Response to interpellation 2023/24:420 on crisis measures for healthcare
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that the government has prioritized welfare in the budget and that healthcare has received the most money of the whole 1. KD emphasizes that the regions are responsible for healthcare and that the state cannot fully compensate for all cost increases 2. KD believes that the regions must prioritize core activities and reduce administrative burden 1. KD believes that the sector needs long-term perspective to find a better balance and improve the working environment 1. KD argues that the state will return with grants to support healthcare 1. KD emphasizes that it has never been discussed to change the welfare system into an insurance system 3. KD believes that the focus should be on the operation meeting quality requirements 3.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Karin Rågsjö has asked me if I and the government intend to convene the parliamentary parties for a Christmas meeting for deliberations on the healthcare crisis and propose an extra supplementary budget to meet the healthcare crisis. Karin Rågsjö has also asked me if I intend to take measures to improve the healthcare staff's working environment.
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 health and medical care. The appropriations within the health and medical care policy for 2024 amount in total to approximately 67 billion kronor, including the pharmaceutical benefit. Additionally, the regions' share of the general state grant is added.
I have in several previous debates stated that it is the healthcare heads, 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. Politicians at all levels need to work on prioritizing core activities. The Government is simultaneously following the issue closely and is prepared to take further measures if necessary.
I keep the Riksdag informed about the situation in healthcare through the relatively frequent visits to the Committee on Health and Social Affairs and intend at this point to also continue to follow the regular structure for the committee work.
With that, I would like to thank Karin Rågsjö for the questions and I look forward to the debate.
Karin Rågsjö (V)
Mr. Speaker! Thank you, Minister, for the answers, even though they are very vague! Sometimes I think about the pandemic and the healthcare system's rather heroic efforts that we all praised. I also think about how the previous government was very quick to see where the resources should be deployed. But the current government and SD have, I think, forgotten the entire process of the pandemic and what it was about. If we were to get a new pandemic in Sweden - God forbid! - or if we were attacked by a foreign power, the healthcare system is not prepared in its current state.
The Minister proposes an increased taxation. That is not something that KD usually warms to. How much can regions and municipalities raise the tax in a recession? One wonders. Otherwise, you are very prepared to, so to speak, lower the tax for the rich.
We are now talking about the state subsidies to healthcare, about what is happening now and about the layoffs that are underway. We are clearly in an economic crisis - a crisis that the government and SD are proving to be very helpless in facing. It is a construction crisis, and it is high unemployment that is ticking up. It is an economic crisis and a welfare crisis. I believe that we have a national healthcare crisis.
Just over two weeks ago, Prime Minister Ulf Kristersson made a promise that the government and SD would provide support that means that employees will not have to be laid off. Now it seems that promise is not worth a drop, but it sounded very nice on TV.
Vänsterpartiet has proposed an extra amendment budget of 15 billion to save healthcare, just so that people would not have to be laid off. Now we have replaced it with a new initiative in the Committee on Finance, which Vänsterpartiet, Socialdemokraterna, and Miljöpartiet stand behind, where we demand that the government and SD present a budget that guarantees staffing, meaning that there will be no layoffs. Then Kristersson's promise would also be fulfilled.
We see now that large staff reductions are underway, among others at the larger university hospitals. We believe that there have been insufficient state grants from the government and SD, and there have been enormous cost increases in the regions due to inflation. Pensions are rising, the population is getting older, and so on.
Resignations can occur in the near future. Are you prepared to act in the near future, I still ask. In the answer to the interpellation, it says that the question will be followed. That sounds very passive, I think. Will the staff eventually get conditions that make them want to stay? The big problem has simply been that so many have left healthcare because of substandard working conditions.
Sveriges Kommuner och Regioner has clarified that approximately 24 billion kronor are missing. It will become the deficit. In that case, one would like to see at least an amendment budget that would cover the potential layoffs, because healthcare cannot handle layoffs.
It is 19 of 21 regions that are doing at least poorly, and there is talk that 5,000-6,000 healthcare workers could be laid off. It concerns the large university hospitals: Sahlgrenska, Akademiska in Uppsala, and Skåne University Hospital. Five of seven university hospitals have cut back on continuing education for staff already in the autumn. What staff will be able to endure such a work environment? Does the Minister intend to, as I asked in the interpellation, take measures to improve the healthcare staff's work environment?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you, the member, for the very important and pressing questions! The member raises many questions that concern healthcare.
Let me begin with the last point the member raised, namely the employees' working environment. It is failing today. The responsibility for this lies, of course, with the employer, but the government is trying to support and back the mandate given to the National Health Competence Council, which is precisely about the fact that we need concrete measures so that more people can manage to work full-time and that more will be able to stay.
Many leave the profession or go on sick leave because the work is too heavy. The employer has the full responsibility for the working environment, but the government will return with proposals.
