Region Stockholm Annual Report 2020 RS 2020-0769

2 Annual Report 2020 Chapter name Contents

Energy to restart...... 4 Patient Advisory Committee...... 62 Stockholm County’s Healthcare Area...... 62 Statement by the Regional Chief Executive...... 6 Karolinska University Hospital...... 64 Transport Committee...... 66 Significant events...... 8 Mobility Service Committee...... 73 COVID-19...... 9 Growth and Regional Planning Committee...... 73 Major investments...... 12 Culture Committee...... 75 Sale of property...... 13 Karolinska University Hospital – the world’s Property and Service Committee...... 77 The Audit Board...... 81 tenth best hospital...... 13 Safety Commission...... 13 Companies...... 82 Landstingshuset i Stockholm AB...... 83 The Regional Group...... 14 Södersjukhuset AB...... 83 Governance and follow-up of regional operations...... 17 Danderyds Sjukhus AB...... 85 Goals and mandates...... 18 Södertälje Sjukhus AB...... 87 Internal control...... 18 S:t Eriks Ögonsjukhus AB...... 89 Folktandvården Stockholms län AB...... 90 Good financial management and financial position ...... 21 Ambulanssjukvården i Storstockholm AB...... 91 Long-term financial sustainability ...... 23 Stockholm Care AB...... 92 Sustainable regional development ...... 29 MediCarrier AB...... 93 Region Stockholm shall be a sustainable employer ...... 35 Locum AB...... 94 Results for committees and companies ...... 38 AB Stockholms Läns Landstings Internfinans...... 94 A comparison of the hospitals’ common indicators ...... 38 AB Storstockholms Lokaltrafik...... 95 Investments inRegion Stockholm...... 41 Investments withincommittees and companies...... 41 Local government federations and foundations...... 96 Local government federations...... 97 Important conditions for the result and Foundations...... 99 the financial position...... 43 Operations and Investment accounts...... 100 Development overview of operations ...... 45 Operational accounts...... 101 Investment accounts...... 102 Expected development...... 47

Notes...... 103 Financial Report...... 50 Income statement...... 51 Auditor’s report regarding the County Council Balance sheet ...... 52 Executive Committee for 2020...... 119 Cash flow statement...... 53 Abbreviations...... 120 Committees...... 54 The Regional Executive Committee...... 55 Healthcare Committee...... 56 Healthcare Service Steering Committee...... 61

Figures in brackets refer to the corresponding period the previous year, unless otherwise specified. Deviations may occur in tables and diagrams, as the figures have been rounded up from SEK thousands to millions. Energy to restart

THE PAST YEAR has been unparalleled to handle extraordinary situations and in the history of Sweden and the region. meet important long-term commit- Tremendous efforts have been made by ments to the county’s inhabitants all parts of and all employees in Region within healthcare and public transport. Stockholm, as well as by those who work When the pandemic broke out in the on behalf of the region. Together we region, we were able to act quickly with summoned our strength to meet the the goal of always being one step ahead. magnitude of the pandemic. Through We prepared for the worst, but hoped concerted efforts, the region has always for the best. had a capacity in healthcare that at any The surplus for 2020 is largely due to given time was greater than what was non-recurring items such as lower needed. At the same time, public trans- pension costs, capital gains from port has been operating according to property sales, lower financial expenses the normal schedule despite having and temporary pandemic-related only a fraction of the regular number of contributions. However, the time ahead passengers. Over the past year, many will be challenging. The economic people have lost their lives during the situation and high unemployment rate pandemic, thousands have been cared mean that there is a risk of lower tax for in our hospitals, and healthcare revenues. Public transport continues to employees have made invaluable generate low revenue, deferred medical contributions. Despite the stressful care must be carried out and a marked year, a number of successes are notable increase in the transfer of tax revenue in the Stockholm healthcare sector. will hit the region with full force over One example is Karolinska University the coming years. Thus, Region Hospital, which was named the world’s Stockholm has significant economic seventh best hospital, another is that challenges in the near future. when ranking cardiac care in Sweden, That is why the 2020 surplus is being three of the five best hospitals are used responsibly to secure resources located in Region Stockholm: Danderyds within healthcare and public transport, Sjukhus AB, Karolinska University so that the recession and worsening Hospital and Capio S:t Görans Sjukhus. financial situation resulting from lower Region Stockholm reported a result passenger revenue and sharply for 2020 of SEK 5,802 million. The increased transfer of tax revenue can be result exceeded the budget for the year bridged. The sick must receive care in by SEK 5,490 million. Region Stockholm time and the county’s inhabitants must has reported a surplus since 2007. This be able to rely on a well-functioning makes Region Stockholm unique in public transport system. Region Sweden as the only region that has not Stockholm will contribute to the restart run a deficit. Furthermore, Region of the Stockholm region. As much of the Stockholm is the only region in Sweden surplus as is legally possible – SEK that did not raise taxes during this 3,247 million – has therefore been set period. Through a surplus and financial aside in a profit equalization reserve. It rectitude, the region has built up buffers will act as a kind of insurance in order to

4 Annual Report 2020 be able to manage a high-capacity focus on future benefits for implement- of great importance for the region’s public transport system and to manage ing the correct priorities. continued development that the econ- deferred medical care due to the pan- The consequences of the pandemic omy can be restarted, but at the same demic over the coming years, as it is are not entirely clear. What is clear, time it must be done in manner that estimated that the recession will result however, is that the pandemic will have minimizes the risk of infection. At the in lower tax revenue. a strong adverse impact on the economy end of 2020, vaccine deliveries began to Region Stockholm has made and in the long term, and risks accelerating arrive. Unfortunately, they were revised continues to make major investments in the downturn in the economy that we down dramatically at the beginning of healthcare by improving, developing saw even before the pandemic. Labour 2021, which will delay the restart and creating new ways of working that market trends are weak. The business of the Stockholm region. The region still bolster the healthcare sector to provide community in our county lost 58.2 has good capacity to carry out the more accessible and more efficient billion in sales during the year, which vaccination programme, but the scope healthcare services, where more means fewer jobs. This risks leading to of the deliveries must increase. patients receive the right care, at the a lower level of tax revenue in the region At the time of writing, we are in the right time, at the right level and at the in the future, at the same time as costs middle of the third wave of the pan- right cost. Within public transport, the are increasing sharply for the transfer demic. I would like to extend a sincere largest investments in modern times of tax revenue. thank you to all the employees in the are being made, with major investments Robust measures are needed to region, everyone who works on behalf of in the expansion of the Underground strengthen Stockholm’s attractiveness the region, and to all the region’s part- network, light-rail network and upgrad- and quickly restart the economy, to ners for their tremendous work during ing of both Roslagsbanan and the Red secure jobs and businesses in the the pandemic in 2020 and the spring of Line to ensure a well-functioning and Stockholm region. The massive infra- 2021. The readjustment that has been accessible public transport system in a structure investments that are cur- carried out is unparalleled in the growing Stockholm region. This year’s rently underway in the expansion of the county’s history. These efforts have lower work-up rate can mainly be Underground network, for example, meant that the region, in any given explained by the COVID-19 pandemic’s will employ many Stockholmers for a situation, could meet the needs of effects on property investments in healt- long time to come, as well as the housing Stockholmers for both intensive care hcare, and postponements of major construction that is taking place in and regular care, and that we had both investments within public transport. alongside it. The positive effects of protective equipment for employees and In order to reduce Region Stockholm’s investments in infrastructure and pharmaceuticals for patients. Buses and investment expenditure, a comprehen- housing provide opportunities for the trains have run on schedule to reduce sive review of Region Stockholm’s Stockholm region to grow and develop. the spread of infection, and at the same investment activities was conducted in At the same time, Region Stockholm is time maintain the need for public the spring of 2020 to ensure clear undersupplied when it comes to govern- transport. These enormous achieve- priorities and principles, lower ment initiatives that facilitate commut- ments have saved lives. I would also like expenses in the long term, and invest- ing and travel. Deficiencies in infra- to express my appreciation for the fact ments that are efficiently implemented. structure in the Stockholm region are a that all parties have shown tremendous It contributes to increased control and national matter, which risks significant responsibility and contributed con- enhanced governance both before, effects in the long term even far beyond structively to the region’s overall crisis during, and after investment decisions our county’s borders. management capability. are made. Essentially, it is about Many companies were hit hard strengthening the overall approach to by the pandemic and, in particular, by Irene Svenonius the investment process, with a stronger the restrictions that were imposed. It is Regional Chair for Finance

Annual Report 2020 5

Statement by the Regional Chief Executive

The year 2020 in Region Stockholm was characterized by the pandemic striking at the beginning of the year and having widespread effects on people’s lives and health, 1 as well as on unemployment, bankruptcies, education and the economy. Many people lost their lives, tens of thousands have been cared for in various ways. At the same time, many inhabitants have had to postpone medical care that could feasibly be postponed in order to divert resources in the healthcare sector to those who became seriously ill from the virus.

6 Annual Report 2020 No one has been unaffected by the have been to stay at home at the slight- during certain periods, down to 50–60 pandemic in 2020. Those who work in est sign of symptoms. However, long- percent of a normal year. It has had the healthcare sector have had a par- term sick leave has been kept at the extensive financial consequences, ticularly difficult time, in the front line same levels as previously. As the work which requires measures to get against a completely new virus, where situation has been difficult, mainly in Stockholmers to return to the high-­ knowledge about the best treatment emergency care, extensive personal capacity public transport system for methods have had to be developed as support in various forms has been commuting and recreational travel after work progressed. In the final days of offered. In order to create conditions for the pandemic. 2020, vaccination of elderly residents in recovery, the focus during the summer The annual accounts show a surplus special forms of housing commenced in was on offering all the region’s employ- for the 14th year in a row, and an excep- the region. It was a bright spot in an oth- ees in the healthcare sector four weeks tional surplus for 2020. This is largely erwise very stressful Christmas period of continuous leave. Fortunately, the due to non-recurring items such as for the healthcare sector, when the recruitment of nurses, among other lower pension costs, capital gains from second wave struck with almost the personnel, has gone well during the property sales, lower financial expenses same intensity as the first. For the year. Several operations have had and temporary pandemic-related public transport system, this meant that reduced staff turnover and an increased contributions. The time ahead will be travel was halved overnight and reve- degree of staff retention compared with challenging, with continued low reve- nue was dramatically reduced, while all previous years. The follow-up of health nue in public transport, deferred services ran according to schedule to and safety that has been carried out has medical care that must be performed, reduce the risk of congestion. Steps shown good results. and a significantly increased transfer of were taken within the scope of the During the spring, the Regional tax revenue over the coming years. As region’s mandate to mitigate the effects Special Healthcare Management, much of the surplus as is legally possible, on the business community and the RSSL, made around 400 decisions has therefore been set aside in a profit culture sector. There has been extensive relating to the pandemic from June to equalization reserve. It will be a form of collaboration with the municipalities, the end of the year. When the produc- insurance in order to be able to cope as well as with the County Administra- tion coordination group for healthcare with a high-capacity public transport tive Board, state agencies, academia, met, RSSL made about ten decisions system, and work with deferred medical other regions, organisations and the during the period of time it was active. care over the coming years when it is business community, all to create the This is the result of extensive learning estimated that the recession will result best possible conditions in a difficult within the organisation and collabora- in lower tax revenue. All our employees time. tion that was engendered by the need to and partners have worked tremen- Employees in all operations within jointly solve healthcare challenges for dously hard, which has enabled the the region’s areas of activity have been the benefit of patients. This has meant region to maintain incredibly important affected, and have displayed a remarka- that everyone has worked, learned, societal functions and, despite enormous ble ability to adapt and adjust to a new evaluated and analysed “as they went”, pressure, they always managed to be one reality. Within the healthcare sector, something that was the Regional step ahead of COVID-19. A huge thank many people have had to switch duties, Executive Committee’s wish to capture you to everyone! managers, teams and physical work- through the request for evaluation of places. Others have been allowed to the pandemic that was decided on in Carina Lundberg Uudelepp work from home, and sick leave has May 2020. Regional Chief Executive been higher than in previous years, not Within public transport, the number least because the recommendations of passengers has fallen dramatically,

Statement by the Regional Chief Executive Annual Report 2020 7

2 Significant events

8 Annual Report 2020 COVID-19 Coordination and unified manage- lutely crucial for effectively treating the During most of 2020, virtually all ment of the health services’ prepared- most severely ill COVID-19 patients. operations within Region Stockholm have ness for the new coronavirus has, in The increase in intensive-care capacity focused on dealing with the COVID-19 accordance with current regulations, has, on the whole, been sufficient to pandemic and its effects. Operations been undertaken by RSSL2 , which was meet the existing need. and resources have been redirected, not established and activated on February In order to free up capacity, re-rout- least in healthcare, where employees 7. LSSL 3 was established at all hospi- ing of medical care within the health- have made outstanding contributions tals, and in Stockholm County’s Health- care sector was also carried out. In and established new forms of collabora- care Area, SLSO, which in close collabo- March, Folktandvården Stockholms län tion. Enhanced production coordina- ration operationally deployed all AB was tasked with reducing its opera- tion has been established between initiatives. The work within RSSL was tions by closing clinics in order to make healthcare providers. During the initially led by the chief medical officer protective equipment and consumables spring, capacity in intensive care in collaboration with infectious disease available to the healthcare sector. The quadrupled, from about 90 to 400 beds, physicians. The work included ensuring burden on emergency hospitals has including Capio S:t Görans Sjukhus. that the region’s total healthcare varied depending on the spread of the The Emergency Agreement was resources were prepared for a possible infection in the region. This has activated during certain periods, and outbreak in Sweden, as well as ensuring resulted in the significant need for the employees in the healthcare sector access to medical supplies during patient transports between hospitals, have worked intensively to care for a disruptions in the supply flow. and, over time, the planned as well as completely new type of patient. Health- From March 18, the director of emergency diversion of ambulances, care providers outside the emergency healthcare was made responsible for and also the transfer of intensive care hospitals, with different types of agree- leading the work within RSSL in collab- patients between hospitals. ments with the region, have contributed oration with the healthcare administra- During the month of March, the staff to emergency care, while individu- tion’s chief medical officer and infectious creation of extra inpatient capacity als have contributed through temporary diseases physicians. The work within commenced in the form of a hospital in employment. each LSSL has been led by the respec- Älvsjö, and on April 6, the hospital was The COVID-19 pandemic has led to a tive production manager with their ready for use. The hospital was intended dramatic reduction in travel on public operational crisis management team. to care for patients with COVID-19, in transport, which has led to reduced RSSL and the Local Special Health- the event that the pandemic led to a lack ticket revenue. In order to limit the care Management, LSSL, worked of capacity in inpatient and inten- spread of infection in accordance with throughout the spring to ensure that sive-care4beds at the emergency hospi- national recommendations, Region protective equipment, medicines and tals. A shortage of capacity failed to Stockholm has operated public trans- other equipment were available to materialize and Älvsjö Hospital could port as normal and urged the county’s ensure emergency and critical care in later be closed down. inhabitants to avoid unnecessary travel. the region; in some areas in collabora- As soon as antibody tests were COVID-19 has affected public health tion with other regions and the National developed, a decision was made, in in a very tangible way. As of Board of Health and Welfare. accordance with the Swedish Public December 31, 2020, a total of 121,874 Work commenced at an early stage to Health Agency’s recommendations, people have been infected with corona- increase the number of beds in the regarding access to these tests. The virus. 3,452 of these have died1. emergency hospitals and geriatric regions were responsible for testing clinics for patients with COVID-19, patients, their own staff and the munici- The healthcare service and to increase the number of inten- palities’ employees, as well as suspected In January 2020, China reported that in sive-care beds in Region Stockholm. cases at assisted living facilities (SÄBO)5. December 2019 and January 2020, they The normal number of intensive-care The test capacity was expanded rapidly. had had a major outbreak of a novel beds at the region’s hospitals quickly A decision was made in the spring to coronavirus, which had resulted in became inadequate as the spread of postpone any planned care that could many deaths. infection gained momentum in March, be postponed without serious conse- and capacity was greatly increased. quences for the patient. Thus, health- The first wave The fact that hospitals could swiftly care professionals could be freed up to At the end of February, the first cases of and agilely allocate resources and bolster the care of COVID-19 patients. COVID-19 were identified in Stockholm increase intensive care capacity at the The Stockholm County’s Healthcare County. beginning of the pandemic was abso- Area established a mobile testing

1 The data was taken from the Public Health Agency of Sweden’s website on February 5, and refers to the last week of 2020. 2 RSSL: Regional Special Healthcare Management. 3 LSSL: Local Special Healthcare Management. 4 ICU – Intensive Care Unit. 5 Assisted living facilities

Significant events Annual Report 2020 9 capacity, which was initially tasked with Agency, FHM. Furthermore, testing ongoing basis6. Healthcare providers testing people suspected of being was offered for ongoing cases of COVID- have implemented capacity increases infected with coronavirus at assisted 19, and the subsequent tracking and for inpatient and intensive care at the living facilities. The testing capacity tracing of positive cases, as well as pace required. was gradually increased. managing deferred medical care. A Due to the strained situation in During the pandemic, the healthcare particular focus has been on adopting intensive care, Region Stockholm service reorganised to meet the consid- measures to reduce the risk of COVID- requested on December 23 that the erable increase in patients in general 19 for residents living in assisted living Swedish Association of Local Authori- and intensive-care patients in particu- facilities, to secure procedures in the ties and Regions, SALAR, activate the lar. In order to cope with the compre- event of new outbreaks, and to ensure Emergency Agreement for the region’s hensive adjustment, the operations the standard of care for the residents. intensive-care operations. On the same recruited new employees, trained and day, SALAR activated the Emergency reallocated staff for new duties, The second wave Agreement for Region Stockholm’s increased the number of temporary During the late autumn, the spread of intensive-care operations. staff, revoked non-statutory holidays infection picked up speed again and the Since October, healthcare providers and ordered employees to work over- waiting lists became longer. The crisis outside the emergency hospitals have time, amongst other things. Healthcare and emergency medical plan was increased or changed their mandates to providers outside the emergency revised in November 2020. Prepared- free up capacity for COVID-19 care at hospitals, with different types of agree- ness was also maintained in order to be the emergency hospitals. In order to ments with the region, have contributed able to quickly adopt measures to scale ensure that local healthcare services staff to emergency care. These efforts up the number of beds, including have the conditions to fulfil their were not sufficient to cope with the staff- intensive-care beds. A decision was mandate during the pandemic, SLSO ing of intensive-care operations and made in the Regional Council, RS has also been given the task, from the Region Stockholm therefore requested 2019–1041, to have a three-month spring to the end of the year, to support that the Swedish Association of Local stock of protective equipment and other and coordinate healthcare providers Authorities and Regions, SALAR, supplies in place in the event of a rapid within community based healthcare activate the Emergency Agreement, increase in the rate of infection. services. which was done on April 3. To safeguard As the spread of infection and the From June 15 to the end of Decem- healthcare services during the summer need for healthcare services increased ber, 864,941 COVID-19 tests have been while employees took their statutory again, the need for infection control carried out in Region Stockholm to test holiday, the Emergency Agreement measures intensified. On October 29, for suspected infection. During the remained in place. the Swedish Public Health Agency, after corresponding time frame, 693,235 At the end of the spring, the spread of consultation and approval from the antibody tests were conducted7. COVID-19 slowed considerably, and the infectious disease physician in Region The planning for vaccination against burden on the emergency hospitals Stockholm, decided on stricter general COVID-19 were clarified at the begin- decreased. guidelines for Stockholm County. The ning of December, and a three-stage County Administrative Board was also vaccination plan was drawn up based The interim consulted. Furthermore, the infectious on expected access to vaccines and the During the summer, the spread of disease physician asked the County Swedish Public Health Agency’s priority infection was low and as a result, RSSL Administrative Board in Stockholm to groups. Following the initial announce- was discontinued on September 7. issue regulations on limiting the num- ments, planning has changed signifi- However, the work of ensuring prepar- ber of participants at public gatherings cantly as the forecasts for vaccine availa- edness to deal with the pandemic and public events. bility have been revised downwards. continued through coordination On November 19, RSSL was acti- between healthcare stakeholders, vated once again. Since June, and with Public transport under their own auspices, and Capio increased frequency during the Within public transport, adaptations S:t Görans Sjukhus., which had com- autumn, a production coordination were made to comply with the Swedish menced before the summer. Early in the group, consisting of all emergency Public Health Agency’s recommenda- autumn, the waiting lists for medical hospitals, including S:t Görans Sjukhus tions not to travel by public transport care decreased. Important measures run by Capio AB, and the Stockholm unless absolutely necessary, in order to during the early autumn included County Healthcare Area, SLSO, the minimize the spread of infection. The monitoring the situation, continuing to regional chief executive, director of mandate has been to run as many buses work preventively, and instructing the healthcare, chief medical officer and and trains as possible to avoid conges- population to follow the recommenda- infectious disease physician, has tion. Extensive information initiatives tions of the Swedish Public Health prepared contingency plans on an have been carried out with the message

6 Contingency planning entails planning and being prepared for a number of different things that may happen in a crisis situation. 7 Statistics from Karolinska University Hospital.

10 Annual Report 2020 Significant events “do not travel by public transport”. general recommendation, which meant has been sent to regional stakeholders. At the same time, public transport has that face masks should be used on The Growth and Regional Planning continued to run on schedule. Travel public transport on weekdays during Committee has carried out a prospec- has decreased dramatically during the rush hour. The new recommendations tive analysis in the wake of COVID-19. year. Despite the challenges posed by regarding face masks on public trans- The report, TRN 2020–0148, was the COVID-19 pandemic, the Transport port will take effect from January 7, presented in December 2020. Committee has maintained a stable 2021 throughout the country. To match the companies’ different level of production and operations. needs, Region Stockholm has created a During the year, the Transport Regional development web service, where companies that need Committee worked with scenarios for Region Stockholm’s mandate to drive work or have manpower available, can crisis management, as well as travel and regional development encompasses post what they can offer. In the same revenue forecasts to support follow-up everything from culture to skills supply, way, companies that need manpower and planning. An important part of the community planning and issues related can post their requirements. The work has been external monitoring and to growth. The pandemic has led to a service is free of charge and the purpose in-depth analyses of attitudes, travel sharp economic downturn that is affect- is to enable companies to locate one behaviour and congestion in order to ing large parts of the business commu- another and collaborate in these very gain a better understanding and a basis nity, both in the Stockholm region as unusual circumstances. The only for short and long-term management of well as nationally and internationally. condition for companies to participate the pandemic. The crisis in the wake of COVID-19 is is that they are VAT registered and have Travel has decreased sharply since affecting the region’s companies in a an F-tax certificate. mid-April by up to 50 percent, to ulti- variety of ways. In some industries, Within all our operations, it has been mately settle at 64.5 percent of the demand has fallen sharply, with fur- clear that collaboration is an absolute previous year’s travel on terrestrial loughing and notifications of redun- prerequisite for effective crisis manage- public transport by the end of the year. dancy as a result. In Sweden, more than ment. This applies both to committees It is worth mentioning that the months 120,000 people have been given notice and companies within Region Stock- of January and February were not of redundancy since the beginning of holm, and to other public and private impacted by the pandemic, and had March 2020. Notifications of redun- stakeholders. normal travel volumes. dancy have increased most in Region During the pandemic, ticket inspec- Stockholm, which accounts for just Culture tors were given an adjusted work under 50 percent of all redundancies in The COVID-19 pandemic has had a schedule, both to observe congestion the country. major impact on the cultural life of the and to contribute to ticket revenue During the pandemic, Region county. Above all, it is the restriction of security. During the summer, exit Stockholm has worked actively to public gatherings that has had checks started on all modes of trans- support the regional business commu- far-reaching consequences for the port, so that the checks could be carried nity and the labour market. Meetings stakeholders, which has only been out in a safe manner. During the month have been held, and continue to be held, partially offset by various forms of of October, ticket checks on board all with business stakeholders in the region support measures. In the spring of rail transport commenced during in which both politicians and officials 2020, it was decided that funds off-peak hours. participate. Among other things, a intended for cancelled events would not In March, the Transport Committee number of digital meetings have been be reclaimed, at the same time as a call decided to keep the front doors on buses held, and at the same time at the for cultural support was being made. closed whilst in service. The installation regional level, we have joined forces of perspex screens by the driver’s seat in with the County Administrative Board Digitalisation buses began in December, starting in in Stockholm to mobilize and get an Collaboration, coordination and new Norrtälje. This enabled a return to overview of developments. working methods, where digitalisation boarding through the front doors and Reports on the situation in the has been developed, and healthcare thus the return of revenue security in Stockholm region’s business commu- operations have developed rapid chan- bus operations. The rollout continued nity and the labour market have been nels for communicating with patients, gradually at the various depots. In Octo- compiled on a weekly basis due to as well as initiatives with municipalities ber, the Transport Committee also COVID-19. The reports have contained and other stakeholders, have been informed the general public that every- facts and statistics regarding the absolutely crucial for Region Stock- one must have a valid ticket on buses, situation in various industries, bank- holm’s handling of the pandemic. and subsequently started charging ruptcy statistics, redundancy notifica- During the year, the Regional additional fees a week or so later to tions and unemployment, as well as Management Office worked to create those who did not have an activated information on regional and national conditions for other parts of the system travel card. initiatives. During the COVID-19 to be able to focus on their core tasks. At the end of December, the Swedish pandemic, the weekly report, COVID- This included participating in and Public Health Agency decided on a new 19: Business in the Stockholm Region, supporting the Regional Special

Significant events Annual Report 2020 11 Healthcare Management on IT and skills-enhancing measures are broad- tions are ongoing between the parties telephony issues, adjustments in and ened to include areas such as automa- and are expected to be completed in the extensions to agreements with provid- tion and AI, which are now increasingly spring of 2021. ers of common infrastructure and used by Region Stockholm. Examples services, preparing and escalating include image analysis of X-ray images Major property investments in the decisions and being a decision-maker that are being trialled in direct clinical healthcare service for an extraordinary Change Advisory operations, and the health and safety • At Capio S:t Görans Sjukhus, two Board to ensure the highest possible survey using AI at a company where the buildings for somatic care were continuity in healthcare IT support. selection of questions is adapted to the completed, of which one building has Digitalisation has meant that a majority operations. been handed over to the healthcare of all meetings, including the Regional One challenge during the pandemic providers. At the beginning of the Council meetings, have been held has been that there has been no solution year, the entrance area to the adult digitally. for electronic signatures in place. Work Accident & Emergency department The accelerated digitalisation has has commenced to urgently develop a was opened. meant opportunities for improvements solution. Some companies have pointed • At Södersjukhuset a new adult in quality as well as efficiency. However, out that the pandemic has also had Accident & Emergency department, in line with the intentions in the IT and some adverse consequences for digitali- including an ambulance station, was digitalisation strategy, RS 2019–0669 sation. These include planned infra- completed and put into service in and RS 2019–0829, increased collabo- structure improvements or system June. ration, consolidation and improved changes that have had to be postponed. • Complete renovation of Sollentuna digital skills are required for Region The law on accessibility to digital Hospital was completed in April and Stockholm to fully achieve the desired public services has come into force. The the hospital now has geriatric care effects of digitalisation and AI. overall assessment is that most of and specialist care. In January, a new The pandemic has put tremendous Region Stockholm’s operations work local emergency clinic was opened at pressure on Region Stockholm, and with accessibility issues, but an the hospital. digital solutions for managing patient increased focus is needed to fully live up care have often been the only sustaina- to the legal requirements. The rapid Major investments in ble alternative for maintaining socially introduction of new working methods public transport important activities and minimizing also had other positive effects, such as • The first service tunnels in the Under- the spread of infection. The focus has reduced travel and, as a result, lower ground network to Barkarby were been on maximizing the benefits of emissions. completed and were given their final services that were in place even before inspection. the pandemic: Major investments • Most allocations have been made for • “Alltid öppet” has gone from 94 to 550 The development of accessible health- service tunnels within the expanded connected units within Region care continued in 2020, including Underground network, for example Stockholm and Region Gotland. rebuilding of and extensions to the Hammarby fabriksväg and Haga­ • The number of chats on “Alltid öppet” region’s healthcare properties. The staden. has increased by just over 1,200 expansion of the Underground network • The Underground to Arenastaden has percent. and Light Rail network, as well as the obtained a legally binding railway • The use of e-services on 1177.se has improvement of Roslagsbanan and the plan and the depot in Högdalen has increased to 2.6 million logins. Red Line, are examples of investments obtained an environmental permit. • The number of video consultations in to ensure a well-functioning public • The allocation of the track and service primary care increased by 1,094 transport sector in a growing Stockholm tunnel from Kungsträdgården and percent. Region. the allocation of the construction • The capacity for home workplaces Stricter national requirements, contract for Sofia station has been increased from 2,000 to 30,000 especially concerning the environment reviewed. concurrent users. and safety, mean that new cost esti- • The new Underground train, C30, • The digital collaboration platform mates for the expansion of the Under- was put into service on the Under- Teams had a major impact in all ground network exceed the agreed cost ground’s Red Line. Ten carriages have administrations and companies. ceiling. Since the autumn of 2019, been delivered, which means that five Region Stockholm, together with the full-length trains can be run. One consequence of the transition to relevant municipalities, has been • Delivery and commissioning of the remote working is that employees have petitioning the government regarding a new A35 train for the Light Rail rapidly increased their basic digital joint proposal for a solution for addi- network. skills, which is a prerequisite for taking tional financing based on the same cost • Upgrades of the C20 Underground the next step in digitalisation. It is of distribution as the original agreement. trains have been approved for serial considerable importance that the On November 20, 2020, the govern- production. All 271 carriages will be investments that have already begun in ment appointed a negotiator. Negotia- modernized by 2023.

12 Annual Report 2020 Significant events • Roslagsbanan’s new Vallentuna depot selling expenses amounted to minus Safety Commission has been given its final inspection. SEK 9 million. In addition, the decon- Region Stockholm has set up a safety • Kista and the Solna section on the tamination costs of SEK –265 million commission, as safety and security are Light Rail network have been con- were added. In total, this corresponded priority issues. The Safety Commis- nected. to a capital gain of SEK 422 million. The sion’s mandate is to shed light on how inner city depot in Hornsberg will be the region can take initiatives to Sale of property replaced by the Tomteboda bus depot in increase the perceived level of safety in In March 2020, the Regional Council Solna. the Stockholm region, both in the short decided on the sale of Bromma Hospital. and long term. The work is being carried The sales price amounted to SEK 570 Karolinska University out together with municipal, regional, million. Book values and selling Hospital – the world’s tenth state, private and civic stakeholders. expenses amounted to SEK –132 mil- best hospital The Commission will monitor and lion, which gave a capital gain of SEK According to a ranking published in the take part in regional analyses, as well as 438 million. Thus, the sale from the magazine Newsweek in early March, national and international research, to County Council’s 2018 budget was Karolinska University Hospital was propose specific measures that can be completed. Purchase contracts have ranked the tenth most distinguished implemented by the region. The Com- been signed and conditioned with hospital in the world. The ranking mission shall propose specific measures requirements that oblige the buyer to included hospitals in 20 countries and to strengthen safety in the region and continue to carry out geriatric inpatient is based on a weighting of medical will submit a final report by November care on the premises to at least the same results, patient-reported quality/ 30, 2021. extent as today. experience, and recommendations from In July 2020, the sale of the depot doctors, other healthcare professionals property in Hornsberg was completed, and managers in the healthcare sector. in accordance with an agreement with Tens of thousands of healthcare work- the City of Stockholm, to the amount of ers in the 20 countries were selected to SEK 696 million. Book values and answer questions online.

Significant events Annual Report 2020 13 3 The Regional Group

14 Annual Report 2020 The Regional Group Contracting companies Contracts Region Stockholm is organised into a A contracting company is a legal entity Region Stockholm’s contracts are number of committees and subsidiaries to which Region Stockholm has trans- operations conducted by another legal assembled into two corporate groups. ferred a certain matter in accordance entity than the committees and compa- In Norrtälje, healthcare services and with the Local Government Act. These nies included in the regional group. social care are provided through a local companies are only included in the Region Stockholm’s transport opera- government federation in collaboration regional group’s income statements and tions are conducted 100 per cent by with Norrtälje Municipality. The table balance sheets when any paid contribu- external contractors, while 38 per cent below lists the committees and compa- tions are reported as an expense in the of healthcare services are carried out by nies that are included in Region Stock- income statement. The following external healthcare providers. holm’s operation and the consolidated summary includes the main contracting accounts for 2020. Region Stockholm’s companies. holdings are shown in brackets.

The Regional Group

The Region Group companies, etc.

Regional Council, committees and Landstingshuset i Stockholm AB AB Storstockholms lokaltrafik boards (100%) (100%) • The Regional Executive Committee • Södersjukhuset AB • SL Infrateknik AB • The Healthcare Committee • Danderyds Sjukhus AB • AB SL Finans • The Healthcare Service Steering – Barnbördshuset Stockholm AB (49%) • SL Älvsjö AB Committee • Södertälje Sjukhus AB • Waxholms Ångfartygs AB • The Patient Advisory Committee • S:t Eriks Ögonsjukhus AB • Stockholm County’s Healthcare Area, • Folktandvården Stockholms län AB The local government federation SLSO • Ambulanssjukvården i Storstockholm AB Sjukvård och omsorg i Norrtälje • Karolinska University Hospital • Stockholm Care AB (50%) • The Transport Committee • MediCarrier AB • Tiohundra AB • The Mobility Service Committee • Locum AB • The Culture Committee – AB Terreno • The Growth and Regional Planning • AB Stockholms Läns Landstings Internfinans Committee • The Property and Service Committee • The Audit Board

Contracting companies

Co-owned legal entities with material influence8 Co-owned legal entities without material influence Contracting companies • ALMI Företagspartner i Stockholm Sörmland AB (40.5%) • The local federation Avancerad Strålbehandling (14.3%) • Mälardalstrafik AB (35%) • Resekortet i Sverige AB (13.3%) • Samordningsförbund (25%)9 • The local government federation Svenskt Ambulansflyg (22.6%)

8 Refers to co-owned legal entities with holdings exceeding 20 percent. 9 Region Stockholm is part of seven coordinating federations together with Försäkringskassan, Arbetsförmedlingen and the municipalities in the region.

The Regional Group Annual Report 2020 15 Organisational changes Stockholm Care AB’s operations Organisational changes regarding the care of foreign patients implemented in 2020 will be transferred on January 1, 2021 to The Property and Service Committee is Karolinska University Hospital. The responsible for Region Stockholm’s main focus for Stockholm Care AB as of properties, including transport facili- 2021 is to manage the Tobias Registry. ties, and for regional service functions. Region Stockholm and the City of During the year, the work on continuing Stockholm collaborate to support film to build the committee’s service opera- production in the region through a tions has been ongoing, and with a regionally-owned company. In addition certain time lag, planned operational to better conditions for film production, transitions have been implemented. In this means a clearer division of respon- February, the first part of the account- sibilities and more efficient use of ing function moved from Stockholm resources, while at the same time County’s Healthcare Area to the service contributing to the county’s attractive- administration. In June, the Financial ness for the creative industries. The Data and Digitalisation operations were new company will be a subsidiary of transferred from the Regional Manage- Lands­tingshuset i Stockholm AB and ment Office to the administration, and operations are planned to commence in in September operations within payroll the spring of 2021. management and systems management A new committee for the environ- moved from Karolinska University ment, sustainability and the climate Hospital to the service administration. will be established in Region Stockholm from the first of July 2021. Upcoming operational changes During the year 2020, work has been underway to draft the necessary deci- sions and prepare for future operational changes.

16 Annual Report 2020 The Regional Group

Governance and follow-up of regional 4 operations

17 Annual Report 2020 Region Stockholm’s work with goals, tives and ensure that they are in line and a target value has been set for each planning, follow-up, analysis, measures with the municipal powers. indicator. The annual target values ​​are and internal control is founded on a The overall assessment of the set on the basis of the prevailing overall common basis, which is summarized in Regional Management Office is that conditions and on the basis of the level to the policy Integrated Management and all committees and companies have be achieved for each year. Governance, ILS, RS 2020–0740. conducted activities that comply with The targeted goals and operational The governance model constitutes a the municipal objectives. goals are presented in Chapter 5. The whole, with which Region Stockholm can committee-specific goals for healthcare, analyse compliance with the council’s Compliance with ownership public transport, regional development, goals, finances, quality and sustainabil- directives culture and structured governance are ity in its operations. In Region Stock- Ownership directives are a tool for the reported under each committee respon- holm’s budget, the Regional Council owner’s, i.e. the Regional Council’s, sible for them. The indicators to be establishes vision, targeted goals, opera- long-term strategic governance of the followed up in the annual report, and tional and committee-specific goals, companies. The ownership directives are which the Regional Council has decided as well as indicators that measure goal determined annually in connection with that the committee or company should fulfilment. ILS covers the entire Region budget, and contain specific rules, aim for, are reported under each com- Stockholm Group, i.e., all committees requirements and mandates for the mittee and company. and companies companies. The Regional Council determines the Region Stockholm is governed by the The companies did not report any direction for the operations, its financial Regional Council, which decides on significant deviations from the estab- conditions, goals and priorities, and Region Stockholm’s main policy docu- lished ownership directives during the gives the committees and company ment, the budget for Region Stockholm. fiscal year 2020. The Regional Executive boards mandates concerning implemen- All committees and companies have Committee’s assessment corresponds tation, investigations and analyses. The an independent responsibility for ensur- with the companies’ own reporting. mandates are one of the council’s meth- ing that the Regional Council’s decisions ods for directing the operations so that it are implemented within the allocated Goals and mandates achieves Region Stockholm’s goals. framework and in accordance with all The Regional Council has decided upon the governing body’s policy documents. a long-term vision, An attractive and Internal control The Regional Executive Committee is sustainable Stockholm region that is Governance of internal control is based responsible for supervising committees growing, and where the inhabitants on the regulation, Policy for Integrated and companies, which means that they have the freedom to shape their own Management and Governance, must continuously follow up and analyse lives and make important decisions. RS 2019–0829, and the region-wide the work of committees and companies The vision describes Region Stockholm’s guideline for internal control, under the mandates determined by the long-term goals in an overall message. In RS 2019–0866. The requirements for the Regional Council, and ensure that the order to achieve the Regional Council’s work are outlined in the Regional Chief work is conducted within agreed finan- vision, three targeted goals have been set Executive’s instructions prior to the cial frameworks. in the 2020 budget that are common annual operational planning, and for the As part of its supervisory duty, the across the Group. The targeted goals quarterly, interim and annual reports. Regional Executive Committee, in indicate the focus for Region Stockholm Region Stockholm’s committees and connection with the interim and annual during the current term of office, and are companies are responsible for ensuring reports, carries out a follow-up of the as follows: Long-term financial sustaina- that the level of internal control is suffi- committees’ and companies’ ability to bility, Sustainable regional development cient and that operations are conducted accomplish their goals, implement the and Region Stockholm shall be a sustain- in an otherwise satisfactory manner. council’s decisions, comply with policy able employer. This means that operations must be documents as well as the level of effi- In the 2020 budget, the Regional conducted safely, effectively, appropri- ciency of their operations. In the event of Council has also decided on operational ately and within the established financial any deviations, the Regional Executive and committee-specific goals, which frameworks, that reporting must be Committee can request additional specify the targeted goals. The opera- reliable, and that laws, regulations, information, urge committees and tional goals apply to the relevant opera- agreements, policy documents and companies to adopt measures or, in the tions and the committee-specific goals decisions must be complied with. The event of serious deviations, propose that apply to a specific committee. The aforementioned includes working the Regional Council take punitive Regional Council’s indicators were also systematically to anticipate and proac- action. determined in the budget. Indicators are tively manage and communicate risks, the measured values ​​used to assess how opportunities, measures and controls. Compliance with municipal committees and companies fulfil the The joint system support, Stödet, is objectives and powers goals of the Regional Council. For each of used to ensure that the functions work- The articles of association for each the operational and committee-specific ing with risk management, internal company establish the municipal objec- goals, one or more indicators are defined, control, compliance and internal audits

Governance and follow-up of regional operations Annual Report 2020 18 have full access to the information Throughout the year, major efforts have been appointed category responsibility required for adequate internal control. been made to ensure a stable supply of for a number of procurement categories. Region Stockholm’s committees and goods. Parts of the procurement opera- Work has begun in twelve procurement companies regularly conduct follow up tions have been affected by trade categories. to ensure that measures and controls barriers and a global imbalance The Regional Management Office’s are carried out effectively. The report- between supply and demand. Higher summary assessment is that commit- ing of the follow-up was presented in prices and uncertainty in the supply tees and companies have essentially each company’s and committee’s chain have been commonplace in the worked in accordance with procure- interim and annual reports. supply of goods. At times, the procure- ment policies and guidelines. ment organisation has been very Compliance strained and special measures have Code of conduct for suppliers Region Stockholm works continuously been needed to secure the region’s Region Stockholm’s work on compli- to monitor and improve compliance purchases. ance with the code of conduct for suppli- with regulations. Region-wide meas- Despite the considerable focus on the ers is carried out by identifying risk ures to strengthen regulatory compli- supply of goods, committees and areas, setting requirements and follow- ance have been implemented in several companies have carried out almost as ing up on selected suppliers. During the areas, which are presented below. much local procurement as in previous year, Region Stockholm has identified The policy Integrated Management years, a total of 189 procurements. The risk areas linked to coordinated agree- and Governance of Region Stockholm, work on regular procurement has been ments. ILS, RS 2020–0740, states that Region difficult to staff, as many employees During the year, Region Stockholm Stockholm’s group-wide policy docu- with medical expertise have had to followed up on the contractual terms for ments shall contribute to meeting the prioritize patient care. The number of sustainable supply chains regarding goals set by the Regional Council in the coordinated procurements has some suppliers of gloves, as well as IT budget for Region Stockholm. In 2020, decreased compared with 2018 and suppliers. When producing procure- an instruction on policy documents has 2019, and amounted to 34 or 15 percent ment documents related to IT products been prepared that specifies ILS in this of all procurements in 2020. Sustaina- in 2020, the Regional Management part. Furthermore, a review of proce- bility requirements have been taken Office applied an award criterion, which dures, processes and templates for into account in virtually all procure- means that tenderers are rewarded in policy documents has been initiated ments. On only a few occasions has it the evaluation process based on their and will continue in 2021. The work not been possible due to lack of time. work on anti-corruption. aims to clarify how policy documents The number of review procedures in During the year, AB Stockholms are part of political governance, and procurement cases in 2020 was 14. Läns Landstings Internfinans had an how they form the basis for operational Region Stockholm won ten of these, additional focus on following up the planning and follow-up of the operations. which corresponds to 71 percent. banks’ work with money laundering. The number of direct procurements For example, when loans for green Code of Conduct for Region over the direct procurement limit has bonds are implemented, the first choice Stockholm and Guidelines for anti- increased sharply in 2020. Direct for arranging the transaction is a bank corruption, travel and entertainment procurements have been necessary and that has been deemed to maintain an In 2020, several measures had been have been carried out on the basis of the approved level in its own sustainability planned regarding the Code of Conduct exceptions for formal procurement that work. for Region Stockholm, LS 2017–1198, exist due to the pandemic. and guidelines for anti-corruption, Based on the experience with the Whistleblower function travel and entertainment, RS 2020– supply of goods during COVID-19, the Since 2019, there has been a whistle- 0266, including training in committees Regional Council in 2020 set targets for blower function, which the Regional and companies with a focus on corrup- the stocking of protective equipment at Executive Committee is responsible for, tion. Proposals for new guidelines on healthcare-producing committees and to which all elected representatives and anti-corruption, travel and entertain- companies, as well as at MediCarrier AB. employees in Region Stockholm can ment was prepared and sent for review An amendment to the ownership report serious misconduct. This is to committees and companies in 2020. directive for MediCarrier AB has also carried out through a web-based The responses from the consultation been decided upon in order to clarify service that is accessed via the intranet process have been taken care of and a the company’s responsibility for conti- and the whistleblower can choose to final proposal will be decided by the nuity in the supply of goods. Overall, the remain anonymous. A reception group Regional Council in the spring of 2021, changes are expected to contribute to a consisting of the General Counsel, HR in accordance with the schedule. more robust supply of goods. Director and Chief Compliance Officer In May 2020, the Regional Council at the Regional Management Office Procurement policy and guidelines decided on a plan for the introduction reviews each whistleblower report and The procurement year 2020 has largely of category-driven procurement, assesses what measures need to be been dominated by COVID-19. RS 2019–1148. Five committees have taken in individual cases.

