Response to interpellation 2024/25:471 on healthcare facility development and skills 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 supply of competence needs to be strengthened 1. KD considers that the National Healthcare Competence Council's proposal contributes to a positive development and that the government is implementing initiatives to increase the number of healthcare beds 1. KD considers that a new ordinance requires regions to increase healthcare capacity and improve the working environment 2. KD argues that the state's governance must be clearer so that money leads to increased healthcare capacity 3 4. SD considers that the government and SD are implementing important reforms to strengthen the supply of competence and increase healthcare capacity 5. SD wants to invest in healthcare staff through education, better working conditions, and more career paths 6. SD wants to increase the number of healthcare beds through targeted initiatives and more efficient resource use 6. S considers that the target values developed by the National Board of Health and Welfare should be made binding in the Riksdag 7. S considers that notices and layoffs are harmful to the long-term supply of competence 7. S argues that long-term supply of competence is important and that the shortage of healthcare beds shows the need for this 8. S considers that it does not work with closures and reductions when healthcare beds need to be expanded 8. S emphasizes that the supply of competence requires national leadership and that healthcare must be equipped quickly for extreme situations 9.
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! Anna Vikström has asked me whether I assess that the measures that the National Health Competence Council proposes in its plan are relevant for the competence supply in healthcare and which measures are necessary to implement.
Anna Vikström has also asked me which measures the National Health Competence Council has proposed in its final report to the government that I and the government will implement.
Anna Vikström has finally asked me what other measures I intend to take so that the number of care beds will increase at a faster rate going forward than during the recent years regarding somatic care beds, psychiatric care beds, and intensive care beds.
Initially, Mr. Speaker, I would like to emphasize that the staff is the most important resource of health and medical care and the foundation upon which health and medical care rests. The work to secure the supply of competence is long-term, and in order to meet the care needs in the entire country, the government considers that the national commitment for the supply of competence needs to be strengthened.
The Government has therefore tasked Socialstyrelsen with preparing proposals for a national plan to improve the healthcare system's competence supply (S2023/00256). The assignment was reported on 31 May 2024, and the National Healthcare Competence Council then presented 25 different 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. In May 2024, the Government changed the assignment, and Socialstyrelsen was thus tasked with, through the National Healthcare Competence Council, obtaining views, adapting, anchoring, and ensuring that the plan contributes to strengthening healthcare capacity. The changed assignment was finally reported on 25 February this year.
The Government considers that the National Health Competence Council's work and proposal for a national plan with interventions contribute to a positive development of the competence supply in health and medical care. The majority of the proposals fall within the framework of what is currently decided by the respective healthcare provider, university, and college, and I have noted that several appropriate interventions are already underway to improve the competence supply within health and medical care. Several of the proposals submitted have been addressed in previous investigations in the area, and the proposals are now being prepared in the Government Offices.
The Government has further 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 continuing education and further education within healthcare and dental care to meet the challenges that these operations face. That assignment shall be reported by May 30, 2025, at the latest.
The government is also implementing a number of different initiatives in health and medical care so that the number of care beds will increase. The government allocates, among other things, 7.5 billion kronor to the regions to strengthen accessibility, increase care capacity, and shorten care queues.
The Government also allocates 250 million kronor in 2025 to establish a national healthcare brokerage that shall provide patients with care where there is available capacity. Furthermore, Socialstyrelsen has been tasked to distribute 500 million kronor to the regions to increase the number of hip, anterior cruciate ligament, and cataract surgeries, where many patients have waited far too long for an operation. All these measures aim to ensure that care is provided at the right level and that the country's total healthcare capacity is used as effectively as possible.
With that, I would like to thank Anna Vikström for the questions and I look forward to the debate!
Anna Vikström (S)
Mr. Speaker! Thank you, Minister, for the answer!
Among the clearest examples of the healthcare system's underdimensioning and lack of staff are the difficulties in addressing the shortage of care beds. From a longer historical perspective, it is natural that the number of care beds has decreased as a result of medical development. But there is still a gap between the calculated needs for and the availability of care beds.
