Nursing Personnel Convention, 1977 (No. 149) - Malta (Ratification: 1990)

Direct Request (CEACR) - adopted 2020, published 109th ILC session (2021)

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. The Committee welcomes the detailed information provided by the Government in its report. In particular, the Committee notes the implementation of the “National Health Systems Strategy for Malta 2014-20” (NHSS), which aims to provide every individual with the opportunity to lead a healthy and active life, and to benefit from equitable access to sustainable quality health care. The NHSS was developed with the technical assistance of the WHO, following an extensive consultation process with a wide range of stakeholders, including health care workers, health care organisations and health authorities. The NHSS is based on a “people-centred” approach, which recognizes four major groups of stakeholders involved in its implementation, including health practitioners (such as nursing personnel). In this regard, the NHSS envisages the involvement of health workers in health care governance and policy decision- making. The NHSS includes among its main objectives the improvement of the quality of care available, by ensuring consistency of care delivered by competent health workers. With a view to achieving this goal, the NHSS establishes a set of initiatives to raise standards for the professional development of health workers in the framework of a patient-centered approach. These initiatives include: strengthening the provision of training, including providing for training in relation to specialization and for the continued professional development of all health workers; moving forward with the development and implementation of the competency programmes for all groups of health care workers; piloting a mentoring programme for newly recruited employees; and supporting associations of health workers in taking steps to improve their continued professional development to in turn improve career advancement opportunities. The Committee also notes the information provided by the Government in relation to the “Health Workforce Planning Framework for Malta 2010-20”, which includes a detailed analysis of the impact of the different components of policy interventions implemented with respect to nursing personnel and nursing services. The Framework evaluates the policy interventions implemented in relation to: nursing workforce planning (planning capacity and stakeholder information); recruitment and retention (including financial and non-financial incentives, career structure and opportunities, nurse involvement in decision making); the deployment and performance of nurses (financial and non-financial incentives, data on activity and workforces, allocation of necessary equipment and material); and effective utilisation of their qualifications in the various health-care establishments (effective strategic management, financial and non-financial incentives, nurse involvement in decision making). Based on this evaluation, the Framework establishes projections of the number of nurses needed and of those available for the period 2010-20 and calculates the minimum standard nurse-to patient ratios needed to deliver adequate hospital services in the country. The Government does not indicate whether the Framework was developed in consultation with the employers’ and workers’ organizations concerned. The Committee requests the Government to provide detailed updated information on the nature and impact of measures implemented in the framework of the “National Health Systems Strategy for Malta 2014-20” and the “Health Workforce Planning Framework for Malta 2010-20”, particularly with respect to measures taken to improve the working conditions, career opportunities and professional competencies of nursing personnel. It also requests the Government to indicate whether the employers' and workers' organisations concerned, including the Malta Union of Midwives and Nurses (MUMN), were consulted in the development of measures taken or envisaged. In the context of the global COVID-19 pandemic, the Committee invites the Government to provide updated information on the impact of the pandemic on nursing personnel and nursing services, including measures taken to mitigate these impacts and to ensure the occupational safety and health of this essential category of frontline workers.

Article 3(1). Nursing education and training. The Committee notes the detailed information provided by the Government concerning the educational system established for nursing personnel in the country. The Government indicates that the courses offered by the University of Malta’s Institute of Health Care were transferred to the Faculty of Health Sciences in 2010, which includes a Nursing Department and a Mental Health Nursing Department. The Faculty offers full-time courses at undergraduate level in general nursing, leading to registration with the Council for Nurses and Midwives as well as degree and postgraduate courses. It works in collaboration with national public and private health care institutions, including the Mater Dei Hospital, which provide on-the-job training in diverse clinical settings. The Faculty promotes faculty exchanges through the Erasmus programme as well as lifelong learning courses for practicing nurses. Moreover, the Government indicates that, to address the increasing demand for qualified nurses, in October 2017, Northumbria University developed a new degree programme in Nursing Studies with the support of the Malta Enterprise and the MUMN. The Committee notes the information provided on the number of graduates accepted into the new programme. The Committee notes from the information provided by the Government that the Maltese Nursing Conversion Programme and the introduction of specialist nurse training have increased the skills, competencies and size of the nursing workforce. It further notes that the number of practicing nurses has increased by more than one-third over the past decade, to reach 7.9 per 1 000 population in 2018, slightly below the EU average of 8.5. The Committee requests the Government to continue to provide updated detailed information on the content and impact of the measures adopted to ensure that nursing personnel are provided with education and training appropriate to the exercise of their functions.

