Response to interpellation 2024/25:124 on access to occupational health care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns access to occupational health care and skills supply. L considers that occupational health care is important for preventive work environment measures 1 and that the government has a responsibility for the skills supply 1. L argues that the government is increasing allocated funds by 20 million kronor to facilitate employers' rehabilitation responsibility 2 and wants to review the amount limits for rehabilitation support 2. S argues that the skills shortage is acute and that the government must appoint an agency as the principal for the specialist medical education and secure the funding 3 4. SD considers that Försäkringskassan is the most suitable instance as the principal for the education 5 and that occupational health care is an important resource to meet the increasing mental ill-health 5 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 Paulina Brandberg (L)
Madam Speaker! [The member] has asked me what concrete measures I intend to take to ensure a sustainable supply of skills for occupational health care. Johanna Haraldsson has also asked me if I plan to proceed with the proposals in Mynas report Coordinated Occupational Health Care's Skill Supply regarding doctors and give an authority the responsibility for the training of occupational health physicians and its funding. Johanna Haraldsson has further asked me what initiatives I intend to take to increase the use of occupational health care in preventive work environment work and the availability of occupational health care at our workplaces.
I would like to begin by thanking Johanna Haraldsson for the questions and the commitment to occupational health care.
Occupational health care is a mix of several actors who can contribute to the work of creating healthy workplaces. The work of occupational health care is important, not least in preventive work environment work and to facilitate return to work. Furthermore, doctors within occupational health care perform medical examinations and issue certificates of fitness for work. The supply of competence regarding doctors within occupational health care therefore needs to function in a good way.
Through its role as an independent and cohesive expert resource, occupational health care has good conditions to see the work-related connections between health and the work environment. But for it to be possible for occupational health care to contribute in a good way, a functioning supply of competence and high quality of care are required. It can be stated that there are few doctors who are trained in the subspecialty of occupational medicine.
The Swedish Work Environment Authority (Mynak) has the task of monitoring and promoting the development of occupational health care. The authority was commissioned to coordinate efforts to promote the competence supply of occupational health care regarding doctors and reported the completion of the assignment on 22 February 2024 (A2022/01549).
On 29 February, Arbetsmiljöverket and Mynak reported on a mandate to submit proposals on how Mynak's tasks can be transferred to and integrated into Arbetsmiljöverket (A2023/01509). The report states that the occupational health care's competence supply is not judged suitable to transfer to Arbetsmiljöverket. The report has been referred, and processing of the referral comments is currently ongoing in the Government Offices. The Government shall then take a position on the proposals in both reports regarding occupational health care.
In conclusion, I want to say that occupational health care is important. I will follow the issue of occupational health care closely going forward.
Johanna Haraldsson (S)
Madam Speaker! Occupational health care plays, just as Paulina Brandberg mentions here in the chamber, an important role in creating healthy workplaces. The challenges in Swedish workplaces are great and workplace accidents and stress-related occupational diseases are increasing.
To manage the problems, a systematic work environment work is required in cooperation with the employees at all workplaces. In that work, expert knowledge is often needed that safety representatives, companies, or public employers themselves do not possess. In that case, occupational health care is a very important resource. It is obvious that it is needed more than in a long time.
Only 60 percent of those who work in Sweden have access to occupational health care through their employer, and there are large differences between different industries. One obstacle, among others, for more people to be able to access occupational health care is the major problems that the industry has with the supply of skills.
Of more than 1,100 doctors, nearly 900 are over 65 years old, and far too few are being trained. Since the Institute of Work Life, which previously was responsible for organizing training for the industry, was shut down by the Alliance government in 2007, the competence supply issue has grown.
I have on several occasions asked the minister what measures she intends to take to secure the competence supply for occupational health care. I mean that I have so far not received any satisfactory answers. To the extent that the minister has produced any answer at all, she has wanted to wait and see.
In February 2023, when I submitted a written question to the Minister, she wanted to wait for the preparation of an investigation. At the same time, she also wanted to wait for the Swedish Work Environment Authority's reporting of its assignment regarding the competence supply within occupational health care.
In February 2024, the minister received the report. In March, the joint report from Arbetsmiljöverket and Mynak arrived, which the minister also mentioned here in his post.
In May 2024, I again posed a question regarding the competence supply in occupational health care. It concerned what initiatives the Minister might consider taking in light of the report from the Swedish Work Environment Knowledge Agency, Mynak.
In August 2024, I once again submitted a written question. At that time, the minister did not want to provide information on when decisions could be made regarding the occupational health care's competence supply. That is why I stand here in the chamber and that is why we have the debate here today.
I ask the minister again: What concrete measures does she intend to take to ensure a sustainable supply of skills for occupational health care? Does the Minister plan to proceed with the proposals in Mynak's report and give an authority the responsibility for the training of occupational physicians and for the funding of the training?
Once again, the Minister, in her first statement, seems to be answering my questions, but says here in the Chamber that occupational health care is important but that she again wants to wait and see a little bit.
