COMMISSION STAFF WORKING DOCUMENT on an Action Plan for the EU Health Workforce
Date: 2012-04-18
Institutions: European Commission
Subjects: economic growth, health care, health care profession, job creation, professional qualifications, public health

EUROPEAN COMMISSION 

Strasbourg, 18.4.2012  
SWD(2012) 93 final 

COMMISSION STAFF WORKING DOCUMENT 

on an Action Plan for the EU Health Workforce 

Accompanying the document 

COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN 
PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL 
COMMITTEE AND THE COMMITTEE OF THE REGIONS 

Towards a job-rich recovery 

{COM(2012) 173 final} 
{SWD(2012) 90 final} 
{SWD(2012) 92 final} 
{SWD(2012) 95 final} 
{SWD(2012) 96 final} 
{SWD(2012) 97 final} 
{SWD(2012) 98 final} 
{SWD(2012) 99 final} 
{SWD(2012) 100 final} 

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COMMISSION STAFF WORKING DOCUMENT 

on an Action Plan for the EU Health Workforce 

Accompanying the document 

COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN 
PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL 
COMMITTEE AND THE COMMITTEE OF THE REGIONS 

Towards a job-rich recovery 

TABLE OF CONTENTS 

1. 

2. 

3. 

4. 

5. 

Introduction .................................................................................................................. 1 

Defining and measuring healthcare jobs ...................................................................... 1 

Key challenges facing the EU Health Workforce ........................................................ 3 

Actions to promote a sustainable workforce for health in Europe............................... 8 

Delivering the actions ................................................................................................ 12 

Disclaimer:  This  document  is  a  European  Commission  staff  working  document  for 
information  purposes.  It  does  not  represent  an  official  position  of  the  Commission  on  this 
issue, nor does it anticipate such a position. 

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1. 

INTRODUCTION 

The healthcare sector constitutes one of the most significant sectors in the EU economy with 
an  important  employment  potential  due  to  an  ageing  population  and  increasing  demand  for 
healthcare. 

However, the sector faces major challenges which are similar to all Member States: the health 
workforce  itself  is  ageing  with  insufficient  new  recruits  to  replace  those  that  are  retiring, 
problems of retention due to demanding working conditions and relatively low pay in some 
health  occupations.  In  addition,  new  care  patterns  to  cope  with  chronic  conditions  of  the 
elderly and the rise in new technologies will require new skills and competences.  

Given the current tough budget constraints, health expenditures are under strong pressure to 
provide high quality healthcare cost effectively and to make fundamental reforms in the way 
in which they deliver healthcare. EU health systems need to find innovative solutions through 
new  technologies,  products  and  organisational  changes  which  depend  on  a  high  quality 
motivated  health  workforce  of  sufficient  capacity  and  with  the  right  skills  to  meet  the 
growing demands of healthcare.  

Recognising the European dimension of the challenges at hand, Members States agreed on the 
added value of EU action and European collaboration, inviting the Commission to propose an 
action  plan  to  assist  Member  States  tackle  the  key  challenges  facing  the  health 
workforce in the medium to longer term1.  

This  Commission  Staff  Working  Document  describes  the  contribution  of  the  EU's  health 
workforce  to  meet  the  2020  employment  target  of  75%  for  women  and  men  aged  20-64.  It 
provides the rationale for measures proposed in the action plan, annexed to the accompanying 
Communication  "Towards  a  job  rich  recovery",  to  assist  Member  States  to  address  the 
shortages of the EU health workforce and boost job creation in the sector.  

2. 

DEFINING AND MEASURING HEALTHCARE JOBS 

The  healthcare  sector  comprises  workers  primarily  delivering  healthcare  services  such  as 
health  professionals  (doctors,  nurses,  midwives,  pharmacists  and  dentists),  allied  health 
professionals, public health professionals, health management and administrative and support 
staff. Many people also work indirectly for the healthcare sector such as those employed in 
the  healthcare  industries  and  support  services,  pharmaceutical,  medical  device  industries, 
health insurance, health research, e-Health, occupational health, spa etc2. 

Health  professionals  can  be  salaried  or  self  employed.  In  several  countries3  General 
Practicians  and  outpatient  specialists  are  mostly  independent  self  employed  with  private 
practices or are contracted by funds or hospitals to provide services. 

1

2

3

See conclusions of the 3053rd EPSCO Council meeting, Brussels, 7 December 2010, Investing in Europe's health workforce of 
tomorrow: Scope for innovation and collaboration. 
Alcimed  (2010),  Study  on  Healthcare  Services,  Sectors  and  Products  in  Europe  for  the  European  Commission,  Final  Report 
February 2010 
AT, BE, DK, FR, DE, EL, NL, LU, SK – European Economy, Joint Report on Health Systems, December 2010cf. p. 111 

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The healthcare workforce thus makes up a large part of the so-called "white jobs" which also 
include professionals delivering social care services.  