Articles 5 (2) and 6. Collective bargaining concerning employment and working conditions of nursing personnel.  Since 2001 the Committee has been requesting the government to provide more detailed information regarding collective agreements for nursing personnel. It notes with interest the information provided by the Government in respect of the set of collective and sectoral agreements signed between 2000 and 2018 with a view to improving the working conditions and career prospects for nursing personnel in the public and the private sectors. The Government indicates that working conditions for nursing personnel are established mainly in two types of agreements: the collective agreements for all public service employees, including nurses working within the public services; and sectoral agreements that are negotiated specifically for nurses and midwives. The Government indicates that both collective and sectoral agreements establish a specific time frame for their implementation. Prior to the expiry of the agreements, workers’ organizations, including the MUMN, submit their proposals concerning working conditions. The Government also adds that the collective agreements concluded between 2000 and 2013 introduced, among other measures, the establishment of a clinical specialist nursing framework (2000) a Continuous Professional Development allowance for all nurses (2006) and a special long service leave scheme for nurses with at least 30 years of full-time service (2013). The Government reports on the conclusion of the fifth Collective Agreement for Public Sector Employees in 2017, including nurses in the public sector, for the period 2017-24. The new collective agreement was signed by, among other actors, the MUMN, the General Workers’ Union (GWU), UĦM – Voice of the Workers, the Malta Union of Teachers (MUT), and the Medical Association of Malta (MAM). The agreement provides for an increase in salaries and certain allowances for Public Administration employees. In particular, the agreement introduces increments on the “shift allowance” for those employees working on a shift basis, a “qualification allowance” for those employees who have acquired additional qualifications beyond those required for the exercise of their duties. The Government adds that the most recent sectoral agreement has been concluded, covering Public Service Nurses for the period 22 November 2018 to 31 December 2022. It sets out a basic salary scale for the different categories of nursing personnel, providing for double pay on Sundays and triple pay on Public Holidays. The 2018 sectoral agreement also provides for different allowances, such as the “Nursing Premium” (varying from €3,843 to €8,960 depending on years of service and working conditions, and a “Continuous Professional Development Allowance” (consisting of €700 per annum for professional educational activities). The Government does not provide information on the current collective agreements covering the employment and working conditions of nursing personnel in the private sector. The Committee requests the Government to continue to provide updated detailed information on the content and impact of collective and sectoral agreements concluded concerning the working conditions (including remuneration and training opportunities) of nursing personnel in public and private hospitals, nursing homes and medical centres. It further requests the Government to provide copies of such agreements in its next report.

Article 5 (3). Procedures for the settlement of disputes arising in connection with the determination of terms and conditions of employment. The Committee notes the information provided by the Government concerning the different procedures contemplated in the Collective Agreement for Public Service Employees 2017-2024 in case of dispute and/or disagreement between the parties arising in connection with the determination of terms and conditions of employment. The Government indicates that such procedures provide for negotiation between the parties through a conciliation mechanism (section 10), as well as for a panel of arbitrators (section 11). Noting that the information provided by the Government concerns the public sector, the Committee requests the Government to also provide information on the procedures for the settlement of disputes arising in connection with the determination of terms and conditions of employment of nursing personnel in the private sector.

Article 6 (g). Social security. The Committee notes that the Government refers to the introduction of a pension reform raising the retirement age of nursing personnel to 65, with a view to increasing their retention in the profession and maintaining the number of nurses in the workforce. The Government also indicates that an agreement was concluded between the Government and the MUMN, which provides the possibility for nurses to continue to work post-retirement age. The Committee requests the Government to provide detailed information on the pension reform introduced raising the retirement age of nurses and the content and impact of its agreement with the MUMN. It further requests the Government to indicate whether, following the pension reform, nursing personnel enjoy conditions with regard to social security that are at least equivalent to those of other workers.

