Annual Report 2014

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Kapitelnamn Annual Report 2014

1

Contents Important events in 2014............................................................4

Karolinska University Hospital ..............................................62

Summary......................................................................................6

Södersjukhuset AB...................................................................63

Administration report................................................................9

Danderyds Sjukhus AB............................................................64 TioHundra AB..........................................................................65

Introduction.................................................................................9

Södertälje Sjukhus AB.............................................................67

The global economic trend....................................................... 10

St. Eriks Ögonsjukhus AB........................................................68

The economic trend in Sweden................................................ 10

Ambulanssjukvården i Storstockholm AB..............................69

The economic trend in Stockholm County.............................. 10

Stockholm Care AB..................................................................70

Significant events during 2014.................................................11

Folktandvården Stockholms län AB........................................70

Goals...........................................................................................12

MediCarrier AB........................................................................72

Assessment of goal attainment................................................ 13

Public transport.........................................................................73

Balanced finances .................................................................... 13

Overall public transport.......................................................... 74

Improved availability and qua­li­t y of health

AB Storstockholms Lokaltrafik...............................................76

and medical care ...................................................................... 14

Waxholms Ångfartygs AB....................................................... 77

Improved reliability of public transport.................................. 15

Transport services for the disabled.........................................78

Sustainable growth.................................................................. 16

Culture........................................................................................79

Free, accessible, high quality cultural life............................... 18 An attractive and competitive employer................................. 18 Financial analysis......................................................................20

Surplus/deficit.......................................................................... 21 Revenues..................................................................................23 Expenses...................................................................................26 Financing .................................................................................28 Investments...............................................................................32

Investment trend......................................................................33 Public transport investments..................................................33 Investments in healthcare including properties.....................34 New Karolinska Solna..............................................................35 Financial performance of boards and committees............................................................37

County Council Executive Board.............................................38 Public Healthcare Services Committee...................................39 Health and Social care Committee in Norrtälje ..................... 41 Traffic Committee....................................................................42 Culture Committee .................................................................44 Patient Advisory Committee...................................................44 County Council Auditors..........................................................45 All Stockholm County Council operations..............................46 Expected development.............................................................47

Free, accessible, high-quality cultural life............................. 80 Sustainable growth..................................................................81

Regional development.............................................................82 The County Council as an employer ........................................88

An attractive and competitive employer.................................89 Salary policy that supports operational improvement.......... 90 The County Council – an employer with breadth................... 90 Skills provisioning.................................................................. 90 Education................................................................................ 90 Greater diversity – equal conditions and opportunities......... 91 Management and leadership...................................................92 Health-promoting work environment ...................................92 Properties in healthcare...........................................................93

Overall properties....................................................................94 Locum AB.................................................................................94 Landstingsfastigheter Stockholm (LFS).................................95 Financial and other operations................................................96

Overall financial operations....................................................97 Group financing........................................................................97 AB Stockholms Läns Landstings Internfinans.......................98 Landstingshuset i Stockholm AB............................................99 Damages Account.....................................................................99

Development over the next few years......................................48

Foundations, endowments and coordinating

Operations report.....................................................................50

Formed by the County Council independently

federations..............................................................................100

Overall areas of operation........................................................50

or with others..........................................................................101

Governance................................................................................52

Financial report.......................................................................104

County Council’s responsibility and mission..........................53

Audit Report for the County Council

Objectives.................................................................................53

Executive Board 2014............................................................ 126

Assignments.............................................................................53

Abbreviations......................................................................... 127

Follow-up of supervisory obligations......................................54

Contact information...............................................................128

Health and medical care...........................................................55

General health and medical care.............................................56 Healthcare Provision, Stockholm County.............................. 60 Follow-up of emergency hospitals...........................................62

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LS 1410-1162

The figures in parentheses refer to the year-before period, unless otherwise specified. Deviations may occur in tables and diagrams  Tosince contents the figures have been rounded from SEK thousands to millions.

Message from the County Council Finance Commissioner Working as the County Council Finance Commissioner in Stockholm County is a privilege. After the election in the autumn, I was privileged to have again been entrusted with the reins of the County Council with the support of the parties of the Alliance. My main responsibility is to ensure that the resources exist to meet the residents’ needs, finance health and medical care and ensure good transport options for all. This must be done with finances balanced on the long term, both with regard to healthcare and public transport. Balanced finances are a prerequisite in order for us to be able to continue developing health and medical care and to meet the needs of tomorrow for accessible and functioning public transportation. 2014 was yet another year that was characterised by rapid growth, population growth and large expansion in the region. Stockholm County is an engine for growth for Sweden as a whole and we must constantly keep our sights set on the future – extensive investments are a must for the region’s continued development. New Karolinska and the Metro expansion are two examples of investments for the future that will develop our operations and I can confidently confirm that both of these projects are continuing according to plan. After eight years of a surplus for the County Council, we now have several years ahead of us with financial challenges. In conclusion, I would like to express our great appreciation to all of our employees throughout the County Council’s operations. It is the personnel who generate the operations, and all of the employees in the County Council who see to it that the residents receive both world-class care and transports.

Torbjörn Rosdahl County Council Finance Commissioner

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Important events in 2014

• Financing for the new Metro line ready In January 2014, an agreement was signed between the national government, the County Council, the City of Stockholm, the Municipality of Nacka, the City of Solna and Järfälla Municipality on the expansion of the Metro. One month later, the County Council Assembly decided on the financing and co-financing of the Metro expansion. In March 2014, the Swedish Parliament passed a bill on higher congestion taxes in the inner city of Stockholm and to introduce congestion tax to the Essingeleden by-pass, meaning that the revenues from the changed congestion taxes will be used to co-finance the Metro. The new Metro line is also being funded through contributions from the City of Stockholm, Municipality of Nacka, City of Solna and Järfälla Municipality. The extended Metro line will run to and from Nacka, Barkarby and Arena­ staden. A branch to Gullmarsplan from the line to Nacka will also be built to increase the southbound capacity. The project is one of the largest infrastructure projects in the county since the construction of the existing Metro.

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Annual Report 2014

• The Plan for Future Health and Medical Care becoming reality The Plan for Future Health and Medical Care (Framtidsplan för hälso- och sjukvården) began to be implemented in 2014. Healthcare is being developed to provide care where all care providers work together and where care is provided closer to the patient. More care capacity is being generated as we build new facilities and upgrade old. Research is being tied more closely to the daily operations with the aim of improving care, increasing quality, improving efficiency of resource utilisation and developing new ways of working. All of these efforts being conducted in health and medical care are based on The Plan for Future Health and Medical Care.

• Collective biobank for better research The County Council established a regional biobank together with Karolinska Institutet. The aim is to coordinate and standardise the handling of samples at all levels of care in the entire region and increase quality of tests and data. Stockholm’s medical biobank is also building up a system to make samples and data more available. This provides good conditions for medical research to be able to lead to better treatments. Important aspects to take into consideration are the patient’s needs and integrity.

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• Effective environmental work inspires others The County Council’s successful environmental work is based on clear and measurable targets which are integrated into its activities. We use biogas, ethanol and electricity from renewable sources in public transport. We prevent climate-impacting emissions from nitrous oxide in healthcare and are phasing out hazardous chemicals. In 2014, an environmental prize was launched for the best innovation and new way of thinking in the County Council’s operations. The prize was awarded to Capio St. Göran Hospital for reduced use of climate-impacting anaesthetics.

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• First Swedish county council to make a stake on green bonds Stockholm was the first county council in Sweden to carry out a transaction on a green bond. This is a way to borrow money for environmentally smart efforts at the same time that investors contribute to a better environment. The technical improvement to the Roslagsbanan suburban railway and the new construction and renovation of Södertälje Hospital are examples of environmentally classified projects. The bond comprised SEK 1.1 billion and was implemented on the Swedish market and was quickly oversubscribed. The amount of SEK 1.1 billion corresponds to approximately 15 per cent of the County Council’s credit requirements for 2014. Green bonds were first issued by the World Bank in 2008.

• Approved budget with a resident focus In 2015, Stockholm County Council is making major investments in healthcare and public transport to contribute to the functioning daily lives of the County’s residents in a quickly growing region. We are upgrading and building new facilities and operations. The large investments place considerable demands on coordinated governance and cost control. One of our major challenges in 2015 is to hold down the rate of cost increases to levels sustainable on the long term and at the same time increase efficiency.

Annual Report 2014

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Summary Stockholm County Council presented a surplus for the eighth consecutive year. The surplus for 2014 amounted to SEK 136 million, which was SEK 84 million higher than budgeted. Balanced finances are one of the County Council’s overriding objectives and a key prerequisite to be able to make the record-breaking investments in healthcare and public transport.

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Annual Report 2014

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of overall tax revenues. Total tax reveincreased by around 35,000 residents nues amounted to SEK 63,971 million in 2014. This is an increase of 1.6 per and increased by SEK 2,169 million or cent and it accounts for 34 per cent of 3.5 per cent compared with 2013. The the population increase in Sweden as a outcome for the year is in line with the whole. It is a positive that many people budget. want to live, work and study in the The economic recovery in the next county. At the same time, it means more few years will contribute to a strong passengers on public transport and development of the total revenues in the more residents in need of well functionCounty Council. In order for the ing health and medical care. finances to continue to be balanced, and The surplus for the year, excluding at the same time enable necessary items affecting comparability, was SEK investments in healthcare and public 386 million, which can be compared transport, the cost trend must be broken with last year’s surplus excluding items and adapted to the County Council’s affecting comparability of SEK 1,684 long-term financial capacity. million. The County Council’s expenses Stockholm County Council’s revetotalled SEK 82,342 million in 2014. nues totalled SEK 82,478 million in Operating Revenuesexpenses 2014 amounted to SEK 2014. The overwhelming majority of 77,661 million and increased by 6.6 per Government grants and other Other revenues, the revenues, 78 per cent, is comprised cent compared with the preceding year The population of Stockholm County

grants, SEK 3,101 million, 4%

SEK 1,550 million, 2%

and 1.2 compared with budget. The largest expense items are personnel costs, purchased health and medical care services and purchased transport services. Stockholm County Council has six emergency hospitals that are run under the County Council’s own direction. The total results for the emergency hospitals amounted to a deficit of SEK 781 million, adjusted for interest expense and payroll tax on the year’s pension liability as a result of a changed discount rate. This was SEK 832 million lower than the budgeted performance requirement of a surplus of SEK 51 million. There are many reasons for the deviation and they vary between the hospitals. Common among them are, however, higher staffing costs for own

Rental income, sales, other services SEK 3,733 million, 4% Sales of primary services SEK 1,820 million, 2%

Revenues 2014

Government grants and other Other revenues, Patient fees SEK 1,325 million, 2% grants, SEK 3,101 million, 4% SEK 1,550 million, 2% Rental income, sales, other services receipts SEKPassenger 3,733 million, 4% SEK 6,978 million, 8% Sales of primary services SEK 1,820 million, 2%

Patient fees SEK 1,325 million, 2%

Total tax revenues SEK 63,971 million, 78%

Total tax revenues SEK 63,971 million, 78%

Passenger receipts SEK 6,978 million, 8%

Expenses 2014 Net financial items SEK 864 million, 1% Depreciation/amortisation SEK 3,817 million, 5%

Other expenses SEK 14,539 million, 18%

Expenses 2014

Personnel costs SEK 27,179 million, 33%

Net financial items SEK 864 million, 1% Depreciation/amortisation Pharmaceuticals SEK SEK 3,817 6,315 million, million, 5% 8% Purchased transport services Other expenses SEK SEK 12,670 14,539 million, million, 15% 18%

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Personnel costs Purchased healthcare 27,179 million, SEK 16,958 33% 20%

Pharmaceuticals SEK 6,315 million, 8%

Purchased transport services SEK 12,670 million, 15%

Summary Annual Report 2014

Purchased healthcare SEK 16,958 million, 20%

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and insourced personnel. The staffing costs increased in part due to a shortage of nurses and higher personnel turnover, which has entailed higher costs for training and for insourced personnel. In dialogue with the County Council’s management, the respective hospitals planned for and implemented a number of measures in 2014 to reduce costs and increase revenues, and these efforts will continue in 2015. The investment volume for the year amounted to SEK 14,988 million and is distributed over multiple large investment projects. Traffic investments extend over all modes of transport and the year’s outcome amounted to SEK 7,873 million. Among other things, a new depot has been built for the Metro’s red line, the Lidingöbanan suburban railway has received technical improvements and three stretches were

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Annual Report 2014 Summary

expanded to dual-track traffic on the Roslagsbanan suburban railway. Healthcare investments in 2014 primarily consist of the construction of New Karolinska Solna, which has proceeded according to plan, in terms of both time and finances. The technical building was taken over by the County Council in spring 2014. In addition to this, work is under way on new construction and renovations of Södertälje Hospital and technical improvements of a building at Löwenströmska Hospital. Work has begun on the new Metro line in Stockholm County. The County Council is responsible for the new Metro line, while the municipalities will build 78,000 residential units in the local vicinity of the line. The new Metro lines to Nacka, Barkarby and Arena­ staden are expected to be complete by

2025. The expansion covers almost 20 kilometres of new track and nine completely new stations. The County Council’s interest-bearing liabilities increased during the year by SEK 4,051 million, totalling SEK 32,931 million at 31 December. Stockholm County Council has six overall objectives. They are: balanced finances, improved availability and quality in healthcare, improved reliability of public transport, sustainable growth, a free, accessible, high-quality cultural life, and being an attractive, competitive employer. The overall objectives are broken down into 18 goals that are all followed up by means of multiple indicators, 42 in total. In 2014, all overall objectives were achieved, and 15 of the 18 broken-down goals and 32 of the 42 measurable indicators were achieved.

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Administration report Introduction The global economy has become divided, but the Swedish economy, especially Stockholm County, began an economic recovery in 2014. Employment both nationally and in Stockholm County increased strongly, which contributed to continued strong growth of the tax base.

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Annual Report 2014

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The global economic trend The economies in the U.S. and the UK gained speed in 2014, while growth in the euro zone remained weak, although GNP growth showed positive figures after a very weak development in 2013. The global economy grew by 3.3 per cent in total in 2014. One contributing factor to this was China’s continued strong economic trend. For the development of the Swedish economy, growth in the euro zone and in the Nordic region is important since these areas constitute significant export markets. The economic situation in the euro zone weakened in the autumn. Uncertainty about the future economic trend in the euro zone and low domestic demand still seem to be dampening corporate investment, despite very expansive monetary policies and low capital costs. Global inflation is very low and is dampened by continued high unemployment, primarily in the euro zone. The low inflation and still subdued growth outlook in the global economy has contributed to major central banks pursuing a very expansive monetary policy. As the UK and U.S. approach a more normal capacity utilisation, monetary policy will become more neutral.

The economic trend in Sweden

2014, inflation was –0.2 per cent, due in part to interest rate cuts and the decline in oil prices, but mainly because of a generally low inflationary pressure both in Sweden and the surrounding world. The final tax outcome for the 2013 income year indicated an increase of the actual tax base nationwide of 3.4 per cent compared with 2012. The forecast for 2014 is that the tax base will grow by 3.2 per cent.

The Swedish economy developed well in 2014. GNP is expected to have grown by nearly 2 per cent at the same time that employment rose rapidly and inflation was low. Growth was driven by domestic demand while exports continued to be weak. Household consumption continued to grow at a good pace at the beginning of the year, at the same time that investments in housing contributed to growth. Household income is rising thanks to the rapid increase in employment and low inflation. In 2014, unemployment was relatively stable at around 8 per cent, but dropped towards the end of the year. Employment adjusted for seasonal variation increased by around 1 per cent, which is a strong increase in relation to growth during this period. According to Statistics Sweden, productivity in the Swedish economy has increased slowly in recent years. Despite rapidly rising employment, salary increases were 2.0 per cent in 2014. Over the past four years, inflation according to the consumer price index (CPI) has been at an average of around 1 per cent, excluding mortgage rates. In

The economic trend in Stockholm County The economic trend was somewhat stronger in Stockholm County compared with Sweden as a whole in 2014. Expectations for the future are moderate. The number of people employed in Stockholm County totalled 1,165,900 in the fourth quarter, corresponding to 70.9 per cent of the population aged 15 to 74 years. This is an increase of 21,000 individuals compared with the year before. For Sweden as a whole, the employment rate was 66.0 per cent during the corresponding period. Only one county, Halland, has an employment rate comparable to Stockholm County. The unemployment rate in Stockholm County rose somewhat in 2014, how-

GDP growth 2013–2015 Percentage change

Outcome 2013

Forecast 2014

Forecast 2015 3.6

2.2

2.4

–0.5

0.9

1.2

China

7.8

7.5

6.8

World

3.3

3.3

3.6

Sweden

1.2

1.9

2.9

Outcome 2013

Forecast 2014

Forecast 2015

GDP

1.2

1.9

2.9

Employment, hours

0.4

1.7

1.3

Unemployment (level)

8.0

7.9

7.6

Hourly pay

2.0

2.0

3.0

Consumer prices, CPI

0.0

-0.2

0.2

Tax base

3.4

3.2

5.1

USA Euro zone

Sources: IMF, SKL and Riksbanken

Swedish economic key figures 2013–2015 Percentage change

Source: SCB, SKL and Riksbanken

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Annual Report 2014 Summary

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ever. In the fourth quarter, unemployment was 6.3 per cent of the workforce, or 79,000 individuals. In Sweden as a whole, unemployment was 1 percentage point higher than in Stockholm County, or 7.3 per cent of the workforce. The population of Stockholm County continues to grow strongly. In 2014, the population grew by 35,000 individuals, which was around 1,000 fewer than in 2013. Stockholm County accounted for 34 per cent of Sweden’s population increase. The tax base in the county increased more than in any other county in Sweden. In the 2013 income year, the increase in the county was 3.4 per cent. For 2014, the increase is expected to amount to 3.2 per cent.

Significant events during 2014 Work on the new Metro under way At the beginning of 2014, the County Council Assembly approved the financing and co-financing of the Metro expansion according to the 2013 Stockholm Negotiations. The expansion to Nacka, Barkarby and Arenastaden is expected to be completed by 2025. In addition, a branch to Gullmarsplan from the line to Nacka will also be built to increase the southbound capacity.

The expansion covers almost 20 kilometres of new track and nine completely new stations. The project is one of the largest infrastructure projects in the county since the construction of the existing Metro. Plan for Future Health and Medical Care becoming a reality Implementation of the Plan for Future Health and Medical Care began in 2014. Healthcare is being developed into a healthcare provision in which all care providers work together and where care is provided closer to the patient. More care capacity is being generated as the County Council builds new facilities and upgrades old ones. Research is being tied more closely to the daily operations, with the aim of improving care, quality and efficiency of resource utilisation, and developing new ways of working. All of these efforts being conducted in health and medical care are based on the Plan for Future Health and Medical Care. Effective environmental work The County Council’s successful environmental work is based on clear and measurable targets which are integrated into its activities. The County Council uses biogas, ethanol and electricity from renewable sources in public

transport. The County Council prevents climate-impacting emissions from nitrous oxide in healthcare and is phasing out hazardous chemicals. In 2014, Stockholm County Council launched an environmental prize for the best innovation and new approach in the County Council’s operations. The prize was awarded to Capio St. Göran Hospital for reduced use of climate-impacting anaesthetics. First county council to work on green bonds Stockholm w as the first county council to implement a green bond. This is a way to borrow money for environmentally smart efforts, while at the same time investors contribute to a better environment. The technical improvement to the Roslagsbanan suburban railway and the new construction and renovation of Södertälje Hospital are examples of environmentally classified projects. The bond comprised SEK 1.1 billion and was implemented on the Swedish market and was quickly oversubscribed. The amount of SEK 1.1 billion corresponds to approximately 15 per cent of the County Council’s credit requirements for 2014. Green bonds were first issued by the World Bank in 2008.

Stockholm County key figures 2012–2014 Employment Unemployment

2014

2013

2012

70.9%

70.6%

69.7%

6.3%

6.1%

6.7%

16,757

16,219

16,226

Bankruptices result

2,343

2,612

2,537

Population result (1 Nov)

1.6%

1.7%

1.7%

Newly started companies (to Sept.)

Source: SCB and Growth Analysis

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Summary Annual Report 2014

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Goals The County Council’s operations are governed by democratic decisions on what needs and objectives should be prioritised. The County Council Assembly makes decisions of a general and principle nature regarding objectives, emphasis, scope and quality of the County Council’s operations. The County Council Executive Board manages and coordinates operations. Goal-orientation provides the prerequisites for governance and development of the County Council’s operations and aims to achieve long-term sustainable development. Based on six overall objectives and 18 broken-down goals, all of which are followed up with multiple indicators, goal attainment for the operations can be monitored.

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Annual Report 2014

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Assessment of goal attainment

is that each generation must itself bear the costs of the services that it consumes.

investments have been self-financed. The financing objective was achieved.

The overall objectives shall be viewed over time and are considered to be fulfilled when at least half of the broken-down goals have been met. The broken-down goals are considered to be met when at least half of the underlying indicators are achieved. In Goals and Budget for 2014 for Stockholm County Council, LS 13010040, the County Council Assembly decided in general for 2014 that the indicators’ value shall be improved or maintained compared with achieved values for 2013. Based on the above, the collective assessment is that, in 2014, all overall objectives were achieved, and 15 of the 18 broken-down goals and 32 of the 42 indicators were achieved. During the year, one new indicator was added in the overall objective of improved reliability in public transport. Under the overall objective of sustainable growth, one indicator was removed and two indicators were clarified and supplemented with new subheadings.

Sound financial management

Debt

The overall objective has a goal, sound financial management, which is monitored through measurable indicators: surplus/deficit, financing, debt, capital costs and debt/equity ratio. The goal of sound financial management presupposes that the financial indicators are met. This is based on the efficient use of taxpayer funds.

To achieve the debt objective, loan financing must not be used to finance operating expenses or replacement investments. The proportion of investments that may be loan-financed is calculated by adjusting the investments for the year for replacement investments and some items that do not affect liquidity. At 31 December 2014, the investments that may be loan -financed amounted to SEK 9,669 million, which is more than the increase in loans raised. The loans thereby did not finance operations or replacement investments. The debt objective was achieved.

Balanced finances The County Council Assembly has expressed the overall objective for finances in Stockholm County Council as: • Balanced finances County Council finances need to be balanced in order to ensure short- and long-term operations. The starting point

Surplus/deficit In order to achieve the surplus/deficit objective, Stockholm County Council must report a surplus according to the balance requirement. The surplus for the year amounted to SEK 136 million at 31 December. The balance requirement result for the year amounts to SEK 3 million. The surplus/deficit objective was achieved. Financing In order to achieve the financing objective, replacement investments must be 100 per cent self-financed. The space to be able to finance investments with own funding comprises the surplus for the year adjusted with items that do not affect liquidity at 31 December. This space must exceed the amount of the year’s replacement investments. The space discerned from the cash flow state­ ment amounts to SEK 6,076 million and is higher than the replacement investments that amount to SEK 3,796 million, which means that the replacement

Capital costs The capital cost share of the collective tax revenues may amount to a maximum of 11 per cent. For 2014, the capital cost share of total tax revenues amounted to 7.1 per cent. The capital cost objective was achieved. Debt/equity ratio The debt share of the collective tax revenues may amount to a maximum of 131 per cent. The liabilities are adjusted for the component related to financing from an external party. The debt share of total tax revenues, adjusted for external financing, is 84 per cent. The debt/equity ratio objective was achieved.

Balanced finances Goals and indicators

Outcome 2013

Outcome 2014

Achieved 2014 Yes •

Sound financial management Results: A positive result according to the balance requirement

SEK 89 million

SEK 3 million

Financing: Replacement investments self-financed to 100 per cent

Achieved

Achieved

Debt: Loan financing is not used to finance operations or replacement investments.

Achieved

Achieved

Yes •

6.9%

7.1%

Yes •

77%

84%

Yes •

Capital costs: The capital cost share may amount to a maximum of 11 per cent of the collective tax revenues. Debt/equity ratio: The debt share may amount to a maximum of 131 per cent of the collective tax revenues.

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Yes •

Goals Annual Report 2014

13

Improved availability and qua­ li­ty of health and medical care The County Council Assembly has expressed the overall objective for health and medical care within Stockholm County Council as: • Improved availability and quality of health and medical care The overall objective has four goals – care at the right time, safe care, high level of efficiency and high confidence in care – each of which is monitored using measurable indicators. Each of the goals is presented below, as well as the indicators linked to each goal. Care at the right time The indicators used to guide towards the goal of care at the right time focus on the aspect of short waiting times for health and medical care. They are measured using the following indicators: • Proportion of patients receiving care within five days at a GP as part of the care guarantee. The result was 89 per cent compared with 89 per cent for the previous year. The target was achieved. • Proportion of patients given an appointment for an initial visit within 30 days as part of the care

guarantee. The result was 70 per cent compared with 73 per cent for the previous year. The target was not achieved. • Proportion of patients receiving treatment within 90 days as part of the care guarantee. The result was 90 per cent compared with 88 per cent for the previous year. The target was achieved. The goal of care at the right time was achieved. Safe care Health and medical care in Stockholm County shall be characterised by high patient safety. Through improved patient safety, unnecessary suffering can be avoided at the same time that healthcare resources are used more efficiently. The goal of safe care is measured using the following indicators: • Prevalence of healthcare-associated infections. The result was 9.0 per cent compared with 9.1 per cent for the previous year. The target was achieved. • 30-day re-admission frequency within inpatient care, 65 years and over. The result was 15.9 per cent compared with 15.9 per cent for the previous year. The target was achieved.

• Antibiotics prescription through the number of antibiotics prescriptions taken out per 1,000 residents. The result is 358 compared with 358. The target was achieved. The goal of safe care was achieved. High level of efficiency A high level of efficiency means the right measures being performed at the right time and in an appropriate and resource-efficient manner. The goal of a high level of efficiency is measured using the following indicators: • Proportion of the population with a resident account on My Healthcare Contacts. The result was 25 per cent compared with 20 per cent for the previous year. The target was achieved. • Proportion of GP clinics conducting active disease prevention work. The result was 51.8 per cent compared with 41 per cent for the previous year. The target was achieved. • Proportion of doctor’s appointments carried out by doctors outside emergency hospitals. The result was 76.8 per cent compared with 76.5 per cent for the previous year. The target was achieved. The goal of a high level of efficiency was achieved.

Improved availability and quality of health and medical care Outcome 2013

Outcome 2014

Achieved 2014

Proportion of patients receiving care within 5 days at a GP (care guarantee)

89%

89%

Yes •

Proportion of patients getting an appointment for an initial visit within 30 days (care guarantee)

73%

70%

No •

Proportion of patients receiving treatment within 90 days (care guarantee)

88%

90%

Yes •

Goals and indicators Care at the right time

Safe care 9.1%

9.0%

Yes •

15.9%

15.9%

Yes •

358

358

Yes •

Proportion of the population with a resident account on My Healthcare Contacts

20%

25%

Proportion of GP clinics conducting active disease prevention work

Yes •

41%

51.8%

Yes •

76.5%

76.8%

Yes •

58%

64%

Yes •

Prevalence of healthcare-associated infections 30 day re-admission frequency in inpatient care Antibiotic prescriptions 1) High level of efficiency

Proportion of specialist appointments performed by specialists outside emergency hospitals High confidence in care Proportion of the population that has considerable confidence in the healthcare services

Use of antibiotics in the County is monitored using the indicator of the number of antibiotic prescriptions taken out per 1,000 residents and year. 1)

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Annual Report 2014 Goals

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High confidence in care The residents of Stockholm County shall feel a high level of confidence in healthcare. The goal of high confidence in care is measured in the spring and autumn using the Healthcare Barometer. • The proportion of the population that has considerable confidence in healthcare is 64 per cent, compared with 58 per cent last year. The measurement was taken in 2014. The target was achieved. The goal of high confidence in care was achieved.

Improved reliability of public transport The County Council Assembly has expressed the overall objective for public transport within Stockholm County Council as: • Improved reliability of public transport

tive journeys is measured using the following indicators: • Public transport’s share of motorised trips. The result was 37 per cent, which is the same as the previous year. The target was achieved. • Proportion of satisfied passengers in general public transport. The result was 81 per cent compared with 79 per cent for the previous year. The target was achieved. • Proportion of satisfied passengers in special public transport. The result was 87 per cent compared with 87 per cent for the previous year. The target was achieved. • Proportion of satisfied passengers in marine public transport. The result was 96 per cent compared with 91 per cent for the previous year. The target was achieved. The goal of attractive journeys was achieved. Accessibility

The overall objective has three goals – attractive journeys, accessibility and efficient journeys – each of which is followed up using measurable indicators. Each of the goals is presented below, together with the indicators linked to each goal. Attractive journeys In order for residents to choose public transport, their trips and commutes need to be attractive. The goal of attrac-

Public transport plays a crucial role for accessibility in the county. In order for residents to choose public transport, their trips need to be accessible. The goal of accessibility is measured using the following indicators: • Proportion of buses with accessible boarding step. The result was 100 per cent compared with 100 per cent for the previous year. The target was achieved.

• Proportion of rail vehicles with accessible boarding step. The result was 84 per cent compared with 83 per cent for the previous year. The target was achieved. The goal of an accessible and cohesive region was achieved. Efficient journeys Trips need to be efficient so that public transport costs do not increase too much. By more people taking public transport at the same time that the proportion of renewable energy increases, the County Council contributes to sustainable development. The goal of efficient journeys is measured using the following indicators: • Proportion of renewable energy in public transport. The result was 93 per cent compared with 92 per cent for the previous year. The target was achieved. • Cost per passenger-kilometre. The result was SEK 3.02 compared with SEK 2.95 for the previous year. The target was not achieved. Cost per passenger-kilometre increased between the years as the rate of cost increase is higher than the growth of the number of passenger-kilometres. The result of SEK 3.02 for 2014 is below the Traffic Committee target that was set at a maximum of SEK 3.08. The goal of efficient journeys was achieved.

Improved reliability of public transport Outcome 2013

Outcome 2014

Achieved 2014

Public transport’s share of motorised trips

37%

37%1)

Yes •

Retained proportion of satisfied passengers in general public transport

79%

81%

Yes •

Retained proportion of satisfied passengers in special public transport

87%

87%

Yes •

Proportion of satisfied passengers in marine public transport2)

91%

96%

Yes •

100%

100%

Yes •

83%

84%

Yes •

92 %

93%

Yes •

3.02 kr

No •

Goals and indicators Attractive journeys

Tillgänglighet Proportion of buses with accessible boarding step Proportion of rail vehicles with accessible boarding step Efficient journeys Proportion of renewable energy in public transport Cost per passenger-kilometre

2.95 kr

3)

1) Updated information for 2014 will be available in spring 2015. 2) New target added in 2014 3) Reported 2013 result was SEK 3.00. Due to recalculated (increased) passenger-kilometres for commuter trains, the 2013 result was converted to SEK 2.95.  To contents

Goals Annual Report 2014

15

Sustainable growth The County Council Assembly has expressed the overall objective in Stockholm County Council as: • Sustainable growth The overall objective has four goals – a leading growth region, effective environmental work, social responsibility and safe processes – each of which is followed up using measurable indicators. Each of the goals is presented below, together with the indicators linked to each goal.

stronger than for Sweden as a whole, and that expectations for the future are moderate. The objective of being a leading growth region has been achieved.

A leading growth region According to the Swedish Association of Local Authorities and Regions (SALAR), the forecast tax base growth in the county for 2014 is 4.1 per cent. This indicates a higher annual rate of growth than the national figure, which is forecast at 3.2 per cent. The economic trend was somewhat stronger in Stockholm County compared with Sweden as a whole in 2014. There are, however, no regional accounts for 2014. The regional barometer shows that the economy in Stockholm County is somewhat

Effective environmental work Locum AB applies the Sweden Green Building Council Gold category in all new construction, which means that the requirement of energy conservation is 35 per cent below the building rule of the Swedish National Board of Housing. The proportion of organic food for patient meals as well as coffee, tea and

Sustainable growth Goals and indicators

Outcome 2013

Outcome 2014

4.2% (3,4)

4.1% (3,2)

Achieved 2014

A leading growth region An annual tax base growth rate in the county equal to or greater than the national average/rest of the country Research and development: Gross regional expenditure for research and development in relation to the gross regional product.1)

3.77%1)

–1)

Yes •

–REMOVED1)

Effective environmental work Energy consumption in operating premises: energy consumption per square metre (kWh/m2)2)

214

211

Yes •

29%

29%

Yes •

2.5

– 3)

– 3)

10%5)

21%

Yes •

5)

0%

5%

Yes •

16%5)

17%

Yes •

2%

– 6)

– 6)

Information security

10%5)

10%

Yes •

Security

45%5)

25%

No •



7)

–7)

Proportion of organic food Climate impact from medical gases: kg CO2 equivalents per resident Social responsibility Equal treatment of all residents: proportion of the County Council’s companies and committees that have introduced methods and tools for systematic work4) Gender statistics National minorities and minority languages Participation for people with disabilities: proportion of companies and committees that have introduced methods and tools for systematic work4) Code of Conduct for suppliers: proportion of significant suppliers that have been audited for social responsibility Secure processes Security work shall be conducted systematically: proportion of companies and committees that have introduced methods and tools for systematic work4)

Sustainable IT delivery of value-generating services: delivery according to agreed service levels

1) Pertains to 2009 published 2011 (taken from Eurostat/County Administrative Board). Only measured every two years. Therefore removed according to 2015 budget and replaced by the indicator Research for healthcare. 2) Pertains to energy consumption for (purchased) electricity and heat, kWh per square metre BRA (Atemp), supplied to the so-called strategic properties managed by Locum AB. The Traffic Committee is also covered by this goal and is included in the result. 3) Data for the calculation of climate impact from medical gases is gathered in connection with the hospitals’ reporting to the Health and Medical Care Administration and reported in the County Council’s separate environmental report. 4) Includes all administrations and companies that have employed staff. 5) Benchmarking was done in connection with the 2013 annual accounts. 6) The result for 2014 was not possible to calculate due to operating changes and reorganisations at affected parties. 7) The result for 2014 cannot be presented as measurements have been done in different ways and the results cannot be compared.

16

Annual Report 2014 Goals

 To contents

fruit for the staff was 29 per cent in 2014. The statistics include food to the value of SEK 114 million. Södersjuk­ huset AB stands out with 46 per cent organic food, to a value of SEK 6.6 million, for its stock of staples. In order to reduce the climate impact of medical gases, the County Council tested various technologies using filters that gather anaesthetic gases from the patient’s exhaled air in 2014. In November, a full-scale test of the most promising filter began at Norrtälje Hospital. The objective of effective environmental work was achieved. Social responsibility Gender statistics Texts and table compilations from administrations and companies show that gender statistics are a largely accepted and established approach in the presentation of results. All administrations and companies have answered the question and 90 per cent say that they, in part or in whole, use tools and methods for systematic work with gender statistics. Several ongoing development projects in gender equality and equal opportunity are described. There is a development potential in terms of systematically analysing gender statistics and linking them to operational development. National minorities and minority languages The work with national minorities and minority languages made progress in 2014. The number of administrations and companies that fully apply tools and methods for fully systematic work increased from 0 to 5 per cent and the proportion that partially applies them increased from 60 to 75 per cent. The consultations with national minorities got started, but should be expanded and cover more administrations and companies. There is collaboration with the County Council’s national minority coordinator. More efforts than before were conducted especially in the areas of information and education, but there is room for further improvement.

 To contents

Participation for people with disabilities The majority of companies and administrations conducted training and seminars during the year, with the aim of increasing staff expertise in personal treatment and issues of accessibility. An electronic course has been developed that targets all employees in Stockholm County Council. The County Council’s operations also measure patient and stakeholder perceptions of accessibility and personal treatment, and then implement various kinds of improvement measures. In 2014, 17 per cent of the operations had methods and tools for systematic work in the various target areas. This is an increase by one percentage point compared with the previous year. The work of implementing the County Council’s programme for people with disabilities, “More than just thresholds”, must be intensified. The issue must be raised both at the management level and in the operations’ various collaboration councils. Code of Conduct for suppliers The Swedish EMAS Council has been a part of the Swedish Competition Authority since mid-2014. A few months before the transition occurred, the Steering Committee for Social Responsibility, a national group for Sweden’s county councils, decided that no new agreements would be permitted to be registered in the follow-up portal, Uppföljningsportalen. This means that it has not been possible to implement follow-up. The goal of social responsibility was achieved. Safe processes Information security This target area is new and constitutes an overall indicator for the County Council’s information security efforts. The presentation is largely based on reported qualitative estimates. The follow-up shows that activities are under way in a large number of County Council operations to put in place central elements of systematic information security work.

Ten per cent of the County Council’s administrations and companies say that they have already introduced methods and tools for systematic work, which corresponds to the base year value. Security This target area and indicator are also new. The presentation is largely based on reported qualitative estimates. The follow-up shows that a considerably smaller proportion of the County Council’s operations introduced systematic security work in 2014 compared with the base year of 2013, representing a sharp decline from 45 per cent to 25 per cent. This significant change is considered to be due to the indicator having been interpreted in a more accurate manner in the 2014 follow-up compared with the base year. The follow-up also shows that the implementation of systematic security work has come somewhat further in the security area compared with the information security area. Reinforcement efforts are considered to be needed in this area in order to achieve the goal, and there is believed to be a development potential in terms of how the indicator should be interpreted. Sustainable IT delivery of value-generating services It should be safe and easy to contact the County Council, and everyone who wants to should be able to use the opportunities that public e-services offer. One way to measure this is by means of the indicator of Delivery according to agreed service levels. The work of identifying what services should be measured has been partially implemented, but needs to be developed. Above all, there is a need for county-council-wide coordination and governance in the area. A new functional area in the County Council Executive Board Administration that will guide and coordinate IT for healthcare will be established in 2015. The safe processes goal was partially achieved.

Goals Annual Report 2014

17

Free, accessible, high quality cultural life The County Council Assembly has expressed the overall objective in Stockholm County Council as: • Free, accessible, high quality cultural life The overall objective has three goals – children and young people are prioritised, culture in healthcare and intensified cooperation with cultural and creative industries. The Cultural Committee’s goals and indicators set out a direction for the Committee’s work and are not immediately quantifiable. Children and young people are prioritised Children and young people are a prioritised target group in cultural policy. Of the activity and project grants awarded in 2014, 77 per cent went to activities for which the target group was children and young people ages 0–25, i.e. a young audience of around 480,000 people was reached. By giving children and young people opportunities to enjoy high quality art and culture and encouraging personal creation, the possibility of self-reflection and insight about the surrounding society is provided. The capacity for empathy can be strengthened through knowledge about and understanding for other people and

their circumstances. Cultural activities often presuppose dialogue and collaboration. Art and culture in healthcare In construction, 2 per cent of the construction costs shall be allocated to artistic presentation in healthcare facilities, and 1 per cent in other premises when the construction costs exceed SEK 3 million. The design assignment for New Karolinska Solna continued in 2014. Major new construction that houses artistic presentations is also under way at Södertälje Hospital, Södersjukhuset, Danderyd Hospital and Karolinska University Hospital in Huddinge. A renewed way of working with Culture in Healthcare will contribute to meaningful stimulation for those who spend considerable time in healthcare and elderly care. Cultural and creative industries The work on management and coordination of the Action plan for cultural and creative industries in the Stockholm region, Creative Stockholm, was implemented through the chairmanship of the Liaison Group for Creative Stockholm and participation in regularly recurring projects and network meetings. The in-depth collaboration between different players in the county on cultural and creative industries, Creative Stockholm, will continue in

2015. The objective is to make Stockholm County a leading, attractive place to live and work in. Stockholm is one of Europe’s leading creative regions and an important labour market for cultural workers in every form and genre of art. Cultural and creative industries contribute to a dynamic region and public support shall be designed to encourage both cultural creators and cultural and creative entrepreneurs. The goal of free, accessible, high quality cultural life was achieved.

An attractive and competitive employer The County Council Assembly has expressed the overall objective in Stockholm County Council as: • An attractive and competitive employer The overall objective has three goals – proud employees, management and leadership, and systematic skills planning – each of which is followed up with measurable indicators. Each of the goals is presented below, together with the indicators linked to each goal. Proud employees In order for the County Council to be an attractive and competitive employer, the County Council needs to conduct systematic improvement work at all

Free, accessible, high quality cultural life Outcome 2013

Outcome 2014

Achieved 2014

81%1)

77%1)

Yes • 

2 per cent of construction costs for healthcare premises should go to artistic presentation

– 2)

– 2)

The Culture in Healthcare programme is offered in all elderly care centres and hospitals in the county

– 2)

– 2)

– 2)

– 2)

Goals and indicators Children and young people are prioritised An overwhelming proportion of the external grants shall go to activities for children and young people Culture in Health Care

More in-depth cooperation in connection with the cultural and creative sectors Collaboration projects according to the Creative Stockholm action programme begin (action programme under RUFS 2010)

1) Activities for children and young people are defined as an audience ages 0–25 2) The Cultural Committee’s targets and indicators set out a direction for the Committee’s work and are not immediately quantifiable.

18

Annual Report 2014 Goals

 To contents

organisational levels, and clarify and create development paths for its employees. Since the ACE index was introduced in 2012, the total index value has increased to 77, the response frequency has increased to 85 per cent and the operations’ follow-up of goals and strategies in the HR policy has been further developed. Altogether, it shows that the employee survey is an effective tool in the County Council’s development work. Management and leadership In the County Council’s employee follow-up, the employees’ perception of management in the operations is presented. Since measurements began in 2006, the proportion of managers with a management index of 70 or higher increased from 47.5 per cent to 67.6 per cent. Well-functioning management and leadership is a key prerequisite in order for the County Council to be

developed and made more efficient. Stockholm County Council works long term and systematically to strengthen the ability of existing managers’ to lead operations and employees. Systematic skills planning Skills supply is one of the most highly prioritised issues for Stockholm County Council. The County Council’s operations work with a uniform model and structure for skills planning (KOLL), which provides conditions to contribute quality assured and high-quality care, as the same skills requirements are set regardless of care provider. The proportion of administrations and companies that have introduced or begun introducing KOLL was nearly 50 per cent and comprised around 5,400 employees at year-end. The goal of being an attractive and competitive employer was achieved.

