Response to interpellation 2022/23:68 on exceptions for interpretation within health and medical care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns exceptions for interpretation support within healthcare. KD believes that interpretation support needs to be reviewed from a cost-effectiveness perspective and based on the individual's needs 1. KD argues that it is not reasonable for taxpayers to finance interpretation for persons with residence permits and Swedish citizenship who live in Sweden 1. KD believes it is reasonable to review free interpretation for all sectors and that the investigation should weigh different interests against each other 2. KD believes it is well-intentioned to clarify the need for Swedish to receive care. S argues that the wording of the Tidö Agreement creates concern and risks patient safety 3. S believes it is inconsistent with basic principles to require that individuals pay for their interpretation services 3. S argues that the reform does not improve deficiencies in communication and goes against the Convention on the Rights of the Child 4. C argues that access to an interpreter is crucial for patient safety 5. C believes it is reasonable that everyone living in Sweden should learn Swedish, but that interpretation must not be withdrawn as a way to force language skills in acute situations 5. C argues that those who truly need an interpreter rarely have the money to pay for it 5.
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 Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you, Member Lundh Sammeli, for the question! Fredrik Lundh Sammeli has asked me whether the investigation directives will be clear that interpretation in health and medical care is excluded.
I have previously answered questions here in the chamber regarding interpreters in health and medical care and have then been clear that issues regarding interpreter support for persons with residence permits and Swedish citizenship need to be reviewed. In connection with a review, consideration must be taken of the conditions and needs that exist within different areas, for example, health and medical care. Health and medical care is a public service with specific needs for well-functioning communication, for example between patient and treating physician, in order to be able to provide the best possible care. That aspect needs to be considered in the continued work.
Mr. Speaker! A starting point for the upcoming review should be that the financing of interpretation support provided by public activities must be based on a balance between a cost-effective and purposeful use of taxpayers' funds and the individual's actual and acceptable need for contact with various societal functions.
On a principled level, it is not a reasonable starting point that taxpayers should finance interpretation for persons with residence permits and Swedish citizenship who live permanently in Sweden. The proposals submitted in this area also need to be designed in accordance with the binding international agreements that Sweden has committed to follow, for example the United Nations Convention on the Rights of the Child, which has also applied as Swedish law since 1 January 2020.
In conclusion, I would like to once again highlight that it is important that people who come to and stay in Sweden are integrated into Swedish society and learn Swedish. It is a prerequisite for being able to fully be a part of society, succeed in school, and get a job. When integration works, a richer, more tolerant, and more successful society is created. When people have been in Sweden for some time, it is reasonable to set requirements for knowledge of Swedish. With good language skills, the need to provide interpreter support in contacts with various societal functions is reduced.
Fredrik Lundh Sammeli (S)
Mr. Speaker! The question I asked is based on the wording in the Tidö Agreement that has created a great deal of attention. Many people from many different professional groups in society have pointed out both a sharp concern and a criticism of this. This applies in particular to healthcare staff, who have pointed out the risks they believe such a reform would entail both for the patients, who risk their health because they cannot make themselves understood or understand the instructions they receive, and for the healthcare staff, who risk making mistakes that could cost them their license.
I submitted a written question on the area during the autumn, and I thought the Minister was initially quite clear that she saw major problems with the wording in the Tidö Agreement and how it could jeopardize patient safety. It felt quite good, because I got the impression that there was something written in the Tidö Agreement, but when one had the opportunity to take a step back and reflect, one saw that it clashes very poorly with the focus we are to have. It is about care based on need, care on equal terms, and ensuring human rights in such an important and decisive issue as health and medical care.
But when I took note of the answer, I no longer perceived that clarity. On one hand, the Minister pointed out that the individual should primarily pay for their interpretation services and that, on a principled level, it could not be seen as a reasonable starting point that we should provide this collectively, and on the other hand, the Minister pointed out all the problems that very many see with the proposal.
It is the common thread that I also experience when I now follow up on this in an interpellation debate. When I receive the answer from the Minister, I do not experience that clarity being there with the focus on healthcare on equal terms.
In the fundamental issue that one can clearly see concerns integration – that all the people who live and reside in Sweden should be able to speak Swedish – the policy needs to do much more. I will come back to this. But in the reality where we still have people who seek care as Swedes and where an interpreter is needed, they now want to remove or undermine that possibility and say that each person should provide it or pay for it themselves. I think that clashes very poorly with precisely the basic principles within health and medical care.
My question to the Minister is: What does the Minister mean by that the interpretation support within health and medical care needs to be reviewed? What is it in a health and medical care perspective that the responsible Minister in the area considers important to review? What is it that is not functioning in a good way today? And with the provisions in the Tidö Agreement – how will society become better from a health and medical care perspective?
Anders W Jonsson (C)
Mr. Speaker! I requested the floor because this is an incredibly important issue in Swedish healthcare.