Article 7. Occupational safety and health of nursing personnel. The Committee notes that, according to the European Commission 2019 Country Health Profile on Malta, in 2017, the country reported the third highest notification rate of new HIV cases in the European Union (EU). The report points out that rates of newly diagnosed cases overall have increased by more than 50 per cent since 2008, in contrast to a general downward trend observed across the EU. In this context, the Committee notes the information provided by the Government regarding the measures taken to prevent occupational transmission of HIV among nurses, including the specialization of nurses working in multidisciplinary teams in decontamination, infection control and HIV to contain infectious diseases, and the implementation of plans for post-exposure management of health care personnel. In this respect, the Committee draws the Government’s attention to the Joint ILO/WHO Guidelines on Health Services and HIV/AIDS, 2005, which contains guidance on the effective prevention of occupational transmission of HIV. The Committee also notes the Government’s indication that national legislation mandates the use of personal protective equipment (PPE) when the risks to the health and safety of workers cannot be avoided or sufficient limited by technical means of collective protection or by measures, methods or procedures of work organization. The legislation further establishes that PPE should be provided free of charge by the employer, who must ensure that the equipment provided is adequate and in a satisfactory hygienic condition. Workers and workers’ representatives are also provided with training in the proper used of PPE. The Government adds that such training must be provided at the expense of the employer and take place during working hours. The Committee notes from the website of the Government that health workers at Mount Carmel Hospital, as well as staff working in Community Mental Health Services have received training on the use of PPE and the management of COVID-19 positive patients. The Committee refers in this regard to paragraph 49 of Recommendation No. 157, which establishes that “(1) all possible steps should be taken to ensure that nursing personnel are not exposed to special risks. Where exposure to special risks is unavoidable, measures should be taken to minimise it; (2) measures such as the provision and use of protective clothing, immunisation, shorter hours, more frequent rest breaks, temporary removal from the risk or longer annual holidays should be provided for in respect to nursing personnel regularly assigned to duties involving special risks so as to reduce their exposure to these risks. (3) In addition, nursing personnel who are exposed to special risks should receive financial compensation.” The Committee notes that the NHSS provides for the adoption of measures to maintain the physical and mental health and well-being of health workers, calling for the necessary infrastructure, including access to psychological support services, to be provided to address stress and burn-out of nursing staff working within the health care system, especially in those areas where staff are dealing with critically-ill or terminally ill patients. Noting that nursing personnel, often in close contact with patients, are at high risk of being infected while treating patients with suspected or confirmed COVID-19 when infection control precautions are not strictly practiced, the Committee requests the Government to provide updated information on all the safety measures taken or envisaged, including the provision of sufficient quantity of appropriate personal protective equipment (PPE) and adequate rest breaks during their shifts, with a view to protecting the health and wellbeing of nurses and limit as much as possible their risk of contracting COVID-19. The Committee also requests the Government to provide information on the measures implemented to prevent and reduce psychosocial risks, including burn-out, violence and harassment, in addition to preventing the risk of long-term repercussions on nurses’ wellbeing. It further requests the Government to indicate whether nurses and/ or their representatives were consulted or participated in the formulation and implementation of such measures.

