Gdansk care cluster report
Report of cluster meeting on social and health services'
The cluster meeting took place in Gdansk on 28th June 2008 from 10.00 to 14.00. Participants from Finland, France, Belgium, Italy, Germany and Poland worked together on the main topic, Social and Health services. The meeting was chaired by Dorotea Daniele (DIESIS).
Presentation of the context
Currently, public services provision is a major issue since there is a crisis of this kind of services. On the one hand, the demographic change results in one of the most important challenges that all countries have to face in the future: population ageing, increasing of specific needs in care, increase of services cost etc. On the other hand, the unbalance of the ratio “old inactive person/workers” would place pressures on public finances. For these raisons, there is a need to find more efficient ways of providing care services, based on an entrepreneurial approach.
In this context, social enterprises and social economy sector act various roles as social services providers:
- adaptation to the society transformations (capacity of innovation quickly) and close to the users
- involved in the territories with values of solidarity
- creation of jobs for disadvantaged persons
- good tradition in providing this kind of services
- quality services provided to general interest
Social enterprises provides a large range of services: specialist transport services for disabled people, leisure (from swimming pools and sport centres, youth hostels and zoos to stately homes and heritage steam railways), environmental services (cleansing and recycling), housing and even utilities such as water, care services including acute medical care, mental health, child and elderly care.
The cluster held by DIESIS begun focusing the attention on some challenging questions concerning “Social and Health services” context:
- the crisis of public services provision
- the changing context
- the role of social enterprises and social economy
- the sectors and typologies of services
Through the presentation of each participant and their structures or best practices, the following theses were transversely discussed during the meeting:
1. Increasing needs in care (e.g. elderly people, children, etc.) 2. The demand side: public sector and private customers 3. The supply side: atouts, problems and fears of social economy providers 4. Public procurement, direct agreements and fair competition 5. Networking at European level: usefulness, objectives and tools.
At the outset, Eveliina Pöyhönen, project manager at STAKES, the National Research and Development Centre for Welfare and Health, in Finland, gave a presentation focused on the development trends of more services and workforce in this sector through the experience of the HOT project. This project model brings together national and transnational partners and promotes new services and new service-providers for social and health sector through social enterprises. At the same time it creates work opportunities for disabled and long-term unemployed people in support services for elderly people and supports the government's strategy to enable older people to live at home as long as possible. Through the HOT project, five pilot social enterprises have been established in social and health services. After the end of EQUAL, the five pilot social enterprises continue to work. The service price is approximately 36 euros per hour.
Afterwards, Momar Lo gave a presentation of the first French social militant network of home help and care services: UNA. This network groups together 144,000 professionals: managers, care service co-ordinators, area managers, home carers. In 2007, UNA network carried out 57,475 interventions and created 11,610 net jobs. Its member structures took care at home of 805,000 persons (elderly, disabled, families in difficulties and individuals). UNA is presently developing a Télé-assistance service that, by adding a special device to a users' phone, enables them to easily make a distress call to the centre.
All participants were particularly interested by the French practices and by the relationship between UNA and the public authorities. Indeed, UNA is also a union of employers, that takes part in negotiations with social partners, particularly concerning a collective labour agreement for the sector. In France, the structure of service supply is regulated by the public authority. In 2004, a new law introduced various quality tools: obligation to be recognized to take care of elderly people, fiscal rewards to foster creation of private enterprises, implementation of a new version of the “chèque service” (subsidised voucher that allows to share the service cost with the users and give a large access of this kind of services).
French regulation of the supply of services is, at the same time binding (recognition etc.) and competitive (users have the choice of different services providers - private enterprises, public providers or non-profit organisations). Despite the opening of the sector to competition, social economy organisations continue to be the major service provider which deliver care responding to old people needs, explained Momar Lo.
