The National Audit Office's report on the state's work regarding waiting times in healthcare
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 SD considers that staffing is a bottleneck 1, welcomes the Riksrevisionen's report 1 and wants an office for the transition 1. 2 M wants to put the patient at the center 2, create more care beds 2 and argues that the new queue billion evaluates waiting times based on the regions' conditions 2. 2 M agrees that regional differences within cancer care are too large 2. 3 V argues that the government has failed to shorten the waiting times 3. 4 KD welcomes the review 4, wants to review the care guarantee's effectiveness 4 and plans an efficiency delegation 5 6. 7 C considers that the government's focus on a national efficiency office is incorrect 7. 8 MP argues that a lack of resources causes queues 8.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Speakers (15)
Carita Boulwén (SD)
Madam Speaker! This evening we are debating the Committee on Social Affairs' report 2023/24:SoU8, the National Audit Office's report on the state's work regarding waiting times in healthcare.
The Swedish National Audit Office has reviewed the effectiveness of the state's management through the healthcare guarantee, the "kömiljarden" 2009-2014, and standardized care pathways within cancer care to reduce waiting times in healthcare. The review also includes whether the management promotes equitable care based on need.
The Riksrevisionen's overall conclusions are that the current management measures in many respects do not effectively reduce waiting times in healthcare, even though some parts of the management have functioned better for standardized healthcare pathways. Furthermore, there is a risk that patients with greater healthcare needs risk displacement and that cancer investigations become resource-inefficient. Riksrevisionen also notes deficiencies in the national statistics on waiting times, which complicates the analysis and follow-up of the waiting time work. There is also a lack of knowledge regarding SVF's effects on the healthcare outcome for patients with cancer.
The Swedish National Audit Office's report on the state's work with waiting times in healthcare
The National Audit Office recommends that the government ensure that a careful follow-up of the work on waiting times is carried out. It also recommends that the state's governance be designed to reduce the risk of displacement of patients with greater care needs. To be more effective, the governance should take into account the regions' differences regarding organization, governance, and structural conditions.
Madam Speaker! This is a welcome review with important areas and questions to highlight. It also appears in the report that it is difficult to draw definitive conclusions about the effects of the healthcare guarantee and the purchase billions on waiting times. Furthermore, it appears that there is a need to review the effectiveness of the healthcare guarantee in order to strengthen the patient's position and the healthcare guarantee's significance as a state steering tool.
Madam Speaker! If we are to truly address the problems that exist within the health and medical care, we need to ensure that the steering mechanisms the state uses actually produce effects and that the reforms being implemented yield good results. We need updated and reliable statistics, and the funds allocated to the regions need to be followed up.
The government, together with the Sweden Democrats, is now making a number of welcome initiatives in the area, and there is an active effort underway to increase accessibility and reduce waiting times in healthcare. The eHealth Agency and the National Board of Health and Welfare have, among other things, been tasked to immediately carry out measures such as supporting the regions' work in offering care in other places in the country to patients who are waiting.
Socialstyrelsen follows the government's mandate to strategically monitor the accessibility of health and medical care, and it is considering giving the Agency for Health and Care Analysis an evaluation mandate. There is also extensive work underway to make health data accessible and usable to improve care, strengthen the patient's position, and reduce the administrative burden for healthcare staff.
Regarding the national cancer strategy, updates are being made to ensure that Sweden has the conditions required to continue being a leading country in cancer care. The updated strategy shall take all ages into account. The Government, together with the Sweden Democrats, has decided on several investigations and assignments for this purpose.
Madam Speaker! Long waiting times have long been a significant problem within healthcare. We have had unreasonably - and illegally - long healthcare queues for far too long, and the consequences are significant for the patients. It risks not only leading to increased costs and lower confidence in healthcare but also to serious health problems for individuals. Despite the fact that Sweden has invested greater economic resources in healthcare in relation to GDP compared to other EU countries, the healthcare queues remain long. It is clear that broader measures are needed than just injecting more money.
The Sweden Democrats' goals for health and medical care are to ensure good health for the entire population, regardless of where in the country one lives. When an individual needs care, the accessibility and quality should be reliable and consistent. To achieve the goal of world-class healthcare, it is required that the accessibility and equality in care are guaranteed across the entire country and within all parts of the healthcare system.
A uniform, accessible and high-quality healthcare strengthens trust in healthcare and increases its legitimacy among the population. It is crucial that the entire healthcare chain is strengthened, with a focus on patient safety and patients' participation in their own care. The goal includes, among other things, ensuring a patient-safe healthcare, offering equal care across the entire country, securing the quality of healthcare as well as offering the right care - and in time, according to the healthcare guarantee.
Madam Speaker! To have competent and well-being staff who feel motivated to go to work every day and who feel safety, pride and joy in a workplace where they receive pay for their work, time for recovery and opportunity for competence and further development is a prerequisite for achieving the other parts of the goal.
That is why I am extremely pleased that the Sweden Democrats, together with the other government parties within the framework of the Tidö Agreement, have agreed on a number of important reforms, not least within healthcare. There we see several of the Sweden Democrats' long-presented measures and proposals to improve [care] for the individual in need of care, but also regarding incentives for the organization of healthcare, the strive towards equality, and not least the extremely long wait for care.
