2023-05-102022/23:SoU12 · p.8SoUHealth & social services
Primary care
Primary care's core mandate and content
What's at stake: The issue concerns how clearly the state should regulate what a health center must be able to offer, particularly in mental health, and whether municipalities and regions should be required to coordinate their planning. It affects how equal primary care is across the country.
Case texts and AI reasoning are AI-translated from the Swedish originals; the Swedish text is authoritative.
What the vote decides
Whether a national basic mandate and a strengthened mental-health effort in primary care should be mandated through a directive, or whether the matter should be left to ongoing review work.
Yes Yes — the committee proposal
The Committee found, taken together, no grounds for a directive to government on primary care's core mandate and content, citing the work already under way to develop more coordinated and accessible primary care. The motions were rejected.
No No — the reservations
Reservation 14 (V)
V held that the government should take the initiative for a national basic mandate clarifying what specialist competence a health center must be able to offer, that primary care's responsibility for mental health should be strengthened — including follow-up of medical treatment and access to counseling and rehabilitation — and that regions and municipalities should be required to draw up a joint plan for primary 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 14 by V.
Abstain The party marks a position of its own that is not one of the two final alternatives.
The decision would have gone the other way
Explicit commitments that contradicted the vote: LLiberalerna, MPMiljöpartiet, SDSverigedemokraterna
Ja 167–21Nej 77–112
Counterfactual: the parties above are moved to the position their own documents explicitly point at, carrying their whole contingent present. Every other party keeps its real figures, including dissenters and absentees.
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 0/21/0/3 | follows the plan | confidence: high | not addressed |
| S | No | Abstain 1/0/93/13 | departs from the plan | confidence: medium | not addressed |
| MP | No | Yes 13/0/1/4 | departs from the planagainst own programme | confidence: high | explicit |
| C | No | Abstain 0/0/21/3 | departs from the plan | confidence: medium | derived |
| L | No | Yes 14/0/0/2 | departs from the planagainst own programme | confidence: high | explicit |
| KD | No | Yes 15/0/0/4 | departs from the plan | confidence: high | not addressed |
| M | No | Yes 60/0/0/8 | departs from the plan | confidence: medium | not addressed |
| SD | No | Yes 63/0/0/9 | departs from the planagainst own programme | confidence: high | explicit |
Broke with the party line
| SAnnika Strandhäll (S, Stockholms kommun) | Yes — party line: Abstain |
| MPDaniel Helldén (MP, Stockholms kommun) | Abstain — party line: Yes |
MPs whose vote differs from their party's majority position in this division. Marked with a dark ring in the chamber view.
Committee proposal
The Riksdag rejects the motions 2022/23:905 by Anders W Jonsson et al. (C) amendments 5 and 8, 2022/23:1234 by Nooshi Dadgostar et al. (V) amendments 13 and 17 and 2022/23:2061 by Fredrik Lundh Sammeli et al. (S) amendments 6 and 11.
Original (Swedish)
Riksdagen avslår motionerna 2022/23:905 av Anders W Jonsson m.fl. (C) yrkandena 5 och 8, 2022/23:1234 av Nooshi Dadgostar m.fl. (V) yrkandena 13 och 17 samt 2022/23:2061 av Fredrik Lundh Sammeli m.fl. (S) yrkandena 6 och 11.
Riksdag decision: The Riksdag rejected approximately 120 proposals in motions from the regular motion period 2022 on the organization of health and medical services. The Riksdag refers, among other things, to ongoing work. The motions concern, among other things, primary care, choice of provider and freedom of choice as well as accessibility.
Counter-proposals
- The counter-proposal wants the state not to take over the primary responsibility for healthcare and medical services. (V) — Reservation 14
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 election manifesto notes that primary healthcare is far too poorly developed and that healthcare has been fragmented between levels and actors so that people are passed around.
