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 as well as SQC member and student representative Tilda Jalakas participated in the Swedish University and College Association's conference on care competence in 2024, where the role of universities in care matters was in focus. At the same time, the government's investigators release new proposals that affect the students, and the situation in healthcare is debated on Sunday in Agenda on SVT. In this blog post, SFS students Jacob and Tilda reflect on the role of the university and the students in healthcare issues going forward.
According to Swedish voters, healthcare is the single most important political issue. In the parliamentary election, it was the whole thing 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 harsh tone between the Christian Democrat Minister of Health Acko Ankarberg Johansson and the Social Democrat Lena Hallengren due to the cuts in healthcare across the country. But what role does the university play in this? The answer to that is, of course, that it has a very large role.
The cooperation that takes place between the university and healthcare is crucial for society and includes both research and education. Many of us saw the icy Nobel celebration in December. Our gratitude to the scientists who won the Nobel Prize in Physiology or Medicine should be endless. Katalin Karikó and Drew Weissman's basic research, which has been going on 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 does the relationship between healthcare and higher education look like? The university also has an enormous task here. To begin with, the majority of healthcare professions are trained in university. This applies to nurses, doctors, physiotherapists, biomedical analysts, midwives and dieticians, among others. Interestingly enough, several nursing courses have not always been under the university's roof. The leadership of nursing education was previously in the then county councils, but after the 1977 university reform, we have moved towards medical and nursing education being under the roof of the university. In 2002, the state took over the responsibility for the medium-term nursing education from the county councils. Today, there are 25 higher education institutions that provide higher education in nursing 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 care is under strain. The National Board of Health and Welfare warns of major challenges with the supply of skills, lack of resources and difficult changes in demographics. In this, the universities will have to take responsibility. Appropriately enough, the universities are already on the ball and we got to see that, among other things, during the Swedish University and College Association's conference on care competence in 2024, which we both gratefully had the privilege of attending.
During the conference day, we got to listen to a series of presentations and discussions about the role of the universities in the supply of skills in care. It all started with a speech by Roger Klinth, rector at Marie Cederschiöld University and also chairman of SUHF's expert group for professional education in health and medical care, who emphasized the responsibility of higher education institutions for providing competence in care and the importance of cooperation between all actors in the higher education and care sectors. The presentations during the day covered a wide range of topics. Collaborations between higher education institutions, statistics on the skill shortage in healthcare, application pressure on nursing education (which in some cases has decreased significantly and in some programs there is less than one applicant per place) and strengthened career opportunities to attract students to the healthcare professions were some of the topics was illuminated. There was also an exciting workshop, led by Anna-Karin Andershed, pro-rector at Örebro University, about how we can collaborate more. We also received a progress report from the National Health Care Skills Council's work in developing a national plan for the supply of skills in healthcare.
One of the highlights of the day was to hear Hans Wiklund, university director at Umeå University but in this context also national coordinator and special investigator for more places for business-based education (VFU) in nursing education, present the results of his investigation. The government decided in June 2022 to appoint Hans Wiklund to, as national coordinator, support universities and colleges, health and medical professionals and care providers in their work to provide appropriate, high-quality learning environments in health and medical care 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 a 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 investigation'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 assesses that the number of students needs to increase by 1 people compared to today's levels or approximately 000 percent until the year 20 in order to meet the expected skills supply needs of the health and medical services. Through extensive dialogue with a broad group of actors, the investigation has presented both short- and long-term proposals to bring about an increase in VFU places. Among the proposed measures is 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. The students have long called for improvements within VFU, not least in terms of the quality of supervision and access to places, both of which are crucial for the education to function. A stronger collaboration between universities, the health care sector and the state can give students a more qualitative and relevant VFU, which in turn better prepares them for their future professional life. Additionally, an increased focus on tutor training can ensure that the professionals receiving students have the tools and knowledge required to provide a supportive and educational time and training at the VFU site. These measures agree well with SFS and the students' visions of seeing a more coherent and qualitative university education.
The investigation highlights an important issue concerning additional costs for students in connection with their VFU, such as costs for travel and accommodation. These extra costs can be a significant obstacle for students, especially those who have to locate their VFU in a different location than where they usually study or live. To address this problem, the investigation 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 enable a wider group to complete their internships without financial constraints. The issue of financial compensation for students who suffer additional costs during their VFU has been a priority issue for SFS since the council decision in 2022. 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, with the emphasis that these additional costs often represent a major obstacle to students' opportunity to participate in quality internships. Tilda has also signed SFS blog on this topic earlier. The investigation's proposal for financial compensation for additional costs during VFU is therefore in line with SFS's goal to improve the conditions for students at VFU and that higher education should be free of charge. We are very happy that the investigation has shed light on this issue!
In addition to the inquiry's proposal, we also want to take the opportunity to draw attention to some other issues that must not be forgotten in the debate about care and the university's role in it.
- Supervisor. High educational quality must be pursued regardless of where students are located. The supervisors at the VFU places have a great responsibility in providing a good education and practical situation for the student. It applies that both the higher education institutions and the care provider have a plan for the training of supervisors and how it is ensured that there are enough supervisors for all students.
- Hollowing out. In Sweden's university teachers and researchers' report System error in the knowledge factory - about erosion of the compensation amounts for higher education current costs and revenues in current prices are compared 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 of the 1990s. In kronor, there are almost seven billion missing. For medical education, costs exceed income 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 healthcare's need for excellent skills on these grounds is nothing short of unrealistic.
- Mixed grants. Education in the university must take place on a scientific basis. SFS believes that the state should open up to allow the universities to redistribute funds from education to research and vice versa in the form of a combined grant. There are education-heavy universities with small research resources that would greatly benefit from using parts of saved education grants to strengthen research, something that in the long run may be absolutely necessary to maintain quality and promote the research connection in the educations. The same applies conversely for universities where the opposite relationship applies.
- The educational institutions can also do their bit 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 the university where the condescending term "teaching burden" is used frequently. University pedagogical development and competence must be stimulated, respected and valued.
- Cooperation between higher education institutions. In the memorandum Five starting points for a new system for resource allocation to the university that SFS presented in the spring of 2023, we propose that we safeguard efficient resource utilization by creating incentives in the resource allocation system to favor sharing and collaboration between higher education institutions to a greater degree. This should of course apply within medicine and nursing education. It could, for example, involve instructing higher education institutions to coordinate parts of certain broad educations. The educational institutions can also do this independently, but then it is important that there are no snags due to administration or the like. As students, we see it as extremely important that we get access to a good education and teachers with scientific competence.
In conclusion, it is clear that the university and the students play a critical role in navigating through the challenges and opportunities that Swedish healthcare is facing. 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 want to end by emphasizing the shared responsibility and that everyone needs to do their part, of course also 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 training in healthcare.