Nursing Personnel Convention, 1977 (No. 149) - Belgium (Ratification: 1988)

Direct Request (CEACR) - adopted 2023, published 112nd ILC session (2024)

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Article 2 of the Convention. Adoption and application of a policy concerning nursing services and nursing personnel. With regard to the impact of the new job classification and pay scale model developed by the Institute of Job Classification (IFIC), the Government indicates in its 2022 report that, when the new pay scale was implemented in the private federal sector in 2018, it proved advantageous for over 90 per cent of nurses in service. The Government states that procedures put in place by the social partners ensure that no worker in service suffers a pay cut, and that anyone can choose whether or not to opt for the new model. The Government adds that the focus has been on raising starting salaries and salaries during the first part of the nursing career, as several studies have shown that many nurses leave the sector after less than 15 years. The Government also considers that the IFIC scale offers greater career development prospects, as it is primarily based on the duties performed and not solely on the level of training or hierarchical function. Moreover, the IFIC scale goes up to 35 years of experience, instead of 27 years (31 years for hospital assistants) under the old scale, thus offering longer-term career prospects. As to the public federal sector, the Government indicates that the implementation of the IFIC classification is under way and that it does not have any data on its impact in this sector. Concerning the healthcare sectors under the jurisdiction of the federated entities, the Government reports that Flanders and the French Community Commission of the Brussels-Capital Region adopted the FIDIC model in 2021. Regarding other measures relating to the policy concerning nursing services and nursing personnel, the Government indicates that in early 2022, the Minister of Social Affairs and Public Health announced his intention to reintroduce a reward for nursing specializations through the introduction of annual bonuses for holders of particular professional titles (TPP) or particular professional qualifications (QPP). The Committee notes that, in view of the growing challenges faced by many societies, such as the ageing population due to longer life expectancies, the explosion in chronic diseases and the emergence of challenges such as pandemics and summer heatwaves, the national policy concerning nursing services and nursing personnel required by the Convention is a crucial aspect of the system that needs to be put in place in order to meet these challenges and guarantee accessibility to care. The Committee therefore requests the Government to continue to provide detailed and up-to-date information on the impact of the IFIC model on the remuneration and career prospects for nursing personnel in the private and public sectors, at the federal and federated level. The Government is also asked to provide an evaluation of the reform and to indicate whether it has enabled the necessary (human and financial) reinvestment in the qualification (students applying to the profession) but also, and above all, in the retention of qualified nursing personnel, by improving career prospects, making the profession more attractive, and ensuring a better work–life balance. The Committee also requests the Government to indicate how nursing personnel representatives are involved in the implementation and evaluation of the policy concerning them, and how the policy is coordinated with the policy concerning other aspects of health, including through the evaluation of attractiveness, talent retention, quality of working life and quality of care. The Government is also asked to provide information on any new measures aimed at improving working conditions, career prospects and remuneration for nursing personnel, including the announced reintroduction of a bonus rewarding nursing specializations.

Articles 3 and 4. Right to exercise the profession. With regard to the impact of Institutional Agreement for the Sixth State Reform of 11 October 2011, which transferred the issue of care provider accreditation to the federated entities, the Committee notes that 7,056 nursing visas were issued in 2018, compared to 5,828 in 2021. Based on the information provided by the Government, the Committee also notes that in 2021, 64 per cent of nursing visas were issued in the Flemish Community, compared to 35 per cent in the French Community and 0.2 percent in the German-speaking Community. The Committee requests the Government to continue to provide information, including statistical data, disaggregated, if possible, by federated entity and sex, on the number of people joining the profession each year.

Part V of the report form. The Committee asks the Government to continue to provide further information on the application of the Convention in practice and to specify the nurse-to-population ratio in the federated entities, as well as the number of nursing personnel in the public and private sectors respectively.

