Response to interpellation 2025/26:587 on measures against micro-management in elderly care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 M argues that the municipalities have the freedom to adapt elderly care but that statutory quality requirements must be met 1. 1 2 M emphasizes that a lack of leadership is a fundamental problem and that the government has appointed an inquiry to strengthen the competence of managers 1 2. 1 M highlights that the government has permanently increased state grants and strengthened the Äldreomsorgslyftet 1. 2 M argues that minute-management is a symptom of a lack of leadership and that physically present managers create a better work environment 2. 3 M argues that resources have increased every year and that claims of cuts are incorrect 3. 3 M emphasizes the importance of improving the work environment and reducing sick leaves 3. 3 4 M has introduced a competence supply plan, a protected professional title, language requirements, and legal support for register extracts 3 4. 4 M welcomes proposals to stop minute-management 4. 5 V argues that municipalities make cuts to achieve positive results 5. 5 V believes that the government has chosen efficiency instead of increasing and indexing state grants 5. 5 V wants to introduce a national crisis commission to provide resources, hire more people, abolish minute-schedules, shorten working hours, and stop the pursuit of profit 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Äldre- och socialförsäkringsministern Anna Tenje (M)
Mr. Speaker! Nadja Awad has asked me whether, since I took office, I have taken any concrete measures to reduce or abolish the detailed management within elderly care and, if so, which measures.
Mr. Speaker! In Sweden, we have a system of municipal self-government. Elderly care falls within the municipal area of responsibility. This naturally means that the municipalities have both an obligation and a freedom to manage and adapt elderly care based on their local needs. Today, we see that there are large differences between municipalities in how home care is managed. Some manage in more detail, others have a more flexible management. I want to emphasize that regardless of which management model the municipalities choose, statutory quality requirements within elderly care must never be disregarded. The elderly have a right to good and safe care, and the staff have a right to a good working environment. From the provisions in the Social Services Act (2025:400), it follows that the activities within social services shall be of good quality and that everyone who performs tasks within the social services' activities shall contribute to ensuring that the interventions carried out have good quality. This applies to all providers, regardless of the form of operation.
Meeting the needs of the elderly, creating security and a secure care relationship, and adapting the care work to the individual's current health status and needs is important for maintaining quality within home care services. This presupposes sufficient time, continuity regarding the staff, and a certain flexibility. The municipalities, as employers and procuring authorities, have a great responsibility in this matter. By, among other things, changing work methods and strengthening leadership, one can significantly improve the balance between management and flexibility in the execution.
In order to strengthen the municipalities' conditions to carry out their welfare mandate and thereby manage and organize elderly care in line with quality requirements, the government has taken several concrete measures. Recently, the government appointed an inquiry that shall submit proposals on strengthening the competence of managers within elderly care through a so-called leadership training for managers within elderly care to improve their conditions to lead and manage the work (dir. 2026:26). The purpose is to ensure safe and secure care and nursing for the elderly by strengthening the conditions for a sustainable competence supply. The assignment shall be reported by April 2, 2027, at the latest.
The municipalities' conditions for governing and organizing elderly care are also affected by the availability of staff and financial resources. Therefore, the government increased the general government grants by 6 billion SEK in the budget bill for 2023 (prop. 2022/23:1) and 10 billion SEK in the budget bill for 2024 (prop. 2023/24:1). The level increases are permanent. The municipalities also continue to receive targeted government grants for elderly care, such as the sector grant, which the municipalities can utilize based on their own conditions and needs. The sector grant amounts to just over 4 billion SEK for 2026.
In the budget bill for 2026 (prop. 2025/26:1), the Government has also strengthened and expanded the Elderly Care Boost (Äldreomsorgslyftet). It is proposed that the competence initiative be extended to 2027 and cover 1.8 billion SEK per year for 2026 and 2027. The Government notes that the Elderly Care Boost has had an extensive impact on operations and assesses that it is important that the municipalities continue to have the opportunity to train staff within this framework even after 2027.
On July 1 of this year, the language requirement in elderly care entered into force. Language skills are incredibly important for improving the work environment and can contribute to attracting new employees and, above all, retaining the employees who already work in elderly care.
The Government assesses that the national commitment for the competence supply in elderly care must be strengthened. On July 16, the Government therefore tasked Socialstyrelsen to propose a national plan for the competence supply of elderly care (S2026/01521). The plan shall, among other things, state what measures are needed for how new employees can be attracted to the profession, how more can be motivated to stay in the profession, how staff who have left can be lured back, and how the competence of existing staff can be developed. The assignment shall be reported by December 10, 2027, at the latest. I definitely look forward to this.
