Certain issues within the health and medical care sector

Christian Carlsson (KD)

Certain issues within the health and medical care area

Mr. Speaker! Within healthcare, people perform fantastic efforts to save lives and strengthen health when we need society's support the most. Swedish health and medical care also maintains high quality once you actually get access to it. But in the most recent parliamentary terms, the healthcare queues have unfortunately increased significantly – they have more than doubled. In June 2014, there were 45,000 who had waited illegally long for care, and in June 2022, the figure had risen to 145,000.

Naturally, the corona pandemic has worsened the situation, but the fact is that the healthcare queues in Sweden had risen and were record-long even before the pandemic. Not even half of all women affected by breast cancer receive care in time, and not even one in three men with prostate cancer.

It simply is not acceptable that we, in a welfare state where people pay such high taxes as we do in Sweden, have the lowest number of healthcare beds per inhabitant in the EU while at the same time hundreds of thousands of people have waited illegally long for care. The long healthcare queues are a betrayal of the welfare state. They must be eliminated so that those who are ill receive care in a timely manner.

Mr. Speaker! The Committee on Social Affairs noted during the previous parliamentary term that the former Social Democratic government did not do enough to address the problems within Swedish healthcare. It was against that background that the committee decided on the announcements that form the basis for the communications being dealt with today.

Sweden now has a new government, and the Christian Democrats are once again responsible for Swedish healthcare. It is a confidence that we are proud of and happy about.

When the Christian Democrats last were responsible for healthcare, the healthcare queues were halved. It will not be as easy this time, but we stand ready to do what we can to ensure that there are more healthcare places and to cut the healthcare queues again so that more people receive care in time. The government has already shown this through several initiatives in the area during the so far short time they have been in power.

An important link in this is, firstly, that a national healthcare brokerage is established with the aim of making the healthcare capacity that exists around the country visible even for the patient. The Government allocates 100 million for this in the budget next year. Despite the fact that the healthcare queues are long because there are too few healthcare places, there are in some cases available places and times in other parts of the country. Through a national healthcare brokerage that the state is responsible for, the capacity utilization within healthcare is therefore increased, and the healthcare queues can then be shortened while those who are ill are given better opportunities to seek care throughout the country.

Secondly, a national long-term strategy for more healthcare beds will be developed while funds for more healthcare beds are allocated. The Government has proposed a performance-based compensation to the regions to increase the number of healthcare beds. This concerns an additional 1 billion kronor to achieve more healthcare beds. We will, of course, return to this in the budget debate in a few weeks.

In conclusion, Mr. Speaker, I want to be clear that the biggest problem with Swedish healthcare is naturally not that there is a lack of beds in the hospitals. The biggest problem is that there is a lack of nurses, doctors, and other healthcare personnel in our hospitals. We need to do more to secure the supply of competence and hire more doctors, nurses, and other people who can work and strengthen the care.

We then need to do several things. We Christian Democrats have previously spoken about how we think it is important that we train more staff for healthcare. We must recruit more, but we must also get the heavily pressured staff to want to and be able to stay within healthcare. We must, in short, improve the working environment and the conditions for the staff.

It is the government's intention to do this through a national plan and through steering the competence supply with concrete measures that improve just the personnel supply.

Mr. Speaker! Sweden has finally received a new government that prioritizes healthcare. As has been said, several important initiatives have already been taken in the area. This means that I, as the new chair of the Committee on Health and Welfare, look forward very much to the continued work in the committee so that those who are ill receive care in time and so that we can offer equal care for everyone in the entire country.

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

Anders W Jonsson (C)

Mr. Speaker! First, I would like to welcome Christian Carlsson to his new role as chairman of the Committee on Social Affairs. I hope that we will have a good cooperation.

The background to this communication is an article in DN Debatt on January 14, 2022, where the chairpersons of Läkarförbundet and Vårdförbundet raised the alarm that we have huge problems in a number of different areas in Swedish healthcare. They did the right thing and first turned to the government, but the government gave them a cold shoulder and was not interested in any dialogue. Therefore, they turned to us four Alliance parties, and we were able to address the issue by pushing through a declaration regarding a number of points.

Now we have, just as Christian Carlsson has pointed out, a new government. Now the roles are reversed: Now we have a government that says it has full control over this, that there is a plan and so on - while the situation in healthcare is, if possible, even worse. Christian Carlsson highlighted in his speech the problem with 145,000 who are in queues and waiting. In that case, one hopes that a sharp proposal will come from the government, but what the government has to come up with is, therefore, that an office shall be established in Stockholm to keep track of the healthcare queues. This is proposed based on a somewhat naive belief that there is available capacity all around the country.

If one provided long-term rules of the game to the Swedish healthcare system, not least the private healthcare providers, they could scale up their capacity and in that way address the healthcare queues. But to believe that one can address the queues by having an office in Stockholm map out and inform about the available capacity that exists here and there is naive to say the least, Mr. Speaker.

My question to Christian Carlsson is: Why not come forward with sharper measures that have an effect on the healthcare queues?

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

Christian Carlsson (KD)

Mr. Speaker! I thank you for the welcome to the work in the committee.

The government has not said it has full control over the entire problem in Swedish healthcare yet. It would be premature to claim that, as there are so many problems. What we are doing now is to point out a new direction and take many important steps on the way toward getting Swedish healthcare in order. The government has, after all, not been in power for very long, so to say that we have full control over everything would be to say too much.

When the member speaks of an office in Stockholm, I understand it as him referring to the national healthcare brokerage that the new government intends to introduce. There is no doubt that there is a shortage of healthcare places in Sweden, but I also do not think we should neglect the value for the individual patient in being able to clearly see where in the country it is possible to turn for the case if one would want to travel to another region to get the best care instead of waiting a bit longer to get the care at home.

When it comes to the long-term conditions for Swedish healthcare, there is a reason why we are injecting nearly 4 billion, apart from the corona funds that have been added. It is simply a matter of us considering that the care needs better conditions and that it needs to become robust moving forward.

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

Anders W Jonsson (C)

Mr. Speaker! These are two completely different things. The proposal for a national healthcare brokerage is based on the accessibility study, which had the picture that there was available capacity here and there and that by simply noting and coordinating it, one could get shorter queues. It is clear that there certainly is available capacity on the margins, but this is not the long-term structural reform that is needed.

Instead, what is needed is what the Alliance has advocated for since 2014, namely that one takes a sharp stance in the Patient Act and gives all patients in Sweden the right to seek not only outpatient care but also inpatient care anywhere in the country. Added to that is the work that was initiated during the last parliamentary term, that is, that 1177 should be given the assignment to - just as in Denmark - report on what the queue situation and the quality situation look like at different clinics.

If these rules of the game were established, it would be possible, not least for private healthcare providers, but also for others, to scale up capacity in the long term. Thus, we could achieve significantly greater volume in Swedish healthcare. This, with an office in Stockholm that looks at where there is available capacity and coordinates it, will not affect it in that way at all.

My question is therefore: Why not take long-term, structural measures that one knows will have an effect? One only has to look at the example of Denmark. That is what should be done instead of searching through old Social Democratic inquiries and picking up proposals from there, for example, the proposal for an office in Stockholm that is supposed to sit and coordinate and say: "In Östersund there are three available spots on Wednesday; then perhaps the patients from Gävle can go there." That is not how you change Swedish healthcare. That is not how you tackle what the Kristdemokraterna call the illegally long queues.

If more workshops are not established, we will have illegally long queues even on the day KD leaves the government.

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

Christian Carlsson (KD)

Mr. Speaker! If there is any party that speaks of the need for long-term structural measures, it is not the Center Party but the Christian Democrats. We are also pleased that we four coalition parties are now taking important steps for increased state responsibility for Swedish healthcare. We will investigate a full or partial nationalization of healthcare. That structural changes are needed to ensure that we have equal and good care throughout the country, we as a party are fully aware of, and the government is also aware of that.

Regarding the national healthcare coordination, I maintain that it would be of great value for the patient to be able to see, in a more transparent way, where they can receive care when they have been struck by illness and their family finds themselves in a very tough and vulnerable situation. That information is important for the patient and the possibility for people to turn to another region.

To speak even about the long-term, it is the case that in order to be able to secure more healthcare beds, we need more doctors, nurses, and other healthcare staff who choose to stay within the profession. That is why the staffing issue becomes so crucial for us to be able to cut the healthcare queues, and we will develop a national plan for the competence supply. It will map out both the need and the distribution of responsibility regarding the staffing issue between the state and the regions. Furthermore, it shall state which concrete measures we shall implement so that more people choose to seek out the healthcare profession and so that more people want to stay to provide care to people on the day they need it.

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

Yasmine Bladelius (S)

Mr. Speaker! The debate we are now having in the chamber is based on a so-called announcement, i.e., a request from the Riksdag to the government, which was proposed by the Committee on Social Affairs during the previous parliamentary term.

It was the opposition parties at the time that made an announcement to the previous government to promptly take a number of measures on seven points to increase the number of care beds, shorten care queues, increase capacity utilization, promote freedom of choice, strengthen the staffing supply, and improve the working environment in healthcare. In a concluding eighth point, it was stated that the previous government would regularly report on the implementation to the parliamentary Committee on Health and Welfare.

The report we are now debating contains the first two reports, or the communications as we call them, which the previous government submitted to the Riksdag on 31 May 2022 and 23 August 2022 respectively. When the announcement was proposed by the Committee on Social Affairs, the issue was debated in connection with the consideration of report SoU36 in this chamber in March. At that time, the parties that proposed the announcement were still in opposition, and I can state that it now sounds a bit different from the new government parties. They do not even follow up on the motions they had in the report.

Mr. Speaker, I will not sound different now compared to then.

We may have changed governments, but the problems in healthcare are exactly the same. It is about a major shortage of staff in healthcare. It is about staff who are on their knees, who cannot run any faster than they already do, who feel forced to resign because they believe they cannot perform their work in a patient-safe manner and because they can no longer endure after having run and run, year after year.

