Response to interpellation 2023/24:361 on home care in times of crisis
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 functioning of home care services during a crisis or war. M argues that the municipalities have the responsibility to ensure the functioning of home care through the principle of responsibility 1 2. M emphasizes that the government has allocated 300 million kronor annually to strengthen the social services' civil defense 1 and prioritizes crisis preparedness through investments in external and internal defense 2 3. M believes that good elderly care in peacetime is fundamental 4 and that the government prioritizes competence supply through Äldreomsorgslyftet 4. S argues that the municipalities are underfunded by the government 5 6 and criticizes that tax reliefs for high-income earners are prioritized over the resilience of home care services 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 Anna Tenje (M)
Mr. Speaker! Linus Sköld has asked me how I will act to ensure that home care continues to function in the event of a crisis or war.
Municipalities have a great responsibility within the public administration. Municipalities shall, within their respective areas of responsibility, be able to prevent, resist and manage crises and accidents of varying nature and scale.
Sweden's crisis preparedness is based on the so-called principle of responsibility, which means that a government agency or another public body that has a specific operational responsibility under normal conditions shall also have it during a peacetime crisis as well as during high alert and, ultimately, war, provided that the activity is to be conducted under such conditions. It is therefore the municipalities that are responsible for ensuring that home care continues to function in the event of a crisis or war.
The deteriorating security situation, previous experiences of crises, and evaluations have clarified that the municipalities' preparedness within social services needs to be significantly strengthened. The Government has therefore allocated 300 million kronor annually from and including 2024 to a targeted state grant to strengthen and develop the municipalities' work with the civil defense of social services and municipal health and medical care.
Through the structure for society's crisis preparedness and civil defense that has applied since 1 October 2022, it is clarified that healthcare is a society-important activity. The Government's purpose with the targeted state grant is to improve the municipalities' conditions to live up to the requirements and expectations that exist.
During 2023, 100 million kronor were allocated, distributed with an equal amount per municipality, for the purpose of providing the municipalities with the conditions to analyze what needs exist regarding the development and strengthening of the municipalities' planning and work. Furthermore, the county administrative boards have a special mandate to provide regional support to the municipalities in their work with the preparedness of the municipal health and medical care and social services.
As Linus Sköld is in his question, the municipalities' ability to ensure home care during a crisis or war is linked to the ability to maintain other functions, such as electricity supply. The deteriorating security situation and the developments in Sweden's immediate vicinity underscore the need for a strong total defense and a strengthened crisis management capability. An important part of this is to strengthen civil defense. The Government considers that measures and investments to develop and strengthen civil defense must continue and be expanded. Municipalities are central actors in the work to strengthen and develop society's crisis preparedness.
The government is therefore also making economic investments in the broad, overarching work on crisis preparedness and civil defense. The government is strengthening the county administrative boards' possibilities to support the municipalities' work with civil defense through an addition of 60 million kronor from 2023. Also in the overarching preparedness work, the county administrative boards have an important role when it comes to supporting the work of developing crisis preparedness at the local level.
The government is also investing 100 million kronor annually from 2024 in increased grants for the municipalities' and regions' work with crisis preparedness and civil defense. This is therefore in addition to the 300 million kronor that have been allocated specifically for the municipalities' work with the social services' and the municipal health and medical care's civil defense.
Sweden's ability to handle high alert and, ultimately, war needs to be strengthened on a broad front. Social services, including home care, are a very important part of this. Since taking office, the Government has prioritized strengthening the nation's preparedness, and we continue that work.
Linus Sköld (S)
Mr. Speaker! Home care is a formidable idea - that our elderly should be able to maintain as much capacity and as high a quality of life as possible by staying at home with support. But home care is therefore also essential for the users' safety and quality of life. It concerns a substantial part of the Swedish welfare.
