Annual Report 2019 RS 2019–0242

2 Annual Report 2019 Chapter name Content

Region ’s surplus gives us the Companies...... 70 power to face the pandemic...... 4 Landstingshuset i Stockholm AB...... 71 Södersjukhuset AB...... 71 Statement by the Regional Chief Executive...... 6 Danderyds Sjukhus AB...... 73 Summary of operational development...... 8 Södertälje Sjukhus AB...... 75

The Regional Group...... 12 S:t Eriks Ögonsjukhus AB...... 76 Folktandvården AB...... 78 Important conditions for profit/loss and Ambulanssjukvården i Storstockholm AB...... 79 financial position...... 14 Stockholm Care AB...... 80 Important events...... 16 MediCarrier AB...... 80 Locum AB...... 81 Steering and follow-up of the regional AB Stockholms Läns Landstings Internfinans...... 82 operations...... 20 AB Storstockholms Lokaltrafik...... 82 Goals and mission...... 21 Internal control...... 21 Local federations and foundations...... 84 Instructions...... 23 Local federations...... 85 Foundations...... 87 Good financial management and financial standing.24 Long-term sustainable economy...... 25 Financial accounts...... 88 A sustainable Region Stockholm...... 29 Profit/loss account...... 89 Region Stockholm shall be an attractive employer...... 31 Balance sheet Financial development within the health service...... 33 ...... 90 Investments...... 36 Cash flow statement...... 91 Investments in committees and companies...... 36 Operation accounts...... 92 Expected development...... 38 Investment accounts...... 93 Development over the coming year...... 39 Accounting principles...... 94 Committees...... 42 Derivatives and hedge accounting...... 95 The Regional Executive Committee ...... 43 The Healthcare Committee...... 44 Notes...... 97 The Transport Committee...... 49 Key performance indicators...... 108 The Growth and Regional Planning Committee...... 56 The Property and Service Committee...... 58 Auditor’s report regarding the County Council The Mobility Service Committee...... 61 Executive Committee for 2019...... 109 The Culture Committee...... 62 Abbreviations...... 110 Health Service Steering Committee...... 64 Patient Advisory Committee...... 65 ’s Healthcare Area...... 65 Karolinska Hospital...... 67 The Audit Board...... 69

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

Annual Report 2019 3 Region Stockholm’s surplus gives us the power to face the pandemic

THE STOCKHOLM REGION, the economy entailed by the pandemic, and the world are facing significantly for example relating to the measures changed circumstances after the spread taken to reduce the spread of infection of covid-19 in a global pandemic that and to treat covid-19, but also measures reaps lives and affects all the economies in , where the national of the world. The health service in strategy has led to considerable loss of Stockholm has carried out an impres- income, while we keep operating public sive feat in increasing capacity, not least transport services as before. Region when it comes to intensive care, in order Stockholm’s profit for 2019 is to provide the right care to a dramati- SEK 1,723 million excluding conversion cally increased number of patients. expenditure, which can be compared to The residents have significantly the budgeted profit for the year of changed their behaviours and adhere SEK 140 million. to the recommendations of the Public A balanced budget provides impor- Health Agency of Sweden to reduce the tant capacity to ensure a robust health- spread of infection. This affects both care system, with available health and businesses and the region’s operations. medical care of high quality and a In addition to the acute medical danger, secure and sustainable public transport primarily to the risk groups, there are that helps the county’s residents effec- apparent long-term consequences for tively get about their day. The changes in the national economy. People will see the expenditure equalisation that was their income sources and life work torn decided by the (Swedish parlia- down as companies go bankrupt, many ment) in November 2019 has a massive will lose their jobs and the company impact on Stockholm already in 2020, revenues deteriorate. This will put a lot but will grow exponentially in the of pressure on the private finances and future. Region Stockholm is the region lives of many people. In addition, it most heavily affected by covid-19 in hollows out the tax base for the munici- Sweden. The Riksdag should therefore palities, regions and the central govern- immediately recall the above mentioned ment, and tax revenues are decreasing changes. The considerable increase in rapidly, which risks having significant the equalisation tax sets high require- long-term impact on the funding of the ments for financial economising in the welfare state. region’s committees and companies and The sound finances of Region now entails an even tougher challenge Stockholm, with bulwarks and sur- as a result of covid-19. pluses each year since 2007, has given The transition to a good local health- us the financial prowess to face the pan- care, for example in health centres, demic head on and make the decisions advanced home care, on-call doctors, that are necessary. At the same time, geriatric and other emergency care out- there is great insecurity regarding side of the hospital emergency wards whether the central government will be continued in 2019. During the year, the able to fully compensate the local number of appointments outside of the authorities of Sweden for the strain on emergency hospitals continued to rise.

4 Annual Report 2019 All emergency wards in the county, care building with 120 single rooms. sions have been reduced by 48 per cent. with the exception of Capio S:t Göran Region Stockholm’s public transport Just like the energy efficiency efforts, received a reduced number of visits. has been named the second best in the the reduced climate impact from anaes- In 2019, the highly appreciated local world, which is also seen in the record thetic gases has already exceeded the set emergency clinics had around the same number of people travelling by public targets. The region’s systematic efforts number of visits as the regular emer- transport in Stockholm during 2019. In to prevent antimicrobial resistance are gency wards. We can note that the addition, Stockholm residents are very successful. The use of antibiotics has region had short waiting periods in the satisfied with the public transport ser- continued to go down; in November health service in 2019 as well. vice. In order to meet the needs of the 2019, the use was the lowest in several During the year, extensive efforts growing Stockholm Region, there is a decades. have been made to turn the financial large expansion and improvement Region Stockholm is to be a more situation of Karolinska University underway of the public transport ser- attractive employer to attract and keep Hospital around. However, many efforts vice with 47 new railway stations and employees; at the same time, the trend is will only have a financial effect in 2020. 60 km of new tracks. The goal is for SL already positive. During 2019, the The organisation has been simplified, to facilitate a million more journeys region’s staff turnover decreased by one the number of managers has been per day by 2030 and for the capacity percentage point to 12 per cent in 2019, reduced by 20 per cent and the health between the north and south of the and at the same time, the employee service production has increased due to county to double. The National Negotia- index went up and sickness absence a large increase in the number of open tion on Housing and Infrastructure’s went down. To create the conditions for beds in 2019. The number of cardiovas- Stockholm project has been moved up skills development and clear career cular surgeries performed was the by several years. The expansion of the paths, we have developed “competence highest in ten years. The waiting periods metro and , as well as the resto- ladders” for eleven professions so far within cancer care have been removed. ration of and the Red within the health and medical services. We are happy to say that a year of hard Line, are examples of investments to I would like to extend a warm thank work has also led to improved satisfac- ensure a well-functioning public trans- you to our employees, both within the tion with the leadership among the port sector in a growing Stockholm region and with our contractors and employees. At the start of 2020, Karo- Region. Region Stockholm and SL private care providers, for the work you linska University Hospital was ranked hosted UITP, the world congress for do. Your work was important in 2019, by the reputable journal Newsweek as public transport, during the year, and but in 2020, they are absolutely essen- the world’s tenth best hospital and the Stockholm public transport received tial to fight the pandemic and its effects. Europe’s third. a great deal of international attention in Major investments within health and conjunction with the event. Irene Svenonius medical care which have been com- The Stockholm region is the most Regional Chair for Finance pleted in the year, refer to a new emer- competitive region in Europe, which gency care building at Danderyd hospi- pushes innovation and enterprise for- tal. At Södersjukhuset, a new treatment ward. It is important that the positive building was completed with a total of development in the Stockholm region 183 single rooms, and a new emergency continues, and that the region’s compet- ward was inaugurated in spring 2020. itiveness is also reinforced in the long At hospital, 96 in-patient beds for term. Region Stockholm’s environmen- psychiatry were completed and taken tal efforts continue to be cutting edge into operation. At Södertälje hospital, and have yielded good results. Since a total renovation was completed of a 2011, Region Stockholm’s climate emis-

Annual Report 2019 5

Statement by the Regional Chief Executive

The past year has been a year of development and transition. The development of our commission to go from county council to region, as well as the transition 1 from a long economic boom to a recession. At the same time, the tax equalisation system has been adjusted in a way that means the region must make significantly higher contributions.

6 Annual Report 2019 The development of the new commis- increase than what the region is able to the perspectives of environmental and sion given to Region Stockholm as of support under the financial circum- social sustainability, research and 2019 has entailed new relationships and stances over the next few years. For development, innovation and technol- needs to collaborate with various actors. these reasons and due to the fact that all ogy all contribute to progress. Collabo- The spring was characterised by emergency hospitals were running at a ration with the private and academic start-up of collaborations and inventory deficit in 2019, it was a year of forceful sectors has been developed in many of the results previously achieved by the measures to create new opportunities to areas, and several of these actors con- county administrative board within face a new financial situation in coming tribute to better health as well as better various areas, as well as by an orienta- years. opportunities for individuals to make tion by the region in terms of which Within public transport, investments choices in everyday life. Within contexts it could step into and which in extended and improved service have research and innovation, the work to contexts required new structures to entailed more satisfied commuter train improve public health has continued take on the assignments. During the passengers than ever before. Despite and made headway. Possibilities to autumn, collaboration began, not least certain delays in the extension of the achieve a prosperous future as part of with the municipalities, as an important dual track of Roslagsbanan, travellers social sustainability has been affected agreement within health and social care heading northeast are starting to see the by the region’s efforts in the cultural was adopted in various forums and as major improvements that this invest- sector, where contributions to organisa- political coordination meetings were ment will lead. Many collaborations are tions, and collaboration with the munic- held. During the later part of the year, underway with the municipalities in the ipalities on culture education and cin- it became evident that the relationships region relating to investments into ema have moved in a positive direction with the county administrative board tracks, bus depots, stations, etc. A num- and “Stockholmstinget” (the “Stock- need to be investigated in a few areas ber of projects have become more holm Council”) was carried out with where both the region and the county expensive than planned, and as part of more than 500 participants. administrative board are working with the “Stockholm negotiation”, dialogues As an employer, the region has con- the same issues. were initiated towards the end of 2019 solidated already positive results in the The transition of all operations has with concerned municipalities and with employee surveys carried out each year. been ongoing in 2019. The transition the central government, in order to find Sickness absence has decreased slightly, within the health and medical service a solution for the objects subject to as has the staff turnover. Challenges has been the most notable. Not only negotiation. The plan for the regional remain in terms of access to nurses and have new health service buildings been development, not least based on the certain specialists within several areas taken into use as part of the health and direction set for RUFS 2050, depends and outside of the health service. The medical care of the future, but we have on increased track capacity and new consultancy exchange within certain also opened local emergency clinics for lines if the population growth is to con- administrations are slower than desired the same reason, and finally, the diver- tinue and housing is built according to due to difficulties finding employees sion from Karolinska University Hospi- previously surveyed needs. with the appropriate competence. Being tal to the other hospitals has been com- In the sustainability field, progress an attractive employer is no simple task pleted. This has entailed clean new has been made linked to both procure- when there is a shortage of a certain premises with entirely new possibilities ment and emissions. The public trans- labour force, since the shortage leads for patients to have privacy and for staff port sector very much contributes to the to lease-in, consultancy dependence to use different working methods. The region moving forwards, as does the and a certain need for overtime. For this working environment has improved, possibilities of eco-friendly new con- reason, we are happy to see that both but rents have also increased as the new struction. But not only does the con- sickness absence and staff turnover has premises are more expensive than the struction itself contribute to an gone down slightly. old ones. Drugs and medical equipment, improved environment and sustainabil- as well as wages, are areas that for a ity, but the way in which the properties Carina Lundberg Uudelepp number of years have entailed a signifi- can then be maintained and operated Regional Chief Executive, cantly higher rate of expenditure also entails sustainability gains. From Region Stockholm

Statement by the Head of Administration Annual Report 2019 7

Summary of operational development

The primary task of Region Stockholm is to ensure that the residents of the region have access to a high-quality health and medical service and a well-functioning public transport 2 service, today and in the future. Region Stockholm is also responsible for regional development issues and for contrib- uting to a free and accessible culture life in the county. Region Stockholm exists for the residents of the county, and the individual patient or traveller is the point of departure for the region’s efforts to develop the operations in the short and long term.

8 Annual Report 2019 Chapters two to seven of the Annual year. The residents of the county Stockholm County, compared to the Report describe the operation’s develop- consumed 311,000 medical care events, national average of 73 per cent. ment, important events, management which is an increase of 0.5 per cent by objectives and the financial develop- compared to the previous year. Public transport ment within the regional group. Chapter The work to implement the Plan for On a daily basis, there are 800,000 nine describes the regional committees, the Future continued in 2019, including travellers making close to 2.9 billion and chapter ten outlines the regional the introduction of a structure for acute journeys by public transport in the companies. Chapter eleven describes the care to direct patients to the appropriate Stockholm region. The total number of local federations that Region Stockholm form of care. This structure consists of boarding passengers in the land-based is a member of as well as foundations. 1177 Vårdguiden for medical advice via public transport was 861 million in The Annual Report closes with financial telephone, family doctor’s practices, 2019, which is an increase of two per information, including the profit/loss on-call family doctors, local emergency cent compared to 2018 (844 million). statement and balance sheet, cashflow clinics, emergency ward, intensive care Travelling by land-based public statement and notes. In addition, the emergency ward and prehospital care. transport, measured as the average report contains the appendices Envi- Redirection of patient flows according number of boarding passengers on a ronmental Report 2019 for Region to the new healthcare structure has regular weekday, did not reach the tar- Stockholm, Follow-up Report Staff and been gradual, which in turn has affected get value for 2019, which corresponded Training 2019 for Region Stockholm, all emergency hospitals and the major- to an increase of 4.3 per cent compared Annual Accounts for Region Stockholm’s ity of healthcare providers. to the previous year. The actual increase total resources for research, develop- The operations have been moved to was 1.3 per cent. The proportion of satis- ment and training 2019, and Annual the New Karolinska University Hospital fied travellers on land-based public Accounts for Innovation 2019. in Solna, and the hospital keeps devel- transport and commuter boats was 80 oping its highly specialised activities. per cent, which is the same level as for Regional formation and coordi- The introduction of local emergency 2018 and above the target value of 75 per nated regional development clinics has continued, and the eleventh cent. On 1 January 2019, Stockholm County one opened at Hötorget in February The commuter train traffic increased Council became Region Stockholm. 2020. Close to half of all visits to emer- the most, with ten percentage points The change meant that Region gency wards were made to the local compared to the year before. The signifi- Stockholm assumed responsibility for emergency clinics, and the goal of “the cant increase is considered a result from the regional growth efforts where the right care in the right place” was thereby the ongoing collaboration between the County Administrative Board was attained. Transport Committee, the Swedish previously the coordinating actor. The Healthcare Committee has Transport Administration and MTR for The extended commission entails adopted a general strategic direction for better reliability and disturbance man- responsibility for the regional develop- the primary care service, and an inquiry agement. The commuter train station ment strategy and the county plan for has been conducted of the structure in Vega on the Nynäs line was opened in transport infrastructure. The collabora- the somatic paediatric care. Patient April. Renovation of remaining Söder- tion with the regional actors intensified choice was introduced within the geriat- ström bridges and rail facilities was during 2019, and a united regional lead- ric out-patient and in-patient care as of completed according to plan in July. ership allows for greater opportunities May 2019. A procurement for a unified At Slussen, the relay room for the metro to lift the Stockholm region’s interests in elderly care at Sollentuna hospital is was moved to make room for the city’s Sweden and in Europe. In November underway, and a new operation will be works, which is an important condition 2019, the Regional Council decided to launched. From January 2020 and four for the progress of projects around Slus- adopt the regional development plan years on, new hospital contracts apply to sen. Works by Enlunda bus depot in RUFS 20501 as the regional develop- the emergency hospitals owned by the Ekerö Municipality were resumed, and ment strategy as well. region. the bridge across the Ulvsunda stretch Region Stockholm’s ambitious goal on the Kista section of the light rail line Health and medical care to provide the right care at the right time Tvärbanan was lifted into place in Every day, an average of 13,400 patients was not achieved in 2019, but the region March. The new depot in Molnby has visit a family doctor’s practice in did well in a national comparison of been named deport and its Stockholm County, 80 children are born waiting times. Approximately 93 per framework has been erected. The con- in our hospitals and 1,323 visits are cent of patients received a first appoint- struction of work tunnels for a metro made to the emergency wards. During ment with a specialist within 90 days, line to is underway. the year, 18,500,000 appointments compared to the national average of 82 From the autumn 2018 until April were carried out with doctors and other per cent. The proportion of patients who 2019, a pilot test was conducted with care providers, which was an increase received a treatment appointment self-driving buses in Barkaby and by 1.5 per cent compared to the previous within 90 days was 89 per cent in continued testing was performed in the

1 Regional Development Plan for the Stockholm Region.

Summary of operational development Annual Report 2019 9 second half of 2019. In December, the accounting were transferred from the deviations from the budgeted profit. Transport Committee set the direction Regional Executive Committee and The majority of the committees and for a new terminal by Skeppsborn, Stockholm County’s healthcare area to companies that had a deviating result which is intended to gather all sea-based the Property and Service Committee. compared to budget have had excessive public transport around Slussen in one As of 1 July 2019, Waxholms staff expenditure. In order to achieve terminal. Ångfartygs AB is a subsidiary of AB balanced finances in the future, the Storstockholm Lokaltrafik. Waxholms major hospitals need to carry out the Organisational changes Ångfartygs AB was previously a subsidi- developed measure programs which On 1 January 2019, Region Stockholm ary of Landstingshuset i Stockholm AB. were not completed in 2019, while the was given a new political organisation Budget 2019 clarifies a new direction measure programmes need to be with a changed structure and new for the Regional Executive Committee. updated according to the new financial responsibilities. Three new committees The Regional Executive Committee’s conditions for 2020 and onwards. were established: the Mobility Service supervision of the finances and opera- Balanced finances are the founda- Committee, the Health Service Steering tions throughout Region Stockholm is tion of long-term sustainable develop- Committee, and the Property and Ser- reinforced, as is the control of the ment and create space for prioritised vice Committee. At the same time, the region’s health and medical care pro- and necessary investments. Region respective commissions were adjusted ducing boards and companies. The Stockholm’s financial conditions from for the Regional Executive Committee, activities of the Regional Executive 2020 and the years to come are expected the Healthcare Committee, the Trans- Committee have been concentrated to to deteriorate due to the tax revenues port Committee and the Growth and strategic governance, monitoring, being expected to increase at a slower Regional Planning Committee. analysis and supervision. Operating rate than before. In addition, the Riks- The Mobility Service Committee is parts are transferred to the new dag’s decision regarding the changes in responsible for the mobility service; it Property and Service Committee. the expenditure equalisation system monitors agreements with contractors During 2019, the Regional Executive results in gradually increasing costs for and collaborates with disability and Committee conducted a review of the Region Stockholm. pensioners’ organisations. regional management’s assignment and The Health Service Steering Com- organisation with the aim of adapting The Regional Council’s goals mittee leads the knowledge manage- competence and working methods to In Budget 2019 for Region Stockholm ment in the assignment to participate in the strategic direction. A new organisa- the Regional Council set eight general the regional and national work with tional structure entered into force on goals and 32 targets. Six of the general level structuring. The Committee’s 1 January 2020. goals were attained, while one was not. responsibilities also include knowledge It has not been possible to measure the support, care programmes, introduc- Economic development and goal of being an attractive growth tion and prioritisation of drugs, ques- economic challenges region. tions relating to the priorities of the Region Stockholm’s profit for 2019, Region Stockholm’s goals are meas- health service, the national cancer strat- excluding transition expenditure2, ured using a total of 50 indicators estab- egy, the regional cancer plan, decreased amounted to SEK 1,723 million as lished by the Regional Council, and 48 use of antibiotics, pharmaceutical compared to the budgeted profit of of these indicators have been used. A support and development of Region SEK 140 million. There is a positive dif- total of 30 indicators were fulfilled, and Stockholm’s overall patient manage- ference compared to the budgeted profit 18 were not during 2019. The indicator ment capacity. amounting to SEK 1,583 million, but it is Proportion of locally produced goods The Property and Service Committee SEK 448 million less than in the previ- has not been possible to measure and is responsible for Region Stockholm’s ous year. The deviation from the budget the indicator public transport propor- properties, including transport facili- is primarily due to increased revenue tion of motorised journeys is only meas- ties, and for regional service functions. from specially targeted government ured every two years, with the next time Over the year, intensive efforts have subsidies, but increased tax revenue and being in the spring of 2020. been made to build the committee’s lower depreciation expenses have also Goals that apply to the whole group operations. The service functions that contributed to the surplus. The profit for or which are common to all operations the Committee is responsible for will 2019, including transition expenditure, within Region Stockholm are described gradually be transferred from their was SEK 1,497 million. in chapter 7, while goals for individual present place in the organisation. The profit includes a larger deficit committees and companies are During the first year, SF IT (formerly within the health and medical service, described in their respective sections. SLL IT), NKS Bygg, Procurement, where Karolinska University Hospital, Facility Management, Digital Commu- Södersjukhuset AB, Danderyds Sjukhus nication, Berga Agricultural School, AB and the local federation Sjukvård operations relating to HR services and och omsorg i Norrtälje report negative

2 Transition expenditure refers to restructuring expenses within the scope of the future health and medical service.

10 Annual Report 2019 Summary of operational development Overall goals, targets and indicators

Fulfilled in 2019

The health service in Stockholm shall be characterised by short queues, high availability, good quality and opportunities for residents to choose their own care. Fulfilled

Healthcare in the right place Fulfilled Healthcare at the right time Not fulfilled Safe healthcare Fulfilled Effective healthcare Fulfilled Good public health Fulfilled High level of trust in the health service Not fulfilled

Attractive public transport in a sustainable transport system Fulfilled

Attractive travel Fulfilled Safe travel Not fulfilled Efficient travel – Accessible and unified region Fulfilled

Free culture for experiences, Fulfilled meetings, education and inclusion

Strategically coordinated cultural life and associations Fulfilled Culture and artistic expressions as an integrated part of the region’s activities for Fulfilled well-being and security.

Regional development planning for sustainable growth Not fulfilled

A regional planning at the cutting edge Not fulfilled Sustainable regional growth and attractiveness Not fulfilled

Long-term sustainable economy Fulfilled

Balanced accounts Fulfilled Self-financing of operations and replacement investments Fulfilled Sustainable investment development Fulfilled

A sustainable Region Stockholm Fulfilled Within five years, the Stockholm region shall be one of Europe’s leading research Fulfilled regions within research aiming to improve health. Region Stockholm’s climate impact shall be reduced Fulfilled

Region Stockholm shall be an attractive employer Fulfilled

Region Stockholm – attractive employer Not fulfilled Systematic skills provision Fulfilled The Stockholm region shall be Europe’s most attractive growth region –

Summary of operational development Annual Report 2019 11 3 The Regional Group

12 Annual Report 2019 The Regional Group Commissioned companies Contracts Region Stockholm is organised as an A commissioned company is a legal per- Region Stockholm’s contracts are opera- organisation of committees and subsid- son to which Region Stockholm has tions conducted by another legal person iaries gathered in two corporate law transferred a certain matter in accord- than the committees and companies groups. In Norrtälje, medical and social ance with the Local Government Act. included in the regional group. Region care are provided through a local feder- These companies are only included in Stockholm’s transport operation is con- ation in collaboration with Norrtälje the regional group’s profit/loss account ducted 100 per cent by external contrac- Municipality. The table below lists the and balance sheets when any paid con- tors, while 35 per cent of the purchased committees and companies that are tributions are reported as an expense in health and medical care is handled by included in Region Stockholm’s opera- the profit/loss account. The following external healthcare providers. tion and the summarised accounts for summary covers the main commis- 2019. The figure in parenthesis is sioned companies. Region Stockholm’s ownership.

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 Health 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 federation • Karolinska University Hospital • Ambulanssjukvården i Storstockholm AB Sjukvård och omsorg i Norrtälje • The Transport Committee • Stockholm Care AB (50 %) • The Mobility Service Committee • MediCarrier AB • Tiohundra AB • The Culture Committee • Locum AB • The Growth and Regional Planning – AB Terreno Committee • AB Stockholms Läns Landstings Internfinans • The Property and Service Committee • The Audit Board

Commissioned companies

Co-owned legal persons with considerable influence3 Co-owned legal persons without considerable influence Commissioned 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 %) • Coordinating federations (25 %)4 • The local federation Svenskt Ambulansflyg (22.6 %)

3 Refers to all co-owned legal persons with an ownership exceeding 20 per cent. 4 Region Stockholm is part of seven coordinating federations together with Försäkringskassan, Arbetsförmedlingen and the municipalities of the region.

The Regional Group Annual Report 2019 13 Important conditions for profit/loss and financial 4 position

14 Annual Report 2019 Financing agreed funding at the same time Balance sheet for liquidation Region Stockholm’s rating from the amounted to a total SEK 13.25 billion, purposes regarding credit rating agency Standard & Poor’s comprising a credit facility linked to the Tiohundra AB remains AA+. group account of SEK three million, Tiohundra AB is owned by the local fed- The Regional Council has estab- credit facilities to commercial banks of eration Sjukvård och omsorg i Norrtälje. lished a borrowing scope of SEK 95 SEK 2.5 million and unused loan agree- The company’s negative results have billion. This amount refers to all agreed ments with the European Investment meant that its equity dropped to below loan and credit commitments, loan pro- Bank (EIB) of SEK 7.75 billion. half of the share capital in March 2019. grammes and lease obligations as well The diagram below shows the matu- For this reason, the respective councils as bank overdraft facilities. The region’s rity structure for Region Stockholm’s of Region Stockholm and Norrtälje interest-bearing liabilities increased debt portfolio. municipality decided in conjunction during the year with SEK 1,112 million with submitting their interim reports in and amounted at the end of December Pensions 2019 to issue a capital cover guarantee to SEK 52 million. In addition to lease The Regional group’s pension obliga- for 2019. In the annual accounts for and loan liabilities, there is a liability tions amounted to SEK 55 billion, 2019, Tiohundra AB has been injected for the financing of the hospital New including special payroll tax, of which with a total of SEK 48.2 million through Karolinska Solna, which at year-end provisions in the balance sheet com- the guarantee, of which SEK 38.6 mil- amounted to SEK 6,176 million. The lia- prised SEK 32 million and the liability lion was from Region Stockholm and bility was amortised over the year with SEK 23 billion. SEK 9.6 million was from Norrtälje SEK 380 million. Pension undertakings within the Municipality. The second general meet- The fixed interest term on the debt committees are calculated at present ing regarding the liquidation on 18 portfolio may, according to Region value in accordance with RIPS 19,5 the December was therefore able to note Stockholm’s financial guidelines, discount rate of which is determined by that the company’s share capital had amount to 2–5 years. Over the year, it the Swedish Association of Local been restored to SEK 17.3 million. varied between 3.8 and 4.2 years, and at Authorities and Regions (SALAR). It the end of December it amounted to 4.1 was set to one per cent in 2019. The pen- years. This corresponds to a proportion sion liability with Region Stockholm’s of variable interest of approximately 25 companies are calculated at present per cent of the total debt portfolio. value based on technical insurance Region Stockholm’s financial guide- rules determined by Finansinspek- lines state that the cash requirement tionen and with a discount interest rate and the current solvency must always be that amounted to 0.3 per cent in 2019. hedged through agreed financing. As of The discount rate was lower than before, 31 December 2019, the maximum cash which in 2019 entailed an increased requirement in the coming six months is expense to Region Stockholm of estimated to SEK 3.6 million. The SEK 667 million.

SEK millions 9,000

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034

Bilateral loans Leasing Bonds Green Bonds

5 RIPS stands for Riktlinjer för beräkning av pensionsskuld (guidelines for calculation of pension liability).

Important conditions for profit/loss and financial position Annual Report 2019 15 Important events

The implementation of the Plan for the future regarding health and medical care, including recon- struction and additions to the region’s healthcare facilities, continues to give a more accessible health and medical service. The expansion of the metro and 5 light rail, as well as the restoration of Roslagsbanan and the Red Line, are examples of investments to ensure a well-functioning public transport sector in a growing Stockholm Region.

16 Annual Report 2019 Plan for the Future regarding oping its highly specialised activities. Ekerö Municipality were resumed, and Health and Medical Care The commissions of the other emer- the bridge across the Ulvsunda stretch The development of the health and med- gency hospitals are being gradually on the Kista section of the light rail line ical service continued during 2019 specialised. Tvärbanan was lifted into place in based on the intentions and main strate- March. The commuter train station gies of the Plan for the Future. The Major property investments in Vega on the Nynäs Line was opened in health-promoting and preventive work health and medical services April and work on Roslagsbanan’s new has also continued. Procedures have for A new emergency care building with an depot Molnby has begun during the example been introduced to ensure that emergency ward, surgery, x-ray and year and the depot has been renamed patients have not been smoking or sterile ward was completed and taken Vallentuna Depot. drinking alcohol prior to surgery. The into operation by Danderyd Sjukhus AB Reparation of Söderströmsbroar, transition of the health service struc- in the autumn. A first step in the mod- including rail facilities, was completed ture has continued with the aim of every ernisation of 40 beds at Danderyds according to plan in July, and large patient receiving the right care in the Sjukhus AB was also completed during parts of station Fridhemsplan were right place. the year. rebuilt during the summer. Between • A general strategic direction for pri- At Södersjukhuset AB, a new treat- Täby kyrkby and Kragstalund, work has mary care 2019–2025 has been ment building was completed including continues to extend Roslagsbanan to a adopted by the Healthcare Commit- surgery and sterile wards, as well as a dual track. New tramways have been tee, HSN 2019–0945. An improved new care building with a total of 183 sin- ordered, which are better adapted to the primary and local care service is an gle rooms, which became operational in infrastructure, have a higher passenger important component for a more the autumn. capacity and runs more quietly. During cohesive care, which better responds A new building with surgery, inter- the autumn, delivery began of the new to the patient’s needs. When it comes vention, x-ray and sterile technology A35 cars. to paediatric care, the Healthcare was completed in the Huddinge hospital In November, the Regional Council Committee has made a decision on a area and will be taken into operation by made a decision to move up the planning clarified care structure in out-patient Karolinska University Hospital Hud- of the National Negotiation on Housing paediatric care and an extension of dinge in the spring 2020. In addition, and Infrastructure’s investments in hospital-based advanced home care, the surrounding premises with the pre Tramway South, Roslagsbanan to City, HSN 2019–1340. and post-op departments and the and metro line Fridhemsplan-Älvsjö, • The structure for emergency manda- delivery ward have been rebuilt. In the RS 2019–0829. A review of the expense tory care has been established. This Huddinge hospital area, a reconstruc- and time of the metro expansion indi- structure includes 1177 Vårdguiden tion of 120 general psychiatric beds was cates increasing costs of SEK nine for medical advice via telephone, fam- completed, and these beds were taken billion. A dialogue is underway on how ily doctor’s practices, on-call family into operation during the year. to finance this expenditure increase doctors, local emergency clinics, At Nacka hospital, 96 in-patient beds between the parties of the Stockholm emergency ward, intensive care emer- for psychiatry were completed and negotiation. gency ward and prehospital care. taken into operation and transferred to A new local emergency clinic has Psykiatri Södra Stockholm. Södertälje Flexible night stops opened by Norrtälje Hospital and Sjukhus AB completed a total renova- in the bus service another one was opened by Hötorget tion of a care building with 120 single During 2019, trials were carried out in February 2020. In order to ensure rooms, which was taken into operation with flexible night stops for the bus that patients are assessed and in the autumn 2019. service on the stretch between Hallon- referred to the most suitable form of New construction and reconstruc- bergen and Ursvik. Ahead of 2020, the care, the so-called “Referral support” tion of out-patient clinics, nursing Transport Committee has been has been developed further and departments and breast centre in the assigned to conduct further trials before information measures have been N block, formerly Thorax, at Karolinska a decision is made regarding flexible implemented. University Hospital in Solna were com- night stops in regular SL services. • Patient choice has been introduced pleted and handed over to the hospital The choice of area for night stops will within the geriatric out-patient and management and the board in the be made in dialogue with transport in-patient care, and as of January autumn 2019. operators. 2020, there is a third geriatric opera- tion in Vårberg. A procurement for a Major investments in Digitalisation unified elderly care at Sollentuna hos- public transport In November 2019, the council made a pital is underway, and a new opera- The extension of work tunnels for a decision regarding a new strategy for IT tion will be launched in 2020. metro line to Barkarby has begun in and digitalisation, RS 2019–0669, RS • The operations have moved into the 2019 and the construction start was 2019–0829. The strategy highlights the New Karolinska University Hospital marked with a first symbolic blasting in effects of digitalisation as an enabler of a in Solna, and the hospital keeps devel- March. Works by Enlunda bus depot in more accessible, effective and qualita-

Important events Annual Report 2019 17 tive service for residents. The strategies focus on active ownership in the core activities, a high degree of joint efforts and a stable, secure and modern digital basic platform. The governance of digitalisation issues has been reinforced and several steps have been taken to create concrete benefits for residents and operations. The strategic assignment of the Regional Executive Committee has been specialised and the new operational IT activities have been transferred to the newly formed Property and Service Committee. A review of the group’s IT infrastruc- ture has been carried out. The review indicates major quality challenges and needs for both modernisation of the infrastructure and developed working methods. This applies to Region Stockholm’s continued digitalisation in general, and for the development of artificial intelligence in particular. Another condition for a successful digitalisation is that employees have the appropriate competence. For this rea- son, a boost of digital skills, especially targeted to operational managers and other leaders within the health service will be initiated in 2020. Several development projects within AI6 linked to innovation and digitalisa- tion are underway. Among other things, a research group within the health and medical service has been training an AI algorithm to interpret x-ray images, and within the public transport service, attempts have been made to improve the forecast for bus service punctuality.

6 AI stands for artificial intelligence.

18 Annual Report 2019 Important events Important events Annual Report 2019 19 Steering and follow-up of the regional operations

According to the Local Government Act, the Regional 6 Executive Committee shall supervise Region Stockholm’s committees, companies and other operations.

