Priorities in healthcare

Jesper Skalberg Karlsson (M)

Mr. Speaker! Today we are debating the Committee on Health and Welfare's report 16 Priorities within health and medical care. It is an important debate given the situation in Swedish health and medical care. Despite the fact that we allocate a relatively large share of GDP to care, health and medical care are burdened with challenges regarding accessibility, equality, and efficiency.

The government needs to work on both the short and long term to address that. If we want Sverige AB to do well, the employees in Sverige AB cannot be stuck in a healthcare queue.

Therefore, it is important that we use all available funds to secure accessibility, equality, and efficiency. This is important not primarily so that the calculations in the Ministry of Social Affairs' memoranda will balance out, but because people who work, struggle, and toil deserve world-class care. They deserve care that not only maintains high quality—it already does today—but that is also accessible and with short queues regardless of which diagnosis it concerns or who is sitting in the waiting room.

Few people would accept the preschool saying that the places are full and that your child specifically can only start next year, or that the vacation weeks are finished and that your vacation can only be taken starting in 2025. Why would people then accept such a wait in healthcare?

Mr. Speaker! Let me say a few words about equality in healthcare. Some proposals concerning maternal healthcare and maternity care are presented in the report. I completely agree that this is an area where Sweden can do better. Therefore, it was good that the government already in 2023 took a stand and stated that the situation is not satisfactory.

A national plan for maternity care that shall contribute to increased accessibility and reduced regional differences shall be developed and financed. The National Board of Health and Welfare presented its first proposal for the plan in January this year, and in September the assignment to develop performance-based measures, which shall be a tool and a checkpoint along the way, was partially reported.

Furthermore, the government has, on behalf of the state, entered into agreements with SKR regarding person-centered, accessible, and equal maternity care. Within the framework of the agreements, the regions shall implement measures for a coordinated pregnancy chain with good personal continuity and ensure that all women are offered follow-up visits. On the grounds that this work is therefore already underway, the motions should be dismissed. At the same time, one may wonder why this work has not been done earlier.

Mr. Speaker! It is also proposed in a motion that innocence testing, that is, to examine someone's female genitalia for one's own or another's sake in order to assess whether the person is or appears to be innocent, shall be criminalized.

I am the first to agree. This type of offensive intervention of honor control should not occur in Sweden. Therefore, it is good that the issue has been investigated and that in the investigation report Reinforced protection for personal integrity presented last year, a ban against exactly this is proposed, with imprisonment in the range of penalties.

Let us not stop there. Innocence checks should and must be criminalized, but we should also criminalize the issuance of certificates of innocence and so-called innocence interventions. It is unacceptable and appalling that such violations have been allowed to continue in Sweden.

This improper control of women's and girls' sexuality does not belong in a modern and equal society. In Sweden, women, children, and homosexuals have rights. Those who do not sign on to that can expect clear consequences.

Furthermore, attempted conversion of hbt-persons should be criminalized and the criminal law protection significantly strengthened. There are no equally ready-made proposals to pass here, but the Tidö parties are in agreement, and this shall be delivered before the end of the mandate period. I very much look forward to pressing the green button when that bill is completed in accordance with our agreement in the Tidö Agreement.

Mr. Speaker! Finally, there are motions concerning vaccination against certain forms of cancer. Let me say something obvious here: Vaccines work. Prevention against cancer is rarely as simple as with the HPV vaccine.

In my previous role as a regional councilor in Gotland, we expanded the HPV vaccination of boys, because we saw that equal protection was the very best if we wanted to protect the entire population. I am proud that we made that decision, even though it cost a lot of money. Even though we in Sweden have come far on the journey towards eradicating cervical cancer, more is required if the general herd immunity against HPV-related cancer is to be achieved.

The government gave the Public Health Agency the assignment last year to investigate whether more people should be included in the general vaccination program against HPV. The assignment was reported a little more than a week ago, in the middle of the European election campaign. The hope is now that recommendations in accordance with the conclusions can become a reality by the autumn.

Just so we don't get confused by technical and political terms - if one can vaccinate oneself against cancer, it is of course a very good idea.

