Working Conditions in the Health and Welfare Sector

Working in healthcare is becoming increasingly challenging, and there is a high turnover rate among staff: a “ticking time bomb.”

How are the working conditions in the health and welfare sector? This study, led by Panteia, examines occupational safety and health (OSH) in the health and welfare sector across 27 EU member states. Concerns are rising over increasing workload and stress, as well as aggression towards personnel. The high turnover rate in healthcare is also notable: in the Netherlands, half of the employees have left their roles over the past five years.

Healthcare work can be literally a matter of life and death. How demanding is this work, and how do the working conditions in health and welfare compare to other sectors? “This is the first EU-wide study to combine so many different data sources,” says researcher Martin Clarke. The study was commissioned by EU-OSHA, the European Union’s agency for workplace safety and health, which also runs campaigns to improve working conditions. “We want to provide a clear picture of healthcare working conditions on an unprecedented scale, aiming to raise awareness of these critical issues.”

High Stress and Mental Health Issues
The statistics are stark: over two-thirds (68%) of all healthcare and welfare workers in the EU report experiencing work-related stress, significantly more than the average across other sectors (46%). No other sector scores as poorly. Additionally, mental health issues (e.g., depression, stress, and anxiety) are highest among healthcare workers (24%). “You are dealing with patients who are often suffering, and you need to make important decisions quickly,” Clarke explains. “Moreover, working hours are irregular. It’s not a 9-5 job, as people often need round-the-clock care.”

The figures show that the workload has grown heavier over the last decade, with the Covid-19 pandemic putting the sector under unprecedented strain, particularly in hospitals and nursing homes. “No one was prepared for this pandemic, and suddenly, healthcare workers were on the front line. Absenteeism increased significantly, and the already high workload rose even further. It could be said that the pandemic exposed structural issues within the sector.” Clarke adds.

“It’s a ticking time bomb: workloads are increasing, and the average age of healthcare staff is rising.”

Aging Workforce: A Ticking Time Bomb
The aging population presents a major challenge, with more people requiring care while the average age of healthcare staff rises. Currently, 37% of healthcare workers are over 50, indicating a large potential exodus in the coming decades. Furthermore, more than half (56%) experience musculoskeletal issues, such as back and joint pain, the highest rate among all sectors. “It’s a ticking time bomb,” says the researcher. “Workload is increasing, and healthcare workers are aging. The job is physically demanding, especially as workers grow older. Sometimes they have to work in awkward positions or do heavy lifting.”

Harassment and Violence
The study also examines the levels of aggression healthcare employees face, including harassment and intimidation by patients. Healthcare and welfare remain the most challenging sectors in terms of working environment, with almost a third (32%) experiencing verbal or physical aggression from patients or their families. These numbers are twice the average across all sectors (16%). In Dutch youth care, a striking 81% have encountered aggression. “This type of aggression is a serious concern. In Italy, there have been so many reported attacks that the unions have asked the government to deploy the military to protect hospital staff.”

“Aggression is a major problem. In Italy, the unions have even requested military protection for healthcare staff.”

Job Insecurity, Particularly in the Netherlands
Working in healthcare is not only demanding but also comes with job insecurity. Almost one in ten (9%) report “precarious working conditions,” with the Netherlands among the five worst-ranking countries. Issues include job insecurity from temporary contracts or insufficient pay to make a living. Home care, social work, outpatient youth care, and childcare score even worse, at 13%, a higher rate than the hospitality and tourism sectors, where seasonal work is common. In-home care, particularly, exploitation is a risk, especially as this workforce includes many women with a migrant background and lower educational levels.

“There are no guidelines for managing risks related to mental health issues. It would be helpful if the EU provided more guidance.”

The study does not propose specific measures but does offer clear recommendations. According to Clarke, it starts with greater recognition of the importance of mental health and psychosocial risks. “There are clear guidelines from the EU for the physical aspects of the work. For instance, they describe in detail how to handle needles, but there’s nothing yet for managing risks related to mental health issues,” he explains. “I think it would be very helpful if the EU provided more guidance.”

Protecting Staff and Attracting Youth
In the Netherlands, half of the healthcare workers have left their jobs in the past five years, with many indicating that their managers could have done more to prevent this. To alleviate workload, Clarke stresses the importance of making the sector more attractive to young people. It is also essential to keep current workers as healthy as possible. “The work is physically demanding, so it’s important to organize it smartly, for instance by investing in better tools and ensuring workers aren’t lifting for long periods. The goal is for healthcare staff to reach retirement in good health.”

Clearly, action is necessary. The challenge lies in bringing all relevant parties together, which is, according to Clarke, precisely what’s needed. “There are so many organizations involved: professional associations, employer and employee organizations, and relevant ministries. We hope they take notice of these findings and that our research can contribute to the debate, leading to concrete steps for improving working conditions.”

This project was funded by EU-OSHA. The research consortium was led by Panteia. Other partners are Vhp Human Performance (NL), IKEI Research and Consultancy (ES), and TNO (NL).

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