Response to interpellation 2023/24:780 on the residents of Sörmland's access to healthcare
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the residents of Sörmland's access to healthcare and the regions' economic situation. KD argues that the regions are responsible for equal healthcare within the framework of local self-government 1 and that the government is implementing measures, including a supplement of 9 billion kronor, to strengthen the conditions and reduce waiting times 1. KD believes that competence supply and the work environment are most important 2 and that the state grant corresponds to 7,000 nursing services 2. KD argues that the government has acted correctly based on the temporary situation 3. S argues that Region Sörmland's deficit and staff reductions are a national issue that the minister should be responsible for 4 and that the state grant is too low 5.
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! Sofia Amloh has asked me if I intend to take any measures so that the people of Sörmland and others can continue to have access to equal care based on need.
Initially, I want to emphasize that waiting times and healthcare queues need to be shortened, accessibility to care improved, and the supply of competence strengthened. Achieving this in the current economic situation is a challenge, but a must.
I am aware of the challenges in health and medical care, which are also affected by the current 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 and equal health and medical care. Furthermore, municipalities and regions have great freedom to choose how an activity shall be conducted within the framework of municipal self-government.
The government is nevertheless implementing a number of different measures to strengthen the regions' conditions to provide good and patient-safe care for the entire population. This includes, among other things, additional funding, where in December 2023 the government announced approximately 10 billion SEK to the regions within the framework of partly a sector grant amounting to 3 billion SEK, and partly five different agreements between the state and Sveriges Kommuner och Regioner, all of which concern different parts of health and medical care. Several measures aimed at increasing accessibility and reducing waiting times are mentioned in the agreements. It has been important for the government to provide notice as early as possible regarding funds to the regions.
Inflation is putting pressure on the regions' economies. The worsened results in the regions are primarily due to temporarily higher pension costs as a result of the pension agreements the regions have signed for their employees. The increased pension costs affect, among other things, the healthcare's personnel budgets. A number of regions have warned of staff reductions or announced personnel cuts. Against the background of the economic development, the government, as is known, announced additional subsidies to the regions in the form of a second sector grant of 6 billion kronor. 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.
In May 2024, the government decided to task a special investigator with analyzing and proposing a new and strengthened healthcare guarantee with significantly shorter time limits than today. The purpose is for healthcare to better meet the requirements for accessible and equitable care. The new healthcare guarantee within specialized care shall be based on the patient's needs. Patients shall also be given the opportunity, earlier than today, to receive care from a healthcare provider in a region other than their own, without extra cost for the patient. The investigator shall also submit proposals for one-off state interventions aimed at increasing the conditions for an individual region or all regions to shorten waiting times.
With that, I would like to thank Sofia Amloh for the question, and I look forward to the debate.
Sofia Amloh (S)
Madam Speaker! I thank the Minister for the opportunity for debate today. I intend to begin by giving a picture of how things look in Region Sörmland and what has happened.
At the end of 2023, 700 employees were laid off. This obviously means serious consequences for patients. It will become harder to get in contact with the health center, and one will have to wait longer to meet one's doctor - there will be longer waiting times.
Sörmland had 1 billion on its reserve account, or capital, that is to say RUR. This was something that had been saved up under a Social Democratic government and a Social Democratic regional government. But these funds ran out before 2023 was over. Directly after the summer, the billion had already run away; it is no longer there. The situation was so serious that one had to borrow money to pay wages to its employees in the month of December 2023.
Region Sörmland ended 2023 with a deficit of 1.2 billion kronor. This corresponds to 4,000 kronor per Sörmland resident. That is an incredible amount of money. It is perhaps difficult to understand how large this deficit is. In 2024, it is heading towards the same result, a deficit of just over 1 billion, despite having laid off 700 employees and adopted a savings package.
The government's extra supplement, the one-off grant, has had no effect on the staff reductions. The notice regarding 700 employees remains. The governing minority is now, for example, putting forward a proposal to close pool training for children – i.e., reductions in rehabilitation for children. It directly affects the care that many are in very great need of.
12 out of 15 district nursing clinics have closed. Folktandvården is closing in several locations around the region. These savings measures are being presented within the healthcare system. That is the situation in Sörmland.
I think this stands in quite direct contrast to what the Minister himself describes regarding what is to be done and how it looks. The Minister clarifies in his answer that the healthcare providers, i.e., the regional politicians, are responsible for good and equal care. Yes, that is obviously the case, but it is not one region or two regions around the country that have these types of problems – there is not a single region that is doing well or that thinks they can do what they are supposed to. It is many regions that have these major challenges.
I then consider it to be a national issue and that it lies on the Council of State's table to also be responsible for this.
I completely agree that the healthcare queues should be shortened and the supply of competence strengthened, but that is not what is happening right now, not with the picture I have just given. What does the Minister want to do so that the picture I have given shall be changed?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member for the questions.
The situation in Sörmland is well known. They share that situation with some regions that are doing just as badly as it is in Sörmland.
