Response to interpellation 2024/25:133 on the right to an interpreter in 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 right to an interpreter in healthcare and how it should be financed. KD considers language to be a key to integration and that the individual should primarily pay for interpretation services 1. KD argues that deficiencies in access to authorized interpreters lead to patient risks 2 and wants an investigation to ensure availability, where services should be subject to fees 2. KD emphasizes that patient safety is the cornerstone 3 and that decisions should be made after proper investigations 4. C argues that everyone has the right to make themselves understood 5 and that interpretation fees risk patient safety and the healthcare staff's working environment 5. C argues that fees can lead to children being forced to interpret 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 Acko Ankarberg Johansson (KD)
Madam Speaker! Christofer Bergenblock has asked me if I intend to proceed with the proposal to charge a fee for interpretation within healthcare, what consequences I assess that the introduction of interpretation fees risks having for patients and staff in healthcare, and if I intend to take any actions based on my assessment.
Christofer Bergenblock refers in his question to a judgment from the Administrative Court in Växjö. I would like to begin by clarifying that I cannot comment on individual judgments.
Language is a key to integration. With good knowledge of Swedish, the need to provide an interpreter in contacts with various societal functions is reduced. It is in light of this that the agreement on a limitation of access to publicly funded interpretation should be read, as well as the starting point that the individual shall primarily pay for interpretation services.
The Government will return regarding the concrete implementation of the agreement in the Tidö Agreement.
Christofer Bergenblock (C)
Madam Speaker! I thank the Minister for the answer, even though the Minister only answered one of my two questions. The first question was answered with a yes, meaning that the government intends to proceed with investigating the issue of a fee for interpretation in healthcare. My second question, regarding what consequences the Minister assesses such a fee may entail, received no answer at all. Here I expect an answer in the Minister's next contribution.
Why was an interpreter needed in healthcare? Well, because everyone has the right to make themselves understood when they seek care and need to get in contact with healthcare services. There are many different parts to this, and it is not just about the patient's perspective but equally about the healthcare staff's perspective. Both parties need to make themselves understood. If a patient cannot describe their symptoms or problems in a correct way, there is a high risk that it leads to misunderstandings and unnecessary examinations that cost the healthcare system unnecessary money. If a doctor or nurse cannot describe to a patient what illness they have contracted, what treatment they need, what medicines they should take and how they should be taken, there is a high risk that it leads to healthcare injuries. This is fundamentally about two things: patient safety and the healthcare staff's working environment.
It is also about something overarching, namely the portal paragraph of the Health and Medical Services Act regarding everyone's right to care on equal terms. There is a great risk that this right will be shattered if a fee for an interpreter is introduced. Next after the law itself, this is perhaps the point in the Tidö Agreement that has received the most criticism. There have been appeals from doctors, nurses, and nursing assistants because they see what the effects of a fee for an interpreter could be: It will hit patient safety and their working environment. The staff also risk losing their licenses if medical injuries occur and Ivo reviews them or reports are made to the Health and Medical Services Responsibility Board – even if the medical injuries are due to language barriers.
From the government's side, it is not about protecting the patients or the staff. It is probably not about money either. In some way, it is about finding ways to pressure people from other backgrounds who have not managed to learn Swedish or who, due to dementia, have forgotten the Swedish they once learned.
What consequences does the Minister assess that an interpreter fee will have for patients and staff?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank Member Bergenblock for the question. It is pleasant that the Member has discovered this issue, for I have been in the Riksdag quite many times and commented on it in interpellation debates. Even though the Member obviously has not read my answers and the long debates we have had on this, I am very happy that the Member raises the issue today so that we get a chance to debate it once again.
Let me begin with the issue at hand, because otherwise, I believe the member knows exactly how the situation stands. It is absolutely necessary that we rectify what is lacking. Many patients who come to healthcare today do not receive the right to the authorized interpreter they need. Instead, children and relatives interpret, which leads to patient risks. I wish the member had asked questions about this several years ago, but at that time there was no commitment. Today, it is a major patient risk that people do not receive the right to the authorized interpreter they need, and we must resolve this. At the same time, we are, of course, strengthening Swedish language instruction so that everyone who comes to Sweden gets the chance to learn the language. There have been views on SFI instruction on good grounds, and these deficiencies need to be rectified.
