Ageing Workforce in an Ageing Society Switzerland s challenge to totally replace its health professionals by 2030
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1 Ageing Workforce in an Ageing Society Switzerland s challenge to totally replace its health professionals by 2030 Dr. Beat Sottas Trustee, Member of the Executive Committee
2 Careum Mission: to tackle Issues that are challenging the Education of Health Professionals and the Systems Development in the Health Sector Since 1882 Careum initiates and supports visionary Projects on national and international Level Rethink the Future of the Health Sector More information: Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 2
3 Current Situation Population Currently well distributed Population (yellow dots) Turns into ageing Population (pink dots) Ratio of the inactive elderly population aged 65 and over to the labour force India Brazil Iceland Mexico China Sweden United States Netherlands New Zealand Luxembourg Canada Norway Russian Federation Australia Turkey Switzerland Denmark United Kingdom Ireland OECD total Austria France Portugal Finland Hungary Belgium Germany Czech Republic Slovak Republic Greece Poland Spain Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 3 OECD 2009 Korea Japan Italy
4 Current Situation Human Resources Physicians in Switzerland 3.9 per 1000 inhabitants -> much higher than average OECD (3.1) Nurses in Switzerland 14.9 per 1000 inhabitants -> much higher than average OECD (9.6) Very comfortable Supply -> Fear of Loss, Fear of Impact on Quality Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 4 OECD 2009
5 Current Situation Health Workforce persons working in Therapy + Nursing (incl. Med, Dent, Pharm) 8% of the working population 80% women and 19% foreing nationality (+5% «Enablers» acc. to WHO) in 3 most important domains: Hospitals (60%), Retirement & Nursing Homes (30%), Spitex services (assistance and care at home) (10%) Nursing Medicine, Pharmacy Dentistry Therapeutical and Technical Professionals Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 5
6 Forecast Demand 2020 Health Observatory Report 35 Reference Scenario Federal Office of Statistics +13% Alternative Scenario Federal Office of Statistics +25% Health Professionals Demand due to Demand due to Ageing Ageing = = Retirement Retirement 30% 30% = = Health Professionals Higher Demand Higher Demand due to Ageing due to Ageing Population Population = = Retirement Retirement 30% 30% = = Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 6
7 Forecast 2020 Trained Professionals or Assistants? Health Observatory Report 35 Additional Personnel needed by 2020 (as compared to 2006) according to Educational + Training Level (Switzerland, Reference Scenario) Spitex Nursing + Retirement Homes Hospitals 3300 Medicine Nursing Nursing Assistance not Qualif. Tert. Niv. Sec. Niv. High Demand in Retirement and Nursing Homes low level qualifications Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 7
8 Leading Question: Linear Progression or Qualitative Changes of Demand by 2030? Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 8
9 Headline last week: «By 2030 Switzerland has to recruit as many Health Professionals as currently work in the hospital sector» 20 years to find Health Professionals! Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 9
10 Forecast 2030 Three Reasons that increase demand for Health Professionals 1. Retirement 2. Drop-out 3. Ageing Demand 2030 Higher than expected Non-Linear Progression! Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 10
11 Forecast Retirement (1) Long Term Nursing Personnel is older Personnel in Nursing + Retirement Homes Overall Federal Statistics draw a too Positive Image Personnel in Hospitals is younger Nursing Homes & Spitex services have older Personnel; they lack young collaborators Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 11
12 Forecast Retirement (2) Health Personnel has to be replaced much faster than expected due to retirement -> non-linear retirement rate (conservative forecast) Current Pension Rate is 1% After 2020 it raises rapidly over 2% T1 Kumulierte Zahlen der Pensionierung beim Gesundheitspersonal Geschätzte Abgänge gemessen am Personalbestand von 2006 (200'000) Vorzeitige Abgänge 1% jeder Kohorte, ab 55 Jahren '000 (20%) (22%) (47%) (55%) Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 12
13 1. Retirement: Age Distribution + Evolution Health Professionals leave earlier for Retirement 2001 Single Peak middle aged 2021 Twin Peak young vs. old % optimistic Expectation? Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 13 NEXT/Hasselhorn 2006 The Greying Nurse Workforce
14 Forecast Retirement (3) Health Sectors unequally threatened Hospitals: 2020 = 15% retired, 2030 = 39% retired Homes: Spitex: 2020 = 30% retired, 2030 = 60% retired as Homes Retirement: avalanche of inevitable departures in sectors with highest demand Early Retirement is frequent: low share of employees older than 54 in the statistics Long Term Care (Homes, Spitex) is endangered Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 14
15 Forecast Retirement (4) = Loss of Expertise Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 15
