Questions and answers

What is the Case for Change?

The Case for Change brings together evidence about how our hospitals are performing today, the challenges they face and why continuing to deliver care in exactly the same way may not be the best approach for patients in the future. 

It also explores opportunities to improve care, including new treatments and technology, providing more care closer to home and making better use of the expertise across our three hospitals. 

It is the first stage of a longer process. It is not a decision about how services will be organised in the future.

Why do hospital services need to change?

There is much to be proud of across our hospitals, and our staff provide excellent care every day. 

However, we know that we are not consistently delivering the quality and timeliness of care our patients deserve. 

Our population is ageing, demand is increasing and some services are becoming more difficult to staff and sustain. We also face challenges with waiting times, financial pressures and ageing hospital buildings. 

We need to understand how to address these challenges while continuing to provide safe, high-quality and accessible care.

Why is this happening now?

We have a significant opportunity to improve services, particularly through the £2.8 billion investment in replacing the Queen Elizabeth Hospital and James Paget University Hospital. 

We need to ensure our new hospitals are designed around the healthcare needs of future generations rather than simply reproducing the services we have today. 

National developments in healthcare also create opportunities to provide more treatment outside hospital, use technology differently and strengthen specialist services.

Who has developed the Case for Change?

The work has been clinically led, with around 60 senior clinicians from across our three hospitals contributing to the Clinical Advisory Group. 

Doctors, nurses, midwives and other healthcare professionals have considered national evidence, clinical standards and the challenges experienced by patients and staff. 

This is not a finished clinical strategy. The next stage would involve further evidence gathering, testing and engagement.

Is this really about saving money?

The starting point is improving the safety, quality and sustainability of patient care. 

Financial pressures are part of the challenge, and we must use NHS resources responsibly. However, financial considerations cannot be viewed in isolation from patient safety, access, workforce requirements and health inequalities. 

Any future proposals would need to be assessed against all these factors.

Are the new hospitals dependent on changes to clinical services?

The New Hospitals Programme requires us to plan for the future healthcare needs of our communities. 

Our clinical strategy will help inform the design of the replacement Queen Elizabeth and James Paget hospitals and how they work alongside Norfolk and Norwich University Hospital. 

This does not mean that particular service changes have already been agreed. The clinical strategy and new hospital planning need to inform one another as the evidence develops.

Are you planning to close or downgrade any of the three hospitals?

No decisions have been made to close or downgrade any hospital. 

All three hospitals have an important role in providing care for their communities. 

The work is about understanding how they can work together more effectively and how services might develop to meet future patient needs.

Will people have to travel further for treatment?

Our ambition is to provide as much care as possible locally or closer to people's homes. 

Early clinical analysis suggests that approximately 97% of current hospital activity could continue to be provided locally or closer to home. 

For a small proportion of patients with particularly complex conditions, there may be benefits from accessing treatment from specialist teams. 

However, the implications for travel, accessibility, patient experience and health inequalities would need to be examined carefully before any proposals could be developed. 

The 97% figure is an early estimate, not a guarantee about individual services.

What does more care closer to home actually mean?

It means supporting people to receive appropriate care without needing to attend or stay in hospital when that can be done safely. 

Examples include: 

• Better support for people living with long-term conditions

• More appointments, tests and treatment in community settings

• Virtual monitoring and support at home

• Helping people leave hospital promptly when they no longer need inpatient care

• Better coordinated care between hospitals, GPs, community services and social care

This would require close collaboration and investment across the wider health and care system.

Does the reference to 11 hospital wards mean wards will close?

No. 

The Case for Change estimates that improving neighbourhood and community care could reduce future demand for hospital beds by an amount equivalent to up to 11 wards. 

This is a modelling estimate of potential future demand, not a proposal to close 11 existing wards. 

The estimate depends on developing effective alternatives to hospital care and would require further testing with health and care partners.

Will planned operations still be available at local hospitals?

The early clinical work suggests that the overwhelming majority of planned care could continue at existing hospital sites. 

There may be opportunities to bring together a small number of highly complex procedures where specialist expertise, equipment and clinical support can improve outcomes. 

No decisions have been made about moving individual surgical services.

Are A&E departments at QEH or James Paget going to close?

No decision has been made to close an emergency department. 

The clinical approach being put forward for further consideration retains 24-hour emergency departments at all three hospitals, alongside critical care. 

The work explores how people with the most serious or complex conditions can access the specialist expertise they need. 

This is not a decision to replace an emergency department with a minor injuries unit.

Does this mean seriously ill patients will be transferred to Norwich?

Some patients already need to travel between hospitals or to specialist centres for particular types of treatment. 

The clinical work is exploring whether there are opportunities to improve care by bringing together specialist expertise for a small proportion of patients. 

Any future arrangements would require detailed evaluation of clinical safety, ambulance services, transfer times, capacity and the impact on patients and families. 

No new transfer arrangements have been agreed.

Why can't every hospital provide every specialist service?

Many treatments can and should be provided locally. 

However, some complex conditions require specialist teams, equipment and experience that may not be practical or clinically appropriate to provide at every hospital. 

National clinical evidence and standards recognise the benefits of specialist teams for certain conditions. 

The challenge is to balance access to specialist expertise with the importance of keeping as much care as possible local.

Will all three hospitals continue to treat very ill patients?

The clinical approach proposed for further consideration includes 24-hour critical care at all three hospitals. 

The precise arrangements for different levels of specialist treatment would require further clinical evaluation. 

No changes have been agreed.

Are you planning to close maternity services at QEH or James Paget?

