For decades, western Europe’s national healthcare systems have been widely touted as among the best in the world.
But an ageing population, more long-term illnesses, a continuing recruitment and retainment crisis plus post-Covid exhaustion have combined, this winter, to create a perfect healthcare storm that is likely to get worse before it gets better.
“All countries of the region face severe problems related to their health and care workforce,” the World Health Organization’s Europe region said in a report earlier this year, warning of potentially dire consequences without urgent government action.
In France, there 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 does not have adequate access to health services.
In Germany, 35,000 care sector posts were vacant last year, 40% more than a decade ago, while a report this summer said that by 2035 more than a third of all health jobs could be unfilled. Facing unprecedented hospital overcrowding due to “a severe shortage of nurses”, even Finland will need 200,000 new workers in the health and social care sector by 2030.
In Spain, the health ministry announced in May that more than 700,000 people were waiting for surgery, and 5,000 frontline GPs and paediatricians in Madrid have been on strike for nearly a month in protest at years of underfunding and overwork.
Efforts to replace retiring workers were already “suboptimal”, the WHO Europe report said, but had to now be urgently extended to “improve retention and tackle an expected increase in younger people leaving the workforce due to burnout, ill health and general dissatisfaction”.
In a third of countries in the region, at least 40% of doctors were aged 55 or over, the report said. Even when younger practitioners stayed despite stress, long hours and often low pay, their reluctance to work in remote rural areas or deprived inner cities had created “medical deserts” that were proving almost impossible to fill.
“All of these threats represent a ticking time bomb … likely to lead to poor health outcomes, long waiting times, many preventable deaths and potentially even health system collapse,” warned Hans Kluge, the WHO regional director for Europe.
In some countries the worst shortages are among GPs, with France in particular paying the price for previous planning errors. Back in 1971, it capped the number of second-year medical students through a so-called numerus clausus aimed at cutting health spending and raising earnings.
The result was a collapse in annual student numbers – from 8,600 in the early 1970s, to 3,500 in 1993 – and while intakes have since climbed somewhat and the cap was lifted altogether two years ago, it will take years for the size of the workforce to recover.
Even though 10% of France’s GPs now work past retirement age, older doctors leaving the profession outnumbered newcomers entering it last year, when numbers were still 6% down on what they were even a