European Hospital & Healthcare Employers’ Association

10-year anniversary of the EPSU-HOSPEEM Code of Conduct on Ethical Cross-Border Recruitment and Retention


In their first Working Group meeting of the European Social Dialogue in the Hospital Sector, on 04 April 2018 HOSPEEM and EPSU looked back to the signing of the EPSU-HOSPEEM Code of Conduct on Ethical Cross-Border Recruitment and Retention on 8 April 2008 and renewed their commitment to promote, guarantee and defend decent recruitment and working conditions for migrant workers, from the EU and from outside the EU, in hospitals and healthcare facilities across Europe. 

HOSPEEM and EPSU issued a Joint Media Release on the 10 years anniversary of the Code of Conduct. It represents an important instrument to support the free movement of workers across the European Union while preventing unethical competition between the Member States and employers in terms of cross-country recruitment process, fair and transparent contracting and the induction of migrant workers at the new workplace. This also holds for their equal and non-discriminatory treatment regarding labour law, social protection provisions and the access to training and career progression and the freedom of association.  

The EPSU-HOSPEEM Code of Conduct on Ethical Cross-Border Recruitment and Retention was inspired by social partner-based or/and public policy tools already in use in different European Union Member States. At international level, the World Health Organisation (WHO) on 21 May 2010 adopted and set into practice the WHO Global Code of Practice on the International Recruitment of Health Personnel. The Global Code, non-binding in nature, addresses a number of similar issues already covered with in the EPSU-HOSPEEM Code of Conduct. 

In the meeting on 4 April 2018, HOSPEEM and EPSU members reiterated their commitment to the 12 key principles of their 2008 Code of Conduct and to the promotion of ethical recruitment and retention practices at European, national, regional and local level in the upcoming years, both in their own work and in the broader context of the European Pillar of Social Rights. 

Tjitte Alkema, Secretary General of HOSPEEM reflected on the impact of the Code of Conduct: “10 years ago, our Code of Conduct was an inspiration for the work of the World Health Organisation. Nowadays, given the migration flows to and within the European Member States, it is still very relevant. 

EPSU General Secretary Jan Willem Goudriaan welcomed the constructive dialogue there has been with the European employers since the Code of Conduct. “We sought to ensure decent working conditions for all, to prevent the exploitation of migrant workers and to make sure public health systems are not undermined by unfair recruitment practices. Our Code was and is a significant contribution to achieve sustainable quality care for all.”  

At the meeting on 4 April 2018, several HOSPEEM members and EPSU affiliates commented on the use and positive effects of the EPSU-HOSPEEM Code of Conduct on Ethical Cross-Border Recruitment and Retention. They also referred to different models of how the 12 principles of the Code of Conduct have been incorporated in their national contexts, either into legislation, by means of collective agreements and/or by using enterprise-based agreements. 

Kate Ling, NHS Confederation, United Kingdom, gave an overview on the use by the employers in the NHS and about the effects of the Code of Conduct in the United Kingdom, showcasing some good practice examples: “NHS organisations should only use recruitment agencies that comply with the Code, which includes guarantees to give overseas recruits good induction, training and employment protection. A key tenet of the UK Code is that recruitment of staff from abroad should not damage healthcare systems in developing countries.  Active recruitment from developing countries shouldn’t take place unless there is a government-to-government agreement. For example, the UK and India have a scheme called Earn Learn and Return where staff from India can come to the UK to fill shortages in specialist areas, and in return they get the opportunity to gain specialist expertise and develop skills that they can then take back with them after they leave the UK to improve healthcare in India. So, both countries benefit.” 

Tjitte Alkema wrapped up the Working Group meeting, reflecting on the freedom of movement of persons in the European Union and the respective aim of the Code of Conduct: “We are in the European Union: one of the fundamental rights is the freedom of movement of people within the European Union. Our Code of Conduct is trying to establish a fair system of mobility in which people are not exploited and countries are not suffering from the mobility of workers. The Code of Conduct is however only as strong as the partners that support it. It only works if we also identify incorrect application, put them on the table and make them transparent. The WHO Code and the Code of Conduct of the Social Partners are complementary in the European setting.”