Mr. Speaker! We are in the middle of the parliamentary term, and the Tidö Agreement is approaching its halfway point. Today's report is perhaps an indicator of how the project to strengthen Swedish health and medical care is progressing, since most of what is mentioned in the motions is already being implemented, at least in some form. That is good, but more can, needs to, and must be done. However, that is the subject of another, perhaps more exhaustive debate than the one regarding this motion report.

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

(Applause)

In this speech, Thomas Ragnarsson (M) agreed.

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

Yasmine Bladelius (S)

Mr. Speaker! Today's debate is based on a so-called motion report, Priorities in health and medical care, and concerns motions from last year's general motion period. The report collects approximately 140 different motion proposals from members of the Riksdag concerning everything from priorities of different diseases, maternity care, donations, innocence checks, and much more.

It is a large and important report, and even though it is not common to stand here and debate on a Saturday, I am happy to do so when it concerns such important issues.

Mr. Speaker! Before I proceed to the substantive issues in the report, I would like to pause for a moment at the words in the title of this report, namely "priorities within health and medical care," because it naturally plays a major role how one chooses to prioritize within Swedish health and medical care.

It is about how one chooses to prioritize healthcare and its organization purely economically. Does one invest in necessary general state grants to municipalities and regions that provide health and medical care and are facing extremely tough economic situations with cutbacks, layoffs, and reductions, or does one prefer to invest in tax cuts for high-income earners, or for that matter, the removal of plastic bag taxes?

It is also about whether one chooses, or does not choose, to prioritize the healthcare staff – the fantastic doctors, nursing assistants, and nurses who work within the healthcare system and who go 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 and lay off or dismiss more healthcare staff?

It is also about whether one chooses to prioritize following the portal paragraph in the Health and Medical Services Act. Is care really provided based on need in Sweden, or is it provided first to the one with the largest wallet?

Mr. Speaker! For me, it is quite obvious that Swedish healthcare 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. Precisely for that reason, we need to prioritize healthcare and its staff.

Mr. Speaker! Sweden is in the midst of a national healthcare crisis. The situation in healthcare today is the worst since the crisis of the 90s. Region after region is now forced to carry out major cuts in an already heavily burdened healthcare system with an already heavily burdened healthcare staff.

When we now debate the motion report on priorities within health and medical care, we do so from the starting point that we are currently in the midst of a national healthcare crisis, created because it was chosen not to prioritize.

I still intend, Mr. Speaker, to go into the report itself and talk a little bit about, above all, one of the important issues that is highlighted in it.

It is about the care and support during pregnancy and childbirth, and about investigating how the regions can be given the right conditions to develop maternal and childbirth care and also ensure that the so important parenting support reaches all expectant parents.

We Social Democrats have long worked for better maternal and obstetric care: that it is accessible, that it is equitable across the entire country and that it is adapted to different needs both for the women and for the families.

We have known for a long time that inequalities in health are largely linked to inequality in access to resources.

We also know that parents' different circumstances, access to resources, living conditions, and health behaviors during this time have a direct impact on the risk of ill health and unequal consequences for children given certain health conditions.

The care and support offered to parents before, during, and after pregnancy and childbirth therefore plays a completely decisive role for the children's health and their opportunities both in the short and long term.

Mr. Speaker! In order to reduce these inequalities in health and create a more equitable healthcare system, we responsible politicians must act on several fronts, including ensuring the funding for municipalities and regions that provide healthcare. It is also a matter of increasing the accessibility of support and counseling for all prospective parents.

I wish to move for approval of our reservation 1.

(Applause)

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

Camilla Rinaldo Miller (KD)

Mr. Speaker! I would like, as is customary, to begin my speech by moving for the approval of the committee's proposed decision in the report and the rejection of all motions.

With a little reference to the debate we have just concluded, I hope it has clearly emerged that the Christian Democrats' priorities for Swedish healthcare are to shorten the long care queues which grew to record lengths during the previous mandate period. But we also prioritize securing more care beds and improving the conditions for the staff.

In addition, the Christian Democrats' focus is on increasing state governance so that those who are ill can be offered good care regardless of where in the country the person lives. We simply want to create the conditions for a more equal and just Swedish healthcare.

