Observation (CEACR) - adopted 2001, published 90th ILC session (2002)

Nursing Personnel Convention, 1977 (No. 149) - Poland (Ratification: 1980)

The Committee notes the information provided in the Government’s report in reply to the comments made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives of Poland alleging the non-application of Convention No. 149, which were transmitted to the Government on 24 July and 11 September 2000, respectively. Following these comments, the Government transmitted to the ILO in January 2001, by way of response, a copy of the Self-Government Act of the Provinces of 5 June 1998, which did not bear any relation in principle to the matters raised by the above organizations. Later, in September 2001, the Government provided a report containing certain elements of a reply to the above comments. The Committee recalls that, in addition to its observation of 2000, it also commented on the application of the Convention in 1999. The Committee had then requested information from the Government relating, among other matters, to Article 2, paragraph 2(b), and Articles 3 and 7 of the Convention. Following the receipt of the Government’s last report, the Committee wishes to draw the Government’s attention to the following points.

1. The Committee notes the Government’s information concerning the introduction in 1999 of a new model of health-care functioning. From that year, successive measures have been adopted to improve conditions of employment and develop nursing-care resources, based on the following: the transformation of the system for the education of nurses and midwives, according to the European standards that are in force; the creation of new jobs through the restructuring of health care; the development of the conditions to acquire new professional qualifications; and the improvement of conditions of work.

2. The Committee notes in particular the adoption on 3 February 2001 by the Sejm of the Republic of Poland of the Act to amend the Act respecting the professions of nurses and midwives (Dziennik Ustaw No. 16, text No. 169), adapting Polish legislation respecting the training and practice of the nursing profession to European Council directives, and the Programme of Transformation of Nurses’ and Midwives’ Education for the years 2001 05, developed under the above Act. The Committee notes that this Programme includes the introduction of professional university studies (BA) for nurses and midwives in 2001-03 in around 30 universities in Poland. The Committee requests the Government to inform the ILO of the practical measures taken under the above Act and Programme. The Committee also notes that a programme of restructuring in the field of health care has been undertaken since 1999. It notes that in 2001-02, this programme has been implemented in accordance with the instructions of the Cabinet dated 28 December 2000 (Dziennik Ustaw No. 122, text No. 1326 as subsequently amended), issued under the Act of 12 May 2000 respecting the principles of supporting regional development (Dziennik Ustaw No. 48, text No. 550 as subsequently amended), copies of which have been provided to the ILO and will be examined once they have been translated. The Committee requests the Government to provide information on the application in practice of this programme and, in particular, improvements that have been made as a result in the provision of health care. The Committee also recalls that, in accordance with Article 2, paragraph 3, of the Convention, when adopting and applying a policy concerning nursing services and nursing personnel, the Government is bound to consult the employers’ and workers’ organizations concerned. In view of the comments made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives of Poland, the Committee requests the Government to indicate whether the consultations envisaged by this provision of the Convention were held and, if not, to take the necessary measures to ensure that the organizations concerned are consulted in future.

3. The Committee notes that, in reply to the comments of the above workers’ organizations alleging poor working conditions of nursing personnel, the Government refers to the general legislation (the Civil Code and the Labour Code) and to certain specific provisions such as the Act on health-care units of 30 August 1991 (Dziennik Ustaw No. 91, text No. 408 as subsequently amended) and the Instructions of the Minister of Health and Social Protection of 13 July 1998 on contracting health services (Dziennik Ustaw No. 93, text No. 592). The Committee notes that this information does not enable it to assess the quality of the conditions of work of the personnel concerned, which are distinct from the laws and regulations existing on this subject. It therefore requests the Government to indicate whether a policy to provide nursing personnel with satisfactory employment and working conditions, including career prospects and adequate remuneration, which are likely to attract persons to the profession and retain them in it so that they can provide nursing care of the quantity and quality that are necessary to provide patients with the highest possible level of health care, has been adopted and applied effectively, in accordance with Article 2, paragraphs 1 and 2, of the Convention.