Right now, there are 27 or 28, I believe, proposals from the healthcare competence council on the table. They are to be worked on during the spring, and they will be ready towards June. They will be important for the entire sector to work with moving forward.
Has the government then acted when the regions have stated that they have problems managing the consequences of inflation with the pension agreement they have? Yes, we introduced a sector grant in the autumn that goes directly towards paying the pensions. It has no connection to any other part of healthcare, but it was a support to manage the increased costs for pensions as a result of the agreement that had been entered into.
Since inflation caused costs to increase by over 8 percent last year - such was the inflation during the previous half-year - a figure was set during the summer, and that is the one the regions have had to pay for the entire coming year. This summer, the figure was set at 9.14 percent. That was the increase, and the regions will have to pay it for all of 2024. Even though we all notice now that inflation is slowly going down, the regions will have to bear the cost for all of this year. It does affect the economy, and the government will therefore return as soon as possible.
But it is not appropriate to simply say that one should come with money. I note that Vänsterpartiet did not receive support for the 15 billion that was proposed. Obviously, no other party supported it, but new initiatives were returned instead.
The government's view is that support is needed in many different ways. There are some regions that need to borrow to manage operations, while at the same time there are three or four that do not need to make a single cut. The others lie in between, many of them with underlying economic problems. Simply put, they have had more employees than they had a budget for. This means that everything tips over as soon as inflation arrives and affects the pension agreement.
How are we then going to support and back them in the best way, so that we are not back in the same situation in half a year or a year? We must now change the regions' situation more long-term. Then, there will certainly be a need for some form of financial supplement, but also other measures, as well as of course that those who are the responsible politicians and have been elected by their residents regionally also do their part of the work, because for the most part all the money comes from the tax that one pays regionally. That governs every regional council.
But the state needs to provide assistance. That is why we have given support, and we will return. What would we be if we did not have a welfare system and a healthcare system that works? It is necessary that we provide support and backing, and we will return as soon as it is possible.
Karin Rågsjö (V)
Mr. Speaker! I thank you for the answer. I think like this: No, we left the 15 billion, and then we went out together. It is always better if one does things together. We request that the government comes back with a budget where one can answer Ulf Kristersson's promise, which is now hovering far up in the sky, so to speak. It is gone.
I am truly very worried. I become worried when I look at the situation with cancer treatment. When it comes to receiving it in time according to the standardized care pathway, it was down to 26 percent in January. One can wonder about that. For the full year 2023, cancer treatment started in time for 40 percent. That is historically low and not anywhere near the goal of 80 percent. It is bad. It really is.
The Minister says in his answer that the regions should prioritize the core activities. I have traveled around quite a bit in the regions. I must say that it is the core activities that is constantly talked about when it comes to cuts. It is about healthcare staff who cannot continue working due to a failing economy, for example. I think that the state has a responsibility.
For example, Region Sörmland, which is a rather small region, they have said that they will notify 700 employees - 500 within healthcare. It is a catastrophe for little Sörmland; that can be understood. I hope that it does not happen.
Värmland is also having a very difficult time. There, they might have to cut 750 employees. Värmland is not gigantic either, and there you will not be able to do anything that improves primary care. It is a catastrophe for primary care right now. There is no doubt about that. Everything we wanted with primary care is running out.
I am extremely worried about all the competence that has been built up by those who work within healthcare. It will be fragmented when people disappear in one way or another. We have asked if the government should not convene the parliamentary parties to specifically deliberate on the healthcare crisis, because we believe it is important for the whole country. Regardless of which party one belongs to, one must think that this is important.
Mr. Speaker! Briefly put, I am still asking: When will the money arrive? The weeks are passing. The promise from Kristersson is, in any case, not being kept. That is what one can say.
Region Östergötland also has an extremely poor economy. 900 employees are affected. We are talking today about a 90 percent occupancy of the care beds. There are no margins. If a pandemic comes, we are quite lost in this.
The patients notice that resources are lacking. The staff knows it. Large cuts are being planned. In that case, I think the state should step in, depending on the fact that one has had extreme costs just because of inflation. I believe it is a government's task to protect exactly the welfare, and if one does not do that, the suspicion arises: The welfare perhaps is not so important for the government and the Sverigedemokraterna. It felt that way anyway when you added 10 billion extra in the form of general state grants when 24 billion were needed. There is a certain discrepancy.
There is a great deal of anxiety in the regions. There is a great deal of anxiety among patients. One feels this when standing in various healthcare queues. It is not getting better. It is getting worse.
I am still waiting for the answer from Minister Acko Ankarberg Johansson, who during the election campaign promoted healthcare as priority one. I cannot see that healthcare is priority one anymore.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! In the budget that the government presented in the autumn, there were 40 billion in total. 40 percent of the resources went to welfare. 40 percent went to households so that they could manage the inflation. What remained went to all the other parts of the state budget. It was a clear prioritization from the government: It is welfare that must be prioritized. Healthcare was the part that received the most money of the whole.