Even when the Tidö Agreement was reached, there were many upset feelings among nurses, doctors, and nursing assistants, who know how significant it is to be able to have access to an interpreter. If one does not have access to an interpreter when one is to speak with the patient and hear what the problem is, patient safety is risked to the highest degree.
That is why the question has been recurring here in the Riksdag - precisely because one is trying to get an answer. There have been somewhat varying answers. When the Sverigedemokraterna participate in the debate, it sounds like this: No, it should not be that one finances interpretation with public funds! Then interpretation will not be accessible for the socioeconomically most vulnerable. Those people who really need interpretation very rarely have money in their pockets so that they can pay large sums for access to an interpreter in the middle of the night.
We have also heard liberal representatives repeat the obvious: Everyone who lives in Sweden should learn Swedish. I think we all agree on that. It is important that one masters Swedish when living in Sweden. But to use the withdrawn interpreter in a situation where someone is acutely ill as a way to get people to learn Swedish, I do not think anyone working in healthcare would agree to at all.
The Minister has previously in the discussion given a very clear statement which I nevertheless feel somewhat uneasy about, namely that if a reduced possibility to use an interpreter in health and medical care in any way were to jeopardize patient safety, such a bill will not land on the Riksdag's table.
The next step, just as Member of Parliament Fredrik Lundh Sammeli pointed out, will be the directives for the investigation that is to look into this. It will be interesting to see exactly how the government formulates itself there. But I also feel a great reassurance that if the bill, when it eventually arrives, in some way departs from what the Minister previously said, that is to say that nothing may jeopardize patient safety in Swedish health and medical care, it will be a numbing message in the referral responses from everyone who has something to do with health and medical care: Do not restrict the right to an interpreter in health and medical care!
I also feel secure in the fact that if we, which God forbid, were to get any type of legislation that attempted to restrict this right, it will result in civil disobedience on a very large scale in Swedish healthcare. No one working in healthcare is, in fact, prepared to sacrifice, endanger, or risk the right for people who do not fully master the Swedish language to receive healthcare on equal terms.
As I said, I still feel a certain reassurance, Mr. Speaker, in the message I heard the last time the Minister was here in the chamber, namely that a legislative proposal or an investigation directive from the government must in no way jeopardize patient safety.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I thank the members for their questions and comments.
The question that Fredrik Lundh Sammeli has asked today is very clear: Should we change the directives for the investigation? My answer there is the same as before. We will conduct an investigation where healthcare is included, just like all other sectors of society. It is precisely when one reaches healthcare that one will need to test it against all the laws that govern it.
Just as both Member Fredrik Lundh Sammeli and Member Anders W Jonsson point out, patient safety is a fundamental cornerstone. It will be important from other aspects as well. When discussing changes or social services, patient safety is always the foundation for health and medical care.
In the upcoming investigation, it will be necessary to examine any proposals for healthcare based on the laws that apply to healthcare. That is how it always goes when one conducts a government investigation: one examines any new proposals against existing laws.
What we have been clear about from the government when we have previously submitted answers in the Riksdag in various ways is that the proposals must comply with both Swedish law and international conventions that we have committed to follow. The Convention on the Rights of the Child is one of them.
Member of Parliament Fredrik Lundh Sammeli raised the question of what is lacking today in interpretation support. We do not always have a functioning interpretation support today. We hear very many stories about children who are forced to interpret for their parents. We hear about very many occasions where one cannot get interpretation support, especially not an authorized interpreter with the correct knowledge. This fails many times.
This shows that the entire issue of interpretation support within healthcare needs to be raised. How do we ensure that the person who needs interpretation assistance receives it?
The proposal in the Tidö Agreement concerns the person who has a residence permit and has become a Swedish citizen, i.e., the person who has decided to permanently be a part of Swedish society. It is not about the person who is newly arrived in Sweden, is in the asylum process, or just has a residence permit. It is about the person who has a citizenship and wants to be part of Swedish society.
Then we need to have as a goal - I am glad to hear that both members emphasize it - that the Swedish language shall be central. We shall enable people to obtain the best Swedish knowledge so that they can participate in society. It is about being able to fulfill one's rights and obligations, being able to participate in social life and the debate, and being able to make one's voice heard. This is often simplified by being able to speak Swedish and being able to participate in the conversation in the best way. It also simplifies all other situations, of which healthcare is a part.
It is not possible to draw the conclusion that one would be forced to be without an interpreter in acute care from a proposal that is to become an investigation, i.e., an investigation that has not yet produced any result. That proposal does not exist. When an investigation eventually arrives, it is the investigation's proposal that we need to look at. I, just like everyone else, will be careful that patient safety is followed and that we fulfill the laws and conventions that Sweden has committed itself to follow.
