2023-11-302023/24:SoU5 · p.1SoUHealth & social services
State governance for improved quality in healthcare and elderly care
State governance and a national action plan for quality in elder care
What's at stake: A national action plan would set clear quality targets for elder care and make nationwide follow-up easier, but the question also concerns whether existing initiatives and ongoing inquiries already address the problems the National Audit Office has identified.
Case texts and AI reasoning are AI-translated from the Swedish originals; the Swedish text is authoritative.
What the vote decides
The question is whether the government should draw up a national action plan to raise the quality of care for older people, in line with a recommendation from the Swedish National Audit Office, or whether the state measures already taken and under way should be considered sufficient without a dedicated action plan.
Yes Yes — the committee proposal
The committee notes that several measures have already been taken and are under way, including a national centre of expertise for elder care, initiatives to strengthen staffing and skills, and a cross-party committee examining state responsibility for healthcare, and on that basis considers there is no reason for the Riksdag to require a dedicated national action plan; the motion is therefore rejected.
No No — the reservations
Reservation 1 (V, C, MP)
The reservation wants the government to draw up a national action plan for improved quality in elder care, in line with a recommendation from the National Audit Office, arguing that such a plan would set a clear target, provide a norm for care providers, and make follow-up easier — a similar plan already exists for patient safety in healthcare but is missing for elder care.
Summarised from the committee report. Party labels in the summary come from the report, not from the vote.
What do the votes mean here?
Yes The committee proposal: rejecting the motions (keeping things as they are).
No Backing the counter-proposal: reservation 1 by V, C, MP.
Abstain The party marks a position of its own that is not one of the two final alternatives.
What each plan points to — and how the party voted
For each party: the vote its own election manifesto and party programme point to in this case, next to how the party actually voted. A plan can only point to Yes or No; a party can also abstain.
| Plan | Vote | Confidence | Evidence | ||
|---|---|---|---|---|---|
| V | No | No 0/19/0/5 | follows the plan | confidence: medium | not addressed |
| S | No | Yes 92/0/0/15 | departs from the plan | confidence: medium | not addressed |
| MP | No | No 0/16/0/2 | follows the plan | confidence: medium | derived |
| C | No | No 0/20/0/4 | follows the plan | confidence: medium | not addressed |
| L | No | Yes 12/0/0/4 | departs from the plan | confidence: medium | derived |
| KD | No | Yes 17/0/0/2 | departs from the plan | confidence: medium | derived |
| M | No | Yes 58/0/0/10 | departs from the plan | confidence: low | not addressed |
| SD | No | Yes 60/0/0/12 | departs from the plan | confidence: medium | derived |
Committee proposal
The Riksdag rejects motion 2023/24:183 by Christofer Bergenblock et al. (C) item 1.
Original (Swedish)
Riksdagen avslår motion 2023/24:183 av Christofer Bergenblock m.fl. (C) yrkande 1.
Riksdag decision: The National Audit Office has reviewed whether the state's measures within the framework of the provisions on lex Maria and lex Sarah are effective in preventing care damage and shortcomings in care and elderly care. The National Audit Office's conclusion is that the state's measures should be strengthened and they present several recommendations in their audit report. The government has in a written statement presented its assessment of the observations and recommendations that the National Audit Office presents in the report and largely agrees with the problem description. However, the government makes a different assessment of which measures should be taken and presents several measures that have already been taken to strengthen national governance and to increase the quality of elderly care and to prevent shortcomings. Furthermore, the government believes that there is already sufficient support, for example through the Board of Health and Welfare's guidance, to inform and involve individuals in cases of care damage and shortcomings. The Riksdag decided to file the written statement with the records, that is, to close the case.
Counter-proposals
- The counter-proposal wants the government to develop a national action plan for increased quality in elderly care. (V, C, MP) — Reservation 1
Plan vs actual vote
Every party, in chamber order: what its own plan pointed to, how it voted, and the reasoning behind both. Highlighted rows are where the two differ — but a vote that follows the plan is a result too, so the reasoning is there for every party.
