Response to interpellations 2022/23:204 and 208 on the Elderly Care Boost
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns Äldreomsorgslyftet and competence supply within elderly care. M argues that the staff is the most important resource and that undersköterska is a protected professional title that ensures competence 1. M believes that the municipalities have the primary responsibility for staffing 1 and that a protected professional title as well as differentiation of work tasks is the right way to increase attractiveness 2. M emphasizes the importance of increased leadership 2 and that digitalization can facilitate the work 3. S argues that Äldreomsorgslyftet delivers and must be extended to 2026 4 5. S believes that the state must take the lead and invest more money in the staff 6 and that the removed support for the initiative causes women to refrain from studies 7. S argues that more employees are needed 8.
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 Anna Tenje (M)
Madam Speaker! It is certainly lovely that we can be a bit efficient when the time is starting to get somewhat late and debate these two fine interpellations together!
Madam Speaker! Mikael Dahlqvist has asked me why I and the government intend to abolish this reform after 2023. Mikael Dahlqvist has also asked me what my and the government's plan looks like to secure competence moving forward. Finally, Mikael Dahlqvist has asked me what measures I and the government plan to take to raise the status of welfare professions.
Lena Hallengren has asked me why the government is abolishing the successful Äldreomsorgslyftet. Lena Hallengren has also asked me what measures I and the government intend to take to ensure competence within elderly care in the long term. Finally, Lena Hallengren has asked me how I and the government intend to reduce the high staff turnover within elderly care.
As appears from the autumn budget bill (prop. 2022/23:1), the Äldreomsorgslyftet continues during 2023. The work on the budget bill for 2024 is ongoing within the Government Offices. The Government will return in the usual order with its proposals and priorities, not least within the important welfare area.
The staff is the most important resource in elderly care, and a well-functioning staff and competence supply is a key issue for the development of elderly care. Furthermore, it is crucial for the quality and safety in elderly care that the staff has the right competence to perform the work tasks.
From and with July 1, 2023, nursing assistant is a protected professional title, which means that the competence for the professional group is ensured. This will contribute to good care and nursing of the elderly. It is primarily about, for example, being an attractive employer, offering career paths, and finding solutions for a sustainable working life. But the reform can also contribute to the status of the profession being raised.
Each municipality is responsible as the principal for elderly care, and issues regarding staffing and competence development are an employer's responsibility. The Government simultaneously sees a need to support the municipalities in the work of meeting the challenges within elderly care.
Through the Riksdag's decision on the government's budget bill for 2023, 4 billion kronor are allocated in state grants to the municipalities to ensure good care and nursing of elderly persons. An additional more than 2 billion kronor goes towards reducing the number of shift positions and towards an initiative to increase staffing and competence of both nurses and doctors within elderly care. Resources are also added to the municipal sector through the general state grant for 2023.
The task of strengthening the supply of skills in the welfare sector is complex and requires efforts within several different policy areas. It involves, for example, being an attractive employer, offering career paths, finding solutions for a sustainable working life, and attracting more people to the healthcare and care profession.
The supply of personnel and skills, however, cannot be solved solely by more resources or more employees. The potential in changed ways of working, digitalization, and other efficiencies also needs to be taken into account. New technology can also contribute to reducing the workload so that more people can manage for longer.
No single measure solves everything, but by working together, it is possible to make a big difference for the supply of skills and the quality within elderly care for our elderly. The state, the municipalities, and the regions need to continue to work together to strengthen the access to skills in elderly care throughout the country in the long term.
Mikael Dahlqvist (S)
Madam Speaker! Thank you, Minister Anna Tenje, for the answer! I note in the Minister's answer that I share much of the Minister's and the Government's view: The staff is elderly care's most important resource. I also share the view on the strategies to create an attractive job, a good working environment and so on. The Minister explains this very well.
I also note that the government partially fulfills the budget investments made by the previous government. That is good. But I also want to emphasize in this context that the Social Democrats, in their budget motion, have a doubling of the money for general welfare. And more money was needed, because if we are to raise the status within healthcare and care professions, it requires money. Better schedules are required, better wages are required, and greater influence is required. And above all: If better schedules are to be achieved, it will require more employees.
However, I lack concrete proposals on how the Minister actually intends to solve the skills shortage within elderly care. One thing that is proven to work today is Äldreomsorgslyftet, and in the government's proposal, I see that it will cease after the end of this year.
