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13th March 2024
Almost one in 10 doctors across the European Union (EU) intend to leave their profession, according to a new cross-sectional study from the EU-funded METEOR Project, highlighting widespread retention issues.
Researchers from the METEOR Project – which collects scientific knowledge on job retention of healthcare workers in Europe to develop policy recommendations to increase job retention – asked 381 physicians and 1,351 nurses at hospitals in Belgium, the Netherlands, Italy and Poland about their intention to exit the profession or leave their current hospital, and the factors influencing their decisions to quit.
The results showed 9% of doctors and nearly 14% of nurses declaring an intention to leave their profession, citing low job satisfaction, growing depersonalisation and emotional exhaustion as the primary factors.
The survey also revealed 16.3% of doctors and 8.4% of nurses are considering leaving their current jobs. Factors impacting nurse and physician retention in hospitals highlighted job dissatisfaction, lack of career development and poor work-life balance as the main determinants of intention to leave,, which the researchers suggested can ‘help governments and hospital administrators combat the trend’.
Laura Maniscalco, co-author of the study and research fellow at the University of Palermo (UNIPA), said: ‘Many doctors want to leave their current workplaces because of the management and personal issues. In the high-stress environment of a hospital, they can face challenges in terms of work-life balance or conflicts that can result in bullying.
‘Additionally, the ineffectiveness of the management system and understaffing can force them to work in areas outside of their expertise, leading to role conflicts and reducing opportunities for career advancement.”
Domenica Matranga, a professor at the UNIPA and co-author of the study, added: ‘Our research suggests that nurses may [also] no longer find their job rewarding or valued. This issue is connected with relatively low salaries, tough working conditions and, of course, the physical and emotional pressure caused by the pandemic.‘
This latest study adds to ongoing research highlighting and addressing the pressures on clinical workforces across the EU and UK.
Recommendations to enhance the wellbeing of doctors in Europe were published in November 2023 as part of a new policy from the Standing Committee of European Doctors. These aimed to improve patient care, professional excellence and overall job satisfaction and included focusing on adequate staffing and workload management, embracing a people-focused working culture, championing mentoring and peer support networks and supporting doctors as parents and carers.
Staff retention and mental health issues have also been noted amongst UK clinicians in recent months. A survey of 1,958 NHS health professionals from across the UK in September highlighted understaffing as a main factor pushing healthcare workers to leave the NHS.
A UK surgical workforce census report published in January 2024 found that 61% of respondents cited burnout and stress as the main challenge in surgery due to excessive workloads, and 50% of respondents across all career grades indicated that they considered leaving the workforce in the past year.
And last summer NHS chief executive Amanda Pritchard acknowledged that the NHS was seeing higher levels of sickness among staff compared to pre-pandemic, particularly due to poor mental health and anxiety, some of which she said was ‘directly related to what people have been through over what was an extraordinarily difficult few years’.
The turnover crisis comes as the healthcare sector struggles with an existing shortage of medical personnel. Projections from the World Health Organization indicate that in six years Europe will need 18.2 million healthcare workers to meet the growing demand for healthcare services driven by an ageing population and increased prevalence of chronic diseases.
As a result, the authors of this latest METEOR Project study are urging healthcare managers across the EU to ‘devise effective retention strategies, taking into account job satisfaction, work engagement, and a positive working climate’, adding that ‘such internal policies are crucial, given the difficulty of finding replacements for departing professionals’.
26th February 2024
An e-health programme developed by the Cardiology Centres Netherlands (CCN) has been rolled out to patients at Amsterdam UMC’s Heart Centre to supplement their care and support cardiologists.
The HartWacht mobile app (HeartGuard, in English) is suitable for patients with high blood pressure, cardiac arrhythmias or heart failure and uses a small measurement instrument, around the size of a cereal bar, to monitor their blood pressure and arrythmias at home.
Making it possible to take an ECG remotely, the app means patients need to visit their cardiologist less frequently. It also gives clinicians more precise measurements and enables them to act faster where necessary.
