Effective approaches to tackling third party violence in the workplace

A project proposal under budget line

FULL REPORT: Respect project report

Project objectives

The project “RESPECT” has the following main objectives:

Final objective

To assist employers in the hospital, local government, private security and commerce sectors, in an independent but coordinated manner with the respective trade unions, to develop an EU multi-sectoral Action Plan which will:

  • Aim to reduce the overall level of third part violence and to mitigate its negative effects;
  • Complement the 2007 cross-sectoral framework agreement adopted by ETUC BusinessEurope CEEP and UEAPME, in particular chapter 4 of this agreement;
  • Take account of health and safety regulations and existing frameworks;
  • Provide an instrument to raise awareness across Europe of the different issues concerning third party violence;
  • Confirm the responsibility of employers, in co-operation with trade unions and workers, to ensure and promote a working environment free from third party violence;
  • Identify the different measures and processes introduced by social partners to prevent and mange problems of third party violence at work;
  • Draw up principles and guidance that can support joint actions by social partners at the different levels to tackle third party violence;
  • Give examples of practical measures which can be taken;
  • Commit trade unions and employers to working together on this issue;
  • Provide a framework for monitoring, evaluation and review

Specific objectives

  1. To build on discussions at the multi-sectoral seminar on third party violence on 14 March 2008 and the multi-sectoral meeting on 4 July 2008 to gather further information on how sectoral social partners at the national level are tackling the issue of third party violence in the workplace. This should contribute to the drafting of multi-sectoral principles and guidelines at European level on how this challenge can be addressed by social partners at the local level.
  2. To assist the sectoral employers organisations involved in the process to date (HOSPEEM, CEMR, CoESS and Eurocommerce) to build up a multisectoral employers’ position and to prepare the employers’ group to eventual negotiations of a multisectoral social dialogue instrument (framework agreement or similar) on third party violence.
  3. To organise a multi-sectoral conference with around 120 participants to present the best practices gathered in the information collection exercise and to discuss the potential outline of a multi-sectoral guidance document. Possibility to launch a joint multi-sectoral declaration on the importance of the issue and key principles for tackling third party violence at workplace level and to announce the intention to prepare joint guidance or another social dialogue instrument.

Project context


According to research carried out by the European Foundation for the Improvement of Living and Working Conditions in the European Working Conditions Survey, approximately one in ten workers in the European Union report that they have suffered violence, bullying or harassment at work in the previous year (results 2005 survey).  According to data from the survey, third party violence at the hands of clients, customers or patients is more common than violence suffered at the hands of work colleagues.

Threats of violence and actual violence from third parties are most common in a number of sectors including health and social work, transport, recreational activities, public administration, air transport and education, but are also widespread in other sectors including retail and private security.

The impact on the mental and physical health of worker of such experiences is significant and ranges from distress and feelings of humiliation suffered to actual severe physical injury (or even death) and severe mental trauma often leading to long absences from work (and associated lost productivity) and difficulties with staff retention. The table below shows the significance of the problem of violence and harassment in the workplace in relation to overall absence due to work related health problems, as well as the magnitude of the number of days lost per year.


The cross-sectoral social partners BusinessEurope, ETUC, CEEP and UEAPME already recognised the importance of the issue of violence and harassment in the workplace in their autonomous framework agreement on work-related stress, signed in October 2004. Considered as one of the important sources of stress in the workplace, it was seen to be sufficiently important to warrant a separate autonomous framework agreement.

A joint seminar on harassment in the workplace was organised in 2005 as part of the 2003-2005 work programme of the cross sectoral social partners. At the same time, the European Commission launched its consultation on the issue of violence at work, which strongly emphasised the importance of tackling third party violence. In their 2006-2008 cross-sectoral social partner work programme BusinessEurope, ETUC, CEEP and UEAPME committed themselves to negotiating an autonomous framework agreement on harassment and violence. Negotiations started in February 2006 and ended in April 2007.

The agreement reached underlines that the harassment and violence are unacceptable and it is in the common interest of the social partners to address the issue as it can have serious social and economic consequences. The cross-sectoral agreement moves on to emphasise the importance of existing health and safety regulation which defines an employers’ duty to protect workers against harassment and violence in the workplace. In its introduction, the agreement specifically refers to third party violence and harassment as one of the areas to be addressed, but is not later referred to in more detail, leaving it up to national social partners to decide whether to cover this aspect in their implementation agreements.

The cross-sectoral agreement aims to raise awareness of the issue and provide employers, workers and their representatives with an action-oriented framework to identify, prevent and manage problems of harassment and violence at work. It goes on to describe the phenomenon; how to prevent, identify and manage it; as well as setting out the implementation and follow-up process of the agreement.

National member organisations of the cross-sectoral social partner are currently in the process of implementing the agreements at national level in accordance with procedures and practices specific to management and labour in the EU and EEA countries. The deadline for implementation is April 2010.

