sou · H9B352 · 2022-01-01 00:00:00 — Både parterna och Arbetsmiljö- verket har tagit fram sådana material. Schemat – en viktig arbetsmiljöfråga Schemat är en betydelsefull arbetsmiljöfråga. Det bör vara möjligt att uppnå balans mellan arbete och fritid. Tid behöver också finnas för återhämtning. Arbetsscheman med delade turer är ofta ett hinder för detta. –Arbetsgivarna inom vården och omsorgen om äldre bör se till att scheman med delade turer tas bort och ersätts med sammanhållen arbetstid. –Arbetsgivarna bör se till att det i arbetsschemat ingår tid för kom- petensutveckling, handledning, dialog och reflektion. Ny teknik i vårdens och omsorgens tjänst Det fjärde av utredningens fyra temaområden handlar om att införa och använda ny teknik. Utveckling av nya arbetssätt är en faktor för att göra arbeten inom branschen mer attraktiva. Den digitala tekni- ken kan bidra till att öka tryggheten och självständigheten för den äldre, som arbetet blir effektivare och resurserna används bättre. Personalens arbetsmiljö kan också förbättras och mer tid ges till mänskliga möten. För att den nya tekniken ska få en positiv inverkan på medarbe- tarnas arbetsmiljö behöver medarbetarna göras delaktiga och ha inflytande under processen: kartläggning av behov, testning, utvär- dering, införande och användning. En politiskt förankrad plan i alla kommuner För att kunna ta till vara den fulla potentialen med ny teknik fordras att kommunerna arbetar systematiskt med aktiviteter som driver fram ett förändringsarbete i verksamheterna, oavsett utförare. –Alla kommuner bör ha en politiskt förankrad plan för införande och användning av ny teknik i vården och omsorgen om äldre. –En sådan plan bör föregås av en inventering av befintlig teknik, behovet av ny teknik samt av utbildningsinsatser hos användare och personal. Ett stöd i arbetet kan vara den kunskap som tas fram inom ramen för regeringens och Kommuners och Regioners (SKR) Överenskommelse äldreomsorg – teknik, kvali- tet och effektivitet med den äldre i fokus. Kunskapen om välfärdsteknik är ojämn hos personalen inom vården och omsorgen om äldre. Det är arbetsgivarnas ansvar att personalen får kunskap om nya arbetssätt som inkluderar användning av ny teknik. –Arbetsgivarna bör erbjuda all personal möjlighet till fortbildning om digitalisering och välfärdsteknik. –Arbetsgivarna bör i samband med införande av ny teknik ta fram utbildningsplaner och IT-stöd för personalen. Långsiktigt nationellt stöd behövs om ny teknik Kommunernas förutsättningar skiljer sig mycket åt när det gäller att införa och hålla sig uppdaterade om ny teknik. –Regeringen bör säkra ett långsiktigt stöd i kommunernas arbete med att införa och använda ny teknik. Nationellt stöd behövs för fortsatt utvecklingsarbete Det är kommunerna – i egenskap av huvudmän – som skapar för- utsättningarna för kompetensförsörjningen. Men det är också en nationell angelägenhet att vården och omsorgen om äldre kan för- nya, behålla och utveckla sin kompetens. Det är en av våra viktiga framtidsfrågor. Därför behövs ett nationellt stöd – på både kort och lång sikt – för att stimulera det utvecklingsarbete som varit denna utrednings uppdrag att initiera. –Regeringen bör överväga att tillsätta en funktion för att samordna och följa upp det fortsatta utvecklingsarbetet när det gäller kom- petensförsörjning inom vården och omsorgen om äldre. Utred- ningens rekommendationer kan användas i arbetet. –En uppgift för en sådan funktion kan därutöver vara att skapa förutsättningar för fortsatt erfarenhetsutbyte och samarbete efter att den nationella samordnarens uppdrag är slutfört. –Regeringen bör även överväga att inrätta ett för utveckling av äldreomsorgen. Ett sådant kan placeras vid lämp- lig myndighet, exempelvis . Lärande exempel från kommuner I utredningens uppdrag har ingått att förmedla lärande exempel på arbetssätt som gynnar kompetensförsörjningen inom vården och om- sorgen om äldre. Från hela landet finns exempel på hur kommuner långsiktigt och systematiskt arbetar för att fler ska vilja välja vård- och omsorgsarbete. I kapitel 12 presenteras några sådana, utifrån utred- ningens fyra temaområden. Exemplen handlar bland annat om att fastställa kompetenskrav och inventera medarbetarnas utbildnings- behov, utveckla ledarskapet, stärka det systematiska arbetsmiljöarbe- tet samt att använda digitala lösningar i utvecklingsarbetet. At its meeting on , the Government decided to appoint an inquiry chair, who is to act as national coordinator, to support the municipalities in their work on laying the foundations for sustainable municipally financed care and healthcare for the elderly. The remit of this inquiry can be said to be twofold: partly a traditional investigative remit, which entails presenting analyses, assessments and recommendations, and partly a remit to help initiate change processes in the municipalities. The remit does not include submitting legislative proposals. The report therefore contains a number of recommendations based on the assessments of the current situation made by the inquiry chair. In the inquiry’s interpretation, the remit – in short – should attempt to answer two questions: –What is required for more women and men to want to start working in care and healthcare for the elderly? –What is required for more people to want to continue working in these professions? The remit concerns skills supply, not the content of such activities overall. The staff, their skills and their ability to provide high-quality care and healthcare are in focus. But content, quality, staff expertise and their ability to carry out their work are closely linked. The outbreak of the coronavirus pandemic in spring came to strongly influence the work of the inquiry. As COVID-19 hit the elderly hardest, a great deal of attention was directed towards elderly care, mainly towards its deficiencies. The pandemic also