In order to reduce regional differences and create a patient-safe, equal, and local healthcare throughout the country, we have concluded important agreements on increased state governance, on developing healthcare in rural and remote areas, and on increased cooperation in the regions. This includes, among other things, a national healthcare brokerage, a national digital infrastructure, and a national plan for the supply of skills.
Together, we within the Tidö parties are now creating the conditions to address the serious deficiencies and the long waiting times in healthcare.
Yasmine Bladelius (S)
Madam Speaker! Swedish health and medical care is in absolute world-class status. Year after year, we deliver fantastically good results. The healthcare staff do everything in their power to provide us with good care in a timely manner. But they are under pressure.
For a decade, their working environment has deteriorated. They are expected to run faster, perform the important work in less time, eat faster, take shorter and fewer breaks, and receive more and more patients. They are given shorter and shorter recovery times, they are forced to forgo their statutory leave, and they work overtime more as a rule than as an exception. They are going to their knees.
Madam Speaker! This naturally has serious consequences for the patients, for the staff, and for our entire society. At its core lies a good and safe healthcare system in the staff and their working conditions. No healthcare queues or waiting times will decrease if the healthcare staff flee their jobs – because they simply cannot endure any more.
Madam Speaker! We have healthcare of absolute world-class quality, but it relies on the healthcare staff who have chosen to stay in the profession stepping up. When now over 60,000 nurses stop working overtime, Swedish healthcare simply no longer functions. I can therefore state that the healthcare system runs on the fact that midwives, X-ray nurses, biomedical analysts, and nurses work overtime. That is where we are today!
It is not strange, Madam Speaker, that staff are fleeing healthcare. It is not strange that there are long waiting times in Sweden. It is a large and serious problem, and we responsible politicians must solve it.
To begin with, healthcare needs a larger suit. Those who work in healthcare need more colleagues, not more demands for layoffs or larger notices.
Madam Speaker! Today we are debating the Swedish National Audit Office's report on the state's work regarding waiting times in healthcare. The Swedish National Audit Office's overall conclusion is that the state's management through the healthcare guarantee, the queue billion, and the standardized healthcare pathways are in many ways not effective in shortening waiting times.
In support of their conclusions, they point out, among other things, that waiting times have deteriorated continuously for many years, despite the fact that the healthcare guarantee is now established as a norm and despite the fact that the time limits are actually statutory.
The Government writes in its response that it, in like manner with the Swedish National Audit Office, considers that there is a need to review the effectiveness of the healthcare guarantee in order to strengthen the patient's position and the healthcare guarantee's importance as a government steering tool in the area of accessibility. The Government also says that it is considering giving an evaluation assignment to the Agency for Health and Social Care Analysis, and with these announcements, the Government considers the Swedish National Audit Office's report to be finalized.
Madam Speaker! We Social Democrats also welcome the Swedish National Audit Office's report and the current letter. The Swedish healthcare system's problems with long waiting times and deficiencies in accessibility are in no way new, and it is clear that the efforts made so far have simply not worked.
There is a broad consensus throughout Vårdsverige that the only realistic path to truly shortened waiting times and improved accessibility in healthcare lies in the transition to good and close care, the so-called primary care reform.
The transition was initiated by the previous Social Democratic-led government, but until now it has proceeded far too slowly. Above all, the staffing is the bottleneck. There is a shortage of both general practice specialists and district nurses. They are important competencies that are needed to carry out the transition fully.
The Social Democrats have submitted a number of proposals to increase the pace of the primary care transition. We want an office for the transition to good and close care to be established at the National Board of Health and Welfare, we want to introduce binding targets of 1,100 inhabitants per doctor within primary care, and we want to make investments in the healthcare personnel. At the same time as these structural reforms are implemented, healthcare needs more resources.
Madam Speaker! This report also comes at a time when Sweden is facing a national healthcare crisis. Over the past years, the economic situation of the regions has deteriorated significantly, and all over our country, regional politicians of different political colors are now making incredibly difficult decisions. Should we lay off more healthcare staff? Do we need to make further large cuts at already heavily strained hospitals?
Madam Speaker! It is not possible to ignore the development when it comes to the work of shortening waiting times. Naturally, the question of the accessibility of health and medical care begins and ends with the question of the conditions for the healthcare staff.
The Social Democrats therefore want the government to immediately appoint a commission for the staffing of the welfare sector while simultaneously inflation-protecting the general state grants.
Jesper Skalberg Karlsson (M)
Madam Speaker! The Moderates want to put the patient at the center, not in a waiting room. Our healthcare policy has as its primary purpose to make care accessible and give patients empowerment. Therefore, measures are needed to shorten the care queues and ensure that care is equitable. We cannot be satisfied when half of all women with breast cancer and fewer than four out of ten men with prostate cancer do not receive care in time. More needs to be done to create conditions for more care beds and to secure the supply of competence.
Madam Speaker! The report from the National Audit Office that we are debating tonight aims to evaluate three reforms. Let me first mention the healthcare guarantee.
