Response to interpellation 2022/23:87 on the situation in healthcare
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 KD argues that the regions' finances are strengthened and that the cause of the situation in healthcare is not a lack of financial resources 1. KD emphasizes that the government is implementing targeted investments to increase the number of care beds and shorten queues 1. KD believes that more employees and a better working environment are required to attract competence 1. KD argues that the Social Democrats' proposal for higher state grants makes a smaller difference than it appears to 2. 3 S argues that the need for general state grants is 20 billion SEK and that the government's 6 billion is not enough 3. 4 S argues that the lack of care beds causes patients to suffer 4. 4 S argues that Region Stockholm warned staff due to finances and labor shortages 4. 5 S believes that more applicants are needed for the nursing program and that it should be investigated whether the full-time requirement can be reduced 5. 6 KD argues that the regions have full responsibility for their operations 6. 6 KD argues that the state must take a national grip on the supply of competence 6. 6 KD emphasizes that the working environment is deficient and that the staff do not get recovery 6. 6 KD wants to strengthen the National Healthcare Competence Council to obtain concrete measures and statistics 6.
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)
Madam Speaker! Mirja Räihä has asked me if I intend to take any initiatives, and if so, which ones, against the background of what is stated in reports on the underfunding of the welfare system. The member has also asked me how I and the government intend to respond to Region Stockholm, which is now providing large resources itself but where the government's budget leaves the regions with a deficit. Finally, Mirja Räihä has asked me what measures I and the government intend to take so that the healthcare staff can endure an upcoming crisis against the background that an important lesson after the pandemic was that it requires both more employees and more investments in healthcare staff so that more can endure and more will choose to work in healthcare.
Madam Speaker! To begin with, the regions' finances have been strengthened over the recent years, and the sector reported its highest result ever in 2021, totaling 22 billion kronor. At the end of 2021, there were a total of 40 billion kronor set aside in result equalization reserves, of which 10 billion kronor were result equalization reserves for the regions. The reason for the situation in healthcare has therefore not been a lack of financial resources.
At the same time, we face a clearly worse economic situation with simultaneously rising inflation. Despite this, it must always be possible to rely on the welfare system. Ensuring that more people in Sweden receive the care they need within a reasonable time is one of the government's most important tasks in the area of welfare policy. The government has presented a restrained budget to ensure room for maneuver for the years to come. A large part of the reform space is used for the permanent level increase of the general state grants to municipalities and regions by 6 billion kronor to reduce the risk that high prices lead to cuts in healthcare and other welfare activities. The government is simultaneously carrying out several targeted initiatives to, among other things, increase the number of care beds and shorten waiting times and care queues. These initiatives are made targeted precisely to strengthen healthcare.
The government provides large supplements in order to increase both care capacity and the number of care beds. In total, the government allocates 2 billion kronor annually in 2023 and the coming years ahead in the budget period to increase the number of care beds. Furthermore, among other things, maternity care and women's health are provided with funds in the budget bill for 2023 totaling 1.7 billion kronor for 2023 and thereafter 1.5 billion kronor per year for the years thereafter. The government also strengthens the sector through supplements to the general state grants with 6 billion kronor per year in permanent investments to municipalities and regions.
Madam Speaker! I agree with Mirja Räihä that both more employees and larger investments in healthcare personnel are required. The shortage of personnel with the right competence in healthcare has never been as palpable as it is now. The working situation for employees within health and social care needs to improve. To attract and retain competence, secure employment, a good working environment, and opportunities for development in the work are required. In the budget bill for 2023, the government therefore allocates 3.2 billion SEK during this year to support regions and municipalities in their work to strengthen the supply of competence in health and social care. One factor to increase competence in care is for more nurses to further their education to become specialist nurses. To get more nurses to further their education, the government allocates a total of 500 million SEK in the budget bill for 2023. The government also allocates 100 million SEK from 2023 onwards to enable development and career opportunities for specialist nurses.
