Proposition 53K0431

Projet de loi fixant la durée du travail des médecins, dentistes, vétérinaires, des candidats médecins en formation, des candidats dentistes en formation et étudiants stagiaires se préparant à ces professions.

General information ¶

Submitted by

CD&V Leterme Ⅱ

Submission date

Oct. 21, 2010

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

EC Directive work working time veterinarian doctor dentist

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP ∉ Open Vld N-VA LDD MR VB

Contact form ¶

Do you have a question or request regarding this proposition? Select the most appropriate option for your request and I will get back to you shortly.

Discussion ¶

Nov. 18, 2010 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker.

In her introductory presentation, the Minister of Employment first recalled that doctors, dentists, veterinarians and trainee students preparing for the exercise of these professions have always been excluded from the provisions of the Law of 16 March 1971 on Labour as regards the duration of work and rest times, so that no limitation applied.

Following the observations of the European Commission on the transposition of Directive 93/104 and the need to include specialized physicians in training within the scope of the provisions on working hours (Directive 2000/34), a legal basis was introduced in the Act of 1971. It allowed the King to provide special conditions of application in terms of working hours, conditions suitable for the medical profession.

After many difficulties, an enforcement order could be adopted on 16 June 2003, but other decisions, in particular on the problem of custody periods, could not be adopted, as the judgments Jaeger and Simap of the Court of Justice prevented the realization of an agreement, which found that custody time should be part of working time.

Following this inability to fulfill the commitments made with the representatives of the medical sector, a request for annulment of the Royal Decree of 16 June 2003 was lodged at the request of the university hospitals. On 9 February 2004, the Council of State annulled the royal decree for formal issues.

Hope had been placed in the proposal for the revision of European Directive 2003/88 concerning certain aspects of the organisation of working time, but this proposal was never adopted due to a disagreement between Parliament and Council, which will be confirmed by the failure of the Conciliation Committee in May 2009.

Following this failure, negotiations were resumed in our country at the initiative of the Minister of Employment and the Minister of Public Health. The need for a solution has been reinforced by the Commission’s complaint, dated 23 November 2009, regarding the non-transposition of the provisions on working hours for these categories of workers.

The average weekly working time of the workers concerned shall not exceed 48 hours on average over a reference period of thirteen weeks and an absolute limit is introduced per day (24 hours) and per week (60 hours), except for cases of force majeure.

Each work service consisting of at least 12 hours and maximum 24 hours shall include a rest interval of at least 12 consecutive hours.

With the written agreement of the employee, an additional working time allows to exceed the limit of 48 hours. This additional working time is a maximum of 12 hours per week in order to ensure, in particular, any type of guard service at the workplace.

This measure is a limited application of the waiver clause. It has an exceptional character given the public health imperatives and the specific nature of the activities and workers concerned. The written agreement which is distinct from the agreement concluded at the time of the commitment must be established before the start of the provision of additional hours. It must be kept for five years and can be terminated with a month’s notice. It is understood that these additional hours of work must be subject to remuneration independent of that fixing the basic remuneration.

This bill is the result of a balanced and delicate consensus between interests sometimes difficult to reconcile. It takes into account the imperatives arising from needs, continuity of care and medical treatments.

During the general discussion and articles, Ms. Gerkens highlighted the strength ratio between hospital managers, interns and interns. This strength ratio implies the need to regulate working time and allow inspections of social laws. However, it expressed concerns about the free choice of interns as regards additional hours and the fact that independent physicians are not covered by the law.

While pointing out that an average weekly working time of 48 hours, ceiling to 60 hours, is relatively high, Mr. Vercamer, however, believes that the bill brings together three fundamental principles: the regulation of working time, which responds to a necessity in the interests of both service providers and patients, the concern for sufficient flexibility and the voluntary nature of supplementary working hours.

by Mr. Clarinval and Ms. Rutten shared Ms. Gerkens’ concerns about possible abuses of additional working hours. Based on the opinion of the State Council, an amendment was submitted. It provides for the possibility of fixing the modalities for the establishment of the individual agreement. Ms Demir expressed some reservations on this point, believing that it would have been better for the terms to be included in the project itself rather than in a royal decree.