16 Forecast Drop-Out Attrition / Drop-out is very common in the Health Sector Working Period after Graduation is (too) short Drop-outs are frequent (but difficult to quantify) Retirement is inevitable School Leavers diminish per year 1-2% Generalized Lack of Workforce in whole Economy Upcoming Competition other fields are more attractive Narrow Room for manoeuvre in Health Sector: Salaries are inflexible in the Public Sector Budgets of Health Sector are under Pressure Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 16
17 Forecast 2030 Leave or Stay? Experiences in Nursing Factors linked with desire to leave the job in Nursing Professional Perspective Uncertainties related to job Organisation of Work, Workload Does Claim to raise Salaries adress the right issues? Tasks Social Environment Private Circumstances Health Salary Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 NEXT/Hasselhorn 2006 Seite 17
18 Forecast Raising Demand: +80 vs. -20 Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 18
19 Forecast Raising Demand (2) More Services needed after 2020 after 2020 share of older than 80 will grow much faster than prior to 2020 these persons are frail and have a high burden of disease; they need mainly long term care the ageing population is a driver and leads to employ additional Health Professionals 90% of the additional personnel has to be recruited for long term care (Homes, Spitex) Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 19
20 Forecast 2030 Ageing Workforce in the Health Sector (ageing workforce) leads to a strong demand of Health Professionals after the year 2020 Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 20
21 Careum Comment on Obsan-Forecast Raising Demand (3) Evaluation of determinants General General health health state stateof of population population Demographic Demographic Evolution Evolution Productivity Productivityof of Institutions Institutions Age Age Structure Structure of of Personnel Personnel ++ Zukünftiger Bedarf an Gesundheitsfachleuten Kind Kind and and Intensity Intensity of of Services Services Required Required Number Numberof of Part-Time Part-TimeJobs Jobs Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 21
22 Careum Comment on Obsan-Forecast: Estimated number is probably too low Demand or higher Obsan = linear evolution of current situation: shorter period in Hospital + better health BUT: Less Care by Family Members Lifestile preferences: Part-Time Job, Family, Multiple Jobs (e.g. Wellness, Complementary Therapies, other Sectors) Early Retirement Much more Female Physicians in Part Time Jobs Demand higher than in other Economic Sectors Competition from other Sectors; high Attrition incentives for drop-outs/job-leavers Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 22
23 Summary Careum In 20 years Switzerland has to produce Health Professionals This number corresponds to those currently working in the Hospitals, Nursing + Retirement Homes, Spitex Services Unprecedent Challenge for the Education and Health System Demand far beyond Education+Training Capacities 600 Assistants, 1500 College Nurses, 500 BSc Nurses, 700 Docs Home Potential by 2030: 3300/year x 20 = Coverage /3 only This raises the Question whether the Health System will - be able to maintain high quality for all - be able to be managed by knowledgeable Professionals Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 23
24 Change Strategy: Raise Competence at all levels! Focus on future Area of Employment Focus on ambulatory Sector in Education + Training Prepare for therapeutical settings with competent patients Do not only train high level, but low level! Get prepared for Primary Care Give Room for new Profiles, new Responsibilites, new Professions Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 24
25 Careums Favorite Solutions In Education & Training Reshape the Training System according to Demand: less Focus on Hospitals but address Long Term Care Be less selective: give all willing Persons a Chance Have more effect: bring Personnel rapidly into the System instead of overspecialised long term Training Train more Generalists Train more low-level Workforce Improve Training through better structured Episodes: on the job, bed-side, accompanied self-teaching etc. Learn in interprofessional Settings and Processes Abolish socio-professional Reglementation and Obstacles Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 25
26 Careums Favorite Solutions In Health System & Care Provision Strengthen Health Promotion and Health Literacy Shift Boundaries Reshape the Care Provision System according to Demand and not by strenthening professional borders & monopolies Implement new Forms of ambulatory Care: new Roles and Competencies for Non-Medical Clinicians Implement Schemes for Persons with Chronic Conditions Raise Job Satisfaction, e.g. flexible work schedules, part time Retain Health Professionals, give Incentives, raise Salaries Develop of Policy to motivate those who have left Look at the Engineers and do Market Research Do not count on Immigration Do not believe in Wonders to overcome the Gap! Sept 3, 2009 Switzerland s challenge to replace all Health Professionals by 2030 Seite 26
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