Kyriacos Athanasis

From Helen Whately MP 
Minister of State for Social Care 

39 Victoria Street 
London 
SW1H 0EU 

 February 2024 

Annex A  

Catherine Wood 
Assistant Coroner 
Norfolk 
Coroner’s Court and Offices 
Beacon House 
Whitehouse Road 
Ipswich  
IP1 5PB 

Dear Mrs Wood, 

Thank you for your letter of 8 January 2023 to Steve Barclay as Secretary of State for Health 
and  Social  Care  about  the  death  of  Kyriacos  Athanasis.   I  am  replying  as  Minister  with 
responsibility  for  Health  and  Secondary  Care.  Please  accept  my  sincere  apologies  for  the 
delay in responding to this matter. 

Firstly, I would like to say how saddened I was to read of the circumstances of Mr Athanasis’ 
death and I offer my sincere condolences to his family and loved ones.  The circumstances 
your report describes are very concerning and I am grateful to you for bringing these matters 
to my attention.  

The  report  raises  concerns  about  ambulance  handover  delays,  emergency  department 
capacity,  patient  safety checks,  and  patient  discharge  at James  Paget University  Hospitals 
NHS Foundation Trust (JPUH). In preparing this response, Departmental officials have made 
enquiries with NHS England and the Care Quality Commission. My officials advise me that 
the Integrated Care Board (ICB) responsible for JPUH, Norfolk and Waveney ICB, provided a 
the 
comprehensive  response  on  3  February  2023  which 
improvements  being  made  locally,  and  details  of  a  serious  incident  investigation  report 
following Mr Athanasis’ death. 

information  on 

included 

I recognise the significant pressure the NHS has been under since the pandemic. That is why 
we published our  Delivery  Plan for  Recovering Urgent  and  Emergency Care  Services.  The 
plan aims to deliver one of the fastest and longest sustained improvements in emergency care 
waiting times in the NHS's history. It sets out an ambition to improve A&E wait times to 76% 
of patients being admitted, transferred, or discharged within four hours and to reduce average 
Category 2 response times to 30 minutes this year, with further improvements to be set as 
part of the NHS planning guidance for next year 2024-25.  

We are taking a number of steps to  improve ambulance response times. Ambulance trusts 
are receiving an additional £200 million of funding this year to expand capacity and deliver 
new ambulances, helping patients receive the treatment they need. We are also delivering 6 

1 

 
 
 
 
 
 
 
  
 
 
   
 
 
    
    
  
  
 new ambulance hubs and 42 new and upgraded discharge lounges in hospitals across the 
country,  backed  by  nearly  £50  million  investment.  The  ambulance  hubs  will  help  reduce 
handover delays and get ambulance back on the road faster, while the discharge lounges will 
speed up the safe and effective discharge of patients from hospital, freeing up hospital beds.   

A key part of the recovery plans is about improving hospital’s patient flow and bed capacity. 
The recovery plan will deliver 5,000 more staffed, permanent beds and scale up virtual ward 
beds which are now over 11,000. This increase is backed by £1 billion of dedicated revenue 
funding and £250m of capital funding.  A further £1.6 billion of funding for social care over two 
years  in  being  provided  to  reduce  the  numbers  of  beds  occupied  by  patients  ready  to  be 
discharged.  These measures will speed up emergency admissions and reduce overcrowding 
in Emergency Departments enabling ambulances to handover patients more quickly.  

In addition, Same Day Emergency Care (SDEC) services will be in place across every hospital 
with  a  major  emergency  department,  helping  avoid  unnecessary  overnight  stays  in 
hospital.   The  SDEC  model  helps to  reduce  pressure  on  emergency  departments  because 
patients  receiving  SDEC  can  be  rapidly  assessed,  diagnosed,  and  treated  without  being 
admitted to  a  ward,  and  if  clinically  safe  to do  so,  will  go  home the  same  day  their  care is 
provided.  

We recognise there is variation in performance across the country. That is why the delivery 
plan  also  provides  for  a  new  tiering  performance  and  improvement  approach  to  provide 
targeted  support  to  challenged  systems.  There  is  support  in  place  at  national  and  regional 
level to support Tiers 1 and 2 with a universal improvement support offer being made available 
for all systems which will help improve system performance across the whole patient pathway.  