There is a crisis within Swedish healthcare, but it is a staffing crisis. There are not enough nurses and doctors to hire, especially not in public care. And far too many experience that their employers do not take their problems seriously. It is quite obvious that healthcare needs a larger team. Those who work in healthcare need more colleagues.

Mr. Speaker! To increase access to the right competence, there is only one way to go, and that is for the healthcare sector to hire more, for the healthcare sector's workplaces to become more attractive for its staff and begin to offer better wages, better working conditions, and a better work environment.

The Health and Medical Services Act is clear. It is the regions that are the primary authorities and who are responsible for the planning of health and medical services in Sweden. This naturally includes securing access to a purposeful number of care beds and ensuring sufficient staffing, a good working environment, and good occupational health services. But for this to function fully, the state must supplement the regions' responsibilities with more training places and more educational pathways. The state also naturally needs to support municipalities and regions financially.

We Social Democrats, during our time in government, provided historically large supplements to the regions and municipalities to manage the challenges within healthcare, not least during the pandemic. But it is now completely clear that it must be ensured that the supplements provided to the regions from the state also go toward what they were intended for. Region after region, we saw how large surpluses were made while large cuts at the hospitals were decided by the politicians in the same regions, where the money was being piled up. It is naturally not a particularly good approach if one wants to truly address the problems.

Therefore, Mr. Speaker, a clear distribution of responsibility is required. During the previous parliamentary term, however, the Kristdemokraterna did everything in this chamber to do exactly the opposite and loosen this distribution of responsibility. Instead of placing the responsibility for conditions and the working environment where it actually belongs, with the employers, they tried to pretend that everything was the government's fault. It created a strange debate where Kristdemokraterna consistently absolved the regions of their responsibility.

It is now the Health and Social Care Inspectorate, IVO, that in report after report is forced to conclude that the regions do not have enough staff to be able to man necessary care beds and that the staff shortage looks set to be significant for several years ahead.

As you sow, so shall you reap, as is well known. Now it is the Christian Democrats who have the responsibility for national health and medical policy. And just as it concerns petrol prices, high-cost protection for electricity and Archer robots, the government sits there in its self-dug pit.

The breach of promise that we have seen in several other areas also applies to health and medical care. Now, it is no longer the government that is to ensure that the crisis in healthcare is solved. Now, it is no longer important to take responsibility. Now, the regions are left alone to handle the situation, and no large supplements are visible when all regions in Sweden appear to be facing large deficits next year.

This is not sufficient, Mr. Speaker. The crisis within healthcare requires priorities. In the short term, the state must provide more funds to regions and municipalities so that they do not risk large cuts or layoffs in the wake of the economic downturn and the high inflation.

Now that the government has presented its budget, it is however clear that it will not prioritize health and medical care or any major supplements. The government is actually allocating much more money to lowering taxes for high-income earners than to welfare.

We Social Democrats clearly show in our budget alternative where our priorities lie. In our budget motion, we allocate 12 billion in increased general government grants to all of Sweden's regions and municipalities. That is twice as much as the government allocates. It is also absolutely necessary so that we do not see the large cuts in the municipalities and regions in the coming years.

Mr. Speaker! There is a crisis in healthcare, but it is a staffing crisis. And it will not be solved with large tax cuts for us high-income earners, but it requires priorities for the welfare system and its employees.

Now it is up to the parties who shouted themselves hoarse before the election that the government must solve the crisis in healthcare to prove themselves. Will they vote for a budget with 12 billion extra in general state grants, or will they instead choose a budget with half as large investments in welfare and large tax cuts for the rich?

I would like, Mr. Speaker, to move for the approval of our reservation number 1.

(Applause)

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

Linda Lindberg (SD)

Mr. Speaker! I thank you for a very interesting speech from Member Yasmine Bladelius.

My question is whether Member of Parliament Yasmine Bladelius is satisfied with the previous government's work when it comes to shortening healthcare queues and increasing equality in healthcare in the country, so that we do not have such great inequality when it comes to, for example, accessibility to care, or if it is Yasmine Bladelius's intention that the more money we spend, the better things will become. Or is it perhaps the case that one needs to have a long-term plan and a long-term thought on how we will address the challenges that we see within the Swedish health and medical care?

For me, who have sat in opposition for a long time, it stands quite clearly that if one has had eight years in Sweden's government and then succeeded in achieving quite little, perhaps one should take a small step back and think that one maybe should have a plan and an agenda for how one really wants to act.

I think it is quite clear in the Tidö Agreement that the government, together with the Sweden Democrats, has a very clear direction for how we are to achieve a better Swedish health and medical care and how we are to shorten the care queues and improve the working situation. We are also prepared to step in and take increased responsibility for the working environment for our healthcare employees.

My question is: Is Member of Parliament Bladelius satisfied with the work that the government has done over an eight-year period for Sweden's health and medical care?

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

Yasmine Bladelius (S)

Mr. Speaker! I thank Member Lindberg for the question.

When the Social Democrats ruled and sat in government, we invested historically large sums in Swedish health and medical care, including in general state grants and targeted initiatives, not least during the pandemic, which ensured that we emerged from the pandemic as well as we did.

When we Social Democrats are now in opposition, we invest twice as much as the member's party and the government parties do in their budget to strengthen health and medical care in general investments for the regions and the municipalities.

We are now receiving reports that all regions will run with large deficits next year. At the same time, the member's party and the government parties are investing 12.9 billion Swedish kronor so that the member, I, and CEOs in Sweden will get 10,000 kronor more in our pockets while Swedish health and medical care is on its knees.

I completely agree with the member that we need long-term investments in Swedish health and medical care. That is also why we Social Democrats are investing in precisely long-term solutions in our budget, where we say that staffing investments, long-term investments in VFU places, and a staffing supply initiative are required, instead of directing the investments toward temporary care places that the staff will not even be able to man, because there is a crisis within Swedish health and medical care. We are ready to address it. Are you, member Lindberg?

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

Linda Lindberg (SD)

Madam Speaker! Once again, the member is drifting slightly off-topic. We are talking about Swedish health and medical care. This is what we are debating here today; we are not talking about the state finances in the large sense.

The point is that Sweden is one of the countries that spends the most money on health and medical care, but Sweden gets the least care for the money. This shows somewhere a system error - we are de facto not getting better and do not get more care because we spend more money. I can think that it was irresponsible of the previous government to manage the state's money in that way.

We should instead see that there is a systemic error and that we must adjust things somewhere. The government, together with the Sverigedemokraterna, has a number of major reforms to improve and raise the quality and efficiency of Swedish health and medical care.

It is not least about getting a clear picture of the competence supply when it comes to the Swedish healthcare personnel, so that we do not here and now, via targeted state grants, get a sense of satisfaction that many funds are being directed, without in the long run being able to see that we achieve stability and a clear competence supply out in the healthcare system. I think this is much more responsible than the system that the previous government used. It turns out here in the chamber that one actually stands in the same place as one did eight years ago; nothing has happened at all.

I ask again: Is Member Bladelius satisfied with the effort that the previous government has made to develop and improve Swedish healthcare?

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

Yasmine Bladelius (S)

Madam Speaker! It sounds fantastically beautiful from the member in the rostrum. The problem is the investments that the member's party, together with the government parties, actually make within the healthcare sector, for example, a performance-based investment of 1 billion to increase the number of care beds. Although it may sound like that I and member Lindberg agree on the problems, we are definitely not in agreement on the solutions to them.

When I spoke about this initiative the other day with a friend who works in healthcare, she said: "Then they couldn't possibly have understood the problem. It doesn't matter how many more care beds or care wards are opened, because we don't have the staff. The staff that exists cannot run any faster."

We Social Democrats take the issue seriously and, in our alternative, invest long-term in ensuring that the supply of skills is strengthened moving forward. We also ensure that the number of VFU places is increased, which is incredibly important to address the crisis prevailing within Swedish health and medical care.

It is not about a shortage of care beds, but about a shortage of staff. This requires long-term solutions and investments in health and medical care before tax cuts for those of us who are already well off.

(Applause)

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

Linda Lindberg (SD)

Madam Speaker! Today, the two reports that have been submitted from the previous government are being debated, on account of the joint budget that the current four coalition parties had passed last autumn, which intended specific investments in Swedish health and medical care. Our work with adjusting health and medical care correctly thus already began during the previous government's time in power by us letting the previous government start the reforms that we wanted to carry out. In order for us to get an understanding of what the government did, or did not do, an initiative was taken which meant that the government should return to the Riksdag with reports on how the work proceeded. It is these reports, Madam Speaker, that are being debated today.

Something that is quite interesting is that the former government parties – the slightly more red parties – are now actually siding with some of the cooperation parties' motions from June, that is, from before the election. This means to me that members from the Socialdemokraterna, Vänsterpartiet, and Centerpartiet themselves consider that their government has done a half-bad job, because the writings concern their own government's response and the cooperation parties' will and ambition regarding Swedish health and medical care. It feels, of course, secure that we have a virtually full majority in the committee for the government's and Sverigedemokraternas policy in these issues.

Madam Speaker! Swedish healthcare should be of world-class standard. When Sweden has one of the world's highest tax rates and is one of the countries in Europe that allocates the most resources to healthcare, measured as a share of GDP, it is obviously unacceptable that today there are people dying in healthcare queues. At the same time, a record number of those working within healthcare are choosing to end their careers in the healthcare profession due to an unsustainably heavy workload and increasingly deteriorating working conditions that create a completely unsustainable situation.

Instead of directing efforts where we have thought they were needed, previous governments have not succeeded in making a real difference. A welfare country like Sweden deserves better, Madam Speaker, and therefore I am proud, happy and positive that we can now continue the work already begun. That the Sweden Democrats, together with the Moderates, Christian Democrats and Liberals in the Tidö Agreement have agreed on many decisive reforms for the future of Swedish healthcare is really good for Sweden.

