Disability-relevance of quality assurance systems in social services : Portugal.
Date: 2024-09-23
Institutions: Directorate-General for Employment, Social Affairs and Inclusion
Subjects: Portugal, care of people with disabilities, disabled person, fundamental rights, provision of services, social integration, social rights, social services, socially disadvantaged class

Disability-relevance of quality 
assurance systems in social 
services 

Portugal 

State of affairs May 2023 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EUROPEAN COMMISSION 
Directorate-General for Employment, Social Affairs and Inclusion 
Directorate D — Social Rights and Inclusion 
Unit D3 — Disability & Inclusion 

European Commission 
B-1049 Brussels 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EUROPEAN COMMISSION 

Disability-relevance of quality 
assurance systems in social 
services 

Portugal 

Maria Paula Campos Pinto 
María Alejandra Acosta Jiménez 

This report has been developed under Contract VC/2020/0273 with the European 
Commission. 

Directorate-General for Employment, Social Affairs and Inclusion  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Manuscript completed in 2024 

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PDF 

ISBN 978-92-68-10806-2    

DOI: 10.2767/916591 

KE-06-23-076-EN-N 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

Table of contents 

1 

2 

3 

4 

5 

Executive summary ......................................................................................... 6 
1.1  Definition and framework of the quality of personal social services ........... 6 
1.2  Evaluation of the quality of social services ................................................ 6 
1.3 
Impact of quality assurance mechanisms .................................................. 7 
1.4  Recommendations for Portugal ................................................................. 7 
1.5  Recommendations for the European Commission ..................................... 7 
Conceptualising the quality of essential services provided directly to the 
person: framework, definition, and research in the European States ......... 8 
2.1  Definitions and frameworks ....................................................................... 8 
2.2  Research studies and national debates ................................................... 10 
Evaluation / assessment of quality assurance for social services ............ 14 
3.1  Types of quality assurance ...................................................................... 14 
3.2  Types of services ..................................................................................... 18 
3.3  The formal bodies .................................................................................... 20 
3.4  Stakeholders, experts by experience and organisations of persons with 

disabilities ................................................................................................ 20 
3.5  Methods and methodologies .................................................................... 20 
3.6  The indicators and the principles ............................................................. 22 
The impact of quality assurance mechanisms and systems and promising 
practices: strengths and weaknesses .......................................................... 29 
4.1  The impact of quality assurance mechanisms ......................................... 29 
4.2  The role of human rights NGOs, Ombudsman, and other related offices  30 
4.3  Promising practice ................................................................................... 31 
4.4  Analytic reflection ..................................................................................... 34 
Recommendations ......................................................................................... 36 
5.1  Recommendations for Portugal ............................................................... 36 
5.2  Recommendations for the European Commission ................................... 36 

5 

 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

1 

Executive summary 

1.1  Definition and framework of the quality of personal social services 

In  Portugal,  the  Social  Security  system  (Segurança  Social)  aims  to  ensure  that  all 
citizens have access to basic rights and equal opportunities. The system comprises 
three  sub-systems:  the  social  protection,  social  action  and  supplementary  systems. 
However,  most  disability  services  in  Portugal  are  provided  by  private  not-for-profit 
organisations and cooperatives, which are funded by the State through agreements 
signed  with  Social  Security.  In  2003,  the  Government  launched  the  Cooperation 
Programme  for  the  Development  of  Quality  and  Safety  of  Social  Responses,  which 
assesses nine social services, four of them  more specifically aimed at persons with 
disabilities (two of them are specialised services for persons with disabilities and the 
other  two  are  mainstream  services  that  cover  persons  with  disabilities  among  other 
groups  at  risk  of  vulnerability).  The  programme  compiles  a  series  of  technical 
recommendations for the facilities in which social services are provided and provides 
quality management manuals, designed as standards that must be used to develop 
and implement a quality management system in social responses. The preparation of 
this model was based on the NP EN ISO 9001:2000 standard – Quality Management 
Systems  –  and  on  the  Excellence  Model  of  the  European  Foundation  for  Quality 
Management (EFQM).  

In  addition,  the  Portuguese  Association  for  Quality  (Associação  Portuguesa  para  a 
Qualidade – APQ), a non-profit organisation, certifies public and private organisations 
that provide social services under the European Quality in Social Services (EQUASS) 
model. 

Other legal provisions are in place to guarantee physical accessibility; access to health 
services and rehabilitation; non-discrimination; participation; and public responsibility, 
among other things, within service provision for persons with disabilities.  

1.2  Evaluation of the quality of social services 

Since  2003,  the  Social  Security  Institute  has  been  implementing  the  Cooperation 
Programme  for  the  Development  of  Quality  and  Safety  of  Social  Responses  in 
Portugal. The programme developed a model for evaluating social responses based 
on  the  NP  EN  ISO  9001:2000  Standard  –  Quality  Management  System  –  and  the 
Excellence Model of the European Foundation for Quality Management (EFQM). The 
model  includes  two  broad  dimensions  of  evaluation:  means  and  results.  Each 
dimension contains four criteria. It was first established in 2005 and revised in 2010 
and consists of a set of requirements for implementing a quality management system 
in the services provided by nine types of social care services. Four of them are part of 
the service portfolio for persons with disabilities. However, the Social Security Institute 
also funds four other types of social care responses for persons with disabilities that 
are not included in this programme.  

The  model  provides  for  three  qualification  levels  (C,  B  and  A).  Although  gaining 
certification at levels B and A is not mandatory, all the organisations that intend to enter 
into  cooperation  agreements  with  the  state  must  fulfil  requirements  for  the  level  C 
qualification, which constitutes the basic level of the model. 

6 

 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

Accredited bodies that are authorised by the Portuguese Quality Institute evaluate and 
train  organisations  that  seek  accreditation  with  the  ISS  quality  model.  There  is  no 
information available on who the experts are, but to the authors’ knowledge, persons 
with disabilities are not part of the evaluation teams. 

1.3 

Impact of quality assurance mechanisms 

Quality  assessments  under  the  Social  Security  model  are  carried  out  by  external 
entities that are recognised by the Portuguese Quality System. All service providers 
that  want  to  enter  into  cooperation  protocols  with  the  state,  and  then  obtain  public 
funding  for  their  activities,  must  obtain  at  least  a  level  C  qualification,  which  is 
mandatory  for  social  services.  However,  the  Social  Security  quality  model  has  not 
established guidelines for all social services provided to persons with disabilities, and 
in the cases in which it has defined them, the references to getting a poor qualification 
do not contain any kind of sanction. The authors have identified that several indicators 
regarding self-determination, autonomy, community-based services and participation 
are included in quality levels A and B, but not at the basic level C. 

1.4  Recommendations for Portugal 

The Social Security Institute’s quality model must be revised. This report recommends 
developing guidelines for all social services provided to persons with disabilities and 
establishing specific indicators that address disability rights issues. In the new/updated 
guidelines, the participation of persons with disabilities must be ensured in assessment 
processes  at  all  levels  (as  service  users  but  also  as  auditors,  through  disability 
representative organisations). 

This  report  further  suggests  that  even  the  basic  level  of  quality  certification  to  be 
granted should already include human rights-based indicators.  

The  Social  Security  Institute  and  the  National  Institute  for  Rehabilitation  (Instituto 
Nacional  para  a  Reabilitação  –  INR),  as  national  entities  that  supervise  service 
provision and the implementation of the National Disability Strategy 2021-2025, should 
provide  training  in  quality  assessment  services  and  support  (including  financial 
support) to disability service providers for undertaking continuous quality assessment 
and implementation processes. 

1.5  Recommendations for the European Commission 

At  the  European  level,  this  report  suggests  that  the  Commission  provides  easy-to-
follow  guidelines  regarding  quality  services  for  persons  with  disabilities  that  every 
organisation and service provider, no matter its capacity, can follow and implement. 

This report also suggests that organisations that access European funds and provide 
services  for  persons  with  disabilities  are  subject  to  monitoring  by  European  bodies. 
Inspection  visits  should  be  planned  periodically  to  verify  the  conditions  in  which 
services  are  provided.  A  minimum  level  of  quality,  which  includes  human  rights 
indicators, should be a requirement to apply for EU funds. 

7 

 
 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

2  Conceptualising  the  quality  of  essential  services  provided  directly  to  the 

person: framework, definition, and research in the European States 

2.1  Definitions and frameworks 

In Portugal, the Social Security system (Segurança Social) aims to guarantee that all 
citizens have access to basic rights and equal opportunities, as well as to guarantee 
the promotion of wellbeing and social cohesion for all Portuguese citizens and foreign 
workers who work or live in Portugal. The state administrates the public component of 
the system and oversees the non-public component. The system is regulated through 
Law 4/2007 of 16 January,1 which defines, among other aspects, the terms of the social 
provision that can be delivered through social services and facilities; programmes for 
combating  poverty,  marginalisation  and  social  exclusion;  and  occasional  and 
exceptional cash benefits and benefits in kind. Although the Law does not define the 
quality of essential services (or essential services themselves), it includes 17 principles 
that  guide  the  system’s  functioning.  The  general  principles  of  the  system  are  the 
principles  of  universality,  equality,  solidarity,  social  equity,  positive  differentiation, 
subsidiarity,  social  insertion,  intergenerational  cohesion,  the  primacy  of  public 
responsibility, complementarity, unity, decentralisation, participation, effectiveness, the 
protection of acquired rights and rights in formation, judicial guarantee and information.  

Most  disability  social  services  in  Portugal  are  provided  by  private  not-for-profit 
organisations and cooperatives that are funded through Social Security. Back in 2003, 
the  Ministry  of  Social  Security  and  Labour,  in  collaboration  with  the  National 
Confederation of Solidarity Institutions, the Union of Misericórdias, and the Union of 
Portuguese  Mutualities, 
the 
Development of Quality and Safety of Social Responses.2 The programme is currently 
managed  by  the  Social  Security  Institute  and  is aimed  at  public,  private,  and  social 
solidarity organisations that develop the following social care services: 

the  Cooperation  Programme 

implemented 

for 

• 
• 
• 
• 
• 
• 
• 
• 
• 

family shelters; 
temporary reception centres; 
occupational activity centres; 
day-care centres; 
nursery; 
foster homes for children and young people; 
residential facilities; 
residential structures for older people; and 
home-based support services. 

The programme was launched to ensure ‘citizens’ access to quality services that meet 
their needs and expectations’. It compiles a series of technical recommendations for 
the facilities in which social responses are provided, and a set of quality management 
manuals, which are standards that must be used to develop and implement a quality 

1   Law 4/2007 on the General Bases of the Social Security System (As bases gerais do Sistema de 

segurança social), 16 January 2007, 
https://www.pgdlisboa.pt/leis/lei_mostra_articulado.php?nid=2243&tabela=leis. 

2   Social Security Institute, Cooperation Programme for the Development of Quality and Safety of 
Social Responses, https://www.seg-social.pt/programa-de-cooperacao-para-o-desenvolvimento-
da-qualidade-e-seguranca-das-respostas-sociais. 

8 

 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

management  system  in  social  responses,  allowing  for  quality  assessment  and  the 
continuing improvement in the organisation and functioning of social services. 

