Response to interpellations 2023/24:575, 617, 641, 643 and 649 on healthcare

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Mirja Räihä has asked me what I and the government intend to do to stop the cuts in the regions and thereby at least maintain the number of healthcare beds.

Anders W Jonsson has asked me what additional measures I and the government will take to shorten the long healthcare queues.

Yasmine Bladelius has asked me what I and the government intend to do to remedy the resource and personnel shortage we see within healthcare.

Yasmine Bladelius has also asked me what measures I and the government are taking to reduce the care queues in the near term so that patients do not risk dying or becoming much worse while waiting for care.

Åsa Eriksson has asked me if I and the government intend to take any measures so that residents of Västmanland and others can continue to have access to equal care.

Madam Speaker! Waiting times and healthcare queues need to be shortened, accessibility to care improved, and the supply of competence strengthened. Achieving this in the current economic situation is a challenge.

Initially, I want to emphasize that the government and I myself are aware of the challenges in health and medical care, which are also affected by the current economic situation in the regional and municipal sectors. The state cannot fully compensate for the regional sector's deficit. It is the healthcare authorities, with directly elected politicians at the municipal and regional levels with taxing rights, who are responsible for providing good health and medical care. Within the framework of municipal self-government, municipalities and regions have great freedom to choose where and how, for example, emergency medical care shall be conducted.

The Government has announced that an efficiency delegation shall be established to provide the regions with support for streamlining within health and medical care. Several steps are being taken for better state governance. The work on national healthcare mediation is being intensified, and available personnel shall be utilized more efficiently from a national perspective. The mission to implement immediate measures that support and strengthen patients' opportunities to receive care from other healthcare providers with shorter waiting times is being moved forward. The Government also intends to commission an inquiry to submit proposals for one-off measures to shorten healthcare queues.

The State and Sweden's Municipalities and Regions entered into five agreements in healthcare in December 2023 which, together with the sector grant decided in the budget bill for 2024, amount to approximately 10 billion kronor. The agreements include increased accessibility in health and medical care, good and close care, women's health with maternal and obstetric care, cancer care with shorter waiting times, as well as supply preparedness for pharmaceuticals. The purpose of the agreements is to create a common direction for the development of health and medical care. Several measures aimed at increasing accessibility and reducing waiting times are mentioned in the agreements. It has been important for the government to provide information as early as possible regarding funds to the regions.

Inflation is putting pressure on the regions' economies. The worsened results in the regions are primarily due to temporarily higher pension costs. Since the government's budget bill for 2024, the outlook for the regions' economies has also worsened further. The increased pension costs affect, among other things, the healthcare's personnel budgets. A number of regions have warned of staff reductions or announced personnel cuts. The coalition parties are therefore contributing 6 billion kronor to the regions in this year's spring budget amendment. The magnitude of the funds corresponds to the personnel cost for approximately 7,000 nurses. The government's explicit expectation is that the regions use the money to avoid general layoffs of healthcare personnel.

Finally, I want to emphasize that the staff is the healthcare system's most important resource and the foundation upon which healthcare rests. The Government has therefore given Socialstyrelsen a mandate to develop proposals for a national plan to improve the healthcare system's competence supply. The national plan shall, among other things, show what measures are needed for both existing and new healthcare staff to improve the competence supply. The mandate is to be reported by May 31, 2024, at the latest.

With that, I would like to thank Mirja Räihä, Anders W Jonsson, Yasmine Bladelius and Åsa Eriksson for the questions. I look forward to the debate.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mirja Räihä (S)

Madam Speaker! We have debated healthcare several times in this chamber since the election. I want to quote what the Minister of State said the last time we debated in March 2023, just over a year ago now:

The government provides large supplements in order to increase both care capacity and the number of care beds. In total, the government allocates 2 billion kronor annually in 2023 and the coming years ahead in the budget period to increase the number of care beds. Furthermore, among other things, maternity care and women's health are provided with funds in the budget bill for 2023 totaling 1.7 billion kronor for 2023 and thereafter 1.5 billion kronor per year for the years thereafter. The government also strengthens the sector through supplements to the general state grants with 6 billion kronor per year in permanent investments to municipalities and regions.

This is a quote from the government's response to the interpellation when we had an interpellation debate on the general state grants. Furthermore, the following is included in the response:

"But it is still the case that we need more care beds. Every time it 'stagnates' in the emergency room, it can be because the home healthcare is too weak and that it needed more medical competence or more medical interventions. It could be about the fact that we do not have beds in the right department, because it might be the outsourcing that is most vulnerable when one does not have the right competence in a department. But it can also be about overcrowding. There are many factors that cause queues and that it 'stagnates' in the system."

Madam Speaker! It sounds very nice with all the promises, but what will "stagnate" moving forward in both emergency rooms and hospital wards is that 12 of 21 regions announce that they need to reduce staff due to the economic situation.

