Medicines and dental care

Jesper Skalberg Karlsson (M)

Madam Speaker! The new Moderate-led government has not arrived at a prepared table. The situation in Sweden is, as we all know, serious. Long healthcare queues, too few staffed healthcare beds, and a healthcare system that is not equal are three major problems and challenges that deserve the attention of politics and a will for reform. Now is the time to get the healthcare system in order - for both the patients' and the employees' sake.

Madam Speaker! The development of new medicines and treatment therapies is moving very quickly, perhaps faster now than ever before. That is good. Medicines improve and prolong life, and therefore their accessibility is so crucial. In this context, I want to say that accessibility is a very broad issue. It is about new treatments being approved in Sweden. It is about the implementation taking place in an equal manner in the regions, that deliveries should function, and that follow-up regarding treatment should take place.

It is against the background of what the new government, among other things, has placed great focus on strengthening the information chain so that patients and healthcare shall be given a warning when there is a risk that shortage situations will arise. We have previously during the year debated exactly this, then in connection with the National Audit Office's report regarding wholesale of pharmaceuticals.

Madam Speaker! The Moderates and our coalition partners want to secure the supply of medicines in Sweden and ensure that we are prepared for crises that may arise. War in our vicinity, new pandemics, and unpredictable disruptions in the supply chain are three important things to continue to monitor closely. It is a high priority for both the Minister for Civil Defence and the Minister for Health and Social Affairs, which we see in the initiatives that have also been taken during the spring.

We also want to create conditions for an industry within life science in Sweden that contributes to new innovations, creates jobs and export revenues, and furthermore extends and improves people's lives. In that context, more clinical trials and faster approval processes are needed. Peter Asplund's recently presented investigation on the life science sector becomes an important part in that context, and we look forward to Minister Busch and Minister Forssmed taking it further.

We also want to continuously evaluate and adapt the rather technical processes behind the approval, funding, and distribution of medicines so that they function in the new landscape emerging within life science. It is worth mentioning here that the EU's new medicines strategy contains very good intentions. The Social Affairs Committee and the EU Committee will, however, need to do a lot of work in the coming period so that the final product does not hinder Swedish competitiveness.

Madam Speaker! It is remarkable that a dozen government inquiries over the last decade, all of which have had an impact on the pharmaceutical supply, have not resulted in more and larger political proposals being submitted to the Riksdag. The explanation lies partly in the complexity of the issues, partly in other things that have happened along the way that one has been forced to prioritize. But when the burden of the EU Presidency is lifted from the Government Offices, while we simultaneously have four ministers at the Ministry of Social Affairs, there is reason to have both good hope and high expectations that more will be done in the area.

Madam Speaker! The new government has, in a short time, changed the course for Sweden. But we also want to do more. In the agreement that we have concluded between our four coalition parties, we establish, for example, that the role of pharmacies in the care chain needs to be developed. We want certain services, for example health examinations and not just blood pressure checks and the like, to be able to be offered at pharmacies. We will also move forward with proposals for a new pharmaceutical range that shall be an intermediate position between over-the-counter and prescription-only. Furthermore, a high-cost protection in dental care shall be investigated to more closely resemble what exists in other areas of care.

Madam Speaker! I note that we have a major task ahead of us to secure access to the medicines and treatments of the future in Sweden. But we have solved major problems before, and step by step we will now tackle this. With a working line that creates resources to share, with regulatory simplifications that strengthen competitiveness and a reform agenda that secures equal access, we take responsibility for getting things in order in Sweden.

I vote in favor of the committee's proposal for a decision.

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Anders W Jonsson (C)

Madam Speaker! Pharmaceutical issues have generated a very great commitment in the chamber, not least during the last parliamentary term when the Center Party and the Moderates, among others, pushed forward a number of announcements.

One of them was about one of perhaps the most upsetting parts regarding medicines here in the country, namely that we have a way of valuing orphan drugs for some of the most ill individuals. They have diagnoses for which very few have a need for medicines, and that means they have not been granted access to these medicines. It was not a unanimous Riksdag but not far from it, and the Moderaterna were very proactive in that something had to happen.

Now Jesper Skalberg Karlsson says that now, indeed, the Moderate, SD-led government has changed course regarding Swedish healthcare. Then I wonder: Why has one not at all changed course to ensure that people with rare diagnoses can get access to orphan drugs? In that regard, there has not come a single active decision from this government.

Now, motions on this theme are being rejected, and it is pointed out that the previous government a year ago gave TLV a mandate to see if a solution could be found. That, Madam Speaker, is not what I call a newly appointed government changing course. One takes no initiatives at all, but instead says that what the old Social Democratic government did in this area is suddenly completely satisfactory.

When there was such a strong commitment from the Moderates and several other parties, why, Jesper Skalberg Karlsson, have you not changed course?

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Jesper Skalberg Karlsson (M)

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

The commitment for more people to gain access to the treatments and medicines they need remains strong. One can also mention in this context that the rare diagnoses we are talking about can be rare in themselves, but it is not so entirely rare to have just a rare diagnosis. The group is, taken as a whole, still quite large, and it is important to keep track of these terms.

I can only maintain what I said in the rostrum, namely that it is reasonable to have continued good hope and high expectations for the new government when it comes to making progress on more issues than what has been done previously. In the current case regarding TLV, I look forward to TLV delivering on the assignments it has received both during the previous and this mandate period and also coming forward with new proposals on how this can be managed in a better way.

It is a priority that more medicines should be approved in Sweden and that they should reach the patients, but as the member also knows, it is a complex system, and it will take some time.

In that context, it can be mentioned that TLV needs to resolve its own personnel supply. It is difficult for TLV to retain competent staff, because they become so incredibly attractive in the market where the life science companies also are. When meeting Swedish pharmaceutical developers, it is not uncommon that some in the management group or among the employees actually come from just TLV.

Much is about giving TLV peace of mind to work, but it is also about continuing to push so that more treatments and therapies can be approved in Sweden. That is the goal, and I am convinced that it is something that we share with Centerpartiet and the opposition.

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Anders W Jonsson (C)

Madam Speaker! For those who have followed this debate for some time, Jesper Skalberg Karlsson's answer is remarkable. There was, in fact, a high tone here in the chamber, and swift actions were demanded from the then government, precisely because it concerned people who actually died because they did not receive medicines – medicines that were available but for which we did not have a Swedish system to be able to provide. Not least Moderate representatives were very eager to point fingers at the Social Democratic government – rightly so, I think – because nothing was happening.

Now I ask Jesper Skalberg Karlsson why the new government has not changed course in this area. Changing course for the Swedish healthcare system seems to be the motto, but here, one has actually done nothing at all.

What is happening now is that we are waiting for TLV to complete a mandate that the old Social Democratic government gave. In that case, the Moderates should have said during the election campaign: Just when it comes to this issue, we are completely satisfied with what the Social Democratic government has done. They have given a mandate to TLV, and we are awaiting it.

That is exactly what this government has done. There is nothing concrete in action to help this group of vulnerable people.

When I now pose the question to Jesper Skalberg Karlsson and try to get an answer as to why nothing has happened, I am told that rare diagnoses are ones that many people have and that they therefore are not rare. No, everyone knows that. Furthermore, I am now told that TLV apparently has staffing problems.

The answer to the question is therefore that we have not changed course because TLV has staffing problems and that rare diagnoses as a group are not rare. Therefore, we do not need to change course, but instead, the moderate-led government is now completely satisfied with what the previous government did, that is, that it gave a mandate to a state agency. It is distressing.

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Jesper Skalberg Karlsson (M)

Madam Speaker! Thank you to Member Jonsson for the follow-up contribution!

It can be tempting to use agitation as a debate technique, and I am sure that people of different party colors have done so in this chamber for many years. I do not believe, however, that it is what moves us forward in the discussion. Much of the anger that the member seems to feel, I believe is actually directed towards those who were members of the Social Affairs Committee during the last term and not towards me as a person.

I still want to say with this that it is important that we get more medicines and treatment therapies approved in Sweden. Just as the member mentions, more people need to get access to medicines that save, prolong, and improve lives. There is a great job to be done in this area. I look forward to the four ministers at the Ministry of Health, but also other ministers who have influence in the area, not least Minister Busch who received Asplund's investigation, doing more.

All good forces are needed for this to become better, and I look forward to following an interpellation debate where Anders W Jonsson directs questions to those who sat in the Social Affairs Committee during the previous mandate period.

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Karin Rågsjö (V)

Madam Speaker! I think that the health and medical care will have to live with this. Inflation is devouring the healthcare's money. That is exactly what we will be talking about today and in the coming days ahead next year.

Now we are talking about medicines. There are fantastically potent medicines that can do incredible things when it comes to saving seriously ill people. This was something we discussed a lot before the election, and the parties that now stand behind the Tidö Agreement were very progressive when it came to exactly medicines and what should and should not happen. One could say that it didn't directly become walk the talk.

I have some questions. It concerns first those who are seriously ill and need, for example, precision medicine. For them, it is very unequal today. It is about which region one lives in and which class one belongs to. I cannot see that the new government has any answer to this.

The second thing is clinical trials, Madam Speaker, which are very difficult to carry out in a stressful work environment. We have heard that for a long time, and it is not going to become less stressful for the staff. The pharmaceutical companies, doctors, and everyone who works with these issues have been very clear that as long as healthcare looks the way it does – and now it actually looks worse – it is difficult to conduct clinical trials. Is that something the member can answer?

The third thing I want to ask about concerns the teeth and the high-cost protection, as it is stated on page 8 in the Tidö Agreement. I wonder: How far down on the priority list does this stand?

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Jesper Skalberg Karlsson (M)

Madam Speaker! Thanks to Member Rågsjö for a cavalcade of questions! If I miss any, it is of course possible to return to them in contribution number two.

Firstly, inflation is the workers' and the government's absolute greatest enemy. With the high inflation we have had recently, the state budget needs to be slightly contractionary or at least neutral. The budget that the Riksdag has adopted is the one that my party and the coalition parties presented. It is our task to hold back and ensure that we do not throw more money onto the inflation fire and to prioritize within the reform space that the expert agencies assess we have. That is one thing.

