Response to interpellation 2024/25:129 on the Health and Social Care Inspectorate
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that Ivo has a unique and important role for patient safety 1 and that the government during 2024 reinforced Ivo with 30 million kronor 1. KD proposes that the grant should be permanently increased by 28 million kronor for 2025 1. KD believes that municipalities and regions need more tools, such as confidentiality-breaking provisions, to carry out reasonable supervision and emphasizes the importance of balancing control with trust. KD argues that previous governments did not handle crime within personal assistance sufficiently. KD is working on equalizing legislation to exclude actors on more grounds and wants to make it unprofitable for criminals. S is prepared to tighten the possibilities in certain areas, such as HVB homes in private ownership, to stop welfare crime 2.
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)
Mr. Speaker! Eva Lindh has asked me how I intend to act to address the serious deficiencies in supervision that the Swedish National Audit Office has identified at the Health and Social Services Inspectorate, IVO.
IVO's role as the state's supervisory authority for health and social care is unique and of utmost importance to ensure that the population receives care that is safe and of good quality. IVO's responsibility for supervision and licensing is one of the most important tools in the work with patient safety and against unserious and criminal actors within health care, dental care, and social care. Within the framework of its supervisory mandate, IVO has the authority to prohibit operations within health and social care and revoke licenses so that unserious and criminal actors are not allowed to continue operating.
It is therefore important that Ivo is given the necessary conditions and powers to conduct effective supervision. Ivo has therefore, during 2024, received a reinforcement of 30 million kronor, through among other things special assignments, to strengthen the work against unserious and criminal actors within health and social care. In the budget bill for 2025, the government proposes that Ivo's appropriation be permanently increased by 28 million kronor for the work.
During 2024, Ivo has received two assignments to strengthen and develop the work of preventing and countering welfare crime and the presence of unscrupulous actors within health and medical care and dental care (S2024/00037) as well as elderly care (S2024/00041). Ivo has also received an assignment to strengthen the supervision of assisted living and homes for care or housing that receive children and young people (S2024/01643).
Ivo is responsible for the examination of complaints according to the Patient Safety Act (2010:659). Complaint handling is important for an effective supervision of patient safety in healthcare and for the interests of individuals to be met.
The Swedish National Audit Office points out in its report Prescription of Medicines - State Governance and Supervision (RiR 2023:23) that the supervision of incorrect prescriptions is not effective and that there are major deficiencies in the regulation of incorrect use of pharmaceutical benefits and infectious disease subsidies. The Swedish National Audit Office submitted a number of recommendations to the government regarding this. Among others, the Swedish National Audit Office recommends that Ivo be given access to more data on medicine prescriptions in order to better be able to carry out a risk-based supervision and thereby strengthen a more proactive supervision.
Data on medicinal prescriptions contain sensitive personal data, and it is therefore necessary to investigate whether an expanded duty to provide such data to Ivo is appropriate. The Government has, among other things against the background of the National Audit Office's review, commissioned an investigator to review certain issues regarding documentation, limitations, and supervision concerning medicinal prescriptions (dir. 2024:82). The purpose is to counter incorrect medicinal prescriptions and prevent public funds from going to unserious and criminal actors within healthcare.
The assignment includes analyzing and proposing how Ivo can gain access to additional information in order to conduct an accurate, efficient, and risk-based supervision of prescribers. The assignment also includes analyzing and proposing how the regulatory framework for interim decisions regarding the revocation of licenses and the restriction of prescribing rights can be changed to better protect patient safety and the legal certainty of the prescriber in question. The investigator shall also, if necessary, propose other changes for the purpose of the supervision achieving greater impact. This could be exemplified with other measures or proposals that can shorten Ivo's processing times. The assignment shall be reported no later than March 12, 2026.
The Swedish National Audit Office states in its report Emergency Number 112 - the state's and SOS Alarm's handling of alarms (RiR 2023:22) that Ivo has the conditions necessary for the supervision to be conducted effectively. In particular, the self-initiated supervision has proven capable of identifying deficiencies and getting SOS Alarm to act to rectify these.
With that, I would like to thank Eva Lindh for the questions, and I look forward to the debate.
