Tough negotiations around reform of occupational health service

Multi-industry bargaining on the reform of the occupational health service came to an end in November 2009 without an agreement being reached by the social partners. The French Ministry of Labour, Social Relations, Family Affairs, Solidarity and Urban Affairs then made proposals that did not resolve the situation. Among the main difficulties is the shortage of occupational health officers, which is leading to cuts in services and an unclear redistribution of workload.

In November 2009, multi-industry bargaining in France on the reform of the occupational health service (Services de santé au travail, SST), which had started 16 months earlier in July 2008 (FR0904029I), came to an end with the social partners unable to reach an agreement. The bargaining was based on various reports, particularly one produced by the Economic and Social Council (Conseil économique et social, CES) in February 2008 (FR0805029I). The trade unions opposed an agreement that they considered inadequate with regard to employers’ obligations towards their employees.

In order to compensate for this failure in reaching an agreement, the Minister of Labour, Social Relations, Family Affairs, Solidarity and Urban Affairs, Xavier Darcos, had to propose a law on this topic, stipulating that it should be adopted before the summer of 2010. Minister Darcos proposed the law on 4 December 2009 at a meeting of the Working Conditions Policy Council (Conseil d’Orientation des Conditions de Travail, COCT), which brings together the social partners and specialist bodies. However, the minister’s proposals are based mainly on those put forward by the employers; the trade union confederations and the unions of those working in the SST thus reacted unfavourably.

The main stumbling blocks between the trade unions and those working in the SST, on the one hand, and the employers and government, on the other, concern the following: the service provided by the SST for all workers, the governance of the SST, the development of prevention of occupational hazards (prévention des risques professionnels, PRP), as well as solutions in relation to the shortage of occupational health officers (médecins du travail).

Scope of services provided

The trade unions deplore the absence in the protocol – despite their demands – of measures promoting access to occupational medicine for precarious employees, such as temporary agency workers and seasonal workers, as well as for employees in small enterprises, to which the SST currently devotes less attention.

The agreement protocol introduces a new definition of fitness or unfitness for work, which some trade unions fear will lead to the end of the notion of partial unfitness. The ministerial proposals also address employees who have been declared unfit to work and are waiting for dismissal. The protocol stipulates that employees who have been declared unfit for work after a long period of sick leave should receive benefits from the Public Sickness Insurance System (Assurance Maladie) within 21 days of the declaration. However, the trade unions argue that the benefits should be the employers’ responsibility.

Governance of health service

Regarding the governance of the SST, all of the trade unions agree on challenging the current local management of the SST, which is in the hands of the employers, without any real opposing forces or financial transparency. The unions warn of the danger of becoming obsessed by profitability to the detriment of the quality of the service provided, with a tendency to neglect risk prevention and monitoring. They demand joint management, but the employers have rejected this idea.

Furthermore, the trade unions regret that the issue of funding is addressed by mere intentions and that no undertaking has been made to change the way that employers’ contributions are calculated and collected.

Improving risk prevention

The social partners agree on improving the PRP, especially by reinforcing a multidisciplinary approach, which is in the gradual process of being introduced since 2003. This means simplifying the accreditation of prevention of occupational hazards officers (intervenants en prévention des risques professionnels, IPRP).

It is also a matter of augmenting the collective approach in the working environment, including the obligation for occupational health officers to spend a third of their time visiting companies and checking on working conditions (‘tiers-temps’). This obligation is inadequately implemented because of the shortage of occupational health officers, who have to give priority to statutory individual employee medical check-ups. In order to cope with the demographic crisis concerning occupational health officers, the trade unions have long demanded – in vain – strong measures regarding both basic and continuing medical training, as well as other career pathways into the profession and rules regarding job sharing and part-time work.

Proposed solutions to shortage of health officers

However, the government’s responses are only a panacea, by transferring some of the tasks of occupational health officers to other professionals. Thus, workplace nurses (infirmiers en santé au travail, IST) would be responsible for carrying out ‘occupational health interviews’; however, what this requires is not defined. The government does not outline the necessary skills involved, the regulatory framework or the relationship with existing measures.

Meanwhile, the frequency of compulsory health check-ups is to be reduced from every two to three years. Before 2002, such check-ups were scheduled on an annual basis but this was reduced to every two years in 2004, for the same reasons, but without any results.

Commentary

The trade unions refuse to use the shortage of occupational health officers as an excuse to justify measures leading to what they consider to be third-rate occupational medicine. They also refuse to take responsibility for this situation, as they have long criticised the state’s lack of action in this area. The government has done nothing to change the way that the situation is developing, whereas it could have improved the attractiveness of this profession and offered additional training. The trade unions suspect that the government does not want to do anything concrete on this topic.

In fact, there is a significant risk that the state – in spite of its declarations and some probably superficial alterations – will adapt to this harmful situation, because it has neglected the demographic crisis in this profession. The disintegration of the current system would lead ultimately to an inequitable and fragile new system reflecting the imbalance of power relations, which would be favourable to employers.

On 15 January 2010, when presenting the second Occupational Health Plan (Plan Santé au Travail, PST) for the period from 2010 to 2014, Minister Darcos spoke again about the reform of the occupational health service, but without providing greater openness. This PST has two main targets: reducing exposure to risks of work accidents and occupational diseases, and developing risk prevention regarding identified occupational hazards, especially in the most dangerous economic sectors. However, it will be impossible to meet these targets without improving occupational health services.

Étienne Lecomte, Institute for Economic and Social Research (IRES)