Health workforce sustainability: A public health perspective on EU policy initiatives

HW4All National Workshop - Netherlands18 June 2014, Utrecht

Sascha MarschangPolicy Coordinator for Health Systems

European Public Health Alliance (EPHA)

OVERVIEW

Presentation outline

Background info: EPHA

Horizon scanning: Challenges for HWF planning

European policy response to health workforce (HWF) ‘crisis’

Public health perspective

‘Recommendations’

WHO ARE WE?

The European Public Health Alliance (EPHA)....

Is a Brussels-based network representing the public health community

+/- 90 member organisations based in EU-28 and EEA/EFTA & beyond

Members include disease-specific organisations (e.g. cancer, diabetes, cardiovascular, HIV/AIDS, mental health), health professionals (nurses, doctors, pharmacists, emerging professions, etc.), vulnerable groups (e.g. older people, children, migrants, Roma), regional & academic interest…

Advocates for more people involvement and transparency in political decision-making processes on health policy at EU level

WHO ARE WE?

EPHA....

Mission: To bring together the public health community to provide thought leadership and facilitate change; to build public health capacity to deliver equitable solutions to European public health challenges, to improve health and reduce health inequalities.

Vision: A Europe with universal good health and well-being, where all have access to a sustainable and high quality health system; a Europe whose policies and practices contribute to health, both within and beyond its borders

Values: equity, sustainability, diversity, solidarity, universality, good governance

Horizon scanning

• Ageing European society

• Increase of chronic diseases & multimorbidities, mental health problems

• ‘Healthy and active ageing’, desire to be independent & engaged into old age

• Increased diversity & migration

• Technological & scientific progress

• eHealth (Electronic Health Records, ePrescription, telecare…)

• mHealth (apps, tablets, remote monitoring, online fora, social media, virtual reality, etc.)

• Robotics, domotics

• Genomics & personalised medicine

• Better informed patients, higher expectations: ‘co-producers’ of health?

Horizon scanning

• Paradigm shift from treatment to prevention / health promotion

• ‘Wellbeing’ & consumer choice (e.g. Complementary & Alternative Medicine)

• Cross-border healthcare

• Integrated care & multidisciplinary teamwork

• New care models: from primary / secondary to community care

• New roles & responsibilities for healthcare professionals, e.g. nurses

• New actors (other health professions, informal carers, patients, family, volunteers…)

• BUT: HWF shortages & migration, increased workload, bad working conditions, lack of data, constrained budgets, staffing / salary cuts, austerity…

New health actors…

European Commission Press releaseBrussels, 5 May 2014Robin the robot helps take care of 94 year old Italian Grandma Lea

mHealth

Future Health

• Who will be responsible for health? Health professionals, individuals, ICT?

• ICT: problems of relevance, usability, liability, interoperability…

• Health literacy: closing digital divide but widening knowledge gap?

• ‘Patient empowerment’ vs. stress & technological pressure

• Full integration of eHealth / mHealth into health systems?

• New jobs vs. reshaped roles: eHealth is not an ‘add-on’ to working time

• Education & training needed at all levels

• Who is providing health information / delivering health?

• What / who will qualify for reimbursement? Will there be consequences if individuals behave irresponsibly?

Future HealthConcerns

• What data is needed to support HWF planning? Can it ever be collected / compared

• Health impact assessments to justify investments

• Capacity & know-how (e.g. managing European Structural Funds)

• Role of regional / local authorities in identifying obstacles / opportunities

• Need for guidance & regulation re: mHealth, eInclusion…

• Exchange of best practices between countries & regions

• Concrete impacts on health outcomes & inequalities?

• HWF changes take a long time to implement! What can be done now?

EU responseHWF & other initiatives

EC Green Paper consultation on a European workforce for health (2008)

EC Communication ‘An Agenda for New Skills and Jobs’ (Nov 2010)

2010 Council Conclusions on Investing in Europe’s health workforce of tomorrow

EC Communication ‘Towards a job-rich recovery’ (Apr 2012) includes Staff Working Document on an Action Plan for the EU Health Workforce

Joint Action on HWF Planning & Forecasting (incl. study mapping education & training capacities)

Better anticipation of skills needs (incl. European Skills Council for nurses & care workers; study mapping Continuous Professional Development in health professions; training recommendations for healthcare assistants & educational support for informal carers)