An attractive and competitive employer Goals and indicators

Outcome 2013

Outcome 2014

Achieved 2014

76

77

Yes •

73

74

Yes •

40%

47%

Yes •

Proud employees ACE index: Follow-up of SCC’s HR policy in the employee questionnaire that consists of actively taking responsibility, customer and result focus, change and development, an equality index, health and stress index and motivation index. Scale 1–100. Management and leadership Management index: Management index on a County Council-wide level from the employee survey. Scale 1–100. Systematic skills planning Systematic skills planning: Proportion of the County Council’s committees and companies that began the introduction of the County Council’s model for systematic skills planning (KOLL).

 To contents

Goals Annual Report 2014

19

Financial analysis Stockholm County Council presents a positive result for 2014, which forms the basis for continued balanced finances and long-term sustainable development. This is a prerequisite for the major investments to be made in coming years in healthcare and public transport.

20

Annual Report 2014

 To contents

Stockholm County Council’s total operations County Council Group

Contract companies

County Council

Group companies, etc.

Boards and committees • County Council Assembly • County Council Executive Board • Public Healthcare Services Committee • Healthcare and Social Services Committee in Norrtälje 1 • Traffic Committee • Culture Committee • Patient Advisory Committee • Audit Board

Landstingshuset i Stockholm AB (100%) • Södersjukhuset AB • Danderyds Sjukhus AB • Södertälje Sjukhus AB • S:t Eriks Ögonsjukhus AB • Folktandvården Stockholms län AB • Ambulanssjukvården i Storstockholm AB • Stockholm Care AB • MediCarrier AB • Locum AB • Waxholms Ångfartygs AB • AB Stockholms Läns Landstings Internfinans

The Board of • Karolinska University Hospital • Healthcare Provision, Stockholm County Administrations • County Council Executive Board Administration • Health and Medical Care Administration • Public Healthcare Services Office • Traffic Administration • Metro Expansion Administration • Cultural Administration • Patient Advisory Committee Administration • County Council Audit Office Administrations under corporate-like forms • Karolinska University Hospital • Healthcare Provision, Stockholm County

Jointly owned companies without significant influence3) • Mälardalstrafik MÄLAB AB (35%) • ALMI Företagspartner i Stockholm Sörmland AB (40.5%) • Barnbördshuset Stockholm AB (49%)

Contracts County council municipal affairs are taken care of by a different legal entity than the County Council. 100 per cent of transport operations are run by external contractors. 34 per cent of healthcare is provided by external care providers

AB Storstockholms lokaltrafik (100%) • SL Infrateknik AB • AB SL Finans • SL Älvsjö AB

Kommunalförbundet ägarsamverkan i Norrtälje Sjukvård och omsorg (50%)2) • TioHundra AB

1) Joint board with Norrtälje Municipality 2) Joint municipal association with Norrtälje Municipality 3) Refers to jointly owned companies with an ownership share in excess of 10 per cent.

Surplus/deficit Stockholm County Council reported a surplus for 2014 of SEK 136 million (934). This was SEK 798 million lower than the year before. The budgeted surplus for 2014 was SEK 52 million, which means that the annual accounts were SEK 84 million higher than budget. Non-recurring items affecting comparability amounted to SEK –250 million. The items pertain to compensation according to an agreement in principle with the City of Solna regarding the Metro expansion, LS 1312-1619. Last year’s result includes non-recurring expenses affecting comparability of SEK –749 million.  To contents

Stockholm County Council’s earnings trend has been positive over the past eight years and the economic trend continued to be somewhat stronger in Stockholm County compared with Sweden as a whole in 2014. At 12.10 per cent, county council tax has been unchanged since 2008. Total tax revenues account for nearly 77.6 per cent of the County Council’s total revenues. Total tax revenues, which consist of tax revenues, general government grants and municipal economic equalisation, amounted to SEK 63,971 million (61,802) and increased by 3.5 per cent compared with the previous year, and was SEK 116 million or 0.2 per cent higher than budget.

Operating revenues amounted to SEK 18,507 million (18,406) and increased by 0.5 per cent compared with the previous year. Operating revenues account for nearly 22.4 per cent of the County Council’s total revenues. Operating expenses amounted to SEK 77,661 million (72,872), which was an increase of 6.6 per cent compared with the preceding year, and was SEK 946 million or 1.2 per cent over budget. Costs for staffing and externally purchased health and medical care services constitute the largest cost items. Costs for health and medical care services purchased from external suppliers increased by 7.4 per cent compared with the previous year and were

Financial analysis Annual Report 2014

21

SEK 309 million over budget. The costs of materials and goods including pharmaceuticals increased by 5.6 per cent compared with the previous year and were SEK 94 million below budget. The costs of purchased transport services increased by 4.9 per cent compared with 2013 and exceeded budget by only SEK 69 million. Depreciation and amortisation costs amounted to SEK 3,817 million (3,589), which is an increase of 6.4 per cent compared with the previous year and was SEK 99 million or 2.7 per cent over budget. The increase of the depreciation and amortisation costs compared with the previous year is due to more completed investments and because the disposal of buildings demolished as a result of new construction in healthcare was not budgeted. Net financial items consist of financial income and expenses and amounted to an expense of SEK 864 million (2,813). This was SEK 1,949 million better than the year before and SEK 347 million better than budget.

The change in the financial expenses of SEK 2,527 million compared with the year before is primarily related to expenses that were SEK 1,564 million lower in connection with the changed discount interest rate applied in calculating the County Council’s 2013 pension liability.

with other periods. The items affecting comparability are specified in Note 6. This year’s surplus includes one item affecting comparability, SEK –250 million. Excluding this item affecting comparability, the surplus was SEK 386 million, which can be compared with last year’s surplus excluding items affecting comparability of SEK 1,684 million.

Capital gains – items affecting comparability The capital gains/losses for the year, which is the net of capital gains and capital losses, amount to a capital loss of SEK 182 million, which should be compared with last year’s capital gain of SEK 276 million. No individual item exceeds SEK 100 million. See also Note 7 to the income statement. When they occur, items affecting comparability are reported separately in notes to the respective item in the income statement and where applicable in the cash-flow statement. Items affecting comparability are events or transactions in excess of SEK 100 million that are not extraordinary, but important to note in a comparison

Adjusted surplus/deficit The wholly owned companies in the County Council Group shall present a so-called adjusted surplus/deficit as per directive. The adjusted surplus/deficit is reconciled against the budgeted surplus/deficit. In the adjusted surplus/ deficit, non-recurring items should be excluded from surplus/deficit before appropriations to achieve greater comparability between the years. For 2014, the companies had higher costs in the pension liability calculation since the interest rate pertaining to the companies was reduced. These costs have been excluded in the adjusted surplus/ deficit.

Surplus/deficit Profit and loss statement SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Deviation from budget

Operating revenues

18,507

18,406

1%

17,974

533

Operating expenses

–77,661

–72,872

7%

–76,716

–946

–3,817

–3,589

6%

–3,717

–99

Gross operating expenses

–81,478

–76,462

7%

–80,433

–1,045

Net operating expenses

–62,971

–58,055

8%

–62,459

–512

63,971

61,802

4%

63,722

250

–864

–2,813

–69%

–1,211

347

136

934



52

84

Depreciation

Tax revenue, general state subsidies and equalisation Net financial income/ expense Earnings

Earnings Stockholm County Council (SEK million) 2,500 2,000 1,500 1,000 500 0

22

2007

2008

2009

Annual Report 2014 Financial analysis

2010

2011

2012

2013

2014

 To contents

A compilation over the whollyowned companies’ surplus/deficit before appropriations, the surplus/ deficit for the year and the adjusted surplus/deficit is presented in Note 23.

Revenues Operating revenues Operating revenues amounted to SEK 18,507 million (18,406), which is an increase of 0.5 per cent compared with the preceding year and was SEK 533 million or 3.0 per cent over budget. For the comparison year 2013, a repayment of premiums from AFA Försäkring (collective agreement insurance) was included in an amount of SEK 529 million. Patient fees Total patient fees amounted to SEK 1,325 million (1,263), which is an increase of 4.9 per cent compared with the preceding year and is SEK 21 million or 1.6 per cent over budget. The dental care component comprises SEK 604 million (616), with a budget of SEK 623 million, and the healthcare component comprises SEK 721 million (647) with a budget of SEK 680 million. The increase in patient fees can be compared to the population increase of 1.6 per cent with increased patient volumes as a result. Passenger receipts Passenger receipts amounted to SEK 6,978 million (6,688), which means that they increased by 4.3 per cent com-

pared with the previous year. This was SEK 178 million or 2.5 per cent below budget. The deviation from budget can be attributed primarily to a larger proportion of tickets sold at a discounted rate and an increase in travel volume that does not correspond to the budgeted level. The increase in travel that existed in 2012 and 2013 levelled off in 2014. Compared with 2013, the increase is around SEK 300 million, of which about SEK 180 million is attributable to a changed accounting principle upon the transition from the pre-purchase strip to the Travel Account.

SEK 1,364 million (1,365) was attributable to the leasing of vehicles for transport operations and SEK 1,086 million (1,068) for the leasing of premises. Sales of laboratory services, which in principle only take place at Karolinska University Hospital, accounted for SEK 379 million (331) of the revenues, and increased by SEK 48 million compared with the previous year and was SEK 42 million over budget. Government grants and other grants Grants received totalled SEK 3,101 million (2,848), which is an increase of 8.9 per cent compared with the preceding year and was SEK 187 million or 6.4 per cent over budget. The increase in the grant revenues is primarily attributable to the grant the County Council receives for purchasing services that are not subject to VAT (the “6 per cent contribution”, Sexprocentsbidraget), which amounted to SEK 1,409 million (1,336) and in part to the specially designated government grants which amounted to SEK 1,375 million (1,238). The single largest specially designated government grant comprises the ALF grant (an agreement on medical education and research), which amounted to SEK 593 million (580) for 2014. The specially designated government grant also includes asylum medical care in an amount of SEK 124 million (99), LSS grants (grants for funding of counselling and personal support as per the Act regarding Support and Service for Persons with Certain Functional Impairments,

Sales of primary services Sales of primary services, which comprise sold healthcare, dental care and sales of other primary services, amounted to SEK 1,820 million (1,844), which is a decrease of 1.3 per cent compared with the preceding year and is SEK 81 million below budget. The largest part of the revenues consists of out-of-county revenues, which totalled SEK 1,001 million (989). This was SEK 12 million, 1.2 per cent, higher than the previous year and SEK 58 below budget. Rental income and other sales revenues Rental income and other sales revenues totalled SEK 3,733 million (3,711), which was an increase of 0.6 per cent compared with the preceding year and was SEK 50 million or 1.4 per cent over budget. Rental income amounted to SEK 2,449 million (2,432), of which

Revenues SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Deviation from budget

Patient fees for health and dental care

1,325

1,263

5%

1,304

21

Passenger receipts

6,978

6,688

4%

7,156

–178

Sales of primary services*

1,820

1,844

–1%

1,901

–81

Rental income, sales, other services, material, goods

3,733

3,711

1%

3,683

50

Government grants and other grants

3,101

2,848

9%

2,914

187

Other revenues

1,550

2,052

–24%

1,015

534



814







18,507

18,406

1,%

17,974

533

of which items affecting comparability** Total operating revenues

* Primary services consist of sold healthcare, medical and dental services plus sales of other primary services. ** Also see Note 6 to the income statement.

 To contents

Financial analysis Annual Report 2014

23

1993:387) and grants under the tissue directive (a directive that establishes quality and safety norms for tissue donation), a patient safety grant of SEK 63 million (95) and the “Sickness Absence Billion” (sjukskrivningsmiljarden) of SEK 155 million (181). The national “Kömiljarden” programme is also reported as a government grant and totalled SEK 171 million (197) in the annual accounts. Other operating revenues Other operating revenues amounted to SEK 1,550 million (2,052 including items affecting comparability), which is a decrease of 24.5 per cent compared with the preceding year and was SEK 533 million or 52.5 per cent over budget. The primary explanation of the reduced revenues compared with the previous year is the repayment of insurance premiums from AFA Försäkring (collective agreement insurance) for 2005 and 2006 totalling SEK 529 million, which took place in 2013. The revenues also include capital gains where four sales were made in 2014. The capital gains amounted to SEK 133 million (409) last year. The capital gains are not budgeted. Adver-

tising revenues from transport operations amounted to SEK 236 million (233), which is on a par with budget.

come deviating positively from budget is that the net fee to the municipal equalisation system was lower than estimated. The following sections provide a presentation of the three sub-items included in total tax revenues: tax revenues, general government grants and municipal economic equalisation.

Total tax revenues The tax base in Sweden and Stockholm County The County Council’s tax revenues are largely dependent on how the tax base in Sweden and Stockholm County develops. The tax base reflects economic trends and comprises taxable income of individuals, such as salaries, social welfare, pensions, etc. The final tax outcome for 2013 that the Swedish Tax Agency presented in November 2014 indicated an increase of the tax base nationwide of 3.4 per cent compared with 2012. In Stockholm County, the tax base increased in 2013 by 4.2 per cent.

Tax revenues from tax on labour Tax revenues are affected by the tax rate approved by the County Council Assembly and by the rate of development of the tax base in the county and, above all, in the country. In 2013, the County Council Assembly set the tax rate for 2014 at 12.10 per cent, the same as for 2013. The national average county council tax was 11.26 per cent in 2014. Preliminary tax revenues rose by SEK 1,759 billion, or 3.0 per cent, compared with 2013. In the 2014 annual accounts, a preliminary deduction was included for 2014 tax revenues in an amount of SEK 47 million. The preliminary deduction was based on the national tax base growth for 2013 being 3.4 per cent instead of 3.9 per cent and in 2014,

Stockholm County Council’s total tax revenues Total tax revenues increased by SEK 2,169 million in 2014. This corresponds to an increase over 2013 of 3.5 per cent and is SEK 116 million, or 1.8 per cent, higher than what had been budgeted in 2014. The primary explanation of the out-

Tax revenue development (%) 6 5

5.2

4

4.2 3.6

3

3.5 2.6

2 1 0

2010

2011

2012

2013

2014

Total tax revenues

SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Deviation from budget

Tax revenues

59,612

57,699

3%

59,986

–374

4,678

4,624

1%

4,676

3

General government grant Equalisation system

–319

–521



–806

487

Total tax revenues

63,971

61,802

4%

63,856

116

24

Annual Report 2014 Financial analysis

 To contents

SALAR assumes that it will be 3.2 per cent instead of 2.7 per cent. The 2014 tax revenues also include an adjustment item that pertains to the forecast of the 2013 final tax assessment that was made in the 2013 financial statements. The definitive final tax settlement for 2013 was SEK 107 million lower than what was assumed in the 2013 annual accounts. General government grant The government grant for pharmaceutical benefits was intended to provide the County Council with the prerequisites to prescribe appropriate and safe medicine for individual residents. Between 2013 and 2014, the grant increased by SEK 54 million or 1.2 per cent and was SEK 3 million higher than budget. System for municipal economic equalisation For 2014, Stockholm County Council must pay a total of SEK 319 million to

the municipal economic equalisation system. The cost equalisation component compensates for cost-driving differences between county councils that cannot be influenced, such as population changes. In the cost equalisation component, Stockholm County Council received a grant that amounted to SEK 557 million in 2014, which is an increase of SEK 60 million compared with 2013. The income equalisation component is calculated based on the difference between the county’s tax capacity, meaning the tax base per resident, and 115 per cent of the average tax capacity in the country, also known as the guaranteed level. The tax capacity in the county was approximately 116 per cent of the average national tax capacity in 2014. Stockholm County Council thereby had to pay an income equalisation fee in an amount of SEK 335 million, which corresponds to SEK 155 per

resident. Stockholm County Council is the only county council that pays an income equalisation fee. The income equalisation component changed as of 2014. The effect of this change is that Stockholm County Council may keep the majority of the tax revenue increase that arises if the tax capacity in Stockholm County increases more than nationally. Stockholm County Council previously was previously able to keep around 21 per cent of such a tax revenue increase, but in 2014, the County Council will be able to keep around 43 per cent. The objective of the change has been to counteract the margin effect that arises when a municipality or county council increases its taxable capacity, through commercial policy measures for instance, and the tax revenue increase at the same time entails a nearly equal increase of the fee to the income equalisation component. The adjustment grant or adjustment fee is used for two purposes. The first is

Tax revenues

SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Deviation from budget

59,672

57,913

3%

59,986

–314

47

–248







–107

35







59,612

57,699

3%

59,986

–374

Outcome 2014

Outcome 2013

Change %

Budget 2014

Deviation from budget

Preliminary county council tax year Forecast for final tax settlement Adjustment item, tax revenues Total tax revenues

General government grant

SEK million Grant for pharmaceutical benefits

4,678

4,624

1%

4,676

3

Total general government grants

4,678

4,624

1%

4,676

3

Outcome 2014

Outcome 2013

Outcome 2012

Outcome 2011

Outcome 2010

557

497

714

810

872

Municipal financial equalisation SEK million Cost equalisation grant Regulation grant Total, grants from equalisation







1,648

877

557

497

714

2,458

1,749

Income equalisation fee

–335

–516

–388

–2,114

–2,134

Adjustment fee

–541

–501

–406





Total charges equalisation

–876

–1,017

–794

–2,114

–2,134

Total municipal economic equalisation

–319

–521

–80

345

–385

 To contents

Financial analysis Annual Report 2014

25

to regulate the difference between the government grant to and potential costs for the equalisation system. The second is to address changes in the division of responsibility and work between the government and the municipal sector according to the financing principle. If the government’s costs for the municipal economic equalisation system exceed the government grant and the fees paid in, a deficit arises in the equalisation system and municipalities and county councils must thereby pay an adjustment fee. In an opposite scenario, municipalities and county councils instead receive an adjustment grant. In 2014, a deficit arose in the equalisation system and Stockholm County Council therefore paid an adjustment fee of SEK 541 million, corresponding to SEK 251 per resident.

Expenses Operating expenses amounted to SEK 77,661 million (72,872), which was an increase of 6.6 per cent compared with the preceding year and was SEK 946 million or 1.2 per cent over budget. The high rate of increase is primarily attributable to higher staffing costs and purchased heathcare and medical services. The staffing costs amounted to SEK 27,677 million (25,911) compared with the budgeted SEK 27,317 million while

purchased heathcare and medical services amounted to SEK 16,958 million (15,790) compared with the budgeted SEK 16,649 million. In addition, the cost increase in 2014 is based on price and salary development. Costs for purchased transport services amounted to SEK 12,670 million (12,083), which is an increase of 4.9 per cent. Compared with the previous year, the costs were also affected by the higher volumes in healthcare consumption and the increase in travel that can be related to the population in the county increasing by around 35,000 residents during the year, corresponding to 1.6 per cent. There were 8.0 million doctor’s appointments and more than 327,000 care episodes, increases of 1.6 and 0.2 per cent, respectively. The increase in healthcare consumption is lower than expected and also lower than the population increase. The number of journeys by public transport on land increased by 1.9 per cent, from 470 to 479 million journeys. The number of journeys by marine public transport increased by 1.2 per cent, from 4,057,000 to 4,107,000. Staffing costs The staffing costs, which consist of personnel costs and costs for insourced personnel, amounted to SEK 27,677

million (25,911). This is an increase of 6.8 per cent compared with the preceding year and was SEK 360 million or 1.3 per cent over budget. Payroll costs amounted to SEK 17,540 million (16,660) and constitute the largest part of the personnel costs, an increase of 5.3 per cent compared with 2013. In 2014, the number of fulltime equivalents increased by 2.1 per cent, causing the payroll cost per fulltime equivalent to increase by an average of 3.2 per cent. Pension costs amounted to SEK 3,706 million (3,326), which was an increase of 11.4 per cent compared with the preceding year and was SEK 238 million or 6.0 per cent below budget. Costs for insourced personnel increased by SEK 150 million, corresponding to 43.1 per cent compared with 2013, totalling SEK 498 million (348), which corresponds to just 1.8 per cent of staffing costs. Sickness absence, etc. In accordance with the County Council-wide objective of increasing health statistics, the administrations and companies further developed their health-strategy work environment efforts. In collaboration with occupational health services, special efforts were made to improve the psychosocial work environment and to prevent

Expenses Outcome 2014

Outcome 2013

Change %

Budget 2014

Deviation from budget

Staffing costs

–27,677

–25,911

7%

–27,317

–360

Purchased health and medical services and operations-related services

–16,958

–15,790

7%

–16,649

–309

Purchased transport services

–12,670

–12,083

5%

–12,600

–69

SEK million

Pharmaceuticals

–6,315

–6,069

4%

–6,270

–45

Other materials and products, etcetera

–4,604

–4,267

8%

–4,743

139

Contributions paid

–1,863

–1,487

25%

–1,871

7

Premises and property expenses, leasing of fixed assets

–2,419

–2,429

0%

–2,364

–56

Other expenses*

–5,155

–4,835

7%

–4,902

–252

–250









Total operation expenses

–77,661

–72,872

7%

–76,716

–946

Depreciation/amortisation

–3,817

–3,589

6%

–3,717

–99

–81,478

–76,462

7%

–80,433

–1,045

of which, items affecting comparability**

Gross operation expenses

* Other costs do not include insourced personnel included in the item staffing costs. ** Also see Note 6 to the income statement.

26

Annual Report 2014 Financial analysis

 To contents

work-related stress and concern in connection with organisation changes. Under the theme “Healthy workplaces prevent stress”, the operations focused on health factors with the aim of strengthening health promotion factors in the work environment. The objective was to prevent and shorten cases of illness and to identify signals of illness at an early stage. Purchased healthcare and medical services Costs for purchased heathcare and medical services amounted to SEK 16,958 million (15,790), which was an increase of 7.4 per cent compared with the preceding year and was SEK 309 million or 1.9 per cent over budget. One explanation for the cost increase year-on-year is higher healthcare volumes, new clinics that opened

and more opportunities for patient care choice. The deviation in the comparison with the previous year is also due to cost increases for somatic specialist care, geriatrics and general psychiatry. This is a result of expanded patient care choice in multiple areas. The costs of externally purchased care increased without a corresponding cost reduction in County Council-operated care despite unchanged or reduced healthcare volumes. Purchased transport services Costs for purchased transport services amounted to SEK 12,670 million (12,083), which was an increase of 4.9 per cent compared with the preceding year and was SEK 69 million or 0.5 per cent over budget. Of the purchased transport services, public transport on land accounted for 90.5 per cent (90.6)

of the cost mix, purchased transports for the disabled for 7.6 per cent (7.7) and purchased marine public transport for 1.9 per cent (1.7). By operation, the cost increase was 4.8 per cent for public land transport, 2.3 per cent for transport services for the disabled and 19.0 per cent for public marine transport. The cost increase for public transport on land compared with 2013 was partly due to full-year effects of service changes, new transport service agreements and upward index adjustment of signed agreements. Pharmaceutical costs Pharmaceutical costs amounted to SEK 6,315 million (6,069), which was an increase of 4.0 per cent compared with the preceding year and was SEK 45 million over budget. The majority of the pharmaceutical costs, 77.9 per cent

Staffing costs SEK million

2014

2013

Change %

Payroll costs

–17,540

–16,660

5%

–276

–260

6%

-holiday period

–2,079

–1,954

6%

-compensation for other absenteeism

–2,791

–2,630

6%

–328

–289

14%

Pension expenses

–3,706

–3,326

11%

Social insurance fees

–5,335

–5,051

6%

Other personnel costs*

–598

–526

14%

Total personnel costs

of which -sick pay

-overtime compensation

–27,179

–25,564

6%

Cost of insourced personnel

–498

–348

43%

of which -Health and medical care, incl. dental care

–422

–290

45%

-Transport

–57

–46

25%

-Property

–14

–7

94%

–5

–4

22%

–27,677

–25,911

7%

-Other Total staffing costs

* For example, company healthcare, preventive healthcare, training and conference costs, employee representation, cost compensation. and changes in holiday pay liability.

Sickness absence as a percentage of ordinary working time SEK million

2014

2013

Sickness absence, women

6

6

Sickness absence, men

3

3

Total proportion of sickness absence

6

6

Sickness absence percentage for employees < =29 years

5

5

Sickness absence percentage for employees 30-49 years

5

5

Sickness absence percentage for employees > = 50 years Sickness absence of 60 days or more in relation to total sickness absence

 To contents

6

6

50

48

Financial analysis Annual Report 2014

27

(77.4), are costs for the compensation that patients receive upon purchasing subscription medication (Läkemedelssubventionen). This cost amounted to SEK 4,918 million (4,697) and increased by 4.7 per cent compared with 2013 and was SEK 28 million higher than budget. The other part of the County Council’s pharmaceutical costs consists of the County Council’s medical care producers’ pharmaceutical costs in the care of patients. These costs were SEK 1,396 million (1,372), which was SEK 17 million higher than budget. Costs rose by SEK 24 million, or 1.7 per cent, compared with 2013. The cost level is influenced in part by continued active work with the Wise Drug Formulary (Kloka listan), which entails a replacement of original preparations with less expensive pharmaceuticals, and in part to expirations of patents for expensive pharmaceuticals. The cost increase in recent years comes primarily from special pharmaceuticals and there is also an underlying volume increase. In 2014, the increase mainly pertains to new pharmaceuticals against hepatitis C.

deficit for 2014 amounted to SEK 12 million, with SEK 7 million in municipal operations and SEK 5 million in the county council component. Compensation according to the agreement in principle with the City of Solna concerning the Metro expansion, LS 1312-1619, was included in an amount of SEK –250 million. The amount for contributions paid also included grants to the cultural sector in an amount of SEK 311 million (300). Premises, properties and leasing of fixed assets Premises and property expenses amounted to SEK 2,328 million (2,342), an increase of 0.6 per cent compared with the previous year. The expenses were SEK 60 million higher than budget, mainly due to higher costs for repair, maintenance and property service. Operating and maintenance expenses and premises rents decreased. Expenses for the leasing of fixed assets that pertain to office equipment and phone exchanges, for example, amounted to SEK 91 million (87) and are on a par with the 2013 outcome and the year’s budget.

Contributions paid Contributions paid amounted to SEK 1,863 million, which is an increase of 25.3 per cent compared with the prece­ ding year and was SEK 8 million below budget. The total contribution from Stockholm County Council to the Health and Social care Committee in Norrtälje was SEK 1,303 million (1,247), an in­crease of SEK 56 million compared with the previous year. The Committee’s

Other expenses Other expenses amounted to SEK 5,155 million (4,835), which was an increase of 6.6 per cent compared with the preceding year and was SEK 252 million over budget. Consulting costs and other purchased services amounted to SEK 2,166 million (1,946), which was an increase of 10.2 per cent compared with the

preceding year, and was SEK 88 million over budget. Of consulting costs, SEK 409 million (441) relate to IT consulting costs. Other expenses include capital losses in an amount of SEK 315 million (132). IT software and licences during the year amounted to SEK 242 million, which was SEK 39 million over budget. Depreciation/amortisation Depreciation/amortisation costs amounted to SEK 3,817 million (3,589), which was an increase of 6.4 per cent compared with the preceding year and was SEK 99 million over budget. The largest part of the cost increase between the years is due to completed investments in public transport, such as Light Rail bridges, Light Rail signal communications and the SL Access payment system. Disposals of premises prior to new construction, primarily in healthcare, increased the depreciation/ amortisation costs for the year.

Financing Cash and cash equivalents and payment capacity At year-end, the Group had cash and cash equivalents in an amount of SEK 334 million, which is SEK 1,506 million lower than at the beginning of the year. More accurate forecasts mean that the County Council can have a somewhat lower liquidity buffer than before. In addition to its own cash and cash equivalents, the County Council has approximately SEK 8,900 million in agreed credit facilities.

Liquidity and borrowings (SEK million) Liquidity

Borrowings

3,000 2,500

34,000

Liquidity

33,000

Borrowings

32,000 2,000

31,000 30,000

1,500

29,000

1,000

28,000 500 0

28

27,000

Dec

Jan

Feb

Mar

Apr

Annual Report 2014 Financial analysis

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

26,000

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The County Council Assembly has established a borrowing limit of SEK 95 billion. This amount refers to all guaranteed credit facilities, borrowing programmes, leasing obligations and bank overdraft facilities. The County Council’s interest-bearing liabilities increased during the year by SEK 4,051 million, totalling SEK 32,931 million at 31 December. Due to lower investments than planned, it was possible for a larger share of the investments to be financed with own cash and cash equivalents. Loan portfolio The total loan portfolio includes leases, mainly for AB Storstockholms Lokal­ trafik. Of the current interest-bearing liabilities of around SEK 33 billion, approximately 31 per cent consists of finance leases and 32 per cent of loans from the European Investment Bank. In addition, bond financing accounted

for 33 per cent and Patientförsäkringen LÖF (patient insurance from the county councils’ mutual insurance provider) accounted for 4 per cent. Net financial items Net financial items consist of financial income and expenses and amounted to an expense of SEK 864 million (2,813). This is an improvement of SEK 1,949 million over 2013 and SEK 347 million compared to budget. In 2013, the decrease in the discount rate, the RIPS rate, resulted in the costs for the interest components of the 2013 pension expenses and payroll tax expenses of SEK 1,564 million negatively impacting net financial items. In 2014, the interest expenses for loans raised and leasing amounted to SEK 721 million (712), a total of SEK 157 million below budget. The reason for the positive deviation was low market

rates, lower credit requirements and the capitalisation of interest in connection with building investments. The outcome was SEK 9 million or 1.3 per cent higher than 2013. Interest income amounted to SEK 12 million (49), due to lower market interest rates and a planned decrease in excess liquidity. Finance policy During 2014, Stockholm County Council retained its rating of AA+ from the credit valuation and rating agency Standard and Poor’s. During the year, AB Stockholms Läns Landstings Internfinans conducted investment and borrowing operations according to the County Council’s finance policy. According to the finance policy, the average payment capacity must be at least 21 days. The average payment capacity in December was 63 days.

Stockholm County Council's borrowing SEK million Loan financing Long-term borrowing Short-term borrowing

18,627 3,948

Total loan financing

22,574

Leasing financing

10,357

Total interest-bearing liabilities

32,931

Unutilised agreed credit facilities and credits Overdraft facilities

3,000

Other agreed credit facilities

8,900

Total unutilised agreed credit facilities and credits

11,900

Co-ordinated borrowing limit established by the County Council Assembly

95,000

Maturity structure for loans and leasing at 31 Dec. 2014 (SEK million) 7,000

Loans

6,000

Leasing

5,000 4,000 3,000 2,000 1,000 0

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2029

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Financial analysis Annual Report 2014

29

The portfolio for managing Stockholm County Council’s financial risks via derivatives amounted to SEK 8,950 million. The corresponding amount for 2013 was SEK 9,550 million. In addition to this, there is hedging of loans in EUR at a value of SEK 5,018 million. The average fixed interest term for the County Council’s loan portfolio on the balance sheet date was 4.0 years, compared with 4.1 years at the beginning of the year. This is within the range for the fixed interest term of two to five years set by the County Council Assembly. The average interest on loans for the County Council’s loan portfolio was 2.6 per cent at year-end. The County Council shall plan the points in time that the loan and leasing agreements will expire so that the refinancing needs do not become too large during any one time period. The diagram shows the amount with which, and the point in time at which the signed loan and leasing agreements expire. Cash-flow statement The cash-flow statement shows the County Council’s inflow and outflow of cash and cash equivalents broken down

by operating activities, investing activities and financing activities. The sum of these components represents the change in cash and cash equivalents. Cash flow for the year meant that the cash and cash equivalents decreased SEK 1,507 million, from SEK 1,841 million to SEK 334 million. Cash flow from operating activities was positive in an amount of SEK 8,342 million, which was in line with 2013. Compared with last year, the changes were affected by a lower surplus, which was primarily balanced by the changes in current receivables and liabilities. Investing activities, which show what funds were used for investments, are the component with the greatest impact on the cash flow. The amount for 2014 was SEK 13,400 million. Compared with the year’s investments, the difference is mainly attributable to the fact that the part of New Karolinska Solna that is comprised of the public private partnership agreement (the PPP agreement) did not affect cash flow during the year. The net change in loan financing of SEK 3,551 million shows how much was financed with external borrowing during the year. The corresponding change

last year indicated decreased borrowing of SEK 2,003 million for 2013. Pension liabilities The County Council’s pension obligations are reported in accordance with the “mixed model”, which means that pensions vested as of 1998 are reported as a provision in the balance sheet, while those vested before 1998 are reported as a contingent liability. At 31 December 2014, provisions for pensions amounted to SEK 22,136 million, which is an increase of SEK 1,213 million compared with the previous year. During the year, the contingent liability decreased by SEK 915 million from SEK 26,376 million to SEK 25,461 million. At 31 December 2014, the County Council’s total pension commitments amounted to SEK 47,597 million, which is an increase of SEK 298 million compared with the previous year. Reconciliation against the balance requirement The surplus for the year according to the balance requirement amounted to SEK 3 million. This means that the County Council met the statutory requirement of a balanced budget.

Cash-flow statement SEK million

2014

2013

Cash flow from operating activities

8,342

8,308

Cash flow from investing activities

–13,400

–9,280

Cash flow after investments

–5,058

–972

3,551

–2,003

–1,507

–2,975

Cash flow from financing activities Change in cash and cash equivalents

Pension obligations and interest-bearing liabilities (SEK million) 80,000

Interest-bearing liabilities

70,000

Pension obligations

60,000 50,000 40,000 30,000 20,000 10,000 0 2010

30

2011

Annual Report 2014 Financial analysis

2012

2013

2014

 To contents

The balance requirement applies to each individual budgetary year. If reason exists, the County Council Assembly can decide to reserve funding in equity to meet future revenue reductions or expense increases. During the period 2012–2014, the County Council Assembly decided to reserve a total of SEK 5.3 billion in equity to cover future transition costs in connection with the implementation of future health and medical care. No further provision is current. Transition costs are defined as temporary additional costs during the period for the structural changes directly linked to the implementation of future health and medical care. The transition costs are not covered by the ordinary operating assignment. The transition costs that arise are linked to programme offices, equipment and furnishings, as well as properties and premises. For 2015–2018, the planned transition costs amount to SEK 3.5 billion.

According to the main rule, equity should also cover the pension commitment in contingent liabilities so that a reservation of equity can be made. The County Council does not meet this requirement. The County Council has a strong population growth and a growing tax base. Since 2007, the County Council has annually reported a surplus and its financial position is strong. From this perspective, the reservation of equity is in agreement with sound financial management.

Surplus for the year according to the balance requirement

Equity (SEK million)

Equity trend The County Council’s equity increased in 2014 by SEK 569 million. Besides the year’s surplus of SEK 136 million, equity was impacted by effects arising as a result of changed accounting principles for companies and a clearer adaptation to the rules on the accounting of specially designated government grants. If pension obligations vested before 1998, which are reported as contingent

liabilities, are taken into account, the County Council Group would report negative equity of SEK 18,043 million (19,519). At year-end 2014, the recognised equity/assets ratio was 8.2 per cent, which is a decrease of 0.2 percentage points compared to the preceding year. In the past five years, the equity/assets ratio improved by 2.5 percentage points, from 5.7 per cent in 2010 to 8.2 per cent in 2014. If the pension obligations recognised as contingent liabilities were included, the equity/assets ratio would be minus 20.0 per cent.

8,000 SEK million Surplus for the year (change in equity) Capital gains

7,000 136

6,000

–133

5,000 4,000

Surplus for the year after balance requirement adjustments

3

Balance requirement result for the year

3

3,000 2,000 1,000 0

2010

2011

2012

2013

2014

8.4

8.2

2013

2014

Equity/assets ratio (%) 9 8 7.6

7

7,6

6 5

5.7

5.7

4 3 2 1 0

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2010

2011

2012

Financial analysis Annual Report 2014

31

Investments The county’s rising population entails a higher investment need in both healthcare and public transport. The investment volume for the year is larger than ever and is in line with the strong regional development. Investments for 2014 amount to nearly than SEK 15 billion.

32

Annual Report 2014

 To contents

Investment trend Decision In the 2014 budget, the County Council Assembly set the investment limits for each administration and company. The budget was revised as a result of the Assembly’s decision on 18 February 2014, LS 1401-0037, for an expansion of the Metro in an amount of SEK 449 million according to the 2013 Stockholm Negotiations (Stockholmsförhandlingen), and the Assembly’s decisions on 6 May 2014, LS 1401-0061 and LS 14010062, on supplemental agreements 28 and 33 in an amount of SEK 74 million regarding the project agreement and additional medical-technical equipment and furnishings for NKS. The budget for 2014 amounts to SEK 16,455 billion. Investing activities The table on investments shows the trend in investing activities in 2014 in relation to the established investment budget. Investments totalled SEK 14,988 million, which corresponds to a

conversion rate of 91 per cent (69) relative to budget. In transport services, the conversion rate was 97 per cent and in healthcare, it was 92 per cent. The outcome was SEK 1,467 million below budget. Large deviations are presented by the table. The development of the investing activity during the five-year period is presented by the diagram.

Public transport investments Public transport by land and sea Investments in transport extend over all modes of transportation and the outcome for the year amounted to SEK 7,873 million, which is SEK 245 million lower than the budget. The investing activities were affected by planning issues, appeals of procurements, changed timetables for vehicle deliveries, and so on. Several major investment projects that aim to expand and modernise the county’s infrastructure are currently being carried out. On the Roslagsbanan suburban railway, three new double

track sections were expanded, noise reduction measures were implemented and the existing wagons were renovated. The technical improvement of the Lidingöbanan suburban railway and the expansion of the railway depot in Lidingö were completed. In the Metro Red Line project, the new depot in Norsborg was built and the stations in Hallunda and Norsborg were improved and modernised. Expenses for the year also pertain to the partial payment of new C30 vehicles that will serve the Metro’s red line. An agreement was reached between the County Council, the City of Stockholm, the Municipality of Nacka and the Municipality of Värmdö on the financing of the bus terminal at Slussen. The programme study for the Southern Tramway continued as planned. One consultation is complete and close cooperation with the municipalities involved has laid the foundation for continued work. Service was halted on the Solna Branch of the Light Rail during the summer for renovations in Alvik, adaptation of the signalling

Investments SEK million

Outcome

Budget

Deviation

Outcome

2014

2014

from budget

2013

2014

Healthcare including properties (LFS)

2,836

3,078

241

2,085

92%

61%

New Karolinska Solna

3,639

4,194

554

3,305

87%

96%

Transport

7,873

8,118

245

5,355

97%

107%

Citybanan

376

477

101

369

79%

86%

Metro Exp. Admin.*

117

449

332



26%



Other

147

140

-7

67

105%

40%

14,988

16,455

1,467

11,180

91%

69%

Total investments SCC Group

Conversion rate 1013

* Metro Expansion Administration

Investments (SEK million) 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0

 To contents

2010

2011

2012

2013

2014

Investments Annual Report 2014

33

systems and test runs. Service resumed on 18 August on the Solna Branch, including the section to Solna Station with departures every ten minutes. The deviations between the 2014 outcome and budget are primarily in the Roslagbanan capacity improvement (SEK 435 million), Spårväg City tramway (SEK 448 million), commuter trains (SEK 412 million) and the Solna Branch of the Light Rail (SEK 290 million). The procurement of vehicles for Roslagsbanan suburban railway was postponed due to the need to review the specifications and agreements to ensure quality, final delivery and a balanced budget. Within Spårväg City tramway, the deviation is mainly due to delayed railway plans. The deviation regarding investments in commuter trains is mostly due to a contractual change with a supplier to ensure that the vehicles are delivered on time for the commissioning of Citybanan. The change entailed changes in the payment plan. The Solna Branch was struck by continued delays in the delivery of the signal safety system and deficiencies in delivered vehicles. Expanded Metro The 2014 investment budget was set at SEK 449 million and the outcome was SEK 117 million. The outcome is below budget, but largely in line with the planning the Metro Expansion Administration made in summer 2014. Metro to Nacka/Southern Stockholm The outcome for the year was SEK 48 million. In 2014, a location study was begun for the route Sofia-Gullmars­ plan/Southern Stockholm. The study

examines various route alternatives and station locations, as well as the rail line and station location according to the wishes of the Municipality of Nacka regarding the placement of entrances. Metro to Arenastaden The outcome for the year was SEK 49 million. In 2014, work commenced on the section to Arenastaden via Haga­ staden. The section runs from Odenplan where a new track and a new platform are planned south of the existing tracks and platforms. The station below Hagastaden will have entrances at Torsplan and at New Karolinska Solna/ Karolinska Institutet/Hagaplan. The section continues on to Arenastaden. Metro to Barkarby The outcome for the year was SEK 16 million. A location study was begun and will form the basis of decisions on the Metro route. A report with a route recommendation is planned for the beginning of 2015. The report will be used as a basis for decisions in the County Council Executive Board. One condition for the work on the location study is to not make it impossible to continue the line towards Hjulsta and Viksjö. In parallel with the location study, work is being conducted on the system documentation project planning. Depots and vehicles The Depots and vehicles project aims to ensure that there are vehicles and depot capacity in place for commencement of the various services within the scope of the new Metro lines. The investment expense for the project amounted to around SEK 3 million and mainly consisted of expenses for project management and project engineering.

