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Welcome to Örebro County Council

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Facts and figuresNumber of inhabitants in Örebro County: 275,000Area of Örebro County: 9,301 square kmArea of Sweden: 450,000 square km

Where to find us

Örebro County is madeup of 12 municipalities.Örebro County Councilis represented and worksin all 12.

Örebro County issituated in the centreof Sweden. Örebro liesbetween Stockholm,the capital of Sweden(200 km away) and themajor city of Gothenburg(300 km away).

Sweden

FinlandNorway

Denmark

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Örebro County Council

Örebro County Council works to develop the countyand improve the quality of life of all its residents. Thisis to be achieved in the areas of health care, dental care,research, culture, education and regional growth. TheCouncil’s principal responsibility is to organise andprovide health care.

The County Council’s vision:

Örebro County Council will bring about healthand vitality through security, quality and sustainabledevelopment.

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Good health care – a universal right

Swedish health services strive to achieve good health andmedical care on equal terms for the entire population. Allcounty inhabitants are entitled to expect good health carethat meets their specific needs and is readily available, andto receive appropriate and respectful treatment.

For us at the County Council, this means that weare to provide good health care and other services toeveryone, irrespective of their location in the county.

Greater accessibility

The Council is working hard to increase access to healthservices in order to meet patient demands for shorterwaiting times. This is being achieved through specificmeasures in various health care operations as well asthrough cooperation with other providers.

The Council’s principal responsibility is health care

Medical advances

Medical advances lead to shorter waiting times andenable the treatment of increasingly elderly patients.Technological developments mean that many operationsare less problematic than in the past, allowing patients toleave hospital earlier. More effective medication enablespeople to be treated at home rather than in hospital.

Working together for an optimal whole

Boosting health, curing diseases or improving qualityof life often involves a chain of events and other playersbesides the County Council. To ensure that countyresidents do not “slip through the gaps”, we at the CountyCouncil liaise with municipalities, social insurance officesand others to optimise the efficiency of the whole process.

Who does what in Sweden?

Sweden is a democracy, which means that everyone has equalvalue and rights. In a democracy, everyone is able to influencedecisions; as the Swedish Constitution puts it, all public powerstems from the people.

National level: Parliament and GovernmentThe Swedish Riksdag (parliament) is the principal popularrepresentative body. It has 349 members, elected by Swedes inparliamentary elections every four years. The parties that forma majority in the Riksdag appoint a government. The Riksdagmakes decisions that affect the whole of society, and interactswith other tiers of the public sector such as county councils andmunicipalities.

The Riksdag also determines the fundamental frameworkof health care. The overall objective of the Swedish Health andMedical Services Act is to ensure good health and health careon equal terms for the entire population.

Swedish health care is decentralised, with the CountyCouncils playing a key role. Health care is largely financedthrough taxes.

The County Councils are responsible for planning all healthcare in their county, for providing health care, financingprivately-run health care and for levying taxes on countyresidents. The County Councils cooperate at national level inthe Swedish Association of Local Authorities and Regions. Theywork together in six health care regions to provide highlyspecialised care. They also have cost responsibility for drugs.Apoteket AB is the state-owned chain of pharmacies that has amonopoly on the sale of drugs throughout Sweden.

Regional level: County CouncilsSweden has 21 County Councils, led by politicians who aredirectly elected in general elections every four years. CountyCouncils are the only popularly elected regional parliamentarybodies.

Örebro County Council is responsible for health care, dental

care, support and help to the disabled, some education andculture. The Council also helps finance various companiesand foundations such as Länstrafiken i Örebro AB (publictransport), the County Theatre, and Länsmusiken (which isresponsible for Örebro Concert Hall, the Swedish ChamberOrchestra in Örebro and other music associations). ÖrebroCounty Council and the county’s 12 municipalities worktogether in a regional association.

The County Council should not be confused with theCounty Administrative Board, which is national governmentactivity at regional level. The executive of the CountyAdministrative Board is made up of the government-appointed County Governor and representatives appointedby the County Council.

At local level: municipalitiesSweden is divided into 290 municipalities led by directlyelected politicians elected by the municipality’s residentsevery four years. Each municipality is responsible forproviding its inhabitants with nurseries, schools, care andservices for the elderly and the disabled, housing, water andsewage, road maintenance, waste disposal and otheramenities. Örebro County contains 12 municipalities.

’’The market’’Democratically elected bodies at national, municipal andcounty level are not alone in being able to exercise powerand influence. Other entities such as “the market”, the massmedia and the courts also wield considerable power.

The market impacts on the country’s economy; privatesector growth has a major impact on employment, which inturn affects tax revenue at national, county and municipallevels. The media play a part in steering the development ofsociety by influencing public opinion and as purveyors ofnews and information. Judicial power is exerted byindependent courts of law.