Madam Speaker! We have the ambition that Swedish healthcare should be at the forefront and maintain high international quality. It is of great importance to us that patients are treated with evidence-based and effective treatment methods and that the waiting time is within the framework of the Swedish healthcare guarantee. It is also important that the status of the healthcare profession is high, so that the care can both attract new labor and retain the competence and the personnel that exist.

To be healthcare personnel in Sweden is something one should be proud of - it should be sought after. To begin this mandate period with the Tidö Agreement as the basis is reassuring for me and the Sverigedemokraterna in the work towards this new goal, Madam Speaker. We believe in Sweden, and we believe in Swedish healthcare.

We are all well aware that healthcare today is exclusively governed by the 21 regions. This has created a great inequality where the care differs significantly depending on where in the country one lives. In some rural areas, for example, the waiting times can be up to twice as long as the waiting times for the same care in other communities and cities.

For Sweden to have a functioning healthcare chain that maintains good quality, where healthcare staff feel well and where patients get a place and care within the healthcare guarantee, we believe a clearer national governance is needed. It should not matter where in the country one lives, Madam Speaker. In the Tidö Agreement, we give a clear message: National governance of healthcare shall be established to ensure this, among other things.

Furthermore, we view with concern how the previous government in some sense has fallen short in large parts of the healthcare system and left people in very long queues.

Sweden has too few intensive care beds in relation to comparable countries in Europe, which became particularly clear during the pandemic. Therefore, the dimensioning of intensive care beds needs to increase. The management of this needs to be intensified nationally so that we can obtain a broad overview, which is lacking today.

In the Tidö Agreement, the coalition parties address, among other things, the issue of a national long-term plan to eliminate the shortage of healthcare beds. Long queues are a problem and a challenge within the Swedish healthcare system. Today, it also differs depending on which part of the country one belongs to, as I mentioned just now. There is no unified coordination responsibility for the healthcare queues.

We from our side have pushed for a care guarantee office with a national waiting list where treatments and operations are presented to those with the longest care queues. The person who is entitled to care could then, for example, on 1177, basically compare quality and waiting times for the treatments that are available in Sweden.

The patient shall also be able to seek care freely in the region where the care is located. Even here, the coalition parties have agreed on important reforms. A national healthcare mediation under state authority, which we refer to in the Tidö Agreement, shall be developed.

Swedish healthcare faces major challenges where region after region reports that they suffer from a shortage of staff in many different departments. Not least have psychiatry and pediatric wards across the country been severely neglected due to staff shortages. To recruit more to, for example, the nursing education, we believe that the government needs to start at the right end. The healthcare profession has long been deprioritized, and we must make it more attractive to work within healthcare in Sweden. We need to review the wage structure, but above all, we need to significantly improve the working conditions.

I would like to say, Madam Speaker, that we are very clear in the Tidö Agreement: We need a national plan and governance of the skills supply to map out the need for healthcare personnel. The mapping shall also show what measures for existing and new healthcare personnel may be needed to improve the staffing supply. The national commitment for the skills supply shall be strengthened so that we can meet the need throughout Sweden in the long term.

Madam Speaker! The Sweden Democrats want to make a real difference. With the Tidö Agreement as a basis, there is now a clear plan to turn the ship in the right direction again for Swedish health and medical care. It is a solid piece of work that will take a long time to repair after previous governance, and the Sweden Democrats are ready, together with the Moderates, the Christian Democrats, and the Liberals, to put in the extra gears that are required and that Sweden needs.

Madam Speaker! Swedish healthcare shall become good again!

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

Anders W Jonsson (C)

Madam Speaker! I just heard the Sweden Democrats' healthcare policy spokesperson say that healthcare is governed only by our 21 regions. But we also have a lot to say here in the chamber, with all the extensive legislation. Even the EU influences Swedish healthcare to some extent, for example with the patient mobility directive. We must also not forget that the municipalities are responsible for a large part of Swedish healthcare.

It was a point of fact, but that was not why I requested the floor.

One of the major problems in Swedish healthcare is the working environment. I visited BUP in Västmanland yesterday. They have managed in an incredibly successful way to actually reduce the queues - not just at different measurement points, but they have actually reduced the queues.

I was curious and asked what it is due to. How have they proceeded? Well, they said, it is about the work environment. If one ensures that psychologists, counselors, child psychiatrists, and nurses enjoy their work - enjoy it in the sense that one feels that one is making a really, really good contribution - then they want to work here, and then we have the basic prerequisites to actually be able to shorten the queues. There was much more as well.

There is a part in the current policy, that is to say the Tidö Agreement, which, to quote a liberal party leader, the Sverigedemokraterna have "dragged in". Two examples are this matter of limiting the right to use interpreters in healthcare and that one should have a completely new task as a healthcare employee, namely to report patients who lack permission to be in Sweden.

When I met BUP in Västmanland, I thought about how it would affect the working environment for psychologists, social workers, and child psychiatrists who meet these families in crisis. I did not ask the question there, but I would like to ask it to Linda Lindberg. The important demands that Sverigedemokraterna have submitted in the healthcare policy reduce the possibility of using interpreters and task the healthcare staff with identifying those who lack permission to be in Sweden. How would that affect the working environment?

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

Linda Lindberg (SD)

Madam Speaker! The regions are not, quite rightly, governed by themselves alone, so to speak. I am fully aware of that. Thank you for the correction! I completely agree with Member Jonsson.

The work environment is extremely important. One of the cornerstones in obtaining the personnel and the competence that is required is that we have a bearable work environment. We want to review that, and we are prepared from the state side to also provide incentives and funds so that one can achieve the bearable work environment that is required. Without personnel and competence, we can simply not shorten the healthcare queues and we can simply not bring in new personnel into healthcare. We also know that there are signals that after education, people choose not to apply for positions within healthcare, because it is such a stressful and unsustainable situation. The work environment is therefore completely fundamental to addressing these parts.

It has been a good cooperation regarding the Tidö Agreement. All parties have had important reforms included. The national healthcare mediation, as we have called it, is one of several important reforms. We get a special initiative on research into women's health, for example, and the cancer issue we have included. There are very many important parts there.

Interpretation actually lies outside the cooperation agreements specifically regarding Swedish health and medical care, but it is touched upon somewhere when it is to be investigated. I do not remember the question that Anders W Jonsson asked in detail, but the point is that first and foremost it is to be investigated to see how it can be done, perhaps by introducing a patient fee. The wording is not that the right to an interpreter should be removed, but the question is who should pay for the interpreter. In Denmark, among others, they have a system with a patient fee. That might be something.

My question back to Anders W Jonsson is how he himself thinks the interpreter issue should be handled.

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

Anders W Jonsson (C)

Madam Speaker! It becomes a bit fluffy when one says that we are to improve the working environment for those who work in healthcare. It is actually concrete things that we decide here in the chamber that have a decisive importance for the working environment for nurses and doctors. It is the requirements we set on documentation, it is the requirements we set on IT systems, and it is the micro-management that we have a tendency to engage in.

Regarding the Tidö Agreement, the parts that the Sverigedemokraterna have "dragged into" the agreement, to quote a party leader, are precisely to reduce the possibility of using interpreters and to give healthcare personnel a completely new task that they have never had before, namely to be controllers of whether those seeking healthcare have permission to stay in the country or not. If they do not have permission, one should not only take care of their anxiety and their pneumonia, but one should also pick up the phone and make a reporting call.

My very concrete question to the healthcare policy spokesperson Lindberg from Sverigedemokraterna concerns these two specific Sverigedemokratiska points that have been included in the joint healthcare policy. How will it affect the working environment for the psychologist in Västerås who is to meet a family in crisis where the language might not be the best and where they might also not have permission to stay in the country? How does it affect the psychologist's feeling of being able to do a good job? How does it affect the working environment?

If this passes, I believe it will have a decisive impact on the working environment for everyone working in healthcare. It would be interesting to hear what assessment Linda Lindberg makes of how these two concrete Sweden Democrat proposals in the Tidö Agreement actually affect the working environment for hundreds of thousands of healthcare employees.

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

Linda Lindberg (SD)

Madam Speaker! It is very interesting that the member seems to have full insight into which negotiations have taken place regarding the Tidö Agreement and which reforms and proposals various parties have submitted.

This is one of many proposals that the Sweden Democrats have submitted in the Tidö Agreement. It doesn't actually have much impact on the health and medical care chapter as a whole, I would like to claim, but there are significantly larger and more important reforms from a health perspective.

We are talking, among other things, about increased national governance to increase equality in Swedish healthcare. It is extremely important. It should not matter whether one lives in Skåne or in Västerbotten when it comes to, for example, which insulin pump one should receive. It simply should not matter where in the country one lives in order to receive good and high-quality care and, in that regard, also good medicines.

We will map out the healthcare staff's needs and analyze them thoroughly. There are incredibly many parts in the Tidö Agreement that I am convinced that Member W Jonsson also thinks are fantastically good. We have, after all, sat in the Social Affairs Committee together and have sent a good number of joint announcements to the previous government regarding things that we have been completely in agreement on. It is therefore a bit mocking and strange that W Jonsson suddenly stands on the other side and pretends as if he has no clue at all about what happened in the Social Affairs Committee during the last parliamentary term. He should perhaps correct that.

And finally, the issue of interpretation is quite interesting. In Sweden, we spend enormous amounts on interpreters. One can ask who is actually supposed to pay. Does W Jonsson think it is reasonable that someone who has lived in Sweden for 20 years should automatically be entitled to an interpreter? Or is it reasonable that at some point along the way, one should learn the Swedish language well enough to be able to get help in getting a bandage?

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

Karin Rågsjö (V)

Madam Speaker! Healthcare is still in crisis. It will be for quite a long time, I believe. When the budget was presented, I did not hear any cheers and jubilation from the healthcare unions, but rather a great concern from the regions and the healthcare workers in different ways. The motto for this government, I think, is: less is more. So one could translate it that way.

