EN Official Journal of the European Union C 44/16

Opinion of the European Economic and Social Committee on ‘The Trends and consequences of future developments in the area of personal social, health and educational services industries in the European Union’ (own-initiative opinion)

2013/C 44/03

Rapporteur: Mr PEZZINI

Co-rapporteur: Mr JARRÉ

On 19 January 2012, the European Economic and Social Committee, acting under Rule 29(2) of its Rules of Procedure, decided to draw up an own-initiative opinion on the

Trends and consequences of future developments in the area of personal social, health and educational services industries in the European Union.

The Consultative Commission on Industrial Change, which was responsible for preparing the Committee's work on the subject, adopted its opinion on 8 November 2012.

At its 485th plenary session, held on 12 and 13 December 2012 (meeting of 13 December), the European Economic and Social Committee adopted the following opinion by 159 votes to 3 with 11 abstentions.

1. Conclusions and recommendations

1.1 The European Economic and Social Committee (EESC) believes that in Europe, personal social, health and educational services form an important cornerstone of the European social model. These services, which are interdependent and mutually reinforcing in their effectiveness, form a ‘golden triangle’ essential to the smooth functioning and quality of society.

1.2 In the EESC's view, these services firstly play a key role in both integrating people into society and preserving social cohesion, thus ensuring effective democratic participation and social justice. Secondly, they are of key importance in the drive to achieve the Europe 2020 goals in respect of sustainability, smart job creation and reinforced economic and social cohesion across the EU.

1.3 The EESC believes that more awareness is needed of the fact that as the population ages and demand for care grows due to the falling number of family caregivers (due, inter alia, to the growing participation of women in the labour market), better planning and programming has become essential, in terms of requirements and training for healthcare workers on the one hand, and in terms of budgetary funding priorities on the other.

1.4 The EESC is aware of the competence of the Member States in this field and the discretion of national, regional and local authorities in the provision of these services. However, the EESC draws attention to the fact that the EU Member States also have a major shared responsibility in this field, pointing out that the Lisbon Treaty has brought in an important innovation here, with the protocol on services of general interest (SGIs) appended to the Treaty; it would take the view that harmonisation between the Member States needs to be pursued, in order to overcome existing inequalities and guarantee the fundamental freedom to establish (while complying at least with the social standards set out in regulations and agreements in the host country) and provide services.

1.5 In view of the sector's importance in terms of its contribution to EU gross domestic product, the significant employment prospects it offers in terms of job and new-business creation, as well as its capacity to deliver innovative, quality responses to the structural changes and needs in European society, and to the Lisbon Treaty objectives in this field, the EESC calls on the Commission, the Council and the European Parliament to: — launch a fully-fledged strategy on innovative and ‘smart’ social and health services in Europe, involving the optimisation of human resources, lifelong training, the definition of quality principles, the introduction of appropriate technologies to support service recipients and providers, the development of a European area of integrated services, and support policies; — promote greater efficiency in the use of financial and human resources; effective management governed by collective bargaining; adequate involvement of the private and voluntary sectors; and prudent assessments of services' efficiency and cost-effectiveness; and — calls specifically on the Commission to establish a common basic framework on personal services, with a regulatory framework and principles on quality, together with well-defined curricular requirements, in order to make easy professional mobility a reality across the EU.

1.6 At EU level, the EESC thinks that a proportion of the various Structural Funds should be earmarked in a coordinated way for developing social infrastructure and health services where shortcomings exist, and for local employment initiatives in the sector. In particular, there should be a funding line for rural areas. The same applies to the Horizon 2020 and Culture programmes and lifelong learning measures that relate to new technologies applied to health and social care. Moreover, research into optimising the results of services should be encouraged, as well as the documenting and exchange of success stories.

