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Regulating the quality and safety of long-term care in England

2012 Conference Presentation

(Inter)national systems EnglandUnited Kingdom

7 September 2012

Regulating the quality and safety of long-term care in England

Juliette Malley, London School of Economics, United Kingdom
Jacquetta Holder, London School of Economics, United Kingdom
Rachael Dodgson, London School of Economics, United Kingdom
Samantha Booth, London School of Economics, United Kingdom


Unlike the publically-funded ‘universally available’ systems of LTC in Germany, Spain and South Korea, England’s social care sector is based on means testing so there is a public and large private system for social care services.

This paper will begin with the relevant political and policy background to LTC regulation, including the recently changed environment, priorities and key policy directions and the financial and political operating constraints. After describing the LTC system in England (funding, the mixed public and private market for provision, responsible local councils and other authorities and the main features and scope of the Quality Assurance system for health and social care, including the role of the Care Quality Commission (CQC)), the presentation will focus on the requirements and processes for the registration and certification of LTC providers.

The framework for monitoring and compliance with standards will then be assessed, including the role of Quality Risk Profiles, site audits, the mechanisms for users/consumer involvement in oversight, and the consequences of failure to comply with standards. A separate section examines the reporting of provider quality, including the publication of information by the CQC.

The paper then goes on to analyse issues that revolve around quality assurance, such as the tensions between local councils and the CQC; the lack of coverage of non-personal care providers and differences in treatment of privately and publicly-funded clients; the ‘grey market’ i.e. services not from regulated providers, but from individuals operating ‘freelance’ as care workers; problems and benefits of a data-driven and risk-based approach in the sector; and the constraints on the regulatory Quality Assurance system and future problems.

A final section brings together pertinent conclusions.