EPSU-PSI Online Platform Safe & Effective Staffing Levels

18 December 2018


1) Introduction

This webpage is the "entry door" to the EPSU/PSI Online Platform on Safe and Effective Staffing. From here you can access both the publicly accessible section and the password-protected section reserved for the national affiliates of EPSU and PSI.

It should serve as a source of information for EPSU and PSI members to support the mutual exchange on this topic. Legislation, collective agreements and other instruments and measures that help secure that sufficient staff with the right qualifications is available in our health care services and institutions and in social services has become a priority issue for trade unions organising in health and social services across Europe and the globe.

2) Information on the purpose and the contents of the online platform

This EPSU/PSI Online Platform on Safe and Effective Staffing has been set up as a tool to share information on how other EPSU and PSI affiliates have already been (succesfully) working on this topic. It has three main purposes:

  • It informs about the objectives they have pursued when fighting for (mandatory/mandated) staffing levels.
  • It illustrates which instruments they have used when working towards the establishment of safe and effective staffing provisions (e.g. “nurse-to-patient-ratios” and “nurse-to-bed-ratios”), with their own members (e.g. based on surveys), jointly with professional organisations, with individual employers or employers' organisations, with governments at the different levels, with parliamentary committes, with the media and/or other civil society organisations. It also showcases the results they could already achieve (“success stories”).
  • The EPSU/PSI Online Platform on Safe and Effective Staffing finally also intends to showcase which systems or provisions exist and which are already in application and - ideally - what the impacts are and to which extent they manage to deliver on the trade union expectations, priorities, demands, etc..

The EPSU/PSI Online Platform on Safe and Effective Staffing aims at covering the topic of safe and effective staffing levels for the health care sector, but also for elderly care, child care, care for persons with disabilities and other fields of social care and social work. It will contain information from trade unions from Europe and outside Europe. For the time being document and links are predominantly in English (but already some are in French and German), but relevant material in a broad range of languages is very welcome.

In the password-protected section the EPSU online survey which was offered back in 2016 to collect input prior to the ver.di-EPSU seminar on safe and effective staffing levels on 16 November 2016 in Berlin can be reactivated, used and adapted by EPSU or PSI members if they wish to do so. It currently is available in three languages, EN, FR and DE.

EPSU/PSI Online Platform on Safe and Effective Staffing should also serve as a communication and campaign tool on the topic of staffing issues and levels for our members.

3) Why do EPSU and PSI and their affiliates work on safe and effective staffing levels?

For trade unions across Europe the staffing agenda does not sit in isolation from other priorities and concerns for their members, including occupational safety and well-being of the workers in health and social care, effective recruitment and retention policies and workforce stability, evolving workforce roles, continuing professional development and the models of funding/financing of health and social care. Successful trade union campaigns to achieve enforceable staffing levels or provisions also clearly show the link between an investment in this agenda, also in working with the own members, and improved options or channels to recruit new members and to retain existing trade union members. All these points illustrate well the importance this topic gained in the last decade for an increasing number of EPSU and PSI members.

Several trade unions in Europe have run surveys with their members and have produced reports, including CFDT-SSS (France) - "Parlons effectifs", ver.di (Germany) - "Überlastungsanzeige Krankenhäuser", "Nachdienstcheck" & "Aktion Überstundenberg" as well as RCN (United Kingdom) -"Safe and Effective Staffing: The Real Picture" (2017) - and UNISON (United Kingdom) - "Ratio Not Rationing" (2018).

One of the main insights of the ver.di-EPSU seminar on safe and effective staffing levels on 16 November 2016 in Berlin was that across Europe there is currently a great deal of variety ranging from no formal approaches to the use of sophisticated software. The participants debated the findings with two main opinions being expressed; the first a view that having a minimum nurse to patient ratio represented a better option than having no staffing control at all, and the second a level of concern regarding the feasibility of arriving at a ratio suitable for application across diverse settings and diverse workforce configurations and/or the concern that staff-patient or staff-user ratios once defined - either by regulation (e.g. legislation at the national level) or based on (collective) agreements of the social partners - would often/quickly be regarded as maximum levels - and this by employers, by funding agencies and by the responsible goverments - rather than minimum levels that would guarantee a high level of health and wellbeing of the workforce and patient/user safety.

At this thematic workshop the participants agreed on the need to keep the safe and effective staffing agenda active and visible and to work to stop the downward spiral in conditions - in relation to the staff numbers, to the appropriate skills mix, to the required levels of investments in VET, CPD and infrastructures, with negative impacts on the health and safety of workers and the patient safety, with restrictions on access to CPD, etc. - that is being experienced in many countries. Many colleagues informed about their "appetite" for their trade unions for the pursuit of mandatory enforceable staffing systems. It was also broadly felt that the work on the safe and effective staffing agenda would - in the mid-and long-term - also need to consider aspects such as “right skills mix” (also depending on legally defined competences for a given profession and e.g. possibilities for task shifts or task substitutions), “variations on staffing according to hospital department (and/or elderly care service), shift and complexity of care tasks” or “type of health (and social) care service” (e.g. university hospital; psychiatric clinics; rehabilitation clinic/institutions; elderly homes or homecare).

4) Video messages from EPSU Secretary General Jan Willem Goudriaan and PSI Secretary General Rosa Pavanelli

[N.B.: Being produced in September and October 2019, in coordination and cooperation with PSI]