Multi-industry talks on occupational health service reform

Work sessions on the reform of the French occupational health service were due to conclude at the end of April 2009 and should lead to a multi-industry agreement in the summer of 2009. The discussions and the issues raised in various reports demonstrate that particular difficulties revolve around the declining number of occupational health officers. Other problems concern governance, funding and the doctors’ role in the workplace.

Following five work sessions from January to April 2009, the French Ministry of Labour, Social Relations, Family Affairs, Solidarity and Urban Affairs (Ministère du Travail, des Relations Sociales, de la Famille, de la Solidarité et de la Ville) wants to see multi-industry negotiations lead to an agreement between the social partners on the reform of the occupational health service.

The ministry sent a guidance document on continuing the reform of the occupational health service to the social partners at the end of July 2008.

Tackling shortage of health officers

Employer organisations have since made several proposals to the trade unions, primarily regarding the growing shortage of occupational health officers. Among these recommendations are the following:

  • using private general practitioners (GPs) for some medical examinations – this proposal has been rejected as GPs do not have expert knowledge on the world of business and its inherent risks;
  • some procedures being carried out by workplace nurses and some medical examinations being replaced by appointments with assistants or health advisors;
  • increasing the time between periodic medical examinations to four years, as opposed to the current period of two years – this proposal is controversial with regard to the issue of risk prevention;
  • tailored state accreditation of health-at-work services (santé et sécurité au travail, SST) based on the shortage of occupational health officers in some areas.

Prolonged discussions

Debates and discussions before a multi-industry agreement will be reached are likely to be protracted due to the major challenges being faced, including the problems of new occupational risks and the ageing labour force. The French occupational health system is undergoing a long transformation process, which has already been the subject of several studies – namely the:

  • Hervé Gosselin report of January 2007, investigating Fitness and unfitness for work: diagnostic and future prospects;
  • Conso-Frimat report (in French, 771Kb PDF) of October 2007, assessing the previous reform of the occupational health service;
  • General Labour Directorate (Direction générale du travail, DGT) report of December 2007, assessing the implementation since 2003 of the multidisciplinary approach to healthcare and occupational risk prevention;
  • Economic and Social Council (Conseil économique et social, CES) opinion (in French, 383Kb PDF) of February 2008, on the future of the occupational health service, approved by all of the social partners (FR0805029I).

Problem areas

Governance

Organisation and overall management are deemed to be lacking, with no strategic management and no coordination with other regional and national public health bodies. A consensus is emerging in favour of a reorganisation at regional level, which appears to be most suitable for the public health dimension.

Local management of SST is currently being carried out by employers. The trade unions are divided in their opinions between maintaining this situation, having true co-management, a three-party structure or management by the social security system.

Funding

SST funding is also problematic, regarding both the source and calculation of this income and the collection method.

Role of health officers

The decline in the number of occupational health officers is a key concern: out of 6,000 posts, 600 are vacant and 1,700 officers will be retiring over the coming years. Trade unions have been calling for many years for comprehensive and swift measures to reverse the demographic trend and make the profession more attractive, by means of medical training – including initial and further training – and the development of other career pathways into the profession, as well as job sharing and part-time work.

The balance between individual medical examinations and time spent in the workplace is a further issue, as both of these facets are crucial to the officer’s understanding of occupational risks. For example, some risks – such as exposure to toxic products and noise – require the doctor to spend time at the work station, while others can only be identified in medical consultations – notably psychosocial risks.

Individual medical examinations are a particular concern. These should be carried out when the worker is recruited, during service, on request and when starting back to work following sick leave. Central issues are the employee’s fitness and the ambiguous nature of the doctor’s role: guaranteeing confidentiality for the employee, on the one hand, and being a vital source of information for the company, on the other. The trade unions have proposed an unfitness prevention scheme focusing on both the individual and the job.

Commentary

The shortage of occupational health officers seems to be the main cause of the deterioration of the occupational health system in France. Despite the fact that the challenge of an ageing population was identified 20 years ago, nothing has been done by successive governments to address the issue. Thus, these multi-industry negotiations are vital. Indeed, their failure could lead to an even less equal system depending on the occupation, status and region in question, moving even further away from being a public health service.

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

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