The National Audit Office's report on Lex Maria and Lex Sarah

Mikael Dahlqvist (S)

Mr. Speaker! The National Audit Office has examined whether the state's efforts within the framework of Lex Maria and Lex Sarah are sufficiently effective so that healthcare injuries and deficiencies within healthcare and elderly care can be prevented. We shall debate this report based on the government's communication and later make a decision on it today.

Lex Sarah is a collective term for provisions regarding the obligation for staff to report, investigate, and address misconduct and tangible risks within the operation, while it can be said that lex Maria is primarily used by the employer to report to Ivo if there are risks in the operation or if things have happened.

Mr. Speaker! We Social Democrats agree with the National Audit Office's overall conclusion that the state's efforts to prevent healthcare injuries and irregularities are not sufficiently effective. But we have chosen to make a specific statement where we argue that more resources from the state are needed for the regions and the municipalities. It concerns both the healthcare crisis and the challenges that we know exist within elderly care.

The fundamental problem is that the welfare system is currently underfunded. The Government and Sverigedemokraterna argue that more money is not needed for the municipalities and regions, but that they must manage with the amount in the proposal for next year's state budget.

I also want to announce that in the coming days, a debate article will be published from all unions involved in elderly care within the municipalities, regarding the lack of resources. A looming crisis is seen within elderly care. It is therefore not only healthcare that is affected, Mr. Speaker.

Of course, one becomes concerned about the serious observations regarding the operations. What concerns me most is the underreporting of healthcare injuries and substandard conditions to Ivo. Specifically, this means that on the one hand, the individual or relatives do not receive redress, and on the other hand, there is no tool to prevent it from happening again and to ensure that the correct measures are taken. That which is not reported simply does not exist on paper. It is a serious concern.

It is also about deficient information and participation for relatives and other close ones. That is also concerning. How can valuable information and knowledge from those affected and their relatives then be taken into account? Furthermore, we know that trust and confidence are created through an open dialogue between the care provider, the care recipient, and relatives.

Mr. Speaker! Last but not least, another problem is raised in the letter. It is that the state today does not know exactly how much healthcare injuries or substandard conditions cost. In addition to the catastrophe it represents for the individual, we also do not know how much money it involves. According to the National Audit Office, sufficient knowledge is often lacking today.

In the report, a number of recommendations to the government are also given. I briefly note that the government makes a different assessment than the Swedish National Audit Office regarding measures.

Here, the government refers to a number of reforms that strengthen elderly care, which is pleasing. But those reforms were what we, the social democratically led government, highlighted. I am thinking of the Elderly Care Boost (Äldreomsorgslyftet). As recently as this spring, the government did not include an extension of it in its budget. Now, thankfully, they have changed their minds. I am also thinking of the protected professional title for nursing assistants. The list can be long of products that the S-led government launched. We Social Democrats truly took the initiative to lift up and develop elderly care.

Mr. Speaker! I am, however, a bit concerned in the speaker's chair today. We took a special initiative to enact an elderly care act. At the Social Affairs Committee meeting on November 23, we received information from the government's representative that the government does not intend to proceed with that investigation. It would be interesting to receive a statement from the government's representative in the chamber regarding what stands in terms of that legislation. It is another step toward achieving a qualitative and good elderly care.

Mr. Speaker! In conclusion: The basis for our special statement on the letter is based on several forecasts and reports that we have all received. We know that the future needs of the municipalities to meet the challenges within elderly care are great.

In addition to what has been stated regarding the state's efforts, we believe above all that a general resource supplement to elderly care is needed in order to be able to increase staffing and competence within the operations. More employees reduce the risk of stress-induced mistakes. A fundamental prerequisite for being able to provide good care and nursing is to have well-motivated and well-educated employees who also have a good working environment and good conditions. It becomes a guarantee for meeting the demographic development and improves the quality for the individual.

We also want to refer to our previous committee motion regarding resources for welfare in general and for healthcare and elderly care.

(Applause)

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

Thomas Ragnarsson (M)

Mr. Speaker! Thank you for the speech, member!

As soon as there are problems in an organization, one always starts talking about money, the lack of money. We must not forget that our regions and municipalities have had quite substantial surpluses in recent years. There is, therefore, a fair amount of money.

Furthermore, the government has allocated 16 billion in the budget to the regions and municipalities. I am fully aware that those funds are not enough to go all the way. But at the same time, we are in a situation of economic crisis, not just in Sweden but globally. In that case, one must sometimes make do with what is available and adjust one's mouth according to the wallet one has.

It is about priorities. In this country, we are not very good at prioritizing, we just want to continue as we always have. We will not be able to do that.

I have a question. I do not know what the demographics look like in Värmland; I come from Småland and Kronobergs län. Our demographic figures do not look particularly fun. We have a shortage of staff today. To shoot for the average is laudable, but from where are we going to get the staff who are going to work? They simply do not exist. And if we count forward a number of years, entire retirement classes in the country will need to work within the welfare sector.

Is it the solution to the problem? Or do we need to think and act differently regarding the welfare of the future – the healthcare and the care?

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

Mikael Dahlqvist (S)

Mr. Speaker! Thank you, Thomas Ragnarsson, for the question!

It is clear that more resources do not solve all problems. It would be naive of me - of us - to believe that. But right now, there is a radical difference - it is actually something we Social Democrats identified already several years ago. Besides underfunding in recent years, despite the fact that we have injected funds, there is a cost crisis in society. It is an enormous inflation, which everyone knows about, and an enormous interest rate development.

The pension agreements for municipalities and regions, which the member surely is well aware of, are in themselves good for the employees, but that is the basis. There, we are not talking about a single million, but about billions that are missing.

We Social Democrats assert firmly that it will get worse and that the quality will also drop. There is always a critical mass when it comes to how many employees are needed at a workplace. There is also a critical mass for how educated one is. It is of course generally true that with a higher level of education and motivated employees who have plenty of time, fewer mistakes occur. There are heaps of reports about that.

The government and the opposition may have different views on this. We consider it to be a major deficiency.

Mr. Speaker! When it comes to the solution of the demographic problem, which the member asked about, Värmland is right in the middle of the hump. Briefly, I can say that it is clear that better conditions can be created for the staff to work within elderly care through better working conditions, a better work environment, and increased co-determination, but then more money is needed. If we cannot solve it, this problem will become even larger.

(Applause)

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

Thomas Ragnarsson (M)

Mr. Speaker! I come from the health and medical care sector and have worked, I would like to assert, for a fairly long time within the care system. I grew up there with the idea that one has almost made it a point of pride not to stick to the budget. Sometimes there has been very little money that has been spent in budget deficits, but nevertheless, one has not stuck to the budget.

I believe we need to get better at both the municipal and regional levels at really looking at what money we have and what we can do. As I said before, we are bad at prioritizing. It is difficult to prioritize, and it often happens in the debate when one starts talking about the heavy economy and the lack of money that it directly translates into believing that one must lay off nursing assistants and nurses, who are important for healthcare. Who has said that? I have never heard from a political standpoint that when a region is to make a saving, it should hit the nursing assistants.

Within municipalities and regions, the administration has grown somewhat copiously during the last decades. Perhaps it is so that we cannot afford all the administration we are engaged in today? Much of it is justifiable, but in this situation, perhaps we must look at what the core activity is and what is most important. I dare say that most nurses and nursing assistants would answer that it is the patient. We should be very happy about that.

We must dare to prioritize, because if we inject new money now, it will be the same next year, and the next, and the next.

