A View from the Top
David Coull

David Coull is Chief Executive of Coverage Care, and Chair of the National Care Forum.


Social care: We are seeing significant changes in the sector that have been anticipated at least 10 years. Especially changes to residential care commissioning. There is more focus on discretionary and non-discretionary spend by local authorities. Within the difficult financial circumstances, where they can delay spending money they will. Providers unprepared to respond and adapt their service offering are experiencing obsolescence as key funders aren’t supporting traditional residential care.

Organisation: We spotted these changes. When we took over the original Shropshire, Telford and Wrekin local authority care homes, much of the contract was unsustainable: day services and meals on wheels. We refocused, invested in specialist staff training and development and developed state of the art nursing homes providing a fuller continuum of care including dementia. Over the last decade we have doubled in size, modernised the organisational structure and developed a fully-integrated governance structure we can be proud of. We have the best of both ‘worlds’ (voluntary and independent sector), while retaining all of the ethics and objectives of a not-for-profit.

Career: This is my 40th year in the sector. I started in a long-stay psychiatric hospital and trained as a nurse when I realised I couldn’t be a marine. I worked in the NHS for 20 years leaving as Corporate Director of a community trust. I worked as an executive director in care, housing and health organisations until I joined Coverage Care as Chief Executive in 2003.


If sense rather than other interests prevail we should move further towards integration. The driver has to be managing long-term conditions, starting with integrating personal budgets (PBs) and personal health budgets. This could impact quickly. However existing barriers, including professional attitudes and costs to individuals must be addressed.

NHS commissioning can make efficiencies and economies. We must stop restructuring commissioning ‘agencies’. It costs a fortune, loses quality individuals and distracts organisations.

Services delivered via PBs must be directed by or exclusively on behalf of the individual. We must be more creative about developing, deploying and sharing scarce or difficult to recruit staff. We are often desperately trying to outbid competing providers, constructing false boundaries and constraining the innovation we need.

I’m positive about the future. Austerity is an impetus for change. Increases in health funding in the 1990s showed additional money doesn’t always drive innovation. People want services delivered differently. Less of the same won’t do.


Honesty counts. Personal and professional integrity is essential. I’m really proud of our organisation. The privilege of operating a not-for-profit enables us to have open discussions with our communities and stakeholders. We don’t have infinite choice but we have added flexibilities which we’re committed to using in the interests of current or future, service users.


My old senior nursing officer, who before coaching and mentoring programmes were so common (in the late 70s) spotted in me something and ‘sponsored’ my career development. We can all identify rising stars and shouldn’t feel threatened by them. They are our future.


Don’t spend your time making yourself busy. There is rarely any correlation between speed of conversation and busyness and quality output. Reflect and focus on what you’re trying to achieve as you’ll have more chance of achieving it.


Apply a simple logic test. If it looks too good to be true, it probably is. If it doesn’t look right, it probably isn’t. If you don’t understand you are probably not alone. If it can’t be explained clearly it is unlikely to be actioned wisely, keep asking questions.

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