Response to interpellation 2022/23:333 on waiting times in cancer care

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Mikael Dahlqvist has asked me what concrete measures are being taken to reduce queues within cancer care. Mikael Dahlqvist has also asked me what measures the government and I intend to take to reduce the differences in the country.

Cancer care in Sweden is, Madam Speaker, highly ranked in international comparisons, and Sweden currently has one of the highest figures in the EU when it comes to cancer survival. Survival continues to increase, moreover, regarding the most common types of cancer. At the same time, improvement is required, and the government has therefore allocated 625 million kronor during 2023 to further develop and improve cancer care.

An important issue in the work to improve Swedish cancer care is to shorten waiting times and reduce inequalities. Getting a diagnosis and treatment quickly has a direct impact on the probability of a good prognosis. That patients are given poorer conditions to survive a cancer diagnosis as a result of long waiting times or because of where in the country they live is unacceptable.

The introduction of standardized healthcare pathways, SVF, in Swedish cancer care began in 2015. The purpose of SVF is to reduce unnecessary waiting and anxiety for patients as well as to counteract inequalities. For the work with SVF, there are two national goals, the inclusion goal and the lead time goal. The inclusion goal is that 70 percent of all patients shall be examined in an SVF. The lead time goal is that 80 percent of these patients shall be investigated within the healthcare pathway's specified times.

All regions met the inclusion goal in 2022, which was the first time. We thus see that the long-term investment in SVF leads to results. On the other hand, the development during 2022 is worse regarding the lead time goal. Even though the goal fulfillment is high for some cancer types, for example acute leukemia, the fulfillment varies greatly between the regions and is often far from 80 percent.

In the agreement between the state and SKR regarding cancer care 2023, there are therefore continued performance-based requirements on the regions for their work with SVF. Within the framework of the agreement, it has also been decided that the performance requirements shall be reviewed for next year's agreement in order to achieve improvement. The agreement also includes a number of other measures to strengthen areas with special challenges. For example, an action plan shall be developed to strengthen urology and a national working group shall be appointed to strengthen radiation care.

A cancer patient often encounters a dozen different specialties during their time in healthcare. Efficient cancer care with short waiting times is therefore dependent on the competence supply being good throughout the healthcare system. To achieve this, the government in January 2023 tasked Socialstyrelsen to, together with the National Healthcare Competence Council, develop proposals for a national plan to improve the competence supply in healthcare.

For the same reason, the accessibility in cancer care is also dependent on the accessibility in healthcare as a whole. To increase accessibility in healthcare, the government in February 2023 tasked Socialstyrelsen to allocate nearly 2 billion SEK in performance-based compensation to the regions to increase the number of care beds. Socialstyrelsen has also been tasked to develop a proposal for a national plan to reduce the shortage of available care beds, as well as to support and strengthen the regions' production and capacity planning. Within the framework of the agreement with SKR on increased accessibility in health and medical care, the government allocates nearly 3 billion SEK annually to the regions to increase accessibility.

In conclusion, I also want to mention that the government has recently initiated an update of the national cancer strategy. The update will take a holistic approach to cancer care and its persistent challenges, including waiting times and inequalities across the country. Sweden shall have a cancer strategy that ensures we remain a leading country within cancer care.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you for the answer, Minister Acko Ankarberg Johansson!

We have a difficult situation within healthcare, with increasing waiting times and lack of availability across the entire country. We have just gone through a global pandemic which has naturally resulted in the care having to concentrate on taking care of patients with covid. This naturally in turn leads to displacement effects for other patient groups. The staff has made fantastic efforts but is exhausted after the pandemic. The queues for cancer care are no exception, even though healthcare has prioritized providing life-saving care as quickly as possible during the pandemic.

Madam Speaker! The reason for today's debate is to show that the queues for certain treatments are unacceptably long. Unfortunately, patients are dying while waiting for care. According to the healthcare sector, long waiting times in some cases have affected patients' ability to get well. I therefore assert that the situation is extremely serious.

A fundamental prerequisite for working away queues and increasing accessibility is that there are resources, which is not the case now. In an economic report from SKR, Sveriges Kommuner och Regioner, for the month of May - it is only a few weeks old - one can read that the economic challenge for Sweden's municipalities and regions is becoming increasingly tangible. The difficult economic situation that Sweden finds itself in right now, with high inflation, rising interest costs and sharply increasing pension costs, is reflected in municipalities and regions, just as in the individual's wallet.

