SICK NOTES IN THE FIRING LINE: ACT’S WELFARE CLAIM NEEDS EVIDENCE, NOT VIBES
If doctors are routinely certifying people who can work, where are the audits, the data, or the documented cases?
A claim circulating in New Zealand political chatter this week says ACT is accusing doctors of wrongly signing people off as unable to work. It is a potent line: simple villain, simple cure, excellent fuel for a welfare crackdown. There is just one awkward problem. On the public record available for this story, the evidence for a widespread problem has not appeared.
A targeted search for recent ACT releases, speeches and policy material found no published ACT document setting out figures, audits, Official Information Act material, disciplinary cases or even a clear worked example showing doctors are routinely mis-certifying beneficiaries as unable to work. ACT has campaigned broadly on welfare “accountability”, but the specific claim about doctors and work-capacity certificates is, so far, much easier to find as political framing than as substantiated fact.
That distinction matters. A social-media spike is a smoke alarm, not the fire report. It can show a claim is travelling. It does not show the claim is true.
What the official system actually says is more prosaic. Work and Income’s guidance says a Work Capacity Medical Certificate helps MSD understand how a person’s health condition, injury or disability affects their ability to work or study, what support they need, what benefit may be appropriate, and whether they should look for suitable work full-time or part-time.[1] Crucially, the same guidance says a medical certificate “doesn’t affect whether a person is eligible for financial support” from Work and Income.[1]
In plain English: the certificate is not a magic benefit ticket. It informs obligations. It helps decide whether someone must look for full-time work, part-time work, prepare for work, or have obligations deferred because they are too unwell or disabled to comply.
The certificate can be completed by medical practitioners and nurse practitioners; dentists and midwives can certify in limited circumstances, such as dental-related or pregnancy-related incapacity.[2] The clinician is asked to give information about the person’s condition and capacity, not to run the welfare state from a consulting room.
There are safeguards already. If MSD thinks the information is inadequate, unclear, or does not fit with other information, it can seek a second opinion from a Designated Health Practitioner.[3] Work and Income says those second opinions can be requested where the certificate does not appear to align with other evidence, or where another opinion would help clarify a person’s capacity.[3] The idea that doctors’ notes simply sail through the system untouched is not what MSD’s own process describes.
The scale of the affected population is real, and large enough that any policy change would matter. MSD’s monthly reporting in early 2026 showed about 125,000 people on Jobseeker Support classified as work ready, and about 96,000 on Jobseeker Support for health condition, injury or disability reasons.[4] Figure.NZ’s MSD-based data shows roughly 105,000 people receiving Supported Living Payment, most because of their own health condition, injury or disability, and a smaller group as carers.[5]
Those numbers do not prove abuse. They prove that illness, disability and injury are major features of the benefit system. This will surprise only people who have never met a spine, a brain, a labour market, or a landlord.
The missing number is the one ACT would need for its argument: how many medical certificates are wrong, misleading, fraudulent or unsupported, and how many of those involve wrongdoing by doctors rather than changing symptoms, incomplete forms, administrative error, or disagreement about what counts as “suitable work”. MSD does not routinely publish annual counts of work-capacity certificates received, how many are challenged, how many are overturned after second opinions, or how many cases of fraud are specifically tied to medical certification.
That absence cuts both ways. It does not prove every certificate is accurate. Any large administrative system will contain errors, and some people will try to game it. But if politicians want to put doctors in the dock, they need more than a useful anecdote and a raised eyebrow.
The clinical reality is messy. A person may be able to stand for 20 minutes but not eight hours. They may be capable on Monday and flattened by Friday. Depression, chronic pain, long Covid, cancer treatment, epilepsy, autoimmune disease, addiction recovery and trauma do not always arrange themselves neatly around job-search obligations. Nor does the labour market kindly produce flexible, nearby, accommodating work on demand.
That is where political slogans tend to cheat. “Can work” can mean “can perform some tasks under ideal conditions”. It can also mean “can reliably get and keep paid work, with transport, medication, appointments, symptoms, employer tolerance and enough stability not to collapse after week two”. Those are not the same thing.
There is international warning here. The United Kingdom’s Work Capability Assessment became a byword for bureaucratic cruelty after years of criticism from disabled people, doctors and campaigners. One study reported by the Guardian linked the programme between 2010 and 2013 to an additional 590 suicides, 279,000 new mental health cases and 725,000 extra antidepressant prescriptions.[6] Correlation in a complex system is not a tidy morality play, but it is a flashing red light against designing assessments as punishment machines.
Australia has had its own problems. A Senate committee report on the Disability Support Pension noted that impairment-table rules, including the requirement to score 20 points on a single table for some applicants, created specific barriers for people trying to qualify for support.[7] Stricter assessment systems can look clean on a ministerial slide and still fail people with complex, fluctuating or multi-system conditions.
New Zealand has been here before, at least politically. In 2007, National attacked “designated GPs” for allegedly signing hundreds of people onto benefits.[8] The script is familiar: find a professional gatekeeper, imply softness, promise toughness, harvest applause. The risk is that the applause lands on people with the least power in the room.
None of this means medical certification should be immune from scrutiny. It should not be. If certificates are vague, MSD should seek clarification. If a practitioner knowingly provides false information, professional and legal consequences should follow. If MSD’s forms produce poor information, fix the forms. If doctors need clearer guidance, provide it. If second-opinion data is not published, publish it.
But “accountability” has to mean evidence-based checking, not intimidation by press release. Doctors have duties to provide independent clinical judgement, to act within their competence, and to avoid harming patients. Turning them into welfare police risks distorting that role. It also risks pressuring sick and disabled people to perform wellness for a bureaucracy that already holds the purse strings.
The sensible policy path is not mysterious. Publish the data: certificate volumes, review rates, second-opinion outcomes, appeals, fraud findings and error categories. Separate doctor misconduct from client error and MSD disagreement. Fund access to treatment and rehabilitation. Build pathways into suitable work rather than pretending any work is suitable if the spreadsheet is impatient enough.
Until then, the basic standard is simple. If ACT, or any party, wants to accuse clinicians of enabling welfare abuse, it should bring the receipts. Not vibes. Not one viral post. Receipts.