Stockholm County Council basically has strong finances, but it does not lack challenges. As Stockholm County grows, more people travel by public transport and more people need healthcare. This is why it is reasonable for the County Council to also plan for rising costs. At the same time, revenues are increasing and the conditions for them to continue increasing are good. This increase is due, for example, to many people choosing to move to the County at the same time that the labour market is good.
Low inflation and low market interest rates are favourable for the County Council, which is in a phase of extensive long-term investments in healthcare and public transport.
The County Council is building for the future, but also for today’s situation. Major on-going investments include the construction of New Karolinska Solna, the expansion of the Metro under the 2013 Stockholm Agreement and the upgrade of the Metro Red Line. The investment plans for 2015 were extensive and the year’s investment volume amounted to more than SEK 14 billion.
Rate of cost increase continues to be in focus
For some time, the costs in Sweden’s different county councils and regions have increased more than can be attributed to higher capacity and a broader offering. In light of the revenues, this increase is not sustainable over the long term. Stockholm County Council is working to reduce the rate of cost increase through action programmes. In 2015, the total rate of cost increase was 3.3 per cent, which can be compared with the 2014 rate of cost increase of 6.6 per cent. In other words, the rate was cut in half between 2014 and 2015. Some of the cost increases over the stated 3.3 per cent are in the areas subject to patient choice. This may be due to several factors. However, on the long term, the expansion of outpatient specialist care will relieve emergency medical care and contribute to more accessible and effective care.
Owner governance in practice
The major on-going and upcoming investments require coherent governance and management. The County Council therefore built up a reinforced owner governance according to a decision in 2014. This owner governance means that the County Council’s own production of health and medical care will be more clearly coordinated than today, with considerable focus on getting different actors to collaborate. Owner governance will also function as a support and control function and support the care providers in their efforts to keep within the set financial limits. Each care provider previously operated its activities with extensive independence within the set limits. Now, a larger measure of cooperation between various care providers is required in order for the decisions on the Future Plan to be implemented in practice. During the time that the changes are being made, the care providers must offer the patients care with just as high quality and patient safety as today. This challenge requires new ways of working together.
Increased focus on cost control
The next few years will entail strains on the County Council’s finances. Operating and interest expenses increase as new facilities and hospital premises are brought into use and the resources and competencies that exist need to be used in a more efficient manner than before.
Within several of the County Council’s operations and within the central administrations, several action programmes were established in 2015. The objective of the programmes is to ensure balanced finances, and to achieve the budgeted results and a long-term sustainable cost growth rate. The action programmes include both improvement and efficiency enhancement measures as well as cost savings, and have generally had the intended effect. This is particularly true of the measures concerning the Public Healthcare Services Committee’s budget, which was reprioritised in 2015 to avoid major deficits in the emergency hospital operations, and to achieve balanced finances during the year. In 2015, the County Council reached new agreements with the County Council-operated emergency hospitals, which with a few exceptions are operated in limited company form. The agreements regulate the production and financial limits during the transition that is under way according to the Future Plan for Health and Medical Care.
Efficiency enhancements in commuter rail and bus traffic
A growing traffic system entails higher costs for operations and administration. For long-term cost control, it is therefore necessary to continuously review and adjust the traffic offering so that both today’s and tomorrow’s offering can be secured and financed.
In 2015, efficiency enhancements in public transport were planned and implemented. The starting point was that they should impact the passengers as little as possible. The efforts made were, for example, adjustments in the commuter rail timetable, in station opening hours and in the offering of bus service. Actions and efforts have also been made to make procurement more cost effective and increase and secure the traffic revenues.