Response to interpellation 2023/24:301 on the financing of healthcare

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Marcus Wennerström has asked the Minister for Finance if she, within her area of responsibility, intends to take any initiatives to avoid the regions being forced to lay off healthcare staff. Marcus Wennerström has also asked the Minister for Finance how she, within her area of responsibility, assesses how the government's budget will affect Swedish healthcare.

The work within the government is distributed in such a way that it is I who shall answer the interpellation.

The government and I myself are aware of the current economic situation in the municipal sector. In the budget bill for 2024, the government has announced extra supplements to the regions in the coming years to strengthen healthcare. For 2024, the regions are provided, for example, with a sector grant of 3 billion kronor. The funds can be used for the areas in which the regions themselves assess that the greatest needs exist. The appropriations within the healthcare policy for 2024 amount in total to approximately 67 billion kronor, including the pharmaceutical benefits. In addition, the regions' share of the general state grant is added.

I have in previous debates stated that it is the healthcare authorities, with directly elected politicians at the municipal and regional levels with taxing rights, who are responsible for health and medical care and that 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 and work with priorities. In addition to the reinforcements of the general state grant and the funds directed to healthcare that the state contributes, politicians at all levels need to work on prioritizing core activities.

On 20 December 2023, I held a press conference together with Sveriges Kommuner och Regioner, where we informed the regions about which supplements they can expect during 2024. The economic framework means that municipalities and regions can, if necessary, for example after the announcement of state supplements, make new decisions regarding the budget. There may therefore be an opportunity for the regions to reduce the need for savings through those announcements.

Many regions, according to SKR's economic report for October 2023, are aiming for a reasonable cost level in 2025 and consider it consistent with good financial management not to temporarily reduce activities unnecessarily much. Some regions have therefore made the assessment that this is possible.

With that, I would like to thank Marcus Wennerström for the questions, and I look forward to the debate.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Marcus Wennerström (S)

Madam Speaker! I want to begin by thanking the Minister for the answer. Yes, the Minister has been here in the chamber earlier and debated this issue, but no, the answers are not sufficient. It is serious now.

When the Social Democratic-led government four years ago faced uncertainty and the threat of a pandemic, the message was clear: costs would not be an obstacle to saving lives. When the SD-government now instead faces economically harsh times with war in our vicinity, tax cuts on snus, plastic bags, and luxury goods are prioritized. Four years later, it can be stated that the memory of the value of healthcare seems to have faded. The applause never turned into any money.

Madam Speaker! Sweden has world-class healthcare. We have well-educated healthcare workers who every day save lives, who care for us and who listen to us when we are at our weakest. Because the government prioritizes tax cuts for those with the highest incomes and refuses to tax the banks, the state's support for health and medical care simply does not suffice to maintain current staff and capacity.

With a projected deficit of 24 billion in 2024, healthcare faces enormous challenges. In that case, the government lets Sweden's regions be Svantesson's crash pad. An estimated 5,000 jobs risk disappearing in Swedish healthcare - people who daily deliver care, support, and service to us who live in the country.

To further highlight the concrete deteriorations that the government's budget contributes to, I have asked some of my party comrades from across the country to come here and join the debate.

Before that, I want to give a picture of how things look in Region Uppsala. There, an intensive effort is underway to find savings that do not make it impossible for Akademiska sjukhus to continue its operations as a university hospital. Within primary care, activities are being adapted and moved to stop the economic arterial bleeding. This means that clinics such as the one in Fjärdhundra are threatened with closure. Even Gimo vårdcentral risks needing to be adapted, geriatrics in Tierp is moving to Uppsala, and the operations at Enköpings lasarett risk being sold off. Healthcare is increasingly becoming a commodity for those who live in the larger towns.

No matter how much it might tempt me as a regional politician to blame the governance we have in Uppsala today, but quite honestly - what conditions do they have to succeed? What is happening here and now is a consequence of the SD government's budget, which severely cripples the regions' conditions.

Madam Speaker! The questions I sent to the Minister for Finance, and which the Minister for Health and Social Affairs is now here to answer, remain. Does the government intend to take some initiatives to avoid the regions being forced to lay off staff? How does the Minister assess that the government's budget will affect Swedish health and medical care?

When I look out over the country, I do not see that there is any room to balance the loss of revenue that the government's policy now entails for the regions. The consequence will be poorer healthcare, a poorer working environment, and a poorer welfare in general.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anna Vikström (S)

Madam Speaker! The welfare state is facing its most difficult economic situation since the 90s. A forecast from SKR says that municipalities and regions are expected to run a deficit of 31 billion next year. It is the worst Swedish economic crisis in 30 years - in large part, all regions are struggling to finance their operations.

What we see is that the government and the Sweden Democrats are letting the inflation crisis become a national healthcare crisis. In a short time, inflation has dug a hole in Region Stockholm's budget of 10 billion kronor. It concerns temporary cost increases, such as large pension costs, but it also concerns lasting cost increases, such as wages and pharmaceuticals. The help the region receives of 700 million to cover 10 billion is, of course, welcome but far from sufficient. The region's leadership describes it as "a small bandage on a gaping wound."

