CMNT_TITLE

CMNT_TITLE

CMNT_TITLE

Article 2, paragraphs 1–3, of the Convention. Formulation and implementation of a policy for nursing services and nursing personnel. The Committee notes the detailed information supplied in the Government’s report and also the attached documentation. Further to its previous comments concerning nursing personnel employed under precarious conditions, the Committee notes the information supplied by the Government indicating positive developments in the number of professionals working in the health sector. It notes that, under section 1 of Legislative Decree No. 276-A/2007 of 31 July 2007 amending the status of the national health service, services within establishments governed by the national health service may, in order to satisfy urgent staff requirements and on an exceptional basis, award fixed-term contracts for a maximum of one year, according to a simplified selection procedure. The Committee recalls that on a number of occasions it underlined the need to take steps to stabilize the situation of contracted personnel who had been admitted to the public service in an irregular, precarious and inappropriate manner, in order to satisfy the ongoing requirements of the services. It therefore requests the Government to indicate: (i) the number of persons still in a precarious situation in the health sector; and (ii) the steps taken or contemplated to stabilize the employment situation of contracted personnel.

Furthermore, with regard to the technical committees for training of nursing personnel and training in medical technologies, to which the Government referred in its previous report, the Committee notes the statement to the effect that these committees do not exist at present but that the Ministry of Science, Technology and Higher Education is continuing to cooperate with the Ministry of Health with regard to nursing personnel. It also notes the establishment in the context of the Bologna Accord of a joint commission for the supervision of nursing personnel and the definition of the education to be provided for them. The Committee requests the Government to supply further information on the work undertaken by this commission and also on any new measure adopted, in consultation with the employers’ and workers’ organizations concerned, with regard to education and training for nursing personnel.

Moreover, the Committee understands that a project was established between 2005 and 2007 to assist immigrant nurses, particularly by permitting the validation of the knowledge of these nurses, who at present work in a number of public health institutions. The Committee requests the Government to supply more detailed information on the implementation of this project and the results achieved, particularly its impact on the conditions of work of foreign nursing personnel. The Committee also requests the Government to provide information, especially statistical data, on the number of foreign nursing personnel currently working in the country and the conditions in which they are recruited.

Finally, the Committee notes the study published in October 2004 concerning the conditions of work of Portuguese nursing personnel. This study, conducted by the Faculty of Human Sciences of the Portuguese Catholic University, at the request of the nursing association, analyses the various elements which have a positive or negative impact on the well-being of nursing personnel. It reveals that the areas posing the most problems for nursing personnel are: occupational safety and health conditions, deficient equipment, working hours and workload, and internal staff movements. The analysis of the situation of nursing personnel also shows that there is a desire to see improvements in conditions of work, particularly with regard to further training, human relations, technical conditions, hours of work and pay. The Committee requests the Government to provide information on any action contemplated in the light of the conclusions of this study.

Article 2, paragraph 4. Consultation with employers’ and workers’ organizations. Further to its previous comments concerning the operation of regional health administrations, the Committee notes that the Government has not supplied any information in this respect. It previously noted the Government’s indication that information was being collected and would be sent to the Office as soon as possible. The Committee once again requests the Government to supply detailed information concerning (i) the working of regional health administrations and (ii) the coordination of health policies.

Article 5, paragraph 2. Determination of conditions of employment and work through collective bargaining. The Committee notes the copies of the collective agreement and enterprise agreements sent by the Government in its report. It also notes the statement that, with regard to the public sector, the rights to collective bargaining and participation provided for by Act No. 23/98 of 26 May 1998 regulating collective bargaining and the participation of employees in public administration, are not expressed in the conclusion of collective labour agreements but in effective bargaining and participation by workers in establishing and amending their staff regulations and also in implementing these amendments. The Committee requests the Government to continue to supply up to date information on the working of collective bargaining in the nursing sector.

Article 7. Occupational safety and health. The Committee notes Resolution No. 105/2004 of the Council of Ministers establishing a national action plan for the prevention of occupational risks, which appears to restrict action by the Ministry of Health to matters relating to protection against ionizing radiation. It emphasizes the fact that nursing personnel also face the risk of contamination by HIV/AIDS in the course of their duties. In this regard, the Committee wishes to draw the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to helping health services to strengthen their capacity for providing workers with a healthy and decent working environment, this being the most effective means of reducing the transmission of HIV and improving the provision of care for patients. The Committee would also like to refer to the discussion held at the June 2009 session of the International Labour Conference on “HIV/AIDS and the world of work”, with a view to the adoption of an international labour Recommendation, in particular paragraph 37 of the draft conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310), which states 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. The Committee requests the Government to keep the Office informed of any new measure taken or contemplated in order to improve the protection of nursing personnel against infectious diseases, including HIV/AIDS.

