The methodology employed in crafting this national report is rooted in socio-legal analysis. It encompasses an examination of legal sources, collective agreements, case law, and pertinent literature within the domain of labour law to delineate the Italian legal and contractual landscape. In addition to this foundational research, insights crucial to understanding the pivotal role of discrimination, particularly concerning women and migrants in the care sector, were gleaned from questionnaires administered to Equality Counsellors. The responses to these questionnaires have been predominantly employed in drafting the report on the discrimination map (work package No. 3 of the CARE4CARE project), although they also played a role in this report’s section on discrimination. Furthermore, the completion of this report was made possible by the wealth of information gathered in preparation for and during the national meeting of Italian stakeholders held in Rome on 10 April 2024 and the European stakeholders meeting held in Brussels on 17 April 2024.3

Primarily focusing on collective agreements within the public and private care and health sectors, the report scrutinises the unique National Collective Labour Agreements (CCNLs) established by the most representative trade unions in the public sector. Meanwhile, in the private sector, a meticulous analysis was conducted, sifting through the archives of the National Economic and Labour Council (CNEL) to identify a selection of fifty contracts. These contracts were chosen based on specific criteria encompassing the rate of application, representativeness of the stipulating social partners, and the scope of facilities covered.

For home caregivers, sixteen collective agreements were identified and analysed. While numerous social partners have been involved in negotiating these agreements, some unions may lack representativeness, potentially indicating the presence of employers’ friendly or “yellow” union.4 Unfortunately, data regarding coverage is not readily available, highlighting an area for further investigation.

The elaboration of data pertaining to the labour market of various healthcare professionals, social and care workers, basic care workers, and home caregivers was meticulously undertaken, drawing from a range of reputable sources including the National Institute for Statistics (ISTAT), the Statistical Office of the European Union (EUROSTAT), and trade union organisations within the sector, among others.

In the domain of healthcare and social services organisation, the Constitutional reform of Title V, Part II, of the Constitution — Constitutional Law No. 3 of 18 October 2001 — affirmed and constitutionally endorsed the decision made in the 1990s to transition towards regionalising the national healthcare system (NHS). Central to this reform is the principle of subsidiarity and proximity, aiming to establish a decentralised system closely attuned to citizens’ needs (see Section 7.4).5

The amendments introduced by Constitutional Law No. 3 of 18 October 2001, address both the horizontal and vertical coordination of legislative functions in the healthcare sector.6

Regarding horizontal legislative coordination, the reform broadened the scope of regional legislative competences, replacing the original reference to “health and hospital care” with the “protection of health”, now classified among the subjects of concurrent legislation in Article 117(3) of the Constitution. The Constitutional Court emphasised that this is a significantly broader range of matters than the previous framework of competences. It includes organisational and management aspects of regional healthcare, allowing for potential differentiation while respecting the fundamental principles established by national legislation. In particular, it does not provide for a separate jurisdictional area devoted exclusively to the “health organisation” of residual regional competence. On the contrary, it encompasses various aspects such as the organisation of pharmaceutical services, the assessment of the appropriateness of therapeutic practices and the regulation of qualifications for health professionals, extending also to veterinary health.7

Concerning vertical legislative coordination, the constitutional reform has not reduced the role of the state legislature. Health protection remains a concurrent legislative matter, with the state responsible for defining the fundamental principles and the regions in charge of detailed regulation. Moreover, the State retains the exclusive competence to ensure “uniformity” in the determination of the essential levels of services pursuant to Article 117(2)(m). It retains the power to enforce effectiveness, using the power of substitution under Article 120(2). However, the state also retains a co-legislative role in various areas that intersect with health protection, complicating efforts to delineate state and regional competences.8

In the Italian legal system, there is no unitary legal notion of care sector and care worker, but there are different forms of care work with autonomous disciplines. These forms of care work share the functional characteristic of providing personal and/or healthcare to people with disabilities, elderly, sick and children. Following the Consortium’s choice on the target of the study, the report excludes consideration of the remaining childcare providers and medical practitioners, concentrating exclusively on care workers possessing qualifications spanning from low to medium levels.

This report considers four types of care workers:

1) Health professionals with at most a Bachelor’s degree.

2) Social and care workers.

3) Basic care workers.

4) Home caregivers.

Each of these four categories corresponds to professions that are autonomously regulated in the Italian legal system.

1) Health professionals with at most a Bachelor’s degree encompass nurses, midwives, healthcare and rehabilitation technicians who obtained their professional qualification after a bachelor’s degree.

2) Social and care workers are a category that corresponds to social and health workers (operatore socio-sanitario or OSS) who have obtained the qualification through a course accredited by public bodies, which requires a secondary school diploma.

3) Basic care workers correspond in Italian law to social assistance workers (operatore socio-assistenziale or OSA) who perform low-complexity and varied care tasks and are involved in personal care, domestic help and hygiene/health services.

Italian legislation is highly fragmented, particularly concerning the professional roles of Social and Care Workers and Basic Care Workers.10 The decentralisation of responsibility to the regions within the healthcare sector has resulted in a proliferation of models and methodologies for recognising these professional roles, which often have varying designations across regions.11 The required training is not standardised nationally but instead determined at the regional level, leading to a wide disparity in the number of training hours. Additionally, national regulations in the healthcare sector suggest that the role of Basic Care Workers (OSA) should no longer be employed in the public sector, yet it continues to be prevalent in the private sector.12

4) Finally, home caregivers (assistenti domiciliari, or badanti) are a category that the law and collective agreements assimilate to domestic workers, albeit they specifically take care of elderly, sick or dependent persons without a specific qualification.

Health professionals with at most a Bachelor’s degree is a broad category encompassing nurses, midwives, healthcare, and rehabilitation technicians who obtained their professional qualification after a three-year degree.13 The nurse and midwife profession has been fully reformed since the 1990s.14 The profession of nurse and midwife requires a Bachelor’s degree that qualifies the holder to exercise the profession after registration in the professional register.15

The activities carried out by nurses vary in nature: taking charge of patients, planning care services, providing care and health services, evaluating, and monitoring the impact of care activities, promoting and educating patients and the community on health and prevention, participating in patient management training and courses, and supporting medical staff.16

Nurses and midwives can work both in public sector institutions such as local health authorities, hospitals, elderly care facilities and public care facilities; and in private sector institutions such as private clinics, large companies, and private elderly care facilities. Furthermore, health professionals may be employed under a subordinate contract or be self-employed (see subsection 2.6).

In their work, health professionals are constantly in contact with illness and suffering and must offer emotional support while managing their own personal involvement. The health professional working in health care facilities has a fixed work schedule or works in shifts. Generally, the health professional works as part of a team coordinated by a qualified nursing coordinator. A health professional working in a public facility is hired after passing a public competition based on qualifications and examinations. The most common employment contract in public facilities is a permanent subordinate contract. Conversely, a health professional working in a private facility may be employed with a fixed-term or permanent employment contract with the only requirement of professional qualification (cf. subsection 2.6). In home care, the health professional is normally self-employed following the instructions of the general practitioner and working predominantly alone.17

In the exercise of their profession, health professionals are bound by the code of ethics drawn up by the FNOPI, which maintains the professional register.18

Social and care workers are workers who have qualified through a publicly accredited course, which requires a high school diploma. In the Italian system this category corresponds to that of social and health workers (operatore socio-sanitario or OSS), to specialised social and health workers (operatore socio sanitario specializzato or OSSS) technical care operator (operatore tecnico addetto all’assistenza or OTA). These figures do not exist in all regional health regulations, some only regulate social and health workers.

An agreement between the Minister of Health, the Minister of Social Solidarity and the Regions and Autonomous Provinces of Trento and Bolzano, as well as Article 5 of Law No. 3 of 11 January 2018, constitute the fundamental regulations for these professions. The figure of the (specialised) social and health worker has progressively absorbed some previous figures that dealt with health care – such as basic and specialised assistants –19 and social assistance – such as socio-sanitary assistants –20 integrating the functions, tasks, and skills of the two areas into a single role.21 The same process occurred for technical assistance workers who reabsorbed the former technical assistance figures.

Social and care workers can be hired as an employee or as a self-employed person both in public and private facilities. If working directly for a public body, he/she needs to pass a competition based on qualifications and examinations in order to be recruited. Law No. 3 of 11 January 2018 officially established the social and health professions under which social and care workers are covered. The legislation of the Regions and Autonomous Provinces may, in a supplementary manner, establish further provisions on the training paths and tasks of these workers.

The social and care workers carry out basic care activities, collaborating and assisting healthcare professionals. These workers carry out activities that help people meet their basic needs: feeding, personal hygiene, activities aimed at recovery and mobilisation, and stretcher transport. They monitor vital signs, carry out minor medication, assist in the administration of oral therapy, transport biological materials, and prepare materials for sterilisation.22

The Regions and Autonomous Provinces are responsible for training; the certificate of professional qualification is awarded at the end of a training course lasting approximately 1,000 hours: 450 hours of theory, 100 hours of exercises and 450 hours of apprenticeship, including a final exam.23

Basic care workers are professionals who perform varied and low-complexity care tasks and are responsible for personal care, domestic assistance, and hygiene services. This category includes social assistance worker (operatore socio-assistenziale or OSA), social assistance auxiliaries (ausiliario socio assistenziale or ASA). These figures do not exist in all regional health regulations, some only regulate social assistance workers.

Basic care workers are established by the same agreement between the Minister for Health, the Minister for Social Solidarity and the Regions and Autonomous Provinces of Trento and Bolzano that introduced social and care workers, and by Law No. 3 of 11 January 2018. This professional figure was created in the reorganisation of previous professional figures related to social and care work (e.g., technical assistants or social assistants)24 and aims to promote the social and relational well-being of patients in their environment.25 Therefore, support is aimed at the social sphere to maintain or recover a person’s autonomy. 26

Basic care workers can be hired as an employee or as a self-employed person in public and private facilities. In the case that he/she works for a public facility, he/she needs to pass a competition based on qualifications and examinations in order to be recruited. In most cases, basic care workers operate in the field of care of dependent persons, persons with disabilities and patients (e.g. in retirement homes, residential communities for children with disabilities and for drug addicts, daycare centres for the elderly, kindergartens, and nursery schools).27

The figure has specific training and implements a direct intervention with the patient in order to promote the recovery of autonomy. Furthermore, the professional performs home care services for the elderly or people with disabilities. The training is regulated at the regional level and the professional qualification certificate is obtained at the end of a training course lasting between 700 and 900 hours with compulsory practical training and a final examination.28

The last category of care workers is that of home caregivers (assistenti domiciliari, or badanti),29 consisting of workers, without any qualifications, who take care of elderly, sick, dependent persons and persons with disabilities.30 The category of home caregivers under Italian law and collective agreements is that of domestic workers. However, the latter include not only home caregivers, but also housepersons, family assistants, baby-sitters, and housekeepers.31 For the purposes of this analysis only home caregivers are studied. Home caregivers are regulated by collective agreements and by Law No. 339 of 2 April 1958, which applies on a residual basis and only in cases where there is no collective agreement (see subsections 2.6, 6.2.1, 6.3.1, and 7.2.1).32

The domestic and home-care sector is shaped by three interrelated features:

1) Strong and uneven territorial differentiation.

2) The role of households.

3) The prevalence of monetary treatments.

These three elements have a significant impact on the services and working conditions of care workers.

