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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.

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The Committee notes that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 2, paragraphs 1 and 3, of the Convention. In the light of current challenges facing health-care systems in general, such as rising costs and restructuring of health services, advances in medical technology and work reorganization, or growing workload and stress, the Committee requests the Government to outline the objectives and priorities of its policy concerning nursing services and to elaborate on any time-bound action plan, programme or initiative aiming at improving the quality of nursing care, promoting knowledge and skill enhancement for nursing personnel and ensuring sufficiently rewarding working conditions for the practice of the nursing profession, especially in the light of the Munich Declaration of the European Health Ministers of June 2000 regarding nursing and midwifery and the WHO European Strategy for Nursing and Midwifery Education.

Articles 5 and 6. Further to its previous comment on this point, the Committee would thank the Government for transmitting, together with its next report, copies of all collective agreements in effect regulating remuneration and working conditions of nursing personnel employed in public or private hospitals, nursing homes and medical centres.

Article 7. The Committee would appreciate receiving information on any new measures or initiatives regarding the adaptation of existing laws and regulations on occupational safety and health to the special nature of nursing work.

Part V of the report form. The Committee would be grateful to the Government for supplying detailed information on the practical application of the Convention, including for instance up to date statistics on the number of nurses employed in the public and private sectors, the nurse-to-population ratio, the number of students attending nursing schools, copies of official reports or studies (e.g., annual reports of the Directorate Nursing Services or publications of the Institute of Health Care and the Nursing and Midwifery Board) addressing labour and employment issues concerning nursing services and nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

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The Committee notes the Government’s report and wishes to draw attention to the following points.

Article 2, paragraphs 1 and 3, of the Convention. In the light of current challenges facing health-care systems in general, such as rising costs and restructuring of health services, advances in medical technology and work reorganization, or growing workload and stress, the Committee requests the Government to outline the objectives and priorities of its policy concerning nursing services and to elaborate on any time-bound action plan, programme or initiative aiming at improving the quality of nursing care, promoting knowledge and skill enhancement for nursing personnel and ensuring sufficiently rewarding working conditions for the practice of the nursing profession, especially in the light of the Munich Declaration of the European Health Ministers of June 2000 regarding nursing and midwifery and the WHO European Strategy for Nursing and Midwifery Education.

Articles 5 and 6. Further to its previous comment on this point, the Committee would thank the Government for transmitting, together with its next report, copies of all collective agreements in effect regulating remuneration and working conditions of nursing personnel employed in public or private hospitals, nursing homes and medical centres.

Article 7. The Committee would appreciate being kept informed of any new measures or initiatives regarding the adaptation of existing laws and regulations on occupational safety and health to the special nature of nursing work.

Part V of the report form. The Committee would be grateful to the Government for supplying detailed information on the practical application of the Convention, including for instance up-to-date statistics on the number of nurses employed in the public and private sectors, the nurse-to-population ratio, the number of students attending nursing schools, copies of official reports or studies (e.g., annual reports of the Directorate Nursing Services or publications of the Institute of Health Care and the Nursing and Midwifery Board) addressing labour and employment issues concerning nursing services and nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

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The Committee notes the information supplied by the Government in its reports.

It notes the information about the dispute between the nursing staff of Mount Carmel hospital, supported by three unions, the Malta Union of Midwives and Nurses (MUMN), the General Workers Union (GWU) and the Union Haddiema Maghqudin (UHM), and the hospital management, in the course of 2000. It notes that Public Services International (PSI) sought the assistance of the International Labour Office (ILO) in settling the dispute about the management’s decision to redeploy nursing staff within the hospital in order to redress an imbalance in the numbers in the various services. The hospital management, supported by the Health Division of the Maltese Government, took the view that the deployment of staff was an absolute prerogative of management, whereas the unions considered that any decision regarding employment or working conditions could be taken only after negotiations with the unions, as prescribed in the conclusions of the ILO Joint Meeting on Human Resource Development in Health Sector Reforms, held in September 1998. The Committee notes that, in response to a letter he received from PSI, the Director General of the International Labour Office wrote to the Maltese Ministry of Health on 10 November 2000 offering the ILO’s assistance in resolving the dispute. The Committee notes that in his reply of 28 November 2000 the Minister stated that the cause of the dispute was the unions’ resistance to the deployment exercise with the result that an unprecedented total strike was declared by the three unions without the provision of emergency services. Noting the subsequent correspondence between the MUMN and the Maltese Minister of Health, and between the ILO and the PSI and International Council of Nurses (ICN), the Committee observes that, in an email message of 26 March 2001, the MUMN informed the ILO that a "final and definite agreement" had been reached by the MUMN and the Health Division, thus putting an end to the dispute. The Committee therefore asks the Government to provide information in its next report about the content of the agreement and particularly on the conditions of work of the nursing staff at Mount Carmel hospital since the resolution of the dispute.