1.7 The EESC considers it important to establish a constructive and well-structured social dialogue between all levels (local, national and European) in all sectors of the personal services industries. This social dialogue should play a crucial role in: — analysing the sector's economic and social significance; — studying development paths for the sector; — preparing projects to allow for upward harmonisation of regulation for the sector; — fighting irregular employment; — improving professional standards and career opportunities in the sector; — improving working conditions and salaries in the sector; — improving the sector's attractiveness and image; and — monitoring the application of collective agreements and regulation in this sector. The European Commission and the Member States should provide concrete and active support to set up and develop this social dialogue and to organise its work. At first, this support could take the form of studies on these sectors and European-level conferences for the sector's social partners.

2. Introduction

2.1 The purpose of this opinion is to identify changes in ongoing trends and future developments in the areas of personal social and health services, related educational and training services, and, in particular, prospects for creating quality jobs in the sector.

2.2 Social and health services concern the basic needs of the individual. The industry, in this sector, operates in various fields ranging from institutions that provide medical and psychosocial treatment to those that provide health and social care services, housing support, in addition to nursing homes, mental health care, and care for children, older people and the differently able.

2.3 Furthermore, the sector is marked by significant migration flows from outside the EU, as well as a strong tendency to use black market labour, with all the harmful consequences that this entails for the individual and for society in general.

2.4 The EESC intends to use this opinion to help identify the added value that the personal services sector can offer the Europe 2020 strategy, in order to identify needs in terms of qualified human resources and new occupational profiles, with a view to innovative social prospects, more and better jobs and improved public wellbeing, as a result of the enhanced integration that ensues from a more cohesive society.

2.5 In Europe, personal social, health and educational services form an important cornerstone of the European social model. These services, which are interdependent and mutually reinforcing in their effectiveness, form a ‘golden triangle’ essential to the smooth functioning and quality of society.

2.6 The EESC endorses this concept of the ‘golden triangle’ of integrated services, aimed at quality education, efficient healthcare and full social integration, and at attaining the highest level of effectiveness possible in all three types of service in terms of the following criteria: availability, universal access, centrality of the person, universality, continuity, high level of quality with a clear focus on results, respect of fundamental rights, participation and partnership, integrated governance, investment in human capital and in social infrastructure, high-level performance and professional jobs with decent working conditions, with career prospects, solidarity and social cohesion.

2.7 The EESC believes that precisely because of these characteristics, the golden triangle of professional personal services should be given priority attention in the drive to achieve the Europe 2020 goals in respect of sustainability, economic development and job creation and economic and social cohesion across the EU.

2.8 The opinion is based on various information sources ranging from general studies to concrete business cases. It should be noted that demographic trends and active ageing, and the consequences of an ageing population on healthcare and welfare systems are issues that have been covered in previous EESC opinions (1). In addition, the EESC itself is engaged in framing roadmap initiatives on problems associated with the ageing of European society, in the context of the next RTDT framework programme and on the participation of older people in society (2).

2.9 Furthermore, personal educational services are mentioned in this opinion only insofar as they are relevant to the delivery of quality and up-to-date social and healthcare services. Numerous detailed EESC opinions on this subject may be consulted for more detailed information on education and lifelong training services (3).

3. The sector's characteristics and prospects

3.1 Over 21.5 million people in the European Union are employed in the healthcare and social sectors and related educational services, as can be seen from Eurostat statistics for the EU-27 in 2009 (4). However, these are more concentrated in the old rather than the new Member States, and are predominantly women, who account for 78 % of workers in this sector, and extremely young, since over 43 % are aged below 40. Over four million new jobs were created by the sector in personal and home social and health services between 2000 and 2010. This has been in sharp contrast to the steady fall in overall employment across the EU due to the economic crisis, with substantial employment growth in this sector over the period 2008-2010, amounting to some 770 000 new jobs (5).