PDF - 304.4 koMedia release

HOSPEEM has also published an article on the event and the 10-year anniversary celebration.

Sectoral Social Dialogue Committee for the Hospital and Healthcare Sector: Main activities and outcomes in 2017

In this document you can find the highlights of the work of the HOSPEEM-EPSU Sectoral Social Dialogue Committee for the Hospital and Healthcare Sector. In 2017 the Sectoral Social Dialogue Committee for the Hospital and Healthcare Sector  dealt with a wide range of topics in the framework of the EPSU-HOSPEEM Joint Work Programme and carried out project-related activities.

PDF - 304.4 koDownload the document

HOSPEEM Activity Report 2017

The HOSPEEM Activity Report 2017 is published. This activity report presents basic information on the history of HOSPEEM, on the membership structure as well as on the main activities carried out during the year.

2017 has been a productive year with a number of achievements: the start of the new joint HOSPEEM-EPSU project on effective recruitment and retention policies including the June conference “Working together, learning together – Switching to the learning mode”, the start of the HOSPEEM-EPSU new work programme 2017-2019 for the European social dialogue, the high-level metings with European Commissioner Vytenis Andriukaitis and the Bulgarian Minister of Health Prof. Nikolai Petrov, the joint HOSPEEM-HOPE workshop “AMR and workplace learning – The case for a multi-professional approach in hospitals” at the European Parliament.

PDF - 304.4 koDownload the report


Media Release : HOSPEEM-HOPE Joint Workshop on AMR & CPD

“AMR and workplace learning, The case for a multi-professional approach in hospitals”


On 22 November 2017, the European Hospital and Healthcare Federation (HOPE) and the European Hospital and Healthcare Employers’ Association (HOSPEEM) organised a workshop “AMR and workplace learning-The case for a multi-professional approach in hospitals” hosted by MEP Soledad Cabezón Ruiz (Spain, S&D) at the European Parliament in Brussels. This HOSPEEM-HOPE Joint Workshop was connected to the 2017 European Antibiotic Awareness Day (EAAD) and the launch of the new EAAD Toolkit for Hospital Staff.

Member of the European Parliament (MEP) Soledad Cabezón Ruiz (S&D, Spain) opened the workshop by reminding some alarming figures published by the European Centre for Disease Prevention and Control (ECDC): the cost of Antimicrobial Resistance (AMR) in the EU represents 25 000 deaths and 1,5 Billion Euro annually. She expressed the need for a comprehensive approach involving the different sectors, such as healthcare, biosafety, environment etc. She also stressed out that the European Action Plan should focus on research (new antibiotics, health devices) but also on monitoring the prescription and use of antibiotics, thanks to a large data base. National Action Plans, coordinated and financially supported by the EU should allow to identify the best practices and the best performing countries.

Pascal Garel, HOPE Chief Executive, emphasized the importance of inter-professional cooperation in combatting AMR “the issue of AMR is complex and multifaceted with differences between countries and even differences between regions of the same country (…) today we are looking at the topic from the angle of Continuing Professional Development and the role of health professionals”. Workshop moderator Jesper Rijpma, Senior advisor public affairs at Dutch Hospital Association (NVZ), defined the AMR phenomenon as a threat for society in the form of a “tsunami in slow motion”.

The Head of the Disease Programmes on AMR and Health-Associated Infections (HAI) at ECDC, Dominique Monnet, focused on the importance of raising awareness about the prevention and control of AMR in healthcare. Firstly, he listed the three-existing surveillance network at EU-level (EARS-Net, ESAC-Net, HAI-Net) and the guidelines exchange platform EPIS. In some countries like Germany, Portugal, the Netherlands, Greece or Belgium, AMR is decreasing due to national actions such as the introduction of new antimicrobial agents in the healthcare sector, the prudent use of antimicrobial agents as well as the prevention and control of infections in hospital and healthcare facilities. He also brought the attention of the audience to the new EAAD Toolkit for Hospital Staff recently published.