But we also have approximately the same number of regions that manage without needing to make savings or even issue warnings. The vast majority of the regions that are in between have underlying structural, economic problems that were exacerbated by the consequences of inflation for pension costs.
It is precisely the regions that bear the heavy burden of inflation. They have a different staff base, more academics, to put it bluntly. More academics means that the pension costs are higher. This also leads to the consequences of inflation, when it is calculated, being greater for the regions than for the municipalities.
I share the member's assessment that it was absolutely necessary for the government to step in and support the regions. We have done so with a total of 9 billion directly to sector grants that can be used to cover pension costs.
Inflation has had consequences for the agreement that the regions have signed. It could not, after all, be foreseen that inflation would rise so high. Already in the summer of 2022, before the election, it was over 8 percent. That had consequences for 2023. Last summer it was 9 percent. That has consequences for this year.
It is nevertheless pleasing that it now looks better. The measures that have been taken have led to inflation slowly decreasing. The assessment from all regions is that 2025 will look significantly better because the consequence of inflation for pensions will decrease. Inflation will go down.
That assessment is also shared by Sveriges Kommuner och Regioner in its latest economic report from May 2024. They also write very clearly that the money from the government was, of course, much needed to manage the consequences of inflation.
But they also write the following, which is quite unusual for SKR. I read directly from page 79 in the economic report: "In the supplementary budget for 2024, a one-time sum targeted at health and medical care of 6 billion kronor is proposed. This is much-needed and facilitates the economic adjustment, and for once it is justified that the supplement is only notified for one year."
SKR makes the same assessment as the government that it is a temporary effort. This means that it was also reasonable that the money was one-off funds. It was a total of 6 billion plus 3 billion that had been previously signaled, that is to say 9 billion for this year. It is somewhat unusual. But it also means that it is assessed that the consequences of inflation will decrease.
For Sörmland, the challenges remain structural and have persisted for a longer period, as the member has pointed out, and where the operations must be adapted. Since I, as Minister, cannot influence which decisions are made in the regions, it is not possible for me to be able to say what should be done or how one should behave in a region. In that respect, I am prevented from giving instructions to a region.
It is still worth noting that the warning that has been issued has not, as feared, been triggered for the healthcare staff. It remains to be seen what will happen with the warning. It naturally remains a concern for all healthcare staff who do not know whether it will be triggered or not. So far, changes have occurred. We also know that a termination has occurred when it concerns healthcare service personnel, but not when it concerns other healthcare staff. That concern naturally remains for everyone.
What we do see as positive is that all regions have made a concerted effort to regain the operating capacity that was had before the pandemic. We were just before the labor market conflict that we are currently in the middle of back to one hundred percent operating capacity.
It is a fantastic effort that the employees have made to be able to provide care to patients. But the situation is very serious, and the need for work environment measures remains.
Sofia Amloh (S)
Madam Speaker! There will absolutely be relief for the regions when inflation goes down. That is how it is. It is a fact that is how it will look. It is parts of the pensions that have made it extra strenuous. But that does not mean that it will not be strenuous, and it does not mean that the consequences during this time will disappear.
The consequences remain. To manage the debt and the deficits, Region Sörmland will have to deal with the economic consequences for many years to come. This is something that will have to be lived with for a very long time.
It is, of course, set against how the care should look and be conducted. In what way should it be developed? We have discussed that many times. There are a lot of things that are very exciting. It is about good and close service and care. There are major reforms that need to be taken further. Investigations have been carried out that are extensive for the entire Swedish healthcare system.
How is the baggage of consequences to be handled? That is also where my concern lies. It is not just about here and now, but also about what it will be like in the future. The Minister gives the impression that when inflation goes down, we will get the conditions we need. I do not quite think so. We must include the consequences that exist.
We need to look at what is happening here and now. Today, there are district nurse clinics that are not operational. They are closed today. Folktandvården does not exist. It has shut down place after place. Even if it is not being carried out, a large warning hangs over the staff, who do not know if it will be carried out. It is a painful procedure, I would say.
At the same time, Vårdförbundet currently has an extensive strike which it is furthermore expanding. It demands decent conditions and a working environment on a basic level. That is the reality that is now. In what way shall the Minister work to ensure that the conditions needed to handle it are created?
It is still, in large parts, a crisis. There are things that can be improved, and efforts are being made. The Minister describes the efforts that the staff are making to achieve capacity. I do not doubt that for a second. The staff are doing their utmost, and quite a lot more than that, and it has its price.
What does the Minister think needs to be done to avoid paying that price? It is not what one should lean back on, but it must be something that is sustainable longer than what we see here and now.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you once again, the member, for continued discussions on important issues!
My main mission is to constantly work so that people receive the care they need. It should be a need-based care. This means that wherever I seek care in the country, I should receive the help I need.
It is the mandate under the laws that every region works with. It also applies to the municipalities that work with health and medical care interventions. They work under the laws. It is not that they work according to free choice, but they work under the laws. They truly do everything they can to offer good care on equal terms to the population.