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

Article 2 of the Convention. Adoption and application of a policy concerning nursing services and nursing personnel. The Committee notes that, following budgetary restrictions and with the agreement of the social partners in the private sector, the individual incentive bonuses for nurses were replaced in January 2018 by a new wage calculation system based on a classification of the duties carried out by nurses, to which scales have been applied (IFIC). It also notes that the negotiations on the implementation of the IFIC in the public sector are currently under way. The Committee requests the Government to provide information on the impact of this new remuneration mechanism (IFIC) since its implementation. It also requests the Government to continue to supply information on the measures taken to ensure that nursing staff are provided with employment and working conditions, and particularly career prospects and remuneration, which are likely to attract persons to the profession and retain them in it.

Articles 3 and 4. Basic requirements regarding education and training. The right to exercise the profession. The Committee notes the Institutional Agreement for the Sixth State Reform of 11 October 2011, which transfers a number of powers to the Federal Entities, and which establishes in point 3.2.4(e) that: “The Federal Entities have the authority to approve care providers in accordance with the conditions determined by the Federal Government.” The Committee requests the Government to provide up-to-date information on the impact of the new distribution of powers on the application in practice of the Convention within the Federal Entities (the Flemish Region, the Walloon Region, the Brussels-Capital Region and the German-speaking Community), by supplying, in particular, statistics on the number of nursing personnel, disaggregated, if possible, by level of training and function, sex 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.

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

The Committee notes the detailed information supplied in the Government’s report and also the attached documentation. It also notes the numerous legislative amendments, in particular the Ministerial Orders of 19 April 2007 fixing the approval criteria authorizing nursing practitioners to use the professional title of nurse specializing in intensive, emergency and geriatric care; the Royal Order of 12 January 2006 establishing the nursing activities which may be performed by nursing aides and the requirements for nursing aides to engage in such activities; and also the creation and funding of a Nursing Advisory Council within hospitals as a representative, advisory and support body for the Nursing Department.

Article 2 of the Convention. Formulation and implementation of a policy on nursing services and nursing personnel. Further to its previous comments relating to changes in nursing personnel wage levels, the Committee notes that each of the joint committees set up in 2008 has adopted, within its area of competence (outpatient care, subsidized establishments, preventive care establishments recognized by the Flemish community, and childcare centres), collective labour agreements which define, inter alia, wages for nursing personnel, conditions for granting the status of employee to nursing personnel and also conditions of work and pay for certain workers.

With regard to ongoing education and further training programmes, the Committee notes the Government’s statement to the effect that every hospital is required to establish a development strategy providing for a training programme accessible to each nurse. It also notes the renewal of the “Nursing Training Project (Project 600)” – adopted in 2000 in the context of the multiyear plan for the health sector – until the end of the 2011 academic year, in order to train more nurses, and thereby alleviate the persistent staff shortages in this sector. It notes that this project will enable 163 new training places to be created in the private health-care sector.

Furthermore, the Committee notes the 2005–10 Social Agreement, signed in April 2005 for the private sector and approved in July 2005 for the public sector, concerning the raising of training standards in healthcare units. It notes that this agreement contains three parts: job creation, incentive bonuses and transfer of know-how. While noting the numerous legislative measures adopted in the health and nursing care sector, the Committee requests the Government to continue supplying information on the formulation and implementation of development strategies and their results, and also on training projects or any other programme, policy or initiative designed to improve the quality of nursing services and make employment and working conditions for nursing personnel more attractive.

Article 7. Occupational safety and health. The Committee notes the implementation of the SOBANE (Screening, OBservation, ANalysis, Expertise) strategy for the management of occupational risks which is designed, in particular, to prevent risks in the healthcare sector and in nursing homes. It also notes the publication of the “Analytical guide to working conditions in hospitals”, which enumerates the various elements which have a positive or negative influence on the welfare of nursing personnel. The Committee would be grateful if the Government would continue supplying information on the abovementioned strategy or any other similar project.

Part V of the report form. Application in practice. The Committee notes the information supplied in the 2007 activity report of the Inter-Sectoral Health Services Fund (a nursing training project set up by the Joint Committee for Health-Care Establishments and Services). It notes in particular that, between 2000 and 2007, 1,251 persons qualified from the training schools as a result of this project and that, at the end of the project in 2010, at least 1,515 workers in the private sector are due to have obtained a nursing diploma. The Committee requests the Government to continue supplying information on the application of the Convention in practice, including, in particular, statistics on the number of nursing personnel (by sectors of activity and by levels of training and functions, if possible), number of persons joining or leaving the profession each year, number of students enrolled at the various nursing schools, copies of reports or official studies, and also information on any practical difficulties encountered in the implementation of the Convention, etc.

