Response to interpellation 2024/25:638 on the Social Insurance Agency's coordination mandate
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
M argues that the government is taking powerful measures in the budget bill for 2025 to improve support for return to work and strengthen the work principle 1 2. M emphasizes that it is a shared responsibility between the public sector, the employer, and the person on sick leave to promote return to work 1 2. M argues that the government is tasking Försäkringskassan and Arbetsmiljöverket to strengthen the coordination and supervision of employers' responsibilities 1 2. M considers the government's investments in the healthcare system's work with mental health to be very positive 3. S argues that Försäkringskassan lacks the tools to ensure that the healthcare provider and the employer do their part 4. S wants to see a sickness insurance that can be relied upon, where Försäkringskassan functions more as an advocate than a gatekeeper 4. S argues that the government's measures are not sufficient and that there must be possibilities for sanctions when employers do not establish plans for return to work 5. S wants to see requirements for better cooperation for access to rehabilitation support and a coherent sickness insurance 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Anna Tenje (M)
Mr. Speaker! Åsa Eriksson has asked me what I intend to do so that Försäkringskassan's coordination mandate can be carried out in a better way so that more people on sick leave receive help with rehabilitation.
It is important that those who are on sick leave are able to participate in effective measures in the form of various treatment and rehabilitation interventions, as well as any coordination measures to counteract unnecessarily long sick leaves. It is also desirable to promote measures that need to be taken in connection with the workplace.
All responsible actors need to contribute for the support for return to work to function effectively. The public sector has a great responsibility through, among other things, healthcare and our social insurances to help those who have become ill to regain their capacity to work.
The employer likewise has a great responsibility to create sustainable and safe workplaces to prevent injuries and sick leave, but also to adapt and provide support during the return to work. Finally, it is obviously also important that the person who has been signed off sick takes their responsibility by participating in planned rehabilitation measures and the meetings with the employer and authorities that are required for a good and orderly return to work.
It is a shared responsibility for the whole to function. From this starting point, the government in the budget bill for 2025 (prop. 2024/25:1) has presented a full battery of measures to improve support for returning to work. Taken together, the government's measures aim to facilitate for people to return to the labor market earlier, which strengthens the work line, enables self-sufficiency, and contributes to promoting Sweden's growth.
Employer measures can be crucial for a sick-leave employee to be able to return to work. Employers are, according to law, obliged to establish plans for return to work when an employee has been on sick leave for 30 days. To support the measures in the workplace, the government has developed the grant to employers for the purchase of workplace-oriented rehabilitation support.
The Government has tasked Försäkringskassan with strengthening the agency's work in following up on employers' plans for return to work as well as strengthening the coordination of rehabilitation efforts for those on long-term sick leave. Försäkringskassan has been allocated 50 million kronor for such an increase in ambition.
Försäkringskassan and Arbetsmiljöverket have further been tasked to develop their cooperation and supervision of employers' work environment and rehabilitation responsibilities. The Government will follow up on the tasks that have been given. The authorities shall, among other things, report on measures taken and planned, and expected effects.
In the budget bill for 2025, the government announced a review of the possibility of work assessment for a shorter period with maintained sickness benefit. It aims to lower the thresholds for returning to work. I am pleased that such a proposal has now been referred.
The government also strengthens the conditions for the healthcare system's work with sick leave and rehabilitation, which in turn improves the possibilities for those who are on sick leave to return to work as soon as possible, for example through the assignment the government has given Socialstyrelsen to pay out state grants to the regions to strengthen and develop primary care's work with mental ill-health.
Mr. Speaker! I am well aware of the challenges that the coordination mandate entails, but at the same time, I cannot emphasize enough the very important role that Försäkringskassan has in promoting that necessary measures are identified and taken by responsible actors. That being said, the government will, of course, analyze more closely the conclusions and recommendations of the Inspectorate for Social Insurance regarding Försäkringskassan's coordination mandate.
In summary, Mr. Speaker, the government is taking powerful measures to strengthen all responsible actors' efforts to facilitate a return to work, which in turn has a positive impact on Försäkringskassan's opportunities to carry out its coordination mandate.
Åsa Eriksson (S)
Mr. Speaker! Thank you, Minister, for the opportunity to debate the vital health insurance once again!
I want to dedicate this debate to all of us who are healthy right now but who are well aware that it can change very quickly. Imagine that you become sick leave, that you have a medical diagnosis, that you have a job you want to return to but that the body or perhaps the psyche cannot bear right now. Then you expect, of course, that society steps up. That is how it should be. But in today's Sweden, it is no longer a given.
Mr. Speaker! As we have heard here, Försäkringskassan is required by law to coordinate rehabilitation so that one receives help to regain their capacity for work. It is a fundamental mission. But when the coordination does not work, as is far too often the case today, it is not the employer or the healthcare system that takes the biggest hit, but it is the individual who is ill. It is that person who is left alone and who risks being left without compensation if it takes too long, despite still being ill.
