In July 2002, the government gave nine public authorities the assignment of drawing up a plan for manpower supply to municipal services for the care of the elderly and disabled. This report contains the results of the assignment.
The authorities propose ten targets and ten measures in a ten-year plan of action designed tosupport investment in better working conditions and qualification levels.
The following targets are proposed:
I The number of personnel per first-line manager is to be limited.
II As a minimum, all personnel are to have basic professional qualifications.
III The number of personnel with post-Upper Secondary-level training in the health and caring sciences is to increase.
IV The number of work-related injuries is to be reduced.
V The average age of retirement is to increase.
VI Current national health targets of a 50% reduction in sick leave by 2008 are also to be achievedfor personnel in services caring for the elderly and disabled.
VII The proportion of care personnel with full-time permanent posts is to increase.
VIII The proportion of personnel employed by the hour is to fall.
IX An increased proportion of staff in posts that require higher education qualifications are to have non-Nordic immigrant background.
X A larger proportion of permanently employed personnel is to be male.
The following measures are proposed:
- Better support to managers.
- Improved skills and better training and development opportunities.
- An improved Upper Secondary Health Care programme.
- More adult education – a "Care Lift".
- Adapted higher education and research.
- Improved working environment.
- Improved paths of recruitment.
- Increased security of employment and full-time employment.
- Better introduction for refugees and immigrants.
- More men in the care services.
Within these overarching measures, we present 61 concrete proposals for government action to improve the prerequisites for manpower supply to the municipalities and enterprises in the sector.
Implementation of the Care Lift should be aided by special process support. The plan should be followed up on an ongoing basis and the measures adjusted with a view to developments. An evaluation of the plan should be carried out after five years.
The proposals presented include those that will be implemented by the authorities themselves as well as ones which require a decision by the Riksdag.
The Assignment
The Labour Market Board, the Working Environment Agency, the Integration Board, the National Agency for Higher Education, the Migration Agency, The Agency of Advanced Vocational Education, the National Social Insurance Board, the National Agency for Education and the National Board of Health and Welfare have had the government assignment of drawing up a joint plan for manpower supply for the care of the elderly and disabled.
The National Board of Student Aid has also participated in the work. The aim of the plan is to improve the prerequisites for the supply of manpower to the municipalities and enterprises in the sector.
The Work of the Authorities
The authorities have studied a large amount of existing material and carried out some investigations of their own. The prerequisites for manpower supply up to 2015 and looking towards 2030 established on the basis of this information are described in the reports Manpower Supply in the Care of the Elderly and Disabled, Parts I and II.
The authorities have consulted with representatives of trade union organisations, user organisations and employers. The work has been led by the Directors General of the authorities.
Prerequisites for Manpower Supply
Just over 360,000 people - 8 per cent of the population - work in the assignment's field of study. In 2002, costs in the field amounted to SEK 104.3 billion, or 4.5 per cent of GDP. The formal level of qualifications among personnel in the field is low. Four of ten personnel in the care services have no formal professional qualifications for their work. Employment and working conditions are not good enough to attract professionally qualified personnel in sufficient numbers. Illness-related absence and the number of work-related injuries are at relatively high levels. Future manpower supply is defined by the generation shift, by which we mean that many employees will be retiring and a large number of professionally qualified personnel must be recruited. The supply of personnel with Upper Secondary-level qualifications in health care does not even begin to meet expected demand. The dimension and orientation of care science courses at universities and colleges must also be reviewed. A large proportion of personnel find work in the care services meaningful. Many younger women are also interested in training and work in the field. Interest among men, on the other hand, is limited. To attract enough people with the right skills will come into the care services, it is necessary that the work, the working conditions and the working environment are made more attractive. The authorities' analysis of the prerequisites for manpower supply shows that there are considerable difficulties involved in meeting short-term, and above all long-term, demand for personnel.
What Changes are Necessary?
Apart from the targets and measures in the action plan, the authorities stress the need of general measures at national level as well as improvement work at municipal level.