The National Board of Health and Welfare wrote in a report in 2024 that there is even an urgent need to increase the number of healthcare beds. The authority saw that over 2,000 healthcare beds were missing during 2023. 18 regions had a shortage of healthcare beds, and there were only two regions that had a healthcare bed shortage of less than 5 percent. The National Board of Health and Welfare also proposed target values for average occupancy rates of 85 percent in unplanned care and 95 percent for planned care. For intensive care, lower target values were proposed.
The Social Democrats have welcomed the assignment given to the National Board of Health and Welfare in 2023 to develop a national plan to reduce the shortage of care beds but simultaneously see that it is insufficient. We believe that greater weight should be given to the target values developed by the National Board of Health and Welfare and have therefore taken the initiative in the Riksdag to make these goals binding.
Mr. Speaker! In order to be able to provide a necessary number of healthcare beds, a functioning supply of competence is required. There was an agreement with Sveriges Kommuner och Regioner regarding this area, and the national plan for competence supply was recently submitted by the Nationella vårdkompetensrådet, which should be relevant for future measures. The measures that the Minister reports are primarily measures that, if implemented and do not just become investigations, are in the right direction. But there is also a reality that the Minister is naturally aware of with warnings and layoffs within healthcare and elderly care – 677 warned so far this year, last year 6,098 within healthcare and elderly care.
The number of employees has decreased in other ways, even if the layoffs do not correspond to the number of notices. I find it difficult to imagine anything other than that reductions and notices are harmful to the long-term supply of skills. Notices and layoffs affect people who are actually needed in healthcare. How is the trust in the employer damaged in the long term? Do notices and closures give a push to trained healthcare personnel to permanently leave the profession? Working in a situation where one risks losing their job involuntarily does, in any case, definitely not provide a good working environment, which is a prerequisite for a good supply of skills.
Carita Boulwén (SD)
Mr. Speaker! I thank the interpellator Anna Vikström for giving us the opportunity to debate these important issues. We welcome the Social Democrats' commitment to these issues, but it cannot be ignored that the Social Democrats have governed Sweden for many years while the problems have been allowed to grow.
Swedish healthcare has for decades struggled with structural problems that have led to long care queues, a shortage of care beds, and increasingly pressured staff. The situation we see today is therefore not new, even though the Social Democrats usually try to make it appear so.
Previous governments have failed to take a unified grip on healthcare. But the Sweden Democrats and the government are now implementing a number of important reforms to strengthen the supply of competence, improve the accessibility of care, and increase the number of care beds.
Mr. Speaker! Healthcare personnel are the backbone of healthcare. Without enough competent staff, we cannot increase healthcare capacity or shorten the healthcare queues. Therefore, the government, in cooperation with the Sweden Democrats, has among other things decided to develop a national plan for competence supply which shall be based on concrete measures to attract, develop, and retain healthcare personnel.
The Government has tasked Socialstyrelsen with developing a national plan to improve the supply of competence in healthcare. The National Healthcare Competence Council has presented 25 proposals, including ensuring time and resources for competence development so that healthcare staff can develop in their profession without being forced to leave clinical work, creating more career paths for healthcare staff to make the healthcare profession more attractive, and reviewing the regulatory framework for specialist training and further education to meet future healthcare needs.
Mr. Speaker! Furthermore, the government has appointed a special inquiry to analyze changes that may be required in the regulatory frameworks and structures for regulated professions, specialist competencies, and further education. This work is ongoing and shall be reported by May 30, 2025, at the latest.
We in the Sweden Democrats stand for this line. Healthcare staff should have better conditions, more career opportunities, and a work environment that makes them want to stay in the profession. That is the only way to solve the healthcare system's problems in the long term. It is not possible to discuss the shortage of healthcare beds without understanding why it has arisen. It is not just about physical beds but also about a shortage of staff and staffing, which the interpellor also highlights. The Social Democrats had eight years to solve this, but they failed.
