Response to interpellation 2024/25:323 on the Health and Medical Services Act
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 Health and Medical Services Act and the hospitals' inability to fulfill the care guarantee. KD argues that the regions are the primary bodies and responsible for accessibility 1. KD emphasizes that the government provides support through investments in care capacity, efficiency delegations, and an inquiry for a new, need-based care guarantee 1 2. KD denies that the state should distribute resources since the regions have their own taxing rights 2. S argues that the government is dodging responsibility by shifting economic problems onto the regions 3. S criticizes that hospitals deliberately minimize purchased care to save money 3 4. S demands that the state invests in staff and resources to ensure compliance with the law 4.
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! Yasmine Bladelius has asked me how I view the fact that hospitals are breaching the healthcare guarantee and thereby breaching the Health and Medical Services Act. Yasmine Bladelius has also asked me what measures I and the government intend to take to ensure that all regions follow the healthcare guarantee and do not make illegal prioritizations for economic reasons. Yasmine Bladelius has finally asked me how I and the government intend to support the regions to ensure a sustainable economic situation that simultaneously enables care to be provided in accordance with the requirements of the legislation.
I would like to emphasize initially that it is the regions, as the primary providers of health and medical care, who are responsible for good accessibility to health and medical care. Increased accessibility to health and medical care is, however, a priority issue for the government, and several measures are being taken to support the regions in this regard.
In recent years, waiting times have continued to increase, and the statutory healthcare guarantee has never been fully met since its introduction in 2010. I view it seriously that patients have to wait longer than the healthcare guarantee's time limits. The Government considers that a new model for the healthcare guarantee is needed that is clearer and sharper and is based on the patient's need for care. In June 2024, the Government gave an inquiry the task of analyzing and proposing a new and strengthened healthcare guarantee with significantly shorter time limits (dir. 2024:50). The assignment includes, among other things, to propose measures as needed that strengthen the conditions for the primary care providers and healthcare providers to fulfill the healthcare guarantee and follow the Patient Act (2014:821). In January 2025, the inquiry submitted a partial report of the assignment with proposals for one-off government interventions aimed at shortening healthcare queues. The proposals are being prepared in the Government Offices, and the Government will return in the near future with a more detailed announcement.
The government is also implementing a number of other initiatives in health and medical care.
During 2025, the government will allocate, among other things, 7.5 billion SEK for the regions to increase healthcare capacity. The government also proposes in the budget bill for 2025 continued reinforcements of the health and medical care in the regions, including by extending the sector grant that is given specifically to facilitate the regions' economic situation.
The Government has also established an efficiency delegation for health and medical care at Kammarkollegiet. The delegation shall assist the regions with analyses, propose measures that can increase the operations' efficiency, and disseminate good examples. The delegation is also responsible for a temporary state grant for measures for an efficient health and medical care. Earlier this year, a region review function was also established at Ekonomistyrningsverket, with the primary mandate to review the regions' economic situation. The Government is also working intensively on the establishment of a national healthcare brokerage, which aims to make the entire country's healthcare capacity available to patients and to cut queues within health and medical care.
I would like to conclude by underlining the importance of the staff as the healthcare system's most important resource. Against that background, the Government has given the National Board of Health and Welfare 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 what measures are needed, both for existing and for new healthcare staff, to improve the competence supply.
Access to health and medical care is an issue that will continue to rank high on my and the government's agenda. With that, I would like to thank Yasmine Bladelius for the questions and look forward to the debate.
Yasmine Bladelius (S)
Mr. Speaker! I naturally want to thank Minister for Health and Welfare Acko Ankarberg Johansson for the answer to my interpellation. But unfortunately, many of my questions are left unanswered and several important aspects remain untouched in the answer. The Minister notes that the regions bear the primary responsibility for health and medical care. We are well aware of that. But the responsibility for distributing the state's resources lies with the Minister and the government she sits in.
The Minister and the government can, for example, choose to lower the tax for people such as myself and the Minister, by thousands of kronor a month. Or one can put the money on a healthcare system in crisis.