General measures at national level
Socio-economic development is the greatest determining factor in manpower supply. A high degree of labour market participation and good economic growth are necessary to create sufficient economic scope in the municipalities to allow the provision of good quality care. The authorities present the following general proposals.
- The effects of economic cycles on municipal finances make it more difficult for municipalities and enterprises to recruit and retain personnel. Against this background, it is important that the balance requirement that now applies to the municipalities is redesigned so that it applies to a period of several years instead of one year. At the time of writing, this is being considered by the Riksdag.
- There are great differences in demographic trends, and thus the prerequisites for manpower supply, between counties.
Increasing regional imbalance underlines the importance of improved professional and geographicalmobility. It is also important that the regional actors together analyse the conditionsin their particular county, and that national measures be adapted to the specific conditions of each county.
- Both the content of health care and other care work and the ways of operating it are dependent on a clarification of public responsibility and its weighing against available financial resources.
The public commitment should therefore be clarified so that it becomes clearer what measures and what quality of measures the public sector is to be responsible for.
- The ability to meet the population's care requirement rests on the financial resources available. The background of the manpower supply situation of recent years and demographic trends give reason for concern about the funding of future care.
Against this background, a review of the long-term funding of the care of the elderly is important if the conditions are to be created for well-functioning manpower supply.
- It is important that care legislation provides personnel with a clear framework for their work. There are today some problems of co-ordination related to the Social Services Act and the Health Care Act, and other associated legislation.
Against this background, a review should be carried out to compile an inventory of the problems that may exist from a manpower supply viewpoint in the application of the Health Care Act, the Social Services Act and other legislation. The National Board of Health and Welfare has the intention of raising with the government the possible need of changes in the legislation that the review brings to light.
Measures by the municipalities
Municipalities have a number of ways of achieving the changes needed to secure manpower supply, and in the end, the important decisions are made at the level of the individual workplace. The good workplace is characterised by a clear mission statement that has the support of personnel. All personnel should be given the chance of permanent full-time employment. The working environment should be systematically improved. Managers should be given reasonable tasks, professional work in the field should be given a clear professional identity, and personnel should be given greater scope for initiative. All personnel should have the professional qualifications required for their work and more personnel should have post-Upper Secondary level education. Opportunities for workplace-related training should be improved and professional supervision offered. Development opportunities for staff need to be improved. It is also important that older colleagues are given the necessary help to want, and have the energy, to remain in working life. It is also important that more men work in the field, and that more people with non-Nordic background are given qualified tasks in the care services.
Invest now!
The proposed plan of action submitted here by the authorities has the object of achieving investment in better operations and a better working environment. Over the next few years, demographic conditions are relatively favourable to implementation of the changes required to deal with long-term challenges. The government and municipalities have different tasks, and if manpower supply is to be secured, both must take steps. Local change must have its foundation in local conditions. This requires that skills development measures be based on local analyses of the operations and skill levels. A national agreement should be concluded between the government and representatives of the municipalities. Such an agreement can form the platform required for both national and local work.
The Structure of the Action Plan
A ten-year plan is proposed, with an evaluation after five years. The reason for the long time frame is that the need of change is extensive and that the necessary changes will take time to implement. It is proposed that the plan contain the following sections:
- operational targets
- measures at national level
- implementation
- follow-up and evaluation.
Operational targets
Operational targets should be set out in the plan within the framework of the overarching goals that apply to the policy areas upon which the action plan touches. Proposed operational targets are submitted in this report. The targets should be quantified in the ongoing preparatory work, with a view to what can be regarded as reasonable improvements within a five-year period.
Measures at national level
Measures at national level comprise measures on which the authorities themselves are able to make decisions concerning 11 changes, and those that are to be adopted by the government and Riksdag. The measures in which the authorities themselves can take steps in some cases only involve one authority, while in other cases collaboration between authorities is necessary. For the measures in which government and Riksdag decisions are required, the authorities leave the necessary decision-making to the government. The authorities will work on those measures that do not require decisions by the government or the Riksdag. Our proposal is however that the proposed action plan should apply first when the Riksdag has made a decision to that effect.