Part V of the report form. Application in practice. The Committee notes the statistics provided by the nursing association for the 2000–07 period. The Committee requests the Government to continue to supply information on the application of the Convention in practice, including, for example, statistics on the numbers of nursing personnel – by sectors of activity and by levels of training and functions, if possible – the number of persons entering and leaving the profession each year, copies of official reports or studies on nursing services, and information on any practical difficulties encountered in the implementation of the Convention.

CMNT_TITLE

The Committee notes the information supplied by the Government in reply to its previous comments and wishes to draw the Government’s attention to the following points.

Article 2, paragraphs 1 to 3, of the Convention. Further to its previous comment concerning measures to regularize the situation of contractual nursing personnel employed under precarious terms, the Committee notes that the Government’s report contains no new information. The Committee is therefore obliged to reiterate its request for specific particulars, including up-to-date statistics, relating to the employment policy in the health-care sector and the evolution of the situation concerning the shortage of nursing personnel.

As regards education and training opportunities for professional nurses, the Committee notes the Government’s reference to the Council of Ministers’ resolution No. 116/2002 of 22 August 2002 concerning a set of measures to promote advanced training in health and improve quality standards. Under the terms of this resolution, a project chief has been appointed to coordinate, supervise and evaluate the programmes to be developed while a monitoring group has been set up for advanced health training. The Government also refers to Joint Directive No. 291/2003, dated 27 February 2003, of the Ministries of Science and Higher Education and Health which established two technical committees, one on nursing training and another on education in medical technologies, to be placed under the responsibility of the monitoring group for advanced health training set up under the Council of Ministers’ resolution No. 116/2002. While noting with interest these institutional developments, the Committee would appreciate receiving additional information on any concrete projects or initiatives undertaken in the field of skill acquisition and vocational training for nursing personnel and the results obtained. It would also be grateful if the Government could provide in its next report more detailed information on the composition, mandate and functioning of the new bodies, and specify whether these measures have been decided in consultation with the employers’ and workers’ organizations concerned, as required under this Article of the Convention.

Article 2, paragraph 4. While noting the Government’s indication that information on this point is being collected and will be forwarded as soon as possible, the Committee is bound to renew its request for supplementary information on the operation of regional health administrations, especially as regards policy coordination in matters of health care. In addition, the Committee asks the Government to elaborate in its next report on the practical manner in which consultations are conducted with employers’ and workers’ organizations for the purpose of integrating the specific policy on the nursing profession into the broader health-care policy framework.

Article 5, paragraph 2. The Committee notes the Government’s reference to Act No. 23/98 on collective bargaining and the participation of public service employees. It asks the Government to supply additional information on any collective agreement in force in either the private or the public sector respecting conditions of work of nursing personnel and also to transmit a copy of any such agreement, bearing in mind that the last copy received of a collective agreement applicable in the private sector dates from 1990.

Article 7. The Committee notes with interest the adoption of Legislative Decree No. 503/99 of 20 November 1999 establishing the legal framework on accidents at work and occupational diseases arising while in the service of the public administration. The Committee requests the Government to continue providing information on any measures, whether legislative, administrative or others, aimed at improving the occupational safety and health conditions in which the nursing profession is carried out.

Part V of the report form. The Committee notes the statistical information concerning the distribution of nursing personnel by geographical region in 2002 and the number of nurses per 1,000 inhabitants. The Committee would be grateful if the Government could continue supplying information on the application of the Convention in practice, including for instance statistics on the number of nurses currently employed in both the public and private sectors, the number of students attending nursing schools and the number of nurses leaving the profession, copies of recent studies or publications examining the employment and working conditions of nursing personnel, as well as any practical difficulties encountered in the implementation of the Convention.

CMNT_TITLE

The Committee notes the information provided in the Government’s last report. In particular, it notes with interest the adoption, among other legislation, of Legislative Decree No. 411/99 of 15 October 1999, amending the conditions of service of nursing careers; Legislative Decree No. 412/98 of 30 December 1998 restructuring nursing careers; and Legislative Decree No. 353/99 of 3 September 1999 issuing general rules for the teaching of nursing care in the context of higher public education.

The Committee notes in particular the information concerning Articles 4, 5 and 6 of the Convention. The Committee also notes with interest the establishment of the Order of Nurses and the approval of its statute by Legislative Decree No. 104/98 of 21 April 1998. The purpose of this professional public association is to defend the quality of nursing care provided to the population and to develop, regulate and control the exercise of the nursing profession.

