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European Commission

László ANDOR

European Commissioner responsible for Employment, Social Affairs and Inclusion

Tackling long-term care challenges

Symposium européen aide aux familles

Brussels, 22 November 2012

Your Royal Highness,

Distinguished guests,

Ladies and gentlemen,

Thank you for the opportunity to address this Symposium gathering mostly practitioners who experience the challenges of their sector every day.

In my intervention I would like to put these challenges in a European perspective and present to you how we try at the European level to foster the job creation potential of social and care services.

The combination of longer life expectancy, low fertility and the retirement of the baby boomers will deeply impact and change the outlook of our societies and economies in the next 30 years.

Leaving families to provide long-term care as we mainly do today, without rethinking delivery models, becomes increasingly unrealistic:

First of all, the number of people in the age group 80+ at risk of developing long-term care needs will triple over the next two decades. Even in the best case scenario, we are likely to face a doubling of the number of people that will develop age-related disabilities and will need special care.

Secondly, the pool of potential carers will shrink substantially over the next decades as working age cohorts become smaller and the employment rates of women increase. Let's not forget that the large majority of carers in the EU are women, which brings me to my third point: labour market integration of women aged 55-64 with substantial informal caring tasks.

Women who deliver unpaid regular long-term care tend to stay outside the labour market. This involves an important loss for the economy and society. We will not achieve the Europe 2020 employment goals if the underemployment of women within the age group 55-64 persists and if lack of access to formal care services for older dependents remains to be a barrier to their continued employment.

Much larger economic value can be created if older women are in paid jobs that correspond to their professional qualifications than if they have to provide informal care for their older dependents.

Staying at home with older dependents or having a paid job and using external care provision should of course be a personal choice for a person in working age. But unless we develop the capacities of the care sector, the choice will simply not be there for many people: they will have to provide informal care at home.

Finally, if we rely primarily on informal care, we also lock in possibilities for productivity growth and quality improvements in care delivery as such.

Ladies and gentlemen,

We need an innovative approach to long-term care services.

Affordable health and care services, activity centres, and residence adaptations can help older members of our societies to remain independent, and reduce long-term care costs.

Efforts aimed at raising productivity, efficiency and effectiveness of care delivery will be crucial. Finding ways to strengthen the financial base for long-term care services is another must.

These efforts must be reinforced by combined health promoting and preventive active ageing policies increasing the capacity for independent living of older people even when they become frail or develop disabilities.

Still, even if we are successful in this endeavour, there is no doubt that over the next decades, there will be a constant increase in the need for professional carers and family assistants.

The main role of the EU is to support the Member States' efforts in tackling these challenges.

The Commission works in particular together with representatives of all Member States in the Social Protection Committee. This Committee recently adopted a European Quality Framework for social services of general interest including long-term care services.

The Working Group on Ageing of the Social Protection Committee is currently considering a proposal for a new work programme on innovative approaches to long-term care which may run till the beginning of 2014. This working group could look at ways to close the gap between demand and supply of long-term care such as:

  • Raising the productivity of care delivery through better organisation, re-engineering, innovation and quality control

  • Reducing the incidence of frailty and disability: active and healthy ageing that involves prevention and rehabilitation strategies

  • Enabling elderly people to continue to lead independent lives with functional limitations

Finally, as part of the Europe 2020 Strategy recommendations Member States are asked to improve the adequacy and coverage of their social and care services, ensure access to quality social services and target social assistance better.

This will also be addressed in the so-called Social Investment Package, the Commission intends to present early 2013. The package will underline the need for Member States to sustain social investment in human capital and social infrastructure. This is a challenging message in times of austerity and budgetary constraints but there is clearly a need to adapt the European Social Models to a new demographic and societal reality. This adaptation should translate into more effective social spending in order to avoid much higher costs in the longer run.

Furthermore, in April 2012, as part of the Employment Package, the Commission published a Staff Working Document on “exploiting the potential of personal and household services”, aimed at identifying possible answers to the issues of better work-life balance, job creation for the relatively low-skilled and improvement in the quality of care. A public consultation based on this document has received a significant number of responses from across the European Union. The main findings of this consultation were:

  • The lack of a clear-cut definition of personal and household services and therefore of precise statistics;

  • The strong demographic impact on the sector; and

  • The need for public intervention to help transform the high proportion of undeclared work in the sector into formal work with decent working conditions.

The Commission will organise a conference in January 2013 with all relevant stakeholders to further discuss these findings and identify the next steps to be taken to fulfil the job creation potential of care services.

Indeed, already over the last decade the number of jobs in the healthcare sector overall increased by about 4 million. Since the onset of the crisis in 2008, while the EU has lost more than two and half million jobs, the health and social sector generated over 2.8 million jobs, one million of which were in the residential and non-residential care sectors.

The enormous employment potential of care services is not confined to the here and now. We need a far-sighted perspective on the demographic ageing of the European population over the coming decades. The 2012 Ageing Report found that healthcare and long-term care expenditure on Gross Domestic Product is expected to increase by about 30% by 2060. Already now we see that many Member States are experiencing labour shortages. This is the result of an increasing ageing and retirement of current professionals across a broad range of occupations – physicians, nurses, paramedics, and medical assistants. Replacement needs are estimated to generate some 7 million vacancies to be filled by 2020. However, in the current situation, there are not enough young people in specialist training to replace them, especially in rural areas.

The Commission is engaged in promoting cross-border mobility of care professionals and students in the EU. It has also proposed to modernise the 2005 Directive on the mutual recognition of professional qualifications. Furthermore, the Commission will support efforts by the Member States to provide an adequate supply of training and continuous professional development programmes for specific care occupations.

The European Social Fund has a major role to play in this respect. It can be used to help families to take care of children and the elderly with the objective to promote employment and improve reconciliation between work and private life. It can support investments in active and healthy ageing. Within its social inclusion objective, the European Social Fund can help enhance access to affordable, sustainable and high-quality services, including health care and social services of general interest. Finally, the ESF can co-finance training of care professionals.

One example of a relevant European Social Fund projects is the "Part-time training in Hamburg" scheme that supports young parents as well as carers to balance their commitments at home with training that will give them the opportunity to improve their employability and fulfil their potential.

Another project financed by the European Social Fund is "Workplace learning in focus" in Sweden, which is an in-service training for healthcare staff to develop skills and improve quality assurance.

Ladies and gentlemen,

We need to improve the quality of care jobs and working conditions in the care sector in order to make them appealing to new labour market entrants. Tackling issues such as unsociable working hours, wage levels and gender pay gaps, as well as work-life balance arrangements is essential particularly for women, who represent the large majority of the health workforce.

Without decisive actions by the Member States, supported by the Commission, we not only risk an under-supply of care services for an ageing population, but also the under-utilisation of a precious source of employment for the years to come.

I wish you a very successful symposium and look forward learning about the outcome of your discussions today.


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