The higher education sector does not live in a vacuum. Several other sectors touch our area and the university collaborates with several other parts of society. Recently, SFS chairman Jacob Färnert and medical student and SQC member and student representative Tilda Jalakas participated in the Swedish University and Higher Education Association's conference on healthcare competence 2024, where the role of the university in healthcare issues was in focus. At the same time, the government's investigators are releasing new proposals that affect students, and the situation in healthcare is debated this Sunday in Agenda on SVT. In this blog post, SFS members Jacob and Tilda reflect on the role of the university and students in healthcare issues in the future.
According to Swedish voters, healthcare is the single most important political issue. In the parliamentary elections, it was the whole 54 percent of voters who put the issue at the top of their agenda. In the latest episode of Agenda on SVT on Sunday 11 February, there was a tough tone between the Christian Democratic Minister of Health Acko Ankarberg Johansson and the Social Democrat Lena Hallengren on the occasion of the cuts occurring in healthcare around the country. But what role does the university have in this? The answer to that is of course that it has a very big role.
The collaboration that takes place between higher education and healthcare is crucial for society and includes both research and education. Many of us watched the ice-cold Nobel celebration in December. Our gratitude to the researchers who won the Nobel Prize in physiology or medicine should be endless. Katalin Karikó and Drew Weissman's basic research, which has been ongoing for several decades, made it possible for us to quickly develop a vaccine during the corona pandemic, save lives and return to a more normal state of society. This should make us think about how we create good conditions for research, academic freedom and the importance of basic research.
But what about the relationship between healthcare and higher education? Here, higher education also has an enormous task. To begin with, most of the healthcare professions are trained in higher education. This includes nurses, doctors, physiotherapists, biomedical analysts, midwives and dieticians. Interestingly, several healthcare education programmes have not always been under the roof of higher education. The responsibility for healthcare education previously lay with the then county councils, but after the 1977 higher education reform, we have moved towards medical and healthcare education being under the roof of higher education. In 2002, the state took over responsibility for medium-term healthcare education programmes from the county councils. Today, there are 25 higher education institutions that provide higher education in healthcare and seven higher education institutions that provide medical education, which are the larger higher education institutions that are affiliated with university hospitals.
It is clear that healthcare is under strain. The National Board of Health and Welfare warns of major challenges with skills supply, resource shortages and difficult changes in demographics. In this, universities will need to take responsibility. Fittingly, universities are already on the ball and we saw this during the Swedish University Association's conference on healthcare skills 2024, which we both gratefully had the privilege of attending.
During the conference day, we listened to a series of presentations and discussions about the role of universities in the supply of healthcare skills. It all began with a speech by Roger Klinth, rector of Marie Cederschiöld University and chairman of SUHF's expert group for professional education in healthcare, who emphasized the responsibility of universities for the supply of healthcare skills and the importance of collaboration between all actors in the higher education and healthcare sectors. The presentations during the day covered a wide range of topics. Collaborations between universities, statistics on the shortage of skills in healthcare, application pressure for healthcare education (which in some cases has decreased sharply and in some programs there is less than one applicant per place) and strengthened career opportunities to attract students to healthcare professions were some of the topics that were highlighted. There was also an exciting workshop, led by Anna-Karin Andershed, vice-chancellor at Örebro University, on how we can collaborate more. We also received a status report from the National Healthcare Competence Council's work on developing a national plan for the supply of skills in healthcare.
One of the highlights of the day was hearing Hans Wiklund, University Director at Umeå University but in this context also national coordinator and special investigator for more places for practice-based education (VFU) in nursing education, present the results of his investigation. The government decided in June 2022 to assign Hans Wiklund to, as national coordinator, support universities and colleges, healthcare professionals and caregivers in their work to provide appropriate, high-quality learning environments in healthcare and coordinate the work in the country. The point of the assignment was to increase access to places where students in nursing education can complete their VFU so that more training places can be offered. SFS has had good dialogue with the investigation during its course and has also been able to appoint a student representative to the investigation's reference group.
The commission's mission was to increase access to VFU places for nursing students, which is critical. There is a great need for more nurses. The University Chancellor's Office estimates that the number of students needs to increase by 1,000 people compared to current levels, or approximately 20 percent, by 2035 to meet the expected skills supply needs of the health and medical services. Through extensive dialogue with a broad group of stakeholders, the commission has presented both short- and long-term proposals to increase the number of VFU placesThe proposed measures include the development of a national and regional agreement system to strengthen collaboration and the quality of VFU, as well as an investment in IT support and supervisor training.
