Response to interpellation 2024/25:571 on a Nordic register for regulated professions within health and medical care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns a Nordic register for credentials within healthcare. KD considers insufficient control to be unacceptable and that the government should prioritize countering criminal actors 1. KD argues that Sweden should not compete for staff without countries taking responsibility for their own competence supply 2. KD considers that it should be made more difficult to obtain immediate workplace codes for foreign credentials due to welfare crime 2 and that a system must be found to handle differences between countries without compromising patient safety 3. KD argues that rules within two years will make it harder for criminals to work in Sweden 3. S considers that patient safety must always come first and that welfare crime must be stopped while competence is strengthened 4. S wants to prevent persons who have been stopped due to negligence from being able to work in another country 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! Eva Lindh has asked me if I intend to act for the introduction of a Nordic register of all those who hold credentials for professions within health and medical care.
I agree with what Eva Lindh writes about the consequences of a doctor who has lost their license being able to continue working in other countries. It is unacceptable if the control is so deficient. At the same time, it is important to promote an exchange of healthcare personnel between our Nordic countries.
It is the National Board of Health and Welfare that is responsible for the so-called HOSP register. The National Board of Health and Welfare also participates in the Nordic official group which for many years has regularly shared information with each other regarding, among other things, revoked qualifications in order to strengthen patient safety when Nordic healthcare personnel move across borders.
Furthermore, there is within the EU the Internal Market Information system, abbreviated IMI. IMI facilitates information exchanges between member states, and through the system, both notifications and warnings can be exchanged. Since 2008, professional qualifications have been able to be checked in the system. I currently see no reason to question the effectiveness of these systems and works.
At home, we see a development with criminal actors actively working to acquire public funds from our shared welfare systems – even within healthcare. It is a priority for the government to actively counter this. For example, in September last year, the government appointed an inquiry with the mandate to review certain issues regarding the duty of disclosure, documentation, limitations, and supervision concerning medicinal prescriptions (dir. 2024:82).
The investigator shall, among other things, analyze and propose how the regulatory framework for interim decisions regarding the revocation of authorization and the limitation of prescribing rights can be changed to better safeguard both patient safety and legal certainty for the prescriber in question. The investigator shall also analyze and propose how Ivo can gain access to additional information in order to be able to conduct an accurate, efficient, and risk-based supervision of prescribers. Furthermore, a so-called literal investigator has a mandate to submit proposals that shall improve Ivo's conditions to counter unserious and criminal actors within the health and medical care sector.
It is important that Ivo has the necessary prerequisites and powers to conduct effective supervision. The authority was therefore given a reinforcement of 30 million kronor during 2024 through, among other things, special assignments to strengthen the work against unserious and criminal actors within healthcare and elderly care. In the budget bill for the current year, the government proposed that Ivo's appropriation be permanently increased by 28 million kronor annually for the work.
Another central authority in this context is the Health and Medical Care Responsibility Board, often abbreviated as HSAN. HSAN's work with the revocation of licenses or other qualifications within health and medical care, as well as the withdrawal and limitation of prescribing rights, constitutes an important part of combating the criminal economy. The Government has therefore allocated 9 million kronor this year and estimates allocating the same in the coming years, 2026 and 2027.
Strict supervision and a strengthened HSAN can contribute to identifying professionals whose credentials need to be revoked or who claim to be licensed without being so – important information that, if necessary, needs to be shared with other countries' authorities for increased security.
It is clear that we need to continue to strengthen our own work to curb fraud and welfare crime. The Nordic cooperation is also important, and I look forward to being able to make the decisions that best benefit healthcare in all our countries.
Eva Lindh (S)
Mr. Speaker! Licensure is the most important evidence that one has the competence and knowledge required to perform the important work conducted within health and medical care. The license shall be a guarantee that one truly has that knowledge. Therefore, it is important with the registers we have so that when you hire a doctor, a nurse, or another person with a licensed profession, you can know that the person in question truly has this knowledge and competence.
In 2010, the Nordic governments decided that a register should be developed jointly for the Nordic countries, because there are many within the health and medical care sector who work for a few years in another Nordic country before returning to Sweden or vice versa. It had then been uncovered an incredibly flagrant and completely unworthy case, where very large errors had been committed and one simply had not proven that they should have the license they had received and yet were still given employment in Sweden. Therefore, it was decided that a Nordic register should be developed.