19 Annual Report 2020 Governance and follow-up of regional operations In 2020, 61 reports were received by the central whistleblower service. A quarter of the reports concerned issues related to the COVID-19 pandemic. Most reports contained views on how different issues were being handled and how managers were acting in different operations, which should primarily be handled within the scope of the relevant operation and be a matter for the senior manager or the HR function. We find that reports have also been received where serious suspicions have been directed at individuals regarding corruption-related crimes or other serious cases of negligence. Upon investigation, it has not been possible in any of the cases to verify any of the allegations of irregularities or serious misconduct that were made. None of the reports or investigations have led to the filing of a police report. In some cases, measures have been taken in the rele- vant operations to remedy the problem reported.

Governance and follow-up of regional operations Annual Report 2020 20 Good financial management and financial position

Region Stockholm shall have good financial 5 management over several budget periods in order to ensure financial stability, while the county’s inhabitants have accessible healthcare of a high quality, and reliable public transport.

21 Annual Report 2020 In accordance with the Policy for Good impact from COVID-19 must be taken target value. A target is considered met Financial Management, RS 2020– into account as Region Stockholm in if more than half of the indicators are 0449, Region Stockholm’s budget must 2020 has been in a crisis situation that met. Out of the number of measurable contain long-term financial goals and to varying degrees has affected the indicators, about 60 percent have operational goals that are essential for operations’ ability to achieve the set achieved their target value and about 40 good financial management. goals. The pandemic has mainly had an percent have not achieved their target In the 2020 budget for Region adverse impact on goal fulfilment. Out value. Stockholm, the Regional Council has of a total of 112 indicators, 22 indicators The overall assessment is that decided on targeted goals, operational could not be measured. Three have not Region Stockholm met the require- goals and committee-specific goals. For been assessed, which means that 87 ments for good financial management the goals, one or more indicators are indicators have been followed up for in 2020 when all targeted goals were defined with a target value to be 2020. Overall 51 indicators have fulfilled. In 2020, Region Stockholm’s achieved by the end of December 2020. achieved their target value, operations have actively worked to When assessing goal fulfilment, any 36 indicators have not achieved their achieve the Regional Council’s goals.

Overall goals, targets and indicators

Targeted goal Long-term financial sustainability Fulfilled●

Operational goal A balanced result Fulfilled● Operational goal Self-financing of operations and replacement investments Fulfilled● Operational goal Sustainable investments Fulfilled●

Targeted goal Sustainable regional development Fulfilled●

Committee-specific goal High quality healthcare services Not fulfilled● Committee-specific goal Attractive public transport in a sustainable transport system Fulfilled● Committee-specific goal Regional development planning for sustainable growth 1 Committee-specific goal Free culture for experiences, meetings, education and inclusion Partially fulfilled● Committee-specific goal Achieve structured governance of Region Stockholm’s operations Not fulfilled● Operational goal Social sustainability Partially fulfilled● Operational goal Region Stockholm’s climate impact shall be reduced Fulfilled● Operational goal Region Stockholm’s environmental impact shall be reduced Fulfilled● Operational goal Socially important functions maintained in the event of extraordinary events and Fulfilled● climate change Operational goal Core operations shall be prioritized 1 Operational goal High degree of innovation and digitalisation Fulfilled● Operational goal One of Europe’s leading research regions within research aimed at improving health Fulfilled● Operational goal Contributes to a transport-efficient society in the Stockholm region Partially fulfilled● Operational goal The Stockholm region shall be Europe’s most attractive growth region Fulfilled●

Targeted goal Region Stockholm shall be an sustainable employer Fulfilled●

Operational goal Region Stockholm – attractive employer Fulfilled● Operational goal Systematic skills supply Fulfilled●

1) It has not been possible to assess whether the goals were achieved in 2020 as too few indicators were measurable.

Good financial management and financial position Annual Report 2020 22 Long-term financial Out of Region Stockholm’s 24 com- Landstingshuset i Stockholm AB to sustainability mittees and companies, the Transport influence. Adjusted for the impairment, A long-term sustainable economy is a Committee, Stockholm Care AB and Landstingshuset i Stockholm AB prerequisite for Region Stockholm to be Landstingshuset i Stockholm AB reported a result that exceeds the able to deliver services to its inhabitants reported a negative result compared budgeted result. Adjusted for these in the short and long term to which the with the budgeted profit requirement. items, the Transport Committee, goals relate. Region Stockholm shall be The Transport Committee’s deficit can Stockholm Care AB and Landstingshu- able to carry out both ongoing and be explained by lower ticket revenue as set i Stockholm AB are deemed to have planned investments and manage the a result of the COVID-19 pandemic. met their profit requirements.The increased operating and capital costs Stockholm Care AB’s result was nega- percentage of profit centres that report that the investments entail, as well as tively affected by a reduction in the results in accordance with profit manage future financial commitments number of foreign patients as a result of requirements thus amounted to 100 in the form of pension payments. the pandemic, as well as impairment of percent and the indicator’s target value The targeted goal on long-term assets in connection with the transfer of was achieved for 2020. financial sustainability has three care for foreign patients to Karolinska In 2020, the pandemic led to the operational goals: A balanced result, University Hospital. The financial government changing the conditions for Self-financing of operations and effects of the pandemic are exempt from a number of government grants, and also replacement investments, and Sustain- the assessment of the profit require- to easing the reporting requirements. able investment development. The goal ment in accordance with a decision by Planned operations have also been was achieved for 2020 when all opera- the Regional Council, RS 2019–1041. affected by the pandemic, which has tional goals were achieved. The impairment cost in Stockholm Care entailed that work on certain govern- AB is due to a change in operations and ment grants has been delayed. In 2020, A balanced result is thus not comparable with the budg- government grants were also received The indicator of A positive result in eted profit requirement. The negative to compensate for additional costs as a accordance with the balance require- budget deviation for Landstingshuset i result of the COVID-19 pandemic. The ment, excluding switching costs and Stockholm AB can be explained by distribution of government grants capital gains, amounted to SEK 5,092 impairment in the value of the shares in linked to the COVID-19 pandemic is the million, which is higher than the target the subsidiaries. The valuation of the responsibility of the Regional Executive value of SEK 634 million. The indicator shares is based on the subsidiaries’ Committee. Throughout the year, achieved its target value for 2020. equity and is thus not possible for structured work was carried out to

Outcome Outcome Target Goal 2020 2019 value 2020 fulfilment

Long-term financial sustainability Fulfilled●

A balanced result Fulfilled● A positive result in accordance with the balance requirement1) MSEK 5,092 MSEK 1,723 MSEK 634 Fulfilled● Percentage of profit centres that provide results in accordance with the profit requirement 100% – 100% Fulfilled● Percentage of government grants applied for that have been utilized 100% – 100% Fulfilled● Self-financing of operations and replacement investments Fulfilled● Self-financing of operations and replacement investments 100% 100% 100% Fulfilled● Sustainable investments Fulfilled●

Percentage of capital expenses2) out of Region Stockholm’s total revenue. 7.0% 7.0% ≤ 8.7% Fulfilled● Percentage of interest-bearing liabilities out of total revenue 43.1% 49.0% ≤ 65% Fulfilled● Percentage of investments where implementation decisions have been preceded by one total financial assessment with total cost calculation 100% – 100% Fulfilled● Percentage of investments where implementation decisions have been preceded by action choice analysis 95% – 100% Not fulfilled● Percentage of implemented investments where determined impact targets have been evaluated N/A – 100% –

1) Refers to the result excluding switching costs and capital gains. 2) Capital costs refer to depreciation costs and interest charges from leasing and borrowing as well as to other corresponding liabilities.

23 Annual Report 2020 Good financial management and financial position secure government support, as well as have been preceded by a total financial healthcare services, the result for the to systematically follow up the financial assessment with total cost calculation, period amounted to SEK 5,949 million. effects of the pandemic for committees Percentage of investments where The deviation can largely be and companies in order to be able to implementation decisions have been explained by one-off effects such as manage and minimize them. The preceded by action choice analysis, and lower pension costs, higher capital indicator for the percentage of govern- Percentage of implemented invest- gains and government grants. Depreci- ment grants applied for that were also ments where determined impact ation costs and interest charges are also used amounted to 100 percent, and targets have been evaluated include lower than budget and are due to a lower reached its target value for 2020. investments decided upon by commit- work-up rate in investment projects. tees, companies or higher decision- The main reason for the lower work-up Self-financing of operations and making bodies during the period for rate is the COVID-19 pandemic’s effects replacement investments Investments guideline, RS 2019–0867. on property investments in healthcare The cash flow analysis shows that The Investments guideline has been in and the postponement of major invest- Regions Stockholm’s cash flow from force since November 2019 and has ments in public transport. operating activities exceeds operating entailed that implementation decisions The total cost for the period, which costs and investment expenses in 2020. in 2020 have been made in accordance includes operating costs, depreciation The indicator Financing of Region with the previous investment strategy, and financial expenses, amounted to Stockholm’s operating costs and LS 1407–0854 and the investments SEK 108,975 million. This corresponds replacement investments shall be done guideline, RS 2019–0867. This has to a cost of increase of 3.8 percent in within the Group’s cash flowhas been resulted in one of the indicators being comparison with the corresponding achieved for 2020. met, one not being met, and one not period last year. With the exception of being possible to measure. additional costs for COVID-19, the costs Sustainable investments were unchanged compared with 2019. The indicator, The cost of capital as a Result The low cost increase, excluding addi- percentage of Region Stockholm’s total Region Stockholm reported a result for tional costs for COVID-19, is partly due revenue, amounted to 7.0 percent for 2020 of SEK 5,802 million, which to the fact that operations have not been 2020. The indicator’s target value has corresponds to a surplus of SEK 2,426 able to be carried out to the extent been achieved for 2020. per inhabitant. The result exceeded the planned due to the pandemic, and that The indicator, Interest-bearing budget for the year by SEK 5,490 pension costs have decreased. The liabilities as a percentage of total million. The deviation corresponds to budgeted cost increase for the year revenue amounted to 43.1 percent. The 5.0 percent of the budgeted turnover for amounted to 3.8 percent. indicator’s target value has been the year. Compared to 2019, the result In the Annual Accounts for 2020, achieved for 2020. increased by SEK 4,305 million. Exclud- Region Stockholm set aside SEK 3,247 The indicators Percentage of invest- ing switching costs relating to restruc- million for a Profit Equalization ments where implementation decisions turing within the scope of future Reserve, RUR, which creates additional

Result Result Budget Deviation from Deviation in Result MSEK 2020 2020 to budget percent 2019 Operating revenue 29,794 25,842 3,951 15.3% 25,036 Operating costs –100,011 –99,232 –779 –0.8% –96,220 Depreciation –6,589 –6,969 380 5.5% –6,201 Operation’s net expenditure –76,806 –80,359 3,552 –4.4% –77,385 Tax revenue 77,392 78,230 –838 –1.1% 76,044 General government grants and equalisation 7,514 5,161 2,353 45.6% 5,374 Operating result 8,099 3,032 5,067 4,033 Financial revenue 78 60 17 28.8% 68 Financial expenses –2,375 –2,781 406 14.6% –2,604 Result after financial items 5,802 311 5,490 1,497 Extraordinary items 0 0 0 0 Result for the year 5,802 311 5,490 1,497 Of which switching costs –147 –323 176 54.3% –226 Result excluding switching costs 5,949 634 5,315 1,723

Good financial management and financial position Annual Report 2020 24 means for handling future adjustments negative results compared with accounts for 74 percent of the total linked to the pandemic. budgeted results. The deviation is due to revenue. Other major sources of reve- The largest negative budget devia- the effects of the COVID-19 pandemic, nue refer to ticket revenue from public tion was reported by the Transport as well as to Stockholm Care AB’s transport and specially designated Committee, and refers to a decrease in impairment of fixed assets in connec- government grants. ticket revenue as a result of reduced tion with the transfer of operations to Region Stockholm’s main expenses travel during the pandemic. Govern- Karolinska University Hospital. are personnel costs, which account for ment grants for decreased ticket reve- Other committees and companies 31 percent of total expenditure. Pur- nue within public transport only cover reported a result at a level equal to or chased healthcare services account for about a third of the reduction in revenue higher than the budgeted result. 22 percent of total expenditure, and in 2020. Region Stockholm’s main revenue purchased transportation accounts for Stockholm Care AB also reported comes from total tax revenue, which 13 percent.

Revenue 2020

Government grants and other grants Other revenue MSEK 13,346 (12%) MSEK 2,979 (2%)

Rental income, sale of other services MSEK 4,363 (4%)

Sales of primary services MSEK 2,353 (2%)

Patient fees MSEK 1,204 [1%) Total tax revenue MSEK 84,905 (74%) Ticket revenue MSEK 5,549 (5%)

Costs 2020 Depreciation MSEK 6,589 (6%) Net financial expenses MSEK 2,297 (2%) Other expenses MSEK 6,542 (6%) Cost of premises MSEK 3,538 (3%) Personnel costs Contributions paid MSEK 33,507 (31%) MSEK 1,799 (2%) Other supplies and goods MSEK 7,702 (7%)

Pharmaceuticals MSEK 5,352 (8%)

Purchased public Purchased healthcare services transport services MSEK 23,874 (22%) MSEK 14,697 (13%)

Additional costs and reduced revenue 2020 Increased Reduced Granted MSEK additional costs* revenue government grants Total Healthcare service, total –4,063 –670 3,708 –1,025 Public transport, total –172 –3,895 1,332 –2,736 Properties and service, total –43 –86 0 –129 Other committees and companies –37 0 0 –37 Total for all profit centres –4,315 –4,651 5,040 –3,926

* Amounts also include investment expenditure of SEK 227 million.

25 Annual Report 2020 Good financial management and financial position Financial consequences as a re- revenue and compensation from the Revenue and expenditure sult of the COVID-19 pandemic government have affected Region Operating revenue COVID-19 has affected the Region Stockholm’s committees and compa- Operating revenue amounted to Stockholm finances with increased nies negatively to the amount of SEK SEK 29,794 million, which exceeded the costs, reduced revenue, additional –3.9 billion. Public transport had a budget by SEK 3,951 million and corre- grants and lower costs. negative impact amounting to a total of sponds to an increase of 15.3 percent. Additional costs within healthcare SEK –2.7 billion. The corresponding Patient fees were SEK 125 million have largely been financed with grants figure for the healthcare service amounts lower than budget, which corresponds from the government. Additional costs to SEK –1.0 billion. Other committees to 9.4 percent of budgeted patient fees. for the month of December have so far and companies, such as property and The largest decrease in revenue not been reimbursed. As for reduced service, have had a total negative impact pertains to passenger revenue within revenue within healthcare, it will not be amounting to SEK –0.2 billion. public transport, which decreased by covered by the government. The region In addition to additional costs and SEK –3,930 million and is due to has had lower costs due to deferred loss of revenue, the result has also been reduced ticket revenue as a conse- medical care due to COVID-19. affected by lower costs for e.g. pur- quence of the pandemic. The decrease Public transport has mainly experi- chased public transport services and in revenue corresponds to 41.5 percent enced reduced ticket revenue and has contributions paid, which all in all of budgeted passenger revenue. not received full compensation for this. amounted to SEK 1.3 billion. Government grants partially compen- The result for public transport is partly During the year, Region Stockholm sated for reduced revenue within public offset by the fact that the costs for also received compensation for sick pay transport and are included in the purchased services have been lower, in costs and furloughing linked to COVID- forecast for government grants to the total the Transport Committee reported 19, which amounted to SEK 0.4 billion. amount of SEK 1,332 million a negative result compared with the As a consequence of the pandemic, Sold primary services for out-of- budgeted result of SEK 1.5 billion. the Regional Council decided that county care and dental care decreased In total, COVID-19 had a negative committees and companies may by SEK 579 million compared with impact on the result for Region exclude the impact of COVID-19 when budget, which mainly consists of Stockholm to the amount of SEK –2.2 assessing whether they have achieved reduced out-of-county care of approxi- billion. As it was not possible to carry their budgeted profit requirements in the mately SEK 270 million and dental care out non-­essential medical care during 2020 annual accounts, RS 2019–1041. of approximately SEK 50 million. The the year due to the pandemic, deferred The decision does not cover the Culture deviation corresponds to 19.7 percent of medical care has had a positive impact Committee, the Growth and Regional the year’s budgeted amount. The on the result in 2020, despite reduced Planning Committee, the Property and decrease in revenue is a consequence of revenue and additional costs as a result Service Committee, Landstingshuset i the effects of COVID-19. of the pandemic. Instead, deferred Stockholm AB, Locum AB, AB Stock- Government grants increased medical care will be managed over the holms Läns Landstings Internfinans, sharply in comparison with budget, coming years, which will also have a and the local government federation mainly due to compensation for addi- negative impact on the result in the Sjukvård och omsorg i Norrtälje. tional costs linked to COVID-19. In future. total, targeted government grants have In total, additional costs, reduced increased by SEK 7,557 million, which

Operating revenue Result Budget Deviation compared Deviation in Result MSEK 2020 2020 to budget percent 2019 Patient fees health and dental care 1,204 1,329 –125 –9.4% 1386 Passenger revenue 5,549 9,479 –3,930 –41.5% 8972 Sales of primary services* 2,353 2,932 –579 –19.7% 2451 Rental income, sale of other services, material, goods 4,363 4,590 –228 –5.0% 4345 Government grants and other grants 13,346 5,789 7,557 130.5% 6,355 Other revenue 2,978 1,723 1,255 72.8% 1,527 of which items affecting comparability 1,129 67 Total operating revenue 29,794 25,842 3,951 15.3% 25,036

* Primary services comprise sold healthcare services, dental care and the sale of other primary services.

Good financial management and financial position Annual Report 2020 26 corresponds to 130.5 percent of budg- sponds to 1.8 percent in comparison with Payments for municipal equalisation eted government grants. The largest the budget. Compared with the previ- increased by SEK –0.6 billion compared items in the result consist of compensa- ous year, the increase was 4.3 percent. with 2019. Compared with the previous tion for additional costs in the health- The tax base for the year has devel- year, the cost of the equalisation system care service as a consequence of oped at a slower pace than planned as a has thus increased by 57.5 percent. COVID-19 of SEK 3,708 million, and consequence of the pandemic, which compensation for reduced ticket reve- meant that tax revenue was SEK 838 Operating costs nue within public transport of SEK million lower than budgeted. The Operating costs for 2020 amounted to 1,332 million. Also targeted govern- deviation from the budget corresponds SEK –100,011 million, which exceeded ment grants for “Kömiljarden” of SEK to 1.1 percent of budgeted tax revenue. the budget by SEK –779 million and 720 million, as well as grants for Compared with the previous year, tax corresponds to an increase of 0.8 percent. COVID-19 testing of SEK 1,434 million, revenue has increased by 1.8 percent. Personnel costs and costs for hired have contributed to the increase in In 2020, general government grants personnel were SEK 1,193 million lower government grant revenue. increased by SEK 2,280 million, partly than budget, which corresponds to 3.4 Sales revenue from property sales of by approximately SEK 500 million as a percent of the budget. The lower cost is Bromma Hospital and the Hornsberg result of Parliament’s and the Govern- due to the fact that pension costs are bus depot are included in the revenue to ment’s decision on the “welfare billions”, approximately SEK 2,200 million lower the amount of SEK 1,266 million and is and partly by approximately SEK 1,700 than budget. Excluding the lower included in the other operating revenue. million in increasing tax revenue as a pension costs, the result is negative consequence of the COVID-19 pandemic. compared with the budget. The budget Tax revenue, general government The deviation from the budget corre- deviation refers to the healthcare grants and equalisation sponds to 33.3 percent of the budgeted service and can be explained, among Tax revenue, general government grants general government grants. Compared other things, by a greater percentage of and equalization amounted to a total of with the previous year, general govern- full-time equivalents than budgeted, SEK 84,905 million, which exceeded the ment grants have increased by 42.6 increased costs for overtime, and budget by SEK 1,515 million and corre­- percent. Emergency Agreements for intensive

Tax revenue, general government grants and equalisation Deviation Outcome Budget compared Outcome MSEK 2020 2020 to budget 2019 Change Tax revenue 77,392 78,230 –838 76,044 1.8% General government grants 9,132 6,853 2,280 6,402 42.6% Equalisation system –1,619 –1,692 73 –1,028 57.5% Total 84,905 83,391 1,515 81,418 4.3%

Change compared to previous year, MSEK 3,487 1,972 3,671 Change compared to previous year, percentage 4.3% 2.4% 4.7%

Tax rate 12.08 12.08 12.08

Operating costs Deviation Result Budget compared Deviation in Result MSEK 2020 2020 to budget percent 2019 Staff expenditure and hired staff –33,507 –34,700 1,193 –3.4% –34,669 Purchased healthcare services –23,874 –21,980 –1895 8.6% –22,633 Purchased transport –14,697 –15,546 849 –5.5% –14,558 Pharmaceuticals –8,352 –8,245 –107 1.3% –7,609 Material and goods, etc. –7,702 –5,861 –1,841 31.4% –5,962 Contributions paid –1,799 –2,221 422 –19.0% –1,753 Cost of premises, equipment rentals –3,538 –3,555 16 –0.5% –2,908 Other expenditure –6,542 –7,124 582 –8.2% –6,128 of which items affecting comparability –415 –226 Total operating costs –100,011 –99,232 –779 0.8% –96,220

27 Annual Report 2020 Good financial management and financial position care staff. Most of the factors mentioned have decreased, which is also related to Financial expenses can be attributed to the situation that COVID-19. Financial expenses amounted to SEK has arisen as a result of the pandemic. The cost of purchased public trans- 2,375 million, which is SEK 406 million The cost for hired staff amounted to port services was SEK 849 million lower lower than budget and corresponds to SEK 1,132 million, which is an increase than budget. Which mainly refers to 14.6 percent. The lower financial of SEK 61 million compared with 2019. lower costs within the Transport Com- expenses in comparison with the The negative deviation with the budget mittee. This is due to the fact that the budget are mainly due to lower costs for can be explained by, among other compensation paid to contractors is borrowings, as well as lower interest things, more full-time equivalents than based on paying passengers in 2019, charges for the pension liability. budgeted, increased costs for overtime, owing to the challenge of validating Emergency Agreements for intensive- travel on buses during the pandemic. Switching costs care staff and an increase in holiday pay Also a lower index trend in the agree- Provision for switching costs for the liability due to the limited opportunities ments and the fact that the budget for implementation of future healthcare to take vacation. Most of the factors replacement services did not need to be services amounted to SEK 3,500 mil- mentioned can be attributed to the used has contributed to the lower costs lion. The year’s switching costs situation that has arisen as a result of for purchased public transport services. amounted to SEK 147 million. During the COVID-19 pandemic. The Mobility Service Committee also the period 2015 to 2020, a total of SEK Cost increases in purchased health- reported significantly lower costs for 3,309 million was utilized. Of the care services can be explained by purchased public transport services. provision, SEK 191 million thus remains additional costs attributable to COVID- Supplies and pharmaceuticals and pertains to Karolinska University 19, such as laboratory costs, ambulance exceeded the budget by a total of SEK Hospital, Stockholm County’s health- operations and an increase in digital 1,948 million. The item largely consists care area and Södersjukhuset AB. visits in out-of-county care. The deficit of additional costs that have arisen as a can also be explained by, among other result of the pandemic. Items affecting comparability things, increased costs for the agree- Contributions made mainly in the Items affecting comparability which are ment with Capio S:t Görans Sjukhus, as field of education and other costs within included in the result for 2020 consist well as cost increases for private health- the Regional Executive Committee were of capital gains and switching costs for care providers within psychiatry, and lower than budget. A reduced use of the implementation of future health- the national agreement within forensic consultants had a positive effect on the care services. As in previous years, psychiatry. However, the costs for result of SEK 213 million, which corre- items affecting comparability are purchased external adult dental care sponds to 21 percent compared with 2019. excluded in the assessment of whether

Items affecting comparability Outcome Outcome MSEK 2020 2019 Under operating revenue: Capital gains 1,129 67

Under operating costs: Switching costs –147 –226 Expenses for the sale of property –268

Below net financial income/expense: Interest rate change pension liability – –667 Total items affecting comparability 714 –826

Result as per balance requirement Outcome Budget Outcome MSEK 2020 2020 2019 Result as per income statement 5,802 311 1,497 Reduction of all capital gains –857 –69 The result for the year after balance requirement 4,945 311 1,428 adjustments Provision of funds for profit equalization reserve –3,247 0 Balance requirement 1,698 311 1,428

Good financial management and financial position Annual Report 2020 28 committees and companies have The Local Government Act requirement specify healthcare, public transport, achieved their budgeted result. for balanced finances was thereby regional development planning, culture fulfilled in 2020. The balance require- and structured governance, and are Balance requirement ment allows a provision for a profit reported under the each relevant The balance requirement is statutory equalization reserve, RUR, of SEK committee. The operational goals and means that operations must be 3,247 million. specify the work with, among other conducted so that revenue is greater things, sustainability, socially impor- than costs. The result is calculated in a Sustainable regional tant functions, research, innovation balance requirement inquiry based on development and digitalisation, and that core opera- the result for the year, which is adjusted Sustainable development provides the tions must be prioritized. for capital gains and capital losses as right conditions for a growing metro- well as the provision and use of the politan region. Today’s inhabitants and Social sustainability equalization reserve. If the result is future generations of Stockholmers are The operational goal negative, the deficit must be restored the central focus of all activities in Social sustainability was partially with a corresponding surplus within Region Stockholm. achieved for 2020 when one indicator three years. The targeted goal A sustainable was achieved and one indicator was not Region Stockholm reported a posi- regional development has five commit- achieved. tive balance requirement after adjust- tee-specific goals and nine operational Based on their assignment, a total of ment for capital gains. goals. The committee-specific goals 16 out of 24 committees and companies

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Social sustainability Partially fulfilled● The differences in expected life expectancy between different municipalities win the county (RUFS) 3.51) – Reduce Not fulfilled● Percentage of operations that, based on their mandate, have carried out activities in accordance with Region Stockholm’s policy documents within social sustainability 73% – ≥ 60% Fulfilled●

1) Outcome refers to 2019 as data for 2020 are not available.

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Region Stockholm’s climate impact shall be reduced Fulfilled● Energy for operations and property in properties owned by Region Stockholm, kWh/sqm (A-temp) –16% –13% ≥ –9% Fulfilled● Percentage of zero-emission vehicles of the owned and leased vehicles within Region Stockholm’s committees and companies 3.6% 3.3% ≥ 7% Not fulfilled●

The climate impact from emissions of greenhouse gases, tonnes of CO2 equivalents –55% –48% ≥ –49% Fulfilled●

Climate impact from business travel, CO2 equivalents in tonnes –87% –10% ≥ 10% Fulfilled● Percentage of renewable sources in Stockholm County’s energy production (RUFS) N/A – Increase – Percentage of projects in the expansion of the Underground network where measures have been implemented in the construction process with the goal of reducing the projects’ climate impact by at least 25% 7 – ≥ 6 Fulfilled● Percentage of other major construction and civil engineering projects within public transport where measures have been implemented in the construction process with the goal of reducing the projects’ climate impact by at least 15% 2 – ≥ 6 Not fulfilled● Number of new climate-impact reducing requirements that are applied in a standardized manner when procuring materials, products or contracts in construction projects 9 – ≥ 2 Fulfilled● Number of construction projects where measures are implemented in the construction process to reduce the projects’ climate impact 1 – ≥ 1 Fulfilled● Number of new climate-impact reducing requirements that are applied in a standardized manner when procuring materials, products or contracts in construction projects 0 – ≥ 1 Not fulfilled●

29 Annual Report 2020 Good financial management and financial position have identified development needs, and tion of 50 percent by 2021. Emissions of The percentage of zero-emission planned and carried out activities in greenhouse gases have been estimated vehicles of the owned and leased accordance with Region Stockholm’s at 110,000 tonnes of carbon dioxide vehicles within Region Stockholm’s policy documents on social sustainabil- equivalents for 2020, which is less than committees and companies amounted ity. Most committees and companies half of the emissions in 2011. to 3.6 percent and is slightly higher than state that certain activities could not be This is a very positive result that the previous year, which was 3.3 per- carried out due to the pandemic. shows that the measures implemented cent. The indicator did not reach its Good examples of work that has been by Region Stockholm are effective. The target value of seven percent as the reported are that management and result is mainly due to the transition to purchase of new vehicles has not been follow-up of committees’ and compa- renewable energy and energy efficiency prioritized in 2020 due to COVID-19. nies’ compliance with the law on acces- in properties and within public trans- sibility to digital public services has port. The outcome for the indicator Region Stockholm’s environmental begun and the work will continue in Energy for operations and property in impact shall be reduced 2021. Epidemiological analyses have properties owned by Region Stockholm The operational goal Region been performed with a focus on groups (A-temp) has decreased by 16 percent Stockholm’s environmental impact in vulnerable areas. Based on these compared with the base year 2011, shall be reduced was met for 2020, as analyses, health communicators have which achieved both the 2020 target of both indicators were achieved. worked in vulnerable areas to spread a nine percent reduction and the goal in Sustainability requirements have information about COVID-19 in order to the Environmental Programme of a ten been set according to the Plan for reduce the spread of infection among percent reduction by 2021. Sustainable Patient Meals, the most vulnerable groups. A guide for Five new indicators were introduced LS 2017–0128, in all three procure- national minorities and minority during the year with the aim of reducing ments of meal services and food that languages, LS 2016–1524, has been the climate impact of construction pro- were carried out during the year, as well drafted and communicated. Despite the jects. The work has got off to a good as in the procurement that has begun pandemic, the work of putting the start and three out of five indicators and will be completed in 2021 The Convention on the Rights of the Child were achieved, which is considered to indicator Reduction in the percentage into practice has continued by, among be a good result given that the indica- of clothing that is out of stock for more other things, strengthening the rights of tors were established in May 2020. We than 30 days amounted to –12 percent children and young people to partici- are working actively to meet all indica- for 2020. More frequent dialogue pate in their own care. tors. The administration for the expan- between the supplier, contract control- sion of the Underground network has a ler and operations has contributed to Region Stockholm’s climate impact well-established climate programme, the positive result, as has increased shall be reduced and forecasts indicate that imple- internal collaboration and communica- The operational-specific goalRegion mented measures will reduce the cli- tion, as well as improved follow-up. Stockholm’s climate impact shall be mate impact from the expansion pro- Measures to improve the logistics reduced was achieved for 2020 when jects by just over 30 percent. The around clothing and textiles have also seven out of ten indicators were Transport Committee has initiated cli- been implemented and created increased achieved. Three indicators were not mate efforts in 25 projects, two of which conditions for achieving the goal. achieved, and one indicator could not be have target levels in accordance with This year’s work regarding the pro- measured. the indicator in the budget. Locum has curement of meal services as well as The key indicator Climate impact worked to limit the climate impact when textiles, environmentally harmful from greenhouse gas emissions saw a designing the building at Danderyds pharmaceuticals and other environ- reduction of 55 percent compared to Sjukhus. During the year, proposals mental goals, has been carried out in a 2011, which exceeded the target value in were also drawn up for possible climate challenging situation with increased the budget of a reduction of at least 49 reduction requirements for selected demands on protective equipment and percent in 2020, and the goal in the product groups that are expected to be considerable strain on staff within the environmental programme of a reduc- included in future construction projects. healthcare service.

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Region Stockholm’s environmental impact shall be reduced Fulfilled● Sustainability requirements are always set when procuring meal services and food 100% – 100% Fulfilled● The reduction in the percentage of clothing that is out of stock for more than 30 days, compared with the outcome for 2018 –12% – ≥ –10% Fulfilled●

Good financial management and financial position Annual Report 2020 30 Environmental accounting decrease. Overall, we have seen a LS 2017–0129, where measures to The Environmental Statement is based decrease of 55 percent since 2011, and reduce the drug spoilage were also on Region Stockholm’s environmental compared to 1990, emissions are 72 implemented. The percentage of organic programme for 2017–2021, LS 2015– percent lower. Although 2020 was ingredients in patient meals was 44 0092, and includes environmental characterized by special circumstances percent in 2020 and the goal for 2021 is objectives for the healthcare service, that significantly reduced emissions 50 percent. public transport and other forms of from business travel, for example, the For 2020, challenges have been transport, as well as property and figures show that the long-term and noted, including in the target area for infrastructure. It also includes Region dedicated environmental efforts carried environmentally and hazardous chemi- Stockholm’s climate commitment and out by Region Stockholm’s operations cals within public transport. Some the aim to be a leading stakeholder in and companies has had a clear positive healthcare operations have had diffi- terms of sustainable procurement. The result. culty measuring the outcome during the environmental programme contains 15 Important measures that have year in terms of food waste, with no environmental goals which are followed contributed to the large reduction are the total figure for the Stockholm Region up by means of 24 indicators. Some of transition to renewable fuels in public being reported. COVID-19 has meant a these indicators also constitute budget- transport and renewable energy in the heavy burden on the healthcare service, ary indicators. The Environmental region’s properties, as well as energy and many healthcare operations have Statement is based on the implementa- efficiency in properties and transport. therefore not had the opportunity to tion instruction for the follow-up of The calculation of climate impact from work as actively with their environmen- Region Stockholm’s environmental energy consumption is based on a life tal goals concerning pharmaceuticals, programme 2017–2021, LS 2016–1486. cycle perspective, which also includes textiles and food in 2020. The target year for the Environmen- production and distribution. In terms of climate impact and mate- tal Programme is 2021, with no final Energy consumption in properties rial recycling in construction projects, report of target fulfilment being carried has been reduced by 16 percent, which continued development is needed to meet out in 2020; however, a number of the meets the target of a ten-percent reduc- the targets for 2021. However, the work targets, such as energy for property and tion by 2021. The climate impact from has got off to a good start and there has operations, reduced emissions of the use of anaesthetic gases has been a lot of positive results. anaesthetic gases and reduced green- decreased by 53 percent, which exceeds All committees and companies house gas emissions, have reached their the target of a 40-percent reduction by within Region Stockholm are certified target values ​​for 2021 in 2020. As a 2021. The climate impact from Region in accordance with ISO 14001:2015. whole, the year was characterized by Stockholm’s business travel has Further information can be found in good results in many areas such as decreased by 87 percent, which is an the appendix, Region Stockholm’s textiles, the climate, organic food and effect of the COVID-19 pandemic. Environmental Statement 2020 in the energy, despite the fact that our opera- To enable the fulfilment of goals for Regional Executive Committee’s official tions had to handle a challenging and sustainable patient meals, as well as for register RS 2020–0769. unpredictable situation for most of the reduced emissions of environmentally year, which placed great demands on harmful pharmaceuticals, committees Socially important functions the operations’ flexibility. and companies work with the imple- maintained in the event of extra­ The results for the 2020 follow-up of mentation of Region Stockholm’s ordinary events and climate change Region Stockholm’s environmental Plan for Sustainable Patient Meals, The operational goal Maintenance of initiatives show that Region Stockholm’s LS 2017–0128, and the Plan for Phar- socially important functions in the overall climate impact continues to maceuticals and the Environment, event of extraordinary events and

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Socially important functions maintained in the event of extraordinary events and climate change Fulfilled● Percentage of security measures in accordance with Region Stockholm’s management system for information security that have been implemented 63% – ≥ 50% Fulfilled● Percentage of committees and companies that have the ability to handle extraordinary events 80% – 100% Not fulfilled● Percentage of adopted measures relating to identified vulnerabilities in climate analyses in committees and companies 73% – ≥ 50% Fulfilled● Percentage of adopted measures relating to identified vulnerabilities in vulnerability analyses in committees and companies 70% – ≥ 50% Fulfilled●

31 Annual Report 2020 Good financial management and financial position climate change was fulfilled for 2020, as reference to continuity planning not management, finance, personnel, legal three out of four indicators were being carried out according to plan costs, procurement and IT. Core opera- achieved. during the year. tions are by definition the healthcare The indicator Percentage of security The COVID-19 pandemic has greatly service, public transport, subsidized measures in accordance with Region affected the ability for committees and transport, culture and regional plan- Stockholm’s management system for companies to carry out planned training ning, as well as education, development information security that have been and exercise operations during the year, and research within core operations. implemented is new for this year. The as well as the implementation of climate, The administration’s share of costs measured value was 63 percent, which risk and vulnerability analyses. As a was 4.7 percent as of December 31, 2020, exceeded the target value. During the result, only nine committees and compa- which is unchanged from the outcome as year, Region Stockholm’s committees nies have been able to report on the of August 31, 2020, when the indicator and companies worked with deviations indicator for identified vulnerability and was measured for the first time. identified in their own inspections. climate analyses, and 15 for the indicator As the indicator is new, it has not been Information and cyber security risks are for identified susceptibility in risk and possible to carry out an assessment of increasing in step with the rapid techno- vulnerability analyses. Based on the the goal as there is no comparison data logical development and the increasing results from the committees and compa- from the previous year. use of data. Committees and companies nies that have been able to report on the Based on this definition, each com- need to continue the work of further indicators, the target value for 2020 has mittee and company has made a detailed strengthening governance and imple- been achieved. The overall assessment, assessment of which administrative mentation of security measures based on however, is that committees and compa- costs are to be measured, and the result the current threat level. nies still need to strengthen their sys- is reported under each committee and The indicator Percentage of commit- tematic work on climate, risk and vulner- company. tees and companies that have the ability ability analyses, and continuity As a result of the fact that Region to handle extraordinary events was 80 planning. At the same time, the manage- Stockholm’s committees and companies, percent and did not achieve its target ment of the COVID-19 pandemic is to varying degrees, conduct administra- value. In order for the indicator to be considered to have contributed to tive operations, a comparison of the considered achieved, all committees and improving our general emergency indicator between the various operations companies need to have an experienced preparedness. is difficult to analyse as the target value and trained crisis management team and varies with the mandate and the initial have continuity plans for the most Core operations shall be prioritized situation. The follow-up takes place with critical areas of the business. The It has not been possible to assess whether a focus on each committee’s and compa- Healthcare Committee, the Growth and the operational goal Core operations ny’s own share of the administrative Regional Planning Committee, the shall be prioritized was fulfilled in 2020 costs decreasing in relation to total costs. Culture Committee, and the Property as only one indicator could be measured. The indicator on legally binding court and Service Committee (service admin- The administrative costs are defined decisions where Region Stockholm has istration) report that the indicator has as costs for administrative support for won was 77.3 percent and achieved its been partially achieved, mainly with core operations, which refer to costs for target value for 2020.

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Core operations shall be prioritized – The administration’s share of the costs 4.7 – Reduce – Percentage of legally binding court decisions where Region Stockholm won 77.30% – ≥ 75% Fulfilled● Number of municipalities that believe that the collaboration with Region Stockholm contributes to creating good conditions for well-functioning community planning N/A – 26 –

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

High degree of innovation and digitalisation Fulfilled● Proportion of committees and companies that have introduced methods and tools to work systematically with innovation 76% 29% ≥ 25% Fulfilled● Degree of innovation 2.5 – ≥ 2 Fulfilled●

Good financial management and financial position Annual Report 2020 32 High degree of innovation research aimed at improving health Annual Accounts for Region and digitalisation was fulfilled in 2020, when four of the Stockholm’s total resources for The operational goal A high degree of six indicators were achieved. research, development, education innovation and digitalisation was Region Stockholm works continu- and innovation in 2020 fulfilled for 2020 when both indicators ously to further improve the response Region Stockholm contributes with achieved their target value. rate for requests from life science support for research in healthcare, In 2020, Region Stockholm decided companies to participate in clinical transport, technology, social sciences on a new innovation strategy and work studies. In 2020, the relevant commit- and natural sciences. By funding is underway to strengthen our ability to tees and companies have been asked to research, making the region’s infra- innovate in all operations owned by, or survey how inquiries are handled structure accessible and welcoming carried out with financing from, Region within each organisation. Based on the researchers to Region Stockholm’s Stockholm, so that new solutions are survey, further proposals for improve- operations, the new knowledge that used, disseminated and integrated in ment will be identified. The indicator research creates can contribute to the long term. Percentage of responses within ten improving quality and efficiency. The percentage of committees and days of requests from life science Region Stockholm’s commitment to companies that have introduced methods companies to participate in clinical research and development, R&D, is and tools for working with innovation in studies was 83 percent, which is lower intended to create the right conditions a systematic way was 76 percent, which than the target value of 85 percent. for the region’s inhabitants to have is an increase compared with 2019. During the year, Region Stockholm access to operations and services that The degree of innovation is a self-­ further developed the Centre for Health are constantly improving and develop- assessment graded on a scale from 1–5 Data by, among other things, develop- ing. Clinical research is conducted towards a gradually increasing profes- ing processes for disclosing data. At primarily in close collaboration with sionalisation of the work on innovation. present, there are still several stages in Karolinska Institutet, KI, but also in The degree of innovation was 2.5 and the process leading to delays, including collaboration with other universities reached its target value. COVID-19 has the ability to extract data from the and higher education institutions. An impacted the work on innovation in patient records system. Work is under- example of this is that the collaboration various ways. Development work has to way to enhance every step of the pro- with the Royal Institute of Technology some extent been delayed, while our cess. From 2021, there will be staff at and Stockholm University continued to ability to innovate has increased the Centre for Health Data specifically be developed and expanded in 2020. through new experiences and working tasked with extracting data for R&D is partly financed through special methods due to the pandemic. research. The indicator Percentage of funding allocated by central govern- requests for data disclosure from the ment, so-called ALF funding, and the One of Europe’s leading research Centre for Health Data where priva- funding invested in research by Region regions within research aimed at cy-protected health data has been Stockholm. Decisions on the allocation improving health disclosed within 30 days was 21 per- of research funds are made in collabo- The operational goal One of Europe’s cent, which is lower than the target ration with the universities. leading research regions within value of 50 percent. Research funds are allocated both in

Outcome Outcome Target Goal Sustainable regional development 2020 2019 value 2020 fulfilment

One of Europe’s leading research regions within research aimed at improving health Fulfilled● Percentage of responses within ten days to requests from Life science companies to participate in clinical trials 83% – ≥ 85% Not fulfilled● Number of ethical review permits where Region Stockholm was the research principal 1,248 – ≥ 775 Fulfilled● Number of publications in peer-reviewed journals by researchers active in medical research in Region Stockholm 4,445 – ≥ 4,100 Fulfilled● Regional cutting-edge science: Number of top-10 rankings for the Stockholm Trio (KI, SU and KTH) in the Times Higher Education Supplement, QS World Universities and Shanghai Ranking among European universities 1 – ≥ 1 Fulfilled● Percentage of requests for data disclosure from Centrum för hälsodata where privacy-protected health data has been disclosed within 30 days 21% – ≥ 50% Not fulfilled● The number of clinical trials completed in Region Stockholm in the last five years that were reported in clinicaltrials.gov 554 – ≥ 305 Fulfilled●

33 Annual Report 2020 Good financial management and financial position the form of searchable project funds clinical placement programme, 43 projects, as well as follow-up, communi- and in the form of support for employ- percent. The largest student groups are cation and support for their dissemina- ing clinical researchers. Within the medical and nursing students. Com- tion. Based on the new innovation healthcare area, a certain basic support pared with 2019, the number of VIL strategy, the criteria for 2021 has been is also allocated, based on previous training weeks has increased by 1,641. broadened so that innovation projects research activity. The basic support The work on innovation during 2020 from all operations in Region Stock- contributes to the research’s basic was largely dominated by the COVID-19 holm will be able to apply for and be infrastructure and is used to pay rent pandemic and the implementation of a allocated funds from the Innovation for research premises but also for new approved innovation strategy, Fund. resources such as research nurses, RS 2019–0672. The aim of the innova- In 2020, the use of funds for doctoral studentships and the like. tion strategy is integrated innovation, research positions, as well as research All regionally funded healthcare is internal development, test environ- and innovation projects, was made covered by an educational mandate. ments, and innovation and purchasing. more difficult by the pandemic, as The educational mandate involves Innovation shall be an obvious tool for employees had to prioritize clinical annually providing educational places continuously developing, quality-assur- work within healthcare. In order for operations-integrated learning, VIL, ing and making the operations of to enable the use of unused funds, for students at a number of colleges, Region Stockholm’s committees and Region Stockholm has signed an agree- universities, vocational colleges and companies more effective. Collaboration ment with the government regarding upper-secondary schools providing is organised by a coordination group for the transfer of unused funds to 2021. healthcare-related education. Continu- innovation, which prepares and produces A total of SEK 123 million has been ous work is underway to ensure the proposals for decisions on joint strate- transferred to 2021. availability of good quality educational gic innovation initiatives for Region An extended description can be places. During the ongoing pandemic, Stockholm. The purpose is to strategi- found in the report Årsbokslut för the educational mandate has continued cally create the right conditions for Region Stockholms samlade resurser to the extent that it has been deemed innovation projects, to raise the level of för forskning, utveckling, utbildning possible, sometimes with some impact understanding and expertise in the area och innovation (FoUUI) (Annual on content and design. No direct educa- of innovation and to increase opportu- Accounts for Region Stockholm’s tional deficit has arisen thanks to good nities for systematics, collaboration, collective resources for research, collaboration between all stakeholders. dissemination and implementation. development, education and innova- In 2020, the number of VIL training Region Stockholm operates and tion), 2020 in the Regional Executive weeks was 101 100, according to statis- develops the Innovation Fund, of which Committee’s official register tics from the accounting system, 57 SEK 15 million in 2020 financed the RS 2020–0769. percent, and from the KliPP IT support, implementation of 55 innovation

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Partially fulfilled Contribute to a transport-efficient society in the Stockholm region ● Percentage of journeys within the county that were carried out on foot, by bicycle or public transport (RUFS) 57% 1) – ≥ 70% Not fulfilled● Number of implemented measures according to the Accessibility Commission’s plan 100% – 100% Fulfilled●

1) Outcome refers to 2019 as data for 2020 are not available.