The Member of the AMR Task Force of the European Commission, Angela Bolufer de Gea, presented the European One Health Action Plan on AMR 2011-2016, reminding that “Progress on AMR is possible but slow’’. She emphasized making the EU a best practice region on AMR requires persistence, innovation and stronger partnerships. To further develop the existing initiatives such as the Guidelines for the prudent use of antimicrobials in human health or the European Antibiotic Awareness Day, the EC supports research and development of new business models in antibiotic research (DRIVE-AB) and jointly funded research with the pharmaceutical industry (IMI).

The CEO of the Platform for Continuous Improvement of Quality of Care and Patient Safety (PAQS) in Belgium, Denis Herbaux, presented a specific example of collaboration on the prevention of Health-associated Infections (HAI) carried out by twenty hospitals working together in Belgium. This collaborative project aims at preventing adverse events such as the outbreak of AMR for example. The Plan-Do-Study-Act (PDSA) methodology consists of regular meetings of a multidisciplinary team which will work out solutions together and bring it back to its own hospital. According to Denis Herbaux, the collaborative step-by-step approach allows the effective implementation of best practices at the system level.

The Senior Advisor on National Safety and Security from the National Institute for Public Health and Environment Centre for Safety and Security in the Netherlands, Marcel Mennen, presented the Dutch One Health strategy to restrain the threat of AMR. This strategy consists of a thorough assessment and monitoring of national risk as well as concrete actions such as a multi-professional model for prevention and outbreak control of AMR (A-Team). In the Netherlands, the “A-Teams” advise colleagues on infection prevention and proper use of antibiotics, including infectious disease professionals, epidemiologists, hospital pharmacists and physicians.

After the presentations, the participants could discuss several issues with the panellists, such as the need of awareness programs for medical students in the medical profession, the research and production of new antibiotics or the challenge of merging and connecting hospital data to inform AMR experts. Participants and speakers debated the need for new business models to create new antibiotics and the need for exploration of cost-effectiveness in this field. They also discussed the ways on how to enhance the level of awareness, where both macro level (national action plans) and micro level (multidisciplinary approaches such as the A-teams in the Dutch hospitals or collaborative improvement initiatives in Belgian hospitals) have shown to be effective.

Member of the European Parliament (MEP) Karin Kadenbach (S&D, Austria) pointed out that expertise and knowledge about AMR is not always shared, especially monitored data on vaccination across the EU or HAI. Stricter rules should be defined regarding the access to antibiotics without prescription and more money should be invested in research and quality monitoring to ensure reliable and up-to-date data. As an incentive, the cost of non-action (compared to concrete action) should be presented to the different stakeholders at national level.

Secretary General of the European Hospital & Healthcare Employers’ Association (HOSPEEM), Tjitte Alkema, closed this workshop addressing the importance of continuing professional development (CPD) for the correct understanding and use of antibiotics by hospital staff and patients and the prevention of infections. He reminded that “there are no simple solutions to complex problems and that (…) learning is a process, not an event (…) Some of the challenges ahead of us that have been underlined today are the issue of professional silos, underreporting, lack of surveillance and staffing challenges (…)” and regarding the issues raised during the workshop, “Prevention and CPD are potential solutions because they allow the involvement of hospital management grass-root staff and they foster new insights and creative solutions through a multi-disciplinary approach”. He called for an overarching PPP-approach. PPP in this case would stand for Public Practice Partnership involving competent authorities, professional organisations, and hospital management.

