Response to interpellation 2023/24:652 on the costs for locum doctors
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 KD argues that the state cannot fully compensate for the regions' deficits since the regions are responsible for healthcare within the framework of local self-government 1. KD emphasizes that permanently employed staff is the foundation for good care 1 2 and that the government has prioritized healthcare by injecting 6 billion kronor 3. KD believes that inflation has affected pension agreements 3, that the regions need to increase efficiency 3, and that investments in primary care increase efficiency 4. 5 S argues that the dependence on hired personnel is unsustainable for the economy, the work environment, and the patients 5. 6 S believes that the government does not compensate for cost increases 6. 7 S argues that the government does not fully support the regions to stop layoffs 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! Lena Bäckelin has asked me what initiatives I and the government intend to take to handle the situation with locum doctors.
Initially, I want to emphasize that the government and I myself are aware of the challenges in healthcare, which are also affected by the economic situation in the regional and municipal sectors. The state cannot fully compensate for the regional sector's deficit. It is the healthcare authorities, with directly elected politicians at the municipal and regional levels with taxing rights, who are responsible for providing good healthcare. Within the framework of municipal self-government, municipalities and regions have great freedom to choose, for example, hired staffing.
I have noted that the regions have jointly entered into a national agreement on agency staffing in health and medical care in order to reduce costs and dependence on agency staffing. Long-term own staffing provides increased continuity for patients and better conditions to develop health and medical care operations with a good working environment. The government's primary care reform has a particular focus on increasing continuity and increasing the conditions for providing care in rural areas.
Hiring of temporary staff can be valuable in cases of, for example, a temporary increased need for personnel or specific expertise.
I want to emphasize that the staff is the healthcare system's most important resource and the foundation upon which healthcare rests. The Government has therefore given Socialstyrelsen a mandate to develop proposals for a national plan to improve the healthcare system's competence supply. The national plan shall, among other things, show what measures are needed, for both existing and new healthcare staff, to improve the competence supply. The mandate shall be reported by May 31, 2024, at the latest.
The State and Sweden's Municipalities and Regions entered into five agreements in the healthcare area in December 2023 which, together with the sector grant decided in the budget bill for 2024, amount to approximately 10 billion kronor.
Inflation is putting pressure on the regions' economies. The worsened results in the regions are primarily due to temporarily higher pension costs. Since the government's budget bill for 2024 was presented, the outlook for the regions' economies has also worsened further. The increased pension costs affect, among other things, the healthcare's personnel budgets.
A number of regions have laid off staff or announced staff reductions. The coalition parties are therefore allocating 6 billion kronor to the regions in this year's spring amendment budget. The magnitude of the funds corresponds to the personnel cost for approximately 7,000 nurses. The government's explicit expectation is that the regions use the money to avoid general layoffs of healthcare personnel.
The government has also announced that an efficiency delegation shall be established to provide the regions with support for streamlining within health and medical care. Several steps are being taken for better state governance.
With that, I would like to thank Lena Bäckelin for the question. I look forward to the debate.
Lena Bäckelin (S)
Madam Speaker! Thank you for the answer, Minister!
In Sweden, we have today a system with hired doctors or hired staff, and the regions' costs for these are skyrocketing in many parts of the country. The regions' costs for hired staffing within health and medical care increased by 17 percent, or 1,375 million kronor, during 2023.
For my home region Jämtland Härjedalen, the increase in the cost for all hired personnel during the second half of 2023 compared to the second half of 2022 is a full 70 percent. The increase for hiring costs in primary care in 2023 compared to 2022 is a full 51 percent for my home region Jämtland Härjedalen. In the area of psychiatry, the costs have increased by a full 124 percent.
Madam Speaker! I wonder if the money could not have been used better. That is also what a GP in Hudiksvall asked in an interview in SVT in April, in connection with a segment about this government's so-called investment in healthcare that was presented at a press conference. It was about an investigation for 500,000 kronor - it must be a promille of a promille investment - to investigate the effect of cold medicines when the healthcare system, as this GP emphasizes, instead needs to take action to do something about the chaos regarding agency staff.
