Proposition 51K2194

Projet de loi désignant les représentants des infirmiers à domicile à la commission de conventions infirmiers-organismes assureurs.

General information ¶

Submitted by

The Senate

Submission date

Nov. 14, 2003

Official page

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Status

Adopted

Requirement

Simple

Subjects

disability insurance paramedical profession social security health insurance

Voting ¶

Voted to adopt

Vooruit LE PS | SP Open Vld MR

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Discussion ¶

March 1, 2007 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, I know that the time is late, but this is a delicate file that has leaked a lot of ink. Wouldn’t it be worthwhile for the Minister Demotte to be present?

by Mr. Demotte told me just recently, when he came for questions, that I could call him to his office. I didn't expect the time to be so late but if you insist, I can try to contact him.

My colleagues are not hot. I will not insist.

by Mr. Dress, I suspect you have a great skill. I thank you.

Mr. Speaker, Mrs. Minister, the Public Health Committee examined the bill during its meetings of 28 March 2006, 23 January and 13 February 2007.

As regards the procedure, the committee held hearings during its meeting of 28 March 2006. The contents of these hearings are attached to the written report. The examination of the draft law and proposals took place during the meeting of 23 January 2007. The bill 1327 establishing a consultative nursing council was initially attached to the discussion but was disjoined during the meeting of 23 January 2007.

At the level of discussion, the Minister stressed that the problem addressed by the bill is related to the fact that home care is organized in two different ways, namely on an employee basis or on an independent basis.

Nurses who are active in the home care sector are represented by different professional organisations.

Some of these organizations represent both independent nurses and employed nurses. These are mainly professional organisations that are members of the General Union of Nurses of Belgium (UGIB). Apart from the UGIB, however, there are also organizations that exclusively defend the interests of independent nurses. Finally, there are organizations that specifically represent employed nurses.

Currently, home nurses are represented in the convention committee in accordance with the Royal Decree of 16 December 1963 fixing the composition of the committees responsible for negotiating and concluding national conventions in the context of health insurance.

For more than 40 years, UGIB, for historical reasons, has held all the mandates of healthcare providers. The Minister wanted to emphasize that the important development observed in this sector has resulted in the emergence of new organizations for both employees and self-employed. He specified that he therefore considered it important that the representation of nurses in the convention committee be modified according to the actual situation on the ground.

For many years, the issue of representation in the convention committee has been a source of tension among nurses and nurses. Since the beginning of the legislature, the Minister has attempted to stimulate consultation with the UGIB member organizations as well as with other organizations that are not represented in the convention committee. Unfortunately without success.

A change in current legislation will reduce existing tensions and better defend the interests of both self-employed and employees.

The Minister recalled how difficult it was to organize elections and cited the following reasons. First of all, a register of nurses should be created within the INAMI in order to distinguish between self-employed and self-employed nurses. The creation of this database will waste precious time. By the way, the INAMI already considers that this is a very, very heavy administrative task.

The registration system proposed by the project provides guarantees for the representativity of independent nurses through the conditions they must meet.

These conditions provide, in particular, that associations must be recognised, that they may only use independent nurses, that their members must pay a contribution and that compliance with these conditions is monitored.

The representation of employees reflects the reality of the field, insofar as employees are represented by specific federations. Since the representation of employees poses little problem, this balance should be ⁇ ined and the project should not be modified on this point.

Ms. Avontroodt emphasized that she had already submitted a bill designating the representatives of home nurses to the Commission of Nurses-Assurance Organizations Agreements on 17 March 2005.

Independent nurses who take over more than 60% of home health care can now also be represented in the different bodies where decisions about home care policy are made.

Mrs Avontroodt was delighted that after 20 years, independent nurses are finally represented in the convention committee.

As for mr. Verhaegen (CD&V), on the other hand, believed that the project is based on a false hypothesis, namely that independent nurses are not represented in the committee of nurses-insurance organisations agreements. However, this assumption does not correspond to the situation on the ground and can therefore easily be refuted.

He believes that home care services and independent nurses are equally represented.

The draft law does not solve any problem, says Mr. In the meantime, it will only create other problems. That is why CD&V decided to vote against this project.