A modern and innovative healthcare sector is a driver for economic growth as keeping people 
healthy benefits productivity and competitiveness. The healthcare sector is also a key driver 
for  research  and  development  and  absorbs  the  highest  amount  of  innovative  products  and 
services.  

Healthcare  is  a  highly  labour  intensive  activity  and  one  of  the  largest  sectors  in  the  EU:  in 
2010 there were around 17, 1 million jobs in the healthcare sector which accounted for 8% of 
all  jobs  in  EU-274.  The  number  of  jobs  in  the  sector  increased  by  21%  between  2000-2010 
creating 4 million new jobs. Even during the economic crisis, employment in the healthcare 
sector  has  continued  to  grow:  while  overall  employment  fell  by  5  million  people  over  the 
period  2008-2010,  the  healthcare  sector  increased  its  share  of  total  employment  by  half  a 
percentage point, creating more than 770 000 new jobs5.  

Most importantly, this positive trend is reflected across all age groups and includes a 3% rise 
in the employment of young people when youth employment fell by 11.3 % in the economy 
overall6. 

Figure 1: Employment growth in health & residential care sector, 2008-10 by age groups 

%  C h a n g e   i n   e m p l o y m e n t  b e tw e e n   2 0 1 0   a n d   2 0 0 8   b y   a g e  
g ro u p

1 5 %

1 0 %

5 %

0 %

-5 %

-1 0 %

-1 5 %

1 5 -2 4

2 5 -4 9

5 0 -6 4

H u m a n   h e a lt h   a n d   R e s id e n t ia l  c a re

A ll  o t h e r  s e c t o rs

Source: based on Eurostat Labour Force Statistics for NACE Rev.2 sectors 86 and 87 

As regards the  level of education, the health and social work7 sector  employs  a  higher  than 
average  number  of  highly  educated  people.  According  to  Eurofound's  data  on  working 
conditions8, more than 55% of people employed in this sector hold at least a post-secondary 
degree whereas the average for all sectors is below 33%. 

4

5

6

7

8

Eurostat (2011) NACE Rev.2 categories 86 & 87 
Eurostat (2011) NACE Rev.2 categories 86 & 87 
Eurostat (2011) 
Disaggregated data for the healthcare sector only are not available 
Eurofound (2010) 

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The  employment  trend  observed  so  far  in  the  healthcare  and  social  sector  will  continue9.  It 
will remain a growing sector according to the forthcoming CEDEFOP skills forecasts10, even 
though  employment  growth  will  be  more  modest  compared  to  2000-2010.  More  than  1 
million new jobs are expected to be created between 2010-2020. The growth rate in this sector 
is projected to be 5%, which is higher than EU average slightly above 3%. There will be about 
7  million  additional  job  openings  between  2010-2020 due  to  replacement  needs.  Together 
with net employment change around 8 million of total job openings are projected. Most jobs 
will  require  highly  qualified  people  (more  than  5  million)  while  the  need  for  medium 
qualified  personnel  will  remain  rather  significant  (around  3  million).  Around  200  000  job 
openings will be for low qualified people.  

3. 

KEY CHALLENGES FACING THE EU HEALTH WORKFORCE 

Labour demand will increase as the population ages… 

The  demand  for  healthcare  will  increase  dramatically  with  Europe's  ageing  population.  The 
number  of  elderly  persons  aged  65  and  over  is  projected  to  almost  double  over  the  next  50 
years, from 87 million in 2010 to 152,7 million in 206011. Long-term and formal care is likely 
to increase with an expected reduction in the availability of informal carers, for example as a 
result of changing family structures.  

… with consequences for future skills and competences… 

These  demographic  changes  will  have  significant  consequences  on  the  way  in  which 
healthcare  systems  respond to  patient needs. The increasing numbers  of elderly people  with 
multiple  chronic  conditions  will  require  new  treatments  and  new  care  delivery  models  and 
necessitate changes in skill mixes and new ways of working for health professionals. 

… while the number of health professionals decreases… 

Most  Member  States  are  currently  facing  critical  workforce  shortages  -  in  certain  health 
professions and medical specialisations or geographic areas – which could be exacerbated if 
no  action  is  taken.  The  retirement  bulge  is  drastically  shrinking  the  EU's  healthcare 
workforce.  In  2009,  about  30%  of  all  doctors  in  the  EU  were  over  55  years  of  age  and  by 
2020  more  than  60  000  doctors  or  3.2%  of  all  European  doctors  are  expected  to  retire 
annually.  Based  on  data  collected  by  some  Member  Sates12  the  average  age  of  nurses 
employed today is between 41-45 years. 

