Response to interpellation 2024/25:157 on surgical waiting lists
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that Sweden has world-class health and medical care but that high costs for operations and pensions have hit the regions' finances hard. KD advocates for a new care guarantee based on the patient's needs, state one-off interventions, increased resources to the regions, as well as a national care brokerage. KD emphasizes the importance of staff and wants to improve the supply of competence. KD believes that Sweden has too few care beds and that the system is choked when staff spend time prioritizing instead of providing care. KD argues that national care brokerage is a digital database that improves access to information 1. KD believes that the regions are making good efforts but are affected by displacement effects 2. C argues that the queues have structural backgrounds and that the government's proposals are the same as those previous governments have proposed without results 3. C believes that structural measures are needed rather than money or one-off interventions 3. C advocates that patients should receive information about quality and waiting times as well as be given the power to seek care where the queues are short 4. C argues that capacity can be increased through better organization of the work 4. C believes that the government's proposals do not address the underlying structures behind the capacity problems 4. C argues that the power to choose inpatient care must lie with the patient and that the Patient Act needs to be changed to enable this 5. C gives the government a grade of "not approved" as the situation is just as bad as before 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! Anders W Jonsson has asked me what additional measures I and the government will take to shorten the long healthcare queues.
Sweden has a healthcare system of very high quality - world-class. At the same time, it is a fact that far too many must wait to receive care. There is a need to create a closer and more accessible care on equal terms throughout the country. The high inflation of recent years has resulted in high costs for operations and pensions, which has hit the regions' finances hard.
The government therefore gave an investigator a mandate in June 2024 to analyze and propose a new and strengthened healthcare guarantee with significantly shorter time limits (dir. 2024:50). The new healthcare guarantee shall, more clearly than today, be based on the patient's need for care. The mandate includes, among other things, to provide proposals for measures, if necessary, that strengthen the conditions of the primary care providers and healthcare providers to fulfill the healthcare guarantee and comply with the Patient Act (2014:821). The investigator shall also provide proposals for one-off state interventions aimed at shortening healthcare queues and waiting times. That part of the investigation shall be reported on January 2, 2025.
The government is also implementing a number of other initiatives in health and medical care. The proposals that the government submits in the budget bill for 2025 involve a total of approximately 18 billion kronor within my area of responsibility, the majority of which goes to the regions.
The Government is pushing for the regions to increase healthcare capacity and allocates 7.5 billion SEK for this purpose next year. The Government also strengthens the conditions for healthcare through an additional sector grant to healthcare amounting to a total of 2 billion SEK during 2025.
Furthermore, the government is accelerating the work to establish a national healthcare brokerage so that waiting patients can be offered care in another location if the waiting time where they live is too long. National healthcare brokerage aims to achieve the goal of accessible and efficient care with shorter waiting times. The government proposes that 250 million kronor be allocated for this work during 2025. The work consists, among other things, of developing methods to make available capacity visible.
I would like to conclude by underlining the importance of the staff for increasing healthcare capacity and shortening healthcare queues. The staff is the healthcare system's most important resource and the foundation upon which healthcare rests. Against that background, the Government has given Socialstyrelsen a mandate to develop proposals for a national plan to improve the healthcare system's competence supply (S2023/00256). The national plan shall, among other things, show which measures are needed, both for existing and for new healthcare staff, to improve the competence supply.
I thank Anders W Jonsson for the interpellation and look forward to the debate.
Anders W Jonsson (C)
Madam Speaker! I thank you for the answer. I can agree with the Minister for Health and Care that we have a fantastic healthcare system in Sweden. But it has obvious problems in some areas. One of the most important is precisely this issue with accessibility. Other comparable countries do not have the same problems with having to stand in a queue week after week, month after month, before one gets through and receives their operation, receives their treatment, or gets to meet their specialist doctor.
This is nothing new, Madam Speaker. This is how it has been in Sweden for decades, I would say. It is clear that one must then understand that it has structural backgrounds. And every government has tried to solve it in its own way.
I remember the high-flown rhetoric from the Minister for Health's party during the election campaign. The queues were illegally long. It violated Swedish law. The word "criminality" perhaps wasn't used, but it was close. The person responsible was the then Minister for Health.
Therefore, expectations were quite high that something would happen when the Christian Democrats received the position of Minister for Health and Care. But if one looks at SKR's statistics on waiting times, one sees that absolutely nothing is happening. Or rather—it is more like that the queues are becoming longer today.
That is why I submitted the interpellation to the Minister for Health and Social Affairs. I assume that the ministry carefully analyzes this statistics. My question was what additional measures will be proposed.