Mr. Speaker! I could actually conclude my speech here, as I have set out the Christian Democrats' priorities. But I still want to take the opportunity to elaborate on it a bit more.

The Riksdag has supported guidelines for priorities within health and medical care 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 initiatives, or how the care of certain patients with certain diseases should best be organized, is usually best decided within the healthcare sector based on these principles.

Based on that decision, the government has, among other things, 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.

The committee has, however, noted that there is a lack of an overall, national action and coordination plan for rare diseases. Therefore, the committee issued a motion to the government last year that a national action and coordination plan for rare diseases should be developed.

In the budget bill for 2024, the government announced its intention to develop a national strategy for rare diagnoses. The government has tasked Socialstyrelsen with developing a proposal for a national strategy for rare health conditions. Socialstyrelsen is also tasked with developing recommendations on national screening programs.

Mr. Speaker! In one of the motions in the report, the issue of parental support is raised. For us Christian Democrats, the family and parents are something we always want to emphasize as one of the pillars for a secure upbringing. Therefore, I am extra glad that the Christian Democrats, together with the government, see it as an important priority to strengthen parental support. It is also an important part of the crime prevention work. In Wednesday's debate here in the chamber, I said: "It is easier to build strong children than to repair broken adults." That bears repeating.

The Government has tasked the Agency for Family Rights and Parenting Support with paying out and monitoring an initiative of state grants to municipalities and regions for reinforced parenting support measures starting in 2023, and it is a permanent initiative.

Mr. Speaker! When it comes to priorities, I must also mention something regarding surrogacy. Surrogacy is not permitted in Sweden today, and the Christian Democrats and our women's association say no to making it permitted.

Surrogacy has become one of the great human rights issues of our time. It concerns our view on women and children and children's rights, but also about society's responsibility to protect them from human trafficking.

Mr. Speaker! In conclusion, I just want to return to where I started. For the Christian Democrats, it is an important priority to shorten the long healthcare queues so that patients receive care in a timely manner.

I have personally, among other things, had surgery on my left knee on two occasions. It was so long ago that it was in the 1900s. When one is struck by an acute accident or illness, the care must function. For me, it did. Two successful operations later, I stand here today and can, in principle, use my left knee without any problems.

For everyone who might happen to end up in the same situation, it should not be decisive where you live or which region you belong to. Everyone has the right to equal and accessible care.

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

Lina Nordquist (L)

Mr. Speaker! The theme is priorities in healthcare. To begin with, I want to say that it is incredibly good and very hopeful that the government is in various ways strengthening care for rare diseases with a strategy, better opportunities for treatment, and other things. It is high time.

It is also very encouraging that the government has stated that primary care must be strengthened. The possibilities of finding a care placement must increase significantly. This applies both to those who work in healthcare and to the patients who today need a care placement.

It is incredibly pleasant to see that dental care is now to be strengthened for those people who have the very worst oral health.

It is encouraging that the government has announced a plan to systematically strengthen maternity care throughout the entire country, including aftercare and rehabilitation for those who need it. There is a focus on women's health throughout their lives: menopause, endometriosis, lipedema, and so on.

But with priorities, there naturally also follow deprioritizations. One thing that the Liberals and the government absolutely do not want to deprioritize is municipal care, which almost always ends up in the shadows despite accounting for more than a quarter of all care in Sweden. Municipal care must be prioritized up. It must be strengthened qualitatively, and it must be a place where one can feel safe.

Something that, on the other hand, really must go is false care – care that is not needed or that can even cause harm. It is high time that innocence checks now become illegal and that it leads to fines or imprisonment to do such things to another human being. We in the Liberals also want to introduce a ban on posing as being able to treat seriously ill people if one de facto has no sensible education at all. There is no place for any make-believe healers who take exorbitant payments for care that does not work. It should not work that way.

Something, however, that there is plenty of room for and a great need to strengthen is skilled employees and workplaces where people thrive and stay. It is very significant that the government has budgeted for skills development, skills supply, support for further education of nurses, development opportunities and career opportunities. There are measures underway for language studies for persons with foreign university education. It is about digital reforms to create tools that work in healthcare for those who work there and who simultaneously make patients safer. This is the way forward.

