IMMIGRANTS AT THE WORKPLACE IN THE HEALTH CARE SECTOR

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1 IMMIGRANTS AT THE WORKPLACE IN THE HEALTH CARE SECTOR Tehy survey on multiculturalism Tehy ry Publication Series B: Surveys 3/2005 Kirsi Markkanen, Soile Tammisto 1

2 Kirsi Markkanen, Soile Tammisto Translation: Heli Setälä Immigrants at the workplace in the health care sector Tehy survey on multiculturalism (Maahanmuutajat hoitoalan työyhteisössä, Tehyn selvitys monikulttuurisuudesta). Publication Series B: Translation, Surveys 2/2006, (3/2005) ISBN Printed in: Multiprint Oy,

3 To the reader Multiculturalism, which has always been evident in the activities of Tehy, can be roughly divided into the following three periods: the era of positive development cooperation in the 1980 s, the time of economic recession in the 1990 s and, later, the free movement of the labour force with many job-seekers moving abroad as a consequence of Finland becoming a member of the European Union. Around the year 2000 the realities of the accelerating retirement age of the labour force, the impending shortage of labour, returnees from the former Soviet Union and other countries, the enlargement of the European Union and the new labour markets which were opening up in the neighbouring regions to the east and south of Finland, were suddenly recognised in Finland, and also within Tehy. Knowledge of the changes which have taken place in the world of work, and of the trends which are to be expected in the development of the labour force, form the background to this survey by Tehy on multiculturalism. However, multiculturalism as a concept also encompasses changes over the years in the content of Tehy s activities as an organisation. One of the aims of this survey on multiculturalism is to produce background information in order to better prepare Tehy, as a trade union, for changes in the world of work, and to help Tehy to see any changes which may have taken place amongst the membership and to enable Tehy to change its own activities towards the desired direction. In addition, we hope that by means of this survey we can unearth those challenges which are linked to the increasing multiculturalism at the workplace and for which we can try, in cooperation with the employer, to find the solutions. The material for this survey was gathered from the branches of Tehy, from those members of Tehy with an immigrant background and from the representatives of the employers. We wish to thank all of those who participated in the interviews and who replied to the questionnaires. We are grateful to the Tehy research team which made its expertise available during the various stages of this survey. We thank the team for all the constructive discussions and their cooperation. Information Officer Katriina Vasama helped to produce and publicise the survey. Special thanks to you, Katriina! Helsinki, December 2005 Ms Kirsi Markkanen M.Sc. (Health Care) Labour Policy Officer Ms Soile Tammisto, Manager International Affairs Political Science Graduate 3

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5 Summary Immigrants at the workplace in the health care sector A Tehy survey on multiculturalism The aim of this survey was to gather information on the number of immigrant workers in the social and health care sector in Finland and on their working conditions and other work-related issues, as well as on the preparedness for multiculturalism in Finland. The material for the study was obtained by sending questionnaires to the 329 branches of Tehy and to those individual members of Tehy whose mother tongue is neither Finnish nor Swedish but a third language. In addition seven matrons, who are in charge of health care units of varying sizes, were interviewed as employer s representatives. The rate of response to the questionnaire by the Tehy branches was 48 % (n = 159), and the response rate by the individual members was 62 % (n = 63). 65 % of the members with an immigrant background who replied to the questionnaire were in permanent employment, 22 % were employed on a short-term contract and 5 % were unemployed. All three groups of respondents stated that in general immigrants are employed in jobs which correspond with their qualifications; mostly as doctors, nurses and practical nurses. The main reasons for being employed in a position which does not correspond with the individual s professional qualifications were found to be insufficient language skills or a qualification gained abroad which is not recognised in Finland. According to the various groups of respondents to this survey, there does not appear to be significant differences in the terms and conditions of employment, rate of pay or occupational health and safety issues between those employees with an immigrant background and any other employee. 76 % of the respondents had used their mother tongue in their work, but only six of them had received any additional remuneration for this. Of those individual members who replied to the questionnaire, only 8.5 % stated that their employer had arranged any special introduction to their new duties or any training for them. According to the Tehy branches, only one in every four employers had provided any special introductory occupational training. It was evident that training in multicultural issues was covered to an even lesser extent. Those matrons who were interviewed did not regard it as being necessary to organise any special introduction or occupational training apart from some individual, clearly defined courses on treatment methods. However, they stated that it could be advantageous for the workplace community to increase the level 5

