Healing Europe's Jobs Disease

The constant refrain of European politicians is the urgent need to create jobs—no surprise in a continent with high and rising unemployment. Across the European Union, 25 million people were jobless this autumn, and in Spain and Greece there is now a quarter of the working population without jobs.

Peter O'Donnell

Inevitably, the search is on for sectors that offer the best hopes of boosting employment—and healthcare is increasingly seen as one of the most promising sectors to examine. The pharmaceutical industry in Europe already sets a fine example. According to figures from its principal European federation, EFPIA, its members employed 660,000 people directly in 2011.

Germany is the largest employer, generating more than 100,000 direct pharma sector jobs, and is closely followed by France, with 97,000. The United Kingdom and Italy come next, each with more than 66,000. And Spain, Switzerland, Poland, and Belgium each provide more than 30,000 jobs. Ireland, Hungary, Romania, and Denmark each generate more than 20,000 as well.

Not only does the sector create direct jobs, but it generated three to four times more employment indirectly—upstream and downstream, says EFPIA. This is attributed largely to its research function, and, EFPIA points out, many of these indirect jobs are of high value, in areas such as clinical science or in academia. The presence of a highly-skilled workforce was one of the key factors in the industry investing €27.5 billion in R&D in Europe last year, it says.

The industry story gets better and better, claims EFPIA. Direct employment has risen to its current level from just over 500,000 in 1990—something like a 35% increase in a decade. And at the same time, the number of direct employees in research has risen too—from 76,000 to 116,000, an even steeper rate of increase.

Wider healthcare sector

Andrzej Rys, the director responsible for health systems in the European Commission (and one of the senior officials behind the proposal to update the clinical trials rules), has been extolling the merits of the healthcare sector as an employer, too. "Health professionals play an important role in the EU economy, accounting for about 17.1 million jobs," he said in a statement in November.

The prospects are good for further employment too, he went on: "With an aging population—the number of people aged 65 and over is projected to almost double over the next 50 years, from 87 million in 2010 to 153 million in 2060—and the rising demand for healthcare, the sector will remain a driver for providing jobs in years to come."

But he underlined the need for greater skills to meet the evolving workforce demand. "The economic crisis has put health systems under pressure to make fundamental reforms in the way they deliver healthcare. New forms of care delivery and new technologies coupled with organizational changes will depend on a highly qualified health workforce equipped with the right skills," he said.

More broadly, the health sector has been specifically recognized as a potential source of employment salvation through healthcare jobs. EU ministers have been promoting the idea energetically, with formal conclusions inviting member states and the commission to support the development of policies on the health workforce. Ministers have shown they are interested in quality as well as quantity. Their focus is on how to assess competence profiles for workers, how to improve planning on the basis of identified health needs, and how to build for the long term. They suggested that the commission should create a platform for cooperation between member states on forecasting health workforce needs and health workforce planning.

As a result, healthcare now appears in the European Commission's strategy for boosting employment across the EU. An "employment package" launched by the commission earlier in 2012 contains recommendations to national governments to coordinate their action on job creation, labor-market reforms, investment in skills, and employment policies and funding. The recommendations aim to provide job seekers with more training and more job opportunities, and to ensure that those in work would get help acquiring the skills they need to stay up-to-date with changing job requirements.

This scheme targets the health sector as a generator of jobs in the longer term. An action plan for the EU health workforce sets out actions to support European cooperation to ensure a sustainable health workforce in the EU. The elements include—in line with ministers' urgings—improved workforce planning and forecasting through a dedicated European platform; better anticipation of health professionals' skill needs, through closer collaboration on education, training, and health; and improved recruitment and retention of health professionals by mapping innovative strategies.

Consultation

These reflections on the employment aspect of healthcare have been going on for several years now. Back in 2008, the commission recognized that progress on improving health and providing better access to healthcare for all cannot be made without a workforce of sufficient capacity and skills. Since then, the commission issued a consultation document that sought wide views on how to tackle these issues facing the health workforce in the EU. The paper suggested that the growing shortage of health workers was a central problem for health systems—a point endorsed by most groups and individuals who responded to the consultation, with repeated alerts to inadequate numbers, particularly of specialist doctors and nurses. One of the main messages to emerge was the danger from an unfortunate coincidence: the predicted increase in chronic illness and concomitant demand for healthcare from Europeans' longer life spans are going to occur just as much of the European health workforce is itself approaching retirement age. On current projections, there will be a lack of new health professionals to replace them, it is feared. As health needs multiply and the replacement of health staff is not guaranteed, more universities, training schools and teachers will be needed, and it will also be important to plan which specialized skills will be the most necessary.

Another of the problems highlighted was the lack of data on healthcare employment. Respondents urged the European Commission to promote the collection of better quantitative and qualitative data to support decision-making and improve working conditions, which are seen as a pre-requisite for improved recruitment and retention. There was wide consensus that better data are also needed on staff mobility—which can be positive in helping adapt supply to demand, with professionals going where they are most needed, and often enhancing their skills through exposure to other approaches. However, there is a related risk that unfettered mobility can create imbalances and inequalities in terms of availability of health staff.

Thirty five doctors' organizations replied to the public consultation. Among their principal worries were the risk that shifting tasks to non-medical staff would negatively impact the quality of care and patient safety, and the threat that new technologies—with all their many merits—could impair doctor/patient confidentiality. They urged an update to the minimum training requirements for doctors, to take account of scientific progress and the subsequent evolution of medical training, and they recommended EU-wide recognition for certain professional qualifications, along with better linguistic competence (since the 27 member states of the European Union enjoy 23 official languages, with dozens more regional and minority languages and variants). Doctors also suggested action to raise awareness in schools about career opportunities in the health sector, as well as more vigorous efforts to retain the existing workforce.

As a footnote, as it were, to so much consensus, there was one area where the consultation revealed sharply divided views: the extent to which entrepreneurialism should be encouraged in healthcare provision. Starting from the evident fact that many health workers run their own practices and employ staff, the consultation suggested encouraging more entrepreneurs to enter the health sector in order to improve planning of healthcare provisions and to create new jobs. It even went so far as to recommend removing the barriers to entrepreneurial activity in the health sector. But while many doctors and individuals thought this was an attractive option, entrepreneurship proved to have negative connotations for many others, and fears were expressed that the commission was calling for deregulation of health services, and threatening patient safety.

The commission is still reflecting on the results of the consultation, to see just where and how the EU can contribute to tackling the challenges identified. But by early 2013, some clear proposals are expected. Meanwhile, it has to solve another dilemma—how to ensure that healthcare workers can move around the EU without too much administrative complications over recognizing their qualifications. Five healthcare professions—doctors, dentists, pharmacists, nurses, and midwives—benefit from a special regime of automatic recognition. But the system has been criticized for being too slack by opponents, and too rigid by its supporters. The EU is attempting a compromise for these professions, by proposing to update the minimum training requirement—which were harmonized as long as 30 years ago. A new control is also proposed, requiring national health authorities to alert all other member states if a health professional has been prohibited from exercising his professional activity by a public authority or a court. But every new safeguard to protect the public amounts to a further obstacle to health professionals changing country, limiting that principle so precious to the EU of free movement of workers. Inevitably, therefore, the proposals have run into widespread opposition.

Peter O'Donnell is a freelance journalist who specializes in European health affairs and is based in Brussels, Belgium.