“It’s a time bomb”

Western Europe’s public health systems have been regarded for decades as the best in the world. However, an aging population, the rise in chronic disease, the ongoing crisis in recruiting and retaining healthcare workers, and burnout from the COVID-19 pandemic are all factors that have combined this winter to lead to a perfect storm that is likely to only get worse.

The health crisis undermines primary care, the greatest strength of the Spanish system

The health crisis undermines primary care, the greatest strength of the Spanish system


“All the countries in the region face serious problems related to their health and care personnel,” stated the Regional Office for Europe of the World Health Organization in a report from the beginning of the year, in which it warned of the potential consequences disastrous if governments do not take urgent action.

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

In Germany, 35,000 healthcare jobs fell vacant last year, 40% more than a decade ago, while a report this summer claimed that by 2035 more than a third of all healthcare jobs could be unfilled. Even Finland, which is facing unprecedented hospital saturation due to “a severe shortage of nursing staff”, will need 200,000 new workers by 2030.

In Spain, the Ministry of Health announced in May that more than 700,000 people are on the waiting list for surgery, and 5,000 GPs and paediatricians in Madrid have been on strike for almost a month to protest years of underfunding and excess of workload.

According to the WHO report for Europe, efforts to replace retiring health personnel were already “insufficient”, but it is now urgent to intensify them to “improve retention and cope with the foreseeable increase in the number of young people leaving the profession due to to exhaustion, poor health and general dissatisfaction.

The report confirms that in a third of the countries in the region, at least 40% of doctors were 55 years of age or older. Even as younger doctors stay behind despite stress, long hours and often low pay, their reluctance to work in remote rural areas or deprived urban centers has created “medical deserts” that are proving almost impossible to fill.

“All these threats represent a time bomb… that can lead to poor outcomes, long waiting times, many preventable deaths and potentially even the collapse of the health system,” warns Hans Kluge, WHO regional director for Europe.

87% of France, “medical desert”

In some countries, the most severe shortages affect family doctors, and France in particular is paying the price for past planning errors. As early as 1971, it reduced the number of second-year medical students by limiting the number of places aimed at cutting health spending and increasing revenue. The result was a plunge in annual student numbers: from 8,600 in the early 1970s to 3,500 in 1993. Although student numbers have risen slightly since then and the cap was lifted two years ago, the size of the workforce will take years to recuperate.

Despite the fact that 10% of French family doctors are already past retirement age, last year the number of older doctors leaving the profession exceeded that of newcomers, which was still 6% less to that of a decade ago. An adequate proportion of doctors per inhabitant will not be reached until 2035.

A more local analysis focused on cities and neighborhoods shows a different situation. The ratio of GPs ranges from 125 or more per 100,000 inhabitants in some wealthy neighborhoods to less than half in remote rural areas or deprived suburbs such as the Seine-Saint-Denis department.

“In fact, one could say that approximately 87% of France is a medical desert,” Health Minister Agnès Firmin Le Bodo declared in November, promising a “complete reconstruction” of general medicine services through more medical centers. multifunctional health and remote consultations, but without forcing doctors to settle in poorly supplied areas.

This winter’s flu epidemic, added to that of COVID-19, has exposed the failures of the system, creating “a crisis not only for the French hospital sector, but for all of French healthcare,” Arnaud Robinet said this month. , of the Federation of French Hospitals. Robinet noted that the service is “no longer capable of systematically responding” to emergencies.

“Unimaginable” scenes in Germany

In Germany, which spends more on healthcare than almost any other country in the world, hospitals are a major concern as this winter’s surge of respiratory syncytial virus (RSV) cases in young children has raised alarm bells across the board. the country.

The newspaper Sueddeutsche Zeitunge he writes that the country is witnessing “what it means for a system to explode…with scenes from the past they might have seemed unimaginable.”