Application in practice. The Committee observes that, according to the European Commission 2019 Country Health Profile on Malta, the reforms undertaken in education, training and employment conditions have increased the number of nurses. The Committee notes in this respect the information provided by the Government regarding the trends during the period 2003-18 in the number of nurses entering in the profession as well as in those leaving the profession, due to retirement or for other reasons, such as career changes or emigration. The Government reports that in 2018 there were 3,420 nurses in the public sector (73.2 per cent were women and 26.8 per cent men). With regard to their qualifications, the Government indicates that 91.9 per cent were first- level nurses, 5.8 per cent were second-level nurses and 2.3 per cent were registered in the mental health part of the register. Nevertheless, the Committee notes from the cited report of the European Commission that, despite these efforts, the country continues to experience a shortage of nursing personnel in hospitals and long-term care and the nursing workforce in these settings is increasingly reliant on migrant workers, posing challenges for recruitment and retention. The Committee requests the Government to continue to continue to provide updated detailed information on the application of the Convention in practice, including statistics disaggregated by sex, age and region, on the ratio of nursing personnel to the population, the number of persons enrolled in nursing schools, the number of men and women nurses who enter and leave the profession each year, the organization and the operation of all institutions in the public and the private sector which provide healthcare. It also requests the Government to provide any official studies, surveys and reports addressing health workforce issues in the health sector, including those that might have been developed in the context of the COVID-19 pandemic.

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(1) and (3) of the Convention. National policy concerning nursing services and nursing personnel. The Committee recalls its previous comments in which it requested the Government to outline the objectives and priorities of its policy concerning nursing services and to describe any plans, programmes or initiatives aimed at improving the quality of nursing care. In the absence of a Government’s reply on this point, the Committee reiterates its request for a comprehensive account on its national health-care policy, especially as regards measures to facilitate the effective utilization of nursing personnel in the country and to promote the fullest use of the qualifications of nursing personnel in the various health-care establishments.

In addition, the Committee had noted that, according to its annual report for 2006, the Department of Nursing Services Standards of the Ministry for Social Policy had completed a report entitled “Nurse Workforce Projections 2007–20” containing projections of the nursing workforce needed during that period. It requests the Government to provide a copy of the Nurse Workforce Projections, and to specify in this respect: (i) whether this document was prepared in consultation with the employers’ and workers’ organizations concerned; and (ii) what concrete measures are taken or envisaged in order to follow up on the findings of the report.

Article 2(2), in conjunction with Article 5(3). Shortage of nurses and settlement of disputes. The Committee notes that according to various sources, there was a long-standing problem of shortage of nursing staff which has become particularly acute since the opening of a new hospital and the extension of another. The Malta Union of Midwives and Nurses (MUMN) in its Memorandum 2008–09 had indicated that the staff shortage causes major problems, including cancellation of vacation leaves, extension of working hours and overtime as well as stress and burnout. The MUMN added that the shortage of nurses was expected to worsen due to the low number of students graduating from the Institute of Health Care each year which hardly replaces the loss of staff mainly due to retirement or maternity reasons. More generally, the Committee had noted that the brain drain in the health sector was caused by an increasing number of medical doctors and nurses who migrate abroad for better wages, which in 2007 led the authorities to try to recruit English-speaking nurses from other EU countries. In addition, the understaffing in the nursing sector had given rise to important industrial action in autumn 2008, the dispute relating also to the payment of a meal allowance and to a number of changes in the nursing courses in order to attract more students to the profession. The Committee requests the Government to provide detailed information on the current situation concerning the shortage of nursing personnel and to elaborate on any practical measures taken in consultation with the workers’ organizations concerned in order to tackle effectively the root causes of the problem and to formulate sustainable solutions.

Article 3(1). Nursing education and training. The Committee had previously noted the information provided by the Government concerning the new diploma, degree and postgraduate courses offered by the University of Malta’s Institute of Health Care, which is the main academic institution providing basic nursing education, but also continuing professional development courses for registered nurses. It also noted the statistical information concerning the number of graduates in nursing, health sciences and other related specialized fields. The Committee requests the Government to provide up-to-date information in this respect.

Articles 5 and 6. Collective bargaining concerning employment and working conditions of nursing personnel. The Committee once again requests the Government to provide copies of all collective agreements currently in force concerning the employment and working conditions of nursing personnel in the public and the private sectors.

Article 7. Occupational safety and health of nursing personnel. The Committee requests once again the Government to indicate any measures taken or envisaged with a view to improving the protection of nursing personnel from infectious diseases, including HIV/AIDS.

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

The Committee notes the Government’s succinct report, which contains no information in reply to the points raised in its previous comments. The Committee hopes that the next report will contain detailed information regarding the following issues.

