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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). Presentation outline Background info: EPHA - PowerPoint PPT Presentation
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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