The speaker is of the opinion that the bill is dictated by a number of independent nurses who wish to take their distance from the façade organizations, which currently represent the other groups of home nurses, and be directly represented in the convention committee.

by Mr. Verhaegen also recalls that these four representative professional associations have already allocated the eight mandates, each to a representative of home care services and a representative of independent nurses.

If, for any reason whatsoever, censuses or elections were to be conducted, they could only intervene in the designation of representatives of home care services.

by Mr. Verhaegen also believes that within INAMI, the representatives of employed nurses are neither elected nor recensed. If representatives for independent nurses were to be appointed, this would be done through existing representative professional associations and not through professional associations that represent exclusively independent nurses.

In accordance with Royal Decree No. 78 on the exercise of health care professions, there are no representative professional associations for independent nurses in any official advisory body. For other professional categories as well, such as doctors, kinesians, professional associations are mixed. It is therefore false to think that the interests of independent nurses should be defended by professional associations that represent only independent nurses. That is why it is more appropriate and more democratic to organize elections rather than censuses.

For my part, I also expressed my support for the bill on behalf of the MR group, insisting on the significant progress of the text under consideration. This represents a step, a great advance, which has already been requested for more than twenty years.

As regards the meeting of 13 February, it examined the amendment submitted by Mr. by Yvan Mayeur. This amendment only envisaged changing the date of entry into force of the law, which was fixed on 1 January 2006. In fact, the aim was not to ensure that the law entered into force with retroactive effect. Furthermore, a number of enforcement orders must still be taken so that the entry into force of the law must be anticipated at a date following its publication.

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I would like to thank you, Mrs. Rapporteur.

The amendment is important for all nurses and, in particular, for all independent nurses in this country.

Since 1963, the convention commission has been established in a somewhat arbitrary and discriminatory manner. For more than 40 years, independent nurses have not really felt represented within the mutual nurses committee. However, we know that the health care system in Belgium is governed by a set of conventions. We are in a conventional system. These conventions allow, in particular, to fix the nomenclature, to decide on the mode of exercise of the profession. Despite this, independent nurses have always been underrepresented or, in any case, they have never felt that they were actually represented there.

Of course, there are professional associations in the convention committee but they indistinguishably group out employed nurses, independent nurses, intra-muros and extra-muros nurses. There was therefore no real representation of independent nurses as such.

This is why, in the last 20 years, this problem of representativity has been the subject of very many discussions. If the question of representation within the convention committee arises, it is precisely because the current composition no longer corresponds at all to today’s nursing landscape.

A representation based on a legal basis could finally put an end to a discriminatory system used for years and which systematically aimed at treating independent nurses, home nurses as a secondary discipline compared to home nursing associations that operate with employed nurses or that I will call “false independent nurses.”

Furthermore, the audit conducted in June 2005 by INAMI, which is entitled "Analysis on Home Nursing", clearly demonstrated that independent nurses account for 60% of home nursing care. So, contrary to a popular idea, employed home care services are a minority in all the services provided by home nurses. In our country, independent nurses account for – I repeat – 60% of the total volume of benefits.

This is obviously another reason for them to be more represented in the convention committee.

We have been trying for years to solve this issue. It was not easy to find a formula considering the multiple facets and various forms of practice in the nursing profession. But we have always advocated for an elective system, which already exists for doctors for several years and for physical therapists. It is the election that seems to us to be the best representation system. Unfortunately – and the minister has reassured us in this idea, as well as the INAMI – in the current state of affairs, such an election is practically impossible to organize, given the diversity of the nursing landscape. In addition, it is very difficult for the INAMI to establish a register of nurses.

We therefore consider that the bill, although it is not perfect and is probably not the definitive version of the adequate representation of independent nurses, nevertheless allows to take an important step in this direction. Thus, these persons will be able to estimate that they are actually represented in the convention committee. This is what the nurses told us during the hearings. This text appeared to them as a truly significant advance, and that is why we will support this project, which has already received widespread membership in the Senate. However, this obviously does not mean that we are abandoning our struggle for a real election of nurses, a system that can only be improved in the future.

Mr. Speaker, I thank the reporter and Mr. Bacquelaine, whose presentation is almost a blueprint of what we want to bring today. This is about a piece of history and the fact that the needs and needs in the field for the self-employed nurses are just slightly different from the interests, needs and questions of the nursing services. As Mr. Bacquelaine has said, this discussion has been ongoing for years and has gained all its support in a number of draft laws and proposals.