We also gave general state grants. In that case, it is about how they are managed locally. I want to say: Not everything a region does is core activity. We can speak about healthcare, specifically that which is the healthcare staff's tasks and everything that nursing assistants, medical secretaries, nurses, doctors, speech therapists, physiotherapists and everyone else does. It is the healthcare staff, those who meet patients. But we also have very much else.
The newspaper Vårdfokus, which is Vårdförbundet's own newspaper, has for several years shown that the number of people working far from healthcare has increased more than the number of people working close to healthcare. This means, in my opinion, that the core activities have not been prioritized, and then we must be able to make some change. When one ends up in times of savings, that is where one should start.
One can still do a fantastic job, but the question is whether this is what is necessary when one needs to prioritize. Then we must remember that quite a lot of administrative matters are policy-driven. We want new data and new comparisons. It usually trickles down to the healthcare staff, who work closest to the patients, having to fill out a new survey and attend new meetings. It becomes an administrative burden for the employees. When it comes to policy-driven administration, we have a lot to do so that we do not burden healthcare with what instead should be money going directly to the healthcare staff. I think we should be self-critical at all levels and begin the work of making savings there.
Take Karolinska University Hospital as an example! At one point, they had more managers than care beds. I am glad they have changed it so that they now have more care beds than managers. It is an example of that one needs to make changes and review one's own operations.
Has the government refrained from doing anything? No, really not. As said: We already did this in the autumn. We will return, but it is also about how one provides support.
During the pandemic, money was given out generally. That was also what led to record surpluses for the regions and the municipal sector in 2020, 2021, and partly 2022. One has thus moved from a situation with record surpluses – the money could not be used, as it was temporary – to a situation with huge deficits. It is clear that it is a major change. But one must also ask: Why were not all the billions that we collectively agreed upon during 2020, 2021, and 2022 used? How was responsibility taken for them?
This has resulted in large fluctuations in the sector. I believe that what we need now is a long-term perspective. It is about trying to find a form where every region finds a better balance moving forward, so that one knows that when one hires employees, it can be sustainable. It is also about ensuring that one improves the working environment.
Right now, many nurses are being sought across the country. There are many vacancies in Platsbanken, but not so many who choose to apply for them. This means that the issues the member raises in the first post, the issues regarding the work environment, are important. We will not manage the competence supply if we do not improve the work environment. It will be crucial for healthcare in the future that the competence supply is met, and the state will, through the government's support, return with grants in various ways in this regard.
Karin Rågsjö (V)
Mr. Speaker! When it comes to Stockholm, we can talk about an extreme administration before the new government – the Social Democrats, the Centre Party, the Green Party and the left – came. There, they really used administration to fix all the private healthcare agreements, which they let grow like mushrooms.
There are still strong demands today from the right and from the business community for a trimmed-down public healthcare system and increased private operation. The trimming of the entire welfare state is going great. I feel a sense of concern. Insurance systems, like in the USA, are a wet dream for many cutters within the welfare market whom you in the government and SD have very good contact with. The privatization craze is now being raised again: Look how poorly things are going in the regions! Let's make this an insurance country instead! I am very concerned about this.
The figures that Sveriges Kommuner och Regioner pulled out were quite shocking. They say that 24 billion is missing in the regions. They are running a deficit with that. This should have prompted someone to do something active.
It sometimes sounds in the government and in the Council of State as if this is not real. I am speaking with Vårdförbundet, with Läkarförbundet, and with Kommunal. It is an incredibly strained situation now. I therefore expect a government with responsibility, and which has lifted healthcare as much as this government – and for example the Kristdemokraterna – have done, to do something. The solution is not to sit behind plans and hope that it goes very well. The thing itself must be that one does something for real. That is what I lack from the government: that one does something for real.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you, member, for the supplementary contribution!
I completely agree with the need for support. That is why the government acted early, already in the autumn, and will return.
Changing our general welfare system to an insurance system has never been on the table. There is no such discussion - yes, possibly in Vänsterpartiet. And I can note, Mr. Speaker, that the only initiative currently being taken to preserve a private initiative in Region Stockholm is with the help of Vänsterpartiet. One must perhaps look at when it is right and when it is wrong, and I am glad that Vänsterpartiet is involved and making it possible to retain a private initiative because it is good for the patients. That must be our focus, not the form of operation but whether it is an activity that meets the quality requirements we have. If we have ourselves decided on a compensation system that we consider reasonable and if we are to follow up on it, we will of course use it and ensure that patients receive the care they need, either in our own management or by a private or non-profit provider.
What has been seen most recently to preserve a private alternative is therefore with the help of the Left Party. Thank you for the discussion!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.