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NHS East of England Annual Report 2010/11

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CONTENTS

SECTIONS: INTRODUCTION FROM THE CHAIRMAN AND CHIEF EXECUTIVE OF NHS EAST OF ENGLAND

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OUR NHS, AND THE PEOPLE WE SERVE

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CHANGING OUR NHS TOGETHER

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OUR VISION

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REINVESTING FOR IMPROVEMENT

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MANAGING MODERNISATION

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HOW HAVE WE PERFORMED?

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THE DIRECTORATES DELIVERING THE PLEDGES AND THE REPORTS ON THE PLEDGES 17 SPOTLIGHT - WORKFORCE

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SPOTLIGHT - DEVELOPING CHOICE AND COMPETITION

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WORKING AT NHS EAST OF ENGLAND

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THE NHS EAST OF ENGLAND BOARD

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INTRODUCTION Welcome to the 2010/11 NHS East of England Annual Report. This year the NHS has seen ground breaking changes and has faced significant challenges. However, despite these, the NHS in the east of England has continued to make visible improvements to the quality, breadth and availability of NHS services for the benefit of all patients.

NHS East of England has continued to deliver on the 11 public pledges we made in Improving Lives; Saving Lives; three years ago and we have continued our strong record of financial management. Whilst there has been a real terms growth in the NHS budget, resources are having to stretch further than ever before to meet the increasing costs of an ageing population, new treatments and new services. Yet even in this challenging economic environment, the NHS in the east of England returned a system-wide surplus of £101 million, which was consistent with our plan. This surplus provides a useful financial ‘buffer’ for future years. New Challenges The Coalition Government has brought to the table proposals for big changes to the way in which the NHS operates in the future, but also a firm commitment to support the NHS. The Government has committed to increasing the NHS budget by 0.4% in real terms until 2014/15.

This settlement includes commitments for additional investment to support social care, expanding access to talking therapies and the new cancer drugs fund. Above all it will allow the NHS in the east of England to maintain the quality of services to patients. The Government has stated its ambition to make the NHS one of the best health services in the world and this chimes with our regional ambition to provide the best health service in England. The Health and Social Care Bill proposes big changes to the way in which the NHS operates in the future, placing patients at the heart of everything it does. One of the most significant changes proposed is to the way in which NHS services are commissioned. Currently local Primary Care Trusts commission services for patients, but from April 2013 those at the coalface of patient care, our clinicians, will be directly responsible for commissioning services for their patients.

We have been supporting this change by working closely with groups of local GPs as they formed local GP Commissioning Consortia and have been encouraging and assisting them to become GP Pathfinders. This prestigious designation is given to those GP consortia who will lead the way in the Government’s plans for commissioning health services. To date we have 24 GP Pathfinders in the region, covering about 81 per cent of the region’s population. Since the changes proposed in June to the Health and Social Care Bill, we have been working with the consortia as they develop into Clinical Commissioning Groups. Whilst a great deal of time and effort is being invested by the SHA to ensure this fresh new approach is successfully implemented and gives the best possible outcomes for patients in the future, NHS East of England has continued to make good improvements on the quality, performance and delivery of NHS services right across the region. >


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Upholding Our Pledges Our final year of our three year Improving Lives; Saving Lives; has delivered further improvements to NHS services for local people. • We promised improvement in patient satisfaction and in a recent survey 71% of patients and residents said they would recommend their hospital and 85% their GP. • We promised to improve privacy and dignity for patients by bringing to an end mixed sex accommodation in hospitals and in 2010 we achieved 100% compliance with the national standards, plus we have the second lowest percentage of breaches in the country. • The NHS Constitution pledges that all patients will be treated within 18 weeks of referral. Despite the Government removing this as a national target in 2010, the majority of patients continue to be seen within 18 weeks. • We promised to improve access to GPs and the region

is now ranked fourth in the country for satisfaction with GP services and the ability to see a GP of their choice. • We promised to ensure NHS dental services were available to all who needed them and a recent survey rated us as one of the best nationally in terms of the proportion of patients who were able to make an NHS dental appointment - 97% in Quarter 3. • We promised to improve stroke services so now have 100% access across the east of England to 24/7 stroke thrombolysis and have gone from the worst performing to joint third best performing in the country for access to acute stroke services. • We promised to make the health service safer and our patient safety programme on Venous Thromboembolism (VTE) has seen a significant rise in the rate of risk assessments carried out on patients at risk of VTE from 37% to 92% this year. • We promised to reduce

Health Care Associated Infections (HCAIs) and the SHA has the lowest rate of Clostridium difficile infection in the country and the third lowest rate of MRSA. • We promised to cut the number of smokers and this year local NHS Stop Smoking Services achieved an increase of 2,944 quitters compared to 2009/10. • We promised to reduce inequalities in health so we are pleased that in our region the difference in life expectancy between the least and most deprived, for both male and females, is below the national average - 7.4 years (male) and 4.8 years (female) compared to 8.8 years and 5.9 years nationally. • We promised to halt the rise in obesity in children and then seek to reduce it. Data collected by the National Child Measurement Programme of children in Reception Year and Year 6 from 2007/08 to 2009/10 shows that the rise in obesity in children has halted over those three years in the east of England. >


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Successes and achievements In addition to delivering on our pledges we have seen many other successes this year that have helped to improve the quality, performance and delivery of services in the east of England. A major success has been the implementation of the Government’s Interim Cancer Drugs Fund which has given a vital lifeline to hundreds of cancer sufferers in the region. More than 265 applicants received funding for specialist life extending drugs not currently available on the NHS. NHS East of England is continuing to work closely with our three Cancer Networks to ensure hundreds more benefit from the new £600 million national Cancer Drugs Fund over the next three years.

Our regional Change 4 Life campaign also hit the road this year taking information and advice on how to live a healthier fitter lifestyle to thousands of people across the region. Ten local convenience stores supported the campaign helping to encourage people to eat more fruit and vegetables. This initiative was endorsed by a personal visit to a shop in Norwich by the Secretary of State for Health and preliminary data shows a 60% increase in fruit and vegetable sales in the participating stores. NHS East of England also held the first ever Staying Healthy at Work Week this year. This aimed to show NHS staff as well as employers and employees in other businesses and organisations across the region how good health is good for you, your career and good for business. We have also joined forces with Investors in People East of England to offer a Health and Wellbeing Good Practice Accreditation and Award.

The Award recognises health and wellbeing achievements in the workplace and reflects an organisations’ commitment to the health and wellbeing of its staff.

Left: Various campaign materials.

We have rolled out Choose and Book to the armed forces and established an NHS Armed Forces Network. Sustainability also remains high on our agenda as there is sound evidence that many components of sustainability achieve immediate health gains plus cost reductions. A focus on sustainability ensures the development of a system which reduces inappropriate demand, reduces waste and incentivises a more effective use of services and products. All of our NHS organisations in the region are committed to becoming low carbon, sustainable organisations.

Thursday 3 March 2011 10am - 3pm Rowley Mile Conference Centre Newmarket, Suffolk, CB8 0TF


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Top: Deputy Chief Nurse Gwen Collins (left) and Head of Clinical Quality & Patient Safety Lyn McIntyre (right), presenting the VTE Assess Prevent campaign to nurses from across the region. Bottom left: Margaret Berry, NHS East of England’s Interim Chief Nurse and Director of Quality and Executive Nurse at NHS Luton. Bottom right: NHS East of England‘s former Chair Sir Keith Pearson.

National recognition Our services, programmes, initiatives and staff have also been recognised nationally with a number of prestigious accolades. These include: • Winning a place in the Sunday Times Top 100 ‘Best Places to Work For’ in the UK - Public and Charity. We were the only NHS organisation in the country to be named in the list this year. • Our innovative stroke telemedicine initiative won the national ‘best use of telehealth and telecare’ in the national E-Health Insider Awards 2010 in association with BT. • A knighthood was awarded to our then NHS East of England Chair Sir Keith Pearson in the Queen’s Birthday Honours for services to healthcare. • The Innovations scheme run jointly by Hertfordshire County Council and the East of England Ambulance Service NHS Trust, which helps older people who have fallen at home - the

first scheme of its kind in the country - came top in the ‘Support for Independence’ category at this year’s National Health and Social Care Awards. • Margaret Berry, NHS East of England’s Interim Chief Nurse and Director of Quality and Executive Nurse at NHS Luton, was awarded an OBE in the New Year’s Honours List for services to healthcare. • In January 2011 the NHS in the east of England received an award from the charity Lifeblood for the best VTE prevention in a region. The programme was also awarded exemplar status by the VTE Exemplar Network in September 2010. What’s next? As part of the proposals in the new Health Bill NHS East of England, along with the other strategic health authorities, will be abolished in April 2013. However, until that time, we will push ahead with improving the quality and performance of NHS services and ensuring we continue to invest resources in protecting

and improving public health. We will be working very closely with GPs and clinicians in the region to ensure the national NHS reforms are implemented locally and that going forward patient services remain safe and deliver the high standards of care that patients expect. NHS East of England will also continue to work with all our NHS organisations on the wide-ranging efficiency drive to achieve productivity improvements of £1.7 billion nationally. Greater productivity will need to be achieved both by commissioners and providers particularly through new ways of working for staff and through better procurement. Every penny of these efficiency savings will be available for reinvestment in frontline healthcare. By increasing efficiency and working smarter within available resources, the NHS in the east of England will be well placed to continue providing healthcare of the highest possible standard, both now and in the future, whilst delivering on our clinically led vision Towards the Best, Together.


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OUR NHS AND THE PEOPLE WE SERVE

Population size and growth The east of England is home to 5.8 million people, with a higher than average proportion of people aged over 65. The population is expected to grow by 11% between 2009 and 2020. This growth will differ locally, with the projected growth rate for North East Essex being 17%, compared to 8% for South East Essex. There are also significant differences in projected growth rates between age bands. The population aged over 85 years is expected to double over the next 20 years whereas the population aged between 15 and 64 years is expected to increase by less than 10%.

The east of England is home to 5.8 million people ‌

Geography

Marginalised Groups

The east of England has both very rural areas and urban conurbations bordering London. This widely differing landscape is illustrated by the fact that the largest business sector is the service industry, although 71% of the land is agricultural. The rural nature of much of the east of England is an important factor in considering appropriate models for service delivery.

Within the population, there are number of groups who may have the greatest need of public services including the NHS, but find it difficult to access them. These include migrant workers, gypsies and travellers and those in the criminal justice system.

Prosperity The east of England is a relatively affluent region, with above average employment. However, there are areas of significant deprivation. Ethnic Origin The vast majority of the east of England population is from a white ethnic background, with about 400,000 people from non-white backgrounds. Although this makes the east of England one of the least ethnically diverse regions in the country, it is expected that the proportion of the population of non-white origin will grow in the future.

The east of England has seen a rapid increase in migration in recent years with a 124% increase in the foreign-born population in the last decade to around 9% of the population and 12% of the workforce*. This increase has been driven in part by new arrivals from Eastern and Central Europe, but migrants in the region are highly diverse in terms of their countries of origin and their employment. >

* Migrant Worker Availability in the East of England: an economic risk assessment by Jill Rutter, Maria Latorre and Sarah Mulley, Institute for Public Policy Research 2009


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The east of England has the highest concentration of gypsies and travellers in its population, with 23% of English gypsies and Irish travellers caravans recorded in the region. As a group, gypsies and travellers have a life expectancy 10-12 years lower than the national average, with higher rates of heart disease and infant mortality. People in the criminal justice system are another marginalised group. They have high rates of mental health problems and difficulties with lifestyle factors such as smoking and lack of exercise. Many prisoners also have difficulty integrating with the healthcare system when they are discharged from prison. Health The health of the east of England’s population as a whole is relatively good compared to the national average. However there are significant health inequalities and variations in life expectancy.

