Opinion of the European Economic and Social Committee on ‘Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions on the European care strategy’

(COM(2022) 440 final)

(2023/C 140/07)

Rapporteur:	Kinga JOÓ
Co-rapporteur:	Zoe TZOTZE-LANARA

Referral	European Commission, 27.10.2022
Legal basis	Article 304 of the Treaty on the Functioning of the European Union
Section responsible	Employment, Social Affairs and Citizenship
Adopted in section	11.1.2023
Adopted at plenary	24.1.2023
Plenary session No	575
Outcome of vote (for/against/abstentions)	169/0/4

1.   Conclusions and recommendations

1.1.

The EESC welcomes the European Care Strategy proposals for EU-level and national actions to strengthen the care infrastructure in Europe based on a whole-society approach and commends its call through the Council Proposals for greater quality services throughout the lifecycle.

1.2.

The EESC renews its proposal to launch a European Care Guarantee, in order to ensure life-long access to affordable quality healthcare and care services for everyone living in the EU. This instrument would contribute with successful implementation to address care deficits and promote decent working conditions for carers, including informal carers.

1.3.

The EESC underlines the importance of supporting families in their fundamental role. This includes investing beyond social policies and in communities. Properly supported families with all their differences act as a safety net, and are essential elements for a sustainable care system based on solidarity. Stressing the importance of prioritising the affordability and continuity of care services in response to shocks is crucial.

1.4.

The EESC plays a key role in raising awareness by collecting and disseminating key elements of good practices among the social partners and civil society organisations regarding tools and infrastructure, as well as sharing new forms of care services. It calls for the allocation of specific budgets to map the needs of care receivers and providers and at-home carers.

1.5.

Gender equality should remain central to the implementation of the Strategy, including through actions to challenge the harmful gender stereotypes corroding the formal and informal care sectors. The EESC reiterates that efforts should be made to incentivise more men to join the care workforce and ensure better distribution of care within households.

1.6.

The EESC highlights the need for a life cycle approach promoting healthy and active ageing, while preventing and providing protection against ageism and other forms of discrimination, elder abuse, mistreatment, and stereotyping. The EESC calls for the development of a European Strategy for Older Persons.

1.7.

The EESC calls for all resources to be mobilised to meet the growing and diverse care demand: adequate funding must be allocated to care infrastructure and people carers in order to enhance growth and employment. The whole range of care suppliers must be mobilised, under strong quality assurance frameworks. Member States must encourage quality job creation and ensure that jobs in social care are attractive, adequately paid and valued and offer good career prospects.

1.8.

The EESC encourages better data provision on children’s participation in early childhood education and care to ensure comparability and the availability of more comprehensive information for designing and implementing reforms.

1.9.

The EESC requests that the EU institutions set up a gender-balanced High-Level Expert Group on Long-Term Care to formalise cooperation, bringing together all actors and their organisations to co-create the care service of tomorrow (1). Care receivers’ and care providers’, as well as their organisations’ meaningful participation throughout the policy cycle is also recommended.

1.10.

The EESC stresses that mobility of care professionals and labour migration from non-EU countries need to be considered, coupled with tools for matching demand and supply as well as recognition of qualifications and notes that the Strategy does not take enough into consideration the many undocumented workers already providing care in Europe.

1.11.

The EESC calls for a mid-term review of the Recommendations based on the monitoring of the Barcelona targets and the general objectives of long-term care reforms, following the EU funding cycle.

2.   Objectives and scope of the opinion

2.1.

The EESC welcomes the European Care Strategy (the Strategy) proposals for EU-level and national actions to strengthen the care infrastructure in Europe, supporting both care receivers (from birth to old age) and care providers (formal and informal), and commends the Communication’s analytical approach in identifying weaknesses, bottlenecks and problem areas that affect the provision of integrated quality care.

2.2.

This Strategy is in line with the 2021 European Commission Action Plan for the implementation of the European Pillar of Social Rights, and provides useful guidance to Member States on accessible, adequate and quality care to meet the increasing and diverse care demands, together with ambitious targets on early childhood education and care (ECEC) and sound governance tools for the monitoring of long-term care (LTC) actions. It builds on existing EU frameworks (2) giving it a cross-cutting nature to address care deficits and advancing the rights of carers and care receivers.

2.3.

Numerous studies and opinions are available to guide implementation, offering insights and data on several aspects of care, including gender (3), (4), the cost of informal care (5), (6), long-term care systems in Europe (7), workforce and employment conditions (8), (9).

2.4.

The European Parliament underlined the importance of accessibility and availability of public care and that everyone should have the right to a genuine choice of services that are suitable for them and their families (family care, community-based care, patient-centred care, personalised care or other forms of care (10)).

3.   General Comments

3.1.

