Changes from plenary report to adopted text

D. whereas unmet demand for the healthcare workforce in the EU is increasing owing to multiple factors, including demographic changes with rising long-term care and societal support needs, the growing incidence of mental health issues, cancer and other non-communicable diseases (NCDs), the continuing threat of antimicrobial resistance (AMR), and persistent risks from pandemics and other public health emergencies, including the health impacts of environmental degradation and extreme weather events;

E. whereas Eurostat data reveals significant disparities both between and within Member States in the density of the healthcare workforce as well as marked differences in wage levels, with remuneration gaps contributing to workforce imbalances, professional migration, and unequal access to healthcare services across the EU; whereas persistent healthcare workforce shortages across the EU have created an unsustainable ratio between patients and the healthcare workforce, which can lead to shorter consultation times, long waiting lists, overcrowded emergency services, delayed diagnosis, poorer health outcomes, significant economic costs, an increased mental health burden, reduced time for preventive care and a general decline in the quality of healthcare services highlighting the urgent need for strategic investments in recruitment, training and retention policies for the healthcare workforce; whereas gender-responsiveness of health systems is also essential for the overall preparedness, resilience and stability of Europe’s health systems;

F. whereas in public health it is acknowledged that everyone must play their part, adopting lifestyles that promote health and prevent disease in order to develop self-care; whereas many people rely on informal caregivers and this is a role that many people will take on in the course of their lives;

G. whereas the healthcare workforce crisis is a major public challenge that needs to be prioritised; whereas the resilience and sustainability of healthcare systems depends on the contribution of a broad range of professionals across the health and care ecosystem, including clinical, technical, administrative, research, digital, logistics and manufacturing roles, whose combined work ensures the continuity, safety and quality of care; whereas strengthening training and recognition of healthcare professions is essential to deliver on the EU’s health, social and industrial policy objectives given that the EU health-related industrial sector requires technical expertise;

H. whereas the healthcare workforce crisis and chronic shortages are not only a resource issue but also a patient safety and care quality concern, as they can be associated with higher rates of avoidable harm, complications and readmissions due to shortened monitoring, necessary checks not being carried out, reduced adherence to clinical protocols, longer waiting times, delayed diagnoses, disruption of care continuity and access, and higher risks of clinical errors;

I. whereas underserved regions, including mountainous, rural, suburban, remote, depopulated, outermost or island areas, face significant challenges in covering health structures with suitably qualified staff; whereas the closure of hospital wards and healthcare facilities is reducing patients’ ability to access services, with pregnant women having to travel over 100 km to reach a maternity ward in some regions of the EU;

P. whereas low pay is one of the main drivers of labour shortages; whereas fair wages and benefits play a significant role in job retention and attracting new talent to the healthcare sector; whereas effective social dialogue and collective bargaining systems are essential to improve wages, working conditions and retention in the healthcare and care sectors; whereas countries with higher collective bargaining coverage generally face fewer staff shortages and lower turnover; whereas EU action should also support capacity-building for social partners;

Q. whereas the EU healthcare workforce shows concerning trends in job satisfaction, including lower tolerance for working conditions that interfere with family and personal life, as well as mental health challenges, including secondary traumatic stress, moral distress, grief, anxiety, high exposure to physical and psychosocial risks, emotional exhaustion, burnout, fatigue, limited flexibility despite rising demand, excessive working hours, lack of recognition and a growing intention to leave the profession, driven by factors such as staff shortages, high workloads, overtime work and inadequate pay;

R. whereas the WHO survey on the mental health of nurses and doctors in the EU, Norway and Iceland reports that longer working hours, job insecurity, and exposure to violence and harassment are consistently associated with poorer mental health, with one in three workers reporting depression or anxiety and one in ten reporting thoughts of ending their life or harming themselves; whereas according to WHO one in four doctors, especially junior doctors, work more than 50 hours per week; whereas 32 % of doctors and 25 % of nurses are on temporary employment contracts, which increases their anxiety about job security; whereas healthcare workers facing less stable working hours, such as extended working hours, night shifts, rotating shifts and temporary contracts, experience higher rates of anxiety, depression and increased prevalence of alcohol dependence; whereas studies indicate that healthcare workers experiencing burnout, such as workers in specialised cardiovascular units, among others, are twice as likely to be involved in patient safety incidents;

