Annual Report 2014

 To contents Kapitelnamn Annual Report 2014 1 Contents

Important events in 2014...... 4 Karolinska University Hospital ...... 62

Summary...... 6 Södersjukhuset AB...... 63 Danderyds Sjukhus AB...... 64 Administration report...... 9 TioHundra AB...... 65 Introduction...... 9 Södertälje Sjukhus AB...... 67 The global economic trend...... 10 St. Eriks Ögonsjukhus AB...... 68 The economic trend in Sweden...... 10 Ambulanssjukvården i Storstockholm AB...... 69 The economic trend in Stockholm County...... 10 Stockholm Care AB...... 70 Significant events during 2014...... 11 Folktandvården Stockholms län AB...... 70

Goals...... 12 MediCarrier AB...... 72 Assessment of goal attainment...... 13 Public transport...... 73 Balanced finances...... 13 Overall public transport...... 74 Improved availability and quality of health AB Storstockholms Lokaltrafik...... 76 and medical care ...... 14 Waxholms Ångfartygs AB...... 77 Improved reliability of public transport...... 15 Transport services for the disabled...... 78

Sustainable growth...... 16 Culture...... 79 Free, accessible, high quality cultural life...... 18 Free, accessible, high-quality cultural life...... 80 An attractive and competitive employer...... 18 Sustainable growth...... 81 Financial analysis...... 20 Regional development...... 82 Surplus/deficit...... 21 The County Council as an employer ...... 88 Revenues...... 23 Expenses...... 26 An attractive and competitive employer...... 89 Financing ...... 28 Salary policy that supports operational improvement...... 90 The County Council – an employer with breadth...... 90 Investments...... 32 Skills provisioning...... 90 Investment trend...... 33 Education...... 90 Public transport investments...... 33 Greater diversity – equal conditions and opportunities...... 91 Investments in healthcare including properties...... 34 Management and leadership...... 92 New Karolinska Solna...... 35 Health-promoting work environment ...... 92 Financial performance of Properties in healthcare...... 93 boards and committees...... 37 Overall properties...... 94 County Council Executive Board...... 38 Locum AB...... 94 Public Healthcare Services Committee...... 39 Landstingsfastigheter Stockholm (LFS)...... 95 Health and Social care Committee in Norrtälje ...... 41 Financial and other operations...... 96 Traffic Committee...... 42 Culture Committee ...... 44 Overall financial operations...... 97 Patient Advisory Committee...... 44 Group financing...... 97 County Council Auditors...... 45 AB Stockholms Läns Landstings Internfinans...... 98 All Stockholm County Council operations...... 46 Landstingshuset i Stockholm AB...... 99 Damages Account...... 99 Expected development...... 47 Foundations, endowments and coordinating Development over the next few years...... 48 federations...... 100 Operations report...... 50 Formed by the County Council independently Overall areas of operation...... 50 or with others...... 101

Governance...... 52 Financial report...... 104 County Council’s responsibility and mission...... 53 Audit Report for the County Council Objectives...... 53 Executive Board 2014...... 126 Assignments...... 53 Abbreviations...... 127 Follow-up of supervisory obligations...... 54 Contact information...... 128

Health and medical care...... 55 General health and medical care...... 56 Healthcare Provision, Stockholm County...... 60 Follow-up of emergency hospitals...... 62

The figures in parentheses refer to the year-before period, unless 2 otherwise specified. Deviations may occur in tables and diagrams To sincecontents LS 1410-1162 the figures have been rounded from SEK thousands to millions. Message from the County Council Finance Commissioner

Working as the County Council Finance Commissioner in Stockholm County is a privilege. After the election in the autumn, I was privileged to have again been entrusted with the reins of the County Council with the support of the parties of the Alliance. My main responsibility is to ensure that the resources exist to meet the residents’ needs, finance health and medical care and ensure good transport options for all. This must be done with finances balanced on the long term, both with regard to healthcare and public transport. Balanced finances are a prerequisite in order for us to be able to continue developing health and medical care and to meet the needs of tomorrow for accessible and functioning public transportation.

2014 was yet another year that was characterised by rapid growth, population growth and large expansion in the region. Stockholm County is an engine for growth for Sweden as a whole and we must constantly keep our sights set on the future – extensive investments are a must for the region’s continued development.

New Karolinska and the Metro expansion are two examples of investments for the future that will develop our operations and I can confidently confirm that both of these projects are continuing according to plan. After eight years of a surplus for the County Council, we now have several years ahead of us with financial challenges.

In conclusion, I would like to express our great appreciation to all of our employees throughout the County Council’s operations. It is the personnel who generate the operations, and all of the employees in the County Council who see to it that the residents receive both world-class care and transports.

Torbjörn Rosdahl County Council Finance Commissioner

3 Important events in 2014

• Financing for the new Metro • The Plan for Future Health and • Collective biobank for line ready Medical Care becoming reality better research In January 2014, an agreement was The Plan for Future Health and The County Council established a signed between the national govern- Medical Care (Framtidsplan för regional biobank together with ment, the County Council, the City of hälso- och sjukvården) began to be Karolinska Institutet. The aim is to Stockholm, the Municipality of Nacka, implemented in 2014. Healthcare is coordinate and standardise the han- the City of Solna and Järfälla Munic- being developed to provide care where dling of samples at all levels of care in ipality on the expansion of the Metro. all care providers work together and the entire region and increase quality One month later, the County Council where care is provided closer to the of tests and data. Stockholm’s medical Assembly decided on the financing and patient. More care capacity is being biobank is also building up a system to co-financing of the Metro expansion. In generated as we build new facilities make samples and data more availa- March 2014, the Swedish Parliament and upgrade old. Research is being ble. This provides good conditions for passed a bill on higher congestion taxes tied more closely to the daily oper- medical research to be able to lead to in the inner city of Stockholm and to ations with the aim of improving better treatments. Important aspects introduce congestion tax to the Essinge- care, increasing quality, improving to take into consideration are the leden by-pass, meaning that the reve- efficiency of resource utilisation and patient’s needs and integrity. nues from the changed congestion taxes developing new ways of working. will be used to co-finance the Metro. All of these efforts being conducted The new Metro line is also being funded in health and medical care are based through contributions from the City of on The Plan for Future Health and Stockholm, Municipality of Nacka, City Medical Care. of Solna and Järfälla Municipality. The extended Metro line will run to and from Nacka, Barkarby and Arena staden. A branch to Gullmarsplan from the line to Nacka will also be built to increase the southbound capacity. The project is one of the largest infrastructure projects in the county since the construction of the existing Metro.

4 Annual Report 2014  To contents • Effective environmental work • First Swedish county council to • Approved budget with a inspires others make a stake on green bonds resident focus The County Council’s successful Stockholm was the first county council In 2015, Stockholm County Council is environmental work is based on clear in Sweden to carry out a transaction making major investments in health- and measurable targets which are on a green bond. This is a way to bor- care and public transport to contrib- integrated into its activities. We use row money for environmentally smart ute to the functioning daily lives of biogas, ethanol and electricity from efforts at the same time that investors the County’s residents in a quickly renewable sources in public transport. contribute to a better environment. growing region. We are upgrading and We prevent climate-impacting emis- The technical improvement to the building new facilities and opera- sions from nitrous oxide in healthcare Roslagsbanan suburban railway and tions. The large investments place and are phasing out hazardous chem- the new construction and renovation considerable demands on coordinated icals. In 2014, an environmental prize of Södertälje Hospital are examples of governance and cost control. One of was launched for the best innovation environmentally classified projects. our major challenges in 2015 is to hold and new way of thinking in the County The bond comprised SEK 1.1 down the rate of cost increases to lev- Council’s operations. The prize was billion and was implemented on the els sustainable on the long term and at awarded to Capio St. Göran Hospital Swedish market and was quickly over- the same time increase efficiency. for reduced use of climate-impacting subscribed. The amount of SEK 1.1 anaesthetics. billion corresponds to approximately 15 per cent of the County Council’s credit requirements for 2014. Green bonds were first issued by the World Bank in 2008.

 To contents Annual Report 2014 5 Summary

Stockholm County Council presented a surplus for the eighth consecutive year. The surplus for 2014 amounted to SEK 136 million, which was SEK 84 million higher than budgeted. Balanced finances are one of the County Council’s overriding objectives and a key prerequisite to be able to make the record-breaking investments in healthcare and public transport.

6 Annual Report 2014  To contents The population of Stockholm County of overall tax revenues. Total tax reve- and 1.2 compared with budget. The increased by around 35,000 residents nues amounted to SEK 63,971 million largest expense items are personnel in 2014. This is an increase of 1.6 per and increased by SEK 2,169 million or costs, purchased health and medical cent and it accounts for 34 per cent of 3.5 per cent compared with 2013. The care services and purchased transport the population increase in Sweden as a outcome for the year is in line with the services. whole. It is a positive that many people budget. Stockholm County Council has six want to live, work and study in the The economic recovery in the next emergency hospitals that are run under county. At the same time, it means more few years will contribute to a strong the County Council’s own direction. passengers on public transport and development of the total revenues in the The total results for the emergency hos- more residents in need of well function- County Council. In order for the pitals amounted to a deficit of SEK 781 ing health and medical care. finances to continue to be balanced, and million, adjusted for interest expense The surplus for the year, excluding at the same time enable necessary and payroll tax on the year’s pension items affecting comparability, was SEK investments in healthcare and public liability as a result of a changed dis- 386 million, which can be compared transport, the cost trend must be broken count rate. This was SEK 832 million with last year’s surplus excluding items and adapted to the County Council’s lower than the budgeted performance affecting comparability of SEK 1,684 long-term financial capacity. requirement of a surplus of SEK 51 mil- million. The County Council’s expenses lion. Stockholm County Council’s reve- totalled SEK 82,342 million in 2014. There are many reasons for the nues totalled SEK 82,478 million in OperatingRevenues expenses 2014 amounted to SEK deviation and they vary between the 2014. The overwhelming majority of 77,661 million and increased by 6.6 per hospitals. Common among them are, the revenues, 78 per cent,Government is comprised grants and othercent comparedOther revenues, with the preceding year however, higher staffing costs for own grants, SEK 3,101 million, 4% SEK 1,550 million, 2% Rental income, sales, other services SEK 3,733 million, 4%

Sales of primary services SEK 1,820 million, 2% Revenues 2014

Government grants and other Other revenues, Patient fees SEK 1,325 million, 2% grants, SEK 3,101 million, 4% SEK 1,550 million, 2% Total tax revenues SEK 63,971 million, 78% Rental income, sales, other services SEKPassenger 3,733 million, receipts 4% SEK 6,978 million, 8% Sales of primary services SEK 1,820 million, 2%

Patient fees SEK 1,325 million, 2% Total tax revenues SEK 63,971 million, 78% Passenger receipts SEK 6,978 million, 8%

Expenses 2014

Net ﬁnancial items SEK 864 million, 1% Depreciation/amortisation SEK 3,817 million, 5%

Other expenses Personnel costs SEK 14,539 million, 18% Expenses 2014 SEK 27,179 million, 33% Net ﬁnancial items SEK 864 million, 1% Depreciation/amortisationPharmaceuticals SEK 3,8176,315 million, 5%8%

Purchased transportOther expenses services PurchasedPersonnel costshealthcare SEK 14,53912,670 million, 18%15% SEK 16,95827,179 million, 20%33%

Pharmaceuticals SEK 6,315 million, 8%  To contents Summary Annual Report 2014 7

Purchased transport services Purchased healthcare SEK 12,670 million, 15% SEK 16,958 million, 20% and insourced personnel. The staffing expanded to dual-track traffic on the 2025. The expansion covers almost costs increased in part due to a shortage Roslagsbanan suburban railway. 20 kilometres of new track and nine of nurses and higher personnel turno- Healthcare investments in 2014 pri- completely new stations. ver, which has entailed higher costs for marily consist of the construction of The County Council’s interest-bear- training and for insourced personnel. New Karolinska Solna, which has pro- ing liabilities increased during the year In dialogue with the County Coun- ceeded according to plan, in terms of by SEK 4,051 million, totalling SEK cil’s management, the respective hospi- both time and finances. The technical 32,931 million at 31 December. tals planned for and implemented a building was taken over by the County Stockholm County Council has six number of measures in 2014 to reduce Council in spring 2014. In addition to overall objectives. They are: balanced costs and increase revenues, and these this, work is under way on new con- finances, improved availability and efforts will continue in 2015. struction and renovations of Södertälje quality in healthcare, improved relia- The investment volume for the year Hospital and technical improvements bility of public transport, sustainable amounted to SEK 14,988 million and is of a building at Löwenströmska growth, a free, accessible, high-quality distributed over multiple large invest- Hospital. cultural life, and being an attractive, ment projects. Traffic investments Work has begun on the new Metro competitive employer. The overall extend over all modes of transport and line in Stockholm County. The County objectives are broken down into 18 the year’s outcome amounted to SEK Council is responsible for the new goals that are all followed up by means 7,873 million. Among other things, a Metro line, while the municipalities will of multiple indicators, 42 in total. In new depot has been built for the Metro’s build 78,000 residential units in the 2014, all overall objectives were red line, the Lidingöbanan suburban local vicinity of the line. The new Metro achieved, and 15 of the 18 broken-down railway has received technical improve- lines to Nacka, Barkarby and Arena goals and 32 of the 42 measurable indi- ments and three stretches were staden are expected to be complete by cators were achieved.

8 Annual Report 2014 Summary  To contents Administration report Introduction

The global economy has become divided, but the Swedish economy, especially Stockholm County, began an economic recovery in 2014. Employment both nationally and in Stockholm County increased strongly, which contributed to continued strong growth of the tax base.

 To contents Annual Report 2014 9 The global economic trend The economic trend in 2014, inflation was –0.2 per cent, due in Sweden part to interest rate cuts and the decline The economies in the U.S. and the UK in oil prices, but mainly because of a gained speed in 2014, while growth in The Swedish economy developed well generally low inflationary pressure the euro zone remained weak, although in 2014. GNP is expected to have grown both in Sweden and the surrounding GNP growth showed positive figures by nearly 2 per cent at the same time world. The final tax outcome for the after a very weak development in 2013. that employment rose rapidly and infla- 2013 income year indicated an increase The global economy grew by 3.3 per tion was low. Growth was driven by of the actual tax base nationwide of 3.4 cent in total in 2014. One contributing domestic demand while exports contin- per cent compared with 2012. The fore- factor to this was China’s continued ued to be weak. cast for 2014 is that the tax base will strong economic trend. Household consumption continued grow by 3.2 per cent. For the development of the Swedish to grow at a good pace at the beginning economy, growth in the euro zone and of the year, at the same time that invest- The economic trend in in the Nordic region is important since ments in housing contributed to these areas constitute significant growth. Household income is rising Stockholm County export markets. The economic situation thanks to the rapid increase in employ- The economic trend was somewhat in the euro zone weakened in the ment and low inflation. stronger in Stockholm County com- autumn. Uncertainty about the future In 2014, unemployment was rela- pared with Sweden as a whole in 2014. economic trend in the euro zone and tively stable at around 8 per cent, but Expectations for the future are low domestic demand still seem to be dropped towards the end of the year. moderate. dampening corporate investment, Employment adjusted for seasonal var- The number of people employed in despite very expansive monetary poli- iation increased by around 1 per cent, Stockholm County totalled 1,165,900 in cies and low capital costs. which is a strong increase in relation to the fourth quarter, corresponding to Global inflation is very low and is growth during this period. According to 70.9 per cent of the population aged 15 dampened by continued high unem- Statistics Sweden, productivity in the to 74 years. This is an increase of 21,000 ployment, primarily in the euro zone. Swedish economy has increased slowly individuals compared with the year The low inflation and still subdued in recent years. before. For Sweden as a whole, the growth outlook in the global economy Despite rapidly rising employment, employment rate was 66.0 per cent dur- has contributed to major central banks salary increases were 2.0 per cent in ing the corresponding period. Only one pursuing a very expansive monetary 2014. Over the past four years, inflation county, Halland, has an employment policy. As the UK and U.S. approach a according to the consumer price index rate comparable to Stockholm County. more normal capacity utilisation, mon- (CPI) has been at an average of around The unemployment rate in Stockholm etary policy will become more neutral. 1 per cent, excluding mortgage rates. In County rose somewhat in 2014, how-

GDP growth 2013–2015

Outcome Forecast Forecast Percentage change 2013 2014 2015 USA 2.2 2.4 3.6 Euro zone –0.5 0.9 1.2 China 7.8 7.5 6.8 World 3.3 3.3 3.6 Sweden 1.2 1.9 2.9

Sources: IMF, SKL and Riksbanken

Swedish economic key figures 2013–2015 Outcome Forecast Forecast Percentage change 2013 2014 2015 GDP 1.2 1.9 2.9 Employment, hours 0.4 1.7 1.3 Unemployment (level) 8.0 7.9 7.6 Hourly pay 2.0 2.0 3.0 Consumer prices, CPI 0.0 -0.2 0.2 Tax base 3.4 3.2 5.1

Source: SCB, SKL and Riksbanken

10 Annual Report 2014 Summary  To contents ever. In the fourth quarter, unemploy- The expansion covers almost 20 kilo- transport. The County Council prevents ment was 6.3 per cent of the workforce, metres of new track and nine com- climate-impacting emissions from or 79,000 individuals. In Sweden as a pletely new stations. The project is one nitrous oxide in healthcare and is phas- whole, unemployment was 1 percentage of the largest infrastructure projects in ing out hazardous chemicals. In 2014, point higher than in Stockholm County, the county since the construction of the Stockholm County Council launched an or 7.3 per cent of the workforce. existing Metro. environmental prize for the best inno- The population of Stockholm County vation and new approach in the County continues to grow strongly. In 2014, the Plan for Future Health and Council’s operations. The prize was population grew by 35,000 individuals, Medical Care becoming a reality awarded to Capio St. Göran Hospital for which was around 1,000 fewer than in Implementation of the Plan for Future reduced use of climate-impacting 2013. Stockholm County accounted for Health and Medical Care began in anaesthetics. 34 per cent of Sweden’s population 2014. Healthcare is being developed increase. into a healthcare provision in which all First county council to work The tax base in the county increased care providers work together and where on green bonds more than in any other county in care is provided closer to the patient. Stockholm w as the first county council Sweden. In the 2013 income year, the More care capacity is being generated to implement a green bond. This is a increase in the county was 3.4 per cent. as the County Council builds new facili- way to borrow money for environmen- For 2014, the increase is expected to ties and upgrades old ones. Research is tally smart efforts, while at the same amount to 3.2 per cent. being tied more closely to the daily time investors contribute to a better operations, with the aim of improving environment. The technical improve- Significant events care, quality and efficiency of resource ment to the Roslagsbanan suburban utilisation, and developing new ways of railway and the new construction and during 2014 working. All of these efforts being con- renovation of Södertälje Hospital are Work on the new Metro under way ducted in health and medical care are examples of environmentally classified At the beginning of 2014, the County based on the Plan for Future Health and projects. Council Assembly approved the financ- Medical Care. The bond comprised SEK 1.1 billion ing and co-financing of the Metro and was implemented on the Swedish expansion according to the 2013 Stock- Effective environmental work market and was quickly oversub- holm Negotiations. The expansion to The County Council’s successful envi- scribed. The amount of SEK 1.1 billion Nacka, Barkarby and Arenastaden is ronmental work is based on clear and corresponds to approximately 15 per expected to be completed by 2025. In measurable targets which are inte- cent of the County Council’s credit addition, a branch to Gullmarsplan grated into its activities. The County requirements for 2014. Green bonds from the line to Nacka will also be built Council uses biogas, ethanol and elec- were first issued by the World Bank in to increase the southbound capacity. tricity from renewable sources in public 2008.

Stockholm County key figures 2012–2014

2014 2013 2012 Employment 70.9% 70.6% 69.7% Unemployment 6.3% 6.1% 6.7% Newly started companies (to Sept.) 16,757 16,219 16,226 Bankruptices result 2,343 2,612 2,537 Population result (1 Nov) 1.6% 1.7% 1.7%

Source: SCB and Growth Analysis

 To contents Summary Annual Report 2014 11 Goals

The County Council’s operations are governed by democratic decisions on what needs and objectives should be prioritised. The County Council Assembly makes decisions of a general and principle nature regarding objectives, emphasis, scope and quality of the County Council’s operations. The County Council Executive Board manages and coordinates operations. Goal-orientation provides the prerequisites for governance and development of the County Council’s operations and aims to achieve long-term sustainable development.

Based on six overall objectives and 18 broken-down goals, all of which are followed up with multiple indicators, goal attainment for the operations can be monitored.

12 Annual Report 2014  To contents Assessment of goal is that each generation must itself bear investments have been self-financed. attainment the costs of the services that it consumes. The financing objective was achieved.

The overall objectives shall be viewed Sound financial management Debt over time and are considered to be The overall objective has a goal, sound To achieve the debt objective, loan fulfilled when at least half of the bro- financial management, which is moni- financing must not be used to finance ken-down goals have been met. The tored through measurable indicators: operating expenses or replacement broken-down goals are considered to be surplus/deficit, financing, debt, capital investments. The proportion of invest- met when at least half of the underlying costs and debt/equity ratio. ments that may be loan-financed is cal- indicators are achieved. The goal of sound financial manage- culated by adjusting the investments In Goals and Budget for 2014 for ment presupposes that the financial for the year for replacement invest- Stockholm County Council, LS 1301- indicators are met. This is based on the ments and some items that do not affect 0040, the County Council Assembly efficient use of taxpayer funds. liquidity. At 31 December 2014, the decided in general for 2014 that the investments that may be loan -financed indicators’ value shall be improved or Surplus/deficit amounted to SEK 9,669 million, which maintained compared with achieved In order to achieve the surplus/deficit is more than the increase in loans values for 2013. objective, Stockholm County Council raised. The loans thereby did not Based on the above, the collective must report a surplus according to the finance operations or replacement assessment is that, in 2014, all overall balance requirement. The surplus for investments. objectives were achieved, and 15 of the the year amounted to SEK 136 million The debt objective was achieved. 18 broken-down goals and 32 of the 42 at 31 December. The balance require- indicators were achieved. ment result for the year amounts to SEK Capital costs During the year, one new indicator 3 million. The capital cost share of the collective was added in the overall objective of The surplus/deficit objective was tax revenues may amount to a maxi- improved reliability in public transport. achieved. mum of 11 per cent. For 2014, the capi- Under the overall objective of sustaina- tal cost share of total tax revenues ble growth, one indicator was removed Financing amounted to 7.1 per cent. and two indicators were clarified and In order to achieve the financing objec- The capital cost objective was supplemented with new subheadings. tive, replacement investments must be achieved. 100 per cent self-financed. The space to Debt/equity ratio Balanced finances be able to finance investments with own funding comprises the surplus for the The debt share of the collective tax The County Council Assembly has year adjusted with items that do not revenues may amount to a maximum of expressed the overall objective for affect liquidity at 31 December. This 131 per cent. The liabilities are adjusted finances in Stockholm County Council space must exceed the amount of the for the component related to financing as: year’s replacement investments. The from an external party. The debt share • Balanced finances space discerned from the cash flow state of total tax revenues, adjusted for exter- ment amounts to SEK 6,076 million and nal financing, is 84 per cent. County Council finances need to be is higher than the replacement invest- The debt/equity ratio objective was balanced in order to ensure short- and ments that amount to SEK 3,796 mil- achieved. long-term operations. The starting point lion, which means that the replacement

Balanced finances

Outcome Outcome Achieved Goals and indicators 2013 2014 2014 Sound financial management Results: SEK 89 SEK 3 Yes • A positive result according to the balance requirement million million Financing: Yes • Replacement investments self-financed to 100 per cent Achieved Achieved Debt: Loan financing is not used to finance operations or replacement investments. Achieved Achieved Yes • Capital costs: The capital cost share may amount to a maximum of 11 per cent of the collective tax revenues. 6.9% 7.1% Yes • Debt/equity ratio: The debt share may amount to a maximum of 131 per cent of the collective tax revenues. 77% 84% Yes •

 To contents Goals Annual Report 2014 13 Improved availability and qua guarantee. The result was 70 per cent • Antibiotics prescription through the lity of health and medical care compared with 73 per cent for the number of antibiotics prescriptions previous year. The target was not taken out per 1,000 residents. The The County Council Assembly has achieved. result is 358 compared with 358. The expressed the overall objective for • Proportion of patients receiving target was achieved. health and medical care within treatment within 90 days as part of The goal of safe care was achieved. Stockholm County Council as: the care guarantee. The result was 90 • Improved availability and quality of per cent compared with 88 per cent High level of efficiency health and medical care for the previous year. The target was A high level of efficiency means the achieved. right measures being performed at the The overall objective has four goals – The goal of care at the right time was right time and in an appropriate and care at the right time, safe care, high achieved. resource-efficient manner. The goal of a level of efficiency and high confidence high level of efficiency is measured in care – each of which is monitored Safe care using the following indicators: using measurable indicators. Each of Health and medical care in Stockholm • Proportion of the population with a the goals is presented below, as well as County shall be characterised by high resident account on My Healthcare the indicators linked to each goal. patient safety. Through improved Contacts. The result was 25 per cent patient safety, unnecessary suffering compared with 20 per cent for the Care at the right time can be avoided at the same time that previous year. The target was The indicators used to guide towards healthcare resources are used more achieved. the goal of care at the right time focus efficiently. The goal of safe care is meas- • Proportion of GP clinics conducting on the aspect of short waiting times for ured using the following indicators: active disease prevention work. The health and medical care. They are • Prevalence of healthcare-associated result was 51.8 per cent compared measured using the following indicators: infections. The result was 9.0 per with 41 per cent for the previous year. • Proportion of patients receiving care cent compared with 9.1 per cent for The target was achieved. within five days at a GP as part of the the previous year. The target was • Proportion of doctor’s appointments care guarantee. The result was 89 per achieved. carried out by doctors outside emer- cent compared with 89 per cent for • 30-day re-admission frequency gency hospitals. The result was 76.8 the previous year. The target was within inpatient care, 65 years and per cent compared with 76.5 per cent achieved. over. The result was 15.9 per cent for the previous year. The target was • Proportion of patients given an compared with 15.9 per cent for the achieved. appointment for an initial visit previous year. The target was The goal of a high level of efficiency within 30 days as part of the care achieved. was achieved.

Improved availability and quality of health and medical care

Outcome Outcome Achieved Goals and indicators 2013 2014 2014 Care at the right time Proportion of patients receiving care within 5 days at a GP (care guarantee) 89% 89% Yes • Proportion of patients getting an appointment for an initial visit within 30 days (care guarantee) 73% 70% No • Proportion of patients receiving treatment within 90 days (care guarantee) 88% 90% Yes • Safe care Prevalence of healthcare-associated infections 9.1% 9.0% Yes • 30 day re-admission frequency in inpatient care 15.9% 15.9% Yes • Antibiotic prescriptions 1) 358 358 Yes • High level of efficiency Proportion of the population with a resident account on My Healthcare Contacts 20% 25% Yes • Proportion of GP clinics conducting active disease prevention work 41% 51.8% Yes • Proportion of specialist appointments performed by specialists outside emergency hospitals 76.5% 76.8% Yes • High confidence in care Proportion of the population that has considerable confidence in the healthcare services 58% 64% Yes •

1) Use of antibiotics in the County is monitored using the indicator of the number of antibiotic prescriptions taken out per 1,000 residents and year.

14 Annual Report 2014 Goals  To contents High confidence in care tive journeys is measured using the fol- • Proportion of rail vehicles with The residents of Stockholm County lowing indicators: accessible boarding step. The result shall feel a high level of confidence in • Public transport’s share of motorised was 84 per cent compared with 83 healthcare. The goal of high confidence trips. The result was 37 per cent, per cent for the previous year. The in care is measured in the spring and which is the same as the previous target was achieved. autumn using the Healthcare Barometer. year. The target was achieved. The goal of an accessible and cohesive • The proportion of the population that • Proportion of satisfied passengers in region was achieved. has considerable confidence in general public transport. The result healthcare is 64 per cent, compared was 81 per cent compared with 79 per Efficient journeys with 58 per cent last year. The meas- cent for the previous year. The target Trips need to be efficient so that public urement was taken in 2014. The tar- was achieved. transport costs do not increase too get was achieved. • Proportion of satisfied passengers in much. By more people taking public The goal of high confidence in care was special public transport. The result transport at the same time that the pro- achieved. was 87 per cent compared with 87 per portion of renewable energy increases, cent for the previous year. The target the County Council contributes to sus- Improved reliability of was achieved. tainable development. The goal of effi- public transport • Proportion of satisfied passengers in cient journeys is measured using the marine public transport. The result following indicators: The County Council Assembly has was 96 per cent compared with 91 per • Proportion of renewable energy in expressed the overall objective for pub- cent for the previous year. The target public transport. The result was 93 lic transport within Stockholm County was achieved. per cent compared with 92 per cent Council as: The goal of attractive journeys was for the previous year. The target was • Improved reliability of public achieved. achieved. transport • Cost per passenger-kilometre. The Accessibility result was SEK 3.02 compared with The overall objective has three goals – Public transport plays a crucial role for SEK 2.95 for the previous year. The attractive journeys, accessibility and accessibility in the county. In order for target was not achieved. efficient journeys – each of which is fol- residents to choose public transport, lowed up using measurable indicators. their trips need to be accessible. The Cost per passenger-kilometre increased Each of the goals is presented below, goal of accessibility is measured using between the years as the rate of cost together with the indicators linked to the following indicators: increase is higher than the growth of each goal. • Proportion of buses with accessible the number of passenger-kilometres. boarding step. The result was 100 per The result of SEK 3.02 for 2014 is below Attractive journeys cent compared with 100 per cent for the Traffic Committee target that was In order for residents to choose public the previous year. The target was set at a maximum of SEK 3.08. transport, their trips and commutes achieved. The goal of efficient journeys was need to be attractive. The goal of attrac- achieved.

Improved reliability of public transport

Outcome Outcome Achieved Goals and indicators 2013 2014 2014 Attractive journeys Public transport’s share of motorised trips 37% 37%1) Yes • Retained proportion of satisfied passengers in general public transport 79% 81% Yes • Retained proportion of satisfied passengers in special public transport 87% 87% Yes • Proportion of satisfied passengers in marine public transport2) 91% 96% Yes • Tillgänglighet Proportion of buses with accessible boarding step 100% 100% Yes • Proportion of rail vehicles with accessible boarding step 83% 84% Yes • Efficient journeys Proportion of renewable energy in public transport 92 % 93% Yes • Cost per passenger-kilometre 2.95 kr3) 3.02 kr No •

1) Updated information for 2014 will be available in spring 2015. 2) New target added in 2014 3) Reported 2013 result was SEK 3.00. Due to recalculated (increased) passenger-kilometres for commuter trains, the 2013 result was converted to SEK 2.95.

 To contents Goals Annual Report 2014 15 Sustainable growth A leading growth region stronger than for Sweden as a whole, According to the Swedish Association and that expectations for the future are The County Council Assembly has of Local Authorities and Regions moderate. expressed the overall objective in (SALAR), the forecast tax base growth The objective of being a leading growth Stockholm County Council as: in the county for 2014 is 4.1 per cent. region has been achieved. • Sustainable growth This indicates a higher annual rate of growth than the national figure, which Effective environmental work The overall objective has four goals is forecast at 3.2 per cent. Locum AB applies the Sweden Green – a leading growth region, effective The economic trend was somewhat Building Council Gold category in all environmental work, social responsi- stronger in Stockholm County com- new construction, which means that bility and safe processes – each of pared with Sweden as a whole in 2014. the requirement of energy conservation which is followed up using measurable There are, however, no regional is 35 per cent below the building rule of indicators. Each of the goals is pre- accounts for 2014. The regional the Swedish National Board of Housing. sented below, together with the indica- barometer shows that the economy in The proportion of organic food for tors linked to each goal. Stockholm County is somewhat patient meals as well as coffee, tea and

Sustainable growth

Outcome Outcome Achieved Goals and indicators 2013 2014 2014 A leading growth region An annual tax base growth rate in the county equal to or greater than the national average/rest of the country 4.2% (3,4) 4.1% (3,2) Yes • Research and development: Gross regional expenditure for research and development in relation to the gross regional product.1) 3.77%1) –1) –REMOVED1) Effective environmental work Energy consumption in operating premises: energy consumption per square metre (kWh/m2)2) 214 211 Yes • Proportion of organic food 29% 29% Yes • Climate impact from medical gases: 3) 3) kg CO2 equivalents per resident 2.5 – – Social responsibility Equal treatment of all residents: proportion of the County Council’s companies and committees that have introduced methods and tools for systematic work4) Gender statistics 10%5) 21% Yes • National minorities and minority languages 0%5) 5% Yes • Participation for people with disabilities: proportion of companies and committees that have introduced methods and tools for systematic work4) 16%5) 17% Yes • Code of Conduct for suppliers: proportion of significant suppliers that have been audited for social responsibility 2% – 6) – 6) Secure processes Security work shall be conducted systematically: proportion of companies and committees that have introduced methods and tools for systematic work4)

Information security 10%5) 10% Yes • Security 45%5) 25% No • Sustainable IT delivery of value-generating services: delivery according to agreed service levels – 7) –7)

1) Pertains to 2009 published 2011 (taken from Eurostat/County Administrative Board). Only measured every two years. Therefore removed according to 2015 budget and replaced by the indicator Research for healthcare. 2) Pertains to energy consumption for (purchased) electricity and heat, kWh per square metre BRA (Atemp), supplied to the so-called strategic properties managed by Locum AB. The Traffic Committee is also covered by this goal and is included in the result. 3) Data for the calculation of climate impact from medical gases is gathered in connection with the hospitals’ reporting to the Health and Medical Care Administration and reported in the County Council’s separate environmental report. 4) Includes all administrations and companies that have employed staff. 5) Benchmarking was done in connection with the 2013 annual accounts. 6) The result for 2014 was not possible to calculate due to operating changes and reorganisations at affected parties. 7) The result for 2014 cannot be presented as measurements have been done in different ways and the results cannot be compared.

16 Annual Report 2014 Goals  To contents fruit for the staff was 29 per cent in Participation for people with Ten per cent of the County Council’s 2014. The statistics include food to the disabilities administrations and companies say value of SEK 114 million. Södersjuk The majority of companies and admin- that they have already introduced huset AB stands out with 46 per cent istrations conducted training and semi- methods and tools for systematic work, organic food, to a value of SEK 6.6 mil- nars during the year, with the aim of which corresponds to the base year lion, for its stock of staples. In order to increasing staff expertise in personal value. reduce the climate impact of medical treatment and issues of accessibility. gases, the County Council tested vari- An electronic course has been devel- Security ous technologies using filters that oped that targets all employees in This target area and indicator are also gather anaesthetic gases from the Stockholm County Council. new. The presentation is largely based patient’s exhaled air in 2014. In Novem- The County Council’s operations on reported qualitative estimates. The ber, a full-scale test of the most promis- also measure patient and stakeholder follow-up shows that a considerably ing filter began at Norrtälje Hospital. perceptions of accessibility and smaller proportion of the County Coun- The objective of effective environmen- personal treatment, and then imple- cil’s operations introduced systematic tal work was achieved. ment various kinds of improvement security work in 2014 compared with measures. the base year of 2013, representing a Social responsibility In 2014, 17 per cent of the operations sharp decline from 45 per cent to 25 per Gender statistics had methods and tools for systematic cent. This significant change is consid- Texts and table compilations from work in the various target areas. This is ered to be due to the indicator having administrations and companies show an increase by one percentage point been interpreted in a more accurate that gender statistics are a largely compared with the previous year. The manner in the 2014 follow-up com- accepted and established approach in work of implementing the County pared with the base year. The follow-up the presentation of results. All adminis- Council’s programme for people with also shows that the implementation of trations and companies have answered disabilities, “More than just thresh- systematic security work has come the question and 90 per cent say that olds”, must be intensified. The issue somewhat further in the security area they, in part or in whole, use tools and must be raised both at the management compared with the information secu- methods for systematic work with gen- level and in the operations’ various col- rity area. Reinforcement efforts are der statistics. Several ongoing develop- laboration councils. considered to be needed in this area in ment projects in gender equality and order to achieve the goal, and there is equal opportunity are described. There Code of Conduct for suppliers believed to be a development potential is a development potential in terms of The Swedish EMAS Council has been in terms of how the indicator should be systematically analysing gender statis- a part of the Swedish Competition interpreted. tics and linking them to operational Authority since mid-2014. A few development. months before the transition occurred, Sustainable IT delivery of the Steering Committee for Social value-generating services National minorities and minority Responsibility, a national group for It should be safe and easy to contact the languages Sweden’s county councils, decided that County Council, and everyone who The work with national minorities and no new agreements would be permitted wants to should be able to use the minority languages made progress in to be registered in the follow-up portal, opportunities that public e-services 2014. The number of administrations Uppföljningsportalen. This means that offer. One way to measure this is by and companies that fully apply tools it has not been possible to implement means of the indicator of Delivery and methods for fully systematic work follow-up. according to agreed service levels. The increased from 0 to 5 per cent and the The goal of social responsibility was work of identifying what services proportion that partially applies them achieved. should be measured has been partially increased from 60 to 75 per cent. implemented, but needs to be devel- The consultations with national Safe processes oped. Above all, there is a need for minorities got started, but should be Information security county-council-wide coordination and expanded and cover more administra- This target area is new and constitutes governance in the area. A new functions and companies. There is collabo- an overall indicator for the County tional area in the County Council ration with the County Council’s Council’s information security efforts. Executive Board Administration that national minority coordinator. More The presentation is largely based on will guide and coordinate IT for health- efforts than before were conducted reported qualitative estimates. The care will be established in 2015. especially in the areas of information follow-up shows that activities are The safe processes goal was partially and education, but there is room for under way in a large number of County achieved. further improvement. Council operations to put in place central elements of systematic information security work.

 To contents Goals Annual Report 2014 17 Free, accessible, high quality their circumstances. Cultural activities 2015. The objective is to make Stock- cultural life often presuppose dialogue and collabo- holm County a leading, attractive place ration. to live and work in. Stockholm is one of The County Council Assembly has Europe’s leading creative regions and expressed the overall objective in Art and culture in healthcare an important labour market for cultural Stockholm County Council as: In construction, 2 per cent of the con- workers in every form and genre of art. • Free, accessible, high quality cultural struction costs shall be allocated to Cultural and creative industries con- life artistic presentation in healthcare facil- tribute to a dynamic region and public ities, and 1 per cent in other premises support shall be designed to encourage The overall objective has three goals – when the construction costs exceed both cultural creators and cultural and children and young people are priori- SEK 3 million. The design assignment creative entrepreneurs. tised, culture in healthcare and intensi- for New Karolinska Solna continued in The goal of free, accessible, high qual- fied cooperation with cultural and 2014. Major new construction that ity cultural life was achieved. creative industries. The Cultural Com- houses artistic presentations is also mittee’s goals and indicators set out a under way at Södertälje Hospital, An attractive and competitive direction for the Committee’s work and Södersjukhuset, Danderyd Hospital employer are not immediately quantifiable. and Karolinska University Hospital in Huddinge. A renewed way of working The County Council Assembly has Children and young people with Culture in Healthcare will contrib- expressed the overall objective in are prioritised ute to meaningful stimulation for those Stockholm County Council as: Children and young people are a priori- who spend considerable time in health- • An attractive and competitive tised target group in cultural policy. Of care and elderly care. employer the activity and project grants awarded in 2014, 77 per cent went to activities Cultural and creative industries The overall objective has three goals for which the target group was children The work on management and coordi- – proud employees, management and and young people ages 0–25, i.e. a nation of the Action plan for cultural leadership, and systematic skills plan- young audience of around 480,000 and creative industries in the Stock- ning – each of which is followed up with people was reached. By giving children holm region, Creative Stockholm, was measurable indicators. Each of the and young people opportunities to implemented through the chairman- goals is presented below, together with enjoy high quality art and culture and ship of the Liaison Group for Creative the indicators linked to each goal. encouraging personal creation, the pos- Stockholm and participation in regu- sibility of self-reflection and insight larly recurring projects and network Proud employees about the surrounding society is pro- meetings. The in-depth collaboration In order for the County Council to be an vided. The capacity for empathy can be between different players in the county attractive and competitive employer, strengthened through knowledge about on cultural and creative industries, the County Council needs to conduct and understanding for other people and Creative Stockholm, will continue in systematic improvement work at all

Free, accessible, high quality cultural life

Outcome Outcome Achieved Goals and indicators 2013 2014 2014 Children and young people are prioritised An overwhelming proportion of the external grants shall go to activities for children and young people 81%1) 77%1) Yes •  Culture in Health Care 2 per cent of construction costs for healthcare premises should go to artistic presentation – 2) – 2) The Culture in Healthcare programme is offered in all elderly care centres and hospitals in the county – 2) – 2) More in-depth cooperation in connection with the cultural and creative sectors Collaboration projects according to the Creative Stockholm action programme begin (action programme under RUFS 2010) – 2) – 2)

1) Activities for children and young people are defined as an audience ages 0–25 2) The Cultural Committee’s targets and indicators set out a direction for the Committee’s work and are not immediately quantifiable.

18 Annual Report 2014 Goals  To contents organisational levels, and clarify and developed and made more efficient. create development paths for its Stockholm County Council works long employees. Since the ACE index was term and systematically to strengthen introduced in 2012, the total index the ability of existing managers’ to lead value has increased to 77, the response operations and employees. frequency has increased to 85 per cent and the operations’ follow-up of goals Systematic skills planning and strategies in the HR policy has been Skills supply is one of the most highly further developed. Altogether, it shows prioritised issues for Stockholm County that the employee survey is an effective Council. The County Council’s opera- tool in the County Council’s develop- tions work with a uniform model and ment work. structure for skills planning (KOLL), which provides conditions to contribute Management and leadership quality assured and high-quality care, In the County Council’s employee fol- as the same skills requirements are set low-up, the employees’ perception of regardless of care provider. The propor- management in the operations is pre- tion of administrations and companies sented. Since measurements began in that have introduced or begun intro- 2006, the proportion of managers with ducing KOLL was nearly 50 per cent a management index of 70 or higher and comprised around 5,400 employees increased from 47.5 per cent to 67.6 per at year-end. cent. Well-functioning management The goal of being an attractive and and leadership is a key prerequisite in competitive employer was achieved. order for the County Council to be

An attractive and competitive employer

Outcome Outcome Achieved Goals and indicators 2013 2014 2014 Proud employees

ACE index: Follow-up of SCC’s HR policy in the employee questionnaire that consists of actively taking responsibility, customer and result focus, change and development, an equality index, health and stress index and motiva- tion index. Scale 1–100. 76 77 Yes • Management and leadership

Management index: Management index on a County Council-wide level from the employee survey. Scale 1–100. 73 74 Yes • Systematic skills planning

Systematic skills planning: Proportion of the County Council’s committees and companies that began the introduction of the County Council’s model for systematic skills planning (KOLL). 40% 47% Yes •

 To contents Goals Annual Report 2014 19 Financial analysis

Stockholm County Council presents a positive result for 2014, which forms the basis for continued balanced finances and long-term sustainable development. This is a prerequisite for the major investments to be made in coming years in healthcare and public transport.