The healthcare guarantee aims to shorten waiting times in healthcare through requirements for the regions to provide care within certain time limits. This means, in broad terms, that a person should receive a first contact with healthcare on the same day they seek care, receive a medical assessment within three days, a visit in specialist care within 90 days, and planned care within 90 days from the time the healthcare provider has made a decision on it.
Here, the government is working to provide better conditions for regions and municipalities to improve accessibility in health and medical care, among other things by increasing the care's capacity and the number of available care beds. Furthermore, work is ongoing to establish a national care brokerage that can create better equality when it comes to referring to another healthcare provider or another region. We know that the regions' work with this differs, and it is not a satisfactory situation. But now, there will be a change.
Madam Speaker! Let us also talk about the queue billion! To strengthen compliance with the healthcare guarantee, the state paid out 1 billion kronor annually between 2009 and 2014 in the form of a performance-based compensation to the regions based on how well they fulfilled the healthcare guarantee. The form was regulated in an agreement with the Swedish Association of Local Authorities and Regions, SKR. It was the old queue billion, the one that has been evaluated here.
The Swedish National Audit Office points out in its review that absolute targets resulted in certain regions having weak incentives to achieve the goals that the environmental billion and the agreement set. I agree with that.
At the same time, it is worth noting that the new purchase billion, which has been in place since 2019, is designed so that several of the performance requirements are based on the conditions in each individual region and thus evaluate waiting times in terms of relative change compared to the previous year.
Furthermore, the Swedish National Audit Office points out that the effects of the new purchase billion should be investigated. That is also reasonable. Therefore, Socialstyrelsen also has a mandate to follow up on the current agreement between the state and SKR within the framework of the mandate to strategically, long-term and continuously follow up and conduct a dialogue on the accessibility of healthcare.
Madam Speaker! Let me also say something about standardized healthcare pathways within cancer care. They have existed since 2015 and aim to shorten waiting times within cancer care by describing which investigations and treatments should be carried out for a specific diagnosis as well as what time limits should be pursued. One of the overarching goals is that 80 percent of the patients who are investigated in a standardized healthcare pathway shall be investigated within the lead time specified in the relevant healthcare pathway.
The Government agrees here with the National Audit Office's assessment that the regional differences are too great. The regions need to continue working to fully implement standardized healthcare pathways. The Government does its part through agreements with SKR, including the agreement on equal and efficient cancer care with shorter waiting times from 2022.
Furthermore, work is ongoing to revise the national cancer strategy, something that, among others, we Moderates have pushed for for several years. In January, the Agency for Health and Social Care Analysis presented its situation report on the old national cancer strategy, and in February, Mef Nilbert was appointed as a special investigator - all this so that Sweden can take the next step and ensure that Sweden has the conditions required to continue being a leading country in cancer care for all ages.
Madam Speaker! The Government governs the realm. But it must be pointed out that it is the primary bodies, that is to say municipalities and regions, who have the responsibility to provide health and medical care and to ensure that good and safe care is given. The Government has the opportunity to govern agencies, conclude agreements with SKR and write laws - but the state is not the primary body for the care.
Madam Speaker! When we look back, as the Swedish National Audit Office has done in this report, we can see that several reforms have been implemented and tested to shorten waiting times in healthcare. At the same time, one should perhaps not draw overly far-reaching conclusions from the recommendations given here. The quantitative analyses are, as the government also writes in its communication, subject to great uncertainty. To explain it in simpler terms: It cannot be said that the situation would have been better if these reforms had been omitted.
Madam Speaker! There are also reasons to be humble. The efforts that have been made have not been perfect. We note, however, that there are no perfect political reforms. As a former Moderate, one might imagine that the job tax credit was a perfect reform. But even the job tax credits had clear flaws: they were too small, and there were too few of them.
Madam Speaker! Finally, a look forward - despite the fact that Sweden has invested greater economic resources in health and medical care in relation to GDP compared to other similar EU countries, the care queues remain long, and they grew during the previous parliamentary term. It calls for reflection: Are we using the money in the right way?
Karin Rågsjö (V)
Madam Speaker! I will focus on the purchase billions - the old and the new.
In the communication, the government accounts for its assessment of the National Audit Office's observations and recommendations in the audit report "Waiting for care - inefficient state governance for shorter queues". I think it is a very good heading.
Vänsterpartiet welcomes the National Audit Office's review and can, in line with the review, state that the government has failed in the work of shortening waiting times in healthcare with these billions of kronor. We have raised this quite many times.
The Government notes in the letter that Socialstyrelsen shall follow up on the new purchase billion within the framework of the mandate to the agency to strategically, long-term and continuously follow up and conduct a dialogue regarding the accessibility of health and medical care. I think that sounds a bit vague and a bit tame.
We mean that Socialstyrelsen's follow-up has not sufficiently taken into account Riksrevisionen's audit. A bit more needs to be done.
The National Audit Office notes that the "kömiljarden" – the older model, at that time – has not had any clear, long-lasting effect on waiting times. Several aspects of the "kömiljarden" have rather worsened the effect, and it cannot be reconciled with the differences between the regions. Something was very wrong in the layout that was chosen during that period.