6 of understanding of multicultural issues, although no particularly training had been organised. Of those immigrants who replied to the questionnaire, 71 % were of the opinion that they were treated at the workplace in the same way as any other employee. However, 49 % had, at some stage of their career, experienced racism which was applied to them by patients, their family members, fellow workers or by the employer. These experiences consisted of name calling, underestimation of their professional competence, unequal treatment, language problems and lack of trust. It was seldom that either the Tehy branches or the employer were aware of any problems which the immigrant might encounter at work. However, inappropriate conduct towards the immigrant, or racism for example, are amongst those problems of which they were aware. According to the results of the survey, those with an immigrant background seem to encounter several obstacles when they seek employment in the social and health care sector. Language difficulties, unacknowledged qualifications and multicultural issues not being understood at the workplace, are some of these obstacles. In order to be able to increase the number of foreign employees in the health care sector to any significant degree, these hindrances to employment in the sector should be dismantled by means of the cooperation of a variety of parties without jeopardising the safety of the patients. 6

7 Contents 1. INTRODUCTION BACKGROUND TO THIS SURVEY Foreign labour in Finland Mobility of labour in the health care sector Agreements which concern health care professionals Foreign health care professionals in Finland Finnish health care professionals abroad As an immigrant in Finland The Foreign Nationals Act The Immigrant Integration Act The Equality Act Regulations on workforce mobility within the European Union Wages, salaries and level of earnings in the EU The immigration policy programme of the Finnish Government Multiculturalism within Tehy The Tehy development cooperation projects and training in internationalism Tehy and EU projects THE AIM OF THIS SURVEY THE IMPLEMENTATION OF THE SURVEY AND THE MATERIALS USED RESULTS Branch enquiry Background information Employment as a health care professional Unionisation The terms of the employment contract Factors which enable multicultural activities at the workplace Experiences and comments on multiculturalism and requests to Tehy Questionnaire to Tehy members with an immigrant background Interviews preceding the questionnaire Background to the membership questionnaire Qualifications and employment in the social and health care sector Employment contracts and associated issues

8 5.2.5 Treatment and attitudes Requests to the employer Requests to the trade union Employer interviews The numbers, duties and qualifications of workers with an immigrant background Type of employment and reasons for unemployment amonst immigrants Special introduction to work and to multiculturalism The attitude to immigrants of patients and colleagues The recruitment of labour from abroad SYNOPSIS AND CONCLUSION... 56

9 1. Introduction The increasing age of the population along with the decreasing supply of workers will constitute the greatest challenge for the whole of Europe. Demographic changes will take place in Finland sooner than in most countries in Europe. It has been estimated that by the year 2030 the number of people who are aged 65 or over in Finland will exceed the current figure by more than 600,000. At the same time the number of people of employable age will fall by more than 300,000. According to the Government survey, Outlook on the Future (2004), a more international labour market will be called for in future. The survey states that foreign workers and their families should be seen as a positive resource. However, the involvement of a more international workforce will present a tough challenge to the Finnish labour market as Finland has traditionally been a country of emigration. Since the Second World War more than 500,000 people have left Finland for Sweden. At the end of 2004 the number of foreign nationals living permanently in Finland stood at 108,346, half of whom lived in the greater Helsinki area and its environs in southern Finland. This group constitute some 2 % of the total population. This represents the lowest percentage in any European Union member state (the Finnish Centre for Statistics, 2005). According to the Centre for Statistics, family relations have been the most common reason for moving to live in Finland from 1990 to the present, some 65 to 70 % of all immigrants to Finland citing this. Other reasons were given as being a refugee (15 %), seeking work (5-10 %) and being a returnee from the area of the former Soviet Union (10 %). Most of the immigrants are of employable age, but only some 47 % are actually in employment (the Finnish Ministry of Labour, 2004). Preparation for an increase of foreign labour in the Finnish workforce is currently a topic of discussion in the health and social care sector. Some employers have already travelled abroad to recruit foreign workers. Of the total number of foreign nationals who emigrated to Finland from 1989 to 2001, approximately 0.9 % found employment in health care and 1.4 % in social services, and this makes the situation particularly interesting for the health and social care sector. (Ailasmaa 2004) Tehy was established in 1982 and has continuously maintained an international dimension in its activities. This multicultural aspect, which has always been evident in the activities of Tehy, can be roughly divided into the following three periods: the era of positive development cooperation in the 1980 s, the time of economic recession in the 1990 s accompanied by high unemployment and many job-seekers moving abroad, and later, the free movement of the 9