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

The Committee takes note of the information supplied in the Government’s report and the attached documentation. It notes in particular the legislative changes intervened during the reporting period, including the adoption of the Royal Order of 2 July 1999 amending the Royal Order of 18 January 1994 on the list of professional titles and specific occupational qualifications of nursing personnel, the Act of 10 August 2001 on measures related to health care, and the Act of 29 January 2003 on the establishment of a federal database of health-care professionals.

Article 2 of the Convention. The Committee notes with interest the information concerning the action plan for the health sector which was jointly proposed by the Ministries of Social Affairs, Public Health and Employment and which was presented to the social partners in March 2000. The Committee notes in particular the declared intention to render the health sector attractive once again in order to face the scarcity of qualified personnel, the consideration of specific end-of-career measures in order to slow down the departure rate of health-care workers and the need to restore and reinforce the social dialogue through the reorganization of the joint committees operating in the field of health care. The Committee requests the Government to keep it informed of any further developments, particularly as regards the implementation of the action plan and the practical results obtained. The Committee would appreciate receiving concrete information concerning the evolution of wage levels in the nursing profession, as compared to the evolution of the average wage, the programmes for continuing nursing education and training, and all other measures designed to improve the working conditions of nursing personnel, for instance in terms of a more humane work organization, better adapted working hours, or upgraded welfare and child- care facilities.

Part V of the report form. The Committee requests the Government to supply up-to-date information on the application of the Convention in practice, including for instance recent statistics on the nurse-to-population ratio, the number of students attending nursing schools and the number of nurses leaving or joining the profession, copies of official publications and studies (e.g. reports of the National Nursing Council (CNAI) or the National Council of Hospital Establishments (CNEH)) 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 1999, published 88th ILC session (2000)

Articles 2 and 4 of the Convention. The Committee notes with interest, from information provided by the Government in its report, the adoption and preparation of new legislation, including:

-- the Royal Order of 18 January 1993 issuing the list of professional titles and specific occupational qualifications;

-- the Royal Order of 15 February 1999 amending the Royal Order of 23 October 1994 establishing standards with which hospitals and their services must comply.

The Committee also notes the Government's statement that the CNAI and the National Council of Hospital Establishments (CNEH) are the bodies responsible for the adoption and application of the policy set out in Article 2, paragraph 1.

Furthermore, the Committee reminds the Government that in its previous comments it requested it to provide detailed information on the progress achieved in taking the necessary measures to provide remuneration which is likely to attract persons to the profession and retain them in it, in accordance with Article 2, paragraph 2. It hopes that the Government will provide detailed comments on this matter in its next report.

Article 5, paragraph 1. The Committee notes with interest the adoption of the Royal Order of 3 May 1999 to amend the Royal Order of 22 October 1975 governing the organization and operation of the CNAI, which expands its board by three members with a view to providing the trade unions with representation, and the Royal Order of 28 April 1999 amending the Royal Order of 24 March 1989 respecting the composition of the CNEH, which expands the representation of nursing personnel with the objective of achieving a more balanced representation for the formulation of appropriate opinions.

Article 7. The Committee notes the information that nursing personnel are also covered by the Act respecting workers' welfare of 4 August 1996 and the Royal Order issued thereunder of 27 March 1998 on welfare policies. The Committee also notes that the opinion of the CNAI was requested with regard to the recognition of the occupational nature of the disease in the event of accidental exposure to the human immunodeficiency virus (HIV). It hopes that the Government will continue to supply information on any progress achieved in this respect and on the adoption of any other measures, in consultation with the organizations of employers and workers concerned, to safeguard the situation of nursing personnel.

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

The Committee notes the detailed information supplied in the Government's report in reply to its previous comments.