The  manuals  set  up  a  model  of  quality  evaluation  for  each  typology  of  social  care 
service: e.g., home support services,3 residential facilities,4 family shelters and centres 
for occupational activities,5 which are the social responses that more directly benefit 
persons with disabilities, and describe the processes and criteria of assessment. The 
outcome of the evaluation is an accreditation at A, B or C level, and recognition as an 
‘ISS  brand’  (Social  Security  Institute  brand)  by  fulfilling  a  series  of  criteria  across 
several dimensions that include leadership, planning processes and strategies; people; 
partnerships and resources; specific processes of each response; results according to 
clients’ needs; results according to people involved; results according to social impact; 
and  results  according  to  performance.  Some  of  these  criteria  overlap  with  the  EU 
Quality Framework principles (e.g. the provision of person-centred services; outcome-
oriented or good governance). The preparation of this model was based on the NP EN 
ISO  9001:2000  standard  –  Quality  Management  Systems  –  and  on  the  Excellence 
Model  of  the  European  Foundation  for  Quality  Management  (EFQM).  However,  the 
evaluation is a voluntary, not a mandatory, process (except for level C, which is the 
basic standard that all service providers must comply with), and therefore it is carried 
out  only  when  service  providers  seek  the  accreditation;  not  all  providers  apply, 
although all of them must fulfil the minimum and mandatory rules for functioning if they 
intend to enter into cooperation agreements with the state and receive public funding 
for their activities (see Section 3.5). 

The model was reviewed in 2010, and there are no records of new revisions after that 
time. The model does not include any reference to the CRPD, nor to the EU Quality 
Framework.  

In addition to this official model, the Portuguese Association for Quality6 (Associação 
Portuguesa para a Qualidade – APQ), a non-profit organisation recognised as a public 
utility institution in 1984, certifies public and private organisations that provide social 
services  using  the  European  Quality  in  Social  Services  (EQUASS)  accreditation 
scheme. Organisations apply voluntarily to obtain this accreditation. As a result, there 
are now 17 organisations for persons with disabilities in the country that are accredited 
through  EQUASS.  EQUASS  certification  is  based  on  10  principles,  which  are: 
leadership,  collaboration,  rights,  ethics,  partnerships,  participation,  person-centred 
approach,  comprehensiveness,  continuous  improvement  and  orientation  to  results. 
Again,  there  is  some  overlap  here  with  the  EU  Quality  Framework.  The  system 
provides  two  levels  of  accreditation:  EQUASS  assurance  and  EQUASS  excellence, 
although the national organisation APQ can certify at the level of EQUASS assurance. 

3   Social Security Institute (2010), Model of quality evaluation of home support services, 

https://www.seg-
social.pt/documents/10152/13337/gqrs_apoio_domiciliario_modelo_avalia%C3%A7%C3%A3o/e3d
bce1e-bc28-45cd-aa61-626d1e6bbc7a/e3dbce1e-bc28-45cd-aa61-626d1e6bbc7a. 

4   Social Security Institute (2010), Model of quality evaluation of residential facilities, https://www.seg-
social.pt/documents/10152/13337/gqrs_lar_residencial_modelo_avalia%C3%A7%C3%A3o/4187da
ea-a0fe-4057-a115-77d7cc6f3808/4187daea-a0fe-4057-a115-77d7cc6f3808. 

5   Social Security Institute (2010), Model of quality evaluation of centres for occupational activities, 
https://www.seg-social.pt/documents/10152/13337/gqrs_cao_modelo_avaliacao/fb7d5482-1d52-
43a3-aa3f-19f82d0c909a/fb7d5482-1d52-43a3-aa3f-19f82d0c909a. 

6   APQ website: https://apq.pt/quem-somos/. 

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Disability relevance of quality assurance systems in social services in Portugal 

Its  principles 

Further to these systems, there are mandatory standards for guaranteeing the removal 
of physical barriers to access the built environment in all public-use facilities, as well 
as  laws  that  protect  access  to  health  services  and  rehabilitation  for  persons  with 
disabilities. Decree-Law 125/20177 of 4 October assigned to the INR the responsibility 
for  awareness  raising  and  monitoring  the  implementation  of  accessibility  standards, 
and established a commission in charge of assessing accessibility in public buildings 
at the national level. It complements the Anti-discrimination Law,8 which defines what 
constitutes discriminatory practices (Article 4). These include the denial or imposition 
of  limitations  in  the provision  of  goods  and services,  including  in access  to  the built 
environment, sign language, education, healthcare and information technologies. Law 
38/20049 of 18 August (known as the Disability Law) established the legal framework 
for  the  prevention,  habilitation,  rehabilitation,  and  participation  of  persons  with 
disabilities. 
include  non-discrimination,  citizenship,  autonomy, 
participation, and public responsibility. This legal framework establishes, among other 
things, that the state is responsible for adopting specific measures necessary to ensure 
the  promotion  of  health  and  healthcare,  screening  and  diagnosis,  early  intervention 
and  the  medical  and  functional  habilitation  and  rehabilitation  for  persons  with 
disabilities. Although previous to the adoption of the CRPD, it also establishes State’s 
responsibilities  to  fulfil  the  rights  of  persons  with  disabilities  in  areas  such  as 
employment, family life, social security, urban development, transport, education and 
vocational training, culture and science, fiscal benefits, and sports practice. The law 
contemplates that persons with disabilities and their organisations should be involved 
in  the  discussion  and  elaboration  of  legislation  and  policies  regarding  disability. 
Moreover, the Health Act10 also ensures that persons with disabilities are entitled ‘to 
the necessary adaptations’ to guarantee their wellbeing, quality of life, autonomy, and 
control of their lives and decisions, as they grow older (Basis 2, item 1 and 2). All those 
regulations are mandatory and monitored by public authorities, and can be demanded 
by service users. Services providers might also be sued where they do not fulfil the 
standards.  

2.2  Research studies and national debates 

Given that the Convention on the Rights of Persons with Disabilities was ratified by 
Portugal  in  2009,  the  authors  of  this  report  searched  only  for  studies  published  in 
Portugal  between  2010  and  2023  that  addressed  the  topic  of  the  quality  of  social 
services.  The  search  was  done  using  Google  Scholar  and  the  databases  of 
Portuguese  universities,  using  the  keywords  ‘quality’,  ‘social  services’,  ‘social 
responses’ and ‘persons with disabilities’, in English and Portuguese. The authors of 
this  report  found  that  most  studies  are  focused  on  social  services  aimed  at  older 
people, which is likely to be related to the country’s demographic reality. In fact, at least 
12  studies  problematised  the  quality  and  innovation  of  services  for  older  people  in 
Portugal, but the research conducted for this report included only those that mentioned 

7   Decree-Law 125/2017, 4 October 2017, https://dre.pt/web/guest/home/-

/dre/108244274/details/maximized?res=en. 

8   Law 46/2006 or Anti-discrimination Law (Proíbe e pune a discriminação em razão da deficiência e 

da existência de risco agravado de saúde), 28 August 2006, https://dre.pt/application/file/a/540732. 

9   Law 38/2004 or Disability Law, (Define as bases gerais do regime jurídico da prevenção, 
habilitação, reabilitação e participação da pessoa com deficiência), 18 August 2006, 
https://dre.pt/application/conteudo/480708. 

10   Law 95/2019 or Health Act, (Aprova a Lei de Bases da Saúde e revoga a Lei n.º 48/90, de 24 de 

agosto, e o Decreto-Lei n.º 185/2002, de 20 de agosto), 4 September 2019, 
https://data.dre.pt/eli/lei/95/2019/09/04/p/dre. 

10 

 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

services that can also be accessed by persons with disabilities (a total of five). It was 
also  found  that  studies  relating  to  the  evaluation  and  monitoring  of  public  policies 
focused on persons with disabilities are more common than those in which the topic is 
the quality of services. In total, 11 studies were found that related to the quality of social 
services for persons with disabilities. Two of them highlighted the challenges for the 
Portuguese state in implementing a system that responds to the new rights’ demands. 
The studies that were found focused on the quality of health services, long-term care 
and nursing services.11 Master’s dissertations and doctoral theses on cases in specific 
regions  and/or  services  (whether  related  to  disability  or  not)  are  common  among 
students  from  social  work  schools,12,13  public  health  schools,  psychology  schools,14 
health  administration15  and  public  management  schools,16  urban  planning  and 
urbanism programmes17 and social economy programmes,18 among others. 

Among the studies focused on quality service, this report highlights the following three: 

• 

Reforming  Long-term  care  in  Portugal:  Dealing  with  the  multidimensional 
character of Quality,19 by Silvina Santana, of the University of Aveiro. The article 
is quoted in 29 other articles that reflect on the long-term care system in Portugal 
and other European countries. The article defines long-term care in Organisation 
for Economic Co-operation and Development (OECD) terms, as ‘a cross-cutting 
policy  issue  that  brings  together  a  range  of  services  for  persons  who  are 
dependent on help for basic activities of daily living over an extended period of 
time’ (OECD, 2005, quoted by Santana, 2010). The article argues that reform of 
the  long-term  care  system,  which  was  under  discussion  at  the  time,  should 
include  quality assessment and management.  According  to the  study’s author, 
‘information about the quality of services provided by the bodies under analysis 
and their users’ satisfaction is scarce’ (p. 521). The information reported by the 
authorities  supervising  the  long-term  care  network  served  as  a  reference  for 
developing the study and was based on personal surveys to which service users 
responded regarding the level of satisfaction with services. Eurobarometer 2007 
was also used by the study’s author to point out that the Portuguese were not 
concerned about the quality of the services provided but considered affordability 
and  availability  as  problematic  aspects.  ‘However,  (…)  the  family  is  always 
perceived as the preferred caregiver. Meanwhile, long-term care in Portugal still 
relies  heavily  on  informal  and  privately  funded  care’  (p. 525).  By  2010,  the 

11   Gil, A. P. (2019), ‘Quality procedures and complaints: nursing homes in Portugal’, Journal of Adult 

Protection. 

12   Braga, A, P. B. (2018), Serviço social e autodeterminação das pessoas com deficiência (Master’s 

dissertation, Iscte - Instituto Universitário de Lisboa), http://hdl.handle.net/10071/17615.  

13   Pacheco, P. M. G. (2018), Serviço Social e Qualidade em Organizações vocacionadas para a 

Deficiência Intelectual (Master’s thesis). 

14   Mendes, M. E. D. S. T. (2010), Avaliação da qualidade em intervenção precoce: Práticas no distrito 

de Portalegre (Doctoral dissertation). 

15   Pinto, D. D. S. (2012), Respostas sociais para idosos em Portugal (Master’s thesis). 
16   Seoane, I. M. E. P. (2018), Qualidade de resposta social para pessoas idosas: Uma análise 

comparada de centros de dia no concelho de Oeiras (Master’s thesis). 

17   Oliveira, M. B. D. (2022), Respostas Socias e Serviços de Proximidade aos Idosos. O Caso de 

Alcabideche (Master’s thesis). 

18   Lima, M. F. M. (2013), Políticas e respostas sociais de apoio à terceira idade em Portugal: o caso 

do Concelho de Vila Verde (Doctoral dissertation). 

19   Santana, S. (2010), ‘Reforming Long-term care in Portugal: dealing with the multidimensional 

character of quality’, Social Policy and Administration, 44(4), pp. 512-528, available at: 
https://doi.org/10.1111/j.1467-9515.2010.00726.x. 

11 

 
 
 
 
 
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• 

Disability relevance of quality assurance systems in social services in Portugal 

National Network for Long-term Integrated Care had been in operation for less 
than four years (it was created by Law 101/2006), and its final design was still to 
be evaluated through pilot projects, although the system has not implemented a 
quality service evaluation apart from personal surveys and later the ‘ISS brand’ 
guidelines (see section 2.1).  

