Priorities in health and medical care

Christian Carlsson (KD)

Madam Speaker! The Christian Democrats' priorities for Swedish healthcare are to focus on shortening the long care queues, which grew to record lengths during the last parliamentary term, on securing more care beds, and on improving the conditions for the staff. We also focus on increasing state governance so that those who are ill can be offered good care regardless of where in the country they live. We simply want to create the conditions for a more equal and just Swedish healthcare.

This is our main focus for our healthcare policy and our priorities.

When it comes to priorities within health and medical care, the Riksdag has supported guidelines based on three fundamental principles: the human dignity principle, the need and solidarity principle, and the cost-effectiveness principle. Assessing which diseases should lead to specific investments or how the care of patients with certain diseases should best be organized is often best decided within the healthcare sector based on these very principles.

Let me nevertheless mention a few more priorities from the government's side that are being addressed here today.

The first one concerns maternity care. Many women have felt an anxiety about how the childbirth will be due to the deficiencies that, not least the midwives, have sounded the alarm about and testified to. The bourgeois government has now, with the Christian Democrats' Minister for Health Acko Ankarberg at the helm, decided on an intensified and extended investment in maternity care and women's health with 4.7 billion kronor this year and the coming two years.

National guidelines were needed to prevent birth injuries and promote competence development among staff, and it is good that Socialstyrelsen has now been commissioned by the government to develop a national birth plan to improve care, increase accessibility, and reduce regional differences.

In addition to this, the government has entered into an agreement with Sveriges Kommuner och Regioner that the regions shall now introduce a coordinated care chain during pregnancy. There shall be good staff continuity. We simply need to reinforce the staffing together so that as many women as possible get access to a delivery team throughout the entire care chain. Then more women can feel security during their pregnancy and at the time of delivery.

The agreement also includes that all women shall be offered follow-up visits. Such a follow-up visit may take place in the home if the woman so wishes. Above all, fast tracks to care are needed for those women who, after childbirth, suffer from either physical or mental problems.

Another priority for the government that I would like to say something about is cancer care and the specific initiatives the government is making to combat cancer. The existing cancer strategy was developed when the Christian Democrats last held the position of Minister for Social Affairs, in 2009. We can state that it has been successful. Very large progress has been made throughout almost the entire disease progression since then. We can also state that the incidence of cancer in Sweden is lower than the European average. We have one of the lowest proportions of the population who die as a result of cancer in the EU. But the work to defeat cancer must, naturally, continue to be highly prioritized. Much remains to be done despite good results.

It is a matter of the accessibility to care needing to increase. There are still large differences regarding opportunities for cancer screening. The probability for early detection of serious cancer diagnoses simply varies far too much depending on where in the country you live.

Now it is time to update the cancer strategy so that Sweden continues to be at the forefront regarding cancer care and that we are competitive in that regard. Therefore, the government has taken an initiative this spring to invite to a hearing. They invited the healthcare profession, civil society, authorities, and patient representatives to a hearing on how this new updated cancer strategy should be designed. My hope is that we will continue to build on the successful strategy we have had, but not least, I also hope that the preventive and rehabilitative work can be given a larger place in the new strategy.

Madam Speaker! In conclusion: During the previous parliamentary term, the Riksdag issued a notification to the government regarding the need for a specific national strategy and specific funding concerning medicines for rare diseases and diagnoses.

The government has since tasked the Dental and Pharmaceutical Benefits Agency, TLV, to analyze and propose how access to medicines for the treatment of rare diseases can be strengthened. This is very good.

The committee has however noted that there is a lack of an overall, national action and coordination plan for rare diseases in Sweden. A unified approach to the care of persons with rare diseases is required, and therefore the committee proposes that the Riksdag issue a motion to the government that it should develop a national action and coordination plan for rare diseases.

With that, I move for approval of the committee's proposal in the report.

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Karin Rågsjö (V)

Madam Speaker! Member Christian Carlsson brings up all the initiatives you have undertaken. They are commendable. It is not possible to say "Well, that was foolish" regarding them.

I have, however, been out and spoken very much with the regions during the recent period, and they do not sense your priorities. Rather, it feels as if the entire healthcare system is shaking. They have huge problems. This applies, for example, to maternity care, where 21 regions will have problems hiring midwives.

This is very much about state grants. You have allocated far too little for state grants in your budget. There were also no supplements in the spring budget. The regions would very much like to have some kind of notification now so that they can have a different planning forward than just cuts.

I am very worried about healthcare. Even though you have made various investments in the regions and said what should and should not be done, commissioned inquiries and so on, it does not land so well if one cannot take care of it in the regions. We have a maternity care where midwives can be laid off and where midwives, for example, have to work nights for an entire week. That is something to reflect on.

Then one can say: This is the regions' responsibility. For eight years you said that all of this was Lena Hallengrens and the Social Democrats' fault. Now that you are in a position of power, it is instead the regions' responsibility. It might have something to do with the fact that very many regions are ruled by the red-greens, what do I know. But how does the member view the conditions for, for example, there being more care beds and better maternity care with so little cash in the chest?

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Christian Carlsson (KD)

Madam Speaker! I share Member Rågsjö's concern regarding the situation that Swedish healthcare has been left in. After eight years of red-green led governments, we in Sweden have set records in healthcare queues, and we also have the lowest number of healthcare beds per capita. That is what we have inherited, so to speak. That is the reality that the red-greens have left the healthcare staff with.

Now Sweden faces tough economic times, but this government still chooses to prioritize welfare. We are allocating 12 billion to municipalities and regions. A third of the government's total reform space we are allocating to strengthening welfare.

Of course, money does not solve everything. But this government is also taking several other important initiatives. We have talked about the care beds, and the government has a special initiative so that the regions can achieve more care beds. We are investing 2 billion kronor, which will last over time, precisely so that the regions, based on their own circumstances, can improve the conditions for the staff or take other measures that allow more care beds to be achieved.

We have also commissioned a mission to develop a national plan for skills supply. We know that in order to get more healthcare beds, staff are needed. More people must want to stay within healthcare.

This government is proactive. This government is taking the long-term important initiatives so that we can get Swedish healthcare in order. One wishes that the work could go faster, but it is underway and it is making a difference.

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Karin Rågsjö (V)

Madam Speaker! You took office after a pandemic when healthcare had been on its knees for two years. At that time, there had been a very large flow of funds to healthcare - naturally during a pandemic. The problem now is that the signals we hear are that healthcare is instead retreating. When 21 regions today say that they will have major problems with the maternity wards during the summer, I think it would have been very good if the regions had had a secure floor to stand on. One can order investigations and drip-feed money into specific areas, but what is required is a substantial pot for the state grants.

What is being said from the regions - but also from the municipalities, as we discussed in the previous debate - is that there is a great deal of concern in the ranks. If we are to stay within the economic frameworks, the care beds will not increase and the maternity care will not function.

You had the opportunity. There is often talk about it being inflation now, and it is indeed an inflation that the ordinary person has to live under - eat oatmeal, what do I know. But what does the National Institute of Economic Research say? "Small inflation effect of public investments" - hm. You perhaps should have had some more state subsidies out to the regions. That would have meant a lot.

I believe that we will be left with a healthcare crisis. You can say that you have inherited it, but if one takes office, one must try to do the best possible. One can choose to lower taxes or to give more state subsidies to healthcare. As politicians, one has choices, and the choice for you was unfortunately to give too little money to healthcare - absolutely!

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Christian Carlsson (KD)

Madam Speaker! It is true, as Karin Rågsjö says, that the bourgeois government took office after the pandemic. The truth, however, is that the healthcare queues were record-long even before the pandemic.

Karin Rågsjö believes that a healthcare crisis will occur. I believe that many in the staff experience that they are standing in the middle of it. It is a fact. That is why it has been important for the government to inject resources, such as the 12 billion to municipalities and regions that I spoke about, but also the 3 billion to shorten waiting times and the 2 billion to produce more healthcare places. These are, of course, initiatives that make a difference.