SKR went out quite early and said: We need approximately 20 billion in increased state grants to maintain the current level when it comes to the entire welfare, including health and medical care. It became 6 billion from the government plus the other sums. This is going to be a bit of a budget debate, but I expect to find out the details.

I wonder how you were thinking, Linda Lindberg. Would the 6 billion in additional funding bear the major crisis that still exists within health and medical care and which is about the staff? It is a staffing crisis. It is not a lack of beds, but a lack of staff who should be trained and employed with very good conditions so that they will want to stay and work within health and medical care.

It is also about prioritizing. The Sweden Democrats have great influence, because you are the largest party in the group of parties that has now formed a government. You must have great power. I wonder, of course, how it only became 6 billion, if one is now to walk the talk. It is not overflowing with money and resources, but people are running themselves ragged within the health and medical care.

I wonder how you thought about whether you will be able to fulfill all the promises you make. There are many good headlines in the palace agreement. But I wonder what you are going to fill them with.

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

Linda Lindberg (SD)

Madam Speaker! When it comes to the personnel issue, we are in complete agreement, Member Rågsjö. I do not believe that any of the parliamentary parties represented here in the chamber think that the personnel issue is not important. It is incredibly important.

It is primarily the municipalities that must take their responsibility, even though we know that many municipalities have tough budget conditions. There is a lot of money to be invested and many things that need to fall into place, everything from social services to elderly care and many other important parts. But at the municipal level, one simply has to ensure that there is a decent and good working environment. It is the same thing at the regional level.

But when we see year after year that they are unable to manage the situation and that it, due to various factors, is becoming increasingly unsustainable, the state needs to step in and ensure that a bearable working environment is achieved in the operations. Then we can stimulate staff to return to the healthcare profession but also bring in new staff who want to stay. It is fundamental for us to be able to move forward, shorten healthcare queues and increase competence. I do not think anyone thinks otherwise. It is really just a matter of doing it.

Just as I said earlier, the issue might not solely be about funneling in more capital. One might perhaps need to look at what needs to be changed and adjusted in order to increase efficiency. I am not saying that we should not invest money. That is very important. We really must do that. But we already see today that Sweden is one of the countries that pays the most for health and medical care but receives the least care. Where are the money going? That is my question to Karin Rågsjö.

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

Karin Rågsjö (V)

Madam Speaker! Yes, where are the money going? One must perhaps look at both things.

Now it is to the extent that it is a major crisis. It is clear that there is a shortage of staff. It is clear that there are care beds that are not staffed. It is a huge crisis.

Then I wonder how you, as a support party to the government and with great influence given that you are the largest of the parties, can land on just increasing the state grants, Linda Lindberg. It is those that make it possible to employ staff. One can have all sorts of sums and headings in one's budget, but if one cannot live up to a kind of base, a foundation to stand on, it becomes almost nothing. And that is what the regions say.

I do not believe that the money goes into black holes. But if there is a complete crisis and there is no staff who can receive the money that you send out in the form of targeted government grants, they will disappear to something else. That is a tip from me.

I wonder why you chose to enter with only 6 billion in additional funding, beyond what has been added previously. SKR said that 20 billion was needed. Why did you then choose to lower the tax for those who earn the absolute most? That amount amounts to 12.9 billion according to the Social Democrats. We raise the bid to 13 billion. That is quite a lot of money.

The question is whether that specific investment is the most valuable. Could one not instead have chosen to spend the money on welfare? That is what the discussion will be about as well when it comes to the budget. And that is what I wonder when I read this and what I hear when the regions call me and tell me how it is going to be. 21 regions will run with a deficit. Then I wonder why the Sverigedemokraterna made the choice to invest in those who are doing absolutely best.

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

Linda Lindberg (SD)

Madam Speaker! I have as my motto to always try to answer the questions that are asked. But here we are quite far from that, regarding certain questions within the health and medical care area, which we are going to debate here today. It covers incredibly important parts: the supply of competence, how we are to get better training positions, and how we are to shorten the care queues.

I think that the budget debate will be a specific debate and that we can analyze each other's budget proposals there. I would very much like to return to the issue once I have had the opportunity to analyze the Left Party's budget proposal. Therefore, I think we can wait with that debate until another time.

But just as Member Rågsjö says, the staffing issue is urgent. I am completely convinced that we agree that it must be addressed. The challenge is that we are not quite in agreement on exactly how it should be addressed. But we need to establish a long-term plan and strategy for the supply of competence within the Swedish health and medical care. It is extremely urgent, to begin with.

We must also achieve a bearable working environment out in our operations. It is a high priority. We need to look at it. And we will do so. We will be a spotlight on the government and ensure that it happens. I can assure Member Rågsjö that.

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

Karin Rågsjö (V)

Madam Speaker! Governments come and go, but the healthcare crisis remains, one could say. There are facts that show the extreme overcrowding all over the country in hospital clinics and care wards - 100-130 percent throughout the weeks. It peaks at 150-200 percent overcrowding during certain weeks. This is extreme and far from the 90 percent that we usually talk about in healthcare policy and which is said to be the limit for providing patient-safe care. So that is the situation. This is the starting point we enter with a new government, unfortunately with large expected cuts within healthcare.

The great needs of care and nursing and the staff's recurring challenge ultimately come down to one thing: time. Being able to provide time in care is crucial, but it is a scarce resource. Employment within care and nursing should be sought after, shouldn't it? Those who work there should want to stay. This is a super important issue. Vänsterpartiet wants to reform the personnel policy so that more people want to start working in health and medical care while those who work there now want to stay. That is not quite the case today.

The reason for increasing the number of healthcare beds is, as previous speakers have said, staffing density. As the population grows and the proportion of elderly people increases, there must be incentives to help, and one must ensure that they end up in good healthcare and primary care. This is A and O.

Resources must be reviewed in order to improve working conditions and the work environment in various ways. We have discussed this during the eight years I have sat on the Social Affairs Committee plus this parliamentary term. We believe that measures are needed in this area, which should be guided by a zero vision for work-related ill health. I believe that the government should return to the Riksdag with a proposal for such a vision. I therefore move for approval of reservation number 2.

Healthcare is, as has been said, in crisis. The queues are still growing, and in that case, one must have some kind of plan that is initiated quickly to stop this. I will touch on the budget a bit, as most do – it is difficult not to do so now when everyone is releasing their budgets. The SD-led right-wing government's state budget was a cold shower for healthcare. The chairman of SKR, who is, moreover, a party comrade of the Finance Minister, was not merciful and called the supplement to the regions insufficient. At least 20 billion in increased state grants would have been needed, says SKR, and it became 6 billion.

I really do not believe that less is more, but we will have to discuss this in December. We chose to settle on a different amount, 24 billion more, within the same framework. We do not have a printing press in the basement, but we have prioritized differently. For example, we do not think it is a good idea to give them a tax cut with incomes over 46,000. One wonders: Is this what healthcare needs right now, or what should we do about it?

Now, Madam Speaker, I will come to a favorite subject that I always tend to discuss. It is about the unregulated market, which I find interesting. No other welfare countries in Western Europe let the market govern primary care as Sweden does, according to researchers. Not even Denmark, which everyone is talking about now and which the Minister for Health looks towards when she wants to make healthcare more equitable.

Sweden's tax-financed healthcare system is the only one in Western Europe without establishment control. I think we can discuss how well this turned out. Not even the private general practitioners are allowed to open clinics wherever they want in Denmark. The regions allocate a certain number of permits and negotiate the terms with the doctors, says Finn Diderichsen, who is a doctor and professor emeritus of social medicine at the University of Copenhagen and who has also worked at the Karolinska Institutet. This is what he says in an article in DN. It might be good to talk about the fact that it is not Vänsterpartiet that has been sitting and fabricating.

If healthcare is commercialized, it is extremely important to regulate where the doctors establish themselves. Since it is most profitable to work in areas where the patients are healthier, there will be a greater establishment in healthier areas. This is what they have wanted to avoid in Denmark, says Finn Diderichsen so wisely. But we do not do that in Sweden. I think this is missing in the government agreement and in what I envision. The market is not regulated here; instead, the healthcare market is sacred. Freedom of establishment makes healthcare more unequal.

I believe that with the Sweden Democrats in one hand and the lobbyists from the healthcare companies in the other, it will become what it becomes within Swedish healthcare.

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

Johan Hultberg (M)

Madam Speaker! Swedish health and medical care is fantastic and performs very good results in international comparison. As an example of this, it can be mentioned that Sweden belongs to the countries that have the absolutely lowest so-called avoidable mortality, i.e., mortality that care and treatment can influence. Swedish health and medical care is upheld by tens of thousands of committed and competent employees who every day do their utmost to provide the very best care, treatment, and nursing.

Mr. Speaker, Swedish healthcare also has long care queues, too few care beds, and unacceptably large regional differences. And these are problems that did not arise during the pandemic. No, these are problems that are almost best described as chronic. At the same time, it is my and the Moderaternas firm opinion that this situation can be changed. It does not have to be this way.

We are convinced that with the right leadership and with reforms that address the problems and challenges that Swedish healthcare has, it is possible to cure the diseases that the Swedish healthcare system has been afflicted by. We are convinced that it is possible to create a healthcare system where one not only receives the right care but also care at the right time. We are convinced that it is possible to create a more equal Swedish healthcare system.

The previous Social Democratic, and before that red-green, government unfortunately lacked the strength and ability to tackle the problems in healthcare. The development went in the completely wrong direction in many respects. Even before the pandemic, the care queues had doubled, and during the pandemic, the care queues naturally grew even longer when care had to be cancelled or postponed.

It was against this background that we Moderates, together with the Christian Democrats, the Liberals, and the Centre Party, submitted a joint committee initiative to urge the then government to increase the number of healthcare beds, shorten waiting times, and promote freedom of choice in healthcare. And we demanded that the government repeatedly report on how the work is progressing, hence the two reports from the government that we are, among other things, debating today.

