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

1. Health workforce sustainability: A public health perspective on EU policy initiatives HW4All National Workshop - Netherlands 18 June 2014, Utrecht Sascha Marschang Policy Coordinator for Health Systems European Public Health Alliance (EPHA)

2. Presentation outline Background info: EPHA Horizon scanning: Challenges for HWF planning European policy response to health workforce (HWF) ‘crisis’ Public health perspective ‘Recommendations’ OVERVIEW

3. TheEuropean 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?

4. 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: AEurope 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 WHO ARE WE?

5. 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

6. 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… Horizon scanning

7. New health actors… European Commission Press release Brussels, 5 May 2014 Robin the robot helps take care of 94 year old Italian Grandma Lea

8. mHealth

9. Who will be responsible for health? Health professionals, individuals, ICT? ICT: problems of relevance, usability, liability, interoperability… Health literacy: closing digital divide but widening knowledgegap? ‘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 Health

10. 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? Future HealthConcerns

11. 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) Supportethical recruitment (implementation of WHO Global Code of Practice) Modernisation of Professional Qualifications Directive (2014) EU responseHWF & other initiatives

12. 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) EU responseHWF & other initiatives

13. 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) EPHA‘Dignified health workers?’Awareness-raising / advocacy

14. 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) EPHAAwareness-raising / advocacy

15. ‘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.’ PositionBriefing on WHO Global Code (2011)

16. 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?

17. 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 andpatient 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 Health workforce

18. Dank u voor uw aandacht! • Sascha MarschangPolicy Coordinator for Health SystemsEuropean Public Health Alliance (EPHA)Rue de Trèves 49 – 51, 2nd floorBE - 1040 Brussels+32 (0) 2 233 3883s.marschang@epha.orgwww.epha.org