Response to interpellation 2024/25:736 on the initiative to provide doctors with the right conditions for issuing sick leave
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 prioritizes the healthcare system's work with sick leave and rehabilitation by strengthening Socialstyrelsen's mandate with a fivefold increase in funds 1. M wants to give doctors the right tools and support for correct medical certificates and mark against false medical certificates and welfare crime 1 2. M considers it serious when doctors help open the door to the welfare system through false certificates 3. M argues that more measures have been taken to support return to work and curb benefit fraud during the last three years than during nearly a decade of Social Democratic rule 3. M argues that the Social Democratic government chose not to prioritize the work against labor-related crime or organized crime 4. M emphasizes that the current government is working on many fronts to protect tax money, put a stop to benefit crime, and provide the right conditions for correct assessments 4. S argues that the sickness insurance is an important social contract that is disrupted if doctors lack competence 5. S considers that the government is not doing enough about the acute shortage of specialist doctors within occupational medicine and requests long-term funding for specialist training 5. S wants a national competence center to improve work ability assessments 6. S advocates for simplified certificates for short, uncomplicated sick leaves to reduce administration and shorten the time until return to work 6.
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)
Madam Speaker! Åsa Eriksson has asked me when I and the government intend to take the initiative to implement the proposals in the investigation Right conditions for sick leave (SOU 2023:48) and thereby give doctors the right conditions for correct sick notes.
During an interpellation debate on February 11, 2025, I answered, among other things, the member's question regarding what the government intends to do to ensure that the proposals in the report *Rätt förutsättningar för sjukskriving* become a reality. I am pleased to once again be able to answer the question of what measures the government has taken or intends to take.
I would like to particularly highlight the reinforced and extended mandate that the government gave Socialstyrelsen in May 2025 to strengthen the healthcare system's work with sick leave and rehabilitation. The government's reinforcement involves a fivefold increase in the funds for the mandate so that Socialstyrelsen can, to an even greater extent, meet the identified need for practical support for the regions' work with sick leave and rehabilitation.
The purpose, Madam Speaker, is to secure the basic prerequisites for work with sick leave and rehabilitation. The National Board of Health and Welfare shall, among other things, support the regions' management work with sick leave and rehabilitation. The National Board of Health and Welfare shall also provide support in the implementation of routines in the work with sick leave and rehabilitation in an operationally close manner.
The Government has, in addition, taken into account several of the proposals in the report.
In June, the government tasked E-hälsomyndigheten and Socialstyrelsen to continue the work of developing and providing a coherent certificate management for certificates from health and medical care, social services, and dental care. At the same time, the government tasked Försäkringskassan to standardize and make the agency's medical certificates uniform, with the aim of making it easier to introduce a nationally coherent management of certificates.
In May, I submitted to the Social Affairs Committee a proposal on work trial with maintained sickness benefit in order to lower the thresholds for returning to work.
The Government has further tasked Karolinska Institutet to prepare the integration of the task to monitor and promote occupational health care regarding the competence supply.
In October last year, the government tasked the Swedish Social Insurance Agency and the Health and Social Care Analysis Authority with following up on the Act (2019:1297) on coordination measures for persons on sick leave. The purpose of the follow-up is that the support for patients on sick leave shall be designed according to their needs as well as facilitate and accelerate the rehabilitation process.
In summary, there is no doubt that the conditions for the healthcare system's and doctors' work with sick leave and rehabilitation are prioritized by the government.
But at the same time, it is important to remember that there are doctors who intentionally issue medical certificates on false grounds so that these certificates can be used as door-openers to the welfare state. This is something that is very serious and something that this government does not accept. As part of the government's systematic work to defend the welfare state from criminal actors, the government in April 2025 gave a special investigator a mandate to investigate what measures are needed to strengthen patient safety and counter welfare crime within health and medical care (dir. 2025:41). The mandate includes, among other things, strengthening the work against false medical certificates.
Åsa Eriksson (S)
Madam Speaker! It is pleasant to be here again in the chamber with the Minister for Social Insurance.
The sickness insurance is one of our important social contracts, a security when we lack the ability to work. But that security is shaken if the doctors issuing sick leave lack the competence to assess the patient's work ability in a correct way, and when there is a lack of skilled occupational physicians who can work preventatively in the workplaces.
The investigation into the significance of medical certificates in sickness benefit cases, which the Social Democratic government commissioned, states in its report "Right conditions for sick leave" that many doctors unfortunately lack sufficient knowledge to write correct statements, which leads to certificates often lacking necessary information for employers, for Försäkringskassan's case officers, and for the rehabilitation process. The substandard quality unfortunately causes unnecessary extra work for Försäkringskassan. It creates frustration for the sick person, who feels questioned and bounced between different instances, and it prolongs the sick leave process, which we all want to prevent.