The Committee also asks the Government to provide information on the following points.

Article 6 of the Convention. Further to its previous comments, the Committee notes the information that the conditions of work of nursing personnel are equivalent to those of other workers in the public sector with regard to the areas covered by this Article. It notes that the Government’s report refers to the national legislation and to agreements between the Government and workers’ unions, but does not specify the laws or regulations adopted to give effect to this Article of the Convention. To enable the Committee better to assess the consistency of the national legislation with the provisions of the Convention, the Government is asked to send with its next report any documents, either general or specific, concerning nursing personnel which have not already been sent to the Office, such as copies of laws, regulations, collective agreements, administrative instructions, etc. The Committee observes that the information supplied by the Government does not allow comparison between the conditions of work of nursing personnel and those of workers in other sectors. The Committee therefore requests the Government to give specific instances showing equality between nursing personnel and workers in other sectors in respect of employment and working conditions. Furthermore, no mention is made of nurses’ working conditions in the private sector. The Committee refers to the Government’s first report, dated 1993, stating that there were no private hospitals in Malta, and asks the Government to state whether this is still the case.

Article 7. The Committee refers to its general observation of 1990, repeated in 1994, in which it stressed the need to take measures to adapt the legislation on health and safety at work to the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel. In this respect, the Committee also suggested to consult with nursing personnel on such measures. Having not received any information from the Government on this matter, the Committee asks the Government to provide detailed information on the measures taken in pursuance of its recommendation, based on Article 7 of the Convention.

Part V of the report reform. The Committee notes the information in the Government’s report to the effect that there are no official statistics on nursing personnel and their relation to the population. It hopes that the Government will shortly be in a position to gather such data and communicate them to the Office, and in the meantime requests the Government to continue to provide general information on the manner in which the Convention is applied in practice, and to notify any difficulties encountered in its implementation.

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The Committee notes that the Government's report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

The Committee takes note of the information supplied in the Government's report.

Article 6, paragraphs (a), (b), (c), (d), (e), (f) and (g), of the Convention. The Committee again requests the Government to describe the conditions of employment and work of nursing personnel under the current law and practice in the fields covered by these provisions and state to what extent the above conditions are comparable to those of other workers.

Part V of the report form. The Committee requests the Government to continue to supply general information on the manner in which the Convention is applied in practice, including for example: statistics on the number of nursing personnel and their relation to the population; the number of persons leaving the profession; any practical difficulties encountered in the implementation of the Convention.

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The Committee takes note of the information supplied in the Government's report.

Article 6, paragraphs (a), (b), (c), (d), (e), (f) and (g) of the Convention. The Committee again requests the Government to describe the conditions of employment and work of nursing personnel under the current law and practice in the fields covered by these provisions and state to what extent the above conditions are comparable to those of other workers.

Point V of the report form. The Committee requests the Government to continue to supply general information on the manner in which the Convention is applied in practice, including for example: statistics on the number of nursing personnel and their relation to the population; the number of persons leaving the profession; any practical difficulties encountered in the implementation of the Convention.

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The Committee notes the Government's first report. In order to enable it to examine the application of the Convention, the Committee requests the Government to provide further information on the following points.

Article 1, paragraph 3, of the Convention. Please indicate any special rules established concerning nursing personnel who give nursing care and services on a voluntary basis and state whether prior consultations were held with the employers' and workers' organizations concerned in this context.

Article 2, paragraph 1. Please supply information on the national policy concerning nursing services and indicate the bodies responsible for formulating and implementing the policy.

Article 2, paragraphs 2(a) and 3. The Committee notes that the Government has embarked upon a process of reform in the health sector aimed at achieving a more personalized and quality service. It requests the Government to supply full information on the nature of the measures which have been taken or are envisaged in the context of this reform (for example, as they affect health institutes and schools, training programmes for nursing personnel, etc.). Please also indicate the manner in which the organizations of employers and workers concerned were consulted in the context of the above reform process.