Finally, I also think that the measures for a sustainable working life are very welcome. We need a strong occupational health care and more specialists in occupational medicine. Minister Paulina Brandberg recently gave a commission of inquiry, Madam Speaker, to develop a strategy for a sustainable, healthy and safe working life. These are completely correct priorities.

When push comes to shove, at the end of the day, what we need in Swedish healthcare is care based on need, of skilled people who are empathetic and who want to stay in healthcare and develop there. But the patient must also have maintained self-determination. The patient shall have continuity and still be able to steer their own life. I am convinced that this is the way forward, and I am glad to see that we are now taking steps in just that direction.

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

Karin Rågsjö (V)

Madam Speaker! Prioritizing is primarily about prioritizing welfare over tax cuts. It is obvious.

Another important priority is to protect healthcare staff and ensure that they have reasonable, or good, working conditions. We cannot see that now, in a time when 5,000 people are being redeployed across the entire country within healthcare. In that case, there is no priority; that is hardly what can be said.

Today, there is a shortfall of 15 billion SEK to maintain healthcare at the level we are used to seeing it. Not even 6 billion, which you announced in the spring budget, is enough. This hits healthcare hard, and it causes the priorities to be skewed.

The second priority, which is immensely important, is of course equal healthcare. Equality is not just about regional equality but also about class equality. Here, investigation after investigation points out that differences in class-based health between those who are rich and healthy and poor and sick are increasing. This should be a self-evident priority. It is about the sickest first, and it should not be the wallet that decides.

I will now move on to speaking about substantive issues. To eradicate the HPV virus in the near future, a massive and sustainable collective effort is required over a few years so that the virus can no longer circulate. Everyone affected must receive vaccination - boys, girls, men and women. It is extremely important. This is a super important issue that we must roll out. It should not depend on who you are or where you live whether you are to be vaccinated.

All types of screening risk hitting the wrong social classes. Great efforts are required here, for example for mammography. We believe that the government should review the issue of screening programs to detect certain diseases. It is very important. It is also necessary that the screening programs' age limits are reviewed and updated based on new research. This is also an issue when it comes to vaccination, which the state perhaps should take a firmer grip on and ensure that it becomes equal across the country. There should be no difference between which region you live in when it comes to which screening you can receive. I therefore move for approval of reservation 5.

Breast cancer is the most common cancer disease among women in the Western world, and it is also increasing. Approximately 61,000 cancer diagnoses are made every year in Sweden. Unlike many other forms of cancer, breast cancer is common in the 50-60 age group, and it also occurs, of course, in younger women. But we also have a very high survival rate when it comes to breast cancer. We have a fantastic cancer care in Sweden; that is what I want to say from this speaker's podium. This specifically concerns breast cancer, and this is what we shall safeguard.

Approximately 80 percent of all those who receive a breast cancer diagnosis are over 50 years old. At the same time as breast cancer is becoming more common, the chance of survival is increasing. More and more people can therefore be cured. Approximately half of all cases of breast cancer are detected during screening with mammography. Three-quarters of the tumors are detected in women who are 55 years and older, while every fifth woman affected by breast cancer is over 74 years old. It is a matter of us living longer and thus also risking getting cancer.

Perhaps the age limit needs to be reviewed. We have mammography up to 74 years. One can attend the examinations as long as that. Socialstyrelsen's previous recommendations regarding age limits have been very clear: 74 years. Now life expectancy is increasing, and the majority of the changes found among older women are precisely cancer that needs to be treated. Therefore, perhaps the recommendations need to be reviewed. There must not be any type of age discrimination in cancer care.

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

Anders W Jonsson (C)

Madam Speaker! The committee report we are debating today, Priorities in the health and medical care, is a report that contains very many different details. I intend to highlight four different ones that are important for us in the Center Party.

The first one concerns rare diseases. These are, therefore, the diseases where relatively few people have the individual disease. The big problem has been being able to organize care so that it becomes efficient. Many doctors only meet a single patient. Knowledge is not concentrated in a few places. Furthermore, we have, like a fish out of water, encountered a problem with the financing of medicines for these groups.