At a national level, we have seen significant improvements in performance this year compared 
to last year. Average Category 2 ambulance response times (including for serious conditions 
such as heart attacks and strokes) were almost 47 minutes faster in December 2023 than the 
same month last year, a 51% reduction. Average East of England Ambulance Service NHS 
Trust Category 2 response times decreased by 60% over the same period. 

Further, national data shows that 69.4% of patients were admitted, transferred, or discharged 
within  4  hours  of  arrival  at  A&E,  compared  to  65.2%  the  same  month  last  year,  while 
performance at JPUH was 66.5% in December 2023, an improvement of 4.4% over the same 
time period. 

I  hope  this  response  is  helpful.  Thank  you  for  bringing  these  important  issues  to  my 
attention.      

 Yours,  

HELEN WHATELY

03 February 2023 

PRIVATE & CONFIDENTIAL 

County Hall 
Martineau Lane 
Norwich NR1 2DH 

Direct Tel: 01603 595857 
Web: https://www.improvinglivesnw.org.uk/ 
Email: nwicb.contactus@nhs.net 

To Catherine Wood, Assistant Coroner for the Norfolk Area 

Re: Prevention of Future Deaths Report for Mr Kyriacos Athanasis 

We are writing in response to the publication of a Prevention of Future Deaths Report (ref. 2023- 
007) dated  06/01/2023  in  relation  to  the  death  of  Mr  Kyriacos  Athanasis  at  the  James  Paget 
University Hospital (JPUH) in Gorleston, Suffolk. As the NHS Integrated Care Board for Norfolk 
and  the  Waveney  area  of  Suffolk,  we  commission  care  from  JPUH  and  the  urgent  and 
emergency care system that it sits within. 

This response  provides  context,  addresses  the  concerns  raised  in your report and  sets out a 
timeline of actions. We hope that the below is helpful, and we would wish to reassure you, and 
the family that in providing this response we have not lost sight of the suffering that has resulted 
from Mr Athanasis’ death and its impact on his family and the staff caring for him at the time.  

Case Background 
Mr  Kyriacos  Athanasis  was  an  88-year-old  man  who  had  a  past  medical  history  of  asthma, 
chronic kidney disease stage 3, hypertension, orthostatic hypotension, type 2 diabetes mellitus 
and ulcerative colitis. At the beginning of 2022 he was becoming frailer and suffered from multiple 
falls, several of which led to admissions for hospital care and treatment. A discharge summary 
from March 2022 summarised a diagnosis of multifactorial falls, including neuropathy  (loss of 
sensation to the lower limbs), reduced vision, frailty due to old age, some cognitive (thinking) 
impairment  and  chest infection.  Mr Athanasis  had  a  fall at home, at  some  point on 16th  May 
2022. There was an extremely long wait for an ambulance to attend, by which time, Mr Athanasis 
was on his feet and mobilising. However, he was subsequently able to communicate that he was 
experiencing a significant amount of pain and he was taken to the JPUH arriving at around 21.30 
on 17th May 2022. Mr Athanasis experienced a delayed handover into the hospital Emergency 
Department (ED), where it was found that he had an unstable cervical fracture. 

Mr Athanasis died from a multifactorial pneumonia, predominately due to the consequences of 
his fall on a background of frailty and type 2 diabetes mellitus, with the inquest finding the short 
form conclusion of accidental death. 

General Background 
In January 2022 a system-level Gold Command Group comprising of chief executives and senior 
clinical and operational leads from provider organisations was established and facilitated by our 
organisation, which was a Clinical Commissioning Group at the time, to develop a plan for ‘in 
extremis’  actions  to  respond  to  system  resilience  incidents  following  increased  operational 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 pressures  over  Winter  2021-2022.  As  a  system,  we  continued  to  experience  the  following 
‘symptoms’ of significant, sustained pressure across 2022, including: 

• 

• 

• 

Increasing  hospital  occupancy.  High  levels  of  occupancy  continued  to  be  sustained 
across  the  system  leaving  very  little  room  for  decompression  actions.  COVID-19  and 
seasonal  illness  continued  to  impact  on  bed  management  and  staffing  levels  across 
health and social care providers. 