The Minister for Health and Social Affairs has pointed out four different areas. If one has been involved in this discussion for a longer period, one sees that it is exactly the same as what the previous government came up with. Some of the proposals are even remaining from the alliance government's and Reinfeldt's time.
The first proposal is that the healthcare guarantee should be tightened. The previous government commissioned an inquiry, the accessibility delegation, which also came up with proposals on how to tighten the legislation. The Alliance government also made changes to the legislation at one time and tightened the healthcare guarantee. It was believed that by a legislative change of which times and limits should apply, a solution to this problem would suddenly be reached.
The second proposal is that one should make state one-off interventions. I assume that means the state should step in and specifically fund a certain number of hip operations, knee operations, or other. Even that is something we have tried before. But neither does that solve the structural problems fundamentally.
The third proposal is that additional billions should be sent to the regions. This, I would say, has been tested since the late 90s, when the so-called "cannon money" were intended to shorten waiting times in healthcare.
The fourth proposal is also something that has been part of the discussion, namely a national healthcare brokerage, an office somewhere in Stockholm where one should be able to see where the available capacity is across the country and where there are operating rooms where the staff are sitting and twiddling their thumbs waiting for new patients. In that case, I want to refer to what Vårdföretagarna says. Is there any healthcare capacity to broker? No, one only has to look around Sweden today – it is not the case that there is available capacity somewhere just standing and waiting. It is structural measures that are needed.
I would like to supplement my question, because the Minister only comes up with the same old proposals as all governments throughout history. Those proposals have not led to any result. What is the analysis from this government's side? What is it due to that we, in Sweden specifically, have had unreasonably long healthcare queues for decades? It is only when that analysis is complete that measures can be taken that actually have an impact, and not this type of "more of the same." More of the same has not led to anything previously and will not do so now either.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member for raising this question, which is a priority for the government.
Let me start by talking a bit about how the figures look. They are a bit more complicated than the member is now highlighting. Those who have waited more than 90 days for surgery or the first visit to specialist healthcare are a specific group. Last autumn, there were approximately 285,000 waiting. This spring, in May, there were 100,000 fewer. Now this autumn, after a summer and a healthcare conflict, it is back at approximately the same levels. There are, therefore, huge fluctuations during a year in Swedish health and medical care. Fantastic things are achieved, but the patients return. This truly confirms what the member highlights regarding structural problems that make it so that much is achieved but not in the long term changed how one works.
We can add that the operating capacity in May was back at the same level as 2019 - 100 percent. This is followed here in the register Spor. We were really back with the operating capacity that we needed. But it is not enough to have 100 percent. We must increase significantly more than to 100 percent to manage all those who are waiting in the queue. It shows that we must think in a different way, which we are now also doing.
When we adopted the budget in the autumn of 2021, my party and others contributed to something significant. Then, for the first time, we wrote that Sweden has too few healthcare beds. For a long time, the mantra had been the opposite: We shall reduce the number of healthcare beds, for that is how we measure medical development.
There are parts of this that are correct. That medicines can replace admission, that medicines allow one to shorten treatment times and that day surgery in many interventions can be done without admission is fantastically good. We shall continue with that.
But the number of care beds has decreased too much. That means that healthcare staff today spend more of their time than they should on reprioritizing and reprioritizing again. When I visit wards around Sweden, they tell me how half an hour to an hour is spent on making the extra list of who should be discharged if the surgical capacity is insufficient, even though they don't actually think they should be discharged. The fact that they even have to spend time making extra lists instead of caring for patients shows how skewed the system is.
There are, however, good examples. Let me highlight Gävleborg, where I was visiting a while ago. There, one can practically always use full capacity in their operating rooms. They have, in fact, found a good system. It is the profession that has found a good management. They almost always have full operating capacity and see the entire region as a whole.
I spoke with the staff and asked: Doesn't anyone need to take parental leave for childcare sometimes? Aren't you sick? I mean, that should happen. They answered: Yes, but we can solve that.
This shows that they have good management, where the profession is involved in the steering, and also that they have a good working environment. They find a way of working that makes it work at the workplace. There are, therefore, good examples in the country.
For me, it is extremely important to highlight the good examples but also to ensure that we identify the things that cause it to take too long. An investigation was therefore commissioned this summer. It was to look at bottlenecks within imaging diagnostics, radiology, and pathology. It turned out that they were not quite as we thought. They were in slightly different places than one could have expected. But the type of work that is currently taking place, not least within the RCCs, is essential to be able to shorten times and find what is wrong.
We want to release that power properly. On Friday, the update of the national cancer strategy from Mef Nilbert will be released. We will see what she finds.
