Response to interpellation 2024/25:339 on competence supply within health and social care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
M believes that the government has strengthened competence by regulating the profession of nursing assistant, extending the Äldreomsorgslyftet, and investigating language requirements 1. M argues that investments in welfare technology and reforms to get more people into work benefit the competence supply 1. M emphasizes the importance of leadership training 2 and that the government has taken initiatives to raise competence through the strengthening of yrkesvux and support for Försäkringskassan 3. S argues that the government is cutting state grants while simultaneously setting requirements for competence 4. S believes that the government prioritizes tax cuts for high-income earners over educating nursing assistants 4 and that the state must contribute funds so that the municipalities can meet the requirements.
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 Anna Tenje (M)
Madam Speaker! Marie Olsson has asked me if I and the government intend to take any initiatives whatsoever to contribute more to the supply of skills and the raising of competence within elderly care. Marie Olsson has also asked me if I and the government intend to in some way contribute to financing the needs for competence raising that exist within elderly care and, if so, in what way.
The task of strengthening the supply of competence in welfare is complex. Even though each municipality, in its capacity as the principal, is responsible for elderly care, and even though issues regarding staffing and competence development are an employer's responsibility, the government sees a need to support the municipalities in the work of meeting challenges in elderly care. No single measure or actor solves everything, but by working together, it is possible to make a big difference for the supply of competence within elderly care and the care of elderly persons.
The supply of competence within elderly care is a priority issue for the government. We have therefore taken several measures to strengthen competence in elderly care. By regulating the profession of nursing assistant with a protected professional title, we strengthen the quality and competence within elderly care as well as increase the attractiveness of the profession. The government has also extended and developed the Elderly Care Boost (Äldreomsorgslyftet), which gives new and existing staff the opportunity to educate themselves. During the period 2020-2023, more than 76,000 employees studied within the framework of this competence initiative.
At the same time, there has been potential for development, as the state grant has not been fully utilized by the municipalities. The Government has therefore broadened the initiative with more educational areas and clarified in the Socialstyrelsen's mandate for the distribution of 2025's funds that municipalities can and should take part in the opportunities that Äldreomsorgslyftet provides to develop the competence of staff in areas that are particularly important for the operations.
Furthermore, good knowledge of the Swedish language is a prerequisite for work within elderly care to be performed in a safe manner. Sufficient knowledge of the Swedish language is of great importance both for the elderly's participation and security as well as for the work environment and for the cooperation between employees. Against the background of the deficient language skills identified by, among others, the Corona Commission, the government appointed the Investigation on language requirements for staff in elderly care in March 2023. The investigation submitted its report A language requirement for language development (SOU2024:78) in December last year and proposed that a language requirement and educational initiatives be introduced to support the municipalities in the language development work. The report is now out for consultation. The final date for response is April 4.
The budgets for the last two years, that is for 2023 and 2024, were characterized by a situation where the municipal sector's finances weakened rapidly, primarily due to the high inflation. The government therefore proposed increases of the general state grants by a total of 16 billion kronor for 2023 and 2024. These level increases are permanent, Madam Speaker, and will therefore remain in place in 2025 and onwards.
The economy of the municipal sector as a whole is expected to strengthen during 2025 compared to the two previous years as a result of the successful fight against inflation. The Government is also implementing reforms so that more people will move from benefits to work, which can also benefit the supply of skills in elderly care.
The municipalities continue to receive state grants specifically for elderly care. This includes partly the sector grant, which the municipalities can use freely to ensure good care and nursing for elderly people, and partly the Elderly Care Boost (Äldreomsorgslyftet), which is thus extended until 2026. The Government also proposes other initiatives in the budget bill for 2025 to strengthen elderly care as a whole.
The staff is, as is well known, the most important resource in elderly care. However, the supply of staff and competence cannot be solved solely with more resources or more employees; the potential in a changed way of working, digitalization, and other efficiencies also need to be taken into account. New technology can also contribute to reducing the workload and complementing the employees' important work so that more people have the strength to work longer. The Government therefore supports the introduction of welfare technology.
