- Will the Government implement the Public Services Action Plan properly?
The words currently on the lips of most charity chief executives are 'public services'. Many will already have discussed with their trustees how they are going to react to the Government's public services agenda, expected to be unveiled in an action plan in early December, and whether or not they are prepared to get into bed with the state and start delivering statutory contracts.
Simon Gillespie, chief executive of the MS Society, is no exception.
The MS Society already provides some services for the state: respite care for people with advanced multiple sclerosis and specialist nurses. Gillespie is now thinking about the next step.
"We're actively considering it," he says. "Our trustees have already had several discussions about the issue over the course of last year and we'll have another one later this year."
In recent months, the public service delivery debate appears to have polarised into two camps: the Blairite camp in favour of transferring large chunks of public services over to the voluntary sector, and the Brownite approach that charities can help spread best practice to statutory organisations. Gillespie brings a third suggestion to the table.
He sees the MS Society acting as an agent for change - setting up, at its own expense, services to help its beneficiaries gain access to the care they need. After a certain time, the services and their accompanying costs will be passed over to the state.
"We're prepared to invest for change," he says. "There's an extent to which we don't mind helping out a bit, because our donors and supporters expect us to be part of delivering good services for people with MS."
This approach undoubtedly sets off a number of alarm bells with those who wax lyrical about how the sector should not be a cheap alternative to the state. On the whole, Gillespie agrees. But he's also a realist.
He knows that charities can talk as much as they like about how the NHS needs to change its ways, but at the end of the day actions always speaks louder than words.
"The NHS is a beast that is very, very slow to change and innovate," he says. "I spent 18 months working as a healthcare commissioner - I know how difficult it is to change; but improvements can be made."
In the case of MS Nurses, the MS Society stumped up £4m of charity cash to ensure that its members got the type of specialist nursing they needed.
It did that on the basis that primary care trusts would take over financial responsibility for the nurses after three years. "We're prepared to innovate, but investment to sustain has got to come from government," Gillespie stresses.
It sounds like a simple formula but in some cases, Gillespie admits, things haven't always gone to plan. He has heard of PCTs making their MS nurses redundant after the three-year period was up. In other areas, they have also been moved to general nursing duties. "When the Government makes that kind of commitment, then it has got to live up to it," he says.
The Public Services Action Plan will no doubt contain plenty of colourful language from central government about using the skills of the voluntary sector to improve services for society.
That will get them a certain distance, says Gillespie, but when it comes to the crunch it has to be about how things happen at a local level. More importantly, he adds, the Government has to start paying its way.
"I think there's enthusiasm to use our skills and creativity for the benefit of people in many quarters of the sector," he says. "But despite what's being said on a national level, just about every organisation you speak to that is operating at a local level is still coming across unpaid bills."