The Government considers that the national commitment to skills supply needs to be strengthened and therefore yesterday tasked Socialstyrelsen to, together with the National Healthcare Competence Council, develop a proposal for a national plan to improve the healthcare system's skills supply.
I would like to conclude by saying that I naturally share the member's commitment when it comes to improving the situation in healthcare, and she can rest assured that the government takes this issue seriously. I look forward to our conversation and discussion on this issue.
Mirja Räihä (S)
Madam Speaker! I must begin by thanking the Minister for the answer. But it is still as if we have two different opinions and two different experiences of how healthcare is functioning right now. This is, of course, connected to the experiences that I have and that the Minister has.
I have been employed within Region Stockholm for 42 years. That is a very long time. I am still employed at Tema Cancer at Karolinska University Hospital. That means I have a commitment to these issues.
SKR has been clear in its message that the need for general state grants to municipalities and regions is in the magnitude of 20 billion. The Government has decided on 6 billion. It is also not 6 billion that goes entirely to the regions, but it is to be shared with 290 municipalities. Then it will not be that much in the coffers per hospital.
Madam Speaker! The Minister concludes his speech by saying that I should feel reassured that the government takes the issue seriously. But I cannot agree. I am not quite reassured. Least reassured I became yesterday when I read about Ivo's latest inspection in the partial report that has been released.
Ivo has inspected 27 hospitals in 21 regions. Of these, 26 received a strike regarding quality and that there are major deficiencies. The 27th has not received its answer. It is Oskarshamn's hospital.
For Region Stockholm's part, Danderyds sjukhus AB, Södersjukhuset AB, Karolinska Huddinge and Astrid Lindgrens barnsjukhus, which belong to Karolinska Universitetssjukhuset, have been inspected.
Furthermore, two of the inspected hospitals risk large fines because the deficiencies are so great. For Sundsvall Hospital, it concerns 15 million kronor and for Akademiska sjukhuset in Uppsala, it concerns 20 million kronor because the deficiencies are so extensive.
What Ivo points out for the 26 hospitals is that there are day-long waiting times at the emergency room and widespread corridor care. The corridor patients are given bells or pot lids to alert the staff because there is no call system. Let alone, there are no oxygen outlets. When I read that report yesterday, it was straight through a very sad reading.
Madam Speaker! In a DN interview on January 17, this week, the Minister says that there are major problems. There we are probably in agreement with each other. In the same breath, the Minister says: We are expanding the number of healthcare beds. It is necessary so that we can cut queues, provide good and close care, and be able to live up to the Health and Medical Services Act.
I completely agree. But it is a bit difficult to believe that this is something that has been pulled out of thin air, as at the same time the cuts have been ongoing for a very long time. I asked a question about Region Stockholm in my interpellation, and that is obviously because it is the region I know best.
One can look at how it looks on the weekends when the queues and waiting times at the emergency departments in Region Stockholm have been very long. Covid-19 is still ongoing and fills the emergency departments. In addition, there is seasonal influenza, which is also not a very easy disease, especially for elderly people. There is winter vomiting disease, and the children's emergency department has been filled with children infected with RS virus.
Every time this happens, the healthcare queues naturally begin to build up, and we need to talk about how to cut the queues. I will return to that in the next post.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, Member, for the contribution and above all for the interpellation! You have made impressive efforts in health and medical care, and you have an experience that few people have.
It is precisely this experience among healthcare personnel that the healthcare heads take advantage of all too poorly. I have met so many employees who tell me that they have expressed their views and reported deficiencies - and then nothing happens. Just as the member says, this has been going on for a very long time.
I want to highlight the first problem that I have chosen to address and which this Riksdag also made a decision on already in December 2021 following an initiative in the Committee on Health and Welfare, where I was chairman: We have too few healthcare beds.
