Norfolk and Waveney Clinical Strategy – Key highlights and progress made over the last 12 months

4th July 2023
Clinical objectiveSub-objective  Progress to dateOutcomes we have achieved
See me as a whole person  Personalised care – giving people control over the way their care is planned and delivered, based on what matters to them, their individual strengths, needs and preferences  A system wide personalisation care strategy is being developed, working with our residents, staff and communities.The strategy will be published by March 2024
Ensure people only have to tell their story once  Our Shared Cared Record (ShCR) has gone live, and several organisations have already started to use it. The system will go live in our three acute hospitals, GP Practices and Community services between October and December 2023  A summary of the Shared Care Record can be found on the Norfolk and Waveney ICS website
We will work with our residents, staff and communities to co-produce and co-design services  A people and communities hub has now been published on the Norfolk and Waveney ICS website. This underpins ongoing work to support system working around participation with people and communities, including carers in service planning and quality.   
Ensuring care is provided closer to home  Care closer to home will be enabled through the development of neighbourhood teams in primary care and also through the re-location of some services from hospital sites and into the community.  Virtual wards are effectively care at home and are also part of this outcome Transformation of multiple services currently provided solely at acute trusts is also underway with a view to moving some to community providers to improve access for patients and release time and capacity in hospitals to focus on more complex care which can only be provided there.  We are engaging extensively with our staff through a Norfolk and Waveney wide Community Services Review to look at how we can improve outcomes and experiences for our residents in the future. A number of dedicated resident events will take place through July and August 2023 to ensure our residents, staff and communities have the opportunity to have their say on future models of care, right from the start.   All three of our Acute hospitals now have ‘step down’ virtual wards to support people to be discharged earlier.   We also have a community based ‘step up’ virtual ward service which is due to launch in September 2023 to help prevent admissions in the first place.   Some of this work is highlighted in the Joint Acute Clinical Strategy: Our Ambitions document developed by our Acute hospitals.  
Aim towards high quality, resilient services, working together  Develop and continually review our system wide focus on Quality to maximise the opportunity for the best outcomes and experiences for our residents  A system wide Quality Strategy has been developed and published in May 2023.A system wide implementation plan is being developed and will be published at the end of July 2023.   A new system quality dashboard is being developed, including a number of metrics to provide a more holistic picture of quality across our ICS.   The NHS Norfolk and Waveney Quality and Safety Committee and ICS System Quality Groups continue to be developed as key system forums for assurance, improvement and escalation.  
Reduce long waiting times  Prioritise waiting lists and target those at highest clinical needWe have and continue to reduce those on waiting lists across Norfolk and Waveney.   104-week waits have been eliminated and we have substantially reduced the number of people waiting 78 weeks or more for surgery or treatment.A unified clinical risk and clinical prioritisation policy has been agreed and was published in July 2022.   Our waiting lists across Norfolk and Waveney, for all procedures and treatments has been clinically prioritised, such that every patient on every Patient Tracking List has a P code.    All Trusts manage their waiting list in line with P codes – P1 are emergency and done first, followed by P2 patients.   Among patients with the same P code, those who have waited longest are seen first.   But there is also a rolling process to review those patients on the waiting list and if any are assessed to have deteriorated or are at risk of harm they are reprioritised and brought forward.    Our Protect NoW team is also proactively contact patients to check on their status, flag any patients at risk of deterioration and provide waiting well support to prevent deconditioning and optimise their health in advance of their surgery.   While You Wait information is also available on the ICS website to help people manage their health whilst waiting for surgery or treatment.  
 Develop diagnostic hubs and Community Diagnostic Centres  Central and West Norfolk – possible site options in Thetford, Norwich and north Norfolk. We expect to know more in the near future.  The funding for our Diagnostic Assessment Centre’s (DACs) has been approved. For our Community Diagnostic Centres, we have also made considerable progress although we are waiting to hear back from the national team whether these bids will be successful or not. East Norfolk – funding has been approved for this centre and will be operational between January and March 2024  
 Expand virtual care, advice and guidance   Primary care can now refer and request advice in the same way across all of our system. Secondary care then review and prioritise those referrals or provide advice electronically.    Patients on Patient Initiated Follow Up pathways (PIFU) can use a platform called DrDoctor engagement platform to contact their specialist directly if they are concerned that their condition has changed to book back into clinics (PIFU).     Diabetes outreach clinics are in place to provide informal advice to practises without the need for referrals and an expansion of this to other specialities using an electronic means (Project Echo) is planned for next year.   Community dermatology services are using telederm to provide advice and guidance.  