Exchange on recruitment & retention (tender re: innovative & effective R&R strategies in MS)

Support ethical recruitment (implementation of WHO Global Code of Practice)

Modernisation of Professional Qualifications Directive (2014)

EU responseHWF & other initiatives

EC Communication on ‘Policy Coherence for Development’ (2009) & annual reports

Global Approach to Migration & Mobility (GAMM; 2005 & 2011)

legal migration and mobility

irregular migration and trafficking in human beings

international protection and asylum policy, and

maximising the development impact of migration and mobility

EC Communication on Mobility Partnerships & Circular Migration (2007)

Council Conclusions on migration and development (2013)

EC Communication on Solidarity in health: reducing health inequalities in the EU (2009)

Europe 2020 strategy for ‘smart, sustainable and inclusive growth’ (2010)

EPHA‘Dignified health workers?’

Awareness-raising / advocacy

Professional Qualifications DIR / EU Working Time DIR / Employer Sanctions DIR

EPHA Briefing on WHO Global Code of Practice ( Nov 2011)

EPHA / EFN article ‘The WHO Global Code: A Lever for Stimulating Better Health Workforce Planning?’ (Jun 2012) re: implementation challenges

Joint Statement with Medicus Mundi & HW4All re: Tallinn Declaration (Oct 2013)

Civil Society Commitment 3rd Global Forum on HRH (Nov 2013)

Seminar on Action Plan on EU Health Workforce (Nov 2013)

Co-promoters of HW4All Call to Action ‘A Health Worker for Everyone, Everywhere!’

Migration indicates bigger flaws in health systems

LMICs and Europe affected by ‘brain drain’ (East-West, South-North flows)

EPHAAwareness-raising / advocacy

Working conditions / attractiveness of professions, planning & forecasting, recruitment & retention, skills-mix, education / training, data needs, performance indicators…

Impacts of economic governance and austerity measures

Impact of HWF shortages on quality of care and on individuals / population groups (e.g., patients, vulnerable groups, health professionals)

Solidarity vs. increase in health inequalities

Human rights aspects of HWF mobility: health system vs. individual needs

Expansion of HWF in Europe, e.g. emerging professions, informal carers

Development of (public health) competences (e.g., EPHO7 Working Group)

PositionBriefing on WHO Global Code (2011)

‘EU governments (…) need to close demand gaps by planning their HWF needs more effectively and proactively. It is not acceptable that EU Member States organise their health

systems based on the assumption that they can rely on migrant health workers to fill significant proportions of their health workforce needs (…)

Training sufficient numbers of health personnel, retaining existing workers by improving working conditions and salaries, and correcting geographical maldistribution to avoid health

inequalities is one of the biggest workforce challenges for achieving the Europe 2020 strategy goals.’

Health workforcePolicy options / guiding questions

Planning & educating for self-sustainability

Temporary migration based on short-term economic needs

Bilateral / multilateral agreements

Managed migration leading to permanent residence & citizenship

EU Blue Card Scheme

Circular migration (triple win or loss?)

Twinning, exchanges, internships

Shift commuting (intra-EU)

Ethical international recruitment respecting WHO Global Code

What are the reasons for shortages?

Can data capture them?

Are jobs long- or short term?

Can gaps be filled at regional / national level?

Who (else) is available to do the job?

How can planning and investments avoid future shortages?

What are the aspirations & needs of migrants? Are their rights respected? Who is their employer?

What if circumstances change?

Health workforce

EPHA supports HWF solutions that…

Demonstrate policy coherence between health, development, employment, mobility, etc. (HIAP approach)

Strike a fair balance between health system & individual needs (migration)

Improve health system efficiency and patient safety via new forms of collaboration between & amongst health professionals and patients

Involve individuals in the policy-making process (e.g. eHealth)

Facilitate the core work of health professionals by freeing up time for patient contact

Meet the needs of vulnerable individuals / groups: provision of stratified health services

Increase quality & continuity of care, e.g. interdisciplinary teams in primary and hospital settings, new arrangements between HCPs and individuals in community care…

Allow health professionals and carers to develop their competences in line with changes

Dank u voor uw aandacht!Sascha Marschang

Policy Coordinator for Health SystemsEuropean Public Health Alliance (EPHA)

Rue de Trèves 49 – 51, 2nd floorBE - 1040 Brussels+32 (0) 2 233 3883

s.marschang@epha.orgwww.epha.org