20 Annual Report 2019 According to the Local Government Act, Compliance with the specific operation, its financial conditions, goals the Regional Executive Committee shall ownership directives and priorities, and assignments of the supervise Region Stockholm’s commit- Ownership directives is a tool for the committees and company boards relat- tees, companies and other operations. owner’s, i.e. the Regional Council’s long- ing to implementation, investigations This supervision is continuous through- term strategic governance of the compa- and analyses. The assignments are one out the year. As part of the supervision, nies. The ownership directives are of the Council’s methods of steering the the Regional Executive Committee con- annually decided in the budget and con- operation to achieve Region Stockholm’s ducts an assessment in conjunction with tain specific regulations, requirements goals. interim and annual reports of the com- and commissions for the companies. mittees’ and companies’ goal attain- The companies have not reported Internal control ment, implementation of council deci- any major or considerable departures The internal control in 2019 is based on sion, compliance with policy documents from the determined, company-specific a cohesive framework described in and efficiency of the operation. In case ownership directives during the fiscal Region Stockholm’s policy for internal of deviations, the Regional Executive year 2019. The Regional Executive Com- control, LS 1303–0431. The policy was Committee can request additional mittee’s assessment corresponds to the replaced in November 2019 by the information, ask committees and com- companies’ own reporting. regional guideline for internal control, panies to take measures or, in case of RS 2019–0866. The requirements for serious deviations, propose that the Goals and mission the work are clarified in the Regional Regional Council takes measures. A In its 2019 Budget for Region Stockholm, Chief Executive’s instructions for the brief report of the committees’ and com- the Regional Council established the annual operations planning and for the panies’ work with previous instructions vision of an attractive, sustainable and interim and annual reports. is given in the respective section of the growing Stockholm region, with free- Region Stockholm’s committees and annual report for each board and com- dom for residents to shape their own companies are responsible for ensuring pany. lives and make essential decisions. that internal control is sufficient and Based on the vision, the Regional that the operation is conducted in an Regulations Council also set overall goals for the otherwise satisfactory manner. This The committees’ areas of responsibility core activities and for joint goals for the means that the operation must be con- are specified in regulations set by the group. ducted safely, effectively, appropriately council in accordance with Chapter 6, These goals have been broken down, and within the established financial Section 44 of the Local Government Act and are followed up, by indicators of scope, that reports must be reliable, (2017:725). All the committees have which the majority have been defined and that laws, regulations, agreements, reported that the regulations have been and set through target values. Another policy documents and decisions must be complied with. The Regional Executive few indicators were defined and targets complied with. The above includes Committee generally agrees with this were set by the council in the reconcilia- working systematically to predict and assessment. tion of the budget and in the interim proactively manage and communicate report 2019. In the annual report, the risks, opportunities, measures and con- Compliance with municipal outcome for each respective indicator is trol elements. goals and powers measured and compared to the target. The Joint System Support The municipal goals are established in The exception is the indicator Propor- The support is used to ensure that the the articles of association for each com- tion of locally produced goods under functions working with risk manage- pany and adhere to the principles of the goal to reduce Region Stockholm’s ment, internal control, compliance and local government law, which supersede climate impact, which has not been pos- internal audit have full access to the the corporate law principle of conduct- sible to measure, and Public transport information required for adequate ing business for profit. All companies proportion of motorised journeys internal control. report that they have complied with the under the goal of Efficient journeys. Region Stockholm’s committees and established municipal goals. The outcome for this indicator will only companies regularly follow up to ensure Folktandvården Stockholms län AB become available in the spring 2020. that measures and control elements are reports that a departure has been made The 2019 Budget stated the goals and carried out effectively. The reporting of from the principle of location due to a indicators that each committee and the follow-up was done during the year collaboration with Folktandvården company must steer towards and follow in each company’s and committee’s Värmland in regard to paediatric ortho- up. Committees and companies were interim and annual reports. dontics. No other company within the assigned to set their own targets for the region has reported any departure from Regional Council’s indicators and the Compliance the municipal authorities in 2019. possibility to decide their own local Compliance efforts were generally The Regional Management’s overall targets and indicators that steer in the reinforced in 2019. A compliance officer assessment coincides with the compa- direction of the Regional Council’s was hired and a central whistle-blower nies’ own reports and no measures are goals. function was introduced. The Regional deemed necessary. The Council sets the direction for the Council also established a Code of

Steering and follow-up of the regional operations Annual Report 2019 21 Conduct, LS 2017–1198, for Region according to the plan. During 2019, planning and coordination, as well as Stockholm’s elected officials, employees a risk and vulnerability analysis was through increased internal control. Out and hired staff. developed for Region Stockholm in of the procurements that were appealed collaboration with representatives and during the year, Region Stockholm lost Information security experts from committees and compa- 13 per cent, as compared to the average Region Stockholm’s committees and nies. The number of operations working in the Swedish public sector, which is 28 companies shall conduct systematic systematically with contingency per cent. information and IT efforts according to increased over the year. The efforts the group’s policy and guidelines for included exercises with internal and Code of conduct for suppliers information security. The general external training programmes and Region Stockholm manages risks of assessment is that Region Stockholm the establishment and revision of docu- inadequate compliance with the code of had a positive development in 2019 in mentation. conduct by suppliers by identifying risk the efforts to comply with regulations Several operations have already areas, setting requirements and follow- and newly added legislative require- accounted for performed and coming ing up on chosen suppliers. In 2019, ments within the area. Just over half of activities within the scope of recon- particular focus was placed on identify- the committees and the companies structing a civil defence and the total ing risks connected to building and con- ensured necessary processes for infor- defence. A few operations stated that struction materials. Committees and mation security, in some cases with a ensuring a supply of resources for 2020 companies have solidified the contract few deviations. Another few committees is a challenge. requirements relating to sustainable and companies reported intensive supplier chains in contracts, and con- change efforts. Other committees and Anti-corruption tract follow-up has been conducted for companies have established important Region Stockholm’s anti-corruption coordinated contracts for IT products, conditions, but need to stay focused on policy, LS 2015–1342, was applicable examination gloves and medicines. change and well-conceived governance during 2019 up until November, when it of their work with information security was replaced by Region Stockholm’s Accessibility for people with so that measures can be implemented new code of conduct, LS 2017–1198. functional impairments based on the current risk situation. In addition, there are guidelines for Committees and companies generally anti-corruption and representation, conduct systematic efforts for increased Security LS 2015–1342. A majority of the com- inclusion of persons with functional Committees and companies shall also mittees and companies reported active impairments; however, increased com- conduct systematic security efforts in prevention efforts in 2019 relating to petence is needed to ensure legislative accordance with the regional security anti-corruption through updating of requirements in the area. Consultation guidelines, LS 2016–1322. This includes local policy documents, ongoing initia- has been carried out with various annual risk and vulnerability analyses tives for information and training, elected officials in Region Stockholm and continuity plans, analysing threats introduced procedures and implemen- and functional impairment interest to the operation and take measures and tation of various types of controls in the organisations. Efforts have been initi- follow up on detected risks and threats. operation. Several committees also ated to issue information regarding the The majority of the committees and reported measures directed externally, Act on accessibility to digital public ser- companies reported that they were such as participation in a network on vice, which is to be implemented by 23 conducting systematic security efforts ethics and information to suppliers. September 2020. and several reported that they have been focusing more than before on Purchasing Gender equality and equal employee training to improve the secu- Compliance within the area of purchas- opportunities, including HBTQ rity culture and increase safety. In 2019, ing is generally assessed to be good. rights a couple of committees and companies Inadequate system support also makes Most committees and companies carry created the conditions for significantly it hard, primarily for major companies out systematic online training relating improved security efforts in 2020. and administrations to effectively follow to gender equality and equal opportuni- up on their purchases, such as the ties, and many managers have under- Contingency number of direct procurements. The gone executive training in gender equal- The committees’ and companies’ con- reported number of such procurements ity, equal opportunities and tingency efforts must adhere to the amounted to a total 1,594, of which 75 discrimination. A few committees and planning direction set in Region was for amounts exceeding limits for companies completed gender equality Stockholm’s Crisis Contingency Plan direct procurement. The total value of analyses and training initiatives on (LS 2017–0149). The direction relates to the direct procurements amounted to HBTQ issues in 2019, but no systematic work before, during and after different SEK 904, which the Regional Manage- efforts have been reported. types of societal disruptions. The ment considers to be too high. The majority of the committees and compa- occurrence of direct procurements nies reported that they had worked needs to be reduced through better

22 Annual Report 2019 Steering and follow-up of the regional operations Public health Instructions In 2017, the council decided on a public The Regional Management’s assessment health policy for 2017–2021, with the is that all the committees and compa- vision of Region Stockholm creating nies are working to implement the conditions for a good, unbiased and instructions they were given in 2019. equal health for all through active The Regional Management makes the health promotion. The majority of the assessment that all instructions have committees and companies have been finally reported and that any reported some form of measures being ongoing measures will be monitored implemented relating to the policy. The from here on as part of the concerned measures primarily concerned working operation’s follow-up and continuous environment and patients. A few boards improvement efforts. and companies reported that they have no identified needs within the area. Improved public health and reduced health disparity is a priority in the regional development plan RUFS 2050. The Healthcare Committee has been assigned to coordinate the work on the prioritisation, RS 2019–0829, which includes developing methods and approaches to reinforce the strategic public health efforts in the Stockholm region.

National minorities Committees and companies were work- ing systematically in 2019 with national minority issues to varying degrees. The Regional Management developed proposals on guidelines for how com- mittees and companies are to work with the Act on National Minorities and National Minority Languages. Repre- sentatives of the national minority groups and Region Stockholm were con- sulted, but a need has been identified for a collaboration agreement in order to streamline the consultation.

Children’s rights Ahead of the ratification of the Conven- tion on the Rights of the Child in 2020, five information clips were produced and published on the intranets of all the committees and companies. Training initiatives were carried out, but more are needed to guarantee access to com- petence. Systematic efforts are generally made within the committees and com- panies, but there are areas left to develop, such as increased inclusion of children and young people in processes and more systematic analysis of conse- quences for children. Operations that have employees with special responsi- bility for children’s rights issues have come significantly further in this work.

Steering and follow-up of the regional operations Annual Report 2019 23 Good financial management and financial standing

The consolidated accounts for Region Stockholm 7 provides an overall view of the committees’ and companies’ finances. This section also includes follow-up of the goals for a sustainable Region Stockholm and Region Stockholm being an attractive employer.

24 Annual Report 2019 Long-term sustainable Self-financing of operations and Sustainable investment development economy replacement investments The capital expense proportion of the The overall goal for a long-term sustain- The replacement investments amounted region’s total income amounted to 7.0 able economy has three objectives: to approximately SEK 3,500 million, per cent for the period and the target Balanced accounts, Self-financing of which is less than the cash flow from value for the indicator was achieved. operations and replacement invest- current operations, which amounted to The proportion of interest-bearing lia- ments and Sustainable investment approximately SEK 10,700 million. The bilities of the total income amounted to development. All the objectives were objective Self-financing of operations 49 per cent and the target value for the achieved in 2019. and replacement investments was indicator was achieved. thereby achieved in 2019. Balanced accounts The profit, excluding transition expend- iture, amounted to SEK 1,723 million. The target for the indicator was SEK 140 million, which was attained.

Long-term sustainable economy Outcome Goal Outcome Fulfilled in Goals and indicators 2019 2019 2018 2019 Balanced accounts Fulfilled ● SEK 1,723 SEK 140 SEK 2,171 A positive outcome according to the balance requirement1) million million million Fulfilled ● Self-financing of operations and replacement investments Fulfilled ● Financing of Region Stockholm’s operating expenditure and replacement investments must be within the consolidated cashflow. 100.0 % 100 % 100 % Fulfilled ● Sustainable investment development Fulfilled ● Proportion of capital expenses2) out of Region Stockholm’s total revenue. 7.0 % ≤ 9.5 % 7.1 % Fulfilled ● Proportion of interest-bearing liabilities in total revenue 49.0 % ≤ 70 % 50.0 % Fulfilled ●

1) Refers to the profit/loss excluding transition expenditure. 2) Capital expenses refer to depreciation expenses and interest charges from leasing and borrowing and to other corresponding liabilities.

Profit/loss Deviation Outcome Budget compared Deviation Outcome SEK millions 2019 2019 to budget percentage 2018 Operating revenue 25,036 23,890 1,146 4.8 % 23,576 Operating expenditure –96,220 –96,390 170 –0.2 % –92,450 Depreciation –6,201 –6,445 244 –3.8 % –5,742 Operation’s net expenditure –77,385 –78,945 1,560 –2.0 % –74,616 Tax revenue 76,044 75,600 444 0.6 % 72,871 General government subsidies and equalisation 5,374 5,594 –220 3.9 % 4,876 Operating profit/loss 4,033 2,249 1,784 3,131 Financial revenues 68 56 12 21.3 % 426 Financial expenses –2,604 –2,523 –81 –3.2 % –2,174 Profit/loss after financial items 1,497 –218 1,715 1,383 Extraordinary items 0 0 0 0 Profit/loss for the year 1,497 –218 1,715 1,383 Of which comprise transition expenditure –226 –358 132 –36.7 % –788 Profit/loss excluding transition expenditure 1,723 140 1,583 2,171

Good financial management and financial standing Annual Report 2019 25 Profit/loss ture increase was 5.0 per cent, and the Region Stockholm’s main revenue The profit for the period, excluding tran- primary reason for the costs increasing items come from total tax revenues, sition expenditure, amounted to at a slower rate than budgeted was lower which represent 77 per cent of total SEK 1,723 million. The profit deviation depreciation expenses due to the time revenue. Other major revenues refer to is positive compared to the budgeted delay in investment projects. ticket revenues from public transport profit of SEK 1,583 million, which is The profit includes a larger deficit and targeted government subsidies. primarily due to increased revenue within the health and medical service, Region Stockholm’s main expense from targeted government subsidies. where Karolinska University Hospital, items come from payroll expenses, Increased tax revenue and lower depre- Södersjukhuset AB, Danderyds Sjukhus which represent 33 per cent of total ciation expenses also contributed. AB and the local federation Sjukvård expenditure. Purchased health and The operating expenditure, includ- och omsorg i Norrtälje report negative medical care represents 21 per cent ing depreciation and financial expenses, deviations from the budget. of total expenditure, and purchased increased by 4.6 per cent compared to transports represent 14 per cent. the year before. The budgeted expendi-

Revenues 2019

Government grants and other grants, Other revenues, SEK 1,527 million (2 %) SEK 6,355 million (6 %) Rental income, sale of other services, SEK 4,345 million (4 %)

Sale of primary services, SEK 2,451 million (2 %)

Patient fees, SEK 1,386 million (1 %)

Ticket revenues, SEK 8,972 million (8 %) Total tax revenues, SEK 81,418 million (77 %)

Expenses 2019

Depreciation/amortisation SEK 6,201 million (6 %) Net financial items, SEK 2,536 million (2 %) Other expenses SEK 6,128 million (6 %) Cost of premises etc. SEK 2,908 million (3 %) Staffing costs, Grants provided SEK 34,669 million (33 %) SEK 1,753 million (2 %) Other materials and products SEK 5,962 million (6 %) Pharmaceuticals SEK 7,609 million (7 %)

Purchased transport services Purchased healthcare SEK 14,558 million (14 %) SEK 22,633 million (21 %)

26 Annual Report 2019 Good financial management and financial standing Operating revenue on primary healthcare, as well as to lion, which is an increase of 5.3 per The operating revenue increased by 4.8 reduce patient queuing times. cent. The charge for the municipal per cent compared to budget. The single The agreements within several of equalisation system amounted to largest revenue increase referred to tar- the areas were not completed until half SEK 1,028 million, which is an increase geted government subsidies and other way through 2019, which meant that of 14.5 per cent. The charge includes subsidies, which increased by 29.8 per the conditions for receiving subsidies to the expense of revenue equalisation cent, corresponding to SEK 1,457 mil- shorten healthcare queues were only amounting to SEK 1,174 million. Region lion compared to budget. achieved in the autumn 2019. This Stockholm is the only region paying Targeted government subsidies are means that it was not possible in the towards the revenue equalisation. provided for a specific purpose. The budget process to fully calculate the All in all, tax revenue, general gov- Government concludes annual agree- financial consequences of the targeted ernment subsidies and equalisation ments with the Swedish Association of government subsidies. amounted to SEK 81,418 million. The Local Authorities and Regions outcome was SEK 224 million higher (SALAR) regarding subsidies within Tax revenue, general government than budget, which corresponds to a areas that both parties have identified subsidies and equalisation deviation of 0.3 per cent. Compared to as being particularly important for the Tax revenue, general government subsi- the previous year, tax revenue, general continued development of health, med- dies and equalisation are calculated government subsidies and equalisation ical and social care. The targeted gov- based on SALAR’s forecast. The tax increased by a total of 4.7 per cent. ernment subsidies refer to: Investments revenues in 2019 amounted to to improve the conditions of healthcare SEK 76,044 million, which is an Operating expenditure workers, to provide appropriate and increase of 4.4 per cent compared to The operating expenditure deviated local care, to facilitate a transition of the year before. General government marginally from the budget with –0.2 the health and medical service focusing subsidies amounted to SEK 6,402 mil- per cent; however, the deviations are

Operating revenue Deviation Outcome Budget compared Deviation Outcome SEK millions 2019 2019 to budget percentage 2018 Patient fees in health and dental care 1,386 1,364 23 1.7 % 1,375 Traveller revenue 8,972 8,787 185 2.1 % 8,470 Sale of primary services1) 2,451 2,487 –36 –1.4 % 2,341 Rental income, sale of other services, material, goods 4,345 4,346 0 0.0 % 4,353 Government subsidies and other grants 6,355 4,897 1,457 29.8 % 5,364 Other revenue 1,527 2,009 –482 –24.0 % 1,673 of which are items affecting comparability 67 349 Total operating revenue 25,036 23,890 1,146 4.8 % 23,576

1) Primary services comprise sold health and medical care, dental care and sale of other primary services.

Tax revenue, general government subsidies and equalisation Deviation Outcome Budget compared Outcome SEK millions 2019 2019 to budget 2018 Change Tax revenue 76,044 75,600 444 72,871 4.4 % General government subsidies 6,402 6,456 –54 6,078 5.3 % Equalisation system –1,028 –862 –166 –1,202 –14.5 % Total 81,418 81,194 224 77,747 4.7 %

Change compared to previous year, SEK million 3,671 3,447 2,798 Change compared to previous year, percentage 4.7 % 4.4 % 3.7 %

Tax rate 12.08 12.08 12.08

Good financial management and financial standing Annual Report 2019 27 reported within different sub-items. lion or 3.2 per cent over budget. The AB and the Property and Service Com- The largest negative deviation is cause of the negative deviation is that mittee. Out of the SEK 3,500 million reported within the item staff expendi- the interest expense of the pension lia- that was budgeted for transition ture and hired staff, which increased by bility for Region Stockholm’s companies expenses, SEK 3,159 million has been 3.2 compared to the budget. This increased when the Swedish Financial used as of 31 December 2019. increase is explained by the number of Supervisory Authority lowered the dis- employees increasing by 1.2 per cent, count rate. Included in the financial Items affecting comparability while wages and the price of hired staff expenditure are interest expenses for Items affecting comparability which are increased by 2.0 per cent. The expendi- borrowings, which was approximately included in the profit/loss consist of ture increase for staff refers to commit- SEK 200 million lower than budget. capital gains, transition expenses for tees and companies within health ser- This is due to a lower borrowing rate due the implementation of future health and vice. The expense of purchased health to time delays in investment projects. medical care and interest changes in the and medical care is reported with a pension liability. Similarly to previous negative deviation compared to budget. Transition expenditure years, items affecting comparability are Contributions paid, primarily within The transition expenditure for the excluded in the assessment of whether education, and other expenses within implementation of the Plan for the committees and companies have the Regional Executive Committee were Future regarding Health and Medical achieved their budgeted outcome. lower than the budget. Expenditure for Care amounted to SEK 226 million, as premises and equipment rent was lower comparable to the budgeted cost of Balance requirement outcome than budget. SEK 358 million. The deviation is due Region Stockholm reports a positive to expenditure that has been moved balance after adjustment for capital Financial expenses forward to coming years, referring to gains. The Local Government Act The financial expenses amounted to Karolinska University Hospital, requirement for balanced finances was SEK 2,604 million, which is SEK 81 mil- Södersjukhuset AB, Södertälje Sjukhus thereby fulfilled in 2019.

Operating expenditure Deviation Outcome Budget compared Deviation Outcome SEK millions 2019 2019 to budget percentage 2018 Staff expenditure and hired staff –34,669 –33,602 –1,068 3.2 % –32,747 Purchased health and medical care –22,633 –22,375 –258 1.2 % –21,518 Purchased transport –14,558 –14,633 75 –0.5 % –13,705 Pharmaceuticals –7,609 –7,830 221 –2.8 % –7,650 Material and goods, etc. –5,962 –5,849 –112 1.9 % –5,725 Contributions paid –1,753 –2,183 430 –19.7 % –1,727 Cost of premises, equipment rentals –2,908 –3,148 240 –7.6 % –3,124 Other expenditure –6,128 –6,771 642 –9.5 % –6,256 of which are items affecting comparability –226 –788 Total operating expenditure –96,220 –96,390 170 –0.2% –92,450

Items affecting comparability Outcome Outcome SEK millions 2019 2018 Under operating revenue: Capital gain/loss 67 349

Under operating expenditure: Transition expenditure –226 –788

Under net financial revenue/expense: Interest change for pension liability in group companies –667 139 Capital gain from sale of claim with AB Storstockholms Lokaltrafik – 337 Total items affecting comparability –826 37

28 Annual Report 2019 Good financial management and financial standing A sustainable Region within five years, and reducing Region to work systematically with innovation” Stockholm Stockholm’s climate impact. The overall amounted to 29 per cent, which exceeded Sustainability is to permeate Region goal was achieved since both the under- the target of 25 per cent. The goal was Stockholm’s operations in a way that lying targets were attained. thereby achieved. contributes to social sustainability, In 2019, Region Stockholm has con- reduced environmental impact, reduced Within five years, the Stockholm tinued to develop the joint information expenses and lower risks in the long region shall be one of Europe’s network with an innovation support term. The overall goal of “A sustainable leading research regions within system and systematic innovation Region Stockholm” was measured research aiming to improve efforts. These efforts are based on policy through the two underlying targets of health. documents such as the innovation and making the Stockholm Region one of The indicator “Proportion of Region digitalisation policy, LS 2015-0833, and Europe’s leading research regions Stockholm’s committees and companies the implementation of the overall inno- within research for improved health that have introduced methods and tools vation strategy.

Balance requirement outcome Outcome Budget Outcome SEK millions 2019 2019 2018 Outcome according to profit/loss account 1,497 –218 1,383 Reduction of all capital gains –69 –686 The profit/loss for the year after balance 1,428 –218 697 requirement adjustments Balance requirement outcome 1,428 –218 697 Special reasons Amount released from equity reserves relating to transition expenditure in conjunction with the introduction of the future health service. 0 583 0 Balance requirement outcome to regulate 0 365 0

A sustainable Region Stockholm Outcome Goal Outcome Fulfilled in Goals and indicators 2019 2019 2018 2019 Within five years, the Stockholm region shall be one of Europe’s leading research regions within research aiming to improve health. Fulfilled ● Proportion of Region Stockholm’s committees and companies that have intro- duced methods and tools to work systematically with innovation 29 % ≥ 25 % – Fulfilled ● Region Stockholm’s climate impact shall be reduced Fulfilled ● Operating and property energy in properties owned by Region Stockholm, kWh/kvm (A–temp) –13 % ≥ –16 % –9.5 % Not fulfilled ● Proportion of owned and leased vehicles running on renewable fuels within Region Stockholm’s committees and companies1) 3.3 % ≥ 3 % Fulfilled ●

The climate impact from emissions of greenhouse gases, tonnes of CO2 equivalents2) –48 % ≥ –48 % –45 % Fulfilled ●

3) Climate impact from patient meals, tonnes of CO2 equivalents –24 % ≥ –5 % Fulfilled ●

The climate impact from Region Stockholm’s business travel, tonnes of CO2 equivalents3) –10 % ≥ –5 % Fulfilled ● The proportion of organic foods in the region’s own operations, percentage4) 54 % ≥ 50 % 41 % Fulfilled ● Proportion of locally produced food5) 6) ≥ 5 % – Fulfilled ●

1) The indicator refers to clean electric cars (not hybrids) and hydrogen cars, known as zero-emission vehicles; Tiohundra AB is not included in the indicator.

2) Certain older emission factors have been updated based on new data, which means that Region Stockholm’s total climate impact is somewhat higher than in the reports from previous years. This is primarily due to the renewable fuel of rapeseed methyl ester has a higher climate impact during production than what was previously stated. 3) Reduction in relation to the baseline year 2016. 4) Patient meals in own operations along with coffee, tea and fruit for the staff. 5) Definition according to the plan for sustainable patient meals LS 2017–0128. 6) The indicator has not been measurable in 2019.

Good financial management and financial standing Annual Report 2019 29 There are many examples of activi- tion has been reduced by 14 per cent, for Climate impact from patient meals, ties that have been carried out. The example through streamlining of heat tonnes of CO2 equivalents Patient Advisory Committee started a and electricity use. The target for 2019 In total, the climate impact from patient collaboration with the Royal Institute of a reduction of at least 16 per cent was meals has been reduced by 24 per cent of Technology (KTH) and Stockholm not achieved. However, the outcome was compared to the baseline year 2016 and University, in which students were at the level of corresponding target the target value of a five per cent reduction offered to carry out degree projects valued in Region Stockholm’s environ- by 2019 was thereby achieved. For several within innovative technology, including mental programme for 2017–2021 and years, the operations have been working artificial intelligence. The Mobility Ser- Budget 2020. From a longer perspec- actively to reduce the climate impact of vice Committee completed accessibility tive, the result is thereby very good the patient meals, and the result is highly adaptations on the online portal for and well on the way to meet Region positive. Among other things, climate travellers and in the customer system Stockholm’s long-term goal for reduced calculations have been made for meals, My Pages. Innovationsplatsen at energy consumption in properties of menus have been reviewed and measures Karolinska University Hospital has 30 per cent by 2030. have been taken to reduce food waste. established programmes at the employee level and at managerial/lead- Proportion of owned and leased The climate impact from Region ership level together with HR. Further- vehicles running on renewable fuels Stockholm’s business travel, tonnes of more, a collaboration has been estab- within Region Stockholm’s committees CO2 equivalents lished with Medical Management and companies Climate impact from Region Stockholm’s Centrum at Karolinska Institutet and The indicator refers to clean electric business travel by train and air amounted

KTH to conduct research into innova- cars and hydrogen cars, also called to 4,580 tonnes of CO 2 equivalents in tion management within health and zero-emission vehicles. 2019, which is a reduction by 10 per cent medical care. Danderyds Sjukhus AB In 2019, there were around 560 compared to the baseline year 2016. The developed new systems and routines for owned and leased vehicles within target of a five per cent reduction was innovation and have hired an innova- Region Stockholm, of which 20 were thereby attained. In total, approxi- tion manager. AB Stockholms Läns pure electric cars, i.e. 3.6 per cent. The mately 34,000 journeys were made by Landstings Internfinans tested a model target of at least three per cent by 2019 train and air in 2019, of which 41 per for more efficient control and financing was thereby achieved. Stockholm cent by air and 59 per cent by train. The of prevention measures through County’s healthcare area owns and proportion of train journeys has “Health Impact Bonds”. In order to leases 500 cars, and in 2019, 16 new increased by seven percentage points reduce manual labour for administra- electric cars were acquired, which was compared to 2016. tive staff by automating repetitive tasks, decisive to attain the target for 2019. virtual robotics (Robotic Process Auto- The proportion of organic foods in the mation, or RPA) have been tested by the The climate impact from emissions region’s own operations, percentage Regional Management. The virtual of greenhouse gases, tonnes of CO2 In 2019, the proportion of organic food robot currently reviews quality and reg- equivalents in the region’s own operations was 54 isters new suppliers, and also carries out Region Stockholm’s total climate impact per cent, which means that the indica- GDPR measures on behalf of the has been reduced by 48 per cent com- tor’s target was attained. The total cost Healthcare Committee by searching for pared to the baseline year 2011, and the of coffee, tea and fruit for the staff corre- sensitive information in their invoices. target value for 2019 was thereby sponds to barely half of the cost for achieved. In 2019, the climate impact patient meals. The proportion of organic Region Stockholm’s climate from emissions of greenhouse gases was items is significantly higher in the cate- impact shall be reduced 128,688 CO2 equivalents. The indicator gory coffee, tea and fruit. This goal was measured using the includes laughing gas, anaesthetic following indicators: gases, energy consumption and cooling Proportion of locally produced food Operating and property energy in agents in properties owned by the According to the definition in Region properties owned by Region Stockholm region, as well as emissions from public Stockholm’s plan for sustainable patient The use of operating and property transport and other significant trans- meals, LS 2017–0129, locally produced energy in the form of electricity, heating ports and journeys with owned vehicles items are those produced in Mälardalen and cooling in Region Stockholm’s or through procured providers. The and . The target for 2019 was a properties has been reduced by 13 per outcome has primarily been achieved proportion of locally produced food of cent compared to the baseline year of through energy streamlining of trans- at least five per cent. No figure can be 2011. In the region’s properties for ports and properties, renewable fuels in reported for 2019, as it is difficult to health and medical care, the energy public transport and reduced emissions obtain information about where food is consumption has been reduced by 13 of laughing gas and anaesthetic gases in produced. The operations have been in per cent, which is a result of stream­ the health service. contact with their suppliers, but no sup- lining operations etc. In the public plier has been able to report a figure at transport properties, energy consump- the regional level.

30 Annual Report 2019 Good financial management and financial standing Environmental report Stockholm’s business travel has The Regional Executive Committee’s In addition to the above-mentioned goals decreased for the first time since the appropriations were therefore increased and indicators, Region Stockholm’s baseline year 2016 and the current out- by SEK 200 million in 2019. In order to environmental work is reported in the come of a ten per cent reduction can be remain a sustainable and attractive appendix Environmental Report 2019. seen as a positive change in the trend. employer, the surplus has been used for The Environmental Report is based on In order to facilitate goal achieve- strategic and long-term investments in Region Stockholm’s environmental pro- ment relating to reduced emissions of education and skills development, lead- gramme for 2017–2021, LS 2015–0092, environmentally damaging pharmaceu- ership initiatives and initiatives within and includes environmental objectives ticals and to sustainable patient meals, systematic work environment manage- for the health service, public transport committees and companies are working ment. As an example, a wage benefit was and other transports as well as proper- with the implementation of Region paid to a little more than 500 nurses, ties and infrastructure. It also contains Stockholm’s plan for sustainable patient who had trained to be specialist nurses Region Stockholm’s climate commit- meals, LS 2017–0128, and the plan for or midwives. Investments in measures ment and the ambition to be a leading pharmaceuticals and environment, to increase competence have also been actor in terms of sustainable procure- LS 2017–0129. The proportion of made relating to assistant nurses and ment. The environmental programme organic raw materials in patient meals orderlies, among others. contains 15 environmental goals which amounts to 42 per cent in 2019 and the are followed up through 24 indicators. goal for 2021 is 50 per cent. Region Stockholm – attractive The Environmental Report is based on For 2019, certain challenges have employer the implementation instruction for the been noted, for example within the goals Staff turnover in Region Stockholm follow-up of Region Stockholm’s envi- relating to chemicals that are hazardous amounted to twelve per cent, while the ronmental programme 2017–2021, to the environment and human health corresponding figure in 2018 was 13 per LS 2016–1486. The implementation within public transport, reduced envi- cent. This meant that the Council’s instruction establishes the measuring ronmental impact from textile use, as target was not attained. A high staff methods used for each goal, as well as well as climate impact and material turnover and a large proportion of hired which committees and companies are recycling within building and construc- employers reduces effectivity and included. The 2019 Environmental tion projects where continued develop- makes development and quality meas- Report also includes a follow-up of ment is needed in 2020 in order to ures more difficult, which is also costly. Region Stockholm’s guidelines for the achieve the goals set for 2021. It is therefore a step in the right direc- environmental efforts, LS 2015–0092, tion that the staff turnover is decreasing which is the first year a consolidated and the hiring of staff also decreased in follow-up of the guidelines has been car- Region Stockholm shall be the latter part of 2019. ried out. All committees and companies an attractive employer The proportion of employees stating with Region Stockholm are certified in The overall goal Region Stockholm shall that they have had an individual per- accordance with ISO 14001:2015. be an attractive employer was meas- formance review with their immediate Further information is available in ured through the two targets Region superior amounted to 81 per cent and Region Stockholm’s Environmental Stockholm – attractive employer and remained unchanged from 2018. The Report 2019. Systematic skills provision. The general target value for the indicator was thereby In brief, the outcome for the year’s goal was achieved as one of the two not attained. As the individual perfor- follow-up of Region Stockholm’s envi- underlying targets, Systematic skills mance reviews are held in the spring in ronmental work shows that Region provision was attained. The target most operations, at the same time as Stockholm’s general climate impact con- Region Stockholm – attractive employees are added throughout the tinues to decrease. In total, there has employer was not attained since more year, it is difficult to fully attain this target. been a reduction of 48 per cent since than half of the underlying indicators To create the conditions for skills 2011. The calculation of climate impact were not fulfilled. development and clear career paths, we from energy consumption is based on a To create the conditions to achieve have developed “competence ladders”7 life cycle perspective, which also the goal of Region Stockholm being an for eleven professions so far within the includes production and distribution. attractive employer, special initiatives health and medical services. In total, 62 The energy consumption in properties have been taken to reinforce the man- per cent of the nurses, specialist nurses has been reduced by 13 per cent, which agement and leadership as well as the and midwives in clinical care have been meets the target of a ten per cent reduc- systematic work environment efforts. placed on a competence ladder. The tar- tion by 2021. The climate impact from The 2019 Budget states that the get for the indicator Implemented com- the use of anaesthetic gases has been Regional Executive Committee’s work petence ladder for nurses was for 80 per reduced by 44 per cent, which exceeds with skills provision shall be intensified cent of nurses to be placed on compe- the target of 40 per cent reduction by to ensure that the Council’s goals for tence ladders by 2019. The target was 2021. The climate impact of Region systematic skills provision are achieved. achieved by Karolinska University

7 The competence ladders are intended to develop competence and to clarify possible career paths.

Good financial management and financial standing Annual Report 2019 31 Hospital, Södersjukhuset AB och The employee survey also measured nurses or midwives, including those Danderyds Sjukhus AB. Out of the other the indicator Proportion of employees who began their studies in 2017 or 2018. competence ladders that have been responding that they have been sub- The number of positions for general completed during the year, x-ray nurses jected to violence and/or threats in their practitioners with supervision (medical and medical secretaries had come the work, where the outcome of ten per cent internship) increased from 220 to 228, furthest with 23 and 22 per cent respec- was the same as the year before. The including with private healthcare pro- tively of employees placed and catego- goal of a reduced proportion subjected viders. The target for the indicator was rised in each ladder. to threats and/or violence is therefore therefore attained. The value of several of the indicators not achieved. Educational efforts are The number of positions with super- under the overall goal of being An made, primarily within health service vision to become a specialist physician attractive employer is taken from the operations, to increase awareness and increased from 1,617 in 2018 to 1,685 in annual employee survey. The year’s knowledge, and to provide the tool for 2019 within Region Stockholm’s own employee survey had a response fre- employees to prevent and manage operations. The Council’s target value quency of 79 per cent and a total index of threats and violent situations. for the indicator was thereby attained. 75 out of 100, which can be compared to Sickness absence, measured as the Private healthcare providers were also 74 in 2018. The employee index was 77, Proportion of sick-listing in relation to commissioned to contribute to educa- which is a higher outcome than in the regular work hours, decreased from tion and the total number of specialist previous year, meaning that the target 6.2 in 2018 to 6.1 per cent in 2019. physicians amounted to 2,230. Invest- for the indicator was attained. ments were made to increase the num- The long-term effort to support and Systematic skills provision ber of positions within priority areas develop managers is an example of In order to measure whether the goal and to provide improved supervision ongoing work contributing to achieving Systematic skills provision had been and quality review of the specialist the goal of being an attractive employer. achieved, three indicators were used, all training programme. The indicator Management index (lead- of which attained their targets. Region ership index) was 78, which is the same Stockholm has offered a full salary for Important staff conditions level as in the previous year. Out of the employees during training to become To create the conditions to achieve the managers in Region Stockholm, 78 per midwives or specialist nurses within goal of Region Stockholm being an cent had a leadership index of at least prioritised specialities. During 2019, attractive and sustainable employer, 70. High leadership indices are impor- 283 nurses started full or part-time special initiatives have been taken to tant, since they indicate that the training with maintained salary. In total, reinforce the management and leader- employees perceive the leadership to 500 nurses have received a salary bene- ship as well as the systematic work envi- function well. fit during studies to become specialist ronment efforts. During the year, the

Region Stockholm shall be an attractive employer Outcome Goal Outcome Fulfilled in Goals and indicators 2019 2019 2018 2019 Region Stockholm – attractive employer Not fulfilled ● Staff turnover 12 % ≤ 10 % 13 Not fulfilled ● Proportion of the employees stating that they have had an individual performance review with their immediate superior in the last year. 81 % 100 % 81 % Not fulfilled ● Competence ladder for nurses implemented 62 % ≥ 80 % – Not fulfilled ● Employee index 77 ≥ 76 76 Fulfilled ● Manager index 78 ≥ 78 78 Fulfilled ● Proportion of employees subjected to threats and violence 10 % Reduce 10 % Not fulfilled ● Proportion of sickness absence in relation to regular working hours* 6.1 % ≤ 6.2 % 6.2 % Fulfilled ● Systematic skills provision Fulfilled ● The number of nurses who trained to be specialist nurses or midwives while maintaining their salary. 2831) ≥ 200 – Fulfilled ● The number of employed medical interns 2282) ≥ 220 220 Fulfilled ● The number of employed specialists in training 1,6853) ≥ 1,617 1,617 Fulfilled ●

1) The number refers to those starting their training during the year 2) Including private healthcare providers 3) Excluding private healthcare providers Including private healthcare providers, the number is 2,230

32 Annual Report 2019 Good financial management and financial standing number of employees increased, while ees. In some operations, it has also been but is at a lower rate than in 2017 when it the staff turnover and sickness absence necessary to give employees notice. was at 52 per cent. decreased. The employee survey, which Danderyds Sjukhus AB, Karolinska reflects the employees’ perception of University Hospital and Södersjukhuset Follow-up report on staff working environment, leadership and AB have issued notice of coming termi- and training work situation, indicated improved or nations. All changes have been made in The report “Staff and training 2019” continued good results for the three dialogue and collaboration with con- contains data and analyses within the overall indices. cerned trade unions and risk assess- area of staffing. The report accounts for The staff volume, measured in the ments relating to the work environment the number of employees within differ- number of full-time equivalents8 have been carried out by employers ent professions, along with statistics amounted to 43,644, which is 503 more together with the safety representatives and measures carried out within the full-time equivalents than in the budget. involved. During 2019, no terminations areas of management and leadership, The majority of the increase can be were carried out due to redundancy. skills provision, training, gender equal- attributed to Karolinska University The transition also relates to shifting ity and equal opportunities. The report Hospital, Stockholm County healthcare and moving resources to local health- contains a summary of the work on the area and Danderyds Sjukhus AB. The care, i.e. shifting the health service systematic work environment manage- deviation from the budgeted volumes towards a more accessible care nearer to ment within Region Stockholm, includ- have different explanations within the the patients. This transition is necessary ing summaries of the year’s employee various operations, but can primarily be in order to secure skills provision in the survey and an in-depth analysis of the explained by planned staff reductions not region for the long term. work against threats and violence, and being implemented to the desired When it comes to sickness absence, the development of sickness absences. extent. In addition, not all operational Region Stockholm has focused on reha- changes were known at the time of bilitation and early measured, for exam- budgeting. Compared to the year before, ple within management training. An Financial development the time agreed for the health service in-depth analysis of sickness absence within the health service increased by 648 full-time equivalents. was initiated during the autumn and The outcome for the overall health ser- The number primarily increased for the will be completed in the spring 2020. vice, excluding items affecting compa- Stockholm County’s healthcare area, The result will be the basis of work with rability relating to increased pension Danderyds Sjukhus AB och Söder­ early measures to prevent ill-health and expenses as a result of a changed dis- sjukhuset AB, which to a great extent is to reduce sickness absence. Sickness count interest, was SEK -1,628 million, due to increased activity and altered absence went down from 6.2 per cent in deviating negatively from the budgeted healthcare commissions. 2018 to 6.1 per cent for all age groups. profit requirement by SEK 1,729 million. Due to the financial situation, several Women’s sickness absence remained The deviation from the budgeted measures have been taken in regard to higher, at 6.8 per cent, compared to that outcome is primarily explained by staffing, including special assessment of of men, which was 3.7 per cent. Sickness increased staff expenditure, higher costs new employments, reduction of hired absence for 60 days or longer increased of purchased health and medical care as staff, changed scheduling, and a somewhat in relation to total sickness well as higher general expenditure. reduced number of fixed-term employ- absence, from 49 per cent to 50 per cent,

Sickness absence report Outcome Outcome Percentage 2019 2018 Proportion of sickness absence in relation to regular working hours* Proportion of sickness absence for women 6.8 6.9 Proportion of sickness absence for men 3.7 3.8 Total proportion of sickness absence 6.1 6.2 29 years or younger 6.0 6.1 30–49 years 5.6 5.7 50 years or older 6.8 6.9 Sickness absence for 60 days or longer in relation to total 50 49 sickness absence

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

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

Good financial management and financial standing Annual Report 2019 33 The operating income of the health the operation’s total staff expenditure. health service amounted to SEK 1,059 service amounted to SEK 74,391 million, Tiohundra AB had SEK 25 million in million and was SEK 243 million or 18.7 which is SEK 300 million or 0.4 per cent costs for hired staff, which was 3.5 per per cent under budget. The deviation over budget. It was primarily the item cent of the operation’s total staff was the result of delayed new building Other contributions that showed a sur- expenditure. S:t Eriks Ögonsjukhus AB and reconstruction, as well as installa- plus compared to budget. The surplus is had SEK five million in costs for hired tions of medical equipment. mainly due to reassessment and repay- staff, which was 1.3 per cent of the oper- Financial revenue and expenditure ment of six per cent VAT compensation ation’s total staff expenditure. were more or less according to budget. and increased government subsidies. The year’s expenditure on purchased Staff expenditure, including hired health and medical care and dental care Risks and opportunities for the staff, deviated negatively by SEK 1,379 ­ from external providers was health service million, 4.7 per cent, compared to the SEK 329 million, 1.5 per cent, over The majority of the committees and budget for the year, of which SEK 653 budget, which is due to the increased companies that had a deviating result million referred to expenditure on hired expenditure on geriatric and somatic compared to budget have had excessive staff. The expense for hired staff com- specialist care, patient choice and pur- staff expenditure. The Regional prised 2.7 per cent of the total staff chased out-of-county and foreign health Management makes the assessment expenditure. Karolinska University care. The majority of the increased that there is a risk of the health service Hospital had SEK 300 million in costs expenditure is due to higher healthcare encountering issues attaining the budg- for hired staff, which was 2.7 per cent of consumption and thereby increased eted profit in 2020 as well. To achieve the operation’s total staff expenditure. healthcare production. Karolinska balanced finances, the major hospitals The Stockholm County’s healthcare University Hospital incurred higher are required to implement produced area had SEK 276 million in costs for costs of purchased medical care from measure programmes, such as hired staff, which was 3.4 per cent of the external healthcare providers linked to increased income in relation to care operation’s total staff expenditure. measures to maintain availability. of out-of-county patients and cost- Danderyds Sjukhus AB had SEK 78 mil- Other expenditure was SEK 565 mil- reducing measures such as lower costs lion in costs for hired staff, which was lion, 2.8 per cent, over budget, which is of materials and testing. The depend- 2.7 per cent of the operation’s total staff due to increased material costs, costs of ence on hired staff must also decrease expenditure. Södersjukhuset AB had premises, repairs and maintenance, and issued notices of termination must SEK 69 million in costs for hired staff, customer losses and IT-related be effectuated. The health service must which was 1.8 per cent of the operation’s expenses. Customer losses represented slow the rate of increasing costs for total staff expenditure. Södertälje SEK 176 millions, 31 per cent, of the purchased external healthcare to attain Sjukhus AB had SEK 42 million in costs deviation for other expenditure. the established profit requirements. for hired staff, which was 4.7 per cent of The depreciation costs within the

Outcome health and medical care* Deviation Outcome Budget compared Deviation Outcome SEK millions 2019 2019 to budget percentage 2018 Patient fees 1,386 1,364 23 1.7 % 1,375 Appropriations 63,261 63,276 –14 0.0 % 61,200 Other revenue 9,743 9,452 291 3.1 % 9,625 Total operating revenue 74,391 74,091 300 0.4 % 72,200 Staff expenditure and hired staff –31,006 –29,626 –1,379 4.7 % –29,319 Purchased health and medical care, dental care –23,000 –22,671 –329 1.5 % –21,814 Other expenditure –20,737 –20,172 –565 2.8 % –20,120 Total operating expenditure –74,742 –72,469 –2,273 3.1 % –71,253 Depreciation –1,059 –1,301 243 –18.7 % –834 Operating profit/loss –1,410 321 –1,731 113 Financial revenues 7 4 2 46.9 % 6 Financial expenses –225 –225 0 0.1 % –263 Results –1,628 101 –1,729 –144

*The health service includes the Healthcare Committee, the Health Service Steering Committee, Patient Advisory Committee, the local federation Sjukvård och omsorg i Norrtälje, Stockholm County Healthcare area, Karolinska University Hospital,Södersjukhuset AB, Danderyds Sjukhus AB, Södertälje Sjukhus AB, Tiohundra AB, S:t Eriks Ögonsjukhus AB, Folktandvården Stockholms län AB, Ambulanssjukvården i Storstockholm AB, Stockholm Care AB and MediCarrier AB.