Amsterdam UMC is the first academic hospital to use this e-health programme, which was developed in 2016 by CCN where it is already being used to track data from more than 3,000 patients.
Michiel Winter, cardiologist at Amsterdam UMC, leader of the HartWacht project, and chairman of CCN’s Board of Directors, said: ‘Since we started the e-health programme we have seen a decrease in the number of ambulance-calls for these patients, and, because we can see what is going on with the patient from a distance, we can immediately reassure and advise or intervene where necessary.’
In addition, CCN analyses show the system results in fewer visits to the emergency department, and that patients who use HartWacht come to the outpatient clinic less often and need fewer nursing days.
Dr Winter said home monitoring with the e-health tool offers peace of mind for patients who often have to deal with lifelong heart disease. ‘It is very reassuring for patients [as] they immediately receive feedback in the app after a measurement,’ he added.
Clinicians can also help patients in a timelier manner with less unnecessary care, as all patient data collected by the app is analysed by a central team before any abnormal readings are shared with the patient’s cardiologist.
Jasper Selder, cardiologist and biomedical engineer at Amsterdam UMC and co-leader of the e-health project, said: ‘It relieves us of our worries because all non-abnormal health measurements are filtered out – often the bulk of all measurements – so that we can focus on patients with abnormal measurements.
‘As a cardiologist, instead of having to look at dozens of heart rhythm and blood pressure measurements during the – often busy – outpatient check-ups, we now receive an immediate notification if one of those measurements falls outside the expected range, so there is more time for the cardiologist to focus on patient care.
‘Deviations also come to light more quickly and not only during checks. Based on the abnormality detected, we can immediately determine whether action is needed, such as adjusting medication or an extra check-up.’
According to Amsterdam UMC, further applications for diabetes and cardiovascular risk management will be added to the e-health programme this year.
16th February 2024
A new international project aiming to use artificial intelligence (AI) and genomics data to personalise therapies for patients with cardiovascular disease (CVD) has been announced.
The Next Generation Tools for Genome-Centric Multimodal Data Integration in Personalised Cardiovascular Medicine (NextGen) project aims to build AI-supported novel and synergistic tools to enable portable multimodal, multiomic and clinically oriented research in high-impact areas of cardiovascular medicine.
The tools will benefit researchers, innovators and healthcare professionals by identifying and overcoming health data linkage barriers in exemplar cardiovascular use cases that are complex or intractable with existing technology.
The ultimate goal is to provide faster diagnosis and better, more personalised treatments for patients while capitalising on increasing innovations and trends in AI technology.
The NextGen project will be delivered by a 21-member consortium of academic, clinical, technical and commercial partners from across Europe and the US, including the European Society for Cardiology, and led by University Medical Center (UMC) Utrecht and Queen Mary University of London.
Project coordinator Professor Pim van der Harst, interventional cardiologist and head of the department of cardiology at the UMC Utrecht, said: ‘No two people are exactly the same, and so it makes sense that each person needs a slightly different strategy to optimise their health. Personalised medicine is, therefore, the way forward for preventing heart disease, speeding up diagnosis, and monitoring and treating people with CVD.
‘To develop individualised therapies, we need to compile as much information as possible about individuals, and that’s where NextGen comes in. The unique picture we generate will then form the basis for improving cardiovascular health and wellbeing.’
Several real-world pilots will demonstrate the effectiveness of NextGen tools and will be integrated in the NextGen Pathfinder network of five collaborating clinical sites as a self-contained data ecosystem and comprehensive proof of concept.
The work will complement the ‘1+ Million Genomes’ initiative, which aims to enable secure access to genomics and clinical data across Europe, and the European Health Data Space – a European Commission governance framework for the safe and secure exchange, use and reuse of health data.