Media release

HOSPEEM-HOPE joint Workshop on AMR & CPD

The European Hospital and Healthcare Federation (HOPE) and the European Hospital and Healthcare Employers' Association (HOSPEEM) organised the following workshop:

HOSPEEM-HOPE joint Workshop on Antimicrobial Resistance and Continuing Professional Development: “AMR and workplace learning-The case for a multi-professional approach in hospitals"
European Parliament, November 22nd, 2017

Agenda and Media release:

Download the Agenda
Download the Media release


 “Prevention and control of AMR in healthcare: raising awareness about best practices” - Dominique Monnet, ECDC, Head of the Disease Programmes on AMR and HAI
“A European One Health action plan on AMR” - Angela Bolufer, European Commission, Member of the AMR Task force
“Collaborating to increase Patient Safety” - Denis Herbaux, CEO, Platform for Continuous Improvement of Quality of Care and Patient Safety (PAQS), Belgium
“The need for cooperation from a One Health perspective against AMR” - Marcel Mennen, Project Manager AMR, National Institute for Public Health and Environment, the Netherlands

This Workshop addressed the importance of continuing professional development for the correct understanding and use of antibiotics by hospital staff and patients and the prevention of infections. Good practice examples to train staff in combatting Antimicrobial Resistance (AMR) in the hospital sector were presented to foster the discussion.

The event also provided the opportunity to emphasize the importance of inter-professional cooperation in combatting AMR. The date chosen for the Workshop  allowed to connect the event to the activities planned for the 2017 European Antibiotic Awareness Day (EAAD) and the launch of the new EAAD Toolkit for Hospital Staff.

The workshop was hosted by MEP Soledad Cabezón Ruiz (Spain, S&D) and took place at the European Parliament, from 15.00 to 17.00 in Room P1C047.

see HOPE Event page 


Photo credits: Mattia Braida, 2017

HOSPEEM Study visit to Bulgaria in September 2017

HOSPEEM visited its Bulgarian member organisation NUPH – National Union of Private Hospitals on September 27, 2017 in Sofia. HOSPEEM had the opportunity to visit two hospitals, members of NUPH, the Academy City Clinic Tokuda, the biggest private hospital in Sofia and Polimed, a small hospital located in the capital. Meetings were arranged with Ms. Boryana Marinkova, PR and marketing officer of Tokuda and with Tsvetan Dimanov, Executive Manager of Polimed.

The visit provided the opportunity to discuss about hospitals’ management and human resources, their functioning and activities and to get an insight into the system of bargaining in Bulgaria. The meeting also provided the opportunity to exchange about the impact of budgetary shortages for the private hospitals and the ongoing problem of fair recruitment and self-sufficiency in their training of health professionals. HOSPEEM would like to express its sincere thanks to Krasimir Grudev, NUPH Board of Directors, the representatives and the staff of the hospitals for the warm welcome and the enriching and fruitful exchange.

VADEMECUM – A Practical Guide for EU Social Partner Organisations and their National Affiliates to Commission support to EU Social Dialogue.

The “VADEMECUM – A Practical Guide for EU Social Partner Organisations and their National Affiliates to Commission support to EU Social Dialogue -2017” provides basic information on the instruments related to EU support to social dialogue and includes the existing rules to be respected when using these tools.  Download the guide.


HOSPEEM-EPSU project – Media release: Social Partners’ Conference on Continuing Professional Development


 Social Partners’ Conference on Continuing Professional Development

“Working together, learning together – Switching to the learning mode”


On 19 and 20 June 2017, HOSPEEM and EPSU – with the support of the Dutch HOSPEEM member Nederlandse Vereniging van Ziekenhuizen (NVZ) – organised the conference “Working together, learning together – Switching to the learning mode” in Amsterdam to pursue and deepen their thematic focus on Continuing Professional Development (CPD) and Life-Long Learning (LLL).