Plan documents: 2022 manifesto
Reasoning and quotes
The election manifesto notes that primary healthcare is far too poorly developed and that healthcare has been fragmented between levels and actors so that people are passed around. It requires the right to quick help regardless of whether you have broken a bone or become burned out and points out that mental illness is increasing without healthcare being expanded. A national basic assignment, strengthened responsibility for mental health and a joint plan for municipalities and regions are measures that respond to these commitments.
Original (Swedish)
Valmanifestet konstaterar att primärvården är alldeles för dåligt utbyggd och att vården styckats upp mellan nivåer och aktörer så att människor bollas runt. Det kräver rätt till snabb hjälp oavsett om man brutit benet eller blivit utbränd och pekar på att den psykiska ohälsan ökar utan att vården byggs ut. Ett nationellt basuppdrag, stärkt ansvar för psykisk hälsa och en gemensam plan för kommuner och regioner är åtgärder som svarar mot dessa åtaganden.
- expand primary healthcaredecisive»Men Sverige har idag minst antal vårdplatser i EU och en alldeles för dåligt utbyggd primärvård.« (2022 manifesto ↗)“But Sweden today has the fewest hospital beds in the EU and a far too poorly developed primary healthcare.”
- mental illness is equated»Du ska ha rätt till hjälp snabbt oavsett om du har brutit benet eller blivit utbränd.« (2022 manifesto ↗)“You should have the right to help quickly regardless of whether you have broken a bone or become burned out.”
- cohesive care»Vården och omsorgen har styckats upp, mellan nivåer och aktörer, människor bollas runt i en stor administrativ apparat och det är ofta en kamp för den enskilde och dess anhöriga att få rätt tillgång till vård.« (2022 manifesto ↗)“Healthcare and care have been fragmented, between levels and actors, people are passed around in a large administrative apparatus and it is often a struggle for the individual and their relatives to get the right access to care.”
- care for mental illness»Stressrelaterade sjukdomar blir allt vanligare och psykisk ohälsa ökar särskilt bland kvinnor och hos unga utan att det leder till utbyggd vård eller förändrad arbetsmiljö.« (2022 manifesto ↗)“Stress-related diseases become increasingly common and mental illness increases especially among women and young people without resulting in expanded care or changed working environment.”
The election manifesto establishes that no one shall need to worry about getting healthcare in time and shows that the party is prepared to establish by law national requirements on healthcare and care, such as a new elderly care act with guaranteed access to nurses.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The election manifesto establishes that no one shall need to worry about getting healthcare in time and shows that the party is prepared to establish by law national requirements on healthcare and care, such as a new elderly care act with guaranteed access to nurses. The plan also wants to strengthen specialist training in healthcare. A national basic assignment that clarifies primary healthcare centres' specialist competence and strengthened responsibility for mental health thus lies in line with the plan.
Original (Swedish)
Valmanifestet slår fast att ingen ska behöva känna oro över att få vård i tid och visar att partiet är berett att lagreglera nationella krav på vården och omsorgen, som en ny äldreomsorgslag med garanterad tillgång till sjuksköterskor. Planen vill också stärka specialistutbildningarna i vården. Ett nationellt basuppdrag som tydliggör vårdcentralernas specialistkompetens och stärkt ansvar för psykisk hälsa ligger därmed i linje med planen.
- trygg tillgång till vårddecisive»Ingen ska behöva känna oro över att få vård i tid.« (2022 manifesto ↗)“No one shall need to worry about getting healthcare in time.”
- nationella krav i lag»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.”
- likvärdig vård i hela landet»Alla invånare i hela landet ska ha likvärdig tillgång till skola, vård och omsorg.« (party programme ↗)“All residents throughout the country shall have equal access to school, healthcare and care.”