The Government has a full mandate to ensure that the regions, which provide healthcare, have sufficient resources to fulfill their mission to provide residents with good care in a timely manner and to manage to comply with the Health and Medical Services Act, the law for which the Minister is responsible and which, among other things, states that care shall be provided according to need and within a certain timeframe.
To constantly do as the government and the minister do and shift the responsibility onto the regions without simultaneously providing them with the economic conditions they need is not to take responsibility. It is to duck the problems.
The Minister highlights in his answer several initiatives, such as investigations, efficiency delegations, and proposals for new healthcare guarantee models. But, Mr. Speaker, what we see here and now is that hospital after hospital is running with large deficits. The healthcare staff are working under unreasonable conditions. They are on their knees. They cannot run faster. So we see the patients, who do not receive the care they have a right to and not at the right time either.
I still think the Minister for Health is responsible: How do further investigations and delegations help the healthcare staff who are currently on their knees? How does it help the patients, who do not receive care in time?
Mr. Speaker! During the past year, the hospital in my home municipality, Helsingborg, has violated the healthcare guarantee and thus also the Health and Medical Services Act on several occasions. Region Skåne's patient committee has received 90 complaints from patients who were denied being sent to other hospitals, even though the hospital has not had the possibility to provide them with good care in a timely manner.
According to the chairman of the hospital board and the minister's party colleague Anders Lundström, the Christian Democrats have deliberately chosen to minimize purchased care in order to save money. This has resulted in 2,319 fewer patients receiving purchased care compared to the previous year, while the goal of saving a lot of money has not even been achieved. We Social Democrats have repeatedly criticized this and pointed out that it is not compatible with Swedish legislation. It is a development that undermines trust in the entire healthcare system.
I mean, Mr. Speaker, that the government has a responsibility to act. The healthcare guarantee is not a recommendation; it is a law.
My question to the Minister for Health and Care is: Does the Minister consider it completely okay for regions to break the law, and how will the Minister act to ensure that the regions have the conditions required to not do so?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you, the member, for the supplementary questions and comments!
In Sweden, all public activities operate under the laws. We do not place ourselves above the law, but we work under it. This means that one must follow the distribution of responsibilities that the Riksdag has decided upon, that is to say, which tasks municipalities and regions have. It also concerns the Health and Medical Services Act, the Work Environment Act, and all other laws. Everything must be followed simultaneously.
I am fully aware that municipal and regional politicians sometimes think it is too much: the demands are too large, and they do not think they can manage it. But both municipalities and regions have, according to the Riksdag's decision, been given their own tax base. Municipalities collect municipal tax, and regions collect the regional tax. They are of slightly different sizes. The region collects about half as much, but they also have a different operation which is generally smaller than the municipalities' operations. But that is where their base lies.
The state does not levy taxes on the inhabitants to pay for healthcare, because the Riksdag has decided that it is the regions and partly the municipalities that are responsible for healthcare. Therefore, they have their own right of taxation, and it also means that they have full responsibility for the healthcare they provide.
At the same time, it is exactly as the member says: If one sees deficiencies, they need to be supplemented from the state's side. What I am opposing with my reasoning is that the member said that the Minister for Health or the government shall allocate the state's resources to healthcare. We do not do that. That is what is done in Denmark, where the state decides entirely over the financing and the regions are providers of healthcare. I think that model is something one should consider further, and there is an opportunity to do that in the Committee on Health and Responsibility.
But that is not how we have it in Sweden; instead, the full responsibility lies with the regions. We have no state healthcare except for a small trickle, where we have responsibility for certain patients within the Prison and Probation Service regarding healthcare and so on. But that is an extremely small part.
The responsibility lies with the regions. The government has chosen to nevertheless provide support in many different ways. Many governments have done this, so it is nothing new. But what the government has focused on is to provide support for increased healthcare capacity. We choose steering mechanisms, and we have hereby left the phase of agreements that cannot be steered or monitored. It is now clear in the ordinance what the money is for. We have announced that 5.9 billion goes to this part. They go towards increasing healthcare capacity, towards shortening queues, towards increasing accessibility, and towards improving competence supply and the work environment.