Increasing  length  of  stay  and  ‘no  criteria  to  reside’.  Patients  were  having  longer 
admissions and remaining in beds with no criteria to reside; having no medical need to 
stay in hospital. This impacted on flow through the hospitals and the wider system, as well 
as deconditioning and the ability to meet patient needs in non-standard ward settings. 

Increasing ambulance handover delays. Poor flow through the system impacted on the 
timeliness  of  ambulance  handover  into  hospital  Emergency  Departments  (ED)  and 
prolonged care of patients in waiting ambulances. This issue was highlighted during the 
inquest of Mr Athanasis. 

•  Worsening ambulance response times. Long handover delays resulted in ambulance 
crews waiting outside ED, which led to longer response times in the community, including 
for  the  most  urgent  life  threatening  and  life  altering  calls.  Again,  this  wider  issue  was 
highlighted during the inquest of Mr Athanasis. 

We are mindful that the challenges described above also reflect a national picture and that we 
are  not  alone  as  a  system  in  responding  to  these  significant  and  sustained  pressures.  Our 
response to the concerns raised in your report set out how the ICB has worked with providers, 
within  our  local  remit  and  resource,  to  collectively  address  and  mitigate  the  risk  of  adverse 
incidences impacting on our patients and staff, and to: 

•  Reduce ambulance handover delays and improve community response times. 
•  Support clinical decision making and improve access to pre-hospital pathways of care. 
• 
•  Support the social care market to ensure it is sustainable and meets population needs. 

Improve discharge and patient flow across the system. 

Concerns Raised by the Coroner 

We understand that the concerns of the Coroner are as follows: 

1.  A delay in the transfer of Mr Athanasis from the ambulance due to a lack of space within 

the ED. 

2.  Due  to  the  known  delays  in  transferring  patients  into  the  ED,  senior  clinicians  were 
undertaking  safety  checks  of  those  patients  left  in  ambulances  to  assess  urgency  and 
need for a trolley or a bed. 

3.  The  mechanism  for  undertaking  this  patient  check  was  not  sufficient  in  this  instance, 

resulting in a delay in diagnosis. 

4.  That  ED overcrowding  is a  frequent  occurrence  and  is a  consequence of an  inability  to 

discharge patients back into the community. 

5.  That  the  ED  continues  to  operate  over  capacity  resulting  in  delays  in  treatment  and 

diagnosis. 

Page 2 of 8 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Response to Concerns 1, 2 and 3 
In summary, we understand that these concerns relate to the delayed handover from the 
ambulance into the Emergency Department (ED), missed opportunities to safety-net the 
patient and delay in diagnosis and treatment. 

ICB actions taken to improve ambulance handover times and reduce delays in diagnosis 
and treatment: 

The ICB continues to commission the East of England Ambulance Service Trust to provide the 
Hospital Ambulance Liaison Officer (HALO) role at our three Acute Hospitals. The HALO works 
closely  with  hospital  Site  Managers  and  clinical  staff,  along  with  the  ambulance  Emergency 
Operational  Control  (EOC)  room,  to  provide  day  to  day  co-ordination  of  emergency  and 
ambulance  staff  in  line  with  Trust  policies  and  procedures  to  reduce  ambulance  turnaround 
times, prioritise patients for handover into ED and ensure that patients in the local communities 
receive the appropriate response to emergency calls.  Additionally the ICB has supported the 
early  implementation  of  an  ambulance  ‘rapid  release’  protocol,  to  enable  crews  waiting  to  
handover to immediately release a patient into the care of the hospital to attend to a patient in 
the community, in a life-threatening condition. This is an exceptional intervention that can only 
be mobilised in specific clinical circumstances. This initiative was mobilised across all 3 Acute 
Hospitals in Norfolk and Waveney in mid-late May 2022. 