Already this year, most regions are expected to run a deficit. This is remarkable, Madam Speaker, given the historical appropriations that the previous government provided, especially during the final stages of the pandemic, and the large surpluses that existed then in Sweden's municipalities and regions. The result is expected to fall by 50 billion this year, and for next year, it looks even gloomier.

We already see that municipalities are pulling the handbrake to manage the economic situation. The day before yesterday, it was reported that schools in many municipalities in Sweden are being forced to make significant cuts, including in Gothenburg. This will of course affect the regions, which are responsible for healthcare. They are being forced to pull the handbrake significantly.

Unfortunately, I cannot see that the government intends to increase the state grants to the municipalities and regions. My question to Acko Ankarberg Johansson is therefore: Does the minister see any problem with the crisis within cancer care? What I see here and now is that the queues are far too long and that far too many people are forced to wait.

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Yasmine Bladelius (S)

Madam Speaker! I want to begin by thanking the interpellator Mikael Dahlqvist for an extremely important question to Minister for Health and Social Affairs Acko Ankarberg Johansson. I signed up for this important debate to take the opportunity to speak about precisely the long waiting times within healthcare in Sweden and, above all, in my home region Skåne. I choose to do this even though I know that the Minister for Health and Social Affairs does not govern Region Skåne but has a national responsibility for healthcare policy. I do it partly because the Minister's party colleagues are, in fact, to the highest degree responsible for the crisis within healthcare in Skåne, where they do govern, and partly because I perceive that there is great concern among both patients and healthcare personnel, but also among residents in Skåne.

Madam Speaker! The waiting times in cancer care in Skåne have not only persisted, but they have also increased. Not even one in three cancer patients in Skåne receives care within the existing time limits. We know, just as the Minister said in his response, that every day counts when it comes to those affected by cancer.

Tens of thousands of people in Skåne have stood in healthcare queues for longer than the law allows. The situation is actually worse in Skåne than in the rest of Sweden. The Minister for Health and Care's party colleagues and other governing right-wing politicians in Skåne blame this on the pandemic, and certainly the pandemic brought with it an extremely high burden on healthcare, even though it would naturally have looked much worse if the Social Democratic-led government had not provided historically large supplements in the form of state grants to the regions.

But the pandemic affected all of Sweden, not just Skåne. Therefore, it cannot be the pandemic that is the reason why the waiting times in healthcare in Skåne are longer than in the rest of the country.

The reason why the healthcare queues in Skåne specifically are so long is a severely underfunded healthcare system. This year alone, the Skåne healthcare system has demands for savings of nearly 3 billion Swedish kronor. Skåne University Hospital has a savings target of 1.4 billion, Helsingborg Hospital 442 million, and Ystad Hospital 155 million. That is how it looks at the Skåne hospitals and health centers.

The Tidö parties act in Skåne in the same way as they do in the rest of the country. The government and the Sverigedemokraterna have, as is well known, prioritized lowering taxes for high-income earners, and in order to afford that, they provide smaller grants to, among other things, healthcare. For Region Skåne's part, the state grants were reduced this year by 428 million kronor. At the same time, the same Tidö parties sit in Region Skåne and maintain one of the country's lowest regional taxes and let the deficits in healthcare run rampant.

This, Madam Speaker, is not correctly prioritized! Therefore, I want to ask the Minister for Health and Social Affairs: Does the Minister for Health and Social Affairs consider it correctly prioritized to lower taxes for high-income earners by twice as much as was given in general state grants to regions and municipalities, which do conduct health and medical care policy and can therefore also influence the length of the cancer care queues? And does the Minister for Health and Social Affairs consider that her party comrades in Region Skåne are making the right priorities when they impose savings requirements of nearly 3 billion Swedish kronor on already extremely strained Skåne healthcare?

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, members, for the interpellation and the supplementary questions! It is truly important that we have cancer care that provides the opportunity for early detection, correct diagnosis, and then the correct treatment for the patient, as well as that the patient is given the opportunity for follow-up care and rehabilitation - sometimes one needs this for a lifetime.