Mr. Speaker! When it comes to the Social Insurance Inspectorate's review of the coordination mandate, it is actually no news that it is failing, but it is a wake-up call. Many have experienced that the coordination mandate does not work, but unfortunately, far too little has been done about it.
It appears from the report that Försäkringskassan lacks the tools to ensure that the healthcare provider and the employer do their part. They often have other priorities, and employers often lack knowledge. Who is it then that suffers? Yes, the one who is already ill. This is not worthy of a secure welfare state. We see now that the sickness insurance has sometimes become more occupied with assessing than with supporting people back into work.
We Social Democrats stand for a different line. We want to see a health insurance that one can rely on and a society that in all parts strives for that the person who is ill receives support, help, and rehabilitation to regain their capacity for work and quickly return to work. The state shall not be passive, but the state shall help to hold society together. Försäkringskassan shall be more of a representative, not just a gatekeeper.
It is time for the SD-led government to take this problem seriously. You Moderates speak passionately about the work line, which is good, but you seem to have forgotten that illness is not a choice. When the state does not coordinate the measures, you fail the individual, and that must come to an end.
Today, it is clear in the legislation that Försäkringskassan should request the employer's plan for return to work for those who are on sick leave. I wonder: Does the Minister intend to act so that the coordination mandate works for all those on sick leave and change it so that Försäkringskassan shall request a plan for return to work from the employer?
Statsrådet Anna Tenje (M)
Mr. Speaker! I am very pleased that the member is raising this important issue.
For those who follow the debate on what is happening in this area, and perhaps also the previous debate that I just had, Mr. Speaker, it is probably difficult to avoid noticing that I myself and the government have a completely different level of commitment to this issue than my predecessor did.
I am therefore very happy to have the opportunity to tell in the chamber about all the good things that are now happening in the area. These are things that could and should have been done a long time ago, and where the government is now taking powerful measures to strengthen all responsible actors' efforts to facilitate a return to work. This, in turn, has a positive impact on Försäkringskassan's opportunities to carry out the coordination mandate that we are discussing here today.
As I began by saying, it is a collective responsibility for the whole to function. From this starting point, the government has, in the budget bill for 2025, presented a whole battery of measures to improve the support for returning to work.
Mr. Speaker! This bill aims to facilitate for people to return to the labor market earlier. It strengthens the work line, enables self-sufficiency and contributes to Sweden's growth, so it is truly of great importance that those who are on sick leave are able to take part in effective measures such as various treatment and rehabilitation measures as well as any coordination measures to counteract unnecessarily long sick leaves.
It is also important to promote measures that need to be taken in connection with the workplace. Försäkringskassan's mission to strengthen the authority's work with monitoring the employer's plans for return to work, as well as to strengthen the coordination of rehabilitation efforts for those on long-term sick leave, is such a measure. Just these plans for return to work are an important tool that we are now significantly strengthening by ensuring that Arbetsmiljöverket but also Försäkringskassan shall monitor that one does what one is supposed to do as an employer.
The government will, of course, follow up on the assignments that have been given to Försäkringskassan, Arbetsmiljöverket, and Arbetsförmedlingen. The agencies shall, among other things, report on measures taken and planned, as well as the expected effects. This is an assignment that we have given now. It should have been given a long time ago, but at that time the commitment was lacking and it was obviously not seen as a good way forward. But precisely what the member is requesting is what we have now tasked the agencies to do.
On several points, we are now strengthening and facilitating for people to return to work. The proposal on work trials is another excellent example – in personal dialogue with their employer, one can try working completely without performance requirements but with maintained sickness benefit.
This is what we are doing now, but Svenskt Näringsliv and SKR have long requested such an opportunity after Försäkringskassan stopped working in that way, which was done until 2016. You had the opportunity when you sat in the government to actually act on the petition from both SKR, Svenskt Näringsliv, and Försäkringskassan regarding these issues, but you chose not to do so. Now we ensure that this happens. We are now proceeding with the bill on work trial with maintained sickness benefit so that this method and this way of working become possible again.
Åsa Eriksson (S)
Mr. Speaker! ISF's report is very clear: the assignments that Anna Tenje has given in this year's budget are not enough. They are good; we do not oppose them, but it is not sufficient. It will not make a big difference.
It is not enough for the Minister to stand here and say nice words about shared responsibility. It sounds good, but it is not happening. It is still the case that Försäkringskassan should request a plan for return to work. The Government has no sanction possibilities whatsoever when employers do not produce a plan for return to work.
We Social Democrats believe that there must be. The healthcare system shall do its part. The employers shall do their part. Försäkringskassan must be given a clearer mandate to coordinate the measures so that the individual receives support and help to return to work.
It is true that we Social Democrats did not do this when we were in government. That was because we prioritized removing the Moderate stumbling block in the health insurance that caused cancer patients and others to be cast out without support and were left to fend for themselves despite being ill. We prioritized reforming the regulatory framework so that one was not dismissed from their job after 180 days because they had not managed to get well, perhaps because they had not received sufficient interventions.
