Addressing the needs of a clinical service in the operational constraints of commissioning

Limited resources, increased demand and current commissioning structures has put the rationalisation of health care high on the agenda. Any prioritisation process needs to be clinically led and client driven so reactive ad hoc arrangements are minimised and structures for good practice enabled. This paper argues that the current context be used as an opportunity to critically evaluate the services speech and language therapy aim to provide. By defining our aims and demonstrating the range and boundaries of our effect we can be proactive in structuring our services appropriately. Such an exercise currently underway in City and Hackney is outlined which aims to: describe an optimum structure for provision and the resources required, propose possible models within current resource and highlight the gap between the two.