9

10

11

12

EN 

Disaggregated data for the healthcare sector only are not available  
Based  on  new  CEDEFOP  skills  demand  and  supply 
forecast 
cedefop/projects/forecasting-skills-demand-and-supply/skills-forecast.apx) 
Eurostat: Europop2010 population projections (online data code: proj_10c2150p) 
Based  on  data  collected  from  6  MS:  DE,  DK,  IE,  FR,  SE,  UK.  (http://www.euro.who.int/en/what-we-do/health-topics/Health-
systems/health-workforce/facts-and-figures, 
http://www.icn.ch/images/stories/documents/pillars/sew/DATASHEET_SUMMARY_NURSING_PROFILE_2011.pdf 

(http://www.cedefop.europa.eu/EN/about-

in  2012 

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Figure 2: Number of physicians by age group in 17 EU member States in 2004 and 2008 

Ageing Health Workforce: 
Headcount of Physicians by Age Group in 17 EU Member States

600.000
500.000
400.000
300.000
200.000
100.000
0

2004

2008

Less than
35 years

From 35 to
44 years

From 45 to
54 years

From 55 to
64 years

65 years
or over 

Source: Eurostat, 2011. Absolute numbers. Data available from 17 MS: AT, BE, CZ, DK, DE, ES, FI, FR, HU, IT, LV, LT, 
NL,  RO,  SK,  SE,  UK  –  note  that  for  F,  NL  and  IT  data  refers to  professionally  active  doctors  who  may  or  may  not  have 
direct contact with a patient.  

… and difficulties to recruit and retain healthcare staff  

This  retirement  bulge  risks  not  being  offset  by  a  sufficient  number  of  new  healthcare 
professionals. Not enough young recruits are coming through the system to replace those who 
leave: In Italy, 13 400 nurses were due to retire in 2010, but only 8500 nurses graduated in 
2008-2009. Germany is facing serious difficulties in training sufficient number of graduates, 
Slovakia  has  insufficient  nurses,  midwives,  physiotherpists,  radiological  assistants  and 
paramedics  and  Hungary  faces  serious  bottlenecks  in  supply  caused  by  reductions  in  nurse 
training.  Unfilled  specialist  training  places  are  reported  in  Romania,  France,  Hungary  and 
Austria13.  The  health  labour  market  has  to  compete  with  other  employers  for  the  younger 
generations  making  career  choices.  On  the  other  hand,  people  who  have  recently  left  the 
health workforce to  take  up other  types of jobs,  may  consider  returning  to  the  health  sector 
because of greater job security. 

Evidence  from  some  countries  shows  an  increasing  turnover  in  the  health  professions.  Low 
pay,  but  also  non  financial  factors  such  as  long  working  hours,  stress  or  difficult  work  life 
balance  constitute  reasons  for  healthcare  workers  to  leave  their  jobs14.  Preliminary  findings 
from one the largest nursing workforce studies ever conducted in Europe and the USA, Nurse 
Forecasting  in  Europe  (RN4Cast)15,  confirm  that,  despite  considerable  differences  in  health 

13

14

15

M. Wismar, C. B. Maier, I. A. Glinos, G. Dussault and J. Figueras (eds., 2011), Health professional mobility and health systems. 
Evidence from 17 European countries, Observatory Study Series No. 23, European Observatory on Health Systems and Policies, 
WHO Regional Office for Europe, Copenhagen. (http://www.euro.who.int/__data/assets/pdf_file/0017/152324/e95812.pdf)  
More detailed analysis can be found in the Employment in Europe 2009 report and the Second Biennial Report on social services 
of general interest, 2011 (http://ec.europa.eu/social/main.jsp?catId=794&langId=en&pubId=5940&type=2&furtherPubs=yes). 
RN4CAST (forthcoming 2012), Nurse forecasting: Human resources planning in nursing. 12 European countries (Belgium, UK, 
Finland,  Germany,  Greece,  Ireland,  Norway,  Poland,  Spain,  Sweden,  Switzerland  and  Netherlands)  and  also  USA,  China, 
Botswana and South Africa 

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systems,  all  twelve  European  countries  studied  face  problems  of  nurse  burnout  and 
dissatisfaction due to working conditions. Many European nurses report they intend to leave 
their hosptial positions, from 19 % in the Netherlands, rising to 49% in Finland and Greece. 

The  issue  of  work  life  balance  is  all  the  more  relevant  in  the  healthcare  sector  as  the 
participation  of  women  in  the  workforce  has  historically  been  significant  and  is  increasing. 
Overall, there were more than 13,1 million women working in the healthcare sector in 2010, 
making up up more than three quarters of the health workforce in the EU16. In many Member 
States  the  intake  of  women  to  medical  schools  is  now  over  50%.  However,  so  far,  this 
growing feminization of the healthcare workforce has  not  always  been properly reflected in 
measures  to  improve  the  reconciliation  of  professional  and  private  life.  It  is  a  factor  which 
might increase the difficulties to retain the healthcare workforce in the future.  