Regarding the other matter, the investigation regarding the high-cost protection for dental care, the Tidö Agreement is an agreement that regulates what we are to do during a mandate period. I cannot today give a date for when the investigation on high-cost protection is appointed or will be completed, but this is part of the Tidö Agreement and shall, of course, be carried out.

I must return to the third question, if Karin Rågsjö can repeat it.

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Karin Rågsjö (V)

Madam Speaker! The question concerns clinical trials, which is what must be done when it comes to new types of medicines, precision medicine, and so on. It is very difficult to conduct clinical trials in a work environment where people are running around to a large extent and have poor conditions for doing their jobs within health and medical care. I do not believe that it will become easier now either.

It was indeed sad that you - and all of us - would end up in an inflation. But I do not believe that welfare and investments in it, like investments in school, in health and medical care and on patients, are what drive inflation. I do not believe either that member Skalberg Karlsson and I are going to have a discussion on just this, but there are several who say that it is so. We are in a very bad position when it comes to health and medical care in the regions, and I hope that the SD-dependent government will look at that a bit extra.

When it comes to dental care, it is something that Vänsterpartiet has also drafted proposals for. There is also a proposal in an investigation that one can look at. This is a reform that is truly needed, because teeth are a terribly strong class marker in various ways. It turns out that the less money one has in one's wallet, the less often one goes to the dental clinic.

Dental care itself is also in crisis. In northern Sweden, there is a lack of dentists and other prerequisites. This may not be something that this government can be blamed for, but it is a collective responsibility to ensure that we get dental care throughout Sweden that works.

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Jesper Skalberg Karlsson (M)

Madam Speaker! Thank you to Karin Rågsjö for the second contribution! When it comes to clinical trials, it has been a goal in the Swedish life science strategy for a number of years that we should have more clinical trials. I think that, fundamentally, is good. What has been the problem is precisely that there have not been so many activities linked to this goal.

We can see across the country that in the places where clinical trials are conducted, it is often dependent on individuals, that is to say, there are individual enthusiasts who get such projects started. But there is, therefore, no coherent system and no coherent structure. It is against this background that I mention Peter Asplund's investigation, which was recently presented to Minister Busch and Minister Forssmed. I look forward to it being taken further.

Finally, I can say that I agree with Karin Rågsjö that we need more dentists in Sweden. We also need more professors who teach a new generation of dentists. It will be difficult, and it will be demanding. We will also need to work more on validating dentists from other countries and ensuring that they undergo knowledge tests when they come to Sweden with their degree so that we know they maintain a high quality.

There is much to say about dental care, but at its core, it is about this: We need more dentists in Sweden.

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Mikael Dahlqvist (S)

Madam Speaker! Member Jonsson addressed a large part of the question I had intended to pose to Member Jesper Skalberg Karlsson regarding the allocation of resources for medical treatment of rare diagnoses in a previous contribution.

When I listened to the member's speech, it sounded grand: We have changed course! If one uses such terminology, Madam Speaker, one must also be held accountable for what has happened with that change of course.

The Speaker cannot add to what his party comrades have previously said in these debates, but the Moderaterna have been extremely clear that when they came to power, they would set aside funds specifically for special medicines, Madam Speaker. Two announcements to the government were also submitted at the committee's proposal during the previous mandate period in that direction, the last one just over a year ago. There, among others, the current Tidö parties pointed out that we should set aside funds specifically for that group.

My question to Member Jesper Skalberg Karlsson is therefore the following: When will this bag of money arrive? The Government has been in power for a year, and now we are starting to want a delivery notice.

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Jesper Skalberg Karlsson (M)

Madam Speaker! Thanks to Member Dahlqvist for the question! I actually have no other answer than that the announcements shall be treated according to the process that exists in the Riksdag. I look forward to the government delivering answers on this question. Several of the ministers were members of the Committee on Social Affairs during the previous parliamentary term, and I know that their commitment to these issues is very great.

Since then, both Member Dahlqvist and I have been aware that it has been an intense spring with the Swedish EU Presidency. Many other processes have been launched during the spring. A great deal of work has taken place at the Government Offices. As I said in my speech, there are reasons to have good hope and high expectations for the government in these matters. I share that opinion with Member Dahlqvist.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you, Jesper Skalberg Karlsson, for your answer!

It is, of course, always easy to be in opposition, but now that one has entered the government, one perhaps sees that the situation is more complicated than one thought. Given the debate during the last parliamentary term, I call on several of you, perhaps, for greater humility in the face of the difficulties. Unfortunately, we were met then with the rhetoric that the previous government was too slow, too sluggish, and so on. It is perhaps an experience that the member can take with them into the future that there is a bit of a difference between governing and not governing the country.

I look forward to the special funds that you have promised. There are many in Sweden who are waiting for them.

I will just briefly ask one more question, Madam Speaker. I will address this matter regarding rural pharmacies in my speech. It is a sore point, but I want to ask a question there. We think it is very good that you are investigating this regarding the pharmaceutical assortment, that one as a patient can have the opportunity to access more medicines. But my simple question is: How does Member Jesper Skalberg Karlsson intend to solve the situation in rural areas, where we do not have pharmacists? If this reform is implemented, which I am convinced we will stand behind, how do we ensure that people in the interior of Sweden, where there are not even pharmacies, can take part in this accessibility reform, if I may call it that?

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Jesper Skalberg Karlsson (M)

Madam Speaker! I have sat in opposition in the Riksdag. It is very rewarding. I have sat in opposition in Region Gotland. I have also sat in the government in Region Gotland. Now I sit here and support the sitting government. It is fun with variety. Variety is pleasing, as people usually say. In opposition, one can naturally use this chamber as a stage, and that has its place and its charm. But it is only when one is involved in governing that one can make a real difference with the decisions one takes. So that is the simple model, at least; then we know that things happen along the way. One does not always have a majority and so on.

Madam Speaker! The question concerned pharmacies in rural areas.

(MIKAEL DAHLQVIST (S): Pharmaceutical range.)

There is a special support for pharmacies in rural areas. It is also worth noting that we have received more pharmacies but above all more open pharmacies over the last ten years, which is very welcome. The times when pharmacies in rural areas are closed, it is usually due to the health center closing. That is what undermines the local pharmacy.

This is a question that I know Minister for Health Acko Ankarberg Johansson is working intensively on. Naturally, we need to secure equal access throughout the country and also look at new solutions for how the medicines can reach the door and into the hands of the patient. It is an intention that I know many of us stand behind. Then there are a whole lot of bureaucratic hurdles that we may need to tear down on the way toward that.

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Mikael Dahlqvist (S)

Madam Speaker! Today we are debating motions from the general motion period concerning pharmacy and pharmaceutical issues as well as dental health.

The pandemic and the ongoing war in our vicinity have challenged us significantly, even though the situation is naturally worse for the Ukrainian population.

The global situation we find ourselves in right now has exposed a number of weaknesses in our society. One of these, Madam Speaker, is the availability of pharmaceuticals and medical technology products, protective equipment and the like.

The number of backordered medicines increased during 2022 by 54 percent from the previous year. Backordered medicines, I want to explain to the listeners, are therefore what it is about when you come to a pharmacy and have a prescription and your product is not in stock – it is out. The backordered medicines amount to 4.6 percent of the total number of medicines in Sweden. They are therefore not at the pharmacy when they are needed.

This is, of course, an enormous problem for the individual person, especially if one suffers from a serious illness, if one, for example, has diabetes and the insulin has run out. It is a problem for healthcare, for the pharmacy, and for everyone.

Both the previous government and the current one have given a number of assignments to try to review what is happening and how the effects can be mitigated. That is, of course, good. However, during the previous mandate period, we often received criticism even on this issue. The previous social democrat-led government was too slow and too sluggish, it was said. Therefore, I now pose the question, Madam Speaker, whether it was just empty words from the current government representatives. The government will soon have governed for a year - one parliamentary year tomorrow - and we are waiting for delivery.

Madam Speaker! Another important issue I want to raise from our committee motion is the consequences of the deregulation of the pharmacy monopoly, which has resulted in a lack of pharmacy availability in some parts of the country. I know that pharmacy availability and opening hours are better in the cities. In rural areas and in smaller towns, however, it is the opposite; one only has to look at reliable statistics. There is also a blurring between owners and other roles that we need to rectify.

Recently, Apotea's CEO Pär Svärdson appeared in a debate article with the headline "Swedish preparedness almost non-existent". What he was referring to was the availability of medicines in pharmacies.

I believe that the issue of access to medicines and to rural pharmacies must be raised on our agenda. Even if there is a pharmacy in a smaller town, Madam Speaker, we now see a tendency that they often close during the summer when the staff are on holiday.

Another question I asked in my exchange with Member Skalberg concerned the pharmaceutical range. Fundamentally, I think it is a good proposal, but how will it work out in the country where there are not even pharmacies?

Madam Speaker! In our committee motion, we also highlight rare diagnoses and the availability of medicines. Here, we must find an arrangement where TLV ensures that there is a good supply and also find long-term funding. As I said in the exchange of remarks, previous governments have had this announced twice. We await the results with anticipation regarding the allocation of funds to this.

Madam Speaker! Finally, the big question regarding the pharmaceutical issues still remains: the financing. The Government must come forward with proposals on how we are to secure long-term financing for Swedish medicines and these treatments. It is primarily about reviewing the processes for pharmaceutical management in the country. Or will the Government, as so far, prioritize tax cuts over the needs and development of the welfare system?

(Applause)

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Dan Hovskär (KD)

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

Medicines and medical devices are an integrated part of healthcare and care. When one becomes ill and needs care, it is important to quickly receive a medical assessment. Can I manage it myself with the help of self-care, or do I need to receive part of the primary care or inpatient care's interventions?

If self-care is best, pharmacies are an indispensable part in terms of providing approved medicines and medical technology products. Pharmacies can also contribute with advice to a greater extent than today, given the pharmacists' high competence. If I need to take part in primary or inpatient care interventions, medicines and medical technology products will probably be an important part of the treatment.

