Response to interpellation 2025/26:432 on state guarantees for investments in healthcare buildings
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns state responsibility for investments in healthcare buildings and how these affect staffing levels and patient safety. KD argues that the regions have the primary responsibility for planning and investments within the framework of local self-government 1 2. KD emphasizes that the state already provides extensive general state grants which the regions themselves get to prioritize 1 2 3. KD argues that earmarked funds for investments could penalize regions that have already taken responsibility 2. S believes that the state should take greater responsibility and provide guarantees that investments do not draw resources from the content of healthcare 4 5 6. S wants a national analysis of the maintenance debt 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.
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! Robert Olesen has asked me whether I and the government intend to ensure that extensive investments in healthcare buildings and new hospitals do not affect staffing levels, care, and patient safety.
Let me initially emphasize that good and safe care is one of the government's highest priorities. Health and medical care shall be accessible, equitable and of high quality throughout the country.
As the interpellator points out, many regions have significant investment needs. The Government is following the developments closely. It is important that investments in the healthcare infrastructure are made in a responsible manner and with a long-term perspective, where both the work environment as well as efficiency and patient safety are taken into account.
It is at the same time the regions which, within the framework of local self-government, have the primary responsibility for planning and implementing investments in healthcare buildings and for ensuring adequate staffing in healthcare.
According to the report of the Healthcare Responsibility Committee (SOU 2025:62), long-term sustainable financing is one of the greatest future challenges for Swedish healthcare. At the same time as the differences in tax capacity between the regions have increased and will likely continue to increase, the costs for healthcare will also likely rise.
In that context, I want to emphasize that the state already today provides extensive resources to the regions through both general state grants and targeted initiatives. These funds amount to significant sums and aim to strengthen healthcare throughout the country, improve accessibility, safeguard the working environment, and contribute to a long-term sustainable supply of skills.
The government also provides targeted funds to carry out necessary investments in critical functions such as electricity, water, and heating supply as well as other basic local functions through the ordinance (2023:30) on state grants to regions for measures to increase the operational security of properties for health and medical care. These measures contribute to maintaining a robust and resilient health and medical care operation even during serious societal disruptions, during heightened alert, and in the event of war.
Robert Olesen (S)
Madam Speaker! I thank the Minister for the answer, but I must state that the answer in large parts describes the problem without actually giving any information about the solution.
My question was not about whether the regions have a responsibility – we know that they do. The question was about what responsibility the state is prepared to take when the regions face very large and necessary investments in hospitals and healthcare buildings – investments that concern patient safety, the work environment, preparedness, and the long-term capacity of the healthcare system.
We have seen certain horror stories of hospital investments that have consumed quite a lot of resources that should actually have gone to the content of the care.
I therefore have a few follow-up questions for the Minister: Does the Minister intend to take the initiative for a specific state support for the regions' necessary investments in hospitals and healthcare buildings beyond that which concerns electricity, water, and heating supply, that is, the basic preparedness?
How will the government ensure that regions with weaker tax capacity do not receive poorer opportunities to invest in modern, safe, and purposeful healthcare environments than regions with stronger economies?
Does the Minister consider it reasonable that billion-dollar investments in healthcare buildings risk leading to savings on staff, care beds, or other ongoing healthcare activities?
What concrete measures is the government prepared to take to ensure that investments in healthcare facilities do not crowd out resources for staff, accessibility, and patient safety?
Will the government analyze how the regions' investment needs affect healthcare queues, staffing, work environment, and patient safety across the entire country?
Is there an intention to produce some form of national picture of the maintenance debt and the investment needs in Swedish health and medical care?
What does the minister actually mean by that the state should contribute to ensuring that the healthcare facilities can meet both today's healthcare needs and future requirements for preparedness, climate adaptation, energy efficiency, and modern medical technology?
Can the Minister guarantee that the government's current policy is sufficient to ensure that necessary construction investments do not lead to cuts in healthcare?
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! It is very unusual that it is requested that the state should have more control over how the regions shall use the state grants they receive from the state.
In two-year cycles, approximately 70 billion is paid out to the regions. They have great freedom to decide how they use the absolute majority of these funds. If the state were to step in and earmark money specifically for investments – new investments and maintenance – it would risk leading to regions that have seen to their houses and taken a greater responsibility for a long time being punished by not getting to share in what the state is going to bail out.
If one believes in today's model with 21 regions that have the right to tax and are responsible for the healthcare's buildings as well as for the healthcare's content and execution in the regions, it is reasonable that the regions are also entrusted to best use the resources where they are needed. I think therefore, Madam Speaker, that it is a bit difficult to understand what the interpellor wishes the state specifically should do in this area.