Additionally,  in  order  to  effect  earlier  release  of  ambulance  resources  into  the  community, 
additional  ambulance  resources  have  been  utilised  across  all  three  Acute  Trusts  to  enable 
cohorting  of  suitable  patients,  thereby  releasing  ambulance  resources.    Whilst  this  does  not 
address  directly,  ambulance  handover  times  it  does  improve  the  safety  of  patients  within  the 
community  who  would  otherwise  face  longer  waits  for  ambulance  attendance.    This  is 
supported  by  established  frameworks  which  identify  the  scope  of  clinical  practice  of  the 
available  hospital  staff  members  and  is  further  supported  by  provider  and  system  level 
escalation frameworks such as the OPEL and critical incident management framework. 

Since  May  2022  the ICB  has  supported  all 3  acute  hospitals  within  our system,  including  the 
JPUH, to further develop and expand its GP Streaming Unit which provides a pathway for ED 
staff to assess patient needs on arrival and ensure that those who are more suitable for GP care 
can attend the unit co-located within the department. This helps to create flow and promote more 
prompt clinical assessment. 

ICB actions taken to support providers to safety-net patients in the event of a delay in 
handover to ED: 

The  ICB  coordinated  systemwide  adoption  in  October  2022  of  the  Professional  Standards  of 
Care for Patients Waiting in Ambulances to ensure patients awaiting handover to ED receive 
consistent,  timely  and  clinically  appropriate  care,  and  that  processes  are  in  place  to  rapidly 
identify  and  escalate  care  needs  for  deteriorating  patients.  The  ICB  continues  to  monitor 
compliance with these standards, through daily system calls and discussion with site teams, as 
well as focussed on-site quality visits. 

In  addition  to  the  above,  the  ICB  has  continued  to  support  provider-level  actions  to  increase 
oversight  of  patients  in  waiting  ambulances,  enabling  collaboration  between  ambulance  and 
hospital providers to put in place new ways of working to maintain patient safety, that transcend 
traditional  organisational  responsibilities.  For  example,  this  includes  a  ‘pit-stop’  assessment 
model  that  came  into  effect  at  JPUH  in  June  2022,  which  enables  early  diagnostics  to  be 
commenced for patients before they enter the ED.  This initiative was supported by the use of 
additional  temporary  staff  including  the  use  of  reservists,  additional  bank  staff  and  medical 

Page 3 of 8 

 
 
 
 
 
 
 
 
 students  as  assist  in  the  more  timely  handover  of  patients  into  the  ED  where  clinically 
appropriate.  

Wider ICB actions taken to avoid unnecessary ambulance conveyances, and ensure that 
community services are utilised to manage activity and demand more effectively: 

The  ICB  has  focussed  resources  into  the  expansion  of  Same  Day  Emergency  Care  (SDEC) 
provision across all acute hospital sites as an alternative to ED attendance. This is an additional 
service  which  provides  an  alternative  pathway  for  patients  who  require  diagnostics  and 
assessment,  which  can  be  undertaken  without  an  overnight  stay  or  prolonged  hospital 
attendance. 

The ICB continues to commission our integrated urgent care provider to deliver a 24-hour Clinical 
Assessment  Service  (CAS)  run  by  GPs  and  Advanced  Practitioners.  The  CAS  undertakes 
revalidation of 999 calls for EEAST to help avoid unnecessary ambulance conveyances as well 
as delivering a direct Healthcare Professional Advice line which provides senior clinical advice, 
including ‘Call Before You Convey’ decision-making support for ambulance staff while they are 
on-scene.  This  work  has  been  developing  over  time,  with  the  ICB  supporting  a  review  and 
refinement  of  these  services  to  meet  presenting  pressures  e.g.,  reduction  of  the  Healthcare 
Professional Advice line response standard from 30min to 10min. 

Additionally, the ICB has worked closely with our integrated urgent care provider to implement a 
virtual ‘Open Room’, which started as a trial in April 2022, to enable senior clinical staff in the 
community  to  ‘pull’  appropriate  patients  out  of  the  999-call  queue  and  divert  them  to  more 
appropriate  alternative  pathways  to  meet  their  needs.  This  could  include  interventions  and 
services  such  as  therapy  assessments,  urgent  community  support,  medication  review  and 
community  falls  response.  This  became  a  substantive  service  from  August  2022  following 
positive evaluation by the ICB. 

