Response to interpellation 2022/23:386 on the Elderly Care Boost
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 M argues that the staff is the most important resource in elderly care and that competence supply is a key issue 1. 1 M emphasizes that the municipalities have the responsibility for staffing but that the state supports them with government grants 1. M argues that the state has an important role and that it is important to evaluate government grants that are not fully utilized. 2 M argues that Äldreomsorgslyftet has functioned well 2. M sees welfare technology as a complement to the staff. S argues that more employees, better wages, and better schedules are required to solve the competence shortage. 3 S believes that funding for municipalities and adult education is being reduced 3. 4 S wants Äldreomsorgslyftet to continue until 2026 4. 2 M argues that it is unsustainable that some municipalities only direct money towards operations in their own management 2.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Anna Tenje (M)
Mr. Speaker! I want to begin by thanking you for the interpellation I have received from Anna-Belle Strömberg. The interpellator has asked me why I and the government do not want to both extend and expand Äldreomsorgslyftet. Anna-Belle Strömberg has also asked me what measures I and the government intend to take to ensure that municipalities and educational providers will manage the competence supply and increase the competence within elderly care in the long term.
The staff in elderly care is its most important resource, and a well-functioning staffing and competence supply is clearly a key issue for the development of elderly care. It is crucial for the quality and safety in elderly care that the staff have the right competence to perform the work tasks.
From and with July 1, 2023 - in just a few weeks - nursing assistant is a protected professional title, which also means that the competence for the professional group is ensured and that this will likely contribute to better care and nursing for the elderly.
The task of strengthening the supply of competence in the welfare sector is complex and requires efforts across many different policy areas. It involves, for example, being an attractive employer, offering different career paths for not least our important nursing assistants, finding solutions for a sustainable working life, and attracting more people to the health and social care profession.
The supply of personnel and skills, however, cannot be solved solely with more resources or more employees. Potential also exists in changed ways of working, digitalization, and other efficiencies, which need to be taken into account. New technology can, among other things, reduce the workload so that more people can manage to work longer.
Each municipality is today responsible as the principal for elderly care, and issues regarding staffing and competence development are an employer's responsibility. The Government simultaneously sees a need to support the municipalities in the work of meeting challenges in elderly care.
As appears from the autumn budget bill (prop. 2022/23:1), the so-called Äldreomsorgslyftet continues throughout the entirety of 2023. It expires in 2023 and is not concluded in an active sense.
In addition, 4 billion kronor in state grants are allocated to the municipalities to ensure good care and nursing for elderly persons. The funds may be used based on local needs in order to enable improvements and development of the operations, for example improvements of the work environment, which is extremely important, working conditions as well as skills development.
An additional 3 billion kronor will be used to reduce the number of temporary positions and for an investment in increased staffing and competence for both nurses and doctors within elderly care. Resources are also added to the municipal sector through the general state grant for 2023.
Let us look ahead. The work on the budget bill for 2024 is ongoing within the Government Offices. The Government will return in the usual order with its proposals and priorities, not least for the important welfare area.
The government is also continuously working to follow up on Äldreomsorgslyftet and other state grants to ensure that state funds are used for their intended purpose and effectively.
When I prepared the response, I had invited SKR and Kommunal to a joint meeting with me to discuss Äldreomsorgslyftet and the evaluation that has been carried out by Socialstyrelsen. Now that I am delivering my response here in the chamber, I can say that the meeting took place this morning. Our evaluation meeting was very good and constructive.
It is, however, important to point out that no single measure solves everything, but by working together, one can make a very big difference for the supply of skills within elderly care and the quality of life for our elderly. The state, the municipalities, and the regions also need to continue working together to strengthen the access to skills within elderly care throughout Sweden in the long term.
Anna-Belle Strömberg (S)
Mr. Speaker! I thank Minister Anna Tenje for the answer. I share the Minister's view that the staff is elderly care's most important resource and that quality, safety, correct competence, and career paths are of the utmost importance in elderly care.