The EESC welcomes the recognition by the Strategy that care is a responsibility for society as a whole and not just families, and both proposals for Council Recommendations that call for greater quality services throughout the lifecycle. It supports a societal paradigm shift on the way care is valued and provided in the EU, bridging the different cultural aspects and national differences.

3.2.

The Strategy intends to shift the European care debate towards a sustainable and human rights-based care model that fosters gender equality in formal and informal care and guarantees human dignity, independent living, and inclusion in the community. The resilience and adequacy of care systems across the EU were tested during the COVID-19 pandemic, which magnified structural problems such as underfunding and understaffing.

3.3.

An effective Strategy requires a transformative and ambitious approach, which places care receivers and care providers’ fundamental rights and needs at its heart, including through their full and meaningful participation in consultations and decisions.

3.4.

The EESC stresses that prevention, habilitation and rehabilitation measures should be an integral part of the implementation of the Strategy. Actions should focus increasingly on early intervention, healthy and active ageing, preventative measures and support for autonomy that can minimise the need to turn to long-term care, and increase inclusion in society and active citizenship, notably though the creation of a comprehensive European Strategy for Older Persons.

3.5.

Recalling the experience of austerity under the recent financial and economic crises, the EESC emphasises the need to prioritise the affordability and continuity of care services in response to the current shocks linked to the war in Ukraine, the energy and the current cost of living crises.

3.6.

The mainstreaming of gender equality throughout the Strategy is welcome. The care sector, formal and informal, is dominated by women. In the EU, 29 % of women say that the main reason for not being active in the labour market or working part-time is because of caring duties, compared to only 6 % of men (11). This unbalanced distribution of care responsibilities is estimated to cost EUR 242 billion per year (12). The recommendations are useful guidelines for Member States to tackle gender stereotypes, gender pay, pension and care gaps.

3.7.

The EESC stresses the importance of family and informal care as an element of sustainable care systems and calls for swift mapping of the needs and realities of this type of care. It is necessary to recognise them as partners in ensuring continuity in care and to provide comprehensive support to them, such as training opportunities with skills validation schemes, and ensuring their participation in the labour market and in social life through a mix of resources, services and time arrangement (linked to the Work-Life Balance Directive) while also securing access to social rights, respite care and mental health services (13).

3.8.

The EESC welcomes the focus placed on better protection of care workers’ rights. It calls on Member States to address gaps in the enforcement of EU labour law, to ratify ILO Convention 189 that provides standards for decent working conditions of domestic workers, and takes steps to regulate the situation of live-in carers (14), including migrant and mobile workers. However, it notes that the Strategy does not take enough into consideration the many undocumented workers already providing care in Europe, and should focus on all care workers living in EU — regardless of their migration and residence status.

3.9.

The EESC commends the commitment to improving working conditions within the care sector by providing up and reskilling, and skills validation, increasing wages, promoting social and labour rights, paying attention to physical and psychosocial health risks and addressing workplace risks of violence and harassment. It calls on Member States to ratify ILO Convention 190 concerning violence and harassment in the world of work. Social partners and governments need to work together to end precarious forms of care work and build strong regulatory, financial and collective bargaining frameworks. The shortages of qualified personnel in almost all Member States endanger health and care standards, especially against the background of demographic change, workers’ mobility and ageing.

4.   Specific Comments

4.1.

The EESC reiterates the urgency of elaborating a dedicated European Care Guarantee (15), as an essential element for the successful implementation of the Strategy based on a mix of policy, practice and funding tools to ensure that the Strategy actions are fully embedded in national legal, policy, funding and service frameworks. Standard setting is crucial for ensuring improvement in the sector, as is monitoring them (16).

4.2.

The European Care Strategy should be supplemented with a structured European implementation plan and funding schemes. Public investment in care is insufficient in many Member States. EU structural and investment funds (ESF+, ERDF), as well as the Recovery and Resilience Facility (RFF) and the Technical Support Instrument (TSI) must be mobilised to support Member States in specific care-related domains (from policy design to service implementation and impact monitoring) notably through socially responsible public procurements.

4.3.

Evaluation of progress and impact on care receivers and care providers will be fundamental. Specific technical guidelines for building monitoring and evaluation frameworks could support national ministries with specific guidance on the development of sustainable care service models, impact measurement and indicators. The European Commission monitoring should include reports on both policy and funding and a call for a mid-term review of the Recommendations. The European Semester has to better target its country-specific recommendations to help Member States prioritise adequate funding for care as a productive, sustainable investment rather than an economic burden.

4.4.

Following the adoption of both Council Recommendations, measures and guidelines should be swiftly embedded in national policy and legal frameworks. The EESC stresses the importance of the LTC National coordinators to ensure coherence and to mainstream care in other fields, ministries and governance levels, going beyond social and health policies (housing, transport, energy, economy etc.).