Citybanan commuter rail The investment in Citybanan commuter rail amounted to SEK 376 million in 2014, which was SEK 101 million less than the budget of SEK 477 million. Citybanan is being built by the Swedish Transport Administration. The project includes two new stations, Odenplan and City, which will connect to the Metro stations Odenplan and T-Centralen. The stations are financed and will be owned by Stockholm County Council. Co-financing Transportation infrastructure investments receive government co-financing in the form of government grants. The extent of the co-financing of new investments is established in negotiations between the government, the County Council and the municipalities in the county. The objects already under way received SEK 710 million in government grants in 2014, broken down as follows: • Lidingöbanan SEK 248 million • Roslagsbanan SEK 351 million • Light Rail East SEK 101 million • Park-and-ride facilities SEK 10 million

Investments in healthcare including properties Investments in healthcare comprise investments in properties reported within Landstingsfastigheter Stockholm and investments in machines and equipment at the respective care producer. The year’s investments in healthcare amounted to SEK 2,836 million, of which SEK 2,254 million related to properties. This provides a conversion rate of 92 per cent compared with the

Transport investments SEK million Metro Red line Commuter Rail Programme Spårväg City, stage 2 Light Rail North Solna Branch Roslagsbanan expansion Programme bus depots

34

Annual Report 2014 Investments

Budget 2014

Outcome 2014

1.211

1.249

883

471

1.397

949

930

640

1.425

991

647

854

 To contents

year’s budget, which amounted to SEK 3,078 million. The conversion rate in the previous year was 61 per cent. Deviations from budget The deviation from the year’s budget is partially related to investments of SEK 146 million in properties in Landstingsfastigheter Stockholm. This was caused by postponed and uncompleted unspecified objects, which were objects with a total expense below SEK 100 million that were affected by and jointly planned with the strategic investments. The outcome for the specified objects was also below budget as they did not proceed at the rate planned, mainly due to changed planning conditions and shifts in timetables. Machinery and equipment The care producers’ investments in machinery and equipment were SEK 580 million, which is SEK 66 million less than the budgeted SEK 646 million. The lower conversion rate is mainly due to Södersjukhuset AB and Karolinska University Hospital. Ongoing projects The largest ongoing objects in healthcare properties are new construction and renovations at Södertälje Hospital, technical improvement of building 01 at Löwenströmska Hospital, and demolition of an existing garage and construction of a new one at Karolinska University Hospital in Huddinge. During the year, implementation decisions were made for a new treatment building at Södersjukhuset and a new treatment building at Danderyd Hospital. Work is under way at both of these objects to prepare for the new construction. The

new construction and renovation of building 30, the emergency ward at St. Göran Hospital, were delayed and became more expensive due to appealed building permits. The table presents investment expenses for the largest objects in healthcare. The demolition of the existing garage and construction of a new garage at Karolinska University Hospital in Huddinge became more expensive due to the adjustments needed due to the purchase agreement reached for the upcoming 3D property above the garage. The new forecast for the object’s total expense amounts to approximately SEK 350 million, which is SEK 64 million or 22 per cent over budget.

acquired new pharmaceutical dispensers.

Replacement investments

Supplemental agreements

The majority of healthcare investments in machinery and equipment comprised replacement investments. During the year, a large amount of radiology equipment was purchased, including two new magnetic resonance tomography (MR) systems that were installed at Södersjukhuset AB. The new MR equipment makes possible a new method for breast diagnostics and has more capacity for the examination of children and cancer patients. A new computer tomography system was installed at the Department of Neuroradiology at Karolinska University Hospital in Solna. Several systems for magnetic resonance tomography were upgraded to a new modern standard, including Paediatric Radiology, Karolinska University Hospital in Solna, and at Södertälje sjukhus AB. At Karolinska University Hospital, an improved security and entry system was installed and the hospital also

During the year, several supplemental agreements were signed. Fitting out of the five storeys in the research building and the hospital dispensary are the largest and these were approved by the County Council Assembly in the spring. In addition to these, decisions were made on additional gas outlets, connecting walkways, a sampling laboratory and several minor changes.

New Karolinska Solna New Karolinska Solna is Stockholm County Council’s single largest investment project for the next few years. Total investment expenses and costs for the project are presented below from project start to the end of December 2014. The construction of the new hospital facility is in full swing and the project timetable is being kept both in terms of time and finances. The technical building was completed and turned over to the County Council during the year.

Presentation of the New Karolinska Solna project In 2014, work on the construction of New Karolinska Solna proceeded according to plan. NKS Construction within the County Council Executive Board Administration has primary responsibility for the construction project and it conducts equipment procurements together with Karolinska University Hospital. Operational responsibility for medical technology expertise and

Investments in healthcare properties SEK million New building western location – treatment building, SÖS

Outcome 2014 209

new construction and renovation of Södertälje Hospital

170

Technical improvement building 01, Löwenströmska

150

New treatment building, Danderyd Hospital

149

Demolition of existing garage/new garage, Karolinska Huddinge

118

Building 30 Renovation and construction of the emergency ward at St. Göran Hospital  To contents

74

Investments Annual Report 2014

35

setting requirements on equipment for clinical use rested with Karolinska University Hospital. The work is conducted within the scope of an overall programme. In a similar manner, cooperation is conducted for the procurement of infrastructure for IT and communication technology, fittings and medical equipment.

the two eastern hospital buildings, construction work was gradually completed during the year and installation of ceiling-mounted medical-technical equipment is under way. In the three other hospital buildings, the internal installation work was completed. The installation of information and communication-technical equipment is under way. The project engineering for the extension of the treatment building was concluded and the foundation work is under way. In the research building, the structural work is being completed.

Investments The technical building was completed according to plan during the spring and turned over to the County Council. In

The investments in new construction according to the “public-private collaboration agreement” follow the project agreement and the method according to which the ongoing construction is reported.

Expenses – New Karolinska Solna

2008–2013

Outcome 2014

Total

Budget 2014

102

5

107

8

152

110

262

100*

1



1



IT and communication technology

14

6

20

2

Medical equipment

57

23

79

26

4

1

6

4

SEK million Management and administration Project Operations-related, transferred to Karolinska Furnishings

Art Evacuation and preparaotry work plus contractual issues

504

52

556

58

Total project

732

193

924



37

151

188

144

872

349

1,219



Operating expenses NKS Parking and technical building Total cost

* SEK 55 million budgeted in compensation from Health and Medical Care Administration to Karolinska. In addition, internally budgeted at Karolinska.

Investments New Karolinska Solna

SEK million

Accumulated 2013

Outcome 2014

Total

Budget 2014

Construction New construction in progress, SCC share

640

92

732

112

Supplemental agreements/Change requests

344

306

650

265

New construction in progress, PPC share

8.940

3.043

11.983

3.063

Total building

9.924

3.441

13.365

3.440

381

1.965

2.346

6

5

11

of which commissioned buildings Art

9

Equipment IT and communication technology

55

48

103

211

Medical equipment

88

138

226

531

Furnishings Total equipment Total

2

5

7

3

145

191

336

745

10.075

3.637

13.712

4.194*

* Incl. supplemental budget of SEK 74 million according to decision in County Council Assembly.

36

Annual Report 2014 Investments

 To contents

Financial performance of boards and committees Through political efforts, approximately SEK 63 billion were allocated to boards and committees to provide the county’s residents with knowledge-based, appropriate, safe and accessible healthcare and attractive public transport that ties the region together.

 To contents

Annual Report 2014

37

Stockholm County Council Committee Organisation

County Council Assembly

Audit Board

County Council Executive Board

Public Healthcare Services Committee

Health and Social care Committee in Norrtälje1)

Traffic Committee

Culture Committee

Patient Advisory Committee

1) Joint board with Norrtälje Municipality.

This section primarily aims to provide a view of operations and financial performance, which in turn are based on the County Council grants decided on by the County Council Assembly in connection with the budget.

County Council Executive Board The County Council Executive Board leads and coordinates the County Council’s committees and their operations, and follows up implementation of the County Council Assembly’s decisions. The County Council Executive Board is also responsible for overall development of the County Council as a whole, such as regional planning, strategic property issues and expansion of the new Metro lines. The County Council Executive Board Administration, including NKS Construction and the Metro Expansion Administration, is a part of the County Council Executive Board. County Council Executive Board Administration Introduction and mission The County Council Executive Board

Administration works directly on behalf of the County Council Executive Board via the County Council Director. The Administration’s foremost task is to support the County Council Executive Board in its task of managing, governing and coordinating the County Council’s operations and to work strategically and operationally in order to achieve the goals set in the budget adopted by the County Council Assembly. The Administration’s core operations support the political organisation and provide operational support to the County Council’s operations. The Administration is also home to SCC IT, which is the County Council’s internal organisation for IT services, and SCC Strategic Property Issues and Investments, which is responsible for the construction of New Karolinska Solna.

higher than budget and was primarily a result of a number of government grants being higher than budgeted. Compared with 2013, the revenues increased by SEK 328 million or 9.4 per cent. The County Council grant increased by SEK 171 million, corresponding to 6.2 per cent. Higher other revenues are partially an effect of reinvoiced expenses for the Metro Expansion Administration. Operating expenses were SEK 108 million or 3.1 per cent higher than budgeted. This is largely due to the redistribution of SEK 60 million to the endeavour with higher staffing in healthcare in the summer of 2014. Compared with 2013, expenses increased by SEK 333 million or 10.2 per cent. Personnel costs increased as a result of a larger number of full-time equivalents in the Administration. The efforts in research, development and education entailed higher costs for grants paid. Depreciation and amortisation costs increased compared with the previous year, but were SEK 13 million lower than budgeted. This is mainly due to SCC IT not having invested at the pace planned for the year.

Finances The surplus in 2014 totalled SEK 9.1 million compared with the budgeted break-even. The goal of balanced finances was achieved. The corresponding surplus for 2013 was SEK 119 million. Operating revenues amounted to SEK 101 million, which was 2.7 per cent

County Council Executive Board Administration SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Revenues

3,835

3,507

9%

3,734

– of which, SCC internal

3,729

3,428

9%

3,627

–3,725

–3,364

11%

–3,630

–101

–24



–104

9

119



0

887

828

7%

824

Expenses Net financial items Surplus/deficit Number of full-time equivalents

38

Annual Report 2014 Financial performance of boards and committees

 To contents

For investments, see the investment section and the heading New Karolinska Solna. Metro Expansion Administration Introduction and mission The County Council Assembly decided on 18 February 2014 to approve an agreement in the 2013 Stockholm Negotiations on an expansion of the Metro. The County Council Executive Board was given the task of being responsible for implementing the expansion. In 2014, the Metro Expansion Administration was formed and began its operations. The Administration has the task of carrying out the expansions as per agreement: • Metro to Nacka/Southern Stockholm • Metro to Arenastaden • Metro to Barkarby The Administration is also responsible for the expansion of depots and the acquisition of the vehicles required for servicing the new parts of the Metro.

Public Healthcare Services Committee

Finances The Metro Expansion Administration is financed through co-financing from the parties that signed the Metro expansion agreement according to the 2013 Stockholm Negotiations. The co-financing should cover the expenses that are directly linked to the respective investment objects, as well as the expenses incurred by the Administration’s staff. The Administration received capital totalling SEK 447 million, which corresponds to annual grants and advances for 2014 in accordance with the agreement. The capital received is SEK 2 million lower than the approved investment budget because of a development in the consumer price index that was lower than assumed in the agreement. The Administration was formed on 1 March 2014, which means that the accounting period only pertains to ten months. For 2014, a zero result is presented. For investments, see the investment section and the heading Expanded Metro.

Introduction and mission The Health and Social Services Committee is responsible for the management of the County Council’s health and medical care. This means that the Committee shall ensure that healthcare is governed, coordinated and developed in such a way that the collective resources are adapted to the needs of the population and contribute to the improvement of the state of healthcare. As a professional committee in charge, the Health and Social Services Committee shall participate in overall planning for investments in healthcare. The Public Healthcare Services Committee finances and governs care through agreements with care providers. The Committee is responsible for ensuring that all healthcare, dental care and efforts under the Act regarding Support and Service for Persons with Certain Functional Impairments (LSS) is managed, coordinated and developed so that the resources are adapted to the

Metro Expansion Administration Outcome 2014

Outcome 2013

Change %

Budget 2014

Revenues

30







– of which, SCC internal

11







–30







0







SEK million

Expenses Surplus/deficit

Private and public share of costs in 2014 (%) 100 90

80

79

38

48

42

62

66

80 70 60

Private production

62

50

52

40

10

58 38

30 20

20

Stockholm County Council production (including other county councils, municipalities and state)

34

21

0 Somatic Psychiatry specialist care

 To contents

Primary care

Elderly care

Dental care Other health and medical care

Total

Financial performance of boards and committees Annual Report 2014

39

population’s needs and contribute to an improvement of the state of health. The Committee plans and monitors the population’s medical care needs and orders and follows up on orders of medical care from the providers. The Public Healthcare Services Committee signs agreements with around 1,000 different care providers, ranging from corporate groups active in healthcare to individual care providers. These agreements have come about through direct agreements with County-Council-operated production, procurement or patient care choice. The Public Healthcare Services Committee is also responsible for agreements with private physicians and physiotherapists that are established under the national tariff scheme. Of the Public Healthcare Services Committee’s expenses of SEK 44,712 million for purchased health and medical care services, private care providers accounted for 34 per cent of the total expenses, which is an increase of one percentage point compared with 2013. The largest cost proportions for private providers are in primary care and other healthcare. The latter includes aids for the disabled, specialist rehabilitation and ambulance healthcare. Finances There was a deficit of SEK 193 million in 2014, which was SEK 193 million lower

than the budgeted break-even. This deficit was SEK 292 million lower than 2013. Operating revenues were SEK 2,213 million higher than in 2013, which is an increase of 4.4 per cent. This outcome was SEK 545 million or 1.1 per cent over budget. The deviation from budget is mainly attributable to higher revenues regarding the 6 per cent government grant, which is a VAT compensation received at the purchase of operations not subject to VAT, revenues from the rehabilitation guarantee and compensation for the summer efforts in healthcare. Operating expenses were SEK 2,476 million higher than in 2013, which is an increase of 5.0 per cent. This outcome was SEK 726 million or 1.4 per cent over budget. The deviation from budget is mainly due to higher costs for purchased heathcare and medical services and higher pharmaceutical costs. An analysis of the Public Healthcare Services Committee’s results for 2014 by operating area shows the following major deviations from budget:

costs for advanced medical care in the home due to more patients and longer care times • psychiatric care, deficit of SEK 74 million, which is mainly attributable to higher costs in general psychiatry • pharmaceuticals, deficit of SEK 139 million, which is primarily attributable to the costs for infectious disease control pharmaceuticals increasing by SEK 250 million or 80 per cent compared with 2013 • other healthcare and other operations, surplus of SEK 273 million, which are mainly due to budgeted provisions as well as aids and care guarantees via the Care Guarantee Registrar. Consumption In 2014, the number of residents in the county increased by around 35,000 people or about 1.6 per cent. The population of Stockholm County was 2,198,044 residents at year-end. Healthcare consumption increased in the majority of operating areas compared with 2013 in both outpatient and inpatient care. This increase is lower than expected, however, and also lower than the population increase. Compared with 2013, the total number of visits to doctors in outpatient care increased by 1.5 per cent. The number of care episodes rose in inpatient care by 0.3 per cent compared with 2013.

• somatic specialist care, deficit of SEK 143 million, which is mainly due to higher costs for patient care choice areas in somatic specialist care outside the emergency hospitals • geriatric care, deficit of SEK 104 million, which is mainly due to higher

Public Healthcare Services Committee SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

49,489 2,544

47,730

4%

49,489

2,091

22%

1,999

52,033

49,820

4%

51,488

–512

–467

10%

–521

–44,712

–42,779

5%

–44,097

Operating revenues County Council grants Other revenues Total operation revenues Operating expenses Personnel costs Purchased health and medical care services Other expenses Total operation expenses

–7,020

–6,522

8%

–6,900

–52,243

–49,767

5%

–51,517

Depreciation/amortisation

–6

–7



–11

Net financial items

23

53



40

–193

99



0

2

8

–71%

32

713

653

9%

650

Surplus/deficit Investments Number of full-time equivalents

40

Annual Report 2014 Financial performance of boards and committees

 To contents

Operations In 2011, the County Council Assembly adopted a Future Plan for Health and Medical Care in Stockholm County Council. In 2014, this work shifted from the earlier analysis, planning and specification efforts to a distinct implementation phase. In December 2014, the County Council Assembly approved the implementation of the adjustments in the care services presented in stage three of the Plan for Future Health and Medical Care. During the year, statements of intent with the emergency hospitals, and overall and detailed implementation plans were prepared at both care providers and central administration. More patient care choice has gradually been introduced according to the Act on Systems of Choice in the Public Sector since 2008. Six new patient care choices were added in 2014, which means that there are now 31 patient care choice areas. During the year, agreements entered into effect in the patient care choice areas of orthopaedics and hand surgery, neurology, clinical neurophysiology, intensive training for children with motor disabilities, paediatric clinics, and rehabilitation from long-term pain and chronic fatigue syndrome. In patient care choice for paediatric clinics, five completely new clinics opened and another two will open in spring 2015. The child vaccination programme was expanded to include rotavirus infections. In March, BB Sophia began

its operations in patient care choice in childbirth. An eye-glass allowance for children was introduced on 1 June. The number of residents who have opened a resident account on My Healthcare Contacts is steadily growing. A total of 25 per cent of the county’s residents now have a resident account and thereby the possibility to use the e-services linked to this. The number of clinics registered with the system increased by 17 per cent and is now around 1,800. Of all general practitioner (GP) clinics, 87 per cent are registered with My Healthcare Contacts. The national patient safety agreement had been in place since 2011 and 2014 was the final year covered by the agreement. Stockholm County Council fulfilled all of the basic requirements and three of six performance requirements in 2014. The objective for the prescription of antibiotics was achieved for 2014. Since 2010, these prescriptions have decreased by 14 per cent. The final year for the national agreement in Coordinated care for the most ill elderly was 2014. Stockholm County achieved the 2014 target for performance requirements regarding reducing avoidable inpatient care and improving pharmaceutical use for the elderly. Stockholm County also received part of the performance compensation for registration in some quality registries. However, the county did not achieve the goal for performance compensation for reducing re-admissions within 30 days.

Open Comparisons 2014, Healthcare, Comparisons between county councils, presents a large number of comparative indicators. In summary, the state of health generally improved gradually in both Stockholm County and Sweden as a whole. There are, however, differences in morbidity that are related to socioeconomic conditions. Access to healthcare is perceived as good in Stockholm County Council and confidence in healthcare centres and hospitals is perceived as good.

Health and Social care Committee in Norrtälje Introduction and mission The Health and Social care Committee in Norrtälje, formerly the TioHundra Council, has been the purchaser of heathcare, medical services and social services in Norrtälje since 1 January 2006. Stockholm County Council and Norrtälje Municipality jointly finance the operations of the committee. The so-called TioHundra project extends through to 31 December 2015.   Finances There was a deficit of SEK 12 million in 2014, which was SEK 12 million lower than the budgeted break-even. The deficit is broken down as SEK 7 million for municipal operations and SEK 5 million for county council operations. The result was SEK 14 million lower than 2013. Within the Committee’s operations funded by the County Council, the devi-

Health and Social care Committee in Norrtälje SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Operating revenues Grants, Stockholm County Council

1,303

1,247

4%

1,303

Grants, Norrtälje Municipality

945

903

5%

945

Other revenues

230

214

8%

106

2,478

2,363

5%

2,354

–39

–36

8%

–41

–2,150

–2,028

6%

–2,026

Total operation revenues Operating expenses Personnel costs Purchased health, medical and social care Other expenses Total operation expenses Surplus/deficit

 To contents

–301

–298

1%

–287

–2,490

–2,362

5%

–2,354

–12

2



0

Financial performance of boards and committees Annual Report 2014

41

ation is mainly attributable to higher costs for the care of Norrtälje residents at hospitals outside of the Norrtälje Municipality. This is partly compensated by higher revenues at Norrtälje Hospital for the care of patients who live outside Norrtälje Municipality, and costs for primary care and pharma­ ceuticals that are below budget. In May 2013, the Committee submitted a request to the County Council Executive Board Administration for an adjusted budget limit for 2013 and 2014, corresponding to SEK 24.1 million per year. A decision to contribute funds for 2013 was made in the County Council Assembly in September 2013. In addition, the Committee was commissioned to carry out an in-depth analysis of and report on medical care needs, the development of prices and volumes for medical care and other expenses for operations financed by Stockholm County Council, in consultation with the Public Healthcare Services Committee and the County Council Executive Board. Reports were submitted in 2014 after which the

County Council Assembly decided in May to approve a supplemental appropriation of SEK 35.6 million for the Committee.

Traffic Committee Introduction and mission The Traffic Committee has the task of fulfilling the County Council’s duties as a regional public transportation authority. The Traffic Committee has overriding responsibility for the planning and procurement of public transport services. It is the Committee’s responsibility to draft proposals on the regional transport provisioning programme. The Committee is responsible for public land transport, public marine transport and transport services for the disabled. Transport services are procured from and operated by external contractors. In order to achieve well-functioning transport solutions, the Committee cooperates with neighbouring municipalities, county councils and other agencies concerned. Every day, over 790,000 people

travel by public land transport (Metro, bus, commuter trains and local trains) and around 11,200 people travel by public marine transport. There are more than 2,800,000 boardings in public land transport, around 8,600 trips with special public transport and some 2,400 patient transports. Stockholm County has the highest market share of public transportation in Sweden. A contributing cause to public transport being used so widely is that it is well developed, has a high frequency of service and has good coverage over the entire county. To encourage more passengers to take public transport, the Traffic Administration worked in 2014 to increase the attractiveness of Stockholm County’s public transport services. Efforts were begun to prioritise the introduction of main routes and to create conditions in the road network for good passability through an action selection study together with the Swedish Transport Administration. In a different action selection study for regional large-capacity public trans-

Traffic Committee SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014 8,423

Operating revenues County Council grants

8,423

7,913

6%

Ticket revenues

6,984

6,696

4%

7,157

Other revenues

3,355

3,373

–1%

3,228

18,762

17,982

4%

18,808

8,679

8,250

5%

8,658

Total operation revenues – of which, SCC internal Operating expenses Personnel costs

–479

–441

9%

–513

–12,674

–12,087

5%

–12,607

–2,843

–2,786

2%

–2,921

Total operation expenses

–15,996

–15,314

4%

–16,041

Depreciation/amortisation

–2,176

–2,010



–2,017

–607

–656



–750

Surplus before appropriations and taxes

–18

2



0

Appropriations**

175







Surplus after appropriations and taxes

157

2



0

30

2



0

7,873

5,355

47%

8,118

652

624

4%

635

Purchased transport services Other expenses

Net financial items

Adjusted surplus* Investments Average number of annual employees

* Pertains to surplus/deficit before appropriations and tax adjusted for interest effect on pension expenses. ** Pertains to tax optimisation for the LISAB Group.

42

Annual Report 2014 Financial performance of boards and committees

 To contents

port, a preliminary study is proposed for the Roslagsbanan suburban railway to be able to conclude what interconnections in the north-east sector best fulfil the study’s goals. In April 2014, the Traffic Committee decided to appoint Stockholms Spårvägar as the transport operator for the Lidingöbanan suburban railway and Spårväg City tramway. Bus services for the inner-city and Lidingö were procured in 2014 and Keolis is now continuing work to introduce a new route network in June 2015. The bus operator Nobina was awarded the contract for bus service in Handen, Tyresö and Nynäshamn. An eight-year agreement was signed with Djurgårdens Färjerederi AB for port public transport with the Djurgård ferries. Service began in April 2014. Procurement of test service in the archipelago with a north-south direction is under way. A ticket cooperation agreement was reached with SJ. The aim of the agreement is to ensure that the Swedish Transport Administration prioritises commuter rail service over other train operators in the event of major traffic outages. SJ’s passengers then have the opportunity to switch to commuter trains without needing to buy an SL ticket. A project is under way together with the City of Stockholm to increase passability in bus service. The City has increased the number of bus lanes, improved signal priority, removed a number of parking spaces and removed some stops, at the same time that boarding has been allowed through more doors. The Metro has expanded service during rush hour with more departures before and after the rush-hour peak to reduce congestion. More trains run during rush-hour on the green and red lines. Weekend service has been expanded by adding more and longer trains. On the blue line, longer trains run in evening service until 9:30 p.m. instead of 7:00 p.m. as before. A number of improvements have been made in the archipelago service by adding more and better connections between land and marine service. A new payment service in marine service is being gradually introduced and is  To contents

expected to be fully introduced in 2015. Since 16 June 2014, the Djurgård ferries have been included in the SL tariff zone A, which means that all SL tickets are valid for travel with the ferries. A study of transport services for the disabled is under way as all agreements for the services must be procured by 2016. The agreement for ordering centres and the travel guarantee in transport services for the disabled entered into effect in February, entailing the outsourcing of call centre tasks. Finances The Traffic Committee had a surplus of SEK 30 million for 2014, adjusted for increased costs for an interest rate change on the calculation of pension liabilities of SEK 48 million. The adjusted surplus was SEK 30 million higher than the budgeted break-even and the goal of balanced finances was achieved. The tax funding ratio for the Traffic Committee was 50 per cent, which is on a par with budget. The target for 2013 was 49 per cent. Operating revenues totalled SEK 18,762 million (17,982) and were below budget by SEK 46 million or 0.2 per cent. Ticket revenues were SEK 173 million or 2.4 per cent below budget. This was mainly due to a larger proportion of tickets sold at a discount and an increase in travel that did not match the budgeted level, which to some extent was due to a mild winter. Compared with the 2013 outcome, operating revenues increased by SEK 780 million or 4.0 per cent. This increase was mainly due to a County Council grant that was SEK 510 million or 6.0 per cent higher, and ticket revenues that were SEK 288 million or 4.0 per cent higher. Operating expenses amounted to SEK 15,996 million (15,314) and were SEK 45 million or 0.3 per cent below budget. The costs for purchased transport services were SEK 67 million or 0.5 per cent over budget. This deviation was attributable to higher incentive costs, new agreements for bus service and supplemental agreements for the Light Rail Solna Branch. New agreements for bus service in the inner-city that entered into effect in 2014 were more expensive than budgeted. The same is true of the Light Rail Solna

Branch, where a supplemental agreement was reached on compensation per kilometre as a complement to earlier agreements on compensation per passenger. One large deviation among the other costs pertains to SEK 97 million or about 3 per cent lower costs for planned maintenance, electrical energy/utilities and urgent and corrective maintenance. As of the 2014 financial year, fixed assets are recognised according to the K3 rules, which entail changes compared with earlier rules. Previously, additional expenses were only capitalised if the asset’s performance was improved. In K3, additional expenses are instead assessed based on general asset criteria, which means that the capitalisation possibilities have increased. In 2014, reclassifications were made from operating costs to fixed assets, which explains the deviation from budget. Compared with 2013, operating expenses were SEK 682 million or 4.0 per cent higher. This is mainly due to higher costs totalling SEK 521 million for purchased land service as a result of new transport service agreements and the full-year effect of service changes in 2013. Depreciation and amortisation were SEK 159 million higher than budget and SEK 166 million higher than 2013. The cost increase is due to higher depreciated/amortised value as a result of an increasing investment volume and several concluded investment projects. Net financial items amounted to an expense of SEK 607 million (expense: 656), which was SEK 143 million below budget. This deviation is attributable to lower market interest rates. Compared with 2013, net financial items were SEK 49 million lower, mainly as a result of a smaller loan portfolio. Investments for the year amounted to SEK 7,873 million. The conditions for public transport are affected by population and commercial growth in the region. For the Stockholm region, the ability of public transport to grow at least at the same pace as the population and the planning of the entire transport system to enable a long-term growth of the share of public transport are major challenges and crucial issues for the future. In recent

Financial performance of boards and committees Annual Report 2014

43

years, the investment volume has increased and it will remain high in the next few years. Some proposed investments need to be reprioritised over the next five-year period.

Culture Committee Introduction and mission The objective of the County Council’s cultural activities is to contribute to a high-quality, free and accessible cultural life. The Culture Committee supports free cultural life in Stockholm County, in part through long-term support to organisations and by supporting various projects. Cultural activities that receive support must be of high quality. All decisions regarding support for cultural and association life are also based on the Committee’s four target areas: democracy, gender equality, equal opportunity and accessibility for the disabled. Grants are awarded to organisations, projects and associations in the county. Stockholm County Council is the chief financier of the Concert House Foundation. Culture must be accessible to all, regardless of age, gender, disability, ethnic background or education. In

general, culture for children and young people is prioritised. An overwhelming proportion of the external grants shall go to activities for children and young people. It is important that culture is readily accessible to the entire region and that it gives children throughout the county the opportunity to grow by participating in high quality cultural life. For those who cannot themselves travel to cultural experiences, the administration has extensive activities with culture in healthcare that is offered to all elderly care centres and hospitals in the county.

arise in contacts with all publiclyfinanced health and medical services. This involves private, municipal and county council municipal care, as well as public dental care and private dental hygienists. The Committee contributes to improving the quality of healthcare by feeding conclusions from received reports back to the healthcare services. The Committee recruits, trains and appoints support persons for patients in compulsory psychiatric care or in isolation in accordance with the Communicable Diseases Act. Activities at the Patient Advisory Committee prioritise the following strategic goals as set forth by the County Council Assembly: • Awareness of the Patient Advisory Committee shall increase among the public and staff. • Complaints shall be analysed and followed up. • Prevention efforts shall be intensified.

Finances There was a deficit of SEK 1 million in 2014, which was SEK 1 million lower than the budgeted break-even. The deviation from budget is mainly due to the cost of students studying in other counties but registered in Stockholm County being higher than budgeted.

Patient Advisory Committee

The Committee’s quality targets are based on five areas of activity: patient reports, support person activities, prevention activities, greater knowledge among healthcare personnel and promoting contact between healthcare

Introduction and mission The Patient Advisory Committee is a non-partisan body that is independent of healthcare services to which patients and relatives can turn when problems

Culture Committee SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014 427

Revenues

429

420

2%

– of which, SCC internal

415

401

3%

414

–430

–421

2%

–427

Expenses Surplus/deficit

–1

–1



0

1.8

0.2



0.4

51

47

9%

43

Outcome 2014

Outcome 2013

Change %

Budget 2014

Revenues

21

21

3%

21

– of which, SCC internal

20

19

3%

20

–21

–21

3%

–21

0

0



0



0.1





20

20



20

Investments Number of full-time equivalents

Patient Advisory Committee SEK million

Expenses Surplus/deficit Investments Number of full–time equivalents

44

Annual Report 2014 Financial performance of boards and committees

 To contents

staff, patients and the public. The quality targets are defined in the quality policy that has applied since 2012. In 2014, the Committee received 6,033 reports, 11 per cent more than the year before. The budgeted number was 5,000. Reports are received in writing, via telephone calls, e-mails or personal visits. The normally more complex written cases have increased continuously in recent years and have more than doubled since 2005. In 2014, the Committee handled ten issues of principle. Several of them involved multiple care providers and care types, as well as multiple patients. These cases involved: • difficulties for patients in choosing a psychiatric clinic • referral handling at local emergency wards • introduction of blocking measures according to the Patient Data Act • incompletely addressed correspondence • deficient coordination • problems getting referral responses upon a block being set in the record systems • a patient being forgotten at an emergency ward. The Committee does not believe it has the possibility to influence the scope of the various operating components since those who express opinions regarding healthcare, apply for a support person

or request statistical compilations contact the administration based on their own needs and desires. The administration continues to be very active in the information efforts targeted at healthcare. The number of applications for support persons will continue to be monitored and special information efforts will be directed at the operations that provide compulsory care.

sional auditors who support the County Council’s elected representative auditors in their assignment. In the annual audit, the risk areas below were examined in 2014: • the build-up of the newly established Metro Expansion Administration • Locum AB’s role in the implementation of future health and medical care the care providers’ work on securing the supply of places for on-the-job training • the administration and development of the compensation systems in emergency somatic care • collaboration between the City of Stockholm and the County Council in terms of elderly mentally impaired individuals • the Traffic Committee’s procurement and follow-up of agreements for transport services for the disabled • the Traffic Committee’s continued development work on the investment process.

Finances There was a surplus of SEK 0 million in 2014, which was in accordance with the budgeted surplus requirement.

County Council Auditors Introduction and mission The County Council Auditors are commissioned by the County Council Assembly to audit all operations in Stockholm County Council regardless of organisational form. Elected representative auditors and lay auditors are the County Council Assembly’s and, ultimately the citizens’, democratic instrument for audit and control of operations conducted in the County Council Executive Board, other boards and committees, as well as companies and foundations. The County Council Auditors’ organisation consists of the Audit Board, which has overall responsibility for administration of the auditors’ activities, three auditor teams and the Audit Office with expert profes-

In 2015, the elected representative auditor organisation will be expanded from 15 elected representative auditors to 21, of which most are newly elected as auditors. Finances There was a surplus of SEK 0 million in 2014, which was in accordance with the budgeted surplus requirement.

County Council Auditors SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014 33

Revenues

33

32

2%

– of which, SCC internal

33

32

2%

33

–33

–32

2%

–33

Expenses Surplus/deficit Number of full–time equivalents

 To contents

0

0



0

24

23

4%

23

Financial performance of boards and committees Annual Report 2014

45

All Stockholm County Council operations The “Financial performance of boards and committees” section aims primarily to provide a view of the operations and financial performance that are based on County Council grants as decided on by the County Council Assembly in connection with the budget. The table provides an overall view of board and committee performance deviations.

In addition to this, Stockholm County Council has a very important and broad operation that mainly consists of companies and administrations that are run under company-like forms. The table provides an initial insight into the reported budget deviations for the respective operations. A closer description of these is provided in the operations report.

Deviations in income compared with budget

SEK million The County Council Executive Board

Surplus/ deficit 2014

Budget 2014

Deviation from budget

831

–310

1,142

–193

0

–193

–12

0

–12

Traffic Committee

30

0

30

Culture Committee

–1

0

–1

Patient Advisory Committee

0

0

0

County Council Auditors

0

0

0

Budget 2014

Deviation from budget

Public Healthcare Services Committee Healthcare and Social Services Committee in Norrtälje

Deviations in income compared with budget

SEK million Healthcare Provision, Stockholm County Karolinska University Hospital Södersjukhuset AB Danderyds Sjukhus AB TioHundra AB Södertälje Sjukhus AB St. Eriks Ögonsjukhus AB Folktandvården Stockholms län AB Ambulanssjukvården i Storstockholm AB Stockholm Care AB

Surplus/ deficit 2014 204

75

128

–561

30

–591

–84

9

–94

–151

7

–157

2

0

2

–1

3

–4

14

1

13

108

20

88

–4

1

–5

4

4

0

–28

0

–28

Special transport services

–9

0

–9

Waxholms Ångfartygs AB

15

0

15

Locum AB

18

5

13

338

235

103

6

0

5

–327

–31

–296

AB SLL Internfinans

3

3

0

Damages account

0

0

0

822

–310

1,132

5

0

5

AB Storstockholms Lokaltrafik

Landstingsfastigheter Stockholm (LFS) MediCarrier AB Landstingshuset i Stockholm AB

Group financing New Karolinska Solna

46

Annual Report 2014 Financial performance of boards and committees

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Expected development The economic recovery over the next few years will contribute to continued development of total revenues in the County Council. In order for the finances to continue to be balanced, while at the same time enabling necessary investments in healthcare and public transport, the cost trend must be broken and adapted to the County Council’s long-term financial conditions.

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Annual Report 2014

47

Development over the next few years Strong finances are necessary as the County Council’s operations strive for development and quality. Balanced finances are the basis of long-term sustainable development. Both the economic development of the surrounding world and the population growth in Stockholm County place considerable demands on responsible policies. The County Council’s resources must not only handle the modernisation and development of healthcare and public transport as well as the expansion required by a growing population, they must also handle the strains that can arise from changing conditions in the surrounding world. There are major challenges and opportunities for the county’s and the County Council’s development. This applies to future health and medical care, completion of New Karolinska Solna, and the major Metro agreement with nine new Metro stations. There are also several other important investments in both healthcare and public transport on a scale of several billion SEK every year over the coming years. These investments create conditions for a growing and functioning Stockholm region. In order for the County Council’s finances to remain balanced, the set investment limits may not be exceeded, while at the same time the cost growth in the operations must be sustainable in the long term. The County Council’s continued work is therefore focused on breaking the rate of cost increase and securing necessary resources. This is to allow the County Council to make the necessary and extensive investments in healthcare, public transport and research, development and education in multiple areas. New agreements with the county’s emergency hospitals are being drafted. The hospitals are being given frameworks and thereby longterm stable conditions in order to achieve the financial and operational objectives. Over the coming years, major demands will be set on a focus on more efficient ways of working and on the County Council utilising every opportunity for consistent joint governance 48

Annual Report 2014 Expected development

with every part of the organisation contributing to coordination, flexibility and efficiency based on operations-specific conditions. Clearer owner governance is necessary to ensure cost control and efficient operations. Sweden and the surrounding world The international recession following the financial and debt crisis that began in 2008 resulted in a long and drawnout recovery process. The economies of the US and the UK are now growing at a good rate, which together with Asia are supporting the recovery of the global economy. However, growth in the euro zone is still relatively weak and the continued economic trend is uncertain. The very expansive monetary policies of key central banks and a less restrictive finance policy will assist the recovery of the global economy over the next few years. The weak growth in the euro zone together with relatively subdued economies in our Nordic neighbours means that the contribution to growth from foreign trade will be limited in the coming year. Despite the moderate growth in the rest of the world, employment in Sweden has continued to grow relatively well. However, this is due in part to a very low productivity growth, which, if it lasts, will reduce the longterm growth potential of the Swedish economy. Most economic analysts expect the Swedish economy to strengthen somewhat in the period 2015 to 2017 and estimate that GDP growth will reach around 2.5 per cent per year after having grown by around 2 per cent in 2014. It is primarily strong domestic demand that will contribute to growth in Sweden during this period. Stockholm County has managed relatively well in the years following the financial crisis, thanks in large part to the county trend of growing faster than the rest of Sweden. The beneficial labour market growth in the region has meant that the tax base has grown rapidly. Target Budget 2015 and plan years 2016–2017 The budgeted surplus for 2015 is SEK 53 million before transition costs for

the Future Plan for Health and Medical Care. For plan years 2016 and 2017, the budgeted results amount to a surplus of SEK 229 million and SEK 420 million, respectively. For the period 2015–2018, the planned transition costs in the scope of the Plan for Future Health and Medical Care total SEK 3.5 billion, of which SEK 2,570 million is budgeted for 2015–2017. The budgeted surplus presupposes that the current cost trend is broken. Sound cost control forms the prerequisite for balanced finances. Stockholm County Council has had a number of years with a high rate of cost growth, which has led to a cost level that only allows limited space for further cost increases in 2015 and on. It is crucial that the operations actively work to introduce new ways of working, use expertise properly and find ways to reduce the rate of cost increases, and that existing resources are used in the most efficient way possible. The budget for 2015 amounts to SEK 85.8 billion. Calculations for planning years 2016 and 2017 include a turnover of SEK 89.5 billion and SEK 93.3 billion, respectively. The County Council’s revenues are largely reliant on external factors, such as population growth, demographic changes and economic growth. The changed revenue level is mainly attributable to higher tax revenues. Tariffs remain unchanged in public transport and only minor adjustments are made in healthcare fees. A price increase of 2.5 per cent for adult dental care in public dental care is proposed in the 2015 budget. Tax revenues Total tax revenues are comprised of tax revenues, general government grants and municipal economic equalisation. Total tax revenues for 2015 are estimated to increase by SEK 3.1 billion compared with the outcome for 2014 and amount to SEK 67.1 billion. The budgeted increase in total tax revenues for 2015 is expected to amount to 4.8 per cent relative to the outcome of 2014, to then reach 4.6 per cent for the planning year 2016 and 4.9 per cent for 2017. The increase rates reflect the economic recovery, which is an important prerequisite for the forecast.

 To contents

In 2016 and 2017, the cost for the municipal equalisation system is expected to increase to SEK 1,600 million towards the end of the period. The increase in total tax revenues will thereby be moderated. The tax rate is unchanged at 12.10 per cent during the entire budget period. A balanced cost trend In the 2015 budget, operating expenses amount to SEK 79.9 billion, an increase of SEK 3.2 billion over budget 2014. Staffing costs and purchased heathcare and medical services mainly account for the increased expenses. At the same time, the capital costs, which consist of depreciation and amortisation costs and interest expenses, are increasing by SEK 1.0 billion in the 2015 budget compared with the 2014 budget. This increase is due to continued large investment volumes and higher market interest rates in connection with the economic upturn. For the planning years, budgeted operating expenses, excluding transition costs, amount to SEK 82.1 billion in 2016 and SEK 85.6 billion in 2017. The budgeted cost increases thereby amount to 2.9 per cent in 2016 and 4.1 per cent in 2017. In addition, financial expenses will continue to rise, by 15.0 per cent in 2016 and by 12.5 per cent in 2017. The County

 To contents

Council will have higher capital costs for New Karolinska Solna, renovations of the other emergency hospitals, and an increased expansion of local healthcare in connection with the implementation of the Plan for Future Health and Medical Care. In public transport, investments will be made in vehicles, technical improvement of existing lines and expansion of the Metro, among other things. Investment scope The calculation of a future investment scope constitutes a complex relationship between the development of the net operating costs (the County Council’s total costs minus operating revenues), estimated tax revenues, composition of the investment volume and the level of interest rates. In addition, Stockholm County Council must take into account the adopted financial targets, which entail additional limitations of the investment scope. One important condition for calculations of the investment scope is the assumption that the Swedish economy will develop towards higher capacity utilisation and a more normal cost increase rate, on a par with the Swedish Central Bank’s inflation target of 2 per cent. Another important prerequisite is that the population growth in Stockholm County continues in line

with the growth of recent years. The available investment scope is compiled based on balanced finances and is estimated at SEK 75 billion over a ten-year period. In addition to this, there are investments for New Karolinska Solna to function optimally at opening and investments in the Metro expansion, which are mainly financed through co-financing. In total, this means investments of SEK 106 billion in the next ten years. In order for this to be possible, the cost growth must be limited, and the implemented investments must lead to higher efficiency in the operations. The investment plan is focused on the next five years and many objects are planned and will be commissioned in 2017–2019, which directly affects the County Council’s finances. In order to achieve the objective of balanced finances, continued cost-efficiency improvements, more co-financing and other sources of finance are necessary, as well as future property development and a reprioritisation of objects over time. The budget for 2015 includes investments totalling over SEK 15.2 billion, of which healthcare amounts to SEK 7.9 billion, public transport to SEK 7.3 billion and other operations to SEK 86 million.  