Let me take some examples from maternity care, where there are major problems and where we need to do more. We are now developing a national maternity plan. My and the Christian Democrats' ambition is that we should have national goals for maternity care, but the national maternity plan is about improving care, increasing accessibility, and reducing regional differences. It is clear that that type of initiative will make a difference.

When we enter into agreements with Sveriges Kommuner och Regioner and set requirements that they must ensure they offer follow-up visits for the women and work for increased staffing, it is clear that it is for real. It also makes a difference for all midwives working in healthcare and all women who today feel anxiety regarding their childbirth. We create the conditions for more women to be able to experience a safe childbirth.

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Ulrika Westerlund (MP)

Madam Speaker! The report we are debating today is very broad. Now I intend to change the subject and take you ten years back in time. Exactly ten years ago yesterday, I sat in the gallery when the Riksdag decided to remove forced sterilizations from the legal text, i.e., the requirement for sterilization for those who wish to change legal gender. The judiciary had managed to get ahead of politics through a judgment in the Court of Appeal in December 2012.

I was active in the LGBTQ+ movement, and we had thought very much about whether we should have pushed more for a larger review of the entire law directly. In the end, however, we decided not to take the chance but to focus on getting the grossest human rights violation out of the law first. It was lucky, because I don't think we could have imagined that we would be continuing and debating the same law – a debate that is quite similar to the previous one but almost even worse – now ten years later.

My question, therefore, concerns the gender identity law. It was on the previous government's table, and it is on this government's table. We were promised a bill in February. We have still not seen it.

It is obvious that there are very different views within the government. My question to Christian Carlsson is simply what Christian Carlsson's view is. Should the gender identity law be changed, and should the change of legal gender be based on self-identification?

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Christian Carlsson (KD)

Madam Speaker! First and foremost, I want to say that I feel great humility towards the situation that many young people with gender dysphoria find themselves in and the suffering that many experience. The waiting times to receive support and treatment are, after all, long, as it stands now. My focus is that we should be able to offer those individuals the best possible support. We need to do what we can so that support can be given faster.

As the member knows, there is a preparatory process ongoing in the government right now. It has taken longer than expected. But the questions are complex. For example, the National Board of Health and Welfare issued new guidelines in December 2022 on how care should be provided in these situations. I therefore do not want to anticipate the discussions that are ongoing.

It is important that we do not have legislation that directs people to begin an irreversible treatment or to undergo physical interventions in order to have their gender identity confirmed. But more work is required before I can take a position on how these specific bills should be handled further.

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Ulrika Westerlund (MP)

Madam Speaker! I thank you for the answer.

Waiting times in healthcare could be shortened if this legislative change were implemented. The point of the legislative change, as it appeared in the draft for the Council on Legislation referral that the Green Party and the Social Democrats stood behind, was namely that medicine and law should be completely separated from each other.

In the current situation, doctors who are engaged in very urgent care are spending time on matters that have nothing to do with healthcare, in order to satisfy assessments that are subsequently to be made in Socialstyrelsen's legal council regarding the change of legal gender. It therefore has nothing to do with any medical treatments. It is important to remember this in this discussion.

I note a commitment from Christian Carlsson. But it also reflects a bit of the confusion that has often been in the debate when one mixes up the law and medicine. I think it is an unfortunate consequence of the fact that the legislation, which is 51 years old, as old as I am, reflects the thinking of that time. Medical procedures were mixed up, for example, forced sterilization for those who wanted to change legal gender, even though changing legal gender has nothing to do with medical treatment.

I fully agree that no one should be forced into a thought. One should not have to receive medical care, undergo treatments, or undergo procedures, whether they are irreversible or not. That is not what this is about. This is about changing the rules for what shall apply for the change of legal gender.

Then the care shall be provided in the best possible way, according to science, proven experience, and so on. I am pleased that the decision from Socialstyrelsen to make the care national highly specialized care has materialized now. A lot has happened there.

But now we are discussing the legislation itself, which concerns the change of legal gender and the importance of separating it from medicine. I wonder how Member Carlsson views it.

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Christian Carlsson (KD)

Madam Speaker! For me, it is important that people who suffer from gender dysphoria can receive support and treatment faster than they do today.

There are also many difficulties with such legislation. It concerns many different parts. Since the government has not finished elaborating on the issue yet, I am not prepared to take a position on just this specific bill.

It is clear that it is positive if we can ensure that we do not open up for legal uncertainty or arbitrariness in those situations and if we can simultaneously speed up and make it easier for people to receive their treatment. But we must ensure that we have legislation that is precisely legally secure. We simply have to return to the question.

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Yasmine Bladelius (S)

Madam Speaker! The report we are now debating in the chamber is titled Priorities in Health and Medical Care. I noted that Member Carlsson, in his speech, spoke warmly about the government's priorities. One can, of course, have different views on which priorities are correct when it comes to a healthcare system that faces enormous challenges and which, I would say, awaits a crisis ahead if more is not done.

I want to ask Member Carlsson about the priorities the government is making that he did not raise from the rostrum. I am talking, among other things, about how the government, with 12 billion Swedish kronor, prioritizes high-income earners but gives only 6 billion kronor to Sweden's municipalities and regions, which are facing a financial crisis.

I also want to ask Member Carlsson about the government's priorities regarding the fact that healthcare staff should spend their working time reporting undocumented persons seeking care. The staff should also try to resolve the situation with the interpretation services, which are incredibly important in order to receive good care when seeking health and medical care.

Madam Speaker! It is quite obvious that Member Carlsson and I have different views on which priorities are correct regarding Swedish health and medical care. But I would very much like to know how the government parties intend to act when they prioritize high-income earners and complicate an already tough working situation for healthcare employees.

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Christian Carlsson (KD)

Madam Speaker! It is clear that the economic situation in which Sweden finds itself is felt by society's activities, the state's activities, and healthcare. It is also felt by households.

It is possible to use rhetoric to portray us as wanting to favor a certain social group. But the fact is that with the Social Democrats' budget alternative, 1 million Swedes would have been taxed more, in a situation where many wonder how they will manage their daily lives. I do not think it is a policy to boast about, wanting to take more of people's money. I think, on the contrary, it is good when people get to keep more of their wages. It creates the conditions for stronger families.

The investments in welfare are important for us. That is why we have allocated a third of the reform space to injecting resources into municipalities and regions. It is simply something we are prepared to continue doing. But our resources are not unlimited. We cannot promise everything to everyone. But we inject resources that make a difference.

Above all, we are trying to address the fundamental problems within Swedish healthcare. More money is obviously not enough in the broken healthcare system we have. We want more state control. A more efficient Swedish healthcare is needed. Therefore, the government needs to take the initiatives it is now taking regarding an investigation of state ownership, wholly or partially, and a national competence supply plan.

One might think that national competence supply plans feel like self-evident matters. But the fact is that the regions do not always have full control over what personnel composition they have. The state must therefore step in. We must address the structural problems within Swedish healthcare.

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Yasmine Bladelius (S)

Madam Speaker! Thank you, Member Carlsson, for the answer! It is clear that when one has no good answers to give, one would rather give a false picture - and that is what I think Member Carlsson does, especially when he says that 1 million Swedes would have received higher taxes and that very many Swedes would have received a worse economic situation if the Social Democrats had been allowed to decide. It is a false picture.

We Social Democrats have presented countless proposals in our budget alternative on how Swedish families with children, the elderly, and single-person households should manage the economic situation. We were also very clear in our budget alternative that we do not intend to spend twice as much on lowering taxes for people who already have large wallets instead of investing where it actually makes a difference, that is, on general state grants to Sweden's municipalities and regions which already today – and for many, many months – are very clear about facing extremely tough economic challenges and will be forced to make cuts and lay off staff when Swedish health and medical care is already in a chaotic situation.

Naturally, politics must step in and take responsibility here. It is primarily about ensuring, in the acute situation, that Sweden's municipalities and regions have the bag of money they need to curb the problems that exist. I therefore do not think it is a completely true picture that Member Carlsson paints. It is also quite obvious that we have different views on which priorities will solve the incredibly tough challenges within Swedish health and medical care.