Definition of a National Model Recognition of Quality Systems in the Institutions 
of  Social  Services20  is  a  study  conducted  in  2012  by  researchers  from  the 
Polytechnic Institute of Setubal and financed by the Operational Programme for 
Technical Assistance – European Social Fund. This study problematised the co-
existence  of  different  quality  models  for  the  social  sector  in  Portugal  and 
assessed  the  possibility  of  creating  a  unified  model  that  could  be  applied  at 
national  level.  The  paper  analysed  the  models  in  place  (EQUASS,  the  Social 
Security  Institute’s  Quality  Model  and  the  ISO  9001) and  their  differences  and 
similarities, and identified the gaps and difficulties that social care organisations 
face when implementing these quality models. Acknowledging that ‘the route to 
quality in social care providers is still far from what is expected from a sector that 
deals  with  sensitive  issues’,  the  research  team  also  offers  ‘a  methodology  for 
incremental quality’ implementation to support organisations that are committed 
to quality, despite their lack of human resources and specific training. The project 
concluded that the model proposed by the Social Security Institute is that which 
is least often applied by institutions and organisations. By 2014, just 8 % of the 
social  service  providers  had  implemented  a  quality  management  system.  The 
project  highlights  the  need  for  a  unified  model,  although  it  recognises  that 
organisations tend to opt for the model that best fits their practices. There are no 
references to the CRPD either. 

During and after the COVID-19 pandemic, several concerns about the capacity 
of  social  responses  in  times  of  crisis  arose.  The  Observatory  of  Disability  and 
Human Rights conducted a study21 on the impact of COVID-19 on people with 
disabilities  and  their  caregivers.  It  collected  information  on  two  phases  of  the 
pandemic: during the first lockdown (April-May 2020) and October 2020, when 
most  activities  had  resumed.  The  two  online  questionnaires  gathered  1 051 
responses:  725  in  the  first  wave  and  326  in  the  second.  Data  collected  in  the 
second wave showed that many healthcare services continued suspended or had 
only  been  partially  resumed:  such  as  physiotherapy  (56.7 %),  speech  therapy 
(46.8 %),  occupational  therapy  (62.3 %),  medical  appointments  (52.8 %)  and 
nursing  care  (45.3 %).  Respondents  also  evaluated  how  accessible  the 
information provided by the Directorate-National for Health was, and the majority 
found the information to be accessible: 79.8 % in the first wave and 69.1 % in the 
second wave.  

20   Sardinha, B., Barszczak, M., Soares, A., Marques, B., and Dias, O. (2015), Definição de um 

Modelo Nacional de Reconhecimento dos Sistemas da Qualidade nas Instituições de Serviço 
Social, available at: 
https://comum.rcaap.pt/bitstream/10400.26/22083/1/ANEXO31_Rel_Sistemas%20de%20qualidad
e_institui%C3%A7%C3%B5es%20sociais.pdf. 

21   Disability and Human Rights Observatory, University of Lisbon (2020), Disability and COVID-19: 

Results of a study produced with people with disabilities and caregivers, 
http://oddh.iscsp.ulisboa.pt/index.php/pt/2013-04-24-18-50-23/publicacoes-dos-investigadores-
oddh/item/483-relatorio-oddh-2020. 

12 

 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

In  addition,  the  municipality  of  Vila  Nova  de  Gaia,  in  collaboration  with  Radio 
Renascença, organised two conferences (‘Pandemic: Responses to the crisis’ in 2021 
and ‘Post-pandemic: Recovery and resilience’ in 2022) to discuss the social responses 
to  the  crisis  and  the  challenges  for  the  social  protection  system  after  the  health 
emergency.  At  the  first  one,  the  State  Secretary  for  Social  Action,  Rita  da  Cunha 
Mendes, declared that extending the Social Equipment Network Programmes (PARES 
2.0  and  3.0)  is  fundamental  for  creating  a  new  generation  of  social  responses, 
especially in relation to home-based services: ‘It is necessary to think about change 
and  reorganisation of these  institutions  in  a proactive  logic of  the  future  and  for the 
future,  trying  to  find  new  models  of  organisation,  articulation,  sharing  of  common 
services,  collaborations,  and  partnerships,  creating  groups  of  institutes  to  generate 
institutions with an adequate critical dimension and which enable their sustainability.’22 
Although there are no references to the quality of services or models for evaluating 
and  monitoring  service  providers  during  the  intervention,  some  elements  from  the 
discourse  can  give  us  clues  about  how  the  state  envisages  the  social  services 
provision, and how local authorities would get involved in the planning process: ‘The 
role  of  the  municipalities  was  all  too  evident  in  the  definition  of  local  strategies  to 
combat  the  pandemic and  in  the  territorialisation  of  the  exceptional  and  emergency 
intersectoral measures dictated at each moment.’23 

Finally, it was evident to the authors of this report that academics from schools that 
train professionals to work with persons with disabilities tend to discuss in their papers 
and dissertations how their practices within social care institutions might respect the 
autonomy,  independence,  decision-making  processes  and  participation  of  persons 
with  disabilities,  among  others.24  This  is  highlighted  because  it  indicates  concerns 
regarding  human  rights  in  professional  interventions,  which  usually  happen  through 
social services. Therefore, the authors of this report view that as an opportunity to open 
the  debate  on  quality  service  provision  in  universities,  even  where  the  academic 
production in this field is not extensive.   

22   Intervention by the State Secretary of Social Action during the ‘Pandemic: Responses to the crisis’ 

conference’, available at: https://www.portugal.gov.pt/download-
ficheiros/ficheiro.aspx?v=%3d%3dBQAAAB%2bLCAAAAAAABAAzNLQwtAQAfcLUoQUAAAA%3d 
23   Intervention by the State Secretary of Social Action during the ‘Pandemic: Responses to the crisis’ 

conference, available at: https://www.portugal.gov.pt/download-
ficheiros/ficheiro.aspx?v=%3d%3dBQAAAB%2bLCAAAAAAABAAzNLQwtAQAfcLUoQUAAAA%3d 

24   For instance: Braga, A, P. B. (2018). Serviço social e autodeterminação das pessoas com 

deficiência (Master’s dissertation, Iscte - Instituto Universitário de Lisboa, 
http://hdl.handle.net/10071/17615. 

  Acosta-Jiménez, M. A. (2022), ‘Social work practices towards people with disabilities in Portugal: A 

reflectiveness proposal for conscious interventions and social work training’, Social Work 
Education, 41(5), pp. 943-961. 

  Pacheco, P. M. G. (2018), Serviço Social e Qualidade em Organizações vocacionadas para a 

Deficiência Intelectual (Master’s dissertation, Instituto Superior Miguel Torga). 

  Cunha, M. D. C. (2010). Auto-determinação e inclusão social das pessoas com deficiência mental-
uma intervenção centrada no sujeito (Marter’s dissertation, Instituto Politécnico do Porto. Escola 
Superior de Tecnologia da Saúde do Porto). 

13 

 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

3  Evaluation / assessment of quality assurance for social services 

3.1  Types of quality assurance 

In  2003,  the  Social  Security  Institute  launched  the  Cooperation  Programme  for  the 
Development of Quality and Safety of Social Responses in Portugal. The programme 
consists of a model for evaluating social services based on the NP EN ISO 9001:2000 
Standard – Quality Management System – and the Excellence Model of the European 
Foundation for Quality Management. It was established in 2005 and revised in 2010 
and involves a set of requirements for implementing quality management systems in 
social  services.  The  model  aims  to  become  an  instrument  of  positive  differentiation 
among social care responses and to promote the improvement of social care services. 
It also seeks to be a self-evaluation tool for social care responses that allow services 
to  systematically  assess  their  organisational  performance,  identify  improvement 
opportunities and assess the results of their practices. In addition, the model supports 
the  implementation  of  quality  management  systems  within  social  care  responses, 
mainly through efficiency and efficacy improvements; increased participation of clients 
in  services  aimed  at  them;  increased  family  participation  in  activities  provided;  and 
increased  levels  of  satisfaction  among  clients,  employees,  suppliers,  partners,  and 
other  stakeholders  directly  or  indirectly  involved  with  the  organisation.  The  model 
further provides an extensive list of requirements that constitute a guide through which 
it  is  possible  to  identify  gaps,  as  well  as  to  plan  solutions  that  contribute  to  the 
improvement of the quality of services.  

The  model  encompasses  eight  criteria:  four  related  to  means  and  four  related  to 
results.  

In the first group, which assesses the means, the four criteria that are evaluated are: 

1. 

institutional 
Leadership,  Planning,  and  Strategy: 
management, and the organisational mission, vision and values are connected 
and how the organisation designs, plans and monitors its corporate strategy and 
formulates goals and action; 

it  evaluates  how 

the 

2.  Persons: it evaluates how the organisation manages and develops the potential 

of its employees; 

3.  Partnerships  and  resources:  it  evaluates  how  the  organisation  plans  and 
manages  its  external  partnerships  and  internal  resources  efficiently  and 
effectively; and 

4.  Processes: it assesses how the organisation plans, manages, and improves its 

operations in order to create client value. 

The second group, which evaluates results, comprises the following criteria: 

1.  Results  according  to  clients:  it  assesses  what  the  organisation  is  achieving  in 

terms of external customers’ satisfaction; 

2.  Results according to persons: it evaluates what the organisation is achieving in 

terms of employees’ satisfaction; 

3.  Results  according  to  society  impact:  it  assesses  what  the  organisation  is 
achieving in terms of meeting the needs and expectations of its community; and 
4.  Performance results: it compares what the organisation is achieving in relation to 

the planned performance.  

14 

 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

Except for the fourth criterion in the group assessing the means – which relates to the 
specific processes of each type of social service – all other requirements are the same 
for all social services, regardless their nature. Disability is not specifically addressed in 
any of them, except in the model related to occupational activity centres. According to 
the  Secretary  of  State  for  Rehabilitation,  who  authored  the  introduction  to  the 
corresponding brochure (issued in 2011),25 this specific model follows the High Level 
Group on Disability recommendation to apply the EU Quality Framework to disability 
services.  No  more  recent  updates  of  the  models  included  in  this  programme  are 
publicly  available,  even  though  the  occupational  activity  centres  were  replaced  by 
activities  and  community  inclusion  centres  in  2021.  Moreover,  the  application  for 
quality  accreditation  remains  a  voluntary  decision  of  the  service  providers  and  is 
granted only for a period of three years. 

The  Portuguese Association  for Quality  (APQ),  as  a  representative  of  the EQUASS 
model in Portugal, has also developed certification processes for entities that provide 
social  services.  EQUASS  is an  initiative of  the  European Platform  for Rehabilitation 
(EPR) and has been developed on the basis of stakeholder consultations as well as 
the  voluntary  European  Quality  Framework  for  Social  Services.  The  accreditation 
process  encompasses  five  levels  of  organisational  learning  and  development,  each 
relating to a different type of qualification: ‘Committed to EQUASS Assurance’ (Phase 
1), ‘EQUASS Assurance Certificate’ (Phase 2), ‘Committed to EQUASS Excellence’ 
(Phase  3)  and  ‘EQUASS  Excellence  Certificate’  (Phases  4  and  5).  The  EQUASS 
model  includes  10  principles.  Each  principle  is  evaluated  through  detailed  quality 
criteria,  which  are  measured  through  specific  performance  indicators.  The  2018 
EQUASS model encompassed 50 criteria for evaluation, classified in 10 dimensions 
(or principles). 