Are all these temporary pension costs? No, because to cover the pension costs, the region is forced to budget with a deficit of over 4 billion. For this, extraordinary reasons are invoked. Despite this, a budget gap of 6 billion kronor remains next year. This corresponds to the entirety of Södersjukhuset with its nearly 5,000 healthcare workers. These are ongoing costs that the region cannot cover through one-off financing, such as extraordinary reasons or the result equalization reserve.

Madam Speaker! This means a very tight budget with hard priorities. To avoid dramatic cuts and to protect healthcare, the region has therefore also had to carry out revenue reinforcements in the form of tax and increased fees on public transport, as well as been forced to impose tough but manageable savings requirements of 2 billion. The region is making efficiency gains and savings measures with a reduction of administration and hired personnel. It is, however, a very tough situation. But because it is a government where the Social Democrats are included, care is prioritized by need. A journey of change has been begun towards a more equitable healthcare where the healthcare's money goes to the care.

The region's political leadership describes the current situation as an inflation crisis where Kristersson's government has left healthcare to its fate, which means that Region Stockholm and other regions receive no assistance and are left completely alone to manage this crisis. Furthermore, there is still a healthcare debt following the pandemic. This will, of course, affect healthcare in Stockholm.

The effects of inflation for residents and patients in Region Stockholm could have been mitigated. It remains a mystery that the government contributes to placing patients and relatives in this serious situation.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Sofia Amloh (S)

Madam Speaker! In Sörmland, there was almost 1 billion in the savings account when the Social Democratic government, both in the region and nationally, handed over to the SD government respectively and the bourgeois government in Sörmland. This capital, however, was burned through in barely nine months. In December, money had to be borrowed to make ends meet for wages.

I know that the government says that nothing can be done about this because inflation must be fought first. Yes, absolutely! We shall fight inflation. But I assert that it is not good, neither for inflation nor for the people of Sörmland, when the region needs to incur debt to afford wages.

One week after the SD government presented the budget for 2024, the bourgeois government in Region Sörmland realized that its appeal to the government had not been heeded. The result was mass warnings for 700 employees. And it will not stop there.

Can inflation and the recession sacrifice just any victims? Is there no lower limit for this government?

In Sörmland, health centers and district nursing clinics are being closed. One cannot account for either wages or other costs during this year. In what way does the SD government mean that the regions are not being left in the lurch? The state grants that the government provides are clearly not enough by a long way. In Region Sörmland, the managers are relinquishing their responsibility for the work environment because the situation is beyond control.

Madam Speaker! These are the consequences of incompetent governance in Sörmland and a government that is prepared to slaughter Swedish healthcare. What is required for the Minister to stop looking away? Even if inflation retreats, Region Sörmland will be left alone on the battlefield, trying to scrape together the remains after the government's betrayal. The damage is happening now, and it will not be repaired automatically because inflation retreats or because interest rates back down.

The Minister for Health and Social Affairs and the government can choose to act today, tomorrow, or on any day they wish by submitting an extra budget or an amended budget. They can choose to do something about this and not leave the regions to their fate.

The question remains: Does the government intend to take any initiatives to at least avoid the regions needing to lay off healthcare staff?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Lena Johansson (S)

Madam Speaker! Thanks to Member Marcus Wennerström, who raises this issue that affects and concerns all of Sweden!

I come from Västmanland. Our region, Region Västmanland, is one of the 17 regions that are announcing reductions, cuts, layoffs, and closures.

When I spoke with my party colleague Kenneth Östberg, who is a regional councillor in opposition, he was very concerned. He is usually a calm man, but when he expresses worry and concern, I become truly concerned.

For me and for the people of Västmanland, it is important that I convey to the Minister the concern that many feel and express. I want the Minister to understand it and carry that knowledge with them, because now it is a crisis.

Healthcare and medical care in Västmanland forecasts a deficit for 2023 of 1.1 billion. As it looks, the city council's party comrades, who sit and govern in a minority together with the Liberals and Moderates as well as with the support of the Sweden Democrats, will resolve the negative result for 2023 by pushing it forward as a deficit in the budget for 2024. It is worrying, as one is only pushing the problem forward.

But it is not only the 2023 economic results and the initial budget for 2024 that create worry and concern. In addition to that, a multitude of savings and cuts are being announced and discussed. I shall mention a few.

The region's government has already decided on 100 fewer employees. Reductions of care beds are also being discussed. Despite investigations speaking of the need for more care beds, cuts and reductions of the existing ones are being discussed. In addition to this, reductions at our smaller hospitals have been discussed.

The worst of all is the proposal to close Köping's emergency department. Here, I share not only regional councilor Kenneth Östberg's concern but also the concern of the residents of Köping. Massive protests and petitions demonstrate the concern and frustration that the residents of Köping and Västmanland feel. The word is enough!

Healthcare is important. People must be able to feel the security they need in the social contract we ask them to sign. It is not possible to demand taxes and loyalty from Sweden, Västmanland, and Köping if you, as a region or the state, are not there when people may find themselves in the most difficult situation in life and need support, care, and help. It is not possible to build a country or a healthcare system that is supposed to function in times of crisis and unrest if we cannot manage to build them strong in a normal situation.