During the previous parliamentary term, we agreed in the Social Affairs Committee – or at least we obtained a majority for it – that a strategy must be developed for how we in Sweden should handle rare diagnoses. We were also in agreement that one must ensure that the financing is managed so that it does not depend on where in the country one lives or how expensive the treatment is if one receives it or not.

Madam Speaker! The Government has initiated the work to develop a strategy, and that is very good – praise to the Government for that! But it is surprising that in the decision it is stated that the issue of medicines for people with rare diagnoses must not be handled. The issue may therefore not be handled, even though this might be the very biggest problem.

There is a proposal from TLV here, but nothing is happening from the government's side. It is completely unreasonable to me that one can push a matter while in opposition before the election, that is to say that we must produce a system that allows us to afford the treatments which many times are life-saving, and then, when one reaches a position in government, say that one will not investigate the issue without having put it on the shelf. I am proceeding on the assumption that very quickly a proposal will come from the government which implies that people with rare diagnoses shall be able to receive their medical treatment in Sweden even if it is expensive.

The second thing I want to raise concerns screening. Many screening methods are very good, but they must be effective. In the area of prostate cancer, for example, there are very effective methods today. I am not talking about the PSA screening mentioned in several motions, but there is a method called Stockholm 3 which is significantly more accurate.

However, two problems arise there. The first is the financing. It is unreasonable that in a situation where it is Socialstyrelsen, i.e., the state, that points out which screening methods should be used and which should not be used, it is not also a national financing. There are regions that do not have the money to introduce the screening programs that are medically justified.

The second thing is that there are also problems with the legislation. I mentioned Stockholm 3, where one combines a genetic marker for prostate cancer with looking at other things. There, Socialstyrelsen has stated that we in Sweden cannot use that method, because it conflicts with the Genetic Integrity Act. This is completely unreasonable to me. I do not believe that any human—or any man, I should say—who wants to take such a test thinks: This is not good to take, because it conflicts with the Genetic Integrity Act.

When the National Board of Health and Welfare made that observation, it was expected that the government would have immediately stepped in and said: This is unreasonable. We cannot have it this way. We must change this legislation so that we can use the best screening method for all men to detect prostate cancer early. But again: Nothing happens from this government's side.

Something else that has been mentioned here in the speaker's chair is that it is absolutely fantastic that we now have the opportunity to vaccinate away a very serious form of cancer, namely cervical cancer, which affects a number of women, sometimes even with a fatal outcome. Here we see a very large difference across the country in how many people are being vaccinated. This is also completely unreasonable. It is the same here: In a situation where the state says that we shall vaccinate away this form of cancer, it should be obvious that the state also finances it and, furthermore, Speaker, ensures that there are tools available to follow up on how successful the work is in the different regions.

The problem when it comes to vaccinations is that one must also reach the socioeconomically vulnerable people. There is not much science on how to do that. On the other hand, one must have a follow-up instrument so that the regions can quickly see how they succeed in reaching those groups in different areas.

This is an area where the government should act and act quickly. It is not acceptable to have a large difference in the country depending on where you live and which socioeconomic group you belong to when it comes to whether you are vaccinated against a serious form of cancer or not.

Finally, I want to bring up virginity tests, which have also been mentioned here. It is completely unacceptable that there are licensed nurses and doctors who engage in something as completely unscientific as what is called virginity tests and which, furthermore, Madam Speaker, is nothing other than a part of oppressing young women and trying to control their sexuality.

It has been said from this rostrum that a bill will be coming. We shall see when that day comes. Speed in this area is by no means something that characterizes this government. I would therefore like to move for the approval of our reservation 9, where we state that the Riksdag should sharply stand behind that this should be delivered now.

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Ulrika Westerlund (MP)

Madam Speaker! In my speech, I intend to spend some time on a very specific issue that I believe I will be alone in raising. It concerns our own motion, and I do not believe that anyone else has motioned on exactly this. Therefore, I take the opportunity now, so that we do not just repeat the same thing over and over again in this debate as well.

