Nursing Personnel Convention, 1977 (No. 149) - France (Ratification: 1984)

Direct Request (CEACR) - adopted 2021, published 110th ILC session (2022)

The Committee notes the observations of the General Confederation of Labour Force Ouvrière (CGT–FO). It requests the Government to provide its comments in this regard.

Article 2 of the Convention. Measures to attract nursing personnel to the profession and to retain them. In response to its previous comments, the Committee notes the statistics provided by the Government for 2003–13. The Committee refers however to the recent publication by the Directorate for Research, Studies, Evaluation and Statistics (DREES) on “healthcare establishments” (DREES 2021), which provides a more up-to-date synthesis of the main available data on French healthcare establishments, and notes that the number of nurses increased by 23 per cent between the end of 2003 and the end of 2018. Nursing personnel as a percentage of total staff also increased, from 24.1 per cent to 26.1 per cent over the same period. The percentage of auxiliary healthcare workers (21.1 per cent at the end of 2018) and of administrative personnel (10.8 per cent at the end of 2018) as a proportion of total hospital personnel remained broadly stable for 15 years. With regard to the distribution of nursing personnel throughout the national territory, the Committee notes, according to DREES 2021, at national level, public health establishments accounted for 60 per cent of hospital beds and places, non-profit private establishments for 15 per cent and profit-making private clinics for 25 per cent. This distribution is however very unequal across the departments. With regard to reforms, the Committee notes the information provided by the Government in respect of demographics, teaching and training, those actively engaged in the profession, career and remuneration and international cooperation for the recognition of occupational qualifications and authorization to practice allowing international mobility of nurses (general and specialized health care). In particular, it notes that nursing personnel have benefited generally from the “Professional development, career and remuneration” (PPCR) protocol, which has resulted in a rebalancing of remuneration in favour of index-related wages (a measure referred to as “bonus-points transfer”), and a revaluation over several years (between 2016 and 2020) of wage scales, with an average increase of around 12 index points. The Government indicates, moreover, that plans to develop status and benefits are in progress. These include the creation, in autumn 2019, of a special status for advanced-practice auxiliary medical workers. The exercise of advanced practice was included in a specific section of the Act of 26 January 2016 modernizing the health system, and its development was reaffirmed as a means of improving career prospects. It will initially concern only nursing personnel, as the diploma and exercise of advanced practice were recognized in France in 2018. As a complement to recognition of advanced practice, a new allowance was to be put in place in the summer of 2019 to reward engagement by healthcare workers in the inter-professional cooperation protocols established under Act No 2009-879, of 21 July 2009 on reforming the hospital and relative to patients, health and the territories (the HPST Act). In this regard, the CGT–FO observes that the establishment of a category of “advanced-practice nurses” looks like a crutch to prop up organized medical shortages. According to the CGT–FO, these specialized nurses will be paid lower wages than doctors and will be called on to perform and take full responsibility for medical acts, in a structure that has not been designed accordingly. The Government further indicates that implementation of the agreement of 2 February 2010 was completed on 1 September 2017, with the reclassification of the body of re-education workers and the body of electro-radiology technicians within Category A of public hospital personnel. The reclassification was optional for a six-month period, during which time the professionals could choose between their revalued status as a body under Category A or their previous status as a body under Category B, which was being phased out, with maintenance of their early retirement rights. In this connection, the CGT–FO observes that the option to choose between early retirement and thus turning down an increase in wages in a profession where wages were already very low, is additional proof of the difficulties encountered by nurses that the Government was not trying to solve. The Committee requests the Government to continue providing detailed and up-to-date information on the impact of recent reforms, in particular regarding employment and working conditions, including on career prospects and remuneration which are likely to attract persons to the nursing profession and retain them in it (Article 2(2)(b)).

Article 5. Consultation with nursing personnel on decisions concerning them. In response to the Committee’s previous comments, the Government indicates that trade unions are involved at local level in developments concerning internal organization of services. These phases of dialogue involve consulting the various groups of personnel, including the nursing personnel represented on the establishments’ technical committees and on the health, safety and working conditions committees. Employment and working conditions require obligatory consultations with these bodies. The Government adds that healthcare establishment professionals, including nurses, can benefit from support provided through mediation. In its observations, the CGT–FO refers to the creation of the “Nursing Order”, membership of which became compulsory in 2016, to point out that this measure simply increases the unattractiveness of the profession, and weakens the representation of nursing personnel, who are largely opposed to such membership. The Committee requests the Government to provide information on the content and development of the support procedure for nurses implemented through mediation. The Government is also requested to provide examples of consultations held with the social partners on issues covered by the Convention.

Article 7. Occupational safety and health. The Government indicates that French occupational safety and health legislation does not provide for specific measures aimed at improving the working conditions (as regards health, safety and security) of nursing personnel. However, the Labour Code provides that certain workers exposed to particular occupational hazards (asbestos, lead, ionising radiations, etc.) must be covered by a reinforced medical follow-up, the form of which is determined by the occupational physician. Nursing personnel may therefore, according to their function, benefit from this follow-up. Moreover, the occupational physician in charge of the multidisciplinary occupational health team can request authorization from the director of the establishment to seek the aid of persons or bodies “with the competences required to prevent occupational hazards and improve working conditions” (R4627-17 of the Labour Code), such persons or bodies may provide advice specifically concerning nurses. In this regard, the CGT–FO observes that the reform of the staff representative bodies under the 2017 Ordinances, as well as the abolition of the health, security and working conditions committee (CHSCT) and of the technical committees, greatly reduce the consideration given to matters of occupational safety, health and security, and worsen nurses’ working conditions. The Government’s revision of the table of occupational diseases and its refusal to take risks to mental health into account also add to the difficulties encountered by workers, in particular nurses. The CGT–FO also observes that the recent reforms led by the Government have resulted in the abolition of individual exposure sheets for exposure to certain factors of occupational hazards. This has also entailed excluding exposure to certain hazardous chemicals as a criterion for entry into the arduous or dangerous work category, regardless of the use of numerous hazardous chemical substances in healthcare establishments that put nurses’ health in danger. The CGT–FO further recalls that the nursing profession is primarily comprised of women and therefore requires solutions adapted to women in respect of working conditions, particularly to combat precarious work for women and gender-based inequality. The Committee also notes the CGT–FO’s observations, which draw attention to the current high level of distress of the healthcare personnel, including nursing personnel. Noting that, because of the specific nature of their work, nursing personnel are often in close contact with patients and so exposed to a very high risk of infection when providing care to patients presenting symptoms of infectious diseases, including COVID-19, especially if precautions to combat infection, such as the use of personal protective equipment (PPE) and vaccines, are not strictly applied or readily available, the Committee requests the Government to provide detailed and up-to-date information on all the safety measures taken or envisaged, to improve working conditions in respect of safety, health and security for nursing personnel specifically.