34 Annual Report 2019 Good financial management and financial standing Profit/loss for committees and companies

Profit/ Adjustment Profit/loss Deviation Deviation loss* for interest incl. Budget from percentage Profit/loss SEK millions 2019 effect** adjustment 2019 budget of turnover 2018 Health and medical care Healthcare Committee 57.2 57.2 0.0 57.2 0.1 % 585.3 Health Service Steering Committee 43.5 43.5 0.0 43.5 10.2 % 0.0 Patient Advisory Committee 0.4 0.4 0.0 0.4 1.2 % 1.0 The local federation Sjukvård och omsorg –44.8 –44.8 0.0 –44.8 –6.4 % 7.2 of which refers to Tiohundra AB –29.5 –29.5 0.0 –29.5 –3.6 % –3.7 Stockholm County’s Healthcare Area 228.6 228.6 199.0 29.6 0.2 % 52.4 Karolinska University Hospital –1,866.6 –1,866.6 –280.0 –1,586.6 –8.4 % –822.4 Södersjukhuset AB –360.6 249.0 –111.6 9.4 –121.0 –2.2 % –51.6 Danderyds Sjukhus AB –352.9 194.5 –158.4 6.5 –164.9 –3.6 % –84.1 Södertälje Sjukhus AB –29.5 52.3 22.8 3.3 19.5 1.3 % 11.0 S:t Eriks Ögonsjukhus AB 22.7 33.0 55.7 33.0 22.7 3.4 % 48.4 Folktandvården Stockholms län AB 52.5 60.0 112.5 112.5 0.0 0.0 % 112.3 Ambulanssjukvården i Storstockholm AB 21.3 4.9 26.2 12.0 14.2 3.7 % –8.2 Stockholm Care AB 0.3 1.4 1.7 0.7 1.0 1.0 % 0.1 MediCarrier AB 3.6 1.5 5.1 5.0 0.1 0.0 % 4.9 Health service, total –2,224.4 596.6 –1,627.8 101.4 –1,729.2 –2.3 % –143.8

Public transport The Transport Committee 569.6 42.0 611.4 400.0 211.4 2.1 % 513.6 of which refers to the Public Transport 6.3 6.3 0.0 6.3 0.1 % 43.1 Administration of which refers to the Extended Metro 0.5 0.5 0.0 0.5 0.4 % 2.0 Administration of which refers to AB Storstockholms 579.3 41.2 620.3 400.0 220.3 1.0 % 479.0 Lokaltrafik of which refers to Waxholms Ångfartygs AB –16.6 0.8 –15.8 0.0 –15.8 –2.8 % –10.5 The Mobility Service Committee 107.7 107.7 0.0 107.7 6.2 % 67.5 Public transport, total 677.3 42.0 719.1 400.0 319.1 0.9 % 581.1

The Culture Committee 2.1 2.1 0.0 2.1 0.4 % 2.6 The Growth and Regional Planning 1.0 1.0 0.0 1.0 0.5 % 0.6 Committee The Regional Executive Committee 286.8 286.8 0.0 286.8 10.2 % –125.6

Properties and Service The Property and Service Committee 485.0 485.0 359.9 125.1 2.0 % 910.7 of which refers to the Service Department –0.2 –0.2 0.0 –0.2 0.0 % 32.5 of which refers to the Property Department 485.2 485.2 359.9 125.3 2.4 % 878.2 Locum AB –14.7 28.3 13.6 7.0 6.6 1.7 % 22.4 Properties and Service, total 470.3 28.3 498.6 366.9 131.7 2.0 % 933.1

Other The Audit Board 0.0 0.0 0.0 0.0 0.0 % 0.1 Landstingshuset i Stockholm AB –16.7 –16.7 –31.3 14.6 133.1 AB SLL Internfinans 3.2 0.4 3.6 3.0 0.6 3.3 % 4.1 Group-wide functions Damage account 3.5 3.5 0.0 3.5 21.0 % 7.7 Group funding 1,663.5 1,663.5 –1,058.4 2,721.9 3.0 % 2.6 Group adjustments and interest effect from 630.1 –667.3 –37.1 0.0 –37.1 –12.8 pensions Total profit/loss for all profit centres 1,496.6 0.0 1,496.6 –218.4 1,714.9 0.8 % 1,382.9 of which comprise transition expenditure –226.5 –226.5 –358.0 131.5 –787.9 Profit/loss excluding transition expenditure 1,723.0 1,723.0 139.6 1,583.4 0.8 % 2,170.8

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

Good financial management and financial standing Annual Report 2019 35 Investments made within the public transport ser- per cent of the budgeted annual volume The Stockholm region is growing, which vice. The metro and the light rail lines of SEK 15,726 million. The expenditure sets high requirements for good availa- are extended while Roslagsbanan and for the year was SEK 3,803 million bility and quality in health and medical the Red Line are being renovated. under budget, of which SEK 1,877 mil- care along with a well-functioning pub- Region Stockholm’s investment lion, primarily referring to property and lic transport system for both existing activities are extensive and complex, equipment investments in the health and new residents. Region Stockholm is with dependence on several processes service, and SEK 1,926 million referred conducting one of the greatest ever outside the region’s control. For several to public transport. Measures that are investments in health and medical care. of major transport investments, current planned but which were not imple- The plan for the future regarding health forecasts indicate changes in both costs mented in 2019 will be deferred to next and medical care means that the region and schedules. year. More detailed information on is building new, renovating and develop- investments is found in chapters 9 ing working methods to reinforce the and 10. health service to provide a more accessi- Investments in committees ble and effective health and medical and companies care, where more patients receive the The investment expenditure for 2019 right care, at the right time, at the right amounted to SEK 11,923 million, which cost. Major investments have also been corresponds to a conversion rate of 76

36 Annual Report 2019 Good financial management and financial standing Investments in committees and companies

Deviation Profit/loss Budget compared Profit/loss SEK millions 2019 2019 to budget 2018 Health and medical care Healthcare Committee 10.3 7.0 –3.3 4.4 Health 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 242.5 238.6 –3.9 108.0 Karolinska University Hospital 549.3 351.0 –198.3 346.5 Södersjukhuset AB 413.0 192.3 –220.7 349.4 Danderyds Sjukhus AB 612.2 70.0 –542.2 127.5 Södertälje Sjukhus AB 69.8 22.1 –47.7 66.2 S:t Eriks Ögonsjukhus AB 33.3 30.0 –3.3 18.8 Folktandvården Stockholms län AB 47.8 100.0 52.2 56.0 Ambulanssjukvården i Storstockholm AB 22.9 28.0 5.1 9.0 Stockholm Care AB 3.2 0.0 –3.2 1.7 MediCarrier AB 2.9 5.0 2.1 1.4 Health service, total 2,007.2 1,044.0 –963.2 1,088.8

Public transport The Transport Committee 6,190.5 8,087.8 1,897.3 5,554.0 of which refers to the Public Transport 613.0 346.9 –266.1 284.7 Administration of which refers to the Extended Metro 1,160.3 1,996.5 836.2 1,137.4 Administration of which refers to AB Storstockholms 4,338.4 5,696.4 1,357.9 4,078.9 Lokaltrafik of which refers to Waxholms Ångfartygs AB 78.8 48.1 –30.7 53.0 The Mobility Service Committee 30.2 58.6 28.4 22.2 Public transport, total 6,220.8 8,146.4 1,925.6 5,576.2

The Culture Committee 0.8 7.9 7.1 0.6 The Regional Executive Committee 6.1 721.8 715.7 109.0

Properties and Service The Property and Service Committee 3,685.9 5,800.9 2,115.0 5,434.1 of which refers to the Service Department 227.4 379.8 152.4 144.7 of which refers to the Property Department 3,458.6 5,421.1 1,962.5 5,289.5 Locum AB 2.1 4.5 2.4 2.1 Properties and Service, total 3,688.1 5,805.4 2,117.3 5,436.3

Other The Audit Board 0.0 0.2 0.2 0.1 AB SLL Internfinans 0.0 0.0 0.0 0.0 Total investments 11,922.9 15,725.7 3,802.8 12,210.9

Good financial management and financial standing Annual Report 2019 37 Expected development

In order for Region Stockholm to be able to conduct an operation of continued high quality, a sound economic plan for balanced finances is necessary. Robust finances are also required to manage the region’s financial commit- ments in the form of non-current liabilities and provisions 8 for pensions. Region Stockholm’s planning needs to ensure that risks and uncertainties in the world and within operations are identified and managed.

38 Annual Report 2019 Development over the to keep the region’s finances in balance. Changes in the municipal coming year To make this happen, each committee equalisation system The ongoing covid-19 pandemic entails and company must attain the profit The system for economic equalisation major consequences for the operation in requirements established by the between municipalities allocates funds coming years. The development during Regional Council, while they must also to local authorities to allow them to the spring 2020 has changed very rap- operate and develop activities in accord- maintain equal service, independent of idly, which has a major impact on both ance with the Council’s goals and com- conditions that are considered difficult Region Stockholm’s future revenue and mission. The development of the operat- to affect. The system includes expendi- expenditure. The Regional Management ing costs is budgeted to an average of 2.7 ture equalisation, income equalisation, believes it is too early to assess to what per cent per year, while the population is adjustment charges and, during 2020– extent the budget 2020 which plans for estimated to increase on average 1.4 per 2022, introduction benefits. the period 2021–2023 will be affected. cent annually. The profit for 2020 is In November 2019, the Riksdag Region Stockholm’s tax revenue, budgeted to SEK 311 million, which cor- decided to make changes in in the sub- general government subsidies and responds to 0.4 per cent taxes and system for expenditure equalisation as equalisation in the tax base are a result equalisation. A higher budgeted profit of 1 January 2020. A special introduc- of the economic development in terms of for the group is not deemed to be possi- tion benefit of SEK 250 per resident and GDP growth, employment and salary ble given the economic conditions. Over year is proposed in order to limit the increases. The general economic condi- the years planned, the profit is budgeted negative effects for individual munici- tions for Region Stockholm are based on to increase gradually in order to reach palities and regions. Sweden, and thus the county, entering a SEK 468 million by 2023. The proposal entails changed eco- downward trend. The growth of the tax The investments within the region nomic conditions for Region Stockholm. base from 2020 and in the years ahead, will remain at a high level during the During 2019, Region Stockholm is expected to be lower than in the years budget and planning period 2020– received expenditure equalisation con- 2018–2019. In addition to the economic 2023, amounting to a total SEK 64 bil- tributions of a total SEK 599 million situation, there are a number of risks at lion. A significant share of these invest- (SEK 256 per resident). The changes in the global level, including the effects of ments are made due to the expansion the system mean that in 2020, Region Brexit, which can further dampen eco- and renovation of public transport, but Stockholm will instead pay an expendi- nomic growth. several investments are also terminated ture equalisation charge of Within public transport, revenues during 2020 in order to support the SEK 1,448 million (SEK 610 per resi- are reinforced through an increase of implementation of future health and dent), which entails a deterioration of ticket prices from 3 January 2020, medical care. Among other things, a SEK 2,047 million compared to 2019. which is a prerequisite for the expansion new treatment building is opened at The negative effects are mitigated in of the public transport service. However, Södersjukhuset AB and a new building 2020 by an introduction benefit of the more difficult economic conditions for surgery, intervention, x-ray and SEK 1,885 million; however, this benefit mean that all of the region’s operations sterilisation at Karolinska University is then gradually phased out and ends must prioritise and rationalise in order Hospital in Huddinge. completely in 2023. According to

Results Profit/loss Budget Plan Plan Plan SEK millions 2019 2020 2021 2022 2023 Operating revenue 25,036 25,644 26,641 27,195 27,654 Operating expenditure –96,220 –99,023 –101,685 –104,266 –107,240 Depreciation –6,201 –6,968 –7,363 –7,593 –7,758 Operation’s net expenditure –77,387 –80,348 –82,407 –84,664 –87,343 Tax revenue, general government subsidies and equalisation 81,418 83,391 85,863 88,252 91,120 Net financial income/expense –2,536 –2,732 –3,040 –3,164 –3,309 Profit/loss for the year 1,497 311 416 424 468 Profit/loss for the year in relation to taxes and equalisation 1.8 % 0.4 % 0.5 % 0.5% 0.5 % Investments 11,923 14,934 15,394 17,302 16,686 Interest-bearing non-current liabilities 51,838 61,906 62,561 65,424 68,969 Solidity incl. total pension undertakings –7.1 % –7.4 % –6.4 % –5.4 % –4.5 % Self-financing ratio for investments (excl. co-financing) 100 % 91 % 94 % 79 % 73 %

Expected development Annual Report 2019 39 SALAR’s latest forecast for 2023, negotiations between the central reduced in scope. In November 2019, Region Stockholm will then be paying government and SALAR, and there is the information was that 250 physi- an expenditure equalisation charge some uncertainty regarding the extent cians and 350 assistant nurses were of SEK 1,902 million (SEK 767 per to which Region Stockholm will benefit covered by the notice of termination. In resident). from these funds in 2020, since the February 2020, Karolinska University All in all, the changes in the munici- terms reward shorter waiting times Hospital announced that a review had pal equalisation system, i.e. the regardless of the starting point in terms been carried out of the operation, along expenditure equalisation, income of availability. Region Stockholm with its needs and its commission, equalisation and adjustment charge, already has higher figures than other which entailed a reduction of the are estimated to entail an increase in regions in regard to many of the meas- notices to include 109 physicians and Region Stockholm’s fee from approxi- urable parameters and it is thus more 157 assistant nurses. mately SEK one billion in 2019 to challenging to improve the values fur- Södersjukhuset AB issued notice of approximately SEK four billion in 2023. ther compared to other regions. Fur- termination in November 2019 relating thermore, the Government proposed to 50 assistant nurses, 25 physicians The Government’s Budget Bill in its budget bill that the government and 25 administrative positions. In The Government’s budget bill for 2020 subsidy for the development of primary February 2020, the notice of termina- did not contain any new general care should be increased and that a tion was changed to no longer include resource injections for local authorities temporary government subsidy is intro- any terminations of health service staff. in addition to those previously duced for VAT expenditure relating to Within the category of administrative announced by the Government. In the hired staff within the health service. A services, the process is still ongoing, bill, the Government proposed a num- number of the other targeted subsides but it appears likely that fewer positions ber of new undertakings for Sweden’s are proposed to be reduced. will be included than the initial assess- regions. Among other things, an ment of 25 positions. obligation has been entered into law of Reduced number of notices issued The notice of termination issued by offering coordination measures for to terminate employees within the Danderyds Sjukhus AB in November sick-listed patients. The Government health service 2019 has changed from 100 to 20 posi- compensates the regions for these new In February 2020, Karolinska Univer- tions. Physicians, nurses and assistant undertakings in accordance with the sity Hospital, Södersjukhuset AB, and nurses will not be terminated, but municipal financing principle. Danderyds Sjukhus AB decided to assistant nurses may come to be offered In addition, the Government pro- reduce the scope of previously issued relocations within the hospital. Profes- posed a number of targeted initiatives. notices for termination of health ser- sional categories, primarily within The subsidy to reduce queues in the vice staff. administration, will be affected by health service was increased from Karolinska University Hospital’s notices of termination. SEK 1.6 billion in 2019 to SEK 2.9 bil- notice of termination, which was issued lion in 2020. The terms are settled in in November 2019, will be significantly

40 Annual Report 2019 Expected development Expected development Annual Report 2019 41 9 Committees

42 Annual Report 2019 The Regional Executive • Increased appropriation to the easy to communicate with the health Committee Regional Executive Committee’s service and patients shall have the pos- The Regional Executive Committee funding for unforeseen expenditure, sibility to participate in their own care manages, leads, coordinates, monitors SEK 130 million. and have increased access to informa- and analyses the management of Region • Increased charge to the Swedish tion and communication regarding their Stockholm’s business, has a supervisory Association of Local Authorities and own health and treatment. responsibility and shall ensure that Regions of SEK 1.8 million. Two pilot projects have been carried committees and companies enforce the out with the aim of providing a basis for decisions of the Regional Council. The The agreement regarding government an efficient process and experience on Regional Executive Committee shall funds “An investment for developing the how to collaborate with patient organi- also ensure that any impact on the group conditions of healthcare workers” was sations and industry. The projects have is considered when making decisions, only concluded in June 2019, which resulted in a solid foundation for the and that established goals and assign- entailed some difficulties in planning continued work. Furthermore, a work- ments are fulfilled within the adopted for an effective and long-term use of ing group for research and development budget. funding. The positive outcome is also has been created, and work is underway due to a lower level of funds granted for on automated transfer of information to Financial outcome the Regional Executive Committee’s the quality registers, so that health The Regional Executive Committee’s unforeseen expenditure at SEK 115 information can be made available. profit was SEK 287 million, which is million. During the year, a procurement of SEK 287 million over budget, which an IT platform has been carried out. corresponds to 10.2 per cent of turnover. Investments Following review of received tenders for This outcome is primarily explained by The investment expenditure for the year FVM, the Regional Executive Commit- lower costs of subsidies granted in the was SEK 716 million below budget. tee decided in December 2019 to abort area of education. The deviation is due to the programme the ongoing procurement due to insuffi- In the 2019 Budget, the Regional “Future healthcare information envi- cient competition. Executive Committee received ronment” still being in the procurement increased appropriations for the follow- phase and the budgeted expenditure has Knowledge creation ing special initiatives: been postponed until 2020. The The Regional Executive Committee has • Skills provision, primarily within the expenditure for the year of SEK 6 mil- established the Centre for Health Data health service, SEK 200 million. lion refers primarily to the Regional (CHD), which is intended to be the • Project funding for the commission to Executive Committee’s replacement region’s coordinating function for place central administrations within investments in IT. knowledge creation within the health the region in one location. service. The centre provides a commu- • Employee security training, primarily Future healthcare information nication channel for researchers want- for health service staff, SEK 5 million. systems ing to apply for disclosure of health data • Increased security initiatives, includ- During 2019, the Regional Executive from the regional health databases. ing non-toxic environments, Committee has had several assignments SEK 2 million. related to the extensive investments into Digitalisation • Reinforced measures within crisis, digital healthcare information, which The new IT and digitalisation strategy safety and vulnerability measures in has been given the name “Future that was decided along with the 2020 record to a new security situation and healthcare information environment” budget shall contribute to the benefits of climate impact, SEK 4 million. (FVM). The level of ambition is high, digitalisation being realised to the high- • Establishment of a function to pro- with the aim of ensuring that healthcare est degree and lowest cost possible. vide health data and facilitate the information in the future follows the The Regional Management initiated work with clinical testing, patient through the health service, an effort in 2019 to develop the group’s SEK 3.5 million. between different principals, healthcare management of digitalisation and IT providers and IT systems. It must be within Region Stockholm. As a first

Financial outcome Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 The Regional Executive Committee 286.8 0.0 286.8 10.2 % –125.6

Committees Annual Report 2019 43 step, a governance and preparation Sjukhus AB was allocated SEK 35 mil- Region Stockholm runs the Innova- structure for the regional IT infrastruc- lion, five per cent, and S:t Eriks Ögons- tion Fund, whose SEK 15 million per ture has been established. jukhus AB was allocated SEK 6 million, year is used to finance innovation pro- A review of the group’s IT infrastruc- or one per cent. In addition, Capio jects. During 2019, 163 applications ture has been carried out. The review S:t Görans Sjukhus AB was allocated were received by the fund, of which 56 indicates quality challenges and needs SEK 3 million, Södertälje Sjukhus AB projects were granted funding. The for both modernisation of the infra- SEK 3 million and Norrtälje sjukhus support offered to employees in the structure and developed working meth- Tiohundra AB SEK 1.5 million separately. application procedure has led to a ods. Work is underway to solidify the The number of study weeks has higher quality of applications, and measures proposed by the enquiry and increased continuously over the last few thereby to better conditions for success- to assess the costs and profitability of years, but remains roughly at the same ful projects. On the Innovation Fund these measures. level in 2019 as in 2018. During the year, Day in April 2019, a large number of A group-wide system support for the operations within the region have innovations were celebrated. A treat- governance, operational planning and managed, despite reconstruction and ment within cognitive behavioural ther- follow-up, “Stödet” (the Support), was transfer of care, to fulfil their educational apy using Virtual Reality was named the developed and gradually introduced in assignment by introducing new educa- innovation of the year, and an applica- 2018 and 2019. The follow-up of goals is tional models and investments in super- tion for life-saving via text messages. now coordinated and uniform, which visor competence. Continued work is streamlines the governance of Region needed to improve learning environments Stockholm. Ahead of 2020, the system and involve more private healthcare The Healthcare Committee solution has also been adapted to inte- providers in the educational assignment. The health service in Region Stockholm grated management and control, which shall be safe, accessible and of a high has been decided by the council. Annual Accounts for Innovation quality, and it shall be characterised by Pilot testing with an administrative Systematic and persistent innovation freedom of choice. The right care shall robot has been carried out to streamline work is essential to ensure that the be given at the right time and at the right the operation and raise the quality of development of Region Stockholm’s institution. Patients shall have a great invoice management. The efforts have operations to achieve the region’s goals. deal of freedom to choose their own care been successful and two pilots have The efforts adhere to established meth- according to need. A health-promoting been launched. ods of innovation in large organisations, and illness-preventing approach shall for example by identifying obstacles and characterise the medical service. The Annual Accounts for Region using the opportunities offered by digi- health service in Region Stockholm is Stockholm’s total resources for talisation and research. conducted within somatic, geriatric, research, development and training An increasing number of committees primary, psychiatric and dental care. Region Stockholm’s commitment to and companies have appointed an inno- The Healthcare Committee manages clinical medical research and develop- vation manager. Training of innovation the health service operation in Region ment (R&D) is intended to create the managers and ambassadors takes place Stockholm in accordance with the conditions for the region’s residents to within the platform called Innovations- Health and Medical Services Act. The have access to a constantly improving platsen at Karolinska University Hospital. Committee is responsible for providing health service. Clinical research is con- Follow-up for 2019 of the council’s indi- a health service that corresponds to the duced, primarily in close collaboration cator Committees/companies have needs of the growing population. The with Karolinska Institutet, but also in introduced methods and tools to work Committee shall maintain a holistic and collaboration with other systematically with innovation in their systematic perspective, in order to and higher education institutions, such own operations shows that 15 out of 21 ensure that the health service is man- as the Royal Institute of Technology and committees and companies have intro- aged, coordinated and developed so that . The operation is duced such methods and tools, while the limited resources are adapted to the financed through special funding allo- the rest report that they have partially population’s needs for strategic and cated by the central government, known done so. long-term development of the health as ALF funding, and the funding invested The promotion of innovation is service and so that the region’s overall into research by Region Stockholm. carried out within health service opera- goals for the health service are achieved. During 2019, Karolinska University tions where innovation units are used to Hospital was allocated SEK 518 million, support employee ideas, lead innovation Plan for the Future regarding Health which corresponds to 77 per cent of projects, train and coordinate with and Medical Care research funding intended for clinical external actors such as incubators, The long-term policy for the health ser- medical research. The Stockholm foundations and universities. During vice is the Plan for the Future regarding County’s healthcare area was allocated 2019, collaboration was developed with Health and Medical Care, also referred to SEK 73 million, eleven per cent. Söder­ the Patient Advisory Committee for as the Plan for the Future, LS 1104–0574, sjukhuset AB was allocated SEK 42 Patient-Initiated Innovation and with LS 1109–1229, LS 1304–0527 and million, six per cent, and Danderyds KI Innovations AB. LS 1409–1068. The Healthcare

44 Annual Report 2019 Committees Committee makes the assessment that choice and quality in the health service through six underlying targets. The the work to develop its operation in and its associated targets. The Health- overall goal was achieved during 2019, accordance with the strategic direction care Committee has the role of client, as two thirds of the underlying targets set out in the Plan for the Future has and shall use contracts with healthcare were attained. been well integrated in the regular man- providers to ensure that the citizens’ agement and with the other changes needs for health and medical care can Healthcare in the right place made to the healthcare system. The be fulfilled. The work to achieve the The indicators used to steer towards the healthcare structure is undergoing overall goal was conducted in 2019 goal of “Healthcare in the right place” change, the commission of the emer- through collaboration with both has been focused on care being provided gency hospitals is being refined and the regional and privately owned healthcare in the right health service institution. new structure for emergency treatment producers. The goal was achieved in 2019. The goal has been established. The overall goal of The health service has been monitored through the follow- shall be characterised by short queues, ing indicators: Goal high availability, good quality and the • The proportion of specialist appoint- The Healthcare Committee is responsi- residents’ possibility to choose their ments outside of the emergency hos- ble for the overall goal of Availability, own care provider has been measured pitals increased marginally compared

The health service in Stockholm shall be characterised by short queues, high vailability, good quality and opportunities for residents to choose their own care.

Profit/loss Goal Profit/loss Fulfilled in Overall goals, targets and indicators 2019 2019 2018 2019

Healthcare in the right place Fulfilled ● Proportion of visits to specialists outside of the emergency hospital 54.4 % ≥ 57 % 49.0 % Not fulfilled ● Proportion of visits to local emergency clinics out of the total number of visits to local emergency clinics and the emergency hospitals’ emergency wards 49.4 % ≥ 45 % 48.6 % Fulfilled ●

Healthcare at the right time Not fulfilled ● Proportion of patients who have spent no more than four hours in the emergency ward 48.0 % ≥ 78 % – Not fulfilled ● Proportion of patients who received an appointment with a family doctor within three days1) 90.0 % ≥ 90 %1) – Fulfilled ● Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 70.0 % ≥ 73 % 73.3 % Not fulfilled ● Proportion of patients who received an appointment with a family doctor within three days1) 85.0 % ≥ 90 % 84.7 % Not fulfilled ●

Safe healthcare Fulfilled ● Prevalence of healthcare-associated infections 7.3 % ≤ 8.2 % 7.1 % Fulfilled ● Readmittance to in-patient care within seven days for patients (80+)2) 7.9 % ≤ 7.5 % – Not fulfilled ● Antibiotic prescriptions (number of collected antibiotic prescriptions per 1,000 residents) 295 ≥ 314 320 Fulfilled ●

Effective healthcare Fulfilled ● Number of cases closed in 1177 Vårdguiden’s e-services per 1,000 residents and month 35.4 ≥ 29 – Fulfilled ● Number of days that patients who have completed medical treatment remain in hospital 3.9 ≥ 3 – Not fulfilled ●

Good public health Fulfilled ● Proportion of family doctor’s clinics conducting active disease prevention 79.8 % ≥ 75 % 74.8 % Fulfilled ● Proportion of 19-year-olds with caries-free surfaces 71.3 % ≥ 71 % 70.8 % Fulfilled ●

High level of trust in the health service Not fulfilled ● Proportion of the population with a high level of trust in the health service 61 % ≥ 65.0 % 57 % Not fulfilled ● Proportion who would recommend their family doctor’s clinic to other people 79 % ≥ 82 % 76 % Not fulfilled ●

1) The Regional Council has established the indicator “Proportion of patients who receive primary care within three days”. Until this indicator has been developed, the “Proportion of patients who receive an appointment with a family doctor within three days” is measured. The target value has been adopted by the Healthcare Committee but not by the Regional Council. 2) The proportion of patients older than 80 years old, who have been discharged during the year and then readmitted within seven days, excluding admissions and referrals to psychiatric in-patient care.

Committees Annual Report 2019 45 to the previous year, to 54.4 per cent, cent, and is thereby on level with the within the healthcare guarantee. The which is lower than the target value of target. As of January 2019, the health- proportion of patients who received 57 per cent. During 2020, a new local care guarantee in primary care was an appointment for treatment within emergency clinic will be opened by changed. The new healthcare guaran- 90 days, in care outside the emer- Hötorget in central Stockholm, which tee sets the limit of three days, as gency hospitals, amounted to 87 per is planned to be operational in Febru- compared to the previous five, and cent, which was one percentage point ary. The reference support imple- includes medical examination by all more than in 2018. Special difficulties mented in 2018 was continuously categories of healthcare staff. Within in fulfilling the healthcare guarantee developed and training measures are the region, the family doctor’s clinics were found in urology and hospital offered to healthcare staff. Both of are still subject to the new primary cardiac care. these measures are deemed to facili- care guarantee. During 2019, only tate a better outcome in 2020. examination by doctors were fol- Safe healthcare • The proportion of visits to local lowed-up, but more professional cate- The Goal of “Safe healthcare” was emergency clinics out of the total gories will gradually be included in achieved in 2019. number of visits to local emergency the follow-up, and the indicator will The goal has been monitored through clinics and emergency wards at be adjusted accordingly. the following indicators: emergency hospitals increased com- • The proportion of patients who • The prevalence of health care- pared to the outcome in 2018 to 49.4 receive a first appointment with a associated infections has been largely per cent, which is higher than the tar- specialist within 30 days amounted unchanged, 7.3 per cent, compared to get of 45 per cent. Visits to hospital to 70 per cent which is lower than in the outcome in the previous year, 7.1 emergency wards decreased by six per the previous year. The outcome did per cent, and lower than the target of cent compared to the previous year, not reach the target of 73 per cent. The 8.2 per cent. In order to prevent while visits to the local emergency outcome was better for the hospitals, healthcare-associated infections clinics increased. where 80 per cent received an (HAIs), Region Stockholm’s action appointment with a specialist within programme in this area was updated. Healthcare at the right time 30 days compared to 78 per cent in The programme is a supportive The indicators used to steer towards the 2018. Outside of the hospitals, the knowledge basis for all healthcare goal of “Healthcare at the right time” outcome was lower, as 68 per cent was providers and a policy document for has been focused on short waiting times attained in 2019, compared to 71 per follow-up of measures within eight for the health service. The goal not was cent in 2018. The availability has been priority areas. Monitoring of HAIs achieved in 2019. more strained within certain spe- will take place using Infektionsverk- The goal is monitored through the cialties, primarily neurology, allergies tyget, a national IT platform which following indicators: and hand surgery. In order to ensure gives the possibility to follow-up on • The proportion of patients who spend the availability of specialists in the healthcare-associated infections and no more than four hours in the emer- future, efforts have been initiated to use of antibiotics. gency ward was 48 per cent and thus increase the number of positions in • Readmittance to in-patient care lower than the target of 78 per cent. specialist training programmes. within seven days for patients (80+). The pressure on the emergency wards • Proportion of patients who receive a The readmittance frequency was 7.9 did decrease compared to the previ- treatment appointment within 90 per cent, which does not meet the tar- ous year, since more patients were days amounted to 85 per cent, which get of 7.5 per cent. Several measures received by the local emergency clin- was the same level as the previous have been taken, including intensified ics. However, these patients were year, but under the target of 90 per efforts to implement working pro- comparatively less severely ill, which cent. The hospitals generally have cesses that emphasise planning for increased the proportion of more good availability, with the exception release and more focus on collabora- severely ill patients in the emergency of certain healthcare areas, where tion for actors from the health service wards. A larger proportion of more Karolinska University Hospital is the and the municipal social care. A dia- severely ill patients, such as elderly only provider. An improvement of the logue meeting has been held with with multiple illnesses, means that waiting time situation has been made healthcare providers during the more of them need to be admitted for at Karolinska University Hospital in autumn 2019. Focus has been on the further examination. This, combined the later part of 2019. During 2019, key role of family doctors’ clinics in with the current shortage of hospital the average fulfilment of the health- collaboration, and their planning beds, has been an important cause for care guarantee at emergency hospi- responsibility in relation to individu- the failure to improve hospitalisation tals was 84 per cent, which was at the als. A new regional agreement has times, despite the reduced patient same level as in 2018. In January been produced which comes into pressure. 2019, penalty fines were reintroduced effect on 1 January 2020. Information • The proportion of patients who for the emergency hospitals for material, method support and training receive care form a family doctor patients who have not received a clinic has been developed for the county’s within three days amounted to 90 per appointment, treatment or measure healthcare providers and published in