Article 2(1) and (3) of the Convention. National policy concerning nursing services and nursing personnel. The Committee recalls its previous comments in which it requested the Government to outline the objectives and priorities of its policy concerning nursing services and to describe any plans, programmes or initiatives aimed at improving the quality of nursing care. In the absence of a Government’s reply on this point, the Committee reiterates its request for a comprehensive account on its national health-care policy, especially as regards measures to facilitate the effective utilization of nursing personnel in the country and to promote the fullest use of the qualifications of nursing personnel in the various health-care establishments.

In addition, the Committee had noted that, according to its annual report for 2006, the Department of Nursing Services Standards of the Ministry for Social Policy had completed a report entitled “Nurse Workforce Projections 2007–20” containing projections of the nursing workforce needed during that period. It requests the Government to provide a copy of the Nurse Workforce Projections, and to specify in this respect: (i) whether this document was prepared in consultation with the employers’ and workers’ organizations concerned; and (ii) what concrete measures are taken or envisaged in order to follow up on the findings of the report.

Article 2(2), in conjunction with Article 5(3). Shortage of nurses and settlement of disputes. The Committee notes that according to various sources, there was a long-standing problem of shortage of nursing staff which has become particularly acute since the opening of a new hospital and the extension of another. The Malta Union of Midwives and Nurses (MUMN) in its Memorandum 2008–09 had indicated that the staff shortage causes major problems, including cancellation of vacation leaves, extension of working hours and overtime as well as stress and burnout. The MUMN added that the shortage of nurses was expected to worsen due to the low number of students graduating from the Institute of Health Care each year which hardly replaces the loss of staff mainly due to retirement or maternity reasons. More generally, the Committee had noted that the brain drain in the health sector was caused by an increasing number of medical doctors and nurses who migrate abroad for better wages, which in 2007 led the authorities to try to recruit English-speaking nurses from other EU countries. In addition, the understaffing in the nursing sector had given rise to important industrial action in autumn 2008, the dispute relating also to the payment of a meal allowance and to a number of changes in the nursing courses in order to attract more students to the profession. The Committee requests the Government to provide detailed information on the current situation concerning the shortage of nursing personnel and to elaborate on any practical measures taken in consultation with the workers’ organizations concerned in order to tackle effectively the root causes of the problem and to formulate sustainable solutions.

Article 3(1). Nursing education and training. The Committee had previously noted the information provided by the Government concerning the new diploma, degree and postgraduate courses offered by the University of Malta’s Institute of Health Care, which is the main academic institution providing basic nursing education, but also continuing professional development courses for registered nurses. It also noted the statistical information concerning the number of graduates in nursing, health sciences and other related specialized fields. The Committee requests the Government to provide up-to-date information in this respect.

Articles 5 and 6. Collective bargaining concerning employment and working conditions of nursing personnel. The Committee once again requests the Government to provide copies of all collective agreements currently in force concerning the employment and working conditions of nursing personnel in the public and the private sectors.

Article 7. Occupational safety and health of nursing personnel. The Committee requests once again the Government to indicate any measures taken or envisaged with a view to improving the protection of nursing personnel from infectious diseases, including HIV/AIDS.

Direct Request (CEACR) - adopted 2013, published 103rd ILC session (2014)

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:

Repetition

Article 2(1) and (3) of the Convention. National policy concerning nursing services and nursing personnel. The Committee recalls its previous comments in which it requested the Government to outline the objectives and priorities of its policy concerning nursing services and to describe any plans, programmes or initiatives aiming at improving the quality of nursing care. In the absence of the Government’s reply on this point, the Committee is obliged to reiterate its request for a comprehensive account on its national health-care policy, especially as regards measures to facilitate the effective utilization of nursing personnel in the country and to promote the fullest use of the qualifications of nursing personnel in the various health-care establishments.