Expected development Annual Report 2014

49

Operations report Overall areas of operation The County Council’s operations and their development are important for the future of the county residents. The foremost task of the County Council is to ensure that county residents have access to high quality healthcare and well-functioning public transport. Stockholm County Council’s surplus for 2014 is in line with the budget, although there are deviations, primarily in emergency medical care.

50

Annual Report 2014

 To contents

County Council administrations and companies divided into overall areas of operation

Healthcare

Public transport

Property

• Healthcare Provision, Stockholm County • Karolinska University Hospital • Södersjukhuset AB • Danderyds Sjukhus AB • TioHundra AB • Södertälje Sjukhus AB • St. Eriks Ögonsjukhus AB • Ambulanssjukvården i Storstockholm AB • Stockholm Care AB • Folktandvården Stockholms län AB • MediCarrier AB

• AB Storstockholms Lokaltrafik • Waxholms Ångfartygs AB • Transport Services for the Disabled

• Locum AB • Landstingsfastigheter Stockholm (LFS)

 To contents

Financial and other operations • Group financing • AB Stockholms Läns Landstings Internfinans • Landstingshuset i Stockholm AB • Damages account • Culture

Operations report Annual Report 2014

51

Governance Stockholm County Council is governed by the County Council Assembly. Governance is based on the Local Government Act and many other laws, such as specific legislation for healthcare, public transport and regional planning. The County Council has extensive operations in healthcare and public transport with its own healthcare operations in corporate form and transport and property operations in corporate form. In addition to this, the County Council procures operations carried out by contractors. Governance is developed and strengthened. The owner policy and general and specific owner directives form the basis of coherent and strong owner governance.

52

Annual Report 2014

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County Council’s responsibility and mission Stockholm County Council’s primary mission is to: • provide well-functioning and accessible healthcare, including dental care • provide reliable public transport, including transport services for the disabled • contribute to a free, accessible, high quality cultural life • manage regional planning and participate in creating conditions for regional growth and development The work for sustainable growth forms a unifying theme through the County Council’s operations and is framed by ambitions regarding research, education, social responsibility and effective environmental efforts. Operations must continuously be developed with a focus on providing the residents with good service in an efficient manner in order to meet present and future needs. In 2014, continued efforts on a coherent financial management strategy were focused on describing the

County Council’s prerequisites and guidelines for sound financial management over time. The areas particularly illustrated are the long-term development of the equity/assets ratio and equity, as well as the management of transition costs over time as a result of the Plan for Future Health and Medical Care.

Objectives To achieve the overall objectives, goals have been broken down that have a clear connection to the respective overriding objective. These goals show what areas are prioritised and they will make it possible to achieve the overall objectives. The goals are followed up using measurable indicators. The overall objectives shall be viewed over time and are considered to be fulfilled when at least half of the total indicators under the respective objectives are achieved. The broken-down goals are considered to be met when at least half of the underlying indicators are achieved. The overall objectives are presented in Chapter 3.

Assignments The County Council Assembly has ultimate responsibility for Stockholm County Council’s operations. The political leadership decides on operational strategy, finances, objectives and priorities, and commissions committees and boards to carry out assignments regarding implementation, investigations and analyses. These assignments are the political leadership’s way of governing the operations and creating changes to thereby achieve the best possible results for the residents of the county. Accordingly, it is of great importance to monitor the work with the set assignments so that the Assembly can get an overall view of the implementation of the assignments. Assignments in budget 2014 In the objectives and budget for Stockholm County Council for 2014 and plans for 2015–2016, the County Council Assembly decided on a number of assignments. Below is a presentation of the collective results of assignments issued by the County Council Assembly in connection with the 2014 budget,

Missions given in budget 2014 Yes

Partially

No

Total

Degree of completion at 31 December, count

21

15

2

38

Degree of completion at 31 December, %

55

40

5

100

Total

Outstanding assignments from 2013 and 2012 budgets Missions given in budget 2014

Yes

Partially

No

Degree of completion at 31 December, count

49

2

0

51

Degree of completion at 31 December, %

96

4

0

100

Degree of completion at 31 December, count

41

2

0

43

Degree of completion at 31 December, %

95

5

0

100

2013

2012

Assignments issued in 2014 Yes

Partially

No

Total

Degree of completion at 31 December, count

46

14

5

65

Degree of completion at 31 December, %

71

21

8

100

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Governance Annual Report 2014

53

LS 1301-0040, and assignments issued in connection with the 2013 budget, LS 1201-0055, and the 2012 budget, LS 1105-0733, which were not reported as resolved in connection with the 2013 year-end report. Assignments issued in 2014 In 2014, the County Council Executive Board and the County Council Assembly made decisions of a financial nature where reporting shall take place in the County Council’s 2014 annual report.

Follow-up of supervisory obligations Supervision concerns establishing that the County Council’s operations in both administration form and company form have been conducted in accordance with applicable legislation, adopted policies and steering documents, and that they have adequate internal control. Supervision report The supervision report is the County Council Executive Board’s tool for reporting back to the County Council Assembly on the supervision of all of the County Council’s committees, boards and company boards and their operations conducted during the year. The supervision report is available as an appendix to the County Council’s 2014 annual report. A brief presentation of the report’s contents is provided below. In connection with reporting for 2014, boards and committees had to submit a governance and corporate governance report, respectively. The latter reporting takes place in accordance with requirements according to the owner policy. The County Council’s governance in general and owner governance in particular are based on legal requirements, steering documents and policies. In accordance with the Local Government

54

Annual Report 2014 Governance

Act, the County Council Executive Board has supervisory responsibility over the County Council’s committees and companies. This involves ensuring compliance with requirements established based on steering documents and requirements. The report there also contains in-depth feedback reporting of the policies for disability, public health and procurement. The County Council Assembly and the County Council Executive Board shall have the right of disposition over the operations conducted in committees and companies. Committees and administrations are governed based on the regulations adopted by the County Council Assembly. Companies are governed in part through specific owner directives. The County Council’s wholly and partially owned companies shall comply with the requirements under the Local Government Act, which include guidelines in the articles of association for each company for the set municipal purpose and the municipal authorisations. In 2014, the Executive Committee and the Production Committee had the express responsibility to take care of owner governance issues before the County Council Executive Board. During the year, continuous owner dialogues were held with the County Council’s companies and administrations under company-like forms. The report also includes feedback on the County Council Assembly’s objectives and assignments in 2014. Compliance with the set municipal objectives After analysis and review of the reports in the submitted corporate governance reports for the County Council’s wholly owned and partially owned companies, it can be confirmed that no deviations occurred from the stipulated municipal objectives during the 2014 financial year.

Compliance with municipal powers After analysis and review of the reports in the submitted corporate governance reports for the County Council’s wholly owned and partially owned companies, it can be confirmed that no deviations occurred from the stipulated municipal powers during the 2014 financial year. Internal control The County Council’s boards and committees must comply with the Policy for Internal Control for Stockholm County Council and Companies (LS 13030431). Boards and committees are responsible for establishing systems for internal control in their operating areas in accordance with the regulations for Stockholm County Council. The objective of internal control is to achieve the following goals: • appropriate, cost-effective and safe operations • reliable accounting and financial reporting and information • compliance with applicable legislation and directions, etcetera. Each committee and board shall, in connection with interim reporting and the year-end report, report the status of internal control in accordance with the County Council Executive Board’s instructions. In connection with this, the respective administration head or company manager must also ensure that necessary steps have been taken to achieve adequate internal control. In the year-end report, all committees and boards submitted an assurance that necessary steps were taken to achieve adequate internal control within the respective committee and board. Almost all committees and boards also appended the 2014 follow-up of internal control. Some units commented that they had not yet finished the follow-up of the 2014 internal control.

 To contents

Health and medical care To meet the residents’ greater need for healthcare, major investments continued to be made in 2014. The implementation of the Plan for Future Health and Medical Care is of considerable importance for achieving better accessibility and quality in healthcare. The vision of the Plan for Future Health and Medical Care shifted to tangible implementation in 2014.

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Annual Report 2014

55

General health and medical care At the national level, the objective for healthcare services is to provide the patient added value in the form of better health. The population should be offered high-quality needs-based, accessible and effective care. Based on these conditions, the government together with the Swedish Association of Local Authorities and Regions identified important development areas where special agreements were reached. To stimulate the County Council’s efforts for improved accessibility in planned and specialised care, the government allocated the “Queue Billion” (Kömiljarden) over the years 2008 to 2014 to shorten waiting times. This funding aims to achieve the goal of care with patient safety and sustainable accessibility over time with the patient’s route through the healthcare system in focus. Stockholm County Council was eligible for this funding for clinic visits in every month of the year. For three months of the year, the performance requirements for treatment were also achieved. Another area was the initiative on the most ill elderly where government grants have been used to encourage, strengthen and intensify collaboration between municipalities and county councils. The work conducted in the scope of the effort will be implemented in the municipalities’ and county councils’ regular work. The agreement expired at year-end. A new Patient Act (2014:821) entered into effect on 1 January 2015. The act aims to strengthen and clarify the patient’s position and promote patient integrity, self-determination and participation. The new act entails the following: • The information obligation to the patient is expanded and clarified. • Health and medical care may as a general rule not be given without the patient’s consent. • The patient’s possibility of getting a second opinion is expanded. • The patient shall be given the opportunity to choose the provider of publicly financed primary care and outpatient specialist care throughout Sweden. 56

Annual Report 2014 Health and medical care

In other respects, the new act includes equivalent formulations to the current regulations regarding, for instance, the care guarantee, a primary care contact, a primary medical contact, individual planning and a choice of treatment options and aids. Regulations concerning a child’s influence over his or her care have also been included in the act. In Stockholm County Council, more patient care choice according to the Act on System of Choice in the Public Sector (LOV) has been gradually introduced since 2008. Six new patient care choices were added in 2014, which means that there are now 31 patient choice areas. A new maternity ward at Sophiahemmet, BB Sophia, was established during the year, increasing the childbirth capacity in the county. BB Sophia has capacity to handle about 4,000 deliveries per year. The Plan for Future Health and Medical Care In 2011, the County Council Assembly adopted the Plan for Future Health and Medical Care in Stockholm County Council. In 2014, this work shifted from the earlier analysis, planning and specification efforts to a distinct implementation phase. In December 2014, the County Council Assembly approved the implementation of the adjustments in the care services presented in stage three of the Plan for Future Health and Medical Care. An important channel to give residents and patients accurate guidance in the relocations and changes in care that will take place based on the Plan for Future Health and Medical Care is the healthcare guide service 1177 Vårdguiden. It is important that the use and spread of 1177 Vårdguiden’s e-services, such as My Healthcare Contacts or Care Events, increase for greater accessibility for residents and patients and as an aid in making care processes more efficient. The proportion of residents and number of clinics that have an account in My Healthcare Contacts increased during the year. To achieve the objectives according to the Plan for Future Health and Medical Care, collaboration between care providers in online healthcare is a fundamental strategy. One of the most important prerequisites to develop such

collaboration is secure and easy access to information on the patient. The County Council Executive Board decided in March 2014 that new system support should be introduced for the handling of care information. This work is now being coordinated with the Region Västra Götaland and Region Skåne. Open comparisons between county councils In Open Comparisons 2014: Healthcare, Comparisons between county councils, a large number of comparative indicators are presented. In general, the state of health improved gradually in both Stockholm County and Sweden as a whole. There are, however, differences in morbidity that are related to socioeconomic conditions. Access to healthcare is perceived as good in Stockholm County Council and confidence in healthcare centres and hospitals is perceived as good. Finances Total healthcare costs for Stockholm County Council increased by 6.2 per cent in 2014, exceeding budget by SEK 1,625 million. The cost of externally purchased care increased without a corresponding cost reduction in County Council operated care despite unchanged or reduced healthcare volumes. On the contrary, staffing costs in particular increased sharply at the same time as considerable care capacity was closed due to difficulties recruiting nurses. To restore balance to the finances, action programmes must be implemented in the county’s emergency hospitals to adapt costs to the scope permitted by the County Council’s finances that has been established as a cost ceiling in the hospitals in the care agreements for 2015. Consumption These statistics present total care consumption for the entire Stockholm County Council, meaning the sum of the Public Healthcare Services Committee and the Health and Social care Committee in Norrtälje. The change in healthcare consumption compared with the previous year should be put in the perspective of population growth, which was 1.6 per cent in Stockholm County in 2014.  To contents

Care episodes in which the patient is meant to stay overnight, as well as doctor’s visits and other healthcare visits, increased compared to last year’s levels. However, the number of care episodes and doctor’s visits were fewer than budgeted. Visits to other care providers were above budget.

cent higher than 2013. Emergency hospital care episodes in obstetrics amounted to approximately 24,200 (26,000), which was 7.1 per cent lower than 2013. This decrease is because BB Sophia began its childbirth activities on 3 March 2014. The number of geriatric care episodes was 6.1 per cent higher than in 2013 and 5.6 per cent over budget, which is mainly attributable to a larger capacity and more capacity per unit. The average time in geriatrics was 10.5 days, which corresponds to a 1.5 per cent shorter care time than in 2013. In psychiatry, the number of care episodes was unchanged compared with 2013.

Care episodes Total production for the year amounted to approximately 327,000 (326,000) care episodes in inpatient care, which was 0.2 per cent higher than 2013 and 1.9 per cent below budget. There were 0.5 per cent fewer care episodes in somatic specialist care and 0.1 per cent fewer care episodes in psychiatry than in 2013. The number of care episodes in geriatrics increased by 6.0 per cent. The average care time in somatic specialist care was 3.5 days, which was a decrease of 0.1 days compared with 2013. The total number of care episodes at emergency hospitals was 1.6 per cent lower than 2013. At Danderyds Sjukhus AB, the number of care episodes was 5.1 per cent lower than in 2013, 0.9 per cent lower at Södersjukhuset AB and 6.3 per cent lower at Södertälje Sjukhus AB. At Karolinska University Hospital, the number of care episodes was 0.2 per

per cent and those in geriatrics for only around 0.2 per cent. The relatively small volumes for geriatrics also mean that the percentage changes between various periods can be relatively large. The total number of visits to doctors in somatic specialist care increased by 2.5 per cent compared with last year. Doctor’s visits at emergency hospitals and in specialist care increased by 7.4 per cent, while visits to private specialists at a national tariff decreased by 17 per cent compared with 2013. In total, the number of visits in primary care amounted to about 12,000,000 (11,500,000). Of these, approximately 40 per cent are visits to doctors, which is an increase of 1.2 per cent higher than 2013 and 2.9 per cent over budget. The increase in the number of visits to doctors is mainly attributable to GP visits. Approximately 60 per cent of the total number of visits are made to care providers other than doctors, such as district nurses and assistant nurses at the GP clinics, physiotherapists, speech therapists, occupational therapists and chiropractors. The total number of other visits for the year amounted to 9,824,000 (9,303,000), an increase of 5.6 per cent higher than 2013 and 5.6 per cent over budget. Most other visits take place in

Visits to doctors and visits to other care providers Total production for the year amounted to approximately 8,001,000 (7,873,000) visits to doctors, which was 1.6 per cent higher than 2013 and 1.9 per cent below budget. The largest number of doctor’s visits can be found in primary care, which accounts for more than half of all doctor’s visits. Visits to doctors in somatic specialist care account for nearly 40 per cent of the total number while doctor’s visits in psychiatry account for approximately 5

Healthcare Stockholm County Council Outcome 2014

SEK million Care episodes

Outcome 2013

Change %

Budget 2014

Deviation from budget

327,151

326,425

0.2%

333,491

–1.9%

Visits to doctors

8,000,773

7,872,806

1.6%

8,159,121

–1.9%

Visits to other care providers

9,823,887

9,303,447

5.6%

9,305,860

5.6%

Consumption Consumption of healthcare of healthcare 2014, 2014, compared compared with 2013 with 2013 Care episodes Care episodes

Visits to Visits doctors to doctors

6.1 % 6.1 %

2.5 % 2.5 %

2.1%

1.2 % 1.2 % –0.5 % –0.5 –0.1% % –0.1%

a

m

So

tic

0.2%

s l y s re ry tr ic ric ta caiat ia iatr at To c h h i i r r c c y e at y Ge Ps G m Ps

re

ca

So

 To contents

0.2%

2.1% 1.6 % 1.6 %

–0.6 % –0.6 %

l s l y s re re re ry tr ic ta are ric ta ca a ca iat iaiatr To ry c at To c y tic c i h h i r r r c c a a a y e at y Ge Ps G m Ps im im m Pr Pr So So

al

t To

Health and medical care Annual Report 2014

57

primary care where the visits amounted to approximately 7,592,000 (7,124,000), 6.6 per cent higher than in 2013 and 6.6 per cent over budget. Prehospital care Road-based paramedic assignments decreased by 0.4 per cent compared with the previous year. Of these, 48 per cent were highest priority assignments. Seven new ambulances were ordered in 2013 pursuant to the Public Healthcare Services Committee’s “Ambulance Improvement” decision and another two were ordered in 2014. There are a total of 73 ambulances in the county, including one out-of-county ambulance and one intensive care ambulance. Dental Care The waiting time for treatment of children and adolescents in specialist dental care stayed within the agreed maximum limit of two months and was thereby on the same level as the corresponding period in the previous year. The proportion of children and young people who visited dental care during the year decreased by 1.4 percentage point to 94.0 per cent compared with the same period last year, but was 1.0 per cent over budget. The proportion of three-year-olds without caries damaged teeth was very high at 96 per cent. The proportion of 19-year-olds with caries-free lateral surfaces has increased in recent years, but has now stabilised at a high level. For 2014, this proportion was 68.3 per cent compared with 67.3 per cent for the previous year. The waiting time for treatment of adults within specialist dental care stayed within the agreed maximum limit of two months. The number of commenced orthodontic treatments increased by 4 per cent to 5,450 compared with the same period last year. This increase is attributable to higher care production by private care providers. The number of adults treated as a part of a disease treatment decreased by 4.0 per cent compared with the same period last year to 6,449. The decrease is mainly due to two patient categories being transferred to a special dental subsidy in the government dental care assistance.

58

Annual Report 2014 Health and medical care

Accessibility Time-related accessibility to care is highly prioritised in Stockholm County Council and accessibility is continuously followed up. The follow-ups are based on the regulations and time limits of the care guarantee. Attainment of the target values for the care guarantee is measured based on reported data. The care guarantee has been a part of the Health and Medical Care Act since 2010. Accessibility measures target fulfilment with regard to same-day telephone contact with healthcare services, a visit to a general practitioner (GP) within five days and a clinic visit to a specialist within 30 days as well as received treatment within 90 days (the “0-5-30-90” rule). Stockholm County Council has chosen more demanding targets for clinic visits and GP visits than those set in the national goals, which are 90 days and seven days, respectively. Care guarantee Waiting times chosen by patients or determined by medical factors are not included when assessing whether the care guarantee has been met, and are removed from calculations of 30 and 90 day waits. These compilations are done in accordance with the directive of the Swedish Association of Local Authorities and Regions according to the formula of the number of patients who wait less time than the care guarantee’s limit divided by the total number of patients waiting. Under the care guarantee, a patient should not have to wait more 90 days for treatment after a decision on treatment has been made. The limit applies to both Stockholm County Council and nationally. Treatment follow-up comprises all planned surgical treatments with only a few exceptions. Phone accessibility Phone accessibility (0 days waiting time) is still acceptable. The 2014 measurements indicate that a total of 94 per cent of all test calls to GP clinics were deemed satisfactory according to the national care guarantee of same-day contact. This result is on a par with the 2013 figure. The clinic that had the lowest result had 69 per cent satisfactory calls according to the care guarantee’s

requirements while the one with the highest result had 100 per cent. Waiting times for GP visits Measurements of waiting times for GP visits in 2014 show that 89 per cent of patients were able to see a GP within five days, which is unchanged compared with 2013 (not counting patient-chosen waits). If the patient has not chosen to wait longer, 93 per cent of GP visits occur within seven days, which is 2 percentage points lower than 2013. The median wait for a GP visit was zero days, not counting patient-chosen waits. All of 69 per cent of the visits took place the same day. The average number of waiting days is two, not counting patient-chosen waits. An average value that is significantly higher than the median value means that the involuntary waiting time was long for a few of the visits although the majority of the patients did not need to wait at all. There are no differences in waiting times between men and women. Waiting times for visits to specialists In the follow-up of the care guarantee for clinic visits, 26 specialities are monitored. Stockholm County Council has a more stringent care guarantee limit for clinic visits than applies nationally. After a decision on a referral or care request, a visit within the planned specialised care should if necessary be offered within a maximum of 30 days after the decision day. The corresponding national limit is 90 days. This is the only difference to the national care guarantee. The proportion of patients who waited 30 days or less for a clinic visit amounted to 65 per cent in December 2014, a decrease of 4 percentage points compared with the same period last year. The average result for 2014 was 70 per cent. The total proportion of those who waited 30 days or less for a clinic visit was relatively stable in the first five months of the year and then lower during the summer months to again increase somewhat the rest of the year. The areas that best managed the proportion of those waiting 30 days or less is vascular surgery and plastic surgery. All had an attainment rate over 94 per cent. The area that showed the lowest  To contents

100% 80% 60%

Percentage of patients who waited within the care guarantee limit for clinic visits 2014 40%

100% 20% 80% 0% 60% 40% 20% 0% Jan

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

SCC 2013

72%

76%

77%

78%

77%

71%

57%

65%

75%

80%

80%

69%

Nat 2013

95%

96%

97%

98%

97%

96%

94%

91%

93%

96%

97%

96%

SCC 2014

78%

81%

79%

76%

71%

66%

51%

62%

74%

70%

72%

65%

Nat 2014

95%

95%

95%

94%

95%

93%

92%

88%

91%

88%

96%

94%

Percentage of patients who waited within the care guarantee limit for treatment 2014 100% 80% 60%

Percentage of patients who waited within the care guarantee limit for treatment 2014 40%

100% 20% 80% 0% Jan

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

2013

88%

88%

90%

91%

90%

89%

86%

82%

84%

90%

92%

91%

2014 40%

90%

90%

90%

92%

88%

92%

89%

85%

87%

93%

94%

92%

60%

20% 0%

Kömiljarden Kömiljarden –– waiting waiting for for treatment treatment 2013 2013 and and 2014 2014 100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% 0%

Jan

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

2013

63%

67%

70%

70%

69%

66%

54%

48%

62%

71%

72%

66%

2014

65%

68%

68%

70%

65%

66%

56%

50%

63%

73%

71%

67%

Kömiljarden Kömiljarden –– waiting waiting for for a a clinic clinic appointment appointment 2013 2013 and and 2014 2014 100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% 0% Jan

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

2013

80%

83%

85%

85%

85%

82%

73%

71%

81%

85%

86%

82%

2014

74%

86%

87%

84%

83%

79%

71%

70%

79%

80%

86%

81%

 To contents

Health and medical care Annual Report 2014

59

result in terms of proportion of patients waiting is hand surgery. The proportion of those waiting less than the national care guarantee’s limit of 90 days amounted to 92 per cent in December 2014, which is a decline of 1 percentage point compared with December 2013. The proportion of waiting patients who received treatment within the national care guarantee limit amounted to 92 per cent in December 2014, which is an improvement of 1 percentage point compared with the same period last year. The average result for 2014 was 90 per cent. The areas with the best results in terms of the proportion of those waiting for treatment within the care guarantee limit are cardiac care, ophthalmology, surgery and gynaecology. In these areas, more than 93 per cent of patients receive care within the care guarantee limit. The areas that show the lowest results are neurosurgery and ear, nose and throat. Orthopaedics and surgery have the highest number of patients waiting.

Patients with a patient-chosen wait (PCW), meaning that they have waived the care guarantee for personal reasons or because they want to see a specific care provider, are included in all parts of the calculation. Extra compensation is payable if 80 per cent of the patients who had an initial clinic visit or underwent an operation or received treatment during the month had waited less than 60 days. For 2014, Stockholm County Council was eligible for Kömiljarden funding for clinics in all months since the basic requirement of a minimum of 70 per cent was achieved during the whole period from January to December. In terms of treatment, the County Council is eligible for Kömiljarden funding for April, October and November since the basic requirement of a minimum of 70 per cent was achieved during these months. For clinics, SCC achieved the extra level of compensation for all months except June, August and September, since more than 80 per cent of the patients who had an initial clinic visit had waited no more than 60 days.

Kömiljarden

Healthcare Provision, Stockholm County

In 2014, the results requirement for receiving funding from the programme was divided into two parts. The basic requirement is that at least 70 per cent of patients should have waited fewer than 60 days as of the end of every month. If the basic requirement is met, the potential performance-based compensation is determined according to the actual waiting times, which is how long the patient had waited at the end of the wait.

rehabilitation units. Healthcare Provision Stockholm County also provides aids for the disabled, habilitation, geriatrics and advanced home healthcare. Finances There was a surplus of SEK 204 million in 2014, which was SEK 129 million higher than the budgeted surplus requirement of SEK 75 million. This surplus was SEK 75 million higher than 2013. The difference against 2013 is mainly attributable to a new compensation model in psychiatry. Operating revenues were SEK 408 million higher than in 2013, which is an increase of 4.3 per cent. This outcome was SEK 398 million or 4.2 per cent over budget. The deviation from budget is mainly due to revenues for sold health care and medical services. Operating expenses were SEK 327 million higher than in 2013, which is an increase of 3.5 per cent. This outcome was SEK 272 million or 2.9 per cent over budget. The deviation from budget is primarily attributable to personnel costs and costs for insourced personnel. Depreciation and amortisation costs were SEK 5 million higher than in 2013 and SEK 2 million below budget. Net financial items (financial income and expenses) were SEK 1 million lower than the preceding year and SEK 1 million lower than budget. This deviation is mainly attributable to the change in the discount interest rate for pension liability calculation.

Introduction and mission Healthcare Provision Stockholm County is responsible for the County Council owned psychiatry for children and adolescents, adults and the elderly and also has specialised dependence care and forensic psychiatry. Primary care comprises health centres, local urgent care clinics, child and maternity care, youth counselling centres and

Goal attainment The balanced finances objective was achieved as the surplus was above the

Kömiljarden actual waiting periods 2014 Stockholm County Council 100% 90% 80% 70%

86% 71%

90%

86% 71%

76%

91%

88% 74%

72%

88% 87% 77%79%

89%

87% 74% 65%

60%

76%

72%

75%

Clinic appointment

89% 77%

Treatment Target 70 %

62%

50% 40% 30% 20% 10% 0% Jan

60

Feb

Mar

Apr

May

Annual Report 2014 Health and medical care

Jun

Jul

Aug

Sep

Oct

Nov

Dec

 To contents

budgeted surplus requirement. Accessibility to GP care within five days was on a par with the outcome for 2013. Accessibility, time to the first visit, decreased by 5 percentage points since 2013 to 79 per cent in adult psychiatry and by 3 percentage points to 97 per cent in dependence care.

higher than 2013 and 1.9 per cent over budget. The average care time was 9.3 days or 0.4 below budget. The number of visits in outpatient care amounted to approximately 8,500 (9,100), which was 6.6 per cent lower than 2013 and 18.1 per cent below budget. The difference is mainly attributable to operational changes and reduced demand. The number of visits in psychiatric care amounted to approximately 1,210,000 (1,206,000), which was 0.4 per cent higher than 2013 and 6.8 per cent below budget. The number of care episodes was 0.9 per cent higher than in 2013 and 0.5 per cent below budget. This difference is mainly attributable to a change in the reporting of visits in 2013.

Production The number of visits in primary care amounted to approximately 3,968,000 (3,902,000), which was 1.7 per cent higher than 2013 and 1.5 per cent below budget. The difference against budget is primarily attributable to the visits by Team Äldredoktorn to assisted living being in the primary care budget, but being reported in geriatrics visit statistics. The number of care episodes in geriatrics amounted to approximately 10,800 (10,100), which was 7.5 per cent

by 2.0 per cent compared with 2013. Production volume increased by 3.3 per cent while expenses, adjusted for price and salary increases, grew by 1.3 per cent. In primary care, productivity decreased by 0.3 per cent, mainly due to cost increases. In geriatrics, productivity increased by 7.6 per cent due to volume increases and in psychiatry, productivity increased by 2.4 per cent due to volume increases and low cost increases. Future outlook Besides on-going development work, Healthcare Provision Stockholm County will also focus on developing four areas in 2015: skills supply, inter-operational care processes, Healthcare Provision Stockholm County as a good recipient, and effective support processes.

Productivity In total, productivity in Healthcare Provision Stockholm County increased

Healthcare Provision, Stockholm County Outcome 2014

Outcome 2013

Change %

Budget 2014

Health and medical care sold

8,213

– Sold health and medical care, SCC

8,023

7,902

4%

8,029

7,726

4%

Other revenues

7,836

1,676

1,579

6%

1,462

Total operation revenues

9,889

9,481

4%

9,491

Personnel costs

–6,842

–6,626

3%

–6,781

Other expenses

–2,769

–2,659

4%

–2,559

Total operation expenses

–9,612

–9,285

4%

–9,340

Depreciation/amortisation

–75

–70



–77

1

2



2

204

129



75

65

84

–23%

66

10,959

10,865

1%

10,950

Outcome 2013

Budget 2014

Deviation from budget

–561

–9

30

–591

–84

–82

9

–94

–151

–66

7

–157

2

–9

0

2

–1

–4

3

–4

SEK million Operating revenues

Operating expenses

Net financial items Surplus/deficit Investments Number of full-time equivalents

Surplus/deficit emergency hospitals

SEK million Karolinska University Hospital Södersjukhuset AB Danderyds Sjukhus AB TioHundra AB Södertälje Sjukhus AB St. Eriks Ögonsjukhus AB Total emergency hospitals

 To contents

Outcome 2014

14

3

1

13

–781

–167

51

–831

Health and medical care Annual Report 2014

61

Revenues for the emergency hospitals amounted to SEK 24,939 million (24,241), which was an increase of 2.9 per cent compared with the preceding year and 0.1 per cent over budget. Above all, revenues increased for sold primary services by SEK 458 million or 2.2 per cent compared with last year, but were SEK 177 million below budget. Through compensation reductions and penalties, the emergency hospitals received less total compensation in 2014 as the requirements concerning accessibility, quality and environmental target were not fully met. There are many reasons for the deviation and they vary between the hospitals. Common among them are, however, higher staffing costs, which are costs for own and insourced personnel. Staffing costs amounted to SEK 16,025 million (14,980), which was an increase of 7.0 per cent compared with the preceding year and 5.0 per cent over budget. The staffing costs increased in part due to a shortage of nurses and higher personnel turnover, which has entailed higher costs for training and insourced personnel. In 2014, production for outpatient care increased by 4.3 per cent and decreased in inpatient care by 1.6 per cent. In dialogue with the County Council’s management, the respective hospitals planned and implemented a num-

ber of measures in 2014 to reduce costs and increase revenues, and these efforts will continue in 2015.

Outcome 2014

Outcome 2013

Change %

Budget 2014

Health and medical care sold

12,865

12,610

2%

12,871

– Sold health and medical care, SCC

12,042

11,768



11,959

Follow-up of emergency hospitals Stockholm County Council has six emergency hospitals that are run under the County Council’s own direction. The task of the emergency hospitals is primarily to satisfy the county’s residents’ need for emergency and planned treatments and visits. The assignment also includes conducting research, education and development as well as national medical care and care for residents of other county councils by agreement. The largest emergency hospital is Karolinska University Hospital, which accounts for around 65 per cent of the collective turnover. Norrtälje Hospital is operated by TioHundra AB, which is a company jointly owned by the County Council and Norrtälje Municipality. St. Eriks Ögonsjukhus AB is specialised in ophthalmology. The other emergency hospitals are Danderyds Sjukhus AB, Södersjukhuset AB and Södertälje Sjukhus AB. The total results for the emergency hospitals amounted to a deficit of SEK 781 million (deficit: 167), adjusted for interest expense and payroll tax on the year’s pension liability as a result of a change in the discount rate. This was SEK 832 million lower than the budgeted surplus requirement of SEK 51 million.

Karolinska University Hospital Introduction and mission Karolinska University Hospital is one of Europe’s largest hospitals. Its main task is to take responsibility for the County Council’s national and regional healthcare. This includes advanced and highly specialised healthcare, as well as research and education. Operations are geographically concentrated to Solna and Huddinge, but the hospital is also responsible for certain operations at Södersjukhuset, Danderyd Hospital, Rosenlund Hospital, Spinalis/Rehab Station Stockholm and around 80 local laboratories in primary care. Finances There was a deficit of SEK 561 million in 2014, which was SEK 552 million lower than 2013. The difference compared to 2013 is mainly due to a high cost growth, mainly for own and insourced personnel and consultants. Operating revenues were SEK 487 million higher than in 2013, which is an increase of 3.1 per cent. This outcome was SEK 268 million or 1.7 per cent over budget. The deviation from budget was due in part to higher revenues for research, development and education

Karolinska University Hospital SEK million Operating revenues

Other revenues Total operation revenues

3,297

3,065

8%

3,023

16,162

15,675

3%

15,894

Operating expenses Personnel costs

–9,484

–8,916

6%

–9,032

Other expenses

–6,889

–6,422

7%

–6,463

Total operation expenses

–16,373

–15,338

7%

–15,495

Depreciation/amortisation

–308

–309



–333

–43

–36



–36

–561

–9



30

208

297

–30%

228

15,371

14,976

3%

15,213

Net financial items Surplus/deficit Investments Number of full-time equivalents

62

Annual Report 2014 Health and medical care

 To contents

(RD&E), external projects such as pharmaceutical trials, and compensation for on-going projects related to New Karolinska Solna. The revenues according to the main agreement signed with the care client, the Public Healthcare Services Committee, were SEK 1 million lower than agreed. The care provided according to the “side agreements” was SEK 13 million less than budgeted. Revenues for the out-ofcounty and international care provided were SEK 8 million over budget. Sales of laboratory services were SEK 71 million higher than budgeted. Operating expenses were SEK 1,035 million higher than in 2013, which is an increase of 6.7 per cent. This outcome was SEK 878 million or 5.7 per cent over budget in 2014. The deviation from budget is largely attributable to staffing costs (own and insourced personnel) being SEK 582 million higher than budgeted. Both the number of employees and the salary levels increased more than was provided for in the budget. The labour market shortage of nurses has driven up the salary levels for new employees and increased the expectations of higher wages and salaries for already employed personnel. During the year, the cost of insourced personnel increased by SEK 111 million as a result of the shortage of specialist nurses, among others. Pharmaceutical costs were a total of SEK 28 million lower than budgeted, mainly due to efficiency enhancement efforts. Material costs and the cost of purchased healthcare services that are linked to care production were SEK 109 million higher than planned. The hospital’s other operating costs were SEK 216 million higher than budgeted, which is mainly attributable to higher costs for consulting services. A large part of the hospital’s consulting services are financed through RD&E, external projects and compensation related to the work with New Karolinska Solna. Depreciation and amortisation costs were SEK 1 million lower than in 2013 and SEK 25 million below budget. Net financial items (financial income and expenses) amounted to an expense of SEK 43 million, which was SEK 7 million lower than the preceding year and SEK 7 million lower than budget. This  To contents

difference is mainly attributable to lower interest income. Goal attainment The balanced finances objective was not achieved as the results were below the budgeted surplus requirement. Accessibility for the number of patients waiting for a new visit and for treatment increased compared with 2013. The quality target of the proportion of healthcare-associated infections was 10 per cent, which is 2 percentage points lower than in 2013. Production Total production for the year amounted to approximately 105,600 (104,900) care episodes in inpatient care and 1,609,200 (1,498,200) visits in outpatient care. Production in outpatient care was 6.0 per cent higher than budget and in inpatient care 4.7 per cent lower than budget. The foremost reason for the lower production for inpatient care episodes was a shortage of available staffed beds. Productivity Productivity (number of points produced/adjusted total cost) decreased by 4.7 per cent compared with 2013. The decrease is due to the price-adjusted costs increasing at the same time as the number of points produced decreased due to a lower weighting. Future outlook In 2015, Karolinska University Hospital will focus on action plans yielding results to achieve balanced finances. Quality and a high level of patient safety will continue to be in focus in this work. The operations will follow budget discipline at the same time as production may not decrease and capacity may not be closed. Managers shall also have more budget and cost responsibility.

Södersjukhuset AB Introduction and mission Södersjukhuset AB is one of the County Council’s emergency hospitals. Its primary assignment is to provide specialised emergency and planned healthcare in the southern part of the county with special responsibility for emergency treatment and pre-hospital care. The

hospital is focused on the major public diseases, such as diabetes, cardiovascular diseases and hip fractures. Vascular surgery is a speciality, as is the regional assignment for hand surgery. Södersjukhuset also conducts education and clinical research related to the healthcare mission. Finances There was a deficit of SEK 84 million in 2014, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 149 million. The adjusted result was SEK 93 million lower than the budgeted surplus requirement of SEK 9 million. The result was SEK 2 million lower than 2013. The difference compared to 2013 is mainly attributable to higher personnel costs. Operating revenues were SEK 97 million higher than in 2013, which is an increase of 2.5 per cent. This outcome was SEK 41 million or 1.0 per cent below budget. The deviation from budget is mainly attributable to lower healthcare volumes. However, revenues increased regarding the side agreements, mainly for the paediatric clinics and ophthalmology clinic. Operating expenses were SEK 181 million higher than in 2013, which is an increase of 4.8 per cent. This outcome was SEK 73 million over budget, which is an increase of 1.9 per cent. The deviation from budget is mainly attributable to higher personnel costs. Depreciation and amortisation costs were SEK 10 million higher than in 2013 and SEK 3 million higher than budget. Net financial items (financial income and expenses) were SEK 170 million lower than the preceding year and SEK 126 million below budget. The difference in net financial items is mainly attributable to items affecting comparability concerning the effect of repaid AFA premiums in 2013 and the change in the discount rate for the pension liability calculation for 2013 and 2014. Södersjukhuset’s investments for 2014 amounted to SEK 123 million with a budget of SEK 162 million. The majority of the investment objects are reinvestments in medical technology equipment.

Health and medical care Annual Report 2014

63

Goal attainment The balanced finances objective was not achieved as the results were below the budgeted surplus requirement. Accessibility for the number of patients waiting for a new visit decreases compared with 2013 while accessibility for patients waiting for treatment improved. The quality target of the proportion of healthcare-associated infections was 6.2 per cent, the same as in 2013.

of childbirths. The average number of available beds decreased by 10.1 per cent, from 713 beds in 2013 to 641 beds in 2014. The decrease in bed numbers mainly arose due to staffing difficulties. Productivity Productivity (number of points produced/adjusted total cost) increased by 0.8 per cent compared with 2013. The productivity increase was due to the hospital’s higher point production.

Production Total production for the year amounted to approximately 59,900 (60,300) care episodes in inpatient care and 499,300 (496,000) visits in outpatient care. Production in outpatient care was 0.6 per cent higher than budget in total. This increase occurred mainly in surgery and gynaecology and at the Sachs’ Children and Youth Hospital. There was also some increase in patient care choice for childbirth. Production in inpatient care decreased during the year and was 3.6 per cent below budget. The main reason for the lower production is fewer open beds, as well as fewer emergency ward patients and thereby fewer admissions, plus a lower number

Future outlook In 2015, Södersjukhuset AB will continue to focus on achieving set quality requirements and the objective of queue-free care. Efforts to use beds as effectively as possible have been made during the year and will continue in 2015. The hospital will also work to develop production planning in 2015 and plans to produce 1 per cent more in healthcare volume in 2015 compared with 2014. The planning of Södersjuk­ huset’s extensions that will be completed in 2018 will intensify during the year. The work of maintaining the budgeted cost level will continue during the year with prepared action plans.

