Health provision across the region is set to change radically over the next few years with Norfolk and Waveney's NHS and social care services staring at a £0.5bn black hole by 2020/21.
Behind closed doors, senior clinicians, hospital chiefs, and other experts are drawing up plans that are likely to have major implications to how people get medical help from the NHS.
Norfolk County Council's managing director, Wendy Thomson, who is leading the project, said the behaviour of both clinicians and the public must change so that NHS services can be sustainable.
As the health service battles to meet rising demand, NHS chiefs have told local leaders they must design a plan which will show how health and social care will be provided sustainably in the next few years.
Today this newspaper can reveal that some of the key challenges facing Norfolk and Waveney's NHS include:
A £545m deficit by 2020/21 if savings are not made;
An estimated 9,000 more people with diabetes and 7,000 more dementia patients;
Emergency admissions increasing at a greater rate than that of Norfolk and Waveney's population as a whole.
These challenges are set out in a joint report by the Sustainability and Transformation Plan (STP) team, which consists of all the chief executives of the local NHS organisations and Norfolk County Council.
In the report it is said the area's annual deficit is estimated to grow by between £9m and £43m per year. The 'do-nothing' scenario, in which savings would not be made, would result in a deficit of £545m by 2020/21.
To stop this financial decline and meet the rising patient demand, the STP will focus on meeting challenges in three vital areas: Acute care, primary care, and prevention.
It means health bosses will review how services are provided across Norfolk's three acute hospitals (the N&N, Queen Elizabeth, and James Paget), improve public education on health, and increase capacity in the community.
Saving back-office costs will also be explored, which could mean closer partnerships or mergers between some of the area's five clinical commissioning groups (CCGs), this newspaper understands.
A public consultation will be launched in September. There are 44 STPs are being drawn up across regions nationally (each one known as 'footprints').
Alex Stewart, chief executive of scrutinising body Healthwatch Norfolk, said: 'The process of creating STPs offers some hope for creating more joined up and more efficient local services, but at this stage it is just that - a hope.'
Dr Thomson said: 'We need a health and care system that serves the right people with the right care in the right place – so that will mean all of the different organisations working together to avoid unnecessary hospital admissions, and make sure that we are supporting people in their own homes.
'Today's healthcare needs to support people who are living longer and managing several long term, often chronic, conditions. The behaviour of clinicians, administrators, and the public will have to change in order to put our services on a sustainable footing.' The Norfolk and Waveney STP must be submitted to NHS England by October. Other STPs are being drawn up for Suffolk and North East Essex, and Cambridgeshire and Peterborough.
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