Policy responses for Czech Republic - HSRM

Czech Republic


Policy responses for Czech Republic

2.2 Workforce

In January, staff shortages in hospitals became critical. On January 22, 728 soldiers were helping in 125 hospitals and social care facilities, while others helped with contact tracing. Medical students were still volunteering, and medical schools oppose any further use of the work duty instrument. The Czech Republic was the only country in Europe to force students to work and some argue this is not in line with basic constitutional rights, especially when applied over a longer period of time (8).  

Further repurposing of wards for COVID-19 patients required additional staff redeployments in hospitals that at the same time have been designated as public vaccination centres, resulting in challenges to ensure adequate staffing of healthcare workers.

On March 3, work duty was imposed by the government on outpatient specialists and other healthcare workers working in private settings (independent offices, non-hospital healthcare providers, and hospitals that do not treat COVID-19 patients; spa healthcare workers were excluded), with the exception of physicians of “first contact” (typically GPs, paediatricians, gynaecologists and palliative care workers). Regional governors can call them to work upon request hospitals in the region they live in that are treating COVID-19 patients. The Czech Association of Ambulatory Specialists voiced concern about many outpatient specialists not having provided inpatient care for many years, thus lacking the necessary up-to-date training. Still, hospitals welcomed any possibility to supplement their healthcare staff, saying they can help in vaccination centres, sample taking places, or other wards. Most regions have not been enforcing work duty call, instead giving priority to reaching mutual agreements with outpatient healthcare workers to take jobs in hospitals.  

On March 8, work duty for medical students (4th and 5th grades), non-medical healthcare undergraduate and graduate students, and specialized healthcare high school students (3rd and 4th grades) was reimposed. Medical school deans strongly opposed this measure, saying it significantly impairs the continuity of students’ education, which may become an issue later on. The deans called for medical students to get proper job placements, as most of them previously only worked as orderlies. This is the third time the government has imposed work duty on medical students during this pandemic. More than 500 medical students are still volunteering in hospitals, although this time medical students have the right to opt-out of a work duty placement by the governor of region that they are registered to live in upon proof they are already volunteering or working in another hospital.   

Source:
(8) https://www.zdravotnickydenik.cz/blog/k-pracovni-povinnosti-studentu/

In early September, as a result of rising infection rates, the Regional Public Health Authorities were facing significant staff shortages. Despite new positions being created over the summer, most of the positions remained unfilled. Health authorities were at their tracing capacity limit (see section 1.4) and an unofficial call was made by the Chief Public Health Officer for medical students to join tracing efforts. Student unions declared that the number of available medical students is limited, given that they must pursue their winter semester studies. A Ministry of Interior proposal to bridge this gap would have enabled police investigators to assist public health authorities, was later accepted, together with other civil servants and private companies’ call centres operators (see section 1.4).

Medical students in the 4th and 5th years were called by government resolution to work duty in October.  Regions decide on the application of the call for students of their domicile. Many medical students already volunteered in hospitals or with tracing contacts at that time; one region (Královéhradecký) applied the work duty call in late October, other regions followed later. The situation differs in Prague –with sufficient volunteers-- compared to regions without a medical school because universities did not suspend medical students’ practical training. The medical students’ work duty was called off on December 10. Over the autumn work duty period, 800 students were called to work duty by the regions and over 2100 students volunteered.

The Czech Red Cross has been offering a 1-day training for anyone to earn an orderly’s qualification since late September to volunteers. After passing the training, people can apply to work as hospital attendants as well as social care workers in senior homes and take care of their disabled close ones at home. Hundreds of volunteers have undergone the training in several spots throughout the country. The Czech Red Cross operates a database through which hospitals and social care facilities can contact these newly trained workers to offer temporary work contract (6) – by the end of February 2021, more than 3000 volunteers have completed this training, with half of them helping in hospitals or social facilities.

With repurposing of existing wards into COVID-19 wards (see Section 2.1), healthcare staff deployment occurred simultaneously. In many hospitals, capacity limits are set by staff availability rather than technical capacity. Regions are responsible for providing day-care for healthcare workers’ children when elementary schools are closed; bigger hospitals provide their own day-care centres as well.
  