Nadja Awad (V)
Madam Speaker! Prime Minister Ulf Kristersson has probably never had to say that he cannot afford to buy clothes for his children. But the nursing assistant Sandra has, who says that her mother chips in money so that she can buy clothes. Herself, she only has a cup of tea when the children eat dinner when things are tight financially.
Ebba Busch has probably never had to apply for sickness benefit from Försäkringskassan because her body was worn out from working in elderly care. But the staff in elderly care know exactly what it means, as it is currently the most frequently signed-off occupational group in Sweden. A single woman and nursing assistant who is on sick leave and has been denied insurance from Försäkringskassan contacted Oskarshamns-Nytt to say: "I am really in the shit – I have no one who can help me."
Jimmie Åkesson probably never had to take time on how long he is allowed to be in the toilet or shower. But for Curt, a toilet visit can take max 10 minutes and a shower max 30 minutes, according to the minute-management in Umeå.
Simona Mohamsson has probably never had to miss a lunch break just because she didn't have enough colleagues who could have relieved her. The elderly care staff, on the other hand, avoid drinking rehydration fluids during the hottest days of summer to avoid time-consuming toilet visits, and they can almost never take their full legal lunch break.
Minister for the Elderly Anna Tenje has probably never been forced to eat a Findus box seven days a week. Annelie Persson in Hjo has grown tired of microwave meals. She says: Taste-wise, it's starting to hit a wall – it is not good.
Finance Minister Elisabeth Svantesson has not paid the penalty fee that the quarantine deduction is at any time. Of the government's 24 ministers, none have reported being sick during the mandate period. Thus, everyone has escaped the quarantine deduction, even though several state councilors have had to cancel assignments due to illness. But healthcare assistants worry about being sick and thus having to pay a penalty fee of thousands of kronor every year.
Madam Speaker! It is not the first or the last time I draw these parallels. As a Member of Parliament for all of Sweden's inhabitants, I want to be part of creating a society, not parallel societies where the economic and political elite do better for themselves and each other while the working and lower classes – call it ordinary people – get worse off. We politicians shall represent the entire Swedish people, not our own interests and the very richest.
The time pressure in elderly care has always been widely known. But it has worsened over the years, also because the government and the Sweden Democrats during these four years have prioritized lowering taxes by over 100 billion kronor, which has primarily benefited the very richest. As a consequence of that, Sweden's municipalities and regions have reported year after year that they are running with deficits. There are fewer staff members, worse wages, worse working hours, and increasing workload.
Despite the fact that the government and the Sweden Democrats are raising the demands on the staff, sufficient state resources are not being provided. Those who have to pay the price are low-paid healthcare and care staff – in the form of worn-out bodies – and elderly care recipients who receive worse food and meet more substitutes than they would have liked. At the same time, the Tidö parties have voted down proposals from us in the Left Party that would actually save elderly care for real.
My question to Minister for Health and Social Affairs Anna Tenje is: Why should the workers in elderly care and the elderly recipients of care give the Tidö Government renewed confidence when they feel they have been so gravely betrayed for four years?
Äldre- och socialförsäkringsministern Anna Tenje (M)
Madam Speaker! The member delivered something of a rhetorical speech from the rostrum. I must state that it was mostly about beautiful words and striking formulations and very little about the actual work.
The member takes as an example Kurt, who was given 10 minutes to go to the toilet and 30 minutes to shower. I assume it is within the home care service in Umeå that the member describes. If it had been reality behind the proposals and the beautiful words that the member had in their opening statement, would it not have been better if one had taken action and made the change on the spot in Umeå instead of standing here in the speaker's chair today and talking about what should be better? The member and the member's party rule in Umeå, after all.
I completely agree that it goes completely wrong in very many parts of the country when one fixates on the minutes, lacks the flexibility and, above all, lacks the leadership. The minute-management in elderly care is a symptom of a much, much larger problem in elderly care. It is precisely the lack of leadership.
During my numerous visits around the country, I can state that where there is a physically present leadership, where there is a manager who is equipped and furthermore has both the administrative manager and the committee behind them, the work environment is significantly much better. There, the number of sick leaves is lower, and there, relatives are significantly much more satisfied, and above all, I meet safe and secure elderly people who also have a joy for life.
What I believe is needed, in many ways, as I also mentioned in my opening remarks, is a very large upgrade of the leadership within Swedish elderly care. The investigation that I recently commissioned, which Acko Ankarberg Johansson is now leading, shall look at precisely those questions of how one strengthens the leadership within Swedish elderly care.
