Next steps for good and close care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 KD believes that a stronger primary care with a fixed point of contact increases security and creates an efficient care chain 1. KD argues that medical competence is strengthened through requirements for medically responsible 1 and that primary care should meet both physical and mental needs 1. KD wants to scrap the 21 self-governing regions so that the state takes full responsibility 2 and argues that the regions must take their responsibility 3. KD wants to reach the goal of 1,100 listed patients per doctor 4 and advocates for a fixed doctor for everyone 5. KD proposes state control of ST-places 5. 6 C wants patients to experience a fixed doctor contact 6.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Christian Carlsson (KD)
Madam Speaker! The core of today's bill – Next steps for a good and close care – is a stronger primary care and a fixed point of contact. A well-functioning primary care with good continuity not only increases the security for the patient in the encounter with care but also creates the conditions for an efficient care chain and healthcare of the highest quality. Therefore, it is so important that the work with the transition to a good and close care continues and that the pace is increased both nationally and out in the regions.
The government's proposal that we have to take a position on today involves, among other things, that the term home healthcare is removed and, in applicable cases, replaced with the term health and medical care at home. It is clarified that regions and municipalities shall cooperate with each other in the planning and development of health and medical care.
I would like to highlight some proposals in particular. A first important matter that we are discussing today is that the medical competence within the municipal health and medical care is now being strengthened. This is being done by introducing requirements in the Health and Medical Care Act that there shall be a medically responsible person for rehabilitation in the municipalities who shall be a physiotherapist or an occupational therapist.
The regions shall also, if necessary, be able to offer a medical assessment by doctors and nurses regardless of the time of day, even within municipal health and medical care. This means important improvements for all patients cared for at home and for all elderly people in special housing.
Another important point is that we now clarify for the record that the primary care's mandate is to meet both physical and mental healthcare needs. We all know that mental ill-health accounts for a large portion of healthcare contacts. The queues to child and adolescent psychiatry tripled during the Socialdemokraternas period in government, and they are still far too long. But far too few regions prioritize psychiatric or psychological competence within primary care. Many do not even have this in their request documents.
The lack of psychological and psychiatric competence in primary care means that far too few people think that one should actually turn to the health center in the first instance, and not to BUP or specialist psychiatry, if one or someone in the family needs to seek care due to their mental health.
This is no longer working. The government has therefore invested more than any other government in psychiatry. For several years, we from the state side have tried to strengthen primary care and first-line work regarding mental health. The psychological and psychiatric competence at the country's health centers needs to be strengthened, and therefore we are now clarifying primary care's mandate in the Health and Medical Services Act.
A third important point is that today's bill means that a fixed point of contact shall also be made the norm within municipal health and medical care. A fixed point of contact means that the patient is given a named person within the care who is responsible for coordinating and following up on the patient's needs.
When a person avoids having to repeatedly repeat their medical history to new people, the risk of misunderstandings and errors is naturally reduced, and the patient receives care that is better connected over time. For older people and patients with chronic diseases, this is of course extra important.
A fixed care contact can then help to hold together interventions between primary care, municipal care, and specialist care, which reduces the risk of people falling between the cracks. Care becomes safer, more cohesive, and easier to navigate while continuity is strengthened.
In conclusion, I want to mention that we are now strengthening the information requirement so that you as a patient will be able to receive information in a better way about who is your fixed care contact and fixed doctor contact.
The issue of a fixed doctor is important for us Christian Democrats. A well-functioning and strengthened primary care with good continuity is the basis for an effective healthcare system. Continuity is particularly important for people with complex care needs. But even for all of us others, preventive measures can be facilitated and care improved by the patient having the opportunity to repeatedly meet the same doctor in primary care.
Having a fixed and named doctor means that the patient receives care from a person who is familiar with the medical history and can offer more personal and effective care over time. It strengthens the relationship between the patient and the doctor but also contributes to better care results and provides earlier detection and a better opportunity to manage health problems.