Moreover,  although  skill  levels  are  relatively  high  and  working  conditions  are  often 
demanding  (for  instance,  night  and  shift  work),  overall  wage  levels  in  the  health  and  social 
services sectors tend to be lower than in other sectors of the economy. This tendency, which is 
related  to  the  high  rate  of  female  employment  in  the  sector  and  to  the  gender  pay  gap,  is 
becoming  more  pronounced17  and  may  be  regarded  as  another  disincentive  to  work  in  this 
sector. 

The working conditions and the level of wages of the healthcare workforce may be affected 
longer  term  by  the  current  economic  crisis.  There  is  recent  and  worrying  evidence  that  the 
cost  containment  measures  to  reduce  public  expenditure  is  profoundly  affecting  the 
recruitment  and  retention  of  healthcare  staff  and  in  particular  nurses,  the  largest  health 
profession,  in  almost  half  of  EU  2718.  Maintaining  an  adequate  supply  and  quality  of 
healthcare  services  under  severe  budget  constraints  is  thus  a  key  issue  to  be  addressed  by 
policy makers.  

… resulting in worsening healthcare labour shortages 

Without  further  measures  to  meet  these  challenges,  the  Commission  estimates  a  potential 
shortfall of around 1 million healthcare workers by 2020 rising up to 2 million if long term 
care and ancillary professions are taken into account19. This means around 15% of total care 
will not be covered20 compared to 2010.  

Potential  shortfalls  might  worsen  the  working  conditions  and  increase  pressures  on  the 
healthcare workforce raising concerns over the impacts on patient safety and quality of care.  

Table 1: SHORTAGES IN SELECTED EU MEMBER STATES 

Country 

Bulgaria 

There  is  an  acute  shortage  of  nurses  and  medical  specialists  (in  particular  of 

16

17

18

19 
20 

Eurostat (2011), NACE Rev.2 categories 86 & 87  
More detailed analysis can be found in the Employment in Europe 2009 report and the Second Biennial Report on social services 
of general interest, 2011 (http://ec.europa.eu/social/main.jsp?catId=794&langId=en&pubId=5940&type=2&furtherPubs=yes). 
European  Federation  of  Nurses  (2011),  Caring  in  Crisis:  The  Impact  of  the  Financial  Crisis  on  Nurses  and  Nursing,  A 
Comparative Overview of 34 European Countries 
These figures are subject to several assumptions and hypotheses. 
An Agenda for new skills and jobs: A European contribution towards full employment, COM (2010) 682 final.  

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anaesthesiologists, gynaecologists and paediatricians). 

Finland 

Shortages  are  particularly  severe  in  health  centres  in  remote  rural  municipalities. 
Significant shortage among dentists. 235,450 additional vacancies in the healthcare 
and social sector projected over the period 2008-2025.  

France 

Shortages  of  obstetrics  and  gynaecologists.  Geographic  misdistribution  of 
physicians and nurses  

Germany 

Shortage of 17,000 doctors in 2010, rising to 45,000 doctors by 2020 and 165,000 
by  2030.  Projections  for  other  health  professions:  150,000  in  2020,  rising  to 
800,000 in 2030. There is also a shortage of elderly care nurses. 

Hungary 

19% of available posts of public health physicians were vacant and 13% of posts of 
physicians in 2008. 

Netherlands 

Shortages  of  doctors 
in  the  mental  healthcare  sector,  dental  surgeons, 
gastroenterologists,  nuclear  physicians,  nurses  in  homes  for  the  elderly  and  in 
nursing homes.  

Spain 

UK 

Forecasting  shortfall  of  14  %  of  medical  specialists  (including  GPs)  by  2025. 
Persistent  shortages  of  specialists  in  anaesthetics,  orthopaedic  and  traumatic 
surgery,  paediatric  surgery,  reconstructive  surgery,  family  and  community 
medicine, paediatrics, radiology and urology. 

Severe  shortages  of  35  specific  health-related  professions,  including  medical 
practitioners,  specialist  nurses,  midwifes  and  therapists.  Vacancy  rates  pharmacy 
(5.3%  vacancy  rate),  other  physiological  sciences  (7.6%),  and  respiratory 
physiology  (6%).  Estimates  for  2014  the  average  number  of  entry-level  posts  for 
specialty training will be around 6511. Unless training posts are revised accordingly, 
there might be a shortage of GP and medical specialists of more than 6,000.  