Life Expectancy

Lifestyle

Long Term Conditions

Life expectancy in the region is above the England average for both men and women, but this hides wide disparities. For men in the region, average life expectancy is 79.3 years, compared to a UK average of 77.7 years and for women it is 83 years, compared to a UK average of 81.9 years. There is, however, a significant and unacceptable difference in life expectancy depending on where in the region you are born.

There are a number of lifestyle factors that are commonly associated with poor health. Most of these are less prevalent in the east of England than across the country. The east of England has the lowest proportion (19% in 2008) 2009/10 figure from the Integrated Household Survey is 20.1% of smokers in the country; however there remain almost 1 million smokers, 50% of who will die from smoking related diseases.

Long term conditions such as diabetes; coronary heart disease; chronic obstructive pulmonary disease; neurological conditions; and others, are extremely common. There are about 1.3 million adults in the east of England with a long term condition, which impacts significantly on their quality of life and that of their carers and family.

Health Inequalities

Alcohol related harm is an area of particular concern in the region. The rate of deaths in the east of England attributable to alcohol use is 31.3 per 100,000 for men and 12.8 per 100,000 for women.

There are significant differences in health outcomes between and within Primary Care Trust (PCT) areas. These inequalities largely are accounted for by differences in lifestyle behaviours, such as smoking, obesity and lack of physical activity and by wider socio-economic factors such as poverty, housing and employment.

Causes of Death The main causes of death in the east of England are cardiovascular diseases and cancer, which between them account for more than 60% of all deaths in the region of people over one year old. This is similar to the national position.

The incidence of long term conditions increases with age, so as the population ages the number of people with long term conditions is expected to increase by about 25% over the next 20 years. 70% of those over 75 have one or more long term condition compared with 20% of 16-44 year olds.

The NHS in the East of England Healthcare in the east of England is commissioned by local Primary Care Trusts who operate as the lead NHS organisations for a specific geographical area. The NHS in the region has over 111,300 staff, of which 3,600 are GPs, 3,600 are consultants, 32,700 are nurses, 2,400 are midwives and 2,600 are dentists. This makes it the largest employer in the region. In 2010/11 the NHS in the east of England had a budget of ÂŁ9 billion equivalent to around 8% of the regional economy. The NHS is overseen by NHS East of England, the strategic health authority for the region. In addition to the strategic health authority, there are seven primary care trust clusters, three community NHS trusts, 17 acute trusts, one specialist cardiothoracic trust, six mental health trusts and one ambulance service trust in our region.

Although the 13 regional PCTs still exist as separate statutory bodies, they have formed operational clusters in 2010/11 in order to make significant management cost savings and in preparation for their abolition in 2013. The population of the east of England is about 11% of the national population, and use of healthcare services is similar. Acute hospitals in the east of England serve larger geographical areas than the national average, reflecting the rural nature of our region. This requires all NHS organisations to work together to ensure the best care is available to all, whilst recognising the need to balance the best possible outcomes for patients.


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CHANGING OUR NHS TOGETHER

We have come a long way in the NHS over the last few years. The results of our focus on delivering a better service and improving outcomes for patients are impressive. We are now working on a new set of challenges and opportunities. Looking ahead: • We will continue to deliver our clinically led vision of an improved NHS, ensuring better outcomes. This is our regional vision Towards the best, together. • We will save £1.7bn in efficiencies to reinvest for these better outcomes. This is the challenge of QIPP which stands for Quality, Improvement, Productivity and Prevention.

The east of England is home to 5.8 million people … We will continue to deliver our clinically led vision of an improved NHS.

• We will continue to put accountability and power as close to the patient as possible, into the hands of GPs and other clinicians. This is the Government’s vision for modernisation as set out in the Health and Social Care Bill. Together they are the most radical and exciting set of

challenges we have ever faced. The prize is a truly patient centred NHS that delivers amongst the best outcomes in the world in a way that is financially sustainable for our children and their children. It is a once in the lifetime opportunity and responsibility, delivering now and for the future. Clinical evidence; new techniques; new equipment; more knowledgeable patients; and an ageing population demands change in how we deliver health and healthcare. We know people want care closer to, and in, their homes. We know people want their choice of treatment and consultant-led team, plus options around time and place, summarised in the phrase “no decision about me, without me”. Change is a constant in the NHS and we will make the new changes that QIPP demands by releasing money from existing services and investing in others. The new approaches to care in Towards the best, together. Strong and clear clinical evidence, experience and knowledge created a road

map of change towards a better quality future. This roadmap, where good progress has already been made, is where we are going to reinvest our savings. The direction of travel towards a better quality future is clear, and the way we are going to pay for it is understood. Now we are going to ensure that responsibility for every pound being well spent is as close to that patient as possible. We will liberate the NHS by putting power in the hands of local GPs, everyone’s family doctor and other clinicians. We are now on a journey that frees up the resources we need, to deliver the new and better outcomes we want, with power to deliver them in the hands of the clinicians closest to the patient. One journey, three strands: Changing our NHS Together. This change is huge as it turns the NHS on its head, but it will be a legacy that NHS East of England will be proud to leave behind in 2013.


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OUR VISION: Towards the best, together Improving Lives; Saving Lives

Towards the best, together and Improving Lives; Saving Lives form the clinical vision for the NHS in the east of England. These are now part of our broader challenge, Changing our NHS together, running in parallel with NHS modernisation and the QIPP (Quality, Innovation, Productivity and Prevention) programme. This vision, developed in 2008 with clinicians, staff, other stakeholders and patients is clinically-led, evidence-based and centred on patients needs. It makes proposals for improvements in every area of the NHS, and for every patient and carer - from before birth for expectant mothers, to after death for families coping with the loss of a loved one.

Towards the best, together and Improving Lives; Saving Lives form the clinical vision for the NHS in the east of England.

Local hospitals are close to the heart of their communities and our vision supports a sustainable future for A&E and maternity services at all the region’s acute hospital trusts. The vision sets out how we will respond to patients’ desire for care closer to home, but also makes a strong case for centralisation of some complex care where that will improve outcomes and save lives.

The vision identifies where we need investment in more staff, including midwives, clinical psychologists and health visitors. It puts in place changes to ensure the NHS focuses on prevention and sound mental and physical health so we will need to cope with less illness in all our lives. The NHS must promote good health as well as providing world class healthcare. And it ensures that NHS patients are treated with respect as individuals, including patients at the end of their lives. The recommendations set out in the combined vision of Towards the best, together and Improving Lives; Saving Lives are long term ambitions that we have been striving to achieve. Later in this report, we describe in detail progress against all of the 11 pledges made in Improving Lives; Saving Lives. Some headline examples of the progress we have made to deliver our vision in 2010/11 are: • Prevention of VTE (Venous ThromboEmbolism) is now embedded into normal practice at all hospitals, with more than 92% of

inpatients in the region now risk assessed compared with 37% in June 2010. This has been helped by a unique regional integrated communications campaign. • As promised last year, personal health planning is now being implemented for people with long term conditions. Following an extensive public consultation, we put together a vision for better health and well being for people with a learning disability and their families in the east of England. • Treatment and care of stroke patients continued to improve. For example, by the end of the financial year, 77.6% of stroke patients were cared for on a stroke unit for 90% of their stay, which is a major improvement on the 55% a year earlier. To find out more, visit www.eoe.nhs.uk/vision


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REINVESTING FOR IMPROVEMENT Opportunities to improve quality were clearly identified by each of the 10 Towards the best, together Clinical Programme Boards

The east of England’s key priorities for improving the quality of NHS services are set out in the Improving Lives; Saving Lives pledges (see pages 17 to 21). Opportunities to improve quality were clearly identified by each of the 10 Towards the best, together Clinical Programme Boards. The financial constraints for the NHS do not change these commitments. The issue now is how to deliver them through better use of existing resources rather than through increased funding. At the same time improving quality, price and activity cost pressures need to be addressed. To do so, the NHS in the east of England needs to achieve productivity improvements of approximately £1.7bn by 2014/15. This greater productivity will have to be made both by commissioners - particularly through the redesign of urgent care, elective care and long-term condition pathways, and by providers - particularly through new ways of working for staff and through better procurement.

PCTs and their providers, supported by social services colleagues and emerging GP consortia, have worked closely together over the last nine months to develop locally owned system QIPP plans. Collectively these plans have identified £2.1bn worth of opportunities to increase productivity between 2011/12 and 2014/15. This is made up of £0.9bn identified by PCTs through a combination of strategic service changes and internal efficiencies, and £1.2bn identified by acute, mental health, community and ambulance providers through greater efficiencies. To support this integrated system planning and ensure the delivery of these productivity improvements, a specific QIPP Programme has been established, with 13 work streams:

1. Delivering Sustainable Care 2. Improving Mental Health Services 3. Improving End of Life Care 4. Delivering Prescribing Efficiencies 5. Transforming Community Services 6. Improving Healthy Lifestyles 7. Delivering Specialised Commissioning Services 8. Improving Emergency Ambulance Services 9. Delivering Acute Workforce Changes 10. Delivering Collaborative Procurement Efficiencies 11. Transforming Pathology Services 12. Providing Safe Care 13. Improving Adoption and Spread Work streams 1-12 are led by a PCT or provider Chief Executive, or a lead clinician, and all involve Directors of NHS East of England. The work of these work streams is coordinated through a single Programme Management Office.


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QIPP COMES TO LIFE ACROSS THE REGION The key priority is to ensure that better quality and better productivity are pursued in tandem and that the processes to achieve this are hardwired into the day-today business of every NHS organisation. During the year, governance structures were reviewed, resulting in the QIPP work streams and Towards the best, together Programme Boards being integrated under a single, simplified structure. This results in greater engagement of clinicians with QIPP, and reflects the need for a simpler structure that delivers management savings.

Role of the QIPP work streams The thirteen work streams fall into three categories; commissioner-led, providerled and supportive activities, some of which will be regionally delivered and some of which will primarily involve support for delivery within local systems. The key roles of each of the regional delivery work streams are to: • Deliver the agreed work programme and the agreed quality and productivity improvements • Link to the national work stream (where one exists) • Identify and disseminate best practice and coordinate regional events

The key roles of each of the system delivery work streams are to: • Support local systems in the delivery of the agreed quality and productivity improvements • Agree productivity and quality improvement KPIs and oversee regional progress • Link to the national work stream (where one exists) • Identify and disseminate best practice and coordinate regional events to encourage adoption and spread. Informatics, as a productive enabler, is integrated within work streams as appropriate.

Personalisation and productivity The Personalisation and Empowerment QIPP subgroup brings together various strands of work, all aiming to deliver personalised care in response to the Government’s emphasis on ‘no decision about me without me’. The range of initiatives, which also improve quality, productivity and patient experience, include: • An ePortal to facilitate personal health planning by providing information, support, education and tools to help both the service user and the care worker. • A web based personal health plan (ePHP), accessible via the ePortal, for individuals to use for considering their goals and the support they need to meet them. • Encouraging commissioners to offer a range of information/education to help individuals to self care.

Quality referrals

Innovation in pathology

The Delivering Sustainable Care QIPP workstream is facilitating GPs having easier access to consultants through a new web-based application called Confer.

A regional project was established in 2010/11 to develop plans to implement the Carter recommendations for transforming pathology services.

The system allows GPs to search for a consultant, to be presented with immediate availability, and to request a “Confer” that will either be immediate or by e-mail.

Through clinical engagement with the pathology community, a shared vision for the future of pathology is being articulated, so that commissioners and acute providers can prepare the ground for change and to agree innovative and effective new models of service delivery.

