‘A ticking time bomb’: health care is under threat across Western Europe | Health | Popgen Tech


For decades, Western Europe’s national healthcare systems have been widely regarded as among the best in the world.

But an aging population, more long-term illnesses, an ongoing recruitment and retention crisis plus post-Covid attrition combined this winter to create a perfect health care storm that is likely to get worse before it gets better.

“All countries of the region are facing serious problems related to their health and care workforce,” the World Health Organization’s Europe region said in a report earlier this year, warning of possible dire consequences without urgent government action.

In France, there are now fewer doctors than in 2012. More than 6 million people, including 600,000 with chronic diseases, do not have a regular family doctor and 30% of the population does not have adequate access to health services.

In Germany, 35,000 jobs in the care sector were vacant last year, up 40% from a decade ago, while a report this summer said that by 2035 more than a third of all health jobs could be unfilled. Even Finland will need 200,000 new workers by 2030, facing unprecedented hospital overcrowding due to “a severe shortage of nurses”.

In Spain, the health ministry announced in May that more than 700,000 people were waiting for surgery, and 5,000 general practitioners and pediatricians in Madrid have been on strike for nearly a month in protest at years of underfunding and overwork.

Efforts to replace retiring workers were already “suboptimal”, the WHO Europe report said, but now urgently needed to be expanded to “improve retention and an expected increase in younger people leaving the workforce due to burnout, ill health and general tackling discontent”.

In a third of the countries in the region, at least 40% of doctors were 55 years or older, the report said. Even when younger practitioners stayed despite stress, long hours and often low pay, their reluctance to work in remote rural areas or deprived inner cities created “medical deserts” that were almost impossible to fill.

“All these threats represent a ticking time bomb … likely to lead to poor health outcomes, long waiting times, many preventable deaths and possibly even collapse of the health system,” warned Hans Kluge, the WHO’s regional director for Europe.

In some countries, the worst shortages are among general practitioners, with France in particular paying the price for past planning mistakes. Back in 1971, it limited the number of second-year medical students through a so-called numerus clausus aimed at cutting health spending and increasing earnings.

The result was a collapse in annual student numbers – from 8,600 in the early 1970s to 3,500 in 1993 – and although intakes have climbed somewhat since then and the cap was lifted entirely two years ago, it will take years for the size of the workforce to to recover

Even though 10% of France’s GPs now work past retirement age, older doctors leaving the profession outnumbered newcomers last year, when numbers were still 6% lower than they were even a decade ago ago was It could be 2035 before the country reaches a satisfactory ratio of doctors to residents nationally.

However, local provision is another matter: GP ratios range from 125 or more per 100,000 people in some wealthier neighborhoods to less than half that in remote rural France or deprived suburbs such as Seine-Saint-Denis.

“In fact, around 87% of France can be called a medical desert,” junior health minister Agnès Firmin Le Bodo said last month, pledging a “complete rebuilding” of general practitioner services through more multifunctional health centers and remote consultations – but no obligation yet on doctors to set up in underserved areas.

This winter’s flu epidemic, which came on top of Covid-19, exposed the shortcomings of the system, creating a crisis not only for France’s hospital sector, but for the whole of French healthcare, Arnaud Robinet of the French Hospital Federation said and warned that the service was “no longer able to respond systematically” to emergencies.

An oximeter is placed on a baby's foot in Germany, where human respiratory syncytial virus (RSV) is pushing some hospitals to their limits.
An oximeter is placed on a baby’s foot in Germany, where human respiratory syncytial virus (RSV) is pushing some hospitals to their limits. Photo: Filip Singer/EPA

In Germany, which spends more on health care than almost any other country in the world, hospitals are a bigger concern, with this winter’s wave of respiratory syncytial virus (RSV) in young children causing alarm across the country.

Amid reports of overcrowded emergency departments and parents forced to sleep in hospital corridors or travel hundreds of kilometers for a child’s treatment, the Süddeutsche Zeitung said the country was witnessing “what it means when a system implodes … in scenes that for a long time may have seemed unimaginable”.

In a petition to parliament entitled: “Warning level red – hospitals at risk”, the German Hospital Association (DKG) again highlighted a chronic lack of staff as the main problem and noted that many hospitals had to temporarily close casualty departments due to a lack of doctors and nurses.

More than 23,000 jobs remain unfilled in Germany’s hospitals after several years of low recruitment and recent mass layoffs, particularly in intensive care and operating theatres, by staff citing a workload so extreme that some cannot even take a short break could not take or go to the toilet. .

Health Minister Karl Lauterbach announced a €300m (£260m) aid package for pediatric clinics and an as yet unspecified “revolution in hospital care” that “puts medicine first rather than the economy”, plus a plan to move nurses and doctors around to fit the demand dismissed as “absurd” by leading medics.

“The problem is that we don’t have any wards that can do without staff, because they can all only offer the minimum level of care,” says Christine Vogler of the German Nursing Council (DPR). “It can only be called an act of desperation.”

Christoph Spinner, a consultant in infectious diseases at Munich’s University Clinic, said the country’s health system “undoubtedly faces enormous challenges”, while pediatrician Nina Schoetzau said the state of Britain’s NHS was ” a taste of things to come” for Germany.

In Spain, the winter has already prompted overstretched frontline staff to strike. The health care crisis, exposed during the Covid pandemic, follows decades of underinvestment, competition between regions for medical staff, and the lure of better pay and conditions abroad.

Much of the discontent has focused on the Madrid region, where in mid-November at least 200,000 people took to the streets to defend public health care against creeping privatization and to voice concerns about the regional government’s restructuring of the primary care system .

Ángela Hernández, a surgeon and general secretary of Madrid’s AMYTS medical association, said the situation in pediatric services was “practically desperate”, adding that it was also “about demand: nobody tells people that if resources are limited, services must be used wisely”.

Politicians had a responsibility to “explain the situation to people”, Hernández said. “But because they are doing the exact opposite in Madrid and in Spain, they are raising people’s expectations.”

The trade union Metges de Catalunya (Doctors of Catalonia) is also planning a two-day strike next month to protest against “overload, disdain and uncertainty”. Xavier Lleonart, its general secretary, said the pandemic is “the icing on the cake”, but the current situation is as predictable as it is depressing.

Some Spanish doctors were so burnt out that they were taking early retirement despite the hit to their pensions, he said, adding that the key imperative was to make the profession more attractive to stop the “bleeding” of professionals.

“People say the best capital a company has is its human capital,” Lleonart said. “The problem is that in health the human capital was systematically abused until it said: enough is enough.”

Italy’s public health service is also facing severe staff shortages, exacerbated by the pandemic, which has caused an exodus of staff from the profession, taking early retirement or moving to roles in the private sector.

Regional governments have signed contracts with freelance doctors to cover hospital shifts where needed, highlighting the low salaries of Italy’s public health sector.

“There are holes that need to be filled everywhere, especially in emergency units,” said Giovanni Leoni, vice president of an Italian doctors’ federation. “The problem is that freelancers earn two to three times more – up to €1,200 for a 10-hour shift.”

Many medics left public sector roles “before their time”, Leoni added. “They have found other types of work in the private sector – roles that mean they don’t have to do night shifts or weekends.”

Italian medics are holding a demonstration of “the invisible” later this week. “We are invisible to the government,” said Leoni. “Salaries for Italian doctors must be at the same level as those in Europe. Currently they are among the lowest.”


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