20 Annual Report 2014  To contents Stockholm County Council’s total operations

County Council Group Contract companies

Jointly owned companies County Council Group companies, etc. without significant influence3) Contracts

Boards and committees Landstingshuset i • Mälardalstrafik MÄLAB AB County council municipal affairs • County Council Assembly Stockholm AB (100%) (35%) are taken care of by a different • County Council Executive Board • Södersjukhuset AB • ALMI legal entity than the County • Public Healthcare Services • Danderyds Sjukhus AB Företagspartner i Stockholm Council. Committee • Södertälje Sjukhus AB Sörmland AB (40.5%) • Healthcare and Social Services • S:t Eriks Ögonsjukhus AB • Barnbördshuset Stockholm AB 100 per cent of transport Committee in Norrtälje 1 • Folktandvården (49%) operations are run by external • Traffic Committee Stockholms län AB contractors. • Culture Committee • Ambulanssjukvården i • Patient Advisory Committee Storstockholm AB 34 per cent of healthcare is • Audit Board • Stockholm Care AB provided by external care • MediCarrier AB providers The Board of • Locum AB • Karolinska University Hospital • Waxholms Ångfartygs AB • Healthcare Provision, • AB Stockholms Läns Stockholm County Landstings Internfinans

Administrations • County Council Executive Board Administration AB Storstockholms • Health and Medical Care lokaltrafik (100%) Administration • SL Infrateknik AB • Public Healthcare Services Office • AB SL Finans • Traffic Administration • SL Älvsjö AB • Metro Expansion Administration • Cultural Administration • Patient Advisory Committee Kommunalförbundet Administration ägarsamverkan i Norrtälje • County Council Audit Office Sjukvård och omsorg (50%)2) Administrations under • TioHundra AB corporate-like forms • Karolinska University Hospital • Healthcare Provision, Stockholm County

1) Joint board with Norrtälje Municipality 2) Joint municipal association with Norrtälje Municipality 3) Refers to jointly owned companies with an ownership share in excess of 10 per cent.

Surplus/deficit Stockholm County Council’s earn- Operating revenues amounted to ings trend has been positive over the SEK 18,507 million (18,406) and Stockholm County Council reported a past eight years and the economic trend increased by 0.5 per cent compared surplus for 2014 of SEK 136 million continued to be somewhat stronger in with the previous year. Operating reve- (934). This was SEK 798 million lower Stockholm County compared with nues account for nearly 22.4 per cent of than the year before. The budgeted sur- Sweden as a whole in 2014. the County Council’s total revenues. plus for 2014 was SEK 52 million, which At 12.10 per cent, county council tax Operating expenses amounted to means that the annual accounts were has been unchanged since 2008. SEK 77,661 million (72,872), which was SEK 84 million higher than budget. Total tax revenues account for nearly an increase of 6.6 per cent compared Non-recurring items affecting com- 77.6 per cent of the County Council’s with the preceding year, and was SEK parability amounted to SEK –250 mil- total revenues. Total tax revenues, 946 million or 1.2 per cent over budget. lion. The items pertain to compensation which consist of tax revenues, general Costs for staffing and externally pur- according to an agreement in principle government grants and municipal eco- chased health and medical care ser- with the City of Solna regarding the nomic equalisation, amounted to SEK vices constitute the largest cost items. Metro expansion, LS 1312-1619. Last 63,971 million (61,802) and increased Costs for health and medical care year’s result includes non-recurring by 3.5 per cent compared with the pre- services purchased from external sup- expenses affecting comparability of vious year, and was SEK 116 million or pliers increased by 7.4 per cent com- SEK –749 million. 0.2 per cent higher than budget. pared with the previous year and were

 To contents Financial analysis Annual Report 2014 21 SEK 309 million over budget. The costs The change in the financial expenses with other periods. The items affecting of materials and goods including phar- of SEK 2,527 million compared with the comparability are specified in Note 6. maceuticals increased by 5.6 per cent year before is primarily related to This year’s surplus includes one item compared with the previous year and expenses that were SEK 1,564 million affecting comparability, SEK –250 mil- were SEK 94 million below budget. The lower in connection with the changed lion. Excluding this item affecting com- costs of purchased transport services discount interest rate applied in calcu- parability, the surplus was SEK 386 increased by 4.9 per cent compared lating the County Council’s 2013 pen- million, which can be compared with with 2013 and exceeded budget by only sion liability. last year’s surplus excluding items SEK 69 million. affecting comparability of SEK 1,684 Depreciation and amortisation costs Capital gains – items affecting million. amounted to SEK 3,817 million (3,589), comparability which is an increase of 6.4 per cent The capital gains/losses for the year, Adjusted surplus/deficit compared with the previous year and which is the net of capital gains and The wholly owned companies in the was SEK 99 million or 2.7 per cent over capital losses, amount to a capital loss County Council Group shall present a budget. of SEK 182 million, which should be so-called adjusted surplus/deficit as per The increase of the depreciation and compared with last year’s capital gain directive. The adjusted surplus/deficit amortisation costs compared with the of SEK 276 million. No individual item is reconciled against the budgeted sur- previous year is due to more completed exceeds SEK 100 million. See also Note plus/deficit. In the adjusted surplus/ investments and because the disposal 7 to the income statement. deficit, non-recurring items should be of buildings demolished as a result of When they occur, items affecting excluded from surplus/deficit before new construction in healthcare was not comparability are reported separately appropriations to achieve greater com- budgeted. in notes to the respective item in the parability between the years. For 2014, Net financial items consist of finan- income statement and where applicable the companies had higher costs in the cial income and expenses and in the cash-flow statement. pension liability calculation since the amounted to an expense of SEK 864 Items affecting comparability are interest rate pertaining to the compa- million (2,813). This was SEK 1,949 events or transactions in excess of SEK nies was reduced. These costs have million better than the year before and 100 million that are not extraordinary, been excluded in the adjusted surplus/ SEK 347 million better than budget. but important to note in a comparison deficit.

Surplus/deficit

Profit and loss statement Outcome Outcome Change Budget Deviation SEK million 2014 2013 % 2014 from budget Operating revenues 18,507 18,406 1% 17,974 533 Operating expenses –77,661 –72,872 7% –76,716 –946 Depreciation –3,817 –3,589 6% –3,717 –99 Gross operating expenses –81,478 –76,462 7% –80,433 –1,045 Net operating expenses –62,971 –58,055 8% –62,459 –512 Tax revenue, general state subsidies and equalisation 63,971 61,802 4% 63,722 250 Net financial income/ expense –864 –2,813 –69% –1,211 347 Earnings 136 934 – 52 84

Earnings Stockholm County Council (SEK million)

2,500

2,000

1,500

1,000

500

0 2007 2008 2009 2010 2011 2012 2013 2014

22 Annual Report 2014 Financial analysis  To contents A compilation over the wholly- pared with the previous year. This was SEK 1,364 million (1,365) was attribut- owned companies’ surplus/deficit SEK 178 million or 2.5 per cent below able to the leasing of vehicles for trans- before appropriations, the surplus/ budget. port operations and SEK 1,086 million deficit for the year and the adjusted The deviation from budget can be (1,068) for the leasing of premises. surplus/deficit is presented in Note 23. attributed primarily to a larger propor- Sales of laboratory services, which in tion of tickets sold at a discounted rate principle only take place at Karolinska Revenues and an increase in travel volume that University Hospital, accounted for SEK does not correspond to the budgeted 379 million (331) of the revenues, and Operating revenues level. The increase in travel that existed increased by SEK 48 million compared Operating revenues amounted to SEK in 2012 and 2013 levelled off in 2014. with the previous year and was SEK 42 18,507 million (18,406), which is an Compared with 2013, the increase is million over budget. increase of 0.5 per cent compared with around SEK 300 million, of which the preceding year and was SEK 533 about SEK 180 million is attributable to Government grants and other grants million or 3.0 per cent over budget. For a changed accounting principle upon Grants received totalled SEK 3,101 mil- the comparison year 2013, a repayment the transition from the pre-purchase lion (2,848), which is an increase of 8.9 of premiums from AFA Försäkring strip to the Travel Account. per cent compared with the preceding (collective agreement insurance) was year and was SEK 187 million or 6.4 per included in an amount of SEK 529 Sales of primary services cent over budget. million. Sales of primary services, which com- The increase in the grant revenues is prise sold healthcare, dental care and primarily attributable to the grant the Patient fees sales of other primary services, County Council receives for purchasing Total patient fees amounted to SEK amounted to SEK 1,820 million (1,844), services that are not subject to VAT (the 1,325 million (1,263), which is an which is a decrease of 1.3 per cent com- “6 per cent contribution”, Sexprocents- increase of 4.9 per cent compared with pared with the preceding year and is bidraget), which amounted to SEK the preceding year and is SEK 21 mil- SEK 81 million below budget. 1,409 million (1,336) and in part to the lion or 1.6 per cent over budget. The largest part of the revenues con- specially designated government grants The dental care component com- sists of out-of-county revenues, which which amounted to SEK 1,375 million prises SEK 604 million (616), with a totalled SEK 1,001 million (989). This (1,238). budget of SEK 623 million, and the was SEK 12 million, 1.2 per cent, higher The single largest specially desig- healthcare component comprises SEK than the previous year and SEK 58 nated government grant comprises the 721 million (647) with a budget of SEK below budget. ALF grant (an agreement on medical 680 million. education and research), which The increase in patient fees can be Rental income and other sales amounted to SEK 593 million (580) for compared to the population increase of revenues 2014. The specially designated govern- 1.6 per cent with increased patient vol- Rental income and other sales revenues ment grant also includes asylum medi- umes as a result. totalled SEK 3,733 million (3,711), cal care in an amount of SEK 124 mil- which was an increase of 0.6 per cent lion (99), LSS grants (grants for Passenger receipts compared with the preceding year and funding of counselling and personal Passenger receipts amounted to SEK was SEK 50 million or 1.4 per cent over support as per the Act regarding 6,978 million (6,688), which means budget. Rental income amounted to Support and Service for Persons with that they increased by 4.3 per cent com- SEK 2,449 million (2,432), of which Certain Functional Impairments,

Revenues

Outcome Outcome Change Budget Deviation SEK million 2014 2013 % 2014 from budget Patient fees for health and dental care 1,325 1,263 5% 1,304 21 Passenger receipts 6,978 6,688 4% 7,156 –178 Sales of primary services* 1,820 1,844 –1% 1,901 –81 Rental income, sales, other services, material, goods 3,733 3,711 1% 3,683 50 Government grants and other grants 3,101 2,848 9% 2,914 187 Other revenues 1,550 2,052 –24% 1,015 534 of which items affecting comparability** – 814 – – – Total operating revenues 18,507 18,406 1,% 17,974 533

* Primary services consist of sold healthcare, medical and dental services plus sales of other primary services. ** Also see Note 6 to the income statement.

 To contents Financial analysis Annual Report 2014 23 1993:387) and grants under the tissue tising revenues from transport opera- come deviating positively from budget directive (a directive that establishes tions amounted to SEK 236 million is that the net fee to the municipal quality and safety norms for tissue (233), which is on a par with budget. equalisation system was lower than donation), a patient safety grant of SEK estimated. 63 million (95) and the “Sickness Total tax revenues The following sections provide a Absence Billion” (sjukskrivningsmil- The tax base in Sweden and presentation of the three sub-items jarden) of SEK 155 million (181). The Stockholm County included in total tax revenues: tax reve- national “Kömiljarden” programme is The County Council’s tax revenues are nues, general government grants and also reported as a government grant largely dependent on how the tax base municipal economic equalisation. and totalled SEK 171 million (197) in the in Sweden and Stockholm County annual accounts. develops. The tax base reflects eco- Tax revenues from tax on labour nomic trends and comprises taxable Tax revenues are affected by the tax rate Other operating revenues income of individuals, such as salaries, approved by the County Council Other operating revenues amounted to social welfare, pensions, etc. Assembly and by the rate of develop- SEK 1,550 million (2,052 including The final tax outcome for 2013 that ment of the tax base in the county and, items affecting comparability), which is the Swedish Tax Agency presented in above all, in the country. In 2013, the a decrease of 24.5 per cent compared November 2014 indicated an increase County Council Assembly set the tax with the preceding year and was SEK of the tax base nationwide of 3.4 per rate for 2014 at 12.10 per cent, the same 533 million or 52.5 per cent over budget. cent compared with 2012. In Stockholm as for 2013. The national average The primary explanation of the County, the tax base increased in 2013 county council tax was 11.26 per cent in reduced revenues compared with the by 4.2 per cent. 2014. previous year is the repayment of insur- Preliminary tax revenues rose by ance premiums from AFA Försäkring Stockholm County Council’s total SEK 1,759 billion, or 3.0 per cent, com- (collective agreement insurance) for tax revenues pared with 2013. 2005 and 2006 totalling SEK 529 mil- Total tax revenues increased by SEK In the 2014 annual accounts, a pre- lion, which took place in 2013. 2,169 million in 2014. This corresponds liminary deduction was included for The revenues also include capital to an increase over 2013 of 3.5 per cent 2014 tax revenues in an amount of SEK gains where four sales were made in and is SEK 116 million, or 1.8 per cent, 47 million. The preliminary deduction 2014. The capital gains amounted to higher than what had been budgeted in was based on the national tax base SEK 133 million (409) last year. The 2014. growth for 2013 being 3.4 per cent capital gains are not budgeted. Adver- The primary explanation of the out- instead of 3.9 per cent and in 2014,

Tax revenue development (%)

5 5.2

4 4.2 3 3.6 3.5

2 2.6

0 2010 2011 2012 2013 2014

Total tax revenues Deviation Outcome Outcome Change Budget from SEK million 2014 2013 % 2014 budget Tax revenues 59,612 57,699 3% 59,986 –374 General government grant 4,678 4,624 1% 4,676 3 Equalisation system –319 –521 – –806 487 Total tax revenues 63,971 61,802 4% 63,856 116

24 Annual Report 2014 Financial analysis  To contents SALAR assumes that it will be 3.2 per the municipal economic equalisation resident. Stockholm County Council is cent instead of 2.7 per cent. The 2014 system. the only county council that pays an tax revenues also include an adjustment The cost equalisation component income equalisation fee. item that pertains to the forecast of the compensates for cost-driving differ- The income equalisation component 2013 final tax assessment that was ences between county councils that changed as of 2014. The effect of this made in the 2013 financial statements. cannot be influenced, such as popula- change is that Stockholm County Coun- The definitive final tax settlement for tion changes. cil may keep the majority of the tax rev- 2013 was SEK 107 million lower than In the cost equalisation component, enue increase that arises if the tax what was assumed in the 2013 annual Stockholm County Council received a capacity in Stockholm County increases accounts. grant that amounted to SEK 557 million more than nationally. Stockholm in 2014, which is an increase of SEK 60 County Council previously was previ- General government grant million compared with 2013. ously able to keep around 21 per cent of The government grant for pharmaceuti- The income equalisation component such a tax revenue increase, but in cal benefits was intended to provide the is calculated based on the difference 2014, the County Council will be able to County Council with the prerequisites between the county’s tax capacity, keep around 43 per cent. The objective to prescribe appropriate and safe medi- meaning the tax base per resident, and of the change has been to counteract the cine for individual residents. Between 115 per cent of the average tax capacity margin effect that arises when a munic- 2013 and 2014, the grant increased by in the country, also known as the guar- ipality or county council increases its SEK 54 million or 1.2 per cent and was anteed level. The tax capacity in the taxable capacity, through commercial SEK 3 million higher than budget. county was approximately 116 per cent policy measures for instance, and the of the average national tax capacity in tax revenue increase at the same time System for municipal economic 2014. Stockholm County Council entails a nearly equal increase of the fee equalisation thereby had to pay an income equalisa- to the income equalisation component. For 2014, Stockholm County Council tion fee in an amount of SEK 335 mil- The adjustment grant or adjustment must pay a total of SEK 319 million to lion, which corresponds to SEK 155 per fee is used for two purposes. The first is

Tax revenues Deviation Outcome Outcome Change Budget from SEK million 2014 2013 % 2014 budget Preliminary county council tax year 59,672 57,913 3% 59,986 –314 Forecast for final tax settlement 47 –248 – – – Adjustment item, tax revenues –107 35 – – – Total tax revenues 59,612 57,699 3% 59,986 –374

General government grant Deviation Outcome Outcome Change Budget from SEK million 2014 2013 % 2014 budget Grant for pharmaceutical benefits 4,678 4,624 1% 4,676 3 Total general government grants 4,678 4,624 1% 4,676 3

Municipal financial equalisation

Outcome Outcome Outcome Outcome Outcome SEK million 2014 2013 2012 2011 2010 Cost equalisation grant 557 497 714 810 872 Regulation grant – – – 1,648 877 Total, grants from equalisation 557 497 714 2,458 1,749

Income equalisation fee –335 –516 –388 –2,114 –2,134 Adjustment fee –541 –501 –406 – – Total charges equalisation –876 –1,017 –794 –2,114 –2,134 Total municipal economic equalisation –319 –521 –80 345 –385

 To contents Financial analysis Annual Report 2014 25 to regulate the difference between the purchased heathcare and medical ser- million (25,911). This is an increase of government grant to and potential costs vices amounted to SEK 16,958 million 6.8 per cent compared with the preced- for the equalisation system. The second (15,790) compared with the budgeted ing year and was SEK 360 million or 1.3 is to address changes in the division of SEK 16,649 million. In addition, the per cent over budget. responsibility and work between the cost increase in 2014 is based on price Payroll costs amounted to SEK government and the municipal sector and salary development. 17,540 million (16,660) and constitute according to the financing principle. If Costs for purchased transport ser- the largest part of the personnel costs, the government’s costs for the munici- vices amounted to SEK 12,670 million an increase of 5.3 per cent compared pal economic equalisation system (12,083), which is an increase of 4.9 per with 2013. In 2014, the number of full- exceed the government grant and the cent. time equivalents increased by 2.1 per fees paid in, a deficit arises in the equal- Compared with the previous year, cent, causing the payroll cost per full- isation system and municipalities and the costs were also affected by the time equivalent to increase by an aver- county councils must thereby pay an higher volumes in healthcare consump- age of 3.2 per cent. adjustment fee. In an opposite scenario, tion and the increase in travel that can Pension costs amounted to SEK municipalities and county councils be related to the population in the 3,706 million (3,326), which was an instead receive an adjustment grant. In county increasing by around 35,000 increase of 11.4 per cent compared with 2014, a deficit arose in the equalisation residents during the year, correspond- the preceding year and was SEK 238 system and Stockholm County Council ing to 1.6 per cent. There were 8.0 mil- million or 6.0 per cent below budget. therefore paid an adjustment fee of SEK lion doctor’s appointments and more Costs for insourced personnel 541 million, corresponding to SEK 251 than 327,000 care episodes, increases increased by SEK 150 million, corre- per resident. of 1.6 and 0.2 per cent, respectively. The sponding to 43.1 per cent compared increase in healthcare consumption is with 2013, totalling SEK 498 million Expenses lower than expected and also lower (348), which corresponds to just 1.8 per than the population increase. The num- cent of staffing costs. Operating expenses amounted to SEK ber of journeys by public transport on 77,661 million (72,872), which was an land increased by 1.9 per cent, from Sickness absence, etc. increase of 6.6 per cent compared with 470 to 479 million journeys. The num- In accordance with the County Coun- the preceding year and was SEK 946 ber of journeys by marine public trans- cil-wide objective of increasing health million or 1.2 per cent over budget. The port increased by 1.2 per cent, from statistics, the administrations and high rate of increase is primarily attrib- 4,057,000 to 4,107,000. companies further developed their utable to higher staffing costs and pur- health-strategy work environment chased heathcare and medical services. Staffing costs efforts. In collaboration with occupa- The staffing costs amounted to SEK The staffing costs, which consist of per- tional health services, special efforts 27,677 million (25,911) compared with sonnel costs and costs for insourced were made to improve the psychosocial the budgeted SEK 27,317 million while personnel, amounted to SEK 27,677 work environment and to prevent

Expenses Deviation Outcome Outcome Change Budget from SEK million 2014 2013 % 2014 budget Staffing costs –27,677 –25,911 7% –27,317 –360 Purchased health and medical services and operations-related services –16,958 –15,790 7% –16,649 –309 Purchased transport services –12,670 –12,083 5% –12,600 –69 Pharmaceuticals –6,315 –6,069 4% –6,270 –45 Other materials and products, etcetera –4,604 –4,267 8% –4,743 139 Contributions paid –1,863 –1,487 25% –1,871 7 Premises and property expenses, leasing of fixed assets –2,419 –2,429 0% –2,364 –56 Other expenses* –5,155 –4,835 7% –4,902 –252 of which, items affecting comparability** –250 – – – – Total operation expenses –77,661 –72,872 7% –76,716 –946 Depreciation/amortisation –3,817 –3,589 6% –3,717 –99 Gross operation expenses –81,478 –76,462 7% –80,433 –1,045

* Other costs do not include insourced personnel included in the item staffing costs. ** Also see Note 6 to the income statement.

26 Annual Report 2014 Financial analysis  To contents work-related stress and concern in con- and more opportunities for patient care of the cost mix, purchased transports nection with organisation changes. choice. The deviation in the comparison for the disabled for 7.6 per cent (7.7) and Under the theme “Healthy workplaces with the previous year is also due to purchased marine public transport for prevent stress”, the operations focused cost increases for somatic specialist 1.9 per cent (1.7). By operation, the cost on health factors with the aim of care, geriatrics and general psychiatry. increase was 4.8 per cent for public land strengthening health promotion factors This is a result of expanded patient care transport, 2.3 per cent for transport in the work environment. The objective choice in multiple areas. The costs of services for the disabled and 19.0 per was to prevent and shorten cases of externally purchased care increased cent for public marine transport. The illness and to identify signals of illness without a corresponding cost reduction cost increase for public transport on at an early stage. in County Council-operated care land compared with 2013 was partly despite unchanged or reduced health- due to full-year effects of service Purchased healthcare and care volumes. changes, new transport service agree- medical services ments and upward index adjustment of Costs for purchased heathcare and Purchased transport services signed agreements. medical services amounted to SEK Costs for purchased transport services 16,958 million (15,790), which was an amounted to SEK 12,670 million Pharmaceutical costs increase of 7.4 per cent compared with (12,083), which was an increase of 4.9 Pharmaceutical costs amounted to SEK the preceding year and was SEK 309 per cent compared with the preceding 6,315 million (6,069), which was an million or 1.9 per cent over budget. year and was SEK 69 million or 0.5 per increase of 4.0 per cent compared with One explanation for the cost cent over budget. Of the purchased the preceding year and was SEK 45 mil- increase year-on-year is higher health- transport services, public transport on lion over budget. The majority of the care volumes, new clinics that opened land accounted for 90.5 per cent (90.6) pharmaceutical costs, 77.9 per cent

Staffing costs

Change SEK million 2014 2013 % Payroll costs –17,540 –16,660 5% of which -sick pay –276 –260 6% -holiday period –2,079 –1,954 6% -compensation for other absenteeism –2,791 –2,630 6% -overtime compensation –328 –289 14% Pension expenses –3,706 –3,326 11% Social insurance fees –5,335 –5,051 6% Other personnel costs* –598 –526 14% Total personnel costs –27,179 –25,564 6% Cost of insourced personnel –498 –348 43% of which -Health and medical care, –422 –290 45% incl. dental care -Transport –57 –46 25% -Property –14 –7 94% -Other –5 –4 22% Total staffing costs –27,677 –25,911 7%

* For example, company healthcare, preventive healthcare, training and conference costs, employee representation, cost compensation. and changes in holiday pay liability.

Sickness absence as a percentage of ordinary working time

SEK million 2014 2013 Sickness absence, women 6 6 Sickness absence, men 3 3 Total proportion of sickness absence 6 6 Sickness absence percentage for employees < =29 years 5 5 Sickness absence percentage for employees 30-49 years 5 5 Sickness absence percentage for employees > = 50 years 6 6 Sickness absence of 60 days or more in relation to total sickness absence 50 48

 To contents Financial analysis Annual Report 2014 27 (77.4), are costs for the compensation deficit for 2014 amounted to SEK 12 preceding year, and was SEK 88 million that patients receive upon purchasing million, with SEK 7 million in municipal over budget. Of consulting costs, SEK subscription medication (Läkemedels- operations and SEK 5 million in the 409 million (441) relate to IT consulting subventionen). This cost amounted to county council component. Compensa- costs. SEK 4,918 million (4,697) and tion according to the agreement in prin- Other expenses include capital increased by 4.7 per cent compared ciple with the City of Solna concerning losses in an amount of SEK 315 million with 2013 and was SEK 28 million the Metro expansion, LS 1312-1619, was (132). IT software and licences during higher than budget. included in an amount of SEK –250 the year amounted to SEK 242 million, The other part of the County million. The amount for contributions which was SEK 39 million over budget. Council’s pharmaceutical costs consists paid also included grants to the cultural of the County Council’s medical care sector in an amount of SEK 311 million Depreciation/amortisation producers’ pharmaceutical costs in the (300). Depreciation/amortisation costs care of patients. These costs were SEK amounted to SEK 3,817 million (3,589), 1,396 million (1,372), which was SEK 17 Premises, properties and leasing which was an increase of 6.4 per cent million higher than budget. Costs rose of fixed assets compared with the preceding year and by SEK 24 million, or 1.7 per cent, com- Premises and property expenses was SEK 99 million over budget. pared with 2013. The cost level is influ- amounted to SEK 2,328 million (2,342), The largest part of the cost increase enced in part by continued active work an increase of 0.6 per cent compared between the years is due to completed with the Wise Drug Formulary (Kloka with the previous year. The expenses investments in public transport, such listan), which entails a replacement of were SEK 60 million higher than budget, as Light Rail bridges, Light Rail signal original preparations with less expen- mainly due to higher costs for repair, communications and the SL Access sive pharmaceuticals, and in part to maintenance and property service. payment system. Disposals of premises expirations of patents for expensive Operating and maintenance expenses prior to new construction, primarily in pharmaceuticals. The cost increase in and premises rents decreased. healthcare, increased the depreciation/ recent years comes primarily from spe- Expenses for the leasing of fixed amortisation costs for the year. cial pharmaceuticals and there is also assets that pertain to office equipment an underlying volume increase. In 2014, and phone exchanges, for example, Financing the increase mainly pertains to new amounted to SEK 91 million (87) and pharmaceuticals against hepatitis C. are on a par with the 2013 outcome and Cash and cash equivalents and the year’s budget. payment capacity Contributions paid At year-end, the Group had cash and Contributions paid amounted to SEK Other expenses cash equivalents in an amount of SEK 1,863 million, which is an increase of Other expenses amounted to SEK 5,155 334 million, which is SEK 1,506 million 25.3 per cent compared with the prece million (4,835), which was an increase lower than at the beginning of the year. ding year and was SEK 8 million below of 6.6 per cent compared with the More accurate forecasts mean that the budget. The total contribution from preceding year and was SEK 252 mil- County Council can have a somewhat Stockholm County Council to the Health lion over budget. lower liquidity buffer than before. In and Social care Committee in Norrtälje Consulting costs and other pur- addition to its own cash and cash equiv- was SEK 1,303 million (1,247), an chased services amounted to SEK 2,166 alents, the County Council has approxi- increase of SEK 56 million compared million (1,946), which was an increase mately SEK 8,900 million in agreed with the previous year. The Committee’s of 10.2 per cent compared with the credit facilities.

Liquidity and borrowings (SEK million)

Liquidity Borrowings

3,000 34,000 Liquidity 33,000 2,500 Borrowings 32,000 2,000 31,000

1,500 30,000 29,000 1,000 28,000 500 27,000

0 26,000 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

28 Annual Report 2014 Financial analysis  To contents The County Council Assembly has for 33 per cent and Patientförsäkringen rates, lower credit requirements and established a borrowing limit of SEK 95 LÖF (patient insurance from the county the capitalisation of interest in connec- billion. This amount refers to all guar- councils’ mutual insurance provider) tion with building investments. The anteed credit facilities, borrowing pro- accounted for 4 per cent. outcome was SEK 9 million or 1.3 per grammes, leasing obligations and bank cent higher than 2013. overdraft facilities. The County Net financial items Interest income amounted to SEK 12 Council’s interest-bearing liabilities Net financial items consist of financial million (49), due to lower market inter- increased during the year by SEK 4,051 income and expenses and amounted to est rates and a planned decrease in million, totalling SEK 32,931 million at an expense of SEK 864 million (2,813). excess liquidity. 31 December. Due to lower investments This is an improvement of SEK 1,949 than planned, it was possible for a larger million over 2013 and SEK 347 million Finance policy share of the investments to be financed compared to budget. During 2014, Stockholm County with own cash and cash equivalents. In 2013, the decrease in the discount Council retained its rating of A A+ from rate, the RIPS rate, resulted in the costs the credit valuation and rating agency Loan portfolio for the interest components of the 2013 Standard and Poor’s. During the year, The total loan portfolio includes leases, pension expenses and payroll tax AB Stockholms Läns Landstings mainly for AB Storstockholms Lokal expenses of SEK 1,564 million nega- Internfinans conducted investment and trafik. Of the current interest-bearing tively impacting net financial items. borrowing operations according to the liabilities of around SEK 33 billion, In 2014, the interest expenses for County Council’s finance policy. approximately 31 per cent consists of loans raised and leasing amounted to According to the finance policy, the finance leases and 32 per cent of loans SEK 721 million (712), a total of SEK 157 average payment capacity must be at from the European Investment Bank. million below budget. The reason for least 21 days. The average payment In addition, bond financing accounted the positive deviation was low market capacity in December was 63 days.

Stockholm County Council's borrowing

SEK million Loan financing Long-term borrowing 18,627 Short-term borrowing 3,948 Total loan financing 22,574 Leasing financing 10,357 Total interest-bearing liabilities 32,931

Unutilised agreed credit facilities and credits Overdraft facilities 3,000 Other agreed credit facilities 8,900 Total unutilised agreed credit facilities and credits 11,900

Co-ordinated borrowing limit established by the County Council Assembly 95,000

Maturity structure for loans and leasing at 31 Dec. 2014 (SEK million)

7,000 Loans 6,000 Leasing

5,000

4,000

3,000

2,000

1,000

0 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2029

 To contents Financial analysis Annual Report 2014 29 The portfolio for managing by operating activities, investing activi- last year indicated decreased borrow- Stockholm County Council’s financial ties and financing activities. The sum of ing of SEK 2,003 million for 2013. risks via derivatives amounted to SEK these components represents the 8,950 million. The corresponding change in cash and cash equivalents. Pension liabilities amount for 2013 was SEK 9,550 mil- Cash flow for the year meant that the The County Council’s pension obliga- lion. In addition to this, there is hedging cash and cash equivalents decreased tions are reported in accordance with of loans in EUR at a value of SEK 5,018 SEK 1,507 million, from SEK 1,841 mil- the “mixed model”, which means that million. The average fixed interest term lion to SEK 334 million. pensions vested as of 1998 are reported for the County Council’s loan portfolio Cash flow from operating activities as a provision in the balance sheet, on the balance sheet date was 4.0 years, was positive in an amount of SEK 8,342 while those vested before 1998 are compared with 4.1 years at the begin- million, which was in line with 2013. reported as a contingent liability. At 31 ning of the year. This is within the range Compared with last year, the changes December 2014, provisions for pen- for the fixed interest term of two to five were affected by a lower surplus, which sions amounted to SEK 22,136 million, years set by the County Council Assem- was primarily balanced by the changes which is an increase of SEK 1,213 mil- bly. The average interest on loans for the in current receivables and liabilities. lion compared with the previous year. County Council’s loan portfolio was 2.6 Investing activities, which show During the year, the contingent liability per cent at year-end. what funds were used for investments, decreased by SEK 915 million from SEK The County Council shall plan the are the component with the greatest 26,376 million to SEK 25,461 million. points in time that the loan and leasing impact on the cash flow. The amount for At 31 December 2014, the County Coun- agreements will expire so that the refi- 2014 was SEK 13,400 million. Com- cil’s total pension commitments nancing needs do not become too large pared with the year’s investments, the amounted to SEK 47,597 million, which during any one time period. The dia- difference is mainly attributable to the is an increase of SEK 298 million com- gram shows the amount with which, fact that the part of New Karolinska pared with the previous year. and the point in time at which the Solna that is comprised of the public signed loan and leasing agreements private partnership agreement (the PPP Reconciliation against the balance expire. agreement) did not affect cash flow dur- requirement ing the year. The surplus for the year according to Cash-flow statement The net change in loan financing of the balance requirement amounted to The cash-flow statement shows the SEK 3,551 million shows how much was SEK 3 million. This means that the County Council’s inflow and outflow of financed with external borrowing dur- County Council met the statutory cash and cash equivalents broken down ing the year. The corresponding change requirement of a balanced budget.

Cash-flow statement

SEK million 2014 2013 Cash flow from operating activities 8,342 8,308 Cash flow from investing activities –13,400 –9,280 Cash flow after investments –5,058 –972 Cash flow from financing activities 3,551 –2,003 Change in cash and cash equivalents –1,507 –2,975

Pension obligations and interest-bearing liabilities (SEK million)

80,000 Interest-bearing liabilities 70,000 Pension obligations 60,000

50,000

40,000

30,000

20,000 10,000

0 2010 2011 2012 2013 2014

30 Annual Report 2014 Financial analysis  To contents The balance requirement applies to According to the main rule, equity liabilities, are taken into account, the each individual budgetary year. If rea- should also cover the pension commit- County Council Group would report son exists, the County Council Assem- ment in contingent liabilities so that a negative equity of SEK 18,043 million bly can decide to reserve funding in reservation of equity can be made. The (19,519). equity to meet future revenue reduc- County Council does not meet this At year-end 2014, the recognised tions or expense increases. requirement. The County Council has a equity/assets ratio was 8.2 per cent, During the period 2012–2014, the strong population growth and a grow- which is a decrease of 0.2 percentage County Council Assembly decided to ing tax base. Since 2007, the County points compared to the preceding year. reserve a total of SEK 5.3 billion in Council has annually reported a sur- In the past five years, the equity/assets equity to cover future transition costs plus and its financial position is strong. ratio improved by 2.5 percentage in connection with the implementation From this perspective, the reservation points, from 5.7 per cent in 2010 to 8.2 of future health and medical care. No of equity is in agreement with sound per cent in 2014. further provision is current. financial management. If the pension obligations recog- Transition costs are defined as tem- nised as contingent liabilities were porary additional costs during the Equity trend included, the equity/assets ratio would period for the structural changes The County Council’s equity increased be minus 20.0 per cent. directly linked to the implementation of in 2014 by SEK 569 million. Besides the future health and medical care. The year’s surplus of SEK 136 million, transition costs are not covered by the equity was impacted by effects arising ordinary operating assignment. The as a result of changed accounting prin- transition costs that arise are linked to ciples for companies and a clearer adap- programme offices, equipment and fur- tation to the rules on the accounting of nishings, as well as properties and specially designated government premises. For 2015–2018, the planned grants. transition costs amount to SEK 3.5 If pension obligations vested before billion. 1998, which are reported as contingent

Surplus for the year according Equity (SEK million) to the balance requirement 8,000

SEK million 7,000 Surplus for the year (change 136 6,000 in equity) Capital gains –133 5,000 Surplus for the year after 4,000 balance requirement 3,000 adjustments 3 Balance requirement result 2,000 for the year 3 1,000

0 2010 2011 2012 2013 2014

Equity/assets ratio (%)

9 Privat prod. 8 8.4 8.2 7 7.6 7,6 6 5 5.7 5.7 4 3 2 1 0 2010 2011 2012 2013 2014

 To contents Financial analysis Annual Report 2014 31

Equity (SEK million)

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0 2010 2011 2012 2013 2014 Investments

The county’s rising population entails a higher investment need in both healthcare and public transport. The investment volume for the year is larger than ever and is in line with the strong regional development. Investments for 2014 amount to nearly than SEK 15 billion.

32 Annual Report 2014  To contents Investment trend conversion rate of 91 per cent (69) rela- track sections were expanded, noise tive to budget. In transport services, the reduction measures were implemented Decision conversion rate was 97 per cent and in and the existing wagons were reno- In the 2014 budget, the County Council healthcare, it was 92 per cent. The out- vated. The technical improvement of Assembly set the investment limits for come was SEK 1,467 million below the Lidingöbanan suburban railway each administration and company. The budget. Large deviations are presented and the expansion of the railway depot budget was revised as a result of the by the table. in Lidingö were completed. In the Assembly’s decision on 18 February The development of the investing Metro Red Line project, the new depot 2014, LS 1401-0037, for an expansion of activity during the five-year period is in Norsborg was built and the stations the Metro in an amount of SEK 449 mil- presented by the diagram. in Hallunda and Norsborg were lion according to the 2013 Stockholm improved and modernised. Expenses Negotiations (Stockholmsförhandlin- Public transport investments for the year also pertain to the partial gen), and the Assembly’s decisions on payment of new C30 vehicles that will 6 May 2014, LS 1401-0061 and LS 1401- Public transport by land and sea serve the Metro’s red line. 0062, on supplemental agreements 28 Investments in transport extend over An agreement was reached between and 33 in an amount of SEK 74 million all modes of transportation and the the County Council, the City of Stock- regarding the project agreement and outcome for the year amounted to SEK holm, the Municipality of Nacka and additional medical-technical equip- 7,873 million, which is SEK 245 million the Municipality of Värmdö on the ment and furnishings for NKS. The lower than the budget. The investing financing of the bus terminal at Slus- budget for 2014 amounts to SEK 16,455 activities were affected by planning sen. The programme study for the billion. issues, appeals of procurements, Southern Tramway continued as changed timetables for vehicle deliver- planned. One consultation is complete Investing activities ies, and so on. and close cooperation with the munici- The table on investments shows the Several major investment projects palities involved has laid the founda- trend in investing activities in 2014 in that aim to expand and modernise the tion for continued work. Service was relation to the established investment county’s infrastructure are currently halted on the Solna Branch of the Light budget. Investments totalled SEK being carried out. On the Roslagsbanan Rail during the summer for renovations 14,988 million, which corresponds to a suburban railway, three new double in Alvik, adaptation of the signalling

Investments

SEK million Outcome Budget Deviation Outcome Conversion rate 2014 2014 from budget 2013 2014 1013 Healthcare including properties (LFS) 2,836 3,078 241 2,085 92% 61% New Karolinska Solna 3,639 4,194 554 3,305 87% 96% Transport 7,873 8,118 245 5,355 97% 107% Citybanan 376 477 101 369 79% 86% Metro Exp. Admin.* 117 449 332 – 26% – Other 147 140 -7 67 105% 40% Total investments SCC Group 14,988 16,455 1,467 11,180 91% 69%

* Metro Expansion Administration

Investments (SEK million)

16,000

14,000

12,000

10,000

8,000

6,000

4,000

2,000

0 2010 2011 2012 2013 2014

 To contents Investments Annual Report 2014 33

Privat prod. systems and test runs. Service resumed examines various route alternatives Citybanan commuter rail on 18 August on the Solna Branch, and station locations, as well as the rail The investment in Citybanan commuter including the section to Solna Station line and station location according to rail amounted to SEK 376 million in with departures every ten minutes. the wishes of the Municipality of Nacka 2014, which was SEK 101 million less The deviations between the 2014 regarding the placement of entrances. than the budget of SEK 477 million. outcome and budget are primarily in Citybanan is being built by the Swedish the Roslagbanan capacity improvement Metro to Arenastaden Transport Administration. The project (SEK 435 million), Spårväg City tram- The outcome for the year was SEK 49 includes two new stations, Odenplan way (SEK 448 million), commuter million. In 2014, work commenced on and City, which will connect to the Metro trains (SEK 412 million) and the Solna the section to Arenastaden via Haga stations Odenplan and T-Centralen. Branch of the Light Rail (SEK 290 mil- staden. The section runs from Oden- The stations are financed and will be lion). plan where a new track and a new plat- owned by Stockholm County Council. The procurement of vehicles for form are planned south of the existing Roslagsbanan suburban railway was tracks and platforms. The station below Co-financing postponed due to the need to review the Hagastaden will have entrances at Transportation infrastructure invest- specifications and agreements to Torsplan and at New Karolinska Solna/ ments receive government co-financing ensure quality, final delivery and a Karolinska Institutet/Hagaplan. The in the form of government grants. The balanced budget. Within Spårväg City section continues on to Arenastaden. extent of the co-financing of new invest- tramway, the deviation is mainly due to ments is established in negotiations delayed railway plans. Metro to Barkarby between the government, the County The deviation regarding invest- The outcome for the year was SEK 16 Council and the municipalities in the ments in commuter trains is mostly due million. A location study was begun and county. The objects already under way to a contractual change with a supplier will form the basis of decisions on the received SEK 710 million in govern- to ensure that the vehicles are delivered Metro route. A report with a route rec- ment grants in 2014, broken down as on time for the commissioning of ommendation is planned for the begin- follows: Citybanan. The change entailed ning of 2015. The report will be used as • Lidingöbanan SEK 248 million changes in the payment plan. The Solna a basis for decisions in the County • Roslagsbanan SEK 351 million Branch was struck by continued delays Council Executive Board. One condi- • Light Rail East SEK 101 million in the delivery of the signal safety tion for the work on the location study is • Park-and-ride system and deficiencies in delivered to not make it impossible to continue facilities SEK 10 million vehicles. the line towards Hjulsta and Viksjö. In parallel with the location study, work is Investments in healthcare Expanded Metro being conducted on the system docu- The 2014 investment budget was set at mentation project planning. including properties SEK 449 million and the outcome was Investments in healthcare comprise SEK 117 million. The outcome is below Depots and vehicles investments in properties reported budget, but largely in line with the plan- The Depots and vehicles project aims to within Landstingsfastigheter Stock- ning the Metro Expansion Administra- ensure that there are vehicles and depot holm and investments in machines and tion made in summer 2014. capacity in place for commencement of equipment at the respective care pro- the various services within the scope of ducer. Metro to Nacka/Southern Stockholm the new Metro lines. The investment The year’s investments in healthcare The outcome for the year was SEK 48 expense for the project amounted to amounted to SEK 2,836 million, of million. In 2014, a location study was around SEK 3 million and mainly con- which SEK 2,254 million related to begun for the route Sofia-Gullmars sisted of expenses for project manage- properties. This provides a conversion plan/Southern Stockholm. The study ment and project engineering. rate of 92 per cent compared with the

Transport investments

Budget Outcome SEK million 2014 2014 Metro Red line 1.211 1.249 Commuter Rail Programme 883 471 Spårväg City, stage 2 1.397 949 Light Rail North Solna Branch 930 640 Roslagsbanan expansion 1.425 991 Programme bus depots 647 854

34 Annual Report 2014 Investments  To contents year’s budget, which amounted to SEK new construction and renovation of acquired new pharmaceutical 3,078 million. The conversion rate in building 30, the emergency ward at St. dispensers. the previous year was 61 per cent. Göran Hospital, were delayed and became more expensive due to Deviations from budget appealed building permits. The table New Karolinska Solna The deviation from the year’s budget is presents investment expenses for the New Karolinska Solna is Stockholm partially related to investments of SEK largest objects in healthcare. County Council’s single largest invest- 146 million in properties in Landst- The demolition of the existing ment project for the next few years. ingsfastigheter Stockholm. This was garage and construction of a new Total investment expenses and costs for caused by postponed and uncompleted garage at Karolinska University Hospi- the project are presented below from unspecified objects, which were objects tal in Huddinge became more expen- project start to the end of December with a total expense below SEK 100 sive due to the adjustments needed due 2014. million that were affected by and jointly to the purchase agreement reached for The construction of the new hospital planned with the strategic investments. the upcoming 3D property above the facility is in full swing and the project The outcome for the specified objects garage. The new forecast for the object’s timetable is being kept both in terms of was also below budget as they did not total expense amounts to approxi- time and finances. The technical build- proceed at the rate planned, mainly due mately SEK 350 million, which is SEK ing was completed and turned over to to changed planning conditions and 64 million or 22 per cent over budget. the County Council during the year. shifts in timetables. Replacement investments Supplemental agreements Machinery and equipment The majority of healthcare investments During the year, several supplemental The care producers’ investments in in machinery and equipment com- agreements were signed. Fitting out of machinery and equipment were SEK prised replacement investments. Dur- the five storeys in the research building 580 million, which is SEK 66 million ing the year, a large amount of radiology and the hospital dispensary are the less than the budgeted SEK 646 million. equipment was purchased, including largest and these were approved by the The lower conversion rate is mainly due two new magnetic resonance tomogra- County Council Assembly in the spring. to Södersjukhuset AB and Karolinska phy (MR) systems that were installed at In addition to these, decisions were University Hospital. Södersjukhuset AB. The new MR equip- made on additional gas outlets, con- ment makes possible a new method for necting walkways, a sampling labora- Ongoing projects breast diagnostics and has more capac- tory and several minor changes. The largest ongoing objects in health- ity for the examination of children and care properties are new construction cancer patients. A new computer Presentation of the New and renovations at Södertälje Hospital, tomography system was installed at the Karolinska Solna project technical improvement of building 01 at Department of Neuroradiology at In 2014, work on the construction of Löwenströmska Hospital, and demoli- Karolinska University Hospital in New Karolinska Solna proceeded tion of an existing garage and construc- Solna. Several systems for magnetic according to plan. tion of a new one at Karolinska Univer- resonance tomography were upgraded NKS Construction within the sity Hospital in Huddinge. During the to a new modern standard, including County Council Executive Board year, implementation decisions were Paediatric Radiology, Karolinska Administration has primary responsi- made for a new treatment building at University Hospital in Solna, and at bility for the construction project and it Södersjukhuset and a new treatment Södertälje sjukhus AB. conducts equipment procurements building at Danderyd Hospital. Work is At Karolinska University Hospital, together with Karolinska University under way at both of these objects to an improved security and entry system Hospital. Operational responsibility prepare for the new construction. The was installed and the hospital also for medical technology expertise and

Investments in healthcare properties

Outcome SEK million 2014 New building western location – treatment building, SÖS 209 new construction and renovation of Södertälje Hospital 170 Technical improvement building 01, Löwenströmska 150 New treatment building, Danderyd Hospital 149 Demolition of existing garage/new garage, Karolinska Huddinge 118 Building 30 Renovation and construction of the emergency ward at St. Göran Hospital 74

 To contents Investments Annual Report 2014 35 setting requirements on equipment for the two eastern hospital buildings, con- The investments in new construc- clinical use rested with Karolinska Uni- struction work was gradually com- tion according to the “public-private versity Hospital. The work is conducted pleted during the year and installation collaboration agreement” follow the within the scope of an overall pro- of ceiling-mounted medical-technical project agreement and the method gramme. In a similar manner, coopera- equipment is under way. In the three according to which the ongoing con- tion is conducted for the procurement other hospital buildings, the internal struction is reported. of infrastructure for IT and communi- installation work was completed. The cation technology, fittings and medical installation of information and commu- equipment. nication-technical equipment is under way. The project engineering for the Investments extension of the treatment building was The technical building was completed concluded and the foundation work is according to plan during the spring and under way. In the research building, the turned over to the County Council. In structural work is being completed.