The strong and uneven territorial differentiation has its roots in Italian regionalism.33 Indeed, according to Title V of the Constitution, regions and municipalities have the main responsibility in the administration of the welfare state.34 The disjointed development is the result of the proliferation of regional regulations and the delay in the definition of the essential levels of services (i.e. the framework regulation) by the government. From 2008 onwards, territorial disparities have been steadily increasing due to the curtailment of national funds for social policies, which then fell on local authorities.35 The latter has been subject to severe budgetary constraints that have had a negative impact on social benefits and working conditions. To overcome the territorial disparities, the Ministry of Labour and Social Policies has created several coordination instruments (e.g. Social Inclusion Protection Network, National Social Plan, Plan for Social Interventions and Services to Combat Poverty, Plan for Non-Self-sufficiency).36

A second characteristic that has a strong impact on care work is the role of households. The Italian welfare model is characterised by the heavy burden of care left to households that is first measure to cushion the effects of unemployment.37 In spite of the centrality of households in care work, Italy lacks a policy to support and promote this work. State intervention is essentially reparative and focuses on emergency conditions, while the family is left with the burden of maintaining care services through forms of paid care work, i.e., domestic work and paid homecare work.38 The economic burden on families is bound to increase as the number of elderly people rises. Italy is in fact the country with the highest number of elderly people in Europe.39 Until now, pension benefits have been largely used to pay for private care. However, the limited amounts of pensions are one of the factors pushing families to turn to cheaper undeclared work, often performed by undocumented migrants. Moreover, as Borelli points out, the increase in the number of poor elderly people suffering from senility-related40 diseases and living alone will have a negative impact in the medium to long term.

The third characteristic of Italian welfare is the prevalence of monetary treatments (i.e. do it yourself welfare).41 The Italian welfare system provides monetary transfers aimed at supporting, at least in part, care services; this circumstance has favoured the privatisation of care work without necessarily guaranteeing the regularity of labour relations.42 Regarding expenditure on financing care services, almost half of the public expenditure on long-term care concerns the accompanying allowance for dependent persons. This allowance is very modest in amount (527.16 euros per month in 2023) and is not subject to any constraints or controls on its use. Thus, this benefit is normally used to purchase paid home care services from dependent persons.43 Low public funding in the care sector acts as an incentive for the non-regular employment of migrant women. The most politically praised and widespread model of care services is the cash-for-care scheme.44 This model is fuelled by the prevalence of public monetary treatments and is politically well-regarded because it allows freedom of choice and public cost containment. However, this scheme displaces private individuals or rather families the cost of the care service feeding a vicious circle.

Article 29 (15–18) of Law No. 56 of 29 April 2024, which converts, with modifications, Decree-Law No. 19 of 2 March 2024, have introduced additional provisions regarding care work, particularly for home caregivers. The legislature aims to progressively enhance the quality and quantity of care and assistance services for elderly individuals who are not self-sufficient, and to regularise care work provided in their homes.

Starting from the date communicated by INPS upon the conclusion of admission procedures for funding under the National Program for Youth, Women, and Employment 2021–2027, and until 31 December 2025, employers hiring or converting domestic workers to indefinite contracts for assisting elderly individuals aged at least eighty years, already receiving the accompanying allowance, are granted a 100% exemption from total social security contributions and insurance premiums for up to 24 months. This exemption is capped at 3,000 euros annually, recalibrated and applied quarterly, while maintaining pension contribution rates.

Employers availing of this benefit must have a current Equivalent Economic Situation Indicator (ISEE)45 not exceeding 6,000.00 euros for facilitated socio-healthcare benefits.

Exceptions to this benefit include situations where less than 6 months have elapsed since the termination of a domestic work relationship with duties as an assistant to elderly individuals between the same worker and employer, or within the same household. Additionally, the benefit does not apply to the hiring of relatives or relatives by marriage, unless the employment concerns specific duties outlined in relevant legislation.

The contribution exemption is subject to maximum expenditure limits: 10 million euros for 2024, 39.9 million euros for 2025, 58.8 million euros for 2026, 27.9 million euros for 2027, and 0.6 million euros for 2028. These funds are allocated within the framework of the National Program for Youth, Women, and Employment 2021–2027, pending Program modifications and admission of the measure to funding, complying with applicable procedures, territorial constraints, and eligibility criteria.

INPS monitors the reduced contribution revenue pursuant to Article 29 (15–17) of Law No. 56 of 29 April 2024. If prospective data indicates the spending limit has been reached, INPS discontinues further applications for contribution relief.

Concerning the annual ISEE threshold of 6,000.00 euros established for eligibility for this contribution relief measure, it is noteworthy that this figure is exceptionally low. For instance, it falls below the threshold required to qualify for the inclusion allowance (set at 9,360.00 euros),46 which serves as a poverty alleviation measure. Moreover, according to ISTAT data, an ISEE of 6,000.00 euros per annum falls beneath the absolute poverty threshold, the benchmark employed in Italy for shaping public policy.47 Consequently, it can be inferred that the contribution relief measure will only benefit a small number of individuals who, in general, are unable to afford to hire a home caregiver.

In a 2019 report, the OECD and the European Commission’s European Observatory of Health Policies and Systems highlighted that Italy employs fewer healthcare professionals than most Western European countries. In 2019, there were 5.8 healthcare professionals per 1,000 inhabitants in Italy, in contrast to 8.5 in the EU. Furthermore, the number of healthcare professionals has been consistently declining; Italy had approximately 557,000 healthcare professionals in 2016, which decreased to about 456,000 by 2022. FNOPI estimates that Italy would need between 50,000 and 60,000 additional healthcare professionals to reach the EU average.48

During the Italian National Stakeholders Meeting, FNOPI, alongside labour unions and employers’ organisations, emphasised the issue of labour shortages.49 Within this context, several discussions emerged regarding the potential of technology to support healthcare and assistance personnel. The role of platforms as facilitators in matching users’ needs with nursing personnel was underlined. In this context, FNOPI stressed the ongoing debate surrounding the possible introduction and dissemination of the community nurse role, as outlined in the Health Pact (Patto per la salute), and legislated in Decree-Law No. 34 of May 19, 2020, subsequently converted into Law No. 77 of July 17, 2020 (Decreto Rilancio) 50

The main cause of these labour shortages has been the numerous turnover blocks introduced by legislation in order to contain public spending on healthcare.51 Alongside this phenomenon, a trend has emerged in the public health sector to outsource care services using forms of contracting and subcontracting to cooperatives and private companies. This trend is homogeneous throughout the country and concerns both health professionals, social and care workers, and basic care workers. There are two main reasons for this choice:

a) the decision to circumvent public recruitment competition procedures, and

b) the containment of personnel costs and NHS expenditure.

The pandemic crisis has forced a temporary change of course. The Decreto Rilancio, provided for the integration of the nursing workforce, initially with temporary contracts, then, from 2021, with permanent contracts.52 There is no evidence that this is a permanent change of policy.

Remuneration is a problematic area, because it is perceived by the workers as inadequate in relation to the growth and increased responsibilities and specialisations of the nursing profession.53 The collective agreements do not provide for management roles for health professionals.54 However, as evidenced by FNOPI, nursing staff are often entrusted with co-ordination roles. The OECD data show that in Italy the average salary of nursing staff is lower than that of the main European partners.55

Concerning distribution in the labour market, FNOPI reports that the vast majority of health professionals (more than 75%) work in hospital facilities. Approximately 14% of health professionals have a part-time contract, 98% of them are women. In 2021, there were approximately 37,000 freelance health professionals, while there were approximately 78,000 health professionals employed by private facilities.56

Regarding age, most health professionals are between 36 and 55 years old. Health professionals over 65 years of age with professional seniority of more than 30 years account for approximately 13,000, while those with no professional seniority of more than 30 years account for approximately 25,000. Health professionals up to 28 years of age number about 39,000. The average age of all health professionals in Italy is about 46 years, while that of civil servants alone is about 51 years with marked differences. In the Regions where the turnover block has been completed the age is markedly higher than in the others.57

Concerning geographical distribution, the largest number of health professionals is concentrated in the North-West regions. This is followed by the South, the Centre, the North-East and the Islands. This uneven distribution is partially explained on the basis of population, which is larger in the North than in the other areas of the country, and on the basis of remuneration, which is slightly higher in the Northern regions.58

According to FNOPI, female health professionals in Italy are about 76% distributed unevenly across the country. In the North-West female health professionals make up 83.83% of the total, while in the North-East they make up 83.28%. The peak of female health professionals is recorded in Trentino-Alto Adige/Süd Tirol with 86.39%. In the Centre, female health care professionals make up 77.64%, in the South 67.37% and in the Islands 64.38%, with Sardinia at 79.23% and Sicily with the lowest figure in Italy at 59.05%.59 Concerning the pay gap, female health professionals earn about 12.8% less than men considering all contracts (full time and part time); however, the gap drops to 2.6% if only full time contracts are considered.60

The pandemic has caused numerous victims especially among female health professionals. In fact, female health professionals account for 34% of the deaths recorded among Italian health professionals. A further issue concerns gender-based violence. According to FNOPI, about 180,000 health professionals have suffered violence in the workplace during their careers, 100,000 of these violences were physical assaults.61

Regarding social and care workers, data are fragmentary because there is no professional register. Trade unions estimate between 200 and 300,000 workers, 90% of whom are women.62 Trade unions indicate an average age of around 45 years.63 The age of the operators ranges from 30 to 60. There are no data available on Social and health workers employed in the private sector (scientific hospitalisation and care institutions or IRCCS, foundations, research institutions, private nursing homes) and in the public sector (prisons, schools, public health facilities), nor on self-employed workers. Furthermore, there is a lack of data on workers employed on a temporary or permanent basis during the COVID-19 pandemic.64 According to trade unions, social and care workers work a wide range of care duties with very heavy shifts, having to make up for shortages of nursing staff and being burdened with a plethora of tasks that are not provided for in contracts and for which they have no specific training.65 During the pandemic, social and care workers and basic care workers experienced a great deal of work-related stress, which led to a significant increase in burnout and occupational accidents and illnesses.

A cross-cutting issue for all healthcare professions (health professionals, social and care workers, primary care workers) working in residential facilities for the elderly, hospices, and long-stay wards, is that of standard costs imposed on the public budget.66 These standard costs refer to a predetermined number of working minutes per patient within which each operator is required to remain. There is a high variability of this minute allocation as it is established in an essentially uncoordinated manner by each Italian region. The allocation of a very low minute allocation for each operation results in a very high workload for healthcare workers and a negative impact on users’ health.67 NURSIND points out that the excessive emphasis on the standardisation and compression of working time has a negative impact on the quality of healthcare.68

According to data from the INPS Observatory on domestic workers, in 2022, the total number of domestic workers contributing to the INPS was 894,299, reflecting a decrease of 7.9% compared to 2021 (-76,548 workers).69 This decline follows increases in the previous years, driven by the regularisation of employment relationships to allow domestic workers to travel to work during lockdown periods and the entry into force of regulations governing the regularization of irregular employment relationships (Decree Law No. 34 of 19 May 2020). Similar phenomena were observed in the years following 2009 (Law, No. 102 of 03 august 2009) and up to 2012 (Legislative Decree No. 109 of 16 July 2012), during which regularization of workers, both EU and non-EU citizens, occurred.70

The data indicates the dual impact of the COVID-19 pandemic on the increase of domestic workers. The first effect is attributed to the containment measures, which restricted movement to those who could demonstrate a legitimate reason, such as having a regular employment relationship. The second effect, also related to the pandemic, is linked to the regularisation procedure for irregular immigrant workers initiated in 2020. This procedure focused on two sectors (agriculture and domestic work), attracting workers from other sectors as well and resulting in an overrepresentation of domestic work in the years immediately following regularization. With the easing of containment measures, many regularised workers shifted sectors, returning to their original fields.

Regarding gender and nationality, there are significant differences. The most pronounced decrease in 2022 was observed among foreign male workers (-21.1%), a group that had seen the most significant increase between 2019 and 2021 (+66.6%). Foreign women, despite a slight decrease in 2022 (-5.6%), remain dominant in the domestic sector, constituting 58.7% of the total. The second-largest group comprises Italian women, representing 27.8% of the total.

