The Queen Elizabeth Hospital King’s Lynn NHS Trust

Annual Report and Accounts 2005-2006

Contents 3 Foreword Sheila Childerhouse, Chair 4 Introduction Ruth May, Chief Executive 5 Who we are and what we do 6 Long term objectives 7 Key performance indicators 8 Operating and Financial Review 9 The year at a glance 10 New developments during the year 11 Risk management; health and safety; our staff 12 Awards 13 Social and community links 14 Complaints; Public Involvement; Communications 15 Clinical Governance 16 Environmental matters 17 Cleanliness; estates 18 Emergency preparedness; Developments since the year end; the future 19 Who’s Who? 20-21 Senior Managers’ remuneration report 22 Finance Director’s report 23 Independent Auditors’ report 24 – 31 Summary Financial Statements

Photos on this page, page 19 and the back cover, courtesy of the Eastern

Daily Press

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Foreword Welcome to the annual report of The Queen Elizabeth Hospital King’s Lynn NHS Trust for the year 2005-6. This has been, arguably, the most difficult year the Trust has ever faced in terms of challenges at every possible level – but it has also been a year of great achievement, with much to be proud of. Our finances have dominated every aspect of life within the hospital and our staff are to be congratulated on the way they have responded to our appeals for suggestions and assistance in reducing our deficit. It is worth remembering that they have been required to grapple with the problems of finance within their own areas, plus the changes and additional work that have come for everyone to ensure that Agenda For Change and many other initiatives are introduced successfully – and at the same time they have run an extremely busy hospital with a level of efficiency that can only be described as superb. Along the way our staff have introduced some truly ground-breaking procedures and innovations that have been properly recognised at national level, demonstrating our lead in nursing and medical matters in so many areas. There have been changes in management – and here I must pay tribute to Ruth May, who joined as Chief Executive during the course of the year. Ruth has led a remarkable ‘turnaround’ process in the way we begin to tackle our financial problems and the way in which our processes are modernised to help us reach the many targets imposed on us by Whitehall. At Board level I am fortunate indeed to have the support of so many able and caring Non-Executive Directors who have each made a valuable contribution to the way the hospital is directed, and who continue to support the Executive Directors in their demanding role. Special mention must be made of the Rev. Simon Stokes, who resigned from the Board during the year in preparation for taking up a new church appointment in Norwich. Simon’s contribution to the life of the Trust over seven years cannot be overstated and his input is greatly missed. Finally – and most importantly – I would like to praise our staff for their continuing hard work and dedication. Despite the many challenges they have faced during the past year, with the prospect of many more to come in the year ahead, they have never once allowed our high standards of service to the public to slip. For that they deserve our unconditional thanks. Sheila Childerhouse Chair July 2006

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Introduction When I joined the Trust during the course of the financial year I knew I would be taking on a major challenge. And I have not been disappointed. However, with the backing of a first-class team – and with good groundwork already put in place by my predecessors – we are now bringing the Trust to the point of ‘turnaround’ with good prospects for our future. I am particularly indebted to previous Chief Executives: Tony Andrews, who left the Trust in July 2005, and Jane Herbert, who took over as Interim Chief Executive prior to my appointment. During their terms of office they began to identify the main issues that would need attention if we were to pull ourselves out of deficit. As a result, the entire ‘turnaround’ process was initiated. During that time we have consistently improved our performance, to the extent that we now regularly achieve above the 98% target for Accident & Emergency patients to be seen and treated within four hours. Our overall high standard of patient care has been achieved by excellent teamwork by all our staff – for which we owe them a debt of gratitude for their continuing dedication to our patients. We have set ourselves on the path to become a centre of excellence in many areas of medical care. Innovative thinking by some of our staff has already paid-off in the form of a regional Award and I am sure that others will soon follow. This has proved to be a difficult year in coming to terms with our financial position and then finding ways of improving it. However, we are now on the road to recovery and although there are many challenges and difficult decisions ahead, I am confident that the hospital has the potential for an increasingly bright future. Our huge task of reorganisation would not be possible without the assistance and overall driving force of our staff. Despite the exceptional demands made of them during the year they managed to keep our hospital functioning efficiently by their sheer professionalism and determination to provide the best possible service to our patients. I cannot thank them enough. Ruth May Chief Executive July 2006