Consortium member Professor Panos Deloukas, professor of cardiovascular genomics and dean for Life Sciences at Queen Mary University of London’s William Harvey Research Institute, added: ‘This is a tremendous opportunity and a challenge we have in building the right toolbox that will allow [us] to unite CVD patient data across Europe and implement precision medicine to improve cardiovascular healthcare.’
The NextGen project has received €7.6 million from the EU’s Horizon Europe programme.
In August 2023, a genetic study revealed how the use of clopidogrel in British patients of south Asian ancestry appears to be less effective at preventing recurrent myocardial infarction than in those of European descent.
And earlier in 2023, single cell and spatial genomics combined with computational techniques were used to develop a comprehensive Heart Cell Atlas to better understand the heart and how it responds to treatments.
23rd January 2024
European doctors’ ambitions to keep building a ‘coherent’ and ‘equitable’ European Health Union have been published by the Standing Committee of European Doctors (CPME).
It’s ‘Health Check for Europe 2024-2029’ sets out a vision for the EU’s health priorities ahead of the upcoming European Parliament election in June.
This includes five ambitions urging European policy makers to tackle the health workforce crisis, ensure a safe digital transformation of healthcare, enable healthier living, guarantee accessibility and effectiveness of medicines and take climate action for better health.
Commenting on the ambitions outlined in the Health Check vision, CPME president Dr Christiaan Keijzer said: ‘Whilst European countries have made huge advances in collaboration on health in recent years, we cannot take a step backwards.
‘The Covid-19 pandemic has shown that health is the foundation of our economy and society, and exposed that problems that have not been solved. Our health systems still suffer from deep structural flaws and our health workforce is exhausted and undervalued.
‘The European Health Union is not complete: the EU needs a coherent long-term vision for health in Europe and beyond for equitable access to healthcare for patients.
‘European doctors remain strongly committed partners in making these ambitions a reality.‘
On the subject of recruitment and retention, the Health Check highlights issues of ‘untenable working conditions, excessive hours, and insufficient resources‘, which mean ‘medicine is losing its attractiveness as a life-long profession, and if we continue in this path we will not have a functioning health workforce.’
This follows the publication of CPME‘s policy in November 2023 providing recommendations to enhance the wellbeing of doctors across Europe.
The policy aims to improve patient care, professional excellence, and overall job satisfaction by addressing challenges such as work-related stress, organisational culture, supportive working environments, burnout and work-life balance.
The CPME presented the five ambitions to the president of the European Parliament, MEP Roberta Metsola on 22 January 2024.
12th January 2024
The subcutaneous drug foslevodopa-foscarbidopa (brand name Produodopa) has been launched in the European Union (EU) for the treatment of advanced Parkinson’s disease, its manufacturer AbbVie has announced.
It becomes the first-and-only subcutaneous 24-hour infusion of levodopa-based therapy available in the EU for the treatment severe motor fluctuations and hyperkinesia (excessive movement) or dyskinesia (involuntary movement) in people living with advanced Parkinson’s disease and whose symptoms are inadequately controlled by other therapies.
The continuous delivery of foslevodopa-foscarbidopa provides levodopa 24-hours a day, which AbbVie said may help patients by extending the period when symptoms are well-controlled – often referred to as ‘On’ time.
‘On’ time signifies when symptoms are controlled, whereas ‘Off’ time occurs when symptoms return between medication doses.
Foslevodopa-foscarbidopa gained marketing authorisation through the European Medicine’s Agency’s decentralised procedure in the third quarter of 2022. The Vyafuser pump for the drug’s subcutaneous delivery received Conformité Européenne (CE) Mark in November of 2023.
Angelo Antonini, professor of neurology at the Department of Neuroscience, University of Padua, Italy, said: ‘This approval represents a significant advancement for those with Parkinson’s disease who have historically had limited treatment options for advanced stages.
‘When oral treatment no longer sufficiently helps with improvement in motor fluctuations, patients need alternative options. Produodopa’s around-the-clock infusion allows for continuous delivery of levodopa, the gold standard of treatment.’
