Raising awareness of the impact of grief

National Grief Awareness Week (2-8 December 2023) is dedicated to raising awareness about grief, providing support to those who are grieving, and fostering a better understanding of the grieving process. It’s about acknowledging that grief is a natural response to loss and aims to break the stigma surrounding this deeply personal experience.

How can you get involved this week?

Attend grief support events

A Grief Awareness Day event is being held on the Wednesday 6 December at the NNUH in the East Atrium – inpatients side, Level 1. The event is 10am- 3pm and designed to highlight how grief and loss is not just to do with death but also loss of identity, function, role, relationships etc throughout illness. The event is open to the general public and health professionals and will include a grief café, conversation cards, and tea and cake (donated by SPONGE and NNUH staff).

Offer a listening ear

Sometimes the most significant support you can provide is to listen without judgment. Offer your time and empathy to someone who is grieving.

The NHS People Plan encourages all NHS organisations to create cultures where our NHS people have regular wellbeing conversations with their line manager or a trusted colleague.  These wellbeing conversations could be held as standalone conversations with a colleague, or incorporated into existing conversations, such as regular 1:1s or during check-ins.  You could also touch base during team meetings or shift handovers to see if anyone would benefit from a follow up conversation.

NCH&C colleagues can find out more about wellbeing conversations on The Loop, just search ‘wellbeing conversations’.

Spread awareness

Use social media and other platforms to share information about National Grief Awareness Week, including facts about grief and resources for support.

Share personal stories

We encourage colleagues to share their experiences with grief, either through written narratives, art, or verbal discussions. This sharing can help you feel less alone in their grief journey.

Last year we produced a special podcast where host Miranda Gretton talked about her personal grief journey following the death of her brother four years ago. Psychological and Bereavement Lead at NCH&C, Tracey Dryhurst, joined Miranda to discuss the complexities of grief and the support available. Listen here.

Signpost to further help and advice

• The Good Grief Trust – https://www.thegoodgrieftrust.org/
• NHS support
• Norfolk County Council Bereavement Support page
• Bereavement support line – 0300 303 4434. Free to access from 8am to 8pm seven days a week. A confidential staff support line is operated by Hospice UK. A team of fully qualified and trained bereavement specialists are available to support you with bereavement and wellbeing issues relating to loss experienced through your work.

UK Disability Month: Accredited in Support of You

Awards and Accreditations are more than just a tick box to NCH&C, they are a symbol that show we understand our responsibility to support and represent our community. They show we are listening to staff and that we will go the extra mile to complete and improve the processes that impact an improved staff experience.

As Norfolk grows in its diversity and our staff become more confident in sharing diversity data such as your diverse abilities, the trust continues to put initiatives in place to support you.

In 2022 the trust became a member of The Employers Network for Equality and Inclusion, otherwise known as enei, a not-for-profit membership organisation that is further enabling the trust to become the most inclusive organisation it can be for its people, including for those that identify as disabled, neurodivergent or as a carer.

NCH&C along with all NHS trusts across England participate in the National NHS Staff Survey annually which ranks us on staff experience across a variety of metrics such as Workforce Disability Equality Standard (WDES). In a similar way, enei encourages its members to particate in the annual Talent for Inclusion and Diversity Evaluation (TiDE) assessment. NCH&C completed the TiDE assessment recently, to measure what we have achieved in the past year since becoming an enei member. We proudly received a Silver TiDE award achieving 82% overall for trust practices across nine specific areas which included: Workforce, Leadership and Accountability, Strategic Development and Planning, Recruitment and Attraction, Communication and Staff Engagement, Learning and Development, Procurement, and other practices. The assessment also benchmarked us against other employers across all sectors. This process was robust, and the trust couldn’t have been more delighted to attend and celebrate at the virtual awards ceremony held in October, represented by Mercy Kaggwa, EDI Advisor and former CEO, Stephen Colman.

All NCH&C staff have access to enei resources by registering on the enei website using your NHS work email address.

Alongside enei, the trust is also affiliated with the Hidden Disabilities Sunflower organisation which provides the trust with resources that support staff who live with hidden and *non-visible disabilities and long-term health conditions to feel seen in the disability community.

