Health and social care: staff shortages critical

Clapping health and care workers was one thing—Europe needs to recruit and retain more of them.

For a long time the European Public Service Union (EPSU) and its affiliates have been warning about increasing staff shortages in health and social care and their negative consequences. Privatisation, austerity and overall neglect have led to severe understaffing, with Covid-19 only exacerbating the problems. Before the next pandemic there is an urgent need finally to act to make the sector more resilient.

The European Labour Authority’s 2021 report on labour shortages, published in November last year, presented a worrying picture of deficits of healthcare professionals in most European countries (in Belgium, regions). Out of 30 surveyed, 18 reported shortages of nursing professionals, 13 of general medical practitioners (GPs) and 11 of healthcare assistants, specialist medical practitioners and nursing associates.

More worrying still, out of 18 countries which provided relevant data, nine reported ‘high magnitude’ shortages of nursing professionals, five of GPs and healthcare assistants and four of nursing associates. Many of these professions, especially nursing, have been among the top-ten shortage occupations since at least 2018—albeit shooting up the rankings in 2020 due to Covid-19.

The pandemic has similarly exacerbated the long-term shortages in social care. An EPSU report showed that employment in residential care across the Europe Union had contracted by 9.5 per cent between 2019 and 2020—a loss of over 421,000 staff. In this year’s European Semester country reports, prepared by the European Commission, Italy and Germany were the only EU member states not subject to concerns about staff shortages and/or poor working conditions in health and care.

Warning reinforced

These warning signs were reinforced last week in a report from the World Health Organization European region. Health and Care Workforce in Europe: Time to Act echoes many demands of health unions (and indeed employers’ organisations) to recruit, and more importantly retain, workers. The urgency in the title was underscored by Dr Hans Henri Kluge, WHO regional director:

Personnel shortages, insufficient recruitment and retention, migration of qualified workers, unattractive working conditions and poor access to continuing professional development opportunities are blighting health systems. These are compounded by inadequate data and limited analytical capacity, poor governance and management, lack of strategic planning and insufficient investment in developing the workforce.

The WHO did not make any direct recommendations on pay or working conditions—these falling within the remit of its sister United Nations agency, the International Labour Organization. But many of the ten actions it advocates could be used, directly or indirectly, to improve employment in the sector. Action five calls for working conditions that promote a healthy work-life balance; action six for protection of workforce health and wellbeing; action nine increased public investment in workforce education, development and protection; action two continuing professional development to equip the workforce with new knowledge and competencies, and action four strategies to attract and retain health workers in rural and remote areas.

Action six in particular connects to the wider demand for a directive on psychosocial risks. Also last week, an initiative on mental health was promised by the commission president, Ursula von der Leyen, in her State of the Union address. That sentence, though, was von der Leyen’s only reference even indirectly to health, with health workers now airbrushed from the picture.

Some of the WHO recommendations are however already to be found in the updated Framework of Actions on Recruitment and Retention in health care signed in June between the EPSU and the European Hospital and Healthcare Employers’ Association (HOSPEEM). The framework aims to ensure that a healthcare system is ‘adequately staffed by a continuously well-trained and motivated workforce’—by, among other things, promoting better work-life balance and continuing professional development and guaranteeing healthy and safe workplaces.

Awareness raised

The troubling data on staff shortages and the associated calls for action by the WHO and the social partners reflect the raising of awareness by health unions’ demands and industrial actions. In the past seven months alone, EPSU affiliates in France, Greece, Austria, Belgium, Portugal and Ireland have organised one-day strikes, rallies and other actions to highlight the need for more staff and pay rises.

And there have been successes in negotiating new contracts with employers which include pay rises to combat inflationary pressures and provisions to tackle excessive workloads. In April Dutch unions concluded agreements covering 700,000 public-sector workers, including nurses and care workers, which provided for increased pay, action on workloads and better conditions. In the same month, the Bulgarian unions CITUB and Podkrepa signed a collective agreement with the Ministry of Health which included pay rises for doctors and nurses—not just a recruitment attraction but a deterrent to emigration.

The Italian federations FP-CGIL, CISL-FP and UIL-FPL negotiated a three-year agreement in June, covering 550,000 health workers, which provides for higher pay and improvements to remote working and leave. Finally, the German government has proposed legislative measures which implement longstanding demands from the public-service union ve.rdi for needs-based staffing. There are however concerning developments in Finland, where government plans to reduce the right to strike for nurses, who were planning a collective resignation to underline the need to address staff shortages.

‘Crucial responsibility’

Applause is not enough for nurses, doctors, carers and other health and social-care workers: they need pay rises and investment in recruiting new staff, which also entails increasing the capacity of education and training systems. At this year’s WHO Europe conference, many nongovernmental organisations supported a statement led by EPSU, which said governments had ‘the crucial responsibility of securing and delivering the required funding to increase investment in recruitment and retention of health and care professionals as well as to improve needs-based staffing’.

There can be no return to austerity and no more public-sector pay freezes, especially considering current high inflation. Expenditure on health and social care is a reward-generating investment in a healthier and more resilient society, better able to resist such shocks as the pandemic. The commission and national governments should learn this lesson sooner rather than later.