I agree with the concern that many are facing costly investments. There are also very difficult distinctions between different types of investments. The state is therefore injecting approximately 650 million just this year to secure operations in the event of war, or simply to strengthen preparedness and have robustness in its properties.
At the same time, healthcare faces major investment needs linked to new treatment conditions and the development of healthcare. Each region needs to be able to make its own prioritizations, given that they are in slightly different positions regarding both premises and other necessary investments.
This is a tough challenge ahead. Healthcare costs a lot of money, and it will continue to cost a lot of money. The regions' conditions look very different. A region like Stockholm goes several billion plus, while there are regions that struggle with deficits year after year.
To step in and rescue the regions that have not been able to make the priorities they need to make would create an injustice in the system. Given that the state grants are very large, I judge, with the organization we have, that the regions themselves need to be able to choose how much they need to allocate to investments – and increased capital costs, which is what it is rather about regarding the general grants – while still managing the healthcare mandate, the supply of competence, the number of healthcare beds, and so on.
Robert Olesen (S)
Madam Speaker! I can agree with much of what the Minister for Health and Care says. I am fully aware that municipal self-government is very important and that as a region, one has a great responsibility to finance its operations, even when it comes to investments.
What is being requested here, however, is whether the state is prepared to have some form of oversight over this, see how it looks in the whole country and perform some form of analysis that can also help the regions to prioritize correctly in these matters. It is nothing that says the state encroaches on municipal self-government if the state helps with these parts.
We want equivalent care throughout the country, and the government also says that it wants that, even if it does not always take that form in politics. The question, therefore, is still whether the minister intends to produce some form of guarantee to help the regions in this so that it does not affect the content of the care more than necessary.
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! Again: We have large, general state grants that the regions can use as they need, based on the need for competence investments in real estate or equipment that facilitates and develops healthcare. In this regard, the regions are in very different positions and have very different needs. There is therefore nothing that suggests they would be helped by us specially earmarking funds for real estate.
The government is investing a considerable sum of money, 650 million just this year, to secure the operation of the properties. It is very important. We have also tasked Socialstyrelsen to develop a model for standby hospitals to secure the healthcare provision in strategic locations across Sweden. The regions shall not be left in a situation where they feel they need to decommission hospitals and emergency rooms because they have a challenging situation with their population and tax base. This is a mission that is ongoing during the year with the aim of being able to scale up and ensure that there is a healthcare provision throughout Sweden.
So, work is ongoing to secure the healthcare provision, but as long as one wants to have this organization with 21 regions, every region must be trusted with how it uses its resources within the region for properties, healthcare staff, healthcare beds, and other things that fall under the regional mandate.
I can be tempted by the idea that the state should step in and analyze how much regions choose to spend on cultural houses or other expenditures within the regional responsibility in relation to healthcare, if that is what the interpellor means. It is something I will gladly take with me and reflect upon.
Robert Olesen (S)
Madam Speaker! The Minister refers to local self-government and to existing state grants. But my question is still whether the state is prepared to take a greater responsibility when it comes to the billion-dollar investments that the regions are facing.
It is clear that the state subsidies are, in their own way, destined from the government's side. But they are rather aimed at shortening queues and the like and not at securing the basic staffing within healthcare. Had it been a bit more, one could have secured the basic staffing within healthcare. In that way, one would also have given the regions greater opportunities to actually be able to prioritize their operations and plan more long-term.
That inadequate premises should be what prevents us from having an equivalent healthcare across the whole country is not good, nor is it that one cannot offer the best surgical opportunities because one has investments that are large and one cannot get state grants that secure this so that one can avoid making those prioritizations. It is good that one looks at preparedness hospitals, but it is one thing to point it out and another thing that it must be followed up with opportunities for the regions to finance it.
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! I would like to clarify that, of course, funds are included for the mission to secure a healthcare provision through emergency hospitals.
I also want to take the opportunity to correct the interpellator slightly. He means that these funds are primarily destined, for example, to shorten queues. That is not the case at all, but rather these in the region of 70 billion are primarily general and it is up to the regions to prioritize them themselves based on their specific conditions and needs.
It does not always sound that way from the regions, but it is a fairly small proportion that is specifically aimed at shortening queues. The one-off measures that have been talked about a lot are, therefore, about 750 million this year. If we put it in relation to the large, general state grants, we might get slightly better nuances in the debate.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.