The regions spent a total of 9.3 billion on hired personnel in 2023. The cost reporting for the full year 2023 also shows a continued increase in costs. Region Jämtland Härjedalen, my home region, had the largest increase of all regions from 2022 to 2023, which is very worrying. This is not sustainable - not for the economy, not for the permanent staff's working environment, and not for the patients.
Madam Speaker! In a segment on SVT in March this year, which I wrote about in my question to the Minister, we received an insight into what reality looks like at many health centers in rural areas. In the segment, they visited Svegs hälsocentral, my health center, in Härjedalen. The unit manager stated that at the current time, it is not possible to provide safe and secure care there without hired doctors. Hired doctors accounted for 80 percent of the total doctor costs. Add to that the fact that it is a health center with approximately 20 miles to the nearest hospital.
In my home municipality, they have even had hired nursing assistants within elderly care to manage the assignment. The dependence on hired staff - doctors, nurses, and nursing assistants - has increased across the entire country. It is among other reasons why I ask the Minister what initiatives the government intends to take to remedy the hired staff chaos.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, Lena Bäckelin, for your question, which is extremely important! But let me nevertheless say initially that the member is anticipating events because we have not decided that the state has responsibility for healthcare, and therefore I cannot in any way control what happens.
I know that the member, just like many other members, requests more state governance in many areas. I see in almost all the interpellations posed to me that it is desired that the government or I, in my role as minister, could rectify things—but it is self-government that applies, as appears from my answer.
When it comes to hired personnel, I have repeatedly highlighted that I am very pleased that the regions have joined forces for a common initiative. They agree on the rules of the game so that there is no competition between the regions. They have a common view on this.
Agency workers are for temporary peaks, but today it has become a permanent feature in healthcare that is very concerning. I have said it before in this chamber, and I am happy to say it again, because it affects and risks affecting patient safety. Furthermore, it directly affects the continuity for the patient, not least in primary care, if one does not have permanently employed staff. Therefore, I repeatedly emphasize the importance of having permanently employed staff in the regions. It guarantees good health and medical care.
There are regions that have a large proportion of hired personnel. I know that they are working intensively to change that situation. I also realize that there will be criticism now when they do so. It is being done on a broad front in the regions. I am grateful that they are tackling the issue, but there is also a concern among employees who wonder if the healthcare will be manageable when there is a stop for hired personnel.
At the same time as one gets better order on the contracting of staffing agencies, which are to be a temporary support and not a permanent fixture in healthcare, one must work with work environment measures, that is, the reasons why people have left the profession. They have chosen not to be permanently employed. If one does not do that simultaneously, it risks becoming truly worrying.
I am pleased that I encounter so many good examples across the country, where the work environment is addressed specifically for the purpose of obtaining more permanent staff. Permanent staff should be the foundation in health and medical care. Region Jämtland Härjedalen is, as mentioned, self-governing, and the parties that govern are the interpellant's and mine. It is up to them to decide. Neither the members nor I can influence the slightest of what happens with hired personnel.
I have told the regions that if they find it difficult to solve the issue, they are welcome to come to the state, so we can discuss whether it is something the state can do. So far, they have chosen to solve the issue themselves, and we cannot take over or precede the investigation that the Vårdansvarskommittén is conducting. But I share the member's view that there really are areas where we can already see that national governance is needed. The issues regarding competence supply are an area where this is clearly seen.
Many thanks to the member for the question! I hope that with joint efforts in Jämtland Härjedalen and all other regions, we can improve the working environment so that people choose to stay or come back as permanent employees.
Lena Bäckelin (S)
Madam Speaker! I am really not in favor of state-controlled healthcare. I do not believe in that. I believe it is difficult for the state to know where the needs lie in the regions. On the other hand, I want to say that the responsibility of a Minister for Health should be to ensure that the resources are sufficient for equal care throughout the country. But I actually believe that the regional politicians should govern. They know their region best – not the state.
