The right initiative at the right time

Jonathon Fagge, Chief Executive Officer of NHS Norwich CCG, on the planning challenges facing CCGs:

THE integration of health and social care is presented by many as the best solution – the answer – to a wide range of challenges faced by the NHS.

It has moved gradually from early pioneers, through to think tanks, to National opinion leaders, and now into National policy. The Better Care Fund will drive health and care systems to look again at their models, and will significantly increase the pace of change.

So if integration is the solution, what is the problem?

The challenges are many, but can be grouped into two overarching imperatives – quality and money. These two are sometimes considered two sides of the same problem; that quality inevitably suffers when money is constrained. This is intuitively rational but ultimately false, because it assumes a steady state in the model of care, and ignores the potential for innovation to improve both at the same time: We could argue that the speed by which a crop can be harvested is limited by and dependent on the number of trained farmhands and the number of sharp scythes; but only until someone invents the combine harvester.

Full health and social care integration, as an idea, is a genuine and major system innovation. It has the potential to deliver significant quality gains and efficiency at the same time, through the reduction of duplication, error, failure, and waste. It may successfully address the growing tension as demand growth exceeds funding growth, and equip local health systems to more consistently deliver great compassionate care. And it does not require a leap into the unknown, but only to harness innovations that already exist, and designs of effective care that have already been proven.

Unified information systems, communication technology, single models of assessment, the more rapid availability of individual packages of care, and comprehensive 7 day working may be culturally radical, but they are technologically mainstream.

My son can buy customized trainers on line, with his name stitched on the tongue. He can track the parcel across Europe to our door, and can use email to feedback on the customer experience. Last week I watched a nurse photocopy a referral form for the dietician, write it by hand, put it in the post tray, tick off the task in an A4 ward diary, and then open a lever arch file to write what she had done in the patient notes. My mother was a ward nurse in the 1960s and I suspect she would have found the medical care transformed, but the paperwork very familiar. We should not accept the claim that the answer is simply to spend more money to make the existing inefficient model struggle on.

Since the Integration Transformation Fund was announced in August, we have been talking to the many stakeholders affected by the integration agenda; our Citizens, Members, Providers, Local Government, and our Voluntary and Community groups.

Earlier this week we presented the findings to our Governing Body and have approval to develop an ambitious transformation programme to fully integrate health and social care in Norwich. This will far exceed the financial parameters of the Better Care Fund; our entire Community and Social Care budgets need to be aligned to the model, and the majority of our clinical and managerial capacity and talent will be focused on delivering the vision over the next two years.

The timelines are – as always – a real challenge. But this is the right initiative at the right time, and we hope to use this call to action: clinical commissioning and system partnership to build an effective and sustainable model of health and social care for our fine City.


Jonathan Fagge

Jonathon originally qualified as a Barrister in 2005, and then joined the Pharmaceutical Industry – working across licensing, marketing, finance, legal and compliance. He left the industry in 2001 to set up a consultancy firm, and worked with NHS customers across the East of England – General Practice, NHS Providers; and PCTs. Services were focused on business development and organisational efficiency; large scale procurements; health system development; and GP Appraisal and Revalidation.

In 2010 Jonathon joined Norwich Practice Based Commissioning Group, and managed the transition to CCGs. He worked with the shadow CCG in Norwich as Programme Director, then Deputy Chief Officer. He was appointed Chief Executive Officer in August 2012.