Good continuity leads to a reduced need for acute care, a reduced need for care outside of working hours, and reduced mortality. Extensive studies show this. The Christian Democrats' ambition is therefore a fixed doctor for everyone – a named doctor, a specialist or aspiring specialist in general medicine, whom the patient themselves know.
We are also working for listing caps for the number of patients at an individual health center as well as for the individual district doctor. It would provide a better working environment for both district doctors and district nurses who work hard within primary care. But above all, it creates the continuity and knowledge of the patient that provides the conditions for both safety for the patient and care of the highest quality.
Our goal is that all citizens should be listed with a fixed and named doctor who is responsible for the patient. But only three out of ten perceive today that they have a fixed doctor. Despite the government's billion-kronor investments to the regions to strengthen primary care, the proportion who experience having a fixed doctor to turn to is not increasing.
The regions themselves claim that significantly more people have been assigned a fixed doctor. But it is not worth much if the patients themselves do not know about it. Therefore, we are now tightening the information requirements. One can imagine information via 1177 or through information leaflets to all households. More patients shall be given the right to a fixed doctor, and more patients shall know who is their fixed doctor and whom they should turn to when they seek care.
Today we take the next step for good and close care. We Christian Democrats look forward to taking many more steps to strengthen primary care moving forward.
Karin Rågsjö (V)
Madam Speaker! Thank you, Member Christian Carlsson!
We all stand behind the reform of primary care. The problem is the speed of the reform itself.
Thus Vårdanalys, which observes more and wonders what is happening, says: ”After several years of investment, none of the government's goals for the transition to good and close care have been achieved so far. The government, the regions and the municipalities need to make a new effort to ensure coordinated governance.”
Vårdanalys also says: "We assess that the failure to achieve the goals is largely due to the fact that the operations have not received improved financial or personnel resources, which are required to implement the changes."
The chairman Christian Carlsson and KD as usual place the entire responsibility on the regions, which have had very tough times behind them. That can be said, despite any investments. According to current forecasts, there will be a shortage of 18 billion kronor in 2027 in regions and municipalities and 34 billion in 2028.
One wonders a bit about the goal fulfillment and why you in the Christian Democrats, who nevertheless own the issue, have not tried to find a way forward that is clearer for those who work within health and medical care and those who want the family doctor, something that feels very far away.
To place the entire responsibility on the regions in every debate is starting to feel a bit peculiar. The hard times have resulted in the regions being blamed in various ways.
Christian Carlsson (KD)
Madam Speaker! The state naturally has a responsibility for the transition, and the regions also have a responsibility for it. Regarding the state's contribution to the transition to good and close care, the government has injected 35 billion since 2019 to strengthen the transition and primary care.
The problem is only that when we have made the agreements with Sveriges Kommuner och Regioner, they have not been able to act in such a way that the money has reached primary care. One cannot see from the regions' way of budgeting that the share for primary care has increased.
Now the government has grown tired of trying to govern via SKR because it is a dysfunctional and inefficient governance. We have therefore said that we need to condition the grants and instead cooperate with the regions directly to achieve results and ensure that the money actually reaches its destination.
We have 21 self-governing regions, and that means we have a very fragmented healthcare system in Sweden. The state does not have the power to govern that we would need to have. That is a reason why the Christian Democrats want to scrap today's 21 self-governing regions and let the state take over the full responsibility. I know that the Christian Democrats are one of the few parties that have landed on that position, so all the more important it is that people vote for us in the next election so that we can push this through.
There are, however, some things we agree on, for example that we could have more common replacement systems at the state level. Then we would come very far, because then we could also reward continuity and staffing. We could find a good balance between steering availability and continuity in our replacement systems, and then we could encourage regions to strengthen primary care.
