Memorandum 05 May 2015 Ministry of Health and Social Affairs Sweden Strategic Social Reporting 2015 Sweden Content 1. Introduction... 2 2. Delivering on the Europe 2020 objective to combat poverty and social exclusion... 2 3. Policy reforms for the period 2014 2015... 3 3.1 Recent reforms and policy initiatives to promote social inclusion... 4 Access for all to the resources, rights and services that prevent and address exclusion and fight all forms of discrimination. Support for people entering the labour market.... 4 Investing in children... 4 Combatting discrimination... 5 3.2 Recent reforms to achieve adequate and sustainable pensions... 6 3.3 Recent reforms in health care policy... 6 Stewardship of health care... 6 Financing and cost sharing... 7 Health care delivery... 7 Investing in healthcare professionals... 7 Enhanced of access to services and patient s choice... 8 3.4 Recent reforms to achieve adequate social protection for long-term care needs... 8 Financing and cost-sharing... 8 Preventing dependency... 8 Investing in the LTC workforce... 9 Enhanced patient s choice and access to services... 9
2 1. Introduction Sweden s national reform programme for 2015 presents reforms to help meet Sweden s national targets for increased social inclusion and reforms that will, in a supplementary way, achieve social inclusion and Europe 2020 strategy s objectives. This report provides supplementary information to the initiatives and measures presented in the national reform programme. In September 2014, general elections were held in Sweden that led to a change of government. The current coalition government of the Social Democratic Party and the Green Party took office in early October 2014. The Government s macroeconomic assessment is that the Swedish economy will gradually recover in the coming years. The economic situation in the rest of the world appears to be improving, even if all the indications are that recovery will be slow, particularly in the euro area. The risk of weaker growth is significant, and poor economic prospects in the euro area are considered the single largest risk. 2. Delivering on the Europe 2020 objective to combat poverty and social exclusion One of the Government s central political priorities is full employment. It is crucial that we create conditions for more jobs and that we take rigorous measures to combat unemployment. The Government s policy is steered by a clear employment target. The goal is that the number of people in work and the number of hours worked in the economy will increase so that Sweden s unemployment rate will be the lowest in the EU by 2020. It is particularly important that we address the high levels of youth and long-term unemployment, and that we improve the matching process in the labour market. Employment policy in Sweden is based on people s desire to work and develop. Work creates a sense of community and belonging the power to shape one s life and future. When more people are employed, the percentage of people at risk of poverty and social exclusion will be reduced. Getting more people in work is crucial for cohesion in Sweden. A country with a high level of employment and low unemployment levels becomes more prosperous, more secure and more open. Consequently, Sweden s national Europe 2020 target includes groups that are not part of or who risk exclusion from the labour force. The
3 target is expressed as Promoting social inclusion by reducing the percentage of women and men aged 20 64 who are not in the labour force (except full-time students), the long-term unemployed or those on long-term sick leave to well under 14 per cent by 2020. Despite lasting effects of the economic crisis, the number of people who are socially excluded, as defined by the Swedish national target, decreased by 86 000 between 2010 and 2014, or from 14.4 to 12.6 per cent. However, as in most EU Member States, the proportion of people living in at risk of poverty or social exclusion has increased over the same period. The Government works continuously to improve the functioning of the labour market through measures to labour supply, prevent long periods of unemployment and strengthen the demand for groups with a weak position in the labour market, and improve matching of jobseekers with available jobs. There is also a continuous focus on reforms to strengthen opportunities for people to support themselves, and to improve standards for groups that nonetheless have a weak economic position and for pensioners. The national target is monitored continuously, directly and indirectly, through various statistics and measurements for groups that are outside the labour market or at risk of becoming socially excluded. 3. Policy reforms for the period 2014 2015 Sweden s national reform programme for 2015 presents reforms to help meet Sweden s national targets for increased social inclusion and reforms that will, in complementary ways, achieve social inclusion and the Europe 2020 strategy s objectives. Sweden s national reform programme includes the following reforms on the objective of increased social inclusion: Support and requirements concerning unemployed people who receive financial assistance Work to combat homelessness Higher maintenance support Work to strengthen parental support The Fund for European Aid to the Most Deprived National coordinator for work concerning vulnerable EEA citizens