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

Mikael Dahlqvist (S)

Mr. Speaker! Thank you, Thomas Ragnarsson, for the comments. I did not perceive any concrete question.

I also have a background in healthcare, which the member is aware of. I also have a background as a municipal councilor, so I believe I have a fairly good picture of what the economy looks like. Furthermore, I represented a municipality that was enormously poor, especially during the previous crisis in the 2010s when we were governed by the Alliance government. It was roughly the same reasoning then; we had to manage on our own. I was involved in cutting the operations by 30 percent. That is how bad it was. But that is another story.

It is a matter of having two balls in the air. I said that money does not solve all problems, but today, I contend that healthcare and elderly care face such challenges that they do not even manage the basics. This means that there has been a status downgrade everywhere within healthcare, but above all within elderly care and LSS. And what is the reason for that? Well, we contend that it is often due to poor working conditions, a poor work environment, and that the staff are not allowed to be involved in influencing things. They are not given the mandate to influence their workplace.

I believe that the basic prerequisites must be corrected here and now in order to solve the skills shortage. I also share the member's view that, in parallel with providing economic resources, one must of course review the administration and governance, because there are clearly a lot of things that have happened over the years that may not have benefited the patients. I share that view, but right now we are facing a cost crisis. I note that the government has chosen to prioritize other investments in society, but we Social Democrats choose to prioritize welfare.

(Applause)

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

Karin Rågsjö (V)

Mr. Speaker! The previous speaker has already described that Lex Sarah is in the Social Services Act and in the Act on Support and Service. It has received its name from the nursing assistant Sarah Wägnert, who revealed neglect at her workplace in 1997. The provisions mean that staff in certain operations are obliged to report irregularities. Lex Maria is used by healthcare providers who are to report healthcare injuries.

Mr. Speaker! It is quite interesting questions we are going to debate today. The National Audit Office has examined whether the state's efforts for Lex Maria and Lex Sarah are so effective that healthcare injuries and irregularities are prevented within healthcare and social services and whether one fulfills one's responsibility towards individuals in healthcare and elderly care. The answer to the question is an absolute no. It is very sad.

Do you remember Attendos' nursing home in Sabbatsberg in Stockholm? There, the residents suffered at least poorly during the pandemic. The deficiencies in care were so extensive that two representatives for Attendo were convicted of crimes. That case shows how important it is that operations and employees can report and do report. The patients and relatives should feel that their situation is taken seriously.

Regarding the pandemic, I must say that it seems that all knowledge from the pandemic disappeared from the government's and even SD's work tables when they submitted their budgets, which we will discuss on December 12. I will therefore not go into it in depth now, Mr. Speaker.

It is obviously the staff that one has to work with, for example within elderly care. If you cut back, as you are doing now, the conditions become very poor. If you also do not produce any elderly care act, as was intended, perhaps the conditions will become even worse. There are many discussions we are to have from now on.

Mr. Speaker! I turn to today's debate. The Swedish National Audit Office's overall conclusion is that the state's efforts are not effective for healthcare and care activities for the elderly to prevent healthcare injuries and malpractice. The Swedish National Audit Office considers that there is a lack of national governance with a clear objective to reduce the number of malpractice cases within elderly care.

Socialstyrelsen does not have the same knowledge about irregularities and what needs to be developed to strengthen the work of preventing irregularities within elderly care as it has within health and medical care. We must therefore do something radical here. We eagerly await that in the coming years.

The agencies should, according to the Swedish National Audit Office, be given an expanded responsibility to inform individuals and their relatives and to give individuals and their relatives an opportunity to provide their account of an event and what is happening – to take them seriously, quite simply.

The organization's responsibility is, according to the National Audit Office's assessment, not sufficiently regulated. Clearer governance was needed. It cannot be free play, so to speak.

We therefore consider that the individual's position should be strengthened in the provisions of lex Maria and lex Sarah and that the responsibility of care and nursing activities to inform individuals and their relatives should be expanded. It is extremely important that one, as both a relative and an elderly person, feels that the individual's life counts, that if something happens I can report it, and then something happens on the other side. It simply does not remain silent.

In order for the increased responsibility according to the provisions to lead to real results, for that is what we want to see, it is also required according to the Swedish National Audit Office that there is an organizational culture - which, therefore, did not exist at Attendo - to base actions on events and highlight them in a different way, to listen to the elderly and the sick and take them seriously. I move for approval of reservation 2.

I also want to say with emphasis that one may certainly think that money means nothing and that one can cut back on administration. I must nevertheless say that within elderly care, it is not teeming with administrators, but it is about hands and feet and trained staff on the floor.

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

Mona Olin (SD)

Mr. Speaker! Today we are debating SoU5 Riksrevisionen's report on lex Maria and lex Sarah. I would like to begin by moving to approve the committee's proposal in the report.

The Sweden Democrats also welcome the National Audit Office's review and consider it an important contribution to the ongoing work being carried out in order to improve care and nursing for the elderly. At the same time, I want to highlight the specific statement that the Sweden Democrats submitted in the matter and advocate for this.

The care and nursing of the most fragile and sick elderly must be permeated by human empathy, safety, trust, and quality. Everyone has the right to safe care and good treatment, in the whole country, in all regions and from north to south.

It is clear that we need to maintain and significantly increase the quality within healthcare and elderly care and also ensure good competence among the staff. Both the state, the principals, and private providers must, in cooperation, take long-term, sustainable measures to promote the supply of competence.

Mr. Speaker! It is noticeable that the government, in cooperation with the Sweden Democrats, has had its ear to the ground and perceived risks and weaknesses and therefore also initiated many important measures to specifically ensure the quality within healthcare and elderly care.

A parliamentary committee has been tasked by the Sverigedemokraterna and the government to prepare a decision basis that makes it possible to introduce, step-by-step and in the long term, full or partial state ownership for health and medical care. This, Mr. Speaker, I believe is absolutely crucial for Swedish healthcare to be able to be strengthened and function as it should in a welfare country like Sweden.

The elderly care boost continues in 2024. By investing in competence-strengthening measures for the staff, the quality within elderly care and elderly services is raised so that the elderly and their relatives feel increased security and are given good care. It also facilitates the organization of the work and enables other ways of working, for example, teamwork.

The title undersköterska (assistant nurse) has been a protected professional title since 1 July 2023. The protected professional title is important for raising the status of the profession and for ensuring the competence of the professional group, which in turn will result in the quality of care being raised.

Furthermore, we have the national action plan for increased patient safety. Socialstyrelsen has a mandate to coordinate efforts for the implementation of just this until 2024. From Socialstyrelsen, guidelines, knowledge support, training, and manuals are also provided with support to the operations on how individuals and relatives should be informed and involved in the event of a healthcare injury or malpractice.

Mr. Speaker! In the report Next steps - Increased quality and equality in care and services for elderly people, it is proposed, among other things, that the social committee shall annually establish a quality story describing how the work to systematically develop and secure quality within elderly care has been conducted, what measures have been taken to ensure the quality of elderly care, and what results have been achieved. We believe, like the government, that there is therefore no reason to, as the National Audit Office recommends, take the initiative to develop an additional national action plan.

It is part of the Socialstyrelsen's mandate to continuously update and develop the support regarding lex Maria and lex Sarah, and Socialstyrelsen is carrying out a review during 2023 of the authority's regulations and general advice regarding specifically lex Sarah. Sverigedemokraterna agrees that it is therefore not currently justified to take any action to strengthen individuals' position according to lex Maria or lex Sarah, but instead prioritize measures that promote that the rules are followed in practice.