It will obviously not solve all the problems. But it will be very important pieces of the puzzle. It is symptomatic that where there has been an investment in leadership, there is a significantly better situation. There, it is often not minute management that is the planning tool one de facto uses to ensure that the elderly receive the care and the attention that they need and are also entitled to.
So it is not a problem in those municipalities or in those home care groups where there is strong and good leadership. I have said it many times before. If a representative for the municipality called me to ask for my views and advice, I would not recommend introducing minute-management. We also see, municipality after municipality, and especially moderately-managed ones, abolishing minute-management and instead investing more in leadership.
When managers have time for their employees, when employees are seen and heard and have influence over their work situation, it is also noticeable in the quality of elderly care. Given that the supply of competence is the hardest nut to crack in Swedish elderly care, it is obvious to us that it is leadership we must invest in to be able to recruit new employees and retain those we have. The purpose of the investigation is to see how we can get back all the skilled, competent nursing assistants who have left the profession for other assignments.
Nadja Awad (V)
Madam Speaker! I just want to correct a factual error. Vänsterpartiet is not involved in governing in Umeå.
The Minister for Older Persons highlights the importance of the major overhaul of leadership but does not want to speak about his own leadership. The Minister for Older Persons is responsible for the entire country's elderly care based on what the government itself can do through legislative changes and state financial resources.
It is regrettable that the Minister for Older Persons, in every debate, wants to refer to everyone else's responsibility and the responsibility of the municipalities and regions to ensure that we have competent staff who can afford and have the energy to work a full professional life and to ensure that the elderly receive the care and support they are entitled to. But she refuses to speak about her own leadership and how it has fallen short for four years.
I have not met a single nursing assistant who is satisfied with how her work situation looks. It is a consequence of the government, with the help of the Sweden Democrats, having cut the state financial resources to the municipalities and regions so that they are running with deficits.
There have been other priorities that have been important. For example, tax cuts for the very wealthiest, as I mentioned in my opening statement. The tax has been lowered by up to 110 billion kronor over four years, something that has primarily benefited the very wealthiest, instead of raising and indexing the state grants to the municipalities.
What has been the consequence? It is very exciting that the Minister for Seniors is also the Minister for Social Insurance, isn't it? On one hand, you are cutting the state financial resources to the municipalities so that we have fewer staff members running to more elderly people. They wear out their bodies and simply cannot afford to give their children food or buy clothes to ensure they do not freeze during our coldest winter days.
When we, on the other hand, have completely exhausted elderly care workers who apply for sickness benefit, they are disqualified by Försäkringskassan. The government presses the working situation for assistant nurses and healthcare assistants with one hand so that they break down. When they are then signed off on sick leave for a long period, they do not even receive sickness benefit, or they are disqualified and end up in poverty.
It sounds like a perfectly bourgeois moderate cycle. One follows the entire cycle. That is what it becomes when you have a Moderate-led government which, in this case, leads the country's elderly care and social security system.
I wonder if the Minister is proud of the work that has been done for the nursing assistants. Is one proud that they are being worn out? They carry a very great professional pride. I have not met a single nursing assistant who does not love their job and is passionate about it. But they do not have the conditions to be able to continue working for an entire professional life. Is the Minister for Older People proud of the work that the government has done for the nursing assistants?
Äldre- och socialförsäkringsministern Anna Tenje (M)
Madam Speaker! It is a bit difficult to know where to start here when there are so many issues to work through. My entire portfolio was contained in the member's speech. I intend to break it down.
I want to start by apologizing. It was an incorrect attack to accuse you of sitting in power in Umeå. There, one needs a lot of help and support, and there, one definitely needs a change of government in the municipality. We will see who they will be in the government after the election.
I will start by fact-checking. First and foremost, the resources for elderly care have increased every year for quite many years. To say that cuts are being made is directly incorrect.
The opposition is now painting a rather dark picture of how the situation looks in Sweden's municipalities. SKR, Sveriges Kommuner och Regioner, shows a completely different picture. From the economic report, it appears that 187 municipalities show a positive result already in 2025. It is an overwhelming majority. Furthermore, the future looks significantly much brighter even when it comes to the other municipalities.
I have also looked at the finances in the different municipalities. There are very many social welfare committees where they are on the edge but still show positive results. What it depends on is that one rather has problems with recruiting staff. I believe we can still agree on that. The work environment within Swedish elderly care must be improved.
We must ensure that more people can move from part-time to full-time and manage a full working life.
