Rapporteur : Birgitta SACRÉDEUS (SE/EPP), Member of County Council, Dalarna Region

POLICY RECOMMENDATIONS

THE EUROPEAN COMMITTEE OF THE REGIONS (CoR)

1.

welcomes the Political Guidelines for the next European Commission 2024-2029 (1) and their promise of a Union that is faster and simpler, more focused, more united and more supportive;

2.

believes that ensuring a good standard of health across the entire population is essential for the prosperity and well-being of society. A good standard of health has an intrinsic value, while a healthy population promotes competitiveness. Equal care for all citizens on equal terms is therefore of paramount importance. The CoR points out that the Constitution of the World Health Organization (WHO) states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition;

3.

considers that a well-functioning healthcare system is an important factor in the EU’s societal resilience, as described in Sauli Niinistö’s report Safer together – Strengthening Europe’s civilian and military preparedness and readiness (2), thus, supporting health systems should be a priority within the EU preparedness agenda. It is important for healthcare to make preparations so that it can manage risks and ensure continuity even in crisis situations;

4.

notes that there are major differences between the Member States when it comes to responsibility for healthcare. Local and regional authorities are often responsible for healthcare as well as social care and other social services, areas which often impact on each other in terms of skills supply. It therefore needs to be ensured that local and regional authorities are involved in designing and implementing all strategies and plans relating to the EU workforce in these areas;

5.

notes that all healthcare systems – whether national or regional – cannot be resilient without their workforce. The OECD report Ready for the next crisis? (3) identifies healthcare workers as an essential component of all efforts to boost resilience;

6.

considers that regional disparities can have an impact on the resilience and cohesion of society, which are important factors in being able to withstand both health crises and geopolitical crises. This means that the EU and its Member States need to invest in efforts to secure the supply of skills across the entire healthcare system;

7.

calls for increased public investment in the healthcare workforce to ensure fair wages, good working conditions, and sustainable staffing levels. Differences between Member States contribute to the migration of healthcare workers, exacerbating regional inequalities. Emphasises the need for strong public health systems that prioritise workforce well-being and retention, strike a balance between different forms of operation, and ensure equitable access to care;

8.

highlights the urgent need to address the gendered nature of unpaid care work, which disproportionately affects women’s participation in the formal healthcare workforce. The CoR calls on the European Commission and Member States to develop strategies to reduce and redistribute unpaid care responsibilities, including through investments in accessible and quality long-term care services, recognition of informal carers, and integration of care leave in employment frameworks. A comprehensive approach to work-life balance is essential to ensure gender equality in healthcare careers and to mitigate the care burden that is rising with demographic ageing;

9.

notes that the demographics of the Member States pose a challenge: fewer children are being born, our ageing population needs more support from society, and the working-age population is not growing at the same pace as labour market needs (4). This is a challenge for society as a whole, not least when it comes to healthcare;

10.

recognises that climate change and environmental degradation exacerbate health inequalities and contribute to new health risks, requiring stronger public health interventions and sustainable healthcare models;

11.

notes that an ageing population living with multiple diseases simultaneously will need more support from society and more healthcare. Medical advances are enabling people to live much longer, and with illnesses that were previously fatal, and, consequently, health and care-related needs are changing. More older people are also living alone, leading to a decline in support and care from close family; this can contribute to loneliness, affecting their health and well-being;

12.

calls on the EU to support just mobility in the healthcare sector, including in the context of the future EU budget. Health worker drain, similar to youth and brain drain, should be addressed through EU-level instruments that promote more equitable internal mobility and strengthen healthcare systems in sending regions through investment, training, and retention strategies. To this end, calls for support to Member States and regions most affected by health worker outflows, enabling them to sustain quality healthcare services and implement effective retention policies;

13.