10 labour force as a consequence of Finland becoming a member of the European Union. At the turn of the millennium the realities of the accelerating ageing of the labour force, the impending shortage of labour, returnees from the former Soviet Union and other countries, the enlargement of the European Union and the new labour markets which were opening up in the neighbouring regions to the east and south of Finland, were suddenly recognised in Finland, and also within Tehy. Knowledge of the changes which have taken place in the world of work, and of the trends which are to be expected in the development of the labour force, form the background to this survey on multiculturalism by Tehy. However, multiculturalism as a concept also encompasses changes over the years in the content of Tehy s activities as an organisation. This survey follows a review of literature on multicultural ethical issues compiled by Taina Keituri (2005) for Tehy. One of the aims of this survey on multiculturalism by Tehy is to produce background information on those health care professionals who have an immigrant history in order to better prepare Tehy, as a trade union, for changes in the world of work, and to help Tehy to see any changes which may have taken place amongst the membership and to enable Tehy to change its own activities towards the desired direction. In addition, we hope that by means of this survey we can, on our part, improve tolerance at the workplace and unearth those challenges which are linked to the increasing multiculturalism at the workplace and for which we can try, in cooperation with the employer, to find the solutions. 2. Background to this survey 2.1 Foreign labour in Finland According to the Government survey, Outlook on the Future (2004), the labour market in Finland is only slowly becoming more international. There are few foreign nationals in employment in Finland, although their numbers have been growing steadily. In some sectors the demand for foreign labour has risen and as a consequence the number of foreign workers in employment in Finland has increased. This cross border workforce mobility is expected to grow as a result of international demographic development and the free market economy. (Government survey, Outlook on the Future 2004) 10

11 The Finnish population is, on a cultural level, still fairly homogeneous. At the end of 2004 some 108,000 foreign nationals and nearly 170,000 individuals who had been born abroad, were living in Finland. Approximately 130,000 people spoke a language other than Finnish or Swedish as their mother tongue. This signifies that only some 2 % of the total population in Finland are of a foreign background. This percentage is very low in comparison with other European countries. Whilst immigration to Finland has increased to some extent during the last decade, at the same time emigration has also increased, and therefore the net immigration figure remains low. The majority of these foreign nationals are of European origin, Russians, Estonians, people from the area of the former Yugoslavia, and Somalis and Iraqis form the largest groups of immigrants. Table 1. (The Finnish Centre for Statistics, 2005) Table 1. The population of Finland, 31st December Population: 5,236,611 NATIONALITY MOTHER TONGUE COUNTRY OF BIRTH Finnish 112,729 Finnish 4,811,945 Finland 5,070,250 Foreign nationals, in total 108,346 Swedish 289,751 Born abroad, in total Largest groups: Sami 1,732 Largest groups: Russians 24,626 Other, in total 133,183 Former Soviet Union 166,361 38,547 Estonians 13,978 Largest groups: Sweden 29,191 Swedes 8,209 Russian 37,253 Estonia 11,238 Somalis 4,689 Estonian 13,784 Former Yugoslavia 4,870 Iraqis 3,392 English 8,345 Somalia 4,771 Serbians and Montenegrins 3,336 Somali 8,096 Russia 4,275 British nationals 2,655 Arabic 6,589 Germany 4,274 Germans 2,626 Albanian 4,808 Iraq 4,250 Chinese 2,625 Kurdish 4,757 China 3,567 Iranians 2,555 Chinese 4,172 UK 3,354 Source: The Finnish Centre for Statistics 11

12 Family relationships have been the main cause for immigration to Finland. According to an estimate produced by the Ministry of Labour, family relationships have been put forward as the most common reason for moving to live in Finland in the period from 1990 to the present, for some 65 % to 70 % of all immigrants to Finland. Other reasons were given as being a refugee (15 %), seeking work (5-10 %) and being a returnee from the area of the former Soviet Union (10 %). The Ministry of Labour has estimated that immigration which is based on work opportunities is currently less than 10 % of all immigration to Finland. (Government survey, Outlook on the Future 2004) Although there is an increase in the number of foreign nationals who live permanently in Finland, this does not show as an increase in the employment figures. It is estimated that of those foreign nationals who live permanently in Finland some 50,100 or 47 % were in employment (the Ministry of Labour 2004). Unemployment amongst these people has remained high (in 2004 the figure was approx. 28 %) (The Government Immigration Policy) Mobility of labour in the health care sector The cross border mobility of labour can be explained, according to various studies (e.g. van Eyck, K 2003), by a number of pulling factors in the target country and pushing factors in the source country. The pulling factors are those characteristics which make the target country attractive and which lead to a decision to move. For example a higher level of pay, better prospects of employment, good working conditions, peaceful political and social environment in the target country, and in addition, a safety net of immigrants who have already moved to that country, represent such pulling factors. On the other hand, the pushing factors consist of characteristics prevalent in the source country and which strengthen the decision to leave. Political instability and ethnic insecurity, high levels of unemployment, low wages, violence, poor working conditions, lack of opportunity for professional development or for career advancement, the absence of the possibility of any participation in decision making and a lack of support by management, are all examples of the pushing factors. These pulling and pushing factors influence the mobility of labour in, amongst others, the health care sector. There exists at present a global shortage of labour within the health care sector. The reasons for this differ in the Western world from those in the developing countries. In Europe and in North-America, the ageing of the population is causing a double problem as an ageing workforce is having to take care of a 12