By enabling a GP to access specialist advice to support their referral decision making, unnecessary outpatient referrals can be avoided and patients will have more appropriate referrals into secondary care. Hospital consultants and GPs across Essex and Norfolk have participated in pilots.


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MANAGING MODERNISATION

The Government’s white paper “Equity and Excellence: Liberating the NHS” was published in July 2010 for consultation. It set out the government’s long term vision for the NHS. The vision builds on the core values and principles of the NHS: a comprehensive service, available to all, free at the point of use, based on need, not ability to pay. It set out how the NHS will: • Put patients at the heart of everything it does. • Focus on continuously improving those things that really matter to patients - the outcome of their healthcare. • Empower and liberate clinicians to innovate with freedom to focus on improving healthcare services. • Cut bureaucracy and improve efficiency. A number of further papers, including specific papers on public health and education and training, were also published for consultation in 2010. NHS East of England encouraged its staff to consider the issues and engage their

professional networks to generate feedback, but the SHA also led on consultation and engagement across the system. We were able to use feedback and opinion from across the region to inform our response to the Department of Health. PCTs and trusts employed a wide range of consultation and engagement methods to elicit views from all stakeholders, including clinicians, managers, local authorities, patients, carers and the public. From small network meetings, to larger stakeholder events and from staff newsletters to micro-blogging on Twitter, a full range of communications channels were used to ensure all voices were heard. In December 2010, the government published its response to the consultation outlining its intent to bring the Health and Social Care Bill to Parliament for consideration. Key elements of the reform programme described in the white paper include: • The establishment of GP commissioning consortia to shift to clinicians the control

of commissioning pathways of care and so improve outcomes for patients. These are now involving a wider set of clinicians and developing into clinical commissioning groups, as proposed by the new Health and Social Care Bill. • A clear split between purchase and providers of healthcare involving an all foundation trust future and divesting primary care trusts of their community services. • Aligning public health with local government focussed on the health needs of the local population through the establishment of health and wellbeing boards. • Changing some of the organisational structures of the NHS, including the abolition of the strategic health authorities and primary care trusts and the creation of new bodies such as the NHS Commissioning Board and Health Education England which will promote excellence and oversee investment in education and training. >


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PROMISING PARTNERSHIPS While a number of elements of the white paper require legislation through the passage of the Health and Social Care Bill, the strategic health authority has been putting in place the necessary steps to plan such a large scale change programme.

of emerging GP commissioning consortia. The aim of this work is to support the development of the consortia so they are ready to take over the commissioning responsibilities from primary care trusts. This work has included:

We are focussed on: • Designing the future • Improving performance • Managing the transition The greatest focus needs to be on maintaining performance and our performance in 2010/11 is described in more detail on page 15. Mirroring the national leadership for the transition, NHS East of England has established regional leads for commissioning and provision. Dr Paul ZollingerRead, a leading GP, has been appointed Director of Commissioning Development and SHA director Dr Stephen Dunn is Director of Provider Development. A workstream has been established at the SHA to facilitate the development

• Running workshops to provide the GPs with the new technical skills they need to commission effectively. • Support the development of the future leaders of commissioning groups. • Ensuring that emerging groups have a series of support materials to create effective local patient engagement. • Supporting the emerging commissioning groups to work with local authorities to integrate health and social care around the needs of patients. The Government announced a programme of GP Commissioning Consortia pathfinders for those emerging consortia that, working under the oversight of their local PCT, want to

take up early responsibility for commissioning. To date within the east of England there are 24 pathfinders covering about 81% of the region’s total population. Since June we have been working closely with these consortia as they widen their membership and become clinical commissioning groups. Across the east of England good progress has been made with developing providers of NHS care. All primary care trusts have signed off plans for the development of external community services providers and have achieved the Department of Health deadline of the 1 of April 2011. The community services providers in Cambridgeshire, Hertfordshire and Norfolk became NHS trusts in 2010 and are now working towards becoming community foundation trusts. Social enterprises have been established in North East Essex and in Mid Essex with another planned for Great Yarmouth and Waveney.

The Queen Elizabeth Hospital King’s Lynn became a Foundation Trust on 1 February 2011; a preferred bidder has been identified for Hinchingbrooke Hospital; and, subject to Monitor approval, Suffolk Mental Health Partnership NHS Trust will be acquired by Norfolk and Waveney Mental Health NHS Foundation Trust. All other NHS trusts within the east of England are moving towards foundation trust status. The reforms signal the creation of health and wellbeing boards at the upper tier local authority level. These will be vehicles to oversee the production of joint strategic needs assessments which in turn will be used to create a joint health and wellbeing strategy and this will drive both health and social care plans for each locality. Subject to the passage of the Health and Social Care Bill through Parliament,clinical commissioning groups will become statutory members of the health and wellbeing boards.

NHS East of England has sought to work in partnership with sister agencies throughout the delivery of the pledges and our partners are vital to our success in delivering these outcomes in the east of England. Work with local government has been particularly important since the government released its White Paper Liberating the NHS which included a stated ambition to enhance the role of local government in health services. To support this we have been working closely with the East of England Local Government Association (EELGA) to ensure local authorities work with primary care trusts, public health teams and the emerging clinical commissioning groups to shape the future direction of health collectively. Through EELGA we have facilitated a focused dialogue with local government leaders, lead members for adult social care and wellbeing as well as chief executives and senior officers in local government. Our local authorities have welcomed this new opportunity - in our region all 11 of our upper tier local authorities have chosen to become early implementers of Health and Wellbeing Boards.

In each of these forums we are promoting integrated approaches to commissioning. Monies from within the NHS budget were shared this year with social care to address winter pressures and reablement services, ensuring a joined up approach to the health and social care offered to often the most vulnerable people in our communities. As part of our work with local government we are also supporting the development of LINks into HealthWatch, where we are seeking to embed a stronger voice for the patient and public at the heart of all future NHS delivery.


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HOW HAVE WE PERFORMED?

Our vision is to provide the best health service in England; moreover we aim to add to the quality and length of life of local people. Improving Lives; Saving Lives makes a series of pledges, centred on our tripartite mission: to deliver a better patient experience; improve people’s health; and reduce unfairness in health. Our successes in 2010/11 against these pledges are discussed in more detail on later pages. The pledges will remain a cornerstone for performance management until the SHA is abolished in 2013. The SHA ended the year with solid performance in many key areas and at this point in time, no provider organisation is registered with Care Quality Commission compliance conditions and this provides extra assurance that healthcare provision in the region meets national standards. Further recognition came when Ipswich Hospital NHS Trust won medium-sized Trust of the Year in the Dr Foster annual awards.

HCAI Other performance successes include HCAI where again the SHA has the lowest rate of Clostridium difficile infection per 100,000 population across all the SHAs. MRSA rates currently suggest the SHA is the third lowest across all SHAs, with just seven cases standing between our region and the top performing SHA. This will spur us on to delivering continued improvements. Dentistry Other successes include regional satisfaction with access to dentistry where 97% of respondents who tried to get a dentist appointment in Quarter 3 were successful. This is the second highest score of any region. Mixed sex accommodation The region’s focus on ensuring dignity and respect had paid great dividends when looking at the breach rates for patients placed into accommodation that is non compliant with mixed sex accommodation guidelines. This provides reassurance to patients that

their dignity will be respected at times when they are often feeling most vulnerable. Stroke care Much work has been undertaken to improve the provision of specialist stroke facilities across the region. At the end of 2009/10, 55.3% of stroke patients were spending 90% of their time on a specialist stroke unit, today that percentage of stroke patients is 77.6% and the region is moving closer with every quarter’s performance to achieving 80%. A&E performance The region has delivered performance in excess of the required operating standard of 95%, despite the country again suffering from a severe cold spell. The focus of performance management in 2011/12 will be to consolidate our solid performance and maintain this during a period of significant change with PCTs moving towards clusters, QIPP plans continuing to be implemented across the region and the abolition of the SHA itself later in 2013. >


Clostridium Difficile monthly rates per 100,000 population aged 2 and over. East of England v the rest of England trends (provisional data). Apr

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MRSA monthly rates per 1,000,000 population. East of England v The rest of England trends (provisional data).

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THE PLEDGES: The Directorates delivering the pledges and the reports on the pledges

Commissioning

Communications

Workforce

Finance

Clinical Quality and Patient Safety

Strategic Information Management & Technology

The directorates delivering the pledges In 2010/11 NHS East of England delivered its work from nine directorates.

CEO: Sir Neil McKay CB

Commissioning:

Director: Professor Robert Harris (from May 2010)

Communications:

Director: Lee Whitehead (joint appointment with NHS East Midlands)

Finance:

Director: Steve Clarke

Clinical Quality and Patient Safety:

Director: Dr Ruth May, assisted by an interim Chief Nurse Margaret Berry OBE from June 2010 to December 2010

Medical Director: Dr Robert Winter OBE

Public Health:

Director (Acting): Dr Anne McConville (from August 2010 - joint appointment with the Government Office for the East of England)

Strategic Partnerships:

Director: Karen Livingstone

Strategy:

Director: Dr Stephen Dunn

Strategic IM&T

Director: Dave Marsden (joint appointment with NHS East Midlands)

Workforce:

Director: Stephen Welfare

The work of all the directorates is focused on delivering Improving Lives; Saving Lives.

In our previous annual report we highlighted the first steps to deliver on the pledges. This section highlights the further progress that has been made towards achieving our aims. Strategy

Public Health Strategic Partnerships


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IMPROVING LIVES; SAVING LIVES: THE PLEDGES

Pledge 1 We will deliver year on year improvements in patient experience Improving Patient and Carer experience remains fundamental to our regional vision, the quality agenda and the NHS Constitution. Public support for hospitals and GP practices across the region remains significantly high. In September 2010, an Ipsos MORI survey asked patients and residents “How likely, if at all, are you to recommend your local hospital/GP practice to a friend or relative?”, 71% said they were likely, or very likely, to recommend their hospital, an increase from 68% in September 2008 and 85% their GP, compared to 84% in September 2008. All of our organisations actively seek and collect the views of service users to ensure we continue to improve and enhance services. This year we have seen an increase

in providers collecting ‘real time-data’ with the use of patient experience trackers. Patients are able to comment immediately on the care they have received, which enables organisations to make immediate changes and improvements. Ensuring the privacy and dignity of patients is respected has never been higher on our agenda. This year all our organisations declared same sex accommodation compliance. Any breaches that occur are investigated and action is taken to prevent further breaches. The east of England is proud to have recorded the second lowest percentage of breaches nationally and we are grateful for the support of the Local Involvement Networks (LINks) which have been helping to monitor compliance and give assurance from an independent view point. The ongoing work of the Regional Carers Leadership Board has ensured that the national carers’ strategy is being taken forward by health organisations, local authorities and voluntary sector partners. Its successes include the Caring

with Confidence training initiative which resulted in over 2500 carers personally receiving support and training to help develop their skills and knowledge. This has helped to make a real difference to their lives and the lives of those they care for. One family carer, who completed the training, said: “I learned to relax, to take a break, rest and eat a balanced meal; I learned the importance of looking after me; I discovered a list of organisations, offices, charities to get in touch with; I learned who to contact about my entitlements.”

Pledge 2 We will extend access guarantees to more of our services Though in 2010/11 the Government announced that the 18 weeks referral to treatment waiting times target was to cease and would no longer be performance

managed, in the region we continued to use the period of 18 weeks to measure nonconsultant led service waits. It is this metric that is primarily used to assess performance against Pledge 2. In the east of England, the majority of patients continue to be seen within 18 weeks. The percentage for the final quarter of 2010/11 was 98.3%, as an average of all PCTs excluding NHS Peterborough. As patients are also entitled under the NHS Constitution to expect treatment within 18 weeks, we have been asking NHS organisations to let us know about queries received on this constitutional pledge. The good news is that queries have been few, providing further assurance on performance in this area.

