a study of government approaches in England and Australia.

Improving the quality of residential care for older people is a priority for many governments, but the relationship between government actions and high-quality provision is unclear. This qualitative research study uses the cases of England and Australia to examine and compare regulatory regimes for raising provider quality. It examines how understandings of quality in each country are linked to differences in the respective regulatory regimes; how and why these regimes have developed; how information on quality is used by each government to influence quality improvement; and how regulatory regimes influence providers to deliver quality. The study develops a new typology of three provider quality orientations (organisation-focused, consumer-directed, relationship-centred) to examine differences between the two regulatory regimes. The research draws on interviews conducted between January 2015 and April 2017 with 79 individuals from different stakeholder groups in England and Australia, and interviews with 24 individuals from five provider organisations in each country. These interviews highlighted greater differences between the two regimes than previous research suggests. For example, while each system includes a government role for inspecting or reviewing provider quality, there are differences around how quality is formally defined, the role and transparency of quality information, and how some provider quality behaviour is influenced by different policy interventions. Two important findings emerge from the study for policymakers and researchers. First, the importance of considering the broader historical and institutional context of the care sector overall, not simply the regulatory environment, as shown by the more welfare-oriented approach in England when compared to Australia’s highly consumerist approach. Second, the importance of considering the overall ‘regulatory space’ when designing policy interventions for quality. Policymakers should consider the effects and interaction of multiple policy interventions, the impact of funding mechanisms and the activity of multiple stakeholders, and not restrict attention to those policy interventions explicitly developed for quality improvement goals.