Madam Speaker! The two communications from the previous government are unfortunately not a particularly uplifting read. In the communications, there is a void of ideas, reforms, and concrete action. Today, however, there is every reason to feel hope and confidence. We have indeed received a new government. Finally, we have received a government of action. Finally, we have received a government that is firmly determined to implement an ambitious and comprehensive reform agenda in the area of health and medical care, which we in the four coalition parties have agreed upon. With the Tidö Agreement and the government's recently submitted budget bill, we have charted the path forward and begun the laborious work of shortening the queues, increasing the number of care beds, and developing the entire Swedish health and medical care system.

Madam Speaker! Let me mention some of all that the new government now intends to do and which responds to just precisely that which was requested in the committee initiative from the previous parliamentary term, which is thus the basis for today's debate.

To shorten the queues, the government is investing 3 billion annually in performance-based compensation. At the same time, work begins to establish a national healthcare brokerage. The healthcare system's total capacity must be utilized better and patients are given better information about where in the country there is available capacity. The establishment of a national healthcare brokerage is important both to shorten the healthcare queues and to strengthen the individual patient's position.

One of the reasons for today's long healthcare queues is the shortage of available healthcare beds. Therefore, a national long-term plan to reduce the shortage of healthcare beds shall be launched. The shortage of healthcare beds shall be mapped out, and to increase the number of healthcare beds, a performance-based compensation shall be introduced. A total of 2 billion is invested in this already next year, and then it is estimated that an equal amount will need to be invested in both 2024 and 2025.

Fundamentally, in order to address the shortage of care beds, to increase accessibility, and to reduce the unjustified regional differences, the supply of competence is essential. Therefore, I am pleased that the new government intends to do exactly what we Moderates have long demanded, namely to take a greater national responsibility for these very important personnel supply issues.

The government shall develop a national plan to improve the supply of skills. Specifically, this concerns a range of measures to improve the working situation for those employed within health and medical care. This includes, for example, measures to improve the work environment and create better development opportunities in the work, but also about supporting the work to increase further education for nurses.

We know that there is a particularly great shortage of, not least, specialist nurses with a focus on, for example, anesthesia, intensive care, and surgical care. In total, the government allocates 3.2 billion in 2023 to support the regions' and municipalities' work with competence development and competence supply. For the work of creating development and career opportunities, an additional 500 million is allocated next year.

Madam Speaker! In a few weeks, we will have the opportunity to return to these budget investments when we have the budget debate on the entire expenditure area 9. But the mentioned investments are examples of how the government is already now, in its very first of hopefully many budget bills, making large and strategically important investments to develop healthcare. It is about shortening the queues, improving equality across the country, and improving the working conditions for those who, as I mentioned in my introduction, uphold the Swedish health and medical care, namely the employees.

With that, I would like to thank you for the floor and vote in favor of the committee's proposal.

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

Anders W Jonsson (C)

Madam Speaker! I want to begin by saying that I agreed with a large part of what Johan Hultberg began his speech by saying. I almost thought that he had copied something from one of my many speeches from the chamber of the Riksdag.

It is about the fact that Swedish healthcare performs incredibly well. We have a fantastically well-functioning healthcare system that has results that people in the rest of the world would only dream of. But that being said, we also have challenges in a large number of areas, and several of them were pointed out by the alliance parties together when we pushed through the announcement. There, I no longer share Johan Hultberg's view on how we should manage healthcare.

I remember a healthcare debate from August or September, so a few months ago, where Vårdförbundet or Sveriges läkarförbund said: For God's sake, no more earmarked state grants! That is not how you can manage Swedish healthcare. Swedish healthcare must be managed through law and regulation and by the regions having enough money.

It was probably I who commented and said: Right now, all of us who are part of this panel probably agree on that. But the one of us who will be responsible for the healthcare policy in the government will love earmarked government grants. That is what we see now. The investments being made in the healthcare area are again earmarked government grants. This time, they are being made to create more healthcare beds.

Would it not be wiser, I wonder, if instead of imposing austerity measures on the Swedish regions, we ensured that they received sufficiently large economic resources, and that at the same time, one ensured that the Inspectorate for Health and Social Services pursued the Swedish healthcare heads with a blue light? The shortage of care beds is an acute problem. It is so in all Swedish hospitals, in some more and in some less.

Would it not be better to use that management method instead of reverting again to targeted state grants?

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

Johan Hultberg (M)

Madam Speaker! Thank you, Member Jonsson, for the question!

We are fundamentally in agreement that Sweden's municipalities and regions need more of general government grants. It is the politicians locally in our regions and, of course, also our municipal politicians who best know the local conditions and can make adjustments.

With that said, I still believe that when the state provides additional funds to the regions in this case, which we are now debating, it is important that requirements are also set on performance—that they must deliver results.

When the Alliance ruled together, we had a successful queue billion. It was an important tool for us to then succeed in shortening the healthcare queues and improving accessibility in care. It set a focus politically but also economically through the stimulus grant in the form of a result-based queue billion.

With experience from that, we have now moved forward with a proposal that we also need a performance-based compensation to increase the number of healthcare beds. Exactly how it should look, we will of course have to come back to.

Furthermore, it is also in that sense that in the budget the government has submitted to the Riksdag, the general state grants are increased. We do this despite the fact that we are in a very tough economic situation with very large needs in many areas.

At the same time, it is extremely important that the government does not drive up inflation by presenting an expansive budget. We have nevertheless succeeded in strengthening the resources to our regions. Will it fully compensate for the cost increases out in the regions and municipalities? No, it will not.

It is tough times that the state, our households, the municipalities and the regions are facing. In that case, it is naturally incredibly important that we stick to a strong work ethic. That is what the Moderaterna are always the guarantee for. That is what creates the resources for the welfare.

I will probably have to return to the questions about how we can strengthen Ivo and so on in my next speech.

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

Anders W Jonsson (C)

Madam Speaker! The shortage of care beds is an acute problem that directly threatens patient safety. At Sundsvall Hospital - Region Västernorrland, which the Moderates and Social Democrats governed together - the doctors say: We are in almost free fall. Heart patients are admitted to the psychiatric ward because of such a shortage of beds.

It still becomes a central question for us to discuss. How are we to govern the Swedish healthcare system from a national level? The model that the government is now entering again, with specially designated state grants to solve this and that, has historically shown itself not to be a particularly sharp governance model.

It is significantly more effective in that situation to ensure that the regions have sufficient resources to provide a patient-safe healthcare by the state providing proper supplements. We shall simultaneously have the Health and Social Services Inspectorate, which with extremely sharp means can travel around the country and exercise supervision and ensure that patients are cared for in the department where the specialist competence is located and that patients are not outsourced or, for that part, have overcrowding.

Just that combination has proven to be very effective. Instead, the government is now doing the opposite, and that is what worries me. It presents a budget that will be discussed later. It means de facto that the regions are forced to implement very tough austerity measures.

At the same time, money is being pulled out for a specially designated government grant that is intended to be focused on solving a specific problem. The risk is that the temporary funds will not be able to be used to make long-term structural changes in the hospitals' way of working. I am seriously concerned about the governance model that even this government seems to be entering.

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

Johan Hultberg (M)

Madam Speaker! I think Member Jonsson is partly contradicting himself a little bit. He begins by saying that the shortage of healthcare beds is an acute problem. Then he does not think we should use the tools that we can still use in the short term to quickly achieve change, namely, for example, economic incentives.

It is too early to judge a system that we have not yet gotten in place. I agree that it is important that we do exactly what Member Jonsson points out. It is about us reviewing how we can tighten the supervision.

We can also, as I know we agree, strengthen the patient's position. It is extremely important so that we can place increased demands on the regions to deliver good results. By good results, I mean both the quality of care and, of course, the accessibility.

It is important that we strengthen the patient's position. A national mediation is also important to shorten the healthcare queues. I was somewhat astonished when I heard how MP Jonsson previously nearly scoffed in his exchange with my colleague from Kristdemokraterna.

This is something that we have jointly pushed for and that should be put in place. I see it as important that we give all of Sweden's inhabitants increased knowledge about what rights exist in healthcare and where there is available capacity.

My perception today is that it is primarily resource-strong patients who utilize the legislated rights we have to seek care outside of their own region when their home region cannot deliver. Now, we are taking initiatives to strengthen everyone's opportunity to receive care in a timely manner outside of their own region and truly ensure that we do not leave any capacity unutilized anywhere.

In this situation, with such long healthcare queues, we must ensure that we use all available capacity. And this government, which took office a month ago, will truly work actively for this.

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

Karin Rågsjö (V)

Madam Speaker and Member Hultberg! I think that in a good world, where there had been available places throughout Sweden, it would have been fantastic with a national healthcare brokerage. But that is not the case, and I believe it will become even worse.

What we are talking about now reflects the submitted material, which is what it is about right now. I am thinking of SKR, which had raised and requested 20 billion. They said that it is an amount that would ensure that welfare will still manage reasonably well and that it was what they needed. But you took the opportunity and went down to 6 billion, Johan Hultberg.

It is incredibly bleak times economically, but I believe there would have been room to meet SKR and their demands to keep the healthcare running. All 21 regions now face cuts and very difficult decisions that they must make. This you could have avoided by putting a little more money into the regions and a little less into the high-paid.

There is also another task that I have received from SKR that worries me. It concerns the targeted government grants, where there will be a reduction of funds for health and medical care from a projected 36 billion in 2022 to 18 billion in 2023. Then it will go down further in the coming years, 2024 and 2025, to 11 billion. There will be very many minuses along the way.

How then should one meet the healthcare crisis? How should one meet the staffing crisis? How should one get people to want to stay working in a healthcare system with constant cuts? How should one get people to stay working on schedules that are completely implausibly bad? How should one capture young people and get them to want to work in healthcare when the economy is going to be so poor? Why have you not chosen to strengthen the state grants to meet this, as we have spoken about for so long?

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

Johan Hultberg (M)

Madam Speaker! As I mentioned in the previous exchange, I am proud that in this tough economic situation we have been able to prioritize healthcare, elderly care, and the core of the welfare system.

