It has been another year of high demand and difficulties for the region's health and social care service, health correspondent Geraldine Scott looks at what 2019 could bring.

Eastern Daily Press: File photo of an ambulance. Photo: Rui Vieira/PA WireFile photo of an ambulance. Photo: Rui Vieira/PA Wire (Image: PA Wire/Press Association Images)

Ambulance queuing outside hospitals

At the start of 2018, as the Beast from the East hit Norfolk, an enduring photo of those weeks was ambulances queuing outside accident and emergency departments.

The problem is a knock on effect of patients who are ready to go home not being able to leave hospital, as the support may not be in place, which then means there are not enough beds to get people into from ambulances.

MORE: Hospitals still too slow at taking patients from crews, ambulance trust winter plan says

The result is crews are forced to keep patients on the back of their trucks until they can hand them over - meaning those calling 999 need to wait longer for a crew to arrive.

It is from that we hear the stories of hours long waits. After last year's winter crisis measures have been put in place where hospitals are meant to take patients off the hands of crews straight away.

But already it is being reported that were 16 ambulances queuing outside the Norfolk and Norwich University Hospital overnight on December 29.

The cycle will be difficult to break.

Final chance for failing care homes

James Bullion, head of adult social services, at Norfolk County Council has vowed to tackle care homes which continually fail to live up to expected standards.

And it seems the regulator, the Care Quality Commission (CQC), has taken a similar hardline approach as we're seeing more and more homes rated as inadequate by inspectors.

In December alone this newspaper reported on 10 separate care providers deemed inadequate.

Eastern Daily Press: James Bullion, executive director of adult social services at Norfolk County Council. Picture Norfolk County CouncilJames Bullion, executive director of adult social services at Norfolk County Council. Picture Norfolk County Council (Image: Archant)

MORE: Poor quality care homes will not be tolerated in Norfolk, says social services boss

Often they are failing to be safe or well-led, a worry for a county such as Norfolk with such a high proportion of elderly people and an aging population.

It is right that both the CQC and council crack down on these failing homes, but many providers are hitting back and saying the inspection process is unfair.

It is an issue which this newspaper will examine in the new year, but for now our priority must be pulling these failing homes up to scratch for the protection of our loved ones.

Eastern Daily Press: Ritson Lodge, in Hopton, which has been rated as inadequate by the CQC. Photo: Nick ButcherRitson Lodge, in Hopton, which has been rated as inadequate by the CQC. Photo: Nick Butcher (Image: ©archant2013)

Long-awaited answers for contaminated blood victims

In 2019, the public inquiry into the contaminated blood scandal will continue and Norfolk victims hope they will get answers.

The investigation is looking at how thousands of NHS patients were given infected blood products during the 1970s and 1980s in what has been dubbed the worst-ever NHS treatment disaster.

MORE: Contaminated blood victim calls for prosecution of those responsible for 'historic and horrific tragedy'

Eastern Daily Press: Michelle Tolley had blood transfusions twice when she was pregnant in the 1980s and got diabetes by the 1990s. Later, she was diagnosed with HIV.PHOTO BY SIMON FINLAYMichelle Tolley had blood transfusions twice when she was pregnant in the 1980s and got diabetes by the 1990s. Later, she was diagnosed with HIV.PHOTO BY SIMON FINLAY

Michelle Tolley, 53 and from Sparham, was one of thousands of people in the 1970s and 1980s who were given blood products infected with hepatitis viruses and HIV.

She has been at the forefront of campaigning on the issue and no doubt will continue to speak out for those who can't.

She said: 'The impact on our lives has been one of devastation, destruction, and ultimately death. 'Those responsible for this historic and horrific tragedy which has lasted decades, must be identified.'

Public meetings are to be held in the first quarter of 2019, with the public hearings due to start at the end of April 2019.

Can hospitals get out of special measures?

It was not just care homes which got a kicking from the CQC in 2018, two of the region's hospitals were also placed into special measures and told they were unsafe.

Both the Norfolk and Norwich University Hospital (NNUH) and the Queen Elizabeth Hospital (QEH) in King's Lynn were given the worst possible rating.

MORE: Unsafe, poorly led and dysfunctional - Shocking report into Norfolk hospital

Eastern Daily Press: A banner outside the Queen Elizabeth Hospital in King's Lynn Picture: Chris BishopA banner outside the Queen Elizabeth Hospital in King's Lynn Picture: Chris Bishop (Image: Archant)

Staff were praised for their hard work but management was criticised, meaning when the James Paget University Hospital (JPUH) received their report at the end of the year - with a rating of good - it made the coastal hospital the only acute hospital in the county which was not failing.

Next year inspectors will return to both hospitals and they will expect to see improvements, and fast.

MORE: Unsafe, poorly led - and getting worse: Inspectors slam county's flagship hospital

But after what is tipped to be another high-demand winter, it may be difficult for those on the frontline to sustain progress, let alone get ahead.

Eastern Daily Press: Norfolk and Norwich University Hospital. NNUHNorfolk and Norwich University Hospital. NNUH (Image: Archant © 2018)

Time for change in mental health care

It is difficult to know what the future holds for mental health care in the region, and what next year will bring.

When Norfolk and Suffolk Foundation Trust (NSFT) was rated inadequate for the third time at the end of the year, many called for the trust to be split in two or placed under government control, known as special administration.

MORE: Inspectors have not ruled out parachuting in government special administrators at mental health trust

Neither has happened yet, but the CQC said they had not ruled special administration out and much is likely to rest on what inspectors find when they return to NSFT in the New Year.

What is clear though is that five years since this newspaper started campaigning for better mental health care in the region, is that enough is enough. The people of Norfolk and Suffolk have been let down for too long and 2019 is the - long overdue - time for change.

New shake up of local health system

The inner workings of the health service are not easy to grasp and often mean little to the patient.

Eastern Daily Press: Patricia Hewitt, who heads up the Norfolk and Waveney Sustainability and Transformation Partnership, which aims to become an Integrated Care System, Byline: Sonya DuncanCopyright: Archant 2018Patricia Hewitt, who heads up the Norfolk and Waveney Sustainability and Transformation Partnership, which aims to become an Integrated Care System, Byline: Sonya DuncanCopyright: Archant 2018 (Image: ARCHANT EASTERN DAILY PRESS (01603) 772434)

But it is expected that Norfolk and Waveney's system will again bid to become an integrated care system (ICS), a new way of working which hopes to break down the silos between providers, commissioner, charities and local authorities.

MORE: Norfolk and Waveney could have one combined health and social care budget under new system

The region was overlooked in 2018 when it submitted its bid, but a change to an ICS could mean the £2.6bn budget for all of health and social care in Norfolk could move more flexibly.

And it could potentially see money moving for organisations in a surplus to those in deficit, which in turn could impact patients.

No doubt those managing their money well will not be best pleased to prop up their neighbours, however much bosses pledge they want to work together. In Norfolk already the county council pushed to ensure 'the financial liabilities of the NHS do not pass to the local authority'.

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