The SHA is ranked 4th in the country on the average of five key indicators, which are:

We will ensure that GP practices improve access and become more responsive to the needs of all patients.

• Satisfaction with telephone access • The ability to see a GP within 48 hours • The ability to book ahead • The opportunity to see a specific GP • Satisfaction with opening hours

Improving access and responsiveness of GP practices remains a key pledge for the NHS East of England and our PCTs. If a patient finds it difficult to get through on the telephone to their GP practice, or has trouble getting an appointment, they may decide to visit the local A&E department instead, which is not an appropriate or costeffective use of NHS resources.

This is an improvement since 2008/09 when the SHA was ranked 5th. The two areas where further improvement is needed is patient satisfaction with telephone access and the ability to book an appointment three days or more in advance. PCT primary care commissioners are working in partnership with those practices where performance in these two areas is poor.

Pledge 3

The latest national GP Patient Survey data covering the 12 month period January 2010 to December 2010 shows that GP practices in our region are in the main providing a good service to our patients.


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a strategy is in NHS Suffolk where extremely innovative ideas were implemented to get the key message across: “Who says you can’t get an NHS dentist?...You can!”

up and running. These will be evaluated and the results used to inform future planning for NHS dental services in the east of England.

Pledge 4 We will ensure that NHS primary dental services are available locally to all who need them. In 2010/11, access to dentistry has been a significant success story in the region. In Quarter 3, 97% of respondents who tried to get a dentist appointment were successful. This is the second highest score of any region. The results from a recent national patient survey showed that the east of England is one of the best performing regions in the country in terms of the proportion of patients who were able to make an NHS dental appointment. This has been achieved by PCT dental commissioners working with local dentists to ensure there is sufficient capacity for patients to be seen and that robust communications strategies are in place so that people know how to access an NHS dentist. An excellent example of such

PCTs have also been active in ensuring we achieve value for money for every NHS pound spent by tackling underperforming dental contracts. This includes clawing back funds and reinvesting them elsewhere to improve access. Also ensuring NICE guidance is met by dental contractors in relation to recall rates, which means patients are asked to visit the dentist at an interval that best meets their individual needs. The Government made a commitment to review the current dental contract and launched a pilot scheme for a proposed new dental contract. The SHA has worked in partnership with PCTs to ensure the region has a good mix of pilots. We received 70 applications from dental practices keen to take part among the highest number of applications received in any region. Ten dental practices have since been selected as suitable pilots and are now

Pledge 5 We will ensure fewer people suffer from, or die prematurely from, heart disease, stroke and cancer. During 2010/11 we were able to offer 100% access across the east of England to 24/7 stroke thrombolysis. This included using the innovation of stroke telemedicine to enable the service to be available in hospitals which were unable to run a viable local service 24/7. Telemedicine makes the best use of skilled expertise and provides a productive and cost effective solution to service delivery. The initiative won the east of England ‘best use of telehealth and telecare’ in the national E-Health Insider Awards 2010 in association with BT. The east of England this year

moved up to joint third place in the National Stroke Sentinel Organisational Audit, reflecting significant improvements in the organisation of stroke services. Further work remains to be done in improving community stroke services and this is a priority for 2011/12. 2011/12 has seen major improvements in access to acute stroke and transient ischemic attack (TIA) services. By quarter 4 2010/11, 77.6% of stroke patients were spending at least 90% of their stay on a stroke unit (compared to 55% at the end of 2009/10). 55% of non admitted high risk TIA patients were being scanned and treated within 24 hrs (compared to 25% at the end of 2009/10). A review of travel times was completed, with the recommendation that Primary Percutaneous Coronary Intervention (PPCI) for STSegment Elevation Myocardial Infarction (STEMI) heart attacks be rolled out across East Suffolk, enabling 100% of east of England residents to have access to this evidence based treatment, which saves 50 lives a year in the region.

The NHS Health Check programme to establish patients risk of developing cardiovascular disease was successfully implemented across the region, with the region exceeding 105% against its target for the number of people receiving a health check.

Pledge 6 We will make our health service the safest in England. Patient Safety is a top priority for the Clinical Quality and Patient Safety team. During the past year a determined effort has been made to engage doctors, nurses and managers working in the Trusts in the patient safety agenda. This has been achieved through events like “Staying ahead: learning through sharing”, Junior Doctor training, working with the Deanery to engage GPs, SpR training, the NHS Institute Leading Improvement in Patient Safety programmes

and whenever members of the team meet Trust staff. Quality Accounts were successful publications which included all community providers and Quality Accounts for GPs are being piloted. Changes to the workforce planned in the coming years will also have an impact on patient safety, quality and productivity. The development now ongoing of a Workforce Assurance Framework for the east of England will help organisations and commissioners to assess the impact of planned workforce change on safety. Partly due to the work of the ‘acutely ill deteriorating patient’ project the Hospital Standardised Mortality Ratio (HSMR) has decreased across the region, falling almost 7% between March 2010 and March 2011. Other ongoing work on the deteriorating patient project is helping to reduce HSMR further. This includes the ‘getting the basics right’ nursing observation audit, mortality case notes review, national cardiac arrest audit and the developing of the Intelligent fluid management bundle. >


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The SHA has received national recognition for its patient safety programme on the prevention of Venous Thromboembolism (VTE). It developed a region wide staff awareness campaign ‘Assess Prevent’ which is being used by teams in hospitals across the region to prevent VTE in patients. As a result of this programme the rate of risk assessments carried out on hospital patients at risk of VTE has risen significantly in the east of England from 37% to 92% in 2010/11. In January 2011 the SHA received an award from the charity Lifeblood for the best VTE prevention in a region and was awarded exemplar status by the VTE Exemplar Network in September 2010. This programme is one element of our work with partners in the national QIPP Safe Care workstream, which is also focussed on the reduction of grade 3 and 4 pressure ulcers, catheter acquired urinary tract infections and falls.

Pledge 7 We will improve the lives of those with long term conditions. During 2010/11 NHS East of England has worked to deliver a more personalised service for people with long term conditions. This will continue as a priority into 2011/12, with a focus on personal health planning and supported self care. Personal Health Budgets give patients more control over how their care is delivered to them. NHS East of England has three pilot sites in place for delivering Personal Health Budgets. All GP practices in the east of England have now received the Personal Health Planning Workforce Guide and work has begun to develop web based resource which will support people with an LTC (Long Term Condition) to access information support and self management tools.

A Respiratory Board has been established and is working to deliver the national chronic obstructive pulmonary disease (COPD) Strategy and a Diabetes Network has now been established supporting clinicians to improve diabetes management; and every trust in the east of England is now signed up to delivering Think Glucose. A very successful Neurological regional meeting was held to support delivery of the National Service Framework for Neurological Conditions; and a report completed on the provision of specialist neurological services across the east of England. A well attended LTC event was held for our GP network to orientate colleagues to the challenges ahead in supporting people with an LTC: there will be a 60% increase in people with an LTC by 2015, and a 252% increase by 2050.

Pledge 8 We will work with our partners to reduce the difference in life expectancy between the poorest 20% of our communities and the average in each PCT. The average life expectancy for both men (79.3 years) and women (83 years) in the region is higher than the national average. The inequalities in life expectancy, the difference between the life expectancy of the least deprived compared to the most deprived, is lower in the region for both males 7.4 years and females 4.8 years compared to national figures of 8.8 and 5.9 respectively. We have continued to work in partnership across the NHS and with Local Authorities (LAs) and communities to reduce health inequalities in the east of England. We have focused on targeting services to our most deprived communities and sharing good practice.

The Marmot review of health inequalities in England, Healthy Society, Healthy Lives was published in February 2009 and we subsequently undertook a review of health inequalities activity at a PCT and LA level. Examples of relevant practice were included in an east of England guide to reducing health inequalities and linked to the Marmot review recommendations. Smoking remains a major factor in health inequalities and we have been leading a multi-agency tobacco control programme as part of the Improving Healthy Lifestyles QIPP work stream. NHS Health checks are continuing to be delivered across the region with PCTs targeting the most deprived communities. Integrating lifestyle advice into NHS health checks also forms part of two Improving Healthy Lifestyles pilots being sponsored by the SHA.

Pledge 9 We will ensure that healthcare is as available to marginalised groups and “looked after” children as it is to the rest of us. It is recognised that for some groups, health outcomes are worse than for the general population, even with equal or better access to services, but the need remains to ensure that the NHS is doing all that it can to achieve equity of access and outcome for these groups. For ‘Looked After Children’ (LAC) we have worked with local areas to develop a set of key principles for commissioning LAC services which can be included in health commissioning specifications, which will be particularly useful for GPs. A project has been undertaken with local commissioners and providers of services to identify how an effective assessment of the emotional health and wellbeing needs of Looked After Children can be >


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incorporated into health assessments early to ensure access to CAMHS services. We have responded to the concerns raised nationally, over a number of years, about the inequalities of access to mainstream health services and the poor health outcomes for people with a learning disability by developing and consulting on a vision Better Health and Well Being for People with a Learning Disability and their Families in the east of England. The Vision’s aim is to ensure that health services in the east of England are transformed so that, through better health, people with a learning disability of whatever age and their families are supported to achieve the lives they want. The focus of the Vision is to put people with a learning disability at the centre of what we do. We must ensure that everyone is treated as a person, not with a learning disability label, supporting them to make informed and personal choice and ensuring providers and healthcare staff are trained to make the reasonable adjustments required under legislation.

Pledge 10 We will cut the number of smokers by 140,000. The East of England Tobacco Control Plan was developed and agreed with all local Directors of Public Health to drive reduction in smoking rates in the East of England. The East of England Illicit Tobacco Partnership Protocol was developed to tackle illicit tobacco, securing partnership commitments between Her Majesty’s Revenue and Customs and regional Trading Standards and the Tobacco Control Teams. Between September 2010 and January 2011, over 2,500 kilos of illegal hand rolling tobacco and 1 million illegal cigarettes were seized regionally.

Local NHS Stop Smoking Services have improved against delivery of targets and quality measures against the same period last year, achieving 2,944 more quitters than in 2009/10. Early data shows the services have met the regional quit target from the 20% most deprived areas. The regional Smoking in Pregnancy forum has continued to share best practice and develop resources and the proportion of pregnant woman in the region smoking at the time of delivery has fallen consistently over the Pledge life, from 14.5% to 13%. Achieving the Pledge required smoking rates to fall by 1% annually. Regional data over the period will be available late in 2011, so we will then be able to provide a clear measure of outcome. Early indications show that during the threeyear life of the Pledge the number of people who have stopped smoking per 1,000 smokers in the region has increased from 41 to an expected 50.6.

programmes offered if appropriate. A standard evaluation framework was implemented across all PCTs to evaluate the interventions and support they commissioned. Pledge 11 We will halt the rise in obesity in children and then seek to reduce it. Data collected by the National Child Measurement Programme of children in Reception Year and Year 6 from 2007/08 to 2009/10 shows that the rise in obesity in children has halted over the last three years in the east of England and England as a whole. Although there was a small, but significant, increase between 2008/09 and 2009/10 in Reception Year children, this is against the general trend and is below the national figure. It does not represent an increase above the level in 2007/08. PCTs continue to work with schools on the National Child Measurement Programme, which measures the weight and height of all children in Reception Year and Year 6. Results are sent to parents, with a range weight management support

Breastfeeding is the best start to life for a child. To help mothers to breastfeed we have encouraged and supported acute hospitals in taking up the UNICEF Baby Friendly Initiative (BFI) accreditation scheme. The scheme trained 51 NHS staff to advise mothers and enable them to continue breastfeeding in their own homes. 360 staff working in both private and public early years centres are being trained to provide nutritional meals to children under five in their care. The Change4Life campaign continued distributing information on healthy lifestyles to children, parents and health professionals. We launched a successful programme to increase fruit and vegetable consumption in ten convenience stores in Norfolk, West Essex, South West Essex and Cambridgeshire. Preliminary data showed a 60% increase in fruit and vegetable sales from participating stores.


