European Hospital & Healthcare Employers’ Association

HOSPEEM response to the European Commission Green Paper Consultation on the European Workforce for Health

This paper summarises the responses received from HOSPEEM members to the Commission’s consultation on European Workforce for Health. HOSPEEM members recognise there are many common challenges on workforce which EU healthcare systems face and welcomes the Commission’s intention to open a wide ranging debate to attempt to identify solutions.

FULL TEXT: HOSPEEM response to EC Green Paper – Euro Workforce

HOSPEEM Position Statement on the Proposal for a Directive of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare

On the 2nd July 2008, the European Commission published its proposal for a Directive of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare. This follows the open consultation that the Commission ran between September 2006 and January 2007 which came in response to a series of European Court of Justice (ECJ) Judgments on health services in the European Union.  The ECJ-Judgements stated that, under certain conditions, EU citizens were entitled to access healthcare in another Member State and be reimbursed for this treatment by their national health systems. The judgments have created uncertainty surrounding the interpretation of case law at European level for patients and for the national healthcare systems.

HOSPEEM supports the desire to establish legal certainty regarding patients’ rights in relation to healthcare treatment in other EU Member States, thus avoiding the situation whereby the ECJ exercises political authority in the field by virtue of its rulings in individual cases. However, the Directive goes beyond the rulings of the ECJ, both in relation to the scope and the content of the Directive, most notably in relation to prior authorisation systems.

HOSPEEM questions that Article 95 of the EC Treaty, relating to internal market harmonisation, is the proper legal basis for a Directive on the application of patients’ rights in cross-border healthcare.  In contrast to the view of the European Commission, HOSPEEM sees a fundamental conflict between Article 95 and the principles enshrined in Article 152 of the EC Treaty which outline the responsibilities of the Member States to fund, organise and deliver health services.

FULL TEXT: HOSPEEM Position Statement

Joint statement on EU and healthcare

The European Federation of Public Service Unions (EPSU) and the European Hospital and Healthcare Employers Association (HOSPEEM) have jointly signed a declaration on health services in the EU.

EPSU-HOSPEEM Joint declaration – December 2007

  HOSPEEM General Secretary Godfrey Perera, and EPSU head of Health, Karen Jennings sign joint declaration on Health Services

The declaration, which marks the first formal joint position between the EU social partners for the hospital sector, sets out clear principles upon which the management, financing and delivery of healthcare in the EU should be based.

The declaration is particularly timely as the European Commission is scheduled to publish a draft directive on cross-border healthcare in the coming weeks. The Commission draft has already caused some controversy on the way cross-border mobility of patients (a phenomenon that currently involves 1% of EU patients) should be regulated.

The Secretary General of HOSPEEM, Godfrey Perera stated that, “this declaration sends a clear signal that healthcare employers and workers have the interests of patients at the heart of our work. For that reason, we call for decisions on health services to be based on what is best for the patient, not on political theories or on the expansion of internal market rules.”

The EPSU Secretary General, Carola Fischbach-Pyttel, added that, “As the recognised social partners in the hospital sector, we hope that this declaration allows the European Commission to realise that the foundation of quality healthcare in the EU is equal access for all, based on medical need, and not an open market based on cost and ability to pay.”

Key passages in the declaration:

• It is not for the European Institutions to impose market and/or competition mechanisms in the health care sector, which could have as consequence the lowering of standards and increasing costs of health care systems and thus diminishing the accessibility to care.

• Health care should therefore be organised on the basis of common European social values including solidarity, social justice and social cohesion.

• They should also follow the principles of general interest, like equality, accessibility and quality.

• It is essential that EU-internal market or competition rules do not limit the EU Member states’ autonomy in the implementation of these national responsibilities.

The launch of the European Social Dialogue in the Hospital Sector in September 2006 is a crucial step in the development of industrial relations in Europe, as it gives the recognized social partners EPSU and HOSPEEM the possibility to take joint actions on the field of human resources, employment and social policies by using the social dialogue instruments. It also gives employers and workers both jointly and individually the possibility to give direct formal input on EU polices affecting the hospital sector and its workers. As employers’ and workers’ representatives we (the social partners) also want to take up our responsibilities as European social partners according to the provisions of article 138 of the European Treaty. Policy initiatives on the field of cross-border health care have many social aspects and will affect management and labour.

