• Regional boss orders “specific approach to managing risks over winter” for Norfolk
  • Ambulance handover delays described as “major problem” in leaked minutes
  • Local STP says different approach needed this winter but “significant progress has been made”

Regional chiefs have identified Norfolk as a trouble spot this winter, with local ambulance handover delays described as a “major problem”, according to leaked meeting minutes obtained by HSJ.

NHS England regional director Paul Watson told a risk summit follow-up meeting for the local ambulance trust he “felt there was a need to develop a specific approach to managing issues in Norfolk to mitigate the risks over winter”.

Dr Watson cited a cocktail of reasons for his concerns, including “ambulance handover delays… [and] the ambulance trust’s capacity shortage; the rurality of the area; staff unrest; issues with 111 delivery; and [that] two of three acute trusts were struggling with [their accident and emergency performance]”.

The Midlands and East director said he would speak to the NHS’ national urgent and emergency care lead Pauline Philip about the area’s ambulance handover delay problems.

The meeting’s minutes also revealed Dr Watson’s concerns about the “significant problems” facing the East of England Ambulance Service Trust.

He raised a series of concerns about the troubled trust at the meeting, including that it was appearing to prioritise less urgent patients over those in greater need and that its winter plan was not “adequate”. This was exclusively revealed by HSJ last week.

The minutes continued: “[Ambulance handover] delays had improved overall. Significantly in some systems [of the East of England], although challenges in some areas remained. The major problem in Norfolk was noted… It was agreed that the chair [Dr Watson] would speak to the national director for urgent and emergency care [Ms Philip] and ask for a reminder to be sent to trusts [about the need for improvements].”

Ambulance handover delays were a significant problem across the NHS last winter. Then health secretary Jeremy Hunt ordered trusts to draw up new plans in April to tackle poor performance last winter, as revealed by HSJ.

Essex, another area covered by the East of England Ambulance Service Trust, was identified as a major handover delays hotspot last winter, as revealed by exclusive HSJ Performance Watch analysis. But the minutes suggest major improvements have been made on that patch, particularly by Colchester hospital.

The three Norfolk hospital foundation trusts are Norfolk and Norwich, James Paget University Hospitals, and Queen Elizabeth Hospital King’s Lynn Trust. Norfolk and Norwich is a major trauma centre.

Norfolk and Norwich, which suffered from reporting data “issues” last winter regarding its ambulance handover delays, and King’s Lynn are both in special measures.

Dr Watson told HSJ in a statement: “Since this meeting in September, NHS England and NHS Improvement have met with the Norfolk health system and had a constructive discussion.The system has a number of plans in place to mitigate against pressures this winter and has already made some improvements, including speeding up ambulance handovers at [NNUH].

“NHS England and NHSI will continue to work closely with partners in Norfolk and Waveney to support the system in its planning for winter.”

A Norfolk and Waveney sustainability and transformation partnership spokesman said: “We share Dr Watson’s view that we have needed a different and more robust approach to planning for winter 2018-19. His comment[s] were made as winter planning was still underway and significant progress has since been made.”

Specific initiatives at NNUH cited by the STP included 57 extra beds; eight new cubicles in its emergency department, and a new discharge facility to support flow, currently under construction.

NNUH has also expanded the opening hours of its older people’s ED and is “looking to increase community beds and reablement capacity,” the statement said. Hospital ambulance liaison officers to coordinate ambulance arrivals and speed up handovers are also being drafted in this winter.

An East of England Ambulance Service Trust statement said: “[NNUH] is one of the busiest hospitals in the region, servicing a large, remote area. We are working closely with the hospital with plans to ensure quicker handover times.”

Meanwhile, the five clinical commissioning groups in Norfolk and Waveney have announced plans to create “one single team of management and staff”. The proposals, which will not result in a formal merger of the individual CCGs, will require formal approval at each of the CCG’s governing body meetings this month.