With this said, Mr. Speaker, I note that the Sweden Democrats share the view that there is currently no reason to take further measures but consider it important that all measures taken are followed up, evaluated, and reported back.

Swedish healthcare should be world-class. We have a long way to go, but every day the Tidö parties take important steps in the right direction.

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

Christofer Bergenblock (C)

Mr. Speaker! Thank you very much, Member, for the speech!

Much attention is drawn to the need for skills supply and the need for increased quality within elderly care. The member also highlights that many measures are being taken from the government's side.

One of the important contributions that we have been waiting for in the Social Affairs Committee is the one concerning a new elderly care act. The establishment of a new elderly care act was an issue that appeared many times during the election campaign, Mr. Speaker, and in a survey from SPF Seniorerna, the Sweden Democrats respond as follows: "We welcome an elderly care act that marks the distribution of responsibility and how the care of our elderly shall become better. The problem is that the quality of elderly care varies greatly across the country, which is not how it should be. Furthermore, it is important to us that the law becomes a rights act, which means that the elderly have a right to certain interventions. Additionally, we believe that the concept 'reasonable standard of living' does not go far enough and we prefer the concept 'good living conditions'."

It is no small request that the Sweden Democrats are putting forward regarding an elderly care law, but rather many steps forward.

That is why it was so surprising when we in the Committee on Welfare and Health, at a meeting last week, were told that the entire idea of a new elderly care law has been scrapped by the government parties together with the Sweden Democrats. It would be interesting, Mr. Speaker, to hear why the Sweden Democrats want to scrap the idea of a new elderly care law.

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

Mona Olin (SD)

Mr. Speaker! Thank you for the question, member!

The Sweden Democrats always want to work to ensure better and increased quality in healthcare and elderly care. In our motions, we have previously written that we want an elderly care law and that it should be a rights law. We have also put forward these requests in discussions with the Tidö parties. But it is a cooperation that no single party can control.

However, we also welcome continued discussions with the Tidö parties about making it a rights law. Surely there is no one in here who does not want to change reasonable living conditions to good living conditions. It should be a self-evident matter for all elderly people in our entire country to receive that right.

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

Christofer Bergenblock (C)

Mr. Speaker! If one wants to change the wording from reasonable standard of living to good living conditions in an elderly care law that will never become a reality, one can certainly work for that. But it is not likely to yield much.

It is very surprising that the Sweden Democrats, who pushed so hard on these issues during the election campaign and were so clear, I would almost say clearest, about how important it was with a new law now say that it is a negotiation issue. "Here we have not reached all the way. Here we have not succeeded."

Has the issue even been negotiated at all? We all know that in the Tidö Agreement, elderly care took up a short piece of text of a couple of sentences in a 60-page document. Elderly care was the least important area at all when the Tidö parties sat and negotiated Sweden's policy during this mandate period. It is very clearly noticeable.

Mr. Speaker! It will be very strange for the voters to hear one thing during the election campaign and a completely different thing when the election is over and one sits in the Swedish Parliament and decides and has a strong influence over the government.

I still think, Mr. Speaker, that there is a lack of a clear answer as to why the Sweden Democrats have agreed to change their minds regarding a new elderly care law. It would guarantee exactly what the member highlighted when she gave her speech earlier about strengthened quality within Swedish elderly care.

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

Mona Olin (SD)

Mr. Speaker! We are continuing the investment in Äldreomsorgslyftet during 2024 with 1.7 billion kronor just to strengthen the quality of elderly care and develop ways to work so that they have a very good life.

We have introduced a protected professional title for nursing assistants. We also have a national action plan for increased patient safety. The rules and regulations for lex Sarah are also being reviewed within the Socialstyrelsen.

We within SD have not changed our opinion on an elderly care law, absolutely not. But right now we see that there are very many interventions ongoing. We have absolutely not laid down our question of an elderly care law as a rights law.

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

Karin Rågsjö (V)

Mr. Speaker! It may sound like the Sweden Democrats have a very small and obscure role among the Tidö parties and no power. It is obvious that you have it in all other issues.

But in the questions concerning welfare, it is obvious that you stand on a completely different side. It is about less money for welfare, less money for elderly care and so on.

Mr. Speaker! It happens again. One can say one thing before the election, like at a market where one pitches fine things to the voters. After the election, none of that applies. I think it is embarrassing. We will be talking about this until the next election. It is important to stand by one's word.

The Sweden Democrats have long considered themselves a welfare party. You have, in any case, spoken about it. But we can probably forget that now, I believe. I wonder, just as the previous member did, why we, apart from just in a small passage in the Social Affairs Committee, have not found out that there will be no elderly care law.

What did it amount to then? That is what I wonder. Very little money was allocated to elderly care. You learned nothing from the pandemic, and there will be no elderly care act. What is it going to be?

What questions will you bring into the cooperation you have with the government? You are responsible. It is not that you stand on the sidelines. You are responsible for the policy.

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

Mona Olin (SD)

Mr. Speaker! Thank you, Karin Rågsjö, for the question!

The Sweden Democrats, as is well known, do not sit in the government. We are a cooperation party in the Tidö Agreement. We work very much to get our policies into the Tidö cooperation.

As I said, it is a continued investment in the Äldreomsorgslyftet at 1.7 billion. I do not think that not providing any funds so that the elderly can have it well is [correct].

We have many different initiatives ongoing right now to ensure that the elderly are well-off, just as I recently highlighted in the previous exchange. We have the national action plan for increased patient safety. We have a report that is the next step, Increased quality and equality in care and nursing for the elderly. There, the quality work in the municipalities is to be developed.

We have another report, Sustainable Social Services - A New Social Services Act. There, it is proposed that activities within the social services shall be of good quality and that the activities shall be conducted in accordance with science and proven experience, and that the quality of the activities shall be systematically and continuously monitored, developed, and secured.

I absolutely believe that we are working with politics that improves the situation for the elderly.

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

Karin Rågsjö (V)

Mr. Speaker! Thank you, member, for the answer!

I believe that the Sweden Democrats have an enormous opportunity to steer the politics with the government. You are present at every press conference that the government has. It is not the case that you sit in a closet and wonder what is happening, but you are on the field with the government.

When it comes to Äldreomsorgslyftet, we were one of the parties that participated in negotiating it during the last parliamentary term. It was good that those funds were allowed to remain. They were probably quite loosely allocated, I believe.

Then there is another question. It concerns the staffing moving forward. Who shall work within elderly care? A small investigation came out the other day, Mr. Speaker. It turns out that eight out of ten unaccompanied minors work within health and care. One can wonder about that. They are the ones who may eventually be deported and so on.

Mr. Speaker and members! If we are to manage the entire elderly care and healthcare, we must have an influx of just immigrants. I wonder anxiously how we are going to be able to fix that. How are we going to be able to look at the issues of healthcare injuries and so on if one simultaneously has a vision that we should have as few immigrants as possible? Who will then do this job?

Who will want to work in elderly care? Who will want to help all elderly people in different ways? It turns out so clearly that we in Sweden are completely dependent on those who have come here.

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

Mona Olin (SD)

Mr. Speaker! Thank you, Member, for the question! Karin Rågsjö speaks about that we should ensure the growth of personnel within elderly care. Sweden needs to promote the conditions for those healthcare providers who want to contribute to meeting the healthcare needs by reducing healthcare queues and by being innovative. In the situation that Swedish healthcare finds itself in, we believe that we must focus on creating good conditions for cooperation between public and private healthcare in order to achieve equitable care.

