Executive Medical Director Blog: December 2023 – Dr Frankie Swords

18th December 2023

Well, the festive period has crept up on us again in the midst of our planning and preparations for the winter period. But looking back over the past year, we have made some impressive strides across our health and care system, so I’d like to take the opportunity to thank you all for your continued hard work and achievements made this year.

In my last blog of 2023, I’d like to focus on the following key updates:

  • clinical strategy
  • prioritisation
  • carers passports
  • dentistry

But before I address these achievements and updates, as you know, the BMA rejected the government’s most recent pay offer with junior doctors set to take industrial action over the Christmas period and into the New Year.

Industrial action is due to take place on:

  • 07:00 on 20 December until 07:00 on 23 December
  • 07:00 on 3 January until 07:00 on 9 January

This will coincide with one of our busiest periods, but we have well prepared plans and we will again use the learning from previous periods of industrial action.

NHS staff have been working extremely hard to prepare for and mitigate disruption and we are prioritising urgent and emergency care, but there is likely to be significant impact upon local services. Many of us have also been working differently in recent weeks to really speed up how quickly ambulances can hand over their patients when they arrive at our emergency departments. This is making a huge difference, speeding up how quickly our ambulances get back out on the road and reducing the waits for people in need in our communities, although it does mean that we have more escalation areas open in our hospitals again which none of us like. This incredible hard work and the knock-on effects of it were recognised in a letter from Steve Powis, Ruth May, NHSE, CQC, GMC and NMC last week. This outlined the actions we should all be taking to prepare for Industrial action but also importantly it acknowledged the need to work differently and “to adapt practice at times of significantly increased pressure” to offload ambulances in a timely fashion.  

Our focus as a health and care system will be on maintaining emergency and life-preserving care during industrial action, and in terms of elective activity, we will be seeing and treating those patients with the greatest clinical need and minimising the cancellations as far as possible.

We will of course have to cancel and rearrange a number of appointments to allow staff who would have been doing them, to cover the work usually done by our junior doctors. But, where appointments have had to be cancelled, these will be rescheduled as quickly as possible. We urge people to be kind and respectful towards our staff needing to reschedule elective care appointments.

We also continue to encourage patients to choose services wisely and take simple steps to help ensure care is available to patients who need it most, but still to come forward if they really do need emergency help. This includes using 111 online as the first port of call for health needs and continuing to only use 999 if it is a life-threatening emergency.

More information and guidance on upcoming industrial action can be found here.

Clinical strategy update

The 5-year Clinical strategy for Norfolk and Waveney, was published back in July 2022, based on the experiences, hopes and ideas of the patients who use the NHS, the staff that work in it, and the communities that it serves.

The strategy outlined six key objectives, which was that my NHS in Norfolk and Waveney would:

  • tackle health inequalities,
  • see me as a whole person,
  • be one service,
  • reduce long waiting times,
  • act early to improve health
  • to be reliable

We published a progress report against Year 1 in July 2023, which can be found here.

We undertook a huge array of work in year one, with 34 actions, many of which have now been completed or built into business as usual for our teams.  

Our ambitions for Year 2 are simpler and each of the 6 Objectives, has a specific focus for year 2:

We have included the 10 actions from year 1 to be carried over, and we have cross checked where there is overlap with the Joint Forward Plan (JFP).

More detail on our progress against these will be published every 6 months on the ICS website.


Our NHS Norfolk and Waveney ICB budget is over £2 billion every year, but demands are ever increasing with huge opportunities to undertake competing pilots, new services and transformation work. We have committed to being transparent with how we spend and allocate our resources and it is imperative that these decisions are made strategically and supported by clear evidence-based decision making.  

So, with this in mind, the ICB has approved a prioritisation process and cycle which will be introduced to influence and help shape the health and care system’s 2024-2025 plan and beyond. This process is designed to make sure we are using our time and resources to focus on doing the right things at the right time to maximise the benefit for patients.