S. whereas according to EU-OSHA, musculoskeletal disorders are the leading cause of work-related health problems in the healthcare sector, with between 60 % and 90 % of nurses reporting such disorders each year due to the intense physical demands of their work; whereas RMDs are the primary health-related reason why healthcare workers leave the profession and thus are a major contributor to Europe’s shortage of healthcare workers; whereas women are disproportionately affected by RMDs;

T. whereas the improvement of working conditions and health and safety, including support for physical and mental health, reliable shift systems and a predictable timetable, together with prevention and protection against violence and harassment, including on social media, are essential for retaining qualified professionals and ensuring patient safety, and thus are key elements of the efforts to address EU-wide healthcare workforce shortages;

U. whereas the human health and social work activities sector is among Europe’s largest and fastest growing employers and the largest single employer of women; whereas the health labour market is strongly gender-segregated with women making up the majority (78 %) of healthcare workers in the EU, whereas women face a 24 percentage point pay gap (in the case of mean monthly earnings) compared to men across the health and care sector and this gap is created through poor recognition of women’s qualifications, lack of career chances, and an overall higher share of caring responsibilities; whereas in around half of the Member States, women account for more than 90 % of the nursing workforce; whereas shortages in the healthcare workforce increase gender inequalities in different ways; whereas women are affected by a growing workload, stress, burnout and emotional burden in higher numbers; whereas women nurses are disproportionately affected by gender inequalities and violence; whereas women in the sector have poorer working conditions, suffer higher workplace violence and sexual harassment and occupy fewer leadership positions than men; whereas these challenges are further exacerbated by insufficient or lacking victims support services; whereas robust education and training for health professionals is essential to prevent, identify and address problematic, harassing and violent behaviours linked to relationships and affectivity;

V. whereas women are often disproportionately affected by public health crises due to persistent inequalities, caregiving responsibilities and exposure to health risks; whereas several professions in the care sector suffer from insufficient visibility and societal recognition, leading to low wages and a lack of attractiveness; whereas the quality of care depends on the existence of a sufficiently large and well-trained workforce, decent working conditions, fair wages, and well-integrated and coordinated services; whereas informal caregivers, who are predominantly women, provide essential care while lowering the burden on healthcare professionals; whereas recognising the status of informal caregivers is a way to address workforce shortages; whereas the 2022 European Care Strategy explicitly recognises that informal care, usually provided by family and friends, and formal care, provided by professional services, must cooperate and be integrated into a coherent care system; whereas this strategy highlights the need for the formal sector to recognise informal carers as partners in care planning and delivery;

W. whereas adequate staffing levels are essential to ensure patient safety and protect the occupational health, mental health and overall well-being and safety of the healthcare workforce, including reducing the risks of burnout and strengthening the efficiency and resilience of healthcare systems and helping to prevent healthcare workers from leaving the profession because of poor working conditions;

X. whereas digitalisation and upgraded IT infrastructure, if well managed, can to a certain extent complement the work of the healthcare workforce, by reducing the workload of staff, particularly with administrative tasks, help leverage technology, redesign service delivery and optimise operations management, by relieving pressure on overstretched systems and improving access in underserved regions as well as rural areas, provided that it is implemented with respect for labour rights and without replacing human staff or leading to further privatisation of services and bearing in mind that it can be associated with psychosocial risks like cognitive overload, job insecurity or lack of trust; whereas any deployment of digital and remote solutions, including artificial intelligence (AI), should be based on a human-centric approach and ethics-by-default principle;

Y. whereas with the rapid development of AI and other emerging technologies, it is essential to invest in training and education in the use of new technologies, in order to provide healthcare workers with the necessary tools to optimise their time and improve patient care; whereas innovative working models, based on an evaluation of the health workforce skill mix, could bring greater efficiency while maintaining quality of care, ensuring that the right tasks are performed by the right worker, including through re-certification processes where appropriate; whereas the reskilling, upskilling and inclusion of new technical skills could lead to an even wider range of jobs in the healthcare sector;