During Inclusion Week 2022, and in summer 2023, the trust achieved the Carers Friendly Tick Award for Employers and Health respectively, taking our understanding about what disability looks like further in support those how carry out unpaid carer work that would otherwise impact the NHS by a further £160 billion annually. Our expert healthcare professionals continue to need our support by raising awareness, and robust polices, such as the trust Staff Carers Policy which includes carers leave.

The trust has been a Disability Confident Leader for three years and is currently going through the process of revalidation. A process that allows us to see what more we have implemented and achieved to ensure that we continue to deserve the status of “Leader”.

Disability looks different from one person to the next: whether neurodiverse, living with mental health unwellness, a long-term health condition or anything else. We are working to ensure that staff can access the support that you need to be successful in your role.

*The term ‘invisible’ disability is deemed a microaggression and those with hidden disabilities unseen. To find out more about inclusive terminology read the We Care Inclusive Terminology Glossary on the We Care website.

Celebrating Squirrels

16 November – 16 December is UK Disability History Month: an annual opportunity to celebrate the achievements of people living with a disability and to raise awareness of their challenges. First launched in 2020, Disability History Month provides a platform to focus on the history of disabled people’s struggle for equality and human rights.

The theme for Disability History Month 2023 focusses on the experience of disablement amongst children and young people in the past, present, and what is needed for the future. To mark the occasion, Christine Little, Senior Nurse on our Children’s Short Breaks Home Nursing Team, created this blog post to explain how our services at NCH&C support children and young people with a disability in Norfolk…

“NCH&C provide a range of services for Children and Young People (CYP). Across a large range of these services, many of the children and young people we work with will have a disability.

“Our services are varied and include a wide range of clinical specialists such as Nurses, Consultants, AHPs, and Psychologists, as well as highly trained support staff. We deliver services that assess and diagnose, services that offer treatment, as well as services that support the families of those CYP that are most vulnerable to maintain resilience.

“Our aim is to ensure that all CYP regardless of any disability of health condition can enjoy and achieve in their communities along side their peers. We offer training and support to education providers and some third sector providers so that CYP with complex health needs and disabilities can take part in a range of activities.

“One very important service we deliver is respite care. This is where we help look after CYP who are usually looked after by their families. For younger children, we deliver this service in their own homes. For older patients (aged 5-18 years), we deliver respite care in our specialist unit, Squirrels, based in Aylsham. The aim of both services is to support families, enabling them to build resilience whilst they take a break from delivering high levels of care. They are also an opportunity to provide a fun and enjoyable time for the CYP.  It is important within these services that we recognise each CYP as an individual and embrace their individuality, their likes and dislikes, tailoring activities to best suit the needs of each child.”

Find out more about our Children’s Short Breaks Residential Service here.

Now hiring for NCH&C’s new Willow Therapy Unit!

Opening at Norwich Community Hospital in Spring 2024, Willow Therapy Unit will be a state-of-the-art, therapy-led centre providing a supportive and comfortable environment for 48 patients.

Ahead of the new unit opening, we’ll be recruiting for many new roles over the next few months. Many of these will be Allied Health Professionals (Therapy Assistants, Occupational Therapists, and Physiotherapists), but we also have exciting opportunities for Nurses, Healthcare Assistants, and Advanced Clinical Practitioners.

NCH&C was awarded £19.3 million in funding from the Department of Health and Social Care to build the new Willow Unit, which was named following suggestions from our patients and staff.

Colleagues at the Willow Unit will work closely with patients, using the latest therapies and practices to promote rehabilitation and avoid readmissions. As well as comfortable and modern wards, the Willow Unit will feature a large therapy space and an assessment kitchen – where patients can build up their strength by making snacks and hot drinks in a safe and supported environment.

We’re hiring for the following roles at the new Willow Therapy Unit:

• Housekeeper (Band 3)
• Staff Nurse (Band 6)
• Assistant Practitioner (Band 4)
• Administration Assistant (Band 3)
• Lead Occupational Therapist (Band 7)
• Ward Clerk (Band 3)
• Unit Lead (Band 8A)
• Registered Nursing Associate (Band 4)
• Lead Physiotherapist (Band 7)
• Lead Nurse (Band 7)
• Physiotherapist (Band 6)
• Physiotherapist (Band 5)
• Occupational Therapist (Band 6)
• Occupational Therapist (Band 5)
• Inpatient Staff Nurse (Band 5)

The closing date for the above vacancies is Thursday 30 November, with more roles to follow in the coming weeks. Find out more about working at the Willow Therapy Unit here.