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

The Stockholm region shall be Europe’s most attractive growth region Fulfilled● Number or head offices established in the Stockholm region 22 – ≥ 22 Fulfilled● Placement in the comparison of gross regional product in metropolitan regions in the EU (RUFS) 61) – ≥ 5 Not fulfilled● Placement in the comparison of competitiveness in metropolitan regions in the EU (EU Index) 11) – ≥ 4 Fulfilled● Number of nights spent in the Stockholm region by international visitors N/A – ≥ 5.6 million –

1) Outcome refers to 2019 as data for 2020 are not available.

Good financial management and financial position Annual Report 2020 34 Contribute to a transport-efficient growth region was fulfilled for 2020 as region. The outcome for the indicator society in the Stockholm region two of the four indicators were achieved. Position in the comparison of gross The operational-specific goalContribute One indicator could not be measured. regional product in metropolitan areas to a transport-efficient society in the The Stockholm region is one of the in the EU (RUFS) refers to 2019 and, at Stockholm region was partly fulfilled as world’s most successful growth regions the time, the Stockholm region had the one indicator was achieved and one with a world class business community. sixth highest gross regional product per indicator was not achieved. The regional export collaboration in capita in comparison with 10 other Through its participation in the Baltic Stockholm County, STHLM GLOBAL, European metropolitan areas where Sea Commission and CPMR, Region assists companies with international Dublin followed by Munich and Paris Stockholm has monitored European growth potential and is important for occupied the top three positions. transport processes that are important goal fulfilment. The global value chains Stockholm comes just after Copenhagen for the Stockholm region. In November, mean that more and more industries are in the ranking but before Oslo and the annual mobility and transport exposed to greater international compe- Helsinki. However, the target value of development report was presented to the tition, and that regional growth has being among the five best metropolitan Growth and Regional Planning Commit- become more sensitive to global crises. areas was not achieved. tee, which will form the basis for Region The pandemic has caused disruptions in Stockholm’s long-term work to contrib- global value chains and thus the produc- Region Stockholm shall be ute to a transport-­efficient society. tion of end products and services, which a sustainable employer During the year, the regional cycle plan in turn has affected the county’s exports. Region Stockholm is one of Sweden’s was revised in consultation with the In order to reduce the effects of the largest employers and needs to recruit, municipalities and other regional stake- pandemic on regional growth, several retain and develop skilled employees and holders, and the reference version was decisions were made during the year managers in its operations. Region decided on by the Growth and Regional regarding project support from both the Stockholm works continuously to be a Planning Committee in November. 1:1 appropriation, Regional Growth sustainable and attractive employer for The Transport Committee’s survey of Measures, as well as the regional sustain- all employees. travel habits for 2019 showed that 57 ability and archipelago appropriation. The goal for Region Stockholm to percent of all journeys in the county had The Stockholm region’s ranking in the become a sustainable employer has two been completed on foot, by bicycle or on EU Regional Competitiveness Index operational specific goals, both of which public transport, an increase of three provides an indication of the Stockholm were achieved: Region Stockholm – an percentage points compared with 2015. region’s ability to offer an attractive and attractive employer and Systematic skills Public transport has the strongest sustainable environment for businesses supply. position when it comes to commuting to and inhabitants, and is thus an indica- In order to create the conditions to and from work, while cars are used more tion of whether the Stockholm region is achieve the goal of Region Stockholm frequently during leisure time and for Europe’s most attractive growth region. being an attractive and sustainable business trips. According to the regional The most recent survey was conducted in employer, special initiatives have been cycle plan, travel by bicycle will account 2019 and the Stockholm region was undertaken to enhance management and for 20 percent of all journeys within the ranked in first place. Whether the pan- leadership as well as the work on system- region by 2030. The latest available demic will have an impact on the Stock- atic health and safety. The Regional outcome refers to the year 2019 and holm region’s future position is still Executive Committee’s increased alloca- shows that the percentage of bicycle unclear, the index is updated every three tion of SEK 200 million to secure the travel was seven percent, and was most years. supply of skills has in 2020 been used for common when travelling to and from According to the Forbes’ list of the strategic and long-term investments in work. During the year, the Accessibility 2,000 largest global companies (Forbes’ education, as well as in skills develop- Commission carried out all planned Global 2000), 22 global companies had ment, leadership initiatives and initia- measures. Three new route studies have their headquarters in the Stockholm tives in systematic health and safety. been carried out and three route studies region in 2020. The indicator Number of have commenced. The 2019 annual established head offices in the Stockholm Region Stockholm – an attractive accounts for the Rapid Bus Transport region had an outcome of 22, which is employer system show that implemented measures one head office more than the previous Due to the pandemic, Region Stockholm’s have had a good effect on shortening year. joint employee survey was not conducted queue times, while also limiting the Gross regional product, GRP, is a in its entirety. This means that six impact on car traffic. measure of the total economic activity in indicators cannot be followed up. The a region over a given period of time. It overall assessment, however, is that the The Stockholm region shall be can be expressed as the value of total Regional Council’s goal for being an Europe’s most attractive consumption of goods and services, attractive employer was achieved, based growth region gross investments and exports minus on reduced staff turnover, increased The operational goal The Stockholm imports. When GRP increases, it is an number of applicants for advertised posi- region shall be Europe’s most attractive indication of economic growth in the tions, as well as maintained and

35 Annual Report 2020 Good financial management and financial position improved results from Sustainable increase can be seen in applications for Systematic skills supply Employee Engagement, HME. the position of biomedical analyst. The goal Systematic Skills Supply has Staff turnover in Region Stockholm The percentage of absence due to been fulfilled as the target value was was 11.1 percent in 2020, the corre- illness in relation to regular working achieved for three out of four indicators. sponding figure in 2019 was 12.2 per- hours was 8.07 percent in 2020, a One indicator, Skills Development cent. This means that staff turnover has marked increase compared with the Index, lacks a measured value as the decreased and the target value of the previous year when absence due to employee follow-up was not carried out indicator was achieved. Reported staff illness was 6.14 percent. The increase is in its entirety due to the pandemic. turnover indicates external turnover, mainly due to increased short-term Region Stockholm has offered full i.e., those who commenced and con- absence linked to the pandemic. The salary to employees who trained to cluded employment with Stockholm target value for the indicator was not become midwives or specialist nurses Region, and includes both permanent achieved. within prioritised specialities. and temporary employees. From 2021, In the autumn of 2020, a short During 2020, 286 nurses started full the report will only include permanent survey was conducted with a focus on or part-time training while maintaining employees as it is a more appropriate motivation, leadership and governance. their salary. In 2020, a total of 621 way of measuring staff turnover. With The questions were also included in the nurses received a payroll benefit while the new way of reporting staff turnover, 2019 employee follow-up and enable studying to become specialist nurses or staff turnover for 2020 was 8.0 percent comparison with other regions. The midwives, including those who com- compared with 9.4 percent in 2019, results of the survey provide a total menced their studies in 2019 or earlier. which was also a decrease from one year index for Sustainable Employee During the year, 232 positions to the next. High staff turnover can Engagement, HME, and is a basis for commenced for medical internships reduce efficiency and complicate work analysing the connection between within Region Stockholm’s operations on development and quality and is employee engagement, operating and private healthcare providers. That costly. results and finances. The result for is four more than was initially planned The number of applicants for adver- Sustainable Employee Engagement in and which, despite the ongoing pan- tised positions has increased to 24.3 2020 was 76, which is the same level as demic, were able to commence, and the applicants per position in 2020, com- in 2019. Results for sub-indices are: indicator’s target value was achieved for pared with 17.3 applicants per position motivation 78 (78), leadership 77 (76), 2020. Continuous work has been in 2019. This applies to virtually all governance 74 (74), the values for 2019 carried out to further increase the occupational categories compared with are given in brackets. number of medical internships (AT) in the previous year, and the largest 2021. The work has been conducted in

Outcome Outcome Target Goal Region Stockholm shall be an Sustainable employer 2020 2019 value 2020 fulfilment

Region Stockholm – attractive employer Fulfilled● Staff turnover 11% 12% ≤ 13% Fulfilled● Percentage of employees who stated that they have had an individual performance review with their immediate manager in the last year. N/A 81% ≥ 81% – Employee index N/A 77 ≥ 76 – Manager index N/A 78 ≥ 78 – Percentage of employees who have been subjected to threats and/or violence in connection with their work N/A 10% Reduce – Percentage of employees who have been subjected to discrimination that is related to their work N/A – Reduce – Percentage of absence due to illness in relation to regular working hours 8.1% 6.1% ≤ 6.2% Not fulfilled●

Systematic skills supply Fulfilled● Skills development index N/A ≥ 76 – The number of nurses who trained to be specialist nurses or midwives while maintaining their salary. 286 283 Increase Fulfilled● Number of appointed medical internships 2321) 228 Increase Fulfilled● Number of ST doctors 1,7372) 1,685 Increase Fulfilled●

1) Incl. private healthcare providers 2) Excl. private healthcare providers, if included the number is just over 2,400

Good financial management and financial position Annual Report 2020 36 parallel with the planning of the new for the healthcare service, many ment needed to be activated once again internship training, (BT) for doctors, employees have had to switch duties, on December 23, RS 2020–1006. which will also be introduced in 2021 workplaces and managers. The burden In accordance with the Swedish The Regional Council’s indicator to in certain parts of the emergency care Public Health Agency’s recommenda- increase the number of doctors who are sector has meant that it has been diffi- tions, employees who were able to, and consultants (ST) achieved its target cult to take leave, except for those who whose circumstances permitted it, have value. The number of employed ST are required to do so by law, and that worked from home. doctors in 2020 was 1,737, compared overtime pay has increased. In order to A significant transition to digital with 1,685 in 2019 in operations run by try to prevent employees from suffering alternatives has been made, and train- Region Stockholm. The total number of from ill health due to the strenuous ing days as well as conferences and STs, including employees of private work situation, extensive preventive exhibitions have been carried out healthcare providers, which are a measures have been introduced, such as digitally. significant part of the system for train- various forms of emergency support This has meant changing require- ing consultants, increased in 2020 to and talk therapy. ments and conditions for managers and just over 2,400 doctors from 2,230 Due to the very strained situation employees to create opportunities for doctors in 2019. Ongoing and long-term within Region Stockholm’s inten- participation and a sustainable working work is underway to meet the need for sive-care units, the Regional Executive environment. The use of digital tools more specialists in general practice Committee requested on April 2, 2020, has increased rapidly, as has the num- medicine, and in 2020 the number of that the Swedish Association of Local ber of digital meetings. This has ena- employed ST doctors in general practice Authorities and Regions, SALAR, and bled a higher degree of flexibility and medicine has therefore increased from Sobona should activate the Emergency reduced travel time for employees, 610 to 636, an increase within the scope Agreement, RS 2020–0356. The spread which has been welcomed by many as a of the primary care strategy. The num- of infection in Region Stockholm way to increase their work-life balance. ber of STs in geriatrics, immunology, slowed down during the summer, which During the year, a number of training pulmonary medicine and emergency led to a reduced burden on inten- sessions aimed at managers within medicine have also increased. sive-care facilities, and the Emergency Region Stockholm were held to develop In order to achieve systematic and Agreement could be deactivated on and train managers in how to manage sustainable work on skills supply, work August 31, 2020, after almost five their employees remotely and how on Region Stockholm’s common skills months, RS 2020–0356. During the digital tools can be used for follow-up. planning model, and the development period in which the Emergency Agree- During the year, an employee policy of career paths in the healthcare ser- ment was activated, approximately for Region Stockholm was developed, vice, continued during the year. 1,600 employees, of which about 100 RS 2019–1060. It sets out guiding In 2020, 13 career paths were developed employees at Capio S:t Görans Sjukhus, principles for employees and managers in order to clarify career paths and were instructed to work in accordance and how Region Stockholm should act development opportunities. with the terms of the Emergency Agree- as an attractive and sustainable ment. The instructions have varied in employer. The policy is also Region Significant staff conditions both scope and duration depending on Stockholm’s occupational health and The extraordinary situation caused by operational needs. At its height, 1,257 safety policy and shall, if necessary, be the pandemic has affected Region employees were working under these supplemented with guidelines. During Stockholm’s employees and managers. instructions at the same time. The the year, regional guidelines were In order to cope with the increased increased burden on intensive-care drawn up against bullying in the work- burden that the pandemic has entailed units meant that the Emergency Agree- place, discrimination, harassment and

Reporting on absence due to illness Outcome Outcome Percentage 2020 2019 Percentage absence due to illness in relation to regular working hours* Percentage of absence due to illness for female employees 8.8 6.8 Percentage of absence due to illness for male employees 5.5 3.7 Total percentage of absence due to illness 8.0 6.1 29 years or younger 8.0 6.0 30–49 years 7.6 5.6 50 years or older 8.6 6.8 Absence due to illness for 60 days or longer in relation to total absence due to illness 40 50

*Regular working hours refer to agreed hours excluding absence without financial value

37 Annual Report 2020 Good financial management and financial position sexual harassment, RS 2020–0446. and managers in 2020. It is important can be explained by impairment in the Staff numbers measured in the to continue working to reduce absence value of the shares in the subsidiaries. number of full-time equivalents10 were due to illness with a focus on mental The valuation of the shares is based 43, 533, which was 596 full-time equiv- ill-health and rehabilitation plans. on the subsidiaries’ equity and is thus alents more than in the budget and not possible for Landstingshuset i corresponds to a deviation of 1.4 per- Follow-up report Attractive and Stockholm AB to influence. Adjusted for cent. Staff numbers exceeded the Sustainable Employer the impairment, Landstingshuset i budget as the healthcare service has The follow-up report, Attractive and Stockholm AB reported a result that been in considerable need of personnel. Sustainable Employer, includes data on exceeds the budgeted result. The The deviations mainly occurred at the number of employees in various percentage of profit centres that report Danderyds Sjukhus AB, Södersjukhu- professions, an in-depth description of results in accordance with the profit set AB and Karolinska University initiatives in leadership and skills requirement was thus 100 percent, and Hospital, as a consequence of the need development, as well as in gender the indicator’s target value was achieved for high staffing levels due to the equality and diversity. The report also for 2020. COVID-19 pandemic. In comparison contains a summary of the systematic with December 2019, the number of occupational health and safety initia- A comparison of the hospi- full-time equivalents in 2020 decreased tives, with a report of results from the tals’ common indicators by a total of 29. The largest decrease employee survey, number of occupa- Region Stockholm operates healthcare was at Karolinska University Hospital, tional injuries and the sick leave trend. services at five hospitals. Karolinska –286, and Södersjukhuset AB, –137. The follow-up report: Attractive and University Hospital is responsible for The reduction in the number of full- Sustainable Employers can be found in highly specialized care at a national time equivalents is spread across many the Regional Executive Committee’s level as well as regional healthcare. professional categories, and the situa- official register RS 2020–0769. Södersjukhuset AB, Danderyds Sjukhus tions at Karolinska University Hospital AB and Södertälje Sjukhus AB are and Södersjukhuset AB are different. Results for committees Region Stockholm’s emergency hospi- However, it should be stated that in both and companies tals with responsibility for specialized hospitals the number of administrators Out of Region Stockholm’s 24 commit- emergency care and planned specialist has decreased. tees and companies, the Transport somatic care. Danderyds Sjukhus AB is Absence due to illness has increased Committee, Stockholm Care AB and also responsible for highly specialized compared with the previous year. It is Landstingshuset i Stockholm AB rehabilitation medicine and, from the mainly short and medium-term sick reported a negative result compared first of January 2020, geriatric care. S:t leave that has increased, which can be with the budgeted profit requirement. Eriks Ögonsjukhus AB conducts highly attributed to the pandemic, and it is The Transport Committee’s deficit can specialised emergency care and applicable to both men and women. The be explained by lower ticket revenue as planned ophthalmic care. Swedish Public Health Agency’s advice, a result of the COVID-19 pandemic. The hospitals’ ability to fulfil the that everyone, even with mild cold Stockholm Care AB’s result was nega- Regional Council’s goals was impacted by symptoms, should stay at home, and tively affected by a reduction in the the effects of the COVID-19 pandemic. that everyone who has been at home due number of foreign patients as a result of Throughout most of 2020, the primary to an infection should stay at home until the pandemic, as well as impairment of focus has been on dealing with the they have been symptom-free for two assets in connection with the transfer of pandemic and its consequences. This days, has had an effect on short-term healthcare for foreign patients to has placed great demands on the hospi- sick leave. In contrast, on the commit- Karolinska University Hospital. The tals, both in terms of increasing capac- tees and in the companies where financial effects of the pandemic are ity and managing the staff situation. employees have had the opportunity to exempt from the assessment of the work from home, absence due to illness profit requirement in accordance with High quality healthcare has decreased somewhat compared a decision by the Regional Council, services with the previous year. The main reason RS 2019–1041. The impairment cost in All hospitals except S: t Eriks Ögon­ is assumed to be that a large proportion Stockholm Care AB is due to a change in sjukhus AB were below the target value of employees are working from home, operations and is thus not comparable for the three accessibility indicators, which entails less risk of infection but with the budgeted profit requirement. Percentage of patients who spent no also that they have been able to perform Adjusted for these items, the Transport more than four hours in an Accident & their work with mild symptoms. To Committee and Stockholm Care AB are Emergency department, Percentage of prevent the risk of mental ill-health, deemed to have met their profit require- patients who received an appointment extensive emergency psychological ments. The negative budget deviation for a first visit with a consultant within support has been provided to employees for Landstingshuset i Stockholm AB 30 days, as well as Percentage of

10 Full-time equivalents refer to contracted time (attendance and absence) in relation to the individual full-time measurement for the number of days in the period.

Good financial management and financial position Annual Report 2020 38 Results for committees and companies Deviation Result Budget percentage Result MSEK 2020 2020 Deviation of turnover 2019 Healthcare service Healthcare Committee 253.1 0.0 253.1 0.4% 57.2 Healthcare Service Steering Committee 1.0 0.0 1.0 0.2% 43.5 Patient Advisory Committee 1.7 0.0 1.7 5.1% 0.4 Local government federation sjukvård och omsorg 62.0 0.1 61.9 3.5% –44.8 of which Tiohundra AB 46.4 0.0 46.4 5.3% –29.5 Stockholm County’s Healthcare Area 228.7 220.0 8.7 0.1% 228.6 Karolinska University Hospital 73.2 53.0 20.2 0.1% –1,866.6 Södersjukhuset AB 66.5 9.0 57.5 1.0% –111.6 Danderyds Sjukhus AB 18.6 8.0 10.6 0.2% –158.4 Södertälje Sjukhus AB 94.9 2.0 92.9 6.1% 22.8 S:t Eriks Ögonsjukhus AB 9.4 3.0 6.4 0.9% 55.7 Folktandvården Stockholms län AB 112.5 112.5 0.0 0.0% 112.5 Ambulanssjukvården i Storstockholm AB 30.5 12.0 18.5 4.4% 26.2 Stockholm Care AB –7.5 1.0 –8.5 –7.3% 1.7 MediCarrier AB 36.6 6.0 30.6 3.2% 5.1 Healthcare service, total 981.1 426.6 554.6 0.5% –1,627.8

Public transport Transport Committee –1,096.2 404.0 –1,500.2 –4.4% 611.4 of which the Transport Administration 14.1 0.0 14.1 0.1% 6.3 of which the Underground Expansion Administration –7.3 0.0 –7.3 –5.1% 0.5 of which AB Storstockholms Lokaltrafik –1,063.7 404.0 –1,467.7 –6.6% 620.3 of which Waxholms Ångfartygs AB –39.3 0.0 –39.3 –6.3% –15.8 Mobility Service Committee 376.6 0.0 376.6 20.6% 107.7 Public transport, total –719.6 404.0 –1,123.6 –3.1% 719.1

Culture Committee 0.5 0.0 0.5 0.1% 2.1 Growth and Regional Planning Committee 0.0 0.0 0.0 0.0% 1.0 Regional Executive Committee 564.5 0.0 564.5 20.6% 286.8

Properties and Service Property and Service Committee 1,096.8 468.0 628.8 8.6% 485.0 of which Service Administration 70.9 5.0 65.9 3.9% –0.2 of which Property Administration 1,025.9 463.0 562.9 10.0% 485.2 Locum AB 13.3 7.0 6.3 1.6% 13.6 Properties and service, total 1,110.1 475.0 635.1 8.2% 498.6

Other The Audit Board 0.1 0.0 0.1 0.2% 0.0 Landstingshuset i Stockholm AB –107.8 –18.0 –89.8 –16.7 AB SLL Internfinans 5.5 3.0 2.5 14.7% 3.6 Group-wide functions Damages account 0.2 0.0 0.2 1.0% 3.5 Group funding 3,876.8 –979.2 4,856.0 5.2% 1,663.5 Group adjustments 90.1 0.0 90.1 –0.1% –37.1 Total result for all profit centres 5,801.6 311.3 5,490.2 5.0% 1,496.6 of which switching costs –147.5 –323.0 175.5 –226.5 Result excluding switching costs 5,949.0 634.3 5,314.7 5.0% 1,723.0

39 Annual Report 2020 Good financial management and financial position Outcome Target value Goal Sustainable regional development 2020 2020 fulfilment

High quality healthcare services Percentage of patients who spent no more than four hours in the Accident ≥ 78% & Emergency department Karolinska University Hospital 54.2% Not fulfilled● Södersjukhuset AB 37.0% Not fulfilled● Danderyds Sjukhus AB 45.0% Not fulfilled● Södertälje Sjukhus AB 62.9% Not fulfilled● S:t Eriks Ögonsjukhus AB 95.3% Fulfilled● Percentage of patients who received an appointment for a first visit with a ≥ 73% specialist within 30 days Karolinska University Hospital 63.5% Not fulfilled● Södersjukhuset AB 59.0% Not fulfilled● Danderyds Sjukhus AB 55.0% Not fulfilled● Södertälje Sjukhus AB 67.8% Not fulfilled● S:t Eriks Ögonsjukhus AB 78.8% Fulfilled● Percentage of patients who received an appointment for treatment within 90 days ≥ 90% Karolinska University Hospital 62.6% Not fulfilled● Södersjukhuset AB 72.0% Not fulfilled● Danderyds Sjukhus AB 62.0% Not fulfilled● Södertälje Sjukhus AB 71.1% Not fulfilled● S:t Eriks Ögonsjukhus AB 92.4% Fulfilled● Incidence of hospital-acquired infections ≤ 7.7% Karolinska University Hospital 11.3% Not fulfilled● Södersjukhuset AB 7.3% Fulfilled● Danderyds Sjukhus AB 7.7% Fulfilled● Södertälje Sjukhus AB 7.2% Fulfilled● S:t Eriks Ögonsjukhus AB 0.0% Fulfilled● Average current quality index for emergency hospitals Increase Karolinska University Hospital 92.41) – Södersjukhuset AB 87.01) – Danderyds Sjukhus AB 90.81) – Södertälje Sjukhus AB 881) – S:t Eriks Ögonsjukhus AB –1) – Number of days ready for discharge per medical care event ≥ 2 Karolinska University Hospital – – Södersjukhuset AB 2.2 Not fulfilled● Danderyds Sjukhus AB 0.4 Fulfilled● Södertälje Sjukhus AB 0.1 Fulfilled● S:t Eriks Ögonsjukhus AB – – Average number of days spent in hospital per medical care event Reduce Karolinska University Hospital 4.4 Not fulfilled● Södersjukhuset AB 3.7 Fulfilled● Danderyds Sjukhus AB 3.2 Not fulfilled● Södertälje Sjukhus AB 3.7 Fulfilled● S:t Eriks Ögonsjukhus AB 2.1 Not fulfilled● The administration’s share of the costs Reduce Karolinska University Hospital 2.0% Fulfilled● Södersjukhuset AB 2.8% Fulfilled● Danderyds Sjukhus AB 2.7% Fulfilled● Södertälje Sjukhus AB 5.5% Not fulfilled● S:t Eriks Ögonsjukhus AB 3.1% Not fulfilled●

1) Refers to outcome for 2019 as data for 2020 were not available.

Good financial management and financial position Annual Report 2020 40 patients who received an appointment for the most seriously ill patients, but Committee, as well as committees and for treatment within 90 days. Follow- despite all these duties, average length companies within the healthcare ing a decision in RSSL,11 the hospitals of hospital stay was the same as in 2019. service. SEK 2,140 million refers to have had to downgrade elective care, The job of taking care of deferred public transport. This year’s work-up cancel planned operations and move medical care needs to have the highest rate can mainly be explained by the staff to handle the urgent task of caring priority over the coming years. effects of the COVID-19 pandemic on for infectious and seriously ill COVID- The outcome as of August 2020 property investments in healthcare, 19 patients. The lack of beds has con- regarding the indicator Administra- and the postponement of major invest- tributed to difficulties in moving tion’s share of the costs constitutes the ments in public transport. patients who have been treated out of baseline against which the indicator is During the year, the COVID-19 the Accident & Emergency department, to be measured in order to assess pandemic entailed reprioritisations of which also has an negative effect on whether the administration’s share of investments in healthcare properties. accessibility indicators. S:t Eriks the costs has decreased during the year. The renovation of healthcare facilities Ögonsjukhus has achieved the indicator Karolinska University Hospital, Söder­ has been put on hold, partly to reduce values ​​because their activities were less sjukhuset AB and Danderyds Sjukhus the spread of infection and partly to affected by the pandemic compared AB achieved the goal of reducing their protect members of staff. Furthermore, with the emergency hospitals. administrative costs in 2020. During other measures than those in the plans The indicator Incidence (prevalence) the year, Södertälje Sjukhus AB and have been prioritized, where the focus of hospital-acquired infections has S: t Eriks Ögonsjukhus AB worked to has been on establishing intensive care been achieved by all hospitals except define which costs should be included in facilities in the Älvsjö field hospital. The Karolinska University Hospital. this indicator, as certain roles and costs deviation can also largely be explained Karolinska University Hospital’s may belong to both core operations and by the fact that Karolinska University healthcare mandate covers a significant administration. Hospital awaited the continuation of proportion of patients who are suscepti- some investments in Huddinge, given ble to infection, and therefore the Investments in the financial situation in 2019, which outcome differs from the other emer- Region Stockholm after a review of the need for investment gency hospitals. Efforts have been made The Stockholm region is growing, which meant that investments were re-­ within the committee with the result places high demands on good accessi- prioritized in 2020. that the percentage of infections have bility and quality in the healthcare The postponements within public decreased in 2020 compared to the service, as well as a well-functioning transport have not been affected to the previous year. public transport system for both exist- same extent by the COVID-19 pan- The indicator Number of days ready ing and new inhabitants. Region demic. The deviation is mainly due to for discharge per medical care event Stockholm is implementing extensive the fact that some major investments was achieved by Södertälje Sjukhus AB investments in both the healthcare have been postponed, which together and Danderyds Sjukhus AB. Söder­ service and public transport. Work make up the majority of the deviation: sjukhuset AB did not achieve the target continues on the rebuilding and refur- in the Red Line upgrade programme, value but has made a clear improvement bishment of properties within the carriages have not been delivered compared with 2019. Karolinska healthcare sector and within public according to plan due to quality issues. University Hospital lacks system transport, both the Underground In the Underground to Nacka and support to follow up this indicator. network and the Light-Rail network Söderort, the service tunnel at Kungs­ The target value for the indicator will be expanded, at the same time as trädgården was subject to appeal after Average number of days spent in Roslagsbanan and the Red Line are the award. In the Underground to hospital per medical care event must be being refurbished. Barkarby, the award took place later reduced. Södersjukhuset AB and than planned. In the replacement of Södertälje Sjukhus AB have achieved Investments within escalators, it has been difficult to find a this. However, all hospitals have committees and companies suitable supplier, as tenders have been reduced the length of hospital stay by The investment expenditure for 2020 withdrawn and an appeal has been excluding COVID-19 care and S:t Eriks amounted to SEK 10,916 million, which made to the administrative court. Ögonsjukhus AB only achieved the corresponds to a work-up rate of 73 Further information on investments value from 2019. For Danderyds percent of the budget of SEK 14,934 mil- can be found in the sections on commit- Sjukhus AB, their new geriatric care lion. This year’s expenditure was below tees and companies. mandate has also had an adverse effect budget by SEK 4,018 million, of which on the outcome. Karolinska University SEK 1,878 million pertained to invest- Hospital has cared for the most COVID- ments in property and equipment 19 patients nationwide, and in Region relating to healthcare, which can be Stockholm they have been responsible found within the Property and Service

11 Regional Special Healthcare Management, RSSL.

41 Annual Report 2020 Good financial management and financial position Investments in committees and companies

Outcome Budget Deviation compared Outcome MSEK 2020 2020 to budget 2019 The healthcare service Healthcare Committee 0.6 7.0 –6.4 10.3 Healthcare Service Steering Committee 0.0 0.0 0.0 0.0 Patient Advisory Committee 0.0 0.0 0.0 0.0 Stockholm County’s Healthcare Area 202.8 326.6 –123.8 242.5 Karolinska University Hospital 662.7 374.7 288.0 549.3 Södersjukhuset AB 181.3 169.4 11.9 413.0 Danderyds Sjukhus AB 124.3 183.0 –58.7 612.2 Södertälje Sjukhus AB 31.4 27.0 4.4 69.8 S:t Eriks Ögonsjukhus AB 40.5 40.0 0.5 33.3 Folktandvården Stockholms län AB 39.1 85.0 –45.9 47.8 Ambulanssjukvården i Storstockholm AB 12.8 28.0 –15.2 22.9 Stockholm Care AB 2.2 0.0 2.2 3.2 MediCarrier AB 2.3 2.0 0.3 2.9 Healthcare service, total 1,300.0 1242.7 57.3 2,007.2

Public transport Transport Committee 8,102.0 10,256.1 –2,154.1 6,190.5 of which the Transport Administration 632.7 497.2 135.5 613.0 of which the Underground Expansion Administration 2,067.2 2,748.6 –681.3 1,160.3 of which AB Storstockholms Lokaltrafik 5,381.9 6,956.6 –1,574.7 4,338.4 of which Waxholms Ångfartygs AB 20.2 53.8 –33.6 78.8 Mobility Service Committee 32.0 18.0 14.0 30.2 Public transport, total 8,134.0 10,274.1 –2,140.1 6,220.8

Culture Committee 2.2 5.6 –3.4 0.8 Regional Executive Committee 0.9 99.7 –98.8 6.1

Properties and Service Property and Service Committee 1,478.0 3,306.8 –1,828.8 3,685.9 of which Service Administration 154.2 256.5 –102.3 227.4 of which Property Administration 1,323.8 3,050.3 –1,726.5 3,458.6 Locum AB 0.5 4.5 –4.0 2.1 Properties and service, total 1,478.5 3,311.3 –1,832.8 3,688.1

Other The Audit Board 0.1 0.2 –0.1 0.0 AB SLL Internfinans 0.0 0.0 0.0 0.0 Total investments 10,915.8 14,933.6 –4,017.8 11,922.9

Good financial management and financial position Annual Report 2020 42 Important conditions for the result and 6 the financial position

43 Annual Report 2020 Financing approximately 25 percent of the total Pensions Region Stockholm’s rating from the debt portfolio. The Regional Group’s pension commit- credit rating agency Standard & Poor’s Region Stockholm’s financial guide- ments amounted to SEK 54,186 million, remains AA+. lines stipulate that the cash require- including special payroll tax, of which The Regional Council has established ments and the current solvency must provisions in the balance sheet com- a borrowing limit of SEK 95 billion. This always be hedged through agreed prised SEK 31,604 million and the amount refers to all agreed loan and financing. As of December 31, 2020, the contingent liability comprised credit commitments, loan programmes maximum cash requirement for the SEK 22,582 million. and leasing obligations, as well as bank coming six months amounts to Financial investments regarding overdraft facilities. The region’s inter- SEK 2.6 million. At the same time, the pension funds do not exist, instead est-bearing liabilities decreased during agreed financing amounted to a total of pension funds are reborrowed in full the year by SEK 2,368 million and SEK 14.25 billion, comprising an into the operations. Total reborrowed amounted, at the end of December, to overdraft facility linked to the group funds thus amounted to SEK 54,186 SEK 49.4 million. In addition to leases account of SEK three billion, credit million, which corresponds to a and loans, there is a liability for the facilities in commercial banks of debt-equity ratio of zero percent. financing of New Karolinska Hospital in SEK five billion and unused loan agree- Pension costs in 2020 were SEK 2.2 Solna, which at year-end amounted to ments with the European Investment billion lower than budget. The reason SEK 5,819 million. The liability was Bank, EIB, of SEK 6.25 billion. for the lower pension costs is that, in amortised during the year to the During the year, a new credit facility 2020, KPA Pension introduced a new amount of SEK 360 million. was procured with a group of Swedish technical tool for pension calculations, The fixed interest term on the debt and foreign banks. The volume amounts which enables more accurate calcula- portfolio may amount to 2–5 years, to four billion and the term is three tions at the individual level. A positive according to Region Stockholm’s years with an option to extend the one-off effect has thus arisen in 2020 in financial guidelines. Over the year, it facility by one year on two occasions. connection with the previous years’ varied between 4.0 and 4.3 years, and The facility replaces the previous credit pension commitments having been as of the end of December it amounted facility that matures in December 2021. revised downwards. to 4.2 years. This corresponds to a The diagram below shows the matu- percentage of variable interest of rity structure of Region Stockholm’s debt portfolio.

MSEK 9,000

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035

Bilateral loans (EIB/NIB) Leasing Bonds Green bonds

Important conditions for the results and the financial position Annual Report 2020 44 Development overview of 7 operations

45 Annual Report 2020 Region Stockholm reported a positive period from 7.2 percent to 13.3 percent. financial result for the fourteenth year On average, population growth over the in a row. Over the last five-year period, same period was 1.4 percent. Region Stockholm’s results have been The result for the year was SEK strong, which can mainly be explained 5,802 million and consists largely of by the fact that tax revenue and govern- one-off effects. Lower costs for pensions, ment grants exceeded the budget The higher general and targeted government equity/assets ratio and the region’s grants and capital gains are the main long-term financial sustainability have reasons for the surplus. improved over the corresponding

Multi-year overview Region Stockholm Group

2020 2019 2018 2017 2016 Operating revenue 29,794 25,036 23,576 22,177 21,102 Operating costs –10,0011 –96,220 –92,450 –88,733 –85,388 Result for the year 5,802 1,497 1,383 1,242 808 Debt-equity ratio 13.3% 9.7% 9.1% 7.7% 7.2% Debt-equity ratio, incl. total pension obligations –2.6% –7.1% –8.8% –11.5% –13.9% Investments (net) 10,916 11,923 12,211 15,216 15,065 Self-financing ratio 100.0% 100.0% 82.1% 75.3% 61.5% Non-current liabilities 49,471 51,838 50,726 45,965 44,597 Number of employees (full-time equivalents) 43,533 43,561 42,951 42,578 42,249

Multi–year overview

Region Stockholm 2020 2019 2018 2017 2016 Population 2,391,841 2,374,550 2,339,640 2,303,417 2,264,111 County tax rate 12.08 12.08 12.08 12.08 12.08 Operating revenue 19,317 13,060 11,876 10,368 9,675 Operating costs –93,219 –89,183 –85,106 –81,106 –78,101 Result for the year 6,492 1,019 728 1,018 435 Debt-equity ratio 14.6% 9.5% 8.4% 8.2% 7.7% Debt-equity ratio, incl. total pension obligations –4.6% –10.6% –13.0% –15.2% –17.9% Investments (net) 2,980 5,108 7,447 8,302 8,566 Self-financing ratio 100.0% 82.6% 27.2% 33.8% 51.1% Non-current liabilities 44,813 46,700 44,473 39,032 36,406 Number of employees (full-time equivalents) 29,346 29,551 29,271 29,033 29,034

Development overview of operations Annual Report 2020 46 8 Expected development

47 Annual Report 2020 Developments in the coming year Region Stockholm less vulnerable in the interest rate,12 are expected to remain The COVID-19 pandemic has had a big event of negative results, as reserved low: 1.1 percent in 2021 and then climb impact on Region Stockholm’s finances equity can compensate for the loss, and to 1.9 percent in 2023. There is great and operations. There is still great Region Stockholm does not have to uncertainty about how unemployment uncertainty about the how the pandemic restore the result in accordance with and working hours will develop when will develop as well as about its effects the requirements in the Local Govern- government measures, such as turno- on socio-economic development in 2021 ment Act. ver-based support and support for and for the coming planning year. The budget shows a balanced result furloughing of employees and shorter In the spring of 2021, the impact of for the coming years 2021–2023 corre- working hours, cease. the pandemic is expected to continue to sponding to SEK 1 million per year. The It is assumed that the government’s be considerable for Region Stockholm’s low budgeted result demonstrates the augmentation of general targeted committees and companies. The uncer- need for available funds to bolster core government grants will be withdrawn, tain planning conditions and the need operations, which means that the cash given that the pandemic is decreasing in to handle both deferred medical care, flow will be lower than previously scope. This is happening at the same paused action programmes, and other planned. time as Region Stockholm’s contribution activities will place demands on Region Region Stockholm’s tax revenue, to the municipal financial equalization Stockholm in the form of new priorities. general government grants and pay- is steadily increasing, by a total of SEK Lessons learned from the pandemic ments for equalization of the tax base –2.5 billion in 2023 compared to 2020. have created opportunities to make pro- are a result of the expected socio-eco- Within public transport, revenue cesses more effective. nomic development in terms of GDP will increase due to an increase in ticket In connection with the decision on growth, employment and wage prices from January 2021. The price for the 2021 budget, the Regional Council increases. Employment is expected to a 30-day travel card will be increased by decided on a revised policy for sound be subdued in the wake of the pandemic, SEK 20 to SEK 950 from January 2021, financial management which, among with a relatively high unemployment and the price for a 30-day travel card for other things, contains governing rate as a result. The National Institute of Waxholmsbolaget will be increased to principles for the application of the Economic Research estimated in the SEK 950 for adults and SEK 640 for profit equalization reserve. In order to forecast from December 2020 that pensioners, young people and students. secure finances that are in long-term unemployment will be 9.0 percent The increase is necessary to finance balance, Region Stockholm’s principles nationwide in 2021 and then decrease to both the continued expansion of public include the possibility of being able to 7.3 percent by 2022. Wage trends are transport and an increased supply reserve funds from good results. expected to be lower than SALAR’s of public transport within Region Reserved funds can, if the need arises, previous assessment from February Stockholm. be used during a recession in accord- 2020, due to the economic situation. The development of the total budgeted ance with the definition established by Price trends, in accordance with the tax revenue for 2021–2023, in relation the Regional Council. This makes Consumer Price Index with a fixed to 2020 is on average 2.3 percent. This

Multi-year overview Outcome Budget Plan Plan MSEK 2020 2021 2022 2023 Operating revenue 29,794 28,597 27,730 26,912 Operating costs –100,011 –104,513 –105,822 –107,410 Depreciation –6,589 –7,200 –7,461 –7,882 Net operating costs –76,806 –83,116 –85,552 –88,380 Tax revenue, general government grants and equalisation 84,905 85,182 87,704 90,857 Operating result 8,099 2,066 2,152 2,477 Net financial income/expense –2,297 –2,065 –2,151 –2,475 Result for the year 5,802 1 1 1 Result for the year in relation to taxes and equalisation 6.8% 0.0% 0.0% 0.0% Investments 10,916 14,055 16,493 16,020 Interest–bearing non–current liabilities 51,838 61,906 62,561 65,424 Debt-equity ratio incl. total pension obligations –2.6% –5.1% –4.1% –3.5% Self–financing ratio for investments (excl. co–financing) 100% 81% 91% 89%