Direct Request (CEACR) - adopted 2018, published 108th ILC session (2019)

The Committee notes that the Government’s report has not been received. It hopes that the next report will contain full information on the matters raised in its previous comments initially made in 2014.

Repetition

Article 2 of the Convention. Measures to attract nursing personnel to the profession and to retain them. The Committee notes with interest the detailed information provided by the Government in its report. The Government indicates that according to the estimates of the Directorate for Research, Studies, Evaluation and Statistics (DREES), there will be 657,800 nurses in 2030, that is 37 per cent more than in 2006. Moreover, regional disparities in terms of the number of nursing personnel in relation to the total population are expected to decrease. The Committee requests the Government to continue to provide information on the measures taken to improve the distribution of nursing personnel across the national territory and the impact of these measures. Furthermore, it requests the Government to provide information on the concrete impact of the reform of the governance of hospitals introduced by the Act of 21 July 2009 on the working conditions of nursing personnel.

The Committee notes that, following the reform of 2010 implying for the nursing personnel with the status of civil servants the choice between moving to category A and benefiting from a higher salary while renouncing the right to retire earlier, or staying in category B and maintaining the right to an anticipated pension without salary increase, the majority of nurses opted for maintaining the right to retire earlier. The Committee requests the Government to provide information on the impact of this reform on the attractiveness of the nursing profession.

Article 5. Participation of nursing personnel on decisions concerning them. In its previous comments, the Committee had noted that the members of the committee for nursing, rehabilitation and medico-technical care were designated by three groups of voters, one of which regroups three occupational groups: nursing, rehabilitation and medico-technical personnel. It had also noted that some representatives of nursing personnel feared that grouping nursing staff with the other two occupational groups referred to above did not allow them to express their views on behalf of their profession. The Committee once again requests the Government to provide information on the manner in which it is ensured that the concerns of the nursing staff are taken into account within the committee for nursing, rehabilitation and medico-technical care.

Article 7. Occupational health and safety. Following its previous comments, the Committee requests the Government to provide detailed information on the measures taken with a view to adapting the occupational safety and health regulations to the specific characteristics of the work of nursing personnel.

The Committee requests the Government to provide in its next report information in reply to the comments of the Committee regarding the regions of French Guiana, Guadeloupe, Martinique, Réunion and St. Pierre and Miquelon.

Direct Request (CEACR) - adopted 2014, published 104th ILC session (2015)

Article 2 of the Convention. Measures to attract nursing personnel to the profession and to retain them. The Committee notes with interest the detailed information provided by the Government in its report. The Government indicates that according to the estimates of the Directorate for Research, Studies, Evaluation and Statistics (DREES), there will be 657,800 nurses in 2030, that is 37 per cent more than in 2006. Moreover, regional disparities in terms of the number of nursing personnel in relation to the total population are expected to decrease. The Committee requests the Government to continue to provide information on the measures taken to improve the distribution of nursing personnel across the national territory and the impact of these measures. Furthermore, it requests the Government to provide information on the concrete impact of the reform of the governance of hospitals introduced by the Act of 21 July 2009 on the working conditions of nursing personnel.

The Committee notes that, following the reform of 2010 implying for the nursing personnel with the status of civil servants the choice between moving to category A and benefiting from a higher salary while renouncing the right to retire earlier, or staying in category B and maintaining the right to an anticipated pension without salary increase, the majority of nurses opted for maintaining the right to retire earlier. The Committee requests the Government to provide information on the impact of this reform on the attractiveness of the nursing profession.

Article 5. Participation of nursing personnel on decisions concerning them. In its previous comments, the Committee had noted that the members of the committee for nursing, rehabilitation and medico-technical care were designated by three groups of voters, one of which regroups three occupational groups: nursing, rehabilitation and medico-technical personnel. It had also noted that some representatives of nursing personnel feared that grouping nursing staff with the other two occupational groups referred to above did not allow them to express their views on behalf of their profession. The Committee once again requests the Government to provide information on the manner in which it is ensured that the concerns of the nursing staff are taken into account within the committee for nursing, rehabilitation and medico-technical care.

Article 7. Occupational health and safety. Following its previous comments, the Committee requests the Government to provide detailed information on the measures taken with a view to adapting the occupational safety and health regulations to the specific characteristics of the work of nursing personnel.

The Committee requests the Government to provide in its next report information in reply to the comments of the Committee regarding the regions of French Guiana, Guadeloupe, Martinique, Réunion and St. Pierre and Miquelon.

Direct Request (CEACR) - adopted 2010, published 100th ILC session (2011)

Article 2 of the Convention. Measures to attract nursing personnel to the profession and to retain them. The Committee notes the Government’s indications that the admission quotas for nursing schools increased from 19,400 in 2000 to 30,000 in 2003 and have since remained at this level. It notes that, according to demographic forecasts, there will be around 650,000 nurses in 2025, that is 45 per cent more than in 2005. However, the Committee understands that around 10 per cent of the places available in nursing training institutes (IFSI) are not filled and that just over 20 per cent of the students enrolled in the first year do not complete their training. The Committee requests the Government to provide further information on this matter and on the measures taken to remedy this situation. The Committee also notes with interest the launch in 2008 of the campaign entitled “Your Hospital Needs You”, which aims to promote all hospital jobs, including the nursing profession, with a view to filling 200,000 posts over a period of five years. It notes that a regional nursing plan was drawn up in the
Île-de-France region covering the period 2003–06 and then updated to cover the period 2008–13. The three themes of the plan are attractiveness, training and staff retention. The Committee requests the Government to indicate the results of these campaigns and to provide information on any similar initiatives adopted in other regions. In general, the Committee requests the Government to provide information on any regional disparities in terms of the number of nursing personnel in relation to the total population and, if applicable, on the measures taken to improve the distribution of nursing personnel across the national territory and the impact of these measures.

The Committee also requests the Government to provide information on any programmes implemented relating to the recruitment of nursing personnel from abroad. In this regard, it refers to the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted on 21 May 2010, which lays down the ethical principles governing international recruitment and aims to strengthen the health systems of developing countries, countries in transition and small island States.

