Response to interpellation 2023/24:689 on information exchange within ambulance care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD considers that a good working environment and safety for ambulance personnel is crucial 1 and that employers must create systems that protect the staff 2. KD argues that information exchange is not the solution to the entire problem but requires parallel efforts 1 and that the investigation should consider provisions that break confidentiality 1. KD considers it wise to investigate legal changes to balance safety against confidentiality 3. KD emphasizes that harsher penalties for crimes against blue-light personnel are important 2 and that crime-preventive measures are needed 4. SD argues that confidentiality walls hinder effective work 5 and that the police should be able to contribute to securing blue-light personnel 5. SD suggests that a distinction should be made between violence and care needs 6. SD considers that previous migration policy has created an exclusion that has affected the respect for blue-light personnel. SD agrees that the working environment is the employer's responsibility 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 Acko Ankarberg Johansson (KD)
Madam Speaker! Mattias Eriksson Falk has asked me how I and the government intend to specifically address and improve the exchange of information between different authorities and operations to protect ambulance personnel against threats and violence.
Mattias Eriksson Falk has also asked me if there are plans to introduce systems or methods that make it possible for ambulance services to access relevant information about previous incidents of violence or threats in order to better prepare and protect the staff.
Mattias Eriksson Falk has further asked me in what way the appointed investigation on improved opportunities for information exchange will take into account the need to protect staff within ambulance services from threats and violence.
Mattias Eriksson Falk has finally asked me how I and the government plan to ensure that measures to improve information exchange are implemented in a way that respects the individual's right to privacy and confidentiality while simultaneously guaranteeing security for those who work within essential societal functions.
Madam Speaker! I would first like to thank Mattias Eriksson Falk for raising this important issue. It is crucial for a well-functioning society that citizens can feel secure that if loved ones or one's self should need acute care, it will be there, regardless of socioeconomic conditions or in which area one lives. It is crucial for a secure society that everyone's need for good care is met.
For this to be possible, a good working environment and safety for ambulance personnel is crucial. It is an important issue that both the government and I take very seriously. In order to function well, the working environment for ambulance care's most important resource – its staff – must be protected and developed. Threats and violence must not occur.
Before I address Mattias Eriksson Falk's more specific questions in this interpellation, I would like, with reference to the question he asked me regarding the safety of ambulance personnel (answer to written question 2023/24:704), to initially mention that threats and violence directed at staff within ambulance care can be due to several factors. Mattias Eriksson Falk highlighted stone-throwing in the written question. It occurs that the medical condition of persons in need of acute care can cause aggressiveness and, from time to time, also threats and violence. This occurs within the entire healthcare system and can involve conditions such as intoxication, influence of substances, or in some cases mental illness.
I see against the background of this that the exchange of information between authorities is not the solution to the entire problem, but that we need to work with several interventions in parallel. These interventions need to safeguard the ambulance staff's safety, the patient's integrity and privacy protection, and also patient safety in a broad sense, including the possibility for the individual to receive help in acute and life-threatening situations.
It is possible today to link pre-hospital ambulance care with the rest of the healthcare system using medical record systems, something that Region Kronoberg was the first in the country to introduce. By integrating the ambulances' medical record systems with the healthcare system's medical record systems, one creates the conditions for an uninterrupted flow of information between ambulance and hospital. It contributes to streamlining the entire emergency and care chain and makes it possible for ambulance personnel to prepare, already upon dispatch, for what type of care may be required.
When it comes to emergency services personnel specifically, there is already a possibility for those who receive calls regarding emergency care to, in case of a suspected threatening situation, inform for example the Polismyndigheten, which then travels with the ambulance during an alarm. This occurs particularly in areas where there is social unrest. In Örebro, Seglet was recently inaugurated as a joint cooperation arena where the police, SOS Alarm, and the rescue services have been gathered, which allows them to have a closer dialogue about which interventions are needed at different alarms.
The investigation Improved opportunities for information exchange between authorities (Ju 2023:22) shall consider and propose improved opportunities to exchange information about individuals within and between authorities and other bodies that are equated with authorities according to the Public Access to Information and Secrecy Act (2009:400) (dir. 2023:146). The purpose is that information shall be able to be exchanged to the extent needed so that the authorities can, among other things, be able to prevent, preclude, detect, investigate and intervene against fraud, incorrect payments, regulatory violations and crime as effectively as possible without it resulting in a disproportionate interference with personal integrity.
The investigator shall, among other things, specifically consider and submit proposals for a general provision that makes it possible to effectively transfer information covered by secrecy for the protection of individuals to another authority, both upon request and on its own initiative. The commission's mandate is broad and is not limited to certain individual authorities. The mandate shall be partially reported in August 2024 and final reported in February 2025.