The ICB continues to commission the East of England Ambulance Service Trust to provide the 
Norfolk and Waveney Mental Health Joint Response Car (MHJRC) which enables a paramedic 
and mental health practitioner to triage people within their home environment, and plan follow 
up care, instead of an ambulance conveyance to hospital for the purposes of accessing mental 
health care provision, where safe and appropriate. 

Response to Concerns 4 and 5 
In  summary,  we  understand that this  concern  relates  to  the  reduced discharge  profile, 
hospital congestion, the ongoing impact on ED capacity and ambulance release and the 
risk  of  harm  to  patients  waiting  for  an  ambulance  as  well as  patients  whose  diagnosis 
and treatment is delayed at ED. 

In Norfolk and Waveney, a focus on the discharge pathways for Pathway 1, 2 and 3 patients 
were identified as the most impactful operational action: 

•  Pathway 0 patients who can return home without any health or social care support. 
•  Pathway 1 patients who need a package of care in their own homes. 
•  Pathway 2 patients requiring a recovery package, rehab or reablement in a bed. 
•  Pathway 3 patients requiring a specialist bed or long-term placement. 

Nationally,  the  NHS  stopped  the  Hospital  Discharge  Fund  on  31  March  2022,  which  had 
essentially funded 4 weeks of ‘free care’ to support patient discharge, regardless of who was 
responsible for commissioning this care and which also paid for a large range of services and 
beds.  This  meant  that  on  1st  April  the  Norfolk  and  Waveney  system  lost  funding  for 

Page 4 of 8 

 
 
 
 
 
 
 
 
 
 
 approximately the equivalent of 161 beds in the health and social care sector.  NHS Norfolk and 
Waveney  ICB  took  a  local  decision  to  create  a  3-month  transition  fund  to  support  this  work, 
utilising our reserve budget. However, on 01 June 2022 this local funding extension ceased, in 
line with the national mandate to stop funded ‘free care’. 

However, since August 2022 the NHS has released additional money for investment in discharge 
resources. In the first allocation the Norfolk and Waveney system was awarded £9m revenue 
and  £2m  capital,  which  was  invested  in  new  health  and  social  care  beds  and  community 
packages of care creating the equivalent of approximately 250 beds. In mid-November 2022 the 
government announced a further £500m fund for health and social care, of which our system 
share was approximately £11m which is currently being used to commission additional care and 
support services to further ease the burden on hospital beds. A third award was announced in 
January 2023 providing a further £3.74m revenue to be spent by 31st March 2023. The ICB is 
coordinating the system Discharge Programme which brings providers together to collaborate 
on the utilisation of this money; jointly planning, delivering, and monitoring improvement actions, 
including: 

•  Executive-level focus on length of stay and discharge and Discharge Board; 
•  Use of an incident management framework to respond to operational pressures robustly; 
•  Deep dives into all pathways and the opening of additional beds; 
•  Additional focus on supporting hospitals with Pathway 0 discharges; 
•  Participating in regional ‘deconditioning games’, and patient reconditioning initiatives; 
•  10 new initiatives to improve hospital flow and discharge in the Acute Hospital setting; 
•  10 new initiatives to improve hospital flow and discharge in the Community setting; 
•  10 new initiatives to improve flow and discharge in Mental Health Services; 
• 
Increasing hospital discharges before 12 noon; 
• 
Improving accessibility of hospital transport to facilitate timely discharge; 
•  Bringing in other agencies to support Domiciliary Care in people’s homes; 
•  Bringing in new agencies to provide additional health and social care staffing; 
•  Active engagement with Voluntary, Community and Social Enterprise sector. 

The ICB has also placed senior clinical staff in to our three Acute Hospitals for focussed periods 
of on-site support, to support the management of escalations in a timely manner. Not only does 
this provide additional operational support to frontline colleagues, utilising ICB staff experience, 
it  also  improves  ICB  oversight  and  assurance,  enabling  the  ICB  to  actively  reflect  on  the 
operational  impact  that  their  system-level  interventions  (as  described  above)  are  having  on 
patients  and  the  staff  delivering  their  care.  The  Norfolk  and  Waveney  ‘Leading  for  System 
Change’ project launched in 2022, bringing together key colleagues involved in discharge across 
the Integrated Care System (ICS) with a focussed remit to understand, mitigate and rectify some 
of our underlying problems as a system which include: 

•  Access to timely assessments (e.g., therapy needs, Continuing Healthcare, Care Act). 
•  Digital solutions to improve communication and workflow. 
• 
•  Workforce support and ‘culture’ of reablement. 

