How heavy and unhealthy work will be implemented in the NHS

This measure aims to address a social security inequality that has existed for years within the National Health System (ESY) and EKAΒ: employees performing exactly the same duties, under the same conditions, had different insurance statuses depending on when they were hired.

Employees classified under the Heavy and Arduous Work (BAE) category will be eligible for full retirement up to five years earlier, while there is also a provision for the buyback of prior insurance periods, which will be considered actual rather than fictitious time.

Government sources present the measure as “restoring justice” for frontline staff in the public health system, noting that the measure has already been budgeted for. However, almost immediately after the announcements, a new wave of opposition emerged from professional groups excluded from the announcement, even though—as they argue—they are included in the Behrakis Committee’s findings.

At the center of the controversy lies the report of the Special Committee on the Assessment of Hazardous and Arduous Occupations (BAE), chaired by Professor Panagiotis Behrakis, which was drafted in 2020, in the midst of the pandemic. The committee was established by the Ministry of Labor to evaluate healthcare professions for inclusion in the VAE system and, according to its findings, recommended a broader expansion of the scheme. In addition to nurses and ambulance crews, the findings reportedly include:

• physical therapists in public hospitals,
• paramedical professions,
• paramedics,
• ward assistants,
• technical staff,
• cleaning staff,
• and even doctors in specific cases of occupational risk exposure.

It is precisely this point that both the Panhellenic Federation of Public Hospital Employees and the Panhellenic Association of Physical Therapists are citing today, arguing that the government is implementing only part of the report’s findings.

The Panhellenic Association of Physical Therapists has strongly protested the exclusion of National Health System (ESY) physical therapists from the regulation. The Association points out that approximately 650 physical therapists from public hospitals are included on the well-known “Behrakis list” and directly asks what institutional criteria are used to select only certain categories of workers. PSF President Petros Lyberidis speaks of a “selective application” of the same findings and argues that physical therapists work under the same conditions as other healthcare workers classified as performing arduous and hazardous work (BAE). In their argument, physical therapists cite not only the Behrakis report but also the fundamental principle of equal treatment for workers who are now covered by the same social security agency, e-EFKA.

POEDIN is on the same page, characterizing the government’s announcement as positive, yet arguing that it leaves out “thousands of workers” who are already recognized as VAE under the regulations of the former IKA. The Federation points out that since 2011, many employees of the National Health System (ESY) and the National Ambulance Service (EKAV)—nurses, paramedical staff, technicians, cleaning staff, and other specialties—are already covered by the BAE, while their older colleagues remain excluded. According to POEDIN, the new regulation addresses only part of this inequality. At the same time, the Federation raises a critical issue regarding how the measure will be implemented: namely, whether the inclusion will be retroactive or whether employees will have to pay the hazardous work premium, which amounts to 3.45% of the pensionable salary.

This is not a minor issue, as establishing pension eligibility under the BAE scheme requires twelve years of participation in the program.

The government’s announcement

According to reports, the proposed regulation allows for full retirementup to five years earlier than the general age limits. For many employees of the National Health System (ESY) and the National Ambulance Service (EKAV), this means retirement even before the age of 62, provided that the required number of days and years of insurance under the BAE scheme are met.

At the same time, the regulation takes on particular significance for supplementary insurance as well , since—according to reports—for the first time there will be a unified approach to primary and supplementary insurance for these specific categories of employees.  

Another key element of the regulation is the possibility of recognizing and buying back prior insurance periods. According to reports, this time will be considered actual rather than fictitious, a distinction of particular significance for insurance purposes. In practice, this means that it will not be counted toward the maximum limit of fictitious years that an employee can recognize to establish pension eligibility. The buyback may be made either as a lump sum or in installments, through payment of the relevant premium.

This issue is not a technical detail, but a critical factor in determining eligibility for retirement. For an employee to establish the right to retire under the BAE scheme, many years of participation in the special insurance scheme are required—usually at least 12 years of BAE insurance. This is why the question of whether enrollment will be fully retroactive is of crucial importance.

The “opening” of the list

The controversy that has erupted brings back to the forefront the broader issue of how the State assesses occupational hazards in the workplace. The Behrakis report, like previous committees, did not treat hazardous occupations as a narrow list of specialties but as the result of an assessment of specific working conditions:

• exposure to biological agents,
• night work and shifts,
• manual strain,
• psychological stress,
• work-related accidents,
• and constant exposure to an unhealthy environment.

This is why professional bodies argue that a report based on uniform scientific criteria cannot be applied selectively.

The government currently appears to be opting for a targeted intervention with a limited fiscal impact, prioritizing nurses and ambulance crews.

Experts, in fact, point out that the basic philosophy of the BAE does not equate to the mere “hazardousness” of a profession. This is because hazardousness is primarily addressed through Health and Safety policies. In other words, preventive measures, medical monitoring, occupational risk assessment, and epidemiological surveillance are required. The BAE scheme should serve as a complementary measure, acting as an insurance mechanism to compensate for premature physical deterioration resulting from work that causes increased morbidity.