Ms Fonck welcomed that the government has been able to reach an agreement that requires the consent of all stakeholders, including the organisations representing candidate trainees. It submitted four amendments aimed at taking into account the next entry into force of the Social Criminal Code.

As regards the Minister’s responses to the questions asked by the various speakers, I will therefore refer to the written report.

All articles, four amendments and the entire text were adopted unanimously. The joint bill proposed by Ms. Gerkens has become pointless.

I will now speak on behalf of the Socialist Group.

First of all, I would like to thank the Minister of Employment and the Minister of Public Health for having been able to carry out the negotiations with all the interlocutors concerned, long and difficult negotiations, but whose central theme is of capital importance for our society because, by regulating the working time, this text is obviously not limited to protecting the health and safety of doctors and trainees but also that of patients.

(Brouhaha) by

(Geroezemoes are)

Dear colleagues, soon Mrs. Burgeon will have to scream!

For a teacher, this is not a problem.

This bill is therefore the result of a balanced consensus that takes into account both the interests of the workers concerned and the requirements related to the quality and continuity of care that too restrictive regulations could hinder.

I will not return to the tumultuous turmoil that struck the year 2008 with regard to the proposal for the revision of the European Directive on the organisation of working time, but it must be remembered that an increasing number of Member States, Britain in the lead, have used and abused, in recent years, the famous so-called waiver clause, in order to circumvent the limits on working time in very different sectors including, for example, health services. These non-collectively-framed remedies contributed to reduced productivity. This is obvious, but they also perpetuate the traditional division of labour between men and women. This is unacceptable compared to what a social Europe should be.

This bill also provides for the possibility of additional working hours due to public health imperatives and the specific nature of the activities of the workers concerned. In any case, it is a limited application of the waiver clause and important tags are provided to avoid forced free choice and to enable the effectiveness of the work of the Social Inspection. In this regard, we fully agree with the amendment submitted and voted in the committee that allows to fix the modalities for establishing the individual employee agreement. It is clear that this law will need to be assessed in consultation with representatives of doctors, trainees and hospitals. If necessary, it will need to be adjusted according to the problems encountered on the ground.

I thank you for your attention.

Mr. Speaker, Mrs. Minister, colleagues, this may sound familiar to your ears: working days of at least 12 hours, one and a half days of uninterrupted work in the wardrobe, on average more than 100 hours per week. I’m sure that many of you feel attracted, that you know this: the feeling of being non-stop occupied, self-washing and continuing tirelessly, creating the delusion of being indispensable and, unlike normal people, hardly need sleep. Some cheat on it, others bluff with it. Those who are honest with themselves, however, know that that lifestyle, that self-deception, always takes revenge. One may find it harder to focus and become more superficial, the reflexes change and one makes mistakes and in a year time one becomes three years older. Colleagues, imagine not being able to go home after a few debilitating or exhausting days or weeks for a warm bath or a warm bed.

I would like to clarify to my dear colleague that there are also beds in the hospital, whose linen are equally pleasant, and the shower too, even when one is on guard several days and several nights in a row. I am talking about experience!

Imagine that you can’t go home, but at such a time you get another person’s life in your hands; that at such a time you have to operate and make decisions that in a fraction of a second determine the difference between life and death. This assumption is not fiction. This is a reality for many doctors, especially in training.

Belgian doctors and training specialists often strike extremely long working days. Although no doctor will leave the operating table after his formal working hours have ended, it is not a good thing to see heroic acts in this type of practice, on the contrary. The exhaustion from long and uninterrupted working days is ultimately completely harmful, both for the patients and the doctors themselves.

In other European countries, this has long been evident under the impetus of the European regulator. Such working conditions are simply no longer of this time. With the proposal presented for voting today, Belgian doctors and specialists, as well as veterinarians, dentists, trainees and students in wage service, finally enter the 21st century.

This proposal limits the average working time to 48 hours per week over a reference period of 13 weeks. There is also an absolute maximum length of 60 hours per week, though. In the context of this law, absolute is something less absolute than the word suggests. The maximum duration can be voluntarily deviated. With the consent of the employee, an additional working time of 12 hours is possible beyond the 60 hours. That brings the total, formal working time still to 72 hours per week.

This is where our biggest concern is situated. In theory it is a written individual agreement based on voluntary, but in practice those 12 extra hours threaten to become the rule rather than the exception. This has to do, for example, with the moral pressure, the competition, the student-master ratio between trainees and doctors in training.