The launch was supported by three studies, including the Phase 3, 12-month open-label M15-741 study in which the primary endpoint was to evaluate the safety and tolerability of foslevodopa-foscarbidopa.
Secondary endpoints included changes from baseline in normalised ‘Off’ and ‘On’ time, the percentage of patients reporting morning akinesia – defined as ‘Off’ time upon waking – and total scores from quality-of-life surveys.
Eligible patients included adults 30 years or older diagnosed with levodopa-responsive idiopathic Parkinson’s disease experiencing an average of greater than or equal to 2.5 hours of ‘Off’ time per day, as assessed by patient’s Parkinson’s disease diaries.
The results, published in the Journal of Neurology & Therapy, observed a reduction in motor fluctuations as early as Week 1 and persisted through Week 52, and the percentage of patients experiencing morning akinesia dropped from 77.7% at baseline to 27.8% at week 52.
The researchers concluded that there was a favourable benefit/risk profile and sustained improvements in ‘Off’ time and ‘On’ time without dyskinesia, and morning akinesia as measured by the percentage of patients in early morning ‘Off’ time.
The 12-week Phase 3 M15-736 study and a Phase 1 pharmacokinetic comparability study also supported the launch.
The majority of adverse events (AEs) with foslevodopa-foscarbidopa were non-serious and mild or moderate in severity. The most frequent AEs (greater than or equal to 10%) were infusion site events (infusion site erythema, infusion site cellulitis, infusion site nodule, infusion site pain, infusion site oedema, infusion site reaction, and infusion site infection), hallucination, fall, and anxiety.
Foslevodopa-foscarbidopa was recommended by the UK’s National Institute of Health and Care Excellence in autumn 2023 for treating advanced Parkinson’s with motor symptoms and the final technology appraisal guidance was published on 29 November 2023.
9th January 2024
Health inequalities saw more than one million people living in 90% of areas in England living shorter lives than they should have between 2011 and the start of the Covid-19 pandemic – equivalent to the whole population of Birmingham, or that of Edinburgh and Glasgow combined, new research has found.
According to research led by University College London’s Institute of Health Equity (IHE), the period from 2011 to 2019 saw more than a million people dying earlier than they otherwise would have done had they experienced the death rates seen in the least deprived decile of areas.
Of these excess deaths, 148,000 were additional to what might have been expected based on levels in the two years prior to 2011, the report – titled ’Health Inequalities, Lives Cut Short’ – said.
And in 2020, the level of excess deaths rose by an additional 28,000 compared to those over the previous five years.
To contextualise the UK’s downwards health trend, the IHE analysed European Union data and compared healthy life years (HLY) – the number of years a person is expected to continue to live in a healthy condition, and also called disability-free life expectancy – in the UK to other European Union countries.
In 2014, both males and females in the UK had a higher average number of healthy years lived (HYL) than those in the EU. However, by 2017, HLY in the UK had stagnated for men, and fallen for women.
In the same period, HLY increased by more than two years in the EU. Consequently, 10 EU countries had higher HLY than the UK for males, and 14 had higher HLY than the UK for females.
UCL IHE Director, Professor Sir Michael Marmot, said: ’If you needed a case study example of what not to do to reduce health inequalities, the UK provides it. The only other developed country doing worse is the USA, where life expectancy is falling.
’Our country has become poor and unhealthy, where a few rich, healthy people live. People care about their health, but it is deteriorating, with their lives shortening, through no fault of their own. Political leaders can choose to prioritise everyone’s health, or not. Currently they are not.’
Referring to this ’dismal state of affairs’, he is calling on political party leaders and MPs to prioritise health equity and wellbeing.
’Important as is the NHS – publicly funded and free at the point of use – action is needed on the social determinants of health: the conditions in which people are born, grow, live, work and age. These social conditions are the main cases of health inequalities,’ he said.