Dimension 1: Leadership 

1. 

2. 

3. 

4. 

5. 

6. 

in 

The  social  service  provider  defines  and  implements  its  vision,  its  mission  and 
the  services  delivered  by  establishing  ambitious 
corporate  values 
organisations and service goals; 
The social service provider defines and implements a system for management 
that promotes a quality culture; 
The  social  service  provider  demonstrates  its  commitment  to  long-term  quality 
goals, continuous learning, innovation and new technology; 
The  social  service  provider  defines  and  implements  an  annual  planning  and 
review  process  reflecting  the  organisations  objectives  and  service  activities 
delivered; 
The  social  service  provider  demonstrates  its  commitment  to  social  justice  and 
active inclusion of persons served into the society; and 
The social service provider demonstrates corporate social responsibility through 
its commitment to sustainable activities contributing to society. 

25   Social Security Institute (2010), Model of quality evaluation of Occupational Activities Centre, 

available at: https://www.seg-
social.pt/documents/10152/13337/gqrs_cao_modelo_avaliacao/fb7d5482-1d52-43a3-aa3f-
19f82d0c909a/fb7d5482-1d52-43a3-aa3f-19f82d0c909a. 

15 

 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

Dimension 2: Staff 

7. 

8. 

9. 

The  social  service  provider  defines  and  implements  a  staff  recruitment  and 
retention policy that promotes the selection of qualified staff based on required 
knowledge, skills and competences; 
The  social  service  provider  operates  its  service  in  compliance  with  mandatory 
national  legislation  for  health  and  safety,  providing  appropriate  working 
conditions, adequate and agreed staff levels and staff ratios, and measures for 
rewarding staff and volunteers; 
The  social  service provider implements measures  for staff  development based 
on a plan for personal growth, continuous learning and development; 

10.  The social service provider defines and implements requirements for competence 
in  the  identified  roles  and  functions  of  staff  and  evaluates  them  on  an  annual 
basis; 

11.  The  social  service  provider  recognises  staff  as  a  resource  for  feedback  and 
engages  staff  in  planning,  in  the  development  of  services  and  in  quality 
improvement; and 

12.  The  social  service  provider  operates  specific  measures  that  enhance  the 

motivation of staff. 

Dimension 3: Rights 

13.  The  social  service  provider  guarantees  the  rights  of  person  served  and  these 
rights are outlined in a charter of rights that is based on international human rights 
conventions; 

14.  The  social  service  provider 

informs  and  supports  persons  served 

in 

understanding their rights in an accessible way; 

15.  The social service provider respects that persons served freely pursue personal 

goals and aspirations in line with their choices, needs and abilities; 

16.  The social service provider evaluates its performance in promoting and practicing 

the rights of persons served in all areas of the organisation; and 

17.  The  social  service  provider  has  an  accessible  complaint  management  system 
that registers and responds to complaints from persons served, purchasers and 
other relevant stakeholders. 

Dimension 4: Ethics 

18.  The  social  service  provider promotes ethical  behaviour and  wellbeing  for staff, 

persons served and their families or caregivers; 

19.  The social service provider defines and implements its guidelines on ethics, which 

ensures that the dignity of the persons served is respected; 

20.  The social service provider facilitates access to services and resources in a non-

discriminatory and transparent manner; 

21.  The  social  service  provider  ensures  services  that  operate  in  a  safe  working 
environment to ensure the physical security of persons served, their families and 
caretakers; 

22.  The  social  service  provider  operates  mechanisms  that  prevent  the  physical, 

mental and financial abuse of persons served; and 

23.  The social service provider defines, monitors and evaluates a set of principles, 
values  and  procedures  that  govern  behaviour  in  service  delivery,  containing 
aspects of confidentiality, accuracy, privacy and integrity. 

16 

 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

Dimension 5: Partnership 

24.  The  social  service  provider  works  in  partnership  with  relevant  stakeholders  to 
ensure a continuum of comprehensive services and inclusion of persons served; 
and  

25.  The social service provider evaluates the results and benefits of its partnership 

for the person served and for the organisation. 

Dimension 6: Participation 

26.  The social service provider is responsive to and supports the persons served in 

expressing individual contributions, opinions and views; 

27.  The  social  service  provider  includes  persons  served  as  active  participants  in 

service planning, service delivery and evaluation of the services; 

28.  The social service provider reviews and reflects annually on the participation of 

persons served, based on their input;  

29.  The social service provider implements specific measures for staff and persons 
served  to  understand,  enhance  and  improve  the  empowerment  of  persons 
served; and 

30.  The social service provider implements specific measures for staff and persons 

served to understand and establish an empowering environment.  

Dimension 7: Person Centred Approach 

31.  The  social  service  provider  delivers  services  that  are  responsive  to  individual 
choices, needs and abilities of the persons served and that are in line with the 
organisation’s mission, vision and values; 

32.  The social service provider has a clear concept of quality of life for persons served 
and  implements  activities,  which  are  based  on  a  needs  assessment  of  the 
persons served, with the aim of improving their quality of life; 

33.  The social service provider documents and reviews the planning and delivery of 
services  based  on  the  identification  of  individual  needs,  expectations  and 
changing circumstances of persons served in an individual plan; 

34.  The  social  service  provider  takes  the  physical  and  social  environment  of  the 
person  served  into  account  when  developing,  delivering  and  evaluating  the 
services provided to the person served; and 

35.  The social service provider involves the persons served in the design and review 

of the individual plan to ensure his/her individual contribution. 

Dimension 8: Comprehensiveness 

36.  The  social  service  provider  ensures  that  the  persons  served  can  access  a 
continuum of services spanning early intervention to support and follow up and 
that responds to changing requirements over time; 

37.  The social service provider operates services from a holistic approach based on 

the needs and expectations of the persons served, family or care givers; 

38.  The social service provider identifies and reviews the service delivery activities 

and monitors and maintains control over their quality;  

39.  The  social  service  provider  delivers  services  to  the  person  served  in  a 
community-based setting and in line with the provider’s vision and mission; 

17 

 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

40.  The social service provider delivers services to the person Criteria 40 Served in 

a coordinated way; and 

41.  The social service provider delivers services to the person Criteria 41 Served in 

a Multi-Disciplinary or Multi-Agency setting. 

Dimension 9: Result Orientation 

42.  The  social  service  provider  identifies  its  business  and  service  results  and  has 

formal periodic and independent review; 

43.  The social service provider records results, outcomes and benefits of services for 

persons served on individual and collective basis; 

44.  The social service provider evaluates results and benefits for persons Served, in 
line with its mission, in order to determine ways to improve and give best value 
for persons served, funders and other relevant stakeholders; 

45.  The social service provider measures the satisfaction of persons served and all 

relevant stakeholders by internal and/or external evaluation; 

46.  The  social  service  provider  provides  accessible  and  easily  understandable 

information on records of results, including results of surveys; and 

47.  The  social  service  provider actively disseminates  organisation performance  on 
business  and  service  results  among  its  staff,  person  served  and  all  relevant 
stakeholders. 

Dimension 10: Continuous improvement 

48.  The  social  service  provider  defines  and  implements  a  system  of  continuous 
improvement of the results of services, the ways of working and learning; 
49.  The social service provider operates mechanisms, which provide information to 

understand the needs of persons served, staff, funders and stakeholders; and 

50.  The  social  service  provider  initiates  improvement  initiatives  by  comparing  and 
exchanging  performances  on  approaches,  results  of  services,  activities,  and 
outcomes, of persons served, with other relevant stakeholders.  

In addition, APQ has developed cooperation projects with some institutions in Portugal 
to support training and preparation for social organisations in applying for the EQUASS 
Assurance  certificate.  In  addition,  between  2013  and  2015,  APQ  participated  in  the 
European Project on Transfer of Innovation of the DeSqual model, which was focused 
on the implementation of the quality systems for professional training and education 
for persons with disabilities. 

3.2  Types of services 

Through  the  Cooperation  Programme  for Quality  Development and  Safety  of  Social 
Responses,  the  Social  Security  Institute  has  developed  guidelines  for implementing 
the  quality  model  explained  above  for  some  social  responses.  The  programme  is 
aimed at public, private and social solidarity organisations that provide social services, 
but it remains a voluntary application – except for the initial and basic level, social care 
providers are not required to apply; they do so on a voluntary basis.  

• 
• 

family shelters;  
temporary reception centres; 

18 

 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

• 

• 
• 
• 
• 
• 
• 

occupational  activity  centres  (which  are  called  now  inclusion  activities  and 
training centres); 
day-care centres; 
nursery; 
foster homes for children and young people; 
residential facilities; 
residential structures for older people; and 
home-based support services.  

Four of them are part of the service portfolio for persons with disabilities included in 
the  social  responses  aimed  at  them:  family  shelters,  occupational  activity  centres, 
residential facilities and home-based support services. However, the Social Security 
Institute funds four other types of social care responses for persons with disabilities 
that are not included in the programme: 

1.  Centres  for  social  care,  counselling  and  rehabilitation.  This  response  ensures 
assistance, counselling and social rehabilitation for persons with disabilities, and 
provides training and support services to their families and informal caregivers. 
The services are provided in two formats:  

• 

• 

as  social  care  and  assistance  that  responds  to  emergent  situations  and 
consists of a set of complementary actions addressed to prevent and give 
solution of social problems presented; and 
as  social  rehabilitation  that  consists  of  the  development  of  personal  and 
social competencies to gain greater autonomy and social participation. The 
services can be provided at home, in a facility or in the community. 

2. 

Transportation  of  persons.  It  is a  personalised  service  provide  to persons  with 
disabilities who need transportation to access health and rehabilitation services. 

3.  Early childhood intervention. This response is provided by the National System 
of Early Childhood Intervention, which is constituted by institutions that work in 
an integrated manner. It is coordinated by the Ministry of Health, the Ministry of 
Education,  and  the  Ministry  of  Work,  Solidarity  and  Social  Security,  in 
collaboration with families and communities. It is addressed to children up to six 
years  old  with  functional  and  physical  impairments  that  may  prevent  their 
participation in regular activities with other children of their age, and children at 
serious risk of developmental delay. The response consists of a set of integrated 
support  measures  aimed  at  children  and  their  families  in  the  areas  of  social, 
education and health rehabilitation and prevention. The measures are defined by 
for  early 
formulate 
Local 
intervention. 

individualised  plans 

Intervention  Teams 

that 

4.  Out-patient  support.  This  social  response  is  addressed  to  evaluate,  guide  and 
provide therapeutic and socio-educational intervention to persons with disabilities 
over  the  age  of  seven.  It  promotes  socio-professional,  educational  and 
community integration. 

19 

 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

3.3  The formal bodies 

Officially,  the  Social  Security  Institute  is  in  charge  of  implementing  the  Cooperation 
Programme for the Development of Quality and Safety of Social Responses. It created 
the  model  of  evaluation  for  nine  social  responses,  four  of  which  are  addressed  to 
persons with disabilities. The model is designed to be evaluated by external accredited 
bodies  that  are  registered  and  authorised  by  the  Portuguese  Quality  System26 
(Sistema  Português  da  Qualidade  –  SPQ),  which  is  coordinated  by  the  Portuguese 
Quality Institute.27 

According to the assessment model, the organisation must organise and implement a 
set  of  documents  and  procedures  that  will  constitute  evidence  of  the  qualification 
system. The system must be documented with evidence that proves its implementation 
for at least six months. Subsequently, the organisation should prepare an application 
file and present it to the certifying body, identifying the qualification level it is applying 
for. The certifying body will assess the dossier. Once all the application requirements 
have  been  met,  an  audit  date  will  be  set.  The  final  objective  will  be  to  obtain  the 
certificate of conformity. 