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Christian Carlsson (KD)

Madam Speaker! It has been known since earlier that Social Democrats and Christian Democrats have different views on taxes. My firm conviction is that high taxes do not make people richer but actually poorer, but the discussion will surely continue. I wish that when we have sorted out the economic situation, we end up in a situation where we have the opportunity to lower taxes even further for ordinary people who work and that we can also invest even more money in healthcare. That was something we succeeded with during the Alliance years when Sweden last had a bourgeois government.

It is the case that if taxes are lowered and more people work, it contributes to increased tax revenues. Then, of course, it is a matter of priorities, but for the Christian Democrats, healthcare always comes first. We will continue to invest in healthcare and also ensure that conditions are created for strong and secure families, because welfare is knowing that care is there in time when it is needed. But welfare is also knowing that one can live on one's salary, support one's family, build up one's own savings, and plan for the future with those one loves.

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Yasmine Bladelius (S)

Madam Speaker! Today we are again debating issues within the field of health and medical care, and even though there will be many debates on the subject and some would probably have preferred an outdoor lunch in the sun this hour, I am glad that these important issues take up much time in this chamber, because when Swedish health and medical care now faces enormous challenges, we politicians must take our responsibility to find the solutions to the problems.

Today's debate is based on a so-called motion report, Prioritizing within health and medical care, from last year's general motion period. The report contains 160 different requests from members of the Riksdag concerning maternity care, cancer care, issues regarding abortion, blood donation, gender identity and much more.

Madam Speaker! How one chooses to prioritize within Swedish health and medical care naturally plays a major role. It is about how one chooses to prioritize purely economically – do you invest in general state grants to municipalities and regions that provide health and medical care and are facing extremely tough economic situations, or do you prefer to invest in large tax cuts for high-income earners? It can be about priorities regarding new products or prioritizing new investigations in the field, or for that matter, prioritizing placing already investigated proposals on the Riksdag's table.

It is also about prioritizing the healthcare staff – the fantastic doctors, nursing assistants, and nurses who work within the health and medical care – who are going to their knees so that we can receive good care in a timely manner. Will they get more colleagues and better working conditions, or will more of the country's hospitals be forced to make cuts? It is also about daring to prioritize following the portal paragraph in the Health and Medical Care Act and ensuring that care is provided based on need and not first to the one with the largest wallet.

Madam Speaker! It is quite obvious that the Swedish health and medical care needs to be prioritized. It needs to be strengthened. It needs a larger suit. Those who work in healthcare need more colleagues and better working conditions. The number of care beds needs to increase. And for that very reason, we need to prioritize healthcare and its staff.

As clearly as it is for me that these priorities must be made, it is that the government does not make the same assessment. Nor in my home region Skåne, which is governed by the Moderaterna, Kristdemokraterna, Liberalerna, and Sverigedemokraterna, is the healthcare staff and their tough working situation prioritized. Nor are more healthcare places or shorter queues prioritized there. Instead, it turns out that the cuts at the Skåne hospitals just continue, even though healthcare in Skåne has long suffered from long waiting times, patients lying in the corridors, and hospital staff fleeing because the working situation is so bad.

Even worse is the development within cancer care, where the care queues have not only become entrenched but also continue to increase. It is not only in Skåne that it looks like this, Madam Speaker. Sweden stands out - not positively, but negatively - compared to the neighboring countries Norway and Denmark when it comes to the queues for cancer care. As an example, the wait for radiation treatment for prostate cancer is 120 days in Sweden, while it is just under 60 days in Norway and Denmark. Naturally, we cannot have that. It is a matter of priorities.

The Social Democrats have for many decades prioritized, for example, precisely cancer care. Through the structured and long-term support for the development of both regional cancer centers and standardized care pathways, great and important progress has been made, not least to shorten the time between suspicion of cancer and the start of treatment. That patients receive treatment quickly and that more receive the best possible care plays a major role for survival. This we know.

Even though it is of course positive that survival rates for several types of cancer have increased, the focus now needs to be placed on shortening waiting times across the entire country. We Social Democrats therefore believe that the government should review the issue of cancer care. We think it is extremely important to let ongoing investments continue but also to take new initiatives within that framework. We also believe that it is time for the government to take further measures to reduce the risk of more people being affected by cervical cancer. It is time to prioritize the Swedish health and medical care, its staff, and patients.

Mr. Speaker! I want to conclude with a question that I know is important for many and which is also touched upon in motions in this report, namely the gender identity law. We Social Democrats, while in government, put forward a proposal that has support in this chamber and which could be laid before the Riksdag today – but despite that, there is no sign of any government bill. We find that very regrettable, and we believe that the government should rather return with a bill on a new and modernized gender identity law.

With this, Mr. Speaker, I would like to move for approval of reservation number 26.

(Applause)

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Thomas Ragnarsson (M)

Mr. Speaker! Today we are debating the Social Affairs Committee's report SoU13 Priorities in health and medical care, and I would like to begin by moving for the approval of the committee's proposed decision.

Mr. Speaker! The Moderates have successfully championed the issues regarding Swedish cancer care for a long time, and we can state that the work has been fruitful. Today we have cancer care of the highest class. But developments within the field are moving at a rapid pace, and therefore one cannot lean back. Developments within gene therapy and precision medicine are now lifting treatment possibilities to entirely new levels, which means that we must continue the investment in Swedish cancer care. Unfortunately, the issue of accessibility also spills over into this area, and that is obviously not acceptable.

Mr. Speaker! An area that is unfortunately neglected is the rehabilitation and aftercare for patients who have been affected by cancer, and it is something that the Tidö parties have taken hold of and agreed to make investments in. There are good examples of how a rehabilitation chain can be built, and within Swedish cardiac care, significant progress has been made in this area. This should be able to serve as a basis for how we should organize rehabilitation and aftercare for those who have been affected by cancer.

Mr. Speaker! The National Board of Health and Welfare has developed national treatment guidelines to support the principals when they prioritize forms of treatment. The guidelines include recommendations, indicators, target levels, and evaluation. Recommendations have also been developed regarding national screening programs. It is then up to the principals to decide on them and when such a program should be introduced. This is obviously a problem, and here is a clear example of when the state governance must become better.

Previous investments in, for example, HPV vaccination are now bearing fruit, and cervical cancer is a form of cancer that could be eradicated in the near future, which is absolutely fantastic.

We have today standard care pathways that are to guide care and treatment for a large number of cancer diagnoses. The pathways are scientifically developed to give the patient the greatest possible chance of recovery. But even here we see that in many areas the time targets are not met, and it is another such matter where state governance and follow-up is very important.

Mr. Speaker! Swedish maternity care has for many years been surrounded by competence supply problems, accessibility issues, and mothers who have witnessed maternity care that, in some places at certain times, has not been particularly pleasant to be in.

When it comes to the issue of accessibility, I have personal experience of this, as I worked as an ambulance nurse during last summer. We then received a delivery at a hospital without a maternity ward. However, we made the decision not to start the transport but to deliver at the hospital's emergency department. All staff on site helped each other, and everyone did as well as they could. After about 15 minutes, a healthy baby boy was delivered. But that was when the problems began. For one and a half hours, we were in contact with five hospitals in four counties, but no one wanted to receive us because it was full. We therefore made the decision to load the family into the ambulance and drive to the nearest maternity clinic. Then they actually had to solve the room problem as best they could.

Mr. Speaker! It should not be this way, and therefore the need for a national maternity plan is very important. It is a task that we within the Tidö parties have agreed upon, partly to increase accessibility, partly to reduce regional differences, and partly to increase the possibility that as many women giving birth as possible shall have access to midwifery teams before, during, and after childbirth.

(Applause)

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Martina Johansson (C)

Mr. Speaker! I thank Member Ragnarsson for the speech.

