Tackling staff shortages in health and social care

On World Health Day, lessons learned from workers’ expressions of discontent must be translated into action.

The third World Health Day marked since the onset of the coronavirus crisis reminds us more than ever of the importance of health and interconnected social care in our societies and daily lives. It reinforces the lessons that should be learned from the pandemic: ensure good pay and working conditions, including occupational health and safety, to address staff shortages and protect health and care from commercialisation.

It is difficult to be precise about staff shortages across the European Union, given the imprecise statistic data collected by member states. But, as to the ballpark, there are estimates of one million for health workers and two million when care workers are included.

Sustained discontent

Workers have had no choice but to organise industrial action to demand this growing problem be addressed. The culmination was the demonstration in Brussels in December, organised by the European Public Service Union (EPSU), where more than 1,000 workers marched as EU health ministers were meeting.

The discontent has been sustained into this year, with health and care unions from Germany, the Netherlands, the United Kingdom, Greece, Austria, Portugal, Belgium and Georgia all taking action. Indeed, the movement is expanding, with the Irish Nurses and Midwives Organisation recently sanctioning a campaign of industrial action to call attention to the staffing crisis in intensive-care units there. Already there are victories for workers in Latvia, Finland, Austria, Bulgaria, the Netherlands and Lithuania, where health unions have negotiated pay increases.

The grievance among healthcare workers is recognised by the World Health Organization, which is preparing a pandemic treaty with a section dedicated to health workers. Late last month, WHO-Europe adopted the Bucharest Declaration on the health and care workforce.

Demands echoed

The declaration, approved by European health ministers, acknowledges the need to enhance conditions for health and care workers and echoes longstanding EPSU demands. It calls for improved recruitment and retention of workers, via:

• encouraging the use of retention measures shown to work at different stages of careers and in different locations, including those impacting on working conditions, career progression and the provision of other support;

• ethically and effectively managing international recruitment policies in line with the WHO Global Code of Practice on the International Recruitment of Health Personnel, including monitoring of migration;

• paying special attention to retaining and attracting health and care workers in rural, remote, and other underserved areas; and

• embracing zero tolerance of violence against health and care workers.

The declaration also recognises the importance of safe staffing levels, employment conditions and occupational health and safety. It commits to optimising the performance of the health and care workforce by:

• creating decent, safe, adequately staffed work environments and terms of employment that motivate and support health and care workers, ensure their occupational health and safety, and protect their health and mental well-being—users and services will benefit when workers are better supported;

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• considering gender and age-based differences in workers’ risks and needs, such as burnout, violence, workplace safety, and child and family care support; and

• ensuring health and care workers’ capabilities are used to the full extent in delivering health and care services.

Social partners

All these recommendations have already been addressed in the various documents produced by the European social partners in health and social care. The WHO declaration must pave the way for their long-awaited implementation at national level, with the support of health ministers and domestic social partners.

For instance, in the updated Framework of Action on Recruitment and Retention, the EPSU and HOSPEEM—the health employers’ organisation—declared:

Workforce planning mechanisms need to take account of present and future needs to ensure that an adequate number of staff with the requisite skills are available in the right place at the right time. Such measures need to adhere to ethical recruitment principles and respond to the changing demographic profile.

Back in 2008, HOSPEEM and the EPSU signed up to a code of conduct on ethical cross-border recruitment and retention.

On the European level, sectoral social partners, including in healthcare, are conducting a project to assess the effectiveness of the multi-sectoral guidelines to tackle and prevent third-party violence and harassment agreed in 2010. To address the mental health of healthcare workers the EPSU, along with Eurocadres and the European Trade Union Confederation, is meanwhile calling for a dedicated directive on psychosocial risks.

Also at EU level, health and care workers have welcomed the recommendation adopted by the European Commission to recognise Covid-19 as an occupational disease. In the November 2022 list of such diseases, it was finally included as caused by work in disease prevention, in health and social care and domiciliary assistance, or, in a pandemic context, in sectors where there is an outbreak in activities in which a risk of infection has been proven. It is a particular victory for social-care workers, as exposed to the disease as health workers yet not adequately protected.

Profit-driven approach

The recent financial collapse of the biggest private long-term-care provider, Orpea—mired in scandal—graphically demonstrates where the profit-driven approach leads. To avoid bankruptcy, in February the company was effectively taken over by the Caisse des dépôts (CDC), a French public financial institution. Access to Orpea share capital with other French mutual and insurance investors, to the tune of a 50.2 per cent stake, provides for the cancellation of debt amounting to €3.8 billion.

The entry of the CDC, and so the French state, into the governance of Orpea was paramount, not only to protect 27,000 jobs in France and 70,000 globally but, still more importantly, to ensure continued delivery of care to the most vulnerable in society. As during the financial crisis of 2008, the state needed to step in to save a private business to avoid further harm. Yet the Orpea collapse is no surprise to the public-service unions, represented by the EPSU, which have long opposed such commercialisation of health and social care.

Policy-makers on the national and European levels seem to be coming to appreciate the importance of investing in health and social care and the associated workforce. Yet lessons learned and recommendations made must be acted upon—so workers can focus on delivering quality care and care recipients are not treated as means for making profit.