Article 2, paragraphs 1 to 3. The Committee recalls that in its previous comment it noted the observations made by the General Confederation of Portuguese Workers (CGTP) indicating that there were still some 9,000 vacancies in the health care sector and that nursing personnel were still to a large extent, employed under contracts. In this respect, the Committee notes that the Government refers to Legislative Decrees Nos. 81 A/96 of 21 June 1996 and 256/98 of 14 August 1998, which are of a general nature but which are applicable to nursing personnel. These texts seek to regularize the situation of workers who over the years have been engaged in an irregular manner in the public service, under precarious or inadequate terms, to meet the permanent needs of these services. It also notes Legislative Decree No. 411/99 of 15 October 1999 authorizing nursing personnel covered by a nominal administrative contract to apply for general internal competitions, on condition that they have completed at least one year of uninterrupted service discharging functions related to the permanent needs of the services. Finally, it notes that, with a view to rationalizing resources and promoting a more balanced distribution of personnel throughout the country, the posts to be filled (quotas) between 1996 and 1999 have been put up for competition, either at the national level or at the level of the specific institutions. While noting this information with interest, the Committee requests the Government to continue providing information on the measures which have or are currently being adopted to stabilize the employment situation of contractual personnel. Furthermore, the Committee notes the Government’s indications concerning the steps taken in relation to higher training schools with a view to raising the number of inscriptions. These resulted in an increase of around 40 per cent in the number of students registered. It also notes that the teaching of nursing care has undergone considerable change intended to improve the training of professional nurses by giving them an opportunity to acquire new skills adapted to the health needs of the community.

Article 2, paragraph 4. The Committee recalls that it requested the Government to provide information on the working in practice of the regional health administrations which had been established as coordination bodies. As it has not received precise information from the Government on this subject, the Committee hopes that the Government will provide any relevant information with its next report on the coordination envisaged by this provision of the Convention. Furthermore, the Committee notes the strategy adopted by the Government to associate nursing personnel with the Health Commitments for 2002 (Compromisso da Saúde para 2002). The Committee requests the Government to continue providing information on the consultations envisaged by this provision of the Convention.

Article 5. The Committee notes the Government’s indications on the measures adopted to adjust the wages of nursing personnel. The Committee requests the Government to continue providing information on the determination of conditions of work of nursing personnel and their participation in this process.

Article 7. The Committee notes the information provided by the Government in reply to its general observation of 1994. It notes in particular that nursing personnel infected by the human immunodeficiency virus (HIV/AIDS) benefit from the same rights, in terms of sick leave, as other workers in the same situation. The corresponding provisions are contained in Legislative Decree No. 874/76 of 28 December 1976, as amended by Legislative Decree No. 397/91 of 16 October 1991, in the case of nursing personnel in the private sector, and in Legislative Decree No. 100/99 of 31 March 1999, for nursing personnel in the public sector. The Committee also notes that, while acquired immune deficiency syndrome is not listed as an occupational disease, it can be treated as such when it is proved that it is indeed a necessary and direct consequence of the work performed. However, the Committee notes that these rules apply solely to nursing personnel covered by individual employment contracts, but that the Government has already received the authorization of the Assembly of the Republic, under the terms of Act No. 105/99 of 26 July 1999, to adapt these rules to the public sector. The Committee requests the Government to inform the ILO of any progress achieved in this respect. Finally, the Committee notes that, in the case of workers infected by HIV/AIDS, including nursing personnel, a specific social protection system has been established, giving entitlement to an invalidity pension under more favourable conditions than those of the general social security scheme, in accordance with Legislative Decree No. 216/98 of 16 July 1998. These specific conditions include a reduction in the qualifying period, a more favourable method of calculating the reference wage and the improvement of annual contributions to the pension fund.

CMNT_TITLE

The Committee notes the information provided by the Government on Articles 3, 4 and 7 of the Convention. It asks the Government to provide further infomation on the following points:

Article 2, paragraphs 1 to 3. The Committee notes the adoption of Decree-Law No. 437/91 to regulate the career of all nursing personnel working in the service of the public administration, and the improvements to conditions of employment which were introduced since the Government's last report. In this respect, the Committee refers to the observation of the General Confederation of Portuguese Workers (CGTP), according to which some 9,000 vacancies continue to exist in the health-care sector and that nursing personnel are still to a large extent employed under contracts. The Committee also notes from the Government report that some 5,500 posts were unfrozen in 1992/93, to satisfy the high demand for health-care services. It requests the Government to continue to supply information on measures to stabilize the employment situation of personnel employed under contracts.