radically changed the practical conditions for the work of the inquiry. The terms of reference state that the approach should be outward- looking. Thus, 21 full-day seminars were planned, the aim being to meet municipalities, organisations, private employers and education providers. These events had to be replaced by 21 online dialogue seminars. The observations of the inquiry are largely based on what has emerged at the dialogue seminars and other contacts with rele- vant actors. The reports of other inquiries and government agencies, along with research, also form the basis of this inquiry. Work on development can now start To ensure a sustainable skills supply, more people need to choose care and healthcare. people need to want to start working in these professions, and want to stay in them. The level of success in recruitment for care and healthcare is affected by how these pro- fessions are viewed – how attractive they are. The inquiry presents a number of recommendations (see chap- ters 7–11 for more details) that aim to address the problems that in many cases have been obvious for a long time. One overall con- clusion is that it is necessary to raise the level of ambition – and that this work can start right now. Äldreomsorgslyftet (a government scheme to raise skills levels among staff working in care and health- care for the elderly) provides the conditions for initiating such long- term work, as new and existing basic-level staff are given the oppor- tunity to undergo training during paid working hours. How care and healthcare for the elderly are prioritised ultimately reflects the way in which society values older people. Several municipalities are already pursuing ambitious develop- ment activities today. Various actors operate in this area and can contribute valuable knowledge. Tools and supporting materials have been produced. Information is available on lessons learned from various parts of . It is the municipality – as principal – that lays the foundations for sustainable skills supply. The majority of the inquiry’s recommen- dations are thus aimed at the municipalities. Recommendations aimed at employers apply regardless of provider. Finally, there are recommendations to the Government, because developing skills supply also requires support at the national level. The four thematic areas of the inquiry Four areas appear crucial to people wanting to start working in the sector – and wishing to continue. The inquiry presents recommen- dations in the areas set out below. –Refresh, maintain and develop skills. –Strengthen leadership. –Create secure employment conditions and a good work environ- ment. –New technology in the service of care and healthcare. Work systematically and follow up A well-known model in development work is determining what you want to achieve, describing the current situation, taking action to achieve your goal, following up on how things have gone, making adjustments, taking new action, setting new goals. As principal for care and healthcare for the elderly, the municipality is responsible for these operations and for following up on com- pliance with laws, regulations and the municipality’s own goals. This is the case regardless of provider. Follow-up can take place locally, regionally and nationally. At the national level, there are a number of sources that allow you to follow developments in the area of skills supply. ’s Enhetsundersökning (a survey to data on the country’s assisted living services and accommo- dation for the elderly based on 27 quality parameters), published every year, is a tool that municipalities can use. The municipalities also have their own systems for follow-up. We recommend follow-up indicators in each thematic chapter. We have selected existing indicators, information that is currently already gathered. Along with the indicators, the recommendations presented by the inquiry constitute a systematic approach to achieving sustainable skills supply. The recommendations of the inquiry: –The municipalities should work systematically, taking a long- term approach and continuously following up on their work. The indicators of the inquiry can be used in the follow-up. –Municipal plans and inventories form part of this systematic work. The recommendations of the inquiry can be used. The work on long-term skills supply should encompass all staff categories. Refresh, maintain and develop skills The first of the inquiry’s four thematic areas is about refreshing, maintaining and developing skills. Many of the elderly people receiving care and healthcare have multiple illnesses and extensive needs. The work is often complex and requires staff to have under- gone the appropriate training and have the right skills. If work in care and healthcare for the elderly is to become more attractive, a greater level of professionalisation is required. Making “assistant nurse” a protected professional title is a crucial step. Knowledge requirements and education The level of education in care and healthcare for the elderly needs to be raised. Employers should take greater responsibility. Vård- och omsorgscollege (a platform for collaboration between employers, trade unions and educators in the care and healthcare sector) has the potential to support the municipalities in developing sustainable skills supply within care and healthcare for the elderly. A lack of knowledge of Swedish is a problem in many places. The recommendations of the inquiry: –’s general advice (2011:12) on basic knowledge among staff working in elderly care provided by social services was determined in 2011 and needs to be reviewed to ensure it is fit for purpose. The Government should task with this. –Employers should take responsibility for all staff newly em- ployed in care and healthcare receiving induction training. has produced such a train- ing programme. –The employer