I want to raise the situation with donated sperm. This is something that has been widely noted in the media in connection with it becoming known that there are donors who have fathered a very large number of children. A man in the Netherlands is estimated to have over 500 genetic children after he donated germ cells to several different clinics.

In Sweden, a sperm donor may father children in a maximum of six families, partly to reduce the risk of genetic half-siblings meeting as adults and becoming parents together without knowing that they are closely related genetically.

Despite this regulatory framework, it has occurred that Swedish clinics have sold donated germ cells to clinics in other countries and also that Swedish clinics have purchased germ cells from other countries when there has been a shortage in Sweden. The effect of this is that for children born in Sweden after treatments with donated germ cells, there may be an unexpectedly large number of genetic half-siblings in other countries. Even though the risk of these people meeting each other as adults is smaller than if they lived in the same country, it can still mean a great emotional challenge to find out as an adult that one has a very large number of genetic half-siblings.

The association Femmis, which organizes people who have voluntarily become single parents through donation, has examples of members who have had children through treatment with donated germ cells in Sweden and who testify that they have encountered over 20 genetic half-siblings in Europe and that there are also half-siblings in more than five other families in Sweden. Both of these situations are effects of the fact that there is no national register. A Swedish clinic that purchases donated germ cells from another country does not know if any other clinic has done the same and happened to receive germ cells from the same donor. In that case, it does not matter if both clinics follow the regulations with a maximum of six families.

Femmis also points out, in a debate article in Göteborgsposten from last summer, that it is very important that children's right to information about their origin, in accordance with the Convention on the Rights of the Child, is ensured. Revelations in the media over recent years have shown that clinics, also in Sweden, do not always keep track of information about the donor and that children conceived through donation are thus denied this right.

Miljöpartiet therefore considers that a national register for gamete donors should be established.

Madam Speaker! I also want to raise something that some previous speakers have raised, namely screening programs for diseases and the importance of the regulations for these being updated and based on science and proven experience.

Miljöpartiet wants the upper age limit for breast cancer screening to be removed and that women over 74 should also be offered screening. At present, women over 74 die from their breast cancer in Sweden more often than younger women, and this is largely due to the fact that their cancer is detected later because they are not offered screening.

Another question that has also been mentioned by several previous speakers is the possibility of vaccinating against HPV. Miljöpartiet wants it to be expanded to also include young men and certain risk groups.

HPV is Sweden's absolutely most common sexually transmitted infection. At present, HPV vaccination is offered in grade 5 within the framework of the national childhood vaccination program, and additionally, an offer of vaccination has been given to young women. This is very positive, but the offer of so-called catch-up vaccination should also be given to all young men.

Transgender people, people living with HIV and men who have sex with men are affected by HPV to a much greater extent than the rest of the population. An expanded offer of vaccination would not only protect these individuals but also contribute to the eradication of cervical cancer through herd immunity.

Madam Speaker! Finally, I want to say something about maternity care. To secure maternity care across the country and improve the quality, Miljöpartiet wants a goal of one midwife per woman giving birth. To achieve this, continued investments are needed in paid further education for nurses and in improving working conditions and the work environment within maternity care.

We also want a safer maternity care in the whole country. Those who have a long way to travel shall have the opportunity to stay at a patient hotel together with their family before the birth for a longer period than today and, if needed, be offered transport to and from home.

We also want to review the possibilities of diversifying the range of care within maternity care. In those parts of the country where it may currently be a question of very long journeys to reach a hospital with a maternity ward, a clinic nearby, even without all the resources of an acute hospital, might perhaps feel like a better alternative for a woman who is expected to have a normal birth and has previously given birth without complications.

In considerations of how healthcare should be organized, different types of risks must be weighed. We would like to see Sweden appropriately take inspiration from, for example, Norway's organization of maternity care to see which parts of it can suit Swedish maternity care.

We will, of course, follow the government's work on this issue closely and see what we may eventually find lacking in the measures that are taken.

Madam Speaker! I want to mention a few more areas within sexual and reproductive health. The right to abortion must continue to be defended. It is a self-evident part of a feminist policy. We also want the right to abortion to be constitutionally protected.