Karin Rågsjö (V)
Madam Speaker and members of the House! We also submitted other proposals from the Care Responsibility Committee, including those regarding competence development and how we should act to ensure that there are more general practitioners, for example. I do not know where you have placed that investigation. You may have lost it – what do I know?
You have had nearly four years now. Why haven't you tried to find ways forward with a real national transition plan where one can follow how it is going and how it is not going? Now Vårdanalys has the responsibility to follow up on this, and when they visit the Social Affairs Committee, it is not exactly like we jump and shout: Oh, how well it is going! It is rather that it is not going well. This is not going well.
When it comes to these four years, one cannot simply blame the regions. It has been an extreme economic crisis, and since the state grants are not index-linked, the regions have had to pay a huge amount for pensions and so on. We live in a country where we have very many elderly people, and they are becoming more and more. It also costs. Demography costs, and the expensive medicines cost.
I am impatiently waiting for you to take a stronger grip on primary care in a way that results in a long-term plan and makes it clear what is going to happen. Otherwise, the next government – which hopefully will be a different one – will also have to start in a situation where there are no permanent doctors. It has not gone so well.
I think it is a dangerous path to take to place all the responsibility on the regions and take very little responsibility yourselves. You could have done quite a bit more in this issue during the nearly four years that have passed. This must be seen as a failure for KD, which nevertheless owns the healthcare in Sweden right now.
Christian Carlsson (KD)
Madam Speaker! When we had a red-green government in Sweden, there was no unified national plan for the supply of skills. There was no common needs analysis and no roadmap to address the skills shortage we have. Now we have that, thanks to this government.
The Care Responsibility Committee has thus stated that the state should take greater responsibility for the supply of competence, and that is absolutely excellent. It is something that we will want to move forward with. From the Kristdemokraterna side, we want the state, based on the collective needs, to be able to point with the whole hand and tell the regions how many ST positions in, for example, general medicine they should deliver. But since we have 21 self-governing regions, the state has not had that possibility so far.
The state must, of course, take responsibility. I think 35 billion is a lot of money, and almost none of it has gone towards an increased share of budgeting in the regions' budgets for primary care. It is a scandal that we have such inefficient governance.
The state does what it can, but the regions must take their responsibility. We are now starting to work more directly towards the regions, and that is good. But it also requires that every region is prepared to take its responsibility. The region we ourselves belong to, Region Stockholm, where the red-greens are in power, is absolutely no model. Here, it is not 25 percent of the budget that goes to primary care; it is not even 20 percent. The regions where Vänsterpartiet is involved in governing also need to take responsibility for strengthening primary care in the country.
Christofer Bergenblock (C)
Madam Speaker! Thank you, Member Christian Carlsson, for the speech!
I share much of what the member said, and it is good that we are now taking another step on the way towards good and close care, which is a task that has been ongoing for many years.
I also share the view of how important it is to have a fixed doctor contact. It is one of the foundations for us to be able to have the good, close, continuous, and secure care with the patient at the center. That is why it is so remarkable that one has not come further regarding a fixed doctor contact. Just as the member said, it is only three out of ten in Sweden who experience having a fixed doctor contact, and that is, of course, a completely unacceptable situation.
It becomes even worse when one looks at our sparsely populated areas and rural regions, because there, only two out of ten state that they consider themselves to have a permanent doctor contact. This is because sufficient measures targeted at sparsely populated areas and rural regions in Sweden have not been made, and no change has occurred during the mandate period either. Even when Kristdemokraterna have sat with the responsibility and held the position of Minister for Health and Care, no changes have occurred nonetheless.
At its core, it is about the availability of competence in our sparsely populated and rural areas so that there can also be a continuity among the doctors there. The Centre Party has presented a number of proposals on how we could make it better and more attractive to fill in at the health centers in the countryside or, for all we care, between the existing health centers, which we have also proposed.
My question to the member is: What is the Christian Democrats' and the government's prescription for addressing this inequality, which we see in Sweden today?