46 Annual Report 2019 Committees Vårdgivarguiden. A coordinated indi- care is responsible for planning when Healthcare Committee will also offer vidual plan is to be offered individual coordinated measures are required. support for healthcare providers. patients when they receive measures Information and support is available • The proportion stating that they from two principals, i.e. the region in Vårdgivarguiden for the regional would recommend their family doc- and the municipality. Continuous healthcare providers. tor’s clinic to others amounted to 79 analysis of statistics regarding such per cent, which was an improvement plans and patients ready for release Good public health of three percentage points compared has been carried out monthly. The goal of Good public health was to the previous year, but lower than • The prescription of antibiotics, which achieved in 2019. The goal has been the target of 82 per cent. The Health- has been monitored through the indi- monitored through the following two care Committee will continue to carry cator Number of collected antibiotics indicators: out patient surveys to monitor the prescriptions per 1,000 residents • The proportion of family doctor’s development of the indicator. The and year amounted to 295, which was clinics that conduct active illness pre- Healthcare Committee will also an improvement compared to the year vention has increased compared to develop new methods to capture before (320) and better than the target the year before, from 74.8 to 79.8 per patient experiences in order to gain a 314. Region Stockholm now has the cent, thereby attaining the target of at more representative documentation fifth lowest prescription of antibiotics least 75.0 per cent. Last year’s invest- for operational development. During per resident out of all the Swedish ment in a regional action programme 2020, special focus is placed on offer- regions. As recently as in 2016, for overweight and obesity, as well ing more ways of responding to the Region Stockholm had the highest as compensation in addition to the national patient survey. consumption of antibiotics. The long- regular appointment allowance to the term national patient safety objective clinics that carry out counselling and Financial outcome is 250 collected antibiotics prescrip- qualified counselling, is deemed to The Healthcare Committee’s profit was tions per 1,000 residents and year. have contributed to making the SEK 57 million, which is SEK 57 million In December 2019, only one region, health-promoting activities a priority. over budget, which corresponds to 0.1 per Region Västerbotten, had attained • Proportion of 19-year-olds with car- cent of turnover. The deviation is pri- the long-term patient safety objective. ies-free surfaces was 71.3 per cent, marily explained by revenue over budget thus exceeding the target of 71.0 per of SEK 459 million, or 0.7 per cent. The Effective healthcare cent. A 19-year-old with caries-free higher revenue was due to repayment of The goal of Effective healthcare was surfaces runs a very small risk of hav- VAT from previous years, government achieved in 2019. The goal has been ing caries in the coming years. When subsidies for women’s health and mater- monitored through the following two this is the case, the preventive meas- nity care as well as government subsidies indicators: ures offered by the dental service are for implementation of standardised care • Number of cases in 1177 Vårdguiden’s deemed to have reached the individ- procedures. The deviation was also due e-services per 1,000 residents and ual. In addition, caries-free surfaces to changed bookkeeping routines for month was 35.4 which is more than is a measurement of preventive meas- pharmaceutical surpluses and compen- the target of 29.0. The use of the ures for good public health, as a good sation for asylum healthcare of e-services at 1177 Vårdguiden has dental health is one of several long- SEK 190 million. increased continuously, which the term factors that promote health. Over the year, the Healthcare Com- new 1177 app is assessed to have con- mittee had a turnover of SEK 66,074 tributed to. The e-service Journalen, High level of trust in the million, of which SEK 62,025 million in which residents can access their health service were appropriations. In the financial own medical records online, is also The goal of High level of trust was not statement 2019, the Healthcare Com- deemed to have contributed to an achieved in 2019. The goal has been mittee therefore has nonrecurring items increased use of 1177 Vårdguiden’s monitored through the following two that increase profit amounting to e-services. indicators: SEK 450 million. • Number of days that patients who • Proportion of the population with a The Committees expenditure was have completed treatment remain in high level of trust in the health service SEK 407 million, 0.6 per cent, over hospital amounted to 3.9 days, which amounted to 61 per cent, which was budget. Major deviations concern means that the target of three days an improvement compared to the year increased expenditure on purchased was not achieved. New procedures before, but under the target of 65 per healthcare services due to an increase in and working processes have been cent. Region Stockholm’s outcome is purchased out-of-county care, geriatric developed, which place greater at the level of the country and the in-patient care, patient choice and aids. emphasis on planning for release and other metropolitan regions. The Other expenditure has increased due more focus on collaboration between Healthcare Committee will continue to injections for Karolinska University the health service and municipal to carry out patient and population Hospital according to a decision by social care. Each patient’s established surveys to monitor the development the Regional Council. The deviation healthcare contact in the out-patient of the indicator. During 2020, the for customer losses amounted to

Committees Annual Report 2019 47 SEK 98 million, which corresponds force in January 2019, and to the plan- approximately SEK 32 million, +27 per to 24 per cent of the total deviation. ning of new vehicles and FRAPP equip- cent, are primarily found within the The cost of the pharmaceutical subsidy ment being completed after the invest- department’s sections for development, was under budget, for example due to ment budget for 2019 was reported. digital health and local care, and are due higher discounts on drugs than to difficulties recruiting for fixed-term expected. Depreciations and net finan- Digitalisation assignments. In terms of the efforts to cial revenue/expenditure show a posi- During 2019, the Healthcare Committee reinforce a holistic perspective, a lot of tive deviation to the budget. was tasked with ensuring that the resi- time has been spent on the reorganisa- The number of full-time equivalents dents have an opportunity to ask not to tion of the health service management within the Healthcare Committee receive notices, test results and other intended to create a more coordinated increased in 2019 due to an increased correspondence on paper, and instead governance of the health service. number of positions within the local receive them in a secure electronic mail- healthcare department, for example box such as 1177 or Kivra. In order to Medical care events within the area of mental health, where assess whether the expected gains from During the year, the residents of investments have been financed digitalisation will be realised, the use of Stockholm County used 311,000 medi- through government funds. During the digital healthcare appointments, the cal care events. Out of these appoint- year, there was also a transfer of the e-services at 1177.se and the residents’ ments, 235,000 were within somatic communication department from the adherence to the advice provided via specialist healthcare, 44,000 within Regional Management to the Service telephone by 1177 Vårdguiden are being geriatrics and 32,000 within psychiatry. Department, and a consultancy monitored. Operations are developed at all hos- exchange was also carried out. In November, the Healthcare Com- pitals and new working methods have Over the year, the Healthcare mittee decided to introduce a digital been introduced, such as “polyclinisa- Committee has been working with healthcare guarantee. The health service tion”10 and redirection of patients to measures to reduce expenditure in the is to be digiphysical, which means that other healthcare providers and institu- form of administrative streamlining of it must be offered both digitally and tions. The planned development and SEK 40 million and savings of physically. expansion of the health service outside SEK 180 million as the result of a new of hospitals continues to take load of the medical service procurement. These Instructions emergency hospitals in accordance with savings were on level with the estab- In 2019, the Healthcare Committee also the transition agreement11. The number lished measure programme. worked with six instructions issued to of medical care events in the emergency the committee by the Regional Execu- hospitals as a whole was reduced by 1.4 Investments tive Committee. The Regional Manage- per cent. The reduction was seen at The investment expenditure for the year ment makes the assessment that the Karolinska University Hospital, amounted to SEK ten million and the committee has essentially worked with Södersjukhuset AB and S:t Eriks Ögon­ conversion rate was 143 per cent in rela- the guidelines and instructions given by sjukhus AB. At Karolinska University tion to the year’s budget of SEK seven the Regional Executive Committee in Hospital, the reduction was partially million. The expenditure consisted of the interim report 2019. The instruc- explained by the intensive care emer- SEK two million for investments within tions have been implemented with devi- gency ward opening at Karolinska Uni- contingency disaster medicine, such as ations relating to higher consultancy versity Hospital in Solna, which only protection equipment against hazard- expenditure than planned, and a lower receives the most acutely ill and injured ous substances, as well as SEK eight mil- rate than planned in the efforts to rein- patients. The number of medical care lion in investments for the IT platform force a holistic perspective, coordina- events increased at Danderyds Sjukhus FRAPP9. The deviation is due to the new tion and effectiveness in the health AB, Södertälje Sjukhus AB and Capio ambulance agreements coming into service. The higher consultancy costs of S:t Görans Sjukhus AB.

Financial outcome Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 The Healthcare Committee 57.2 0.0 57.2 0.1 585.3

9 FRAPP is the future IT platform for prehospital care. 10 Care that was previously carried out within the in-patient service was instead provided by the out-patient service. 11 Through the transition agreements, the emergency hospitals have the conditions and the incentives to develop the operation towards long-term goals for healthcare assignments, quality and hospitality.

48 Annual Report 2019 Committees Within the psychiatric service, the doctor’s practice, and 100 new doctors helicopter. The newly added bariatric number of medical care events was 3.1 can thereby be listed in the county, ambulance13 works well, and the per cent higher than the previous year, which is an increase by ten per cent. In patients within this target group have which is due to an increase in the num- addition, more than SEK 300 million obtained improved patient safety and a ber of in-patient beds. Within the geriat- was injected into the family doctor more ethical treatment. ric care, the number of medical care commission in 2019. events increased by 9.2 per cent, which Dental care is explained by an increased number of Maternity care The number of new referrals within beds and by a reduced average care Maternity care includes both out-­ specialist dental care increased by 10.2 period per appointment. patient and in-patient care, and the per cent compared to the previous year, in-patient care in turn includes before to 19,400. The main explanations is that Doctor's visits and other visits to and after care, in addition to deliveries. the age limit for free healthcare for chil- healthcare providers12 The number of visits in maternity care dren and young people was raised from Up until December, 18,500,000 visits amounted to 113,000, which is an 22 to 23 years old, along with the gen- were made to doctors and other care increase of 1.6 per cent compared to the eral population increase. The average providers, which was an increase by 1.5 year before. In total, the number of cost per patient increased by 13 per cent per cent compared to the previous year. in-patient appointments was 2,800, compared to the previous year. The number of doctor’s visits was which was a reduction of 1.4 per cent. All The number of patients with long- 7,200,000, which was a reduction of 2.0 in all, 94.5 per cent of deliveries took term illness or functional impairment, per cent. The reduction is explained by place in the maternity clinic that was the who have received “F-dental care” ongoing structural changes, where the parents’ first choice, which is an increased by 15.9 per cent compared to family doctor’s clinics took care of a increases compared to the year before. the previous year, to 4,400. The increase larger proportion of the patients requir- is partly due to increased information ing longer appointments and more Prehospital care about F-dental care. extensive investigation. This is also Prehospital care has been adapted to the explained by new benefit models Plan for the Future, and over the year, encouraging fewer and to some extent the final planned operations were The Transport Committee longer doctor’s appointments, and by a launched, and the coordination of The Transport Committee is responsible shift towards more nurse’s visits in resources is based on the prioritisation for public transport on land and water, cases of less severe conditions. The and direction service. Availability of with the exception of special public number of visits to other healthcare pro- ambulances is good, but the waiting transport. All forms of transport are fessional was 11,300,000, which was an times for patients in ambulance care operated by transport contractors increase of 3.9 per cent. The increase in were unchanged during 2019 despite an through competitive procurement. other visits has primarily taken place in increased number of ambulances. An Within the Transport Committee, the primary care, and is mainly due to an investigation is underway to analyse overall outcomes for the Public Trans- increased number or visits to assistant how waiting periods can be reduced, port Administration, the Extended nurses within basic home care. and how the goal for a waiting period of Metro Administration and AB Stor- In 2019, the Healthcare Committee less than 12 minutes can be achieved. stockholms Lokaltrafik with subsidiar- has been working to increase the capac- The median waiting period in 2019 ies are reported. AB Storstockholms ity of primary healthcare. The Commit- was 13 minutes. For better control, the Lokaltrafik (SL) is the collective name tee has for example made it possible for criteria have been clarified for hospital and brand for the procured general more specialists to operate in a family affiliation and use of the ambulance public transport service on land in the

Healthcare consumption Financial Healthcare Region Stockholm* Profit/loss Budget Deviation statement Change total thousands 2019 2019 % 2018 Medical care events 301 327 –8.1% 299 0.5% Doctor’s appointments 7,248 7,557 –4.1% 7,394 –2.0% Appointments with other 11,279 11,414 –1.2% 10,856 3.9% healthcare providers

* Excluding KSON.

12 Visits to district and assistant nurses at family doctor’s clinics and to physiotherapists, speech therapists, occupational therapists and chiropractors. 13 Ambulances for persons with severe overweight.

Committees Annual Report 2019 49 Stockholm Region. Waxholms Ång­ Goal port Committee collaborates with the fartygs AB (WÅ AB) is the name and The Transport Committee is responsible Transport Committee and concerned brand of the procured general public for the overall goal Attractive public municipalities to review measures for transport service on water in the Stock- transport in a sustainable transport the bus service and find efficient pro- holm archipelago. As of 1 July 2019, system. This means that the committee cesses in the event of traffic disrupt- Waxholms Ångfartygs AB is a subsidi- shall steer towards the goal, follow up ing works. In order to keep this matter ary of AB Storstockholms Lokaltrafik. and take measures if the goal is at risk of up to date, an annual account is pro- Waxholms Ångfartygs AB was previ- not being achieved. duced for the buses, which is reported ously a subsidiary of Landstingshuset i The overall goal has four targets: to the Transport Committee. Stockholm AB. “Attractive travel” and “Accessible and • The proportion of satisfied travellers A few events from the year for the unified region” were attained in 2019, in special public transport amounted public transport system are listed below: while “Safe travel” and “Effective travel” to 86 per cent during the period, • The Nynäs Line commuter train were not. The overall goal was achieved which is at the level of the target value. station Vega was opened. since at least half of the underlying tar- Suppliers of mobility service taxi are • Four Djurgården were gets were attained. continuously working with driver adapted for accessibility. training in order to improve the trav- • /, Väsby/Vallentuna Attractive travel ellers’ experience. and Ekerö started two new bus trans- The goal is measured through three • The proportion of satisfied travellers port contracts. At the same time, five indicators, which were all achieved in in public transport by seaamounted new electric buses were taken into 2019. The proportion of satisfied travel- to 96 per cent, which is the same high traffic. lers is measured through customer level as the previous year. • At the websites .se, and waxholms- surveys. bolaget.se it is possible to search for • Proportion of Satisfied travellers in Safe travel journeys with other transport actors public transport amounted to 80 per The goal and its indicators were not than SL and . cent. Time keeping, frequency of ser- achieved in 2019. The goal is measured • Trials were carries out with flexible vice, disruption information are the through the following indicators: night stops for the bus service on the factors that influence customer satis- • Proportion of travellers who feel safe stretch between Hallonbergen and faction the most. Key factors to main- in public transport on land and by Ursvik. tain the high level are considered to commuter boat amounted to 72 per • Construction was started on tunnels be commuter train punctuality and cent, unchanged from 2018. The tar- for the metro to Barkarby. access to the bus services. The Trans- get is challenging, considering the

Attractive public transport in a sustainable transport system

Profit/loss Goal Profit/loss Fulfilled in Goals and indicators 2019 2019 2018 2019

Attractive travel Fulfilled ● Satisfied travellers – general public transport 80 % ≥ 75 % 80 % Fulfilled ● Satisfied travellers – special public transport1 86 % ≥ 86 % 86 % Fulfilled ● Satisfied travellers – general archipelago transport 96 % ≥ 91 % 96 % Fulfilled ●

Safe travel Not fulfilled ● Proportion of travellers who feel safe in public transport on land and by commuter boats 72 % ≤ 78 % 72 % Not fulfilled ● Efficient travel – Proportion of renewable energy in public transport 91 % ≥ 92 % 91 % Not fulfilled ● Expenditure per person and kilometre, SL service SEK 3.30 ≤ SEK 3.32 SEK 3.24 Fulfilled ● Thousands of boarding passengers on a regular weekday 2,851 ≥ 2,936 2,814 Not fulfilled ● The public transport sector’s share of motorised journeys – ≥ 51 % – –

Accessible and unified region Fulfilled ● Bus transport, functioning automatic inside announcements 96 % ≥ 87 % 91 % 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 overall goal of “Attractive public transport in a sustainable transport system”.

50 Annual Report 2019 Committees increased sense of insecurity in soci- • The indicator Cost per person and ments contributes to increased acces- ety in general.14 Focus of this work is kilometre amounted to SEK 3.30, sibility and the outcome was 96 per collaboration with other actors such thus attaining the target. The costs, cent. Measurements are taken as municipalities, property owners excluding items affecting comparabil- through “mystery shopper” surveys16, and police. SL’s security centre is the ity,15 increased by 4.5 per cent, and the and the outcome, including proposed hub of the daily operational security number of kilometres per person improvements, is reported back to the efforts. Several measures have been increased by 3.7 per cent. transport operators. taken; there is for example a pilot pro- • The outcome for the indicator Thou- ject with a security chat a as a supple- sands of boarding passengers on a Travellers ment to the security number. There regular weekday, on land, was 2.85 Public transport on land are also more security resources and million travellers. The number of Travelling by land-based public trans- security guards out in the public boarding passengers increased by 1.3 port, measured as the average number transport services. per cent compared to 2018, but the of boarding passengers on a regular outcome did not attain the target. weekday, increased by 1.3 per cent com- Efficient travel This is explained by extensive recon- pared to the previous year. Percent- The goal is measured through four indi- struction which has impacted on age-wise, travel increases at roughly the cators: For one of these, the target was metro traffic and problems with same rate as the population of Stockholm attained; for two the target was not accessibility for bus transport in the County, which increased by 1.4 per cent attained, and for one indicator, the out- inner city. More information in the in 2019. Travel on commuter trains, come will be measured in the spring comment with the title “Travellers”. light rail and bus increased, while travel 2020. For this reason, it has not been • The indicator Public transport ser- by metro decreased. possible to determine whether the goal vice’s proportion of motorised jour- The average number of boarding pas- has been achieved. neys is monitored through the travel sengers in the commuter train service • Proportion of renewable energy in habit survey, which examines the increased by 14.4 per cent compared to public transport amounted to 91 per share of travel with motorised modes the previous year.17 The increase can be cent. The outcome is the same as in of transport, walking, bicycle and explained to a certain extent by the pre- the year before, but the target of 92 other modes of transport for the vious year’s challenges in the commuter per cent was not attained. Rail trans- county’s residents. The government train service, including infrastructure port runs on electricity and energy agency Transport Analysis carried issues, and to a certain extent by a short- from renewable sources, and since out a new national travel habit survey age of vehicles and drivers, which caused 2018, the entire bus fleet runs on in 2019, and the result of Region service cancellations. The increase can renewable fuels. Maritime transport Stockholm’s market share will be be seen in all commuter train lines, and contributes to the goal through the presented in the spring 2020. is assumed to be due to the population introduction of renewable fuels. growth, the increased transport offer, The fact that the goal has not been Accessible and unified region the new station in Vega as well as an achieved is explained by a delayed The goal and its indicators were increased trust in the commuter train introduction of an increased propor- achieved in 2019. service. This brings to light the chal- tion of renewable fuels for maritime • The indicator Bus service with func- lenges involving crowding and the need transport. tioning automatic inside announce- for new transport supply solutions.

Travellers in public transport Profit/loss Budget Deviation Profit/loss* Change Total thousands 2019 2019 budget 2018 % Public transport on land. Boarding 2,851 2,936 –2.9 % 2,814 1.3 % passengers** Public transport on water. Passengers*** 5,859 6,090 –3.8 % 6,072 –3.5 %

*The values of previous years may differ from previously reported values, as adjustments are made retroactively. **AB Storstockholms Lokaltrafik reports an average number of boarding passengers on a weekday. ***Including archipelago transport and commuter boat lines.

14 BRÅ, National Security Survey, NTU 2018. 15 Transport expenditure for previous years and retirement of fixed assets. 16 Anonymous visits to the public transport service with the aim of gauging its quality. 17 Information regarding boarding passengers may need to be revised, as data from the transport contracts for Ekerö and Märsta, which entered into force in June, need to be quality assured.

Committees Annual Report 2019 51 The average number of boarding by 2.6 per cent compared to the previous Djurgården ferries19 due to the recon- passengers in the light rail service year. The reduction primarily concerns struction of Slussen, the new stretch of increased by 8.9 per cent compared to the metro service’s green line, but the the tramway line 7 and the closure of the the previous year. The positive trend red and blue lines are also affected, Riddarfjärden trial line.20 However, the continues with increased travel by Tvär- which is explained primarily by the number of boarding passengers on banan, Roslagsbanan and Tramway extensive reconstruction that impacted Sjövägen21 has increased due to an City, where the new terminus by T-cen- the metro traffic, such as renovation of increased population in Nacka and the tralen has been a positive factor in the Fridhemsplan and maintenance work reconstruction of Slussen. The line travel development. The increased ser- on Söderströmsbron. Towards the end Ekerö-Gamla Stan22 has an increased vice on Lidingöbanan in rush hour has of 2019, the outcome was nearly at the number of boarding passengers, as a led to increased travel. Reinforced ser- level of the year before, but far from the new transport contract entered into vice has been introduced on Tvärbanan ambitious target, which is based on the force in August 2018, with higher fre- to counteract crowding and work is goal of an increased market share. quency of service and weekend service. underway to achieve full vehicle provi- sion on all light rail lines. Public transport on water Financial outcome The average number of boarding The number of passengers in the public The outcome for the Transport Commit- passengers in the bus service increased transport at sea decreased by 3.5 per tee, excluding items affecting compara- by 0.2 per cent compared to the previ- cent compared to previous years, while bility, relating to increased pension ous year. The increased travel refers the number of passengers in the archi- expenditure due to an altered discount primarily to Järfälla, where the syn- pelagic transport service decreased by rate amounted to SEK 611 million, which chronisation of time tables for the new 2.4 per cent. The decrease in the archi- is SEK 211 million over budget. The lines to Barkarbystaden and pelagic service is primarily explained by deviation from the budget corresponds and the commuter train has achieved an the summer being colder than in the to 2.1 per cent of turnover. The deviation increase in the number of boarding pas- previous year. is primarily explained by higher ticket sengers on lines connecting to Spånga The number of passengers in the revenues and lower depreciation costs. station. Travel has also increased on the commuter boat service decreased by 4.0 The volume-based ticket revenues line Ropsten–Karolinska.18 per cent compared to the previous year. increased in 2019, as more passengers The average number of boarding pas- The decrease is explained by a wavering travelled by SL services. The largest sengers in the metro service increased number of boarding passengers on the increase referred to travel cards and

Profit/loss for the Transport Committee* Profit/ Financial loss** Budget Deviation Deviation statement SEK millions 2019 2019 to budget percentage 2018 Ticket revenue 8,811 8,625 186 2.2 % 8,315 Appropriations 9,491 9,491 0 0.0 % 9,267 Other revenue 4,179 3,956 223 5.6 % 3,972 Total operating revenue 22,480 22,072 409 1.9 % 21,554 Staff expenditure and hired staff –947 –937 –10 1.0 % –828 Purchased transport –13,522 –13,449 –74 0.5 % –12,703 Other expenditure –3,604 –3,446 –158 4.6 % –4,113 Total operating expenditure –18,073 –17,832 –241 1.4 % –17,644 Depreciation –3,249 –3,302 53 –1.6 % –3,205 Operating profit/loss 1,159 938 221 705 Financial revenues 63 51 12 23.6 % 388 Financial expenses –610 –589 –21 10.8 % –579 Results 611 400 211 514

*The Transport Committee includes the Public Transport Administration, AB Storstockholms Lokaltrafik, Waxholms Ångfartygs AB and the Extended Metro Administration.

**Refers to the profit/loss before appropriations and taxes, adjusted for interest effect on pension expenses.

18 Line 6. 19 Line 82 Djurgården ferries. 20 Line 85 Riddarfjärden. 21 Line 80 Sjövägen. 22 Line 89 Ekerö-Gamla Stan.

52 Annual Report 2019 Committees single tickets. Areas with lower reve- agreements, which are based on both hour, higher fuel prices and an nues included the Djurgården line due price and volume. The expenditure for increased hovercraft service. to reconstruction at Slussen and a new SL services was over budget, with the The expenditure on operation and stretch of Tramway City. The external deviation being primarily due to maintenance of the transport facilities funding was lower than planned, as the increased VBP contracts23, primarily for was over budget. The expenditure budgeted subsidy for youth tickets to the Tvärbanan but also for Roslagsbanan related to track construction, property region was never allocated, following a due to an increased number of passen- management and depots, as well as a government decision. The advertising gers. The commuter train expenditure greater need for maintenance on lifts revenues increased due to the final regu- also increased as a result of regulations and escalators than planned. Roslags- lation of Clear Channel’s advertising regarding electricity consumption. The banan’s maintenance needs increased sales in 2018, but also due to additional deviation is counteracted for example by due to adaptation measures related to sales in 2019. Capital gains, primarily lower costs within the bus service as the the renovation of the line. Expenditure relating to the sale of land in Roslags- result of fewer passengers than planned. relating to disposal of older facilities Näsby, contributed SEK 59 million. The expenditure in the archipelagic ser- and project expenditure amounted to a The transport operators supply vice was over budget due to additional total SEK 183 billion. transport services based on transport contracts at a higher price per traffic The number of full-time equivalents

Public transport investments of more than SEK 300 million

Total Expenditure Budget Budget Total Total Total conv. Completion SEK millions 2019 2019 deviation expenditure forecast Budget1 rate (%) (year) Programme for the extension of Roslagsbanan 986 1,365 380 7,098 9,651 9,644 74% 2024 Programme bus depots 395 495 100 2,859 4,048 4,048 71% 2025 Programme Slussen 96 23 –74 376 439 439 86% 2021/2022 Programme Saltsjöbanan 77 45 –32 1,327 1,835 1,835 72% 2026 Programme Light Rail Line North Solna Section 32 25 –7 5,469 5,541 5,541 99% 2022 Programme Tramway City 73 66 –7 2,892 2,932 2,932 99% 2020 Programme Commuter Train 118 9 –109 11,804 11,804 11,712 101% 2019 Programme Kista Section 493 696 203 1,171 4,936 4,936 24% 2024 Bus Terminal Slussen 480 222 –258 1,096 2,618 2,618 42% 2023 Programme Red Line Upgrade 170 1,088 918 5,484 10,710 10,710 51% 2024 SL LÅS (Programme IT security aspect) 27 76 48 314 401 401 78% 2021

C20 – upgrade 129 199 70 447 1,453 1,453 31% 2023 Low-frequency Maintenance Commuter Train X60 8 16 9 414 449 449 92% 2020 Exchange of lifts and escalators 151 196 45 665 1,500 1,500 44% 2025 Rissne Metro Depot 7 40 33 10 632 632 2% 2025 Metro to Nacka and Söderort2 551 1,119 568 2,111 23,092 13,654 15% 2030 Metro to Arenastaden2 172 299 127 881 6,022 4,214 21% 2028 Station Södra Hagalund2 49 97 48 141 1,295 1,282 11% 2028 Metro to Barkarby2,3 234 283 49 803 5,513 3,249 25% 2026 Depot2 142 196 54 386 4,389 3,481 11% 2025 Vehicles2 2 3 1 7 2,521 2,389 0% 2024 Metro Älvsjö–Fridhemsplan2 0 0 0 0 13,631 14,266 0% 2034

1 According to Region Stockholm’s Budget 2020, RS 2019–0829 2 There is an ongoing dialogue between the parties in the Stockholm negotiation regarding how financing of the cost increase of the metro objects within that negotiation are to be resolved. A forecast for the total co-funding can therefore not be provided. In the total forecast, the amounts have been adjusted for staff and operating costs, and they have been adjusted by an index of two per cent annually. In the previous total budget, this adjustment has not been made for Älvsjö–Fridhemsplan. 3 The total forecast for Metro to Barkaby includes a separate contract with Järfälla Municipality in regard to Veddestauppgången.

23 VBP contracts are transport contracts where the contractor is compensated for each verified paying passenger.

Committees Annual Report 2019 53 was 915, which is 44 full-time equiva- RS 2019–0936. As mentioned above, has been worked into the investment lents fewer than budget, but compared there is a dialogue on the funding of the plan for the 2020 Budget. The comple- to the year before, the Transport Com- expenditure increase for the extension tion of Tomteboda is postponed from mittee has 96 more full-time equiva- of the metro between the parties of the 2020 to 2021 due to delays in the start of lents. The Public Transport Administra- Stockholm negotiation. construction because the detailed devel- tion is carrying out a consultancy The table shows major investments opment plan and building permit for the exchange, in which client competency is within the Transport Committee, i.e. bus depot have not been obtained reinforced by hiring in-house staff. At investments for which the total budget according to schedule. The completion the same time, the Extended Metro exceeds SEK 300 million. Renewed of Enlunda has been pushed from 2020 Administration is extending its organi- implementation decisions and devia- to 2025 due to the delayed detailed sation, as the projects enter procure- tions between forecast and budget that development plan and the cadastral ment phases and start of construction. were reported in 2019 were handled survey for the new property. In the autumn 2019, a review was within the budget process 2020 and carried out of costs and time for the adopted by the Regional Council in Programme Slussen extension projects. The new assess- November 2019. Significant events and The renovation of the remaining bridges ments show that the expenditure scope deviations are commented below. across Söderström was completed for the extension of the metro has been according to plan in July, and the final exceeded by just over SEK nine billion. Programme for the extension inspection was carried out in October The majority of this increase is due to of Roslagsbanan 2019. A renewed implementation deci- more strict national requirements, pri- The construction of the new depot in sion was made by the Transport Com- marily relating to environment and Molnby, the Vallentuna depot, contin- mittee for SEK 439 million, with 2021 as safety. The construction period is now ued according to plan. In Åkersberga, the new year of completion. The expend- assessed to eight years for the metro the construction of level crossings24 has iture for the year exceeded budget by to Arenastaden and Barkarby, and to continued in parallel with planning of SEK 74 million, which is due to increased ten years for the metro to Nacka and the first stage of the station extension. investment expenditure for the renova- Söderort. A dialogue is being conducted The construction started on the stretch tion of Söderströmsbron. The year of between the parties on how funding of Täby Kyrkby-Kragstalund, and the completion for technological equipment this cost increase will be solved. design phase was completed for vehicle and electrical power for Slussen has been x15p. The completion schedule was postponed from 2019 to 2022 due to Investments postponed by a year to 2020, and the delays relating to the City of Stockholm’s The Transport Committee is responsible expenditure for the year was works around Slussen and delays in for the regional public transport invest- SEK 380 million under budget. The rea- planning and procurement. ments, excluding mobility service son for this was partly that the railway investments. The committee’s invest- plan was appealed, which delays the Programme Saltsjöbanan ment budget for the year was SEK 8,088 construction of dual tracks, and partly During the year, the renovation of Neg- million, of which SEK 6,091 million that the procurement of new vehicles linge depot was completed, and the referred to transport investments, and was appealed. vehicles on Saltsjöbanan were equipped SEK 1,997 million to the extension of the with the signal security system ATC. metro. The expenditure for the year Programme bus depots System documents for Tattby and amounted to SEK 6,707 million, which Reconstruction of existing buildings Fisksätra were developed along with a corresponds to a conversion rate of 83 and new construction of Tomteboda bus system description for Henriksdal- per cent in relation to the budget. The depot in Solna continued during the Slussen The expenditure for the year deviation between expenditure and year and the work on Enlunda bus depot was SEK 32 over budget, partly due to budget was SEK 1,381 million, and was at Ekerö was resumed after previous the delayed launch of ATC25, from 2018 primarily due to a shift in the schedules delays. The contract for Tomteboda has to 2019, and partly due to renovation for the major investments. been delayed, since the supplier has not measures on the Neglinge depot and the During the year, the Regional achieved operation according to plan, London viaduct being postponed until Council renewed implementation and the expenditure for the year was 2019, partly due to unforeseen expenses decisions for Bus Terminal Slussen, therefore SEK 100 million. The total relating to infrastructure at Slussen. RS 2019–0884, C20 upgrade, investment forecast increased by The total investment forecast is cur- RS 2019–0896, and upgrade of the Red SEK 231 million, as the result of a six- rently SEK 165 million over total budget Line, RS 2019–0885, and implementa- year delay of the construction start for due to more advanced knowledge fol- tion decision for Depot new metro, Enlunda and an updated calculation for lowing completed system documents, RS 2019–0681, and Rissne Metro, the construction. The forecast deviation postponed measures and extended

24 A level crossing is a place where roads and/or railways/tramways intersect at different levels, i.e. where intersecting traffic can move simultaneously without impact. 25 Automatic Train Control.

54 Annual Report 2019 Committees measures to complete availability Programme Light Rail Line North of the programme due to the previously requirements and future capacity Kista section cancelled supplier contract. The needs. The deviation has been worked The bridge across Ulvsundaleden on the reduced scope has resulted in a renewed into the investment plan for the 2020 Kista section of Tvärbanan was lifted implementation decision of SEK 10,710 Budget. The completion year has been into place, and the works by Bromma million, with a completion date in 2024, postponed from 2024 to 2026 depend- Airport are still underway according to which was made by the Regional Council ing on Slussen’s schedule and since no plan. A turnkey contract was awarded in November in conjunction with the schedule had been established at the for the stretch Bromma Airport–Helen- 2020 Budget. time of the implementation decision. elund. Separate preparatory contracts

were procured, of which a few started C2O upgrade Programme Light Rail Line North during the year, and in the autumn, The production of prototypes is under- Solna section delivery of A35 tramways started. way. The expenditure for the year was During the period, a test launch of the The expenditure for the year was SEK 70 million under budget, which was digital information system ATP S3R4 SEK 203 million, which is primarily due primarily due to a postponement in the was carried out as part of the comple- to vehicle delivery of A35 to the Kista contractor’s time and production sched- tion of the signal security system ATC. section being partially postponed ules. Increased security investments, The total investment forecast of because only three out of eight vehicles new IT infrastructure and installation SEK 12 million became more expensive were delivered, and because the sched- of cameras in the C2o carriages has and completion is postponed from 2020 ule for the Rissne depot was postponed. resulted in a renewed implementation until 2022, as the signal system has not The start of traffic on the final stretch, decision of SEK 1,453 million, which been delivered according to schedule. Helenelund, has been planned for the was made by the Regional Council in The deviation has been worked into the autumn 2023. conjunction with the 2020 Budget. investment plan for the 2020 Budget. The total budget for the implementation Bus terminal Slussen Exchange of lifts and escalators decision is SEK 5,678 million. The work with blasting for the bus ter- The expenditure for the year was minal has been ongoing and reached 20 SEK 45 million, which was largely due Programme Tramway City per cent of plan by the end of the year. to a lower outcome for changes and The reconstruction and addition of the Replacement transport was delivered additions, which has postponed tramway depot Alkärrshallen was according to plan. A renewed implemen- expenses from 2019 to 2020. The com- started after the detailed development tation decision of SEK 2,618 million was pletion is postponed from 2019 until plan gained legal force in the early sum- made by the council in November in 2025 due to a limited supplier market, mer. A reduced scope in one of the pro- conjunction with the 2020 Budget. The and since a short timeline gives a large gramme projects contributes to the total expenditure for the year was impact on travellers. forecast coming in SEK 17 million under SEK 258 million over budget, which is total budget; the deviation is included in due to major partial payments for the Metro to Nacka and Söderort the investment plan for the 2020 acquisition of a new bus terminal by All necessary permits were obtained Budget. The reduced scope and the Slussen to the City of Stockholm. The during the year to start production of budget cut carried out in 2015, which led payments adhere to the city’s processing the major rock contracts. Five out of a to a gradual construction of the AGA of contracts, and the rate of the con- total six construction contracts related depot has resulted in completion being tracts was over budget during the year. to working tunnels in Nacka and Söder- expected in 2020 rather than in 2017. The completion year set in the imple- ort. Work on the construction documents mentation decision is 2023, with a risk was ongoing relating to the main tunnels Programme Commuter Train of delays due to the City of Stockholm’s and the facilities for electricity and All projects in the programme were blasting in Katarinaberget. signalling systems, the so-called BEST completed in 2019. The expenditure for facilities.26 The need for escalators the year was over budget, and the total Programme Red Line Upgrade and lifts was planned and area-based forecast is expected to exceed the total The first C30 vehicle was delivered and usufructuary agreements were con- budget by SEK 93 million. The devia- successfully tested in the metro system. cluded. In June, the Land and Environ- tions are due to a judgement issued in a The Swedish Transport Agency approved ment Court issued an environmental legal dispute with Alstom Transport the transport safety and measures were permit. The detailed development plan Deutschland GmbH, which entailed planned for an IT system used for the for the City of Stockholm gained legal increased expenditure. All documenta- operation and maintenance of the force during the autumn after the tion associated with vehicle X60B was metro. The expenditure for the year was appeal was rejected and leave to appeal obtained at the end of the year. SEK 918 million under budget, which is was denied. The railway plan also mainly due to a postponement of the gained legal force during the autumn vehicle delivery and the reduced scope after the appeal has been withdrawn.

26 BEST stands for Bana (track), El (electricity), Signal (signal), Tele (telecommunications).

Committees Annual Report 2019 55 The expenditure for the year was SEK 49 million below budget. The devi- been developed which is beneficial for SEK 568 million, which is due to a ation is primarily due to a slightly later local residents when blasting is carried delayed building production, primarily start and slower progress for one of the out. Quality assurance shall be automat- due to the appealed detailed develop- work tunnel contracts. ically implemented for deliveries from ment plan. metro project actors. Other than saving Depot Högdalen time, it is assessed to enable more faults Metro to Arenastaden, including The railway plan for a depot in Högdalen to be detected at an early stage. Station Hagalund27 was reviewed by the public, concerned There has been ongoing procurement operations and government agencies in Instructions throughout the year for the two work the late summer. During the year, solu- In 2019, the Transport Committee also tunnels. A construction contract for the tions have been established for the worked with five instructions issued to work tunnel Hagalund was awarded at depot area and a procurement strategy the committee by the Regional Execu- the end of the year, and the award for the has been developed. Consultation for a tive Committee. The Regional Manage- work tunnel contract in Hagastaden is new connection to the Farsta section ment’s assessment is that the Transport planned for early 2020. Planning was was completed at the start of the year. Committee has worked actively with the carried out of BEST facilities and of the In June, a permit application was sub- guidelines and instructions given by the switch-back in Åkeshov. The detailed mitted to the Land and Environment Regional Executive Committee in con- development plan gained legal force Court and the environmental impact junction with the interim report of 2019. after the appeal. The detailed develop- assessment for the railway plan was sent The work on the instructions have been ment plan in Solna was adopted in to the County Administrative Board for carried out with a deviation relating to August, but has been appealed by two approval. An implementation decision higher expenditure on consultants than parties. In August, the railway plan was in line with the Stockholm negotiation planned and integration of information submitted to the Swedish Transport was made by the Regional Council in security in existing steering and fol- Administration for review. During the September. The decision entails low-up processes. The Transport Com- establishment period, collaboration is increased funding and a decision to mittee is reporting that the consultancy carried out on intersections with the implement contract procurements and expenditure has increased by approxi- Swedish Transport Administration’s the start of production. The expenditure mately SEK 11 million, or 28 per cent, as facilities, as implementation agree- for the year was SEK 54 million below the rate of consultancy exchange has not ments for each intersection are required budget. The deviation is due to the 2018 been according to plan. The work con- before the plan can be adopted. The retakes in the planning due to altered tinues in 2020 to carry out items in the expenditure for the year was SEK 175 conditions in the localisation and scope action plan for information security. million under budget, which is due to of the depot extension, which caused During 2019, the Extended Metro delays in the detailed development plan some delay in 2019. Administration has been working with and permit processes. five instructions. Work was carried out Digitalisation without deviations. Metro to Barkarby A programme is underway to create the During the year, the construction of next generation ticket system. No later work tunnels for a metro line to than in 2023, this new system shall fully The Growth and Regional Barkarby was underway along with a replace the current ticket system and Planning Committee procurement of escalators. Work was make everyday life easier for travellers. The Growth and Regional Planning conducted to complete the tender docu- In October, a new ticket type was Committee fulfils Region Stockholm’s ments for the large construction and launched in the mobile ticket system, responsibility for physical regional installation contract, and to produce an and travellers can now purchase and planning in accordance with the agreement with Järfälla Municipality validate 24-hour tickets in the app. It is Planning and Building Act, and carries for sites where coordination is required. also possible to validate the digital out the region’s tasks in accordance Tender evaluation was initiated in Octo- “Movingo tickets”28 in SL’s services. with the Act on regional development ber in the large procurement of rock and For the extension of the metro, responsibility in certain counties, with construction contracts for the Järfälla digitalisation efforts are made partly to the exception of the county’s transport tunnel, with the contracts expected to create benefit for the residents and oth- infrastructure plan and the other be awarded in early 2020. An environ- ers who are affected by the construction assignments placed on the Regional mental judgement has been issued and phase, and partly to give employees an Executive Committee. The committee’s the municipal detailed development overview and help processing the enor- responsibilities include producing a plans have been adjusted accordingly. mous documentation produced in the regional development plan/develop- The expenditure for the year was projects. A text message service has ment strategy for the Stockholm region

27 Station Hagalund 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 metro to Arenastaden. 28 Movingo tickets are commuter tickets for regional and local travel.