Madam Speaker! I believe that no one in this chamber, nor the Minister, is of any other opinion. But if one carries this knowledge with them, it creates an obligation. It is the government's and the Minister's duty to work towards contributing to the robust social construction that we all strive for. I hope that the Minister sees this and takes the responsibility that the office requires.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Hanna Westerén (S)

Madam Speaker! It is difficult to balance the words when we speak about something so basic and at the same time life-critical as healthcare.

We have legislation in the country that stipulates that the need for care shall be decisive when it is determined which interventions we shall receive, not what we earn or where we reside.

I come from Gotland, which is by far the country's smallest healthcare region. Nevertheless, we must have an acute hospital with everything that entails, as well as a constant overcapacity given the vulnerability of our geographical location.

I live in a part of the country where, even before the ongoing healthcare crisis, it was exceptionally tough to make the finances work and to deliver the elementary: the right care at the right time. But thanks to the outstanding efforts of the healthcare workers, Gotland still delivers cancer treatments, maternity care, and interventions against mental illness.

It is clearly anything but free. We are running a deficit of hundreds of millions, and we are structurally underfunded by approximately 300 million kronor per year. With inflation and the ongoing healthcare crisis, we end up with a deficit of 400 million kronor. It is completely unsustainable.

If we return to what we as Members of Parliament are tasked to manage – the legislation, the Health and Medical Services Act, and the promising formulation regarding equal care – it is a fact that the ongoing healthcare crisis significantly exacerbates the damage in an already severely battered region like mine.

When Gotland healthcare is cut by 400 million kronor per year in a total budget reduction of 2.1 billion, it is obvious that it is not possible to nickel and dime one's way out of this. The question then becomes: What should be removed? Which care is it that the people of Gotland will no longer receive? Given our geographical location, we can cooperate with others on certain types of care. But in some cases, we must have our own capacity. The government must answer as to what should be removed.

When healthcare is as catastrophically underfunded as it is now and when sufficient consideration is not given to geography, care intensity, increasing costs, or anything else that could provide a respite, the signal to the regions is clear: Savings must be made. But on what?

I believe that the people of Gotland and, of course, the citizens in all of Sweden's regions covered by the Health and Medical Services Act deserve to be informed about what it is that the regions are to stop performing, who is to be laid off, and what care we can no longer count on.

A Christian Democrat representative has spoken in this chamber about patients who have waited illegally long. Then one wonders where the limit is for Swedish regions. When have they waited illegally long for information on whether the government intends to take some initiatives to prevent the regions from laying off even more healthcare personnel?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Heléne Björklund (S)

Madam Speaker! Today I will also give the Minister for Health Care some examples from my home county of Blekinge. I am a mother to children with several chronic diagnoses. I regularly meet fantastic healthcare staff at Blekingesjukhuset here in Blekinge. They make outstanding efforts, not just for our family but for the entire county's small population. But the question is how long they will be able to endure.

It is the Christian Democrats and the Sweden Democrats who together govern in Blekinge. They have now given a savings target of 600 million kronor. It may not seem like much, but in my small county, it is a savings target of 14 percent. That corresponds to a tax increase of a full 2 kronor. It is a completely unreasonable budget that will have completely unreasonable consequences.

The regional management, with Kristdemokrater and Sverigedemokrater at the forefront, has so far not given any directives on how this is to proceed. But a very clear directive has been given; it is that the budget must be maintained. How is this to proceed? How will the staff be able to manage? How can it even work? It will become a truly deep and difficult healthcare crisis.

I really want to appeal to the Minister for Health and Social Affairs to listen to his party colleagues in Blekinge and around the country and ensure that this is resolved, so that it does not need to be such a large number of staff as we fear are laid off.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Sundin (S)

Madam Speaker! Until September 2022, I was a regional councillor and politically responsible for healthcare in Örebro County. Now, like many others, I read and listen with great concern to the reports on what is happening with healthcare in my county, the healthcare that I myself am so proud of.

It has been said that 414 million shall be saved in healthcare in Örebro län this year. This means a hiring freeze at a time when healthcare needs more staff more than anything else. This means that health centers will remain closed. This means new discussions and new anxiety among patients and staff at the county's two smaller hospitals, Karlskoga lasarett and Lindesbergs lasarett. This means many questions about how the university hospital in Örebro will manage to keep up with everything. And what will happen with the space for the preventive work, the health-promoting interventions? And what happens with the important cooperation with the municipalities and with the transition to good and close care?

It will not add up. It will also not be enough with 414 million. Larger savings than that will be required.

However, no layoffs have been laid off in Örebro County. I believe it is due to the organizational memory. In Örebro County, we still remember what happened in 1995 when almost every fourth employee at the hospital in Örebro was laid off. 1,000 employees were forced to leave. 4,500 employees became 3,500 employees. There were 6 percent fewer doctors, 12 percent fewer nurses, 43 percent fewer nursing assistants, and 18 percent fewer medical secretaries.

Anna Hertting, who is a psychologist and doctor of medical science, has written a thesis on the Swedish healthcare crisis in the 90s. She describes what happened to the healthcare in Örebro County with the words collective grief. That grief still remains in the organization.