3.4  Stakeholders,  experts  by  experience  and  organisations  of  persons  with 

disabilities 

There  are  three  accredited  bodies  that  are  authorised  by  the  Portuguese  Quality 
Institute to evaluate and train organisations that seek accreditation with the ISS Quality 
Model. There is no information available on who the experts are, but to the best of our 
knowledge, persons with disabilities are not part of the evaluation teams. Two of the 
bodies  mentioned  in  the  Social  Security  Institute’s  website  do  not  have  available 
information on the processes in their websites (SGS28 and APCER).29 The other one, 
Empresa Internacional de Certificação (EIC),30 includes information on the certification 
process for social responses, although it does not contain an extensive explanation of 
the procedures, teams, or partner organisations. 

Persons with disabilities are involved in quality assessment processes only in so far as 
they are clients of the services and must therefore complete annual service satisfaction 
surveys.  

3.5  Methods and methodologies 

The ISS Quality Model, which was developed by the Social Security Institute, is based 
on the NP EN ISO 9001:2000 and the European Foundation for Quality Management 
(EFQM)  models.  The  model  is  based  on  a  perspective  of  continuous  quality 
improvement, whereby three levels of demand are established for each criterion. The 
fulfilment  of  the  requirements  determines  the  level  of  competency,  and  it  allows  for 
their gradual implementation over a certain period. Thus, the model provides for three 
qualification levels (A, B and C). Although gaining certification at levels A and B is not 
mandatory, all the organisations that intend to enter into cooperation agreements with 

26   Portuguese Quality System: https://www.ipq.pt/sistema-portugues-da-qualidade/. 
27   Portuguese Quality Institute: https://www.ipq.pt/sobre-o-ipq/. 
28   SGS website: https://www.sgs.pt/pt-pt/certification#4FAAB70C21EC421CB16A90EDA10FD23F. 
29   APCER website: https://apcergroup.com/pt/#. 
30   EIC website: https://www.eic.pt/wp-content/uploads/2019/02/EICCertificacaoRespostasSociais.pdf. 

20 

 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

the  state  must  fulfil  requirements  for  the  level  C  qualification,  which  constitutes  the 
basic level. The qualification will allow, at an external level, evidence that the social 
response has a management system in place that guarantees the conformity of the 
services provided with basic standards.  

The fulfilment of the requirements corresponding to levels A and B will be voluntary 
and considered as a positive differentiation factor among the Social Responses. The 
Social  Security  Institute  will  ensure  that  information  on  organisations  that  have 
obtained  qualification  levels  A  and  B  is  made  publicly  available.  The  evaluation 
methodology  is  based  on  audits  made  by  an  external  entity  recognised  under  the 
Portuguese Quality System. To evaluate and monitor the degree of implementation of 
the requirements established for the three levels, the following audits will be carried 
out: 

• 

• 

• 

• 

• 

• 

Level C Award audit: assesses whether the Quality Management System meets 
all the requirements established for level C qualification. This audit can occur only 
after six months of operation or implementation of the conditions specified in the 
model.  If  the  Social  Response  has  partially  implemented  (not  all)  the 
requirements  corresponding  to  a  higher  level  of  qualification  (A  or  B),  it  may 
request its evaluation during the audit. As such, it will appear in the Audit Report. 
However,  the  Certificate  of  Higher  Qualification  will  not  be  issued  since  it 
presupposes the fulfilment of all the requirements established. 

Level B Award audit: assesses whether the Quality Management System meets 
all the requirements set out for qualification levels B and C. If the Social Response 
has partially (not fully) implemented the requirements corresponding to Level A 
qualification,  it may  request  its  evaluation  during  the  audit and  as  such  will  be 
included in the Audit Report. However, the Level A certificate of qualification will 
not  be  issued  since  it  presupposes  the  fulfilment  of  all  the  established 
requirements. 

Level A Award audit: assesses whether the Quality Management System meets 
all the mandatory requirements set out for qualification levels A, B and C. 

Follow-up audit: corresponds to the audits carried out annually after the level C, 
B or A qualification certificate has been awarded. Its objective is to confirm that 
the Quality Management System remains adequate and continues to meet the 
requirements established for the qualification levels A, B or C. This audit does not 
imply the verification of all the requirements and will have a shorter duration than 
the concession/renewal audit. 

Renewal audit: corresponds to the audit carried out every three years, after the 
awarding of the A, B or C Qualification certificate. Its objective is to confirm that 
the Quality Management System remains adequate and continues to fulfil all the 
requirements established for the A, B or C qualification level. 

Follow-up audits: corresponding to the audits carried out when there is the need 
to  verify  ‘in  situ’  the  implementation  of  corrective  actions  to  overcome  lack  of 
conformity detected in previous audits. 

21 

 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

• 

Extraordinary  audits:  these  are  audits  carried  out  following  complaints,  public 
participation, or significant changes in the structure of the Social Response. 

During these audits, the service provider must present evidence of the fulfilment of the 
requirements. In order to do so, reviews of paperwork will be conducted, and evidence 
of annual reports as well as of the assessment of quality of service by staff, service 
users and other stakeholders (which are also conducted on an annual basis) will be 
presented and audited. 

3.6  The indicators and the principles 

We will present the quality manual from the Social Security Institute’s model for two 
different services: occupational activity centres31 32 and home support services.33 The 
main reason for choosing these two evaluation models is that, even though both are 
social responses addressed to persons with disabilities, the terms used to refer to them 
vary. Therefore, in the first one, the introduction explicitly mentions the Declaration of 
the  European  Union  High-Level  Group  on  Disability  and  its  guiding  principles  on 
service provision for persons with disabilities. These principles include: 

• 

• 

• 

• 

the need for the existence of a quality reference of European scope, oriented by 
the total quality model, based on values, principles and reference criteria; 
the implementation of this European quality benchmark in member countries, in 
accordance with the diversity and specificity of each one; 
the  focus  of  quality  systems  on  the  promotion  and  recognition  of  continuous 
improvement,  stimulating  the  improvement  of  the  performance  of  service 
providers, in terms of effectiveness and efficiency; and 
the promotion and adoption of quality management systems and practices. 

The other manual that defines the quality evaluation model for home support services 
refers  to  the  beneficiaries  of  services  as  clients,  and  never  mentions  their 
characteristics, such as their need for assistance or their level of dependency. 

So, bearing that in mind, this report will explain each criterion within the quality model. 
Since the model is the same for all social responses for seven of the eight criteria, this 
analysis  will  focus  on  criterion  4  (Processes),  which  compiles  specific  indicators  for 
each type of response (see Section 3.1). While the EU Quality Framework highlights 
the  importance  of  measuring  quality  of  life  (and  finding  ways  to  do  it),  the  Social 
Security Institute’s model has focused on means and results.  

31   Social Security Institute (2010) Model of quality evaluation for Occupational Activities Centres 

https://www.seg-social.pt/documents/10152/13337/gqrs_cao_modelo_avaliacao/fb7d5482-1d52-
43a3-aa3f-19f82d0c909a/fb7d5482-1d52-43a3-aa3f-19f82d0c909a. 

32   It must be noted, however, that occupational activity centres have been replaced by the new 

centres for autonomy and community inclusion (CACI), as per Decree No. 70/2021 
(https://dre.pt/dre/detalhe/portaria/70-2021-160316760). At the time, the occupational activity 
centres had 24 months to adapt to the new legislation, a time period that expired on 26 March 
2023. However, Social Security has not yet published a new quality assessment manual for the 
new service. 

33   Social Security Institute (2010), Model of quality evaluation for Home Support Services, 

https://www.seg-
social.pt/documents/10152/13337/gqrs_apoio_domiciliario_modelo_avalia%C3%A7%C3%A3o/e3d
bce1e-bc28-45cd-aa61-626d1e6bbc7a/e3dbce1e-bc28-45cd-aa61-626d1e6bbc7a. 

22 

 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

For the item on clients’ results, the model requires the organisation to provide evidence 
of  the  level  of  client  satisfaction  with  the  service  in  general;  equal  treatment; 
receptiveness; accessibility; professionalism; communication and information sharing; 
flexibility; complaints management; employees’ behaviour; participation of the client’s 
legal representative, family or significant persons in the provision of the service; the 
service provided; and the relationship between the service and involved stakeholders. 
The main concern that this report identifies in respect of these types of indicators has 
to do with the source of information used, which is frequently just individual surveys 
that beneficiaries complete every year. As the EASPD study on measuring quality in 
social  services34  mentions,  people’s  perspectives  are  not  enough  to  measure 
satisfaction  with  the  service.  Apart  from  that,  the  model  also  seeks  to  identify  the 
organisation  indicators  to  measure  the  number  of  claims  received  versus  the 
responses given to clients; the time taken for claims to be processed; the number of 
training activities on communication with clients; the number of activities developed to 
involve  clients  in  improving  services  and  processes;  the  number  of  suggestions 
received  that  were  subsequently  adopted;  the  number  of  commitments  with  quality-
quality charters; the number of actions aimed at improving and boosting information 
transparency.  All  these  are  process  and  output  indicators,  rather  than  outcome 
indicators that really measure the quality achieved in respect of the lives of the service 
beneficiaries. 

Similarly, the criteria on which employees’ results are evaluated involve indicators that 
assess the level of satisfaction of employees regarding service management, including 
the  workplace  environment;  hygiene  and  health  and  safety  in  the  workplace; 
information  and  communication;  career  prospects;  evaluation  systems;  recognition 
systems;  training;  general  satisfaction;  and  motivation.  Again,  however,  the  type  of 
‘evidence’  is  not  determined  by  the  model  and  most  probably  is,  again,  individual 
surveys. Furthermore, the model requires information on several indicators that assess 
other aspects of employees’ satisfaction, including levels of absenteeism or sickness, 
staff turnover, number of training hours and number of internal promotions.  

Regarding results relating to societal impact, the model divides the criteria into social 
performance  and  environmental  impact.  The  first  group  includes  indicators  that 
measure whether the activities developed by the social service are disseminated in the 
community;  whether  there  are  ways  in  which  the  community  can  participate  in  the 
activities  planned  by  the  organisation  (such  as  plenaries,  thematic  meetings, 
celebration  events,  training  courses,  activities  planning,  activities  development, 
suggestions for improvement); whether there are actions to promote the involvement 
of  the  social  service  in  the  community,  namely  through  support  to  local  and  social 
activities; whether there are specific activities to support the community (e.g. internship 
programmes); and whether there is information collected about the community’s views 
on the social service (in relation to aspects such as the importance of the service to 
the community, the relationship between the service and the community, job offers and 
internships, the impact of the social response on the community’s quality of life). The 
second group of criteria includes one indicator relating to the environmental policy of 
the  organisation  and  requires  information  specifically  on  whether  the  service  policy 
mentions reduction of waste, use of recycled materials, material recycling measures, 

34   EASPD (2021), Innovative Frameworks for measuring the Quality of services for Persons with 

Disabilities, Brussels, available at: 
https://www.easpd.eu/fileadmin/user_upload/Quality_of_services-Report_Finall.pdf. 