Article 2, paragraph 2(b). Please supply further information on the career prospects of nursing personnel in the public and private sectors.

Article 2, paragraph 4. Please indicate the manner in which the coordination and consultation laid down in this paragraph are ensured.

Article 3, paragraph 1. Please indicate the manner in which the basic requirements regarding education and training are laid down and how education and training are supervised.

Article 3, paragraph 2. Please indicate how the coordination called for by this paragraph is ensured.

Article 4. Please supply information on any laws or regulations which specify the requirements for the practice of providing nursing care and services.

Article 5, paragraph 1. The Committee notes that discussions and negotiations regarding the status and conditions of employment of nursing personnel have been organized with trade union organizations. Please supply full information on the manner in which this consultation was held and its outcome in the public and private sectors, together with a copy of the collective agreements governing the conditions of employment of nursing personnel in the private sector. Please also indicate the dispute settlement procedures which are applied for nursing personnel.

Article 6, paragraphs (a), (b), (c), (d), (e), (f) and (g). Please describe the conditions of employment and work of nursing personnel under the current law and practice in the fields covered by these provisions and state to what extent the above conditions are comparable to those of other workers.

Article 7. Please indicate the laws and regulations which are in force respecting occupational health and safety, as well as the measures which have been taken or are envisaged to improve these provisions by adapting them to the special nature of nursing work and of the environment in which it is carried out. Please also indicate any measures which have been taken or are envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel.

Point V of the report form. Please supply general information on the manner in which the Convention is applied in practice, including for example: statistics on the number of nursing personnel and their relation to the population; the number of persons leaving the profession; any practical difficulties encountered in the implementation of the Convention; etc.

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The Committee notes that the Government's report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the following matters raised in its previous direct request:

Article 1, paragraph 3, of the Convention. Please indicate any special rules established concerning nursing personnel who give nursing care and services on a voluntary basis and state whether prior consultations were held with the employers' and workers' organizations concerned in this context.

Article 2, paragraph 1. Please supply information on the national policy concerning nursing services and indicate the bodies responsible for formulating and implementing the policy.

Article 2, paragraphs 2(a) and 3. The Committee noted that the Government has embarked upon a process of reform in the health sector aimed at achieving a more personalized and quality service. It requests the Government to supply full information on the nature of the measures which have been taken or are envisaged in the context of this reform (for example, as they affect health institutes and schools, training programmes for nursing personnel, etc.). Please also indicate the manner in which the organizations of employers and workers concerned were consulted in the context of the above reform process.

Article 2, paragraph 2(b). Please supply further information on the career prospects of nursing personnel in the public and private sectors.

Article 2, paragraph 4. Please indicate the manner in which the coordination and consultation laid down in this paragraph are ensured.

Article 3, paragraph 1. Please indicate the manner in which the basic requirements regarding education and training are laid down and how education and training are supervised.

Article 3, paragraph 2. Please indicate how the coordination called for by this paragraph is ensured.

Article 4. Please supply information on any laws or regulations which specify the requirements for the practice of providing nursing care and services.

Article 5, paragraph 1. The Committee noted that discussions and negotiations regarding the status and conditions of employment of nursing personnel have been organized with trade union organizations. Please supply full information on the manner in which this consultation was held and its outcome in the public and private sectors, together with a copy of the collective agreements governing the conditions of employment of nursing personnel in the private sector. Please also indicate the dispute settlement procedures which are applied for nursing personnel.

Article 6, paragraphs (a), (b), (c), (d), (e), (f) and (g). Please describe the conditions of employment and work of nursing personnel under the current law and practice in the fields covered by these provisions and state to what extent the above conditions are comparable to those of other workers.

Article 7. Please indicate the laws and regulations which are in force respecting occupational health and safety, as well as the measures which have been taken or are envisaged to improve these provisions by adapting them to the special nature of nursing work and of the environment in which it is carried out. Please also indicate any measures which have been taken or are envisaged, in consultation with the employers' and workers' organizations concerned, to take into account the particular risk of accidental exposure to the human immunodeficiency virus (HIV) among nursing personnel.

Point V of the report form. Please supply general information on the manner in which the Convention is applied in practice, including for example: statistics on the number of nursing personnel and their relation to the population; the number of persons leaving the profession; any practical difficulties encountered in the implementation of the Convention; etc.