3.2 In the EU, healthcare represents about 10 % of GDP and employs one in ten workers, with a higher-than-average percentage of service-sector workers having tertiary-level education (6). Employment in the sector is rising as the population ages (7), more and more women enter the labour market, and demand for healthcare grows, and this is creating a growing need for harmonised definitions and training standards at EU level to ensure geographical mobility and evolving job profiles for effective and sustainable high-quality services across Europe.

3.3 Occupation profiles identified include, amongst others, care assistants, nurses, youth workers, social workers and doctors in all branches of medicine: according to recent studies (8), despite low wage levels and the lack of recognition for their work, care workers have a high work morale and sense of responsibility. Some studies also reveal serious staff shortages and growing problems to recruit and retain suitable and qualified operational managerial staff.

3.4 A European strategy within Europe 2020 is needed (9), to ensure higher levels of technical and structural innovation, reduce costs and promote quality jobs, while improving access to healthcare, especially in disadvantaged areas and in specific medical fields facing national staff shortages, by setting up networks of high-quality European medical centres with highly-motivated qualified staff to be made available to all EU citizens.

3.5 As regards pay levels in this sector, these are generally below the national average for comparable jobs, and female workers – who are the vast majority and are often immigrants – are generally underpaid (10), overlooked, and have precarious contracts even if well-qualified, according to recent studies in the following sub-sectors (11): health care, childcare, care for older people and other dependant care.

3.6 Furthermore, the sector has other specific characteristics that distinguish it from others (12): — average working hours per week are less than in other sectors of the economy, whereas shifts, night work, part-time work and temporary contracts are more common when compared with the economy as a whole; — there is a growing demand for a unified service that combines all healthcare aspects and skills with the specificities of social care; — recurrent vocational and language training is important for stepping up the use of IT-assisted first-line care, telemedicine and telediagnosis; and — the need for better, more coordinated infrastructure for the three types of service in question, accessible to all through suitable means (and reference structures on the ground?).

3.7 Furthermore, as has been pointed out concerning personal services, account needs to be taken ‘of the specific characteristics of small operators providing SGEI, social services and non-profit services, whose particular features and contribution to the general interest must be better taken on board’ (13), in the context of social dialogue with the social partners and civil society at large.

3.8 The situation is particularly worrying in rural areas and other disadvantaged areas, where the lack of social, medical and educational infrastructure often leads to an exodus of skilled labour, with repercussions on the creation and location of businesses and the development of those areas: more balanced regional development thus needs to be ensured and greater territorial cohesion promoted, especially in terms of personal social, healthcare and educational services for children and infants (14).

3.9 To promote better migrant worker integration, it is necessary to provide for financial and organisational support measures comprising language courses, enhancing the image of their work, reception and housing and vocational training in care practices, taking into account subsequent reintegration in their countries of origin, to avoid a brain-drain in the health field (15).

3.10 Investment costs in the sector are therefore quite high and often controversial in terms of sustainability since the financial crisis has revealed the need to improve the cost-efficiency ratio of health and social services and Member States are under pressure to find the right balance between providing healthcare services for everyone and respecting budgetary constraints. However, looking at the results obtained, it is clear that investment in this service sector is highly productive and profitable: the workforce enjoys better health and is better integrated, more skilled, more motivated and more stable.

3.11 The Lisbon Treaty has also brought in an important innovation here, with the protocol on services of general interest (SGIs) appended to the Treaty, ‘as it covers all SGIs and for the first time in a treaty introduces the concept of “non-economic services of general interest’ in contrast to “services of general economic interest”’ (16). Unquestionably, personal services have both an ‘economic’ and a ‘non-economic’ aspect. The general economic interest aspect is connected to their importance for the smooth functioning of all industries, both manufacturing and services, while the non-economic aspect refers to their importance for the integration of all individuals and the cohesion of society.

3.12 In the EESC's view, ‘the protocol is not just an interpretative declaration on the Union's treaties and common values regarding SGIs; rather, it is a set of operating instructions aimed at the Union and its Member States. It consistently places the user, the satisfaction of his needs, his preferences and rights at the heart of the proposals and enshrines the common principles of a high level of quality, safety and accessibility, equal treatment and promotion of universal access’ (17).

