Health services and social dialogue

Labour relations

Labour relations in the health services are very complex: different labour legislation applies in public institutions and in the private sector; the services may be subject to national as well as to local regulations; the wide range of personnel has differing professional qualifications and occupational interests; at least in large units there is a highly structured system of work organization; and as the sector provides an essential service to the public, restrictions on trade union rights might be deemed necessary by the authorities. Labour relation systems in this sector evolved in many countries only in the 1980s. The right to strike varies greatly. In countries with no legal restrictions, employers and workers reach mostly voluntary agreements on minimum services during labour disputes. Other countries make this a legal requirement. Some countries prohibit all strike action in this sector, either on the grounds that the sector performs essential services or as part of the ban on industrial action applying to the public sector.

The decentralization of bargaining has been perceived as a challenge as well as an opportunity for the various stakeholders, depending on the negotiation skills and resources available to them at the different levels of the health system. The move from centralised bargaining has often required a significant training effort within organisations or services and a decentralisation of finances as well as responsibilities for the social partners.