Always act early to improve health  Develop a Health Improvement and Transformation Partnership to support tobacco, mental health and wellbeing, weight and alcohol and programmes   A Health Improvement Transformation Group across Norfolk and Waveney has been stood up and fully functioning.  Priority areas include: tobacconutrition and healthy weightCardiovascular diseasemental health and wellbeingphysical activityNHS health checksalcohol
Develop a plan to help support people with Long Term Conditions   A new programme board is in place, which is supported by the Planned Care and Medicines Management Working. As part of our commitment to supporting people living with Dementia, a new objective has been developed, which will feature in the Joint Forward Plan to help transform care for people in later life.  
Ensure a structured programme is in place to increase vaccination across Norfolk and WaveneyVaccine inequalities oversight group (VIOG) submit and present information to a vaccination programme board.   This forms the basis of ongoing campaigns and supports the roving model & Grab a Jab service.   The re-establishment of the Health Inequalities Oversight Group will create an additional focus on this and the development of the wellness hub at Castle Quarter.  For COVID-19 vaccination, Norfolk and Waveney continues to perform well.   The latest COVID-19 Spring booster sees Norfolk and Waveney sit as the second highest performer in the country.
Be reliable – for our staff, residents and communities  Adopt value-based healthcare We have a adopted a prioritisation matrix to rank and score what we do as an ICS.   The matrix looks at the cost, impact and outcomes to maximise outcomes for our residents, making sure we use our budget wisely.   This has been agreed and adopted.  
 Reduce appointment cancellations   Patient focussed booking is now in place as part of personalised outpatient programme.   This means that patients are offered choice to mutually agree their appointment time and date, with an access policy in place to determine how these are arranged if missed.   Patients also receive text message reminders for all appointments.   Inpatient cancellations are largely due to a change in clinical condition which are minimised by the waiting well, pre-optimisation and digital pre-operation assessment programmes.   However, some cancellations may occur due to staffing issues including industrial action, and late notice sickness which is often beyond our control.  
 Improve efficiency across our ICSOur Improving Lives Together programme is helping us develop cases for change for improvements in Digital and Workforce services.   These proposals are being considered by partner organisations across our ICS.   Individual projects are being set up to deliver the agreed changes beginning, where possible, in the second half of 2023-24.   
Tackle health inequalities  Produce a plan to address CORE20Plus5We are producing a plan that targets resources to deliver the national Core 20 Plus 5 plan in Norfolk and Waveney.    This includes reducing health gaps for people who live in the least well-off neighbourhoods. Five key areas are addressed within the plan which are known to have the greatest impact on Health Inequalities: maternitysevere mental illnesslong-term breathing illnessesearly cancer diagnosis andhigh blood pressure.We expect this plan to produced by the end of March 2024. This will build on the work taking place already across Norfolk and Waveney, including our Protect NoW programme.
Improve screening uptake  The Eastern Academic Health Science Network is working with us to improve awareness of Faecal Immunochemical Testing (FIT) testing, as part of our Community Voices project. This involves reaching out to our residents who we would not normally hear from.   We are also looking to improve access for our patients who live with a learning disability and/or autism with cancer services.   
Long term resource to minimise inequalities from pandemic  The Elective Recovery Board regularly reviews the waiting list by deprivation and other measures of inequalities, and this is actively monitored and measured with no systematic inequalities identified.   However, we are not yet identifying those whose pre-existing Health Inequalities impact the timeliness of them reaching the waiting list.   This will be tackled using Population Health Management techniques with a focus on early detection in people at risk of Health Inequalities.   This is being led through the Population Health, Health Inequalities and Prevention ambition in the Joint Forward Plan.