3.13 It is therefore necessary, above all, to provide this sector with a strong European dimension through a harmonised EU framework backed up by an EU strategy of structural measures; at the same time, the Committee would emphasise again ‘the essential role and the wide discretion of national, regional and local authorities in providing, commissioning and organising services of general economic interest as closely as possible to the needs of the users’ (18).

4. Towards a European strategy on innovative and ‘smart’ health and social services

4.1 The Committee considers it vital to launch a European strategy in order to anticipate and manage the current changes in European society and its socio-economic model which require strategic priorities to be set for Europe's personal social, health and educational services industries, with regard to: — human resources and training and information measures; — appropriate technologies; — a European area of integrated services; — better conditions for mobility and exchanges; — the acceptance of European quality principles; — full recognition of diplomas; — research aimed at optimising the results of services; — the documentation and exchange of success stories; and — support policies, structures and infrastructure.

4.2 Human resources constitute the first fundamental pillar of the personal services industry, as demonstrated by the funds allocated under the Europe 2020 strategy towards the objective of keeping Europeans active, socially integrated and healthy for longer, which will have a positive impact on productivity and competitiveness. This sector is among the first listed in the Lead Markets Initiative for Europe and is an integral part of the flagship initiative An agenda for new skills and jobs.

4.2.1 Given the significance of the services in question, the EU's strategic action on human resources should be geared towards: — information systems on occupation profiles needed and job opportunities; — measures to increase and consolidate the acquisition of skills; — international recognition of qualifications/diplomas to facilitate mobility; — efficient systems for career guidance and communication, including, in particular, with a view to language-learning; — IT training/e-literacy; — training and refresher courses on new technologies and new therapeutic methods; — stabilisation mechanisms in the sector and attractive working conditions and career prospects, and better gender balance; — enhancing the image of the various professions in this service sector; — regulatory agreement on quality principles and their application, and well-defined curricular requirements; and — the introduction of support services, such as temporary replacements, training and advice to ensure the quality of the social economy and of care and improve the welfare of carers; and — drawing on the valuable resources of the voluntary sector, which can make an important contribution in terms of quality, emotional warmth, and disinterested interpersonal relations, vital for the mental and physical wellbeing of those receiving care. These EU-level actions should be accompanied by continuous monitoring based on rigorous, scientific assessment.

4.3 The introduction of appropriate technologies in the sector to support both service recipients and providers constitutes the second pillar of this strategy: innovation – both structural, and methodological and technical – in personal health and social services can contribute to meeting the challenge of sustainability in the context of ongoing demographic changes and achieving inclusive growth.

4.3.1 Communication and information technologies must be used to facilitate autonomy and a greater assumption of responsibility, and a personal health culture, as well as coordination between health and social services to develop increasingly integrated services that place people at the heart of a coordinated continuum of quality services.

4.3.2 e-Health, e-literacy in information technology and telemedicine constitute a fundamental pillar of the drive for innovation in healthcare and rehabilitation in that they enable patients to carry their medical history with them wherever they go and thus to benefit from the most customised medical care possible (19).

4.3.3 In order to be efficient, personal services systems need an advanced technological platform for sharing the most successful practices among LTC users and providers, sharing guidelines to steer decision-making and quality assessment at the local level, and fine-tuning the use of care planning processes to improve social, health and paramedical service cost-sharing systems for services (20).

4.3.4 It is vital to maximise the IT skills applied to personal social, health and educational services, by means of national and EU R&D, in order to optimise new occupation profiles, tailored to the different needs of children, the disabled, older people and physical and mental illnesses.