The category of home caregivers (assistenti domiciliari, or badanti) among domestic workers is more prevalent among nationals from Eastern European countries, such as Georgia (82.4%), Bulgaria (73.8%), Ukraine (65.7%), and Romania (63.0%). Among workers of Asian origin, the presence of caregivers is less significant, dropping below 20% for Bangladesh, the Philippines, and Pakistan.71

Specifically focusing on home caregivers, their average age is slightly higher (51.3 years) compared to other domestic workers (47 years). Moreover, the majority of caregivers are over 50 years old (62.2%), while only a small percentage are under 30 (4.9%). This demographic profile reflects the demanding nature of caregiving roles, often attracting older individuals with more experience.72

In terms of hours worked, home caregivers tend to work longer hours on average compared to other domestic workers. Only a small percentage of caregivers (6.1%) work less than 10 hours per week, with a significant portion (42.2%) working over 40 hours per week. This contrasts with the majority of other domestic workers who work fewer hours, with 84% of them working less than 30 hours per week.73

Italian home caregivers, a vital component of the caregiving sector in Italy, represent a noteworthy portion of the domestic workforce. While constituting a minority, their numbers are significant given Italy’s ageing population. Unlike foreign caregivers, Italian home caregivers display a diverse range of ages and backgrounds, reflecting various entry points into the profession. With approximately 48% of caregivers being Italian, they contribute substantially to meeting the care needs of families. Despite their local familiarity, Italian home caregivers face challenges such as long hours and low wages, with 42.9% working over 40 hours per week and 60% earning less than 6,000 euros annually.74

The level of undeclared work in the domestic sector remains a significant concern.75 The historical trend shows that the majority of domestic workers have been engaged in irregular employment relationships. While there have been efforts to reduce informality through regularisation measures, the sector still exhibits a high prevalence of undeclared work, with the current rate standing at 51.8% in 2021.76

The irregularities detected in the sector include, in addition to undeclared work, under-declared work (i.e. declared for fewer hours than those actually worked or according to a lower professional classification).77 In both cases, the worker receives all or part of the wages irregularly. The effect of these forms paying of irregular work is twofold: the employer saves on the cost of care (by not paying taxes and social security contributions and by paying a lower wage than that stipulated by collective agreements), the worker receives a payment on which he/she does not pay taxes and contributions.78

The reasons behind the recourse to irregular work stem from the combination of do-it-yourself welfare with the calculation of convenience on the part of workers. Households cut down on welfare costs and workers opt for immediate payments.79

Another problem reported in the analyses on domestic work is the scarcity of irregularity complaints by workers; they only turn to the authorities in cases of serious exploitation, and at the end of their working relationship. Although labour inspectors could carry out inspections at any time, it is very rare that checks on domestic work are carried out ex officio. Generally, the labour inspector intervenes upon a direct complaint from the worker.80

To promote the regularisation of domestic work, it has been suggested to increase the tax and social security benefits associated with this activity.81 Currently, anyone who regularly employs a domestic worker can, when making a tax declaration, deduct the amount of the sums paid quarterly to INPS as long as it does not exceed the threshold of 1,549.37 euros per year (Article 10(1)(e) and 10(2) Presidential Decree No. 917 of 22 December 1986). Moreover, the employer may also deduct from the gross tax the 19% of the expenses incurred for caregivers of dependent persons in the performance of daily life acts, up to a maximum amount of 2,100 euros per year, but only if the total income does not exceed 40,000 euros (Article 15(1)(i-septies) of Presidential Decree No. 917 of 22 December 1986).82

Trade union freedom is sanctioned by the first part of Article 39 of the Constitution, which guarantees immunity against the sanctioning power of the state and the employer.94 This article is a specification of the more general freedom of association guaranteed in Article 18 of the Constitution. The Constitution guarantees both freedom from interference in trade union activity and the freedom to act collectively. Trade union freedom is an individual right to collective exercise. The protection offered by the Constitution alone is not sufficient to guarantee the right to conduct a specific trade union activity that entails the immediate sacrifice of the employer’s reasons and requires ad hoc legislation to be exercised. This legislation is contained in Title II and Title III of Law No. 300 of 20 May 1970 (Statute of Workers).95

Title II of the Statute of Workers (Articles 14–18) regulates freedom of association and unionisation.

Title III (Articles 19 to 27) provides for support legislation that aims to promote trade union activity in the workplace and enable trade unions to effectively protect workers. Promotion and support are used by the legislator in a “selective” manner, and therefore this legislation is limited in two directions:

The limitations are designed to avoid imposing excessive burdens on small companies and to favour trade unions with a strong tradition, in order to avoid excessive fragmentation of representation.97

The rights provided for in Title III are exercised by the Workplace Union Structure (Rappresentanza Sindacale Aziendale or RSA) in every production unit with more than 15 employees within the framework of trade union associations that have participated in negotiations or have concluded collective agreements applied in the production unit (Article 19 Statute of the Workers).98

According to the 1993 inter-union agreement Ciampi Protocol (Protocollo Ciampi), the parties added to the RSA a model of Unitary Workplace Union Structure (Rappresentanza Sindacale Unitaria or RSU) elected by the workers. This model was strengthened by the 2014 Inter-union agreement Single Text on Trade Union Representation (Testo unico sulla rappresentanza sindacale), which provided for thresholds and mechanisms for quantifying and certifying representation.99

Title III grants Workplace Union Structures’ and Unitary Workplace Union Structures’ right to call assemblies, the right to call referendums, the right to post notices on notice boards, the right to company premises for holding trade union meetings, and the right to paid and unpaid leave.100 In order to repress anti-union behaviour, in addition to the ordinary civil process, the Statute of the Workers provides for a simplified and rapid procedure that can only be activated by the local bodies of the national associations concerned (Article 28).

Whistleblowing in Italy is regulated by Law No. 179 of 30 November 2017 that sets out protective measures for workers in both the private and public sector. In the private sector, protective measures for workers are applicable only when the employer has adopted the company’s compliance program (Model 231).116 In particular, Law No. 179 of 30 November 2017 requires companies that have implemented or intend to implement such Model 231 to set up a reporting system and ensure the whistleblowers’ protection. Further, there is specific legislation concerning whistleblowers in Banking, Finance or Insurances.117

Law No. 179 of 30 November 2017 provides that public employees can report any “unlawful conduct that they become aware of by reason of their employment.” The National Anti-Corruption Authority (ANAC) has clarified that “unlawful conduct” includes crimes against the public administration, situations of abuse of administrative power to obtain private benefits, and cases of malfunctioning of the administration due to the use of public functions for private purposes (waste, nepotism, failure to comply with procedural deadlines, non-transparent recruitment, accounting irregularities, false declarations, violation of OSH regulations).118

In the private sector, whistleblower protection measures apply when a worker reports unlawful conduct that could lead to the company’s liability for one of the criminal offences covered by Legislative Decree no. 231 of 8 June 2001 on corporate liability for criminal offences. Therefore, whistleblowing concerns crimes such as corruption, forgery, money laundering, crimes against industry and trade, fraud against the state, cybercrimes; and/or violations of the company’s Model 231. The whistleblower becomes aware of such offences as a result of his/her work. According to Article 6.2-bis(a) Legislative Decree no. 231 of 8 June 2001, reports must be based on “precise and concordant elements of fact.”

Concerning the personal scope, Law No. 179 of 30 November 2017 provides that whistleblowers’ protection covers public employees/managers as well as employees of state-owned companies and workers/collaborators of private companies providing goods or services and carrying out activities for the public administration. In the private sector, Article 6.2-bis(a) Legislative Decree no. 231 of 8 June 2001 refers to senior managers and their subordinates. However, according to National Anti-Corruption Authority guidelines, whistleblowing procedures should also be addressed to third parties including collaborators, consultants with any type of contract or assignment, persons acting on behalf of the organisation as intermediaries and agents, and suppliers of products or services.119

In the public and private sectors, Law No. 179 of 30 November 2017 states that the protection of whistleblowers applies when the report does not constitute an offence of calumny or defamation or is in good faith. The protection does not apply in cases where the report contains false information made with malice or negligence.

Law No. 179 of 30 November 2017 does not provide guidance on the possibility of making anonymous reports. However, in the public sector, the ANAC guidelines explain that the protection can only cover public employees who identify themselves and is limited only to retaliation that may occur within the employment relationship. In the private sector, the question remains open. In any case, in both the private and public sectors, entities must guarantee the confidentiality of the whistleblower’s identity.

Italian legislation provides for two reporting channels: internal and external. In the public sector, the law requires that measures be taken to provide an effective internal reporting system. In the private sector, companies may voluntarily adopt an internal reporting system that complies with whistleblower protection rules. With respect to external reporting, the law only indicates the authorities competent to receive public employees’ whistleblowing, which are the ANAC, the judicial authority and the accounting authority.

The protections guaranteed by the legislation are the same as those provided by Directive 2019/1937 on whistleblowers. Thus, whistleblowers are protected against dismissal, demotion, and other forms of discrimination.120

In Italy, labour law intricately governs the conduct of occupational activities, historically placing considerable emphasis on subordinate employment as the cornerstone of protective regulations. This traditional doctrinal perspective stems from the premise that employees represent the vulnerable party within contractual relationships and thus warrant significant legal safeguards. Conversely, self-employed persons have traditionally operated outside such regulatory frameworks, with their presumed autonomy and professional expertise seen as sufficient protection. However, the shifting economic landscape has necessitated legal adaptations to ensure equitable protections for all workers.

Central to Italian labour law is the legal distinction between subordinate employee and self-employed person. Article 2094 of the Civil Code delineates subordinate employee as the person engaged in intellectual or manual labour under the direction of an entrepreneur, receiving compensation for their services. This relationship is characterised by the “hetero-direction” of the employers, whereby the employer exercises managerial control, authority to monitor, and disciplinary power.121

Identifying subordination is not always simple. To qualify the relationship, the case law applies the following cumulative criteria: permanent inclusion of the worker in the company’s organisation; use of working equipment owned by the company; working time; regular payment of a salary based on working time; no economic risk for the worker; exclusivity of working activity.122 When a worker is identified as a subordinate employee, legislation provides for the application of protective apparatus (see Section 4.2). The type of contract is unavailable to the parties and is determined,123 in the event of a dispute, by the court having regard to the substantive manner in which it is carried out.

In contrast, self-employed individuals, as outlined in Article 2222 of the Civil Code, undertake work or services for compensation without subordination to a specific client. Unlike subordinate workers, self-employed individuals primarily rely on personal labour and autonomy in executing their tasks. In the Italian legal system, self-employed persons are those who perform a work or service in favour of an employer, for remuneration and without subordination (e.g. artisans, professionals, consultants, agents, and sales representatives). The current regulation is contained both in the Civil Code and in Law No. 81 of 22 May 2017, which intervened by outlining a defined framework of protections and rights relating to self-employment relationships under Title III of the Civil Code (Articles 2222–2238), with the express exclusion of entrepreneurs and small businessmen (Article 2083 Civil Code).124

Law No. 81 of 22 May 2017 provides for the written form of the contract and regulates abusive conduct of the principal that renders certain clauses ineffective (Article 3). In particular, the following are considered unfair clauses and, therefore, ineffective:125

Similarly, a refusal by the principal to enter into the contract in writing is deemed abusive. In the event of the occurrence of such conduct or in the presence of unfair clauses, the self-employed worker is entitled to compensation for damages, also by promoting an attempt at conciliation through the authorised bodies. Moreover, the Law grants to self-employment relationships the principle of the prohibition of abuse of economic dependence (Article 9, Law No. 192 of 18 June 1998) on the part of the principal, in order to counteract an imbalance of rights and obligations between the parties to the relationship.126

With a view to fostering work-life balance processes, self-employed parents, including adoptive or foster parents, are entitled to parental leave of three months each within the first 12 years of the child’s life. In addition, within the same period, parents are entitled, alternatively, to a further 3 months of leave. The financial payments for parental leave may not exceed the overall limit of 9 months between both parents (Article 8, paragraph 4, Law No. 81 of 22 May 2017, as amended by Legislative Decree No. 105 of 30 June 2022).