Expenses – New Karolinska Solna

Outcome Budget SEK million 2008–2013 2014 Total 2014 Management and administration 102 5 107 8

Project Operations-related, transferred to Karolinska 152 110 262 100* Furnishings 1 – 1 – IT and communication technology 14 6 20 2 Medical equipment 57 23 79 26 Art 4 1 6 4 Evacuation and preparaotry work plus contractual issues 504 52 556 58 Total project 732 193 924 –

Operating expenses NKS Parking and technical building 37 151 188 144

Total cost 872 349 1,219 –

* SEK 55 million budgeted in compensation from Health and Medical Care Administration to Karolinska. In addition, internally budgeted at Karolinska.

Investments New Karolinska Solna

Accumulated Outcome Budget SEK million 2013 2014 Total 2014 Construction New construction in progress, SCC share 640 92 732 112 Supplemental agreements/Change requests 344 306 650 265 New construction in progress, PPC share 8.940 3.043 11.983 3.063 Total building 9.924 3.441 13.365 3.440 of which commissioned buildings 381 1.965 2.346 Art 6 5 11 9 Equipment IT and communication technology 55 48 103 211 Medical equipment 88 138 226 531 Furnishings 2 5 7 3 Total equipment 145 191 336 745 Total 10.075 3.637 13.712 4.194*

* Incl. supplemental budget of SEK 74 million according to decision in County Council Assembly.

36 Annual Report 2014 Investments  To contents Financial performance of boards and committees

Through political efforts, approximately SEK 63 billion were allocated to boards and committees to provide the county’s residents with knowledge-based, appropriate, safe and accessible healthcare and attractive public transport that ties the region together.

 To contents Annual Report 2014 37 Stockholm County Council Committee Organisation

County Council Audit Board Assembly

County Council Executive Board

Health and Social Public Healthcare Traffic Culture Patient Advisory care Committee in Services Committee Committee Committee Committee Norrtälje1)

1) Joint board with Norrtälje Municipality.

This section primarily aims to provide a Administration works directly on higher than budget and was primarily a view of operations and financial perfor- behalf of the County Council Executive result of a number of government mance, which in turn are based on the Board via the County Council Director. grants being higher than budgeted. County Council grants decided on by The Administration’s foremost task is Compared with 2013, the revenues the County Council Assembly in con- to support the County Council Execu- increased by SEK 328 million or 9.4 per nection with the budget. tive Board in its task of managing, gov- cent. The County Council grant erning and coordinating the County increased by SEK 171 million, corre- Council’s operations and to work sponding to 6.2 per cent. Higher other County Council Executive strategically and operationally in order revenues are partially an effect of re- Board to achieve the goals set in the budget invoiced expenses for the Metro Expan- The County Council Executive Board adopted by the County Council sion Administration. leads and coordinates the County Assembly. Operating expenses were SEK 108 Council’s committees and their opera- The Administration’s core opera- million or 3.1 per cent higher than tions, and follows up implementation of tions support the political organisation budgeted. This is largely due to the the County Council Assembly’s deci- and provide operational support to the redistribution of SEK 60 million to the sions. The County Council Executive County Council’s operations. The endeavour with higher staffing in Board is also responsible for overall Administration is also home to SCC IT, healthcare in the summer of 2014. development of the County Council as a which is the County Council’s internal Compared with 2013, expenses whole, such as regional planning, stra- organisation for IT services, and SCC increased by SEK 333 million or 10.2 tegic property issues and expansion of Strategic Property Issues and Invest- per cent. Personnel costs increased as a the new Metro lines. ments, which is responsible for the con- result of a larger number of full-time The County Council Executive Board struction of New Karolinska Solna. equivalents in the Administration. The Administration, including NKS Con- efforts in research, development and struction and the Metro Expansion Finances education entailed higher costs for Administration, is a part of the County The surplus in 2014 totalled SEK 9.1 grants paid. Council Executive Board. million compared with the budgeted Depreciation and amortisation costs break-even. The goal of balanced increased compared with the previous County Council Executive Board finances was achieved. The correspond- year, but were SEK 13 million lower Administration ing surplus for 2013 was SEK 119 million. than budgeted. This is mainly due to Introduction and mission Operating revenues amounted to SCC IT not having invested at the pace The County Council Executive Board SEK 101 million, which was 2.7 per cent planned for the year.

County Council Executive Board Administration

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 3,835 3,507 9% 3,734 – of which, SCC internal 3,729 3,428 9% 3,627 Expenses –3,725 –3,364 11% –3,630 Net financial items –101 –24 – –104 Surplus/deficit 9 119 – 0 Number of full-time equivalents 887 828 7% 824

38 Annual Report 2014 Financial performance of boards and committees  To contents For investments, see the investment Finances Public Healthcare Services section and the heading New Karolinska The Metro Expansion Administration Committee Solna. is financed through co-financing from the parties that signed the Metro Introduction and mission Metro Expansion Administration expansion agreement according to the The Health and Social Services Com- Introduction and mission 2013 Stockholm Negotiations. The mittee is responsible for the manage- The County Council Assembly decided co-financing should cover the expenses ment of the County Council’s health and on 18 February 2014 to approve an that are directly linked to the respective medical care. This means that the Com- agreement in the 2013 Stockholm investment objects, as well as the mittee shall ensure that healthcare is Negotiations on an expansion of the expenses incurred by the Administra- governed, coordinated and developed Metro. The County Council Executive tion’s staff. in such a way that the collective Board was given the task of being The Administration received capital resources are adapted to the needs of responsible for implementing the totalling SEK 447 million, which corre- the population and contribute to the expansion. In 2014, the Metro Expan- sponds to annual grants and advances improvement of the state of healthcare. sion Administration was formed and for 2014 in accordance with the agree- As a professional committee in charge, began its operations. The Administra- ment. The capital received is SEK 2 mil- the Health and Social Services Com- tion has the task of carrying out the lion lower than the approved invest- mittee shall participate in overall plan- expansions as per agreement: ment budget because of a development ning for investments in healthcare. • Metro to Nacka/Southern Stockholm in the consumer price index that was The Public Healthcare Services • Metro to Arenastaden lower than assumed in the agreement. Committee finances and governs care • Metro to Barkarby The Administration was formed on 1 through agreements with care provid- March 2014, which means that the ers. The Committee is responsible for The Administration is also responsible accounting period only pertains to ten ensuring that all healthcare, dental for the expansion of depots and the months. For 2014, a zero result is pre- care and efforts under the Act regarding acquisition of the vehicles required for sented. Support and Service for Persons with servicing the new parts of the Metro. For investments, see the investment Certain Functional Impairments (LSS) section and the heading Expanded is managed, coordinated and developed Metro. so that the resources are adapted to the

Metro Expansion Administration

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 30 – – – – of which, SCC internal 11 – – – Expenses –30 – – – Surplus/deficit 0 – – –

Private and public share of costs in 2014 (%)

100 80 79 38 48 42 62 66 Stockholm County Council 90 production (including other county councils, 80 municipalities and state) 70 Private production 60 62 58 50 52 40 38 30 34 20 20 21 10 0 Somatic Psychiatry Primary Elderly Other Dental care Total specialist care care care health and medical care

 To contents Financial performance of boards and committees Annual Report 2014 39 population’s needs and contribute to an than the budgeted break-even. This costs for advanced medical care in improvement of the state of health. The deficit was SEK 292 million lower than the home due to more patients and Committee plans and monitors the pop- 2013. longer care times ulation’s medical care needs and orders Operating revenues were SEK 2,213 • psychiatric care, deficit of SEK 74 and follows up on orders of medical million higher than in 2013, which is an million, which is mainly attributable care from the providers. increase of 4.4 per cent. This outcome to higher costs in general psychiatry The Public Healthcare Services was SEK 545 million or 1.1 per cent over • pharmaceuticals, deficit of SEK 139 Committee signs agreements with budget. The deviation from budget is million, which is primarily attributa- around 1,000 different care providers, mainly attributable to higher revenues ble to the costs for infectious disease ranging from corporate groups active in regarding the 6 per cent government control pharmaceuticals increasing healthcare to individual care providers. grant, which is a VAT compensation by SEK 250 million or 80 per cent These agreements have come about received at the purchase of operations compared with 2013 through direct agreements with not subject to VAT, revenues from the • other healthcare and other opera- County-Council-operated production, rehabilitation guarantee and compen- tions, surplus of SEK 273 million, procurement or patient care choice. The sation for the summer efforts in health- which are mainly due to budgeted Public Healthcare Services Committee care. provisions as well as aids and care is also responsible for agreements with Operating expenses were SEK 2,476 guarantees via the Care Guarantee private physicians and physiotherapists million higher than in 2013, which is an Registrar. that are established under the national increase of 5.0 per cent. This outcome tariff scheme. was SEK 726 million or 1.4 per cent over Consumption Of the Public Healthcare Services budget. The deviation from budget is In 2014, the number of residents in the Committee’s expenses of SEK 44,712 mainly due to higher costs for pur- county increased by around 35,000 million for purchased health and medi- chased heathcare and medical services people or about 1.6 per cent. The popu- cal care services, private care providers and higher pharmaceutical costs. lation of Stockholm County was accounted for 34 per cent of the total An analysis of the Public Healthcare 2,198,044 residents at year-end. expenses, which is an increase of one Services Committee’s results for 2014 Healthcare consumption increased in percentage point compared with 2013. by operating area shows the following the majority of operating areas com- The largest cost proportions for private major deviations from budget: pared with 2013 in both outpatient and providers are in primary care and other inpatient care. This increase is lower healthcare. The latter includes aids for • somatic specialist care, deficit of SEK than expected, however, and also lower the disabled, specialist rehabilitation 143 million, which is mainly due to than the population increase. Com- and ambulance healthcare. higher costs for patient care choice pared with 2013, the total number of areas in somatic specialist care out- visits to doctors in outpatient care Finances side the emergency hospitals increased by 1.5 per cent. The number There was a deficit of SEK 193 million in • geriatric care, deficit of SEK 104 mil- of care episodes rose in inpatient care 2014, which was SEK 193 million lower lion, which is mainly due to higher by 0.3 per cent compared with 2013.

Public Healthcare Services Committee

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues County Council grants 49,489 47,730 4% 49,489 Other revenues 2,544 2,091 22% 1,999 Total operation revenues 52,033 49,820 4% 51,488

Operating expenses Personnel costs –512 –467 10% –521 Purchased health and medical –44,712 –42,779 5% –44,097 care services Other expenses –7,020 –6,522 8% –6,900 Total operation expenses –52,243 –49,767 5% –51,517 Depreciation/amortisation –6 –7 – –11 Net financial items 23 53 – 40 Surplus/deficit –193 99 – 0 Investments 2 8 –71% 32 Number of full-time equivalents 713 653 9% 650

40 Annual Report 2014 Financial performance of boards and committees  To contents Operations its operations in patient care choice in Open Comparisons 2014, Health- In 2011, the County Council Assembly childbirth. An eye-glass allowance for care, Comparisons between county adopted a Future Plan for Health and children was introduced on 1 June. councils, presents a large number of Medical Care in Stockholm County The number of residents who have comparative indicators. In summary, Council. In 2014, this work shifted from opened a resident account on My the state of health generally improved the earlier analysis, planning and spec- Healthcare Contacts is steadily grow- gradually in both Stockholm County ification efforts to a distinct implemen- ing. A total of 25 per cent of the county’s and Sweden as a whole. There are, how- tation phase. In December 2014, the residents now have a resident account ever, differences in morbidity that are County Council Assembly approved the and thereby the possibility to use the related to socioeconomic conditions. implementation of the adjustments in e-services linked to this. The number of Access to healthcare is perceived as the care services presented in stage clinics registered with the system good in Stockholm County Council and three of the Plan for Future Health and increased by 17 per cent and is now confidence in healthcare centres and Medical Care. During the year, state- around 1,800. Of all general practi- hospitals is perceived as good. ments of intent with the emergency tioner (GP) clinics, 87 per cent are reg- hospitals, and overall and detailed istered with My Healthcare Contacts. Health and Social care implementation plans were prepared at The national patient safety agree- both care providers and central admin- ment had been in place since 2011 and Committee in Norrtälje istration. 2014 was the final year covered by the Introduction and mission More patient care choice has gradu- agreement. Stockholm County Council The Health and Social care Committee ally been introduced according to the fulfilled all of the basic requirements in Norrtälje, formerly the TioHundra Act on Systems of Choice in the Public and three of six performance require- Council, has been the purchaser of Sector since 2008. Six new patient care ments in 2014. The objective for the heathcare, medical services and social choices were added in 2014, which prescription of antibiotics was achieved services in Norrtälje since 1 January means that there are now 31 patient for 2014. Since 2010, these prescrip- 2006. Stockholm County Council and care choice areas. During the year, tions have decreased by 14 per cent. Norrtälje Municipality jointly finance agreements entered into effect in the The final year for the national agree- the operations of the committee. The patient care choice areas of orthopae- ment in Coordinated care for the most so-called TioHundra project extends dics and hand surgery, neurology, clini- ill elderly was 2014. Stockholm County through to 31 December 2015. cal neurophysiology, intensive training achieved the 2014 target for perfor- for children with motor disabilities, mance requirements regarding reduc- Finances paediatric clinics, and rehabilitation ing avoidable inpatient care and There was a deficit of SEK 12 million in from long-term pain and chronic improving pharmaceutical use for the 2014, which was SEK 12 million lower fatigue syndrome. In patient care elderly. Stockholm County also received than the budgeted break-even. The defi- choice for paediatric clinics, five com- part of the performance compensation cit is broken down as SEK 7 million for pletely new clinics opened and another for registration in some quality regis- municipal operations and SEK 5 million two will open in spring 2015. tries. However, the county did not for county council operations. The result The child vaccination programme achieve the goal for performance com- was SEK 14 million lower than 2013. was expanded to include rotavirus pensation for reducing re-admissions Within the Committee’s operations infections. In March, BB Sophia began within 30 days. funded by the County Council, the devi-

Health and Social care Committee in Norrtälje

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Grants, Stockholm County Council 1,303 1,247 4% 1,303 Grants, Norrtälje Municipality 945 903 5% 945 Other revenues 230 214 8% 106 Total operation revenues 2,478 2,363 5% 2,354

Operating expenses Personnel costs –39 –36 8% –41 Purchased health, medical –2,150 –2,028 6% –2,026 and social care Other expenses –301 –298 1% –287 Total operation expenses –2,490 –2,362 5% –2,354 Surplus/deficit –12 2 – 0

 To contents Financial performance of boards and committees Annual Report 2014 41 ation is mainly attributable to higher County Council Assembly decided in travel by public land transport (Metro, costs for the care of Norrtälje residents May to approve a supplemental appro- bus, commuter trains and local trains) at hospitals outside of the Norrtälje priation of SEK 35.6 million for the and around 11,200 people travel by Municipality. This is partly compen- Committee. public marine transport. There are sated by higher revenues at Norrtälje more than 2,800,000 boardings in Hospital for the care of patients who Traffic Committee public land transport, around 8,600 live outside Norrtälje Municipality, and trips with special public transport and costs for primary care and pharma Introduction and mission some 2,400 patient transports. ceuticals that are below budget. The Traffic Committee has the task of Stockholm County has the highest In May 2013, the Committee submit- fulfilling the County Council’s duties as market share of public transportation ted a request to the County Council a regional public transportation in Sweden. A contributing cause to pub- Executive Board Administration for an authority. The Traffic Committee has lic transport being used so widely is adjusted budget limit for 2013 and overriding responsibility for the plan- that it is well developed, has a high fre- 2014, corresponding to SEK 24.1 mil- ning and procurement of public trans- quency of service and has good cover- lion per year. A decision to contribute port services. It is the Committee’s age over the entire county. To encourage funds for 2013 was made in the County responsibility to draft proposals on the more passengers to take public trans- Council Assembly in September 2013. regional transport provisioning pro- port, the Traffic Administration worked In addition, the Committee was com- gramme. The Committee is responsible in 2014 to increase the attractiveness of missioned to carry out an in-depth for public land transport, public marine Stockholm County’s public transport analysis of and report on medical care transport and transport services for the services. needs, the development of prices and disabled. Transport services are pro- Efforts were begun to prioritise the volumes for medical care and other cured from and operated by external introduction of main routes and to cre- expenses for operations financed by contractors. In order to achieve ate conditions in the road network for Stockholm County Council, in consul- well-functioning transport solutions, good passability through an action tation with the Public Healthcare the Committee cooperates with neigh- selection study together with the Services Committee and the County bouring municipalities, county councils Swedish Transport Administration. In Council Executive Board. Reports were and other agencies concerned. a different action selection study for submitted in 2014 after which the Every day, over 790,000 people regional large-capacity public trans-

Traffic Committee

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues County Council grants 8,423 7,913 6% 8,423 Ticket revenues 6,984 6,696 4% 7,157 Other revenues 3,355 3,373 –1% 3,228 Total operation revenues 18,762 17,982 4% 18,808 – of which, SCC internal 8,679 8,250 5% 8,658

Operating expenses Personnel costs –479 –441 9% –513 Purchased transport services –12,674 –12,087 5% –12,607 Other expenses –2,843 –2,786 2% –2,921 Total operation expenses –15,996 –15,314 4% –16,041 Depreciation/amortisation –2,176 –2,010 – –2,017 Net financial items –607 –656 – –750 Surplus before appropriations and taxes –18 2 – 0 Appropriations** 175 – – – Surplus after appropriations and taxes 157 2 – 0 Adjusted surplus* 30 2 – 0 Investments 7,873 5,355 47% 8,118 Average number of annual employees 652 624 4% 635

* Pertains to surplus/deficit before appropriations and tax adjusted for interest effect on pension expenses. ** Pertains to tax optimisation for the LISAB Group.

42 Annual Report 2014 Financial performance of boards and committees  To contents port, a preliminary study is proposed expected to be fully introduced in 2015. Branch, where a supplemental agree- for the Roslagsbanan suburban railway Since 16 June 2014, the Djurgård fer- ment was reached on compensation per to be able to conclude what intercon- ries have been included in the SL tariff kilometre as a complement to earlier nections in the north-east sector best zone A, which means that all SL tickets agreements on compensation per pas- fulfil the study’s goals. are valid for travel with the ferries. senger. In April 2014, the Traffic Committee A study of transport services for the One large deviation among the other decided to appoint Stockholms disabled is under way as all agreements costs pertains to SEK 97 million or Spårvägar as the transport operator for for the services must be procured by about 3 per cent lower costs for planned the Lidingöbanan suburban railway 2016. The agreement for ordering cen- maintenance, electrical energy/utilities and Spårväg City tramway. Bus services tres and the travel guarantee in trans- and urgent and corrective mainte- for the inner-city and Lidingö were pro- port services for the disabled entered nance. As of the 2014 financial year, cured in 2014 and Keolis is now contin- into effect in February, entailing the fixed assets are recognised according to uing work to introduce a new route net- outsourcing of call centre tasks. the K3 rules, which entail changes com- work in June 2015. The bus operator pared with earlier rules. Previously, Nobina was awarded the contract for Finances additional expenses were only capital- bus service in Handen, Tyresö and The Traffic Committee had a surplus of ised if the asset’s performance was Nynäshamn. SEK 30 million for 2014, adjusted for improved. In K3, additional expenses An eight-year agreement was signed increased costs for an interest rate are instead assessed based on general with Djurgårdens Färjerederi AB for change on the calculation of pension asset criteria, which means that the port public transport with the Djurgård liabilities of SEK 48 million. The capitalisation possibilities have ferries. Service began in April 2014. adjusted surplus was SEK 30 million increased. In 2014, reclassifications Procurement of test service in the higher than the budgeted break-even were made from operating costs to fixed archipelago with a north-south direc- and the goal of balanced finances was assets, which explains the deviation tion is under way. achieved. The tax funding ratio for the from budget. A ticket cooperation agreement was Traffic Committee was 50 per cent, Compared with 2013, operating reached with SJ. The aim of the agree- which is on a par with budget. The tar- expenses were SEK 682 million or 4.0 ment is to ensure that the Swedish get for 2013 was 49 per cent. per cent higher. This is mainly due to Transport Administration prioritises Operating revenues totalled SEK higher costs totalling SEK 521 million commuter rail service over other train 18,762 million (17,982) and were below for purchased land service as a result of operators in the event of major traffic budget by SEK 46 million or 0.2 per new transport service agreements and outages. SJ’s passengers then have the cent. Ticket revenues were SEK 173 mil- the full-year effect of service changes in opportunity to switch to commuter lion or 2.4 per cent below budget. This 2013. trains without needing to buy an SL was mainly due to a larger proportion of Depreciation and amortisation were ticket. tickets sold at a discount and an SEK 159 million higher than budget and A project is under way together with increase in travel that did not match the SEK 166 million higher than 2013. The the City of Stockholm to increase passa- budgeted level, which to some extent cost increase is due to higher depreci- bility in bus service. The City has was due to a mild winter. ated/amortised value as a result of an increased the number of bus lanes, Compared with the 2013 outcome, increasing investment volume and sev- improved signal priority, removed a operating revenues increased by SEK eral concluded investment projects. number of parking spaces and removed 780 million or 4.0 per cent. This Net financial items amounted to an some stops, at the same time that increase was mainly due to a County expense of SEK 607 million (expense: boarding has been allowed through Council grant that was SEK 510 million 656), which was SEK 143 million below more doors. or 6.0 per cent higher, and ticket reve- budget. This deviation is attributable to The Metro has expanded service nues that were SEK 288 million or 4.0 lower market interest rates. Compared during rush hour with more departures per cent higher. with 2013, net financial items were SEK before and after the rush-hour peak to Operating expenses amounted to 49 million lower, mainly as a result of a reduce congestion. More trains run SEK 15,996 million (15,314) and were smaller loan portfolio. during rush-hour on the green and red SEK 45 million or 0.3 per cent below Investments for the year amounted lines. Weekend service has been budget. The costs for purchased trans- to SEK 7,873 million. expanded by adding more and longer port services were SEK 67 million or The conditions for public transport trains. On the blue line, longer trains 0.5 per cent over budget. This deviation are affected by population and com- run in evening service until 9:30 p.m. was attributable to higher incentive mercial growth in the region. For the instead of 7:00 p.m. as before. costs, new agreements for bus service Stockholm region, the ability of public A number of improvements have and supplemental agreements for the transport to grow at least at the same been made in the archipelago service by Light Rail Solna Branch. New agree- pace as the population and the planning adding more and better connections ments for bus service in the inner-city of the entire transport system to enable between land and marine service. A that entered into effect in 2014 were a long-term growth of the share of pub- new payment service in marine service more expensive than budgeted. The lic transport are major challenges and is being gradually introduced and is same is true of the Light Rail Solna crucial issues for the future. In recent

 To contents Financial performance of boards and committees Annual Report 2014 43 years, the investment volume has general, culture for children and young arise in contacts with all publicly- increased and it will remain high in the people is prioritised. An overwhelming financed health and medical services. next few years. Some proposed invest- proportion of the external grants shall This involves private, municipal and ments need to be reprioritised over the go to activities for children and young county council municipal care, as well next five-year period. people. It is important that culture is as public dental care and private dental readily accessible to the entire region hygienists. The Committee contributes and that it gives children throughout to improving the quality of healthcare Culture Committee the county the opportunity to grow by by feeding conclusions from received Introduction and mission participating in high quality cultural reports back to the healthcare services. The objective of the County Council’s life. For those who cannot themselves The Committee recruits, trains and cultural activities is to contribute to a travel to cultural experiences, the appoints support persons for patients in high-quality, free and accessible administration has extensive activities compulsory psychiatric care or in isola- cultural life. The Culture Committee with culture in healthcare that is tion in accordance with the Communi- supports free cultural life in Stockholm offered to all elderly care centres and cable Diseases Act. County, in part through long-term hospitals in the county. Activities at the Patient Advisory support to organisations and by Committee prioritise the following supporting various projects. Finances strategic goals as set forth by the Cultural activities that receive sup- There was a deficit of SEK 1 million in County Council Assembly: port must be of high quality. All deci- 2014, which was SEK 1 million lower • Awareness of the Patient Advisory sions regarding support for cultural than the budgeted break-even. The Committee shall increase among the and association life are also based on deviation from budget is mainly due to public and staff. the Committee’s four target areas: the cost of students studying in other • Complaints shall be analysed and democracy, gender equality, equal counties but registered in Stockholm followed up. opportunity and accessibility for the County being higher than budgeted. • Prevention efforts shall be intensi- disabled. Grants are awarded to organi- fied. sations, projects and associations in the Patient Advisory Committee county. Stockholm County Council is The Committee’s quality targets are the chief financier of the Concert House Introduction and mission based on five areas of activity: patient Foundation. The Patient Advisory Committee is a reports, support person activities, pre- Culture must be accessible to all, non-partisan body that is independent vention activities, greater knowledge regardless of age, gender, disability, of healthcare services to which patients among healthcare personnel and pro- ethnic background or education. In and relatives can turn when problems moting contact between healthcare

Culture Committee

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 429 420 2% 427 – of which, SCC internal 415 401 3% 414 Expenses –430 –421 2% –427 Surplus/deficit –1 –1 – 0 Investments 1.8 0.2 – 0.4 Number of full-time equivalents 51 47 9% 43

Patient Advisory Committee

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 21 21 3% 21 – of which, SCC internal 20 19 3% 20 Expenses –21 –21 3% –21 Surplus/deficit 0 0 – 0 Investments – 0.1 – – Number of full–time equivalents 20 20 – 20

44 Annual Report 2014 Financial performance of boards and committees  To contents staff, patients and the public. The qual- or request statistical compilations con- sional auditors who support the County ity targets are defined in the quality tact the administration based on their Council’s elected representative audi- policy that has applied since 2012. own needs and desires. The adminis- tors in their assignment. In 2014, the Committee received tration continues to be very active in the In the annual audit, the risk areas 6,033 reports, 11 per cent more than the information efforts targeted at health- below were examined in 2014: year before. The budgeted number was care. The number of applications for • the build-up of the newly established 5,000. Reports are received in writing, support persons will continue to be Metro Expansion Administration via telephone calls, e-mails or personal monitored and special information • Locum AB’s role in the implementa- visits. The normally more complex efforts will be directed at the operations tion of future health and medical care written cases have increased continu- that provide compulsory care. the care providers’ work on securing ously in recent years and have more the supply of places for on-the-job than doubled since 2005. Finances training In 2014, the Committee handled ten There was a surplus of SEK 0 million in • the administration and development issues of principle. Several of them 2014, which was in accordance with the of the compensation systems in involved multiple care providers and budgeted surplus requirement. emergency somatic care care types, as well as multiple patients. • collaboration between the City of These cases involved: County Council Auditors Stockholm and the County Council in • difficulties for patients in choosing a terms of elderly mentally impaired psychiatric clinic Introduction and mission individuals • referral handling at local emergency The County Council Auditors are com- • the Traffic Committee’s procurement wards missioned by the County Council and follow-up of agreements for • introduction of blocking measures Assembly to audit all operations in transport services for the disabled according to the Patient Data Act Stockholm County Council regardless • the Traffic Committee’s continued • incompletely addressed correspond- of organisational form. Elected repre- development work on the investment ence sentative auditors and lay auditors are process. • deficient coordination the County Council Assembly’s and, • problems getting referral responses ultimately the citizens’, democratic In 2015, the elected representative upon a block being set in the record instrument for audit and control of auditor organisation will be expanded systems operations conducted in the County from 15 elected representative auditors • a patient being forgotten at an Council Executive Board, other boards to 21, of which most are newly elected as emergency ward. and committees, as well as companies auditors. and foundations. The County Council The Committee does not believe it has Auditors’ organisation consists of the Finances the possibility to influence the scope of Audit Board, which has overall respon- There was a surplus of SEK 0 million in the various operating components since sibility for administration of the audi- 2014, which was in accordance with the those who express opinions regarding tors’ activities, three auditor teams and budgeted surplus requirement. healthcare, apply for a support person the Audit Office with expert profes-

County Council Auditors

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 33 32 2% 33 – of which, SCC internal 33 32 2% 33 Expenses –33 –32 2% –33 Surplus/deficit 0 0 – 0 Number of full–time equivalents 24 23 4% 23

 To contents Financial performance of boards and committees Annual Report 2014 45 All Stockholm County Council In addition to this, Stockholm operations County Council has a very important and broad operation that mainly con- The “Financial performance of boards sists of companies and administrations and committees” section aims primar- that are run under company-like forms. ily to provide a view of the operations The table provides an initial insight into and financial performance that are the reported budget deviations for the based on County Council grants as respective operations. A closer descrip- decided on by the County Council tion of these is provided in the opera- Assembly in connection with the tions report. budget. The table provides an overall view of board and committee performance deviations.

Deviations in income compared with budget Surplus/ deficit Budget Deviation SEK million 2014 2014 from budget The County Council Executive Board 831 –310 1,142 Public Healthcare Services Committee –193 0 –193 Healthcare and Social Services Committee –12 0 –12 in Norrtälje Traffic Committee 30 0 30 Culture Committee –1 0 –1 Patient Advisory Committee 0 0 0 County Council Auditors 0 0 0

Deviations in income compared with budget Surplus/ deficit Budget Deviation SEK million 2014 2014 from budget Healthcare Provision, Stockholm County 204 75 128 Karolinska University Hospital –561 30 –591 Södersjukhuset AB –84 9 –94 Danderyds Sjukhus AB –151 7 –157 TioHundra AB 2 0 2 Södertälje Sjukhus AB –1 3 –4 St. Eriks Ögonsjukhus AB 14 1 13 Folktandvården Stockholms län AB 108 20 88 Ambulanssjukvården i Storstockholm AB –4 1 –5 Stockholm Care AB 4 4 0 AB Storstockholms Lokaltrafik –28 0 –28 Special transport services –9 0 –9 Waxholms Ångfartygs AB 15 0 15 Locum AB 18 5 13 Landstingsfastigheter Stockholm (LFS) 338 235 103 MediCarrier AB 6 0 5 Landstingshuset i Stockholm AB –327 –31 –296 AB SLL Internfinans 3 3 0 Damages account 0 0 0 Group financing 822 –310 1,132 New Karolinska Solna 5 0 5

46 Annual Report 2014 Financial performance of boards and committees  To contents Expected development

The economic recovery over the next few years will contribute to continued development of total revenues in the County Council. In order for the finances to continue to be balanced, while at the same time enabling necessary investments in healthcare and public transport, the cost trend must be broken and adapted to the County Council’s long-term financial conditions.

 To contents Annual Report 2014 47 Development over the with every part of the organisation con- the Future Plan for Health and Medical next few years tributing to coordination, flexibility Care. For plan years 2016 and 2017, the and efficiency based on operations-spe- budgeted results amount to a surplus of Strong finances are necessary as the cific conditions. Clearer owner govern- SEK 229 million and SEK 420 million, County Council’s operations strive for ance is necessary to ensure cost control respectively. For the period 2015–2018, development and quality. Balanced and efficient operations. the planned transition costs in the finances are the basis of long-term sus- scope of the Plan for Future Health and tainable development. Both the eco- Sweden and the surrounding Medical Care total SEK 3.5 billion, of nomic development of the surrounding world which SEK 2,570 million is budgeted for world and the population growth in The international recession following 2015–2017. Stockholm County place considerable the financial and debt crisis that began The budgeted surplus presupposes demands on responsible policies. The in 2008 resulted in a long and drawn- that the current cost trend is broken. County Council’s resources must not out recovery process. The economies of Sound cost control forms the prerequi- only handle the modernisation and the US and the UK are now growing at a site for balanced finances. Stockholm development of healthcare and public good rate, which together with Asia are County Council has had a number of transport as well as the expansion supporting the recovery of the global years with a high rate of cost growth, required by a growing population, they economy. However, growth in the euro which has led to a cost level that only must also handle the strains that can zone is still relatively weak and the con- allows limited space for further cost arise from changing conditions in the tinued economic trend is uncertain. increases in 2015 and on. It is crucial surrounding world. The very expansive monetary policies that the operations actively work to There are major challenges and of key central banks and a less restric- introduce new ways of working, use opportunities for the county’s and the tive finance policy will assist the recov- expertise properly and find ways to County Council’s development. This ery of the global economy over the next reduce the rate of cost increases, and applies to future health and medical few years. that existing resources are used in the care, completion of New Karolinska The weak growth in the euro zone most efficient way possible. Solna, and the major Metro agreement together with relatively subdued econo- The budget for 2015 amounts to SEK with nine new Metro stations. There are mies in our Nordic neighbours means 85.8 billion. Calculations for planning also several other important invest- that the contribution to growth from years 2016 and 2017 include a turnover ments in both healthcare and public foreign trade will be limited in the com- of SEK 89.5 billion and SEK 93.3 bil- transport on a scale of several billion ing year. Despite the moderate growth lion, respectively. The County Council’s SEK every year over the coming years. in the rest of the world, employment in revenues are largely reliant on external These investments create conditions for Sweden has continued to grow rela- factors, such as population growth, a growing and functioning Stockholm tively well. However, this is due in part demographic changes and economic region. to a very low productivity growth, growth. The changed revenue level is In order for the County Council’s which, if it lasts, will reduce the long- mainly attributable to higher tax reve- finances to remain balanced, the set term growth potential of the Swedish nues. Tariffs remain unchanged in pub- investment limits may not be exceeded, economy. lic transport and only minor adjust- while at the same time the cost growth Most economic analysts expect the ments are made in healthcare fees. A in the operations must be sustainable in Swedish economy to strengthen some- price increase of 2.5 per cent for adult the long term. The County Council’s what in the period 2015 to 2017 and dental care in public dental care is pro- continued work is therefore focused on estimate that GDP growth will reach posed in the 2015 budget. breaking the rate of cost increase and around 2.5 per cent per year after hav- securing necessary resources. This is to ing grown by around 2 per cent in 2014. Tax revenues allow the County Council to make the It is primarily strong domestic demand Total tax revenues are comprised of tax necessary and extensive investments in that will contribute to growth in revenues, general government grants healthcare, public transport and Sweden during this period. and municipal economic equalisation. research, development and education Stockholm County has managed rel- Total tax revenues for 2015 are esti- in multiple areas. New agreements with atively well in the years following the mated to increase by SEK 3.1 billion the county’s emergency hospitals are financial crisis, thanks in large part to compared with the outcome for 2014 being drafted. The hospitals are being the county trend of growing faster than and amount to SEK 67.1 billion. The given frameworks and thereby long- the rest of Sweden. The beneficial budgeted increase in total tax revenues term stable conditions in order to labour market growth in the region has for 2015 is expected to amount to 4.8 achieve the financial and operational meant that the tax base has grown per cent relative to the outcome of 2014, objectives. rapidly. to then reach 4.6 per cent for the plan- Over the coming years, major ning year 2016 and 4.9 per cent for 2017. demands will be set on a focus on more Target Budget 2015 and plan The increase rates reflect the economic efficient ways of working and on the years 2016–2017 recovery, which is an important prereq- County Council utilising every oppor- The budgeted surplus for 2015 is SEK uisite for the forecast. tunity for consistent joint governance 53 million before transition costs for

48 Annual Report 2014 Expected development  To contents In 2016 and 2017, the cost for the Council will have higher capital costs with the growth of recent years. municipal equalisation system is for New Karolinska Solna, renovations The available investment scope is expected to increase to SEK 1,600 mil- of the other emergency hospitals, and compiled based on balanced finances lion towards the end of the period. The an increased expansion of local health- and is estimated at SEK 75 billion increase in total tax revenues will care in connection with the implemen- over a ten-year period. In addition to thereby be moderated. tation of the Plan for Future Health and this, there are investments for New The tax rate is unchanged at 12.10 Medical Care. In public transport, Karolinska Solna to function optimally per cent during the entire budget investments will be made in vehicles, at opening and investments in the period. technical improvement of existing lines Metro expansion, which are mainly and expansion of the Metro, among financed through co-financing. In total, A balanced cost trend other things. this means investments of SEK 106 bil- In the 2015 budget, operating expenses lion in the next ten years. In order for amount to SEK 79.9 billion, an increase Investment scope this to be possible, the cost growth must of SEK 3.2 billion over budget 2014. The calculation of a future investment be limited, and the implemented invest- Staffing costs and purchased heathcare scope constitutes a complex relation- ments must lead to higher efficiency in and medical services mainly account ship between the development of the the operations. for the increased expenses. At the same net operating costs (the County Coun- The investment plan is focused on time, the capital costs, which consist of cil’s total costs minus operating reve- the next five years and many objects are depreciation and amortisation costs nues), estimated tax revenues, compo- planned and will be commissioned in and interest expenses, are increasing by sition of the investment volume and the 2017–2019, which directly affects the SEK 1.0 billion in the 2015 budget com- level of interest rates. In addition, County Council’s finances. In order pared with the 2014 budget. This Stockholm County Council must take to achieve the objective of balanced increase is due to continued large into account the adopted financial tar- finances, continued cost-efficiency investment volumes and higher market gets, which entail additional limitations improvements, more co-financing and interest rates in connection with the of the investment scope. other sources of finance are necessary, economic upturn. For the planning One important condition for calcula- as well as future property development years, budgeted operating expenses, tions of the investment scope is the and a reprioritisation of objects over excluding transition costs, amount to assumption that the Swedish economy time. The budget for 2015 includes SEK 82.1 billion in 2016 and SEK 85.6 will develop towards higher capacity investments totalling over SEK 15.2 billion in 2017. The budgeted cost utilisation and a more normal cost billion, of which healthcare amounts to increases thereby amount to 2.9 per increase rate, on a par with the Swedish SEK 7.9 billion, public transport to cent in 2016 and 4.1 per cent in 2017. Central Bank’s inflation target of 2 per SEK 7.3 billion and other operations to In addition, financial expenses will cent. Another important prerequisite SEK 86 million. continue to rise, by 15.0 per cent in 2016 is that the population growth in and by 12.5 per cent in 2017. The County Stockholm County continues in line

 To contents Expected development Annual Report 2014 49 Operations report Overall areas of operation

The County Council’s operations and their development are important for the future of the county residents. The foremost task of the County Council is to ensure that county residents have access to high quality healthcare and well-functioning public transport. Stockholm County Council’s surplus for 2014 is in line with the budget, although there are deviations, primarily in emergency medical care.