We and the government have tasked a special investigator to analyze and produce proposals on how requirements for knowledge of the Swedish language for staff in elderly care can be regulated. It is very good that we have received many immigrants who work within elderly care, but the main purpose of setting requirements for language skills is to guarantee patient safety. Nils, 88 years old, who has home care, does not feel secure not understanding what the home care staff says. It is an important part of increasing the quality of elderly care.

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

Mikael Dahlqvist (S)

Mr. Speaker! Thank you, Mona Olin, for your speech! Some of what I intended to ask the member has already been raised in previous replies, but I will try to highlight it a bit from other angles.

First and foremost: When it comes to the Sweden Democrats' role in the government, I think it is important that we clarify for the voters that the Sweden Democrats are the largest party in the government base. Furthermore, you have a solid Tidö Agreement, and as was mentioned earlier by a member here, elderly care is not directly prioritized there. The Sweden Democrats have obviously chosen to prioritize issues concerning migration and crime-fighting measures.

Previously, the Sweden Democrats have been able to say, rightly so, that they have no influence and that they sit in opposition. They have claimed many different things, Mr. Speaker, here in the chamber. But now it is a fact that the Sweden Democrats are a decisive basis for us having a bourgeois government. We also have a government office where you convene on every issue. I therefore want to put that myth to rest.

I would like to ask the member of Parliament two questions. I am glad that you refer to several reforms that the S-led government initiated and continued with. That is good. But what is the current government doing? You refer, among other things, to a government inquiry. But what does that help with here and now when it comes to healthcare injuries and poor conditions in the working environment? It might be finished in three or four years, Mr. Speaker, if there is even any finished product at all.

I would like to hear what the government is doing here and now and what the Sweden Democrats are doing to counteract the care crisis that is beginning to loom on the horizon.

Finally: Does the member believe that more money is needed for Swedish elderly care in the future?

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

Mona Olin (SD)

Mr. Speaker! Thank you, Mikael, for your questions! It is true as you say that the Sweden Democrats have a role in the government's governance. That is true. We are the largest party in the Tidö Agreement group. That does not mean that we sit in the government. We have a role in the government cooperation, and we have a Tidö Agreement that we adhere to. This applies to all parties that are part of the Tidö Agreement.

However, there is nothing that says that the Sweden Democrats cannot conduct politics outside of the Tidö Agreement that are not covered there. We are free to conduct politics even outside of the Tidö Agreement, which we also do.

A government investigation takes time. You wonder what kind of things we are doing here and now. One can wonder that, but I can think that things could have been done earlier – before we ended up here and now. The investigation that we have discussed here today is based on information from the previous government's table. It is not quite right to direct criticism at today's government for how things looked during the previous government block's time.

We are taking many measures, and we are working hard to ensure that things are resolved here and now and for the future.

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

Mikael Dahlqvist (S)

Mr. Speaker! Thank you very much, Mona Olin, for your answer! I still think that we need to reason a bit more about the Sweden Democrats' role in the government. It is exactly as the member says: You are not in Sweden's government.

But you are still the largest basis for the premise that the government came to power. You have together agreed on an agreement and which issues are prioritized during the mandate period. Elderly care is not prioritized by the government or by Sverigedemokraterna; that can be read from the Tidö Agreement. I still think that we should be in agreement on that.

Mr. Speaker! We received a lot of criticism during the previous parliamentary term when we were in government and cooperated with different parties. I have learned during my political life that if one cooperates, one is in agreement from an outside perspective. Then one participates, and then one prioritizes. That one might then not get exactly what one wants is another discussion.

I dare to assert, however, that if the Sweden Democrats had truly wanted to elevate Swedish elderly care, one would have reached a completely different agreement. Instead, they focus on immigration issues and the like.

The opposition asks what we have done. It was a very grateful question to receive! We have done an enormous amount. We gave historically large grants to the welfare system during the previous mandate period, which ensured that neither regions nor municipalities had any concerns regarding the financial part. It was a deliberate strategy to manage the pandemic given the serious situation that prevailed.

We launched many of the reforms that the member refers to. It was the Social Democratic-led government, together with the coalition partners, that came up with them. Furthermore, in our budget committee, we have highlighted the need for specific funds for elderly care as a sector.

But you are tearing up the elderly care legislation, which we consider to be one of the most important reforms that we launched.

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

Mona Olin (SD)

Mr. Speaker! The Tidö Agreement is an agreement that is very large, Mikael, and which has very many points. It is also a living document that we work on updating every year, and then one has to take one thing at a time. We chose to take that which was highest priority and which could solve many difficult questions in our country. We continue to work with our policy within the elderly care area.

Mikael wonders how we are to make the money last within regions and municipalities. You also said that you gave historically large grants which meant that no regions and municipalities had problems with the finances. I have probably never heard a region say that they have no problems with the finances.

As I see it, there are different ways to work. One might look at how the organizations are structured. One should ask what the core activity is, concentrate on it, and change the administrative side of the operations so that one primarily works with the core activity and the patients.

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

Christofer Bergenblock (C)

Mr. Speaker! Initially, I would like to move for approval of the Centerpartiet's reservation 1 under point 1 regarding state management for increased quality in healthcare and care for the elderly.

The report that the Swedish National Audit Office placed on the table at the beginning of the year regarding the state's work against healthcare injuries and deficiencies within elderly care and nursing should have hit like a bomb, but it did not because we already knew that it looked bad. Both the Corona Commission's partial report in December 2020 and the final report in February 2022 show that there are major problems within Swedish elderly care and that these must be taken seriously.

This is confirmed and specified in the National Audit Office's report, which we are debating here today. Well - it is not the report itself that we are debating, but the conclusions, or possibly the lack of conclusions, that the government has drawn from the report and which appear in the Social Affairs Committee's report. The National Audit Office, in fact, leaves a scathing criticism of the state's work to prevent healthcare injuries and irregularities. The audit that the National Audit Office has conducted is based on Lex Maria and Lex Sarah reports made within healthcare and elderly care, whose purpose is to capture, investigate, and remedy incidents that have caused, or could have caused, a healthcare injury or an irregularity.

Care is provided, as everyone knows, mainly by municipalities and regions, but the state has a responsibility for standardization, supervision, support, and follow-up. And it is also there that measures can be implemented from the state's side.

Mr. Speaker! The National Audit Office highlights a number of deficiencies but also presents proposals for measures to address the problems. I shall highlight some of these.

Firstly, the Swedish National Audit Office notes that one of the major overarching problems is that it looks different across the country in terms of how quality work within elderly care is viewed and thus the work of preventing and counteracting healthcare injuries and substandard conditions. For that reason, it is proposed that national governance should be increased, for example through a national action plan.

A national action plan for increased patient safety within healthcare already exists today but is missing within elderly care. We from Centerpartiet therefore propose that a national action plan for increased quality within the care of our elderly should be developed.

Secondly, Mr. Speaker, the Swedish National Audit Office notes that there are problems with individual care recipients and relatives not being involved to a sufficiently high degree when Lex Maria and Lex Sarah reports are made. This is problematic, partly because there is a risk of missing important perspectives on what has happened, and partly because it is important for the individual and their relatives to be able to describe their own experience of what has happened in connection with a healthcare injury or a malpractice.

Even more important, of course, is that the information is communicated to individuals and relatives when a report is made. It has unfortunately been shown in the Riksrevisionen's report that this is far from a given.

From the Center Party's side, we therefore propose that Socialstyrelsen shall be tasked to develop support for the elderly care activities on how to work with information and participation, and authorize Socialstyrelsen to set mandatory requirements that individuals and next of kin must be informed and involved in connection with reports.

