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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 services.

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 statutory services.

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 of".

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.