The first proposal that our party has submitted in this regard was made by Minister Van Mechelen in 1994, in which the track of the number of members for representativity was pushed forward. Since 1998, we have been seeking a viable compromise for the representativity of the independent nurses.

1998 is also the year that a new era has begun for the medical elections. Since 1998, every four years, the representativity of doctors has been tested for what lives in the workplace. This is, in my opinion, the best path for representation in the agreement committees. It all seems very technical, but ultimately it is decided which values to which performance and what remuneration to be awarded to the people in the healthcare sector. That sounds like a technical discussion, but whoever in the field faces the actual performance, the workload, the tax, the best care at the best price, knows that this discussion has not yet ended after there is a representative representation.

Mr Bacquelaine also pointed out that the track now pushed forward as a viable compromise does not correspond to the reality on the ground. After all, the reality on the ground is that more than 60% of nursing care is provided by self-employed nurses. The current path to move towards a paritary distribution between the services on the one hand and the representatives of the self-employed nurses on the other is, of course, not an accurate representation of the reality on the ground, but it is in all a huge step forward in the transparency of who who represents.

After we had first chosen the numbering of members with the proposal of Minister Van Mechelen, we would also have preferred to see elections be held for that representation. We failed to do this because even the minister has admitted that there is no register of nurses so far. Therefore, the present draft is a compromise but feasible and widely tested in the field both with the services and with the representatives of the self-employed nurses.

We know that not everyone shares our opinion on this issue. I would like to refer to the remarks made by Mrs. De Meyer in the committee. She argues that the organizations that are a dome and both services and groups of self-employed nurses cannot end up on the banks of the self-employed nurses. I believe that a solution can also be found for this. This will only benefit transparency.

Mr. Speaker, I decide to thank the services, colleagues and those present at the hearings for their contributions. The representation of the services is clear and clear: on the one hand, the Flemish Federation of Services for Home Care and the Confédération des centres de coordination de soins et de services à domicile and, on the other hand, the pure representation of the self-employed nurses.

Of course, an evaluation in the field is necessary. We may be able and should update as soon as a register of the self-employed nurses is available. All in all, this is a major step forward both in terms of transparency and the fact that the government, insurance institutions and professional organisations will have a clear interlocutor, yet the most important point.

I now give the floor to Ms. Gerkens.

We still have 14 international treaties and two or three projects.

The [...]

This is the price of democracy.

I will be brief.

I did not target you.

I can see that my colleagues want this to end.

It is a desire that I share.

Since I disagree with the previous speakers, I thought it was worth taking two or three minutes to mean it.

After the hearings we conducted almost a year ago, it seemed clear to me that the provisions we were going to adopt did not meet a need for nurses, except for a few representatives of small associations of independent nurses.

On the other hand, during my various interviews with nurses and nurses, I felt the need to maintain mixedness at home by insisting on the dimension of home care, on respecting the difference in status and on recognizing the difficulties encountered by independent or employee home care actors.

I feel that the project under discussion proposes that employed nurses no longer be represented as such. They will do so through representatives of federations, services, home care coordinations, mutual associations. It is therefore important associations that will come to defend interests that are sometimes very distant from those of nurses on the ground. For the self-employed, they will be represented by self-employed, however in conflicting position with the employees.

I liked the mixed system very much. I believe that we could have incorporated – this is already the case now – the need for a parity between self-employed and self-employed.

You say that elections are impossible.

An amendment has just been adopted stipulating that the draft will enter into force one year after its publication in the Monitor. We have one year to react.

From the moment when we have the profile of all nurses since there is reimbursement of care, from the moment when the ONSS declarations have returned for all employees, how can we say that it is impossible to make a cadastre allowing elections? I think there is a lack of will to do this.

This lack of willingness is palpable within some independent nursing associations but ⁇ also among the federations and services representing home nurses who prefer to represent them rather than let them represent themselves.

Given the absence of demand, in any case among the nurses I meet, given the hypocrisy consisting of saying that one cannot organize a cadastral or elections, given the rivalry that this will cause between employees and self-employed, we can only vote against this project.