Madam Speaker! My main purpose with today's interpellation debate is to argue and demonstrate how important the reform is. We have a competence shortage within the welfare sector, or rather: We have a general competence shortage that seriously threatens our ability to maintain high quality within the welfare area. Today, I will content myself with discussing elderly care specifically because that is what the debate is about.
The elderly care boost is delivering. It is a state initiative that the previous Social Democratic government initiated in 2020. The purpose is to raise the competence of primarily nursing assistants and healthcare assistants, but it also applies to other positions. One has the opportunity to receive paid training during working hours. This will, of course, collectively aim to increase the supply of competence in the municipalities and increase their attractiveness.
During 2021, Madam Speaker, over 6,000 people began studies to become a care assistant or nursing assistant. Over 2,000 completed their studies with a passing grade and began working in elderly care. Unfortunately, the government announces that it will scrap the initiative after the end of the year. Given the competence challenge that elderly care faces, the initiative must be extended.
Madam Speaker! Personnel testify that they escape the insecurity of being a substitute by being given the opportunity to receive education and obtain a permanent employment. One gains new knowledge that strengthens one in the profession of meeting the needs of the elderly. Even our union comrades and employers testify to the reform's importance for elderly care.
Therefore, I must once again, Madam Speaker, ask the Minister whether she - or the government - intends to extend the Äldreomsorgslyftet after the end of the year or not.
Lena Hallengren (S)
Madam Speaker! I thank the Minister for the answer and for describing all the initiatives that were implemented during the previous government and during my time as responsible for elderly care within the framework of my area of responsibility for a number of years.
I am convinced that elderly care needs elevated status, and this work was initiated. But elevated status is not enough; there is also a need for more employees, welfare technology and – naturally – a protected professional title. This was a task that we pursued purposefully and which took many years. Not least the protected professional title means that from a state level, one must consider how to help when people working in elderly care do not have the competence that is actually required.
The Minister stated in the response that the supply of personnel and competence cannot be solved solely with more resources or more employees, but it is nevertheless undoubtedly the case that more employees are needed in elderly care. We do not want people to step in without the competence required to perform the important work that is done in elderly care.
Therefore, I must regret that the answer is that a decision will be made in connection with the budget bill for 2024. That is not how one conducts education policy, and that is not how one makes long-term investments. That was precisely why the investment existed in both 2020, 2021, and 2022. In 2023 it exists, but in order to conduct and start a new education during 2023, one must know that one can complete the education, which one would do in 2024 because the education is at least one and a half years long.
The government must realize the following: If the government does not provide a decision for more than 2023, one may complete the educations that have already started, but one does not start new educations. I hope that the minister has been reached by all the voices that are now being raised all around the country so that one can be given this opportunity.
Money is certainly not everything, but it is clear that the person working in elderly care with a considerably lower income does not just take leave and study to become an assistant nurse for one and a half or two years to then return to the profession. Some do, but that 25,000 people chose to do this during the past two years was solely due to the fact that Äldreomsorgslyftet existed, with the possibility to study to become a care assistant or assistant nurse during paid working hours. There was – and is – also the possibility, within the framework of Äldreomsorgslyftet, to strengthen first-line managers, which I think is absolutely excellent.
I want to ask once again why the government does not intend to continue perhaps the best initiative that exists to get more nursing assistants in place. It is not something that only I am saying, but this was done together with the trade union Kommunal, which organizes care assistants and nursing assistants, and Sveriges Kommuner och Regioner, which is the absolute largest employer.
I must say that this is very regrettable, and I hope that we can get a different answer in the chamber during the course of the debate.
Statsrådet Anna Tenje (M)
Madam Speaker! I thank both the interpellants for their contributions. I agree with a great deal of what was said, especially the description that several different parts are needed to tackle the skills supply in elderly care. It is a matter of many small streams. It is primarily the municipalities that have the great responsibility - the great principalship - and who are often employers, but private healthcare providers must also do their part to ensure that the work environment improves and that attractiveness is increased. It is a matter of us ensuring together that more people seek out healthcare and care professions and, above all, that those who already work there want to stay.
There are, therefore, many different parts to this, and when it comes to skills supply and skills development, this is extremely important.
