primary provider. The care must be connected.

Recently, the E-health Agency presented a roadmap for how a common digital infrastructure can be introduced and function. It is about giving every resident better access to their own information, about reducing double work, about freeing up time for healthcare staff, but also about taking advantage of the enormous potential that exists in health data – for research, for better decision support, for the development of precision medicine, and for training AI models.

We strengthen healthcare by making it easier to do the right thing. When the right information is available at the right time, both the safety for the patient and the job satisfaction of the staff increase. It is digitalization that makes a real difference in people's everyday lives.

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Karin Rågsjö (V)

Madam Speaker! Yes, everything will be fantastic if the state takes care of all healthcare. That was, so to speak, the basic message in Mathias Bengtsson's speech. It actually sounds like an advertising campaign before the decision we are to make in the committee that is looking at these issues.

But it also has to be a bit about here and now, doesn't it? It is not about some kind of future perspective where the state soon takes over, but one must look at how it looks in reality.

What I find tedious about you Christian Democrats is that you constantly shift the entire responsibility onto the regions. It sounds as if you are, so to speak, dodging responsibility somewhere, that you do not take the responsibility that you should take.

We have had very heavy years within healthcare in the regions – everyone knows that. It has been two massive crisis years – 2023 and 2024. 5,000 have been laid off. The layoffs are now also continuing in Skåne, where 1,000 people will be laid off. They are to save 1 billion.

Then one must take responsibility for that. What is it that is happening? Are they necessary layoffs? It is about a lack of resources.

Another very interesting question, I think, concerns good and close care. It has instead become bad care far away, if one is to speak of the reality. Vårdanalys has followed the process of close care itself. They completely sweep the carpet under the rug with the responsible politicians, because nothing has happened. It remains and ticks. There has been no trade-off. It is not the case that patients are met with continuity, that there are people on site, that there is care on site in primary care and that there are 1,100 patients per doctor. On the contrary, it has moved backwards during these years.

Then I wonder: What do the Christian Democrats intend to do about just that?

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Mathias Bengtsson (KD)

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

It is naturally the case that the regions have been pressured financially by both inflation and the higher pension costs that have followed it. The government has made several interventions to mitigate the worst effects.

During 2024, 9 billion kronor were added in two different sector grants targeted specifically at health and medical care. During 2025, a number of state grants of various sizes continue to go to health and medical care.

But my point with stating that a greater state responsibility would be needed was precisely that we have 21 different healthcare systems that function somewhat differently. The quality is also very different in different regions. It becomes especially clear when there is this type of inflation and when one is pressured by increased costs. It works in different ways, and different regions handle it differently well.

To some extent, the regions naturally need to streamline and ensure that staff are used in the right way, so that staff who are skilled at operating perform surgery and do not engage in administration, as we, for example, heard in the latest exchange of remarks.

I also have another point: Pouring money into a system that does not work is a bit like filling a leaking bucket with water. It is not a long-term solution. Therefore, the state needs to take greater responsibility. We would need to get rid of 21 different healthcare organizations and instead have a common state responsibility. I believe that would be the solution for many of the healthcare issues.

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Karin Rågsjö (V)

Madam Speaker! Yes, it has been your party's message for a very long time that the state should take over responsibility for healthcare. You have pushed this with emphasis, so I am not surprised that the member is taking a turn on that again.

Care is unequal. It is a regional inequality. It may be due to the fact that there is a completely different demography in, for example, northern Sweden – isn't that right? Perhaps more resources are needed in northern Sweden because of the demography and because of the distances, for example.

The inequality is also class-based. There is an enormous difference in the care people receive depending on which class they belong to and where they live. The best health centers perhaps should not be located in Kungsholmen. They should, for example, be located in Tensta, Rinkeby, and Botkyrka, where there is poorer public health. They perhaps should not be located in Lomma but maybe in Rosengård. That is how one works to reduce inequality. One must also have a plan on how one is supposed to lift people who need more health-oriented interventions.

I am thinking of everyone who is struggling in the regions. I am thinking primarily of the staff, because it has been tough. In 2024, 38 motions regarding work environment measures were received from safety representatives at hospitals. These were reports of deficient work environments. It is, so to speak, a world record in Sweden. It concerns, for example, understaffing, deficiencies in the physical work environment, excessively high workload, and substandard psychosocial work environment because the staff is so pressured all over the country.

I think that both from the member's colleague from the Moderaterna and from the member themselves, it sounds like it is a bit too easy-going in the regions, that it is a bit slashed over the whole thing. So that is really not the case. The staff is really struggling. How this is to be addressed, we can discuss another time.

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Mathias Bengtsson (KD)

Madam Speaker! The big difference between the Christian Democrats and the Left Party is that we do not believe that more money is the solution to all problems in the public sector. It is not higher taxes for everyone who works in healthcare, who make enormous contributions every day, that is the solution to all of healthcare's problems.

On the contrary, there is a systemic problem affecting those who work in healthcare. There is a reason why eight out of ten of the Läkarförbundet members want the state to take over the responsibility. They see the problem with their own eyes.

There is a very clear example when it comes to e-health: that the medical record system cannot be properly synchronized between different regions. The state needs to take greater responsibility. We see it in several areas. That is exactly why it is time for us to carry out the healthcare reform of the century with a state governance of healthcare.

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Anna Vikström (S)

Madam Speaker! Mathias Bengtsson speaks about state governance in his speeches. Then I become a bit curious because it is about adapting national legislation to the national digital infrastructure. What does the roadmap look like? I am thinking, for example, of this with the European Health Data Space, which is coming in, which the government has voted against.

As I mentioned in my speech, there are very many investigations carried out in this area. We have conducted investigations, and the government has commissioned a number of new investigations. But it is very difficult to see that they are presented to the Riksdag and translated into practical action.