We must definitely ensure that sick leaves decrease, so that people are at work and can work. But it is also about being able to hold out.
This is one of the basic prerequisites for also being able to attract new staff and for new people to want to work in elderly care. But it is obviously also about what I mentioned and which the investigation has a mandate to look at, namely how we can get back all those who have left the profession. It is absolutely crucial.
Securing the necessary skills is the hardest nut to crack, but it is perhaps also the most important. That is precisely why it was so important for me not only to point out that it is the responsibility of the municipalities and regions, but also to give this assignment regarding a skills supply plan. Just as in healthcare, the state is now responsible for developing a skills supply plan also for elderly care – precisely to help and support municipalities in working better and more proactively to be able to recruit and also retain the staff they so desperately need.
When it comes to single-person households of nursing assistants, the government has ensured that they have 3,200 kronor more in their wallets every month than they had before we took office. It is 3,200 kronor to buy more food for. With reduced food VAT, it also results in a cheaper grocery bag. It is lower fuel prices, so that they can get to and from work, which is not always next door. Above all, it is about ensuring that the children get to their extracurricular activities. It is 3,200 kronor that allows them to buy more clothes when it starts to get cold outside.
But the question is what you get with Vänsterpartiet – which promises everything to everyone and which will then have to negotiate with the Socialdemokrater, who already have a budget hole of 50 billion. Yes, then it is as it usually is. Then it is the hard-working nursing assistants, factory workers and police who have to pay for that party instead and who are left with significantly less money in their wallets when the tax is deducted. It is definitely not to stand on the nursing assistant's side and ensure that she has more money left over and fares better.
Nadja Awad (V)
Madam Speaker! I would like to thank the Minister for Seniors for this debate.
I have a few closing remarks. Municipalities can report a positive result after they have cut back on operations, so that it is a smaller group of trained staff working and who need to take care of more. That is how municipalities unfortunately need to manage today's economy. They need to make cuts in order to be able to achieve a positive result.
Instead, one could have increased and indexed the state grants as soon as this government was appointed. But one chose not to do that. One thought that either the municipal tax would be raised or cuts would be made in welfare activities because – in the Minister for Seniors' own words – it is important to streamline the work.
We in Vänsterpartiet see a completely different path. That is why we have repeatedly raised – just like Kommunal, PRO, and SPF Seniorerna – that we need to take elderly care seriously by introducing a national crisis commission. It is about looking at what resources need to be added, how many more we need to hire, and in what way we can abolish minute-by-minute schedules, reduce working hours, or stop the pursuit of profit. These were our initial demands, and we got the entire opposition on board with the proposal for such a national crisis commission. But the Tidö parties voted it down when we presented it as a proposal in the committee.
We have thus shown decisiveness. I and many others across the country would have wished that the government and the Sverigedemokraterna had shown the same type of decisiveness in issues regarding elderly care.
Äldre- och socialförsäkringsministern Anna Tenje (M)
Madam Speaker! Many thanks for the debate, Nadja Awad! I think it has been very interesting to debate with Nadja Awad over these four years. I think her interest and commitment to these issues really shine through. It is genuine, and I appreciate that.
During this parliamentary term, we have worked proactively to step by step raise the requirements for one to work within Swedish elderly care. We have introduced a protected professional title and ensured that it is competence that shall guide, and that one must meet competence requirements to work within Swedish elderly care. We have introduced a language requirement so that the elderly can understand and make themselves understood and so that medical safety can be guaranteed. We have also partly done this so that the work environment will improve and so that employees will be able to speak with one another.
We have also ensured that there is now a clear legal basis when it comes to making extracts from criminal record registers and suspicion registers. We want to continue working on this, so that it should become mandatory to make extracts from criminal record registers and suspicion registers even during ongoing employment, both to increase the safety and security for the elderly but also to improve the working environment for everyone who works there, so that they can feel safe and secure with their colleagues and coworkers.
Madam Speaker! In addition to that, we have taken many different measures, not least recently regarding a new skills supply plan. We have ensured that the leadership training is now being properly investigated so that those parts can be strengthened in order to improve the work environment, retain staff, and see how many employees per manager we should actually have.
But again: If a municipal representative calls me and asks how I view the minute-by-minute management, it is definitely nothing that I would recommend. I welcome the Left Party, where the Left Party is part of the government, to present proposals to stop the minute-by-minute management. That is exactly what is happening in the municipalities where the Moderates are in power. Sigtuna, Täby, Hudiksvall, Uddevalla and Alvesta are just a few examples where we are at the forefront to do just this.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.