Mr. Speaker! My purpose with today's interpellation debate is to argue and to demonstrate how important the Äldreomsorgslyftet is for Västernorrland County. In Dagens Samhälle on April 27, party representatives for the Socialdemokraterna, Moderaterna, and Centerpartiet from Kommunförbundet i Västernorrland write a debate article where they are very concerned that the government has not presented any funding for Äldreomsorgslyftet for 2023.
In Västernorrland, there are a total of 440 people undergoing training funded by Äldreomsorgslyftet to become nursing assistants. Employees and substitutes are given the opportunity to train in lifting techniques, nutrition, dementia, welfare technology, language, supervision, and strengthening the management role.
The elderly care boost has enabled the municipality of Örnsköldsvik to further educate 68 people. In Sundsvall it is 130, in Kramfors 120, in Ånge 10, in Timrå 26, in Sollefteå 24 and in Härnösand 62 people. These are small and medium-sized municipalities in Västernorrland.
This is a good first step, but many more are needed. The need for trained staff for the welfare sector is great both here and now and in the coming years. According to SKR's forecasts, approximately 14,000 new nursing assistants and healthcare assistants will be needed per year for the next ten years. The need is enormous, and this worries our local decision-makers. Municipalities and education coordinators need long-term thinking when it comes to the investments in education.
Mr. Speaker! I regret that the answer to my questions is that the government, in the usual manner, returns with its proposals and priorities in the budget bill for 2024 and that work is being done continuously to follow up on Äldreomsorgslyftet. The initiative exists in 2023. But if one starts a new education during 2023, one must know that one can complete the education. That will be done during 2024, because the education is at least one and a half years long. If the government does not provide notice for more than 2023, the educations must be completed this year, and no new ones are started. I hope that the Minister has been reached by all the voices being raised in Västernorrland and around the country that one must be given the conditions for long-term planning.
Mr. Speaker! Therefore, I must once again ask the Minister if she and the government intend to extend the Äldreomsorgslyftet after the end of the year or not.
Peter Hedberg (S)
Mr. Speaker! I too must thank the Minister for the answer, but I also thank my party colleague Anna-Belle Strömberg for the interpellation and the opportunity to debate the issue.
We have today had the summer recess in the Riksdag. Summer is thus here. There are many municipalities that are still struggling to put together their summer schedules within elderly care. The Minister will probably not be surprised if I say that it would have been excellent if we could have received some clearer information for the future than what appears in the interpellation response. Just as Anna-Belle Strömberg mentioned, in April 2023 political representatives for our home county Västernorrland wrote a debate article with the headline "Maintain a state-funded elderly care boost". The signatories were Social Democrats, Center Party members and Moderates.
The municipalities are struggling with the supply of skills within elderly care. Lyftet was an important part in facilitating this and raising the quality. But now the government chooses to phase out Äldreomsorgslyftet - at least that is how I would like to express it. In the Minister's response, it is emphasized that the municipality is the principal for elderly care. That is true, of course, but it is perhaps a bit easy to do so because the state, the regions, and the municipalities are significantly more dependent on each other than that. There are laws and regulations that influence, but also the demographics and the view on how the whole country should live.
In other interpellation debates, this has been linked back to a party group debate. I would also like to do that. In a party group debate last week, one of the government's leading ministers argued that the municipalities now need to make tough prioritizations. If I remember correctly, the person in question pitted schools against swimming pools.
In my home municipality, Kramfors, we are used to making tough priorities. 85 percent of the municipality's budget goes to school, elderly care, and welfare. A good portion of the rest is public transport, water, and the like. Kramfors struggles, like many other rural municipalities, with the supply of skills and with making the money stretch so that one can have schools and swimming pools to enable swimming lessons and meaningful leisure activities.