Law No. 81 of 22 May 2017 granted a monthly unemployment benefit to self-employed workers carrying out coordinated and continuous collaboration activities, research fellows and doctoral students. The Budget Law 2021 (Article 1, paragraphs 386–401) established on an experimental basis, for the three-year period 2021–2023, the extraordinary income and business continuity allowance (Indennità Straordinaria di Continuità Reddituale e Operativa or ISCRO), paid by INPS, in favour of persons enrolled in the Separate Account who habitually carry out self-employment activities. The budget law of 2024, Law 213 of 30 December 2023 confirmed the measure with minor modifications.

Lastly, Decree-Law No. 146 of 21 October 2021 (Article 13), converted with amendments into Law No. 215 of 17 December 2021, introduced the mandatory communication of occasional self-employment relationships.

In addressing self-employment, lawmakers acknowledged that certain contracts, such as coordinated and continuous collaborations (co.co.co.), warranted protections akin to those afforded to employees.127

The concept of co.co.co. represents a significant aspect of this evolution. Recognised as a form of self-employment, co.co.co. contracts exhibit characteristics resembling subordination due to the significant coordination exerted by users or clients over the service providers. Consequently, regulatory measures have been introduced to mitigate potential abuses and ensure adequate protections for individuals engaged in co.co.co. arrangements. Legislative interventions, such as Legislative Decree No. 276 of 10 September 2003, aimed to address widespread abuses by transforming co.co.co. into project-based collaborations (co.co.pro.) and imposing additional constraints.128

However, persistent challenges led to further legislative amendments, including Legislative Decree No. 81/2015, which abolished co.co.pro. and reinstated co.co.co., subjecting such arrangements to rules akin to subordinate employment. Article 2 of this decree stipulates that the rules of subordinate employment apply to self-employed workers engaged in hetero-organised but not hetero-directed work activities.129

The emergence of platform workers further complicates the landscape of labour relations. These workers, who operate within digital platforms, may take on the status of self-employed workers or employees (although most of them are self-employed), raising questions about their qualification and protection under existing labour laws. Legislative measures, such as Article 47-bis of Legislative Decree No. 81 of 15 June 2015, seek to establish minimum levels of protection for self-employed platform workers, encompassing various aspects such as access to information, remuneration, data protection, non-discrimination, and insurance coverage against occupational hazards.130

Furthermore, the employment status of care workers, whether in the public or private sectors, adds another layer of complexity to the legal framework. Their classification may vary, with some falling under subordinate employment arrangements while others operate as self-employed individuals. This nuanced approach underscores the importance of ensuring adequate protections for all workers, irrespective of their employment status, within the evolving landscape of labour relations in Italy.

The subordinate employment relationship is protected by a set of mandatory rules. Defining the difference between subordinate employment and self-employment is particularly relevant because it determines the application of the rights, powers and obligations of the parties established in laws and collective agreements. In the public and private sectors, the employment relationship is based on a contract founded on the exchange between work and remuneration.131

The employee works for the employer by performing a task identified in the contract whose content is determined during the relationship through the exercise of managerial control by the employer.132

During the course of the labour relationship, the main employees’ obligations are: diligence, obedience, loyalty and non-competition. The obligation of diligence entails that the worker executes the service with the diligence corresponding to the professionalism possessed and the task performed (Article 2104 of the Civil Code). The obligation of obedience entails that the worker has to comply with the employer instructions in performing the working activities (Article 2104 of the Civil Code). The obligation of loyalty and non-competition implies that the worker shall not: a) conduct business on his/her own account or on behalf of third parties in the same sector of the company for which he/she works; b) disclose confidential information relating to the organisation and production methods of the company or use it in such a way as to prejudice the company (Article 2105 of the Civil Code). Furthermore, the employee must respect the general principle of good faith and fair conduct in the fulfilment of the employment relationship (Article 1375 of the Civil Code).133

In the employment relationship, the employer’s powers are managerial control, authority to monitor, and disciplinary power. These powers are functional to the organisation of the productive activity and when exercised, they make it possible to discern a subordinate worker from a self-employed one.

The employer exercises managerial control by orienting the worker’s activities towards the achievement of the company’s aims and concretely determining the content of the work obligation. The managerial control includes the power to modify the tasks contractually assigned to the worker within the limits of the provisions of Article 2103 of the Civil Code. Indeed, the Civil Code provides that the employer has the possibility of assigning the employee to tasks belonging to a lower level than that of employment. This possibility is contemplated only in the event of organisational needs, without prejudice to the original contractual classification and corresponding remuneration, which may not be diminished. However, demotion agreements with a simultaneous reduction in level and salary are permitted if agreed before a public authority that certifies the consent of the parties.134

The employer exercises the authority to monitor to protect company assets and ensure workplace health and safety. The law limits indirect control by the employer in order to protect the privacy of workers. These limits concern control entrusted to persons outside the business organisation or carried out by means of technological instruments that allow remote control (in time and space).135

The employer exercises disciplinary power in the event of a breach by the worker of his/her obligations. In fact, the employer may impose conservative disciplinary sanctions (verbal warning, written warning, fine and suspension) and expulsive sanctions (disciplinary dismissal) to sanction the worker’s behaviour contrary to the contractual rules. The law (Article 2106 of the Civil Code and Article 7 of the Statute of Workers) limits the disciplinary power in a substantive (gravity of the sanction) and procedural (manner of infliction) way.136

The Civil Code states that the sanction must be proportionate to the offence (substantive limit). Collective agreements establish the correspondence between infringements and sanctions, but it is ultimately up to the judge to assess proportionality. Moreover, the law dictates a precise procedure that must be followed to impose the sanction, under penalty of its nullity (Article 7 of the Statute of Workers).

The employee has numerous rights protecting his/her physical and psychological integrity. The rights are provided for by law, in accordance with the EU law, and by collective agreements, which tend to introduce only more favourable treatment.137 The worker has the right to proportionate (Section 5) and sufficient pay and to work in healthy and safe conditions (Section 6).138 In addition, the employee has the right not to be subjected to discriminatory treatment on the grounds of personal characteristics (gender, race…), both at the recruitment and at the termination stage (Subsection 4.7). Both direct and indirect discrimination is prohibited. Harassment and sexual harassment also fall under the same protection regulation, in line with the EU Directives.139

Over the last twenty years, the legislator has allowed collective agreements to introduce even worsening derogations in the event of specific needs, mostly corresponding to company crises and temporary difficulty in maintaining the bargained-for wages.

Historically, Law No. 1369 of 23 October 1960 (now repealed) prohibited a worker from being employed by a company other than the one where the worker was working. The first significant derogation came with Law No. 196 of 24 June 1997, which introduced temporary agency work only on a fixed-term basis and in the presence of circumscribed hypotheses established by collective agreements.153

Legislative Decree No. 276 of 10 September 2003 has completely reformed the matter by providing that a user company may turn to an authorised staff agency to obtain a certain supply of labour based on an agency work contract. The agency work contract regulates the relationship between the user and the agency and may be either permanent (so-called “staff leasing”) or fixed-term. The employee, employed under this contract, works for the user, under its direction and control, but maintains an employment relationship only with the agency, which is responsible for exercising disciplinary power. Moreover, the law lists in a defined manner the cases in which it is prohibited to use an agency work contract and, in the case of irregular or fraudulent administration, provides specific safeguards to protect the worker.154

The employment contract shall be written. The principle of equal treatment applies to remuneration and trade union rights and protections. Moreover, the temporary worker, like any other worker, must be employed for the tasks specified in the contract. If, on the other hand, he/she is employed for different tasks, specific protective actions can be proposed.

Agency work has undergone a rather troubled legislative evolution: following the amendments introduced to the original regulation by the so-called Poletti Decree, the discipline was subject to a comprehensive revision as part of the reforms introduced by the so-called Jobs Act, being then partly reformed also by Decree-Law No. 87 of 12 July 2018, converted by Law No. 96 of 9 August 2018. In particular, Legislative Decree No. 81 of 25 June 2015, provided for the elimination of the peremptory list of grounds for legitimising temporary agency work and, on the other hand, the confirmation of the choice not to subordinate the possibility of signing a fixed-term agency contract to the necessary indication of specific productive, technical, organisational or replacement reasons.

Decree-Law No. 87 of 12 July 2018 amended the discipline of temporary agency contracts, seeking to make it consistent with the new regulations for fixed-term contracts. Moreover, the reform amended the regulation of the relationship between the agency and the worker, providing that almost the entire discipline of the fixed-term contract (including the regime of the grounds for the contract) also applies to the relationship between the agency and the worker. Some further minor changes were introduced by Decree-Law No. 48 of 4 May 2023, converted into Law No. 85 of 3 July 2023.

Finally, fraudulent agency work has been reinserted.155

The fixed-term contract is a subordinate employment contract in which a predetermined duration is provided in advance. Fixed-term contracts are governed by Legislative Decree No. 81 of 15 June 2015 (Articles 19–29) recently revised by Decree-Law No. 48 of 4 May 2023 converted into Law No. 85 of 3 July 2023. The ordinary form of the subordinate employment relationship remains the permanent contract, therefore, the setting of a term – although permitted – is subject to compliance with certain conditions.161

Decree-Law No. 87 of 12 July 2018 provides that a term may be added to a subordinate employment contract provided that it is agreed in writing and subject to a duration limit of 12 months. However, a term may be added to the contract for a duration of more than 12 months, but not more than 24 months, as long as there are three legal grounds:162

a) Temporary and objective needs, unrelated to the ordinary activity, or needs to replace other workers.

b) Needs related to significant and unforeseeable temporary increases in ordinary activities.

c) Specific needs provided for by collective agreements.

These grounds were repealed by Decree-Law No. 48 of 4 May 2023 converted into Law No. 85 of 3 July 2023, which essentially referred to the determination of the grounds justifying the imposition of a term to national or company collective agreements. Furthermore, the provisions on causal grounds do not apply to contracts concluded by public administrations, as well as fixed-term employment contracts concluded by private universities, including branches of foreign universities, research institutes. Therefore, fixed-term contracts may not last longer than 24 months, including extensions or renewals, unless otherwise provided for in national, territorial or company collective agreements. Periods of temporary agency work are also taken into account for the purposes of calculating the 24 months.163

The term of the fixed-term contract may be extended, with the worker’s consent, only when the initial duration of the contract is less than 24 months and, in any case, for a maximum of 4 times within 24 months, regardless of the number of contracts. If the number of extensions is higher, the contract is converted into a permanent contract from the date of commencement of the fifth extension (Article 21). Extensions may be made freely during the first 12 months and, thereafter, only in the presence of the so-called causal reasons legitimising the signing of a fixed-term contract (under Article 19(1)). However, for renewal purposes, a time gap must be observed between the signing of the two fixed-term contracts:164

If the provisions on these time gaps are breached, the second contract is converted into a permanent contract.

The current legislation also regulates the hypotheses of continuation of the relationship beyond the expiry of the term, providing that in such cases the employer is obliged to pay the employee an increase in salary for each day of continuation of the relationship equal to 20% up to the tenth day and 40% for each additional day (Article 22). Moreover, provision is made for the transformation of the fixed-term contract into an open-ended contract if the employment relationship continues:

Employers may hire fixed-term workers to an extent not exceeding 20% of the number of permanent workers in force on 1 January of the year of hiring, unless otherwise provided by collective agreements (Article 23).

