Response to interpellation 2023/24:135 on savings in healthcare
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the government's management of the healthcare crisis and savings. KD considers that the government's investments amount to approximately 16 billion kronor 1 and that the regions are responsible for their own operations 1 2. KD argues that it is wise for the regions to make their own decisions regarding budget and use of surpluses 1 3 4. KD also considers that money must be used efficiently 3 and that it is correct for regions to reduce their dependence on hired staff 2. S is concerned about the healthcare crisis and argues that the regions are forced into savings due to the government's budget 5. S considers that the government chose tax cuts over healthcare 5 6. S argues that the government is handing over the responsibility to the regions in a time of crisis 7.
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! Yasmine Bladelius has asked me if I can account for what facts underlie my statement that it is a total of 16 billion kronor that goes to healthcare and whether I consider this to be a correct way to account for how much money the government contributes to healthcare. Yasmine Bladelius has also asked me how I intend to act in view of the consequences we now see in many regions where emergency departments are being closed and healthcare staff are being laid off. Yasmine Bladelius has finally asked me if I stand by my appeal to the municipal and regional sectors to budget for large deficits.
My statement, Madam Speaker, among other things during the Riksdag's question period on September 28, 2023, concerned the government's total investments in the healthcare area within my areas in the budget bill for 2024, that is to say, also those that have been signaled in previous budget bills. These investments amount in total to approximately 16 billion kronor in 2024. This therefore includes more than the net supplement to health and medical care that is presented in the budget bill for 2024. The calculation includes, as the government has previously communicated, among other things reinforced investments for improved cancer care, continued support for the development towards good and close care with primary care as the hub, and measures for increased accessibility with shorter queues and more available care beds.
The Government has, among other things, announced a sector grant of 3 billion kronor during 2024, for the purpose of strengthening the possibilities for health and medical care to provide good and patient-safe health and medical care. The calculation also includes already announced funds for, among other things, civil defense and national healthcare coordination.
Against this background, I consider my statement during the Riksdag's question time on September 28 to be correct. The appropriations within health and medical care policy for 2024 amount in total to approximately 67 billion kronor. Furthermore, the regions' share of the general state grant is added.
The government and I myself are aware of the current economic situation in the municipal sector. The economic situation is challenging, and high inflation combined with a high interest rate level affects all parts of society - welfare, companies, and households.
At the same time, it is the healthcare heads, with directly elected politicians at the municipal and regional levels with taxing rights, who are responsible for health and healthcare, and the operations are financed largely by taxes. The state cannot fully compensate for the cost increases that the municipal sector has. Municipalities and regions also need to take responsibility. In addition to the reinforcements of the general state grant and funds directed towards healthcare that the state contributes, politicians at all levels need to work on prioritizing core activities.
The economic regulatory framework means that municipalities and regions can, if necessary, for example after notification of state grants, make new decisions regarding the budget.
A number of regions have set aside funds in result equalization reserves, RUR, during recent years when the results have been good. The Government views positively that municipalities and regions have had the opportunity to set aside funds in RUR. RUR was introduced after the financial crisis 2007-2010 specifically for the purpose of giving municipalities and regions better economic planning conditions.
On 1 January 2024, the planning conditions are further improved when the sector is given the opportunity to allocate funds in a result reserve. The new result reserve implies a more flexible regulatory framework regarding when the funds may be used and thus, in the long run, a more flexible balance requirement.
According to the Swedish Association of Local Authorities and Regions' economic report for October 2023, the regions have generally not issued large warnings or decided on drastic savings for 2024, with the explanation that the increased costs are largely temporary. Many regions, according to the report, are aiming for a reasonable cost level in 2025 and consider it consistent with good economic management not to temporarily reduce operations unnecessarily much. Some regions have thus made the assessment that this is possible.
Regarding my statement during the Riksdag's question period on September 28, 2023, it was not an appeal to the municipal and regional sectors, but I mentioned Region Skåne as an example where they have chosen to use the tools available to meet the challenging economic situation. It is, as stated, possible under certain conditions for the regions to use previous surpluses to smooth out the cycle or to budget with a deficit in individual years.
With that, I would like to thank Yasmine Bladelius for the questions and I look forward to the debate.
Yasmine Bladelius (S)
Madam Speaker! I naturally thank the Minister for the answer and shall comment on it in a moment. I must, however, begin by saying that the background to why I have submitted this interpellation is that I am deeply concerned about the crisis that healthcare in Sweden is facing.