I intend to enter an area that the member did not address in his speech. I noted that the Christian Democrats also did not address the subject in their speech earlier. It concerns the gender identity legislation. It is an important change that was needed and an issue that has been driven for many years by the LGBTQ+ movement. The purpose of the legislation is to make it easier to change legal gender.

Let us look at what has happened in recent years. In November 2021, a first proposal for a referral to the Council on Legislation was submitted, which was then sent out for consultation. We in Centerpartiet thought that many of the proposals were good. Then the government at the time worked on the proposals and submitted a referral to the Council on Legislation in the summer of 2022. This government announced in a list of government bills that a bill on the area would be submitted this winter, but nothing has happened. The answers that have come from the responsible minister during question periods here in the chamber and in interpellations and written questions have been that the issue is being prepared intensively within the Government Offices.

Now we stand here in May 2023 without the announced bill. It has moved in and out of the list, but nothing is happening. The issue is very prioritized for this group and for this movement. They also say that they have had to change their focus from improving their rights to instead having to defend them. This legislation would mean an improvement for the target group. Why is nothing happening from the government's side?

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Thomas Ragnarsson (M)

Mr. Speaker! I thank the member for the question.

I have full confidence that the government is handling the issues that it says it is handling. It has surely not escaped anyone that very much has happened since the election, partly positively in the form of changes for the country, partly we have been affected by many external factors that have taken much of our focus. There has been the war in Ukraine and all decisions in connection with how we should support the country in its fight against Putin. We have an economic crisis that must be handled both nationally and internationally. We have sky-high inflation which has led to the costs for the individual citizen being extreme. This has in turn led to the government having been forced to work very actively with, for example, the electricity support issue.

I do not want to undermine the question that the member is raising in any way; I understand that it is extremely important. But just as in healthcare, the government must also prioritize its work in certain situations, and I am quite convinced that a prioritization order has been made that one feels one can stand by in the future.

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Martina Johansson (C)

Mr. Speaker! I entered politics very many years ago because I believe that all people have equal value and the right to live their lives exactly as they want to live their lives. It is still one of my flagship issues and that is what makes me engage politically. It is that which makes me get up every morning and love coming here and being part of the change.

Not prioritizing the little person feels incredibly strange to me. A lot of things have absolutely happened in the world around us, but when the government submitted this bill, there must have been a plan. Already then, unfortunately, a war was ongoing in Europe, and already then we knew that we were heading into a recession. Already then, it was known that more issues needed to be prioritized.

The question is whether the Ministry of Justice is the ministry that has worked most with the economic issues, such as the electricity support and support in the form of artillery and so on to Ukraine. Or is it the case that within the government, one cannot agree on how important the issue is and on actually proceeding with amended legislation? Is it one of the three government parties that actually does not want to do this – or is it the Sweden Democrats who do not want to implement this change?

That is what I suspect. I suspect that there are forces within the governing parties that do not want to make this change. If one wants to make a change, one prioritizes it.

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Thomas Ragnarsson (M)

Mr. Speaker! I do not intend to stand here and speculate on whether there is anyone or some who think differently, but when I speak with the Minister, I do not get the impression that that is the large part. Work is being done internally on the issue, and it is with that law, as with all other laws – it is not done in a forenoon. It takes quite a long time to make these types of changes.

I think it is absolutely excellent if we get a law that actually becomes good. Someone mentioned earlier that one made small changes to the law but did not run the whole line out. Sometimes it can be better to do it that way, but in this case, I hope that we will get a good law that is to the benefit of those who feel that they need this support.

I have worked as a nurse for 35 years and have also always protected the individual human being. I have many bad sides, but one good side I have is that I have actually always been the patient's advocate. I personally think that I stand up for the individual in a good way, and we are a party that believes in the individual. It is therefore obvious that we should create conditions; in that regard, we are in agreement. It is obvious that one should be able to live one's life exactly as one wants - within the boundaries of the law - in this country. It is a self-evident matter for me, just as it seems to be for you, Martina Johansson.

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Ulrika Westerlund (MP)

Mr. Speaker! Here comes this "someone" who mentioned the change to the law that was made ten years ago! It was a fairly large change that was about getting rid of the forced sterilizations, and it was good that the hbtqi movement put all their effort into that because it then turned out to take such an incredibly long time to get the rest of the changes done.

I will read a free translation of parts of Argentina's law on this area. It was enacted in 2012. It states: All people have the right to recognition of their gender identity, to freely develop their personality in accordance with their gender identity, to be treated in accordance with their gender identity and, in particular, to be identified in such a way in documents showing a person's name, image and gender.

One then lays out the text a great deal about how it shall never, ever be required to undergo medical treatments, investigations, or the like without this simply being about the individual's self-determination. What gender identity you or I have, no one knows but ourselves, and therefore all types of assessments necessarily become arbitrary.

This has been understood and pushed for by the entire European, and almost the entire global, LGBTQ+ movement for a very long time. This also applies to Öppna Moderater, Öppna Kristdemokrater, HBT-liberaler, and the European umbrella organization for LGBTQ+ organizations at the EU level; I believe it is called Centre-Right. Everyone agrees that this is what should apply.

Sweden is now last in the Nordic countries to introduce a law based on self-determination, and we have been overtaken not only by countries like Argentina – which was the first in the entire world – but also by Malta, Ireland, and Spain. I find it very difficult to understand why it is not possible to move forward in just Sweden. What is it that makes us so special?

My question to the member is therefore: What is the member's opinion? Is self-determination a good idea when it comes to changing legal gender?

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Thomas Ragnarsson (M)

Mr. Speaker! I thank the member for the question.

I believe in the free human being. I believe that people should have self-determination and be able to live their lives exactly as they want - obviously within the boundaries of the law, as I said. For my part, I see no problem at all in the issue. When it then comes to the legal text and the like, it is, as I said earlier, very much that needs to be done before it is in place. It is my hope that one is actually working quite intensively on it.

In the case the member mentioned, the forced sterilization was removed, and that was extremely important. It is one of the worst interventions one can perform on a human being – to sterilize a person against their will. It was therefore good that in that situation, a small part was actually broken out and removed. But as the member himself says, there have been almost four governments – at least three – since that part was removed from the law, and the law is still not finished. It has therefore not just taken time for this government; there have been previous governments that could have done this if it were to go so quickly.

There is some suspicion that there might be internal conflicts, and then the question is whether there were internal conflicts during the previous eight years. Was that the reason why we didn't move forward? I don't know, and I don't intend to speculate on that either. Instead, I hope that we will really get this legislation in place. Since the Minister has said that it should happen during the spring and that something is to come, I assume that it will.

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Ulrika Westerlund (MP)

Mr. Speaker! I thank Thomas Ragnarsson for the answer.

I believe that conflicts have occurred within several different governments, and I am afraid that those conflicts are not about things that actually deserve this type of attention. That is why I am putting a certain pressure on this now.

This is a discussion that, to some extent, has derailed in the public debate. It is interpreted as if this is a law change that could affect many more people than those who are actually affected, that is to say the small group that wants to change legal gender. It is an obvious minority in society. All possible strange claims have been put forward in the debate, and I am afraid that this protracted process is unfortunately due a bit to that – that it is not just about the priorities that all governments obviously must make, but also about that people have allowed themselves to be influenced by things that actually are not quite correct.

Fortunately for us, one might think, we have neighboring countries that we usually consider to be very similar to us. This applies, for example, to Norway. To the great joy of the Norwegian LGBTQ movement - and to the irritation of the Swedish movement - they took the proposal from our 2014 inquiry in principle and introduced the law in their own country. We have, therefore, still not succeeded with this, even though this was a Swedish government inquiry. Norway adopted essentially the proposal that was in the inquiry, but they changed the age limit to six years. This concerns the change of legal gender, not any interventions or medical treatments of any kind. Otherwise, they adopted the proposal essentially as it looked in the inquiry. They did that in 2016. Here we could study Norway. How has it gone in Norway? Has it involved any problems of the kind that are sometimes flagged up in the debate? The answer from the Riksdag's inquiry service when I asked it was: No.