should carry out language training initiatives for care and healthcare staff who lack sufficient skills in Swedish. Vård- och omsorgscollege has a model for this. Cooperation between different skills – a means of professionalising activities In many areas, care and healthcare for the elderly is fragmented. To ensure that different perspectives are taken into account, specialist skills are required from doctors, nurses, physiotherapists, occu- pational therapists and other occupational groups. Relatives also need to be involved. The recommendations of the inquiry: –The municipalities, which bear overall responsibility, should ensure that various skills and perspectives are continuously avail- able and work together in care and healthcare for the elderly. –The municipalities should lay the foundations for developing a team-based approach, which is supported by research. Clear professional roles, skills development and career opportunities Professional roles in care and healthcare for the elderly are unclear, and career paths are often lacking. This negatively impacts the attractiveness of these professions. The recommendations of the inquiry: –Professional roles need clarifying. Inventories and plans can serve as tools in this work. Trained care assistants, assistant nurses and assistant nurses with specialist skills form the basic staff. –Staff carrying out tasks delegated under the Health and Act should be trained assistant nurses, that is, they should have graduated from the Health and Social Care Programme at upper-secondary level or equivalent. However, an individual assess- ment of actual competence for the task must always be made. –The Government should task the appropriate agency with initi- ating a study on the effects of differentiating tasks within care and healthcare, and how the sector can be organised sustainably. –Employers should offer employees continuous skills develop- ment. –Employers should develop career paths and stimulate employees’ career development. Strengthened leadership is the second of the inquiry’s four thematic areas. The coronavirus pandemic has demonstrated the importance of clear leadership that is close to operations. Leadership – both at a political level and at public servant level – is fundamental to sustainable skills supply in care and healthcare for the elderly. It concerns overall management and development, as well as supporting the individual employee. It requires skills. It is also a requirement that the conditions for being able to lead are provided. The focus of the inquiry has primarily been managers with HR responsibilities working close to operations and their conditions. Limit the number of employees per manager and secure access to support resources A reasonable number of employees to be responsible for, along with access to support resources (for example, the finance function, administrative support, IT support, HR function, methodological support) are key requirements for managers working close to operations being able to practice and present leadership. These conditions are often lacking at present. The recommendations of the inquiry: –Employers in care and healthcare for the elderly should establish a ceiling for the number of employees that managers working close to operations are to be responsible for. A suitable range is 20–30 people. This should include both permanent and tempo- rary employees. –Employers should ensure that managers working close to opera- tions have access to support resources. Suitable education and skills requirements for managers working close to operations There is a lack of clarity regarding the educational requirements that can be made of managers working close to operations. Setting a national educational level for managers is desirable. The inquiry’s recommendation: –The Government should task an appropriate government agency with producing documentation with assessments of advantages and disadvantages of regulating or otherwise clarifying educa- tional requirements for managers working close to operations in municipally financed care and healthcare for the elderly. Continuous skills development for managers Continuous skills development for managers needs to be guaran- teed. The recommendations of the inquiry: –Employers should take responsibility for sufficient time and resources being allocated to continuous skills development for managers in care and healthcare for the elderly. –Employers should enable heads of department to attend the leadership training offered to the target group. expertise among management of the operations –expertise needs to be strengthened in care and healthcare for the elderly while maintaining the social perspective. –The municipalities should ensure that there is expertise among the overarching management in operations providing care and healthcare for the elderly. Work using knowledge-based methods needs to be strengthened. The recommendations of the inquiry: –The municipalities should, as part of the development of a knowledge-based approach, support work in teams within care and healthcare for the elderly. –The municipalities should support the Regional Cooperation and Support Structures, which are a key forum for strengthening knowledge management in the area. –The Government should task with producing material that describes the team-based approach in work with elderly people with complex needs, based on knowledge materials regarding work in dementia teams. Create secure employment conditions and a good work environment The third of the inquiry’s four thematic areas concerns employment terms and work environment. These are closely connected. Secure employment conditions and a good work environment are crucial if people are to want to work in care and healthcare for the elderly. Permanent and full-time employment should be the norm Full-time employment is a key