Eva Lindh (S)
Mr. Speaker! Awareness of welfare crime has increased not only among us politicians but among everyone, because welfare crime in Sweden is unfortunately increasing.
There are fundamentally two problems with welfare crime and unserious actors.
Firstly, the taxpayers' money is not going to what it is intended to go to. We hope that our money will strengthen the welfare and go to healthcare and so on. But now we know that very much money disappears to welfare crime and that unserious entrepreneurs and healthcare providers take money from the care we pay for. It is very serious.
Secondly, yesterday we heard about a dentist who pulled teeth that did not need to be pulled - 20 pieces in one case. This is one of the examples where we are alerted to what happens when someone cares more about the money than the care they provide.
So, it is about both the fact that taxpayers' money, which should go to healthcare instead, disappears to other things, and about patient safety. This concerns many different operations within, among other things, dental care, healthcare, and HVB homes, and in countless cases, there are deficiencies. What is common is that Ivo has the supervisory responsibility. They are to inspect these operations in Sweden.
We have been informed in various ways - most recently very clearly pointed out by the Swedish National Audit Office - that the oversight we expect and believe takes place does not occur in the way we hope. Time is lacking or there are no possibilities and resources to carry out the oversight that is needed.
I initiated this debate because it concerns me very much, not only that welfare crime exists and that the deficiencies affect patients incredibly much, but also that there is much more than we see, because the supervision is not sufficient. It does not occur to the extent we hope for.
I have received a response from the Minister for Health and Social Affairs and thank him for that, but I actually have three questions. I understood that the Minister recognizes the needs and sees the problems, so I do not ask about that. But are the funds that have been added sufficient? Does one intend to strengthen the powers so that the supervision is improved and expanded? How does one intend to handle the influx, that is, to stop the welfare crime before it happens?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I thank the member for raising the issue and describing the situation well. It can be about inaccuracies within healthcare and elderly care, where there is no intent but where the consequences can still be catastrophic for a patient or care recipient. We need supervision of that. It is very important, because poor treatment can affect a person's entire life. In those cases, I would like to say that we perhaps have the biggest problems today, because many other issues are vying for attention at the same time as patients feel that it takes far too long before they get answers regarding what they have experienced of inaccuracies or poor treatment. It is one of the issues we highlight.
We expect that this will be improved with the help of all the new millions the government gives to Ivo, both temporarily this year and permanently. I want to bring this up because we will be discussing welfare crime, which the member describes very well, but also because it is important for trust in the common good. If one experiences that something is lacking, one must have their case examined. That is why Ivo exists.
It is important for me, in all dialogues and meetings with staff, to emphasize the importance of them being there so that one can maintain the trust in and confidence for the common good. We have a law enacted by the Swedish Riksdag that says what one can expect. We work under the laws and do not place ourselves above them. We ensure that the work is carried out in the best possible way.
If something fails, whether due to inaccuracies and mistakes or what we often return to, namely unserious and criminal actors, someone must react. The first instance are those who have the primary responsibility, namely municipalities and regions. It appears from the Local Government Act that if the municipality or region hands over the operation to someone else, they must ensure full transparency and the possibility to control that it is managed in the correct way.
It can be noted that municipalities and regions need to improve their own supervision, but that they do not have all the tools that are needed. It has been shown in the work that the government has undertaken that municipalities and regions need more tools – probably more confidentiality-breaking provisions and more registers that can be cross-referenced. When we go through those questions, they also correspond with Ivo's needs, because when municipalities and regions have not been able to sufficiently ensure that what they hand over to someone else functions well, the supervision from Ivo must function. Both parties have a need for stricter legislation in several areas to perform their assignments well. Therefore, we have commissioned the investigations I mention and several others within the justice area, which indeed affect all municipalities and regions.
Municipalities and regions need more tools to conduct a reasonable supervision, and it will be a difficult balance. I guess the Riksdag will also return to those issues, because they are important. How far should we go with controls? How much should we preserve trust? For me, trust is efficient. If we can trust each other, we know that it will also be more economically efficient. But we need to supplement with some more control. It is a matter of finding balance.