Ahead of the general election, the IHE is also proposing the appointment of an independent health equity commissioner and the establishment of a new cabinet-level health equity and wellbeing cross-departmental committee.
In 2020, Sir Michael’s ’Build Back Fairer: The Covid-19 Marmot Review’ document highlighted how pre-pandemic social and economic conditions contributed to the unequal Covid-19 death toll.
The UK cabinet office cited the report as ‘the most comprehensive early assessment of how Covid-19 exacerbated existing health inequalities’ when he was named in the 2023 King’s New Year Honours.
Last January, Sir Michael criticised the UK Government’s short-term policies being announced and rolled out, stating that they damage the service overall, and warning health leaders to be ‘aware of short-term fixes that might undermine a longer term agenda’ for the service.
18th September 2023
A translation function has been added to the Hospital Healthcare Europe website, meaning users can now read all content in their choice of English, French, German, Italian or Spanish.
In broadening access to content in this way, hospital managers and departmental heads across Europe can more easily stay up to date with innovative developments in healthcare to support their practice.
Users can select their language from the dropdown menu in the top right-hand corner of the site to access the latest news, reviews, interviews, case studies and more in their native, or chosen, language.
The launch of the translation function follows other recent developments to the Hospital Healthcare Europe website such as the introduction of a web browser notification system and and in-app notifications on iOS and Android to alert users when new content is published.
Further upgrades will be introduced over the coming weeks and months to provide a more comprehensive and streamlined user experience.
4th July 2023
Life expectancy in Sweden is among the highest in the EU, although it declined by nearly one year in 2020 as a result of the Covid-19 pandemic. The healthcare system generally performs well in providing good access to high-quality care.
However, challenges persist in providing equal access to care for the population living in different regions, ensuring timely access to care, achieving greater care coordination for people with chronic diseases and improving the quality of long-term care.
Life expectancy at birth was 82.4 years in 2020 – almost two years above the EU average – but it fell by almost one year in 2020 because of the high number of deaths from Covid-19. More than two thirds of Covid-19 deaths were among people aged 80 and over.
Smoking rates among adults in Sweden are among the lowest in EU countries, but use of other tobacco products such as snuff is common. Overall alcohol consumption per adult has decreased over the past decade and is much lower than the EU average. Adolescents in Sweden also report low rates of smoking and excessive alcohol intake, but high rates of physical inactivity.
Health spending per capita in Sweden was the fourth highest in the EU in 2019, and the third highest in terms of health spending as a share of GDP. Most health spending is publicly funded (85%). The growth rate in health spending was relatively modest in the years prior to the pandemic, but the government increased spending on health in 2020 and 2021 in response to Covid-19.
Sweden had low rates of mortality from preventable and treatable causes in 2018, pointing to a generally effective public health and healthcare system under normal circumstances.
During the first year following the pandemic, one in six people in Sweden reported some unmet needs for medical care, which is slower than the EU average. The use of teleconsultations increased quickly in Sweden during the pandemic to maintain access to care.
Sweden tried to balance protection of people’s health and protection of economic and social activities in managing the Covid-19 crisis. While fewer restrictions were imposed, particularly during the first wave, the death toll was high compared with other Nordic countries. By end of August 2021, 58% of the population had received two doses or the equivalent – slightly more than the EU average.
OECD/European Observatory on Health Systems and Policies (2021), Sweden: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
Life expectancy in Slovenia has increased markedly since 2000, but in 2020 the Covid-19 pandemic temporarily erased a year’s worth of gains. The Slovenian health system provides near universal coverage and a broad benefits package.
Voluntary health insurance plays a large role in covering co-payments levied on services; this also confers a considerable degree of financial protection from out-of-pocket payments.
The pandemic exacerbated or laid bare health system weaknesses, including workforce shortages, long waiting times, ageing hospital facilities and fragmented and underfunded long-term care.