Article 2, paragraph 4. The Committee notes the planned installation of five regional health administrations which are to function as coordinating bodies for the regions concerned, and of health units in the form of health centres and individual hospitals. It requests the Government to supply information on the working in practice of these new bodies, especially with a view to coordination with policies relating to other aspects of health care and to other workers in the field of health, in consultation with the employers' and workers' organizations concerned.

Article 5. The Committee notes the information in the report concerning participation of nursing personnel in planning of nursing services and consultation with such personnel on decisions concerning them. In this respect, it also refers to the observation of the CGTP alleging that neither the employers in private institutions of social solidarity nor the Government were prepared to renegotiate a resolution from 1985, to guarantee to the nursing personnel a career and remuneration which were in conformity with the Convention. The Committee asks the Government to indicate what steps, if any, are taken or envisaged to amend the 1985 resolution.

Article 6. The Committee notes the collective agreements of 1986 and 1990, respecting conditions of work of nursing personnel in the private sector. It also notes that, as far as maternity leave, sick leave and social security of nursing personnel in the public sector are concerned, it is subject to the same provisions as all other personnel in the public sector. The Government is asked to indicate in detail the provisions that regulate these questions.

CMNT_TITLE

The Committee takes note of the comprehensive Government report, and of the comments of the General Confederation of Portuguese Workers (CGTP) regarding the application of certain provisions of the Convention. The Committee asks the Government to refer to its direct request in which these points are treated in detail.

CMNT_TITLE

The Committee has taken note of the detailed information and the documentation supplied by the Government in reply to earlier comments and to the allegations formulated by the General Confederation of Workers of Portugal (CGTP/IN) and by the Nursing Personnel Union of the southern district and of the autonomous region of the Azores. The Committee has also noted the comments formulated by the Portuguese Nurses' Union (SEP) on the Government's reply to these allegations. These comments were transmitted by the above-mentioned union confederation with its communication of 23 January 1990, a copy of which was sent on 6 February 1990 to the Government for its observations.

The Committee would also like to draw attention to the following:

Article 2, paragraphs 1 to 3, of the Convention. The Government refers in its report to the efforts undertaken, and to the legislative and other measures adopted, to improve working conditions, hours of work, remuneration and career prospects of nursing personnel, notably by Legislative Decree No. 134/87. It indicates, on the basis of the statistical data supplied, that during the period covered by the report, membership of this profession had increased (from 22,084 in 1987 to 23,641 in 1988), that the vast majority (about 90 per cent) are employed in the public sector and that the employers' and workers' organisations concerned are consulted on the formulation and adoption of the policy concerning nursing services and nursing personnel. With regard to the private sector, the Government states that conditions of employment in this sector are determined by collective agreements which stipulate standards comparable to those that apply in the public sector. The comments of the above-mentioned organisations, however, indicate that Legislative Decree No. 134/87 has not been applied in an equal fashion to nursing personnel assigned to the various ministries or to all categories of this personnel, and that the geographical distribution of nursing personnel has deteriorated owing to the lack of measures designed to encourage the assignment of this personnel to rural and peripheral regions. The Government admits that it is indeed difficult to engage nursing personnel in certain districts of the country, but it indicates that measures are being studied with a view to remedying the situation. As regards nurses engaged under contract ("tareifeiros"), as a result of the freeze on recruitment to the public sector (introduced by Legislative Decree No. 41/84) despite the shortage of nursing personnel - a question also referred to in the comments from the trade union organisations - the Government admits that the number of these nurses has increased from 2,380 on 31.12.87 to 2,656 on 31.12.88, but it indicates that legislative provisions are being formulated with a view to putting these workers on the same footing as public servants so as to improve the situation. The Committee notes these indications and the efforts being made by the Government. It hopes, however, that the necessary measures will be adopted within the framework of a general health programme with a view to improving the quantity and quality of nursing care in accordance with the Convention, by providing appropriate education and training, employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it. (In this respect, the Committee notes that according to the comments of the trade union organisations the number of persons leaving the profession is still fairly high.) The Committee would be grateful if the Government would indicate all progress made in this respect, and especially with regard to improving the status of nurses engaged under contract, the measures adopted to attract nursing personnel to the rural and peripheral regions and to increase the number of nurses assigned to primary health care, a category of personnel which appears to be lacking in certain hospitals, according to the above-mentioned comments from the trade union organisations.