I also want to say something about free contraceptives for young people, which is an important measure for good sexual and reproductive health. In our budget motion, we propose that funds should be allocated so that it becomes free for all young people under 26 years of age. We also want different types of free sanitary products to be offered through, for example, youth health services, schools, and other suitable locations.

Finally: We would like to see an investigation into midwives' prescribing rights, in order to improve care during abortion and for various conditions such as severe menstrual pain, endometriosis, and menopausal issues.

I move for approval only of Miljöpartiet's reservation 7, but I obviously stand behind all of Miljöpartiet's reservations.

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

Mona Olin (SD)

Madam Speaker! We are now debating the Social Affairs Committee's report number 16 Priorities in health and medical care. We in the Sweden Democrats stand behind all of our reservations but move here for approval only of reservation number 10.

Since 1997, the ethical platform for prioritization has been part of the Health and Medical Services Act. It governs how resources are distributed within public healthcare. The platform addresses three ethical principles for priorities in health and care and serves as a support in prioritization situations. The guidelines are based on three fundamental principles: the human dignity principle, the need and solidarity principle, and the cost-effectiveness principle. The Riksdag stood behind these guidelines at that time.

Healthcare is about the measures taken to care for those who are ill and about developing care. Care shall be equal, gender-equal, and accessible, and offered based on need on equal terms.

Madam Speaker! Regarding priorities, we believe that the priority within health and medical care must primarily be to address the deficiencies that exist regarding availability and competence supply, as well as to shorten the care queues and improve the conditions for the staff, both to retain those we have and to be able to recruit more.

I intend to touch upon different parts of the report, some a bit more than others. First and foremost, we see that there is a need for the government to review how continuous follow-up of care and treatment of asthma and COPD patients can be carried out. These diseases affect many people in Sweden and require a systematic and regular follow-up to ensure that patients receive the best possible care.

Furthermore, we want to highlight the importance of expanding and improving the national screening programs. We believe that the government should consider making it mandatory to also call women over 74 years of age for mammography. It is a measure that could save many lives through early detection of breast cancer. Additionally, we should work towards increased knowledge about risk factors and risk models to identify women at high risk for breast cancer.

Madam Speaker! We also mean that it is important that the government introduces more national screening programs to detect other serious diseases at an early stage.

The Sweden Democrats, together with the other government parties within the framework of the Tidö Agreement, have agreed on a number of priorities and reforms. Let me mention some of them.

The first is an updated national cancer strategy. Cancer is today the second most common cause of death in Sweden after heart and vascular disease. It is expected to become the absolute most common in the near future. To counter this development as well as ensure that people who are affected are given the opportunity to live a life of high quality, we need to strengthen cancer care and childhood cancer care.

Cancer is a disease that affects us all. The majority of all Swedes have been affected, will be affected, or have someone close who has been affected. Cancer care and childhood cancer care are of high priority for the Tidö parties. An important step in this ambition increase is to update the national cancer strategy. Waiting times within cancer care shall be shortened, and the cooperation and follow-up of the rehabilitation shall be strengthened.

Today's national cancer strategy has been guiding for the design of Swedish cancer care for nearly 14 years. Measures within the framework of the strategy have led to great progress within cancer care. Concentration of highly specialized care, the development of national care programs, and the introduction of standardized care pathways are just a few examples.

Madam Speaker! In order to ensure that Swedish cancer care and childhood cancer care have the prerequisites to meet even future challenges, the strategy will therefore now be updated. This is being done through the Tidö Agreement with further broad investments in, among other things, equal care, women's health, and maternity care.

Another important area of intervention in the agreement concerns ensuring that care for girls and women who have been subjected to sexual violence and genital mutilation is accessible, equitable, and knowledge-based.

There is much important in this report, but in conclusion, I shall touch upon our reservation which I initially moved for approval and which concerns the gender-affirming care.

After a long debate in the chamber, new legislation regarding gender identity was recently passed. It is expected to enter into force on July 1, 2025. This occurred after M and L submitted a proposal for a committee initiative in the Social Affairs Committee.