12 Statistics Sweden: KPIF – Consumer price index with fixed interest rate.

Expected development Annual Report 2020 48 can be compared with the good years ments where Region Stockholm has submitted by the investigators on from 2016–2019, which saw an average agreements with the government and March 8, 2021, RS 2020-0384. development of 4.9 percent per year. municipalities on co-financing, the The purpose of the review is to learn The demographic trend with a higher self-financing rate amounts to an lessons for the future and provide a proportion of younger and older people average of 88 percent per year during basis for Region Stockholm’s improve- at the same time as the proportion of the period 2021–2023. ment efforts. Region Stockholm will gainfully employed people decreases, collectively and in a transparent man- will lead to lower tax revenue develop- The Government’s budget bill ner manage the conclusions and recom- ment and place demands on priorities. In the budget bill, the government mendations specified in the report. The The tougher economic conditions presented general contributions for work of handling the conclusions and mean that all the region’s operations 2021, which will then be halved for recommendations specified in the will need to be prioritized, and effi- 2022. The government promised a total report will be led by a special change ciency improvements will need to be of SEK 4 billion per year for dealing manager who will work directly under made in order for the region to continue with deferred medical care in 2021 and the regional chief executive. This work to have balanced finances. In order for 2022 and compensation for loss of will be long-term and it presupposes this to happen, committees and compa- ticket revenue within public transport both great openness to change and nies must achieve the profit require- amounting to a total of SEK 2 billion. humility, because everyone throughout ments that the Regional Council has The targeted investments in effective the course of the work, from the begin- adopted, while also running and devel- and local healthcare services, accessi- ning of last year and onwards, has done oping the operations in accordance with bility, cancer care and mental health and is doing their utmost to provide the council’s goals and mandates. The continue, while women’s health will be Stockholmers with the best possible development for operating costs is improved somewhat. Since the budget healthcare, accessible public transport budgeted at an average of 2.4 percent bill was decided upon, the government and support for business, culture and per year, while the population is esti- has announced a change in the purpose visitors, in compliance with the govern- mated to increase by an average of 1.2 of half of the funds that were to be set ment’s and authorities’ recommenda- percent per year. The result for 2021 is aside for deferred medical care in 2021. tions and guidelines. All the relevant budgeted at SEK 1 million, which They will now be used for COVID-19 committees and companies have corresponds to zero percent of taxes related care. The uncertainty sur- received the review in order to take and equalization. A higher budgeted rounding conditions and requirements measures in their relevant areas to result for the group than that is not that already exist regarding targeted strengthen their capacity in a crisis considered possible, given the prevail- government grants has thus been situation, as well as to take advantage of ing financial conditions with deferred intensified. the review’s conclusions and recom- medical care and lost revenue within mendations in the continued improve- public transport. During the planning Independent review of Region ment efforts. The review will continue years, the result is budgeted at SEK Stockholm’s management of the in 2021, mainly on the vaccination 1 million each year. effects of the new coronavirus programme and the third wave of Investments in the region will On May 19, 2020, the Regional Execu- infection, as the impact of the pandemic continue to remain at a high level tive Committee decided to initiate on the Stockholm region continues to be during the budget and planning period an independent review of Region significant. 2021–2023, and will amount to a total Stockholm’s management of the effects of SEK 47 billion. Excluding the invest- of the new coronavirus. The report was

49 Annual Report 2020 Expected development 9 Financial Report

50 Annual Report 2020 Income statement

The Regional Group The Region

MSEK Note 2020 2019 2020 2019 Operating revenue 2 29,794 25,036 19,317 13,060 Operating costs 2 –100,011 –96,220 –93,219 –89,183 Depreciation 3 –6,589 –6,201 –2,931 –2,738 Net operating costs –76,806 –77,385 –76,833 –78,861 Of which items affecting comparability 7 714 –159 292 –220

Tax revenue 4 77,392 76,044 77,392 76,044 General government grants and equalisation 4 7,514 5,374 7,514 5,374 Total tax revenue 84,905 81,418 84,905 81,418

Financial revenue 5 78 68 569 568 Financial expenses 6 –2,375 –2,604 –2,150 –2,106 Net financial income/expense –2,297 –2,536 –1,581 –1,538 Of which items affecting comparability 7 – –667 – –

Extraordinary items 0 0 0 0 Result for the year 5,802 1,497 6,492 1,019

Financial Report Annual Report 2020 51 Balance sheet

The Regional Group The Region

MSEK Note 2020 2019 2020 2019 Assets Fixed assets Intangible fixed assets Rights of use and other intangible fixed assets 9 369 372 77 96

Tangible fixed assets Land, buildings and technical facilities 10 69,031 68,600 37,792 37,456 Machines and inventory 11 34,329 32,774 15,923 14,662 Fixed assets under construction, advance payments relating to tangible fixed assets 12 22,667 20,728 4,240 10,040

Financial assets Financial assets 13 1,199 1,147 45,463 38,520 Total fixed assets 127,595 123,622 103,495 100,774

Current assets Storage, etc. 621 301 273 143 Current receivables 14 9,626 8,011 13,179 11,830 Current investments 0 0 0 0 Cash and bank balance 4,012 3,385 1,002 0 Total current assets 14,259 11,697 14,454 11,973

Total assets 141,854 135,319 117,949 112,747

Equity, provisions and liabilities Equity 15 Result for the year 5,802 1,497 6,492 1,019 Profit equalisation reserve 3,247 3,247 Other equity 9,822 11,573 7,428 9,656 Total equity 18,871 13,069 17,167 10,675

Provisions Provisions for pensions and similar obligations 16 31,604 31,684 23,863 24,207 Other provisions 17 1,307 1,048 590 615 Total provisions 32,911 32,732 24,453 24,823

Liabilities Non-current liabilities 18 59,876 63,766 44,862 52,641 Current liabilities 19 30,197 25,751 31,468 24,608 Total liabilities 90,073 89,517 76,330 77,249

Total equity, provisions and liabilities 141,854 135,319 117,949 112,747

Pledges and comparable securities none none none none

Contingent liabilities 20 Pension obligations not recognised in liabilities or provisions 22,582 22,610 22,582 22,610 Other contingent liabilities 1,644 1,088 16,871 16,837 Total contingent liabilities 24,226 23,698 39,453 39,447

52 Annual Report 2020 Financial Report Cash flow statement

The Regional Group The Region

MSEK 2020 2019 2020 2019 Operating activities Result for the year 5,802 1,497 6,492 1,019 Adjustment for items not affecting liquidity* 5,860 9,121 2,121 4,052 Funds from operations before changes in working capital 11,662 10,618 8,613 5,071

Increase (+) and decrease(–) of stock and inventory –320 281 –130 293 Increase (+) and decrease(–) in current receivables –1,677 –480 –1,350 –1,984 Increase(+) and decrease(–) in current liabilities (excl. leasing and lending) 2,774 233 2,437 840 Cash flow from operating activities 12,439 10,652 9,570 4,220

Investment activities Investment in intangible fixed assets –112 –157 –5 –14 Investment in tangible fixed assets –10,804 –11,936 –3,008 –6,299 Sale of tangible fixed assets 1,276 71 4,744 16 Cash flow from investment activities –9,640 –12,022 1,731 –6,297

Financing activities New loans 6,957 8,066 9,655 6,561 Amortisation of non-current liabilities –9,200 –6,219 –9,200 –6,219 Changes in non-current receivables –52 –426 –6,943 –159 Changes in non-current liabilities –74 720 –4,070 2 Changes in lease financing –481 –1,115 0 0 Contributions received 678 1,835 259 1,636 Cash flow from financing activities –2,172 2,861 –10,299 1,821

Cash flow for the year 627 1,491 1,002 –256

Opening cash and cash equivalents 3,385 1,894 0 256 Closing cash and cash equivalents 4,012 3,385 1,002 0

*) Specification of items not affecting liquidity Depreciation 6,589 6,201 2,931 2,738 Changes in provisions 179 2,153 –370 969 Capital gain/loss and disposals –809 160 –369 30 Other items –99 607 –71 315 Adjustment for items not affecting liquidity 5,860 9,121 2,121 4,052

Financial Report Annual Report 2020 53 10 Committees

54 Annual Report 2020 The Regional Executive Stockholm’s operations, which means Karolinska University Hospital, and is Committee that the committee must manage and thus not comparable with budgeted The Regional Executive Committee follow up on the goal and its indicators. results. manages, leads, coordinates, follows up One of three indicators achieved its The indicator Percentage of commit- and analyses the management of Region target value, which means that the tees and companies that have achieved Stockholm’s affairs. It has a supervisory target was not achieved for 2020. goal fulfilment for at least 80 percent of responsibility and shall ensure that the indicators assigned to them, and committees and companies enforce the Achieve structured governance of which can be followed up in the annual decisions of the Regional Council. The Region Stockholm’s operations report was 33 per cent, which is lower Regional Executive Committee shall The structured governance is based on than the target value of 90 percent. also ensure that any effects from a Region Stockholm’s model for inte- COVID-19 has contributed to reduced group perspective are considered when grated management and governance, goal fulfilment for committees and making decisions, and that established ILS. The work on goals, planning, companies, which is one reason why the goals and mandates are fulfilled within follow-up, analysis, actions and internal indicator was not achieved. the adopted budget. control is based on a common founda- The pandemic has had a major tion, and applies to the entire group. The administration’s share impact on Region Stockholm and the The profit requirement for commit- of the costs Regional Executive Committee’s tees and companies within the health- The administrative costs are defined as finances and operations. The Regional care service and public transport as well costs for administrative support for Executive Committee has prioritized as the Regional Executive Committee is core operations, and were 38.0 percent operations and resources for handling measured excluding COVID-19, in for the Regional Management Office. new tasks linked to the pandemic, and accordance with a decision by the Administrative costs at the end of the has postponed planned developments, Regional Council, RS 2019–1041. The year decreased by 10.0 percentage and made trade-offs to reduce the proportion of committees and compa- points compared to 2019. workload for companies and committees. nies that met their profit requirement was 100 percent. Only one company, Financial result Goals Stockholm Care AB, reported a negative The Regional Executive Committee’s The committee is responsible for the result. The deficit was caused by impair- result amounted to SEK 564 million, committee-specific goal,Achieve ments in connection with the prepara- which corresponds to 21 percent of the structured governance of Region tion of the transfer of operations to turnover.

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Achieve structured governance of Region Stockholm’s operations Not fulfilled● Structured governance Percentage of committees and companies that have delivered results in accordance with the profit requirement1) 100% – ≥ 100% Fulfilled● Percentage of committees and companies that have achieved target fulfilment for at least 80 percent of the indicators assigned to them and which can be followed up in the annual report 33.3% – ≥ 90% Not fulfilled● Percentage of committees and companies that have both delivered results in accordance with the profit requirement1) and achieved goal fulfilment for at least 80 percent of the indicators assigned to them and which can be followed up in the annual report 33.3% – ≥ 90% Not fulfilled●

Core operations shall be prioritized The administration’s share of the costs 38.0% 48.0% Reduce Fulfilled●

1) For committees and companies within the healthcare service and public transport as well as the Regional Executive Committee, revenue and expenses relating to COVID–19 are excluded from the profit requirement; in accordance with a decision by the Regional Council, RF 2019–1041.

Financial result Regional Executive Committee

Result Budget Deviation Deviation as percent Result MSEK 2020 2020 to budget of turnover 2019 Regional Executive Committee 564.5 0.0 564.5 20.6% 286.8

Committees Annual Report 2020 55 The positive deviation of SEK 564 working parties, RS 2020–0318. Healthcare Committee million was mainly a result of lower During the year, all political meetings The Healthcare Committee manages costs to the amount of SEK 224 million were completely or partly digital. the healthcare service in Region for grants provided within education The pandemic has led to a rapid Stockholm in accordance with the and skills supply, and that the Regional transition to digital working methods Health and Medical Services Act. The Executive Committee’s allocation of for managers and employees. The Committee is responsible for providing SEK 200 million for unforeseen funds adjustment has worked beyond all our a healthcare service that correspond to was not used. Personnel costs were SEK expectations and to improve the condi- the needs of the growing population. 93 million lower than budget, mainly tions for working from home, all The Committee must have an all-­ due to unfilled job vacancies. Restric- employees have been offered equipment encompassing perspective to ensure tiveness has been applied in the rede- to borrow in order to work from home. that healthcare is managed, coordi- ployment of services and the operations Managers in the Regional Manage- nated and developed at an overall level Financial data and digitalisation has ment Office have been offered training so that the limited resources are been transferred from the Regional in remote management and in how adapted to the needs of the population. Management Office to the Property and digital tools can be used for manage- The single most important event Service Committee. Costs for the use of ment and follow-up. Efforts have also during the reporting period has been consultants decreased by SEK 3 million been made to increase skills in how the pandemic, which has had a major compared with budget, which was a Teams can be used for effective remote impact on the Healthcare Committee’s decrease of SEK 145 million compared working. opportunities to achieve the committee- with 2019. The net cost for COVID-19 A pilot project for measuring digital specific goal “High quality healthcare amounted to SEK 11 million as a result maturity was completed during the year services”. of government grants received, which and resulted in the new indicator During the year, many inhabitants provided full coverage of certain addi- “Degree of digital maturity”, which was and healthcare providers took a major tional costs within R&D, relating to the introduced in Goals and Budget 2021. step towards digi-physical healthcare. Dillner study at Karolinska University Over the course of the year, the There has been a great demand for Hospital, of SEK 15 million and SEK 0.3 Regional Executive Committee handled healthcare via various types of e-ser- million within HR. 32 mandates, assigned by the Regional vices and digital solutions. Council, of which ten were completed During the year, the Healthcare Investments during the year. 16 mandates are ongo- Committee had 49 mandates that were Investment expenditure for the year ing according to plan, while six man- assigned by the Regional Council, of amounted to SEK 0.9 million, which is dates are ongoing with a schedule that which 24 were completed during the SEK 98.8 million lower than the budg- deviates from the original schedule. The year. A total of 15 of the mandates went eted amount of SEK 99.7 million. The cause of the deviations can in four cases according to plan, while nine deviated greater part of the budget , SEK 70.0 be attributed to the pandemic. In the from the established plan. One mandate million, refers to FVM, (the Future other two cases, the mandates have has not commenced. The reason why Healthcare Information Environment). been strategically redesigned to these mandates deviated from the The programme’s procurement has improve the delivery. established plan and why one mandate been suspended. From 2021, the invest- has not commenced can be linked to ment budget for FVM will be trans- Future healthcare information COVID-19, as certain de-prioritisations ferred to funds for measures to extend system have been necessary. These mandates the lifespan of the healthcare service’s In connection with the Regional Execu- will commence as soon as possible in existing IT system and the work on a tive Committee’s decision to suspend 2021, if the pandemic subsides. generational shift in the healthcare IT the procurement of FVM, RS 2019– environment. The expenditure for the 1041, the regional chief executive was Goals year of SEK 0.9 million refers primarily tasked with presenting proposals for The committee is responsible for the to the Regional Executive Committee’s measures to extend the lifespan of the committee-specific goalHigh quality replacement investments within IT. healthcare service’s existing IT system healthcare services, which means that and how work on a generational shift in the committee must manage and follow Digitalisation the healthcare IT environment could be up on the goal and its indicators. Two To safeguard Region Stockholm’s resumed. A process has been estab- indicators could not be measured due to decision-making process during the lished based on the healthcare provid- the fact that there was no available pandemic, the Regional Council ers’ needs, and a number of measures outcome at the time of the annual decided in March 2020 to enable digital have been decided on by the regional accounts. Of the 20 indicators that were meetings, RS 2020–0284. In line with chief executive, including the develop- measurable, eight indicators achieved this, the Regional Executive Committee ment of new and improved functional- their target value, which means that the decided in April to allow digital remote ity. A proposal for a plan to resume the target was not reached for 2020. For participation at meetings of the execu- generational shift will be developed in two of the indicators, it was not possible tive committee’s committees and the first half of 2021. to assess goal fulfilment.

56 Annual Report 2020 Committees Healthcare in the right place half of the year, patients have also Healthcare at the right time Healthcare in the right place has been largely refrained from seeking care. The pandemic has had an impact on the affected by the pandemic, which has Inpatient patterns for geriatric care healthcare guarantee for both treatment meant that none of the indicators have been affected by COVID-19. This and visits to clinics. Many patients have achieved their target value. The com- can be explained by the fact that patients themselves cancelled scheduled health- mittee decided to cancel planned have not come directly to geriatric care appointments and treatments medical care to be able to take care of departments to the same extent, but during the pandemic, for example in COVID-19 patients, which has affected have first been to an emergency hospital somatic care, GP practice, podiatry, the distribution of where the care has before being admitted to geriatric care. hearing rehabilitation and speech been carried out. For most of the first therapy.

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

High quality healthcare services Not fulfilled● Healthcare in the right place Percentage of consultant visits carried out by consultants outside emergency hospitals 54.6% 54.4% ≥ 57% Not fulfilled● Percentage of visits to local emergency clinics out of the total number of visits to local emergency clinics and the emergency hospitals’ Accident & Emergency departments 48.7% 49.4% ≥ 52% Not fulfilled● Percentage of emergency admissions of patients over the age of 80 who have been admitted directly from home to a geriatric clinic 21.2% 24.2% Increase Not fulfilled●

Healthcare at the right time Percentage of patients who spent no more than four hours in the Accident & Emergency department 47.0% 48.0% ≥ 78% Not fulfilled● Percentage of patients who received a medical evaluation within three days at their GP clinic 90.0% 90.0% ≥ 85% Fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 68.0% 70.0% ≥ 73% Not fulfilled● Percentage of patients who received an appointment for treatment within 90 days 74.0% 85.0% ≥ 90% Not fulfilled●

Safe healthcare Incidence of hospital-acquired infections 8.5% 7.3% ≤ 7.7% Not fulfilled● Readmission to inpatient care within seven days (patients over 80 years2) 7.1% 7.9% ≤ 7.5% Fulfilled● Antibiotic prescriptions (number of prescriptions filled for antibiotics per 1,000 inhabitants) 238 295 ≥ 296 Fulfilled● Average current quality index for emergency hospitals N/A 91.8 Increase –

Effective healthcare Structure-adjusted healthcare costs per inhabitant, SALAR processing N/A1) SEK 29, 888 ≤ SEK 27,844 Not fulfilled● Number of cases closed in 1177 Vårdguiden’s e-services per 1,000 inhabitants and month 60.6 35.4 ≥ 42 Fulfilled● Percentage of GPs who offer video conferencing 79.0% – ≥ 40% Fulfilled● Number of days ready for discharge per medical care event 0.8 – ≥ 2 Fulfilled● Average number of days spent in hospital per medical care event 3.6 3.6 Reduce Not fulfilled● Cost per DRG point (Diagnosis Related Groups), SALAR processing N/A SEK 64,641 Reduce – High efficiency in care N/A – ≥ 60% –

Improved public health Percentage of GP clinics conducting active disease prevention 75.7% 79.8% ≥ 80% Not fulfilled● Percentage of 19-year-olds with lateral surfaces that are free from caries 73.5% 71.3% ≥ 71% Fulfilled●

Healthcare focused on the patient Percentage of the county’s inhabitants with a high level of trust in the healthcare service 69% 61.0% ≥ 65% Fulfilled● Percentage of people who would recommend their GP clinics to others 81.0% 79.0% ≥ 82% Not fulfilled●

Core operations shall be prioritized The administration’s share of the costs 1.2% 1.2% Reduce Not fulfilled●

1) Goal assessment has been made based on outcomes from previous years. 2) Percentage of patients over 80 years of age who were discharged during the year and who were then re–admitted within 7 days, excluding admissions and discharges to psychiatric inpatient care.

Committees Annual Report 2020 57 The COVID-19 pandemic has greatly not achieved the set target value due programme in areas with poorer dental affected the work in Accident & Emer- to the trend of increasing costs within health has probably been important. gency departments. The work has been the healthcare service. The indicator organized in new flows, where patients value for 2020 is based on the outcome Healthcare focused on the patient with a suspected COVID-19 infection for 2019. In 2020, a continued positive trend of are separated from other patients. Number of completed cases in 1177 confidence in the healthcare service Processing times have been extended Vårdguiden’s e-services per 1,000 was seen, and the outcome was 69 due to, among other things, the use of inhabitants per month exceeded the set percent, which exceeded the Regional protective equipment, increased testing level, 61 cases compared to 42 cases, Council’s target value by four percent- and the larger proportion of substitute and Percentage of GPs who offer video age points. It is likely that confidence in staff and newly hired staff who have conferencing has increased, 79 percent the healthcare service has been affected been working in the Accident & Emer- compared to 40 percent. The number of by the pandemic, based on the popula- gency departments. days ready for discharge per medical tion’s experience of the healthcare care event, 0.8 days, is better than the service’s ability to handle the pandemic. Safe healthcare set level of 2.0 days. The indicator Percentage of people With COVID-19, the most important Average number of days spent in who would recommend their GP clinic work has been to safeguard patient hospital per medical care event is 3.6 to others, which was 81 percent, has safety within the healthcare service. days, which is the same level as in 2019, improved by two percentage points New routines for coping with the situa- and thus has not achieved the target compared with the outcome in 2019, but tion within the healthcare service have value of a declining average length of did not reach the target value of 82 been developed in a short period of time. hospital stay. A declining average length percent. Measures that have been planned within of hospital stay has been difficult to the scope of regular patient safety have achieve during the year. An important The administration’s share been postponed to a future date. explanation for this is that the emer- of the costs Reporting on the number of hospital- gency hospitals have cared for a large The outcome for the indicator was 1.2 acquired infections could not be carried number of patients with COVID-19. percent for 2020, which is equal to the out as planned. Only one point-­ These patients have had a greater need outcome in 2019 and thus the indicator prevalence measurement has been for care and generally a longer average was not achieved. One explanation for carried out instead of the normal two length of hospital stay than the average the fact that the administration’s costs measurements. The target value for for other types of care. have not decreased is the resources that Incidence (prevalence) of hospital-­ have been required to cope with the acquired infections has not been Improved public health ongoing pandemic. achieved and has been at a higher level Percentage of GP clinics that carry out in 2020 compared with 2019. active disease prevention was 75 Healthcare consumption Prescription of antibiotics (number of percent, which is lower than the target The pandemic has had a major impact antibiotic prescriptions filled per 1,000 value of 80 percent. The pandemic has on the healthcare consumption in the inhabitants) has continued to decline, meant that GP clinics have given prior- region. Doctor visits decreased by 18 which is positive. The number of pre- ity to emergency appointments for care percent compared to 2019. The number scriptions filled is now 238 compared to that cannot wait due to the pandemic. of other visits (such as nurse visits, 295 the previous year, and has also As a result, disease prevention has had physiotherapy, occupational therapy, achieved the target value. The target to take a back seat. speech therapy and podiatry) decreased level for 2020 was 296 antibiotic pre- The indicator Percentage of 19-year- by nine percent. Remote contacts scriptions filled per 1,000 inhabitants. olds with lateral surfaces that are free increased sharply, for example within from caries had a better outcome, general practitioner operations, where Effective healthcare 73.5 percent for both the target value, remote contacts increased by 1,300 Structure-adjusted healthcare costs 71 percent, and for the previous year, percent compared with 2019. The per inhabitant, SALAR processing has 71.3 percent. The enhanced prevention number of medical care events in

Healthcare consumption Healthcare Region Stockholm* Outcome Budget Deviation Annual accounts Change total ’000 2020 2020 % 2019 Medical care events 292 310 –5.9% 301 –2.8% Doctor’s appointments 5,944 7,436 –20.1% 7,248 –18.0% Appointments with other healthcare providers 10,216 11,635 –12.2% 11,279 –9.4%

* Excluding KSON.

58 Annual Report 2020 Committees inpatient care declined by 2.8 percent. subsequently increase more and more The pandemic has meant that digi-­ The reduction corresponds to 9,000 during the autumn. This meant that the physical healthcare has had a break- medical care events and is found mainly emergency hospitals once again had to through and has increased dramatically. in specialist somatic care. downgrade planned care. The number Ever since the COVID-19 pandemic of medical care events in emergency Maternity care began, the emergency hospitals in care decreased by 1.7 percent compared Maternity care includes both outpatient Region Stockholm have experienced a with the previous year. A decrease and inpatient care, and the inpatient care very high number of people with sus- occurred at Södersjukhuset AB, Capio in turn includes antenatal and postnatal pected or confirmed infection, and with S:t Görans Sjukhus, S:t Eriks Ögon­ care, in addition to the actual birth. an urgent need for the emergency sjukhus AB and Danderyds Sjukhus AB. The number of visits within maternity hospital’s resources. Elective care was On the other hand, the number of medical care was 112,000, which is a decrease of suspended, following a decision by care events increased at Karolinska 0.8 percent compared to the previous RSSL, the Regional Special Healthcare University Hospital and Södertälje year. In total, the number of births was Management, in order to maintain Sjukhus AB.. 28,362. This corresponds to an increase emergency and critical care. Demand Within psychiatry, the number of of 0.1 percent compared with 2019. In for care has also changed as a result of medical care events was 4.7 percent total, 95.1 percent of births took place in the COVID-19 pandemic, which has lower than the previous year. Within the maternity clinic that was the par- affected total healthcare consumption. geriatric care, the number of medical ents’ first choice, which is an increase Visits have been cancelled and physical care events decreased by 7.3 percent. compared with the previous year. visits have to some extent declined in Inpatient geriatric care has decreased favour of digital visits. In the areas as a result of the geriatric clinics having Prehospital care where digital visits occur, for example to reorganize their operations to be able The pandemic has created many chal- in primary care and psychiatry, there to accept patients diagnosed with lenges and has affected prehospital care has been a sharp increase. The emer- COVID-19. To cope with this, the in 2020. Through good collaboration gency hospitals have found other operations have reduced their number and by joining forces, voluntary produc- approaches, and offered their patients of beds, which means fewer medical tion coordination within the region has remote contact in order to maintain as care events. The reduction in the num- been able to maintain a good level of good a level of accessibility as possible. ber of medical care events within accessibility and preparedness, and psychiatry and geriatrics can be attrib- parts of the prehospital care system Medical care events uted to COVID-19. have been directed to Karolinska COVID-19 has affected all operations University Hospital. COVID-19 has led both in emergency hospitals, geriatrics Doctor’s visits and visits to other to the re-routing of patients between and psychiatry, as well as by external healthcare professionals13 emergency hospitals, which has private healthcare providers. Overall, Up to and including December, required special measures to improve the number of medical care events has 16,100,000 visits were made to doctors the transport capacity of the prehospi- decreased by 2.8 percent compared and other healthcare providers, which tal system. In total, more than 300,000 with the previous year. The emergency was a decrease of 12.8 percent compared patient transports were carried out hospitals have had to postpone planned to the previous year. The number of doc- within prehospital care, which was an care so that emergency and critical care tor’s visits was 5,900,000, which was a increase of eleven percent compared could be maintained. During the reduction of 18.0 percent. The number with the previous year. summer, the intense pressure on the of visits to other healthcare providers In January, a new organisation was emergency hospitals as a consequence was 10,200,000, which was a decrease introduced at the Prioritization and of COVID-19 eased, which meant that of 9.4 percent. The decrease can be Routing Service (SOS Alarm). The the emergency hospitals could begin to explained by the ongoing pandemic purpose is to streamline and simplify deal with elective care to a greater which, among other things, has led to a the allocation of assignments. extent. In September, the spread of change in behaviour among the popula- infection began to pick up again, to then tion in terms of seeking medical care.

Financial result Healthcare Committee

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Healthcare Committee 253.1 0.0 253.1 0.4% 57.2

13 These include visits to district and assistant nurses at general practitioners’ clinics and to physiotherapists, speech therapists, occupational therapists and chiropractors.

Committees Annual Report 2020 59 Dental care 3,890 million, corresponding to 5.8 due to lower IT costs in health reim- The loss of production within dental percent, and can primarily be explained bursement systems and aid operations. care as a consequence of COVID-19 was by higher government grants received Other costs showed a deficit of SEK greatest in the number of oral health than were budgeted for. Government 465 million. The deficit can partly be examinations, which decreased by 69 grants that have increased or been explained by additional COVID-19 costs percent compared with the previous added during the year include general for Capio S:t Görans Sjukhus AB, costs year. RSSL decided that Folktand- government grants, SEK 503 million, for Älvsjö Hospital as well as communi- vården would conduct its activities to a grants related to healthcare accessibil- cations. The deficit for other costs can limited extent for a period of time in ity, SEK 611 million, grants as a conse- also be explained by the cost for external order to provide additional protective quence of COVID-19 for the period consultants amounting to SEK 58 equipment to the healthcare sector. January to November, SEK 993 million, million, of which consultancy costs Also in essential dental care and dental and grants for testing for COVID-19, attributable to COVID-19 were SEK 17 care as part of the treatment of disease, SEK 1,434 million. million. Remaining consultancy costs the decrease was considerable com- The committees operating expendi- were attributed to IT development for pared with the previous year, –20.7 ture was SEK 3,640 million, 5.4 percent health reimbursement systems as well percent and –12.9 percent, respectively. over budget. Purchased healthcare as to decision support systems for In child and adolescent dental care, services showed a deficit of pharmaceuticals. there was a loss of production in the SEK 3,209 million. To a large degree, The 2020 budget included adminis- autumn, which has largely been recov- the higher costs can be attributed to the trative savings of SEK 66 million, of ered. The percentage of children and pandemic. Karolinska University which SEK 42 million related to in- adolescents who visit public dental care Hospital has produced 5.7 percent more house staff, and SEK 24 million related was 90 percent, which is 2.4 percentage healthcare during the year compared to to consultancy costs. The outcome for points lower than the previous year and the agreement. The overproduction is staff costs, including hired staff, was lower than budget by 3.4 percentage due to more patients with COVID-19 SEK 14 million below budget, which points The number of referrals to being treated, which generated higher means that the streamlining efforts specialist dental care for children and costs for the Healthcare Committee. were more successful than planned. The adolescents increased by 14.4 percent The costs for advanced home care, outcome for consultancy costs was SEK compared with the previous year. The ASIH, increased due to increased 158 million, which is SEK 58 million reform of free dental care for the age volumes as well as higher costs per day higher than budgeted. If consultancy group 20–23 years during the period of care during the pandemic. The costs related to COVID-19 are excluded, 2017–2019 has led to a growing increase ambulance services also saw higher consultancy costs amounted to SEK 141 in the number of patients within spe- costs, which were due to additional million. That means a reduction of SEK cialist dental care for children and units being deployed and higher varia- 12 million compared to the 2019 out- adolescents in 2020 as well. ble costs than were budgeted for. The come, which corresponds to a reduction number of face-to-face appointments at of eight percent. Financial result GP clinics declined due to COVID-19. The Healthcare Committee’s result Instead, many patients have turned to Investments amounted to SEK 253 million, which is stakeholders within online out-of- Investment expenditure amounted to SEK 253 million higher than budgeted county care. The pandemic has also SEK 0.6 million and the work-up rate and corresponds to 0.4 percent of entailed additional costs for testing was nine percent in relation to the turnover. The deviation can primarily related to COVID-19 and interventions budget of SEK seven million. The be explained by higher revenue than to relieve the emergency hospitals. expenditure for the year referred to SEK was budgeted for. The higher revenue Staffing costs showed a surplus, 0.1 million for IT equipment, and SEK can primarily be linked to higher which was due to falling numbers of 0.5 million for other equipment. government grants. full-time equivalents in healthcare The result includes negative finan- administration as a consequence of the Digitalisation cial effects from the COVID-19 pan- administration’s efforts to streamline The year has seen a considerable demic amounting to a total of SEK –68 operations and make resources availa- increase in the use of digital services. million. The item comprises loss of ble to core operations. The number of video consultations in revenue as well as additional costs for Pharmaceuticals showed an surplus primary care increased by 1,094 percent December. Elsewhere, the result was of SEK 91 million, which was due to compared to the previous year. Around positively affected by medical care that pharmaceutical discounts and lower 84 percent of the Region Stockholm was deferred due to COVID-19. costs for infectious disease medicine. inhabitants now have an account with During the year, the Healthcare Property costs showed a deficit of SEK 1177.se, and in November the number of Committee had a turnover of SEK 71,234 93 million, which can be partly logins was 2.6 million, which is the million, of which SEK 63,588 million explained by the cost of premises for highest number so far. In the age range were appropriations. Älvsjö Hospital. IT and telecommunica- 60 and older, the total number of log-ins Revenue exceeded the budget by SEK tions costs showed a surplus, which was have increased by 70 percent.

60 Annual Report 2020 Committees In the spring of 2020, a self-assess- The committee leads Region for the National Programme Area, NPO, ment service for COVID-19 was devel- Stockholm’s structuring on the national for Infection and has worked intensively oped. The service quickly had consider- and regional level. The committee is with the development of national able impact and usage continued to responsible for ensuring that Region guidelines for the management of increase in the autumn. A little over two Stockholm reaches its antibiotics goal COVID-19 in collaboration with the million tests were carried out on the and that the vaccination rate is main- National Board of Health and Welfare, website. It is believed that the service tained at a nationally determined level. professional associations and the relieved the pressure on 1177 Vård- Hygiene within the healthcare sector patient association. guiden på telefon, which was under very has played a central role during the During the year, the Healthcare significant pressure, particularly at the pandemic. In order to meet the exten- Service Steering Committee had eleven beginning of the pandemic. In august sive need for Vårdhygien’s (Healthcare mandates assigned by the Regional 2020, a self-help programme for those Hygiene’s) expertise, from both the Council. Five of these mandates were concerned about COVID-19 was administration and authorities such as completed during the year. Four of the launched. The service is available at healthcare services and social care, it mandates went according to plan, while 1177.se. The service “Egen provhanter- was decided in March that Vårdhygien’s two deviated from the established plan. ing” has been used to manage analyses resources would be managed and The reason the mandates deviated from of COVID-19. prioritized from RSSL. the plan can be linked to COVID-19, as During the year, a project was Overall, cancer care in the region has certain deprioritisations were neces- developed to contribute to digital skills worked well for those who sought care. sary. These mandates will be recom- training in the healthcare sector. The Lead times have shortened during the menced as soon as the extent of COVID- goal was to provide practical support year, despite the strained situation 19 decreases. aimed at managers and employees who caused by the pandemic in the region. are working on developing their opera- However, 18–20 percent fewer patients Goals tions. The focus was on combining have been diagnosed with cancer High quality healthcare services digital and face-to-face approaches in during the year. People with symptoms Reporting of the percentage of hospi- contact with patients. Work is ongoing of cancer have sought care to a lesser tal-acquired infections could not be on developing a website, “Jobba digify- extent. In total for all care processes carried out as planned. Only one siskt”, which will provide guidance on and treatments within standardized point-prevalence measurement has how the departments can take the next care processes, SVF, where the patient been carried out instead of the normal step into a new way of working. has received care within the specified two measurements. The target value for lead time, the outcome for Region Incidence (prevalence) of hospital-ac- Healthcare Service Stockholm was 60 percent, which is an quired infections has not been achieved Steering Committee improvement compared to the outcome and was at a higher level in 2020 com- The Committee shall lead the know­ in 2019 of 47 percent. The national pared with 2019. ledge management organisation and the average was 51 percent in 2020, Antibiotic prescriptions (number of expertise structure within the health- 44 percent in 201914. antibiotic prescriptions filled per 1,000 care service in Region Stockholm. Region Stockholm acts as the host inhabitants) has continued to decline,

Sustainable regional development Outcome Outcome Target Goal Healthcare Service Steering Committee 2020 2019 value 2020 fulfilment

High quality healthcare services Incidence of hospital-acquired infections 8.5% 7.3% ≤ 7.7% Not fulfilled● Antibiotic prescriptions (number of prescriptions filled for antibiotics per 1,000 inhabitants) 238 295 ≥ 296 Fulfilled●

Core operations shall be prioritized The administration’s share of the costs 19.0% 34.0% Reduce Fulfilled●

Financial result Healthcare Service Steering Committee

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Healthcare Service Steering Committee 1.0 0.0 1.0 0.2% 43.5

14 https://cancercentrum.se/samverkan/vara-uppdrag/statistik/svf-statistik/vantetider-i-svf/

Committees Annual Report 2020 61 which is positive. The number of pre- service. The committee is also responsi- Digitalisation scriptions filled is now 238 compared to ble for analysing complaints and com- During the year, the Patient Advisory 295 the previous year, and has also ments to be used in the Healthcare Committee developed new digital achieved the target value. Committee’s and the healthcare provid- procedures to comply with the recom- ers’ systematic improvement efforts. mendations regarding working from The administration’s share of The number of cases linked to home. the costs COVID-19 since the pandemic began In March, the Patient Advisory The outcome for the indicator was was 799 and constitutes 11 percent of all Committee began receiving digital 19 percent for 2020, which is lower cases received during the year. It is still comments via the e-service 117. Due to than the outcome in 2019 and thus the too early to evaluate the long-term prevailing circumstances, the service indicator for 2020 was achieved. effects of the pandemic, but the com- could not be marketed according to mittee has not reported any increased plan, but it turned out that patients and Financial result costs linked to COVID-19 for 2020. their representatives were still able to The financial result for the Healthcare find the service and by the end of the Service Steering Committee amounted Goals year, 1,801 cases had been received. to one million kronor, which is one The administration’s share of During the same period, the number of million kronor better than the budgeted the costs incoming submissions and e-mails result of zero. The surplus is due to The outcome for the indicator was 18 decreased, which indicates a successful lower costs for fees to elected represent- percent, which is an increase compared transition. atives than budgeted. The committee with the outcome in 2019. The increase has not had any additional costs or is due to the fact that the administration Stockholm County’s reduced revenue linked to COVID-19. in 2020 has integrated existing system Healthcare Area support with 1177, enabling patients and Stockholm County’s Healthcare Area Digitalisation relatives to contact the administration (SLSO) is responsible for Region The Healthcare Service Steering more easily. Stockholm’s operations within primary Committee works with digitalisation The financial result for the Patient care, psychiatric care, child and adoles- issues jointly with the Healthcare Advisory Committee was SEK two mil- cent psychiatric care, addiction treat- Committee, see section 10.2. lion, a deviation of SEK two million ment, geriatric care, advanced home from the budgeted result. The deviation care, disability and rehabilitation Patient Advisory corresponds to 5.1 percent of turnover, services, including interpreters’ centre, Committee which can mainly be explained by lower aids, diet and somatic specialist care The Patient Advisory Committee is the personnel costs than budgeted. Due to a through special agreements. SLSO shall healthcare service’s independent and ban on visits to the departments, be responsible for R&D and education15 impartial body to which patients, physical visits have been replaced by within the areas of public health, and relatives, and healthcare personnel can telephone contact, which has entailed perform other mandates in accordance turn when there have been problems lower costs for support personnel as with special decisions. concerning the healthcare service, or there has been less demands on their In February, SLSO went into rein- when there are complaints relating to time. Furthermore, the administration forcement mode and, on the advice of how they have been treated, as well as to has not been able to hire new adminis- RSSL, activated LSSL16. In March, attitudes and quality in the healthcare trative officials due to COVID-19. SLSO was tasked by RSSL to coordinate

Outcome Outcome Target value Goal Sustainable regional development Patient Advisory Committee 2020 2019 2020 fulfilment

Core operations shall be prioritized The administration’s share of the costs 18.0% 12.0% Reduce Not fulfilled●

Financial result Patient Advisory Committee

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Patient Advisory Committee 1.7 0.0 1.7 5.1% 0.4

15 R&D and education: Research, development and education 16 Local Special Hospital Management

62 Annual Report 2020 Committees all local healthcare, i.e. primary care, In March, SLSO was given responsi- High quality healthcare psychiatry, ASiH17 and geriatric care bility for the Älvsjö emergency hospital services within Region Stockholm, regardless with operational capability until the Both the indicators Percentage of of whether the operations were run summer. In July, SLSO’s operations patients who received a medical evalu- in-house or privately. SLSO was also returned to normal, as the number of ation within three days at their GP clinic given responsibility for an emergency patients with COVID-19 in need of and the indicator Percentage of patients warehouse and distribution of critical medical care gradually decreased. who received an appointment for a first protective equipment, such as face In November, SLSO was again tasked visit to a consultant within 30 days have masks, respiratory equipment and with establishing an operational coordi- achieved their target values. Despite the visors, to all operations in local health- nation function with the task of support- COVID-19 pandemic, accessibility has care. ing healthcare providers, and collabo- been good, but this may to some extent A collaborative organisation for rating with municipalities during the be due to the fact that the public is operational crisis management of all pandemic, HSN 2020–1637. In Decem- seeking less medical care. The number healthcare providers was established in ber, the Healthcare Committee decided of inhabitants seeking medical care for collaboration with all the county’s to give SLSO responsibility for the problems other than suspected COVID- municipalities. Separate care flows to operational planning of the vaccination 19 fell sharply during the period March reduce the spread of COVID-19 were programme for the elderly and risk to May. Percentage of patients who established throughout the county and groups within local healthcare. Vaccina- received an appointment for treatment SLSO’s app Alltid öppet was launched. tion of the elderly and risk groups in within 90 days did not achieve the The percentage of digital contacts local healthcare is expected to continue target value, but the outcome has increased by more than 1,000 percent. until June 2021. improved compared with the previous SLSO also set up a mobile testing unit year. that initially had the task of sampling Goals Number of days ready for discharge SÄBO residents that had suspected Stockholm County’s Healthcare Area per medical care event was 2.4. The COVID-19 infections18. The testing shall aim to achieve indicators linked to indicator did not achieve its target value, capacity was gradually increased. Crisis the goal: High quality healthcare ser- but there has been a clear improvement support at both an individual and group vices. Of the seven indicators that the during the year. level and special management support committee aims to achieve, four indica- was established. tors achieved their target values.

Sustainable regional development Outcome Outcome Target Goal Stockholm County’s Healthcare Area 2020 2019 value 2020 fulfilment

High quality healthcare services Percentage of patients who received a medical evaluation within three days at their GP clinic 96% – ≥ 85% Fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 75% 81% ≥ 73% Fulfilled● Percentage of patients who received an appointment for treatment within 90 days 83% 79% ≥ 90% Not fulfilled● Incidence of hospital-acquired infections 3.7% 2.20% ≤ 7.7% Fulfilled● Number of days ready for discharge per medical care event 2.4% 4.9 ≥ 2 Not fulfilled● Percentage of GP clinics conducting active disease prevention 92% 92% ≥ 80% Fulfilled● Percentage of people who say they would recommend their GP clinics to others 80% 84% ≥ 82% Not fulfilled●

Core operations shall be prioritized The administration’s share of the costs 1.6% – Reduce Fulfilled●

Financial result for Stockholm County’s Healthcare Area

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Stockholm County’s Healthcare Area 228.7 220.0 8.7 0.1% 228.6

17 Advanced home care 18 SÄBO (Assisted living facilities)

Committees Annual Report 2020 63 The administration’s share affected by medical care that was Karolinska of the costs deferred due to COVID-19. University Hospital The outcome for the indicator was 1.6 The operating revenue was The committee is Region Stockholm’s percent for the year, which is a decrease SEK 166 million, 1.3 percent over university hospital responsible for compared with the previous year. budget. The positive deviation can national highly specialised healthcare Adjustments in operational support mainly be explained by contributions and regional hospital care, with the have been carried out to make the received, such as compensation for sick exception of ophthalmology, rehabili­ administration more efficient, and pay costs from Försäkringskassan and tation medicine and hand surgery. experience of new working methods government compensation for addi- Furthermore, the committee is Region during the COVID-19 pandemic will tional costs linked to COVID-19. Stockholm’s specialised trauma centre, form the basis for further efficiencies. Operating costs exceeded the budget with responsibility for the care of by SEK 161 million, 1.3 percent. The severely injured patients. The health- Healthcare production largest deviation was for personnel care mandate shall cover specialised In 2020, the COVID-19 pandemic had costs, sick pay costs and overtime pay, and highly specialised healthcare and a major impact on production. Within which exceeded the budget by SEK 194 shall be related to the hospital’s geriatric care, both outpatient and million, corresponding to 1.7 percent. research and education mandate. inpatient geriatric care, production was The increase in personnel-related costs According to a ranking published in significantly lower than budget, –37 is largely an effect of the ongoing pan- the magazine Newsweek in early March, percent and –18 percent, respectively. demic. Premises and property costs Karolinska University Hospital was Outpatient care was closed during the exceeded budget by SEK 47 million, 4.5 ranked the tenth most distinguished period from March to July, a measure percent, due to partly non-budgeted hospital in the world. The ranking intended to reduce the spread of infec- rent for vacant premises and double included hospitals in 20 countries and tion and facilitate the work within rent pertaining to FHS (the Swedish is based on a weighting of medical geriatric care. In inpatient care, more Defence University) and rent of isola- results, patient-reported quality/expe- beds have been closed as the COVID-19 tion tents within primary care. rience, and recommendations from pandemic took up human resources. doctors, other healthcare professionals Psychiatry has also been affected by the Investments and managers in the healthcare sector. pandemic as staff sick leave contributed The expenditure for the year, excluding Tens of thousands of healthcare work- to a lower outcome for the number of strategic equipment investments, ers in the 20 countries selected were visits. Since the summer, there has amounted to SEK 203 million and was chosen to answer questions online. generally been an increase in the SEK 124 million under budget. The In 2020, Karolinska University number of visits. Compared with the work-up rate was 62.1 per cent in Hospital cared for the most patients and budget, 18,000 visits have been made, relation to the year’s budget of took the most tests related to the 1.4 percent more visits in psychiatric SEK 327 million, excluding strategic COVID-19 pandemic nationwide. The outpatient care. For operations within equipment investments. The deviation employees have experienced very primary care, the COVID-19 pandemic is mainly due to delays in planned IT difficult working conditions with has resulted in fewer visits due to investments. overtime and long shifts. Despite the sickness among both staff and patients, tough start, Karolinska University and visits have been cancelled to pre- Digitalisation Hospital has succeeded in accomplish- vent the spread of infection. Other The organisation’s operational develop- ing 106 percent of the healthcare reasons for the reduction in visits to ment and digitalisation have acceler- assignments ordered by the region and primary care were that four out of six ated rapidly during the pandemic. accomplished approximately 90 per- GP clinics suspended operations on Interest downloading the “Alltid öppet” cent, if COVID-19 care is excluded. To March 20, as they could not accept app increased, and at the end of the help them, the staff have had a new infectious patients due to the risk of year, 346 care units within SLSO used information supply tool as well as a spreading the infection. the app for video conferencing, which change in management and organisation can be compared to 94 units in Decem- with smaller and more efficient admin- Financial result ber 2019. istration. During the pandemic, the The result amounted to SEK 229 million In total, just over 264,000 video­ committee has also been given an addi­ and thus exceeds the budgeted result by conferences were held, compared with tional mandate by Region Stockholm, SEK nine million. The deviation corre- 21,000 video conferences in 2019. to establish a Command Center to take sponds to 0.1 per cent of turnover. During the year, SLSO’s operations also care of the region’s need for protective The result includes negative financial began to use the chat feature to a greater equipment in respect of COVID-19. effects from the COVID-19 pandemic extent, almost 130 units in SLSO have amounting to a total of SEK –285 million. started to use the chat feature, which Goals The item comprises loss of revenue as can be compared with the seven units Karolinska University Hospital shall well as additional costs for December. that used the feature in 2019. aim to achieve indicators linked to the Elsewhere, the result was positively goal: High quality healthcare services.