In healthcare, pharmacies, medicines, and medical technology products are equally important parts for maintaining good quality and for providing care recipients with good living conditions. The Christian Democrats' view on medicines and medical technology products, the pharmacies and the pharmacists' role in health and medical care, as well as a secure medicine supply, is that they are important for the whole to function. All parts are also needed if we are to manage to have need-based care and healthcare on equal terms for the entire population.

The pharmacy industry is not just any industry. The person who takes on the responsibility for an operation in this large sector also takes on the responsibility of providing many life-saving medicines and medical technology products to the population. The Christian Democrats want to secure quality and availability by guarding and developing the re-regulation of the pharmacies.

By giving more people the opportunity to start and run their own pharmacies, entrepreneurship and initiative are unleashed. It is also about strengthening the role of pharmacies and pharmacists in the healthcare chain. It is an important development, not least for attracting more people to pharmaceutical professions.

When the Christian Democrats in 2006, in the then Alliance government, took over the responsibility for the pharmacies, Sweden was at the bottom of the OECD area in terms of the number of pharmacies per inhabitant. In 2009, the deregulation of the pharmacy market was carried out with the goal of ensuring a secure and good pharmaceutical supply. Throughout the country, there are today pharmacies with generous opening hours and highly educated staff. The citizens have a high level of confidence in the pharmacies.

Madam Speaker! Since the deregulation of the pharmacy market, pharmacy density and accessibility have increased. The figures in the Swedish Pharmacy Association's industry report from October 2022 show that the number of pharmacies has increased from just over 900 in 2008 to just over 1,400 today. It is an increase of approximately 50 percent. We in the Christian Democrats consider this a positive development. In addition, all pharmacy chains offer e-commerce via internet pharmacies.

The deregulated pharmacy market is still a relatively young market that can be further developed. The actors today are both large and small, state-owned and private, and all meet the strict requirements that regulate the market.

Overall, the increased accessibility, customer benefit, and service range, together with the stable and high customer satisfaction, show that the deregulation of the pharmacy market was a successful and appreciated reform. The Christian Democrats, however, see that we must continue to strengthen access to pharmacies also in rural areas. The number of pharmacies in these areas today is approximately unchanged compared to before the deregulation. Some have been started, but in recent years, some have unfortunately also been closed down.

Madam Speaker! Pharmacy e-commerce plays, according to an analysis from the Dental and Pharmaceutical Benefits Agency, TLV, a major role for the access of residents in sparse and rural areas to pharmacies. E-commerce can therefore be seen as a good complement to the physical pharmacies in both densely populated and sparsely populated areas. But they cannot fully replace the physical pharmacies, partly because certain medicines, for example, narcotics-classified medicines and antibiotic solutions, must be prepared in connection with dispensing. They cannot be handled in the same way via e-commerce.

The Christian Democrats also consider it important that people in rural areas are also given the opportunity to visit a physical pharmacy. There is a sense of security in visiting a pharmacy and receiving advice from the pharmacy's competent staff regarding the use of prescription drugs and self-care.

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Anders W Jonsson (C)

Madam Speaker! During the election campaign, KD tried to present themselves as the great champions of the rural areas. They fought for the countryside. But after the election, it has been significantly quieter about that. In this report, it becomes, as some party leader said, obvious – one says one thing before the election, and after the election, it is something completely different.

Dan Hovskär touched upon one of the truly major problems: access to medicines in rural areas. The report contains concrete proposals on what could be done. The first thing that should be done is to quickly step in and review the special grant that is paid out to pharmacies in rural areas. That is the lever we can turn so that it becomes more profitable to run pharmacies even in the smaller towns. KD says no to that.

The second thing is to open up the possibility of using pharmacists remotely. The shortage of pharmacists and prescriptionists is a major problem. This could be addressed if the legislation stated that prescriptionists do not need to be physically present at the pharmacy, but that one can have digital access to it. That is a proposal that we have put forward. That too would drastically improve the situation in sparsely populated areas and rural areas. But KD says no to that.

Perhaps the most surprising thing is to hear Dan Hovskär say that e-commerce is an important part, except when it comes to narcotic drugs and antibiotics that must be prepared. They are not included in e-commerce. But right now, the Medical Products Agency is working, with the government's good pleasure, on a proposal that would put a total stop to e-commerce. One must be at home for perhaps six to eight hours and stand at the door and wait with one's ID to be able to receive the antibiotics one has been prescribed. It seems KD is prepared to let it through completely.

Why is KD so hostile to improving access to medicines in rural areas?

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Dan Hovskär (KD)

Madam Speaker! When it comes to the Christian Democrats and the work on rural issues, one does not need to be as anxious as Anders W Jonsson is. We work with these issues in different parts. When it comes to rural area grants, there is one such now that I believe 44 pharmacies received in 2022. 12 million kronor were paid out for that. So it exists today. I know that you also work with this issue and want to strengthen it.

Regarding prescriptions digitally, we have, as far as I know, not said no to that proposal. But different possible solutions have been looked at.

The Chairman of the Committee is talking about e-commerce and TLV's new investigation. A position has not been taken on that yet. I know that there are quite a few parts that cause problems, but according to the information I have received, no final position has been reached on it yet.

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Anders W Jonsson (C)

Madam Speaker! I may have expressed myself somewhat unclearly. There are three sharp proposals to improve the accessibility of medicines in rural areas.

The first thing is to directly review how the support is constructed. The support has existed since 2008/2009 and must be reformed. In the report, there is such a proposal from the Center Party's side. KD intends to vote no and reject it.

The second point concerns the proposal regarding a remote pharmacist. It must be investigated because it requires a legislative change. In the report, the Center Party has submitted a concrete proposal that one should be able to have a remote pharmacist, that is, not have any pharmacist present during the entire opening hours of the pharmacy in the small community. Instead, that access should be available remotely. KD votes no. You do not support the Center Party's proposal.

The third point concerns the fact that the Medical Products Agency - not TLV - intends to put a complete stop to the possibility of distance trade with medicines in rural areas. They do this by stating that if one is to receive medicines in rural areas, one must stand there at one's door between 1:00 PM and 7:00 PM with identification ready at the ready. In cities, it can work, depending on the fact that it is significantly denser there, but for rural areas, it will mean a complete stop to the possibilities of obtaining medicines in a simple way - not least for the elderly and those who perhaps are not even car owners - to get medicines home.

We have submitted all these three proposals. They are concrete proposals that would improve the situation quite quickly. KD says no to all three. Regarding the third one about stopping e-commerce, one does indeed let the Medical Products Agency hold the axe, but I do not understand how a party that said during the election campaign that they are for the Swedish countryside can so consistently block proposals that involve better access to medicines in the Swedish countryside.

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Dan Hovskär (KD)

Madam Speaker! When it comes to e-commerce, the member is completely right that it concerns the Medical Products Agency, not TLV. They are now looking at whether it is possible to find new solutions so that people do not have to stay at home, as that would be a devastating blow to, among other things, the countryside and rural areas. I know that they are looking at whether it is possible to find other solutions in that issue. We will have to return to it when the final proposal arrives.

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Karin Rågsjö (V)

Madam Speaker! When the former Alliance sold off Apoteket AB, it perhaps would have been good to have some directives regarding that deal. They spoke very nicely about small pharmacies. Now that didn't happen, instead it is large business chains and clusters that are connected in different ways. These are, for example, grocery stores with pharmacies, pharmacies with healthcare companies, digital doctors - you name it. It is a giant market.

One can wonder where the public health aspect went in this. For example, it is not possible to check the entire supply of medicines among the pharmacies.

When it comes to the rural areas and the belief that market forces will take responsibility for the countryside, I think it is quite naive. In an establishment analysis conducted in 2022, one can see the reduction of pharmacies that have been located more than 6 kilometers from another pharmacy. Simply put: the number of pharmacies in rural areas, where access is already at its worst, has decreased. Instead, they are increasing in the cities, where I myself live. I have extreme access to pharmacies, I must say! I live in Stockholm's inner city.

I wonder if this is not something that must be addressed in some way. Accessibility just becomes worse and worse if you live in rural areas or a bit further out from the cities. What do the Tidö parties, that is, the SD-supported government, intend to do about this?

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Dan Hovskär (KD)

Madam Speaker! In my speech, I touched upon the question that since this entire reform was implemented, there has been a largely 50 percent increase in the number of pharmacies - from 900 in 2008 to approximately 1,400 today. That means that accessibility has increased significantly, also regarding the opening hours which have become considerably better.

I also mentioned that a number of pharmacies in rural areas have been closed down. Most often, it is linked to the fact that health centers have disappeared, because then it is difficult for pharmacies to survive.

These are questions that we monitor to see how one can work further. I mentioned further that it is important to in some way be able to visit a pharmacy in one's local area to get advice and so on. It is therefore an important question that Karin Rågsjö takes up and which is important to monitor moving forward.

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Karin Rågsjö (V)

Madam Speaker! This development has been seen over several years. It is nothing that has appeared now. I have pointed this out since 2014 when I entered the Riksdag and was tasked with working on healthcare issues.

It is clear that there are many new pharmacies. Everyone who lives in the city center or in larger suburbs such as Täby can see that, oops, how many pharmacies there have become. There are fewer pharmacies if you go further out. I am thinking of, for example, Birger Lahti, my comrade in Vänsterpartiet, who lives in Pajala. How many pharmacies are there?

Regarding the connection to health centers, it is also a matter of the market. Where does the market want to position itself? Where is it profitable to position itself?

If you open the door for the market, it becomes market-driven. You don't need to have attended the School of Business to understand that. There will be greater opportunities for the market to open here in Kungsholmen or Södermalm or down in central Gothenburg. There isn't that much cash to be made by opening in Pajala. This has therefore become a market issue.

Madam Speaker! I believe it is always the case that if one hands something over to the market, it happens on the market's terms. As politicians, one then has to sit in the stands and hope that it goes reasonably well, unless one finds steering instruments. I therefore still wonder what the SD-dependent government intends to do.