In conclusion, I also want to clarify that the work environment legislation is clear. It is always the employer who has the responsibility for the work environment, so also for personnel within ambulance care. In this work, it is very important to have knowledge of the work environment and where the risks are, as well as how these risks can be prevented. Good dialogue and cooperation between employers, employees, and safety representatives is absolutely crucial for a good and preventive systematic work environment management.
The government's ambition to provide the regions, as the primary bodies for health and medical care, with the conditions to offer care and nursing of good quality is clear, which is evident not least from the Tidö Agreement, the government's budget bill and also the spring budget with an additional 6 billion kronor to the regions.
Mattias Eriksson Falk (SD)
Madam Speaker! I have submitted this interpellation on information exchange within ambulance care to address the issues I have received from active employees within ambulance care in my home county of Gävleborg.
I have previously submitted a written question in this area, which the minister mentioned, but an interpellation was needed to delve deeper into this issue and debate the various parts contained in both my questions and the minister's response. I would, of course, like to thank the Minister for Health and Care for the response to the interpellation.
The Minister's response is comprehensive and points out many good things that exist today or are being investigated and which will hopefully contribute to creating a better situation generally, both within healthcare as well as between the authorities and healthcare. It is about tearing down the walls of secrecy that I and the Sverigedemokraterna many times see exist between different parts. These walls hinder effective work between different parts of society in the use of our available resources, not least in cases where children are involved and where society many times must be able to act quickly. There, of course, the Tidö Agreement between the government and Sverigedemokraterna is also an important part. Even though the secrecy issues there primarily relate to the school, welcome changes occur that create new and better conditions.
As I mentioned in the introduction, my questions are based on what I have received from employees within the ambulance services in Gävleborg. Examples are given of people having been violent. Threats and violence occur, and sometimes one needs to have the police with them as a resource in order to be able to carry out their mission and work. In these parts, the minister and I agree. The police should be able to contribute to securing the situation of other blue-light personnel connected to an intervention taking place in society. The threats and violence do not, of course, need to come from those who need care. It can be other family members or not, but such situations occur often.
When the ambulance staff are finished, the scene is left. In time, the mission will be complete. One of the first thoughts that strikes an employee after that is, of course, a desire to tell their colleagues about the situation and what happened in order to thereby be able to contribute to the same situation not arising again. It does not even have to be connected to the same person; it could be a specific area, a single house, or a particular stairwell. But for confidentiality reasons, one is not allowed to inform them about the things that happened or warn them.
The Minister mentions that problems can be solved through the interconnection of journal systems. That is an interesting example that I take with me. The Minister also mentioned Seglet in Örebro with regard to areas where there is social unrest. That is, of course, yet another good example that the Minister points out. However, these examples do not cover all the instances that I mention. It could involve different patients and even areas without social unrest. There, as I see it, the Minister's examples may perhaps not work in practice all the time.
Even though I think the Minister's answer is comprehensive in the large sense and points out many good things, I lack a concretization based on my specific questions regarding how this issue is to be addressed, what potential confidentiality barriers need to be broken down, and what measures the state can in that case make. In other words, I would have gladly seen an answer that focused more on how the problem is to be solved and not as much on overall strategies and existing possibilities with the laws we have. At the same time, I want to say with all clarity that I in no way distrust the Minister's commitment to these issues, which I am of course convinced the Minister considers important.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I am pleased that the interpellor, in their interpellation, raises both the working environment for the employees in health and medical care and the patient's need for confidentiality. It is precisely these two things that must be weighed against each other. How does one do that in practice? I am pleased that the interpellor from the beginning has raised the difficulty of handling these things simultaneously.
The short answer to the interpellation is actually that we are investigating this and will get back to you. But I have chosen to go a bit deeper into this and broaden the question. None of us know what the investigation will conclude, but it is necessary.
The Public Access to Information and Secrecy Act is based on the principle that information we have judged needs secrecy shall be confidential. It is not permitted to automatically share such information with any other authority. Nor is it permitted to share them within the authority if there are no reasons to do so. I think that is wise, because information can be misused and used by someone who has no reason to use it. Information that exists about me, the member, or someone else shall be handled with secrecy if there are reasons to have a secrecy assessment.
But then, from time to time, we have reasons to make an exception to this. Then we call them secrecy-breaking provisions. The Government's view is that we need a few more such provisions, because we see problems in society where secrecy becomes an obstacle to upholding other laws, just as the member points out. It is then we need to see how we can supplement the legislation with more secrecy-breaking provisions that, in a balanced way, provide support for accessing information even though it is not normally included in the agency's or the operation's scope.
I think it is wise that we do it through an inquiry - that is, in itself, the only way to make a legislative change. These are such difficult matters that we need a basis to know what trade-offs are required in the upcoming legislative change and to know that we are doing the right thing.