The regions' incentives to do something have also been weakened by the fact that the climate billion does not take into account relative improvement. That is to say, the climate billion has given the regions different strengths of incentives depending on how far from the goals they were located. It sounds like some kind of strange calculation. The performance requirements within the climate billion have thus not taken into account relative improvement, which meant that regions that were already doing well were rewarded. Yes, sometimes it goes wrong.
Furthermore, the Swedish National Audit Office points out that the environmental billion risks leading to displacement, but this has not been possible to substantiate quantitatively due to a lack of statistics. It has been raised year after year after year that the displacement must be audited, but that has obviously not been done. It is about the displacement of the sickest, of those with the greatest needs.
Vänsterpartiet has for a longer period been critical of the performance-based care billion because it does not shorten care queues, does not raise the quality of care, and cannot be reconciled with the goal of equal care. It basically became a crash there.
And since the Swedish National Audit Office's review presents similar criticism - which one can be happy about sometimes - a more extensive investigation should be carried out to quantitatively look at the effect of the "queue billion". We want the government to task the appropriate authority with quantitatively investigating the new queue billion's effect on healthcare queues as well as any displacement effects.
I therefore wish to move for approval of reservation 2.
This is quite obvious. It is about a considerable amount of money that is being scattered and that they don't really have a handle on. SD and the government talk a lot about the inefficient healthcare in the regions. They place a great deal of responsibility on them for the fact that it doesn't work. Some kind of office is also to be established to look into inefficient governance, but I think that the government might have an inefficient governance of these issues because they just keep continuing.
It is also the case that we are in a national healthcare crisis. That cannot be ignored.
We have a fantastic healthcare system in Sweden, I must say. It applies to cancer and heart care, everything that is serious. But there is so much else that is not working.
We also have a health and medical care system where the staff are suffering terribly. We have also talked about that for a long time. What are we going to do?
Today, Vårdförbundet went on strike against overtime and so on. It will be noticed. I think it is good, actually.
But we have a crisis. We have overcrowding that just continues in the country's hospitals. The intensive care beds are decreasing and are fewer than before the pandemic. I think this is very serious. The figures for the full year 2023 show that 40 percent started their cancer treatment on time, which was historically low. The figure should be 80 percent. I think this is bad. What is missing is probably resources and that staff are seen as an asset.
In the midst of all this, the healthcare staff is heading towards an even worse "steel bath" (mass layoffs). If 6,000 healthcare workers are to be laid off across the country, one can imagine that it won't get much better. It concerns nurses, doctors, and nursing assistants. The unions have blown the whistle - Kommunal, Vårdförbundet, and Läkarförbundet are sounding the alarm about the serious situation throughout Sweden. Then perhaps one must do more than establish some kind of efficiency office, I believe.
The government has now provided an extra 6 billion to healthcare. That is something to be happy about, but it is not enough. The cuts and the layoffs will continue.
It is said that healthcare is inefficient and that this efficiency office should be established. Then we must also take into account that we have a demography that means people are getting older and older and requiring more and more. The medicines are very expensive, and inflation is high. Then it might have been good with a slightly larger budget for the regions and not to lay off another 6,000 people within healthcare. It will be noticed.
We can look back at what this issue is about, Madam Speaker; it is the carbon billions. When it comes to the carbon billions, I must say that it feels like I have a broken leg and am being given a plaster.
Dan Hovskär (KD)
Madam Speaker! I would like to begin by moving for the approval of the committee's report.
The Christian Democrats' policy is based on the premise that every human being is unique and that all persons have the same absolute and inviolable value. Health and medical care shall be characterized by dignity, quality, accessibility, and equality. A fundamental part in the development of care and nursing is self-determination and freedom of choice. Self-determination strengthens the quality within healthcare and creates a more dignified care.
Person-centered and coordinated care and services are therefore necessary. Both individual patients and users, as well as patient and interest organizations, can contribute to us finding the best methods for person-centered care and services. Therefore, the continued work needs to more tangibly include patients and users.
Much has been done in recent years to design care and nursing based on the individual's needs. But more needs to be done. The patient's position needs to be strengthened, we Christian Democrats believe.
The Swedish National Audit Office has, in the report, examined whether the state's management through the healthcare guarantee, the "kömiljarden" for 2009-2014, and standardized care pathways within cancer care is effective in shortening waiting times in healthcare. The audit also covers whether the management is designed in a way that is compatible with equitable care based on need.
Let me first say that the government welcomes the Swedish National Audit Office's review and its contribution to developing and improving the accessibility of Swedish health and medical care.
In the communication, the government underlines that it is the main entities, namely primarily regions and municipalities, that are responsible for providing health and medical care and for ensuring that good and safe care is provided. The government also emphasizes that its possibilities to govern health and medical care today are primarily limited to legislation and agreements, above all with SKR.
In line with the National Audit Office, the government considers the long waiting times in healthcare to be a problem. We also think that this is a major problem and are constantly working to try to reduce them.