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

Dan Hovskär (KD)

Madam Speaker! We have seen a doubling, Karin Rågsjö, of the number of pharmacies since the new reform came into force. It is thanks to the fact that the market has been opened. You must also see that there have been many more pharmacies, and it is a positive effect of the market having been given space. There have been more pharmacies and longer opening hours. Both state-owned and private companies have been part of the development.

Just as I highlighted, there are concerns. We must continue to monitor the rural establishments. More needs to be done there. But the market has been positive for the pharmacy development.

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Mikael Dahlqvist (S)

Madam Speaker! Member Rågsjö raised the market conditions, and I completely share her view. It is clear that we should be pleased that there have been more pharmacies - in some parts of the country. But it does not help those who live in remote areas or rural areas.

I myself come from a relatively small town called Hagfors. We have a pharmacy with the same opening hours, and we have not received more pharmacies. It would be pleasant if the member had an idea of how political decisions should be made that the market does not need to take into account. The market is governed by supply and demand. That is how it is in the public sector at all. It is the Social Democrats' fear regarding providers. There is no question that there are many great providers. The problem is who takes into account or is responsible for the whole.

The exact same question applies to the pharmacy market. The market will never establish a pharmacy in Sysslebäck in northern Värmland. Here, I call for more activity and creativity from the government's representatives.

Madam Speaker! The Christian Democrats are a party that places healthcare issues high on its agenda, and the party should be commended for that. But pharmaceutical issues are largely about financing, and there is a lack of money. The regions pay a large part of the pharmaceutical costs. We know that we are facing a welfare crisis in Sveriges Kommuner och Regioner. In the forecast for 2024, the figures show that 31 billion is missing. This will naturally affect the possibility of purchasing pharmaceuticals. How do the Christian Democrats in the government intend to ensure that welfare is financed?

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Dan Hovskär (KD)

Madam Speaker! I thank Mikael Dahlqvist for the question.

Everyone knows that we live in a tough economic reality. We have ensured that municipalities and county councils have received 12 billion this year. Large parts of Kommun- och Regionsverige have had large surpluses in recent years. I have worked in Västra Götalandsregionen and in Falköpings kommun. Many municipalities have large surpluses. But now we find ourselves in tougher times, and that requires measures.

The government has added 12 billion during this year. Then we shall look at what is needed moving forward. Large expenditures are coming. Inflation ran wild earlier, but now it is dipping downwards. And that is positive.

The first question concerned how one can stimulate the establishment of more pharmacies in rural areas. I mentioned earlier that there is a so-called rural area grant. We paid out 12 million in rural area grants in 2022. But I said honestly earlier that we need to look at what additional incentives are needed. So there is a grant, and the regulation of the grant has resulted in 44 pharmacies receiving the grant last year.

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Mikael Dahlqvist (S)

Madam Speaker! I thank Dan Hovskär for the answer.

Politics is about prioritizing. It is true that you have given 12 billion extra to Sveriges Kommuner och Regioner. It is also true that the Social Democrats, in their budget motion, have doubled that amount. Politics is about prioritizing. It would be interesting to hear how the member views the prioritization that was made, where it was chosen to lower the tax for you and me with high incomes instead of stopping the indexation and giving the money to, for example, healthcare.

Madam Speaker! The member says that the Christian Democrats safeguard and stand as a guarantor for health and medical care. But in my eyes, you are a guarantor for the economies of high-income earners. Politics is about will and prioritization.

Then it is good if the government comes back in the autumn budget. The situation is acute. It is true that the previous S-led government received historical appropriations, and there was a surplus for a number of years. But now the members must remember that there is inflation right now. Then there is a pension agreement that costs billions extra. The entire surplus in that sector is gone. That is why a deficit of 31 billion is projected for 2024 if nothing is done from the government's side. It is important to keep that in mind.

Madam Speaker! I do not think I can get an answer from the member as to whether an announcement is intended before Midsummer regarding priorities for the sector. It would be welcome because municipalities and regions are already in the process of laying off staff. It is a bit late to provide an announcement in November.

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Dan Hovskär (KD)

Madam Speaker! Politics is about taking responsibility. We can both agree on that.

There has been a gigantic inflation in our society, and we all lose out on that - even low-income earners as well as municipalities and regions. Therefore, we must prioritize trying to bring down inflation and achieve balance in the economy. That is what we have been working on.

It must also pay to work. By getting more people into work, our country fares better. Therefore, we believe that if more people have access to work, Sweden and the individual fare better. Therefore, we are working on many different parts. Then we have to return to what the budget looks like for the coming year. I do not think the member will receive notice before the Riksdag ends tomorrow. But we shall see!

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Johnny Svedin (SD)

Madam Speaker! We view pharmaceuticals and dental care somewhat differently. As a specialist nurse with a focus on psychiatry, I have met and treated children and young people with most types of pharmaceuticals within the walls of psychiatry. We know how much benefit medication can have for children so that they can function in a world that today can be extremely stressful and demanding. And even worse is it if you have some form of NPF-diagnosis, that is to say, a neuropsychiatric diagnosis.

But medication with antidepressants must never be the routine first choice for dealing with children's problems. This is something that, unfortunately, is done to all too great an extent today. This happens because of too long queues within psychiatry and BUP, which means that society does not have time to deal with those who need help.

Madam Speaker! What does it look like then? The number of children aged 0-17 who are prescribed ADHD medication increased from nearly 28,000 children in 2011 to nearly 77,000 children in 2022. But what is more worrying is that the prescription of antidepressant medication to children has increased from nearly 12,000 children in 2011 to over 37,000 children in 2022.

This concerns not only me but also the UN Committee on the Rights of the Child. In a review of how Sweden complies with the Convention on the Rights of the Child, the committee has, among other things, noted the high levels of depression, anxiety, and self-harm among children as well as the long waiting times for psychiatry.

Madam Speaker! The increase over the last ten years has resulted in that today it is three times more common for children to be prescribed antidepressants in Sweden than in our neighboring countries Norway and Denmark, and the difference between the countries is reported to have increased over a long period.

Psychiatry, child and adolescent psychiatry, and care for children and young people is strained in Sweden as a result of previous governments' dismantling and deprioritization over a long period. Those who seek care do not receive help in time but end up in year-long queues. At the same time, mental ill-health is increasing and spreading further down into the ages.

Approximately 70-80 percent of children and young adults diagnosed with depression begin treatment with antidepressant medications. The proportion has remained unchanged at least over the last ten years. A corresponding situation exists for various sedatives or anxiolytics and sleep medications, where prescription is made to 20 percent of children and 35 percent of young adults in cases of depression and anxiety disorders. This indicates that treatment practice regarding mental ill-health has not changed. But because the number of cases has increased sharply, the total prescription has also increased.

Madam Speaker! The increased use of antidepressant drugs must be reviewed in order to get to the root of the problem. We must be completely certain that it is indeed depression that is the basis for why children and young people are being prescribed more and more antidepressant drugs. It is unacceptable and directly inhumane if antidepressant drugs are prescribed as a simpler solution due to a lack of resources within psychiatry when young people who are suffering primarily need to be offered the support, the treatment, and the care that they need.

The Sweden Democrats believe that the government should review the increased use of antidepressants among young people and map out the causes of this. Everyone deserves a safe and healthy future.

With this, Madam Speaker, I wish to move for approval of reservation 4.

Madam Speaker! I also want to highlight another pharmaceutical issue now that we are touching on the subject, namely the handling of pharmaceuticals and the environmental aspect of pharmaceuticals.

Medicines consist of substances that are constructed and designed to have a biological effect. As such, they can potentially have effects in nature when released. Many medicinal substances are so stable that they pass through the human body quite unchanged or in another biologically active form. Medicines that enter nature affect fish and aquatic animals even at very low concentrations. Antibiotics in the environment can also seriously threaten our health.

We believe that more knowledge is needed regarding the impact of pharmaceuticals on the environment. Pharmaceuticals are a special group of chemical substances because we need them to cure and alleviate diseases. Other substances that affect the environment can be banned, but that does not apply to pharmaceuticals.

Medicines are developed and used in large quantities. This applies in particular to over-the-counter medicines. Large emissions are made of the substance diclofenac, which is part of the group of pain-relieving medicines. Emissions of substances included in hormone preparations such as birth control pills are also extensive.

Several harmful substances have been shown to have negative effects on birds. Relatively recently, a Swedish research group demonstrated large occurrences in Swedish watercourses. The findings highlight the question of whether an environmental assessment should be conducted at some stage. It should at least be relevant regarding over-the-counter medicines. The medicines' most important function, to save lives and improve the health of humans and animals, must of course carry the most weight. Given the development of emissions and risks to the environment, assessments must be considered. Such an assessment could accelerate the development of medically equivalent preparations with lower environmental effects and alternative treatment methods.

Madam Speaker! The Sweden Democrats consider that an investigation needs to be appointed to review how an environmental assessment could be designed as part of the approval process for pharmaceuticals and as part of the prescription of such, as well as what consequences different forms of regulation can have.

Madam Speaker! During the election campaign, the Sweden Democrats highlighted the need for a new dental care reform, and dental care is also presented in the Tidö Agreement.

The Sweden Democrats want to see that the high-cost protection for dental care is reformed to more closely resemble what exists within health and medical care, which would make dental care more equitable and accessible so that even elderly people with low income or pension have the opportunity to visit the dentist before oral health becomes too poor and the costs even greater.

Exactly how such a reform should look is not yet finished, but the Tidö parties will return with it after the issue has been investigated. But the Sverigedemokraternas standpoint is that the mouth is a part of the body and that this should be reflected in the systems.

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Anders W Jonsson (C)

Madam Speaker! I noted that there were a few sentences at the end where Johnny Svedin from Sverigedemokraterna touched upon dental care. I can understand that it wasn't many sentences, because here one can see how a sharp election promise is transformed into a thumb-sucking or perhaps not even that.

In the election campaign, the Sweden Democrats were extremely clear that a high-cost protection would be introduced. It was to be of the type that is in the rest of the health and medical care. It was to cost 7 billion kronor, and the money would be obtained by cutting back on aid and cutting back on climate work. Cutting back on climate work, they have done; cutting back on aid, they have done, but there is no money for a high-cost protection.