The third part is the way there. One will not succeed in increasing healthcare capacity and getting more employees who can perform the job if one does not improve skills supply and the work environment.
Almost the entire country needs to take measures, and that is why we are directing the money to this. It is a clear regulation. This is to be achieved, otherwise the regions must pay back the money at the end of the year. It is a clearer and sharper steering from the government's side to the regions to succeed in achieving this.
I am a bit concerned that the member is scoffing at the government appointing an inquiry. Again: We have that order in Swedish administration. We do not make decisions because I read something in the newspaper in the morning, but we have a solid inquiry that states how we should proceed. Consequences, for and against, are reported, and then the government makes a decision after referral.
This is also how we do it with the healthcare guarantee. It has been necessary to review the healthcare guarantee. I regret that we have not done it earlier. But I do not believe that any of us have proposed it earlier, rather it is now that we have decided on it. The healthcare guarantee has not been implemented in its entirety at any time since it was introduced. We have a common problem when we have promised a law and decided on it in the Riksdag and it has not been implemented.
Now we say: Redo it! And above all, change the perspective and move away from fixed time limits! Is 90 days need-based? For me, it is not. It must be need-based in a different way and be decided in meetings between healthcare staff and the patient: When do you need your operation?
I really look forward to the commission's proposal, and hopefully the commission will find a model that can work. It will be difficult, but that is why it is important that we now do what we can to shorten queues so that we do not enter the new healthcare guarantee with worse conditions.
Yasmine Bladelius (S)
Mr. Speaker! It is obvious that we have a healthcare system in crisis in Sweden. The healthcare staff are on their knees. With the policy that the government has pursued so far in its budgets, we now see how hospitals are forced to lay off and dismiss staff at hospitals that already suffer from a major staff shortage in order to manage their financial problems.
Mr. Speaker! It is not the Minister or I who suffer from this on a daily basis, unless we seek care. On a daily basis, it is the patients who need care who suffer from this. It is the healthcare staff out on the floors who pay the price when the healthcare guarantee cannot be upheld and when the requirements of the legislation are set aside.
Even though the situation in Helsingborg is unfortunately not entirely unique when it comes to living up to the healthcare guarantee that we have decided upon in the Riksdag and which is law - even though we are now reviewing it, the healthcare guarantee is the law that applies today - Region Skåne stands out. Even the own patient committee has pointed out to Ivo that the law is so deliberately not being followed.
It is, of course, remarkable that a part of the right-wing-led Region Skåne reports another part of the same region. It still says a lot, Mr. Speaker, about how far the cutback policy has gone. It shows quite clearly how a low-tax policy has consequences for the patients' need for care and the healthcare staff's right to a good working environment.
Mr. Speaker! I mean that the government still has a responsibility to act. I say it again: the healthcare guarantee is not a recommendation. It is a law. When hospitals all over the country are unable to meet these requirements due to savings and underfunding, the state must step in and ensure that healthcare in Sweden functions. It is about protecting both the patients' rights and the healthcare staff's working environment.
In Helsingborg, the chairman of the hospital board, Anders Lundström, Kristdemokraterna, has himself said that the cuts are a way to manage a tough economic situation. Then the question must still be asked, Mr. Speaker: How can the government defend a policy that leads to hospitals cutting back on care while the healthcare staff are being pushed to the breaking point?
We Social Democrats believe that the solution is not to save our way out of the crisis. The solution is quite simply to invest our way out of the crisis. We need more training places for staff, we need better working conditions for healthcare staff, and we need long-term sustainable resources for healthcare. Furthermore, the government must ensure that the regions have the economic conditions now, in the acute crisis, to be able to follow the healthcare guarantee and live up to the Health and Medical Services Act.
My question to the Minister is therefore: What concrete measures does the government intend to take to ensure that all regions can comply with the current legislation?
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.