Direct Request (CEACR) - adopted 2009, published 99th ILC session (2010)

Article 2, paragraphs 1 and 3, of the Convention. National policy concerning nursing services and nursing personnel. The Committee recalls its previous comments in which it requested the Government to outline the objectives and priorities of its policy concerning nursing services and to describe any plans, programmes or initiatives aiming at improving the quality of nursing care. In the absence of the Government’s reply on this point, the Committee is obliged to reiterate its request for a comprehensive account on its national health-care policy, especially as regards measures to facilitate the effective utilization of nursing personnel in the country and to promote the fullest use of the qualifications of nursing personnel in the various health-care establishments.

In addition, the Committee notes that according to its Annual Report for 2006, the Department of Nursing Services Standards of the Ministry for Social Policy has completed a report entitled “Nurse Workforce Projections 2007–20” containing projections of the nursing workforce needed during that period. It requests the Government to provide a copy of the Nurse Workforce Projections, and to specify in this respect: (i) whether this document was prepared in consultation with the employers’ and workers’ organizations concerned; and (ii) what concrete measures are taken or envisaged in order to follow up on the findings of the report.

Article 2, paragraph 2, in conjunction with Article 5, paragraph 3. Shortage of nurses and settlement of disputes. The Committee notes that according to various sources, there is a long-standing problem of shortage of nursing staff which has become particularly acute since the opening of a new hospital and the extension of another. The Malta Union of Midwives and Nurses (MUMN) in its Memorandum 2008–09 indicates that the staff shortage causes major problems, including cancellation of vacation leaves, extension of working hours and overtime as well as stress and burnout. The MUMN adds that the shortage of nurses is expected to worsen due to the low number of students graduating from the Institute of Health-care each year which hardly replaces the loss of staff mainly due to retirement or maternity reasons. More generally, the Committee notes that the brain drain in the health sector is caused by an increasing number of medical doctors and nurses who migrate abroad for better wages, which in 2007 led the authorities to try to recruit English-speaking nurses from other EU countries. In addition, it understands that the understaffing in the nursing sector has given rise to important industrial action in autumn 2008, the dispute relating also to the payment of a meal allowance and to a number of changes in the nursing courses in order to attract more students to the profession. The Committee requests the Government to provide detailed information on the current situation concerning the shortage of nursing personnel and to elaborate on any practical measures taken in consultation with the workers’ organizations concerned in order to tackle effectively the root causes of the problem and to formulate sustainable solutions. The Committee would also appreciate receiving additional explanations on the outcome of the recent industrial dispute between the Government and the MUMN especially in the light of Article 5(3) of the Convention which requires the settlement of collective labour disputes through independent and impartial procedures such as mediation, conciliation and voluntary arbitration with a view to making it unnecessary for the organizations of nursing personnel to have recourse to industrial action which may be disruptive of sensitive health-care operations.

Article 3, paragraph 1. Nursing education and training. The Committee notes the information provided by the Government concerning the new diploma, degree and postgraduate courses offered by the University of Malta’s Institute of Health-care, which is the main academic institution providing basic nursing education, but also continuing professional development courses for registered nurses. It also notes the statistical information concerning the number of graduates in nursing, health sciences and other related specialized fields. The Committee would appreciate if the Government would continue providing all relevant information in this respect.

Articles 5 and 6. Collective bargaining concerning employment and working conditions of nursing personnel. The Committee once again requests the Government to provide copies of all collective agreements currently in force concerning the employment and working conditions of nursing personnel in the public and the private sectors.

Article 7. Occupational safety and health of nursing personnel. In the absence of the Government’s reply on this point, the Committee requests the Government to indicate any measures taken or envisaged with a view to improving the protection of nursing personnel from infectious diseases, including HIV/AIDS. In this connection, the Committee draws the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to assisting health services in building their capacities to provide their workers with a safe, healthy and decent working environment as the most effective way both to reduce transmission of HIV and to improve the delivery of care to patients. The Committee also wishes to refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS.

Part V of the report form. Application in practice. The Committee would be grateful if the Government would continue providing up to date and documented information concerning the application of the Convention in practice, including, for instance, the number of students attending or graduating nursing schools every year, the number of practising nurses registered with the Council for Nurses and Midwives, the nurse–population ratio, copies of official reports addressing nursing-related issues, for instance, studies undertaken by the Department of Nursing Services Standards, the Council for Nurses and Midwives or the Institute of Health Care, etc.