HOSPEEM response to the Commission questionnaire on the practical implementation of Directive 2003/88/EC concerning certain aspects of the organisation of working time

Introductory comments

This paper summarises the responses received from HOSPEEM members to the Commission’s questionnaire. As a general remark, HOSPEEM members believe that patients should not be treated by tired staff and that staff are entitled to fair working conditions. While the Working Time Directive has been fully implemented by HOSPEEM members, the Directive and the subsequent rulings of the European Court of Justice (ECJ) have caused the hospital and healthcare sector problems and have imposed significant and unnecessary costs on hospital and healthcare employers.

The main problems emerging from the SiMAP and Jaeger judgments are around the interpretation of the term working time for on-call duties and the requirement for immediate compensatory rest. These rulings have caused serious problems in the operation of health systems and have led to Members States recruiting extra staff to prevent gaps in patient services at a large cost without improving productivity.  HOSPEEM members have been both gainers and losers.  In order to resolve the problems caused by the SiMAP and Jaeger judgments, some HOSPEEM members recruited staff from outside Europe as well as healthcare staff from the new Member States.  Losing staff in this way has had a large adverse impact on those health systems.

FULL TEXT: HOSPEEM Answer WTD questionnaire

HOSPEEM response to the first stage of consultation of the social partners on protecting European healthcare workers from blood-borne infections due to needlestick injuries

The Issue

The European Commission has launched a first stage consultation of the European Social Partners (according to article 138 of the EC Treaty) on protecting European healthcare workers from blood-borne infections due to needlestick injuries. The consultation follows the adoption on 6th of July by the European Parliament of a resolution (hereby “the EP Resolution”) that calls the Commission to bring forward a legislative proposal for a Directive amending Directive 2005/54/EC.

The questions that the Commission is asking are:

  1. Do you consider it useful to take an initiative to strengthen the protection of European healthcare workers from blood-borne infections due to needlestick injuries?
  2. Do you think that a joint initiative by the European Social Partners under Article 139 of the Treaty establishing the European Community would be appropriate?

Position Statement

Needlestick injuries, whilst stressful and with the potential for transmission of a blood-borne infections to staff, are not a major cause of incidents in the healthcare sector in Europe. HOSPEEM members believe that there is sufficient legislation, at European and, consequently, national level, to manage and control the incidence of needlestick injuries, provided that legislation is followed.

Effective management of needlestick injuries requires proper risk assessment, effective and regular training and updates and the provision, in those areas identified by risk assessment as being the most at risk, of safer devices that, if properly used, will reduce the transmission of blood-borne infections. It is not necessary, in areas identified as having little or no risk of transmitting bloodborne infection, to introduce more expensive safer devices.

HOSPEEM supports the principle of subsidiarity in this field. It is the responsibility of Member States to determine the details of regulations the framework of which has been set at European level. This is the approach, for instance, taken by Directive 200/54/EC. HOSPEEM would like this approach to be respected.

FULL TEXT: Response to the first stage of consultation of the social partners on protecting European healthcare workers from blood-borne infections due to needlestick injuries

Response to the Consultation regarding Community action on health services

HOSPEEM is pleased that the Commission acknowledges the general interest nature of healthcare services. These irreplaceable services perform special missions and are provided directly or are controlled by the public authorities or entrusted to specific actors who are responsible for them.  They are therefore subject to a process of public regulation under the general supervision of the Member State based on the objectives of the public policies assigned to them with respect to public health.

HOSPEEM would like to underline the important nature of health services and the requirement of access to quality health services for all citizens.  It recalls that it is the responsibility of Member States to define and to organise the services in question as well as the scope of coverage of the health and social needs to be satisfied, in keeping with the principles of subsidiarity and of universal access to healthcare services in the Member States. Furthermore, healthcare services are characterised by asymmetric information between the principal (the patient) and the agent (the doctor). Therefore, we consider as main result that economic allocation of the usual market mechanisms do not apply in this area, but rather resources are planned/organised by the respective authorities.

In view of the diversity of the services concerned and the variety of approaches, organisational and funding methods in the Member States, HOSPEEM welcomes an in depth consultation on these matters.

At the end of this consultation process, the relationship between a possible general framework on services of general economic interest and potential legal initiatives on health services should be answered. Furthermore, any future Community action should include an assessment of the potential impact on national healthcare systems.

FULL TEXT: Response to the Consultation regarding Community action on health services