Confidential documents reveal health chiefs' fears over money, while reform plans are being held up by lack of cash and huge staff shortages. Tom Bristow reports.
Three years ago NHS bosses promised to transform Norfolk and Waveney's health and care services.
Hundreds of meetings, billions of pounds and dozens of reports later the same problems of not enough staff and cash to cope with the rising demand remain, according to minutes of private meetings.
The minutes, obtained under the Freedom of Information Act, are from meetings of the Norfolk and Waveney Sustainability and Transformation Partnership (STP) - a forum for NHS leaders.
When the STP first met in 2016 it said it would balance the NHS' books and reduce demand, but the opposite has happened.
The deficit of Norfolk and Waveney's NHS organisations grew to almost £100m last year.
There are 3,000 staff vacancies and A&E attendances have increased by 15pc since 2016, while emergency waiting times have worsened.
In August the Norfolk and Norwich University Hospital (NNUH) had the third worst waiting times of any A&E in England.
It, along with the Queen Elizabeth in King's Lynn - as well as the region's mental health trust - are in special measures.
But chair of the STP, Patricia Hewitt, defended its record.
"One of the biggest achievements of our STP cannot be measured by numbers and spreadsheets," she said.
"We have brought health, social care and public health partners in Norfolk and Waveney together in a way which was not in place before."
The STP listed improvements in GP and cancer care among its success stories as well as attracting new money to Norfolk.
But the minutes from 2016 to 2018, which the NHS fought to keep secret from this newspaper, have little mention of concrete achievements and show frustration at the pace of change.
"It is essential that we start to take action," reads one minute from October 2018 - two years after the STP had launched its initial plan.
"We need a clear narrative about what has gone wrong in Norfolk and Waveney and what we are doing to fix it now, not in five years time," they add.
An STP spokesman said: "There have been many notable achievements under the STP to date in respect of prevention. This includes the increase in take up of flu immunisations amongst children and infants."
They also cited nurse training and a review of mental health services.
Patient group Healthwatch Norfolk said the STP was a good concept but "very poor" at engaging with the public, was "over dependent" on management consultants and reform had been too slow.
Alex Stewart, Healthwatch chief executive, said: "I think they believe someone else will come along with the answer to everything."
Meanwhile, a spokesman for the Campaign to Save Mental Health Services in Norfolk and Suffolk accused health bosses of focusing on "spin rather than delivery, finance rather than quality".
"Our hospitals and trusts are repeatedly failing and they are sitting around, drinking tea and paying expensive management consultants to do the work they should be doing," they said.
The STP has spent £1.9m since 2016 on consultants but Ms Hewitt said they were "incredibly good value" and she was "incredibly proud that our work... has brought so much benefit to the people of Norfolk and Waveney".
The government awarded £133m to the region's NHS in August and Ms Hewitt put that down to the work of the STP's consultants.
An STP spokesman added: "The success of the STP is based on partners working together over a wide range of initiatives and services to create a sustainable health and social care system corroboratively."
The NHS tried to stop the minutes being released by arguing it would endanger health, but eight months later, after an appeal by this newspaper to the Information Commissioner's Office, they were published.
Ms Hewitt said: "The minutes were marked as confidential precisely because attendees needed to speak freely and in confidence for the whole meeting."
But North Norfolk MP Norman Lamb, a former health minister, said: "There is no justification for keeping this secret.
"Without the accountability that comes with transparency people can keep talking without actually achieving anything.
"I think there is good leadership in the STP now but my advice to them would be to embrace transparency."
-The money
On July 1 2017 NHS England told an STP meeting that it had to close its financial gap "urgently", minutes obtained by this newspaper reveal.
But by March 2019, when it was meant to run up a deficit of £32m for the financial year, Norfolk and Waveney's NHS ended up almost £100m in the red.
Part of the problem, according to a meeting in November 2017, was Norfolk's different NHS organisations needing to be "more open and honest" with each other about the true state of their finances.
In June last year the minutes said: "We should speak with one voice about the underfunding of health and social care."
And in September the minutes read: "We're running a system we can't afford and so either need to be massively more efficient or we need to stop doing things."
This is not mentioned in the public updates the STP publishes.
But an STP spokesman said health chiefs often spoke about the financial challenge as well concerns about recruiting and retaining staff.
In October 2018 another STP meeting was told "funding is a real problem".
"We can't just ask for money, although we need it," the minutes read. "Staffing issues are a real problem.
"The STP needs a fundamentally different approach to the financial challenge."
An STP spokesman said: "The reason for the overspend is that demand for NHS services is ever rising - the population is growing, we are living longer and lifestyles are changing, so we are seeing much more instances of disease and illness, for example diabetes and dementia."
This year, the STP said it would cut the deficit from almost £100m to £16.4m and a spokesman said it was on track to do this.
They also said it had attracted more investment into the region's NHS and had made savings of £78m last year.
Savings have been made by using cheaper medicines and keeping patients at home rather than in hospital, they added.
Last month Norfolk's NHS also received a major cash boost from the government with three projects being awarded £133m.
The NNUH will get £69.7m to provide assessment centres, the Norfolk and Suffolk NHS Foundation Trust was given £38m to build four new hospital wards and South Norfolk CCG was awarded £25.2m for GP services.
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