Open Vld does not like hypocritical regulations and therefore attaches special importance to the provisions of that individual agreement. If we really want to change the working situation of doctors and other categories covered by this bill, it is extremely important that those 12 extra hours are actually optional and not compulsory. For us, free choice is central.

Although we fully understand the continuity of care, in the interests of doctors and patients we want to counter potential excesses in this area.

That is why we submitted an amendment during the examination in the committee, allowing us to provide for the future the possibility to further determine the implementation of that individual agreement in a royal decree submitted by the Council of Ministers. In this way, the draft law now provides for the possibility to take action if it turns out that the provisions on the drafting of the writing in practice would cause problems, coercion or abuse. The amendment makes it possible to intervene faster than the planned evaluation.

I would therefore like to take the opportunity to point out to the people on the ground that relatively flexible possibility for further refinement of the modalities of the individual agreement. From the date of its entry into force, it shall keep everyone aware of the voluntary nature of that provision.

Of course, even the possibility of further refinement with an amendment does not solve everything. The success of legislation stands or falls with the responsible attitude of actors in the field. We, as legislators, can direct and correct, but the changes in the work ethos and the informal plugs will, of course, first and foremost have to happen in the workplace. Such a thing takes time, but if there is a will, and with the consensus around this proposal, it must succeed.

For those who, nevertheless, continue to hardly believe in the pseudo-healing of too long working days and little sleep, the law also provides for sanctions. Thanks to a number of amendments approved in the committee, the social inspectors will be able to have the various powers listed in the Social Criminal Code.

You have understood that our concern as liberals lies with the health of patients and doctors, with better services and free choice. These are the principles for our legislative action. That does not mean, however, that we agree with the often too populist imagery that presupposes only exploitation or abuse. Nothing is less true. True understanding is also needed for both doctors and hospitals, who want and must ensure the continuity of care. In other words, whoever wants to give the impression that in hospitals there are only disadvantages in which the medical staff is exploited, really takes a walk with the truth.

With this proposal, under pressure from Europe, but better late than never, we settle a delicate matter that has led to heated discussions for ten years. Finally, sufficient rest time is provided for people who struggle long days and who are expected to be constantly alert and expert in performing their job. Human lives depend on it.

We believe that this bill balances between a modern working regime in the interests of patients and care providers and the continuity of care. We attach particular importance to the voluntary nature of supplementary hours, and to the amendment to determine the modalities.

With those reasons in mind, the Open Vld group will approve this bill later. May it inspire the greatest heroes of sleep deprivation and absurd long hours of work among us politicians.

Dear colleagues, you tiens à féliciter Mme Rutten pour sa première intervention dans cette enceinte. (Applause of Applause)

Mr. Speaker, Mrs. Minister, colleagues, it is a good thing that we can vote today on the bill.

It finally settles a very delicate point, on which, after very much and intense consultation, a consensus with all stakeholders has been reached. Very much and intense consultation has its advantages and disadvantages. The advantage is that you have a large support with all involved. The disadvantage is that it takes a lot of time and that we are indeed one year late with the transposition of the European Directive. Therefore, it is really good that we can vote on this today.

Our group will approve the draft law, as adopted by the committee after amendment, because we believe that it ⁇ ins a good balance between three key principles. First, working hours are specifically regulated. Second, sufficient flexibility is built in. Third, the principle of voluntariness in the provision of additional working hours shall be respected.

That arrangement of working time, an average of 48 hours per week with a maximum of 60 hours per week, is nothing. There are mandatory rest breaks. This is in the interests of both the patient and the healthcare provider. This should be the guarantee for the quality of care.

The draft legislation also provides for sufficient flexibility and at the same time includes safeguards to avoid abuse of flexibility. In fact, if one wishes to exceed the limits of working time, this can only be done in limited and well-defined cases.

Finally, our group emphasizes that the principle of voluntariness in the performance of additional work is guaranteed in the bill. The amendment also provided for the possibility of strengthening this guarantee.