Improving system intelligence around ‘demand’ and resource management. 

The success of this workstream is dependent on a whole system approach, but fundamentally 
relies on adequate social care provision so that patients can be discharged with a safe level of 
support  that  meets  their  needs  and  optimises  their  recovery  and  reablement  post-hospital 
admission.  The  ICB  has  continued  to  fund  additional  social  workers,  to  undertake  Care  Act 
assessments  to  enable  discharge  from  recovery  beds.  We  have  also  increased  funding  for 
additional  domiciliary  care  and  accessed  external  agencies  to  help  provide  this,  to  support 
patients to return home. To date, we have commissioned a number of new beds for pre-hospital 
Page 5 of 8 

 
 
 
 
 
 
 capacity and more generally, across the Norfolk and Waveney care sector. The ICB has also 
commissioned additional domiciliary care, put in place in partnership with the local authorities. 
The resilience and capacity of our health and social care workforce is escalated regularly to our 
NHSE Regional Team, for support and we continue to work closely with Norfolk County Council 
and Suffolk County Council to support the local social care provider market. 

ICB Oversight of Serious Incident and Learning 
The James Paget University Hospital undertook a serious incident investigation at the time of Mr 
Athanasis’ death, in line with NHS national policy and the learning was shared with NHS Norfolk 
and Waveney ICB (at that time, NHS Norfolk and Waveney Clinical Commissioning Group). The 
hospital investigation identified learning points around the management of cervical spine injuries 
in the elderly and the challenges of neck immobilisation, versus respiratory distress. An action 
plan for improvements has been shared internally and with NHS Norfolk and Waveney ICB. In 
summary, progress with the identified actions is as follows: 

Action  1:  Hospital  to  provide  dedicated  educational  sessions  to  their  Trauma  &  Orthopaedics 
junior/senior  doctors  and  consultant  surgeons  and  ED  staff,  on  the  management  of  cervical 
trauma in the elderly, including the challenges of immobilisation. Progress: Trauma training in 
place. 

Action  2:  Hospital  to  undertake  a  review  of  their  spinal  referral  process  and  develop  a  new 
Standard Operating Procedure to supplement their existing clinical guidelines. Progress: Action 
to be completed by the end of March 2023. ICB will monitor and provide any support required.  

Action  3:  Hospital  to  share  the  learning  from  this  case  at  their  Medical  and  Surgical  Clinical 
Governance Meetings. Progress: Itemised for 24 March 2023. ICB will monitor and provide any 
support required. 

Action  4:  Hospital  to  source  Aspen®  Collars  for  their  Emergency  Department.  Progress: 
Action complete.  

NHS Norfolk and Waveney ICB continue to work closely with NHS Suffolk and North East Essex 
ICB, which is the regional lead commissioning body for the East of England Ambulance Service 
Trust  (EEAST)  to  ensure  there  is  a  common  approach  between  healthcare  providers  and  the 
local  ambulance  service  to  learning  and  preventing  future  adverse  incidents,  including  those 
arising from ambulance handover delays, across the EEAST footprint and the Hospitals across 
the region so that there is parity and consistency. 

In March 2022, NHS Norfolk and Waveney ICB became an early implementer locality for a new 
regional framework , developed by Suffolk and North East Essex and EEAST, which has been 
rolled  out  to  each  ICB  in  the  region  (Bedfordshire,  Luton  and  Milton  Keynes;  Cambridgeshire 
and Peterborough; Hertfordshire and West Essex, Mid and South Essex, Norfolk and Waveney 
and  Suffolk  and  North  East  Essex),  EEAST  and  the  hospitals  within  their  footprint.  The 
framework  provides  a  consistent  approach  to  system  level  learning  in  response  to  urgent  and 
emergency care treatment delays. In Norfolk and Waveney this is delivered by the System UEC 
SI  Tactical  Group,  which  brings  together  Norfolk  and  Waveney  providers  to  share  and  review 
themes, identify learning and, where appropriate, make shared recommendations, in addition to 
their internal organisational learning. These recommendations are then fed into the Norfolk and 
Waveney  system  resilience  and  transformation  plans,  as  well  as  broader  quality  improvement 
work around patient flow, including pre-Hospital community-based interventions and discharge 
to assess. 