I will return to this in the next post, but somewhere it is also actually about tweaking the system in the form of a care guarantee or other things to create the right drivers. We do not have that today when we do not go by need but on 90 days. This does not align with a patient's needs - that I can say.
Anders W Jonsson (C)
Madam Speaker! Fluctuations regarding waiting times have existed in all years. It is exactly as the Minister describes. Before the summer, the queues are shorter, but after the summer, the queues are longer. That is why one must look at this on an annual basis, and there is, therefore, no change between 2022 and 2023. We do not have the figures for 2024. That is why I request an analysis.
The Minister is somewhat on the right track. The problem is that we have too low capacity in Swedish healthcare, and there is another interesting example there. When I travel around the country and meet orthopedic heads, I usually ask: How many hips do you operate per day and per operating room? Then I get the answer: two, three, four, or five hips. It is not a difference in economic resources or in how much staff one has for the individual operating room, but it is a question of how one organizes the work.
Can one then go from two hips per room to three hips per room, one increases the capacity by 50 percent. That is why the political question becomes: How do we create structures in healthcare in Sweden to encourage this and ensure that people work in a different way so that we can build up surgical capacity and healthcare capacity in the long term? It is not impossible. It is not always about money. It is not always about a lack of competence. And there are good examples.
I am thinking of the neighboring country Denmark, where they essentially have a system where individuals themselves decide where in Denmark they should be operated. It is also opened up so that one can be able to access this information. For patients, it is very difficult today to know what the waiting time is and what the quality looks like.
Let us say that one were to only make that change: One would give patients information about quality, ensure that all patients had information about how long the actual waiting times are and - finally - give them the power to then be able to seek care in places where the quality is high and where the queues are short. Then we would get a completely different dynamic in Swedish healthcare. This is what one has seen in Denmark.
This would also mean that the healthcare units that today see an opportunity to increase their capacity could do so. Then it is not about whether there is available capacity tomorrow, but rather about increasing their capacity in the long term when there is a stable regulatory framework that a broad majority in Sweden's Riksdag stands behind. Then one would have the possibility to increase the capacity.
In the discussion with Vårdföretagarna, it was said: This is simple. It is obvious. This is something we could do. But we cannot do it by tomorrow or by next week. Above all, we cannot do it if we do not have a structure, a legislation, that actually opens up for this and provides dynamics. It is one of two reasons, actually.
One can travel across the strait to Denmark and meet our Danish colleagues. There, it is not the same problem regarding accessibility. One has significantly shorter queues. But nothing of what the government has proposed breathes any signs of wanting to do something about the underlying structures and the background to why we in Sweden have these capacity problems, but it is more of the same methods that we have used for decades, I would say. We know the effect of them. I am thinking of the Accessibility Delegation. Nothing came of the result. We have also previously been able to see that it does not lead to anything if one does not make the structural changes.
That is why I asked in my previous question: What is the government's analysis? Why does it look like this in Sweden but not in other countries? It is only when that analysis is complete that one can propose other measures than just this.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! One must be very much in opposition if one first says that what the government proposes is rubbish and then says that this is what should be done – and then says exactly what the government does.
National healthcare mediation is not an office in Stockholm. It is a digital database where one can see what the waiting times look like. One should also be able to input quality there. That is why Vårdföretagarna welcomes this measure from the government.
This system will begin to be tested in the near future - it will of course be a pilot - to see how it works. A number of operations have been entered. One must, in fact, learn the system. There is quite a lot that differs in terms of ASA assessments and many other things. One must, so to speak, know which factors should be included in the system.
This healthcare search system is about to be established. We will test it for a period to learn. I believe it is wise that we actually build this ourselves. We have been able to see examples of that it might not always be optimal to just pick up systems from other places. There is therefore a point with us building it ourselves with the help of Ehälsomyndigheten and the 21 regions.
It is precisely this that is needed for the profession to be able to give good information to the patient. The doctor says: I assess that you need this operation. At our hospital, we cannot give it to you right now, but here and there there is available capacity. How do you feel about being operated on there?
It is precisely that information that both healthcare providers and patients shall have access to, and that is the system we are building. It will be developed gradually. I believe it is wise that we do it step by step so that we learn. But it is precisely this that a national healthcare mediation is.
This, however, clashes with Denmark and the investigation we have regarding the healthcare guarantee. They have a 30-day guarantee in Denmark. There, the focus is mostly on that the own region should arrange care for you within 30 days. If it cannot do that, you have the opportunity to seek care somewhere else. If a bit more time has passed, you can even seek care abroad. Those are the Danish rules.