Thirdly, the Swedish National Audit Office notes that there are deficiencies in the supervisory authority Ivo's work in following up on activities within municipalities and regions. In order to follow up on healthcare injuries and conditions of neglect within healthcare and elderly care, it is required that Ivo has both sufficient knowledge and capacity. Ivo should also not only follow up on the primary bodies that report Lex Maria and Lex Sarah notifications, but also those that rarely or never do so.

A well-functioning supervision should lead to increased quality with fewer healthcare injuries and substandard conditions, but the prerequisite is, of course, that Ivo manages his assignment. From the Center Party's side, we want to review whether Ivo has sufficient resources to audit and follow up on the quality within healthcare and the care of our elderly.

Mr. Speaker! In summary, I can state that the National Audit Office has issued sharp and justified criticism regarding the state's efforts to prevent and avert healthcare injuries and deficiencies within Swedish elderly care. From the Center Party's side, we view the measures that the government has taken positively but argue that more needs to be done.

We want to see a national action plan for increased quality, we want to increase the requirements for information and participation in connection with reports, and we want to investigate whether Ivo has sufficient resources for the review of quality within healthcare and the care of our elderly.

At its core, it is about everyone who gets older having a self-evident right to feel secure with the care and support that society offers. It should be a matter of course.

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

Thomas Ragnarsson (M)

Mr. Speaker! Today we are debating the report SoU5, the National Audit Office's report on lex Maria and lex Sarah. And I would like to begin by moving for approval of the committee's proposal for a decision.

Mr. Speaker! It is quite tragic that one should have to enact laws at all to prevent healthcare injuries and malpractice within healthcare and the care of the elderly. The laws have been introduced for a reason, and it is my conviction that these laws have played an important role in the work for our patients and elderly care recipients. They have formed the basis for the systematic work for the patients and have been guiding in the creation of routines and processes.

Mr. Speaker! The National Audit Office, in its review of these laws, has concluded that there are deficiencies in the state's efforts against healthcare injuries and substandard conditions, and it has also submitted four recommendations to the government on what it considers needs to be done.

The recommendations include, among other things, the national management, the experiences of the individual and relatives of the incident, the development of a common support system for information to and communication with those affected and relatives, as well as assigning the task to an appropriate actor to calculate the cost of healthcare damages within healthcare and conditions of neglect in elderly care.

Mr. Speaker! There is probably no one who does not agree with the deficiencies that the Swedish National Audit Office describes in its review, but that does not mean one has to agree on which measures need to be implemented. There are often several solutions to a problem, and the government describes this with all clarity in its response. There is already ongoing work on increased state governance, continued investment in Äldreomsorgslyftet, the introduction of a protected professional title for nursing assistants, and the establishment of a National Competence Center for Elderly Care at the National Board of Health and Welfare. There will also be a new Social Services Act that will strengthen national governance and in that way benefit the care recipient.

Mr. Speaker! The position of the individual and their relatives must be central in connection with healthcare injuries and malpractice, and there is currently great support for this in the regulations that exist in the area, but it may be the case that the operations do not fully follow these routines. Socialstyrelsen is therefore carrying out a review of these regulations during this year, and the result of this will, of course, be taken into account by the government.

Mr. Speaker! We know through previous smaller calculations that healthcare and care-related injuries cost enormous amounts of money. Therefore, it is not a priority to perform such a calculation again. The result would not be relevant because we know that there is a large dark figure within these areas and the purpose would then miss the mark. It is enough that we know that these conditions cost a lot of money, money that we could use in a better way if we minimize this type of conditions and injuries.

Mr. Speaker! We have functioning laws in the area today, and there are clear guidelines for how they should be interpreted and implemented. Despite this, there is underreporting, and incidents do not receive the attention and investigation they deserve.

I see this as a major problem. The question needs to be raised and discussed. Why do staff choose not to report incidents? Are they afraid of reprisals, or is the system where they are supposed to report inadequate? Is the incident analysis work perceived as too time-consuming in relation to what the change leads to, and are there economic priorities in the operations that mean no time is allocated for this purpose? My answer is: I don't know.

Mr. Speaker! What I do know is that we who work within these operations spend endless time on over-documentation, not for the patient's or the healthcare recipient's sake, but for our own sake in the event that it should become a reporting matter. Documentation is obviously important, but it must be value-creating for the patient.

How this feeling has arisen among us in the staff is very unclear. Is our authorities' follow-up perceived as accusatory and judgmental? That is not the intention of the legislation. The intention is that we should minimize mistakes and irregularities that are uncovered so that no further patients and healthcare recipients are affected.

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

Christofer Bergenblock (C)

Mr. Speaker! Thank you, Thomas Ragnarsson, for the speech!

In his speech, the member highlighted a number of measures that the government proposes and which are included in the report to improve the care of the elderly and the state governance of care. The elderly care boost was highlighted. Protected professional title for nursing assistants was highlighted. National competence center was highlighted, and it is a really good measure.

In the report, the SOU titled Nästa steg - Ökad kvalitet och jämlikhet i vård och omsorg för äldre personer is also highlighted. When I read the report, Mr. Speaker, I saw that there was a short description but that the word äldreomsorgslag was not mentioned. It is this investigation that is about a new äldreomsorgslag. I thought that it was not a matter of having changed one's mind on the issue, but merely that the text was devoted to describing the content instead. But now it has emerged that it is a changed position from the government and also from M.

The Moderates also responded to the SPF survey during the election. It was the current Minister for Health and Social Affairs, Camilla Waltersson Grönvall, who responded to the survey and was positive towards the establishment of an elderly care law in Sweden. Now, it is clearly a different tune. But it is Camilla Waltersson Grönvall and Anna Tenje, Moderate ministers, who have the responsibility to potentially submit such a proposal.

Mr. Speaker! Why have the Moderates, I wonder, changed their minds regarding an elderly care law?

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Thomas Ragnarsson (M)

Mr. Speaker! That is a good question. We are currently working on a transition process regarding a fairly large number of laws. We have a new Social Services Act which will also, to some extent, include our elderly citizens.

In that situation, having a whole host of new laws to be created that might overlap each other, I do not think is either relevant or particularly smart. If one does the work and gets a new social services act in place that we actually see benefits the area, maybe we do not need an elderly care act. The Social Services Act is not quite in place yet, but if we see that it is not sufficient, we have to look at the issue again and see what needs to be done.

We have great confidence in documents, laws, and different types of guidelines for how we should work. For me, it is more important that the things we do actually achieve relevant impact.

It concerns, for example, action plans. I believe that the member is also quite aware that we have a fair amount of action plans. Some of them are fantastically good, but others are completely meaningless. No one implements them in their operations. It becomes, as I sloppily put it, a cliché that could be embroidered and hung as a painting on the wall.

If we are to have action plans, they must be good action plans. When it comes to action plans for elderly care, I feel that it might not be the right time to present them just now while Socialstyrelsen is carrying out its work.

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Christofer Bergenblock (C)

Mr. Speaker! It still feels reassuring that the member has great confidence in documents and laws, considering that it is precisely legislation that we engage in in this assembly. Anything else would have been strange.

The question remains regarding this with a new elderly care act. That there was a new social services act in the works was also known by everyone during the election campaign. It is no news. The problem there has been that it takes such an eternal amount of time to arrive at a bill for a new social services act. There we are still waiting. But the very idea of an elderly care act is about bridging the problems that exist in the current social services act linked to the health and medical services act and putting the elderly's needs at the center for increased quality and equality, just as the heading is on that investigation. It is about creating a coherent and coordinated elderly care and elderly care for those who are most fragile and sick, and that is precisely what is the very idea with an elderly care act.