In Älvsbyn, on January 4th this year, we saw an example of how fragile this can be when a crisis or an accident occurs. It happened to be -40 degrees in Älvsbyn at the same time as a transformer station in the middle of the village caught fire, and several thousand households were left without power. Without power, it takes no more than four hours before the backup power runs out for the telecommunications mast in the center of the village; I have had a debate with the Minister for Civil Affairs about this since he is responsible for telecommunications.
This means that the home care service's alarms are switched off. The home care service's cars can neither be charged with electricity nor fueled at the gas pumps that are powered by electricity. Inside the houses, where the elderly are presumed to live, the circulation pumps stand still. Even if one has district heating, the house therefore does not get warm. It becomes cold indoors quickly in -40 degrees.
Preparedness for such a scenario needs to be robust. I hear Anna Tenje give two answers to my question about what she intends to do. One is that it is the municipalities' responsibility, and I think that is a poor answer to the question of what Anna Tenje intends to do. The other is to refer to a number of targeted government grants. Someone who has not read the answer in advance will probably have difficulty keeping track of which government grant is to go to what. My summary is that it is 60 million to the county administrative boards and 100 million generally to the municipalities, distributed in an equally large pot to each municipality. That means approximately 300,000 per municipality in Sweden today, or perhaps 350,000. It is also 300 million to the social services generally, distributed among the municipalities to work with crisis preparedness.
These are the amounts I derived from the review. If it is the municipalities that are to take responsibility for ensuring that home care is robust, this must be reflected in how things are going for the municipalities. At the moment, things are going very poorly for the municipalities. A couple of examples of this are that the average tax rate in the municipal tax is 10 öre higher since the turn of the year, that every third municipality is expected to have a deficit for 2023, and that 48 municipalities are budgeting for a deficit for 2024.
Anna Tenje says that it is the municipalities' responsibility, but then she and her government underfinance the municipalities so that they are brought to their knees and have to save.
Statsrådet Anna Tenje (M)
Mr. Speaker! I want to begin by establishing, so that we are clear and precise on this, that Sweden's crisis preparedness, therefore, rests on the principle of responsibility. That is to say that everyone at the different levels does their part within their area and shall maintain – not in full but to some extent – the parts that they normally also are responsible for in peacetime.
I can agree with Linus Sköld in the description of the home care service and its extremely important significance. The previous debate here was about childcare, and childcare and elderly care are two extremely important things for civil defense and total defense to function at all. These are two things that rest with the municipalities, just as healthcare is the regions' responsibility. Then there are masses of other things at the state level.
If one starts to rock that principle, we will face significantly greater problems than that. The money that this government has ensured that municipalities and regions receive to kickstart the reconstruction of the total defense and civil defense should have come much earlier. I can agree with that. Much more should have been done much earlier. But this work was not started by the previous government, rather it is something that has been prioritized here and now by this government. Now, one has come a good way, but obviously not all the way.
We live in restless times. It was evident during the pandemic, and for those of us who held mandates of trust as municipal representatives, it became very clear what deficiencies existed and what needed to be done. Many municipalities took on an enormous responsibility. The municipalities that had previously experienced the storms Gudrun and Per and floods perhaps had a small head start, but it was still evident and clear that more needed to be done.
We are now undertaking a major upgrade and a kickstart of both the total defense and the civil defense, which together will benefit safety and security in Sweden. When we become full members of Nato, we will be one of the member countries that meets the two percent goal. This is important, not least for safety and security but also for a strong civil defense.
For a strong crisis preparedness, one must simultaneously be able to protect the outer border and the inner border. The money that we have now allocated to municipalities and regions is intended to strengthen civil defense, total defense, and crisis preparedness in municipalities and regions. It is about making the overarching analysis so that the municipalities in their area of responsibility know what needs to be prioritized and specifically invested in.
