The intricate and uncertain future of the labour market in the Dutch care sector Erik de Gier

1. Barcelona XREAP-Radboud University Seminar, 14 - 15 October 2010 The intricate and uncertain future of the labour market in the Dutch care sectorErik de Gier

2. Circumscription of the current labour market in care sector • The labour market in the care sector in the Netherlands is an expression of a delicate and dynamic demand and supply balance of formal carers, informal carers and self-caring of patients and clients. • Currently there are about 700.000 million paid care workers and in addition, 3.7 million informal carers that supply some care

3. The intricate labour market in the care sector at a glance Increase of labour force and labour demand in care sector till 2025 Source: CPB 2009, CBS Statline

4. Difficulties • Ageinig population: increase of (a more diverse and complex) demand of care and cure + consequently, increase of labour demand • Ageing and shrinking labor force decrease of labour supply • Far reaching cuts of public spending about 20% in five years _______________________________________ 2010: 2025: 2.5 Mio 65+ 3.7 Mio 65+ 640.000 65+ 910.000 80+

5. Consequences • Limitation of collectively paid supply of health care • Privatization of non-basic care provisions and arrangements • A larger appeal on self-management of patients and clients • A further substitution of formal carers by informal carers: re-institutionalization of the role of the (extended) family • Increase of productivity of the (formal) health care sector

6. Pecularities of labour market Dutch care sector • Majority of carers are non-paid, informal workers (family, neighbours, volunteers) • Relatively small proportion is paid professional workers, but nevertheless 15% of Dutch labour force (expected increase towards 22% in 2025) • Workers in care sector are mainly female • Workers in care sector are mainly elder workers: average age above 40 • Continuous rationalization processes contribute to high work pressure and work-stress (50% of the workers expect a further increase of work pressure in the future!) (Menzis 2010)

7. Circumsription of future labour market in care sector • Stabilization or even decrease of number of formal (paid) carers • Increase of number of informal carers (elder male, school leavers, family, neigbours, volunteers) • Self-help of patients contributes substantially to lower demand of paid workers and informal carers • New patterns of labour: increase of combinations of formal, informal and self-care with the support of new technologies • Key role for new applied technologies!

8. Increase of employability of care personnell • Continuous investments in life long learning • Introduction of new, more horizontal forms of work organization with re-valuation of professional craftmanship of care workers (Buurtzorg Nederland) • Implementation of social innovation of management and leadership styles, work organization and work processes (working smarter!) • More attention to work-life balance workers • More attention to older workers and workers which also act as informal carers In short: introduction of strategic HRM at organizational level

9. Empowerment of patients, clients and informal carers • On the long run a cultural shift from “sickness and care” towards “health and behaviour” (RVZ 2010) • Prevention of chronical diseases elderly • More intensive and extensive use of financial incentives • An increase of supply of combinations of formal and informal care • Extensive use of supportive and labour saving applied technology • More attention in HRM of care organizations to their own informal carers

10. Conclusions and debate • Perhaps not all intricacies of care labour market can be solved in due time • Remaining tensions between dynamic trade-off between formal care and informal care and between formal care and privatized care • Risk of a dual labour market in care sector • Risk of a social division in supply of care