It is still difficult to understand, Mr. Speaker, what it is that has changed in practice from the election campaign to the present day in the view on an elderly care law. The conditions have been known all along, and the purpose of the law has been known all along. That work is ongoing with a new social services act has also been known all along.

I ask the question again: What is it that has caused the Moderates to change their minds regarding a new elderly care act?

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

Thomas Ragnarsson (M)

Mr. Speaker! I say as I said earlier: the Social Services Act is fundamentally a law even for the elderly. We should not actually need to have special laws for everything, but a good Social Services Act should cover this area.

When it comes to the connection to health and medical care, it is problematic that different laws apply. We have a health and medical care act, and we have a social services act. They do not always speak the same language.

It has also been quite difficult for healthcare to speak with social services in certain matters until now due to secrecy legislation and the like. Here come changes, and I really look forward to them.

There is definitely no ill intent towards our elderly in that we are not presenting an elderly care act now. But I have great confidence in a new social services act, simplified legislation on confidentiality between authorities, and that people are starting to look at whether the Social Services Act truly aligns with the Health and Medical Services Act. In that way, we do not need a specific elderly care act - that is my opinion.

(Applause)

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Karin Rågsjö (V)

Mr. Speaker! I have a few questions. I worked very much with the pandemic during the years it lasted. If there was anything that people were concerned about, Mr. Speaker, it was elderly care.

Now I wonder anxiously what the government has learned from the pandemic. This is connected to healthcare injuries. If a new pandemic were to sail into Sweden, we would get the same dismal results, Mr. Speaker, when it comes specifically to elderly care. You in the Moderaterna were in opposition during those years, and you were very eager to talk about what should and should not be done. Now that we stand here and the pandemic is gone – people are getting vaccinated and so on – I am very worried. If a pandemic comes, we have done nothing, and you are doing nothing in a government position that would ensure the elderly leave it with better conditions.

There is still a shortage of trained staff. There are still extremely poor working conditions within elderly care. Everything that the Corona Commission pointed out is exactly as it was before the pandemic.

I wonder how you have thought about this. When one looks at the Tidö Agreement, one sees that there are like four sentences about elderly care. And in your budget, one cannot say that there is very much cash for the municipalities for elderly care. If one speaks with Kommunal, who look at these issues all the time, Mr. Speaker, they say that it will once again become a crisis within elderly care in the municipalities. How have you thought?

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

Thomas Ragnarsson (M)

Mr. Speaker! Thank you, Member, for the questions! Yes, elderly care was hit enormously during the pandemic - I agree. But if we break it down, what actually happened?

In Sweden, we had the strategy that we would keep as many elderly people as possible in our residential facilities. That was something we did not have the capacity to handle. One of the reasons why so many people died of covid in Sweden was that we could not offer the patients hospital care; that has also been established. Had it instead been possible to handle these patients within the healthcare system, where they belonged, we probably would not have seen the workload and the problems that we actually saw.

What is the government doing then? Quite a lot of targeted funds have been allocated to the regions to increase the number of available care beds. It is a problem in Sweden that we have too few care beds per 1,000 inhabitants - actually the lowest number in all of Europe. I therefore do not see this as any bad investment.

With the protected professional title for nursing assistants, we simultaneously get a value of what a nursing assistant is. This has been a bit scattered. I know that there have been supplementary courses and similar things that have led to people suddenly being able to call themselves a nursing assistant without perhaps really having the knowledge for it. I believe, therefore, that this will mean an enormous amount for elderly care, where nursing assistants are incredibly important employees.

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Karin Rågsjö (V)

Mr. Speaker! Thank you, Thomas Ragnarsson, for elaborating on these questions a bit! It is very good that the member also raises the protected professional title because it is one of the issues that Vänsterpartiet pushed for quite a long time. We are grateful for that.

But back to elderly care! It is the staff who are to do the work within elderly care. The member says that there is an incredible amount of money to open care beds, for example; we know that it is the elderly who end up in the emergency room, for example, and need care beds. But this is not correct. If you look around in the regions, you see that enormous cuts are being made. In Sörmland, perhaps 500 people are being let go, for example. It is therefore not a huge investment.

If there is no foundation to stand on, I believe it will be very difficult when one moves forward with targeted grants. There is, so to speak, no one who can receive them. When the staff are running in the corridors, it is very difficult to carry out targeted interventions from the government.

My question remains. We should have learned significantly more from the pandemic, and I actually expected the next government to pick up the various points of view from the Corona Commission and do something about them. It is about oxygen in elderly care, for example. There are plenty of issues that one could have "pointed out", I think, from the Tidö parties, i.e., the Sverigedemokraterna and the government.

I find it astonishing that we still have such a staffing situation as we do for nursing assistants within elderly care. It is they who have to do the grueling work and have the poor working hours and the extremely poor wages and so on.

I have a tip. One can, for example, see that eight out of ten of the unaccompanied minors work in elderly care. Take care of them!

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

Thomas Ragnarsson (M)

Mr. Speaker! Thank you, member, for the questions!

When it comes to the staffing supply, I am the first to agree that all people who can work need to be in work in this country. That is a self-evident matter for me. The problem has been that, due to staff shortages, the requirements have been lowered quite significantly. I usually perceive myself as a fairly normal person. I can understand what people say to me and so on. But when I do not understand what the staff says to me, how is my father-in-law, who is 90 years old, supposed to do it? There we have a problem.

But otherwise, I am fully aware that the reserve we have today when it comes to people who can work in the welfare sector consists of the people who stand outside the labor market. It is no secret that many of them have a foreign background. It is an incredible reserve, but we must get them into work.

The protected professional title was discussed a lot, and it was a good proposal. I am not a worse politician because I can think that a proposal from the Left is very good. But we need to work on this issue so that it does not just become a statement that it is now a protected professional title. Now the great work begins to ensure that the persons who receive the protected professional title do the right things. It is now we need to adjust and make the competence shift and really ensure that it becomes the right competence. This we have talked about in Kronoberg County; we call it RAK.

I am completely convinced that this will play a role, but it is a tough situation - for the entire healthcare sector.

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Mikael Dahlqvist (S)

Mr. Speaker! Thank you, Thomas Ragnarsson, for the speech! I note briefly that in the forecast from SKR, Sveriges Kommuner och Regioner, it is written that they already this year fear that Sweden's municipalities and county councils will run a deficit of 6 billion kronor. It will be even worse for next year. There, they fear a deficit of 31 billion kronor.

It is historical deficits, and that is naturally due to the cost shock we have in society today with inflation and interest rates and higher pension costs.

As I understand it, Mr. Speaker, we and the Moderates do not quite have the same priorities and views on how this situation should be resolved when it comes to economic conditions. Therefore, I ask, Thomas Ragnarsson: When you hear the figures that I describe, are the Moderates prepared to provide additional resources to manage elderly care?

What is happening right now is that people are being laid off even within elderly care. Take Örebro county as an example. There, it is announced that they will reduce the staffing.

The debate here today is about healthcare injuries and poor conditions within elderly care. With fewer staff, lower education levels, and more stress, the risk of healthcare injuries increases. I believe we are quite in agreement on that, Thomas Ragnarsson and I.

My question to Thomas Ragnarsson, who is the representative for the government, is therefore: Is the government prepared to provide more money next year?