There have been some minor implementation problems and some challenges for people who have changed their legal gender. We already have that here in Sweden. It becomes a problem to get grades, certificates and so on in your new name and personal identity number. But that is already the case. It is something that still must be addressed.

I wish I could share Member Ragnarsson's optimism that a government bill will be submitted in the near future. I hope that we can count on the Member in the lobbying work internally within the government parties to ensure that it becomes a reality.

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Thomas Ragnarsson (M)

Mr. Speaker! I assume that at the Government Offices, just as here in the Riksdag, there is a monitoring of the world and that they look at the good examples. We are usually quite good at looking at the countries in our immediate vicinity, Norway, Finland and Denmark. If there are good examples, it is certainly excellent to look at them.

I will willingly admit that I am not very deeply knowledgeable on this issue. That is how it is, but there are those who are. It is extremely important that the question is raised in the way the member does today. I am nevertheless expectant that something will happen.

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Karin Rågsjö (V)

Mr. Speaker! I must ask a question, Thomas Ragnarsson. Is it really the case that the SD-dependent government prioritizes healthcare? That is what I wonder after having spoken with a number of regions. It was quite a few. Is it really so?

You say that it is inflation that prevents one from supporting the regions even further with state grants. Is it really the case that investments in healthcare staff are inflation-driving? Or are investments in welfare at all inflation-driving? Even the National Institute of Economic Research does not consider that to be the case.

I have a question. Now, municipalities and regions are sitting and reviewing their budgets for the future. They want some kind of message from the government. They are not going to get that, as I understand it. What is it going to look like this autumn? What should we do? What should we cut back on? That is exactly what it is about in the regions within health and medical care. That is my one question.

My second question is this. You sit in a government that is very dependent on the Sverigedemokraterna. Your spotlight is constantly seeking out the issue of immigration. Is reporting really something that the healthcare system should be occupied with? Should sick people and women who are going to give birth and who need an interpreter not receive it? It should be investigated.

It is such questions that go around in my head. I wonder what Member Ragnarsson thinks about this, Mr. Speaker.

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

Thomas Ragnarsson (M)

Mr. Speaker! It can be stated, and we already did so in the previous debate, that Member Karin Rågsjö and I do not share the same view on the economy. In that regard, we are in complete disagreement.

Economy for me is about variations and fluctuations. We had small regions that made a surplus of 400 million last year. Now the economy is doing worse. Then suddenly you are supposed to have money. Those 400 million, or even more in many cases, have been saved. Many have not spent that money.

Enormous surpluses were made in Swedish municipalities and regions. Then there is one region and a few municipalities that actually have it tough financially. But generally speaking, enormous surpluses were made over the last two years.

I think it is quite reasonable to use that money when one sees that tighter and tougher times are coming now. It is quite reasonable for my part.

Injecting money into a system where one is constantly asking for money is rarely or never successful. I do, however, have some experience from the health and medical care sector.

During my 35 years, I have never heard anyone say: We must make changes now, because our budget will not hold. We make it a point of pride within Swedish health and medical care to think: There is a budget, but we must still provide care. At the end of the year, when the deficit is there, people shrug their shoulders.

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Karin Rågsjö (V)

Mr. Speaker! I hope that Vårdförbundet, Sveriges läkarförbund and Kommunal are listening to this. They are in a very difficult situation right now. I hope that the women who are going to give birth within the healthcare system during the summer know that there is very little staff on site because we have a financial crisis in health and medical care and listen to this.

Priorities are to get the healthcare staff to stay. Will the staff stay in a system within healthcare where fewer and fewer people are staying in their jobs?

Mr. Speaker! We only have 21 regions in Sweden. It is 21 regions that say they will have it extremely difficult this summer when it comes to childbirths. Are they making it up? Is Vårdförbundet making up the problems? That is not the case.

Mr. Speaker! The thing is that during the last four years, everything was Lena Hallengren's fault in different ways and during the pandemic. You know the whole story. Now that you are in power because you have SD with you, almost everything is the regions' fault. It is they who should toughen up. It is they who should work their backs off. The problem in the regions is that healthcare staff are running and that healthcare staff are taking sick leave because they are completely burnt out.

One can do very much. One can, for example, ensure that there are medical secretaries on site who write instead of the healthcare staff doing it. One can make very many changes. But one cannot care for people with too few staff. It is simply no longer safe for the patients. I think we are at that turning point.

(Applause)

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

Thomas Ragnarsson (M)

Mr. Speaker! I still think it is quite exciting. I hear all the time: There is no staff. The staff choose to quit.

Some have chosen to end their service within health and medical care. It is a question where one, as a politician and leader, must stand before the mirror and look: What is my part in this? Why do people who have studied for three years to become nurses suddenly choose to leave the profession entirely? It is a huge problem.

But the regions have never had as many nurses and doctors employed as they do now. The problem is that within healthcare, we have been good at rewarding licensed staff who choose to work administratively. One gets a higher salary, and one gets a better schedule.

There lies the fundamental problem. I speak a lot about straight, correct competence. For me, it is completely incomprehensible that I, as an administrator and nurse, can be higher-paid than the trade professionals at a hospital. It goes without saying that those who work out there with the patients must, of course, be the highest-paid.

We have been good at prioritizing administrative work, and we have created a very large amount of administrative work. We have staff. The point is to stimulate those people to want to work in healthcare. You do not do that by raising the salary so that you will stop working in healthcare.

I can sometimes get a bit tired of hearing that it is so bad and that there is no staff - yes, there is staff. I know quite a few people who work in health and medical care, and they love their jobs.

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

Johnny Svedin (SD)

Mr. Speaker! In Sweden, a disease is defined as a rare diagnosis if it occurs in fewer than 1 in 10,000 inhabitants and leads to a functional impairment. There is a large number of rare diagnoses, so even if each disease in itself is uncommon, it is a large number of people in Sweden in total who are affected.

More than 80 percent of rare diagnoses are of genetic origin, and many are chronic and life-threatening. Since rare diagnoses are individually uncommon and many in number, it is very difficult for an individual doctor to have the full picture of knowledge regarding all these diseases. This means that many patients with rare diagnoses and other hereditary diseases have to wait longer for a diagnosis and thus for treatment and follow-up. Therefore, broad cooperation regionally, nationally, and internationally is needed to improve care for these patients.

Sweden currently has no national action and coordination plan for rare diseases, which exists in the majority of the other European countries. Given the unusual and complex needs associated with rare diagnoses, there needs to be an action plan that takes a collective approach to care and support. Only with a collective approach will we be able to achieve equal and equivalent healthcare across the entire country. For this reason, it now feels good that the committee approves our motion 19 on a national action and coordination plan for rare diseases, something we have long requested.

Mr. Speaker! One of many other important areas is how healthcare is organized regarding palliative care for children and young people. Tragically, between 400 and 500 children die every year due to various diseases. Everyone who needs palliative care, i.e., care at the end of life, should be able to receive it from competent and well-educated staff, regardless of place of residence. End-of-life care is characterized by dignity, care, and respect. The right to adequate pain management should be a given, as well as psychological, social, and spiritual or existential support for both patients and relatives.

Many families wish that their seriously ill children are cared for at home as far as possible. It is then important that there is access to palliative home care teams. It should not matter where in the country the person lives - children and parents should be able to feel secure with the medical treatment offered together with conversation support and advice in an extremely difficult situation.

However, not all families want their children to be cared for at home. It is then important to respect their wishes and ensure that other possibilities exist. As it stands today, there is only a single hospice for seriously ill and dying children in the entire country, with a total of eight care places. That is far too little to cover the needs that exist. Parents who find themselves in this incredibly difficult situation, with all the worry and fear it entails, should be met with adequate palliative care that is specifically adapted for the encounter with children. We Sverigedemokrater consider, therefore, that the government should review the issue of strengthening palliative care for children and young people.