With the missing answers, I wonder if the Minister at all considers that she and the government have a responsibility to ensure that there is a unified supply of competence within occupational health care. I would like the Minister to answer this in her upcoming statements.
Clara Aranda (SD)
Madam Speaker! The question of access to occupational health care is both important and pressing. I would first like to thank the interpellor for a relevant interpellation with wise questions that give us the opportunity to dig a little deeper into this subject today.
My intention in participating in this debate is to provide a health insurance perspective. This is due to the fact that Försäkringskassan is proposed as the principal for the specialist service in occupational medicine in the report that the Agency for Occupational Health Knowledge has prepared.
I also want to take the opportunity to highlight the clear impact of the work environment on sick leave, linked to the importance of preventive occupational health work and access to occupational health services.
First and foremost, it is important to know that there have never previously been so many cases of sick leave due to stress, and it is mental ill-health that causes over half of all longer sick leaves in the current situation.
Here, the research is clear that the work environment is a decisive cause behind the development, where we can see structural problems particularly within female-dominated industries.
This is an important explanation for the high sickness absence within health, school, and care. There is an obvious imbalance between the demands being made and the resources available.
The increasing prevalence of stress-related occupational diseases needs to be met with available expert knowledge. It must be adapted to specific needs and working conditions, and in that context, occupational health care also has an immensely important role to play.
Madam Speaker! If we then look at measures to promote the supply of competence in occupational health care when it concerns doctors, something that the Swedish Work Environment Authority specifically examined in the report that I mentioned initially, we see that it is noted that there is currently a lack of a primary provider for the residency in occupational medicine.
The authority's overall assessment is that one of the most important factors for improving the educational situation for doctors working within occupational health care is the question of the employer of the education.
The authority, after a careful analysis of the gathered information, has made the assessment that Försäkringskassan is the instance that is best suited as the principal for educational issues concerning specifically occupational physicians.
Arguments are highlighted, among others, that Försäkringskassan's cooperation already extends across several areas today, which includes support for employers and the management of sick leave. A cooperation between Försäkringskassan and occupational health care is therefore seen as a strategic alliance to promote both the employers' and the employees' well-being.
What is particularly interesting here is that the support from occupational health care does not only become an advantage for the employers and their employees, but also that it can become a valuable resource for Försäkringskassan's own processing.
By the occupational health care's company doctor providing well-founded and expert information, Försäkringskassan also gets better conditions to assess cases of illness. They can then make more individually tailored decisions regarding compensation and rehabilitation measures.
I find this very interesting, and I would therefore appreciate it if the Minister could say something about the proposal that Försäkringskassan should become the principal for the training of Sweden's occupational physicians.
Statsrådet Paulina Brandberg (L)
Madam Speaker! I shall begin my contribution by answering the interpellant's question on whether the government considers that it has a responsibility in the issue regarding the supply of skills. The answer to the question is an absolute yes. This is not an issue that the government backs away from, but we are working on it and we are working on it actively. It is a complex issue. The important thing is that what we eventually land on is the right decision and a decision that has an effect over time.
A process is currently underway where Mynak is being integrated into Arbetsmiljöverket in parallel with us having received the assessment in the assignment given to Mynak. We also have the Office for Sustainable Working Life, which in its final report considers that the state's responsibility for occupational health care should be coordinated collectively by an agency. The final report was submitted on September 17 this year.
This which the government has received is something that we need to weigh carefully. It is also something that, of course, affects several departments within the Government Offices, above all my own department but of course also the Ministry of Social Affairs.
The government will make careful considerations so that we obtain a sustainable solution to the situation. I will not anticipate the process, but the work is in full swing.
Johanna Haraldsson (S)
Madam Speaker! I may be a little impatient, but if so, I am not alone. Sveriges Företagshälsor wrote, together with Läkarförbundet, a debate article a few weeks ago in which they urged the government to act. The headline speaks for itself: Do not wait to act until all occupational physicians are retirees, government.
Furthermore, they write that the competence shortage in the country's occupational health care risks being exacerbated if nothing is done immediately. Their demands to ensure the supply of competence are presented in the article: Appoint an authority as the principal for the specialist medical training in occupational medicine and secure the funding!
It is also exactly what Mynak proposes in its report Coordinating the competence supply of occupational health care regarding doctors, namely that an authority is given the main responsibility for the training and its financing. Also, the Office for Sustainable Working Life puts forward proposals in its final report on occupational health care that are consistent with Mynak's.
The parties in the labor market are also engaged in the issue and have, in conversations with me, and I also assume with the Minister, several times raised that the competence supply issue regarding company doctors must be resolved. What the government, according to several instances, needs to do is therefore to make a decision on which authority should have the assignment as the principal for the education and provide the funds required.
It has taken far too long to reach this point, and there is hardly any time left to solve the problems. But now there are proposals that many agree on, and I hope that the responsible minister realizes that the problems are quite acute.
