This paper reports the findings of a process evaluation of a quality assurance initiative in an English local authority (LA). The paper is part of a larger study that explores local initiatives to improve the quality of social care services through market shaping in English LAs. LAs are mandated through the Care Act of 2014 to manage the local market and to assure that quality services are available to the local population. In order to do this, LAs engage in a wide variety of quality assurance and improvement activities.
This paper used a process evaluation approach to understand the implementation of one such initiative: contract monitoring through a combination of self-assessment and site visits. The aim of the initiative was to contain spending as well as to encourage providers to engage in quality assurance and improvement. We then used Normalisation Process Theory to analyse the collected data.
We found that implementation was hampered by a lack of resources allocated to consultation during the design phase, the sharing of information throughout and importantly, and training both within the LA and among providers in how to use the new system. Context also proved a barrier to successful implementation, including the characteristics of the previous quality assurance structure as well as relations with stakeholders, including a provider organisation.
The findings offer important insights into implementation of local care market initiatives in a resource-constrained environment.