The plan establishes that elderly care should be given more resources and that the tragedy in elderly care follows from withdrawn resources and privatizations, and that care should be given according to need regardless of housing form and be equivalent throughout the country.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan establishes that elderly care should be given more resources and that the tragedy in elderly care follows from withdrawn resources and privatizations, and that care should be given according to need regardless of housing form and be equivalent throughout the country. A national action plan that sets goals, works normatively and facilitates follow-up serves this purpose. The plan says nothing about the committee's reason that current efforts already are sufficient.
Original (Swedish)
Planen slår fast att äldreomsorgen ska ges mer resurser och att tragedin i äldreomsorgen följer av undandragna resurser och utförsäljningar, samt att omsorg ska ges efter behov oavsett boendeform och vara likvärdig i hela landet. En nationell handlingsplan som sätter mål, verkar normerande och underlättar uppföljning tjänar detta syfte. Planen säger inget om utskottets skäl att pågående satsningar redan räcker.
- more resources to elderly caredecisive»Därför vill Vänsterpartiet satsa mer resurser på hälso- och sjukvården och äldreomsorgen, samt satsa på personalen så att vi samtidigt får bort personalbristen och stärker personalens villkor och arbetsmiljö.« (2022 manifesto ↗)“Therefore, the Left Party wants to invest more resources in health and medical care and elderly care, and invest in staff so that we at the same time get rid of staff shortages and strengthen staff's conditions and work environment.”
- elderly care quality crisis»Tragedin i äldreomsorgen beror på att resurser har dragits undan och verksamheter sålts ut så att skattepengar som skulle gått till de äldre istället blivit miljardvinster för lägstbjudande företag.« (2022 manifesto ↗)“The tragedy in elderly care is due to resources being withdrawn and operations sold off so that tax money that should have gone to the elderly instead became billions in profit for lowest-bidder companies.”
- care according to need»Vård och omsorg måste ges efter behov oavsett om du bor på ett särskilt boende eller har insatser av hemtjänsten.« (2022 manifesto ↗)“Care and support must be given according to need regardless of whether you live in special housing or receive home care services.”
- equivalent care throughout the country»alla kommuner och landsting ska ha likvärdiga förutsättningar« (party programme ↗)“all municipalities and counties should have equivalent conditions”
The plan wishes to legislate a new elderly care act that ensures equally good care throughout the country and establishes the state's responsibility for ensuring competence in welfare.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan wishes to legislate a new elderly care act that ensures equally good care throughout the country and establishes the state's responsibility for ensuring competence in welfare. A national action plan that sets clear targets and facilitates monitoring of the quality of elderly care serves the same purpose. The party programme also sets high demands for good care for all elderly people. The committee's reasons concerning ongoing initiatives are not affected by the plan.
Original (Swedish)
Planen vill lagstifta om en ny äldreomsorgslag som säkerställer lika bra omsorg i hela landet och slår fast statens ansvar för kompetensförsörjningen i välfärden. En nationell handlingsplan som sätter tydliga mål och underlättar uppföljning av kvaliteten i äldreomsorgen tjänar samma syfte. Partiprogrammet ställer dessutom höga krav på god omsorg för alla äldre. Utskottets skäl om redan pågående satsningar berörs inte av planen.
- equal care throughout the countrydecisive»Vi vill ha en ny äldreomsorgslag som säkerställer att alla får en lika bra omsorg i hela landet och tillgång till sjuksköterskor dygnet runt.« (2022 manifesto ↗)“We want a new elderly care act that ensures everyone receives equally good care throughout the country and access to nurses around the clock.”
- state responsibility for quality»Staten har ett ansvar för att säkra kompetensförsörjningen, inte minst i välfärden.« (2022 manifesto ↗)“The state has a responsibility to ensure competence supply, not least in welfare.”