Article 2, paragraphs 1 and 2, of the Convention. The Committee notes with interest that by virtue of the circular to hospital managers, dated 21 January 1994, the measures taken between 1989 and 1993 have made it possible to revalue nursing work both in financial terms and at the level of the numbers of personnel providing hospital services. It also notes that the preparation of social agreements has been completed and that the measures taken by the Government to safeguard competitiveness and social security mean that additional wage increases cannot be awarded between 1994 and 1996 inclusive.

The Committee requests the Government to continue supplying detailed information on the progress achieved in ensuring career prospects and remuneration that are likely to attract persons to the profession and retain them in it, in accordance with these provisions of the Convention.

Article 7. The Committee requests the Government to indicate the measures which have been taken or are envisaged to improve existing laws and regulations on occupational health and safety by adapting them to the special nature of nursing work and of the environment in which it is carried out. Furthermore, with reference to its general observation of 1990, which was repeated in 1994, the Committee requests the Government to indicate the 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: for example, by the arrangement of working conditions, the confidentiality of test results, recognition that the cause of infection was occupational, etc.

Point V of the report form. The Committee notes the statistics on the distribution of nursing personnel. It requests the Government to continue supplying information on this subject and to provide data on the number of persons who are leaving the profession.

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

The Committee notes the Government report and asks it to provide additional information on the following points.

Article 1 of the Convention. The Committee notes that a draft to amend Royal Decree No. 78 of 10.11.1967, in order to reorganize the categories of nursing personnel, has been prepared. It asks the Government to keep it informed about the new classifications of nursing personel, once adopted.

Article 2, paragraphs 1 and 2. The Committee takes note of the information and recommendations contained in the "White Book of the Nursing Profession" of May 1992, issued by the Ministry of Public Health and the Environment. It notes that the shortage of nursing personnel persists, amounting to an estimated 6,000 persons out of a total of approximately 75,000 health-care workers in 1992, due to the often adverse employment conditions. It also notes the recommendations concerning career prospects, training and further training, in order to promote the nursing profession, as laid down in the brochure "The Permanent Training of Nurses".

The Committee asks the Government to continue to provide particulars on progress made regarding measures concerning career prospects and remuneration which are likely to attract persons to the profession and retain them in it, in accordance with this provision of the Convention.

Article 6. The Committee notes the copies of collective agreements concerning nursing personnel, concluded during the reporting period. It asks the Government to keep it informed about any new agreements.

Point V of the report form. The Committee notes the statistical information concerning the distribution of nursing personnel. It would be grateful if the Government could provide further information on the practical application of the Convention and indicate the number of nursing personnel in the public and private sectors in relation to the population. Please also supply information on the number of persons leaving the profession.

Direct Request (CEACR) - adopted 1992, published 79th ILC session (1992)

The Committee notes the Government's first report. It asks the Government to provide additional information on the following points.

Article 2, paragraphs 1 and 2, of the Convention. The Committee takes note of the information and recommendations contained in the note of the Minister of Social Affairs on "the future of the art of nursing with the advent of the year 2000", which establishes the broad outlines of a policy concerning nursing services and nursing personnel in accordance with Article 2 of the Convention. It also notes the shortage of nursing personnel - an estimated 7,000 persons out of a total of approximately 60,000 health-care workers in 1987 - particularly in hospital and psychiatric institutions, owing partly to the working conditions of such personnel. At the same time, the number of nursing students dropped from 8,044 in 1981-82 to 6,027 in 1988-89. The Committee notes that the Government intends to adapt all training to future requirements in the area of health and nursing practice, and to take measures regarding working and employment conditions in order to promote the nursing profession.

The Committee asks the Government to provide particulars of the measures taken with regard to training nursing personnel and on progress made regarding work and employment conditions, in both the public and private sectors, including measures concerning career prospects and remuneration which is appropriate to the level of responsibility, which are likely to attract persons to the profession and retain them in it, in accordance with this provision of the Convention.

Article 6. With reference to the information supplied by the Government in its report, the Committee would like to receive copies of any new agreements applying to nursing personnel concluded in either the public sector or the private sector, concerning the requirements set forth in this Article.

Point V of the report form. Please provide information on the practical application of the Convention and indicate the number of nursing personnel in the public and private sectors in relation to the population. Please provide information on the number of persons leaving the profession.