Developments in health care technology and rising patient expectations coupled with significant organizationalchanges have led to a dramatic increase in home enteral tube feeding. There are a variety of ways in which such a service can be provided within the existing national funding framework. However, it is not always possible to realize this potential at local level. This paper describes current funding arrangements and some of the constraints thereby generated in service delivery. The drivers for change are identified together with criteria for a patient-focused home enteral tube feeding service. An innovative approach to these challenges has been adopted by one health authority in response to patient needs, staff concerns and clinical governance requirements. The ‘Avon Scheme’ is the result of viring funding from primary to secondary care and concurrently, abandoning the National Health Service prescription route. This has led to economies generated by larger scale purchasing. The savings thus realized have been reinvested in a comprehensive scheme resulting in an equitable approach to service provision, improved patient satisfaction and enhanced clinical care.