European Care Strategy

The European Commission has published the European Care Strategy to ensure quality, affordable and accessible care services right across the European Union and seeks to improve the situation for both care receivers and the people caring for them, professionally or informally.

The Strategy is accompanied by two Recommendations for Member States on the revision of the Barcelona targets on early childhood education and care, and on access to affordable high-quality long-term care.               

Grounded in the European Pillar of Social Rights

Principle 11 of the European Pillar of Social Rights is "Childcare and support to children - Children have the right to affordable early childhood education and care of good quality."

The most striking feature of investment in education in Ireland relative to other OECD countries is its under-investment in early childhood education. In consecutive studies, Ireland has one of the lowest levels of expenditure in preprimary education in the OECD. Ireland has the highest level of private provision of Early Childhood Care and Education in the OECD, although it is mainly financed by public sources [1] along with relatively low Government investment, low wages for educators and high fees for consumers. [2] Looking at expenditure on education for three to five year olds in the OECD, Ireland had the second lowest amount of expenditure at 0.3 per cent of GDP despite a trebling of public investment in childcare programmes between 2011 and 2016. In comparison, Iceland, Norway and Sweden spent between 1.1 and 0.9 per cent of GDP.

Early childhood is the stage where education can most effectively influence the development of children and help reverse disadvantage. [3] Pupils who had access to quality early childhood education perform better on PISA [4] testing than those who did not attend pre-primary education, even allowing for differences in their socio-economic backgrounds. [5] International evidence indicates that in countries where there is primarily public provision of early childhood care and education it tends to be more affordable, accessible, and of higher quality than in private provision countries. [2] One of the key challenges identified towards the provision of universal early childcare in Ireland is the market driven approach to provision at present. High staff turnover and poor pay and conditions are also a feature of the sector. [6]  A review of Early Years Education published by the Department of Education and Skills [7] found that while almost all services provide warm and welcoming environments and strong evidence of positive relations was found between the staff, the children and their families, there remained many challenges including the need to improve working conditions for staff in the sector. A well-resourced and integrated policy is required to address the issues raised in the review and to deliver high quality early years learning provision for children and their families. ‘First 5: A Whole of Government Strategy for Babies, Young Children and their Families’ contains welcome high-level policy commitments and strategic actions. In order to deliver on the commitment of all children having access to safe, high-quality, developmentally appropriate early childhood education, long-term planning and sufficient resourcing are vital to embed quality and deliver on this commitment.

Principle 18 is "Long-term care - Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services."

Our population is growing and it is ageing which means we need a different approach to healthcare – one we can access in our communities, close to home. The population is growing across all regions and age groups, with the most significant growth among older people. Thus, although Ireland’s population is young in comparison to other European countries, it is ageing. 

According to the ESRI, good home care and long-term residential care services help reduce older people’s lengths of stay in acute hospitals, and hospital stays are shorter in Irish counties that are better supplied with these service. [8] Ireland provides relatively low levels of formal home care by comparison with several other countries, with research suggesting that 38 per cent of older people who need home care do not have their needs met. [9] 

A co-ordinated service needs to be provided to meet the demand occasioned by population ageing. Older people with dementia are a particularly vulnerable group. They are estimated to number between 39,000 and 55,000 people, and the incidence is increasing as the population ages. [10]  Specialist care units are required to care for people with dementia, but their provision is very limited, and there are significant inequities regarding access to them and their geographic location. [11] A National Dementia Strategy was published in 2014 focused on three priority areas– intensive home care supports, GP education, and training and dementia awareness. In addition, there are many areas that also require investment, including day centres, respite services and other supports for carers, quality long-term care (at home and in care settings) and specialist care units, as well as evaluation and monitoring of all services.

High-quality, affordable and accessible care services with better working conditions and work-life balance for carers

The provision of affordable and accessible quality care delivers benefits for all ages. The Strategy notes that "participation in early childhood education has a positive impact on a child's development and helps reduce the risk of social exclusion and poverty, also later in life.....(and that) long-term care empowers people, who as a result of old age, illness and/or disability depend on help for daily activities, to maintain their autonomy and live with dignity".

We need to invest in those providing that high quality care, be it to pre school children or older people. The Strategy says that it "is important to attract and retain talents in the care sector, which is often characterised by difficult working conditions and low wages, as well as to address labour shortages and fulfil the sector's economic and job creation potential". Also of note in the Strategy is that "women still bear the main brunt of care responsibilities, with 90% of the formal care workforce made up of women, and 7.7 million women out of employment because of care responsibilities".  