Source: European Commission (forthcoming in 2012), Feasibility Study EU level collaboration on forecasting 

health workforce needs, workforce planning and health workforce trends 

Table 2: ESTIMATED SHORTAGE IN HEALTHCARE SECTOR BY 2020 

Health professionals or 
other health workers 

Physicians 
Dentists, pharmacists and 
physiotherapists 

Nurse 

Total 
Source: European Comm ission  

Estimated shortage by 2020

Estimated percentage of 
care not covered 

230.000 

150.000 

590.000 

970.000 

13,5% 

13,5% 

14,0% 

13,8% 

Many Member States also face the challenge of shortages caused by an unequal distribution 
of health professionals within their country, raising serious concerns over the availability of 

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healthcare in certain regions. The EU research project on Health Professional Mobility and 
Health Systems (PROMeTHEUS)21 provides evidence from 17 European countries, that there 
is an undersupply of health professionals in rural and sparsely populated areas, for example in 
Denmark, Finland, France, Germany, Romania, and an oversupply of doctors in some urban 
areas, particularly in Germany, and an oversupply of nurses in Belgium.  

In addition, the number of medical specialists is increasing much more rapidly than generalist 
practitioners22. This trend is raising concerns about the access to care for certain population 
groups. Many countries are therefore looking to improve the attractiveness of general practice 
as well as the development of new roles other healthcare providers. 

With regard to mobility of health professionals within the EU, the PROMeTHEUS research 
concludes there are significant differences in cross-border movements with a clear east-west 
asymmetry  for  doctors,  nurses  and  dentists.  While  all  27  Member  States  experienced 
migration  of  health  professionals,  western  and  northern  Member  States  are  simultaneously 
receiving  health  professionals  from  other  countries.  However,  based  on  the  limited  data 
available,  outflows  have  rarely  exceeded  3%  of  the  domestic  workforce,  although  there  are 
serious shortages in certain medical specialists in some countries.  

The EU faces competition from other countries as many health professionals migrate to non-
EU  countries:  for  example,  health  workers  migrate  to  the  United  States,  Australia,  New 
Zealand  and  Canada  and  the  inflows  of  foreign  doctors  with  long-term  permits  have  also 
increased markedly in Switzerland (+70% between 2001 and 2008), mainly from Germany23. 
Forthcoming  findings  from  the  EU  project  Mobility  of  Health  Professionals  (MoHPRof24) 
will improve understanding of the complex phenomenon of international migration of health 
workers in 25 countries with a focus on migration within, to and from the EU.  

The high outflow of health professionals ("brain drain") has provoked policy debates on the 
impact on healthcare systems in some Member States, reinforcing the need for accurate and 
comparable data on mobility and migration flows in the EU to develop policy responses based 
on evidence.  

Health  workforce  shortages  in  many  Member  States  have  increased  the  reliance  on  the 
recruitment  of  healthcare  professionals  from  outside  the  EU.  National  patterns  of  migration 
flows of doctors coming from outside the EU vary widely: out of 10 Member States, nearly 
30%  of  all  migrant  doctors  come  from  outside  the  EU  in  Austria,  Belgium,  Denmark, 
Germany, Netherlands and Poland. This figure rises to 60% in France and Italy and to 80% in 
Ireland and the UK25. To mitigate the negative effects of migration on fragile health systems, 
Member States are committed to the 2010 WHO Global Code on the international recruitment 
of health personnel, currently in its implementation phase.  

21

22

23

24

25

M. Wismar, C. B. Maier, I. A. Glinos, G. Dussault and J. Figueras (eds., 2011), Health professional mobility and health systems. 
Evidence from 17 European countries, Observatory Study Series No. 23, European Observatory on Health Systems and Policies, 
WHO Regional Office for Europe, Copenhagen. (http://www.euro.who.int/__data/assets/pdf_file/0017/152324/e95812.pdf) 
OECD report 2010 "Health at a Glance", http://www.oecd.org/health/healthataglance/europe 
OECD policy brief on the migration of health workers, February 2010, www.oecd.org/publications/Policybriefs 
EU project, Mobility of Health Professionals (MoHPRof), http://www.mohprof.eu/LIVE/ 
Gilles  Dussault,  Inês  Fronteire  and  Jorge  Cabral  (2009)  Instituto  de  Higiene  e  Medicina  Tropical,  Lisbon,  Migration  of  health 
personnel in the WHO European Region.  

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4. 

ACTIONS TO PROMOTE A SUSTAINABLE WORKFORCE FOR HEALTH IN EUROPE 

Recognising the European dimension of the above challenges, Member States agreed on the 
added  value  of  European  cooperation  to  help  tackle  EU  health  workforce  shortages  and 
invited the Commission to propose concrete actions in the following areas,  bearing  in mind 
the Member States competence for organising and delivering healthcare systems26: 

• 

• 

• 

Forecasting workforce needs and improving workforce planning methodologies 

Anticipating future skills needs in the health professions; 

Share  good  practice  on  effective  recruitment  and  retention  strategies  for  health 
professionals 

These  areas  for  action  reflect  feedback  from  the  Commission's  public  consultation  on  the 
Green Paper European Workforce for Health27 which drew over 200 responses from a wide 
range of stakeholders, the majority of which saw added EU value in European collaboration to 
exchange  best  practice,  to  foster  European  networks  and  to  improve  European  data  on  the 
health workforce. 

