Contracting for quality in long-term care in Europe

Follow-up study



Kai Leichsenring


Rahel Kahlert, Selma Kadi


Alfonso Lara Montero and Martin Lichte, European Social Network (Brussels)


This project was built on the exploratory study “Contracting for Quality” (2010) that the European Centre and the European Social Network (ESN) carried out to analyse the relationships between financers, regulators, planners, case-managers, providers and users of long-term care in Europe.

Since that time, both political and legal frameworks have evolved rapidly. Already in 2010, the Social Protection Committee published the Voluntary European Quality Framework for Social Services, in 2014 the Directive 2014/24/EU on public procurement guided EU Member States “to ensure quality, continuity, accessibility, affordability, availability and comprehensiveness of the services, the specific needs of different categories of users, including disadvantaged and vulnerable groups, the involvement and empowerment of users and innovation.” And by 2017, the European Pillar of Social Rights guaranteed “the right to affordable long-term care services of good quality”. It was therefore analysed how sustainable provision and good quality of long-term care services can be ensured by public authorities. ESN members were involved to assess current policy and practice in procuring, commissioning and contracting long-term care services with a view to quality assurance and the choice of providers based on the best price-quality ratio.


Apart from trying to disentangle terminological issues of procurement, commissioning and contracting, the study addressed the following research questions:

  • Who are the stakeholders in procuring, commissioning and contracting of long-term care?
  • How do models of procuring, commissioning and contracting of long-term care services in Europe differ?
  • How is quality defined and what types of agencies are responsible to ensure quality?
  • What are good practices in procuring, commissioning and contracting long-term care services in EU Member States?


  • Desk research
  • Online survey
  • Policy seminar


  • Short literature review
  • Online survey
  • Policy seminar
  • Final report


The report confirms that public procurement, when compared to a decade ago, has become established in the area of long-term care across Europe. Some countries have started to use public procurement as a tool to improve and ensure quality of care. This includes a general shift from residential to home and community care to enable people to stay in their community.

The report highlights some examples in which procurement, quality assurance and community-based services were successfully linked, e.g. in Swindon (UK), Hämeenlinna (Finland) or in the Municipality of Avilés (Spain).

In most European countries, legal regulations define quality of LTC services at national or regional levels. An important aspect of quality assurance is the participation of people using services in planning, delivery and evaluation of services. The report includes numerous examples of good practice aimed at achieving better-quality outcomes in long-term care. These may serve as models for enhancing public service delivery across Europe. To prepare long-term care services for future challenges, ESN and the European Centre recommend the following activities at EU level:

  1. Support the expansion of home and community care for older people, 
  2. Recast the 2010 voluntary Quality Framework for Social Services,
  3. Uphold and implement Principle 18 of the European Pillar of Social Rights (EPSR) underpinning the right of everyone to quality long-term care, 
  4. Recognise the importance of informal carers and the care workforce,
  5. Progress towards outcome-based commissioning and procurement of long-term care.

The full report including outcomes and recommendations is accessible here.

The European Centre for Social Welfare Policy and Research supports the Sustainable Development Goals

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ESN - European Social Network


02/2020 – 02/2021