Response to interpellation 2024/25:146 on the healthcare system's competence supply
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD considers the staff to be the healthcare's most important resource and that the national commitment for the competence supply needs to be strengthened 1. KD argues that the government is working to anchor the National Healthcare Competence Council's proposals and that several proposals are already being addressed 2. KD emphasizes the importance of Harriet Wallberg's investigation for regulating specialist competencies 2. KD argues that the regions have done all they can to retain staff 3, but that a national preparation does not work because the regions lack a national mandate 4. S considers that the National Healthcare Competence Council's proposals are well-elaborated 5. S considers that the competence supply is a long-term task and wants to see an analysis of the proposals 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! Anna Vikström has asked me whether the government's mandate to the National Health Competence Council has changed, or will be changed, in light of the described warnings and reductions in staff and their effects on the long-term supply of competence.
Anna Vikström has also asked me whether I and the government have implemented any of the measures that the National Health Competence Council has so far proposed in partial reports, final reports, or the national plan, and which of the proposed measures I and the government will implement.
Anna Vikström has finally asked me what other measures I will take to strengthen the national commitment for the healthcare sector's competence supply.
Initially, I want to emphasize the importance of staff for increasing healthcare capacity and shortening healthcare queues. Staff are the healthcare system's most important resource and the foundation upon which healthcare rests. The work to secure the supply of competence is long-term, and to meet the healthcare needs in the entire country, the government believes that the national commitment for the supply of competence needs to be strengthened.
The Government has therefore given Socialstyrelsen, through the National Healthcare Competence Council, a mandate to develop proposals for a national plan to improve the healthcare system's competence supply (S2023/00256). The mandate was reported on 31 May 2024, and the National Healthcare Competence Council then presented 25 proposals for measures to improve the competence supply in Sweden. The proposals concern, among other things, ensuring time and resources for competence development and providing increased opportunities for career paths to attract, develop, and retain healthcare personnel.
The Government changed the assignment on 23 May 2024, and the National Healthcare Competence Council shall therefore gather views and adapt, anchor, and ensure that the plan contributes to strengthening healthcare capacity. In the assignment, the National Healthcare Competence Council shall also coordinate, support, and follow up the regional healthcare competence councils' work with the national plan. The assignment shall be final reported by 28 February 2025 at the latest.
The Government has also tasked a special investigator to analyze possible changes that may be needed in regulations and structures regarding regulated professions, specialist competencies and specialist educations, as well as further education and continuing education within healthcare and dental care to meet the challenges that these activities face (dir. 2023:148). That assignment shall be reported by March 30, 2025, at the latest.
At the same time, the government is carrying out a number of different initiatives in health and medical care. The government has provided additional supplements of funds to the regions within the framework of partly a sector grant amounting to 3 billion kronor, which was reinforced in connection with the healthcare reform budget for 2024 with an additional 6 billion kronor, and partly five different agreements between the state and Sveriges Kommuner och Regioner totaling just under 9 billion kronor.
The sector contribution of 6 billion kronor corresponds to the personnel costs for approximately 7,000 nurses. The government's explicit expectation is that the regions use the money to avoid layoffs of healthcare personnel. The government also proposes continued support to the regions during 2025 and that 2 billion kronor be allocated for 2025 in a sector contribution to health and medical care.
In addition to this, the government proposes further investments. Among other things, the initiative for increased healthcare capacity is strengthened by 1 billion SEK compared to previously, and additional funds during 2025 for national healthcare coordination and funding for an equitable implementation of precision health.
Together with previously announced funds, the supplementary funds that the government proposes for health and medical care during 2025 within my area of responsibility amount to 18 billion kronor.
With that, I would like to thank Anna Vikström for the questions. I look forward to the debate.
Anna Vikström (S)
Madam Speaker! Thank you for the answer, Minister for Health and Social Affairs!
I wrote my questions to the Minister for Health and Social Affairs because I have not been able to get clarity on whether the government has implemented or intends to implement any of the measures that the National Healthcare Competence Council has proposed in the parts concerning decisions from the government. It has long been clear that measures need to be taken for the long-term competence supply of healthcare. That was also a reason why the previous government appointed the National Healthcare Competence Council.
I agree with the Minister's words regarding the importance of staff in increasing healthcare capacity and shortening healthcare queues, and that the staff is the healthcare's most important resource and the foundation upon which healthcare rests.