Those who were forced to leave then are still missed in the organization, not just figuratively but literally. Even today, there is a generation gap in some operations that arose when so many employees were laid off nearly 30 years ago. The employees who were forced to leave then would be needed now, as senior employees with long experience, because long experience and deep and broad competence are necessary for care of good quality. It was needed for research and development, but it was also needed to receive and mentor students and to introduce new employees.

Madam Speaker! The policy that the Tidö government is now implementing, where tax cuts are prioritized over welfare, contributes to the deepest cost crisis in Swedish healthcare in decades. I sincerely hope that it does not lead to large-scale layoffs in Region Örebro län, because we know what that can bring about.

I want the Minister for Health and Care, Acko Ankarberg Johansson, to know that the large-scale warnings that are now being issued in healthcare across Sweden will be felt for a long time to come, not just this year, not just next year. In some parts of healthcare, they will be felt for decades, perhaps until 2054/55. That is the experience we have from Örebro County.

I repeat the question that has been asked by Marcus Wennerström: Does the Minister for Health intend to take any initiatives to avoid the regions being forced to lay off healthcare staff?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Niklas Sigvardsson (S)

Madam Speaker! All over the country, healthcare is being negatively affected by the SD government's self-inflicted healthcare crisis. Regions are being brought to their knees, and other regions know what is waiting around the corner.

In my home county of Jönköpings län, the region is currently managing to avoid layoffs and notices of layoffs. But this is thanks to a strong underlying economy and the fact that the Social Democratic-led Region Jönköpings län has made tough prioritizations in recent years specifically to avoid mass layoff notices, which many neighboring regions have been forced to do.

There is a concern about how the coming years will look. For last year and the current year, the deficit is estimated to amount to 1 billion kronor, and that is only managed thanks to a strong economy and by using the local government act's extraordinary reasons to run with a deficit right now.

This means that the principle of a balanced budget is being departed from, and this must be done carefully. The Social Democratic-led regional government has considered it necessary so that the residents of Jönköping County can receive the care they deserve and are entitled to. But when other, neighboring regions strike, it will affect the care that the residents of Jönköping County receive. In today's cooperation between regions regarding healthcare, residents in neighboring counties are also affected by mass strikes. The major – and real – priorities that the previous Social Democratic government made have been erased in only two budgets.

The government seems to know what they are doing at the national level, but they do not seem to understand the consequences in regions and municipalities. In their response, the Minister for Health and Care mentions the right to levy taxes, and I cannot interpret that in any other way than as an urge to the country's regions to raise taxes to make the healthcare system sustainable. At the same time, the government comes up with proposal after proposal for tax cuts at the national level. It doesn't rhyme very well when massive tax cuts are made at the national level while region after region and municipality after municipality will be forced to raise taxes.

It is a thank you to the staff who have worked hard in recent years with the pandemic and a significant healthcare debt. It is a thank you from Sverigedemokraterna, Moderaterna, Kristdemokraterna and Liberalerna for the hard work that nurses, nursing assistants and doctors do every day in Swedish hospitals.

If there is one thing that can be known, it is that we Social Democrats across the country, in the Riksdag and in the regions, will work to ensure that all inhabitants in the entire country – including in Jönköping County – receive the healthcare they have a right to and deserve.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Tomas Eneroth (S)

Madam Speaker! I thank the Minister. It is tough to be responsible for healthcare in a Moderate-led government that rests on the goodwill of the Sweden Democrats. I understand it, because history has shown us that Moderate finance ministers are not prepared to either answer interpellations or provide resources to healthcare.

I share all my party colleagues' view here that the healthcare is fantastic. The staff are making incredibly great efforts. I believe we have all encountered that, regardless of whether we ourselves have been there or if it has concerned close relatives. The staff are making an incredible effort. But it is becoming increasingly tougher.

I come from Kronoberg County, which is now ruled by the right. There are many great challenges there. There were thoughts about – finally – building a new county hospital. It would be needed to create a good working environment, a better care chain, and better flows within healthcare. But because of the crisis, those plans have had to be set aside. There is a deficit of 182 million kronor, and according to the majority, it will not be balanced until 2026 at the earliest for the simple reason that the economic situation is so dramatic, even in the previously well-managed Kronoberg.

When we were in government, as late as 2020, I believe the region had a surplus of 400 million kronor. During the pandemic, we allocated resources to healthcare. We ensured that all those who made important contributions received the right support and opportunities to manage the efforts.

What is the Minister thinking now? There was an expectation of being able to catch one's breath a bit after the pandemic, to take on new challenges, further one's education and learn from the experiences, but instead, one is met with closures of healthcare beds, austerity measures, layoffs or notices. This is actually the experience from many regions.

In Kronoberg County, the staff is deeply concerned about patient safety. It has been a tough personnel policy that has led to employees going to the media and warning that patient safety is threatened. It is for good reason. Vårdförbundet has made more reports than before to Arbetsmiljöverket. Ivo has reviewed the situation in Kronoberg and made serious remarks, precisely because patient safety is threatened as a result of closed care beds or vacancies. A large number of managers have also resigned, because they themselves feel that they cannot stand for an operation that is hit by stingy appropriations and where one is not prepared to invest in developing healthcare.