I am in no way less concerned when I hear the answer from the responsible minister. This is for real. At this moment, large savings are expected in the regions. Healthcare is being hit extremely hard.
Ekot recently conducted a survey which showed that all but four regions have so far either decided to introduce savings or are in discussions about doing so.
It is about cuts of around 10 billion Swedish kronor in total, so far. Furthermore, there are regions that did not even have a figure to provide. The total amount is therefore expected to be higher. Therefore, it is extremely worrying to hear the Minister for Health and Social Affairs' answer here today. She somehow manages to make it sound as if it is not a major problem. I and many with me are of a different opinion.
It is also no news. During the past year, the economic situation of the municipalities and, above all, the regions has deteriorated significantly. SKR (Sveriges Kommuner och Regioner) has on several occasions alerted the government that large subsidies will be needed for the municipalities but especially for the regions in order to be able to maintain today's level in health and medical care.
In last year's budget bill, the government chose to invest twice as much in tax cuts for high-income earners as on the municipal and regional sectors. This has led to the fact that the reserves that existed in the regions are now exhausted. Despite alarmist reports and loud criticism, the government has also not, in the budget bill for 2024, invested even a fraction of what SKR believes is needed to curb the crisis in healthcare.
That the state does not take responsibility in times of crisis has consequences. In the hardest-hit regions, a healthcare crisis is now following with layoffs, notices, closures, and increased patient fees as a result of the government's budget. We see it happening already now. In Västra Götaland, the emergency room is being closed. In Örebro, the three hospitals will no longer be able to offer the same range, and the staff strength is to be reduced by 600 people. In Östergötland, personnel costs are to be reduced by a corresponding 600 million kronor. In Sörmland, they plan to get rid of 10 of the 15 incredibly important clinical pharmacists who work close to the patients. And in eleven regions, increased patient fees are now being planned.
It is my firm opinion that a government should take responsibility in a time of crisis. The Social Democratic government did so during the pandemic. It was admittedly a completely different form of crisis. But it also hit healthcare hard. Now that we find ourselves in an inflation crisis, the right-wing government should take responsibility for welfare and health and medical care.
My first question to the Minister for Health and Social Affairs is: In this historically difficult situation, why are you not taking responsibility? Why is the message from you to grit your teeth, save harder, let the staff run faster, or for that matter, set aside the budget rules and run a deficit? I really do not understand.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you for your response to my answer, member!
It does not appear anywhere that the government is taking this lightly, on the contrary. It is one of the worst crises in a very long time, and it is special. It is not only a recession that we have to deal with now. The regions also have to deal with the consequences of inflation.
On the municipal side, it looks different. Some municipalities manage reasonably well. Others do not. But on the regional side, almost all of them are having difficulties. Several regions can, in and of themselves, say that they do not need to make cuts. There are some that still have a reasonable situation, such as my own region, Region Jönköpings län, and Region Kalmar län. But the vast majority have really large challenges. I have returned to this quite many times.
It is also the reason why we are introducing a specific sector grant that the regions can use directly to manage pension costs. It is not underlying problems in the economy that are the reason why it is tough. If that had been the case, one would not have been able to manage the budget in the way that many regions do. If one has underlying problems, one must manage them. But if one has specific problems, one can manage it by using temporary surpluses, even for a single year. One can also do it by managing deficits. The law allows for that.
The point is that each regional council makes its own trade-offs and makes the decision. It is actually not just crowns and öre in those figures they are to consider. They must also look at population growth, and they must look at the investment need. They have a number of things to manage when they make their assessment of how they should handle the budget and whether they should use the concept of special reasons as the reason for the measure they take.
They have more things to take into account: the Work Environment Act, ensuring their employees good conditions. They have to take into account the Health and Medical Services Act, which states that we shall provide good care on equal terms to the entire population, and more laws.
When the regions now make their decisions - I have said that I have full understanding of decisions made regarding using previous surpluses or even budgeting for deficits - the council has made an assessment of how things look and how to weigh all the assignments they have according to laws and what they see ahead. It is therefore the regional council that makes the assessment and decides.
I think it is necessary not to only look at the new money that has been added. That is the reason why I have highlighted the entire sum that lies within my area of responsibility. Reports from the Swedish National Audit Office, which the Riksdag has also dealt with, show that the money does not reach its destination. For many years, they have been micro-managed. Therefore, the operations do not even notice them. Women's health is probably the latest thing I believe the National Audit Office has looked at and concluded this. These are investments that we have agreed upon politically. But we must see that the way in which we send the money to the regions also has significance for whether it has an effect.