When this came to the Tidö Agreement, it had changed. Then, the issue was to be investigated and the elderly were to be prioritized.

In the budget proposal for 2023, it was to be reviewed and investigated during the mandate period, and then it was no longer about all older persons but the older persons who have the worst oral health.

From a general high-cost protection of 7 billion, one has thus ended up investigating a high-cost protection for the elderly who have the worst oral health.

Everyone in here knows that if a new high-cost protection is to be introduced, it is required that the government appoints an inquiry, that an inquiry directive is drawn up, and that an investigator is appointed who will then need to have a secure two years to work before there is a finished proposal to be referred, processed in the Government Offices, and perhaps pass the Council on Legislation before it possibly becomes a government bill. It is therefore obvious that the election promise of a high-cost protection will not materialize during this mandate period.

One might wonder what it is due to. Either it was the case that for you in Sverigedemokraterna, this was a rather uninteresting election promise that you released at once in the negotiations, or it is the case that you have been fundamentally deceived by the other parties. I wonder why you have not pushed this issue harder if it was so important that it should even be included in the election manifesto.

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Johnny Svedin (SD)

Madam Speaker! Thank you for the question, member!

Yes, it was an election promise that we had and went to the election with. We said that we would make a dental care reform of some kind, quite correctly.

It is still in the Tidö Agreement, and therefore we expect it to be implemented during the mandate period.

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Anders W Jonsson (C)

Madam Speaker! It is an obvious change from the election promise of a high-cost protection for everyone at a cost of 7 billion, which then meant that everyone would receive the high-cost protection, to the increasingly weaker formulations and, finally, that it should be investigated and that it concerns the elderly who have the worst oral health.

Everyone who knows anything about how legislation is changed and how the budget is worked on in Sweden knows that it is not possible to pull a new legislative proposal out of thin air from one day to the next and believe that it will become a reality a few months later. If you sit down and look at this and calculate the lead times that exist, it becomes obvious. There is no government decision, there is no directive, and there is no investigator, so this is going to be something that possibly ends up on the other side of the 2026 election.

Once again, my question is why you have released this. Had it been an important issue for the Sverigedemokraterna, one would have ensured not just to have a loose formulation in the budget bill for 2023, but an actual timetable where it clearly states that the directive shall be drafted before May 2023 and the investigator appointed before June 2023 with a delivery date two years later, in order to at least have a schedule that makes it even theoretically possible to get this in place during this mandate period. But that has been completely ignored.

For my part, there are only two possible interpretations of this.

One is that the Sweden Democrats are aware that this was not an important election promise. They do not mind that it is swept under the rug and placed somewhere far in the future. The other is that you have simply been cheated on this issue - that other parties do not think this is important and therefore have been able to handle the Sweden Democrats in this way.

I think it would be interesting to hear an explanation, alternatively a statement now that this will be implemented in the near future, as it is usually called when ministers speak. What is the explanation for why this, the central election promise in the election manifesto, didn't even make a dent?

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Johnny Svedin (SD)

Madam Speaker! Anders W Jonsson is naturally right that it takes time. Such a reform obviously cannot be carried out overnight.

For the first thing, we have not swept anything under the carpet – I can say that straight away. This is an important reform; it is needed. And who is it that needs it the most? Well, probably older people with poor dental hygiene and oral health. We are fully aware that they also have the hardest time getting to dental care. Here, we would of course like to see much more being done. It is therefore not a question of deprioritizing this in any way, but the question is when it lands on the agenda.

We have approximately 28 points in the Tidö Agreement that concern the Committee on Health and Social Affairs in one way or another. For other committees, there are probably more points. It is a question of prioritization what we need to invest in at this particular moment. I believe this issue will land on the agenda quite soon.

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Mikael Dahlqvist (S)

Madam Speaker! The Sweden Democrats are now part of the government. They do not sit physically in the government, but they rule the government, I believe - with the help of the Tidö Agreement, a chancellery and leading positions that they have here in the Riksdag. They thus have a great influence on the current government's policy and also on certain issues that are regulated in the Tidö Agreement.

I want to tell Member of Parliament Johnny Svedin that I agree with much of what you say in your speech. The queues to child and adolescent psychiatry are a dilemma and have been for many years. When it comes to this matter of treatment methods, you also know, Johnny Svedin, as someone who works within the industry yourself, that it also has to do with competence and access to resources.

I react to one thing in your speech, Johnny Svedin, namely that the previous government would have dismantled healthcare. I just want to remind the member that we added over 100,000 new public jobs when we were in government. It will be interesting to see how it looks when this government, together with SD, does its final accounting.

We had historical allocations for health and medical care. We even valued the state grants, according to SKR.

I would like to ask a simple question to Member Johnny Svedin, Madam Speaker. We are facing a welfare crisis. 31 billion is missing for next year. The Government, together with the Sweden Democrats, has prioritized tax cuts for the Member and me. How will the Member ensure that the resources needed are provided to Sveriges Kommuner och Regioner?

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Johnny Svedin (SD)

Madam Speaker! Thank you, Mikael Dahlqvist, for the questions! You claim that you have added 100,000 new public jobs during your government's period, and also a lot of appropriations to health and medical care. I assume that they have gone to the 100,000 public administrative jobs instead of to healthcare personnel. This is a huge problem today. We are sitting with a large administrative colossus but very few people who work out in the operations. Thank you for that!

When it comes to the budget, it is set for the past year, and there are large investments underway. Then, money is not always the solution to an issue, but it is also about how one manages the money. It is proven that if one adds a lot of money, the administration increases; we have seen that during these eight years. And the money does not go to healthcare-related professions, which we are in greatest need of and where we lack staff today.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you, Johnny Svedin, for your answer! Those who are listening and have received jobs within healthcare or elderly care are probably wondering a bit about your statement now that the money has only gone to administrative jobs. I think one should be extremely careful about drawing such conclusions in this chamber, Madam Speaker. I agree that the administrative jobs are increasing faster than they should. It is a problem; we see that too. We are also one of the parties that want to remove a large part of the regions, but then the bourgeois side said no earlier. It is a problem with administration, but such generalizations and myths, as I want to call them, do not benefit the political debate, Johnny Svedin.

How does the member believe the queues to BUP will become shorter if more money is not added? The member says themselves that it is about how one works and how one administers. Yes, I agree. I want to assert that if you have too much money you waste it, and if you have too little money you become smart. I have myself managed and worked at different levels, so I also have experience of this.

But look at the truth in your own eyes, Johnny Svedin! Tens of billions are missing. It is reported every day in the newspapers that staff are being laid off, both within healthcare and within the municipalities. This will, ultimately, affect the pharmaceutical budget regarding the area we are debating here today. And what will the consequences be?

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Johnny Svedin (SD)

Madam Speaker! Thank you again, Mikael Dahlqvist, for the questions! We can talk about the administrative part as much as we want, but in my home region, Kalmar län, the increase was significantly larger for the administrative positions than for the healthcare-related staff. This is not insignificant, and it is probably quite comparable across the entire country.

You admit yourself that you have seen with concern that the administration has grown and become larger, which is a problem. One needs to work with that problem. What do we need? Another administrative position that is not close to care, or a new nurse, nursing assistant, or care assistant on the floor? I believe the choice is obvious.

We need people who work close to the sick and those in need. Probably there is also money to be found there. It is up to the regions to decide such things. We cannot do that here, we are talking about the big picture.

But as I said before: We have 28 points in the Tidö Agreement that in one way or another concern the Committee on Health and Social Affairs and aim to improve healthcare in the direction we desire. Among other things, we talk about finally trying to address this with the role of primary care in the healthcare chain. We talk about the pharmacies. In the Tidö Agreement, it also states that we shall develop the pharmacies' role in the healthcare chain.

So it will happen. I am not at all worried about it. I actually feel quite confident that these are good measures that will benefit Swedish health and medical care in the long run.

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Karin Rågsjö (V)

Madam Speaker! I wonder a bit, Member Johnny Svedin. I am standing here with a newspaper, Dagens Medicin, where it says: "Inflation is devouring the healthcare's money." I do not think it feels okay to hide behind the fact that it is only administrators who are leaving healthcare. This is a crisis in the entire healthcare system.

The Speaker raised this regarding children with different mental health diagnoses and it is quite bad. There, we are in complete agreement. There is an enormous prescription of, for example, antidepressants and also medications for ADHD. What is prescribed looks very different across the country.

We had a few simple small proposals in our small motion, namely that the government should carry out a national review of the prescription of antidepressants and that the government should take the initiative for a review of guidelines for the medication of children and young people. But it was only we in Vänsterpartiet and Miljöpartiet who were positive towards this, which was a bit disappointing.

I wonder, of course, if the member perhaps thinks that it is something he can pass on, because the Sweden Democrats have an enormous impact on this government. It is because of you that there is a government at all right now, so to speak.

My second question concerns the dental care reform that you went out and said would be implemented. Just as Anders W Jonsson said, it sounded very pompous: Now there is going to be a dental care reform! Then it has collapsed into very little. Now it applies to older people with the worst oral health, and that is something completely different from a general dental care reform, which we believe is needed.

How does Member Johnny Svedin think this will turn out in the end?

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Johnny Svedin (SD)

Madam Speaker! Karin Rågsjö receives the same answer as the previous speaker received when he asked how I viewed this. I am quite confident that this will be implemented during this mandate period. We need to conduct an investigation. It will absolutely take some time. But these are no empty promises.

That we then speak about the oral health of the elderly or the elderly's lack of good oral health is quite natural, because that is how it is today. This is a huge problem in elderly care, and therefore we have also highlighted it as one of the major problems and a reason why we should push through this dental care reform.

Then it was the question of neuropsychiatry and such. Yes, how do we deal with that? There are a number of measures within the Tidö Agreement that will lead us in that direction.

I agree with Karin Rågsjö, and she surely agrees with what I said in my speech as well, that we need to do something here. We really need to review what it is that makes children feel so poorly, why the poor well-being is increasing, and above all also why the medication is increasing instead of the care that they would actually need.