points out that, although the number of doctors and nurses per inhabitant has increased in most countries over the last 20 years, the report Health at a Glance: Europe 2024 (5) speaks of a shortage of health professionals, with an estimated shortage of 1.2 million doctors, nurses and midwives in 2022. There are several factors affecting this, and population ageing is also having an impact in the case of healthcare professionals. The shortage of healthcare workers affects each Member State differently, and rural areas are more affected than cities;

14.

points out that not all residents have equal access to healthcare and that this depends on, among other things, where they live. There are areas, known as medical deserts, where access to healthcare professionals is more limited and where people face more difficulties in accessing healthcare (6); calls on the Member States to use data to identify medical deserts, make investments, and take measures to improve access to care in these areas;

15.

agrees with the calls made in the WHO’s 2023 Bucharest Declaration on health and care workforce (7);

16.

believes that the supply of health-related skills is a complex challenge that requires action at all levels and from a variety of perspectives. Considering demographic developments, and the fact that society as a whole is in need of labour, it is not possible to focus simply on increasing the number of staff working the healthcare system. A wide range of measures are needed to address the skills challenge;

Prevention, promoting health and supporting self-care

17.

calls on the European Commission to continue the important health promotion efforts undertaken under the EU4Health programme 2021-2027 (8), and stresses the importance of prevention in strengthening health, preventing illness, and improving mental health, thereby reducing the need for healthcare. Investing in public health for all and in more healthy and autonomous years in an ageing population is a long-term investment that will not only provide people with a decent life but also reduce the need for social support;

18.

believes that the Member States need to work systematically to promote public health, prevent disease through vaccination, and detect ill health early through screening programmes; points out that climate change and environmental degradation can give rise to new health risks and that action is needed to reduce the negative health impact of, for example, pollution and poor living and working conditions;

19.

stresses the need to work on the basis of a broad societal perspective to boost public health and reduce the impact of socioeconomic factors on health. This could, for example, include improving health literacy throughout the population and aiming, in spatial planning, for healthy living environments that encourage physical activity and social engagement;

20.

sees value in a more independent life for people, given them more wide-ranging opportunities to contribute to their own health and well-being through self-care. This can enable individuals to live their lives without continuous contact with, or visits to, the healthcare system, while at the same time potentially reducing the need for healthcare professionals;

Attracting, training and recruiting healthcare professionals

21.

considers that there is great potential in promoting the significant opportunities for meaningful jobs and livelihoods in the healthcare sector. These are important jobs that offer a chance to contribute to the well-being and health of others, enabling them to live decent lives despite illness and ageing. Attracting young people to healthcare professions is key to meeting the skills challenge;

22.

wishes to clarify that training for healthcare professionals needs to be prioritised and that each Member State also needs to maintain the quality of education and training in the field of healthcare. As society changes, future skills needs must be included in healthcare training curricula and in skills development for staff. This will require coordination between the healthcare and education sectors. It may also be useful to review the opportunities available to individuals to train in locations where there is a major need for healthcare professionals, for example decentralised and remote training;

23.

believes that there are opportunities to make it easier for more people to work more and longer in healthcare, for example enabling existing staff to work more providing the conditions for older workers to extend their careers until later in life, and enabling persons with disabilities to contribute their skills. It is a matter both of making the most of people’s skills and experience in a flexible way and of giving them a good opportunity to contribute, in a job that can provide satisfaction and meaning in everyday life;

24.

points out that taking skills as a starting point rather than just training can be an effective way of utilising existing skills, regardless of how they were acquired, and that the validation of skills should be used as a tool, where appropriate;

25.

welcomes the EU’s proposal (9) to create a matching tool in the form of a talent pool consisting of an IT platform that would facilitate matching between EU employers and workers from non-EU countries. Where it is not possible to find competent staff to recruit within one’s own country or from other EU/EEA countries, the conditions need to be in place to recruit from outside the EU/EEA;

26.

