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Norfolk and Waveney Integrated Care System has been lifted out of the lowest category of NHS England’s performance management regime.
The system received official confirmation yesterday that it had been elevated from the bottom rung of the national oversight framework. It has been a member of the fourth tier group since shadow ICSs were formed in July 2021.
ICB boss Tracey Bleakley told HSJ the adoption of a “North Bristol-style” patient flow model had been key to the system’s recent success. She claimed care had improved after staff bought into “the massive culture shift” required to deliver the “Right Care NoW” model.
However, she admitted the model’s introduction had caused “moral injury” to some staff.
The Norfolk approach is based on the much-debated North Bristol model, which NHSE wants rolled out more widely. It involves admitting patients from accident and emergency departments to wards on a regular basis regardless of whether a bed is available, leading to some patients being initially cared for in corridors. Changes have also been made to discharge processes.
HSJ understands that national leaders have viewed the Norfolk experience as a key test of the principles of the North Bristol model, because it is a system that has struggled with flow for so long.
Discharge discrepancy
Practically every hospital in the NHS is struggling to discharge patients who are fit to leave in a timely manner, but unacceptable variety in performance remains rife.
In Cornwall, there seems to be a particular problem with discharging patients to their own home.
Not enough patients are being put on this pathway, according to Cornwall and Isles of Scilly Integrated Care Board chief executive Kate Shields – who claimed there was a systemwide “aversion” to risk.
She said the integrated care system was a national outlier for a low number of patients going home, and the ICB has prioritised further work to tackle this particular issue.
Ms Shields’ comments are similar to analysis carried out in 2022 in Cornwall by external consultancy Prism, which reported an “over-reliance on bedded care” and a “culture of additional support on discharge”.
This suggests Ms Shields’s observations are – to some extent – accurate, although it is not clear why such an attitude to risk should be so prevalent in Cornwall.
Changing culture and attitudes can be notoriously difficult, but improvements are needed quickly.
Royal Cornwall Hospitals Trust CEO Steve Williamson has already warned several times about the impact of delayed discharges on the trust’s emergency care performance.
With trusts now under increasing pressure to hit the 76 per cent A&E target, the incentive to change risk-attitudes has rarely been greater.
Also on hsj.co.uk today
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