In elderly care, one struggles with recruiting staff and with financing, for example, skills development. This is where Äldreomsorgslyftet comes in. Just as Anna-Belle Strömberg previously lifted, Äldreomsorgslyftet in my municipality has made it possible for 120 people to increase their competence. 120 people in a municipality with approximately 2,000 employees - that would not have been possible without the previous Social Democratic government's initiatives.
Not only Kramfors but also many other municipalities in Västernorrland and Sweden know exactly what it means to make tough priorities. They struggle with the tax base and demographics. Despite limited resources, citizens must receive public services of good quality.
Since I requested a clearer statement, my question to the Minister is the following: Will the Minister and, in the long run, the government be able to make tough priorities and ensure that Äldreomsorgslyftet is strengthened instead of, for example, lowering taxes for the richest?
Eva Lindh (S)
Mr. Speaker! Many municipalities say that the great challenge ahead is the supply of skills. Now, I believe that most also say that resources are a great challenge ahead because they do not receive sufficient resources to meet the challenges of the welfare state in the future.
The competence supply within elderly care has been a major issue for quite a long time. I remember it because I myself have been a municipal council member with responsibility for elderly care. Even then, we struggled with measures to get more people to work within elderly care.
Those who complete upper secondary education are not numerous enough. If we were to rely only on those who complete the care program, we would not be able to manage elderly care in Sweden today. Very many also educate themselves within adult education. But now those resources are being reduced. Both the resources for welfare and the resources for adult education and labor market measures are being reduced now. In that case, Äldreomsorgslyftet becomes even more important for us to be able to manage elderly care in the future.
Many of us are passionate about elderly care and believe that it is extremely important. If one has fought all their life, they should, of course, also be entitled to a secure elderly care of good quality. Just as the Minister said, elderly care is nothing without its staff, who are very important.
The S-led government introduced the Elderly Care Boost (Äldreomsorgslyftet) to be able to meet the challenge of competence supply within elderly care. Not all initiatives take root with municipalities and regions, but this specific initiative has done so. The municipalities say that this really makes a difference. I have not heard anyone say anything else – people speak very highly of this.
Sometimes I have heard from other cabinet ministers that the money is not being fully utilized and that this would mean that one does not need the Äldreomsorgslyftet. I believe that this is completely wrong. When one introduces such an investment, it takes time for the municipalities to get started with it, and it means that sometimes one cannot train as many as one had hoped.
It is therefore required to take time to get such an initiative started and to make it fully effective. But it also requires long-term perspective - that one knows that this is something one can work with moving forward.
Our concern, which my party colleague Anna-Belle has formulated so well in her interpellation, is not just taken out of thin air, but it is seriously intended. We are concerned about the supply of competence within elderly care and have met many others who are too. When one sees that the money for Äldreomsorgslyftet is gone from 2024 onwards, it is therefore worrying.
I actually did not become less worried when the Minister said that it is not being concluded in any active sense. Either it is being concluded or it is not – there cannot be any middle ground. Therefore, we here in the chamber, but naturally also the municipalities and those who work within elderly care and are passionate about it, need to receive a decision now. What will happen with Äldreomsorgslyftet? Will it continue or not?
Statsrådet Anna Tenje (M)
Mr. Speaker! There are many questions from the interpellator and the members participating in this debate. It pleases me immensely that more people are engaging in this important issue and that more share the government's view that the supply of competence is in all respects perhaps the most important issue to crack moving forward, not least when it comes to elderly care. The shortage of competence is great in many different industries, but for my part, I am passionate about elderly care and about helping and supporting the municipalities in this important work.
Member of the Executive Board Peter Hedberg was suggesting that I am making it easy for myself. That is probably a misunderstanding - it is absolutely not about making it easy for oneself. But I just want to clarify that we have municipal self-government, and it is the municipalities that are the principals and have the primary responsibility for precisely the competence supply. With that said, I was also clear that the state has a very important role to play here.