- good care for all elderly»trygg ekonomi och en god omsorg ställs höga krav på ett starkt och stabilt pensionssystem« (party programme ↗)“secure economy and good care place high demands on a strong and stable pension system”
- equivalent welfare throughout the country»Alla invånare i hela landet ska ha likvärdig tillgång till skola, vård och omsorg.« (party programme ↗)“All inhabitants throughout the country shall have equal access to education, healthcare and care.”
The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.
The plan wants to improve care and services for older people, requires a safe and good eldercare based on individual needs and that quality is continuously monitored with various tools.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan wants to improve care and services for older people, requires a safe and good eldercare based on individual needs and that quality is continuously monitored with various tools. A national action plan that sets targets, works normatively and facilitates follow-up is such an instrument. The plan does not specify the form of governance, so the position is derived from the quality and staffing commitments.
Original (Swedish)
Planen vill förbättra vård och omsorg för äldre, kräver en trygg och god äldreomsorg utifrån individuella behov och att kvaliteten ständigt följs upp med olika verktyg. En nationell handlingsplan som sätter mål, verkar normerande och underlättar uppföljning är ett sådant instrument. Planen anger inte formen för styrningen, varför ställningstagandet härleds ur kvalitets- och bemanningsåtagandena.
- better eldercaredecisive»förbättra vård och omsorg för äldre och stärka resurserna till hemsjukvården.« (2022 manifesto ↗)“improve care and services for older people and strengthen resources for home healthcare.”
- safe and good eldercare»viktigt med en trygg och god äldreomsorg som« (party programme ↗)“important to have safe and good eldercare that”
- systematic quality monitoring»Kvaliteten ska ständigt följas upp med« (party programme ↗)“Quality should be continuously monitored with”
- adequate staffing»Personaltätheten måste hålla tillräcklig nivå så att« (party programme ↗)“Staff density must be maintained at a sufficient level so that”
The plan requires that quality in elderly care is improved and it does not shy away from national steering instruments, but wants, for example, to make management training mandatory and set targets for the number of employees per manager.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan requires that quality in elderly care is improved and it does not shy away from national steering instruments, but wants, for example, to make management training mandatory and set targets for the number of employees per manager. A national action plan that sets targets and facilitates follow-up is in line with this and with the goal that everyone should be able to have a secure old age. At the same time, the plan values the responsibility of regions and municipalities, but an action plan does not transfer principal responsibility.
Original (Swedish)
Planen kräver att kvaliteten i äldreomsorgen lyfts och den drar sig inte för nationella styrinstrument, utan vill exempelvis göra chefsutbildning obligatorisk och sätta mål för antalet medarbetare per chef. En nationell handlingsplan som sätter målsättning och underlättar uppföljning ligger i linje med detta och med att alla ska kunna få en trygg ålderdom. Planen värnar samtidigt regionernas och kommunernas ansvar, men en handlingsplan flyttar inte huvudmannaskapet.
- improved quality in elderly caredecisive»Kvaliteten i sjukvården och äldreomsorgen ska lyftas.« (2022 manifesto ↗)“The quality of healthcare and elderly care must be improved.”
- national requirements for care management»Därför vill vi införa en obligatorisk utbildning för alla som får en chefstjänst i vård och omsorg, och skapa mindre arbetsgrupper med ett mål om max 25 medarbetare per chef.« (2022 manifesto ↗)“Therefore, we want to introduce mandatory training for everyone who gets a management position in care and welfare, and create smaller work groups with a goal of a maximum of 25 employees per manager.”
- secure old age»Alla ska kunna få en trygg ålderdom med hög livskvalitet och värdighet.« (party programme ↗)“Everyone should be able to have a secure old age with high quality of life and dignity.”
- preserved principal responsibility»Ansvaret för vården ska inte flyttas från regionerna till staten.« (2022 manifesto ↗)“Responsibility for healthcare should not be transferred from the regions to the state.”