4.5.

Undesired risk selection, commercialisation and the pursuit of revenue and profit over care and health can exacerbate inequalities in access to care. Proportionate control measures are needed to prevent unhealthy practices and to secure strong guarantees of high-quality services and proper use of funds. LTC and ECEC at Member State level need strong social protection systems and quality public services based on solidarity, social investment and social economy actors — e.g. mutual societies — to provide various kinds of financing and cost-sharing systems for community and home-based care by adequately trained carers (17). To fund the provisions, alternatives to social contributions should be envisaged (18). Incorporating voluntary support from not profit organisations that benefit both care and health systems are to be considered, but not as a cost cutting measure.

4.6.

As regards national competences and subsidiarity, the European Commission should ensure that high-quality care services developed by Member States are inclusive. The Strategy needs to ensure that every person in need of care has full and equal access to the services, notably through strong and binding quality frameworks. Special attention should be paid to groups that are typically excluded such as Roma persons, migrants etc. and the effect of intersecting and structural discriminations. This also means that care infrastructure be made accessible in remote areas and low-density population areas.

4.7.

Investing in digital infrastructure can facilitate effective care planning and provision, to store, exchange and communicate information between different health and social care providers, enabling the effective monitoring of quality and equal access. Multiple opportunities, such as assistive technologies, prevention measures, robotics, telehealth and more, if fully inclusive and accessible, can support the outreach, continuity, coordination and high-quality of care services.

4.8.

The proposed LTC Recommendation notes that systems must also cater for the support needs of persons with disabilities, while clearly referencing the UN Convention on the Rights of Persons with Disabilities. The Commission should ensure that EU funds mobilised under the Strategy respect the objective of deinstitutionalisation and support inclusion through the development of community-based services with a well-trained workforce (19). The EESC reiterates the need to support children and parents with disabilities (20) and welcomes this focus in the ECEC recommendation.

5.   Implementation of the ECEC Recommendation

5.1.

The EESC supports the revision of the Barcelona targets to improve availability of accessible, affordable, inclusive and quality childcare. The Member States that have reached or surpassed the targets should concentrate more on providing quality standards and developing diverse forms of ECEC according to the different age groups. Targets on increasing the availability of ECEC must go hand in hand with quality assurance frameworks and decent working conditions. Member States should work on indicators to monitor access to care models according to national preferences and differences, while fulfilling the objectives, quality and other standards of the revised targets.

5.2.

The EESC welcomes the call to ensure that all children have a legal entitlement to access quality services, and the interplay of the Strategy with the European Child Guarantee, taking forward its multigenerational approach, which is crucial for work-life balance and family well-being. Free access to ECEC for families in need has to be supplemented by a set of measures that include free meals, free hygiene products (e.g. diapers) and assistance with physical and mental development (fine motor skills, speech and language therapy, etc.).

5.3.

The EESC welcomes references to EU equality frameworks and to children in vulnerable situations, to create inclusive systems respectful of all family forms. Actions to be put in place should include outreach, training for staff on the rights of service users and on inclusions and bias. The EESC particularly welcomes the proposals for the provision of adequate child/staff ratios, continuous professional training of staff, and the inclusion of time requirements in the indicators, which is especially relevant for children with disabilities who often can only access ECEC partially.

5.4.

Good practice ECEC models need to be at the heart of measures to implement the Council recommendation, supported by sub-national policies and funding frameworks, with the allocation of specific budgets to map the needs of care receivers and providers, and by testing new forms of care services. Children’s rights should remain central. Children need a healthy, nurturing environment in their early years, whether through family or professional care; therefore different care models (day centres, work-place nurseries, childminders, maternal assistants, playgroups, out-of-school care) must be available to choose from, taking into account the developmental needs of children of different ages.

6.   Implementation of the LTC Recommendation

6.1.

The EESC calls for strong Implementation Plans covering the full spectrum of Long-Term Care. The European Commission should formalise cooperation by setting up a High-Level Expert group on LTC, bringing together social partners, civil society organisations, national coordinators, beneficiaries of LTC, in particular older persons and persons with disabilities and other relevant experts and practitioners. To inform the work of the group, an online public platform could be created to gather data and research and foster sharing of good practices.

6.2.

The EESC has adopted several opinions on LTC provision in the EU (21), stressing the need to invest in high-quality, sustainable and accessible care for all. The EESC emphasises the need to maximise complementarity and synergy between all care and health providers in both the public and private sectors (profit and non-profit) to achieve coverage for everyone, considering good practices in the Member States.

6.3.

The EESC welcomes the acknowledgement in the LTC proposal of the importance of social economy actors as service providers. The EESC encourages the Commission to further explore ways to create structured lines of communication between social economy actors and European institutions in the LTC policy space.