It is now 2025, and here we stand. Even though work has been done on this, abuse has still occurred during these years. It still does not work quite right, and even though this occurs at irregular intervals and is not very common, it is incredibly bad when it happens.
I submitted the interpellation because I want to know if there are further things that we together in the Nordic countries can do to ensure that this never happens again. The Minister has given a good and clear answer on what has been done and what is happening now. But is it enough, or do we need to do more? Can the Minister elaborate on his answer: Is there a stop to this now or not?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Thank you, the member, for the supplementary submission!
In the current situation it is not sufficient, and it is precisely in order to be better equipped in the legislation that we have commissioned all the inquiries.
Let me go back a bit to the ministerial council meeting a couple of weeks ago. There, we discussed that we want to facilitate for employees to be able to work in the different countries. We have different views on what a nurse should be allowed to do. One does not do the same things in every country, rather the license implies different things. To be very clear, no country wants to worsen its situation. One wants to keep what one has, and for Sweden's part, it is such that our nurses can do much more than nurses in other countries. That is something I do not want to back down from. I think we have a reasonable arrangement. Our nurses are well-educated, and we have evidence that it works well.
So there are problems, but that is also why we point out that the group of officials, as it is called, who work with the issues and who have also worked with the specific part that the member raises, should look further into whether things can be done without forcing us to make changes in our education systems, for example by finding better validation of people's competencies.
I also had a point where I highlighted two things. One is that I assume that each country takes responsibility for having the personnel it needs, that is to say, we should not compete for personnel. The Nordic countries should not start competing with each other with wages or anything else, instead, this must be built on a respect that each country takes its responsibility for having enough personnel. Then, people's own choices should be able to determine where within the Nordic countries they want to work.
So we are not going to compete against each other. We have had such situations, and it is important that we are attentive so that it does not happen again.
The second thing I raised was that this will go in a tougher direction where we actually do not facilitate the ability to work in Sweden if you have, for example, a European medical license, just as the investigation refers to. Today, we see significant risks with that when it comes to workplace codes and the prescription of medicines.
I went through for the colleagues how we work with welfare crime in Sweden, which we do by actually tightening the regulatory framework through more controls and more supervision. It is the only way to meet the criminals who step in, but it also means that there is a risk that Nordic cooperation on the labor front is hindered.
Other countries said they did not have the same problems with welfare crime. I really hope it stays there, but one can never be sure. It usually moves between our countries: if one country succeeds in closing a gap, one moves on to the next country. That is also how it works in the positive part of Nordic integration – it is easy to move on.
We thus raised both easy and more difficult issues with each other, and the basic tone is that we want to make it easier for staff to be able to work in the entire Nordic region. There are many things that can be facilitated and that are not tricky, but some are really tricky, for example when it comes to validating credentials. There, we would like to see if we can do something without any country feeling that what we do becomes patient unsafe, that is, changing the order we have. But one must remember that we are currently taking measures that make it more difficult for others to come to Sweden and work. We want to be sure that they have the competence that is required, and we have quite open doors today, which is one of the reasons for the welfare crime we see.
With an identification from another country within the EU system, you can enter Sweden and immediately obtain a workplace code and start prescribing medicines, which the taxpayers pay for. Many of those who have done so have turned out not to be working in healthcare at all, but obviously are here solely for criminal reasons. We will need to tighten measures that make it difficult for some. I have told my colleagues that everything we do will not facilitate things. But I find it necessary that we in Sweden take the measures we are taking right now.
Eva Lindh (S)
Mr. Speaker! Let me begin with the part that the Minister touched upon. We think it is important and good with exchange between the personnel who work within health and medical care. One can often get a different perspective, experiences that are important for one in the profession, inspiration, increased commitment – all such things that are important and facilitate what we have previously talked about, namely that one should be able to live and work in the entire Nordic region. But patient safety must, of course, always take precedence.
It is important to have clear limitations, guidelines, and controls so that it will be possible in the future to have an exchange and that one can work in the other countries. In a way, it is therefore not a contradiction – but it can become one, just as the Minister is touching upon. I just want that said. We are in complete agreement that it is good that there is an opportunity for staff to work in other countries. This applies primarily to the Nordic countries because it is much easier both linguistically and in other ways.