When one is entitled to an interpreter, the interpreter must be authorized, because it is quite advanced to interpret in healthcare matters. Here I see weaknesses, and I am disappointed by the lack of commitment in the issue. No one is asking the regions how they handle this. It would need to be done much more forcefully, and I assume that the member's party friends will take up this in those regions where they have the opportunity to influence.
The government's view, which has emerged in the interpellation debates I have participated in, is that interpretation in healthcare should be subject to a fee. There are already fees in healthcare today. No one enters healthcare without paying a fee. Today, they are not income-related but are the same for everyone. I share the member's assessment that every new fee entails a risk, but it is no news that there are fees for visits to healthcare where the regions have decided that it shall be so. So, it could also become the case for interpretation services in healthcare.
There is no proposal yet, so what the member is asking me to assess is precisely what an inquiry will assess. We agree that an inquiry should be appointed, that we broadly should ensure access to an interpreter, and that this should be subject to a fee when there are no reasons for otherwise. It has also emerged that it concerns those who have been in Sweden for a long time and have been granted citizenship and where there are no reasons to believe that they have not been able to take advantage of Swedish language instruction. The member gave good examples of those who cannot be expected to know Swedish based on their situation. The government's position has emerged from every answer I have given in the Riksdag, and it is the same message today.
An inquiry will be appointed in the near future, and only once it is completed will the government return with its assessment. I do not know what the inquiry will conclude. First, the directives must be decided and the inquiry carried out. Thereafter, the government will jointly return with a decision.
Christofer Bergenblock (C)
Madam Speaker! I thank the Minister for the answer.
The Minister points out that many healthcare fees currently exist. This was actually the core of the court ruling from the Administrative Court in Växjö: the Health and Medical Services Act does not encompass this form of fee. What was examined in the Administrative Court was Region Blekinge's decision to introduce an interpreter fee, which was appealed. The Administrative Court in Växjö concluded that it was not compatible with the Health and Medical Services Act to have this form of fee. It was established that this was not a healthcare fee.
This assessment has now been made and prompted me to ask my question. It is therefore a new situation. The picture I have received is that the government has waited for an assessment to be made regarding Region Blekinge's introduction of an interpreter fee.
It is not only Region Blekinge that has been dealing with this issue. In large part, every region in Sweden where the Sverigedemokraterna sit in the regional council has received a motion or a proposal regarding the introduction of an interpretation fee. But obviously, it is not possible to introduce this today.
The most interesting thing, of course, is to find out whether an interpretation fee conflicts with the portal paragraph in the Health and Medical Services Act regarding equal care for everyone. We shall have to wait and see how that matter turns out.
What I asked about was what consequences the minister assesses it could have. She does not want to answer that at all but is awaiting the investigation. On the other hand, the consequences are described at the beginning of the minister's post, where she describes how it looks when children and relatives are forced to interpret instead of authorized interpreters.
This is something that still occurs quite frequently, although perhaps to a lesser extent than in the 1990s and the beginning of the 2000s. A situation that we absolutely do not want to arrive at is that child and relative interpretation is expanded. But the risk is enormous that it is precisely that which will happen.
Children will be accompanying their parents to healthcare and receiving medical diagnoses and translating them for the parents. They may need to describe illnesses that their parents have for the healthcare services—illnesses that may be intimate or invasive of privacy. We must instead ensure that we counteract that situation in every way. There, the regional politicians naturally have a great responsibility, but there the government also has a great responsibility.
I thought I understood that the minister asked why I had not acted on this issue several years ago. I was not in the Riksdag several years ago, but I have been since 2022. What has been up in the debate since 2022 is the Tidö Agreement, which concerns worsening the possibility of an interpreter in healthcare.
I would still like to hear an answer from the Minister for Health and Social Affairs. We all know that the background is the Sweden Democrats' view on this. It is they who have motioned for it in all regions in Sweden.
What is most important for the minister? Is it the relationship with the Sweden Democrats, or is it to safeguard patient safety and the working environment for our healthcare staff? Consider that the minister is the Minister for Health and Social Affairs.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I believe it is wise for all parties to think more about what policy they themselves have rather than talking about that party that constantly becomes the red line that prevents one from moving forward in their own policy development.
