Medical Director Blog: August 2022 – Dr Frankie Swords

11th August 2022

It’s just over a month since I started my new post with NHS Norfolk and Waveney, in a new role on the Board as Medical Director. It’s been brilliant to get out and about to meet so many of you in person and on the screen and I’ve been really struck by the sheer will and determination to do what is right for people and communities across Norfolk and Waveney. I’m definitely seeing a huge desire to continue and do much more to work together, as one.

So, I thought it would be useful to start by reminding you what an Integrated Care System (ICS) is all about, why things need to change and how we want to do things differently now that the ICS is in place.

What is the ICS?

On 1 July 2022, England was divided into 42 Integrated Care Systems (ICSs). These are a partnership of health providers, steered by NHS Norfolk and Waveney, which is responsible for NHS performance and finances: and all other providers of care including the public health and adult and children’s social care provided by the county councils of Norfolk and Suffolk, our Voluntary, Community and Social Enterprise organisations (VCSE) and other care providers. Bringing it all together, the four pillars of our ICS are as follows:

  • NHS organisations
  • Local Authorities – counties, boroughs, and districts
  • VCSE organisations
  • People and communities – the people we are here for, to help improve their health and wellbeing.

ICS’ exist to:

  • improve outcomes in population health and healthcare
  • tackle inequalities in outcomes, experience and access
  • enhance productivity and value for money
  • help the NHS support broader social and economic development.

And our local goals are:

  • To help people to live as healthy lives as possible
  • To tell your story only once
  • To make N&W the best place to work in health and social care

Clinical and Care Professional Leadership

Norfolk and Waveney ICS is committed to put quality at the heart of all we do. We want to ensure that we work with patients and our communities to design services with them. But, we also want to harness the voice of our clinical and care professionals (CCPs) in all of our decision making and structures. We know that CCPs are on the front line every day, and they often have the best ideas for what would make their services better. So, we’re committed to support our CCPs, to build a community of leaders across health and social care. We want to give them the training, tools and support to innovate. Over the last month I’ve held a series of open sessions to launch our draft CCP framework and to review what our CCPs want us to do, to really bake this voice into NHS Norfolk and Waveney and the wider ICS.

The next step is a workshop to be held on September 8 for existing CCP leaders to thrash out the detail of how we do this, and we have a series of masterclasses, staring 27 September. If you’ve not received a direct invitation but would like to attend any of these workshops, please contact Jane Bacon by email ( who can add you to our circulation list.

Communication and how I can support you

Our system and all of us remain under huge pressure at the moment, with what feels like impossible and competing demands some of the time. So, it’s more important than ever for us to listen to each other and to support each other professionally and personally. This month I held my first open meeting for all medical staff across our system – our MD medical staff meeting (MDMS). Thank you to everyone who was able to make it, and please come along next time so that I can share any live updates from the ICS and so that I can listen to any concerns or ideas that you have. I really want us to work together and put everything we’ve got into helping people lead longer, healthier and happier lives.

Current Priorities

Longer term, we absolutely want to focus on providing personalised, person-centred care, and moving more to prevention as opposed to just crisis management. I’m optimistic that the use of new digital tools and population health management techniques, and to move to system by default will really help cut out waste and avoid duplication.

But, right now, there are a few really pressing issues that we are focusing on as a matter of urgency.

Here’s a snapshot at some of our key challenges:

  • Exiting SOF4 or Recovery Support Programme – as a system we’ve been placed in the Recovery Support Programme (previously known as special measures). We’ve been set 4 tasks by NHS England to exit this: at least one of our providers to exit special measures which we’ve already achieved; improving urgent and emergency care performance; reducing mental health delays and improving our financial position as a system. So, these are key priorities for us to focus on as a system.
  • Urgent and emergency care pressures – we recognise that some people are waiting too long for emergency care and are coming to avoidable harm while they are waiting for an ambulance, or indeed having to wait when they arrive in the grounds of our hospitals. We also recognise that hospital admissions are associated with harm for many people, particularly people with frailty. So the answer is to do things differently and we are focusing on three key strands at present:
  • Avoiding unnecessary hospital admissions
  • Improving flow within our hospitals
  • Discharging patients who are not best served by being in hospital
  • Care closer to home – as a system, we are performing well in terms of access to primary care services, despite what you might read in the news. Nationally primary care is delivering around 62% appointments on a face to face basis, while our latest data shows that Norfolk and Waveney is delivering 73% of all appointments face to face. We’re also delivering more primary care contacts than before the pandemic – about 200,000 extra contacts last year alone (not to mention the entire vaccination programme)! Yet people are still not always able to access the care they need. So we want to co-design our services with patients to simplify access to what they really need as early as possible, to prevent deterioration and also to address frustrations. We’ll also be using the Fuller report to guide this. And we are doing a huge piece of work to try to support people at home, through early support, community led home based care or virtual wards to avoid admissions.
  • Transformation of mental health services – elements of our mental health services and provision are excellent, but there are still real areas of concern, as evidenced by some absolutely tragic cases, and by the recent concerns expressed by the consultant staff committee at NSFT. We recognise that this is not want we want. We are passionate about supporting people to maintain mental health and wellbeing, about improving earlier local access to support to intervene at an early stage, and to further improve specialist services and the mental health support needed for those in crisis. So, we are working closely with colleagues across our whole system and region to see how we can do things differently to transform these services to something we can all be proud of – this is what our local communities and our staff deserve.
  • Elective recovery – it’s official, together, we cleared the huge numbers of people waiting 104 weeks for treatment in time for the 1 July deadline, which was brilliant – an outstanding piece of true system work. Thank you to all of you who were involved across all of our organisations, who worked together to make sure those waiting longest had the treatment they needed. We are now focusing on delivering on 62-day cancer treatments and clearing 78 week waits over the next year to make sure that we focus on the patients most at risk of harm due to time critical conditions as well as those who have experienced the longest delays in their care. We have implemented a unified harm review and clinical prioritisation policy across all of our acute hospitals using standardised definitions of physical and psychological harms. If you’ve not seen it, have a look at the web-based resource While you Wait, which is designed to support people to wait well, and prevent deconditioning and last-minute cancellations. We’ve also got the national My Planned Care website which gives average waiting times for each procedure at each of our providers, along with specific information on what to do if people are worried while waiting.

So am I ready for all this, are we all ready for this? Too right we are.

We’ve got some big mountains to climb and some real knotty issues to address – but I am absolutely confident that together, we can bring about real change for the better.

Thank you for your incredible dedication, hard work and support to help us achieve this.

Best wishes,