Madam Speaker! For the government, it is important to continue supporting the municipalities in their work to strengthen the competence of staff within the elderly care sector. We therefore continue the work with reforms in several different areas for a stronger and safer elderly care throughout the country.
Marie Olsson (S)
Madam Speaker! I would like to begin by thanking the Minister for the answer to my interpellation.
Most municipalities already face major challenges regarding the supply of competence within elderly care, and they will face even greater challenges. Many municipalities have an aging population, whose need for elderly care is increasing. Some municipalities are already facing a sharp increase in needs today.
The demographic development looks somewhat different across the country. The large cities are faring slightly better than many rural and sparsely populated municipalities. The new proposal for the equalization system could, to some extent, compensate for this. The SD government, however, seems to have stalled that proposal in the drawer, as a number of municipalities that consider themselves to be losing out on the proposal are the ones that have shouted the loudest.
In Dalarna, where I come from, there is an agreement across all block boundaries that it is high time for a new and more just equalization system. Now we shall see if, and if so when, the government dares to pull it out of the filing cabinet. In anticipation of this, many municipalities are struggling to manage the finances with a growing need for elderly care.
At the same time as the needs are increasing and the government is cutting state grants to the municipalities, the state is demanding competence from the staff working within elderly care. These requirements are fundamentally good both for the elderly and for the staff who work within elderly care. The state requires, for example, that trained nursing assistants shall be the fixed care contact within home care services. The investigation on language requirements that the minister mentioned in his response has been submitted to the government and will surely lead to the introduction of language requirements.
All this is good for strengthening the quality, patient safety, and security within elderly care. The question is only whether the government gives and will give the municipalities the conditions to meet the requirements that are set.
Madam Speaker! There is a great concern for the future of elderly care, and I do not see in concrete measures that the SD government takes this concern seriously. Significantly more decisiveness is required from the government so that we can manage to quality-assure, ensure patient safety, and create security within elderly care.
The municipalities must absolutely take their responsibility as employers and principals. But the state cannot simply be a demand machine; it must also contribute to creating conditions for the municipalities. The elderly care boost (Äldreomsorgslyftet), which was introduced by the Social Democratic government, is a concrete example of how the state can contribute to creating conditions to build up competence out in the municipalities. It is a very accurate measure to increase quality and strengthen patient safety. Thanks to all the pressure on the government to continue with Äldreomsorgslyftet, it remained. After having, for some time, reinforced Äldreomsorgslyftet with extra money, the government withdrew those funds.
Instead of ensuring that we get more trained nursing assistants in elderly care, the government chooses to prioritize tax cuts for high-income earners. I can guarantee that nursing assistants are not high-income earners and therefore do not belong to the group the government has chosen to prioritize.
Statsrådet Anna Tenje (M)
Madam Speaker! Problems with competence supply are unfortunately nothing new in elderly care. Elderly care is struggling today with the same competence shortage and work environment problems as 20 years ago, which is completely unacceptable. The need for new hires will also increase in the future, just as the member points out. It is required that we already today have a long-term and structural perspective so that we create sustainable care even for the future.
That is why I, as a newly appointed minister, chose to commission several inquiries to specifically reverse this development. We commissioned an inquiry on language requirements for staff in elderly care and one on strengthened medical competence. The deficiencies were well known from the Corona Commission, but the then Social Democratic government chose to turn a blind eye to them. But we have been working on these issues since day one.
The government's policy is completely in line with the other areas identified by the National Board of Health and Welfare. Earlier this year, the National Board of Health and Welfare released a mapping of the staff in elderly care. In summary, the mapping shows how we solve current and future competence shortages through investments in the work environment, the Swedish language, leadership, competence training, and welfare technology.
The mapping from January shows that 74 percent of those who work in health and social care think that their work is meaningful. The figure is significantly higher than in other professions, which makes me very happy. The report also shows that when the work feels meaningful, the relationship with colleagues is good, and the staff have support from the manager, the individuals enjoy their role. These are fundamental parts of a good working environment. These points cannot be understated. We also know very well what we need to invest in and base our actions on.
