Board agrees Case for Change to improve healthcare across Norfolk and Waveney
Clinical approach retains 24-hour emergency departments and critical care at all three hospitals, while maternity, neonatal and children’s services require further detailed assessment
The Norfolk and Waveney University Hospitals Group Board has agreed there is a case for change and supported further work to explore how healthcare could be improved across Norfolk and Waveney.
At its public meeting on Monday 2 November, the Board considered evidence about changing population needs, quality and access, workforce pressures and services that are becoming increasingly difficult to sustain.
The Case for Change sets out an approach based on strong local hospitals, more care provided through community and neighbourhood services closer to where people live, and better access to specialist expertise.
The clinical approach supported by the Board for further development retains 24-hour emergency departments and critical care at Norfolk and Norwich University Hospital, The Queen Elizabeth Hospital King’s Lynn and James Paget University Hospital.
Maternity, neonatal and children’s services have been identified as requiring further detailed assessment. Clinicians have tested scenarios in which hospital births continue at three hospitals or are provided at two or one hospital.
This scenario testing does not represent a formal proposal or preferred option. The Board’s agreement does not authorise the closure, relocation or reorganisation of individual services. Further assessment, involvement and formal decision-making would be required before any service changes could be agreed.
Professor Lesley Dwyer, Group Chief Executive of Norfolk and Waveney University Hospitals Group, said: “We have a simple ambition: to provide better care for the people of Norfolk and Waveney, now and in the future. “There is much to be proud of across our hospitals, but we also know that we do not consistently deliver the quality of care people need.
“Demand is growing, people’s needs are changing and some services are becoming increasingly difficult to staff and sustain.
“The Board has agreed that the evidence supports a case for change and that further work should now take place. This is not a decision to close or relocate individual services.
“Our hospitals will remain at the heart of the future. We want to build on their strengths, provide more care closer to where people live where appropriate, and ensure patients can access specialist expertise when they need it.”
Strong local hospitals and more care locally
Current modelling indicates that approximately 97% of the planned and unplanned hospital care examined could continue to be provided at its current hospital site or, where clinically appropriate, closer to where patients live.
This could include some appointments, diagnostic tests, treatment, follow-up and rehabilitation being provided through community or neighbourhood services where the necessary staff, facilities and investment are in place.
The modelling also suggests that more than 99% of planned-care patients could continue to receive treatment at their local hospital or closer to home.
These figures are modelling estimates, not guarantees or final decisions about individual services. Further work is needed to test clinical safety, staffing, travel, access and whether the necessary local services could be provided.
The Case for Change also considers whether bringing together some highly specialist services could improve outcomes for people with complex or time-critical conditions. No decisions have been made about where individual specialist services would be provided.
Strengthening services under pressure
The Case for Change identifies 11 services experiencing significant staffing, capacity or specialist pressures:
- ear, nose and throat, including oral surgery
- paediatric cystic fibrosis
- paediatric audiology
- histopathology
- spinal surgery
- plastic surgery
- urology
- paediatric respiratory medicine
- paediatric gastroenterology
- clinical haematology
- oncology
Describing these services as “fragile” does not mean they are unsafe or expected to close. It means action is needed to make their future provision more reliable.
The pressures differ between services and will need tailored responses. These could include closer working between clinical teams, regional support, improved care pathways and targeted investment.
Work to strengthen these services can begin without waiting for decisions about the longer-term organisation of hospital care.
Maternity, neonatal and children’s services
In 2024/25, The QEH and James Paget were among 12 hospitals in England with fewer than 2,000 births a year. ONS-based modelling projects that births could fall by between 9% and 13% over the period examined.
Birth numbers alone do not determine where services should be provided or which arrangement would be safest. Further assessment must consider clinical outcomes, staffing, patient choice, travel, access and health inequalities, together with the links between maternity, neonatal, children’s, emergency and critical care services.
As part of the early clinical work, three broad scenarios have been examined:
- hospital births continuing at all three hospitals
- hospital births being provided at two hospitals
- hospital births being provided at one hospital
This scenario testing does not represent formal proposals or a preferred option. No preferred approach has been identified and no decision has been made to close or relocate maternity, neonatal or children’s services.
Professor Dwyer added: “We understand how important local maternity and children’s services are to families and colleagues.
“The scenarios examined so far are a starting point for further assessment, not formal proposals. No preferred approach has been identified and no decision has been made to close or relocate these services.
“Patient safety must remain at the centre of this work. We also need to understand what different approaches could mean for choice, travel, access and the experiences of women, babies, children and families.
“What works for someone living in Norwich may be very different from what works for someone in rural west Norfolk, a coastal community or one of the neighbouring areas served by our hospitals. Those differences matter.”
Investment in future care
Around £2.8 billion has been allocated through the New Hospital Programme to replace The QEH and James Paget.
The investment, alongside advances in treatment and digital technology, provides an opportunity to design modern hospitals around future healthcare needs.
New buildings alone will not address waiting times, workforce pressures or gaps between hospital and community services. The replacement hospitals will need to be developed alongside credible clinical plans, safe staffing and the local services needed to support patients.
What happens next?
NHS Norfolk and Suffolk Integrated Care Board will consider the Norfolk and Waveney University Hospitals Group Case for Change on Wednesday 4 November and decide whether to commission the next stage of detailed work.
If commissioned, this would include further assessment of clinical safety and outcomes, workforce requirements, travel and access, health inequalities, affordability and the practical implications for patients, communities and staff.
Patients, staff and communities would have opportunities to contribute and help test any potential options.
Any significant proposed service change would be subject to the necessary clinical assurance, scrutiny, engagement and, where required, public consultation before a final decision.
Professor Dwyer concluded:
“The Case for Change begins the next stage of the conversation. It does not settle the future of individual services.
“We will be open about the evidence, clear about what has and has not been decided, and involve the people who provide and rely on our services in shaping what happens next.”