It is, however, very positive that regions are already finding methods to solve this issue, which is acute every day for employees in ambulance care. I completely understand their frustration when we say that an investigation will come in February next year, that it will then go out for consultation, and that we will then write a government bill. This is their everyday life now. It is a work environment problem for many, for some every day.
What needs to be included in the other scale is that confidentiality-breaking provisions will certainly need to be hedged by many reservations. For example, it is not uncommon for a patient to have a disease that can lead to outward-acting behavior and to both threats and violence in healthcare. Even if as staff one knows that this is part of the clinical picture, it is still a matter of threats and violence. This must be handled in a way that is wise for both the patient and the staff who are to take care of them.
Then one might think that registers should be established for persons who have a certain illness or a certain predisposition. But is it really relevant that all these persons could become violent? No, it is not, of course. As the member points out, it is about knowing for certain that something could happen again. How do we then ensure that a register that could be accessible at certain times is not used for the wrong purposes or could lead to risks in other ways? It is one of the difficult questions where the investigation must take a stand.
I am very pleased that the government and the coalition parties have chosen to do this. If we do not address the issue of more confidentiality-breaking provisions, we will also not be able to live up to the other laws. Therefore, it is necessary, regarding both the Health and Medical Services Act as well as safety and security in society, that we find a solution. I look forward to taking part in the investigation when it arrives, so that we get better tools to protect both patients and employees.
Mattias Eriksson Falk (SD)
Madam Speaker! I thank the Minister again for the answer. Like the Minister, I also want to raise the issue of the working environment. Naturally, it is the employer's responsibility. On that, we are in complete agreement. These are issues that must be worked on, especially in the systematic work environment management at all levels. It contributes to increasing safety for the staff. We are in agreement on that.
The question of confidentiality perhaps it is also important to discuss further with, for example, Sveriges Kommuner och Regioner in upcoming talks, but also with SOS Alarm, because it is through that the cooperation takes place with, for example, ambulance care within the respective regions.
We touched a bit on the question of the need for care versus what might potentially arise regarding, for example, violence. I believe that the two questions are connected to some extent, but I also actually believe that they can be distinguished. When ambulance personnel go out on a call or want to know if something might happen, they might not primarily think about what connection there is to the care needs of individuals or to what medical condition might exist in the context. I believe it is about being able to somehow make a marking, for example, to SOS Alarm, so that they are aware that a violent incident has occurred and perhaps that it is linked to a specific address or a specific person. That is what is being sought. In that way, questions about medical conditions and the like can be kept separate.
I believe that one must distinguish between the two parts, even though I naturally understand that there is also a context. I want to add that this could be a simple solution to the problems.
Now we will receive an investigation that looks at these parts, but I want to point out that the ambulance staff, for example, could call back to SOS Alarm if the incident occurred. SOS Alarm are usually those who handle matters concerning the dispatch of, for example, ambulances or police. They would then have direct knowledge and be able to alert the police directly when something is linked to that specific address or person. The time for an intervention naturally also decreases when the police can be directly present at an intervention and the ambulance staff do not need to stand and wait. It increases safety both for those who need care and for our employees within ambulance healthcare. I want to send those parts specifically. The Minister will, of course, have conversations with SKR about many things and surely also with SOS Alarm. I am sending this along for future discussions, so that the Minister has it with them.
Even though the Minister naturally cannot promise anything here today, the debate we are now having together with other debates and the examples I highlight is a seed that hopefully can grow and become an important social change that ultimately is for the benefit of staff within healthcare in general and specifically ambulance healthcare, which I highlight now. It will be for the benefit of society and naturally for the individual citizen who, for example, needs care or becomes upset and frustrated by the violence that our blue-light personnel within various operations encounter from persons who do not respect their work and their role.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, Member, for the supplementary comments!
It is, just as the member says, many different kinds of situations. It happens from time to time that people are simply out to destroy, cause trouble, and stop an important intervention. There, I believe nevertheless that the legislative changes we have made with tightenings regarding crimes against blue-light personnel, but also other people, have an effect. I hope that it will also be noticed that it can be handled and that the law can be used.
For some groups, it still has a great significance. I know that if I do this, I risk a punishment. It is important to know: If I break the law, I shall receive a punishment. I shall take my punishment, and I shall atone for my crime. It is a part of the chain we have to achieve trust and confidence in society. I can make mistakes, but then I shall take my punishment and atone for my crime.
Therefore, the relatively new laws regarding crimes against emergency services are still important parts of this. I hope that they will be used so that they are both reported and applied so that we will see in the future how they function, what the practice becomes, and if they need to be supplemented or changed in any way.