Member of the Board Eva Lindh was on about that she had heard a minister say that the fact that money is not being used is a reason to abolish the state grant. This is a very clear misunderstanding. But one must nevertheless be careful that if you have a state grant that the municipalities then cannot utilize so that it reaches the elderly or the employees, it is important to review the state grant, evaluate it, and look at what it was that made it impossible to utilize and produce the effects that had been requested.
In the Swedish Social Insurance Authority's evaluation of Äldreomsorgslyftet, it appears that 31 percent of the funds were used in 2020. In 2021, it was 42 percent that were used, and according to the preliminary figures for 2022, 77 percent have been used. The pandemic and the difficult situation regarding competence supply in the municipalities in general have thus obviously put a spoke in the wheels. But in 2022 and hopefully to an even greater extent in 2023, the money has been able to be used to an ever greater extent - to make competence-enhancing interventions for our employees, train nursing assistants and have a specialist education for nurses, but also and above all to focus on the important leadership in our municipalities.
With this said, I believe there are few government representatives who have stood in the rostrum in an interpellation debate and revealed upcoming investments or, for that matter, what is contained in the budget bill. We will, just like all previous governments, present our priorities later this autumn, when the Members of Parliament return from their summer holidays. I believe that is hardly surprising.
I do not think that it will surprise our Members of Parliament to any great extent that there will be no further announcements regarding Äldreomsorgslyftet other than that we will return after the summer with a possible continuation and development.
With this said, I still want to point out that the issue of competence supply is and remains the most important issue to solve moving forward when it comes to strengthening Swedish elderly care. These are issues that I work with daily and that I cooperate on daily with SKR, Kommunal, private healthcare providers and other stakeholders. Yesterday, I also met Ung Omsorg, which works actively to attract new young people to the profession.
Anna-Belle Strömberg (S)
Mr. Speaker! I thank Minister Anna Tenje again for the answer. The Minister said in her first statement that elderly care needs an elevated status, and I am also completely convinced of that. This work was initiated under a Social Democratic government. But it is not enough with just an elevated status; there is also a need for more employees, welfare technology, and naturally a protected professional title, just as the Minister touched upon. This was a task that we Social Democrats pursued purposefully for many years.
Not least the protected professional title means that from a state level, one must now consider how to help people who work in elderly care and do not have the competence that is actually required today. Women and men who work in elderly care often do not have such a high income and do not have the possibility to take leave of absence and study to become an assistant nurse for one and a half or sometimes two years to then return to the profession.
But that 440 people in Västernorrland chose to do this is solely due to the fact that Äldreomsorgslyftet exists, with the possibility to study to become a care assistant or assistant nurse during paid working hours. There is also a possibility, within the framework of Äldreomsorgslyftet, to strengthen the first-line managers, which I think is absolutely excellent.
I know that it is extremely complicated to attract staff to the welfare sector. I myself have a background in elderly care; I was the chairman of the elderly care committee in Örnsköldsvik municipality for eight years. At the beginning of my mandate, about 13 years ago, we had to work hard to get substitutes during the holiday months. Today, one has to work hard to get substitutes every day. Furthermore, three holiday periods are now being introduced to piece together schedules so that the few employees one has are sufficient. I therefore know what that difficulty is like. The fear is great that one will be forced to close care places because staff are not available.
More money is needed if we want to retain the staff we have and attract new employees. Better schedules, better wages, and greater influence are required. And above all – if better schedules are to be achieved, more employees will be required.
Mr. Speaker! My question to the Minister is: What concrete measures is the government taking to raise the status within the welfare profession and achieve a better working environment, better schedules, more employees, and the education that is the basis for us to be able to solve the skills supply and the skills shortage within elderly care?
Peter Hedberg (S)
Mr. Speaker! I cannot be blamed for trying to get a budget news item out before the bill is released - but no!
I think it is good that the Minister highlights Socialstyrelsen's evaluation. Given what the Minister says in his second speech, the utilization rate seems to have been significantly better in 2022 than it was when the initiative began, perhaps largely because the effects of the pandemic have subsided.