Furthermore, the Committee notes the adoption of the Act of 21 July 2009 introducing hospital reforms and concerning patients, health and territories, which provides for the creation of regional health agencies and substantially reforms the governance of hospitals, including the conclusion of long-term agreements on objectives and means. It also understands that a large number of job losses is envisaged in public hospitals. The Committee requests the Government to provide further information on the impact of this reform on the working conditions of nursing personnel and on the reductions in nursing personnel envisaged in the public sector.

The Committee also notes the draft agreement concluded on 2 February 2010 between the Health and Sports Minister and five trade union organizations concerning the inclusion of nurses who graduate from IFSI in category A of the hospital civil service, resulting in a pay increase for the personnel concerned. It also notes that, under section 37 of Act No. 2010-751 of 5 July 2010 reforming social dialogue and containing various provisions relating to the civil service, nurses and paramedical staff having the status of civil servants in category A are no longer grouped in the active category of the civil service, which previously allowed them to retire at 55 years of age instead of at 60 years of age due to the difficult nature of their work. It notes that, during a six-month period starting on 1 September 2010, civil servants currently in employment may choose to remain in category B and benefit from a limited pay increase while retaining the right to retire earlier, or be moved to category A and renounce this right. The Committee understands that the new provisions applicable, in particular the major concessions that have to be made in terms of retirement rights in order to move into category A, have been very controversial among nursing personnel. It requests the Government to provide further information on this reform and its expected impact on the attractiveness of the nursing profession, as well as on the way in which this reform relates to the current debate concerning the plans to raise the retirement age.

Article 3. Training. The Committee notes the adoption of the Order of 31 July 2009 concerning the state nursing diploma. It understands that this text has given rise to some fears among the nursing personnel concerning the duration of the training reduced from 38 to 34 months, the number of hours of study, from 4,760 to 4,200 (the number of hours allocated to individual work has in turn been increased) and the duration of placements, from 68 weeks to 60 weeks. The Committee requests the Government to provide any information it has available in reply to the concerns expressed.

Article 5. Consultation of nursing personnel on decisions concerning them. The Committee notes the adoption of Act No. 2006-1668 of 21 December 2006 creating a National Association of Nurses which is intended to replace the Central Council for the Paramedical Professions with an interdisciplinary body designed to create the necessary links between all health system stakeholders. It notes the organization of the first elections of the departmental and regional councils, as well as those of the national council, which were held in 2008. It notes that the Association is entrusted with the task of ensuring the monitoring of the number of staff in the profession and defending the profession or professionals and that it should be consulted on legislative texts and regulations concerning the nursing profession. The Committee requests the Government to provide information on the functioning of the National Association of Nurses in practice and on the role that it plays in improving the working conditions of nursing personnel in France.

Article 7. Occupational health and safety. The Committee notes that the above draft agreement of 2 February 2010 provides for the continuation of local agreements on improved working conditions by placing greater emphasis on actions relating to the prevention of occupational hazards and improved organization of the work. It requests the Government to provide more detailed information on the measures taken with a view to adapting the occupational safety and health regulations to the specific characteristics of the work of nursing personnel. In this regard, the Committee draws the Government’s attention to the HIV and AIDS Recommendation, 2010 (No. 200), which was adopted by the International Labour Conference in June 2010, and in particular to Paragraph 31 of that Recommendation, which provides that “Safety and health measures to prevent workers’ exposure to HIV at work should include universal precautions, accident and hazard prevention measures …, environmental control measures and post-exposure prophylaxis and other safety measures to minimize the risk of contracting HIV and tuberculosis, especially in occupations most at risk, including in the health-care sector”.

Part V of the report form. Application in practice. The Committee would be grateful if the Government would continue providing general information on the manner in which the Convention is applied in practice, in particular in overseas departments and collectivities, including, for example, statistics relating to the number of nursing personnel, disaggregated, if possible, by level of training and function, gender and age, the nurse-to-population ratio, the number of persons joining and leaving the profession each year, copies of official reports or studies concerning nursing services, as well as information concerning any difficulties encountered in practice in implementing the Convention.

Observation (CEACR) - adopted 2010, published 100th ILC session (2011)

Article 5(1) of the Convention. Participation of nursing personnel in the planning of nursing services. The Committee notes the adoption of Decree No. 2005-1656 of 26 December 2005 concerning the councils covering areas of activity and the committee for nursing, rehabilitation and medico-technical care in public health establishments. Further to its previous comments, it notes with satisfaction that the members of this committee, which has replaced the nursing care committee, are elected and no longer appointed by drawing lots. The Committee notes, however, that the members of this body are designated by three groups of voters, one of which regroups three occupational groups: nursing, rehabilitation and medico-technical personnel. The Committee understands that some representatives of nursing personnel fear that grouping nursing staff with the other two occupational groups referred to above does not allow to express their views on behalf of their profession within the framework of the committee for nursing, rehabilitation and medico-technical care. Furthermore, the Committee notes the adoption of Decree No. 2010-449 of 30 April 2010 concerning the committee for nursing, rehabilitation and medico-technical care in public health establishments. The Committee requests the Government to provide further information on the manner in which it is ensured that the concerns of the nursing staff are taken into account in the context of the new regulations.

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

Direct Request (CEACR) - adopted 2009, published 99th ILC session (2010)

The Committee notes with regret 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 2, of the Convention. Measures to improve the employment and working conditions of nursing personnel. The Committee understands that the Government has launched in 2002 a major reform programme regarding hospital services (“Hospital 2007”) with the aim of harmonizing the funding and pricing procedures of public and private establishments, simplifying the financial management of institutional health-care providers, and modernizing the working methods of health professionals. The Committee would appreciate receiving additional information on the implementation of this programme and its possible impact on the employment conditions of nursing personnel. In addition, the Committee requests the Government to indicate whether the reform plan also concerns overseas departments and collectivities.

Moreover, the Committee notes the Government’s reference to the flow of nurses leaving the profession, it being estimated that between 7,000 and 9,000 nurses have been leaving work annually from 1997 to 2003. The Committee also notes that according to other sources of information, 6 per cent of the nursing workforce left the public sector in 2001, and 18,000 nurses leave public hospitals every year while the situation would appear even worse in the private sector. The Committee requests the Government to clarify whether this constant decrease in the overall number of nursing staff is in any manner linked to unsatisfactory employment and working conditions, for instance, low pay and poor career prospects, and also to supply full particulars on any additional incentives, financial or other, designed to retain qualified nurses in the profession.