4 Children in economically and socially vulnerable situations statistics and administration Compensation for high sick pay costs Higher housing supplements for pensioners Greater health equity and access to high quality health and medical care The national reform programme further states that a number of reforms listed in other chapters also contribute to the Europe 2020 strategy objectives on social inclusion. Supplementary information regarding the initiatives and measures presented in Sweden s national reform programme for 2015 is given below. 3.1 Recent reforms and policy initiatives to promote social inclusion Access for all to the resources, rights and services that prevent and address exclusion and fight all forms of discrimination. Support for people entering the labour market. People who become unemployed must not be made to suffer immediate financial stress. The individual is to be given good opportunities to actively seek and find a new job, preferably equivalent to his or her skills and qualifications. The Government considers that it is vital to raise the highest daily allowance in the unemployment insurance so that the insurance can serve as a loss of income insurance and a safety net for the individual in the event of unemployment. In the spring budget for 2015, the Government therefore proposes raising the highest daily allowance in the loss of income insurance from 7 September 2015 so that people with a monthly income of SEK 25 000 will receive 80 per cent of their income for the first 100 benefit days. The highest daily allowance will thereby be raised from the current SEK 680 to SEK 910 for benefit days 1 100, after which the allowance will be scaled down to SEK 760 per day. The Government also proposes an increase in the minimum level of compensation from unemployment insurance from SEK 320 to SEK 365 per day, starting on 7 September 2015. Investing in children Action targeting economic vulnerability among children
In 2014, the County Administrative Board in Skåne County and the County Administrative Board in Västerbotten County were given the task of supporting the municipalities in their work to produce action plans to counter economic vulnerability among children. The county administrative boards are to encourage municipalities to produce, develop and follow up local plans to combat economic vulnerability and its effects on children. The assignment also included supporting municipalities wanting to introduce the perspective of children in economically vulnerable situations in existing action plans and related documents. Based on previous experiences, and new ones that may emerge, the assignment includes drawing up common proposals on how the municipalities efforts on these issues can continue to receive regional support. The assignment has been presented in a report submitted to the Government Offices and the proposals are being prepared. Child services on the internet The National Board of Health and Welfare and the Ombudsman for Children in Sweden are responsible for formulating and disseminating information to children and young people about social services and their mandate. It should be clear to children and young people what social services can offer children and young people in need of support and protection and where they can turn if they need help and support. At the local level, the responsibility also includes stimulating and making it easier for municipalities to produce their information and make it available to children and young people. The Ombudsman for Children in Sweden has been responsible for involving children in the implementation, and listening to their experiences and needs. The National Board of Health and Welfare will present its final report by 1 December 2015. 5 Combatting discrimination Discrimination Act In 2014, the Swedish Government proposed an amendment to the Discrimination Act regarding inadequate accessibility as a form of discrimination. The purpose of this legislative amendment is to strengthen protection for persons with disabilities so that failure to take reasonable measures to increase accessibility may be deemed to constitute discrimination. Inadequate accessibility means, for example that a person with a disability is disadvantaged when accessibility measures have not been taken to put people with disabilities in a situation comparable to that of people without such disabilities.
6 The prohibition of discrimination through inadequate accessibility should apply to the following areas of society: working life, education, labour market policy activities and employment services not under public contract, starting or running a business, professional recognition, membership of certain organisations, goods and services, public meetings, public events, health and medical care, social services, social insurance, unemployment insurance, state financial aid for studies, national military and civilian service, and public employment. The amendments entered into force on 1 January 2015. Commission on information and communication on the rights of persons with disabilities The Government has tasked the Agency for Participation (MFD) with implementing a communication initiative to increase knowledge and awareness among the general public, employees in the public sector, the private sector and among women and men, girls and boys with disabilities on the contents of the Convention on the Rights of Persons with Disabilities. The assignment will be carried out in 20152017 and the aim is to prevent and combat discrimination of persons with disabilities. It will be carried out in cooperation with the Equality Ombudsman (DO). 3.2 Recent reforms to achieve adequate and sustainable pensions In 2014, the Working Group on Pensions, consisting of representatives of the Swedish Social Democratic Party, Green Party, Moderate Party, Liberal Party, Centre Party and the Christian Democrats, reached an agreement regarding changes to the current pension system. The changes relate to a proposed change to the AP Funds investment rules, promoting a longer working life, a review of the premium pension system and amended rules for the automatic balancing mechanism, etc. The Government Offices and the Working Group on Pensions are now working on these changes. 3.3 Recent reforms in health care policy Stewardship of health care The Swedish health care system is decentralised to a high degree, with 21 county councils responsible for providing health care for their citizens. However, there are a number of ongoing efforts focusing on optimising healthcare resources in different parts of the country. The Government is working to implement its National Cancer Strategy.