The plan states that differences in elderly care quality are far too large between municipalities and demands that national steering of quality is strengthened.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The plan states that differences in elderly care quality are far too large between municipalities and demands that national steering of quality is strengthened. A national action plan with clear objectives and normative effect is precisely such a national steering instrument. That good elderly care is a right regardless of economics and place of residence strengthens the conclusion.
Original (Swedish)
Planen konstaterar att skillnaderna i äldreomsorgens kvalitet är alltför stora mellan kommunerna och kräver att den nationella styrningen av kvaliteten stärks. En nationell handlingsplan med tydlig målsättning och normerande verkan är just ett sådant nationellt styrinstrument. Att god äldreomsorg är en rättighet oavsett ekonomi och bostadsort förstärker slutsatsen.
- quality differences too largedecisive»Skillnaderna i äldreomsorgens kvalitet är alltför stora mellan kommunerna.« (party programme ↗)“Differences in elderly care quality are far too large between municipalities.”
- strengthened national steering»styrningen av äldreomsorgens kvalitet behöver stärkas.« (party programme ↗)“steering of elderly care quality needs to be strengthened.”
- elderly care as a right»En god äldreomsorg är en rättighet för alla som behöver den, oavsett ekonomi.« (party programme ↗)“Good elderly care is a right for everyone who needs it, regardless of economics.”
- security and continuity»Vi vill att du som har hemtjänst ska ha ett eget team av omvårdnadspersonal så att du slipper möta nya ansikten varje dag.« (2022 manifesto ↗)“We want you who have home care to have your own team of care staff so you do not have to meet new faces every day.”
The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.
The election manifesto stipulates that Sweden shall have world-class elderly care and wants to steer the core of welfare nationally, among other things by the state taking over responsibility for care, which speaks for a national action plan that sets targets and standardizes activities.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The election manifesto stipulates that Sweden shall have world-class elderly care and wants to steer the core of welfare nationally, among other things by the state taking over responsibility for care, which speaks for a national action plan that sets targets and standardizes activities. The plan also requires dignity guarantees and increased medical expertise in elderly care. A standardizing plan is a tool for these commitments.
Original (Swedish)
Valmanifestet slår fast att Sverige ska ha en äldreomsorg i världsklass och vill styra välfärdens kärna nationellt, bland annat genom att staten tar över ansvaret för vården, vilket talar för en nationell handlingsplan som sätter mål och normerar verksamheterna. Planen kräver också värdighetsgarantier och ökad medicinsk kompetens i äldreomsorgen. En normerande plan är ett medel för dessa åtaganden.
- elderly care of world classdecisive»Sverige ska ha en äldreomsorg i världsklass.« (2022 manifesto ↗)“Sweden shall have world-class elderly care.”
- national governance of welfare»Avskaffa regionernas ansvar för sjukvården.« (2022 manifesto ↗)“Abolish the regions' responsibility for healthcare.”
- medical expertise in care»Ökad medicinsk kompetens inom äldreomsorgen.« (2022 manifesto ↗)“Increased medical expertise in elderly care.”
- dignity guarantees»Därför ska det finnas värdighetsgarantier inom vård och omsorg« (party programme ↗)“Therefore there shall be dignity guarantees within care and welfare”
The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.
The plan establishes that the Corona Commission's conclusions about an unprepared elderly care must lead to change and that the same quality requirements must be able to be placed on elderly care as on healthcare.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan establishes that the Corona Commission's conclusions about an unprepared elderly care must lead to change and that the same quality requirements must be able to be placed on elderly care as on healthcare. It also wants to see systematic improvements in competence, continuity and meals. A national action plan with clear targets and follow-up is a means that is in line with these commitments, even though the plan does not mention such a plan.