When it comes to the second part that arises, where what the member says is more linked to the place one arrives at and the situation, it is another kind of situation that can be charged in many different ways. There, I believe that the work environment work is important. One can get help with working on how to meet people in difficult situations.
My experience is that ambulance healthcare personnel are really good at that. I believe the member shares that perception. They are really experienced and good at, when they enter someone's home, as it often is, or at a location, sensing: What is the situation? How should we act? They are really good.
Therefore, it is even more important that one as an employer does not only rely on having skilled staff but also supplements with structures and systems that support good work environment work. Sometimes it happens that when one has skilled staff, sometimes enthusiasts, who do much more than one can expect, that one as the responsible party backs off because the staff solve it so well.
But when it comes to the work environment, as an employer, one must constantly be there and ensure that one replenishes, strengthens, and protects so that it is not about individual individuals being skilled, but that the entire system supports a safe and secure workplace. I believe that is part of the issues that need to be raised.
The second part is precisely the cooperation between healthcare and the police. It is very interesting to follow Seglet in Örebro to see: Can one better find quick connections via SOS Alarm? But even SOS Alarm, in many situations, has a need to receive more information.
A part of all the investigations we have are about: How much information should we share? When is it expedient, and when should we refrain from doing so? There are many investigations ongoing. It is about being able to access health data and everything that is being done at the Ministry of Health regarding this. There we still have major problems between the regions and the municipalities. But it is also about the investigations that are now ongoing regarding confidentiality-breaking provisions in different ways.
I still want to maintain that, just as the member says himself, many different kinds of measures were needed. The government is working on all these parts in different ways. Unfortunately, it will take time. That is the problem for ambulance care.
Therefore, of course, the dialogue with responsible employers is extremely important. It is a matter of doing what one can until one has better legal support in place.
Mattias Eriksson Falk (SD)
Madam Speaker! Thank you again, Minister, for the answer!
I can start by agreeing that we have an ambulance staff member who is fantastically skilled at their work and who does their very best every day.
Part of that work is the preventive work, which the minister also mentions. It is about being prepared for which situations can arise. One can be trained to gain that knowledge.
I mention examples of how we, through confidentiality-breaking provisions, ensure that one can warn colleagues about an incident when it is new personnel from the ambulance service who arrive at the scene at the next occasion.
Since this is my last post, I would also like to mention the good efforts that Sverigedemokraterna and the government are making to strengthen and improve healthcare, not least through the Tidö Agreement.
Health and medical care are also mentioned first. But it is through the state budget that we increase both the general appropriation and the targeted state grant to health and medical care to facilitate during times of high inflation, while at the same time we work to strengthen medical care and thereby, naturally, also ambulance medical care.
I want to particularly highlight the doubled investment that the Sweden Democrats and the government are making within cancer and children's healthcare. It is an important investment to, among other things, shorten waiting times in healthcare.
Finally, I also want to mention something about the social unrest that the Minister highlighted in his answer. We have an extensive exclusion linked to the previously pursued and unsustainable migration policy. There, many times the respect for emergency services personnel and their safety is small or largely lacking.
It is a serious problem that must be addressed. Examples such as breaking down secrecy barriers or the increased penalties for attacks against blue-light personnel are important parts of getting to the bottom of it.
With that, I would like to thank the Minister for a good debate. I promise that for my part, I will follow the work regarding ambulance care, and I will certainly return during the parliamentary term.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Once again: Thank you, Member, for highlighting the issues! It is significant even if nothing is happening right now, as the Member said. But the fact that one highlights the issues and discusses them also affects what happens in many different ways.
I want to circle back to something the member said. I am much older than the member. When I grew up, it was a given that the rescue services, ambulance, and such had everyone's trust. There was not a thought that one would try to harm someone who was there to help. On the contrary, they were often the ones you could use to achieve change in an area.
We have seen a development where this no longer applies. People are even prepared to attack those who are there to help during a fire, or where someone is injured or ill. It is so inconceivable that we have ended up there. Therefore, we must take many kinds of measures, which we have also captured in the Tidö Agreement.
It is about crime prevention measures for children and young people and families. It is about supporting the families and ensuring that a situation does not arise where one thinks it is natural to resort to violence. We carry out measures on the side of health and medical care and social services, when it comes to migration and in many areas. It is also crime prevention measures in the form of changed sentences. It can also affect the situation when I know that there will be a harsher sentence if I do this.
The entire program contributes to bringing about a change. Our mission is to ensure that it happens. We have a lot going on now with investigations. But it is important to ensure that they are carried out and that we also follow up on them. We may have had the right idea. But when it then has to work in reality, one may sometimes need to adjust it and follow it.
Thank you very much for the member having close contact with the operation and being able to report back on how it works so that we can do a good job together!
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.