Life expectancy in Slovenia had increased by over five years between 2000 and 2019. However, in 2020 the Covid-19 pandemic reversed this trend: life expectancy fell from 81.6 years in 2019 to 80.6 in 2020. Stroke, ischaemic heart disease and lung cancer are usually the main causes of mortality, but Covid-19 was responsible for the largest number of deaths in 2020.
More than one fifth of Slovenian adolescents were overweight or obese in 2018. Alcohol intake among both adults and adolescents ranks above the average across EU countries, with binge drinking much more prevalent among male adults. Smoking prevalence has decreased for both adults and adolescents over the last decade, but over one in six adults are still daily smokers. The increasing popularity and use of e-cigarettes is also a concern.
Health expenditure per capita has risen marginally over the last few years, but it remains well below the rate across the EU as a whole, as does spending as a share of GDP. Public financing of the health system accounted for 73% of health spending in 2019. Out-of-pocket spending is among the lowest in the EU, however, due mainly to extensive uptake of voluntary health insurance to cover co-payments.
Mortality from preventable causes remains above the EU average. In contrast, mortality from treatable causes is lower than the EU average, indicating that the healthcare system is generally effective in providing care for people with potentially fatal conditions.
Prior to the Covid-19 pandemic, unmet needs for medical care were low, at 2.9% of the population, with waiting times the primary driver. In 2020, the demand for Covid-19-related care often led to delayed or forgone consultations and treatment for other health issues. Around 24% of the population reported forgone medical care during the first 12 months of the pandemic.
The Covid-19 pandemic revealed several resilience challenges, including workforce shortages and underdeveloped long-term care infrastructure prompting plans for more investment. Slovenia accelerated its vaccination campaign in spring 2021, and at the end of August 2021, 43% of the population had received two vaccine doses (or equivalent).
OECD/European Observatory on Health Systems and Policies (2021), Slovenia: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
3rd July 2023
Life expectancy in Slovakia is among the lowest in Europe, and temporarily fell by almost one year in 2020 due to the impact of Covid-19. Behavioural and environmental risk factors contribute to nearly half of all deaths.
The Slovak population enjoys a broad benefits package, which includes recently introduced telemedicine. However, low levels of health spending and health workforce shortages remain persistent issues that were exacerbated by the pandemic.
Life expectancy in Slovakia increased by more than two years between 2010 and 2019, only to fall by almost one year in 2020 due to Covid-19 deaths. It remains nearly four years below the EU average. Disparities in life expectancy by socioeconomic status remain among the largest in the EU. Slovakia also has one of the highest cancer mortality rates in the EU.
While adult tobacco consumption declined in most countries over the past decade, in Slovakia it remained stable and is currently above the EU average. Alcohol consumption is comparable to the EU average. Obesity rates among adults and adolescents are on the rise and higher than the EU average, due in part to poor nutritional habits and limited levels of physical activity.
Slovakia spends less than half the EU average on health, at €1,513 compared to €3,521 per person in 2019, adjusted for differences in purchasing power. Around 80% of health spending is publicly financed, and out-of-pocket payments accounted for almost 20% of health expenditure in 2019 compared to 15.4% in the EU.
Slovakia has among the highest mortality rates from preventable and treatable causes in the EU. Despite improvements, cardiovascular disease remains the leading cause of death. Substantial room for improvement remains for effective public health policies to reduce premature deaths.
Access to healthcare is generally good in Slovakia, with only 2.7% of the population reporting unmet medical care needs before the pandemic. However, during the first 12 months of the pandemic, 23% of people reported forgone medical care. The introduction of telemedicine helped to maintain access to care during the second wave of the pandemic.
Slovakia had low Covid-19 case numbers during the first wave of the pandemic, due in part to quick implementation of containment measures. However, numbers rose significantly during the second wave; three quarters of all Covid-19 deaths occurred in the first half of 2021. As of August 2021, 40% of the population had received two vaccine doses (or equivalent) – a proportion lower than the EU average.
OECD/European Observatory on Health Systems and Policies (2021), Slovakia: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
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