Z. whereas AI systems used in employment, worker management and access to self-employment, in particular for the recruitment and selection of persons, for making decisions affecting terms of the work-related relationship, promotion and termination of work-related contractual relationships, for allocating tasks on the basis of individual behaviour, personal traits or characteristics and for monitoring or evaluation of persons in work-related contractual relationships, are classified as high-risk in the Artificial Intelligence Act, since those systems may have an appreciable impact on future career prospects, livelihoods of those persons and workers’ rights;

AA. whereas under Article 168 TFEU, the organisation of health services and medical care is a competence of the Member States, with EU action subject to the principles of subsidiarity and proportionality; whereas the EU policies should help strengthen access to effective and sustainable healthcare systems in line with national contexts;

AB. whereas in its report on the health and care workforce in Europe, the WHO has warned of a future healthcare workforce crisis and future shortages and proposed ten actions and seven policy actions on mental health to strengthen the healthcare workforce in the EU and broader European region; whereas medical students and early-career healthcare professionals represent the future of Europe’s health system; whereas there is a need for an intergenerational workforce transition; whereas declining enrolment in health-related studies poses a long-term risk to the sustainability of healthcare; whereas in several Member States medical education and training capacity are set by budgetary constraints rather than by transparent assessments of population health needs; whereas hospital-centric planning leaves rural, peripheral and outermost areas underserved;

AC. whereas measures to facilitate intra-EU mobility and third-country recruitment should be equitable and sustainable, avoiding a brain drain from regions already suffering shortages, and in line with the WHO Global Code of Practice on the international recruitment of health personnel; whereas, however, the voluntary control mechanisms of the WHO Global Code of Practice are not sufficient to respond effectively to the diverse needs of EU health systems;

AD. whereas the European Court of Auditors concluded that the EU system for recognising professional qualifications is ‘used sparsely and inconsistently’ and called on the Commission to better monitor Member States’ compliance with the Professional Qualifications Directive;

AE. whereas the European Committee of the Regions has called for data-driven solutions to address medical deserts, enhanced EU4Health prevention efforts, effective qualifications recognition, and a robust cohesion policy for expanded healthcare training;

AF. whereas the Commission proposal amending Regulation (EU) 2021/1057 does not specifically mention funds from the ESF+ going towards the healthcare sector, nor does it mention the sector’s specific challenges and fails to provide earmarking for the public health sector and for decent working conditions for health professionals, in particular women and young workers; whereas the privatisation of healthcare providers could reduce patients’ ability to access certain services and could lead to a loss of control over the public healthcare system;

AG. whereas funds from the national recovery plans were intended to support the resilience and development of healthcare systems and need to be complemented by further measures to properly address the healthcare workforce crisis;

AH. whereas the European Semester provides a key framework for coordinating economic, employment and social policies across the EU, and should support Member States in addressing health workforce challenges;

AI. whereas the Niinistö report acknowledges that a well-functioning healthcare system is a key element of the EU’s societal resilience and a priority within the EU’s preparedness agenda, including strengthening healthcare workforce, medical supply chains and improving mobility frameworks; whereas the lack of healthcare workforce is a threat to health security; whereas the Commission has announced the crisis preparedness strategy, which demands sufficient health workforce resources; whereas the Council (Employment, Social Policy, Health and Consumer Affairs Council) is not paying sufficient attention to shortages in the healthcare workforce;

AJ. whereas the rapidly changing global security environment, marked by increasing geopolitical tensions, armed conflicts, hybrid threats, misinformation and instability in the EU’s neighbourhood, has significant implications for public healthcare systems and the resilience of the healthcare workforce;

AK. whereas national and pan-European actions to respond to healthcare workforce shortages often remain poorly connected while effective governance and implementation strategies are ill developed or even lacking, whereas dysfunctional healthcare labour markets are impacting EU societies beyond the health sector, hampering economic development, social cohesion and equity, and ultimately trust in governments and democracy;