Mr. Speaker! Since I am on the topic of children and young people, we in Sverigedemokrater want to ban non-medical circumcision of minors. Circumcision of boys was legalized in 2001 in Sweden, and as a consequence of this, Socialstyrelsen recommends that the country's regions offer the service as a service for those guardians who wish to have their children circumcised.

By Sweden committing itself to the Convention on the Rights of the Child, it has also committed itself to taking all effective and appropriate measures aimed at abolishing traditional practices that are harmful to children's health. Article 2 of the Convention on the Rights of the Child states: "States Parties shall respect and ensure for every child within their jurisdiction the rights set forth in this Convention without distinction of any kind, regardless of the child's or his or her parents' or guardians' race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status." Furthermore, it states: "States Parties shall take all appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on account of the status, activities, expressed opinions or beliefs of parents, guardians or family members."

Madam Speaker! All children shall have the right to their own body and to equality before the law. We Sverigedemokrater, with children's rights in focus, believe that the government should ban non-medical circumcision of minors.

Madam Speaker! A treatment that needs further investigation is interventions for children and young people with gender dysphoria. Since there is a lack of secure evidence for treating children and young adults with gender dysphoria, this type of intervention and treatment should not be allowed to occur for persons under 25 years of age. The side effects that we know of at the present time can become very severe, and the future for children and young people who undergo gender-affirming treatment is thus very uncertain. We firmly believe that there must be clear scientific support for treating children and young people with gender dysphoria. Sverigedemokraterna considers that the government, in its work, should appoint an independent investigation that reviews the trans care and the gender-affirming treatment that has been carried out on thousands of children and young adults in Sweden.

Madam Speaker! We Sweden Democrats consider that all interventions and treatments within healthcare should be evidence-based and scientifically derived. We do not want the patient to be a test subject.

With this said, I would like to move for approval of reservation 29.

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Ulrika Westerlund (MP)

Madam Speaker! This will be a somewhat spontaneous remark; it concerns, of course, the last point the member raised.

I believe we all here agree that healthcare should be conducted based on proven experience and science. Is there anything specific that distinguishes gender-affirming care and makes it specifically the one that should be scrutinized, or is there reason to also scrutinize other procedures and other care provided, where there may also be people who have regretted it or think that they did not quite receive all the information? It could involve arthroplasty, gastric bypass, or all possible types of procedures where a fairly large proportion of people regret it.

When it comes to gender-affirming care, there are some people who have stated that they are not satisfied with the care they have received. It can be about all sorts of things. It can be about the fact that it didn't turn out as good to live with my new body as I thought it would be, which can be due to, for example, society's transphobia, that one did not receive as good a reception as one expected from close people, or that one is not completely satisfied; it didn't turn out quite as good with the body as I thought it would be. It does not have to be about the care being wrong.

Gender-affirming care has just become national highly specialized care. There is knowledge support in the area that Socialstyrelsen publishes. Is there anything special about just that care that makes it deserve any other type of scrutiny than that which the profession stands for? I am, of course, of the opinion that it is the profession that judges on what grounds care should be given, how it should best be given, and what should be required in terms of science, other experience, or evidence for a certain type of care to be offered. Is there anything special about just this care?

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Johnny Svedin (SD)

Madam Speaker! Thank you for the question, Member Ulrika Westerlund! That we highlight this issue is, of course, because we have included this as a motion. We have placed some focus on it, because in the debate on gender dysphoria in Sweden, we think, as you yourself said earlier today, that so much happens and so much is said back and forth regarding what is right and wrong.

Healthcare in itself must rest on evidence-based and researched knowledge in order to be legitimate at all.

Then there was the question of the 25-year limit for operations regarding gender dysphoria. According to the National Board of Health and Welfare, it is the case that many who choose to change their gender suffer mentally and have an underlying mental diagnosis. If one suffers in a young age, is one truly capable of making such a decision? That is the question we ask ourselves.

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Ulrika Westerlund (MP)

Madam Speaker! It is indeed a fact that many who seek gender-affirming care are not doing well. The queues are many years long, and in some places in Sweden, there is not even a queue to join, because there are no doctors who provide such care. In that case, it is incorrect to state that there is even a queue, because there is no queue to get through. It is in many ways a catastrophe for the health of the group of trans people.

I have hope that the decision on a national highly specialized care will improve the situation, but it continues to require that regions dare to provide additional funds to shorten the queues. Not doing so is to leave a large group of people in endless queues without the possibility of getting help with what they lack.

One can have many different types of challenges in one's life. One may be in need of gender-affirming care and at the same time perhaps need support because one is on the autism spectrum or is depressed. None of this excludes the need for gender-affirming care at the same time. One is not disqualified from gender-affirming care - not even according to Socialstyrelsen - because one also has other challenges. In that case, one also needs support with these other challenges.

None of this is solved by not providing access to gender-affirming care or an investigation into whether gender-affirming care is what is good for this specific person. Not everyone who seeks gender-affirming care actually needs gender-affirming care. But those who are to make that assessment are the specialized doctors, not anyone else. And the assessment of what can benefit a specific person cannot be made until the person is with the specialized team.

This with evidence is also quite tricky. SBU has made a statement where they emphasize that there is much care that is provided without strict evidence, because it may perhaps never truly be possible to conduct research in such a way that evidence is achieved in a strict scientific sense. But one still provides the care, because there is other experience that indicates it is beneficial for the group. That politicians put their foot down in this strict way is very unfavorable for a vulnerable group.

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Johnny Svedin (SD)

Madam Speaker! I agree with the member in what she says. There is nothing strange in that. We are not against gender care or gender-affirming care. That is not what the question concerns, but it is about an age limit for when one should be able to make a decision based on what one actually thinks and feels. By then, one should also have had time to think about what is right for oneself: Is it a matter of gender dysphoria, or is there an underlying clinical picture that makes one feel unwell or feel that this is important and so on?

This was the only thing I actually said. I also said that it should be evidence-based and scientifically proven that this is what works best. Those were the two things I said.

We agree with the rest. It is nothing strange. We are not against it. It is just that it is easy to say that one is like a young girl or boy or - I have encountered such an example - an astral body. One thus claims to be astral. Then one is neither he nor she, so what is one then? Is it the next step, the third alternative? It is very strange.

The question is: Is this fiction, or is it what the person feels as being decisive? Or should we wait and see that there really is a sober state where one can make correct decisions, so that one does not regret it afterwards?

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Juno Blom (L)

Madam Speaker! An investigation has finally been commissioned regarding measures against controls of girls' and women's sexuality. The investigation has been tasked with submitting proposals that involve a criminalization of virginity tests, virginity certificates, and virginity procedures.

But this is definitely not a new problem. At the end of the 1990s, I came into contact with vulnerable and frightened girls who had sought care to get help with putting stitches in the genital area so that there would be blood on the sheet on the wedding night. In some cases, the healthcare system met their requests, and in other cases, the healthcare system refused.

Since then, I have met countless girls who have been forced into virginity checks by their families. In some cases, it has occurred together with one or more relatives who were present at the check at the hospital – a check of a hymen that does not exist! In other cases, it has occurred at home at the kitchen table by a relative who is a doctor and fully aware that what he does cannot show anything. However, he is equally aware that the effect of the act strikes terror into the family's girls. In other cases, it has occurred when the girl has been taken out of the country.

I have met young girls who have been left to their fate and see no other way out than to plead for a virginity operation when they are forced to marry against their will. This has continued despite us having known that it occurs in one of the world's most egalitarian countries.

I will never forget a reference group meeting at NCK in 2011, which I left in protest when reference was made to a care program developed at Karolinska Institutet for the care of women with innocence issues.

In that care program, it stated, among other things: "Blood on the sheet can be achieved in different ways. Most effective is that she immediately after the intercourse goes to the toilet and pricks herself in the inner labia. The prick must be practiced at home in advance so that she knows how hard she should prick and how much it hurts. (What is worse: being murdered or pricking oneself?) Hide the needle among the sewing accessories in the toiletry bag or in the hem of the wedding dress (forgotten by the seamstress). In an emergency, use a safety pin hidden in the vagina or the rectum."

