1. Health Sector Reform, Health Workforce Distribution and Dynamics in Europe Prof. James Buchan jbuchan@qmuc.ac.uk

2. WHO Euro: Doctor: Population ratio

3. WHO Euro: Nurse: Population Ratio

4. Dynamics European health care labour markets are dynamic- will change in response to: -demographic change (ageing populations) -general economic conditions -health sector reform and funding -relative earnings and career prospects -regulatory change

5. Common questions from/ for Stakeholders and Policy makers How do we plan how many health workers to educate, and employ? How can we improve recruitment, retention and return?- which incentives are effective in motivating staff? How can we determine and deploy the most effective skill mix of staff?

6. Common HRH Challenges Skills shortages Geographic maldistribution Fragmented planning Education- employer linkages Staff Performance

7. A Framework for Solutions Integrated planning Improve recruitment Improve retention Improve skill mix Improve deployment

8. Planning Flexible, integrated and inclusive planning, involving the education sector, based on service delivery plans Include employers/private sector in the planning process- “bottom up” planning Planning is not sufficient to prevent shortages, but it highlights where and when shortages are likely to occur (and what can be done to intervene)

9. Incentives and Motivation “Fair” pay and working conditions are pre- requisites for sustained improvements (equal opportunities/ gender ) Other key factors: -education/competence fit for practice -provision of educational opportunities -career development opportunities -participation in decision making -flexibility in work / life balance

10. Incentives and Motivation Improving retention and “return” of staff can be more cost effective- and timely- than increasing recruitment There are “good” and “bad” employers in any labour market (learn from the good ones- e.g. magnet hospitals)

11. Skill Mix Different contexts…different solutions: Not just a technical exercise, or a quick fix- it should be part of a broader change management agenda Requires “buy in” from staff and effective management/ communications Scope for change varies in different countries/contexts (incremental change?)

12. Skill Mix Evidence base (much from the USA): persuasive evidence that there is scope for cost effective deployment of nurses and midwives in advanced roles Evidence on skill substitution of nurses and midwives by care assistants is more mixed.

13. Summary: Integrate planning and resource allocation Identify and implement cost effective incentives to improve recruitment, retention, “return” and motivation Adopt a long term and broad based approach to skill mix and utilisation - learn from the evidence base Aim for staffing stability

14. Summary: Policy challenges How to??: Grow your own= develop non traditional routes and sources of recruits Keep your own (and keep an eye on the competitors) = pay/career structure; “returners”; monitor staff movement Develop your own = employment flexibility, professional development, participation in decision making etc