Health associate professionals: skills opportunities and challenges (2019 update)

Summary

Health associate professionals are responsible for carrying out a range of practical and technical activities to support the diagnosis and subsequent treatment, or care, for humans or animals suffering from illness, disease, injury or impairment. 

Key facts

• Around 6.2 million people were employed as health associate professionals in 2018. Employment in the occupation grew by almost 17 per cent between 2006 and 2018.
• Employment is projected to grow by 9 per cent over the period 2018 to 2030. This equates with the creation of 536,000 new jobs. 
• The number of job openings that will need to be filled will be much higher than this. In order to replace those workers who will leave the occupation for one reason or another – about 3 million between 2018 and 2030 – and meet the projected growth in demand over the same period, around 3.5 million job openings will need to be filled.
• The occupation increasingly relies on highly qualified individuals. In 2018, 52 per cent of heath associate professionals had medium level qualifications, and this percentage is expected to fall to 44 per cent by 2030. In contrast, the share accounted for by those with high level qualifications is projected to increase from 41 per cent in 2018 to 50 per cent in 2030.
• The key three tasks of health associate professionals are teamwork, gather and evaluate information and service and attend.
• Interestingly, the anticipated employment growth in health associate professionals over the next decade will probably not come from health sector.
• Europe’s ageing population increases the challenges for public health policies as well as the demand for healthcare associate professionals to work in healthcare provision and pharmaceuticals.
• Changing lifestyles are heavily impacting on the types of diseases, injuries and ailments that health associate professionals will increasingly manage and treat.

Tasks and skills

Health associate professionals are responsible for carrying out a range of practical and technical activities to support the diagnosis and subsequent treatment, or care, for humans or animals suffering from illness, disease, injury or impairment [1]. Tasks carried out include: providing nursing, midwifery and/or physiotherapy support services; clinical testing of bodily tissue and fluids; preparing medications, under the supervision of pharmacists; formulating and dispensing optical prescriptions; operating, testing or maintaining medical equipment; and providing advice and consultation regarding diet, family planning or occupational health.

According to Eurofound's Job Monitor, the key workplace 3 tasks and skills of health associate professionals are teamwork, gather and evaluate information and service and attend.

Figure 1: Importance of tasks and skills of health associate professionals

Note: The importance of tasks and skills is measured on 0-1 scale, where 0 means least important and 1 means most important.

What are the trends for the future? 2

The employment level of health associate professionals across European countries is expected to grow by 9 per cent between 2018 and 2030 – around 536,00 jobs – following a period of substantial growth between 2006 to 2018 when employment increased by 17 per cent. The strong growth in employment can be attributed to the overall increased demand for healthcare services, driven by demographic changes, and shifting healthcare needs. However, only 17 of analysed European countries are expected to create more jobs for health associate professionals; the opposite trend shall be observed in remaining 11 countries. 

Figure 2: Future employment growth of health associate professionals in European countries (2018-2030, in %)

The 9 per cent growth in employment between 2018 and 2030 understates the growth in demand for people to work as health associate professionals. Over the same period an estimated 3 million people are projected to leave the occupation for one reason or another such as retirement [3] due to the ageing of workers in this occupation [4]. Given the projected increase in employment over the same period, this will result in there being around 3.5 million job openings that will need to be filled between 2018 and 2030.

Figure 3: Future job openings of health associate professionals (2018-2030)

Traditionally, the majority of health associate professionals hold medium-level qualifications. By 2030 a shift of balance is expected in qualification levels, as half will hold high-level qualifications and 44 per cent will hold medium-level qualifications. The trend towards higher qualifications can be attributed to the changing role of associate professionals in healthcare as they will continue to take on additional responsibilities from more senior level practitioners. It is interesting to note though, that higher level qualifications (Bachelor’s degree) are found to be linked to lower rates of patient mortality and quality of care [5]. As many of the occupations in this group are regulated, respective changes in domestic and EU regulations will also have an impact. For example, in some occupations the level of compulsory qualifications has increased - a trend which is likely to continue [6]. Furthermore, in order to receive one’s license or registration to practice, the provision of evidence demonstrating continued professional development is mandatory in a number of European countries [7]. This includes medical and pharmaceutical assistant staff, physiotherapists and those working in dentistry.

Interestingly, the anticipated employment growth in health associate professionals over the next decade will probably not come from health sector. Employment growth is foreseen in sectors closely connected to changing demands in the health industry. For example, increase in lifestyle-induced chronic diseases is expected to boost the demand for pharmaceuticals [8]; which in turn will likely contribute to a strong increase of employees in the pharmaceuticals sector over the next decade. Respectively, employment of health associate professionals in wholesale and retail sector is forecast to grow, encompassing those responsible for dispensing pharmaceuticals.

Which drivers of change will affect their skills?

