CQC finds work is needed to reduce pressure on urgent and emergency care in Norfolk and Waveney

Published: 18 May 2022 Page last updated: 26 May 2022

The Care Quality Commission (CQC) has found work is needed to alleviate significant pressure on urgent and emergency care in Norfolk and Waveney, which has caused people to face lengthy waits for assessment and treatment. This is despite many services being individually well-run, providing safe care and effective treatment to people.

CQC’s findings come as part of a series of reviews into urgent and emergency care. These assessments consider how services work together in a geographic area to ensure people receive the right care in the right place at the right time.    

This review involved over 20 individual inspections across a range of health and social care services in the area covered by the Norfolk and Waveney Integrated Care System, also known as In Good Health.

Integrated Care Systems (ICSs) are new partnerships between organisations involved in health and care across an area. They coordinate services to improve people’s health and will replace clinical commissioning groups (CCGs).

As part of its review in Norfolk and Waveney, CQC inspected urgent and emergency care and medical services run by James Paget University Hospitals, the Queen Elizabeth Hospital King’s Lynn and Norfolk and Norwich University Hospitals NHS Foundation Trust.

CQC also inspected some local GP surgeries, urgent care, adult social care services and the NHS 111 service.

A full list of the services inspected and links to their reports can be found at the end of this press release.

Mandy Williams, CQC director of integrated care, inequalities and improvement, said:

“Many of the services we inspected in Norfolk and Waveney as part of this review were providing good care that met people’s needs and ensured their safety.

“Although the emergency departments we visited were well run, a high number of people waited over 12 hours for assessment and treatment. This led to overcrowded departments, delayed ambulance handovers and risk to patients.

“A significant issue behind this was staff shortages affecting other services people used when they had less pressing medical needs.

“This meant people couldn’t always access their GP, dentist or NHS 111 service when they needed – resulting in unnecessary 999 call or visits to hospital when minor ailments became unmanageable.

“We also found staff shortages in adult social care meant people remained in hospital when they should have been discharged to respite services. Not only was this wrong for these patients, it led to delays in emergency departments due to insufficient beds elsewhere in hospitals for people to receive further assessment and treatment.

“However, healthcare leaders had developed some strategies to alleviate this pressure.

“GP provision had been established alongside emergency departments, so patients attending hospital with issues that could be dealt with by GPs were immediately referred. This made a significant difference, reducing the number of people accessing emergency care by up to a third.   

“A hotel had also been used where people ready for discharge from hospital could receive step-down care.

“However – despite these initiatives and the examples of good practice we saw at individual services – system-wide workforce planning, and increased community health and social care provision is required to meet local people’s needs. If delivered successfully, this would reduce pressure on urgent and emergency care services and reduce the risk of harm to people living in Norfolk and Waveney.”  

Across the system, inspectors found:

  • A lack of staff and high levels of absence in GP and dental services meant people waited too long for appointments. These waits meant some people’s problems became more serious, leading them to call 999 or visit hospital – increasing pressure on these services.
  • People could not always access care or support for mental health issues when they needed to, and this also led to people presenting at emergency departments when their needs would be better met by mental health services.
  • The local NHS 111 service had significant staff shortages, largely due to the COVID-19 pandemic. Leaders in this service had a recovery plan in place, but staff shortages and increased demand resulted in significant delays in call answering and call-back times, leading to a high instance of people abandoning their call before speaking to an advisor. However, these delays were, on average, shorter than regional and national averages.
  • Staffing pressures in adult social care services caused discharge delays for patients who needed care packages to leave hospital. This meant there was a lack of space on wards for people who needed to be referred from emergency departments.
  • A high number of patients waited over 12 hours in emergency departments, resulting in overcrowding. This also impacted ambulance handovers and delayed ambulance crews returning into the community to respond to new 999 calls.
  • Some good practice had been developed to alleviate pressure on emergency departments. This included establishing GP provision alongside urgent and emergency care at hospitals, meaning people could be referred accordingly. This also cut admissions to emergency departments by up to a third.
  • A hotel was also used as a stepdown facility where people fit enough to be discharged from hospital but still needing some care and treatment could be referred.

The following reports have already been published and can be found via the links:

GP surgeries

Heacham Group Practice, Heacham

The Millwood Partnership, Bradwell

Church Hill Surgery, Pulham Market

Grove Surgery, Thetford

Manor Farm Medical Centre, Swaffham

Coltishall Medical Practice, Coltishall

Wensum Valley Medical Practice, West Earlham

Beccles Medical Centre, Beccles

Adult social care

Lulu's, Mundesley

New Dawn, Horsford

Strawberry Field, Walcott

Lindum, Salhouse

Dorrington House, Dereham

Oak House, Diss

Ashfields, Rackheath


The Queen Elizabeth Hospital King’s Lynn, King’s Lynn – urgent and emergency care and medical care

Reports for the following services will be published on Friday 13 May. 


Norfolk and Norwich University Hospital, Norwich – medical care

Cromer Hospital, Cromer – minor injuries unit – urgent and emergency services

James Paget Hospital, Gorleston-on-Sea – urgent and emergency services and medical care

Urgent care centres

Norwich Practices Health Centre and Walk in Centre, Norwich

Integrated Care 24 – Norfolk & Waveney, Norwich

For enquiries about this press release please email regional.engagement@cqc.org.uk.

Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the press office is unable to advise members of the public on health or social care matters.)

Urgent and emergency care (UEC) system wide inspections

See more information about UEC system wide inspections.

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.