4.1. 

Forecasting Health Workforce Needs  

Across  the  EU  there  is  growing  interest  in  the  development  of  integrated  health  workforce 
planning  and  forecasting  which  takes  account  of  a  number  of  factors  –  the  age,  gender, 
number,  specialisations  and  distribution  of  health  workers,  skills  and  competence  mix, 
working  practices  –  to  develop  policy  interventions  and  inform  investment  decisions  in 
education, training and recruitment to better match demand and supply of health professionals 
while offering long-term job prospects for healthcare workers.  

A three year EU joint action on forecasting health workforce needs for effective planning 
in the EU will be launched by the end of 2012. This joint action, as foreseen in the 2012 work 
plan of the Health Programme28, will create a partnership of Member States and professional 
organisations  to  share  good  practice  and  to  develop  methodologies  on  forecasting  health 
workforce  and  skill  needs,  workforce  planning  methods  and  to  improve  EU  wide  data 
availability on mobility and migration trends of health professionals.  

To  assist  Member  States  with  forecasting  scenarios  on  the  future  training  needs  for  health 
professionals, a study will be carried out, in cooperation with the OECD, on the structure and 
training capacities in the EU. Moreover, the Commission will work with partners in the EU 
joint action on workforce planning to produce guidance to develop effective partnerships 
to  make  best  use  of  training  capacities  and  to  help  respond  to  recent  European  Court  of 
Justice cases on the mobility of medical students29. 

26

27
28 
29

Council  Conclusions  (7  December  2010),  Investing  in  Europe's  health  workforce  of  tomorrow:  Scope  for  innovation  and 
collaboration. 
Commission report on the open consultation on the Green Paper on the European Health Workforce, 2010 
Commission Implementing Decision (2011/C/ 358/06 
C-73/08; C-417/03 

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4.2. 

Anticipating skills needs in the health professions  

Anticipating future skill needs for health professionals to meet new healthcare demands is a 
further challenge. Member States need to act swiftly to avoid skills mismatches and gaps in 
the  healthcare  sector  to  ensure  tomorrow's  health  professionals  are  equipped  with  the  right 
skills.  

While  national  health  authorities  are  responding  to  the  challenge  of  delivering  high  quality 
healthcare  in  different  ways,  there  are  nonetheless  common  trends  in  the  EU  which  are 
changing  the  way  in  which  health  professionals  work  and  creating  new  employment 
opportunities in healthcare: 

The  development  of  new  integrated  care  delivery  models  -  with  a  shift  from  care  in 
hospitals to the delivery of primary care closer to home - to cope with elderly patients with 
multiple chronic conditions, such as heart disease and diabetes, requires different skill mixes 
and, new ways of working within a wider interdisciplinary team.  

The  growth  of  new  technologies,  new  medical  appliances  and  diagnostic  techniques, 
requires  technical  know-how  in  addition  to  clinical  knowledge.  The  expansion  of  e-health, 
which enables distant diagnostics services, is leading to new ways of working and a new mix 
of skills including technical and e-skills. The expansion of telemedicine, to improve access to 
specialised health services will require doctors to work beyond the boundaries of face-to-face 
counselling and to be trained to work in a technological environment. 

The  operation  of  e-health  systems  such  as  telemonitoring  for  nurses  or  teleradiology  will 
change work patterns and open new job opportunities in the healthcare sector, including the 
need for ICT specialists. 

Figure 4: Health Professionals in Europe: New Roles, New Skills 

Source: European Hospital and Healthcare Federation (2009), Health Professionals in Europe: New Roles, New Skills 

At  the  same  time  the  increased  use  of  telemedicine  will  help  address  shortages  of  health 
workers  and  secure  better  healthcare  coverage  in  remote  areas  as  it  will  enable  medical 
specialists  to  provide  quality  services  to  more  patients  in  different  care  settings  and  across 
different Member States.  

Member States need to adjust their education and training curricula to fast moving changes in 
healthcare  and  to  equip  people  with  the  right  skills  for  the  job  market  and  improve  their 
employability.  These  changes  require  increased  coordination  between  education/training 
providers  and  employment  to  assess  and  anticipate  the  different  mix  of  skills  and 
competencies needed in the healthcare sector in the future.  

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At  EU  level,  there  are  several  actions  under  development  to  assist  Member  States  to  better 
anticipate skills' needs and competences in the healthcare sector: an EU skills council in the 
area of nursing and care, which will review the competence profiles of the nursing and care 
sector,  and  a  pilot  health  care  assistants  expert  network  and  database30  which  will 
examine the scope of skills and competences required from healthcare assistants for uptake by 
national  education  and  training  programmes.  In  addition,  the  EU  joint  action  on  health 
workforce planning (cf. 4.1.) will develop European guidelines on forecasting methodologies 
and analyse future skills need in the healthcare sector. 