As well as a rewarding and flexible career, colleagues at the new Willow therapy Unit will benefit from plenty of learning and progression opportunities, a comprehensive wellbeing offering (including free staff gyms), and a competitive salary and generous NHS pension.

Apply now and take the next step in your career at Norfolk’s community NHS!

Celebrating OT Week 2023

Occupational Therapy Week this year was all about supporting OTs to create a better understanding of occupations, in the context of occupational therapy.

What are occupations and why do they matter? Through having these conversations and raising awareness everyone will better understand the role of occupational therapy, its impact and value.

Occupations are any activity that we need, want or like to do to live and to look after our physical and mental health. They can be self-care, productive or leisure. Find out more about occupational therapy in our NCH&C community and hear from some of our OTs here.

Rowena is a Children’s Occupational Therapist. She talks about how she makes a difference to her patient’s lives here.

The awareness raising opportunities don’t end this week though, the Royal College of Occupational Therapists has put together a calendar of activities for November with ideas to help spread the message:

Step into your new community career

We have many brilliant career opportunities available at various bands, in numerous specialisms, across many teams and services in Norfolk. You can check out our current vacancies here.

But wait! Right now is an even more exciting time to consider a career at NCH&C.

In August we were awarded £19.3 million Department of Health and Social Care funding to build the Willow Therapy Unit for 48 patients at Norwich Community Hospital. This state-of-the-art therapy led facility will help patients move from hospital care to the community with the latest therapy and rehabilitation technology and practices.

The unit will provide a supportive and comfortable environment for patients and their families, with healthcare delivered by a multidisciplinary team of clinical professionals dedicated to patient recovery and well-being.

In the coming weeks we’ll be looking for more excellent staff who share our vision of delivering the highest levels of community patient care to join our outstanding trust.

Ankita is a physiotherapist at NCH&C, working at Norwich Community Hospital. Hear from her about what is different about being a community physio.

If this sounds like something you want to be part of, click here to register your interest in hearing about the roles we have available at Willow Therapy Unit when they go live.

Why work in the community? Why NCH&C?

Working in the community is very different to providing health and care in an acute setting, but it is just as rewarding. It’s one of the most cherished parts of the NHS.

But we would say that, wouldn’t we?

Don’t just take our word for it though. Our staff will also tell you that being part of NCH&C is very special.

Hear Beth, head of IPAC at NCH&C, talk about why she prefers working in the community.

Also Alex tells us about why she thinks community health and care offers something special to staff and patients.

Click here to find out more about why it’s great to work in the community and at NCH&C.

NCH&C has enviably high levels of staff satisfaction, as seen in our annual NHS Staff Survey results. We demonstrate this via our open and supportive culture, and our commitment to colleagues’ development and wellbeing. See here for more details about our wellbeing offering. We also have a video of NCH&C staff talking about the difference this has made to them here.

Our colleagues talk openly about various subjects that are important to them personally and professionally on our podcast, you can hear these here.

And it’s not just our staff who say we’re excellent. We’re immensely proud that we achieve consistently high patient satisfaction scores. And we were the first community NHS trust in the UK to be rated ‘Outstanding’ by the Care Quality Commission.

NCH&C is a place where you can start your career; it’s somewhere you can develop your career; and we have opportunities for you to diversify your experience and skills at any point in your career. We will support you as much as we can – we believe that our staff are our biggest asset.

The range of roles at NCH&C is wide. We provide services in our eleven community hospital and inpatient units, GP surgeries, schools, and in patients’ homes across the whole of Norfolk.  There’s more about all the services we offer on the Working at NCH&C page of this website.

With the Willow Therapy Unit opening in the coming months it’s a really great time to be working in our community trust. If you feel that you would like to take a new step in your career, now is the time to come to the community and join us in our mission of looking after you locally.

Sign up to hear about the vacancies at Willow Therapy Unit when they go live.

The heart of the NHS for 75 years

Wednesday 1 November is Community Health & Care Day: an annual awareness day launched by NCH&C to raise the profile of community-based health and care.

We may not have the visibility of an ambulance siren or a local GP practice, but for those patients who rely on us, we provide a valuable lifeline to health and independence.