It has been a mantra for a very long time that we can reduce the number of care beds, because we have a medical development that means we can avoid treating people in hospitals for several days. It is clear that I am very happy about medicines that can replace an operation or for the fact that one can have day surgery instead of being admitted.
But it is still the case that we need more care beds. Every time it "bottlenecks" at the emergency room, it can be because the home care is too weak and that it would have needed more medical competence or more medical interventions. It could be about us not having beds in the right department, because it might be outsourcing that is most vulnerable when one does not have the right competence in a department. But it can also be about overcrowding. There are many factors that cause queues and that it "bottlenecks" in the system.
Then one must dare to say what the Riksdag said and what I am very pleased that the Social Democrats later followed, for then we were in agreement: We must increase the number of healthcare beds. It has been a mantra to the contrary for a long time in Swedish health and medical care, but now we have turned it around.
The state is involved and contributes with money, and I fully understand that one wants more money. As a municipal politician, I have always wished for that. But a lot of money was given during the pandemic that could not be used because it was short-term. Therefore, we have these large surpluses, which of course stick in the eyes of employees who wonder why they are not being used.
As a regional politician, one has full responsibility for health and medical care and works under the laws that we have decided upon in the Riksdag. In that case, one must also ensure that the funds are long-term, and I can understand that one did not dare to use temporary state grants during the pandemic to hire staff.
Therefore, my ambition now is that we shall together look at how all the state grants that exist for health and medical care can be used in a better way. We might be able to combine them in another way so that they become long-term and the regions can employ permanent staff. It is only then that one can have development in the profession and improve the working environment.
I am willing to contribute to a different view on state subsidies, but I want the money to go to healthcare. It is important for the government that they do not disappear to other things, which of course can be just as important. It could be about public transport, culture and regional development, which are very important things. But we have a clear address label: It is healthcare that should have the money.
General state grants are an issue that the member raises. It certainly provides more room. But when one says that it is 20 billion that is to go to health and medical care, it is not so, just as the member says, but it becomes a smaller part. We have noted that the Social Democrats propose a doubling compared to the government of general state grants.
But what then will be the difference between the Social Democrats in the Riksdag and the government? It actually amounts to somewhere around 1.3 billion for healthcare. Of the 6 billion you add, only 1.8 go to the regions, and some need to go to public transport and other things. Then perhaps 1.5 billion remain. Then you have made a saving in the budget for healthcare of 200 million under section 9. So it is 1.3 billion left that you give more than the government. I do not think that is what is the difference between good and bad, but there are many more factors that play a role.
But the government will return to the issue of economic resources. We are listening carefully to the healthcare sector, and we do not hesitate to provide more support if it is needed.
Mirja Räihä (S)
Madam Speaker and Minister! I intend to continue speaking about the lack of healthcare beds, because I believe I have a quite good picture of the reasons why we have far too few healthcare beds.
In Region Stockholm, the number of care beds decreased when Nya Karolinska was built. There was a significant reduction in the number of care beds. I do not know what it was due to – whether Stockholmers are not getting sick or if the plot was too small. That remains to be discussed.
The shortage of care beds is causing people to suffer. In Ivo's report, which describes what the inspectors have seen, one can read that patients lie in the corridor in a bed without oxygen or a call bell. At one hospital, a patient with sepsis, i.e., blood poisoning, who actually should have been admitted, was sent home. I can imagine what a nightmare it must have been for the doctor to send home such a sick patient because there are no care beds.
These questions are obviously felt in the heart, and it is good that the Minister nevertheless has a plan for how we are to work so that we can increase the number of available healthcare beds.
But one must remember one thing. As I said, I have worked in Region Stockholm for 42 years. I belong to the last generation that is so loyal to and faithful to its workplace. Those who come after me will not be. They will also not let themselves be satisfied with what we have let ourselves be satisfied with: that this is a very fun job. You have no idea how fun it is to be a nursing assistant in acute care! I see the young people there, and it is so incredibly fun. But that is not the image people have today, and that is what diminishes the loyalty and this being faithful.
