April 28, 2015
Guest blogpost by Sascha Marschang, European Public Health Alliance & Linda Mans, Health Workers for All.
The economic crisis has led to increased mobility of health professionals within Europe and in some cases it has even replaced recruitment from non-EU member states, thereby adding a distinctly European dimension to the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel. Large numbers of health workers from Southern Europe escaping unemployment and austerity policies are being joined by their peers from Romania, Bulgaria and other EU accession countries where salaries remain extremely low.
While the many health professionals opting for either short or long-term spells abroad cannot be blamed – after all, doctors and nurses benefit from automatic recognition of their credentials under the Professional Qualifications Directive, opportunities are easily identified on the Internet, and labour mobility is generally encouraged in the Single Market – the recent surge in mobility is also a sign that something isn’t quite right in Europe’s health systems. On the one hand, there are poor employment and career prospects, low salaries and deteriorating working conditions, while on the other hand we witness significant and persistent vacancies in many destination countries.
Worse still, while certain gaps are being filled in the North, they open up new ones in countries of origin where health systems are much less able to cope with the loss of qualified professionals and where patients cannot afford to travel to bigger cities in order to access healthcare services and medicines. In light of this, wouldn’t it make sense if all EU health systems, both in richer and poorer member states, adopted strategies for achieving self-sustainability? And for international recruitment to become an exception rather than the norm? A plea also supported by the European Health Commissioner Vytenis Andriukaitis.[i]
Two case studies brought to light by Health Workers for All (HW4All) partners Redemptoris Missio (Poland) and Health Poverty Action (UK) highlight the growing importance of ‘taking stock’ of the numbers of health professionals that are actually entering and leaving domestic labour markets. Knowing who’s coming and who’s going will not only equip health systems to better plan ahead for a sustainable future but it also creates better awareness of the global consequences of unbalanced migratory flows. Both points are also underlined in HW4All’s European Call to Action in support of the enactment of the principles enshrined in the WHO Global Code of Practice. Although it is important to note that moves towards self-sufficiency in training, recruiting and retaining health workers should not undermine the right of individual health professionals to seek opportunities to work and develop their careers in another country.
Since EU accession in 2004, Polish workers including health professionals have been among the most mobile in Europe and many thousands continue to engage in short- and long-term migration in order to access employment in other EU and EFTA countries. There is an abundance of inexpensive travel options which enable Polish health professionals working abroad to maintain active links with their country of origin, and relative proximity to key destination countries makes back-and-forth movement a distinct possibility. Most recently the Polish economy has seen big improvements and rising salaries prompting the return of some of the earlier migrants, however jobs in Western Europe are still much better remunerated. Unsurprisingly, such flux makes it difficult to determine the actual scale of migration of Polish health professionals.
To obtain a clearer picture, the National Chamber of Nurses and Midwives in Poland proactively realised the importance of working with the appropriate stakeholders in other EU member states – mainly professional associations – and made direct requests about the numbers registered in these countries. The result was that, although data was not always accurate, is could be used as a means to raise awareness of the problem and influence health workforce policy in the Polish health sector.
Another good practice example is the extensive Labour Market Review exercise carried out by the UK Royal College of Nursing (RCN). Well connected, multicultural and flexible, the UK remains the top destination for foreign health professionals in Europe (in overall numbers), also as a result of the dominance of the English language and the job opportunities offered by the NHS and care home sector. However, this does not necessarily mean that individuals are staying long term, i.e. due to comparatively high costs of living and transportation. Many people are ‘dipping in and out’ of the UK labour market, something that is generally more complicated to do in other EU countries. Hence the RCN review becomes all the more important: based on the Nursing and Midwifery Council’s register of healthcare professionals (the largest worldwide), data gathered by the Office for National Statistics and the number of training places commissioned by universities, it provides the most accurate picture possible of the UK nursing labour market including both information on the overall workforce and on the number of internationally recruited nurses. Importantly, the latter point also includes an analysis of the effects of this practice on a global level, and the RCN uses this data and other sources such as the RCN Frontline First reports to identify future needs of the nursing workforce, inform about best practices and develop policy responses to national, European and international issues. Hence the Labour Market Review is not only a tool to inform workforce planning but also an instrument for policy development and advocacy at national and supranational levels. These include its forthcoming position statement and practical guidance for internationally recruited nurses.
It is however important to realise that data limitations exist. For example, the number of registered health workers doesn’t reflect the real numbers. There are many possible reasons for this: not all health professionals on national registers are actually working or they may be working in less skilled jobs in other sectors which often generate higher salaries than professional work at home. Moreover, the different health system structures and functions available in a given country (e.g. dissimilar job categories and support positions, opportunities offered by the private sector and recruitment agencies, consultant jobs, etc.) means that not everybody is easily captured. Some health professionals only engage in (very) temporary shifts or they habitually work in more than one foreign country, modes of working that are also difficult to track. Finally, human nature and circumstances prompt people to form families or pursue further education, i.e. they might leave the profession for good. The RCN’s review is very broad, and often more detailed information (e.g. breakdown of registrants by individual country) has to be sought through individual Freedom of Information requests to regulators and other authorities, rather than being readily available. This makes it more difficult to analyse the impact of outflows and the needs of individual countries both in the EU and those suffering critical shortages in the developing world. We therefore appreciate the European Commission supporting a European network to improve health workforce planning and forecasting and better data collection and availability.
Nonetheless both case studies should be seen as good practices as they illustrate a growing recognition that effective domestic and cross-border collaboration with relevant authorities and stakeholders in order to obtain reliable data is crucial to move ahead with the successful application of the WHO Global Code of Practice in Europe. They also make a case for the utility of establishing a practicable European system for data collection, storage and dissemination of health professional movement in the 21st century.Blogactiv Team