4. The Committee notes the information that independent public health-care units no longer have the status of (state) budget units and that, in accordance with section 77-2(1) of the Labour Code, the terms of wage settlements are those set out in the salary regulations until the employees are covered by the enterprise or sectoral collective agreement. The Committee notes that, according to the Government, there are no grounds for determining the salary rules for employees of independent public health-care units in the form of instructions or sectoral collective agreements. It notes that it is only in the case of public health services organized as budget units that the Minister of Health can, under the terms of section 40(2) of the Act of 30 August 1991, determine the salary rules for the employees. The Committee draws the Government’s attention to the fact that it has not provided any information in reply to the allegations made by the Trade Union of Medical Analysis Technicians and the National Trade Union of Nurses and Midwives of Poland to the effect that the wage scales are not adapted to the work performed and that the wages are declining. It therefore requests the Government to provide detailed information in its next report on these points.

5. The Committee notes that, with regard to occupational safety and health, the Government refers to sections 94 and 210 of the Labour Code which provide, inter alia, that the employer is obliged to ensure safe and healthy working conditions and that employees have the right to withdraw from work, while retaining the right to remuneration, in the event of physical or mental danger to themselves or others. Recalling that the National Trade Union of Nurses and Midwives of Poland alleged in its comments the non-compliance of employers with the basic principles of safety and health and the absence of legislative provisions on this subject, the Committee requests the Government to indicate whether it has taken additional measures to ensure the effective application of the current provisions.

6. The Committee notes that, with regard to conditions of work, the Government indicates that Poland is currently in a special situation and that the implementation of the first phase of the transformation of the health-care system is causing anxiety among certain occupational organizations. It notes that this restructuring often requires mass redundancies and changes in their jobs and the necessity for them to accept to change their qualifications. The Committee notes that, in the view of the Government, such action does not prove that the Government does not respect the employment and social rights of the staff. The Government indicates that, on the contrary, in its efforts to provide the highest level of health care, which also concerns the level of nursing services, it has recently taken several decisions to achieve these objectives. The Committee notes the introduction in 1999 of the so-called "group nursing practice" as a different form of performing the nurse’s and midwife’s profession. It requests the Government to provide additional information on such practice. Furthermore, it requests the Government to indicate whether the employers’ and workers’ organizations concerned were consulted in this respect. The Committee notes the signature by the Minister of Health on 21 December 1999 of the Directive determining the minimum standards of employment of nurses and midwives in health-care units and requests the Government to provide a copy of the above Directive to the ILO. While noting that a Bill was submitted to the Sejm for the granting of preferential loans to employees who have lost their jobs during the restructuring process, the Committee requests the Government to provide any practical information concerning improvements in the conditions of work of nursing personnel.

7. The Committee notes the adoption of the Act of 22 December 1999 amending the Act on health-care units which is intended, according to the Government, to maintain the rights granted by the Cabinet instructions of 27 December 1974, which were repealed on 30 September 1999. In addition, it notes the information that the above Act, which entered into force on 1 October 1999, maintains the continuity of the rights of employees in public health-care units in relation to working time, as well as of those employed in independent public health-care units, and in terms of the long-service benefit and retirement or pension benefits due to incapacity for work. The Committee also notes the adoption of the Act of 1 March 2001 amending the Act issuing the Labour Code (Dziennik Ustaw No. 28, text No. 301), which introduced the five-day working week. The Government adds that the regulations respecting hours of work, shift-work bonuses, the continuous provision of health care and supplements for employees in emergency ambulance services, also cover employees in the private sector. For all these reasons, the Government considers that the comments of the National Trade Union of Nurses and Midwives of Poland concerning the loss of their acquired rights are difficult to accept. The Committee notes these comments. The Committee hopes to be able to examine the legal texts provided by the Government once they have been translated. In the meantime, it asks the Government to take the necessary measures to ensure compliance with the provisions of the Convention, and accordingly to ensure the rights of nursing personnel in the country.

The Committee is raising other points in a request addressed directly to the Government.

[The Government is asked to report in detail in 2003.]