The government has appointed councils of various kinds and also a national coordinator. However, it will not be enough to govern the regions, because it is a matter of making quite large changes in the regions' systems – which, moreover, can consist of 100 different systems. It is not the case that there is a single system per region. We can compare this with a national medicine list, for which a decision was made here in the Riksdag, and see how long it has taken just for these rather small amounts of information to be realized.

There is a proposal for a roadmap, but it has not been decided, and it will cost money. How will a long-term roadmap become a reality so that all those involved can see how this is going to work and how long it will take?

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Mathias Bengtsson (KD)

Madam Speaker! Thank you, Member Anna Vikström, for the questions and also for the Member raising such an important issue!

In my speech, I tried to describe why the issue is so important, and it is precisely because it is unreasonable that the digital infrastructure looks so different in different parts of the country. Patient information that gets stuck in different medical record systems depending on where one is in the country and receives care leads to double work, waste of resources, and in the worst cases, poorer care.

I have no up-to-the-minute information on exactly where this work stands, but the government's objective is very clear: health data must be able to be shared smoothly and securely throughout the entire care chain, whether it concerns municipal care, regional healthcare, or for that matter, dental care.

It also points out exactly the point I am trying to make, namely that it is difficult for the state to take a holistic approach when there are 21 self-governing regions that have their own healthcare systems. In that case, there is no quick fix for the state to coordinate and take over. We would need more state governance, and we would need to abolish the regions' responsibility for healthcare.

Therefore, my counter-question to the member is: Are the Social Democrats on board with the policy of letting the state take over the responsibility for healthcare?

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Anna Vikström (S)

Madam Speaker! Thank you, Mathias Bengtsson, for the answer!

I want to say first that when it comes to the e-health area specifically, we do not have any significant party-political differences of opinion; we both want this to become a reality.

I believe that we from all parties in the Social Affairs Committee envisioned that there would truly be a change – that a roadmap would emerge that clearly and step-by-step shows how this is to be done, what it will cost, and what the regions and perhaps even municipalities should do. This responsibility actually needs to be taken by the state level, otherwise nothing will happen at all.

When we look at the report that we are debating today, we see that there are 29 hits on investigations being prepared in the Government Offices. The vast majority of them concern health data and the digitalization area. There are therefore heaps of investigations that are completed and referred, but no proposals proceed to the Riksdag.

Here, the Christian Democrats, with their ministers, have a unique chance to do something for the national digital infrastructure through state governance. I do not understand why the government is not taking that chance. Why are new inquiries constantly being appointed that result in nothing? Why are there no measures that make a difference?

What does the member say about this? Why don't you take the chance for state governance now when you have it?

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Mathias Bengtsson (KD)

Madam Speaker! It is possible that this is not a partisan issue, but the reason why the government and the Christian Democrats need to carry this out now is that the previous, Social Democratic government failed to do so.

It is completely obvious that the state needs to take this responsibility for coordinating patient data. But it is not only that responsibility that the state needs to take; the state would need to take a much greater responsibility for the entire healthcare system.

I think the member argues for state-run healthcare in an absolutely excellent way, and therefore it is unfortunate that the Social Democrats cannot give an indication that they also want the state to take over full responsibility for healthcare. Then we could join forces on this important issue.

Until then, the government can continue to work at a high pace for more state control of healthcare so that we can put the patients at the center and not in waiting rooms.

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Anders W Jonsson (C)

Madam Speaker! I requested the floor when I heard Mathias Bengtsson point out the problem that we have in Sweden, namely that there are large regional differences regarding what healthcare is offered. There are also large intra-regional differences regarding what healthcare is offered. But to jump from there to the simple solution that if only the state takes over everything then we will be able to solve this, I must say, Madam Speaker, shows a somewhat flawed analysis.

If one looks at corresponding countries that also have sparsely populated areas and rural areas, there are large regional differences regardless of whether it is the state that is the principal, as in England, Scotland and Norway, if one has regional principals or if one has mandatory insurance solutions as in large parts of Continental Europe.

The reason we have regional differences is largely due to the issue of competence. In Sweden, we have approximately 100 pediatric neurologists, of whom 50 live in Stockholm and work at Karolinska Hospital. It is then no wonder that more pediatric neurology is offered in Stockholm than is done in Gällivare or, for that matter, on Gotland.

It would be interesting to hear how Mathias Bengtsson and the Kristdemokraterna envision this. If we simply let the state take responsibility for all of this, will we suddenly get an even distribution of pediatric neurologists, neurosurgeons, and specialist nurses? Because that is where the root of the evil, the lack of regional equality, lies.

Should we start forcing pediatric neurologists to move? Is that what the state should decide: Now the National Board of Health and Welfare says that three shall move to Luleå and two to Visby, because now it is to become equal when the state has taken responsibility!

What does the Christian Democratic analysis look like?

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

Mathias Bengtsson (KD)

Madam Speaker! Thank you to Member Anders W Jonsson for the question!

I would say that it is quite obvious that if you have 21 different healthcare organizations, you will also get 21 different outcomes. It naturally becomes very difficult to achieve equal care between 21 different principals, and there are obviously better conditions for achieving equal care if you have a state principal instead.

I believe there is a reason why seven out of ten Swedes want the state to take over responsibility for healthcare. One sees the deficiencies that exist. One sees that today, it is the zip code that determines how great a chance one has of surviving a cancer diagnosis.

It is also the case that eight out of ten of Läkarförbundet's members believe that the state has better conditions to achieve equitable care. Eight out of ten of Läkarförbundet's members therefore believe more in Kristdemokraterna's policy than in Centerpartiets policy.

If one were to look at a country of 10 million with Sweden's geography and create a healthcare system for that country, would one then divide it into 21 different regions that get to manage their own healthcare organization? The member is welcome to try to explain that to me.

I do not believe that, and therefore we need to leave this system from the 1800s and instead do as our neighboring countries and reform the healthcare system.

