After privatisation and austerity, long-term care needs to be restored to resilience and readiness for an ageing population.
The Council of the European Union recently endorsed a report on long-term care prepared by the European Commission and the advisory Social Protection Committee. The report echoes many demands from the European Federation of Public Service Unions (EPSU)—supporting improved working conditions, collective bargaining, adequate staffing and increased investment.
The report recognises that the pandemic has exacerbated existing problems in long-term care. Privatisation, lack of investment and austerity not only rendered the sector vulnerable to such shocks but also underlined how ill-prepared it was for the predicted ageing of the European population.
The appalling working conditions of residential-care workers, before and during the pandemic, have been widely researched. Care Workers on the Corona Frontline, published by EPSU’s Swedish affiliate, Kommunal, the Swedish think-tank Arena Idé and the Friedrich Ebert Stiftung, analyses the situation in a number of European countries, concluding that across the continent the sector had not been prioritised.
The report highlighted a lack of personal protective equipment (PPE) and workers being forced to work unlimited hours. Excessive responsibility placed on individual care workers has resulted in widespread mental-health problems. Yet many workers have been denied access to sick leave or social benefits and, as Amnesty International has documented, hundreds have died from Covid-19.
More than ever there is a need to implement prior and new demands from health and care unions. For all the applause of care workers, the praise has not been followed up and policy-makers and employers need to do more to live up to their promises and make health and care systems resilient in the face of future health emergencies.
To begin with, we need an integrated approach to care. This focuses on quality services for people throughout their lives, from early childhood through primary care to elderly and home care. All the parts of the healthcare service should be recognised by governments and adequately financed.
This includes suitable recognition of workers in the health and care sector, such as health-care assistants or nurses who are differently renumerated, depending on whether they work in a hospital or a care home. An integrated approach will protect care workers from being treated as a secondary category, as happened with provision of PPE in the first wave of the pandemic.
This change of perspective should be followed by recognition that funding for care services is not expenditure but an investment. The support countries will receive through the EU Recovery and Resilience Facility should be used for this. It is important that national plans are only approved if significant funding is directly allocated to public health and care systems.
Long-term care should be included in the so-called stress tests set out in the EU regulation on serious cross-border threats. These tests should be carried out according to clear public-health parameters and should involve the social partners from the care sector. Weaknesses identified must be addressed through the Recovery and Resilience Facility and the EU programme for health (EU4Health), and through recommendations on financing as part of the European Semester.
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Structural shortcomings in national financing systems for social care should be identified and addressed. This can be done by tackling low corporate taxes and tax evasion and through redistribution of wealth. Public contracts for care services should not be awarded to companies which avoid paying taxes or eschew collective agreements.
Collective barging is crucial for improving workers’ rights—in particular in a sector with low union density and union-busting practices. The current draft of the directive on adequate wages proposes to improve collective-bargaining coverage. It requires support for social dialogue from member states.
Collective bargaining will contribute to improving working conditions and reduce resort to precarious types of employment. It will help eliminate the gender pay gap—vital for the highly feminised care sector.
Apart from sectoral collective bargaining, there is a need for a European social dialogue in the care sector, which employs almost 11.5 milion workers. The EPSU is working with the Federation of European Social Employers to set up a European Social Dialogue Committee on Social Care. This could address the challenges facing the sector, as with the parallel committee covering hospitals, where the EPSU and the employers’ organisation (HOSPEEM) have negotiated various agreements improving working conditions for hospital workers, including vis-à-vis staff recruitment/retention and skills.
In light of the new EU strategy on occupational safety and health (2021-27), care workers should be prioritised, including protecting them against psychosocial risks and stress. There is also a need to focus on the gender-related aspects of the sector, as well as to be more sensitive towards ethnicity and migration.
Finally, all these solutions should be implemented within the principle that care is a fundamental social right, as stipulated by the European Pillar of Social Rights. To that end, it is crucial to reverse the commercialisation of the sector and strengthen European public services.
One of the lessons learnt from the pandemic is that care should not be treated as a commodity—but as a public good from which no one should make a profit.
Adam Rogalewski is policy officer for health and social services in the European Federation of Public Service Unions, having worked for the British public-services union Unison, the Swiss general trade union Unia and the Polish federation of trade unions, OPZZ. He has a PhD from London Metropolitan University.