Response to interpellation 2023/24:644 on the primary care reform
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that primary care should be expanded over ten years with 3 billion kronor annually 1. KD emphasizes the need for more doctors and team members 2, as well as the importance of coordination and continuity for patients 3 4. KD claims that the government has provided 9 billion kronor in sector support 3 and that inflation is due to complex events 3. KD argues that S only allocated 1.5 billion of its 6 billion extra in general state grants 4. S considers that the transition is moving too slowly due to staff shortages and a healthcare crisis 5. S argues that the government has chosen tax cuts over healthcare resources 6 and that it is possible to prioritize in the budget 7. S claims that they have invested significantly more in healthcare than the government 7.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Yasmine Bladelius has asked me what measures I and the government intend to take to accelerate the transition and achieve the primary care reform.
An expanded primary care is in itself a prerequisite for a transformation of the system as a whole. In the Tidö Agreement, it is therefore established that primary care shall be expanded over a ten-year period. As Yasmine Bladelius points out, we have signaled that the transformation of health and medical care to a good and close care, where primary care constitutes a larger share, shall continue.
Follow-ups and evaluations conducted so far show that there is great support for the goals of the transition and that much work is underway in regions and municipalities both at a strategic level and in project form. At the same time, this work has not yet achieved a clear impact in the form of effects in the healthcare operations. That it takes time with a change that encompasses organization and methods of work in the entire healthcare system is not surprising. There is also no given answer as to how far we should have come or exactly how the development should be measured. To maintain the commitment and the will for transition work, we nevertheless need to begin to see more systematic results in the work.
The government therefore allocates 3 billion kronor annually for the purpose of supporting the transition to a close and accessible healthcare system with a focus on primary care. In addition, the government has allocated a further 43 million kronor during 2024 for an increased investment in an expanded primary care. The reinforcement amounts to 544 million kronor for 2025 and 389 million kronor for 2026. The government has previously allocated 300 million kronor for primary care in rural areas in 2024 and estimates that a corresponding sum will be allocated for this purpose the following year.
The majority of these funds are allocated to regions and municipalities to strengthen their work with the transition to good and close care. The funds are distributed within the framework of the state's agreement with Sveriges Kommuner och Regioner on good and close care. The intention is that the majority of these funds from 2025 shall instead be managed through a decree-regulated state grant. Special support has also been given to the ongoing project for the development of good and close care in rural areas, in which 15 municipalities and 4 regions in northern Sweden are included.
In addition to this, the government has also given several agencies assignments that in different ways aim to support the transition. Let me specifically mention Socialstyrelsen's renewed long-term assignment to promote, support, and monitor the transition to good and close care (S2023/01930). A specifically highlighted part of the assignment is to provide support to the regions to achieve Socialstyrelsen's national target for fixed doctor contact in primary care of 1,100 inhabitants per specialist doctor and 550 inhabitants per ST-doctor. Research shows, among other things, that continuity regarding fixed doctor contact in primary care reduces the need for emergency care.
A good supply of competence is fundamental both for the healthcare system as a whole to function and for primary care to be expanded and constitute the hub of healthcare. The Government has therefore, among other things, given the National Board of Health and Welfare a mandate to develop proposals for a national plan to improve the healthcare system's supply of competence. The national plan shall, among other things, show which measures are needed for both existing and new healthcare personnel to improve the supply of competence. The mandate is to be reported by May 31 of this year at the latest.
I would like to thank Yasmine Bladelius for the question and I look forward to the debate, Madam Speaker.
Yasmine Bladelius (S)
Madam Speaker! An important part of increasing the quality and increasing the system efficiency within healthcare is the implementation of the so-called primary care reform. The idea behind the reform is to transition healthcare so that primary care shall constitute the hub of the Swedish healthcare system. A better functioning and better expanded outpatient care as well as a better home healthcare have the prerequisites to offer patients better care - at the right level of care - than today.
At the same time, the need for hospital care can decrease with close care by the primary care providing the health and medical services required to meet common healthcare needs. Primary care then is responsible for assessment, treatment, nursing, preventive work, and rehabilitation that do not require special medical or technical resources or any other special competence.