When I protested at the meeting, I was asked if I was against diabetes care. I explained that I lacked the knowledge to comment on it. They then explained that the healthcare system urges those with diabetes to prick their finger every day.

This healthcare program and the analogy with diabetes care is an expression of the total fear of touching that has existed and unfortunately still exists to an all too high degree when it comes to countering the norms and values that the culture of honor rests on.

We in Sweden have spent time recreating a veil of modesty that never existed instead of putting all our effort into giving all girls and women the right to own their bodies and their sexuality and the right to shape and influence their lives, as our gender equality goals clearly indicate. No girl should be forced into marriage, and no girl should live with the fear that there will be no blood on the sheets.

We judge, view and treat girls and women with completely different yardsticks.

I think of the girl who over and over again asked her school nurse if it was true that it was she who decided over her own body and that no one could force her to marry in the future. Every time the school nurse confirmed this, the girl's eyes lit up - until the day she came in with a dull gaze and had realized that it didn't matter that she now knew it because her parents had not been taught that it is so in Sweden.

I think of the anger of the mothers when I brought up the importance of talking to their children about falling in love, love, intimacy, contraceptives, and the right to decide over one's own body and sexuality: Who was I to demand it of them, who had never experienced any of what I spoke about?

A woman came into my room and described how she had learned to bite her pillow to endure the abuse she was subjected to at night by the man she had been forced to marry as a child. A "no" did not exist, and contraception was ruled out. Her task was to obey and bear children.

If we seriously want all children and women to have access to freedom and empowerment, it requires a cultural shift regarding sexuality in the suburbs, similar to the one that was implemented in Sweden 90 years ago. We shall draw strength and faith for the future from our own history.

In the wake of the suffrage movement, women worked to repeal the laws that prohibited information about contraceptives and homosexual contacts. They advocated for sex education and free abortion. They traveled around the country and met the women who were in greatest need of their struggle for liberation. They did not waver, even though they knew they were challenging strong, traditional, and patriarchal forces.

The Liberals have pushed for the sex and cohabitation education to include the conditions for children growing up in a culture of honor. But that is not enough, as the girl explained to her school nurse.

Clear information must be given to every parent in the suburbs. The information may meet with opposition, but that opposition must then be taken into account so that we work correctly. The opponents shall be met with full force, and the message shall be backed by a clear backbone.

Behind the requirements for innocence checks, certificates, and operations lie values that lead to enormous suffering among girls and women who have sought protection in one of the world's most egalitarian countries.

Now there is broad support for introducing new legislation. The remarkable thing is that it does not already exist. Legislating is absolutely the easiest part. But if we are to seriously take on the fight against honor-related violence and oppression, it is required that the politics see and understand the norms and values that lie behind the oppression.

Virginity checks are a symptom of a much larger problem. This is shown by the mappings that have been conducted, among others in Uppsala. In one mapping, it was shown that 66 percent of the girls lived with requirements to be virgins when they marry. In this case, they had parents born outside of the Nordic countries.

I believe that the longing for freedom is universal. It is about the right to love whoever one wants.

I feel proud that we now actually have a government that dares to tackle these issues and that together we can create opportunities for every girl and woman to feel that freedom and have the rights that we have taken for granted in life.

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Karin Rågsjö (V)

Madam Speaker! We are speaking here today about healthcare priorities in a broad sense. I ask myself: Does the government and its supporting parties really prioritize healthcare? It is difficult to believe that after conversations with the regions.

The government and the Sweden Democrats refer to the high inflation and the fiscal space to explain away the lack of necessary policies that would make the difference that the healthcare staff would need so much. I do not believe that investments in healthcare staff so that they stay are inflation-driving. I do not believe either that investments in welfare at all are inflation-driving.

Municipalities and regions need to know the minimum level for state grants for the autumn before the summer, as they need to sit down and prepare their budget. From what I understand, they will not receive it.

The state must also, I think, have long-term guarantees for municipalities and regions and index the state grants so that they follow the cost developments. It is quite important.

In the Left Party's budget motion, we have presented proposals for significantly increased general government grants for, among other things, increased staffing levels, higher wages, and an improved working environment. That is what the healthcare staff have long been asking for.

It is the attitude and the difference between right and left, or whatever one should call it, that we need to talk about. But we must also start talking about the interpretation law. What will happen to it when it is to be investigated? Or what happens to the free interpreters? What happens if they are removed - if this investigation shows that it is a clever idea? Such things we shall talk about.

Increased equality in healthcare is needed. It is about state influence over economic redistribution, the guidelines, which are not always followed in the regions, and education. It is about increased resources for healthcare. And the care people receive should not be dependent on social class, gender, origin, and where they live.

Healthcare is governed by the principle of need. Greatest need comes first, so to speak. We all agree on this, but it has not quite become so. The development is going in another direction. One can see that online doctor companies and other private providers take the healthy patients first, those who require the fewest interventions but provide high compensation. They are the most profitable. This can also be seen in various investigations in the Health and Care Analysis.

Then it will be the public healthcare that is responsible for caring for those with the greatest care needs, which means an increased burden on the regions specifically.

We consider it extremely important that Sweden returns to what we believe is best for the sick, namely that needs shall govern. We also want to remove the freedom of establishment - you know that. It is about the healthcare companies not being able to decide for themselves where they should strike their stakes, but rather it should be politicians who do so based on needs, so to speak.

Breast cancer is the most common cancer disease among women in the Western world, and it is increasing. In total, 61,000 cancer diagnoses are made every year in Sweden. 9,000 of them are breast cancer diagnoses. These are very many figures here, but they are quite interesting figures, I think. 80 percent of all those who receive a breast cancer diagnosis are over 50 years old.

At the same time as breast cancer becomes more common, the chance of survival is increasing. We have a fantastic cancer care in Sweden - I must say that. That more and more people can be cured is considered primarily due to research leading to good treatment and to the mammography screenings, which ensure that breast cancer is detected early. Approximately half of all cases of breast cancer are detected during screening.

We were the party that, together with the previous government, introduced free mammography across the country for women between 40 and 74 years old. Every fifth woman affected by breast cancer is over 74 years old but therefore receives no screening, no mammography. That is where the limit is. One can then ask: Are those women not worth receiving timely care?

Two out of three cases in the age category 40-74 years are detected thanks to screening. The age limit is based on Socialstyrelsen's recommendations. Now Socialstyrelsen is in the process of looking at this. That has been done for quite a long time. At the same time, average life expectancy has increased, and a majority of the changes found among older women are precisely cancer that needs to be treated.

We want the government to work actively for equal mammography, also for women over 74 years old, in order to counter age discrimination. Therefore, I raise reservation number 15.

The National Board of Health and Welfare reports that all 21 regions have a shortage of midwives. Employers are attempting to solve this by closing delivery rooms or worsening the availability at the midwifery clinics. At the same time, midwives across the country are sounding the alarm.

Of course, healthcare and maternity care must function throughout the entire country. The crisis in maternity care has been ongoing every summer, it feels like. And there is simply no improvement. The mothers who give birth today sense the enormous pressure placed on the midwives and on the maternity wards. There is so much stress that it can also lead to mistakes.

Several maternity clinics have been closed in recent years, and the dismantling follows a clear pattern. Those who already have a long way to travel to the maternity ward will have an even longer way. We must consider how we are to solve the conditions in rural areas to actually have good maternity care. At the same time, the care needs to adapt its work in areas with large distances. Therefore, we want to supplement 1177 with a midwife competence where pregnant women can turn for advice.

Different types of maternity wards are also needed to meet women's different needs. The Government should look at initiatives to develop different types of maternity wards based on women's expected births and wishes. These wards should, of course, be located in hospitals with emergency departments.

We want, like many other parties, that there should be a midwife for every birth. It will be much better for the one giving birth, the woman, and for the midwife, who can follow her patient at all times.

This year's summer will mean a major crisis for maternity care, and there is a risk for both mothers and children. The care has no margins in Sweden today.

