On Oct. 18, 2022, Germany’s health minister, Karl Lauterbach, claimed on ZDF’s Morgenmagazin: “Germany doesn’t have too few caregivers measured against the population, we just use them very inefficiently.” We find this claim to be uncheckable.
Germany has a shortage of care workers and it appears that the situation will become worse in the future. Despite having many healthcare workers (see first graph), the country is still below average when converted to full-time equivalents and most of the care workers are part-time employees, leading to inefficient use of the available care workers.
By 2030, there will be a shortage of 500.000 care workers in Germany. Also, according to forecasts by the Bertelsmann Foundation, the number of people in need of care will rise by 50 percent. Simultaneously the situation in the care sector will become worse because caregivers will stop working.
The impact of the Corona pandemic on care workers
The Corona pandemic has revealed and clarified how difficult the situation in the German healthcare system is. According to a survey by the opinion research institute YouGov, 16 percent of care workers want to leave the industry behind. Two out of three respondents (69 percent) are thinking about quitting their job.
In order to better understand the situation in Germany, it is useful to compare it with other EU countries: According to eurostat, Germany had the highest number of professionally practicing nurses among EU member states with just over one million in 2020. In this case Eurostat speaks of “nursing associates” and “nursing professionals” as they are allowed to do more difficult tasks and have a higher education than caring personnel. They can work in hospitals, but also in offices of physicians or in care retirement homes. Germany had considerably higher numbers than the second highest count recorded in France (764.000). In turn, the number of nurses in France was twice that recorded in Italy (373.000).
But according to the German Employment Agency, almost three-fifths of the employed nurses work part-time. Among women, it is about 62 percent and among men about 40 percent. So, let’s take that into consideration as well. The second graph above shows that Germany is with 12.06 full-time equivalents (FTE) per 1.000 inhabitants in 3rd place out of the EU member states – clearly above the EU average of 8.5 FTE. Finland (13.56 FTE) and Ireland (16.17 FTE) have more full-time nurses. Most of the direct neighbour countries of Germany are ranked within the frontmost places. In contrast to that, eastern and more western European states than Germany and its neighbour countries have significantly lower numbers of nurses. Among them, Greece is the country with the lowest full-time nurses per 1.000 inhabitants with 3.38 FTE. That is three and a half times lower than in Germany.
According to eurostat, a full-time equivalent is obtained by comparing an employee’s average number of hours worked to the average number of hours of a full-time worker. A full-time person is therefore counted as one FTE. For example, a part-time worker employed for 20 hours a week when full-time work consists of 40 hours, is counted as 0.5 FTE.
If one compares the statistics above, Germany is in both the absolute number of nurses and the nurses per 1.000 inhabitants on a very good ranking place compared to other EU members. One might think that the frontmost countries in the FTE ranking have good healthcare conditions, but there are many reports of staff shortages. Ireland, Finland, Luxembourg, France and Belgium report a lack of staff personnel in healthcare. The situation in the most highly ranked country, Ireland, seems to be dramatic. 100.000 patients have been left waiting on trolleys in the Republic’s hospitals in 2022. Karen McGowan, president of the Irish Nurses and Midwives Organisation (INMO) who works as an advanced nurse practitioner in a Dublin hospital, said that conditions are “horrendous”. Germany faces 30.000 job vacancies in health care according to an interview of Focus with the German hospital society.
Improvement of the healthcare system
In the interview with ZDF back in October, Karl Lauterbach addressed the inefficient use of care workers and demanded the optimizations of processes and structures of the healthcare system.
The introduction of the new concept for nursing documentation envisaged by Lauterbach is intended to provide more time and resources for actual nursing and care. This concept is suitable for both inpatient and outpatient long-term care facilities, as well as for day and short-term care facilities. Unnecessary documentation effort is to be reduced. According to the statement of the facility provider associations at the federal level, around 80 percent of all outpatient and inpatient care facilities in Germany will already have implemented the structural model by the end of 2020.
The planned hospital reform is intended to relieve the burden on nursing by eliminating “heavy shift work”. The aim is to provide all treatments suitable for this as day treatments. Night services will thus be eliminated. The reform is also intended to overcome the so-called “per-case flat rate” in the hospital system. This allows hospitals to make a profit if they treat a large number of patients at low cost. “The whole system becomes less economic,” Lauterbach said. This would also relieve the burden on nursing care.
With the “Hospital Care Relief Act” presented by Lauterbach, the staffing requirements are to be recorded in a first phase, at a representative selection of hospitals. On this basis, hospitals are to be given guidelines for staffing levels in a legal ordinance.
Although Germany has many healthcare workers, many of them only work part-time which complicates workflows and makes more documentation necessary. We suspect that increased shift handovers, for example, lead to less efficiency. In addition, many workers are likely to change departments or even branches in the future, leaving positions unfilled. The extent to which the healthcare system can be improved in the near future by the reforms announced by Minister Karl Lauterbach is not predictable. In combination with the rising numbers of people needing care, we conclude that his statement is uncheckable.
RESEARCH | ARTICLE: Lisa-Marie Riffelt & Fabio Ulrich, Hochschule der Medien, Stuttgart (Germany)
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