I find it particularly serious when investments in the further education of staff are reduced by almost 50 percent. For many, it was an opportunity to, for example, further their education from nurse to specialist nurse, build a career within the profession, and feel that they were developing. Instead, those funds are being cut now here in my county. I believe that it is also one of the reasons why some choose to quit.

The signal from the government and the leadership is not to invest in healthcare and that other things are more important. They are giving 13 billion kronor in tax cuts only to high-income earners! It is clear that it is about politics. It is about the distribution of our common resources. It is about a government that could have allocated more resources to healthcare but chooses not to do so.

Even more remarkable in this situation, I think, are the symbolic gestures. In Folk och Försvar it was said that one should prepare for times of crisis. Yet, resources for the supply readiness of medicines are being cut by 80 percent in our county. That is not strengthening society during crises. That is not strengthening healthcare and trusting the regions. Think and provide resources! It was needed now.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Peter Hedberg (S)

Madam Speaker! I begin by thanking Marcus Wennerström for the interpellation, for just as nine other comrades before me have done, I shall now highlight my home county's perspective on the ongoing healthcare crisis. It concerns Region Västernorrland.

My home region has a very difficult economic situation. This has primarily historically been due to the increasing dependence on expensive staffing companies, but it has worsened in light of the economic crisis, inflation, and what several have noted today, namely that the government is not taking responsibility for the financing of healthcare.

It is stated in the Minister for Health and Social Affairs' response that one must prioritize core activities. I do not know of anything my region prioritizes other than core activities. Karin Sundin touched upon things regarding development, transition, and skills development, which we spoke about just now, which are important but will probably have to take a backseat. That is also core activity.

In my county, we will see the waiting times for operations increase. The queues will grow, and we know what frustration that leads to among the citizens. In the priorities the region is forced into, everything is done to avoid laying off staff closest to the patient. They try to focus on, for example, administration, but as everyone knows, and as is talked about a lot in the public sector, the demands for documentation and administration are increasing. Where does that burden risk falling? Yes, on the staff closest to the patient.

The result may very well be what we have feared and can now see, namely a worse working environment, greater risks for patients in healthcare, and worse welfare for ordinary people. I believe many are asking themselves if this was what the Tidö parties promised the voters in Västernorrland in the 2022 election.

Madam Speaker! I was brief on that point but I must elaborate a little, because it is not possible to mention healthcare in today's Sweden without raising the issue of agency work and staffing companies. An absurd situation has arisen in this country where certain companies can drain healthcare of large sums. They rent out staff for shorter periods. It is staff who are absolutely needed but who cost very much money. What remains is the regular, permanent staff who have to take responsibility for induction, continuity, and order.

Now we even hear reports that there are "relay influencers" who, in social media, report on how fantastic it is to escape the responsibility that rests on the permanent staff. I do not think I will comment on that further, as such language is probably not permitted in this chamber.

The agency worker issue, in combination with inflation and the underfunding of healthcare, has made the crisis acute in Västernorrland County. Since the Minister for Health and Care visited Västernorrland in early October last year, the costs for agency staff have increased by an additional 25 million kronor. In total, the cost in 2023 was over 800 million kronor for agency staff in Västernorrland County. The result for the entire Region Västernorrland was minus 730 million kronor. To restore that, the result equalization reserve will need to be used, but it corresponds to 250 million kronor. Every human understands that it is an unsustainable situation.

I would like to conclude this contribution by mentioning that the Minister for Health and Social Affairs' party leader during the previous parliamentary term showed very great interest in the healthcare in Västernorrland and also had views on where certain operations should be located. It would be desirable for the Christian Democrats and other Tidö parties to take responsibility and show equal interest during this parliamentary term for the healthcare crisis prevailing in Västernorrland. It is simply the case that more money needs to be injected so that we can have equivalent healthcare throughout the country. Will any such initiatives come?

(Applause)

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Yasmine Bladelius (S)

Madam Speaker! Just like in the rest of Sweden, there is a crisis in the Skåne healthcare system. The surgical queues are longer now than ever before. The availability in the Skåne healthcare system is lower in three out of four areas measured according to the national healthcare guarantee. The availability in the Skåne cancer care continues to deteriorate, and Skåne is now the worst in the entire country at providing cancer patients with care in a timely manner. Skåne healthcare staff are fleeing the care system. They are doing everything they can and running as fast as they can. They are going down on their knees and can no longer cope. It is actually a completely unacceptable situation, and it has worsened over the past years.

Madam Speaker! Despite the fact that healthcare in Skåne is in an ongoing crisis, the savings target for 2024 is almost 2 billion Swedish kronor. I will mention some of the deteriorations that have occurred so far in Skåne and want to emphasize that these are only examples. It concerns the closure of the health center in Degeberga, the district clinic and the BVC branch in Hästveda, the BVC branch in Köpingebro and the children's clinic in Trelleborg, the closure of the psychiatric emergency room in Kristianstad during evenings and nights, a savings demand of 186 million within psychiatry, habilitation and the assistive devices activity, the closure of the palliative ward in Trelleborg and the closure of the special unit Dumle, an incredibly important activity that since 1985 has helped severely disabled children and adults to play on their own terms and find the right ones among simpler assistive devices. Skåne University Hospital, which has the largest deficit in the region, is expected to save a total of 815 million kronor in 2024. Over five years, every ninth healthcare bed has disappeared in the Skåne healthcare system.