Article 5, paragraph 2. Determination of conditions of employment and work by negotiation. Further to its previous comment, the Committee asks the Government to transmit copies of all national collective agreements in force covering nursing personnel in the private sector.

Article 7. Occupational health and safety. The Committee notes the detailed information provided by the Government on preventive and protective procedures against HIV-infection in medical establishments. It notes, in particular, circular DGS/DH/98/249 of 20 April 1998 which takes into account the particular risks of exposure of health-care workers to HIV and other blood-borne pathogens and sets a programme for the prevention and protection of health-care workers mainly based on vaccination, workers’ health surveillance, information and training, and the respect of March 1995 which specifies the modalities of handling
cases of HIV-infection as occupational accidents, and circular DGS/DHOS/DRT/DSS/2003/165 of 2 April 2003 which provides for a post-HIV exposure antiretroviral treatment. While noting that according to news reports, in France, of the 13 proven cases of occupational HIV infection, 12 concerned nurses, the Committee would be grateful if the Government would continue supplying information on any further developments on these matters.

Moreover, the Committee wishes to draw the Government’s attention to the adoption in April 2005 of the Joint ILO/WHO guidelines on health services and HIV/AIDS, which aim at promoting sound management of HIV/AIDS in health services providing for wide-ranging and practical approaches to protection, training, screening, treatment, confidentiality, prevention, the minimizing of occupational risk and the care and support of health-care workers. The Committee trusts that the Government will give due consideration to these guidelines with a view to improving existing laws and regulations on occupational health and safety for health professionals.

Part V of the report form. Application in practice. The Committee notes the statistical data provided by the Government on the number of nursing personnel by category and by grade, the proportion of nursing staff in relation to other health workers, and their geographical distribution by region and department. The Committee requests the Government to continue to provide up to date information on the organization of health services in general (e.g. number of medical establishments, nurse-to-population ratio, number of nurses attending nursing schools, new nursing positions established per year) as well as on any broader issues having an impact on the quality of nursing services (e.g. health system reforms, resources and funding of medical establishments, medical research and new technologies, shortage of specialized personnel, recruitment of nurses from foreign countries, etc.).

Observation (CEACR) - adopted 2009, published 99th ILC session (2010)

The Committee notes with regret that the Government’s report has not been received. It must therefore repeat its previous observation which read as follows:

Article 5, paragraph 1, of the Convention. Participation of nursing personnel in the planning of nursing services. The Committee has been commenting for the last 15 years on the method for appointing members of the nursing care committees and has been requesting information on the participation of representative organizations in these consultative bodies. The Government in successive reports has not supplied any explanations on this point, nor has it informed of any follow-up discussions concerning the modification of the method of appointing members of the nursing care committees which were to be held with trade union organizations under the terms of the protocol agreement signed in March 2000 by the Government and representative organizations of nursing personnel.

The Committee recalls once again that Article 5(1) of the Convention does not specify the role to be played by the representatives of nursing personnel in promoting participative and consultative practices within health care establishments, nor does it indicate any particular method of appointing representatives of the personnel. However, reference may be made to Paragraphs 19(2) and 20 of the Nursing Personnel Recommendation, 1977 (No. 157), according to which the representatives of nursing personnel should be understood within the meaning of Article 3 of the Workers’ Representatives Convention, 1971 (No. 135), which sets out specific procedures for the appointment of representatives.

The Committee requests the Government once again to indicate whether the possible modification of the method of appointing members of nursing care committees by drawing lots is still under consideration and to report on any further developments in this regard.

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

The Committee hopes that the Government will make every effort to take the necessary action in the very near future.

Direct Request (CEACR) - adopted 2008, published 98th ILC session (2009)

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 2, of the Convention. The Committee understands that the Government has launched in 2002 a major reform programme regarding hospital services (“Hospital 2007”) with the aim of harmonizing the funding and pricing procedures of public and private establishments, simplifying the financial management of institutional health-care providers, and modernizing the working methods of health professionals. The Committee would appreciate receiving additional information on the implementation of this programme and its possible impact on the employment conditions of nursing personnel. In addition, the Committee requests the Government to indicate whether the reform plan also concerns overseas departments and collectivities.

Moreover, the Committee notes the Government’s reference to the flow of nurses leaving the profession, it being estimated that between 7,000 and 9,000 nurses have been leaving work annually from 1997 to 2003. The Committee also notes that according to other sources of information, 6 per cent of the nursing workforce left the public sector in 2001, and 18,000 nurses leave public hospitals every year while the situation would appear even worse in the private sector. The Committee requests the Government to clarify whether this constant decrease in the overall number of nursing staff is in any manner linked to unsatisfactory employment and working conditions, for instance, low pay and poor career prospects, and also to supply full particulars on any additional incentives, financial or other, designed to retain qualified nurses in the profession.

Article 5, paragraph 2. Further to its previous comment, the Committee asks the Government to transmit copies of all national collective agreements in force covering nursing personnel in the private sector.

Article 7. The Committee notes the detailed information provided by the Government on preventive and protective procedures against HIV-infection in medical establishments. It notes, in particular, circular DGS/DH/98/249 of 20 April 1998 which takes into account the particular risks of exposure of health-care workers to HIV and other blood-borne pathogens and sets a programme for the prevention and protection of health-care workers mainly based on vaccination, workers’ health surveillance, information and training, and the respect of hygienic 1995 which specifies the modalities of handling cases of HIV-infection as occupational accidents, and circular DGS/DHOS/DRT/DSS/2003/165 of 2 April 2003 which provides for a post-HIV exposure antiretroviral treatment. While noting that according to news reports, in France, of the 13 proven cases of occupational HIV infection, 12 concerned nurses, the Committee would be grateful if the Government would continue supplying information on any further developments on these matters.

Moreover, the Committee wishes to draw the Government’s attention to the adoption in April 2005 of the Joint ILO–WHO Guidelines on Health Services and HIV/AIDS, which aim at promoting sound management of HIV/AIDS in health services providing for wide-ranging and practical approaches to protection, training, screening, treatment, confidentiality, prevention, the minimizing of occupational risk and the care and support of health-care workers. The Committee trusts that the Government will give due consideration to these guidelines with a view to improving existing laws and regulations on occupational health and safety for health professionals.