50 Annual Report 2014  To contents County Council administrations and companies divided into overall areas of operation

Financial and Healthcare Public transport Property other operations

• Healthcare Provision, • AB Storstockholms Lokaltrafik • Locum AB • Group financing Stockholm County • Waxholms Ångfartygs AB • Landstingsfastigheter • AB Stockholms Läns • Karolinska University Hospital • Transport Services for the Stockholm (LFS) Landstings Internfinans • Södersjukhuset AB Disabled • Landstingshuset i Stockholm AB • Danderyds Sjukhus AB • Damages account • TioHundra AB • Culture • Södertälje Sjukhus AB • St. Eriks Ögonsjukhus AB • Ambulanssjukvården i Storstockholm AB • Stockholm Care AB • Folktandvården Stockholms län AB • MediCarrier AB

 To contents Operations report Annual Report 2014 51 Governance

Stockholm County Council is governed by the County Council Assembly. Governance is based on the Local Government Act and many other laws, such as specific legislation for healthcare, public transport and regional planning.

The County Council has extensive operations in healthcare and public transport with its own healthcare operations in corporate form and transport and property operations in corporate form. In addition to this, the County Council procures operations carried out by contractors. Governance is developed and strengthened. The owner policy and general and specific owner directives form the basis of coherent and strong owner governance.

52 Annual Report 2014  To contents County Council’s County Council’s prerequisites and Assignments responsibility and mission guidelines for sound financial management over time. The areas particularly The County Council Assembly has ulti- Stockholm County Council’s primary illustrated are the long-term develop- mate responsibility for Stockholm mission is to: ment of the equity/assets ratio and County Council’s operations. The politi- • provide well-functioning and acces- equity, as well as the management of cal leadership decides on operational sible healthcare, including dental transition costs over time as a result of strategy, finances, objectives and prior- care the Plan for Future Health and Medical ities, and commissions committees and • provide reliable public transport, Care. boards to carry out assignments including transport services for the regarding implementation, investiga- disabled tions and analyses. These assignments • contribute to a free, accessible, high Objectives are the political leadership’s way of gov- quality cultural life To achieve the overall objectives, goals erning the operations and creating • manage regional planning and par- have been broken down that have a changes to thereby achieve the best ticipate in creating conditions for clear connection to the respective over- possible results for the residents of the regional growth and development riding objective. These goals show what county. Accordingly, it is of great areas are prioritised and they will make importance to monitor the work with The work for sustainable growth forms it possible to achieve the overall objec- the set assignments so that the Assem- a unifying theme through the County tives. The goals are followed up using bly can get an overall view of the imple- Council’s operations and is framed by measurable indicators. The overall mentation of the assignments. ambitions regarding research, educa- objectives shall be viewed over time and tion, social responsibility and effective are considered to be fulfilled when at Assignments in budget 2014 environmental efforts. Operations least half of the total indicators under In the objectives and budget for must continuously be developed with a the respective objectives are achieved. Stockholm County Council for 2014 and focus on providing the residents with The broken-down goals are considered plans for 2015–2016, the County Council good service in an efficient manner in to be met when at least half of the Assembly decided on a number of order to meet present and future needs. underlying indicators are achieved. The assignments. Below is a presentation of In 2014, continued efforts on a overall objectives are presented in the collective results of assignments coherent financial management strat- Chapter 3. issued by the County Council Assembly egy were focused on describing the in connection with the 2014 budget,

Missions given in budget 2014

Yes Partially No Total

Degree of completion at 31 December, count 21 15 2 38 Degree of completion at 31 December, % 55 40 5 100

Outstanding assignments from 2013 and 2012 budgets

Missions given in budget 2014 Yes Partially No Total

2013 Degree of completion at 31 December, count 49 2 0 51 Degree of completion at 31 December, % 96 4 0 100 2012 Degree of completion at 31 December, count 41 2 0 43 Degree of completion at 31 December, % 95 5 0 100

Assignments issued in 2014

Yes Partially No Total Degree of completion at 31 December, count 46 14 5 65 Degree of completion at 31 December, % 71 21 8 100

 To contents Governance Annual Report 2014 53 LS 1301-0040, and assignments issued Act, the County Council Executive Compliance with municipal powers in connection with the 2013 budget, Board has supervisory responsibility After analysis and review of the reports LS 1201-0055, and the 2012 budget, over the County Council’s committees in the submitted corporate governance LS 1105-0733, which were not reported and companies. This involves ensuring reports for the County Council’s wholly as resolved in connection with the 2013 compliance with requirements estab- owned and partially owned companies, year-end report. lished based on steering documents it can be confirmed that no deviations and requirements. The report there occurred from the stipulated municipal Assignments issued in 2014 also contains in-depth feedback report- powers during the 2014 financial year. In 2014, the County Council Executive ing of the policies for disability, public Board and the County Council Assem- health and procurement. Internal control bly made decisions of a financial nature The County Council Assembly and The County Council’s boards and com- where reporting shall take place in the the County Council Executive Board mittees must comply with the Policy for County Council’s 2014 annual report. shall have the right of disposition over Internal Control for Stockholm County the operations conducted in commit- Council and Companies (LS 1303- tees and companies. Committees and 0431). Boards and committees are Follow-up of supervisory administrations are governed based on responsible for establishing systems for obligations the regulations adopted by the County internal control in their operating areas Supervision concerns establishing that Council Assembly. Companies are gov- in accordance with the regulations for the County Council’s operations in both erned in part through specific owner Stockholm County Council. administration form and company directives. The objective of internal control is to form have been conducted in accord- The County Council’s wholly and achieve the following goals: ance with applicable legislation, partially owned companies shall com- • appropriate, cost-effective and safe adopted policies and steering docu- ply with the requirements under the operations ments, and that they have adequate Local Government Act, which include • reliable accounting and financial internal control. guidelines in the articles of association reporting and information for each company for the set municipal • compliance with applicable legisla- Supervision report purpose and the municipal authorisa- tion and directions, etcetera. The supervision report is the County tions. Council Executive Board’s tool for In 2014, the Executive Committee Each committee and board shall, in reporting back to the County Council and the Production Committee had the connection with interim reporting and Assembly on the supervision of all of express responsibility to take care of the year-end report, report the status of the County Council’s committees, owner governance issues before the internal control in accordance with the boards and company boards and their County Council Executive Board. Dur- County Council Executive Board’s operations conducted during the year. ing the year, continuous owner dia- instructions. In connection with this, The supervision report is available as logues were held with the County Coun- the respective administration head or an appendix to the County Council’s cil’s companies and administrations company manager must also ensure 2014 annual report. A brief presenta- under company-like forms. that necessary steps have been taken to tion of the report’s contents is provided The report also includes feedback on achieve adequate internal control. below. the County Council Assembly’s objec- In the year-end report, all commit- In connection with reporting for tives and assignments in 2014. tees and boards submitted an assur- 2014, boards and committees had to ance that necessary steps were taken to submit a governance and corporate Compliance with the set achieve adequate internal control governance report, respectively. The municipal objectives within the respective committee and latter reporting takes place in accord- After analysis and review of the reports board. Almost all committees and ance with requirements according to in the submitted corporate governance boards also appended the 2014 fol- the owner policy. reports for the County Council’s wholly low-up of internal control. Some units The County Council’s governance in owned and partially owned companies, commented that they had not yet fin- general and owner governance in par- it can be confirmed that no deviations ished the follow-up of the 2014 internal ticular are based on legal requirements, occurred from the stipulated municipal control. steering documents and policies. In objectives during the 2014 financial accordance with the Local Government year.

54 Annual Report 2014 Governance  To contents Health and medical care

To meet the residents’ greater need for healthcare, major investments continued to be made in 2014. The implementation of the Plan for Future Health and Medical Care is of considerable importance for achieving better accessibility and quality in healthcare. The vision of the Plan for Future Health and Medical Care shifted to tangible implementation in 2014.

 To contents Annual Report 2014 55 General health and In other respects, the new act includes collaboration is secure and easy access to medical care equivalent formulations to the current information on the patient. The County regulations regarding, for instance, the Council Executive Board decided in At the national level, the objective for care guarantee, a primary care contact, March 2014 that new system support healthcare services is to provide the a primary medical contact, individual should be introduced for the handling patient added value in the form of better planning and a choice of treatment of care information. This work is now health. The population should be offered options and aids. Regulations concern- being coordinated with the Region high-quality needs-based, accessible ing a child’s influence over his or her Västra Götaland and Region Skåne. and effective care. Based on these con- care have also been included in the act. ditions, the government together with In Stockholm County Council, more Open comparisons between the Swedish Association of Local patient care choice according to the Act county councils Authorities and Regions identified on System of Choice in the Public Sector In Open Comparisons 2014: Health- important development areas where (LOV) has been gradually introduced care, Comparisons between county special agreements were reached. since 2008. Six new patient care councils, a large number of comparative To stimulate the County Council’s choices were added in 2014, which indicators are presented. In general, the efforts for improved accessibility in means that there are now 31 patient state of health improved gradually in planned and specialised care, the gov- choice areas. A new maternity ward at both Stockholm County and Sweden as ernment allocated the “Queue Billion” Sophiahemmet, BB Sophia, was estab- a whole. There are, however, differences (Kömiljarden) over the years 2008 to lished during the year, increasing the in morbidity that are related to socioec- 2014 to shorten waiting times. This childbirth capacity in the county. BB onomic conditions. Access to health- funding aims to achieve the goal of care Sophia has capacity to handle about care is perceived as good in Stockholm with patient safety and sustainable 4,000 deliveries per year. County Council and confidence in accessibility over time with the healthcare centres and hospitals is per- patient’s route through the healthcare The Plan for Future Health ceived as good. system in focus. Stockholm County and Medical Care Council was eligible for this funding for In 2011, the County Council Assembly Finances clinic visits in every month of the year. adopted the Plan for Future Health and Total healthcare costs for Stockholm For three months of the year, the per- Medical Care in Stockholm County County Council increased by 6.2 per formance requirements for treatment Council. In 2014, this work shifted from cent in 2014, exceeding budget by SEK were also achieved. the earlier analysis, planning and spec- 1,625 million. The cost of externally Another area was the initiative on ification efforts to a distinct implemen- purchased care increased without a the most ill elderly where government tation phase. In December 2014, the corresponding cost reduction in County grants have been used to encourage, County Council Assembly approved the Council operated care despite strengthen and intensify collaboration implementation of the adjustments in unchanged or reduced healthcare vol- between municipalities and county the care services presented in stage umes. On the contrary, staffing costs in councils. The work conducted in the three of the Plan for Future Health and particular increased sharply at the scope of the effort will be implemented Medical Care. An important channel to same time as considerable care capacity in the municipalities’ and county coun- give residents and patients accurate was closed due to difficulties recruiting cils’ regular work. The agreement guidance in the relocations and changes nurses. To restore balance to the expired at year-end. in care that will take place based on the finances, action programmes must be A new Patient Act (2014:821) entered Plan for Future Health and Medical implemented in the county’s emergency into effect on 1 January 2015. The act Care is the healthcare guide service hospitals to adapt costs to the scope aims to strengthen and clarify the 1177 Vårdguiden. permitted by the County Council’s patient’s position and promote patient It is important that the use and finances that has been established as a integrity, self-determination and par- spread of 1177 Vårdguiden’s e-services, cost ceiling in the hospitals in the care ticipation. such as My Healthcare Contacts or Care agreements for 2015. The new act entails the following: Events, increase for greater accessibil- • The information obligation to the ity for residents and patients and as an Consumption patient is expanded and clarified. aid in making care processes more effi- These statistics present total care con- • Health and medical care may as a cient. The proportion of residents and sumption for the entire Stockholm general rule not be given without the number of clinics that have an account County Council, meaning the sum of patient’s consent. in My Healthcare Contacts increased the Public Healthcare Services Com- • The patient’s possibility of getting a during the year. mittee and the Health and Social care second opinion is expanded. To achieve the objectives according Committee in Norrtälje. • The patient shall be given the oppor- to the Plan for Future Health and Medi- The change in healthcare consump- tunity to choose the provider of cal Care, collaboration between care tion compared with the previous year publicly financed primary care and providers in online healthcare is a fun- should be put in the perspective of pop- outpatient specialist care throughout damental strategy. One of the most ulation growth, which was 1.6 per cent Sweden. important prerequisites to develop such in Stockholm County in 2014.

56 Annual Report 2014 Health and medical care  To contents Care episodes in which the patient is cent higher than 2013. Emergency hos- per cent and those in geriatrics for only meant to stay overnight, as well as pital care episodes in obstetrics around 0.2 per cent. The relatively doctor’s visits and other healthcare amounted to approximately 24,200 small volumes for geriatrics also mean visits, increased compared to last year’s (26,000), which was 7.1 per cent lower that the percentage changes between levels. However, the number of care epi- than 2013. This decrease is because BB various periods can be relatively large. sodes and doctor’s visits were fewer Sophia began its childbirth activities on The total number of visits to doctors in than budgeted. 3 March 2014. somatic specialist care increased by 2.5 Visits to other care providers were The number of geriatric care episodes per cent compared with last year. Doc- above budget. was 6.1 per cent higher than in 2013 and tor’s visits at emergency hospitals and 5.6 per cent over budget, which is mainly in specialist care increased by 7.4 per Care episodes attributable to a larger capacity and cent, while visits to private specialists Total production for the year amounted more capacity per unit. The average at a national tariff decreased by 17 per to approximately 327,000 (326,000) time in geriatrics was 10.5 days, which cent compared with 2013. care episodes in inpatient care, which corresponds to a 1.5 per cent shorter In total, the number of visits in was 0.2 per cent higher than 2013 and care time than in 2013. primary care amounted to about 1.9 per cent below budget. There were In psychiatry, the number of care 12,000,000 (11,500,000). Of these, 0.5 per cent fewer care episodes in episodes was unchanged compared approximately 40 per cent are visits to somatic specialist care and 0.1 per cent with 2013. doctors, which is an increase of 1.2 per fewer care episodes in psychiatry than cent higher than 2013 and 2.9 per cent in 2013. The number of care episodes in Visits to doctors and visits to other over budget. The increase in the num- geriatrics increased by 6.0 per cent. The care providers ber of visits to doctors is mainly attrib- average care time in somatic specialist Total production for the year amounted utable to GP visits. Approximately 60 care was 3.5 days, which was a decrease to approximately 8,001,000 per cent of the total number of visits are of 0.1 days compared with 2013. (7,873,000) visits to doctors, which was made to care providers other than The total number of care episodes at 1.6 per cent higher than 2013 and 1.9 doctors, such as district nurses and emergency hospitals was 1.6 per cent per cent below budget. The largest num- assistant nurses at the GP clinics, phys- lower than 2013. At Danderyds Sjukhus ber of doctor’s visits can be found in pri- iotherapists, speech therapists, occupa- AB, the number of care episodes was 5.1 mary care, which accounts for more tional therapists and chiropractors. per cent lower than in 2013, 0.9 per cent than half of all doctor’s visits. Visits to The total number of other visits for lower at Södersjukhuset AB and 6.3 per doctors in somatic specialist care the year amounted to 9,824,000 cent lower at Södertälje Sjukhus AB. At account for nearly 40 per cent of the (9,303,000), an increase of 5.6 per cent Karolinska University Hospital, the total number while doctor’s visits in higher than 2013 and 5.6 per cent over number of care episodes was 0.2 per psychiatry account for approximately 5 budget. Most other visits take place in

Healthcare Stockholm County Council Deviation Outcome Outcome Change Budget from SEK million 2014 2013 % 2014 budget Care episodes 327,151 326,425 0.2% 333,491 –1.9% Visits to doctors 8,000,773 7,872,806 1.6% 8,159,121 –1.9% Visits to other care 9,823,887 9,303,447 5.6% 9,305,860 5.6% providers

ConsumptionConsumption of healthcare of healthcare 2014, 2014,compared compared with 2013with 2013

Care episodesCare episodes Visits toVisits doctors to doctors

6.1% 6.1%

2.5 % 2.5 % 2.1% 2.1% 1.6% 1.6% 1.2% 1.2%

–0.5 % –0.–0.1%5 % –0.1% 0.2% 0.2% –0.6% –0.6%

Total Total Total Total PsychiatryPsychiatryGeriatrics Geriatrics PsychiatryPsychiatryGeriatrics Geriatrics Somatic careSomatic care Primary carePrimarySomatic care careSomatic care

 To contents Health and medical care Annual Report 2014 57 primary care where the visits amounted Accessibility requirements while the one with the to approximately 7,592,000 (7,124,000), Time-related accessibility to care is highest result had 100 per cent. 6.6 per cent higher than in 2013 and highly prioritised in Stockholm County 6.6 per cent over budget. Council and accessibility is continu- Waiting times for GP visits ously followed up. The follow-ups are Measurements of waiting times for GP Prehospital care based on the regulations and time lim- visits in 2014 show that 89 per cent of Road-based paramedic assignments its of the care guarantee. Attainment of patients were able to see a GP within decreased by 0.4 per cent compared the target values for the care guarantee five days, which is unchanged com- with the previous year. Of these, 48 per is measured based on reported data. The pared with 2013 (not counting cent were highest priority assignments. care guarantee has been a part of the patient-chosen waits). If the patient has Seven new ambulances were ordered in Health and Medical Care Act since 2010. not chosen to wait longer, 93 per cent of 2013 pursuant to the Public Healthcare Accessibility measures target fulfil- GP visits occur within seven days, which Services Committee’s “Ambulance ment with regard to same-day tele- is 2 percentage points lower than 2013. Improvement” decision and another phone contact with healthcare services, The median wait for a GP visit was two were ordered in 2014. There are a a visit to a general practitioner (GP) zero days, not counting patient-chosen total of 73 ambulances in the county, within five days and a clinic visit to a waits. All of 69 per cent of the visits including one out-of-county ambulance specialist within 30 days as well as took place the same day. The average and one intensive care ambulance. received treatment within 90 days (the number of waiting days is two, not “0-5-30-90” rule). Stockholm County counting patient-chosen waits. An aver- Dental Care Council has chosen more demanding age value that is significantly higher The waiting time for treatment of targets for clinic visits and GP visits than the median value means that the children and adolescents in specialist than those set in the national goals, involuntary waiting time was long for a dental care stayed within the agreed which are 90 days and seven days, few of the visits although the majority maximum limit of two months and was respectively. of the patients did not need to wait at thereby on the same level as the corre- all. There are no differences in waiting sponding period in the previous year. Care guarantee times between men and women. The proportion of children and young Waiting times chosen by patients or people who visited dental care during determined by medical factors are not Waiting times for visits to specialists the year decreased by 1.4 percentage included when assessing whether the In the follow-up of the care guarantee point to 94.0 per cent compared with care guarantee has been met, and are for clinic visits, 26 specialities are mon- the same period last year, but was 1.0 removed from calculations of 30 and 90 itored. Stockholm County Council has a per cent over budget. The proportion of day waits. These compilations are done more stringent care guarantee limit for three-year-olds without caries dam- in accordance with the directive of the clinic visits than applies nationally. aged teeth was very high at 96 per cent. Swedish Association of Local Authori- After a decision on a referral or care The proportion of 19-year-olds with ties and Regions according to the for- request, a visit within the planned spe- caries-free lateral surfaces has mula of the number of patients who cialised care should if necessary be increased in recent years, but has now wait less time than the care guarantee’s offered within a maximum of 30 days stabilised at a high level. For 2014, this limit divided by the total number of after the decision day. The correspond- proportion was 68.3 per cent compared patients waiting. ing national limit is 90 days. This is the with 67.3 per cent for the previous year. Under the care guarantee, a patient only difference to the national care The waiting time for treatment of should not have to wait more 90 days guarantee. adults within specialist dental care for treatment after a decision on treat- The proportion of patients who stayed within the agreed maximum ment has been made. The limit applies waited 30 days or less for a clinic visit limit of two months. The number of to both Stockholm County Council and amounted to 65 per cent in December commenced orthodontic treatments nationally. Treatment follow-up com- 2014, a decrease of 4 percentage points increased by 4 per cent to 5,450 comprises all planned surgical treatments compared with the same period last pared with the same period last year. with only a few exceptions. year. The average result for 2014 was This increase is attributable to higher 70 per cent. care production by private care provid- Phone accessibility The total proportion of those who ers. The number of adults treated as a Phone accessibility (0 days waiting waited 30 days or less for a clinic visit part of a disease treatment decreased time) is still acceptable. The 2014 meas- was relatively stable in the first five by 4.0 per cent compared with the same urements indicate that a total of 94 per months of the year and then lower period last year to 6,449. The decrease cent of all test calls to GP clinics were during the summer months to again is mainly due to two patient categories deemed satisfactory according to the increase somewhat the rest of the year. being transferred to a special dental national care guarantee of same-day The areas that best managed the pro- subsidy in the government dental care contact. This result is on a par with the portion of those waiting 30 days or less assistance. 2013 figure. The clinic that had the low- is vascular surgery and plastic surgery. est result had 69 per cent satisfactory All had an attainment rate over 94 per calls according to the care guarantee’s cent. The area that showed the lowest

58 Annual Report 2014 Health and medical care  To contents Percentage of patients who waited within the care guarantee limit for clinic visits 2014

100%

80%

60% Percentage of patients who waited within the care guarantee limit for clinic visits 2014 40%

100%20%

80%0% 60%

40%

20%

0% Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec SCC 2013 72% 76% 77% 78% 77% 71% 57% 65% 75% 80% 80% 69% Nat 2013 95% 96% 97% 98% 97% 96% 94% 91% 93% 96% 97% 96% SCC 2014 78% 81% 79% 76% 71% 66% 51% 62% 74% 70% 72% 65% Nat 2014 95% 95% 95% 94% 95% 93% 92% 88% 91% 88% 96% 94%

Percentage of patients who waited within the care guarantee limit for treatment 2014

100%

80%

60% Percentage of patients who waited within the care guarantee limit for treatment 2014 40%

100%20%

80%0% Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 60% 2013 88% 88% 90% 91% 90% 89% 86% 82% 84% 90% 92% 91% 201440% 90% 90% 90% 92% 88% 92% 89% 85% 87% 93% 94% 92%

20%

Kömiljarden – waiting for treatment 2013 and 2014

100%

80%

60%

40%

20%

0% Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2013 63% 67% 70% 70% 69% 66% 54% 48% 62% 71% 72% 66% 2014 65% 68% 68% 70% 65% 66% 56% 50% 63% 73% 71% 67%

Kömiljarden – waiting for a clinic appointment 2013 and 2014

100%

80%

60%

40%

20%

0% Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2013 80% 83% 85% 85% 85% 82% 73% 71% 81% 85% 86% 82% 2014 74% 86% 87% 84% 83% 79% 71% 70% 79% 80% 86% 81%

 To contents Health and medical care Annual Report 2014 59 result in terms of proportion of patients Patients with a patient-chosen wait rehabilitation units. Healthcare Provi- waiting is hand surgery. (PCW), meaning that they have waived sion Stockholm County also provides The proportion of those waiting less the care guarantee for personal reasons aids for the disabled, habilitation, geri- than the national care guarantee’s limit or because they want to see a specific atrics and advanced home healthcare. of 90 days amounted to 92 per cent in care provider, are included in all parts December 2014, which is a decline of 1 of the calculation. Finances percentage point compared with Extra compensation is payable if There was a surplus of SEK 204 million December 2013. 80 per cent of the patients who had an in 2014, which was SEK 129 million The proportion of waiting patients initial clinic visit or underwent an oper- higher than the budgeted surplus who received treatment within the ation or received treatment during the requirement of SEK 75 million. This national care guarantee limit amounted month had waited less than 60 days. surplus was SEK 75 million higher than to 92 per cent in December 2014, which For 2014, Stockholm County Council 2013. The difference against 2013 is is an improvement of 1 percentage point was eligible for Kömiljarden funding for mainly attributable to a new compensa- compared with the same period last clinics in all months since the basic tion model in psychiatry. year. The average result for 2014 was 90 requirement of a minimum of 70 per cent Operating revenues were SEK 408 per cent. was achieved during the whole period million higher than in 2013, which is an The areas with the best results in from January to December. In terms of increase of 4.3 per cent. This outcome terms of the proportion of those waiting treatment, the County Council is eligible was SEK 398 million or 4.2 per cent for treatment within the care guarantee for Kömiljarden funding for April, over budget. The deviation from budget limit are cardiac care, ophthalmology, October and November since the basic is mainly due to revenues for sold health surgery and gynaecology. In these requirement of a minimum of 70 per care and medical services. areas, more than 93 per cent of patients cent was achieved during these months. Operating expenses were SEK 327 receive care within the care guarantee For clinics, SCC achieved the extra million higher than in 2013, which is an limit. The areas that show the lowest level of compensation for all months increase of 3.5 per cent. This outcome results are neurosurgery and ear, nose except June, August and September, was SEK 272 million or 2.9 per cent over and throat. Orthopaedics and surgery since more than 80 per cent of the budget. The deviation from budget is have the highest number of patients patients who had an initial clinic visit primarily attributable to personnel waiting. had waited no more than 60 days. costs and costs for insourced personnel. Depreciation and amortisation costs Kömiljarden Healthcare Provision, were SEK 5 million higher than in 2013 In 2014, the results requirement for and SEK 2 million below budget. receiving funding from the programme Stockholm County Net financial items (financial income was divided into two parts. The basic Introduction and mission and expenses) were SEK 1 million lower requirement is that at least 70 per cent Healthcare Provision Stockholm than the preceding year and SEK 1 mil- of patients should have waited fewer County is responsible for the County lion lower than budget. This deviation than 60 days as of the end of every Council owned psychiatry for children is mainly attributable to the change in month. If the basic requirement is met, and adolescents, adults and the elderly the discount interest rate for pension the potential performance-based com- and also has specialised dependence liability calculation. pensation is determined according to care and forensic psychiatry. Primary the actual waiting times, which is how care comprises health centres, local Goal attainment long the patient had waited at the end of urgent care clinics, child and maternity The balanced finances objective was the wait. care, youth counselling centres and achieved as the surplus was above the

Kömiljarden actual waiting periods 2014 Stockholm County Council

100% 91% Clinic appointment 90% 89% 89% 90% 86% 86% 88% 88%87% 87% 79% Treatment 76% 77% 77% 80% 74% 74% 76% 75% 71% 71% 72% 72% 70% 65% Target 70 % 62% 60% 50% 40% 30% 20% 10% 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

60 Annual Report 2014 Health and medical care  To contents budgeted surplus requirement. Acces- higher than 2013 and 1.9 per cent over by 2.0 per cent compared with 2013. sibility to GP care within five days was budget. The average care time was 9.3 Production volume increased by 3.3 per on a par with the outcome for 2013. days or 0.4 below budget. The number cent while expenses, adjusted for price Accessibility, time to the first visit, of visits in outpatient care amounted to and salary increases, grew by 1.3 per decreased by 5 percentage points since approximately 8,500 (9,100), which cent. In primary care, productivity 2013 to 79 per cent in adult psychiatry was 6.6 per cent lower than 2013 and decreased by 0.3 per cent, mainly due to and by 3 percentage points to 97 per 18.1 per cent below budget. The differ- cost increases. In geriatrics, productiv- cent in dependence care. ence is mainly attributable to opera- ity increased by 7.6 per cent due to vol- tional changes and reduced demand. ume increases and in psychiatry, pro- Production The number of visits in psychiatric ductivity increased by 2.4 per cent due The number of visits in primary care care amounted to approximately to volume increases and low cost amounted to approximately 3,968,000 1,210,000 (1,206,000), which was 0.4 increases. (3,902,000), which was 1.7 per cent per cent higher than 2013 and 6.8 per higher than 2013 and 1.5 per cent below cent below budget. The number of care Future outlook budget. The difference against budget is episodes was 0.9 per cent higher than in Besides on-going development work, primarily attributable to the visits by 2013 and 0.5 per cent below budget. Healthcare Provision Stockholm Team Äldredoktorn to assisted living This difference is mainly attributable to County will also focus on developing being in the primary care budget, a change in the reporting of visits in four areas in 2015: skills supply, but being reported in geriatrics visit 2013. inter-operational care processes, statistics. Healthcare Provision Stockholm The number of care episodes in Productivity County as a good recipient, and effec- geriatrics amounted to approximately In total, productivity in Healthcare tive support processes. 10,800 (10,100), which was 7.5 per cent Provision Stockholm County increased

Healthcare Provision, Stockholm County

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Health and medical care sold 8,213 7,902 4% 8,029 – Sold health and medical care, SCC 8,023 7,726 4% 7,836 Other revenues 1,676 1,579 6% 1,462 Total operation revenues 9,889 9,481 4% 9,491

Operating expenses Personnel costs –6,842 –6,626 3% –6,781 Other expenses –2,769 –2,659 4% –2,559 Total operation expenses –9,612 –9,285 4% –9,340 Depreciation/amortisation –75 –70 – –77 Net financial items 1 2 – 2 Surplus/deficit 204 129 – 75 Investments 65 84 –23% 66 Number of full-time equivalents 10,959 10,865 1% 10,950

Surplus/deficit emergency hospitals Deviation Outcome Outcome Budget from SEK million 2014 2013 2014 budget Karolinska University Hospital –561 –9 30 –591 Södersjukhuset AB –84 –82 9 –94 Danderyds Sjukhus AB –151 –66 7 –157 TioHundra AB 2 –9 0 2 Södertälje Sjukhus AB –1 –4 3 –4 St. Eriks Ögonsjukhus AB 14 3 1 13 Total emergency hospitals –781 –167 51 –831

 To contents Health and medical care Annual Report 2014 61 Follow-up of emergency Revenues for the emergency hospi- ber of measures in 2014 to reduce costs hospitals tals amounted to SEK 24,939 million and increase revenues, and these (24,241), which was an increase of 2.9 efforts will continue in 2015. Stockholm County Council has six per cent compared with the preceding emergency hospitals that are run under year and 0.1 per cent over budget. Karolinska University Hospital the County Council’s own direction. Above all, revenues increased for sold The task of the emergency hospitals is primary services by SEK 458 million or Introduction and mission primarily to satisfy the county’s resi- 2.2 per cent compared with last year, Karolinska University Hospital is one of dents’ need for emergency and planned but were SEK 177 million below budget. Europe’s largest hospitals. Its main task treatments and visits. The assignment Through compensation reductions and is to take responsibility for the County also includes conducting research, penalties, the emergency hospitals Council’s national and regional health- education and development as well as received less total compensation in care. This includes advanced and highly national medical care and care for 2014 as the requirements concerning specialised healthcare, as well as residents of other county councils by accessibility, quality and environmen- research and education. Operations are agreement. tal target were not fully met. geographically concentrated to Solna The largest emergency hospital is There are many reasons for the devi- and Huddinge, but the hospital is also Karolinska University Hospital, which ation and they vary between the hospi- responsible for certain operations at accounts for around 65 per cent of the tals. Common among them are, how- Södersjukhuset, Danderyd Hospital, collective turnover. Norrtälje Hospital ever, higher staffing costs, which are Rosenlund Hospital, Spinalis/Rehab is operated by TioHundra AB, which is a costs for own and insourced personnel. Station Stockholm and around 80 local company jointly owned by the County Staffing costs amounted to SEK 16,025 laboratories in primary care. Council and Norrtälje Municipality. St. million (14,980), which was an increase Eriks Ögonsjukhus AB is specialised in of 7.0 per cent compared with the Finances ophthalmology. The other emergency preceding year and 5.0 per cent over There was a deficit of SEK 561 million in hospitals are Danderyds Sjukhus AB, budget. The staffing costs increased in 2014, which was SEK 552 million lower Södersjukhuset AB and Södertälje part due to a shortage of nurses and than 2013. The difference compared to Sjukhus AB. higher personnel turnover, which has 2013 is mainly due to a high cost The total results for the emergency entailed higher costs for training and growth, mainly for own and insourced hospitals amounted to a deficit of SEK insourced personnel. personnel and consultants. 781 million (deficit: 167), adjusted for In 2014, production for outpatient Operating revenues were SEK 487 interest expense and payroll tax on the care increased by 4.3 per cent and million higher than in 2013, which is an year’s pension liability as a result of a decreased in inpatient care by 1.6 per increase of 3.1 per cent. This outcome change in the discount rate. This was cent. was SEK 268 million or 1.7 per cent over SEK 832 million lower than the budg- In dialogue with the County Coun- budget. The deviation from budget was eted surplus requirement of SEK 51 cil’s management, the respective hospi- due in part to higher revenues for million. tals planned and implemented a num- research, development and education

Karolinska University Hospital

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Health and medical care sold 12,865 12,610 2% 12,871 – Sold health and medical care, SCC 12,042 11,768 – 11,959 Other revenues 3,297 3,065 8% 3,023 Total operation revenues 16,162 15,675 3% 15,894

Operating expenses Personnel costs –9,484 –8,916 6% –9,032 Other expenses –6,889 –6,422 7% –6,463 Total operation expenses –16,373 –15,338 7% –15,495 Depreciation/amortisation –308 –309 – –333 Net financial items –43 –36 – –36 Surplus/deficit –561 –9 – 30 Investments 208 297 –30% 228 Number of full-time equivalents 15,371 14,976 3 % 15,213

62 Annual Report 2014 Health and medical care  To contents (RD&E), external projects such as difference is mainly attributable to hospital is focused on the major public pharmaceutical trials, and compensa- lower interest income. diseases, such as diabetes, cardiovas- tion for on-going projects related to cular diseases and hip fractures. Vascu- New Karolinska Solna. The revenues Goal attainment lar surgery is a speciality, as is the according to the main agreement The balanced finances objective was regional assignment for hand surgery. signed with the care client, the Public not achieved as the results were below Södersjukhuset also conducts educa- Healthcare Services Committee, were the budgeted surplus requirement. tion and clinical research related to the SEK 1 million lower than agreed. The Accessibility for the number of patients healthcare mission. care provided according to the “side waiting for a new visit and for treatment agreements” was SEK 13 million less increased compared with 2013. The Finances than budgeted. Revenues for the out-of- quality target of the proportion of There was a deficit of SEK 84 million in county and international care provided healthcare-associated infections was 10 2014, adjusted for increased costs were SEK 8 million over budget. Sales per cent, which is 2 percentage points resulting from an interest rate change of laboratory services were SEK 71 mil- lower than in 2013. in the calculation of pension liabilities lion higher than budgeted. of SEK 149 million. The adjusted result Operating expenses were SEK 1,035 Production was SEK 93 million lower than the million higher than in 2013, which is an Total production for the year amounted budgeted surplus requirement of SEK 9 increase of 6.7 per cent. This outcome to approximately 105,600 (104,900) million. The result was SEK 2 million was SEK 878 million or 5.7 per cent over care episodes in inpatient care and lower than 2013. The difference com- budget in 2014. The deviation from 1,609,200 (1,498,200) visits in outpa- pared to 2013 is mainly attributable to budget is largely attributable to staffing tient care. Production in outpatient higher personnel costs. costs (own and insourced personnel) care was 6.0 per cent higher than Operating revenues were SEK 97 being SEK 582 million higher than budget and in inpatient care 4.7 per cent million higher than in 2013, which is an budgeted. Both the number of employ- lower than budget. The foremost reason increase of 2.5 per cent. This outcome ees and the salary levels increased more for the lower production for inpatient was SEK 41 million or 1.0 per cent below than was provided for in the budget. care episodes was a shortage of availa- budget. The deviation from budget is The labour market shortage of nurses ble staffed beds. mainly attributable to lower healthcare has driven up the salary levels for new volumes. However, revenues increased employees and increased the expecta- Productivity regarding the side agreements, mainly tions of higher wages and salaries for Productivity (number of points pro- for the paediatric clinics and ophthal- already employed personnel. During duced/adjusted total cost) decreased by mology clinic. the year, the cost of insourced person- 4.7 per cent compared with 2013. The Operating expenses were SEK 181 nel increased by SEK 111 million as a decrease is due to the price-adjusted million higher than in 2013, which is an result of the shortage of specialist costs increasing at the same time as the increase of 4.8 per cent. This outcome nurses, among others. number of points produced decreased was SEK 73 million over budget, which Pharmaceutical costs were a total of due to a lower weighting. is an increase of 1.9 per cent. The devia- SEK 28 million lower than budgeted, tion from budget is mainly attributable mainly due to efficiency enhancement Future outlook to higher personnel costs. efforts. Material costs and the cost of In 2015, Karolinska University Hospi- Depreciation and amortisation costs purchased healthcare services that are tal will focus on action plans yielding were SEK 10 million higher than in linked to care production were SEK 109 results to achieve balanced finances. 2013 and SEK 3 million higher than million higher than planned. Quality and a high level of patient safety budget. Net financial items (financial The hospital’s other operating costs will continue to be in focus in this work. income and expenses) were SEK 170 were SEK 216 million higher than The operations will follow budget disci- million lower than the preceding year budgeted, which is mainly attributable pline at the same time as production and SEK 126 million below budget. The to higher costs for consulting services. may not decrease and capacity may not difference in net financial items is A large part of the hospital’s consulting be closed. Managers shall also have mainly attributable to items affecting services are financed through RD&E, more budget and cost responsibility. comparability concerning the effect of external projects and compensation repaid AFA premiums in 2013 and the related to the work with New Karolinska change in the discount rate for the pen- Solna. Södersjukhuset AB sion liability calculation for 2013 and Depreciation and amortisation costs Introduction and mission 2014. were SEK 1 million lower than in 2013 Södersjukhuset AB is one of the County Södersjukhuset’s investments for and SEK 25 million below budget. Net Council’s emergency hospitals. Its pri- 2014 amounted to SEK 123 million financial items (financial income and mary assignment is to provide special- with a budget of SEK 162 million. The expenses) amounted to an expense of ised emergency and planned healthcare majority of the investment objects are SEK 43 million, which was SEK 7 mil- in the southern part of the county with reinvestments in medical technology lion lower than the preceding year and special responsibility for emergency equipment. SEK 7 million lower than budget. This treatment and pre-hospital care. The

 To contents Health and medical care Annual Report 2014 63 Goal attainment of childbirths. The average number of Danderyds Sjukhus AB The balanced finances objective was available beds decreased by 10.1 per not achieved as the results were below cent, from 713 beds in 2013 to 641 beds Introduction and mission the budgeted surplus requirement. in 2014. The decrease in bed numbers Danderyds Sjukhus AB is an emergency Accessibility for the number of patients mainly arose due to staffing difficulties. hospital that conducts specialist care, waiting for a new visit decreases com- clinical training and patient-centred pared with 2013 while accessibility for Productivity research for the patients of today and patients waiting for treatment improved. Productivity (number of points pro- tomorrow. The quality target of the proportion of duced/adjusted total cost) increased by healthcare-associated infections was 0.8 per cent compared with 2013. The Finances 6.2 per cent, the same as in 2013. productivity increase was due to the There was a deficit of SEK 151 million in hospital’s higher point production. 2014, adjusted for the effect of an inter- Production est rate change on the calculation of Total production for the year amounted Future outlook pension liabilities of SEK 119 million. to approximately 59,900 (60,300) care In 2015, Södersjukhuset AB will con- The adjusted result was SEK 157 million episodes in inpatient care and 499,300 tinue to focus on achieving set quality lower than the budgeted surplus (496,000) visits in outpatient care. Pro- requirements and the objective of requirement of SEK 6 million. The duction in outpatient care was 0.6 per queue-free care. Efforts to use beds as result was SEK 85 million lower than cent higher than budget in total. This effectively as possible have been made 2013. The difference compared to 2013 increase occurred mainly in surgery during the year and will continue in is mainly attributable to higher person- and gynaecology and at the Sachs’ 2015. The hospital will also work to nel costs. The deficit before appropria- Children and Youth Hospital. There develop production planning in 2015 tions and tax amounted to SEK 269 was also some increase in patient care and plans to produce 1 per cent more in million. choice for childbirth. Production in healthcare volume in 2015 compared Operating revenues were SEK 56 inpatient care decreased during the with 2014. The planning of Södersjuk million higher than in 2013, an increase year and was 3.6 per cent below budget. huset’s extensions that will be com- of 1.7 per cent. This outcome was SEK The main reason for the lower produc- pleted in 2018 will intensify during the 28 million or 0.8 per cent below budget. tion is fewer open beds, as well as fewer year. The work of maintaining the budg- The deviation from budget is mainly emergency ward patients and thereby eted cost level will continue during the attributable to lower production. The fewer admissions, plus a lower number year with prepared action plans. main reason for the low production in

Södersjukhuset AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Health and medical care sold 3,487 3,380 3% 3,570 – Sold health and medical care, SCC 3,425 3,324 3% 3,447 Other revenues 448 458 –2% 406 Total operation revenues 3,935 3,838 3% 3,976

Operating expenses Personnel costs –2,586 –2,430 6% –2,529 Other expenses –1,340 –1,315 2% –1,323 Total operation expenses –3,926 –3,745 5% –3,853 Depreciation/amortisation –104 –94 – –101 Net financial items –138 32 – –12 Surplus before appropriations and taxes –233 31 – 9 Appropriations** 247 65 – – Surplus after appropriations and taxes 13 96 – 0 Adjusted surplus* –84 –82 – 0 Investments 123 137 –10% 162 Number of full-time equivalents 4,227 4,173 1% 4,113