Public administrations, as a general rule, hire exclusively with permanent employment contracts. However, the public administration may also use flexible forms of employment provided for by law, albeit only subject to certain limits and modalities (Article 36). Indeed, in the public sector, it is possible to use these types of contracts only for proven needs of an exclusively temporary or exceptional nature.165

Legislative Decree No. 81 of 15 June 2015 regulates the job-on-call. The job-on-call contract is concluded in writing and may be for a fixed-term or permanent period; this contract stipulates that the worker works in a discontinuous or intermittent manner according to the needs identified by collective agreements or, in the absence thereof, by decree of the Minister of Labour.

Even beyond the hypotheses provided for in the above-mentioned Ministerial Decree, the job on-call contract can be concluded:166

a) With persons under 24 years of age, provided that the work is carried out by the age of 25.

b) With persons over 55 years of age.

Except for the sectors of tourism, public establishments and entertainment, the job on call is admitted for each worker with the same employer for a total period not exceeding 400 days of actual work within three years. If this period is exceeded, the employment relationship is transformed into a full-time, permanent employment contract.167

During the periods in which the on-call worker is not employed, he/she does not earn any salary, unless he/she has contractually guaranteed his/her availability to answer calls to the employer. In the latter case, the worker is entitled to the on-call allowance determined by collective agreements or by decree of the Minister of Labour. An unjustified refusal to answer the call may constitute grounds for dismissal and lead to the reimbursement of the on-call allowance for the period following the refusal. 168

Job on call is forbidden:169

c) To replace workers on strike.

d) In establishments where collective redundancies have taken place within the previous 6 months.

e) To employers who have not carried out a risk assessment in application of the OSH legislation.

The employer may be an individual, a family or a non-profit community. Domestic work is regulated by the rules on employment, provided that the work must be: a) performed within the family; b) continuous and not sporadic (there must be an employment relationship with fixed and repeated hours at fixed intervals); c) “prevalent”, i.e. it must take at least four hours, even if separate from each other, within each day. Fixed-term employment is permitted in compliance with the provisions of Legislative Decree No. 81 of 15 June 2015 (Articles 19–29).

Law No. 339 of 2 April 1958 distinguishes domestic workers between clerical workers and manual workers. However, the classification into categories and the specification of tasks are regulated by collective agreements.

Remuneration can be either in cash or in kind. However, it is the collective agreement that establishes the minimum wage as well as the annual adjustment. In addition, domestic workers are entitled to maternity and paternity leave (but not parental leave), rest leave, sick leave and holidays. Working hours are determined by the collective agreement and may not exceed a maximum weekly limit of 54 hours for cohabiting workers and 40 hours for non-cohabiting workers.

The domestic employment relationship may be terminated for one of the following reasons: a) interruption of the probationary period; b) termination of employment at will with notice (Section 4.2.1); c) termination for just cause; d) resignation; e) death of the employee.

Italian anti-discrimination laws are constitutionally grounded in Article 3. This article asserts the principle of equal social dignity among citizens and mandates equality before the law, prohibiting discrimination based on sex, race, language, religion, political opinions, and personal or social conditions. However, it is widely believed that this list is not exhaustive, meaning that violations of the principle of equality can occur outside of those cases. Paragraph 2 of Article 3 indicates the principle of substantive equality, which requires the Republic to remove economic and social obstacles that effectively limit the equality of citizens.

One of the first legislative provisions to implement these principles within the framework of labour law is Article 15 of the Statute of Workers. This provision renders null any agreement or action aiming to condition a worker’s employment on union membership, dismissal for union activity, or discriminatory treatment based on affiliation, participation in strikes, or other factors. Moreover, Article 15, paragraph 2, extends the nullification to agreements or actions rooted in political, religious, racial, linguistic, or gender discrimination.

In alignment with EU directives, Italian legislation has evolved by integrating specific anti-discrimination provisions addressing various facets. However, a comprehensive regulatory framework is yet to be established.170 The principle of non-discrimination renders discriminatory acts unlawful only if they contravene the grounds specified by legislation, including gender (Legislative Decree no. 198 of 11 April 2006), political opinions and trade union activity (Article 15 of the Statute of Workers), race and ethnic origins (Legislative Decree No. 215 of 9 July 2003), language group and nationality (Article 2(3) and Article 43(2)(e) Consolidated Act on Immigration), religion, belief, disability, age, and sexual orientation (Legislative Decree No. 216 of 9 July 2003). 171

Discrimination may manifest in direct or indirect forms, either individually or collectively. Legitimate discrimination is recognised when it aligns with lawful purposes (Article 3(4) Legislative Decree No. 215 of 9 July 2003). Furthermore, discrimination that necessitates a protected characteristic for performing certain work is considered legitimate if it is proportionate and reasonable (Article 3(3) Legislative Decree No. 215 of 9 July 2003). In cases of discrimination, Article 28 of Legislative Decree no. 150 of 1 September 2011 provides for a partial reversal of the burden of proof in favour of the worker. 172

To bolster gender equality in the workplace, Italy enacted Law No. 162 of 5 November 2021. This legislation expands the scope of direct discrimination to include the personnel selection stage. Moreover, it mandates companies to produce periodic reports on personnel to combat gender disparity. Enterprises that attain gender equality certification receive incentives such as exemption from total social security contributions and priority access to funding opportunities. Additionally, the introduction of Equality Counsellors (Consigliere di Parità) aims to address gender discrimination and promote equal opportunities through collaboration with relevant bodies responsible for labour policies, training, and mediation.

However, access to justice and case law concerning discrimination remains limited compared to other areas of labour law. This scarcity underscores the challenge of identifying and addressing discrimination, particularly within the framework of individual contractual freedoms versus the principle of equality.

Regarding discrimination in the care sector, the survey for Equality Councillors and the Italian National Stakeholder Meeting highlighted several cases of discrimination faced by workers in the care sector. These cases shed light on significant challenges related to equality and fair treatment in the workplace.173

One prominent form of discrimination highlighted during the Italian National Stakeholder Meeting was gender-based discrimination, particularly concerning maternity rights. For example, a female worker in a public health institution encountered resistance when seeking to transition from full-time to part-time employment due to maternity reasons. Despite legal provisions mandating equal treatment for part-time and full-time working mothers, the administration initially denied her request. However, following intervention from the Inspectorate of Labour and legal action, the issue was ultimately resolved.174

Another prevalent issue discussed was discrimination based on contractual terms, particularly concerning part-time employment. A young mother employed under a discriminatory part-time contract faced challenges in negotiating fair working conditions. Despite efforts by the worker, her union representative, and legal counsel, the employer refused to engage in discussions, leading to the worker reluctantly accepting a full-time position to avoid job loss.

Additionally, cases of discrimination against foreign workers were highlighted during the dialogue. In one instance, a worker from Albania faced harassment and coercion to resign after returning from maternity leave. Despite attempts to intervene and address the discriminatory behaviour of the employer, procedural limitations hindered effective resolution of the issue. The Equality Councillors highlighted forms of intersectional discrimination, particularly concerning gender, religion, and ethnicity. Individuals of colour, especially Moroccan women wearing the Hijab, experienced significant difficulties in the workplace, often encountering discrimination and prejudice.175

Regarding workers employed in the care sector, including nursing professionals, healthcare assistants, caregivers, and similar roles, several critical issues were identified. The boundary between gender discrimination, work-life balance issues, organizational discomfort, endogenous or induced psychological distress, harassment, or bullying is often blurred. The precarious nature of the female labour market, especially among young women, leads to increased apprehension about speaking out, with many preferring to seek advice and information from equality councillors rather than directly confronting their employers.176

The Italian National Stakeholder Meeting also revealed challenges related to work-life balance, temporary work assignments, and flexible working hours within the healthcare sector. While positive steps have been taken, such as the signing of agreements to promote work-life balance initiatives, the dialogue underscored the ongoing need for vigilance and proactive measures to combat discrimination in the workplace.177

Remuneration is the compensation for the work carried out by the employee, entitling them to a remuneration commensurate with the quantity and quality of their work. This remuneration should, in any case, be adequate to ensure both the employee and their family a dignified standard of living, as enshrined in Article 36 of the Constitution.178

In Italy, the minimum wage is not established by law. Generally, remuneration is determined freely by the parties involved, yet subject to a minimum threshold. However, due to the non-implementation of Article 39, second part, of the Constitution, which if implemented would have provided for universal effect of collective agreements, the judiciary has identified this threshold in the minimum wage values set by collective agreements signed by the most representative unions in the sector. Remuneration may be provided in cash or in kind and is determined by regular monthly payments, payments made more frequently than monthly, and severance pay.179

The law does not provide an explicit definition of remuneration. In contrast, the Supreme Court defines it as everything the worker receives from the employer in exchange for his work and because of the personal subjection to the employment relationship (Cass. SS.UU. 13 Decembre 1984, no. 1069). The four principles that govern remuneration are consideration, obligatory nature, continuity, and irreducibility. These principles cannot be derogated by collective agreement or by the parties.

The most common forms of remuneration include time-based wages, piece-work compensation, in-kind benefits, as well as profit-sharing, commissions, and product sharing schemes. The remuneration is paid on a monthly basis. Employer-paid wages comprise both fundamental components and supplementary or in-kind elements. Fundamental elements consist of the minimum contractual remuneration stipulated by collective agreements corresponding to each contractual qualification, contingency allowances (formerly used for adjusting wages to cost-of-living increments until 31 December 1991, but now static), separate pay elements (such as the 10.33 euros per month EDR introduced from 1 January 1993), and length-of-service increments. These amounts vary by qualification and are periodically adjusted according to the relevant collective agreement’s terms and conditions.180

In addition to the basic elements, remuneration may consist of other accessory elements. These elements are established by collective or individual agreements and are of two types:181

1) Superminimum (consisting of sums agreed in the individual contract between the parties, or as part of company agreements).

2) Allowances (consisting of sums agreed in collective agreements and intended to compensate for performing work that entails greater burdens and difficulties for the worker).

In addition to monetary benefits, the employer may also provide benefits in kind such as accommodation, canteen, and fringe benefits.

The Italian system provides for compensation paid on a multi-monthly basis, which may be compulsory or voluntary. The remunerations that fall into this category are the thirteenth-month wage, the fourteenth-month wage and loyalty/productivity/performance bonuses. The thirteenth-month wage is provided for by law (Presidential Decree No. 1070 of 28 July 1960) and is currently regulated by collective agreements. The thirteenth month’s wage is paid once a year, usually in December. This wage is normally equal to one month’s ordinary salary. The fourteenth-month wage is an additional monthly payment provided for by some collective agreements. The amount and modalities are similar to those of the thirteenth-month wage, but usually, the fourteenth-month wage is paid in the summer. Bonuses are regulated by collective agreements and are often linked to the achievement of a production, seniority, or productivity goal.182

The elements of remuneration are compiled by collective agreements in tables that are used to determine the correct wage to be paid. The items included in these tables are numerous and have a decisive influence on the salary. Thus, the wage actually paid to an employee to whom all the allowances provided for in the collective agreement are applied may be much higher than the basic wage and may fluctuate significantly over time. In this system, it is rather complex to determine the value of the work performed. Furthermore, collective agreements do not value soft skills or do so only to a very limited extent, giving much more weight to qualifications and hard skills. This is problematic precisely in the care sector, in which interpersonal skills, empathy and other soft skills are indispensable.

As we have seen, Italy has historically adopted the wage determination model based on collective bargaining. This model has allowed a progressive increase in the national wage. However, the precondition for the functioning of the bargaining system is a high rate of unionisation and enforcement of collective agreements. The unionisation rate is difficult to measure in Italy, but since the 1980s there has been a reduction in the number of trade union members. Visser’s studies, conducted between 2004 and 2016, showed a national downward trend, placing Italian national unionisation at around 50% in 2003, 40% in 2005, and around 35% in 2016.183 Additionally, the variability of unionisation in relation to the sector of work must be considered: in some sectors, it is very high, while in others, such as domestic work, it is very low. Regarding the application of collective agreements, measurement is virtually unfeasible because there is no authority to record this data. Moreover, as there is no certification of representation and the constitutional mechanism of collective bargaining is not applied, the statistics on this issue have very limited value.