• Europe’s ageing population increases the challenges for public health policies as well as the demand for healthcare associate professionals to work in healthcare provision and pharmaceuticals. Incidences of chronic and degenerative conditions (e.g. Alzheimer’s, arthritis and cancer) are expected to increase in frequency across Europe. Thus, regardless of their medical discipline or level of seniority, health associate professionals should possess particular expertise in delivering integrated geriatric care [9].
• Changing lifestyles are heavily impacting on the types of diseases, injuries and ailments that health associate professionals will increasingly manage and treat. For example, with a growing number of obese European citizens, and the resulting associated symptoms (e.g. diabetes and muscular and skeletal problems), expertise in disease management and patient counselling will become more important [10], while specific skills will be needed for occupations like physiotherapists. [11] Collaborative skills have also been cited as essential in order to provide a comprehensive plan that is managed by multiple care providers, including nurses, dieticians and community health workers [12].
• Shifts towards preventative and community-based healthcare are changing the role of many health associate professionals, who are increasingly expected to fulfil new roles that focus on the promotion of good health and the prevention of disease and injury. Public health practitioners, nurses and community care workers, in a number of EU countries, have played a key role in improving patients’ adherence to treatment regimes, knowledge of their conditions and self-management [13]. This move towards preventative practice requires specific expertise in health promotion activities throughout the healthcare profession, and an understanding of the key factors that negatively impact public health [14]. In order for community-based heath associate professionals to impart knowledge and advice to patients, communication skills are vital, along with the ability to work in a range of environments and with different groups who have varying healthcare needs.
• Technological advances are changing the way that patients understand their own health needs, whilst also enabling health workers to deliver more person-centred care. Associate professionals, such as nurses and technicians, need technical skills and experience in a variety of emerging practices; playing a proactive role in their own professional development is vital [15]. Emerging practices such as e-health (healthcare delivery that is facilitated by electronic processes and devices) and m-health (care that is provided via mobile communication devices) require staff to possess ICT skills. Effective communicative skills are also important to enable associate professionals to engage with patients in non-traditional ways, through telephone communications or using online platforms. Keeping up to date with new, evidence-based, best practices has also been cited as essential [16].

“Numerous patient groups experience significant advantages from being closely monitored while they are in their own home. Patients often feel more secure at home and do not have to commute to and from outpatient departments.

Telehealth solutions not only benefit the patients in terms of avoiding unnecessary transportation – they are also cost-efficient for the society as a whole. Effective collaboration between municipalities and medical professionals and experts brought in from hospitals, ensures that patients receive better treatment with both faster and better outcomes.

Videoconferencing and home monitoring of patients offer a good supplement to physical consultations with caregivers, and online tools for rehabilitation are increasingly being implemented to prevent readmissions. Online dialogue-based tools provide caregivers in the municipalities with the ability to tailor rehabilitation programs for their patients. The results from the rehabilitation programs are available online, and the caregiver can assess the data and adjust the exercises if needed”.

Source: Healthcare Denmark [17]

• Efforts to overcome fiscal challenges of healthcare organisations across the EU [18] may lead to changes such as the redistribution of roles carried out by hospital staff. Expanding the role of nurses, and merging their activities with those of more senior healthcare professionals, has been identified by academics, and employed as a policy measure in the United Kingdom, as an efficient means to improve the quality of care in the face of budget constraints. Movement towards more advanced roles will require additional soft skills, such as complex decision making, and specialist technical skills [19]. Important technical skills will include managing chronic disease, carrying out clinical assessments, ordering investigations, referring patients for onward care, clinical management and prescribing medication [20]. The prospect of fulfilling more advanced roles, along with the greater potential for career development, can also play an important part in encouraging younger people to enter the health associate professions.
• Mobility will continue to play a significant role in increasing the diversity of health workforces throughout Europe, with many new healthcare associate professionals moving within the EU or coming from abroad. Mobility can be an important response to staffing shortages. It is therefore important that experienced staff, well-acquainted with national regulations and standards of care, possess the ability to supervise, manage and assist colleagues who are new to the health system [21].
• As a part of its Ditigitalization and future of work project, Cedefop estimates the risks of automation for occupations. The most exposed occupations are those with significant share of tasks that can be automated – operation of specialised technical equipment, routine or non-autonomous tasks  – and those with a small reliance on communication, collaboration, critical thinking and customer-serving skills. The risk of automation is further accentuated in those (occupations) in which people report they have little access to professional training that could help them to cope with labour market changes. Hospitality and retail managers belong to occupations where the automation risk is low.

How can these skill needs be met?

To meet the increasing demand for and address the changing roles of some health associate professionals, workforce planning will be important. Planning could also include measures to encourage lower-skilled workers join the health and social care sector, by offering them training opportunities.

The challenges reshaping the health care workforce can be primarily tackled through high quality and updated initial education on which associate professionals will develop their occupation-specific expertise throughout their careers [22]. High quality initial education can also attract people to these professions, especially if offering agile learning pathways, such as dual routes of specialization in health or social care [23].

Perhaps more than other occupational groups, health associate professionals need to have continuous learning opportunities for re- and up-training throughout their careers. This seems to be the case in the majority of EU Member States: in nursing occupations, for example, continuing professional development is carried out by roughly 90% of EU countries; other training addressing management, communication and patient records, and chronic disease management is provided by 75%, 71% and 68% of EU countries respectively [24]. However, establishing mandatory continuous medical education could ensure that health associate professionals maintain a satisfactory level of skills development, measured in terms of competences developed through a mandatory number of hours or assessment credits, or a combination of these methods [25].

The main responsibility for promoting lifelong learning in this occupational group lies with the employer [26] that will need to plan such training offers in concurrence with healthcare developments and skills upgrade of health professionals. [27] Employers also need to have the capacity to tailor such training programmes to country or even local-specific requirements, and thus enabling the workforce to better support the local community.