Care and service inspections have primarily an improvement function. Where areas for improvements are identified, care inspectorates usually follow a graduated approach to enforcement seeking to adopt the least restrictive action in bringing about the necessary improvements and outcomes for people. Enforcement of standards is a last resort and takes place after all collaborative efforts to improve have been unsuccessful. Indeed, enforcement is usually not within the remit of the care inspectorates, as it is generally the role of central, regional or local authorities.
3.2 What mechanisms can be put in place to ensure quality assurance? Based on legislation, there are various ways in which public authorities may ensure fulfilment of requirements and standards in LTC service provision. The mechanism mentioned by most respondents was regular inspection by a public agency; for instance, a care inspectorate that is somehow linked to national or regional ministries or departments. However, as there are so many providers, additional mechanisms have been developed including internal quality management, quality certification by a third party, or an evaluation in the case of a pilot project or a specific programme (see Table 5 for further information).
Indeed, very few instances were reported of such situations. Our ESN member in the City of Hämeenlinna (FI) explained that if providers were unable to comply with requested improvements,
Table 5 Quality assurance mechanisms Inspection by public agency (e.g. care inspectorate)
21
Satisfaction questionnaires
16
Internal quality management (self-assessment)
15
Complaint mechanisms
14
Public reporting (website)
10
Certification by third party (quality management system)
8
Outcomes based evaluations
8
Other, e.g. external evaluation
7
Source: ESN Questionnaire, Q27, n=26 (multiple answers possible).
46