- specialistkompetens i vården»mer stöd till specialistutbildningar i vården, exempelvis för sjuksköterskor och undersköterskor« (2022 manifesto ↗)“more support for specialist training in healthcare, for example for nurses and nursing assistants”
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 promises to invest in primary care and increase access to mental health care, and the party programme establishes that primary care is the foundation of healthcare and that psychiatric and psychological expertise there shall be strong and quality assured.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The election manifesto promises to invest in primary care and increase access to mental health care, and the party programme establishes that primary care is the foundation of healthcare and that psychiatric and psychological expertise there shall be strong and quality assured. The counter-proposal's requirement for a core national mandate, strengthened responsibility for mental health and joint planning between municipality and region realises these commitments. The programme also calls for increased coordination between different forms of care.
Original (Swedish)
Valmanifestet lovar att satsa på primärvården och öka tillgången till vård för psykisk ohälsa, och partiprogrammet slår fast att primärvården är basen i vården och att den psykiatriska och psykologiska kompetensen där ska vara stark och kvalitetssäkrad. Motförslagets krav på ett nationellt basuppdrag, stärkt ansvar för psykisk hälsa och gemensam planering mellan kommun och region förverkligar dessa åtaganden. Programmet efterlyser dessutom ökad samordning mellan vårdformer.
- investment in primary care and mental healthdecisive»satsa på primärvården och öka tillgången till vård för psykisk ohälsa.« (2022 manifesto ↗)“invest in primary care and increase access to mental health care.”
- primary care as foundation»Primärvården ska utvecklas och är basen i vården.« (party programme ↗)“Primary care shall be developed and is the foundation of healthcare.”
- psychiatric expertise in primary care»Den psykiatriska och psykologiska kompetensen i primärvården ska vara stark och kvalitetssäkrad.« (party programme ↗)“The psychiatric and psychological expertise in primary care shall be strong and quality assured.”
- coordination between forms of care»en ökad samordning mellan olika vårdformer, till exempel mellan primärvård och äldreomsorg.« (party programme ↗)“increased coordination between different forms of care, for example between primary care and elderly care.”
The stance rests on the quoted commitment in the party's own documents; the actual vote deviated. Click the quote to verify it in the document.
The plan requires that care be provided close to people with the right to a fixed doctor contact and that support for mental health be improved with a simple and unified point of access.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan requires that care be provided close to people with the right to a fixed doctor contact and that support for mental health be improved with a simple and unified point of access. It further wants to increase cooperation between municipal and regional health and medical care. A clarified core mandate with strengthened responsibility for mental health and joint planning is in line with these commitments.
Original (Swedish)
Planen kräver att vården bedrivs nära människan med rätt till fast läkarkontakt och att stödet vid psykisk ohälsa förbättras med en enkel och samlad väg in. Den vill dessutom öka samarbetet mellan kommunal och regional hälso- och sjukvård. Ett tydliggjort basuppdrag med stärkt ansvar för psykisk hälsa och gemensam planering ligger i linje med dessa åtaganden.
- unified access point for mental healthdecisive»Stödet för personer med psykisk ohälsa måste förbättras, inte minst för unga. Den som söker hjälp ska ha en enkel och samlad väg in till vården.« (2022 manifesto ↗)“Support for people with mental health problems must be improved, especially for young people. Those who seek help shall have a simple and unified path into healthcare.”
- fixed doctor contact»Vi vill ge alla rätt till en fast läkarkontakt.« (2022 manifesto ↗)“We want to give everyone the right to a fixed doctor contact.”
- cooperation between municipality and region»Genom en platsmiljard och ökat samarbete mellan kommunal och regional hälso- och sjukvård ökar vi möjligheterna att nå målet om en beläggningsgrad på 90% på våra sjukhus.« (2022 manifesto ↗)“Through a platform investment and increased cooperation between municipal and regional health and medical care we increase the opportunities to reach the goal of 90% occupancy at our hospitals.”
- strengthened primary care psychiatry»Samarbetet mellan elevhälsovården och primärvårdspsykiatrin måste öka och köerna till BUP kortas.« (2022 manifesto ↗)“Cooperation between school health services and primary care psychiatry must increase and queues to child and adolescent psychiatry must be shortened.”