Ongoing ICB Monitoring and Escalation 
As an area, we currently continue to experience capacity pressures, alongside many other areas 
Page 6 of 8 

 
 
 
 
 
 
 
 
 
 nationally.  We  continue  to  follow  the  national  NHS  Operational  Pressure  Escalation  Level 
Framework  to  identify,  escalate  and  respond  to  flow  pressures  across  our  system.  The  ICB 
continues to coordinate a programme of local improvement, which is built optimising and utilising 
the funding we have been allocated, to focus on the following local priorities: 

•  Alternatives to ambulance conveyance; 
•  Falls response; 
•  ED surge measures; 
•  Care Home support; 
•  System incident management; 
•  Workforce; 
•  Discharge. 

Following  the  abolition  of  CCGs  and the  creation of  Integrated  Care  Boards  in  July 2022,  our 
organisation is now a Category 1 Responder under the Civil Contingencies Act 2004. This builds 
on the ‘oversight’ role of commissioners, extending its responsibilities to coordinate the activities 
of  the  wider  health  system  to  support  critical  and  major  incidents  including  sustained  surge 
pressures.  This is achieved by: 

•  System-level  grip  and  control  of  operational  activity  across  the  ICS  and  system  level 

operational reporting; 

•  Providing a platform for ICS organisations to collaborate and manage variations in patient 

flow and operational delivery and remove barriers to collaboration; 

•  Agree short term operational work that needs to happen at ICS level and link to medium 

to longer term Transformation Plans. 

•  Provide system challenge / support to maintain delivery of ICS operational activity and 

flow; 

•  Agree key ICS operational risks and monitor delivery / impact of mitigation actions and 

escalate to ICS Executive Management Team where necessary. 

•  Coordinate  expenditure  of  regionally  and  nationally  allocated  short  term  /  seasonal 
funding  for  our  area,  and  ICS  urgent  and  emergency  care  response  to  significant  and 
major incidents. 

Formalisation of these responsibilities provides the ICB with a much more clearly defined role to 
coordinate the system’s response to demand and capacity pressures, as described within this 
response. It provides operational ‘grip’ on emerging risk that is required to keep the system as 
safe as possible while improvement and transformation actions embed. 

Additionally, following the formation of the Integrated Care Board (ICB) in July 2023, the Urgent 
and Emergency Care (UEC) Board was formalised within the ICB governance arrangements. 
Under  Executive  Director  sponsorship  the  role  of  the  UEC  Board  is  to  lead  on  the 
transformation and improvement work within our area. The Board membership includes system 
partners  and  is  responsible  for  the  implementation  and  oversight  of  several  workstreams 
including:  

•  Development  of  a  virtual  ward  across  our  three  Acute  Hospital  sites  to  support  early 
discharge,  enabling  patients 
investigation, 
management, treatment, and care from the comfort of their own homes, thereby diverting 

the  same  high 

to  receive 

level  of 

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 those who might otherwise attend the ED.   

•  Development of an urgent community response service offering an alternative to meet the 
needs of individuals, rather than requiring an ambulance response and/or attendance at 
the ED. 

•  Development  of  Urgent  Treatment  Centres  as  an  alternative  to  ED  attendance  where 

clinically appropriate. 

Conclusion 
We hope that the above is helpful. The Norfolk and Waveney system continues to respond to 
the  pressures  and  challenges  described  in  this response,  in  a  way  that  shares  accountability 
and  responsibility  for  mitigating  actions  across  the  system.  Ambulance  handover  is  a  theme 
that  the  system  has  collectively prioritised, and  learning  from  adverse  incidents  has  informed 
the quality improvement and patient safety initiatives described above.  

Our thoughts are with the family as they come to terms with their loss. 

If you require any further information relating to this response, please contact:  

Executive Director of Nursing  
NHS Norfolk and Waveney Integrated Care Board 

Yours sincerely  

Chief Executive Officer 

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