We were clear that we did not stand behind these changes and that we will continue to work to ensure that the increasing proportion who experience that they cannot identify with their gender actually receive the care they need. They should not undergo irreversible treatments without a proper investigation with requirements for mental stability, and no treatments should be carried out before the age of 25. That irrevocable interventions, such as surgery and hormone treatment, are today used as primary treatment methods is very concerning, not least when there is no full evidence for either risks or side effects.

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Ulrika Westerlund (MP)

Madam Speaker! I will not be long-winded, but I would like to hear how the member and her party view the fact that it is still normally doctors and healthcare providers who assess what care should be given, not legislators who, for example, set age limits for certain types of care.

In Sweden, we have recently decided that gender-affirming care shall become nationally highly specialized care. The National Board of Health and Welfare's knowledge support has been updated based on research and proven experience. Do the member and the Sweden Democrats believe that politicians, not doctors, should decide how the care shall be conducted?

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Mona Olin (SD)

Madam Speaker! Thank you for the question, Member Ulrika Westerlund!

I was asked whether it is politics that should set age limits for treatment in laws. It should not be, but that is what happens all the time, including when we set a limit of 74 years for breast cancer. It should not be there.

At the same time, we have decided that one shall be allowed to change their legal gender, which often leads to continued treatment based on a simpler assessment from doctors who do not even have the right to assess or question what the patients are actually suffering from. If a patient says that they want to change gender, the doctor cannot say no unless one finds very clear signs that it would not be so.

We mean that many who seek help suffer from several different diagnoses. One must be careful to investigate all diagnoses. Is it a depression due to gender dysphoria, or is it gender dysphoria due to depression, ADHD, or all the different diagnoses one can have? We mean that it is incredibly important to identify all diagnoses and treat them before proceeding with hormone treatments and other irreversible treatments.

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Ulrika Westerlund (MP)

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

I would really like to urge the member and her party to familiarize themselves a bit more with how this healthcare is conducted and what different effects can be seen. In Norway, for example, it has been possible to change legal gender entirely based on self-determination for almost a decade, and they note no increase in the number of people seeking or receiving gender-affirming care. On the contrary, a debate just as heated as the one here is taking place in Norway, which concerns the fact that there is too poor access and too long a queue for gender-affirming care, which is also put forward by various actors in Sweden. It has not been eased by the fact that it is possible to change legal gender. There is no such connection.

The National Board of Health and Welfare has clarified that care is not provided based on what legal gender one has, but an investigation is always conducted before treatment is given, regardless of whether the person has changed their legal gender or not.

I think we should show greater trust in doctors. That was also raised in the debate on the gender identity law. Even though it was about legal gender, it is the doctors' task to make assessments.

There are many examples of diagnoses and conditions that coexist with gender dysphoria or the need for gender-affirming treatment. There is nothing preventing all these conditions from being investigated simultaneously. Of course, people should receive help with all the problems they seek care for. If one suffers from depression, one should naturally receive help with that, but it is nothing that says one cannot be in need of gender-affirming care and simultaneously receive help with one's depression.

It is the doctors' responsibility to ensure that care is provided correctly. It is the doctors who assess who needs to receive a certain type of care. I think it is remarkable to say that a doctor would provide care just because someone says they want it. So that's just not how it works. Investigations are carried out, and then it is assessed who should receive what kind of care and what will be beneficial. That is also the case within gender-affirming care.

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Mona Olin (SD)

Madam Speaker! As I see it, this is about two different things.

One is the first basis that a doctor shall prepare when someone wants to change legal gender. There, I believe that doctors' hands are often tied by the fact that they are not to perform background checks or investigate how long it has been going on or how one lives and so on. I think that is a problem.

The second thing is that many young people with gender dysphoria seek out healthcare. It is not uncommon that they are prescribed hormones already at the first or second visit. I think that is a problem. It then turns out that young people who have not been treated with hormones but have received other care, when they reach adulthood, want to keep their original gender.

I think it is important to let children be children and become adults at their own pace. If they need help, they must absolutely receive all the care they can get to function and be happy.

The deliberation was hereby concluded.

(A decision was to be taken on 18 June.)

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