Working together to reduce system pressures

26th January 2023

For all staff across the Norfolk and Waveney Integrated Care System (ICS)

Dear colleagues,

As you know, over the last few months, we have experienced unprecedented pressures across our health and care system and we know you have been working under extremely difficult circumstances and in ways we would not normally ask of you.

We wrote to you in December about these extreme pressures and how high demand and staffing levels presented a challenging situation for us all.  

Thanks to your hard work, services have been able to partially recover and the risk to patient safety has reduced substantially. Our system has therefore met the criteria to move from critical incident level 2 to Opel 4 status. This status still represents a high level of escalation and demand, and we know that services remain very busy.

The main reasons behind this de-escalation are that we have seen a reduction in:

  • The amount of time people have to wait for an emergency ambulance
  • The amount of time lost to the ambulance service through waiting at our hospital forecourts for patients to be assessed
  • The amount of time patients wait in ambulances at our hospitals or within our emergency departments for assessment, treatment and admission (if required).

A number of escalation beds are still in use and it’s our priority to reduce these as we know the impact staffing the additional beds can have on your teams, and ultimately the patient experience. Discharging patients when they are well enough to leave hospital and creating flow out of our acute hospitals and into the community will be vital to helping us achieve this.

We must balance the risk to other patients waiting in our emergency departments, being cared for in escalation beds or worse still, in our communities waiting for an ambulance if we are unable to free up space in our acute, community and mental health hospitals for them.

Home really is the best place for people after they have recovered from the most acute phase of their illness or injury. Please continue to think ‘why not home’, and ‘why not today’ for every patient.

There has been significant work to help discharge people directly home, into long-term care and with home care support, but we know there is much more to do. We have received further funding this month to continue our progress and create new step-down beds in the community to help free up acute hospital beds.

We are not out of the woods yet and we know for many, you won’t have felt a reduction in the pressure your teams are under, so we must continue to drive forward the work and innovation which has enabled us to reduce our system level status.

The lessons over the last few months will allow us to identify the areas where winter escalation capacity is needed most and more importantly, the staff to support this. We’re also looking at the balance of beds across the system and how we can ease demand on the providers who have seen the most pressure.  

We really appreciate the contributions you have made to our patients and communities under some very difficult circumstances. Your efforts make our health and care system stronger.

Thank you,


Marcus Bailey

Winter System Director – NHS Norfolk and Waveney