23 

 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

energy-saving measures, the use of renewable energy and the degree of commitment 
to environmental standards. However, none of these criteria, whether related to client, 
employee or societal results,  is required  for the  C quality  level (the  only one  that  is 
mandatory),  which  may  result  in  restrictions  on  the  full  enjoyment  of  rights,  social 
inclusion and developing a life in a community for service users. In the authors’ view 
this  aspect  does  not  encourage  the  development  of  strong  relations  and  synergies 
between social services and the local community, contrary to the European  Union’s 
attempts to boost community-based services. 

Finally,  the  key  performance  results  criteria  include  indicators  that  measure  the 
performance of the social care service in relation to its objectives, in areas such as: 
results of key processes; impact on the promotion of the client’s autonomy; results of 
inspections; partner satisfaction; stakeholders’ involvement (for B quality level); better 
use of information technology; and results of internal and external audits (for A quality 
level). This set of criteria includes two concepts that are relevant to achieve quality of 
life for persons with disabilities and the implementation of the Convention on the Rights 
of  Persons  with  Disabilities.  One  of  them  is  clients’  autonomy,  which  should  be  an 
outcome of any kind of social intervention. The other one is the participation of different 
stakeholders in service provision. Those two conditions enable persons with disabilities 
to access other rights and gain social recognition. However, it is somewhat problematic 
when  these  key  concepts  are  not  part  of  the  set  of  criteria  that  evaluates  clients’ 
satisfaction  with  the  service.  Another  concern  is  how  the  service  provider  defines 
‘autonomy’ and ‘participation’; as the concepts are not defined in the Social Security 
guidelines,  it  is  very  likely  that  social  services  and  social  providers  understand  and 
define those dimensions differently. 

Criteria regarding key performance results further include financial execution (budget 
execution, degree of achievement of financial objectives and financial audits). 

For  getting  an  A  quality  level,  the  model  also  assesses  whether  the  organisation 
compares its previous results with the new ones for all the groups of results; whether 
the  results  are  compared  to  other  organisations;  and  whether  the  results  of  the 
evaluation are publicly available and all stakeholders are aware of them.  

For measuring means, the model has established indicators across four criteria: 

1. 

Leadership, planning and strategy: which include definitions of the mission, vision 
and  values,  and  their  correspondence  with  the  activities’  plan.  It  also  seeks  to 
identify  the  level  of  involvement  of  the  employees  and  clients  in  the  planning 
activities process, and the ways in which the plan is periodically evaluated and 
whether there are communication strategies to inform all stakeholders about it.  

2.  Persons: which evaluates whether the organisation fulfils all legal requirements 
in  staff  hiring  processes  and  whether  the  tasks  and  responsibilities  of  each 
professional and volunteer group are well defined, including how tasks are to be 
ensured  in  case  of  employee  absence.  It  also  assesses  the  professional 
adequacy  of  the  staff  and  particularly  of  the  service  director;  whether  the  staff 
underwent psychometric tests during the hiring process; and whether there is a 
welcome  manual  for  new  employees.  This  dimension  also  examines  how 
employees’ performance is evaluated, and how the organisation recognises them 
when their performance is good as expected. In addition, the dimension considers 

24 

 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

whether  the  staff  actively  participates  in  decision-making  processes  regarding 
activities  planning  and  improvement.  Apart  from  that,  as  in  other  indicators,  it 
seeks  to  assess  whether  there  is  a  methodology  to  identify  staff  satisfaction 
levels;  the  tools  used  for  collecting  data  (surveys,  interviews,  meetings,  or 
suggestions system); how the information is analysed; and the results presented 
and  how  they  are  used  to  define  new  actions  to  promote  staff  wellbeing.  It 
especially  considers  emotional  support,  mental  health  promotion  activities, 
psychological assessment and follow-up. In general terms, these indicators are 
aligned with the outline proposed by the EU Quality Framework when referring to 
staff. The main concern, in the view of the authors of this report, relates to the 
satisfaction  methodology  due  to  the  limitations  of  the  methods,  as  it  is  the 
interested  party  (the  service  provider  itself)  that  collects  and  processes  the 
information.  

3.  Partnerships and resources, which evaluates: 

• 

• 

• 

• 

Partnership  management,  which  assesses  whether  the  social  service 
regularly  collects  information  on  community  resources  and  the  existing 
entities/institutions  with  which  they  can  collaborate.  It  also  evaluates 
whether  there  is  a  specific  methodology  to  sign  memorandums  of 
agreement with community partners and whether the existing agreements 
set  up  precise  objectives  and  expected  results  according  to  specific  time 
frames; how the partners are involved in the planning process; and how their 
participation and satisfaction with the agreement is evaluated. 

The  financial  resources  management,  which  looks  at  the  financial 
performance of the social service. It evaluates whether the organisation has 
established  an  annual  budget  plan  coherent  with  the  action  plan,  and 
whether  it  reports  its  financial  situation  periodically,  making  annual 
estimates, balances and cash-flow estimates. It also seeks to identify the 
legal  and  fiscal  conditions  of  the  organisation  (corporate  income  taxes, 
value  added  tax,  and  Social  Security  and  Finances  payments)  through 
updated  registers,  regarding,  among  other  aspects,  financial  activities 
including payments to third parties, credits, loans, etc. 

Information  management,  which  evaluates  the  information  provided  to 
clients,  and  the  ways  in  which  the  staff  communicate  with  them;  the 
management  of  claims;  internal  communication;  the  registers  regarding 
personal information management; the fulfilment of habeas data legislation; 
and the management of data and documentation. This criterion evaluates 
the right to privacy and to receive dignified treatment as well as the right to 
access information. 

Equipment, facilities and resources management: evaluates accessibility for 
persons with reduced mobility and the fulfilment of the legal requirements 
for installation and operation of the social service. It also assesses whether 
the  organisation  has  established  a  maintenance  plan  for  its  facilities.  It 
further considers the equipment used for the service provision; if all of this 
is in  line  with  the  existing  legislation;  and  whether the equipment used  is 
subject to periodic maintenance. In terms of resources, it further evaluates 
whether the organisation has defined procedures to manipulate and process 

25 

 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

foods,  medicines,  and  hygiene  materials.  It  also  evaluates  whether  the 
furniture and other materials fulfil the regulations, among other conditions 
that guarantee safety for employees and clients.  

• 

Safety: which is divided into three categories that contemplate security in 
terms  of  avoiding  external  intrusion  in  the  facilities  that  can  put  at  risk 
employees and clients and evaluates if there is a security system approved 
by  law  that  can  guarantee  security.  It  also  defines  security  in  terms  of 
protection  from  abuse,  neglect  and  mistreatment,  and  assesses  whether 
there  is  a  policy  in  place  to  guarantee  clients’  rights  that  promote  their 
wellbeing and overall development. It specifically assesses whether there is 
a neglect, abuse and mistreatment prevention and management policy in 
place  for  clients  and  employees.  Finally,  it  defines  security  in  terms  of 
hygiene and a healthy space, and protection against fires.  

The  authors  of  this  report  identify  this  third  criterion  as  a  cornerstone  of  the  quality 
model since it complies with a series of items included in the personal dimensions of 
the EU Quality Framework approach, mainly regarding three domains of the individual 
outcomes: rights, material wellbeing and physical wellbeing.  

Finally,  the  manuals  we  selected  as  examples  –  home  support  services,  and 
occupational  activity  centres  –  presented  different  ways  to  evaluate  key  processes, 
which  correspond  to  the  fourth  set  of  criteria  of  the  quality  model  proposed  by  the 
Social  Security  Institute.  Processes  are  part  of  the  ‘Means’  content  block.  Although 
some indicators are different (in terms of the objectives of the service) most of them 
are similar.  

In both social services, there were criteria that evaluated: 

• 

• 

How the organisations define indicators for their key processes, whether the key 
processes meet all existing legal requirements, whether there is a definition of 
the  staff  roles  (which  is  also  included  in  the  ‘persons-employees’  dimension), 
whether  good  practices  are  taken  into  account  and  whether  the  social  service 
keeps records about all the key processes developed and whether these records 
are also included in the individual clients’ files. 

How the service users can access the service, whether the service provider has 
a  dedicated  person  for  customer  service;  whether  privacy,  confidentiality  and 
comfort  are  guaranteed  in  the  customer  service;  whether  the  service  user  is 
aware of the internal regulations, the cost of services, the admission criteria and 
how  applications  are  prioritised;  the  opening  hours,  services  and  activities 
available;  the  scope  of  the  insurance  provided  by  the  establishment;  and  the 
documentation that they must submit to apply. In addition, it evaluates how the 
selection process is done and the admission requirements defined, whether the 
living  conditions  of  the  clients  are  evaluated;  whether  domiciliary  visits  are 
planned and arranged between clients and service providers; whether there is a 
report about the home visit; and whether the client participates in the evaluation 
of her/his living conditions and health. It also evaluates how the service provider 
identifies  special  needs,  and  defines  the  services  needed  by  the  person.  This 
point also assesses whether there are defined criteria for prioritising candidates’ 
admissions. 

26 

 
 
 
 
 
 
 
 
• 

• 

Disability relevance of quality assurance systems in social services in Portugal 

How  admission  and  reception  processes  determine  the  assessment  of  initial 
expectations and needs, and how the service providers promote the participation 
of the persons and/or their legal representatives in this identification process. In 
addition,  it  addresses  whether  the  service  provider  enters  into  a  contract  that 
defines rights and duties of service users and service providers; conditions for 
the use of equipment, facilities and technical support devices; cost of services; 
activities  included  in  the  service;  etc.  Apart  from  the  contract,  this  item  also 
evaluates  whether  each  service  user  has  an  individual  file  in  which  the 
information compiled from the first stages of the admission process is included 
and  available  for  consultation.  The  personal  file  must  periodically  include 
monitoring  reports  and  other  information  that  refer  to  individual  progress.  This 
content block also evaluates how new service users are welcome in the service; 
whether there are activities and staff responsible for doing so; whether the family 
members and other significant persons can participate (in the case of the home 
support service); whether there is an information policy in place to inform family 
members and significant others about how the integration process is made (in the 
case of the occupational activity centres), among other aspects.  

Note: It is important to highlight that while in the occupational activity centres, the 
participation of the service user in the integration programme must be ensured, 
the  home  support  services  must  guarantee  the  participation  of  families  and 
significant others, but not the participation of service users themselves. 

Individual Plan: this item corresponds directly to the objective indicators of the EU 
Quality  Framework  proposal  that  refer  to  individual  assessment,  planning  and 
review. The difference between the home support service and the occupational 
activity centres is that the latter includes the definition and assessment of the so-
called socially useful activities. The Individual Plan is also more comprehensive 
in  occupational  activity  centres,  encompassing  areas  such  as  emotional 
wellbeing, interpersonal relationships, material wellbeing, personal development, 
physical wellbeing, self-determination, social inclusion and rights, while the home 
support services manual mentions only the areas of interpersonal relationships, 
material  wellbeing,  physical  and  mental  wellbeing,  social  inclusion,  and  rights, 
duties  and  obligations.  Similarly  in  both  services,  Individual  Plans  also 
contemplate  indicators  relating  to  service  provider  relationships  with  other 
organisations and entities. This report highlights this particular indicator, given its 
importance  for  developing  community-based  services.  However,  this  indicator 
applies only for those who are applying for quality level B, which means that it is 
not mandatory for all service providers.  