I am simultaneously prevented from commenting on what should be done in Sörmland. I am not allowed to do that as a government minister. The member also knows that. I am likewise prevented from commenting on the conflict that is ongoing in the labor market, as that belongs to the parties in the labor market.
One can still note that the government has for a long time worked with issues regarding the work environment. We have identified that if we do not succeed in improving the work environment and the supply of skills, we will not succeed in increasing the healthcare capacity and being able to develop good and close care.
The second report from the National Health Competence Council arrived a few weeks ago. There are many proposals for the regions to work with in order to increase the supply of competence and improve the working environment. It will be the single most important measure that is taken in the regions to be able to retain staff and to enable people to have a healthy working life so that we can thereby provide care to the patients.
I already started last spring to convene all parties specifically to discuss work environment measures, and it continued after the summer. The National Health Competence Council is now presenting its proposed measures. We consider it extremely central to work on work environment issues.
I note now in conversations with the regions that they see the consequences of inflation as being temporary. They are assessing it right now. It is the competence supply that we have to work with. It is about us making it possible to stay and work with us and that we get more people applying for our professions.
More and more regions are stating that the focus must be on skills supply and the work environment. It makes me very happy that they are making that assessment. That is where we must put most of the energy and most of the work going forward.
It is, just as the member says, heavy when a warning remains. That is how it is. One does not get notice if it even happens. That is the case right now in Sörmland. It has not happened with 700, and no one knows if it will.
At the time the government gave notice this spring, there was no summary from Sveriges Kommuner och Regioner regarding how many layoffs were involved. Now there is such a summary; it arrived in May in SKR's economic report. They assess that the layoffs from the regions for 2024 and 2025 will amount to approximately 6,000 employees. The money that the government has provided just this year corresponds to 7,000 nursing services. The support we provide for the temporary consequence is therefore in parity with what the regions themselves assess.
But we need to add that, in addition, other measures have been taken that will require efforts from the regions. Moving from rental dependency to permanently employed staff will be a change that will require its share of work environment and perhaps working conditions. It is an incredibly large and tough challenge that all regional politicians face. I am, however, very happy that work environment and competence supply are increasingly appearing in their priorities. It is the right way forward.
Sofia Amloh (S)
Madam Speaker! I share the view on the last point. It is fantastic that the work environment, working conditions, and skills supply are moved up and prioritized. But then there also need to be staff to do this. They need to have colleagues, and conditions must be created so that they can work sustainably in a long professional life. They need to receive skills supply so that they can do this under good conditions. There must be colleagues who cover for you when you do this or compensate for something else.
Almost 6,000 layoffs are pending, and the government says that they will compensate a little and increase the state grant. But Sörmland, the Sörmland politicians and the Moderate regional government say that these funds do not play any role at all. The notice for 700 people remains. These are funds that are quite paltry in the context they find themselves in. They play no role, and the notice still remains.
It needs to be ensured that there is staff, that staff are not laid off, and that they also have the strength to stay in order to then be able to secure their own competence supply and remain. There must be an employer who sees this.
But this government does not. The government has not seen the difficult economic situation that the regions face. The government has provided state grants, absolutely, but in relation to the need, they have been very low. And that has consequences.
My message to the government is that it is still like this, and my question remains: Is the Minister doing everything she can to alleviate the crisis?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, Member, for further comments! If we do enough, we will probably never know. When one looks in the rearview mirror, one can always say that one should have done this or that. But I can still rely on the economic report from Sveriges Kommuner och Regioner that arrived now. It is the first time they speak about how large they believe the layoffs will be in 2024 and 2025, and the layoffs amount to almost 6,000 employees. Already at the beginning of the year, the government announced that we are providing extra support equivalent to 7,000 nurses. It is therefore not at all true when one says that the government is slow to act and does not have the right level.
When SKR for once states in its text that it was right to give a temporary grant because this is a temporary situation, it means that we have not ended up completely wrong based on the temporary situation.
However, I believe that what the member is highlighting, above all the structural problems that Sörmland and many other regions face - that is to say, things that have not arisen because of inflation but that have existed for a long time - is what needs to be looked at.
It is about ensuring that healthcare staff are used in the best possible way and that they have a functioning work environment so that they have the opportunity to be their best self at work. They should be able to provide the care that people need and not live with an ethical stress that prevents them from providing what they intended every day at work.
It is the underlying structural problems that I believe will be the major issue for the regions moving forward. But again: The differences are very large. Socialstyrelsen stated this week that three or four regions now almost have a situation with the care capacity required and the care beds that were needed. It is no longer just Kalmar that has it, but it is more regions. Örebro belongs to those that have been added. It is immensely pleasing that more regions are heading in that direction. It is not the number of beds it is about, and this means that one has the healthcare staff needed to be able to care for patients.
Therefore, I hope that we can contribute together with the regions to help them find a more sustainable path. Competence supply and the work environment will be number one in order to manage this.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.