The adoption of Directive 2022/2041 on adequate minimum wages in the EU, as is well known, does not oblige member states to introduce legal minimum wages, nor does it establish a common threshold valid throughout the EU. It merely establishes some criteria to ensure minimum wages, above the subsistence threshold, taking into account the cost of living and purchasing power of the relevant member state. The two alternative ways to achieve this are to set a statutory minimum wage or to extend the coverage of collective bargaining. This coverage will have to reach 80% also, if necessary, through an action plan under EU monitoring.

All available estimates for Italy indicate a coverage rate, at least formally, well above 80% (100% for the OECD, 99% for the ILO, 97% for Eurofound’s European Business Survey); from a formal point of view, therefore, no action by the Italian legislator seems necessary to comply with the directive.184

It is worth mentioning, however, that in July 2023 a bill (A.C. 1275) for the establishment of a legal minimum wage was submitted to the Italian Parliament by the opposition parties.185 The proposal aims to introduce a minimum wage of 9.00 euros per hour. According to the proponents, this figure would be calculated on the basis of 50% of the national average wage revalued in light of last year’s inflation. Again, according to the proponents, this minimum level would correspond to approximately 70% of the median wage. The parliamentary process was suspended due to the government’s decision to entrust the CNEL with a study on the subject, before also taking a position in relation to the transposition of the 2022/2041 directive.

The document drawn up by the CNEL, and approved on 12 October 2023,186 expressed a negative opinion on the need to legislate on the minimum wage, also in view of the high rate of coverage of collective bargaining, which far exceeds the 80% threshold stipulated in the directive. According to the CNEL, therefore, collective bargaining is still the medium to be privileged and valorised for the definition of an adequate wage. Nevertheless, it is acknowledged, as also evidenced from discussions with national stakeholders engaged in the Care4Care project, that reliance solely on minimum wages established by collective agreements may not consistently ensure an adequate wage, primarily due to the time required for agreement renewal. This stance has, temporarily, halted the legislative progression.

The table compares the wage levels of health professionals, social and health workers and basic care workers.187 In the table, social and health workers and basic care workers are reported together, because the relevant collective agreements treat them as a single category. The remuneration shown in the table is gross annual remuneration. The economic amounts shown in the table are those provided for in the collective agreements analysed, at the time they were concluded. The table uses as its main reference the salary levels established by the CCNL concluded by the most representative social partners (CCNL for non-medical staff employed by the Scientific Hospitalization and Treatment Institutes and hospital health facilities registered with AIOP and ARIS). Furthermore, the salary range established by other collective agreements has been indicated.

Table 3 – Gross annual remuneration under key private-sector National Collective Labour Agreements (CCNLs)for health professionals, social and health workers and basic care workers.

In the following table,188 two job profiles were selected: cohabiting (live-in) home caregivers, whose pay is determined monthly by the CCNL, and non-cohabiting (non-live-in) home caregivers, whose pay is determined on an hourly basis by the CCNL. Each job profile has three possible salary levels, depending on the applicable contractual classification. The table shows the pay levels established by the most representative social partners (CCNL DOMINA FIDALDO) and the pay range established by other collective agreements. The lowest figure corresponds to the lowest remuneration set for the B SUPER level, while the highest figure represents the highest remuneration set for the D SUPER level. Note that in every collective agreement only Level D SUPER enjoys an indemnity. Also, the other collective agreements provide for “night assistance”, which is nearly always close to the “night assistance” set by the CCNL DOMINA FIDALDO.

Table 4 – Classification and remuneration of home caregivers: CCNL DOMINA–FIDALDO vs other CCNLs (as of 16-01-2023).

The table illustrates the gross annual remuneration outlined in the collective agreement for the public health sector, encompassing health professionals, social and health workers, and basic care workers. The collective agreement is unique for the whole sector.

Table 5 – Gross annual remuneration in the public health sector CCNL (comparto sanità) by professional profile.

It is noteworthy that in 2022, the collective agreement for the public health sector underwent revisions in classification levels and remuneration, placing greater emphasis on supplementary elements of remuneration. Consequently, the actual salary of each worker comprises not only the basic salary delineated in the table but also various specific allowances.

This emphasis on supplementary elements also extends to the private health sector. However, following the renewal of the national collective agreement for the public health sector in 2022, the significance of these auxiliary components in relation to the basic salary is more pronounced within the public sector.

The regulation of working time has been amended several times in recent years. Initially, the legislator intervened with Law No. 196 of 24 June 1997 (the so-called “Treu Law”). Subsequently, Legislative Decree No. 66 of 8 April 2003, implementing EU Directives 93/104/EC and 2000/34/EC, introduced a framework regulation on working time and other important related issues.189

Based on the new legislation, working time can be defined as the period during which the worker is at work and at the disposal of the employer, with the obligation to perform his activity or duties. Conversely, any period that is not part of working time is defined as rest time. The law distinguishes between normal working time and overtime. The former is set at 40 hours per week, although the law introduces a number of exceptions to this general rule:190

Numerous categories of workers are excluded from the regulation of normal working hours and, in particular, from the legislative limit of 40 hours, without prejudice; however, to more favourable conditions established by collective agreements.

A distinction is made between normal working hours and overtime, i.e. work in excess of normal working hours and which must in any case be contained, as well as separately remunerated and compensated with increases laid down by collective agreement. The latter may allow workers to benefit from compensatory rest time as an alternative or in addition to pay increases.191

Collective agreements indicate the manner in which overtime work is to be performed, subject to the aforementioned limit of an average of 48 hours of work per week over four months. In the absence of such agreements, the law provides that recourse to overtime work is permissible only by agreement with the employee and for a period not exceeding 250 hours per year. However, the law also provides for other cases in which overtime is nevertheless permitted, i.e. irrespective of the will of the individual worker and unless otherwise provided for by collective agreements:

Italian law provides legal and social security protection for illness, accident and the birth or adoption of a child.206

The worker has the right to be absent from work and to receive pay or an allowance in the event of illness or accident. The rules are partially different depending on whether the pathological event has an aetiology in the performance of work or not. In particular, the social security body that pays the allowance and the duration of the so-called “time of respite” change. In order for an illness or an accident to have the effect of suspending work performance, imputing to the employer the burden of bearing the employee’s absence, it is necessary that they cause absolute and temporary inability to work. When, on the other hand, the impossibility generated by the event is permanent, it determines an unfitness for work that justifies dismissal for objective reasons, unless it is possible to employ the worker in different tasks compatible with his psycho-physical condition. Case law has also brought under this protection cases in which the worker needs to undergo therapeutic treatment, as well as the convalescence time necessary for the restoration of a normal state of health.207

In the case of illness or accident due to a common risk, the worker may be absent from work for the duration of the so-called “time of respite” fixed by collective agreements or, in the absence of a provision, by the court according to equity. If the illness or injury is caused by a work-related cause, the worker has the right to be absent until full recovery. During this time, the employee may not be dismissed. Dismissal prior to the expiry of the leave period for a reason inherent in sick leave is null and void. Dismissal for reasons other than sickness and attributable to a justified reason for termination is temporarily ineffective and does not take effect until the end of the sickness or the expiry of the “time of respite”. On the other hand, dismissal for just cause, dismissal due to cessation of activity and termination due to expiry of the term in a fixed-term contract shall have immediate effect.

During the period of absence from work due to illness, the worker is entitled to remuneration or an equivalent allowance. The sum paid to the worker is subject to social security contributions. When the law places the financial burden of the worker’s absence from work for health reasons on the social security institution (generally INPS, in the case of illness or accident caused by common risks, and INAIL, in the case of occupational illness or accident at work), the employer is in any case obliged to advance the allowance, and can then recover the sum through the mechanism of adjustment of contributions due. The indemnity paid by the social security institution does not correspond to the entire remuneration due to the worker, but collective agreements may provide for an obligation on the part of the employer to supplement the amount due to the worker up to 80% or 100% of the remuneration. There is also a so-called three-day waiting period, during which the employee is not entitled to any economic benefit. The duration of the economic treatment (be it remuneration or indemnity), in any case, may be less than the duration of the period of comportment, and therefore the economic burden of part of the tolerated period of absence from work may fall on the worker. Sickness and accident periods are counted in the length of service.208

Special protection is provided for the mother worker. The source regulating the matter of maternity and parental leave is Legislative Decree No. 151 of 26 March 2001. From the day the pregnancy is notified and until the child is seven months old, the woman has the right not to be employed in dangerous, hard and unhealthy work, including work that involves lifting weights. The employer, when assigning the woman to new tasks, must comply with the provisions of Article 2103 of the Civil Code but, as a last resort, may assign her to inferior tasks while maintaining her level of classification and salary unchanged. When this change of tasks is not possible, the employee is entitled to anticipation of maternity leave. The employer has the obligation to carry out the assessment of specific risks with respect to the condition of pregnant workers and mothers (Article 11 and Article 28 c. 1 Legislative Decree No. 81 of 9 April 2008) and to inform the workers and safety representatives of the results of the assessment and of the prevention and protection measures to be adopted. The worker is also entitled to an indefinite number of paid leaves for carrying out prenatal controls.209

The law establishes an absolute prohibition for the employer to engage the employee in any work activity during the two months preceding the birth and the three months following the birth of the child, as well as during the days between the presumed date of birth and the day of the birth. The prohibition also covers days not taken before the birth if the birth takes place before the expected date, even if they exceed the five-month limit. The employee may postpone the start of her leave to the eighth and up to the day of delivery, provided, however, that there is double medical certification. Violation of this prohibition is punishable under criminal law with imprisonment for up to six months. The commencement of maternity leave is brought forward to the third month before the expected date of childbirth if the woman is engaged in work that is burdensome or prejudicial to her own health and/or that of the foetus. During the maternity leave period, the woman is entitled to an allowance equal to 80% of her salary, paid by INPS. In addition, the taking of leave entitles the employee to the crediting of the notional contribution and the periods of absence are taken into account for the purposes of seniority, calculation of 13th-month wage and holidays and are considered as periods of employment for the purposes of career progression. Adoptive and foster parents shall be placed on an equal footing with biological parents in taking maternity leave.210

If the mother has died or is seriously ill or has abandoned the child or the child has been entrusted exclusively to the father, the father has the right to abstain from work for the whole duration of the maternity leave (up to 5 months) and certainly for the remaining part of the postpartum maternity leave (Article 28). The leave is covered by an allowance equal to 80% of salary, paid by INPS. In 2012, a mandatory paternity leave was provided for (Article 4(24) Law No. 92 of 28 June 2012), on an experimental basis. The measure was financed until 2022, to become structural in 2023. The employed father, within 5 months from the birth of the child, has the obligation to abstain from work for a period of 10 days, subject to written notice to the employer at least 5 days before the beginning of the leave. An allowance of 100% of the salary is paid for the days of leave. Unlike in the case of maternity leave, the employer is not penalised if he does not require the working father to be absent from work for 10 days. Rather, it is penalised if it prevents or hinders the working father from taking the leave once he has requested it. The paternity leave is also due to adoptive fathers.211

Under Article 32, each parent is entitled to take leave from work regardless of whether the other parent is entitled to it. Parents may also take parental leave at the same time, just as the father may take parental leave while the mother takes maternity leave. Each parent may take a maximum of 6 months leave, which becomes 7 months, as an incentive, for the father who is absent for at least 3 months. However, in total, the father and mother may take a maximum of 10 months of leave, raised to 11 if the father has taken at least 3 months of leave. The leave must be taken by the end of the child’s twelfth year of life or, in the case of fostering or adoption, by the twelfth year of the child’s entry into the family or into Italy, respectively in the case of national or international fostering/adoption. The lone parent, on the other hand, has 11 months of parental leave. The leave, as described, is due to the parents for “each child”. It follows that, in the case of a twin or multiple births, the duration of the leave will be proportional to the number of births. Parental leave is also due in the case of national or international fostering and adoption. Worker and/or woman taking parental leave is entitled to an allowance equal to 30% of salary, paid by INPS, for a maximum total period of 9 months, 3 of which are non-transferable. It is due within the 12th year of the child’s life or within the 12th year of the child’s entry into the family/Italy in case of fostering or adoption.