The event built on the HOSPEEM-EPSU Joint Declaration on Continuing Professional Development and Life-Long Learning for All Health Workers in the EU adopted in November 2016. In this document the sectoral social partners in the hospital and health care sector recognise CPD as paramount for the maintenance and improvement of the quality of care and patient safety. Access to CPD and career options are presented as supportive of effective recruitment and retention policies. The joint declaration highlights that CPD and LLL initiatives should be considered as a long-term investment in the (productivity of the) health workforce and not as a cost factor. Social partners have a major role to play when it comes to CPD, in partnership with competent authorities and other relevant stakeholders. The declaration also states that undertaking CPD is a shared responsibility of employers and workers and depends to a large extent on the intrinsic motivation of employees to invest in their own development. HOSPEEM and EPSU finally recall the importance of taking local specificities into consideration and respecting the different national legal and regulatory frameworks when designing CPD systems.

The conference provided a forum for exchange and debate on a number of social partner-based initiatives presented by representatives of HOSPEEM members and EPSU affiliates from Belgium, Denmark, Finland, France, Germany, The Netherlands, Sweden and the United Kingdom and on the key role played by social partners in this field. It offered the opportunity to learn more about supportive regulatory frameworks for CPD and about policy measures aimed at facilitating access to CPD, updating or upgrading qualifications, skills, competence and professional practice, the provision of quality services by a hospital/health care workforce fit for practice and at a high level of patient safety. In addition, several researchers shared their insights and experiences during the plenary sessions or during one of the four thematic break-out sessions organised. Balazs Lengyel of DG SANTE presented the main insights and selected conclusions and recommendations from the study “Mapping CPD and LLL for health professionals in the EU” – focusing on nurses, midwifes, doctors, dentists and pharmacists – issued in 2015 and commissioned by the European Commission.

A range of aspects related to CPD was covered by the presentations and discussions at the HOSPEEM-EPSU conference. These include: How to ensure sustainable models of financing of CPD for all types of health workers? How to best make CPD available for all health workers in an equal manner across all age groups, occupational groups, working patterns and all types of contracts? What can social partners at the different levels do to give better access to groups often under-represented in CPD and LLL, such as health workers aged 45+, part-time workers or workers with lower formal qualifications (mainly health care support staff)? Which models of CPD to use to support increasing demands of working in teams bringing together different health professions? How to best organise CPD on the backdrop of an increasing digitalisation of health care services (e-health; m-health; telemedicine)? How to build CPD as a key element into team and personal development planning and organisational development strategies? How to develop a partnership approach in designing, organising, implementing and assessing CPD policies and tools at national, sectoral and enterprise level?

Looking at the health professions, a particular focus was given to nurses, health care support staff and doctors. This was also underpinned by four short testimonial videos of Dutch nurses produced by NVZ about how they have benefited from CPD in their professional career and various work contexts so far and which expectations they have as to the organisation of CPD in the future.

The conference was opened by a group interview involving Bas van den Dungen, representative of the Dutch Ministry of Health, Elise Merlijn, FNV, The Netherlands, representing EPSU, and Kate Ling, NHS, United Kingdom, representing HOSPEEM. The social partner representatives highlighted some of the trade unions’ and employers’ priorities in the field of CPD and LLL, the key opportunities and problems to be addressed. The participants watched a video message by Commissioner Andriukaitis in which he expressed his support for the Joint HOSPEEM-EPSU Declaration on CPD and LLL for all Health Workers in the EU and for the ongoing work of the sectoral social partners in the hospital sector in the field of CPD.

During the conference, participants were asked to write down and share the most relevant “take home messages” to them. This input as well as visuals of a graphic recorder were used by the chairpersons and the moderator of the closing panel, Nico Knibbe, LOCOmotion, The Netherlands. Wrapping up the conference, Sabine Scheer, NVZ, The Netherlands, representing HOSPEEM, Kirsi Sillanpää, Tehy, Finland, representing EPSU, and Alice Casagrande, FEHAP, France, pointed to their key “learning experiences” during the conference and highlighted the take home messages they consider most relevant.