Region Sörmland lays off 700 employees. Region Östergötland lays off 900 employees. Skåne University Hospital lays off 640 employees. Region Värmland lays off 750 employees. Region Örebro has a hiring freeze and does not fill positions, for example, upon retirements. That sounds gentler than a layoff, but in practice, it is a layoff.

I believe that when the Chamber already dealt with my previous interpellation, we discussed the definition of a care unit. A care unit is not a bed, because there is an abundance of beds in this country. A care unit is a bed, a nursing assistant, a nurse, and a doctor. These functions are supported by local care that keeps track of basic hygiene routines and a number of people in the kitchen who ensure that the patient receives nutritious food. The care unit is supported by physiotherapists, counselors, dietitians, etcetera. That is how the Swedish health and medical care functions.

It is clear that as things currently stand in the regions, the number of healthcare beds will not increase. Regardless of whether the government increases the state control of healthcare, the number of healthcare beds in our country will decrease.

How is it possible to believe that in a situation like this one, it would be possible to expand the number of care beds so that patients actually receive their treatments in a reasonable time? When it concerns staff, that the staff are laid off due to a shortage of work, it first affects the staff who become unemployed. But in the long run, it is always the patient who is affected in the form of ending up in a long queue, not getting their operation in time, etcetera.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! Sweden has among the world's best healthcare systems with absolutely fantastic results. But for decades now we have had a problem, and that is that we have far too long healthcare queues in relation to most other countries. It takes too long to move forward in the queue, and that has consequences. It has consequences for patient safety. But it also has consequences for equality in society, when those who have contacts or cash always move forward. The gaps are widening. This is a very large concern in Swedish healthcare and has been for decades.

The Minister for Health's party said during the election campaign that these are criminal queues or illegally long queues and promised to do something about it. All the more regrettable it is then, Madam Speaker, that the development is going in completely the wrong direction.

That is what made me submit this interpellation. If one compares January 2022 with January 2024, one sees that there are more people today waiting to receive a first visit with a specialist doctor and more people today standing in queue for an operation. Despite the Minister for Health and Social Affairs and her promises during the election campaign, it has not become better, after 500 days, and that is why the alarm bells should be ringing.

That is why I asked what additional measures will now be proposed from the government's side, because I assume that this is high on the agenda.

I am, Madam Speaker, disappointed when I see that the Minister for Health chooses to downgrade the issue of queues by combining it with the questions regarding the regions' economic crisis and the competence shortage, as if this were one single large problem in healthcare. It is not so. The economic concerns in the regions will of course exacerbate this, but it has been the same problem even in a situation where the regions have had a good economy. And countries that spend significantly less than we do as a share of GDP do not have the same problems with queues.

The minister then chooses to also bring up the issue of the skills shortage. If one now has to dismiss and get rid of staff, it is clear that this will not improve the situation regarding queues but rather worsen it. But that is not where the root of the evil lies. Sweden has relatively many nurses and doctors per 1,000 inhabitants - more than other countries that manage to have shorter queues.

The care queues in Sweden are thus a structural problem that we have had for a long time. When I ask the minister what additional measures the government will now take, she repeats in her answer three proposals that have been known for a long time.

First of all, it is about having an agreement with SKR. Every government has had one since decades ago. It has not led to any change.

The second thing is that a temporary one-off investment should be made to likely purchase operations during one year or another. It is not wrong to do that, but it does not solve the underlying problem.

The third is that an old social democratic proposal that the previous government put forward is being raised, namely that we should have a healthcare mediation in Stockholm, an office on Kungsholmen, where the regions can turn to find out where in the country there is available capacity. This will not make a bit of difference.

What is needed are structural changes aimed at giving patients the power to choose freely in the country and also to create long-term conditions that make it possible for other actors to expand their offerings.

So, Madam Speaker, my question remains: What additional measures will the government propose? This situation is, in fact, extremely alarming, with queues that today are longer than they were 500 days ago.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Yasmine Bladelius (S)

Madam Speaker! A national healthcare crisis is unfolding in Sweden. Not in over 30 years have we seen such an extensive crisis in health and medical care. All around our country, regional politicians of all different political colors are now making unimaginably difficult decisions. Shall we warn more healthcare personnel? Do we need to make further large cuts at already hard-pressed hospitals? Will we now have to close a health center or some other equally much-needed healthcare facility?

This is a crisis that hits incredibly hard - against the healthcare staff, the patients, and the entire society - when healthcare is not given the conditions required to maintain good care for the entire population.

Madam Speaker! The worst part of all this is probably that it is a crisis that could have been avoided. Many of us for a long time both warned and pleaded with the government to take responsibility – to curb the crisis and compensate the regions for the cost increases. But despite the fact that all trade unions, regional politicians from right to left, healthcare staff and many politicians here in the Riksdag's rostrum for a long time warned and pleaded, the government turned a deaf ear. Budget after budget, one actively chose not to compensate for the cost increases and thereby created the crisis in healthcare in Sweden that we see today.