Christian Carlsson (KD)
Madam Speaker! It is pleasing to hear that there is a great consensus in the ambition and that we need to do more moving forward.
When it comes to the ambition for how many general practitioners per inhabitant there should be, there is a target value from Socialstyrelsen, where they aim for 1,100 listed patients per doctor. It is quite interesting. It is because only one region manages to live up to this at the moment. It is Region Jämtland Härjedalen, which has a fair amount of countryside and rural areas, which the member chose to mention.
I believe that what is important is that one dares to map out an ambitious course forward and dares to say that there should be a fixed doctor for everyone and that there are listing caps at the health centers.
It is possible that 1,500 could be a first step in some places. One could make use of vacant lists where one initially brings in locum doctors to manage this, and one might also need to take help from other specialist doctors at the beginning to ensure that everyone has a permanent doctor. Then you will still get started with this in earnest and can begin working towards the goal of 1,100.
To meet the demand for competence, we need to train more ST-doctors in general medicine. Such a state initiative is needed. We need a state steering that means the state gets to specify how many ST-places each region shall provide. A proposal that the Kristdemokraterna are driving is also that one, as a specialist doctor, should be able to train to become a general practitioner and retain their specialist salary.
These are some examples, but we need to do very much to be able to reach our goal in this area.
Christofer Bergenblock (C)
Madam Speaker! I share the ambition of 1,100 listed patients per doctor, but the most important thing is that the patients experience having a fixed doctor contact, that is to say, the opposite relationship. A prerequisite for this is, of course, that the doctors do not have far too many listed patients.
I am becoming a bit worried when the member speaks about bringing in more locum doctors to solve this form of staffing problems. It is clear that we need structures that make it so that people actually seek out positions even in our sparsely populated areas and rural regions.
From the Center Party's side, we have highlighted a number of proposals, including covering the gap with more doctor-led small healthcare units alongside the health centers. This could also serve as an incentive for doctors to build up their own practices and make them more accessible for the patients.
We have also highlighted the need for economic incentives. This could, for example, involve writing off student debts. One can also make use of relocation grants for services in the more sparsely populated parts of the country.
I believe that the member and I agree that the education needs to reach out in a different way, not least with basic service and specialization service throughout the country as well as the possibility for internships. A greater national responsibility was needed in precisely that area.
It does, however, become a bit contradictory when we simultaneously stand in a situation where the government is pursuing a deportation policy that means sought-after healthcare personnel in Sweden are forced to leave their positions and doctors say that Sweden is no longer as attractive to move to; the latter was stated as recently as yesterday in DN Debatt.
There is a homework for the government to do when it comes to the competence supply in our sparse and rural areas.
Christian Carlsson (KD)
Madam Speaker! Let me be clear: Our ambition is, of course, that there should be 1,100 patients per general practitioner. Nothing else is our ultimate goal. At the same time, one must be realistic and see that there may need to be certain transitional solutions. I believe it is better to have certain transitional solutions and move forward with these ambitions than to let the difficulties cause everything to come to a standstill. That is why I mentioned locum doctors as a temporary transitional solution. It is not only the Kristdemokraterna who have considered this, but for example, the Distriktsläkarföreningen also advocates for that model.
Just as the member said, it is very important that the educational places are distributed in a smart way across the country so that the probability of choosing to stay and work in the region increases.
In conclusion, I would like to agree with something the member said. It is not sufficient for the regions to say themselves that six out of ten patients, or whatever it may be, have a primary doctor if the patients themselves experience that it is only three out of ten who have a primary doctor. We believe that a national listing system would be needed to make people aware of this. Today's decision is about tightening the information requirements on the regions – they must tell people who is their primary doctor. This is a way to increase people's knowledge of who is their primary doctor, but it also puts pressure on the regions. If everyone knows who is their primary doctor, expectations are created. In that case, it is a matter of organizing healthcare so that we move forward in the issue of primary doctors.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.