is in favour of the IT platform building on the existing system of the European Employment Services (EURES) and of simplifying the process of recruiting labour. Under the proposal, only occupations on the EU list of shortage occupations would be included in the matching tool; however, the Committee stresses the importance of developing a methodology for drawing up this list, in order to reflect the actual shortages in specific professions across the various EU Member States; also believes that it is beneficial for the Member States to be free to choose whether or not to participate in or join the proposed platform;

27.

recommends compliance with the WHO Global Code of Practice on the International Recruitment of Health Personnel, so that the recruitment of healthcare professionals from other countries is carried out in a way that benefits healthcare systems in these countries, as well as preventing, for example, work-related exploitation and brain drain (10);

28.

believes that, when recruiting from other countries, it is essential to focus on language development and training, as good language skills are essential for the communication with patients, relatives and colleagues that is so important;

Promoting healthy workplaces, developing ways of working, and harnessing the potential of technology

29.

draws attention to the importance of promoting healthy workplaces, developing health factors, and safeguarding job satisfaction in order to attract and retain staff. A fundamental factor in this is good leadership. Similarly, efforts are also needed to eliminate situations involving threats and violence in healthcare and to provide better protection for healthcare workers in risk situations;

30.

considers that a strong emphasis needs to be placed on the retention of healthcare professionals. This could include, for example, facilitating clinical career development where the skills of experienced staff are used and promoted, and ensuring good working conditions and the possibility of achieving a work-life balance. Accessible childcare is also important, so that both women and men can contribute to the world of work, even when they become parents; many women work in the healthcare sector, which makes this a particularly important issue for this sector;

31.

believes that changes in ways of working are needed to make optimal use of healthcare skills, and that business development needs to be based on the premise that human resources are finite. A practice-orientated approach needs to be adopted so that innovative solutions can be used effectively, and good examples that can offer inspiration should be made visible in order that they can be disseminated, such as opting for ways of working that require fewer staff and working to develop person-centred care (11) based on patients’ specific needs and harnessing the individual’s own strengths;

32.

believes that healthcare skills need to be utilised in an efficient way, making use of the skills of all. Potential opportunities include using the skills of the whole team so that different professionals can complement each other, reviewing who is doing what, and implementing task shifting. Various examples can be highlighted to inspire development in others; for example, work on different types of task shifting has been carried out as part of the TaSHI project (12) in five countries;

33.

believes that the Member States need to focus on strengthening their primary healthcare, including in terms of skills supply. Primary healthcare systems play an important role in meeting the needs of an ageing population. Cooperation also needs to be developed in order to increase the efficiency of the entire care chain;

34.

believes that technological and digital developments, including the development of AI, offer great potential. Healthcare can be made more effective by improving prevention, detection, diagnosis, treatment, information, and communication. Digital tools can allow certain tasks to be done away with completely, for example through more efficient administration. Others can be made non-location-specific whereby they can be performed remotely, for example those involving remote assessments, remote care, remote monitoring, or remote peer-to-peer support and coaching. This would be of particular importance in those areas designated as medical deserts. The development of digital tools also requires infrastructure to be deployed everywhere to support the digital transition. The possibility for patients to read their own medical records from all their care interactions digitally also strengthens patients’ participation in their own care; calls for ethical AI use in healthcare, ensuring that digitalisation does not replace human care but rather enhances accessibility and efficiency;

35.

stresses the importance of involving healthcare workers in hospital and healthcare facility planning to ensure that buildings and work environments support both efficiency and staff well-being. Highlights that well-designed workplaces contribute to job satisfaction, reduce stress, and improve overall healthcare delivery;

36.

considers that digital and technological developments require new skills and developments in ways of working in healthcare; considers it essential that the Member States pay attention to this and prepare both new and existing staff for this transition, in order to harness the full potential of a digital and technological transition with effective support from AI. It is therefore essential that healthcare education provide the skills needed to work with digital tools, in order to support and complement close contact with patients. Digital developments also need to be implemented in close cooperation with users, in order to optimise the efficiency gains that come from using them;

Skills development and cooperation

37.