In October, the government also called students of social services fields on work duty to work in social care facilities and students at universities of education to help with providing day-care for school-age children of critical infrastructure employees. Apart from medical students, other students’ (such as dentists, physiotherapists, nurses, psychologists, and social workers) work duty continued beyond December 10 and was suspended on December 15. 

Soldiers are involved as care givers and support staff in major hospitals and social care facilities where staff shortages become critical. On November 9, the government assigned additional 540 soldiers, bringing the total number of engaged soldiers to 900 (out of them 400 designated to help in hospitals).

The Czech Medical Chamber called for Czech physicians working abroad to return temporarily to the country to help in hospitals. Though several physicians were interested, unfortunately the administrative barriers become an obstacle that prevented interested physicians in pursuing the job in their home country. A month after the appeal the Czech Medical Chamber only 1 physician pursued the job on a voluntary basis (7).

The Czech government’s October call for international help resulted in temporary help of healthcare workers from USA (7 persons), Great Britain (6 persons), and Germany (2 persons) in November.

Sources:
(1) Ministry of Health Extraordinary Measures issued on March 16, 2020 (MZDR 12066/2020-1/MIN/KAN) and March 19, 2020 (MZDR 12312/2020-2/MIN/KAN)
(2) Ministry of Health recommendation for healthcare providers, issued on April 14, 2020 https://koronavirus.mzcr.cz/doporuceni-poskytovatelum-zdravotni-pece/
(3) qualified estimate by medical schools’ authorities, mid-April 2020
(4) Czech Republic Government Resolutions no. 216 (issued March 15), no. 278 (issued March 23), and no. 403 (issued April 9)
(5) https://www.ceskenoviny.cz/zpravy/kabinet-od-11-kvetna-rusi-pracovni-povinnost-studentu-mediciny/1887296
(6) https://zvladnemeto.cervenykriz.eu/
(7) Respekt, 12.11.2020

At the beginning of May, there were no reported staff shortages to manage the COVID-19 outbreak in hospitals, also because of positive epidemiological development. The Ministry of Health ordered hospitals to suspend planned and non-urgent procedures on March 17, 2020 (1). This enabled hospitals to implement measures to limit physical contact of critical staff, to limit physicians’ concurrent working in multiple facilities, and to introduce employee groups that do not get in touch with each other. In general, a redeployment from other specialities to deal with COVID-19 patients did not occur. The suspension of  non-urgent procedures was relaxed by an MoH recommendation issued on April 14 (2).

Although there was no official call for medical students volunteers at the beginning of the COVID-19 outbreak, there were about 3 000 students volunteering mostly as nurses, orderlies or at Public Health Authorities call centres providing information, and a further 2000 registered students ready to start working if needed by mid-April (3). Following these volunteering initiatives, the government issued the Resolution ordering medical students in their two final years of study (the 5th and the 6th grade) to be on call and be ready to start working if requested. However, the call requiring medical students to work was not made and the resolution was cancelled on May 11 (5).

Hospital and public health authorities’ needs for volunteers were met. The exact conditions differed, some hospitals provided a short training while some required an online course prior to beginning work.

There was a discussion on whether retired physicians should return to work, however, no official statement was issued. Relatively high number of physicians, especially in primary care, are continuing their work even in the senior age (average ages for some specialties are above 55 years).

Regional authorities were responsible for securing childcare for health workers (as well as for other defined critical infrastructure employees) when schools were closed. Generally, a list of designated facilities providing daycare was issued shortly after school closures.

On March 15, 2020, the government prohibited all medical workers (physicians, pharmacists, as well as nurses and other staff) from taking regular leave during the state of emergency; this resolution was revoked on April 10, 2020 (4).

During the state of emergency, physicians from third countries (outside the EU) could pursue their job without having passed the Czech specialisation exam (aprobační zkouška). The government planned to extend this exception for another 3 months when the state of emergency is concluded; however, the measure was rejected by the Parliament. 