13 growing number of old people. This problem also exists in Finland. In the poorer countries, and particularly in those in Africa, one of the reasons for the labour shortage is that of HIV/AIDS, which on the one hand increases the demand for care whilst on the other it threatens the health of the carers. Low pay, poor working conditions and pressure at work are additional reasons why workers in the health care sector in the developing countries decide to leave. The removal of the obstacles to free labour mobility has made it easier for the workforce to move from one country or continent to another. At present in the health care sector a large-scale recruitment of workers, from the developing countries to the industrialised countries is taking place. Public Services International (PSI) has drafted ethical principles for the recruitment of workers to the health care sector. These guidelines state for example that emigration is a human right, but that any decision for emigration should be made by comparing equal employment in the person s own country and should be based on the correct information on employment opportunities in the country of destination. An additional requirement is that the terms and conditions of employment in the health care sector in the worker s own country must be sufficient, and emigration must not be used as an aid for cutting the necessary funding of public services. (What is Ethical Recruitment?) Further details of these ethical principles are available at the PSI campaign pages Agreements which concern health care professionals The European Union (EU) The key orders concerning the free movement of health care professionals within the area of the European Union (EU) and the European Economic Area (EEA) are recorded in the basic agreements of the EU and stated in five special directives on the training, degree certificates and the right to professional practice of a physician, dentist, head dispenser, nurse and midwife. ( The general directive on the minimum of three years of professional higher training is applied to other health care professions. At present a new directive on professional qualifications is being drafted for the EU. The directives regulate the recognition of professional qualifications based on degrees. The degrees must meet the minimum requirements stated in directives, even though strict equivalence is not required in different member countries. The National Authority for Medicolegal Affairs is a competent authority in matters concerning the right to practise a profession by citizens of EU and EEA states. In order to be able to commence work in Finland as a health care professional who has qualified abroad in any one of the EU/EEA states, an application for 13

14 the right to practise a profession in Finland must be submitted to the National Authority for Medicolegal Affairs (TEO). A certificate of a valid licence to practise as a health care professional in the EU country from where the applicant has come must be included in the application together with a certificate which shows that the qualification fulfils the requirements of the relevant EU directives. A language skill certificate by a state authority is not required for a licence nor for permission to use a protected occupational title. However, an employer (for example a health care centre or a hospital) may require a certificate of language skills. ( The Nordic Agreement The agreement on the joint Nordic labour market (SoPS 2/1994) came into effect at the beginning of the year The agreement has been made in compliance with EU directives. The agreement concerns the following occupations in health care: physician, dentist, nurse, physiotherapist, occupational therapist, midwife, public health nurse, psychologist, pharmacist, radiographer, practical mental nurse, dental hygienist, dental assistant, dental technician, practical nurse, practical nurse for social and health care, chiropractor, medical laboratory technician. ( The qualifications for the above mentioned professions are similar in the various Nordic countries and cross-border approval of these was reached between the Nordic countries during the drafting of the agreement. As a result the agreement is applicable to the practitioners of the said professions, and where the right to practise a profession is granted in one Nordic country the corresponding right may be granted in any other of the countries which are party to the agreement. This agreement is applied to professionals who are citizens of Iceland, Norway, Sweden, Finland or Denmark. Those who come from outside the EU/EEA states A health care professional who comes from outside the area of the EU/EEA may be granted a licence to practise their particular profession or be granted the right to use a protected occupational title if the training which they have received corresponds with Finnish training. Such licences and rights are granted by the National Authority for Medicolegal Affairs (TEO). In principle, any training which has been undertaken outside the EU/EEA states will be directly compared to current Finnish training. The Finnish Health and Social Care Professionals Act (559/1994) decrees that a sufficiency of language skills are required from those who come from a country which is not an EU/EEA member state (but not required from the citizens of 14