Madam Speaker! I am pleased with the Minister's answer. It is clear that Anna Tenje has accelerated things following our last interpellation debate in February. Since then, the Minister has, as we just heard, given no fewer than five different assignments to different agencies to improve the work regarding sick leave and medical certificates. Interpellation debates apparently make a big difference, and that is good. Thank you for that, the government!
But the most important question and the biggest problem that the government unfortunately does nothing about. It is about the availability of specialist doctors in occupational medicine. We finance all other specialist medical training together, as with other educations. But just the specialist training in occupational medicine lacks long-term funding. That means we have a glaring shortage of just that competence.
Madam Speaker! I would like to quote directly from a debate article from Altinget that came out this weekend:
"Shortly, the government will present its budget for next year. Ahead of this, we who represent the country's quality-assured occupational healthcare – operating as private companies, embedded within industry, municipalities, regions, and the state – wish to alert the responsible ministers to the acute crisis threatening both public health and the ability to work: the serious shortage of occupational physicians! If powerful measures are not taken now, we risk being left completely without this socially vital expertise within a few years. … When we can work proactively to improve the work environment for those who face the greatest challenges, it ultimately improves for everyone. This makes us a central actor in both labor and equality policy as well as public health policy and in the work to prevent high sickness absence rates."
I cannot express it better myself. Therefore, I snatched this long quote. It is, thus, an acute shortage of doctors in occupational medicine. What does the minister want to answer the occupational health physicians? Will the government do something about the acute threat and propose a long-term joint funding of the specialist training in occupational medicine?
Statsrådet Anna Tenje (M)
Madam Speaker! Thank you, Member, for the contribution and for the quote from the article, which is a very good article. I take that question with me. I think it is an important point that is highlighted. It is also important to keep in mind.
In the row of other measures that we have now taken – perhaps not because of an interpellation debate, Madam Speaker, but perhaps because we have a solid, great interest in these issues and think they are important – there are ongoing, just as I said in the answer, a long series of measures to create better conditions for healthcare and for the doctors' work with sick leave and rehabilitation. These measures collectively contribute to better medical certificates and also reduce the risks of unconscious errors.
This is an important issue, definitely, and the member also highlights that. Not least, it is important for the doctors who every day face complex assessments in just sick leave cases.
The government has during the spring and summer taken several concrete measures to strengthen the healthcare system's work with sick leave and rehabilitation, and the reinforced mandate to Socialstyrelsen involves a fivefold increase in resources. These are clear examples that we not only listen to the professionals' needs but that we also act.
Socialstyrelsen's work to support the regions' management and implementation of routines is now being carried out in a more operationally close manner, which is crucial for the measures to also have a real effect. It is about giving doctors the right tools, the right support, and the right conditions to issue correct and legally secure medical certificates.
The government has also taken the initiative for a unified certificate management, which will reduce the administrative burden and increase the quality of the certificate process. It is an important step towards a more efficient and legally secure welfare.
At the same time, Madam Speaker, it is important to clearly mark against false medical certificates in these contexts. It is a very large problem. That certain actors exploit medical certificates as a way into the welfare system is completely unacceptable. Therefore, in April, just as I said in my previous contribution, we appointed a special investigation with the mandate to strengthen patient safety and counter welfare crimes within healthcare. This work is, of course, part of the government's broader strategy to defend the welfare against criminal actors.
We really want medical certificates to be a tool and a support – not a shortcut to incorrect compensations. I am very well aware that the vast majority of doctors do a fantastic and solid job every day.
Through our assignments to Socialstyrelsen, Ehälsomyndigheten, Försäkringskassan and Karolinska institutet, we in the government show that we take responsibility for both quality and integrity in the sick leave process.
Åsa Eriksson (S)
Madam Speaker! As I have said, I am pleased with the initiatives the government has taken since February, but it is not enough. Of course, all types of welfare crime must be prosecuted; that is something we completely agree on. But I think it is unfortunate that the Minister prefers to cast suspicion on doctors who, without intent, write incorrect certificates because they have too poor knowledge, rather than doing anything about the cause of the poor knowledge. There, we have different views.
Karolinska Institutet was given the assignment earlier this year to coordinate the supply of competence within occupational health care. That is good. It is a step in the right direction, but as said, it is devastating that the specialist education in occupational medicine is not included in this assignment. There, I believe the government has made a fatal mistake.
It is positive that the Minister just a few moments ago said that she is taking this with her. It is very good – one can redo and do right. It is however urgent, because without specialist doctors, the medical expertise that the working life requires is missing. I believe that many of us want this government to value expert knowledge a bit higher than what seems to be being done.
Madam Speaker! The investigation that we have talked about several times highlights the need for a national competence center. I believe that could provide long-term results. More money, which the government has in this year's budget, is welcome. It is good, and it will yield results. But if we are to achieve results in a slightly more long-term way, I believe we need exactly this type of competence center, where cooperation between professions can be developed into a more continuous structure. Doctors issuing sick leave must receive support through cooperation with healthcare, Försäkringskassan, and other actors to improve their assessments of work capacity. I urge Anna Tenje to do something about that matter.