As the government writes in its response to the National Audit Office's letter, it is not possible to draw any far-reaching conclusions about what effects the healthcare guarantee and the queue billion have had on waiting times. As the National Audit Office has also highlighted, there is a high degree of uncertainty in the quantitative analyses.
Therefore, according to the government, it is not possible to comment on how the waiting times would have developed without the state's interventions in the area based on the Swedish National Audit Office's analyses. There is thus a partial lack of support for the conclusion that the state's management measures have not been effective. On the other hand, according to the government, it can be stated that Sweden has invested greater economic resources in health and medical care in relation to the gross national product in comparison with other EU countries and that the care queues are nevertheless still long.
Madam Speaker! With this said, we believe, like the National Audit Office, that there is a need to review the effectiveness of the healthcare guarantee in order to strengthen the patient's position and the healthcare guarantee's importance as a government steering tool.
The Government agrees with the National Audit Office's observation that the regions' work with referring patients further to other healthcare providers differs in cases where the regions cannot offer care within the boundaries of the healthcare guarantee.
The Government highlights in its letter that it is working to provide better conditions for regions and municipalities to improve accessibility in health and medical care, among other things by increasing the care's capacity and the number of available care beds. To address the fact that the regions' work differs when it comes to referring patients further to other healthcare providers, the Government has begun work to establish a national healthcare brokerage.
We are doing a large and important piece of work within the Tidösamarbetet to reduce queues and increase accessibility to care. The Government has tasked the E-hälsomyndigheten and Socialstyrelsen to immediately implement measures that support and strengthen the regions' work to enable patients waiting for care to have the care performed elsewhere in the country.
The E-health Agency was commissioned in June 2023 to provide an infrastructure for a national healthcare search system. It shall make it possible for healthcare providers to search for other healthcare providers who can more quickly perform the care that a waiting patient needs.
When it further concerns the Riksrevisionen's recommendation to task an appropriate authority with studying SVF's effects on patients' healthcare outcomes and quality of care, the government refers to a mandate given to the Agency for Health and Care Analysis to produce a situational overview of the national cancer strategy.
Madam Speaker! What does the situation look like in healthcare today? I will make a brief observation. As many operations are being performed as before the pandemic. In the latest figures from the Swedish Perioperative Register, it appears that almost exactly as many operations are being performed as before the pandemic.
So, a lot of good healthcare work is being done all around Sweden, but it needs to be developed even further.
Anders W Jonsson (C)
Madam Speaker! I will likely be neither popular in the Speaker's chair nor among my colleagues in the Social Affairs Committee when I request the floor, but I could not help myself.
Dan Hovskär stood in the election debate for the party that said there were criminally long queues in Swedish health and medical care. They were illegally long, it was said, and everything was the social democratic government's fault. Now I hear Dan Hovskär deliver a speech that a social democratic member could have delivered in 2022. There isn't much new, I must say.
I wonder if Dan Hovskär and the Christian Democrats are satisfied with the result of their policy. We are soon into the middle of the parliamentary term. The National Audit Office is not satisfied, and if one looks at the figures, one sees that they are not directly better than they were during the time of the Social Democratic government. But given Dan Hovskär's statement, I still ask the question: Is Dan Hovskär satisfied with the result during these first two years?
We have heard that as much surgery is being performed as was done before the pandemic, and that is more or less self-evident. But the result in terms of people who are waiting is different. My question is therefore quite simply: Is Dan Hovskär satisfied?
Dan Hovskär (KD)
Madam Speaker! I thank Member Anders W Jonsson for the question. No one can be completely satisfied with the development that has occurred over the last few years, and above all not over a longer period.
We see that the waiting times and healthcare queues are increasing, and they must be shortened. We have now initiated a number of different measures from the government's side and from the Kristdemokraternas side. We have established a national healthcare brokerage, which is long-awaited. It will work on trying to improve the development so that one can get help in another region and so on, in order to thereby be able to reduce the waiting times.
Long waiting times have been a problem for a long time within Swedish health and medical care, and the differences in waiting times between the regions are very large. It varies a lot in terms of how it looks. The national healthcare coordination means that waiting patients should be able to be offered care at another healthcare provider in a shorter time. The waiting times will then be able to decrease.
This is one of the parts that is now underway, and there are many more measures.
Anders W Jonsson (C)
Madam Speaker! If one looks at the figures, one sees that it is actually not as bad as it was two years ago, but it is worse. There were 65,000 who had waited too long for their operation in January 2022. In January 2024, it was 69,000. The development is therefore going in completely the wrong direction.
When we had an interpellation debate with the Minister for Health and Social Affairs, she was also asked: What are you going to do? Then she said there were three things, and these are the ones that Dan Hovskär is now repeating.
First and foremost, one must provide economic resources of 6 billion. Perhaps more may also come. That is exactly what the Social Democratic government did during its years in power; it provided additional economic resources to the regions.
The second thing the Minister for Health and Social Affairs mentioned was that one should sign agreements with SKR. And what did the Social Democratic government do during all those years? Well, they had their agreements with SKR, which they tweaked the wording of.