Regarding healthcare workers’ mental health, there were 2 designated hotlines providing psychological support for them.

Workforce - autumn development:
 
In early September, as a result of rising infection rates, the Regional Public Health Authorities were facing significant staff shortages. Despite new positions being created over the summer, most of the positions remained unfilled. Health authorities were at their tracing capacity limit (see section 1.4) and an unofficial call was made by the Chief Public Health Officer for medical students to join tracing efforts. Student unions declared that the number of available medical students is limited, given that they must pursue their winter semester studies. A Ministry of Interior proposal to bridge this gap would have enabled police investigators to assist public health authorities, was later accepted, together with other civil servants and private companies’ call centres operators (see section 1.4).

Medical students in the 4th and 5th years were called by government resolution to work duty in October.  Regions decide on the application of the call for students of their domicile. Many medical students already volunteered in hospitals or with tracing contacts at that time; one region (Královéhradecký) applied the work duty call in late October, other regions followed later. The situation differs in Prague –with sufficient volunteers-- compared to regions without a medical school because universities did not suspend medical students’ practical training. The medical students’ work duty was called off on December 10. Over the autumn work duty period, 800 students were called to work duty by the regions and over 2100 students volunteered.

The Czech Red Cross organized 1-day training for anyone to earn an orderly’s qualification since late September for volunteers. After passing the training, people can pursue the job of hospital attendants as well as social care workers in senior homes and take care of their disabled close ones at home. Hundreds of volunteers have undergone the training on several spots throughout the country. The Czech Red Cross operates database through which hospitals and social care facilities can contact these newly trained workers to offer temporary work contract (6). With repurposing of existing wards into COVID-19 wards (see Section 2.1), healthcare staff deployment occurred simultaneously. In many hospitals, capacity limits are set by staff availability rather than technical capacity. Regions are responsible for providing day-care for healthcare workers’ children when elementary schools are closed; bigger hospitals provide their own day-care centres as well.  

In October, the government also called students of social services fields on work duty to work in social care facilities and students at universities of education to help with providing day-care for school-age children of critical infrastructure employees. Apart from medical students, other students’ (such as dentists, physiotherapists, nurses, psychologists, and social workers) work duty continued beyond December 10. 

Soldiers are involved as care givers and support staff in major hospitals and social care facilities where staff shortages become critical. On November 9, the government assigned additional 540 soldiers, bringing the total number of engaged soldiers to 900 (out of them 400 designated to help in hospitals).

The Czech Medical Chamber called for Czech physicians working abroad to return temporarily to the country to help in hospitals. Though several  physicians were interested, unfortunately the administrative barriers become an obstacle that prevented interested physicians in pursuing the job in their home country. A month after the appeal the Czech Medical Chamber  only 1 physician pursued the job on a voluntary basis (7).

The Czech government’s October call for international help resulted in temporary help of healthcare workers from USA (7), Great Britain (6), and Germany (2) in November.

In January, staff shortages in hospitals became critical. On January 22, 728 soldiers were helping in 125 hospitals and social care facilities, while others helped with contact tracing. Medical students are still volunteering, but medical schools oppose any further use of the work duty instrument. The Czech Republic was the only country in Europe to force students to work and some argue this is not in line with basic constitutional rights, especially when applied over a longer period of time (8).  
  
Sources:
(1) Ministry of Health Extraordinary Measures issued on March 16, 2020 (MZDR 12066/2020-1/MIN/KAN) and March 19, 2020 (MZDR 12312/2020-2/MIN/KAN)
(2) Ministry of Health recommendation for healthcare providers, issued on April 14, 2020 https://koronavirus.mzcr.cz/doporuceni-poskytovatelum-zdravotni-pece/
(3) qualified estimate by medical schools’ authorities, mid-April 2020
(4) Czech Republic Government Resolutions no. 216 (issued March 15), no. 278 (issued March 23), and no. 403 (issued April 9)
(5) https://www.ceskenoviny.cz/zpravy/kabinet-od-11-kvetna-rusi-pracovni-povinnost-studentu-mediciny/1887296