All in all, there is a good balance, which should enable healthcare institutions to continue to organize good services, with respect for the healthcare provider, and guarantees for quality care for patients.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. Many negotiations were held on this matter and the compromise was difficult to ⁇ . There are numerous divisions in this matter, between hospitals that are sometimes looking for very cheap labor and doctors in training who want to benefit from hours of decent benefits. There may also be differences of interest between interns and doctors in training.

This is a difficult case that concerns the organization of continuity of care, the safety of patients. This can lead to budgetary problems with staff involvement in hospitals. The press regularly echoes the exploitation of doctor candidate specialists and the dangers that this creates, especially in terms of safety for the patient. For their part, hospitals and especially university hospitals would face very important organizational problems to ensure continuity of care in the services if the working time of doctors in training was drastically reduced. They could theoretically hire other doctors but would then face budgetary problems as no budget is planned to finance the guards currently provided by trainees.

Regarding the specific issue referred to in Article 7 of granting 12 additional hours for doctors in training on the basis of an individual agreement that must be concluded outside the act of commitment itself, we cannot help but think that there is a risk of pressure from hospitals or trainees on doctors in training. No matter what you think, we should expect conflicts on this issue. Notwithstanding Article 7, paragraph 5, which provides that the worker may not suffer any damage from the employer, the candidate specialist will inevitably fear a disadvantageous report from his internship master. Controls and sanctions are well planned, but in practice, it will be about ensuring the effectiveness of the control. In this regard, we will be ⁇ attentive to the assessment announced by the Minister.

Mr. Speaker, Mrs. Minister, dear colleagues, the MR group will support this project during the vote, the result of a compromise to which hospitals, doctors and universities can join, on the one hand, the associations representing candidate doctors specialists in training and the various universities, on the other. This project constitutes a certain advance from the current legal vacuum which has as a result that candidate doctors specialists in training are absolutely not protected. This situation was no longer acceptable. We will vote in favour of this bill.

Mr. Speaker, Mrs. Minister, our group supports the bill because it finally provides a basic protection regarding working time after many hard-working attempts. This is necessary not only from the perspective of the trainees or the doctors in training, but also from that of the protection of the patient.

As many previous speakers have already said, we will have to follow the application of the existing possibility to exceed the maximum limit of 60 hours on an individual basis by 12 hours with argus eyes. Therefore, it is important that the statutory foreseeable evaluation, which should come within two years, be well prepared.

It is time for this bill to come to the table and be voted. In fact, it concerns a category of workers subject to unbalanced working and training conditions, given the force ratio that inevitably exists between a trainee and a doctor candidate in training. Previously, these latter were subjected – we all know – to ⁇ difficult timetables. Indeed, they had to work for long hours without possible recovery, with the risk that it represented for them, but also in terms of quality of services and patient safety.

As early as 2008, I had submitted a bill requesting that the working time of candidate trainees be incorporated into the Working Time Act. In the Public Health Committee, a whole series of hearings had been conducted. This is how we heard of hospital managers, representatives of internship masters, representatives of university deans, in order to have a broad and comprehensive view of the situation.

In the Health Commission, the members of Ecolo-Groen! have agreed to adhere to the bill presented by the minister considering that our bill becomes obsolete, even though that bill includes a number of compromises. I don’t think we could do more on this issue.

The bill under consideration presents ⁇ positive elements: the inclusion of candidates for internship (doctors, dentists, veterinarians, etc.) in the law on working time, the possibility and even the obligation to recover hours through rest hours when the hours of service exceed a certain time. All these elements constitute a guarantee of guarantee and security.

This text also includes – I said – a number of compromises, some of which will require us to be vigilant. Thus, as already underlined, the trainee candidate will be able to provide, on a voluntary basis, twelve hours in addition to the working time regulated by the project. This additional benefit must be the subject of an agreement signed by the trainee and his master of the internship and this, regardless of the internship contract negotiated in advance. But, as it has already been mentioned, everyone knows the strength ratio that exists between the master of the internship and his trainee and everyone knows that the voluntary choice will be all relative. It is clear that the trainee will notice quite quickly whether he has an interest in signing or not the aforementioned agreement.

Nevertheless, students and internship candidates are aware of the need for the number of hours to lend, but also the shortage of specialist doctors in hospitals. That is why they accept to lend all these hours.