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Örebro County Council’s main task is to provide

the county’s 275,000 residents with health care.

About 1,900 people visit a doctor in Örebro County each day.

Some 1,000 patients a day are cared for

at one or other of the county’s hospitals.

The County Council employs roughly 8,700 people whose task

is to ensure the health and security of county residents.

Health care guarantee

Patients with urgent conditions are always treated directly.Planned operations or treatments are subject to aguarantee for maximum waiting times that appliesthroughout Sweden. The guarantee states the numberof days within which the patient is to be offered plannedmedical care. The number of days varies, depending onthe treatment that the patient needs, but nobody shouldneed to wait more than three months for a plannedoperation or treatment. If the County Council cannotmanage this, the patient is offered the treatment byanother care provider.

Freedom of choice

Residents of Örebro County can choose any care providerin the county or elsewhere in Sweden. This freedom ofchoice does not apply to highly specialised care such asheart surgery and transplants.

Cost ceiling and free care for under-20s

In Örebro County, health care is free to all under-20s;others pay a patient fee. There are three types of costceiling to ensure that nobody incurs prohibitive costs forhealth care. These are for health care appointments, forpatient transport and for medication.

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Local primary care centres are the bedrock of Swedishhealth care. These centres treat 90 per cent of all illnessesand injuries. If necessary, the doctor will refer a patient toa specialist at the county’s hospitals.

About 1,900 people in Örebro County visit a doctoron any given day. The vast majority of patients see doctorsat their primary care centres. These doctors are specialistsin general medicine and are experienced in dealing withmost conditions. Doctors, district nurses, child healthcare, midwives and physiotherapy are available at primarycare centres. Patients can also see a social worker orpsychologist. In addition there are special youth familyplanning clinics where teenagers can get advice and help.

Örebro County has 29 primary care centres, four of

which are run by sub-contractors. Each municipality hasat least one primary care centre.

People who fall ill during an evening or weekend canturn to the primary care centre’s on-call and telephoneadvisory services.

Round-the-clock health care advice

The health care advisory service Sjukvårdsrådgivningenis a supplement to the primary care centre, and serves theentire county. People can call the service 24 hours a day,7 days a week. Experienced district nurses take the callsand provide medical information and advice about self-care. They also assess whether the patient needs to contacta doctor.

First tier:Local primary care centres

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Specialist care, such as surgery or treatment, is provided athospitals. County health care services are also responsiblefor providing support and help to the mentally ill.

Örebro County has three hospitals. The largest isÖrebro University Hospital (USÖ), with 37 clinics, 590beds and 3,500 employees. Karlskoga Hospital in the westof the county has 6 clinics, 150 beds and 900 employees.Lindesberg Hospital, in the north of the county, has5 clinics, 100 beds and 700 employees. All three hospitalshave accident and emergency departments that are open24 hours a day.

The hospitals in Karlskoga and Lindesberg primarilyprovide specialist care to residents in their catchment

areas, but they work together with USÖ in various ways.Karlskoga Hospital cooperates with health care servicesin Värmland County and also treats patients fromVärmland.

Ambulance care is an important part of the healthcare chain. Skilled ambulance staff often start treatmentat the scene, thus saving lives. Örebro County Councilhas long focused on having highly qualified ambulancestaff, and each ambulance must be staffed by at least onenurse. The roof of USÖ has a helipad for patients whoneed to be transported to the hospital especially quickly,due to urgent illnesses or injuries.

Second tier:County health care at our hospitals

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Patients with complicated or rare diseases or injuriesreceive highly specialised care. Hospitals that provide suchcare are also centres of research and medical training.Örebro University Hospital – USÖ – is one of eightUniversity hospitals in Sweden and a centre for highlyspecialised care. USÖ has an impressive track record ofsuccess in cardiology, cancer therapy and eye treatments.

Most of USÖ’s clinics work with highly specialisedcare, but the hospital also provides second-tier specialistcare to county residents. Highly specialised care is pro-vided to patients from large areas of central Sweden andthe rest of the country, as well as patients from ÖrebroCounty.

USÖ trains doctors from the Department of Medicineat Linköping University. Each year, 60–70 medical stu-dents do part of their training at USÖ. The CountyCouncil works with Örebro University in the field ofmedical sciences, and are currently jointly working on theestablishment of a comprehensive medical degree coursein Örebro.

USÖ’s medical device projects attract widespreadattention throughout Sweden. One such project is thedevelopment of digital imaging technology, which isalso linked to a system between the different hospitals.