When it comes to the Äldreomsorgslyftet, which is what we are here to discuss and debate today, I can state that it expires in 2023. It is therefore nothing that one has actively scrapped or announced that one will scrap, but it is de facto something that is expiring.
Socialstyrelsen has been tasked, in accordance with the announcement we made when we were in opposition, to carry out a follow-up and evaluation of Äldreomsorgslyftet as well as the annual resource supplement of 4 billion kronor that municipalities have been allocated via Socialstyrelsen since 2021. The evaluation shall report how the municipalities have used the extra funds allocated in accordance with the initiatives and what results they have yielded. The assignment will be reported to me by March 31, 2023, at the latest.
The elderly care boost covers a very large amount of money. Such a large investment in an area so crucial for welfare must, of course, be followed up and evaluated. I am completely convinced that there are many lessons to be drawn from the elderly care boost.
I conduct many site visits and meet many employees within health and social care, especially within elderly care. I myself have a background as the chairman of the municipal executive board and have worked with Äldreomsorgslyftet. I know that there are a lot of obstacles. Not all municipalities have received it. We have the largest municipality, that is Stockholm, and then we have very many small municipalities.
We have also seen that there are requests to utilize a competence supply initiative such as Äldreomsorgslyftet - if one were to be granted - in a slightly different way, so that it could be used to a greater extent and perhaps for other things. It is not the case, after all, that all the educations that Äldreomsorgslyftet has been used for are one and a half years long - some are significantly shorter, and some are not about studying from healthcare assistant to assistant nurse. This has been used widely and extensively. Precisely for that reason, it is important to evaluate how the taxpayers' money has been used in order to be able to learn from it, follow good examples, and scale this up so that more municipalities can benefit and so that we can truly help each other to tackle the competence supply problem.
I think it is important with evidence. I think it is important to follow up. I think it is important that one uses the taxpayers' money in the best possible way, but I also want to emphasize that it is far from all the money that has been used for skills supply and skills development. The municipalities' budget has large investments, and so does the regions' budget. I will not say, however, that this does not have significance, because I believe that it does.
Let us return to this when we have seen the evaluation and, above all, when we submit the budget bill for 2024.
Mikael Dahlqvist (S)
Madam Speaker! I thank the Minister once again for the answer.
In my first speech, I addressed the importance of Äldreomsorgslyftet for competence supply and quality development. Before I respond to the Minister's speech in detail, I think it is worth noting some background facts. If one reads the Swedish Association of Local Authorities and Regions' (SKR) personnel forecast, one becomes alarmed. Over 410,000 employees will need to be hired by 2031 if nothing changes. If one looks at the demographics—that is, the age development—one sees that the proportion of people over 80 years old will increase by almost 50 percent during the same period. We know, Madam Speaker, that it is often when people turn 80 or older that they need help and support, which, according to SKR's own forecast, will mean that 30 percent of these 410,000 people should go to elderly care.
And not only that, Madam Speaker. In six out of ten municipalities, the working-age population is decreasing while the need for welfare is increasing. This should be a wake-up call for all of us and in particular for the Minister.
When I, as a member of Parliament, read the government's budget, I can see that Äldreomsorgslyftet is concluded in 2023. We Social Democrats have been clear in our budget motion that this reform is important and that we see positive effects from it. In our motion, we have therefore written that it should continue until 2026. This provides exactly the tool that the previous speaker Lena Hallengren spoke about: that the municipalities get good foresight, can plan and allocate, and know how to view this moving forward.
We also know that Äldreomsorgslyftet delivers. During 2020-2022, that is over two years, 25,000 people have started a training program.
I naturally know that it is extremely complicated to attract staff to the welfare sector. I myself have a background in the welfare sector. I have such a profession and have a cohabitant who works as a dementia nurse, so I understand the complexity. But this is still, I want to say to the Minister, a tool that is proven to work.
I nevertheless note with some confidence that the Minister, in his answer, says that one is in any case considering looking closer at a continuation of Äldreomsorgslyftet for 2024 and onwards. At the same time, I want to get clarity that this is an important issue. It is important for Kommunals members but above all for those they care for, the elderly, so that they receive good quality and competent staff. We know that it is this that it often depends on.
My question to the Minister is also what concrete measures the Minister and the Government intend to take to raise the status within the welfare profession. A better working environment, more employees, and education are the foundation for us to solve the competence supply moving forward.
