Published: 17/02/2005, Volume II5, No. 5943 Page 24

Stephen Collinson, director of healthcare, Sue Ryder Care

Sue Ryder Care is all too aware how important it is for charities and statutory bodies to make their relationships work equitably (news analysis, pages 14-15, 27 January).

Currently, the future of critical and vital care across the voluntary healthcare sector is under pressure, with Sue Ryder Care alone needing to raise£7m from voluntary donations to close the shortfall in statutory funding in 2004.

We recently launched a campaign entitled We Care: Who Pays? to address this. We fully support the National Council for Voluntary Organisations' stance that statutory service commissioners who require the voluntary sector to deliver care to standards determined by national inspection bodies should meet the full cost of those services.

We Care: Who Pays? also calls on the government to:

support the fact that money the charity gains from donations should be used to develop new services, maintain facilities and offer support to those in need - not meet statutory shortfalls;

introduce a tariff pricing system for voluntary and NHS providers by 2006;

ringfence funds for palliative care and re-assess cancer networks' role in the regional allocation of funds;

commit to additional funding of at least£100m for voluntary sector healthcare by 2006;

introduce as standard more appropriate assessment tools to establish the full cost of care;

provide a clear and defined pathway of palliative care to enable voluntary providers to plan and develop services appropriately and effectively to universal benefit.

There is still a lack of understanding among some in the statutory sector that the service user's needs will increase over time, usually incurring a higher cost for care. Consequently much of our time and effort is wasted on contract renegotiation every year.

Due to the short-term nature of current commissioning practices, we are often forced to work without clear direction, strategy or focus. We want to work in partnership as part of local networks with statutory commissioners and other agencies and providers to plan for need over time.

I know I will not be alone in feeling that there is still a sense of paternalism at work in commissioning - that by providing payment in grant form, somehow the state is doing charities a favour - when the bottom line is that if services are provided to an agreed standard, why shouldn't costs of care be fully met?