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

Anders W Jonsson (C)

Madam Speaker! So that is how the Christian Democrats see this, that is to say as a small playground. Now we have a new country where we are suddenly going to build something and how are we to organize it? Research suggests that we should have mandatory insurance systems because those systems deliver efficiency in a completely different way. But that was not my question, which Member Mathias Bengtsson so carefully avoids and instead repeats opinion polls.

We now have a situation where half of the pediatric neurologists are located in the Stockholm area. How would it solve the situation if the state suddenly becomes responsible? The Christian Democrats propose an argument for merging everything into a single giant state agency with 450,000 employees. Then everything is solved. But then the countries that have chosen that path – England, Scotland, Norway, New Zealand, and Canada – would not have any regional differences. But they do. There is nothing in the research that supports the thesis that just the organization of healthcare would be the solution to how one reduces the regional differences.

Since then, we have had the overconfidence that if only the state, Stockholm, decides, most problems will be solved. I want to remind that one of the worst healthcare crises Sweden has gone through was the pandemic. It was not solved by the state taking a large responsibility for healthcare. It was also not solved by the regional politicians stepping forward, but it was solved by decentralizing and letting the people on the ground, doctors and nurses, solve the major challenges that the Swedish healthcare system was subjected to at that time.

It is not centralization, power to Stockholm in all respects, that is the solution to the tough challenges that Swedish healthcare has.

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

Mathias Bengtsson (KD)

Madam Speaker! I can assure Anders W Jonsson that I do not see Stockholm as the solution to all of Sweden's problems.

Anders W Jonsson does not answer the question of why he wants to go against eight out of ten of the Läkarförbundet members. He also does not answer the question of why seven out of ten in the Swedish population would be wrong.

Let us look at the example of the journal system, which is raised in the report. It is quite obvious that it is a problem today that a patient who has been investigated in their home region but then falls ill in another region can be met by healthcare staff who have no information at all. It is quite obvious that this must be changed because it is inefficient, unsafe, and unnecessary. It is quite an obvious example that the state governance and organization of sharing e-health data is going so slowly because of the 21 different self-governing authorities.

There are significant advantages to scrapping the system from the 1800s and instead creating a new, modern state healthcare system.

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

Carita Boulwén (SD)

Madam Speaker! Today we are debating the Committee on Health and Welfare's report SoU22 Competence Supply, e-health and preparedness. These are three completely crucial areas for a functioning healthcare system.

We in the Sweden Democrats stand behind our reservations, and also large parts of the report, but I move here for approval of only reservation 10.

We are dealing with a report concerning fundamental parts of Swedish health and medical care, including how we secure competence, how we use technology correctly, and how we equip healthcare in everyday life and ahead of a crisis or, in the worst case, war.

A well-functioning healthcare system is one of the most important cornerstones of a welfare society. It is about a healthcare system of high quality where all of Sweden's citizens, regardless of where in the country they live, in a large city or rural area, should be able to rely on receiving the right care at the right time. For the Sverigedemokraterna, it is about the care being accessible, secure, and long-term sustainable. We have therefore presented several proposals that clearly point out what needs to be done and why.

For healthcare to function, it is also required that the healthcare staff, who constitute the very heart of the entire operation, have a safe and sustainable working environment. The most important things for healthcare staff to stay is safe conditions, reasonable workload, influence over their work and, not least, time for recovery.

We must return to a healthcare system where the staff are allowed to be healthcare staff. Many leave the profession not because of the salary, but because they can no longer cope. We are pushing for better scheduling, permanent employment, and for the healthcare resources to actually go to patients and staff, not to a swelling administration, consultants, or inefficient double-reporting systems. There must be less bureaucracy and more time for the patients.

Without a skilled and well-off workforce, we will not be able to meet the future's healthcare needs. Precisely for that reason, investments in skills development and improved working conditions are not optional, but they are absolutely crucial. Healthcare staff must have better conditions, more career opportunities, and a work environment that makes them want to stay in the profession. It is the only way to solve healthcare's problems in the long term.

Competence shortages, growing healthcare queues, and overworked staff have long been everyday occurrences in many regions. Swedish healthcare needs both long-term reforms and concrete decisions here and now. The Sweden Democrats, as I stated previously, stand behind several proposals and reservations in the report, and we are proud that, within the framework of our budget cooperation with the government, we are already involved in and implementing many necessary investments.

Madam Speaker! The National Board of Health and Welfare has, for example, been tasked with developing a national plan to improve the supply of skills in healthcare. The National Healthcare Competence Council has presented 25 proposals, including to ensure time and resources for skills development, so that healthcare staff can develop in their profession without being forced to leave clinical work. We want to create more career paths for healthcare staff to make the healthcare profession more attractive. We want to review the regulations for specialist training and further education to meet future healthcare needs. Furthermore, an investigation is underway on how we should change the regulations for regulated professions and further education. The results will be reported on May 30, 2025. It is a long-term but necessary work.

500 million was allocated in 2023 for nurses' further education. It shall be 400 million per year from 2024 for a continued investment. Furthermore, it shall be 100 million annually from 2023 for development and career opportunities. Then there is 229 million to Socialstyrelsen 2024 to increase the number of internship weeks in the nursing program.

Those who work in healthcare know that knowledge quickly becomes outdated. New methods, new medicines, new technology – it happens all the time. Therefore, continuous competence development is not a luxury but a necessity. Today, it is unfortunately all too often up to each individual employer whether further education is offered. And that creates unequal care. It is about long-term perspective, safety, and respect for the profession.

We further consider that patient safety in healthcare requires clearer and sharper routines for register checks. Everyone who works, practices, or studies within healthcare should be covered by register checks. It should not stop at one occasion at the beginning of employment. There must be the possibility for recurring checks throughout the entire time one is active in healthcare. It is a fundamental safety issue, especially when it concerns the protection of children, the elderly, and the seriously ill. Today, there is a clear gap in the legislation. Those who have access to our most vulnerable must also endure being scrutinized.