The transition was initiated by the previous, Social Democratic-led, government. The current government has signaled that it intends to continue the work already started with the primary care reform. This is a welcome announcement. At the same time, it is clear that the transition has proceeded far too slowly so far. Given the healthcare crisis we now have in Sweden, I and many others are very concerned that the transition will take far too long, at the expense of both patients and healthcare staff.
Madam Speaker! There is a broad consensus throughout our healthcare system that the only realistic path to shortened waiting times and improved accessibility in care is the transition to good and close care – the so-called primary care reform. But the transition, as has been said, is going far too slowly. The Agency for Health and Care Analysis noted during 2023 that the transition work has so far primarily been conducted at a strategic level and that it has not had sufficient effects in the operations. Above all, the staffing is a bottleneck. There is a shortage of both general practice specialists and district nurses.
We Social Democrats have submitted a number of proposals to increase the pace of the primary care transition. Among others, I can, just as the minister did, mention the introduction of binding targets of 1,100 inhabitants per doctor in primary care as well as the establishment of an office at the National Board of Health and Welfare for the transition to good and close care.
Madam Speaker! The crisis in healthcare is a fact. We Social Democrats have for a long time both warned and pleaded with the government to curb the healthcare crisis, which is largely due to the fact that the government has not chosen to fully compensate the regions for the cost increases that Sweden has been hit by in recent years.
At this moment, thousands of employees within healthcare across our country are being laid off. At this moment, already heavily burdened hospitals are being forced to scale back their operations due to the large demands for cuts hanging over them. At this moment, health centers are being closed down instead of becoming more numerous. My question to the Minister for Health and Social Affairs is therefore: What measures does the Minister and the Government intend to take to accelerate the transition and achieve the primary care reform?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member for the questions.
I completely agree that it is necessary that we succeed with the reform for good and close care. I know that the investigator, like the previous government, was quite careful that this is not a primary care reform but a reform for good and close care. Primary care is the basis for this to work. I am pleased with the member's commitment to the issue.
Just as the member says, it is difficult to expand primary care if there is less primary care. The new Social Democratic government in Kronoberg is already signaling that there may be fewer health centers, but regardless of the region and who is governing there, this is no good development. We need to maintain all the health centers and all the primary care we have.
We need more doctors with a specialty in general medicine, more district nurses, more physiotherapists, more occupational therapists, and more of all the others who work in primary care, because it truly is about teamwork. One needs one's regular doctor contact for continuity and medical follow-up regarding one's diagnosis, but one also needs all the others in the team to receive help in the best way.
Let me point out to the member that it is obvious that the government is providing a significant contribution. The first time specific funds were added to the 2019 budget was at the initiative of M and KD. We then made a supplement to S's budget with 3 billion for primary care. Now we are increasing this in the coming year, but we also need to see more clearly how we target the money. Therefore, we are moving to a regulation starting from next year and will build much more on the plans that regions and municipalities have taken for how they shall develop good, close care. This is what we prioritize and follow up. This is one of the measures we are taking that will lead to giving the development a boost.
Mr. Speaker! Quite a lot is being done all over the country, and we would like to hear that we see it. I share the member's frustration that it was not done a long time ago because the patient benefits from it, it is good for patient safety, and it results in more efficient health and medical care. But as said, quite a lot is being done anyway, and we need to help each other highlight all the good examples that exist around the country, both to spread them and to increase the pressure on every region in the whole country to want to be part of the transition. In Norrbotten, despite a rather tough situation, they are investing in primary care research because they see how important it is to follow up on what is being done and to support good development. The regions are therefore, despite a tough economic situation, making good priorities.
I intend to continue to highlight all the good examples I see and insist that we provide continued state support and that we change from agreement to ordinance next year so that we can better build on the agreements that have been made in a democratic manner between municipalities and regions. It is this development that we support. This will occur in somewhat different ways in the country, but I believe that this is the best way forward.