The National Health Competence Council has submitted a number of different reports. I will not undertake to count them exactly, but it looks to be at least 20. Examples are Competence Supply within Primary Care, Competence Supply of Midwives in Maternity Care, Joint Appointments at the Medical Faculties 2018 - 2020 and most recently Proposal for a National Plan for the Health and Medical Care's Competence Supply.
In the proposal for a national plan, there are 25 proposed measures, most of which are directed at regions, municipalities, colleges, and universities. But quite a few, about ten, are directed directly at the government, for example, to review the possibilities for national coordination of systematic and continuous continuing education for healthcare professions and to task the appropriate authority with developing a national leadership program for managers within health and medical care as well as dental care.
Other examples are to ensure that agreements for health science education, learning, and research, so-called Vulfavtal, are introduced for certain health and medical care educations in order to strengthen the conditions for workplace-based education and ensure research funds for more health and medical care educations. Further proposals are to stimulate universities and colleges to coordinate certain health and medical care educations with few students. These are only examples.
Two years ago, many and clear proposals also were submitted to improve the supply of skills within primary care, for example, to increase the number of ST-positions in general medicine and to appoint a national coordinator to work with regions towards the goal for specialist doctors in primary care.
The Minister for Health and Social Affairs refers to an investigation mandate regarding regulations and structures for personnel within health and medical care and dental care. In the directive for that investigation, I see a reference back to the work of the National Health Competence Council. I am therefore not particularly clear on what the investigation is supposed to do more exactly.
I would very much like to know more about how the government has acted in light of the proposals from the National Health Competence Council. Are any measures underway? Has the government taken a position on any of these proposals or not?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I would like to thank the member for raising these questions. It gives us the opportunity to get more people interested and perhaps involved in these important issues.
The government is working in a few different ways in parallel. Time flies. Therefore, we need to do things in parallel. One thing is that just a couple of days before they submitted their report on the plan, they gave the renewed mandate and said: You do not stop here, but you continue your mission.
We received very clear assignments to anchor, discuss, and listen to what the regional competence councils think about the 25 proposals. When we are to take the next step, we may possibly need to correct something, if they have views on that, but also obtain a collective momentum forward. The reports I have received so far are that, in general, there is great support for the 25 proposals, but there is also good feedback on what can be adjusted.
In that part, we hope to receive a final report in February and that by then, what the regional competence councils consider has been gathered together. They are also working in parallel, and their experiences and impressions also need to be taken into account in the work. Even though this is being done nationally and we agree that it is a national issue to do so, one needs to gather what they think regionally. That is why we have created that model.
Parallel to that, we are still working on the majority of the proposals. Just as the member points out, many proposals concern both Vulf and VFU. Everything concerning Vulf is included in the work of the Vulf Coordinator at the Ministry of Education. There, those proposals will be handled when the government proceeds with those parts. I think that aligns well with what the Vulf Coordinator himself came to. It feels a bit like hand in glove. I hope that the Ministry of Education finds a good way forward.
The same applies to VFU, where we have had an investigation. The proposals from the National Health Competence Council also align well with that. They are therefore handled in that work.
I am pleased that the member also highlights the investigation on specialist competencies that we have commissioned, so that we can reach a consensus on what competencies one has as, for example, a physiotherapist. It is an example of that we have such professional titles today but not a consensus on what they entail, that is to say, what competence one has. For a long time, it has been requested from the various associations of the profession that we should bring some order to the specialist competencies, so that we know what is taught in the education and what competence one has when one is finished.
Harriet Wallberg's investigation has as one leg to see which more specialist competencies we should have and how we should regulate them. The other is precisely that we need to get some form of regulation for continuing education and further education. We do not have that at all today.
One can very well say that it actually already states in the Health and Medical Services Act what responsibility an employer has. But the government's view is that since so few employees are able to participate in continuing education and further education, we need to find a clearer regulation for how it should take place.
Harriet Wallberg's investigation is therefore extremely essential. That there is a feedback loop to the National Health Competence Council is natural, so that one knows that both parts exist and are working in parallel. The results of Harriet Wallberg's investigation will arrive in the spring. We will need to take care of that, to see where it should land.
When it comes to, for example, the leadership program, it is gratifying that SKR has taken over the baton and is maintaining a national one.
