The three acute trusts in the Norfolk and Waveney ICS – James Paget University Hospitals NHS Foundation Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, and the Queen Elizabeth Hospital King's Lynn NHS Foundation Trust – came together in 2020 to establish the Norfolk and Waveney Acute Hospital Collaborative (N&W AHC). The collaborative aims to enhance clinical effectiveness and patient experience, and reduce known inequalities in health outcomes and access to services (Norfolk and Waveney integrated care system). To deliver on these aims, N&W AHC has been organised around five work programmes – all areas in which combining efforts is deemed to make the greatest difference. These five programmes are: delivery of a single electronic patient record; a joint clinical strategy; unblocking delayed discharges; improving productivity across the acute providers and the wider system; and delivery of major capital projects. The trusts are delivering three new diagnostic centres one for each hospital site – through the major capital projects workstream.
The Norfolk and Waveney system first outlined plans to increase imaging capacity through the development of diagnostic centres on all three sites in 2019. The system identified a shortfall in imaging capacity, evidenced by the outsourcing of scanning and reporting for ultrasound, MRI, and other imaging, costing the trusts £2m per year combined. Some imaging equipment was ageing, and all three providers were having difficulty meeting performance targets. The trusts identified that additional capacity would be required at each of the three sites – which are spread across a wide area and serve a dispersed population – to meet the shortfall. Sir Mike Richards' review included this proposal as a case study to demonstrate the concept of community diagnostic centres. Despite being initially unsuccessful in securing funding, the proposal was resubmitted and successfully secured funding through a collaborative submission.
Despite securing national funding, developing the centres has required additional funds from the Norfolk & Waveney ICB, the Norfolk and Norwich Hospitals Charity (which pledged £1.6m for imaging equipment), and all three trusts. The scale of the programme, the major capital investment, and need for system-wide diagnostic capacity, in the context of greater collaboration between partners in systems, were all factors that led the trusts to come together to maximise the benefits of working at scale.
From the outset, the programme has been delivered collaboratively. The director of strategy and major projects at Norfolk and Norwich University Hospitals, Simon Hackwell was appointed to lead the programme as Senior Responsible Officer (SRO) on behalf of the three trusts, with individual SROs from each trust to support decision-making as well as local implementation of the centres. Running the programme through the provider collaborative has enabled agreement on single models for managing demand and capacity, workforce and procurement – from which all three trusts used as they developed their plans. This has allowed the programme to purchase equipment as a collective, and to link to the collaborative’s work to deliver an electronic health record by ensuring the centres' digital infrastructure supports collaboration and is future-proof. From a workforce perspective, a common approach to developing existing staff, skill mixing and identifying new roles has been agreed, as part of a collaborative approach to recruitment, training and development.
Alongside the collaborative elements of the approach, some aspects of the programme have been managed individually by trusts, including the location and design of each facility. N&W AHC has demonstrated the need to balance realising the benefits of working collaboratively at scale, while retaining the value of individual trust autonomy and decision-making.
The delivery of the three centres is in progress. The site at James Paget University Hospital is expected to open in July 2024, The Queen Elizabeth Hospital King’s Lynn site from September 2024 and the Norfolk and Norwich University Hospital site in February 2025. Once operational, each of the sites will house MRI and CT scanners as well as X-ray and ultrasound imaging functionality. The collaborative approach between hospitals and the ICB to deliver the services will increase the capacity for diagnostic imaging across the system, will allow for GP referrals and outpatient appointments from inpatient and emergency departments, and will standardise practices and collaborative working in imaging services across the three trusts. The trusts have also jointly agreed to a common approach to utilisation of the centres, all agreeing to operate a 7-day a week service, at a 90% utilisation rate of the scanners. For some trusts this has meant moving from 5-day models to 7-day, showing how trusts are standardising access and ensuring that the centres are delivering maximum capacity on behalf of the system.
Once operational, the three sites are expected to deliver over 280,000 tests per year. By working together to deliver on this transformational programme, the acute hospitals collaborative will improve access to faster diagnosis and significantly build diagnostic capacity for the benefit of the whole system.