Implementation
The implementation of the plan requires ongoing collaboration at national level between the authorities involved. It also assumes systematic long-term work in municipalities and enterprises in an interplay with stakeholders at local level. There is reason to provide support for local change at county level. Process support should be offered to help workplaces implement the analyses of the operations and the skill levels that should underlie the proposed Care Lift.
Follow-up and evaluation
The implementation of the plan should be followed up and reported on an annual basis. An evaluation of the plan should take place after five years. It is proposed that the annual follow-up should take place at municipal level by the reporting of the degree of fulfilment of national operational targets, and that the national authorities should report the progress of implementation of the measures they have undertaken to implement.
Structure of the Action Plan
The proposed action plan consists of ten targets and ten main areas of action within which 61 concrete proposed measures are submitted. Since the authorities have chosen to describe the proposed measures very briefly in the main text, this summary simply provides reader's guide to the proposed measures in the running text of the report.
The following main areas of action are presented under the policy area involved.
Policy for the elderly and disabled, health policy
- Measure 1 – Better support for managers – reported on page 24.
- Measure 2 – Improved qualification level and better development opportunities –reported on page 25.
Educational policy
- Measure 3 – An improved Health Care programme – reported on page 26.
- Measure 4 – More adult education – a Care Lift – reported on page 28.
- Measure 5 – Adapted higher education and research –reported on page 29.
Working life policy and policy for financial security in illness and disability
- Measure 6 – Improved working environment – reported on page 31.
Labour market policy
- Measure 7 – Improved paths of recruitment – reported on page 35.
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- Measure 8 – Greater security of employment and full-time employment – reported on page 38.
Migration and integration policy
- Measure 9 – Better introduction for refugees and immigrants – reported on page 39.
Gender equality policy
- Measure 10 – More men in the care services – reported on page 43.
Costs and Funding
The authorities have in this report undertaken to implement a number of measures, separately or jointly. Implementation is judged to be possible without further resources being granted to the authorities.
However, several of the measures proposed by the authorities that require decisions by the government or Riksdag require the provision of special funding. The Care Lift has large financial consequences compared to other proposals. The total cost of the proposals in the action plan for the first five-year period is SEK 4,693 million, or SEK 939 million per year.
The cost to municipalities and enterprises is hard to assess. In total, however, we make the assessment that no significant net increases in cost should arise.
In considering financing the extra costs at government level, it should be borne in mind that the government's contribution to the European Social Fund ends at the end of 2006, that government costs for part-time unemployment in the municipalities are significant, and that medication-related costs for the elderly can be limited by a more appropriate use of medication. An investment in improved qualifications and better employment conditions for personnel should lead to positive effects, not least in the last two areas.
Structure of the Report – A Guide for the Reader
The first section, The Assignment, provides a brief description of the assignment and the work of the authorities on this.
The assignment in its entirety is described in Annex 1.
The second section, Prerequisites for Manpower Supply, contains a summary of how the authorities view the prerequisites for manpower supply up to 2015. Those who wish a more detailed description of this should read our sub-report Manpower Supply in the Care of the Elderly and Disabled, part I – Considerations and Assessments and Part II – Facts and Calculations. These also contain sources and references to the material used. We have chosen not to report these in this report however. The sub-reports are available at www.sos.se/Hs/aldreenh/kompfor/index.html (in Swedish).
In the third section, National Targets and Methods, the authorities report their proposals for targets and methods in the action plan.
The fourth section, What Changes are Needed? contains some general changes that are important from a manpower supply viewpoint and a report of which changes should take place in municipalities and enterprises.
The fifth section, Implementation, Follow-up and Evaluation, is about how the authorities view the implementation of the action plan at national, regional and local level and proposed follow-up and evaluation.
Finally, the sixth section, Costs and Funding, describes the financial consequences of the presented proposals and contains a discussion about the funding of these.
Appendix 2 describes how the proposed Care Lift should be implemented.