The third was that the Minister for Health and Social Affairs, just like Dan Hovskär now, pointed out that a national healthcare brokerage is to be introduced. But for goodness' sake, that is a proposal that the Social Democrats came up with! They appointed an inquiry to solve this, the Accessibility Delegation. The only sharp proposal it came up with was that one should have this office in Stockholm that can broker available capacity. But which regions are it that have available capacity? The proposal has received sharp criticism from everyone who knows anything about healthcare.
These three proposals that were sharp from the Minister for Health and Social Affairs and from Hovskär are nothing other than what the Social Democrats said two years ago.
I would like to ask a question given that the situation now is worse than it was then: What is it, apart from the Social Democratic policy, that the Christian Democrats and the Tidö parties are now adding? What Dan Hovskär has spoken about so far in the speech he has given has been solid Social Democratic policy. Something more was needed, and what is it?
Dan Hovskär (KD)
Madam Speaker! We have now presented a long series of proposals. I can count up five of them, one of which I have already entered into.
We are appointing an efficiency delegation that will provide the regions with support for efficiency within health and medical care. We continue the work with the care brokerage, which I mentioned. We have a mandate to carry out redesigned measures that support and strengthen the patient's opportunities to receive care from another healthcare provider. That was also what I mentioned.
The appropriation for the establishment of a national healthcare brokerage is added to the healthcare budget adjustment of 25 million in order to strengthen the ongoing work. This means that the appropriation has been adjusted from 100 million to 150 million for the coming year. The E-health Agency's and the National Board of Health and Welfare's mandate to carry out immediate measures that support and strengthen the patient's opportunity to receive care from other healthcare providers will also shorten waiting times.
We see that the number of operations during the entire autumn, winter, and beginning of spring has been between 94 and 100 percent higher. One has comparative figures from representative weeks before the pandemic and sees that it has gone down and that it is now going up again.
At the same time, there are great differences across our country, and therefore we must continue to work to achieve equal healthcare throughout the country. A long series of different initiatives are underway.
Karin Rågsjö (V)
Madam Speaker! I have some questions for Member Dan Hovskär. One of them concerns the efficiency office that you are to establish. I am very curious about that. It seems to be you yourselves who need such an office in order to get the healthcare in Sweden to work. I would like to hear a bit more about this and how it is to be built up.
It also becomes a direct answer to the regions: You are not doing your job, and now you are to become more efficient! It is a kind of castle in the air that the Christian Democrats, who call themselves the healthcare party, have built up. When you say that it is an inefficient healthcare system in the regions, that things are being done incorrectly, that it is teeming with administrators, you name it, you are somehow hiding the crisis behind this—the crisis that actually exists with 6,000 people who have to leave the regions. That was my one question.
My second question is perhaps a bit more specific. Why is the government not looking further into the quantitative study? In the world I come from, it is very good to follow up on things that one decides on, so that one knows what one is doing for something. When it comes to the new "kömiljarder" (purchase billions), perhaps one should look at the effects of them to see if they eventually contribute to something very good. Does it become more equal, or is it exactly the opposite – that there are displacement effects and much more inequality? Those were my questions.
Dan Hovskär (KD)
Madam Speaker! Thank you, Member Karin Rågsjö, for the questions! If we look a bit at the different parts, we see that long waiting times have been a problem for a long period in Swedish health and medical care. There are quite substantial differences in the waiting times in the different regions and in different parts of health and medical care. That is why we are now establishing a national healthcare brokerage to see how we can equalize the differences. Different specialties can have different lengths of queues in different parts of the country, and in this way, one can move forward faster.
Then you asked a question about the efficiency delegation. It means that the regions shall receive support for various efficiencies within health and medical care. We shall look at good examples and see how it has been done in other places so that one can identify different parts that have been effective.
I have my background in healthcare, and good things are often developed locally. But often they remain local, and the different parts do not spread. Above all, one can then highlight good ways of working. And through this establishment, one should also be able to spread good examples. I believe this is an exciting and good way that I understand has also been requested from different regions, i.e., how one can cooperate and get good examples from each other.
Karin Rågsjö (V)
Madam Speaker! Good examples are always talked about. It sounds a bit like post-it notes that one puts up on a screen. Then one has to divide into groups and see what happens with that.
Will this change anything? For example, in 2023, 40 percent started their cancer treatment on time. That was, therefore, historically low. Will this efficiency office benefit the women who did not make it into that specific queue? I think that establishing such an office sounds like a kind of over-administration. One can simply call SKR. They have plenty of material that they could have donated to you in a large box.
I am very surprised that a party that calls itself a healthcare party, which is now in the government and has two ministers at the Ministry of Health, is not getting any further, I must say. It is a bit like the former member said, that the clock is ticking. It seems that the queues are also ticking in the same way.
With the deep problems we have had economically, it would not have been wrong if one had actually ensured to favor the staff within healthcare, who have been on their knees for so long, and listened to them. It is obvious that you have not done that and that the efficiency office you are going to build up will not look at it either. I am therefore somewhat surprised. And I am perhaps most surprised that you do not go in and look at what the new purchase billion has contributed to and what can be done with it.
I mean that if one does not look at things and evaluate them, then one actually does not know what one is doing.