From the SFS student perspective, several of the proposals in the investigation are welcome. Students have long called for improvements in VFU, not least in terms of the quality of supervision and access to places, both of which are crucial for the education to function. Stronger collaboration between higher education institutions, the health sector and the state can provide students with a more qualitative and relevant VFU, which in turn better prepares them for their future professional lives. In addition, an increased focus on supervisor training can ensure that the professionals who receive students have the tools and knowledge required to provide a supportive and educational time and education at the VFU place. These measures are well aligned with SFS and the students' visions of seeing a more coherent and qualitative higher education.
The inquiry highlights an important issue concerning additional costs for students in connection with their VFU, such as travel and accommodation costs. These additional costs can constitute a significant obstacle for students, especially those who have to place their VFU in a different location than where they usually study or live. To address this issue, the inquiry proposes the introduction of a system for compensation for students who suffer additional costs during their VFU. This proposal aims to reduce the financial burden on students and thereby make it possible for a wider group to complete their internship periods without finances being an obstacle. The issue of financial compensation for students who suffer additional costs during their VFU has been a priority issue for SFS since the 2022 council decision. The student unions see this issue as particularly important. SFS has therefore worked to draw attention to and address the financial challenges that may arise during VFU for students, emphasizing that these additional costs often constitute a major obstacle to students' ability to participate in quality internships. Tilda has also signed SFS blog on this topic previously. The inquiry's proposal for financial compensation for additional costs during VFU is therefore in line with SFS's goal of improving the conditions for students at VFU and making higher education free of charge. We are very pleased that the inquiry has shed light on this issue!
In addition to the inquiry's proposals, we would also like to take the opportunity to draw attention to some other issues that must not be forgotten in the debate about healthcare and the role of higher education in it.
- Supervisor. High educational quality should be strived for regardless of where students are located. The supervisors at the VFU places have a great responsibility in providing a good education and internship situation for the student. It is important that both the higher education institution and the care provider have a plan for training supervisors and how to ensure that there are enough supervisors for all students.
- Hollowing out. In the report of Sweden's university teachers and researchers System errors in the knowledge factory – about the erosion of compensation amounts for higher education compares current costs and revenues in current prices with the starting year of the current resource allocation system in 1994/95. The results show that most areas of education would need per capita increases of between 30 and 50 percent to reach the levels that applied in the 1990s. In terms of kronor, the shortfall is almost seven billion. For medical education, costs exceed revenues by 47 percent and for nursing education, the figure is 32 percent. The erosion of higher education is a fact, and to believe that we can meet the healthcare sector's need for excellent competence on these grounds is nothing short of unrealistic.
- Mixed messages. Education in higher education should be based on science. SFS believes that the state should open up to allowing higher education institutions to reallocate funds from education to research and vice versa in the form of a collective grant. There are education-heavy higher education institutions with small research resources that would greatly benefit from using parts of saved education grants to strengthen research, something that in the long term may be absolutely necessary to maintain quality and promote research connections in education. The same applies vice versa for higher education institutions where the opposite situation applies.
- Universities can also do their part for quality. For a long time, research and scientific skill have been the most important merit for university teachers. It is time that education is allowed into the same halls. We still have parts of higher education where the condescending term “teaching burden” is frequently used. Higher education pedagogical development and competence must be stimulated, respected and valued.
- Collaboration between higher education institutions. In the memorandum Five starting points for a new system for resource allocation to higher education as SFS presented in the spring of 2023, we propose that we safeguard efficient resource utilization by creating incentives in the resource allocation system to a greater extent favor shared use and cooperation between higher education institutions. This should of course apply to medical and healthcare education. For example, it could involve instructing higher education institutions to coordinate parts of certain broad education programs. The higher education institutions can also do this voluntarily, but then it is important that there are no obstacles due to administration or the like. As students, we see it as extremely important that we have access to good education and teachers with scientific expertise.
In conclusion, it is clear that the university and the students play a critical role in navigating the challenges and opportunities facing Swedish healthcare. The commitment and work that has been shown so far bodes well for the future, and it is with optimism that we look forward to the positive changes that these efforts will bring for both students and healthcare in general. In true collegial spirit, however, we would like to conclude by emphasizing the shared responsibility and that everyone needs to do their part, of course including us students.
This post is written by Jacob Färnert, SFS chairman, and medical student Tilda Jalakas, member of the SFS quality committee and SFS student representative in SUHF's expert group for professional education in healthcare.