Yes, it is about priorities. But we Social Democrats are not satisfied. We will not stop until Sweden has a health insurance worth the name, a health insurance that all wage earners can rely on when their ability to work declines.
Mr. Speaker! The government has the power to act but does not do so. We all know, both Anna Tenje and I and several others sitting here in the chamber, that when coordination really works, it makes a real difference. Then things happen for people. Then one succeeds in putting their life together. With support and help, one can increase their work capacity and, in peace and in security, return to work. That is what we should do instead of bouncing individuals around between different agencies or leaving them alone and letting Försäkringskassan have this unclear coordination mandate, which, according to ISF's report, does not work.
We Social Democrats will continue to fight for safety nets that will be there when life takes a turn. That is how it should be in a solidary welfare state. We want to see demands for better cooperation for access to rehabilitation support and a unified health insurance. That is how we build Sweden safely and strongly together.
I want to ask the Minister Anna Tenje once again: Will the government take the ISF's recommendation to heart and appoint a review of Försäkringskassan's coordination responsibility, and if so, when?
Statsrådet Anna Tenje (M)
Mr. Speaker! Regarding the report that ISF has presented, I just want to emphasize that I think ISF's reports are always good. More information and more knowledge is always good.
ISF's reasoning regarding the complexity and challenges of the coordination mandate has been known for some time. The Government is well aware of all responsible actors. It concerns Försäkringskassan, the employer, and the health and medical care. All these actors need to contribute for the support for return to work to function effectively. The individual obviously has an important part in this.
I am well aware of the challenges that the coordination mandate entails. In this, Försäkringskassan has a very important part and an important role in promoting that necessary measures are identified and taken by responsible actors.
ISF's conclusions are not, however, based on any study of the outcome in any individual cases. ISF's review provides an overview of the coordination mandate and the challenges it entails for Försäkringskassan, the health and medical care, and the employers. The initiatives that the government has taken to strengthen the support for return to work mean that there are better conditions today than previously for Försäkringskassan, employers, and the health and medical care to take their statutory responsibility.
The government's initiatives regarding the healthcare system's work with mental health are also judged to clarify the healthcare system's responsibility and work to ensure that people on sick leave can return to work, which is very positive. The government has clarified its expectations for Försäkringskassan's coordination mandate and given the authorities increased resources precisely to strengthen this work. That being said, the government will, of course, analyze ISF's conclusions and recommendations regarding Försäkringskassan's coordination mandate more closely.
At the same time, we continue with undiminished strength our important work of lowering thresholds and opening more doors to employment.
Åsa Eriksson (S)
Mr. Speaker! It is unfortunately frighteningly clear what can happen to individuals when the coordination mandate does not function.
This week we could read in an article in Arbetsvärlden that Arbetsförmedlingen now has a project where they are trying to conclude troublesome cases, that is, unemployed people who have ill health. It would not surprise me if many of the individuals included in this project are such as have been on sick leave but have not received coordinated help. The coordination mandate has failed so that they have been moved over to Arbetsförmedlingen despite not having sufficient work capacity to manage a job. That is why we have, for example, the excellent safety net legislation Finsam to catch these individuals.
Mr. Speaker! Yesterday, I took the initiative to call the directors-general of Arbetsförmedlingen and Försäkringskassan to the Riksdag for a joint inquiry on why they do not use the safety net legislation Finsam to help people who are unemployed and have ill health instead of starting a project on how to terminate them. The question is what happens to their work capacity then.
Mr. Speaker! Again: I mean that Anna Tenje and the government need to take ISF's report seriously. I mean that an investigation needs to be appointed on how Försäkringskassan's coordination responsibility can be clarified for the sake of the individuals. It is time for the government to stop dodging. Put the individual's right to support first!
Statsrådet Anna Tenje (M)
Mr. Speaker! I would like to begin by saying thank you for the debate and for the interpellation.
I also think it is an excellent initiative by the member to call responsible directors to the committee. I am completely convinced that the member's concerns there will receive clear answers, that is to say that it is not about eliminating people but about providing the right support at the right time. It is about not doing what the previous government loved to do, namely hiding and forgetting people in statistics, but instead implementing the right measures at the right time so that one can get closer to the labor market and closer to inclusion but also find the right place in society.
Undoubtedly, a great deal is happening in this area. The Government is very active in the work of lowering the thresholds and opening the doors back to work for as many as possible. Today, Mr. Speaker, I have presented a broad palette of measures that I believe will be of great significance for the affected groups.
I welcome, once again, ISF's report and will further analyze these conclusions at the Ministry of Social Affairs. But above all, I now look forward to the continued work with work trials, partial suspension of sickness and activity compensation for studies, and other important reforms that make it both easier and more accessible for more people to find ways back to the work community and self-sufficiency.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.