We have ended up on a downward slope. It should not feel as if the welfare state is facing a systemic collapse. This is an incredibly important issue, and therefore we believe that the SD-dependent government should take its responsibility and increase the state grants.

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

Martina Johansson (C)

Madam Speaker! This is an area that concerns many different parts, and it is difficult to know what to enter and discuss. I intended to stay around that which concerns children and the creation of children and would initially move for approval of reservation 28.

Today, there are indeed many more opportunities to become a parent than a hundred years ago when it often involved a man and a woman who were married to each other. This means that the legislation and regulations we have need to be updated to correspond with how things look today and for equal treatment and equal care and support throughout the country.

When it comes to IVF, that is, support and help in different ways to become pregnant, it does not look the same across the whole country today. Today, there are different age limits regarding how long you can receive help with such a treatment. Centerpartiet believes that an individual medical assessment should be made regarding how long one should be able to receive help with IVF, just as an investigation is made regarding parental capacity.

When it comes to embryo donations, that is, the possibility of being able to donate surplus fertilized eggs to another person, there is currently a requirement that you must have had a child previously. We believe that the person who wants to donate should be able to do so and that it is sufficient.

A method for having children that often evokes many emotions is surrogacy. Here, the Center Party wants to investigate and introduce this possibility in Sweden, without money involved. This is something that is done in other countries today. Swedish women travel to another country, receive help with insemination, and then give birth to the child in Sweden for a sister or sister-in-law. But it is also about Swedish individuals and couples who seek help from a woman in another country with precisely surrogacy.

In order for this to be good for both the child and the involved adults, I want to see that we do it under orderly conditions, preferably in Sweden, so that we can ensure that the host mother's situation is good and that the whole thing is not something forced. Even the Swedish Ethical Review Authority says that this is possible, if we just focus on the fact that no money is involved.

Madam Speaker! If we work on this issue in Sweden, we can also facilitate the legal parenthood regarding these children. Today, they are affected in such a way that there is not always a guardian who can make decisions about their care and treatment, this because the legislation does not hang together.

Maternity care also needs to be updated to become equal and good throughout the country. It also needs to gain increased flexibility. We need to develop the national guidelines both before, during, and after childbirth, and we need to have a flexibility both for the one who is to give birth to the child and for the midwives. Being able to have midwife-led units and home birth for those who choose it is an important issue of freedom of choice.

I have earlier today been in on the need for a new gender identity legislation. The important thing about that is that I should be able to make an independent decision without interference from authorities when it comes to my legal gender. This is nothing that we should mix up with what medical care should be given to these persons, but it is about distinguishing between the medical and the legal. That is the important point.

I see nothing that indicates any abuse in the other Nordic countries that have already introduced this, and I can rhetorically ask the Liberals, who usually stand for the liberal flag and defend the rights of hbtqi persons: Where is your fight to implement this change in the government you are part of, where not much has happened? Regardless of the previous government's sluggishness, this government could have prioritized and put the bill on the table.

I therefore simply conclude my speech with two questions. Where is the government's proposal for a new and better gender identity legislation? Where is the Liberals' backbone in these issues?

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

Ulrika Westerlund (MP)

Madam Speaker! Ulrika Westerlund will try to keep it brief, Madam Speaker.

We have talked a lot about the Swedish Gender Identity Act, which celebrates 51 years this year and which is clearly marked by the mindset of its time. The worst human rights violations have disappeared, as we have mentioned earlier here in today's debate. The forced sterilizations are gone. Remaining, however, are various formulations that are in no way precise or can be objectively established, for example that it is only possible to change legal gender if a person "has for a long time experienced that he or she belongs to the other gender" and "has for a time acted in accordance with this gender identity." The assessment of whether this is the case is made by an external party, the Socialstyrelsen's legal council. The risk that criteria of this kind lead to arbitrary decisions can be considered very high.

I previously mentioned Argentina's legislation that came in 2012. In that and other laws in other countries that have been enacted significantly later than the Swedish law, the difference in perspective is very clear. Where the Swedish law sets requirements on the person who wants to change legal gender, later laws emphasize these persons' – the individual's – rights, as opposed to the state's rights.

The Green Party wants the law to be separated from medicine. The change of legal gender shall be decoupled from any healthcare interventions that a person may need, and the change shall be based on self-determination. The old law shall become two new separate laws.

In the sometimes rather heated public debate, it has been expressed that such a legislative change would mean a transition to a completely new view on what gender is. But we already have a view on gender where gender identity forms the basis for legal gender. We have had that since 1972, when the Gender Identity Act was first introduced. If legal gender were not at all considered capable of being based on gender identity and could only be based on physical sex, we would not have any Gender Identity Act. The very point of the law is to enable the change of legal gender based on the individual's own gender identity.

Madam Speaker! There is much to do in many areas in what we are debating in today's committee report. I also want to talk a little about reproductive health in Sweden.

In our gender equality motion, we have chosen to focus heavily on maternity care, and several other speakers have mentioned this earlier. To secure maternity care throughout the country and improve its quality, Miljöpartiet wants a goal of one midwife per woman giving birth. To achieve this, continued investments in paid further education for nurses and on improving working conditions and the work environment within maternity care are needed.

Miljöpartiet also wants to see a permanent, state-funded major initiative for an improved work environment and improved working conditions through new hires and increased wages for staff in health and medical care. Midwives' genuine professional expertise regarding healthy pregnancy and childbirth also needs to be given more space and better conditions within healthcare. To improve care for abortions and for various other conditions such as severe menstrual pain, endometriosis, and menopausal issues, we also want the midwives' prescription rights to be investigated.

We also want to appoint an inquiry to review the entire maternity care. We need to become better at counteracting birth injuries and accommodating different needs during childbirth. Among other things, we want to review whether so-called cultural interpreter doulas, which exist in some regions, should be spread to more. The safety for those giving birth with a long travel distance to maternity care must also be ensured, partly by offering accommodation at patient hotels.

Miljöpartiet also wants that women and others who can become pregnant who are not Swedish citizens or residents in Sweden should be able to have an abortion here. It has been possible since 2007. However, many are still hindered by high costs. To enable real access to abortion, we want to open for subsidized abortion for foreign citizens. We also want to simplify for home abortions. When the individual pregnant person themselves wishes and there is no risk of complications, it should be fully possible to carry out the abortion at home. For those who wish, the possibility to obviously always exist to have an abortion at a hospital.

Madam Speaker! There are many areas where care needs to be improved, not least regarding the diseases that most often affect women. Care for endometriosis patients must be improved. In 2018, national guidelines for the care of endometriosis were issued with a large number of recommendations concerning diagnostics, treatment, and nursing care. In 2019, a follow-up and evaluation of the care of endometriosis was also published. The evaluation was carried out partly in parallel with the development of the guidelines, and therefore the regions did not have time to adapt the operations' interventions according to the recommendations in the guidelines. But the National Board of Health and Welfare identified a number of areas for improvement, and I believe that several of us have noted that the areas for improvement still remain.

More hospitals need a routine for pain relief during acute care visits. More patients need to be offered hormonal treatment. Better follow-up of the treatment effect is needed. More women's clinics need to have a multiprofessional endometriosis team, and a more structured management is needed within primary care and school health. It is central that the guidelines are applied, followed up, and evaluated. And the government should ensure that this happens.

Madam Speaker! In conclusion, I would like to mention the need to improve screening for breast cancer. Miljöpartiet believes that the government should work actively for equal mammography even for women over 74 years of age in order to counter age discrimination. Furthermore, the government should investigate the introduction of individualized breast cancer screening and review the issue of whether everyone who wants it should receive information about their so-called breast density in connection with mammography. Having dense breasts increases the risk of breast cancer. Unfortunately, it also complicates detection during standardized mammography.

Priorities within health and medical care

I support all of the Green Party's reservations, but I move for approval only of reservation 27.

The deliberation was hereby concluded.

(The decision was to be taken on 24 May.)

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