The EU Blue Card scheme - Implications for the health workforce in and outside the EU

The policy behind the European Union Blue Card

The Hague Programme, approved by the European Council in November 2004, stressed the importance of having common immigration and asylum policy guidelines, including on economic immigration into the EU for the (then) 25 EU Member States. Proponents argue that economic migration could help the EU face its looming demographic crisis and related skills shortage, and realize the objectives set in the EU’s Lisbon strategy for growth and jobs.

However, one needs to be careful with considering this kind of immigration as an answer to the demographic and workforce shortages the EU faces. Despite a few potential benefits, Economic Migration brings a number of serious challenges. This kind of migration must be correctly managed - if it is introduced at all. In 2005 the European Commission (EC) adopted a Green Paper on an EU approach to managing economic migration and a subsequent Policy Plan on legal migration. The plan listed a series of measures to be adopted by 2009, including a horizontal directive introducing a single permit and a single procedure for migrants seeking to work in the EU (presented by the EC in October 2007). 2009 saw the introduction of this single permit: the EU Blue Card.

The Blue Card proposal: attracting highly-skilled labour

So, what is behind the Blue Card proposal? It is the EU’s main policy initiative in the global competition for the best, highly-skilled workers. The aim is to create a single application procedure for non-EU workers to reside and work within the EU. The scheme aims to attract up to 20 million skilled workers from outside the EU by 2030.

Currently, most highly-expert workers go to Canada, the US and Australia - allegedly due to the difficulties in applying to 27 different and conflicting procedures. By comparison - about 85% of global unskilled migrant labour heads to the EU but only 5% goes to the US, while 55% of skilled workers go to the US and just 5% to the EU. The EU has ambitions to change this proportion. However, one might ask - do we really need them so badly? Are we going for quantity? Wouldn’t it be better to go for quality? Wouldn’t we try to seek solutions within the EU borders? Considering the difficulties Member States have in agreeing on health professionals’ competences within the EU, how can we expect non-EU trained workers to present no problems with their - even greater - skills differences?

The strategy: What does the Blue Card offer?

According to the EU Directive presented on 25 May 2009, Blue Card holders will receive a number of privileges in areas such as:
 working conditions, including pay and dismissal;
 freedom of association;
 education, training and recognition of qualifications;
 a number of provisions in national law regarding social security and pensions;
 access to goods and services, including procedures for obtaining housing, information and counselling services;
 free access to the entire territory of the member state concerned within the limits provided for by national law.

However, these advantages are believed to fall far below what the US Green Card has to offer, making the EU Blue Card not competitive enough, and thus not more attractive by any means. So, whatever it is, one might want to consider how this new "initiative" will affect workforce worldwide - before accepting it as the solution.

Implications for health workforce both within the EU and third countries

Several objections have been raised to this proposal and to the way it has been framed. By introducing the Blue Card system, the EU is in danger of increasing the brain drain from developing countries, with negative consequences for key development sectors. In particular the health sector in developing countries suffers from the loss of highly skilled workers, which results in severely weakened health systems that can barely provide services, let alone pursuing the aspirations of the Millennium Development Goals (MDGs) - one of the priorities of the EU’s development policy as outlined in the European Consensus on Development andthe EU’s Policy Coherence for Development. For example, of migration trends continue, of the 1,600 doctors in Zambia, there will only be 400 left in 10 years time, and there are more Malawian-trained doctors in Manchester city alone than in the whole of Malawi.

In a similar vein as the adopted Blue Card scheme, the EC produced a Green Paper on the EU workforce for health at the end of 2008. The EC held a consultation on the Green Paper, EPHA provided a number of recommendations that the Commission must take into account to adequately approach the EU workforce for health strategy.

One of the issues raised in EPHA Consultation Response was the global migration of healthcare workers. EPHA urged the Commission to support the establishment of a strong EU code for ethical recruitment from third countries - especially for vital development-driving sectors like health and education, the developers of the Blue Card must take this into consideration.

The EU Blue Card plus...?

A belief in the advantages of the Blue Card in fulfilling the demand on highly-skilled labour to replenish ageing and diminishing workforce within the EU is quite huge. However, it must be a win-win structure for both developed and developing countries, for all countries within the EU. In order to avoid the Blue Card aggravating - or literally turning "blue" - the current health workforce in these regions, the EU must consider the moral and ethical implications of such action. Additionally, the efforts must be collaborative between developing countries’ governments to address the problem from both sides. Not only must the "pull" factors of labour migration be discussed, also the powers that push health workers to seek employment outside their countries have to be given sufficient recognition and action.

In its consultation on the Green Paper EPHA stressed out that any aggressive recruitment aimed at developing countries health workforce should be prevented, and that an ethical recruitment - accompanied by a special Code of Conduct - should be put into operation to assure that development in the low- and middle-income countries will not suffer for the sake of the Europeans benefit solely.

The EU cannot go for quantity and attract as many highly-skilled (health) workers to take care of its ageing society. This kind of action cannot be seen as the solution to such need-demand gaps. There are issues that this blue card cannot possibly help to solve such as the issues of language, comparable skills, professional competences have these been taken into account or is this just a blind attempt to increase immigration? In the situation that we cannot even agree on common EU competences in health professions across different EU countries, how can we assume that non-EU trained professionals will perfectly fit into this reality?

EPHA articles

 Green Paper on the European Workforce for Health, December 2008
 Commission introduction to Patient Safety and Workforce mobility
 Free movement of professionals: opening up opportunities or perpetuating problems?
 Lisbon Strategy achieves ’limited progress’ for European workers