believes that continuous skills development and training are needed to develop healthcare. In this context, the support of experienced staff through guidance and mentoring takes on particular importance, as does the opportunity to gain new knowledge, for example on digital tools and AI. This is also of great importance in the area of research, development and innovation;

38.

wishes to highlight the possibility of creating knowledge centres where knowledge support can be developed jointly and used in a broader context. Sweden, for example, has long experience of this in the field of cancer;

39.

supports the opportunities offered by the Erasmus programme, i.e. exchanges and opportunities for students to learn from each other, in order both to develop skills and to develop ways of working and take advantage of the opportunities offered by digital developments. The programme also facilitates important traineeships and work experience;

40.

points out that the EU adopted the Professional Qualifications Directive in 2005, with the amending Directive entering into force in 2014 and being implemented in the Member States in 2016; is concerned about the European Court of Auditors’ conclusions (13) that the EU’s system for recognising professional qualifications is ‘used sparsely and inconsistently’. and calls on the Commission to better monitor Member States’ compliance with the Directive, as proposed in the report. It is important, for example, to ensure that the deadline for having professional qualifications recognised is respected and that the alert mechanism is used in the recognition procedure;

41.

points out that cooperation between Member States’ healthcare systems could be developed in border areas where the nearest healthcare facilities may be a long way away; recommends that national legislation be revised in order to facilitate this. Examples of cross-border cooperation can be found in the ambulance service sector, an issue addressed by the Committee’s opinion on Solving obstacles to the cooperation of emergency services in the EU’s border regions (COTER-VII/042);

42.

believes that it would be useful for the Member States, as a complement to the EU’s capabilities under the rescEU initiative, to support each other by making healthcare professionals available in the event of a short-term need in the context of a crisis or other serious event in one or more Member States. Legislation may hinder the timely receipt of support in the event of an emergency; the Committee therefore proposes that each Member State revise its legislation to ensure that it is possible to both receive and provide urgent and short-term support in the form of healthcare professionals;

43.

calls for a strong cohesion policy over the long term in order to increase the opportunities for all cities and regions to offer education and training to more people in the healthcare sector; The EU needs to meet the demand for staff and also provide career opportunities for existing staff. As Enrico Letta points out in his report Much more than a market (14), cohesion funds can also play an important role when it comes to investing in local healthcare infrastructure and screening centres in less populated areas as well as in creating incentives to attract and retain healthcare workers;

44.

calls for cooperation at EU level to be developed in order to support knowledge sharing between Member States on, for example, strategies, digital solutions, and developments leading to improved skills supply in the healthcare sector. Cooperation should also include inspiring examples of measures for retaining staff, developing primary care, and increasing access to healthcare in medical deserts.

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(1)   Political guidelines for the next European Commission 2024-2029.

(2)   Report: Safer Together – Strengthening Europe’s Civilian and Military Preparedness and Readiness | European Commission.

(3)   Ready for the Next Crisis? Investing in Health System Resilience | OECD.

(4)   Health at a Glance: Europe 2024 – State of health in the EU cycle.

(5)   Health at a Glance: Europe 2024 – State of health in the EU cycle.

(6)   Health at a Glance: Europe 2024 – State of health in the EU cycle.

(7)   Bucharest Declaration on health and care workforce. High-level Regional Meeting on Health and Care Workforce in Europe: time to act, 22–23 March 2023, Bucharest, Romania.

(8)   EU4Health programme 2021-2027.

(9)   EU Talent Pool to help address labour shortages across Europe.

(10)   WHO Global Code of Practice on the International Recruitment of Health Personnel.

(11)  An approach in which patients and their family members play an active role and participate in planning and implementing care, and patients are seen as more than just their condition.

(12)   TaSHI Outcomes – Tashi.

(13)   Special report 10/2024: The recognition of professional qualifications in the EU | European Court of Auditors.

(14)   Enrico Letta – Much more than a market (April 2024).