Response to interpellation 2024/25:424 on the management of healthcare in Västernorrland

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Malin Larsson has asked me on what grounds I base my critical stance regarding the proposal to change the operations at Sollefteå Hospital and what I mean by the statement that the region should take a new approach.

It is the healthcare authorities, with directly elected politicians at the municipal and regional levels with taxing rights, who are responsible for providing good health and medical care in accordance with the provisions of the Health and Medical Services Act (2017:30), abbreviated HSL. Within the framework of municipal self-government, municipalities and regions have great freedom to choose where and how, for example, emergency medical care shall be conducted.

From the HSL, it appears, among other things, that the region shall plan its health and medical care based on the need for care among those covered by the region's responsibility for health and medical care and that the region shall plan its health and medical care so that disaster medicine preparedness is maintained. The law further states that the region shall organize the health and medical care activities so that care can be provided close to the population. If it is justified by quality or efficiency reasons, the care may be concentrated geographically.

The development towards a more local care with a focus on primary care aims to be able to meet the challenges that the health and medical care faces and at the same time have control over the costs. This requires changes in the structure and the way care is organized. The overall objective is to ensure the conditions to provide the right care at the right time and in the right place in a clearly level-structured system and always based on medically prioritized needs. This also involves partially changed roles for the hospitals based on the needs of the population and the development of other health and medical care.

With this said, a robust and accessible healthcare system with preparedness for crisis and war is also a fundamental prerequisite for ensuring good care. Therefore, it is crucial to carefully analyze what consequences the decommissioning of acute care can have, especially in a time when Sweden is strengthening its preparedness.

I am aware of the challenges in healthcare, which are also affected by the economic situation in the regional and municipal sectors. Inflation and higher pension costs have pressured the regions' finances. The state cannot fully compensate for the regional sector's deficit, but to mitigate the worst effects, the government added a total of 9 billion kronor during 2024 through two sector grants specifically aimed at healthcare, in light of the regions' challenging economic situation.

Even though the economic situation has now improved, the situation remains challenging for the regions. The Government therefore allocates 2 billion kronor in an additional sector grant for 2025. Furthermore, the Government allocates just under 3.7 billion kronor through the new government grant ordinance on good and close care, which replaces the previous agreement and provides increased clarity and predictability. An additional 5.9 billion kronor is allocated to the regions according to the new government grant ordinance on strengthened accessibility and appropriate care capacity within specialized health and medical care.

With this, I would like to, Madam Speaker, thank Malin Larsson for the question and I look forward to the debate.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Malin Larsson (S)

Madam Speaker! Thank you to the Minister for the answer!

Today's healthcare does not look like the healthcare did a few decades ago, and the future's healthcare will not look like the healthcare does today either. With new technology and new medicines and treatment methods, Swedish health and medical care has made great progress in recent decades. This makes it so that we feel better and live longer today. Many of the diseases that were previously fatal can today be cured or treated, and many become chronic conditions that one lives with for the rest of one's life. It is good that we can live a good life longer, but it also means that the need for care increases and that more and more people will have to share the resources that health and medical care has today.

In order for us in Västernorrland and the rest of the country to be able to meet the future needs of healthcare, it is required that we transform healthcare. This requires, among other things, changed ways of working, that we utilize the possibilities of technology, and that we place a greater focus on primary care, which the minister also touched upon in his speech.

In Västernorrland, we have also had a declining population; it has decreased by 25,000 people since 1970. In Sollefteå and Kramfors alone, the decrease is 20,000 people. At the same time, the proportion of elderly people has increased in the county, and it is particularly clear in these areas. The elderly are a patient group that has greater healthcare needs and therefore require more resources from the healthcare system.

Region Västernorrland, which I belong to, has the second most expensive hospital care in the country and spends the second least on primary care. Very recent figures show a trend break in the costs for hired personnel, thank goodness, but despite this, we still have the largest shortage of hired staff in the country.

These are circumstances that have caused our regional politicians to now carry out structural changes. Part of this is changes in the hospital structure in the region – today we have three hospitals – precisely to reduce costs and rental dependency but also to create a long-term perspective in the economy, which in turn will create a scope for action for development and improvement.

The political majority, consisting of S, M and C, is now taking its responsibility to ensure that all the county's citizens have good healthcare. Based on an external review of the hospital structure during the past year, a mandate was given to the civil service management to return with proposals for changes. Just a few weeks ago, the proposals were presented. They proposed, among other things, larger changes at Sollefteå hospital with a reduced activity as a result.

The Minister for Health Care was quick to appear in the media and criticized the civil servant proposal and urged the region to rethink regarding Sollefteå hospital. This also shows that the minister tried to influence the decision-making by telling the region how she thinks they should prioritize in their operations.

Therefore, I want to ask the Minister what range she considers it reasonable to have in a county such as Västernorrland, against the background of how the demographics look, the medical developments of recent years, and the economy.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, Member, for the question! Let me begin with the parts that the Member so wisely highlights, namely that we have the opportunity to feel better thanks to fantastic healthcare but that we still do not always do so. Sick leave is increasing with many people experiencing mental ill-health, stress, and much more. In those cases, we do not reach them with the best care and help. We improve welfare conditions in many ways, but we cannot always balance them with better health. It is one of the challenges we have ahead, i.e., to also in that perspective transition so that we actually respond to people's needs.