Just as the member says, several issues are directly linked to employers and healthcare providers. But even there, we need to have a form of follow-up so that we can monitor if anything happens. Even if they lie with the regional healthcare providers, one still needs to know what has happened and what the situation looks like.
I hope that the National Health Competence Council in its final report will also provide proposals on how we follow up on the work that takes place regionally. A national plan is not enough if nothing happens. We need to become better at effective follow-up, which is not just checklists but which describes how it has turned out for staff and patients.
Anna Vikström (S)
Madam Speaker! Thank you, Minister for Health and Social Affairs, for the supplementary answer!
I personally think that the National Health Competence Council's proposals seem well-thought-out. They have published reports since 2020, and some of the proposals recur in several reports. They seem to be well-elaborated.
When I have asked on a few occasions previously what the government is doing with the proposals, I have always been referred to the fact that the work on the national plan is ongoing. But it has been here since the end of May, and furthermore, the council has submitted an interim report on the extended mandate that the government gave, a mandate on anchoring. It looks like the anchoring is going well. There might also be some accompanying parts. But I still find it difficult to believe that it changes these proposals completely in any decisive way. There might be some adjustments, absolutely.
Now the proposals are being anchored with other stakeholders – regions, universities and so on. But are they being anchored with the government? What does the government say in that case? Are some proposals rejected? Or has any statement been made that they are not relevant? That is what I would like to know.
I still think it is a bit messy regarding who is supposed to do what. I would very much like to have a clearer picture of how the government views the actual usability of the proposals.
Furthermore, I find it difficult to believe that the Minister for Health's views on these issues do not have significance, for example, in conversations with the Minister for Education. I hear now that there is a collaboration at the Ministry of Education, but if this is being done from a skills supply perspective, then the Minister for Health's views must be important. Different departments must work together here, as it concerns measures that truly promote the skills supply in healthcare in the long term.
The government has both said and written that it wants to strengthen the national work for skills supply. Now there are concrete proposals to address. As I mentioned earlier, this also applies to primary care.
Right now, there are 4,627 vacancies for nurses and 1,035 vacancies for doctors in Platsbanken. At the same time, approximately 13,000 nurses are not employed in their professional role.
My question to the Minister for Health and Social Affairs concerns whether the mandate of the National Care Competence Council has changed or will be changed due to warnings and reductions of staff and the mandate's effects on the long-term supply of competence. I asked this question because we know that reductions affect the attractiveness of the profession and of the employer. In response, I have received some budget figures, but that was not what I asked for.
In some regions, notices have been issued and layoffs have occurred. That is just a fact. But working with skills supply is a long-term task, so how should the authorities and the government act in this situation to reduce a long-term negative impact on the attractiveness of healthcare professions and among employers? Are the proposals that the National Health Skills Council has developed still relevant, or should they be supplemented by the council given the situation we find ourselves in? It may be a difficult question to answer, but I think it should be asked.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member for the supplementary questions.
Of 21 regions, 5 regions have issued warnings and laid off staff. The government's view was, as stated, to do what can be done to retain healthcare staff. Regions across the board have truly done that. They have done everything they could to retain healthcare staff. I think that is fantastically good, because we need every single employee.
Our joint submission also concerned the way to retain employees. The member highlighted that while perhaps 800 or 1,000 risk being laid off within Swedish healthcare, 4,000 nurses are simultaneously being sought, which demonstrates the turnover in the profession. The reasons for this can be entirely natural, such as moving or changing residence. But when it is done because the job is too heavy or that one does not enjoy their work, the employer has a major problem.
The large rotation that is occurring is a warning signal. That was also the background for why we gave the National Health Competence Council a mandate to look at what one as an employer should do to retain staff so that they feel they are developing and can remain in the profession. Perhaps one can change direction and move on to another part but still remain in the profession. That is the entire background to the council's work.
We completely share the view that it is necessary to gather strength not only to retain staff but also to ensure that it is an attractive profession. I truly hope that all the parts of the plan that concern employers are taken into account. The report I received recently shows that regional skills councils are taking this to heart and are doing what they can to act. When I myself meet regions on-site, I see that they have truly taken this to heart and want to make changes and improvements.
I understand that this won't happen overnight, but the staff must see that there is a will on the part of the employer to change the way of working. One cannot just say that one wants a good working environment, one must see that it makes a difference on-site. In that regard, the employer naturally has a great responsibility, but the National Health Competence Council contributes by providing good examples of what can be done.