AL. whereas the Draghi report identifies public health and the life sciences as a core tenet of European competitiveness and resilience for the continent and acknowledges the situation of health-related industries as a competitiveness issue;

Employment, working conditions and the safeguarding of mental health

2. Reiterates that any EU action in this field should respect the principle of subsidiarity, national competences and the autonomy of social partners;

3. Calls on the Member States to adopt and regularly update comprehensive national strategies in this field, including long-term action plans and effective workforce planning covering all stages of the professional life cycle, from promoting education, recruitment and retention, to continuing professional development and late-career engagement, with particular attention to underserved areas and those with constrained health infrastructure capacity; underlines that such long-term action plans require strong multi-sectoral coordination, involving all relevant authorities, to ensure that education systems, funding mechanisms and labour market policies are consistent and responsive to national and regional health needs; furthermore calls on the Commission to support cooperation and the exchange of best practice among Member States;

4. Calls on the Commission and the Member States to promote and coordinate – in close cooperation with social partners – integrated workforce strategies at both national and EU levels, aimed at attracting young people to healthcare professions while tackling brain drain, aligning educational capacities with healthcare system needs and ensuring that all Member States have a sufficient number of adequately trained healthcare professionals, in particular in the most understaffed specialisations; further encourages cross-border collaboration and exchange in education and training, notably through mobility programmes such as Erasmus+; calls for a separate Erasmus exchange programme to be set up for healthcare education and training institutions so as to contribute to skills development throughout the EU and to foster the development of transnational and transdisciplinary curricula;

5. Underlines that safe staffing levels, good working conditions and the right combination of professionals in the healthcare workforce are essential for patient safety, quality of care and staff well-being; calls moreover on the Commission to propose a Council recommendation setting out common principles for safe, evidence-based and high-quality staffing for the whole healthcare workforce, anchored in patient safety outcomes, social dialogue and collective bargaining and risk-based assessment while fully respecting the diversity of healthcare system models; calls for such a recommendation to recognise unsafe staffing levels as an occupational hazard; calls on the Commission to consider the need for an obligatory framework to this end which comprises workload controls and doctor-to-patient/nurse-to-patient ratios, including in high-acuity settings and measures to relieve the physical, psychological and administrative burden faced by healthcare workers, aiming to reduce errors and strengthening overall healthcare system performance, while recognising the need for flexibility for health organisations to adapt to labour-market realities and workforce planning priorities without compromising quality of care or patient safety; calls on the Member States to adopt, implement and regularly review national legislative frameworks thereafter, including minimum thresholds and benchmarks on safe staffing, as well as minimum consultation times that are sufficient to ensure an accurate assessment and appropriate care of patients with increasingly complex clinical profiles, also in the light of the expansion of treatment options, where applicable; calls for national approaches to be based on evidence, clinical context, social dialogue and collective agreements, ensuring transparent reporting on quality and safety indicators;

6. Calls on the Commission, in cooperation with the Member States and relevant professional organisations, to develop a standardised EU tool for measuring nurses’ workload, such as through validated systems similar to the Nursing Activity Score, in order to ensure safe staffing levels and improve patient safety;

7. Calls on the Member States to recognise the healthcare workforce as strategic for social and economic cohesion, and to ensure working conditions that reflect their contribution to society, as well as a formal recognition of healthcare professions as strenuous and particularly demanding; calls on the Commission and the Member States to address workforce shortages by ensuring job security, fair working conditions, fair remuneration and adequate minimum wages following the Directive on Adequate Minimum Wages and commensurate with responsibilities and skills level, as well as by addressing occupational health and safety including mental health, musculoskeletal disorders and exposure to hazardous substances and environments; calls in this regard for the protection of workers’ rights, notably respecting working hours, improving predictability and flexibility related to shift work, limiting consecutive night shifts and long shifts, ensuring adequate rest and recovery periods, statutory paid annual leave, access to occupational health and safety services, and enhancement of other protective factors, including social support and workplace support structures, and the protection of the healthcare workforce against precarious employment; looks forward, in this regard, to the Commission’s upcoming proposals on a Quality Jobs Act;

