We stand a real chance

Prof. Isfort, where does Germany stand with respect to care on a global scale? 

No other country has experienced mergers among care and nursing homes to the same degree as Germany. In the field of domiciliary and inpatient care, Germany sees itself faced with both sociodemographic and vocational challenges. Many nurses and care workers are aged 50 or over. Over the next ten years, we are set to lose 30% of the workforce, or even 40% in the domiciliary care sector, as employees enter retirement. The results are extreme pressure and a lack of personnel across a broad front. We have been warning about this for years – I sometimes feel like a climate researcher warning of an environmental catastrophe some 15 years ago. 

And what about care levels in hospitals? 

On an international scale, we have been able to catch up over recent years in this occupational category. Whereas until January 31, 2021, up to 2.5 patients in intensive care were looked after on a day shift, and up to 3.5 intensive cases were cared for by a single staff member on a night shift, the figures since February 1, 2021, have now dropped to 2 and 3 patients respectively. Our medical care has always been excellent, but in nursing care, we are still a developing nation in terms of staffing levels and far removed from Australia and the USA, for example. 

How can care professions be made more attractive? 

The branch has never lost its appeal. Even in the worst days of Covid-19, there was never the mass exodus from the nursing sector which had been forecast by the media. People are satisfied with their careers but are less satisfied with their jobs. Simply because they no longer do what they originally set out to do. At their various workplaces, they are under enormous pressure, and that's why they move from full-time to part-time employment. A dangerous downward spiral which results in the number of employees dropping and the workload rising – and ultimately in even more part-time jobs. In hospitals and clinics, the share has already risen to 50%. 

How could things be done better? 

A fixed rota and plannable leisure time – 'off-duty' should mean 'off-duty' and not that one needs to fear being called in. We must avoid unnecessary treatment and operations. On a European scale, Germany carries out the biggest number of back, hip and knee operations. France lags far behind us, and still people there are not hobbling across the road. Surgery here is partly superfluous and could be avoided using conservative forms of therapy. And I find this figure dramatic: Hospitals employ more than 65% more medics than 25 years ago, but only 3% more nursing staff. That is a recipe for failure. 

One part of the problem is undoubtedly that too few young people are coming into the profession. 

In that sense, we are in the same boat as most other branches and are no different to most tradesmen and small businesses. At the moment, 3 to 5% of school leavers can be convinced to go into the care sector. This is quite a reasonable figure. And I find it unrealistic to want to increase it further, say to 7%. 

In that case, things ought to be OK – but they aren't! 

More and more school-leavers are staying on to upper school so that they can go on to university. In Bonn, it's 50% for example; in Münster it's even 55%. Other countries have turned nursing into a degree course. Here in Germany, young people with the right qualifications tend to go on to read social studies or education science. So you see, the academisation of care plays a key role in opening up attractive career paths. 

The fact that we have ended compulsory community service doesn't make things any easier. 

Correct. And Germany's voluntary service cannot stop the gap, either. Virtually all men working in care came in through community service in lieu of joining the military. Many of them found their calling during this time. I know because I was one of them. But I still think any reintroduction of compulsory service would be fatal. This would mean that the care sector would be awash with people who are not fit for the job. Their ranks would even include persons you would like to protect patients from! Our task is to convincingly present young men with the breadth of choice within the care sector as there is no such thing as the archetypal care worker. This is what makes school placements and Boys’ Days so valuable. We must learn to fight for up-and-coming talent – and follow the example so beautifully set by industry. 

So the prospects for the future seem pretty bleak on the whole. Is there no medium- or even short-term solution to the shortage of nursing staff? 

We have a real opportunity – if politicians address the subject and the operators of care homes don't simply continue to build homes for which there is insufficient staff. New care models must be defined. In other countries, care providers and local authorities work hand in hand, and towns and municipalities provide support with the introduction of new technologies in the form of technical subsidies and manpower. And yet, in Germany, neither politicians nor care home operators seem to have any interest.