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 party programme requires that the primary healthcare role be strengthened through a family doctor system where patient responsibility lies in primary healthcare, and that primary healthcare shall be responsible for patients with mild mental health problems.
Plan documents: party programme · 2022 manifesto
Reasoning and quotes
The party programme requires that the primary healthcare role be strengthened through a family doctor system where patient responsibility lies in primary healthcare, and that primary healthcare shall be responsible for patients with mild mental health problems. The election manifesto grants the right to a fixed doctor at the health centre. The counter-proposal's requirement for a national core mandate that clarifies competence, strengthened responsibility for mental health and a shared plan for municipalities and regions follows from these commitments.
Original (Swedish)
Partiprogrammet kräver att primärvårdens roll stärks genom ett husläkarsystem där patientansvaret ligger i primärvården, och att primärvården ska ansvara för patienter med mildare psykisk ohälsa. Valmanifestet ger rätt till en fast läkare på vårdcentralen. Motförslagets krav på ett nationellt basuppdrag som tydliggör kompetensen, stärkt ansvar för psykisk hälsa och en gemensam plan för kommuner och regioner följer av dessa åtaganden.
- strengthened primary healthcaredecisive»Primärvårdens roll i sjukvårdssystemet ska stärkas. Ett husläkarsystem där patientansvaret ligger i« (party programme ↗)“Primary healthcare's role in the healthcare system shall be strengthened. A family doctor system where patient responsibility lies in”
- primary healthcare and mental health»Primärvården bör ansvara för patienter med mildare psykisk ohälsa.« (party programme ↗)“Primary healthcare should be responsible for patients with mild mental health problems.”
- fixed doctor at health centre»Du ska ha rätt till en fast läkare på din vårdcentral som har tid för – och som lär känna – just dig.« (2022 manifesto ↗)“You shall have the right to a fixed doctor at your health centre who has time for – and who gets to know – you.”
- mental care equal to physical»Rätten till vård och behandling är lika självklar för både fysiska och psykiska sjukdomar.« (party programme ↗)“The right to care and treatment is equally self-evident for both physical and mental illnesses.”
The stance rests on the quoted commitment in the party's own documents; the actual vote deviated. Click the quote to verify it in the document.
The plan requires steady doctor contact with a named physician and patient cap and more health centres near patients, which presupposes that primary care's mandate be clarified nationally.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan requires steady doctor contact with a named physician and patient cap and more health centres near patients, which presupposes that primary care's mandate be clarified nationally. The requirement that primary care's responsibility for mental health be strengthened responds to the plan's commitment to accessible and flexible psychiatric care based on patient needs. That the plan wants to replace 21 regional organizations with a common one also speaks for a national base mandate.
Original (Swedish)
Planen kräver fast läkarkontakt med namngiven läkare och patienttak samt fler vårdcentraler nära patienterna, vilket förutsätter att primärvårdens uppdrag tydliggörs nationellt. Kravet att primärvårdens ansvar för psykisk hälsa stärks svarar mot planens åtagande om tillgänglig och flexibel psykiatrisk vård utifrån patientens behov. Att planen vill ersätta 21 regionala organisationer med en gemensam talar också för ett nationellt basuppdrag.
- steady doctor contactdecisive»Inför fast läkarkontakt med en namngiven läkare och tak för antal patienter för att möjliggöra relationsbyggande mellan patient och läkare.« (2022 manifesto ↗)“Introduce steady doctor contact with a named physician and a cap on number of patients to enable relationship-building between patient and physician.”
- primary care close at hand»Fler vårdcentraler på landsbygden och enklare för enskilda läkare att starta egen verksamhet - så att vården finns nära till hands.« (2022 manifesto ↗)“More health centres in the countryside and easier for individual doctors to start their own practice - so that care is available close at hand.”