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

Thomas Ragnarsson (M)

Mr. Speaker! Thank you, Member, for the question! I want to start by agreeing on one thing: We do not quite have the same view on economics. Economics for me is not ad hoc and here and now, but economics is a long-term task.

The previous government provided a very large amount of money to our regions and municipalities in a situation of real crisis. That was very good. On the other hand, I think one could have looked a bit at how much money was provided when one of Sweden's smallest regions – the region I come from – has now made a surplus of 640 million over two years. But if you wash that result, you are still 25-30 million in the red within health and medical care, as is usually the case.

The money means a great deal. But it has been paid out and exists somewhere. One has hardly spent it. I know there is some region that thought one should spend when one had money in the pocket, but most regions and municipalities have actually set aside money. If one looks at the economy in a longer perspective, there should therefore be some money to take from now to save the economy.

I agree with the member: It is tough this year, and it will be even tougher next year.

I think one must look at one's economy over time and not just from year to year. If we were to now provide funds and cover all deficits this year, they will want to have full cost coverage for next year as well, and then it will be a bit more, just as the member says. I do not think it is a reasonable way to manage the economy.

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Mikael Dahlqvist (S)

Mr. Speaker! Thank you, Thomas Ragnarsson, for the answer! I feel, however, that the member does not quite have confidence in how Sweden's municipalities and regions manage their finances.

Of course, one can always make changes to the operations. Perhaps the money has been used a bit lavishly. I get the feeling that the member has that opinion.

The problem remains. The Social Democratic-led government provided historically large appropriations. One can discuss whether the level was too high – it probably was during certain periods – but we said clearly that during the pandemic no one should suffer for economic reasons, and therefore there should be no lack of resources.

In SKR's, Kommunals' and others' forecasts, we see a significant debt in elderly care ahead due to the demographic development. In six out of ten Swedish municipalities, a huge hump is on the way. Furthermore, there is a lack of labor. To attract labor, one needs to have good working conditions and a work environment, which I do not think the elderly care's personnel fully have today. More resources are needed.

Mr. Speaker! In conclusion, I would like to ask a question to Thomas Ragnarsson. Some regions have surpluses and money in reserve. I agree with that. But one must remember that those funds are intended for the pension debt. There is an enormous pension debt in municipalities and regions today, and the idea with these funds is, therefore, to pay a debt one already has. Now, the debt will instead remain also in those regions that have money. In that way, one pushes the problems into the future. How will it solve the challenges of elderly care in municipalities in the future if there are no resources?

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Thomas Ragnarsson (M)

Mr. Speaker! Thank you, member, for the question! The pension debt has existed for a long time in the operations. I can see it as somewhat poor economic management. If one knows that one has a debt, one also knows that one will have to pay it at some point.

Then one can take a chance and think that one will have money in one's pocket when one needs it, or one can, in one's basic budget every year, set aside an amount for the debt one has. One also makes pension contributions.

Then came the new pension agreement. I agree with the member that it is a fantastic agreement for our employees. The problem, however, is that it seems to have escaped everyone's radar that this blow would come. This, in turn, has meant that most have been caught off guard and thought: What is this? It is not included in any plans!

It is a tough situation. We will have to suffer from it for a few years.

Again: The money that the red-green government distributed during the pandemic was not the Social Democrats' money, but Sweden's money. And Sweden's wallet neither grows nor shrinks based on which government we have – we know what money we have to work with. If more money has been paid out than was needed, the consequence, especially in a situation when it is tough all over the world, is that there is less money left to distribute from the very beginning.

The municipalities and regions received a lawful supplement. Many of them have put these funds on the shelf. Those funds should be used to some extent now. That is my opinion.

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Katarina Luhr (MP)

Mr. Speaker! In the National Audit Office's audit report on the state's work against healthcare injuries and deficiencies within healthcare and elderly care, one arrives at the overall conclusion that the state's efforts are not effective for healthcare and elderly care operations to prevent healthcare injuries and deficiencies and fulfill their responsibility towards individuals within the framework of the Lex Maria and Lex Sarah provisions. The National Audit Office also assesses that the operations' responsibilities should be expanded when it comes to informing individuals and their relatives and giving them the opportunity to participate in investigations.

The government, in turn, states in its letter – which is what we are debating here today – that the report is an important contribution to the work of improving care and nursing for the elderly, but that the government makes a different assessment than the National Audit Office regarding which measures should be taken. Among other things, the government refers to an investigation on language requirements in elderly care and to the fact that the National Competence Centre for Elderly Care has been established at the Socialstyrelsen. The government therefore considers the report to be finalized. But Miljöpartiet does not agree.

Mr. Speaker! The National Audit Office states in its audit report that healthcare injuries and mistreatment can be traumatic for those affected and also for their relatives. Mistreatment can involve abuse and coercive measures, and healthcare injuries can lead to permanent physical injuries or to someone passing away.

Individuals affected want to be listened to and want to receive confirmation that there have been deficiencies in an operation when they have been affected by a healthcare injury or a malpractice. The fact that it is not mandatory for operations to inform individuals or their relatives in cases of malpractice - or to hear them when healthcare injuries or malpractices have occurred - is a problem. The operations' responsibility towards individuals and their relatives should therefore, according to the Swedish National Audit Office, be expanded.

The National Audit Office submits several different proposals in its report to both the government, to Ivo, and to the National Board of Health and Welfare.

The Government is recommended, among other things, to strengthen the national governance of quality in elderly care with the aim of reducing the number of deficiencies, for example through a national action plan or equivalent. The Government is also recommended to take measures to strengthen individuals in the provisions on lex Maria and lex Sarah and to give Socialstyrelsen extended authorization to set mandatory requirements that next of kin shall be given the opportunity to describe their experience of an incident that has led to a serious healthcare injury, that individuals and next of kin shall be informed in the event of a deficiency, and that individuals and next of kin shall be given the opportunity to describe their experience of an incident that has led to a serious deficiency.

The Government does not consider these measures to be necessary and refers to various documents stating that the individual should already be involved. We believe that it is clear that this is not the case in practice and that more needs to be done.

It is obvious that the instrument Lex Sarah has a tendency to be bureaucratized. We believe that the opposite is important – to see the individual more and take into account the aspects of the individual and their relatives in order to be able to ensure just good care and secure living conditions.

It is both strange and remarkable that individual people, or their relatives, who have been subjected to poor conditions risk disappearing in all interventions at different levels where work is to be done on quality development.

Miljöpartiet believes that it is not only the individual and their relatives who would benefit from this. We are convinced that information, that people are involved in investigations into healthcare injuries and deficiencies, and that views are simultaneously taken into account, will lead to learning organizations that handle the views better.

In this context, I also want to point out that Miljöpartiet has submitted a question to the responsible Minister Anna Tenje regarding the elderly care act.

Today, there is a lack of clarity regarding which basic requirements elderly care should be based on. A specific law could emphasize the preventive work and contribute to making the municipalities' responsibilities visible and clear. And it can create a framework for governance, follow-up, and supervision.

In a recent meeting in the Committee on Social Affairs, it was mentioned in passing that a proposal for such a law will not be submitted by the government. In that case, the Green Party considers it deeply regrettable.

I support Miljöpartiet's both reservations in the report, but I move for approval only of reservation 2.

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Dan Hovskär (KD)

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

For the Christian Democrats, it is of the utmost importance that one can feel safe as one gets older and that care and support are available on the day they are needed. That is why a report submitted by the National Audit Office regarding lex Maria and lex Sarah is important. This is, therefore, based on the Patient Safety Act and the Social Services Act.

