ESN members in practice

The way we provide services is changing. Local public social services are developing new relationships with independent care providers. These relationships, which may involve contracts or grant-funding, need to be well-managed so that older people get a better quality of services.

While this should be a welcome stimulus for improvements in quality, if not well-managed, it can have detrimental effects. To ensure better quality of care, service developments driven by project-based funding, e.g. for home-care, should be carried out on the basis of local strategic planning.

Outsourcing or privatisation has at times been presented as a threatening trend. ESN’s long-term care working group recognised the dangers but members from Italy and Scotland stressed that “where a public duty is in part or in whole delegated to another organisation, it is still a public duty”. In other words, while service delivery is outsourced (whether by tender or grant) to another organisation, accountability for the service should still lie with the public authority.

In England, all service providers including local authority providers are registered with the national regulation agency, the Care Quality Commission (formerly Commission for Social Care Inspection), which accredits providers and monitors national standards. In Scotland, meanwhile, a new organisation, Social Care and Social Work Improvement Scotland, was established in April 2011, to replace the previous regulators, Care Commission (registration and inspection of providers) and Social Work Inspection Agency (inspection of local authorities as service commissioners). In Germany care providers and institutions are registered with the long-term care insurance regulator. In the Veneto Region in Italy, a regional agency registers service providers. In Sweden meanwhile, private service providers are registered with the county authority.

In the UK and Ireland, quality assurance tends to be seen as a matter for national regulation and inspection. This extends beyond service provision into the quality of strategic service planning and needs assessment (‘commissioning’) by local government. Alexis Jay Chief Inspector of Social Work in Scotland cites “clear evidence that the public wants assurance about the quality of care provided through independent inspection.”

“I see the ULSS (local social service agency) as an important facilitator, shaping the care systems and building community capacity, facilitating networking and investing in cooperatives,” emphasises Teresa Spaliviero from Italy. “That’s right,” agrees Luc Kupers, chair of the Flemish association of social directors: “While the public sector role in direct provision of services is shrinking, our new role is to ensure that quality services are available.”

Outsourcing delivery, not accountability

Even from these few examples, it should be apparent that registration processes and requirements vary widely between countries. There are very different trains of thought about who should be responsible for quality. In some countries, the predominant view is that service providers should be responsible for quality assurance. In others, the view is that municipalities must take the lead in defining standards and ensuring they are respected by providers they work with through contracts.

Older people are receiving services from a growing range of organisations and from social and health services. Despite the different welfare state models and histories, the public sector has a vital role in coordinating different local actors and service providers. This may imply a correspondingly important responsibility for local authorities to ensure not only that citizens receive services that they need and want but is able to ensure that they are of the highest quality.

Accountability for quality services has also been a discussion point between ESN members in the seminar Commissioning for Quality last November in Brussels. Read more about the discussion.

This is the last in a series of three articles offering an insight into current issues for managers of older people’s services.