How can we ensure and measure progress in achieving the right to affordable long-term care (LTC) services of good quality, as stipulated by the European Pillar of Social Rights (EPSR)? This question is currently being discussed at the Social Protection Committee (SPC) - a forum of exchange for EU member states to improve access to Social Protection across the Union. European Social Network (ESN) Chief Executive Officer Alfonso Lara Montero contributed to this debate, delivering several key messages based on ESN’s latest Reports on Promoting Quality in Long-Term Care.

Current EU Quality Frameworks require review

It is more than a decade since EU member states agreed with the European Commission a voluntary framework for social services quality. However, the social services landscape and the view on quality assurance is not the same as it was 10 years ago. Therefore, ESN proposes to review current EU Care Quality Guidance, focussing on elements that have evolved or that would be beneficial for overall quality assurance in the current and future social services context.

The users’ quality of life must be in the centre

Users should always be in the centre of quality assurance from service planning, to procurement, provision and evaluation. Instead of input-oriented quality goals such as number of beds available, output-oriented goals should be defined. Ensuring a good life for the users and carers should be a primary quality outcome of long-term care services. What constitutes a good life should be defined in dialogue with the users, carers and other stakeholders involved.

Long-term care at home as the new “normal”

Residential care is just one form of long-term care. The current COVID19 crisis has shown that long-term-care provision in big institutions can be fatal because care homes concentrate many people with vulnerable health conditions in one place. Consequently, home and community care should be the new norm. However, it will be important to develop policies that ensure quality of care in home-based care environments.

Achieving quality by outcome-based procurement

Outcome related payments of LTC care services could help to achieve specific goals. For example, a) full or partial recovery of users, b) care intensity not preventing increases in care intensity, and c) people remain in their own home. To ensure the achievement of these goals, public authorities could include payment-by-results clauses in contracts with service providers that specify compensation if targets for assisted clients remaining at home are reached i.e. (>85%) if a certain percentage of persons discharged from hospital recover i.e. (>70%).

Quality Agencies a key actor in quality assurance

Care Inspection Agencies such as the Irish Health Information and Quality Authority (HIQA) play a key role in quality assurance. For example, in providing guidance on how quality standards can be translated in quality assurance frameworks for different care settings and supporting providers in setting up services that are compliant to national care quality legislation.

ESN as partner for future EU Policies on Quality Care

ESN CEO Alfonso Lara Montero proposed to continue the dialogue on Quality Assurance with EU institutions and Member States, building on ESN expertise and knowledge gathered from its members over more than a decade. “Social services in local authorities are key in managing and providing quality care that promotes the autonomy of older adults with long-term needs”. Upcoming events such as the ESN Quality Round Table in the European Parliament will provide the opportunity to continue the dialogue on advancing Quality Care across Europe. 



ESN (2010) Contracting for Quality

ESN (2011) Developing community care

ESN (2012) Retaining and regaining independence in later life: the role of social services

ESN (2013) Discussion note - Long-term care & social investment: issues for social services

ESN (2016) Integrated Social Services in Europe

ESN (2017a) Investing in the social services workforce

ESN (2017b) Investing in Later life – A toolkit for social services providing care for older people

ESN (2020a) COVID-19: Impact on long-term care,

ESN (2020b) Striving for Quality in Social Services and Social Care

ESN (2021) Putting Quality First – Contracting for Long-Term Care

HIQA (2020) Guidance for the assessment of designated centres for older people