Part V of the report form. The Committee notes with interest the statistical data provided by the Government on the number of nursing personnel by category and by grade, the proportion of nursing staff in relation to other health workers, and their geographical distribution by region and department. The Committee requests the Government to continue to provide up to date information on the organization of health services in general (e.g. number of medical establishments, nurse-to-population ratio, number of nurses attending nursing schools, new nursing positions established per year) as well as on any broader issues having an impact on the quality of nursing services (e.g. health system reforms, resources and funding of medical establishments, medical research and new technologies, shortage of specialized personnel, recruitment of nurses from foreign countries, etc.).

Observation (CEACR) - adopted 2008, published 98th ILC session (2009)

The Committee notes that the Government’s report has not been received. It must therefore repeat its previous observation which read as follows:

The Committee has been commenting for the last ten years on the method for appointing members of the nursing care committees and has been requesting information on the participation of representative organizations in these consultative bodies. The Government in successive reports has not supplied any explanations on this point, nor has it informed of any follow-up discussions concerning the modification of the method of appointing members of the nursing care committees which were to be held with trade union organizations under the terms of the protocol agreement signed in March 2000 by the Government and representative organizations of nursing personnel.

The Committee recalls once again that Article 5, paragraph 1, of the Convention does not specify the role to be played by the representatives of nursing personnel in promoting participative and consultative practices within health care establishments, nor does it indicate any particular method of appointing representatives of the personnel. However, reference may be made to Paragraphs 19(2) and 20 of the Nursing Personnel Recommendation, 1977 (No. 157), according to which the representatives of nursing personnel should be understood within the meaning of Article 3 of the Workers’ Representatives Convention, 1971 (No. 135), which sets out specific procedures for the appointment of representatives.

The Committee requests the Government once again to indicate whether the possible modification of the method of appointing members of nursing care committees by drawing lots is still under consideration and to report on any further developments in this regard.

The Committee is also addressing a direct request to the Government concerning certain other points.

The Committee hopes that the Government will make every effort to take the necessary action in the very near future.

Direct Request (CEACR) - adopted 2005, published 95th ILC session (2006)

The Committee notes the information provided by the Government in reply to its previous comments.

Article 2, paragraphs 1 and 2, of the Convention. The Committee understands that the Government has launched in 2002 a major reform programme regarding hospital services ("Hospital 2007") with the aim of harmonizing the funding and pricing procedures of public and private establishments, simplifying the financial management of institutional health-care providers, and modernizing the working methods of health professionals. The Committee would appreciate receiving additional information on the implementation of this programme and its possible impact on the employment conditions of nursing personnel. In addition, the Committee requests the Government to indicate whether the reform plan also concerns overseas departments and collectivities.

Moreover, the Committee notes the Government’s reference to the flow of nurses leaving the profession, it being estimated that between 7,000 and 9,000 nurses have been leaving work annually from 1997 to 2003. The Committee also notes that according to other sources of information, 6 per cent of the nursing workforce left the public sector in 2001, and 18,000 nurses leave public hospitals every year while the situation would appear even worse in the private sector. The Committee requests the Government to clarify whether this constant decrease in the overall number of nursing staff is in any manner linked to unsatisfactory employment and working conditions, for instance, low pay and poor career prospects, and also to supply full particulars on any additional incentives, financial or other, designed to retain qualified nurses in the profession.

Article 5, paragraph 2. Further to its previous comment, the Committee asks the Government to transmit copies of all national collective agreements in force covering nursing personnel in the private sector.

Article 7. The Committee notes the detailed information provided by the Government on preventive and protective procedures against HIV-infection in medical establishments. It notes, in particular, circular DGS/DH/98/249 of 20 April 1998 which takes into account the particular risks of exposure of health-care workers to HIV and other blood-borne pathogens and sets a programme for the prevention and protection of health-care workers mainly based on vaccination, workers’ health surveillance, information and training, and the respect of hygienic regulations. Moreover, modalities of handling cases of HIV-infection as occupational accidents, and circular DGS/DHOS/DRT/DSS/2003/165 of 2 April 2003 which provides for a post-HIV exposure antiretroviral treatment. While noting that according to news reports, in France, of the 13 proven cases of occupational HIV infection, 12 concerned nurses, the Committee would be grateful if the Government would continue supplying information on any further developments on these matters.

Moreover, the Committee wishes to draw the Government’s attention to the adoption in April 2005 of the Joint ILO/WHO Guidelines on Health Services and HIV/AIDS, which aim at promoting sound management of HIV/AIDS in health services providing for wide-ranging and practical approaches to protection, training, screening, treatment, confidentiality, prevention, the minimizing of occupational risk and the care and support of health-care workers. The Committee trusts that the Government will give due consideration to these guidelines with a view to improving existing laws and regulations on occupational health and safety for health professionals.

Part V of the report form. The Committee notes with interest the statistical data provided by the Government on the number of nursing personnel by category and by grade, the proportion of nursing staff in relation to other health workers, and their geographical distribution by region and department. The Committee requests the Government to continue to provide up-to-date information on the organization of health services in general (e.g. number of medical establishments, nurse-to-population ratio, number of nurses attending nursing schools, new nursing positions established per year) as well as on any broader issues having an impact on the quality of nursing services (e.g. health system reforms, resources and funding of medical establishments, medical research and new technologies, shortage of specialized personnel, recruitment of nurses from foreign countries, etc.).

Observation (CEACR) - adopted 2005, published 95th ILC session (2006)

The Committee has been commenting for the last ten years on the method for appointing members of the nursing care committees and has been requesting information on the participation of representative organizations in these consultative bodies. The Government in successive reports has not supplied any explanations on this point, nor has it informed of any follow-up discussions concerning the modification of the method of appointing members of the nursing care committees which were to be held with trade union organizations under the terms of the protocol agreement signed in March 2000 by the Government and representative organizations of nursing personnel.

The Committee recalls once again that Article 5, paragraph 1, of the Convention does not specify the role to be played by the representatives of nursing personnel in promoting participative and consultative practices within health care establishments, nor does it indicate any particular method of appointing representatives of the personnel. However, reference may be made to Paragraphs 19(2) and 20 of the Nursing Personnel Recommendation, 1977 (No. 157), according to which the representatives of nursing personnel should be understood within the meaning of Article 3 of the Workers’ Representatives Convention, 1971 (No. 135), which sets out specific procedures for the appointment of representatives.

The Committee requests the Government once again to indicate whether the possible modification of the method of appointing members of nursing care committees by drawing lots is still under consideration and to report on any further developments in this regard.

The Committee is also addressing a direct request to the Government concerning certain other points.

Direct Request (CEACR) - adopted 2000, published 89th ILC session (2001)

The Committee notes that the Government’s report does not provide any information in reply to the questions raised in its previous direct request, which are therefore taken up again in its comments.