6.4.

The EESC notes the importance of the various initiatives under the Green and Digital transition to use the full potential of technologies to create, rethink and renovate the housing stock in a more inclusive, sustainable way.

6.5.

Good practice LTC models can include more structured and efficient home support, as well as new housing alternatives, such as sheltered, supervised or community-based housing, cohabitation units or other alternatives, according to the needs and preferences of the care receivers, and based on legally approved quality frameworks. Other types of care models should also be considered in order to cover the full spectrum of care in an integrated approach such as mental health support, family centres, parental support groups and short-term housing support in a way that eases the transition from one model to another with variation in the intensity or nature of the services required, without disrupting the continuity of care.

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(1)  Opinion of the European Economic and Social Committee on the Co-creation of services of general interest as a contribution to a more participative democracy in the EU (own-initiative opinion (OJ C 486, 21.12.2022, p. 76).

(2)  European Strategy for the Rights of Persons with Disabilities 2021-2030, the Child Guarantee, the European Strategy for the Rights of the Child, the Work Life Balance Directive, the Gender Equality Strategy and other relevant initiatives under the European Pillar of Social Rights.

(3)  Gender inequalities in care and pay in the EU: https://eige.europa.eu/publications/gender-inequalities-care-and-pay-eu

(4)  Gender Equality Index: https://eige.europa.eu/gender-equality-index/2022

(5)  What if care work were recognised as a driver of sustainable growth?: https://epthinktank.eu/2022/09/07/what-if-care-work-were-recognised-as-a-driver-of-sustainable-growth/

(6)  Study on exploring the incidence and costs of informal long-term care: https://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=8423&furtherPubs=no

(7)  2021 Long-term care in the EU: https://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=8396

(8)  Long-term care workforce: Employment and working conditions: https://www.eurofound.europa.eu/publications/customised-report/2020/long-term-care-workforce-employment-and-working-conditions

(9)  Opinion of the European Economic and Social Committee on Health Workforce and Care Strategy for the future of Europe (own-initiative opinion) (OJ C 486, 21.12.2022, p. 37).

(10)  European Parliament Resolution of 22.6.2022 Report towards a European action on care.

(11)  EIGE, idem.

(12)  EP Research, idem.

(13)  European Charter for Family Carers: https://coface-eu.org/european-charter-for-family-carers/

(14)  Opinion of the European Economic and Social Committee on ‘The rights of live-in care workers’ (own-initiative opinion) (OJ C 487, 28.12.2016, p. 7).

(15)  Opinion of the European Economic and Social Committee on Health Workforce and Care Strategy for the future of Europe (own-initiative opinion) (OJ C 486, 21.12.2022, p. 37).

(16)  OECD. 2019. Improving healthcare quality in Europe — Characteristics, effectiveness and implementation of different strategies.

(17)  Opinion of the European Economic and Social Committee on ‘The impact of social investment on employment and public budgets’ (own-initiative opinion) (OJ C 226, 16.7.2014, p. 21).

(18)  Event report: European Care systems: Solidarity and sustainability — friends or foes? https://www.aim-mutual.org/mediaroom/event-report-european-care-systems-solidarity-and-sustainability-friends-or-foes/

(19)  European Expert Group on the transition from institutional to community-based care, EU Guidance on independent living and inclusion in the community and EU funds. Checklist to promote independent living and deinstitutionalisation.

(20)  Opinion of the European Economic and Social Committee on The role of family members caring for people with disabilities and older persons: the explosion of the phenomenon during the pandemic (own-initiative opinion) (OJ C 75, 28.2.2023, p. 75).

(21)  Opinion of the European Economic and Social Committee on the ‘Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions an initiative to support work-life balance for working parents and carers’ [COM(2017) 252 final] — ‘Proposal for a Directive of the European Parliament and of the Council on work-life balance for parents and carers and repealing Council Directive 2010/18/EU’ [COM(2017) 253 final — 2017/0085 (COD)] (OJ C 129, 11.4.2018, p. 44); Opinion of the European Economic and Social Committee on ‘The rights of live-in care workers’ (own-initiative opinion) (OJ C 487, 28.12.2016, p. 7); Opinion of the European Economic and Social Committee on Guaranteeing universal access to long-term care and the financial sustainability of long-term care systems for older people (OJ C 204, 9.8.2008, p. 103); Brochure on Economic, technological and social changes in advanced health services for the elderly; Opinion of the European Economic and Social Committee on ‘Economic, technological and social changes in advanced health services for the elderly’ (own-initiative opinion) (OJ C 240, 16.7.2019, p. 10); Opinion of the European Economic and Social Committee on ‘Towards a new care model for older people: learning from COVID-19’ (own-initiative opinion) (OJ C 194, 12.5.2022, p. 19).