What has happened in Region Stockholm, for example, is that as recently as the autumn of 2019, 350 nursing assistants and 250 doctors were notified of termination only at Karolinska due to the economy and due to a shortage of work. I have never had a shortage of work at my workplace - never ever. They state that the reasons are that the care has moved out to the city, but at the same time, those who are admitted are sicker. They are very sick patients who need good care. This was not taken into account, because they wanted to save money.
Then the pandemic came, and then the redundancies were shifted. Then suddenly everyone needed to stay and take care of covid-19 patients, especially during that first very heavy phase. When that was over, in 2020, the redundancies were taken up again. But the number had decreased. At that time, it was 157 nursing assistants - however one arrived at that figure - and 109 doctors who were to be let go due to lack of work. But one did not reduce the redundancy because one needed more, rather it was because so many had quit during the time due to the insecure situation and the pandemic. Therefore, one could reduce the redundancy. In the end, the redundancy was withdrawn, but by then all those who one had needed to dismiss had already quit. It thus became a proper reduction.
When we talk about available healthcare beds, it is not about a bed, a call bell, and oxygen. Naturally, a nurse and a nursing assistant are required to provide the care. How to get people to apply to both the nursing program and to study to become a nursing assistant is a task that is very heavy and very large. And I promise: I will help!
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, Member, for the conversation and for all the experience we gain from it! I am prevented from making decisions for Region Stockholm because it has regional self-government, so I naturally find it difficult to enter into these issues. Region Stockholm has full responsibility for its operations.
I fully share the picture that Ivo provides. It is not possible to evade it. At the same time, we have Arbetsmiljöverket, which is out conducting its inspections. These are the tools we in the state use, and I believe we must be transparent.
If the member has followed the posts I have made in the Riksdag over the last four years, she notices that I have always said that we are very good in healthcare. We have fantastic competence, and we succeed with a great deal. But at the same time, we have problems. And right now, I almost have to only talk about the problems, because they are so large and tangible that I must address them.
That is why the government has not only allocated money in the budget but also yesterday made decisions to take a national grip on the supply of skills. Every region is truly doing what it can, but it does not work to do this in a fragmented way in 21 parts. Sometimes national measures are needed.
We have today a level that is too low. The staffing is too low, so we are unable to provide the staff with the summer vacation they are entitled to. We cannot manage Christmas, when several viruses arrive and rage simultaneously. Would we then manage crises in the form of a war or an invasion? Not a chance! We therefore have every reason in the world, for everyday life and for larger crises, to increase the baseline level in health and medical care.
We must get more healthcare beds, staffed with the right competence. It is about permanent staff who can manage to work the full-time extent they have. I have no problem with people wanting to reduce their hours for personal or private reasons. One has every right to do that. But many reduce their hours because they can no longer handle the profession, because it is too heavy at one's workplace. Then it is an employer problem. Then the situation must be changed.
Figures from Vårdförbundet show that if all midwives who work part-time, which many do depending on the workload, were to move to full-time, it would correspond to 790 more full-time positions for midwives. It is absolutely fantastic! Then it is the work environment that is at issue.
Yesterday, the government therefore decided to take a national initiative where we shall use the National Healthcare Competence Council, which was appointed three years ago by the previous government. I have many times in this chamber said that it was a very good decision: not just to say that this is the regions' task but to actually take a national responsibility. Now we are strengthening the council and giving it a somewhat larger mandate. They shall identify the concrete measures that are required which lead to real improvements.
They must also ensure that we receive data and statistics so that we can plan ahead. Today, we do not even have a planning horizon for more nursing assistants, nurses, occupational therapists, or physiotherapists. There is no picture of this from the state side; instead, we have to live with individual pictures from the regions. We therefore need to take a major grip.