gender equality issue in a strongly female-dominated sector. The inquiry’s recommendation: –Employers should ensure that full-time and permanent employ- ment is the norm. Employers in care and healthcare for the elderly should apprise themselves of the knowledge available on this subject in the Heltidsresan development project run by the Authorities and Regions and the trade union . Systematic work environment efforts Systematic work environment efforts are lacking in many areas. Both the public servant level and the political leadership of the muni- cipality are responsible for these efforts. The recommendations of the inquiry: –The political leadership of the municipality needs to take its statutory responsibility for systematic work environment efforts being conducted in care and healthcare for the elderly, regardless of provider. –Employers should use the supporting materials available for such efforts. Both the parties and the Swedish Work Environment Authority have produced such materials. The schedule – a key work environment issue The schedule is a significant work environment issue. It should be possible to achieve a work-life balance. Recovery time is also required. Work schedules with split shifts often present an obstacle to this. The recommendations of the inquiry: –Employers in care and healthcare for the elderly should ensure that schedules with split shifts are removed and replaced by consecutive working hours. –They should ensure that the work schedule includes time for skills development, supervision, dialogue and reflection. New technology in the service of care and healthcare The fourth of the four thematic areas of the inquiry relates to introducing and using new technology. A factor for making work in the sector more attractive is the development of new working methods. Digital technology can help increase independence and a sense of security in older people while increasing efficiency and making better use of resources. The work environment for staff can also be improved and more time devoted to human interaction. In order for the new technology to have a positive impact on the employees' work environment, the employees need to be involved and have an influence during the process: mapping needs, testing, evaluation, implementation and use. A plan politically embedded in all municipalities To be able to make use of the full potential of new technology, municipalities are required to work systematically with activities that drive work for change in the operations, regardless of provider. The inquiry’s recommendation: –All municipalities should have a politically embedded plan for introducing and using new technology in care and healthcare for the elderly. –Such a plan should be preceded by an inventory of existing technology, the need for new technology and of training initia- tives among users and staff. The work can be supported by the knowledge produced within the Government’s and SKR’s Över- enskommelse äldreomsorg – teknik, kvalitet och effektivitet med den äldre i fokus (Elderly care agreement – technology, quality and efficiency with older people in focus). Training and support resources Knowledge of assistive technology is uneven among staff in care and healthcare for the elderly. It is the responsibility of employers to ensure that staff gain knowledge of new working methods that include the use of new technology. The recommendations of the inquiry: –Employers should offer all staff the opportunity for in-service training on digitalisation and assistive technology. –When introducing new technology, employers should draft train- ing plans and offer IT support for staff. Long-term national-level support required for new technology The conditions of municipalities differ widely regarding introducing and staying up to date on new technology. The inquiry’s recommendation: –The Government should guarantee long-term support in the work of municipalities on introducing and using new technology. National-level support needed to continue development work –in the short and long term It is the municipalities – as principals – that lay the foundations for skills supply. But it is also a matter of national importance that those working in care and healthcare for the elderly are able to refresh, maintain and develop their skills. This is one of our key issues for the future and is why support at the national level is required – in both the short and the long term – to stimulate the development work that it has been this inquiry’s task to initiate. The recommendations of the inquiry: –The Government should consider appointing a function for coordinating and following up on the development as it continues regarding skills supply in care and healthcare for the elderly. The recommendations of the inquiry can be used in the work. –An additional task for such a function could be to lay the foun- dations for continuing to exchange experiences and cooperate after the assignment of the national coordinator has been concluded. –The Government should also consider establishing a centre of excellence for developing elderly care. Such a centre can be loca- ted at a suitable government agency such as . Lessons learned from municipalities The remit of the inquiry included conveying lessons learned about approaches that benefit skills supply in care and healthcare for the elderly. There are examples from all over of how muni- cipalities are systematically working in the long term to ensure that more people choose care and healthcare professions. Chapter 12 presents some of these, based on the four thematic areas of the inquiry. Examples include defining skills requirements and making an inventory of employees’ training needs, developing leadership, strengthening systematic work environment efforts and using digital solutions in the development work. 1Utredningens uppdrag och arbete