Furthermore, we want to see clearer national guidelines for self-care counseling. It is time to see the individual's ability as an asset. By strengthening patients' knowledge and providing the right support, we can reduce unnecessary pressure on primary care. This frees up resources for those who truly need care while simultaneously strengthening the individual's responsibility.

Madam Speaker! We also see great opportunities in the technological development. Modern healthcare requires modern tools. Therefore, it is positive that we are now investing in a coherent digital healthcare infrastructure where medical records can be shared smoothly across regional boundaries. The introduction of AI-based systems shall streamline triage, diagnosis, and follow-up. Digital healthcare in rural areas shall provide increased accessibility regardless of where one lives.

Madam Speaker! Digitalization is not an end in itself, and it is not about replacing healthcare staff but about freeing up their time for patient-oriented work.

In our motions, we highlight the need to develop the use of AI in, for example, mammography screening. AI can never replace human judgment, but it can be a powerful tool to be able to detect cancer earlier and save lives.

We also want the government to create the conditions for the regions to expand self-monitoring, not least within cancer care. When patients, with the support of technical aids, can monitor their own treatment from home, both safety and the efficiency of care increase.

Madam Speaker! Finally, I want to mention preparedness. Healthcare's preparedness must withstand both crisis and war. The pandemic exposed something that we in the Sweden Democrats have long warned about: a healthcare system without margins and a preparedness on a budget.

It changes the Tidö parties now. It is about having functional and updated preparedness stocks for medicines, protective equipment, and life-saving medical supplies, but also about access to backup power, food, and robust IT systems. We must have the ability to handle incidents with many injured or deceased. And we need hospital buildings that are robust and resilient. Regular crisis and war exercises within health and medical care are crucial, as are clear guidelines for how care should be prioritized during a serious incident.

All this requires clear and functioning coordination between, among others, regions, municipalities, MSB and the state. With the support of Sverigedemokraterna, the government has intensified the work to strengthen Sweden's preparedness. MSB has received a clearer coordination responsibility.

Civil defense is being built up again. And civil service is on its way back. The appropriation for civil defense has increased from a few hundred million to over 4 billion annually, with a planned further increase to 15 billion kronor per year from 2028.

Civil society constitutes a very important part. I personally had the privilege of traveling to Ukraine with supplies together with seven other women in the Riksdag. It provided an important insight into what it is actually like to live in a war-affected area and what resources are needed, how civil society can mobilize and what power exists.

Madam Speaker! The Sweden Democrats are clear that Swedish healthcare must be secure, accessible, and long-term sustainable. We strengthen the staff, improve the availability of care beds, and modernize the systems. We do this together with the government within the framework of the responsibility-heavy Tidö Agreement. It is time for a healthcare system that works, not just in large cities but in all of Sweden.

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

Karin Rågsjö (V)

Madam Speaker! At this late hour, I must ask a question. Carita Boulwén raised the alert and so on. I agree with that. We should have learned quite a lot from what happened during the pandemic. Therefore, I think it is a bit shaky from the government and Sverigedemokraterna.

In 2024, we can see that the healthcare system cannot keep up. Compared to other countries, we are still doing very poorly when it comes to intensive care beds. And compared to before the pandemic, the number of intensive care beds has actually decreased, five years after the outbreak of the pandemic. That cannot be reasonable, I mean.

The National Board of Health and Welfare has said that it must reach between 10 and 20 percent, to 535 intensive care beds, in Sweden for us to be able to feel somewhat secure. How is that going to happen if one does not have a robust economy for it? That is my one question.

My second question concerns the fact that there are currently no regional stocks. As far as I know, there is no legislation regarding this. There wasn't any during the pandemic either. The regions had no stocks of their own. It would be good to have legislation that stated that specifically the regions should have stocks.

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

Carita Boulwén (SD)

Madam Speaker! I want to begin by amending my motion. I move for approval of reservation 15.

I would like to thank Member Rågsjö for the questions.

The pandemic meant a rather large awakening for many. We saw that we did not have the resources and the care beds that were needed. It is still a huge concern. In view of what is happening in our immediate vicinity, where there is war, we have now also seen that we really need to expand. We need more care beds.

A lot of investments are being made. For 2025, a total of 18.4 billion is being invested. Among other things, healthcare capacity is increased by 7.5 billion. Investments are made in a sector contribution of 2 billion and in a national healthcare brokerage with 250 million, so that one can find available healthcare capacity and get rid of the healthcare queues, which we believe have been illegally long for far too long.

We are investing a lot in addressing the problems that have existed for a very long time. The healthcare queues are nothing new. We have had them for a long time. They doubled under the Social Democratic-led government. One wonders why they did not tackle it earlier. Now we have quite a lot to tackle after the previous government, which did not ensure that the healthcare queues were cut and that the staff within healthcare were given better conditions.

I still think the government has a lot going on. The Sweden Democrats are also pushing to achieve a good, functioning healthcare system and to ensure that the resources needed are allocated. At the same time, as we have discussed before, it is the regions' responsibility.

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

Karin Rågsjö (V)

Madam Speaker! Taking action cannot mean starving the regions for two years, during 2022 and 2023. It is not taking action; it was to truly ignore the needs that existed.

Another issue that Member Carita Boulwén raises is the staff. In October 2024, 38 reports of proposals for work environment measures from safety representatives at hospitals due to a deficient work environment had been submitted to the Swedish Work Environment Authority for that year. It is a record figure. According to the protocols, it concerned understaffing, deficiencies in the physical work environment, excessive workload, inadequate psychosocial work environment, lack of safety, working hours and schedules. That was what lay behind it.

Then one cannot say that anyone has taken action on this at the state level. It was well known even before 2024 that the staff in the regions had it very difficult.

Madam Speaker! I naturally wonder what the Sweden Democrats will do moving forward regarding personnel issues. Perhaps something radical must also be done to get staff to return. Who wants to work in a healthcare system where there is an incredible amount of pressure? Very many within healthcare do not even work full-time because the workload is so high.

What does member Carita Boulwén consider to be the solution when it comes to personnel issues?

