ICN Congress 2025 - Plenary 4: Health systems in Europe

Plenary session addressed the ways major challenges in health care in Europe are being tackled, and described opportunities for advancing health equity, quality, and sustainability across the region.

Moderating the session, ICN President Dr Pamela Cipriano said the European health systems are among the most developed in the world, yet all of them are facing challenges, including ageing populations, rising costs, workforce pressures and inequalities of access.

Dr Cipriano said: “Post Covid, we have to be clear. We have to be prepared, we have to move beyond reactive systems and make sure that we have centred our interventions on people. As we think about strengthening systems, making sure they are people centred and nurse informed. We also know that health is more than what we talk about when we just say health care - it's really about societal well-being.”

Dr Natasha Azzopardi Muscat, World Health Organization (WHO) Europe Regional Office Director, said that as a young doctor she learned an important lesson, that “the quality of your health service, the humanity of your health service, does not depend on the latest gadgets, it depends on nursing.”

But she said that despite people’s best efforts, even in Europe, which has highly developed health systems, all 53 member states are facing a crisis.

“Everybody is talking about the health workforce – unpack that a little bit and quickly you realise that people are really talking about nurses, because nursing is the backbone of our health systems”.

She said the WHO Europe office has adopted a framework for resilient and sustainable health systems, but it will only be successful in transforming the current situation if the health workforce and patients work together.

“We are doing our best to ensure that nursing remains high on the agenda, blending, advocacy and evidence, and listening carefully to countries. And this is the recipe that allows us to work. ‘We know that recruitment is going to be tough because of demography – it’s simple: there are going to be less people around to do jobs.

'We know that fewer young people are interested in choosing nursing – probably because they see that the work is too hard and that’s not what they want for their lives. So, we need to get real about retention of the staff that we have.”

Dr Azzopardi Muscat said working conditions for nurses need to be improved, not just their pay, and that there should be zero tolerance for violence.

She said an important focus for the next five years will be on health emergencies and health security, because of the threats from the climate crisis, conflicts and the next communicable diseases.

“We need to continue to show that if we truly care about the well-being of our citizens, about society, cohesion, political stability, we must work to create a well-being economy, something which Finland can teach us a lot about. And we can only continue to create well-being economies if we continue to invest in our nurses.”

Dr Paivi Sillanaukee, Special Envoy for Health and Well-being at the Finnish Ministry of Health, spoke about the inclusion of health in all government policies in Finland since 2006, and how that has influenced the whole development of Finnish society.

Dr Sillanaukee said: “We take people’s health and well-being pretty seriously in Finland. We have, in our constitution, the right for everyone to get the services and support they need. And we have a taxation-based society, where people pay taxes and then our public sector, our government, allocates the money to our 22 well-being districts, which then organise the care.”

She said having health in all policies helps Finland to keep people out of hospital.

“Health has to be taken into account in all the ministries’ decision making. That's really important when we think about health, because we can establish health in our society before people get ill. Prevention is a really important focus for us. If we educate people, we take care of their social and health needs, give health services to them, and take account of gender equality in our society, that's the way we can also enhance economy. Finland and the Nordic countries really are strong showcases for this, because we have had this well-being model in our countries.”

Paula Risikko, First Deputy Speaker of the Parliament of Finland, who is also a nurse, said nurses have a role in the security of societies.

“The skill requirements of nurses are changing because of the complex problems service users have, the changing age structure of the population, and the state of the economy in each country.

‘The primary purpose of nursing is to help individuals, families, and groups to maintain the physical, psychological and social functional capacity, and fulfil the potential in the environment in which they live and work.

‘We nurses play an important role in building the comprehensive security of a society, not only at the individual level, but at the societal level as well.”

‘Inclusion and social capital are important factors contributing to an individual's coping. Because of this, it is important for different people to be able to feel that they are a valuable part of society and their local community.”

She said the professional skills of nurses are vital in helping to build psychological resilience, which enables individuals, communities and societies to recover from the impact of crisis situations.

President of the Finnish Nurses Association Dr Heljä Lundgrén-Laine said Finland differs from most countries because it has a low number of doctors and a high number of nurses.

“This is something that tells you how much power we have in Finland. In Europe, the average is 8.5 nurses per 1,000 of the population and 4.1 doctors. In Finland we have 19 nurses per 1,000 and 3.5 doctors. And every year we get between 4,000 and 4,500 additional nurses.”

Dr Lundgrén-Laine said this was achieved by educating all nurses in applied science universities. And all nurse teachers are educated in Nursing science to Masters or PhD level, and quite often they also have extensive clinical experience. There is also investment in nurses’ professional development and the broad use of their skills in many areas, including prescribing, management of long-term conditions in primary care and autonomous outpatient care.

She said Finland also has all its health care data in electronic form, and artificial intelligence is in use for routine work, such as managing appointments, planning staff rotas, making phone calls and speech recognition.

“At the moment we are promoting career pathways, trying to find new, innovative models of care and opportunities for nurses to work to the full scope of their practice, including advanced practice nurses, clinical nurse specialists and nurse practitioners. We are doing this because of a worsening workforce crisis for nurses and doctors, the crucial role of nurses in maintaining preparedness and planning in our society, and our huge reform of social and health services. And we should always remember that career paths include management and nurse leaders.”