This conference was a key step for the sectoral social partners in the hospital and health care sector, HOSPEEM and EPSU, in identifying successful approaches, instruments and formats of CPD, both from the management and workers’ perspective. It brought together more than 100 participants from 18 EU Member States and 4 non-EU countries, including 35 participants from the Netherlands. The event was organised in the framework of the HOSPEEM-EPSU EU-funded project “Promoting effective recruitment and retention policies for health workers in the EU by ensuring access to CPD and healthy and safe workplaces supportive of patient safety and quality care” (2017-2018) and a contribution of the hospital and healthcare sector social partners to the 2016-2017 EU-OSHA Campaign ”Healthy Workplaces For All Ages”.

EPSU’s and HOSPEEM’s work on this issue will continue in 2017 and 2018. A report on the conference, also containing the key take-home messages, will be published by the end of 2017. It will be disseminated at national and at EU level and will feed into the future work of the Sectoral Social Dialogue Committee for the Hospital Sector on CPD.

Amsterdam/Brussels, 23 June 2017

PDF - 304.4 ko Media release


HOSPEEM: Emilie Sourdoire, Policy Officer,, +32/2/2292158

EPSU: Mathias Maucher, Policy Officer “Health & Social Services”,, +32/2/2501093

EPSU & HOSPEEM Meeting Bulgarian Health Minister Petrov

Sofia, 1 June 2017

The Secretary General of HOSPEEM (European Hospital and Healthcare Employers’ Association), Tjitte Alkema, and Mathias Maucher, Policy Officer “Health and Social Services”, EPSU (European Federation of Public Service Unions) on 1 June 2017 met the Bulgarian Minister of Health, Prof. Nikolai Petrov. Slava Zlatanova, Vice President of FSZ-CITUB, and Krasimir Dimitrov Grudev, Member of the Managing Board of the National Union of Private Hospitals, also participated in the meeting.

The main purpose of the meeting was to allow for a first exchange on the planned priorities and major fields of action of Bulgaria in the field of health policies and with regard to the health workforce in the context of the Trio Work Programme agreed upon by Estonia, Bulgaria and Austria and to identify possible fields of common interest with the European social partners in the hospital/health care sector.

The Bulgarian Health Minister pointed out a number of topics Bulgaria has a strong interest in and could prioritise in the context of its Presidency of the European Council in the first half of 2018. Amongst those are the numerous challenges related to the cross-border migration of health workers, effective recruitment and retention policies to prevent from strong regional disparities within EU MS when it comes to the quality and availability of health services and a qualified health workforce, measures to ensure access to health care for the whole population, the reorganisation of emergency services with the aim to improve accessibility and quality as well as investment in continuing professional development for all health workers. In setting out his ideas to the representatives of HOSPEEM and EPSU Health Minister Prof. Nikolai Petrov advocated  to better address the consequences of outflow of qualified health workers, including from Bulgaria, to other EU MS. The Bulgarian Health Minister also showed a high interest in a mutual exchange across Europe on policies to guarantee access to health care.

Tjitte Alkema, Secretary General of HOSPEEM highlighted the priorities for the European social partners in the hospital/health care sector for the next three years as outlined in the joint work programme and gave examples of outcomes of the HOSPEEM-EPSU joint work. Tjitte Alkema also underlined the focus of EPSU and HOSPEEM on the health sector as services of general interest and the positive effects of (public) investment in health care services and the health workforce, including in continuing professional development.  Tjitte Alkema pointed out the role of European Economic Governance for policy initiatives on health employment and the need to focus on achieving greater self-sufficiency based on nationally trained health workforce  to address the problem of brain drain of health workers.

At the end of the meeting – that also included an exchange amongst the Bulgarian participants – it was agreed to explore fields for possible joint initiatives or activities once the Trio Work Programme would be formally adopted.