When it comes to specifically achieving a healthcare guarantee where the focus is more on needs than on the 90 days, we have commissioned an inquiry. I note that it is being very well received by both the healthcare authorities and Vårdföretagarna. We need to find a healthcare guarantee system that aligns with the new way of working, which the member actually describes and which I and the government are working with.
One does not, therefore, need to think that everything the government does is wrong, especially not when it proposes the same as one thinks oneself.
It is essential that patients have access to information. I believe that the first step will be that they have access to waiting times in different ways. I want to say that the waiting time databases we have today are not good. It is information from a long time ago. We cannot get real-time information, and there are quite few data points. Now, Imy has also shown that there is a lack of support for a very large amount of the data collection that takes place. We therefore need to make a change also when it comes to the waiting time database.
The Government's view is that we would rather take a collective grip on everything – it concerns waiting times, the healthcare search system and a national healthcare brokerage – so that we have a system that hangs together for both patients and healthcare providers.
It should be said that SKR tried to create a healthcare search system or a national healthcare brokerage a couple of years ago. But they said: We gave up. It was difficult to do it.
It proves that it is a rather tough task we have taken on. We receive many inputs from the regions when I have meetings and conversations with them regarding the national healthcare coordination. But I perceive it as them seeing advantages with this. We can get a much better and more equal access to health and medical care by showing where available capacity exists.
I really look forward to this. It is about the measures we have taken. The question of need-based care is essential in the investigation that Anna Nergårdh is working on and leading. In my next contribution, I will explain why we must ensure that we do not get displacement effects.
Anders W Jonsson (C)
Madam Speaker! This is what has been requested. You must have the information, and this is part of what is contained in the directives regarding the investigation. But it is not enough for the patient to have the information. The important thing is also: Where does the power lie? Who is it that makes the decision on where I should be operated? It is about introducing the possibility that the patient de facto has the right. It is then not dependent on a doctor saying: I do not have available capacity here. It is completely okay that you go somewhere else in the country. In line with the Patient Act regarding outpatient care, i.e., that it is you as a patient who today makes the decision where you want to have your specialist visit, it shall also be you as a patient who makes the decision where you want to have inpatient care. Today, it works in healthcare that when you visit an orthopedist who says that your hip is worn out and you must be operated, the next sentence is that we put you on the waiting list here at our hospital.
We must turn this around. The power to make that decision should lie with the patient. The obstacle lies in the Patient Act; today, as a patient, one only has the right to choose outpatient care anywhere in the country. But it says nowhere in the directives to the investigation that one should also go in and look at this. If we see to changing the Patient Act so that it becomes possible to apply for inpatient care all around the country, we have the basis for a system that, in the long run, can do something about the lack of accessibility.
We will be able to follow this very closely, and so far I would say that the government receives the grade fail. The situation is just as bad today as it was earlier.
There are almost two years left until the election, and this will be one of the issues that determines whether the government has succeeded in solving one of the truly major problems in Swedish healthcare, namely the lack of accessibility.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you to the member for raising this question!
I want to say that the regions have made many good attempts to shorten the queues. Let me give an example: One thinks that one must ensure that those with severe cancer receive care at the hospital. They are the most prioritized, so they are kept, while one, if I simplify something, buys a knee or something else that we can buy privately in town. But those who work in the private operation have left their position at the hospital for a period to work privately, whereupon the hospital, because it has lost employees and labor, cannot provide the care that the region itself has judged as most prioritized.
We have quite a few such examples from the regions. One wants to do the right thing, but it results in a displacement effect.
It shows that when one writes agreements and makes such somewhat larger investments, the regions need to work together. Therefore, we have given Anna Nergårdh the assignment to, together with the regions, find a model for a good way forward. She is to present this on January 2.
How do we manage to perhaps, during a concentrated period, handle the queues that plague patients and staff? What I am concerned about is not the choice, but it is the patients who every day wait for care and who need just that specific care. It stands very clearly in the directives that one should also be able to choose in inpatient care, and then one must gradually change the law. But the order is that the investigator themselves looks at which legislative changes are needed for the proposals, and then one returns. That is how it works in all state investigations, and so also in this one.
Just as the member says, I believe it is necessary to think anew. Let me therefore conclude with a good example from Helsingborg Hospital. There, some time ago, there were terrible waiting times for those who had bladder cancer. Approximately 7 percent received care in time. A wise nursing assistant sat down and began to reflect on what it was that made it take so long at the hospital. She found the errors, gathered everyone involved, and ensured that all lead times were shortened. Today, they manage somewhere around 50-60, sometimes 70, percent within the correct time, this without adding any money.
Through wise employees who are allowed to make their voices heard, good changes can therefore be achieved.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.