15 an EU country). The language skill requirements are similar, for example, for both doctors and nurses. According to TEO, attendance for further training in Finland, in a college where tuition is given in Finnish, will count as sufficient proof of language skills for a nurse. Finnish language tuition is usually included in such studies. Where a nursing qualification which has been obtained abroad is acceptable in Finland without any further training, the nurse must provide a certificate of sufficient language skills prior to a licence to practise in the profession being granted. (TEO) In order to clarify the equivalence of training, an applicant who comes from outside the EU/EEA states may either directly contact a university or college which provides training to the profession in question or contact the National Authority for Medicolegal Affairs. Further information can be found on the website of the National Authority for Medicolegal Affairs Language requirements for work Over 90 % of the population in Finland possess Finnish as their mother tongue whilst around 5 % possess Swedish. The requirement of sufficient language skills is considered to be particularly important for working in the health care sector. However, for those who come from an EU/EEA state there is no official language skill requirement as a prerequisite for a licence to practise as a health care professional nor for being granted the right to use a protected occupational title. Nevertheless, sufficient language skills are required from those who come from outside the EU/EEA states (and who are not EU citizens). In addition, an employer (for example a health care centre or a hospital) may require a certificate of language skills. ( These language skill requirements are supported by the Finnish Constitution, by the Language Act and by the Act on the Status and Rights of the Patient, and also by the obligations which are laid down by the Public Health Act and the Special Nursing Act. These regulations place particular requirements on health care professionals who come to Finland from elsewhere. The Finnish Constitution (731/1999) states that every person has an equal status in law (6 ). No person should be treated differently from another on the basis of sex, age, origins, language, religion, beliefs, opinions, state of health, disability or any other personal attribute. It is stated in Paragraph 17 of the Constitution, that the national languages of Finland shall be Finnish and Swedish. The law guarantees the Sami as the indigenous people of Lapland, those of Romany origin and some other groups, the right to maintain and to develop their own languages and culture. It is also stated in the Language Act ( /423) that Finnish and Swedish 15

16 are the national languages of Finland. Individual and merged municipalities are both obliged to provide health care and nursing services in both the Finnish and Swedish languages as is decreed in the Public Health Act (66/1972) and the Special Nursing Act (1062/1989). The Act on the Status and Rights of the Patient (785/1992) stipulates that it is an entitlement of the patient to receive good quality health care and nursing. The patient must be cared for and treated in such a manner which does not violate their human dignity, beliefs or privacy. The mother tongue of the patient, along with their personal needs and culture, must be taken into account as far as is possible in all health care and treatment. The employer may request an employee to provide a certificate of language skills. In the municipal sector the employee will receive, if they are expected to use both Finnish and Swedish, or Sami or sign language at work, an extra language payment which is in addition to the regular salary unless the requirement of a knowledge of languages was taken into account when the salary or wage for the particular job was calculated (the Municipal Sector Collective Agreement KVTES, Paragraph 9 of the Chapter on Pay). 16

17 2.2.2 Foreign health care professionals in Finland The percentage of foreign nationals working in the health care and social services sector in Finland is very low. According to employment statistics provided by the Centre for Statistics, it is in the region of only 2.3 %. See Figure 1. Figure 1. Employment status and sector in 2001 of foreign nationals who had moved to Finland during the period Total 124,000 Unemployed 12,2 % Social services 1,4 % Employed, other 24,0 % Other (at home, student, etc) 61,5 % Health care services 0,9 % Source: Centre for Statistics, Stakes Information In order to conduct the supervisory duties which it is legally obliged to undertake (the Health Care Professionals Act 559/1994), the National Authority for Medicolegal Affairs (TEO) maintains a central register of health care professionals (TERHIKKI), which contains information on over 300,000 health care professionals and with reference to their right to practise. Those foreign nationals who have obtained their qualifications abroad and to whom the National Authority for Medicolegal Affairs (TEO) has granted a licence to practise as a health care professional or to whom it has granted the right to use a particular professional title In Finland are entered in this register. At the end of May 2005 there were 1358 such foreign nationals in the TEO register. Of this number, 165 were members of the nursing personnel and the remainder consisted of physicians and dentists. See Table 2. 17

18 Table 2. The number in Finland, on 30th May 2005, of health care professionals who had qualified abroad. Source: TEO Occupation Finnish national Foreign national Total Doctors 579 1,029 1,608 Dentists Nurses Midwives Public health nurses Medical laboratory technicians Physiotherapists Dental hygienists Radiographers Paediatric nurses Practical nurses Dental assistants Practical mental nurses Total 997 1,358 2,355 On 1st May 2004 ten new member states joined the European Union. Estonia was one of these new members. Finland attempts to curb access to the labour market by nationals of the new member states by particular transition period legislation (309/2004). However, when the numbers for the years 2003 and 2004 of health care professionals, who have qualified abroad, are examined, it becomes evident that there is a slight growth despite the legislation regarding the transition period. The increase from the previous year is, according to TEO, almost entirely due to the growing number of those from Estonia. Most of the health care professionals who emigrate to Finland are nurses. Their country of origin is most frequently Estonia, with Sweden in second place. Other than nurses, health care personnel usually emigrate as single individuals. The nationalities of those health care professionals who had obtained their qualifications abroad, has not been considered in the following Table 3. 18