In the evaluation, it was also noted that the municipalities have primarily worked in line with the government's purpose for the initiatives, but that they have progressed to slightly different extents.
There are also requests for continued government investments in elderly care, including regarding the supply of competence. Requests are also made from the municipalities' side for more long-term solutions. They want a dialogue with the municipalities so that this would better suit the local conditions, which have influenced how far progress has been made.
Based on that, I would like to ask what conclusions the Minister for Finance draws from the evaluation and what opportunities she sees based on it.
I want to emphasize that I choose to raise the issue for my home municipality because I have a fairly good picture of how things look there. There are many aspects to take into account. We have had debates about green transition here, for example. That also poses great challenges for us in the county, both by the municipality perhaps having to compete with some company that establishes itself and by more people probably wanting to move to us. Then it is also more people who need care. From this perspective, this is a very important issue for my home municipality and my home county.
The Minister is welcome to rename Äldreomsorgslyftet in the budget bill, let it reappear or give it another construction. But I truly hope that the Minister means business with the ambition to push for competence supply and put resources behind the words. And I would, as I said, like to hear what conclusions the Minister draws based on the evaluation.
Eva Lindh (S)
Mr. Speaker! Staffing within the welfare sector is not only worrying when it comes to elderly care, but there is a major challenge within the entire welfare area.
Sveriges Kommuner och Regioner has calculated that 410,000 need to be employed in the coming years - if one does nothing, of course. There may be measures that can be taken that facilitate this. The Minister has himself raised a few examples of this.
But despite everything – even though I am also positive about welfare technology and other measures that can be taken to facilitate things for staff and residents – a digital robot or anything else cannot hold the hand when the elderly person feels anxious. Staff are required.
I am really worried about how this is going to be resolved moving forward. Funding is being cut for municipalities and regions, which makes it harder for them to handle the issues themselves. Funding is also being cut for adult education and the labor market, as I mentioned earlier, which also makes it harder.
One cannot say that one is making investments in adult education and the labor market when one removes a large pot from the budget and then gives back half. It is not an investment.
I am, therefore, concerned, and it is actually possible to give a statement. It is interesting, because it is many cabinet ministers who have recently been saying: Previous governments did not give a statement either on how it would be in the future! It is not in so many other issues regarding positive things that one refers to the previous government. But when it comes to this, one does. It is actually not true, because one can include things in the budget in the long term to show that one can make an investment. It is that statement we hope the minister can give now.
Statsrådet Anna Tenje (M)
Mr. Speaker! I thought I would begin with Anna-Belle Strömberg's questions regarding what initiatives we are making beyond this to secure competence supply issues. I fully and completely share the interpellant's assessment of how important this is and how important it is that one works broadly.
I touched upon this somewhat in my interpellation answer. It is about being an attractive employer, and there I believe it largely concerns investments in an active leadership that includes, and where the staff otherwise feel a great influence and participation.
It also contributes to my second point, regarding the retention of staff. Furthermore, creating a better working environment together can mean that all those who currently work part-time can manage and cope with moving up to work an increased part-time, or, for that matter, hopefully even a full-time position.
It would make an enormous difference regarding the issue of skills supply. If more people worked more and were able to work a few more hours, one could not only fill the gaps with competent and experienced staff; it would also contribute immensely positively to the employees themselves, not least to their future pension. This is something I definitely feel strongly about.
Then it is also a matter of attracting new ones. In that case, one needs to spread the good examples and ensure this fantastically important work is done.
In conclusion: In my previous post, I mentioned that I met Ung Omsorg yesterday. They operate an activity where they employ young people – so young that they are in the seventh, eighth, and ninth grades – to work certain hours during the weekends within elderly care. It is partly about adding a golden touch to the lives of the elderly, and partly about getting an extra job and earning a little extra money. But above all, it is about increasing the interest in care among these youths so that they can more readily consider pursuing a care and nursing education when they eventually start high school.