Article 2, paragraphs 1 and 2, of the Convention.  Further to its previous comments, the Committee once again requests the Government to provide statistical data on the number of persons entering the profession annually, the number of nursing personnel by category and by grade, the proportion of nursing personnel in relation to other workers in the health sector, and their geographic distribution in the regions and departments, including overseas departments (Guadeloupe, French Guiana, Martinique, Reunion).

Article 7.  In its previous comments, the Committee noted circular DSS/AT No. 93-32 of 23 March 1993, specifying the methods of implementing the regulations set out in Decree No. 93-74 of 18 January 1993 and the Order of 18 January 1993, which establishes a new procedure for the coverage under employment injury legislation of workers who have contracted the human immunodeficiency virus (HIV). The Committee once again requests the Government to indicate the extent to which the above circular and regulations apply in the overseas departments.

Furthermore, referring to its general observation of 1990, which it repeated in 1994, the Committee once again requests the Government to indicate the measures taken or under consideration, in consultation with the employers’ and workers’ organizations concerned, to take account of the particular risk among nursing personnel of accidental exposure to HIV: for example, working conditions, confidentiality of test results, acknowledgement that the cause of the infection was occupational, etc. The Committee once again requests the Government to indicate the conditions under which these measures are extended to the overseas departments.

Part V of the report form.  The Committee once again hopes that the Government will be able to provide information on persons leaving the profession.

Observation (CEACR) - adopted 2000, published 89th ILC session (2001)

The Committee notes the information contained in the Government’s report.

1.  Further to its previous comments concerning circular No. 20 of 4 May 1994, changing the methods for taking into account seniority and also service on humanitarian missions abroad, the Committee notes the information provided by the Government that the above circular does not apply to the private sector. It also notes, from the information contained in the Government’s report, that nursing personnel in that sector do not enjoy the status of employees of the public hospital service and that they are recruited under contracts of employment the conditions of which are determined in collective agreements negotiated by employers and representatives of employees. The Committee therefore requests the Government to provide copies of the above collective agreements.

2.  The Committee notes the information provided by the Government concerning work schedules. It requests the Government to continue providing information on the application of adjusted working hours to all hospital centres and, in particular, on the debate on the organization and arrangement of working time in the context of the 35-hour week.

3.  In its previous comments, the Committee noted that under section R.714-26-1 of the Public Health Code, members of the nursing care service committee are appointed by drawing lots among volunteers who must let the director of the establishment know that they are willing to stand. The Committee notes the information provided by the Government to the effect that the nursing care service committee was established to strengthen the participation and dialogue with nursing personnel in public health establishments. The Committee also notes the information provided by the Government on the method of appointing the members of the above committee by drawing lots. Furthermore, it notes that a protocol agreement was signed on 14 March 2000 between the Government and the representative organizations of nursing personnel. This agreement envisages the modification of this method of appointment and is due to be discussed with trade union organizations.

The Committee notes once again that Article 5, paragraph 1, of the Convention does not specify the role to be played by the representatives of nursing personnel in implementing the measures that must be taken, in accordance with methods appropriate to national conditions, to encourage consultation of such personnel in decisions concerning them. The above Article does not therefore a fortiori contain any provision respecting the methods of appointing representatives of the personnel. Nevertheless, the Committee recalls that Paragraphs 19(2) and 20 of the Nursing Personnel Recommendation, 1977, (No. 157), refer explicitly to the representatives of the personnel within the meaning of Article 3 of the Workers’ Representatives Convention, 1971 (No. 135), which sets out specific procedures for the appointment of these representatives, who must be designated or elected by trade unions or by members of such unions or freely elected by the workers in the enterprise.

The Committee requests the Government to provide information on the discussions concerning the modification of the method of appointing members of the nursing care service committee which are to be held with trade union organizations under the terms of the protocol agreement signed by the Government and the representative organizations of nursing personnel. It also requests the Government to provide information on the participation of representative organizations in nursing care service committees.

The Committee is also addressing a request directly to the Government on certain matters.

Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

The Committee notes that the Government's report contains no reply to previous comments. It hopes that the next report will include full information on the matters raised in its previous direct request, which read as follows:

Article 2, paragraphs 1 and 2, of the Convention. Please provide statistical data on the number of persons entering the profession annually, the number of nursing personnel by category and by grade, the proportion of nursing personnel in relation to other workers in the health sector, and the geographic distribution in the regions and departments, including overseas departments (Guadeloupe, French Guiana, Martinique, Reunion).

Article 7. The Committee notes circular DSS/AT No. 93-32 of 23 March 1993 specifying the methods of implementing the regulations set out in Decree No. 93-74 of 18 January 1993 and the Order of 18 January 1993, which establish a new procedure for the coverage under employment injury legislation of workers who have contracted the human immunodeficiency virus (HIV). It asks the Government to state to what extent the above-mentioned circular and regulatory texts apply in the overseas departments. Furthermore, referring to its general observation of 1990, which it repeated in 1994, the Committee asks the Government to indicate the measures taken or under consideration, in consultation with the employers' and workers' organizations concerned, to take account of the particular risk among nursing personnel of accidental exposure to HIV: for example, working conditions, confidentiality of test results, acknowledgement that the cause of the infection was occupational, etc. Please also state the conditions under which these measures are extended to the overseas departments.

Part V of the report form. The Committee expresses the hope that the Government will be able to provide information on persons leaving the profession.

Observation (CEACR) - adopted 1999, published 88th ILC session (2000)

The Committee notes that the Government's report contains no reply to previous comments. It must therefore return to its previous observation in relation to the following points:

1. The Committee notes with interest circular No. 20 of 4 May 1994 which changes the methods for taking account of former service and also allows service on humanitarian missions abroad to be taken into account. It asks the Government to indicate whether the principles laid down in this circular also apply to the private sector.

2. The Committee notes the information provided by the Government on the adjustment of working hours. The Committee asks the Government to continue to provide information on the application of the adjusted working hours to all hospital centres.

3. The Committee notes that under section R.714-26-1 of the Public Health Code, members of the nursing care service committee are appointed by drawing lots among volunteers who must let the director of the establishment know that they are willing to stand.

