‘A ticking time bomb’: healthcare under threat across western Europe | Health

For decades, Western Europe’s national health systems have been widely touted as some of the best in the world.

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

“All countries in the region face serious problems related to their health and care workforce,” the Europe region of the World Health Organization said in a statement. report earlier this yearwarning of potentially dire consequences without urgent government action.

In Francethere are fewer doctors now than in 2012. More than 6 million people, including 600,000 with chronic illnesses, do not have a regular GP and 30% of the population do not have adequate access to health services.

In Germany, 35,000 jobs in the care sector became vacant last year, 40% more than a decade ago, while a report this summer indicated that by 2035 more than a third of all jobs in healthcare could be vacant. Facing unprecedented hospital overcrowding due to “a serious shortage of nurses”even Finland will need 200,000 new workers by 2030.

In Spainthe Ministry of Health announced in May that more than 700,000 people were waiting to undergo surgery, and 5,000 Madrid GPs and paediatricians have been on strike for nearly a month in protest of years of underfunding and overwork.

Efforts to replace retiring workers were already “sub-optimal”, the WHO Europe report said, but now needed to be urgently scaled up to “improve retention and address the expected increase in younger people leaving the workforce due to exhaustion, poor health and general dissatisfaction.

In a third of the countries in the region, at least 40% of doctors were 55 or older, according to the report. Even when younger practitioners stayed on despite the stress, long hours, and often low pay, their reluctance to work in remote rural areas or deprived city centers had 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 potentially even the collapse of the health system,” warned Hans Kluge, WHO regional director for Europe.

In some countries, the worst shortages are among GPs, with France in particular paying the price for past planning errors. In 1971, he limited the number of second-year medical students through a so-called number clauses designed to reduce health spending and increase revenue.

The result was a collapse in annual student numbers, from 8,600 in the early 1970s to 3,500 in 1993, and while enrollment has since risen somewhat and the cap was lifted entirely two years ago, it will take years to the size of the labor force recovers. retrieve.

Despite 10% of France’s GPs now working past retirement age, older doctors leaving the profession outnumbered newcomers entering last year, when the numbers were still a 6% lower than a decade ago. It could be 2035 before the country reaches a satisfactory physician to population ratio at the national level.

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

“In fact, around 87% of France could be called a medical desert,” said junior health minister Agnès Firmin Le Bodo. last monthpromising a “complete rebuild” of GP services through more multi-functional health centers and remote consultations, but with no requirement, so far, for doctors to set up in under-served areas.

This winter’s flu epidemic, on top of Covid-19, exposed the flaws in the system, creating “a crisis not just for France’s hospital sector but for all of French healthcare.” said Arnaud Robinet of the French Federation of Hospitals, warning that the service was “no longer able to respond systematically” to emergencies.

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

Amid reports of overcrowded emergency departments and parents forced to sleep in hospital corridors or travel hundreds of miles 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 could have seemed unimaginable”.

In a petition to parliament titled: “Alert level red: hospitals in danger”, the German Hospital Society (DKG) again highlighted chronic understaffing as the main problem, noting that many hospitals had had to close temporarily. emergency departments due to a shortage of doctors and nurses.

More than 23,000 positions remain open at Germany’s hospitals after several years of low recruitment and recent mass resignations, particularly in intensive care and operating rooms, by staff citing a workload so extreme that some were unable to take even a brief rest or go to the bathroom. .

Health Minister Karl Lauterbach has announced a €300 million (£260 million) 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 match the lawsuit that was dismissed as “absurd” by leading physicians.

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

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

In Spain, winter has already led overstretched frontline staff to go on strike. The health crisis, uncovered during the Covid pandemicit 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 Community of Madrid, where in mid-November at least 200,000 people took to the streets defend public health against increasing privatization and express concern about the restructuring of the primary care system by the regional government.

Ángela Hernández, surgeon and general secretary of the Madrid Hospital AMYTS medical associationHe said the situation in pediatric services was “almost hopeless”, adding that it was also “demand: no one is telling people that if resources are limited, services should be used wisely”.

Politicians had a responsibility to “explain the situation to the people,” Hernández said. “But since they do the exact opposite in Madrid and Spain, they raise people’s expectations.”

the Métges de Catalunya The union (Médicos de Catalunya) also plans a two-day strike next month to protest against “overload, disdain and precariousness”. Xavier Lleonart, its secretary general, said that the pandemic was “the icing on the cake” but that the current situation was as predictable as it was depressing.

Some Spanish doctors were so burned out that they took early retirement, despite the impact on their pensions, he said, adding that the main imperative was to make the profession more attractive to stop the “haemorrhage” of professionals.

“People say that the best capital a company has is its human capital,” said Lleonart. “The problem is that in health, human capital has been systematically mistreated to the point of saying: enough is enough.”

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

Regional governments have signed contracts with independent doctors to cover hospital shifts when necessary, highlighting the low wages in Italy’s public health sector.

“There are gaps that need to be filled everywhere, especially in emergency units,” said Giovanni Leoni, vice president of a federation of Italian doctors. “The problem is that the self-employed earn between two and three times more, up to 1,200 euros for a 10-hour shift.”

Many doctors had left their roles in the public sector “early,” Leoni added. “They have found other kinds of jobs in the private sector, roles that mean they don’t have to work nights or weekends.”

Italian doctors will perform a demonstration of “the invisibles” later this week. “We are invisible to the government,” Leoni said. “The salaries of Italian doctors must be at the same level as those in Europe. Currently, they are among the lowest.”