19 Table 3. Numbers of health care professionals in with qualifications obtained abroad. Nationality not taken into account. Source: TEO Occupation The most common countries Doctors Estonia, Sweden, Germany Dentists Estonia, Sweden Nurses Estonia, Sweden, Norway Midwives 5 0 Public health nurses 1 1 Switzerland Medical laboratory technicians 0 1 France Physiotherapists 6 5 Sweden, Spain, Switzerland, Australia Practical nurses 3 7 Sweden Dental assistants 0 1 Germany Practical mental nurses 1 4 Sweden Total Finnish health care professionals abroad According to statistics drawn up by Stakes (Ailasmaa 2004) there are some 10,500 Finnish health care professionals living abroad. Of these some 9,100 are of working age, i.e. less than 63 years of age. In this group there are some 4,400 working age nurses and health care professionals who are qualified at the same level as nurses (for example midwives, public health nurses, radiographers, etc). The largest group consists of nurses, of whom there are some 3,300. See Figure 2. 19

20 Figure 2. Finnish health care professionals abroad in Working age All lääkäri sairhoit muut doctors nurses (or similar) other health care professionals Stakes Info 2004 Stakes Info 2004, Register of Health Care Professionals It has often been suggested in discussions that this emigrant Finnish workforce should be brought back to Finland. However, it should be remembered that amongst this group there are those who emigrated a long time ago and therefore their return to Finland is unlikely, for example for family reasons. On the other hand, a person is not obliged to give any reason for emigration, therefore it is not known how many of those who have emigrated from Finland are working in the health care sector and are maintaining their professional skills by means of their work. According to the most recent statistics, the number of those returning to Finland from abroad seems to have increased. See Figure 3. 20

21 Figure 3. Finnish health care professionals of working age (under 62 years of age) emigration in Departure from Finland lääkärit sairhoitajat (tai vast) muut terv.huollon ammattilaiset Return to Finland Stakes Info 2004 doctor nurse (or similar) other Stakes Info 2004, Register of Health Care Professionals 2.3. As an immigrant in Finland Some of the legislation and the regulations which affect the status and rights of the immigrant in Finland are presented in this section The Foreign Nationals Act According to Paragraph 9.4 of the Finnish Constitution, the right of any foreign national to enter and stay in Finland is governed by legislation. A new Foreign Nationals Act (301/2004) came into effect on 1st May This stipulates that in order to take up employment in Finland, any foreign national who comes from outside the EU and EEA countries must be the possessor of a work and residence permit. This is granted by means of a process which consists of two levels. Firstly the Labour Force Office considers whether or not there are Finnish nationals available for any particular work and in addition it ensures that the terms and conditions of work, which are offered, are sufficient. If there is a positive decision, the Office for Alien Affairs will grant a residence permit. The essential terms and conditions of work for any foreign employee are determined by the legislation which is in effect in Finland. This legislation governs employment, including those cases whereby a foreign employer sends 21

22 an employee to Finland on a temporary basis. It is mainly the duty of the health and safety authorities, and to some extent that of the trade unions and the employers federations, to ensure that the minimum terms and conditions of employment are honoured. In order to make it easier to control the terms and conditions of employment for the migrant workforce, Tehy has signed two cooperation agreements which bind the union to a reciprocal union membership and to the exchange of information. The first agreement was signed in 1998 with UNISON, the largest public sector union in the UK, and another agreement was signed in 2004 with ENA, the Estonian Union of Nurses The Immigrant Integration Act The Act on the integration of immigrants and the reception of asylum seekers (493/1999) came into effect in May This law has been amended several times since the year The most recent amendment, which mainly concerns the status of asylum seekers, came into effect on 10th June In this context, integration means the individual development of the immigrant towards the goal of being able to participate in the world of work and society whilst retaining their own language and culture. This goal covers all longterm immigrants to Finland. In the Immigrant Integration Act there are listed individual actions which have been drawn up particularly to support those immigrants who are unemployed or who otherwise require the help of the social service network. All immigrants are entitled to an integration plan, for a period of three years from their arrival, if they are unemployed job-seekers who are entitled to a labour market benefit and/or to a social security benefit. However, the municipalities are not directly obliged to provide integration nor to draw up integration plans for those immigrants who are unemployable and this is regarded as a defect in this legislation. (The Ministry of Labour 2004) These personal integration actions do not in general cover those immigrants who either have employment when they arrive or who are entrepreneurs, and their family members are similarly not covered. This legislation affects a foreign national who has come to Finland on the basis of a particular job, or possibly to join a family member, only in the case of them becoming unemployed. First and foremost it is the duty of the employer to support the employee in gaining the knowledge and skills which are necessary for successful employment. However, it is to the advantage of society as a whole that the immigrant who is working in the country becomes well integrated with the surrounding people and life, and therefore the integration of those who are in employment should also be considered. 22