When it comes to large parts of healthcare, we are at the top of the world. The care is truly of international class. But when we simultaneously face how the situation looks – very many, around 40 percent is usually counted, of those in the waiting rooms of health centers or community clinics seeking for exhaustion depression, stress or mental ill-health – it turns out that we do not quite meet the needs.

There is, therefore, a great need for good and local care, as the member highlights, in order to better, more person-centered, and more coordinated respond to the population's needs. This very division is indeed special. It shows both that we have fantastic world-class care and that we simultaneously do not have the accessibility that is needed.

But what is Västernorrland's challenge is probably not a lack of good and close care. You do that excellently in Västernorrland. I have visited Kramfors and the operations with the SPOT teams there, as well as the work in Näsåker and much more. There are a lot of good development opportunities that I repeatedly spread to the rest of Sweden. But the challenge is preparedness. It is about the big question that the chamber has just discussed for over an hour: How are we to handle the new security policy situation?

The interview that the member referred to was not conducted after the investigation was released; rather, it was conducted on Monday the week before. I had therefore not received the investigation, and I did not comment on the investigation either, as it did not exist at the time. Then TV4 chose to broadcast my interview much later, which has led the member to have that impression. But the interview was, therefore, conducted on Monday. It is possible to verify this with TV4 if one so wishes.

I stand by the fact that a new approach is needed. Now, I believe that those in power in Västernorrland think that what they are doing now is a new approach, given the long history there has been regarding Sollefteå hospital. I have, of course, read the investigation and also the appendix concerning preparedness. They have been forward-thinking enough to look at preparedness issues and made an assessment from that perspective. They have, therefore, not only looked at healthcare in normal times but also from a preparedness perspective. I also want to give a plus to the fact that they are working with their own capabilities and not always bringing in outside consultants. They have started from those who already exist in the operations. I believe it is an advantage when conducting investigations not to only have outside consultants but to work with those who exist locally and regionally.

In the report, we can see – I am reading it aloud now – that literature reviews have been conducted of much of the legislation and the ordinances and regulations that exist. Then it states that some communication has been had with the Armed Forces during the autumn of 2024. There, one perhaps needs to deliberate even further with the Armed Forces in Sollefteå based on the security policy situation: How do they view the needs there? How should we think forward and get this across the finish line together?

I note that my own party is united regarding how this is viewed in Västernorrland. I believe the municipal council meeting there is still ongoing. The question is not decided, and at the same time, we are discussing this in the chamber of the Riksdag. But several other parties are divided, which shows how difficult a situation it is for the council in the region to make decisions. In that case, it may be wise to ensure that all alternatives have been examined before the final decision is made.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Malin Larsson (S)

Madam Speaker! Thank you, Minister, for the answers so far! It is very pleasing that the Minister has visited the county and seen all the good work being done. Our regional politicians are working very hard to develop the care we have with the scarce resources available, which must suffice for more and more. Now the Minister highlighted some good examples from a part of the county.

I can also tell you that we in Överturingen have a digital care room, where one can connect to healthcare to avoid making long journeys. Sweden is, after all, a long country, and Västernorrland is a very large county. It is not only in certain parts of the county that we have long distances, but particularly in western Medelpad, one has incredibly long distances to healthcare. Finding solutions that enable good and close care for all citizens in our county is very important.

Then the minister takes up the issue of preparedness. It is very important. We know that it will be important going forward. But it is not just about us having premises, it also requires that we have personnel resources, and not just in one place right in our county but in several places in the county and in the country. The problem here is that there are no national directives from the government yet. That the minister should then express an opinion on an issue where the government itself has not provided either financial resources or directives can, I think, be a bit strange.

Unfortunately, there are fewer babies in our area and the population is getting older. That is where we have the basic problem. Between 2022 and 2030, the proportion that is 80 years and older will increase by a full 32 percent. It is a challenge. The care that one often needs, primary care, is the care that we must expand and make more accessible for the entire population everywhere and not in a certain area. Specialist care, the care that one rarely needs, we must focus on making so specialized and competence-supplied that it can continue to be offered. This means that it is centralized to fewer locations, because there simply are not enough trained people in the country.

What it is about now is to transform healthcare and work smarter to meet today's and, above all, the future's challenges. Therefore, I can think it is remarkable that the country's Minister for Health has expressed a critical stance towards the structural changes. Our regional politicians are actually taking their responsibility so that we get good care for all citizens.

The Minister has previously stated in the media that she thinks our regional politicians should take a new approach: "I believe that a new approach is needed in Västernorrland and to ensure that Sollefteå has good and patient-safe care." Does the Minister stand by that statement?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Yes, it would have been strange if I had not considered that the people of Sollefteå should have good, safe, and patient-safe health and medical care. It is stated in the law. Had I expressed myself in any other way, I think the members would have had to raise it.