No maternity closure has been agreed and there is no preferred future maternity model. 

Clinicians have identified several possible approaches for further evaluation, including retaining hospital delivery units at all three sites. 

Other scenarios explore whether a different number of hospital delivery units could offer benefits for clinical safety, workforce resilience and quality of care. 

These are early scenarios, not agreed proposals.

Why are maternity services being reviewed?

Birth numbers at QEH and James Paget are relatively low and are projected to decline further, while the complexity of maternity care is increasing. 

Clinicians have raised questions about maintaining the skills, experience, staffing and clinical support needed to deliver safe maternity care around the clock. 

These questions need careful examination alongside the importance of local access, choice and the needs of women and families.

Does this mean everyone would have to travel to Norwich to give birth?

No such decision has been made. 

One of the scenarios identified for further evaluation involves a single hospital delivery unit, but others retain two or three. 

Each would need detailed assessment of safety, staffing, facilities, capacity, travel times, transport and the impact on women and families. 

The current scenarios should not be interpreted as a preferred or predetermined outcome.

What about antenatal and postnatal care?

An important part of the clinical thinking is how more maternity care could be provided closer to home. 

This could include antenatal and postnatal appointments, scans, community midwifery, early pregnancy services and additional support for women and babies. 

Any future model would need to consider the full maternity pathway, not simply where births take place.

NNUH already transfers some women to other hospitals. How could it accommodate more births?

This is an important question that would need to be answered through detailed evaluation. 

Any future scenario involving a different distribution of births would require robust modelling of capacity, staffing, facilities, emergency arrangements and the investment needed. 

Current maternity transfers and operational pressures must form part of that evidence.

No assumption should be made that NNUH could accommodate additional births within its existing capacity. 

Validated transfer figures and their underlying reasons should be considered as part of the next stage of work.

What would happen to paediatric and neonatal services?

The early clinical work includes retaining 24-hour paediatric same-day emergency care at all three hospitals. 

It also considers how neonatal and inpatient paediatric services would need to support different maternity arrangements. 

These services are closely connected, and any future proposals would need to assess their implications together. 

No changes to individual paediatric or neonatal services have been approved.

Does the Case for Change mean our hospitals are unsafe?

The Case for Change is open about areas where quality, performance and resilience need to improve. 

Our teams seek to deliver high-quality care every day, often under considerable pressure. 

We have a responsibility both to address immediate quality concerns and to consider longer-term changes that could improve patient outcomes and make services more resilient.

What about concerns over medical training placements at QEH?

Concerns relating to medical education and training are taken seriously and require appropriate action with the relevant education and training bodies. 

These are important issues in their own right, but decisions about training placements are not the same as decisions about the future configuration of hospital services. 

Specific questions about the reasons for training decisions, current staffing arrangements and improvement actions should be answered by the relevant QEH clinical and medical education leads.

What does this mean for hospital staff?

No staffing changes have been agreed as a result of the Case for Change. 

Our staff are central to developing any future approaches to care, and their expertise and experience will be essential to understanding what is safe and deliverable. 

If further work is commissioned, workforce implications would be a major part of the evaluation. 

We recognise that uncertainty can be unsettling and are committed to keeping colleagues informed and providing opportunities to contribute.

Why should people trust this process?

We recognise that discussions about the future of hospital services can cause concern, particularly in communities with strong connections to their local hospital. 

That makes transparency and meaningful engagement essential. 

The Group has published the evidence and early clinical scenarios so that people can understand the questions being explored. 

Independent engagement through Healthwatch has already received more than 5,000 responses, and further opportunities for involvement would form part of the next stage. 

We need to be willing to listen, challenge assumptions and change our thinking in response to evidence.

Has the Board approved the scenarios?

The Board has supported further consideration of the clinical scenarios as part of the Case for Change. 

It has not selected a preferred scenario or approved any changes to individual services. 

The scenarios provide a starting point for more detailed analysis. Some may not progress once they are tested against the evidence.

Who will make the final decisions?

The Case for Change will now be considered by NHS Norfolk and Suffolk Integrated Care Board, with scrutiny from the Norfolk Health Overview Select Committee. 

The ICB will determine the next stage of work and the appropriate process for developing and considering any future proposals. 

Any significant service changes would need to follow the relevant NHS decision-making, scrutiny and consultation requirements.

Will there be a public consultation?

If significant changes to services are proposed, formal public consultation may be required. 

However, the process is not at that stage. 

Before any consultation, there would need to be further work to develop and assess options, understand their impact and determine which, if any, should be taken forward. 

Engagement with patients, staff, partners and communities should continue throughout that process, not simply at the point of formal consultation.

How have patients and the public been involved so far?

Healthwatch has been independently commissioned to gather people's views about hospital care and the issues that matter most to them. 

More than 5,000 responses had been received by late October 2026. 

Early themes include the importance of local access, travel and transport, waiting times and confidence in services. 

The engagement findings will inform the next stage of the work. An interim report is expected in November 2026, with a final report in January 2027.

When will decisions be made?

There is no final decision timetable at this stage. 

The next steps depend on consideration by the ICB and the further work it may commission. 

We recognise that people want certainty, but it is important not to rush a process involving complex clinical questions and potentially significant implications for communities.

How can partners and communities contribute?

We welcome constructive challenge and local insight, particularly about access to care, transport, health inequalities and the needs of different communities. 

Partners can help by sharing accurate information, listening to the questions and concerns raised locally and ensuring that the experiences of people who may be less likely to participate are heard. 

Further engagement arrangements will be shared as the next stage of work is confirmed.