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SPOTLIGHT: WORKFORCE

National recognition for workforce redevelopment The 2010/11 MultiProfessional Education and Training (MPET) Investment Plan saw ambitious plans to develop a more flexible, responsive workforce who will improve patient quality, enable change and deliver QIPP. Here we draw out some of the key achievements against the Investment Plan, demonstrating how our programmes of work support the delivery of national priorities, the 11 pledges in Improving Lives; Saving Lives, the strategic workforce priorities in Towards the best, together and QIPP. Our achievements

The Workforce Programmes Team were rewarded this year for their outstanding contribution to the Working Time Directive by Skills for Health.

The Workforce Programmes Team were rewarded this year for their outstanding contribution to the Working Time Directive by Skills for Health. The award was given to key European Working Time Directive pilot partners and stakeholders who helped to make compliance achievable across the NHS.

In November, the NHS East of England Multi-Professional Deanery had a very successful visit from the regulator for the Foundation programme (QAFP). The team have also introduced new programmes this year in Sport and Exercise medicine, Stroke medicine and Sexual and Reproductive Health as well as two new dental vocational training schemes in Hertfordshire and Essex. Preparation for Professional Practice is also helping to deliver year-onyear improvements in patient experience by inducting new doctors into employment with the opportunity to shadow their new role. With the implementation of Education Commissioning for Quality (EQC), there have been significant improvements in the performance and quality of the health programmes of our regional Universities. We are also proud of our improved engagement with service users and trainees in the design and delivery of programmes.

The quality management framework relating to medical and dental training has been refreshed, including the reintroduction of Deans’ visits and Institutional Review visits. Five trusts have been reviewed so far. Our partnership programme with the Prince’s Trust, Get Into Hospital Services received national recognition for excellence. The programme which has seen six cohorts take part offers short vocational courses to young people aged 16 to 25 years. Two ‘graduates’ have been nominated for Prince’s Trust awards; ‘Young Achiever of the Year’ and ‘Flying Start’. We have made significant and ground breaking developments to the education and development of pre-professional workforce. Working in partnership with the East of England Development Agency (EEDA), Skills Funding Agency, Skills for Health, National Apprenticeship Agency and local training providers, 1511 individuals across the region received apprenticeship training against a target of 513. >


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In 2010/11, the east of England became the first region in the country to offer apprenticeships for Midwifery Support Workers, in response to the shortage of midwives in the region. The new apprenticeships are part of a Skills Mix project which includes ongoing recruitment and retention of midwives. The workforce planning process was also re-designed this year to align with QIPP and the introduction of workforce modelling capability. Great leadership will be central to the successful transformation of our regional NHS and we continue to invest in our region’s leaders. 165 participants have taken part in our executive and clinical Leadership programmes; High Potential Executive Programme (HPEP), Aspiring Directors and the Senior Clinical Leadership Programmes. 13% of HPEP participants have moved on to Chief Executive roles and 22% of Aspiring Directors participants have since received promotions. We are proud to report that all east of England NHS employers are committed to

improving staff health and wellbeing with the Staying Healthy at Work programme. Staying Healthy at Work helps employers focus on improving health and wellbeing in the workplace. The productivity opportunity in relation to sickness and absence amounts to approximately £43 million in the region and so a focus on health will deliver benefits for both individuals and employers. The Innovations Team allocated Regional Innovation Funds totalling £1.6 million to help support the adoption and spread of innovations to improve the lives of people in the region with long-term conditions. Looking ahead Over the course of the next 12-18 months the architecture of the system will change radically to support the provisions in the Health and Social Care Bill. Three key areas will dominate the strategic context underpinning the MPET Investment priorities during 2011/12 and beyond:

• Integrated System Plan; which sets out plans for the regional delivery of QIPP priorities and modernisation. • Strategic Workforce Priorities; setting out our key workforce priorities for the next five years. • NHS East of England will work with NHS West Midlands and other SHAs to co-design and implement a Workforce Assurance Framework for application in the east of England. This will enable organisations to assess the impact of workforce demand plans on patient safety, quality and productivity. For more detailed information please visit: www.eoedeanery.nhs.uk Sign-up to Worklife at www.eoeworklife.nhs.uk to receive the latest news from NHS East of England and across the region on education, training and development.

Top: Stephen Welfare, NHS East of England’s Deputy Chief Executive and Director of Workforce celebrates with Christie Wilson, the 500th apprentice in the region and a theatre support assistant at Cambridge University Hospitals NHS Foundation Trust. Bottom: Leadership learning at an Aspiring Directors event.


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SPOTLIGHT: DEVELOPING CHOICE AND COMPETITION

Innovations at Hinchingbrooke Health Care NHS Trust and a series of successful divestments demonstrate that NHS East of England has continued to lead the way in developing a competitive and commercial environment for the healthcare sector. As individual Trusts and PCTs strive to meet the challenges posed by QIPP, the TCS* deadline and changes needed to meet the ‘Liberating the NHS’ vision, we have been providing bespoke, end to end solutions, supporting our NHS colleagues to deliver the necessary and often complex transactions. One of the most high profile of these has been the Hinchingbrooke Next Steps project. Hinchingbrooke is a small district general hospital delivering services to patients in Huntingdonshire. It had amassed a debt of £38.8m, and its future sustainability looked in question.

A commitment had already been made by NHS Cambridgeshire to continue the full range of services at the hospital. NHS East of England’s Strategic Projects Team was entrusted with designing and managing a creative solution to sustain the hospital’s future, pay back its debt while delivering safe and sustainable services for patients. An operating franchise was agreed following public consultation as a means of opening the opportunity to as broad a range of potential partners as possible while maintaining public ownership.

It will provide significant financial savings and stability for the Trust and, unlike previous attempts at this type of partnership, it is, for the first time, an ‘all risks’ transfer to the franchisee, forming a unique ‘right to supply’.

The procurement was open to bidders from inside and outside the NHS. History was made on 25 November 2010 when Circle was appointed recommended bidder. The franchise is designed to pass full operational responsibility and day to day control to the franchisee, for a period of up to 10 years.

In a controversial climate of NHS change the project has been a significant achievement. As the CBI’s Susan Anderson said on 26 November “This trailblazing decision ... could act as a template for other struggling hospitals, allowing them to benefit from fresh ideas, improved management and better outcomes for patients.” >

Circle has developed proposals to pay off the debt and help address the £250m QIPP efficiency challenge; the biggest identified within the system. The contract is due for signature in the summer of 2011 following an extended full business case approval by the Department of Health and HM Treasury.


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Providers were supported during 2010/11 to meet the TCS deadline for the separation of externalisation of community service provider arms from their PCTs. All met the 1 April 2011 deadline. The SHA’s provider development team oversaw the creation of three new Community NHS Trusts, seven Community Social Enterprises and the acquisition or hosting of nine community service providers. The organisations involved ranged from small teams in the region of 15 staff, to whole community service arms, involving over 1,000. The year started with a bang, when Cambridgeshire Community Services became the first Community NHS Trust in the country in April 2010. Secretary of State for Health, Andrew Lansley CBE, MP become the first local resident to sign up as a member of its subsequent drive to become a Foundation Trust.

NHS North East Essex Provider Services (NEEPS) was chosen by the Cabinet Office in August 2010 to be one of just twelve ‘pathfinder’ organisations across the UK. Under the initiative, as well as receiving the support from the SHA provider development team, NEEPS was supported by an expert mentor from one of the country’s most successful businesses to assist it in its drive to develop a range of sustainable, efficient and pioneering employeeled services. It was given the go-ahead to separate from its PCT in December 2010, becoming Anglian Community Enterprise (ACE) Community Interest Company.

* Transforming Community Services - visit www.dh.gov.uk/tcs


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WORKING AT NHS EAST OF ENGLAND

NHS East of England directly employs around 300 staff. Our ten year vision Towards the best, together, and our success as an organisation depends on the commitment, morale and performance of our staff. We strive to be a model employer, so we were delighted to be named in the Health Service Journal’s Top Employers List for 2010 and, for the first time, to earn a place in the Times Top 100 Employers in the Public Sector 2010. These accolades are a tremendous reward for our staff who continue to deliver outstanding results. We aim to lead by example, promote best practice and support NHS employers across the region, building on the commitments to staff made in the NHS Constitution.

We will continue to support staff and to seek their feedback through regular engagement and the NHS Staff Survey.

Amidst the context of a changing NHS, we are committed to ensuring that 2011/12 is a year of pro-active support and encouragement for staff to seize control and equip themselves for the future beyond the SHA. We will continue to support staff and to seek their feedback through regular engagement and the NHS Staff Survey.

This staff feedback has led to a number of high profile initiatives to improve the performance and health of the organisation. In 2010/11 we: • Recognised staff achievements through the introduction of an Employee of the Month scheme, nominated by members of staff themselves, and a bi-annual Staff Awards ceremony. • Delivered a successful, high quality in-house Mentoring scheme, training staff to become mentors to their colleagues. • Piloted a Job Rotation scheme, allowing staff the opportunity to work in different roles across the organisation. • Developed and launched a Staff Support Package to help our staff feel prepared for the transition. This included a series of online resources and workshops as well as an HR Handbook for Managers that has been highlighted as an example of good practice. Staff involvement played a huge role in redesigning the way we conduct Performance Appraisals, resulting in more

focus on the individual. This led to 97% appraisal returns - a 20% improvement on last year. Two formal “Staff Conversations” were introduced during the year, where managers and staff met to discuss their aspirations for the future and formally review objectives. The national Mutually Agreed Resignation Scheme (MARS) ran from September to January, giving staff the opportunity to leave the organisation in return for a severance payment. Those who chose to leave through MARS were able to take control of their futures and make a positive decision to exit the organisation, whilst contributing to a reduction in management costs. The promotion of equality and diversity is central to NHS East of England and extensive work has been undertaken on the development of the Single Equality Scheme. We now hold the Positive about Disability ‘two ticks’ symbol award, which demonstrates our commitment as an employer to support people with a disability throughout recruitment and employment. >


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Sustainability With QIPP high on our agenda, a focus on sustainability helps us to deliver financial savings and health benefits for staff, whilst reducing our carbon footprint. This was demonstrated in 2010/11 by: • A range of green travel and physical activity initiatives, including a pool bike scheme launched in July and a Pedometer Challenge in January 2011, encouraging staff to get fitter and healthier. • An improved Energy Performance Operational Rating for our Fulbourn offices to a score of 92 in 2010. A score of 100 would be typical for this historic building. • A number of activities and promotions for ‘Climate Week’ within the SHA. • Reductions since 2007 in gas and water usage - and waste generated.

NHS East of England continues to support the regional implementation of the NHS Carbon Reduction Strategy, ensuring that NHS organisations meet the legislative and regulatory requirements placed upon them. With SHA support, NHS organisations in the region have delivered a 13% increase in the numbers of Board-approved Sustainable Development Management plans to 53% of organisations, and a 16% increase in the use of the Good Corporate Citizenship Assessment Model to 68%. During 2010, the SHA secured the commitment of 13 NHS organisations for an electric vehicle charging infrastructure: they have all agreed to have charging posts installed during 2011/12.