This is also, Madam Speaker, a crisis that comes at a time when healthcare is already facing incredibly difficult and tough challenges. Already today, 172,000 patients are waiting for surgery in Sweden, while the queues for all kinds of care are already long, especially after the pandemic. The crisis comes at a time when some patients in Sweden actually manage to become so ill that it is no longer possible to operate on them.

It is clear, Madam Speaker, that a welfare country like Sweden can do better than this. But it goes without saying that no healthcare queues will decrease when we are now simultaneously facing a national healthcare crisis, with warnings, resignations, and cuts in healthcare.

It is naturally possible to prioritize differently. For although we have regional self-government in Sweden, it is entirely possible for a government to step in and act in times of crisis. It would have been entirely possible for the government to invest 13 billion in healthcare instead of on tax cuts for people like myself and the minister when the crisis started. It would have been entirely possible to skip removing the plastic bag tax and instead put the money on the healthcare staff, who are struggling and are on their knees. And it would have been entirely possible to vote for the Social Democrats' proposal on doubled grants to the regions and healthcare for two years in a row – or for that matter to tax the almost unimaginably large profits that the banks have made in the wake of the economic crisis in order to instead invest those funds in curbing the crisis and thereby also begin the work of shortening the queues for surgery and giving the healthcare staff more colleagues and better working conditions.

But, Madam Speaker, the government and the responsible minister have simply not wanted to do this. My question to the Minister is therefore: What measures does the Minister and the government now intend to take to shorten the healthcare queues in the near term, so that patients do not risk dying or becoming much worse while waiting for care?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Åsa Eriksson (S)

Madam Speaker! As we have heard, the SD government's healthcare crisis affects the whole of Sweden. Region after region, healthcare staff are being laid off because the government has not increased the state grants in line with inflation.

My county, Västmanland, is also being hit hard. On March 19, the regional director in Västmanland announced that a hiring freeze must now be introduced because the money no longer suffices. The unions are, of course, protesting loudly and say that their members cannot run faster than they already do.

Madam Speaker! The bourgeois parties, who together with the Sweden Democrats govern Region Västmanland, have decided to close the medicine clinic at Köping Hospital. This affects 90,000 people - those of us who live in northern and northwestern Västmanland.

Already now, just a few months after the announcement was made, staff working at and around the medicine ward at Köping Hospital have begun seeking employment at other hospitals and resigning because their work tasks will disappear. All of this obviously worsens the access to good and equal care.

Madam Speaker! If a grandmother in Köping or a child in Kolsva falls acutely ill and access to care becomes even worse when the medicine emergency room is closed, this is a great loss. The people of Västmanland are already in a care queue for far too long, but now acute care also risks deteriorating. It is the Minister's party comrades who sit on the board, and it is the Minister's party that holds the government power. What does the Minister want to say to all the people of Västmanland who are now raging against the worsened care and the threat of a closed medicine emergency room in Köping?

Madam Speaker! It is not just about 102 fewer job opportunities in Köping. It is primarily about worse and less accessible care for the residents of Västmanland in the future. The healthcare provision is deteriorating, and more people will have to travel further. Is it this type of efficiency measure that the Minister described in his response to this interpellation? Is it this type of support that the regions are to receive?

Treatment for stroke, chest pains, infections, and breathing difficulties is part of what will disappear from Köping Hospital. In my view, this means a deterioration in the availability of good care. Staff are resigning, the proportion of hired personnel needs to be increased, and the costs for this are rising. Is it this type of efficiency that the Minister wants to see?

Madam Speaker! My question to the Minister is whether the Minister shares my view: Is it the case that dismissals of healthcare personnel, hiring freezes, and the closure of medicine queues entail a deterioration of people's access to good and equal care?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Eleonore Lundkvist (M)

Madam Speaker! It is pleasing that my home county of Västmanland is being raised in the national debate. Less pleasing, however, is the picture that Member Eriksson paints of our region in her interpellation. It is not, in fact, a completely correct description of reality that she provides.

There will still be an urgent care center in Köping, where primary care, local healthcare, and ambulance care cooperate in basic acute management. Direct admissions will still be possible around the clock, and the most seriously ill will be referred to the emergency department in Västerås, with the larger hospital's full range of expertise.

It is also important to remember that the economic situation in Västmanland today did not arise overnight, but is a legacy of twelve years of Social Democratic rule. Therefore, the now Moderate-led government in Västmanland has initiated an absolutely necessary work to get the economy in order. In Västmanland, they prioritize new, smart ways of working, and at the same time, they are reducing the administration. For example, they have reduced the number of political committees, trimmed the number of steering documents, and digitized a number of processes. All of this is done to be able to place as much focus as possible on the core activities, namely health and medical care. This work should be welcomed by Member Eriksson, instead of painting Västmanland in black.

Highlight that in Region Västmanland there is Sweden's best heart attack care, they are first in Sweden to employ student nurses, and the proportion who survive after being diagnosed with breast cancer is higher in Västmanland than in any other region in all of Sweden! By highlighting good examples we can also attract more people to take a position in the region. It is completely crucial if we are to be able to get the equal care that the Socialdemokraterna say they strive for.