How are we to achieve a primary care reform and know when it is finished? I do not think we will know, because as I perceive the investigations that form the basis for this, the direction towards good and close care is not that we are to reach an exact goal, but rather to mentally shift when it comes to how we view healthcare. Care should be made more continuity-based so that the patient has a fixed contact and receives follow-up, and it must truly be person-centered and coordinated for the patient. It is perhaps not about a goal for how the operations should look, but the goal is the path, i.e., that we change our attitude regarding how we view the patient and on healthcare. Even if our objective is that this should be completed in ten years, it is rather an ongoing work that we need to help each other push forward.
Yasmine Bladelius (S)
Mr. Speaker! I know that the Minister safeguards healthcare in Sweden, as we sat together in the Committee on Health and Welfare for a long time and worked on healthcare issues. I also know that we agree that the primary care reform is important and should be implemented, and I hear the Minister's enumeration of the investments to get closer to achieving it.
The problem is only, as the Minister, I, and many others know, that this work will never be able to be carried out even remotely fully when there is simultaneously a national healthcare crisis in Sweden. It is naturally so that if one is busy trying to extinguish the fires from completely wiping out existing activities, one does not focus on starting new ones. If in regions all around Sweden every single krona is being turned over and in this moment one stands and chooses between laying off further staff or closing a healthcare clinic, the work with the transition to a good and close care is not particularly high on the agenda.
If the government had been serious about wanting to implement the primary care reform, one should, first and foremost, focus on curbing the crisis in healthcare.
Mr. Speaker! Regardless of what the Minister and other government representatives say, it is actually the SD government itself that has created today's healthcare crisis in Sweden. We are indescribably many – trade unions, regional politicians from different political parties, members of parliament in endless debates, healthcare staff and many others – who for a long time have both warned and pleaded with the government to provide the resources required to not risk a healthcare system in crisis with cuts and layoffs as a consequence. But despite many and serious testimonies about the crisis, the government has for three budgets in a row actively chosen not to compensate the regions for the cost increases. This has led to the healthcare crisis we now see, and it is judged to be the most serious since the 90s.
Answer number one from the government and the responsible minister has long been that it is not possible because it would increase inflation. But that is basically only the government's opinion, as all other experts in the field say that is not the case at all. Answer number two has been that it is the regions' responsibility. Of course, it is the regions' responsibility because we have regional self-government in Sweden. But just as obvious as this is, is that a government can step in and act in a time of crisis.
It would have been fully possible for the government to provide the funds required to stop the crisis in time. It is a matter of political will and choosing not to prioritize 13 billion in tax cuts for people like me and the minister, but instead allocating them to healthcare. It would have been fully possible. It would also have been fully possible for the government to vote for the Social Democrats' proposal for twice as large an injection to the regions and healthcare in the budget for both 2023 and 2024. If this had been done, I would have felt a bit more secure and satisfied with the answers the minister gives in the rostrum.
My question remains: Why is the government not doing more to curb the crisis in healthcare so that the important work with the primary care reform can be started?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! The Social Democrats added 6 billion more than the government to healthcare, and we have just added 6 billion for this year. The difference is therefore non-existent.
Neither the Social Democrats nor the government have chosen to fully compensate the regions for the consequences, which I think is right. It was neither the Social Democrats nor the government who made the decision to enter into the regions' agreements.
Nor neither the opposition nor the government has caused us to have high inflation; it is much more complicated than that. It is neither the fault of the previous or the current government, but due to many different events we find ourselves in a situation with high inflation. The development began long before this government took office, and it has continued with speed, which has caused the regions' agreements to have these consequences. If one pretends that it is the current government's fault or claims that it is the previous government's fault, one is completely wrong. That is not the case. We have to deal with high inflation, and we have done so by having a restrained budget. Now we see the light, and inflation is starting to go in the right direction. We therefore seem to have contributed to holding back inflation.
Quite a few weeks ago, we were able to announce that we are reinforcing the regions' finances with the 6 billion I mentioned. We also chose to separate it completely from the budget amendment and to provide notice very early. We agreed much earlier that the regions needed to receive this notice, and therefore they received it quite a few weeks ago so that they know what money they have. The money more than corresponds to the warnings we see right now, but none of us know how it will develop. Therefore, the government, of course, follows the issue.