Both municipalities and regions, as well as Ivo, therefore need more tools to be able to carry out the supervision and the controls that are necessary. That is why we have started that work. Investigations are still ongoing, and the matter is moving forward - not least in Civil Minister Erik Slottner's area.
I will return in the next post to the unserious and criminal actors, but that municipalities and regions do not have the possibility to follow - for example in the case the member mentioned - what has happened somewhere else in Sweden is quite unacceptable. If someone has established that an error has been committed and that a person is not suitable, others should be given that information. It is a good example of the deficiencies that exist today.
Eva Lindh (S)
Mr. Speaker! The Minister mentions something that I did not mention but which is naturally also important. Some have perceived that I have asked the question and then contacted me regarding the handling of complaints. The Swedish National Audit Office will specifically audit this in the coming years. I think that is very good.
Errors have occurred. I have received examples of appalling things, including that tests were not proceeded with and treatments were delayed, which may have resulted in the patient suffering from poor health or not surviving their illness. It is completely appalling. Of course, Ivo should also focus on those issues. That may be what we intended for Ivo to do.
Welfare crime is increasing to such an extent that it competes with both the competence and the resources for supervision. It is regrettable. Therefore, I ask again whether the money will be sufficient, given the major challenges that exist. Can one imagine reinforced powers, which are also requested by Ivo? I think that when they stretch out their hand and say what they need, we should have big ears and see if there are additional things we can do.
As a social worker, I myself have struggled with confidentiality in order for people to be able to talk more with one another. I saw that one could not cooperate for the best interests of children. It is also clear that it was needed even in those cases where we must cooperate to prevent welfare crime and that unserious actors exploit the systems. I therefore completely agree with that. I look forward to us being able to do something in that area.
When it comes to handling what I call the influx, I hope that we can stop the possibility of making money by exploiting patients, because that is what welfare crime is about. As I said, it is not just about taking money, even though it is upsetting in itself because it is billions of kronor that we would have great use of and joy from in order to strengthen the welfare. It is about the healthcare that I know we both are passionate about. Those resources are incredibly important. But there are still opportunities to make money by not giving patients what they need or by giving patients treatments they do not need, for example, pulling teeth or performing other interventions. It harms health.
There are countless cases. Therefore, it is important to strengthen the supervision and limit the opportunities for welfare crime. Unserious actors should not be able to do these incredibly harmful things just to make money and put it in their own pockets.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! We have encountered crime within the welfare system ever since 2009 or 2010, when we discovered it within personal assistance. We did not get very far then because it became a difficult balance between the need for assistance, when one has a right to it, and the measures taken to control it. It risked affecting those who needed assistance when we were to reach the criminals. Under the previous bourgeois government, we therefore did not get far enough with the issue of assistance and the crime that existed there.
When Sweden then received many unaccompanied children in 2015, we needed HVB homes for care or housing, and many homes were started. I am grateful to all who could provide help, but homes were also opened by persons who were solely criminals.
We have during the entire period afterwards seen that such things have crept into HVB. The latest I saw concerned Borås and two municipal residences where the manager had drugs in the office in order to be able to sell to the residents. If one is to take care of children and young people who need a better start in life, there simply should not be drugs there. But it has thus gone so far that one doesn't even ponder this, but just does it and exploits the situation.
When it comes to HVB, we have, as we said, seen such things since 2015 or 2016. We did, of course, what we could in that situation, but we did not have the tools to be able to ensure that it was the right people starting the homes or that the money was being used in the right way.
In recent years, crime has also entered the health and medical care sector, just as the member highlighted. Unfortunately, we have the entire spectrum, from those who pretend to be sicker than they are to those who set up a health center that does not even exist and has no patients. They fake information about personal identity numbers, medical history, and other things, and then they withdraw money from the region.
It is clear that the regions concerned find it extremely problematic that such agreements have been written. One is supposed to investigate everything when writing agreements and ensure that they are correct.
When it comes to drafting contracts, we need to find opportunities to exclude different actors on more grounds. This is one of the examples that the government is working on. When regions and municipalities enter into contracts, they should be able to control more things and also exclude actors on more grounds than they can today. There is therefore an ongoing effort to harmonize the legislation in a better way so that better tools are obtained.
