When health secretary Andy Burnham used a speech to healthcare charity the King's Fund in September to say the NHS was the preferred provider of health services, it plunged some charities into confusion and anxiety.
The issue flared up again last week when left-wing pressure group Progress said Burnham risked "alienating" the voluntary sector. Burnham's move away from the previous 'any willing provider' policy appeared to contradict Labour's oft-repeated pledge to increase the proportion of public services run by voluntary organisations. It also left charities wondering what local commissioners would make of it all.
Paul Farmer, chief executive of mental health charity Mind, whose local networks derive three-quarters of their income from health and social service contracts, said the Government needed to provide clear, unequivocal guidance. "We would be concerned if, at just the point when the sector is being encouraged to consider more commissioning, the door is slammed in its face," he said.
A Department of Health spokeswoman did little to settle his nerves. She told Third Sector primary care trusts were expected to "engage with a range of potential providers". But she added: "Where existing NHS services are delivering a good standard of care for patients, there is no need to look to the market."
A spokesman for shadow health secretary Andrew Lansley said the Tories would stick with 'any willing provider'. "We think competition is a good thing and are keen to get voluntary sector providers running more health services," he said.
But Mike Hobday, head of campaigns, policy and public affairs at Macmillan Cancer Support, said he supported Burnham's stance. "We have concerns about the amount of competition that has taken place in the NHS," he said. "Services can become fragmented and inconsistent."
Trade union Unite, which has 60,000 members in the not-for-profit sector and was holding its annual conference last week, was delighted by Burnham's comments. It said high staff turnover, low pay and short-term funding at charities meant they were ill-equipped to run services.
This provoked an angry response from Peter Kyle, deputy chief executive of chief executives body Acevo, a strong advocate of charities running public services. Kyle said the union's views on charities were "insulting and ignorant".
And he added that Burnham's comments were "profoundly worrying".