Madam Speaker! The Social Democrats' standard answer in debate after debate is always more money from the state, which in a magical way is supposed to solve the structural and complex problems that exist in the entire healthcare sector. But given that Västmanland is so known for its innovative power, would it still not be too much to ask that the Social Democrats come up with some more creative solutions than just more state grants?

The government and Minister Ankarberg Johansson are actually already taking their share of the responsibility. The government's notification of 6 billion extra to the regional sector means 165 million to Västmanland, and that supplement means that the region can continue with its work of change for better health and medical care for the residents of Västmanland both today and in the future.

Madam Speaker! The Government takes its responsibility. The Moderate-led regional government in Västmanland takes its responsibility. Now it is actually also time for the Social Democrats to take their responsibility and start contributing constructively instead of just blackening their own county.

(Applause)

In this speech, Magnus Resare (M) agreed.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, interpellators and members who are part of the discussion! I must begin by saying that I have misjudged the opposition. I assumed that you had a common view on the problems in healthcare, but that is not the case.

The problems in healthcare are many and complex. There is a shortage of healthcare capacity. It is a matter of us not having enough competence. Even though Anders W Jonsson emphasizes that we have more nurses than we perhaps have ever had, it is not enough. They must be given an opportunity to work in healthcare. They must be given the opportunity to work full-time and have a functioning work environment. This is the reason why one turns to hired personnel instead of having permanent employees.

It is obvious that the opposition does not have a common view on which problems in healthcare exist today and what we need to do about them. On the other hand, I completely agree with Member of Parliament Jonsson that we have had healthcare queues for decades. There is no doubt about that. Therefore, there are reasons to look at what Member of Parliament Jonsson raises, namely structural issues and how laws and regulations lead to us unnecessarily prolonging queues. The Government will return to the issue of the healthcare guarantee and the possibility of seeking care in different ways in the future.

But when it comes to the acute situation with layoffs, it is serious that, according to Sveriges kommuner och regioner, there are today approximately 5,600 employees in healthcare who have a notice of layoff pending. Many regions have, however, exempted both nurses and doctors from layoffs. Such notices do exist, however, and it is of course problematic for individuals who are affected but also for the development in the long term. That is the reason the government has come forward with a new sector grant for this year of 6 billion, which means that we can retain the equivalent of 7,000 nurses.

The message to Member Eriksson is, just as I said in my response, that the government's view is that we are providing these funds because we need to retain the healthcare staff. We need them in health and medical care.

We also have a proposal that will apply for the next six years and which means that regions may be able to apply for support—it is about 250 million annually—if they want to deal with the structural economic problems they have in the long term. If one has had problems for many years, one does not make quick turns.

It is not all regions that only have problems with inflation. Some have also had long-standing structural economic problems, and in those cases, one may need this support from the government, which is long-term. It is thus a variant of the municipal rescue that has existed before. Now we are establishing it for the regions, and it will exist for six years ahead.

So, what is the situation right now? Right now, I want to tell the members of the Riksdag, as many operations are being performed as before the pandemic. In the latest figures from Spor, the Swedish perioperative register, which is the profession's register, it appears that almost exactly as many operations are being performed now as before the pandemic, or 98 percent. So, there is not much difference. Throughout the entire autumn, winter, and beginning of spring, the proportion of operations has been between 94 and 100 percent compared to representative weeks before the pandemic, all according to Spor.

At the same time, there are large regional differences, and we see once again that healthcare and its capacity are unequally distributed. This, of course, affects patients in Sweden. But several good examples are worth highlighting in particular. Region Gotland and Region Sörmland have completed 115 and 112 percent respectively of operations compared to how it looked before the pandemic. At 30 hospitals, more operations are now being performed than before the pandemic. At, for example, Alingsås lasarett, Helsingborgs lasarett, and the hospital in Kalix, a third more operations are performed compared to before the pandemic. This could never have happened without the hard and dedicated work of the healthcare workers. Let those who deserve honor be honored, and it is therefore the healthcare staff and the hospital managements who have worked purposefully in a good way.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mirja Räihä (S)

Madam Speaker! "Thank you, member, for a very important question! I will do my best. Otherwise, come back and scold me a little!" This is what the Minister of State said in our previous joint debate on health and medical care.

I have a background of about 40 years in the Stockholm healthcare system. I have witnessed a number of warnings in our region, and I believe I know what the consequences will be when the warnings arrive.

Probably these notices will also be withdrawn. That is usually the case. But then it is not a matter of the healthcare system having judged that, despite everything, one needs to keep 900 employees in Östergötland or 750 employees in Värmland. No, it is because on the very first day the notice is issued, everyone starts looking for new jobs in the surrounding area, and when six months have passed, as many people have managed to quit as there were people noticed. Then we get other newspaper headlines, and it says that the notice at Karolinska is withdrawn or that the notice in Värmland is withdrawn.