I agree that it is a large and important task that lies ahead of us. This is very neighborly and not enough given the situation we find ourselves in today with an uneasy world. But this government prioritizes these issues, both when it comes to external defense and when it comes to internal defense, in order to create opportunities for a secure total defense and civil defense but also so that municipalities and regions can manage their neighborly tasks in the event of crisis and war.
Linus Sköld (S)
Mr. Speaker! Then we add another point to Anna Tenje's accountability: It is the municipalities' responsibility, and it is the responsibility of the previous Social Democratic-led government.
I am requesting what Anna Tenje intends to do to strengthen crisis preparedness in home care, and I still hear no answer to that. If the answer is the principle of responsibility, then one should, as a minister responsible for ensuring that home care functions, be interested in that the municipalities have sufficient resources to finance their home care, so that it is robust from the very beginning. A home care service that must cut back, that saves, and that cannot recruit staff will not have any resilience the day a crisis or, God forbid, a war should occur.
Politics is about prioritizing. In Anna Tenje's response, a number of specific targeted government grants are mentioned, one of 100 million, one of 300 million, and one of 60 million. But the municipal sector's deficit for 2023 - projected, as the annual accounts are not complete - is 7 billion, and that is because this government has not provided enough general government grants. The general government grants were indeed increased nominally, but that does not correspond to the inflation of 9 percent last year.
The result of this is, therefore, that we see large increases in the municipal tax. Increases as large as those between 2023 and 2024, we have not seen since the last time the Alliance sat in government. It is when the Alliance sits in a governing position that municipalities feel forced to raise the municipal tax.
Politics is about priorities, I want to say, and this government prioritizes lowering taxes for high-income earners. 960 million goes towards a discount on high-income earners' luxury renovations of kitchens and so that they can hire a home helper or get house cleaning. It is the 50 percent who have the highest incomes who take part in that reinforcement of the rot- and rut-deductions that this government is making. This one manages to prioritize 960 million for. But when I ask how we are to strengthen the home care's crisis preparedness, one comes up with a targeted government grant of 300 million.
One can also abolish the plastic bag tax. It costs more than what the municipalities received to analyze their need for crisis preparedness, which was an example of what the government could do and still respect the principle of responsibility.
The prioritization here is crystal clear. At the expense of ordinary people and at the expense of the welfare system, taxes are to be lowered for high-income earners, while at the same time municipalities are forced to raise taxes for everyone. I think Anna Tenje should answer my question instead of trying to shift the responsibility onto the Social Democrats or onto the municipalities. What does Anna Tenje intend to do to strengthen the home care's resilience in the event of crisis and war?
Statsrådet Anna Tenje (M)
Mr. Speaker! I did not blame the previous government for everything and anything. But I stated that it would have been good if one had started significantly earlier, both regarding the investments we are now making in defense and the justice system and, above all, regarding the crisis and war preparedness in municipalities and regions.
As I see it, three things are needed for elderly care to function during a crisis situation. First and foremost, one needs to have good elderly care under normal conditions. It is no secret that there are major challenges and deficiencies in elderly care. They have been known for a long time. Many municipalities have also worked with these problems, not least when it comes to the supply of competence, for a long time. But this was identified, not least in connection with the corona pandemic.
I am therefore happy with this government. Our Prime Minister did not only appoint a minister for civil preparedness. We think those issues are important and that they need to be prioritized. Our Prime Minister also appointed an older minister. We consider those issues to be important and that they need to be prioritized.
In connection with my appointment to this office, I commissioned an investigation regarding language requirements, precisely to ensure that older people can understand and make themselves understood. This was one of the major deficiencies highlighted, not least in the Corona Commission's report and in Ivo's reviews.
We also ensured that an investigation was appointed to look at how medical competence can be strengthened in municipal health and medical care, given that patients or the elderly are becoming increasingly multi-morbid and that there are more complicated cases. We provide home care and nursing that is becoming increasingly advanced. At the same time, the gap between municipality and region is still sometimes far too large, and our elderly fall between the cracks.