Community Health & Care Day 2023 coincides with NHS75: a yearlong celebration marking 75 years of universal healthcare in the UK. Since its inception, community healthcare has been a vital component of the NHS. Delivering care to patients in their home environments and local communities is, and has always been, one of the best ways to keep the population healthy, safe, and living independently.

Although NCH&C was formed 13 years ago (November 2010), community healthcare professionals have been looking after the population of Norfolk for much longer. The NHS was formed in 1949, but community nursing is much older. The first trained district nurses started working in 1859 – 90 years before the foundation of the NHS. Likewise, some of our institutions have histories that extend beyond NCH&C. For example, the Priscilla Bacon Lodge hospice was launched in 1970, so has existed for over half the NHS’s lifetime.

As well as looking back on our roots, there is much to celebrate as we look to the future. As well as the launch of the new PBL facility, upcoming developments like the creation of the new Willow Therapy Unit and the further rollout of Virtual Ward will ensure that Norfolk’s community NHS is serving the county’s population for many more years to come.

Today is also a significant day for NCH&C because it’s the day that our new Interim CEO, Matthew Winn, officially joins us. Matthew serves as joint CEO for both NCH&C and Cambridge Community Services NHS Trust, where he has been CEO for the past 15 years.

Matthew showed his support for his first Community Health & Care Day at NCH&C:

“There really is no better day to be joining NCH&C as your new Chief Executive. Thank you to Stephen Collman for his leadership over the past few years, and we wish him well as he takes the helm at Worcester Hospital in a week’s time.

“I hope that as I lead two great community health organisations for the next year, I can ensure we learn from each other and collaborate wherever possible. My focus will be working with health and care partners in Norfolk and Waveney to agree the strategy for community health and care at home and ensure this is delivered. There are so many challenges facing us all, from the huge rise in children needing SEND support through to the vast numbers of older people who must get exemplary rehabilitation following a change in their health or functional status. These and so many other service areas are the areas we excel in, and we need to continue to push the professional and clinical boundaries even further.”

Here’s how we’re celebrating Community Health & Care Day 2023:

• NCH&C colleagues and system stakeholders will be sharing their reflections on 75 years of community NHS across social media channels. If you want to get involved, download the comms pack and don’t forget to use the hashtag #CommunityHealthAndCareDay2023.
• We also produced this short social media video summing up 75 years of community NHS. Please watch and share with pride!

• Continuing the NHS75 celebrations, we’ve produced a commemorative plaque featuring patient reflections on 75 years of the NHS for the Mulberry Garden. If you’d like to share a reflection, please email communications@nchc.nhs.uk

• Following the completion of our first NHS75 mural in July, we’re working with Estates to get more murals completed across the trust. More details coming in the next few weeks!
  

• Colleagues from the Learning Disabilities Service are holding their own celebrations today to mark LD Nursing Day.
• As part of the transition to the new PBL, we worked with colleagues and the charity to produce a video commemorating their symbolic lantern-lit walk from the old hospice to the new. We’re pleased to share this with colleagues and volunteers at PBL on Community Health & Care Day. It will be made available to all colleagues shortly after.

Are you celebrating Community Health & Care Day? Let us know on communications@nchc.nhs.uk

A Royal visit to NCH&C's Priscilla Bacon Hospice

On Thursday 26 October, King Charles III attended NCH&C’s Priscilla Bacon Lodge Hospice (PBL) to officially open the new facility.

The Royal visit was arranged by the Priscilla Bacon Hospice Charity, who raised £12 million to fund the new hospice.

Upon arriving at the new PBL, the King was greeted by Agnes, a therapy dog who volunteers at the hospice to boost the morale of the patients. He then attended NCH&C’s Breathlessness Clinic in the day unit, where he met outpatients and trust colleagues, followed by a visit to the inpatient unit. The King was shown around by Tracey Dryhurst (Service Lead for Psychological Services), Charlotte Shawe (Specialist Palliative Care Pathway Lead) and Lauren Isaacs (Head of Palliative Care Services).

King Charles III meets an NCH&C outpatient in the Breathlessness Clinic

The King also toured the gardens, where he was shown the outdoors gym equipment by Senior Physiotherapist, Wendy Smith. Our Lead Chaplain, the Reverend Helen Garrard, showed the King the new chapel.