8. Calls on the Commission to monitor and ensure compliance with the Working Time Directive since one in four doctors, in particular junior doctors, and one in ten nurses work more than 50 hours per week, which, according to the WHO survey on the mental health of nurses and doctors in the EU, Norway and Iceland, leads to exhaustion, burnout and higher risk of medical errors;

9. Calls on the Member States to support the financing of traineeships for students enrolled in accredited first-cycle and single-cycle programmes in medicine and other healthcare studies, and explore the possible complementary leverage of EU instruments; calls for the establishment of dedicated support to cover the full duration of studies, including clinical placements; calls on the Commission and the Member States to explore the possibility of setting up, with support from EU instruments, a monitoring framework to track uptake and impact of the financing support mechanism that will be provided to students;

10. Recognises the dual and vital role of junior doctors, residents and postgraduate trainees as both learners and workers; calls for their specific legal protection, ensuring fair remuneration, safe working conditions, protected rest, social security coverage, support for pregnancy and parenthood and adequate supervision in line with EU and national labour law; calls for safeguards to protect students from being used as a substitute for staff, thereby ensuring that their learning and safety are prioritised; emphasises the need to develop a European framework of minimum quality standards for residency programmes, guaranteeing fair remuneration, transparent career progression, adequate supervision and mentoring, and full respect for occupational health and safety, including rest periods and access to mental health support; underlines that investing in residents means investing in the future resilience and quality of European healthcare;

11. Calls for the health sector to be protected from the Omnibus deregulation agenda;

12. Calls on the Member States to ensure a genuine work-life balance, fair working hours, voluntary part-time work, and control over work and scheduling for the whole healthcare workforce, family-friendly and flexible work arrangements, affordable high-quality childcare facilities and other family support services; deplores the fact that difficulties in accessing affordable high-quality formal care lead to overreliance on informal care or undeclared work, with consequences for women; recognises the gender dimension in health work especially in women-dominated jobs such as nursing or midwifery, and in the care sector and calls for gender inequalities to be tackled and equal pay for equal work to be ensured, calls for better tailored and targeted occupational health and safety measures, measures to combat wage disparities, career barriers, unsafe working conditions and workplace violence against women, to tackle gender inequalities and ensure equal pay for equal work, and highlights the need to protect them with safer, more equitable, and supportive work environments; calls in this respect on the Member States to implement the Pay Transparency Directive fully without delay and to address the gender pay gap and gender glass ceiling; underlines the higher prevalence of depression and anxiety among women healthcare workers, as reported in the WHO survey on the mental health of nurses and doctors in the EU, Norway and Iceland; reminds the Member States that Article 10 of Council Directive 2013/59/Euratom introduces exposure to radiation limits for pregnant and breastfeeding workers;

13. Calls on the Commission and the Member States to take action to ensure strong protection against gender-based discrimination and violence in the workplace; calls on the Commission to ensure the effective implementation of the Pregnant Workers Directive; calls, furthermore, for the provision of incentives to support women’s return to the labour market;

14. Deplores the growing number of violent acts against healthcare professionals and calls on the Member States to establish national action plans to improve the safety of healthcare professionals that include the integration of relevant training programmes, and in particular of de-escalation communication strategies, into curricula for the healthcare professions and to establish comprehensive support mechanisms such as structured cooperation protocols;

15. Highlights the importance of the mental health and well-being of the healthcare workforce; underlines the need to address the high prevalence of burnout, depression and anxiety among healthcare workers in the EU; notes that burnout rates in the healthcare workforce are particularly high, especially among cardiovascular professionals (79 % of nurses and 65 % of doctors) and that, according to the WHO survey on the mental health of nurses and doctors in the EU, Norway and Iceland, one in three nurses and doctors experience mental health challenges and doctors and nurses are five times as likely as the general population to experience symptoms of depression (32 % compared with 6 %); notes the increased risk of errors caused by excessive fatigue, physical exhaustion, depression and mental strain, with potentially fatal consequences; highlights that patients’ lives often depend on the endurance limits of exhausted staff; calls on the Commission and the Member States to ensure the proper implementation of the Framework Directive for occupational safety and health (OSH Framework Directive), in order to prevent and manage the occupational risk factors affecting the healthcare workforce, including excessive workloads, work-related stress, unsafe working conditions, violence and harassment; emphasises furthermore the need and calls for mental health and substance-dependency support programmes to be made available and accessible to the whole healthcare workforce, and the recognition of the long-term effects of the COVID-19 pandemic on the mental health of the healthcare workforce; calls on the Member States to exchange good practices and implement measures promoting prevention, early intervention and long-term person-centred support measures such as regular recovery and resilience programmes, including access to psychological support, which can improve job satisfaction and prevent burnout without necessarily requiring a large financial investment;

