Now is the time to deliver concrete results and to embrace a European Health Union

DISCLAIMER: All opinions in this column reflect the views of the author(s), not of EURACTIV Media network.

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At the beginning of 2020, the world was hit by an unprecedented health emergency. The COVID-19 pandemic has put the EU health systems under severe pressure and has shown a massive staff shortage in many Intensive Care Units (ICUs) across the EU.

Redeployment and training of healthcare professionals in Intensive Care (IC) during COVID-19 became of utmost importance as in many hospitals in Europe the medical and nursing staff was far beyond their limits. Reporters showed images from ICUs describing a critical situation, lack of ICU beds, and a worrying lack of staff prepared to work in these units. One thing is clear, after the pandemic, we will need not only an economic recovery but also a long recovery of our healthcare systems.

In fact, whereas ICUs already experienced surges and crises before COVID-19 (such as terrorist attacks, SARS, H1N1, MERS etc.), the phenomenon has only been put under the spotlight in the wake of the current pandemic. Even before this public health emergency, the European Society of Intensive Care Medicine (ESICM) has been advocating for the importance of improving the standards of care for patients by facilitating intensivists’ free movement across EU countries. The primary objective of this free movement is to explore paths for intensivists to freely operate within the EU, sharing knowledge and competences and improving the standards of care. ESICM believes that the Intensive Care Medicine’s inclusion using a “novel approach” to Annex V of the Directive on the Recognition of Professional Qualifications (2005/36/EC) will represent a significant progress towards the rapid recognition of these essential healthcare professionals. During the first wave of this pandemic, EU Member States have shown a great degree of solidarity and trust, easing the process to move critically ill patients from one country to another with the aim to provide the best possible care to them. Movement of doctors between countries occurred only marginally. The pandemic has highlighted this issue present in our healthcare systems for a long time and this is why we see an opportunity for Europe to fully acknowledge the importance of Intensive Care Medicine (ICM) for our healthcare systems and to urgently find a flexible and long term solution to this issue.

Europe needs to rebuild its citizens’ trust by making them feel secure again while guaranteeing the best possible healthcare service. In a crisis like this, the only thing people need is to feel protected and to trust their leaders and healthcare practices.

ESICM has consistently promoted the multidisciplinary and inclusive vision of Intensive Care Medicine, by framing diversity, and believes that the presence of the various base specialties in an ICU is very enriching for the profession. This multidisciplinarity and inclusiveness needs to be safeguarded and promoted. The reality shows that there are many training paths across the Member States on becoming an intensivist and working in an ICU.

ESICM aims to find the common denominator defining an Intensivist in different countries and common standards that could lead to recognition at the European level. Whatever pathway, ie a primary specialty or a subspecialty of two years of Intensive care training (within, on top or across the base speciality), everyone, as long as competencies are achieved, should be recognised as Intensivists at the European level and move and work freely. In its inclusive approach ESICM believes that Intensive Care specialists’ free movement is possible with a multidisciplinary approach to the profession while not being against a primary speciality in ICM. ESICM’s approach does not set out to interfere with national regulation and does not seek to dictate any changes to national training systems.

Furthermore, ESICM’s mission comes very much in line with the EU’s ambition to build a Health Union. In September 2020, the European Commission declared that the EU would work towards the establishment of a European Health Union to address the EU’s health security framework, to reinforce the preparedness and response to the current health crisis, as well as to future ones. National health systems become more and more interlinked by common challenges which require a common approach.

Nevertheless, there is a massive gap between the reality we are currently living in and what we would imagine to achieve together at the EU level. Even the anti-COVID vaccination campaign showed divergences in the national strategies. The lack of coordination and mutual understanding between countries is a serious threat towards a functional Health Union. EU citizens need to feel safe and protected again and now more than ever the EU should act with a single voice and not give reason to populist critics. We should strive to avoid unnecessary bureaucratic limits that could restrict the free movement of essential medical specialists that could save critically ill patients in another Member State.

The recognition of Intensive Care Medicine as a profession able to move without restrictions in the EU would lay down the base of the future EU Health Union, providing European Intensivists ready to be mobilised and to apply their competences across the EU, especially, but not only, in times of crisis where an immediate response is vital.

We acknowledge that there is a huge gap between the real situation in Intensive Care Units and the official information reported by the governments. The medical community keeps sending warnings on the lack of beds, capacities and trained staff in the European Intensive Care Units. The neglect of these very important alerts risk to lead very soon to a difficult scenario. Given all these facts and developments, ESICM urges for the recognition of the ICM profession able to move freely at EU level.

We are currently living in extraordinary times which require extraordinary solutions. We need to adapt quickly to the new challenges we are facing in the health system.

It is crucial that the EU takes the lead to guarantee our resilience in future health crises, now is the time to show a true political will and to act in a better synergy towards the establishment of a functional European Health Union.

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