Danderyds Sjukhus AB Introduction and mission Danderyds Sjukhus AB is an emergency hospital that conducts specialist care, clinical training and patient-centred research for the patients of today and tomorrow. Finances There was a deficit of SEK 151 million in 2014, adjusted for the effect of an interest rate change on the calculation of pension liabilities of SEK 119 million. The adjusted result was SEK 157 million lower than the budgeted surplus requirement of SEK 6 million. The result was SEK 85 million lower than 2013. The difference compared to 2013 is mainly attributable to higher personnel costs. The deficit before appropriations and tax amounted to SEK 269 million. Operating revenues were SEK 56 million higher than in 2013, an increase of 1.7 per cent. This outcome was SEK 28 million or 0.8 per cent below budget. The deviation from budget is mainly attributable to lower production. The main reason for the low production in

Södersjukhuset AB Outcome 2014

Outcome 2013

Change %

Budget 2014

Health and medical care sold

3,487

3,380

3%

3,570

– Sold health and medical care, SCC

3,425

3,324

3%

3,447

448

458

–2%

406

3,935

3,838

3%

3,976

Personnel costs

–2,586

–2,430

6%

–2,529

Other expenses

–1,340

–1,315

2%

–1,323

Total operation expenses

–3,926

–3,745

5%

–3,853

Depreciation/amortisation

–104

–94



–101

Net financial items

–138

32



–12

Surplus before appropriations and taxes

–233

31



9

247

65





13

96



0

Adjusted surplus*

–84

–82



0

Investments

123

137

–10%

162

4,227

4,173

1%

4,113

SEK million Operating revenues

Other revenues Total operation revenues Operating expenses

Appropriations** Surplus after appropriations and taxes

Number of full-time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Annual Report 2014 Health and medical care

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inpatient care was that the hospital was forced to close a large number of beds due to a shortage of nurses. Operating expenses were SEK 203 million higher than in 2013, which is an increase of 6.4 per cent. This outcome was SEK 157 million or 4.9 per cent over budget. The deviation from budget is mainly attributable to higher personnel costs of SEK 103 million. Depreciation and amortisation costs were SEK 3 million higher than in 2013, but on a par with budget. Net financial items (financial income and expenses) were SEK 132 million lower than last year. This deviation is mainly attributable to the changed discount interest rate for the pension liability calculation.

Production Total production for the year amounted to approximately 44,500 (46,600) care episodes in inpatient care and 407,900 (400,300) visits in outpatient care. Production in outpatient care was 1.9 per cent higher than last year while inpatient care was 4.6 per cent lower than last year. The main reason for the lower production in inpatient care was the shortage of nurses, which led to an average of 45 fewer open beds in 2014 compared with 2013.

healthcare. A prerequisite for this is that the hospital succeed in recruiting the nurses it currently lacks.

TioHundra AB Introduction and mission

In 2015, Danderyds sjukhus AB will continue to work on achieving balanced finances, improving accessibility for patients and improving quality in

As of 1 January 2006, the County Council owned health and medical care services and the municipally owned social care services and associated operations in Norrtälje are operated by a company named TioHundra AB, which was formed jointly by Stockholm County Council and Norrtälje Municipality. The company is wholly owned by Kommunalförbundet Ägarsamverkan i Norrtälje Sjukvård och Omsorg, which is in turn owned in equal parts by Stockholm County Council and Norrtälje Municipality. The municipal association’s annual report was dealt with in the County Council Assembly in a separate case. The client is the Health and Social care Committee in Norrtälje. The overall aim of this collaboration between the County Council and the Municipality is to work together with a focus on patient needs to create more efficient care chains in healthcare and

Outcome 2014

Outcome 2013

Change %

Budget 2014

Health and medical care sold

2,829

2,817

0%

2,924

– Sold health and medical care, SCC

2,768

2,751

1%

2,859

441

397

11%

373

3,269

3,213

2%

3,297

Personnel costs

–2,190

–2,044

7%

–2,089

Other expenses

–1,182

–1,125

5%

–1,126

–3,372

–3,169

6%

–3,215

Goal attainment The balanced finances objective was not achieved as the results were below the budgeted surplus requirement. Accessibility for the number of patients waiting for a new visit and for treatment decreased compared with 2013. The quality target of the proportion of healthcare-associated infections was 7.3 per cent, which is 0.6 percentage points higher than in 2013.

Productivity Productivity (number of points produced/adjusted total cost) decreased by 2.0 per cent compared with 2013. The productivity decrease was due to the cost increase, mainly staffing costs, being higher than the increase in points. It is difficult to adjust the personnel volume at the same rate at which the production volume decreases. Future outlook

Danderyds sjukhus AB SEK million Operating revenues

Other revenues Total operation revenues Operating expenses

Total operation expenses Depreciation/amortisation

–59

–56



–59

Net financial items

–107

25



–17

Surplus before appropriations and taxes

–269

13



6

271

75





2

88



6

–151

–66



6

68

103

–34%

75

3,559

3,512

1%

3,470

Appropriations** Surplus after appropriations and taxes Adjusted surplus* Investments Number of full–time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Health and medical care Annual Report 2014

65

social care services in Norrtälje. The “TioHundra project” currently extends through to 31 December 2015. TioHundra AB conducts activities in somatic emergency medical care, geriatrics, primary care, outpatient psychiatric care, dependence care and habilitation, care for the elderly and the disabled, social psychiatry and school health care in Norrtälje Municipality.

Operating expenses were SEK 11 million lower than in 2013, a decrease of 0.7 per cent. This outcome was SEK 4 million below budget, a decrease of 0.3 per cent. The deviation from budget is mainly due to lower staffing costs as a result of the savings and efficiency improvement measures conducted during the year, as well as lower production. Costs for insourced personnel and overtime, however, were higher than budgeted. Depreciation and amortisation costs were SEK 2 million lower than in 2013 and SEK 3 million below budget. Net financial items were an expense of SEK 4 million, a deterioration of SEK 9 million compared to last year due to positive non-recurring items in 2013, but was on a par with the budget for the year.

Finances There was a surplus of SEK 5 million in 2014, which was SEK 5 million higher than the budgeted break-even. This surplus was SEK 23 million higher than 2013. The difference compared to 2013 is mainly attributable to higher compensation per point produced and lower personnel costs. Operating revenues were SEK 18 million higher than in 2013, an increase of 1.2 per cent. This outcome was SEK 2 million or 0.1 per cent below budget. The deviation from budget is mainly due to lower revenues for patient fees, lower compensation and production in emergency somatics, and lower production in geriatrics. These lower revenues were largely balanced by higher compensation in psychiatric activities, higher revenues in primary care and higher revenues for radiology services and clinical physiology than budgeted.

6 per cent, which is 4 percentage points lower than in 2013. Production Total production for the year in somatic emergency medical care, geriatrics, primary care and psychiatry amounted to approximately 8,000 (8,200) care episodes in inpatient care and 315,300 (321,100) visits in outpatient care. Production in outpatient care was 6.6 per cent lower than budget and inpatient care was 5.8 per cent lower than budget. Productivity Productivity (number of points produced/adjusted total cost) in Norrtälje Hospital increased by 0.7 per cent compared with 2013. This increase is due to the cost decrease being larger relative to the decrease in the number of points produced.

Goal attainment The balanced finances objective was achieved as the results were above the budgeted surplus requirement. Accessibility measured as the proportion of patients who received GP care within five days was somewhat lower than in 2013. Accessibility for patients waiting for a new visit and for treatment decreased compared with 2013. The quality target of the proportion of healthcare-associated infections was

Future outlook In 2015, TioHundra AB will continue the work of developing integrated healthcare processes. An extensive investment in employees and managers is being made to continue developing the cooperation over operational boundaries for the best of the patients and the customers.

TioHundra AB TioHundra AB total SEK million

Percentage of TioHundra AB (50%)

Outcome 2014

Outcome 2013

Budget 2014

Outcome 2014

Outcome 2013

Change %

Budget 2014

Operating revenues Health and medical care sold

703

669

707

351

335

5%

353

– of which, SCC internal

695

657

613

347

329

6%

306

Other revenues

808

823

806

404

412

–2%

403

1,511

1,493

1,513

755

746

1%

757

Personnel costs

–1,166

–1,174

–1,188

–583

–587

–1%

–594

Other expenses

–315

–318

–297

–157

–159

–1%

–149

Total operation expenses

–1,481

–1,492

–1,485

–741

–746

–1%

–743

Depreciation/amortisation

–21

–23

–24

–11

–12



–12

–4

5

–4

–2

2



–2

5

–18

0

2

–9



0

2,102

2,142

2,110

2,102

2,142

–2 %

2,110

Total operation revenues Operating expenses

Net financial items Surplus/deficit Number of full-time equivalents*

* Number of full-time equivalents is reported at 100 per cent.

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Annual Report 2014 Health and medical care

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Södertälje Sjukhus AB Introduction and mission Södertälje Sjukhus AB offers both emergency and planned specialist care in general internal medicine, surgery, orthopaedics, urology, anaesthesia, obstetrics and gynaecology, paediatrics, radiology, ear, nose and throat care, geriatrics and palliative care. Finances There was a deficit of SEK 1 million in 2014, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 25 million. The adjusted result was SEK 4 million lower than the budgeted surplus requirement of SEK 3 million. The result was SEK 3 million higher than in 2013. The difference compared to 2013 is mainly due to higher revenues for sold health care under the care agreement. Operating revenues were SEK 45 million higher than in 2013, which is an increase of 4.8 per cent. This outcome was SEK 11 million or 1.1 per cent over budget. The deviation from budget is mainly attributable to higher out-ofcounty and international revenues,

grants received and higher patient fees linked to a higher number of visits. Operating expenses were SEK 51 million higher than in 2013, which is an increase of 5.6 per cent. This outcome was SEK 19 million or 2.0 per cent over budget. The deviation from budget is mainly attributable to higher personnel costs, which are linked to the high personnel turnover among nurses, pension expenses and higher material costs that are due to a different case-mix in the surgical specialities. Depreciation and amortisation costs were SEK 7 million lower than in 2013 and SEK 2 million below budget. Net financial items (financial income and expenses) amounted to an expense of SEK 23 million, which was SEK 30 million lower than the preceding year and SEK 21 million lower than budget. This deviation is mainly attributable to the change in the discount interest rate for the pension liability calculation. Goal attainment The balanced finances objective was not achieved as the results were below the budgeted surplus requirement. Accessibility for the number of patients waiting for a new visit decreased some-

what, while accessibility for patients waiting for treatment was unchanged compared with 2013. The quality target of healthcare-associated infections was 4 per cent, which is a decrease by 2 percentage points between 2013 and 2014. Production Total production for the year amounted to approximately 12,600 (13,300) care episodes in inpatient care and 132,400 (125,900) visits in outpatient care. Production in outpatient care was a total of 5.1 per cent higher than budget while inpatient care was 7.3 per cent lower than budget. The main reason for the lower production for care episodes in inpatient care was that the hospital had fewer emergency admissions in emergency somatics. Productivity Productivity (number of points produced/adjusted total cost) increased by 0.4 per cent compared with 2013. The productivity improvement is due to a new case mix at t he hospital, which has resulted in a higher healthcare burden in inpatient care.

Södertälje Sjukhus AB Outcome 2014

Outcome 2013

Health and medical care sold

861

839

3%

872

– Sold health and medical care, SCC

837

818

2%

852

SEK million

Change %

Budget 2014

Operating revenues

Other revenues

127

104

23%

106

Total operation revenues

988

943

5%

977

Personnel costs

–665

–629

6%

–651

Other expenses

–299

–283

6%

–294

Total operation expenses

–964

–913

6%

–945

Depreciation/amortisation

–25

–32



–27

Net financial items

–23

7



–2

Surplus before appropriations and taxes

–25

5



3

Appropriations**

25

–6





Surplus after appropriations and taxes

–1

0



3

Adjusted surplus*

–1

–4



3

Investments

24

20

20%

35

1,040

1,025

1%

1,020

Operating expenses

Number of full-time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Health and medical care Annual Report 2014

67

Future outlook In 2015, the company will conduct development work linked to project planning and the upcoming start of operations at the newly renovated hospital. Developing new ways of working will be a high priority during the year.

St. Eriks Ögonsjukhus AB Introduction and mission St. Eriks Ögonsjukhus AB (St. Erik) is a university hospital that conducts ophthalmology in Stockholm County Council and highly specialised ophthalmology for patients from outside the county as well. The hospital has extensive research, development and educational activities in collaboration with Karolinska Institutet. Finances There was a surplus of SEK 14 million in 2014, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 22 million. The adjusted result was SEK 13 million higher than the budgeted surplus requirement of SEK 1 million. The result was SEK 11 million higher than in 2013. The difference

compared to 2013 is mainly attributable to higher revenues for sold health care under the care agreement and a higher volume of patients treated with intravitreal injections. There was a deficit before appropriations and tax in an amount of SEK 7 million. Operating revenues were SEK 36 million higher than in 2013, which is an increase of 7.6 per cent. This outcome was SEK 19 million or 3.9 per cent over budget. The deviation from budget is mainly attributable to a higher volume of patients who are treated with intravitreal injections and higher out-ofcounty revenues. Operating expenses were SEK 35 million higher than in 2013, which is an increase of 7.8 per cent. This outcome was SEK 9 million or 1.9 per cent over budget. The deviation from budget is mainly due to higher costs for surgical materials and pharmaceuticals for intravitreal injections. Depreciation and amortisation costs were SEK 1 million higher than in 2013 and budget. Net financial items (financial income and expenses) amounted to an expense of SEK 20 million, which was SEK 24 million lower than the preceding year and SEK 18 million

lower than budget. This deviation is mainly attributable to the change in the discount interest rate for the pension liability calculation. Goal attainment The balanced finances objective was achieved as the results were above the budgeted surplus requirement. Accessibility for patients waiting for a new visit and for treatment decreased compared with 2013. The quality target of the proportion of healthcare-associated infections was 5 per cent, which is an increase of 1 percentage point between 2013 and 2014. Production Total production for the year amounted to approximately 1,800 (1,800) care episodes in inpatient care and 199,700 (201,600) visits in outpatient care. Production in outpatient care was 3.0 per cent lower than budget while inpatient care was 4.9 per cent higher than budget. The foremost reason for the higher production for inpatient care episodes was an increase in out-ofcounty admissions.

St. Eriks Ögonsjukhus AB Outcome 2014

Outcome 2013

Health and medical care sold

432

388

11%

411

– Sold health and medical care, SCC

389

354

10%

378

SEK million

Change %

Budget 2014

Operating revenues

76

84

–10%

78

508

472

8%

489

Personnel costs

–268

–252

6%

–263

Other expenses

–215

–197

9%

–210

Total operation expenses

–483

–448

8%

–474

Depreciation/amortisation

–12

–11



–11

Net financial items

–20

4



–2

Surplus before appropriations and taxes

–7

17



1

Appropriations**

11

–2



– 1

Other revenues Total operation revenues Operating expenses

Surplus after appropriations and taxes

4

15



Adjusted surplus*

14

3



1

Investments

13

11

18%

12

377

365

3%

360

Number of full-time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Annual Report 2014 Health and medical care

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Productivity Productivity (number of points produced/adjusted total cost) decreased by 0.1 per cent compared with 2013. The decrease is due to an increase in personnel resources and a high personnel turnover in certain areas, which has led to somewhat higher personnel costs. Future outlook In 2015, the hospital will continue to work on achieving balanced finances, improving accessibility for patients and improving quality in healthcare. To be able to give the patients the best ophthalmology care, the hospital will develop its methods of measuring and following up medical results.

Ambulanssjukvården i Storstockholm AB Introduction and mission Ambulanssjukvården i Storstockholm AB provides ambulance services on behalf of the County Council, using a fleet of 27 ambulances, including intensive care and inter-county ambulance service and two units for the transportation of deceased persons. Finances There was a deficit of SEK 4.1 million in 2014, adjusted for increased costs for an interest rate change on the calculation of pension liabilities of SEK 2.1 million. The adjusted result was SEK 4.8 million lower than the budgeted surplus requirement of SEK 0.7 million.

The result was on a par with 2013. The difference compared to 2013 is mainly attributable to an increase in activities and high personnel turnover. The deficit before appropriations and tax amounted to SEK 6.2 million. Operating revenues were SEK 18 million higher than in 2013, which is an increase of 9.5 per cent. This outcome was SEK 11 million or 5.5 per cent over budget. The deviation from budget is mainly due to revenues from contract education and events. Operating expenses were SEK 24 million higher than in 2013, which is an increase of 12.7 per cent. This outcome was SEK 17 million or 8.7 per cent over budget. The deviation from budget was mainly due to a higher number of employees, which led to higher personnel costs. The year’s salary increase was higher than budgeted. Depreciation and amortisation costs were SEK 1.9 million higher than in 2013, but on a par with budget. Net financial items (financial income and expenses) were SEK 2.6 million higher than the preceding year and SEK 1.5 million higher than budget. This deviation is mainly attributable to the change in the discount interest rate for the pension liability calculation. Goal attainment The balanced finances objective was not achieved as the results were below the budgeted surplus requirement. The accessibility goal was achieved in 2014.

Production Total production for the year amounted to approximately 77,400 (76,300) ambulance assignments and 4,400 (3,800) transport of deceased persons. Production in ambulance assignments was a total of 3.2 per cent lower than budget while transport of deceased persons was 12.1 per cent higher than budget. The reason for the lower production was a seasonal adjustment of the ambulance services. The number of on-call hours for ambulance operations totalled approximately 159,000 (149,100) during the year, which was 7.0 per cent more than in 2013. The number of on-call hours for transport of deceased persons was approximately 12,000, which was unchanged compared with 2013. Future outlook In 2015, Ambulanssjukvården i Storstockholm AB will work to clarify the role of pre-hospital medical care in the future healthcare structure. In 2015, the last of the ambulances included in the “Ambulance Improvement” programme, in which Stockholm County Council will receive ten new ambulance units, will being operating. The FRAPP IT platform will be implemented in the ambulance services in 2015 and 2016. It consists of a new record system and EKG system with digital map support.

Ambulanssjukvården i Storstockholm AB Outcome 2014

Outcome 2013

Revenues

207

– of which, SCC internal

205

SEK million

Expenses Surplus before appropriations and taxes

Change %

Budget 2014

189

9%

196

185

11%

196

–213

–189

13%

–196

–6

0



1

Appropriations**

6

0





Surplus after appropriations and taxes

0

0



1

Adjusted surplus*

–4

–4



1

Investments

12

19

–37%

10

283

255

11%

258

Number of full-time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Health and medical care Annual Report 2014

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Stockholm Care AB Introduction and mission Stockholm Care AB is Stockholm County Council’s company for the export of healthcare and healthcare services. The company’s main emphasis is offering and conveying available capacity in highly specialised care at the County Council’s healthcare units to foreign patients. On behalf of the County Council, the company also owns and operates the Tobias Register, which is Sweden’s national blood stem cell register.

was SEK 27 million or 25.5 per cent over budget. The deviation from budget is mainly due to an increase in purchased health care and medical services. Depreciation and amortisation costs were unchanged compared with 2013 and were in line with budget. Net financial items (financial income and expenses) were SEK 1.3 million lower than the preceding year and SEK 1.5 million higher than budget. This deviation is mainly attributable to the change in the discount interest rate for the pension liability calculation.

There was a surplus of SEK 4.0 million in 2014, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 0.9 million. The adjusted result was on a par with the budgeted surplus requirement. The result was SEK 0.4 million lower than 2013. The difference compared to 2013 is mainly attributable to an anticipated bad debt loss. The surplus before appropriations and tax amounted to SEK 3.1 million. Operating revenues were SEK 13 million higher than in 2013, which is an increase of 11.0 per cent. This outcome was SEK 26 million or 23.6 per cent over budget. The deviation from budget is mainly due to higher revenues for sold health care and medical services. Operating expenses were SEK 15 million higher than in 2013, which is an increase of 12.7 per cent. This outcome

In 2015, collaboration with Karolinska University Hospital will continue in order to complete the introduction of a common process with the aim of reducing processing times for foreign patients. The launch of a new website and upgrade of the case management system are expected to improve efficiency in processing requests.

Folktandvården Stockholms län AB Introduction and mission

Goal attainment Finances

Future outlook

The balanced finances objective was not achieved as the results were below the budgeted surplus requirement. The accessibility goal was achieved in both patient care and the Tobias Register. Accessibility increased compared with 2013. Production Total production for the year in highly specialised care amounted to approximately 330 (410) concluded patient cases. Turnover in patient care was SEK 4.9 million higher than in 2013. The main reason for the higher turnover was more extensive, advanced treatments than in 2013. In 2014, the Tobias Register received approximately 11,900 (4,400) new potential donors, of which approximately 7,100 (2,700) were in the 18-30 age group. The number of conveyed units of blood-forming stem cells was higher than in 2013 at 40 (25).

Folktandvården Stockholms län AB offers a complete range of general, medical and specialist dental care. With a total of 80 clinics, the company has a wide geographical coverage in the county. Finances There was a surplus of SEK 108 million in 2014, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 43 million. The adjusted result was SEK 88 million higher than the budgeted surplus requirement of SEK 20 million. The result was SEK 22 million lower than 2013. The difference compared to 2013 is mainly attributable to higher costs for staffing as a result of a new clinic in Liljeholmen. The surplus before appropriations and tax amounted to SEK 64 million. Operating revenues were SEK 11 million lower than in 2013, which is a

Stockholm Care AB Change %

Budget 2014

123

10%

110

15

89%

33

–133

–118

12%

–106

3

5



4

Appropriations**

–5

–3





Surplus after appropriations and taxes

–1

2



4

Adjusted surplus*

4

4



4

Average number of annual employees

9

9



10

SEK million Revenues – of which, SCC internal Expenses Surplus before appropriations and taxes

Outcome 2014

Outcome 2013

136 28

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Annual Report 2014 Health and medical care

 To contents

decrease of 0.7 per cent. This outcome was SEK 24 million or 1.6 per cent over budget. The deviation from budget is mainly attributable to higher revenues from adult dental care and higher efficiency in general dental care. Operating expenses were SEK 47 million higher than in 2013, which is an increase of 3.6 per cent. This outcome was SEK 42 million or 3.1 per cent below budget. The deviation from budget is mainly attributable to lower costs for purchased operations-related services and materials and goods. Depreciation and amortisation costs were SEK 1 million higher than in 2013 and SEK 8 million below budget. Net financial items (financial income and expenses) were SEK 48 million lower than the preceding year and SEK 29 million below budget. This deviation is mainly attributable to the changed discount interest rate for the pension liability calculation.

budgeted surplus requirement. The goal that adult patients without urgent problems should be offered an examination appointment within four weeks was achieved. The goal that children and adolescents should be referred to specialist dental care within two months, and that referred adult patients should need to wait no more than six months was not fully achieved. The quality target that all patients should be satisfied with treatment and service in Folktandvården Stockholms län AB was achieved at 99.5 per cent. Production Total production for the year in general dental care amounted to approximately 323,200 (322, 000) treated adults and 161,000 (160,300) treated children and adolescents. Production was 8.8 per cent and 3.2 per cent below budget, respectively. Specialist dental care treated 24,000 (27,900) compared with the budgeted 28,000.

ing hours) in general dental care decreased by 1.0 percentage points compared with 2013. Productivity in specialist dental care decreased by 0.6 percentage points compared with 2013. The decrease is mainly linked to the evacuation of the Eastman building. Future outlook Efforts to attract and retain adult patients will continue in 2015 with the dental fitness contracts (Frisktandvårdsavtal) introduced in 2010 which enable patients to purchase dental services at a fixed monthly cost. At the end of 2014, more than 64,000 contracts had been signed. The specialist operations evacuated from the Eastman building will begin their move back at the end of 2015. At the beginning of 2015, the emergency clinic in the St. Eriks area and the clinic at Fridhems­ plan will be co-located in new premises in the Västermalmsgallerian shopping centre.

Goal attainment The balanced finances objective was achieved as the results were above the

Productivity Productivity (booked time/total work-

Folktandvården Stockholms län AB Outcome 2014

Outcome 2013

Change %

Budget 2014

Fees from private persons

695

680

2%

668

Dental care sold

540

538



552

Other revenues

290

318

–9%

282

1,525

1,536

–1%

1,501

563

555

1%

568

–968

–916

6%

–970

–1

–1

–13%

–1

–402

–406

–1%

–440

Total operation expenses

–1,370

–1,323

4%

–1,412

Depreciation/amortisation

–52

–51



–60

Net financial items

–38

10



–9

64

172



20

Appropriations**

–79

–152





Surplus after appropriations and taxes

–15

20



20

Adjusted surplus*

108

130



20

66

62

6%

58

1,811

1,784

2%

1,785

SEK million Operating revenues

Total operation revenues – of which within the County Council Operating expenses Personnel costs Dental care purchased Other expenses

Surplus before appropriations and taxes

Investments Number of full-time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Health and medical care Annual Report 2014

71

MediCarrier AB

Operating revenues were SEK 36 million higher than in 2013, which is an increase of 5.9 per cent. This outcome was SEK 40 million or 6.5 per cent over budget. The deviation from budget is mainly due to higher revenues from sales of materials and goods. Operating expenses were SEK 35 million higher than in 2013, which is an increase of 5.6 per cent. This outcome was SEK 35 million or 5.8 per cent over budget. The deviation from budget is mainly attributable to higher sales volumes. Depreciation and amortisation costs were on a par with 2013 and 0.8 lower than budget. Net financial items (financial income and expenses) were SEK 1.1 million lower than the preceding year and SEK 0.6 million lower than budget. This deviation is mainly attributable to the change in the discount interest rate for the pension liability calculation.

Goal attainment

Outcome 2014

Outcome 2013

Budget 2014

Revenues

642

606

6%

602

– of which, SCC internal

513

483

6%

481

–637

–602

6%

–602

4.8

3



0

Introduction and mission MediCarrier AB warehouses and distributes medical and consumable items that can be requisitioned and functions as a logistics unit for environmentally adapted transportation to units within the County Council. Finances There was a surplus of SEK 5.7 million in 2014, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 0.7 million. The adjusted result was SEK 5.4 million higher than the budgeted surplus requirement of SEK 0.3 million. The result was SEK 3.8 million higher than in 2013. The difference compared to 2013 is mainly attributable to increased sales volume with a maintained cost level for the costs that are not directly linked to revenues. The surplus before appropriations and tax amounted to SEK 4.8 million.

The balanced finances objective was achieved as the results were above the budgeted surplus requirement. Accessibility measured as service level to customers was over the budgeted target during the entire year and was on a par with the 2013 outcome. The number of complaints was 0.16 per cent, which was higher than the budgeted level of 0.15 per cent and on a par with the 2013 outcome. Future outlook In 2015, MediCarrier AB will focus on increased efficiency and delivery reliability. The investment in an integrated sterile equipment picker is expected to contribute to further efficiency enhancements in the warehouse organisation.

MediCarrier AB SEK million

Expenses Surplus before appropriations and taxes

Change %

–4.8

–1





Surplus after appropriations and taxes

0

3



0

Adjusted surplus*

6

2



0

Investments

3

0.7

329%

4

107

106

1%

104

Appropriations**

Number of full-time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

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Annual Report 2014 Health and medical care

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Public transport Public transport is important to facilitate the region’s development and growth. Considerable work is under way to expand and modernise public transport services. The objective is to create world class public transport to meet the needs the Stockholm region is facing.

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Annual Report 2014

73

Overall public transport The County Council has the overall responsibility for providing access to well developed, easily accessible and reliable public transport to everyone who lives in or visits Stockholm County. The public transport vision is attractive public transport in a sustainable transport system that contributes to Stockholm being Europe’s most attractive metropolitan region. Public transport plays a crucial role for accessibility in the county. Consequently, modern, high-capacity public transport is a necessity in order for the daily lives of Stockholm residents to function and to maintain the region’s attractiveness. This demands both long-term and rapid solutions to increase capacity. The Citybanan commuter rail line and upgrade of the Metro red line are examples of long-term solutions, while investments in accessibility for the main bus lines are examples of quick solutions to increase capacity. Stockholm is strategically located next to both Lake Mälaren and the Saltsjön bay of the Baltic Sea. This is why an expansion of commuter ferry services is being striven for to relieve land-based services and shorten travel times in the county. In 2014, a prestudy was begun regarding a potential future procurement of a modern fleet with environmentally friendly propulsion for commuter ferry services in Lake Mälaren and Saltsjön. The Traffic Committee made a strategic decision in 2014 to begin procurement of three new commuter ferry routes. In 2014, several events occurred that affect public transport and demand for its services. In the spring, a decision was made regarding a new national plan and county plan for transport infrastructure for 2014–2025. The county plan was approved on 31 May 2014 and the national plan on 8 April 2014. In these plans, funds are allocated to public transport for new investments. The focus in the plans is also on maintaining the existing infrastructure and sustainable means of transport, such as greater initiatives on cycling. At the beginning of the year, the Swedish Parliament also decided on an increase in congestion charges in Stockholm’s inner city and that conges74

Annual Report 2014 Public transport

tion charges will be introduced on the Essingeleden bypass on 1 January 2016. The objective of the changes is to improve accessibility and the environment in Stockholm, and to contribute to an expansion of the Metro in Stockholm County. This increase in congestion charges is equivalent to approximately half of the financing of the Stockholm Agreement for three new Metro routes and 78,000 new residential units that were approved by the Assembly at the beginning of the year. The cities of Stockholm and Solna and the municipalities of Nacka and Järfälla have important responsibilities in this respect, as does the national government. To take on the major task of expanding the Metro to this extent in a relatively short amount of time, the County Council established an Extended Metro Administration during the year. With experience from the 2013 Stockholm Negotiations, the government also presented a new assignment to look more closely at the conditions for more investment in infrastructure and housing through a joint agreement. This time with a national focus on main railway lines, but the assignment also includes reviewing further investments in the three major cities. The initiative, which is called the “Sweden Negotiation”, will generate more studies of various public transport investments at the County Council together with municipalities concerned in 2015 and 2016. Regional transport provisioning programme for Stockholm County The regional transport provisioning programme includes Stockholm County’s long-term public transport objectives. The programme describes the scope and the most important conditions for the procured transport services to achieve the goals, and what commercial transports can contribute. The current transport provisioning programme was adopted in 2012 and supplemented in 2013 with a description of public marine transport. The main task within the transport provisioning programme in 2014 was to conduct the first follow-up of the set targets. The follow-up indicates that there are challenges in strengthening the

competitiveness of public transport over road transport. The work of prioritising public transport and creating more competitive travel times needs to be developed to reach the goal of a larger market share. At the same time, the development in, for instance, public transport environmental performance appears to be positive, although there is a need for development in public marine transport. In connection with the evaluation, the decision was made to also begin the process of drafting a new regional transport provisioning programme for approval in 2016. In autumn 2014, initial dialogue meetings were held with the public and key regional actors to obtain input for the continued process. Regional development plan for the Stockholm region The regional development plan for the Stockholm region (RUFS) is Stockholm County’s regional plan and regional development plan. The currently valid RUFS 2010 describes the main strategies for the region’s development and challenges in various areas where spatial development constitutes an important component. In 2013–2014, work was conducted to analyse RUFS 2010 from a usability and current applicability perspective. In connection with the budget decision in the County Council in 2015, SCC Growth, Environment and Regional Planning was commissioned to begin the process of preparing a new regional development plan for the Stockholm region and programme work was prepared in the autumn. In 2015, the programme for a new RUFS will be adopted and work on preparing a consultation proposal will begin. This work is a major challenge as the region’s development in both development planning and transport systems is the subject of a number of other simultaneous studies, such as within the scope of the Sweden Negotiation. Coordinating these different planning processes in time, content, objectives and focus is an important prerequisite for a successful RUFS process. Travel Within public land transport, the number of boardings increased by 19,000  To contents

per day, which corresponds to an increase of 1 per cent compared with 2013. Travel increased in all modes of transport. Local urban rail service and bus service show the greatest increase in the number of boardings. Metro and commuter rail service also have a larger number of passengers compared with the previous year. The outcome is 3 per cent higher than the 2014 targets. In public marine transport, the number of passengers was 1 per cent higher in 2014 than in 2013. The increase corresponds to 51,000 passengers, 9,000 of whom are in the archipelago services and 42,000 in the port services. Compared with budget, the number of passengers was 4 per cent higher, which corresponds to 156,000 passengers. The largest increase is in port services at 140,000 passengers or 6 per cent. The number of passengers in port services is increasing after the introduction of the SL tariff on 16 June. The total number of journeys in transport services for the disabled increased by 6,000 during the year, which is a marginal increase compared with 2013. This outcome was 1 per cent

below budget. The number of journeys in transport services for the disabled decreased while patient transportation increased compared with both budget and the 2013 outcome. As in the previous year, taxi journeys are decreasing while journeys with wheelchair taxis continue to rise. Wheelchair taxi passengers made an average of 77 journeys per person and thereby increased their travelling by 12 journeys over budget and 8 journeys compared with last year. The outcome reflects the passenger trend, continued high demand for wheelchair taxis and accessibility investments in general public transport. Compared with 2013, passengers from transport services for the disabled increased their travel on general public transport by 7 per cent.

which exceeds the target of 94 per cent and is an improvement compared with 2013 when the figure was 94 per cent. The punctuality of Metro services developed positively compared with 2013 and met the target for 2014. Commuter rail services’ punctuality was on a par with 2013, but did not reach the 2014 target. The punctuality of the local urban rail services did not reach the 2013 level, but exceeded the 2014 target. Bus services’ punctuality was on a par with 2013, but was below the 2014 target. Metro expansion On 11 November 2013, the 2013 Stockholm Negotiations were signed by government negotiators and Stockholm County Council, the City of Stockholm, the Municipality of Nacka, the City of Solna and Järfälla Municipality. The agreement means that Stockholm’s Metro will be extended to Nacka, Arenastaden and Barkarby. The Nacka branch will be extended to Gullmarsplan and linked with the Hagsätra line, which increases the capacity of the existing Metro through

Punctuality In 2014, punctuality in public marine transport was 93 per cent, which is on a par with the 2013 outcome and 10 percentage points higher than the target of 83 per cent. In public transport services for the disabled, punctuality was 95 per cent,

Transport Outcome 2014

Outcome 2013

Change %

Target 2014

Public transport on land. Boardings*

2,802

2,783

1%

2,730

3%

Public marine transport. Passengers

4,108

4,057

1%

3,952

4%

Public transport for the disabled. Journeys

4,091

4,085

0%

4,130

–1%

Total (000s)

Deviation from target

*SL reports the number of boardings on a common winter weekday.

Punctuality in public transport (%) 100

2013

95 93

93

94

94

95

95

96

92

90

Targets

96

96 93

92

95

2014

93 90

90

89

85 83

80 75

Marine vessels

 To contents

Transportation of the disabled

Metro

Commuter rail

Local trains

Bus services

Public transport Annual Report 2014

75

central Stockholm. The expansion means that nine new stations will be added to the system, giving residents and businesses in the Stockholm region greater accessibility. The Metro expansion will begin in stages in 2016 and will be completed around 2025. The decision on financing and cofinancing of the Metro expansion made by the County Council Assembly on 18 February 2014 within the scope of the 2013 Stockholm Negotiations also includes the various parties’ financing and responsibilities regarding the extended Metro. Besides a co-financing of the Metro, the municipalities are contributing by building a large number of residential units to meet the needs of the growing region. The Stockholm Negotiations can be seen as a result of the visions in the regional development plan for the Stockholm region (RUFS 2010) and the regional transport provisioning programme for Stockholm County. In these visions, strategies are set forth for how the region will handle a sharp rise in population and at the same time reduce its climate impact. The region’s vision is for the Stockholm region to become Europe’s most attractive metropolitan

region. Expanded public transport is a key element in this strategy.

AB Storstockholms Lokaltrafik Introduction and mission AB Storstockholms Lokaltrafik (SL) organises local and regional public transport within Stockholm County and adjacent areas, owns and manages fixed and moveable property and conducts operations associated therewith. Finances With its subsidiaries, AB Storstockholms Lokaltrafik had a deficit of SEK 28 million, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 47 million. This was SEK 28 million lower than the budgeted surplus requirement of SEK 0 million. The tax funding ratio was 48 per cent (48). Operating revenues were SEK 670 million higher than in 2013, which is an increase of 4.0 per cent. This was lower than the year’s budget by SEK 25 million, corresponding to 0.1 per cent. A major deviation relates to ticket revenues which were below budget by SEK 152 million or 2.2 per cent. There was a

trend towards a larger share of reduced price tickets, which yields a lower average revenue per ticket. At the same time, the increase in the number of boardings levelled off in 2014 compared with 2012–2013. Ticket revenues increased by SEK 299 million compared with 2013. Accounting changes in conjunction with the introduction of the travel account in 2013 had a major impact on comparison between the years. These changes have entailed a shift of the revenues in 2013 in an amount of SEK 182 million, which partially explains the increase between 2013 and 2014. Otherwise, efforts to secure revenues have been effective. Operating expenses were SEK 612 million higher than in 2013, which is an increase of 4.0 per cent. This outcome was SEK 27 million or 0.2 per cent higher than the year’s budget. The cost of purchased transport services was SEK 55 million over budget. The new agreement for bus services in the inner city and Lidingö that entered into effect in August was more expensive than budgeted. The costs for the year’s incentives were over budget for commuter trains and bus service due in part to a

AB Storstockholms Lokaltrafik Outcome 2014

Outcome 2013

Ticket revenues

6,747

Other revenues

3,081

SEK million

Change %

Budget 2014

6,448

5%

6,899

3,138

–2%

2,954

Operating revenues

7,223

6,796

6%

7,223

17,051

16,381

4%

17,076

7,250

6,947

4%

7,231

–11,470

–10,949

5%

–11,415

–2,924

–2,833

3%

–2,951

Total operation expenses

–14,394

–13,782

4%

–14,367

Participation in the results associated companies

0

0





Depreciation/amortisation

–2,132

–1,972



–1,969

–600

–647



–741

Surplus/deficit

–75

–21



0

Adjusted surplus*

–28

–21



0

7,744

5,301

46%

8,020

County Council grants Total operation revenues – of which, SCC internal Operating expenses Purchased transport services Other expenses

Net financial items

Investments

* Pertains to surplus/deficit adjusted for interest effect on pension costs.

76

Annual Report 2014 Public transport

 To contents

high customer satisfaction index. Other expenses were SEK 27 million below budget, in part because of reclassifications from operating costs to reinvestments. Compared with 2013, costs for purchased transport services rose by SEK 521 million, or 5.0 per cent. The cost increase is due to new transport service agreements, service changes and fullyear costs for changes in 2013. Depreciation increased by SEK 160 million or 8.1 per cent compared with 2013 and was SEK 163 million over budget as a result of additional investments and several concluded projects. During the year, a number of large capitalisations were made of X60 commuter trains, a bridge over the Light Rail, signal communication for the Light Rail and the SL Access payment system. Net financial items were better than both last year’s result and budget. This was attributable to lower market rates, which affect the interest expenses positively for both leasing costs and loans raised with variable interest. The loan portfolio was also lower than budgeted, which also affected the interest expenses positively.

Goal attainment SL achieved the goal of better reliability. The proportion of satisfied passengers on general public transport increased from 79 per cent in 2013 to 81 per cent in 2014, according to measurements in the Public Transport Barometer. The proportion of buses and rail vehicles with a boarding step amounted to 100 per cent and 84 per cent, respectively, compared with 100 per cent and 83 per cent in 2013. The goal of balanced finances was not achieved. The Traffic Committee as a whole did, however, achieve the Assembly’s adopted results requirement.

Waxholms Ångfartygs AB Introduction and mission Waxholms Ångfartygs AB, WÅAB, arranges marine public marine transport within Stockholm County, conducts shipping operations and owns and manages property. Finances

The burden on the public transport system is increasing and there are major needs for investment and development, which involve higher costs for public transport. To create a sustainable cost trend, the Traffic Administration will carry out efficiency enhancements, rationalisations and reviews in 2015. The focus will continue to be on securing revenues and better internal control.

With its subsidiaries, Waxholms Ångfartygs AB showed a surplus of SEK 15 million in 2014, adjusted for increased costs resulting from an interest rate change in the calculation of pension liabilities of SEK 1 million. This was SEK 15 million higher than the budgeted surplus requirement of SEK 0 million. The tax funding ratio was 68 per cent (64). Operating revenues were SEK 25 million higher than in 2013, which is an increase of 7.0 per cent. This was SEK 6 million below budget. Compared with 2013, ticket revenues decreased by SEK 31 million or 29.0 per cent. The decrease occurred in port service as a result of the introduction of the SL tariff zone A on 16 June 2014. The county council grant increased by SEK 33 million or

Outcome 2014

Outcome 2013

Change %

Budget 2014

Ticket revenues

78

109

–29%

107

Other revenues

48

23

103%

25

County Council grants

280

247

13%

280

Total operation revenues

405

380

7%

411

– of which, SCC internal

318

273

16%

305

Future outlook

Waxholms Ångfartygs AB SEK million Operating revenues

Operating expenses Personnel costs

–6

–19

–67%

–23

–251

–212

18%

–244

–87

–85

3%

–90

Total operation expenses

–345

–317

9%

–357

Depreciation/amortisation

–39

–34



–45

Net financial items

–7

–9



–9

Surplus before appropriations and taxes

14

21



0

Appropriations**

175







Surplus after appropriations and taxes

189

21



0

15

21



0

101

43

135%

91

11

30

–63%

30

Purchased transport services Other expenses

Adjusted surplus* Investments Average number of annual employees

* Pertains to surplus/deficit before appropriations and tax adjusted for interest effect on pension expenses. ** Pertains to tax optimisation for the LISAB Group.

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Public transport Annual Report 2014

77

Transport services for the disabled

13.0 per cent compared with 2013. Operating expenses were SEK 28 million higher than in 2013, which is an increase of 9.0 per cent. Expenses were SEK 12 million or 3.4 per cent below budget. The increase compared with 2013 is primarily attributable to higher costs for purchased marine services as a result of newly signed short-term agreements while awaiting a new procurement of archipelago services. The deviation from budget is mainly related to lower costs for operations and maintenance as a result of mild winter conditions and low market prices for oil. Depreciation and amortisation costs were SEK 6 million below budget since major investment objects were delayed and are still under way.

Goal attainment Transport services for the disabled did not achieve the balanced finances objective in 2014. The proportion of satisfied passengers in special public transport was 87 per cent, which is unchanged compared with 2013.

Introduction and mission Transport services for the disabled is a separate cost centre within the County Council for the accounting of revenues and expenses for transport services provided, and for other costs related to these transport services.

Future outlook A study of the transport services for the disabled will be carried out in 2015. The objective of the study is to bring about freer travel to give the individual passenger the possibility to travel based on his or her needs and wishes to a greater extent than today.