The Swedish National Audit Office has examined whether the state's efforts within the framework of Lex Maria and Lex Sarah are so effective that healthcare injuries and deficiencies are prevented and whether healthcare and elderly care activities fulfill their responsibility towards individuals in healthcare and elderly care.

Let me begin by saying that we Christian Democrats take the conditions and the healthcare injuries that have been uncovered within elderly care seriously. In the report, the Swedish National Audit Office's overall conclusion is that the state's efforts are not effective in ensuring that healthcare and care activities for the elderly prevent healthcare injuries and conditions and fulfill their responsibility towards individuals within the framework of Lex Maria and Lex Sarah. This is something that we in the governing parties do not take lightly.

The Swedish National Audit Office also argues that the agencies' responsibility to inform individuals and their relatives and give them the opportunity to participate in investigations should be expanded. The Swedish National Audit Office also argues that the management and follow-up of the work to prevent healthcare injuries and conditions of neglect in healthcare and elderly care should be strengthened.

As the government writes in its letter, we welcome the review and believe that the report constitutes an important contribution to the ongoing work that the government is undertaking in order to improve care and support for the elderly.

At the same time, we have different conclusions about what needs to be done to rectify the problems that exist. The Government is now taking several measures to strengthen the quality of care and elderly care. An inquiry has been appointed regarding language requirements within elderly care and a national knowledge center for elderly care has been established at Socialstyrelsen.

For the Christian Democrats, elderly care issues are high priorities. We have for a long time and in various ways promoted issues aimed at strengthening security, dignity, and things that provide quality of life within care. This also includes that good care and nursing are provided. And we have a focus on the individual.

The supply of competence is one of the greatest challenges within elderly care. The most important resource in elderly care is the staff. It is crucial that they have the right competence for their work tasks. Therefore, the government proposes in the budget for 2024 that 1.7 billion kronor shall be allocated to continue the initiated competence initiative for staff within municipally funded elderly care. The government estimates that it will allocate a corresponding amount also in 2025 and 2026.

During the summer, "undersköterska" (assistant nurse) also became a protected professional title to guarantee that the staff have the correct competence. At the same time, it strengthens the profession's attractiveness.

Mr. Speaker! In the 2023 budget bill, the Government completes the three-year initiative called Äldreomsorgslyftet, which gives staff in elderly care the opportunity for further education during paid working hours. During only the first two years of the initiative, almost 3,000 people have been able to complete their education - they have trained as care assistants, nursing assistants, or specialist nursing assistants, or have completed a leadership training. This is an important step to strengthen the supply of competence.

Furthermore, there is an inquiry regarding increased quality and equality in care and services for elderly people. There, proposals are made on how medical competence can strengthen the operations. That inquiry is currently being prepared in the Government Offices.

Our society is increasingly organized in a way that does not encourage support and help between generations, with the consequence that many elderly people are left in loneliness in the autumn of their lives. In order to encourage and help those who wish to support their parents when they become old, we Christian Democrats want to investigate the possibility of introducing a support for care of parents, VAF. Within the health insurance system, a relative should then be able to receive a number of days per year when they can step in to help the elderly relative with medical visits or help out at home in the event of sudden illness, among other things.

The government also presented a special community initiative in February 2023 to counter involuntary loneliness, which particularly affects our elderly.

Loneliness negatively affects mental and physical health and general quality of life. The community initiative amounts to 300 million kronor distributed over three years. The funds shall, among other things, go towards outreach health consultations and to create social contact points and activities that feel meaningful.

Mr. Speaker! A society where everyone can age in safety and dignity is an important goal for us Christian Democrats. Elderly people are an asset to the entire society. A welfare society can largely be judged by criteria such as respect for, preservation of, and care for the older generation.

The elderly should be able to live an active life, have influence in society and over their everyday lives, be able to age in security and with maintained independence, be met with respect and have access to good care and support. Each individual should be seen as a person with their own and unique value and with different interests and backgrounds. Good care, a need-adapted housing and self-determination over one's everyday life should be a matter of course throughout life.

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

Christofer Bergenblock (C)

Mr. Speaker! I thank the member for the speech. I noted that elderly care issues are a high priority for the Christian Democrats. I do not doubt that. I believe that the Christian Democrats have a great commitment to these issues.

I want to go back to the report we have received from the Swedish National Audit Office which points out a number of problems within Swedish elderly care, and above all when it concerns the state governance of Swedish elderly care, and ask a question.

The Christian Democrats have profiled themselves as the party that wants to nationalize the entire healthcare system. And it is no small reform to nationalize the entire healthcare system. I truly hope that it will not become a reality, and I do not believe it will either because there is no majority in the Riksdag for such a nationalization. But there are, of course, parts of our healthcare and care in Sweden that should receive increased national governance.

In the Riksrevisionen's report, it is noted that it looks very different across the country in terms of quality work within elderly care and the work to prevent and counteract healthcare injuries and poor conditions. Therefore, Riksrevisionen proposes that a national action plan be developed. In approximately the same way as there is a national action plan for increased patient safety within healthcare, a national action plan for better quality work within elderly care should be developed.

Mr. Speaker! Then I ask: Why do the Christian Democrats not stand behind that part, namely an increased national governance of Swedish elderly care?

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

Dan Hovskär (KD)

Mr. Speaker! A major effort is currently underway and a number of different measures are being taken within elderly care, not least when it comes to trying to improve the quality.

We believe, however, that a nationalization of health and medical care would be good when it comes to the large and broad parts at the national level, where we need to link our different regions together in a different way.

We have a slightly different view when it comes to elderly care, which is the responsibility of the different municipalities. There, we try to provide the municipalities with support and help to facilitate the work in elderly care. There, we have not proposed a state management, but we believe that there are ways to provide good quality characterized by respect through the assignment to the different municipalities. We believe that in that specific part, we can provide the different tools in a different way than through a nationalization.

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

Christofer Bergenblock (C)

Mr. Speaker! It is pleasing that the Christian Democrats do not want to nationalize Swedish elderly care. I do not believe, to be honest, that any party wants that.

But I notice that the member highlights that more support and help is needed for the municipalities in this work.

What the National Audit Office proposes with a national action plan is not about taking over the responsibility for elderly care, but about providing the municipalities with more support and help, just as the member himself expresses it.

Then it becomes very strange to me that one has not stood behind the very clear proposal from the National Audit Office to develop a national action plan as support and help for the municipalities to obtain the safe, quality-assured, and good elderly care that our elderly in Sweden deserve.

Mr. Speaker! I repeat therefore my question: Why can the Christian Democrats not stand behind the National Audit Office's proposal for a national action plan for quality in Swedish elderly care?

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

Dan Hovskär (KD)

Mr. Speaker! We are currently implementing several major reforms. We are allocating 1.7 billion in the budget to implement the Elderly Care Boost, which is one such tool. Within the Elderly Care Boost, we provide resources to the municipalities so that they can train and strengthen the staff. We have parts where we provide resources to work with relative care. We are working in a broad way, and it is a number of different parts. An attempt is being made to investigate a new Social Services Act that shall provide support. We see that very much is underway, and we want to launch these pieces now.

When it comes to a nationalization of healthcare, it is a different matter. Unlike the member, I believe it would be very good for Sweden. Instead of having 21 different regions that have different levels, we could have a completely different management, especially of specialized healthcare. I believe that would be good for Sweden.

The deliberation was hereby concluded.

(Decisions were made under § 8.)

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