That is where the basis lies, somewhere, because patient safety is enormously important. It is clear that it cuts to the heart when something happens that has already been discovered somewhere else and could have been prevented. Therefore, these registers and all the controls we perform are truly crucial. If one has been stripped of their license in a Nordic country, one should obviously not be able to continue working in another Nordic country, for example Sweden.
Let me chime in on this matter of welfare crime, because it is completely unworthy of Sweden today. It is about an abuse of our systems that we must put a stop to. That is something we completely agree on, but our views on the path to get there sometimes differ. My view is that we must stop a number of systems that enable welfare crime.
We agree that controls must increase and that we shall do everything to stop welfare crime. It is naturally not just about resources disappearing out of the system. They do. It is also about the resources being used for other criminal activities, which makes it even worse, and about the fact that those who do not have the competence needed to work within healthcare should not also work there.
I understand the perspective that this could be a major obstacle. But I also unfortunately believe that it is not something that will stop in Sweden. It is as with other criminal activity and gang crime. When our neighboring countries alert us that Swedish gang criminals are committing crimes there, there is naturally a risk that it will spread even within this area. I am pleased with the answers the Minister gives, but is there anything concrete that the Minister considers needs to be done when it comes to this specific register?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Work is ongoing, as said. The Nordic working group for healthcare personnel continues to work on the issue in the respective agencies. It was important that we had an open conversation between ministers about the development and how it looks, not least regarding the question of competition.
We have had a situation where we have experienced that there is not quite a good balance between our countries – Sweden versus Denmark, Sweden versus Norway and to some extent northern Sweden versus Finland. We must feel that each one takes responsibility for having sufficient competence supply while at the same time individuals should have the opportunity to live and work where they themselves want.
We should not count on being able to "take" nurses from another country, but we must ourselves take responsibility for having the ones we need. That is important to me. It does not only concern our Nordic countries; it concerns the situation as a whole. There, we have different views. Denmark is working in a slightly different direction and is open to receiving labor migrants from far away as healthcare personnel. These are national decisions that, of course, one makes oneself. But my view is that we should take responsibility for having enough staff.
In our conversation, we assessed that it is probably possible, within the framework of each country's rules for identification and what is included in professions, to perform validations that facilitate for someone to enter and work. She should, for example, be informed of which limitations in delegation apply but be given the opportunity to work. It is on that line that work continues, to see the practical feasibility in delegating and validating the competence people have.
Much more can be done. None of us are prepared to compromise on patient safety. That we and our neighboring countries have slightly different views is not so complicated. It is more about finding a system to manage it. I perceive that there is a consensus among all countries. We are working on that. But it was, as said, necessary for me to raise the issue of welfare crime, because within a year or two we will have rules that actually make it harder to work in Sweden as healthcare personnel. It is so that we can ensure that criminals do not get in. It could affect people in the Nordic region who do not have that background at all but just want to come here and work. I want them to know that.
Parallel to this, we must constantly think about the balance. I often mention that we all want control, but we must not lose what is the reason why we enable work in different countries. It is a rather tricky task, but it is absolutely necessary that we do it. Many investigations are ongoing. We will see where we land. But a good conversation is taking place, and I want to say that we have very good consensus in the Nordic Council of Ministers. In that way, we resemble the Nordic Council, I perceive it as.
Eva Lindh (S)
Mr. Speaker! Yes, patient safety must always come first. That means having the conditions to stop those who should not have credentials and should not work within health and medical care. We must stop welfare crime but also strengthen competence. It is clear that it is about trade-offs, just as the Minister was touching upon.
Some of the things that we are not discussing today, but which have to do with, for example, ambulance and medical transports and other matters, are hindered by the fact that we have different requirements for competence. This can sometimes be very unfortunate, because it means difficulties for a patient to receive the care they need and that is most readily available. Patient safety must always come first.
I thank you for the debate, the discussion, or whatever one should call this. I also appreciate that the Minister has taken up the issue with the other ministers. As mentioned, it has been a few years. We want to prevent that someone who has been stopped due to negligence or errors committed in their professional practice can then continue to work in another country. We must put a stop to that. Therefore, I appreciate the answer. I look forward to this no longer being possible.
(TALMANNEN: Minister Acko Ankarberg Johansson states that she has nothing further to add.)
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.