Putting Quality First

Contracting for Long-Term Care


Alfonso Lara Montero, Ronan Mangan, Martin Lichte (ESN)




European Social Network (ed.) (2021) Putting Quality First – Contracting for Long-Term Care. Brussels: The European Social Network.


Following a year of work together with the European Centre, the European Social Network (ESN) has published the report Putting Quality First – Contracting for Long-Term Care. The report examines how public procurement and quality assurance policies can ensure better access to quality long-term care services. A decade after ESN’s 2010 publication ‘Contracting for Quality’ - with Kai Leichsenring and Ricardo Rodrigues as co-authors - this report is based on contributions by Kai Leichsenring, Selma Kadi and Rahel Kahlert who analysed over 70 scientific publications and 30 questionnaire responses from ESN members. Additional input to the final report was generated from ESN’s 2020 Seminar on Quality in Ageing and Care

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.