Covid lays bare staffing crisis in Europe’s hospitals
Exhaustion and burnout. Patients at risk in understaffed hospitals. These and similar stories of woe were told by many of the roughly 6,000 nurses, doctors, and ambulance drivers who protested outside the health ministry in Paris this month.
Their diagnosis was brutal. The French healthcare system has suffered chronic under-investment and mismanagement for decades, they said, and the Covid-19 pandemic had pushed it past its limits, leading to a staff retention and recruitment crisis.
Waving a banner demanding “More beds! More staff!”, George Palomas, an ambulance technician from Lille, said some hospitals in his region had been forced to close emergency departments at night and weekends because of lack of staff.
“Sometimes we have to drive an extra 20 or 30 kilometres to get a patient to hospital,” he said.
With France in the middle of another Covid-19 surge, even before the full impact of the highly transmissible Omicron variant has made itself felt, the stress on the health system and the people who work in it is growing.
The country is far from alone in facing a workforce crisis. Dr Natasha Azzopardi-Muscat, a senior World Health Organization official who works on health systems in Europe, said staff shortages were the overriding problem for hard-pressed health services.
Some European countries, such as Germany and Austria, started the pandemic with more intensive care beds, relative to population, than others. According to the OECD, Germany has 28.2 hospital beds per 100,000 inhabitants and Austria 21.8 against a European average of 14.1. However, Azzopardi-Muscat said, many disparities in infrastructure had been addressed between successive infection waves.
“The one that was not resolved was workforce . . . You don’t make health workers overnight,” she added.
In France, rising Covid-19 infections coupled with staff shortages have forced seven out of 13 regions to trigger hospital emergency plans, allowing them to delay operations, call in private sector reinforcements and cancel staff holidays.
Hospital cases have increased steadily since late November to reach about 7,000 new admissions a week, a figure that, thanks to widespread vaccination, remains lower than the 10,000 to 15,000 at the height of previous waves. But government officials have warned that the system could still be overwhelmed in the coming weeks unless Omicron proves to cause milder disease than feared.
In the greater Paris hospital system about 1,000 nursing jobs remained unfilled out of a total of 18,000, forcing the closure of 13 per cent of its beds as of late November.
A study by the Federation of French Hospitals that surveyed 330 institutions nationally in November found 6 per cent of beds were unavailable because of staff shortages, while just under 5 per cent of nursing jobs were unfilled.
Similar problems have cropped up in Germany. According to a 2021 survey by the German Hospital Institute (DKI), some 72 per cent of those questioned said they had fewer intensive care staff than last year because of resignations, job changes or cuts in working hours. Almost 90 per cent of hospitals reported being unable to operate fully all their intensive care beds.
Professional organisations have begun to report higher rates of depression, anxiety, and insomnia among health workers. A recent survey by the Irish Nurses and Midwives Organisation found nearly two-thirds of respondents had cared for patients who died of Covid-19 and 85 per cent believed the experience had a negative psychological impact on them.
“Staggeringly, 97 per cent believe it had a negative impact on their colleagues as they were seeing [them] burnt out, day in, day out,” said Siobhan de Paor, an INMO official.
The impact is beginning to be felt on the front line, where beds have had to be closed because of staff shortages in some areas — particularly in Ireland’s rural communities, she added.
A report last month by the European Observatory on Health Systems and Policies, in partnership with the WHO, said an ability to keep health services functioning normally had “been unevenly achieved across countries”.
Some nations displayed “resourcefulness and ability to absorb, adapt and transform themselves in the face of shock”. But this “tale of hope” was balanced by “a tale of despair, laying bare the chronic under-investment in health systems, manifested in health coverage gaps, workforce shortages, flawed health information systems, and many other weaknesses”, according to the analysis.
France has tried to shore up its health system and fix the problems exposed by the first Covid wave.
President Emmanuel Macron’s government passed a reform plan in July that pledged €8bn in salary increases for health workers, €19bn in investment for hospitals over 10 years to pay down debt, renovate wards and boost technology spending, and promised to create 15,000 jobs in public hospitals. It also abolished an unpopular cap on the number of medical students allowed to advance to a second year of training in an effort to address longstanding doctor shortages.
Critics have said the reform does not go far enough. “It is a drop in the ocean,” said Emmanuelle Durand, who works in cardiovascular surgery in a Reims hospital and is active in a doctors’ union. “The gangrene is so deep and people are so disillusioned.”
Before the reform, French nurses earned less than the national average wage with their pay ranked 22nd out of 33 countries in the OECD. The new plan gives them a €183 per month rise.
Arnaud Chiche, a doctor in the northern city of Tourcoing who founded advocacy group, Health in Danger, said he hoped Macron and other candidates for next year’s presidential election, would propose genuine plans to rebuild the healthcare system. “The state has lowered budgets for 30 years and asked us to do more with less. We are at the end of this process,” he warned.
Samira Bordeau, an intensive-care nurse in Brittany with 12 years’ experience, said she was thinking of quitting. “I was supposed to have three days off for Christmas this year but it’ll probably get cancelled because of the Covid-19 emergency plan. The sacrifices asked of us and our families are just too big,” she said.
Additional reporting by Guy Chazan