56 Annual Report 2019 Committees (referred to as RUFS), as well as coordi- the predecessor RUFS 2010, the build- sion entailed a need for increased staff nation and knowledge bases relating, for ing development structure was not as resources and new recruitment was example, to social development, traffic well adapted to the conditions of the carried out continuously over the year. planning excluding public transport, various parts of the counties as it is in Positions being continuously filled was strategic skills provision and business RUFS 2050. The assessment is therefore the primary reason for staff expenditure development. This work is conducted in that there are great conditions for an amounting to SEK 12 million, which is collaboration with the municipalities, outcome of over 80 per cent, when the 22 per cent below budget. The lower among other actors. Region Stockholm now applicable overall plans are gradu- staff expenditure was redistributed to is the principal funder of the Archipelago ally revised. purchasing of consultancy services, Foundation, and the committee is hired staff, increased IT expenditure responsible for the region’s commitments Sustainable regional growth and other expenses. The appropriations to the foundation and for the follow-up and attractiveness for sustainability, archipelago and of the foundation’s activities. The Growth The outcome for the indicator Number freight were fully implemented. The and Regional Planning Committee also of start-up enterprises per 1,000 resi- established profit requirement for 2019 ensures that Region Stockholm’s needs dents is measured through statistics was exceeded, and the profit was for public statistics are met ahead of made available by the government SEK one million compared to the budg- planning within other operations. agency Growth Analysis. The outcome eted break-even, which corresponds to for 2019 will be reported during the first 0.5 per cent of turnover. Goal half of 2020, and a correct assessment The overall goal of the Growth and of the target attainment has not been Digitalisation Regional Planning Committee of possible. The outcome in the table above The committee is developing digital ser- “Regional development planning for is therefore preliminary and will be vices, among other things with the help sustainable growth” is measured updated in the interim report for 2020. of focus groups to ensure that the work through two targets: “A regional plan- However, the preliminary assessment is has established support and is based on ning at the cutting edge”, and “Sustaina- that the target was not attained. the user needs. One example of a digital- ble regional growth and attractiveness”. isation initiative is the committee, in Financial outcome collaboration with the Transport Com- A regional planning at the The Growth and Regional Planning mittee and Waxholmsbolaget, investing cutting edge Committee was given an extended com- in and developing the freight benefit The outcome for the indicator Conform- mission in 2019 to complete tasks portal, a digital service that handles the ity between the municipal plans and the within Region Stockholm’s regional archipelagic companies’ applications for plan in RUFS is based on an analysis of development responsibilities. Over the freight benefits more efficiently and all the municipal overall plans. The tar- year, the committees implemented its simply. Employees and managers are get was not attained. The majority of the two commissions: to make the regional offered an introduction and training in plans were developed before RUFS 2050 bicycle office permanent and to estab- new digital services. was adopted (during 2019, no new or lish a climate office. Within Region Stockholm’s collabo- revised overall plans were added) and in The committee’s extended commis- ration with the Royal Institute of

Regional development planning for sustainable growth Profit/loss Goal Profit/loss Fulfilled in Goals and indicators 2019 2019 2018 2019

A regional planning at the cutting edge Not fulfilled ● Correspondence of municipal plans with the plan in RUFS. 79 % ≥ 80 % Not fulfilled ●

Sustainable regional growth and attractiveness Not fulfilled ● Number of start-ups per 1,000 residents. 14 ≥ 16 Not fulfilled ●

Financial outcome Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 The Growth and Regional Planning 1.0 0.0 1.0 0.5 % 0.6 Committee

Committees Annual Report 2019 57 Technology, the Growth and Regional the long term. The committee is further- The Property Management increased Planning Administration together with more responsible for the Project Agree- rental income over the year, primarily the Public Transport Administration ment between Region Stockholm and from completed premises for the have issued a call relating to research Swedish Hospital Partners AB in regard Region’s own committees and compa- within the field of digitalisation and to New Karolinska Solna, and for the nies. Increased sales of services and open data. disposal rights and compensation for property networks contributed to the this agreement in relation to Karolinska department’s positive deviation of Instructions University Hospital. The Property and SEK 125 million. The increased revenue In 2019, the Growth and Regional Plan- Service Committee thereby assumes the from the sale of property networks was ning Committee also worked with three responsibility for these matters from generated by a higher level of work than instructions issued to the committee the Regional Executive Committee. expected in the strategic property by the Regional Executive Committee. The committee shall also provide IT and investments budgeted based on the pre- The Regional Management’s assessment service, in exchange for compensation, cautionary principle. Expenditure was is that the committee has essentially in accordance with the orders submitted lower than expected in conjunction with worked with the guidelines and instruc- by committees and companies. The the commissioning of new treatment tions given by the Regional Executive Property and Service Committee’s oper- and nursing buildings for Södersjukhu- Committee in conjunction with the ation is divided into two departments: set AB and Danderyds Sjukhus AB. interim report of 2019. The work with the Property Department and the Ser- The Service Department’s outcome the instructions has been carried out vice Department. of SEK –0.2 million is distributed as with a deviation relating to increased SEK –1.4 million for SF IT and consultancy expenditure than planned. Financial outcome SEK –5.4 million for Berga Naturbruks- The committee reports that the consul- During 2019, Locum AB focused on its gymnasium due to increased staff tancy expenditure is SEK 7.7 million, management assignment and the imple- expenditure. Within other operations, or 28.5 per cent, higher than planned. mentation of a large number of con- the outcome was SEK 6.7 million, The committee is working actively with struction projects in health service primarily due to a time delay within the consultancy exchange, but makes the properties. A preparatory committee for collocation project. assessment that a further decrease of property conversion was set up with the the consultancy budget is not advisable, task of monitoring issues relating to Investments since a scope of at least SEK 3 million is energy efficiency, local energy produc- The Property and Service Committee is required to periodically reinforce the tion and charging possibilities as well as responsible for investments in Region analytical competence. climate adaptations. Stockholm’s property holdings29 and The Property and Service Committee’s provision of information technology30. profit for the period was SEK 485 mil- The committee’s investment budget is The Property and Service lion, which is a positive deviation of SEK SEK 5,801 million, which is distributed Committee 125 million compared to budget. The primarily over investments in property, The Property and Service Committee deviation from the budget corresponds equipment and information technology. was formed on 1 January 2019, and is to 2 per cent of turnover. The profit is The expenditure for the year relating responsible for Region Stockholm’s distributed between Property Manage- to property investments31 amounted to property holdings through Locum AB, ment, which reports a profit of SEK 485 SEK 3,459 million, which corresponds with the exception of the public trans- million, and the Service Department, to a conversion rate of 89 per cent in port service’s properties. The commit- which reported a loss of SEK –0.2 million relation to the budget of SEK 3,886 mil- tee shall develop its property holdings in compared to the budgeted break-even. lion. The expenditure for the year was

Financial outcome Property and Service Committee Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 The Property and Service Committee 485.0 359.9 125.1 2.0 % 910.7 of which refers to the Service –0.2 0.0 –0.2 0.0 % 32.5 Department of which refers to the Property 485.2 359.9 125.3 2.4 % 878.2 Department

29 Excluding the public transport service properties, which are the responsibility of the Transport Committee. 30 Excluding the public transport service information technology provision, which is the responsibility of the Transport Committee. 31 The equipment investments made by the committee relating to property investments for the implementation of the Plan for the Future regarding Health and Medical Care, which are reported separately.

58 Annual Report 2019 Committees SEK 427 million under budget, which reconstruction was completed on 120 New treatment building was primarily due to non-completed, general psychiatry beds, and 96 beds Danderyds Sjukhus AB unspecified32 new investments in for in-patient psychiatric care were The new treatment building has been properties. completed at Nacka hospital. completed and was taken into use by At Danderyds Sjukhus AB, a new At Södertälje Sjukhus AB, a new fully Danderyds Sjukhus AB in October. emergency care building became opera- renovated nursing building became Work on minor service and guarantee tional during the autumn. A first stage of operational during the autumn. measures are underway. A number of modernisation and technical renovation New construction and renovation late programme changes which have of healthcare wards at Danderyds of the N block, previously Thorax, at entailed a more expensive production Sjukhus AB was completed. Karolinska University Hospital Solna caused the expenditure for the year to At Södersjukhuset AB, a new treat- was completed and handed over to the exceed the budget by SEK 27 million, ment building and a new nursing build- hospital operation. and the total forecasted expense is esti- ing were completed, which were taken The table shows major33 property mated to exceed the total budget for the into use during the autumn. investments within the health service investment by SEK 53 million, which A new building with surgery, inter- which are implemented over the year. corresponds to a deviation of 3 per cent. vention, x-ray and sterilisation was Significant events and major deviations completed in the Huddinge hospital area. for 2019 are commented below. In the Huddinge hospital area,

Property investments in health and medical care

Expenditure Budget Budget Total Total Total Total conv. Completion SEK millions 2019 2019 deviation expenditure forecast Budget rate (%) (year) DS New treatment building 52 236 209 –27 1,886 1,882 1,829 103% 2019 DS Reconst. for hospital ward stage 1 incl. tech. upgr. 34 25 –9 547 556 608 90% 2019 S:t Göran hospital ward and treatm. incl. tech. upgr. 723 541 –182 1,553 2,537 2,337 66% 2022 New construction and reconstruction, Södertälje Hospital 101 13 –88 1,219 1,251 1,200 102% 2019 SÖS New building west treatm. building incl. tech. upgr. 241 194 –47 2,301 2,411 2,382 97% 2020 SÖS New building west – nursing building 82 61 –21 745 749 763 98% 2019 SÖS–By 74 – new service centre 16 20 4 552 555 578 95% 2018 Sollentuna – hospital ward, entrance incl. tech. upgr. 146 106 –40 1,093 1,207 1,207 91% 2020 Nacka – hospital wards 142 45 –97 376 400 400 94% 2019 HS New construction and recon­ struction of surgery ward (CHOPIN) 315 414 99 1,574 1,787 1,940 81% 2020 General psychiatry, single room, HS 21 37 16 118 120 140 84% 2019 New construction and reconstruction of N block (former Thorax) 138 134 –4 456 500 543 84% 2019 HS–extension of fire alarm 9 3 –6 107 113 109 98% 2019 HS – Adaptation 2 wards/year 50 70 20 103 272 272 38% 2020 HS – Adaptation of wards, stage 2 6 39 33 6 423 423 1% 2024 HS–reconstruction of clinic, 2 per year 48 32 –16 52 128 128 41% 2020 HS – reconstruction of wards, stage 2 0 26 26 0 266 266 0% 2024 HS New construction and reconstruc- tion of emergency ward 13 30 17 16 190 190 8% 2022

32 Property investments for which the total budget is less than SEK 100 million. 33 Property investments for which the total budget is more than SEK 100 million.

Committees Annual Report 2019 59 Reconstruction of nursing New building West, during December. The time schedule wards, stage 1, Danderyds treatment building at was partially delayed until 2019, which Sjukhus AB Södersjukhuset AB meant that the expenditure for the year Stage 1 of the reconstruction of nursing The new treatment building has been was SEK 40 million over budget. The wards at Danderyds Sjukhus AB has completed and was taken into use by final inspection of the hospital has been been completed and handed over to the Södersjukhuset AB in October. Sub-pro- planned for the end of January 2020, operation. Lower expenditure for com- jects involving an emergency ward and which entails continued expenditure at pleted contracts than what was origi- ambulance hall have been completed the start of 2020. The total forecasted nally budgeted, and few changes during and handed over to Södersjukhuset AB. expenditure is considered to be covered the reconstruction, have led to a the Production is underway for sub-project by the total budget for the investment. total expected expenditure being new emergency ward entrance which is SEK 52 million below total budget for planned to be operational during the Nursing wards Nacka hospital the investment, which corresponds to a third quarter of 2020. The time schedule During a first stage, 96 psychiatric beds deviation of nine per cent. was partially delayed until 2019, which have been created at Nacka hospital. meant that the expenditure for the year Stage 1 has been completed and handed Nursing wards and treatment, was SEK 47 million over budget. This over. The time schedule was partially S:t Görans Sjukhus AB does not affect the time for completion. delayed until 2019, which meant that Installation and surface layers are car- The total forecasted expenditure for the the expenditure for the year was ried out for the two new buildings in the investment is assessed to exceed the SEK 97 million over budget. This has not hospital area. In parallel with the new total budget by SEK 29 million, which affected the time for completion, and construction, there is reconstruction of corresponds to a deviation of one per the total forecasted expenditure is the surgery ward in the current nursing cent, due to additional works in ongoing deemed to be covered by the total building. A renewed implementation sub-projects. budget for the investment. decision was approved by the council in 2018, LS 2017–1137. A certain delay of New building West, nursing New construction and recon- the time schedule and pushing up pro- building at Södersjukhuset AB struction of surgery and radiol- duction meant that the expenditure for The new nursing building has been ogy wards, Karolinska Univer- the year was SEK 182 million over completed and was taken into use by sity Hospital Huddinge budget. The total forecasted expendi- Söder­sjukhuset AB in November. Due New construction and reconstruction ture is assessed to exceed the total to expenses relating to earthworks, has been completed and handed over to budget by SEK 200 million, which cor- the expenditure for the year was the operation. The expenditure relating responds to a deviation of 9 per cent, SEK 21 million over budget. The total to risk expenses and contracts has been due to cost increases in the contract. forecasted expenditure is SEK 14 mil- lower than originally budgeted; the The total budget for the investment was lion lower than the total investment expenditure for the year was therefore reviewed in conjunction with the 2020 budget, which corresponds to a devia- SEK 99 million under budget and the budget process, and the budget for the tion of two per cent. total forecasted expenditure is assessed investment has been extended by to be SEK 153 million under the total SEK 200 million. Building 74 – New service centre, budget for the investment, which corre- Södersjukhuset AB sponds to a deviation of eight per cent. New construction and recon- The service centre at Södersjukhuset AB struction, Södertälje Sjukhus AB was completed and operational in 2018. New construction and Stage two of the reconstruction of a The expenditure for the year refers to reconstruction N block nursing building has been completed distribution of joint contract expenses The investment refers to new construc- and the building was taken into use by for the treatment and nursing building tion and reconstruction of the N block, Södertälje Sjukhus AB in October. A and for the service centre at Söder­sjuk­ formerly Thorax, at Karolinska Univer- negotiation regarding the final regula- huset AB. The total forecasted expendi- sity Hospital Solna. The investment has tion of stage one of the new construction ture is SEK 23 million lower than the been completed and handed over to the for the treatment building is underway, total budget for the investment, which operation. Work on guarantee measures and there is a risk of slightly exceeding corresponds to a deviation of four per and certain calibrations of technical the total budget for the investment. The cent. systems are still underway. Due to lower time schedule was partially delayed expenditure than budgeted for the com- until 2019, which meant that the Hospital wards, entrance, pleted contract, the total expected expenditure for the year was Sollentuna hospital expenditure is SEK 43 million under the SEK 88 million over budget. Work is underway with functional test- totala budget for the investment, which ing focusing on completion and deploy- corresponds to a deviation of eight per ment. Parts of Sollentuna hospital have cent. been handed over to the operation

60 Annual Report 2019 Committees New Karolinska Solna for the year amounted to SEK 255 mil- ment and follow-up processes. The Investments for New Karolinska Solna lion, distributed as 37 per cent to IT service management reports that the primarily consist of medical equipment work places and 63 per cent to storage, consultancy expenditure is SEK 12.1 and ICT34. The expenditure for the year servers and networks. The expenditure million, or eleven per cent, higher than for New Karolinska Solna amounted for the year was SEK 71 million below budgeted for 2019. The consultancy to SEK 368 million, which corresponds budget. The deviation is primarily due expenditure has primarily increased to a conversion rate of 104 per cent in to time delays in ongoing IT infrastruc- within the IT operation and an action relation to the budget of SEK 354 mil- ture investments, such as for new con- programme has been initiated to lower it. lion. The expenditure for the year struction at Karolinska University exceeded the budget for the year by Hospital Solna, Karolinska University SEK 14 million, which is due, for exam- Hospital Huddinge, Lindhagensgatan The Mobility Service ple, to delayed deliveries within ICT and and Södersjukhuset AB, as well as time Committee schedule delays for radiation equipment delays regarding the investments in net- The Mobility Service Committee was and patient monitoring systems. The work equipment. formed on 1 January 2019 and is respon- total investment budget for the projects From 2019, the investment budget sible for transports specially arranged was not exceeded. for the collocation was transferred from for people with functional impairments the Regional Executive Committee to in accordance with the Mobility Service Equipment investments the Property and Service Committee, Act, applicable agreements between The equipment investments are linked and the budget for the year amounted to Region Stockholm and the county to the region’s investments in properties SEK 121 million. The expenditure for the municipalities and the Public Transport for the implementation of the Plan for year was SEK 80 million under budget, Act in regard to mobility service trans- the Future regarding Health and and this deviation is due to the complex- port. All forms of transport are operated Medical Care. These relate to medical ity and scope of the collocation project, by transport contractors through com- equipment, ICT and interior fittings. which has led to an extension of the time petitive procurement. The budget for the year amounted to schedule and a postponement of the SEK 1,535 million distributed as 30 per project end. Goal cent to Karolinska University Hospital, The budget for the year for Berga The Mobility Service Committee has 31 per cent to Danderyds Sjukhus AB, Naturbruksgymnasium amounted to attained the target for the indicator 26 per cent to Södersjukhuset AB, eight SEK four million and the expenditure Satisfied travellers in special public per cent to Stockholm County’s health- for the year was SEK two million under transport services. care area and two per cent to Södertälje budget. The proportion of satisfied travellers Sjukhus AB. in special public transport services was The expenditure for the year Digitalisation 86 per cent, which means that the indi- amounted to SEK 1,237 million, which The Property and Service Department cator attained its target. The satisfaction corresponds to a conversion rate of was formed in 2019 and is currently varied from month to month, but there 81 per cent in relation to the budget. being developed in terms of its opera- was a correlation between good time-­ The expenditure for the year was tions, processes and procedures. During keeping and satisfied travellers. SEK 298 million under budget, which is 2020, the department will integrate dig- primarily due to purchasing of equip- italisation and innovation into its opera- Travellers ment not being made for Sollentuna tions planning. In order to simplify and The number of travellers with a mobility hospital and to equipment investments streamline the management of contract service permit increased by 593 permits for new construction and reconstruc- signing, a test has been conducted with to 68,354, which was below the target of tion of surgery and radiology wards electronical signing of decisions. The 71,000 permits. at Karolinska University Hospital Property and Service Committee other- The number of travellers in special Huddinge being of a smaller scope than wise refers to the digitalisation carried public transport decreased by 2.5 per in the budget. out by Locum AB. cent compared to 2018. On 1 January The expenditure for the year relating 2019, the allocation of leisure journeys to service management amounted to Instructions was limited to 500 per year for travellers SEK 227 million, which corresponds to a In 2019, the Property and Service Com- with wheelchair taxi permits, while the conversion rate of 60 per cent in relation mittee worked with four instructions allocation for mobility service taxi was to the budget of SEK 380 million. The issued to the committee by the Regional increased to 216 leisure journeys per budget for the year was distributed as Executive Committee. The work was year. The lower outcome is also explained 67 per cent for information technology, carried out with one deviation referring by the limited number of available 32 per cent for collocation and one per to higher expenditure than planned for vehicles. The new taxi agreement that cent for Berga Naturbruksgymnasium. the use of consultants and for integrat- entered into force in April 2019 led to The information technology budget ing information security in manage- increased availability in the form of

34 ICT stands for information, communication and technology.

Committees Annual Report 2019 61 more vehicles, but the reduction during ture for the year amounted to tions given by the Regional Executive the first quarter was so great that the SEK 28.4 million, which corresponds to Committee in conjunction with the number of journeys remained at a lower a conversion rate of 52 per cent in rela- interim report of 2019. The instructions level for the year. When it comes to tion to the budget. The deviation is due have been implemented with a deviation medical journeys, the healthcare units to the new mobility service permit sys- relating to higher expenditure on con- are issuing more permits than before. tem being more complex than expected sultants than planned and integration and to deliveries from external suppliers of information security in steering and Financial outcome delaying the project, which has resulted follow-up processes. The Mobility The Mobility Service Committee’s profit in a delay of budgeted expenditure. Service Committee purchases adminis- for the period was SEK 108 million, trative services from the Public Trans- which is a positive deviation of Digitalisation port Administration, which means that SEK 108 million compared to budget. During 2019, a digital application was what is written above regarding the The deviation corresponds to 6.2 per developed for the mobility service oper- Public Transport Administration’s cent of turnover. The deviation is pri- ation, which makes it easier for clients to instructions also applies to the Mobility marily explained by lower expenditure manage their bookings. A new cohesive Service Committee. for purchased transport, which is system support was also completed for mainly a result of a decreased number of customer matter, order management journeys by mobility service taxi and and product management. This system The Culture Committee wheelchair taxi, and to some extent by is directed to the Transport Committee’s The Culture Committee leads Region fines paid by providers. private and business customers, as well Stockholm's operations in the cultural The new contract is expected to led to as to the mobility service operation’s field. The Committee shall promote cul- a continued increase in travel during customers. ture in the Stockholm region, provide 2020, which will also result in an financial support for organisations in expected increase in the expenditure for Instructions the creation of culture and promote purchased transports. In 2019, the Mobility Service Commit- quality and diversity in the area of cul- tee worked with four instructions issued ture. This work is conducted in collabo- Investments to the committee by the Regional Execu- ration with the municipalities, among The committee’s ongoing investments tive Committee. The Regional Manage- other actors. The Committee is respon- include a new system support for the ment’s assessment is that the Mobility sible for work on artistic design and cul- mobility service operation and the Service Committee has essentially tural activity in the health service and development of a new app. The expendi- worked with the guidelines and instruc- gives instructions to other committees

The Mobility Service Committee Profit/ Goal value Goal Target Indicator loss committee achievement* council

Satisfied travellers – special public transport 86 % ≥ 86 % Fulfilled ● ≥ 86 %

*Goal achievement is measured in relation to the committee’s target, and if no such target has been set, to the council’s target.

Travellers in public transport Profit/loss Budget Deviation Profit/loss* Change Total thousands 2019 2019 to budget 2018 % Special public transport Number of 3,968 4,317 –8.1 % 4,071 –2.5 % journeys**

*The values of previous years may differ from previously reported values, as adjustments are made retroactively. ** Includes mobility service, medical and business travel.

Financial outcome Mobility Service Committee Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 The Mobility Service Committee 107.7 0.0 107.7 6.2 % 67.5

*The values of previous years may differ from previously reported values, as adjustments are made retroactively. ** Includes mobility service, medical and business travel.

62 Annual Report 2019 Committees in Region Stockholm regarding meas- The proportion who answered yes to the adapted to needs, as well as purchasing ures for care and maintenance of the question of whether Region Stockholm of furniture and AV equipment. The region’s art. The Culture Committee is is clearly coordinating the region’s cul- expenditure for the year amounted to also the regional archiving authority. ture life and associations was 80 per SEK seven million, which corresponds Region Stockholm is the principal cent. Municipal representatives have to a conversion rate of ten per cent. funder of the Stockholm Concert Hall not been specifically asked during 2019 The deviation is partly due to the project Foundation in regard to the property, (although many municipalities were being delayed and to expenditure being and the Culture Committee is responsi- represented at the event) and the meas- recognised in 2020, and partly due to ble for the region’s commitments to the uring method was developed in 2020. SEK four million for the regional foundation and for the follow-up of the However, the target is deemed to be archives not being used, as the need was foundation’s activities. attained for 2019. lower than estimated.

Goal Culture and artistic expressions Digitalisation The overall goal of a free culture for as an integrated part of the The Culture Committee has developed a experiences, meetings, education and region’s activities for well-being plan for digitalisation of internal pro- inclusion was measured through two and security. cesses and working methods, as well as targets: Strategically coordinated cul- The target for the indicator Proportion a skills development plan for digitalisa- tural life and associations as well as of property investments in the health tion. A plan for external digitalisation Culture and artistic expressions as an service used for artistic design was has been initiated. Employees have integrated part of the regions’ activities attained in 2019. The outcome was 1.5 received training in several IT tools and for well-being and security. Since both per cent, which is within the scope of the the technical conditions for working out of these targets were attained, the goal target of 1–2 per cent. of office have been improved. Opera- was achieved in 2019. tion-based information reporting has Financial outcome been introduced, which means that the Strategically coordinated cul- The Culture Committee’s profit was information will be more transparent tural life and associations SEK two million, as compared to the and easily accessible. Since the new The indicator Proportion of municipali- budgeted break-even. The deviation year, the regional archive has been ties and representatives for culture and corresponds to 0.4 per cent of turnover. ready to start the transfer of healthcare associations who feel that the region is The reason was lower staff expenditure information to the new E-arkiv 3.0. coordinating the county’s culture life due to vacancies within the regional and associations in a clearly strategical archives. Instructions manner is measured through a survey In 2019, the Culture Committee worked that was answered by 500 participants Investments with five instructions issued to the com- from the region’s culture life and associ- The Committee’s investments refers to mittee by the Regional Executive Com- ations in conjunction with the event the reconstruction of premises in mittee. The work has been carried out Stockholmstinget in November 2019. Södermalmsallén for a working method with a deviation relating to increased

Free culture for experiences, meetings, education and inclusion Profit/loss Goal Profit/loss Fulfilled in Goals and indicators 2019 2019 2018 2019 Strategically coordinated cultural life and associations Fulfilled ● Proportion of municipalities and representatives for culture and associations who feel that the region is coordinating the county’s culture life and associations in a clearly strategical manner. 80.0 % ≥ 75 % 1) Fulfilled ● Culture and artistic expressions as an integrated part of the region’s activi- ties for well-being and security. Fulfilled ● Proportion of property investments in the health service used for artistic design 1.5 % 1–2 % 1.4 % Fulfilled ●

1) The indicator is new for 2019

Financial outcome Culture Committee Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 The Culture Committee 2.1 0.0 2.1 0.4 % 2.6

Committees Annual Report 2019 63 consultancy expenditure than planned. Goal Financial outcome The Culture Department reports that The Health Service Steering Committee The expenditure of the Health Service the consultancy expenditure is has attained the target for the indicator Steering Committee consists of remu- SEK 2.5 million, or 84 per cent higher Antibiotics prescription. neration to the Healthcare Committee than planned, primarily referring to The use of antibiotics, measured as for knowledge services provided within consultancy services within the area of the number of antibiotic prescriptions the Healthcare Department, amounting e-services for archiving and in-depth collected per 1,000 residents and year, to SEK 383 million in 2019. The Com- review of financial information. continued to decrease in Region mittee’s profit for 2019 amounted to Stockholm during 2019. In November SEK 44 million, which corresponds to 2019, the level was at 295 collected anti- 10.2 per cent of turnover. The majority Health Service Steering biotics prescriptions per 1,000 residents of the divisions and units included in the Committee and 12-month period. This was the Health Service Steering Committee had The Health Service Steering Committee lowest level in decades. a positive deviation from the budget. shall lead the knowledge management The reduction in the number of col- organisation and the expertise struc- lected antibiotics prescriptions was 5.9 Digitalisation ture within Region Stockholm’s health per cent over the year, which can be The digital platforms within Region service. The Committee leads the compared to a national reduction of 3.5 Stockholm are being adapted to visual- knowledge management with the com- per cent. The reduction referred to all ise national content supplemented with mission to participate in regional and age groups, but especially for children regional information. The goal is for this national efforts involving level struc- and young people, with the exception of information to also be available in the turing and is responsible for ensuring people over the age of 90 years, where the healthcare information systems. Region that Region Stockholm reaches the anti- antibiotics prescription increased slightly. Stockholm manages a number of knowl- biotics target and the nationally estab- However, the number of collected anti- edge supports, which are used nation- lished vaccination rate. The Committee biotic prescriptions from digital health- ally within the field of medicine. These was first established on 1 January 2019 care providers increased. It remains a supports make information available in and has developed its operation over the challenge to follow up on digital pre- the medical record systems, which leads year. During 2020, the Committee will scriptions and to reach digital health- to increased patient safety. make a decision on a patient safety plan, care providers with information regard- which will be based on the national ing restrictive antibiotics prescription. Instructions action plan for increased patient safety In 2019, the Health Service Steering in the health service 2020–2024. Committee worked with three instruc- tions issued to the committee by the Regional Executive Committee. Work was carried out without deviations.

Health Service Steering Committee Committee Goal Indicator Outcome target achievement* Council target Antibiotic prescriptions (number of collected antibiotic prescriptions per 1,000 residents) 295 ≥ 314 Fulfilled ● ≥ 314

*Goal achievement is measured in relation to the committee’s target, and if no such target has been set, to the council’s target.

Financial outcome for the Health Knowledge Management Committee Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 Health Service Knowledge 43.5 0.0 43.5 10.2 % 0.0 Management Committee

Financial outcome Patient Advisory Committee Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 Patient Advisory Committee 0.4 0.0 0.4 1.2 % 1.0

64 Annual Report 2019 Committees Patient Advisory Committee Stockholm County’s improvement of support processes, The Patient Advisory Committee is the Healthcare Area follow-up and analysis. Within primary independent and impartial body of the Stockholm County’s Healthcare Area is care, processes were initiated for shared health service where patients, family responsible for Region Stockholm’s use of rehabilitation coordinators and members and employees within the operations within primary care, psychi- home care. health service can turn in case of issues atric care, paediatric psychiatric care, The targets were attained for the in the contacts with the health service or addiction treatment, geriatric care, indicator “proportion of patients who complaints relating to hospitality, atti- advanced home care, disability and would recommend their family doctor’s tudes and quality in the health service. habilitation, including interpreter cen- clinic to others” and for the indicator tre, aids, diet and somatic specialist care “proportion of patients who feel Financial outcome through special agreements. Stockholm included in their care”. Within psychia- During 2019, the work to digitalise the County’s Healthcare Area is responsible try, work with user influence continued operation has become more intensive and for research, development and training and one more user influence coordina- this development is expected to continue within their operational areas, includ- tor was hired. in 2020, among other ways through the ing development of public health. The integration of the local case management operation includes the healthcare and Healthcare production system with 1177.se. This is expected to services contracted by the Healthcare Over the year, operations within the increase the accessibility for citizens and Committee or other clients. Stockholm County’s Healthcare Area increase the efficiency of the commit- carried out 5,600,000 visits. Doctor’s tee’s administration. During the year, Goal appointments to family doctor’s clinics the Committee has also made efforts to Stockholm County’s Healthcare Area and all-night clinics were fewer than provide more information to the region’s attained the targets for five of the seven budgeted, which is explained by population, and the number of support indicators that the committee was appointments transferred from emer- persons has increased during the year. aiming for under the overall goal for the gency hospitals being more time con- Despite this, the total operating expend- health service. Two indicators failed to suming and by vacancies impacting the iture was under budget. The Patient attain the target. production. In total, the number of Advisory Committee’s reported profit The Committee achieved the indica- visits within primary care was 6.0 per amounted to SEK 0.4 million, which tor for healthcare within three days with cent lower than budget. Within the psy- corresponds to 1.2 per cent of turnover. family doctors and a first appointment chiatry service, visits have increased with a specialist within 30 days. All over time for all operations. The number Digitalisation operations were working to improve of medical care events was 8.2 per cent The Patient Advisory Committee availability; the psychiatric service for under budget, and the number of days administration has been transferred example developed its quality and avail- spent in advanced medical care at home almost entirely to digital during the year. ability surveys. Within primary care, and palliative care was 2.6 per cent The transition has been quick and “online clinics” were opened and a pilot under budget. The fact that the number encountered no greater obstacles. study was initiated for a chat function. of completed medical care events was Several initiatives have been carried out When it comes the indicator of pro- lower than budget is primarily explained to make it easier for residents to contact portion of patients who receive an by a reduction in the psychiatry service, the department. The development appointment for treatment within 90 where patients are hospitalised for continues in 2020 to further increase days, it has not yet been established longer periods. accessibility for residents and to which patient groups and which treat- increase the department’s effectiveness ments are to be included. Proportion of Financial outcome in the long term. patients within child and adolescent The profit was SEK 229 million, thereby A collaboration has been initiated psychiatry who started treatment deviating from the budget by with the Royal Institute of Technology within 90 days during the year SEK 30 million compared to the budg- and Stockholm University to increase amounted to 79 per cent. The target was eted profit. The deviation corresponds digitalisation and implement artificial not attained. to 0.2 per cent of turnover. The opera- intelligence with the aim of stream­ The proportion of healthcare-­ tion’s expenditure was SEK 258 million, lining internal processing. associated infections was 2.2 per cent, 2.1 per cent, over budget. The positive which meant that the targets of both the deviation was primarily a result of Instructions Regional Council and the committee increased revenue from product sales In 2019, the Patient Advisory Commit- were attained. and rentals within the aid operation. tee worked with three instructions The average number of days that The operation’s expenditure was issued to the committee by the Regional patients who have finished medical SEK 256 million, 2.2 per cent, over Executive Committee. Work was carried treatment remained in the hospital budget. It was mainly staff expenditure out without deviations. exceeded the target for the indicator. that exceeded the budget. Material The work to increase efficiency is under- expenditure was also over budget as a way, including digitalisation and result of increased demand for medical

Committees Annual Report 2019 65 equipment in the home, which also pro- Digitalisation Instructions duced increased revenues. During 2019, During 2019, Stockholm County’s In 2019, Stockholm County’s Health- the Stockholm County’s Healthcare Healthcare Area reinforced its portfolio care Area also worked with five instruc- Area adopted an action programme of management, which provides support tions issued to the committee by the SEK 224 million, of which SEK 147 mil- for the planning and prioritising of initi- Regional Executive Committee. The lion were achieved. The main explana- atives. The general efforts relating to Regional Management’s assessment is tion for the failure to complete the digitalisation and how these are linked that the Stockholm County’s Healthcare measure programme is that the combi- to Region Stockholm are visualised, Area has essentially worked with the nation of teams within ASiH did not which contributes to increased effi- guidelines and instructions given by the entail the expected savings, that staff ciency in the production of services and Regional Executive Committee in con- expenditure was not reduced according improves the conditions for analysis. junction with the interim report of 2019. to plan and that the production did not One of the major projects carried out The work has been carried out with a increase as expected. over the year is “Always Open” which is deviation relating to increased consul- an application enabling various types of tancy expenditure than planned. The Investments digital meetings between residents and Stockholm County’s Healthcare Area The expenditure for the year, excluding healthcare providers. The application reports that the consultancy expendi- strategic equipment investments, had a major impact within primary care ture is SEK 21.3 million or 98 per cent amounted to SEK 219 million and was in terms of follow-up and prescription over budget. SEK 20 million under budget. The con- renewals. version rate was 92 per cent in relation Akademiskt specialistcentrum is to the year’s budget of SEK 239 million, conducting a pilot project exclusively excluding strategic equipment invest- offering appointments in “Always Open” ments. The deviation is due to delays to individuals with chronic illnesses. in the planned IT investments and to The online family doctor’s clinics several planned reconstructions were have been established where patients not implemented according to budget. with symptoms described in a guide can The expenditure for the year, including quickly receive help. strategic equipment investments was SEK 242 million.

Stockholm County’s Healthcare Area Committee Goal Council Indicator Outcome target achievement* target Proportion of patients who received an appointment with a family doctor within three days 97 % ≥ 90 % Fulfilled ● ≥ 90 % Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 81 % ≥ 73 % Fulfilled ● ≥ 73 % Proportion of patients who receive an appointment for treatment within 90 days 79 % ≥ 90 % Not fulfilled ● ≥ 90 % Prevalence of healthcare-associated infections 2.2 % ≤ 5.0 % Fulfilled ● ≤ 7.9 % Number of days that patients who have completed medical treatment remain in hospital 4.9 % ≥ 3 Not fulfilled ● ≥ 3 Proportion of family doctor’s clinics conducting active disease prevention 92 % ≥ 75 % Fulfilled ● ≥ 75 % Proportion who would recommend their family doctor’s clinic to other people 84 % ≥ 82 % Fulfilled ● ≥ 82 %

*Goal achievement is measured in relation to the committee’s target, and if no such target has been set, to the council’s target.

