Building the infrastructure for long-term care has for a long time been equated with the construction of care homes, but policies such as ‘ageing in place’ (Pani-Harreman et al., 2020) or the development of community care (European Social Network, 2011) have promoted care in the community. Community care may include supported housing, day-care and active participation centres, and the provision of care and adaptations at home to allow people to stay in their own homes and communities for as long as possible. At the same time, within health care systems it has become increasingly evident that new treatments and care pathways are needed to deliver personcentred care for the rising number of older people with multiple chronic diseases. Therefore, there has been a need for more communication, interprofessional collaboration and networking, as well as for coordination between services and organisations to overcome fragmentation and increase joint planning and delivery of services (Billings & Leichsenring, 2005). where private not-for-profit providers have always played an important role in social service provision.
This led to the concept of integrated care, which has underpinned the debate about reforms in health and social care over recent decades, with thousands of pilot initiatives, research and evaluation projects, local and national reform programmes, green and white papers, legal action at national level, and policy initiatives also at supra-national levels (SPC, 2010; WHO, 2019; OECD, 2013; European Social Network, 2016). As a result, a wide consensus has been established that long-term care, with its health and social care components, needs to be addressed in an integrated way.
In the first group (e.g. SE, UK), the introduction of a purchaser-provider split within public authorities or compulsory competitive tendering contributed to the emergence of:
1.2 Procurement, Contracting, Commissioning
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new stakeholders such as private for-profit providers,
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new procedures such as competitive tendering,
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related measures regarding contracting and quality assurance.
In the second group (e.g. DE, FR, the NL) the challenge was not about contracting services out to private providers, but to adapt the traditional system of grants and subsidies to a market where public, not-for-profit and for-profit providers interact on a level playing field.
With the dissemination of New Public Management principles (see box below) over the past three decades, practices of procurement, commissioning, purchasing and contracting have entered public service provision and governance in Europe, though with rather different meanings, scope and impact. This is particularly true for the area of social, health and long-term care services.
In short, while in many countries the key question about relying on procurement had already been answered positively beforehand, in others it needed an explicit political decision to introduce ‘markets for care’ through competition. Against this backdrop, issues of market-oriented governance, choice and competition were likely less well received in some EU Member States (e.g. FR, DE) due to the impression that regulations, which mostly came from the EU, tended to expand market-oriented governance to the area of ‘social services of general interest’, including long-term care.
The general tendency towards market-oriented governance was based on the assumption that competition among private providers would increase eff iciency and reduce prices against public service provision. While this might be true for network industries, there have always been critical voices when it comes to the procurement of social services of general interest, which has been seen by many as a de facto privation of public social services. Procurement rules could impact negatively the quality of social services, but this also depends on national implementation. For instance, the introduction of procurement impacts differently systems with a previous public in-house provision than those with a long tradition of ‘welfare mixes’,
Social services respond to vital human needs, contributing to non-discrimination, creating equal opportunities and jobs. Organisational and regulatory frameworks therefore should enhance their social cohesion role rather than hamper their efficiency and quality, e.g. by creating additional
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