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

64 Annual Report 2014 Health and medical care  To contents inpatient care was that the hospital was Production healthcare. A prerequisite for this is forced to close a large number of beds Total production for the year amounted that the hospital succeed in recruiting due to a shortage of nurses. to approximately 44,500 (46,600) care the nurses it currently lacks. Operating expenses were SEK 203 episodes in inpatient care and 407,900 million higher than in 2013, which is an (400,300) visits in outpatient care. increase of 6.4 per cent. This outcome Production in outpatient care was 1.9 TioHundra AB was SEK 157 million or 4.9 per cent over per cent higher than last year while Introduction and mission budget. The deviation from budget is inpatient care was 4.6 per cent lower As of 1 January 2006, the County mainly attributable to higher personnel than last year. The main reason for the Council owned health and medical care costs of SEK 103 million. lower production in inpatient care was services and the municipally owned Depreciation and amortisation costs the shortage of nurses, which led to an social care services and associated were SEK 3 million higher than in 2013, average of 45 fewer open beds in 2014 operations in Norrtälje are operated by but on a par with budget. Net financial compared with 2013. a company named TioHundra AB, items (financial income and expenses) which was formed jointly by Stockholm were SEK 132 million lower than last Productivity County Council and Norrtälje Munici- year. This deviation is mainly attributa- Productivity (number of points pro- pality. The company is wholly owned by ble to the changed discount interest rate duced/adjusted total cost) decreased by Kommunalförbundet Ägarsamverkan for the pension liability calculation. 2.0 per cent compared with 2013. The i Norrtälje Sjukvård och Omsorg, productivity decrease was due to the which is in turn owned in equal parts Goal attainment cost increase, mainly staffing costs, by Stockholm County Council and The balanced finances objective was being higher than the increase in Norrtälje Municipality. The municipal not achieved as the results were below points. It is difficult to adjust the per- association’s annual report was dealt the budgeted surplus requirement. sonnel volume at the same rate at which with in the County Council Assembly in Accessibility for the number of patients the production volume decreases. a separate case. The client is the Health waiting for a new visit and for treatment and Social care Committee in Norrtälje. decreased compared with 2013. The Future outlook The overall aim of this collaboration quality target of the proportion of In 2015, Danderyds sjukhus AB will between the County Council and the healthcare-associated infections was continue to work on achieving balanced Municipality is to work together with a 7.3 per cent, which is 0.6 percentage finances, improving accessibility for focus on patient needs to create more points higher than in 2013. patients and improving quality in efficient care chains in healthcare and

Danderyds sjukhus AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Health and medical care sold 2,829 2,817 0% 2,924 – Sold health and medical care, SCC 2,768 2,751 1% 2,859 Other revenues 441 397 11% 373 Total operation revenues 3,269 3,213 2% 3,297

Operating expenses Personnel costs –2,190 –2,044 7% –2,089 Other expenses –1,182 –1,125 5% –1,126 Total operation expenses –3,372 –3,169 6% –3,215 Depreciation/amortisation –59 –56 – –59 Net financial items –107 25 – –17 Surplus before appropriations and taxes –269 13 – 6 Appropriations** 271 75 – – Surplus after appropriations and taxes 2 88 – 6 Adjusted surplus* –151 –66 – 6 Investments 68 103 –34% 75 Number of full–time equivalents 3,559 3,512 1% 3,470

 To contents Health and medical care Annual Report 2014 65 social care services in Norrtälje. The Operating expenses were SEK 11 6 per cent, which is 4 percentage points “TioHundra project” currently extends million lower than in 2013, a decrease lower than in 2013. through to 31 December 2015. of 0.7 per cent. This outcome was SEK 4 TioHundra AB conducts activities in million below budget, a decrease of 0.3 Production somatic emergency medical care, geri- per cent. The deviation from budget is Total production for the year in somatic atrics, primary care, outpatient psychi- mainly due to lower staffing costs as a emergency medical care, geriatrics, atric care, dependence care and habili- result of the savings and efficiency primary care and psychiatry amounted tation, care for the elderly and the improvement measures conducted dur- to approximately 8,000 (8,200) care disabled, social psychiatry and school ing the year, as well as lower produc- episodes in inpatient care and 315,300 health care in Norrtälje Municipality. tion. Costs for insourced personnel and (321,100) visits in outpatient care. Pro- overtime, however, were higher than duction in outpatient care was 6.6 per Finances budgeted. cent lower than budget and inpatient There was a surplus of SEK 5 million in Depreciation and amortisation costs care was 5.8 per cent lower than budget. 2014, which was SEK 5 million higher were SEK 2 million lower than in 2013 than the budgeted break-even. This and SEK 3 million below budget. Net Productivity surplus was SEK 23 million higher than financial items were an expense of Productivity (number of points pro- 2013. The difference compared to 2013 SEK 4 million, a deterioration of SEK duced/adjusted total cost) in Norrtälje is mainly attributable to higher com- 9 million compared to last year due to Hospital increased by 0.7 per cent compensation per point produced and lower positive non-recurring items in 2013, pared with 2013. This increase is due to personnel costs. but was on a par with the budget for the the cost decrease being larger relative Operating revenues were SEK 18 year. to the decrease in the number of points million higher than in 2013, an increase produced. of 1.2 per cent. This outcome was SEK 2 Goal attainment million or 0.1 per cent below budget. The balanced finances objective was Future outlook The deviation from budget is mainly achieved as the results were above the In 2015, TioHundra AB will continue due to lower revenues for patient fees, budgeted surplus requirement. Acces- the work of developing integrated lower compensation and production in sibility measured as the proportion of healthcare processes. An extensive emergency somatics, and lower produc- patients who received GP care within investment in employees and managers tion in geriatrics. These lower revenues five days was somewhat lower than in is being made to continue developing were largely balanced by higher com- 2013. Accessibility for patients waiting the cooperation over operational pensation in psychiatric activities, for a new visit and for treatment boundaries for the best of the patients higher revenues in primary care and decreased compared with 2013. The and the customers. higher revenues for radiology services quality target of the proportion of and clinical physiology than budgeted. healthcare-associated infections was

TioHundra AB

TioHundra AB total Percentage of TioHundra AB (50%)

Outcome Outcome Budget Outcome Outcome Change Budget SEK million 2014 2013 2014 2014 2013 % 2014 Operating revenues Health and medical care sold 703 669 707 351 335 5% 353 – of which, SCC internal 695 657 613 347 329 6% 306 Other revenues 808 823 806 404 412 –2% 403 Total operation revenues 1,511 1,493 1,513 755 746 1% 757

Operating expenses Personnel costs –1,166 –1,174 –1,188 –583 –587 –1% –594 Other expenses –315 –318 –297 –157 –159 –1% –149 Total operation expenses –1,481 –1,492 –1,485 –741 –746 –1% –743 Depreciation/amortisation –21 –23 –24 –11 –12 – –12 Net financial items –4 5 –4 –2 2 – –2 Surplus/deficit 5 –18 0 2 –9 – 0 Number of full-time equivalents* 2,102 2,142 2,110 2,102 2,142 –2 % 2,110

* Number of full-time equivalents is reported at 100 per cent.

66 Annual Report 2014 Health and medical care  To contents Södertälje Sjukhus AB grants received and higher patient fees what, while accessibility for patients linked to a higher number of visits. waiting for treatment was unchanged Introduction and mission Operating expenses were SEK 51 compared with 2013. The quality target Södertälje Sjukhus AB offers both million higher than in 2013, which is an of healthcare-associated infections was emergency and planned specialist care increase of 5.6 per cent. This outcome 4 per cent, which is a decrease by 2 per- in general internal medicine, surgery, was SEK 19 million or 2.0 per cent over centage points between 2013 and 2014. orthopaedics, urology, anaesthesia, budget. The deviation from budget is obstetrics and gynaecology, paediat- mainly attributable to higher personnel Production rics, radiology, ear, nose and throat costs, which are linked to the high per- Total production for the year amounted care, geriatrics and palliative care. sonnel turnover among nurses, pension to approximately 12,600 (13,300) care expenses and higher material costs that episodes in inpatient care and 132,400 Finances are due to a different case-mix in the (125,900) visits in outpatient care. Pro- There was a deficit of SEK 1 million in surgical specialities. duction in outpatient care was a total of 2014, adjusted for increased costs Depreciation and amortisation costs 5.1 per cent higher than budget while resulting from an interest rate change were SEK 7 million lower than in 2013 inpatient care was 7.3 per cent lower in the calculation of pension liabilities and SEK 2 million below budget. Net than budget. The main reason for the of SEK 25 million. The adjusted result financial items (financial income and lower production for care episodes in was SEK 4 million lower than the budg- expenses) amounted to an expense of inpatient care was that the hospital had eted surplus requirement of SEK 3 mil- SEK 23 million, which was SEK 30 mil- fewer emergency admissions in emer- lion. The result was SEK 3 million lion lower than the preceding year and gency somatics. higher than in 2013. The difference SEK 21 million lower than budget. This compared to 2013 is mainly due to deviation is mainly attributable to the Productivity higher revenues for sold health care change in the discount interest rate for Productivity (number of points pro- under the care agreement. the pension liability calculation. duced/adjusted total cost) increased by Operating revenues were SEK 45 0.4 per cent compared with 2013. The million higher than in 2013, which is an Goal attainment productivity improvement is due to a increase of 4.8 per cent. This outcome The balanced finances objective was new case mix at t he hospital, which has was SEK 11 million or 1.1 per cent over not achieved as the results were below resulted in a higher healthcare burden budget. The deviation from budget is the budgeted surplus requirement. in inpatient care. mainly attributable to higher out-of- Accessibility for the number of patients county and international revenues, waiting for a new visit decreased some-

Södertälje Sjukhus AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Health and medical care sold 861 839 3% 872 – Sold health and medical care, SCC 837 818 2% 852 Other revenues 127 104 23% 106 Total operation revenues 988 943 5% 977

Operating expenses Personnel costs –665 –629 6% –651 Other expenses –299 –283 6% –294 Total operation expenses –964 –913 6% –945 Depreciation/amortisation –25 –32 – –27 Net financial items –23 7 – –2 Surplus before appropriations and taxes –25 5 – 3 Appropriations** 25 –6 – – Surplus after appropriations and taxes –1 0 – 3 Adjusted surplus* –1 –4 – 3 Investments 24 20 20% 35 Number of full-time equivalents 1,040 1,025 1% 1,020

 To contents Health and medical care Annual Report 2014 67 Future outlook compared to 2013 is mainly attributa- lower than budget. This deviation is In 2015, the company will conduct ble to higher revenues for sold health mainly attributable to the change in the development work linked to project care under the care agreement and a discount interest rate for the pension planning and the upcoming start of higher volume of patients treated with liability calculation. operations at the newly renovated hos- intravitreal injections. There was a pital. Developing new ways of working deficit before appropriations and tax in Goal attainment will be a high priority during the year. an amount of SEK 7 million. The balanced finances objective was Operating revenues were SEK 36 achieved as the results were above the million higher than in 2013, which is an budgeted surplus requirement. Acces- St. Eriks Ögonsjukhus AB increase of 7.6 per cent. This outcome sibility for patients waiting for a new Introduction and mission was SEK 19 million or 3.9 per cent over visit and for treatment decreased com- St. Eriks Ögonsjukhus AB (St. Erik) is budget. The deviation from budget is pared with 2013. The quality target of a university hospital that conducts mainly attributable to a higher volume the proportion of healthcare-associated ophthalmology in Stockholm County of patients who are treated with intra- infections was 5 per cent, which is an Council and highly specialised ophthal- vitreal injections and higher out-of- increase of 1 percentage point between mology for patients from outside the county revenues. 2013 and 2014. county as well. The hospital has exten- Operating expenses were SEK 35 sive research, development and educa- million higher than in 2013, which is an Production tional activities in collaboration with increase of 7.8 per cent. This outcome Total production for the year amounted Karolinska Institutet. was SEK 9 million or 1.9 per cent over to approximately 1,800 (1,800) care budget. The deviation from budget is episodes in inpatient care and 199,700 Finances mainly due to higher costs for surgical (201,600) visits in outpatient care. Pro- There was a surplus of SEK 14 million materials and pharmaceuticals for duction in outpatient care was 3.0 per in 2014, adjusted for increased costs intravitreal injections. cent lower than budget while inpatient resulting from an interest rate change Depreciation and amortisation costs care was 4.9 per cent higher than in the calculation of pension liabilities were SEK 1 million higher than in 2013 budget. The foremost reason for the of SEK 22 million. The adjusted result and budget. Net financial items (finan- higher production for inpatient care was SEK 13 million higher than the cial income and expenses) amounted to episodes was an increase in out-of- budgeted surplus requirement of SEK 1 an expense of SEK 20 million, which county admissions. million. The result was SEK 11 million was SEK 24 million lower than the higher than in 2013. The difference preceding year and SEK 18 million

St. Eriks Ögonsjukhus AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Health and medical care sold 432 388 11% 411 – Sold health and medical care, SCC 389 354 10% 378 Other revenues 76 84 –10% 78 Total operation revenues 508 472 8% 489

Operating expenses Personnel costs –268 –252 6% –263 Other expenses –215 –197 9% –210 Total operation expenses –483 –448 8% –474 Depreciation/amortisation –12 –11 – –11 Net financial items –20 4 – –2 Surplus before appropriations and taxes –7 17 – 1 Appropriations** 11 –2 – – Surplus after appropriations and taxes 4 15 – 1 Adjusted surplus* 14 3 – 1 Investments 13 11 18% 12 Number of full-time equivalents 377 365 3% 360

68 Annual Report 2014 Health and medical care  To contents Productivity The result was on a par with 2013. The Production Productivity (number of points pro- difference compared to 2013 is mainly Total production for the year amounted duced/adjusted total cost) decreased by attributable to an increase in activities to approximately 77,400 (76,300) 0.1 per cent compared with 2013. The and high personnel turnover. The ambulance assignments and 4,400 decrease is due to an increase in per- deficit before appropriations and tax (3,800) transport of deceased persons. sonnel resources and a high personnel amounted to SEK 6.2 million. Production in ambulance assignments turnover in certain areas, which has led Operating revenues were SEK 18 was a total of 3.2 per cent lower than to somewhat higher personnel costs. million higher than in 2013, which is an budget while transport of deceased increase of 9.5 per cent. This outcome persons was 12.1 per cent higher than Future outlook was SEK 11 million or 5.5 per cent over budget. The reason for the lower pro- In 2015, the hospital will continue to budget. The deviation from budget is duction was a seasonal adjustment of work on achieving balanced finances, mainly due to revenues from contract the ambulance services. The number of improving accessibility for patients education and events. on-call hours for ambulance operations and improving quality in healthcare. Operating expenses were SEK 24 totalled approximately 159,000 To be able to give the patients the best million higher than in 2013, which is an (149,100) during the year, which was 7.0 ophthalmology care, the hospital will increase of 12.7 per cent. This outcome per cent more than in 2013. The num- develop its methods of measuring and was SEK 17 million or 8.7 per cent over ber of on-call hours for transport of following up medical results. budget. The deviation from budget was deceased persons was approximately mainly due to a higher number of 12,000, which was unchanged com- Ambulanssjukvården i employees, which led to higher person- pared with 2013. nel costs. The year’s salary increase was Storstockholm AB higher than budgeted. Future outlook Introduction and mission Depreciation and amortisation costs In 2015, Ambulanssjukvården i Ambulanssjukvården i Storstockholm were SEK 1.9 million higher than in Storstockholm AB will work to clarify AB provides ambulance services on 2013, but on a par with budget. Net the role of pre-hospital medical care behalf of the County Council, using a financial items (financial income and in the future healthcare structure. fleet of 27 ambulances, including inten- expenses) were SEK 2.6 million higher In 2015, the last of the ambulances sive care and inter-county ambulance than the preceding year and SEK 1.5 included in the “Ambulance Improve- service and two units for the transpor- million higher than budget. This devia- ment” programme, in which Stockholm tation of deceased persons. tion is mainly attributable to the change County Council will receive ten new in the discount interest rate for the pen- ambulance units, will being operating. Finances sion liability calculation. The FRAPP IT platform will be imple- There was a deficit of SEK 4.1 million in mented in the ambulance services in 2014, adjusted for increased costs for Goal attainment 2015 and 2016. It consists of a new an interest rate change on the calcula- The balanced finances objective was record system and EKG system with tion of pension liabilities of SEK 2.1 mil- not achieved as the results were below digital map support. lion. The adjusted result was SEK 4.8 the budgeted surplus requirement. The million lower than the budgeted sur- accessibility goal was achieved in 2014. plus requirement of SEK 0.7 million.

Ambulanssjukvården i Storstockholm AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 207 189 9% 196 – of which, SCC internal 205 185 11% 196 Expenses –213 –189 13% –196 Surplus before appropriations and taxes –6 0 – 1 Appropriations** 6 0 – – Surplus after appropriations and taxes 0 0 – 1 Adjusted surplus* –4 –4 – 1 Investments 12 19 –37% 10 Number of full-time equivalents 283 255 11% 258

 To contents Health and medical care Annual Report 2014 69 Stockholm Care AB was SEK 27 million or 25.5 per cent over Future outlook budget. The deviation from budget is In 2015, collaboration with Karolinska Introduction and mission mainly due to an increase in purchased University Hospital will continue in Stockholm Care AB is Stockholm health care and medical services. order to complete the introduction of County Council’s company for the Depreciation and amortisation costs a common process with the aim of export of healthcare and healthcare were unchanged compared with 2013 reducing processing times for foreign services. The company’s main empha- and were in line with budget. Net finan- patients. The launch of a new website sis is offering and conveying available cial items (financial income and and upgrade of the case management capacity in highly specialised care at expenses) were SEK 1.3 million lower system are expected to improve the County Council’s healthcare units than the preceding year and SEK 1.5 efficiency in processing requests. to foreign patients. On behalf of the million higher than budget. This devia- County Council, the company also owns tion is mainly attributable to the change Folktandvården and operates the Tobias Register, which in the discount interest rate for the pen- is Sweden’s national blood stem cell sion liability calculation. Stockholms län AB register. Introduction and mission Goal attainment Folktandvården Stockholms län AB Finances The balanced finances objective was offers a complete range of general, med- There was a surplus of SEK 4.0 million not achieved as the results were below ical and specialist dental care. With a in 2014, adjusted for increased costs the budgeted surplus requirement. The total of 80 clinics, the company has a resulting from an interest rate change accessibility goal was achieved in both wide geographical coverage in the in the calculation of pension liabilities patient care and the Tobias Register. county. of SEK 0.9 million. The adjusted result Accessibility increased compared with was on a par with the budgeted surplus 2013. Finances requirement. The result was SEK 0.4 There was a surplus of SEK 108 million million lower than 2013. The difference Production in 2014, adjusted for increased costs compared to 2013 is mainly attributa- Total production for the year in highly resulting from an interest rate change ble to an anticipated bad debt loss. The specialised care amounted to approxi- in the calculation of pension liabilities surplus before appropriations and tax mately 330 (410) concluded patient of SEK 43 million. The adjusted result amounted to SEK 3.1 million. cases. Turnover in patient care was SEK was SEK 88 million higher than the Operating revenues were SEK 13 4.9 million higher than in 2013. The budgeted surplus requirement of SEK million higher than in 2013, which is an main reason for the higher turnover 20 million. The result was SEK 22 mil- increase of 11.0 per cent. This outcome was more extensive, advanced treat- lion lower than 2013. The difference was SEK 26 million or 23.6 per cent ments than in 2013. In 2014, the Tobias compared to 2013 is mainly attributa- over budget. The deviation from budget Register received approximately 11,900 ble to higher costs for staffing as a result is mainly due to higher revenues for (4,400) new potential donors, of which of a new clinic in Liljeholmen. The sold health care and medical services. approximately 7,100 (2,700) were in the surplus before appropriations and tax Operating expenses were SEK 15 18-30 age group. The number of con- amounted to SEK 64 million. million higher than in 2013, which is an veyed units of blood-forming stem cells Operating revenues were SEK 11 increase of 12.7 per cent. This outcome was higher than in 2013 at 40 (25). million lower than in 2013, which is a

Stockholm Care AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 136 123 10% 110 – of which, SCC internal 28 15 89% 33 Expenses –133 –118 12% –106 Surplus before appropriations and taxes 3 5 – 4 Appropriations** –5 –3 – – Surplus after appropriations and taxes –1 2 – 4 Adjusted surplus* 4 4 – 4 Average number of annual employees 9 9 – 10

70 Annual Report 2014 Health and medical care  To contents decrease of 0.7 per cent. This outcome budgeted surplus requirement. The ing hours) in general dental care was SEK 24 million or 1.6 per cent over goal that adult patients without urgent decreased by 1.0 percentage points budget. The deviation from budget is problems should be offered an exami- compared with 2013. Productivity in mainly attributable to higher revenues nation appointment within four weeks specialist dental care decreased by 0.6 from adult dental care and higher effi- was achieved. The goal that children percentage points compared with 2013. ciency in general dental care. and adolescents should be referred to The decrease is mainly linked to the Operating expenses were SEK 47 specialist dental care within two evacuation of the Eastman building. million higher than in 2013, which is an months, and that referred adult increase of 3.6 per cent. This outcome patients should need to wait no more Future outlook was SEK 42 million or 3.1 per cent than six months was not fully achieved. Efforts to attract and retain adult below budget. The deviation from The quality target that all patients patients will continue in 2015 with the budget is mainly attributable to lower should be satisfied with treatment and dental fitness contracts (Frisktand- costs for purchased operations-related service in Folktandvården Stockholms vårdsavtal) introduced in 2010 which services and materials and goods. län AB was achieved at 99.5 per cent. enable patients to purchase dental ser- Depreciation and amortisation costs vices at a fixed monthly cost. At the end were SEK 1 million higher than in 2013 Production of 2014, more than 64,000 contracts and SEK 8 million below budget. Net Total production for the year in general had been signed. The specialist opera- financial items (financial income and dental care amounted to approximately tions evacuated from the Eastman expenses) were SEK 48 million lower 323,200 (322, 000) treated adults and building will begin their move back at than the preceding year and SEK 29 161,000 (160,300) treated children and the end of 2015. At the beginning of million below budget. This deviation adolescents. Production was 8.8 per 2015, the emergency clinic in the St. is mainly attributable to the changed cent and 3.2 per cent below budget, Eriks area and the clinic at Fridhems discount interest rate for the pension respectively. Specialist dental care plan will be co-located in new premises liability calculation. treated 24,000 (27,900) compared with in the Västermalmsgallerian shopping the budgeted 28,000. centre. Goal attainment The balanced finances objective was Productivity achieved as the results were above the Productivity (booked time/total work-

Folktandvården Stockholms län AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Fees from private persons 695 680 2% 668 Dental care sold 540 538 – 552 Other revenues 290 318 –9% 282 Total operation revenues 1,525 1,536 –1% 1,501 – of which within the County Council 563 555 1% 568

Operating expenses Personnel costs –968 –916 6% –970 Dental care purchased –1 –1 –13% –1 Other expenses –402 –406 –1% –440 Total operation expenses –1,370 –1,323 4% –1,412 Depreciation/amortisation –52 –51 – –60 Net financial items –38 10 – –9 Surplus before appropriations and taxes 64 172 – 20 Appropriations** –79 –152 – – Surplus after appropriations and taxes –15 20 – 20 Adjusted surplus* 108 130 – 20 Investments 66 62 6% 58 Number of full-time equivalents 1,811 1,784 2% 1,785

 To contents Health and medical care Annual Report 2014 71 MediCarrier AB Operating revenues were SEK 36 Goal attainment million higher than in 2013, which is an The balanced finances objective was Introduction and mission increase of 5.9 per cent. This outcome achieved as the results were above MediCarrier AB warehouses and dis- was SEK 40 million or 6.5 per cent over the budgeted surplus requirement. tributes medical and consumable items budget. The deviation from budget is Accessibility measured as service level that can be requisitioned and functions mainly due to higher revenues from to customers was over the budgeted as a logistics unit for environmentally sales of materials and goods. target during the entire year and was on adapted transportation to units within Operating expenses were SEK 35 a par with the 2013 outcome. The num- the County Council. million higher than in 2013, which is an ber of complaints was 0.16 per cent, increase of 5.6 per cent. This outcome which was higher than the budgeted Finances was SEK 35 million or 5.8 per cent over level of 0.15 per cent and on a par with There was a surplus of SEK 5.7 million budget. The deviation from budget is the 2013 outcome. in 2014, adjusted for increased costs mainly attributable to higher sales resulting from an interest rate change volumes. Future outlook in the calculation of pension liabilities Depreciation and amortisation costs In 2015, MediCarrier AB will focus on of SEK 0.7 million. The adjusted result were on a par with 2013 and 0.8 lower increased efficiency and delivery relia- was SEK 5.4 million higher than the than budget. Net financial items (finan- bility. The investment in an integrated budgeted surplus requirement of SEK cial income and expenses) were SEK 1.1 sterile equipment picker is expected 0.3 million. The result was SEK 3.8 mil- million lower than the preceding year to contribute to further efficiency lion higher than in 2013. The difference and SEK 0.6 million lower than budget. enhancements in the warehouse organ- compared to 2013 is mainly attributa- This deviation is mainly attributable to isation. ble to increased sales volume with a the change in the discount interest rate maintained cost level for the costs that for the pension liability calculation. are not directly linked to revenues. The surplus before appropriations and tax amounted to SEK 4.8 million.

MediCarrier AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 642 606 6% 602 – of which, SCC internal 513 483 6% 481 Expenses –637 –602 6% –602 Surplus before appropriations and taxes 4.8 3 – 0 Appropriations** –4.8 –1 – – Surplus after appropriations and taxes 0 3 – 0 Adjusted surplus* 6 2 – 0 Investments 3 0.7 329% 4 Number of full-time equivalents 107 106 1% 104

72 Annual Report 2014 Health and medical care  To contents Public transport

Public transport is important to facilitate the region’s development and growth. Considerable work is under way to expand and modernise public transport services. The objective is to create world class public transport to meet the needs the Stockholm region is facing.

 To contents Annual Report 2014 73 Overall public transport tion charges will be introduced on the competitiveness of public transport Essingeleden bypass on 1 January 2016. over road transport. The work of prior- The County Council has the overall The objective of the changes is to itising public transport and creating responsibility for providing access to improve accessibility and the environ- more competitive travel times needs to well developed, easily accessible and ment in Stockholm, and to contribute to be developed to reach the goal of a reliable public transport to everyone an expansion of the Metro in Stockholm larger market share. At the same time, who lives in or visits Stockholm County. County. the development in, for instance, public The public transport vision is attractive This increase in congestion charges transport environmental performance public transport in a sustainable trans- is equivalent to approximately half of appears to be positive, although there is port system that contributes to Stock- the financing of the Stockholm Agree- a need for development in public holm being Europe’s most attractive ment for three new Metro routes and marine transport. metropolitan region. 78,000 new residential units that were In connection with the evaluation, Public transport plays a crucial role approved by the Assembly at the begin- the decision was made to also begin the for accessibility in the county. Conse- ning of the year. The cities of Stockholm process of drafting a new regional quently, modern, high-capacity public and Solna and the municipalities of transport provisioning programme for transport is a necessity in order for the Nacka and Järfälla have important approval in 2016. In autumn 2014, ini- daily lives of Stockholm residents to responsibilities in this respect, as does tial dialogue meetings were held with function and to maintain the region’s the national government. To take on the the public and key regional actors to attractiveness. This demands both major task of expanding the Metro to obtain input for the continued process. long-term and rapid solutions to this extent in a relatively short amount increase capacity. The Citybanan com- of time, the County Council established Regional development plan for muter rail line and upgrade of the Metro an Extended Metro Administration the Stockholm region red line are examples of long-term solu- during the year. The regional development plan for the tions, while investments in accessibility With experience from the 2013 Stockholm region (RUFS) is Stockholm for the main bus lines are examples of Stockholm Negotiations, the govern- County’s regional plan and regional quick solutions to increase capacity. ment also presented a new assignment development plan. The currently valid Stockholm is strategically located to look more closely at the conditions RUFS 2010 describes the main strate- next to both Lake Mälaren and the for more investment in infrastructure gies for the region’s development and Saltsjön bay of the Baltic Sea. This is and housing through a joint agreement. challenges in various areas where spa- why an expansion of commuter ferry This time with a national focus on main tial development constitutes an impor- services is being striven for to relieve railway lines, but the assignment also tant component. land-based services and shorten travel includes reviewing further investments In 2013–2014, work was conducted times in the county. In 2014, a prestudy in the three major cities. The initiative, to analyse RUFS 2010 from a usability was begun regarding a potential future which is called the “Sweden Negotia- and current applicability perspective. procurement of a modern fleet with tion”, will generate more studies of vari- In connection with the budget decision environmentally friendly propulsion ous public transport investments at the in the County Council in 2015, SCC for commuter ferry services in Lake County Council together with munici- Growth, Environment and Regional Mälaren and Saltsjön. The Traffic Com- palities concerned in 2015 and 2016. Planning was commissioned to begin mittee made a strategic decision in 2014 the process of preparing a new regional to begin procurement of three new Regional transport provisioning development plan for the Stockholm commuter ferry routes. programme for Stockholm County region and programme work was In 2014, several events occurred that The regional transport provisioning prepared in the autumn. affect public transport and demand for programme includes Stockholm Coun- In 2015, the programme for a new its services. In the spring, a decision ty’s long-term public transport objec- RUFS will be adopted and work on pre- was made regarding a new national tives. The programme describes the paring a consultation proposal will plan and county plan for transport scope and the most important condi- begin. This work is a major challenge as infrastructure for 2014–2025. The tions for the procured transport ser- the region’s development in both devel- county plan was approved on 31 May vices to achieve the goals, and what opment planning and transport systems 2014 and the national plan on 8 April commercial transports can contribute. is the subject of a number of other 2014. In these plans, funds are allo- The current transport provisioning simultaneous studies, such as within cated to public transport for new invest- programme was adopted in 2012 and the scope of the Sweden Negotiation. ments. The focus in the plans is also on supplemented in 2013 with a descrip- Coordinating these different planning maintaining the existing infrastructure tion of public marine transport. The processes in time, content, objectives and sustainable means of transport, main task within the transport provi- and focus is an important prerequisite such as greater initiatives on cycling. sioning programme in 2014 was to for a successful RUFS process. At the beginning of the year, the conduct the first follow-up of the set Swedish Parliament also decided on an targets. Travel increase in congestion charges in The follow-up indicates that there Within public land transport, the num- Stockholm’s inner city and that conges- are challenges in strengthening the ber of boardings increased by 19,000

74 Annual Report 2014 Public transport  To contents per day, which corresponds to an below budget. The number of journeys which exceeds the target of 94 per cent increase of 1 per cent compared with in transport services for the disabled and is an improvement compared with 2013. Travel increased in all modes of decreased while patient transportation 2013 when the figure was 94 per cent. transport. Local urban rail service and increased compared with both budget The punctuality of Metro services bus service show the greatest increase and the 2013 outcome. As in the previ- developed positively compared with in the number of boardings. Metro and ous year, taxi journeys are decreasing 2013 and met the target for 2014. Com- commuter rail service also have a larger while journeys with wheelchair taxis muter rail services’ punctuality was on number of passengers compared with continue to rise. a par with 2013, but did not reach the the previous year. The outcome is 3 per Wheelchair taxi passengers made an 2014 target. cent higher than the 2014 targets. average of 77 journeys per person and The punctuality of the local urban In public marine transport, the thereby increased their travelling by 12 rail services did not reach the 2013 number of passengers was 1 per cent journeys over budget and 8 journeys level, but exceeded the 2014 target. Bus higher in 2014 than in 2013. The compared with last year. The outcome services’ punctuality was on a par with increase corresponds to 51,000 passen- reflects the passenger trend, continued 2013, but was below the 2014 target. gers, 9,000 of whom are in the archipel- high demand for wheelchair taxis and ago services and 42,000 in the port ser- accessibility investments in general Metro expansion vices. Compared with budget, the public transport. Compared with 2013, On 11 November 2013, the 2013 number of passengers was 4 per cent passengers from transport services for Stockholm Negotiations were signed by higher, which corresponds to 156,000 the disabled increased their travel on government negotiators and Stockholm passengers. The largest increase is in general public transport by 7 per cent. County Council, the City of Stockholm, port services at 140,000 passengers or the Municipality of Nacka, the City of 6 per cent. The number of passengers in Punctuality Solna and Järfälla Municipality. port services is increasing after the In 2014, punctuality in public marine The agreement means that introduction of the SL tariff on 16 June. transport was 93 per cent, which is on Stockholm’s Metro will be extended to The total number of journeys in a par with the 2013 outcome and 10 Nacka, Arenastaden and Barkarby. transport services for the disabled percentage points higher than the The Nacka branch will be extended to increased by 6,000 during the year, target of 83 per cent. Gullmarsplan and linked with the which is a marginal increase compared In public transport services for the Hagsätra line, which increases the with 2013. This outcome was 1 per cent disabled, punctuality was 95 per cent, capacity of the existing Metro through

Transport

Outcome Outcome Change Target Deviation Total (000s) 2014 2013 % 2014 from target Public transport on land. Boardings* 2,802 2,783 1% 2,730 3% Public marine transport. Passengers 4,108 4,057 1% 3,952 4%

Public transport for the disabled. Journeys 4,091 4,085 0% 4,130 –1%

*SL reports the number of boardings on a common winter weekday.

Punctuality in public transport (%)

100 2013 Targets 95 96 96 96 95 95 95 94 94 2014 93 93 93 93 92 92 90 90 90 89

83 80

75 Marine Transportation Metro Commuter rail Local trains Bus services vessels of the disabled

 To contents Public transport Annual Report 2014 75 central Stockholm. The expansion region. Expanded public transport is a trend towards a larger share of reduced means that nine new stations will be key element in this strategy. price tickets, which yields a lower added to the system, giving residents average revenue per ticket. At the same and businesses in the Stockholm region AB Storstockholms Lokaltrafik time, the increase in the number of greater accessibility. The Metro expan- boardings levelled off in 2014 com- sion will begin in stages in 2016 and will Introduction and mission pared with 2012–2013. be completed around 2025. AB Storstockholms Lokaltrafik (SL) Ticket revenues increased by SEK The decision on financing and co- organises local and regional public 299 million compared with 2013. financing of the Metro expansion made transport within Stockholm County Accounting changes in conjunction by the County Council Assembly on 18 and adjacent areas, owns and manages with the introduction of the travel February 2014 within the scope of the fixed and moveable property and con- account in 2013 had a major impact on 2013 Stockholm Negotiations also ducts operations associated therewith. comparison between the years. These includes the various parties’ financing changes have entailed a shift of the rev- and responsibilities regarding the Finances enues in 2013 in an amount of SEK 182 extended Metro. Besides a co-financing With its subsidiaries, AB Storstock- million, which partially explains the of the Metro, the municipalities are holms Lokaltrafik had a deficit of SEK increase between 2013 and 2014. Oth- contributing by building a large num- 28 million, adjusted for increased costs erwise, efforts to secure revenues have ber of residential units to meet the resulting from an interest rate change been effective. needs of the growing region. in the calculation of pension liabilities Operating expenses were SEK 612 The Stockholm Negotiations can be of SEK 47 million. This was SEK 28 mil- million higher than in 2013, which is an seen as a result of the visions in the lion lower than the budgeted surplus increase of 4.0 per cent. This outcome regional development plan for the requirement of SEK 0 million. The tax was SEK 27 million or 0.2 per cent Stockholm region (RUFS 2010) and the funding ratio was 48 per cent (48). higher than the year’s budget. The cost regional transport provisioning pro- Operating revenues were SEK 670 of purchased transport services was gramme for Stockholm County. In these million higher than in 2013, which is an SEK 55 million over budget. The new visions, strategies are set forth for how increase of 4.0 per cent. This was lower agreement for bus services in the inner the region will handle a sharp rise in than the year’s budget by SEK 25 mil- city and Lidingö that entered into effect population and at the same time reduce lion, corresponding to 0.1 per cent. A in August was more expensive than its climate impact. The region’s vision is major deviation relates to ticket reve- budgeted. The costs for the year’s incen- for the Stockholm region to become nues which were below budget by SEK tives were over budget for commuter Europe’s most attractive metropolitan 152 million or 2.2 per cent. There was a trains and bus service due in part to a

AB Storstockholms Lokaltrafik

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Ticket revenues 6,747 6,448 5% 6,899 Other revenues 3,081 3,138 –2% 2,954 County Council grants 7,223 6,796 6% 7,223 Total operation revenues 17,051 16,381 4% 17,076 – of which, SCC internal 7,250 6,947 4% 7,231

Operating expenses Purchased transport services –11,470 –10,949 5% –11,415 Other expenses –2,924 –2,833 3% –2,951 Total operation expenses –14,394 –13,782 4% –14,367 Participation in the results 0 0 – – associated companies Depreciation/amortisation –2,132 –1,972 – –1,969 Net financial items –600 –647 – –741 Surplus/deficit –75 –21 – 0 Adjusted surplus* –28 –21 – 0 Investments 7,744 5,301 46% 8,020

* Pertains to surplus/deficit adjusted for interest effect on pension costs.

76 Annual Report 2014 Public transport  To contents high customer satisfaction index. Other Goal attainment Waxholms Ångfartygs AB expenses were SEK 27 million below SL achieved the goal of better reliabil- budget, in part because of reclassifica- ity. The proportion of satisfied passen- Introduction and mission tions from operating costs to reinvest- gers on general public transport Waxholms Ångfartygs AB, WÅ AB, ments. increased from 79 per cent in 2013 to 81 arranges marine public marine trans- Compared with 2013, costs for pur- per cent in 2014, according to measure- port within Stockholm County, con- chased transport services rose by SEK ments in the Public Transport Barome- ducts shipping operations and owns 521 million, or 5.0 per cent. The cost ter. The proportion of buses and rail and manages property. increase is due to new transport service vehicles with a boarding step amounted agreements, service changes and full- to 100 per cent and 84 per cent, respec- Finances year costs for changes in 2013. tively, compared with 100 per cent and With its subsidiaries, Waxholms Depreciation increased by SEK 160 83 per cent in 2013. Ångfartygs AB showed a surplus of million or 8.1 per cent compared with The goal of balanced finances was SEK 15 million in 2014, adjusted for 2013 and was SEK 163 million over not achieved. The Traffic Committee as increased costs resulting from an inter- budget as a result of additional invest- a whole did, however, achieve the est rate change in the calculation of ments and several concluded projects. Assembly’s adopted results require- pension liabilities of SEK 1 million. This During the year, a number of large capi- ment. was SEK 15 million higher than the talisations were made of X60 commuter budgeted surplus requirement of SEK 0 trains, a bridge over the Light Rail, sig- Future outlook million. The tax funding ratio was 68 nal communication for the Light Rail The burden on the public transport per cent (64). and the SL Access payment system. system is increasing and there are Operating revenues were SEK 25 Net financial items were better than major needs for investment and devel- million higher than in 2013, which is an both last year’s result and budget. This opment, which involve higher costs for increase of 7.0 per cent. This was SEK 6 was attributable to lower market rates, public transport. To create a sustaina- million below budget. Compared with which affect the interest expenses posi- ble cost trend, the Traffic Administra- 2013, ticket revenues decreased by SEK tively for both leasing costs and loans tion will carry out efficiency enhance- 31 million or 29.0 per cent. The decrease raised with variable interest. The loan ments, rationalisations and reviews in occurred in port service as a result of portfolio was also lower than budgeted, 2015. The focus will continue to be on the introduction of the SL tariff zone which also affected the interest securing revenues and better internal A on 16 June 2014. The county council expenses positively. control. grant increased by SEK 33 million or

Waxholms Ångfartygs AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues Ticket revenues 78 109 –29% 107 Other revenues 48 23 103% 25 County Council grants 280 247 13% 280 Total operation revenues 405 380 7% 411 – of which, SCC internal 318 273 16% 305

Operating expenses Personnel costs –6 –19 –67% –23 Purchased transport services –251 –212 18% –244 Other expenses –87 –85 3% –90 Total operation expenses –345 –317 9% –357 Depreciation/amortisation –39 –34 – –45 Net financial items –7 –9 – –9 Surplus before appropriations and taxes 14 21 – 0 Appropriations** 175 – – – Surplus after appropriations and taxes 189 21 – 0 Adjusted surplus* 15 21 – 0 Investments 101 43 135% 91 Average number of annual employees 11 30 –63% 30

* Pertains to surplus/deficit before appropriations and tax adjusted for interest effect on pension expenses. ** Pertains to tax optimisation for the LISAB Group.

 To contents Public transport Annual Report 2014 77 13.0 per cent compared with 2013. Transport services Goal attainment Operating expenses were SEK 28 for the disabled Transport services for the disabled did million higher than in 2013, which is an not achieve the balanced finances increase of 9.0 per cent. Expenses were Introduction and mission objective in 2014. The proportion of SEK 12 million or 3.4 per cent below Transport services for the disabled is a satisfied passengers in special public budget. The increase compared with separate cost centre within the County transport was 87 per cent, which is 2013 is primarily attributable to higher Council for the accounting of revenues unchanged compared with 2013. costs for purchased marine services as and expenses for transport services a result of newly signed short-term provided, and for other costs related to Future outlook agreements while awaiting a new pro- these transport services. A study of the transport services for the curement of archipelago services. The disabled will be carried out in 2015. The deviation from budget is mainly related Finances objective of the study is to bring about to lower costs for operations and main- There was a deficit of SEK 9 million in freer travel to give the individual pas- tenance as a result of mild winter condi- transport services for the disabled for senger the possibility to travel based on tions and low market prices for oil. 2014, which was SEK 9 million below his or her needs and wishes to a greater Depreciation and amortisation costs budgeted break-even. This was SEK 3 extent than today. were SEK 6 million below budget since million better than the 2013 result. major investment objects were delayed Operating revenues were SEK 21 and are still under way. million higher than in 2013, which is an increase of 2.0 per cent. This outcome Goal attainment was SEK 9 million, nearly 0.7 per cent, Waxholms Ångfartygs AB achieved the higher than budget, mainly as a result balanced finances objective for 2014. of a higher number of patients trans- The proportion of satisfied passengers ported, which are compensated by the in public marine transport was 96 per healthcare services. cent, which is an increase of 5 percent- Operating expenses were SEK 18 age points compared with 2013. million higher than in 2013, which was an increase of 1.0 per cent. Expenses Future outlook were SEK 18 million or 1.4 per cent over A trial with another three new com- budget. Expenses follow the travel vol- muter ferry routes in the county will be umes and exceed both budget and the carried out in 2016 and 2017. Trials will previous year’s outcome. The increase be carried out with high-speed, envi- pertains to a higher volume of patient ronmentally friendly ferries that can transportation and a redistribution of serve longer marine routes in both travel volumes from transport of the Saltsjön and Lake Mälaren efficiently to disabled by taxi to the more expensive thereby contribute to more cross con- wheelchair taxi. A higher cost per jour- nections in the county. ney in the services than budgeted is offset by a lower total volume of journeys in the services.