Financial outcome for Stockholm County’s Healthcare Area Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 Stockholm County’s Healthcare Area 228.6 199.0 29.6 0.2 % 52.4

66 Annual Report 2019 Committees Karolinska University prioritising is carried out every day to ber of visits to out-patient care Hospital avoid any waiting for patients that increased by 2.5 per cent, and the num- Karolinska University Hospital is entails medical risk. ber of medical care events increased by Region Stockholm’s university hospital The proportion of healthcare-­ 5.7 per cent. The change is due among responsible for national specialised care associated infections in the hospital was other reasons to the transition from a and regional hospital care, in addition 11.8 per cent, which is an increase from traditional emergency ward to a new to eye care, rehabilitation medicine and the year before, when the outcome was intensive care emergency ward at Nya hand surgery. Karolinska University 10.2 per cent. Karolinska University Karolinska Solna. An increased health- Hospital is furthermore the region’s Hospital has a relatively high propor- care production could be seen in the specialised trauma centre, responsible tion of high-risk patients, which pre- hospital during late autumn. for the care of seriously injured patients. sents a challenge in attaining these tar- The situation has remained strained Karolinska University Hospital is to gets. During the year, the tool TakeCare in the emergency wards, primarily in conduct its operation in accordance was introduced in the medical record Huddinge. However, fewer patients have with agreements concluded with the system. This means that it is now possi- had to spend the night in the emergency Healthcare Committee or other clients. ble to monitor healthcare-associated ward, and the duration of the visits has The healthcare commission covers spe- infections on a continuous basis for the been slightly shorter than in the year cialised and highly specialised care and whole hospital, rather than through before. The number of births decreased shall be related to the hospital’s research annual surveys, as was done before. by 7.0 per cent compared to the previous and education commission. Work is underway to reduce the year. The healthcare volumes for out-of- number of days that patients who have county and foreign patients decreased Goal completed medical treatment remain in by 8.4 per cent for the out-patient care Karolinska University Hospital attained hospital. and by 7.0 per cent for the in-patient care. the targets for one of the seven indica- tors that the committee was aiming for Healthcare production Financial outcome under the overall goal for the health ser- The hospital has been focusing on During the year, Karolinska University vice. Three of the indicators were not improving availability and nursing Hospital took measures to improve the attained, and one indicator could not be capacity. Paediatric care and cancer financial situation, in addition to the measured. care were prioritised in particular. A measure programmes developed in con- The situation remained strained at number of positive factors in healthcare junction with the 2019 budget. During the emergency wards, although waiting production have indicated that the the spring, an employment stop was periods were slightly shorter. The Com- measures taken over the year have implemented along with a dispensation mittee attained its own target but not started to take effect. Healthcare pro- procedure, and 550 administrative the Regional Council’s higher set target duction within elective in-patient and positions were given notice of termina- for the indicator. out-patient care was higher in the later tion. A new hospital-wide measure pro- The Council did not attain the targets part of the autumn than in the same gramme was developed to create short- for waiting periods for a first appoint- period the year before. An increased term savings and structural long-term ment with a specialist or for treatment. share of the advanced care was provided changes to achieve balanced finances. During 2019, there was a positive devel- in Solna, especially within the in-patient At the same time, work was clarified to opment in healthcare production, which care, which is in line with the Plan for follow-up and develop the implementa- increased compared to the year before. the future regarding health and medical tion of operational measures. Ten new Local production plans have been devel- care. During the year, the average care hospital-wide initiatives were also oped for each operation and reconciled period increased from 4.00 to 4.16 days. started. In all measure programmes, between collaborating activities to The negative trend seen over several Karolinska University Hospital has pri- improve planning and predictability years, with a decreasing number of oritised patients, patient safety, clinical within the hospital. The effect of this available beds in the summer, has activities and maintaining the number work is seen already at the end of the been broken. The number of beds has of beds. year in the form of increased production increased and is now at the planned During the year, a review of Karolin- and productivity within the surgery level. ska University Hospital’s organisational activities and in-patient care. This also The shortage of specialist nurses and and operational model was carried out led to improved availability and shorter staffing problems in nursing wards, to simplify and reduce ambiguities. health service queues in the final along with interruptions in the flow of Work relating to information was also months of the year. sterile equipment and other materials conducted to support the opportunities Several measures were planned and for the surgery ward in Solna have led to for first line managers to control implemented to improve availability. a lower production than budgeted. The finances, healthcare production and The hospital continues to review the number of visits was 3.4 per cent under quality of care. The hospital manage- possibilities of increasing the capacity budget, and the number of medical care ment reintroduced an investment coun- of the sterilisation centre and staff more events was 12.9 per cent below budget. cil for structured efforts in prioritising hospital beds. Customary medical In relation to the year before, the num- the right investments and promote

Committees Annual Report 2019 67 economising of resources, given the drugs and purchased external medical stabilised. The rate of increase for drug difficult financial situation. services being higher than budget. expenditure improved during the Karolinska University Hospital has The operating revenue was below autumn and was at 5.9 per cent for 2019. continued to adjust the healthcare budget as the result of lower revenues The cost development during 2019 relat- organisation to an appropriate size for from the transition contract due to ing to consultancy expenses decreased the commission to provide highly spe- unobtained availability and quality tar- by 34.7 per cent. cialised care. In November, another gets. The hospital charged nonrecurring There is a risk of Karolinska Univer- notice of termination was issued for 250 expenses from previous years to the sity Hospital’s financial issues continu- doctors, 350 assistant nurses and for a outcome for 2019 in the amount of ing in 2019. Measures to ensure bal- number of positions within hospital ser- SEK 189 million. The nonrecurring anced finances are therefore the top vices. The majority of the additional items consisted primarily of expenses priority and now include measures aim- measures taken in 2019 will only have relating to bad debts and capitalised ing to reduce expenditure by SEK 800– an effect in 2020 and the years to come. depreciation expenses for strategic 900 million for 2020 and increase reve- Karolinska University Hospital has investments from 2017 and 2018. nues for out-of-county and foreign had a budgeted measure programme of Despite the negative outcome devia- healthcare of SEK 300 million. SEK 550 million, of which 95 per cent tion, there were positive trends in 2019 has been reported as completed. Despite in regard to expenditure development. Investments this, the effect has been counteracted by The operating expenditure has seen a The expenditure for the year, excluding increased expenditure for medicines downwards trend and as of December strategic equipment investments, and materials and excessive staff 2019, the development amounted to 2.5 amounted to SEK 255 million and was expenditure. Karolinska University per cent compared to 6.5 per cent in SEK 96 million under budget. The con- Hospital reported a loss of December 2018. In addition, staff version rate was 73 per cent in relation SEK 1,867 million, thereby deviating expenditure has developed in the to the year’s budget of SEK 351 million, SEK 1,587 million from the budgeted desired direction, at 1.1 per cent, which excluding strategic equipment invest- outcome, which corresponds to 8.4 per is primarily due to the number of full- ments. The deviation was due to restric- cent of turnover. time equivalents decreasing compared tive decision-making relating to invest- Karolinska University Hospital’s to the year before. The number of full- ments. The expenditure for the year deviating outcome is primarily time equivalents (contracted hours) was included investments in RIS/PACS,35 explained by staff expenditure, repairs reduced by 254, or 1.6 per cent, com- and IT platform for SMB,36 a large- and maintenance costs, customer pared to the year before. The expendi- animal laboratory in Huddinge for losses, costs of IT services, materials, ture for hired nurses appears to have research and investments in a new

Karolinska University Hospital Committee Goal Council Indicator Outcome target achievement* target Proportion of patients who have spent no more than four hours in the emergency ward 56 % ≥ 54 % Fulfilled ● ≥ 78 % Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 49 % – Not fulfilled ● ≥ 73 % Proportion of patients who receive an appointment for treatment within 90 days 73 % ≥ 90 % Not fulfilled ● ≥ 90 % Prevalence of healthcare-associated infections 11.8 % Not fulfilled ● ≤ 7.9 % Number of days that patients who have completed medical treatment remain in hospital – – – ≥ 3

*Goal achievement is measured in relation to the committee’s target, and if no such target has been set, to the council’s target.

Financial outcome for Karolinska University Hospital Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 Karolinska University Hospital –1,866.6 –280.0 –1,586.6 –8.4 % –822.4

35 RIS/PACS is an x-ray information system/picture archiving and communication system. 36 SMB stands for Stockholm Medical Biobank.

68 Annual Report 2019 Committees pathology and cytology laboratory for The Audit Board the activities at Södersjukhuset AB, in The elected auditors are the Regional addition to replacement investments for Council’s, and ultimately the residents’, medical equipment. The expenditure for tool for democratic control. The Audit the year, including strategic equipment Board’s commission is to review all investments was SEK 549 million. activities and assess how committees and companies have handled their Digitalisation responsibilities. Karolinska University Hospital’s strate- The profit/loss for the Audit Board gic digitalisation plan is established by was SEK 0 million, which is in accord- the executive council or the Karolinska ance with the budget. University Hospital Management Council. A large number of digitalisa- Investments tion initiatives have been carried out The Audit Board had budgeted during the year, including: implementa- SEK 0.2 million for the year in minor tion of IT infrastructure in new build- investments, but no expenditure has ings, close to 100 systems have been been produced. prepared for the move to new buildings, and a new and improved information Digitalisation provision has been introduced to the During the year, the Audit Office devel- Karolinska University Hospital man- oped its case management so that it agement. Furthermore, the hospital has works together with Region Stockholm’s tested an app-based emergency medical case management system, EDIT. Initia- record service. Examples of benefits tives were also taken to increase the use include improved patient collaboration, of joint platforms, such as SharePoint. more stable IT solutions and stream­ lining of clinical operations. Instructions In 2019, the Audit Board worked Instructions with two instructions issued to the In 2019, Karolinska University Hospital committee by the Regional Executive worked with five instructions issued to Committee. The instructions have been the committee by the Regional Execu- implemented without deviations. tive Committee. The Regional Manage- ment’s assessment is that Karolinska University Hospital has essentially worked with the guidelines and instruc- tions given by the Regional Executive Committee in conjunction with the interim report of 2019. This work was conducted with deviations relating to the financial outcome, adaptation of expenditure and staffing for the health- care commission and the fulfilment of the availability goal of “Care at the right time”.

Financial outcome the Audit Board Deviation Profit/loss Budget Deviation percentage Profit/loss SEK millions 2019 2019 to budget of turnover 2018 The Audit Board 0.0 0.0 0.0 0.0 % 0.1

Committees Annual Report 2019 69 10 Companies

70 Annual Report 2019 Landstingshuset i by the Healthcare Committee and other target for the number of days that Stockholm AB clients. patients who have completed treatment Landstingshuset i Stockholm AB remain in hospital. (LISAB) is a parent company commis- Goal and indicators sioned with owning and managing Södersjukhuset AB attained the targets Healthcare production shares in the group subsidiaries. The for three of the five indicators that the During the autumn 2019, Södersjuk­ aim is to coordinate the wholly-owned committee was aiming for under the huset AB moved into new premises for subsidiaries and sub-subsidiaries in overall goal for the health service. Two surgery and nursing according to plan, a manner appropriate to Region of the indicators were not fulfilled. but with a certain drop in production as Stockholm. LISAB is wholly owned by The waiting times for the adult emer- a result. The move to the new emergency Region Stockholm and the subsidiaries gency ward were among the highest ward will be completed in 2020. Much conduct operations primarily within among the emergency hospitals in like before, preparations will be made in healthcare, medical care and dental Region Stockholm, and the target was order to minimise disruptions in the care. not attained. Several development pro- production. jects are underway to shorten the wait- Södersjukhuset AB is working Financial outcome ing times. The shortage of beds due to actively to receive patients to the appro- Landstingshuset i Stockholm AB staffing problems at the hospital is an priate form of care. The healthcare pro- reports a loss for the period of aggravating factor when it comes to duction was 3.0 per cent over budget, SEK –17 million, which is SEK 15 million improving waiting times at the emer- measured as the number of out-patient over budget. This outcome is due to gency ward, in combination with insuffi- appointments, but 10.9 per cent lower in lower interest expenditure on borrow- cient possibilities to transfer patients to terms of the number of in-patient ings, as well as dividends from Ambu- geriatric care. events. In relation to the previous year, lanssjukvården i Storstockholm AB. The proportion of patients who have the number of out-patient appointments The company has received share- been waiting for no longer than 30 days, increased by 6.2 per cent and the num- holder injections of SEK 600 million including child and adolescent clinics ber of in-patient events was reduced by from Region Stockholm in order to outside of Södersjukhuset AB, was 74 2.8 per cent. The reduction within increase equity in response to the defi- per cent at the end of December, and the in-patient care was seen in all opera- cits in LISAB’s subsidiaries. Regional Council’s target was thereby tional areas. The average care period On 1 July, ownership of Waxholms attained. was 3.72 days, which is slightly higher Ångfartygs AB was transferred from The proportion of patients who than the year before. The cardiology LISAB to AB Storstockholms received an appointment for treatment clinic has increased the number of day Lokaltrafik. The compensation for within 90 days was 95 per cent, and the surgeries, and both cardiology and shares in Waxholms Ångfartygs AB target was therefore attained. The internal medicine opened day care amounted to SEK 52 million, which cor- surgery operation was moved into new wards in the autumn 2019. This was responds to the recognised value of the premises in the autumn of 2019 and an done to improve the care given to shares. This means that there was no extensive effort is being made to patients from the emergency ward who effect on profit in LISAB in conjunction improve the hospital’s capability of receive day care rather than being with the sale. planning production and balancing admitted to a nursing ward. needs and capacity. The healthcare production relating The proportion of patients who con- to out-of-county and foreign patients Södersjukhuset AB tracted a healthcare-associated infec- increased in out-patient care by 3.6 per Södersjukhuset AB is one of Region tion decreased somewhat compared to cent and in in-patient care by 0.9 per Stockholm’s emergency hospitals, which 2018 and the target was attained. The cent. The number of births increased is responsible for specialised emergency hospital-wide project concerning safe by 1.7 per cent. The hospital has long care, somatic specialist care, as well as sepsis care involved multiple units at the durations of stay in the adult emergency highly specialised vascular surgery and hospital and the result is expected to ward, despite the addition of a local hand surgery. The operation includes improve further with time. emergency clinic in Rosenlund. The the healthcare and services contracted Södersjukhuset AB did not attain the local emergency clinic has reduced the

Financial outcome Landstingshuset i Stockholm AB Deviation Profit/loss* Budget Deviation percentage Profit/loss* SEK millions 2019 2019 to budget of turnover 2018 Landstingshuset i Stockholm AB –16.7 –31.3 14.6 – 133.1

*Refers to the profit/loss before appropriations and taxes, adjusted for interest effect on pension expenses.

Companies Annual Report 2019 71 total number of patients in the hospital dure and a stop on hired staff. New use of drugs have had a large impact on emergency ward, but the burden of care measures were identified on a monthly the expenditure. The costs of laboratory has increased, meaning that the propor- basis to replace the planned measures and x-ray services have also increased, tion of more severely ill patients is that for various reasons could not be primarily due to an increased number of higher. Several development projects completed. examinations and tests. are underway to improve the duration of Södersjukhuset AB reported a loss of Södersjukhuset AB’s work to attract, stays, including altered working meth- SEK –112 million, excluding items maintain and develop their employees ods in the x-ray unit. affecting comparability, relating to indicate a positive outcome. The results In October, the programme for effi- increased pension expenditure due to of the employee survey continue to show cient emergency care was completed. an altered discount rate. This outcome is strong indices and the staff turnover A certain effect can be seen, which is a negative deviation compared to the among permanent employees is expected to be greater once the emer- budgeted profit requirement by decreasing. The financial conditions, gency ward is moved to new premises in SEK 121 million, corresponding to 2.2 with revaluation of agreements of one 2020, and the x-ray operation becomes per cent of turnover. Including items per cent, are very limited, and the hospi- an integral part of the emergency ward. affecting comparability, the loss tal has identified a need to reduce staff- By reducing stress and anxiety in amounted to SEK –361 million. ing by approximately eight per cent. Due patients and relatives, the goal is to The greatest deviation from budget is to this need, the hospital issued notice relieve the staff and improve both their due to increased staff expenditure relat- in November for termination of 100 working environment and the patient’s ing to an increased number of full-time positions. In December, the hospital experience. equivalents in an attempt to maintain board decided on a measure programme availability. The increase in the number corresponding to SEK 300 million for Financial outcome of full-time equivalents is found pri- 2020 with the aim of achieving a sus- Considering the financial situation of marily within the groups assistant tainable operation and balanced Södersjukhuset AB:s prior to 2019, a nurses, doctors and administrative finances in the long term. measure programme was drawn up for staff. Expenditure has also increased the year comprising SEK 134 million, for pensions and hired staff. The drug Investments of which SEK 98 million, or 73 per cent, expenditure is increasing within The expenditure for the year, excluding had been completed at the end of the oncology, internal medicine, cardiology, strategic equipment investments, year. The measures were primarily Sachs’ Children’s Hospital, and the skin amounted to SEK 53 million and was taken within the areas of staffing and and eye clinic. Drugs for the oncology SEK 139 million under budget. The con- drugs. Further measures were decided operation represent 40 per cent of the version rate was 28 per cent in relation in October in the form of an employ- hospital’s total pharmaceutical budget. to the year’s budget of SEK 192 million. ment stop with a dispensation proce- Changed recommendations and altered The deviation is due to factors such as

Goal Södersjukhuset AB Board Goal Council Indicator Outcome target achievement* target Proportion of patients who have spent no more than four hours in the emergency ward 38 % ≥ 50 % Not fulfilled ● ≥ 78 % Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 74 % – Fulfilled ● ≥ 73 % Proportion of patients who receive an appointment for treatment within 90 days 95 % – Fulfilled ● ≥ 90 % Prevalence of healthcare-associated infections 6.4 % ≤ 7.9 % Fulfilled ● ≤ 7.9 % Number of days that patients who have completed medical treatment remain in hospital 6.2 – Not fulfilled ● ≥ 3

*Goal achievement is measured in relation to the board’s target, and if no such target has been set, to the council’s target.

Financial outcome for Södersjukhuset AB Adjustment Outcome Deviation Profit/loss* for interest incl. Budget Deviation percentage Outcome SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 Södersjukhuset AB –360.6 249.0 –111.6 9.4 –121.0 –2.2 % –51.6

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

72 Annual Report 2019 Companies reconstruction and savings, which have Danderyds Sjukhus AB indicator target was therefore not meant that investments have not been Danderyds Sjukhus AB is one of Region attained. The hospital is conducting made according to budget. The total Stockholm’s emergency hospitals, which active efforts to reduce the number of investment expenditure for the year is responsible for specialised emergency healthcare-associated infections, for consisted of replacement investments care, planned somatic specialist care, as example by analysing in which patient for medical equipment, amounting to well as highly specialised rehabilitation process infections occur, correct man- SEK 413 million. medicine. The operation includes the agement of risk factors along with skills healthcare and services contracted by development. Digitalisation the Healthcare Committee, owner or Danderyds sjukhus AB did not attain Södersjukhuset AB has been working to other clients. the target for the number of days that improve the patient experience prior, patients who have completed treatment during and after planned orthopaedic Goal and indicators remain in hospital. The indicator was surgery. One insight is that with the help Danderyds Sjukhus AB attained the new in 2019, and the hospital did not of digitalisation, 30 per cent of patients targets for one of the five indicators that have time to implement it within all would not need to visit the hospital on the company was aiming for under the operations. However, the company did the day of admission. The project has overall goal for the health service. Four work on the hospital’s discharge pro- already entailed time savings for both of the indicators were not fulfilled. cess, through healthcare coordinators employees and patients. Projects are Danderyds Sjukhus AB did not attain and network meetings with collabora- also underway to connect the new solu- the target relating to waiting times in tion stakeholders. The hospital was tion to a form in the medical record sys- the emergency ward. Since the redirec- working to develop more efficient work- tem that is expected to make it possible tion of ambulances from Karolinska ing methods relating to the Act on for fewer patients to see an anaesthetist University Hospital in Solna began, the Cooperation during Discharge from prior to surgery. emergency ward has been receives a far In-patient Healthcare. Targeted initia- The “Always Open” solution has been greater number of sick patients, who tives were carried out relating to the tested during 2019 within one area of often need to be cared for by large network medical care to ensure that the operation. The pilot has been very teams. In order to shorten the waiting patients are treated at the right institu- successful, and planning is underway to periods, the hospital introduced new tion. Regular meetings were held with introduce the system elsewhere. working methods in 2019, primarily for municipalities, advanced home care and A pilot for “Digital Employee” has been the admission of patients. geriatric operations, where patient flows carried out and time-consuming man- Danderyds Sjukhus AB attained the were reviewed and improvements were ual tasks, such as transferring informa- target relating to waiting periods for a made based on the reported deviations. tion from one system to another, is now first appointment with a specialist, and carried out by software instead. is working actively to further improve Healthcare production In its report, Södersjukhuset AB the outcome, primarily through produc- Danderyds Sjukhus AB has been work- highlights shortcomings in infrastruc- tion planning and altered working ing continuously to find a way to move ture as a strongly limiting factor for the methods. in-patient care to out-patient care, a hospital’s digitalisation initiatives. Danderyds Sjukhus AB had good process referred to as polyclinisation, availability of treatment, but did not where the cardiac clinic has provided an Instructions entirely attain the target for the indica- example. This work has meant that the In 2019, Södersjukhuset AB worked tor. During 2019, collaboration between hospital has been able to care for more with six instructions issued to the com- the surgery specialties improved, which patients without increasing the number pany by the Regional Executive Com- increased the degree of use for the hos- of beds. mittee. The Regional Management’s pital’s surgical capacity. Measures Following extensive preparations, assessment is that the hospital has included starting surgeries earlier in the the hospital opened the new emergency essentially worked with the guidelines morning, in order to improve availabil- care building, which is now fully opera- and instructions given by the Regional ity and reduce the number of cancelled tional and functional. The production Executive Committee in conjunction surgeries, and to increase the number of and quality remained at a high level with the interim report of 2019. The polyclinical surgeries. during the redirection, and the goal instructions were implemented with The number of healthcare-associated achievement was high. The emergency deviations relating to the financial infections increased compared to the care building is an important condition outcome. year before. However, the number of for the hospital’s altered emergency care infections acquired in hospital was assignment, with more severely ill reduced. The outcome of 6.1 per cent patients. exceeded the company’s own target of The healthcare production was 3.7 6.0 per cent, but was below the Regional per cent under budget for the period37, Council’s target of 7.9 per cent, and the measured as the number of appoint-

37 Processing of the target volumes for 2019 was completed in April, and comparisons are made in relation to these volumes.

Companies Annual Report 2019 73 ments, an 2.6 per cent lower in terms of The average care period within the an altered discount rate, which is a the number of in-patient events. in-patient care was 3.1 days, which is negative deviation compared to the In relation to the corresponding period slightly lower than the year before. budgeted profit requirement by SEK 165 in the year before, the number of visits Healthcare production relating to million or 3.6 per cent of turnover. to out-patient care increased by 2.0 per out-of-county and foreign patients in Including items affecting comparability, cent, and the number of medical care out-patient care was 6.2 per cent over the loss amounted to SEK –353 million. events increased by 3.0 per cent. The budget, and in the in-patient care it was The largest budget deviation was reduction is explained primarily by 4.9 per cent over budget. The number of the result of increased expenditure for fewer beds, a more complex mix of births increased by 1.1 per cent com- in-house and hired staff. The goal of patients, increased polyclinisation and pared to the previous year. keeping beds open in the summer the transfer of activities to the new affected the staff expenditure both in emergency care building, which Financial outcome terms of overtime for regular staff and impacted on the planned (elective) care. During the year, Danderyds Sjukhus AB the need for hired staff. Costs relating to Within out-patient care, the reduction is took further measures to improve the laboratory services, materials, IT ser- explained by the emergency visits not financial situation, for example within vices, as well as premises and properties increasing to the extent budgeted for, the programme A Sustainable Danderyd deviated negatively from the budget. while the burden of care within the Hospital. The hospital's action areas are The increased expenditure referring to emergency out-patient care has skills provision and skills development, material and laboratory services was a increased following the transfer of new working methods and healthcare result of the hospital’s altered patient patients from Karolinska University forms, digitalisation, in- and outflow to/ mix and the increased burden of care. Hospital in 2018. from the emergency hospital and finan- Danderyds Sjukhus AB’s work to Other explanations for production cial management with an extended attract, maintain and develop their within out-patient care not reaching the action programme. The measures had employees indicate a positive outcome. budgeted volumes is the exchange of an effect of SEK 85 million during the The results of the employee survey care according to the “LEON” principle, year, but despite the measures being continue to show strong indices and the which states that patients shall be generally in accordance with the estab- staff turnover among permanent treated at the lowest effective level lished action programme, it was not employees is decreasing. Since the of care, and changed registration enough to achieve balanced finances. hospital submitted a negative forecast procedures from individual visits to The hospital had a loss of during the year, and the financial “thematic visits”. In addition, distance SEK –158 million, excluding items conditions, including a revaluation of visits, such as wireless pacemaker affecting comparability, relating to agreements, are very limited, further check-ups, are not registered as visits. increased pension expenditure due to measures were taken to achieve a finan-

Goal Danderyds Sjukhus AB Board Goal Council Indicator Outcome target achievement* target Proportion of patients who have spent no more than four hours in the emergency ward 45 % ≥ 78 % Not fulfilled ● ≥ 78 % Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 90 % ≥ 90 % Fulfilled ● ≥ 73 % Proportion of patients who receive an appointment for treatment within 90 days 87 % ≥ 90 % Not fulfilled ● ≥ 90 % Prevalence of healthcare-associated infections 6.1 % ≤ 6 % Not fulfilled ● ≤ 7.9 % Number of days that patients who have completed medical treatment remain in hospital 3.8 ≥ 3 Not fulfilled ● ≥ 3

*Goal achievement is measured in relation to the board’s target, and if no such target has been set, to the council’s target.

Financial outcome for Danderyds Sjukhus AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 Danderyds Sjukhus AB –352.9 194.5 –158.4 6.5 –164.9 –3.6 % -84.1

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

74 Annual Report 2019 Companies cially sustainable operation in the long assessment is that the hospital has worked in close collaboration with pri- term, such as the implementation of essentially worked with the guidelines mary care and municipalities to reduce an employment stop and notices of and instructions given by the Regional the number of days that patients who termination. Executive Committee in conjunction had completed their medical treatment with the interim report of 2019. The remained in hospital. However, the tar- Investments instructions were implemented with get for this indicator was not attained. The investment expenditure for the deviations relating to the financial year, excluding strategic equipment outcome. Healthcare production investments, amounted to SEK 96 During the spring of 2019, new beds million and was SEK 27 million over Södertälje Sjukhus AB opened up within emergency somatics budget. The conversion rate was 137 per Södertälje Sjukhus AB is one of Region and geriatrics, and in the autumn, the cent. Expenditure comprised invest- Stockholm’s emergency hospitals, which emergency somatic nursing wards were ments in the patient monitoring system is responsible for specialised emergency moved into new and modern premises. PAMS and replacement investments for care and planned somatic specialist The healthcare environment of single medical equipment. The deviation is care. The operation involves the health- rooms offers privacy and stimulates due to a delay in the PAMS investment. care and services contracted by the recovery, while these premises give an The expenditure for the year, including Healthcare Committee, owner or other improved work environment and ena- strategic equipment investments was clients. bles more efficient working methods. SEK 612 million. Even so, the hospital had an average Goal and indicators occupancy rate of 100.6 per cent of dis- Digitalisation Södertälje Sjukhus AB attained the tar- posable beds. The number of patients Danderyds Sjukhus AB has created an gets for three of the five indicators that seeking emergency care, including the interdisciplinary meeting forum to the committee was aiming for under the emergency ward and local emergency improve control of the digitalisation overall goal for the health service. Two clinics, has increased, and the waiting efforts. The aim is to capture, discuss of the indicators were not fulfilled. times in the emergency ward have dete- and make decisions regarding the The hospital’s emergency ward had riorated. The hospital still has a high initiatives proposed by operations. an increased influx of both visitors and staff turnover for nurses within the 24/7 Such initiatives are often assessed in ambulances. In combination with the operation. pilot formats, after which their benefits entire hospital having a high level of The healthcare production was 12.7 are evaluated. When the results are occupancy, the duration of stays in the per cent under budget, measured as the positive, the initiatives are then imple- emergency ward was negatively number of out-patient appointments, mented, for example in clinical opera- impacted by patients to an increasing but 5.9 per cent over budget in terms of tions. extent being treated in the emergency the number of in-patient events. The There are two major initiatives cur- ward. An employee-run project directed fact that the number of in-patient events rently underway at the hospital relating towards patients over the age of 80 is over budget is largely due to an to artificial intelligence (AI). One is a years was implemented with excellent increase in the proportion of patients system that can assist in the assessment results for the waiting periods of elderly arriving by ambulance and subse- of invoices, and which since the autumn patients. quently being admitted . In relation to 2019 is part of orthopaedic clinical oper- The availability of specialists was the previous year, the number of out-pa- ations. The other is a unique study by good. The proportion of patients who tient appointments increased by 4.0 per the cardiac clinic, Cleos, which exam- received a first appointment with a spe- cent and the number of in-patient events ines whether digital patient history38 cialist within 30 days attained the target increased by 7.4 per cent. The deviation can lead to a more certain diagnosis and set by the Regional Council as well as compared to budget in out-patient care make the health service more efficient. the higher target set by the company. is due partly to lower volumes than cal- The study means that the questions The proportion of patients who culated for the local emergency clinic’s asked to each patients are gradually received an appointment for treatment paediatric activities, and partly to the adapted, through an advanced algo- within 90 days was 94.8 per cent, and target volume in the transition agree- rithm, to the patient’s previous the target for the indicator was therefore ment, which the hospital management responses to ensure that all relevant attained. The situation with available finds excessive. questions are asked. beds and high occupancy during the Healthcare production relating to summer had a negative impact on avail- out-of-county and foreign patients has Instructions ability. increased in both out-patient and in-­ In 2019, Danderyds Sjukhus AB worked The occurrence of healthcare-associ- patient care, by 11.0 and 9.1 per cent with six instructions issued to the com- ated infections was four per cent, and respectively. The number of births pany by the Regional Executive Com- the target for the indicator was attained. decreased by 1.5 per cent compared to mittee. The Regional Management’s Discharge teams and healthcare staff the previous year. The average care

38 Patient history is a compilation of information that is important for diagnostics and care.

Companies Annual Report 2019 75 period was 3.16 days, which is slightly nurses, along with skills development is planned for 2020 relating to care in higher than the year before. activities for assistant nurses. The hos- the home for patients with cardiac pital has developed and action pro- insufficiency. The project aims to rein- Financial outcome gramme within each operation in order force the hospital’s capacity to imple- One of Södertälje Sjukhus AB’s greatest to keep its finances in balance over the ment measures in the home through challenges is to recruit and keep coming year as well. digitalisation and cooperation, and to employees, and primarily nurses work- create joint healthcare processed ing in the 24/7 operation. In order to Investments between specialised care, primary care achieve balanced finances, the hospital The expenditure for the year, excluding and municipal social care. management decided during the strategic equipment investments, autumn to implement an employment amounted to SEK 28 million and was Instructions stop within all professional categories SEK 6 million over budget. The figure In 2019, Södertälje Sjukhus AB worked and a stop on hiring temporary staff. consists of replacement investments with five instructions issued to the com- Södertälje Sjukhus AB reported a relating to x-ray equipment and medical pany by the Regional Executive Com- loss of SEK –29.5 million. Excluding equipment. The conversion rate was 127 mittee. The instructions were imple- items affecting comparability relating to per cent in relation to the year’s budget mented without deviations. increased pension expenses as a result of SEK 22 million. The deviation is due of a changed discount interest, was to a delivery of x-ray equipment being SEK 22.8 million, deviating positively postponed from 2018 to 2019 due to S:t Eriks Ögonsjukhus AB from the budgeted profit requirement by technical construction issues. The S:t Eriks Ögonsjukhus AB conducts SEK 19.5 million. The deviation corre- expenditure for the year, including stra- specialised and highly specialised sponds to 1.3 per cent of turnover. The tegic equipment investments was emergency and planned eye care. The positive deviation is primarily due to SEK 70 million. operation includes the services con- increased revenue from patient fees, tracted by the Healthcare Committee, sale of other services and lower staff Digitalisation owner or other clients. The hospital is expenditure. A new solution for communication tele- commissioned as a university hospital Södertälje Sjukhus AB is working vision enables communication with the with extensive research, development actively to reduce its dependence on patient. A new card payment solution and training activities in collaboration hired staff, and the establishment of an with contactless payment has been with Karolinska Institutet. The hospital in-house staffing centre is underway. In introduced. A preliminary study relat- is also conducting national healthcare order to reduce staff turnover, a compe- ing to distance diagnostics in the home within eye oncology, childhood cataract tence ladder is being introduced for has been conducted, and a pilot project and childhood glaucoma.

Goal Södertälje Sjukhus AB Board Goal Council Indicator Outcome target achievement* target Proportion of patients who have spent no more than four hours in the emergency ward 67 % ≥ 75 % Not fulfilled ● ≥ 78 % Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 91 % ≥ 90 % Fulfilled ● ≥ 73 % Proportion of patients who receive an appointment for treatment within 90 days 95 % ≥ 90 % Fulfilled ● ≥ 90 % Prevalence of healthcare-associated infections 4.0 % ≤ 7.9 % Fulfilled ● ≤ 7.9 % Number of days that patients who have completed medical treatment remain in hospital 3.6 ≥ 3 Not fulfilled ● ≥ 3

*Goal achievement is measured in relation to the board’s target, and if no such target has been set, to the council’s target.

Financial outcome for Södertälje Sjukhus AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 Södertälje Sjukhus AB –29.5 52.3 22.8 3.3 19.5 1.3 % 11.0

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

76 Annual Report 2019 Companies Goal and indicators sjukhus AB has developed into becom- relating to increased pension expenses S:t Eriks Ögonsjukhus AB attained the ing increasingly complex and highly as a result of a changed discount inter- targets for four of the indicators that the specialised. The hospital has been est, was SEK 56 million, deviating posi- company was aiming for under the over- striving to ensure that patients receive tively from the budgeted profit require- all goal for the health service. care at the right level and that as much ment by SEK 23 million. The deviation The availability in the emergency as possible of that care being provided corresponds to 3.4 per cent of turnover. ward was very high in 2019. On average, during one and the same contact, so that The surplus was primarily due to 96.4 per cent of the patients waited no the patient does not need to come back increased revenue relating to out-of- longer than four hours, and the target for further visits. county patients and lower costs for for the indicator was therefore not The healthcare production was materials and other expenses. attained. under budget in terms of both the num- During the year, the hospital contin- The availability for new visits was also ber of visits, 3.8 per cent, and the num- ued the positive development of revenue good. On average, 93.5 per cent of patients ber of medical care events, 5.2 per cent. from out-of-county healthcare, which received a first appointment with a spe- In comparison to the previous year, the increased by 4.3 per cent. This revenue cialist within 30 days, and the target for number of out-patient appointments corresponding to a total twelve per cent the indicator was thereby achieved. decreased by 2.4 per cent and the num- of total turnover. The hospital had more The availability of surgery and treat- ber of medical care events was reduced full-time equivalents, and thereby a ment has improved during the autumn. by 2.5 per cent. The deviation compared staff expenditure over budget. The devi- On average, 98.9 per cent of patients to the budget and the year before was ation is primarily due to the prepara- received a first appointment for treat- mainly due to continued polyclinisation tions made ahead of the move to new ment within 90 days, and the target for of in-patient care and to more measures premises during 2020 and to more the indicator was thereby achieved. The being taken per out-patient visit. The nurses being recruited to ensure skills waiting period for surgery and treat- average care period was reduced from provision of eye and surgery nurses. ment was negatively impacted by diffi- 3.31 to 3.16 days compared to the year culties in recruiting surgical nurses. before. The healthcare production Investments No healthcare-associated infections relating to out-of-county and foreign The investment expenditure for the year were noted in the year’s survey. patients decreased in out-patient care amounted to SEK 33 million and the by 5.0 per cent and in in-patient care by conversion rate was 110 per cent in rela- Healthcare production 7.5 per cent. tion to the year’s budget of SEK 30 mil- During the year, the hospital fulfilled lion. The expenditure consisted of new the healthcare guarantee relating to Financial outcome investments of SEK 20 million for the waiting periods for surgery and waiting S:t Eriks Ögonsjukhus AB maintained new eye hospital and replacement periods for new doctor’s appointments. balanced finances in 2019. The profit, investments in medical equipment, IT The healthcare at S:t Eriks Ögon­ excluding items affecting comparability and other inventory of SEK 13 million.

Goal S:t Eriks Ögonsjukhus AB Board Goal Council Indicator Outcome target achievement* target Proportion of patients who have spent no more than four hours in the emergency ward 96 % ≥ 78 % Fulfilled ● ≥ 78 % Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 94 % ≥ 73 % Fulfilled ● ≥ 73 % Proportion of patients who receive an appointment for treatment within 90 days 94 % ≥ 90 % Fulfilled ● ≥ 90 % Prevalence of healthcare-associated infections 0.0 % ≤ 2.0 % Fulfilled ● ≤ 7.9 %

*Goal achievement is measured in relation to the board’s target, and if no such target has been set, to the council’s target.