One proposal is that we should clarify the doctor's role in the care chain. This is included in the Tidö Agreement. It could also be part of the investigation. We will also have an investigation on ownership. It could also become a part of this.

So, there are several measures that intersect in this issue. There is no direct proposal on paper that is going to address exactly everything. But I believe that if we combine these different measures, we will also see an improvement. We will ensure that it is included among what we are planning for.

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Karin Rågsjö (V)

Madam Speaker! I do not believe that children and young people will benefit from the cuts in schools that we are now seeing somewhat around the country. I can also refer to a survey that Friends has conducted, which shows that bullying due to ethnicity has increased incredibly. Perhaps that is something to reflect on. It cannot be anything positive.

Let me go back to this regarding the dental care reform. This SD-dependent government has spat out investigations of various kinds. For example, there is an investigation underway regarding snitching. There are masses of investigations. But this, therefore, lies in some kind of bureaucratic box.

If one is then to carry out the major reform that this is anyway – I mean that it is not just about the elderly, but poor dental health may have more to do with class than with age – it could still happen that it comes to nothing. It will once again become something that comes very close to the next election, and then we know that it is not something that anyone will raise in the next government. But we will fight for it, I can say.

I am concerned about the investigation. When one goes out and says things before an election, it is very good to then adhere to what one has said. In all issues concerning immigration, crime and so on, you have followed what is to be done to the letter, Johnny Svedin, but regarding just this with the dental care investigation and general support, which is to be equated with what we have for the body, there is nothing of that sort right now.

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Johnny Svedin (SD)

Madam Speaker! Thank you, Karin Rågsjö, for the question! Once again, I can only say that this is something we would like to push through. It is a question that has come from us. It is a question that we have used in the election campaign and will implement in the Tidö Agreement. It is stated there.

That it has not been started yet may be due to the fact that we have prioritized something else just for the moment. I do not dare to answer that. I cannot give a date for when this will exactly take place, but it is an important issue. Karin Rågsjö can be completely sure that we consider it to be. We will not let this drop in any way. That is how it is.

Regarding the initiatives, I agree with Karin Rågsjö: One has to start somewhere. That is what I also said in my speech, and I have said it before as well. What do we need to do to reduce, for example, the medication of children and young people, and what do we need to do so that they feel better and do not need to come to BUP? School health care is one of the things I know the current government is investing in.

I also know from my own experience that among the first things people look at in the municipalities when it comes to things that can be cut back a bit in schools is school health care. It is easy money to pick. The members must guard against this just as I do and ensure that such things do not happen, because it is incredibly important that we have a functioning school health care.

This is included in the total investment on the 28 points. We will monitor this. We will strengthen Swedish health and medical care and care for children and young people. This is what I can say.

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Lina Nordquist (L)

Madam Speaker! In this area, I was very pleased with the government's statement and the government's priorities. As a pharmacist, I was pleased, as a resident I was pleased, and as a liberal I was very pleased. We are getting a pharmacy reform and a dental care reform. It feels very good.

Regarding the pharmacies, I want to say that it is high time to develop their role in the care chain. During this mandate period, the government shall ensure that certain services can be offered, for example, health examinations. We will also introduce a pharmacist range, an intermediate step between over-the-counter and prescription-only.

On the pharmaceutical front, furthermore, very much decisive work is ongoing, I would like to say, for all people who need medicines in one way or another. It is about updates and a new pharmaceutical strategy. We are finally getting a national strategy when it comes to rare conditions – in a broad sense, but where medicines obviously are included.

It is also about work to ensure that medicines are available where they are needed when they are needed. There should be fewer medicines with travel notes. We are also working to introduce an environmental premium in the benefit system and weigh in environmental aspects when it comes to over-the-counter medicines. It is something that the Liberalerna have worked for for a very long time.

So there is a lot going on. It will be very interesting to see this.

Then we have this with the dental care reform, where an investigation is appointed to strengthen the high-cost protection for dental care. Those who have the worst oral health should be prioritized. It is incredibly important. Today, it is expensive for those who have poor oral health. Furthermore, poor oral health often goes hand in hand with poor finances.

We must all have knowledge in order to be able to prevent. We must all have the means to prevent and treat. Those with the greatest risk shall be prioritized highest.

I am very pleased that the government has tasked Socialstyrelsen with preparing a basis for a national risk assessment. It is important.

The work for equal dental care for children and adults across the entire country is currently underway. The work for better pharmaceutical supply and wiser pharmaceutical legislation is underway. I truly look forward to the finished proposals.

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

Anders W Jonsson (C)

Madam Speaker! The discussion on the pharmaceutical side is very much about that we should increase access so that all people can get access to medicines. But what one forgets then is that there is another side of the sword, namely incorrectly used medicines. Perhaps most upsetting are the people who are affected by addiction diseases due to incorrect prescription of narcotic preparations. This can happen out of pure ignorance, but there are in Sweden a number of doctors who earn very gross money by prescribing narcotic preparations to people who have addiction diseases.

The teeth are far too weak here. It is very difficult for Ivo to find these individuals, depending on the fact that Ivo must first obtain a suspicion that there is an individual engaged in this, shall we say, criminal behavior. Then one can request information about that specific individual.

One could, in a fairly simple way, catch these ugly fish by simply changing the legislation so that the E-hälsomyndigheten at regular intervals reports prescription patterns regarding narcotic preparations. Who prescribes more than five times as much as the other doctors in the country? Then one could quite easily pick out those who work at oncology clinics and so on. It would be a precise way to actually supervise and put a stop to this.

We have submitted that proposal. The Liberals will vote no to it. One will also vote no to something else, and I do not understand that. Today, it is permitted for a doctor to prescribe narcotic preparations to themselves. That should be stopped.

My question to Lina Nordquist, who has an involvement in these issues, is: Why do the Liberals not contribute to curbing the damage that is actually caused by unserious doctors in this country?

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Lina Nordquist (L)

Madam Speaker! Thank you, Member, for the question! I am glad that this topic is being raised, for it is a very important area. There we also see that HSAN has had far too thin muscles. The Liberals pushed through during the previous parliamentary term, together with among others the Center Party, that when one is suspected of serious offenses, one should not be able to work as a doctor. One should not be able to continue with the inaccuracies that one has engaged in when they actually involve risks to other people's lives and health.

We have also long worked precisely so that it can be more easily detected when a doctor prescribes medications that are directly dangerous for the patient. It can also very well be several doctors together who do it, without them actually knowing what the other is doing, so to speak.

There has previously been an incredibly strong resistance from the medical profession itself, which has not at all wanted anyone to interfere with what they prescribe. But now, finally, with the new infrastructure, it will be possible in a completely different way.

I am pleased with the member's commitment. I am pleased with the motions. However, the fact is that the Liberals are now a governing party. In that case, one does not submit motions, but rather prepares matters in the Government Offices. But I completely agree with the member that the work of obtaining information about which healthcare professionals may pose a direct risk to patients and who hinder rather than help is very, very important. And I can assure you that it is ongoing.

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Anders W Jonsson (C)

Madam Speaker! It is simply a matter of that Ivo today does not have the possibility to find these individuals. Ivo must, in fact, receive a report that it is an individual doctor at a medical clinic who is making money by doing this in this manner and who has a completely incorrect prescription.

In order to be able to find these individuals, a legislative change is required. It is required that Ivo be given the opportunity to request this statistics from E-hälsomyndigheten once a month.

It is incomprehensible to me that these proposals are not being moved forward. You reject them from the majority's, the Tidö parties', side and refer to SOU 2022:72. But I have read it forwards and backwards. It does not say a word about this. It is about the sales statistics, which are to be reported to Socialstyrelsen and other things.

I am nevertheless pleased that the Liberal Party's representative is now positive towards this, and I hope that it is raised from the Liberal Party's side in the discussions at the Ministry of Social Affairs. This is, in fact, a major problem in Sweden, and it is something that one could actually rectify.

The second part of this is completely absurd. As a doctor, one should not treat oneself in a situation where one has severe illnesses. It goes without saying. One should not treat one's family either. But here we have a loophole that allows a doctor who has a narcotics addiction to sit and prescribe, not with their pen but with their phone, unlimited amounts of narcotics to themselves, and no one stops it.

I take what Lina Nordquist has said here to heart because these two concrete proposals will be on the agenda – let's assume they are rejected tomorrow by the Tidö parties. This cannot continue any longer. It harms many people, and there are simple methods that could stop it.

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Lina Nordquist (L)

Madam Speaker! I cannot, of course, promise that the government will choose to implement exactly the Center Party's proposal in a motion. But I can absolutely promise something when it comes to safe care. The major work needs to be about having one's healthcare close by. It must be knowledgeable people, who have a right to continuing education and who receive that continuing education. It must be the responsibility of those who employ the healthcare professions to provide continuing education. And as the member is pointing out: When rot finally appears, those persons must be detected. They must be scrutinized, and some of them must no longer remain in healthcare. One must not be able to expose a patient to risk, whether through ignorance or intentionally - it is that simple. We can absolutely shake hands on that, and I look forward to pushing this further regardless of whether I am in opposition or in the majority.

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Karin Rågsjö (V)

Madam Speaker! This is the last debate on health and medical care during this year, so to speak. There have been quite a few debates, and what has colored this year and what will color next year is what stands in a newspaper headline: Inflation is devouring the healthcare's money.

I believe we will be reading more articles of this kind. We are, in fact, facing a welfare crisis, and municipalities and regions will have to make cuts. This is already happening. This will, of course, affect patients. It will also affect preventive measures.

Many children suffer mentally - we have discussed that before. It concerns many things: home conditions, school, and leisure. But it also concerns very clear signals. If you have roots in another country, you are a burden - that is what very many children feel today in different places all over Sweden. For example, reporting stands on the agenda. It is perhaps not so fortunate for a child living in an immigrant-dense environment. Such things are frightening. The family can be evicted and so on.