Let me clarify something. Quite many parts that are also completely essential for the National Health Competence Council concern educational issues. I think the member is completely right there. We must get this in order, because it is very important. It concerns, for example, joint appointments.
Practically, the questions fall on the Ministry of Education, which will submit the bills that are the result of the various investigations and the National Health Competence Council's proposals. But the government always cooperates, and in all matters where it is relevant, we have joint preparation. The member does not need to be worried about that. There will, however, be a practical distribution when it is time for a bill or to submit proposals to the Riksdag. That is the order that has been decided for how a government works and is nothing new in substance.
That the breadth of issues is highlighted is one of the advantages of the National Healthcare Competence Council. They do not just look narrowly at things concerning the Ministry of Health and Social Affairs, but they look broadly: What can employers do? What can regions do together? What can the government, in the form of the Ministry of Health and Social Affairs but also other ministries or agencies, do? I really like that they do not start by narrowing down but instead ask the question of what the staff needs. Therefore, we have received a large variety of proposals.
Until now, we have not found anything that we have had reason to withdraw or where we have had views in a negative sense. On the other hand, there are several proposals that require preparation. Just those that concern the Ministry of Education are such. One does not write a proposition on the National Health Competence Council's plan; rather, it requires investigative work.
We were lucky to have both the VULF coordinator's work and the VFU investigation. That means we can dock these together and hopefully obtain a basis that allows us to write a proposition.
I hope that I and the government will be able to return to the Riksdag with many of these proposals. Other things will be implemented in other ways, perhaps by the regions themselves or in some form of cooperation. But what I am looking for and what I raised earlier is that we must ask the employees after a while if they have noticed any difference. If they have not, we must increase the pace.
Anna Vikström (S)
Madam Speaker! I thank the Minister for Health and Care for the answer and for the debate.
The competence supply in healthcare feels like an eternal question. I thought it was a good move by the previous government to appoint the National Healthcare Competence Council, and they have handed over many very important documents. I agree that the employer's responsibility is important. However, it is not they but the Minister for Health and Social Affairs who stands here at the rostrum, and in that case, I am primarily posing questions that directly concern the government. I still think it sounds quite positive and look forward to the possibility that there may be bills developed in cooperation with the Ministry of Education.
We in the Social Democrats, against the background of the growing staff shortage and its consequences, have raised a need for a preparation for the welfare sector's staffing. We see that one can have the preparations that exist within the defense and security areas as a model, if the effect hoped for is not achieved. There are also opportunities for a unified dialogue with many other stakeholders and actors in the area in a way that this form perhaps did not quite have from the beginning.
We have also already submitted motions regarding the so-called VULF agreements in two different committees. We are therefore slightly ahead and hope that the government will present such a bill. But we also want to see an analysis of the proposals that have been submitted by the National Health Competence Council and that selected measures are implemented. It feels like the whole thing is happening a bit undercover.
Now I have learned much more through this debate, which I am very happy about. It is important to move from words to action.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member again for raising this.
A proposal for a special preparation is always interesting. But what distinguishes this area from a defense preparation and a preparation within the legal area is that they have responsibility for state activities. If you are sitting at the table, you can say that you will do this within the police or within the defense. That cannot be done when it concerns 21 directly elected regions. In that case, a national preparation does not work, because no one has the mandate to decide over them.
That is the difference with the structure we currently have for health and medical care. I truly welcome the Social Democrats' proposal for a new party program where one emphasizes the importance of national governance and even control, as I thought I could read, of health and medical care. You will, of course, have to decide on this in the spring, but it would mean that the possibility increases to take responsibility and make decisions at a national level.
It would also make a preparation possible in the future. But for a preparation to have an effect, it must concern state activity. Sitting in a preparation that cannot influence anything and which 21 directly elected regions are responsible for, I believe, only leads to mistrust – people talk but nothing gets done.
We therefore gladly use preparations where they have the possibility to have an effect. I would like to have more national governance, but that question is being prepared in a parliamentary inquiry. Until it is completed: Warm thanks to the member for the questions being asked and for us having had the chance to exchange experiences! I see a great consensus when it comes to using the National Health Competence Council. I am grateful that it exists, that the council was appointed during the previous mandate period and that we can now continue to work with it.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.