New legislation of working conditions

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The new legislation's main objectives are to regulate labour conditions of health professionals; to move from personnel policies, mainly focused on a bureaucratic labour resources management type, towards a more human resources and professional policies approach that reduces the rigidities of traditional labour legislation; to promote continuing education of health professionals and a professional career based on excellence.

Purpose of health policy or idea

After many decades without it, in December 2003 two laws were approved: the "Law of Labour conditions of Health Professionals" (Estatuto Marco del Personal Sanitario- EMPS)), and the "Law of Regulation of Health Professions" (Ley  55/2003 de Ordenación de Profesiones Sanitarias - LOPS-). Both come out after the 1986 General Law of Health was approved and no legislation of health professionals came out. Until 2003 there was no general law for the healthcare professions; legislation was still of the pre-democratic political period.

The first law (EMPS) will regulate the labour conditions of health professionals (basic remunerations, working hours, geographical mobility, personnel classification, professional career, etc.).

The second one (LOPS) is much more concerned with improving the formation of doctors and nurses, putting them in line with new developments and new epidemiology needs of population; regulates their careers and formation paths, and also recognizes the need of continuous publicly financed formation, the relevance of research for the quality of the health system, and the need to match supply and demand of medical specialities.

Both laws are an attempt to move from personnel policies, mainly focused on a bureaucratic labour resources management type, towards a more human resources and professional policies management, that reduces the rigidities of the labour legislation up to date, which ignores regional differences, creates a surplus of spare specialists because of lack of available positions in the public sector, and in general imposes barriers to modern policies on human resources. For that purpose, the Law incorporates some significant changes in salary matters (basically salaries increases according to a previous evaluation of the level attained in the professional career); and also tries to increase the productivity of health care professionals, by means of  introducing the appropriate incentives for this professionals, and reduce the labour management rigidities of the "civil servants" status.

However, one of its main characteristics seems that it will not change much the status quo, due to the opposition it has (mainly from unions and some professional organizations, as well as some political parties and regional governments), because of the political costs of implementing it, and also because it being probably too vague and timid. Finally, it is also worth mentioning that there is work unemployment in the health sector, which is creating the emigration of Spanish well trained health professionals to other countries (e.g. to U.K.).

Main points

Main objectives

• To regulate the labour conditions of health professionals (basic remunerations, working hours, geographical mobility, personnel classification, professional career, etc.)
• To move from personnel policies, mainly focused on a bureaucratic labour resources management type, towards a more human resources and professional policies management, that reduces the rigidities of the labour legislation up to date
• To promote continuous formation of health professionals and a professional career based on "excellence

Type of incentives

Financial (e.g. changes in salary matters); non-financial (eg. Regulation of undergraduate, graduate and continuous education; regulation of professional careers).

Groups affected

Directly affected are health professionals (mainly doctors and in general all graduates professionals; postgraduates in formation), regional governments and doctors colleges (associations), more indirectly are directors of health institutions and patients

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

These two regulations can be included within the group of legislation that the political party in the government has been approving lately, which concerns many different areas (secondary education, health, universities, financial stability for administrations, etc.). Within the health sector, the two laws reported here are coming after a big one (Ley de Cohesion, see 2nd round of reports, year 2003), that try to regulate different areas under a general law, to be applied in all Spain.

These two regulations were probably needed, since there has been no general regulation from a long time, which is according to new and actual circumstances. However, they do not aim at attaining any specific goal formulated in the health policy, but the ones of quality and homogenization included in the Cohesion Law.

The Law for Health Professions (Ley de Profesiones Sanitarias, 55/2003, 16th December) was passed in 2003, after the Cohesion Law (also in 2003, see reports of the 2nd round) was approved and a National Commission on Human Resources did work on the following subjects: training of health care professionals, professionals' careers and the update of professionals' knowledge.

The Estatuto Marco law also regulates all health sector workers daily schedule, by applying directive 93/104/CE of the European Council, amended by the directive 2000/34/CE of 22 June 2000, standardizing the workers minimum health and safety conditions.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The idea seems to come out from the central government and specially the political party with absolute majority in the Parliament (Partido Popular), who engaged in a series of regulations of a general-type (i.e. trying to be the framework that regulates all important aspects of a given subject). In relation to health, it comes after the Cohesion and Quality of the National Health System Act (Law 16/2003, 28th May), which was a broader one, from which a Commission came out in order to study the subjects treated by the two laws we are considering here now.

Discussions on health professionals' careers and formation, as well as their working conditions and status have been quite continuous. Lately, matters such as   health professionals being underpaid or contracted with bad labour conditions and contracts, health professionals perceiving having a lower social status than before, and in the other hand the need for greater labour flexibility asked by hospital managers, have been in the social and media arena quite frequently.

The laws are new in the sense that no general laws existed since pre-democratic times. However, it seems that part of what they consider was already considered in a previous initiative of the previous socialist government.

