The intricate and uncertain future of the labour market in the Dutch care sector Erik de Gier Barcelona XREAP-Radboud University Seminar, October 2010

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 million paid care workers and in addition, 3.7 million informal carers that supply some care

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

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 Mio

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

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)

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!

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

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

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