When it comes to the Swedish language, it is not only important for the elderly to be able to understand and make themselves understood, but it is equally important for the work environment. Feeling a sense of community with one's colleagues during the coffee break is an important part of the work environment, and the Swedish language is a key to feeling a sense of meaning. Therefore, the government's investigation into language requirements in elderly care is so important.
In order for us to meet the challenges within elderly care, the use of welfare technology is a must, something that the National Board of Health and Welfare also highlights. Welfare technology can never replace staff, but it can complement and facilitate. It is an important tool to strengthen elderly care by increasing safety, participation, and independence for the elderly while simultaneously facilitating for the staff. The Government is now working to clarify the regulatory framework to simplify the introduction of welfare technology both for those with somatic illnesses, where we have already delivered, and for persons with cognitive impairment. It is about giving agency mandates but also support to SKR to support the municipalities in introducing welfare technology.
Marie Olsson (S)
Madam Speaker! In the interpellation, I have taken the Malung-Sälens municipality as an example. It is not a unique example, but rather an example of how it can look in reality outside of this chamber and outside of the large cities. For a number of years, in Malung-Sälens municipality, the requirements for competence for those employed within elderly care have had to be lowered. There are not enough trained nursing assistants, not even enough trained healthcare assistants. The competence shortage is not the same as it was 20 years ago; rather, it has clearly worsened.
Naturally, this has consequences for both the quality of care and patient safety, even though those who are employed do everything they can to fulfill their work duties. For the staff who are trained and experienced, it also results in a high workload when it comes to, for example, the delegation of administering medications and training colleagues. The staff shortage has also meant that some employees need language support to manage the work.
I know that this situation, as mentioned, is not unique to Malung-Sälens municipality. The municipality itself invests in education in vocational Swedish and has trained language representatives out at the workplaces as support. The grant the municipality receives through Äldreomsorgslyftet only suffices to have approximately ten employees in training to become assistant nurses at the same time and not for any other educational initiative. The need to train assistant nurses is at least double, and it could have been met if the extra grant had remained.
In his answer, the Minister states that the grant for Äldreomsorgslyftet was not fully utilized, but that is a truth with qualifications. Many municipalities used it fully and others did not. The municipalities that had and still have large needs and which used the grant fully can now not train assistant nurses at the rate that is needed.
Madam Speaker! We politicians need to take responsibility for the whole country. There was a lot of talk about the heartland and the countryside during the election campaign, but it ended quite quickly after the election. The policy for the needs within elderly care needs to take significantly greater consideration of the fact that it looks very different across the country. That perspective is missing today.
Both the municipalities and the government must take responsibility for elderly care. If the state sets requirements for the municipalities, it must also be accompanied by funding so that the municipalities are given the conditions to manage to fulfill these requirements.
I really hope that the government, based on the investigation into language requirements, does not only introduce the part concerning language requirements but also includes the investigation's proposals on incentive grants to the municipalities so that they are given the conditions to raise the level of language skills for the staff within elderly care who need it.
Elderly care with quality, patient safety, and security requires an interaction between the state and the municipality, an interaction that ensures the staff within elderly care receive the conditions they need to be able to provide what they most want to provide, which is precisely quality, patient safety, and security for the elderly.
Statsrådet Anna Tenje (M)
Madam Speaker! I am fully aware that we have 290 municipalities in our country and that the conditions for them differ regarding personnel recruitment, skills supply, skills development, and the use of Äldreomsorgslyftet. Precisely for that reason, in every budget since the day I took office, I have developed Äldreomsorgslyftet by broadening it and ensuring that more municipalities can participate in it in different ways. Some municipalities have a high level of education because many have moved from care assistant to assistant nurse. There, one may perhaps need to invest in other types of training, which we have made possible. Other municipalities have other needs. We have tried to broaden this state grant so that there are no hurdles when it comes to being able to participate in it. I believe, in fact, that this is one of the few targeted state grants that makes a big difference. Furthermore, Sveriges kommuner appreciate this grant very much.
We are investing in training in the Swedish language this year, but we also support minority languages and sign language.