Now, I am working, among other things, to ensure that the money that is significant and concerns shortening queues, increasing healthcare capacity, and strengthening primary care reaches the regions so that they can use it. Normally, it is not used during the year but ends up as a new surplus at the end of the year when it is known how it has gone. But next year, 2024, that money must be available for use in each region. If they so wish, they also have the opportunity to make a supplementary budget when they learn of the Riksdag's decision on the budget and how the money is distributed.
The government's view is that we need to support the regions but also ensure that the money can be used by them to the full extent, so that it goes directly into healthcare. We cannot waste money that is not used correctly. Now, every single krona must be used in the best possible way.
Yasmine Bladelius (S)
Madam Speaker! I would like to thank the Minister again. I must say again that I am very concerned about the situation. I feel no less concerned after hearing the Minister's answer in her second speech. I am quite convinced that I am not alone in this concern.
In this, regional politicians are making, regardless of political color, completely impossible trade-offs when the healthcare economy is worse than during the 90s crisis. They would not have had to do so in the same way if the government had taken responsibility in the healthcare crisis in the same way as the Social Democratic government took responsibility during the previous crisis.
That the government repeatedly claims that investments in welfare would fuel inflation is something that soon will only be the government claiming and hiding behind. Most economists agree that such investments in welfare and healthcare would not fuel inflation at all. Not having the will or the energy to carry the healthcare system through the inflation crisis is an active choice by the government. I see it as a major sign of weakness.
Madam Speaker! Let me go back a bit. When the government, in last year's budget bill, invested twice as much on tax cuts for the wealthy as on healthcare, the minister responded in a debate with me, roughly, that the vast majority of the regions would manage well because they had saved money to use. They had that, moreover, only because the Social Democratic-led government actually gave them, with flying colors, the resources they needed during the previous crisis.
The accounts are now empty in the vast majority of regions. The minister knows this. What will be the government's answer this time? This time the answer is: go into deficit, borrow money to pay out wages and cover the operations. Furthermore, far from everyone agrees with the minister that this management is in accordance with Swedish law.
In my home region, Skåne, may have escaped the recent writings about the skyrocketing deficits and the political battle over the so-called special reasons. It is questioned whether it is even legal to do what the Tidö parties in Region Skåne want, that is, to actively budget for large operating deficits that do not even need to be restored in the coming years. This has, regardless of what the minister herself says here, been praised by the Minister for Health Care in a debate with me where she highlighted Region Skåne's decision as a good example.
It is naturally remarkable that the Minister for Health and Care urges the regions to budget for large deficits, which are passed on to our children and grandchildren to pay in the future, because the government in its budget is unable to meet the needs that exist.
Madam Speaker! We Social Democrats have shown in our budget alternative that one can take responsibility for both inflation and the crisis in welfare at the same time. My second question to the Minister for Health and Care is therefore whether the Minister still stands by her appeal to the municipal and regional sectors to budget for large deficits. In light of the large and severe consequences we are now seeing in many regions where emergency rooms are being closed and healthcare staff are being laid off – does the Minister truly believe that she and the government are doing everything they can?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! That is how bad the debate becomes sometimes when one picks out something and claims something else about what was said. I think that is really bad. I haven't even claimed that everyone should use a deficit. I haven't asked Region Skåne to do that. What I have said is that it is wise to actually make a choice, either to use previous surpluses if one has them or to create a deficit.
The thing is that it is decided at the regional level. That is how the law is designed. Neither the member of parliament nor the minister and the government decide whether it is right and proper, but it is decided when it is examined in court. It is possible that it will be done in Skåne, but it is the municipal council that decides and makes its assessment. That is how the law is designed. It is not designed according to what are the pluses and minuses in the budget lines, but it also appears from the law – not least from the preparatory works – that they shall take many more things into account when they make their assessment. It is about how well one has justified its decision.
The Chairman claims something about how I respond and what I urge – but that is something I have not done, so I will not be able to address that.
We return to the issue at hand. It is very tough in health and medical care, and that despite having had large surpluses. I am, just like the member, grateful that they were had. But it was once again a message that we paid out money that could not be used in the regions and therefore was set aside.
We therefore have something to do in the state administration, in the government, to ensure that the money we want to go to healthcare also gets there. They didn't do that during the pandemic, instead there were huge surpluses - record surpluses - for two years in a row. We therefore have something to do when it comes to ensuring that the money gets out.