Whenever appropriate, according to the user’s needs, home support services may be 
required to offer and evaluate psycho-social support services. These should be stated 
in the Individual Plan, and may include the provision of psychological, legal and social 
support to the user, and information/guidance to the family. 

In both services, there are indicators to assess the actions that must be taken when 
the service user leaves the service. These may include assessing whether the user 
and the family (in the case of home support services) were included in the leave plan, 
whether records were kept of all the steps taken and whether psycho-social support 
was provided to peers and staff. 

27 

 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

In addition, the services define some specific dimensions to be evaluated. In the case 
of  the  occupational  activity  centres,  there  are  indicators  to  evaluate  whether  the 
centres  can  provide  appropriate  medical  support  to  users  who  use  medication,  and 
whether  there  is  a  policy  and  a  staff  responsible  for  the  administration  of  the 
medication,  and  procedures  in  place  in  the  event  of  emergency  due  to  secondary 
effects of medication. There is also a set of indicators relating to nutrition and meals 
that  evaluate  the  process  of  food  preparation;  the  staff  responsible  for  this  area; 
whether weekly menus are available to users; the quality and adequacy of the meals 
provided;  the  support  provided  to  users  during  meals;  and  whether  gradual  self-
determination in the nutrition process is provided to users, among other things. Finally, 
there are indicators to assess the special transportation service for users, where the 
need for an accompanying person whenever the user goes outside the service is stated 
in the Individual Plan and where the centre provides this service.  

In home support services, the dimension of personal care is evaluated in terms of how 
the personal hygiene is provided, whether it promotes autonomy and supports clients 
to  become  more  autonomous,  how  the  support  is  provided  to  persons  that  need 
medical  assistance,  or  have  had  an  accident,  and  the  procedures  to  administrate 
medicines to them. It also includes the nutrition and meals dimension, which evaluates 
similar aspects to those mentioned above for the occupational activity centres. Another 
dimension that is evaluated is the so-called ‘Instrumental daily activities support’, which 
includes an assessment of support provided with garment care, home cleaning, home 
reparations,  accompanying  persons  outside  and  using  transportation,  as  well  as 
support in the purchase of goods and services. 

Finally,  for  both  services  there  is  a  final  assessment  dimension  which  concerns 
indicators related to measurement, analysis and improvement. These indicators aim to 
evaluate whether the service has set up a methodology to monitor and measure the 
key  processes  identified;  whether  there  is  a  methodology  to  guarantee  that  service 
users, employees and partners’ views are taken into consideration for the improvement 
of the services; whether there is a methodology to evaluate service users’ satisfaction; 
whether  there  are  internal  indicators  to  monitor  the  level  of  satisfaction  of  clients; 
whether the information collected is used as input for reports and recommendations to 
implement improvements; and whether a methodology for data collection exists and 
whether it includes several sources of information and stakeholders (external audits, 
surveys,  complaints  analysis,  suggestions  analysis,  planned  monitoring  and 
measurement actions). However, all these indicators are required only where services 
are applying for level A or B, so they are not part of the standard service provision.  

28 

 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

4  The  impact of  quality  assurance  mechanisms  and systems  and promising 

practices: strengths and weaknesses 

4.1  The impact of quality assurance mechanisms  

Quality assessments undertaken under the Social Security Model are carried out by 
external entities that are recognised by the Portuguese Quality System. The level of 
certification is granted for a period of three years.  

All  service  providers  that  want  to  sign  collaboration  agreements  with  the  state,  and 
then obtain public funding for their activities, must obtain at least a level C qualification, 
which is mandatory for social services. However, the Social Security Quality Model has 
not established guidelines for all the types of social services provided to persons with 
disabilities, and, in the cases where it has defined them, the references to getting a 
poor qualification do not mention any kind of sanction, although it is mentioned that: 

• 

• 

• 

For obtaining quality level C, the service providers may only apply for an audit 
only after six months of operation; 

The audit report classifies the level of non-conformity with standards as more or 
less  critical  and  establishes  a  plan  for  corrective  actions.  The  plan  includes 
recommendations and activities that the service provider must perform to improve 
the areas/dimensions that it needs to develop, and audits may take place to verify 
in loco whether these changes have been implemented. Extraordinary audits can 
also be carried out in response to complaints or where significant changes to the 
social service structure are implemented; 

Every year,  after receiving  any  of  the quality  level certificates,  follow-up  audits 
are  planned  just  to  confirm  that  the  Quality  Management  System  remains 
adequate and continues to meet the requirements for its level. These are shorter 
audits than those intended to grant the quality level for the first time or to renew 
it; and 

• 

Every three years, after awarding the A, B or C Qualification certificate, the social 
provider can apply for a renewal. 

No references to social services being rated negatively for not meeting the principles 
of the CRPD were found. However, the authors of this report identified a few indicators 
relating to self-determination, autonomy, community-based services and participation 
within quality levels A and B. Yet, none of them are part of the basic qualification (level 
C), which is the only mandatory one. 

The reports are usually available on the websites of the service providers, but that is 
not mandatory (although levels A and B suggest making available all the information 
regarding quality evaluation). On the other hand, the Social Security Institute does not 
provide a list of social services that have obtained certificates at any level, so there is 
no statistical information on how many services are qualified.  

29 

 
 
 
 
 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

4.2  The role of human rights NGOs, Ombudsman, and other related offices 

In  Portugal,  the  Ombudsman,  as  a  state  body  elected  by  the  Parliament,  is  an 
independent entity that promotes the rights and freedoms of citizens and safeguards 
and guarantees their interests. It is in charge of watching over the enjoyment of the 
rights of citizens. It monitors the activities of the services provided by public institutions, 
administrative  bodies,  public  associations,  and  private  entities  that  exercise  public 
authority  or  provide  services.  Law  9/91  of  9  April35  defines  the  Statute  of  the 
Ombudsman. It explains, in Article 3, the Right of Complaint, through which citizens 
may submit complaints to the Ombudsman concerning actions or omissions by public 
authorities.  It  would  examine  such  complaints  and  address  the  public  bodies 
concerned and make recommendations to prevent and remedy injustice. However, it 
is important to mention that such recommendations are not legally enforceable. Among 
other powers, the Ombudsman can make inspection visits without prior notice to any 
public  entity,  including  services  providers,  regardless  of  their  nature,  and  undertake 
investigations  and  enquiries  to  produce  evidence  that  may  be  used  to  formulate 
solutions  that  might  respond  to  the  protection  of  citizens’  interests  and  the 
improvement of the administration’s activity or service provided. In 2021, the hotline of 
the  Ombudsman’s  Office  dedicated  to  the  submission  of  complaints  or  information 
requests on the rights of citizens with disabilities received 457 calls, of which roughly 
7 %  concerned  disability  social  services,  as  reported  by  the  Disability  and  Human 
Rights  Observatory  in  its  report  Persons  with  disabilities  in  Portugal.  Human  Rights 
Indicators 2022.36  

The Portuguese Association of Persons with Disabilities (Associação Portuguesa dos 
Deficientes  –  APD37)  is  a  disabled  persons  organisation  (DPO)  that  defends  and 
promotes  the  personal  and  collective  interests  of  persons  with  disabilities.  It  often 
presents  position  papers  and  offers  alternative  solutions  to  situations  in  which  the 
rights of persons with disabilities may be at risk.  

Finally, the Disability and Human Rights Observatory38 publishes an annual report with 
disability  human  rights  indicators.  It  analyses  four  dimensions:  discrimination, 
education, work and employment, and social protection and living conditions. Although 
the publication is not, per se, a mechanism for legally enforcing policies or services, it 
is a tool that enables activists, public policy makers and Governments to take action to 
promote the enjoyment of human rights by all persons with disabilities.  

35   Law 9/91 or Statute of the Ombudsman, 9 April, https://www.provedor-jus.pt/en/who-we-are/basic-

legislation/statute-of-the-ombudsman/. 

36   Disability and Human Rights Observatory (2022), Persons with disabilities in Portugal: Human 

Rights Indicators 2022, Lisbon, available at: http://oddh.iscsp.ulisboa.pt/index.php/pt/2013-04-24-
18-50-23/publicacoes-dos-investigadores-oddh/item/600-relatorio-oddh-2022. 

37   Associação Portuguesa dos Deficientes website: https://www.apd.org.pt/. 
38   Disability and Human Rights Observatory website: http://oddh.iscsp.ulisboa.pt/index.php/pt/2013-

04-24-18-50-23/publicacoes-dos-investigadores-oddh. 

30 

 
 
 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

4.3  Promising practice 

Three case 
studies 

Describe the 
type, scope and 
aim of the 
service used by 
persons with 
disabilities.  

What quality 
assurance 
systems exist? 
Is there a 
timeframe? 
What is the 
relevant 
authority? 
(questions under 
Section 3.1, 3.2, 
3.3) 

Does the quality 
assurance 
system explicitly 
address 
disability 
issues? 

Public service 

Private 

NGO 

The Vocational 
Rehabilitation Centre 
of Gaia (Centro de 
Reabilitação 
Profissional de Gaia39) 
is a semi-public 
organisation created 
through an agreement 
between the Institute 
for Employment and 
Vocational Training 
(IEFP), the 
Cooperative for the 
Education and 
Rehabilitation of 
Disabled Citizens 
(CERCIGAIA), and the 
Association of the 
Disabled from the 
Armed Forces (ADFA). 
It provides services in 
the area of vocational 
training and 
professional 
rehabilitation for 
persons with 
disabilities in the North 
region of the country. 
The organisation is 
recognised by 
implementing several 
systems for improving 
quality. It got EQUASS 
Level II status in 2006, 
2009 and 2012, and 
got the EFQM 3 stars 
in 2022. In addition, it 
has participated in the 
design of quality 
frameworks for 
professional 
rehabilitation of 
persons with 
disabilities through the 
project GESQUAL- 
Model of Quality 
Management of the 
Vocational 
Rehabilitation System 
of People with 
Disabilities. (2006-
2007), Prometheus 

Fundação COI40 provides 
services for persons with 
disabilities, older people 
and children and young 
persons. The social 
services provided to 
persons with disabilities 
include residential 
facilities, group homes 
(residência autónoma), 
and the occupational 
activity centres.   

ARCIL41 is a social 
solidarity institution that 
provides services for 
persons with disabilities 
in the areas of vocational 
training, occupational 
activity centres, home 
support, residential 
facilities, and education 
(Resources for Inclusion 
centre). 

The quality systems 
implemented and certified 
are the Social Security 
Quality Model (A Quality 
Level for the residential 
facilities, and the 
occupational activity 
centres) and the ISO 
9001:2015 (for the same 
responses + the group 
home setting). 
The Social Security 
Quality Model has defined 
a set of requirements 
regarding service users, 
but the model does not 
explicitly include disability 
issues. However, the 
model establishes key 
process guidelines, 
through which it defines 
some of the indicators 
evaluated by dimension 4 
of the Quality Model. For 

The association obtained 
the EQUASS Assurance 
in 2022 for two years, 
from July 2022 to July 
2025.  
We would like to highlight 
that the EQUASS 
Assurance model 
specifically includes two 
dimensions addressed to 
evaluate rights and 
ethics.  

The Association has 
defined a Quality Policy 
which aims to: 

• 

• 

control work 
processes; 
seek continuous 
improvement of the 
QMS based on the 
PDCA model; 

39   CRPG website: https://crpg.pt/. 
40   Fundacão COI website: https://www.fundacao-coi.pt/. 
41   ARCIL website: https://arcil.org.pt/. 

