NHS European Office

No country is an island – tackling health workforce supply challenges across Europe

Kate ling

11 / 5 / 2016 4.15pm

Kate Ling, senior policy manager for the NHS Confederation’s European Office, reflects on her time in Mons, Belgium, where European member states came together recently to tackle the shared challenges of health workforce planning.

Health and social care organisations across England are battling to maintain and improve services within current resources. Politicians and policy-makers debate the ‘demographic timebomb’ of an ageing population, coupled with ever-increasing demand and fewer young people to join the healthcare professions. Where are our doctors, nurses and other healthcare professionals going to come from in future?

Are we alone?

The UK has always relied heavily on overseas staff to run our health service; historically, from Commonwealth countries, and more recently from other European countries too. The UK is a magnet for highly qualified health professionals from the rest of Europe: about 10 per cent of doctors working in the UK qualified in other EU countries, and a staggering 17 per cent of dentists. In addition, there are many more training places in England for doctors and nurses than there were ten years ago. Yet we still struggle to fill posts in certain geographical areas or medical specialties such as general practice and accident and emergency medicine. Are we alone in facing this dilemma?

Not at all. Earlier this month I took part in the final event in Mons, Belgium of the Joint Action on Health Workforce Planning and Forecasting, an initiative funded by the EU that brings together European member states to tackle these issues jointly. Across Europe there are critical shortages of healthcare staff, especially in remote, rural and/or unattractive areas, and imbalances both between and within countries. Some countries that cannot afford to pay as well as their wealthier neighbours, experience a ‘brain drain,’ primarily from eastern to western Europe, which they try to fill by importing staff from outside the EU. Others (mostly in southern Europe) have been hit hard by the economic crisis and have had to cut posts, leaving highly skilled staff looking for work abroad. Meanwhile, other countries are over-reliant on imported staff and need to work towards greater self-sufficiency. But, in the current economic climate it is not easy to take a longer term view and invest now for the future.

Sharing expertise to build robust systems

It’s clear that no one country can tackle these challenges on its own. The aim of the joint action has been to help member states build robust national workforce planning and forecasting systems that will help them anticipate (and plan for) future workforce needs, to identify pinch points and develop strategies to combat them. Countries such as the UK, which have relatively well-developed workforce planning systems, have shared their expertise with the many countries that have had little or no systematic planning until now, and have developed a handbook of workforce planning methodologies and a planning and forecasting guide.  From the UK’s point of view this is not a one-way traffic – our own track record demonstrates that we don’t always get it right. We have learned from the approaches and methods of some other countries and – most importantly – have contributed to raising standards of workforce planning across Europe, from which we will ourselves benefit in future.

Raise standards overall

Of course it’s not just about quantity, but quality. If we import staff qualified elsewhere to help run the NHS we want them to be as good as possible. We need to bear in mind that there are significant variations in curriculum, scope of practice, culture and expectations between staff trained in different EU countries. So it’s very much in our interest to work with other member states to raise standards overall. Not to mention the nearly 2 million British citizens who live in Spain or other EU countries and access local health services, or our own young health professionals who may relish the chance to travel and work elsewhere.

Nor is it just about more of the same. The joint action has highlighted the different ways in which countries use their healthcare professionals. For example, nurses performing tasks in one country that doctors would be expected to do in another, and the development of new roles and skill mixes to provide the kind of healthcare that will be needed in future. Workforce planning has to evolve constantly to take into account changes in medical technology, new treatments and techniques as well as societal changes such as an increase in long-term, chronic conditions, more care outside the hospital environment and an increasingly feminised workforce. 

So, although the joint action is coming to a successful conclusion, the event I attended was anything but a closing event - rather the opposite. Next steps canvassed included building a network of workforce planning experts across the EU to exchange best practice and share knowledge. Such a network could help to: 

  • improve the evidence base across Europe by building a more accurate picture of the EU health workforce, migration patterns and trends
  • build capacity at member state level to plan effectively on the basis of sound information
  • inform policy makers and politicians when deciding when, where and how much to invest in education and training of healthcare professionals – decisions that must be made at national level but need to be taken in the light of the wider migratory picture
  • inform decisions about the kind of roles and skills that will be needed, rather than simply replicating historic patterns, and how existing health professionals’ skills can be constantly refreshed and updated
  • share successful approaches to recruiting and retaining the people we need.

Mons has the melancholy distinction of being ‘the first and the last’ – the city where the first and last British soldiers were killed in the first world war. Over a hundred years later in Mons, participants from 28 countries worked on the same side to face a common enemy. Although there is no universal panacea - each country has its specific challenges – co-operation at European level can only strengthen, rather than undermine, our national health systems. 

Kate Ling is a senior policy manager at the NHS European Office, part of the NHS Confederation. 

Follow the organisation on Twitter @NHSConfed_EU.

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