In addition, the Committee notes that according to its Annual Report for 2006, the Department of Nursing Services Standards of the Ministry for Social Policy has completed a report entitled “Nurse Workforce Projections 2007–20” containing projections of the nursing workforce needed during that period. It requests the Government to provide a copy of the Nurse Workforce Projections, and to specify in this respect: (i) whether this document was prepared in consultation with the employers’ and workers’ organizations concerned; and (ii) what concrete measures are taken or envisaged in order to follow up on the findings of the report.

Article 2(2), in conjunction with Article 5(3). Shortage of nurses and settlement of disputes. The Committee notes that according to various sources, there is a long-standing problem of shortage of nursing staff which has become particularly acute since the opening of a new hospital and the extension of another. The Malta Union of Midwives and Nurses (MUMN) in its Memorandum 2008–09 indicates that the staff shortage causes major problems, including cancellation of vacation leaves, extension of working hours and overtime as well as stress and burnout. The MUMN adds that the shortage of nurses is expected to worsen due to the low number of students graduating from the Institute of Health-care each year which hardly replaces the loss of staff mainly due to retirement or maternity reasons. More generally, the Committee notes that the brain drain in the health sector is caused by an increasing number of medical doctors and nurses who migrate abroad for better wages, which in 2007 led the authorities to try to recruit English-speaking nurses from other EU countries. In addition, it understands that the understaffing in the nursing sector has given rise to important industrial action in autumn 2008, the dispute relating also to the payment of a meal allowance and to a number of changes in the nursing courses in order to attract more students to the profession. The Committee requests the Government to provide detailed information on the current situation concerning the shortage of nursing personnel and to elaborate on any practical measures taken in consultation with the workers’ organizations concerned in order to tackle effectively the root causes of the problem and to formulate sustainable solutions. The Committee would also appreciate receiving additional explanations on the outcome of the recent industrial dispute between the Government and the MUMN especially in the light of Article 5(3) of the Convention which requires the settlement of collective labour disputes through independent and impartial procedures such as mediation, conciliation and voluntary arbitration with a view to making it unnecessary for the organizations of nursing personnel to have recourse to industrial action which may be disruptive of sensitive health-care operations.

Article 3(1). Nursing education and training. The Committee notes the information provided by the Government concerning the new diploma, degree and postgraduate courses offered by the University of Malta’s Institute of Health-care, which is the main academic institution providing basic nursing education, but also continuing professional development courses for registered nurses. It also notes the statistical information concerning the number of graduates in nursing, health sciences and other related specialized fields. The Committee would appreciate if the Government would continue providing all relevant information in this respect.

Articles 5 and 6. Collective bargaining concerning employment and working conditions of nursing personnel. The Committee once again requests the Government to provide copies of all collective agreements currently in force concerning the employment and working conditions of nursing personnel in the public and the private sectors.

Article 7. Occupational safety and health of nursing personnel. In the absence of the Government’s reply on this point, the Committee requests the Government to indicate any measures taken or envisaged with a view to improving the protection of nursing personnel from infectious diseases, including HIV/AIDS.

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

Article 2, paragraphs 1 and 3, of the Convention. National policy concerning nursing services and nursing personnel. The Committee recalls its previous comments in which it requested the Government to outline the objectives and priorities of its policy concerning nursing services and to describe any plans, programmes or initiatives aiming at improving the quality of nursing care. In the absence of the Government’s reply on this point, the Committee is obliged to reiterate its request for a comprehensive account on its national health-care policy, especially as regards measures to facilitate the effective utilization of nursing personnel in the country and to promote the fullest use of the qualifications of nursing personnel in the various health-care establishments.

In addition, the Committee notes that according to its Annual Report for 2006, the Department of Nursing Services Standards of the Ministry for Social Policy has completed a report entitled “Nurse Workforce Projections 2007–20” containing projections of the nursing workforce needed during that period. It requests the Government to provide a copy of the Nurse Workforce Projections, and to specify in this respect: (i) whether this document was prepared in consultation with the employers’ and workers’ organizations concerned; and (ii) what concrete measures are taken or envisaged in order to follow up on the findings of the report.