Finances There was a deficit of SEK 9 million in transport services for the disabled for 2014, which was SEK 9 million below budgeted break-even. This was SEK 3 million better than the 2013 result. Operating revenues were SEK 21 million higher than in 2013, which is an increase of 2.0 per cent. This outcome was SEK 9 million, nearly 0.7 per cent, higher than budget, mainly as a result of a higher number of patients transported, which are compensated by the healthcare services. Operating expenses were SEK 18 million higher than in 2013, which was an increase of 1.0 per cent. Expenses were SEK 18 million or 1.4 per cent over budget. Expenses follow the travel volumes and exceed both budget and the previous year’s outcome. The increase pertains to a higher volume of patient transportation and a redistribution of travel volumes from transport of the disabled by taxi to the more expensive wheelchair taxi. A higher cost per journey in the services than budgeted is offset by a lower total volume of journeys in the services.

Goal attainment Waxholms Ångfartygs AB achieved the balanced finances objective for 2014. The proportion of satisfied passengers in public marine transport was 96 per cent, which is an increase of 5 percentage points compared with 2013. Future outlook A trial with another three new commuter ferry routes in the county will be carried out in 2016 and 2017. Trials will be carried out with high-speed, environmentally friendly ferries that can serve longer marine routes in both Saltsjön and Lake Mälaren efficiently to thereby contribute to more cross connections in the county.

Transport Services for the Disabled Outcome 2014

Outcome 2013

Revenues

1,285

1,264

2%

1,276

– of which, SCC internal

1,102

1,079

2%

1,087

–1,294

–1,276

1%

–1,276

–9

–12



0

SEK million

Expenses Surplus/deficit

78

Annual Report 2014 Financial report

Change %

Budget 2014

 To contents

Culture The objective of the Culture Committee is to work for a highquality, free, accessible cultural life where the set goals are to prioritise children and young people, culture in healthcare services and in-depth cooperation in cultural and creative industries.

 To contents

Annual Report 2014

79

Free, accessible, high-quality cultural life In the area of culture, the County Council should contribute to cultural life in Stockholm County being accessible and of high quality. The County Council therefore distributes funding to various organisations and projects active in the county. In cultural activities, a grant is paid to the Concert House Foundation. In 2014, the Concert House Foundation was awarded a grant of SEK 128 million, which was an increase of SEK 3 million. Funding is also invested in artistic decoration of the County Council’s premises. During the mandate period, the Culture Committee initiated a review of the County Cultural Functions, the Regional Library and Culture in Healthcare with the aim of ensuring continuous development of the administration’s activities. In spring 2013, the Culture Committee took the initiative on a grant review and a nomination group. In September 2014, the Culture Administration was commissioned to further prepare the grant review with continuous reports at the Committee’s meetings during the 2014–2015 period.

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Annual Report 2014 Culture

Development of culture Major changes have occurred in the cultural policy landscape in recent years. Cultural actors have partly adopted new processes and collaborative methods. The changes also meant that culture has in recent years come to be recognised as an important factor in healthcare, urban planning and regional development. In Stockholm County, the County Council’s Plan for Future Health and Medical Care involves a unique investment in the artistic shaping of the hospital settings. Another example of changes in the surrounding world is the internationalisation process that is increasingly being seen in cultural life. Artistic quality is the foundation of and the prerequisite for this positive development. In recent years, Stockholm County Council has increased the appropriations to the Culture Committee. Culture should play a greater role in the major challenges and changes that characterise one of Europe’s fastest growing regions.

 To contents

Sustainable growth Sustainable growth is an overall objective for several areas that are important to the future of Stockholm’s residents. This involves growth aspects, such as the work to develop as a leading growth region and the planning to provide the conditions for this. It also involves consideration of the environment and future generations. The County Council must have environmentally sustainable operations. Research and development are important both to continue development of treatments in healthcare and because it contributes to the county’s economic growth. A fourth dimension is social responsibility – working for the equal worth of all, both now and in the future. The sustainability concept also involves the County Council’s processes, such as IT and administrative systems, operating smoothly and securely to contribute to robust operations resistant to risks.

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Regional development Regional planning Within the Diversity Orientation action programme, the County Council Executive Board Administration continued to cooperate with other functions in the County Council and with companies in the “Cooperate for Diversity” network. Within the Regional Cores action programme, synergies between the investments have been analysed. The work of stimulating the production of more student housing in the Knowledge Region Stockholm action programme has borne fruit. A number of municipal and private actors have begun concrete efforts, of which the largest is the planning of a student housing trade fair in 2017. In addition, action programmes have been evaluated as a way of working in accordance with the assignment from the County Council Assembly. Planning to conclude the Diversity Orientation and Knowledge Region Stockholm action programmes has begun. An assessment of RUFS 2010 current applicability has been made according to the County Council Assembly’s commission and the result is ready for political drafting. The activities that can be included in the RUFS implementation have also been inventoried, in part as a basis for future prioritisations. The County Council Executive Board Administration has also begun preparations for a new RUFS. The special conditions that apply to countryside areas near metropolitan areas have been formulated as a sub-project in the work on a new RUFS. The new plan will include an analysis of sustainable rural development and a stronger city and country perspective. The work with a regional climate flight plan is being prepared as a sub-project in the work on a new RUFS. The preparations for a new RUFS were begun when the current applicability work was concluded in the spring. This year’s Situation in the Region Conference attracted a record number of participants and provided a view of both the region’s development and new development perspectives to include in continued planning. During the autumn, contacts with

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the Culture Administration were strengthened with the aim of clarifying how cultural issues come into urban planning, strengthen the region’s attractiveness and constitute a tool to reduce socioeconomic segregation. Close cooperation between the County Council and the municipalities in the county as well as the County Administrative Board is important for the whole region to develop in the desired direction. During the year, cooperation comprised action programmes under RUFS, comprehensive planning and the current applicability work linked to RUFS 2010. As a regional planning body, the County Council also submitted formal statements on comprehensive plans and legislative bills. In terms of housing construction and the housing shortage, new informational input on existing housing was prepared. The material, which has been partly used in seminars and workshops, is intended to be published in spring 2015. The Administration has held several meetings with the secretariat for the parliamentary committee, which will investigate the role of regional planning in the supply of housing. The County Council is continuing cooperation in “Innovationskraft Stockholm”. The work of innovation procurement is being conducted with SCC Innovation as a coordinating force for the regional work as well. Prior to the continued work on innovation procurement, the County Council’s internal organisation is being reviewed. A report on the County Council’s role primarily in economic growth has been completed and approved by the County Council Assembly. In 2014, the EU began a new seven-year programme period. New opportunities are thereby being created to partake of the EU funds and programmes to support the development of operations and generate growth. The County Council is participating in a regional effort that aims to use structural fund resources more efficiently and strategically to achieve the goals in RUFS and other strategic steering documents during the programme period. Work has begun to better describe the connection between the EU, the region and the County Council

and show which funds can be better used by the County Council. The work on archipelago, freight and environmental grants has continued according to plan. An effort has been initiated to see if, and, if so, how the regional Archipelago Council’s role and work can be developed even further. In 2015, cooperation will continue with other parties in the region on tourism industry issues and sustainable destination development in the archipelago. During the year, demographic forecasts were produced after being ordered mainly by the healthcare services. In addition, material on dependency ratios has been prepared down to a municipal district level. A study that measures segregation with a new method has also been devised. The method is not based on a traditional geographic break-down, but rather on the probability that individuals meet socioeconomically similar or dissimilar people. Comments have been provided on several comprehensive exposure draft reports during the year. Most are based on changes in the Planning and Building Act and other regulations that aim to simplify planning processes and increase housing construction. Some municipalities have submitted comprehensive plans for comment. Extensive work has also been done in connection with proposals for expanded coastal protection, which were submitted for comment in several rounds from the County Administrative Board. Regional environmental strategy for water In spring 2014, a current status description was begun of the four target areas included in the County Council’s regional environmental strategy for water: secured drinking water, knowledge exchange, target-group-adapted planning input and regional coordination. The current status description was conducted according to a model that will also be used to follow up the respective target areas. A proposed final current status description exists and will be addressed in the new Committee of Growth and Regional Planning at the beginning of 2015. During the autumn, a prestudy was

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begun within the scope of target area three, target-group-adapted planning input. The prestudy covers how the prepared planning input should be prioritised, what format it should be presented in, how the connections between water in regional physical planning and the region’s ecosystem services can be strengthened, and the extent to which the work must be done to be able to be incorporated into the work on a new regional development plan. The prestudy will be completed in the first quarter of 2015. In autumn 2014, a current status description was made in target area 2, knowledge exchange. An informational package will be drawn up based on this description in 2015. The aim is to spread the County Council’s experiences to municipalities and actors in the region for a reduced environmental impact from pharmaceuticals, chemicals and transportation and an increased regional coordination, target area 4. Archipelago Stockholm’s archipelago should have vibrant communities for both permanent and leisure-time residents all year round, at the same time as it should be attractive to visit. The open and accessible archipelago must therefore be developed and safeguarded. It is important to simplify rules so that it is possible to conduct business and live in the archipelago today. The archipelago is a unique part of the Stockholm region and needs rule simplification, regional cooperation, growth and good transportation to develop. Stockholm County Council has been a driving factor in starting up regional cooperation to support and develop the tourism industry in the archipelago. The County Council will continue to be an active party in this cooperation. The County Council has also long been the main funder of the Archipelago Foundation in Stockholm County and provides an annual operating grant to the foundation. The foundation is facing major investments as the requirements and conditions for water, sewage, environmental adaptation and accessibility have been made stricter. The foundation has mapped the needs and  To contents

what steps need to be prioritised in the upcoming year. Within the foundation, work is also under way to develop its own revenue opportunities. In 2015, the County Council and the Archipelago Foundation will enter a long-term agreement on increased grants for the foundation’s activities. Research, development and innovation Extensive work was done during the year to formulate a new strategy for research, development, innovation and education. Various parties from the business community, universities and the County Council’s own operations have met in dialogue meetings and discussed the challenges faced by healthcare, public transport and dental care in the future. Stockholm County Council and Stockholm University have signed a statement of intent regarding cooperation. In accordance with this statement, work has continued on formulating a proposal for a cooperation agreement that will be drafted politically at the beginning of 2015. This cooperation will cover every department of the university. Project 4D is a collaborative project on the diagnoses arthritis, breast cancer, type-2 diabetes and heart failure. During the year, the project mapped processes and took steps to implement research findings in the care chain more quickly. In spring 2014, Project 4D was also presented for the Directorate-General for Research and Innovation at the European Commission. The main objective was to work for more calls for proposals in the EU Framework Programme for Research and Innovation Horizon 2020 that fit the 4D concept. A statement of intent was also signed regarding collaboration between the County Council and the pharmaceutical company Meckert Sharpe and Dome (MSD). The statement of intent should result in concrete cooperation projects regarding knowledge gaps in healthcare where both parties contribute to develop new pharmaceuticals in relevant areas. The County Council Assembly decided on 10 June to establish the Stockholm Medical Biobank (SMB).

The new regional biobank means that the County Council can coordinate and harmonise sampling for both research and healthcare samples that are stored throughout the County Council, which considerably increases the quality of biobank samples in the County Council. The biobank also means that it is possible to follow patient data in the entire care chain, removing the need to take new or the same samples on a patient. Some internal reorganisation was done in the work to establish the biobank in the latter half of 2014. For example, the Regional Biobank Centre (RBC) now belongs to the regional biobank instead of the County Council Archives. In 2014, negotiations were held regarding a new national agreement on medical education and research (ALF agreement) between the national government and affected county councils and regions. On 18 November 2014, the Assembly approved the national agreement, which involves very large changes compared with the old agreement from 2004, including the requirement that an evaluation of the clinical benefit of research be made place at the national level. In addition, “university healthcare” will be introduced in the county councils and regions affected by the national ALF agreement. This has meant that this kind of evaluation will take place in all county councils and regions with university hospitals. The national agreement also stipulated that county councils and regions must reach regional ALF agreements with the medical faculty conducting medical education in the respective county. Stockholm County Council must accordingly collaborate with Karolinska Institutet and the parties have agreed to enter a temporary regional ALF agreement for 2015. The County Council and Karolinska Institutet concluded their collaboration on the temporary agreement at the end of the year and the agreement will be drafted politically at the beginning of 2015. The collaboration between the County Council and KTH Royal Institute of Technology is continuing. Calls for proposals for research funding for cooperation between researchers from the County Council and the university were made during the spring and natio­ nally composed assessment groups

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submitted proposals for approval. The research projects approved will begin at the beginning of 2015. This call for proposals is unique in Sweden as no other county council or region has a corresponding cooperation agreement in the subject area of health, medicine and technology to that between Stockholm County Council and the KTH Royal Institute of Technology. The County Council has mapped the county’s various County Council financed actors in the innovation area. This review has resulted in various proposals for how the actors will be able to be coordinated to further improve and enhance the efficiency of the County Council’s innovation activities. The work on an innovation strategy is a part of the process of drafting a new strategy for research, development, innovation and education for the County Council. Focus has been placed on mobilising the County Council for the EU’s new research programme period 2014– 2020: Horizon 2020. Targeted efforts to market Stockholm as a successful research region and attractive cooperation partner in health have been conducted through various activities in Brussels during the year. Strategic recruitment has also been conducted of expertise to work with research and innovation issues in the EU programmes and funds in particular. Effective environmental work The County Council’s environmental policy programme, Environmental Challenge 2016 (Miljöutmaning 2016), is broken down into three target areas: • Climate efficient. • Resource efficient. • Health-promoting environmental work. During the year, work began to prepare a proposal for a new environmental programme for the years 2017–2021. The project is now meeting various stakeholders to gather their knowledge and experience to eventually concretely formulate ideas and ambitions as targets in the programme. In June, the County Council’s environmental prize was awarded for the first time. The prize went to a doctor and a nurse at Capio St. Göran Hospital for their work on reducing the use of cli84

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mate-impacting anaesthetics. The environmental prize attracted a great deal of attention and 44 submissions from various County Council financed operations were nominated. The great interest motivated the County Council to employ a coordinator to capture, develop and distribute all of the good examples. Stockholm County Council was also the first county council to issue “green bonds” during the spring. The money the County Council borrows through the bonds is earmarked for environmental investments. The County Council’s Spårväg City programme received an award for innovation and collaboration on sustainable development of infrastructure projects that was awarded by the Sweden Green Building Council. Climate efficient In May 2014, the proportion of renewable fuel used by SL’s buses was 84 per cent. This proportion is distributed over 298 biogas buses, 721 ethanol buses and 849 RME/biodiesel buses. SL’s roughly 2,200 buses account for a large part of the County Council’s total fuel consumption. This success therefore makes a major contribution to the County Council being able to achieve the target of 75 per cent renewable fuels in transportation by 2016. In summer 2014, a study was conducted of the County Council’s conditions to produce its own solar electricity. The study shows that Locum AB has more than 125,000 square metres of roof area with good solar radiation. In 2014, to reduce the climate impact from medical gases, the County Council tested various techniques with filters that collect anaesthesia gases from the patient’s exhaled air. In November, a full-scale test began of the most promising filter at Norrtälje Hospital. The County Council’s healthcare operations also work to reduce the climate impact from patient meals. Climate and environmental impact from food production was, for example, an area that was included in Karolinska University Hospital’s training package for meal planners. Karolinska also arranged a recipe competition on the perfect lunch – a lunch that should be tasty, nutritious, good value for money and at the same time environment- and climate-smart.

Resource efficient A new support tool for environmentally adapted procurement was launched in 2014. The tool contains five modules with environmental requirements that have been compiled in appendices for a number of specific products and services. The tool is mainly adapted to the procurements conducted locally in healthcare. A project about sustainable IT in healthcare began in autumn 2014. The project examines the possibilities to reduce environmental impact from IT through material and energy efficiency enhancements, as well as how IT can be an aid in reducing the operations’ environmental impact. A good example is an on-going pilot project to increase the re-use of furniture at Karolinska University Hospital with the help of a web-based advertising service. The County Council’s waste minimisation plan, “Resource efficient in practice”, which was launched in February, describes the work of reducing waste, increasing re-use and recycling, and prioritising renewable resources. An example of a waste-reducing measure is a collaboration project between environmental coordinators and dietary controllers at Södersjukhuset AB and Rosenlund’s dietary unit where causes and possible resolutions to reduce food waste are identified. Measurements have shown that one out of five portions of food at the hospital is thrown out. The project has proposed changes in the food ordering system as well as an effort to change food types. To prioritise renewable resources, the County Council conducted a procurement in 2014 with requirements that favoured the development of bin sacks made of bio-based polyethylene that have significantly lower climate impact than those made from fossil oil. To further increase the proportion of biomaterials in healthcare materials, cooperation was begun with actors in research and industry. A template for “material rounds” was also tested during the year in a number of healthcare operations. The round should be a support in local efforts to reduce environmental impact from the use of single-use materials. The County Council, the plastics industry and the recycling industry also participated in a Vinnova  To contents

project with the aim of improving recycling of plastic from healthcare. Health-promoting environmental work In 2014, measurements taken in 2005– 2012 of pharmaceutical remnants in waste water, drinking water and in the archipelago were compiled. The study of pharmaceutical emissions from hospitals in Stockholm County that began in 2014 will contribute knowledge on how the County Council should prioritise the future work on reducing the environmental impact from pharmaceuticals. The annual sampling of pharmaceutical remnants in water was conducted in the autumn, and the results will be analysed at the beginning of 2015. The County Council’s guide for the handling of pharmaceutical waste was updated and improved in 2014. Information was added regarding the scrapping of vaccines, inhalers and plasters. Within the scope of the County Council’s chemical strategy, the KLARA chemical management system was introduced at Locum AB’s contractors and at the Berga Natural Resource High School. A study of the environmental and health impact from plasters was conducted to acquire knowledge on selected plastic materials and new kinds of plasticisers used in items in medical and dental care. During the year, the County Council also initiated cooperation with Swetox, a recently established Swedish research centre, to further develop the County Council’s health-promoting environmental work. Conceivable projects might be to study if new alternative plasticisers are better and the connection between nanomaterials, antibacterial products and antibiotic resistance. Social responsibility Equal treatment for all citizens Equal treatment for all citizens, the action plan based on the European Charter for Equality of Women and Men in local life (the CEMR charter) was developed and revised during the spring. In addition to gender equality, the new action plan covers equal opportunities and diversity and was adopted by the County Council Executive Board on 22 May.

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The certified training for managers and administrators in gender equality and equal opportunities continued during the year with fully booked courses. To further stimulate local efforts, participants who attended the training can now apply for funding for operational development linked to gender equality, equal opportunities and diversity. The maximum amount per application is SEK 100,000. During the year, 14 applications were approved. As the agreement with the current providers of the training expires at year-end, new providers were procured in the spring. Collaboration in the area with the Health and Medical Care Administration and the Traffic Administration was intensified during the year and will continue with various joint projects and efforts next year as well. Minorities and minority languages A national minority coordinator position has been established in the County Council. In the first year, the area was reinforced with a half-time position to support the coordinator and to work with a focus on the Roma in particular. A language package to support Finnish as a minority language was distributed to the child welfare centres for distribution to Finnish-speaking families. The County Council Executive Board Administration has held initial consultations with national minorities and a proposal has been drafted with a plan on how the consultations will work moving ahead. The employees have been trained in issues concerning national minorities through meetings, lectures, seminars and internal information. Additional efforts have been conducted to facilitate the work for administrations and companies with regard to mapping the personnel’s language skills. Work for accessibility: More than just thresholds “More than just thresholds” is Stockholm County Council’s 2011–2015 programme for participation for the disabled. The County Council Executive Board Administration has worked with a skills development project in cooperation with the Swedish Disability Federation (HSO). The objective is

for the County Council as an employer to increase knowledge about people with disabilities. Practical placement positions for those with disabilities have been established. A revision of the programme will begin in the autumn with the aim of a new programme beginning to apply as of 2016. Code of Conduct for suppliers In the work on the follow-up of social requirements in procurement, follow-ups were conducted in 2014 of the agreements in the areas of textiles, pharmaceuticals, instruments and gloves. Two audit reports have been published: IT products in Stockholm County Council and surgical textiles in Region Skåne. An audit in the area of textiles was conducted in China where a subcontractor to Textilia was visited. To increase competency in the county councils and among the procuring companies, the national county council network prepared new communication materials and a new process description for social responsibility in public procurement. Procurement SCC Procurement has systematically steered towards taking into account the total cost in procurements instead of purchase price. Within the scope of health economics, consideration is for instance taken to the time and frequency of changing bandages on wounds in wound care specials. The department consistently works for greater coordination to fulfil the procurement policy goals regarding qualitative and commercial gains in procurements. In the purchase of medical technology equipment for New Karolinska Solna, the department worked for more procurements to be coordinated for all hospitals in the County Council. This work is expected to increase and intensify in 2015. Work is under way to introduce GS1 standards on article information and to establish a master database that makes it possible to use patient-centred scanning. The article flow has been mapped, which by extension can lead to article information being categorised and converted to such a database.

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Secure processes Information security Rapid IT development, complex systems and greater information sharing demand secure processes for information handling. The County Council’s information security policy serves as the guide in this work. In 2014, the County Council’s management system for information security continued to be developed. A number of efforts were made to strengthen the County Council’s capacity in the area. A new online training programme, DISA, was implemented in the County Council’s educational platform Lärtorget and is now being gradually introduced in administrations and companies with the aim of increasing awareness of information security. County-council-wide operational support that enables systematic work with information security has been established and control points have been developed to be able to measure how well the rules are followed and to enable self-evaluation and follow-up. Preparations were also made during the year for the establishment of an overall function that will support the County Council’s operations to identify and manage IT-security-related threats and incidents. The task of preparing an action plan and application instructions for information security is under way, but has been delayed due to necessary reprioritisations resulting from urgent events that needed to be addressed. The work of establishing and strengthening processes for information security in the County Council will continue in 2015 with the goal of creating conditions so that all administrations and companies will have implemented systematic information security efforts. Security The County Council shall conduct systematic security work to ensure integrity and security of patients, passengers, employees, elected representatives and others affected by the County Council’s different operations. The focus in the security work is to prevent causes and reduce vulnerabilities, as well as the ability to prevent, manage and rebuild. At the same time, the surrounding world is constantly changing, often rapidly. Threats can change 86

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through an unforeseeable sequence of events both nationally and internationally and changes can occur suddenly and unexpectedly. In 2014, a review of the systematic security work was conducted and important areas were identified and prioritised. Work is under way with regard to security protection and the systematic fire safety work and measures following audits. During the year, the County Council’s insurance coverage was also strengthened. Information and education efforts were conducted, a procurement of the County Council’s insurance solution was carried out and a procurement of insurance brokerage services has begun. In addition to this, rules and procedures in the damages account have been adjusted. Most of stage three in the implementation process of Rakel has been completed and the remaining parts will continue to be implemented in 2015. Education efforts linked to Rakel with regard to healthcare, security functions, property operations and to some extent public transport functions have been carried out and will continue in 2015. An update of the County Council’s steering documents in the security area has begun, but has been delayed due to planning of the work concerning critical societal functions. Work on this assignment will continue in 2015. Emergency preparedness Stockholm County Council is an example of a critical societal function since large parts of the core operations are healthcare and public transport. The County Council also has a sector responsibility with regard to healthcare and public transport. This requires well-organised, efficient and systematic preparedness and security work of high quality, which is a prerequisite for the County Council’s operations and ability to provide service to the residents in the event of a crisis and severe strains on society. Ensuring preparedness and security demands clear governance in this area and that the work is done in cooperation between the various operations of the County Council. During the year, several preparedness-strengthening measures were carried out in the County Council’s administrations and companies. These

were compiled and submitted to the County Administrative Board and the National Board of Health and Welfare during the year. In 2014, a proposal for an updated emergency preparedness plan was also prepared where the starting point was threat- and scenario-based modelling. The plan will be prepared in 2015. In addition, an overview was made of the County Council’s steering documents and capacity in terms of protecting critical societal functions, total defence planning and Styrel (electricity supply plan for critical functions), and the requirements set in the Act on Municipal and County Council Measures prior to and in the event of Extraordinary Incidents and during High Alert (2006:544). Work was also begun with regard to effective handling of tactical situation reports within the County Council, which will continue in the next year. Sustainable IT delivery of valuegenerating services Various alternatives for standardising, consolidating and improving the efficiency of the operation of servers, storage, IT workstations, service desk and local networks in the County Council (excluding the Traffic Administration) are currently being evaluated. The evaluation is based on operational plans, strategies, earlier analyses, surveys and other available materials. The following alternatives will be evaluated: • divided responsibility, as today, and internally driven standardisation, consolidation and efficiency enhancement • coordinated internal responsibility and internally driven standardisation, consolidation and efficiency enhancement • coordinated internal responsibility and outsourcing to achieve desired effects.

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Data was collected and interviews were held and the results are being analysed relative to needs and costs. The work will be concluded in the first quarter of 2015. A new function in the County Council Executive Board Administration that will guide and coordinate strategic IT will be established. Recruitment of a manager for a new function for managing strategic IT is under way. The main mission for the function will be to ensure short- and long-term management, prioritise and follow up on the County Council’s IT operations. Another task will be to secure the exchange of information between healthcare actors and research, as well as residents and patients. Once the manager for the function has been appointed, work will begin to revise the financing model. The investigation assignment regarding alternatives for standardising, consolidating and enhancing efficiency will provide partial input for this work. In parallel with this, work is under way to establish the administration management model pm³ for all shared objects so that roles and responsibilities are clarified. The objective is to be able to manage IT support in a good way and to take control over the costs. In the long term, consensus and a good overview will lead to less, but more effective and more user-friendly IT support, and will increase the possibilities to collaborate and re-use solutions.

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This work covers all shared IT systems in healthcare around which there is a need to cooperate. The objects are divided into three families: eHealth, administration, and information and communication technology (ICT). Cooperation (3R) has been established between the three major actors: Stockholm County Council, Region Västra Götaland and Region Skåne. Within the scope of the cooperation, a programme proposal regarding the next generation of healthcare information environment has been prepared. The objective of the programme is to: • set requirements, procure and implement the next generation healthcare information environment within 3R through appointed operations representatives • create conditions for patient interaction, knowledge management and healthcare collaboration in a costeffective manner both within and across regional boundaries. This also means that 3R wishes to influence and contribute to the national work in these areas. The objectives for the programme: • A deployed system solution within 3R that clearly supports both current and future needs in healthcare processes with the patient and resident as participants. • An established joint administration organisation that the programme steering committee deems to be able,

in cooperation with the operation, to administer the system solution in such a way that it can be further developed in pace with operations and events in the world around. • The programme shall aim for current needs and requirements, but also prepare a solution that can handle future functions and the requirements they entail. Improvements to IT systems To facilitate the care providers’ administration of identities, a pilot project has been carried out to adapt the ordering portal for aids and system support for healthcare planning to Sambi. With the Sambi service, identity management can be coordinated between authorities, county councils and municipalities. A prestudy has been made to investigate the possibilities to connect IT support in healthcare to national security services for blocking and logging of record access, for example. It initially involves supporting the ambulance system and pregnancy and childbirth system. The consolidation of the emergency hospitals’ PC platforms, from Windows XP to a common standardised IT workstation (a PC platform based on Windows 7), will continue until May 2015. The project has been delayed due to a combination of technical obstacles, a large flora of applications and protracted supplier negotiations. In the autumn, 4,200 IT workstations were replaced and installed.

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The County Council as an employer Stockholm County Council is an attractive and competitive employer. Good healthcare, well-functioning public transport, a rich cultural life and good planning to meet the region’s growth are secured by having the right expertise within the organisation.

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An attractive and competitive employer The County Council’s personnel and skills supply is crucial to meet the need for well-trained personnel. Demands increase with the future health and medical care efforts and the infrastructure and public transport investments the County Council is facing. At the same time, the focus is on the overall objectives of a high level of accessibility, greater efficiency and strengthened patient safety. During the year, a number of activities and actions were carried out to secure the future skills supply. Development is proceeding in several strategic areas to provide greater clarity in the educational area and

strengthen the County Council in its role as a purchaser of education. Cooperation with the region’s universities has been further developed. Quality assurance of health science programme content and emphasis continues, as do efforts to increase the number of places on specialist education programmes. The human resource strategy work is based on the fundamental principles in the County Council’s HR policy: • actively take responsibility • customer and results focus • change and development. Staffing levels The average number of annual employees in all health and medical care was 38,687, which was 453 more than the year’s budget and 652 more than the

previous year. In the transport area, the corresponding figure is 646, which is 11 more than budget and 22 more than in 2013. Other operations have 151 more full-time equivalents than planned, which corresponds to an increase of 163 compared with last year. The number of full-time equivalents including extra time, such as hourly-paid personnel and compensated time in excess of normal working hours, was 2.2 per cent higher than in 2013. Extra time increased by 4.0 per cent during the same period. The number of full-time equivalents excluding extra time or corresponding measurements in Stockholm County Council was 41,411 in 2014, which is 615 more than budget and 837 more than in 2013. Karolinska University Hospital,

Workforce by area of activity Gender distribution 2014 (number of employees) Health and medical care, inc. dental care* Transport

2014

2013

Change %

Women

Men

42,398

41,570

2%

80%

20%

638

623

2%

54%

46%

Property operations

291

253

15%

47%

53%

Other operations**

1,048

1,082

–3%

50%

50%

Total

44,375

43,528

2%

79%

21%

Of whom, in administrations

29,823

29,072

3%

78%

22%

Of whom, in companies

14,552

14,456

1%

83%

17%

Employment rate***

97%

96%

96%

98%

Part-time employees****

13%

13%

89%

11%

42,847

41,921

79%

21%

Number of annual employees*****

2%

* The underlying data includes employees in TioHundra AB, which is jointly and equally owned by the County Council and Norrtälje Municipality. In total, TioHundra has 2,902 monthly employees. ** Other operations include AB SLL Internfinans, Culture Administration. The County Council Executive Board Administration, MediCarrier AB, the County Council Audit Office and the Patient Advisory Committee *** Employment rate vis-à-vis the number of employees. **** Proportion of men and women of the total number of part-time employees. ***** Aggregate employment rate.

Stockholm County Council Staffing levels (full-time equivalents)

Outcome 2013

40,574

Outcome 2014

41,411

Budget 2014

40,796

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Healthcare Provision Stockholm County, the County Council Executive Board Administration, the Public Healthcare Services Committee and Södersjukhuset AB showed the largest increase in the number of full-time equivalents.

Salary policy that supports operational improvement The special salary efforts with certain specialist nurses, biomedical analysts and midwives has been implemented and evaluated. A new effort has begun to develop processes for the setting of salaries, working conditions and salary structures to better support long-term skills supply and local salary determination. This work will continue in 2015, in parallel with the preparation of a salary police for the County Council. Salary development within the whole of SCC in 2014 totalled 3.1 per cent, 3.4 per cent for women and 1.8 per cent for men.

The County Council – an employer with breadth Efforts to increase awareness of Stockholm County Council as an employer and strengthen the view of the County Council as an attractive employer are long term. During the year, the County Council participated in labour market days for university students and at job fairs for schoolchildren and professionals. In addition, work experience positions and summer jobs were offered to young people. As a complement to the hospitals’ and healthcare operations’ own recruitment efforts, a large joint advertising effort for summer substitutes in healthcare was carried out with all of the County Council’s care providers as the sender. Other advertising efforts that aim to emphasise some of the County Council’s less well-known professional categories were also carried out.

Skills provisioning Skills provisioning was one of the areas of highest priority during the year. A county-council-wide model for needs assessment and management of future skills provisioning in healthcare was 90

prepared within the scope of the Plan for Future Health and Medical Care and implemented in 2014. Forecasts are based on annual employees in County Council-financed healthcare and an estimated future care need. Using key figures such as retirements and an annually changing care need, the County Council obtains input to be able to prioritise and initiate measures at an early stage. During the year, nurses were a prioritised professional category and a number of proposed activities and measures were prepared together with healthcare operations. The model was also used as a basis in the formulation of ST Stockholm with the aim of establishing continuous control and management of medical specialists in Stockholm County Council. To make the formal and real skills of the employees visible, the County Council continued to introduce KOLL, the County Council’s uniform model and structure for skills planning. The model provides a basis for planning and follow-up of skills development, based on goals and assignments, and is an important tool to better secure future skills provisioning. To quality assure and enhance the efficiency of the introduction of KOLL, the preparation of definitions for the employees’ roles is increasingly done jointly, over administration and company boundaries. In 2014, role preparation took place for example in the areas of communication, procurement, physiotherapy and occupational therapy. A joint role preparation gives stronger consensus regarding duties and roles and increases the possibilities to coordinate skills development efforts. It also provides better conditions to be able to contribute quality-assured and qualitative care when the same competence requirements are set regardless of care provider. The proportion of administrations and companies that have introduced or begun to introduce KOLL, including the ProCompetence IT tool, is nearly 50 per cent and currently encompasses around 5,400 employees. Administrations and companies make annual skills provisioning plans in accordance with the budget instructions. The plans describe existing skills gaps and special recruitment needs as

Annual Report 2014 The County Council as an employer

well as measures and activities that are planned to secure skills supply. They also describe the need for overall and coordinated efforts. It is apparent in the plans that healthcare operations work on the planning of the Plan for Future Health and Medical Care implementation to meet the requirements set for both the organisation and the employees’ competence. Healthcare operations describe a shortage of nurses during the year, both general nurses and specialist nurses. One measure has therefore been to offer study pay to nurses attending specialist training in specialities with staff shortages with the aim of increasing the influx to them. Introduction and development programmes for recent nursing graduates have been developed to create security in the professional role and cover skills gaps between theoretical training and practical reality. The needs for county-council-wide measures that are emphasized in the skills provisioning plans mainly involve working to ensure that the dimensioning of the educational places and the content and quality of the programmes match needs. There is also note of the need to secure the supply of certain medical specialists by increasing and distributing medical specialist positions.

Education The County Council cooperates with upper secondary schools, universities and institutions of higher education in Stockholm as well as the University of Gävle and Mälardalen University in terms of operations-integrated learning for students in healthcare programmes. A cooperation group with participants from the County Council, Karolinska Institutet and the other universities has worked on optimising the flow of students over the terms to ensure the supply of clinical training places for students in operations-integrated learning. Various activities have been carried out to develop educational learning environments, such as student halls, inter-professional learning environments and clinical training centres. A new version of KliPP, a system for the registration of educational places for operations-integrated learning, has  To contents

been deployed. KliPP is beginning to gradually be introduced in the medical programme. Four new academic health centres (AVC) were established during the year: the private care provider St. Eriks health centre and the county-council-operated Mörby health centre, Huddinge health centre and TioHundra AB in Norrtälje. Within geriatric care operations, efforts began during the year to strengthen and build up the academic environment for students. A systematic quality follow-up of operations-integrated learning was introduced in the County Council. In 2014, students from Karolinska Institutet and the individual universities, employees and managers at Danderyds Sjukhus AB, Karolinska University Hospital, Healthcare Provision Stockholm County and Södersjukhuset AB participated in the follow-up. The follow-up, which is conducted in questionnaire form, means that it is possible to also follow up qualitative parts of the education assignment in the annual education accounts. The County Council and Karolinska Institutet have drawn up criteria for how the programmes’ quality and research ties can be strengthened. The County Council cooperates with the KTH Royal Institute of Technology with regard to skills development and educational efforts in areas that are in the intersection of health, medicine and technology. The Safe Technology course in practical healthcare has been devel-

oped in collaboration with the university and Karolinska Institutet. The course was held for the first time in autumn 2014. The Academic Ambulance effort continued during the year to strengthen patient-centred research, education and development in pre-hospital care. The County Council has been a driver to realise a higher vocational education programme to be a paramedic in Stockholm and the first round of the education began in autumn 2014. Academic Ambulance will contribute to some extent. Contract education of specialist nurses in paediatric healthcare, paediatrics with a focus on neonatology, intensive care and surgery has begun. In 2014, the contract education programmes encompassed a total of 100 places. Cooperation with Karolinska Institutet is under way in terms of elective courses in the regular specialist nurse programme with a focus on medicine and surgery.

Greater diversity – equal conditions and opportunities Gender equality, equal opportunities and diversity are prioritised areas. The County Council conducts goal-oriented work to actively prevent and combat all forms of discrimination and abusive treatment. The advertising tool Rekrytera has been accessibility-­ adapted to emphasize that the recruitment process takes place from a diver-

sity perspective. A third alternative for gender has been added and the developed version of Rekrytera will be launched at the beginning of 2015. The certified gender equality and equal opportunities training for managers and administrators was held on six occasions in 2014. In addition to the online lesbian, gay, bisexual and transsexual (LGBT) training programme, an online training programme to remove obstacles with a focus on disabilities has been developed and launched. The online training programme is directed at all employees in the County Council and employees at suppliers that have agreements with the County Council. The work on key figures for gender equality, Jämix, and for ethnic diversity has continued and in 2014, work began on implementing new measurements throughout the Group in 2015. The key figures form the basis of a successful strategic diversity effort. A mapping of salaries was made during the year and no non-objective salary differences were indicated according to the Office of the Equality Ombudsman (DO). The County Council has continued to conduct active efforts to facilitate employment for people with disabilities. In the budget for 2014, SEK 5 million was allocated to further support the operations in the recruitment of people with disabilities. During the year, 18 people were offered practical placement positions at the County Council’s administrations and compa-

Number and proportion managers* at various levels, by gender 2014 Women ProporNumber tion

2013

Men

Total

Number

Proportion

Number

Women

Men

Number

Proportion

Total

Number

Proportion

Number

AA – Managers reporting directly to a political committee/board

3

19%

13

81%

16

7

35%

13

65%

20

BA – Managers reporting directly to AA-managers

42

55%

34

45%

76

49

51%

48

49%

97

BB – Middle managers reporting to AA/BA- managers

226

64%

125

36%

351

219

63%

130

37%

349

BC – Managers directly superior of C-managers

68

83%

14

17%

82

66

79%

18

21%

84

C – First line managers

1,098

76%

345

24%

1,442

1,062

76%

336

24%

1,398

Total

1,436

73%

531

27%

1,967

1,403

72%

545

28%

1,948

* The term manager applies to people with responsibility for personnel, budgets and operations.

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The County Council as an employer Annual Report 2014

91

nies. Work to offer practical placement to people with various disabilities will continue in 2015–2017.

Management and leadership Well-functioning management and leadership is a key prerequisite in order for the County Council to be developed and made more efficient. To secure the supply of managers, Stockholm County Council works systematically and longterm on management provisioning. In the employee follow-up, the employees’ perception of management in the operations is presented. Since measurements began in 2006, the proportion of managers with a management index of 70 or higher increased from 47.5 per cent to 67.6 per cent. The County Council needs a common management structure to secure the supply of managers in the short and long term. In the autumn, work began on preparing a proposal on such a county-council-wide structure.

To realise the Plan for Future Health and Medical Care, all managers must have the skills necessary to drive and implement the change. With the aim of securing competency in change management, the County Council planned to conduct a training effort for middle managers. In consultation with representatives of the administrations and companies concerned, the effort was cancelled. The reason was that more time is needed for dialogue and to establish support before a countycouncil-wide development effort can be implemented that will be a support for and complement to the activities being carried out at the respective operations.

developing teamwork based on the patient’s needs. Risk prevention work has been made more effective and the use of puncture-safe products has increased to prevent puncture wounds. Healthcare operations have made special efforts to prevent work-environment-related problems with ties to the new construction and renovations taking place in connection with the Plan for Future Health and Medical Care. To avoid unnecessary strain on the work environment during the change period, the operations have been able to apply for financial support through the Work Environment Improvement project. So far, 54 local efforts have been awarded grants, such as the development of new methods, training in load ergonomics, measures to improve the psychosocial work environment, and training for managers and safety representatives in change efforts and communication.

Health-promoting work environment Based on the results of the employee survey, an action programme has been drawn up. Several operations have conducted training efforts with the aim of

Key health-related ratios 2014

2013

2012

ACE index

77

76

76

Employee index

76

75

75

Attendance rate, %* Sick days per employee

2011

2010

75

75

63

64

64

69

73

18.0

17.9

17.2

16.3

15.4

* Due to a miscalculation in historical data, the figures are not comparable with past years. The error has been corrected as of 2012.

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Annual Report 2014 The County Council as an employer

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Properties in healthcare To meet the Plan for Future Health and Medical Care’s vision, a large number of property projects will be under way in Stockholm County Council over the next few years. In 2014, work on the strategic investments shifted into a distinct implementation phase.

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Annual Report 2014

93

Overall properties

Locum AB also assists the owner and the Public Healthcare Services Committee in property issues, including in connection with investment planning. There was a surplus of SEK 18 million in 2014, adjusted for the effect of an interest rate change on the calculation of pension liabilities of SEK 13 million. The adjusted result was SEK 13 million higher than the budgeted surplus requirement of SEK 5 million. The result was SEK 16 million lower than 2013. The surplus before appropriations and tax amounted to SEK 31 million. Operating revenues were SEK 36 million higher than in 2013, an increase of 13 per cent. This outcome was SEK 38 million or 14 per cent over budget. The deviation from budget is mainly attributable to higher service sales. The increase is linked to the higher activity mainly on the project side with more employees charging for their time. Operating expenses were SEK 53 million higher than in 2013, an increase of 22 per cent. This outcome was SEK 22 million or 8 per cent over budget. The deviation from budget is mainly due to higher costs for insourced personnel and higher costs for consultants. Premises costs also exceeded the budget. The break-down of Locum AB’s strategic objectives is based on four target areas:

• • • •

Outcome 2014

Outcome 2013

Change %

Budget 2014

Operating revenues

318

282

13%

280

– of which, SCC internal

318

277

14%

279

–293

–240

22%

–271

–2

–2



–3

The property portfolio in Landstingsfastigheter Stockholm is mainly comprised of seven emergency hospital buildings (two of which are used as university hospitals), ten local hospitals and a number of healthcare centres, psychiatric clinics and dental clinics. The property portfolio’s total floor space amounts to 2.0 million square metres in gross floor space, of which the strategic properties’ gross floor space is 1.9 million square metres. The occupancy ratio for the strategic properties amounted to 91 per cent in December 2014, which is 2 percentage points lower than in December 2013. Strategic properties are those that the County Council intends to retain, such as the emergency hospitals.

