In the run-up to the event, ‘Mobility of Health Professionals in the EU: Ethical Recruitment and Policy Coherence’, Health Workers for All (HW4All) have released a number of case studies that highlight good practices related to achieving a more equitable distribution of health workers across Europe, while highlighting the importance of respecting internationally mobile health workers’ rights.
Four op-ed articles have been released since December by HW4All coordinator Linda Mans (Wemos Foundation, Netherlands) and Sascha Marschang, EPHA Policy Manager for Health Systems, in advance of the policy debate that will take place on 5 May 2015 at the European Parliament, hosted by Nessa Childers MEP (S&D, Ireland) and jointly organised by HW4All, EPHA and the European Federation of Public Service Unions (EPSU). The op-eds all describe cases brought forward by HW4All partners from across Europe and are part of a collection that will be launched at the event.
The first op-ed article from November 2014 described what on the surface sounds like a relatively straightforward retention practice, which however appears to be quite under-utilised in Europe: regional cross-border collaboration for retention. By recruiting Bulgarian medical specialists from across the border, a Southern Romanian hospital helped fill crucial shortages and successfully ‘integrated’ Bulgarian shift workers who remain living and working in their own country. This worked because the Romanian hospital offered the same salaries and working conditions that they offer to Romanian workers, and in return they were rewarded with the Bulgarian workers’ enthusiasm to quickly learn the language, share their expetise and adapt to the working culture. In the end, this represents a ‘win’ for the region given that both the Romanian and Bulgarian health systems are under pressure due to severe out-migration of health professionals to other EU countries where remuneration can be much higher and career prospects brighter.
The second article, released in December 2014, shed light on the plight of a number of Spanish nurses that were recruited by a private, German-based agency. The case made headlines across Europe since the nurses – who, given their Spanish university education, were effectively better educated than their German counterparts – were taken advantage of by the agency who placed them into jobs in Germany that were below their skill level and that paid a lower salary. Moreover, promises regarding choice of location and working conditions were not kept. Disillusioned, many of the nurses set out to break their contracts but had to learn the hard way that this is not an easy task. Only a joint intervention effort by Spanish and German labour unions, supported by EPSU, helped to rectify the situation somewhat.
The third article was released in January in relation to the 2015 European Year of Development and made reference to the recent rise of non-EU recruitment in Germany, e.g. nurses from the Philippines. This is not only a German phenomenon as Filipino health workers can also be found working in the UK, Ireland, Italy, Netherlands and other countries; however, while some countries have shifted their recruitment to EU sources, in Germany non-EU recruitment is a fairly recent move in that occurs in spite of the WHO Global Code and in the face of ongoing migration of German nurses to other EU countries where they can expand their skills and earn more. That said, this case is also positive since the Filipino newcomers were given appropriate induction including language training prior to arrival.
The most recent article illustrates the importance of having accurate data for health workforce planning and taking informed policy decisions. it describes efforts undertaken in Poland and in the United Kingdom to collect the best possible data on actual ‘stocks and flows’ of nurses. In the UK case, the Royal College of Nurses (RCN, also active EPHA members) set out to produce a comprehensive annual Labour Market Review based on data compiled from different sources, including the Nursing and Midwifery Council register, the Office for National Statistics and the number of training places commissioned by universities. This covers both the domestic nursing workforce as well as the internationally trained. Moreover, RCN released the Frontline First Reports which in 2013 uncovered the scale of the nursing shortage in the NHS Combined, these reports acts as a multiple purpose tools for data analysis, policy making, and advocacy.
While professional mobility and migration are part and parcel of the Single Market and undoubtedly expand working opportunities for individuals, HW4All, EPSU and EPHA believe that, in the health sector, close attention must be paid to the potential unintended consequences of unbalanced professional mobility. Unequal distribution can amplify health inequalities and create access to healthcare problems – especially in times of crisis. In cases where health professional mobility is a viable option, the rights and conditions of migrant health workers must be safeguarded no matter where they are in Europe as social dumping and discrimination are clearly unethical.
Given Europe’s increasingly mobile health workforce, the WHO Global Code of Practice has a role to play as a voluntary yet crucial instrument that can contribute to correct imbalances between Member States and help create (self)sustainable health systems.