64 Annual Report 2020 Committees Three indicators could not be measured resources in favour of pandemic-related exhibit approximately a doubling in the due to the fact that there was no availa- care. average length of hospital stay. ble outcome at the time of the annual Incidence (prevalence) of hospital-­ accounts. Of the six indicators that were acquired infections was 11.3 percent, The administration’s share of measurable, none of the indicators which is a decrease from the previous the costs achieved their target value. year when the outcome was 11.8 per- In comparison with the outcome in cent. The committee has a relatively 2019, the indicator Administration’s High quality healthcare services high proportion of at-risk patients, in share of the costs has fallen by 0.44 Percentage of patients who spent no accordance with its care mandate, percent to two percent of total costs. more than four hours at the Accident & which means it is a challenge to achieve Changes in the hospital’s organisation Emergency department. The indicator the target value. Efforts to reduce the and management have been imple- was not achieved as it has been affected incidence of hospital-acquired infec- mented to reduce and streamline the by the extent of the influx of patients tions must be balanced against, for administration. with suspected or confirmed COVID-19. example, excessive use of antibiotics, Additional challenges, such as the which entails other risks for patient Healthcare production possibility of triage in external tents, safety. During the year, Karolinska University availability and response time for acute Number of days ready for discharge Hospital managed to keep production at COVID-19 tests as well as varying per medical care event could not be a good level, and including the demand- staffing levels have had an impact. measured as there was a lack of appro- ing and staff-intensive care for COVID­ The committee did not achieve the priate system support. In general, the 19 patients, they have exceeded their target values ​​for Percentage of patients committee’s assessment is that an production mandate. Karolinska who waited a maximum of 30 days and improvement has taken place in recent University Hospital is the hospital that Percentage of patients who received an years, although probably not yet in line has cared for the most patients with appointment for treatment within 90 with the target value. COVID-19 nationwide. In 2020, more days. The pandemic has affected the Average number of days spent in than 7,500 patients were treated and at outcome of both indicators through, for hospital per medical care event has a its peak, 50 percent of the hospital was example, reduced referral inflows and tangent value compared with 2019. In dedicated to COVID-19-related care. the absence of patients. Non-emergency 2020, it could be considered a good Accessibility was affected by the care has been deferred to redistribute result because COVID-19 patients pandemic and medical care that could

Target Outcome Outcome value Goal Sustainable regional development Karolinska University Hospital 2020 2019 2020 fulfilment

High quality healthcare services Percentage of patients who spent no more than four hours in the Accident & Emergency department 54.2% 56% ≥ 78% Not fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 63.5% 49% ≥ 73% Not fulfilled● Percentage of patients who received an appointment for treatment within 90 days 62.6% 73% ≥ 90% Not fulfilled● Incidence of hospital-acquired infections 11.3% 11.80% ≤ 7.7% Not fulfilled● Average current quality index for emergency hospitals N/A 92.4 Increase – Number of days ready for discharge per medical care event N/A – ≥ 2 – Average number of days spent in hospital per medical care event 4.4 – Reduce Not fulfilled● Cost per DRG point (Diagnosis Related Groups), SALAR processing1) N/A SEK 88,504 Reduce – High efficiency in care N/A ≥ 60% –

Core operations shall be prioritized The administration’s share of the costs 2% Reduce Fulfilled●

1) Data from SALAR, inpatient and outpatient care excluding outliers

Financial result Karolinska University Hospital

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Karolinska University Hospital 73.2 53.0 20.2 0.1% –18,66.6

Committees Annual Report 2020 65 have been delayed has been deferred. committee’s laboratory operations. order to be able to handle the pandemic. During the year, the committee intro- Contributions received caused a large Medical technology and IT have been duced measures to shorten the waiting positive deviation, SEK 1,634 million, brought together in one organisation so list, improved flows and processes as which mainly refers to government that the hospital can be a developmental well as improved management close to grants received by the committee for leader. Increased use of data and analy- the point of care. additional costs for COVID-19. Other sis to design inpatient care has been An important aspect of meeting this revenue also shows a positive deviation, implemented. The result of this has been year’s challenges has been to adapt the SEK 683 million, as the committee that for each month in 2020, the hospital number of employees to the mandate. received compensation for increased sick has had significantly more beds than the A prerequisite for enabling an increase in pay costs and the resale of protective previous year. The challenges ahead capacity in inpatient care was to increase equipment within the Command Center. consist of making processes more the number of available beds. A project Operating costs exceeded the budget efficient, including automation/digitali- with a harmonization of working meth- by SEK 2,943 million, or 13.9 percent. sation, including administrative IT tools. ods and increased use of data and analy- The deviation was driven by COVID-19 sis to design inpatient care has been and most of the costs have matching Transport Committee carried out by the hospital’s care manag- revenue in the form of various remunera- The Transport Committee is responsible ers. The result of this has been that for tions linked to COVID-19. Personnel for terrestrial public transport and pub- each month in 2020, the hospital has had costs show a negative deviation of SEK lic transport at sea, with the exception of significantly more beds available than 966 million, 8.6 percent, against budget, special public transport which refers to the corresponding month in 2019. of which hired personnel account for just transport for people with disabilities and The aim to maintain out-of-county under a quarter. The cost of hired per- neurodiversity. The Transport Commit- and foreign patients in 2020 has not sonnel was double what was budgeted. tee is responsible for coordination of been fully met due to the COVID-19 Purchased healthcare and operational overall issues of a fundamental nature pandemic and the consequent regional services had higher costs than budgeted, between AB Storstockholms Lokaltrafik, guidelines for restricted travel into the mainly due to the coordination of mass AB SL, and Waxholms Ångfartygs AB, country and the limited mobility of testing and for maintaining healthcare WÅAB. The fact that the Transport patients within the country. production. Another deviation from the Committee has an overall perspective budget is cost of supplies, SEK 1.5 billion, on, and takes overall responsibility for, Financial result which in summary is due to mass testing the public transport system is crucial for The result amounted to SEK 73 million and the Command Center’s large inven- achieving the council’s goals. The com- and thus exceeded the budgeted result by tory, as well as the impairment of mittee’s mandate includes the expansion 20 million. The deviation corresponds to approximately SEK 700 million due to of the new Underground network. 0.1 percent of turnover. The result changed net sales value. Managing the Significant events that characterized includes negative financial effects from Command Center has also meant the year have been linked to the meas- the COVID-19 pandemic amounting to a increased transport costs. ures that had to be taken within public total of SEK –653 million. The item transport due to the pandemic. The comprises loss of revenue as well as Investments majority of the work that had to be additional costs for December. In other The expenditure for the year, excluding carried out concerned reducing conges- respects, the result for the year was strategic equipment investments, tion within public transport, thereby positively affected by lower costs as a amounted to SEK 390 million and preventing the spread of infection. result of medical care that has had to be exceeded the year’s budget by Agreements have been renegotiated and deferred until next year due to COVID-19. SEK 15 million. The work-up rate communication campaigns have been Operating revenue exceeds the budget amounted to 104 percent in relation to carried out to urge passengers not to by SEK 2,990 million, or 13.6 percent in the year’s budget of SEK 375 million. travel unless they have to. Where the risk comparison with the budget. The result includes COVID-19-related of congestion has been greatest, for Revenue for the production of health- investments amounting to SEK 112 example travelling to and from hospitals care fell below the budget by SEK 644 million. The committee has applied for and certain departures in the archipel- million. The decrease was mainly due to and received special compensation for ago transport system, reinforcements in reduced demand for out-of-county care most of the investments. The expendi- the form of additional buses, trains and and the care of foreign patients as a ture for the year, including strategic boats have been implemented. During result of COVID-19. This was partially equipment investments amounted to the pandemic, ticket inspectors have had compensated by increased care contract SEK 663 million. to adjust their approach in order to both revenue for the client mandate within observe congestion and contribute to Region Stockholm due to overproduction. Digitalisation ticket revenue security. Sales of healthcare services were A clear success factor for Karolinska A selection of other public transport higher than budget, SEK 1,335 million, University Hospital has been a new events during the year is listed below: due to the mass testing linked to COVID- digital information supply tool for The new Underground train, C30, was 19, which was carried out within the structuring and quickly adapting in put into service on the Underground’s

66 Annual Report 2020 Committees Red Line. Ten carriages have been Goals which means that the indicators could delivered, which means that five full- The committee is responsible for the not be followed up. length trains can be run. committee-specific goalAttractive In order to still be able to get an idea • Delivery and commissioning of the public transport in a sustainable public of the​​ trend in respect of passenger new A35 train for the Light Rail transport system, which means that the satisfaction, the development is being network. committee must manage and follow up followed via the survey, the Public • Upgrades of the C20 Underground the goal and its indicators. Three Transport Barometer, which the indus- trains have been approved for serial indicators could not be measured due to try organisation Swedish Public Trans- production. All 271 carriages will be the COVID-19 pandemic. Of the ten port conducts. Over time, both meas- modernized by 2023. indicators that were measurable, six urements show the same trend, that the • Roslagsbanan’s new Vallentuna depot indicators achieved their target values, perceived satisfaction with public was given its final inspection. which means that the goal was achieved transport remains good. • Kista and Solnagren on the Light Rail for 2020. During the year, a new SL app (iOS network have been connected. and Android) was launched to provide • The number 83 commuter boat line, Attractive travel passengers with clearer and more the new commuter route from The percentage of satisfied passengers accessible information about public Vaxholm, commenced and will go within public transport and public transport. It is likely that the result is back and forth between Vaxholm and archipelago transport has, over time, reflected in the Public Transport Strömkajen. had a stable trend above the target value Barometer as several quality factors • A new version of the SL app and the of the indicator. In April 2020, the within the area of ​​information were website SL.se was launched. Transport Committee decided not to rated higher in December, such as the conduct the customer survey on per- information prior to travelling and in ceived quality due to the pandemic, the event of changes and disruptions.

Outcome Outcome Target value Goal Sustainable regional development Transport Committee 2020 2019 2020 fulfilment

Attractive public transport in a sustainable transport system Fulfilled● Attractive travel Satisfied passengers – public transport N/A 80% ≥ 78% – Satisfied passengers – special public transport1) 90% 86% ≥ 86% Fulfilled● Satisfied passengers – archipelago public transport N/A 96% ≥ 96% –

Safe travel Percentage of passengers who feel safe on terrestrial public transport and on commuter boats N/A 72% ≥ 79% – Percentage of safe journeys – special public transport1) 77% – ≥ 76% Fulfilled●

Efficient travel Expenditure per person and kilometre, SL service SEK 5.14 SEK 3.30 ≤ SEK 3.35 Not fulfilled● Thousands of passengers on a regular weekday 1,859 2,851 ≥ 3,037 Not fulfilled● The public transport sector’s share of motorised journeys 47.5% – ≥ 51.5% Not fulfilled●

Sustainable travel Fulfilment of environmental goals in the environmental programme 33% – ≥ 80% Not fulfilled● Fulfilment of environmental goals in the public transport supply programme 57% – ≥ 58% Fulfilled● Percentage of renewable energy in public transport 93% 91% ≥ 93% Fulfilled●

Accessible and cohesive region Fully accessible route or transfer point (excl. boat traffic) 80% – ≥ 80% Fulfilled● Public transport travel time between regional city centres and Arlanda Airport must be competitive with travel time by car (RUFS), percentage of the regional city centres that have a travel time ratio below 1.5 57% – ≥ 50% Fulfilled●

Core operations shall be prioritized The administration’s share of the costs Transport Administration 2.4% 2.3% Reduce Not fulfilled● Underground Expansion Administration 10.8% 14.2% Reduce Fulfilled●

1) The Mobility Service Committee is responsible for this indicator. The indicator is reported in the table to provide an overview of the indicators included in the committee– specific goal of “Attractive public transport in a sustainable transport system”.

Committees Annual Report 2020 67 Safe travel experiments to increase the safety of Efficient travel Feeling safe on the way to and from female passengers have not been Travel has decreased drastically as a one’s destination on public transport is possible. However, a number of other result of the pandemic and the recom- crucial in order for the inhabitants in activities have been carried out. mendations issued by the Swedish the county to choose public transport • A safety chat feature, which contrib- Public Health Agency. At the same time instead of the car. The goal is particu- utes to increased safety for passen- as passengers are urged not to travel, larly challenging as COVID-19 has made gers regardless of the type of public public transport has been running passengers feel a different type of transport or the time of day, con- according to regular timetables to insecurity when travelling by public nected to Trygghetscentralen has minimize congestion and the spread of transport. When the customer survey been launched. infection for those who have to travel by Perceived Quality, which includes • More cameras have been installed in public transport. safety, was not carried out in 2020, the new places within the public trans- Reduced travel means that the indicators connected to the target could port system. targets for passengers, public trans- not be measured for the year. • Collaboration has been carried out port’s percentage of motorized travel Perceived safety, measured via the with municipalities and the police to and cost per passenger kilometre have Public Transport Barometer, has focus on particularly vulnerable not been achieved. The indicator, decreased significantly since February. individuals and groups. Number of thousand passengers on a In the survey, 61 percent of passengers • Collaboration agreements have been normal weekday, showed a 35 percent feel that it is safe to travel with SL. drawn up to enable Region Stockholm decrease compared to the previous There is a clear link between those who to work with the organisations year’s outcome. feel unsafe and those who are worried Stadsmissionen and Nattskiftet. about contracting infection on public • Furthermore, procurement of safety Sustainable travel transport. stewards for particularly vulnerable Achieving sustainable travel is very Work with initiatives to increase individuals/groups, such as the much about fulfilling the environmen- safety in 2020 have to some extent been homeless and people who live in tal goals in the 2021 environmental affected by the pandemic, where experi- vulnerable areas, has been carried programme. The lower outcome in 2020 ments with flexible night stops and pilot out. was largely due to the pandemic. How-

Passengers on public transport Outcome Budget Deviation Outcome Change Total thousands 2020 2020 budget 2019 % Terrestrial public transport Passengers* 1,859 3,037 –39% 2,851 –35% Maritime public transport Passengers** 3,168 6,463 –51% 5,859 –46%

* AB Storstockholms Lokaltrafik reports an average number of passengers on a weekday. ** Including archipelago transport and commuter boat routes.

Financial result Transport Committee Result Budget Deviation Deviation in Annual accounts MSEK 2020 2020 to budget percent 2019 Ticket revenue 5,437 9,308 –3,871 –41.6% 8,811 Appropriations 9,804 9,804 0 0.0% 9,491 Other revenue 5,914 3,962 1,952 49.3% 4,179 Total operating revenue 21,155 23,074 –1,919 –8.3% 22,480 Staff expenditure and hired staff –955 –1,011 56 –5.6% –947 Purchased transport –13,718 –14,326 608 –4.2% –13,522 Other expenses –3,734 –3,368 –367 10.9% –3,604 Total operating costs –18,407 –18,705 298 –1.6% –18,073 Depreciation –3,316 –3,462 146 –4.2% –3,249 Operating result –568 907 –1,475 1,159 Financial revenue 58 56 2 4.1% 63 Financial expenses –586 –558 –28 4.9% –610 Result –1,096 404 –1,500 611

*The Transport Committee includes the Transport Administration, AB Storstockholms Lokaltrafik, Waxholms Ångfartygs AB.

68 Annual Report 2020 Committees ever, the use of renewable energy Accessible and cohesive region The administration’s share of remains high. Newer transport agree- The COVID-19 pandemic has also the costs ments require 100 percent renewable affected work on accessibility, but For the Transport Administration, electricity, heating and cooling. The despite this, the goal has been achieved. Administration’s share of the costs was latest bus agreements signed before the The work of developing public transport 2.4 percent, compared to 2.3 percent in pandemic broke out, contain stricter in Region Stockholm continues, for 2019. The smaller increase is due to the requirements for energy efficiency, such example through ongoing dialogue for a fact that the costs for purchased admin- as economical driving, route optimiza- future supply of public transport to istrative services were higher compared tion (for example driving to and from Norra Djurgårdsstaden, investigation with the previous year. Administrative depots), innovative technology such as and planning for the expansion of tasks that were previously performed electrification, and higher occupancy Roslagsbanan to the city and Spårväg in-house started to be procured in 2020 rates (number of passengers travelling Syd, ongoing and planned expansion of instead. For administration of the on buses). COVID-19 means that signed the Underground network. Examples of expansion of the Underground network, agreements, to some extent, have had to other activities include, the develop- the outcome was 10.8 percent, com- be adapted in order to avoid congestion. ment of concepts for public transport in pared with 14.2 percent in 2019. The The entire bus fleet has been operated rural areas and a maritime transport decrease was due to the fact that admin- on renewable fuels since 2017, which inquiry for future maritime transport. istrative costs did not increase at the attracted attention when the Transport same rate as costs for core operations. Administration was awarded the region’s environmental award.

Selected public transport investments

SEK millions Status Out- Budget Budget Total Total Total Total Completion come 2020 deviation acc. forecast budget work-up (year) 2020 out- rate (%) come Underground Fridhemsplan – Älvsjö Ongoing 23 43 20 23 14,428 14,266 0% 2035 Underground to Nacka and Söderort Ongoing 1,042 1,430 388 3,152 24,214 13,654 23% 2030 Programme for the upgrading of Ongoing 627 1,514 888 6,111 10,710 10,710 57% 2026 the Red Line Programme for the expansion of Ongoing 979 710 –269 8,076 10,450 9,644 84% 2026 Roslagsbanan Programme Light Rail Network Ongoing 47 29 –18 5,516 5,576 5,541 100% 2022 North Solna Section Programme Light Rail Network Ongoing 1,104 986 –118 2,274 4,937 4,936 46% 2023 North Kista Section Depot new Underground Ongoing 242 252 10 628 4,380 4,530 14% 2028 Underground to Arenastaden Ongoing 302 252 –51 1,183 6,333 4,214 28% 2028 Programme bus depots Ongoing 359 368 9 3,218 3,910 4,048 79% 2025 Underground to Barkarby Ongoing 393 683 290 1,195 5,842 3,249 37% 2026 Slussen bus terminal Ongoing 541 373 –169 1,638 3,388 2,618 63% 2025 Trains new Underground Ongoing 3 3 –1 10 2,712 2,389 0% 2024 Programme Saltsjöbanan Ongoing 35 39 4 1,363 1,835 1,835 74% 2026 Replacement of lifts and escalators Ongoing 21 167 146 686 1,500 1,500 46% 2025 C20 – upgrade Ongoing 62 379 317 508 1,453 1,453 35% 2023 Station Södra Hagalund Ongoing 82 87 5 225 1,384 1,282 18% 2028 Saltsjöbanan and entrances at Slussen Ongoing 56 39 –17 67 1,014 1,026 7% 2026 Extension of Älvsjö Depot Ongoing 41 51 11 67 865 865 8% 2025 Rissne Underground Depot Ongoing 28 107 79 37 632 632 6% 2025 Adaptation of traffic system Ongoing –3 17 20 8 588 559 1% 2026 Underground Programme Slussen Ongoing 6 40 34 383 439 439 87% 2023 Low-frequency maintenance X60 Ongoing 36 27 –8 450 443 449 100% 2026 Commuter Train SL Lås Ongoing 22 46 23 336 401 401 84% 2022 Ceiling reinforcement Fridhemsplan Ongoing 40 70 30 309 315 346 89% 2021

Programme Spårväg City Completed 54 77 23 2,946 2,946 2,932 100% 2020

Committees Annual Report 2020 69 Terrestrial public transport ticket revenue. The grant amounted to strengthening its organisation, as the Travel decreased due to the COVID-19 SEK 1,332 million and thus covers only projects enter procurement phases and pandemic. Those who did not have to about a third of the lost revenue. The the start of construction. travel by public transport were encour- reason the grant only partially covers aged not to travel and many people the reduced ticket revenue is that the Investments worked from home. Travel for the year government only provided compensa- The Transport Administration is was 35 percent lower and all modes of tion for the period from March – June. responsible for regional public trans- transport were affected. January and The result for the year includes a port investments, excluding invest- February were at normal levels, but capital gain from the sale of the prop- ments in subsidized transport. The then travel plummeted in March when erty connected to the Hornsberg bus committee’s investment budget for the the first wave of COVID-19 hit. In April, depot. The net profit from the sale was year was SEK 10,256 million, of which travel reached a low point with recom- SEK 422 million. The costs for opera- SEK 7,508 million pertained to trans- mendations for working from home and tion and maintenance exceeded the port investments, and SEK 2,748 mil- avoidance of public transport, after budget, most of which is due to decon- lion to the expansion of the Under- which passengers gradually returned to tamination costs for Hornsberg’s bus ground network. The expenditure for public transport until the end of October depot connected to the sale of the the year amounted to SEK 8,102 mil- when travel declined again as a conse- property. lion, which corresponds to a work-up quence of the second wave, and earlier The costs for purchased public rate of 79 percent in relation to the recommendations were reintroduced. transport services were below budget by budget. Of this, SEK 680 million per- The percentage of passengers on SEK 608 million. In order to contribute tained to co-financing by the govern- maritime public transport decreased by to the reduced spread of infection, ment and municipalities. The deviation 46 percent compared with the previous passengers boarded via the middle in comparison with the budget was SEK year. Current restrictions meant that section of buses. A total of 50,000 extra 2,154 million and is mainly due to a fewer passengers could be allowed to departures were added to bus routes, delay in the schedules for the major board in order to limit congestion and while an increased number of longer investments. The deviation is mainly reduce the spread of infection. trains were also in operation. As a due to the fact that some major invest- For terrestrial transport, the Under- consequence of passengers having ments have been postponed, which ground had the largest reduction in the challenges validating their tickets on together make up the majority of the number of passengers with a decrease buses and local trains, the transport deviation: in the Red Line upgrade of 40 percent. Followed by local trains, contractors received compensation programme, carriages have not been commuter trains and finally bus traffic, based on the number of verified paying delivered according to plan due to which had the smallest decline of 31 passengers, or VBP, last year for VBP quality issues. In the Underground to percent. agreements.19. The different modes of Nacka and Söderort, the service tunnel transport had lower costs as a result of a at Kungsträdgården was subject to Financial result lower index trend in the agreements, appeal after the award. In the Under- The Transport Committee’s result for and the fact that the budget for replace- ground to Barkarby, the award took the period amounted to SEK –1,096 ment services did not need to be used. place later than planned. In the replace- million, which is SEK 1,500 million Decontamination costs for the ment of escalators, it has been difficult below the budgeted result. The devia- Hornsberg bus depot, which were to find a suitable supplier, as tenders tion compared to the budgeted result linked to the sale of the property, meant have been withdrawn and an appeal has corresponds to 4.4 percent of turnover that miscellaneous costs exceeded the been made to the administrative court. and can mainly be explained by lower budget. Another reason was the dis- The table shows major investment ticket revenue due to fewer passengers. posal of facilities, including for the projects within the Transport Commit- The Regional Council has decided that refurbishment of Roslagsbanan, which tee, which have a total budget for all the Transport Committee may exclude was expensed during the year. years of the investment projects that the negative financial consequences of The number of full-time equivalents exceed SEK 300 million. COVID-19 when following up its profit was 965, which is 27 full-time equiva- requirement, which means that the lents fewer than budget, but compared The Underground to Nacka and committee met its profit requirement. to the previous year, the Transport Söderort As a result of the recommendations Committee has 50 more full-time With an environmental ruling and that inhabitants in the Stockholm equivalents. The Transport Administra- detailed development plans in place for region should restrict their travel, ticket tion is carrying out a consultant both Nacka and the City of Stockholm, revenue decreased by SEK 3,871 million exchange, in which procurement skills as well as a rail plan that has gained compared with the budget. The Trans- are improved by hiring in-house staff. legal force, the project entered a pro- port Committee applied for and was At the same time, the administration for ducti0n phase in 2020. Work has also granted a government grant for lost extending the Underground network is been carried out with follow-up linked

19 VBP agreements are transport contracts where the contractor is reimbursed for each verified paying passenger.

70 Annual Report 2020 Committees to the terms of the environmental ruling Programme for the upgrading Service commenced according to the and in securing ground access for the of the Red Line revised timetable on December 20, service tunnels in the contract work. The first C30 train was put into opera- 2020 coordinated with the work on the Tender documents for the develop- tion in October 2020, and during the Vallentuna-Kårsta section. ment’s major construction contracts year twelve carriages were handed over The total forecast of SEK 10,450 were sent out for tender during the year. to the contractor MTR. The first tests of million exceeded the total budget for Construction contracts were awarded the IT system for the C30 train com- 2020 by SEK 806 million. In connection during the autumn but were appealed. menced. A detailed plan has been with the decision on the investment Since the turn of the year, construction procured and initiated for Nyboda budget for 2021, a renewed implementa- has started on seven of the project’s depot, and parts of Norsborg depot have tion decision was approved by the eight service tunnels. Procurement for been put into service. The result for the Regional Council. the contract for the eighth service year is lower than budget by SEK 888 tunnel, at Kungsträdgården, was million, which is mainly due to delayed Programme Light Rail Network appealed after it was awarded and was train deliveries. Contract negotiations North Kista Section suspended in June 2020. As the pro- with the supplier have resulted in a new The Ulvsunda to Kista section of the curement will have to be repeated, this delivery plan. Light Rail network was completed is also the main reason why the result according to plan during the summer. for the year was below budget by SEK Programme for the expansion The tracks to Bromma Airport have 388 million, as the start of construction of Roslagsbanan been completed, but the planned start has been postponed until the beginning The double-track expansion together of the service in December was post- of 2021. with new trains, model X15p, and a new poned due to technical problems that During the autumn of 2019, the costs depot in Molnby, means a passenger arose at a late stage, and outstanding and schedule for the expansion projects service that is more frequent and less contract issues. In order for the trams to was reviewed. The new assessments sensitive to disruptions. The construc- be able to operate with passengers, an show that the cost ceiling for the expan- tion of the Vallentuna depot has contin- agreement is needed with Swedavia, sion of the Underground network has ued largely according to plan. Delivery which is responsible for Bromma been exceeded. The majority of this of components and equipment, and thus Airport. The award of the turnkey increase is due to stricter national the completion of the depot, has been contract on the section Bromma Air- requirements, primarily relating to the delayed by several weeks due to the port-Helenelund was reviewed, but the environment and safety. The construc- COVID-19 pandemic. Delivery of the Administrative Court of Appeal found tion time is now estimated at eight years first train took place at the end of the award valid. This has caused a delay for the Underground to Arenastaden October 2020. In August, double-track of 12 months for the section to Helene- and Barkarby, and ten years for the service commenced on a new flyover lund. Ten A35 trams were delivered Underground to Nacka and Söderort. bridge as a replacement for Båthamns- during the year. A dialogue is underway between the vägen’s level crossing in Åkersberga. parties regarding how funding of this Work on double tracks has taken place cost increase will be solved. between Täby kyrkby-Kragstalund.

Outcome Outcome Target Goal Sustainable regional development Mobility Service Committee 2020 2019 value 2020 fulfilment

Attractive public transport in a sustainable transport system Satisfied passengers – special public transport 90% 86% ≥ 86% Fulfilled● Percentage of safe journeys – special public transport 77% – ≥ 76% Fulfilled●

Core operations shall be prioritized The administration’s share of the costs N/A – Reduce

Passengers on public transport Outcome Budget Deviation Outcome Change Total thousands 2020 2020 budget 2019 % Special public transport Number of journeys* 2,809 4,140 –32.1% 3,968 –29.2%

* Includes subsidized transport, medical and business travel.

Committees Annual Report 2020 71 The Underground to Arenastaden, at a later date than planned, which end of the year the first train was put including Hagalund station20 meant that expenses were deferred to into service. A delay in the contractor’s Detailed development plans have 2021. The tender for the Järfälla tunnel time and production plan has led to a gained legal force for both Solna and was also lower than the calculations on delay of twelve months. Stockholm in 2020, where the rail plan which the budget was based. was established in December after a Rissne Underground Depot number of appeal processes that led to a The Slussen bus terminal During the reconstruction of the Rissne review by the government. Construction The City of Stockholm’s Underground Underground depot, system documents of the service tunnels began in 2020 in construction work for the bus terminal have been completed and detailed Hagalund and Hagastaden, and work is in Katarinaberget has been ongoing planning has commenced. The lower underway with tunnelling, excavation during the year. The project includes work-up rate is due to the fact that the work and pile driving. During 2020, continuously delivering replacement planning phase took longer than work has also been underway with the services. The result for the year expected as a new procurement of a procurement of large contracts for exceeded the budget by SEK 169 mil- projector for future construction Arenastaden – Södra Hagalund station lion. The deviation is due to larger documents had to be carried out. It has and Hagastaden. For Arenastaden – intermediate payments to the City of also resulted in a delay of six months. Södra Hagalund station, tender docu- Stockholm in connection with the ments for civil engineering contracts construction of a new Bus Terminal at Programme Spårväg City have been sent out for tender. Tenders Slussen than budgeted. Following a phased construction, were received for the contract in The total forecast exceeded the total the AGA depot was completed three Hagastaden during the autumn, after budget by SEK 770 million. The devia- years after the original plan, as a re-­ which an evaluation took place. During tion is largely due to increased devel- prioritization of investment funds took the summer, new switches were also oper overheads and contract costs place during the programme’s imple- installed in Åkeshov to improve the where the City of Stockholm is the mentation period. During the year, the robustness of the Green Line prior to developer. The Transport Committee’s remaining two A35B trams were also the changes being made in Odenplan in costs for project management and delivered and put into service. connection with the Yellow Line. The replacement services increased as a result for the year exceeded the budget consequence of this. A renewed imple- Digitalisation by SEK 46 million, which was due to the mentation decision was made in the During the year, tunnel blasting and fact that the tenders for the service Regional Council during the autumn inspections were connected to a new IT tunnels were higher than the calcula- with a total investment expenditure of tool, which provides new possibilities. tions on which the budget was based. SEK 3,388 million. Automated review of deliveries replaces previous spot checks. Automation saves The Underground to Barkarby Replacement of lifts and time and improves quality. During the All necessary land and building permits escalators in our own stations year, systems for monitoring environ- have been applied for and work on these Procurements for the replacement of mental data replaced a temporary IT has been ongoing throughout the year. the remaining lifts, escalators and solution. The system support facilitates All building permits have been obtained, travelators for our own stations have the work of measuring groundwater, but a starting clearance is still being been ongoing throughout the year. among other things. Automatic report- awaited for the ticket halls. Essential There have been difficulties finding ing from certain measuring points is detailed development plans did not gain suppliers to carry out the planned also available. During the spring, it was legal force until June, which made replacements. The allocation of escala- a major problem to access IT services certain building permits time-critical. tors and travelators has been postponed available at the Transport Administra- Two service tunnels have been in full due to a review of the procurement. tion. The cause was changes in the construction during the first half of the Procurement documents for lifts have network to create capacity for the year. They were completed during the been published and tenders are healthcare service. spring and summer and were inspected expected to be received in early 2021. and finally settled at the end of the year. The construction contract for the C20 upgrade Järfälla tunnel has been awarded, and The C20 upgrade provides the Under- construction began in the spring/ ground network with upgraded trains. summer. The result for the year was During the year, four prototypes were below budget by SEK 290 million, which completed and the C20 train was was mainly due to the fact that the approved for series production. Produc- award of the Järfälla tunnel took place tion of trains has commenced and at the

20 Hagalund Station is reported as a separate investment item in the budget for 2018 and 2019, but works are carried out and reported within the same project as the Underground to Arenastaden.

72 Annual Report 2020 Committees Mobility Service Committee quence of the Swedish Public Health to initiate a digital application for a The committee is responsible for Agency’s advice to people who belong to subsidized travel permit and have the specially arranged transport for a risk group or who are over 70 years of opportunity for direct dialogue with people with disabilities and neurodiver- age to avoid meeting other people. The administrators, and to be able to follow sity according to the Subsidized Trans- number of journeys by wheelchair taxis the administrative process digitally. port Services Act, concerning decreased by 40 percent. The number of agreements between Region Stockholm patient transports decreased by 13 Growth and Regional and the county’s municipalities, as well percent and thus did not have as sharp a Planning Committee as the Public Transport Act pertaining decline as other journeys with subsi- The Growth and Regional Planning to subsidized transport services. dized transport services. Committee is responsible for regional All forms of transport are operated by spatial planning and regional growth, transport contractors through competi- Financial result which includes transport planning tive procurement. The Mobility Service Committee’s linked to the regional development result for the period amounted to mandate: in addition to public trans- Goals SEK 377 million, which is a positive port, regional development for commu- Attractive public transport in a deviation compared with the budgeted nity building, infrastructure and sustainable transport system result of zero. The deviation can mainly transport, in addition to the county The Mobility Service Committee is be explained by lower costs for pur- plan, and business development, responsible for the indicators on pas- chased transport services in relation to strategic skills supply and labour senger satisfaction and safe travel, both budget, which was a consequence of market development in respect of the of which were met for 2020. Passenger reduced travel. aspects that are not under other com- satisfaction had an outcome of 90 During the year, the Mobility Service mittees, as well as rural areas and the percent. That the outcome is so high is Committee’s suppliers assisted with archipelago. probably a consequence of COVID-19, ambulance transports, testing at home During the year, the Growth and which has meant the removal of inte- of Region Stockholm’s inhabitants and Regional Planning Committee’s grated planning and that punctuality transportation of healthcare staff. resources were largely focused on increased markedly due to a sharp initiatives that countered the pan­ reduction in travel within the taxi Investments demic’s effects on business and the industry, which contributed to an The investment in new system support labour market. A future analysis has increased supply of vehicles. for subsidized transport was increased been carried out as a consequence during the year by SEK 32 million. of the pandemic and the report, Core operations shall be Delivery approval has been granted for TRN 2020–0148, was presented to prioritized the first stage of the new permit system. the committee in December. The administration’s share of the costs Further development of a customer has not been followed up within the service module for the new permit Goals Mobility Service Committee but is part system was ordered in the autumn. The committee is responsible for the of the committee’s indicator, as the staff committee-specific goalRegional are employed within the Transport Digitalisation development planning for sustainable Administration. In February, an app was launched that growth, which means that the commit- makes it possible for passengers to book tee must manage and follow up the goal Passengers trips on their mobile phones. The and its indicators. Six indicators could The number of passengers with a Mobility Service Committee has worked not be measured. Of the seven indicators subsidized travel permit was 64,968, on a project for a new joint permit that were measurable, one indicator which was a decrease of minus four system that will enable more efficient achieved its target value. It has not been percent compared with the previous and more legally secure handling of possible to assess whether the target year. The number of passengers in permit processing. It will enable the was achieved for 2020 as too few indica- special public transport decreased by handling of applications and customer tors were measurable. 29 percent compared to 2019. The cases digitally. This also means that it reduction comes as a natural conse- will be possible for passengers to be able

Financial result Mobility Service Committee

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Mobility Service Committee 376.6 0.0 376.6 20.6% 107.7

Committees Annual Report 2020 73 Regional planning at the Development Plan for the Stockholm comprehensive plans were established cutting edge region, RUFS 2050. During the year, in 2020 in the county’s municipalities, As of 2019, the Growth and Regional a model was implemented that makes the value is unchanged compared with Planning Committee has been given the visible the implementation of the the previous year. extended mandate to be responsible for regional priorities in RUFS 2050, which transport planning linked to the is a prerequisite for goal fulfilment. A Sustainable regional growth and regional development mandate with the new meeting arena, Forum for Regional attractiveness exception of public transport The work Planning, has been established to During the year, reprioritisations were with regional spatial planning is long- further strengthen collaboration with implemented due to the pandemic’s term and is not directly affected by the the county’s municipalities. The indica- effects on business and growth in the pandemic, but shows the importance of tor Conformity of municipal plans with Stockholm region. Project support robust and resilient regional spatial the plan map in RUFS had an outcome corresponding to SEK 5 million has planning in accordance with the vision, of 79 percent compared to the target of been distributed from the regional goals and ambitions in the Regional 80 percent. As no new municipal sustainability and archipelago grant to

Sustainable regional development Growth and Outcome Outcome Target value Goal Regional Planning Committee 2020 2019 2020 fulfilment

Regional development planning for sustainable growth – Regional planning at the cutting edge Compliance of municipal plans with the plan in RUFS. 79% 79% ≥ 80% Not fulfilled● Future building development in the Stockholm region’s most relatively accessible locations, (RUFS) N/A – ≥ 95% –

Greenhouse gas emissions from the Stockholm region in tonnes of CO2 per capita (RUFS) N/A – ≥ 2.6 –

Sustainable regional growth and attractiveness Number of start-ups per 1,000 inhabitants 141) – ≥ 18 Not fulfilled● Private and public investment in research and development (R&D) as a percentage of GDP 3.4%1) – ≥ 4.5% Not fulfilled● Percentage of people employed in knowledge-intensive occupations (RUFS) N/A – ≥ 50% – Access to connection speed of 100 Mbps for workplaces (RUFS) 92%1) – ≥ 90% Fulfilled● Harness the skills and facilitate matching in the labour market in the Stockholm region Percentage of partner stakeholders who find that Region Stockholm contributes to harnessing the skills and facilitating matching in the labour market in the Stockholm region N/A – ≥ 75% – Percentage of upper-secondary-school students who graduated within three years (RUFS) 74.5%1) – ≥ 80% Not fulfilled● Discrepancy in percentage of the workforce between those born in Sweden and those born abroad (RUFS) N/A – ≤ 17.5% – Contribute to achieving RUFS’s goals regarding increased housing construction and creation of attractive habitats in the Stockholm region Percentage of partner stakeholders who find that Region Stockholm contributes to increasing housing construction and creating attractive habitats in the Stockholm region N/A – ≥ 75% – Annual quantity of completed homes (RUFS) 16,7001) – ≥ 22,000 Not fulfilled● Percentage of inhabitants who state that a lack of safety impacts quality of life (RUFS) 10%2) – ≤ 18% Not fulfilled●

Core operations shall be prioritized The administration’s share of the costs 8.6% – Reduce Not fulfilled●

1) Outcome refers to 2019 as data for 2020 are not available. 2) The question has changed, so the outcome is not comparable to the goal.