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

Carita Boulwén (SD)

Madam Speaker! As I mentioned earlier, a problem we have is that we must address the healthcare queues. We are now providing funds so that healthcare capacity can be increased.

In the national plan for skills supply, many of these problems are addressed and how they should be resolved and how to achieve the working conditions required to have good workplaces. Something that I also highlighted in my speech is how important it is that the staff actually feel well and, not least, get time for recovery, as well as having permanent employment.

The issue of hired personnel has been addressed in the regions, so that it has decreased significantly. But it has also resulted in that one has contributed to existing staff not receiving the employment that is actually needed. They might call them in extra instead, in their spare time, when they are actually free.

There is much we need to work on. We need to ensure that they get more influence over the schedule and get more predictable workplaces with clear rules on how they are to work and when they are to be off, as well as opportunities for skills development. It is such things that are very important. We are making major investments in this. I hope that it will be in place very soon, because it is urgent.

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

Lina Nordquist (L)

Madam Speaker! The development of healthcare is incredibly rapid. This naturally means that the right skills are absolutely crucial. Therefore, the government has commissioned an analysis of future regulated professions, specialist competencies, specialist educations, further education, and continuing education within healthcare. In addition to the basic education itself and the specialization one often receives at the beginning of one's career, continuing education is absolutely crucial, Madam Speaker, for every professional in healthcare throughout their entire working life. Continuing education must be a right for every employee and a responsibility for every employer to provide. This is the foundation. In addition to that, a large number of proposals from the National Healthcare Competence Council are currently being prepared, for example, regarding a national leadership program for managers, a secured systematic work environment management, and more career paths.

Another piece of the pie is the sensible work tools. When you now have the competence you need, good leadership, a good situation at work, and good career paths, how are you then to make your workday as good as possible? It is truly high time, Madam Speaker, for a common digital infrastructure for the entire healthcare system. It should not be a hundred flowers blooming in 21 regions, in dental care, and in hundreds of municipalities. It is I myself who should decide what data someone should see regarding my health and my care, not the firewalls and the design of the systems.

Now we have a roadmap for this. The State is intended to take a greater responsibility. We have a coordinator for national digital infrastructure who is to provide an account before the new year. This, Madam Speaker, I am convinced will lead to better work tools, as I just said, but also naturally a significantly better patient safety.

Then I want to spend a few minutes on a particular specialization. I am referring to the doctors who handle the work environment not only in healthcare but at all workplaces across Sweden. The very question of specialists in occupational medicine is very closely linked to the competence supply problem. It is a separate specialization, and it is about how the work environment affects us and our health. There has been a competence shortage here for a long time. Right now, I believe that occupational health care is mostly running on the fumes of committed and truly knowledgeable retirees.

This really requires a clear principal for the education, clear funding, and coordination of supervisors and study directors. The Liberals want to focus on this area so that all workplaces will become healthy workplaces far into the future. The Government Offices are working on this, and it is very significant.

We live in serious times. Preparedness naturally involves men and women in green, but it does not have to be camouflage patterns, and it could just as well be a sarong. Yes, it does not even need to be green – it can also be white. Of course, preparedness stocks are needed, and of course, we need to be ready for our own production of equipment and certain medicines if it is truly necessary. We need war placement, civil duty, wise agreements between the regions and municipalities, as well as private operators with skilled personnel.

But none of those measures are more important than that healthcare is a place where skilled, empathetic people have enough colleagues, where one can practice difficult scenarios, where one receives new knowledge throughout their entire professional life, and where one enjoys their work and wants to stay. The work environment and the working conditions that need to be really good in the everyday routine are also those that are absolutely crucial for our preparedness and our ability to handle crisis or war to be as good as we need.

I vote in favor of the committee's proposal.

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

Karin Rågsjö (V)

Madam Speaker! This government is based on a cooperation between parts of the former Alliance and the Sweden Democrats, and the policy follows accordingly. We get the Alliance's cuts, now with ethnic markings. We get the depletion of safety nets, eroded and underfunded welfare, and large tax cuts for high-income earners. In the Tidö Agreement, those born abroad have been made to take the role of scapegoat for all of Sweden's problems. By portraying those not born here as a threat and a burden, it becomes easier to condition their welfare and rights. The dismantling of safety nets, welfare, and legal protections is easier to justify if one points at certain groups and starts there.

In healthcare, the policy becomes clearest in the government's proposal to introduce a reporting law and limit the right to interpretation services. These are direct commissioned works from SD. By pointing at minorities as scapegoats, the government avoids taking responsibility for the fact that the policy does not work, that Sweden's growth is among the lowest in Europe, that unemployment stands at 10 percent, and that food prices have increased by 25 percent since 2022.

During the pandemic, the government at the time provided more resources to the regions. But during the extreme economic crisis in 2023 and 2024, the government did not provide sufficient state grants to meet the needs when there was high inflation and high pension costs. In these recent days, we have, for example, been able to see that Skåne is cutting back by 1 billion this year. Up to 1,000 people are said to be laid off. There, the Moderaterna, KD and L govern with the support of the Sverigedemokraterna.

In 2024, there were 6.7 over-occupancies per 100 staffed healthcare beds in the country's hospitals. This is an increase of 60 percent since 2014, so it is naturally several governments that bear responsibility for this. The number of intensive care beds in Sweden has continued to decrease five years after the pandemic, even though Region Stockholm breaks the trend as Karolinska opens for three new beds. Socialstyrelsen has calculated that the intensive care beds would need to increase by between 10 and 20 percent to 535 units to meet the future healthcare need. In that case, one must probably hurry up.

Everything we spoke about during and after the pandemic – a robust healthcare system and a better working environment for healthcare workers – is as if it has blown away. Crisis, crisis, crisis and pandemic! This government lacks the insight that the pandemic could come tomorrow. The responsible ministers blame the regions and convey that everything will get better if it becomes a fully state-run healthcare system. It is a way to avoid taking responsibility. One can also say that KD has gone from a healthcare party to a nuclear power party. That can perhaps be debated some other time, I think.