I have said many times that I am extremely grateful that the care has a surplus that can be used temporarily to meet the inflation. Had it been a recession where temporary money was used, it would have been very difficult to do so according to the law, I believe. But when one has a temporary event such as an increase in pensions linked to KPI, then it is an individual event that is connected to the inflation.
If one has a hope that the government will contribute to inflation going down - at least not do the opposite - one can, of course, make such decisions in Region Skåne. But if one does not believe that inflation will go down, one cannot make such decisions, because then the level of 9 percent will remain. To pay a 9 percent deduction annually, with the price adjustment, on the pensions would be truly devastating for healthcare.
Just as it was said in the previous interpellation debate by the Minister for Finance and Member of Parliament Eva Lindh, it is the inflation that, after all, must be lowered. I perceived that they both agreed on that, but not on the path there. The important thing is that the policy holds firm on getting down the inflation. Then, in the long term, we will give the regions the opportunity to manage their economy. My perception is that there is an underlying functioning economy. Some have had more challenges than others but could manage the situation. Inflation is the great ghost, and it is that which must be removed.
Regarding what is right and wrong about inflation, one can see every week when the messages come that experts give different reports. It is difficult to know, because there is no truth. This is about how one perceives things and how one perceives what the government does. Are we really making a restrained budget? How is that perceived in the market? What is happening geopolitically in the world, and what conclusions are drawn from that? The financial market is affected by what happens when one buys and sells money. Therefore, it is important that the state holds firm and that it is perceived that we are holding firm on our budget.
The budget has not been decided by the Riksdag yet. The Member of Parliament is therefore asking a question before the Riksdag has even made a decision on the budget. But just as the Finance Minister mentioned, the government follows this all the time. How is it done? What is done? We will return so that we can manage the cyclical fluctuations that exist. It is not a lack of money in the state, but it is the risk that inflation will become permanent that must be prioritized right now.
Yasmine Bladelius (S)
Madam Speaker! I must say again that I truly find it remarkable that, from the minister's and the government's side, all responsibility is handed over to the municipalities and regions in times of crisis. It is also quite remarkable when the minister places the responsibility for solving the crisis on the regions, when the minister himself considers that the state should actually have that responsibility.
The government has a responsibility to take in times of crisis. The Social Democrats' budget has shown that it is entirely possible to take responsibility for healthcare in times of crisis and at the same time not fuel inflation. It is an active choice by the government not to take that responsibility in the times we are in. It is also an active choice by the government to say that healthcare, instead of receiving help from the government, can borrow money to pay wages or for operations. The government says that it is perfectly okay – but it is our children and grandchildren who will have to pay because we now have a healthcare crisis that the government is unable to manage.
Madam Speaker! I believe that the Minister and the Government should take the concern that I and, above all, all regional politicians and citizens are trying to convey much more seriously than what I have seen in the answer and in the exchanges we have had in this chamber today. I am truly concerned.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member for the question, as it is particularly pertinent. My workday is filled every day with ensuring that the regions receive support in the right way. If one chooses to only look at the supplements and not at the total sum of money that goes from the government to the regions, one will end up off track again. Then we will receive new reports from the National Audit Office to the Riksdag stating that the government is not managing the money correctly.
I intend to ensure - when the Riksdag finally decides on the budget towards December - that all those funds can be used by the regions in the best possible way. I am in no way satisfied that such large amounts - not least the 5 billion that are to go towards shortening the queues and increasing healthcare capacity - do not reach the regions in time so that they can make a budget and staff accordingly. I want to change that situation so that the money the Riksdag decides on can be used in the regions in an active way.
It is quite obvious that the regions bear the responsibility, because they are directly elected. It is stated in the law. It is also the case that the regions themselves decide how they manage the budget. Right now, several of them are choosing very unusual paths, both regarding running a deficit and managing previous surpluses. But none of them do only that. They are doing a lot of other things that are really difficult now.
I visited Halland on Wednesday. They told me that they are trying to reduce their costs - in a very good way, I think - by reducing the dependence on hired staff. It is not good that one pays so much when one could have permanent staff instead. It involves direct consequences in the form of lower-staffed departments.
The maneuver that needs to be made now to get away from the rental dependency while simultaneously having a tough economic situation is difficult, but I think one is doing the right thing by trying to get away from the rental dependency, because the money needs to be spent on the permanent staff. We must collectively take responsibility for the situation. I have full confidence in the region's solutions - just as in other regions - and that they are making the best of the situation now.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.