Hospital sector social dialogue: skills mix, workforce planning and leadership

The European Social Dialogue Committee in Hospitals held a ‘New Skill Needs’ seminar on 16 September 2009. HOSPEEM and EPSU participants exchanged experiences in these three areas (skills mix, workforce planning and leadership).

The seminar was chaired by Kim Ost-Jacobsen of the Danish Nursing Organisation. Concretely, the main decision was to establish a drafting group to explore these issues further and to submit a position paper to the Hospital Social Dialogue Plenary session, scheduled for 8 December 2009.

The Social partners identified that one of the main challenges was to improve the status of healthcare staff by offering clear and attractive career paths for both women and men. It is therefore important to find the right mix of skills in order to free up more staff time for the treatment of patients. Potential avenues to practically apply this include: proper identification of new skill, identifying and addressing where skill shortages (and over-capacity), occur, and outlining clear leadership ‘paths’ to ensure retention of highly qualified staff.

Background: At the Plenary meeting on 4 December 2008, EPSU and HOSPEEM decided to develop a social dialogue instrument either in the form of a framework of actions or guidelines. The instrument should cover skills mix, leadership in the hospital sector at all levels and in all areas and workforce planning at macro level.

New Skill Needs Background Paper

HOSPEEM response to the first consultation of the European social partners on the protection of workers from the risks related to exposure to electromagnetic fields at work

This paper summarises the responses received from HOSPEEM members to the Commission’s consultation on the protection of workers from the risks related to exposure to electromagnetic fields at work.


The protection of the health workforce from workplace risks is a key priority for hospital and healthcare employers across Europe and HOSPEEM fully supports the risk assessment-based approach which underpins the legislative framework for health and safety at work. There is a strong safety culture in the hospital and healthcare sector, focussing on minimising risks to both workers and the patients they care for.

In this context, given the lack of evidence for any long-term adverse health effects and the exceptional rarity of even short term effects associated with the use of magnetic resonance imaging (MRI) in the hospital and healthcare sector, HOSPEEM’s view is that the directive 2004/40/EC, in its current form, is not fit for purpose. In fact, if implemented it could expose healthcare workers to greater risks as it would be likely to lead to the increased use of other imaging techniques that rely on ionising radiation, the potential negative health effects of which are well known. HOSPEEM would therefore support a revision of the existing directive so that it is based upon the principle of risk assessment, excluding restrictive compliance with exposure limit values for the hospital and healthcare sector which already has alternative adequate safeguards in place.

FULL TEXT: HOSPEEM response to EMF first Social Partner Consultation

Joint Framework Agreement on prevention from sharp injuries

The Joint Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector

The European Hospital and Healthcare Employers’ Association (HOSPEEM) and the European Public Services Union (EPSU) today signed an EU-wide agreement to prevent injuries from needlesticks and other sharp objects.

The Joint Framework Agreement was concluded after five months of negotiations by the European social partner organisations in the sector, which employs around 3.5 million people.

In 2006, the European Parliament adopted a resolution requesting the Commission to submit a legislative proposal on protecting healthcare workers from blood-borne infections due to needle stick injuries.
After the two-stage consultations on this issue, in 2006 and 2007, the EU social partners decided to organise a technical seminar with all stakeholders (nurses, doctors, surgeons and so on), which highlighted the many causes of injuries in hospitals and healthcare services.
In December 2008, they informed the Commission of their intention to negotiate on a wider basis covering all types of sharp injuries (including needle sticks). The negotiations, to which the commission provided technical and logistical support, started in January 2009 and were completed on 2 June 2009.

The agreement aims to:
– achieve the safest possible working environment for employees in the sector and protect workers at risk;
– prevent injuries to workers caused by all types of sharp medical objects (including needle sticks);
– set up an integrated approach to assessing and preventing risks as well as to training and informing workers.

At the request of the European social partners and after having examined their representativeness and the legal conformity of the text, the Commission intends to submit, after the summer, a proposal to the Council for implementation of the agreement by a directive, in accordance with article 139 of the Treaty. The agreement specifically addresses one of the priority objectives of the EU’s current strategy for health and safety at work (2007-2012).

FULL TEXT: HOSPEEM-EPSU Sharp injuries signed joint agreement

EU health ministers to let the national experts run their national healthcare systems

Press release

Hospital Social Partners urge EU health ministers to let the national experts run their national healthcare systems

We cannot let market forces run healthcare systems or we will end up with a two-tier system of healthcare delivery” said Godfrey Perera, General Secretary, European Hospital and Healthcare Employers association (HOSPEEM).

The Hospital sector employers and trade unions in Europe today joined forces to send a message to EU Health Ministers. The Social Partners for the sector were speaking on the draft EU directive on cross-border healthcare which is being discussed by EU Health Ministers in Luxembourg today.