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THE NHS EAST OF ENGLAND BOARD

The Board met on a total of six occasions during the year, three times in Cambridge and three times in other locations within the region. The Board oversees the organisation’s plan of work in conjunction with the sub committees. The Board has a prime responsibility for:

The work of the SHA Board is supported and informed by the underpinning principles of the NHS Constitution. Board meetings are held in public every two months. Past Board papers and dates of future Board meetings can be found on our website at: www.eoe.nhs.uk Executive Directors

• Agreeing the strategy. • Satisfying itself that the strategy can be and is being implemented by the Executive Team.

The Chief Executive and Executive Directors are responsible for the day-to-day running of the organisation. Non-Executive Directors

• Ensuring that PCTs are held to account. • Delivering financial and short-term delivery targets and overall value for money. • Establishing the values and standards for the NHS across the east of England.

The Chairman and NonExecutive Directors are recruited from the local community by the NHS Appointments Commission. They provide guidance to the Chief Executive and the Directors and they contribute to the development of organisational strategy. Importantly, they also act as custodians of the governance process, in ensuring that the organisation is unpinned by openness, integrity and accountability in its decision making process. >


NHS East of England Annual Report 2010/11

29

NHS EAST OF ENGLAND REGISTER OF DECLARATION OF DIRECTORS’ INTERESTS Membership of the Board and their Declared Interests for the year were as follows:

Name

Designation

Declaration

Sir Neil McKay CB

Chief Executive

None

Sarah Boulton

Interim Chair

Director of WMBV Steele (2009) & Co Ltd Director of Ringmount Director of Bridgehall Properties

Lee Whitehead

Director of Communications

None

Dr Stephen Dunn

Director of Strategy

None

Steve Clarke

Director of Finance

None

Karen Livingstone

Director of Strategic Partnerships

Non Remunerated Board Member EEDA Non Remunerated Board Member, East of England Information, Diagnostic and Brokerage Limited

Dr Anne McConville

Acting Regional Director of Public Health

None

Dave Marsden

Chief Information Officer

None

Stephen Welfare

Director of Workforce

Spouse is Nursing Director of Anglia Cancer Network National Council Member - Skills for Health National Committee on MIP

Valerie Morton

Non-Executive Director

Provide consultancy services to a wide range of charities and other organisations including some in the field of health e.g. Kidney Research UK. Associate of the Corporate Responsibility Agency called; Two Tomorrows

Mohammed Hussain

Non-Executive Director

Shareholder to ASep Healthcare UK Sales Director - IDS Pharma

Dr Neil Johnston

Non Executive Director

Spouse is Head of Paediatric Speech and Language Therapy for Hertfordshire

Continued on next page >


NHS East of England Annual Report 2010/11

30

NHS EAST OF ENGLAND REGISTER OF DECLARATION OF DIRECTORS’ INTERESTS CONTINUED Name

Designation

Declaration

Mike Burrows

Non-Executive Director and Chair of Audit Committee

Director of Community Music East Governor of Open Academy Heartsease Vice Chairman, Shaping Norfolk’s Future Independent Director of Flagship Pedders Way Housing Association Trustee of Genome Analysis Centre

Geoff Chilton

Non Executive Director

None

Dr Robert Winter OBE

Medical Director

Medical Patron of Cherry Lodge Barnet (a support charity for people with cancer and their carers) Vice President, British Lung Foundation Trustee of St Ives Acorn Trust

Dr Ruth May

Chief Nursing Officer

None

Professor Robert Harris

Director of Commissioning and Performance

Professor of Health Management, Cass Business School, City University London Convocation Representative on the University Court of Bristol, the governing body of the University of Bristol

Margaret Berry OBE

Interim Chief Nurse, June to December 2010

Director of Quality and Executive Nurse at NHS Luton


Interim Chief Nurse, June to December 2010

31

NHS East of England Annual Report 2010/11

THE NHS EAST OF ENGLAND BOARD IN 2010/11

Sarah Boulton Chair

Sir Neil McKay CB Chief Executive

Stephen Welfare Deputy Chief Executive and Director of Workforce

Margaret Berry OBE Interim Chief Nurse June to December 2010

Steve Clarke Director of Finance

Dr Stephen Dunn Director of Strategy

Professor Robert Harris Director of Commissioning and Performance

Karen Livingstone Director of Strategic Partnerships

Dave Marsden Chief Information Officer

Dr Ruth May Chief Nursing Officer

Dr Anne McConville Acting Regional Director of Public Health

Lee Whitehead Director of Communications

Dr Robert Winter OBE Medical Director

Mike Burrows Non-Executive Director and Chair of Audit Committee

Geoff Chilton Non-Executive Director

Mohammed Hussain Non-Executive Director

Dr Neil Johnston Non-Executive Director

Valerie Morton Non-Executive Director


NHS East of England Annual Report 2010/11

32

OTHER STATUTORY COMMITTEES The following committees were established by NHS East of England and were in operation during the financial year, the details of which are as follows:

Audit Committee and Risk Assurance

Remuneration and Terms of Service Committee

The principal role of the Audit Committee is to contribute independently to the Authority Board’s overall process for ensuring that an effective internal system is maintained.

The Chair of the Strategic Health Authority Remuneration and Terms of Service Committee is Geoff Chilton (Non Executive Director), and the members are Sarah Boulton (interim Chair of the SHA) Neil Johnston and Mohammed Hussain (Non Executive Directors). Sir Neil McKay (Chief Executive) and a senior member of the HR team attend the meeting in an ex officio capacity.

The membership of the East of England’s Audit Committee comprises three Non-Executive Members of the Board. The Audit Committee met on five occasions during 2010/11. The Committee received and discussed reports from the Audit Commission and Internal Auditors covering a range of issues. In addition, it has considered and received reports from the Chair of the Risk Assurance Committee detailing the progress that has been made in establishing an infrastructure with which to take Risk Management forward within NHS East of England and in developing an aligned Board Assurance Framework and Corporate Risk Register.

Policy on the Remuneration and Terms of Service for Executive Directors • The Remuneration and Terms of Service Committee of the Strategic Health Authority has terms of reference that follow guidance and instructions from the Department of Health, including the publication of the Pay Framework for Very Senior Managers in November 2006, as updated. • All decisions on the pay, terms and conditions of service for Executive Directors employed by the SHA are determined by the Remuneration and Terms of Service Committee. • The Committee agrees the costs associated with members of the SHA’s Executive Team seconded in from, and seconded out to other organisations. • The Remuneration and Terms of Service Committee agrees the objectives for the Executive Directors, and reviews performance against the objectives at the end of the year.

• All Executive Directors are on permanent contracts, with a notice period of six months, in line with the Very Senior Manager Framework. • All Non-Executive Directors (NEDS) are on national terms and conditions, including terms of office, agreed with the Appointments Commission. • All Executive Directors are subject to new redundancy arrangements agreed by NHS Employers for all NHS employees with effect from 1 October 2006. For Executive Directors aged under 50 years, one month’s salary for each year of NHS service will be payable, up to a maximum of 24 months. For Executive Directors over 50 years with 5 years’ service in the NHS, a reduced enhancement to their pension will be payable, which declines to September 2011, when no enhancement will be payable on redundancy.

In accordance with best practice and the recommendations of the Higgs Report, the Non Executive Directors of the Strategic Health Authority met on the 31 March without the Chair present. They discussed the performance of the Chair during the year and it was agreed that there were no issues of any material nature to report.


NHS East of England Annual Report 2010/11

33

STATEMENT OF ACCOUNTING OFFICER’S RESPONSIBILITIES The Strategic Health Authority is required to state the responsibilities of the Accountable Office under IAS 700. The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the authority. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that: - there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; - value for money is achieved from the resources available to the authority; - the expenditure and income of the authority has been applied to the purposes intended by Parliament and conform to the authorities which govern them; - effective and sound financial management systems are in place; and - annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and losses and cash flows for the year.

STATEMENT ON INTERNAL CONTROL 1. Scope of responsibility The Board is accountable for internal control. As Accountable Officer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Officer Memorandum. As Chief Executive, I have overall responsibility and accountability for risk management, and was informed on such issues by the Audit Committee which reports directly to the SHA Board. In addition, I received reports on clinical risk and governance issues at Board meetings.

2. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to: • Identify and prioritise the risks to the achievement of the organisation’s policies, aims and objectives • Evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place within the East of England Strategic Health Authority for the year ended 31 March 2011 and up to the date of approval of the annual report and accounts.

3. Capacity to handle risk The SHA Board provided leadership to ensure that risk management was embedded within the organisation; this incorporated the development of an annual Business Plan, which identified the key objectives, and related risks. The Risk Assurance Committee, chaired by a non-executive director, has taken a lead in developing a Risk Management Strategy, Risk Management Policy and Risk Register within the SHA. In addition, counterfraud awareness training has been made available to all staff. Operational control of risk management was co-ordinated by the Corporate Affairs Manager and the Internal Auditors have provided support and guidance. Staff are appraised of the key issues involved in managing risk on induction and at awareness sessions.

4. The risk and control framework The Risk Management Strategy of the Strategic Health Authority has a number of key elements as follows: • Definition of risk • Responsibility for risk within the Strategic Health Authority • Risk Management Structure • Linking Clinical, Organisational and Financial Controls • Principles of the SHA’s approach to risk management • Implementation of Strategy with particular reference to (i) risk identification (ii) risk analysis (iii) risk treatment and (iv) risk management evaluation Integral to implementation of the Strategy is working with partner organisations within the NHS East of England. Engagement with stakeholders is carried out predominantly through the constituent PCTs and trusts within the Region. >


NHS East of England Annual Report 2010/11

34

STATEMENT ON INTERNAL CONTROL CONTINUED The Risk Assurance Committee of the SHA meets on a regular basis to review the risk register and to consider in detail particular risks that have arisen or which face NHS East of England. The Risk Assurance Committee reports its activities to the Audit Committee at each meeting. A Board Assurance Framework has been developed and embodies the following elements: • Overarching objectives in the context of transition • Identification of key risks to achieving overarching objectives • Evaluation of the controls in place to manage risk, and identification of any gaps • Evaluation of the sources of assurance on controls available to the Board, and identification of any gaps The Board Assurance Framework is regularly reviewed and updated to reflect changes in achievement of objectives and the risks affecting them.

Control measures are in place to ensure that all the organisations obligations under Equality and Diversity legislation are complied with. As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme Reports are accurately updated in accordance with the timescales detailed in the regulations. The SHA has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaption Reporting requirements are complied with.

5. Review of effectiveness As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways; the Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Board Assurance Framework and on the controls reviewed as part of the internal audit work. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. My review is also informed by Internal Audit and External Audit.

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee, and the Risk Assurance Committee, as outlined in Section 1. A plan to address weaknesses and ensure continuous improvements of the system will be put in place. The Board and the Committees referred to, together with Internal Audit, maintain a regular review of the effectiveness of the process of internal control. The external auditors of the NHS Business Services Authority have provided a third-party assurance report for users of NHS Student Bursaries Services. This report identified weaknesses within the student bursary system relating to controls for ensuring claims are correctly calculated and valid. The Strategic Health Authority will ensure that NHS Business Services Authority address the control issues identified. If this is not possible, the Authority will consider what additional controls can be put into place to check the accuracy and validity of student bursary payments.