The principle issue, however, is about what we also seem to agree on: It is reasonable to learn Swedish. We shall do everything we can so that one can do so. The second principle is that when one needs an interpretation service, it must function very well. It does not do that today. There, we need to implement measures so that there are enough authorized interpreters with healthcare competence who can provide the support the person needs.
Every time a relative needs to interpret for their loved one, it is a failure, I want to say. Such a situation should not have to arise; instead, you should receive the help you need from an authorized interpreter.
The investigation will start in a while. We will have the opportunity to discuss this further in the future. I look forward to that.
Fredrik Lundh Sammeli (S)
Mr. Speaker! I said in my first speech that it is incredibly important that people in our country learn Swedish. It has been important for us Social Democrats in government. Therefore, we have actively worked with labor market policy to get people into jobs. In that area, the sitting government is now carrying out a major slaughter. We have reformed SFI, a task that needs to continue in order to combine language with practical experience in order to speed up learning in that way. We have ensured a more even reception across the country so that every new Swede will have better conditions to become a part of our society.
If one does not have grounds for asylum, one should not stay in our country. If one has grounds for asylum and is granted a residence permit, one should become part of our society as quickly as possible. Thus, one tackles the problem of lacking language skills.
To that, we have also added a language requirement as part of the policy that we would have wanted to implement in a government position moving forward – to set clearer requirements for a new Swede to participate in SFI teaching, to ensure that people are integrated as part of the parenthood linked to language training, and to find ways to focus on this, which I perceive that both the Minister and I think is an important issue.
What the government is doing with the Tidö Agreement is that the Sweden Democrats' signaling of malice becomes the government's policy. They attack the problem of lack of integration by making this opportunity more difficult within health and medical care. With that, they do not solve the problem of lack of Swedish language skills; instead, they create large new problems for the individual, for the profession and the staff, and not least for the children.
The Minister pointed out what also needs to be included. Today, there are major deficiencies within the interpretation support, and I think the Minister highlighted that in a very good way. It is children who need to carry knowledge and information that mom has terminal cancer or other information from health and medical care in incredibly vulnerable situations. No child should have to do that.
If the government wants to address this lack of interpreter support, that is welcome. But I would like to know how the Minister intends for the Tidö Agreement's provisions on hindered access to interpreter support meet the challenges that we already see and which affect the children, the patients, and the staff.
Furthermore, I think that it is not only in politics that the criticism is clear. It is perhaps even greater outside this chamber. All trade unions within the welfare sector have clearly pointed out what could be jeopardized in terms of patient safety and vulnerability. Many, including children's rights organizations such as Unga Örnar and Rädda Barnen, also point to the vulnerability and how very poorly it aligns with the fact that we have made decisions that the Convention on the Rights of the Child is Swedish law. We should, after all, need to improve children's rights and their lives.
My reflection and follow-up question to the Minister is: In what ways will this reform improve the deficiencies we have today and improve communication within healthcare?
Anders W Jonsson (C)
Mr. Speaker! As I have said before, I am very pleased with the positions that the Minister for Health and Social Affairs has taken, namely that the provisions in the Tidö Agreement regarding limiting the right to an interpreter must absolutely not jeopardize patient safety in Swedish healthcare. Everyone who knows anything about Swedish healthcare or healthcare in general knows that if you deteriorate the right to and the possibility of an interpreter, you jeopardize patient safety.
I am also pleased to hear the Minister for Health arguing here in the chamber for what is actually an expanded right to an interpreter in healthcare. Just as the Minister for Health says, there are interpreters in healthcare today, but it does not work well every time. There are a number of areas where one would actually need to improve the quality and increase the possibility of an interpreter in healthcare. It is gratifying to hear the Minister for Health state that.
One must however remember that the statements made by the Minister for Health and Social Affairs stand in stark contrast to the answers delivered in the chamber by representatives for Sverigedemokraterna. There, it is a completely different tune. For them, this is about a measure to worsen things for those who do not master the Swedish language, regardless of whether it jeopardizes patient safety or not.
And with the fact that this is the document that the government parties signed in order to even be able to take office and that it is the Sweden Democrats who have the dominant influence in not only this issue but also others to come, just as Fredrik Lundh Sammeli has pointed out, it will be very interesting to closely follow the continued journey regarding the realization of this part. The next step will be to very carefully read the directives for the investigation that is to look into it.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thanks again to the members for important points of view!
Today, there are deficiencies in the interpretation support. We receive such messages repeatedly. This means that those responsible for healthcare are not investing the resources that are needed. Sometimes it leads to the introduction of fees. It is not always that fees lead to what was intended. But we have, for example, patient fees, which everyone must pay when they come to healthcare. We believe, in fact, that it can make it so that, in some sense, one does not seek care unnecessarily but when one really needs it. Therefore, one has to pay patient fees.