Now I am going to speak about antidepressant medications for children and young people. The increase in the prescription of antidepressant medications in recent years is clearest for children. The proportion of girls aged 10-14 who were prescribed antidepressant medication increased by almost 60 percent between 2014 and 2018 and by an additional 9 percent between 2019 and 2020. For boys of the same age, the increase was over 40 percent between 2014 and 2018. These are unprecedented figures. The prescription of medications for ADHD has also increased. During 2017, 5.6 percent and 2.6 percent of all boys and girls aged 10-17 respectively collected at least one ADHD medication on prescription. These are high figures and something we need to reflect on.

According to the National Board of Health and Welfare, the large regional differences in prescriptions are very concerning. The differences may be due to over-treatment in some regions with high prescription rates and under-diagnosis and under-prescription in other regions. The research in the field, regarding this type of treatment, is very uncertain in terms of the effect and the long-term consequences of children's and adolescents' use. This should be investigated.

We have submitted a proposal. We want the government to carry out a national review of the prescription of antidepressants and ADHD medication for children and young people and for the government to take the initiative for a review of guidelines for the medication of children and young people. I move for approval of reservation number 5.

Then we move on to the pharmacies - there are very diverse debates today. The purpose of the pharmacies is that one should alleviate and, so to speak, cure illness through approved medicines. I think that one perhaps could have given good directives to Apoteket AB instead of carrying out the sell-off. After the Alliance sold out the pharmacies, new business models have been developed. They are different clusters. They are chains. They are grocery stores that are located near pharmacies - you get a bonus if you shop in that pharmacy. They join together, so to speak. They are not small cute family pharmacies, as was talked about when this reform was carried out, but they are large clusters.

The public health work regarding the pharmacies has been pushed into the background. It is also because they are competing entities. It is a market, quite simply.

It is no news that Vänsterpartiet wants to look into nationalization. We are not alone in this. When Novus conducted a survey in 2020, six out of ten Swedes wanted to nationalize the pharmacies again.

Access to medicines must be secured even in rural areas. We have also spoken about that. To believe that market forces will take responsibility for ensuring that rural and more sparsely populated rural areas have access to medicine is to turn a blind eye to reality and fail to take political responsibility.

According to an establishment analysis 2022, the number of pharmacies located more than six kilometers from another existing pharmacy is simultaneously decreasing. Simply put, the number of pharmacies in rural areas, where access is already scarce, is decreasing, and increasing in cities.

There has been an enormous increase for those of us who live in the big cities. We have no problems getting medicine at any time on Saturdays, Sundays, and evenings. That is very good, I suppose. But if you live anywhere else in Sweden, it is more problematic.

Now we leave the pharmacies and move on to the teeth. We consider the teeth to be a class issue. In the Tidö Agreement, on page 8, it states: Dental care reform. An investigation is appointed to strengthen the high-cost protection for dental care to more closely resemble what exists in other healthcare. Older people with the worst oral health shall be prioritized.

It was not quite what was said during the election campaign by the Sverigedemokraterna. We have already spoken about that. One can wonder when the investigation will come and if it will come at all. It is an enormous equality reform.

It is also not unknown that Vänsterpartiet wants a real high-cost protection in dental care like the one in healthcare. Over the last decades, the welfare has been eroded. We see cuts and passivity, and a naive belief in the market has been allowed to rule. That is what we want to reverse.

It is time to build welfare. A dental care reform would be very welcome for very many. It costs a lot to go to the dentist today. I can attest to that.

It is always those with low incomes, regardless of age, who do not go to the dentist. They have no benefit from today's high-cost protection because it only applies to costs over 3,000 kronor, and it is only half of the cost that is reimbursed. Good teeth have always been a class issue.

We have reform plans for dental care in Sweden. They aim for increased equality, improved accessibility, and better general dental health in the population. They also prevent serious diseases, which we have also touched upon here.

Dental health would, through this reform, become a part of the universal Swedish welfare model and would undoubtedly represent a progressive gain. But we understand. We do not believe that the SD-dependent government will take what is stated on page 8 of the Tidö Agreement further.

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

Anders W Jonsson (C)

Madam Speaker! We have had an interesting debate today. It concerns two very important issues. It is the management of pharmaceuticals in Sweden and furthermore dental care. There have been quite a few details in the discussion. I would like to highlight two areas where there are significantly larger problems.

Let us look at the pharmaceutical area. Sweden is one of the world's richest countries. We are not at all the best, even in Europe, at introducing new medicines. It takes far too long before a new medicine reaches an entire patient group in this country.

It depends on the fact that, to a very large extent, it is the individual doctor's free choice which medicines they prescribe. That is one part.

The second part is that we have a number of medicines where it is already known that they have no effect. But they are still prescribed, and they are paid for and funded by the tax-paying public.

It is at least as important that the introduction of new medicines occurs in an efficient manner and equitably across the entire country as it is that we phase out the drug therapies that are no longer relevant and should not occur. It is about the tapering off of antidepressants for the elderly and so on. There are a number of examples of this.

It leads to an unequal healthcare system that very much depends on where you were born in the country, if you were born in another country, what education level you have, what your parents look like and so on. It makes it vary. So it would not have to be.

In the area of pharmaceuticals, unlike other areas within healthcare, we have incredibly good statistics. We can, in principle, monitor in real-time which medicines are prescribed and also to which patient groups.

The problem is that we do not have sufficiently strong national steering instruments. It is not possible for Ivo to exercise supervision over it and be able to see that a medicine is being used that should not be used on that patient group at all.

For me, it is such a clear example of that what we need much more of in Swedish health and medical care is national governance. The Committee on Health and Welfare visited Intermountain Health in Utah in the USA a number of years ago. It is one of the world's absolutely best functioning healthcare systems.

There, in Salt Lake City, one could essentially see instantly if the prescription pattern changed and whether the recommendations that existed were followed or not. That is where we must reach, Mr. Speaker.

I would have wished that the Government, instead of now appointing an inquiry that is to look at the nationalization of Swedish healthcare, had chosen to appoint an inquiry that would more precisely look at which areas much more national governance was needed in.

It can no longer be a matter of free choice and up to the individual doctor or clinic how to act. That problem exists in all areas of healthcare. But specifically when it comes to pharmaceuticals, we actually have the tools. What is missing is both the stick and the carrot, and the possibility to intervene sharply from the supervisory authority's side.

The second area that we have discussed in the motion report, where there are a number of proposals from individuals and parties, is dental care. The discussion here has been somewhat about high-cost protection.

Member of the Board Karin Rågsjö pointed out that it is a class issue how dental health looks. We can probably all agree on that. It is possible to look in the mouth. We had it described well for us when the committee was in Ekerö and visited a Sis home. Virtually all the youths who came there had deplorable dental health.

But it is not as simple as that if one just makes dental care free, then it is solved or costs are kept down. We see that depending on the fact that children's dental care in Sweden is free. Despite that, there are enormous class differences in how the dental health is among children in vulnerable socioeconomic environments in relation to others.

I would say that perhaps it is not the economic conditions for dental care that is the most acute problem we have. The big problem now is that we do not have staff in Swedish dental care and especially in public dental care. That means that one does not even have time to fulfill their basic mandate.

In that case, the state has a responsibility because it is the state that regulates the volume of education. We can only hope that another dental school can soon be established in Sweden. It is Jönköping that is next in line to be able to offer that education. Here, the state has a responsibility, and we must take that responsibility.

What is unfortunate there is, of course, that what the Tidö parties and the Moderate-led government are doing in that area is rather to ensure that staff from other countries are kept out. It will affect both healthcare and dental care.

One raises the income requirement and says: You are not welcome here if you do not have a monthly salary of more than 33,000-34,000 kronor. That will make it significantly harder to recruit, Mr. Speaker, to both dental care and health and medical care.

Someone may object and say that there is no dentist or, for that matter, a doctor who earns under 33,000-34,000 kronor. But when one recruits staff from countries outside the EU, it never goes into a full dentist's salary or a full senior physician's salary, but it starts significantly lower.

If one then limits the possibility of labor migration, it will not be a positive force for Swedish dental health and not least for the Swedish national dental care.

I support all the reservations that Centerpartiet has in the report but move, for the sake of time, only for approval of reservation 12.

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Jesper Skalberg Karlsson (M)

Mr. Speaker! I thank Member Jonsson for his very engaged speech.

Just as Member Jonsson sees, I see that Swedish healthcare needs to be developed, and if it is to be developed, something different needs to be done. One of the lessons I took away after the corona pandemic when I was a regional councillor on Gotland was that more things should be elevated to a state responsibility. The state needs to take an increased responsibility for the management of healthcare. I perceive that Anders W Jonsson agrees with that, at least in parts.

It is therefore strange when Member Jonsson says that the government is simply going to draw a line and then all healthcare will suddenly be state-run. In the assignments given to the committee for the investigation on state-run care, it is stated that they shall analyze and highlight the advantages and disadvantages of full or partial state ownership for health and medical care. They shall submit proposals that ensure a more efficient health and medical care system that is based on patients and takes into account the needs of employees.

Is this not actually exactly what Anders W Jonsson and I myself are calling for? One should look without preconceived notions at how it could function better with increased state control. One is, of course, open to it being entirely or partially state-owned.

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Anders W Jonsson (C)

Mr. Speaker! I thank you for a very interesting question.

I believe there is a broad consensus in Sweden that increased national governance is needed in a number of areas. But to simply achieve increased national governance is an immensely extensive task. It requires changes in a large number of laws. One must also look at which parts of the healthcare infrastructure should be state-run, that is, have state ownership. That alone is an immensely large reform task. I believe there can be a broad consensus among the different parties there, which we have heard in the discussion for many years. The question of state ownership, however, is something completely different.

I assume that Jesper Skalberg Karlsson closely follows what is happening at Ratio, which is a Swedish research institute. For several years, they have put in a very large amount of work reviewing the research on whether it is more efficient to have the entire Swedish health and medical care system under a single principal, managed by a director general who would presumably sit on Kungsholmen. That would be the most devastating thing one could do for Swedish health and medical care.

In Sweden, we have two such processes in fresh memory.