Financial outcome S:t Eriks Ögonsjukhus AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 S:t Eriks Ögonsjukhus AB 22.7 33.0 55.7 33.0 22.7 3.4 % 48.4

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

Companies Annual Report 2019 77 Digitalisation dental care. The number of treated chil- strained, partly due to the number of Applicable legislation has been a chal- dren and young people also exceeded old-age retirements being higher than lenge for the hospital’s digitalisation the budget by 2.5 per cent. the number of graduates, and partly due efforts. One initiative with great poten- Folktandvården Stockholms län AB to increased competition from other tial for resource efficiency in the eye has introduced a new procedure for dental health providers on the market. oncology operation has been paused due children who do not come to their dental Given the difficult recruitment situa- to current legislation being an obstacle care appointments. A more clear com- tion and the need to keep existing to collaboration with an external sup- munication has been established with employees, all of Folktandvården’s plier. This initiative related to screening parents regarding the children’s right to employees participated in a number of for uveal melanoma (eye cancer) using dental care, which has had an effect for different lectures during the Swedish artificial intelligence. An initiative younger children. The number of Dental Association’s national conven- involving eye pressure measurement in treated adults decreased by 3.1 per cent tion, which was held at Stockholmsmäs- the home for patients with glaucoma has compared to the year before and was 2.2 san. The training initiative, which cost also been paused. per cent below budget. The reduction is SEK five million within Folktand- explained partly by the larger number of vården’s skills development budget, was Instructions registered children and young people carried out with the aim of reinforcing In 2019, S:t Eriks Ögonsjukhus AB due to the added age group, and partly to the sense of community and to be an worked with five instructions issued to difficulties recruiting dental health pro- attractive employee. the company by the Regional Executive fessionals. Many new recruits are also Folktandvården Stockholms län AB’s Committee. The instructions were lacking experience, which has had a profit amounted to SEK 52.5 million. implemented without deviations. negative impact on production. The Excluding items affecting comparabil- number of treated children and adults ity, relating to increased pension within specialised dental care expenditure due to an altered discount Folktandvården decreased by 3.2 per cent compared to rate, the profit amounted to SEK 112.5 Stockholms län AB the year before and was 7 per cent below million, which is in accordance with the Folktandvården Stockholms län AB budget. The reduction is largely due to budgeted profit requirement. provided public dental care within great difficulties in recruiting special- Folktandvården Stockholms län AB Region Stockholm in accordance with ists within several areas. is working continuously to streamline the region’s responsibilities in accord- all parts of the operation, which has ance with the Dental Care Act. The com- Financial outcome meant that they for a long time have pany also carries out commissions on During the year, Folktandvården been working with a slightly under-­ behalf of the Healthcare Committee, Stockholms län AB worked hard during dimensioned organisation. With mainly within paediatric dental care. the year to attain the profit requirement reduced revenue relating to a strained set by the council, both through staffing situation and lowered compen- Healthcare production restricted expenditure and through an sation for specialist care for children, The age limit for free dental care has active effort to increase revenue. The in combination with the effects of the been raised from 22 to 23 years, and the work was made more difficult due to the reform raising the age for free dental number of treated children and young increased age limit for free dental care care, the company expects to have great people increased by 9.9 per cent during for children and young people, which challenges in attaining the council’s the year compared to the year before. has meant that the clinics have had less profit requirement in the future. During This is primarily explained by the num- time to treat adult patients. The adult 2020, the company will continue its ber of registered children and young rate is higher than the child rate, and the work with digitalisation and to develop people having increased, primarily company’s profitability has decreased, its brand platform and strategy for skills 23-year-olds, who have been called in despite a maintained production rate. In provision, including active efforts for an accordance with the Region Stockholm addition, the staffing situation with a extensive internal mobility of dental healthcare programme for children’s large staff turnover has been very health professionals.

Financial outcome for Folktandvården Stockholms län AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 Folktandvården 52.5 60.0 112.5 112.5 0.0 0.0 % 112.3 Stockholms län AB

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

78 Annual Report 2019 Companies Investments Ambulanssjukvården i enue and a higher rate of variable com- The expenditure for the year amounted Storstockholm AB pensation for ambulance events. The to SEK 48 million and the conversion Ambulanssjukvården i Storstockholm outcome for staff expenditure was under rate was 48 per cent in relation to the AB (AISAB) provides ambulance care budget. More employees were recruited year’s budget of SEK 100 million. The services on behalf of Region Stockholm, in the latter half of 2019 in order to start expenditure comprised replacement and can carry out interhospital trans- two 24/7 units in early 2020. The com- investments and new investments, as ports and transport the bodies of the pany’s operating expenditure was well as 3D printers for Folktandvården deceased for Region Stockholm. The SEK 2 million, or 0.5 per cent, over Stockholms län AB’s prosthetics lab, operation includes the services con- budget, which is partly due to increased new payment stations and microscopes tracted by the Healthcare Committee, material expenses, expenses relating to for several clinics. The deviation for the owner or other clients. the move to new premises and increased year is largely due to planned recon- rent for the new premises. struction in externally rented premises Healthcare production not having to be carried out as budgeted. As of February 2019, AISAB received Investments new and extended commissions and The expenditure for the year amounted Digitalisation contracts entailing an increase of the to SEK 23 million and the conversion During 2019, Folktandvården operation by 15 per cent. The contract rate was 82 per cent in relation to the Stockholms län AB broadly introduced extensions occurred at a slightly lower year’s budget of SEK 28 million. The intraoral scanning. This means scan- rate than was originally planned, but expenditure consisted of investments in ning the mouth, rather than making an the capacity is gradually increasing. ambulance vehicles and investments impression in a soft mould which is then The healthcare production was 8.3 due to the move to new premises in left to harden in the mouth, a procedure per cent over budget, measured as the Rissne. The deviation is due to delayed that has increase customer comfort. number of ambulance events, but 3.7 per deliveries of new ambulance vehicles. The method is also quicker, and the cent lower in terms of the number of 3-dimensional image produced is more transport of the deceased. In compari- Digitalisation exact. As part of meeting the customers’ son to the previous year, the number of During 2019, AISAB was still working rapidly increasing preference for digital ambulance events increased by 0.6 per on developing and launching an online communication, all appointment cent and the number of deceased trans- platform and a new system for digital notices are now sent digitally via text port events was reduced by 2.7 per cent. training operations. The aim is to create message. a digital workplace for improved com- Goal achievement regarding digitali- Financial outcome munication and more clear information sation is measured through employee The profit, excluding items affecting for control, management and operating surveys and customer surveys and the comparability relating to increased pen- activities. The solution is also to facili- outcome for 2019 is very positive. sion expenses as a result of a changed tate individual digital skills develop- discount interest, was SEK 26 million, ment, primarily for ambulance staff. Instructions deviating positively from the budgeted In 2019, Folktandvården Stockholms profit requirement by SEK 14 million, Instructions län AB worked with six instructions which corresponds to 3.7 per cent of In 2019, AISAB worked with six instruc- issued to the company by the Regional turnover. tions issued to the company by the Executive Committee. The instructions AISAB’s total revenue amounted to Regional Executive Committee. The were implemented without deviations. SEK 13 million, or 3.4 per cent, over instructions were implemented without budget thanks to increased training rev- deviations.

Financial outcome Ambulanssjukvården i Storstockholm AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 Ambulanssjukvården i 21.3 4.9 26.2 12.0 14.2 3.7 % –8.2 Storstockholm AB

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

Companies Annual Report 2019 79 Stockholm Care AB pension expenses as a result of a MediCarrier AB Stockholm Care AB acts as an interme- changed discount interest, the profit was MediCarrier AB makes orders, stores, diary for foreign patients, primarily SEK 1.7 million, deviating positively packages and distributes medical sup- to the highly specialised healthcare from the budgeted profit requirement. plies and consumables to the operations operations within Region Stockholm, The deviation corresponds to one per within Region Stockholm. The operation which are thereby able to improve their cent of turnover. Both revenue and is commercial. development opportunities through an expenditure were under budget, which extended patient base. The company was primarily the result of a lower Financial outcome also assists the healthcare operations turnover in the foreign operation as a Over the year, MediCarrier AB delivered with support and service of an adminis- result of capacity issues within Region higher volumes in the healthcare flow to trative and practical nature, and Stockholm’s highly specialised care. existing customers, and the revenue manages the Swedish register for from the business area Medical supplies blood-forming stem cells, the Tobias Investments and consumables increased by three per Registry. The expenditure for the year amounted cent. The profit amounts to SEK 3.6 mil- to SEK 3 million compared to the break- lion. Excluding items affecting compara- Healthcare production even budget for the year. bility, relating to increased pension The foreign healthcare is affected by the expenditure due to an altered discount capacity shortage in the health service, Digitalisation rate, the profit amounted to SEK 5.1 which limits the possibilities of receiving During the year, digital forms were million, which is in accordance with international patients for specialised developed for healthcare requests, the council’s profit requirement of and highly specialised care. The Tobias which is assessed to have made the SEK 5 million. In order to ensure fulfil- Registry continued to develop, however. operation more efficient by significantly ment of the profit requirement, meas- The number of confirmatory typings reducing the unqualified and irrelevant ures were taken within ongoing develop- (CT) of potential donors increased by 22 healthcare requests. The possibility of ment projects, and planned development per cent compared to the previous year. using e-invoices was also introduced. initiatives were paused or postponed. The number of confirmatory typings is an important indicator of future sales of Instructions Investments stem cell harvests. The Tobias Registry In 2019, Stockholm Care AB worked The investment expenditure for the mediated 108 stem cell harvests, which with three instructions issued to the year amounted to SEK 3 million, which is an increase of 27 per cent compared to company by the Regional Executive corresponds to a conversion rate of 60 the previous year. Committee. The instructions were per cent in relation to the year's budget implemented without deviations. of SEK 5 million. The expenditure com- Financial outcome prised replacement investments in the Stockholm Care AB reported a profit of production, such as purchasing of trol- SEK 0.3 million. Excluding items affect- leys and investments into a reconstruc- ing comparability relating to increased tion of existing premises in Spånga in

Financial outcome for Stockholm Care AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 Stockholm Care AB 0.3 1.4 1.7 0.7 1.0 1.0 % 0.1

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

Financial outcome for MediCarrier AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 MediCarrier AB 3.6 1.5 5.1 5.0 0.1 0.0 % 4.9

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

80 Annual Report 2019 Companies order to accommodate operations from the Property and Service Committee’s During the coming year, work continues the premises in Västberga. The devia- property management. As of March to further develop properties for tion for the year is due to investments 2019, the company is responsible for increased reliability and to ensure col- into a reinforced perimeter protection certain strategic property issues and laboration and communication with could only be implemented to a smaller investments, such as the contract man- customers in order to create appropriate scope than budgeted. agement for Nya Karolinska Solna. healthcare premises.

Digitalisation Goal and indicators Investments MediCarrier AB’s work with digitalisa- Locum AB attained the target for the The expenditure for the year amounted tion is currently intended partly to indicator relating to the proportion of to SEK 2 million and the conversion rate ensure stable and appropriate IT sys- property investments in the health was 40 per cent in relation to the year’s tems, and partly to streamline manual service used for artistic design. budget of SEK 5 million. The expendi- and administrative tasks. During 2019, The proportion of property invest- ture consisted of IT equipment and the company introduced an IT-based ments in the health service used for office furniture. management model and trained supe- artistic design was 1.5 per cent for the rusers for the model. The transport investments completed during the year. Digitalisation department digitalised certain tasks, This is an increase of 0.3 percentage Digitalisation is viewed as a condition to which has streamlined the work and points compared to the outcome in the succeed in the task of providing health- contributed to more reliable deliveries previous year. care buildings. In 2019, the company and more even quality. introduced a new document manage- Financial outcome ment system and developed the prop- Instructions The outcome for Locum AB, excluding erty management system and the Inter- In 2019, MediCarrier AB worked with items affecting comparability, relating net of Things (IoT) for energy-efficient five instructions issued to the company to increased pension expenditure due to care and improved air quality. by the Regional Executive Committee. an altered discount rate amounted to The instructions were implemented SEK 14 million, which is SEK 7 million Instructions without deviations. over budget, corresponding to 1.7 per In 2019, Locum AB worked with six cent of turnover. The deviation is instructions issued to the company by Locum AB explained primarily by lower consul- the Regional Executive Committee. The Locum AB is responsible for ownership tancy fees and IT-related costs com- instructions were implemented without issues relating to property management pared to budget. During the year, the deviations. and financial administration for the company worked systematically to health service properties. The company improve operation and maintenance of also assists the Property and Service the properties, focusing on reinforcing Committee in property strategy issues the relationship with customers and and is responsible for profits relating to increasing customer satisfaction.

Locum Board Goal Council Indicator Outcome target achievement* target Proportion of property investments in the health service used for artistic design 1.5 % ≥ 1 % Fulfilled ● ≥ 1 %

*Goal achievement is measured in relation to the board’s target, and if no such target has been set, to the council’s target.

Financial outcome for Locum AB Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 Locum AB –14.7 28.3 13.6 7.0 6.6 1.7 % 22.4

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

Companies Annual Report 2019 81 AB Stockholms Läns AB Storstockholms Financial outcome Landstings Internfinans Lokaltrafik AB Storstockholms Lokaltrafik’s profit, AB Stockholms Läns Landstings Intern- AB Storstockholms Lokaltrafik (AB SL) excluding items affecting comparability finans is the internal bank of Region is the collective name and brand for the relating to increased pension expenses Stockholm, formerly Stockholm County procured general public transport ser- as a result of a changed discount interest, Council. The company assists Region vice on land in Stockholm county. Via was SEK 621 million, deviating posi- Stockholm, its committees, companies SL, Region Stockholm manages certain tively from the budgeted profit require- and foundations to manage a central contracts and assets. ment by SEK 221 million. The deviation liquidity, borrow on the capital market The company has three wholly-­ corresponds to one per cent of turnover. and carry out internal lending for owned subsidiaries: AB SL Finans, The positive deviation is primarily due the investments. The operation is SL Älvsjö AB and Waxholms Ångfartygs to an increased number of travellers and commercial. AB. AB SL Finans provides vehicles, increased ticket revenue. carriages, machines and other invento- Financial outcome ries and facilities for local transport pro- AB Stockholms Läns Landstings Intern- viders in exchange for compensation. SL finans’ profit amounted to SEK 4 million, Älvsjö AB owns, manages and develops which was SEK 3 million over budget. properties and associated operations. The deviation corresponds to 3.3 per Waxholms Ångfartygs AB (WÅ AB), cent. The deviation is due to the expendi- which is included in the SL group from ture relating to business system and July 2019. WÅ AB handles public trans- investor relations being under budget. port on water in the Stockholm archipel- ago and manages certain contracts and Digitalisation assets on behalf of Region Stockholm. In 2019, the company was working to WÅAB shall continuously conduct the develop the possibilities of distance measures established by the Transport working to enable employees to improve Committee in terms of development of the company’s digital methods. passenger and freight transports in the archipelago. Instructions In 2019, AB Stockholms Läns Landstings Internfinans worked with three instruc- tions issued to the company by the Regional Executive Committee. The instructions were implemented without deviations.

Financial outcome AB Stockholms Läns Landstings Internfinans Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 AB SLL Internfinans 3.2 0.4 3.6 3.0 0.6 3.3 % 4.1

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

Financial outcome AB Storstockholms Lokaltrafik Adjustment Profit/loss Deviation Profit/loss* for interest incl. Budget Deviation percentage Profit/loss SEK millions 2019 effect** adjustment 2019 to budget of turnover 2018 AB Storstockholms 579.3 41.2 620.3 400.0 220.3 1.0 % 479.0 Lokaltrafik

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

82 Annual Report 2019 Companies Companies Annual Report 2019 83 Local federations 11 and foundations

84 Annual Report 2019 Local federations and at a number of health centres and receive a first appointment with a spe- Region Stockholm is a member of local social care operations. cialist within 30 days amounted to 93 federations: per cent, and the target for the indicator • The local federation Sjukvård och Goal and indicators was thereby attained. omsorg i Norrtälje. Tiohundra AB attained six of the seven The proportion of patients who • The local federation Svenskt indicators that the company was aiming received an appointment for treatment Ambulansflyg for under the overall goal for the health within 90 days was 98 per cent, and the • The local federation Avancerad service. One indicator was not attained. target for the indicator was therefore Strålbehandling. During the year, Norrtälje hospital attained. had several new employees, which The proportion of patients who con- In accordance with the Local Govern- entailed longer stays in the emergency tracted a healthcare-associated infection ment Act, local federations can from ward. However, the target for the pro- at Norrtälje hospital was 5.6 per cent, most aspects be considered individual portion of patients who spent no more and the indicator achieved the target. municipalities; for example, they are than four hours in the emergency ward Patients who had completed medical subject to the same rule as municipali- was attained. The hospital wards also treatment remained in hospital for an ties for any deficits to be balanced had a lot of new staff, which contributed average of 2.3 days in 2019. This is fewer within three years. to it taking longer for patients to be days compared to other emergency received on a ward. wards in Region Stockholm, which The local federation Sjukvård The proportion of patients who meant that the target for the indicator och omsorg i Norrtälje. received an appointment with a family was achieved. The outcome was largely The local federation Sjukvård och doctor within three days was lower than due to effective collaboration with omsorg i Norrtälje (KSON) comprises the target, but due to technical difficul- KSON’s benefit department and two members: Region Stockholm and ties, the measure does not refer to the between the hospital and the municipal- Norrtälje Municipality. KSON plans and entire year. A lack of resources reduced ity’s nursing homes. This in turn was orders health and medical care as well availability during the summer. Tiohun- assessed to be the result of the “Norrtälje as social care in Norrtälje municipality. dra AB is working to design and intro- model” on which KSON is based. KSON also owns the company Tiohun- duced new work processes to fulfil the All of Tiohundra AB’s health centres dra AB, which is responsible for health healthcare guarantee. were working to promote health, and the service operations at Norrtälje hospital The proportion of patients who target for the indicator was attained.

Goal Tiohundra AB Management Goal Council Indicator Outcome target achievement* target Proportion of patients who have spent no more than four hours in the emergency ward 78 % – Fulfilled ● ≥ 78 % Proportion of patients who received an appointment with a family doctor within three days 72 % – Not fulfilled ● ≥ 90 % Proportion of patients who receive an appointment for a first visit with a specialist within 30 days 93 % – Fulfilled ● ≥ 73 % Proportion of patients who receive an appointment for treatment within 90 days 98 % – Fulfilled ● ≥ 90 % Prevalence of healthcare-associated infections 5.6 % ≤ 7.7 % Fulfilled ● ≤ 7.9 % Number of days that patients who have completed medical treatment remain in hospital 2.3 – Fulfilled ● ≥ 3 Proportion of family doctor’s clinics conducting active disease prevention 100 % – Fulfilled ● ≥ 75 %

*Goal achievement is measured in relation to the board’s target, and if no such target has been set, to the council’s target.

Healthcare consumption, local federation Sjukvård och omsorg i Norrtälje. Profit/loss Budget Deviation Profit/loss Change 2019 2019 budget 2018 % Medical care events 9,975 10,180 –2.0 % 10,300 –3.2 % Doctor’s appointments 221,534 238,000 –6.9 % 223,550 –0.9 % Appointments with other 340,435 375,000 –9.2 % 349,600 –2.6 % healthcare providers

* Excluding KSON.

Local federations and foundations Annual Report 2019 85 Training in various diagnoses was reduced by 3.5 per cent. One reason for produced a balance sheet for liquida- offered and all health centres offered the reduction in out-patient care tion, which was adopted by a first gen- lifestyle consultations. The screens in appointments was the introduction of a eral meeting for liquidation on 23 May the health centre waiting rooms provide new referral support in the emergency 2019, in accordance with the Companies information and health tips for resi- ward during the summer. Within pri- Act. The law requires the equity to be dents. mary care, the number of doctor’s restored to correspond to the entire appointments was lower than budgeted, share capital within eight months. A Healthcare consumption which was primarily due to fewer physi- second general meeting for liquidation During 2019, the residents of Norrtälje cian’s hours than planned. The average established on 18 December that the Municipality consumed 3.2 per cent period of care increased compared to share capital has been restored to fewer medical care events than in the the previous year, from 3.28 to 3.44 SEK 17.3 million. year before. Just as at other emergency days, which corresponds to 2.1 per cent. In the annual accounts for 2019, hospitals within Region Stockholm, Tiohundra AB has been injected with a the hospital is working to develop the Financial outcome shareholder contribution of SEK 48.2 operation, and new working methods KSON’s outcome for the year was nega- million through the members of the were introduced during the year. Out of tive, amounting for Region Stockholm local federation, where Region Stockholm these appointments, 83 per cent were to SEK –45 million, which corresponds contributed SEK 38.6 million. within somatic specialist healthcare, 10 to 6.4 per cent of the turnover. The loss per cent within geriatrics and 7 per cent refers both to the operations of the Instructions within psychiatry. local federation and the operations of In 2019, KSON was given four instruc- The number of doctor’s appoint- Tiohundra AB. tions by the Regional Executive Com- ments was lower than in the previous KSON has been working with a mittee. Region Stockholm did not year, as was the number of visits to other measure programme that had a certain receive any feedback in neither the healthcare providers, such as district impact during the year, and the loss cor- interim report or annual report 2019 on and assistant nurses in family doctor’s responds to the measures that could not how the work is progressing. More clinics, and physiotherapists, speech be taken. Tiohundra AB’s income was indepth work with Norrtälje Municipal- therapists, occupational therapists and lower than planned, among other things ity in regard to KSON is underway. chiropractors. The reduction in the due to lower compensation for residen- number of doctor’s visits is explained by tial care homes and an adjustment of the The local federation Svenskt new compensation models encouraging hospital’s compensation. The staff Ambulansflyg fewer and to some extent longer doctor’s expenditure was higher than planned The aim of the local federation Svenskt appointments, and a shift towards more due to hired staff, the new nurse’s agree- Ambulansflyg (KSA) is to invest in nurse’s visits in cases of less severe ment and the higher cost of overtime. ambulance flights and to operate ambu- conditions. However, on 31 December 2019, the lance flight operations throughout company no longer had any contracts Sweden. All the Swedish regions are Healthcare production at with staffing companies, as several members of KSA. During 2019, KSA Norrtälje hospital successful recruitments of nurses were carried out a procurement of six air- The healthcare production at Norrtälje carried out. The company has also craft, which will be delivered in 2020. A hospital was lower than planned both implemented an action programme, procurement was then initiated relating for in-patient events and out-patient which amounted to SEK 16 million in to flight operators, but this procurement appointments. In comparison to the 2019. was cancelled due to ambiguities in the same period in the previous year, the Tiohundra AB’s negative outcome evaluation model. number of out-patient appointments meant that its equity dropped to below In 2019, Region Stockholm paid a decreased by 0.6 per cent and the num- half of the share capital in March 2019. membership contribution of ber of in-patient care events was The company’s board of directors then SEK 1.2 million. The membership

Financial outcome, local federation Sjukvård och omsorg i Norrtälje. Deviation Profit/loss* Budget Deviation percentage Profit/loss* SEK millions 2019 2019 to budget of turnover 2018 The local federation Sjukvård och –44.8 0.0 –44.8 –6.4 % 7.2 omsorg i Norrtälje. of which refers to Tiohundra AB** –29.5 0.0 –29.5 –3.6 % –3.7

*Refers to Region Stockholm’s share of the profit, which is 50 per cent. **Refers to profit/loss before appropriations and taxes.

86 Annual Report 2019 Local federations and foundations contribution will increase once the proportion of board members appointed The Archipelago Foundation manages ambulance operation is up and running. by Region Stockholm is presented in properties and aims to preserve the KSA’s preliminary profit for the year is parentheses. and the develop- SEK one million. ment of outdoor activities in the archi- The foundation Cancercentrum pelago. Region Stockholm is the princi- The local federation Avancerad Karolinska aims to promote experimen- pal funder of the foundation, which Strålbehandling. tal cancer research. The foundation is receives annual contributions for opera- The aim of the local federation working to promote the development of tions and property maintenance. In Avancerad Strålbehandling is to build individualised cancer treatment, in 2019, Region Stockholm and the foun- and operate a national facility for proton close collaboration with Karolinska dation concluded an agreement relating beam therapy, the Skandion Clinic, University Hospital and Karolinska to operating and investment funds in and to safeguard the opportunities for Institutet. the form of granted contributions in the research and development of operations. period 2020–2023. The local federation is having finan- The foundation Centrum för Molekylär cial issues due to the number of referred Medicin works primarily with research The foundation Flemingsbergs Science patients not reaching the planned level. relating to chronic inflammatory dis- aims among other things to reinforce The regional subscription charge was eases. During the year, the foundation collaboration between the actors in therefore increased as of 2019 from 50 acquired new and advanced molecular Flemingsberg. In the period 2019– to 70 per cent of the Skandion Clinic’s diagnostics. 2022, the foundation is working to pro- expenditure. This improved the finan- mote continued campus development cial conditions for the local federation. The foundation Stockholms läns Äldre- and increased collaboration within The federation reported a preliminary centrum is an interdisciplinary centre areas such as ageing, diversity and loss of SEK –0.9 million for 2019. The for research and development relating health. budget for 2020 entails a deficit of to the health, treatment and care of the SEK –0.1 million. elderly. The Stockholm Concert Hall Founda- tion is to maintain an active music oper- The foundation Stockholms läns ation by giving concerts and to maintain Foundations museum is a county cultural function the Royal Stockholm Philharmonic A foundation is a legal entity, with no with the aim of conducting scientific Orchestra for this purpose. Region owner nor membership, which holds sampling and documentation and to Stockholm is the principal funder of the assets devoted to permanently fulfil a carry out external operations within the foundation, which receives annual con- specific purpose. Foundations are not care of ancient monuments and muse- tributions for operations and property included in the 2019 profit/loss account ums in the county. The council supports maintenance. In 2019, Region Stock- or balance sheet of the regional group, a permutation, i.e. a major change, of holm and the foundation concluded an other than in the form of any contribu- foundation’s statutes. If the permutation agreement relating to operating and tions allocated, which are recognise as is approved by the Legal, Financial and investment funds in the form of granted expenditure in the profit/loss account. Administrative Services Agency, the contributions in the period 2019–2022. The following is a presentation of the operation can be integrated in the foundations that Region Stockholm was administration of the Culture responsible for supervising in 2019. The Committee.

Operating foundations

Foundations where Region Stockholm is the sole founder Foundation where Region Stockholm has co-founders

• The foundation Cancercentrum Karolinska (100 %) • The foundation Stockholms läns museum (44 %) • The foundation Centrum för Molekylär Medicin (100 %) • The foundation Stockholms läns Äldrecentrum (50 %) • The Clara Foundation (0 %)39 • The Archipelago Foundation in Stockholm County (53 %) • The foundation Flemingsberg Science (25 %)

Foundation where Region Stockholm is the principal funder

• The Stockholm Concert Hall Foundation (67 %)

39 As of February 2018, the region does not appoint any members or auditors in the Clara Foundation.

Local federations and foundations Annual Report 2019 87 Financial 12 accounts

88 Annual Report 2019 Profit/loss account

The Regional Group The Region

SEK millions Note 2019 2018 2019 2018 Operating revenue 1 25,036 23,576 13,060 11,876 Operating expenditure 1 –96,220 –92,450 –89,183 –85,106 Depreciation 2 –6,201 –5,742 –2,738 –2,342 Operation’s net expenditure –77,385 –74,616 –78,861 –75,572 Of which are items affecting comparability 6 –159 –439 –220 –440

Tax revenue 3 76,044 72,871 76,044 72,871 General government subsidies and equalisation 3 5,374 4,876 5,374 4,876 Total tax revenue 81,418 77,747 81,418 77,747

Financial revenues 4 68 426 568 624 Financial expenses 5 –2,604 –2,174 –2,106 –2,071 Net financial income/expense –2,536 –1,748 –1,538 –1,447 Of which are items affecting comparability 6 –667 476 – –

Extraordinary items 0 0 0 0 Profit/loss for the year 1,497 1,383 1,019 728

Financial accounts Annual Report 2019 89 Balance sheet

The Regional Group The Region

SEK millions Note 2019 2018 2019 2018 Assets Fixed assets Intangible fixed assets Rights of use and other intangible fixed assets 8 372 347 96 108

Tangible fixed assets Land, buildings and technical facilities 9 68,600 66,348 37,456 35,543 Machines and inventory 10 32,774 26,801 14,662 8,788 Fixed assets under construction, advances relating to tangible fixed assets 11 20,728 23,193 10,040 14,004

Financial assets Financial assets 12 1,147 721 38,520 38,361 Total fixed assets 123,622 117,410 100,774 96,804

Current assets Stores, etc. 301 583 143 435 Current receivables 13 8,011 7,983 11,830 9,488 Current investments 0 0 0 0 Cash and bank balances 3,385 1,894 0 256 Total current assets 11,697 10,459 11,973 10,179

Total assets 135,319 127,869 112,747 106,983

Equity, provisions and liabilities Equity 14 Opening equity 11,573 9,477 9,656 8,228 Other changes in equity – 713 – 700 Profit/loss for the year 1,497 1,383 1,019 728 Total equity 13,070 11,573 10,675 9,656

Provisions Provisions for pensions and similar obligations 15 31,684 28,810 24,207 22,531 Other provisions 16 1,048 1,069 615 622 Total provisions 32,732 29,880 24,823 23,154

Liabilities Non-current liabilities 17 63,766 64,345 52,641 53,155 Current liabilities 18 25,751 22,072 24,608 21,019 Total liabilities 89,517 86,417 77,249 74,174

Total equity, provisions and liabilities 135,319 127,869 112,747 106,983

Pledges and comparable securities none none none none

Contingent liabilities 19 Pension undertakings not recognised in liabilities or provisions 22,610 22,879 22,610 22,879 Other contingent liabilities 1,088 857 16,837 16,256 Total contingent liabilities 23,698 23,736 39,447 39,135

90 Annual Report 2019 Financial accounts Cash flow statement

The Regional Group The Region

SEK millions 2019 2018 2019 2018 Operating activities Profit/loss for the year 1,497 1,383 1,019 728 Adjustment for items not affecting liquidity* 9,121 6,796 4,052 2,610 Funds from operations before changes in working capital 10,618 8,179 5,071 3,338

Increase(-) and decrease(+) of stores and stock 281 –4 293 –21 Increase(-) and decrease(+) in current receivables –480 –279 –1,984 –1,162 Increase(-) and decrease(+) in current liabilities (excl. leasing and lending) 233 480 840 –132 Cash flow from operating activities 10,652 8,376 4,220 2,023

Investment activities Investment in intangible assets –157 –143 –14 –45 Investment in tangible assets –11,936 –12,068 –6,299 –7,402 Sale of tangible assets 71 398 16 398 Sale of financial assets 0 337 0 0 Cash flow from investment activities –12,022 –11,476 –6,297 –7,049

Financing activities New loans 8,786 2,951 6,563 4,792 Amortisation of non-current liabilities –6,219 –1,700 –6,219 –1,700 Change in non-current receivables –426 790 –159 820 Change in lease financing –1,115 –680 0 0 Contributions received 1,835 1,650 1,636 1,369 Cash flow from financing activities 2,861 3,011 1,821 5,281

Cash flow for the year 1,491 –89 –256 255

Cash and cash equivalents at the start of the year 1,894 1,983 256 1 Cash and cash equivalents at year-end 3,385 1,894 0 256

*) Specification of items not affecting liquidity Depreciation 6,201 5,742 2,738 2,342 Changes in provisions 2,153 2,459 969 1,612 Capital gain/loss and disposals 160 –238 30 –332 Other items 607 –1,167 315 –1,012 Adjustment for items not affecting liquidity 9,121 6,796 4,052 2,610

Financial accounts Annual Report 2019 91 Operation accounts

Adjustment Profit/loss Revenue Expenditure Profit/loss* for interest incl. Budget SEK millions 2019 2019 2019 effect** adjustment 2019

Health and medical care Healthcare Committee 66,076.8 –66,019.6 57.2 57.2 0.0 Health Service Steering Committee 427.5 –384.0 43.5 43.5 0.0 Patient Advisory Committee 32.6 –32.2 0.4 0.4 0.0 The local federation Sjukvård och omsorg 1,621.8 –1,666.7 –44.8 –44.8 0.0 of which refers to Tiohundra AB 835.9 –865.4 –29.5 –29.5 0.0 Stockholm County’s Healthcare Area 12,580.0 –12,351.4 228.6 228.6 199.0 Karolinska University Hospital 18,914.7 –20,781.4 –1,866.6 –1,866.6 –280.0 Södersjukhuset AB 5,514.9 –5,875.5 –360.6 249.0 –111.6 9.4 Danderyds Sjukhus AB 4,580.7 –4,933.6 –352.9 194.5 –158.4 6.5 Södertälje Sjukhus AB 1,471.9 –1,501.4 –29.5 52.3 22.8 3.3 S:t Eriks Ögonsjukhus AB 674.6 –652.0 22.7 33.0 55.7 33.0 Folktandvården Stockholms län AB 1,731.9 –1,679.4 52.5 60.0 112.5 112.5 Ambulanssjukvården i Storstockholm AB 390.7 –369.4 21.3 4.9 26.2 12.0 Stockholm Care AB 97.2 –96.9 0.3 1.4 1.7 0.7 MediCarrier AB 923.8 –920.2 3.6 1.5 5.1 5.0 Health service, total 115,039.2 –117,263.6 –2,224.4 596.6 –1,627.8 101.4

Public transport The Transport Committee 32,181.0 –31,611.5 569.6 42.0 611.6 400.0 of which refers to the Public Transport Administration 10,024.8 –10,018.5 6.3 6.3 0.0 of which refers to the Extended Metro Administration 121.8 –121.2 0.5 0.5 0.0 of which refers to AB Storstockholms Lokaltrafik 21,473.6 –20,894.2 579.3 41.2 620.5 400.0 of which refers to Waxholms Ångfartygs AB 560.9 –577.5 –16.6 0.8 –15.8 0.0 The Mobility Service Committee 1,743.7 –1,636.1 107.7 107.7 0.0 Public transport, total 33,924.8 –33,247.5 677.3 42.0 719.3 400.0

The Culture Committee 580.2 –578.2 2.1 2.1 0.0 The Growth and Regional Planning Committee 189.8 –188.8 1.0 1.0 0.0 The Regional Executive Committee 2,928.5 –2,641.7 286.8 286.8 0.0

Properties and Service The Property and Service Committee 6,346.1 –5,861.2 485.0 485.0 359.9 of which refers to the Service Department 1,244.1 –1,244.3 –0.2 –0.2 0.0 of which refers to the Property Department 5,102.0 –4,616.9 485.2 485.2 359.9 Locum AB 387.8 –402.5 –14.7 28.3 13.6 7.0 Properties and Service, total 6,734.0 –6,263.7 470.3 28.3 498.6 366.9

Other The Audit Board 37.3 –37.3 0.0 0.0 0.0 Landstingshuset i Stockholm AB 15.3 –32.0 –16.7 –16.7 –31.3 AB SLL Internfinans 17.4 –14.2 3.2 0.4 3.6 3.0 Group-wide functions Damage account 17.7 –14.2 3.5 3.5 0.0 Group funding 92,348.4 –90,684.9 1,663.5 1,663.5 –1,058.4 Group adjustments –145,310.5 145,940.6 630.1 –667.3 –37.1 0.0 Total profit/loss for all profit centres 106,522.2 –105,025.6 1,496.6 0.0 1,496.6 –218.4

*Refers to profit/loss before appropriations and taxes. **Refers to adjustment of cost effect for changed discount rate relating to pensions with the companies

92 Annual Report 2019 Financial accounts Investment accounts

Deviation Profit/loss Budget compared Profit/loss SEK millions 2019 2019 to budget 2018 Health and medical care Healthcare Committee 10.3 7.0 –3.3 4.4 Health Service Knowledge Management 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 242.5 238.6 –3.9 108.0 Karolinska University Hospital 549.3 351.0 –198.3 346.5 Södersjukhuset AB 413.0 192.3 –220.7 349.4 Danderyds Sjukhus AB 612.2 70.0 –542.2 127.5 Södertälje Sjukhus AB 69.8 22.1 –47.7 66.2 S:t Eriks Ögonsjukhus AB 33.3 30.0 –3.3 18.8 Folktandvården Stockholms län AB 47.8 100.0 52.2 56.0 Ambulanssjukvården i Storstockholm AB 22.9 28.0 5.1 9.0 Stockholm Care AB 3.2 0.0 –3.2 1.7 MediCarrier AB 2.9 5.0 2.1 1.4 Health service, total 2,007.2 1,044.0 –963.2 1,088.8

Public transport The Transport Committee 6,190.5 8,087.8 1,897.3 5,554.0 of which refers to the Public Transport Administration 613.0 346.9 –266.1 284.7 of which refers to the Extended Metro Administration 1,160.3 1,996.5 836.2 1,137.4 of which refers to AB Storstockholms Lokaltrafik 4,338.4 5,696.4 1,357.9 4,078.9 of which refers to Waxholms Ångfartygs AB 78.8 48.1 –30.7 53.0 The Mobility Service Committee 30.2 58.6 28.4 22.2 Public transport, total 6,220.8 8,146.4 1,925.6 5,576.2

The Culture Committee 0.8 7.9 7.1 0.6 The Regional Executive Committee 6.1 721.8 715.7 109.0

Properties and Service The Property and Service Committee 3,685.9 5,800.9 2,115.0 5,434.1 of which refers to the Service Department 227.4 379.8 152.4 144.7 of which refers to the Property Department 3,458.6 5,421.1 1,962.5 5,289.5 Locum AB 2.1 4.5 2.4 2.1 Properties and Service, total 3,688.1 5,805.4 2,117.3 5,436.3

Other The Audit Board 0.0 0.2 0.2 0.1 AB SLL Internfinans 0.0 0.0 0.0 0.0 Other, total 0.0 0.2 0.2 0.1 Total investments 11,922.9 15,725.7 3,802.8 12,210.9