A bit about crises: In many of Sweden's regions, there are today insufficient stocks for the event that the pandemic should break out. Purchasing protective equipment and other necessary items during a pandemic is expensive. We saw that when we had the pandemic. The regions should have a legal requirement to have crisis stocks for at least three months' consumption. We, Madam Speaker, want to see that all private healthcare companies that have agreements with the region according to law shall be included in the regions' and the state's crisis preparedness. I move for approval of reservation 33.

For Vänsterpartiet, it is obvious that the state must take greater responsibility for the planning of staffing needs and education within healthcare. Basic education, further education, and continuing education need to be secured for the entire country and based on the population's needs.

We want to see a long-term national economic plan for basic education, continuing education, and further education. We also want to see individual further education plans.

The opportunity for professional development shall exist regardless of where the employee works. For that reason, the left wants to see a statutory requirement for further education.

Madam Speaker! The regions' costs for hired personnel have been extreme. Billions of kronor that could have been used to build the welfare state have, year after year, disappeared into the hiring systems. In 2023, the hiring bill for the entire country landed at 9.3 billion kronor. Think of all the healthcare workers who could have been employed for that money.

For many regions, hired personnel is currently the only possible way. Vänsterpartiet wants to see an abolition of hired personnel in healthcare by 2027. But of course, a stop must be combined with other measures from the state to secure the staffing supply. We therefore propose a ten-point program to abolish hired personnel in healthcare.

Madam Speaker! Up until the beginning of October 2024, 38 reports of proposals for work environment measures from safety representatives at hospitals regarding poor working environments had been made that year, that is 2024. It is a record, and it is only getting worse.

It is about understaffing, deficiencies in the physical work environment, excessive workload, inadequate psychosocial work environment, lack of safety, and working hours. The entire collective of healthcare workers speaks about the work environment at every meeting I have had with healthcare staff.

The staff is the gold. They are not something we can constantly view as consumables. Reduced working hours, reasonable schedules and more colleagues are necessary.

If the general state grants had followed wages, prices, and demographics since 2011, they would be at a level that is 27 billion higher than today. It is a matter of needing indexing of the state grants. That is what we want to proceed with.

Madam Speaker! After Hamas's terror attack against the Israeli civilian population, the gates of hell opened for Palestinians in Gaza. Gaza lies in ruins. 50,000 people are killed, many children, many adults of course and many women. An unimaginable 100,000 people are estimated to be injured.

At the same time, the healthcare system has completely collapsed, and most of Gaza's hospitals are completely out of operation. Thousands of people in Gaza are now in urgent need of medical evacuation.

Now the ceasefire has been broken again, and Israel has resumed the killing in Gaza and in the West Bank. In 2024, more than five times as many children were killed in Gaza than in 2005–2022 in the entire world, in the world's armed conflicts. One can wonder about that.

The European Commission has pleaded with the member states to receive Palestinian patients. But despite the fact that Swedish healthcare has the capacity to save lives, the government refuses to help.

WHO has identified approximately 10,000 severely ill people who are in acute need of care, and the EU was urged to receive a portion of those patients. It concerns people who have been injured by Israel's bombs, but also about cancer patients who cannot receive their treatment. It concerns children.

Doctors Without Borders has offered us in Sweden to support the government with their personnel on the ground. Swedish healthcare personnel stand ready to save lives.

Belgium, Germany, Italy, Spain, Slovakia and Romania are accepting patients and so is also Norway. Sweden has the capacity and the possibility, but then the Swedish government says no.

Karolinska University Hospital in Stockholm has stated that it both wants to and can take its responsibility. Likewise, the organization Sjukhusläkarna and Vårdförbundet are pushing forward.

We are very proud that Sweden did not hesitate to receive war-wounded patients from Ukraine. It is a matter of course. Now, approximately 185 Ukrainians have received necessary care in Sweden. That is very good.

Then it should also be self-evident to receive patients from Gaza. I wonder: Where is Sweden? Is there help on site? That is what people sometimes say. In which hospital then?

It is about humanism. Once, we were a humanistic superpower. But the government that took office with SD's support in 2022 has no ambitions whatsoever to provide protection and help to those most in need.

The government should provide healthcare for Gaza's seriously ill and injured in Sweden. I highlight reservation 35.

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

Anders W Jonsson (C)

Madam Speaker! At this late hour, accompanied by the cries of the seagulls, we are debating a motion report with 120 proposals concerning competence supply, e-health, and preparedness.

Madam Speaker! I only intend to highlight the competence supply. It is a fundamental problem in Swedish healthcare. It matters very little which challenge one chooses to start unraveling. You end up at the competence supply in the end.

A poor consolation is that it is in no way a uniquely Swedish problem. It is possibly only one party that can say that the solution to this is to nationalize healthcare. All European countries have this challenge, and also many other countries. Ultimately, it is about the demographic changes, but also about how the demands in healthcare are evolving.

We also have a dimension in Sweden that one has in many other countries. The challenge is even greater in the more sparsely populated parts of the country. That is the case in all countries that have a sparsely populated area or a countryside to speak of. It is nothing that is unique to Sweden.

We also have some special challenges in Sweden that are somewhat self-constructed. We have major problems with the supply of skills in primary care. In other countries, the development when working in healthcare is that you eventually end up working in primary care. But in Sweden, we have organized it in such a way that both doctors and nurses unfortunately flee primary care.

We also have problems regarding nurses, in getting the most qualified nurses to want to stay at our hospitals. Even there, it is the work environment and the working hours that make people seek to leave.

Madam Speaker! Finally, we have also acquired a particularly Swedish problem in recent years. In Sweden, we have for many years been dependent on obtaining competence from other countries. In that regard, Sweden has been an attractive country for both doctors, nurses, and other staff to come to and work.