Research in Örebro County Council

Örebro County Council is working hard alongsideÖrebro University to build up the field of medical sci-ences. We are concentrating on establishing scientificexpertise with the main focus on clinical point-of-careresearch. A number of research groups are studyingdifferent types of ill-health, spanning the field from stressand burn-out to modern genetics, and common diseasessuch as diabetes and cancer. The clinical research centre atUSÖ is a hub of education, research and health careevaluation.

Örebro County Council earmarks about SEK100 million a year for research; part of this is financedthrough various funds.

Third tier: Highly specialised care at USÖ

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Lifestyle and health promotion work

Lifestyle – our habits regarding diet, exercise, stress, sleep,tobacco and alcohol – has a significant impact on ourwellbeing. With the right support we can make wiserchoices and stay healthy for most of our lives. This is whythe County Council is focusing on maternity care,paediatric care, stop-smoking groups, and weight loss andexercise groups. The County Council also providesfinancial assistance to sports and exercise activities thatcontribute to better health in the county.

This health promotion work aims to give people thebasis they need to make sound choices. The CountyCouncil is working to eradicate differences in health basedon gender, class and ethnic origin. Most emphasis isplaced on children and young people, the elderly andpeople with psychiatric conditions.

The County Council wants to enable detection ofdisease at an early stage through regular health checks.Mammography and smear tests help in the early detectionand cure of many cases of cancer.

Care of the elderly – cooperation between the

County Council and municipalities is crucial

An increasingly elderly population requires more healthcare and nursing. Responsibility for provision of goodhealth care to the elderly is shared by the county’smunicipalities and the County Council. Municipal nursesand occupational therapists and County Council doctorsand physiotherapists at primary care centres areresponsible for different treatment measures.

The County Council provides health care at primarycare centres and hospitals, and each of the county’s threehospitals has a geriatric clinic for treatment and rehabili-tation.

Home care enables people with prolonged illnessesto receive care in their own home. This care is givenby nurses, occupational therapists and other care staffemployed by the municipality, as well as doctors andphysiotherapists employed by the County Council.

Palliative care is a joint effort involving doctors atprimary care centres and municipal nurses and care staff.

What else do the health services do?

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Psychiatry

Psychiatry is part of the County Council’s specialisthealth care, with the task of examining and treating thementally ill. Primary care services are responsible forinitial care of patients with mental health problems. Ifthe problems become very severe, the patient is referredto the County Council’s specialist psychiatric services.Most psychiatry is provided as outpatient and primarycare, but County Council psychiatric services also include150 inpatient beds.

Besides general psychiatry, Örebro County Council’sservices have psychiatric units for children and youngpeople, addiction problems, forensic psychiatry andpsychosis care. There are also teams working on specialareas such as crisis and trauma clinics and teams for thedeaf and hearing impaired.

Services for the disabled

People with brain damage, learning difficulties or whofor other reasons have difficulty in coping with everydaylife are to be able to live as normally as possible. Servicesto the disabled are provided by municipalities and theCounty Council. Municipalities give support in day-to-day living and the County Council provides health careand treatment. The most important task of Council-runhabilitation activities is to make life easier for people withdisabilities.

Assistive technology for people with disabilities

The Council supplies assistive technology for peoplewith physical disabilities, learning difficulties and variouscommunication difficulties such as blindness or impairedvision, deafness or hearing impairments. The Council alsoruns an interpretation centre for the deaf, adult deaf anddeaf-blind.

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Dental care for everyone in the county

The County Council is responsible for the dental healthof the population and for the provision of good needs-based dental care. Patients can choose Council-run dentalcare or private dentists. About 95 per cent of children andyoung people up to 19 years old, and some 40 per cent ofthe county’s adult population, choose Council-run dentalcare, Folktandvården.

Folktandvården is the collective name of the CountyCouncil’s dental clinics. Most of their work is generaldental care, i.e. ordinary dental care for children, youngpeople and adults. There are 23 clinics in Örebro County.

Folktandvården also provides specialist dental careat hospitals. These services offer more complicatedtreatments. Folktandvården’s centre for specialist dentalcare includes all types of specialist dentistry. Patientsreferred to the centre might have serious periodontaldiseases, require tooth implants or orthodontic treatment,or be children in need of some form of specialist dentaltreatment. The centre is also home to one of Sweden’s

largest dental training clinics. Folktandvården has adental laboratory in the same building.

Dental care is free for children and young peopleunder 20. The County Council pays for all dental carefor children, including specialist treatment, irrespectiveof whether the child, parent or guardian chooses a privatedentist or Folktandvården.

From the year when patients turn 20, they mustpay for a large proportion of their dental care themselves.Patients are covered by national dental insurance, whichmeans that the Social Insurance Agency pays some of thecost of dental care.