We have much more to do to ensure early detection. We already have good treatments today, but we must strengthen the rehabilitation side. That is the reason why we have taken the initiative to revise the national cancer strategy. It has been a request from the Riksdag for several years, but previous governments have not chosen to do it.

The basis of the strategy is good; it is not that which is to be changed. It is a national strategy that is specific to cancer and which is forward-looking. Those things remain fixed. But one needs to constantly update and renew based on new challenges, new technologies, and new opportunities. That is what the government has taken the initiative on this spring.

What the members are highlighting here is also the lack of resources. It is palpable right now as a result of inflation. I note that the Social Democrats have not provided any other money for healthcare or regions in their spring revision budget, but they are at the same level as the government. The Social Democrats therefore have no other funding proposals to support regions, municipalities, or healthcare during the current year than what the government has. There we stand at the same point.

It is clear that it is necessary to strengthen healthcare. Therefore, we provide special government grants that go specifically to healthcare. I will continue to fight for it.

We have a need for general government grants, especially to the municipalities, which have a broad and wide scope of activities. But regarding the regions' activities, my focus will be on specific government grants that go to healthcare, so that queues can be shortened, care capacity can be increased, and primary care and many other parts can be strengthened. That is my focus.

I am pleased that the government also increased the support for healthcare in the budget for the current year. It is necessary to continue that work.

Something has however happened that is very pleasing. In week 11 this year, we reached a peak. From week 11 onwards, we perform as many operations in Sweden as we did before the pandemic. It is fantastic, and it is not due to either the previous government or the current one. It is due to the employees in health and medical care, who have been able to set goals and work through queues, so that one is now actually back at the same level regarding the number of operations as before the pandemic during the corresponding month and week. It is truly impressive.

Those who hold the register say that this is actually a difference that can be talked about, so that is why I did so a few weeks ago. One must know that it is not just a temporary jump, but we are actually in an improvement. Then summer comes, and then employees must get vacation, so there will be a decline. So it must be. But a big thank you to all employees who have actually achieved this recovery when it comes to operations!

It is largely about elective, planned care, but it is also about care for cancer patients. There we must make a reinforcement, so that resources go where the needs are greatest and so that we can ensure that we have competent staff who can be involved in this work.

This matter regarding raising the tax then? It was given for our government to increase the support in all transfers as a result of inflation, where they are adjusted automatically. We have in the state finances that rule that support and grants are adjusted in relation to inflation or if it goes in the opposite direction. The same applies to tax brackets, for example.

The government has not made a decision to lower the tax for any specific group. What happened was a consequence of us both increasing the support for those who need different transfers and that there was also a corresponding percentage increase of threshold limits in the tax system. The question is whether the Social Democrats intend to raise the tax for midwives and police officers before next year or how they intend to do so.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you once again for the answer, Minister Ankarberg Johansson!

I share the Minister for Health and Social Affairs' view that it is good that we have strategic guidelines specifically for cancer care. We know that this with regional centers means a lot. We know that a national strategy means a lot. We also know that the standardized care pathways have been a fantastic development. That is something we completely agree on.

But, Madam Speaker, that is not what my interpellation is about. My interpellation is about the situation we find ourselves in now, a situation that is acute for Sweden's municipalities and regions. It does not help if one injects state grants to, for example, increase healthcare beds, because they are swallowed by a black hole.

My colleague Yasmine Bladelius mentioned Skåne. I can also take Värmland as an example of how acute the situation is. Värmland is a fairly small county with 280,000 inhabitants. This year, the forecast points to minus 700 million for healthcare in Värmland, and next year the deficit will be 1.3 billion. We have three hospitals in the county, and the deficit corresponds to the entire operation at more than one of them. So serious is the situation, and so quickly it has happened.

I also want to further emphasize the importance of how serious the situation is and supplement what Member Bladelius took up regarding Skåne. I have, in fact, received a communication from Regionsamverkan Sydsverige, in which Region Skåne is among others included. It was recently sent to the Ministry of Finance to demonstrate how acute the economic situation is. There it is written: In the current situation, temporary financial assistance from the state is needed to alleviate the acute economic crisis if the high inflation is not to have long-term lingering negative effects on the regions' ability to deliver health and medical care. Furthermore, it is written that economic support in the form of general state grants is needed to manage the short-term cost shock - yes, that is what is written - caused by the rapid price development.

