3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
On aggregate the Swedish health care system’s capacity for intensive care has doubled during the COVID-19 outbreak. Hospitals have made organizational adjustments to meet the required needs and have allocated both material and personnel resources to the intensive care units (ICUs). Different regions and hospitals have taken somewhat different measures. The number of surgeries almost halved in April compared with the average for April in the previous three years. In particular, many surgeries were cancelled in orthopaedics, general surgery and eye care. The number of physical visits to primary care fell by about 800,000 during the spring. Visits to specialized care also fell sharply. However, digital care visits increased. People with a background in care or health care have offered their services to hospitals who have been hiring on demand. The private sector and military have provided support with material resources. A selection of primary care providers work with sentinel surveillance, reports the incidence of infection, and sends samples to labs. In general, there is no designation of specific hospitals and/or departments that are meant to deal exclusively with COVID-19 patients.
Organizational adjustments and re-allocation of resources in the health care system
• March 13th. In order to take pressure off the health care system, the requirement for presenting a medical certificate for sick leave from the eighth day of sickness has been temporarily removed.
• March 14th. The National Board of Health and Welfare has been assigned to be national purchasing centre for medical supplies, protective equipment and certain medical technical equipment. The Swedish Work Environment Authority has been assigned to ensure that there is a procedure for providing non-CE-marked personal protective equipment (PPE) for socially important occupational groups.
• March18th. The government assigns the National Board of Health and Welfare to set up a coordination function for ICUs. The purpose is to support the regions in the coordination and expansion of intensive care centres in the country.
• March 23rd .The National Board of Health and Welfare develops national principles for prioritization, in case of intensive care shortages, to support health care personal.
• April 14th. On aggregate the capacity for intensive care has doubled and is now able to take care of 1046 intensive care patients.
• April 15th. ICU beds rises to 1064
The role of the National Board of Health and Welfare in securing material resources
• Signed an agreement for SEK 1 billion. For example, for 800 respirators, 12 million face masks; has also secured large deliveries of hand sanitizers and surface disinfectants.
• Close collaboration with the Swedish Defence Materiel Administration, which supports contractual agreements and quality contracts with suppliers.
• Deliveries are made on a continuous basis and distributed after quality control to the health care system.
• Few regions have an urgent needs for protective equipment, but several will need more in the next few days (from April 16th). The authority makes daily decisions on material support for regions and municipalities.
Role of the Swedish Armed Forces
The Swedish Armed Forces have contributed with equipment, e.g. ambulances and about 50 000 military masks and 150 respirators. They are also contributing with a field hospital with capacity for 40 patients and 30 intensive care patients in Stockholm. In Gothenburg, a similar module has been raised with capacity for 50 patients and 20 intensive care patients. They are also contributing with personnel in different functions. Hospital tents and beds have been installed in several other regions.
• 27th March. The Swedish Armed Forces hands over the responsibility for the ICU at the field hospital in Gothenburg to the region of Västra Götaland
• April 6th. Älvsjö Hospital in Stockholm is operational
Role of the private sector
Upon the initiative of the Government and private actors themselves, several Swedish companies have started to change their production to ensure domestic production of PPE for health care, including masks and disinfectant. The state research institute, Rise, is responsible for quality control.
Role of Primary care – Sentinel Surveillance and general guidelines
The Regions have developed different guidelines on how the primary care units should operate when meeting patients with respiratory symptoms. The guidelines concerns both more general hygiene guidelines and practical procedural guidelines concerning distancing and isolation of patients.
A selection of primary care units works with sentinel sampling in order to determine how many patients with flu-like symptoms actually have the flu or COVID-19. In connection with the spread of COVID-19 in Europe, the Public Health Agency has decided to include analysis for COVID-19 in the sentinel samples. This is to get a better idea of the spread of influenza and COVID-19 as well as the risk groups and age groups affected. The units participating in sentinel sampling each week take samples from patients with flu-like illness and submit them to the Public Health Agency for analysis.
Improving access to COVID-19 services for vulnerable populations
Children who are undocumented migrants or seeking asylum have the same right to health care as Swedish citizens. Adult asylum seekers or undocumented migrants have the right to care that cannot wait, which means that they are entitled to health care in case of serious illness caused by COVID-19.
Sweden’s 290 municipalities have the ultimate responsibility for ensuring that people living or staying in the municipality receive the support and assistance they need. On April 24th Amnesty International encouraged the National Board of Health and Welfare to publish national guidelines which clarify the municipalities’ responsibilities for homeless people during the COVID-19 crisis.
The Prison and Probation Service have prohibited visits to prisons and remand prisons. The restrictions do not concern lawyers, prosecutors and police officers.
Guidance for long-term care providers
The National Board of Health and Welfare have produced guidelines, online training courses and support documents to long-term care facilities regarding COVID-19. Long-term care is a municipal responsibility and supply of both physical and personnel resources and contingency plans and routines differ between municipalities and care providers, the National Board of Health and Welfare are producing follow-up reports on this matter.
May 12th. The Government presents measures with the aim of strengthening the human capital in the sector of care for older people. The government allocates SEK 2.2 billion to give employers in the sector paid education during working hours. The aim and hope is that this will increase the number of permanent employees.