We are now taking responsibility. Therefore, the government and the Sverigedemokraterna are implementing, among other things, the following measures, which the Minister of State has creditably outlined: 7.5 billion kronor go to regions to increase healthcare capacity and shorten healthcare queues. 500 million go to more operations, particularly more cataract and glaucoma operations, which many patients have waited far too long for. 250 million go to establishing a national healthcare brokerage. Patients shall be able to receive care where there is available capacity instead of getting stuck in healthcare queues in their region. Furthermore, it is worth mentioning that a historic investment of 1 billion is being made to reduce the queues to child and adolescent psychiatry.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I thank members Vikström and Boulwén for their contributions.
Let me begin with the question of the supply of competence, which is absolutely crucial for our health and medical care. I am very pleased that the interpellator links the National Care Competence Council and increased care capacity together, because they are completely interconnected. That was also why we chose to no longer solely have agreements with Sveriges Kommuner och Regioner as steering tools, but instead have a regulation stating that one must succeed with three things to receive and retain the money – otherwise, they must be paid back: increase care capacity, shorten the queues, and spend money on competence supply and the work environment.
It is precisely this third part, competence supply and work environment, that is the key to the other two, increased healthcare capacity and shorter queues. Therefore, I am very pleased that the interpellor combines this with the National Healthcare Competence Council, because they truly go together.
It is of course interesting with initiatives from the Social Democrats in the Riksdag. However, during this parliamentary term, we have made a decision on a regulation, a governing document, which means that one must pay back the money if one does not deliver increased healthcare capacity and an improved working environment.
The interpellator also raised the issue of the many who were given notice. It is really not good to give notice to many, as it creates the feeling: What will happen to me moving forward? But pleasingly, the regions have listened to the messages from the government. We also provided 9 billion during the last year to reduce the risk of layoffs. It is very few who have been laid off from Swedish health and medical care. It is not anywhere near thousands.
When the government feared last spring that 5,000–6,000 people would be laid off, we added an additional 6 billion to the previously announced 3 billion. Collectively, this corresponded to 10,500 nursing services. Extra funds were provided so that the risk of layoffs could be reduced, and they have truly responded to that. This is necessary for us to manage the future and today's healthcare.
The national plan for the healthcare sector's competence supply contains very many different proposals. The entire final report is about 120 pages long, so it is clear that one cannot go through everything, but for every proposed measure, it is stated who has the mandate to carry it out. It also ensures that we can follow up in the future on whether the municipal, regional, and state levels have done their part and see how we should proceed forward.
I want to highlight one of the conclusions in this document, which the interpellator also mentions, namely that the regional healthcare competence councils have progressed to different degrees. One of the tasks that I believe needs to be done moving forward is to ensure that there are regional healthcare competence councils throughout the country that perceive themselves to have the mandate they need to be able to make wise interventions together. But so far, they have functioned somewhat differently. This is probably quite natural, given that it has started in this way. They need to become more united, so that they collectively have the power required when they gather all actors to take wise measures.
Otherwise, I think Member Boulwén went through the National Health Competence Council's proposals well, so I do not need to repeat them.
Anna Vikström (S)
Mr. Speaker! I thank the Minister again for the answer. That the regional health competence councils have progressed to different extents is good information to receive. That they are working on it is reassuring.
I would also like to mention another area. I mentioned earlier that only 70 new care beds were added in total in the regions during 2023. On the occasion of the anniversary of the WHO's classification of covid-19 as a global pandemic, the media have reported very much about intensive care and intensive care beds from different parts of Sweden over the last few weeks. When Socialstyrelsen conducted an annual follow-up, it was assessed that there was a shortage of around 50 care beds within intensive care and that the shortage of ICU beds was substantially unchanged. The number of beds had, therefore, not increased.
It looks like the only region that has succeeded in reversing the trend in intensive care is Stockholm. Pleasantly enough, the intensive care beds are increasing by three beds in Region Stockholm despite the national healthcare crisis and inflation crisis. But unfortunately, there are examples of intensive care beds being closed permanently in other places. We have been able to read that in the media recently.