That is also why I am asking again whether the Minister plans to proceed with the proposals and, if so, when. I do not, of course, mean that I need to be given a date or a time, but when will it be? It is quite urgent.
If decisions are delayed or not made at all, access to occupational health care will decrease. The loss of this expertise in the field of the work environment risks weakening the vital preventive work environment work at many workplaces.
This may be a superfluous question, but I still wonder what happens if such a decision is not understood and if we do not move forward, which I nevertheless hear somewhere that the minister would like to do. Has any analysis been made of the consequences if the specialty disappears and the employers therefore cannot get competent help in creating better workplaces?
I think this is important, and I am very glad to hear that the government believes that one has a responsibility and that the minister here also says that the government has a responsibility and is actively working on the issue. It is important that the right decision is made and that it is made quite soon. And let not the unwelcome merger of the Agency for Occupational Health Knowledge and the Swedish Work Environment Authority cause this to be delayed even further!
Clara Aranda (SD)
Madam Speaker! In view of the increasing mental ill-health in society, Försäkringskassan sees a greater need for support for employers. Occupational health physicians can play a central role here, both in the preventive work to reduce the risk of mental ill-health in the workplace and in supporting employers when the ill-health has already occurred.
A central part of the cooperation between Försäkringskassan and occupational health care concerns workplace adaptation and rehabilitation. Occupational health care can, in its role, assist employers in creating individual action plans for employees who have been affected by illness or injury.
It can, in turn, facilitate a smooth return to work for the employee and at the same time provide the employer with tools to handle these situations in a professional and efficient manner.
Madam Speaker! In a report that Försäkringskassan recently presented, it emerged that among people with psychiatric diagnoses, a full 86 percent stated that work has contributed to their sick leave. My view is that a change must occur, and I hope that Sverigedemokraterna, together with the government, can work to secure the supply of competence of doctors in the Swedish occupational health care. This will be absolutely crucial for continued development.
In cooperation with the government, we have already taken many important measures to meet the increasing mental ill-health in society in a number of different areas. I also view positively the possibility of working more specifically to prevent the negative development with, among other things, work-related mental ill-health and to find ways to effectively prevent long-term sick leave for psychiatric diagnoses to the greatest extent possible.
Statsrådet Paulina Brandberg (L)
Madam Speaker! Just as the interpellor knows, one cannot as a minister precede a preparatory process, and I unfortunately do not have any date to provide here either. But I absolutely want to provide the partial statement that it is not an option for this specialty to disappear. It is important, and it fulfills a very important function in our working lives and when it comes to issues regarding the work environment.
Just as the interpellator has said and as has also been raised here, it is important that we ensure that occupational health care continues to function both through the measures we take and, of course, through the funding. If one doubts that the government takes the issue seriously, one can look at what we have signaled in the budget for next year, where we increase the allocated funds by 20 million kronor to facilitate for employers to take their rehabilitation responsibility and make use of occupational health care's expert resources. Therefore, the grant for workplace-oriented rehabilitation support is being developed. This is part of the government's budget.
The Government will review the amount limits in the ordinance on grants to employers for the purchase of workplace-oriented rehabilitation support for return to work. In addition to this, Försäkringskassan and Arbetsmiljöverket will be tasked with developing their cooperation and supervision of employers' work environment and rehabilitation responsibilities. Here, it is particularly important to promote employers' work with rehabilitation and workplace adaptation, but also to take measures against those employers who fail in their rehabilitation or workplace adaptation responsibilities. For this assignment, the agencies will be allocated 5 million kronor starting from 2025.
In this context, even though it is a question that lies slightly to the side, I also want to remind that the government has appointed an inquiry to produce a new work environment strategy. This is a whole. We shall have a working life where no one becomes ill or is injured at work, and we must have measures to ensure that. But we must also have measures to handle the cases where this nevertheless happens.
Johanna Haraldsson (S)
Madam Speaker! I would like to begin by thanking the Minister for the account of the measures being made linked to health in the work.
In the occupational health and safety strategy that is currently in force, occupational health services are highlighted as an important resource in several respects. But in order to be able to develop and strengthen its role in occupational health and safety work, in order to be able to expand the use of occupational health services in preventive work, and so that it can be a knowledge support for companies and public employers and contribute to more healthy workplaces, it is fundamental that the issue of skills supply is resolved.
The government needs to make decisions and take responsibility to ensure that there will also be high-quality occupational health care in the future by appointing a responsible authority as the principal for the training and securing the funding. This is something that is broadly agreed upon among authorities, parties, and other actors. It is also not a decision that can be postponed any longer.
Statsrådet Paulina Brandberg (L)
Madam Speaker! I want to use my closing remarks to thank you for this important debate. It is an important part of occupational health and safety issues that we have a functioning occupational health care system, and the government will continue to work on these issues so that it functions in a satisfactory way.
With this, I would like to thank both the interpellor and Member Aranda for today's debate.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.