23 2.3.3 The Equality Act A new Equality Act (21/2004) came into effect on 1st February This legislation forbids any discrimination which is based on age, ethnic or national origin, nationality, language, religion, beliefs, opinions, state of health, disability, sexual orientation or on any other personal characteristic. This law also forbids any direct or indirect discrimination, harassment and any instructions or orders to discriminate against a person. This legislation is to be applied to the principles for employment, terms and conditions of work, career development, training, and to the conditions and the support for entrepreneurship. In addition it is applied to being a member of a trade union or to an employers federation and to participation in the activities of such organisations. The enforcement of this legislation is the duty of those authorities which govern health and safety issues at work, of the minority representatives and of the anti-discrimination board Regulations on workforce mobility within the European Union Entry into a country and the right of residence as far as EU nationals are concerned, is at present governed by a very complicated set of regulations, which consist of two separate statutes and as many as nine directives. However, the aim is to create a common immigration strategy for the whole of the European Union. This is a difficult task because the various member states have widely differing traditions, focal points, structures and rates of employment. A target was set in Lisbon in the year 2000 for the EU to be developed into the most competitive and dynamic knowledge-based economy in the world by the year 2010 (the Lisbon European Council on 23rd and 24th March 2000). This requires measures to be taken in order to improve workforce mobility. Draft directives on the free movement of services (COM (2004) 2) and on the approval of professional qualifications (COM(2004) 317 final) and the directive 2004/38/EC on the right of EU nationals and of their family members to move and to stay freely in the area of the member states, represent some of these measures. Current legislation enables a fairly uncontrolled use of a short-term temporary workforce, which is a very doubtful practice for the health care sector. Short term contracts and the constant change of personnel presents major risks to the quality of care and of in-patient safety, despite the fact that these employees are required to be fully qualified professionals. The regulations governing the free movement of people will be applied in Finland to the nationals of the new EU member states only following the socalled transition period (309/2004). The aim of the transition period legislation 23

24 is to limit the access of the nationals of the new member states to the Finnish labour market. This transition period commenced on 1st May 2004 and will last for two years. After this period the Commission will review the situation, at which time the old member states may either decide to apply the community rules on the nationals of the new member states or to continue to apply their own national rules for a further three years. Even after the expiry of the extended transition period it will be possible in some cases to continue adhering to the transition rules for yet a further two years. The immigration rights of third country nationals will be based on national regulations. According to the Schengen agreement, a visa for a stay exceeding three months may be granted in the various member states according to their national legislation. The Commission released a communique on the social programme in It advocates that the year 2006 will be the year of workforce mobility in Europe. It is the aim of the Commission to make such mobility easier, and to this end there is a plan for the development of employment exchange services and for the simplification of the social security systems in order to make coordination easier. In addition, there are plans for making the approval of qualifications obtained abroad simpler and easier, which on the other hand causes one to wonder whether the level of requirements is being lowered in order to increase mobility and to make it less complicated. The social programme also contains the idea of making cross-border negotiations less difficult Wages, salaries and level of earnings in the EU The introduction of the single currency in the EMU countries together with the free movement of labour within the European Union are both factors which have caused increased interest in the differences in pay in the EU area. The single currency has of course made these differences in the levels of pay more noticeable than has been the case hitherto. However, international (and in particular, European) pay comparisons between the equivalent categories of health care personnel are difficult to make because of the lack of harmonised statistics on wages and salaries. The Statistical Office of the European Communities, Eurostat, is currently developing comparable pay statistics which will, for example, make it possible to compare the wages and salaries of health care personnel in different countries. Nevertheless, this work has not yet been completed. Although difference in pay is neither the only, nor the most significant, reason for workforce migration, it still counts as an important factor in any decision on location by both the employees and the employers. 24

25 The average pay in Finland is, using most methods of calculation, close to the average EU level. Differences in pay are small in Finland, and as mentioned, the level of pay is more or less average, and as a consequence of this the lowest pay in Finland is relatively high, whilst the highest salaries are clearly lower than in most other EU countries. If taxation and the cost of living are taken into the equation, the average pay level in Finland goes down, although it is estimated that the standard of public services increases the purchasing power of the Finnish employee in general. (Moisala 2004) The immigration policy programme of the Finnish Government An immigration policy programme which follows the Government agenda has been drafted by a working group consisting of a number of civil servants with County Governor Rauni Saari in the chair. The first draft that was produced by the working group was widely circulated with the object of getting various points of view (120 statements of opinion were presented). The trade union views were delivered by the three central organisations of trade unions (SAK - the Central Organisation of Finnish Trade Unions; STTK the Finnish Confederation of Salaried Employees; and Akava - the Confederation of Unions for Academic Professionals in Finland). In December 2005 the working group presented its proposal to the Labour Minister, Ms Filatov, who was the leader of the ministerial immigration policy group. The new proposal contained 35 different policy guidelines. The central themes of the programme are, for example, being prepared for the recruitment problems which are likely to arise in the not too distant future by developing employment driven immigration, creating a guidance system, making the integration guidance system more efficient, improving relations between the various groups of the indigenous population and the different ethnic groups, and ensuring that Finland will continue to be able in the future to fulfil its humanitarian and other international commitments. However, the main focus of this programme is on the development of employment driven immigration. The working group proposes that for the implementation of the immigration policy programme a particular implementation programme will be drafted. This implementation programme would contain an assessment of the costs which will be incurred by the implementation of the policy programme as well as the division of such costs, the authorities responsible, cooperation partners and the forms of cooperation. The timing of the implementation of the various measures would also be defined in the implementation programme. (The proposal for Government Immigration Policy Programme by the working group) 25