Madam Speaker! The constant budget cuts in the Skåne healthcare system lead to an unsustainable working environment, impaired patient safety, and even less accessible care. It is a worrying development.

Madam Speaker! This is something the government's friends who run Region Skåne must actually take responsibility for. But the government and the responsible minister must also take responsibility. The budget that the government presented last year and which applies to the current year has paved the way for a healthcare crisis also in Skåne. It does not even cover one-third of the needs that exist to maintain today's level. It has paved the way for the cuts that we are now seeing, not least in Skåne, where the same parties rule as here in the country. It is now time, Madam Speaker, for the Tidö parties and the SD government to take responsibility in the healthcare crisis.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! I thank the interpellor for raising this important issue and I also naturally thank the Minister for Health and Care for her initial response. With my contribution, I want to describe what the situation looks like in my home county, Värmland.

The healthcare crisis is here and now. It has been warned that 750 positions will be removed in Region Värmland. It is a historically large and extensive proposal to be able to meet the economic conditions we have, says Peter Bäckstrand, regional director in Värmland. Despite the warning that 750 positions will be removed, it corresponds to only half of the savings target, which for last year amounts to 1 billion in Värmland. In that case, I have not, Madam Speaker, accounted for this year's budgeted deficit.

Excuse my language, Madam Speaker, but there is a slaughter of Swedish health and medical care taking place - in Värmland and in the rest of Sweden. The situation is extremely serious and difficult. Healthcare has hardly recovered after the pandemic and actually needs more resources to be able to pay the healthcare debt that has arisen. Furthermore, we have an increasingly aging population that requires greater resources. But instead, we have ever fewer resources - fewer than we have ever had. During the pandemic, all of us parties, including the current government parties and SD, stood on the barricades and hailed the heroes of the welfare state. Now we need more resources and more legislative changes. But where are the government and the Sweden Democrats? Not a sound is heard.

I can rattle off several examples of which measures will potentially be taken in Värmland. Among others, I can take an example from Arvika hospital, where it is proposed to close the emergency line. It is also proposed that the lab and X-ray should only be available during the daytime. That is just a small excerpt.

In line with what many have previously reported, this will naturally lead to poorer patient safety, longer queues and, above all, poorer accessibility for our residents of Värmland. And what happens to the staff who remain when the work environment deteriorates? Actually, we need to have a better work environment, Madam Speaker, in order to attract more people to healthcare.

Dissatisfaction is growing among the public. On Friday, thousands of Arvika residents gathered to show their dissatisfaction. The message was clear and distinct: We want our hospital to stay! Värmland is a large county in terms of area, and level structuring has already been carried out. We have three hospitals left in this large area. This is only the beginning, I believe, of a large public dissatisfaction. The savings that have been presented so far for Arvika hospital correspond to only 22.9 million, but even now, dissatisfaction is growing.

Madam Speaker! We Social Democrats wanted to give more money to healthcare already in last year's budget, and that is also the case in this year's budget. Both of these budget proposals have, however, been voted down by the government parties and SD. Politics is about prioritizing. Politics is about wanting.

My question to the Minister for Health and Social Affairs has been asked before: What is Acko Ankarberg Johansson doing concretely here and now to ensure that the healthcare crisis is lifted?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Björn Wiechel (S)

Madam Speaker! There are two big problems here, I would say. One is the reality that healthcare faces. The other is that we have a government that does not see and acknowledge that reality.

It does not only concern State Secretary Ankarberg Johansson. The Minister for Finance has also been asked about the crisis in healthcare. But the Minister for Finance could not confirm that there should be any specific problems worthy of the government's attention or economic interventions. The Minister for Civil Affairs was also asked the same question, but he downplayed the entire matter.

Nor even those who run the government, the Sweden Democrats, see that there is any problem. The answer instead becomes that we must prioritize and that the regions must prioritize, which is deeply provoking. For the SD government has, in fact, chosen to prioritize lowering taxes for the country's high-income earners, instead of investing in health and medical care for the citizens.

In Västerbotten, which is my home region, we can see that it has major consequences. People are very used to taking economic responsibility. They do it in a structured and continuous manner because there are constant cost increases as a result of new medical technology that they want to introduce and that ordinary people should benefit from, and because of an aging population.

But what we are seeing now, or what people outside the SD government see in any case, is something beyond the ordinary. The first consequence for the situation in healthcare in Västerbotten is that investments need to be put on ice. It is about maintenance and renovations of properties and premises so that they are fit for purpose and safe. Stopping those investments obviously affects the quality of care, the work environment, and patient safety negatively.

In Västerbotten, an extensive new industrial growth is also underway, which requires that the region be an active party so that society and welfare remain secure and stable. But this is now being undermined.