Original (Swedish)
Planen slår fast att Coronakommissionens slutsatser om en oförberedd äldreomsorg måste leda till förändring och att samma kvalitetskrav ska kunna ställas på äldreomsorgen som på sjukvården. Den vill också se systematiska lyft av kompetens, kontinuitet och måltider. En nationell handlingsplan med tydliga mål och uppföljning är ett medel som ligger i linje med dessa åtaganden, även om planen inte nämner en sådan plan.
- elderly care must changedecisive»Coronakommissionens slutsatser om att äldreomsorgen inte stod förberedd och rustad att möta samhällsspridningen i pandemin måste leda till förändring.« (2022 manifesto ↗)“The Corona Commission's conclusions that elderly care was not prepared and equipped to meet community spread in the pandemic must lead to change.”
- same quality requirements on elderly care»Samma krav ska naturligtvis kunna ställas på äldreomsorgen, när den behövs på ålderns höst. Det är en anständighetsfråga.« (2022 manifesto ↗)“Of course, the same requirements must be able to be placed on elderly care when needed in old age. This is a matter of decency.”
- strengthened quality in care»Den medicinska kompetensen och kontinuiteten måste stärkas inom äldreomsorgen.« (2022 manifesto ↗)“Medical competence and continuity must be strengthened within elderly care.”
- systematic quality improvements»Verka för ett systematiskt måltidslyft inom äldrevården och äldreomsorgen« (2022 manifesto ↗)“Work for a systematic meal improvement in elderly care and elderly services”
The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.
The counter-proposal wants to see a national action plan that sets clear targets and acts normatively for the quality of care for the elderly.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The counter-proposal wants to see a national action plan that sets clear targets and acts normatively for the quality of care for the elderly. The plan is based on the elderly receiving the world's best eldercare, that national quality requirements must exist and cannot be undercut and that governance be strengthened with a dedicated elder care minister and new eldercare law. A national action plan is thus a means in the plan's direction.
Original (Swedish)
Motförslaget vill se en nationell handlingsplan som sätter tydlig målsättning och verkar normerande för kvaliteten i omsorgen om äldre. Planen bygger på att äldre ska få världens bästa äldreomsorg, att nationella kvalitetskrav måste finnas och inte får underskridas och att styrningen ska stärkas med en renodlad äldreminister och ny äldreomsorgslag. En nationell handlingsplan är därmed ett medel i planens riktning.
- highest ambition for eldercaredecisive»De äldre i Sverige förtjänar att få tillgång till världens bästa äldreomsorg.« (party programme ↗)“The elderly in Sweden deserve access to the world's best eldercare.”
- national quality requirements»Nationella kvalitetskrav inom vård och omsorg måste finnas och får inte underskridas.« (party programme ↗)“National quality requirements in healthcare and care must exist and cannot be undercut.”
- stronger national regulation»En ny äldreomsorgslag måste stärka lagstödet för goda levnadsvillkor då den nuvarande benämningen med skäliga levnadsvillkor inte duger.« (2022 manifesto ↗)“A new eldercare law must strengthen the legal basis for good living conditions since the current term of adequate living conditions is insufficient.”
- clearer state governance»Tillse en renodlad äldreminister.« (2022 manifesto ↗)“Ensure a dedicated elder care minister.”
The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.
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Sources and documents
- The committee report on riksdagen.se (2023/24:SoU5)
- Committee report full text (HB01SoU5)
- Per-MP voting data (API)
- Case status (API)
Documents under consideration
- Motion 2023/24:183 — med anledning av skr. 2022/23:141 Riksrevisionens rapport om lex Maria och lex Sarah av Christofer Bergenblock m.fl. (C)
- Motion 2023/24:221 — med anledning av skr. 2022/23:141 Riksrevisionens rapport om lex Maria och lex Sarah av Ulrika Westerlund m.fl. (MP)
- Regeringens skrivelse 2022/23:141 — Riksrevisionens rapport om lex Maria och lex Sarah
Source: The Swedish Parliament