NCW recommendations on a European Workforce for Health:
Pre-Budget 2011

Publication by the European Commission of the Green Paper on the European workforce for health. Demographic change and its impact on the workforce and workload in the healthcare sector are described by the Green Paper.

Overview
EU health systems have to deal with constantly increasing demands on health services, respond to changing health needs and be prepared for major public health crises. At the same time, there is a high level of expectations with regard to the quality of healthcare services. The Green Paper concentrates on nine key areas:
• Demography
• Public Health Capacity
• Training
• Managing mobility of health workers within the EU
• Global Migration of Health Workers
• Data to support decision-making
• The impact of new technology: improving the efficiency of the health workforce
• Strengthening the principle of self-employment
• Cohesion policy.

In the Green Paper, the European Commission sets out key questions relating to the problems and challenges of healthcare provision so as to encourage discussion. These key questions include:
• the ageing population;
• new technologies;
• the need for healthcare services to be more accessible;
• service quality and, with that, more cost-intensive treatments;
• the outbreak and potential of epidemic diseases, and
• local availability of healthcare

Definition of "Healthcare workers": all those working in the healthcare sector who provide services in patient care and welfare, nursing care, social and welfare services, and all those belonging to specialised professions. Preventive and curative healthcare both have an economic component. The healthcare sector requires trained and experienced staff with recognised qualifications. These make up a significant part of the knowledge society

Recommendations
• Measures should be taken to make jobs in the health care sector more attractive to young people, so that later on, more of them enter the healthcare professions or look for jobs in the sector. If more young people, and more men, are to be encouraged to choose careers in healthcare, nursing care and social care, such employment must be made more attractive through better pay and working conditions throughout the whole of their career.
• Sufficient staffing capacity should be created in health care systems to meet health care needs, boost health care, health promotion and disease prevention.
• The use of new technologies in healthcare is to be encouraged where these reduce the workload of healthcare staff, improve the quality of care and support patients. The EESC is aware that this may lead to a re-examination of how the division of tasks among health care staff works in practice.
• Priority should be given to the key role of social standards in ensuring a high quality of patient care and patient safety, and is unequivocally opposed to any attempt to undermine these (no race to the bottom).
• Emphasis should be put on the key part the professions play in the health care sector, alongside hospitals and publicly-run health services, since it is in large part through these professionals that personal treatment and care can be secured in an environment of competence and safety.
• However caution is needed in the Green Paper proposal to encourage healthcare workers to practice as self-employed persons, especially in view of the increasing trend towards apparent self-employment where this is problematic for the particular activity concerned (e.g. nursing and care of the elderly).
• The discussion about a new division of tasks in healthcare with the aim of replacing treatment by qualified staff with cheaper alternatives needs to be carefully addressed. Structural considerations regarding the division of tasks among the healthcare professions should be focused on clinical need, skill levels and the needs of patients.
• Healthcare institutions and their staff provide services of general interest and that more use should therefore be made of the Structural Funds for their training. It is vital to ensure conditions which can enable healthcare professionals to participate in continuous training programmes, thereby ensuring they can extend the breadth and depth of their skills, and also helping to remedy the under-provision of healthcare in structurally weak regions.
• Priority should be given to the outstanding role the social partners and social dialogue in determining pay, working conditions and skills for healthcare workers.
• The contribution of social professions who play a key role in patient welfare and care and thus have a significant role in healthcare should be considered and acknowledged

NCW has noted that the proportion of women working in the health care sector has risen over the last few years, and that their number is very likely to increase further and therefore suggests measures to make it easier to reconcile professional, family and private life in order to secure the supply of health service employees and skilled workers in the sector.

This applies across the board. Equal treatment is necessary to ensure gender equality in accordance with the Equal Treatment Directives and also to encourage more men to go and work in the various parts of the healthcare sector. This would include measures to help reconcile work and family life, recognising skills used and the onerous nature of the work involved, and to help women stay in employment and support those re-entering the labour market after extended periods looking after families

Data to support decision-making
It is important for national statistics to be comparable across Europe. One obstacle is the fact that some health care professions are classified differently in the various Member States. Distinctive national features relating to competence and descriptions of healthcare professions should not be concealed for the sake of achieving uniform indicators. Corresponding statistics be compiled on health professions in Europe and on migration between states.

In general terms, data should be improved by establishing a data register. The monitoring of health care professions referred to in the Green Paper could be tied in with other EU projects, such as steps to promote health care information systems and to improve the communication between national registers – where these exist – for all professions.

The impact of new technology: improving the efficiency of the health workforce
The EESC suggests that research look into whether new technologies can, in the interests of the workforce, be used together with new opportunities for treatment, tied in with electronic communications networks and provided comprehensively in very remote areas, including arrangements for self-diagnosis and patient participation

Before new technologies can be introduced:
• they need to be accepted by the medical professions.
• to secure such acceptance, those working in this domain must be involved in developing the e-health technology, to make sure that the electronic tools used in everyday practice can be used in a straightforward, safe manner.
• proper, optimal training of medical staff in the new technologies is essential if they are to be successfully introduced.
• the introduction of new technologies must be geared to the different national health systems. it could trigger a change in the national laws on medical accountability applying in every Member State.

Even during the financial crisis, Member States should still be willing to provide adequate funding for their health care systems (financial management), not least to ensure that there are adequate staff resources that can provide high-quality services. This also involves improving the working conditions of employees in this sector.

Grace Attard, NCW President