The Committee notes that Article 5, paragraph 1, of the Convention does not specify the role to be played by the representatives of nursing personnel in implementing the measures that must be taken, in accordance with methods appropriate to national conditions, to encourage consultation of such personnel in decisions concerning them. Even less does it specify how staff representatives should be appointed. The Committee nonetheless recalls the indications in Paragraphs 19(2) and 20 of the Nursing Personnel Recommendation (No. 157), which refer expressly to representatives of personnel within the meaning of Article 3 of the Workers' Representatives Convention, 1971 (No. 135), which sets out specific procedures for the appointment of representatives.

The Committee asks the Government to indicate why the drawing of lots was adopted as the procedure for appointing members of nursing care service committees, and to provide information on the participation of representative organizations in nursing care service committees.

The Committee is also addressing a direct request to the Government concerning certain other points.

Direct Request (CEACR) - adopted 1995, published 82nd ILC session (1995)

The Committee notes that the Government's report does not supply information answering the points raised in the previous direct request. It therefore reiterates them, together with new comments.

Article 2, paragraphs 1 and 2, of the Convention. Please provide statistical data on the number of persons entering the profession annually, the number of nursing personnel by category and by grade, the proportion of nursing personnel in relation to other workers in the health sector, and the geographic distribution in the regions and departments, including overseas departments (Guadeloupe, French Guyana, Martinique, Reunion).

Article 7. The Committee notes circular DSS/AT No. 93-32 of 23 March 1993 specifying the methods of implementing the regulations set out in Decree No. 93-74 of 18 January 1993 and the Order of 18 January 1993, which establish a new procedure for the coverage under employment injury legislation of workers who have contracted the human immunodeficiency virus (HIV). It asks the Government to state to what extent the above-mentioned circular and regulatory texts apply in the overseas departments. Furthermore, referring to its general observation of 1990, which it repeated in 1994, the Committee asks the Government to indicate the measures taken or under consideration, in consultation with the employers' and workers' organizations concerned, to take account of the particular risk among nursing personnel of accidental exposure to HIV: for example, working conditions, confidentiality of test results, acknowledgement that the cause of the infection was occupational, etc. Please also state the conditions under which these measures are extended to the overseas departments.

Point V of the report form. The Committee expresses the hope that the Government will be able to provide information on persons leaving the profession.

Observation (CEACR) - adopted 1995, published 82nd ILC session (1995)

With reference to the previous comments concerning the observations of the French Confederation of Christian Workers (CFTC), the General Confederation of Labour Force ouvrière (CGT-FO) and the French Democratic Confederation of Labour Health and Social Federation (CFDT), the Committee notes the information supplied by the Government.

1. The Committee notes with interest circular No. 20 of 4 May 1994 which changes the methods for taking account of former service and also allows service on humanitarian missions abroad to be taken into account. It asks the Government to indicate whether the principles laid down in this circular also apply to the private sector.

2. The Committee notes the Government's statement that the application of Protocol No. 1 concerning the reduction of working hours in the event of night work has required an increase in periods and funds. It notes that the application of the working hours established for nursing personnel in the public sector (39 hours per week reduced to 35 hours in the event of night work) is ensured in 51.55 per cent of public health establishments, covering 43.48 per cent of such staff in hospital establishments. It also notes that additional funds were allocated early in May 1994 by the Regional Directorates for Health and Social Matters (DRASS) so as to complete implementation of the system. The Committee asks the Government to continue to provide information on the application of the adjusted working hours to all hospital centres.

3. The Committee notes that Act No. 91-748 to reform hospitals establishes, in addition to advisory committees with trade union representation: (i) procedures for direct consultation with the service councils made up, depending on the size of the service or department, either of medical and non-medical staff of the service or department, or of representatives from the "functional units", in accordance with requirements established in regulations; (ii) procedures for specific consultation with nursing care committees composed of all personnel participating in the provision of nursing care, such as nurses and auxiliaries. It also notes that under section R.714-26-1 of the Public Health Code, members of the nursing care service committee are appointed by drawing lots among volunteers who must let the director of the establishment know that they are willing to stand. The nursing care service committee is consulted on the general organization of the service as part of a nursing care project, on monitoring and research in nursing care, on the preparation of a training policy and the establishment project. According to the survey on the nursing care service committees carried out in September 1993, of the 722 hospital establishments consulted, 25 indicated that they had no nursing care service committee.

The Committee notes that no mention is made of any participation by organizations representing the staff in the survey of September 1993 on nursing care committees, conducted by the Ministry of Social Affairs.

The Committee notes that the method for appointing members of the nursing care service committee is to draw lots among a set of volunteers. It understands that, although it is not unknown in French law, this method of appointment is exceptional in the area of staff representation. In the hospital sector, for example, section L.714-17 of the above-mentioned Code provides for the election of the members of the establishment's technical committee and recalls the requirements regarding representativeness for submitting the lists of candidates.

The Committee notes that Article 5, paragraph 1, of the Convention does not specify the role to be played by the representatives of nursing personnel in implementing the measures that must be taken, in accordance with methods appropriate to national conditions, to encourage consultation of such personnel in decisions concerning them. Even less does it specify how staff representatives should be appointed. The Committee none the less recalls the indications in Paragraphs 19(2) and 20 of the Nursing Personnel Recommendation (No. 157), which refer expressly to representatives of personnel within the meaning of Article 3 of the Workers' Representatives Convention, 1971 (No. 135), which sets out specific procedures for the appointment of representatives.

The Committee asks the Government to indicate why the drawing of lots was adopted as the procedure for appointing members of nursing care service committees, and to provide information on the participation of representative organizations in nursing care service committees.

The Committee is also addressing a direct request to the Government concerning certain other points.

Direct Request (CEACR) - adopted 1994, published 81st ILC session (1994)

The Committee asks the Government to provide information on the following points:

Article 2, paragraphs 1 and 2 of the Convention. Statistical data on the number of persons entering the profession annually, the number of nursing personnel by category and by grade, the proportion of nursing personnel in relation to other workers in the health sector, and the geographic distribution of nursing personnel in the regions and Departments, including overseas Departments (Guadeloupe, French Guiana, Martinique, Réunion).

Point V of the report form. The Committee expresses the hope that the Government will be able to provide data on persons leaving the profession.

Observation (CEACR) - adopted 1994, published 81st ILC session (1994)

The Committee notes the information supplied by the Government in its report and the comments made by the French Confederation of Christian Workers (CFTC), the General Confederation of Labour "Force-Ouvrière" (CGT-FO) and the French Democratic Confederation of Labour - Health and Social Federation (CFDT).