For some people, the fees are particularly burdensome because they have very low incomes or benefits that make it difficult to go to healthcare. It is not simple with any fee. But we have nevertheless grown accustomed to it. Everyone assumes that we have patient fees in healthcare and that one is to pay part of the cost for medicines oneself. But it is always problematic with fees if we are to ensure that we have good care on equal terms for the entire population. That is what no one questions today. Everyone accepts that we have patient fees.
What the Tidö Agreement is about is whether a patient fee should be introduced for interpreter support for the group that has residence permits and has become Swedish citizens. When evaluating any proposals there, one needs to use the exact same reasoning as was used when patient fees were introduced.
But what makes it a bit more problematic is that it is not just about access to healthcare, but also about being able to understand each other in the relationship. It is about weighing the different interests against each other in every investigation. In healthcare, the requirement for patient safety is heavy. For it to work, the patient must understand the healthcare provider they encounter. In the same way, we obviously need to demand that all healthcare providers one encounters as a patient can sufficient Swedish so that one understands each other.
It is therefore not strange that the Social Democrats are coming forward with proposals on language requirements to tighten those requirements. I can have great sympathy for those proposals. I believe it is well-intentioned to clarify that one needs to be able to speak Swedish to be able to be a part of society, to be able to do one's job in the best way, and in this case, to receive the care one needs.
We need to manage to discuss different principles simultaneously. The government's answers are those that I have given today - what I say is on paper - and which have been given earlier in this chamber. That is also the starting point when directives are to be written.
I do not fear the discussion. For every new political proposal, many voices were needed. Opinions and thoughts were needed. If it goes too easily, I believe one is making a mistake. It is necessary that we have people who react and provide viewpoints, either from you here in the chamber or from those who are active in healthcare.
I want to go back to the fact that it is not the case that the interpretation support works well today. Sometimes it does. I am very happy about all the occasions when it works well. But all too often there are deficiencies. I hear many stories about deficiencies, which can also lead to patient risks and to people not receiving the care they need. The person who needs an interpreter for their relative is also subjected to a difficult situation.
Overall, we therefore need to see how we are to handle the interpretation support, not just for the large group that may not be relevant at all for the possible reform that might come, but for all people. How do we ensure that the interpretation support becomes better? It is a question that, of course, will recur in my meeting with those responsible for healthcare, the regions. What can we do from the regions' side and from the state's side to raise the status of authorized interpreters and ensure that patients receive the help when it is needed?
Fredrik Lundh Sammeli (S)
Mr. Speaker! I do not doubt the Minister's good intentions. But I am afraid they cannot be combined with administering the provisions of the Tidö Agreement.
How do the deficiencies in interpretation support become better by making access worse? How does Swedish among newcomers and new Swedes in our society become better with a policy where one cuts 1.2 billion on komvux, where SFI is located, and where Swedish is completely removed from day one?
Politics is about will, but it is also about a reality that one needs to manage. The lack of qualified interpreters for health and medical care can definitely lead to serious consequences. The review that Socialstyrelsen has conducted in recent years points out that it is an area that needs to be improved even further. I cannot figure out how it is to be done with this investigation. Sverigedemokraterna are clear that the reform runs counter to today's legislation and that is the point. They want to fundamentally change the operations based on that reform.
For me, it is difficult to understand why healthcare is included in the investigation if one does not believe in the idea fundamentally. Of course, everything that one wants to change and improve should be investigated. But if the Minister does not himself believe that health and healthcare is a good area for it and that the children's perspective is not strengthened – why should it be included?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you again, Member Lundh Sammeli, for your question which has given us the opportunity to discuss this today!
I think it is reasonable that we review the issue of free interpretation for all sectors of society. Therefore, it is also good to have different points of comparison. How does it work in schools? How does it work in healthcare? How does it work in the courtroom? These are some examples where we clearly see that there are many values that must be weighed against the question of free interpretation services or not.
Then there are other areas where it may feel more natural to have a fee-based interpretation service for people who have been in Sweden for a long time, if they happen to need it.
I believe that in order to be able to make a comparison in an investigation, it is good to know which are the difficult and easy areas and how they should be weighed against each other. Therefore, I believe that an investigation has certain merits by being able to see the entire social sector and what is relevant and expedient to do, and where measures can lead to conflicts with the legislation or something that goes against it. That is why the investigation will be appointed.
All the parts we have touched upon today will need to be tested, but the question remains that we others will have to work on every day moving forward: How can the interpretation service be improved? How often have we even raised the issue of interpretation services? I take that to heart myself. When did we, for example, in the Riksdag, discuss interpretation support in healthcare in an active way, and how do we go about strengthening it? We have not done that until now.
It may be a good eye-opener for all of us to see that there are major deficiencies today that action has been omitted on. We need to do that now, starting today, for everyone who needs health and medical care.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.