I am well aware that the member is new to the Riksdag. But the Center Party has been here for a very long time. I welcome the commitment that is now shown regarding the interpretation issue. But it perhaps should have existed earlier if one seriously sees the deficiencies that exist today, because they do exist. It is extremely important that people have an authorized interpreter when they enter healthcare and when they need it.
It is not the case that we have appealed any judgment in Blekinge regarding what is happening there. That is completely made up. Everyone understands that what one does, one does under the laws. Everything we do, we do under the laws. We do not place ourselves above them. There is no such law.
Whether one should have such a law in general, and whether it should be introduced in healthcare, is what is to be investigated. Such legislation does not exist today. We could have calculated that in advance. We did not need to wait for a court ruling for that. It is quite obvious.
Again: I cannot comment on a judgment. One is not allowed to as a minister. It has been given, and it is being handled in its own way. But it is absolutely necessary that when the investigation arrives, all consequences are reviewed. That is what we have done with other issues, and we have arrived at different answers. Each investigator receives directives from the government and makes their assessment: How should I understand this question?
It is exactly as the member highlights. It is about how it should be when one comes to health and medical care. The investigator shall go through all areas of society where it is relevant. When one comes to health and medical care, the Health and Medical Services Act, the Patient Safety Act, and the Patient Act are governing.
Patient safety is the cornerstone of the entire healthcare system. That is why I highlight the deficiencies that exist today, where people do not get access to an interpreter despite needing it.
All regions operate under the law. It states in the law that they have responsibility for healthcare. We have no state-run healthcare, but they have responsibility to ensure that people receive the care they need on equal terms throughout the country.
It is necessary that the issue is taken seriously. I hope that from the debate, more initiatives will now come from the regions, where they review the situation in their own region and make the improvements that are needed.
In the matter at hand, we will not be able to proceed until we have had an investigation. It will be presented in the near future. After that, the government will return once it has been completed and has been sent for consultation. Then the government will present its opinion.
Christofer Bergenblock (C)
Madam Speaker! The Minister for Health and Social Affairs says that it is important that we highlight the deficiencies that exist today. I can only agree. It is extremely important that we do so and move away from the use of child interpretation and relative interpretation. It is not reasonable. Above all, it is not reasonable to place the responsibility of interpretation on parents or other relatives for children and young people.
What surprises me in this entire issue is that while the Minister so clearly points out the deficiencies that exist today, she is prepared to investigate further deteriorations that will create new deficiencies.
The risk is exactly the one that has been reported from healthcare. The introduction of interpreter fees will lead to more people using relatives and children as interpreters, or alternatively, that they have no interpreter at all in the conversation.
It will cause longer healthcare processes with more unnecessary examinations, more healthcare visits to perhaps reach a diagnosis, more mistreatments, and more patient injuries. It is precisely patient safety that we need to safeguard.
Is it about saving money? In Denmark, they introduced interpreter fees in five regions in 2018. They later concluded that it cost more in administration than what they received through the interpreter fees. In any case, it is hardly a supporting argument.
We may not get any further in this debate. But for me and for Centerpartiet, patient safety is what stands at the center. Regardless of how the minister expresses himself, it is not what I perceive stands at the center for the Tidö parties.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I note that members use patient safety when it suits them. When they feel it suits them, they highlight patient safety. When discussing medicine transport in rural areas, it is good sometimes but not always. Keep a straight line. Then I think it will be easier to handle all the questions.
I fully agree with the member. Patient safety is number one. All issues that are brought forward concerning healthcare must be examined from the perspective of patient safety. However, I do not proceed to speculate on what might happen until something has been investigated. It is precisely when something has been investigated, and a good basis has been obtained for what the matter concerns and what consequences it will have, that one makes a decision and decides what one thinks.
It is wise that we have inquiries that provide us with a basis, instead of loose opinions about what I think would be possible or something I have read about in the newspaper. I would like to hold the Swedish inquiry system in high regard. It is wise that we let it take time. We get solid inquiries. We send them out for consultation and listen to what different representatives think, and then we make decisions.
I like the Swedish investigative system. I look forward to it also being used for this issue so that we know more before we make decisions.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.