1. The Committee notes from the Government's report that by virtue of Circular No. 8 of 1 February 1993 of the Hospital Directorate of the Ministry of Health, nursing personnel may be made available to participate in short-term humanitarian activities, with guarantees for the maintenance of their career and the payment of their remuneration by the hospital which employs them for periods not exceeding 15 days. The Committee notes that in its comments the CFDT states that the above Circular does not have the force of regulations and is not therefore enforceable in respect of the directors of hospitals and that its scope is limited to public hospitals, thereby excluding a number of services in which nursing personnel are employed, as well as private establishments. Furthermore, the CGT-FO states that the Ministry of Health refuses to take into account time spent performing humanitarian activities when calculating seniority.

The Committee requests the Government to supply a copy of Circular No. 8 of 1 February 1993 of the Hospital Directorate and to indicate the measures which are envisaged under Article 1, paragraph 3, of the Convention.

2. The Committee also notes the information supplied by the Government concerning the working hours of nursing personnel in the public sector (39 hours a week, reduced to 35 hours in the event of night work). In its comments, the CGT-FO states that, for lack of funds, the 35-hour week in the case of night work is only applied in two regional university hospital centres (CHRU) out of the 29 which exist.

The Committee requests the Government to indicate the measures which have been taken or are envisaged to ensure the application of established working hours to all hospital centres.

3. With regard to the consultation procedures in hospitals provided for by virtue of Hospital Act No. 91.748, the Committee notes the comment made by the CGT-FO that the composition of these bodies takes no account of trade union representation as it may be evaluated from elections to joint committees.

The Committee requests the Government to supply information on the composition of the committees established in hospital establishments under the Hospital Act No. 91.748.

[The Government is asked to report in detail for the period ending 30 June 1994.]

Direct Request (CEACR) - adopted 1991, published 78th ILC session (1991)

1. Further to its previous comments, the Committee takes note of the information supplied by the Government on the application of Article 5 of the Convention concerning consultation with nursing personnel in the context of the health and safety committees, on decisions concerning the determination of working conditions, and on the participation of these committees in the settlement of disputes over conditions of employment. The Committee also takes note of the copies of the legal provisions supplied by the Government in connection with Article 6 and of the information concerning the reinforcement of the health and safety committees provided in connection with Article 7.

2. The Committee asks the Government to provide additional information on the following points:

(a) Article 2, paragraphs 1 and 2. The Committee requested the Government to provide information on the policy concerning nursing services and personnel and the planning of nursing care, on the role and place of nursing personnel in the organisation of hospital care and the measures taken or envisaged to implement the Agreement of 21 October 1988. It also requested statistical data on the number of persons entering the profession annually, the number of nursing personnel by category and by grade, the proportion of nursing personnel in relation to other workers in the health sector, and the geographic distribution of nursing personnel in the regions and Departments, including overseas Departments (Guadeloupe, French Guiana, Martinique, Réunion). The Committee hopes that the Government will provide this information in its next report.

(b) Point V of the report form. The Committee takes note of the statistics provided by the Government and expresses the hope that the Government will continue to provide such statistics and that it will also be able to provide data on persons leaving the profession.

Direct Request (CEACR) - adopted 1990, published 77th ILC session (1990)

The Committee takes note of the Government's first report.

Article 2, paragraph 1, of the Convention. The Committee notes that the Ministry of Solidarity, Health and Social Welfare is responsible for the formulation of health policy and that the measures taken after consultation with the occupational organisations and nurses' unions concerned, particularly those taken within the Central Council for the Paramedical Professions, are implemented by the State and its external services, the local communities, and by numerous public and private bodies. The Committee requests the Government to provide information on the policy concerning nursing services and personnel designed, within the framework of the general health programme, to provide the quantity and quality of nursing care necessary for attaining the highest possible level of health for the population. It requests the Government, in particular, to provide statistics of the number of persons entering the profession annually, the number of nursing personnel by sector (public, private, self-employed), by category and grade, the proportion of nursing personnel in relation to other workers in the health sector, and the geographical distribution of nursing personnel. It also requests the Government to provide information on the conclusions of the general reflection engaged in with all health-care personnel, on the role and place of nursing personnel in the organisation of health care.

Article 2, paragraph 2. The Committee notes the provisions concerning employment conditions, working conditions, initial training and continuing training, and the promotion of nursing personnel set out in the Agreement of 21 October 1988. It asks the Government to indicate the measures taken or under consideration to give effect to these provisions: preparation of specific methodology to analyse job content; recording, examination and promotion of innovations in the organisation of work and the planning of nursing care; reflection on the place of nursing personnel in the hospital; redeployment of personnel in the Departments and Regions; modification of holiday system. It also requests the Government to provide a copy of the conditions of employment of nursing personnel and auxiliary nurses, which are to be submitted to the Central Council of Public Hospital Employees.

Article 5, paragraph 1. With reference to the above Agreement, the Committee asks the Government to indicate the measures taken to strengthen the role and duties of the health and safety committees, particularly with regard to the consultations that must be held prior to any decisions concerning changes in working conditions. It requests the Government to provide a copy of the directive provided for in the above-mentioned Agreement. The Committee also requests the Government to indicate the measures that apply in the private sector to give effect to this provision of the Convention.

Article 5, paragraph 2. The Committee requests the Government to supply information on the results of the negotiations prescribed in the amendment to the Agreement of 21 October, submitted to the Central Council of Public Hospital Employees. It also asks the Government to provide information on the discussions with the social partners concerned on contractual problems in the non-profit-making private sector, provided for in the above amendment.

Article 5, paragraph 3. The Committee notes that the Government's report refers to provisions concerning disciplinary procedures (dereliction of duty, breaches against law). It requests the Government to indicate the provisions governing the settlement of disputes arising in connection with the determination of terms and conditions of employment which apply to nursing personnel.

Article 6. The Committee requests the Government to provide a copy of Circular No. 4/DH/8D, of 5 March 1982, concerning weekly working hours and annual holidays in public hospital establishments; of Circular No. 221/DH/4, of 30 July 1975, concerning the undertaking by public hospital establishments and certain social care establishments, to pay their employees during leave of absence for workers' education; and of Circular No. 210/DH/8D/87, of 7 October 1987, laying down the conditions for the granting of maternity leave, or copies of any texts which may have been adopted to replace the above Circulars.

Article 7. With reference to the above draft Agreement, the Committee asks the Government to state the measures taken to strengthen the role and duties of the health and safety committees, particularly with regard to protection of the health and safety of employees in the workplace.

Point V of the report form. The Committee requests the Government to provide information on the practical application of the Convention called for under point V of the report form.