The solution everyone is talking about, and which is very important, is to improve the working environment for the staff. That one invests in its own staff is crucial for creating a safe and efficient healthcare with good continuity for the patients. But the regions are in a dilemma with skyrocketing costs for locum doctors and increased costs due to inflation - which the Minister also touched upon - and yet the right-wing government does not compensate for the cost increases.
Investments in own staff are crucial for creating safe and effective care with good continuity for the patients. For many – not least the elderly and the chronically ill who often seek care – it provides security to meet the same healthcare staff, who have good knowledge of the patients and their needs. When the proportion of hired staff becomes too large, the regular staff's working environment suffers. This has also been pointed out from the government's side. Additionally, the continuity decreases, as mentioned. The possibility for development work is also hindered and can affect patient safety negatively. Stable and lasting staffing creates better conditions for a good working environment and long-term care development work where everyone can participate and contribute to increased quality.
Madam Speaker! The staffing dependency, as we also tend to call the issue, is a symptom of unequal conditions for attracting labor. Rural areas face specific challenges in that regard. Furthermore, there is a risk that small municipalities and regions will lose tax revenue if staffing personnel live in a large city and pay taxes there while working in a municipality or region where they do not pay taxes. The result is that municipalities and regions, often in rural areas, are hit economically in a disproportionate way. They are simply being double-penalized.
More resources and governance are required. This government has so far treated healthcare neglectfully and said that healthcare must be made more efficient, but that is not the whole problem. Long-term sustainable funding is a prerequisite for the regions to be able to work towards an improved working environment that can make more people seek permanent positions, which in turn leads to higher quality in healthcare.
We Social Democrats have shown in our budget alternative that it is possible to inflation-proof the state grants and in that way prevent the healthcare crisis. One must provide long-term conditions and create a reasonable situation where one can build a workforce over time. Then the healthcare system can avoid being drained by, for example, staffing costs and losing in working environment for the permanent staff, and continuity will remain for the patients. Unfortunately, bourgeois parties have voted it down. Reforms require money, and it is of course difficult when we have the lowest tax ratio since 1975. Then it becomes difficult to invest in healthcare reforms of significance.
I would like to have an answer as to whether the Minister has any thoughts on taking measures against the chaos regarding hired personnel that prevails.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, Member, above all for the commitment to the issue! I hope that it also makes an impression at home in Region Jämtland Härjedalen where the Member's party is responsible for healthcare. I am, however, a bit confounded that the question I receive concerns the situation in Jämtland Härjedalen where the Member resides and is well acquainted with the situation.
The member of Parliament asks me as a minister to rule over what happens in her home turf. This is directly in conflict with the laws that the Riksdag has enacted. Still, the member of Parliament says that one does not want national governance. I believe that the member of Parliament must choose a path; either one thinks it is good to have national governance in this issue or one does not. I perceive it as that the member of Parliament does not want it unless it was the local and regional politicians, and then the question should be posed in the home turf.
Let me also address some of the member's other questions and assertions. Where are the needs? Yesterday, the government submitted the supplementary budget to the Riksdag. Of the 17 billion in it, which is unusually high, 6 billion go to healthcare. It is a clear prioritization that such a large share of the appropriations goes directly to healthcare.
In the autumn when we presented the entire budget proposal, which is for another period and a longer time, 40 percent of the entire budget went to welfare and 40 percent to households to compensate for inflation. Then there was a little left for all other sectors. These were clear priorities. Households needed support as a result of inflation, as did welfare.
When we now make changes during the current year - for that is what can be done in a spring budget amendment, nothing else - the largest item, 6 billion, goes to the regions based on our assessment that it is there that the needs exist.