Lena Hallengren (S)
Madam Speaker! As both the Minister and the previous interpellor have mentioned, Äldreomsorgslyftet expires in 2023. We Social Democrats intended to extend and continue with Äldreomsorgslyftet. It is not a one-year initiative; it is a long-term project. We are not going to recruit 100,000 new employees in two years, but over the coming ten years. We also say that one must have the title of assistant nurse to perform many of the tasks and work duties that exist in elderly care from July 1. I believe it is the state's responsibility to assist all those women who may not have the required competence, but also to make it attractive for those who are considering working in elderly care but who do not yet have that competence.
During the election campaign, I spoke with very many people who were worried: What if you don't get to continue, what happens to Äldreomsorgslyftet then? To them I said: I actually believe that we, across party lines, still think this is important. I don't think you need to be so worried, because there isn't a municipal representative who doesn't see the need to educate care assistants and nursing assistants if we are to have any chance at all of managing the quality in elderly care with the demographic development we have ahead of us.
The sad thing is that during the time when the Minister is to conduct an evaluation, it is tens of thousands of women who are now losing the opportunity for this competence development. It is not enough that one is to conduct an evaluation; during 2023 there are also fewer komvux places, which means that even if one maintains Äldreomsorgslyftet 2023, it is done with fewer training places. Now we do not know what the budget looks like for 2024, but I am not all too optimistic that there would be any major changes and even more komvux places, perhaps rather the opposite. But I am gladly positively surprised by the Minister's answer.
It is very important, says the Minister, because it is so much money, that we truly evaluate that they go to the right things. 1.7 billion kronor in a year is very much money.
It may be 10,000 women who have been given the opportunity to study. What does the tax cut that the government presented in the same budget cost? Well, 10 billion. I think it would be quite pleasant to still consider how the state's budget is used in the very best way. Tax cuts we can discuss in another debate, absolutely, but one must still have some proportion. 1.7 billion would give many, especially women, the opportunity to study and become nursing assistants, which is for their benefit but naturally also for all elderly people who need elderly care of good quality.
My question is actually: How can fewer places in adult education and a removed opportunity to study during paid working hours be able to provide more nursing assistants and healthcare assistants?
Statsrådet Anna Tenje (M)
Madam Speaker! Mikael Dahlqvist raises several questions in his speech which I intend to try to answer.
Among other things, it was about what I specifically want to do to increase the attractiveness of the important healthcare and care professions. There, I believe we are on the completely right track. I believe that the regulation regarding protected professional titles for assistant nurses is a very good start. It is also a matter of whether we perhaps need to follow up with a differentiation of the work tasks, that is, that one actually works with what one is trained for. Then we can have more paths into the healthcare and care professions so that healthcare assistants or other staff can get in and perform other tasks but still feel that this really is valuable work to do – and perhaps even become eager to continue.
I believe that leadership is extremely important, not least within elderly care. I believe that leadership is important in all parts of the municipal and regional operations, and also in the state operations, but I believe that it is particularly important within elderly care.
I have met many employees who do not think that the scheduling is a problem or that shared shifts are a major problem - I know that there are differing opinions regarding that - but who feel that they can be involved in influencing and, not least, have control over their day. They feel that what they achieve makes a difference and that the experiences they have are heard, listened to, and lead to changes.
Then we have other employees who perhaps work in a home care group just a few kilometers away and who definitely do not experience the same thing. They talk about minute-hunting, feel stressed and pressured, and experience that they have no influence over their own work situation.
This can be summarized by one thing, and that is leadership. We have capable managers within elderly care, and we have less capable managers within elderly care. I believe it is extremely important that we invest in expanded leadership and competence development, not least for our managers, so that the situation and the attractiveness within elderly care will improve.
But there are other things we also need to look at. From our side, we have announced that we need to look at the language requirements within elderly care. An investigation will look further into this eventually. Above all, it is important to take into account that this must not lead to more hurdles for the municipalities when it comes to the competence supply. Here, we obviously need to work hand in hand and help each other - find the good examples of language proxies, find the good examples where one has worked very strategically and successfully with people learning Swedish at work, but also entering the work in a significantly better way even if they might not have the language to begin with.
I also believe that a protected professional title can be a way in, as well as differentiation of the work tasks. I also believe that it is extremely important for the elderly to be able to understand and make themselves understood, but also to increase the attractiveness of the workplace, that employees can cooperate and speak with one another and in a safe way transfer information and documentation.
