My practice

    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.

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