Article 2, paragraph 4. The Committee again requests the Government to indicate the measures introduced or planned to improve co-ordination between the various health institutions, and to co-ordinate the policy concerning nursing personnel with policies relating to other aspects of health care and to other workers in the field of health, in consultation with the employers' and workers' organisations concerned, in accordance with the above-mentioned provision of the Convention.

Articles 3 and 4. The Committee notes with interest the adoption of Legislative Decree No. 261/88 referred to in the report, which defines admission requirements for general nursing training, and the adoption of Legislative Decree No. 480/88 which provides for the integration of nursing training into the national education system and stipulates that this training shall be subject to control by the Ministry of Education and the Ministry of Health. The Government also indicates that an official course designed to train ancillary personnel was created by the Ministerial Decree No. 7/89, and that with regard to the comments of the employers' and workers' organisations, according to which certain courses intended for this personnel category are still being given without any inspection being carried out by the competent authorities, or that they are being given by unqualified persons, these comments had been reported to the governing bodies of the hospitals concerned so that they may take the necessary steps. The Government adds that a Circular from the Department of Human Resources for Health (No. 12/89) has been sent to all hospital establishments within the jurisdiction of the Ministry of Health to ensure that ancillary personnel are assigned exclusively to tasks for which they had been trained.

The Committee notes this information and would be grateful if the Government would supply details on the results of these reforms, and hopes that measures may also be adopted to increase the number and improve the situation of nursing personnel training instructors, as referred to in the comments of the above-mentioned trade union organisations.

Article 5, paragraph 1. In its previous comments, the Committee had referred to observations by the Nursing Personnel Union indicating that nursing personnel were not sufficiently consulted on decisions concerning them. It had therefore requested the Government to indicate the measures introduced or planned to promote better possibilities of consultation with the personnel in question on decisions concerning them. In its latest report the Government supplied certain information on consultations which are taking place at various levels with members of the personnel and indicated its intention of involving representatives of the nurses' unions in the consultations due to take place with a view to modifying the legislation in force on the practice of the nursing profession. The Government also referred to the participation of these representatives in working groups organised by regional and international agencies.

The Committee takes note of this informnation and hopes that the Government will make every effort to encourage the participation of nursing personnel in the planning of nursing services and consultation with such personnel on decisions concerning them at national level, as well as at the level of the hospital establishments where they work.

Article 6. The Committee notes that, according to the information supplied by the Government on the subject of hours of work, weekly rest time, paid annual holidays and educational leave of nursing personnel in the public sector, conditions are the same as those that apply to public servants. With regard to the private sector, the Committee notes that the above questions are dealt with in the collective agreements, in particular, in the agreement which came into effect on 1 May 1988 between the Portuguese Association of Private Hospitals and the Portuguese Nursing Personnel Union. The Committee would be grateful if the Government would supply a copy of this Convention, bearing in mind that the copy attached to the report dates from 1986.

The Committee would also be grateful if the Government would indicate the provisions that ensure the application of sub-paragraphs (e), (f) and (g) of the Convention concerning maternity leave, sick leave and social security in the case of nursing personnel employed in the public sector.

Article 7. The Committee notes with interest the information supplied by the Government on the extension of occupational health and safety legislation to commercial establishments, offices and services including nursing personnel under the jurisdiction of the Ministry of Health. It would be grateful if the Government would keep it informed of all further developments in this respect and especially of all the provisions introduced to adapt this legislation to the special nature of nursing work and of the environment in which it is carried out.

CMNT_TITLE

In its direct request of 1989, the Committee had taken note of the allegations of the General Confederation of Workers of Portugal (CGTP/IN) and of the Union of Nursing Personnel of the southern district and of the autonomous region of the Azores concerning the non-application of certain provisions of the Convention, including those relating to training, employment conditions, hours of work, remuneration, career prospects and consultation with the nursing personnel on decisions concerning them (Articles 2, 3, 5, paragraph 1, 6(a) of the Convention. The Committee had therefore requested the Government to supply information in reply to these allegations, as well as detailed information on the application of certain other provisions of the Convention and statistical data, especially on the number of persons employed in the nursing profession and the number of persons who have left it.

The Committee takes note of the detailed information and statistical data supplied by the Government in its report in reply to the above-mentioned comments, as well as the legal texts adopted during the period covered by the report and the documentation attached thereto.

The Committee also takes note of the comments formulated by the Portuguese Nursing Personnel Union (SEP) on the Government's reply to the above-mentioned allegations. These comments were transmitted by the General Confederation of Workers of Portugal with its communication of 23 January 1990, a copy of which was sent on 9 February 1990 to the Government for its observations.

The Committee has examined the Government's reply and the comments of the SEP in a new direct request to which it would ask the Government to refer.