The Budget Law 2024 (Law No. 213 of 30 December 2023) increased the amount of the parental leave allowance available to mothers or fathers for a second month, out of the total of 6 months within the 6th year of the child’s life. In particular, the allowance (ordinarily set at 30% of taxable salary) is increased: a) to 80% for two months in 2024 and b) to 80 per cent for one month and 60 per cent for a further month, when fully effective, from 2025. The innovation is applicable to employees in both the public and private sectors ending their maternity or, alternatively, paternity leave after 31 December 2023.

Periods of parental leave are counted in the seniority and do not lead to a reduction in holidays, or 13th-month wage, with the exception of additional emoluments linked to actual presence on duty, unless otherwise provided for by collective bargaining. More favourable economic conditions are provided for parents with very low incomes.212

The working parent may, in lieu of parental leave and within the limits of his/her remaining leave entitlement, request to convert the full-time employment relationship into a part-time one. There is also a priority in the assignment to the agile work (lavoro agile).213

During the first year of the child’s life, female workers are entitled to two rest periods, of one hour each, which can also be accumulated during the working day. The rest period is only one when the working day is less than six hours. In the case of multiple births, the rest periods are doubled. The working father is also entitled to these rest periods, but only: when the children are entrusted exclusively to him; as an alternative to the employed mother who does not make use of them; when the mother is not an employee and is not entitled to use them. Daily leave is also granted to foster and adoptive parents. These leaves are covered by an allowance equal to the full amount of the salary due for the hours of suspension of work. Both parents, alternatively, are entitled to leave on the occasion of illness of their child up to 8 years of age. When the child is less than 3 years old, the parent may take off work for an indefinite number of days per year, while when the child is between 3 and 8 years old, each parent may take off work for only 5 days per year. If the child’s illness results in hospitalisation, it interrupts any leave the parent may be enjoying. Adoptive or foster parents may also take this leave.214

The dismissal of a mother worker during the period from the beginning of her pregnancy to the completion of the child’s first year of age is prohibited and administratively sanctioned, regardless of whether the employer is aware of the worker’s condition. The judge who determines the illegitimacy of the dismissal orders the employer to reinstate the employee. In addition, the judge orders the employer to pay an indemnity of no less than 5 months of the last global remuneration, reduced by the remuneration received from other work activities during the dismissal, with the obligation to pay social security and welfare contributions. Moreover, resignations tendered by the employee during the period of pregnancy and during the first 3 years of the child’s life or during the first 3 years of the child’s placement with an adopted or foster child, or, in the case of international adoption, during the first 3 years of the child’s stay in Italy, must be validated by the territorial labour inspectorate. The same applies in the case of consensual termination of employment.215

The employer has an obligation to ensure the occupational safety and health (OSH) of workers (Article 2087 of the Civil Code) through the implementation of all measures that meet the case law requirement of the “best technologically feasible arrangement”. The notion of workers’ health includes psychological health, so the employer is also obliged to detect the risk of work-related stress and to implement all the necessary measures to prevent a condition of psychological malaise from arising from the performance of work.219

Specifically, Legislative Decree No. 81 of 9 April 2008 is divided into 14 Titles and about fifty annexes and implementing decrees, substantially taking up in its formulation a regulatory technique of EU derivation.

Title I (common principles), Title XII (provisions on criminal law and criminal procedure) and Title XIII (transitional and final provisions) are those that contain general provisions to which specific provisions are added for each sector, including the healthcare sector. 220

Legislative Decree No. 81 of 9 April 2008:

a) Lists subjects, functions and activities that cover the whole range of prevention legislation.

b) Identifies the scope of application of this legislation, which extends to all private and public sectors of activity except for domestic workers.

c) Establishes the general protective measures, the duties of the persons involved and the activities that the employer may delegate to designated persons.

d) Provides for risk assessment (a fundamental activity that the employer cannot delegate).

e) Establishes the prevention service, the responsible person for the service appointed by the employer, the tasks and the organisation of the service (internal or external, with one or more members, carried out by the employer himself).

f) Provides for the education, information and training of workers.

g) Provides for health surveillance conducted- in the cases provided for by law—by a competent doctor through a series of medical acts (not only personal examinations) aiming to assess the suitability of the worker for a specific task rather than for work in general.

h) Identifies procedures for emergency management, first aid and fire prevention.

i) Provides for consultation and participation of workers’ representatives.

j) Establishes sanctions.

Moreover, the legislature strengthened Article 25-septies of Legislative Decree No. 231 of 8 June 2001, expanding corporate administrative liability for manslaughter and for serious or very serious bodily injury committed in breach of OSH rules, where the offence is carried out by corporate representatives and in the company’s interest or to its advantage. 221

Finally, the legislator superseded special legislation based on the technological vision by imposing diversified, interconnected, and planned behaviour and technical, organisational and procedural measures on the employer and workers.222

In both private and public healthcare institutions, there is a concerning rise in incidents of physical assault perpetrated by patients or their relatives, particularly targeting nurses. In 2022, a significant 130,000 cases of physical assaults on nurses were recorded.223 A study conducted by FNOPI in 2023 revealed that 40.2% of surveyed nurses reported experiencing multiple assaults within a year. Notably, these aggressions disproportionately target female nurses and are most prevalent in emergency departments.224

During the Italian national stakeholder meeting, trade unions brought attention to the serious issue of physical assaults. Proposed remedies ranged from the deployment of security personnel in hospitals to augmenting public investment in the healthcare sector to enhance service efficiency, thereby addressing the underlying grievances contributing to these assaults.225

The COVID-19 pandemic significantly affected the working conditions of care workers. Being essential workers, this group kept performing its tasks even during the pandemic peaks, thus being exposed to a higher health risk. Moreover, the intense working rhythms and the difficulties associated with managing the virus exacerbated their working conditions.

The pandemic reaffirmed the indispensability of care workers. At the same time, the pandemic exposed the vulnerabilities of this sector: employment shortages, difficult working conditions, widespread reliance on foreign workers, often irregularly employed.227

Decree-Law No. 34 of 19 May 2020, converted into Law No. 77 of 17 July 2020 introduced a collective regularisation procedure for irregular (undocumented) migrant workers employed in agriculture, care, and domestic work. This measure benefits irregular (undocumented) migrant workers employed in one of these sectors and residing on Italian territory as of 8 March 2020. Article 103 of this decree established that, between 1 June and 15 August 2020, the employer could submit an application to conclude an employment contract or to declare the existence of an irregular employment relationship with an irregular migrant worker present on Italian territory in one of the identified sectors. This application should specify the duration of the employment contract and the agreed remuneration, which could not be lower than that provided for in the collective agreement applied in the sector.

The government conceived this procedure to regularise and reduce labour shortages in the agricultural sector. However, at the urging of the sector’s employer organisations, 85% of the regularisation applications submitted concerned care and domestic workers228 This procedure posed serious problems for its implementation. The data on the status of the processing of applications show serious delays and long completion times due to critical issues in the wording of the law and administrative difficulties.229

The recent Decree of the President of the Council of Ministers concerning the programming of legal entry flows for migrant workers into Italy for the 2023–2025 period has resulted in an increase in quotas for lawful entry for employment purposes. Furthermore, it has expanded the scope of professional categories and production sectors eligible for consideration. Over the span of three years, a total of 452,000 new admissions are projected (136,000 for 2023, 151,000 for 2024, and 165,000 for 2025), contrasted with an identified demand of 833,000 (274,800 for 2023, 277,600 for 2024, and 280,600 for 2025). Specifically, in sectors such as transportation, construction, tourism, mechanics, telecommunications, food processing, and shipbuilding, additional professional profiles have been approved for entry into Italy. In the sector of care and healthcare, employers are permitted to apply for the admission of 9,500 migrant workers annually over the three-year period, equating to a total of 28,500 individuals. However, this figure falls significantly short of meeting the demands of the care sector.230 According to recent research, the care sector requires between 57,000 and 68,000 migrant workers during the 2023–2025 period.231

As part of the emergency measures temporarily adopted to deal with the COVID-19 pandemic, Decree-Law No. 18 of 17 March 2020 converted into Law No. 27 of 24 April 2020 (Decreto Cura Italia), also granted domestic workers the right to abstention from work during periods of active surveillance when in close contact with confirmed cases (Article 26(1)). For the purposes of economic treatment, this period was equally equated with illness, so the cost fell entirely on families. Law Decree 18/2020 also extended the provision on contracting the COVID-19 virus at work to domestic workers (Article 42(2)). However, domestic work has not been listed among the services at high risk of contagion for which “the simple presumption of occupational origin” operates (INAIL Circular No. 13/2020), although the list provided by INAIL is merely illustrative.

During the COVID-19 pandemic, the legislator confirmed the exclusion of domestic workers and home caregivers from the Wages Guarantee Fund in derogation (Article 22(2) Decree-Law No. 18 of 17 March 2020) but created an allowance paid in the case of non-cohabiting domestic workers and home caregivers with Decree-Law No 34 of 19 May 2020. In essence, the legislator presumed that, during the pandemic, cohabiting domestic workers continued to carry out their activities, being regularly paid, a presumption that has been largely disproved.232

During the COVID-19 pandemic emergency, the Italian Government adopted a series of assistance measures. A series of economic benefits were provided for employers, workers (both subordinate and—although to a lesser extent—self-employed) and families.233

The Italian government recently enacted a landmark reform aimed at addressing the care needs of elderly individuals, both able-bodied and non-self-sufficient.234 This legislative initiative, which came into effect on 19 March 2024, represent an effort to modernise its eldercare system. The reform seeks to streamline existing policies, enhance coordination in elderly care services, and promote active aging.

The reform, mandated by National Recovery and Resilience Plan directives, was enacted through Legislative Decree No. 29 of 15 March 2024. Article 9 of Legislative Decree No. 29 of 15 March 2024 establishes the Essential Levels of Social Benefits (Livelli essenziali delle prestazioni sociali, or LEPS) and the Essential Levels of Health and Sociomedical Assistance (Livelli essenziali di assistenza sanitaria e sociosanitaria, or LEA), which are included in the individualised integrated assistance projects (Progetti individualizzati di assistenza integrata, or PAI), which are activated by accessing the single access points (Punti unici di accesso, or PUA) pertaining to the social territorial ambits (Ambiti territoriali sociali, or ATS).

A core aspect of the reform is the emphasis on preventive healthcare measures and promoting active aging. Initiatives such as telemedicine and preventive health screenings aim to enhance early detection and management of health issues among the elderly population, enabling timely interventions and improved health outcomes. Recognising the importance of social connections, the reform introduces measures to combat social isolation and promote community engagement among older adults. Initiatives such as slow tourism, volunteering, and lifelong learning programs aim to enhance social inclusion and overall well-being among seniors. Moreover, to address housing needs, the reform encourages the adoption of innovative housing models, including shared living arrangements and intergenerational cohabitation. These initiatives aim to create supportive environments where older adults can live independently while fostering social connections and mutual support.