That a government, regardless of who sits in it, would fully compensate the regions for the agreements they themselves have concluded is probably not possible. We have to live with that. Autonomy has consequences, and this is one of them. The government has, however, ensured to provide substantial support. We have given a total of 9 billion so that the regions can manage the consequences of inflation. It is a sector support that goes directly to the regions and which they can use in the way they themselves find appropriate.
The government has stated the assessment that it is necessary to retain healthcare staff, and we hope that as many regions as possible maintain that line. Otherwise, we cannot expand primary care - for that to be possible, more employees are needed. It will require more general specialists, more district nurses, and more of all other healthcare staff. That is how we build a better foundation for healthcare.
One point is also that it is good to do, for example, as Jämtland Härjedalen did a couple of years ago. There, they invested in more general specialists and more district doctors. They ventured into unknown territory and did not even have a budget for this when the decision was made. The initiative meant that general specialists could be offered a position with a reasonable number of patients, reasonable working conditions, and responsibility for their own list – and the general specialists came there. It yields good effects for the patients when they get a fixed care contact and a fixed doctor contact.
There are many good examples of regions where these maneuvers have been made and where they have dared to step out and invest in primary care. I welcome every region that does so. Now we look forward to taking part in the regions' democratically made decisions on how they want to develop good, close care. We will provide our support with the money we have from the government's side to support the development - 3.5 billion next year. I completely agree with the member: We shall ensure that good and close care becomes a reality.
Yasmine Bladelius (S)
Mr. Speaker! The pandemic is a good example, I think. It was not the regions' fault, nor was it the government's fault. It was something that happened, just like inflation. That crisis was not the same as this crisis, but even that hit the health and medical care sector extremely hard. At that time, we Social Democrats were in government, and we fully compensated the regions. It is entirely possible for a government to choose to compensate the regions and ensure that a healthcare crisis is curbed. It is a matter of how one chooses to prioritize in its budget.
The Minister chooses to mislead those listening to the debate from the speaker's chair by saying: We are putting in exactly the same amount of money for healthcare. The Minister knows that this is not true. Since I have had the opportunity to "confer" with the Minister for a long time, I think it is a bit unfortunate that it turns out this way in a debate – that she in this way actively chooses to mislead those listening.
Mr. Speaker! One cannot simply count the budget that has been presented for this year. The crisis started before that. In the budget motions that we have raised since the current government came to power, we have allocated significantly more than the government on healthcare. In the budget motion for 2023, we doubled the government's investment. That must also be taken into account. This year, we invested 6 billion more. The Minister says that we have invested as much and that it is 6 billion. But in addition to the government's budget, we have invested at least 8 billion extra on health and medical care. What the Minister says in the rostrum is, therefore, not entirely honest.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! In 2023, the Social Democrats added 6 billion more in general state grants to municipalities and regions. Of these funds, approximately 1.5 billion went to the regions and the rest to the primary municipalities. It was therefore not 6 billion more to the regions.
In the autumn budget, you allocated 6 billion more to healthcare than the government. That was the case at that time, but we have now added these funds. So, they are not gigantic differences. If one tries to claim that the Social Democrats have presented a budget that would erase all problems for the regions, the answer is that it is not true.
However, we are in complete agreement that we need to support the regions. None of us are submitting budget proposals that fully compensate for the agreements the regions have entered into. They bear that responsibility themselves. We do, however, ensure that we provide support, because they need it. Inflation is not their fault. But they have entered into the agreements and must bear the consequences of that.
We do not want the consequences to affect healthcare. That is why we are allocating funds that allow healthcare staff to be retained. It is necessary for primary care, which the member's interpellation concerns. If one does not have staff in primary care, it will not be good and close care.
The perspective in the good-and-near-care reform is that the patient shall be met with better coordination and better continuity. None of us want to go to the doctor unnecessarily. We want to get help in meeting the needs we have and addressing that which makes us not feel well or that we have an illness. If I as a patient can get more coordinated help, it will be better for me. When I get help with what I need from the right authority and in a coordinated way, it also leads in the long run to lower costs for health and medical care.
That is why we need to hold on to the reform and ensure that the resources needed are available. I believe that the reforms we make next year with changed grant allocations will contribute to us better following the development decided by municipalities and regions.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.