Locum AB Locum AB’s mission is to be a service unit in Stockholm County Council with responsibility for property management related owner issues with regard to Landstingsfastigheter Stockholm and to assist the owner in property strategy issues on behalf of the County Council. According to agreements with the County Council, Locum AB is responsible for both technical and financial management of properties in Landstingsfastigheter Stockholm.

satisfied customers sustainable development balanced finances an attractive employer and proud employees.

In 2014, the main focus was on developing and improving customer relations and customer satisfaction in the premises that Locum AB manages and preparing the implementation of the strate­ gic investments for the Plan for Future Health and Medical Care. Locum AB began work on the various activities in all focus areas in 2014. Work in some activities will continue in 2015. During the year, Locum AB drew up a new operating strategy and began the implementation of a new property management system with the aim of impro­ ving the follow-up of operations. During the autumn, Locum AB launched a new customer service called “one number in” to improve efficiency in customer case handling and improve customer service and personal treatment. The main focus in 2015 will continue to be to develop and improve customer relations and customer satisfaction in the premises that Locum AB manages. Locum AB is also continuing the work of ensuring the delivery of the projects for the Future Plan for Health and Medical Care, with a focus on quality assurance, finances and time management, and risk management.

Pr in ca

Locum AB SEK million

Operating expenses Depreciation/amortisation

8





–2

31

39



5

–32

–39





Surplus after appropriations and taxes

–1

1



5

Adjusted surplus*

18

34



5

3

1

–84%

4

260

227

2%

254

Net financial items Surplus before appropriations and taxes Appropriations**

Investments Number of full-time equivalents

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

94

Annual Report 2014 Properties in healthcare

 To contents

Landstingsfastigheter Stockholm (LFS) Landstingsfastigheter Stockholm is a profit centre within Stockholm County Council, in which reports are issued on the County Council’s property management. The properties are managed by Locum AB according to agreements with Stockholm County Council and in accordance with the owner directives established by the County Council Assembly. There was a surplus of SEK 338 million in 2014, which was SEK 103 million higher than the budgeted surplus requirement of SEK 235 million. The result was SEK 313 million lower than 2013. Net property sales (not budgeted) amounted to SEK 132 million. The surplus excluding property sales amounted to SEK 206 million, which was SEK 29 million below budget. Total operating revenues, including net property sales, were SEK 130 million lower than in 2013, which is a decrease of 4 per cent. This outcome

Properties n healthare

was SEK 321 million or 12 per cent over budget. The deviation from budget is mainly attributable to capital gains from property sales and higher rental income than budgeted. Operating expenses were SEK 177 million higher than in 2013, which is an increase of 12 per cent. This outcome was SEK 287 million or 20 per cent over budget. The deviation from budget is mainly attributable to expenses for disposals of buildings demolished in connection with the implementation of the the Plan for Future Health and Medical Care and other property costs. Net financial items was an expense of SEK 202 million in 2014, which was SEK 60 million higher than the budgeted net financial expense of SEK 262 million. This deviation is due to continued low interest rates. Investments in Landstingsfastigheter Stockholm were made in an amount of SEK 2,254 million. The budgeted investment volume amounted to SEK 2,400 million. The projects with the largest outcome in 2014 are:

• technical improvement of building 1 at Löwenströmska Hospital • new garage at Huddinge Hospital • new construction and renovation of Södertälje Hospital • new treatment building at Södersjuk­ huset • renovation and construction of the emergency ward at Danderyd Hospital • renovation for care wards and treatment at St. Göran Hospital. The main focus in the coming period will remain on preparing the work on the strategic investments for the Plan for Future Health and Medical Care and developing and improving customer relations and customer satisfaction. In 2014, work began on introducing component depreciation (RKR 11.4). The financial impact of the introduction is deemed to be marginal. This work will be completed in 2015.

Landstingsfastigheter Stockholm (LFS) SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Operating revenues

2,947

2,862

3%

2,758

– of which, SCC internal

2,487

2,388



2,361

132

347

–62%

0

Gains from property sales Total operation revenues

3,079

3,209

–4%

2,758

–1,699

–1,522

12%

–1,412

Depreciation/amortisation

–839

–816



–849

Net financial items

–202

–219



–262

338

651



235

2,254

1,352

67%

2,400

Operating expenses

Surplus/deficit Investments

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Properties in healthcare Annual Report 2014

95

Financial and other operations Due to Stockholm County Council’s high investment volumes in 2014 and coming years, the focus in 2014 was on financial operations – primarily the handling of liquidity and external borrowing.

96

Annual Report 2014

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Overall financial operations In 2014, Stockholm’s population continued to grow and the County Council made major investments during the year in both healthcare and public transport to meet the residents’ needs. This meant that liquidity was in focus during the year and the borrowing limits were raised. Stockholm County Council needs to have diversified borrowing and several sources of financing so it can choose the most suitable when external financing is needed. In 2014, Stockholm County Council was the first county council to conduct a transaction on a green bond. This is a loan where the funds go to environmentally classified investments. The loan amount of SEK 1.1 billion was equivalent to approximately 15 per cent of the County Council’s estimated credit requirement for 2014. Stockholm County Council retained its strong credit rating. This was confirmed by the independent credit rating institute Standard & Poor’s. Both the long-term and short-term credit rating of AA+ and A-1 are affirmed and deemed to have a stable outlook. The news from Standard & Poor’s means that Stockholm County Council continues to have the second highest credit rating on the long term and the highest credit rating on the short term. It is important for the County Council to retain a very high credit rating and the rating needs to reflect the capacity to keep payment commitments and financial obligations in the short and long term. For future investments, this

credit rating means that lending money to the County Council is associated with a very low risk. This allows the County Council to continue to obtain advantageous loan terms. Expectations for 2015 are to continue to focus on implementing and planning for both this year’s and future years’ financing.

Group financing Introduction and mission Group financing is the County Council’s central accounting unit where items of a county-council-wide nature are reported, such as tax revenues and disbursements of county council grants as well as employer’s contributions and pensions for personnel in the County Council’s administrations. The unit has no employees and conducts no operations. Finances There was a surplus of SEK 822 million (deficit: 337), which was an increase of SEK 1,159 million compared with last year and was SEK 1,132 million over budget. Non-recurring items resulted in a net charge of SEK 1,164 million compared to last year’s result, which is the main reason for this year’s positive deviation. Operating revenues amounted to SEK 6,369 million (6,656), which was a decrease of 4.3 per cent compared with the previous year and was SEK 52 million over budget. Operating expenses amounted to

SEK 69,929 million (66,792), which was an increase of 4.7 per cent compared with the previous year and was SEK 527 million below budget. Compensation according to the agreement in principle with the City of Solna concerning the Metro extension, LS 1312-1619, was included in an amount of SEK 250 million. Personnel costs amounted to SEK 6,649 million (6,232), which was an increase of 6.7 per cent compared with the previous year and was SEK 586 million below budget. The deviation from budget mainly consisted of lower employer’s contributions and lower pension expenses. Total tax revenues for the year amounted to SEK 63,971 million (61,802), which was an increase of 3.5 per cent compared with the preceding year and was SEK 116 million over budget. See the separate section regarding total tax revenues. Net financial items amounted to income of SEK 411 million (expense: 2,003), which was an increase of SEK 2,414 million compared with last year and was SEK 438 million over budget. The difference compared with last year is primarily related to the interest component of future pension commitments of SEK 2,317 million. The deviation from budget related to the interest component of future pension commitments was SEK 454 million. Investments for the year amounted to SEK 376 million with a budget of SEK 477 million. The investments related to Citybanan and are planned to continue through 2017.

Group financing SEK million

Outcome 2014

Outcome 2013

Change %

Budget 2014

Operating revenues

6,369

6,656

–4%

6,317

Operating expenses

–69,929

–66,792

5%

–70,456

Net operation expenses

–63,560

–60,136



–64,139

Tax revenues, general government grants and equalisation

63,971

61,802

63,856

Net financial items

411

–2,003

–27

Surplus/deficit

822

–337

Investments

376

369

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–310 2%

477 Financial and other operations Annual Report 2014

97

AB Stockholms Läns Landstings Internfinans Introduction and mission AB Stockholms Läns Landstings Internfinans (Internal Finance) is commissioned by the County Council to serve as an internal bank for County Council administrations and wholly owned companies and to act in a coordinated fashion towards external actors in the financial markets. AB Stockholms Läns Landstings Internfinans provides assistance on commercial terms to Stockholm County Council, its administrations and companies in the central management of liquidity, borrowing in capital markets and lending to the County Council’s administrations and companies. AB Stockholms Läns Landstings Internfinans also manages the County Council Group’s financial risks, administers the County Council’s Group account system and manages the County Council’s endowments, of which there are around 140 with managed assets totalling SEK 532 million at 31 December 2014.

Finances

Future outlook

There was a surplus of SEK 3 million (9) for 2014, which was in line with budget. This result is lower than last year, mainly due to lower net financial items attributable to lower excess liquidity and lower interest rates.

In 2014, Stockholm’s population continued to grow and the County Council will be making major investments over the next few years in both healthcare and public transport to meet the residents’ needs. The investments entail greater borrowing requirements for the County Council and a continued strong focus on financial risks and liquidity in 2015. Expectations for 2015 are even more focused on implementing and planning for both this year’s and future years’ financing. In addition, adaptation will be required to additional regulatory frameworks in the credit and financial markets, which mean that AB Stockholms Läns Landstings Internfinans will prioritise internal controls and sound risk management.

Goal attainment AB Stockholms Läns Landstings Internfinans achieved the balanced finances objective. The task of ensuring that the target in Stockholm County Council’s finance policy regarding payment capacity for the County Council amounting to a minimum of three weeks was also achieved during the entire period. AB Stockholms Läns Landstings Internfinans also has local goals comprising the areas of customers, employees, the environment, international work, processes and finances. AB Stockholms Läns Landstings Internfinans also fulfilled its measurable internal goals.

AB SLL Internfinans Outcome 2014

Outcome 2013

Change %

Revenues

12

12

–1%

11

– of which, SCC internal

11

11



11 –11

SEK million

Expenses

Budget 2014

–11

–10

11%

Net financial items

3

8



3

Surplus before appropriations and taxes

3

10



3

–3

–8





Surplus after appropriations and taxes

0

2



3

Adjusted surplus*

3

9



3

Number of full-time equivalents

9

9

0%

9

Appropriations**

* Pertains to surplus/deficit before appropriations and tax adjusted for the effect of repaid AFA premiums (2013) and interest effects on pension expenses (2013 and 2014). ** Pertains to tax optimisation for the LISAB Group.

98

Annual Report 2014 Financial and other operations

 To contents

Landstingshuset i Stockholm AB For 2014, Landstingshuset i Stockholm AB posted a deficit of SEK 589 million. Reversals of impairments of financial assets and shares in subsidiaries totalling SEK 16 million had an impact on the result. In addition, revenues are recognised regarding dividends on shares in subsidiaries in an amount of SEK 26 million from Waxholms Ångfartygs AB, MediCarrier AB and AB Stockholms Läns Landstings Internfinans.

Damages Account The Damages Account is the County Council’s system for property and consequential loss insurance. All the County Council’s properties and the units’ operations, except the transport companies, are insured via the Damages Account. The operation is financed through annual premiums from the insured parties. The result for 2014 is in line with budget through adjustment against the Damages Account’s account for provisions of SEK 3.9 million.

Landstingshuset i Stockholm AB SEK million Revenues – of which, SCC internal Expenses Surplus before appropriations and taxes

Outcome 2014

Outcome 2013

Change %

Budget 2014

57

230

–75%

0

0

0



0

–35

–25

41%

–32

22

205



–31

Appropriations*

–611

70





Surplus after appropriations and taxes

–589

274



–24

Outcome 2014

Outcome 2013

Change %

Budget 2014

Revenues

13

13

3%

13

– of which, SCC internal

13

12

5%

13

–13

–13

3%

–13

0

0



0

* Pertains to tax optimisation within the LISAB Group.

Damages account SEK million

Expenses Surplus/deficit

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Financial and other operations Annual Report 2014

99

Foundations, endowments and coordinating federations The County Council manages and distributes funds to various causes. Initiatives within the Archipelago Foundation, for example, are conducted to promote the archipelago’s positive development, vibrant communities and accessibility for the county’s residents and visitors.

100

Annual Report 2014

 To contents

Formed by the County Council independently or with others The County Council’s consolidated income statement and consolidated balance sheet include committees, administrations and companies in which its ownership share is higher than 50 per cent. Associated companies (companies in which the ownership share is 20 to 50 per cent) are reported according to the equity method (see Note 12). Foundations are not consolidated in the Group income statement or balance sheet in any way other than that any grants provided are recognised as expenses in the income statement. The major foundations and associations that the County Council has formed independently or with others are presented below. The surplus/deficit for 2013 is established in the first half of 2014; accordingly, the table pertains to the surplus/ deficit at 2013 compared with 2012. Karolinska Cancer Centre Foundation, CCK The Karolinska Cancer Centre Foundation (CCK) gathers all experimental cancer research at Karolinska University Hospital. Its activities strengthen clinical cancer research at the hospital. The foundation was formed in 1994. The foundation’s revenues consist primarily of rental income. Centre for Molecular Medicine Foundation, CMM The Centre for Molecular Medicine Foundation (CMM) brings together 500 persons with clinical experience from Karolinska University Hospital and

research competence from Karolinska Institutet, for research on public diseases. By identifying the molecular mechanisms behind these diseases, it is possible to develop better diagnostics, treatment and preventive measures. The foundation’s revenues consist primarily of rental income.

status of the elderly in society. The foundation was established in 1986 by Stockholm County Council and the City of Stockholm, which remain the principals. The County Council’s grant to the foundation amounted to SEK 7 million in 2014. Archipelago Foundation The Archipelago Foundation owns and manages land in the Stockholm archipelago. The foundation’s objective is to maintain the distinctive character, natural values and landscape of the archipelago, while promoting the development of outdoor life, culture, recreation and tourism. The foundation works in a long-term perspective to ensure a thriving archipelago. The County Council is the main source of financing, and its grant to the foundation in 2014 amounted to SEK 44 million.

Clara Foundation The Clara Foundation’s role is to finance, construct, own and manage premises on behalf of Södertörn University College. The foundation was formed by the County Council in 1998. The foundation’s revenues consist primarily of rental income. Stockholm County Museum Foundation The Stockholm County Museum Foundation works to increase awareness of the significance of the county’s history and the value of cultural environments. The foundation was formed in 1982 through an agreement between Stockholm County Council and the Municipalities of Norrtälje, Sigtuna and Södertälje, the City of Stockholm, and Stockholms läns hembygdsförbund (Stockholm County Regional History Society). The County Council’s grant to the foundation amounted to SEK 12 million in 2014.

Concert House Foundation The Concert House Foundation is charged with realising artistic and cultural goals and actively promoting musical events. As resources permit, the foundation is also charged with actively promoting other activities that directly or indirectly stimulate interest in music and broaden the range of music on offer. The Concert House Foundation owns Konserthuset, the Stockholm Concert Hall, and the Stockholm County Council is the main source of financing for its operations and the Royal Stockholm Philharmonic Orchestra. The County Council’s grant to the Stockholm Concert Hall amounted to SEK 128 million in 2014. During the period 2007 through 2009, extensive renovations were made to the

Stockholm Gerontology Research Centre The Stockholm Gerontology Research Centre initiates and conducts research in gerontology. The foundation also works to apply in practice the centre’s experience and research results in areas of particular importance for the

Foundations SEK 000s Karolinska Cancer Centre Foundation Centre for Molecular Medicine Foundation

Surplus/Deficit for the year 2013

Surplus/Deficit for the year 2012

Equity 31 Dec. 2013

Total assets 31 Dec. 2013

2,913

929

73,727

110,883

573

3,386

94,738

167,865 1,306,305

1,184

–1,021

171,279

Stockholm County Museum Foundation

497

789

4,304

6,774

Stockholm Gerontology Research Centre

295

350

6,125

38,160

-1,776

2,520

9,604

91,291

562

1,327

14,564

60,894

-429

91

11,386

12,449

Clara

Stockholm County Archipelago Foundation Concert House Foundation The Flemingsberg Science Foundation

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Foundations, endowments and coordinating federations Annual Report 2014

101

Stockholm Concert Hall. The renovations were financed through an interest-free loan from Stockholm County Council of SEK 123.4 million to be repaid over 20 years.

The founders comprise Stockholm County Council and the municipalities of Huddinge and Botkyrka. The County Council’s grant to the foundation amounted to SEK 1 million in 2014.

The Flemingsberg Science Foundation

Endowments

On 12 October 2010, the County Council Assembly decided to approve the formation of the Flemingsberg Science Foundation. The foundation was formed on 1 January 2011, with equity of SEK 10 million, of which Stockholm County Council contributed SEK 3.5 million. The Flemingsberg Science Foundation will promote collaboration between science, business and the community in Flemingsberg.

102

The County Council’s endowments, which are managed by AB Stockholms Läns Landstings Internfinans on behalf of the County Council Executive Board, consist of 140 foundations and gift funds. The market value was SEK 532 million at 31 December 2014. In 2014, the foundations distributed SEK 22.1 million in accordance with the appropriation provisions. The carrying amount was SEK 484 million.

Annual Report 2014 Foundations, endowments and coordinating federations

Coordinating federations The purpose of the coordinating federations is to oversee financial coordination in rehabilitation activities between social insurance offices, employment services, county councils and municipalities. In 2014, a new coordinating federation was formed, Södra Roslagen, which encompasses the municipalities of Täby and Österåker. There were already coordinating federations for the municipalities of Nacka, Södertälje and Värmdö and joint federations for the municipalities of Botkyrka, Huddinge and Salem (HBS) as well as Haninge, Nynäshamn and Tyresö (Östra Södertörn). In 2014, Stockholm County Council contributed SEK 14.1 million to the coordinating federations.

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Annual Report 2014

103

Financial report

104

Annual Report 2014

 To contents

Income statement Group

SEK million

County Council

Note

2014

2013

2014

2013

Operating revenues

1

18,507

18,406

8,782

8,846

Operating expenses

1

–77,661

–72,872

–70,820

–66,465

Depreciation/amortisation

2

–3,817

–3,589

–1,368

–1,313

Net operation expenses

–62,971

–58,055

–63,405

–58,933

Of which, items affecting comparability

6

–250

814

–250

685

Tax revenues

3

59,612

57,699

59,612

57,699

General government grant

3

4,678

4,624

4,678

4,624

Income and expenses equalisation

3

Total tax revenues

–319

–521

–319

–521

63,971

61,802

63,971

61,802

Financial income

4

126

704

654

597

Financial expenses

5

–990

–3,517

–565

–2,824

–864

–2,813

90

–2,226



–1,564

372

–1,752

136

934

656

643

Net financial items Of which, items affecting comparability Surplus for the year

6

Surplus for the year according to the balance requirement Surplus for the year Capital gains

136

934

–133

–409

Surplus for the year after balance requirement adjustments

3

525

RIPS rate / Interest expense pensions company



1,564

Reserved equity



–2,000

Balance requirement result for the year

3

89

 To contents

Financial report Annual Report 2014

105

Balance sheet Group

SEK million

County Council

Note

2014

2013

2014

2013

8

108

59

47

45

Assets Fixed assets Intangible assets Tangible assets Land, buildings, plant and machinery Machinery and equipment

9

35,065

31,174

15,296

12,799

10

19,451

19,457

4,309

4,107

11

28,141

21,246

14,289

11,689

Constructions in progress, advance payments for tangible assets Financial assets Financial assets

12

Total fixed assets

1,087

1,126

30,248

25,067

83,851

73,063

64,189

53,707

Current assets Stocks, etcetera Current receivables

13

Current investments Cash and cash equivalents Total current assets Total assets

469

426

280

225

5,779

6,002

4,670

4,478

0

0

0

0

334

1,841

34

7,852

6,582

8,269

4,983

12,555

90,433

81,331

69,172

66,262

4,461

Equity, provisions and liabilities Equity

14

Opening equity

6,857

5,923

5,104

Other change in equity

433



368



Surplus for the year

136

934

656

643

7,426

6,857

6,128

5,104

17,864

Total equity Provisions Provisions for pensions and similar obligations

15

22,136

20,923

18,467

Other provisions

16

748

510

374

96

22,884

21,433

18,841

17,961

20,452

Total provisions Liabilities Long-term liabilities

17

39,709

36,210

24,762

Current liabilities

18

20,414

16,832

19,441

22,745

Total liabilities

60,123

53,042

44,203

43,197

Total equity, provisions and liabilities

90,433

81,331

69,172

66,262

none

none

none

none

25,461

26,376

25,461

26,376

439

788

15,838

15,942

25,900

27,164

41,299

42,318

Pledges and equivalent collateral Contingent liabilities

19

Pension commitments not recognised as liabilities or provisions Other contingent liabilities Total contingent liabilities

106

Annual Report 2014 Financial report

 To contents

Cash-flow statement Group

SEK million Note

2014

County Council 2013

2014

2013

Operation activities Surplus for the year

136

934

656

643

Adjustment for non-cash items*

5,940

5,361

2,681

3,394

Funds from operations before changes in working capital

6,076

6,295

3,337

4,037

Increase (–) or decrease (+) in stocks and inventory

–43

261

–55

–23

Increase (–) or decrease (+) in current receivables

221

1,182

–53

1,842

Increase (+) or decrease (–) in current liabilities (excluding leases and loan financing)

2,088

570

263

352

Cash flow from operating activities

8,342

8,308

3,492

6,208

–77

–3

–15



–13,476

–9,810

–5,381

–4,101

153

533

152

533

–13,400

–9,280

–5,244

–3,568

Investing activities Investments in intangible assets Investments in tangible assets Sales of tangible assets Cash flow from investing activities* Financing activities Newly raised loans Repayment of long-term liabilities Increase in long-term receivables

9,296

867

3,218

3,728

–4,100

–2,100

–4,100

–2,100

39

–278

–5,181

–4,595

–1,937

–772

–3

–3

253

280





3,551

–2,003

–6,066

–2,970

–1,507

–2,975

–7,818

–330

1,841

4,816

7,852

8,182

334

1,841

34

7,852

Depreciation/amortisation

3,817

3,589

1,368

1,313

Change in provisions

1,451

2,501

881

2,453

182

–276

1

–348

Change in leasing financing Grants received Cash flow from financing activities Cash flow for the year Cash and cash equivalents at the beginning of the year Cash and cash equivalents at the end of the year *) Specification of non-cash items

Capital gain/loss (– capital gain/+ capital loss) Other items Adjustment for non-cash items

7

490

–453

431

–24

5,940

5,361

2,681

3,394

* The part of New Karolinska Solna that is comprised of the public private partnership agreement (the PPP agreement) did not affect cash flow during the year.

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Financial report Annual Report 2014

107

Operating report

SEK million

Adjusted surplus/ deficit**

Revenues

Expenses

Surplus/ deficit*

3,560.4

–3,556.0

4.4

4.4

13.3

–13.3

0.0

0.0

0.0

71,475.6

–70,653.7

821.9

821.9

–310.5

286.9

–282.1

4.8

4.8

0.0

Pensions

Budget 2014

The County Council Executive Board County Council Executive Board Administration Damages account Group financing New Karolinska Solna Metro Expansion Administration Total County Council Executive Board

0.0

29.9

–29.9

0.0

75,336.1

–74,505.1

831.0

52,057.2

–52,250.4

–193.2

–193.2

0.0

9,890.2

–9,686.6

203.6

203.6

75.3

–561.2

30.2

0.0

0.0

0.0

831.0

–310.5

Health and medical care Public Healthcare Services Committee Healthcare Provision, Stockholm County

16,165.2

–16,726.4

–561.2

Södersjukhuset AB

3,940.8

–4,174.1

–233.3

149.0

–84.3

9.4

Danderyds Sjukhus AB

3,279.2

–3,548.4

–269.3

118.5

–150.8

6.5

2.3

0.0

24.5

–0.9

3.3

Karolinska University Hospital

TioHundra AB

755.9

–753.6

2.3

Södertälje Sjukhus AB

988.3

–1,013.7

–25.4

St. Eriks Ögonsjukhus AB Total emergency hospitals Folktandvården Stockholms län AB Ambulanssjukvården i Storstockholm AB

508.5

–515.9

–7.4

21.8

14.4

1.3

25,637.9

–26,732.1

–1,094.3

313.8

–780.5

50.6

1,528.9

–1,464.5

64.3

43.3

107.6

20.0

207.2

–213.5

–6.3

2.1

–4.1

0.7

135.9

–132.8

3.1

0.9

4.0

4.1

89,457.3

–90,479.9

–1,022.6

360.2

–662.4

150.7

AB Storstockholms Lokaltrafik

17,116.8

–17,191.7

–74.9

46.8

–28.1

0.0

Special transport services

1,284.8

–1,293.9

–9.0

–9.0

0.0

Traffic Administration

677.5

–625.3

52.2

52.2

0.0

Waxholms Ångfartygs AB

405.6

–391.7

13.8

1.2

15.0

0.0

19,484.8

–19,502.6

–17.9

48.0

30.1

0.0

–12.8

Stockholm Care AB Total health and medical care Transport

Total County Council Traffic Committee Property Locum AB Landstingsfastigheter Stockholm (LFS) Total property

321.1

–290.2

30.9

3,079.1

–2,741.2

337.9

3,400.2

–3,031.4

368.8

–12.8

0.9

18.1

5.0

337.9

234.9

356.0

239.9

Other MediCarrier AB

641.5

–636.7

4.8

5.7

0.3

Culture Committee

429.5

–430.3

–0.8

–0.8

0.0

Patient Advisory Committee

21.3

–21.3

0.0

0.0

0.0

County Council Auditors

32.9

–32.9

0.1

0.1

0.0

Landstingshuset i Stockholm AB

57.3

–35.1

22.1

–327.4

–31.3

AB SLL Internfinans Total other Group adjustments All results all profit centres

–349.6

31.9

–28.8

3.1

0.1

3.3

3.0

1,214.4

–1,185.0

29.4

–348.5

–319.1

–28.0

–724.0

671.6

–52.4

–46.8

–99.2

0.0

136.3

0.0

136.3

52.0

* Surplus before appropriations and taxes. ** Pertains to surplus/deficit before appropriations and tax adjusted for interest effect on pension expenses.

108

Annual Report 2014 Financial report

 To contents

Investment report

SEK million

Outcome 2014

Outcome 2013

Budget 2014

Deviation from budget

The County Council Executive Board County Council Executive Board Administration

139.6

64.0

131.3

–8.3

Group financing

375.9

368.8

477.0

101.1

3,639.3

3,304.8

4,193.5

554.2

117.0



449.0

332.0

4,271.9

3,737.6

5,250.8

978.9

29.7

New Karolinska Solna Metro Expansion Administration Total County Council Executive Board Health and medical care Public Healthcare Services Committee

2.3

7.5

32.0

65.2

84.4

65.6

0.4

Karolinska University Hospital

208.2

296.5

228.0

19.8

Södersjukhuset AB

38.8

Healthcare Provision, Stockholm County

123.2

135.8

162.0

Danderyds Sjukhus AB

68.4

95.9

75.0

6.6

Södertälje Sjukhus AB

23.7

20.2

35.0

11.3

St. Eriks Ögonsjukhus AB Total emergency hospitals

13.0

10.9

12.0

–1.0

436.6

559.3

512.0

75.4

Folktandvården Stockholms län AB

66.3

61.6

58.0

–8.3

Ambulanssjukvården i Storstockholm AB

12.0

19.2

10.2

–1.8



0.3





582.3

732.3

677.8

95.5

Stockholm Care AB Total health and medical care Transport Trafikförvaltningen inkl färdtjänst AB Storstockholms Lokaltrafik Waxholms Ångfartygs AB Total County Council Traffic Committee

28.2

11.3

7.0

–21.2

7,744.0

5,301.1

8,019.7

275.7

100.5

42.6

91.1

–9.4

7,872.7

5,354.9

8,117.8

245.1

Property Locum AB

2.6

1.2

4.0

1.4

Landstingsfastigheter Stockholm (LFS)

2,254.0

1,352.2

2,400.0

146.0

Total property

2,256.6

1,353.4

2,404.0

147.4

Other MediCarrier AB

2.6

0.7

4.0

1.4

Culture Committee

1.8

0.2

0.4

–1.4



0.1





Patient Advisory Committee County Council Auditors

0.1

0.7

0.2

0.1

Total other

4.5

1.7

4.6

0.1

14,988.0

11,180.0

16,455.0

1,467.0

All investments

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Financial report Annual Report 2014

109

Accounting principles This Annual Report was prepared in accordance with the Swedish Local Government Act, the Swedish Local Government Accounting Act and the recommendations issued by the Swedish Council for Municipal Accounting (RKR), except for the reporting of tax revenues, provisions, recognition of borrowing costs and component depreciation. These recommendations apply to the legal entity, the County Council, and the County Council’s consolidated accounting. The companies’ reports have been prepared in accordance with the Swedish Annual Accounts Act (ÅRL) and the Swedish Accounting Standards Board’s general guidelines regarding annual accounts and consolidated accounts (BFNAR 2012:1), K3. Changed application during the year and effects of revised estimates and assessments Introduction of K3 As of 2014, the companies apply the new standard rules K3. The transition has affected the principles for the recognition of tangible fixed assets through the introduction of component depreciation. Since the requirement for component depreciation beginning in 2014 also concerns the municipal accounts, the changes made at the companies impacted the consolidated accounts. The change in the companies’ accounts has been made through a recalculation of comparative figures for previous years. A corresponding change in the consolidated accounts has been reported for 2014 as an additional or deductible item in affected notes and as a change in equity. The transition to component depreciation has had the following effects on the opening balance of equity: Company Amount (SEK millions) AB Storstockholms lokaltrafik, SL –27 Waxholms Ångfartyg AB 6 Total –21

110

Annual Report 2014 Financial report

Inspection expenses AB Storstockholms lokaltrafik changed its principle regarding the recognition of inspection expenses for the X60 commuter trains. They were previously expensed directly in profit or loss. As of 2014, they are recognised as fixed assets and depreciated straight-line over the period until the next inspection. Component depreciation As of 2014, there is a requirement to divide up a tangible fixed asset into significant components if the difference in the consumption of these components is expected to be material. For operations in the County Council, including properties owned by the County Council, preparatory work was done during the year. The activities conducted included the determination of components and preparation of a method for transfer of historical installations. Component depreciation for county-council-owned properties is planned to be introduced in 2015. The companies adjusted their accounts to the requirements in K3 and introduced component depreciation where applicable. Components have been introduced on: • Railway installations and buildings and land for public transport • Marine vessels Reclassification of fixed assets During the year, a review was conducted of the accounting plan. One result of this review is that a reclassification was applied between Land, buildings, plant and machinery and Machinery and equipment. The reclassification pertains to rail vehicles, marine vessels and renovations to leased premises, which were previously recognised in the item Land, buildings, plant and machinery. The amount totals SEK 12,713 million. In conjunction with this, comparative figures were also adjusted. Government grants In 2014, the accounting of specially designated government grants was more clearly adapted to the current recommendation. This entailed a transfer

where previous years’ government grants of SEK 368 million were transferred from liabilities to equity. Consolidated accounting The consolidated accounts shall provide a summarative and accurate view of the County Council’s overall financial position and performance regardless of whether the operations are conducted as administrations or companies. The consolidated accounts were prepared in accordance with the acquisition method. The accounts of the subgroups of AB Storstockholms Lokaltrafik and Landstingshuset i Stockholm AB (LISAB) were prepared with full consolidation and incorporated in their entirety into the County Council Group. The consolidated accounts of the municipal association, Ägarsamverkan i Norrtälje Sjukvård och Omsorg, and its subsidiary TioHundra AB were incorporated by proportional consolidation. The ownership share was 50 per cent. Associated companies were included in accordance with the equity method. Shares of profit/loss of associated companies were included in net operating expenses. In the consolidated accounts, the companies’ financial statements, which have been prepared in accordance with the Annual Accounts Act and the Swedish Accounting Standards Board’s regulations on generally accepted accounting principles in municipal operations, are translated if material discrepancies exist. The effects of the introduction of K3 have been assessed to not entail any material deviations necessitating a recalculation. Included units and participating interests are shown in the illustration in Section 4. Items affecting comparability When they occur, items affecting comparability are reported separately in notes to the respective item in the income statement and where applicable in the cash-flow statement. An item affecting comparability means the result of events or transac To contents

tions that is not extraordinary, but important to note in a comparison with other periods. This may, for example, concern measures for conversion, impairment losses and capital gains. To establish what constitutes an item affecting comparability for the County Council in terms of amounts, an assessment has been made based on the County Council’s turnover and operations. In consideration of this, an item affecting comparability is comprised of a rarely occurring item that exceeds SEK 100 million. The items affecting comparability are specified in Note 6. Period allocation Period allocation is done to provide an accurate picture of the County Council’s performance and financial position for the period in question. This means that the main principle is that expenditures have been expensed in the year that consumption occurred and revenues have been recognised as income in the year the income was generated. Revenues Revenues are reported to the extent it is likely that the financial assets will be utilised by the County Council and the revenues can be reliably calculated. Revenues from fees, grants and sales Revenues from grants and fees are recognised in the period in which the expense is expected to arise. Grants that should cover already accrued expenses are recognised as revenue directly. If the grant is intended to cover expenses over a multi-year period, the revenue is allocated over the years involved. Dividends are recognised when the right to receive a dividend can be secured, normally in conjunction with the annual general meeting of a company. Sales revenues from property sales are normally recognised as revenue on the date of possession. Tax revenues Tax revenues are recognised according to the recommendation from the Swedish Council for Municipal Accounting, 4.2 Reporting of Tax Revenues. The tax credit forecast published by the Swedish Association of Local Authorities and Regions in December has mainly been used for estimation of tax revenues in  To contents

2013 and 2014, respectively. In its tax revenue forecasts, the County Council uses the tax base forecasts published by the Swedish Association of Local Authorities and Regions in the Planning Conditions documents. This applies to the tax base trend nationally and in the county. However, the County Council does not use the population forecasts of the Swedish Association of Local Authorities and Regions. The County Council obtains a specially ordered population forecast for Sweden and the county from Statistics Sweden and SCC Growth, Environment and Regional Planning. This entails some minor differences between the County Council’s and the Swedish Association of Local Authorities and Regions’ forecasts regarding the final tax settlements and municipal economic equalisation. In addition, there is some difference in methodology in the calculation of the forecast for the final tax settlement, which also causes a minor difference. The reason for the discrepancies is that a more accurate illustration is believed to be able to be presented.

No depreciation/amortisation is applied to land, art and work in progress.

Expenses Depreciation/amortisation

Impairment losses

The depreciation of tangible assets and amortisation of intangible assets are applied to the estimated useful life with straight-line application based on the cost excluding any residual value. Depreciation/amortisation is begun when the asset is brought into use. The useful life constitutes the basis of the assessment of the length of the period of depreciation/amortisation. This assessment is based on a local judgement and adjusted to the current facility’s special conditions, such as the operations’ nature, utilisation of the asset and geographic conditions. The following depreciation/amortisation periods are generally applied: Intangible assets 3–5 years Machinery and equipment 3–10 years Buildings 25–50 years Permanent equipment in buildings 17 years Rail vehicles 10–30 years Buses 12 years Railway installations See components Marine vessels See components

Components In the case of assets where significant components have been identified and the difference in their consumption is expected to be material, component depreciation is applied. This applies for the following categories of fixed assets: Fixed asset: Railway installations Buildings and land, public transport (foundation/ structural system Marine vessels

Depreciation interval for components 10–50 years (substructure 40–100 years) 17–50 years 20–50 years) 15–30 years (hull 30 or 80 years)

No recalculation has been made in the consolidated accounts due to the introduction of component depreciation in the stated areas.

Assets are tested for impairment requirements or reversal of previously applied impairment losses. Rental and leasing agreements In a presentation of significant contracts, to present a true and fair view, objects leased under finance leases are included in the balance sheet for the Group and the County Council. At the same time, all leases are reported as operating leases in underlying units. Finance leases primarily apply to rail vehicles and are recognised as fixed assets and as a liability item to the lessor, also refer to Note 20. Borrowing costs Borrowing costs are recognised using the alternative method, meaning that borrowing costs are included in the asset’s cost if they are directly attributable to the purchase, construction or production of an asset. In its subsidiary Locum AB, Stockholm County Council uses an estimated borrower interest rate that is a deviation from recommendation RKR 15.1, which stipulates that a

Financial report Annual Report 2014

111

borrower interest rate can only exist if there is a real borrowing cost. AB Storstockholms lokaltrafik’s borrowing costs are primarily charged to profit or loss. In 2014, an average interest rate on property investments of 3.0 per cent, equivalent to SEK 83 million, was capitalised. In addition to this, SEK 557 million was capitalised at an average interest rate of 5.6 per cent with regard to New Karolinska Solna.

holding is for the asset to be held or used continuously. Funds that are continuously subject to purchase and sale and are available to meet on-going disbursements are classified as current assets. Current assets Current assets are valued as a main principle at the lower of cost and fair value. Fair value refers to the market value less estimated selling expenses. Stocks

Corporate tax The companies in the Landstingshuset i Stockholm AB Group are not currently required to pay income tax since, under current tax regulations, the Group is able to offset taxable earnings in the Group through Group and shareholder contributions and use loss carryforwards from previous years. For Södertälje Sjukhus AB, whose operations started in company form in 2009, a block on Group contributions applies for the income years 2009 – 2014. Any corporate tax is recognised under other operating expenses in the consolidated accounts. The companies are assessed to not be able to utilise existing loss carryforwards in the next few years. This means that no deferred tax assets are recognised on tax loss carryforwards. Fixed assets An intangible asset is an identifiable, non-monetary asset without physical form while a tangible asset is a physical asset intended for continuous use. An intangible fixed asset shall meet the following criteria: • it shall be identifiable • it shall be a resource over which the County Council has control • it is expected to provide future financial benefits • it has arisen as a result of events that have occurred • it has a cost that can be reliably calculated. To be classified as a tangible fixed asset, the value must amount to a minimum of a half price base amount per object and have a useful life in excess of three years. Financial assets are classified as fixed assets when the purpose of the 112

Annual Report 2014 Financial report

Stocks are valued at the lower of cost and fair value on the balance-sheet date. Collective valuation is applied to homogeneous product groups. Stocks primarily consist of consumable materials used for repairs and maintenance and consumable products. Receivables Receivables are recognised in the amount expected to be received following an individual assessment. Receivables and liabilities in foreign currencies are valued at the rate on the balance-sheet date. If hedging measures, such as forward contracts, are employed, the forward rate is applied. Provisions Provisions are made for commitments that are uncertain as regards maturity dates and amounts. A provision is reported in the balance sheet when it is likely that an outflow of resources will be required to settle the commitment and a reliable estimate of the amount can be made. Only legal obligations are recognised in the balance sheet. Constructive obligations are recognised as a contingent liability, See also Note 16. A deviation from the applicable principles is done with regard to the recognition of provisions for future pension expenses in an amount of SEK 700 million. The provisions were made in 2007. Pensions Under the Local Government Accounting Act, Chapter 5, Section 4, pensions are reported according to what is referred to as the mixed model. This means that pensions earned before 1998 are reported as contingent liabilities instead of as a liability or provision in the balance sheet. Pensions earned during the year and pensions paid that were

earned up to and including 1998 are recognised in the income statement. Pensions for the County Council’s administrative organisations are calculated according to RIPS 07. See also Note 15. The companies calculate pension commitments on the basis of the Swedish Financial Supervisory Authority’s main rule. KPA Pension’s calculations provide the basis for the companies’ pension provisions. The lowered interest rate, according to the main rule, means that the companies’ pension liability increased by SEK 397 million. The difference in values obtained using the main rule and the alternative rule is recorded at the comprehensive level in the Group. Pension liabilities estimated using the alternative rule are assessed to better reflect the actual liability that would arise if operations were transferred back to the County Council or sold. In addition to the pension cost, there are also costs for special payroll tax. In 2014, the interest rate for the pension liability calculation as per the main rule was lowered from 2.6 per cent to 1.9 per cent while the rate for the alternative rule remains at 1.5 per cent. The decrease in the rate under the main rule has meant that the companies’ pension liability has increased, which affects the companies’ surplus negatively for 2014. The difference between the main rule and the alternative rule amounted to SEK 494 million, including special payroll tax in 2014. In 2013, the difference was SEK 866 million, a decrease of SEK 372 million. Liabilities Received investment grants are recognised as current or long-term prepaid income in the balance sheet and are gradually recognised as income in the income statement over the asset’s useful life. See also Note 17. Off-balance-sheet commitments Recognition of derivatives and hedge accounting Hedge accounting is applied for all external derivative instruments. This is done in both the County Council and in the consolidated accounts. For intra-Group derivative instruments, hedge accounting is applied for intra-Group forward exchange contracts, while the lowest value principle is  To contents

applied for intra-Group interest swaps in the County Council’s accounts. Since intra-Group derivative instruments are eliminated in the consolidated accounts, they have no impact on the consolidated income statement and balance sheet. All implemented hedges are governed by the finance policy requirement to reduce currency and interest rate risks. The hedging relationships that were outstanding at 31 December 2014 were of three different types: 1. Borrowing in SEK For these hedging relationships, the hedged item is comprised of borrowing in SEK at a variable interest rate. The hedging instruments are comprised of interest swaps where the County Council receives a variable interest and pays a fixed interest. The County Council’s aim with these hedging relationships is to reduce the uncertainty regarding future interest expenses for borrowing at variable interest. This uncertainty can be attributed to changes in the variable interest rate. The hedged risk is comprised of the variability of future interest payments on the basis of changes in the base interest rate, STIBOR. Interest swaps with future starts where the County Council receives variable and pays fixed interest may also constitute hedging instruments. At 31 December 2014, the County Council had a total of 43 outstanding hedging instruments of this type in a

total nominal amount of SEK 8,950 million. The market value for all interest swaps that constitute hedging instruments in these hedging relationships amounted to SEK -759 million. During the 2014 financial year, the hedging instruments affected interest expenses in the income statement by SEK -192 million. The interest expense pertains to the net of paid, received and accrued interest on all swaps. Unrealised market value changes have not impacted the income statement. The hedging instruments’ impact on the average fixed interest term and borrowing cost is shown in the table below. 2. Borrowing in foreign currencies For these hedging relationships, the hedged item is comprised of borrowing in foreign currencies at a fixed interest rate. The hedging instrument is comprised of exchange rate swaps, where the County Council receives a fixed interest in foreign currencies and pays a fixed or variable interest in SEK. A combination of exchange rate swaps and interest swaps in SEK can also constitute hedging instruments if the County Council wishes to change the proportion of fixed and variable interest in SEK after the time of borrowing. If the County Council intends to hedge its borrowing cost before the time of borrowing, swaps with future starts with terms as per above may also constitute hedging instruments.

