Almost every meeting that I attend examining aspects of health
services at some point deteriorates into paralysis when the “f”
word is used to defend, attack or rationalise decisions.
Funding is an issue which can distract lots of practitioners
from the work they signed up to do in health care. In both
statutory services and the non-statutory sector, it takes a
considerable effort to keep focused on need, when reward might be
based on other concepts of outcomes. Although some funds might be
allocated by social deprivation, rurality, age and so on, there
seems to be little equity when it comes to non-statutory
So how can the voluntary or non-statutory sector convince
commissioners to have confidence in them? Successful voluntary
services might even pose a threat to the ongoing delivery of some
One lesson that statutory services might take is that in the
voluntary sector, people aren’t afraid to stop doing things that
don’t work. There is an expectation of NHS trusts to deliver
national targets through an increasingly complex system, but in
many areas this seems to be “as well as” rather than “instead
The non-statutory sector is often well placed to deliver on
national targets, but because of funding routes or perceptions of
value, these data do not get to the bean counters’ desks. Many
non-statutory services are usually closer to their communities,
more integrated, more easily accessed and more cost-effective.
However, it’s not a competition, although it can certainly feel
like it when you are constantly making repeated bids against other
providers for funds to survive. This is worrying for the people who
receive these services, and the people who work within them. It’s a
damaging process, which like a free-floating anxiety, never seems
to go away.
If some underpinning values of services are to help improve
quality of life, reduce suffering and help people manage their
experiences, then couldn’t these values be evolved into outcomes
which are “commissionable”? If funding was to follow the client,
and services were founded on the values of what makes sense to
clients and their families, then we might see a very different
landscape of health and social care economies.
So, is it time to challenge custom and practice? Is it time for
commissioners to cut a new path rather than taking the one of least
resistance? Or are we to be forever clutching at straws, and often
drawing the short one?
Chris Coates is team manager of the Rural Emotional
Support Team in Staffordshire.