Transport Services for the Disabled

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 1,285 1,264 2% 1,276 – of which, SCC internal 1,102 1,079 2% 1,087 Expenses –1,294 –1,276 1% –1,276 Surplus/deficit –9 –12 – 0

78 Annual Report 2014 Financial report  To contents Culture

The objective of the Culture Committee is to work for a high- quality, free, accessible cultural life where the set goals are to prioritise children and young people, culture in healthcare services and in-depth cooperation in cultural and creative industries.

 To contents Annual Report 2014 79 Free, accessible, high-quality Development of culture cultural life Major changes have occurred in the cultural policy landscape in recent years. In the area of culture, the County Cultural actors have partly adopted Council should contribute to cultural new processes and collaborative life in Stockholm County being accessi- methods. The changes also meant that ble and of high quality. The County culture has in recent years come to be Council therefore distributes funding recognised as an important factor in to various organisations and projects healthcare, urban planning and active in the county. In cultural activi- regional development. In Stockholm ties, a grant is paid to the Concert County, the County Council’s Plan for House Foundation. In 2014, the Con- Future Health and Medical Care cert House Foundation was awarded a involves a unique investment in the grant of SEK 128 million, which was an artistic shaping of the hospital settings. increase of SEK 3 million. Funding is Another example of changes in the sur- also invested in artistic decoration of rounding world is the internationalisa- the County Council’s premises. tion process that is increasingly being During the mandate period, the seen in cultural life. Artistic quality is Culture Committee initiated a review of the foundation of and the prerequisite the County Cultural Functions, the for this positive development. Regional Library and Culture in In recent years, Stockholm County Healthcare with the aim of ensuring Council has increased the appropria- continuous development of the admin- tions to the Culture Committee. Culture istration’s activities. In spring 2013, the should play a greater role in the major Culture Committee took the initiative challenges and changes that character- on a grant review and a nomination ise one of Europe’s fastest growing group. In September 2014, the Culture regions. Administration was commissioned to further prepare the grant review with continuous reports at the Committee’s meetings during the 2014–2015 period.

80 Annual Report 2014 Culture  To contents Sustainable growth

Sustainable growth is an overall objective for several areas that are important to the future of Stockholm’s residents. This involves growth aspects, such as the work to develop as a leading growth region and the planning to provide the conditions for this. It also involves consideration of the environment and future generations. The County Council must have environmentally sustainable operations. Research and development are important both to continue development of treatments in healthcare and because it contributes to the county’s economic growth. A fourth dimension is social responsibility – working for the equal worth of all, both now and in the future. The sustainability concept also involves the County Council’s processes, such as IT and administrative systems, operating smoothly and securely to contribute to robust operations resistant to risks.

 To contents Annual Report 2014 81 Regional development the Culture Administration were and show which funds can be better strengthened with the aim of clarifying used by the County Council. Regional planning how cultural issues come into urban The work on archipelago, freight and Within the Diversity Orientation action planning, strengthen the region’s environmental grants has continued programme, the County Council Execu- attractiveness and constitute a tool to according to plan. An effort has been tive Board Administration continued to reduce socioeconomic segregation. initiated to see if, and, if so, how the cooperate with other functions in the Close cooperation between the regional Archipelago Council’s role and County Council and with companies in County Council and the municipalities work can be developed even further. In the “Cooperate for Diversity” network. in the county as well as the County 2015, cooperation will continue with Within the Regional Cores action pro- Administrative Board is important for other parties in the region on tourism gramme, synergies between the invest- the whole region to develop in the industry issues and sustainable desti- ments have been analysed. desired direction. During the year, nation development in the archipelago. The work of stimulating the produc- cooperation comprised action pro- During the year, demographic fore- tion of more student housing in the grammes under RUFS, comprehensive casts were produced after being Knowledge Region Stockholm action planning and the current applicability ordered mainly by the healthcare ser- programme has borne fruit. A number work linked to RUFS 2010. As a vices. In addition, material on depend- of municipal and private actors have regional planning body, the County ency ratios has been prepared down to a begun concrete efforts, of which the Council also submitted formal state- municipal district level. A study that largest is the planning of a student ments on comprehensive plans and leg- measures segregation with a new housing trade fair in 2017. In addition, islative bills. method has also been devised. The action programmes have been evalu- In terms of housing construction method is not based on a traditional ated as a way of working in accordance and the housing shortage, new informa- geographic break-down, but rather on with the assignment from the County tional input on existing housing was the probability that individuals meet Council Assembly. Planning to con- prepared. The material, which has been socioeconomically similar or dissimilar clude the Diversity Orientation and partly used in seminars and workshops, people. Knowledge Region Stockholm action is intended to be published in spring Comments have been provided on programmes has begun. 2015. The Administration has held sev- several comprehensive exposure draft An assessment of RUFS 2010 cur- eral meetings with the secretariat for reports during the year. Most are based rent applicability has been made the parliamentary committee, which on changes in the Planning and Build- according to the County Council will investigate the role of regional ing Act and other regulations that aim Assembly’s commission and the result planning in the supply of housing. to simplify planning processes and is ready for political drafting. The activ- The County Council is continuing increase housing construction. Some ities that can be included in the RUFS cooperation in “Innovationskraft municipalities have submitted compre- implementation have also been inven- Stockholm”. The work of innovation hensive plans for comment. Extensive toried, in part as a basis for future pri- procurement is being conducted with work has also been done in connection oritisations. The County Council Exec- SCC Innovation as a coordinating force with proposals for expanded coastal utive Board Administration has also for the regional work as well. Prior to protection, which were submitted for begun preparations for a new RUFS. the continued work on innovation pro- comment in several rounds from the The special conditions that apply to curement, the County Council’s inter- County Administrative Board. countryside areas near metropolitan nal organisation is being reviewed. areas have been formulated as a A report on the County Council’s role Regional environmental strategy sub-project in the work on a new RUFS. primarily in economic growth has been for water The new plan will include an analysis of completed and approved by the County In spring 2014, a current status sustainable rural development and a Council Assembly. In 2014, the EU description was begun of the four target stronger city and country perspective. began a new seven-year programme areas included in the County Council’s The work with a regional climate flight period. New opportunities are thereby regional environmental strategy for plan is being prepared as a sub-project being created to partake of the EU water: secured drinking water, knowl- in the work on a new RUFS. funds and programmes to support the edge exchange, target-group-adapted The preparations for a new RUFS development of operations and gener- planning input and regional coordina- were begun when the current applica- ate growth. The County Council is par- tion. The current status description was bility work was concluded in the spring. ticipating in a regional effort that aims conducted according to a model that This year’s Situation in the Region Con- to use structural fund resources more will also be used to follow up the ference attracted a record number of efficiently and strategically to achieve respective target areas. A proposed participants and provided a view of the goals in RUFS and other strategic final current status description exists both the region’s development and new steering documents during the pro- and will be addressed in the new development perspectives to include in gramme period. Work has begun to bet- Committee of Growth and Regional continued planning. ter describe the connection between the Planning at the beginning of 2015. During the autumn, contacts with EU, the region and the County Council During the autumn, a prestudy was

82 Annual Report 2014 Sustainable growth  To contents begun within the scope of target area what steps need to be prioritised in the The new regional biobank means that three, target-group-adapted planning upcoming year. Within the foundation, the County Council can coordinate and input. The prestudy covers how the work is also under way to develop its harmonise sampling for both research prepared planning input should be own revenue opportunities. In 2015, and healthcare samples that are stored prioritised, what format it should be the County Council and the Archipelago throughout the County Council, which presented in, how the connections Foundation will enter a long-term considerably increases the quality of between water in regional physical agreement on increased grants for the biobank samples in the County Council. planning and the region’s ecosystem foundation’s activities. The biobank also means that it is possi- services can be strengthened, and the ble to follow patient data in the entire extent to which the work must be done Research, development care chain, removing the need to take to be able to be incorporated into the and innovation new or the same samples on a patient. work on a new regional development Extensive work was done during the Some internal reorganisation was done plan. The prestudy will be completed in year to formulate a new strategy for in the work to establish the biobank in the first quarter of 2015. research, development, innovation and the latter half of 2014. For example, the In autumn 2014, a current status education. Various parties from the Regional Biobank Centre (RBC) now description was made in target area 2, business community, universities and belongs to the regional biobank instead knowledge exchange. An informational the County Council’s own operations of the County Council Archives. package will be drawn up based on this have met in dialogue meetings and dis- In 2014, negotiations were held description in 2015. The aim is to cussed the challenges faced by health- regarding a new national agreement on spread the County Council’s experi- care, public transport and dental care medical education and research (ALF ences to municipalities and actors in in the future. agreement) between the national gov- the region for a reduced environmental Stockholm County Council and ernment and affected county councils impact from pharmaceuticals, chemi- Stockholm University have signed a and regions. On 18 November 2014, the cals and transportation and an statement of intent regarding coopera- Assembly approved the national agree- increased regional coordination, target tion. In accordance with this statement, ment, which involves very large area 4. work has continued on formulating a changes compared with the old agree- proposal for a cooperation agreement ment from 2004, including the require- Archipelago that will be drafted politically at the ment that an evaluation of the clinical Stockholm’s archipelago should have beginning of 2015. This cooperation benefit of research be made place at the vibrant communities for both perma- will cover every department of the national level. In addition, “university nent and leisure-time residents all year university. healthcare” will be introduced in the round, at the same time as it should be Project 4D is a collaborative project county councils and regions affected by attractive to visit. The open and accessi- on the diagnoses arthritis, breast can- the national ALF agreement. This has ble archipelago must therefore be devel- cer, type-2 diabetes and heart failure. meant that this kind of evaluation will oped and safeguarded. It is important During the year, the project mapped take place in all county councils and to simplify rules so that it is possible to processes and took steps to implement regions with university hospitals. The conduct business and live in the archi- research findings in the care chain national agreement also stipulated that pelago today. more quickly. In spring 2014, Project county councils and regions must reach The archipelago is a unique part of 4D was also presented for the Directo- regional ALF agreements with the med- the Stockholm region and needs rule rate-General for Research and Innova- ical faculty conducting medical educa- simplification, regional cooperation, tion at the European Commission. The tion in the respective county. Stock- growth and good transportation to main objective was to work for more holm County Council must accordingly develop. Stockholm County Council has calls for proposals in the EU Frame- collaborate with Karolinska Institutet been a driving factor in starting up work Programme for Research and and the parties have agreed to enter a regional cooperation to support and Innovation Horizon 2020 that fit the 4D temporary regional ALF agreement for develop the tourism industry in the concept. 2015. The County Council and Karolin- archipelago. The County Council will A statement of intent was also signed ska Institutet concluded their collabo- continue to be an active party in this regarding collaboration between the ration on the temporary agreement at cooperation. County Council and the pharmaceutical the end of the year and the agreement The County Council has also long company Meckert Sharpe and Dome will be drafted politically at the begin- been the main funder of the Archipelago (MSD). The statement of intent should ning of 2015. Foundation in Stockholm County and result in concrete cooperation projects The collaboration between the provides an annual operating grant to regarding knowledge gaps in health- County Council and KTH Royal Insti- the foundation. The foundation is fac- care where both parties contribute to tute of Technology is continuing. Calls ing major investments as the require- develop new pharmaceuticals in rele- for proposals for research funding for ments and conditions for water, sewage, vant areas. cooperation between researchers from environmental adaptation and accessi- The County Council Assembly the County Council and the university bility have been made stricter. The decided on 10 June to establish the were made during the spring and natio foundation has mapped the needs and Stockholm Medical Biobank (SMB). nally composed assessment groups

 To contents Sustainable growth Annual Report 2014 83 submitted proposals for approval. The mate-impacting anaesthetics. The envi- Resource efficient research projects approved will begin at ronmental prize attracted a great deal A new support tool for environmentally the beginning of 2015. This call for pro- of attention and 44 submissions from adapted procurement was launched in posals is unique in Sweden as no other various County Council financed opera- 2014. The tool contains five modules county council or region has a corre- tions were nominated. The great inter- with environmental requirements that sponding cooperation agreement in the est motivated the County Council to have been compiled in appendices for a subject area of health, medicine and employ a coordinator to capture, number of specific products and ser- technology to that between Stockholm develop and distribute all of the good vices. The tool is mainly adapted to the County Council and the KTH Royal examples. Stockholm County Council procurements conducted locally in Institute of Technology. was also the first county council to issue healthcare. A project about sustainable The County Council has mapped the “green bonds” during the spring. The IT in healthcare began in autumn 2014. county’s various County Council money the County Council borrows The project examines the possibilities financed actors in the innovation area. through the bonds is earmarked for to reduce environmental impact from This review has resulted in various pro- environmental investments. IT through material and energy effi- posals for how the actors will be able to The County Council’s Spårväg City ciency enhancements, as well as how IT be coordinated to further improve and programme received an award for inno- can be an aid in reducing the opera- enhance the efficiency of the County vation and collaboration on sustainable tions’ environmental impact. A good Council’s innovation activities. The development of infrastructure projects example is an on-going pilot project to work on an innovation strategy is a part that was awarded by the Sweden Green increase the re-use of furniture at of the process of drafting a new strategy Building Council. Karolinska University Hospital with for research, development, innovation the help of a web-based advertising and education for the County Council. Climate efficient service. Focus has been placed on mobilising In May 2014, the proportion of renewa- The County Council’s waste minimi- the County Council for the EU’s new ble fuel used by SL’s buses was 84 per sation plan, “Resource efficient in prac- research programme period 2014– cent. This proportion is distributed tice”, which was launched in February, 2020: Horizon 2020. Targeted efforts over 298 biogas buses, 721 ethanol describes the work of reducing waste, to market Stockholm as a successful buses and 849 RME/biodiesel buses. increasing re-use and recycling, and research region and attractive coopera- SL’s roughly 2,200 buses account for a prioritising renewable resources. An tion partner in health have been con- large part of the County Council’s total example of a waste-reducing measure is ducted through various activities in fuel consumption. This success there- a collaboration project between envi- Brussels during the year. Strategic fore makes a major contribution to the ronmental coordinators and dietary recruitment has also been conducted of County Council being able to achieve controllers at Södersjukhuset AB and expertise to work with research and the target of 75 per cent renewable fuels Rosenlund’s dietary unit where causes innovation issues in the EU pro- in transportation by 2016. and possible resolutions to reduce food grammes and funds in particular. In summer 2014, a study was con- waste are identified. Measurements ducted of the County Council’s condi- have shown that one out of five portions Effective environmental work tions to produce its own solar electric- of food at the hospital is thrown out. The County Council’s environmental ity. The study shows that Locum AB has The project has proposed changes in policy programme, Environmental more than 125,000 square metres of the food ordering system as well as an Challenge 2016 (Miljöutmaning 2016), roof area with good solar radiation. In effort to change food types. is broken down into three target areas: 2014, to reduce the climate impact from To prioritise renewable resources, • Climate efficient. medical gases, the County Council the County Council conducted a pro- • Resource efficient. tested various techniques with filters curement in 2014 with requirements • Health-promoting environmental that collect anaesthesia gases from the that favoured the development of bin work. patient’s exhaled air. In November, a sacks made of bio-based polyethylene full-scale test began of the most prom- that have significantly lower climate During the year, work began to prepare ising filter at Norrtälje Hospital. The impact than those made from fossil oil. a proposal for a new environmental County Council’s healthcare operations To further increase the proportion of programme for the years 2017–2021. also work to reduce the climate impact biomaterials in healthcare materials, The project is now meeting various from patient meals. Climate and envi- cooperation was begun with actors in stakeholders to gather their knowledge ronmental impact from food produc- research and industry. A template for and experience to eventually concretely tion was, for example, an area that was “material rounds” was also tested dur- formulate ideas and ambitions as tar- included in Karolinska University Hos- ing the year in a number of healthcare gets in the programme. pital’s training package for meal plan- operations. The round should be a sup- In June, the County Council’s envi- ners. Karolinska also arranged a recipe port in local efforts to reduce environ- ronmental prize was awarded for the competition on the perfect lunch – a mental impact from the use of sin- first time. The prize went to a doctor lunch that should be tasty, nutritious, gle-use materials. The County Council, and a nurse at Capio St. Göran Hospital good value for money and at the same the plastics industry and the recycling for their work on reducing the use of cli- time environment- and climate-smart. industry also participated in a Vinnova

84 Annual Report 2014 Sustainable growth  To contents project with the aim of improving recy- The certified training for managers for the County Council as an employer cling of plastic from healthcare. and administrators in gender equality to increase knowledge about people and equal opportunities continued dur- with disabilities. Practical placement Health-promoting ing the year with fully booked courses. positions for those with disabilities environmental work To further stimulate local efforts, par- have been established. A revision of the In 2014, measurements taken in 2005– ticipants who attended the training can programme will begin in the autumn 2012 of pharmaceutical remnants in now apply for funding for operational with the aim of a new programme waste water, drinking water and in the development linked to gender equality, beginning to apply as of 2016. archipelago were compiled. The study equal opportunities and diversity. The of pharmaceutical emissions from hos- maximum amount per application is Code of Conduct for suppliers pitals in Stockholm County that began SEK 100,000. During the year, 14 appli- In the work on the follow-up of social in 2014 will contribute knowledge on cations were approved. As the agree- requirements in procurement, fol- how the County Council should priori- ment with the current providers of the low-ups were conducted in 2014 of the tise the future work on reducing the training expires at year-end, new pro- agreements in the areas of textiles, environmental impact from pharma- viders were procured in the spring. pharmaceuticals, instruments and ceuticals. The annual sampling of phar- Collaboration in the area with the gloves. Two audit reports have been maceutical remnants in water was con- Health and Medical Care Administra- published: IT products in Stockholm ducted in the autumn, and the results will tion and the Traffic Administration was County Council and surgical textiles in be analysed at the beginning of 2015. intensified during the year and will Region Skåne. An audit in the area of The County Council’s guide for the han- continue with various joint projects and textiles was conducted in China where a dling of pharmaceutical waste was efforts next year as well. subcontractor to Textilia was visited. updated and improved in 2014. Infor- To increase competency in the mation was added regarding the scrap- Minorities and minority languages county councils and among the procur- ping of vaccines, inhalers and plasters. A national minority coordinator posi- ing companies, the national county Within the scope of the County tion has been established in the County council network prepared new commu- Council’s chemical strategy, the Council. In the first year, the area was nication materials and a new process KLARA chemical management system reinforced with a half-time position to description for social responsibility in was introduced at Locum AB’s contrac- support the coordinator and to work public procurement. tors and at the Berga Natural Resource with a focus on the Roma in particular. High School. A study of the environ- A language package to support Procurement mental and health impact from plasters Finnish as a minority language was dis- SCC Procurement has systematically was conducted to acquire knowledge on tributed to the child welfare centres for steered towards taking into account the selected plastic materials and new distribution to Finnish-speaking fami- total cost in procurements instead of kinds of plasticisers used in items in lies. The County Council Executive purchase price. Within the scope of medical and dental care. During the Board Administration has held initial health economics, consideration is year, the County Council also initiated consultations with national minorities for instance taken to the time and cooperation with Swetox, a recently and a proposal has been drafted with a frequency of changing bandages on established Swedish research centre, to plan on how the consultations will work wounds in wound care specials. further develop the County Council’s moving ahead. The department consistently works health-promoting environmental work. The employees have been trained in for greater coordination to fulfil the Conceivable projects might be to study issues concerning national minorities procurement policy goals regarding if new alternative plasticisers are better through meetings, lectures, seminars qualitative and commercial gains in and the connection between nanomate- and internal information. Additional procurements. In the purchase of rials, antibacterial products and antibi- efforts have been conducted to facilitate medical technology equipment for otic resistance. the work for administrations and com- New Karolinska Solna, the department panies with regard to mapping the worked for more procurements to be Social responsibility personnel’s language skills. coordinated for all hospitals in the Equal treatment for all citizens County Council. This work is expected Equal treatment for all citizens, the Work for accessibility: to increase and intensify in 2015. action plan based on the European More than just thresholds Work is under way to introduce GS1 Charter for Equality of Women and “More than just thresholds” is Stock- standards on article information and to Men in local life (the CEMR charter) holm County Council’s 2011–2015 pro- establish a master database that makes was developed and revised during the gramme for participation for the disa- it possible to use patient-centred scan- spring. In addition to gender equality, bled. The County Council Executive ning. The article flow has been mapped, the new action plan covers equal oppor- Board Administration has worked which by extension can lead to article tunities and diversity and was adopted with a skills development project in information being categorised and con- by the County Council Executive Board cooperation with the Swedish Disabil- verted to such a database. on 22 May. ity Federation (HSO). The objective is

 To contents Sustainable growth Annual Report 2014 85 Secure processes through an unforeseeable sequence of were compiled and submitted to the Information security events both nationally and internation- County Administrative Board and the Rapid IT development, complex sys- ally and changes can occur suddenly National Board of Health and Welfare tems and greater information sharing and unexpectedly. during the year. demand secure processes for informa- In 2014, a review of the systematic In 2014, a proposal for an updated tion handling. The County Council’s security work was conducted and emergency preparedness plan was also information security policy serves as important areas were identified and prepared where the starting point was the guide in this work. In 2014, the prioritised. Work is under way with threat- and scenario-based modelling. County Council’s management system regard to security protection and the The plan will be prepared in 2015. In for information security continued to systematic fire safety work and meas- addition, an overview was made of the be developed. A number of efforts were ures following audits. During the year, County Council’s steering documents made to strengthen the County Coun- the County Council’s insurance cover- and capacity in terms of protecting crit- cil’s capacity in the area. age was also strengthened. Information ical societal functions, total defence A new online training programme, and education efforts were conducted, a planning and Styrel (electricity supply DISA, was implemented in the County procurement of the County Council’s plan for critical functions), and the Council’s educational platform Lärtorget insurance solution was carried out and requirements set in the Act on Munici- and is now being gradually introduced a procurement of insurance brokerage pal and County Council Measures prior in administrations and companies with services has begun. In addition to this, to and in the event of Extraordinary the aim of increasing awareness of rules and procedures in the damages Incidents and during High Alert information security. County-coun- account have been adjusted. Most of (2006:544). Work was also begun with cil-wide operational support that ena- stage three in the implementation pro- regard to effective handling of tactical bles systematic work with information cess of Rakel has been completed and situation reports within the County security has been established and con- the remaining parts will continue to be Council, which will continue in the next trol points have been developed to be implemented in 2015. Education efforts year. able to measure how well the rules are linked to Rakel with regard to health- followed and to enable self-evaluation care, security functions, property oper- Sustainable IT delivery of value- and follow-up. Preparations were also ations and to some extent public trans- generating services made during the year for the establish- port functions have been carried out Various alternatives for standardising, ment of an overall function that will and will continue in 2015. An update of consolidating and improving the effi- support the County Council’s opera- the County Council’s steering docu- ciency of the operation of servers, stor- tions to identify and manage IT-securi- ments in the security area has begun, age, IT workstations, service desk and ty-related threats and incidents. The but has been delayed due to planning of local networks in the County Council task of preparing an action plan and the work concerning critical societal (excluding the Traffic Administration) application instructions for informa- functions. Work on this assignment will are currently being evaluated. tion security is under way, but has been continue in 2015. The evaluation is based on opera- delayed due to necessary reprioritisa- tional plans, strategies, earlier analyses, tions resulting from urgent events that Emergency preparedness surveys and other available materials. needed to be addressed. The work of Stockholm County Council is an exam- The following alternatives will be establishing and strengthening pro- ple of a critical societal function since evaluated: cesses for information security in the large parts of the core operations are • divided responsibility, as today, and County Council will continue in 2015 healthcare and public transport. The internally driven standardisation, with the goal of creating conditions so County Council also has a sector consolidation and efficiency that all administrations and companies responsibility with regard to healthcare enhancement will have implemented systematic and public transport. This requires • coordinated internal responsibility information security efforts. well-organised, efficient and systematic and internally driven standardisa- preparedness and security work of high tion, consolidation and efficiency Security quality, which is a prerequisite for the enhancement The County Council shall conduct County Council’s operations and ability • coordinated internal responsibility systematic security work to ensure to provide service to the residents in the and outsourcing to achieve desired integrity and security of patients, event of a crisis and severe strains on effects. passengers, employees, elected repre- society. Ensuring preparedness and sentatives and others affected by the security demands clear governance in County Council’s different operations. this area and that the work is done in The focus in the security work is to pre- cooperation between the various opera- vent causes and reduce vulnerabilities, tions of the County Council. as well as the ability to prevent, manage During the year, several prepared- and rebuild. At the same time, the sur- ness-strengthening measures were rounding world is constantly changing, carried out in the County Council’s often rapidly. Threats can change administrations and companies. These

86 Annual Report 2014 Sustainable growth  To contents Data was collected and interviews This work covers all shared IT sys- in cooperation with the operation, to were held and the results are being tems in healthcare around which there administer the system solution in analysed relative to needs and costs. is a need to cooperate. The objects are such a way that it can be further The work will be concluded in the first divided into three families: eHealth, developed in pace with operations quarter of 2015. administration, and information and and events in the world around. A new function in the County communication technology (ICT). • The programme shall aim for current Council Executive Board Administra- Cooperation (3R) has been estab- needs and requirements, but also tion that will guide and coordinate lished between the three major actors: prepare a solution that can handle strategic IT will be established. Stockholm County Council, Region future functions and the require- Recruitment of a manager for a new Västra Götaland and Region Skåne. ments they entail. function for managing strategic IT is Within the scope of the cooperation, a under way. The main mission for the programme proposal regarding the Improvements to IT systems function will be to ensure short- and next generation of healthcare informa- To facilitate the care providers’ admin- long-term management, prioritise and tion environment has been prepared. istration of identities, a pilot project has follow up on the County Council’s IT The objective of the programme is to: been carried out to adapt the ordering operations. Another task will be to • set requirements, procure and imple- portal for aids and system support for secure the exchange of information ment the next generation healthcare healthcare planning to Sambi. With the between healthcare actors and information environment within 3R Sambi service, identity management research, as well as residents and through appointed operations repre- can be coordinated between authorities, patients. sentatives county councils and municipalities. Once the manager for the function • create conditions for patient interac- A prestudy has been made to investi- has been appointed, work will begin to tion, knowledge management and gate the possibilities to connect IT sup- revise the financing model. The investi- healthcare collaboration in a cost- port in healthcare to national security gation assignment regarding alterna- effective manner both within and services for blocking and logging of tives for standardising, consolidating across regional boundaries. record access, for example. It initially and enhancing efficiency will provide involves supporting the ambulance partial input for this work. This also means that 3R wishes to influ- system and pregnancy and childbirth In parallel with this, work is under ence and contribute to the national system. way to establish the administration work in these areas. The consolidation of the emergency management model pm³ for all shared hospitals’ PC platforms, from Windows objects so that roles and responsibili- The objectives for the programme: XP to a common standardised IT ties are clarified. The objective is to be • A deployed system solution within 3R workstation (a PC platform based on able to manage IT support in a good way that clearly supports both current Windows 7), will continue until May and to take control over the costs. In the and future needs in healthcare pro- 2015. The project has been delayed due long term, consensus and a good over- cesses with the patient and resident to a combination of technical obstacles, view will lead to less, but more effective as participants. a large flora of applications and pro- and more user-friendly IT support, and • An established joint administration tracted supplier negotiations. In the will increase the possibilities to collab- organisation that the programme autumn, 4,200 IT workstations were orate and re-use solutions. steering committee deems to be able, replaced and installed.

 To contents Sustainable growth Annual Report 2014 87 The County Council as an employer

Stockholm County Council is an attractive and competitive employer. Good healthcare, well-functioning public transport, a rich cultural life and good planning to meet the region’s growth are secured by having the right expertise within the organisation.

88 Annual Report 2014 a  To contents An attractive and competitive strengthen the County Council in its previous year. In the transport area, the employer role as a purchaser of education. Coop- corresponding figure is 646, which is 11 eration with the region’s universities more than budget and 22 more than in The County Council’s personnel and has been further developed. Quality 2013. Other operations have 151 more skills supply is crucial to meet the need assurance of health science programme full-time equivalents than planned, for well-trained personnel. Demands content and emphasis continues, as do which corresponds to an increase of 163 increase with the future health and efforts to increase the number of places compared with last year. medical care efforts and the infrastruc- on specialist education programmes. The number of full-time equivalents ture and public transport investments The human resource strategy work is including extra time, such as hour- the County Council is facing. At the based on the fundamental principles in ly-paid personnel and compensated same time, the focus is on the overall the County Council’s HR policy: time in excess of normal working hours, objectives of a high level of accessibility, • actively take responsibility was 2.2 per cent higher than in 2013. greater efficiency and strengthened • customer and results focus Extra time increased by 4.0 per cent patient safety. During the year, a num- • change and development. during the same period. ber of activities and actions were The number of full-time equivalents carried out to secure the future skills Staffing levels excluding extra time or corresponding supply. The average number of annual employ- measurements in Stockholm County Development is proceeding in sev- ees in all health and medical care was Council was 41,411 in 2014, which is 615 eral strategic areas to provide greater 38,687, which was 453 more than the more than budget and 837 more than in clarity in the educational area and year’s budget and 652 more than the 2013. Karolinska University Hospital,

Workforce by area of activity

Gender distribution 2014 (number of employees) 2014 2013 Change % Women Men Health and medical care, inc. dental care* 42,398 41,570 2% 80% 20% Transport 638 623 2% 54% 46% Property operations 291 253 15% 47% 53% Other operations** 1,048 1,082 –3% 50% 50% Total 44,375 43,528 2% 79% 21% Of whom, in administrations 29,823 29,072 3% 78% 22% Of whom, in companies 14,552 14,456 1% 83% 17% Employment rate*** 97% 96% 96% 98% Part-time employees**** 13% 13% 89% 11% Number of annual employees***** 42,847 41,921 2% 79% 21%

* The underlying data includes employees in TioHundra AB, which is jointly and equally owned by the County Council and Norrtälje Municipality. In total, TioHundra has 2,902 monthly employees. ** Other operations include AB SLL Internfinans, Culture Administration. The County Council Executive Board Administration, MediCarrier AB, the County Council Audit Office and the Patient Advisory Committee *** Employment rate vis-à-vis the number of employees. **** Proportion of men and women of the total number of part-time employees. ***** Aggregate employment rate.

Stockholm County Council Stafﬁng levels (full-time equivalents)

Outcome 2013 40,574

Outcome 2014 41,411

Budget 2014 40,796

 To contents The County Council as an employer Annual Report 2014 89 Healthcare Provision Stockholm prepared within the scope of the Plan well as measures and activities that are County, the County Council Executive for Future Health and Medical Care and planned to secure skills supply. They Board Administration, the Public implemented in 2014. Forecasts are also describe the need for overall and Healthcare Services Committee and based on annual employees in County coordinated efforts. It is apparent in Södersjukhuset AB showed the largest Council-financed healthcare and an the plans that healthcare operations increase in the number of full-time estimated future care need. Using key work on the planning of the Plan for equivalents. figures such as retirements and an Future Health and Medical Care imple- annually changing care need, the mentation to meet the requirements set Salary policy that supports County Council obtains input to be able for both the organisation and the to prioritise and initiate measures at an employees’ competence. operational improvement early stage. During the year, nurses Healthcare operations describe a The special salary efforts with certain were a prioritised professional category shortage of nurses during the year, both specialist nurses, biomedical analysts and a number of proposed activities general nurses and specialist nurses. and midwives has been implemented and measures were prepared together One measure has therefore been to offer and evaluated. A new effort has begun with healthcare operations. The model study pay to nurses attending specialist to develop processes for the setting of was also used as a basis in the formula- training in specialities with staff short- salaries, working conditions and salary tion of ST Stockholm with the aim of ages with the aim of increasing the structures to better support long-term establishing continuous control and influx to them. Introduction and devel- skills supply and local salary determi- management of medical specialists in opment programmes for recent nursing nation. This work will continue in 2015, Stockholm County Council. graduates have been developed to cre- in parallel with the preparation of a To make the formal and real skills of ate security in the professional role and salary police for the County Council. the employees visible, the County cover skills gaps between theoretical Salary development within the Council continued to introduce KOLL, training and practical reality. whole of SCC in 2014 totalled 3.1 per the County Council’s uniform model The needs for county-council-wide cent, 3.4 per cent for women and 1.8 per and structure for skills planning. The measures that are emphasized in the cent for men. model provides a basis for planning and skills provisioning plans mainly involve follow-up of skills development, based working to ensure that the dimensioning The County Council on goals and assignments, and is an of the educational places and the content important tool to better secure future and quality of the programmes match – an employer with breadth skills provisioning. To quality assure needs. There is also note of the need to Efforts to increase awareness of and enhance the efficiency of the intro- secure the supply of certain medical Stockholm County Council as an duction of KOLL, the preparation of specialists by increasing and distribut- employer and strengthen the view of definitions for the employees’ roles is ing medical specialist positions. the County Council as an attractive increasingly done jointly, over adminis- employer are long term. During the tration and company boundaries. In Education year, the County Council participated 2014, role preparation took place for in labour market days for university example in the areas of communication, The County Council cooperates with students and at job fairs for schoolchil- procurement, physiotherapy and occu- upper secondary schools, universities dren and professionals. In addition, pational therapy. and institutions of higher education in work experience positions and summer A joint role preparation gives Stockholm as well as the University of jobs were offered to young people. stronger consensus regarding duties Gävle and Mälardalen University in As a complement to the hospitals’ and roles and increases the possibilities terms of operations-integrated learning and healthcare operations’ own recruit- to coordinate skills development for students in healthcare programmes. ment efforts, a large joint advertising efforts. It also provides better condi- A cooperation group with participants effort for summer substitutes in health- tions to be able to contribute quality-as- from the County Council, Karolinska care was carried out with all of the sured and qualitative care when the Institutet and the other universities has County Council’s care providers as the same competence requirements are set worked on optimising the flow of stu- sender. Other advertising efforts that regardless of care provider. The propor- dents over the terms to ensure the sup- aim to emphasise some of the County tion of administrations and companies ply of clinical training places for stu- Council’s less well-known professional that have introduced or begun to intro- dents in operations-integrated categories were also carried out. duce KOLL, including the ProCompe- learning. tence IT tool, is nearly 50 per cent and Various activities have been carried Skills provisioning currently encompasses around 5,400 out to develop educational learning employees. environments, such as student halls, Skills provisioning was one of the areas Administrations and companies inter-professional learning environ- of highest priority during the year. A make annual skills provisioning plans ments and clinical training centres. county-council-wide model for needs in accordance with the budget instruc- A new version of KliPP, a system for assessment and management of future tions. The plans describe existing skills the registration of educational places skills provisioning in healthcare was gaps and special recruitment needs as for operations-integrated learning, has

90 Annual Report 2014 The County Council as an employer  To contents been deployed. KliPP is beginning to oped in collaboration with the university perspective. A third alternative for gradually be introduced in the medical sity and Karolinska Institutet. The gender has been added and the devel- programme. course was held for the first time in oped version of Rekrytera will be Four new academic health centres autumn 2014. launched at the beginning of 2015. (AVC) were established during the year: The Academic Ambulance effort The certified gender equality and the private care provider St. Eriks continued during the year to strengthen equal opportunities training for man- health centre and the county-coun- patient-centred research, education agers and administrators was held on cil-operated Mörby health centre, Hud- and development in pre-hospital care. six occasions in 2014. In addition to the dinge health centre and TioHundra AB The County Council has been a driver online lesbian, gay, bisexual and trans- in Norrtälje. Within geriatric care oper- to realise a higher vocational education sexual (LGBT) training programme, an ations, efforts began during the year to programme to be a paramedic in online training programme to remove strengthen and build up the academic Stockholm and the first round of the obstacles with a focus on disabilities environment for students. education began in autumn 2014. Aca- has been developed and launched. The A systematic quality follow-up of demic Ambulance will contribute to online training programme is directed operations-integrated learning was some extent. at all employees in the County Council introduced in the County Council. Contract education of specialist and employees at suppliers that have In 2014, students from Karolinska nurses in paediatric healthcare, agreements with the County Council. Institutet and the individual universi- paediatrics with a focus on neonatol- The work on key figures for gender ties, employees and managers at ogy, intensive care and surgery has equality, Jämix, and for ethnic diversity Danderyds Sjukhus AB, Karolinska begun. In 2014, the contract education has continued and in 2014, work began University Hospital, Healthcare programmes encompassed a total of on implementing new measurements Provision Stockholm County and 100 places. Cooperation with Karolin- throughout the Group in 2015. The key Södersjukhuset AB participated in the ska Institutet is under way in terms of figures form the basis of a successful follow-up. The follow-up, which is con- elective courses in the regular specialist strategic diversity effort. ducted in questionnaire form, means nurse programme with a focus on med- A mapping of salaries was made dur- that it is possible to also follow up quali- icine and surgery. ing the year and no non-objective salary tative parts of the education assign- differences were indicated according to ment in the annual education accounts. Greater diversity – equal the Office of the Equality Ombudsman The County Council and Karolinska (DO). Institutet have drawn up criteria for conditions and opportunities The County Council has continued how the programmes’ quality and Gender equality, equal opportunities to conduct active efforts to facilitate research ties can be strengthened. and diversity are prioritised areas. The employment for people with disabili- The County Council cooperates with County Council conducts goal-oriented ties. In the budget for 2014, SEK 5 mil- the KTH Royal Institute of Technology work to actively prevent and combat lion was allocated to further support with regard to skills development and all forms of discrimination and abusive the operations in the recruitment of educational efforts in areas that are in treatment. The advertising tool people with disabilities. During the the intersection of health, medicine and Rekrytera has been accessibility- year, 18 people were offered practical technology. The Safe Technology course adapted to emphasize that the recruit- placement positions at the County in practical healthcare has been devel- ment process takes place from a diver- Council’s administrations and compa-

Number and proportion managers* at various levels, by gender

2014 2013 Women Men Total Women Men Total Propor- Propor- Propor- Propor- Number Number Number Number Number Number tion tion tion tion AA – Managers reporting directly to a political committee/board 3 19% 13 81% 16 7 35% 13 65% 20 BA – Managers reporting directly to AA-managers 42 55% 34 45% 76 49 51% 48 49% 97 BB – Middle managers reporting to AA/BA- managers 226 64% 125 36% 351 219 63% 130 37% 349 BC – Managers directly superior of C-managers 68 83% 14 17% 82 66 79% 18 21% 84 C – First line managers 1,098 76% 345 24% 1,442 1,062 76% 336 24% 1,398 Total 1,436 73% 531 27% 1,967 1,403 72% 545 28% 1,948

* The term manager applies to people with responsibility for personnel, budgets and operations.

 To contents The County Council as an employer Annual Report 2014 91 nies. Work to offer practical placement To realise the Plan for Future Health developing teamwork based on the to people with various disabilities will and Medical Care, all managers must patient’s needs. continue in 2015–2017. have the skills necessary to drive and Risk prevention work has been made implement the change. With the aim of more effective and the use of punc- Management and leadership securing competency in change man- ture-safe products has increased to pre- agement, the County Council planned vent puncture wounds. Well-functioning management and to conduct a training effort for middle Healthcare operations have made leadership is a key prerequisite in order managers. In consultation with repre- special efforts to prevent work-environ- for the County Council to be developed sentatives of the administrations and ment-related problems with ties to the and made more efficient. To secure the companies concerned, the effort was new construction and renovations tak- supply of managers, Stockholm County cancelled. The reason was that more ing place in connection with the Plan Council works systematically and long- time is needed for dialogue and to for Future Health and Medical Care. To term on management provisioning. In establish support before a county- avoid unnecessary strain on the work the employee follow-up, the employees’ council-wide development effort can be environment during the change period, perception of management in the oper- implemented that will be a support for the operations have been able to apply ations is presented. Since measure- and complement to the activities being for financial support through the Work ments began in 2006, the proportion of carried out at the respective operations. Environment Improvement project. managers with a management index of So far, 54 local efforts have been 70 or higher increased from 47.5 per Health-promoting work awarded grants, such as the develop- cent to 67.6 per cent. The County Coun- ment of new methods, training in load cil needs a common management struc- environment ergonomics, measures to improve the ture to secure the supply of managers in Based on the results of the employee psychosocial work environment, and the short and long term. In the autumn, survey, an action programme has been training for managers and safety repre- work began on preparing a proposal on drawn up. Several operations have con- sentatives in change efforts and com- such a county-council-wide structure. ducted training efforts with the aim of munication.

Key health-related ratios

2014 2013 2012 2011 2010 ACE index 77 76 76 Employee index 76 75 75 75 75 Attendance rate, %* 63 64 64 69 73 Sick days per employee 18.0 17.9 17.2 16.3 15.4

* Due to a miscalculation in historical data, the figures are not comparable with past years. The error has been corrected as of 2012.

92 Annual Report 2014 The County Council as an employer  To contents Properties in healthcare

To meet the Plan for Future Health and Medical Care’s vision, a large number of property projects will be under way in Stockholm County Council over the next few years. In 2014, work on the strategic investments shifted into a distinct implementation phase.