I also want to emphasize the importance of being able to utilize the Äldreomsorgslyftet to invest in leadership training, which I believe can be the single most important measure to improve the work environment and create better conditions to attract future nursing assistants to these important jobs. Investing in first-line managers has been a clear call from me to Sweden's municipalities. The municipalities must prioritize and provide leaders with the right competence and conditions to exercise good leadership where employees are heard.
It is not only through Äldreomsorgslyftet that the government strengthens elderly care and tries to curb the skills shortage, but we are also adding 900 million kronor to yrkesvux. Health and care educations account for 38 percent of yrkesvux, where there are people who hopefully will eventually become a part of elderly care all around the country.
In Socialstyrelsen's mapping, which I raised earlier, it was also demonstrated that nursing assistants within elderly care are on sick leave twice as much as the average. Let me, Madam Speaker, illustrate the importance of addressing this issue.
The Socialstyrelsen report states that if the number of sick days for nursing assistants were to decrease to the average number of sick days in the labor market, it would mean an increase of a corresponding 6,000 years of work - 6,000! If one succeeds with only half, it would result in very many more hours worked that can help solve the skills supply in the country's various municipalities.
Employers must take their responsibility to counteract sick leave, partly to solve the skills shortage in their own municipality, but above all because they do not want their employees to be on sick leave and feel unwell. All the incentives are here to prioritize these issues.
For that reason, Madam Speaker, I invited the SKR leadership together with representatives from Kommun- och Regionsverige to a round-table discussion to issue a sharp appeal to them to work on these important issues. There is a self-interest and a self-value in reducing sick leaves within these important professions, but then we must work together. Above all, they must do their part.
The government has put many different proposals on the table to contribute to a faster return to work. My sharp urge to the country's municipalities and regions is that they must do their part.
Marie Olsson (S)
Madam Speaker! The Minister said in his answer that the staff is the most important resource in elderly care. This is something that I completely agree with, and where we are in full agreement, but the municipality and the state need to help each other to give this most important resource - the staff - the conditions to perform a good job so that the elderly receive good care and support.
Unfortunately, I cannot see in the government's budget that what the Minister says in his answer matches what the government chooses to prioritize. I can state that the SD-government chooses to prioritize tax cuts for those who earn a lot over investments in elderly care. It is the answer to those municipalities that already have great needs within elderly care and where the needs are constantly increasing.
It is also the answer to the nursing assistant who has received approximately 150 kronor in tax reduction per month while the minister has received several thousand more in their wallet every month. The nursing assistant needs their tax reduction, but neither the minister nor I as a member of parliament need our large tax reductions. That money would do significantly more good within elderly care.
Politics is about priorities. For me and for us Social Democrats, elderly care is significantly higher prioritized than the large tax cuts that the SD government gives to high-income earners.
The Minister concludes his response by saying that it is important for the government to continue to support the municipalities in their work to strengthen the competence of staff within elderly care. I would wish that the Minister dedicated his concluding remarks to describing what concrete initiatives the government will make for the elderly and for the staff within elderly care.
Statsrådet Anna Tenje (M)
Madam Speaker! One would wish that some interpellation debates were given more time and more space, and this is definitely one of them. I would like to thank you for the interpellation and for the debate on this important issue that affects many in Sweden, both employees within elderly care and people who are dependent on it.
Elderly care is a question of the future. More and more of us are becoming older, which is fundamentally something very positive and a success story for us. It is a consequence of the prosperity that has been built up in Sweden and something that we really should be proud of.
However, challenges are not lacking, and above all, within elderly care, the supply of competence is the hardest nut to crack. The Government has taken countless initiatives to curb the competence shortage and increase competence within elderly care through a developed and broadened elderly care initiative, reinforcement of yrkesvux, and additional funding to Försäkringskassan to improve support for return to work and rehabilitation. These are just some of the proposals that we have put on the table recently.
The question is complex, and for that reason, we are taking action from several sides. But we need to have the employers with us, and regardless of the government's reforms, elderly care remains a municipal responsibility. The government has provided resources that we expect to be used effectively.
With good leadership, good use of welfare technology and the right support, the trend can be reversed. That is how we create good and sustainable elderly care, both for the elderly and for the vital staff.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.