One of the highlights for many NCH&C colleagues was seeing the King meet Rebecca, a 31-year-old inpatient with stage three melanoma. Rebecca’s four-year-old daughter, Arielle, presented King Charles with a paper crown that she had crafted with PBL volunteers that afternoon. After a cup of tea, presented by a PBL volunteer, the King unveiled a commemorative plaque, declaring the new hospice officially open.

Patient’s daughter presents the King with a crafted paper crown

During his visit, the King greeted NCH&C CEO Stephen Collman, trust Chair Lynda Thomas, and our Director of Strategy & Transformation, Laura Clear. Other figures from the Norfolk & Waveney Integrated Care System also attended the event, including Chair Patricia Hewitt, and Chief Executive Tracey Bleakley.

Members of the NCH&C Exec team meet the King

PBL is a specialist unit for adults with complex palliative care needs which cannot be met in their own homes. The centre comprises a short-stay inpatient ward and a state-of-the-art day unit, featuring a gym and counselling and therapy spaces. NCH&C staff at PBL provide holistic care that incorporates the physical, emotional, social, and spiritual needs of our patients. The new unit, based on the outskirts of the NNUH campus, replaces the former PBL located on Unthank Road in the city centre. The palliative care provided at PBL is complemented by our community palliative teams, who provide end-of-life and palliative care in patients’ homes.

Director of Strategy & Transformation, Laura Clear, with NCH&C PBL Nurses

Celebrating our Allied Health Professionals

Today NCH&C is celebrating AHPs’ Day in recognition of all the remarkable work our Allied Health Professionals (AHPs) do in delivering care to patients in the community. As the third-largest clinical workforce group within health and care, AHPs play a pivotal role in supporting the NHS Long-Term Plan. The theme for this year’s AHPs’ Day is: AHPs in the right place, at the right time, with the right skills which recognises this valuable contribution, and aims to spotlight careers in the 15 AHP specialisms.

AHPs play a vital role in enabling and enhancing patients’ recovery from a range of illnesses and injuries, and supporting those with life limiting conditions. Read more below from Carolyn Fowler, Executive Director of Nursing and Quality, and Kate Pontin, Operations Director for Transformation and Delivery, about how valued our AHP workforce are at NCH&C and how we are committed to working with them on future developments for the trust.

Carolyn Fowler, Executive Director or Nursing and Quality at NCH&C and also our AHP lead

“To all our Allied Health Professionals I want to wish you a happy AHPs’ Day and celebrate the incredible contribution you make with all our colleagues to the quality of the patient care we give. I know that AHPs are each unique and not just one group of staff. You bring a huge variety of specialised and individual skills and knowledge.

“Each one of your professions deserves their own day but this is just one way to say thank you and remind everyone of what you do, that is so special.

“Having listened to what is important to you, I know career progression and equal opportunities is key. Welcoming Kate Harman and Zoe Carroll  into our teams to specifically support you with learning and development, the championing of your roles and career opportunities has been a starting point. I hope in the coming months we can do more to make your working environment the best it can be, and that you keep telling me what is important to you.

“Have a great day and be proud of who you are and what you do.”

Watch Carolyn’s video message for NCH&C AHPs here.

Kate Pontin, Operations Director for Transformation and Delivery at NCH&C

Before training to become an Occupational Therapist (OT), Kate was a qualified nurse and worked as a therapy assistant. She qualified as an OT in 2001 and worked as a rotational B5 in Sheffield. While on rotation she did medicine, orthopaedics, amputee rehabilitation, burns and plastics, cardiac rehab and A&E.

Kate then moved to a B6 position in A&E and a five day turn around unit, which worked with social care and the voluntary sector.

When she moved to Norfolk, Kate worked at the NNUH before moving to NCH&C in 2004, working in North Norfolk covering both wards and community. She became OT clinical lead for the North in 2008 and then in 2014 was promoted to Head of Integrated Care for South.

After working in the integrated space alongside social care she had the opportunity to apply for the Deputy Director for Integrated Care, which she started in February 2018. During the Primary Care Network (PCN) restructure in 2019 she applied for an Operational Director post for South and started that in 2020.