The County Council is responsible for outreachactivities to certain care-intensive groups such as theelderly and the disabled. The visits take place in thepatients’ own homes. Most of these patients receivenecessary dental care according to the same fee systemthat applies to the County Council’s health care services.The Council finances dental care in the same way fora number of other patient groups with special needs.

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The County Council Assembly is the County Council’shighest decision-making body, and is the only popularly-elected county-level parliamentary body. Every four years,the county’s inhabitants elect 71 members of differentpolitical parties to the County Council Assembly. Thepoliticians come from all over the county. Their task isto represent the county’s inhabitants.

The needs of the population are paramount

Örebro County Council exists to serve the county’sinhabitants, and their needs are to guide Councilplanning. The politicians must also ensure that Councilactivities are run so efficiently that taxpayers’ money isused appropriately.

County Council Assembly

Each year, the County Council Assembly decides howmuch county tax county residents will pay. The Assemblysets economic frameworks and guidelines for the CountyCouncil’s activities and adopts the budget. The Assemblyholds six meetings a year, which are open to the public.The vast majority of those elected to the Assembly arepoliticians in their spare time; only a few are salariedfull-time or part-time politicians.

The County Council Executive Board leads

The County Council Executive Board leads andcoordinates Council activities. All issues raised by theCounty Council Assembly have first been processedby the County Council Executive Board. The Board

The County Council: a democratically-governed body

comprises 15 members elected by the County CouncilAssembly. The members come from the political majorityas well as from the opposition.

Preparatory committees identify needs

The basis of the political organisation is made up ofpreparatory committees that survey the population’sneeds and requests, and propose changes from a citizen’sperspective. The committees work in various parts of thecounty to make it easy for inhabitants to interact withpoliticians.

Specialist boards weigh proposals

The preparatory committees’ proposals are then broughtto two specialist boards for decision. Health care issues areprocessed by the Health Care Board, while the ResearchBoard deals with research issues.

Preparatory work and contact with citizens

Between County Council Assembly meetings, manypoliticians meet in various working groups. This is whereall issues are prepared for later decisions.

As a democratic organisation, the County Councilcomplies with the Swedish principle of public access. Thismeans that citizens are entitled to see public documenta-tion and keep themselves informed of the CountyCouncil’s activities. All county inhabitants can also submitcitizens’ proposals to the County Council Assembly.Citizens’ proposals are prepared and processed in the sameway as proposals from elected members.

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The Örebro County Council

Assembly has 71 seats.

Distribution of seats for 2007–2010:

Social Democratic Party (s) 31 seatsModerate Party (m) 13 seatsChristian Democrats (kd) 6 seatsCentre Party (c) 5 seatsLiberal Party (fp) 5 seatsLeft Party (v) 5 seatsGreen Party (mp) 3 seatsSweden Democrats (sd) 3 seats

Örebro County Council´s

political organisation as from 2007

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Örebro County Council´s

administrative organisation 2007–2010

County Counciladministrative organisation

Politicians decide which goals the County Councilwill work towards and how the money is to bedistributed between different areas. A great dealof the work however is governed by legislation suchas the Swedish Health and Medical Services Act.

The practical work of leading the CountyCouncil’s activities and complying withlegislation and decisions is a task for thecivil service (administrative) organisationand senior County Council staff. TheCounty Council Director leads theadministrative organisation with its 8,700employees. This is the highest civil serviceposition in the County Council.

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SEK 6 billionto run the County Council

Örebro County Council’s activities cost about SEK6 billion a year to run. This is mainly funded throughtaxes paid by the county’s inhabitants. An average wageearner pays about SEK 2,000 a month in tax to theCounty Council. Thanks to that money, the Council canprovide good health care to all, free health and dental careto children and young people, habilitation for people withdisabilities, education, support for culture, and generallysafeguard of the interests of county inhabitants.

Eighty-six per centis spent on health care

Health care is the County Council’s largest area ofoperation. It accounts for more than 86 per cent of theCouncil’s costs. More than half of the County Council’scosts are salaries. With 8,700 employees, the CountyCouncil is one of the county’s biggest employers.

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A typical day in Örebro County

Seven babies are born, and nine people die.

Ambulances make 64 call-outs.

70 patients undergo surgery in the county’s hospitals.

1,000 patients are cared for at the

county’s three hospitals.

About 1,900 people go to a doctor somewhere

in the county.

Health care costs SEK 12.8 million.

About 4,700 people are at work in Council-run

health care services.

Box 1613, SE-701 16 Örebro, SwedenTel. (switchboard): +46 19-602 70 00E-mail: info@orebroll.sewww.orebroll.se P

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