The member states that the Social Democrats have shown that it is possible to inflation-proof the state grants. I would like to know more. The inflation is 9.14 percent this year, if one calculates how the regions are affected by the pension agreement. Has the member's party made an increase of the state grants - which are quite large - by 9.14 percent? I did not perceive that. It was 6 billion that separated the Social Democrats from the government in the autumn, and these funds we delivered yesterday in the year-end budget.
It is a difficult matter to inflation-proof state grants. It can feel pleasant when inflation goes up, but when inflation goes down and no new money arrives even though there is a need and a desire to develop, it does not feel so pleasant. I have been a municipal politician for a very long time and also a regional politician, and therefore see that the long-term conditions are the important ones, just as that the tax base increases. The regions did, after all, get an improved situation when they summarized 2023 because the tax base became better than expected, which has strengthened them somewhat. But 2024 is a difficult year, and that is solely due to the consequences of inflation on the pension agreement the regions have signed.
Right now, inflation is gladly going down, so the government's budget, which was restrained in the autumn, has obviously contributed to the fact that inflation is decreasing. The opposite would have been very troublesome, i.e., if we had not managed to bring down inflation. Now we can see that moving forward we will have a better and more stable situation and that both the regions and the state can return in a better way with the investments that are needed. But the regions would have been left with continued very high costs for the pension agreement if we had not managed to bring down inflation. But the agreement they themselves signed is so constructed that the consequences remain throughout 2024, and that is tough for every single region. There are three or four that do not need to make any savings at all, others have it very difficult, such as Jämtland Härjedalen, and many in between need to review their situation.
I am completely convinced that the regions need to look at efficiencies in order to achieve a sustainable situation in the long term. Every member from the regions has told us that it is necessary to get the finances in order in the long term, and it is wise to do so.
Lena Bäckelin (S)
Madam Speaker! Sometimes I wonder why we have a Minister for Health and Care.
Let me clarify that this concerns the entire country. My home region is a telling example, but I am not speaking solely about Region Jämtland Härjedalen.
The Minister states in her response to the interpellation that she and the government are aware of the situation in healthcare. However, she says nothing about it being a healthcare crisis. Despite this awareness, the government does not support the regions fully or based on the need that SKR has collectively presented from the regions to stop resignations and notices. They only support to half and too late, even though the crisis is a fact in all regions. Instead, there are to be efficiencies, and an efficiency delegation is to be appointed. In plain terms, it means that the staff will be reduced and they will have to run faster. But I do not believe that is how one solves the healthcare crisis, and it certainly does not solve the hired staff chaos either—on the contrary.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Neither the Social Democrats nor the government are fully compensating the regions for the deficit they have. SKR has not at any point stated how much money the regions are to receive. What has been reported is a projected deficit for 2024. There is a fairly large difference and they are two completely different things. Which deficit one receives is not the same as what savings one imposes on the operations.
What we know is that approximately 5,600 people have been laid off so far. This worries the government and is the reason why we are providing 6 billion, which corresponds to 7,000 nursing services, with the hope that healthcare staff will not be laid off. Everyone who works in healthcare is needed moving forward. The regions must, however, make their own assessment and see what is appropriate. SKR has, as stated, not specified how many billions are to be given to the regions, but they have informed about a presumed deficit for 2024.
The efficiency delegation is based on the regions themselves applying for help to be able to do something and receiving support for it, not on someone from above deciding. But it has certainly come across, even if it is rhetorically stated otherwise.
The best way to increase efficiency is to invest in primary care. If everyone gets a fixed doctor contact and the care team in primary care is expanded, the care will also become more efficient in economic terms. If one can build trust and confidence from the patient in the care – that they know it exists and know the name of the person who is responsible – it will become much better. Research shows this. Several research reports show that it is good to invest in primary care. It is not that my or the member's needs decrease, as care needs have completely different reasons. But they will be better met if we have a strong and well-expanded primary care.
My best advice to the regions, which I presented at the conference Vårdarenan here in Stockholm this morning, is to invest in primary care. I usually highlight Jämtland as a good example, Lena Bäckelin, because you are at least trying. Keep it up!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.