As said: The interview was conducted on Monday in connection with another press conference where I also answered these questions. The investigation itself had not arrived. I could not comment on it, because it did not exist in the world of thought. I did not have the opportunity to look at it. I have therefore not commented on it.

My assessment concerns what is happening in Västernorrland and in many other places, where things are being changed slowly. I am not specifying this to Sollefteå, but it is about what happens in many places when one competence after another is slowly moved away from the healthcare operations. Eventually, after many years, one has to conclude: Now we cannot continue to operate a hospital with emergency services.

I believe that it is a bad way to handle structural changes. I believe that one needs to make them more concentrated and precise, if they are to be made. Slowly moving one thing after another is not a good development. Instead, one needs to take responsibility for the whole in a different way.

I perceive that the regional council today has the opportunity to make decisions on how one wishes to proceed. I believe that both the member and I can say that everyone is taking responsibility. That is what one thinks one is doing based on one's situation and the perception one has on the issue. It is quite obvious that parties make different decisions and that there are split opinions within parties. It remains to be seen what the council's decision itself will be today. I understand that from the governing majority, it is considered that one has just made a course correction. The council must judge today whether one has done so and if it is sufficient.

I will never back down from the fact that the people of Sollefteå need good, safe, and patient-secure healthcare, as this is stipulated by law. This mandate belongs to every member of the regional council.

I would have liked to have a state care. I believe, in fact, that there is a point in pointing this out nationally: How should we have the healthcare? Where should we have the different competencies? It is far from houses that it is about, but it is about competencies, the employees' knowledge. Where should they be in the country? Where should we have the larger nodes, which supply the others with a lot of competence? How do we need to expand the other network, which is much more finely grained? I think that this is a state task.

When one distributes this to the regions – there are 21, and they are self-governing – the whole is not in sight. It is, of course, about what one can take responsibility for in its own region and about the economic means one has.

But what I am raising now is not possible to implement unless the Healthcare Responsibility Committee, with all parties, chooses to see this in a different way.

I note that several professions are raising these questions. Most recently, it was the Hospital Doctors, who in a debate article just raised that we would need more national governance. It remains to be seen what the parties in the Riksdag think about that. My party thinks that more national governance is needed, but today it is the regional politicians who have the responsibility. There should also be good, safe, and patient-secure care in Sollefteå.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Malin Larsson (S)

Madam Speaker! That the healthcare structure in our county is being reviewed is definitely not a new issue. It is an issue that has been pushed, pulled, and investigated both internally and externally many times, and there have been many proposals over the years. But the basis is that we have a declining population, and we will have a significantly older population moving forward.

One must also act according to the current situation and, above all, the economy. The money must suffice for more. They must suffice for better care and good care for everyone who exists in our county and our country, I would like to say.

Everyone needs good and patient-safe care. That has also been the starting point for our regional politicians back home. That can be seen when one looks at the proposals that exist.

I can think, Madam Speaker, that a better insight into and understanding of what challenges actually exist out in the regions and especially up here in the north, with the long distances and a declining population in some places, would be needed.

We also see that this government has chosen to close service offices now. They are closing down and moving both Sidas offices and the Folke Bernadotte Academy from Västernorrland. Thus, they are moving jobs that exist in Västernorrland to Stockholm. It is also a population base, and it is about us being able to have more healthcare and more welfare.

I know that the Minister has received an invitation to a dialogue and to visit Region Västernorrland following her statements, but despite the Minister considering this to be an important issue and having had clear views, she has not freed up time to actually visit Västernorrland and have this dialogue. Will the Minister visit Västernorrland in the near future?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! My next regional tours are to Jönköpings län and Västmanland – in the near future. I was in Region Jämtland Härjedalen quite recently. The last visit was in Skåne.

But this is not in the near future. It is just as good to say that, so that the member knows about it.

The Council has a proposal to take a position on today. The investigation has been very clear that it is not simple to quickly reduce costs, because new costs will arise elsewhere, above all new costs for transport. The net saving is 46 million annually, which the investigation has taken a position on. I think it is wise that one does not just calculate gross but actually looks at the total costs.

I note that Sollefteå municipality raises exactly the perspective that the member does: It is a matter of ensuring that as many as possible want to stay in Sollefteå, i.e., to secure the population base. Therefore, a decision has been made that they would like to support the hospital remaining in various ways. There may be formal reasons why they cannot do this from the municipality's side based on the responsibility they have, but I share the municipality's view that it is important to have activities on site.

A defense expansion is underway, and it is precisely this question of readiness that I have raised in my discussions. Based on the expansion of the regiment and based on the position that the Riksdag has judged to be important in Västernorrland – with the expansion of the regiment in Sollefteå – one also needs to look at the healthcare needs.

Ensuring that there is sufficient healthcare also enables the regiment to develop in the way it wants. One gets a better population base.

Then there is always the difficult question: Will they commute, or will they settle there? If one has a functioning welfare structure in place, the chance increases that they will actually want to settle there. There is therefore much to be gained by thinking as Sollefteå kommun does and by doing what can be done to retain important welfare functions. It strengthens Sollefteå kommun, and it strengthens all of Västernorrland.

The interpellations debate was hereby concluded.

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