For two years now, we have had a government that does everything it can to make it difficult for people who want to come here and work. Perhaps not a day goes by, but at least not a week, without us reading about healthcare personnel who speak good Swedish, have education and so on, and who are to be deported from the country.

Most recently, it was a young doctor here in the Stockholm area who had completed all the training and was now at Karolinska for his residency. But nevertheless, the government had ensured that this person would indeed be deported. Talk about shooting oneself in the foot!

30 percent of those who work in Swedish healthcare are born abroad. We shall ensure that we continue to also be an attractive country for people who have a good healthcare education to come here and support us.

What is it then that we can do? It is a problem that exists in all countries. For the first thing, we must look at the distribution of responsibility. It is not a well-functioning system in a situation where both the state and the regions dimension the education system.

The state does it through how the healthcare education programs in the universities are dimensioned. Then it is the regions that dimension, for example, how many specialist doctors we get. It is time that we review that system and ensure that we have a national responsibility and a national decision-making.

That the regions had such great influence on this worked well in a situation where, if you trained to be a midwife in Östersund, you stayed a midwife in Östersund your whole life. But that is not how the labor market looks. Then we must also change that system.

The second thing we can do is to become much better at utilizing the digital opportunities. It is something that many stand here in the speaker's chair and sing their hearts out about. But when it then comes to concrete proposals, one is indeed very quick to find reasons why it cannot be done.

We can take such a simple example as remote pharmacist. It would be an excellent way to be able to ensure that we around the country have a staffing of pharmacists even at the small pharmacies in the rural areas. But there, one is very quick to constantly find reasons why one cannot do it.

The third is to review who should do what in healthcare. Something that a nurse does today can just as well, and perhaps better, be done by an assistant nurse. That which has been done by doctors throughout the ages can perhaps be performed much better by a nurse.

We must get a government that dares to look at the administration. We have heard several speakers here, Madam Speaker, who have said that the administration is a huge concern and that it is increasing so rapidly. But why is it increasing? Well, it is connected to the fact that this government, and also previous governments, have released and have released the state authorities in the area, a total of eleven or twelve, quite free to come up with new rules, new instructions, and new regulations which in themselves mean more administration.

We have for a long time now in Sweden at least had an ambition to reduce the regulatory burden for Swedish companies, but I believe it is time that we also set a clear goal to reduce the regulatory burden for Swedish healthcare.

Madam Speaker! The last thing, and what should be the simplest, is whether we could get a government in this country that ensures that Sweden once again becomes an attractive country for people from other parts of the world and Europe so that they want to come and work in the fantastic Swedish healthcare system. It would be a fairly simple measure.

Madam Speaker! I move for approval of reservation 4.

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

Nils Seye Larsen (MP)

Madam Speaker! Some have mentioned these seagulls we hear outside. I must admit that I think it feels quite nice to have a bit of an audience here on the evening branch.

I thought I would start, so that I do not forget, by stating what it is that we in Miljöpartiet are going to demand. It is reservation 14 under point 9 on the working environment, which I move to approve.

I intended to focus on the supply of skills, which I see as a major challenge. The staff shortage is probably one of the biggest challenges within healthcare, now and especially in the long term ahead. The staff shortage risks becoming a negative spiral that affects in many ways. It becomes difficult for the invaluable staff we have within healthcare when hands are missing and when employees are missing. It risks making the workload even harder and leading to an unsustainable work situation that burns out the staff whom we so sincerely need.

The staff shortage also has consequences for us as residents and as patients. It takes longer before we receive care, and it destroys the conditions for the continuity of care that we need. I am thinking in particular of the unequal conditions that we have in Sweden.

We can, for example, see health centers and community health centers in Västerbotten, in the inland, and in the other northern regions, which have long been seeking general practitioners who can be on-site continuously. That means incredibly much. I do not forget our visit to Lövånger's health center, which still has some general practitioners who should have retired a long time ago but who are, therefore, still there, and how invaluable that is for the residents in Lövånger. When we sat and ate lunch with them, they said they would have to be really sick if they were to call and seek other emergency care on a Saturday or Sunday, because they want to come to their health center where they can meet the doctor they know and whom they have met for so long. That is what provides better care.

That is why it is extra worrying when one sees that many regions in Sweden are now going on a starvation diet. Already now, despite the fact that we have a need for more employees within health and care, one sees that cuts are being made or that necessary recruitments are being held back.

We must remember that if we look ahead – and here I am using SKR's figures – the situation looks very bleak. In the forecast to 2033, we see that the working-age population will increase by approximately 166,000 people.

At the same time, we see that due to the democratic changes, within elderly care alone, it will be necessary to increase the number of employees by 32 percent, which is 66,000 people.

Within healthcare, the need for employees will increase by 17,700 people. But then we have retirements during the same period of 66,000 people. That makes the total recruitment need within healthcare until 2033 amount to 83,500 people, which is approximately half of the total incoming amount of working-age people. And I haven't even mentioned the quarter within elderly care who will have retired by 2033.

This is an equation that is impossible to solve. Precisely because of that, we need to address the skills supply properly already now. We in Miljöpartiet have ourselves highlighted the importance of a national coordinator for skills supply. Therefore, we have chosen to support the Socialdemokraternas motion, which concerns developing a national action plan for how the skills and staffing in welfare should be secured in the short and long term. I believe that we need to work with this strategically from a national level and in cooperation with regions and municipalities.

Furthermore, we must remember that the situation is very unequal, which I have returned to many times. We already have today in regions, for example in the northern regions that I come from, a prevailing skills crisis. We are therefore sitting with a historically low unemployment rate and are having difficulty recruiting staff.

We need to invest in a better working environment. Here is the motion that we in Miljöpartiet have submitted. But we have also included funds in our budget for the recovery bonus, which would have been so important as part of the work to try to find different models to create sustainable working conditions for the staff.

All of this is ultimately about resources. Here I completely agree with what Karin has raised several times from Vänsterpartiet: There is an enormous need for increased resources. SKR speaks of that approximately 27 billion that would need to be added, which is missing today given the increase in inflation. This has devastating consequences for the regions.