Financial result Growth and Regional Planning Committee

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Growth and Regional Planning Committee 0.0 0.0 0.0 0.0% 1.0

74 Annual Report 2020 Committees nine projects whose applications have Harness the skills and facilitate pandemic. The indicator Annual num- been judged to meet the challenges of matching in the labour market in ber of completed homes had an outcome the business community due to the the Stockholm region of 16,700 homes in 2019, of which pandemic. With regard to project In November 2020, Region Stockholm approximately 1,600 constituted support from the grant for Regional launched Kompetensarena Stockholm, renovations. Growth Measures, almost SEK 12 which is a regional platform for dialogue million has been allocated to 14 projects and cooperation with a large number of The administration’s share of that were prioritized, also based on the stakeholders within skills development. the costs applications that were judged to con- As part of that arena, start-up of Region The outcome for the indicator tribute to counteracting the pandemic’s Stockholm’s skills council is being amounted to 8.6 percent, which is effects on business and growth in the planned, assembling politics, public higher than in 2019, primarily due to Stockholm region. stakeholders and social partners with a increased rents in connection with the The Swedish Agency for Economic focus on mobilising around strategic co-location to the Lindhagen area. and Regional Growth has, in conjunc- skills development issues. tion with the administration, regional The indicator Percentage of Financial result stakeholders and the structural funds upper-secondary-school students who The financial result for the Growth and partnership, put out a request within graduated within three years had an Regional Planning Committee amounted the European Regional Development outcome of 66.4 percent for the 2011/12 to SEK zero million and are in line with Fund, ERDF, for projects that can academic year. For the 2016/2017 the budgeted profit requirement. provide support to small and medi- academic year , 74.5 percent of upper- um-sized companies. The request took secondary-school students graduated Digitalisation place at the initiative of the European within three years (2014/2015). Devel- Around ten conferences have been held Commission to use the remaining struc- opment over time shows a steadily as webinars, such as the Cycle Seminar, tural funds for projects that can help positive trend, but is still below the the Forum for Regional Planning, the counteract the effects of the pandemic. target of 80 percent. There are great Electric Road Presentation, the Annual The indicator Number of start-ups per differences between municipalities, Cycle Accounts, the Climate Control 1,000 inhabitants is based on the where Värmdö municipality had the Station, and the launching of “Kompe- outcome in 2019 and was 13.7, which is highest percentage of pupils (85.1 tensarena Stockholm”. In addition to below the target of 18 start-ups but percent) and Järfälla municipality had these webinars, the virtual education higher than the national average of 10.7 the lowest percentage of pupils (51.5 and recruitment expo, Bazaren, was start-ups per 1,000 inhabitants. percent) who graduated within three held at the beginning of December and In April 2020, Region Stockholm years. The indicator is based on the had 2,500 visitors. received the government’s offer to outcome from 2019 and will probably be produce support documentation for the impacted in 2020 by reason of the Culture Committee regional structural fund programme for pandemic, when upper-secondary The Culture Committee leads Region Stockholm County prior to the pro- schools had to switch to remote teaching. Stockholm’s activities in the cultural gramme period 2021–2027, within the arena. The committee shall promote framework of the European Regional Contribute to achieving RUFS’s culture in the Stockholm region, finan- Development Fund, ERDF. The pro- goals regarding increased housing cially support organisations in creating posal for a regional structural fund construction and creation of culture and work to promote quality programme was sent out for review to attractive habitats in the and diversity in the culture sector. This the county’s municipalities and regional Stockholm region work is carried out in collaboration with stakeholders and was decided on by the Housing construction takes place in a the municipalities, as well as other Regional Council in December. market with several stakeholders and stakeholders. The Culture Committee is The Stockholm region has well-de- different drivers. The municipalities responsible for work on the arts and veloped broadband infrastructure, but and the state provide the scope and cultural activities in the healthcare there are significant differences conditions for construction, through sector, and provides Region Stockholm’s between the county’s densely populated planning, legislation and prerequisites other committees with instructions and sparsely populated areas in terms for financing. The regional housing regarding measures for the inventory- of access to high-speed broadband (100 discussions will continue as an essen- ing, care and maintenance of the Mbit/s or more). The indicator “Access tial part of fulfilling the goals. During region’s artworks, as well as purchasing to an internet connection of 100 Mbps the year, documentation on the county’s artwork on behalf of other committees. for workplaces” has been met and just housing market has been drafted to pro- The Culture Committee is also Region over 94 percent of households and 92 vide support to the region’s municipali- Stockholm’s archiving authority. percent of workplaces in the region had ties and housing stakeholders, and a Region Stockholm is the principal access to high-speed broadband in 2019. dialogue has been initiated with the funder of the The Stockholm Concert construction, housing and property Hall Foundation, and the Culture industry to discuss the impact of the Committee is responsible for Region

Committees Annual Report 2020 75 Stockholm’s commitments to the been intensified, with the aim of mak- Goals foundation, and for the follow-up of the ing the Stockholm region film-produc- The committee is responsible for the foundation’s activities. tion friendly and that more stories from committee-specific goalFree culture The changed circumstances for the the region should be presented. The experiences meetings, education and cultural sector, as well as for local Culture Committee decided in their participation, which means that the associations and education caused by June meeting to propose to the Regional committee shall manage and follow up the pandemic has meant that the Executive Committee that in turn the goal and its indicators. Two indica- Culture Committee has had to rear- would propose to the Council that a tors could not be measured due to the range their planned activities. For this regionally owned company be formed, COVID-19 pandemic. Of the four reason, the committee decided early on with the task of supporting film produc- indicators that were measurable, two not to reclaim any support already tion in the county. The decision to do so indicators achieved their target values, provided on non-delivery. was made by the Council in December. which means that the goal was partly Since 2017, on behalf of the Regional During the year, the Culture achieved for 2020. Council, a process has been ongoing Committee had eight mandates that about relocating the operations of were assigned by the Regional Council. Cultural experiences accessible to Stockholm County museums under the Four of these mandates were completed the region’s inhabitants through committee’s administration. In June during year. The completed mandates strategic coordination and support 2020, all parties involved agreed to include: Carrying out an organisational The indicator Number of municipalities apply for decommissioning of the change of the Stockholm county muse- that find that Region Stockholm con- foundation to the relevant authority. ums, and the committee adopting a tributes with cultural events for the Stockholm has the potential to grow regional library plan for 2020–2023. county’s inhabitants has not achieved as an attractive film region in Europe The other four mandates continue the target value of 80 percent. 20 and in 2020, the partnership with the according to plan. municipalities out of 26 responded to City of Stockholm in this regard has the survey. Of these, 19 responded with

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

Free culture for experiences, meetings, education and inclusion Partially fulfilled● Cultural experiences accessible to the region’s inhabitants through strategic coordination and support Percentage of cultural stakeholders who find that Region Stockholm contributes with cultural events for the county’s inhabitants N/A – ≥ 65% – Percentage of municipalities who find that Region Stockholm contributes with cultural events for the county’s inhabitants 73.0% – ≥ 80% Not fulfilled●

Encounters with artistic expression enrich the regions inhabitants Percentage of property investments in the healthcare service used for artistic design 0.6% 1.5% ≥ 1% Not fulfilled●

Education in a growing region Percentage of adult educational associations and folk high-schools who find that Region Stockholm strategically coordinate education in the Stockholm region N/A – ≥ 75% – Percentage of customers who use the regional archive’s digital services for increased knowledge and information 83.0% – ≥ 10% Fulfilled●

Participation in culture and local associations for a sustainable region Percentage of youth organisations who find that Region Stockholm strategically coordinate education in the Stockholm region 100.0% – ≥ 75% Fulfilled●

Core operations shall be prioritized The administration’s share of the costs 5.1% 5.2% Reduce Fulfilled●

Financial result Culture Committee

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Culture Committee 0.5 0.0 0.5 0.1% 2.1

76 Annual Report 2020 Committees Agree Fully or Agree, and one responded The administration’s share Property and Service with Neither. of the costs Committee For the indicator Percentage of The outcome for the indicator was 5.1 The Property and Service Committee cultural stakeholders who find that percent as per December 31, 2020, is responsible for Region Stockholm’s Region Stockholm contributes with which is a decrease compared with the property holdings, through Locum AB, cultural events for the county’s inhabit- previous year. Administrative costs with the exception of the public trans- ants, there is no outcome for the year as have increased, but not at the same rate port service’s properties. In the long the planned survey was never con- as total costs. term, the committee shall develop their ducted in connection with the cancelled property holdings through property meeting, “Stockholmstinget”. Financial result management agreements between The financial result for the Cultural Locum AB and Region Stockholm (1993), Encounters with artistic expres- Affairs Committee amounted to as well as through supplementary sion enrich the regions inhabitants SEK 0.5 million, which was 0.5 million agreements (2001), jointly designated The investment in art in Region kronor better than the budgeted result. the Property Agreement. Furthermore, Stockholm’s property investments is The deviation corresponds to 0.1 the committee is responsible for the ongoing with some delay due to the percent of turnover. The positive devia- Project Agreement between Region pandemic. The Indicator Percentage of tion can primarily be explained by Stockholm and Swedish Hospital property investments in the healthcare lower costs for consultants and art Partners AB in regard to New Karolinska service used for artistic expression was purchases. In 2020, the Culture Com- Solna, as well as for the right of disposal 0.6 percent and did not achieve the mittee received a little over SEK ten and compensation for this agreement in target value of 1.5 percent. million in grants and activities associ- relation to Karolinska University ated with COVID-19, where over half, Hospital. The committee shall also Education in a growing region SEK 6.4 million, comprised an espe- provide IT services and service in For the indicator Percentage of adult cially announced support which was exchange for compensation, in accord- educational associations and folk included in the existing budget. ance with the orders submitted by high-schools who find that Region committees and companies. Stockholm strategically coordinate Investments In January, the adult Accident & education in the Stockholm region, The investment outcome for 2020 was Emergency department opened at Capio there is no outcome for the year as the SEK 2.2 million, in comparison with the S:t Görans Sjukhus, and the new adult planned survey was never conducted. budgeted SEK 5.6 million. The cost for Accident & Emergency department at Percentage of customers who use the refurbishing the premises and interiors Södersjukhuset opened in April. The regional archive’s digital services for was lower than budgeted. Another Regional Council decided to sell increased knowledge and information reason was that fewer servers than Bromma Hospital in March, and the had an outcome of 83 percent and planned were replaced at the Regional buyer took over on June 1, 2020. The achieved the target value of ten percent. Archive. development of the service administra- The foremost e-service aimed at health- tion continued throughout the year, and care operations and the public is the Digitalisation the planned changeover of operations ordering of public documents from the Solutions for e-signatures through a was completed. Procurement has been archives. This services is continuously Case Management System and bank-id fully focused on supplying healthcare being developed in order to be as acces- were developed, particularly for com- operations and on the critical work of sible as possible and during the year, the mittee meeting minutes, as well as for primarily providing PPE, nutrition and work resulted in the share of digital the signing of agreements and con- medical consumables to intensive care orders increasing by 16 percentage tracts. For more efficient management units. points from 2019. of reports and assessments, a new system was procured, which will also be Goals Participation in culture and local used to follow up financial management Free culture for experiences, associations for a sustainable at various events. The work on imple- meetings, education and inclusion region menting an efficacy plan, a digitalisation The Property and Service Committee is Percentage of youth organisations that plan and an information management responsible for the indicator Percent- believe that Region Stockholm clearly plan, and the work to increase accessi- age of investments in the healthcare coordinates association activities in bility to the library in Landstings­huset sector that were used for artistic the Stockholm region had an outcome of has been successful. expression. The investment in art in 100 percent and achieved the target Region Stockholm’s property invest- value of 75 percent. By providing ments is ongoing with some delays due support to local associations, the to the pandemic. The indicator was 0.6 Culture Committee contributes to percent for the investments that were creating conditions for people’s partici- completed during the year. This falls pation in the region. below the target value of one percent.

Committees Annual Report 2020 77 The administration’s share from April 1 to December 31, 2020. The During the spring when the pandemic of the costs purpose of this was to ensure that healt­h­ broke out, a decision was taken to wait The outcome of the indicator for prop- care personnel could travel to and from with the implementation of renovations erty operations refers to Locum AB, and their workplace in a safe manner. in healthcare facilities, partly to reduce was 4.1 percent, and the target value the spread of infection, and partly to was achieved for the year. For the Investments protect the staff. Furthermore, other service administration, the indicator is The Property and Service Committee is measures have been prioritized above not applicable as the entire operation is responsible for investments in Region those in the plans, where, among other 100 percent administrative. Stockholm’s property holdings21 and things, the focus has been on establish- supply of information technology22. The ing intensive-care beds at the Älvsjö Financial result committee’s investment budget during field hospital. Remote working has The financial result for the Property the year amounted to SEK 3,307 million also made it more difficult to manage and Service Committee amounted to and mainly comprised investments in projects on site. The deviation can also SEK 1,097 million, which was SEK 629 property, equipment and information be explained by the fact that Karolinska million better than the budgeted profit technology. University Hospital in Huddinge had requirement. The positive deviation The budget includes equipment postponed some investments due to can primarily be explained by the investments connected to property deficits in their finances in 2019, which divestment of Bromma Hospital, which investments for the implementation of after a review of the need for investment generated capital gains of SEK 438 the Future Plan for the Healthcare meant that investments were re-­ million. Exempting the capital gains, Service with SEK 284 million, where prioritized in 2020. the committee reported a result of SEK the outcome is reported under each The expenditure for the year relating 659 million, which exceeded the budget committee and company within the to property investments amounted to by SEK 191 million. The committee’s healthcare service. SEK 1,258 million, which corresponds result included the result concerning The committee’s total investment to a work-up rate of 48 percent in NKS Bygg, which was SEK 89 million expenditure during the year, adjusted relation to the budget of SEK 2,644 mil- better than budget, primarily thanks to for equipment investments, amounted lion. The deficit against the budget was lower interest charges. to SEK 1,847 million, which was equiva- mainly caused by the fact that a number RSSL and the Property and Service lent to a work-up rate of 56 percent in of planned investments in healthcare Committee decided on free parking for relation to this year’s budget. The properties could not be implemented healthcare personnel in the visitor and deviation was mainly due to delays due to the COVID-19 pandemic. Reno- staff car parks adjacent to the hospitals caused by the COVID-19 pandemic. vation of healthcare facilities has been

Sustainable regional development Property and Outcome Outcome Target Goal Service Committee 2020 2019 value 2020 fulfilment

Free culture for experiences,meetings, education and inclusion Percentage of property investments in the healthcare service used for artistic design 0.60% 1.50% ≥ 1% Not fulfilled●

Core operations shall be prioritized The administration’s share of the costs Property Administration 4.1%1) 5.7%1) Reduce Fulfilled● Service Administration 100% 2) – Reduce

1) The outcome refers to Locum AB 2) Not applicable as 100% of operations are classed as administrative

Financial result Property and Service Committee

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 Property and Service Committee 1,096.8 468.0 628.8 8.6% 485.0 of which Service Administration 70.9 5.0 65.9 3.9% –0.2 of which Property Administration 1,025.9 463.0 562.9 10.0% 485.2

21 Excluding public transport properties, which are the responsibility of the Transport Committee. 22 Excluding public transport’s provision of information technology, which is the responsibility of the Transport Committee.

78 Annual Report 2020 Committees postponed, partly to take into account budget is partly due to the reduced total University Hospital until 2024. The first the spread of infection, and partly to cost forecast, and partly to the fact that double department has been completed switch to COVID-19-related measures guarantee funds have been postponed and handed over. The planning for the such as the establishment of intensive to later years. second (K47-49) is finalized but was put care beds in the Älvsjö field hospital. on hold when Karolinska University The table shows major property Hospital wards and treatment, Hospital initiated a review of the project investments within the healthcare Capio S:t Görans Sjukhus in respect of the Accident & Emergency service which have been implemented Building 20 was handed over to Capio departments, where location and scope throughout the year. Significant events S:t Görans Sjukhus in November and are being reviewed. The project was and major deviations for 2020 have the moving in phase has commenced. In paused at the beginning of the year due been commented on below. building 45, remediation of inspection to a review of the hospital’s finances, but remarks are in progress prior to hando- was resumed in the final quarter with New construction and renovation ver. In the existing buildings 30 and 40, the intention of continuing the imple- of surgical and radiology depart- the Norra surgical department has been mentation planning. The expenditure ments, Karolinska University handed over. In other respects, demoli- for the year was below budget, which Hospital Huddinge tion work is underway for a new X-ray was due to the fact that the measures The main part of the investment has department and ground work for new were already paused before the invest- been completed and handed over to car parks on Södra Terrassen. The ment, and were allocated across more Karolinska University Hospital. The schedule has been postponed by six years than originally planned. In sterile centre, imaging and function, months, which has meant that comple- November, it was decided that the total and surgery have started operations. tion of the last stage has been resched- budget for the investment would be The work that remains includes work uled to June 2023. reduced by SEK 187 million. related to the hospital park and will continue during the first quarter of Conversion of wards Stage 2, Renovation of wards Stage 2, 2021. Delivery and clinical commis- Karolinska University Hospital Karolinska University Hospital sioning went better than planned, Huddinge Huddinge which has contributed to a reduction in The investment refers to stage two of a The investment refers to stage two the total cost forecast of SEK 197 mil- total of 13 stages in the rebuilding of of a total of 13 stages in the rebuilding lion. The deviation from this year’s hospital wards within Karolinska of hospital wards within Karolinska

Property investments within the healthcare service

Out- Total come Budget Budget Total acc. Total Total work-up Completion MSEK Status 2020 2020 deviation outcome forecast budget rate (%) (year) New construction and reconstruction of surgical and radiology depart- Ongoing 103 300 197 1,649 1,701 1,840 90% 2021 ments, Karolinska Hospital Huddinge Hospital wards and treatment, Ongoing 400 425 25 1,952 2,537 2,537 77% 2023 S:t Görans Sjukhus Conversion of wards Stage 2, Ongoing 25 148 123 31 423 423 7% 2024 Karolinska Hospital Huddinge Renovation of wards Stage 2, Ongoing 5 65 60 5 266 266 2% 2025 Karolinska Hospital Huddinge New construction and renovation of the Accident & Emergency depart- Ongoing –16 62 78 1 180 190 0% 2022 ment, Karolinska Hospital Huddinge Neonatal building 07/52, Ongoing 61 90 29 81 150 150 54% 2022 Södersjukhuset

New building West – treatment Completed 94 99 5 2,394 2,411 2,411 99% 2020 building, Södersjukhuset Hospital wards, main entrance, Completed 46 0 –46 1,139 1,207 1,207 94% 2020 Sollentuna hospital Conversion of two wards per year, Karolinska University Hospital Completed 9 0 –9 127 130 272 47% 2020 Huddinge Renovation of two clinics per year, Completed 25 0 –25 78 77 128 61% 2020 Karolinska Hospital Huddinge

Committees Annual Report 2020 79 University Hospital until 2025. completed and put into service. The have been completed include, among Feasibility studies for two subprojects remaining part of the investment other things, the completion of ground and a changing room have been com- regarding the construction of a new surfaces around the N-block. pleted. The project was paused by Accident & Emergency department, Equipment investments are almost Karolinska University Hospital Hud- including an ambulance station, was completely finalized. The expenditure dinge at the beginning of the year due to completed and put into operation in its for the year exceeded budget by SEK 85 a review of the hospital’s finances, but entirety in June 2020. million and are due to deferrals from was resumed in the final quarter with 2019. The total budget has been the intention of continuing the imple- Hospital wards, main entrance, assessed to be included. mentation planning. The expenditure Sollentuna Hospital for the year was below budget, which The final inspection of Sollentuna Equipment investments was due to the fact that the measures Hospital was approved in April. The The equipment investments are linked were already paused before the invest- overrun against this year’s budget was to the region’s investments in properties ment, and were allocated across more due to work planned for 2019 being for the implementation of the Future years than originally planned. In postponed, which meant that invest- Plan for the Healthcare Service. They November, it was decided that the total ment funds were reallocated to 2020 include medical equipment, informa- budget for the investment would be onwards. Total expenditure has been tion and communication technology reduced by SEK 132 million. assessed to be included within the total and furnishings. Expenditure for the established budget. year amounted to SEK 369 million, New construction and renovation which corresponds to a work-up rate of of the Accident & Emergency Conversion of two wards per year, 130 percent in relation to the budget of department, Karolinska Univer- Karolinska University Hospital SEK 284 million. Expenditure for the sity Hospital Huddinge Huddinge year exceeded the budget by SEK 54 The investment was put on hold at the The investment refers to stage one, million, which was mainly due to beginning of the year before the imple- rebuilding of two hospital wards at deferrals from 2019. During the year, mentation phase had commenced. This Karolinska University Hospital Hud- the specified strategic equipment was due to the review of the hospital’s dinge. All wards have been completed projects at Södertälje Sjukhus, finances. A decision on restarting the and handed over to the operations. Total Danderyds Sjukhus and Södersjuk­ project has been made, but the project expenditure was included in the total huset were completed. The projects has been delayed by at least one year, established budget. have procured, installed and commis- which also explains the deviation sioned equipment that is now being between this year’s expenditure and Renovation of two wards fully utilized by the hospitals. The budget. In the autumn, Karolinska per year, Karolinska University projects have been formally completed University Hospital Huddinge submit- Hospital Huddinge with an outcome that was below the ted new needs analyses, and a new The investment refers to stage one, total budget. The strategic equipment feasibility study was initiated in rebuilding of two clinics at Karolinska project for Chopin at Karolinska November. In November, it was decided University Hospital Huddinge. The final University Hospital Huddinge has that the total budget for the investment clinic (K51-53) was completed in the almost been completed. The remaining would be reduced by SEK 10 million. third quarter and handed over to the work mainly relates to the delivery of an operations. Total expenditure was integration solution for the operating Neonatal building 07/52, included in the total adopted budget. theatres, which is expected to be com- Södersjukhuset pleted in 2021. The unspecified strate- The investment concerns the rebuilding Karolinska University Hospital gic equipment projects have also ended and conversion of the old adult Accident in Solna with expenditure below budget. & Emergency department to a neonatal Investments in Karolinska University ward where premature babies and sick Hospital Solna mainly consist of medi- The Service Administration newborn babies can be cared for at cal equipment, information and com- The investment expenditure for the Södersjukhuset. Expenditure for the munication technology and tenant Service Administration amounted to year was below budget, which was due adaptations. Expenditure for the year SEK 154 million, which corresponds to to a roughly estimated timetable in the amounted to SEK 66 million, which a work-up rate of 60 percent in relation budget which was made at an early stage corresponded to a work-up rate of 54 to the budget of SEK 257 million. The and that has now been corrected and percent in relation to this year’s budget budget for the year was divided into 71 includes greater detail. of SEK 123 million. The expenditure for percent for information technology, 27 the year was below budget by SEK 57 percent for co-location and two percent New building West – treatment million, which was mainly due to for Berga Naturbruksgymnasium. building, Södersjukhuset planned tenant adaptations being put The budget for the year for IT invest- The majority of the investment regard- on hold in 2020 due to the COVID-19 ments amounted to SEK 182 million, ing a new treatment building has been pandemic. Property investments that the majority of which consisted of

80 Annual Report 2020 Committees replacement investments. The invest- workplaces. 30,000 users within and schedules for the audits. In Septem- ments included the hospitals’ orders for healthcare, public transport and ber, the auditors adopted a position on a network infrastructure and clients, as administrative operations have func- revised audit plan. well as requirements for data storage tioning IT support around the clock. A and life cycle management. The expend- decision has been made to consolidate, Financial result iture for the year was below budget by among other things, IT services The financial result for the Audit Board SEK 54 million, which is mainly due to between Stockholm County’s Health- amounted to SEK 0.1 million, which is Karolinska University Hospital and care Area and the Service Administra- SEK 0.1 million higher than the budg- Södersjukhuset postponing the life tion, the same applies to Södertälje eted profit requirement of SEK zero cycle management of network infra- Sjukhus. Joint work within the Regional million. The positive deviation can be structure. Postponements have been Executive Committee to hand over IT explained by lower costs for consultants made due to the COVID-19 pandemic services to the Service Administration. and reduced costs for office operations and the burden on the healthcare service. In 2020, a pilot study with customer as employees were working from home The budget for the year for the teams was carried out within the IT as a consequence of the pandemic. co-location project amounted to SEK 70 area. New for 2020 is that the Service million. The expenditure was below Administration also offers services Investments budget by SEK 45 million, which was related to financial data and digitali­ The Audit Board budgeted SEK 0.2 mainly due to the fact that phase 2 of the sation, which means changes and million for the year and has made co-location project was postponed. streamlining relating to identifying investments of SEK 0.1 million. The investments have been assessed to manual procedures that are suitable for be included in the total budget. automation. Digitalisation The budget for the year for Berga The Audit Office has introduced digital Naturbruksgymnasium amounted to The Audit Board signing of agreements, committee SEK four million and the expenditure The task of the elected auditors is to decisions as well as minutes and dis- for the year was SEK two million under review and check the operations that patches. By availing of the opportunity budget. are run by the Regional Executive to work digitally, the elected represent- Committee, other committees and atives have been able to use their tablets Digitalisation companies, as well as foundations. to participate in the Audit Board’s and The opportunity for employees to work The Audit Board’s audit of operations the auditing teams’ meetings as well as from home has increased from 2,000 to has been affected by the situation with bureau meetings with the region’s 30,000 possible connected remote COVID-19, which influenced the design committees and boards.

Financial result Audit Board

Result Budget Deviation as percent Result MSEK 2020 2020 Deviation of turnover 2019 The Audit Board 0.1 0.0 0.1 0.2% 0.0

Committees Annual Report 2020 81 11 Companies

82 Annual Report 2020 Landstingshuset i Södersjukhuset AB growing number required inpatient Stockholm AB Södersjukhuset AB is one of Region care, intensive care and X-ray. The Landstingshuset i Stockholm AB, Stockholm’s emergency hospitals, with number of patients with milder symp- LISAB, is wholly owned by Region responsibility for specialised emer- toms has decreased. All in all, this has Stockholm and is the parent company in gency care, and planned somatic spe- meant that throughput at the Accident a group consisting of the subsidiaries cialist care, as well as highly specialised & Emergency department has been Södersjukhuset AB, Danderyds Sjukhus vascular surgery and hand surgery. lower than expected, and that the AB, Södertälje Sjukhus AB, S:t Eriks From March 2020 onwards, the four-hour target could not be achieved. Ögonsjukhus AB, Folktandvården COVID-19 pandemic has had considera- Percentage of patients waiting no Stockholms län AB, Ambulanssjuk­ ble impact on hospital operations. The more than 30 days has been severely vården i Storstockholm AB, Stockholm hospital entered reinforcement mode impacted by the pandemic, as elective Care AB, MediCarrier AB, Locum AB on March 13, 2020. On June 11, the care was cancelled in order to treat and AB Stockholms Läns Landstings hospital returned to staff mode, and COVID-19 patients. Internfinans. The company shall own eventually to normal operations on July 1. Percentage of patients who received and manage shares in LLCs that Region As the number of COVID-19 patients an appointment within 90 days was 72 Stockholm uses for its operations. From gradually increased in the autumn, the percent. The target value was not 2021, Region Stockholm and the City of hospital resumed staff and reinforce- achieved due to COVID-19. In order to Stockholm will collaborate to support ment mode. increase ICU capacity at the hospital, film production in the region through a During the year, Södersjukhuset AB anaesthesia staff, physicians and nurses regionally-owned company. The new has been given two mandates by the from other departments have worked in company will be a subsidiary of Regional Council. These mandates were intensive care, which resulted in con- Lands­tingshuset i Stockholm AB and completed during the year. The com- siderably fewer surgical procedures operations are planned to commence in pleted mandates were Developing being performed last year. the spring of 2021. FHS23, the Third Step and Enabling Percentage of patients who con- FVM SLL. tracted hospital-acquired infections Financial result increased somewhat in 2020, 7.3 The financial result for Landstings­ Goals percent, compared to 2019, 6.4 percent, huset i Stockholm AB amounted to SEK Södersjukhuset shall aim to achieve but the target value was achieved. –108 million, which was SEK 90 million indicators linked to the High quality Södersjukhuset AB did not achieve below the budgeted profit requirement healthcare services goal. For three the target for the number of days of SEK –18 million. The negative budget indicators, no outcome was available at patients remain in hospital following deviation from the established profit the time of the annual accounts. Of the completion of treatment. Following the requirement can be explained by six indicators that were measurable, regional agreement from January 1, impairments in the value of shares in two indicators achieved their target 2020, the Cooperation on Discharge Act the subsidiaries. The valuation of the value. (LUS), which came into force on Janu- shares is based on the subsidiaries’ ary 1, 2018, is starting to have a wider equity and is thus not possible for High quality healthcare impact, as indicated by the considerable Landstingshuset i Stockholm AB to services improvement in the overall figures for influence. Adjusted for the impairment, Waiting times at the adult Accident & the year. Landstingshuset i Stockholm AB Emergency department have not The indicator Average number of reported a result of minus SEK eight improved and the target value was not days spent in hospital per medical care million, which is SEK ten million better achieved. During the pandemic, the event has fallen marginally for the year, than the budgeted result. hospital’s Accident & Emergency despite the impact of COVID-19 patients department has seen increased pres- and the lengthy hospital stays for this sure from severely ill patients of whom a patient group. The mix of patients and

Financial result Landstingshuset i Stockholm AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Landstingshuset i Stockholm AB –107.8 –18.0 –89.8 –16.7 * Refers to result before appropriations and taxes

23 FHS: Future Healthcare Services

Companies Annual Report 2020 83 their allocation to inpatient care across medical care events in emergency during the year in order to meet the different clinics have changed at the inpatient care has fallen by 8.0 percent, need for primarily COVID-19 patients. hospital due to COVID-19 compared to and in elective care the decrease was Normally, there are 16 ICU beds at the previous years. 26.7 percent. hospital. At its peak, at the end of April, The number of foreign and out-of- the hospital had almost quadrupled its The administration’s share county patients was lower in outpatient capacity to 60 available ICU beds. At the of the costs care, –26.2 percent, as well as inpatient end of the year there were 40 ICU beds. The outcome for the indicator was 2.8 care, –8.6 percent, compared to budget. percent, which is lower than the out- The number of births were 8.2 percent Financial result come in 2o19 at 2.9 percent. Vacancies lower than budgeted. Södersjukhuset AB’s result amounted and fewer new hires of administrative The average length of hospital stay to SEK 66 million, which is SEK 58 mil- staff explain the decrease. for inpatient care has fallen somewhat lion over budget. The deviation corre- compared to the previous year, from sponds to 1.0 percent of turnover. Healthcare production 3.72 days to 3.68 days. The average The result includes negative finan- In 2020, 2,243 patients who had length of hospital stay has fallen due to cial effects from the COVID-19 pan- COVID-19 left the hospital. The average a change in the mix of patients at the demic amounting to a total of SEK –103 length of hospital stay for all patients hospital. The number of elective proce- million. The item comprises loss of with confirmed COVID-19 was 7.04 dures that often require a longer hospi- revenue as well as additional costs for days. One sixth of COVID-19 patients tal stay have fallen. The number of December. Elsewhere, the result was received intensive care. emergency admissions, where the positively affected by medical care that The number of visits fell significantly required length of hospital stay is often was deferred due to COVID-19. during the year. The decrease compared shorter, have fallen. The number of Operating revenue exceeded the to budget can be seen in emergency beds have varied during the year, budget by SEK 146 million, 2.5 percent. care, –20.8 percent, as well as elective depending on the COVID-19 patient Contributions received have created a care, –12.7 percent. The number of situation. April was the month with the positive deviation, SEK 217 million, inpatient medical care events have also highest average number of beds availa- which mainly refers to government fallen. There has been a clear transition ble, 668. The average number of availa- grants received by the hospital to cover to more inpatient care for COVID-19 ble beds for the year was 570, which was additional costs for COVID-19. During patients, and an increase in ICU beds. two fewer than the previous year. the year, the hospital also received Compared to budget, the number of The ICU capacity was expanded funding in order to compensate for

Outcome Outcome Target Goal Sustainable regional development Södersjukhuset AB 2020 2019 value 2020 fulfilment

High quality healthcare services Percentage of patients who spent no more than four hours in the Accident & Emergency department 37.0% 38% ≥ 78% Not fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 59.0% 74% ≥ 73% Not fulfilled● Percentage of patients who received an appointment for treatment within 90 days 72.0% 95% ≥ 90% Not fulfilled● Incidence of hospital-acquired infections 7.3% 6.40% ≤ 7.7% Fulfilled● Average current quality index for emergency hospitals N/A 87 Increase – Number of days ready for discharge per medical care event 2.2 – ≥ 2 Not fulfilled● Average number of days spent in hospital per medical care event 3.68% 3.72% Reduce Fulfilled● Cost per DRG point (Diagnosis Related Groups), SALAR processing1) N/A SEK 64,032 Reduce – High efficiency in care N/A – ≥ 60% – Core operations shall be prioritized The administration’s share of the costs 2.8% 2.9% Reduce Fulfilled●

1) Data from SALAR, inpatient and outpatient care excluding outliers

Financial result for Södersjukhuset AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Södersjukhuset AB 66.5 9.0 57.5 1.0% –111.6 * Refers to result before appropriations and taxes

84 Annual Report 2020 Companies increased sick pay costs. Care revenue in the investment budget due to COVID- returned to normal operations. As the was lower than budget, SEK –79 mil- 19. The outcome for investments relat- number of COVID-19 patients gradually lion, mainly within chosen childbirth, ing to COVID-19 was SEK 16 million. increased in the autumn, the hospital but also within chosen orthopaedics, resumed staff and reinforcement mode. hip and knee, due to cancelled elective Digitalisation care. The revenue from out-of-county Digital processes such as remote con- Goals and foreign patients fell as a conse- tacts have increased by just over 20,000 Danderyds Sjukhus AB shall aim to quence of COVID-19. The pandemic has visits from the previous year. In-person achieve indicators linked to the High impacted the revenue from collateral visits, particularly group visits such as in quality healthcare services goal. For contracts, as elective care was post- occupational therapy and physiotherapy, three indicators, no outcome was poned and cancelled during the year. have decreased significantly. The increase available at the time of the annual Operating costs exceeded the budget in digital contacts can be seen across accounts. Of the six indicators that were by SEK 134 million, or 2.4 percent. more or less all clinics. The roadmap for measurable, two indicators achieved There is a negative deviation for person- Södersjukhuset’s digitalisation 2020– their target value. nel costs of SEK –153 million, 4.5 2025 was drafted with the aim of percent, from the budget. The main coordinating and controlling the meas- High quality healthcare services reason was increased costs for tempo- ures, as well as securing delivery within Percentage of patients who spent no rary staff and costs for the Emergency the priority areas. One priority initia- more than four hours at the Accident & Agreement related to COVID-19. The tive is a pilot project for transferring Emergency department achieved its increase in personnel costs was partly vital parameters directly from medical target value. The new patient group offset by a positive one-off effect of the devices to the patient records to save with COVID-19 requires more changed pension liability, correspond- time for the clinical staff, and to reduce resources and at the same time, other ing to SEK 153 million. the risk of incorrectly entering data. patients have avoided going to the Rent and property costs increased by Success factors in the digitalisation Accident & Emergency department for SEK 13 million, compared to the budget, efforts in 2020 have been clear owner- less severe ailments. 2.3 percent, due to higher costs for ship of the digitalisation initiatives that During large parts of the year, strategic rents than estimated. In were prioritised by core operations. planned care has been put on hold, addition, adaptations of our premises partly due to patients cancelling were carried out as a consequence of the Danderyds Sjukhus AB appointments but primarily in order to pandemic. The costs for pharmaceuti- Danderyds Sjukhus AB is one of Region focus the emergency hospital’s cals, material, depreciations and net Stockholm’s emergency hospitals, resources on emergencies, which financial expenses were lower than the which is responsible for specialised increased considerably because of the budgeted level due to a lower production emergency care, planned somatic pandemic. This impacted both Percent- than the budget, as well as a lower rate specialist care, as well as highly special- age of patients who waited no more of investment than planned. ised rehabilitation medicine. In Janu- than 30 days and Percentage of During the year, the hospital had an ary 2020, Danderyds Sjukhus AB took patients who received an appointment action programme of SEK 300 million. over responsibility for the geriatric care within 90 days, and Danderyds Sjukhus Actions and measures have been taken at Danderyd hospital from Stockholm AB did not achieve either of these to a value of SEK 120 million. In 2020, County’s Healthcare Area. indicators’ target values. the remaining part of the programme The hospital entered into reinforce- Percentage of patients who con- was given a lower priority in 2020 due ment mode on March 14, 2020 which tracted hospital-acquired infections to COVID-19. meant that it was led by Local Special increased somewhat in 2020, compared Healthcare Management, LSSL. During to 2019, but the target value was Investments the pandemic, the hospital has been in achieved. The expenditure for the year, excluding frequent contact and collaborated Number of days ready for discharge strategic equipment investments, closely with the Regional Special per medical care event has fallen from amounted to SEK 94 million and was Healthcare Management, RSSL. During 3.8 to this year’s outcome of 0.4. New SEK 79 million under budget. The the autumn, the hospital’s highly legislation24, regional agreements25 and work-up rate was 56 percent in relation specialised university clinic for rehabil- increased collaboration between the to the year’s budget of SEK 169 million. itation medicine received a mandate hospital and the next level of care have The investment expenditure for the from HSF concerning highly specialised contributed to the decrease in the year, including strategic property post-COVID rehabilitation. number of days ready for discharge per investments, amounted to SEK 181 mil- After more than four months with medical care event. The low numbers lion. The reason for the lower outcome raised preparedness levels (staff mode are partly due to the hospital having was that priorities needed to be changed and reinforcement mode), the hospital worked on its operating flow, partly on

24 The Act on Cooperation on Discharge from Inpatient Care (2017:612). January 1, 2018. 25 Regional agreement from January 1, 2020.

Companies Annual Report 2020 85 the new agreement with the municipali- 2,241 patients diagnosed with COVID- greater. Video consultations grew from ties to receive patients earlier. During 19 were treated at the hospital. During more or less zero in January–February the pandemic, it has been particularly the year, Danderyds Sjukhus AB has to a peak of just below 550. important to prepare beds for new produced less than per the agreement in The number of inpatient medical patients requiring the resources of the both emergency and elective care. care events were 1,653, which was 3.1 emergency hospital. Between the first and the second wave percent lower than budgeted. Elective The indicator Average number of of the pandemic, the hospital resumed care decreased by 13.4 percent as a days spent in hospital per medical care normal capacity in elective care and large portion of the elective care was event was impacted by two major increased the agreed production. But postponed due to COVID-19. Emer- changes: the COVID-19 pandemic and when infections increased again in the gency inpatient medical care events the takeover of the geriatrics depart- autumn, the so-called second wave, decreased by 0.6 percent. Compared to ment from SLSO. If these two factors planned care were given less priority the outcome from the previous year, the are excluded, the average length of again. number of inpatient medical care events hospital stay was 2.8 days, which is The number of outpatient appoint- increased by 2.4 percent, where elective better than the previous year’s outcome. ments were 60,000, 14.1 percent lower inpatient medical care events increased than budgeted. The emergency outpa- by 14.5 percent and emergency events The administration’s share tient cases were 12.8 percent lower and increased by o.1 percent. of the costs the elective cases were 14.4 percent In 2020, the average length of The outcome for the indicator fell to 2.7 lower. Compared with the same period hospital stay was primarily impacted by percent compared to 2019, when it was the previous year, the number of outpa- two major changes: the COVID-19 2.9 percent. Despite the pandemic, the tient care appointments have decreased pandemic and the addition of Geriatric support functions were partly able to by 12.1 percent. care from SLSO. The average length of work on their action plans and thus able Because of the pandemic, digitalisa- hospital stay increased somewhat from to keep costs down. tion is progressing rapidly, where a the previous year, from 3 to 3.2 days. If growing share of personal appoint- we exclude geriatric care and patients Healthcare production ments have been replaced by remote with COVID-19, the average length of The first patient with COVID-19 was contacts. If this had not happened, the hospital stay was 2.88 days. admitted on March 7 and since then, negative deviation would be even

Outcome Outcome Target Goal Sustainable regional development Danderyds Sjukhus AB 2020 2019 value 2020 fulfilment

High quality healthcare services Percentage of patients who spent no more than four hours in the Accident & Emergency department 45% 45% ≥ 78% Not fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 55% 90% ≥ 73% Not fulfilled● Percentage of patients who received an appointment for treatment within 90 days 62% 87% ≥ 90% Not fulfilled● Incidence of hospital-acquired infections 7.7% 6.1% ≤ 7.7% Fulfilled● Average current quality index for emergency hospitals N/A 90.8 Increase – Number of days ready for discharge per medical care event 0.4 3.8 ≥ 2 Fulfilled● Average number of days spent in hospital per medical care event 3.2 3 Reduce Not fulfilled● Cost per DRG point (Diagnosis Related Groups), SALAR processing1) N/A SEK 57,471 Reduce – High efficiency in care N/A – ≥ 60% – Core operations shall be prioritized The administration’s share of the costs 2.7% 2.9% Reduce Fulfilled●

1) Data from SALAR, inpatient and outpatient care excluding outliers

Financial result for Danderyds Sjukhus AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Danderyds Sjukhus AB 18.6 8.0 10.6 0.2% –158.4 * Refers to result before appropriations and taxes

86 Annual Report 2020 Companies Financial result the budget was mainly due to the effects measurable, three indicators achieved Danderyd Hospital AB’s result of the COVID-19 pandemic. During the their target value. amounted to SEK 19 million which is a year, the hospital prioritised maintain- deviation from the budgeted result by ing emergency and critical care. In this High quality healthcare SEK eleven million. The deviation situation, the work on planned replace- services corresponds to 0.2 percent of turnover. ment investments also decreased. The Percentage of patients who spent no The result includes negative finan- investment expenditure for the year, more than four hours in the Accident & cial effects from the COVID-19 pan- including strategic equipment invest- Emergency department (excluding the demic amounting to a total of SEK –146 ments, amounted to SEK 127 million. local emergency clinic) has decreased million. The item comprises loss of compared to the previous year, and did revenue as well as additional costs for Digitalisation not achieve the target value. The pres- December. Elsewhere, the result was At an early stage during the first wave of sure on the Accident & Emergency positively affected by medical care that COVID-19, the introduction of digital department was periodically very was deferred due to COVID-19. consultations accelerated and is cur- intense. The situation was aggravated Operating revenue exceeded the rently in use in more or less all opera- by having to separate patients with budget by SEK 285 million, 5.8 percent. tions. The use of digital consultations suspected COVID-19 from other patients. Care revenue was SEK 45 million lower, grew rapidly, and widespread use will During large parts of the year, primarily in chosen care. The revenue continue after the pandemic, as well as planned care was put on hold, partly from out-of-county and foreign patients the continued use of the recording due to patients cancelling appointments has fallen as a consequence of COVID-19. features for lectures and training but primarily in order to focus the Contributions received have created courses. Hospital patients and their emergency hospital’s resources on a positive deviation, SEK 325 million, families have been given the opportu- emergencies, which increased consider- which mainly refers to government nity to stay in contact via video calls ably because of the pandemic. This grants received by the hospital to cover using smartphones and tablets. The impacted both the Percentage of additional costs for COVID-19. During digital maturity of the organisation has patients who waited no more than 30 the year, the hospital also received improved during the period, which also days and the Percentage of patients funding in order to compensate for means that future introductions of new who received an appointment within increased sick pay costs. digital solutions may be made easier, 90 days, and Södertälje Sjukhus AB did Operating costs exceeded the budget this creates good conditions for better not achieve either of these indicators’ by SEK 316 million, or 6.8 percent. efficiency. target values. Personnel costs deviated negatively by The hospital managed to achieve the SEK 177 million, 6.0 percent, from the Södertälje Sjukhus AB target value for the incidence of hospi- budget. The main reason was increased Södertälje Sjukhus AB is one of Region tal-acquired infections. Compared to costs for temporary staff and costs for Stockholm’s emergency hospitals, and 2019 there has been a deterioration, the Emergency Agreement related to is responsible for specialised emergency which can be attributed to the pandemic. COVID-19. One major positive item was care and planned somatic specialist care. The number of days ready for dis- a one-off effect from the changed The hospital entered into reinforce- charge per patient and medical care pension liability corresponding to SEK ment mode on March 14, 2020 which event was 0.1 for 2020. Work has been 139 million. meant that it was led by Local Special ongoing to create good cooperation The hospital’s transition to providing Healthcare Management, LSSL. During between the hospital and the munici- care to COVID-19 patients meant that the pandemic, the hospital has been in palities, but also for good cooperation the adopted action programme of SEK frequent contact and collaborated between hospital departments to 300 million could not be realised to the closely with Regional Special Health- improve patient flow. During the pan- required extent. In September, an care Management, RSSL. demic, the hospital’s departments and estimate was made that the effects At the end of June 2020, the hospital discharge teams were in more frequent achieved corresponded to a result of returned to staff mode, and from July contact over the phone with the munici- SEK 108 million. Since the hospital 20 to normal operations. As the number pality’s assistance assessors and dis- returned to enforcement mode no of COVID-19 patients gradually trict nurses in primary care, which additional follow-up was conducted. increased in the autumn, the hospital probably speeded up the decision-­ resumed staff and reinforcement mode. making process for discharges. Investments Investment expenditure for the year, Goals The administration’s share excluding strategic equipment invest- Södertälje Sjukhus AB shall aim to of the costs ments amounted to SEK 120 million achieve indicators linked to the goal The outcome for the indicator was 5.5 and was SEK 63 million under budget. High quality healthcare services. For percent. The hospital has reported The work-up rate amounted to 66 three indicators, no outcome was separately the cost for the part of the percent in relation to the year’s budget available at the time of the annual operations that can be attributed to of SEK 183 million. The deviation from accounts. Of the six indicators that were overall hospital administration.

