Significant national investment in the health labour force across the European Union (EU) is needed to address skills and labour shortages, attainment and retention of staff, and the preparation of the workforce for green and digital transitions, according to several public health bodies.

A regional report published by the World Health Organization (WHO) Europe in September 2022 warned of a “ticking timebomb” threatening health systems in Europe and central Asia. As well as an ageing population, much of Europe is experiencing an ageing health workforce, with 40% of medical doctors in a third of countries across the WHO European region already aged 55 years or older. Along with a surge in chronic illnesses and the effects of the Covid-19 pandemic, the report warned of imminent collapse in key areas of countries’ health systems unless political actions tackle these issues promptly.

The role of Covid-19 in exposing pre-existing shortages

While highlighting the importance of the healthcare workforce, the pandemic also brought to light pre-existing challenges related to staff retention, working conditions, and labour and skill shortages.

Perhaps most notably, the pandemic laid bare the shortage of doctors and nurses in many countries. According to a recent report from the European Policy Centre (EPC), in 2019, there were on average 3.9 doctors and 8.4 nurses per 1000 population in the EU. While this signalled an increase of 16% and 14% over 10 years, the demand for care has grown at a faster rate due to the ageing population and the increasing burden of chronic diseases.

“We could face a crippling shortage of nearly 1.8 million healthcare workers, and the numbers are climbing,” Dr Hans Kluge, WHO Regional Director for Europe, told the European Health Forum Gastein in September 2023. He went on to say: “In some countries there are just 2.4 doctors for every 1,000 people. That’s not a gap. It’s a gulf.”

Irene Mandl, Head of Information and the EURES European Employment Services unit at the European Labour Authority, told the BMJ: “A shortage of specialist medical practitioners has been identified in 16 out of the 31 countries we are investigating.”

In some countries, over 80% of nurses have reported some form of pandemic-related psychological distress, with WHO Europe having received reports that nine out of 10 nurses had declared their intention to quit their jobs. A report by the EPC’s Policy Analyst, Danielle Brady, and Associate Director and Head of the Social Europe & Well-being programme, Elizabeth Kuiper, concluded that it was “imperative that initiatives to improve the wellbeing of the health workforce are prioritised and incorporated into the EU’s European Mental Health Strategy”. Put forth by the EPC, member state action should be complemented with EU-level programmes to upskill and reskill the health workforce.

The 2023 Bucharest Declaration

In March 2023, representatives from 50 out of 53 Member States of WHO Europe joined health workers, their unions, and associations, along with academics and experts, in adopting a bold declaration urging political action and commitment to protect, support and invest in health and care workers across Europe and central Asia.

Co-organised by WHO Europe and the Romanian Ministry of Health, the Bucharest Declaration comes against the backdrop of a crisis affecting health workers across Europe, which has led to widespread strikes and industrial action.

Sandra Gallina, Director General for Health and Food Safety at the European Commission pointed out that despite an increase in impact since Covid-19 hit, shortages are not a new problem. “There are long-term problems with staff retention, money, motivation, upskilling, and with medical deserts appearing,” she recently told the BMJ.

In response to the challenges outlined above, the 2023 Bucharest Declaration called for political action to:

• Improve the recruitment and retention of health and care workers
• Improve health workforce supply mechanisms
• Optimise the performance of the health and care workforce
• Better plan the health and care workforce
• Increase in public investment in workforce education, development, and protection.

The Declaration recognises the links between these priorities and the need for collaboration with all stakeholders, including health and care workforce representatives, their employers, national ministries of finance and education, and international non-profit organisations, trusts, and foundations.

Andrzej Rys, Director of Health Systems, Medical Products and Innovation for the European Commission, emphasised the importance of investing in keeping people in good health for as long as possible. He said: "At the same time, investing in the national health workforce is an essential part of that, keeping health professionals current, safe to practice, and able to meet new skill needs.”

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