In a petition to Parliament entitled “Alert Level Red: Hospitals in Danger”, the German Hospital Society (DKG) once again highlighted the chronic lack of medical personnel as the main problem, pointing out that many Hospitals had had to temporarily close emergency services due to a lack of doctors and nursing staff.

In German hospitals, more than 23,000 jobs remain unfilled after several years of low recruitment and recent mass resignations of staff, especially in intensive care and operating rooms, citing such an extreme workload that some could not even take a short break or go to the bathroom.

The Minister of Health, Karl Lauterbach, has announced an aid package of 300 million euros for pediatric clinics and a “revolution in hospital care” still unspecified that will put “medicine before the economy”, in addition to a plan to displace to doctors and nursing staff based on the demand that prominent doctors dismissed as “absurd”. “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,” says Christine Vogler of the German Nursing Council (DPR). “This can only be described as a desperate act.”

Christoph Spinner, an infectious disease consultant at the University Clinic in Munich, says the country’s healthcare system is “certainly facing enormous challenges”, while pediatrician Nina Schoetzau says the current situation of the UK healthcare system is only “a foretaste of what awaits Germany”.

Thousands of nurses joined the wave of strikes that affected public health in the United Kingdom this month with a 12-hour strike to demand wage increases this Thursday. It is considered the biggest strike in the history of the British National Health Service (NHS), according to the BBC. A report commissioned by the British government says that a “decade of neglect” by successive Conservative administrations has weakened the NHS to the point that it will be unable to cope with the seven million backlogs of healthcare.

Spain, “desperate” situation

In Spain, winter has already led overworked frontline staff to go on strike. The health crisis, which was exposed during the COVID-19 pandemic, is due to decades of lack of investment, competition between autonomous communities for medical personnel and the lure of better wages and conditions abroad.

Much of the discontent has been concentrated in the Community of Madrid, where in mid-November at least 200,000 people took to the streets to defend public health against progressive privatization and express their concern about the restructuring of the primary care system carried out carried out by the Community of Madrid. In this sense, Ángela Hernández, surgeon and general secretary of the Madrid medical association AMYTS, says that the situation of pediatric services is “desperate”, and adds that it is also “a matter of demand: no one has explained to the population that, if resources are limited, they should use them with common sense.” Politicians have the responsibility to “explain the situation to the population,” says Hernández. “But since they do the exact opposite in Madrid in particular and in Spain in general, they only manage to generate false expectations.”

The Metges de Catalunya (Doctors of Catalonia) union is also planning a two-day strike in January to protest “the overload, contempt and precariousness”. Xavier Lleonart, the union’s general secretary, says that the pandemic has been “the icing on the cake”, but that in reality the current situation was as predictable as it was depressing. He claims that some Spanish doctors are so burned out that they retire early, despite the impact on their retirement pension. In his opinion, it is a priority to make the profession more attractive to stop the “hemorrhage” of professionals. “It is said that the best capital of a company is its human capital”, says Lleonart. “The problem is that in healthcare human capital has been systematically mistreated until it has said ‘enough’”.

Italy, exodus to the private sector

Italian public healthcare is also facing severe staff shortages, exacerbated by the pandemic, which has triggered an exodus of healthcare professionals, who have taken early retirement or have chosen to work in the private sector. Regional governments have signed contracts with freelance doctors to cover hospital shifts when necessary, highlighting the low wages in the Italian public health sector.

“There are gaps to fill everywhere, especially in emergency services,” says Giovanni Leoni, vice president of an Italian federation of doctors. “The problem is that the self-employed earn two or three times more: up to 1,200 euros for a 10-hour shift.” Leoni explains that many doctors have left the public sector “early”: “They have found other types of jobs in the private sector, functions that allow them not to have to do night shifts or weekends.”

Italian doctors protest with demonstrations of “the invisible”. “We are invisible to the government,” says Leoni. “The salaries of Italian doctors have to be at the same level as the European average. Currently, they are among the lowest.”

Translation by Emma Reverter

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