Madam Speaker! Another proposal included in the investigation *Rätt förutsättningar för sjukskrivning* is simplified certificates for short, uncomplicated sick leaves. The Social Democrats consider this a good proposal that is very interesting. We often talk – in all parties – about wanting to reduce unnecessary administration and simplify things. Here, the Social Democrats believe there is a low-hanging fruit that the government should pick – otherwise, the Social Democrats will do it in 2026. It would reduce the administration. We would save precious resources. It would also shorten the time it takes for those on sick leave to return to work, which would be the greatest gain of all.
I would therefore like to ask the Minister: Will the government take the initiative to introduce this long-awaited simplification of certificates for uncomplicated sick leaves?
Statsrådet Anna Tenje (M)
Madam Speaker! I have previously accounted for several important steps and decisive reforms to improve the conditions for sick leave and rehabilitation.
The Chairman said in his speech that I am casting suspicion on doctors, simply because we are now going head-to-head when it comes to protecting the common welfare from crime. That is definitely not the case, but I also do not turn a blind eye to the fact that false medical certificates are used as tools to commit benefit fraud. Every year, 15–20 billion are paid out incorrectly from the state welfare systems. These are tax funds that could have gone to significantly better things. These are tax funds that we must care for and protect and instead direct to those who truly are in need of help and support.
The picture is both extensive and complex when it comes to the fake medical certificates, and the parts we are talking about now are an important piece of the puzzle. It is deeply serious that doctors – people who enjoy a special trust in society – on false grounds help to open the door to our welfare system.
The subsidy crimes are a major problem. Last year, over 22,000 subsidy crimes were reported in Sweden, which represents an increase of over 100 percent compared to 2015, according to statistics from Brå. The member pointed out the problem himself by very clearly showing the Social Democratic position when it comes to subsidy crimes. The member wrote in his interpellation that all types of fraud and corruption should, of course, be prosecuted. This was, however, followed by a "but".
I can state that the Social Democrats were in power for eight years. If one now thinks that it is so important to combat all types of cheating and corruption, one could have been expected to move the positions forward and actually do something, but that was not done. They did not take hold of these issues. They did not appoint any inquiry, which this government has now done. They also did not go head-to-head regarding combating welfare crime. They did not do it during the time they were in a government position, and they do not think it is just as important today.
In three years, more measures have been taken to support return to work and curb benefit fraud than during nearly a decade of Social Democratic rule. It is, after all, the Social Democrats who are the benchmark in this area.
Åsa Eriksson (S)
Madam Speaker! I say as Ola Möller: I ask concrete questions and get, I believe, babbles in return. I think it is disappointing. I think it is a level that does not befit a government. It is, however, an explanation for the minister's and her chief's low trust figures. If one constantly talks about it being others' fault, what one wants to do oneself becomes less credible.
False certificates, which the Minister spoke about, are one thing. They are welfare crimes and must, of course, be condemned, which I have said and written. But that Försäkringskassan now has a new instruction that one should report incorrect medical certificates to the police when the doctors have not had intent is a completely different matter.
We must increase the competence of those doctors who do not make mistakes with intent but happen to make mistakes. That is where the shoe pinches; that is what we must do something about. At the same time, welfare crime and corruption must, of course, be condemned – there we are in complete agreement.
Incorrect sick leaves cause unnecessary loss of income. Substandard medical certificates result in many people being denied sickness benefit despite their work capacity being clearly impaired. This is serious.
It is not a luxury to have doctors with sufficient knowledge. It is not a luxury to have enough specialists in occupational medicine. It is a necessity for people to have confidence in one of our most important insurance systems. I expect the government to do what is necessary for this.
I have asked two concrete questions but have not received any answers. Instead, we get this babble back. I am grateful for that. I hope that answers will come in the Minister's final entry.
Statsrådet Anna Tenje (M)
Madam Speaker! You can call it bjäbb or whatever you want. It is criticism directed at the Social Democrats and what was done during the time they held government power.
There have not been any missing warning signs or lack of knowledge. On the contrary, there has been great knowledge that billions of our common tax funds have gone to grant fraud and organized crime.
It was not actually a lack of time for the Social Democrats to rectify the major deficiencies that existed. They chose, however, not to do so. They chose not to go head-to-head. They chose not to prioritize the work against crime in the workplace or the work against organized crime. What we see today is a result of the paralysis of action that the Social Democratic government exhibited in these areas.
So we cannot have that, Madam Speaker. We must safeguard our common tax resources and put a stop to benefit crime. That is exactly what the government that I represent is doing now. The work is taking place on many fronts. I have accounted for this today. It is a matter of ensuring that more people can return to work and providing the right conditions to make correct assessments. It is also about meeting force with force against those who exploit our welfare system. That is what I am proud of.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.