- accessible psychiatric care»Psykiatrisk vård och omsorg ska präglas av tillgänglighet och flexibilitet utifrån patientens behov.« (party programme ↗)“Psychiatric care and support shall be characterized by accessibility and flexibility based on patient needs.”
- national governance of care»Avskaffa regionernas ansvar för sjukvården.« (2022 manifesto ↗)“Abolish regions' responsibility for health 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 is prepared to direct healthcare's core mission nationally: the patient-responsible doctor contact shall form the hub, a new statutory healthcare guarantee shall be introduced for children and a national healthcare brokering service shall guide patients between regions.
Plan documents: 2022 manifesto
Reasoning and quotes
The plan is prepared to direct healthcare's core mission nationally: the patient-responsible doctor contact shall form the hub, a new statutory healthcare guarantee shall be introduced for children and a national healthcare brokering service shall guide patients between regions. It also wants to strengthen child and youth psychiatry so that the one who feels bad gets help quickly, which responds to the demand for a strengthened responsibility for mental health. A national core mission and joint plans thereby align with the plan's will to govern.
Original (Swedish)
Planen är beredd att styra vårdens grunduppdrag nationellt: den patientansvariga läkarkontakten ska utgöra navet, en ny lagstadgad vårdgaranti ska införas för barn och en nationell vårdförmedling ska lotsa patienter mellan regioner. Den vill också stärka barn- och ungdomspsykiatrin så att den som mår dåligt får hjälp snabbt, vilket svarar mot kravet på ett stärkt ansvar för psykisk hälsa. Ett nationellt basuppdrag och gemensamma planer ligger därmed i linje med planens styrningsvilja.
- clear core healthcare missiondecisive»Se till att den patientansvariga läkarkontakten ska utgöra navet i äldres sjukvård« (2022 manifesto ↗)“Ensure that the patient-responsible doctor contact shall form the hub in elderly care”
- nationally regulated accessibility»Införa en ny lagstadgad vårdgaranti för barn« (2022 manifesto ↗)“Introduce a new statutory healthcare guarantee for children”
- strengthened mental health»Stärka barn- och ungdomspsykiatrin så att barn och unga som mår dåligt får hjälp snabbt« (2022 manifesto ↗)“Strengthen child and youth psychiatry so that children and young people who feel bad get help quickly”
- national coordination of healthcare»Inrätta en nationell vårdförmedling som ska hjälpa patienter med lång väntetid att få vård i en annan del av landet där det finns ledig kapacitet« (2022 manifesto ↗)“Establish a national healthcare brokering service that shall help patients with long waiting times to receive care in another part of the country where there is spare capacity”
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 invest in primary care with greater patient contact and a patient-responsible doctor to relieve acute and specialist care.
Plan documents: 2022 manifesto · party programme
Reasoning and quotes
The plan wants to invest in primary care with greater patient contact and a patient-responsible doctor to relieve acute and specialist care. It also requires that effective treatment measures such as talk therapy are offered to a greater degree and that treatment resources for mental ill-health are not limited to CAMHS. A national basic mandate with clear specialist competence and strengthened responsibility for mental health responds to these commitments.
Original (Swedish)
Planen vill satsa på primärvården med större patientkontakt och en patientansvarig läkare för att avlasta akut- och specialistvården. Den kräver också att effektiva behandlingsåtgärder som samtalsterapi erbjuds i högre grad och att behandlingsresurser för psykisk ohälsa inte begränsas till BUP. Ett nationellt basuppdrag med tydlig specialistkompetens och stärkt ansvar för psykisk hälsa svarar mot dessa åtaganden.
- strengthened primary caredecisive»Satsningar på primärvården med större patientkontakt och samordning av en patientansvarig läkare kan avlasta akut- och specialistvården genom snabbare vård.« (2022 manifesto ↗)“Investments in primary care with greater patient contact and coordination by a patient-responsible doctor can relieve acute and specialist care through faster care.”
