Abstract

Objectives: Quality of service provision is a significant problem for long-term care and is an important priority across countries. The challenge for policymakers is to understand what can be done to assure and improve the quality long-term care. In most countries private or third sector organisations are in change of managing the quality of service delivery. Hence, for policy makers the key focus is one of governance, i.e. how to effectively regulate, incentivise and educate in relation to quality of service provision. In the literature this question is generally addressed at the national level, even though the governance of quality often occurs at the local or regional level. This is the case in England where local authorities (LAs) have the formal duty to ensure the availability of high quality care services in their area. The aim of this study was to understand how English LAs assure and improve the quality of LTC services for older people, to characterise the approaches taken and to explore the role of contextual factors in explaining the observed mix of policy responses.

Methods: The study data were gathered from LA websites. We adapted systematic review methods to generate a corpus of data and used qualitative content analysis to assess the variety and frequency of use of policy instruments to assure and improve quality within LAs across England. The frequency of use of different types of policy instruments were analysed using latent class techniques to explore patterns in the adoption of instruments and their relationship to context.

Results and conclusion: We find that LAs use a wide range of types of quality instruments, including contract-based ‘regulatory’ approaches and voluntary accreditation schemes; economic instruments, such as subsidies, quality-related procurement and quality-related payment; and information instruments supporting quality improvement, and incentivising quality through awards, quality marks, and public reporting. There is a tendency, however, to rely on contract-based approaches, which to some extent duplicate the work of the Care Quality Commission and are not suited to improving quality across the entire care market. There is also wide variation in how the policy instruments are designed and implemented, and evidence of substantial flux with clear efforts in some areas to coordinate approaches across the health and social care divide and across LAs within the same region.

Latent class analysis is still ongoing, but we will report on the findings from this stage of the work at the conference.