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Several regions adopted priority guidelines for hospital care at the beginning of the pandemic when there were concerns that places of care were not enough. The Stockholm Region prioritization document, which used a low-value frailty scale to assess the elderly and how they should be prioritized for hospital care, is described as the most far-reaching, according to the Corona Commission, which believes guidelines with categorical patient divisions should be avoided in a pandemic. According to the Commission, it cannot be ruled out that guidelines like this have prompted decisions about palliative care rather than hospital care or curative treatment.
In a revised version of the May 22 document, numerical compensation disappeared and the use of the scale was toned down.
The guidelines were never approved by the political bodies, but were decided by the regional administration of special medical care, RSSL, and signed by the chief physician Johan Bratt.
Talla Alkurdi, a member of the health and medical care committee, says S began asking questions about elderly care in the spring, among other things, after the guiding document was noticed in the media and when reviews of the media showed no physical medical evaluations were performed.
The organization of the Stockholm region for medical interventions in nursing homes is regulated according to the choice of care. Two large companies share 90 percent of the responsibility.
– Now the region must take control of the medical liability of special housing, it can no longer be managed by a market. The approach with RSSL has led to a reduction in transparency around a number of decisions and we have requested minutes and more information, Talla Alkurdi says.
It also points out that the RSSL does not have a political body to report to in the delegation procedure, so the health and medical care committee has not been permanently informed.
– This has had very serious consequences and now we see that the elderly in nursing homes have not been protected. It is not enough that the problem is investigated, the organization must also change.
Jonas Lindberg (V), health care policy spokesman, says it is no coincidence that the Stockholm Region stands out in the country with 9 percent deaths in county nursing homes. He believes that behind this are conscious political decisions.
– It is clear that the region’s own guidelines have contributed to the poor care received by the elderly during the pandemic. At the same time that the threshold for the hospital was raised, it has not been possible to outsource care to the elderly. The elderly have been sacrificed at the altar of freedom of choice, says Jonas Lindberg, who also criticizes the fact that the document was never politically handled.
– These guidelines and directives have not been approved by political bodies, but they have been fully incorporated into the organization of public officials. It is extremely strange that these directives did not endorse the policy, as political decisions about the structure of care are largely dependent on priorities, says Jonas Lindberg.
Regional Health Advisor Anna Starbrink (L) says the Board of Health and Medical Care was informed of the guidance document after RSSL made the decision.
– The criticism of the Commission is very serious. However, in all prioritization documents, an individual assessment has been emphasized. There was also a demand from the profession to guide the guiding documents because it was a critical situation. Both the Commission’s review and Ivo’s review, we must learn lessons not to end there again, says Anna Starbrink.
He does not think the documents should have been politically handled.
– There are many medical guidelines that are never discussed politically; It would be unreasonable if I, as a layman, had to review medical guidelines politically. But we need to have a discussion about medical interventions in special housing and how we should strengthen long-term medical participation.
The ultimate responsibility for the care of the elderly in the region rests with the Christian Democrats. Maria Fälth (KD), spokesperson for health issues, says that all errors and deficiencies must be examined and remedied.
– That is why we have also designated our own review in the region. Older people must receive the care to which they are entitled, and nursing home care staff need the presence of a doctor in order to plan for individual patients to receive the care and medical interventions they need, says Maria Fälth, who does not agree that the governing documents should be handled politically.
– It is a professional medical decision. It would be remarkable if it were tried or formulated politically. However, what the policy should do is follow up on delegated decisions and take action if necessary. Individual assessments must be done first and are always clearly marked. Unfortunately, this has not always happened. That is why we have started an investigation.
