This is how NATO increases the demands on Swedish healthcare

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As a classic sign of spring, the healthcare staff’s anxiety about the summer blossoms. Kai Knudsen is associate professor and chief physician in intensive care at Sahlgrenska University Hospital in Gothenburg. He has recently been told that the hospital’s iva places will be reduced this summer and there are already too few, he says.

– I feel worried about how we will accomplish our mission.

Sweden has an immediate need for 2,360 more staffed care places, of which 60 in intensive care, according to The National Board of Health and Welfare’s latest calculation. Lack of nurses is pointed out as the main explanation for the problem.

– There is reason to be concerned about how we would cope with a war situation or a missile damage situation. This applies above all to personnel, but also premises and medicines, says Kai Knudsen.

Kai Knudsen, associate professor and iva physician at Sahlgrenska University Hospital in Gothenburg, hears the word “preparedness” more and more often but sees savings instead of investments. Photo: Tomas Ohlsson

Several government investigations has pointed out that Swedish healthcare needs to be strengthened to improve preparedness for crisis and war. One of the latest heavy alarms that the modernization of healthcare is going too slowly came from the Defense Committee.

Sweden’s ÖB has been clear that both civilians and soldiers must be taken care of by the usual healthcare in a war situation, because the military’s healthcare resources are small. With Sweden’s entry into NATO, the pressure has increased further.

According to Johan Hjelm, head of unit at the Norwegian Agency for Community Protection and Preparedness, MSB, the defense alliance’s general expectations for the member states are to be able to handle large worm damage outcomes and health crises. According to NATO’s view on civil preparedness, a functioning healthcare system is an important part of a country’s resilience.

– NATO does not go into civil preparedness in detail, but all member states have a responsibility to have their own capability, he says.

Last fall, the healthcare system in Stockholm trained for the first time based on the scenario that Sweden is at war. Ambulance flights drove between Gärdet and Södersjukhuset in with injured extras. Photo: Magnus Hallgren

This was clarified by NATO Secretary General Jens Stoltenberg when he said in an interview with Sveriges Radio in April that Swedish healthcare is good but needs to “increase in capacity” to meet NATO’s requirements.

Sweden’s military commitments in NATO’s joint defense planning are expected to become clearer during the year. NATO’s demands on Swedish military capability will also place demands on the country’s civil defense and preparedness, says Johan Hjelm.

Among other things, it is about being able to receive wounded from other countries. In the most conceivable scenario from Baltic States and Finland.

– Exactly what we should be prepared for is of course difficult to know, but it is an increase in capacity that we need to do, says Johan Hjelm.

Another important part that MSB highlights is that Sweden needs to have plans to be able to receive civilian aid from outside and to be a host country to foreign troops in both exercises, crisis and war.

So how will Sweden be able to meet NATO’s requirements?

Health Minister Acko Ankarberg Johansson (KD) says that it is a priority issue for the government to increase capacity in Swedish health care.

– That would have been the case even without NATO. We must be able to provide patients with the care they need.

“As inflation goes down, we can come back with better support for important welfare areas,” says Health Minister Acko Ankarberg Johansson (KD). Photo: Alexander Mahmoud

She explains that healthcare personnel, such as iva doctor Kai Knudsen in Gothenburg, instead have to witness cutbacks with the tough financial situation that municipalities and regions are currently in.

As DN previously told need a large part of the country’s regions cut back on healthcare in 2024. The culprit in the drama is inflation and high costs for pensions. The worst hit was the university hospital is Sahlgrenska in Gothenburg.

In the spring amendment budget, the government allocated six extra billion so that regions do not have to notify healthcare staff. Acko Ankarberg Johansson describes 2024 as a problematic year that healthcare needs to “get through”.

– As inflation goes down, we can come back with better support for important welfare areas and healthcare is a priority area for the government.

A little over a week ago, the Defense Committee came up with its final report which proposes increased investment in civil defense. How it will be financed is still unclear.

Will the state take greater financial responsibility for healthcare preparedness for war?

– That decision will come this autumn, based on the Defense Committee’s reports. The regions still have the ultimate responsibility for healthcare, says Acko Ankarberg Johansson.

A lot of work too strengthening health care’s preparedness for war is already underway, says Taha Alexandersson, head of crisis preparedness at the National Board of Health and Welfare.

“I thought that other NATO countries had come further in this co-planning,” says the National Board of Health and Welfare’s Taha Alexandersson about how civilian and military care needs should be coordinated. Photo: Mickan Palmqvist

– We assess that NATO’s expectations are in line with the work that is planned and carried out, but that it simply takes time and costs money, she says.

At the same time, she sees the acute shortage of care places as “serious”. She recognizes the concerns that iva doctor Kai Knudsen at Sahlgrenska describes.

Basically, it is about the fact that Swedish healthcare in a severe crisis situation would have to make hard priorities between people in great need of help. Doctors and nurses got a painful taste of this during the pandemic when, among other things, elderly people with covid did not get the care they needed.

– The most critical resource for good preparedness is access to healthcare personnel. We need to have a robust everyday life to cope with crisis and ultimately war, says Taha Alexandersson.

The challenges faced by Swedish healthcare are not unique, she adds. Throughout Europe, the older and more care-requiring part of the population is growing. There are large retirements and increasingly difficult to recruit and retain healthcare staff.

Injured extras were cared for at Södersjukhuset in Stockholm in November 2023, to train staff on a disaster with many civilian casualties. Photo: Magnus Hallgren

The pandemic exposed serious deficiencies such as insufficient drug stocks. Within NATO as a whole, civil preparedness has gone from a dormant to a highly topical issue, says Taha Alexandersson.

– When we had submitted the NATO application, I naively thought that there might be a blueprint for how civil preparedness work and civil-military cooperation should be conducted. But I can briefly say that, there is not.

Instead, she meets an interest among European colleagues in how Sweden built its old total defense and now chooses to re-arm.

– I thought that other NATO countries had come further in this joint planning and was a little relieved that we are not far behind, she says.

One of many The government mandate that the National Board of Health and Welfare has presented so far is a plan for how Sweden should handle a situation with a large number of injured people.

But iva doctor Kai Knudsen wants to see more than plans and reports.

– We are already walking around with the feeling that we are not providing good care and are discharging patients who should be allowed to remain on iva. It’s a constant pit in the stomach, he says.

Fact. NATO’s requirement for civil preparedness

NATO’s requirement for member countries according to Article 3 is to build strong functioning societies that can withstand and recover from both war and crisis. Ultimately, it is about building resistance – resilience – to deter attacks.

In recent years, NATO has raised the requirements for civil preparedness. But it is still the nations’ own responsibility to live up to NATO’s expectations. It is both about ensuring important social functions and that civil society should be able to support the military in the event of a conflict.

NATO has identified seven civilian capabilities that are of particular priority:

1: Political decision-making and central management functions.

2: Sustainable energy supply.

3: Management of uncontrolled population movements.

4: Food and drinking water supply system.

5: Management of major worm damage outcomes and health crises.

6: Sustainable civil communication systems.

7: Sustainable transport systems.

Source: MSB

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