In the run-up to the event, ‘Mobility of Health Professionals in the EU: Ethical Recruitment and Policy Coherence’, Health Workers for All (HW4All) released a compilation 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.
To complement the case studies, and prior to the 5 May event on the applicability of the WHO Global Code in Europe, four op-ed articles have been published by HW4All coordinator Linda Mans (Wemos Foundation, Netherlands) and Sascha Marschang, EPHA Policy Manager for Health Systems. They describe recruitment practices brought forward by HW4All partners from across Europe.
The first op-ed article from November 2014 described what on the surface sounds like a straightforward retention practice, which remains however quite underutilised in Europe: regional cross-border collaboration. 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 has worked because the Romanian hospital provided the same salaries and working conditions they offer to Romanian workers, and in return they were rewarded with the Bulgarian workers’ enthusiasm to quickly learn the language, share their expertise and adapt to the working culture. This represents a ‘win’ for the region given that both health systems are under pressure due to severe out-migration of health professionals to other EU countries where remuneration is much better.
The second article, released in December 2014, shed light on the plight of a number of Spanish nurses hired by a private German recruitment agency. The case made headlines across Europe since the nurses – who, given their Spanish university education, were better educated than their German counterparts – were taken advantage of by German employers who placed them into positions below their skill level and with a lower salary. Promises regarding free choice of location and working conditions were also not kept. Disillusioned, many of the nurses set out to break their contracts but were forced to pay fines. Only a joint intervention effort by Spanish and German labour unions, supported by EPSU, helped 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 recruitment from non-EU countries in Germany including 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 work 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.
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