EU 2020 and

the healthcare labour market

Future proof for cure and care

Hasselt, 20 September 2011

Willy Palm

Dissemination development Officer

The importance of the health workforce

After the EU Commission’s health

strategy « Together for Health »

(2007)

Developing effective and efficient

health systems, with the capacity

to improve health and prevent

disease, depends on having a high-

quality, efficient health workforce

with the right skills – throughout the

EU Member States

2008 EU Commission’s

Green Paper on the

European Workforce for Health

Developing sufficient, capable,

motivated and supported health

workers is essential for overcoming

bottlenecks to achieve national and

global health goals.

Working Together for Health

World Health Report 2006

2

The EU policy context

• EU = 27 Member States, 493

million citizens

• Health sector

• Total expenditure on health:

8.2% of GDP (OECD 2006)

(with 70% of budget allocated

to salaries and other charges)

• Employer for 10% of the EU

workforce (15 million people)

• EU2020 strategy for smart,

sustainable and inclusive

growth

• New skills and new jobs

• Youth on the move

3

The health workforce crisis

• Increasing needs

• Ageing workforce

• Changing expectations (work-

life balance, career planning)

• Unattractive remuneration and

working conditions (workload,

etc.)

• Evolving skills and

competencies (quality and

safety)

• Organisational change

• Regulation and policy

• Mobility (within and between

countries)

• External factors

– Labour market dynamics

– Economic crisis

– Societal perception and

appreciation

4

Main concern: growing shortages

• By 2020: nearly 1,000,000*

health workers missing

• Representing almost 15% of

the necessary care to be

covered

Moreover

• The figure of 1.000.000

doubles if long-term care and

ancillary health professions

are taken into account

Health

professionals

Estimated

shortage by

2020

Estimated % of

care not

covered

Physicians 230.000 13.5%

Dentists,

pharmacists,

physiotherapists

150.000 13.5%

Nurses 590.000 14%

Total 970.000 13.8%

5

Source. European Commission,

DG Health & Consumers

(internal estimates)

6

“Workforce stocks and flows”

Health

Workforce Immigration Emigration

Education Re-entry

Retirement

Death

Parental

leave

Working

time

reduction Other

occupation

Working time

Directive

2003/88/EC

PQ Directive

2005/36/EC

The EU mandate on health workforce?

• Union action to respect

responsibilities of the

Member States for the

organisation and delivery

of health care, incl.

management and

allocation of resources

(art. 168.7 TFEU)

– Community to complement

policies of the Member

States

• Working Time Directive

2003/88/EC

– Currently under revision

• Directive on the

recognition of

professional qualifications

2005/36/EC

– Currently under evaluation

7

8

PROMeTHEUS - the Project Health PROfessional Mobility in THe European Union Study

The research leading to these

results has received funding from

the European Community's Seventh

Framework Programme (FP7/2007-

2013) under grant agreement

n°223383.

1. What is the magnitude: reliance &

trends?

2. What are the geographical patterns?

Effects of EU enlargement?

3. What are the motivations to move?

4. What are the impacts on HS

performance?

Policy relevant?

5. What are the policy options?

Matthias Wismar, Claudia Maier, Irene Glinos,

Gilles Dussault, Josep Figueras (eds.)

Magnitude of mobility: significant but diverse INFLOWS

Proportion foreign inflows/ all new entrants (2008):

• Foreign medical doctors: UK (43%), BE (25%),

AU (13.5%), HU (5%), POL (3%)

• Foreign nurses: IT (28%), UK (15%), BE (14%),

HU (2%)

• Foreign dentists: FIN (43%), AU (41%), UK (34%),

BE (19%), HU (10%), POL (3%)

After EU enlargement:

Outflows Significant

but lower than expected • Annual emigration intentions in

EU-12: ca.3%

• Peaks e.g.: EST 6.5% of MDs 2004;

SK 7.4% nurses 2005-6

• Decreasing trend after accession

– Return flows, e.g.: Polish MDs

• New surge in outflows (2009-10)

e.g.: EST, HU, RO

• East-West asymmetries worsened – Outflows in all MS but EU-15 have

significant inflows

Prof. JM Martin-Moreno, WHO/Europe, 2010

Policy relevance and implications

• Migration is rather a symptom of broader health

workforce problems, but it can aggravate them

significantly

• In the face of growing shortages, there is a need for a

more integrated approach at EU level

– Improve transparency and monitoring

– Support planning and training capacity

– Foster skills and competences

– Strenghten general workforce strategies (retention and

recruitment)

13

Green paper and consultation

1. Demography and the promotion of a sustainable health workforce

2. Public Health Capacity

3. Training

4. Managing mobility of health workers within the EU

5. Global migration of health workers

6. Data to support decision-making

7. Impact of new technology on efficiency and effectiveness of health workforce

8. Role of health professional entrepreneurs in the workforce

9. Cohesion policy

• Overwhelming support for a European dimension and need for EU action

• Action needs to be cross-cutting (human resources, education and training) (EU employment, social affairs, internal market and cohesion policies)

• Priorities

1. Assessing future needs (workforce forecasting)

2. Mapping skills and competences (training)

3. Raising attractiveness by improving working conditions

4. Addressing the challenges of global migration and mobility within EU

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Investing in Europe’s Health Workforce of Tomorrow: Scope for Innovation and Collaboration

– Assessment of future health workforce needs

– Adapting skills to new needs and lifelong learning

– Create an attractive and supportive working environment

– Improving performance for quality and safety

BE Presidency conclusions

• Need for collaboration on the short, medium and long term

• Involving MS, EC, patient representatives, and other relevant stakeholders

• Develop by 2011 a joint action providing a platform for cooperation between member states on forecasting HWF needs and workforce planning

• Development of comprehensive action plan on HWF by 2012

• Implementation of the WHO Code of Practice and continue taking up EU leading role in this process

EU action on health workforce

• Green Paper on the European Workforce for Health

(Dec 2008)

• Followed by a public consultation and a series of policy

dialogues in 2009-10

• BEL Presidency 2010:Investing in Europe’s Health

Workforce of Tomorrow: Scope for Innovation and

Collaboration

– joint action on forecasting HWF needs and workforce planning

– Implementation of the WHO Code of Practice international

recruitment of health personnel

• HUN Presidency 2011:

– health professional mobility and health systems

– Towards modern, responsive and sustainable health systems

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EU 2020 Strategy for smart,

sustainable and inclusive growth

• Exit from the crisis, entry into structural change

• 5 target areas, including employment, innovation,

education

• 7 flagship initiatives, including

– Youth on the move

– An agenda for new skills and jobs

• Instruments

– Structural funds

– Joint actions

– European Innovation Platform "Active and Healthy Ageing”

18

Analysing

Health Systems and Policies

Thank you

for your attention

wpa@obs.euro.who.int