This ESN policy & practice research project started out looking at the changing relationships between financer, provider and user in older people’s services in Europe but developed to cover the relationships between a wider range of stakeholders - financer, regulator, planner, case-manager, provider – and of course the service user and his/her family. The final report covers Belgium (Flanders), the Czech Republic, Germany, Spain, Sweden and the UK (England).

It was concluded that very few of the relationships described could be argued to be ‘contracts for quality’ in the sense of legal contracts containing financial incentives to deliver clearly defined quality care. However, several other tools and systemic incentives (e.g. accreditation, inspection, information for users) do exist for assuring an agreed level of quality in regulated quasi-markets. The study found that measures to define, assess and control quality tended to focus on individual organisations, agencies or services, rather than looking at the whole system, notably across health and social care. Quality indicators that would serve to improve inter-agency working, case management and interfaces along the ‘chain of care’ (including informal care and health care organisations) remain to be developed.

The three research workshops were a key part of the project and featured practice examples on the relationships between actors in this area from various perspectives:

• Belgium and Sweden 
• Germany and UK
• Spain and Czech Republic

This project has now concluded, but ESN continues to take a keen interest in the issues raised by the report and the wider long-term care landscape in Europe. A repeat of this study in as little as five years’ time would doubtless reveal further developments in regulation, financing, planning, case-management and provision in the long-term care sector – it remains to be seen whether this will lead to improvements in the quality of care and quality of life of older people needing care.