What strategies are countries using to expand health workforce surge capacity to treat COVID-19 patients?
The COVID-19 pandemic has placed immense pressure on the health workforce across Europe and worldwide, which has been exacerbated by workforce depletion as health professionals themselves are at high risk of being infected by COVID-19.
This raises a number of questions: What have countries done to increase surge capacity of their health workforce to treat COVID-19 patients while at the same time maintain essential services? Whom did they target and what was the response?
Details on strategies to expand workforce surge capacity from countries across Europe and beyond were extracted from the COVID-19 Health System and Response Monitor using a standardised template (up to 15 April 2020).
Table 1. Country strategies for scaling up workforce capacity
Multiple strategies have been implemented ad-hoc expanding the capacity of the existing workforce, often underpinned by emergency legislation
Table 1 shows that the majority of countries have implemented a range of policy measures to expand the capacity of the existing health workforce. The most common strategies (reported by 17 countries) include expanding capacity among the professional workforce by: asking health professionals to work extra hours, including moving from part-time to full-time work, modifying work schedules and cancelling leaves of absence. Two countries (the Netherlands and the UK) have also postponed re-registration and revalidation obligations for physicians thus lowering their administrative burden.
The implementation of many of these strategies has necessitated the adoption of emergency legislation. Examples include a decree enacted in Finland to require all staff between the age of 18 and 68 working in both private and public health care to work to tackle the crisis as needed. Greece meanwhile has officially revoked leave of absences for public sector staff, while Israel has prohibited health care workers from leaving the country. In Canada, the provinces of Ontario and Quebec have announced regional legislation to redeploy health and social care professionals to different units/facilities based on need and to cancel vacations and modify work schedules.
Most countries have called upon medical and nursing students to work in clinical practice
In 18 countries, provisions have been made to recruit medical and nursing students to support health professionals, for instance by allowing (final year) students to graduate early and join the workforce or offer them a gap semester to support health professionals.
Campaigns were launched to bring retired or inactive health professionals back to the workforce
In several countries including Ireland, Italy, the Netherlands, the UK and the provinces of Ontario and Quebec in Canada and Bavaria in Germany, national or regional campaigns have been launched asking retired and/or other previously registered health professionals to join the COVID-19 response. These measures have been supported by the creation of temporary registers, underpinned by emergency legislation (e.g. the UK) and online portals (e.g. Ontario, Canada and Bavaria, Germany) that match demand from health facilities in need, with supply. Hospitals in outbreak areas in the Netherlands have also made appeals to former health care personnel with recently lapsed registration to volunteer to return. In Bosnia, one hospital has initiated a call asking retired health professionals to return to work.
Other strategies target migrant health workers, health professionals from the private sector or armed forces
Italy, the UK and one region in Germany (Bavaria) have developed strategies to bring foreign-trained but unregistered health professionals into the workforce or speed up recognition procedures for foreign-trained professionals. In Serbia, an NGO invited Serbian medical workers abroad to report their availability to temporarily return to help with the COVID-19 epidemic.
Additionally, a small number of countries have redeployed private sector staff into the public sector. For instance, in England, an agreement has also been brokered for the government to take over private hospitals and their staff for the duration of the crisis, resulting in tens of thousands of clinical staff moving to the public sector.
These strategies have necessitated rapid adaptations to the recruitment, planning and integration of these new workers in clinical practice. There is little information on how this has played out in practice, and it is too early to evaluate the impact this rapid expansion has had on workforce expansion, workflows, skill-mix and quality of care.
Volunteers have also been enlisted to support the COVID-19 response in selected countries
In France, the “medical care reserve” was mobilised to allow for volunteers, mostly with previous health education such as retired nurses and physicians or students, but also medical secretaries and psychologists, to be deployed by the government. Other countries (including Cyprus, Estonia, Germany, Greece, Italy, Malta and the UK) have also asked for volunteers with little or no prior experience to help, often in basic support roles such as operating helplines or delivering medication to the most vulnerable. To date, there is limited information on how volunteers will be or have been deployed in practice and how safety standards have been adapted and ensured. In Malta, volunteers have also assisted the test and trace service through data inputting, contact tracing, patient-follow-ups, and phoning people to attend swabbing centres.
Policy lessons and implications
The examples above show that a range of policy options at different levels (national, regional and local) are available to enhance the surge capacity of the health workforce to meet the unprecedented demand during the COVID-19 pandemic. These include strategies to enhance the capacity of the existing workforce, combined with recruiting (final year) medical and nursing students. Some countries have also taken measures to bring retired, inactive or foreign-trained but unregistered health professionals into to the workforce, redeploying private sector workers into the public sector and asking volunteers to support the response.
The implementation of many of these changes has necessitated the rapid adoption of emergency legislation to give planners, providers and commissioners of health services temporary new powers related to changing recruitment and working practices. Additionally, online portals have been critical to enable current or inactive health care workers to register their interest in joining the response, to facilitate temporary registration where required and to match workforce shortages with supply.
Evaluations of the different workforce strategies that have been employed ad-hoc in the various countries would be beneficial to learn from during this crisis and thus re-consider options for the future.
Claudia B. Maier, Giada Scarpetti, Gemma A. Williams