One of the main reforms in this Strategy is to develop regional cancer Centres (RCC) for the purpose of achieving higher quality care, improved patient outcomes and a more efficient use of healthcare resources. There are now six RCCs in operation serving 20 county councils. 7 Financing and cost sharing No recent reforms target changes to healthcare financing. However, the current Government is shortly due to implement a new reform targeting children s medication expenses. There are indications that children in families with limited financial resources may experience delayed access to pharmaceuticals. As of 2016, pharmaceuticals will be free of charge for children and young people below 18 years of age. The reform is intended to contribute to more equitable access to pharmaceuticals, regardless of the financial situation of the family. Health care delivery There are currently a number of reforms/strategies at national level supporting the development of service delivery, and health promotion and disease prevention. For example, one major strategy targets chronic disease management and includes efforts to develop and improve primary care s role in addressing chronic disease patients. Also, this strategy reinforces the focus on and the importance of health promotion and disease prevention. The strategy is in line with international initiatives launched by WHO and European Commission. Due to Sweden s decentralised health system, the State has supported many projects that facilitate the exchange of patient information between different care providers as well as between the healthcare system and the patient. Investing in healthcare professionals The number of places in the education and training programmes has increased. Moreover, an ongoing inquiry will conduct an analysis of how healthcare professionals can use their resources more efficiently and propose measures that can be taken at national, regional and local level to ensure that healthcare professionals use their time, knowledge and commitment in the best possible way in order to increase healthcare efficiency.
8 Enhanced of access to services and patient s choice In January 2015, a new patient act was introduced in Sweden, reinforcing a number of issues related to patients rights to information, second opinion, etc. Furthermore, the act significantly improves possibilities for patients to choose primary care health providers and open specialist care providers. 3.4 Recent reforms to achieve adequate social protection for long-term care needs Financing and cost-sharing Incentive measures to improve quality in health and social care for elderly people An incentive grant of over SEK 1 billion (EUR 106 776 005) has been set aside in 2015 to support municipalities and county councils in their efforts to improve the quality of health and social care for elderly people. The incentive grant has helped to give groups of health and social care staff more knowledge about patient-centred care, rehabilitative practices, medication for the elderly, diet and nutrition as well as the importance of social content in the daily life of the elderly. The incentive grant has also made team-based work possible in several municipalities and county councils. Preventing dependency Welfare technology In 2015, the Government is investing SEK 15 million (EUR 1 607 630) in support and information related to the use and implementation of welfare technology in the municipalities. Welfare technology has a great potential to contribute to security, independence, social activity, participation and self-determination. The initiative comprises a government assignment to the Agency for Participation (MFD) to draft and disseminate information as well as to provide support and information for the use and implementation of welfare technology in the municipalities. Action plan to prevent and avoid coercive and control measures The National Board of Health and Welfare has been commissioned by the Government to follow up the development of health and social care for adults with reduced decision-making capacity and support to their close relatives. In February 2015, the National Board of Health
and Welfare reported a positive trend in the field and stated that a majority of the municipalities see a gradual decrease in the use of control and coercive measures. The positive trend has been facilitated by a patient-centred approach, providing opportunities for preventive efforts. 9 Investing in the LTC workforce Increased staffing levels in elderly care The Government intends to set aside SEK 1 billion in 2015 for an initiative to increase staffing levels in elderly care aimed to improve security and the level of quality for the individual. Increased staffing levels can create opportunities for staff to spend more time with individuals, but can also allow more time for staff to develop their professional activities together. Higher staffing levels can also be expected to improve the work environment and thereby increase the attractiveness of elderly care professions. Educational and training initiatives The Boost for Carers is a four-year training initiative for elderly care professionals which ended in 2014. The purpose has been to enhance both basic and specialised skills among elderly care staff. Since its launch, some 17 000 people have begun training within the framework of the Boost for Carers. Also, more than 54 000 people have undergone web-based training on patient-centred care for people with dementia. Leadership training at higher education level for managers in elderly care The training programme, worth approximately SEK 1 billion, is under way during 2013 2015. The aim is to increase skills and the status of elderly care managers. The National Board of Health and Welfare has been tasked with administering and following up the training, equivalent to 30 higher education credits. By late 2014, some 1075 elderly care managers had participated in the training. Enhanced patient s choice and access to services Review of financing in welfare services The Government has appointed an Inquiry Chair to propose how public funding of privately conducted welfare services can be designed to ensure equity, quality, economic efficiency, requirement adjustment and transparency. The aim of the inquiry is to ensure that public funds
10 are used for the activity for which they are intended and in a way that will benefit the users and that, as a rule, any surplus is to be returned to the activity where it arose. The Inquiry s final report is due by 1 November 2016.