For Norrland University Hospital to meet its responsibility for specialized care for the whole of northern Sweden, it requires investments in real estate and in medical technology. Now, the region is instead forced to reduce investments by 10 percent. Real estate maintenance, renovations and investments are decreasing when we rather had needed to increase them.

Despite the fact that there is already a major shortage of staff - which is the primary reason why care beds are being closed - one cannot rule out warnings due to the government not taking its economic responsibility.

To solve the staff shortage, it would not only have been necessary to have money. It would also have been necessary to have a labor market policy, an education policy, and a housing policy from a national level. But even here, the government is completely passive.

One must remember that during the pandemic, the Social Democratic government provided coverage with plenty of times to the regions for the increased costs that arose in healthcare. But the SD government does differently.

Usually, people blame inflation, but that is wrong. All judges know that investments in welfare do not drive inflation. It is simply a matter of having prioritized lowering taxes for the high-earners instead of providing healthcare for ordinary people.

One can also consider the requirements for readiness and defense capability and the regions' need for robustness. It requires adequate staffing. The Government should ask itself whether it wants the regions to be ready if war or the crisis comes.

To solve this problem, one must have a government that understands it, acknowledges it, and then also takes its responsibility.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Sanna Backeskog (S)

Madam Speaker! Healthcare in Sweden is in a deep crisis. In Region Gävleborg, a deficit of up to 700 million is expected for 2023, and if nothing drastic happens, it could result in a billion-kronor deficit for 2024.

Madam Speaker! It is about a deficit of up to 700 million with a risk of a billion-kronor deficit. Unfortunately, the government chooses tax cuts over supporting healthcare. This means that regions across the country, as we have heard here, have been forced to implement large and painful measures to save healthcare.

In Region Gävleborg, the governing parties Sverigedemokraterna, Moderaterna and Kristdemokraterna choose to do nothing and wait and see, even though they know that sufficient financial support will not come from the government. That passivity and inability to act is in itself a threat to healthcare in my home region.

Madam Speaker! The SD government is forcing healthcare in Gävleborg to its knees. The betrayal is obvious. The consequences are borne by the healthcare staff and by the patients.

At Christmas 2023, patients at the emergency department at Gävle Hospital were subjected to a completely unacceptable situation. Patients and relatives were forced to stand in long queues outdoors in a snowstorm and unplowed roads to wait for assessment.

The local media have reported on how patients and relatives had to put up with a situation without assessment of medical severity. They were left without supervision and without the possibility to contact staff or call for help. For the visitors, it was uncertain for a long time whether their presence was even noted.

It is obvious that the Tidö parties in Gävleborg have failed and that they lack both competence and economic decisiveness from the government.

Madam Speaker! Politics is most important in difficult times. Here, the government's passivity and inability to prioritize have been obvious. All around the country, there are testimonies of long waiting times, serious failures, and a frustration over the lack of continuity.

Madam Speaker! But much also works really well, so far. Swedish healthcare is high-quality, world-leading actually, when it comes to, for example, maternity care and child healthcare. Hudiksvall is a brilliant example where the employees are the best in the country at avoiding birth injuries.

Healthcare workers are some of society's most loyal. They are the ones who carry our welfare. They are the ones who are there for us when we need them most. But behind the curtains, aching bodies and strong conscience-stress over not being enough are not visible. The salary is sometimes so low that one cannot make it stretch for the most basic needs.

But soon this government will no longer be able to turn a blind eye. It is when enough employees leave our healthcare because they simply can no longer cope, or when the skills shortage becomes obvious enough to the average person. But then, Madam Speaker, it will be too late.

When I meet employees in Gävleborg, they describe a very difficult situation with too few colleagues and too little time with their patients. But they hang in there and grit their teeth to support each other and to be able to take care of their patients. The government's and the Sverigedemokraternas tax cut policy from this chamber does not make it easier in Gävleborg, only harder.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dzenan Cisija (S)

Madam Speaker! My name is Dzenan Cisija, and I want to report on the economic situation in my home region, Västra Götalandsregionen, VGR.

The government's general state grants to regions of 6.7 billion kronor for the year 2024 are unworthy of being called an investment in Swedish healthcare. Nor can the targeted state grants help much, as they have almost been halved. This has occurred because Sweden's regions have incurred significantly increased costs which SKR estimates at over 20 billion kronor. For VGR's part, the cost increase is estimated to be 3.8 billion. Even for the large Västra Götalandsregionen, this implies a healthcare crisis.

Madam Speaker! The red-green leadership, which governs VGR in a minority, takes its share of the responsibility by streamlining operations but also by budgeting with a deficit. In this way, they attempt to safeguard the most necessary healthcare. For 2024, VGR budgets a deficit of 1.5 billion kronor. This means that investments that should be made to build up healthcare in uncertain times are pushed into the future.

The cuts are coming at a time when we know that the healthcare system's great challenge will be the supply of competence. With the aging population, we need more of us working in healthcare and not fewer.

VGR is unfortunately forced to introduce hiring freezes within certain occupational categories, and most hospitals are forced to make staff reductions. They are trying to avoid layoffs of healthcare personnel by ensuring that it occurs through natural attrition.