To address these issues, the Commission is proposing concrete actions to support Member States in increasing access to high-quality and affordable care services, while improving working conditions and work-life balance for carers.

Proposals

Early childhood education and care

The European Commission proposes that Member States revise the targets on early childhood education and care to enhance women's labour market participation, also called ‘the Barcelona Targets', which were set in 2002. The current targets call on Member States to provide childcare to 33% of children under 3 and to 90% of children from age 3 until mandatory school age. The Commission proposes to set new ambitious yet realistic targets so that by 2030 at least:

• 50% of children below the age of 3 are in early childhood education and care;
• 96% of children between the age of 3 and the starting age for compulsory primary education are in early childhood education and care, as already agreed in the European Education Area framework.

The Commission also recommends that, among others, Member States:

• Ensure that childcare services are affordable, accessible and of high quality, available in urban as well as rural or disadvantaged areas;
• Introduce a legal entitlement to early childhood education and care, ideally with no gap between the end of paid family leave and the legal entitlement; Have targeted measures in place to enable and increase participation of children from disadvantaged backgrounds, with disabilities or with special needs in education and care, to close the gap with the overall population of children;
• Look at the number of hours children spend in childcare (‘time-intensity') and ensure that childcare is available for a duration that allows parents to engage meaningfully in paid work; and
• Encourage equal sharing of childcare between parents by combating gender stereotypes and support family-friendly working-time arrangements.

Long-term care

The Commission recommends that Member States draw up national action plans to make care in the EU more available, accessible and of better quality for all, for instance by:

• Ensuring that long-term care is timely, comprehensive and affordable, allowing a decent standard of living for people with long-term care needs;
• Increasing the offer and mix of professional long-term care services (homecare, community-based care and residential care), close territorial gaps in the access to long-term care, roll-out accessible digital solutions in the provision of care services, and ensure that long-term care services and facilities are accessible to people with disabilities;
• Ensuring high-quality criteria and standards for long-term care providers;

• Supporting informal carers, who are often women and relatives of care receivers, through training, counselling, psychological and financial support; and
• Mobilising adequate and sustainable funding for long-term care, including by using EU funds.

Fair working conditions and training for care staff

To improve working conditions and attract more people – in particular men – to the care sector, Member States are recommended to:

• Promote collective bargaining and social dialogue with a view to improving wages and working conditions;
• Ensure the highest standards of occupational health and safety;
• Design continuous education and training for care workers;
• Tackle gender stereotypes around care and launch communication campaigns;
• Ratify and implement ILO Convention 189 on domestic workers.

[1] OECD (2019) OECD Skills Strategy Ireland 2019. Paris: OECD Publishing.

[2] Oireachtas Library & Research Service (2020) L&RS Note Public provision of early childhood education: an overview of the international evidence. Dublin: Oireachtas Library

[3] European Commission (2011) Early Childhood Education and Care: Providing all our children with the best start for the world of tomorrow. Brussels: European Commission.

[4] Programmes for International Student Assessment (PISA) assesses the preparedness of 15-year-olds to meet the challenges they may encounter in their future lives, including education.

[5] OECD (2016): PISA 2015 Results (Volume II), Policies and Practices for Successful Schools

[6] Early Childhood Ireland (2020) Pathways to Better Prospects: Delivering Proper Terms and Conditions for the Early Years Workforce in Ireland A Literature Review. Dublin: Early Childhood Ireland.

[7] Department of Education and Skills (2018) Ireland’s National Skills Strategy 2025. Dublin: Stationery Office.

[8] Walsh, B., Wren, M-A, Smith, S., Lyons, S., Eighan, J. and Morgenroth, E. (2019) An Analysis of the Effects on Irish Hospital Care of the Supply of Care Inside and Outside the Hospital. Dublin: Economic and Social Research Institute

[9] Privalko. I., Maître, B., Watson, and D., Grotti, R. (2019) Access to Care Services Across Europe. Dublin: Department of Employment Affairs and Social Protection and Economic and Social Research Institute

[10] Pierse, T., O’Shea, E. and Carney, P. 2019. Estimates of the prevalence, incidence and severity of dementia in Ireland. Irish Journal of Psychological Medicine.

[11] Cahill, S., O’Nolan, C., O’Caheny, D., Bobersky, A. (2015) An Irish National Survey of Dementia in Long-term Residential Care. Dublin: Dementia Services Information and Development Centre