 To contents Annual Report 2014 93 Overall properties Locum AB also assists the owner and • satisfied customers the Public Healthcare Services Com- • sustainable development The property portfolio in Landstings- mittee in property issues, including in • balanced finances fastigheter Stockholm is mainly com- connection with investment planning. • an attractive employer and proud prised of seven emergency hospital There was a surplus of SEK 18 mil- employees. buildings (two of which are used as uni- lion in 2014, adjusted for the effect of an versity hospitals), ten local hospitals interest rate change on the calculation In 2014, the main focus was on develop- and a number of healthcare centres, of pension liabilities of SEK 13 million. ing and improving customer relations psychiatric clinics and dental clinics. The adjusted result was SEK 13 million and customer satisfaction in the prem- The property portfolio’s total floor higher than the budgeted surplus ises that Locum AB manages and pre- space amounts to 2.0 million square requirement of SEK 5 million. The paring the implementation of the strate metres in gross floor space, of which the result was SEK 16 million lower than gic investments for the Plan for Future strategic properties’ gross floor space is 2013. The surplus before appropria- Health and Medical Care. Locum AB 1.9 million square metres. The occu- tions and tax amounted to SEK 31 began work on the various activities in pancy ratio for the strategic properties million. all focus areas in 2014. Work in some amounted to 91 per cent in December Operating revenues were SEK 36 activities will continue in 2015. 2014, which is 2 percentage points million higher than in 2013, an increase During the year, Locum AB drew up lower than in December 2013. Strategic of 13 per cent. This outcome was SEK 38 a new operating strategy and began the properties are those that the County million or 14 per cent over budget. The implementation of a new property man- Council intends to retain, such as the deviation from budget is mainly attrib- agement system with the aim of impro emergency hospitals. utable to higher service sales. The ving the follow-up of operations. Dur- increase is linked to the higher activity ing the autumn, Locum AB launched a Locum AB mainly on the project side with more new customer service called “one num- employees charging for their time. ber in” to improve efficiency in cus- Locum AB’s mission is to be a service Operating expenses were SEK 53 tomer case handling and improve cus- unit in Stockholm County Council with million higher than in 2013, an increase tomer service and personal treatment. responsibility for property manage- of 22 per cent. This outcome was SEK The main focus in 2015 will continue ment related owner issues with regard 22 million or 8 per cent over budget. to be to develop and improve customer to Landstingsfastigheter Stockholm The deviation from budget is mainly relations and customer satisfaction in and to assist the owner in property due to higher costs for insourced per- the premises that Locum AB manages. strategy issues on behalf of the County sonnel and higher costs for consultants. Locum AB is also continuing the work Council. According to agreements with Premises costs also exceeded the of ensuring the delivery of the projects the County Council, Locum AB is budget. for the Future Plan for Health and Med- responsible for both technical and The break-down of Locum AB’s stra- ical Care, with a focus on quality assur- financial management of properties in tegic objectives is based on four target ance, finances and time management, Landstingsfastigheter Stockholm. areas: and risk management.

Locum AB Outcome Outcome Change Budget Properties SEK million 2014 2013 % 2014 Operating revenues 318 282 13% 280 – of which, SCC internal 318 277 14% 279 in health- Operating expenses –293 –240 22% –271 Depreciation/amortisation –2 –2 – –3 Net financial items 8 – – –2 care Surplus before appropriations and taxes 31 39 – 5 Appropriations** –32 –39 – – Surplus after appropriations and taxes –1 1 – 5 Adjusted surplus* 18 34 – 5 Investments 3 1 –84% 4 Number of full-time equivalents 260 227 2% 254

94 Annual Report 2014 Properties in healthcare  To contents Landstingsfastigheter was SEK 321 million or 12 per cent over • technical improvement of building 1 Stockholm (LFS) budget. The deviation from budget is at Löwenströmska Hospital mainly attributable to capital gains • new garage at Huddinge Hospital Landstingsfastigheter Stockholm is a from property sales and higher rental • new construction and renovation of profit centre within Stockholm County income than budgeted. Södertälje Hospital Council, in which reports are issued on Operating expenses were SEK 177 • new treatment building at Södersjuk the County Council’s property manage- million higher than in 2013, which is an huset ment. The properties are managed by increase of 12 per cent. This outcome • renovation and construction of the Locum AB according to agreements was SEK 287 million or 20 per cent over emergency ward at Danderyd with Stockholm County Council and in budget. The deviation from budget is Hospital accordance with the owner directives mainly attributable to expenses for dis- • renovation for care wards and treat- established by the County Council posals of buildings demolished in con- ment at St. Göran Hospital. Assembly. nection with the implementation of the There was a surplus of SEK 338 mil- the Plan for Future Health and Medical The main focus in the coming period lion in 2014, which was SEK 103 million Care and other property costs. will remain on preparing the work on higher than the budgeted surplus Net financial items was an expense the strategic investments for the Plan requirement of SEK 235 million. The of SEK 202 million in 2014, which was for Future Health and Medical Care and result was SEK 313 million lower than SEK 60 million higher than the budg- developing and improving customer 2013. Net property sales (not budgeted) eted net financial expense of SEK 262 relations and customer satisfaction. amounted to SEK 132 million. The sur- million. This deviation is due to contin- In 2014, work began on introducing plus excluding property sales amounted ued low interest rates. component depreciation (RKR 11.4). to SEK 206 million, which was SEK 29 Investments in Landstingsfas- The financial impact of the introduction million below budget. tigheter Stockholm were made in an is deemed to be marginal. This work Total operating revenues, including amount of SEK 2,254 million. The will be completed in 2015. net property sales, were SEK 130 mil- budgeted investment volume amounted lion lower than in 2013, which is a to SEK 2,400 million. The projects with decrease of 4 per cent. This outcome the largest outcome in 2014 are:

Properties in healthLandstingsfastigheter- Stockholm (LFS)

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 care Operating revenues 2,947 2,862 3% 2,758 – of which, SCC internal 2,487 2,388 – 2,361 Gains from property sales 132 347 –62% 0 Total operation revenues 3,079 3,209 –4% 2,758 Operating expenses –1,699 –1,522 12% –1,412 Depreciation/amortisation –839 –816 – –849 Net financial items –202 –219 – –262 Surplus/deficit 338 651 – 235 Investments 2,254 1,352 67% 2,400

 To contents Properties in healthcare Annual Report 2014 95 Financial and other operations

Due to Stockholm County Council’s high investment volumes in 2014 and coming years, the focus in 2014 was on financial operations – primarily the handling of liquidity and external borrowing.

96 Annual Report 2014  To contents Overall financial operations credit rating means that lending money SEK 69,929 million (66,792), which was to the County Council is associated with an increase of 4.7 per cent compared In 2014, Stockholm’s population con- a very low risk. This allows the County with the previous year and was SEK 527 tinued to grow and the County Council Council to continue to obtain advanta- million below budget. Compensation made major investments during the geous loan terms. according to the agreement in principle year in both healthcare and public Expectations for 2015 are to con- with the City of Solna concerning the transport to meet the residents’ needs. tinue to focus on implementing and Metro extension, LS 1312-1619, was This meant that liquidity was in planning for both this year’s and future included in an amount of SEK 250 mil- focus during the year and the borrow- years’ financing. lion. ing limits were raised. Stockholm Personnel costs amounted to SEK County Council needs to have diversi- Group financing 6,649 million (6,232), which was an fied borrowing and several sources of increase of 6.7 per cent compared with financing so it can choose the most suit- Introduction and mission the previous year and was SEK 586 mil- able when external financing is needed. Group financing is the County Council’s lion below budget. The deviation from In 2014, Stockholm County Council central accounting unit where items of budget mainly consisted of lower was the first county council to conduct a a county-council-wide nature are employer’s contributions and lower transaction on a green bond. This is a reported, such as tax revenues and dis- pension expenses. loan where the funds go to environmen- bursements of county council grants as Total tax revenues for the year tally classified investments. The loan well as employer’s contributions and amounted to SEK 63,971 million amount of SEK 1.1 billion was equiva- pensions for personnel in the County (61,802), which was an increase of 3.5 lent to approximately 15 per cent of the Council’s administrations. The unit has per cent compared with the preceding County Council’s estimated credit no employees and conducts no opera- year and was SEK 116 million over requirement for 2014. tions. budget. See the separate section regard- Stockholm County Council retained ing total tax revenues. its strong credit rating. This was con- Finances Net financial items amounted to firmed by the independent credit rating There was a surplus of SEK 822 million income of SEK 411 million (expense: institute Standard & Poor’s. Both the (deficit: 337), which was an increase of 2,003), which was an increase of SEK long-term and short-term credit rating SEK 1,159 million compared with last 2,414 million compared with last year of A A+ and A-1 are affirmed and year and was SEK 1,132 million over and was SEK 438 million over budget. deemed to have a stable outlook. The budget. The difference compared with last year news from Standard & Poor’s means Non-recurring items resulted in a is primarily related to the interest com- that Stockholm County Council contin- net charge of SEK 1,164 million component of future pension commitments ues to have the second highest credit pared to last year’s result, which is the of SEK 2,317 million. The deviation rating on the long term and the highest main reason for this year’s positive from budget related to the interest com- credit rating on the short term. deviation. ponent of future pension commitments It is important for the County Coun- Operating revenues amounted to was SEK 454 million. cil to retain a very high credit rating and SEK 6,369 million (6,656), which was a Investments for the year amounted the rating needs to reflect the capacity decrease of 4.3 per cent compared with to SEK 376 million with a budget of SEK to keep payment commitments and the previous year and was SEK 52 mil- 477 million. The investments related to financial obligations in the short and lion over budget. Citybanan and are planned to continue long term. For future investments, this Operating expenses amounted to through 2017.

Group financing

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Operating revenues 6,369 6,656 –4% 6,317 Operating expenses –69,929 –66,792 5% –70,456 Net operation expenses –63,560 – 60,136 – – 64,139 Tax revenues, general government grants and equalisation 63,971 61,802 63,856 Net financial items 411 –2,003 –27 Surplus/deficit 822 –337 –310 Investments 376 369 2% 477

 To contents Financial and other operations Annual Report 2014 97 AB Stockholms Läns Finances Future outlook Landstings Internfinans There was a surplus of SEK 3 million (9) In 2014, Stockholm’s population con- for 2014, which was in line with budget. tinued to grow and the County Council Introduction and mission This result is lower than last year, will be making major investments over AB Stockholms Läns Landstings mainly due to lower net financial items the next few years in both healthcare Internfinans (Internal Finance) is com- attributable to lower excess liquidity and public transport to meet the resi- missioned by the County Council to and lower interest rates. dents’ needs. The investments entail serve as an internal bank for County greater borrowing requirements for the Council administrations and wholly Goal attainment County Council and a continued strong owned companies and to act in a coor- AB Stockholms Läns Landstings focus on financial risks and liquidity in dinated fashion towards external actors Internfinans achieved the balanced 2015. Expectations for 2015 are even in the financial markets. finances objective. The task of ensuring more focused on implementing and AB Stockholms Läns Landstings that the target in Stockholm County planning for both this year’s and future Internfinans provides assistance on Council’s finance policy regarding pay- years’ financing. In addition, adapta- commercial terms to Stockholm County ment capacity for the County Council tion will be required to additional regu- Council, its administrations and compa- amounting to a minimum of three latory frameworks in the credit and nies in the central management of liquid- weeks was also achieved during the financial markets, which mean that AB ity, borrowing in capital markets and entire period. AB Stockholms Läns Stockholms Läns Landstings Intern- lending to the County Council’s adminis- Landstings Internfinans also has local finans will prioritise internal controls trations and companies. AB Stockholms goals comprising the areas of custom- and sound risk management. Läns Landstings Internfinans also man- ers, employees, the environment, inter- ages the County Council Group’s finan- national work, processes and finances. cial risks, administers the County Coun- AB Stockholms Läns Landstings cil’s Group account system and manages Internfinans also fulfilled its measura- the County Council’s endowments, of ble internal goals. which there are around 140 with managed assets totalling SEK 532 million at 31 December 2014.

AB SLL Internfinans

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 12 12 –1% 11 – of which, SCC internal 11 11 – 11 Expenses –11 –10 11% –11 Net financial items 3 8 – 3 Surplus before appropriations and taxes 3 10 – 3 Appropriations** –3 –8 – – Surplus after appropriations and taxes 0 2 – 3 Adjusted surplus* 3 9 – 3 Number of full-time equivalents 9 9 0% 9

98 Annual Report 2014 Financial and other operations  To contents Landstingshuset i Damages Account Stockholm AB The Damages Account is the County For 2014, Landstingshuset i Stockholm Council’s system for property and con- AB posted a deficit of SEK 589 million. sequential loss insurance. All the Reversals of impairments of financial County Council’s properties and the assets and shares in subsidiaries total- units’ operations, except the transport ling SEK 16 million had an impact on companies, are insured via the Dam- the result. In addition, revenues are ages Account. The operation is financed recognised regarding dividends on through annual premiums from the shares in subsidiaries in an amount insured parties. of SEK 26 million from Waxholms The result for 2014 is in line with Ångfartygs AB, MediCarrier AB and AB budget through adjustment against the Stockholms Läns Landstings Intern- Damages Account’s account for provi- finans. sions of SEK 3.9 million.

Landstingshuset i Stockholm AB

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 57 230 –75% 0 – of which, SCC internal 0 0 – 0 Expenses –35 –25 41% –32 Surplus before appropriations and taxes 22 205 – –31 Appropriations* – 611 70 – – Surplus after appropriations and taxes –589 274 – –24

* Pertains to tax optimisation within the LISAB Group.

Damages account

Outcome Outcome Change Budget SEK million 2014 2013 % 2014 Revenues 13 13 3% 13 – of which, SCC internal 13 12 5% 13 Expenses –13 –13 3% –13 Surplus/deficit 0 0 – 0

 To contents Financial and other operations Annual Report 2014 99 Foundations, endowments and coordinating federations

The County Council manages and distributes funds to various causes. Initiatives within the Archipelago Foundation, for example, are conducted to promote the archipelago’s positive development, vibrant communities and accessibility for the county’s residents and visitors.

100 Annual Report 2014  To contents Formed by the County research competence from Karolinska status of the elderly in society. The Council independently or Institutet, for research on public dis- foundation was established in 1986 by with others eases. By identifying the molecular Stockholm County Council and the City mechanisms behind these diseases, it is of Stockholm, which remain the princi- The County Council’s consolidated possible to develop better diagnostics, pals. The County Council’s grant to the income statement and consolidated bal- treatment and preventive measures. foundation amounted to SEK 7 million ance sheet include committees, admin- The foundation’s revenues consist pri- in 2014. istrations and companies in which its marily of rental income. ownership share is higher than 50 per Archipelago Foundation cent. Associated companies (companies Clara Foundation The Archipelago Foundation owns and in which the ownership share is 20 to 50 The Clara Foundation’s role is to manages land in the Stockholm archi- per cent) are reported according to the finance, construct, own and manage pelago. The foundation’s objective is to equity method (see Note 12). Founda- premises on behalf of Södertörn Uni- maintain the distinctive character, tions are not consolidated in the Group versity College. The foundation was natural values and landscape of the income statement or balance sheet in formed by the County Council in 1998. archipelago, while promoting the devel- any way other than that any grants pro- The foundation’s revenues consist pri- opment of outdoor life, culture, recrea- vided are recognised as expenses in the marily of rental income. tion and tourism. The foundation works income statement. The major founda- in a long-term perspective to ensure a tions and associations that the County Stockholm County Museum thriving archipelago. The County Council has formed independently or Foundation Council is the main source of financing, with others are presented below. The Stockholm County Museum Foun- and its grant to the foundation in 2014 The surplus/deficit for 2013 is estab- dation works to increase awareness of amounted to SEK 44 million. lished in the first half of 2014; accord- the significance of the county’s history ingly, the table pertains to the surplus/ and the value of cultural environments. Concert House Foundation deficit at 2013 compared with 2012. The foundation was formed in 1982 The Concert House Foundation is through an agreement between charged with realising artistic and cul- Karolinska Cancer Centre Stockholm County Council and the tural goals and actively promoting Foundation, CCK Municipalities of Norrtälje, Sigtuna musical events. As resources permit, The Karolinska Cancer Centre Founda- and Södertälje, the City of Stockholm, the foundation is also charged with tion (CCK) gathers all experimental and Stockholms läns hembygdsförbund actively promoting other activities that cancer research at Karolinska Univer- (Stockholm County Regional History directly or indirectly stimulate interest sity Hospital. Its activities strengthen Society). The County Council’s grant to in music and broaden the range of music clinical cancer research at the hospital. the foundation amounted to SEK 12 on offer. The Concert House Foundation The foundation was formed in 1994. million in 2014. owns Konserthuset, the Stockholm The foundation’s revenues consist Concert Hall, and the Stockholm primarily of rental income. Stockholm Gerontology County Council is the main source of Research Centre financing for its operations and the Centre for Molecular Medicine The Stockholm Gerontology Research Royal Stockholm Philharmonic Foundation, CMM Centre initiates and conducts research Orchestra. The County Council’s grant The Centre for Molecular Medicine in gerontology. The foundation also to the Stockholm Concert Hall Foundation (CMM) brings together 500 works to apply in practice the centre’s amounted to SEK 128 million in 2014. persons with clinical experience from experience and research results in During the period 2007 through 2009, Karolinska University Hospital and areas of particular importance for the extensive renovations were made to the

Foundations

Surplus/Deficit for Surplus/Deficit for Equity Total assets SEK 000s the year 2013 the year 2012 31 Dec. 2013 31 Dec. 2013 Karolinska Cancer Centre Foundation 2,913 929 73,727 110,883 Centre for Molecular Medicine Foundation 573 3,386 94,738 167,865 Clara 1,184 –1,021 171,279 1,306,305 Stockholm County Museum Foundation 497 789 4,304 6,774 Stockholm Gerontology Research Centre 295 350 6,125 38,160 Stockholm County Archipelago Foundation -1,776 2,520 9,604 91,291 Concert House Foundation 562 1,327 14,564 60,894 The Flemingsberg Science Foundation -429 91 11,386 12,449

 To contents Foundations, endowments and coordinating federations Annual Report 2014 101 Stockholm Concert Hall. The renova- The founders comprise Stockholm Coordinating federations tions were financed through an inter- County Council and the municipalities The purpose of the coordinating federa- est-free loan from Stockholm County of Huddinge and Botkyrka. The County tions is to oversee financial coordina- Council of SEK 123.4 million to be Council’s grant to the foundation tion in rehabilitation activities between repaid over 20 years. amounted to SEK 1 million in 2014. social insurance offices, employment services, county councils and munici- The Flemingsberg Science Endowments palities. In 2014, a new coordinating Foundation The County Council’s endowments, federation was formed, Södra Roslagen, On 12 October 2010, the County which are managed by AB Stockholms which encompasses the municipalities Council Assembly decided to approve Läns Landstings Internfinans on behalf of Täby and Österåker. There were the formation of the Flemingsberg of the County Council Executive Board, already coordinating federations for Science Foundation. The foundation consist of 140 foundations and gift the municipalities of Nacka, Södertälje was formed on 1 January 2011, with funds. The market value was SEK 532 and Värmdö and joint federations equity of SEK 10 million, of which million at 31 December 2014. In 2014, for the municipalities of Botkyrka, Stockholm County Council contributed the foundations distributed SEK 22.1 Huddinge and Salem (HBS) as well as SEK 3.5 million. The Flemingsberg million in accordance with the appro- Haninge, Nynäshamn and Tyresö Science Foundation will promote col- priation provisions. The carrying (Östra Södertörn). In 2014, Stockholm laboration between science, business amount was SEK 484 million. County Council contributed SEK 14.1 and the community in Flemingsberg. million to the coordinating federations.

102 Annual Report 2014 Foundations, endowments and coordinating federations  To contents  To contents Annual Report 2014 103 Financial report

104 Annual Report 2014  To contents Income statement

SEK million Group County Council Note 2014 2013 2014 2013 Operating revenues 1 18,507 18,406 8,782 8,846 Operating expenses 1 –77,661 –72,872 –70,820 –66,465 Depreciation/amortisation 2 –3,817 –3,589 –1,368 –1,313 Net operation expenses –62,971 –58,055 –63,405 –58,933 Of which, items affecting comparability 6 –250 814 –250 685

Tax revenues 3 59,612 57,699 59,612 57,699 General government grant 3 4,678 4,624 4,678 4,624 Income and expenses equalisation 3 –319 –521 –319 –521 Total tax revenues 63,971 61,802 63,971 61,802

Financial income 4 126 704 654 597 Financial expenses 5 –990 –3,517 –565 –2,824 Net financial items –864 –2,813 90 –2,226 Of which, items affecting comparability 6 – –1,564 372 –1,752

Surplus for the year 136 934 656 643

Surplus for the year according to the balance requirement Surplus for the year 136 934 Capital gains –133 –409 Surplus for the year after balance requirement adjustments 3 525 RIPS rate / Interest expense pensions company – 1,564 Reserved equity – –2,000 Balance requirement result for the year 3 89

 To contents Financial report Annual Report 2014 105 Balance sheet

SEK million Group County Council Note 2014 2013 2014 2013 Assets Fixed assets Intangible assets 8 108 59 47 45

Tangible assets Land, buildings, plant and machinery 9 35,065 31,174 15,296 12,799 Machinery and equipment 10 19,451 19,457 4,309 4,107 Constructions in progress, advance payments for tangible assets 11 28,141 21,246 14,289 11,689

Financial assets Financial assets 12 1,087 1,126 30,248 25,067 Total fixed assets 83,851 73,063 64,189 53,707

Current assets Stocks, etcetera 469 426 280 225 Current receivables 13 5,779 6,002 4,670 4,478 Current investments 0 0 0 0 Cash and cash equivalents 334 1,841 34 7,852 Total current assets 6,582 8,269 4,983 12,555

Total assets 90,433 81,331 69,172 66,262

Equity, provisions and liabilities Equity 14 Opening equity 6,857 5,923 5,104 4,461 Other change in equity 433 – 368 – Surplus for the year 136 934 656 643 Total equity 7,426 6,857 6,128 5,104

Provisions Provisions for pensions and similar obligations 15 22,136 20,923 18,467 17,864 Other provisions 16 748 510 374 96 Total provisions 22,884 21,433 18,841 17,961

Liabilities Long-term liabilities 17 39,709 36,210 24,762 20,452 Current liabilities 18 20,414 16,832 19,441 22,745 Total liabilities 60,123 53,042 44,203 43,197

Total equity, provisions and liabilities 90,433 81,331 69,172 66,262

Pledges and equivalent collateral none none none none

Contingent liabilities 19 Pension commitments not recognised as liabilities or provisions 25,461 26,376 25,461 26,376 Other contingent liabilities 439 788 15,838 15,942 Total contingent liabilities 25,900 27,164 41,299 42,318

106 Annual Report 2014 Financial report  To contents Cash-flow statement

SEK million Group County Council Note 2014 2013 2014 2013 Operation activities Surplus for the year 136 934 656 643 Adjustment for non-cash items* 5,940 5,361 2,681 3,394 Funds from operations before changes in working capital 6,076 6,295 3,337 4,037

Increase (–) or decrease (+) in stocks and inventory –43 261 –55 –23 Increase (–) or decrease (+) in current receivables 221 1,182 –53 1,842 Increase (+) or decrease (–) in current liabilities (excluding leases and loan financing) 2,088 570 263 352 Cash flow from operating activities 8,342 8,308 3,492 6,208

Investing activities Investments in intangible assets –77 –3 –15 – Investments in tangible assets –13,476 –9,810 –5,381 – 4,101 Sales of tangible assets 153 533 152 533 Cash flow from investing activities* –13,400 –9,280 –5,244 –3,568

Financing activities Newly raised loans 9,296 867 3,218 3,728 Repayment of long-term liabilities – 4,100 –2,100 – 4,100 –2,100 Increase in long-term receivables 39 –278 –5,181 –4,595 Change in leasing financing –1,937 –772 –3 –3 Grants received 253 280 – – Cash flow from financing activities 3,551 –2,003 –6,066 –2,970

Cash flow for the year –1,507 –2,975 –7,818 –330

Cash and cash equivalents at the beginning of the year 1,841 4,816 7,852 8,182 Cash and cash equivalents at the end of the year 334 1,841 34 7,852

*) Specification of non-cash items Depreciation/amortisation 3,817 3,589 1,368 1,313 Change in provisions 1,451 2,501 881 2,453 Capital gain/loss (– capital gain/+ capital loss) 7 182 –276 1 –348 Other items 490 –453 431 –24 Adjustment for non-cash items 5,940 5,361 2,681 3,394

* The part of New Karolinska Solna that is comprised of the public private partnership agreement (the PPP agreement) did not affect cash flow during the year.

 To contents Financial report Annual Report 2014 107 Operating report

Adjusted Surplus/ surplus/ Budget SEK million Revenues Expenses deficit* Pensions deficit** 2014 The County Council Executive Board County Council Executive Board Administration 3,560.4 –3,556.0 4.4 4.4 0.0 Damages account 13.3 –13.3 0.0 0.0 0.0 Group financing 71,475.6 –70,653.7 821.9 821.9 –310.5 New Karolinska Solna 286.9 –282.1 4.8 4.8 0.0 Metro Expansion Administration 29.9 –29.9 0.0 0.0 0.0 Total County Council Executive Board 75,336.1 –74,505.1 831.0 0.0 831.0 –310.5

Health and medical care Public Healthcare Services Committee 52,057.2 –52,250.4 –193.2 –193.2 0.0 Healthcare Provision, Stockholm County 9,890.2 –9,686.6 203.6 203.6 75.3 Karolinska University Hospital 16,165.2 –16,726.4 –561.2 –561.2 30.2 Södersjukhuset AB 3,940.8 – 4,174.1 –233.3 149.0 –84.3 9.4 Danderyds Sjukhus AB 3,279.2 –3,548.4 –269.3 118.5 –150.8 6.5 TioHundra AB 755.9 –753.6 2.3 2.3 0.0 Södertälje Sjukhus AB 988.3 –1,013.7 –25.4 24.5 –0.9 3.3 St. Eriks Ögonsjukhus AB 508.5 –515.9 –7.4 21.8 14.4 1.3 Total emergency hospitals 25,637.9 –26,732.1 –1,094.3 313.8 –780.5 50.6

Folktandvården Stockholms län AB 1,528.9 –1,464.5 64.3 43.3 107.6 20.0 Ambulanssjukvården i Storstockholm AB 207.2 –213.5 –6.3 2.1 – 4.1 0.7 Stockholm Care AB 135.9 –132.8 3.1 0.9 4.0 4.1 Total health and medical care 89,457.3 –90,479.9 –1,022.6 360.2 –662.4 150.7

Transport AB Storstockholms Lokaltrafik 17,116.8 –17,191.7 –74.9 46.8 –28.1 0.0 Special transport services 1,284.8 –1,293.9 –9.0 –9.0 0.0 Traffic Administration 677.5 –625.3 52.2 52.2 0.0 Waxholms Ångfartygs AB 405.6 –391.7 13.8 1.2 15.0 0.0 Total County Council Traffic Committee 19,484.8 –19,502.6 –17.9 48.0 30.1 0.0

Property Locum AB 321.1 –290.2 30.9 –12.8 18.1 5.0 Landstingsfastigheter Stockholm (LFS) 3,079.1 –2,741.2 337.9 337.9 234.9 Total property 3,400.2 –3,031.4 368.8 –12.8 356.0 239.9

Other MediCarrier AB 641.5 –636.7 4.8 0.9 5.7 0.3 Culture Committee 429.5 –430.3 –0.8 –0.8 0.0 Patient Advisory Committee 21.3 –21.3 0.0 0.0 0.0 County Council Auditors 32.9 –32.9 0.1 0.1 0.0 Landstingshuset i Stockholm AB 57.3 –35.1 22.1 –349.6 –327.4 –31.3 AB SLL Internfinans 31.9 –28.8 3.1 0.1 3.3 3.0 Total other 1,214.4 –1,185.0 29.4 –348.5 –319.1 –28.0 Group adjustments –724.0 671.6 –52.4 –46.8 –99.2 0.0 All results all profit centres 136.3 0.0 136.3 52.0

* Surplus before appropriations and taxes. ** Pertains to surplus/deficit before appropriations and tax adjusted for interest effect on pension expenses.

108 Annual Report 2014 Financial report  To contents Investment report

Outcome Outcome Budget Deviation SEK million 2014 2013 2014 from budget The County Council Executive Board County Council Executive Board Administration 139.6 64.0 131.3 –8.3 Group financing 375.9 368.8 477.0 101.1 New Karolinska Solna 3,639.3 3,304.8 4,193.5 554.2 Metro Expansion Administration 117.0 – 449.0 332.0 Total County Council Executive Board 4,271.9 3,737.6 5,250.8 978.9

Health and medical care Public Healthcare Services Committee 2.3 7.5 32.0 29.7 Healthcare Provision, Stockholm County 65.2 84.4 65.6 0.4 Karolinska University Hospital 208.2 296.5 228.0 19.8 Södersjukhuset AB 123.2 135.8 162.0 38.8 Danderyds Sjukhus AB 68.4 95.9 75.0 6.6 Södertälje Sjukhus AB 23.7 20.2 35.0 11.3 St. Eriks Ögonsjukhus AB 13.0 10.9 12.0 –1.0 Total emergency hospitals 436.6 559.3 512.0 75.4

Folktandvården Stockholms län AB 66.3 61.6 58.0 –8.3 Ambulanssjukvården i Storstockholm AB 12.0 19.2 10.2 –1.8 Stockholm Care AB – 0.3 – – Total health and medical care 582.3 732.3 677.8 95.5

Transport Trafikförvaltningen inkl färdtjänst 28.2 11.3 7.0 –21.2 AB Storstockholms Lokaltrafik 7,744.0 5,301.1 8,019.7 275.7 Waxholms Ångfartygs AB 100.5 42.6 91.1 –9.4 Total County Council Traffic Committee 7,872.7 5,354.9 8,117.8 245.1

Property Locum AB 2.6 1.2 4.0 1.4 Landstingsfastigheter Stockholm (LFS) 2,254.0 1,352.2 2,400.0 146.0 Total property 2,256.6 1,353.4 2,404.0 147.4

Other MediCarrier AB 2.6 0.7 4.0 1.4 Culture Committee 1.8 0.2 0.4 –1.4 Patient Advisory Committee – 0.1 – – County Council Auditors 0.1 0.7 0.2 0.1 Total other 4.5 1.7 4.6 0.1 All investments 14,988.0 11,180.0 16,455.0 1,467.0

 To contents Financial report Annual Report 2014 109 Accounting principles

This Annual Report was prepared in Inspection expenses where previous years’ government accordance with the Swedish Local AB Storstockholms lokaltrafik changed grants of SEK 368 million were trans- Government Act, the Swedish Local its principle regarding the recognition ferred from liabilities to equity. Government Accounting Act and the of inspection expenses for the X60 com- recommendations issued by the Swed- muter trains. They were previously Consolidated accounting ish Council for Municipal Accounting expensed directly in profit or loss. As of The consolidated accounts shall provide (RKR), except for the reporting of tax 2014, they are recognised as fixed assets a summarative and accurate view of the revenues, provisions, recognition of and depreciated straight-line over the County Council’s overall financial posi- borrowing costs and component depre- period until the next inspection. tion and performance regardless of ciation. These recommendations apply whether the operations are conducted to the legal entity, the County Council, Component depreciation as administrations or companies. and the County Council’s consolidated As of 2014, there is a requirement to The consolidated accounts were pre- accounting. divide up a tangible fixed asset into sig- pared in accordance with the acquisi- The companies’ reports have been nificant components if the difference in tion method. The accounts of the sub- prepared in accordance with the Swed- the consumption of these components is groups of AB Storstockholms ish Annual Accounts Act (ÅRL) and the expected to be material. Lokaltrafik and Landstingshuset i Swedish Accounting Standards Board’s For operations in the County Coun- Stockholm AB (LISAB) were prepared general guidelines regarding annual cil, including properties owned by the with full consolidation and incorpo- accounts and consolidated accounts County Council, preparatory work was rated in their entirety into the County (BFNAR 2012:1), K3. done during the year. The activities con- Council Group. The consolidated ducted included the determination of accounts of the municipal association, Changed application during the components and preparation of a Ägarsamverkan i Norrtälje Sjukvård year and effects of revised estima- method for transfer of historical instal- och Omsorg, and its subsidiary TioHun- tes and assessments lations. Component depreciation for dra AB were incorporated by propor- county-council-owned properties is tional consolidation. The ownership Introduction of K3 planned to be introduced in 2015. share was 50 per cent. Associated com- As of 2014, the companies apply the new The companies adjusted their panies were included in accordance standard rules K3. The transition has accounts to the requirements in K3 and with the equity method. Shares of affected the principles for the recogni- introduced component depreciation profit/loss of associated companies tion of tangible fixed assets through the where applicable. were included in net operating introduction of component deprecia- Components have been introduced on: expenses. tion. Since the requirement for compo- • Railway installations and buildings In the consolidated accounts, the nent depreciation beginning in 2014 and land for public transport companies’ financial statements, which also concerns the municipal accounts, • Marine vessels have been prepared in accordance with the changes made at the companies the Annual Accounts Act and the Swed- impacted the consolidated accounts. Reclassification of fixed assets ish Accounting Standards Board’s regu- The change in the companies’ accounts During the year, a review was conducted lations on generally accepted account- has been made through a recalculation of the accounting plan. One result of this ing principles in municipal operations, of comparative figures for previous review is that a reclassification was are translated if material discrepancies years. A corresponding change in the applied between Land, buildings, plant exist. The effects of the introduction of consolidated accounts has been and machinery and Machinery and K3 have been assessed to not entail any reported for 2014 as an additional or equipment. The reclassification per- material deviations necessitating a deductible item in affected notes and as tains to rail vehicles, marine vessels and recalculation. a change in equity. renovations to leased premises, which Included units and participating The transition to component depreci- were previously recognised in the item interests are shown in the illustration in ation has had the following effects on Land, buildings, plant and machinery. Section 4. the opening balance of equity: The amount totals SEK 12,713 million. In conjunction with this, comparative Items affecting comparability Company Amount (SEK millions) figures were also adjusted. When they occur, items affecting com- AB Storstockholms parability are reported separately in lokaltrafik, SL –27 Government grants notes to the respective item in the Waxholms Ångfartyg AB 6 In 2014, the accounting of specially des- income statement and where applicable Total –21 ignated government grants was more in the cash-flow statement. clearly adapted to the current recom- An item affecting comparability mendation. This entailed a transfer means the result of events or transac-

110 Annual Report 2014 Financial report  To contents tions that is not extraordinary, but 2013 and 2014, respectively. In its tax No depreciation/amortisation is applied important to note in a comparison with revenue forecasts, the County Council to land, art and work in progress. other periods. This may, for example, uses the tax base forecasts published by concern measures for conversion, the Swedish Association of Local Components impairment losses and capital gains. Authorities and Regions in the Planning In the case of assets where significant To establish what constitutes an item Conditions documents. This applies to components have been identified and affecting comparability for the County the tax base trend nationally and in the the difference in their consumption is Council in terms of amounts, an assess- county. However, the County Council expected to be material, component ment has been made based on the does not use the population forecasts of depreciation is applied. This applies for County Council’s turnover and opera- the Swedish Association of Local the following categories of fixed assets: tions. In consideration of this, an item Authorities and Regions. affecting comparability is comprised of The County Council obtains a spe- Fixed asset: Depreciation a rarely occurring item that exceeds cially ordered population forecast for interval for SEK 100 million. The items affecting Sweden and the county from Statistics components comparability are specified in Note 6. Sweden and SCC Growth, Environment Railway installations 10–50 years and Regional Planning. This entails (substructure Period allocation some minor differences between the 40–100 years) Period allocation is done to provide an County Council’s and the Swedish Asso- Buildings and land, accurate picture of the County Council’s ciation of Local Authorities and public transport 17–50 years performance and financial position for Regions’ forecasts regarding the final (foundation/ the period in question. This means that tax settlements and municipal eco- structural system 20–50 years) the main principle is that expenditures nomic equalisation. In addition, there is Marine vessels 15–30 years have been expensed in the year that con- some difference in methodology in the (hull 30 or 80 sumption occurred and revenues have calculation of the forecast for the final years) been recognised as income in the year tax settlement, which also causes a the income was generated. minor difference. The reason for the dis- No recalculation has been made in the crepancies is that a more accurate illus- consolidated accounts due to the intro- Revenues tration is believed to be able to be pre- duction of component depreciation in Revenues are reported to the extent it is sented. the stated areas. likely that the financial assets will be utilised by the County Council and the Expenses Impairment losses revenues can be reliably calculated. Depreciation/amortisation Assets are tested for impairment The depreciation of tangible assets and requirements or reversal of previously Revenues from fees, grants and sales amortisation of intangible assets are applied impairment losses. Revenues from grants and fees are rec- applied to the estimated useful life with ognised in the period in which the straight-line application based on the Rental and leasing agreements expense is expected to arise. Grants that cost excluding any residual value. In a presentation of significant con- should cover already accrued expenses Depreciation/amortisation is begun tracts, to present a true and fair view, are recognised as revenue directly. If the when the asset is brought into use. objects leased under finance leases are grant is intended to cover expenses over The useful life constitutes the basis included in the balance sheet for the a multi-year period, the revenue is allo- of the assessment of the length of the Group and the County Council. At the cated over the years involved. Dividends period of depreciation/amortisation. same time, all leases are reported as are recognised when the right to receive This assessment is based on a local operating leases in underlying units. a dividend can be secured, normally in judgement and adjusted to the current Finance leases primarily apply to rail conjunction with the annual general facility’s special conditions, such as the vehicles and are recognised as fixed meeting of a company. Sales revenues operations’ nature, utilisation of the assets and as a liability item to the les- from property sales are normally recog- asset and geographic conditions. sor, also refer to Note 20. nised as revenue on the date of posses- The following depreciation/amorti- sion. sation periods are generally applied: Borrowing costs Intangible assets 3–5 years Borrowing costs are recognised using Tax revenues Machinery and equipment 3–10 years the alternative method, meaning that Tax revenues are recognised according Buildings 25–50 years borrowing costs are included in the to the recommendation from the Swed- Permanent equipment asset’s cost if they are directly attributa- ish Council for Municipal Accounting, in buildings 17 years ble to the purchase, construction or pro- 4.2 Reporting of Tax Revenues. The tax Rail vehicles 10–30 years duction of an asset. In its subsidiary credit forecast published by the Swedish Buses 12 years Locum AB, Stockholm County Council Association of Local Authorities and Railway installations See components uses an estimated borrower interest rate Regions in December has mainly been Marine vessels See components that is a deviation from recommenda- used for estimation of tax revenues in tion RKR 15.1, which stipulates that a

 To contents Financial report Annual Report 2014 111 borrower interest rate can only exist if holding is for the asset to be held or used earned up to and including 1998 are rec- there is a real borrowing cost. AB Stor- continuously. Funds that are continu- ognised in the income statement. Pen- stockholms lokaltrafik’s borrowing ously subject to purchase and sale and sions for the County Council’s adminis- costs are primarily charged to profit or are available to meet on-going disburse- trative organisations are calculated loss. ments are classified as current assets. according to RIPS 07. See also Note 15. In 2014, an average interest rate on The companies calculate pension property investments of 3.0 per cent, Current assets commitments on the basis of the Swed- equivalent to SEK 83 million, was capi- Current assets are valued as a main ish Financial Supervisory Authority’s talised. In addition to this, SEK 557 mil- principle at the lower of cost and fair main rule. KPA Pension’s calculations lion was capitalised at an average inter- value. Fair value refers to the market provide the basis for the companies’ est rate of 5.6 per cent with regard to value less estimated selling expenses. pension provisions. The lowered inter- New Karolinska Solna. est rate, according to the main rule, Stocks means that the companies’ pension lia- Corporate tax Stocks are valued at the lower of cost bility increased by SEK 397 million. The The companies in the Landstingshuset i and fair value on the balance-sheet date. difference in values obtained using the Stockholm AB Group are not currently Collective valuation is applied to homo- main rule and the alternative rule is required to pay income tax since, under geneous product groups. Stocks primar- recorded at the comprehensive level in current tax regulations, the Group is ily consist of consumable materials used the Group. Pension liabilities estimated able to offset taxable earnings in the for repairs and maintenance and con- using the alternative rule are assessed Group through Group and shareholder sumable products. to better reflect the actual liability that contributions and use loss carryfor- would arise if operations were trans- wards from previous years. For Söder- Receivables ferred back to the County Council or sold. tälje Sjukhus AB, whose operations Receivables are recognised in the In addition to the pension cost, there are started in company form in 2009, a amount expected to be received follow- also costs for special payroll tax. block on Group contributions applies for ing an individual assessment. In 2014, the interest rate for the pen- the income years 2009 – 2014. Any cor- Receivables and liabilities in foreign sion liability calculation as per the main porate tax is recognised under other currencies are valued at the rate on the rule was lowered from 2.6 per cent to 1.9 operating expenses in the consolidated balance-sheet date. If hedging meas- per cent while the rate for the alternative accounts. ures, such as forward contracts, are rule remains at 1.5 per cent. The decrease The companies are assessed to not be employed, the forward rate is applied. in the rate under the main rule has able to utilise existing loss carryfor- meant that the companies’ pension lia- wards in the next few years. This means Provisions bility has increased, which affects the that no deferred tax assets are recog- Provisions are made for commitments companies’ surplus negatively for 2014. nised on tax loss carryforwards. that are uncertain as regards maturity The difference between the main rule dates and amounts. A provision is and the alternative rule amounted to Fixed assets reported in the balance sheet when it is SEK 494 million, including special pay- An intangible asset is an identifiable, likely that an outflow of resources will roll tax in 2014. In 2013, the difference non-monetary asset without physical be required to settle the commitment was SEK 866 million, a decrease of SEK form while a tangible asset is a physical and a reliable estimate of the amount 372 million. asset intended for continuous use. can be made. Only legal obligations are An intangible fixed asset shall meet recognised in the balance sheet. Con- Liabilities the following criteria: structive obligations are recognised as a Received investment grants are recog- • it shall be identifiable contingent liability, See also Note 16. nised as current or long-term prepaid • it shall be a resource over which the A deviation from the applicable prin- income in the balance sheet and are County Council has control ciples is done with regard to the recogni- gradually recognised as income in the • it is expected to provide future finan- tion of provisions for future pension income statement over the asset’s useful cial benefits expenses in an amount of SEK 700 mil- life. See also Note 17. • it has arisen as a result of events that lion. The provisions were made in 2007. have occurred Off-balance-sheet commitments • it has a cost that can be reliably calcu- Pensions Recognition of derivatives and hedge lated. Under the Local Government Account- accounting ing Act, Chapter 5, Section 4, pensions Hedge accounting is applied for all To be classified as a tangible fixed asset, are reported according to what is external derivative instruments. This is the value must amount to a minimum of referred to as the mixed model. This done in both the County Council and in a half price base amount per object and means that pensions earned before 1998 the consolidated accounts. have a useful life in excess of three are reported as contingent liabilities For intra-Group derivative instru- years. instead of as a liability or provision in ments, hedge accounting is applied for Financial assets are classified as the balance sheet. Pensions earned dur- intra-Group forward exchange con- fixed assets when the purpose of the ing the year and pensions paid that were tracts, while the lowest value principle is

112 Annual Report 2014 Financial report  To contents applied for intra-Group interest swaps total nominal amount of SEK 8,950 mil- The County Council’s intention with in the County Council’s accounts. Since lion. The market value for all interest this hedging strategy is to reduce the intra-Group derivative instruments are swaps that constitute hedging instru- exchange rate risk and interest rate risk eliminated in the consolidated accounts, ments in these hedging relationships that are associated with borrowing in they have no impact on the consolidated amounted to SEK -759 million. foreign currencies. The uncertainty can income statement and balance sheet. During the 2014 financial year, the be attributed to exchange rate fluctua- All implemented hedges are gov- hedging instruments affected interest tions. The hedged risk is the spot risk, erned by the finance policy requirement expenses in the income statement by which is future changes in spot rates to reduce currency and interest rate SEK -192 million. The interest expense compared with the time of hedging and risks. pertains to the net of paid, received and the interest risk in the respective bor- The hedging relationships that were accrued interest on all swaps. Unreal- rowing currency. The hedged risk may outstanding at 31 December 2014 were ised market value changes have not also be the interest rate risk in SEK after of three different types: impacted the income statement. the time of borrowing. The hedging instruments’ impact on At 31 December 2014, the County 1. Borrowing in SEK the average fixed interest term and bor- Council had a total of five outstanding For these hedging relationships, the rowing cost is shown in the table below. hedging instruments of this type in a hedged item is comprised of borrowing total nominal amount of EUR 575 mil- in SEK at a variable interest rate. The 2. Borrowing in foreign currencies lion, corresponding to SEK 5,018 mil- hedging instruments are comprised of For these hedging relationships, the lion. The market value for all interest interest swaps where the County Coun- hedged item is comprised of borrowing swaps that constitute hedging instru- cil receives a variable interest and pays a in foreign currencies at a fixed interest ments in these hedging relationships fixed interest. The County Council’s aim rate. The hedging instrument is com- amounted to SEK +290 million. with these hedging relationships is to prised of exchange rate swaps, where During the 2014 financial year, the reduce the uncertainty regarding future the County Council receives a fixed hedging instruments affected interest interest expenses for borrowing at vari- interest in foreign currencies and pays a expenses in the income statement by able interest. This uncertainty can be fixed or variable interest in SEK. A com- SEK –49 million. The interest expense attributed to changes in the variable bination of exchange rate swaps and pertains to the net of paid, received and interest rate. The hedged risk is com- interest swaps in SEK can also consti- accrued interest on all swaps. Unreal- prised of the variability of future inter- tute hedging instruments if the County ised market value changes and exchange est payments on the basis of changes in Council wishes to change the proportion rate changes have not impacted the the base interest rate, STIBOR. Interest of fixed and variable interest in SEK income statement. swaps with future starts where the after the time of borrowing. If the The hedging instruments’ impact on County Council receives variable and County Council intends to hedge its bor- the average fixed interest term and bor- pays fixed interest may also constitute rowing cost before the time of borrow- rowing cost is presented in the table hedging instruments. ing, swaps with future starts with terms below. At 31 December 2014, the County as per above may also constitute hedg- Council had a total of 43 outstanding ing instruments. hedging instruments of this type in a

Before hedging After hedging

Average fixed-rate period 2.03 years 3.4 years

Average borrowing cost* • in per cent 1.69% 2.45% • in EURm/SEK million SEK 432 million SEK 624 million

*) The intent of the above hedges is to reduce uncertainty of future interest payments and obtain a stable interest expense that does not change over time.

