3.4 How can we overcome the challenges in improving quality in long-term care? Public authorities have engaged in addressing quality issues in long-term care, but there have been few concrete cases in which contracting was used to trigger quality improvement. This is due to a complicated mix of interests within and between contracting parties. On the one hand, public authorities would like to procure high quality services, but additional requirements may drive up their price. On the other hand, while providers also have an interest in decent quality provision, they often have to work with standard fees for individual services.
Examples of developments combining contract management, quality develop¬ment and the involvement of relevant stakeholders can be found in several local authorities across Europe. At ESN we have implemented a learning process between public authorities with responsibility for social care and social services to address the challenges of procuring care and support with an increasing number of private providers, as we did at our annual seminar.
Therefore, some countries, particularly those where quality is still a relatively new concept, seem to have placed an emphasis on defining minimum standards, e.g. Italian regions have defined ‘essential levels of service provision’. This process went hand in hand with the introduction of indicators measuring wellbeing and a review of out-of-date quality indicators (Q32).
For instance, the City of Madrid has made progress in addressing potential resistance against quality assurance through a public-private partnership approach (see detailed example below).
These and other improvements that were recently introduced show some trends towards embedding health and social care standards in service delivery with a focus on human rights and the assessment of service users experience.
In France, in addition to the care provider and County Council, Regional Health Agencies are also party to the contract ensuring that quality safeguards are included in the contract. Such tripartite ‘multi-annual contracts of objectives and resources’ are based on a shared quality aim by the three stakeholders involved: the buyers (the County Council and the Health Regional Agency) and the providers. Based on an assessment, they set the contract size and quality objectives to be met over a multiannual timeline (generally 5 years). The objectives, which are reviewed by the authorities every year, can include for instance improvements in the lives of people using the services, staff working conditions, including training for staff to respond better to the needs of people using services, as well as support for family members (Agence Régionale de Santé, 2018).
“Over the years, there has been a gradual introduction in some regions of indicators regarding people’s wellbeing and above all a greater involvement of users and families in the assessment of services.” Tobias Voltan, Italian National Council of Social Workers
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