The  outcomes  from  these  initiatives  will  contribute  to  the  EU  skills  panorama31  to  be 
launched by the end of 2012 will provide a comprehensive overview of emerging skills needs 
as  they  evolve  up  to  2020.  Furthermore,  the  common  multilingual  classification  of 
occupations,  qualifications  and  skills  (ESCO),  will  provide  a  resource  for  education  and 
training providers in the healthcare sector. The outcome of these initiatives needs also to be 
aligned  with  the  proposal  on  the  modernisation  of  the  Professional  Qualifications  Directive 
once agreed by the Council and the European Parliament.  

To help bridge the gap between education and employment, a pilot EU sector skills alliance 
in  the  healthcare  sector  will  seek  to  investigate  the  feasibility  for  developing  new  sector–
specific curricula and innovative forms of vocational teaching and training32.  

Transnational  mobility  offers  access  to  new  jobs  and  new  training  opportunties  to  enhance 
skills. Intra-EU professional mobility, facilitated by the Directive 2005/36/EC on the mutual 
recognition of professional qualifications, can help address the mismatches between labour 
supply and demand, while offering health professionals new career and training opportunities 
or better pay and conditions. The Commission proposal to modernise the Directive33 aims to 
simplify  rules  and  make  it  easier  for  health  and  other  regulated  professionals  to  practise  in 
other EU countries. 

The  EU  funding  programmes  Erasmus  and  Leonardo  da  Vinci34  and  its  proposed  successor 
programme  Erasmus  for  All  2012-201435  provide  support  for  cross-border  education  and 
training, also for medical students and healthcare workers. More promotion could help raise 
the visibility of these programmes in the healthcare sector  

Access  to  lifelong  learning  and  continuous  professional  development  (CPD)  plays  an 
important  role  to  update  professional  competence  and  also  to  motivate  and  retain  staff.  The 
Directive  on  the  mutual  recognition  of  professional  qualifications  obliges  Member  States 
already  since  2005  to  ensure  that  individuals  are  able  to  keep  abreast  of  professional 
developments  to  the  extent  necessary  and  the  Commission's  recent  proposal  would  require 
Member  States  to  report  to  the  Commission  and  other  Member  States  on  their  continuing 
education and training procedures related to the regulated health professions36. 

30

31

32

33

34

35

36

http://www.hca-network.eu 
Communication "Towards a job rich and inclusive recovery, COM add ref 2012 
Erasmus Programme 2012 
EC Directive on the mutual recognition of professional qualifications, 2005/36/EC. 
http://ec.europa.eu/dgs/education_culture/index_en.htm  
Erasmus for All, the EU Programme for Education, Training , Youth and Sport, COM (2011) 787 final  
Article 22, EC Directive on the mutual recognition of professional qualifications, 2005/36/EC. 

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CPD  systems  and  regulations  vary  significantly  across  Member  States  and  country  specific 
data  remain  scarce.  A  majority  of  stakeholder  respondents  and  the  European  Parliament37 
suggested  that,  while  lifelong  learning  is  a  competence  of  the  Member  States,  European 
collaboration  in  sharing  good  practice  on  CPD  approaches  and  accreditation  systems  would 
also help improve mutual understanding between Member States. 

4.3. 

Share  good  practice  on  effective  recruitment  and  retention  of  health 
professionals 

To ensure a sustainable health workforce in the EU crucially depends on atttracting people to 
work  in  the  healthcare  services  as  well  as  retaining  qualified  experienced  staff  in  a  highly 
competitive global labour market. 

Member States need to step up efforts to attract and recruit young people into the health 
professions  and  raise  awareness  in  schools  on  the  high  employment  potential  of  the 
healthcare sector and the wide variety of careers available in the healthcare sector requiring 
different skills and levels of qualifications. Moreover, return to work campaigns are important 
to attract experienced older health workers back into the professions.  

While  wage  levels  play  a  crucial  role,  non-financial  factors  such  as  a  supportive  and  safe 
work  environment  are  important  to  recruit  and  retain  health  workers,  particularly  women38, 
Moreover, recent evidence from the project Nurse forecasting in Europe (RN4Cast) suggests 
that  low  cost  approaches  to  improve  the  hospital  work  environment,  through  nurse 
participation  in  decision-making  or  managerial  support  for  nursing  care  for  example,  can 
retain  staff.  Workforce  planning  should  therefore  factor  in  an  analysis  of  the  work 
environment  as  it  influences  recruitment,  retention,  mobilty,  performance  and  ultimately 
health outputs and quality of care39. 