- talk therapy in care»Effektiva behandlingsåtgärder, i form av exempelvis samtalsterapi, bör i högre grad erbjudas för att den psykiska hälsan hos patienten inte ska riskera att försämras.« (2022 manifesto ↗)“Effective treatment measures, such as for example talk therapy, should be offered to a greater degree so that the patient's mental health does not risk worsening.”
- mental health care outside CAMHS»Sverigedemokraternas uppfattning är att behandlingsresurser inte enbart ska begränsas till barn- och ungdomspsykiatrin (BUP).« (2022 manifesto ↗)“Sweden Democrats' view is that treatment resources should not be limited solely to child and adolescent psychiatry (CAMHS).”
- national quality requirements»Nationella kvalitetskrav inom vård och omsorg måste finnas och får inte underskridas.« (party programme ↗)“National quality requirements in care and support must exist and must not be undershooted.”
The stance rests on the quoted commitment in the party's own documents; the actual vote deviated. Click the quote to verify it in the document.
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Sources and documents
- The committee report on riksdagen.se (2022/23:SoU12)
- Committee report full text (HA01SoU12)
- Per-MP voting data (API)
- Case status (API)
Documents under consideration
- Motion 2022/23:1102 — Lex Rebecka av Ann-Sofie Alm (M)
- Motion 2022/23:111 — Huvudmannaskap för specialistsjukvården av Saila Quicklund (M)
- Motion 2022/23:1121 — Fler företag, fler jobb och stärkt konkurrenskraft i hela landet av Elisabeth Thand Ringqvist m.fl. (C)
- Motion 2022/23:1141 — En tillgänglig sjukvård i världsklass av Linda Lindberg m.fl. (SD)
- Motion 2022/23:1182 — Begränsning av bemanningsföretagen i vården av Peder Björk och Peter Hedberg (båda S)
- Motion 2022/23:1229 — En förbättrad och jämlik barnhälsa av Karin Rågsjö m.fl. (V)
- Motion 2022/23:1232 — En funktionsrättspolitik för trygghet och delaktighet av Maj Karlsson m.fl. (V)
- Motion 2022/23:1234 — En hälso- och sjukvård för jämlikhet och jämställdhet i hela landet av Nooshi Dadgostar m.fl. (V)
- Motion 2022/23:1286 — Bemanningsföretagens effekter på den svenska sjukvården av Adrian Magnusson (S)
- Motion 2022/23:1499 — Barns och ungas psykiska hälsa av Lili André och Cecilia Engström (båda KD)
- Motion 2022/23:1502 — Öläge av Hanna Westerén (S)
- Motion 2022/23:1559 — Bibehållande av rätt till tolk inom vården av Matilda Ernkrans och Denis Begic (båda S)
- Motion 2022/23:159 — Jämlik vård av Sofia Skönnbrink och Sanne Lennström (båda S)
- Motion 2022/23:1618 — Psykisk ohälsa kan leda till diskriminering av Ulrika Heie och Martina Johansson (båda C)
- Motion 2022/23:1672 — En levande landsbygd för Sveriges bästa av Annie Lööf m.fl. (C)
- Motion 2022/23:1673 — Jämställdhet för hållbar utveckling av Annie Lööf m.fl. (C)
- Motion 2022/23:1683 — Tydligt uppdrag för primärvården att förebygga ohälsa av Ulrika Heie (C)
- Motion 2022/23:1841 — Bättre behandling för människor med diagnosen ME/CFS av Maria Stockhaus (M)
- Motion 2022/23:1927 — Utvärdering av den svenska missbrukspolitiken av Niels Paarup-Petersen och Alireza Akhondi (båda C)
- Motion 2022/23:1979 — En mer jämlik sjukvård av Linnéa Wickman m.fl. (S)
Source: The Swedish Parliament