We are increasing the general government grants by 6 billion, and we are making important targeted investments to address some of the fundamental problems we have within Swedish health and medical care. It is lack of accessibility, lack of care beds and an insufficient supply of competence - three problems that in many ways are one and the same problem. They are truly interconnected.

If we are to be able to improve accessibility and increase the number of healthcare beds, it is not just a matter of pouring more money into the system. It is about ensuring that there is staff who – as Member Rågsjö was touching upon – want to, can, and have the energy to stay in healthcare.

It is naturally required that we do everything we can as national decision-makers, but also that our regional and municipal representatives do their part of the work. Neither I nor Member Rågsjö set schedules or are responsible for the local work environment work, but we must create conditions in the form of care beds, good educational places, and opportunities for career and skills development. We must take all the initiatives we can to improve the work environment.

When it comes to the targeted state grants and their reduction, this is a logical and obvious consequence of the fact that we have now left the acute phase of the pandemic. A very large amount of the targeted state grants that Member Rågsjö refers to are linked to measures during the pandemic.

We are no longer in that situation, so I do not think that either SKR or anyone else is surprised that the grants are being phased out. It is natural when one does not have the extra work and the extra costs that have been associated with vaccination efforts, information efforts, and the major transition that one had to make during the pandemic to a more acute operation from having a more planned operation, which we are now returning to.

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

Karin Rågsjö (V)

Madam Speaker! I am thinking of a good expression that goes: Walk the talk. When we listened to the right-wing group during the last parliamentary term, it sounded like this: When we come to power, then you shall see! Then it will get better!

We are, in itself, in a major crisis, but I do not think it is okay to talk about pouring money into the system. I do not think that is how those who work within health and medical care see it. They experience a crisis every day, they have to sit in extremely overloaded emergency departments, they have to run around and so on. I do not think it is about pouring money into the system, but I think it is about the fact that more state grants would have been needed.

SKR said 20 billion, and you landed on 6 billion, Johan Hultberg. Okay, I still have to say that it is a huge discrepancy. Not just me, but also many others are concerned.

Politics is about prioritizing. What should we prioritize now as we enter a crisis? Should we prioritize those like me and many others here in the chamber - those who earn over 46,000? Should we prioritize them, give them slightly less tax and change the threshold?

Or should we take those money back and leave it be? They will manage. The absolutely richest will manage. Those who have it the best in society will manage. We take this money and put it on welfare instead! Then it would have become a performance of ringing and cheering. Then one could have said: Wow, look, they are doing this! Even the SD-led government is doing this - it is fantastic!

But now it won't be like that. Now, instead, there is a great concern in Sweden's regions, and it is not the politicians who are most worried. They are also worried, but most worried are nurses, doctors, nursing assistants, psychologists - you name it! It is they who work and who know that it will now be truly hard times. It will not be like what we have seen previously, but it will be worse. That is what is so tragic.

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

Johan Hultberg (M)

Madam Speaker! Many people feel anxiety in our society today, and with all justification because we find ourselves in a concerning security policy, economic, and climatic situation.

I am proud that the government that has now taken office has been able to address much of this concern. I am proud that we have been able to make important investments in upgrading the defense and important investments so that ordinary people can afford to take their children to extracurricular activities or commute to work. I am proud that we have been able to provide resources to health and medical care.

Will this completely solve the challenges that the regions are currently facing? No, it will not. These are tough and harsh times. It is very possible that the government will need to return in future budgets with additional state grants to the regions, depending on how the economy develops.

It is still somehow fantastic to hear the high expectations that Member Rågsjö has for the newly appointed government and for us four coalition parties! Now it has been a month since the new government took office, and it sounds like, according to Member Rågsjö, that the healthcare's challenges and problems should be gone by this point.

I am a bit more humble than that and note that the problems are, as I described in my speech, almost chronic. It will take time to solve the lack of accessibility and the shortage of care beds. But we are taking important steps in the Tidö Agreement, in the budget bill, and in the government statement to realign the policy and truly tackle the underlying problems.

Madam Speaker! I can conclude that the report we are considering today contains zero proposals from Vänsterpartiet. There are no motions, and no motions have been raised on the grounds of the letters. It is therefore very much - if the expression is permitted - hot air from Member Rågsjö.

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

Yasmine Bladelius (S)

Madam Speaker! I can state that it sounds quite similar from us opposition parties when we request the floor to ask questions to Member Hultberg.

I noted that Centerpartiet member Jonsson asked member Hultberg whether it would not be better to invest in general state grants to the regions and municipalities rather than having targeted state grants. I would like to rephrase the question to member Hultberg a little bit.

The regions and municipalities are now expected to enter a tough economic situation. We hear from all 21 of the country's regions that they expect to run large deficits in the coming years and thus, naturally, also to have to make cuts and layoffs. Would it not then be better, Member Hultberg, to invest 12.9 billion in general state grants to our regions and municipalities rather than tax cuts of an extra 10,000 kronor for you and me?

The Moderate member said in his speech that he was convinced that it is possible to solve these problems within the health and medical care. Then the next question to member Hultberg becomes: But how?

Together with the Sweden Democrats, the members and the government parties are allocating 6 billion in targeted state grants. They are lowering taxes for those who already earn well by 12.9 billion, and they are directing state grants of 6 billion to a sector that is expected to run with large deficits and which will need to lay off staff and make cuts at our hospitals.

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

Johan Hultberg (M)

Madam Speaker! Let me begin by correcting a few things. We are, therefore, increasing the general state grants by 6 billion. These are already very extensive state grants that we are further strengthening.

I naturally understand that Sveriges Kommuner och Regioner would have wanted more. It would have been almost a dereliction of duty by the chairman of SKR if he had not expressed disappointment that more was not granted by the government. I am, as I said, nevertheless proud that we have been able to provide additional resources in this difficult economic situation.

When it comes to the debate on state income tax, I can state that it is about an upward adjustment of the threshold for state income tax, a model that has applied for a long time. It is adjusted in the same way as we adjust very much of the social security benefits. It results in increased benefits for those living on social assistance, for example, and it is linked to the cost developments in society.

I note that it was the Bladelius government that abolished, for example, the wealth tax. Had we Moderates been in power, we would have made a different prioritization. We would have thought that it was important for some to abolish the wealth tax, but that it was even more important to lower the tax for those with low incomes. That is where it is extra important to strengthen the incentives for work. To do that, to have a strong work line, is the basis for us to have resources for the welfare in the long term. That is where the Social Democrats and the red-green parties lack an answer.

Then I delivered quite a few answers, Madam Speaker, on how we should develop Swedish health and medical care. I spoke about the need to take increased national responsibility for the supply of competence. I can gladly add how important it is that we create better conditions for information sharing within health and medical care. It is also something that contributes to improving the working environment and creating conditions for more efficient work.

How the Social Democrats want to develop Swedish health and medical care is still a mystery.

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

Yasmine Bladelius (S)

Madam Speaker! SKR is clear: At least 20 billion Swedish kronor are required just to maintain the level we have today. Sweden's regions are also clear: They will all run with large deficits next year.

How many of the initiatives that Member Hultberg's party, together with the other government parties and the Sweden Democrats, are now directing, and which Member Hultberg also provides examples of in this exchange of remarks, does Member Hultberg believe will be implemented? How many of them does Member Hultberg actually believe will be implemented and have an effect in the operations? These are simultaneously reporting that they are forced to run with large deficits next year. They will be forced to make deprioritizations, forced to make cuts, and forced to lay off staff.

None of the initiatives that the Moderate Party member presents here at the rostrum and that the government parties present in their budget will achieve one hundred percent, full effect in the operations because, at the same time, one is not investing in the general state grants even close to what SKR claims is needed to maintain current levels.

What one does, however, Madam Speaker, is lower the taxes for those who already earn a shitload of money with 10,000 kronor. And then I haven't even included the other tax cuts that the government parties are making.

If, instead of spending 12.9 billion to lower taxes for the rich, they had spent them on general state grants, it might have been reasonable to believe that the proposals the member presents could be implemented in practice. That will, however, not be the case, Madam Speaker.

(Applause)

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

Johan Hultberg (M)

Madam Speaker! Of course, it matters greatly what resources Swedish healthcare has at its disposal. In that case, it is, as said, extremely important that we have a strong work line and get more people into work. That was something the previous government failed gravely with. They promised Europe's lowest unemployment but delivered Europe's lowest growth. Had we had different policies, Swedish healthcare would have been better equipped financially.

Now I am glad that we have a strong government that will have a focus on creating more jobs and having order in the public finances so that the state does not contribute to driving up inflation further and putting the regions in an even tougher economic position. Now we are strengthening the general government grants. We are beginning an important reform journey within Swedish health and medical care.

I also note that the proposals the Social Democrats are pushing are moderate proposals. That is positive. The reservations made by the Social Democrats in this report are such proposals as the Moderates have put forward. It is positive that the Social Democrats are inspired by us Moderates when it comes to how the Swedish health and medical care should be developed.

We have many answers. We have delivered them in the government statement, we have delivered them in the Tidö Agreement and we have delivered them in the recently submitted budget bill. But it is an arduous and long-term work that naturally is about resources but also about structural reforms.

I would like to continue talking a bit about, for example, the importance of reforming when it comes to digital infrastructure and digitalization. Here we have an enormous need to achieve better legislation but also better infrastructure so that healthcare information can be shared better, for the benefit of healthcare development and research, but also to ensure that the staff on the floor in our hospitals do not have to report the same information in several different systems but can spend more time on the important patient encounter instead of on administration.

Thank you for this exchange, Yasmine Bladelius! I look forward to many more debates on how we can develop Swedish healthcare.

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Anders W Jonsson (C)

Madam Speaker! The debate we have had today began on January 14, when the chairman of Vårdförbundet, together with the chairman of Läkarförbundet, published a rather much-discussed article in DN Debatt with the headline "A crisis commission is required for healthcare". Those were words, not mere sentiments. It was serious signals from their members that made them take this step.