The hospitals in VGR report challenges of 3.3 billion to manage during 2024. NU-sjukvården in Trollhättan and Uddevalla budget a deficit of 109 million but have a total challenge of 450 million kronor. Skaraborgs Sjukhus in Skövde, Falköping, Lidköping and Mariestad budget a deficit of 230 million. Södra Älvsborgs Sjukhus in Borås and Skene plan staff reductions corresponding to 150 million. The hospitals in the west, in Angered, Frölunda, Högsbo, Kungälv and Alingsås, need to manage half a billion in measures.

Finally, Sweden's largest hospital, Sahlgrenska in Gothenburg, faces a completely unreasonable challenge to save 1.7 billion, an amount that would easily have sufficed for 2,000 employees.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Fredrik Lundh Sammeli (S)

Madam Speaker! In Norrbotten, where our citizens already face unique challenges with long distances and already limited access to healthcare, a healthcare crisis is the last thing we need. I have decided to join this debate, as Marcus Wennerström has requested, to highlight the serious situation that our country finds itself in. The government's passivity has triggered an acute healthcare crisis that now affects every region. I see it as my task and duty to address how this affects my own home region, Norrbotten.

Region after region has for more than a year called for help, but the government has turned a deaf ear. This debate is an attempt to convey the healthcare system's cry for help. The government must listen and act.

A crashed healthcare system is what Sweden needs least of all in this situation - not the staff, not the patients, not public health, and not our preparedness. We need a government that sees the seriousness of the crisis and takes its responsibility.

My colleagues have in an exemplary manner highlighted various concrete examples of how the healthcare crisis hits. Amidst all the billions in deficit and thousands of employees who are being laid off and given redundancy notices, where health centers and various healthcare facilities are being closed down, we must never forget that it is fundamentally about people's lives and health.

The government's silence and reluctance to act has created a healthcare crisis that Sweden does not need, which leads to withdrawals and cuts and is fundamentally a breakdown of our healthcare. Fantastic staff, who should be getting more colleagues, are instead getting fewer colleagues and are expected to run faster. Waiting times and treatment times will increase, and the lack of necessary care will hit many hard.

This is Kristersson's and Åkesson's healthcare crisis. It is quite clear that our citizens deserve something else. Norrbotten is in no way protected from this, and when the government talks about efficiencies and priorities, it is perceived many times as a mockery.

The reality in Norrbotten is that the work with good and close care - an important reform effort that has now been ongoing for a few years - is now coming to a standstill. When you remove the 35 million that made a difference in competence development and in the work to create attractiveness in the profession, an important part stops.

The vaccinations need to continue. In a county like Norrbotten, it is about 26 million to organize and continue vaccinating. These are burdens being placed on an already strained budget.

It is two small parts of 35 and 26 million respectively. One can often think that a region can solve such things, but in Norrbotten's case, it is about having received changed conditions in a short time and heading towards a deficit of half a billion. It hits directly against such as is core activity and against the possibilities to retain staff and to recruit new ones.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Eva Lindh (S)

Madam Speaker! We have now received testimonies from many different parts of Sweden that we have a healthcare crisis. Healthcare is threatened in many places.

Östgötska healthcare is among the hardest hit in the country. The region moved towards a deficit of a staggering 1.6 billion last year. Here, the personnel cost is to be reduced by a corresponding 600 people - at least.

This is serious. It involves risks for patients and also for the staff's working environment. Already now, so early in the year, we see how the queues are growing. The availability of emergency care is decreasing. This will truly be noticed for the people of East Götaland and in the East Götaland healthcare system.

Welfare has not been this tough since the 1990s crisis. In the same way that inflation has eroded our wallets, it has naturally also affected our municipalities and regions. It has also made the situation more difficult.

What the SD-led government should have done in this situation is to truly inject money, so that these savings would not have been needed. The targeted state grants and general state grants that the government calls investments are not enough. They are not enough to save healthcare.

What is also serious is that the SD-led government is actually shirking responsibility for the situation. It seriously upsets both me and those I have met in the healthcare system.

Most people still understand that the regions are not alone regarding healthcare. They are also dependent on receiving resources and funds from us, from the state level, and that requires a government that seriously prioritizes healthcare. That is what we Social Democrats would have done.

In Östergötland, it is the same parties that lead the region that also govern the country. That is also why the whole thing is a bit strange. It is not only social democratically led regions in the country, and I think the government should listen to its party comrades and see how it is.

In Östergötland, M, KD and L are therefore governing in cooperation with the Sweden Democrats. What that region is now responding with is to introduce more healthcare choices. Even at the local level, politics plays a role.

The care choices are therefore being introduced despite the fact that we know they cost more money and that the analyses that have been conducted prior to the introduction also point out that they fragment the care and risk patient safety, just as they risk leading to a shortage of competence within the care sector.

In this situation, every tax crown in welfare must be used to increase quality and retain staff. Marketization has not brought anything good for healthcare and will not do so either. I now appeal to the Minister for Health: Ensure that the regions, that is, the healthcare, receive the money and resources needed to save healthcare in Sweden!

(Applause)

In this speech, Björn Wiechel (S) agreed.

(cont.)

The speech at riksdagen.se, in Swedish (opens in a new tab)