16. Supports making the protection of staff mental health a key performance indicator to build on the accountability of healthcare managers to promote and protect staff mental health and well-being;

17. Calls on the Commission and the Member States to ensure the proper implementation of the OSH Framework Directive, particularly with regard to occupational exposure to hazardous medicinal products, in line with the Carcinogens, Mutagens and Reprotoxic Substances Directive; emphasises that RMDs are a primary reason why healthcare workers leave the profession on health grounds; highlights the need for the Commission and the Member States to ensure occupational health and safety measures to address RMDs and psychosocial risks, including through enhanced research and prevention; calls on the Commission to strengthen the EU legislative framework on RMDs and psychosocial risks, also within the framework of the Quality Jobs Act;

18. Underlines the crucial role of social partners and professional organisations, academic institutions and scientific societies, and other relevant stakeholders at national and EU level, as well as that of social dialogue and collective bargaining at national and EU level, and calls for their close and structured involvement in the design, implementation and evaluation of workforce strategies, and in improving workplace standards;

Tackling inequalities in access to healthcare

19. Recommends that the relevant authorities in the Member States enhance coordination to develop integrated regional health strategies that establish better integrated care pathways and adopt a comprehensive and integrated model of care covering hospital, home, community and outpatient care; underlines that the reorganisation and modernisation of patient pathways are critical to improving the strategic allocation and utilisation of the health workforce, enhancing system efficiency and patient outcomes; calls on the Member States to strengthen services dedicated to women’s health to provide integrated, gender-responsive care and recognises the unique role of formal and informal carers;

20. Calls for the recognition of the status of informal caregivers, who are predominantly women, in order to acknowledge and compensate their unpaid work and to ensure them adequate social and labour protection, including access to social security, training and support services;

21. Emphasises that disparities in access to and quality of care perpetuate health inequalities and jeopardise health coverage in underserved areas, such as mountainous, rural, island, remote, outermost, suburban and depopulated areas, owing to workforce shortages, in particular for elderly and disadvantaged populations and persons with disabilities; calls for the development of targeted and specific healthcare strategies to strengthen healthcare infrastructure; stresses that home and community care services must be considered essential social infrastructure; furthermore calls on the Member States to improve data collection and analysis to help prevent the over-concentration of medical professionals in certain large cities and developed regions; encourages the strengthening of data-driven approaches to identify and address regional and territorial disparities in the availability of healthcare professionals and to ensure adequate and equitable distribution of services in underserved areas;

22. Recommends integrating data on regional health disparities into national health workforce and cohesion policy planning, supporting the creation of a dedicated funding window under the ESF+ and cohesion policy to help the Member States implement sustainable healthcare workforce strategies; underlines that cohesion funds play an important role in investing in local healthcare infrastructure and creating incentives to attract and sustain healthcare workers in underserved and less populated areas, thereby promoting territorial cohesion;

23. Urges the Member States and authorities at local and regional levels to optimise the use of EU and national funds, included but not limited to innovative and financial and non-financial incentives for attracting and retaining health professionals in underserved areas, such as mountain, rural, island, remote, suburban, outermost, hard-to-reach and depopulated regions; suggests that these incentives include supporting housing solutions for healthcare professionals, funding scholarships, research grants and structured career development opportunities, as well as providing tax benefits; calls on the Member States to accelerate and facilitate the use of cohesion funds, in particular to support targeted and economically sustainable initiatives and to address medical deserts; suggests exploring cross-border healthcare initiatives where isolated areas are a consequence of administrative borders;