But still, a large number of employees have disappeared. This affects patient safety, and it affects the number of care beds in the country.

Madam Speaker! Every warning in our hospitals leads to anxiety and to a working environment that does not meet the standard. When the working environment does not meet the standard, the patient is affected.

An example of insecurity within healthcare right now is Sahlgrenska in Gothenburg. The hospital director there has a savings list of several hundred points, as I have understood it. Furthermore, it has not been shown to anyone, not even staff organizations. Nothing has been negotiated or collaborated on.

No warning is being issued there, but the idea is that the number of employees during the year shall decrease by 2,000 people. Care beds have already been closed within psychiatry, women's healthcare, and infectious disease care. That is today's fact regarding Sahlgrenska.

But this does not cause headlines in the same way as the words warning and layoffs. This, in fact, does not sound as dangerous, and it does not sound as dangerous for patients.

I can state that the cuts have an effect, not just on the economy. They rather have an effect precisely on the number of healthcare beds. They risk being further reduced when healthcare-trained staff are thrown out of the hospitals.

Everyone needs to understand what consequences and risks the mandates entail. I have a background in Kommunal. The first thing I ask the employer is: What are the risks? How do we create action plans? What will be the consequences?

But this is not something we do in this chamber. I wonder if the Minister himself has understood both the consequences and the risks regarding the situation that has now arisen in very many regions. Ultimately, it is about patient safety. It is not as much about my job at Karolinska University Hospital. It is about how the patients will fare.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! I am almost a little sad when I hear how the Minister defends himself by saying that the number of operations is now as large as before the pandemic. Yes, but the problem for the individual patient is not the number of operations, the problem is that today there are 69,000 standing in the queue. In January 2022, there were 65,000. It is therefore 69,000 individual people.

Then the Minister points out that the economy is now a major problem and that we have explanations for that. It is clear that this is exacerbated if neither the government nor others can manage the economy. That the government is unable to manage the skills shortage does not make the situation better regarding healthcare queues. That one has failed regarding the working hours directive and created major problems in healthcare causes the queues to become longer. That the government limits labor immigration also affects the queues and causes chaos in home care and elderly care in many places. It is clear that the talk about reporting and about limitations regarding interpreters makes it less attractive to be in healthcare, which affects the queues.

But fundamentally, it is a different problem, namely that we have had insufficient accessibility and far too long healthcare queues since decades ago. There, it is not just about economy, competence, or anything else.

I can tell the Minister how it works in healthcare. When I meet orthopedic heads, I usually ask the simple question: How many hips do you operate on per day and per operating room? Then I get the answer: two, three, or four. Yes, some even say five. Then one wonders why some say two and some say five. Is it that those who say five have masses more staff, masses more money, and so on? No, they organize the work in a completely different way.

I return to the fact that what is needed to fundamentally be able to influence the situation are structural reforms. I feel that the Minister and I were previously in agreement that the solution to this is to give the patient power. It is therefore about the patient being able to receive information on how long the queues are at the different locations in Sweden where one operates and on quality, just as in Denmark, in an easily accessible way. Furthermore, one shall ensure that the patient has the right to choose. This is a structural reform that could give the patient power and give healthcare providers – both regions and private – opportunities to plan long-term for increased capacity.

From this, nothing will come from the government's side, but what has been repeated so far, I would say, is old Social Democratic policy. It is about continuing with agreements with SKR. Yes, that is very good. Furthermore, one should perhaps make a one-time investment in purchasing a large number of operations. Yes, that would also be good. Furthermore, there is the Social Democratic proposal that we should have a healthcare brokerage with offices in Stockholm which, when the regions call, should be able to say: Now we know that there is available capacity in Norrbotten. You can send your patients from Skåne there.

Everyone who knows anything about healthcare knows that this will not have any impact whatsoever. What fundamentally matters is daring to make structural changes. We have a problem in Sweden with long healthcare queues, and this has existed for decades. I believe we are up to nearly 55 or 60 billion that the state has injected to solve the problem with long healthcare queues. This has not been the solution to the problem. That is the reason for my question, which I have not yet received an answer to: What additional measures will the minister propose in this situation? There are thousands more people standing in queue today compared to what it was 500 days ago.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Yasmine Bladelius (S)

Madam Speaker! How the government chooses to prioritize in its budgets naturally plays a major role. An even greater role is played by what the government chooses to spend money on in its budgets in times of crisis. Does one invest in, for example, state grants to the regions, which provide healthcare in a crisis? Or does one rather invest in large tax cuts for high-income earners? Does one choose to listen to the pleas for help in the crisis from Sveriges Kommuner och Regioner and from trade unions, regional politicians, and hospital managers? Or does one instead choose to abolish the plastic bag tax or to, for that matter, increase the luxury deduction, which, by the way, will not even be used by those affected in the wake of the crisis?