Mr. Speaker! Intensive care nurses and other staff made heroic efforts in regions that were hit hard by covid-19. Some have left their workplaces and unfortunately also the profession. It was an exceptional situation. Naturally, it would be important with measures to try to get the intensive care nurses back into healthcare.
There are proposals for measures in the national plan for skills supply that we have discussed. Some are directed at the regions, but some are also directed at the state.
The shortage of care beds shows why long-term competence supply is so important. It does not work with closures, layoffs, and reductions in the wake of the healthcare crisis. This unfortunately occurs in several regions when the care beds should instead be expanded. This is unfortunately still ongoing.
Carita Boulwén (SD)
Mr. Speaker! During the pandemic, we became painfully aware of the deficiencies that have long existed within the health and medical care system. Much was clarified during that time. I hope that we do not end up there again, but we must have preparedness to do so. We will unfortunately likely end up there eventually.
We are fully aware that the shortage of care beds and the shortage of staff cannot be solved overnight, but we see now that powerful reforms are being implemented. Our policy is clear: Invest in healthcare staff through education, better working conditions, and more career paths! Increase the number of care beds through targeted investments and more efficient use of resources! Shorten the care queues through billion-kronor investments and better coordination!
This is the Sverigedemokraternas and the government's way forward. I really hope that we see results quite soon.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you, members, for the supplementary remarks!
Let me say to Member Anna Vikström that I am very pleased that you in the Social Democrats have changed your stance. During the last parliamentary term, you did not think that increased healthcare capacity was needed. Today, we are in complete agreement. I am glad that it is so and that we can take common steps forward.
I am also pleased that the Social Democrats now see the need for more national governance – I even believe that you express it as control. I think it is a good idea. My view is that we should have state-run healthcare, but even if we do not have that, the money we provide from the state must have an effect. That is why we have changed the form of governance during this year. It is no longer a hope that the healthcare places will be increased, but the nearly 6 billion kronor that have been paid out must lead to that – otherwise, they must be paid back. It is a completely new variant that has not existed before in the Ministry of Health and Social Affairs' area.
I completely share the member's view that it must yield results and that there must be an increase in the number of healthcare beds. For it to succeed, it is a matter of improved working environment and competence supply.
Anna Vikström (S)
Mr. Speaker! Thank you, Minister, for the answer and for the debate!
In 2020, before the pandemic, Sweden had 528 intensive care beds. Now, with a population that is several hundred thousand larger, there are fewer beds – one calculation was 490 beds. Despite the pandemic and despite the realization that the intensive care capacity was too small, the number is therefore even smaller now, even though Socialstyrelsen is clear that the number of beds needs to increase by between 10 and 20 percent.
A completely decisive piece of the puzzle for increasing healthcare beds in general is the supply of competence. To secure it, a national leadership is required. One tool is the national plan for competence supply, which we have mentioned, and the completed investigation on site-based education, vulf, which the government can proceed with directly.
Another tool is the Socialstyrelsen's proposal for measures in the national plan to reduce the shortage of care beds, which in many respects aligns with the other investigations we have mentioned. There are also completely different proposals concerning the state acting to reduce the burden of administrative requirements from national actors. I believe that is a very good proposal.
What I cannot find is an agreement with Sveriges Kommuner och Regioner regarding care places, but this has been commented on by the Minister.
Civil defense is also an important aspect. I therefore want to conclude with something that Aida Hadžialić, regional councilor from S in Stockholm, has said: Sweden is in the worst security policy situation since World War II. In that case, it is not possible to put welfare on a starvation diet. Healthcare must be reinforced to handle extreme situations, and it needs to happen quickly.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I would like to once again thank the member for the interpellation and for the broad consensus that exists that the healthcare capacity must increase. This can be achieved by improving the supply of competence and the working environment. The state's governance must also be clearer.
We may not agree as much on the primary responsibility for healthcare and how it should be distributed, but I am very pleased that we are strengthening the governance so that the money we provide leads to increased care capacity. This applies to both the preparedness and the daily care that the patients need.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.