The Belgian presidency’s work on an EU health workforce strategy must result in urgent and concrete action as health systems continue to lose health workers, resulting in rebellion and a hit to care offered to patients, experts warn.
The World Health Organisation has highlighted that the current healthcare crisis is multifaceted, consisting of many individual crises, including labour, mental health, education, gender equality and lack of financial investments.
“It’s quite difficult. Across Europe, we see a lot of doctors going on the streets protesting working conditions, excessive hours and a lack of resources,” Christiaan Keijzer, president of the Standing Committee of European Doctors, told Euractiv.
Paul De Raeve, secretary-general of the European Federation of Nurses, agreed: “The shortage of nurses in the EU situation today is critical, with nurses massively leaving the profession – up to 30% in some member states – and nursing students dropping out of the nursing programmes.”
Every single EU country lacks health workers, concluded the European Commission in their State of Health in the EU report from 15 December 2023.
“There is an urgent need to invest in health workforce,” the report reads, explaining that as the population ages, demand for health workers will further increase, while Europe faces more chronic diseases.
On top of this, the health workforce is ageing, and educating, recruiting, retaining and re-skilling health workers is a challenge.
The Belgian EU presidency has announced it will take steps towards an EU health workforce strategy during the first half of 2024.
This topic was on the agenda during the previous Belgian presidency in 2010 when Council conclusions about “investing in Europe’s health workforce of tomorrow” were adopted.
“We saw it a long time coming,” said Elizabeth Kuiper, a health policy analyst at the European Policy Centre, about the problems, adding that the issue should have been addressed back then.
De Raeve argues that the main reason for letting the problem get this out of hand is that there is “no political interest in supporting the nurses” as well as “no budget to develop a health workforce capacity”, particularly due to a lack of proper cooperation between health and finance ministers.
Well-being as a top priority
Mental health is also high on the agenda, and Keijzer, De Raeve and Kuiper highlight this as a main concern to address in an upcoming strategy.
The struggling and short-staffed health systems have stretched health workers thinner, making burnouts gradually more common.
“In the last ten years, we’ve seen an increase in the Western world on healthcare demand from the population, but we did not very well increase our numbers of healthcare workforce because it’s so expensive,” argued Keijzer.
Consequently, he said, doctors have begun to reduce their working hours.
“The shifts have stayed the same, but (…) this younger generation does not work full time anymore,” he continued, adding that working only 0.8 of a 46-hour-per-week contract in the end corresponds to a typical working week in the Netherlands.
These topics are also crucial among nurses, said De Raeve.
“If we do not care for the nurses, they will leave the profession. Imagine that we have a new pandemic coming to us. Who will be there to take care of the people? I don’t know,” De Raeve added, saying we are now “without a doubt” worse off than before the COVID-19 pandemic.
Therefore, well-being and working conditions are key to fixing the problems and retaining people in the health sector; otherwise, training investments will be wasted.
How to approach the strategy
Keijzer said an EU strategy should include talks on a European monitoring system showing data on the true amount of healthcare workers, shortages, and working conditions in all countries. This could then lead to investment recommendations and action.
Collecting “high-quality and comparable data” to support member states’ health workforce policies and planning was already in the 2010 Council conclusions, but the experts argue the available data does not reflect reality.
Keijzer also suggested agreeing on how many doctors and nurses are needed in each country and countries committing to training the number of workers they need.
“If you don’t train enough doctors and nurses, you’re dependent on other countries, and you’re stealing health workforce trained in other European countries,” Keijzer said.
Training and education, along with ensuring safe staffing levels, are at the top of the priorities for De Raeve and collective agreements for nurses to improve salaries and more “flesh on the bones” than the 2010 Council conclusions.
“Make sure your nurses stay in the profession by giving them a decent salary,” De Raeve concluded.
Kuiper hopes the approach to the strategy will be holistic, covering data, definitions of health care professionals, well-being and sharing of best practices for the countries to find the best way to increase collaboration between health, education and economic ministries.
From a European perspective, we have to make this work”, Kuiper said, adding, “We don’t have the choice because the whole implementation of the European Health Union hinges on a steady health workforce.”
Article published in Euractiv