Madam Speaker! It is also about whether one chooses or simply does not choose to invest in the healthcare staff – the fantastic doctors, nursing assistants, and nurses who work within the health and medical care and who are now going to their knees because they do everything in their power to try to give us good care in a timely manner. At the same time, they see colleague after colleague forced to leave and shift after shift being cut. Will they get more colleagues and better working conditions? Or will more of the country's hospitals now be forced to make large cuts and lay off even more staff?

Madam Speaker! The Swedish healthcare system is full of heroes. But they need more colleagues. The Swedish healthcare system needs a larger costume. There is already today a great shortage of both resources and staff within the Swedish health and medical care. It is clear that the healthcare system is under-dimensioned, which of course leads to capacity and quality deficiencies and to difficulties for the healthcare system to meet the citizens' expectations.

The staff shortage itself also leads to a continuous high workload for the existing staff, which of course takes a toll on job satisfaction and engagement. The risk is therefore great for a vicious spiral, where the development with declining attractiveness continues and makes it even more difficult to recruit.

Long-term and large-scale investments in staff are necessary to address the crisis we are now seeing in Swedish healthcare. The strikes in healthcare that are now occurring throughout our country will, of course, hit the supply of competence in healthcare hard in the long term.

Madam Speaker! In view of this, I would like to ask the Minister Acko Ankarberg Johansson: Does the Minister for Health really consider that the 6 billion that the government boasts about and which has been announced in the spring budget is sufficient to curb the crisis we are now seeing in healthcare? Can they put a stop to the serious cuts and to the many layoffs? Can the healthcare staff then get more colleagues, and can the healthcare then get a larger costume, not less? Can those who work in healthcare therefore get better working conditions, and can the operation queues decrease?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Åsa Eriksson (S)

Madam Speaker! On the government's website, it states in the presentation of Minister Ankarberg that "Sweden shall offer good care in a timely manner and equal care throughout the country." That sounds very good, but I wonder how the Minister can then just stand by and watch when the development goes in the opposite direction. The supplement to the regions that comes in the healthcare budget and which the Minister refers to is nowhere near enough. We all see that. The cuts continue. The hiring freeze in Västmanland was announced after the government's announcement of 6 billion. That is far too little money.

Madam Speaker! Many of us pleaded and warned: SKR, trade unions, healthcare staff, and politicians from all political parties. The government's own party comrades in the regions wrote letters to the government and pleaded for support and help. Yet, the SD-led government has ignored the warnings and allowed the healthcare crisis to continue.

I will admit, Madam Speaker, that everything was not perfect when we Social Democrats were in government and when we governed Region Västmanland. But in government, we have always prioritized increasing state grants and investing in welfare, and in Region Västmanland, we left a financial surplus every year. We did not make access to equal care worse. We did not close any medical clinics.

Madam Speaker! Despite all the alarm reports that came and a shortage of nearly 24 billion SEK in the regions, they did not even receive one-third of the supplement that had been needed in the autumn budget to maintain today's level. Therefore, the regions in Västmanland and in many other places in Sweden, as we have heard today, continue to make cuts and lay off healthcare staff.

We Social Democrats have proposed that the state grants should be inflation-proofed. You bourgeois parties have voted no to that. Instead, people are now being warned about layoffs. It is a development that runs completely contrary to what the Minister himself writes in his presentation on the government's website. I think it is unfortunate.

Madam Speaker! To Member Lundkvist, I would first like to say welcome to the Riksdag. I believe, however, that the Member has misunderstood a little, because this is not a regional political debate. I do not want to portray our county in a negative light in any way, but what I have done is to shine a light on what happens when bourgeois parties govern Sweden and when bourgeois parties govern a region. The effect is that the availability of equal healthcare decreases, and that is what we need to clarify here in the Swedish Riksdag.

I still have not received any answer from the Minister on my first question, so I will try with another question: Does Minister Ankarberg Johansson feel satisfied with the development of healthcare in Västmanland? Is it good and equal healthcare for everyone in all of Sweden when employment freezes are introduced and when the medicine queue is abolished? Is it consistent with the Minister's presentation on the website regarding good healthcare in time and equal healthcare in the whole country?

(Applause)

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Eleonore Lundkvist (M)

Madam Speaker! Thank you, Minister, for the clear statements on the health policy moving forward! Thanks also to Member Eriksson for the welcome to the Riksdag.

I still think it is a bit strange to listen to representatives for the Social Democrats who constantly highlight the value of healthcare staff and investments in their competence while simultaneously claiming that the solution to the healthcare system's problems would be tax increases. Such increases will actually also affect the healthcare staff. Is it really the Social Democrats' intention that it should be less profitable to undergo the long healthcare educations, for example to become a specialist doctor? That is what the situation would become if we were to follow what the Social Democrats want and budget for.