The criminals did not enter because they want to help in health and medical care. As I mentioned, unfortunately, errors were committed, but that is about people who want to do the right thing and about mistakes that sometimes occur. The criminals are a completely different group. They step in to make money from our common resources, and they do not even want to try to provide care. Sometimes they fabricate information from beginning to end.
It has turned out that the criminals are really skilled, and our authorities, municipalities, and regions are lagging slightly behind. But we have two regions that have worked well: Stockholm and Västra Götaland. Stockholm started several years ago and Västra Götaland shortly thereafter. They are working really well today to raise the guard and ensure that they have control over things.
Skåne has followed suit, and Halland has joined them. SKR is doing a very good job with this, and the government will return with more assignments in the near future so that more of our agencies can become even better at this.
This must be done on a very broad front. One measure is not enough, but quite a few things will be needed, such as legislation and reinforced resources to Ivo, which we have provided. We must also go through all variants of the regulatory framework.
If we are to succeed in stopping the criminals, we must make it difficult in very many different ways, so that it is no longer profitable to be among us in healthcare. We must tighten things up in all places and make it difficult for them to get in. Otherwise, we will never succeed in stopping them.
Eva Lindh (S)
Mr. Speaker! That sounds promising, especially the last part. It is precisely about tightening the taps and not making it possible for welfare crime. I believe this is the important thing. Supervision is incredibly important – otherwise, I would not have asked the question.
I am doubtful as to whether the resources are sufficient, but it is not my place to judge. I am just saying it. I believe it is important that we focus on ensuring that Ivo really has the opportunities to carry out the supervision that is needed. I hope that there are several of us who follow the prerequisites so that the supervision we can expect and need is carried out.
There is one thing where I believe we differ. It is that we Social Democrats are prepared to sometimes tighten the possibilities in certain areas, for example when it concerns HVB homes in private hands or having the Act on Choice Systems, LOV, within the areas where we see the most cheating. We think that the taps should be tightened there, that is, the possibilities to commit welfare crimes should be stopped.
It is not about us being against all privatization, but it is about us not wanting to open up opportunities for welfare crime. Sometimes money speaks louder than moral values, and this is something we do not want to allow.
It is no threat from me, but I will follow the question. I still hope that it is appreciated that we are driven by the fact that we must have good healthcare. For it to be so, we must have good supervision.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I thank the member again for raising this. As said, there is quite a lot that needs to be done. Ivo already submitted, in 2019 when I sat on the oversight council, 40 different proposals to the government at that time, but a pandemic came in between. I want to say that. I understand that it was not possible to start everything, but we are working our way through the list.
One thing that we have added and which is not on the list concerns the fact that we do not even have a healthcare and care provider register in Sweden. We therefore cannot even see who is active, if they are in control, if they have authorization, or who they are. We are therefore in the process of establishing such a register.
We are quite far behind, and this means we need to do many things right now for it to become really good. One thing we have done is to provide money to Ivo, at the beginning of the year. It takes time for them to get the right and competent employees. They must be able to handle the operations, and they also often need to be security-cleared as they are out in areas with a lot of crime. We must ensure that they have a protection and know that it works. It is, therefore, a rather tough journey that Ivo is undertaking right now.
Currently – or it has been for a long time, perhaps it is best if I say – they are getting scolded for closing too early and scolded for closing too late, at the same time. On Gotland, people are quite dismayed right now because practically all HVB homes have closed. What are municipalities that are supposed to take care of young people going to do when they have nowhere to send them?
This shows that if one goes out with general measures, such as that all private operations shall be terminated, then the municipalities will not have anywhere to send the young people. Every municipality that enters into an agreement must, however, ensure that the operation is good.
The example with HVB has been the most telling. Young people who need support and help have come to homes where criminals teach them to become even more criminal and, furthermore, exploit them in their activities. The state, municipalities, and regions must not contribute to more people becoming criminals, but we have done so in many different ways.
I therefore completely agree that the supervision from Ivo is absolutely crucial. We write that it is prioritized, but municipalities and regions also need to do their part. I am very pleased with the work that has begun over the past year. We need to continue with that.
Thank you very much for the question! We will certainly return to this.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.