LTCcovid Country Profiles

Responses to 4.07. Reforms to Long-term care regulatory and quality assurance systems

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science.

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.



Fourteen EU Member States introduced reforms focusing on enhanced control and monitoring of LTC services. Some reforms have implemented new quality-assessment procedures or improved administrative procedures or were linked to investments in residential care facilities (source:

International reports and sources

EU report on LTC (2021) highlights recent reforms related to care quality in Member States.

 Health Standards Organization (HSO) is developing (as of November 2021) a National Standard of Canada (NSC) for the co-design and delivery of integratedresident-and-family-centred LTC services across CanadaThe HSO National Long-Term Care Services Standard will provide LTC homes across Canada with evidence-informed practices that define how LTC homes and LTC teams can work collaboratively to keep people safe, provide safe, reliable, and high-quality care, and demonstrate positive, outcomes-focused change (source: Long-Term Care Services – HSO Health Standards Organization).

Last updated: February 11th, 2022

The government plans to establish an enhanced assurance framework for adult social care, working alongside the Care Quality Commission (CQC) and local authorities to improve adult social care oversight, access, and outcomes across England.

The Health and Care Bill introduces a new duty for the CQC to review and make an assessment of the delivery of adult social care duties by local authorities. Where they find a significant failure, the Secretary of State will act to secure improvement. The CQC will publish the findings of their reviews with the intentions of allowing people to see how their local authority is performing in the delivery of its adult social care duties.

On May 27, 2021, the CQC launched its new strategy outlining how it plans to change and transform to deliver more effective regulation. There are four key themes set out.

  1. People & communities – The CQC wants regulation to be driven by people’s needs and experiences, placing a focus on what’s important to people and communities as they access, use, and move between services. A key outcome for this is the development of a clear definition of quality and safety that is in line with people’s changing needs and expectations.
  2. Smarter regulation – The CQC wants to use smarter, more dynamic, and flexible regulation that provides up-to-date and high-quality information and ratings. In achieving this the CQC aims to move away from inspection-reliant regulation by placing more focus on data and feedback from people on their experiences of care.
  3. Safety through learning – The CQC wants to regulate for stronger safety cultures across the sector, prioritising learning and improvement, and collaboration.
  4. Accelerating improvement – The CQC aims to have accelerated improvements in the quality of care and encouraged and enabled safe innovation that benefits people or results in more effective and efficient services (Sources:;

Last updated: March 28th, 2022   Contributors: William Byrd  |  

The Health and Social Care (Quality and Engagement) (Wales) Act became law on June 1, 2020. The Welsh Government is working to bring the Act into force in spring 2023. The Act will strengthen the existing duty of quality on NHS bodies and extend this to the Welsh Ministers in relation to their health service functions. This places an overarching duty of quality on the Welsh Ministers and reframes and broadens the existing duty on NHS bodies. Additionally, the duty seeks to strengthen governance arrangements by requiring the Welsh Ministers and NHS bodies to report annually on the steps they have taken to comply with the duty and assess the extent of any improvement in outcomes (Source:

Last updated: March 28th, 2022

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica BreuerJorge Browne Salas, Jenni Burton, William Byrd, Sara CharlesworthAdelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin HämelNina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’DonovanCamille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. SchmidtAgnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.