As I interpret this, Madam Speaker, it will affect healthcare. It will naturally affect accessibility, and the queues will increase.

When it comes to how much money is prioritized from different parties and from the government, we can state that we have an equal budget when it comes to targeted state grants. The Minister for Health and Social Affairs is completely right in that. On the other hand, we have doubled the appropriation when it comes to general welfare funds. It is actually over 6 billion more than what the government allocated last autumn. You choose to prioritize a tax cut for those who have high incomes. This concerns the state tax rate. This can be adjusted. It is simply a matter of political will. It is clear that one can adjust with different steering mechanisms.

I have asked another question to Minister Acko Ankarberg Johansson. Do you agree with me regarding the problem picture when it comes to the upcoming welfare crisis, given the difficult economic situation that is looming? Does the government intend to provide an announcement on whether it intends to strengthen the state budget regarding regions and municipalities?

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Yasmine Bladelius (S)

Madam Speaker! Thank you, Minister, for the answer! I know that the Minister has an enormous commitment to these issues. It is just that we see things a bit differently on how we should find the solutions.

I want to tell you about my sister who works in healthcare. We often talk about her tough work situation, but of course not about the patients. She often feels: Today was probably the last day. And she is far from alone in feeling that way.

To address the queues in healthcare, Madam Speaker, it is a matter of the staff. It is about the staff's working situation and about more colleagues for the healthcare staff. There lies the solution; at least this is one of the very largest parts when it comes to finding solutions to the problems.

Then one can ask how they are to get more colleagues for those who work in healthcare and how they are to get a better working situation. In my opinion, it is about how one chooses to prioritize. Purely financially, it naturally concerns how one chooses to structure the state budget and where one chooses to allocate, for example, the general state grants. One might prefer to lower taxes for high-income earners.

But it is also, of course, about which proposals one chooses to submit to improve, for example, the working situation for healthcare personnel. One of the proposals currently being investigated within the Government Offices concerns the reporting law. I would like to ask the Minister for Health and Care how she views that healthcare personnel should be forced to report undocumented persons to the police and the Migration Agency.

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, members, for the questions and additions! Regarding the last question, about the responsibility for information, there will be a government inquiry. It already states in the Tidö Agreement that there are circumstances that make it necessary to exempt certain sectors. Healthcare is already mentioned in this.

I am very pleased that the member is raising the issue of the working environment, as the government has been doing so continuously. It is not that the first thing we should do is only talk about more educational places. It is also about those who already work in healthcare. It is about those who have actually worked and who have education and experience but who have left the sector.

It is 13,600 nurses who have left the sector over the last six years. They do not work in healthcare at all. There are very many nurses, midwives, and district doctors who go down to part-time because the job is too heavy. One obviously has every right in the world to work part-time. There can be private reasons. It can be about work, family, and whatever it may be. But one should not do it because the job is too heavy, because then it is an employer issue. Then it is not a sufficiently good working environment for one to be able to work full-time.

I can give a calculation example. If all nurses who today work part-time were to move up to full-time, we would have 8,000 more full-time positions when it comes to nurses. That is a fantastic figure. Here, every employer has an opportunity to make changes and improvements in the work environment. These people are already trained and have experience. Some of them might want to move up to full-time – then the pension will be improved. But then the work environment must become better. Maybe some who have previously worked in the sector want to return to it, but then there must be a trust that there have been changes and that it has become better. Otherwise, they will not return.

That is why I, as minister, took the initiative and called Sveriges Kommuner och Regioner and the then-chairman of the healthcare delegation to a meeting in the spring together with all trade union representatives. Now we have received a new healthcare delegation at SKR, and I have contacted the current chairman there. We will have a follow-up meeting, probably after the summer. We must, in fact, be able to report concrete changes to the employees regarding the work environment. It is the only way to retain them in healthcare or to get back those who are already experienced and skilled.

We must, of course, also ensure that we have enough training places and that the profession is attractive for those young people who want to seek it out.