These are two things that we have already prepared and that we want to continue working with. Furthermore, we moved forward and extended Äldreomsorgslyftet, a quality initiative to specifically increase competence. It is a very good initiative that has turned out very well. I do not usually speak particularly highly of targeted government grants otherwise, but I must state that this has been a government grant that has definitely hit the mark and provided increased competence. We will continue this for three years forward in order to specifically increase competence.
The second thing that must be in place - besides a well-functioning elderly care in peacetime - for this to work in wartime is that the primary authorities, which in this case are the municipalities, have a good crisis preparedness and are equipped with a well-prepared civil defense. The crisis preparedness in our municipalities is in no way fully developed. It is being upgraded, and the government supports and will continue to support this important work.
Thirdly, society must provide a basic infrastructure for this rest to function. The government has already begun active work in this area regarding, among other things, what we were discussing earlier – electricity preparedness and a secure energy supply. We have begun the work on a secure, stable and clean electricity supply in the future, not least through nuclear power. We are also investing heavily when it comes to cyber defense. We know that cyber threats are a threat that definitely hits many of our municipalities hard.
For me, crisis preparedness is about a very broad and long-term effort. It is a task that I wish we had started much earlier, because then we would have come much further now. But this government definitely prioritizes this and will continue to work with it.
Linus Sköld (S)
Mr. Speaker! Thank you, Anna Tenje, for a long answer that did not contain an answer to the question I asked! The answer here was about what Anna Tenje thinks is needed for a home care service that should function even in times of crisis, but I heard nothing about what Anna Tenje intends to do. It is a simple question. I have asked it in the interpellation. I have repeated it in every post so far. Anna Tenje will soon have a final statement, and then she can account for what she intends to do more than just being appointed by the Prime Minister because these are such prioritized issues.
I summarize this debate by stating that every third municipality is expected to submit a year-end account for 2023 with a deficit - 7 billion in total deficit. We see a record increase in the municipal tax from 2023 to 2024, that is to say, signs that things are going very poorly for the municipalities' finances when this government is at the helm.
In order for good elderly care to be able to be maintained even in times of war, it needs to be financed. When you cut back this much on welfare, it will also affect elderly care and home care services. It will weaken the crisis preparedness in home care services.
This is my summary, and Anna Tenje has not touched it with a single word. One can manage to prioritize 1 billion for luxury renovations of high-income earners' kitchens. One cannot manage to prioritize securing the municipalities' finances in this crisis.
Statsrådet Anna Tenje (M)
Mr. Speaker! It is perhaps obvious that the communication might not be coming through quite correctly tonight. In that case, I simply want to repeat what I said earlier.
I believe that it rests on three things if one is to have a successful crisis and war preparedness. The first part is perhaps the most important. That one has good elderly care in peacetime is the fundamental factor for also being able to have good elderly care in times of crisis and war.
The government has prioritized continuing to invest in the competence supply regarding the Elderly Care Boost (Äldreomsorgslyftet) to secure competence within elderly care. We have commissioned an inquiry to ensure that we obtain a language requirement so that elderly people can understand and make themselves understood within home care and special housing. We want to strengthen the medical competence so that the elderly do not fall between the cracks but receive the care and support they are entitled to, regardless of whether it is in the home, in a special housing facility, or in a hospital.
We have invested in a relative strategy to ensure that more relatives receive better support from the municipality and region. We have also initiated work on a dementia strategy, given that dementia is one of the largest common diseases. Today, approximately 150,000 live with a dementia diagnosis, and 25,000 receive such a diagnosis annually.
Overall, this provides a stronger and better elderly care that can stand strong in peacetime but also in times of crisis.
The government supports municipalities and regions - at the state level, the regional level and the municipal level - when it comes to strengthening crisis and war preparedness. This is a very high-priority issue for the government. I believe that has been seen, not least in the 78 points that the Minister for Civil Affairs recently presented.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.