Financial accounts Annual Report 2019 93 Accounting principles

The Annual Report has been produced Association of Local Authorities and Committee is making exceptions from in accordance with the Local Govern- Regions (SALAR) in December during the main rule and instead include inter- ment Act, the Municipal Accounting Act the financial year has been used to est costs in the acquisition value of the (LKBR), and the recommendations of calculate and distribute tax revenue. asset during the construction period, if the Swedish Council for Municipal it can be directly attributed to purchas- Accounting (RKR), which are applicable Depreciation ing, construction or production of an to Region Stockholm as a legal person Depreciation of tangible and intangible asset. The Property and Service Com- and to the summarised accounts. assets for the estimated period of use mittee uses a calculated fictive credit are reported with linear depreciation rate, which entails a departure from the Summarised accounts based on the acquisition value excluding real borrowing interest rate. In 2019, The summarised accounts have been any residual value. The depreciation interest expenses were capitalised for produced in accordance with the pro- starts when the asset is ready to be property investments corresponding to portional consolidation method, which taken into use. SEK 128 million. means that we only include the owned share of municipal group companies’ The following depreciation periods are Corporation tax account items in the consolidated generally applied: The companies within the group accounts. The exception is the associ- Intangible fixed assets 3–10 years Landstingshuset i Stockholm AB and ated company Barnbördshuset Machines and inventories 3–10 years the group AB Storstockholms Stockholm AB, which is consolidated in Buildings See components Lokaltrafik are currently paying no accordance with the equity method. Building inventories 17 years income tax, in accordance with applica- Companies and local federations Rail-bound vehicles 10–30 years ble tax regulations, since the taxable where Region Stockholm has a signifi- Buses 12 years deficit deductions are considerable. cant influence, but which are not Track facilities See components Tax expenditure is only created if the included in the summarised accounts Vessels See components Swedish Tax Agency reassesses the since the operation is of an inconsidera- taxable profit of previous years in any of ble scope, are the local federation No depreciation is applicable to assets the companies. Svenskt Ambulansflyg, ALMI Företags­ such as land and art. In Region Stockholm, the companies’ partner i Stockholm Sörmland AB, deferred taxes are recognised as equity Mälardalstrafik AB and operating Components in the item untaxed reserves. Region foundations. For assets where significant compo- Stockholm’s companies have large taxa- nents have been identified and where ble deficit deductions, which means that Items affecting comparability the difference in the use of such compo- no tax expenditure and no deferred tax An item affecting comparability is nents can be expected to be considera- is created. defined within Region Stockholm as an ble, component depreciation is applied infrequently occurring item exceeding as of 2015. This applies for the following Pensions SEK 100 million. The amount limit has fixed asset categories: In accordance with the Municipal been set with consideration to the Accounts Act, pensions are recognised region’s turnover and operation. One Depreciation in accordance with the municipal mixed exception is capital gains from the sale interval for model. This means that pensions earned Fixed asset components of fixed assets, which are always defined before 1998 are recognised under con- as affecting comparability. The items Track facilities 10–50 years tingent liabilities rather than liabilities defined as affecting comparability in (substructure 40–100 years) or provisions in the balance sheet. 2019 are capital gains, changed interest Buildings, 17–50 years (foundation/ Pensions earned during the year, as well rate in the pension liability and transi- public transport framework 20–50 as paid pensions earned up until 1998, tion expenditure for the implementation y e a r s) are distributed across the profit/loss Plan for the Future regarding Health Vessels 15–30 years account. The committees’ pensions are and Medical Care. (hull 30, alternatively 80 years) calculated in accordance with RIPS (guidelines for calculating pension lia- Tax revenue bilities), which corresponds to a dis- Tax revenue is reported in accordance Borrowing costs count interest of one per cent. with recommendation R2 Revenue from Region Stockholm’s main rule for recog- In Region Stockholm’s company the Swedish Council for Municipal nition of borrowing costs is to charge group, the entire pension liability is Accounting (RKR), The forecast for tax them to the profit for the period they recognised in the balance sheet based deduction published by the Swedish concern. The Property and Service on the K3 regulations. When calculating

94 Annual Report 2019 Financial accounts the pension liability in the financial The separate accounts are available amount for the interest swaps was statement for 2019, we used the Swedish from each operation and at the Region SEK 8,807 million as per 31 December Financial Supervisory Authority’s dis- Stockholm website provided below. 2019. The market value of all the interest count rate for 2020 of 0.3 per cent. • Folktandvården Stockholm län AB, swaps, which comprise hedge instru- For agreements with a coordination telephone +46 (0)8-123 166 00 ments in the hedge contracts, amounted clause, the calculation is based on the • Karolinska Universitetssjukhuset, to SEK –558 million. conditions that are known at the time telephone +46 (0)8-517 700 00 During the financial year 2019, the of producing the financial statement. • https://www.sll.se/om-regionstock- interest expenditure for the hedge If nothing emerges to the contrary, holm/ekonomi/finansiella-rapporter/ instruments was SEK 209 million. The the calculation assumes that no coordi- interest expenditure refers to the net nation will occur. Derivatives and hedge amount of the paid, received and Fixed-term appointments entitling accounting accrued interest of all the swaps. Unre- special collective agreement occupa- Hedge accounting is applied for all alised changes in the market value have tional pension are recognised under external derivatives. An application is not been recognised in the accounts in provisions when they are likely to entail carried out both in Region Stockholm accordance with RKR R8. disbursements. Contracts that have not and in the summarised accounts. All The impact of the hedge instruments been redeemed are recognised as con- completed hedging is governed by the on the average period for fixed interest tingent liabilities. requirements of the financial policies to and the borrowing expense are listed in reduce currency and interest risks. The the table below. Public investment contributions hedging contracts that were outstand- received ing as per 31 December 2019 were of Borrowing in foreign currency Investment contributions received from three different types: borrowing in For these hedging contracts, the hedged central and local government refer to Swedish kronor, borrowing in foreign item comprises a loan in foreign cur- public transport expansion. The invest- currencies and forward foreign-ex- rency at fixed interest. The hedge ment contributions are recognised as change contracts. instruments comprise currency swaps income in the profit/loss account sys- where the region receives a fixed inter- tematically over the asset’s period of Borrowing in Swedish kronor est rate in the foreign currency and pays use, and for staff expenditure during the For these hedging contracts, the hedged a fixed or variable interest rate in construction period for the new metro. item comprises a loan in Swedish cur- Swedish currency. rency at variable interest. The hedge Loans in other currencies are taken Cost of financial audit instruments consist of interest swaps when the interest expense, including the As of 2019, information about the year’s where the region receives a net variable currency hedging, is considered to be expenditure for financial audit in rate and pays a fixed rate. Region Stock- lower than if the loan was taken in accordance with the Swedish Council holm’s aim with these hedge contracts is Swedish currency. The aim of this hedg- for Municipal Accounting (RKR) R18. to reduce the uncertainty for the future ing strategy is to reduce the currency Expenditure for the year amounted to interest expenditure in the event of bor- risk and interest risk associated with SEK 8.4 million. Included in the cost are rowing at variable rates. The uncer- borrowing in foreign currency. The procured audit consultants amounting tainty is linked to changes in the varia- uncertainty is related to changes in the to SEK 7.2 million. ble interest rate. The hedged risk exchange rate. The hedged risk refers to consists of the variability in future currency risk, i.e. future exchange rate Information regarding separate interest payments due to changes in the changes in relation to the time of hedg- accounts base interest rate STIBOR. ing, and the interest risk in each bor- Separate accounts have been produced On 31 December 2019, Region rowing currency. in accordance with the Insight into Stockholm had a total of 115 outstand- As per 31 December 2019, the region Certain Financial Links and related ing hedge instruments of this type, had a total of 14 outstanding hedge matters Act (2005:590) and include with a total nominal amount of instruments of this type. The total nom- Folktandvården Stockholms län AB and SEK 43,683 million. In the swap portfo- inal amounts were EUR 1,175 million, and laboratory activities within Karolinska lio, there are swaps that both shorten NOK 1,100 million respectively, which University Hospital. and extend maturity, and the net corresponded to SEK 11,698 million.

Borrowing in Swedish kronor Before hedging After hedging Average fixed interest period 3.00 years 5.33 years Average borrowing cost, % 1.08 % 1.65 % Average borrowing cost, SEK millions SEK 376 million SEK 574 million

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

Financial accounts Annual Report 2019 95 The market value of all the interest foreign currency cash flows. The hedge contracts. The negative instalment swaps, which comprise hedge instru- instruments consist of forward for- premium is due to the Swedish interest ments in the hedge contracts, amounted eign-exchange contracts, where the rate being lower than the American. to SEK 1,695 million. region has bought or sold foreign Unrealised changes in the market value During the financial year 2019, the currency by instalments. Region have not been recognised in the interest expenditure for the hedge Stockholm’s aim with this hedging accounts in accordance with RKR R8. instruments was SEK 49 million. The strategy is to reduce the currency risk interest expenditure refers to the net associated with foreign currency cash Other amount of the paid, received and flows. The uncertainty is linked to The assessment is that the surety that accrued interest of all the swaps. The exchange rate changes between Swedish the region has for AB SL Finans’ leases interest expense is associated with the and other currencies. constitutes a binding undertaking for currency hedged loans taken in foreign On 31 December 2019, the region had the region. This means that the leasing currency. Unrealised changes in the a total of eight outstanding hedge within AB SL Finans is reported as a market value have not been recognised instruments of this type, with a total hedged item in Region Stockholm’s in the accounts in accordance with nominal amount of USD 59 million, summarised hedge accounting. RKR R8. which corresponds to SEK 485 million. The impact of the hedge instruments The market value of all the forward for- on the average period for fixed interest eign-exchange contracts in the hedge and the borrowing expense are listed in contracts, amounted to SEK -58 million. the table below. During the financial year 2019, the interest expenditure for the hedge Forward foreign-exchange contracts instruments was SEK 12 million. The For these hedge contracts, the hedged interest expense refers to a distributed item consists of contracted, or very part of the negative instalment premium likely and forecasted, as well as future on all the forward foreign-exchange

Borrowing in Euro Before hedging After hedging Average fixed interest period 3.87 years (EUR) 2.25 years (SEK) Average borrowing cost, % 1.39 % 2.02 % Average borrowing cost, SEK/EUR millions EUR 16.3 million SEK 216 million

Borrowing in Norwegian kronor Before hedging After hedging Average fixed interest period 0.13 years (NOK) 0.14 years (SEK) Average borrowing cost, % 2.01 % 0.22 % Average borrowing cost, NOK/SEK millions NOK 22 million SEK 2.6 million

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

96 Annual Report 2019 Financial accounts Notes

Note 1: Operating revenue and expenditure

The Regional Group The Region SEK millions 2019 2018 2019 2018 Patient fees healthcare 859 823 461 440 Patient fees dental care 527 552 0 0 Traveller fees 8,972 8,470 199 190 Sold health and medical care 1,869 1,759 1,513 1,439 Sold dental care 294 297 0 0 Sale of other primary services 289 284 78 75 Rental income, sale of other services 4,345 4,353 4,377 4,210 Government subsidies 5,403 4,358 5,333 4,284 Other subsidies 952 1,007 21 120 Other revenue 1,527 1,673 1,078 1,119 of which are items affecting comparability 67 349 6 348 Operating revenue 25,036 23,576 13,060 11,876

Staff costs 33,598 31,850 23,148 22,389 Purchased health and medical care 20,624 19,428 30,226 28,438 Purchased dental care 542 496 1,207 1,141 Purchased transport 14,558 13,705 1,243 1,190 Purchased other primary services 148 14 162 26 Ancillary services (lab, x-ray) 1,319 1,580 1,279 1,555 Drugs covered by the pharmaceutical subsidy 5,901 6,038 5,714 5,854 Other drugs 1,708 1,612 1,356 1,262 Other material and goods, etc. 5,962 5,725 2,541 2,531 Contributions paid 1,753 1,727 3,701 3,031 Contributions made to SL and WÅAB 0 0 9,382 9,045 Cost of premises, equipment rentals 2,908 3,124 3,184 3,319 Tax expenditure in subsidiaries 1 0 Other expenditure 7,199 7,152 6,040 5,325 of which are items affecting comparability 226 788 226 788 Operating expenditure 96,220 92,450 89,183 85,106

Note 2: Depreciation

The Regional Group The Region SEK millions 2019 2018 2019 2018 Depreciation on intangible fixed assets –131 –114 –26 –23 Depreciation on buildings and facilities –2,736 –2,707 –1,081 –1,057 Depreciation on machines and inventories –3,335 –2,801 –1,632 –1,113 Impairments – –120 – –149 Total depreciation –6,201 –5,742 –2,738 –2,342

Financial accounts Annual Report 2019 97 Note 3: Tax revenue, general government subsidies and municipal equalisation

The Regional Group The Region SEK millions 2019 2018 2019 2018 Preliminary tax revenue 76,469 73,092 76,469 73,092 Forecasted settlement in 2019 and 2018 respectively –505 –54 –505 –54 Adjustment item for tax revenue in 2018 and 2017 respectively 80 –167 80 –167 Total tax revenue 76,044 72,871 76,044 72,871

Contributions for pharmaceutical subsidy 6,241 5,873 6,241 5,873 Other general government subsidies 161 205 161 205 Total general government subsidies 6,402 6,078 6,402 6,078

Expenditure equalisation contributions 599 647 599 647 Total contribution from equalisation 599 647 599 647

Revenue equalisation charge –1,174 –1,152 –1,174 –1,152 Appropriation charge –452 –698 –452 –698 Total charges for equalisation –1,627 –1,849 –1,627 –1,849

Total expenditure and revenue equalisation –1,028 –1,202 –1,028 –1,202

Total tax revenue, general government subsidies and municipal equalisation 81,418 77,747 81,418 77,747

Note 4: Financial revenues

The Regional Group The Region SEK millions 2019 2018 2019 2018 Interest income 3 2 566 606 Profit from the sale of receivables with the SL Group – 337 Other financial revenue 65 87 2 18 Total financial revenue 68 426 568 624

Note 5: Financial expenses

The Regional Group The Region SEK millions 2019 2018 2019 2018 Interests –1,317 –1,408 –1,300 –1,436 Interest on pension provisions –611 –600 –798 –619 Other financial expenses –9 –26 –8 –17 Financial expense affecting comparability (note 6) Interest change for pension liability –667 –139 – – Total financial expenditure –2,604 –2,174 –2,106 –2,071

Note 6: Items affecting comparability

The Regional Group The Region SEK millions 2019 2018 2019 2018 Under operating revenue: Capital gain/loss 67 349 6 348

Under operating expenditure: Transition expenditure –226 –788 –226 –788

Under net financial revenue/expense: Capital gain from sale of claim with AB Storstockholms Lokaltrafik – 337 – – Interest change for pension liability –667 139 – – Total items affecting comparability –826 37 –220 –440

98 Annual Report 2019 Financial accounts Note 7: Specification of capital gain/loss The Regional Group The Region SEK millions 2019 2018 2019 2018 Other operating revenue Capital gain Sale of tangible fixed assets from Landstingsfastigheter Stockholm 0 348 0 348 Sale of tangible fixed assets with the SL Group 59 1 – – Sale of tangible fixed assets with other units 10 0 6 0

Other operating expenditure Capital loss Sale of tangible fixed assets with the SL Group –2 –7 – – Sale of tangible fixed assets with other units 0 7 – 0

Net financial income/expense Capital gain Capital gain from sale of claim with AB Storstockholms Lokaltrafik – 337 Net capital gain/loss from the sale of tangible fixed assets 67 686 6 348

Note 8: Intangible fixed assets

The Regional Group The Region SEK millions 2019 2018 2019 2018 Opening costs of acquisition 696 552 164 119 Purchasing 15 2 8 –3 Transfer from fixed assets under construction 141 141 6 48 Sales and disposals –28 0 – – Closing accumulated costs of acquisition 824 696 177 164 Opening depreciations –349 –235 –56 –33 Depreciation for the year –131 –114 –26 –23 Sales and disposals 28 0 – – Closing accumulated depreciation –452 –349 –82 –56 Total closing value 372 347 96 108 Average period of use (years) 6 6 7 7

Note 9: Land, buildings and technical facilities

The Regional Group The Region SEK millions 2019 2018 2019 2018 Opening costs of acquisition 90,879 85,938 46,064 44,911 Purchasing 19 0 – 0 Transfer from fixed assets under construction 5,099 5,803 3,017 1,348 Sales and disposals –357 –778 –12 –114 Reclassifications –15 –84 –12 –82 Closing accumulated costs of acquisition 95,625 90,879 49,057 46,064 Opening depreciations –24,413 –22,166 –10,403 –9,401 Depreciation for the year –2,736 –2,707 –1,081 –1,057 Sales and disposals 242 459 1 55 Reclassifications 1 – – – Closing accumulated depreciation –26,907 –24,413 –11,483 –10,403 Opening impairment –118 –118 –118 –118 Closing accumulated impairment –118 –118 –118 –118 Total closing value 68,600 66,348 37,456 35,543 Closing residual value according to plan, by facility type: Buildings 43,223 41,902 32,221 30,573 Land 2,364 2,342 1,466 1,466 Land improvements 23,012 22,104 3,769 3,503 Total closing value 68,600 66,348 37,456 35,543 Average period of use (years) 35 34 45 44

Financial accounts Annual Report 2019 99 Note 10: Machines and inventory

The Regional Group The Region SEK millions 2019 2018 2019 2018 Opening costs of acquisition 51,036 47,521 17,544 14,435 Purchasing 1,467 885 751 481 Transfer from fixed assets under construction 7,570 3,134 6,459 2,702 Sales and disposals –1,233 –352 –769 –147 Corrections – –230 – – Reclassifications 2,911 77 1,067 74 Closing accumulated costs of acquisition 61,751 51,036 25,053 17,544 Opening depreciations –24,224 –21,762 –8,755 –7,787 Depreciation for the year –3,335 –2,801 –1,632 –1,113 Sales and disposals 1,188 333 753 137 Reclassifications –2,596 7 –756 8 Closing accumulated depreciation –28,966 –24,224 –10,390 –8,755 Opening impairment –11 –16 –1 –6 Sales and disposals – 5 – 5 Closing accumulated impairment –11 –11 –1 –1 Total closing value 32,774 26,801 14,662 8,788 Closing residual value according to plan, by facility type: Cars and other modes of transport 9,388 9,014 7 2 Medical equipment 3,695 2,720 2,273 1,895 Reconstruction in rented premises 468 259 135 129 Permanent equipment, service facilities etc. 11,868 6,875 10,567 5,525 Art and inventories not subject to depreciation 106 100 104 98 Leases, machines and inventory 4,659 5,737 – – IT equipment 937 867 625 613 Other machines and inventory 1,653 1,230 951 524 Total closing value 32,774 26,801 14,662 8,788 Average period of use (years) 19 18 15 16

Note 11: Fixed assets under construction and advances relating to tangible fixed assets

The Regional Group The Region SEK millions 2019 2018 2019 2018 Opening balance 23,193 21,148 14,004 11,226 Expenditure during the year on buildings* 9,333 10,240 4,506 5,916 Expenditure during the year for machines and inventories 1,101 1,092 1,034 1,053 Transfer to other fixed assets –12,810 –9,079 –9,482 –4,097 Reclassifications –1 78 78 Sales and disposals –88 –286 –22 –171 Total fixed assets under construction and advance payments 20,728 23,193 10,040 14,004

*The amount for 2019 includes capitalised interest of SEK 128 million (2018: SEK 179 million).

Note 12: Financial assets The Regional Group The Region SEK millions 2019 2018 2019 2018 Loans provided to group companies – – 31,807 31,664 Other loans provided 625 27 16 – Shares in subsidiaries1) 0 0 6,380 6,380 Shares in associated companies 2) 10 11 – – Other shares and debentures 509 680 314 314 Tenant-owner’s rights 3 3 3 3 Total financial assets 1,147 721 38,520 38,361

100 Annual Report 2019 Financial accounts Note 12: Financial assets, cont.

1) Shares in subsidiaries, Region Stockholm Number of Book value, Shares in subsidiaries Holding % shares SEK million AB Storstockholms Lokaltrafik 100 80,000,000 5,974 Landstingshuset i Stockholm AB 100 1,000 406 Total 6,380

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

2) Shares in associated companies Associated companies C.I.N. Holding % Proportion of equity, SEK million Barnbördshuset Stockholm AB (49 %) 556612-1290 49.0 10 Total 10

Note 13: Current receivables The Regional Group The Region SEK millions 2019 2018 2019 2018 Accounts receivable 1,529 1,823 1,445 1,320 Government subsidies receivable 1,503 1,526 1,502 1,526 Tax assets 353 289 317 217 Deferred expenditure 1,380 1,250 1,226 1,132 Accrued revenue 1,422 1,101 1,286 1,023 Other receivables 1,824 1,994 6,054 4,269 Total current receivables 8,011 7,983 11,830 9,488

Note 14: Equity The Regional Group The Region SEK millions 2019 2018 2019 2018 Opening equity 11,573 9,477 9,656 8,228 Correction in reference to equity in Region* 700 700 Correction in reference to equity in Wåab* 13 Profit/loss for the year 1,497 1,383 1,019 728 Opening equity 13,070 11,573 10,675 9,656

*Due to ambiguous accounting grounds for the additional pension provision made in the region’s annual accounts 2007, the region has made a correction in regard to equity in the annual accounts for 2019 amounting to SEK 700 million. **Correction of provision.

Additional information, equity reserve SEK millions 2019 2018 Transition expenditure for future health and medical care Reserved in the 2011 financial statement 1,200 1,200 Reserved in the 2012 financial statement 2,100 2,100 Reserved in the 2013 financial statement 2,000 2,000 Utilised in the 2015 financial statement –159 –159 Total transition expenditure 5,141 5,141

During the period 2012–2014, the Since the decision of this equity reserve During the period 2015–2019, a total of County Council Assembly decided to was made, the total budget to cover SEK 3,159 million was utilised for the reserve a total of SEK 5,300 million in future transition expenditure in con- transition expenditure, of which equity in order to cover future transi- junction with the implementation of SEK 159 million was from the reserve. tion expenditure in conjunction with future health and medical care has The remaining SEK 3,000 million was the implementation of future health been set to SEK 3,500 million. funded within the profit of the financial and medical care. statements of 2016–2019.

Financial accounts Annual Report 2019 101 Note 15: Pension provisions The Regional Group The Region SEK millions 2019 2018 2019 2018 Opening pension provisions, incl. payroll tax 28,810 27,346 22,531 21,619 Newly earned pension, of which – defined-benefit retirement pension 1,889 1,735 1,256 1,140 – pension agreement PA–KFS 2 2 0 0 – special collective agreement occupational pension –1 –1 –1 –1 – survivor’s pension 3 3 0 0 – other 11 11 19 19 Disbursements for the year –520 –465 –412 –372 Upwards adjustment of interest and base amount 821 627 594 457 Change in insurance rules 535 –112 2 –2 Other items –193 49 –109 56 Change in payroll tax 327 315 327 315 Change in provisions from previous years – –700 – –700 Total pension provisions, incl. payroll tax 31,684 28,810 24,207 22,531

The Regional Group The Region SEK millions 2019 2018 2019 2018 Opening contingent liabilities for pensions, incl. payroll tax 22,879 23,559 22,879 23,559 Upwards adjustment of interest and base amount 666 549 666 549 Change in insurance rules 0 0 0 0 Disbursements for the year –1,029 –984 –1,029 –984 Other items 147 –112 147 –112 Change in payroll tax –53 –133 –53 –133 Closing contingent liabilities for pensions, incl. payroll tax 22,610 22,879 22,610 22,879

Other information regarding pensions The Regional Group The Region 2019 2018 2019 2018 Number of fixed-term appointments Politicians 10 9 10 9 Officials 0 0 0 0 Update rate 97 % 97 % 97 % 97 %

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

102 Annual Report 2019 Financial accounts Note 16: Other provisions Reversal of Summary Utilised unutilised Provisions SEK millions 2018 during the year amount for the year 2019 Group Other provisions 1,069 –29 0 8 1,048 The Region Other provisions 622 –13 0 6 615

Expected Specification of provisions Reversal of time of Companies Utilised unutilised Provisions regulation, SEK millions 2018 during the year amount for the year 2019 year AB SL’s estimated maintenance expenditure 58 0 0 2 60 2024* for vehicle C20 AB SL new signal system 8 –8 0 0 0 – AB SL environmental risk reserve for ground 35 0 0 0 35 ** pollution AB SL Settlement expenditure 338 0 0 0 338 2020/21 Tiohundra AB, share relating to pension 8 –8 0 0 0 *** provisions Total other provisions 447 –16 0 2 433

* No earlier than 2024 – a new assessment needs to be made in 2024, when there is a new metro contract in place. ** Cannot be specified as the time of when the land will enter into use is unknown. *** Transferred in 2019 to note 15 Pension provisions Expected Reversal of time of Region Utilised unutilised Provisions regulation, SEK millions 2018 during the year amount for the year 2019 year County Council properties in Stockholm The property Beckomberga, selling expenses 3 –2 0 0 1 2020 The property Patienten Karolinska, selling expenses 23 0 0 0 23 2021 The property Patienthotellet Karolinska, selling expenses 2 0 0 0 2 2020 The property Medicinaren 5, development contribution, infrastructure 6 –6 0 0 0 – The property Medicinaren 5, selling expenses 15 0 0 0 15 2020 Dispute with the Swedish Work Environment Authority relating to premises at Södersjukhuset 5 0 0 0 5 * Dispute with the Swedish Work Environment Authority relating to premises at Södertälje Sjukhus 1 0 0 5 6 * Dispute with the Swedish Work Environ- ment Authority Nya Karolinska Solna 2 –2 0 0 0 – The Culture Committee Compensation STIM 6 0 0 1 7 2020 The Regional Executive Committee Landstingens Ömsesidiga Försäkringsbolag, additional premium 286 0 0 0 286 2020 Co-financing contribution to City of Solna relating to Norra Hagastaden 250 0 0 0 250 ** Lifetime damages 10 0 0 0 10 2044 The Transport Committee Procurement damages 13 –3 0 0 10 2020 Total other provisions 622 –13 0 6 615

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

Financial accounts Annual Report 2019 103 Note 17: Non-current liabilities

The Regional Group The Region SEK millions 2019 2018 2019 2018 Liabilities with banks and credit institutions 41,636 43,473 41,636 43,473 Non-current leasing liabilities 4,657 5,168 – – Investment contributions 11,039 8,890 4,828 3,124 OPS liability Nya Karolinska Solna 6,177 6,558 6,177 6,558 Other non-current liabilities 257 256 – – Total non-current liabilities 63,766 64,345 52,641 53,155

Liabilities with banks and credit institutions The Regional Group The Region 2019 2018 2019 2018 Average interest rate (%) 1.7 1.7 1.7 1.7 Average fixed interest period (years) 4.1 3.8 4.1 3.8 Loans that mature within (SEK millions) 1–5 years 11,757 14,211 11,757 14,211 Later than 5 years 29,879 29,262 29,879 29,262

Note 18: Current liabilities

The Regional Group The Region SEK millions 2019 2018 2019 2018 Liabilities with banks and credit institutions 5,064 1,000 9,006 6,446 Advance payments from customers 1,133 1,101 622 629 Trade creditors 7,076 7,419 6,284 6,525 Liabilities to central government 779 684 779 684 Current leasing liabilities 481 1,086 0 0 Holiday pay and wage liability 2,046 1,883 1,397 1,264 Accrued costs 4,881 5,043 3,217 3,103 Deferred revenue 1,120 972 375 301 Other liabilities 3,171 2,884 2,928 2,068 Total current liabilities 25,751 22,072 24,608 21,019

104 Annual Report 2019 Financial accounts Note 19: Guarantees and other contingent liabilities

The Regional Group The Region SEK millions 2019 2018 2019 2018 Contingent liabilities to the benefit of group companies and associated companies* AB SL, financial leasing – – 6,747 7,880 The local federation Sjukvård och omsorg i Norrtälje. capital cover guarantee for Tiohundra AB** – – 39 – AB Storstockholms Lokaltrafik, pension undertakings – – 709 665 Waxholms Ångfartygs AB, pension undertakings – – 17 16 Locum AB, pension undertakings – – 355 329 Danderyds Sjukhus AB, pension undertakings – – 2,517 2,085 S:t Eriks Ögonsjukhus AB, pension undertakings – – 452 379 Södersjukhuset AB, pension undertakings – – 3,259 2,681 Södertälje Sjukhus AB, pension undertakings – – 671 535 Tiohundra AB, pension undertakings 320 283 320 283 Folktandvården Stockholms län AB, pension undertakings – – 878 750 Other companies, pension undertakings – – 105 79 Total 320 283 16,069 15,682

Contingent liabilities to the benefit of parties outside the group*** AB Transitio**** 711 510 711 510 The Archipelago Foundation in Stockholm County, pension undertakings and loans 41 47 41 47 Other guarantees, pension undertakings 16 17 16 17 Total 768 574 768 574 Total contingent liabilities***** 1,088 857 16,837 16,256

*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. **During 2019, Tiohundra AB has 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 has been recognised during the year. ***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 2019, the premium for Region Stockholm amounted to SEK 331.9 million. ****Region Stockholm has provided a joint and several liability guarantee with a ceiling of SEK 8 billion for AB Transitio relating to the funding of rail vehicles. As per 31/12/2019, SEK 6.3 billion has been 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. On 31/12/2019, this funding amounted to SEK 0.7 billion. *****The contingent liabilities are not expected to entail future expenditure for Region Stockholm.

Note 20: Lease charges

The Regional Group The Region SEK millions 2019 2018 2019 2018 Financial leases longer than 3 years* Total minimum lease charges 5,247 6,431 Present value of minimum lease charges 4,887 5,960 Of which mature within 1 year 468 1,058 Of which mature within 2–5 years 3,526 3,400 Of which mature after 5 years or more 893 1,502

Non-callable operating leases longer than 3 years* Lease charges that mature within 1 year 224 381 32 45 Lease charges that mature within 2–5 years 851 1,294 396 356 Lease charges that mature after 5 years or longer 842 259 114 134

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

Financial accounts Annual Report 2019 105 Note 21: Group relationships

Unit Owner injection Group contributions Dividend SEK millions Provided Received Provided Received Provided Received Region Stockholm 600 Landstingshuset i Stockholm AB 600 739 97 8 Danderyds Sjukhus AB 344 Södersjukhuset AB 352 Södertälje Sjukhus AB 29 S:t Eriks Ögonsjukhus AB 23 Ambulanssjukvården i Storstockholm AB 21 8 Stockholm Care AB 0 Folktandvården Stockholms län AB 45 Locum AB 14 AB SLL Internfinans 3 MediCarrier AB 4 AB Storstockholms Lokaltrafik 430 AB SL Finans 430 SL Infrateknik AB SL Älvsjö AB Waxholms Ångfartygs AB All companies are owned 100 % by Region Stockholm or their respective parent company.

Unit Sale Contribution Interests, etc. SEK millions Revenue Expenditure Revenue Expenditure Revenue Expenditure Region Stockholm 3,428 13,053 9,965 576 –12 Landstingshuset i Stockholm AB Danderyds Sjukhus AB 4,112 942 174 Södersjukhuset AB 5,002 1,043 304 Södertälje Sjukhus AB 1,346 248 34 S:t Eriks Ögonsjukhus AB 516 83 52 Ambulanssjukvården i Storstockholm AB 385 16 Stockholm Care AB 23 59 Folktandvården Stockholms län AB 720 65 18 Locum AB 387 7 AB SLL Internfinans 16 1 0 0 MediCarrier AB 704 13 AB Storstockholms Lokaltrafik 389 1,263 9,002 –10 555 AB SL Finans 263 12 SL Infrateknik AB SL Älvsjö AB 6 0 2 Waxholms Ångfartygs AB 54 31 380 0 2

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

Unit Loans Guarantee Provided Received Provided Received SEK millions by by by by Region Stockholm 31,779 15,605 Landstingshuset i Stockholm AB 524 Danderyds Sjukhus AB 2,517 Södersjukhuset AB 3,259 Södertälje Sjukhus AB 671 S:t Eriks Ögonsjukhus AB 452 Ambulanssjukvården i Storstockholm AB Stockholm Care AB Folktandvården Stockholms län AB 878 Locum AB 355 AB SLL Internfinans MediCarrier AB AB Storstockholms Lokaltrafik 71 30,935 7,456 AB SL Finans SL Infrateknik AB SL Älvsjö AB 71 Waxholms Ångfartygs AB 320 17

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

106 Annual Report 2019 Financial accounts Note 22: Average number of full-time equivalents per operating area

Number of full-time Number of full-time equivalents in 2019 equivalents in 2018 Health service, incl. dental care* 41,256 40,811 Transport 915 819 Culture 112 106 Regional planning 57 44 Other operations 1,221 1,179 Total 43,561 42,959

*Including 50 % of employees within Tiohundra AB.

Financial accounts Annual Report 2019 107 Key performance indicators

Key performance indicators Unit 2019 2018 2017 2016 2015

Population Stockholm County Number 2,374,550 2,339,640 2,303,417 2,264,111 2,231,439 – Population development % 1.5 % 1.6 % 1.7 % 1.5 % 1.5 % Sweden Number 10,319,473 10,215,309 10,104,036 9,967,637 9,851,017 – Population development % 1.0 % 1.1 % 1.4 % 1.2 % 1.1 % Proportion in Stockholm County % 23.0 % 22.9 % 22.8 % 22.7 % 22.7 %

Tax Tax revenue, general government subsidies and SEK millions 81,418 77,747 74,949 71,010 67,264 equalisation Tax revenue, general government subsidies and SEK/ 34,288 33,230 32,538 31,363 30,144 equalisation resident Tax revenue development % 4.7 % 3.7 % 5.5 % 5.6 % 5.1 % Tax rate Region Stockholm SEK 12.08 12.08 12.08 12.08 12.10 Average county council tax nationally SEK 11.49 11.39 11.36 11.35 11.29

Profit/loss account Turnover SEK millions 106,454 101,323 97,126 92,112 86,680 Profit/loss Region Stockholm SEK millions 1,723 2,171 2,130 1,708 343 The proportion of tax revenue, general government subsidies and equalisation in the profit % 2.1 % 2.8 % 2.8 % 2.4 % 0.5 % Operating revenue, development % 6.2 % 6.3 % 5.1 % 8.7 % 4.9 % Operating expenditure, development % 4.1 % 5.2 % 4.0 % 5.4 % 3.3 % Depreciation expenditure, development % 8.0 % 11.2 % 11.4 % 10.3 % 10.1 % Net expenditure development % 3.7 % 5.3 % 4.1 % 4.7 % 3.2 %

Balance sheet Balance sheet total SEK millions 135,319 127,869 122,366 113,824 105,250 Equity SEK millions 13,070 11,573 9,477 8,239 7,451 Solidity % 9.7 % 9.1 % 7.7 % 7.2 % 7.1 % Solidity incl. contingent liabilities % –7.1 % –8.8 % –11.5 % –13.9 % –16.5 % Liquidity SEK millions 3,385 1,894 1,983 2,878 3,634 Borrowing and lease liability SEK millions 51,838 50,726 45,965 44,597 41,938 Total pension undertakings (incl. payroll tax) SEK millions 54,294 51,689 50,905 49,649 49,182

Investments Investments SEK millions 11,923 12,211 15,216 15,065 14,285 Self-financing ratio for investments % 100.0 % 82.1 % 75.3 % 61.5 % 38.7 %

Operations Health service appointments Quantity 19,088,883 18,779,618 18,486,187 18,129,427 18,275,571 Medical care events Quantity 310,574 309,285 312,647 318,786 325,427 Level of occupancy, properties % 96 90 92 90 90 Boarding passengers on a regular weekday Quantity 2,851 2,814 2,744 2,716 2,651 (thousands) Public transport, tax funding rate* % 45 45 48 48 49 Culture expenditure SEK/resident 223 201 227 211 216

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

Staff Number of full-time equivalents Region Stockholm Quantity 43,561 42,951 42,578 42,249 42,165 – of which refers to health and medical care Quantity 41,256 40,811 40,468 40,211 40,189 – of which refers to transport Quantity 915 819 749 695 685 – of which refers to culture Quantity 112 106 57 52 49 – of which refers to regional planning Quantity 57 44 42 35 29 – of which refers to other staff Quantity 1,221 1,171 1,260 1,256 1,214

108 Annual Report 2019 Financial accounts Auditor’s report regarding the County Council Executive Committee for 2019

We, the auditor's appointed by the council, have reviewed the Karolinska University Hospital has continued to increase, Regional Executive Committee’s operations and financial and the outcome for the hospital entails a negative deviation accounts for 2019. of SEK 1.6 billion, which affects the finances of the entire The Regional Executive Committee is responsible for the region. Furthermore, we make the assessment that the management and coordination of Region Stockholm’s opera- Regional Executive Committee’s supervision of the region’s tions and to supervise the other committees and boards, investment operation has been lacking, since a number of i.e. continuously monitor that operations are conducted in transport investments have been handled at the incorrect accordance with applicable goals, decisions and guidelines decision-making level in 2019. and in accordance with the laws and regulations that apply to Furthermore, we believe that the Regional Executive the operation. The Committee has a leading position and is to Committee needs to take measures within purchasing, partly have keep a holistic perspective with responsibility for fol- to reinforce coordination of acquisitions for the health ser- low-up and feedback to the Council. The Committee is vice, and partly to ensure that the region benefits from the responsible for monitoring the development of operations coordination opportunities of being a large client, which can and finances and to take measures when necessary. result in lower costs. Our responsibility as auditors is to review operations, When it comes to extraordinary events in peacetime, we internal management and accounts, and to assess whether believe that the Regional Executive Committee should ensure the operation has been conducted in accordance with the that the work and staff committee, at times when the crisis commission and goals set out by the Council and with the management committee is inactive, follows up on contin- regulations that apply to the operation. We must also assess gency measures in order to be able to priorities and develop whether the annual accounts are in accordance with the the measures. The Regional Executive Committee should also financial and operational goals decided by the Council. clarify where in the organisation that operation-wide issues The audit has been carried out in accordance with the are to be managed and adapt the contingency plan to the cur- Local Government Act, generally accepted auditing stand- rent organisation. ards and auditing regulations. The review has been con- We make the assessment that the annual report provides a ducted with the focus and scope needed to provide a reasona- fair picture of the year’s outcome and financial standing. All ble basis for assessment and liability testing, and the results in all, we make the assessment that the financial and operat- of this review is reported in the Audit Office’s Annual Report ing outcome for 2019 is satisfactory. We furthermore make on the Regional Executive Committee in 2019. We are attach- the assessment that the internal control is insufficient. We ing an account of the results from the review. would like to emphasise that the Regional Executive Commit- We have reviewed whether the outcome for 2019 meets tee needs to reinforce its financial management in future. the Council’s decisions regarding goals and guidelines for We recommend that the complete annual report of Region financial management. Our assessment, based on what is Stockholm 2019 is established. stated in the annual report, is that the goal of balanced We recommend the Council to discharge the Regional finances and the financial targets have been attained in 2019. Executive Committee and its individual members. When it comes to the Council’s other overall goals, we find that it is still difficult to measure and thereby to assess the goal achievement for most of them, since the indicators cho- Stockholm, 15/04/2020 sen only measure part of the goal. However, we have noted that efforts are being made to develop additional indicators. We make the assessment that the Regional Executive Kenneth Strömberg Iréne Seth Committee’s financial management in 2019 has not been Anita Johansson Christer Grunder completely satisfactory. The Regional Executive Committee Göran Råsmar Lars Bergstig and its work and staff committees have in 2019 encouraged Ewa Törngren committees and companies forecasting a deficit to promptly take the measures needed to balance their finances. Even so, the deviation to the Council’s profit requirement for

Financial accounts Annual Report 2019 109 Abbreviations

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

110 Annual Report 2019 Financial accounts The Annual Report is published on www.sll.se

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