I note that an Internal Audit review of the HR Appointments Process carried out during the year, contained an opinion of insufficient assurance. However, I am advised that following detailed work by the HR Team, Internal Audit re-performed testing in a follow up exercise and identified that good progress had been made, enabling an opinion of substantial assurance to be given. The Head of Internal Audit has concluded that an Assurance Framework has been established which is designed and operating to meet the requirements of the statement of internal control for the year ended 31st March 2011 and provides significant assurance that there was an effective system of internal control to manage the principal risks identified by the SHA. In terms of reliances placed upon third party assurances I note that Internal Audit has used information provided by NHS Shared Business Systems and Anglia Support Partnership to inform its opinion, giving rise to “substantial” assurances in each case.

My review confirms that the East of England Strategic Health Authority has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.

Sir Neil McKay CB Chief Executive NHS East of England


NHS East of England Annual Report 2010/11

35

SUMMARY FINANCIAL ACCOUNTS

Revenue 2010-11 2009-10 £000 £000 Net Operating Cost for the financial year Revenue Resource Limit Surplus carried forward

601,567 (549,459) 685,527 684,848 83,960 135,389

Capital 2010-11 2009-10 £000 £000 Gross Capital Expenditure Capital Resource Limit Under spend against Capital Resource Limit

437 289 600 348 163 59

Statement of Comprehensive Net Expenditure for the Year Ended 31 March 2011

2010-11 2009-10 £000 £000

Pay & Related Costs Other Costs Less: Operating Revenue Net operating costs for the financial year

22,610 22,597 585,179 536,629 (6,222) (9,797) 601,567 549,459

Other Comprehensive Net Expenditure Impairments Adjustment for nominal cost of capital charge Total Comprehensive Net Expenditure for the year

19 166 - 637 601,586 550,262

From 2010/11 the interest element of capital costs is no longer charged under capital charges.


NHS East of England Annual Report 2010/11

36

Statement of Financial Position as at 31 March 2011

2010-11 2009-10 £000 £000

Non Current Assets Property, Plant & Equipment Intangible Assets Total Non-Current Assets

2,435 2,667 233 146 2,668 2,813

Current Assets Trade and other receivables Cash and cash equivalents Total Current Assets Total Assets

3,203 15,275 2 4 3,205 15,279 5,873 18,092

Current Liabilities Trades and other payables Provisions Total Current Liabilities Non-Current Assets plus/less Net Current Assets/Liabilities Total Assets Employed: Financed by Taxpayers’ Equity General Fund Revaluation Reserve Total Taxpayers Equity:

Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2011

44,877 27,604 1,632 2,538 46,509 30,142 (40,636) (12,050) (40,636) (12,050)

(40,653) (12,093) 17 43 (40,636) (12,050)

2010-11 2009-10 £000 £000

Opening Reserves (12,050) (24,288) Net Operating Cost for the Year (601,567) (549,459) Net gain on revaluation of Property, Plant & Equipment Impairments and Reversals (19) (166) Non-Cash Charges - cost of capital - (637) Total recognised income and expense for the year (601,586) (550,262) Net Parliamentary Funding 573,000 562,500 Balance at 31 March 2010 (40,636) (12,050)

Statement of Cash Flows for the Year Ended 31 March 2011

2010-11 2009-10 £000 £000

Cash Flows from operating activities Net Operating Costs Other cash flow adjustments Movement in Working Capital Provisions utilised Net Cash Outflow from Operating Activities

(601,567) (549,459) 805 115 29,345 (12,364) (1,148) (542) (572,565) (562,250)

Cash Flows from Investing Activities Payments for purchase of plant, property and equipment Payments for purchase of intangible assets Net Cash Outflow from Investing Activities Net Cash Outflow before Financing

(297) (227) (140) (62) (437) (289) (573,002) (562,539)

Cash Flows from Financing Activities Net Parliamentary Funding Net Cash Inflow from Financing Net Increase/(Decrease) in Cash and Cash Equivalents Cash and cash equivalents at beginning of the financial year Cash and cash equivalents at end of the financial year

573,000 562,500 573,000 562,500 (2) (39) 4 43 2 4

Management Costs 2010-11 2009-10 Restated £000 £000 SHA Staff Costs SHA Non-Staff Costs Total SHA Management Costs

9,243 8,751 3,298 5,314 12,541 14,065

Management costs for 2009/10 have been restated to bring them into line with current DH guidance (2009/10 £15,287k)


NHS East of England Annual Report 2010/11

37

Exit Packages Running Costs SHA Public 1 April 2010 to 31 March 2011 Health Running Costs in 2010/11 (£000) 30,798 1,089 Weighted population in 2010/11 (number) 5,399,159 5,399,159 Running cost per weighted head of population in 2010/11 (£) 5.70 0.20

Total Public Health Expenditure

2010-11 £000

Total Public Health Expenditure 4,982 Running costs and public health expenditure separately identified for the first time in 2010/11

Better Payment Practice Code - Measure of Compliance

£000

Number

Total Invoices paid in 2010/11 Total Invoices paid within target in 2010/11 Percentage of Total Invoices paid within target in 2010/11

575,864 563,560 97.9%

13,640 13,016 95.4%

Total Invoices paid in 2009/10 Total Invoices paid within target in 2009/10 Percentage of Total Invoices paid within target in 2010/11

561,018 548,633 97.8%

15,460 14,916 96.5%

Staff Sickness Absences

2010-11 2009-10

Total Days Lost Total Staff Years Average Working Days Lost

1,964 325 6

2,168 326 7

Staff sickness absence is reported on a calendar year basis. The Strategic Health Authority’s accounts are audited by the Audit Commission and the audit costs for the financial year were £199k. A full set of audited accounts can be obtained from the Authority’s website www.eoe.nhs.uk

Exit Package (including special payment element) <£20,001

£20,001£100,000

£100,001£150,000

£150,001£200,000

Total No. and Cost

Number of Compulsory Redundancies

2

3

-

-

5

Cost of Compulsory Redundancies £

25,775

117,925

-

-

143,700

Number of other Departures agreed

15

5

-

-

20

Cost of other Departures agreed £

107,361

255,506

-

-

362,867

Total Number of Exit Packages by Cost Band

17

8

-

-

25

Total Cost of Exit Packages by Cost Band £

133,136

373,431

-

-

506,567

Number of Departures where Special Payments have been made

-

-

-

-

-

Cost of Departures where Special Payments have been made £

-

-

-

-

-


NHS East of England Annual Report 2010/11

38

RENUMERATION REPORT FOR THE PERIOD 1 APRIL 2010 - 31 MARCH 2011: Salaries and Allowances for Senior Managers 2010-11

2009-10

Salary (bands of £5,000)

Other renumeration (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

Salary (bands of £5,000)

Other renumeration (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

£000

£000

£000

£000

£000

£000

Sir Neil McKay CB Chief Executive

230-235

-

0.6

230-235

-

0.6

Steve Clarke Director of Finance

150-155

-

2.1

155-160

-

2.2

Dr Paul Cosford Regional Director of Public Health 01/04/09 - 06/09/10

65-70

-

1.1

150-155

-

0.6

Dr Ruth May Chief Nurse 01/07/09 - 12/06/10 & 19/12/10 - 31/03/11

70-75

-

0.1

110-115

-

0.1

Margaret Berry OBE Acting Chief Nurse 13/06/10 - 18/12/10

25-30

-

-

-

-

-

Prof Robert Harris Director of Commissioning 10/05/10 - 31/03/11

120-125

-

0.3

-

-

-

Victoria Corbishley Acting Director of Performance 06/01/10 - 09/05/10

10-15

-

-

40-45

-

20.8

Stephen Welfare Director of Workforce

145-150

-

0.2

140-145

-

0.2

Lee Whitehead Director of Communications

75-80

-

3.2

100-105

-

3.5

Name and Title

Continued on next page >


NHS East of England Annual Report 2010/11

39

RENUMERATION REPORT FOR THE PERIOD 1 APRIL 2010 - 31 MARCH 2011: Salaries and Allowances for Senior Managers 2010-11

2009-10

Salary (bands of £5,000)

Other renumeration (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

Salary (bands of £5,000)

Other renumeration (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

£000

£000

£000

£000

£000

£000

Karen Livingstone Director of Strategic Partnerships

95-100

-

2.7

80-85

-

5.6

Dr Stephen Dunn Director of Provider Development

125-130

-

0.4

115-120

-

0.2

Dr Robert Winter OBE Medical Director

110-115

-

-

105-110

-

-

Dr Paul Zollinger-Read Director of Commissioning Development 14/02/11 - 31/03/11

5-10

-

-

-

-

-

Dr Paul Watson Director of Commissioning & Deputy Chief Executive 01/04/09 - 06/01/10

-

-

-

120-125

-

0.6

Dave Marsden Chief Information Officer 01/04/10 - 31/03/11

85-90

-

-

-

-

-

Graham Folmer Chief Information Officer 01/04/09 - 31/03/10

-

-

-

110-115

-

0.9

Sarah Boulton Interim Chair 01/06/10 - 31/03/11

40-45

-

0.5

-

-

-

Sir Keith Pearson JP Chair 01/04/09 - 31/05/10

5-10

-

0.1

50-55

-

0.7

Name and Title

Continued on next page >


NHS East of England Annual Report 2010/11

40

RENUMERATION REPORT FOR THE PERIOD 1 APRIL 2010 - 31 MARCH 2011: Salaries and Allowances for Senior Managers 2010-11

2009-10

Salary (bands of £5,000)

Other renumeration (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

Salary (bands of £5,000)

Other renumeration (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

£000

£000

£000

£000

£000

£000

Mike Burrows Non-Executive Director & Audit Committee Chair

10-15

-

0.6

10-15

-

0.8

Carrie Armitage Non-Executive Director 01/04/09 - 01/08/10

0.5

-

0.1

5-10

-

0.3

Mohammed Hussain Non-Executive Director

5-10

-

0.1

5-10

-

0.4

Valerie Morton Non-Executive Director

5-10

-

0.1

5-10

-

0.1

Dr Neil Johnston Non-Executive Director 01/04/10 - 31/03/11

5-10

-

0.1

-

-

-

Geoffrey Chilton Non-Executive Director 01/04/09 - 13/12/09 & 01/09/10 - 31/03/11

0-5

-

0.1

10-15

-

0.3

Name and Title

Benefits in kind are related to the reimbursement of travelling expenses and lease car benefits.