4.4 Third pillar: the creation of a European area of integrated services should be carefully considered, with the aim of overcoming the existing inequalities and properly ensuring the fundamental freedom of establishment (while complying at least with the social standards set out in regulations and agreements in the host country) and to provide services (particularly in this sector, being of vital importance to ensuring the free movement of services) by means of mutual recognition, administrative cooperation and, where necessary, harmonisation, in order to ensure the provision of a set of responsible people-centred services throughout the EU. To achieve this objective, the Member States and the EU will have to exercise their responsibilities jointly.

4.4.1 The challenge of transforming Europe's economy into an innovative and modern economy based on the full implementation of the fourth freedom (the free movement of services), as well as the development of a ‘fifth freedom’, i.e. full and free movement of knowledge, would allow Europe to fully tap its creative potential. In this context, the performance of innovation in the health and social services would have to be monitored on the basis of an EU assessment system set up for that purpose.

4.4.2 A solidarity-based European services area is needed which guarantees access to high-quality basic services in the area of personal social, health and educational services across the whole EU, including by implementing a ‘voluntary European Quality Framework in different Member States and in a variety of sectors’ (21), involving users in the definition and evaluation of quality.

4.4.3 A system of integrated services requires – in addition to harmonised quality principles – mutual recognition of qualifications, monitoring of service quality, and the launch of social dialogue at the various levels, close to the citizen, which involves all stakeholders, to step up cooperation.

4.5 Support policies, structures and infrastructure constitute the fourth pillar on which the European strategy for the personal services industry should be built.

4.5.1 A key element of this pillar is the targeted activation – alongside the actions provided for under Europe 2020 – of EU structural programmes and measures, with particular regard to the European Social Fund, the European Regional Development Fund and the European Agricultural Fund for Rural Development, as well as the EU Culture and Horizon programmes 2014/2020.

4.5.2 Also required at EU level are measures to develop an EU framework which facilitates and encourages good performance in respect of professional qualifications and service quality, the documentation and exchange of success stories, and standardised systems for monitoring quality, customer satisfaction and value for money in the sector, with regard to the professionalisation and the working conditions and career prospects of service providers, the public, private and social-economy enterprises operating in this sector, and, finally, the service recipients and their families, as well as the social economy.

4.5.2.1 The voluntary sector constitutes a significant element here, which should be supported and encouraged especially as regards its high-quality human, social and emotional contribution: EU measures supporting the exchange of best practice in volunteering in the personal services sector merit particular attention.

4.5.3 Account needs to be taken of the importance of committing investment and, in particular, of the need to diversify financial cover (tax, various contributory forms of social security (protection), insurance, inter-generational solidarity, public-private partnerships) taking into consideration that the cost of long-term healthcare and support is not sustainable for most of the population.

4.5.4 At EU level, a proportion of the Structural Funds should be earmarked for developing social infrastructure, health and care services, where shortcomings exist, and for local employment initiatives in the sector. In particular, there should be a funding line here for rural areas and other disadvantaged areas, tapping into the European Agricultural Fund for Rural Development and the Leader initiative.

4.5.5 Also at EU level, support measures for family policies and for ensuring more flexible arrangements in the workplace for those providing care in their family need to be reviewed.

5. Concluding comments

5.1 The EESC is convinced that ‘in areas such as health care, childcare or care for the elderly, assistance to disabled persons or social housing, these services provide an essential safety net for citizens and help promote social cohesion’ (22).

5.2 The Committee emphasises that social, health and educational services are a matter of general interest – both economic and non-economic – and play an important role in the quality and functioning of European society, contributing to social protection, inclusion and in a significant way to the performance and competitiveness of the economy. At the same time, demand for these services is growing, while the capacity to fund them becomes more limited as a result of the economic crisis and, in the longer term, demographic trends.

5.3 The Committee strongly reaffirms the objectives in the Lisbon Treaty as regards education, social protection and health, which reflect the collective social conscience and the desire to give people as high a standard of living as is compatible with the economic potential of all Member States.