The Council began its work as early as yesterday. Based on the mandate the government gave in the morning, they had their first meeting yesterday. They will report to the government continuously, but they also have some fixed occasions every half-year where we are prepared to make decisions.
They also need to work in dialogue with municipalities and regions. We asked them to not only look at the regions' healthcare but also at the municipalities' health and medical care, which is a significant part today and which is very important for people. It will therefore be about the entire health and medical care, municipal and regional.
Of course, they also need to engage in dialogue with the private employers that exist. They need to engage with all the professional unions and organizations, with patient organizations, with academia and with educational providers. They have a broad mandate to gather all opinions so that we can truly make a difference.
I am very pleased with the strong desire that exists from all parties to improve the working environment. We are present in every region and in every municipality. With combined forces, we shall in the near term show the staff that there will be a change. We must do this, both for the patients' and for the staff's sake.
Mirja Räihä (S)
Madam Speaker! Yesterday I looked a bit at the figures on how many who have applied for these educations, both the nursing program and the upper secondary school's health and care program. For the spring semester 2023, 2,433 applied to the nursing program. That is far too few. To the upper secondary school's health and care program, 4,322 applied. These figures have been decreasing for many years, regardless of who has governed. One must step in and look: How do we increase the number of applicants to these educations?
Of course, it is about the conditions. It is about the salary, but it is also about looking at whether we can, for example, reduce the full-time equivalent slightly. It is an important thing. I am not talking about a six-hour workday, but about reducing the measure slightly. There must be carrots to apply for these professions.
The problem is also that one might study to become a nurse but then quit after a few years and seek employment elsewhere. There are nurses who work at Scania in Södertälje, so then you know, for example, what the working hours are.
I also want to bring up the queue-jumping when it comes to healthcare places. Region Stockholm has been doing this throughout the entire autumn. Today, one actually fulfills 82 out of 88 healthcare guarantees, but at what price? This has been done on the weekends. Operations have been performed on the weekends, and then the surgical staff, the anesthesia staff, the care departments, and the recovery room must work overtime. And they do, with risk to their own health. The queues are gone, but now one gets new queues after the Christmas holidays.
I am still worried, but I still think it is good that the government is now saying that one should work on these issues. I want to thank you for the debate. It was refreshing and healthy.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I really want to thank the member for raising the question today. It is absolutely necessary that we hold onto it.
I would gladly, even though the young people in the stands have just left us, tell about all the advantages of the profession, of being involved and working with nursing and medical issues. But today I actually must also focus on everything that is not working. It is not possible to just paint a rosy picture, because that is not the case today.
It is precisely about attracting back those who have left the profession. The Swedish-Swedish Nurses' Association usually says that 12,000-13,000 nurses have left the profession. Imagine if we could attract them! Then they must, just as the member says, be able to trust that it is different when they return. They must be able to know that if I have a free weekend, it is a free weekend where I am not called.
I understand that the regions do what they can to cut queues. They want to use many more hours of expensive machines. But there is a difference between people and machines. You can use machines for many hours. Some even become very good from being used for many hours. But we humans must have recovery. One cannot think that the machines should be used every single hour and then use the people in the same way. One must make a difference.
It becomes a burden when one has just had a heavy Christmas and New Year's weekend, and a Wednesday holiday weekend that is perhaps the worst, and then additionally has to replenish even more. As an employer, one must ensure that the workplace environment requirements are met. That is why both Ivo's and Arbetsmiljöverket's inspections are important. They make the problems visible, and every healthcare manager must take them seriously.
I really hope that we, from politics, can be clear and hold on to this and also provide the conditions. It can be about money, but it can also be about those who are leaders of a department or in a work team getting more mandate to be exactly managers and leaders. There should not be too much central steering, but they should have the opportunity to make the changes that the specific staff group needs. I believe that we also have a job to do moving forward.
Thank you, Mr. Speaker, for a very important question! I will do my best. Otherwise, come back and scold me a little!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.