Throughout her time managing teams Kate has kept a strong focus on putting the patient first, maintaining core OT values and principles, and developing her leadership skills. As part of AHPs’ Day, she has this message for all AHPs at NCH&C:

“We recently got the go ahead to build a new unit at Norwich Community Hospital. The Willow Unit will have an underpinning therapy ethos, with staff working as a whole team. Each member of the team will play an active part in supporting patients to achieve their functional goals. This will enable therapists and nursing colleagues to work alongside each other collaborating seamlessly to promote discharge. This is a hugely exciting development for NCH&C and its AHPs.

“I was very recently appointed as Operations Director for Transformation and Delivery at NCH&C. As part of this role I’ll be leading on writing an AHP strategy for NCH&C and working alongside AHP colleagues to find out what matters to you. I want to know how you see the future of AHP development and careers at NCH&C and in the Norfolk and Waveney system as a whole, and to ensure that your voice is heard in the strategy.  I look forward to meeting more AHP colleagues and collaborating with you.”

#AHPsDay

This week (9 – 15 October), we're celebrating hospice care and sharing the incredible work that NCH&C staff do to ensure our patients receive the best end-of-life care possible.

This week (9 – 15 October) is Hospice Care Week. We’re celebrating hospice care and sharing the incredible work that NCH&C staff do to ensure our patients receive the best end-of-life care possible.

We deliver a number of services to palliative and end-of-life patients across Norfolk, including community service, day treatment, and specialist in-patient units.

One of our palliative units, the Priscilla Bacon Lodge Hospice, recently moved to a brand new facility, following an extensive fundraising appeal from the Priscilla Bacon Hospice Charity.  The new PBL hospice is conveniently located on the NNUH campus.

The launch of the new PBL marks the launch of a new Palliative Care Provider Collaborative between NCH&C, NNUH, and the Priscilla Bacon Hospice charity to seamlessly deliver specialist palliative care in Norfolk. The new facility will be a platform for education and research, supporting improvements in palliative and end-of-life care locally and nationally. It will become a hub for palliative care services, working with the University of East Anglia, and collaborating with the Norwich Research Park.

To celebrate Hospice Care Week and the opening of the new PBL, Ruby Cox, a Staff Nurse at PBL, shares her career journey and how she unexpectedly found a passion for working in end-of-life care…

My Hospice Journey

“My first experience of working in palliative care was as a student nurse. I trained at the University of Suffolk and I was in my final year of training. The allocations are pot-luck and I lucked in! (Although, at the time I didn’t think so). The university assigned me to work at St Elizabeth’s Hospice and my initial thoughts were “how am I going to cope with this?”, “what will I say to someone that is dying?”, “will it be too depressing?”.  The thought of palliative care was daunting to me. However, I ended my twelve-week placement having found that a palliative pathway would be my future career.

“As nurses, we are taught to make our patients better and fix their problems. With palliative care, this mindset changes because we are not trying to treat our patients or heal them; we are there to support them holistically and provide comfort at their time of need. We have to realise that we cannot change the outcome for these people, but we can affect their journey. The most rewarding aspect of palliative care is learning about our patients’ lives and not just their diagnosis. It is paramount for us to not only know about our patients but also their families (this is known as family-centred care) and what matters the most to them. Palliative care creates a space for reflection and exploring our spirituality, and a hospice setting delivers the environment to do this.

“I knew after this placement at St Elizabeth’s that palliative care was my future. I was keen to work in a hospice straightaway, although after receiving guidance from previous mentors, I decided to gain some acute medical experience so began my nursing journey on A&E and AMU at the Norfolk and Norwich University Hospital. This allowed me to learn about the deteriorating patient and helped me to identify the difference between a patient who is dying and a patient who has a reversible cause for their deterioration. After two years working in the hospital, I moved on to the Priscilla Bacon Lodge (PBL) where I have progressed to become one of the Senior Nurses. At PBL, we provide many palliative treatments such as intravenous antibiotics/fluids, bisphosphonates, blood transfusions, syringe drivers etc. These treatments are not curative but can be offered to support a better quality of life for our patients. Our wonderful new hospice setting provides a peaceful environment for patients and their loved ones to share their last precious memories. I feel so thankful to have been given the opportunity to work amongst so many compassionate and caring nurses who share the same passion for palliative care. To us, this is not a job but a vocation.”

Thanks so much to Ruby for sharing her career journey this Hospice Care Week. 

Feeling inspired by Ruby’s story? Click here to see a list of our vacancies working with palliative patients in Norfolk.