NHS East of England Annual Report 2010/11

41

PENSION BENEFITS Real increase in pension at age 60 (bands of £2,500)

Real increase in pension lump sum at age 60 (bands of £2,500)

Total accrued pension at age 60 at 31 March 2011 (bands of £5,000)

Lump sum at age 60 related to accrued pension at 31 March 2011 (bands of £5,000)

Cash Equivalent Transfer Value at 31 March 2011

Cash Equivalent Transfer Value at 31 March 2010

Real increase in Cash Equivalent Transfer Value

Employer’s contribution to stakeholder pension

£000

£000

£000

£000

£000

£000

£000

£000

Sir Neil McKay CB Chief Executive

(2.5-5)

(10-12.5)

100-105

305-310

2,394

2,588

(194)

-

Steve Clarke Director of Finance

0-2.5

0-2.5

70-75

210-215

1,514

1,611

(97)

-

Dr Paul Cosford Regional Director of Public Health 01/04/09 - 06/09/10

2.5-5

10-12.5

40-45

125-130

648

686

(38)

-

Dr Ruth May Chief Nurse 01/07/09 - 12/06/10 & 19/12/10 - 31/03/11

(2.5-5)

(10-12.5)

40-45

125-130

535

687

(152)

-

Prof Robert Harris Director of Commissioning 10/05/10 - 31/03/11

-

-

0.5

-

20

-

-

-

Stephen Welfare Director of Workforce

2.5-5

10-12.5

40-45

125-130

719

737

(18)

-

Lee Whitehead Director of Communications

0-2.5

2.5-5

5-10

15-20

62

55

7

-

Karen Livingstone Director of Strategic Partnerships

0-2.5

2.5-5

0-5

10-15

59

49

10

-

Name and Title

Continued on next page >


NHS East of England Annual Report 2010/11

42

PENSION BENEFITS Real increase in pension at age 60 (bands of £2,500)

Real increase in pension lump sum at age 60 (bands of £2,500)

Total accrued pension at age 60 at 31 March 2011 (bands of £5,000)

Lump sum at age 60 related to accrued pension at 31 March 2011 (bands of £5,000)

Cash Equivalent Transfer Value at 31 March 2011

Cash Equivalent Transfer Value at 31 March 2010

Real increase in Cash Equivalent Transfer Value

Employer’s contribution to stakeholder pension

£000

£000

£000

£000

£000

£000

£000

£000

Dr Stephen Dunn Director of Provider Development

2.5-5

-

30-35

-

208

236

(28)

-

Victoria Corbishley Acting Director of Performance 06/01/10 - 09/05/10

0-2-5

-

0-5

-

14

5

8

-

Dr Paul Zollinger-Read Director of Commissioning Development 14/02/2011 - 31/03/11

2.5-5

5-10

50-55

155-160

849

-

(31)

-

Dr Paul Watson Director of Commissioning & Deputy Chief Executive 01/04/09 - 06/01/10

-

-

-

-

-

669

-

-

Graham Folmer Chief Information Officer 01/04/09 - 31/03/10

-

-

-

-

-

332

-

-

Name and Title

Non-Executive members do not receive pensionable remuneration and there are, therefore, no entries in respect of pensions included in relation to them.


NHS East of England Annual Report 2010/11

43

Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of

their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

therefore the value of the CETV’s for some members has fallen since 31.03.2010. Pension benefits are compiled from information provided by the NHS Pension Agency.

Real Increase in CETV

Additional Notes

This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

1. The information included in the salary and pension tables above is subject to audit.

In the budget of 22nd July 2010 the Chancellor announced that the uprating (annual increase) of public sector pensions would change from the Retail Price Index (RPI) to the Consumer Prices Index (CPI). As a result the Government Actuaries Department undertook a review of all transfer factors. The new CETV factors have been used in pension calculations and are lower than the previous factors used

2. The East of England SHA retains the full pension liability for staff in its employ at the end of the financial year irrespective of the period during the year which they worked at the Authority or periods of secondments to other bodies. 3. The senior managers included in the report were employed throughout the two year period 1 April 2009 to 31 March 2011 unless otherwise indicated. 4. The salary figures disclosed for senior managers relate only to the proportion of time employed at NHS East of England.

5. Pension benefits are based on his total pension apportioned in line with proportion of time employed at NHS East of England at the end of each relevant financial year or point of departure from the SHA. 6. Dr Anne McConville and Dr Paul Cosford are joint appointments with the Government Office. The Department of Health is responsible for appointments to this post. 7. Dr Anne McConville was on a fully funded seconded on a full time basis from the Government Office from 7 September 2010 to 31 March 2011. 8. Dr Paul Cosford was seconded to the Health Protection Agency on a full time basis from 7 September 2010. 9. Margaret Berry was seconded from NHS Luton on a part-time basis (0.2 WTE) from 13 June 2010 to 18 December 2010.

10. Lee Whitehead was seconded to NHS East Midlands on a part-time basis (0.3 WTE) from 1 February 2010 to 31 March 2011. 11. Karen Livingstone increased her part-time commitment to NHS East of England from 0.8 WTE to full time in November 2009. She was seconded to the Department of Health on a part-time basis (0.4 WTE) from 24/3/11. 12. Dr Robert Winter was seconded from Cambridge University Hospitals NHS Foundation Trust on a part-time basis (0.5 WTE). 13. Paul Zollinger-Read joined the SHA on a full time basis on 14/02/11 and was seconded to the King’s Fund on a part-time basis (0.5 WTE) from that date. 14. Dave Marsden was seconded from NHS East Midlands on a part-time basis (0.5 WTE).

15. Allowances relating to Geoffrey Chilton included an overpayment in 2009/10 which was recovered in 2010/11. 16. No pension benefits are included in the statement for those staff seconded into the SHA on a parttime basis (Margaret Berry, Dr Robert Winter & Dave Marsden). Where relevant, these benefits are reported, in full, by their employing organisations.


NHS East of England Annual Report 2010/11

44

INDEPENDENT AUDITOR’S REPORT TO THE DIRECTORS OF NHS EAST OF ENGLAND I have examined the summary financial statement for the year ended 31 March 2011. This comprises Performance against revenue and capital resource limits, Statement of Comprehensive Net Expenditure, Statement of Financial Position, Statement of Changes in Taxpayers’ Equity, Statement of Cash flows, Management Costs, Running Costs, Total Public Health Expenditure, Better Payment Practice Code and Staff Sickness Absences. This report is made solely to the Board of Directors of East of England Strategic Health Authority in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010.

Respective responsibilities of directors and auditor The directors are responsible for preparing the Annual Report. My responsibility is to report to you my opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statement. I conducted my work in accordance with Bulletin 2008/03 “The auditor’s statement on the summary financial statement in the United Kingdom” issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of my opinion on those financial statements.

Opinion In my opinion the summary financial statement is consistent with the statutory financial statements of the East of England Strategic Health Authority for the year ended 31 March 2011. I have not considered the effects of any events between the date on which I signed my report on the statutory financial statements (9th June 2011) and the date of this statement. Debbie Hanson Officer of the Audit Commission Audit Commission 3rd Floor, Eastbrook Shaftesbury Road Cambridge CB2 8BF 19 July 2011


NHS East of England Annual Report 2010/11

45

GLOSSARY OF FINANCIAL TERMS Benefits in kind Taxable benefits arising from goods and services received by the employee in addition to salary. Better Payment Practice Code Requirement for the Authority to aim to pay all valid invoices by the due date or within 30 days of receipt of goods or valid invoice, whichever is later. Capital Resource Limit The amount that the Authority is approved to charge to capital expenditure in the year by the Department of Health. Current Liabilities Amounts owed by the Authority to other organisations and individuals. Current Assets Amounts owed to the Authority by other organisations and individuals. General Fund The accumulated surpluses or deficits attributable to the Authority since its formation net of parliamentary funding received.

Impairment Recognition of losses in value of non-current assets held by the Authority.

Provisions Amounts charged to operating costs for liabilities of uncertain timing or amount.

Intangible Assets Non-current assets held by the Authority which do not have physical substance, for example, software licences.

Revaluation Reserve Reserve arising from the revaluation of non-current assets required to maintain such assets in the accounts at fair value.

Management Costs Costs defined by the Department of Health as relating to the management of the Authority rather than for the direct provision of services. Net Operating Costs The running costs of the Authority (staff salaries, rent, telephones, office equipment, stationery, etc), less any income received. Non-Current Assets Assets which have a use or operational term spanning more than one financial period. Pay and Related Costs These are referred to as Employee Benefits in the Authority’s annual accounts and relate to salaries and associated costs.

Revenue Resource Limit The amount that the Authority is approved to charge to operating cost statement in the year by the Department of Health. Running Costs Costs incurred that are not direct payments for the provision of healthcare or healthcare related services. Statement of Cash Flows Summary of the movements in cash and cash equivalents between statement dates. Statement of Changes in Taxpayers’ Equity Summary of movements in the Authority’s General Fund and Revaluation Reserve during the financial period.

Statement of Comprehensive Net Expenditure Summary of costs and revenue for the Authority during the financial year. Statement of Financial Position Summary of the assets, liabilities and taxpayers equity at the financial year end date: a snapshot of the Authority’s financial position at that point in time.


NHS East of England Annual Report 2010/11

46

NHS EAST OF ENGLAND

Acute and Specialist Trusts (HQs)

1.

Norfolk and Norwich University Hospital NHS Foundation Trust James Paget University Hospital NHS Foundation Trust West Suffolk Hospital NHS Trust The Ipswich Hospital NHS Trust Colchester Hospitals University NHS Foundation Trust Mid Essex Hospital Services NHS Trust Southend University Hospital NHS Foundation Trust Basildon and Thurrock University Hospital NHS Foundation Trust The Princess Alexandra Hospital NHS Trust West Hertfordshire Hospitals NHS Trust Luton & Dunstable Hospital NHS Foundation Trust East & North Hertfordshire NHS Trust Bedford Hospital NHS Trust Cambridge University Hospitals NHS Foundation Trust Papworth Hospital NHS Foundation Trust Hinchingbrooke Health Care NHS Trust Peterborough and Stamford Hospitals NHS Foundation Trust

King’s Lynn

18 1

NHS NORFOLK

NHS PETERBOROUGH

3

2.

3 Norwich

1

1

Great Yarmouth

2

17 13 2

NHS GREAT YARMOUTH & WAVENEY

NHS CAMBRIDGESHIRE

15

1

Bury St Edmunds

Newmarket

Cambridge

NHS SUFFOLK

3

12 6 14

Bedford 11

Ipswich

Stevenage

2 9 Hertford

10 Watford

Bishop’s Stortford

9

NHS MID ESSEX

NHS WEST ESSEX

12

5

4 2

NHS HERTFORDSHIRE

7.

3

NHS BEDFORDSHIRE

10

5.

8.

2

5 13

11

4.

6.

1 16

NHS LUTON

3.

9. 10.

4 5 Colchester

Braintree

NHS NORTH EAST ESSEX

11. 12.

6 4

Harlow

5

8

3

Chelmsford

13. 14.

Brentwood

7 4

Basildon

NHS 8 SOUTH WEST ESSEX

NHS SOUTH EAST ESSEX 7 6

15. 16. 17.

18. The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust

NHS East of England

1.

2. 3. 4.

5. 6.

Mental Health Trusts (HQs) Norfolk and Waveney Mental Health NHS Foundation Trust Suffolk Mental Health Partnership NHS Trust North Essex Partnership NHS Foundation Trust South Essex Partnership University NHS Foundation Trust Hertfordshire Partnership NHS Foundation Trust Cambridgeshire and Peterborough NHS Foundation Trust

Community Services Trusts (HQ)

1.

Cambridgeshire Community Services NHS Trust Hertfordshire Community NHS Trust Norfolk Community Health and Care NHS Trust

2. 3.

East of England Ambulance Service NHS Trust Sites

1. Cambourne (HQ) 2. Melbourn (Regional HART Training & Ops Centre) 3. Norwich (HEOC) 4. Chelmsford (HEOC) 5. Bedford (HEOC)

PCT Headquarters

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

NHS Norfolk NHS Great Yarmouth and Waveney NHS Suffolk NHS North East Essex NHS Mid Essex NHS South East Essex NHS South West Essex NHS West Essex NHS Hertfordshire NHS Luton NHS Bedfordshire NHS Cambridgeshire NHS Peterborough

CLUSTERS:

Hertfordshire Bedfordshire and Luton North Essex South Essex Cambridgeshire and Peterborough

Norfolk and Waveney

Suffolk


NHS East of England Annual Report 2010/11

NHS East of England Victoria House Capital Park Fulbourn Cambridge CB21 5XB T: 01223 597 500 E: comms@eoe.nhs.uk www.eoe.nhs.uk

For a copy of the full annual accounts, please contact: Steve Clarke Director of Finance NHS East of England T: 01223 597 572 E: steve.clarke@eoe.nhs.uk Designed by 297 Creative Communications. www.twonineseven.co.uk


NHS East of England Annual Report 2010/11  

The Annual Report for NHS East of England, the strategic health authority for the NHS in the east.

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