The European Federation of Public Service Unions (EPSU), represented by Karen Jennings (UNISON, UK) and the European Hospital and Healthcare Employers association (HOSPEEM), represented by Mr. Perera sent the joint message to the EU Health Ministers before 600 public service trade unionists at the EPSU Congress in Brussels.

They urged the EU Ministers to base the directive on a joint legal basis of public health and the internal market. The joint basis would have allowed Member States to ensure that all citizens have equal rights to high quality healthcare based on medical need, and not just the ability to pay their travel, accommodation and other costs.

EPSU Chair of the Healthcare Committee, Karen Jennings:
“The EU Ministers, meeting today, have a chance to put this health debate back on the right track, by recognizing that the universal principles of healthcare solidarity are the starting point and not the internal market”.

Secretary General of HOSPEEM, Godfrey Perera:
“To guard the principle of healthcare systems based on solidiarity, national healthcare systems must have the right to organise those systems – to do this, they need proper prior authorisation abilities”.

The issue of allowing Member State to give prior authorisation to patients, who wish to travel, remains a major issue, as is the need to consider the subject of rare diseases under separate legislations. The EU Health Ministers are expected to conclude discussions tomorrow, 10 June.

For further information, please contact:
EPSU: Brian Synnott +32 474 98 96 75 | E-mail:
HOSPEEM: Valeria Ronzitti / Gin Ngan +32 2 229 21 57 | E-mail:

HOSPEEM is the European Hospital and Healthcare Employers Association. It regroups at European level national , regional and local employers’ associations operating in the hospital and health care sector and delivering services of general interest, in order to co-ordinate their views and actions with regard to a sector and a market in constant evolution. HOSPEEM is an individual member of CEEP.

EPSU is the European Federation of Public Service Unions. It is the largest federation of the ETUC. 8 million public service workers from over 200 trade unions are members. They organise workers in the energy, water and waste sectors, health and social services and local and national administration.

Social Partners announce EU-wide agreement on Medical Sharps injuries

EPSU 8th Congress: European Hospital Social Partners announce EU-wide agreement on Medical Sharps injuries

Press Communication

First EU wide text agreed by Hospital trade unions and employers set to prevent over one million injuries per year.

The European Hospital Social Partners – The European Federation of Public Service Unions (EPSU) represented by the President of EPSU health Committee, Karen Jennings and the European Hospital and Healthcare Employers’ Association (HOSPEEM) represented by General Secretary, Godfrey Perera have announced, before 600 trade union leaders attending the EPSU Congress, a European agreement, which is set to prevent over 1 million medical sharp injuries per year, for healthcare workers.

Welcoming the agreement, Karen Jennings stated that “this represents tremendous progress for the European Hospital social dialogue process, but most importantly it makes a clear and positive contribution to the working lives of Europe’s healthcare workers.”

Godfrey Perera said that “ this deal is in the interest of the Hospital Employers, who have a moral obligation to protect their workers health and safety, but who gain also in financial terms as good protection decreases any days lost for these highly trained hospital staff.”

The aim of the negotiations (successfully concluded) was to reach a European-wide agreement on measures to tackle the issue of injuries from sharps (such as needlesticks) in hospitals. This issue has been estimated to cause up to one million injuries to healthcare staff per annum.

The European Social Partners will ask for the Commission to present this agreement to the Council of Ministers to implement it through an EU directive.

The Social Partners (HOSPEEM and EPSU) met with Commissioner for Employment and Social Affairs Vladimir Spidla on 20 January 2009. Mr. Spidla expressed his support for the negotiations and stated that he was pleased that the European Social Dialogue process was being used to address such an important health and safety issue.

This is the first formal agreement between the European Hospital Social Partners.

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

Commissioner on ‘Sharp Injuries’ negotiations

Hospital Social Partners meet Employment Commissioner on ‘Sharp Injuries’ negotiations

Representatives of the European Hospital Social Partners met with the European Commission for high level talks on the upcoming ‘Sharp Injuries’ negotiations.

The Social Partners (HOSPEEM and EPSU for hospital employees) met with Commissioner for Employment and Social Affairs Vladimir Spidla on 20 January. Mr Spidla expressed his support for the upcoming negotiations and stated that he was pleased that the European Social Dialogue process was being used to address such an important health and safety issue.

The aim of the negotiations is to reach a European-wide agreement on measures to tackle the issue of injuries from sharps (such as needlesticks) in hospitals. HOSPEEM Secretary General Godfrey Perera and EPSU General Secretary Carola Fischbach-Pyttel (pictured with Commissioner Spidla) had previously sent a joint letter to the Commissioner announcing their intention to start formal social dialogue negotiations on the issue of sharp injuries in hospitals. The Social Dialogue talks are due to start on 26 January 2009.

HOSPEEM-EPSU ‘Sharp Injuries’ negotiations letter to Commissoner Spidla

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