The element that will have to keep our vigilance in the monitoring and evaluation of this measure is that the interns cannot abuse their position in the evaluation, length and quality of the training of the internship candidate. Mr. Minister, as in the committee, I draw your attention: among the evaluation criteria for all candidates, it will be to examine the duration, the scope, the quality of the training, as well as their relationship with their internship master.

Another compromise is the four hours to be reserved for research work required by candidates in training. Four hours is insufficient, but a compromise was needed. There too, it will be appropriate to evaluate in order to observe whether candidates for internships retain the opportunity to increase this time spent on research. Indeed, they are not workers, but students in training; that is why this research capacity is required from them.

I would like to address one last point for our discussion.

We are at the intersection of the competences of a Minister of Health and of a Minister of Social Affairs.

In order to improve the quality of the training of these candidates, a reflection will need to be carried out on the presence of sufficient number of specialized doctors in the hospitals in order to be able to frame all these trainees during their training. In fact, these trainees do not replace the absent medical specialists, but must benefit from their accompaniment.

Furthermore, the method of evaluation of training should be harmonised: when does it correspond to the expected skills and capabilities?

Some universities, for some disciplines, make a real effort to ⁇ this. Thus, in surgery, a study is conducted to determine the operations to be performed, the number of hours to be performed in the various possible contexts.

An objectivation of this evaluation of the progress of the training and its purpose will be indispensable in order to attribute to it a correct value, satisfying for all and to enable candidate interns to benefit from a quality, balanced and training of quality specialists, and this, of course, to the benefit of patients.

Ecologically green! He will stand in favour of this bill, but will remain vigilant with regard to the elements of compromise that have had to be accepted.

Mr. Speaker, Mrs. Minister, dear colleagues, I am pleased that a legal framework for working hours for doctors, dentists and doctors in training is finally being created. This legislation should have been in place for a long time.

In the draft law, we have two concerns that I have pushed forward in the Social Affairs Committee.

First, I note that with the bill it is still possible in practice that doctors or candidate doctors work 72 hours in hospitals. That seems to me on the high side, knowing that the legal working time in this country is 38 hours for wage workers.

Secondly, I am also concerned about the voluntary nature of the 12 additional hours that a doctor or an internship doctor must perform. I wonder to what extent a trainee doctor who is asked by a head of service to work an additional 12 hours can refuse. Gwendolyn Rutten submitted an amendment. I hope that the modalities will soon come to KB.

Despite these concerns, our group will approve this bill, Mrs. Minister.

Nevertheless, I am very dissatisfied with the way this case was dealt with. On 20 November 2009, you will receive a tick from the European Commission that the directive should be transposed into national law. On Tuesday evening I had to find out that the agenda of the Social Affairs Committee is suddenly changing. On Wednesday morning we will have to decide on the draft law. I think this testifies to a lack of parliamentary democracy.

Mr. Minister, your draft law has taken it with the heels over the lock. You know that during this time there can be a lot of water in the lock. I think it is dangerous to jump over the lock in this way. The next time you come up with a bill, Mrs. Minister, I hope that this can be scheduled a little earlier so that every member of parliament can do his job.

Mrs Demir, congratulations on your maiden speech.

Mr. President, Mrs. Minister

, gentlemen ministers, a priori, this file was an impossible equation because it is not from today or yesterday that assistant doctors, for example, performed more than one hundred hours a week. I have experienced this situation myself. I’m talking about an impossible equation because it was multi-component: the positioning, the issues, the reality of hospitals and that of the providers were very different.

The government has been able to solve this impossible equation through human and public health advances. My colleagues have talked about this and I think this is ⁇ true in terms of quality of care, added value for patients and reduced risk of accidents while ensuring continuity of care.

With regard to this equation that I said impossible, it is necessary to emphasize the professional conscience of all those who represented hospitals and care providers. Without the professional awareness they have demonstrated in the negotiations, it would have been difficult to solve the equation. Whatever their positioning and reality may have been, they have pursued this double goal of not damaging the organization of care and taking into account the reality of the work of the providers.

Of course, history will not stop there because the implications for the future are many. First, within the hospitals, there will be the question of the reorganization of work. Then, for the federal and for the Communities, the question of the number of doctors and assistant doctors will have to be restored to ensure continuity of care and so that hospitals can continue to work on the quality of care given to patients.

I will not be surprised to tell you that the CDH group will support this text.