There are many different parts in this - many small streams - that will improve the situation and the supply of skills in the country's municipalities and within elderly care.
Mikael Dahlqvist (S)
Madam Speaker! Once again, I thank Minister Anna Tenje for the answer.
Working in elderly care is both meaningful and important. Therefore, the status must be raised through various measures. I am convinced that the Elderly Care Boost is such an important initiative. What the previous government started by putting elderly care higher on the agenda was also extremely important. Many measures were taken, including a protected professional title, which the Minister himself referred to.
During the pandemic, elderly care received rightful attention from the entire society for its fantastic efforts. Healthcare also received it, but since we are debating elderly care, I choose to highlight that. Where have these voices gone now, Madam Speaker? Now it is worryingly quiet about the challenges of elderly care.
We Social Democrats will do everything we can to push the government forward when it comes to investing more money in welfare and in the staff. The competence supply within elderly care is crucial for what care and healthcare our elderly are to receive. Here, the state must take on the leadership role and invest significantly more money.
I share the Minister's view that the measures the Minister presented are important and constitute the basis for good leadership, the work environment, and so on. But one important thing distinguishes between the Minister's view and my view, and that concerns resources. More money is needed, and more employees are needed in the elderly care homes and in home care services. Knowledge provides good conditions for the staff and, above all, for the elderly.
I hope that this debate has provided some food for thought and that this will be reflected in the upcoming budget proposals.
Lena Hallengren (S)
Madam Speaker! The National Board of Health and Welfare has a government mandate to carry out a follow-up and evaluation of the financial support for elderly care, which concerns the Elderly Care Boost 2020-2021 but also the state grant to the municipalities to ensure good care and support for elderly persons.
Just to take something out of the pile, I can say that SKPF Pensionärerna, that is, the pensioners who themselves have a background in these professions, mean the following: The initiative Äldreomsorgslyftet must be made permanent. Increasing competence and making healthcare professions more attractive through long-term investments in staff is crucial for the possibilities of good elderly care. The changes that are required take a long time and are not solved by short-term projects. For that reason, the initiative has so far had a limited effect. Not all the money could be used, and SKF Pensionärerna can see several reasons for this, which one can take part in.
I want to say that leadership, as the Minister highlights, is naturally important, but it requires that there are people to lead who have the competence to do the job that is expected. The elderly care boost is a way to provide the conditions that the municipality needs as an employer, but also that the employees need to be able to acquire the competence that we now require when we introduce a protected professional title, which the elderly care act shall clarify.
However, it is clear that if there are fewer places in adult education and poorer economic opportunities to study, groups of women will abstain. We know this because they did so before Äldreomsorgslyftet existed. At that time, not many had the opportunity to study, and they continued to work as untrained, with both insecure and precarious employment as a result.
I must conclude with the question once more: How are fewer places in adult education and a removed elderly care lift to lead to more healthcare assistants and assistant nurses being trained?
Statsrådet Anna Tenje (M)
Madam Speaker! I would really like to thank you for this debate. I can state that there is a very great interest in the chamber regarding issues of skills supply, and I think it is extremely good that more parties and members share my assessment that the skills supply is one of the perhaps most important issues right now.
I can assure Member Mikael Dahlqvist that the municipal representatives I meet definitely have not fallen silent when it comes to the issues they raise for me regarding elderly care and what they think I should invest more in and, above all, what we must cooperate on. The alarm clocks sounded much earlier there than they did here in the chamber or in the Government Offices when it comes to the competence supply issues and how competence within welfare is to be secured regarding the municipal representatives.
These are questions that we have talked about long before the pandemic hit and long before the former government announced the Äldreomsorgslyftet. We have discussed this in SKR contexts, and SKR has also raised many of the parts concerning that one not only needs to become more numerous but also work in a different way. We must adopt digitalization and welfare technology in a smart or good way that benefits both the elderly and the employees, so that it becomes both easier and perhaps actually more fun to work in elderly care and so that, above all, the safety and security for the elderly can increase.
This concerns many different issues. The issue of skills supply is not a simple matter, but I am completely convinced that we can get very far if we can join forces here, if we share the view that the skills supply issue is perhaps the single most important issue for elderly care and if we then join forces in an even better way with both municipalities and regions.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.