Companies Annual Report 2020 87 However, the figures are misleading as primary care associated with patients Financial result the currently recognised cost also ready for discharge. Södertälje Sjukhus AB’s result includes the hospital’s own IT costs as Opportunities for elective medical amounted to SEK 95 million which is a well as costs for hospital security. In care events were affected throughout deviation from the budgeted result by 2021, the cost of IT systems and secu- the year by planned operations that SEK 93 million. The deviation corre- rity have been separated into two were cancelled in favour of emergency sponds to 6.1 percent of turnover. different cost centres, which will result care of inpatients with suspected or The result includes negative financial in more correct accounting for 2021. confirmed COVID-19 infection. effects from the COVID-19 pandemic Maternity care has had more medi- amounting to a total of SEK –20 million. Healthcare production cal care events, both compared with the The item comprises loss of revenue as Inpatient care production in 2020 was previous year and with budget. In order well as additional costs for December. 3.1 percent higher than for the previous to meet the increased need and in order Elsewhere, the result was positively year, which partly is due to the not to contribute to an increased spread affected by medical care that was increased patient flow related to the of infection, operations have worked for deferred due to COVID-19. pandemic, and partly to an increase in early discharge and expanded at-home The deviation in the result is attrib- the number of childbirths. Compared to maternity care. The operations have utable to a changed pension forecast budget, inpatient care was 1.2 percent taken advantage of access to digitalised from KPA, fixed compensation for the lower than budget. As a consequence of contact with healthcare to a large extent. hospital agreement and lower cost of the pandemic, outpatient care produc- In this way, the average length of hospi- supplies for elective care that was not tion was 11.4 percent lower than the tal stay has decreased by 13.7 percent carried out. previous year and 16.4 percent lower compared with the previous year. The hospital’s reported additional than budget. Out-of-county production has costs for COVID-19 amounted to SEK The average length of hospital stay decreased as a direct consequence of 93 million. Of the additional costs, decreased considerably compared to changed guidelines for out-of-county staffing comprised 58 percent, supplies the previous year, –7.8 in emergency healthcare according to a decision by 27 percent and other costs 15 percent. somatic care and –23.2 percent in RSSL. During the spring, when the The hospital has received a government geriatric care. The reduction is a result pandemic was at its peak, the guidelines grant of SEK 79 million in respect of of good collaboration between the called for a restriction in the level of these additional costs. hospital’s discharge team and the care provided to patients from other As of December, the hospital surrounding municipalities, as well as counties. received a new pension forecast. The

Outcome Outcome Target Goal Sustainable regional development Södertälje Sjukhus AB 2020 2019 value 2020 fulfilment

High quality healthcare services Percentage of patients who spent no more than four hours in the Accident & Emergency department 62.9% 67% ≥ 78% Not fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 67.8% 91% ≥ 73% Not fulfilled● Percentage of patients who received an appointment for treatment within 90 days 71.0% 95% ≥ 90% Not fulfilled● Incidence of hospital-acquired infections 7.2% 4.00% ≤ 7.7% Fulfilled● Average current quality index for emergency hospitals N/A 88 Increase – Number of days ready for discharge per medical care event 0.1 – ≥ 2 Fulfilled● Average number of days spent in hospital per medical care event 3.7 4.2 Reduce Fulfilled● Cost per DRG point (Diagnosis Related Groups), SALAR processing1) N/A SEK 68,929 Reduce – High efficiency in care N/A – ≥ 60% – Core operations shall be prioritized The administration’s share of the costs 5.5% – Reduce –

1) Data from SALAR, inpatient and outpatient care excluding outliers

Financial result Södertälje Sjukhus AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Södertälje Sjukhus AB 94.9 2.0 92.9 6.1% 22.8 * Refers to result before appropriations and taxes

88 Annual Report 2020 Companies forecast resulted in a positive deviation These needs have been met through the successful and carried out with lower compared with the budget of SEK 84 mil- application “Alltid öppet” and other relocation costs than budgeted. lion regarding pension costs, including digital services. One lesson we have financial expenses. learned is that when employees see a Goals clear need for a service/system, imple- S:t Eriks Ögonsjukhus AB shall aim to Investments mentation is much easier and employees achieve indicators linked to the goal Investment expenditure for the year, are motivated and interested. The High quality healthcare services. For excluding strategic equipment invest- hospital participates in the European three indicators, no outcome was availa- ments, amounted to SEK 29 million, Social Fund’s projects to increase digital ble at the time of the annual accounts. Of which corresponds to a work-up rate of skills for employees and managers, and the six indicators that were measurable, 116 percent. Due to the current pandemic, aims to increase the use of digital tools all indicators achieved their target value. the hospital has been forced to down- and e-health services, which in turn grade many of this year’s replacement leads to reduced paperwork and less High quality healthcare services investments in favour of new investments travel for patients. Accessibility at the Accident & Emer- concerning COVID-19 care. Investments gency department was high in 2020. On of SEK 2 million were linked to strategic S:t Eriks Ögonsjukhus AB average, 95.3 percent of patients waited equipment investments at the New S:t Eriks Ögonsjukhus AB conducts no more than four hours, and the indica- Södertälje Hospital. SEK twelve million specialised and highly specialised tor Percentage of patients who spent no pertains to investments connected to an emergency and planned ophthalmology. more than four hours at the Accident & increase in the number of beds due to the The hospital has a university hospital Emergency department achieved its pandemic. Of the pandemic-related mandate with extensive research, target for the year. investment expenditure, the majority development and educational activities Accessibility for new visits was relates to ventilators, monitoring equip- in collaboration with Karolinska Institu- affected by the pandemic, and is some- ment, infusion pumps as well as beds tet. The hospital also conducts national what lower this year than in 2019. and mattresses. healthcare within ophthalmic oncology, Despite this, S:t Eriks Ögonsjukhus AB paediatric cataracts and paediatric achieved the target for the percentage of Digitalisation glaucoma. patients who received a first appoint- One effect of the pandemic has been the During the year, S:t Eriks Ögonsjuk­ ment with a consultant within 3o days. increased demand for digital meetings, hus AB moved into newly built premises The outcome was 78.8 percent. both between employees in the region in Hagastaden. The move required Accessibility for surgery and treat- but also with patients and relatives. tremendous commitment and was ment has been high. On average, 92.4

Outcome Outcome Target Goal Sustainable regional development S:t Eriks Ögonsjukhus AB 2020 2019 value 2020 fulfilment

High quality healthcare services Percentage of patients who spent no more than 4 hours in the Accident & Emergency department 95.3% 96.0% ≥ 78% Fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 78.8% 94.0% ≥ 73% Fulfilled● Percentage of patients who received an appointment for treatment within 90 days 92.4% 94.0% ≥ 90% Fulfilled● Incidence of hospital-acquired infections 0% 0% ≤ 7.7% Fulfilled● Average current quality index for emergency hospitals N/A – Increase – Number of days ready for discharge per medical care event – ≥ 2 Fulfilled● Average number of days spent in hospital per medical care event 2.1 2.1 Reduce Fulfilled● Cost per DRG point (Diagnosis Related Groups), SALAR processing N/A – Reduce – High efficiency in care N/A – ≥ 60% – Core operations shall be prioritized The administration’s share of the costs 3.1% 2.7% Reduce Not fulfilled●

Financial result S:t Eriks Ögonsjukhus AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 S:t Eriks Ögonsjukhus AB 9.4 3.0 6.4 0.9% 55.7 * Refers to result before appropriations and taxes

Companies Annual Report 2020 89 percent of patients received an appoint- –26.9 percent for outpatient care and expenditure comprised new invest- ment for treatment within 90 days, and –29.2 percent for inpatient care. The ments of SEK 29 million for the new eye the target for the indicator was thereby average length of hospital stay was hospital as well as replacement invest- achieved. unchanged from the previous year: ments in medical devices, IT and other 2.1 days. equipment amounting to SEK 11.5 million. The administration’s share of the costs Financial result Digitalisation The administration’s share of the costs S:t Eriks Ögonsjukhus AB had balanced In the spring, “Alltid öppet” was increased somewhat to 3.1 percent from finances in 2020. The result amounted launched for digital appointments. 2.7 percent. The increase from the to SEK nine million, which is a positive Digital meetings and remote working previous year is due to the fact that the deviation from the budgeted profit was introduced for staff. The conclusion costs for core operations, such as the requirement by SEK three million. The was that all meetings held online saved purchase of supplies and pharmaceuti- deviation corresponds to 0.9 percent of time and money, as well as being better cals, has fallen as a consequence of the turnover. for the environment. At the same time, COVID-19 pandemic, as well as lower The result includes negative financial there were challenges, as most employ- pension costs. As the administrative effects from the COVID-19 pandemic ees were unused to participating in costs have not fallen to the same extent, amounting to a total of SEK –42 million. meetings using this technology, and this means that these costs have The item comprises loss of revenue initially needed considerable support increased in relation to total costs. The primarily from less foreign and out-of- and help. The conditions for improving indicator was not achieved for the year. county care, as well as additional costs employee participation and skills in for December. Elsewhere, the result was digitalising ophthalmic care have Healthcare production positively affected by medical care that improved after the move to Hagastaden. During the year, the hospital fulfilled was deferred due to COVID-19. the healthcare guarantee regarding During the year, revenue for foreign Folktandvården Stockholms waiting times for surgery and for new and out-of-county care fell by SEK 30.8 län AB doctor’s appointments. million compared to budget. Patient fees Folktandvården Stockholms län AB Healthcare production of all types were also SEK 3.4 million lower than shall provide public dental care within has been impacted by the COVID-19 budgeted. The costs for hired personnel Region Stockholm within the scope of pandemic as fewer patients have visited were higher than budgeted, primarily the region’s responsibilities in accord- the hospital. Healthcare production was relating to reinforcing the IT support in ance with the Dental Care Act. In the significantly under budget in terms of connection with the move to new prem- region, Folktandvården Stockholms län both the number of visits and the num- ises. Sick pay costs were also higher, and AB carries out assignments on behalf of ber of medical care events, –24.4 per- can be attributed to the pandemic due to the Healthcare Committee, which cent and –19.3 percent respectively. In higher levels of sick leave. according to the procurement shall comparison to the previous year, the include paediatric dental care. number of outpatient appointments Investments Folktandvården Stockholms län AB decreased by –17.6 percent and the num- Investment expenditure for the year shall be a competitive dental care ber of medical care events decreased by amounted to SEK 40.5 million and the company. –16.9 per cent. Foreign and out-of- work-up rate was 101 percent in relation Due to the COVID-19 pandemic, county care were also under budget, to the budget of SEK 40 million. The RSSL decided that Folktandvården

Sustainable regional development Folktandvården Outcome Outcome Target Goal Stockholm län AB 2020 2019 value 2020 fulfilment

High quality healthcare services Percentage of 19-year-olds with lateral surfaces that are free from caries 71% 68.9% ≥ 71% Fulfilled● Core operations shall be prioritized The administration’s share of the costs 5.4% 4.9% Reduce Not fulfilled●

Financial result Folktandvården Stockholms län AB Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Folktandvården Stockholms län AB 112.5 112.5 0.0 0.0% 112.5 * Refers to result before appropriations and taxes

90 Annual Report 2020 Company Stockholms län AB, in March, should of a considerably reduced number of quence of the COVID-19 pandemic, as limit their operations by closing clinics patients in adult dental care, which fell well as due to less wear and tear on in order to make protective equipment by 17.5 percent from the previous year. equipment during the period, and partly and consumables available to the health- Specialist dental care also saw decreased due to the fact that there was no agree- care service. Furloughing was intro- healthcare production due to the ment for treatment units, which caused duced on May 4 for a large number of the COVID-19 pandemic. The backlog of delays. company’s employees, who were fur- deferred medical care has already had, loughed and worked 40 percent of their and will continue to have, major conse- Digitalisation normal working hours. In June, opera- quences for the company’s finances in Folktandvården saw very positive results tions were gradually resumed to full the form of falling revenue due to lost in the assessment of digital maturity, an capacity. In the autumn, operations have market share in terms of adult patients. organisation’s ability to take advantage been at normal levels, but with a backlog The challenges from previous years of digitalisation, which the region of deferred medical care to handle. concerning skills supply remain, as there conducted in 2020. In connection with is a shortage of experienced dental care the pandemic, a quick and successful Goals providers. A high retirement rate has led implementation of digital meetings was High quality healthcare services to an ongoing generational shift, where carried out for remote working and The percentage of 19-year-olds with experienced care providers are replaced training. A pilot for digital healthcare lateral surfaces that are free from caries by less experienced staff, which has had consultations was also developed, but was 71 percent, which is an increase from an adverse effect on production. was put on hold due to the pricing model the previous year of 2.1 percentage points. that was presented. The increase is due to preventive Financial result measures that have been ongoing for Folktandvården Stockholms län AB’s Ambulanssjukvården i some time. Preventive measures such as result amounted to SEK 113 million, Storstockholm AB information and the use of fluoride in which was in line with the budgeted Ambulanssjukvården i Storstockholm schools, as well as outreach operations profit requirement. This includes SEK AB, AISAB, shall provide ambulance have meant that the trend has been 218 million attributable to additional services for Region Stockholm. AISAB positive for a considerable time. The costs and loss of revenue linked to can carry out interhospital transports indicator was achieved for the year, COVID-19 in the form of SEK 210 million and the transport of the deceased on despite the fact that it was not possible to in lower revenue, primarily from adult behalf of Region Stockholm. carry out all preventive measures due to dental care. The COVID-19 pandemic has COVID-19. To some extent, the loss of revenue impacted AISAB for almost the entire was compensated by increased revenue financial year. There have been chal- The administration’s share of in the form of government compensation lenges to staffing, commissioning new the costs for furloughing amounting to SEK 17 units and maintaining a consistent The outcome for the indicator was 5.4 million, compensation for sick pay supply of protective equipment. percent, which is a decrease compared to amounting to SEK 15 million, as well as the interim report of 0.3 percentage career readjustment insurance in May Goals points, but an increase from the previous amounting to SEK five million. The administration’s share of year of 0.5 percentage points. The Personnel costs were SEK 135 million the costs increase compared to the previous year lower than budgeted, of which SEK 59 The indicator was first measured in 2021. is due to the fact that the costs for core million concerned payroll costs, and operations, such as materials and pur- SEK 48 million concerned pension costs. Healthcare production chased services, have decreased as a The deviation is largely due to the intro- The number of ambulance assignments consequence of the COVID-19 pandemic, duction of a recruitment freeze in the in 2020 was 104,759. This was five as well as lower pension costs. As the spring for non-essential recruitments as percent higher than budgeted. However, administrative costs have not fallen to a consequence of COVID-19, and to the compared to the previous year, there the same extent, this means that these fact that temporary employment and was a decrease of three percent. The costs have increased in relation to total employment on an hourly basis were number of assignments for transporting costs. The indicator was not achieved for ended. the deceased was eight percent higher the year. than budgeted and increased by 12 Investments percent compared to the previous year. Healthcare production The expenditure for the year amounted The statistics do not include cancelled The company has managed to reduce to SEK 39 million and the work-up rate ambulance assignments. AISAB receives much of the backlog of deferred medical was 46 percent in relation to the year’s variable remuneration for the number of care that arose earlier in the year for budget of SEK 85 million. The deviation assignments, and cancelled assignments patients in paediatric dental care, which is partly due to the introduction of an are included in this. If cancelled assign- fell by 1.5 percent from the previous year. investment freeze in the spring for ments had been included, the number of However, it was achieved at the expense non-essential investments as a conse- assignments for 2020 would be 114,000.

Companies Annual Report 2020 91 Around 8,600 assignments on behalf Digitalisation operations regarding healthcare for of the extra transport organisation The pandemic had an adverse impact on foreign patients will cease on January 1, in Älvsjö should be added to these digitalisation, and led to delays in 2021 and will be transferred to assignments. various projects, such as the introduc- Karolinska University Hospital. In tion of new and updated IT infrastruc- accordance with a proposal to the Financial result ture, a new external website, a new Regional Council, Stockholm Care AB’s Ambulanssjukvården i Storstockholm intranet, new IT equipment in the remit from 2021 will be to administrate AB’s result amounted to SEK 30.5 mil- ambulances, and the continued imple- the Tobias Registry. lion and thus exceeded the budgeted mentation of online training has been COVID-19 had an extensive impact, result by 18.5 million. The deviation affected. A senior IT coordinator has which significantly limited the compa- corresponds to four percent of turnover. been recruited to improve digital skills ny’s ability to operate regarding health- As per agreement, additional costs of and abilities. care exports due to periods of closed SEK 46 million related to COVID-19 borders and cancelled air travel. have been invoiced to the Healthcare The Regional Council decided to Committee throughout the year. This Stockholm Care AB transfer healthcare for foreign patients means that ASAB’s financial result has Stockholm Care AB shall act as an to Karolinska University Hospital, not been impacted by these additional intermediary for foreign patients, commencing January 1, 2021, which has costs. primarily to the highly specialised adversely impacted the 2020 results healthcare operations within Region due to the need for impairments. Investments Stockholm, which are able to improve The investment expenditure for the their development opportunities Goals year was SEK 13 million, as compared to through an extended patient base. In The administration’s share of the budgeted amount of SEK 28 million. addition, the company shall provide the the costs As a consequence of the pandemic, all healthcare operations with administra- The outcome for the indicator was 3.5 planned purchases of vehicles were not tive and practical support and service. percent, which is in line with the carried out, and some purchases have Stockholm Care AB also manages the interim report. The company was been delayed and will be delivered at Tobias Registry. measured against the interim value as the beginning of 2021. Upcoming organisational changes there was no measurement for 2019. will mean that Stockholm Care AB’s The indicator was not achieved as there

Sustainable regional development Ambulanssjukvården i Outcome Outcome Target Goal Storstockholm AB 2020 2019 value 2020 fulfilment

Core operations shall be prioritized The administration’s share of the costs N/A Reduce –

Financial result Ambulanssjukvården i Storstockholm AB Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Ambulanssjukvården i Storstockholm AB 30.5 12.0 18.5 4.4% 26.2 * Refers to result before appropriations and taxes

Outcome Outcome Target Goal Sustainable regional development Stockholm Care AB 2020 2019 value 2020 fulfilment

Core operations shall be prioritized The administration’s share of the costs 3.5% 3.5% Reduce Not fulfilled●

Financial result Stockholm Care AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Stockholm Care AB –7.5 1.0 –8.5 –7.3% 1.7 * Refers to result before appropriations and taxes

92 Annual Report 2020 Company was no reduction compared with the The result includes negative finan- During the year, MediCarrier AB interim value. cial effects from the COVID-19 pan- was given an extended mandate to demic amounting to a total of SEK –7 provide an emergency stockpile corre- Healthcare production million. The item comprises loss of sponding to three months’ forecasted The total turnover of invoiced cases revenue as well as additional costs for consumption of protective equipment decreased by 45 percent compared with December. Elsewhere, the result was and other critical items. At the begin- 2019. The percentage of healthcare positively affected by medical care that ning of the pandemic, the Karolinska inquiries received decreased by 37 was deferred due to COVID-19. Command Center was responsible for percent compared to 2019. The pan- managing this mandate, but it was demic has had the greatest impact on Digitalisation taken over by MediCarrier AB during the lower outcome. Above all, the pandemic has shown that the year. In connection with the takeo- The number of completed confirma- good conditions prevail for working ver, the inventory value was impaired as tory typings26, CT, increased by eleven effectively with digital solutions. The items were purchased at the beginning percent compared to the previous year challenges have been to get the same of the pandemic, during a state of and on average 20 to 25 percent of CT team spirit when working remotely as shortage, which are now not expected to lead to the harvesting of stem cells. The when the staff meet physically. be sold at the purchase price. Tobias Registry mediated 107 stem cell Revenues amounted to SEK 1,181 harvests, which is one less than the MediCarrier AB million, which was 22.6 percent above previous year. This year’s target for new MediCarrier AB is Region Stockholm’s budget. The increase can be explained donors was exceeded and SIFO’s survey logistics and transport company and by the increased demand for healthcare of the public’s awareness of the business will, on a commercial basis, suborder, materials caused by COVID-19. Medi- showed gratifyingly that 53 percent of store, package and distribute healthcare Carrier AB has received compensation those surveyed, compared with 22 supplies and consumables to operations for additional costs corresponding to percent in 2019, know about the Tobias within the Stockholm Region. revenue of SEK 85 million to cover the Registry and the type of business in extraordinary costs connected with the which it is engaged. Goals impairment of inventory, rental of The administration’s share of premises and additional personnel Financial result the costs costs caused by COVID-19. Stockholm Care AB’s result amounted The outcome for the indicator was 3.5 The costs of SEK 187 million were to minus SEK 8 million and deviated percent at the end of December 2020, higher than budget, and corresponds to negatively by SEK 9 million from the which is 0.1 percentage points lower 19.6 percent. The largest cost relates to budgeted profit requirement. Non-­ than the outcome in 2019, which was the impairment of inventory of SEK 63 recurring items including, among other 3.6 percent. million. Furthermore, the costs for things, impairment of all the company’s hired personnel were SEK 22 million, development projects due to the fact Financial result SEK 13 million over budget. Other costs that transfer of operations related to MediCarrier AB’s result amounted to include SEK 48 million, SEK 9 million care for foreign patients have had a SEK 37 million, SEK 31 million above over budget, mainly driven by rent for negative effect on earnings of approxi- the established profit requirement of external premises in connection with mately SEK 9 million. SEK six million. the stock balance increasing markedly.

Outcome Outcome Target value Goal Sustainable regional development MediCarrier AB 2020 2019 2020 fulfilment

Core operations shall be prioritized The administration’s share of the costs 3.5% 3.6% Reduce Fulfilled●

Financial result MediCarrier AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 MediCarrier AB 36.6 6.0 30.6 3.2% 5.1 * Refers to result before appropriations and taxes

26 They perform the administration/investigation after a treatment centre has found a match between a patient and a potential stem cell donor.

Companies Annual Report 2020 93 The result includes negative finan- skills-enhancing initiatives in the area eted profit requirement of SEK seven cial effects from the COVID-19 pan- of ​​digital skills. million. The positive deviation from the demic amounting to a total of SEK –7 profit requirement can be explained by million. The item consists of loss of Locum AB lower personnel costs due to retirement, revenue and additional costs, mainly Locum AB is responsible for ownership and vacancies that were not filled. relating to depreciation of inventory, issues related to property management hired personnel and external rents, for and financial administration regarding Investments the month of December. Elsewhere, the the Property and Service Committee’s The expenditure for the year amounted result was positively affected by medical profit centre Landstingfastigheter to SEK 0.5 million and the work-up rate care that was deferred due to COVID-19. Stockholm. The company shall other- was 46 percent in relation to the budget wise assist the Property and Service for the year of SEK 4.5 million. Investments Committee in strategic property mat- The expenditure consisted of invest- Investment expenditure for the year ters. Ownership of Region Stockholm’s ments in IT and office equipment. The amounted to SEK 2.3 million, which properties is reported in the Property low work-up rate can be explained by meant a work-up rate of 115 percent in and Service Committee. the fact that the COVID-19 pandemic relation to the budget for the year of During the year, Locum AB actively meant that investments in office equip- SEK 2.0 million. The investments participated in the work of the Regional ment were not carried out as planned. consisted of replacement investments Special Healthcare Management, in production, such as the purchase of RSSL, to increase the number of beds Digitalisation shopping carts, as well as investments for COVID-19 patients The focus has One success factor and a lesson learned in the renovation of existing premises to been on safeguarding the operation of that has been identified is not to wait be able to assume operations from new the properties. and do things on a large scale, but to expanded premises. start small and scale up gradually. In Goals this way, Locum has become more agile. Digitalisation The administration’s share of During the year, various initiatives were As a result of the pandemic, employees the costs implemented to increase digital skills have been encouraged to work remotely, The outcome for the indicator was 4.1 within Locum. which in turn has meant that managers percent at the end of December 2020, have had to review existing procedures which was 1.6 percentage points lower AB Stockholms Läns and working methods to adapt these to than the outcome in 2019, which was 5.7 Landstings Internfinans digital management. For the most part, percent. The lower outcome is mainly due AB Stockholms Läns Landstings the pandemic’s effect on digitalisation to lower personnel costs caused by Internfinans is Region Stockholm’s has been very positive as we have been retirement and the fact that vacancies internal bank with the main task of forced to apply new routines and work- have not been filled. The reduction ensuring the region’s liquidity. The ing methods. exceeds ten percent and the target has company assists, on a commercial basis, The digital skills in the company thus been met. Region Stockholm’s committees, were raised more swiftly than planned companies and foundations with when the COVID-19 pandemic struck. Financial result managing central liquidity, borrowing In other respects, also as a result of the The financial result for Locum AB funds on the capital market and con- ongoing COVID-19 pandemic, the amounted to SEK 13 million, which was ducting lending for investments to the company has not implemented any SEK six million better than the budg- region’s committees and companies.

Outcome Outcome Target Goal Sustainable regional development Locum AB 2020 2019 value 2020 fulfilment

Core operations shall be prioritized The administration’s share of the costs 4.1% 5.7% Reduce Fulfilled●

Financial result Locum AB

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 Locum AB 13.3 7.0 6.3 1.6% 13.6 * Refers to result before appropriations and taxes

94 Annual Report 2020 Company In 2020, Internfinans negotiated a During the year, the company received a AB SL Finans provides, in exchange for syndicated credit facility27 on Region new pension forecast where the debt reimbursement, vehicles, carriages, Stockholm’s behalf with eight Swedish and pension costs decreased by approx- machines and other inventories and and international banks as counterpar- imately SEK 1.6 million compared with facilities for local transport providers. ties. The credit facility replaces the the budget. SL Älvsjö AB owns, manages and previous credit facility that was entered develops properties and associated into in December 2015. Digitalisation operations. Waxholms Ångfartygs AB, As Internfinans had previously imple- WÅAB, which is part of the SL Group as Goals mented a digital tool, the company was of July 2019, manages maritime public The administration’s share of well equipped for the transition from transport in the Stockholm archipelago the costs physical meetings to digital meetings. and manages certain agreements and The administrative costs are defined as The pandemic’s effect on digitalisation assets for Region Stockholm. costs for administrative support for the has led to an increased need to imple- core operations. Internfinans’s opera- ment digital signatures. Financial result tions are a support operation, which AB Storstockholms Lokaltrafik’s result means that all costs are judged to be AB Storstockholms for the period amounted to SEK –1,115 administrative. Lokaltrafik million, which was SEK –1,519 million AB Storstockholms Lokaltrafik (AB SL) below the budgeted result. The devia- Financial result is the collective name and brand for the tion corresponds to 4.9 percent of AB Stockholms Läns Landstings procured general terrestrial public turnover. The deviation can mainly be Internfinans’s result amounted to SEK 5 transport service in the Stockholm explained by lower ticket revenue due to million, which is a positive deviation of Region. Via SL, Region Stockholm fewer passengers. Except for the effects SEK 2 million from the budgeted result. manages certain contracts and assets. of reduced ticket revenue and additional The deviation corresponds to 15 percent The company has three wholly owned costs as a result of the pandemic, the of turnover. The result can primarily be subsidiaries. AB SL Finans, SL Älvsjö AB company has met its budgeted profit explained by lower costs than budgeted. and Waxholms Ångfartygs AB. requirement.

Outcome Outcome Target Goal Sustainable regional development 2020 2019 value 2020 fulfilment

Core operations shall be prioritized The administration’s share of the costs 100% 1) 100% 1) Reduce –

1) Not applicable as 100% of operations are classed as administrative

Financial result AB Stockholms Läns Landstings Internfinans

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 AB SLL Internfinans 5.5 3.0 2.5 14.7% 3.6 * Refers to result before appropriations and taxes

Financial result AB Storstockholms Lokaltrafik

Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 AB Storstockholms Lokaltrafik and subsidiaries –1,114.8 404.0 –1,518.8 –4.9% 604.0 * Refers to result before appropriations and taxes

27 A syndicated credit facility is a loan that has been agreed jointly with several financiers.

Companies Annual Report 2020 95 Local government federations and 12 foundations

96 Annual Report 2020 Local government reduced consumption of healthcare ant within 30 days. Periodically, elec- federations services. tive care has had to be completely Region Stockholm is a member of three In other respects, it should be men- deferred in favour of COVID-19 care, local government federations: tioned that a fixed temporary remuner- which in turn means that the amount of • The local government federation ation has been introduced in both deferred medical care has increased. Sjukvård och omsorg i Norrtälje. primary care and in several internal The target value for the percentage of • The local government federation contracts with Tiohundra AB. The patients who spent no more than four Svenskt Ambulansflyg. purpose of this has been to minimize hours in the Accident & Emergency • The local government federation the administrative burden, ensure department was not achieved, mainly Avancerad Strålbehandling. stable financing and make it possible to due to fewer available beds caused by easily reallocate staff between different the pandemic. In accordance with the Local Govern- areas of the healthcare service and The percentage of patients who ment Act, local government federations between healthcare providers. As a received an appointment for a first visit can in most aspects be considered as result, primary care staff have been able to a consultant within 30 days was 92 separate municipalities, as they are to relieve Norrtälje Hospital by carrying percent, and the indicator achieved its subject to the same rule as municipali- out home visits and visiting special target value even though it was below ties in that any deficits must be restored accommodation. the 2019 value of 93 percent. The within three years. accumulated outcome for the year was Goals 80 percent. The local government federation Tiohundra AB has had nine indicators The percentage of patients who Sjukvård och omsorg i Norrtälje connected to the goal High quality received an appointment for treatment The local government federation healthcare services. Three of the within 90 days was 73 percent, and the Sjukvård och omsorg i Norrtälje indicators achieved their target values, target for the indicator was therefore (KSON) comprises two members: while three did not achieve their target achieved. The accumulated outcome for Region Stockholm and Norrtälje values. No outcome was available for the year was 81 percent. Municipality. KSON plans and orders two of the indicators at the time of the The percentage of patients who healthcare services as well as social annual accounts. contracted a hospital-acquired infection care in Norrtälje municipality. KSON at Norrtälje Hospital was 2.7 percent, and owns the company Tiohundra AB, High quality healthcare services the indicator achieved the target value. which is responsible for healthcare The COVID-19 pandemic has had a The low prevalence of hospital-­acquired operations at Norrtälje Hospital and at major adverse effect on the fulfilment of infections can probably, to some extent, a number of health centres and social goals within the healthcare service, be related to fewer medical care events care operations. especially with regard to the goal of and new procedures due to COVID-19. The pandemic has had a major impact treatment within 90 days and the However, the measurements were not both on the operations and on the percentage of patients who received an carried out in the same way as previ- financial result, which is reflected in the appointment for a first visit to a consult- ously, due to the COVID-19 pandemic.

Outcome Outcome Target value Goal Sustainable regional development 2020 2019 2020 fulfilment

High quality healthcare services Percentage of patients who spent no more than four hours in the Accident & Emergency department 73.8% 78% ≥ 78% Not fulfilled● Percentage of patients who received an appointment for a first visit with a specialist within 30 days 92.0% 93% ≥ 73% Fulfilled● Percentage of patients who received an appointment for treatment within 90 days 73.0% 98% ≥ 90% Not fulfilled● Incidence of hospital-acquired infections 2.7% 5.6% ≤ 7.7% Fulfilled● Average current quality index for emergency hospitals 98.81) – Increase – Number of days ready for discharge per medical care event 1.8 2.3 ≥ 2 Fulfilled● Average number of days spent in hospital per medical care event 4.5 4.4 Reduce Not fulfilled● Cost per DRG point (Diagnosis Related Groups), SALAR processing2) SEK 52,0761) – Reduce – High efficiency in care N/A – ≥ 60% – Core operations shall be prioritized The administration’s share of the costs 3.1% Reduce Not fulfilled●

1) Outcome refers to 2019 as data for 2020 are not available. 2) Data from SALAR, inpatient and outpatient care excluding outliers.

Local government federations and foundations Annual Report 2020 97 The indicator for the number of days decreased. Financial result ready for discharge per medical care The number of visits to GP clinics KSON’s result for the year was positive event was 1.8 days, which is lower than decreased by 18 percent compared with and Region Stockholm’s share amounted the target value and lower compared the previous year, and in specialized to SEK 62 million, which corresponds to with 2019. physiotherapy the decline was 33 3.5 percent of the turnover. The positive The indicator for the average number percent compared with 2019. result refers both to the operations of of days spent in hospital per medical The number of visits to Norrtälje the local government federation and the care event had an outcome of 4.5 days, Hospital decreased by 28 percent, operations of Tiohundra AB. The result but compared with 2019 it was a small compared with 2019. The number of in relation to the region’s share includes increase of 0.1 percentage points. medical care events at Norrtälje Hospi- SEK 43 million in additional costs for tal decreased by ten percent, while the COVID-19. Lost revenue from patient The administration’s share number of medical care events in fees amounted to SEK 23 million. Both of the costs psychiatry increased by seven percent. KSON and Tiohundra AB received The outcome for the indicator was 3.1 compensation from the government for percent. Measurement of the indicator Healthcare production at COVID-19 which covers these addi- was not performed in 2019. In the 2020 Norrtälje Hospital tional costs, therefore the result was not interim report, the outcome for the indi- All planned care that could be delayed affected. cator was 3.4 percent. The reason for was postponed from 23 March in In May, the members decided to add the reduction was lower staffing levels accordance with a decision by Region extra membership fees, where Region for administrative services because Stockholm. Some elective care was Stockholm was accountable for SEK 71 vacancies have not been filled. resumed in August. When the spread of million. The grant financed in full the infection picked up speed again and beds extension of compensation terms for Healthcare consumption for COVID-19 patients and other emer- agreements with Tiohundra regarding Healthcare consumption shows consist- gency cases needed to be secured, elec- Norrtälje Hospital, including its collat- ently negative deviations as a result of tive inpatient care had to be postponed eral agreements until December 31, 2020. the COVID-19 pandemic. The number again During the summer, the hospital’s Tiohundra AB began the year with of medical care events, doctors’ visits, wards had problems with overcrowd- low equity, with a share capital of SEK and visits to other healthcare providers ing, the occupancy rate has even been 17 million. A shareholder injection has did not reach the budgeted figure and higher than in previous summers. been received corresponding to the was lower compared with 2019. Healthcare production at Norrtälje estimated cost of the reduced discount In 2020, the inhabitants of Norrtälje Hospital was lower than planned both rate in the pension system of SEK 52 Municipality consumed 6.3 percent for inpatient events and outpatient million, of which SEK 44 million per- fewer medical care events than in the appointments. In comparison to the tains to Region Stockholm’s share. The previous year. The number of doctors’ budget, the number of outpatient shareholder injection together with a visits and visits to other healthcare appointments decreased by 14.6 per- positive result for the period has providers, such as district and assistant cent and the number of inpatient events strengthened the company’s equity, nurses at GP clinics as well as physio- decreased by 18.2 per cent. The number which at the end of the year amounted therapists, speech therapists, occupa- of beds fell below the budgeted 87 by 15, to SEK 110 million. tional therapists and chiropractors, also a negative deviation of 16.3 percent.

Healthcare consumption

Care, excluding basic home nursing and Outcome Outcome Deviation Result Change home rehabilitation 2020 2020 budget 2019 % Medical care events 8,456 10,400 –18.7% 9,025 –6.3% Doctor’s appointments 177,441 242,000 –26.7% 218,770 –18.9% Appointments with other healthcare providers 125,023 170,500 –26.7% 160,191 –22.0%

Financial result Result* Budget Deviation as percent Result* MSEK 2020 2020 Deviation of turnover 2019 The local government federation Sjukvård 62.0 0.1 61.9 3.5% –44.8 och omsorg of which Tiohundra AB** 46.4 0.0 46.4 5.3% –29.5

*Refers to Region Stockholm’s share of the profit, which is 50 percent ** Refers to result before appropriations and taxes

98 Annual Report 2020 Local government federations and foundations The local government federation Foundations foundation’s board decided to transfer Svenskt Ambulansflyg A foundation is a self-owned asset, the foundation’s operations to Region The aim of the local government federa- without owners or members, which is Stockholm as of January 1, 2021, tion Svenskt Ambulansflyg (KSA) is to dedicated to permanently fulfilling a whereby it will be integrated into the invest in ambulance flights and to specific purpose. Foundations are not Culture Committee’s management. operate ambulance flight operations included in the 2020 income statement throughout Sweden. All the Swedish or balance sheet of the regional group, The Archipelago Foundation in regions are members of KSA. In 2019, other than in the form of any contribu- Stockholm County manages properties KSA procured six aircraft, which will be tions allocated, which are recognised as and aims to preserve the Stockholm delivered in 2020. The Federal Council expenditure in the income statement. archipelago and the development of decided in June 2020 that operations The following is a presentation of the outdoor activities in the archipelago. will be run under its own permits and foundations that Region Stockholm had Region Stockholm is the principal funder licences as well as contracted personnel. supervisory responsibility for in 2020. of the foundation, which receives annual Air ambulance operations will commence The percentage of board members contributions for operations and prop- in 2021 as the aircraft are delivered. appointed by Region Stockholm is shown erty maintenance. In 2019, Region In 2020, Region Stockholm paid a in brackets. Stockholm and the foundation concluded membership contribution of SEK 2.3 mil- an agreement relating to operating and lion. The membership contribution will The foundation Cancercentrum­ investment funds in the form of granted increase once the ambulance service is Karolinska aims to promote experimen- contributions for the period 2020–2023. fully operational. KSA’s preliminary tal cancer research. The foundation is result for the year was SEK one million. working to promote the development of The foundation Flemingsberg Science individualised cancer treatment, in close aims to improving collaboration between The local government federation collaboration with Karolinska University the stakeholders in Flemingsberg. Avancerad Strålbehandling Hospital and Karolinska Institutet. During the period 2019–2022, the The aim of the local government federa- foundation will work to promote contin- tion Avancerad Strålbehandling is to The foundation Centrum för Molekylär ued campus development and increased build and operate a national facility for Medicin works primarily with research collaboration in areas such as ageing, proton beam therapy, the Skandion relating to chronic inflammatory dis- diversity and health. Clinic, and to safeguard opportunities eases. During the year, the foundation for research and development of its acquired new and advanced molecular The Stockholm Concert Hall Foundation operations. diagnostics. shall promote musical activities by In 2020, the local government holding concerts and maintaining the federation commenced treatment of 297 The foundation Stockholms läns Royal Stockholm Philharmonic patients, an increase of 29 (11 percent). Äldrecentrum is an interdisciplinary Orchestra for this purpose. Region The number of foreign patients treated centre for research and development Stockholm is the principal funder of was 31, which was an increase of two. relating to the health and social care of the foundation, which receives annual The foreign patients came mainly from the elderly. contributions for operations and prop- Norway. A total of 62 patients came from erty maintenance. In 2019, Region Stockholm, which was an The foundation Stockholms läns Region Stockholm and the foundation increase of two compared with the museum is a so-called county cultural concluded an agreement relating to previous year. function with the aim of conducting operating and investment funds in the The local government federation’s scientific collection and documentation, form of granted contributions for the preliminary result for the year 2020 and carrying out external operations in period 2019–2022. amounted to SEK 15 million, which was the care of ancient monuments and SEK 8 million better than budget. museums in the county. In 2020, the

Operating foundations

Foundations where Region Stockholm is Foundations where Region Stockholm Foundations where Region Stockholm the sole founder: are co-founders: is the principal funder:

• The foundation Cancercentrum • The foundation Stockholms läns • The Stockholm Concert Hall Karolinska (100%) museum (44%) Foundation (67%) • The foundation Centrum för • The foundation Stockholms läns Molekylär Medicin (100%) Äldrecentrum (50%) • The Clara Foundation (0%)28 • The Archipelago Foundation in Stockholm County (53%) • The foundation Flemingsberg Science (25%)

28 As of February 2018, the region no longer appoints any members or auditors to the Clara Foundation.

Local government federations and foundations Annual Report 2020 99 Operations and 13 Investment accounts

100 Annual Report 2020 Operational accounts

Deviation Revenue* Costs* Result Budget compared MSEK 2020 2020 2020 2020 to budget

The healthcare service Healthcare Committee 71,234.0 –70,980.9 253.1 0.0 253.1 Healthcare Service Steering Committee 487.8 –486.7 1.0 0.0 1.0 Patient Advisory Committee 34.3 –32.6 1.7 0.0 1.7 The local government federation Sjukvård och omsorg 1,767.2 –1,705.3 62.0 0.1 61.9 of which Tiohundra AB 905.1 –858.7 46.4 0.0 46.4 Stockholm County’s Healthcare Area 12,858.2 –12,629.5 228.7 220.0 8.7 Karolinska University Hospital 24,933.6 –24,860.4 73.2 53.0 20.2 Södersjukhuset AB 5,995.7 –5,929.3 66.5 9.0 57.5 Danderyds Sjukhus AB 5,227.5 –5,208.9 18.6 8.0 10.6 Södertälje Sjukhus AB 1,652.1 –1,557.2 94.9 2.0 92.9 S:t Eriks Ögonsjukhus AB 682.1 –672.7 9.4 3.0 6.4 Folktandvården Stockholms län AB 1,599.6 –1,487.2 112.5 112.5 0.0 Ambulanssjukvården i Storstockholm AB 474.0 –443.5 30.5 12.0 18.5 Stockholm Care AB 83.5 –91.0 –7.5 1.0 –8.5 MediCarrier AB 1,180.7 –1,144.1 36.6 6.0 30.6 Healthcare service, total 128,210.3 –127,229.3 981.1 426.6 554.6

Public transport Transport Committee 32,257.5 –33,353.6 –1,096.2 404.0 –1,500.2 of which the Transport Administration 11,040.7 –11,026.6 14.1 0.0 14.1 of which the Underground Expansion Administration 183.4 –179.0 4.4 0.0 4.4 of which AB Storstockholms Lokaltrafik 20,500.1 –21,575.6 –1,075.5 404.0 –1,479.5 of which Waxholms Ångfartygs AB 533.2 –572.5 –39.3 0.0 –39.3 Mobility Service Committee 1,906.8 –1,530.2 376.6 0.0 376.6 Public transport, total 34,164.2 –34,883.8 –719.6 404.0 –1,123.6

Culture Committee 588.5 –588.1 0.5 0.0 0.5 The Growth and Regional Planning Committee 191.8 –191.8 0.0 0.0 0.0 Regional Executive Committee 2,679.6 –2,115.1 564.5 0.0 564.5

Properties and Service Property and Service Committee 7,842.3 –6,745.5 1,096.8 468.0 628.8 of which Service Administration 1,718.9 –1,648.1 70.9 5.0 65.9 of which Property Administration 6,123.3 –5,097.4 1,025.9 463.0 562.9 Locum AB 376.9 –363.6 13.3 7.0 6.3 Properties and service, total 8,219.2 –7,109.1 1,110.1 475.0 635.1

Other The Audit Board 38.1 –38.0 0.1 0.0 0.1 Landstingshuset i Stockholm AB 0.4 –108.1 –107.8 –18.0 –89.8 AB SLL Internfinans 17.0 –11.5 5.5 3.0 2.5 Group-wide functions Damages account 19.3 –19.1 0.2 0.0 0.2 Group funding 101,365.3 –97,488.6 3,876.8 –979.2 4,856.0 Group adjustments –160,717.0 160,807.2 90.1 0.0 90.1 Total result for all profit centres* 114,776.7 –108,975.2 5,801.6 311.3 5,490.2 of which switching costs 0.7 –148.2 –147.5 –323.0 175.5 Result excluding switching costs 114,776.0 –108,827.0 5,949.0 634.3 5,314.7 * Revenue corresponds to operating revenue, tax revenue general government grants as well as financial revenue. Expenditure corresponds to operating costs, depreciation and financial expenses.