Article 2, paragraph 2, in conjunction with Article 5, paragraph 3. Shortage of nurses and settlement of disputes. The Committee notes that according to various sources, there is a long-standing problem of shortage of nursing staff which has become particularly acute since the opening of a new hospital and the extension of another. The Malta Union of Midwives and Nurses (MUMN) in its Memorandum 2008–09 indicates that the staff shortage causes major problems, including cancellation of vacation leaves, extension of working hours and overtime as well as stress and burnout. The MUMN adds that the shortage of nurses is expected to worsen due to the low number of students graduating from the Institute of Health-care each year which hardly replaces the loss of staff mainly due to retirement or maternity reasons. More generally, the Committee notes that the brain drain in the health sector is caused by an increasing number of medical doctors and nurses who migrate abroad for better wages, which in 2007 led the authorities to try to recruit English-speaking nurses from other EU countries. In addition, it understands that the understaffing in the nursing sector has given rise to important industrial action in autumn 2008, the dispute relating also to the payment of a meal allowance and to a number of changes in the nursing courses in order to attract more students to the profession. The Committee requests the Government to provide detailed information on the current situation concerning the shortage of nursing personnel and to elaborate on any practical measures taken in consultation with the workers’ organizations concerned in order to tackle effectively the root causes of the problem and to formulate sustainable solutions. The Committee would also appreciate receiving additional explanations on the outcome of the recent industrial dispute between the Government and the MUMN especially in the light of Article 5(3) of the Convention which requires the settlement of collective labour disputes through independent and impartial procedures such as mediation, conciliation and voluntary arbitration with a view to making it unnecessary for the organizations of nursing personnel to have recourse to industrial action which may be disruptive of sensitive health-care operations.

Article 3, paragraph 1. Nursing education and training. The Committee notes the information provided by the Government concerning the new diploma, degree and postgraduate courses offered by the University of Malta’s Institute of Health-care, which is the main academic institution providing basic nursing education, but also continuing professional development courses for registered nurses. It also notes the statistical information concerning the number of graduates in nursing, health sciences and other related specialized fields. The Committee would appreciate if the Government would continue providing all relevant information in this respect.

Articles 5 and 6. Collective bargaining concerning employment and working conditions of nursing personnel. The Committee once again requests the Government to provide copies of all collective agreements currently in force concerning the employment and working conditions of nursing personnel in the public and the private sectors.

Article 7. Occupational safety and health of nursing personnel. In the absence of the Government’s reply on this point, the Committee requests the Government to indicate any measures taken or envisaged with a view to improving the protection of nursing personnel from infectious diseases, including HIV/AIDS. In this connection, the Committee draws the Government’s attention to the Joint ILO/WHO guidelines on health services and HIV/AIDS, published in 2005, with a view to assisting health services in building their capacities to provide their workers with a safe, healthy and decent working environment as the most effective way both to reduce transmission of HIV and to improve the delivery of care to patients. The Committee also wishes to refer to the International Labour Conference discussion held in June 2009 on “HIV/AIDS and the world of work” with a view to adopting an international labour Recommendation, and in particular to paragraph 37 of the proposed conclusions (see ILC, 98th Session, 2009, Report IV(2), page 310) which provides that public health systems should be strengthened, where appropriate, in order to ensure greater access to prevention, treatment, care and support, and to reduce the additional strain on public services, particularly on health workers, caused by HIV/AIDS.

Part V of the report form. Application in practice. The Committee would be grateful if the Government would continue providing up to date and documented information concerning the application of the Convention in practice, including, for instance, the number of students attending or graduating nursing schools every year, the number of practising nurses registered with the Council for Nurses and Midwives, the nurse–population ratio, copies of official reports addressing nursing-related issues, for instance, studies undertaken by the Department of Nursing Services Standards, the Council for Nurses and Midwives or the Institute of Health Care, etc.

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

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

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

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

Direct Request (CEACR) - adopted 2004, published 93rd ILC session (2005)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Direct Request (CEACR) - adopted 1996, published 85th ILC session (1997)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Direct Request (CEACR) - adopted 1995, published 83rd ILC session (1996)

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

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

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

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

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

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

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

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

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

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

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

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

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