31 

 
 
 
 
 
 
  
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

(2008-2010). The 
organisation has also 
participated in the 
adaptation of the 
EQUASS model to be 
implemented by 
providers of Vocational 
rehabilitation, 
throughout the project 
EQUASS in practice 
between 2008-2010. In 
addition, it participated 
in EQUABENCH-
Benchmarking 
European Excellence, 
and EQUAVET, to 
develop collaborative 
practices between 
organisations that 
develop similar 
practices. (2008-2010 
and 2007)   

Which methods 
and 
methodologies 
were used in the 
quality 
assurance 
system? 
(questions 
Section 3.4)? 

The model in place, 
EFQM, consists of 
self-evaluation reports. 
The organisation has 
collected information 
from service users and 
partners to measure 
the impact of its 
interventions and the 
level of satisfaction 
through personal 
surveys. It also 
provides reports, 
strategic plans, 
management and 
performance reports, 
balances, planning for 
the prevention of risks 
of corruption and other 
infractions, among 
other aspects.   

instance, the Occupational 
Activity Centre Guideline 
for Key Processes, 
describes how 
occupational activities 
might improve social 
inclusion, quality of life, 
self-perception, autonomy 
and independency, and 
community life. It also 
mentions that the service 
providers should 
guarantee users’ rights, 
especially participation, 
autonomy, privacy, 
confidentiality, dignified 
treatment, equal 
opportunities and non-
discrimination.  
On the other hand, the 
model ISO 9001:2015 
seeks to value the clients’ 
perspectives, but does not 
include principles of non-
discrimination, 
representativeness of 
users, does not define 
rights and duties, does not 
evaluates an ethics policy, 
and does not evaluate 
situations of 
mistreatments, neglect, 
and abuse.  
The methods comprehend 
Satisfaction surveys 
(users, employees, 
partners), benchmarking, 
performance reports, 
balances, action plans and 
emergency plans. 

•  promote growing 

customer satisfaction; 
•  permanently seek the 
development and 
satisfaction of our 
employees; 
stimulate the 
establishment of solid 
strategic 
partnerships, and 

• 

•  encourage the 

creation of a culture 
of research and 
innovation.  

For getting an EQUASS 
Assurance qualification, 
the main method is 
based in a self-
evaluation and in a report 
with the findings. 
Subsequently, an 
external audit is planned. 
Documentation on quality 
management, diagnosis 
of clients’ expectations, 
process management, 
responsibilities 
management, sources 
management, monitoring 
and data analysis are 
part of the process.  

Personal surveys for 
employees and external 
audits are developed as 
well. 

32 

 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

How are people 
with disabilities / 
disability 
organisations 
involved in the 
assessment 
process? Are they 
consulted? 
(questions under 
Section 3.5) 

What indicators are 
used in this 
particular quality 
assurance system? 

Which CRPD 
principles are 
included in the 
quality assurance 
framework? 

Persons with disabilities 
as service users are 
consulted through 
responding to personal 
surveys on their level of 
satisfaction with the 
service provided. For 
2022, 88 % of the 
service users reported 
being satisfied with the 
service, and 93 % 
evaluated the quality of 
the training as positive.   
There are nine ‘big 
ideas’ or criteria in the 
model that underpin this 
premise and attempt to 
cover all of an 
organisation’s activities. 

1.  Leadership 
2.  People 
3.  Policy and strategy 
4.  Partnerships and 

resources 
5.  Processes 
6.  People results 
7.  Customer results 
8.  Society results 
9.  Key performance 

results 

The model is not 
especially linked to the 
UN CRPD, however, 
the evaluation of some 
criteria regarding 
participation, self-
determination, decision-
making processes, and 
transparency can be 
linked to CRPD 
principles.   

What evidence is 
there that the 
relevant quality 
assurance system 
has an impact on 
the quality of the 
social services 
delivered to persons 
with disabilities, on 
the attractiveness of 
the sector and on 
the skills of the 
workforce? 

The model includes 
criteria to evaluate how 
satisfied employees are 
with their jobs, including 
training, promotions, 
and recognition (among 
others). However, it is 
not possible to assess if 
the sector is particularly 
attractive for the sector 
workforce’s skills. 

Persons with 
disabilities, as service 
users, are consulted to 
respond personal 
surveys on their level 
of satisfaction with the 
service provided. Most 
of the dimensions 
evaluated obtained no 
less than 90 % of 
satisfaction for the 
three social services 
mentioned above.  
All the indicators 
mentioned in point 3.6 

Persons with disabilities 
as service users, are 
consulted to respond 
personal surveys on 
their level of satisfaction 
with the service 
provided.  

There is no information 
available on how else 
persons with disabilities 
get involved in the 
assessment. 
All the indicators 
mentioned in point 3.1 

The EQUASS model 
includes several 
principles related to the 
UN CRPD; this report 
highlights especially the 
dimensions of rights 
and ethics (see section 
3.1), which includes, 
among other things, 
respect of human rights, 
self-determination and 
declaration with 
commitments to rights.  

The model includes 
criteria to evaluate how 
satisfied employees are 
with their jobs, including 
training, promotions, 
and recognition (among 
others). However, it is 
not possible to assess 
whether the 
organisation is 
particularly attractive for 
the sector workforce’s 
skills, although the 

Since the organisation 
has reached an A 
quality level, and most 
of the evaluated 
criteria connected to 
the UN CRPD 
(described in 
section 3.6) are part of 
A and B Levels, there 
are greater possibilities 
to see if the service 
provider develop 
practices according to 
the Convention. 
Nonetheless, the 
model is not especially 
linked to the CRPD. 
The model includes 
criteria to evaluate how 
satisfied employees 
are with their jobs, 
including training, 
promotions and 
recognition (among 
others). However, it is 
not possible to assess 
if the sector is 
particularly attractive 
for the sector 
workforce's skills. 

33 

 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

organisation has 
provided a link in their 
website in which people 
interested in working 
with them can submit 
their CV. 

4.4  Analytic reflection 

There are three models in place in Portugal for quality assessment: the Social Security 
Institute’s  Model,  EQUASS  and  ISO  9001:2015.  The  first  one  determines  a  set  of 
criteria  that  should  be  fulfilled  by  organisations  that  provide  a  certain  service  for 
persons  with  disabilities.  However,  the  model  contemplates  just  four  out  of  eight 
existing  social  services  for  persons  with  disabilities  in  the  country.  Since  the  Social 
Security Institute has designed specific guidelines for each service, those not covered 
on the list are outside of this monitoring system. This Quality Model provides different 
levels of qualification. The basic one is insufficient to fulfil human rights, but it is the 
only one that is mandatory. If a service provider decides to stay at that level forever, 
no sanctions oblige it to take measures to advance to get a better qualification. In other 
words,  it  depends  on  the  willingness  of  the  service  provider  to  develop  actions  to 
improve its practices. For instance, the level C qualification does not consider any of 
the  results  criteria,  which  are  those  more  closely  related  to  human  rights,  such  as 
participation,  protection  against  mistreatment  and  abuse,  empowerment,  self-
determination  and  autonomy,  among  others.  Moreover,  the  results  criteria  also 
contemplate the strengthening of the community-based services, which are a condition 
for independent living.  

EQUASS  is  the  assessment  model  that  better  addresses  disability  rights  issues  by 
including two blocks of criteria related to rights and ethics. Apart from that, the model 
has  considered  person-centred  services  and  explicitly  promotes  self-representation 
and self-determination. Although the model is more comprehensive regarding a rights 
emphasis,  it  is not  mandatory  but  voluntary. In  addition,  the  EQUASS  methodology 
starts with a self-evaluation in which employees of the organisation are involved but 
not service users. It is therefore a methodology that is demanding of staff resources 
and questionable in terms of service users’ involvement in the evaluation. 

Finally, ISO 9001:2015 provides a framework for improving and implementing quality 
practices but it does not focus on human rights issues. It instead prioritises strategies 
to respond to social demands on services and determines preventive actions for facing 
risks.  However,  it  is  not  concerned  with  promoting  empowerment  or  participation  of 
service users in the monitoring process, although it contemplates collecting information 
from  clients.  Although  the  model  does  not  respond  to  disability  issues,  some 
organisations get this certificate as it provides evidence of great efficiency and efficacy 
in processes and accountability. 

In addition to these shortcomings, specific to each model, there is an underlying issue 
that is common to any quality assessment process. According to information gathered 
by the authors, these systems tend to demand considerable paperwork and to be time 
consuming.  Social  care  organisations  are  typically  short  of  human  resources  and 
complying with the requirements of any certification model often diverts attention from 
providing  direct  quality  care.  Collecting  quality-related  evidence  becomes  at  times, 
paradoxically, a task competing with service provision itself. In these systems, users 

34 

 
 
 
 
 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

tend to be excluded from assessments and even more from decisions about service 
improvement – apart from filling out an annual survey, they continue to have very little 
say in the services they get and how those are provided. However, given the scarcity 
of social services, especially for adults with more severe disabilities in this country (who 
now tend  to  live  longer too), users (and  their  families) often  accept  low-quality  care 
provision  and  still  provide  a  positive  evaluation  to  services  that  indeed  are  of  poor 
quality. 

35 

 
 
 
Disability relevance of quality assurance systems in social services in Portugal 

5  Recommendations  

5.1  Recommendations for Portugal 

The Social Security Institute’s Quality Model must be revised. The last time the model 
was reviewed was in 2010; by then, the CRPD had been in place for just one year. 
Manuals for all social services for persons with disabilities need to be developed and/or 
updated, establishing specific indicators that address disability rights issues, especially 
those  regarding  participation,  empowerment,  self-determination,  social  inclusion, 
independent  living  and  community-based  services.  In  the  new  guidelines,  the 
participation of persons with disabilities must be ensured in the assessment processes 
at  all  levels  (as  service  users  but  also  as  auditors,  through  disability  representative 
organisations). 

We also strongly suggest that the basic quality level in this system includes a human 
rights approach.  

The Social Security Institute and the National Institute for Rehabilitation, as national 
entities  that  supervise  service  provision  and  the  implementation  of  the  National 
Strategy  for  the  Inclusion  of  Persons  with  Disabilities  2021-2025,  should  provide 
training in quality services and quality models for social service, and establish special 
funds for supporting small and medium size organisations that offer social services for 
persons with disabilities in their continuous quality assessment and implementation. It 
is  important  to  create  human  capacity  within  organisations  to  carry  out  quality 
assessment processes and guarantee continuous improvement practices. 

5.2  Recommendations for the European Commission 

At the European level, the authors of this report suggest that the Commission provides 
easy-to-follow  guidelines  regarding  quality  services  for  persons  with  disabilities  that 
every  organisation  and  service  provider,  no  matter  its  capacity,  can  follow  and 
implement. We understand that there are several difficulties in implementing a unified 
model. Still, by providing essential guidance, service providers can implement actions 
to improve their performance according to a human rights approach. 

This report also suggests that organisations that access European funds and provide 
services  for  persons  with  disabilities  are  subject  to  monitoring  and  assessment  by 
European bodies. A minimum level of quality, which includes human rights indicators, 
should be a requirement to apply for EU funds.  Inspection visits and audits should be 
planned periodically to verify the conditions in which services are provided. In addition, 
the European Commission may collect information regarding the satisfaction of service 
users  and  process 
the 
projects/actions/programmes implemented by those organisations. 

information  as  part  of 

final  evaluation  of 

the 

the 

36 

 
 
 
 
 
 
 
 
 
 
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