In the article, a number of major problems in Swedish healthcare were pointed out. This concerned, among other things, the problems in the work environment. More and more employees are choosing to leave, not least from acute care, because they feel that they can no longer do a good job. It concerned the supply of competence, which is far from satisfactory. It concerned the shortage of care beds, which previously was something that occurred at some hospitals in Sweden but which today, according to Vårdförbundet and Läkarförbundet, exists at almost all Swedish hospitals. It is no longer a local problem.

Finally, it was about the queues in Swedish healthcare, which is something quite unique for Swedish healthcare. We perform well in many areas, but we have completely unacceptable long queues and have had so for a long time - I could even say decades. The first attempts to solve this came in a 2001 agreement between the Socialdemokraterna and Centerpartiet.

This was an alarm signal from the Swedish healthcare sector. Läkarförbundet and Vårdförbundet had contacted the government and the then healthcare minister. It was about getting the government to take a national responsibility. It was not a cold shoulder, but not far from it, was the experience. One was completely dismissive of the idea of a national crisis commission.

It was also this that caused the Center Party, the Moderates, the Christian Democrats and the Liberals to work out a proposal for an announcement in order to bring the issue here to the Riksdag and push the government forward so that something would happen. What we are now discussing is the reporting based on that announcement.

Madam Speaker! The situation in healthcare in Sweden is not better than a year ago, when the work on this DN Debatt article was underway, but rather worse. I have mentioned Sundsvall Hospital previously. It is probably one of the hardest-hit hospitals. A few weeks ago, doctors alerted in an article in Svenska Dagbladet that they are close to being in free fall at this hospital. It is a region that has been governed by Social Democrats and Moderates during the past parliamentary term. The article also described how patients who have heart problems are admitted to a psychiatric ward.

The answer from the previous government was that this is not the state's responsibility but that the regions must take responsibility for it. It is somewhat striking that the newly appointed government has exactly the same message; this is the regions' responsibility, we have heard in the debate today.

Once again, we also have a government that falls back on targeted state grants, large and small, and believes that problems can be solved in that way. That is not the case. If one is to be able to solve the major problem that the debate article in January pointed out, namely the shortage of hospital beds, it is a matter of structural measures at the hospitals that can be planned for a long time ahead. If the regions receive general state grants, they can be used to address the bottlenecks one has at their own hospital. Sharp supervision in the form of Ivo is also needed.

The problems with the queues will not be solved by the old Social Democratic proposal that there should be an office in Stockholm that coordinates available capacity in Swedish healthcare. Available capacity largely does not exist. If, on the other hand, long-term rules of the game for Swedish healthcare were provided by making changes to the Patient Act and ensuring that there is proper information for the patients, a number of healthcare providers could in the long term plan to solve these problems and increase their capacity. This has been clearly signaled, at least by the private healthcare providers. But they have not received these long-term messages, not from the previous government and absolutely not from the current one. In that situation, it is very difficult for a private company to increase its capacity.

Madam Speaker! I feel somewhat disheartened, because neither the former nor the current government has responded to the demands made by healthcare workers, which fundamentally are about creating a good working environment for those who work in healthcare. It is, after all, there that healthcare is created: in the meeting between the individual nurse or doctor and the patient.

Madam Speaker! I move for approval of reservation number 3 from the Center Party.

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Lina Nordquist (L)

Madam Speaker! During the previous parliamentary year and also before that, the Liberals made several requests to the then government to improve Swedish healthcare in crucial areas. Swedish healthcare is, as many here today have stated, absolutely crucial for people to get their lives back. But it is also, unfortunately, a place where employees are often drained of their very lives.

Madam Speaker! We noted – sometimes ourselves in our shadow budget, sometimes together with other parties – that the state needs to take a greater strategic responsibility so that Swedish healthcare can have more care beds and to shorten the care queues, so that sick people do not have to wait for care. We also requested time and again that one should be able to be operated on somewhere else in the country than where one lives if one so wishes.

Madam Speaker! We also issued demands regarding the state's role when it comes to hiring and retaining skilled employees in healthcare. Those who choose to work in healthcare should be certain of receiving a good working environment, enough colleagues, and continuing education. This applies to bedside, labs, radiology departments, and all other places in healthcare where we today often have a shortage of crucial competence. Simply hiring and retaining the skilled and caring is, we Liberals would say, the most important measure to get more healthcare beds and to get more operations and other care in a timely manner. No decision in any boardroom or any chamber, Madam Speaker, can strengthen Swedish healthcare as much as skilled colleagues who can be relied upon.

The government at the time did not want to deal with self-determination, neither for employees nor for patients, but they did want to deal with care beds. There we perhaps actually had an agreement, at least towards the spring, but we did not have an agreement on how it was to be done. There is a tendency among many parties to want to pour in large lump sums. But these sums cannot be used to employ a single human being. No one wants to be employed for four months' pay that runs out at Christmas, because what happens then? It is as if a care bed were a bed with an IV stand and not care and knowledge around the clock for the person who becomes ill.

But now it is happening, Madam Speaker, and I am very happy about that. Now the new government has begun the work of strengthening the work environment. Digital tools are being introduced that make a big difference both for the patients' safety and for the employees' work environment. There will be stronger occupational health care and insurance protection. There will be long-term funding in the supplements instead of individual lump sums that run out at the turn of the year. Care is taken to ensure that money for care beds actually turns into just care beds - places where patients receive help around the clock until they are able to be discharged. The care chain, Madam Speaker, will be strengthened across the entire country. There will be more small-scale care in primary care, more autonomy even for those who are ill and need inpatient care, and more support for relatives.

I feel hopeful. The new government has only been in the Ministry of Health and Social Affairs for a month, but I already see clear signs of more knowledge and care, less bureaucratic micro-management and more humanity and freedom - even for those who are ill and even for those who choose to work in healthcare.

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

Anders W Jonsson (C)

Madam Speaker! In the article that gave rise to this debate, both Vårdförbundet and Läkarförbundet highlight the work environment as perhaps the most important thing. I recognize that very well, among other things from the emergency department at Gävle Hospital. The staff say that it is the most fantastic place one can work if one has the feeling that one is doing a good job.

When we worked on the announcement, the Liberals were driving, not least for occupational health care. I also note that Lina Nordquist highlighted that issue in her speech.

In the Tidö Agreement, there are two points that will affect the working environment for everyone working in healthcare in a decisive way. We have already heard this from reactions from the Swedish healthcare sector. It is felt that this will, in a serious way, reduce the possibilities to do a good job.

The first point is that it has been agreed to limit the possibility of having interpreters in healthcare. The second is that it has been opened up for healthcare personnel to be able to receive an additional task beyond diagnosing and treating, namely to check that the patient has permission to stay in the country and, if not, to report it.

I therefore have a question for Lina Nordquist. In a situation where the Liberals believe that the work environment is so important, how will these concrete proposals, when implemented, affect the work environment for those who work at BUP in Västerås and for those who work at the emergency department in Gävle, with the two completely new conditions for doing a good job?

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Lina Nordquist (L)

Madam Speaker! I thank the member for the question.

For me and other liberals, it was important with the complete wording when it comes to the two parts of the Tidö Agreement that the member is raising.

The first point concerns the internal border control, that is to say that those people who stay illegally in the country need to be highlighted and made visible to the Swedish Migration Agency and the Police Authority when they come into contact with Swedish authorities. There, it is important for us that we gain control over which people are not allowed to stay in the country and thus which persons should be reported to the police and the Migration Agency. It was also very important for us Liberals to also talk about investigating the exceptions that should exist. There is most certainly a need for clear exceptions. Even those who do not have the right to stay in the country need certain basic safety factors met. It is very important that the upcoming investigation shall review which exceptions are needed.

The same applies to the issue of interpretation. We think it is important that the possibility to learn Swedish is strengthened. Someone who, after a certain period in Sweden, receives a residence permit should not only have permission to stay in the country but also an opportunity to familiarize themselves with the country, be part of a society, influence the society, and understand important parts of the information one receives in newspapers and in other ways.

We think it is reasonable to investigate whether fees should be introduced a certain time after a residence permit has been obtained. I do not want to anticipate what the investigation will conclude. But naturally, this also presupposes a great opportunity to learn the language. Otherwise, everything becomes toothless.

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

Anders W Jonsson (C)

Madam Speaker! This was hardly reassuring for Swedish healthcare personnel. All legislative proposals must be investigated. Otherwise, it is not possible to introduce a new law.

Here it is a question of two specific points. It is not a question of whether the law should be introduced, but how it should be introduced in Swedish healthcare. I am a bit surprised when I hear a liberal representative defend that the possibility of hiring interpreters in healthcare should be limited. Families with children who do not fully master the Swedish language must pay for interpreters themselves with money they do not have. For the father who has been affected by cancer and who does not have money for the interpreter, one of the children must convey the message that it is cancer that is the cause of his symptoms. It is a frightening attitude. If there is anything that would truly worsen the working environment for people in healthcare, it is this.

The second point is that when someone arrives at the emergency department, healthcare personnel should not only make the diagnosis that the leg is broken and must be casted, but there is also a theoretical possibility that they should check that the person has the right to stay in the country. If the person does not have it, they should immediately contact the border police so that they can come and take the individual. This means that all undocumented people will not dare to seek Swedish healthcare regardless of what they suffer from.

Madam Speaker! I am surprised to hear a liberal representative, who safeguards the working environment in healthcare, be prepared to open the door to these two measures, which would be devastating not only for those who work within child and adolescent psychiatry but above all for those who work at the emergency departments. That, Madam Speaker, I had not expected.

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Lina Nordquist (L)

Madam Speaker! Yes, my friends, it is not often that I become angry in this chamber. But this, Member Jonsson, is pure misdirection.

