Blog post

Strengthening social dialogue in the hospital sector in the East, South and Central Europe

Expert insights from the 'Strengthening social dialogue' regional workshop.
Kate Ling

15 November 2019

On 15 November I  attended a workshop in Rome jointly organised by HOSPEEM (the European Hospital and Healthcare Employers’ Association), and EPSU (European Public Service Union).  The event was the second of 3 conferences funded by the European Union as part of a project to strengthen social dialogue across the EU - you can read more on this project here.

“Social dialogue” is a term unfamiliar to most people in the UK – it refers to joint working, including negotations, between representatives of employers’ associations and their trade union counterparts. In the UK for example this would be the CBI and the TUC – except that we don’t really “do” social dialogue in the UK in the way that it’s done in many European countries. In some countries, for example Austria, employment legislation is based on agreements reached between employers, trade unions and government, and this method of setting wages and terms and conditions is embedded in the Nordic countries. They find it rather odd that matters such as occupational health and safety and employee rights (for example maternity/paternity leave) are NOT reached by consensus between the two “sides” of the workforce at national level. 

We do of course have social partnership working in England  in the NHS - you can read more here on how NHS employers and the NHS trade unions do valuable joint work on a wide range of topics such as bullying and harassment, mental wellbeing and working longer, but this method of collaborating is not enshrined in legislation at national level.

Social partners have far more power at EU level and the NHS Confederation, through our membership of HOSPEEM, can speak up loudly for our members at this level.  HOSPEEM and EPSU, as recognised social partners, have the right to be consulted about all proposed EU legislation touching on workers’ rights, such as working time, health and safety and work/life balance, and can significantly change and influence EU laws at all stages, including as they pass through the European Parliament.  Social partners even have the right to conclude agreements which are then “rubberstamped” at EU level and become EU-wide law – an example of this is the Directive on protecting healthcare workers from sharps injuries, which started life as an agreement and became binding legislation. 

In addition to legislation, social partners work together on codes of conduct, guidelines and good practice covering a wide range of employment-related areas. 

Every country has a different history of industrial relations: in some social dialogue is strong, in others it’s non-existent. The healthcare sector is very diverse as in some EU countries healthcare workers in the public sector are employed directly by the State (the Ministry of Health). In others, healthcare is provided primarily by the private (profit or not for profit) sector, with a multiplicity of different employers, or certain groups of workers such as doctors (in secondary as well as primary care) are independent contractors. And in the UK we have a different model again whereby in secondary care each provider is an autonomous employer but pay and conditions of service are negotiated nationally. 

The event in Rome, hosted by Italian healthcare employers and unions, brought together representatives of employers and trade unions from across Europe, but with a focus on Southern Europe, in particular those countries which do not currently have members in both HOSPEEM and CEEP. (Malta, Cyprus, Portugal, Spain, Greece). The workshop showcased the current work being undertaken by social partners on topics such recruitment and retention in the healthcare sector, lifelong learning, occupational safety and health, and tackling violence and harassment. A particularly interesting presentation from Sweden demonstrated how deeply embedded Swedish social partners are in influencing national social and economic policy and meeting EU recommendations in these areas.

I found especially interesting the dialogue with Malta and Cyprus, countries which have strong historic links with the UK and (for example) import a high proportion of medicines from the UK, train many professionals here, and send many patients for specialist treatment which is unavailable in their much smaller healthcare systems. This led to interesting conversations about the potential impact of Brexit, for example on supply of medicines and reciprocal healthcare.

A report on each of the “target” countries, developed collaboratively with the relevant employers/unions, was presented and discussed to identify the challenges in that country and the areas where social partner working could be most effective. Many of them identified similar issues such as staff shortages, need for digital upskilling and staff development, burnout, attracting young people to the sector, strained budgets and the need for reform and sustainability in the sector. The exchanges between the countries concerned, pointing up both similarities and differences, was fascinating and resulted in a determination to reinvigorate  social dialogue and make the most of sharing good practices and experiences. 

Conference: Strengthening social dialogue: regional workshop 2 - Southern Europe, Rome, 15 November 2019