101 Annual Report 2020 Operations and Investment accounts Investment accounts

Deviation Investments for all profit centres in the regional group Outcome Budget compared Outcome MSEK 2019 2020 to budget 2019 Healthcare service Healthcare Committee 0.6 7.0 –6.4 10.3 Healthcare Service Steering Committee 0.0 0.0 0.0 0.0 Patient Advisory Committee 0.0 0.0 0.0 0.0 Stockholm County’s Healthcare Area 202.8 326.6 –123.8 242.5 Karolinska University Hospital 662.7 374.7 288.0 549.3 Södersjukhuset AB 181.3 169.4 11.9 413.0 Danderyds Sjukhus AB 124.3 183.0 –58.7 612.2 Södertälje Sjukhus AB 31.4 27.0 4.4 69.8 S:t Eriks Ögonsjukhus AB 40.5 40.0 0.5 33.3 Folktandvården Stockholms län AB 39.1 85.0 –45.9 47.8 Ambulanssjukvården i Storstockholm AB 12.8 28.0 –15.2 22.9 Stockholm Care AB 2.2 0.0 2.2 3.2 MediCarrier AB 2.3 2.0 0.3 2.9 Healthcare service, total 1,300.0 1,242.7 57.3 2,007.2

Public transport Transport Committee 8,102.0 10,256.1 –2,154.1 6,190.5 of which the Transport Administration 632.7 497.2 135.5 613.0 of which the Underground Expansion Administration 2,067.2 2,748.6 –681.3 1,160.3 of which AB Storstockholms Lokaltrafik 5,381.9 6,956.6 –1,574.7 4,338.4 of which Waxholms Ångfartygs AB 20.2 53.8 –33.6 78.8 Mobility Service Committee 32.0 18.0 14.0 30.2 Public transport, total 8,134.0 10,274.1 –2,140.1 6,220.8

Culture Committee 2.2 5.6 –3.4 0.8 Regional Executive Committee 0.9 99.7 –98.8 6.1

Properties and Service Property and Service Committee 1,478.0 3,306.8 –1,828.8 3,685.9 of which Service Administration 154.2 256.5 –102.3 227.4 of which Property Administration 1,323.8 3,050.3 –1,726.5 3,458.6 Locum AB 0.5 4.5 –4.0 2.1 Properties and service, total 1,478.5 3,311.3 –1,832.8 3,688.1

Other The Audit Board 0.1 0.2 –0.1 0.0 AB SLL Internfinans 0.0 0.0 0.0 0.0 Total investments 10,915.8 14,933.6 –4,017.8 11,922.9

Operations and Investment accounts Annual Report 2020 102 14 Notes

103 Annual Report 2020 Note 1. Accounting principles Depreciation for property investments correspond- The Annual Report has been drawn up Depreciation of tangible and intangible ing to SEK 51 million. in accordance with the Local Govern- assets for the estimated period of use ment Act, the Municipal Accounting are reported with linear depreciation Corporation tax Act, LKBR, and the recommendations based on the acquisition value, exclud- The companies within the group of the Swedish Council for Municipal ing any residual value. The depreciation Landstingshuset i Stockholm AB and Accounting, RKR, which are applicable starts when the asset is ready to be the group AB Storstockholms to Region Stockholm as a legal entity taken into use. Lokaltrafik are currently paying no and to the consolidated accounts. income tax, in accordance with applica- The following depreciation periods are ble tax regulations, since the taxable Consolidated financial statements generally applied: deficit deductions are considerable. The consolidated financial statements Intangible fixed assets 3–10 years Tax expenditure is only created if the have been prepared in accordance with Machines and inventories 3–10 years Swedish Tax Agency reassesses the the proportional consolidation method, Buildings See components taxable profit of previous years in any of which means that only the owned share Building inventories 17 years the companies. of the municipal group companies’ is Rail-bound vehicles 10–30 years In Region Stockholm, the compa- included in the consolidated accounts. Buses 12 years nies’ deferred taxes are recognised as The exception is the associated com- Track facilities See components equity under the item untaxed reserves. pany Barnbördshuset Stockholm AB, Vessels See components Region Stockholm’s companies have which is consolidated according to the large taxable deficit deductions, which equity method. No depreciation is applicable to assets means that no tax expenditure and no Companies and local government such as land and art. deferred tax is created. federations where Region Stockholm has a significant influence, but which Components Pensions are not included in the consolidated For assets where significant compo- In accordance with the Municipal financial statements because the nents have been identified, and where Accounts Act, pensions are recognised operation is of an insignificant scope, the difference in the use of such compo- in accordance with the municipal mixed are the coordinating federations, nents can be expected to be considera- model. This means that pensions Svenskt Ambulansflyg, ALMI Företags­ ble, component depreciation is applied earned before 1998 are recognised partner i Stockholm Sörmland AB, as of 2015. This applies for the following under contingent liabilities rather Mälardalstrafik AB and operating fixed asset categories: than provisions in the balance sheet. foundations. Pensions earned during the year, as well Depreciation as paid pensions earned up until 1998, Items affecting comparability interval for are distributed across the income Fixed asset components An item affecting comparability is statement. The committees’ pensions defined within Region Stockholm as an Track facilities 10–50 years are calculated in accordance with RIPS infrequently occurring item exceeding (substructure 40–100 years) (guidelines for calculating pension SEK 100 million. The amount limit has Buildings, public transport 17–50 years liabilities), which corresponds to a been set with consideration to the (foundation/framework 20–50 years) discount interest of one per cent. region’s turnover and operations. One Vessels 15–30 years In Region Stockholm’s company exception is capital gains from the sale (hull 30, alternatively 80 years) groups, the pension commitments are of fixed assets, which are always defined recognised in the balance sheet as a as affecting comparability. The items Borrowing costs provision based on the K3 regulations. defined as affecting comparability in Region Stockholm’s main rule for In the calculation in the financial 2020 are capital gains and switching recognition of borrowing costs is to statement for 2020, we used the costs for the implementation of the charge them to the result for the period Swedish Financial Supervisory Future Plan for the Healthcare Service. they concern. The Property and Service Authority’s discount rate for 2020, Committee makes an exception from of 0.3 percent. From the 2020 annual Tax revenue the main rule and instead includes accounts, the discount rate of the Tax revenue is reported in accordance interest charges in the acquisition value current year is applied, as determined with recommendation R2 Revenue of the asset during the construction by the Swedish Financial Supervisory from the Swedish Council for Municipal period, if it can be directly attributed to Authority, when calculating the pension Accounting (RKR). The forecast for tax purchasing, construction or production provision. This is a change from previ- deduction published by the Swedish of an asset. The Property and Service ous years, when the next year’s discount Association of Local Authorities and Committee uses a calculated fictive rate was used for calculating the pension Regions (SALAR) in December of the credit rate, which entails a departure provision. The change will have no financial year has been used to calculate from the real borrowing interest rate. In financial effect in 2020, as the discount and distribute tax revenue. 2020, interest charges were capitalised rate for 2020 has already been included

104 Annual Report 2020 Notes in the pension provision for the 2019 borrowing in Swedish krona, borrow- on the average fixed interest term and annual accounts. ing in foreign currencies and forward the cost of borrowing is presented in the For agreements with a coordination foreign–exchange contracts. table below. clause, the calculation is based on the conditions that prevailed at the time Borrowing in Swedish krona Borrowing in foreign currency the financial statements were compiled. For these hedging contracts, the hedged For these hedging contracts, the hedged If nothing emerges to the contrary, the item comprises a loan in Swedish item comprises a loan in foreign cur- calculation assumes that no coordina- currency at variable interest. The hedge rency at a fixed interest rate. The hedge tion will occur. instruments consist of interest swaps instruments comprise currency swaps Fixed–term appointments entitling where the region receives a net variable where the region receives a fixed inter- special collective agreement occupa- rate and pays a fixed rate. Region est rate in the foreign currency and pays tional pensions are recognised under Stockholm’s aim with these hedge a fixed or variable interest rate in provisions when they are likely to entail contracts is to reduce the uncertainty Swedish currency. disbursements. Contracts that have not for future interest expenditure in the Loans in other currencies are taken been redeemed are recognised as event of borrowing at variable rates. The when the interest charge, including the contingent liabilities. uncertainty is linked to changes in the currency hedging, is considered to be variable interest rate. The hedged risk lower than taking the loan in SEK. Public investment contributions consists of the variability in future Region Stockholm’s intention with received interest payments due to changes in the this hedging strategy is to reduce the Received investment contributions base interest rate, STIBOR. currency risk and interest-rate risk from the state and municipalities refer On December 31, 2020, Region associated with borrowing in a foreign to expansion of public transport, as well Stockholm had a total of 128 outstand- currency. The uncertainty is related to as parts of government grants relating ing hedge instruments of this type, with changes in the exchange rate. The to additional costs linked to COVID-19, a total nominal amount of hedged risk refers to the spot risk, i.e. concerning acquisition of fixed assets. MSEK 54,423. In the swap portfolio, future changes in spot rates compared The investment contributions are there are swaps that both shorten and to the time of hedging, and the interest-­ recognised as income in the income extend maturity, and the net amount for rate risk in each borrowing currency. statement systematically over the the interest swaps was MSEK 6,287 as As per December 31, 2020, the asset’s period of use, and for staff per December 31, 2020. The market region had a total of ten outstanding expenditure during the construction value of all the interest swaps, which hedge instruments of this type. The period for the new Underground net- comprise hedge instruments in the total nominal amount was EUR 1,175 work. hedge contracts, amounted to million, which corresponded to MSEK –709. SEK 10,534 million. The market value of Derivatives and hedge accounting During the financial year 2020, all the interest swaps, which comprise Hedge accounting is applied for all the interest charges for the hedge hedge instruments in these hedge con- external derivatives. It applies to both instruments was MSEK 150. The tracts, amounted to SEK 1,247 million. Region Stockholm and the consolidated interest expenditure refers to the net During the financial year 2020, the accounts. All completed hedging is amount of the paid, received and interest charges for the hedge instru- governed by the requirements in the accrued interest of all swaps. Unreal- ments was MSEK 66. The interest financial policies to reduce currency ised changes in the market value have charge refers to the net amount of the and interest risks. The hedging contracts not been recognised in the accounts in paid, received and accrued interest of that were outstanding as per December accordance with RKR R8. all swaps. The interest charge is associ- 31, 2020 were of three different types: The effect of the hedge instruments ated with the currency-hedged loans

Borrowing in Swedish krona Before hedging After hedging Average fixed interest period 3.44 years 5.76 years Average borrowing cost, % 0.88% 1.29% Average borrowing cost, MSEK MSEK 299 MSEK 440

*) The aim of the aforementioned hedging is to reduce the uncertainty of future interest payments to maintain a stable interest charge that does not change over time.

Borrowing in Euro Before hedging After hedging Average fixed interest period 2.90 years (EUR) 1.60 years (SEK) Average borrowing cost, % 1.39% 1.96% Average borrowing cost, SEK/EUR millions EUR 16.3 million MSEK 210

*) The aim of the aforementioned hedging is to reduce uncertainty of future interest payments and amortisations in foreign currencies.

Notes Annual Report 2020 105 taken in a foreign currency. Unrealised with this hedging strategy is to reduce forward foreign–exchange contracts. changes in the market value have not the currency risk associated with The negative instalment premium is been recognised in the accounts in foreign-currency cash flows. The due to the Swedish interest rate being accordance with RKR R8. uncertainty is linked to exchange rate lower than the American rate. Unreal- The effect of the hedge instruments changes between Swedish and other ised changes in the market value have on the average fixed interest term and currencies. not been recognised in the accounts in the cost of borrowing is presented in the On December 31, 2020, the region accordance with RKR R8. table below. had a total of four outstanding hedge instruments of this type, with a total Other Forward foreign-exchange nominal amount of USD 33 million, The assessment is that the surety that contracts which corresponds to SEK 280 million. the region has for the AB SL Finans For these hedge contracts, the hedged The market value of all the forward lease agreements constitutes a binding item consists of contracted, or very foreign-exchange contracts in hedge undertaking for the region. This means likely and forecasted, as well as future contracts amounted to SEK six million. that the leasing within AB SL Finans is foreign currency cash flows. The hedge During the financial year 2020, the reported as a hedged item in Region instruments consist of forward foreign- interest charges for the hedge instru- Stockholm’s summarised hedge exchange contracts, where the region ments was SEK 11 million. The interest accounting. has bought or sold foreign currency by charge refers to a distributed part of the instalments. Region Stockholm’s aim negative instalment premium on all the

106 Annual Report 2020 Notes Note 2. Operating revenue and costs

The Regional Group The Region MSEK 2020 2019 2020 2019 Patient fees healthcare 772 859 418 461 Patient fees dental care 432 527 0 0 Passenger fees 5,549 8,972 148 199 Sold healthcare services 1,819 1,869 1,483 1,513 Sold dental care 250 294 0 0 Sale of other primary services 284 289 72 78 Rental income, sale of other services 4,363 4,345 4,618 4,377 Government grants 12,199 5,403 10,719 5,333 Other grants 1,147 952 19 21 Other revenue 2,978 1,527 1,840 1,078 of which are items affecting comparability 1,129 67 442 6 Operating revenue 29,794 25,036 19,317 13,060

Staff costs 32,374 33,598 22,276 23,148 Purchased healthcare services 21,333 20,624 32,003 30,226 Purchased dental care 449 542 1,081 1,207 Purchased transport 14,697 14,558 1,016 1,243 Purchased other primary services 238 148 258 162 Ancillary services (lab, x-ray) 1,855 1,319 1,811 1,279 Pharmaceuticals covered by the pharmaceutical subsidy 6,421 5,901 6,211 5,714 Other pharmaceuticals 1,932 1,708 1,593 1,356 Other supplies and goods, etc. 7,702 5,962 4,098 2,541 Contributions paid 1,799 1,753 3,237 3,701 Contributions made to SL and WÅAB 0 0 9,685 9,382 Cost of premises, equipment rentals 3,538 2,908 3,504 3,184 Tax expenditure in subsidiaries 10 1 Other expenses 7,664 7,199 6,446 6,040 of which are items affecting comparability 415 226 150 226 Operating costs 100,011 96,220 93,218 89,183

Note 3. Depreciation

The Regional Group The Region MSEK 2020 2019 2020 2019 Depreciation on intangible fixed assets –133 –131 –24 –26 Depreciation on buildings and facilities –2,729 –2,736 –1,043 –1,081 Depreciation on machines and inventories –3,721 –3,335 –1,864 –1,632 Impairments –7 0 0 0 Total depreciation –6,589 –6,201 –2,931 –2,738

Notes Annual Report 2020 107 Note 4. Tax revenue

The Regional Group The Region MSEK 2020 2019 2020 2019 Preliminary tax revenue 78,595 76,469 78,595 76,469 Forecasted settlement in 2019 and 2018 respectively –911 –505 –911 –505 Adjustment item for tax revenue in 2018 and 2017 respectively –292 80 –292 80 Total tax revenue 77,392 76,044 77,392 76,044

Contributions for pharmaceutical subsidy 6,701 6,241 6,701 6,241 Other general government grants 2,432 161 2,432 161 Total general government grants 9,132 6,402 9,132 6,402

Implementation contributions 1,885 1,885 Expenditure equalisation contributions 0 599 0 599 Total contribution from equalisation 1,885 599 1,885 599

Revenue equalisation charge –1,489 –1,174 –1,489 –1,174 Appropriation charge –567 –452 –567 –452 Cost equalisation fee –1,448 –1,448 Total charges for equalisation –3,504 –1,627 –3,504 –1,627

Total expenditure and revenue equalisation –1,619 –1,028 –1,619 –1,028

Total tax revenue, general government grants and municipal equalisation 84,905 81,418 84,905 81,418

Note 5. Financial revenues

The Regional Group The Region MSEK 2020 2019 2020 2019 Interest revenue 3 3 548 566 Other financial revenue 74 65 21 2 Total financial revenue 78 68 569 568

Note 6. Financial expenses

The Regional Group The Region MSEK 2020 2019 2020 2019 Interest charges on loans –1,449 –1,317 –1,470 –1,300 Financial expenses, changes to pension provisions –860 –1,278 –638 –798 Other financial expenses –67 –9 –42 –8 Total financial expenses –2,375 –2,604 –2,150 –2,106 Average interest rate, % 1.31 1.54 1.31 1.54 Average interest rate, %, excluding derivatives 1.02 1.16 1.02 1.16 Interest hedging has impacted cost by –227 –270 –227 –270

Note 7. Items affecting comparability

The Regional Group The Region MSEK 2020 2019 2020 2019 Under operating revenue: Capital gains 1,129 67 442 6

Under operating costs: Switching costs –147 –226 –147 –226 Expenses for the sale of property –268 – –3 –

Below net financial income/expense: Interest change for pension liability – –667 – – Total items affecting comparability 714 –826 292 –220

108 Annual Report 2020 Notes Note 8. Specification of capital gain/loss

The Regional Group The Region MSEK 2020 2019 2020 2019 Other operating revenue Capital gains Sale of tangible fixed assets Property and Service Committee 439 0 439 0 SL group 422 59 other units 14 10 7 6

Other operating expenditure Capital loss Sale of tangible fixed assets SL group –18 –2 other units 0 0 –4 0

Net capital gain/loss from the sale of tangible fixed assets 857 67 442 6

Note 9. Intangible fixed assets The Regional Group The Region MSEK 2020 2019 2020 2019 Opening costs of acquisition 824 696 177 164 Purchasing 3 15 0 8 Transfer from fixed assets under construction 109 141 5 6 Sales and disposals –2 –28 –2 0 Reclassifications 25 0 0 0 Closing accumulated costs of acquisition 958 824 180 177 Opening depreciation –452 –349 –82 –56 Depreciation for the year –133 –131 –24 –26 Sales and disposals 2 28 2 0 Closing accumulated depreciation –582 –452 –103 –82 Impairments for the year –7 0 0 0 Closing impairments –7 0 0 0 Total closing value 369 372 77 96 Average period of use (years) 7.2 6.3 7.6 6.9

Note 10. Land, buildings and technical facilities The Regional Group The Region MSEK 2020 2019 2020 2019 Opening costs of acquisition 95,625 90,879 49,057 46,064 Purchasing 0 19 0 0 Transfer from fixed assets under construction 3,373 5,099 1,495 3,017 Sales and disposals –687 –357 –286 –12 Reclassifications 0 –15 0 –12 Closing accumulated costs of acquisition 98,311 95,625 50,266 49,057 Opening depreciation –26,907 –24,413 –11,483 –10,403 Depreciation for the year –2,729 –2,736 –1,043 –1,081 Sales and disposals 473 242 170 1 Reclassifications 0 1 0 0 Closing accumulated depreciation –29,163 –26,907 –12,356 –11,483 Opening impairment –118 –118 –118 –118 Closing accumulated impairment –118 –118 –118 –118 Total closing value 69,031 68,600 37,792 37,456 Closing residual value according to plan, by facility type: Buildings 43,563 43,223 32,350 32,221 Land 2,353 2,364 1,459 1,466 Land improvements 23,114 23,012 3,983 3,769 Total closing value 69,031 68,600 37,792 37,456 Average period of use (years) 36 35 48 45

Notes Annual Report 2020 109 Note 11. Machines and inventory

The Regional Group The Region MSEK 2020 2019 2020 2019 Opening costs of acquisition 61,751 51,036 25,052 17,544 Purchasing 1,186 1,467 752 751 Transfer from fixed assets under construction 4,148 7,570 2,407 6,459 Sales and disposals –1,398 –1,233 –433 –769 Reclassifications 11 2910 11 1,066 Closing accumulated costs of acquisition 65,697 61,751 27,789 25,052 Opening depreciation –28,966 –24,224 –10,389 –8,755 Depreciation for the year –3,720 –3,335 –1,864 –1,632 Sales and disposals 1,335 1,188 394 753 Reclassifications –7 –2,595 –7 –755 Closing accumulated depreciation –31,357 –28,966 –11,866 –10,389 Opening impairment –11 –11 –1 –1 Reclassifications 1 0 1 0 Closing accumulated impairment –10 –11 –1 –1 Total closing value 34,329 32,774 15,923 14,662 Closing residual value according to plan, by facility type: Cars and other modes of transport 10,044 9,388 5 7 Medical equipment 4,012 3,695 2,475 2,273 Reconstruction in rented premises 492 468 112 135 Permanent equipment, service facilities etc. 12,723 11,868 11,432 10,567 Art and inventories not subject to depreciation 108 106 107 104 Leases, machines and inventory 4,186 4,659 0 0 IT equipment 878 937 534 625 Other machines and inventory 1,886 1,653 1,258 951 Total closing value 34,329 32,774 15,923 14,662 Average period of use (years) 17.7 18.5 14.9 15.4

Note 12. Fixed assets under construction and advances relating to tangible fixed assets

The Regional Group The Region MSEK 2020 2019 2020 2019 Opening balance 20,728 23,193 10,040 14,004 Expenditure on buildings for the year 9,337 9,333 1,982 4,506 Expenditure on machines and equipment for the year 400 1,101 295 1,034 Transfer to other fixed assets –7,630 –12,810 –3,907 –9,482 Reclassifications –25 –1 0 Sales and disposals –144 –88 –4,170 –22 Total fixed assets under construction and advance payments 22,667 20,728 4,240 10,040

A significant portion of the year’s expenditure is attributable to investments in SL and Landstingsfastigheter.

110 Annual Report 2020 Notes Note 13. Financial assets

The Regional Group The Region MSEK 2020 2019 2020 2019 Shares and participations AB Storstockholms Lokaltrafik 0 0 5,974 5,974 Landstingshuset i Stockholm AB 0 0 406 406 Barnbördshuset Stockholm AB 9 10 0 0 Landstingens Ömsesidiga Försäkringsbolag 311 311 311 311 Svenskt ambulansflyg 2 2 2 2 Other securities 237 195 Other shares and participations 0 1 0 Total shares and participations 560 519 6,693 6,694 Non-current lending AB Storstockholms Lokaltrafik 37,888 30,935 Landstingshuset i Stockholm AB 530 524 Waxholms Ångfartygs AB 320 320 Local government federation Norrtälje 28 28 Other non–current receivables 636 625 1 16 Total non-current lending 636 625 38,766 31,823 Tenant–owned property 3 3 3 3 Total financial assets 1,199 1,147 45,463 38,520

Information regarding corporate identity number and registered office Registered Subsidiary C.I.N. office AB Storstockholms Lokaltrafik 556013-0683 Stockholm Landstingshuset i Stockholm AB 556477-9378 Stockholm

Note 14. Current receivables The Regional Group The Region MSEK 2020 2019 2020 2019 Accounts receivable 1,571 1,529 1,739 1,445 Government grants receivable 3,291 1,503 3,288 1,502 Tax assets 399 353 356 317 Deferred expenditure 1,222 1,380 1,036 1,226 Accrued revenue 1,209 1,422 1,084 1,286 Other receivables 1,934 1,824 5,677 6,054 Total current receivables 9,626 8,011 13,179 11,830

Note 15. Equity The Regional Group The Region MSEK 2020 2019 2020 2019 Opening equity 13,070 11,573 10,675 9,656 Result for the year 5,802 1,497 6,492 1,019 of which increase in profit equalization reserve 3,247 3,247 Opening equity 18,871 13,070 17,167 10,675

Notes Annual Report 2020 111 Note 16. Provisions and contingent liabilities for pensions and similar obligations

Pension provisions The Regional Group The Region MSEK 2020 2019 2020 2019 Opening pension provisions, incl. payroll tax 31,684 28,810 24,207 22,531 Newly earned pension, of which – defined-benefit retirement pension 477 1,889 279 1,256 – pension agreement PA-KFS 0 2 0 0 – special collective agreement occupational pension –1 –1 0 –1 – survivor’s pension 0 3 0 0 – other 11 11 11 19 Disbursements for the year –556 –520 –433 –412 Upwards adjustment of interest rate and base amount 679 821 474 594 Change in insurance rules 37 535 0 2 Other items –660 –193 –608 –109 Change in payroll tax –67 327 –67 327 Total pension provisions, incl. payroll tax 31,604 31,684 23,863 24,207

Contingent liabilities for pensions The Regional Group The Region MSEK 2020 2019 2020 2019 Opening contingent liabilities for pensions, incl. payroll tax 22,610 22,879 22,610 22,879 Upwards adjustment of interest rate and base amount 534 666 534 666 Change in insurance rules 0 0 0 0 Disbursements for the year –1,064 –1,029 –1,064 –1,029 Other items 507 147 507 147 Change in payroll tax –5 –53 –5 –53 Closing contingent liabilities for pensions, incl. payroll tax 22,582 22,610 22,582 22,610

Other information regarding pensions The Regional Group The Region 2020 2019 2020 2019 Number of fixed-term appointments Politicians 6 10 6 10 Officials 0 0 0 0 Update rate 97% 97% 97% 97%

The basis for pension calculations is specified in the section Accounting Principles.

112 Annual Report 2020 Notes Note 17. Other provisions Reversal of Summary Utilised during unutilised Provisions SEK millions 2019 the year amount for the year 2020 Group Other provisions 1,048 –26 0 285 1307 The Region Other provisions 615 –26 0 1 590

Expected Specification of provisions Reversal of time of Companies Utilised during unutilised Provisions regulation, MSEK 2019 the year amount for the year 2020 year AB SL’s estimated maintenance expenditure for 60 0 0 2 62 2024* vehicle C20 AB SL demolition and decontamination measures 0 0 0 247 247 2021/22 AB SL environmental risk reserve for ground 35 0 0 0 35 ** pollution AB SL Settlement expenditure 338 0 0 0 338 2021 AB SL administrative fine supervisory matter 0 0 0 11 11 2021 Tiohundra AB 0 0 0 24 24 2021 Total other provisions 433 0 0 284 717

* No earlier than 2024 – a new assessment needs to be carried out in 2024, when there is a new Underground contract in place. ** Cannot be specified, as the date when the land will enter into use is not known.

Expected Reversal of time of Region Utilised during unutilised Provisions regulation, SEK millions 2019 the year amount for the year 2020 year County Council properties in Stockholm The property Beckomberga, selling expenses 1 –1 0 0 0 – The property Patienten Karolinska, selling expenses 23 0 0 0 23 2021 The property Patienthotellet Karolinska, selling expenses 2 0 0 0 2 2021 The property Medicinaren 5, development grant infrastructure 0 0 0 0 0 – The property Medicinaren 5, selling expenses 15 –15 0 0 0 – Dispute with the Swedish Work Environment Authority pertaining to premises at Södersjukhuset 5 0 0 0 5 * Dispute with the Swedish Work Environment Authority pertaining to premises at Södertälje Hospital 6 0 0 0 6 2021 Dispute with the Swedish Work Environment Authority Nya Karolinska Solna 0 0 0 0 0 – Culture Committee Compensation STIM 7 0 0 1 8 2021 Regional Executive Committee Landstingens Ömsesidiga Försäkringsbolag, additional premium 286 0 0 0 286 2021 Co-financing contribution to Solna stad concerning Norra Hagastaden 250 0 0 0 250 ** Lifetime damages 10 0 0 0 10 2044 Transport Committee Procurement damages 10 –10 0 0 0 – Total other provisions 615 –26 0 1 590

* Time and outflow of resources depend on the Swedish Work Environment Authority’s processing of cases, and can therefore not be estimated. ** Time and outflow of resources depend on when the detailed development plan gains legal force, and can therefore not be estimated.

Notes Annual Report 2020 113 Note 18. Non–current liabilities

The Regional Group The Region MSEK 2020 2019 2020 2019 Liabilities with banks and credit institutions 38,025 41,636 38,025 41,636 Non-current leasing liabilities 4,228 4,657 0 0 Investment contributions 11,544 11,039 1,016 4,828 OPS liability Nya Karolinska Solna 5,819 6,177 5,819 6,177 Other non-current liabilities 259 257 2 0 Total non-current liabilities 59,876 63,766 44,862 52,641 Information on non-current and current borrowing Capital decay share of loans 0–1 year 17% 12% 17% 12% 1–3 years 24% 31% 24% 31% 3–5 years 23% 10% 23% 10% 5–10 years 31% 38% 31% 38% > 10 years 5% 9% 5% 9%

Average interest rate, % 1.31 1.54 1.31 1.54 Average interest rate, %, excluding derivatives 1.02 1.16 1.02 1.16 Average capital tie-up period 4.47 4.65 4.47 4.65

Average fixed interest term, including derivatives, years 4.2 4.1 4.2 4.1 Average fixed interest term, excluding derivatives, years 2.6 2.5 2.6 2.5

Information on hedge instruments Hedged borrowings 22,688 26,422 22,688 26,422 Market value derivatives 544 1,079 544 1,079

Note 19. Current liabilities

The Regional Group The Region MSEK 2020 2019 2020 2019 Liabilities with banks and credit institutions 6,980 5,064 13,621 9,006 Advance payments from customers 1,123 1,133 654 622 Trade creditors 7,438 7,076 6,367 6,284 Liabilities to central government 2,026 779 2,026 779 Current leasing liabilities 429 481 0 0 Holiday pay and wage liability 2,653 2,046 1,830 1,397 Accrued costs 5,842 4,881 3,723 3,217 Deferred revenue 1,051 1,120 530 375 Other liabilities 2,656 3,171 2,717 2,928 Total current liabilities 30,197 25,751 31,468 24,608

114 Annual Report 2020 Notes Note 20. Contingent liabilities

The Regional Group The Region MSEK 2020 2019 2020 2019 Contingent liabilities to the benefit of group companies and associated companies* AB SL, financial leasing – – 5,947 6,747 The local government federation Sjukvård och omsorg i Norrtälje. capital cover guarantee for Tiohundra AB** – – 0 39 AB Storstockholms Lokaltrafik, pension obligations – – 709 709 Waxholms Ångfartygs AB, pension obligations – – 16 17 Locum AB, pension obligations – – 343 355 Danderyds Sjukhus AB, pension obligations – – 2,607 2,517 S:t Eriks Ögonsjukhus AB, pension obligations – – 487 452 Södersjukhuset AB, pension obligations – – 3,445 3,259 Södertälje Sjukhus AB, pension obligations – – 682 671 Tiohundra AB, pension obligations 363 320 363 320 Folktandvården Stockholms län AB, pension obligations – – 880 878 Other companies, pension obligations – – 111 105 Total 363 320 15,590 16,069

Contingent liabilities for the benefit of parties outside the group*** AB Transitio**** 1,221 711 1221 711 The Archipelago Foundation in Stockholm County, pension obligations 43 41 43 41 and loans Other guarantees, pension obligations 17 16 17 16 Total 1,281 768 1,281 768 Total contingent liabilities***** 1,644 1,088 16,871 16,837

*Region Stockholm has provided guarantees for group companies in regard to financial leases, primarily relating to SL. These guarantees are not recognised as contingent liabilities in the group, as financial lease undertakings are recognised in the consolidated balance sheet. **In 2019, Tiohundra AB received a shareholder injection from KSON which in turn has received additional contributions from Region Stockholm of SEK 39 million in accordance with the contingent liability, which was recognised in 2019. ***Regions are responsible, as part owners in the patient insurance LÖF, for the company’s undertakings of an amount corresponding to 10 times the premium that the county council has had to pay each year that a loss has occurred in the patient insurance. In 2020, the premium for Region Stockholm amounted to MSEK 373.3. ****Region Stockholm has provided a joint and several guarantee with a ceiling of MSEK 8 for AB Transitio relating to the funding of rail vehicles. As of 2020-12-31, SEK 5.4 billion was utilised. Through an agreement with right of recourse, Region Stockholm’s undertaking is limited to the financing provided for vehicles by SL through AB Transitio. As per 2020-12-31, this amounted to SEK 1.2 billion. *****The contingent liabilities are not expected to entail future expenditure for Region Stockholm.

Note 21. Lease charges

The Regional Group The Region MSEK 2020 2019 2020 2019 Financial lease agreements* Total minimum lease charges 4,657 5,138 Present value of minimum lease charges 4,417 4,887 Of which mature within 1 year 406 468 Of which mature within 2–5 years 2,932 3,526 Of which mature after 5 years or more 1,079 893

Non–cancellable operating leases Lease charges that mature within 1 year 347 224 66 32 Lease charges that mature within 2–5 years 1,150 851 385 396 Lease charges that mature after 5 years or more 1,811 842 92 114

*Financial lease agreements refer to rail vehicles and buses. Financial leasing is recognised in the balance sheet and is included in the item machines and inventory.

Notes Annual Report 2020 115 Note 22. Costs of financial audit

The Regional Group The Region MSEK 2020 2019 2020 2019 Costs of financial audit 9.1 8.4 5.2 4.9

Note 23. Information regarding prepared separate accounts

The report refers to Legislation Dental care within Folktandvården Stockholms län AB The Act on Insight into Financial Links and Related Matters (2005:590)

Laboratory operations within Karolinska University Hospital The Act on Insight into Financial Links and Related Matters (2005:590)

The separate accounts are available from each operation and at the Region Stockholm website provided below. • Folktandvården Stockholms län AB, phone +46 (0)8-123 166 00 • Karolinska University Hospital, phone +46 (0)8-517 700 00 • https://www.sll.se/om-regionstockholm/ekonomi/finansiella-rapporter/

116 Annual Report 2020 Notes Note 24. Group relationships

Unit Owners’ contributions Group contributions Dividend MSEK Provided Received Provided Received Provided Received Region Stockholm Landstingshuset i Stockholm AB 124 481 Danderyds Sjukhus AB 75 Södersjukhuset AB 85 Södertälje Sjukhus AB 97 S:t Eriks Ögonsjukhus AB 14 Ambulanssjukvården i Storstockholm AB 31 Stockholm Care AB Folktandvården Stockholms län AB 124 124 Locum AB 14 AB SLL Internfinans 6 MediCarrier AB 36 AB Storstockholms Lokaltrafik 86 410 AB SL Finans 466 SL Älvsjö AB 11 Waxholms Ångfartygs AB 75 56 All companies are 100% owned by Region Stockholm or their respective parent company.

Unit Sale Contribution Interest rates, etc. MSEK Revenue Cost Revenue Cost Revenue Cost Region Stockholm 3,263 13,798 10,996 547 –9 Landstingshuset i Stockholm AB 7 Danderyds Sjukhus AB 4,296 840 631 Södersjukhuset AB 5,331 1,059 422 Södertälje Sjukhus AB 1,443 256 113 S:t Eriks Ögonsjukhus AB 540 64 54 Ambulanssjukvården i Storstockholm AB 470 29 Stockholm Care AB 17 32 Folktandvården Stockholms län AB 692 66 16 Locum AB 375 8 AB SLL Internfinans 16 MediCarrier AB 826 53 85 AB Storstockholms Lokaltrafik 380 1,169 9,272 –7 526 AB SL Finans 286 11 SL Älvsjö AB 6 2 Waxholms Ångfartygs AB 27 21 403 2

All companies are 100% owned by Region Stockholm or their respective parent company.

Unit Loans Guarantee Provided Provided MSEK by Received by by Received by Region Stockholm 37,290 15,116 Landstingshuset i Stockholm AB 530 Danderyds Sjukhus AB 2,607 Södersjukhuset AB 3,445 Södertälje Sjukhus AB 682 S:t Eriks Ögonsjukhus AB 487 Ambulanssjukvården i Storstockholm AB Stockholm Care AB Folktandvården Stockholms län AB 880 Locum AB 343 AB SLL Internfinans MediCarrier AB AB Storstockholms Lokaltrafik 71 36,440 6,656 AB SL Finans 0 SL Älvsjö AB 71 Waxholms Ångfartygs AB 320 16

All companies are 100% owned by Region Stockholm or their respective parent company.

Notes Annual Report 2020 117 Note 25. Key performance indicators

Key performance indicators Unit 2020 2019 2018 2017 2016

Population Stockholm County Number 2,391,841 2,374,550 2,339,640 2,303,417 2,264,111 – Demographic trend % 0.7% 1.5% 1.6% 1.7% 1.5% Sweden Population 10,378,483 10,319,473 10,215,309 10,104,036 9,967,637 – Demographic trend % 0.6% 1.0% 1.1% 1.4% 1.2% Percentage in Stockholm County % 23.0% 23.0% 22.9% 22.8% 22.7%

Tax Tax revenue, general government grants and MSEK 84,905 81,418 77,747 74,949 71,010 equalisation Tax revenue, general government grants and SEK/inhabitant 35,498 34,288 33,230 32,538 31,363 equalisation Tax revenue trend % 4.3% 4.7% 3.7% 5.5% 5.6% Tax rate Region Stockholm SEK 12.08 12.08 12.08 12.08 12.08 Average county council tax nationally SEK 11.56 11.49 11.39 11.36 11.35

Income statement Turnover MSEK 114,699 106,454 101,323 97,126 92,112 Result Region Stockholm MSEK 5,802 1,723 2,171 2,130 1,708 The proportion of tax revenue, general government grants and equalisation in the profit % 6.8% 2.1% 2.8% 2.8% 2.4% Operating revenue, trend % 19.0% 6.2% 6.3% 5.1% 8.7% Operating costs, trend % 3.9% 4.1% 5.2% 4.0% 5.4% Depreciation costs, trend % 6.3% 8.0% 11.2% 11.4% 10.3% Net expenditure development % –0.7% 3.7% 5.3% 4.1% 4.7%

Balance sheet Balance sheet total MSEK 141,854 135,319 127,869 122,366 113,824 Equity MSEK 18,871 13,070 11,573 9,477 8,239 Debt–equity ratio % 13.3% 9.7% 9.1% 7.7% 7.2% Debt-equity ratio incl. contingent liabilities % –2.6% –7.1% –8.8% –11.5% –13.9% Liquidity MSEK 4,012 3,385 1,894 1,983 2,878 Borrowing and lease liability MSEK 49,471 51,838 50,726 45,965 44,597 Total pension undertakings (incl. payroll tax) SEK millions 54,186 54,294 51,689 50,905 49,649

Investments Investments SEK millions 10,916 11,923 12,211 15,216 15,065 Self-financing ratio for investments % 100.0% 100.0% 82.1% 75.3% 61.5%

Operations Appointments within the healthcare service Number 19,373,464 19,088,883 18,779,618 18,486,187 18,129,427 Medical care events Number 300,456 310,574 309,285 312,647 318,786 Level of occupancy, properties % 97 96 90 92 90 Passengers on a regular weekday (’000) Number 1,859 2,851 2,814 2,744 2,716 Public transport, tax funding rate* % 54 45 45 48 48 Culture expenditure SEK/inhabitant 226 223 201 227 211

*As of 2019, Waxholmsbolaget is included in the public transport figure

Staff Number of full-time equivalents Region Number 43,533 43,561 42,951 42,578 42,249 Stockholm – of which refers to the healthcare service Number 41,183 41,256 40,811 40,468 40,211 – of which refers to transport Number 965 915 819 749 695 – of which refers to culture Number 112 112 106 57 52 – of which refers to regional planning Number 68 57 44 42 35 – of which refers to other staff Number 1,205 1,221 1,171 1,260 1,256

118 Annual Report 2020 Notes Auditor’s report regarding the County Council Executive Committee for 2020

We, the auditors appointed by the council, have reviewed the additional costs and reduced revenue as a consequence of the Regional Executive Committee’s operations and financial pandemic should be exempted when assessing whether the accounts for 2020. profit requirement had been met for the majority of commit- The Regional Executive Committee is responsible for the tees and companies. We believe that the Council has not management and coordination of Region Stockholm’s opera- taken a corresponding decision on how the outcome for tions and to supervise the other committees and boards, i.e. objectives and indicators should be handled. continuously monitor that operations are conducted in Our assessment, based on what is stated in the annual accordance with applicable goals, decisions and guidelines, report, is that the goal of balanced finances and the financial as well as in accordance with the laws and regulations that targets have been attained in 2020. As regards the Council’s apply to the operations. The Committee has a leading posi- other operating targets, we find that several of them are tion and is to have a holistic perspective with responsibility difficult to assess. This is partly due to the adverse impact for follow-up and feedback to the Council. The Committee is from the pandemic on the efforts to attain the goals, and responsible for monitoring the development of operations partly as it has not been possible to measure several underly- and finances, as well as for taking measures when necessary. ing indicators. We believe that the Regional Executive Com- Our responsibility as auditors is to review operations, mittee should develop a coherent strategy for how the region internal management and accounts, as well as to assess will maintain balanced finances in the long term. Further- whether the operations have been conducted in accordance more, the region’s budget process needs to be developed in with the commissions and goals set out by the Council, and order to achieve better transparency and quality assurance. with the regulations that apply to the operations. We must Management by Objectives should be an integral part of the also assess whether the annual accounts are in accordance budget process. The Regional Executive Committee also with the financial and operational goals decided by the Council. needs to develop the follow–up of investments, and The audit has been carried out in accordance with the strengthen the accounting of investments so that all multi– Local Government Act, generally accepted auditing stand- year ongoing and completed investments for the year can be ards and auditing regulations. The review has been carried reconciled against decided or estimated total expenditure. out with the focus and scope needed to provide a reasonable We have also made the assessment that the responsibility for basis for assessment and liability testing, and the results of the regional growth and development mandate should be this review are reported in the Audit Office’s 2020 Annual made clearer between the Regional Executive Committee Report for the Regional Executive Committee. We have and the Growth and Regional Planning Committee. In attached an account of the results from the review. addition, we find that internal governance and control needs The coronavirus pandemic has had a considerable impact to be strengthened concerning IT security in connected on the year’s regional operations, which quickly had to adapt medical devices, planning and designing the scope of ST in order to be able to provide care to COVID–19 patients, and doctors, development of digiphysical care, and socially to take steps to reduce the level of infection. We find that the sustainable purchase processes. Regional Executive Committee began to try to get an overall We have determined that the annual report provides a fair impression of the economic impact on the region at an early picture of the year’s outcome and financial position. Overall stage, and that follow-up and control linked to that has we believe that operations under the conditions imposed by worked well in general, in light of the circumstances. However, the pandemic, have, substantially been run in an effective we find that the pandemic and its long-term effects on the and, from a financial perspective, satisfactory manner. healthcare service and public transport involve significant However, the operating goals have been difficult to assess as risk to the region’s finances over the coming years. certain indicators have not been achieved or measurable due We find that the Regional Executive Committee’s prepar- to the pandemic. Furthermore, we have made the assessment edness should be strengthened in order to provide better that the internal control is not entirely sufficient. clarity in the event of any similar crises, like the pandemic, in We recommend that the complete annual report of Region the future. For example, the emergency plan and the disaster Stockholm 2020 is adopted. medicine contingency plan should be reviewed and harmo- We recommend the Council to discharge the Regional nised. In addition, a clear, transparent and flexible organisation Executive Committee and its individual members from for managing future crises should be adopted. Furthermore, liability. we find that the Regional Executive Committee should improve governance and control within procurement by regulating Stockholm 2021-04-13 how purchasing and supply can be maintained in a crisis. We have reviewed whether the outcome for 2020 meets Kenneth Strömberg Iréne Seth the Council’s decisions regarding goals and guidelines for Anita Johansson Christer Grunder financial management. In connection with the four-month Göran Råsmar Lars Bergstig period closing in April 2020, the Council decided that Ewa Törngren

Audit report Annual Report 2020 119 Abbreviations

AISAB Ambulanssjukvården i Storstockholm AB NKS New Karolinska Solna Care Stockholm Care AB PaN Patient Advisory Committee DSAB Danderyds Sjukhus AB PaNF Patient Advisory Committee Administration FSN the Property and Service Committee RF Regional Council FTN the Mobility Services Committee RK Audit Board FTV Folktandvården Stockholms län AB RLK Regional Management Office FUT the Underground Expansion Administration RS Regional Executive Committee HSF the Healthcare Administration SL AB Storstockholms Lokaltrafik HSN the Healthcare Committee SLL Stockholm County Council Internfinans AB Stockholms Läns Landstings Internfinans SLSO Stockholm County’s Healthcare Area Karolinska Karolinska University Hospital S:t Erik S:t Eriks Ögonsjukhus AB KcFi Group funding StSAB Södertälje Sjukhus AB KuN the Culture Committee SÖS Södersjukhuset AB KuNF the Culture Administration Tiohundra Tiohundra AB KSON Local Government Federation Sjukvård och TF Public Transport Administration omsorg i Norrtälje TN Transport Committee LFS Landstingsfastigheter Stockholm TRF Growth and Regional Planning Administration LISAB Landstingshuset i Stockholm AB TRN Growth and Regional Planning Committee Locum Locum AB VKN Healthcare Service Steering Committee Lrev County auditors WÅAB Waxholms Ångfartygs AB MediC MediCarrier AB

120 Annual Report 2020 Abbreviations The Annual Report is published on www.sll.se

Cover photo: Maskot Bildbyrå AB

Annual Report 2020 121 Regionledningskontoret Box 22550, 104 22 Stockholm Telephone: 08-737 25 00 www.sll.se122 Annual Report 2020 Chapter name