The government has definitely not been idle when it comes to elderly care. We have continued the important work - where I still want to give credit to the previous government - regarding protected professional titles. I make exactly the same assessment: This is an incredibly important reform to raise status and so that one can practice what one is trained for.
It makes the work with differentiation of work tasks so much simpler, not least when it concerns our important nursing assistants. One does what one is trained for, and one can receive delegation from a nurse to perform an extended task. The healthcare assistants have other work tasks and can complement the nursing assistants' important work.
It is also about a permanent care contact within home care. I believe that is extremely important, not least to ensure that the elderly do not fall through the cracks. But it is also about providing better support, not least to relatives.
Regarding the other parts, the government made a decision last week on a bill concerning welfare technology. I definitely do not believe, Eva Lindh, that a robot can replace a person. But the technology can complement the nursing assistants' important work. It can make it so that a medication robot de facto dispenses the medicine so that a nursing assistant can spend more time with another elderly person and have time to hold their hand.
It is also about a new dementia strategy and an investigation into language requirements. It is one of our major challenges alongside the competence supply, that is to say that one might not only have the wrong education but also not master the Swedish language. It is about an investigation into the relatives' initiative and how we can in a better way strengthen and support our relatives' caregivers in Sweden.
It is also, of course, about continuing to develop and support when it comes to the issues of skills supply.
Anna-Belle Strömberg (S)
Mr. Speaker! Thank you again, Anna Tenje, for the answer and for an important interpellation debate!
I hope that I and my party colleagues Peter Hedberg and Eva Lindh have succeeded in both debating, arguing, and also signaling the concern and how important it is to continue perhaps the best initiative there is to get more nursing assistants in place.
This is not something that only I, but also the Kommunförbundet i Västernorrland and all of Kommunsverige as well as the trade union Kommunal and Sveriges Kommuner och Regioner, are saying. Since SKR is the absolute largest employer, the concern that they also signal should carry significant weight.
We Social Democrats have been clear in our budget motion that this reform is important and that we see positive effects from it. In our motion, we have also written that it shall continue until 2026. This provides exactly the tool that the municipalities need to have a good foresight and to be able to plan and allocate, which provides enormous security in the operations.
We also know that Äldreomsorgslyftet has delivered. During 2020-2022, 25,000 people have started an education.
Right now, all municipalities in Sweden are struggling to recruit qualified staff. For many municipalities, it is a very difficult situation. Therefore, the government needs to act now and give an answer – a clear answer!
With that, I would like to thank the Minister, the Presidium, and the members for a good interpellation debate and wish everyone a pleasant summer.
Statsrådet Anna Tenje (M)
Mr. Speaker! I realize that I did not answer Member Peter Hedberg's questions regarding what conclusions I draw from the analysis that Socialstyrelsen has made of Äldreomsorgslyftet. I only intended to briefly touch upon it, as it is still somewhat important.
Unfortunately, the figures are lagging, so the evaluation does not provide much, given that the figures for 2022 are not really included and definitely not for 2023. That being said, the municipalities have nevertheless definitely worked in line with the intentions. It has worked well, I would like to assert. The pandemic put many spokes in the wheels in the beginning, and it has been complicated for some municipalities given that it has been difficult to find substitutes who could replace during the time other training was underway.
There are still important things that could be improved if one chooses to continue developing this even further. Some municipalities have decided that the money should only be directed towards activities in their own management, which means that if one has private healthcare providers or private home care, these have not been given the opportunity to further educate their staff.
For me, it is quite unsustainable. For me, it is not about my children and other's kids, or in this case our elderly and others' - yes, whatever one would call it. The point is that this should come to all employees who work with elderly care. It should come to all elderly people regardless of whether one has chosen to work at an independent elderly home or for part of the time chosen to live in a special residence operated in independent management.
There are other things one can look at in these issues. It concerns educational places. This must go hand in hand. There must be educational places, while at the same time providing resources for the whole.
There are, therefore, many different conclusions to be drawn from the Socialstyrelsen report.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.