Of course, there are great challenges in many regions, but we lack the will and the strength from the Social Democratic side to not only point at things that do not work but also to be involved and actively want to solve them. When it comes to solving the structural problems that exist and have existed for many years of Social Democratic rule, one will have good help from the resources that the government and the Council of State are now ensuring are put in place. But fundamentally, the regions must also do the work, and then the question is: Are the Social Democrats prepared to do that work? I doubt it, Madam Speaker.

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you once again to the members for good contributions and good cooperation! It will certainly be as Member Mirja Räihä said, that she gets the opportunity to bark at me once again. I believe there is a point in that the Riksdag always has the power of control over the government.

The government has ensured from the first day that we provide increased resources to health and medical care, but that the consequences of inflation would be so great in the regions, I could not have predicted. It was not the state that entered into the agreements, but the regions did so themselves. The government has contributed to pushing back inflation, so we are beginning to see a slight improvement, but the regions bear the costs of inflation for the entirety of 2024 due to the agreement they themselves have concluded.

We could not know the full consequences of this when we took office, but even then the government was firmly determined to work for measures leading to more equal care, both in the form of the state parliamentary inquiry into whether we should move the responsibility from the regions to the state, entirely or partially, and all the other measures that Member Jonsson touched upon, where we want to be able to show what healthcare capacity exists in the country through so-called national healthcare mediation. We are currently focusing on operations that are very important and urgent - breast cancer, prostate cancer and colorectal cancer - to see what we can use of existing healthcare capacity so that all patients in the country get a share of it.

An office in Kungsholmen, as the member suggested, would be a rather bad idea. It is not an idea that the government has, but we are thinking of more digital solutions. Furthermore, the regions are working very well with different types of patient offices today, and it is from them that these systems are developed so that it becomes a nationally coherent system for the benefit of patients who, in conversation with their doctor, have been told that they need an intervention or an operation. There, one can see where there is available healthcare capacity if the own hospital cannot manage it.

Madam Speaker! I want to return to the fact that it is possible that it was a misjudgment on my part to take all these interpellations collectively. When I read them, I thought that the opposition had a similar view on whether more money is needed or not and whether we have enough staff in healthcare. However, it is not the opposition's view that is common; rather, the Social Democrats and the Centre Party have different views on it. So be it; I will learn from this, and we shall divide the interpellations going forward since you now have completely different directions when it comes to how you want to see healthcare in the future.

What needs to be done moving forward? It is both about continuing to maintain the support to the regions in the form of money and about structural changes. One of the things that we will return to and that we spoke about in connection with the extra sector support of 6 billion is that we nationally need to follow the developments in the regions much better than what has been done. It has been entirely up to each region because they are decentralised self-governing according to law from the Riksdag, but we now intend to take a better national grip so that we more clearly see what the money is used for and what good examples exist where the money ends up in the core operations and instead withdraw the costs for that which is not healthcare-related and close to the patients.

Therefore, I now welcome all regions that review things that do not belong to the core tasks, that is to say, care close to the patients. What medical secretaries, nursing assistants, physiotherapists, doctors, nurses and all others do is what is close to care, and it is what we must safeguard and maintain.

That is also why the government is working to provide support to the regions. However, we will not be able to fully support them in the agreement that they themselves have signed and which has had unreasonably large consequences right now. Through joint efforts, we will lower inflation, and thus we will also be able to see a better situation next year for the regions. That is my assessment, Madam Speaker.

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Mirja Räihä (S)

Madam Speaker! I cannot help but comment that it has been said that the Social Democrats have caused Västmanland's problems. In Region Stockholm, there has been conservative rule for 16 years, and there are even greater problems there. I do not believe we can blame each other's healthcare problems from the speaker's podium.

When the cuts arrive in the regions, the most common group that loses their jobs and is kicked out are the nursing assistants. It is easiest to take the nursing assistants, and that is how it is in Östergötland. The cuts concern 900 nursing assistants.

The Minister says that nurses must be able to do their jobs, but that type of notice counteracts the nurses' ability to manage their jobs. The work tasks that I perform as an assistant nurse are assigned to someone else, and that is a nurse. It means that those with the syringe and the medicine cup in one hand have to carry the basin in the other hand, and then they have to try to roll even faster with the rollerblades to keep up. This does not help the situation.

Furthermore, it is said that an equal number of operations are being performed. But then one must say how. When Region Stockholm was to shorten the operation queues, everything was done on the staff's overtime. They operated on Saturdays, Sundays, and late evenings. Everything went on the overtime account. It was not free. Obviously, the staff's health was risked. With as much overtime as there was in Stockholm, we once again risked the most important thing for those of us who have worked in healthcare, namely patient safety.

I thank the Minister for the debate.

(Applause)

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Anders W Jonsson (C)

Madam Speaker! I raised the interpellation because the development is going completely in the wrong direction. 65,000 were queued for surgery in January 2022, and today it is 69,000. What additional measures will the government propose?

I am disappointed that the interpellation is suddenly being drawn into an interpellation debate about competence, economy, and other issues that affect the queues. They become longer in a situation with even those problems. But healthcare queues and lack of accessibility is a problem that has existed in Sweden for decades, and where structural measures are required.