I have just explained to the member, very pedagogically, that if one reads the full wording in the agreement, one can clearly see that exceptions shall be investigated. The question is whether fees should be introduced after some time after a residence permit. Do not shake your head, Anders W Jonsson! I have read this agreement - probably more carefully, it seems. I have been very pedagogical and clear. This is pure misleading.

I had hoped that the snow slush would stay outside the Riksdag building and not be dragged in here to the speakers' podiums.

After eight years of socialist rule in this country and attempts to achieve something that provides liberal reforms, we in the Liberals make the assessment that rather than spinning around like a ceiling fan, throwing things in all directions and only cooperating with ourselves, we should accept democracy, accept the mathematics, and ensure that we get in as many liberal reforms as possible so that the risks become as small as possible.

Instead of trying to create real change, one stands in the parliamentary rostrum and deliberately informs the Swedish people of direct inaccuracies. It explicitly states that exceptions for healthcare shall be investigated. I am so angry right now that I am glad I do not know many swear words. If I did, I would be listing a whole long row of them right now.

This agreement was a necessity to achieve a bourgeois liberal government. There are always things in every cooperation that are not what an individual party wants. But not cooperating, to only look at everyone else's mistakes, means that there will be no result at all.

Let us meet here in three and a half years, then we shall see which reforms we received!

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Karin Rågsjö (V)

Madam Speaker! Lina Nordquist mentioned humanity and freedom at the end of her speech. It is an epithet that I recognize from the liberal side. But I don't really think the Tidö Agreement feels super-liberal – if I'm being honest.

I intended to limit myself to the interpreter issue. It is to be investigated that one should pay for an interpreter. Many in healthcare have reacted strongly to this. It is doctors and nurses who know that this can cause major problems.

When one seeks healthcare, it can sometimes feel as if one needs an interpreter oneself. I am Swedish-speaking and well-educated, but for me, a well-educated middle-class woman, it can sometimes be difficult material to take in.

How is this intended? This will cause big problems for families who speak shaky Swedish. This applies especially to the staff as well. It could be that the husband has to interpret for his wife. Is that fair? It could be that the children have to interpret for their parents because the parents do not have money for an interpreter. Then the situation is resolved in that way. It usually never turns out well.

People live under economically constrained circumstances today when they come to Sweden. It takes time to establish oneself, to get a job and get started. It is not so strange. It would be so for Lina Nordquist and for me if we ended up in, for example, Afghanistan, for some reason. It would take a long time for us to understand where we are and in what way we should move forward.

Madam Speaker! How do you think about these border demarcations moving forward, Lina Nordquist?

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Lina Nordquist (L)

Madam Speaker! I thank the member for the question.

I believe that the member and I largely share the view that we today have a healthcare system that is not equal. There are large differences between people depending on where in the country they live or where in the city they live. It depends on education, background, and illnesses. There are too large differences.

When we come to healthcare, the first difference can be whether there is a healthcare service to go to. There are important agreements there, and I am very happy about that. The new government will push for greater opportunities to provide close care both in remote areas and in rural areas, for small-scale care, and for an opportunity to have care close to you.

There are also writings that I would say are very crucial regarding the time in care. The person employed in healthcare must have time for the patient. Just as Member Rågsjö mentions, it can be about language barriers. It can be about dementia diseases and other things. There is much that makes a care meeting need to take more time. An interpreter is one example. There, the meeting automatically becomes longer because one additional person needs to come in and convey what is happening. But there are many other contexts where one needs to have time to meet to talk about a disease that the patient perhaps did not even know existed or a disease that the patient has forgotten they suffer from.

I do not believe there is much that is more important than the time in healthcare and the will of the most knowledgeable to stay in healthcare and know for certain that they have the knowledge they need and the time to see both patients and relatives.

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Karin Rågsjö (V)

Madam Speaker! I think that this issue with time also means that it must be patient-safe when one sits there as a doctor and has to make difficult decisions with a patient who perhaps does not master Swedish well enough to talk about difficult developments and difficult processes. This, as said, can be difficult to talk about with anyone in healthcare today. We live in some kind of class-oriented society today, I believe, and then it becomes difficult to understand.

Many people have reacted very strongly to this. People are running themselves ragged within the health and medical care system, and I unfortunately believe that people will have to run even faster if they remain in a care system that is now subject to major cuts.

It is obvious that it will become very restless within healthcare when one sees this type of proposal. Regarding much of what I read in the Palace Agreement, in parts of the health and medical care section, I could feel that "well, that, that, and that." Some things in the area of health and medical care I absolutely did not like. But these proposals, partly about the detention center and partly about the interpreter, felt very separate. I hardly believe that these are liberal proposals.

I still wonder how this is to be implemented. If an investigation is conducted and it is concluded that this is to be paid for by the patient, is there not a great risk that patients who feel they cannot afford to pay will instead bring in their husband, their child, their cousin, or their friend as an interpreter? And will it not then become very shaky for the healthcare staff, let us say a doctor, to ask the right questions, get the right answers, and make the right decisions?

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Lina Nordquist (L)

Madam Speaker! The member highlights an issue that is extremely important, above all for people in healthcare, sick individuals, but also for us Liberals – precisely this with, for example, honor-based oppression, where an additional person present in the healthcare meeting might be more or less a spy who can prevent the patient from speaking as it is but also spread what has been said. It is completely unacceptable.

We Liberals do not want it to be permitted to let children interpret in healthcare. We also do not want relatives to do it. On the other hand, we want people to have the very best conditions to learn the Swedish language when they come here to build a new future. We think that is extremely important.

We have accepted the wording in the Tidö Agreement which states that, firstly, the quality of interpreters shall be strengthened throughout society and, secondly, an investigation shall be allowed to consider, which means weighing the pros and cons of, charging a fee after a certain period of time has passed after someone has received their residence permit. What that investigation will come to, I do not know, but I assume that it is a thorough investigation.

I believe that this entire debate is important because it contains many completely decisive issues for people, both for those who work in the public sector and for those who need the public sector. But I also believe that the debate to some extent has become a bit of a horror movie because we have for a long time had a situation with difficult mathematics in Sweden's Riksdag and a very harsh debate climate. Now we are also entering a harsh winter with a very difficult situation where many people's everyday lives risk actually tipping over. In that case, I believe that as soon as the discussion becomes somewhat irrelevant, we are in a very precarious position, so I hope that the anxiety can be dampened and that the investigations are very thorough.

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Ulrika Westerlund (MP)

Madam Speaker! This has been an interesting debate. I thank my colleagues in the committee for all the contributions, and I assume that we will have reason to return to several of these discussions.

I want to highlight some proposals that were in my accompanying motion to this committee report. They concern areas that several have already raised, even if we perhaps have slightly different proposed solutions.

I want to say something about a government initiative for a strengthened work environment and strengthened working conditions for healthcare personnel. It has to do with the care beds, as several of you have noted. Then I want to say something about a specific training for managers in healthcare that Miljöpartiet has looked into a bit. I also want to say something about the recovery bonus and a zero vision for work-related ill health.

Several of you have noted - and I assume we all actually agree - that the staff's working conditions and work environment are the cornerstone of healthcare. It is not possible to have physical care facilities open if there is no staff on site to man them, and therefore the question of care places is closely linked to the staff's work environment and working conditions. Healthcare must be able to attract new employees and also get those who work in healthcare to want to stay and have the strength to keep working. Every time someone who actually likes their job in healthcare and would like to continue nevertheless leaves, it is a failure.

The government has given an additional 500 million kronor to Socialstyrelsen to distribute for the purpose of increasing the number of care beds. This can be valuable depending on how the money is used.

We think it is problematic with one-off initiatives that one cannot plan for in the long term. We want to see instead an ambition for long-term strengthened support, an increased state responsibility, and permanent support in order to reverse the negative spiral that exists in many places in healthcare today and create a positive working environment and a positive working climate for healthcare workers where there is time for recovery in a realistic way.

The issue of the work environment is completely central, but the issue of wages is also very important. We want both of these issues to be prioritized moving forward. A structure is needed for long-term strengthened support. Therefore, the government should return with proposals for a construction for a permanent state initiative on strengthened work environment and strengthened working conditions for healthcare personnel and not these temporary initiatives.

We also do not think it is a good solution for the state to take over responsibility for the entire healthcare system. It would be a gigantic reorganization that the healthcare system does not need. Several of you have also noted earlier in this debate that it would be enormously resource-intensive to initiate such an investigation and that it is not quite realistic to believe that it is possible to plan healthcare in such a centralized way. We need to be able to continue developing healthcare based on the different needs that exist in different parts of Sweden, but the state support needs to be expanded.

Vårdförbundet is promoting the idea that healthcare should need a qualitative education equivalent to the school system's principal training. We think it is an interesting proposal and therefore want to highlight it. It should be possible to study a higher education that can be combined with continuing to work part-time, and the education should be available at several colleges. We hope that the government wants to review this.

The recovery bonus pushed Miljöpartiet through during 2021. It is funds at Socialstyrelsen that one can apply for as a working group within healthcare and elderly care if one wants to try to develop new ways of working aimed at an improved work environment. This can also include working time models. The purpose is, of course, to take advantage of staff groups' own development ideas and give them the opportunity to test them.

This was introduced in the summer of 2021, with 300 million kronor in funds, and was a very popular measure. It was 190 municipalities and 16 regions that applied for the support. Now, in 2022, 1 billion is allocated annually and additionally 300 million kronor to reduce or remove shared shifts, which is very valuable. Shared shifts are, in fact, a hostage if it is not something the staff themselves desire.

We believe that the government should work to make this model better known and, in the long term, review the possibility of further strengthening the recovery bonus.

The last thing I want to bring up is a zero vision for work-related ill health. Work life can be health-promoting; that is how we want it to be. Therefore, we must take action to counter the problems that today create ill health. Here, the government could return with a proposal on how a zero vision can be introduced, and health and medical care can be a first focus area for such work.

I move for approval of reservation 4 in the committee report.

The deliberation was hereby concluded.

(Decisions were made under § 19.)

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