I heard the Moderate member say that he thought it was remarkable that we have four emergency hospitals and that several of them are threatened with closure. I think it is remarkable that one thinks it is remarkable. Is it something that forces this out, it is partly the competence shortage, partly the resource shortage.

It is a great challenge for, for example, Sollefteå, which would really need this, especially when we talk about long-term preparedness. Västernorrland is one of the regions that is really struggling financially. Resources are needed, and here the government and the Tidö parties have a great responsibility.

I will conclude by mentioning something that I also think is important in this equation. In the forecast for the upcoming population of working age, it states that foreign-born individuals account for almost all of that increase. I remember once when I came to a class in Umeå with future nursing assistants. They were people from all over the world, who were passionate about eventually being able to work helping people within health and social care.

It is people we will need. It is clear that we view with great concern that one is now doing everything to tighten and make it harder for people who have full-time jobs, who have the qualifications required to work as an assistant nurse, nurse, or healthcare assistant, and who now risk deportation due to the unreasonably high maintenance requirements. We need to take advantage of the competence we have here.

With this, I would like to once again move for the approval of the reservation I have already raised. Naturally, I also stand behind Miljöpartiet's other reservations.

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Thomas Ragnarsson (M)

Madam Speaker! I felt compelled to enter a rejoinder. Yes, I think it is remarkable. As I said, we have never had so many staff members employed within Swedish health and medical care and municipal medical care as we have today. Yet we produce less. I assert that it is a system failure.

The member does not know me, but I am actually still a practicing nurse. I have worked for 37 years and followed this from the inside. In many ways, I can say, the problems that the member raises in their speech are linked to leadership.

We have had a tendency within healthcare for many years to centralize leadership. If there are several hospitals, the leadership is in one place but hospitals are also operated in other places. It is completely impossible to lead remotely. If one is to get a staff group to feel involved and be able to participate in influencing their operations, the leadership must be on-site. It is a fundamental pillar. Here, it fails in very many places.

At the same time, there is a lot of talk about the work environment. The work environment has deteriorated enormously, actually due to schedule changes linked to what is, in my eyes, an incredibly stupid agreement with eleven hours of daily rest, which has broken the scheduling horribly within the welfare sector. There we have one of the basic problems. I will return to that in just a moment.

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Nils Seye Larsen (MP)

Madam Speaker! I am well aware that there are challenges with the existing working time act. I have had to deal with that regarding assistance schedules and other matters. On the other hand, I understand why it was introduced within the EU. There were a number of sectors where people were forced to work unreasonably long shifts, and that has consequences.

What we are hearing here is interesting. I completely agree: If one has the opportunity to work closer to the staff and listen to the staff, one will get very good input on how to develop the work in the organization. Therefore, I also do not believe that the solution for Swedish healthcare is to nationalize it and then centralize the management even further.

Nevertheless, it is also, after all, a question of resources. We can take Region Västerbotten, which I come from. When you have an entire organization that year after year sits and struggles with budget deficits and hardly has the resources to be able to manage it, it becomes very difficult to work proactively, even though one would like to.

There are still positive examples where one tries, where one has an ear to the local community and can make decisions. But it is difficult, and resources are needed regardless so that one can work more proactively within the regions.

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Thomas Ragnarsson (M)

Madam Speaker! I have actually visited Västerbotten and am very fascinated by it. There, they have looked at the issue of leadership between the hospitals. They have divided a part of the county-wide clinics, and it had a fairly good effect.

There is still a major problem regarding hospital care and staffing, and it is on the BB-side in Lycksele. There will likely be a closure this summer as well, which is an incredible problem for someone who is pregnant in that area. There are journeys of 15, 20, or 30 miles. It is not something I wish anyone who is about to give birth should have to do.

Västerbotten also has its health centers, which are fantastic. Someone spoke about good and local care here earlier and that we are not succeeding with it. I agree: unfortunately, we have not come anywhere, in my eyes, when it comes to good and local care. But in Västerbotten, they have done it. They have incredible health centers and a rural medicine center that is a driving force. I believe that is where we should look. What is delivered there is good and local care.

Yes, it is certainly tough economically. In many ways, my feeling is that we in healthcare – I say we, because I am part of that world – have taken this with the budget very lightly. If a politician says that you must save money, one sends in a scarred doctor who sits down with the politician and says that then we cannot treat the children with cancer, or something else. No politician wants to front that, and so one gets away with it that year as well.

We must achieve better governance and management of the health and medical care. And budget discipline is actually important.

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Nils Seye Larsen (MP)

Madam Speaker! I am pleased that the member is highlighting Västerbotten, while at the same time I am aware of how hard we have struggled with deficit after deficit. I believe that we now have a deficit in the budget that is quite considerable, which is absolutely not optimal for the future. But that is what happens when you have a region that is one and a half times the size of Belgium with a population that is smaller than Malmö's. Furthermore, in the vast majority of municipalities, we have a median income that is 10,000 kronor below the national average and among the highest municipal taxes. There are not many more resources there.

That is why I return to this, regarding being able to work with more equal conditions: Many regions are probably well aware of the needs that exist. Then, of course, there are sometimes systemic challenges. But I can say that, both as a municipal politician and as a national politician: I do not believe that it is something that is specifically a regional problem. There are a lot of systemic mechanisms that are challenging in public governance.

I believe, however, that there is a danger here, that if one experiences political stress from not getting the output one would like to have, that one simply pushes on with even more investigations, even more steering, and even more targeted grants – and then one only gets less effect from the whole of it. Here, general grants would help more.

Here I truly believe that we still must show some sensitivity towards our different regions' challenges. The competence shortage we will need to tackle, and we need to do that nationally and in a coordinated manner. We need to work together with municipalities and regions to solve this.

The deliberation was hereby concluded.

(A decision was to be taken on 10 April.)

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