Dan Hovskär (KD)
Madam Speaker! If we look historically at what has happened, we see that the previous alliance government halved the queues. They took various measures. When the red-green government with the Social Democrats then ruled, the queues doubled again.
We work very hard every day to try to reduce the queues. We have a large battery of very many measures. We have two capable ministers, Acko Ankarberg Johansson and Jakob Forssmed, who work every day on this. And they have many employees who work very much to get this large ocean liner – a description of the healthcare system – to turn and become even more efficient. There is a lot going on. I therefore have good confidence that the queues will decrease. But it is a tough and large job that is underway.
Right now, there are good examples all around our country. For example, Region Gotland and Region Sörmland have performed 115 percent and 112 percent more operations now compared to before the pandemic. 30 hospitals are now performing more operations than before the pandemic. This applies to, among others, Alingsås lasarett, Helsingborgs lasarett, and the hospital in Kalix, which have found very good working methods to improve their efficiency. So much is underway, and I have great confidence in the future.
Anders W Jonsson (C)
Madam Speaker! The other day there was an interesting article in DN Debatt signed by SKR's chief economist and the head of the healthcare department. They pointed out that there was a lot of positive about Swedish healthcare. It has high productivity and so on. But in the final phase, one comes to the conclusion that we have a really big challenge, and that is the waiting times. It is so difficult to get through in the Swedish healthcare system. This is what we are debating.
The National Audit Office has reviewed what has been done so far by governments, and it has not been successful. This government will also not come up with anything that will be successful; let me say that.
Waiting times do not sound so serious if you have to wait when you are going to carry out an errand or something else. But waiting times in healthcare have very serious consequences. It means a patient risk to stand and wait to get an initial assessment at a health center or to stand and wait to get an initial assessment from a specialist doctor at a hospital, or in the worst case to have to wait for an operation. It can have very serious medical consequences.
Madam Speaker! Furthermore, it has another equally serious effect, I would like to say. And that is that it increases the gaps in society. Those who always push forward when there are queues are those who have contacts or cash.
Many years ago, I visited a city in Sweden where they had opened an emergency clinic for evening hours. There, one had to pay up to 1,000 kronor for a visit. I said then to the person who ran this clinic that it must only be the upper class in the city who can afford to pay 1,000 spänn for someone to look at a sick child. Then he said: No, the upper class – the judge, the prosecutor, and the others – can always ensure they get an appointment with a doctor the same day. The one who comes here is the single mother from a suburb who has not managed to get an appointment for an assessment of her sick three-year-old, even though she has been lying there.
This is what is very serious about the great deficiency we have in Swedish healthcare, namely that the waiting times are too long. They entail medical risks for the patients. Furthermore, the gaps in society regarding illness are increasing. That is why something must be done about this.
The measures that the previous government has devoted itself to, such as agreements with SKR, have not had any major effect. Additional resources have been added since the 90s. And someone calculated that it is 50-55 billion that has been added to the regions so that they should do something about the queues.
Madam Speaker! Structural measures are required instead. One can work more efficiently in Swedish healthcare. I have previously in this chamber raised one of many examples. It concerns precisely hip operations. In Sweden, the numbers vary. I always ask the orthopedic heads I meet how many hips they operate per operating room and day. I get the answer: two, three, four, and even five. It is not because one has more resources when one operates five hips instead of two, but it is because one works more efficiently. It does not mean that one runs faster, not that one neglects to go to the toilet or that one does not take any lunch, but one works significantly more efficiently.
That is where the thinking of the current government becomes so wrong. One establishes a central, national efficiency office that is to achieve this development.
When I visit a place such as that, which operates four hips per day, I usually say that there must be a queue of people who want to come there and see how one works when one is so efficient. But they say that there are almost none at all who come on study visits.
Efficiency can never be ordered from above; rather, that is where structural changes are required. There are several such [changes] on the table. It is incomprehensible to me that this government does not pick the low-hanging fruit. One such is to give patients power. It is today practically impossible for a patient who is to have hip surgery to find out what the waiting time is at the five different hospitals that exist in the patient's vicinity. It is not possible to obtain this information. It is very carefully hidden.
Furthermore, it is not possible for a patient to obtain simple quality parameters. It is clear that for me it is not only important that the operation takes place relatively quickly, but I also want to be operated on at a place where there is good quality. This information is also not available.
During the period of the January Agreement, we secured funds to set up such a register. The assignment was even given to SKR and Inera. But this project was sunk by other forces. The money was there, and the assignment from the government was there. But the project was shut down. Give this information to the patients! There would be enormous pressure to ensure that changes occur.
The second thing is to ensure that long-term conditions are created for healthcare providers. This could, for example, be done through a simple amendment to the Patient Act where it is stated that patients do not only have the right to choose outpatient care throughout the country, as they do today, but also the right to choose inpatient care. This could mean that the hospital in Oskarshamn could start planning long-term to increase its capacity. They might not have any problems finding competent people and so on, but they must know the long-term rules of the game.