The  European  Social  Dialogue  in  the  hospital  and  healthcare  sector40  has  led  to  several 
agreements  aimed  at  improving  working  practices,  among  which  Council  Directive 
2010/32/EC on the prevention of sharp injuries in the hospital and healthcare sector, the Code 
of  Conduct  on  the  Ethical  Cross-Border  Recruitment  and  Retention  in  the  Hospital  Sector, 
and  the  Framework  of  Actions  on  Recruitment  and  Retention.  Working  conditions  are  an 
important  factor  to  retain  workers  in  the  health  professions  as  they  grow  older  and  the 
Commission  is  working  closely  with  the  social  partners,  European  Federation  of  Public 
Service  Unions  (EPSU)  and  European  Hospital  and  Healthcare  Employers  Association 
(HOSPEEM),  on  the  EU  Social  Dialogue  Committee  to  develop  common  guidelines  in 
relation to the ageing workforce As set out in the Commission's White Paper on sustainable 
pensions41, Member States need to adapt work place and labour market practices to improve 
opportunities for older workers.  

37

38

39
40 
41

EP Report on the implementation of the Professional Qualifications Directive, Committee on the Internal Market and Consumer 
Protection (2005/36/EC) (2011/2024(INI)). 
WHO  Policy  Brief  How  to  create  an  attractive  and supportive  working environment  for health  professionals,  Health  Evidence 
Network and the European Observatory on Health Systems and Policies, 2010 
Interview with RN4Cast coordinator, http://www.rn4cast.eu/en/index.php 
http://ec.europa.eu/social/main.jsp?catId=480&langId=en&intPageId=37 
White Paper "An agenda for adequate, safe and sustainable pensions", COM (2012) 55 final  

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Feedback from stakeholders and Member States42 suggest that the EU could assist in further 
exploration of factors that contribute to a supportive working environment and that European 
cooperation  could  help  promote  good  practice  on  innovative  and  effective  recruitment  and 
retention strategies in the EU. 

4.4. 

Addressing the ethical recruitment of health professionals  

There  is  a  range  of  EU  policies  in  the  fields  of  education,  development  aid  and  migration 
policy  which  support  the  implementation  of  the  WHO  Global  Code  on  the  international 
recruitment of health personnel and reinforce Member States' commitment to the Code to help 
reduce the negative impact of migrants' flow on fragile healthcare systems.  

The EU Blue Card Directive which facilitates the  admission of highly qualified migrants in 
the EU also allows Member States to reject applications in order to ensure ethical recruitment 
from countries suffering from a lack of qualified workers43, for example in the health sector. 
Member  States  using  this  possibility  must  communicate  to  the  Commission  and  the  other 
Member  States  the  countries and sectors  involved44.  The  Commission  must  present  a  report 
on the application of the Directive in 2014, which will be an occasion to look at how, and to 
what extent, these provisions on ethical recruitment have been used.  

5. 

DELIVERING THE ACTIONS  

Implementation  of  actions  to  tackle  the  challenges  facing  the  EU  health  workforce  requires 
enhanced  cooperation  -  between  the  Commission,  the  Member  States,  stakeholders,  social 
partners - and improved coordination across a range of policies - health, education, social 
policy, employment, internal market, development and cohesion.  

Member  States  are  urged  to  maximise  the  use  of  European  funding  instruments  to 
support  actions  to  tackle  health  workforce  shortages  and  to  boost  job  creation  in  the 
healthcare sector:  

In  line  with  the  Common  Strategic  Framework45,  the  proposed  Cohesion  and  Structual 
Funds 2014-2020 could be used for investments in jobs in the healthcare sector, for example 
to  support  measures  for  upgrading  skills  and  training  as  well  as  counselling  on  long-term 
employment opportunities in the healthcare sector.  

The  EU  programmes  Leonardo  da  Vinci46  and  Erasmus47  and  the  proposed  successor 
"Erasmus  for  All"48  support  cross-border  education  and  training  projects  to  help  healthcare 
workers  to  develop  new  skills  and  to  support  schemes  to  attract  young  people  into  the 
healthcare sector.  

42

43

44

45

46

47

48

Council Conclusions Scope of innovation and collaboration, 7 December 2010 
Article 8(2) and recital 22 
Article 20 
Common Strategic Framework  
Leonardo Da Vinci Programme, http://ec.europa.eu/education/programmes/leonardo/leonardo_en.html 
Erasmus Programme, http://ec.europa.eu/education/lifelong-learning-programme/doc80_en.htm  
COM(2011) 787 final Communication from the Commission to the European Parliament, the Council, the European Economic 
and Social Committee and the Committee of the Regions Erasmus For All: The EU Programme for Education, Training, Youth 
and Sport 

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The  proposed  Health  for  Growth  Programme  2014-202049  puts  the  contribution  of 
innovative  and  sustainable  health  systems  to  economic  growth  as  a  key  objective.  The 
programme proposes to help Member States to develop common tools and mechanisms at EU 
level to address shortages of resources and to facilitate the uptake of innovation in healthcare.  

49

Proposal for a Health for Growth Programme 2014-2020, COM (2011) 709 final of 9.11.2011 

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