Gisa Haas (Paritätischer) took the floor and presented the development partnership of the first EQUAL round and the structure of service provision. She spoke, in particular, about the Baden-Württemberg region in the south of Germany. In this area, there are 2,000 organisations for elderly care, 54% of elderly people are cared by professionals, and 88,000 employees in the elderly care.
Elderly care is a traditional field of the social economy welfare federations (such as Caritas, Diakonie, Paritätischer) but service provision in elderly care in Germany is characterised by a number of issues:
- transition to free market initiated 10 years ago. The difference between profit and non-profit organisations is not really clear;
- a “black market” with low paid immigrant women (about 20% of the staff in the institutional care are female immigrants), a lack of knowledge on the working conditions, a lack of professional training and qualifications etc.;
- a lack of public authority regulations.
In Germany, some workers involved in the black market are paid only €1 per hour. Gisa Haas was particularly interested to learn more about the French situation. The final part of her presentation was focused on the following issues:
- How to determine the price of services?
- How to integrate the black market?
- How to persuade clients to pay more than €1 per hour for the services?
- How to establish relationships with public authorities in order to regulate the sector and organise professional training?
Szansa i Wsparcie, Poland
In Poland, a member of the Szansa i Wsparcie social co-operative took the floor in order to present his co-operative, created within the The Virtual Incubator of Social Economy – model of acting in the cooperation network (WISP) project. This co-operative has been created by unemployed women, that were given a special training and as a result gained a new profession of hospital attendant with a specific qualification. This course was organised according to the guidelines of Polish Health Department. The training included: 80 hours of theoretical classes, 160 hours of practical classes and a 6-month internship as a hospital attendant. Currently, there are 13 women employed in the co-operative, 6 from them have elementary education, 8 are above 40 years old, 8 have been long-term unemployed.
The co-operative develops contracts with hospitals in the other regions. These annual contracts guarantee the survival of the organization. Furthermore, there are subsidies for this type of activities. This unique experience in Poland results from the fact that hospitals will not pay for tasks which they cannot fulfil with internal staff.
Dorotea Daniele took the floor in order to give a presentation of Italy. Social co-operatives are private enterprises, recognised by the Italian state, which have the objective of "the human promotion and social integration of the citizens". In 1991 they were recognised by a specific law, which distinguished two types of cooperatives:
- Type “A”: Management of social, health and educational services;
- Type “B”: Work inclusion co-operatives.
Since the beginning, social co-operatives created consortia in order to provide common services and to have a better visibility. In Italy, the social services sector is regulated at the regional level (agreement of quality, fixing of the cost of services etc). Municipalities can give contracts directly to social co-operatives.
The current challenge is to create trademarks in order to give a quality brand and a common image to social co-operatives respecting an ethic charter and quality principles.
A European network?
To conclude this cluster meeting, Maud Candela (European Think Tank Pour la Solidarité) took the floor to propose the creation of the European Network of social economy providers of proximity and social services.
Pour la Solidarité is a major actor of social economy in Belgium which works on five main issues:
- social cohesion
- social economy
- diversity and CSR
- citizenship and participatory democracy
- territorial sustainable development
The implementation of a European Network of social economy providers of proximity and social services aims to link social economy providers in order to show that a social aim may be a guarantee of quality and efficiency with principles and values of social economy. Concretely, this network aims:
- to prepare a common definition of social and proximity services and make it recognised at the European level
- to develop exchanges of best practices between the members
- to inform on European and national legislation
- to lobby at the European level
- to find new members across Europe
- to answer European calls for proposals
Finally, some common challenges resulted from all the presentations:
- increase the quality of jobs
- increase the quality of care
- training for the low-qualified and unemployed
- integrate the “black market”
Thanks to all the presentations of the various system of care and health services provision in Europe, the cluster was very stimulating and enriching. Through this cluster, all participants agreed on the fact that they should work together in Europe. We can highlight that Germany was very interested in the good practices in France and the implementation of a network. We would like to draw the attention on the fact that further discussions continued informally later on.
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