One thing is the nationalization of Försäkringskassan, which led to the fact that Försäkringskassan did not function for ten years. It was, in itself, justified to do that with an activity governed by legislation where there should be exactly the same decision in Vittangi as there is in Ystad. There, it is reasonable to have a single organization under a director-general. But healthcare is incredibly complex.

The second example in Sweden is the nationalization of the police. We moved from a number of different police authorities to a single one. Even for that, there were incredibly weighty reasons.

Creating an NHS in Sweden with 455,000 employees and a budget of approximately the same amount in billions is a dead end. It would have been better to focus on what yields results.

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Jesper Skalberg Karlsson (M)

Mr. Speaker! I thank Member Jonsson for the answer.

I look forward to the committee's work where they will look at how one can partially or completely take a greater state responsibility, move forward and solve real problems. Then one gets many tools in the toolbox that one can use.

Mr. Speaker! My follow-up question is not about this. We have heard in the debate that we have an SD-led government. Just as the Sweden Democrats are a support party to the current government, the Centre Party was a support party to the previous government.

People are talking here about it having to go much faster and that everything should happen at once. It doesn't matter that the Tidö Agreement regulates a mandate period; everything is to be completed in the first year. In that case, it is interesting to hear more about how fast it actually went during the previous mandate period.

A question that the member touched upon in their speech was the national medicine list. I wonder why it took such a long time if everything went so fast when Centerpartiet was a supporting party. Why was it not finished when Moderaterna took over Rosenbad in the autumn?

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Anders W Jonsson (C)

Mr. Speaker! The national pharmaceutical list was not part of the January Agreement. On the other hand, we had learned how government cooperation works. The agreement we had was therefore extremely carefully specified regarding which investigations were to be appointed, which dates applied, when the investigations were to deliver, and so on.

When one sees how your cooperation is laid out, it is so obvious that it is not in the same way. That is what makes it so that the Sweden Democrats' important demands for a high-cost protection will likely not be able to become a reality during the period because it is deprioritized in a drawer far down and because the Sweden Democrats have not pushed and obtained sufficiently sharp commitments in these areas.

If one is to achieve anything, one must first appoint an inquiry, and that takes time. It takes time to change Sweden, and that is something one must realize.

The fact that the national medicine list has taken time is due to the fact that what was initially an initiative from the Alliance government, which Member of Parliament Skalberg Karlsson knows, repeatedly encountered obstacles because it was not easy to implement. The final stop for the process during the previous parliamentary term came when SKR, which was then governed by the Alliance, gave a unanimous no to forcing the process. Otherwise, we would have risked patient safety. That caused the then-government to slow down the pace for the timeline for an introduction of the national medicine list, which the current government has also done.

This shows that things take time. Therefore, one must be well-prepared and use the investigation resources for things that truly make a difference.

Regarding national governance, there is plenty to do in terms of legislative work. But spending time finding out whether a nationalization of the entire Swedish health and medical care is possible is a false trail.

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Ulrika Westerlund (MP)

Mr. Speaker! The problem with incorrect medication use has been addressed by several in the debate. I want to take us back to something that happened quite a long time ago, but which still deserves attention.

The elderly are often particularly vulnerable. About 15 years ago, the issue received significant attention through a case involving a woman named Gulli Johansson. It was believed that she was dying, and when she, in her condition, could no longer take the medications she was prescribed, she unexpectedly began to recover. It was revealed that for many years she had been completely overmedicated and barely conscious due to the combined effects and side effects of the medications. When she died a few years later, her situation was described as having lost eleven years of her life due to incorrect medication.

Miljöpartiet proposed, in connection with the case, the establishment of a lex Gulli. The idea behind it was to introduce a reporting obligation if staff suspect medication neglect by someone being affected by serious medication-related problems as a consequence of incorrect prescription.

No Lex Gulli was ever introduced, but a number of other measures that improve the situation for the elderly in connection with pharmaceuticals have been taken. According to the Patient Safety Act, which came into force in 2011, mix-ups, incorrect prescriptions, and incorrect dosages of pharmaceuticals shall be reported. It is intended that relatives shall be given the opportunity to participate in patient safety work. Complaints can be reported to the Socialstyrelsen.

The National Board of Health and Welfare has also issued regulations that require that persons who are 75 years of age or older and who have more than five medications prescribed at least once a year shall be offered regular medication reviews. How this works in practice is difficult to say, and it is quite clear that many elderly people do not know that this is a right and something that should occur. The work to ensure that this functions must therefore be improved.

Miljöpartiet also considers that the limitations regarding age and number of medications should be reviewed when it comes to the right to a simplified medication review. Doctors' responsibility should also be clarified regarding the issue of performing a simple medication review at every prescription of medication as well as in other treatment situations where it is deemed appropriate. Finally, in-depth medication reviews should be carried out when elderly people move into a healthcare and nursing home and thereafter annually. The Government should review all these issues. Perhaps it is time for a lex Gulli.

Mr. Speaker! As also mentioned by colleagues here earlier, the UN Committee on the Rights of the Child has recently reviewed Sweden regarding how well we comply with the Convention on the Rights of the Child. The review was published in March, and the committee noted with concern the level of depression, anxiety, and self-harm among children as well as the long waiting times for psychiatric care. According to an article in DN, which monitored this, the number of children up to 17 years old who take antidepressant medication has increased by 190 percent over ten years, which is much higher than in our neighboring countries.

It is extremely important that all children and young people who have problems with mental health receive the help they need. Queues must be shortened and the right help must be provided in time. The right help can be medication, but there can also be other measures and interventions that can help. Resources to shorten the queues and ensure that all young people receive the right help in time must therefore be secured. Cooperation between different healthcare interventions must function, and there must be clear guidelines and boundaries between BUP and other instances in connection with medication prescription. Therefore, the government should take the initiative for a review of the current guidelines for the medication of children and young people.

Mr. Speaker! We seem to be raising roughly the same issues in this debate. Now I intended to say something about dental care. Sweden should have a unified health and medical care system. No one should have to forgo preventive or necessary dental care for economic reasons. We are living longer today, and more and more elderly people still have more of their own teeth. This increases the need for regular dental care. The work of creating equitable dental care that is accessible to everyone must continue.

The government has announced that it intends to review the high-cost protection for dental care during the mandate period so that it more closely resembles the high-cost protection that exists in other healthcare. They have also stated that older people with the worst oral health should be prioritized. We think it is very positive that the government clarifies that it wants to do something about the high cost levels that affect individuals and that it is raising the issue of high-cost protection. Miljöpartiets goal is that dental care should be included in the same high-cost protection as healthcare in general for everyone in the way that is possible without the current possibilities for dental care to, for example, be at the technical forefront and provide preventive care being threatened. It is important to get the promised investigation in place, where all these challenges can be taken into account.

Mr. Speaker! Finally, I want to say something about the environmental impact of pharmaceuticals. There is much to be done to see how this can be reduced. The Government should take measures so that the EU sets stricter environmental requirements on pharmaceutical manufacturing in order to eliminate more harmful substances than today. The Government should also work to ensure that the EU allows the Member States to decide that directly environmentally hazardous pharmaceuticals shall not be sold over the counter.

The drug diclofenac has often been mentioned here. The government should allow an investigation into how the sale of products containing diclofenac can be more strictly regulated. Now, I have seen several times at the pharmacy that they have labeled the shelves themselves and pointed out that this is a very environmentally hazardous drug, but there is more to be done here. It is in everyone's interest to counteract harmful environmental impact in all areas. Pharmaceutical production and the use of pharmaceuticals must not make people sick.

I move for approval of reservation 6 but naturally stand behind all of the Miljöpartiets reservations.

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

Anna Vikström (S)

Mr. Speaker! Good oral health is an important part of people's well-being and health. Poor oral health can not only be perceived as stigmatizing but also lead to serious follow-up diseases. Thanks to free dental care for children and young people and the dental care insurance, oral health has become much better compared to previous generations.

At the same time as oral health at the population level continues to improve, differences in oral health between different socioeconomic groups persist. The frequency of visits differs greatly between different groups in the population. Persons with a high level of education and those with a high income visit dental care more often than persons with a lower level of education and low income. Quite recently, two new agency reports have been released showing rather serious deficiencies in the information on prices to patients, which can also contribute.

There is a shortage of dentists and dental hygienists. In 2022, 17 and 19 regions respectively reported that they had such a shortage. There are still large regional differences. Dental care has recruitment problems that manifest throughout the country, but especially in the northern parts of Sweden. The government is happy to refer to the National Health Competence Council when they are asked about the competence supply in dental care, but what I can see is that the council has not received any specific government mandate to work on this issue. One such might be needed.

We Social Democrats believe that the investigation commissioned by our previous government, which presented its very detailed proposal in 2021, should be a basis for developing a new high-cost protection. But the government and SD want instead to commission a new investigation to review the dental care's high-cost protection, according to the Tidö Agreement. We believe that it is unnecessary and that the government should take the work further based on the already submitted proposal and the referral responses.

Mr. Speaker! There are also different statements from the Sweden Democrats and the government regarding the introduction of a new high-cost protection. In the Tidö Agreement, as I have mentioned, there is only one point about a new investigation. But during the spring, representatives for the Sweden Democrats have stated in the media that the introduction of the high-cost protection has already been negotiated and that it will be introduced by 99 percent during the mandate period. The same was said here in the speaker's chair by the Sweden Democrats' representative. If the government and the Sweden Democrats agree on it, why is it then not in the Tidö Agreement? It becomes very unclear what actually applies. If it were to be the case that an introduction will become relevant during the mandate period, the question also arises as to why a new investigation should be appointed when there is already a very detailed investigation. It looks as if the purpose of the new investigation is to bury the issue.

Against the background of the public health policy goal to close the addressable health gaps within a generation, it is also important to include dental health in the work. An important way to increase accessibility to good dental care for everyone and thereby contribute to improved dental health in the population is to lower the economic thresholds to dental care. That was why the previous government commissioned the dental care inquiry, whose proposals are submitted, ready to be used.

Medicines and dental care

We stand behind all our reservations but move for approval only to reservation 20.

(Applause)

The deliberation was hereby concluded.

(A decision was to be taken on 21 June.)

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