This means that all transformation and change ideas which required investment or have the potential for future cost pressure will go through the process. This includes:

  • Investment, Transformation and Cost Pressures
  • Forthcoming Procurements or Contracts
  • Cessation or Decommissioning of Services

The prioritisation matrix was first developed by our Project Management Office, with input from nearly 300 stakeholders from across our system. The process has been refined in two trial rounds and the first deliberation panel will be on 19 December 2023, which is in time to align with the 2024-2025 planning cycle.

There will be quarterly deliberation panels which will review and rank all change opportunities with subsequent panels in March, June, September, and December 2024 to help shape future system plans.

This means that we review all aspects of a project before deciding which schemes or services we will commission. This includes considering:

  • evidence base,
  • ethical considerations including impact on health inequalities,
  • workforce considerations,
  • financial implications (e.g. if there is short term funding but no long-term funding for a project – is it still affordable long term?),
  • operational considerations,
  • forward looking considerations,
  • access to health services,
  • health outcomes

So, moving forward this will help us to make better long-term decisions about how and where we spend our money as a system, and help all of our providers understand and contribute to this process.

Carers passports

This is a great news story which has really helped our system.

At our board meeting last month, we celebrated 12 months since we launched carers’ passports. These passports enable individuals looking after family members or friends to be recognised as a carer when they are in healthcare settings and to receive the support they require.

The Carers Identity Passport is currently recognised in NHS organisations across Norfolk and Waveney, and I am pleased to say that we have now issued over 2,000 passports, helping to recognise the voice, expertise and input that our unpaid carers give to so many members of our community.

In recognising the massive value that these individuals contribute to our system – and by listening to what they can tell us – we are improving and speeding up the care of those that they love and care for.

So, please recognise the card and purple lanyard when you come across people wearing these and ask them for their input. And when you come across other people accompanying a patient, please don’t be afraid to ask: “Do you look after someone?”

And if so, encourage them to have a look at the Carers Matter website to find out more, as our census data indicates that there are actually 180,000 carers of all ages across Norfolk and Waveney.


Changing tack, I’m sure we are all aware of the massive issues facing our community with the lack of NHS dentistry across Norfolk and Waveney.

Since this has come across to the ICB in April of this year, I did want to highlight the work led by our Director of Primary Care, Sadie Parker, and her team to improve emergency access with protected slots for urgent care and children, stabilising our workforce, as well as longer term work lobbying for a new dental contract and to expand dental training. Longer term, the vision will be to improve prevention and maintaining oral health particularly in children and high-risk groups.

The ICB’s one-year Short Term Dental Plan for short term interventions will address urgent priorities and begin to improve patient access to dental services. It was approved by the ICB’s Primary Care Commissioning Committee (PCCC) on 12 September.

A copy of the plan is available here. It includes five key areas that the ICB can now work towards to help stabilise services and to improve patient access to dental services.

As a local health and care system, we are investing £1.05m to improve access to urgent dental treatment. To do this, we are working with local dental professionals and have agreed additional funding to ensure more urgent dental appointments are available through an Urgent Treatment Service.

This will see urgent appointments provided by 20 dental providers across 27 locations in Norfolk and Waveney. This was set up from October 2023 and is available for referral by NHS111 following clinical assessment of the individual’s need for an urgent appointment only.

In addition to the above investment, we are also going to expand the current out hours service. We are aiming to both significantly increase the availability of appointments for people needing urgent treatment and to provide appointments across Norfolk and Waveney.

Our current out of hours provider of dental services in Norfolk and Waveney has offered to expand their services at weekends and bank holidays, as well as to provide an additional session per day, Monday to Friday, at their new site in Norwich. This dental provider has also expressed an interest in being involved in the pilot for direct booking from NHS 111. In addition, we are supporting practices to become more child friendly, and also considering proposals to expand urgent treatment capacity at weekends and bank holidays across Norfolk and Waveney.

Finally, I would just like to round off and extend a personal “thank you” to all colleagues working over the period. Your hard work and dedication, over what has been a challenging year, does not go unrecognised. I wish you all a very, merry Christmas and a happy, healthy New Year.

Best wishes,