While the reform outlines a comprehensive architecture for elderly care, significant challenges remain, particularly concerning the integration of healthcare and social services across the country. Although the government allocated approximately one billion euros to kickstart the reform, experts estimate that at least seven billion euros will be needed over the legislative term to fully realise its objectives. The challenge lies in mobilising adequate resources and fostering collaboration among regional authorities, local health agencies, municipalities, the third sector, private entities, and citizens to ensure the seamless delivery of care services.235

Articles 5 and 6 of Law No 53 of 8 March 2000 and collective agreements regulate training leave in both the private and public sectors.

To ensure the right to education, employees, both in the public and private sectors, have the option to request specific training leave from their employer, as outlined in Article 5 of Law No. 53 of 8 March 2000. This leave is intended to facilitate the completion of the employee’s studies or participation in independently chosen training activities not organised by the employer. Collective agreements govern the procedures and timing for taking this leave, within the legal parameters.

These parameters include: a maximum duration of 11 months over the entire working life; the leave can be taken continuously or in fractions; it’s only available after 5 years of service in the same company or administration, with a minimum notice period of 30 days. The employer retains the right to refuse or postpone the request based on proven organisational needs, as outlined in collective bargaining agreements.

Training leave is unpaid, it does not contribute to seniority, it cannot be combined with vacation, sick leave, or other types of leave, and it does not qualify for social security coverage. However, job retention is guaranteed during the leave period.236

Life-long learning leave is leave aimed at enhancing professional knowledge and skills throughout working life and all workers are entitled to it. The training may correspond to an autonomous choice of the worker or be organised by the company, through company or territorial plans agreed between the social partners. Collective agreements define criteria, modalities and number of hours and may provide for a reduction in working hours for worker training projects, financed by the Regions, using an annual share of the Employment Fund. These training projects can also be submitted directly by workers.237

During the national stakeholder meeting, two key challenges within the sector were highlighted, both of which could be addressed through enhanced training initiatives. Firstly, there’s a notable gap in understanding among professionals regarding each other’s competencies. This lack of clarity often leads to uncertainty about what tasks can be reasonably expected from each role. Secondly, there’s a recognised lack of team collaboration skills. Effective teamwork not only relies on understanding the capabilities of team members but also on the development of individual competencies. It was noted that current educational programs fail to provide ample opportunities for professionals to acquaint themselves with one another’s strengths. Introducing collaborative elements into training courses could be beneficial in fostering teamwork capabilities among future practitioners.238

Social security law in Italy encompasses legislation aimed at guaranteeing the protection of persons in situations of socially relevant need. This legislation finds its constitutional foundation in Article 3(2) of the Constitution, which states that the Republic has the obligation to “remove obstacles of an economic and social nature” that prevent substantial equality among citizens.

The Italian welfare state model is a mixed one and incorporates elements of the Bismarckian model (i.e. the social insurance model) and the Beveridgian model (i.e. the social security model).239

The constitutional provision that governs the welfare state in Italy is Article 38 of the Constitution, which provides for social assistance and social security.240 Article 38(1) establishes a right to social assistance for citizens who are both unable to work and lack the economic means to meet basic living needs. These persons are entitled to existential maintenance in order to meet every day needs. Article 38(2) provides for a right to social security for workers. Workers have the right to have adequate means provided and insured for their life needs in the event of an accident, illness, invalidity and old age, or involuntary unemployment. Article 38(3) affirms the right of disabled and disadvantaged persons to education and vocational training. Article 38(4) stipulates that it is the State that is required to intervene, through specially designed or integrated bodies and institutions to guarantee both assistance and social security. Finally, Article 38(5) recognises the freedom of private care.241

Regarding social legislation, the Italian Constitution guarantees equal treatment of nationals and non-nationals. However, legislation limits access to certain social security and assistance benefits for non-nationals. Specifically, benefits under the ordinary social security system (e.g. sickness or old age insurance) tend to be guaranteed to nationals and non-nationals. However, non-national seasonal workers are excluded from unemployment protection and the right to family allowances. Regarding social assistance, non-nationals face significant legislative limitations that link access to benefits to citizenship and/or a specific residence title and/or prolonged residence in the territory.

The Italian social security system tends to cover all workers, employed and self-employed. The five essential pillars that constitute the Italian social security system are:242

A distinction must be made between pension treatments and other forms of social security protection both in relation to subordinate employment and self-employment.

Pension benefits cover all employed and self-employed workers, and also extend to situations where work was absent (e.g. survivor’s pension). Employees and, in different forms, self-employed persons have social security protection in case of illness and maternity. Conversely, insurance against accidents at work and occupational diseases applies to all employees and only to a limited number of categories of self-employed workers.

Instruments designed to respond to economic needs following the suspension or loss of work cover all employees and, following the financial and economic crisis of 2009–2012 and the COVID-19 pandemic emergency, partially the self-employed workers.

Institutionally, all forms of protection for employees and some categories of self-employed workers are mainly managed by two public bodies at the national level: the National Social Security Institute (INPS) for pensions and the National Insurance Institute for Accidents at Work (INAIL) for insurance against accidents at work and occupational diseases.

The financing of the social security system is mixed and therefore based on social security contributions and state transfers. The latter increased following the emergence of a structural shortfall during the COVID-19 pandemic and the economic crisis of 2009–2012. However, the increase in contributions has posed the problem of the financial sustainability of the system, leading to periodic consolidation interventions.

The Italian social security model evolved in the 1980s, moving away from the social insurance model to structure itself around the principle of solidarity from a social security perspective. The central moment in this process was the adoption of the pay-as-you-go pension system in the management of social security resources, instead of the capitalisation system typical of social insurance.

The cornerstone of the pension system is intergenerational solidarity between those who work today and those who will work tomorrow. As a consequence of the adoption of this model, minimum pensions, the indexation of pensions, and the principle of automaticity of benefits were progressively introduced, allowing the worker access to protection even if the employer fails to pay contributions.

It is noteworthy that Legislative Decree 21 April 2011, No. 67 delineates a framework for “heavy work” (lavori usuranti) classifications and the corresponding benefits extended to individuals engaged in physically demanding tasks, which often lead to a diminished quality of life or premature aging. Workers falling within these categories are afforded facilitated access to pension schemes. However, a significant concern highlighted by stakeholders involved in the CARE4CARE project pertains to the exclusion of certain care workers from the benefits outlined in the decree, despite their engagement in unquestionably strenuous activities.243

Another pertinent issue, particularly relevant to migrant care workers, revolves around the retention of social security rights accrued in Italy upon their return to their country of origin.244 Existing legislation precludes the reimbursement of contributions upon repatriation, potentially fostering indifference towards fulfilling social security obligations. One potential mitigation strategy lies in international social security conventions between Italy and select non-EU countries. The latest agreement, a rarity in number, was finalised with Moldova on18 June 2021, officially enforced on 1 December 2023, as ratified by Law no. 94 of 11 July 2023, which formalised the Agreement between the Italian Republic and the Republic of Moldova on social security. This development was also acknowledged in the INAIL Circular Letter, 11 April 2024, no. 9.245 This mechanism prevents career fragmentation and ensures entitlement to pension benefits, with contributions distributed proportionally between the respective insurance institutions. However, it is imperative to note that this system’s applicability is limited to workers from countries with which Italy has such agreements in place.

Regarding social assistance, Law No. 328 of 8 November 2000 established an integrated system of measures and social services with an explicit character of universality, which recognises the right to benefits and services for Italian and EU citizens and their family members, as well as for documented third-country nationals, refugees and stateless persons. However, the legitimacy of the different treatment of non-nationals is debated in the case law. Among all protected persons, priority is given to those in conditions of poverty or economic need.248

Institutionally, the social assistance system is structured around the principle of subsidiarity, recognised by Article 118(4) of the Constitution.

Administrative functions are divided among several local authorities that compose the Italian State’s institutional framework: the Municipalities, the Regions and the State. The municipalities are responsible for the functions concerning welfare interventions at the local level and participation in regional planning. The Regions are responsible for planning, coordinating, directing social interventions and verifying their implementation. The State has powers to direct, coordinate and regulate social policies, as well as to identify the essential levels of services. Moreover, public administrations must recognise and facilitate the role of private operators.

As for the sources of funding, welfare benefits and services are primarily addressed to those without means of subsistence and are subsidised through taxes paid by citizens.

The typology of benefits and services is very diversified both because of the social dynamics that can generate new needs and because the competence to regulate them lies with the Regions. However, these benefits are provided in the presence of situations of personal and/or family need, both from an economic point of view and in relation to health conditions or social difficulties.

Some economic benefits are provided at the national level and granted by INPS in favour of certain categories of civil invalids: persons with visual disabilities (Law No. 66 of 10 February 1962 and Law No. 382 of 27 May 1970), persons with hearing disabilities (Law No. 381 of 26 May 1970), persons with physical disabilities (Law No. 118 of 30 March 1971).The benefits provided are the civil disability pension and the monthly assistance allowance (Law No. 118 of 30 March 1971). In order to be entitled to these disability benefits, it is necessary to prove a significant reduction in working capacity or a total inability to work, as well as a situation of economic need, attested by the possession of an income requirement. A disabled person who needs continuous assistance and is unable to perform daily acts of life is also entitled to an accompaniment allowance (Law No. 18/1989) in addition to the disability allowance. Upon reaching retirement age (67 years of age), the allowances change to a civil disability pension.249

At the state level, the citizenship income was introduced (Law No. 26 of 28 March 2019). It was a social assistance measure to combat poverty and, at the same time, an active labour policy. However, this benefit was repealed by the Meloni government with Budget Law 2023 (Article 1(318) Law No. 197 of 29 December 2022) and will no longer be applied from 2024.

Article 32 of the Italian Constitution stipulates the right to health.250 To implement this article, Law No. 833 of 1978 established the National Health Service (NHS). The NHS provides free healthcare to all citizens (including non-nationals) regardless of gender, location, age, income and employment and is based on the following fundamental principles:

The governance of the health system is exercised mainly by the State and the Regions, according to the distribution of competencies established by the Constitution and the legislation. The healthcare system is a shared competence between State and Regions. State legislation is responsible for determining the essential levels of care that must be guaranteed throughout the national territory. Regions legislate on the matter in compliance with the fundamental principles and essential levels of care laid down by State legislation. According to the constitutional principle of subsidiarity, the health service is articulated according to two levels of responsibility and governance:251

The NHS is composed of agencies and bodies of different institutional levels, which contribute to achieving the objectives of protecting the health of citizens. The Ministry of Health is the central authority and is assisted at the national level by the Superior Institute of Health and the Experimental Zoo-prophylactic Institutes. At the territorial level, the Regions and Autonomous Provinces and the Local Health Authorities are NHS bodies.

For the purposes of this study, it is of relevance to note that irregular foreigners are entitled to benefit from health services that cannot be postponed and are urgent on the basis of the provisions of Article 35 of the Consolidated Immigration Act.

Since 2016, collective agreements have started to introduce company welfare schemes. The metalworkers’ trade unions were the first to sign a collective agreement providing for company welfare in November 2016, followed in June 2017, by the goldsmiths-jewellers and in 2018, by the telecommunications workers.

National collective agreements in the care sector do not provide for specific forms of company welfare. However, healthcare institutions may sign supplementary territorial or company agreements that provide for benefits and company welfare.

In Italy the existing models of company welfare are of two types: compulsory and optional. Compulsory company welfare is that specifically established by a collective agreement, whereas optional welfare is a disbursement established by the employer.252

Existing company welfare schemes mainly include purchase vouchers (provided by the company itself or through agreements with other organisations); fuel vouchers; recreational benefits (e.g. magazine or pay TV subscriptions); scholarships; study holidays for youth; educational and training courses; cultural activities; sports activities; medical check-ups and specialist visits; and care services for children, elderly or disabled people.

The devices used to provide these forms of company welfare are digital platforms on which workers have an account that allows them to use the vouchers. These company welfare schemes are not subject to taxation or social security contributions.