Think Tank, 2020

Pandemics, nurses and older people – how do we plan for the future?

1st October 2020

Prof Dr Paul De Raeve reflects on plans for advances in health and active ageing as we celebrate International Day of Older Persons

The United Nations International Day of Older Persons on the 1st October each year affords us the opportunity to reflect and continue to plan for advances in healthy and active ageing. In light of the COVID-19 pandemic, this year the initiative also looks at how pandemics impact our ageing population. As we know, older people have been particularly affected by COVID-19, as a risk factor of the disease is age itself. Older people have suffered greatly as a result of outbreaks in care homes, and more serious forms of the disease. They are inherently vulnerable within pandemics as they often have other health conditions such as chronic diseases, which means they require specific and continuous care.

The healthcare workforce has faced extreme challenges during the pandemic in caring for both COVID-19 patients and those with non-COVID-19 related conditions, many of whom are elderly. We have seen vulnerable populations deeply affected by the restrictions placed on healthcare services as a result of the pandemic, and many older people have been left without necessary care. At this time, we need to reflect on the lessons of COVID-19, and consider how we can be better prepared to deal with pandemics in the future – not only for those who are infected by related viruses, but also those who are indirectly affected such as those with other conditions, the elderly, and of course healthcare professionals on the front line.

A major strength observed by the EFN during the pandemic is the incredible resilience and efforts of the frontline nursing workforce. They have all done an amazing job which has been recognised by citizens and stakeholders at all levels. On the other hand, the major weakness has been the obvious lack of preparedness, which has, on many occasions, left healthcare professionals at risk. This lack of preparedness extends beyond individual Member States, to coordinated planning on the EU level. A report by the EFN, ‘Lessons Learned from Ebola and COVID-19’, is an important document for politicians both at the EU and Member State level to read and learn from. This report contains valuable lessons on how the EU should prepare for future health emergencies and pandemics. “We are not prepared unless we are all prepared” is the underlining motto of the report and its conclusions.

A significant challenge we observe is that nurses are often missing from discussions relating to policy, and this must change. Co-creating health policies with representatives of end-users, such as the EFN, is vital to make sure that EU and national policies are fit-for-purpose and address the frontline reality and needs.

Preparedness at all levels of healthcare means empowering your frontline nursing workforce with the knowledge and tools that they will need to tackle health crises. COVID-19 has taught us that the nursing workforce was (and still is in some cases) in urgent need of adequate personal protective equipment (PPE), donning and doffing training (disposal of PPE), and, most importantly, increased patient-nurse ratios to provide safe and high-quality care. We need more general care nurses on the front line – in hospitals and in the elderly care and homecare settings. In some EU countries, workforce shortages observed during the pandemic have highlighted the shortsightedness of previous national governmental decisions to make healthcare savings by reducing funding for the nursing workforce, resulting in some nurses being made redundant (particularly driven by the 2009 economic crisis).

It is key, especially considering the various lockdowns that have been imposed, and that may be imposed again if we face increased infection rates, that we empower community care nurses who are able to care for people at home. All of this, of course, requires funding and the challenge is that such funding relies on the Member States which often leads to siloed approaches. As we have seen with the ongoing planning of the next EU budget, this is marred with complexities. Having proposed a 9.4 billion health programme, the European Commission was overruled by member states within the negotiations seeing the budget being cut significantly (by approximately 80%). And so, the message is clear as I see it – national governments want to address their own healthcare systems and do not want to open this up to EU involvement. This leaves us at a distinct disadvantage as a continent, as we are not acting together.

So, how do we prepare healthcare professionals for future pandemics?

The are many areas that need to be addressed for our future preparedness – resources and support for healthcare professionals, equipment guarantees, and social and mental health programmes are key.

To be better prepared for future waves in the EU, we need to be simultaneously developing mental health preparedness for nurses as they are confronted daily with high volumes of pressure and stress. We appeal to EU policy makers within the Commission to develop a mechanism to support the mental health and wellbeing of healthcare professionals including nurses.

Another idea the EFN has been advocating for is that of creating a stockpile of PPE at the EU level, coordinated by one EU Agency or one Commission department. On training, EU nurses would benefit from having a centralised accreditation training center for continuing professional development (CPD). There is currently a lot of patchwork in training courses – often commercially or very medically focused and not driven by the nurses themselves, which can make courses unfit-for-purpose.

Data from the frontline to help real time response in times of crisis is also an important consideration. Policy makers at EU and Member State level should consult frontline healthcare professionals about the needs and opportunities of collecting data in relation to pandemics to better plan resources in a coordinated way to ensure efficiencies in both consultation and policy making at all levels including governments, the World Health Organization, the Organisation for Economic Co-operation and Development and the European Commission. Furthermore, it is key that technology supports frontline nurses rather than becoming a bureaucratic burden. Therefore, data coordination and interoperability are key with the support of artificial intelligence to reduce nurse’s workloads. Technology needs to support nurses in collecting data, getting immediate feedback and being able to act on it.

Pandemics know no borders, so we must act together as Europe in preparing our healthcare systems and wider society for the future. We simply must become more resilient, and we can do that by identifying common goals, objectives and priorities. And then, by minimising bureaucratic procedures and working together with key stakeholders at all levels (and I stress that inclusion of implementers is key here). We need to set emergency priorities, co-creating with frontline nurses and other healthcare professionals. The EFN is ready to support the dialogue and make the Commissioners preparedness strategies more fit-for-purpose and as such impactful.