The County Council’s intention with this hedging strategy is to reduce the exchange rate risk and interest rate risk that are associated with borrowing in foreign currencies. The uncertainty can be attributed to exchange rate fluctuations. The hedged risk is the spot risk, which is future changes in spot rates compared with the time of hedging and the interest risk in the respective borrowing currency. The hedged risk may also be the interest rate risk in SEK after the time of borrowing. At 31 December 2014, the County Council had a total of five outstanding hedging instruments of this type in a total nominal amount of EUR 575 million, corresponding to SEK 5,018 million. The market value for all interest swaps that constitute hedging instruments in these hedging relationships amounted to SEK +290 million. During the 2014 financial year, the hedging instruments affected interest expenses in the income statement by SEK –49 million. The interest expense pertains to the net of paid, received and accrued interest on all swaps. Unrealised market value changes and exchange rate changes have not impacted the income statement. The hedging instruments’ impact on the average fixed interest term and borrowing cost is presented in the table below.

Before hedging

After hedging

Average fixed-rate period

2.03 years

3.4 years

Average borrowing cost* • in per cent • in EURm/SEK million

1.69% SEK 432 million

2.45% SEK 624 million

*) The intent of the above hedges is to reduce uncertainty of future interest payments and obtain a stable interest expense that does not change over time.

Before hedging

After hedging

Average fixed-rate period

7.81 years (EUR)

6.94 years (SEK)

Average borrowing cost* • in per cent • in EURm/SEK million

2.125% EUR 12 million

3.15% SEK 152 million

*) The intention of the above hedges is to reduce uncertainty regarding future interest payments in foreign currencies. **) The “Before hedging” figures pertain to the total borrowing in SEK, which also includes the part of the SEK debt that is issued against fixed interest. “After hedging” pertains to the total borrowing in SEK with addition of the aforementioned interest hedges. ***) Note that a direct comparison is not possible between the borrowing costs since the “Before hedging” values pertain to EUR rates and the “After hedging” values to SEK rates.

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Financial report Annual Report 2014

113

3. Forward exchange contracts For these hedging relationships, the hedged item is comprised of contracted or very likely forecast future cash flows in foreign currencies. The hedging instruments are comprised of forward exchange contracts where the County Council has purchased currency on a forward contract. The County Council’s intention with this hedging strategy is to reduce the exchange rate risk associated with cash flows in foreign currencies. This uncertainty can be attributed to exchange rate fluctuations between SEK and various foreign currencies. At 31 December 2014, the County Council had a total of two outstanding hedging instruments of this type in a total nominal amount of EUR 21.44 million, corresponding to SEK 203.3 million. The market value for all forward contracts in these hedging relationships amounted to SEK 6 million.

114

Annual Report 2014 Financial report

During the 2014 financial year, the hedging instruments increased interest expenses in the income statement by SEK 530,000. The interest expense pertains to a period-allocated component of the forward premium on all forward contracts. Unrealised market value changes have not impacted the income statement. Other For 2014, it was assessed that the surety that the County Council has for AB SL Finans’ leases constitutes an unrecognised binding commitment for the County Council and thereby constitutes a hedged item. Other commitments Other commitments are contingent liabilities, among other things for pensions earned before 1998. Refer to Notes 15 and 19.

 To contents

Notes Note 1 Operation revenues and expenses SEK million

Group

County Council

2014

2013

2014

2013

Patient fees, healthcare

721

647

459

407

Patient fees, dental care

604

616

0

0

Passenger fares

6,978

6,688

180

182

Health and medical care sold

1,150

1,337

1,338

1,140

Dental care sold

262

272

0

0

Sales of other primary services

222

234

53

62

Rental income, sales, other services

3,733

3,711

3,155

3,001

Government grants and other grants

3,101

2,848

2,832

2,615

Other revenues

1,550

1,238

963

742



814



685

18,507

18,406

8,782

8,846

Personnel costs

27,179

25,564

19,449

18,294

Purchased health and medical care services

14,878

13,769

22,484

21,234

364

325

872

830

12,670

12,083

986

960

Revenues affecting comparability Operating revenues

Dental care purchased Purchased transport services Other primary services purchased

15

15

24

24

1,701

1,680

1,769

1,733

Pharmaceuticals in pharmaceutical benefit scheme

4,918

4,697

4,856

4,653

Other pharmaceuticals

1,396

1,372

1,169

1,137

Other materials and products, etcetera

4,604

4,267

2,118

1,864

Contributions paid

1,613

1,487

2,469

2,405

0

0

7,503

7,043

Premises costs, lease of equipment

2,419

2,429

2,511

2,485

Other expenses

5,652

5,182

4,360

3,804

250



250



77,661

72,872

70,820

66,465

Operations-related services (lab, radiology)

Grants provided to SL and WÅAB

Expenses affecting comparability Operating expenses

Note 2 Depreciation/amortisation SEK million

Group

County Council

2014

2013

2014

–28

–19

–13

–12

Depreciation of buildings and plant

–1,475

–1,358

–512

–473

Depreciation of machinery and equipment

–2,314

–2,212

–843

–827









–3,817

–3,589

–1,368

–1,313

Amortisation of intangible assets

Impairment losses Total depreciation/amortisation

2013

A reclassification of assets was done in 2014 as a result of changes in the accounting plan. This also affects the division of depreciation/amortisation.

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Financial report Annual Report 2014

115

Note 3 Tax revenues, general government grants and municipal economic equalisation SEK million Preliminary tax revenues Forecast for final tax settlement tax in 2014 and 2013, respectively Adjustment item for tax revenues in 2013 and 2012, respectively Total tax revenues

Group

County Council

2014

2013

2014

2013

59,672

57,913

59,672

57,913

47

–248

47

–248

–107

35

–107

35

59,612

57,699

59,612

57,699

Grant for pharmaceutical benefits

4,678

4,624

4,678

4,624

Total general government grants

4,678

4,624

4,678

4,624

Cost equalisation grant

557

497

557

497

Total, grants from equalisation

557

497

557

497

Income equalisation fee

–335

–516

–335

–516

Adjustment fee

–541

–501

–541

–501

Total charges equalisation

–876

–1,017

–876

–1,017

Total, cost and income equalisation

–319

–521

–319

–521

63,971

61,802

63,971

61,802

2014

2013

2014

2013

12

49

601

567

Other financial income

114

654

53

30

Total financial income

126

704

654

597

Total tax revenues, general government grants and municipal economic equalisation

Note 4 Financial income SEK million Interest income

Group

County Council

Note 5 Financial expenses SEK million

Group

County Council

2014

2013

2014

Interest

–721

–712

–645

–619

Interest on pension provisions

–210

–552

–225

–418

–59

–689

–67

–34



–1,564

372

–1,752

–990

–3,517

–565

–2,824

2013

2014

2013

Other financial expenses Financial expenses affecting comparability (Note 6) Total financial expenses

2013

Note 6 Items affecting comparability SEK million

Group 2014

County Council

Under operation revenues: Repayment of premiums AFA Försäkring



529



400

Capital gains, property sales*



285



285

–250



–250





–1,564



–1,564

Under operating expenses: Metro expansion** Under financial expenses: Interest reduction, pension liability RIPS Interest change pension liability main rule/alternative rule Total items affecting comparability





372

–188

–250

–749

122

–1,067

* Amount 2013 pertains to sale of two properties at Beckomberga. ** Compensation according to an agreement in principle with the City of Solna regarding the Metro expansion, LS 1312-1619.

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Annual Report 2014 Financial report

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Note 7 Specification of capital gains/losses, Group SEK million

Group

County Council

2014

2013

2014

2013

347

Other operation revenues Capital gains on Landstingsfastigheter Stockholm's (LFS) sales of tangible assets

132

349

132

on SL Group’s sales of other assets



56





on other units' sales of tangible assets

1

4



4

on SL Group’s sales of other assets

–175

–127





on other sales of tangible assets

–140

–5

–133

–3

Net capital gains from sales of tangible assets

–182

276

–1

348

2014

2013

2014

2013

Cost on the opening date

93

91

62

62

Purchases

78

3

15





–1





Accumulated cost on the closing date

171

93

77

62

Depreciation/amortisation on the opening date

–34

–16

–17

–5

Depreciation/amortisation for the year

–28

–19

–13

–12

Operations’ other expenses Capital losses

Note 8 Intangible fixed assets SEK million

Sales and disposals

Reclassifications

Group

County Council

–1







Accumulated depreciation/amortisation on the closing date

–63

–34

–30

–17

Total value on the closing date

108

59

47

45

2014

2013

2014

2013

45,238

41,063

17,793

16,830

Purchases

2,796

3,735

376

400

Transfer from construction in progress

2,756

628

2,756

628

–324

–128

–172

–64

The majority of the intangible assets pertain to software.

Note 9 Land, buildings, plant and machinery SEK million Cost on the opening date

Sales and disposals Reclassifications

Group

County Council



–60





Accumulated cost on the closing date

50,467

45,238

20,753

17,793

Depreciation/amortisation on the opening date

–13,945

–12,584

–4,876

–4,425

117

45

49

23

–1,475

–1,380

–512

–473

Sales and disposals Depreciation/amortisation for the year Reclassifications Accumulated depreciation/amortisation on the closing date

19

–26





–15,283

–13,945

–5,338

–4,876

Impairment on the opening date

–119

–119

–119

–119

Accumulated impairment on the closing date

–119

–119

–119

–119

35,065

31,174

15,296

12,799

17,396

14,950

10,717

8,591

2,223

2,038

1,477

1,478

Land improvements

15,445

14,186

3,103

2,729

Total value on the closing date

35,065

31,174

15,296

12,799

Total value on the closing date Residual value according to plan on the closing date by type of asset: Buildings Land

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Financial report Annual Report 2014

117

Note 10 Machines and equipment SEK million Cost on the opening date Purchases

Group

County Council

2014

2013

2014

2013

37,749

35,260

11,238

10,332 497

1,619

2,435

423

Adjustment due to component depreciation

100







Transfer from construction in progress

709

718

662

718

–698

–937

–256

–310

2

291

2



Accumulated cost on the closing date

39,481

37,767

12,068

11,238

Depreciation/amortisation on the opening date

–6,587

Sales and disposals Reclassifications

–18,287

–16,811

–7,125

Adjustment due to component depreciation

–32







Sales and disposals

628

782

216

289

–2,314

–2,191

–843

–827

–20

–84

–2



–20,024

–18,304

–7,754

–7,125

Depreciation/amortisation for the year Reclassifications/adjustments Accumulated depreciation/amortisation on the closing date Impairment on the opening date

–6

–6

–6

–6

Accumulated impairment on the closing date

–6

–6

–6

–6

19,451

19,457

4,309

4,107

Cars and other means of transport

2,699

2,495

7



Medical equipment

1,440



665



311

319

199

228

3,801

3,527

2,957

2,701

69

64

69

64

9,456

9,913

1

4

241

179

218

157

Total value on the closing date Residual value according to plan on the closing date by type of asset:

Refurbishment of leased premises Permanent equipment in buildings Art and non-depreciable equipment Leases, machinery and equipment IT equipment Other machinery and equipment

1,435

2,961

192

953

Total value on the closing date

19,451

19,457

4,309

4,107

Note 11 Construction in progress and advance payment for tangible assets SEK million

Group

County Council

2014

2013

2014

2013

Balance on the opening date

21,246

17,558

11,689

8,422

Costs incurred during the year, buildings

10,209

5,002

5,826

4,575

Costs incurred during the year, machinery and equipment

191

87

191

87

Transfer to other assets

–3,506

–1,401

–3,418

–1,394

Total construction in progress and advances

28,141

21,246

14,289

11,689

A large part of the costs incurred during the year relate to the construction of New Karolinska Solna and investments at SL and Landstingsfastigheter.

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Annual Report 2014 Financial report

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Note 12 Financial assets Group

SEK million

County Council

2014

2013

2014

2013





24,044

18,815

1,027

1,105

104

215





6,055

6,034

Participation in associated companies**

13

15





Other shares and subordinated debentures

44

1

42



3

3

3

3

1,087

1,126

30,248

25,067

Loans provided to Group companies Other loans provided Shares in subsidiaries*

Tenant-ownership rights Total financial assets * Shares in subsidiaries, County Council

Percentage holding %

Number of shares

Carrying amount, SEK million

AB Storstockholms Lokaltrafik

100

80,000,000

5,649

Landstingshuset i Stockholm AB

100

1,000

Shares in subsidiaries

406

Total

6,055

Information on corporate registration number and registered office Subsidiary

Corp. reg. no.

Registered office

AB Storstockholms Lokaltrafik

556013-0683

Stockholm

Landstingshuset i Stockholm AB

556477-9378

Stockholm

Corp. reg. no.

Percentage holding %

Share of equity, SEK million

556612-1290

49.0

** Participation in associated companies Associated company Barnbördshuset Stockholm AB

13

Total

13

Note 13 Current receivables SEK million

Group

County Council

2014

2013

2014

Accounts receivable

1,460

1,455

1,084

956

Government grant receivables

1,466

1,596

1,459

1,535

Tax assets Prepaid expenses and accrued income

2013

50

341

16

329

1,393

1,396

1,090

952

Other receivables

1,411

1,214

1,021

706

Total current receivables

5,779

6,002

4,670

4,478

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Financial report Annual Report 2014

119

Note 14 Equity Group

SEK million

County Council

2014

2013

2014

2013

6,857

5,923

5,104

4,461

Changed accounting principles at SL*

71







Changed accounting principles at WÅAB*

–6







Adjustment to recommendation at Public Healthcare Services Committee**

368



368



Surplus for the year

136

934

656

643

7,426

6,857

6,128

5,104

Opening equity

Closing equity

* Effect arising as a result of changed accounting principles for the companies has been booked against equity. ** Period allocated government grants have been booked against equity at the Public Healthcare Services Committee to more clearly adjust reporting to current accounting recommendations.

Supplementary disclosure reserved equity 2014

2013

Reserved in 2011 annual accounts

1,200

1,200

Reserved in 2012 annual accounts

2,100

2,100

Reserved in 2013 annual accounts

2,000

2,000

Total transition costs

5,300

5,300

SEK million Transition costs future health and medical care 2015-2018

Note 15 Provisions for pensions and similar obligations, Group SEK million

Group

County Council

Pension liabilities (incl. payroll tax)1) 2) 3) 4) Provision for pensions according to the balance sheet at 31/12/2013

20,923

Change in provision for pensions, incl. payroll tax and interest component Provision for pensions according to the balance sheet at 31/12/2014 – of which payroll tax5) – of which, pension assets – of which, defined-benefit retirement pensions – of which, special collectively agreed occupational and fixed-term pensions6)

17,864

1,213

603

22,136

18,467

3,372

3,372

949

949

13,974

10,813

95

92

– of which, accrued pension rights, companies

207



– of which, pensions for Locum AB, the majority are PA KFS pensions

231



1,547

1,547

– of which, company pensions at Group financing – of which, provisions for future pension expenses7)

700

700

– of which recording of difference between alternative/main rule including payroll tax 2)

494

494

– of which, other pension benefits

567

500

SEK million

Group

County Council

2014

2013

2014

2013

Change in provision for pensions during the year

833

642

604

450

Defined-contribution retirement pension

838

774

578

546

Pension expense for the year

Pensions paid for contingent liabilities

881

862

881

862

-881

344

-881

281

Payroll tax on pensions

826

657

615

551

Other pension expenses

-21

47

-44

12

2,475

3,326

1,753

2,702

Other pensions paid

Total pension expenses, excl. financial expense Plus interest component of pension expenses Total pension expenses, incl. financial expense of which, items affecting comparability

210

2,116

-147

2,170

2,686

5,442

1,606

4,872

1,564

1,752

1) Pension commitments within the Stockholm County Council Administration organisation were calculated according to RIPS 07, while the valuation for the companies was performed according to what is known as the main rule established by the Swedish Financial Supervisory Authority (FFFS 2007:24). 2) A reserve of SEK 494 million, including payroll tax, was recognised, which refers to the difference between the main rule of the Swedish Financial Supervisory Authority and the alternative rule when estimating pension liabilities for companies. Pension liabilities estimated using the alternative rule are assessed as better reflecting the liability that would arise if operations were transferred back to the County Council or sold externally. 3) The County Council's administration organisation is updated to 93.0 per cent in KPA Pension's register. 4) All pension funds are re-lent. 5) County councils and municipalities pay special payroll tax on pensions paid, while companies pay payroll tax on pension costs for the year. Payroll tax reported pertains to pension provisions in the County Council. 6) Of the total amounts included under "Special collectively agreed occupational and fixed-term pensions," fixed-term pensions represented SEK 89 million (34 people) on 31/12/2014. The remaining amount consists of special retirement pensions as decided. Fixed-term pensions for elected full-time politicians with on-going assignments are included in the pension liability as of 2011. 7) There is a provision of SEK 700 million for future pension costs reported in the 2007 annual accounts in line with the decision of the County Council Assembly, LS 0710-1116. Under the Local Government Accounting Act, which came into force on 1 January 1998, pension commitments earned prior to 1998 are reported as contingent liabilities for employees in the County Council's administrative organisation.

120

Annual Report 2014 Financial report

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Note 16 Other provisions Group SEK million

2013

Utilised during the year

32 359

Selling expenses, property Estimated maintenance costs

Reversal of unutilised amount

Provisions for the year

2014

–6





26



–22



337

Other provisions

119

–26

–7

299

385

Total other provisions

510

–32

–29

299

748

2013

Utilised during the year

Reversal of unutilised amount

Provisions for the year

2014

Selling expenses, property

32

–6





26

Other provisions

64

–9

–2

295

348

Total other provisions

96

–15

–2

295

374

County Council SEK million

Note 17 Long-term liabilities SEK million

Group

County Council

2014

2013

2014

2013

18,627

16,030

18,627

16,030

Long-term liability leasing

8,863

10,088



1

Investment grants

6,086

5,651

25



Other long-term liabilities*

6,133

4,441

6,110

4,422

Total long-term liabilities

39,709

36,210

24,762

20,452

Liabilities to banks and credit institutions

* Other long-term liabilities includes PPP liabilities for New Karolinska Solna in an amount of SEK 6,110 million in 2014 and SEK 4,422 million in 2013.

Information on liabilities to banks and credit institutions Group

County Council

2014

2013

2014

2013

Average interest rate (%)

2.6

3.0

2.6

3.0

Average fixed interest term (years)

4.0

4.1

4.0

4.1

Loans maturing within (SEK million) 1–5 years Later than 5 years

3,502

3,800

3,502

3,800

15,124

12,230

15,124

12,230

2014

2013

2014

2013

3,948

2,050

7,779

11,547

Note 18 Current liabilities SEK million Current liabilities to banks and credit institutions Advanced payments from customers

Group

County Council

702

636

434

427

6,810

6,032

5,887

5,364

346

31

346

31

1

713

1

3

Holiday pay and salary liabilities

1,672

1,596

1,148

1,100

Accrued expenses and deferred income

4,306

3,998

2,840

2,637

Other liabilities

2,630

1,776

1,007

1,636

20,414

16,832

19,441

22,745

Accounts payable Liabilities to the Swedish State Current liability leasing

Total current liabilities

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Financial report Annual Report 2014

121

Note 19 Guarantees and other contingent liabilities SEK million

Group

County Council

2014

2013

2014

2013

20,490

21,226

20,490

21,226

4,971

5,150

4,971

5,150

25,461

26,376

25,461

26,376



2,047



2,047

AB SL, financial leases





11,744

12,092

County Council's wholly owned companies, financial leases





1

3

SL Group, pension liability





475

448

Waxholms Ångfartygs AB (WÅAB), pension liability





13

12

Locum AB, pension liability





231

245 728

Pension commitments not taken up among liabilities or provisions, see Note 15 Pensions Payroll tax Total of which, items affecting comparability Contingent liabilities for the benefit of Group companies and associated companies*

Danderyds Sjukhus AB, pension liability





911

St. Eriks Ögonsjukhus AB, pension liability





171

138

Södersjukhuset AB, pension liability





1,161

934

Södertälje Sjukhus AB





178

124

113

99

226

197

Folktandvården Stockholms län AB, pension liability





368

303

Other companies, pension liability





33

28

113

99

15,512

15,252

276

266

276

266

36

35

36

35



375



375

TioHundra AB, pension liability

Total Contingent liabilities for the benefit of external parties** AB Transitio*** Stockholm County Archipelago Foundation Clara Foundation Other guarantee commitments Total Total other contingent liabilities Total contingent liabilities

14

13

14

13

326

689

326

690

439

788

15,838

15,942

25,900

27,164

41,299

42,318

* The County Council has guarantee commitments for Group companies relating to financial lease contracts, primarily attributable to SL. These guarantee commitments are not recognised as contingent liabilities in the Group, since financial lease commitments are recognised in the consolidated balance sheet. ** County councils are responsible as partners in Patientförsäkringen LÖF for the company's obligations in an amount corresponding to ten times the premium the county council has had to pay for each year that losses have arisen in the patient insurance. In 2014, the premium amounted to SEK 211.5 million. *** The County Council has enter an agreement as a joint and several creditor with a ceiling of SEK 8 billion for AB Transitio with regard to financing of rail vehicles. At 31 December 2014, SEK 6.3 billion had been utilised. Through an agreement with a right of regress, SCC's commitment is limited to the extent to which SL has financed vehicles through AB Transitio. At 31/12/2014, this component amounted to SEK 0.3 billion.

Note 20 Leasing fees SEK million

Group

County Council

2014

2013

2014

2013

Total minimum leasing fees

11,066

11,729

1

4

Current minimum leasing fees

10,161

11,155

1

4

Of which maturing within 1 year

1,531

795

1

3

Of which maturing within 1-5 years

5,130

6,274



1

Of which maturing after 5 years

3,500

4,086





Financial leases exceeding 3 years*

Non-cancellable operating leases exceeding 3 years Leasing fees maturing within 1 year

321

89

128

73

Leasing fees maturing within 1-5 years

573

165

389

137

71

4

58



Leasing fees maturing after 5 years

* Financial leases primarily related to rail vehicles and buses as well as certain medical equipment. Finance leases are recognised in the balance sheet and are included in the item machinery and equipment.

In 2014, operating leases were supplemented with premises leases. Information for comparison year 2013 has not been updated with corresponding information.

122

Annual Report 2014 Financial report

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Note 21 Intra-Group relationships Unit SEK million

Owner contributions Paid

Group contributions

Received

Stockholm County Council

Paid

Received

Dividends Paid

Received

21

Landstingshuset i Stockholm AB

735

124

Danderyds Sjukhus AB

271

Södersjukhuset AB

247

Södertälje Sjukhus AB

25

St. Eriks Ögonsjukhus AB

11

Ambulansjukvården i Storstockholm AB

26

6

Stockholm Care AB

5

Folktandvården Stockholms län AB

79

Waxholms Ångfartygs AB

175

Locum AB

21

32

AB SLL Internfinans

3

MediCarrier AB

5

AB Storstockholms Lokaltrafik

21

AB SL Finans

2 3

7

508

508

SL Infrateknik AB

7

SL Älvsjö AB All companies are wholly owned by Stockholm County Council or the respective Parent Company Unit SEK million Stockholm County Council

Sales Revenue

Contributions

Expense

Revenue

Interest, etc.

Expense

Revenue

7,694

611

1,956

9,333

3,000

558

54

3 4

Expense

Landstingshuset i Stockholm AB Danderyds Sjukhus AB Södersjukhuset AB

20 807

709

114

3,712

140

18

St. Eriks Ögonsjukhus AB

437

72

4

Ambulansjukvården i Storstockholm AB

204

10

1

28

93

563

56

38

23

318

5

2 3

Södertälje Sjukhus AB

Stockholm Care AB Folktandvården Stockholms län AB Waxholms Ångfartygs AB Locum AB AB SLL Internfinans

11

1

MediCarrier AB

495

2

AB Storstockholms Lokaltrafik

242

817

AB SL Finans

133

133

85

83

SL Infrateknik AB SL Älvsjö AB

2 280

6

7,223

18 581

6

All companies are wholly owned by Stockholm County Council or the respective Parent Company Unit SEK million Stockholm County Council

Loans Donors

Guarantees

Recipient

Donors

24,016

Landstingshuset i Stockholm AB

524

Danderyds Sjukhus AB

911

Södersjukhuset AB

1,161

Södertälje Sjukhus AB

178

St. Eriks Ögonsjukhus AB

171

Ambulansjukvården i Storstockholm AB

5

Stockholm Care AB

368

Waxholms Ångfartygs AB

371

Locum AB

13 231

239

2

MediCarrier AB AB Storstockholms Lokaltrafik

16 8

Folktandvården Stockholms län AB

AB SLL Internfinans

Recipient

15,285

7 23,355

12,219

AB SL Finans SL Infrateknik AB SL Älvsjö AB All companies are wholly owned by Stockholm County Council or the respective Parent Company

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Financial report Annual Report 2014

123

Note 22 Average number of annual employees by area of operations Number of annual employees 2014

Number of annual employees 2013

37,636

36,964

Health and medical care, incl. dental care Transport Other operations Total excl TioHundra AB TioHundra AB* Total

652

624

2,071

1,915

40,359

39,503

1,051

1,071

41,410

40,574

* TioHundra AB is 50-per-cent owned so only 50 per cent of the work force is presented above.

Note 23 Surplus/deficit for the year and adjusted surplus/deficit 2014 SEK million Company Surplus/deficit before appropriations

Internfinans

WÅAB

Care

AISAB

MediC

Locum

DSAB

3

14

3

–6

5

31

–269

Appropriations Effect of lowered interest 0

1

1

2

1

–13

119

Tax disposition

pension liability calculation

–3

174

–6

4

–6

–19

152

Total appropriations

–3

175

–5

6

–5

–32

271

Surplus for the year

0

189

–2

0

0

–1

2

Surplus/deficit before appropriations

3

14

3

–6

5

31

–269

Compensation for pensions

0

1

1

2

1

–13

119

Adjusted surplus/deficit

3

15

4

–4

6

18

–151

St. Erik

SÖS

StS AB

FTV

LISAB

SL

–7

–233

–25

64

22

–75

0

SEK million Company Surplus/deficit before appropriations Appropriations Effect of lowered interest pension liability calculation

22

149

25

43

–111

–11

98

0

–123

–297

0

Total appropriations

11

247

25

–79

–408

0

Surplus for the year

4

13

–1

–15

–386

–75

Surplus/deficit before appropriations

–7

–233

–25

64

22

–75

Compensation for pensions

22

149

25

43

–111

47

Adjusted surplus/deficit

14

–84

–1

108

–89

–28

Tax disposition

124

Annual Report 2014 Financial report

 To contents

Key ratios 2010–2014 Unit

2014

2013

2012

2011

2010

Number

2,198,044

2,163,042

2,127,006

2,091,473

2,054,343

%

1.6 %

1.7 %

1.7 %

1.8 %

1.7 %

Number

9,747,355

9,644,864

9,555,893

9,482,855

9,415,570

Population Stockholm County – Population development Sweden – Population development

%

1.1 %

0.9 %

0.8 %

0.7 %

0.8 %

Participation in Stockholm County

%

22.6 %

22.4 %

22.3 %

22.1 %

21.8 %

SEK million

63,971

61,802

59,328

57,965

55,085

SEK/inh.

29,104

28,572

27,893

27,715

26,814

%

3.5%

4.2%

2.6%

5.2%

3.6%

Tax rate SCC

SEK

12.10

12.10

12.10

12.10

12.10

Average county council tax, nationwide

SEK

11.20

11.11

11.01

10.82

10.82

Tax Tax revenues, general government grants and equalisation* Tax revenues, general government grants and equalisation* Tax revenue development*

* Conversions have been made in 2012 due to changed policy for reporting of government grant for reduced sickness absence. Refer to Notes 1 and 3.

Income statement Turnover

SEK million

82,478

80,208

77,123

73,803

69,762

Surplus/deficit SCC

SEK million

136

934

1,984

512

1,306

general government grants and equalisation

%

0.2%

1.5%

3.3%

0.9%

2.4%

Operation revenue, development*

%

0.5%

3.4%

11.3%

7.9%

–0.1%

Operations’ expenses, development

%

6.6%

4.0%

3.0%

5.2%

2.8%

Depreciation/amortisation costs, development

%

6.4%

5.3%

10.1%

4.8%

6.3%

Net cost development

%

8.5%

4.2%

1.0%

4.4%

3.8%

Total Assets

SEK million

90,433

81,331

77,744

68,604

59,855

Equity

SEK million

7,426

6,857

5,923

3,944

3,434

Equity/assets ratio

%

8.2%

8.4%

7.6%

5.7%

5.7%

Equity/assets ratio including contingent liabilities

%

–20.0%

–24.0%

–23.9%

–29.8%

–31.2%

Result share of tax revenues,

Balance sheet

Liquidity

SEK million

334

1,841

4,816

1,821

2,034

Loan and leasing debt

SEK million

32,931

28,881

30,998

27,141

21,113

Pension obligations (incl. payroll tax)

SEK million

47,597

47,299

42,548

40,700

35,554

SEK million

14,988

11,180

9,389

9,764

8,260

%

55.7%

74.3%

89.3%

28.9%

66.8%

Visits in healthcare

Number

17,824,660

17,176,253

16,414,139

16,017,905

15,524,207

Care episodes in healthcare

Number

327,151

326,425

324,500

318,059

311,585

sq.m.

2,014

2,047

2,103

2,099

2,084

%

91

93

93

93

92

Number

791

786

763

739

722

%

47.8

48

46

49

51

SEK/inh.

200

196

187

190

193

Investments Investments Self-financing degree of investments Operations

Gross area ('000s) Occupancy rate property Passengers, winter day ('000s) Public transport on land, tax funding ratio Culture expense Staff Number of full-time equivalents SCC

Number

41,410

40,574

40,189

39,662

39,502

– of which health and medical care

Number

38,687

38,035

37,810

37,237

36,925

– of which transport services

Number

652

624

633

688

809

– of which other personnel

Number

2,071

1,915

1,746

1,737

1,768

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Financial report Annual Report 2014

125

Audit Report for the County Council Executive Board 2014 In our capacity as auditors appointed by the Assembly, we have audited the County Council Executive Board’s activities and financial accounts for the year 2014. The County Council Executive Board is responsible for managing and coordinating the County Council’s operations and having supervision over other committees and boards, i.e. continuous supervision that the operations are conducted in accordance with applicable objectives, decisions and guidelines and the regulations that apply for the operations. The Board has a leading position and shall have an overview of the whole with responsibility for follow up and feedback to the Assembly. The Board is responsible for monitoring the development of the operations and finances and taking action when necessary. Our responsibility as auditors is to review operations, internal control and accounts and determine if operations were conducted according to the Assembly’s assignment and objectives as well as the regulations that apply to the operations. We shall also assess whether the annual accounts are consistent with the financial targets and operating objectives decided on by the Assembly. The audit has been carried out in accordance with the Swedish Local Government Act, generally accepted auditing practices in local government in Sweden and the County Council’s auditing regulations. The audit was of the nature and scope necessary to provide a reasonable basis for assessment and determining liability, and produced the results presented in the Audit Office’s Annual Report for 2014 to the County Council Executive Board. We are appending a summary report of the results of our audit. We assess that the County Council Executive Board continued to strengthen owner governance and supervision over the County Council’s operations in certain respects in 2014. The supervision report, which is presented in an appendix to the Annual Report, is an important basis for the County Council Executive Board’s reporting on owner governance to the Assembly. The conclusions drawn in the supervision report regarding compliance to laws, steering documents and the municipal objective are based on information provided by the operations. The information needs to be quality assured, however. We want to again state that there is ambiguity in the governance of the County Council’s emergency hospitals, which in our opinion are not adequately coordinated with the Public Healthcare Services Committee’s governance in agreements. This is at risk of affecting the hospitals in terms of undertaking adequate and long-term sustainable measures. Recurring decisions on exceptions to the surplus appropriation rules entail additional ambiguous signals as to what rules apply.

126

Annual Report 2014 Financial report

According to the audit, the rules should be changed since they have now been deviated from for the third consecutive year. We note a relatively high rate of cost increase, mainly in health and medical care. We therefore want to particularly emphasize the importance of the County Council Executive Board ensuring that action is taken that is adequate, feasible and sustainable on the long term in order to achieve the Assembly’s goal of balanced finances in the future. Especially since the planned investment volumes in the next ten years will have a major financial impact on the County Council’s conditions to maintain balanced finances. It was also noted in the audit that the financial consequences and the financing of the investments are not always clearly presented by decisions, which means that the Assembly is not provided enough input to assess what effect an investment decision will have on the County Council’s finances. We have examined if the results are in agreement with the County Council Assembly’s decisions regarding goals and guidelines for sound financial management. Based on the information in the Annual Report, we assess that the overall objective of balanced finances and the other financial targets have been achieved. The overall objectives of accessibility and quality in healthcare and reliability in public transport have not been achieved in all respects. The County Council Executive Board’s conclusion that they have been achieved is, according to the audit, not sufficiently supported as there are too few indicators or the indicators only measure a part of the objective. We assess that the Annual Report provides a true and fair view of the financial position and performance of the year, with exception for the deviations from generally accepted accounting principles that exist since before, but that have not affected the surplus for the year. We assess overall that the County Council Executive Board’s financial and operating results are not entirely satisfactory. In addition, we assess that the County Council Executive Board’s work on internal governance and control has been developed, but that internal governance and control is still not fully adequate. We recommend that the 2014 consolidated annual accounts for Stockholm County Council be adopted. We recommend that the Assembly grant discharge from liability to the members of the County Council Executive Board.

Stockholm, 16 April 2015 Kenneth Strömberg Lars Bergstig

Peter Kockum

Benkt Kullgard

Gunnar Ågren

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Abbreviations AISAB

Ambulanssjukvården i Storstockholm AB

Care

Stockholm Care AB

DSAB

Danderyds Sjukhus AB (Danderyd Hospital)

FtjV

Färdtjänstverksamheten (Transport services for the disabled)

FTV

Folktandvården Stockholms län AB (Public Dental Service in Stockholm County)

FUT

Förvaltning för utbyggd tunnelbana (Extended Metro Administration)

HSN

Hälso- och sjukvårdsnämnden (Public Healthcare Services Committee)

HSF

Hälso- och sjukvårdsförvaltningen (Health and Medical Care Administration)

Internfinans

AB Stockholms Läns Landstings Internfinans

Karolinska

Karolinska Universitetssjukhuset (Karolinska University Hospital)

KcFi

Koncernfinansiering (Group financing)

KuN

Kulturnämnden (Culture Committee)

KuNF

Kulturförvaltningen (Culture Administration)

LFS

Landstingsfastigheter Stockholm

LISAB

Landstingshuset i Stockholm AB

Locum

Locum AB

Lrev

Landstingsrevisorerna (County Council Audit Office)

LSF

Landstingsstyrelsens förvaltning (County Council Executive Board Administration)

MediC

MediCarrier AB

NKS

New Karolinska Solna

PaN

Patientnämnden (Patient Advisory Committee)

PaNF

Patientnämndens förvaltning (Patient Advisory Committee Administration)

SL

AB Storstockholms Lokaltrafik

SCC

Stockholm County Council

SLSO

Stockholms läns sjukvårdsområde (Healthcare Provision Stockholm County)

SoN

Health and Social care Committee in Norrtälje

St. Erik

St. Eriks Ögonsjukhus AB

StSAB

Södertälje Sjukhus AB

SÖS

Södersjukhuset AB (Stockholm South General Hospital)

TioHundra

TioHundra AB

TF

Trafikförvaltningen (Traffic Administration)

TN

Trafiknämnden (Traffic Committee)

WÅAB

Waxholms Ångfartygs AB

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127

Contact information Administration Corporate registration number SCC: 232100-0016 Metro Expansion Administration Box 22550 SE-104 22 Stockholm Health and Medical Care Administration Box 6909 SE-102 39 Stockholm Tel: +46-8-123 132 00 E-post: [email protected] Karolinska University Hospital Huddinge: 141 86 Stockholm Tel: +46-8-585 800 00 Solna: SE-171 76 Stockholm Tel: +46-8-517 700 00 www.karolinska.se

Cultural Administration Box 38204 SE-100 64 Stockholm Tel: +46-8-690 51 00 E-post: [email protected] County Council Auditors Box 22230 SE-104 22 Stockholm Tel: +46-8-737 25 00 E-post: [email protected]

Public Healthcare Services Office* Box 801 SE-761 28 Norrtälje Healthcare Provision, Stockholm County Box 17914 SE-118 95 Stockholm Tel: +46-8-123 400 00 E-post: [email protected] www.slso.sll.se

County Council Executive Board Administration Box 22550 SE-104 22 Stockholm Tel: +46-8-737 25 00 E-post: [email protected]

Traffic Administration Box 30103 SE-104 25 Stockholm Tel: +46-8-686 16 00 E-post: [email protected]

Patient Advisory Committee Administration Box 17535 SE-118 91 Stockholm Tel: +46-8-690 67 00 E-post: [email protected]

* jointly with Norrtälje Municipality

MediCarrier AB Corp.reg.no. 556543-6168 Finspångsgatan 44 SE-163 53 Spånga Tel: +46-8-795 28 00 E-mail: [email protected]

Södersjukhuset AB Corp.reg.no. 556595-7403 Sjukhusbacken 10 SE-118 83 Stockholm Tel: +46-8-616 10 00 www.sodersjukhuset.se

St. Eriks Ögonsjukhus AB Corp.reg.no. 556574-3589 Polhemsgatan 50 SE-112 82 Stockholm Tel: +46-8-672 30 00 www.sankterik.se

Södertälje Sjukhus AB Corp.reg.no. 556775-9922 SE-152 86 Södertälje Tel: +46(0)8-550 240 00 E-mail: [email protected] www.sodertaljesjukhus.se

Companies Ambulanssjukvården i Storstockholm AB Corp.reg.no. 556461-6695 Box 5191 SE-121 18 Johanneshov Tel: +46-8-602 62 50 E-mail: [email protected] www.aisab.nu Danderyds Sjukhus AB Corp.reg.no. 556575-6169 SE-182 88 Danderyd Tel: +46(0)8-123 550 00 www.ds.se Folktandvården Stockholms län AB Corp.reg.no. 556574-3597 Box: 6420 SE-113 82 Stockholm Tel: +46(0)8-123 166 00 E-mail: [email protected] www.ftv.sll.se Landstingshuset i Stockholm AB Corp.reg.no. 556477-9378 Box 22550 SE-104 22 Stockholm Tel: +46-8-737 25 00 Locum AB Corp.reg.no. 556438-7909 Box 17201 SE-104 62 Stockholm Tel: +46(0)8-123 170 00 www.locum.se

128

Stockholm Care AB Corp.reg.no. 556253-1896 Box 6423 SE-113 82 Stockholm Tel: +46-8-672 24 00 E-mail: [email protected] AB Stockholms Läns Landstings Internfinans Corp.reg.no. 556449-9183 Box 22550 SE-104 22 Stockholm Tel: +46-8-737 25 00 AB Storstockholms Lokaltrafik, SL Corp.reg.no. 556013-0683 SE-105 73 Stockholm Tel: +46-8-686 16 00 www.sl.se

TioHundra AB Corp.reg.no. 556595-7395 Box 905 SE-761 29 Norrtälje Tel: +46-176-32 60 00 E-mail: [email protected] www.tiohundra.se Waxholms Ångfartygs AB Corp.reg.no. 556087-9859 Box 7422 SE-103 91 Stockholm Tel: +46-8-614 64 50 E-mail: [email protected] www.waxholmsbolaget.se

 To contents

Ovan här placeras svanen- och FSC-märkningen in

For 2014, we prepared an annual review in addition to the formal annual report. The annual review describes the County Council’s efforts and objectives and contains an overall description of the financial results for 2014. Both the annual report and annual review for 2014 are on our website www.sll.se Printed copies of the 2014 annual report and annual review can be ordered at: [email protected]

Graphic design: Fidelity Stockholm Photo: Erja Lempinen page 1, Anna Molander page 3 and 4, Jan Danielsson page 4.

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131

County Council Executive Board Administration Box 22550, SE-104 22 Stockholm Telephone: +46-8-737 25 00 www.sll.se

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