Staff burnout and demographic changes threaten a permanent contraction in the European health workforce, with the sector’s leaders warning they may never restore the capacity to treat patients to pre-pandemic levels.
Across the continent, clinicians are confronting a damaging mismatch between demand and resources, with public spending cuts forcing them to consider different ways of treating patients.
“Covid-19, an ageing society and people who feel really overworked . . . might add up to a long-term reduction in the capacity of the healthcare system,” said Heyo Kroemer, chief executive of the Charité hospital in Berlin, one of Europe’s biggest teaching hospitals. “I’m not really sure whether in Germany we will ever come back to the 2019 capacity.”
Chronic shortages have been aggravated by a struggle to replace workers who have left public health services. Kroemer’s concerns are shared across Europe. Elie Azoulay, professor of critical care medicine at Saint-Louis Hospital in Paris and president of the European Society of Intensive Care Medicine, said that between 15 and 25 per cent of hospital beds across the EU were out of commission because of a lack of personnel.
Staff must still cope with a big backlog of treatment even after the World Health Organization declared an end to the pandemic on Friday. Stefano Fagiuoli, a 64-year-old gastroenterologist at Bergamo Hospital in northern Italy, said he and his colleagues were “working at a rhythm more than 100 per cent higher than in 2019, but staffing levels have not increased proportionally”.
He added: “Plus, we have three years of fatigue and psychological pressure behind us.”
The trends had hit some EU countries worse than others, said Azoulay, whose organisation represents more than 10,000 intensive care staff. Central Europe was “very much affected”, with nurses from Romania and the Czech Republic leaving to help fill staffing shortages in wealthier countries such as Germany.
Giuseppe Bonsignore, a 61-year-old radiologist, from the Villa Sofia-Cervello hospital in the Sicilian city of Palermo, said six emergency room doctors had left in recent weeks, two of them moving to northern Italy to undertake less intense on-call work. His own department was now short of 10 doctors, he noted, following recent departures and retirements.
“This means doing more shifts, less holidays,” he added.
In Bergamo, Fagiuoli said a few of his colleagues had left his unit for less-pressured work in the private sector or at other hospitals.
Psychologist Laurence Erdur, who was transferred to Charité’s ICU to support both staff and patients at the start of the pandemic, said some colleagues had struggled then to make sense of the large numbers of young people dying.
While everyone had received the same professional care, the need to treat people who had opted not to be vaccinated had intensified the sense of frustration and helplessness. “When people consider that their work doesn’t make sense, that’s a crucial point where [they] quit the job,” she added.
Reflecting the pressures, health workers in France, Ireland, Germany and other countries have turned to industrial action over the past year to protest against working conditions and a lack of resources. Demographic shifts are leaving health systems with far more elderly people to care for and far fewer workers to undertake that care.
“If you compare the birth year 1960 with the birth year 1975, in Germany you have a decrease in birth rates of more than 30 per cent. So a third of the population will be lacking within the next 10 years,” Kroemer said. International recruitment would only partly make up for this shortfall, he added.
Kroemer said the traditional approaches to hiring workers “will be of limited value because you cannot recruit people who are simply not there”.
Some European countries are bucking the trend. In Sweden, Karolinska University Hospital has increased its overall workforce since the start of the pandemic. Its chief executive, Björn Zoëga, attributed this to the extent of psychological support the hospital offered staff and to Stockholm’s decision to avoid lockdowns, which spared his workforce from the stresses of home-schooling.
“Of course, we lost some staff but we gained some staff,” he said. In March, Karolinska’s nursing staff numbers were the same compared with December 2019, but the number of assistant nurses had increased by 4 per cent and doctors by 9 per cent.
However, Zoëga is braced for the same demographic pressures as the rest of Europe. About 6 per cent of the workforce in the Stockholm region was employed in healthcare, he said, but if the population continued to age at the current rate, that would need to rise to 36 per cent in 10 years and “that is never going to happen”.
The contraction in the region’s health workforce had begun long before Covid because of years of “chronic under-investment”, said Hans Kluge, the WHO’s director for Europe. The UN body estimates that the global shortfall in healthcare workers will reach 10mn by 2030.
Healthcare spending needed to be redefined as an investment rather than simply a sunk cost, he said, with politicians often believing that such expenditure disappeared into “a black hole”. To counter this narrative, he has established an independent commission chaired by the economist Mario Monti, a former Italian prime minister, to rethink policy priorities and consider how scarce resources can best be used.
Covid’s key lesson, according to Kluge, was that there should not be a “false dichotomy” between health and economic development.
Health leaders are focusing on the ways doctors work and patients expect to be treated. Kroemer said using digital technologies more effectively to communicate with, and assess, patients would help a broader shift in focus to preventing, rather than simply treating, disease — an approach he said Germany had been slow to adopt.
“You have to reduce the number of people who get sick . . . to cope with this [demographic shift],” he argued.
Kluge agreed that better use of digital tools was vital, allied with the more flexible deployment of staff. He cited the example of an isolated region in the north of Sweden with emergency facilities operated wholly by nurses, who received advice on diagnosis and treatment from a doctor via video call.
“Nurses and midwives are the biggest health workforce in the region and we could make far better use of that in many countries,” he said. “You’ll never hear me saying that health is everything, but without health there is nothing.”