I am disappointed that more has not come from the government. I expected there would be significantly more sharp proposals, other than that one wants to continue with agreements with SKR, provide special funds to urgently purchase healthcare places, or establish this healthcare mediation, which will have extremely limited effect. That is why I asked the question about what additional measures will be taken. The minister has not provided any answer there. In this debate, it has been about all sorts of things, high and low, but not about the fundamental problem itself, namely that Sweden is performing significantly worse than other comparable countries. We have some of the world's best-functioning healthcare, but we have a very large problem regarding accessibility.

Madam Speaker! I am forced to return with an interpellation, where I once again pose the question: The situation today is worse than it was nearly two years ago. What additional measures will the government propose to ensure that queues are shortened in Sweden, so that we are not among the worst in the class in this area?

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Yasmine Bladelius (S)

Madam Speaker! It is a bit exciting that the Minister chooses to lecture the opposition from the rostrum because we are not in agreement or have coordinated our interpellations. That is not really our responsibility in the opposition.

It is also a bit exciting that the Minister points out that we are not in agreement in the opposition. First and foremost, the government itself does not seem to be particularly in agreement. Let me mention, for example, the issue of the gender identity law. It is also a fact that the Minister's party chair and government colleague Ebba Busch has explicitly stated that the 6 billion that the government has signaled in our bill will indeed cover all the warnings that have now been signaled in healthcare. It does not sound the same from the Minister for Health in my direct question from the rostrum.

Madam Speaker! I pose the question to the Minister again: Does the Minister for Health and Social Affairs consider that the 6 billion that the government has announced in the spring budget are sufficient to curb the healthcare crisis, put a stop to the cuts and stop the warnings, so that the healthcare staff get more colleagues, not fewer, and thus better working conditions, so that the operation queues in Sweden decrease, not increase?

(Applause)

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Åsa Eriksson (S)

Madam Speaker! I submitted my interpellation to the Minister because I am concerned. I am concerned about the access of the people of Västmanland and others to good and equal care. I have received the impression that this is something the Minister truly cares about and works for, and I had hoped that we would receive word here today that the Minister is prepared to take measures so that access to good and equal care does not deteriorate.

But, Madam Speaker, the message I have heard today from the Minister is that the government cannot compensate for the cost increases that inflation has brought about. We Social Democrats have done so in our budget alternative, and the bourgeois majority in the Swedish Riksdag has unfortunately voted it down.

But there are alternatives. It is possible to prevent crises. It is possible to retain healthcare staff. It is possible to improve access to good and equal care throughout Sweden - if one wants to. But it is a matter of priorities. If one, as the SD-led government, prioritizes tax cuts for high-income earners, it will result in a healthcare crisis. Then the residents of Västmanland and others will have to wait longer for care. Then the emergency clinic in Köping will be closed so that heart patients have to travel further for emergency care.

There are choices to be made, but it is about priorities. I hope, Madam Speaker, that the Minister takes with her all the wise suggestions she has received in the debate and uses them as arguments. I assume that in every budget negotiation in the government, the Minister works to ensure that there will be more money for high-quality care throughout Sweden.

(Applause)

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! I thank you for all the interpellations that allow us to discuss health and medical care. A warm thank you for your engagement and for writing the interpellations!

Let me begin with the question of whether the number of operations has any significance. I raised the question for two reasons. One is that I am fantastically happy about the work that is being done. It is so often today that healthcare staff tell me that we should not just tell about all the problems. They do a fantastic job every day, and the fact that the number of operations is back to practically the same level as before the pandemic is a message of strength for the healthcare staff. Therefore, there are reasons to tell about this today.

The second reason is that the number of operations is significant for the healthcare queues. If we had not returned to the number of operations compared to before the pandemic, the healthcare queues would have looked even worse. Now we see that it is on the right track, but it is important to keep it up. It is about the healthcare staff's working conditions and work environment if they are to remain in healthcare. The decisions that the government and the Riksdag make and the decisions that are made at every workplace are of the utmost importance.

Madam Speaker! Let me stop for a moment at what Member Eriksson said about there having been more money for healthcare today if one had voted for the Social Democrats' alternative. I want to know exactly how many more billions healthcare would have received this year with the Social Democrats' alternative. It is exactly as much as the government is investing right now; there is no difference.

The point is that none of us believe that we are going to fully compensate for the agreements that the regions themselves conclude. That one is expected to run a deficit has no direct connection with how many notices are issued or with the risk of staff being laid off.

Madam Speaker! Member Eriksson said that healthcare staff are being laid off in region after region. I would like the member to state where this is occurring. So far, warnings have been issued, and from the government's side, we think they are very serious. This is the reason why we have added an additional 6 billion to the regions this year so that they can retain healthcare staff. This still corresponds to 7,000 nurses.

I thank everyone who has participated in the debate.

The interpellations debate was hereby concluded.

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