26 2.4 Multiculturalism within Tehy The measures which Tehy has taken in its endeavours to increase tolerance, solidarity and multiculturalism in its activities are presented in this section The Tehy development cooperation projects and training in internationalism Supporting the developing trade unions has been one of the core values of Tehy ever since a decision to this effect was made at the first meeting of the Tehy Executive Council in Following this decision by the Executive Council, the Tehy Development Cooperation Fund was established, and this has since been replenished by means of national fund raising. Tehy started by giving one-off aid in the form of goods and materials, but progressed gradually into providing occupational training. This was later followed with support for the strengthening of trade union activities. Improvements, both in the status of women and in health through training has become the core idea. The target countries for the receipt of aid have been Tanzania, Nicaragua, Estonia, Latvia, Lithuania, Bosnia-Herzegovina, Brazil and Kosovo. Projects are still continuing in these last two countries. The Finnish Ministry of Foreign Affairs has granted supporting funding for all of these projects. (Tammisto 2002) Tehy has been partly responsible for the funding of each project and for this reason Tehy has been obliged to organise fund raising. The union as an organisation and its active members have carried a huge responsibility on their shoulders. In connection with fund raising Tehy has endeavoured to give information on the target countries, on living conditions there and on everyday realities. Articles in the Tehy journal, series of slides, campaign materials and fund raising functions in different localities have been the most important methods of providing information on the development cooperation issues to the membership of the union. The activities were given an extra boost with a musical theme The Waves of Tunes, and with an art competition and an associated campaign Healthy Peace, which for Tehy meant practical work for peace instead of marches. The most important aim has been to learn to understand differences and as a result, to be able to prevent misunderstanding and conflict. In order to get closer to this aim, Tehy has been actively involved in the Doctors against Nuclear War movement in the health care sector activities. (Tammisto 2002) Tehy members have also been willing to help in more concrete ways. The Tehy Journal organised a reader survey in the late 1980 s and this revealed 26

27 that there were numerous members who were willing to move abroad. The desire to become involved in development cooperation was stated as being the most popular reason for leaving the country. Only a few though, have had the opportunity or the necessary skills for making such wishes materialise. However, as Tehy was aware that many members had moved abroad, and had done so for various reasons, it was decided in 1990 to hold a writing competition on this topic and in this way to collect together the members experiences of working abroad. These experiences, which are an important element in the international tradition and knowledge of the members, were made into a book which was entitled Improving the World. (Tammisto 2002) Tehy and EU projects The role of the European Social Fund (ESF) is to assist in the prevention of unemployment, to advance the professional skills of the workforce and to give support to the workforce and to companies in their endeavours to meet new challenges in the world of work. Funding is provided through the European Social Fund to projects which help to reach the goals defined in the ESF programmes. Tehy has participated in several ESF projects and three of these are described below. The aim of the PETMO project is to promote equality in the world of work and in particular the acceptance of difference and multiculturalism at the workplace. PETMO is an EU European Social Fund project which is funded through the Equal Community Initiative Programme. The focus of the Petmo project is on training and information, and the aim of the project is to generate competence and special skills at the workplace, to develop diversity and to promote mutual multicultural understanding. Improvements in the employment opportunities of immigrants is another aim. A training programme for a diversity counsellor will be drawn up during the project, with the aim of this training programme being suitable for workplaces in general and not exclusively for those 17 workplaces which are participating in the project. The project will be continued until April 2007, SAK, the Central Organisation of Finnish Trade Unions, being the project administrator. Tehy is one of the 12 Development Partnerships which participate in the Petmo project. ( Equality in Health is an international EU-funded project ( ). Its aim is to create a reliable tool for health care workplaces which can be used to reveal possible cases of discrimination at the workplace or in the allocation of services. Various organisations and institutions which deal with immigrants, along with specialists, are brought together under this project in Italy, Greece and Finland. The project as a whole is coordinated by UEHR, the Research 27

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