Stakeholder positions

The Law was approved by the Spanish parliament with the votes of only two  political parties Partido Popular and Coalición Canaria, having the absolute majority of the parliament. The main political party in the opposition (PSOE, the socialist one) and other political parties in the opposition criticized the laws because of the following reasons, amongst others: i/ the power it gives to professional colleges (the LOPS), ii/ it does not include enough financial resources to implement the reforms approved (the LOPS); iii/ it attempts against the autonomy of the regional governments -for example in terms of the agreements with universities, concerning the formation of future health professionals, or the possibility of deciding members of different committees and councils (e.g. the General Council of Specialities) which will be created by this Law, and also the members of the director boards of health centres.

Opponents were also unions and some professional organizations, because the labour regime of the health care professionals working for the public sector existing until now is quite generous, and they do not like to renounce to it: they have rights similar to those of civil servants (they are called statutory personnel), which include the"ownership" of their position. Unions (mainly UGT and CCOO) also criticize that the formation path included in the Law is not taking into account the Bolognia Document concerning university degrees, nor takes into account those workers coming from degrees lower than university ones. They also criticize that the control over "good practice" of professionals is given exclusively to professional colleges (associations).

Influences in policy making and legislation

Both laws were approved in the Spanish Parliament with the favourable votes of the political party in power (PP) and also Coalición Canaria (a regional-based party). Together had absolute majority in the Parliament. Main political parties in the opposition voted in blank, after having proposed some partial reforms to the project presented by the government. The main criticisms coming from the political parties in the opposition, that were probably a cause for not having given their support.

Legislative outcome

success

Adoption and implementation

Implementation has still to come. The laws foresee a period for the implementation of the different aspects it contains, for example up to three years. But the recent change in the Spanish Parliament composition and in the Spanish government after the general elections makes the process still more uncertain. However, some things have already been done. For example, in 1998 a national commission was created to certify continued training for the National Health System. This commission is concerned with the continuous training of all health care professionals. In the case of doctors, in 2003 an accreditation organisation was created with the participation of doctors' professional associations, scientific societies, the university and institutional representatives for medical specialities. In December 2003 an agreement of mutual recognition of training credits was signed with the European Accreditation Council for Continuing Medical Education.

One possible barrier to overcome if implementation is to come out is the necessary coordination and agreement with the regional governments, who share responsibilities in training and working conditions related to health professionals, as well as financial responsibilities for health provision and will probably have to put the resources to finance the training of their professionals.

It is also mentioning that doctors have had great power within the public sector, and it does not seem that they will easily renounce to their status.

Expected outcome

Some experts consider that these long-waited laws are extremely vague and timid and therefore will not substantially change the status quo, especially in terms of achieving greater flexibility for the managing of health organizations (there are currently 135,000 workers in the Spanish Health Service with "statutory" status). However, the laws can include some rationalization of the health profession, depending on the way it is finally implemented. In respect to training of doctors, an important effect of the LOPS would be the coordination of the three stages of the training process (university undergraduate degree, the specialization process and the continuous training), making training also more in line with professional demands, new technical developments, changes in the health system (e.g. need of working in teams), and a greater match between the types of specialization needed and the ones provided by the system (e.g. to reduce the shortage of some specialities and the surplus of others).

Better trained professionals will also be very important for patients, for example in terms of MIR doctors (postgraduates in formation), and better labour conditions for doctors and other health professional (e.g. nurses) who sometimes have quite bad labour conditions (e.g. concerning contracts). However, the bulk of the legislation concerns the "statutory" doctors; they consider the reforms will reduce the quality of the health services.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

Potentially of great impact, but probably low impact in practice. In relation to training, there is too much noise, too many voices with opposing interests intervene in the process of decision making on human resources in the health sector. The Central Administration and, within, the Health, Education and Economy Departments, Regional Governments and Local Government, Scientific Societies and Associations, Professional Associations, prestigious Hospitals  and those with no prestige, Unions, and Universities all contribute to the noise without there being ever being consensus on the number of professionals that the country needs within a given time frame. Concerning labour conditions, not all which could be changed has been changed, and the opposition of professionals (mainly the "statutory" ones) can put strong limits to the impact of the policy.

References

Sources of Information

• B. González, C.D. Dávila, E. Rodríguez, (2004): Research Project on human resources for health. Case study: Spain; document elaborated for the European Observatory, WHO. More information available in www.euro.who.int/observatory/  and http//beavalcarcel.com/Bea
• Organización Médica Colegial (OMC) (www. cgcom.org)
• Ministerio de Sanidad y Consumo (www.msc.es)
• CCOO (www.ccoo.es)  and UGT (www.ugt.es)
• Federación Europea de Sindicatos Médicos (www.fems.net)
• Actualidad del derecho sanitario(www.actualderechosanitario.com)
• Colegio General de Colegios Oficiales de Médicos (www.cgcom.org)

Author/s and/or contributors to this survey

Esther Martinez-Garcia

Empfohlene Zitierweise für diesen Online-Artikel:

Esther Martinez-Garcia. "New legislation of working conditions". Health Policy Monitor, 04/04. Available at http://www.hpm.org/survey/es/b3/2