It is also there that the proposal from the Accessibility Delegation, which the Social Democratic government put forward and which this government is now additionally rolling forward, is so completely misguided. Suddenly, there would therefore be available capacity somewhere right now, and one should then just be able to call from the Norrbotten region and say: Hello, we need to operate on ten knees. Where is there available capacity in the country? It goes without saying that this will have no effect at all, other than providing employment for some who are to work in the office at Kungsholmen.
Madam Speaker! I am extremely disappointed that neither the previous nor the current government is taking this problem seriously. I expected significantly more from the Christian Democrats, at least, than that in this debate, just as when the Minister for Health and Social Affairs was here in the chamber, they stand and repeat that they will do exactly the same as the Social Democrats have done for many years and that they are not prepared to make any structural changes - not least considering the high tone they had in the election debates. The queues were illegally long. The queues were criminally long. Now the queues are longer, but nothing is happening.
I would like, Madam Speaker, to move for approval of reservation 4.
Ulrika Westerlund (MP)
Madam Speaker! It became a dramatic day for our debate on this very subject because Vårdförbundet went into conflict this afternoon. 63,000 midwives, biomedical analysts, X-ray nurses, and nurses in all the country's regions will no longer work overtime or extra hours.
Their demands towards SKR are gradual reduction of working hours, sustainable schedules and four weeks of continuous summer vacation. Vårdförbundet also points out that the relevant professional groups worked 3 million hours of overtime last year, that every third member regularly works overtime and that Swedish healthcare cannot be built on certain professional groups working millions of hours of overtime.
Our debate is naturally not about this conflict, but it cannot be decoupled from what Vårdförbundet states as the reasons for the conflict: that employees within healthcare have unreasonable working conditions. For Miljöpartiet, it is quite clear what the unreasonable working conditions are due to, namely a lack of resources. The report on waiting times in healthcare that we highlight here tonight is not specifically about resources, but resources are naturally central to the possibility of reducing the queues.
The Vårdförbundet's counterpart in the conflict is SKR. SKR has pointed out its needs for additional supplements, and the supplement that the government provides is not sufficient. It is not about putting welfare first, and it is also not about improving the preparedness that healthcare needs to have in our society. We find it difficult to understand that one prefers to prioritize lowering taxes in several areas.
Queues in healthcare are very closely linked to staff shortages. The various occupational categories in healthcare depend on a good working environment to want to and have the energy to stay in their jobs. Otherwise, people flee the profession or reduce their hours, which makes the pressure harder on those who remain. It becomes a vicious circle, and the queues get longer. The Government needs to increase the general grants to the regions and provide healthcare with broad and continuous conditions across all of Sweden.
In the Green Party's budget motion, we add an additional 7 billion to healthcare, in addition to what the government has allocated. We also believe that the state's contribution to regions and municipalities should be linked to cost developments to avoid similar situations with fire brigade deployments occurring in the future.
Madam Speaker! One of the Swedish National Audit Office's conclusions is particularly interesting in this context. It concerns the fact that targeted government grants do not steer towards long-term change. Targeted government grants can be powerful steering instruments and be particularly suitable for getting a new initiative started, for example, standardized healthcare pathways and the queue billion. The Swedish National Audit Office writes, however: "The government grants within the framework of the queue billion and SVF are characterized by similar deficiencies as those the Swedish National Audit Office has previously noted with targeted government grants within health and medical care: they hinder long-term planning and risk stimulating, above all, short-term measures. Short-term measures can take focus away from necessary, long-term measures for structural change." This was what the previous post was very much about. "Furthermore," the Swedish National Audit Office writes, "there are limits to what the staff can manage."
The National Audit Office also points out that standardized healthcare pathways as state grants have been more predictable and provided better conditions for long-term work than many other state grants within healthcare because, in the agreements, they were presented as a long-term investment with recurring funds.
Madam Speaker! The National Audit Office points out in its review that the healthcare guarantee, the queue billion, and standardized healthcare pathways are not so effective tools for shortening waiting times and that there is a risk of, among other things, displacement of patients with greater healthcare needs. The National Audit Office therefore leaves a recommendation to task an appropriate authority with quantitatively investigating the new queue billion's effect on healthcare queues as well as any displacement effects. The Government writes in its communication that it intends to review whether there is a need to supplement the National Board of Health and Welfare's follow-up with an evaluation assignment to the Agency for Health and Social Care Analysis.
We think it does. The question of any displacement effects is so relevant that it may need to be evaluated separately, and we think the government should give such an evaluation assignment to the Agency for Health and Social Care Analysis. Such an assignment should not only be quantitative but also qualitative so as not to miss important aspects.
The National Audit Office has also looked at the design of the healthcare guarantee, and the Green Party welcomes that the government proceeds with the question of how the healthcare guarantee should be changed to become more functional. Ahead of the upcoming work, I want to emphasize that the healthcare guarantee should include investigations and examinations and that both previously known and new health problems should be included. Also, the total time from the first healthcare contact to treatment should be included. We also consider that assistive devices should be covered by the guarantee and by the high-cost protection. The government should, overall, take measures for a better functioning healthcare guarantee.
I vote in favor of reservation 6.
The deliberation was hereby concluded.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.