Before hedging After hedging

Average fixed-rate period 7.81 years (EUR) 6.94 years (SEK)

Average borrowing cost* • in per cent 2.125% 3.15% • in EURm/SEK million EUR 12 million SEK 152 million

*) The intention of the above hedges is to reduce uncertainty regarding future interest payments in foreign currencies. **) The “Before hedging” figures pertain to the total borrowing in SEK, which also includes the part of the SEK debt that is issued against fixed interest. “After hedging” pertains to the total borrowing in SEK with addition of the aforementioned interest hedges. ***) Note that a direct comparison is not possible between the borrowing costs since the “Before hedging” values pertain to EUR rates and the “After hedging” values to SEK rates.

 To contents Financial report Annual Report 2014 113 3. Forward exchange contracts During the 2014 financial year, the For these hedging relationships, the hedging instruments increased interest hedged item is comprised of contracted expenses in the income statement by or very likely forecast future cash flows SEK 530,000. The interest expense per- in foreign currencies. The hedging tains to a period-allocated component of instruments are comprised of forward the forward premium on all forward exchange contracts where the County contracts. Unrealised market value Council has purchased currency on a changes have not impacted the income forward contract. The County Council’s statement. intention with this hedging strategy is to reduce the exchange rate risk associated Other with cash flows in foreign currencies. For 2014, it was assessed that the surety This uncertainty can be attributed to that the County Council has for AB SL exchange rate fluctuations between SEK Finans’ leases constitutes an unrecog- and various foreign currencies. nised binding commitment for the At 31 December 2014, the County County Council and thereby constitutes Council had a total of two outstanding a hedged item. hedging instruments of this type in a total nominal amount of EUR 21.44 mil- Other commitments lion, corresponding to SEK 203.3 mil- Other commitments are contingent lia- lion. The market value for all forward bilities, among other things for pensions contracts in these hedging relationships earned before 1998. Refer to Notes 15 amounted to SEK 6 million. and 19.

114 Annual Report 2014 Financial report  To contents Notes

Note 1 Operation revenues and expenses SEK million Group County Council 2014 2013 2014 2013 Patient fees, healthcare 721 647 459 407 Patient fees, dental care 604 616 0 0 Passenger fares 6,978 6,688 180 182 Health and medical care sold 1,337 1,338 1,140 1,150 Dental care sold 262 272 0 0 Sales of other primary services 222 234 53 62 Rental income, sales, other services 3,733 3,711 3,155 3,001 Government grants and other grants 3,101 2,848 2,832 2,615 Other revenues 1,550 1,238 963 742 Revenues affecting comparability – 814 – 685 Operating revenues 18,507 18,406 8,782 8,846

Personnel costs 27,179 25,564 19,449 18,294 Purchased health and medical care services 14,878 13,769 22,484 21,234 Dental care purchased 364 325 872 830 Purchased transport services 12,670 12,083 986 960 Other primary services purchased 15 15 24 24 Operations-related services (lab, radiology) 1,701 1,680 1,769 1,733 Pharmaceuticals in pharmaceutical benefit scheme 4,918 4,697 4,856 4,653 Other pharmaceuticals 1,396 1,372 1,169 1,137 Other materials and products, etcetera 4,604 4,267 2,118 1,864 Contributions paid 1,613 1,487 2,469 2,405 Grants provided to SL and WÅAB 0 0 7,503 7,043 Premises costs, lease of equipment 2,419 2,429 2,511 2,485 Other expenses 5,652 5,182 4,360 3,804 Expenses affecting comparability 250 – 250 – Operating expenses 77,661 72,872 70,820 66,465

Note 2 Depreciation/amortisation SEK million Group County Council 2014 2013 2014 2013 Amortisation of intangible assets –28 –19 –13 –12 Depreciation of buildings and plant –1,475 –1,358 –512 –473 Depreciation of machinery and equipment –2,314 –2,212 –843 –827 Impairment losses – – – – Total depreciation/amortisation –3,817 –3,589 –1,368 –1,313

A reclassification of assets was done in 2014 as a result of changes in the accounting plan. This also affects the division of depreciation/amortisation.

 To contents Financial report Annual Report 2014 115 Note 3 Tax revenues, general government grants and municipal economic equalisation

SEK million Group County Council 2014 2013 2014 2013 Preliminary tax revenues 59,672 57,913 59,672 57,913 Forecast for final tax settlement tax in 2014 and 2013, respectively 47 –248 47 –248

Adjustment item for tax revenues in 2013 and 2012, respectively –107 35 –107 35 Total tax revenues 59,612 57,699 59,612 57,699

Grant for pharmaceutical benefits 4,678 4,624 4,678 4,624 Total general government grants 4,678 4,624 4,678 4,624

Cost equalisation grant 557 497 557 497 Total, grants from equalisation 557 497 557 497

Income equalisation fee –335 –516 –335 –516 Adjustment fee –541 –501 –541 –501 Total charges equalisation –876 –1,017 –876 –1,017

Total, cost and income equalisation –319 –521 –319 –521 Total tax revenues, general government grants and municipal economic equalisation 63,971 61,802 63,971 61,802

Note 4 Financial income SEK million Group County Council 2014 2013 2014 2013 Interest income 12 49 601 567 Other financial income 114 654 53 30 Total financial income 126 704 654 597

Note 5 Financial expenses SEK million Group County Council 2014 2013 2014 2013 Interest –721 –712 –645 –619 Interest on pension provisions –210 –552 –225 –418 Other financial expenses –59 –689 –67 –34 Financial expenses affecting comparability (Note 6) – –1,564 372 –1,752 Total financial expenses –990 –3,517 –565 –2,824

Note 6 Items affecting comparability

SEK million Group County Council 2014 2013 2014 2013 Under operation revenues: Repayment of premiums AFA Försäkring – 529 – 400 Capital gains, property sales* – 285 – 285

Under operating expenses: Metro expansion** –250 – –250 –

Under financial expenses: Interest reduction, pension liability RIPS – –1,564 – –1,564 Interest change pension liability main rule/alternative rule – – 372 –188 Total items affecting comparability –250 –749 122 –1,067

* Amount 2013 pertains to sale of two properties at Beckomberga. ** Compensation according to an agreement in principle with the City of Solna regarding the Metro expansion, LS 1312-1619.

116 Annual Report 2014 Financial report  To contents Note 7 Specification of capital gains/losses, Group

SEK million Group County Council 2014 2013 2014 2013 Other operation revenues Capital gains on Landstingsfastigheter Stockholm's (LFS) sales of tangible assets 132 349 132 347 on SL Group’s sales of other assets – 56 – – on other units' sales of tangible assets 1 4 – 4

Operations’ other expenses Capital losses on SL Group’s sales of other assets –175 –127 – – on other sales of tangible assets –140 –5 –133 –3 Net capital gains from sales of tangible assets –182 276 –1 348

Note 8 Intangible fixed assets

SEK million Group County Council 2014 2013 2014 2013 Cost on the opening date 93 91 62 62 Purchases 78 3 15 – Sales and disposals – –1 – – Accumulated cost on the closing date 171 93 77 62 Depreciation/amortisation on the opening date –34 –16 –17 –5 Depreciation/amortisation for the year –28 –19 –13 –12 Reclassifications –1 – – – Accumulated depreciation/amortisation on the closing date –63 –34 –30 –17 Total value on the closing date 108 59 47 45

The majority of the intangible assets pertain to software.

Note 9 Land, buildings, plant and machinery

SEK million Group County Council 2014 2013 2014 2013 Cost on the opening date 45,238 41,063 17,793 16,830 Purchases 2,796 3,735 376 400 Transfer from construction in progress 2,756 628 2,756 628 Sales and disposals –324 –128 –172 –64 Reclassifications – –60 – – Accumulated cost on the closing date 50,467 45,238 20,753 17,793 Depreciation/amortisation on the opening date –13,945 –12,584 –4,876 –4,425 Sales and disposals 117 45 49 23 Depreciation/amortisation for the year –1,475 –1,380 –512 –473 Reclassifications 19 –26 – – Accumulated depreciation/amortisation on the closing date –15,283 –13,945 –5,338 –4,876 Impairment on the opening date –119 –119 –119 –119 Accumulated impairment on the closing date –119 –119 –119 –119 Total value on the closing date 35,065 31,174 15,296 12,799 Residual value according to plan on the closing date by type of asset: Buildings 17,396 14,950 10,717 8,591 Land 2,223 2,038 1,477 1,478 Land improvements 15,445 14,186 3,103 2,729 Total value on the closing date 35,065 31,174 15,296 12,799

 To contents Financial report Annual Report 2014 117 Note 10 Machines and equipment

SEK million Group County Council 2014 2013 2014 2013 Cost on the opening date 37,749 35,260 11,238 10,332 Purchases 1,619 2,435 423 497 Adjustment due to component depreciation 100 – – – Transfer from construction in progress 709 718 662 718 Sales and disposals –698 –937 –256 –310 Reclassifications 2 291 2 – Accumulated cost on the closing date 39,481 37,767 12,068 11,238 Depreciation/amortisation on the opening date –18,287 –16,811 –7,125 –6,587 Adjustment due to component depreciation –32 – – – Sales and disposals 628 782 216 289 Depreciation/amortisation for the year –2,314 –2,191 –843 –827 Reclassifications/adjustments –20 –84 –2 – Accumulated depreciation/amortisation on the closing date –20,024 –18,304 –7,754 –7,125 Impairment on the opening date –6 –6 –6 –6 Accumulated impairment on the closing date –6 –6 –6 –6 Total value on the closing date 19,451 19,457 4,309 4,107 Residual value according to plan on the closing date by type of asset: Cars and other means of transport 2,699 2,495 7 – Medical equipment 1,440 – 665 – Refurbishment of leased premises 311 319 199 228 Permanent equipment in buildings 3,801 3,527 2,957 2,701 Art and non-depreciable equipment 69 64 69 64 Leases, machinery and equipment 9,456 9,913 1 4 IT equipment 241 179 218 157 Other machinery and equipment 1,435 2,961 192 953 Total value on the closing date 19,451 19,457 4,309 4,107

Note 11 Construction in progress and advance payment for tangible assets

SEK million Group County Council 2014 2013 2014 2013 Balance on the opening date 21,246 17,558 11,689 8,422 Costs incurred during the year, buildings 10,209 5,002 5,826 4,575 Costs incurred during the year, machinery and equipment 191 87 191 87 Transfer to other assets –3,506 –1,401 –3,418 –1,394 Total construction in progress and advances 28,141 21,246 14,289 11,689 A large part of the costs incurred during the year relate to the construction of New Karolinska Solna and investments at SL and Landstingsfastigheter.

118 Annual Report 2014 Financial report  To contents Note 12 Financial assets

SEK million Group County Council 2014 2013 2014 2013 Loans provided to Group companies – – 24,044 18,815 Other loans provided 1,027 1,105 104 215 Shares in subsidiaries* – – 6,055 6,034 Participation in associated companies** 13 15 – – Other shares and subordinated debentures 44 1 42 – Tenant-ownership rights 3 3 3 3 Total financial assets 1,087 1,126 30,248 25,067

* Shares in subsidiaries, County Council Percentage Number of Carrying amount, Shares in subsidiaries holding % shares SEK million AB Storstockholms Lokaltrafik 100 80,000,000 5,649 Landstingshuset i Stockholm AB 100 1,000 406 Total 6,055

Information on corporate registration number and registered office Subsidiary Corp. reg. no. Registered office AB Storstockholms Lokaltrafik 556013-0683 Stockholm Landstingshuset i Stockholm AB 556477-9378 Stockholm

** Participation in associated companies Associated company Corp. reg. no. Percentage Share of equity, holding % SEK million Barnbördshuset Stockholm AB 556612-1290 49.0 13 Total 13

Note 13 Current receivables

SEK million Group County Council 2014 2013 2014 2013 Accounts receivable 1,460 1,455 1,084 956 Government grant receivables 1,466 1,596 1,459 1,535 Tax assets 50 341 16 329 Prepaid expenses and accrued income 1,393 1,396 1,090 952 Other receivables 1,411 1,214 1,021 706 Total current receivables 5,779 6,002 4,670 4,478

 To contents Financial report Annual Report 2014 119 Note 14 Equity

SEK million Group County Council 2014 2013 2014 2013 Opening equity 6,857 5,923 5,104 4,461 Changed accounting principles at SL* 71 – – – Changed accounting principles at WÅAB* –6 – – – Adjustment to recommendation at Public Healthcare Services Committee** 368 – 368 – Surplus for the year 136 934 656 643 Closing equity 7,426 6,857 6,128 5,104

* Effect arising as a result of changed accounting principles for the companies has been booked against equity. ** Period allocated government grants have been booked against equity at the Public Healthcare Services Committee to more clearly adjust reporting to current accounting recommendations.

Supplementary disclosure reserved equity SEK million 2014 2013 Transition costs future health and medical care 2015-2018 Reserved in 2011 annual accounts 1,200 1,200 Reserved in 2012 annual accounts 2,100 2,100 Reserved in 2013 annual accounts 2,000 2,000 Total transition costs 5,300 5,300

Note 15 Provisions for pensions and similar obligations, Group

SEK million Group County Council Pension liabilities (incl. payroll tax)1) 2) 3) 4) Provision for pensions according to the balance sheet at 31/12/2013 20,923 17,864 Change in provision for pensions, incl. payroll tax and interest component 1,213 603 Provision for pensions according to the balance sheet at 31/12/2014 22,136 18,467 – of which payroll tax5) 3,372 3,372 – of which, pension assets 949 949 – of which, defined-benefit retirement pensions 13,974 10,813 – of which, special collectively agreed occupational and fixed-term pensions6) 95 92 – of which, accrued pension rights, companies 207 – – of which, pensions for Locum AB, the majority are PA KFS pensions 231 – – of which, company pensions at Group financing 1,547 1,547 – of which, provisions for future pension expenses7) 700 700 – of which recording of difference between alternative/main rule including payroll tax 2) 494 494 – of which, other pension benefits 567 500

SEK million Group County Council 2014 2013 2014 2013 Pension expense for the year Change in provision for pensions during the year 833 642 604 450 Defined-contribution retirement pension 838 774 578 546 Pensions paid for contingent liabilities 881 862 881 862 Other pensions paid -881 344 -881 281 Payroll tax on pensions 826 657 615 551 Other pension expenses -21 47 -44 12 Total pension expenses, excl. financial expense 2,475 3,326 1,753 2,702 Plus interest component of pension expenses 210 2,116 -147 2,170 Total pension expenses, incl. financial expense 2,686 5,442 1,606 4,872 of which, items affecting comparability 1,564 1,752

1) Pension commitments within the Stockholm County Council Administration organisation were calculated according to RIPS 07, while the valuation for the companies was performed according to what is known as the main rule established by the Swedish Financial Supervisory Authority (FFFS 2007:24). 2) A reserve of SEK 494 million, including payroll tax, was recognised, which refers to the difference between the main rule of the Swedish Financial Supervisory Authority and the alternative rule when estimating pension liabilities for companies. Pension liabilities estimated using the alternative rule are assessed as better reflecting the liability that would arise if operations were transferred back to the County Council or sold externally. 3) The County Council's administration organisation is updated to 93.0 per cent in KPA Pension's register. 4) All pension funds are re-lent. 5) County councils and municipalities pay special payroll tax on pensions paid, while companies pay payroll tax on pension costs for the year. Payroll tax reported pertains to pension provisions in the County Council. 6) Of the total amounts included under "Special collectively agreed occupational and fixed-term pensions," fixed-term pensions represented SEK 89 million (34 people) on 31/12/2014. The remaining amount consists of special retirement pensions as decided. Fixed-term pensions for elected full-time politicians with on-going assignments are included in the pension liability as of 2011. 7) There is a provision of SEK 700 million for future pension costs reported in the 2007 annual accounts in line with the decision of the County Council Assembly, LS 0710-1116.

Under the Local Government Accounting Act, which came into force on 1 January 1998, pension commitments earned prior to 1998 are reported as contingent liabilities for employees in the County Council's administrative organisation.

120 Annual Report 2014 Financial report  To contents Note 16 Other provisions

Group 2013 Utilised during Reversal of Provisions for 2014 SEK million the year unutilised the year amount Selling expenses, property 32 –6 – – 26 Estimated maintenance costs 359 – –22 – 337 Other provisions 119 –26 –7 299 385 Total other provisions 510 –32 –29 299 748

County Council 2013 Utilised during Reversal of Provisions for 2014 SEK million the year unutilised the year amount Selling expenses, property 32 –6 – – 26 Other provisions 64 –9 –2 295 348 Total other provisions 96 –15 –2 295 374

Note 17 Long-term liabilities

SEK million Group County Council 2014 2013 2014 2013 Liabilities to banks and credit institutions 18,627 16,030 18,627 16,030 Long-term liability leasing 8,863 10,088 – 1 Investment grants 6,086 5,651 25 – Other long-term liabilities* 6,133 4,441 6,110 4,422 Total long-term liabilities 39,709 36,210 24,762 20,452

* Other long-term liabilities includes PPP liabilities for New Karolinska Solna in an amount of SEK 6,110 million in 2014 and SEK 4,422 million in 2013.

Information on liabilities to banks and credit institutions Group County Council 2014 2013 2014 2013 Average interest rate (%) 2.6 3.0 2.6 3.0 Average fixed interest term (years) 4.0 4.1 4.0 4.1 Loans maturing within (SEK million) 1–5 years 3,502 3,800 3,502 3,800 Later than 5 years 15,124 12,230 15,124 12,230

Note 18 Current liabilities

SEK million Group County Council 2014 2013 2014 2013 Current liabilities to banks and credit institutions 3,948 2,050 7,779 11,547 Advanced payments from customers 702 636 434 427 Accounts payable 6,810 6,032 5,887 5,364 Liabilities to the Swedish State 346 31 346 31 Current liability leasing 1 713 1 3 Holiday pay and salary liabilities 1,672 1,596 1,148 1,100 Accrued expenses and deferred income 4,306 3,998 2,840 2,637 Other liabilities 2,630 1,776 1,007 1,636 Total current liabilities 20,414 16,832 19,441 22,745

 To contents Financial report Annual Report 2014 121 Note 19 Guarantees and other contingent liabilities

SEK million Group County Council 2014 2013 2014 2013 Pension commitments not taken up among liabilities or provisions, see Note 15 Pensions 20,490 21,226 20,490 21,226 Payroll tax 4,971 5,150 4,971 5,150 Total 25,461 26,376 25,461 26,376 of which, items affecting comparability – 2,047 – 2,047

Contingent liabilities for the benefit of Group companies and associated companies* AB SL, financial leases – – 11,744 12,092 County Council's wholly owned companies, financial leases – – 1 3 SL Group, pension liability – – 475 448 Waxholms Ångfartygs AB (WÅAB), pension liability – – 13 12 Locum AB, pension liability – – 231 245 Danderyds Sjukhus AB, pension liability – – 911 728 St. Eriks Ögonsjukhus AB, pension liability – – 171 138 Södersjukhuset AB, pension liability – – 1,161 934 Södertälje Sjukhus AB – – 178 124 TioHundra AB, pension liability 113 99 226 197 Folktandvården Stockholms län AB, pension liability – – 368 303 Other companies, pension liability – – 33 28 Total 113 99 15,512 15,252

Contingent liabilities for the benefit of external parties** AB Transitio*** 276 266 276 266 Stockholm County Archipelago Foundation 36 35 36 35 Clara Foundation – 375 – 375 Other guarantee commitments 14 13 14 13 Total 326 689 326 690 Total other contingent liabilities 439 788 15,838 15,942 Total contingent liabilities 25,900 27,164 41,299 42,318

* The County Council has guarantee commitments for Group companies relating to financial lease contracts, primarily attributable to SL. These guarantee commitments are not recognised as contingent liabilities in the Group, since financial lease commitments are recognised in the consolidated balance sheet. ** County councils are responsible as partners in Patientförsäkringen LÖF for the company's obligations in an amount corresponding to ten times the premium the county council has had to pay for each year that losses have arisen in the patient insurance. In 2014, the premium amounted to SEK 211.5 million. *** The County Council has enter an agreement as a joint and several creditor with a ceiling of SEK 8 billion for AB Transitio with regard to financing of rail vehicles. At 31 December 2014, SEK 6.3 billion had been utilised. Through an agreement with a right of regress, SCC's commitment is limited to the extent to which SL has financed vehicles through AB Transitio. At 31/12/2014, this component amounted to SEK 0.3 billion.

Note 20 Leasing fees

SEK million Group County Council 2014 2013 2014 2013 Financial leases exceeding 3 years* Total minimum leasing fees 11,066 11,729 1 4 Current minimum leasing fees 10,161 11,155 1 4 Of which maturing within 1 year 1,531 795 1 3 Of which maturing within 1-5 years 5,130 6,274 – 1 Of which maturing after 5 years 3,500 4,086 – –

Non-cancellable operating leases exceeding 3 years Leasing fees maturing within 1 year 321 89 128 73 Leasing fees maturing within 1-5 years 573 165 389 137 Leasing fees maturing after 5 years 71 4 58 –

* Financial leases primarily related to rail vehicles and buses as well as certain medical equipment. Finance leases are recognised in the balance sheet and are included in the item machinery and equipment.

In 2014, operating leases were supplemented with premises leases. Information for comparison year 2013 has not been updated with corresponding information.

122 Annual Report 2014 Financial report  To contents Note 21 Intra-Group relationships

Unit Owner contributions Group contributions Dividends SEK million Paid Received Paid Received Paid Received Stockholm County Council 21 Landstingshuset i Stockholm AB 735 124 26 Danderyds Sjukhus AB 271 Södersjukhuset AB 247 Södertälje Sjukhus AB 25 St. Eriks Ögonsjukhus AB 11 Ambulansjukvården i Storstockholm AB 6 Stockholm Care AB 5 Folktandvården Stockholms län AB 79 Waxholms Ångfartygs AB 175 21 Locum AB 32 AB SLL Internfinans 3 2 MediCarrier AB 5 3 AB Storstockholms Lokaltrafik 21 7 508 AB SL Finans 508 SL Infrateknik AB 7 SL Älvsjö AB All companies are wholly owned by Stockholm County Council or the respective Parent Company

Unit Sales Contributions Interest, etc. SEK million Revenue Expense Revenue Expense Revenue Expense Stockholm County Council 1,956 9,333 7,694 611 Landstingshuset i Stockholm AB 20 Danderyds Sjukhus AB 3,000 558 54 3 Södersjukhuset AB 807 709 114 4 Södertälje Sjukhus AB 3,712 140 18 St. Eriks Ögonsjukhus AB 437 72 4 Ambulansjukvården i Storstockholm AB 204 10 1 Stockholm Care AB 28 93 Folktandvården Stockholms län AB 563 56 2 Waxholms Ångfartygs AB 38 23 280 6 Locum AB 318 5 2 AB SLL Internfinans 11 1 3 18 MediCarrier AB 495 2 AB Storstockholms Lokaltrafik 242 817 7,223 581 AB SL Finans 133 133 SL Infrateknik AB 85 83 SL Älvsjö AB 6 All companies are wholly owned by Stockholm County Council or the respective Parent Company

Unit Loans Guarantees SEK million Donors Recipient Donors Recipient Stockholm County Council 24,016 15,285 Landstingshuset i Stockholm AB 524 Danderyds Sjukhus AB 911 Södersjukhuset AB 1,161 Södertälje Sjukhus AB 178 St. Eriks Ögonsjukhus AB 171 Ambulansjukvården i Storstockholm AB 5 16 Stockholm Care AB 8 Folktandvården Stockholms län AB 368 Waxholms Ångfartygs AB 371 13 Locum AB 231 AB SLL Internfinans 239 2 MediCarrier AB 7 AB Storstockholms Lokaltrafik 23,355 12,219 AB SL Finans SL Infrateknik AB SL Älvsjö AB All companies are wholly owned by Stockholm County Council or the respective Parent Company

 To contents Financial report Annual Report 2014 123 Note 22 Average number of annual employees by area of operations

Number of annual Number of annual employees 2014 employees 2013 Health and medical care, incl. dental care 37,636 36,964 Transport 652 624 Other operations 2,071 1,915 Total excl TioHundra AB 40,359 39,503 TioHundra AB* 1,051 1,071 Total 41,410 40,574

* TioHundra AB is 50-per-cent owned so only 50 per cent of the work force is presented above.

Note 23 Surplus/deficit for the year and adjusted surplus/deficit 2014

SEK million Intern- Company finans WÅAB Care AISAB MediC Locum DSAB Surplus/deficit before appropriations 3 14 3 –6 5 31 –269 Appropriations Effect of lowered interest pension liability calculation 0 1 1 2 1 –13 119 Tax disposition –3 174 –6 4 –6 –19 152 Total appropriations –3 175 –5 6 –5 –32 271 Surplus for the year 0 189 –2 0 0 –1 2

Surplus/deficit before appropriations 3 14 3 –6 5 31 –269 Compensation for pensions 0 1 1 2 1 –13 119 Adjusted surplus/deficit 3 15 4 –4 6 18 –151

SEK million Company St. Erik SÖS StS AB FTV LISAB SL Surplus/deficit before appropriations –7 –233 –25 64 22 –75 Appropriations Effect of lowered interest pension liability calculation 22 149 25 43 –111 0 Tax disposition –11 98 0 –123 –297 0 Total appropriations 11 247 25 –79 –408 0 Surplus for the year 4 13 –1 –15 –386 –75

Surplus/deficit before appropriations –7 –233 –25 64 22 –75 Compensation for pensions 22 149 25 43 –111 47 Adjusted surplus/deficit 14 –84 –1 108 –89 –28

124 Annual Report 2014 Financial report  To contents Key ratios 2010–2014

Unit 2014 2013 2012 2011 2010 Population Stockholm County Number 2,198,044 2,163,042 2,127,006 2,091,473 2,054,343 – Population development % 1.6 % 1.7 % 1.7 % 1.8 % 1.7 % Sweden Number 9,747,355 9,644,864 9,555,893 9,482,855 9,415,570 – Population development % 1.1 % 0.9 % 0.8 % 0.7 % 0.8 % Participation in Stockholm County % 22.6 % 22.4 % 22.3 % 22.1 % 21.8 %

Tax Tax revenues, general government grants and equalisation* SEK million 63,971 61,802 59,328 57,965 55,085 Tax revenues, general government grants and equalisation* SEK/inh. 29,104 28,572 27,893 27,715 26,814 Tax revenue development* % 3.5% 4.2% 2.6% 5.2% 3.6% Tax rate SCC SEK 12.10 12.10 12.10 12.10 12.10 Average county council tax, nationwide SEK 11.20 11.11 11.01 10.82 10.82 * Conversions have been made in 2012 due to changed policy for reporting of government grant for reduced sickness absence. Refer to Notes 1 and 3.

Income statement Turnover SEK million 82,478 80,208 77,123 73,803 69,762 Surplus/deficit SCC SEK million 136 934 1,984 512 1,306 Result share of tax revenues, general government grants and equalisation % 0.2% 1.5% 3.3% 0.9% 2.4% Operation revenue, development* % 0.5% 3.4% 11.3% 7.9% – 0.1% Operations’ expenses, development % 6.6% 4.0% 3.0% 5.2% 2.8% Depreciation/amortisation costs, development % 6.4% 5.3% 10.1% 4.8% 6.3% Net cost development % 8.5% 4.2% 1.0% 4.4% 3.8%

Balance sheet Total Assets SEK million 90,433 81,331 77,744 68,604 59,855 Equity SEK million 7,426 6,857 5,923 3,944 3,434 Equity/assets ratio % 8.2% 8.4% 7.6% 5.7% 5.7% Equity/assets ratio including contingent % –20.0% –24.0% –23.9% –29.8% –31.2% liabilities Liquidity SEK million 334 1,841 4,816 1,821 2,034 Loan and leasing debt SEK million 32,931 28,881 30,998 27,141 21,113 Pension obligations (incl. payroll tax) SEK million 47,597 47,299 42,548 40,700 35,554

Investments Investments SEK million 14,988 11,180 9,389 9,764 8,260 Self-financing degree of investments % 55.7% 74.3% 89.3% 28.9% 66.8%

Operations Visits in healthcare Number 17,824,660 17,176,253 16,414,139 16,017,905 15,524,207 Care episodes in healthcare Number 327,151 326,425 324,500 318,059 311,585 Gross area ('000s) sq.m. 2,014 2,047 2,103 2,099 2,084 Occupancy rate property % 91 93 93 93 92 Passengers, winter day ('000s) Number 791 786 763 739 722 Public transport on land, tax funding ratio % 47.8 48 46 49 51 Culture expense SEK/inh. 200 196 187 190 193

Staff Number of full-time equivalents SCC Number 41,410 40,574 40,189 39,662 39,502 – of which health and medical care Number 38,687 38,035 37,810 37,237 36,925 – of which transport services Number 652 624 633 688 809 – of which other personnel Number 2,071 1,915 1,746 1,737 1,768

 To contents Financial report Annual Report 2014 125 Audit Report for the County Council Executive Board 2014

In our capacity as auditors appointed by the Assembly, we have According to the audit, the rules should be changed since they audited the County Council Executive Board’s activities and have now been deviated from for the third consecutive year. financial accounts for the year 2014. We note a relatively high rate of cost increase, mainly in health and medical care. We therefore want to particularly emphasize The County Council Executive Board is responsible for manag- the importance of the County Council Executive Board ensuring and coordinating the County Council’s operations and having that action is taken that is adequate, feasible and sustaina- ing supervision over other committees and boards, i.e. contin- ble on the long term in order to achieve the Assembly’s goal of uous supervision that the operations are conducted in balanced finances in the future. Especially since the planned accordance with applicable objectives, decisions and guide- investment volumes in the next ten years will have a major lines and the regulations that apply for the operations. The financial impact on the County Council’s conditions to main- Board has a leading position and shall have an overview of the tain balanced finances. It was also noted in the audit that the whole with responsibility for follow up and feedback to the financial consequences and the financing of the investments Assembly. The Board is responsible for monitoring the devel- are not always clearly presented by decisions, which means opment of the operations and finances and taking action when that the Assembly is not provided enough input to assess what necessary. effect an investment decision will have on the County Council’s finances. Our responsibility as auditors is to review operations, internal control and accounts and determine if operations were con- We have examined if the results are in agreement with the ducted according to the Assembly’s assignment and objectives County Council Assembly’s decisions regarding goals and as well as the regulations that apply to the operations. We shall guidelines for sound financial management. Based on the also assess whether the annual accounts are consistent with information in the Annual Report, we assess that the overall the financial targets and operating objectives decided on by the objective of balanced finances and the other financial targets Assembly. have been achieved. The overall objectives of accessibility and quality in healthcare and reliability in public transport have The audit has been carried out in accordance with the Swedish not been achieved in all respects. The County Council Execu- Local Government Act, generally accepted auditing practices tive Board’s conclusion that they have been achieved is, in local government in Sweden and the County Council’s audit- according to the audit, not sufficiently supported as there are ing regulations. The audit was of the nature and scope neces- too few indicators or the indicators only measure a part of the sary to provide a reasonable basis for assessment and deter- objective. mining liability, and produced the results presented in the Audit Office’s Annual Report for 2014 to the County Council We assess that the Annual Report provides a true and fair view Executive Board. We are appending a summary report of the of the financial position and performance of the year, with results of our audit. exception for the deviations from generally accepted accounting principles that exist since before, but that have not affected We assess that the County Council Executive Board continued the surplus for the year. We assess overall that the County to strengthen owner governance and supervision over the Council Executive Board’s financial and operating results are County Council’s operations in certain respects in 2014. The not entirely satisfactory. In addition, we assess that the County supervision report, which is presented in an appendix to the Council Executive Board’s work on internal governance and Annual Report, is an important basis for the County Council control has been developed, but that internal governance and Executive Board’s reporting on owner governance to the control is still not fully adequate. Assembly. The conclusions drawn in the supervision report regarding compliance to laws, steering documents and the We recommend that the 2014 consolidated annual accounts for municipal objective are based on information provided by the Stockholm County Council be adopted. operations. The information needs to be quality assured, however. We recommend that the Assembly grant discharge from liability to the members of the County Council Executive Board. We want to again state that there is ambiguity in the governance of the County Council’s emergency hospitals, which in our opinion are not adequately coordinated with the Public Healthcare Services Committee’s governance in agreements. Stockholm, 16 April 2015 This is at risk of affecting the hospitals in terms of undertaking adequate and long-term sustainable measures. Recurring Kenneth Strömberg Peter Kockum decisions on exceptions to the surplus appropriation rules entail additional ambiguous signals as to what rules apply. Lars Bergstig Benkt Kullgard Gunnar Ågren

126 Annual Report 2014 Financial report  To contents Abbreviations

AISAB Ambulanssjukvården i Storstockholm AB Care Stockholm Care AB DSAB Danderyds Sjukhus AB (Danderyd Hospital) FtjV Färdtjänstverksamheten (Transport services for the disabled) FTV Folktandvården Stockholms län AB (Public Dental Service in Stockholm County) FUT Förvaltning för utbyggd tunnelbana (Extended Metro Administration) HSN Hälso- och sjukvårdsnämnden (Public Healthcare Services Committee) HSF Hälso- och sjukvårdsförvaltningen (Health and Medical Care Administration) Internfinans AB Stockholms Läns Landstings Internfinans Karolinska Karolinska Universitetssjukhuset (Karolinska University Hospital) KcFi Koncernfinansiering (Group financing) KuN Kulturnämnden (Culture Committee) KuNF Kulturförvaltningen (Culture Administration) LFS Landstingsfastigheter Stockholm LISAB Landstingshuset i Stockholm AB Locum Locum AB Lrev Landstingsrevisorerna (County Council Audit Office) LSF Landstingsstyrelsens förvaltning (County Council Executive Board Administration) MediC MediCarrier AB NKS New Karolinska Solna PaN Patientnämnden (Patient Advisory Committee) PaNF Patientnämndens förvaltning (Patient Advisory Committee Administration) SL AB Storstockholms Lokaltrafik SCC Stockholm County Council SLSO Stockholms läns sjukvårdsområde (Healthcare Provision Stockholm County) SoN Health and Social care Committee in Norrtälje St. Erik St. Eriks Ögonsjukhus AB StSAB Södertälje Sjukhus AB SÖS Södersjukhuset AB (Stockholm South General Hospital) TioHundra TioHundra AB TF Trafikförvaltningen (Traffic Administration) TN Trafiknämnden (Traffic Committee) WÅAB Waxholms Ångfartygs AB

 To contents 127 Contact information

Administration Corporate registration number SCC: 232100-0016

Metro Expansion Administration Cultural Administration Public Healthcare Services Office* Box 22550 Box 38204 Box 801 SE-104 22 Stockholm SE-100 64 Stockholm SE-761 28 Norrtälje Tel: +46-8-690 51 00 Health and Medical Care E-post: [email protected] Healthcare Provision, Administration Stockholm County Box 6909 County Council Auditors Box 17914 SE-102 39 Stockholm Box 22230 SE-118 95 Stockholm Tel: +46-8-123 132 00 SE-104 22 Stockholm Tel: +46-8-123 400 00 E-post: [email protected] Tel: +46-8-737 25 00 E-post: [email protected] E-post: [email protected] www.slso.sll.se Karolinska University Hospital Huddinge: County Council Executive Traffic Administration 141 86 Stockholm Board Administration Box 30103 Tel: +46-8-585 800 00 Box 22550 SE-104 25 Stockholm Solna: SE-104 22 Stockholm Tel: +46-8-686 16 00 SE-171 76 Stockholm Tel: +46-8-737 25 00 E-post: [email protected] Tel: +46-8-517 700 00 E-post: [email protected] www.karolinska.se Patient Advisory Committee * jointly with Norrtälje Municipality Administration Box 17535 SE-118 91 Stockholm Tel: +46-8-690 67 00 E-post: [email protected]

Companies

Ambulanssjukvården i MediCarrier AB Södersjukhuset AB Storstockholm AB Corp.reg.no. 556543-6168 Corp.reg.no. 556595-7403 Corp.reg.no. 556461-6695 Finspångsgatan 44 Sjukhusbacken 10 Box 5191 SE-163 53 Spånga SE-118 83 Stockholm SE-121 18 Johanneshov Tel: +46-8-795 28 00 Tel: +46-8-616 10 00 Tel: +46-8-602 62 50 E-mail: [email protected] www.sodersjukhuset.se E-mail: [email protected] www.aisab.nu St. Eriks Ögonsjukhus AB Södertälje Sjukhus AB Corp.reg.no. 556574-3589 Corp.reg.no. 556775-9922 Danderyds Sjukhus AB Polhemsgatan 50 SE-152 86 Södertälje Corp.reg.no. 556575-6169 SE-112 82 Stockholm Tel: +46(0)8-550 240 00 SE-182 88 Danderyd Tel: +46-8-672 30 00 E-mail: Tel: +46(0)8-123 550 00 www.sankterik.se [email protected] www.ds.se www.sodertaljesjukhus.se Stockholm Care AB Folktandvården Stockholms län AB Corp.reg.no. 556253-1896 TioHundra AB Corp.reg.no. 556574-3597 Box 6423 Corp.reg.no. 556595-7395 Box: 6420 SE-113 82 Stockholm Box 905 SE-113 82 Stockholm Tel: +46-8-672 24 00 SE-761 29 Norrtälje Tel: +46(0)8-123 166 00 E-mail: [email protected] Tel: +46-176-32 60 00 E-mail: [email protected] E-mail: [email protected] www.ftv.sll.se AB Stockholms Läns Landstings www.tiohundra.se Internfinans Landstingshuset i Stockholm AB Corp.reg.no. 556449-9183 Waxholms Ångfartygs AB Corp.reg.no. 556477-9378 Box 22550 Corp.reg.no. 556087-9859 Box 22550 SE-104 22 Stockholm Box 7422 SE-104 22 Stockholm Tel: +46-8-737 25 00 SE-103 91 Stockholm Tel: +46-8-737 25 00 Tel: +46-8-614 64 50 AB Storstockholms Lokaltrafik, SL E-mail: info@waxholmsbolaget.sll.se Locum AB Corp.reg.no. 556013-0683 www.waxholmsbolaget.se Corp.reg.no. 556438-7909 SE-105 73 Stockholm Box 17201 Tel: +46-8-686 16 00 SE-104 62 Stockholm www.sl.se Tel: +46(0)8-123 170 00 www.locum.se

128  To contents

Ovan här placeras svanen- och FSC-märkningen in

For 2014, we prepared an annual review in addition to the formal annual report. The annual review describes the County Council’s efforts and objectives and contains an overall description of the financial results for 2014. Both the annual report and annual review for 2014 are on our website www.sll.se

Printed copies of the 2014 annual report and annual review can be ordered at: [email protected]

Graphic design: Fidelity Stockholm Photo: Erja Lempinen page 1, Anna Molander page 3 and 4, Jan Danielsson page 4.  To contents 131 County Council Executive Board Administration Box 22550, SE-104 22 Stockholm Telephone: +46-8-737 25 00 www.sll.se  To contents