5.4 The EESC thus believes that in the current climate, further developments in these sectors require: — the launch of a fully-fledged European strategy on innovative and ‘smart’ social and health services and the associated educational services, involving the optimisation of human resources, the introduction of appropriate technologies to support service recipients and providers, the development of a European area of integrated services, and structural and infrastructural support policies, backed up by social dialogue and dialogue with civil society at the various levels; as well as — greater efficiency in the use of financial and human resources, and of the existing infrastructure, the application of quality principles, and performance assessment, with measures to increase and consolidate the acquisition of skills; increasing competitiveness through collective bargaining; greater involvement of the private and voluntary sectors and the social economy; new forms of partnership between the sectors and prudent spending reviews and joint assessments of services' efficiency and cost-effectiveness.

Brussels, 13 December 2012. The President of the European Economic and Social Committee Staffan NILSSON

(1) EESC opinions on The impact of population ageing on health and welfare systems, OJ C 44, 11.2.2011, p. 10; Solidarity in health: reducing health inequalities in the EU, OJ C 18, 19.1.2011, p. 74.; Taking into account the needs of older people, OJ C 77, 31.3.2009, p. 115; and Elder abuse, OJ C 44, 16.2.2008, p. 109.

(2) EESC opinions on Active ageing/Horizon 2020, OJ C 229, 31.7.2012, p. 13; and The involvement and participation of older people in society (not yet published in the OJ).

(3) EESC opinions on Taking into account the needs of older people, OJ C 77, 31.3.2009, p. 115; Adult learning, OJ C 204, 9.8.2008, p. 89; Migration, mobility and education, OJ C 218, 11.9.2009, p. 85; Quality assurance in Vocational Education and Training (VET), OJ C 100, 30.4.2009, p. 136.

(4) Eurostat, Labour Force Survey – DS-073433, 3/2010.

(5) Joint contribution of EPSU and ETUC to the EC consultation on the employment potential of personal and household services; Brussels 18 July 2012.

(6) COM(2011) 709 final.

(7) The European Economy Series 2011/4 – The 2012 Ageing Report – European Commission, Directorate-General for Economic and Financial Affairs.

(8) Report on the study by EPSU on Pay in the care sector in relation to overall pay levels and the gender pay gap in different countries in the European Union, by J. Pillinger, February 2010.

(9) COM(2010) 2020 final with priority initiatives such as Innovation Union and the Digital Agenda for Europe.

(10) EESC opinions on Tackling the pay gap between women and men, OJ C 211, 19.8.2008, p. 54; Equality between men and women 2006-2010, OJ C 318, 23.12.2006, p. 173; the ETUC Charter on Gender Mainstreaming in Trade Unions, ETUC Congress in Seville, 23.5.2007; and the European Commission Manual for Gender Mainstreaming of Employment Policies, 2007.

(11) Report on the study by EPSU on Pay in the care sector in relation to overall pay levels and the gender pay gap in different countries in the European Union, J. Pillinger, February 2010.

(12) AMECO database – Employment in Europe – EU KLEMS Accounts (Capital (K), Labour (L), Energy (E), Material (M) and Service inputs (S)). European Commission quarterly review.

(13) ETUC report on preparation of implementation of the Directive on Services in the Internal Market 2010.

(14) COM(2011) 66 final.

(15) EESC opinions on Family policy and demographic change, OJ C 218, 23.7.2011, p. 7; and Modernisation of higher education, OJ C 181, 21.6.2012, p. 143-149.

(16) EESC opinion on Services of general economic interest: how should responsibilities be divided up between the EU and the Member States?, OJ C 128, 18.5.2010, p. 65-68.

(17) See footnote 16.

(18) See footnote 16.

(19) eHealth conference 2012, Copenhagen.

(20) Help Wanted? Providing and Paying for Long-Term Care, OECD, 2011.

(21) COM(2011) 900 final.

(22) COM(2011) 900 final.