When it comes to state subsidies, which Member Dahlqvist would like to highlight, the difference between the government and the Social Democrats is very small. The Social Democrats did not add a single krona to healthcare, the municipalities, or the regions in the spring budget, but instead made the same assessment as the government did. We must have a restrained spring budget. Inflation is, in fact, what hits households the hardest, every single household. It makes households poor. We must counteract inflation in every way we can, so that purchasing power is recovered and so that wages have the purchasing power they are supposed to have.

Both the Social Democrats and the government judged that we needed a restrained budget, so there we have no difference.

The Speaker then instead raises the autumn budget, which applies to the current year. There, the Social Democrats added 6 billion more to municipalities and regions, but it is not 6 billion to healthcare. In practice, it means approximately 1.4-1.5 billion to healthcare. You also made a reduction of 200 million under the public health and healthcare account. The part that remains for healthcare is approximately 1.4-1.5 billion.

It is certainly substantial money, and we will return to that from the government's side this autumn when we present a new budget. But this is not the big difference between things going well and things going poorly. I believe one should be careful when pretending to have given a lot of new money when one hasn't done so.

We have a shared responsibility to ensure that healthcare has the funding it requires. And there, both the government and, I imagine, the Social Democrats will return when it comes to the autumn budget and ensure that healthcare receives the resources it needs. But we must work on the working environment every day, because it is absolutely crucial for the future of healthcare.

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Mikael Dahlqvist (S)

Madam Speaker! Thank you, once again, Acko Ankarberg Johansson, for your answer! I know that the Minister for Health and Care has a great commitment to the issue. We have fought together earlier in the Committee on Health and Welfare for many years, so I do not doubt the commitment. We perhaps have slightly different views on how we should reach the goal.

I mentioned in my first speech that the staff are exhausted after the pandemic, Madam Speaker. It is clear that this is reflected in a continued tough working environment. We agree on that. And it is clear that there is a great deal to do within health and medical care when it comes to governance and management issues. It is not always just about economic resources. I agree with that. It is also about governance and management. It perhaps also concerns a bit about how one distributes administrative and patient-oriented care.

It is about being able to achieve a good schedule, Madam Speaker. Now we risk large warnings within health and medical care, and then there may be fewer employees. It is clear that fewer employees will not result in a reduced workload for the existing employees. If we are to get back all the employees who have unfortunately left the care sector, it is, among other things, about raising the status. Then we must ensure, just as when it concerns elderly care, that one receives a reasonable salary, a good working environment, and good conditions. Therefore, general government grants are important.

In conclusion, Madam Speaker: When it comes to the distribution of money to the general system, it is clear that the previous Social Democratic government announced a higher sum. But the difference is also that we are prepared to reconsider, especially now that we see how the economic development looks.

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you once again, member! It is an important subject, and I see no difference between the government and the Social Democrats in the ambition for cancer care or what needs to be done moving forward. I look forward to developing the cooperation in how we develop the cancer strategy and that work.

There are differences in how much money we have given, but they are not large differences. We will both return in the autumn budget: the Social Democrats did not return in the year-end budget but will, roughly like the government, return in the autumn. We must first fight down inflation and then secure the support for all welfare activities, in addition to the money we have already given for the current year.

Every region currently has a very tough situation regarding setting a budget, whether one does it now for the June meeting or waits until November. There are pros and cons to both. The risk is that one proceeds with a budget that is too harsh now and, in practice, sounds as if one is making savings twice. If one waits and makes the budget decision in November, it can be difficult to achieve an effect in January. It is therefore no easy choice that the regions face right now.

I have noted that some region is actually submitting an underfunded budget just because they have had a surplus. The special state grants that went to healthcare during two years of the pandemic could not be used, because they were temporary. They were set aside, because it was not known how temporary money could be used.

Some regions have now therefore chosen to handle it by underfunding the budget, and I believe it is a wise choice to do so right now when one has a temporary situation.

I also see, quite pleasingly, some regions that are specifically investing in staff and work environment issues in their budget proposals. I note that Region Kronoberg recently presented a substantial package of measures for the employees.

I would like to see more of this. I understand that the packages will be somewhat different depending on the region and the needs. But that is precisely what one needs to focus on: employee packages that focus on the work environment and ensuring that one strengthens the patient-facing work. We need to reduce the amount of work that is not patient-facing, which can largely be administration.

The interpellation debate was hereby concluded.

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