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Who we are and what we do The Queen Elizabeth Hospital King’s Lynn NHS Trust is a 500-bed hospital providing district general hospital services to north-west Norfolk plus parts of Breckland, North Cambridgeshire and South Lincolnshire, and operating from one site on the outskirts of King’s Lynn, Norfolk. The population of this area is approximately 220,000 people. The Queen Elizabeth Hospital King’s Lynn is within the area of the East of England Strategic Health Authority (formerly, and during the time covered by this report, the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority) and within the area of West Norfolk Primary Care Trust. Our catchment area has been defined as having several pockets of severe deprivation within King’s Lynn town and in some outlying districts (ref: Director of Public Health ‘Health Atlas’ 2005-6). In addition to King’s Lynn other concentrations of population are in small market towns: Hunstanton, Wisbech, Swaffham and Downham Market and the remainder of the population is in scattered villages and hamlets across an area of approximately 750 square miles. The population profile includes a high proportion of older residents, since this is a popular retirement area. However, new housing developments in recent years have seen large population growth in towns such as Downham Market, principally of families with children. The area also attracts large numbers of temporary residents. For example, the population during the summer months almost doubles, with an influx of holiday-makers, second-home owners and seasonal agricultural workers, many of them from Eastern Europe. Our purpose and main objective is this: The aim of the Trust is to contribute to the health improvement of the local community through the provision of a comprehensive range of specialist services. Working in partnership with other agencies, the Trust will endeavour to provide services which are locally accessible, cost effective and responsive to the needs of patients, their families and carers and are of assured quality. Our values are as follows:

• Putting the patient first in the way we provide our services

• Delivering care to the highest possible standards

• Being responsive to the needs of the individual (patients, their families and colleagues)

• The provision of a service that is efficient, clinically effective and of assured quality

• Working in partnership with other agencies involved in health care and social care issues

• Endeavouring at all times to promote equity and fairness in delivering our services

• Ensuring effective communications with all staff so that they have the opportunity to influence the way services are planned and delivered

• Actively supporting our staff in maintaining and developing skills and knowledge The Trust is governed by the Trust Board which is made up of Executive Directors and Non-Executive Directors. The Chairman and Non-Executive Directors are appointed independently by the NHS Appointments Commission and sit on a number of standing committees. The day to day management of the hospital is taken care of by the Executive Directors and the Directorate Managers. They have regular Trust Executive Board meetings into which a number of committees report.

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Directorates All clinical activities in the hospital are managed by a number of directorates. Each has a Clinical Manager and a General Manager. The directorates are as follows:

• Cancer Services

• Diagnostic and Therapeutic

• Emergency and Access

• Medical

• Surgical and Anaesthetic

• Women and Children

Support Services There are many support services in the hospital ranging from Finance through Human Resources to Risk Management and Hotel Services. Our competitive position The introduction of patient Choice has placed us in competition with a number of alternative NHS providers in this region. They are:

• The Norfolk & Norwich University Hospital NHS Trust

• The Cambridge University Hospitals NHS Foundation Trust

• Peterborough and Stamford Hospitals NHS Foundation Trust In addition to the general hospital services provided by these NHS Trusts, patients requiring specialist care, for example for burns, head injuries or heart surgery, may be referred-on to one of the above or to a specialist unit such as Papworth hospital for cardiac treatment. Under the Choice programme more use is made locally of other NHS providers within Primary Care. This may include, for example, minor surgery for cataracts and hernia repairs. These procedures are provided at a number of GP practices in our area.

Long term objectives Our long-term aim is to become the best-possible provider of choice for the population we serve. As part of our current ‘turnaround’ process we have been taking a comprehensive look at the way our services are provided, and how these may be improved in the future. Working in close collaboration with local Primary Care Trusts and GP Commissioning consortiums we are aiming to implement additional admission-avoidance and early-discharge schemes to reduce the demand for emergency admissions. By 2011 we aim

• To be the main centre for emergency services in this area

• To have set-up a network of services for smaller specialities and specialist services

• To be the hospital of choice for elective services for our population

• To be the main diagnostic hub of the local health economy

• To provide high quality cancer services for this area

• To encourage local centres of excellence for our specialities – such as Critical Care, Day Surgery and Radiology.

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Key Performance indicators All NHS Trusts are required to achieve standard levels of care and to hit a number of key targets covering hospital admissions, referrals, bookings, finance and patients’ welfare. In past years the Healthcare Commission has measured our annual progress by way of its ‘star rating’ system, in which top-performing Trusts received three-stars and Trusts that had not achieved the national standards being awarded two or one stars. Our financial deficit, accumulated in recent years where our spending on healthcare has exceeded the amount of money we collect from various sources, dominated the performance ratings. This was despite the fact that The Queen Elizabeth Hospital King’s Lynn is now one of the top 12 most efficient NHS Trusts in the country, in that the cost of treating patients in West Norfolk is significantly lower than many other parts of the country. As a result of our financial deficit, the Trust was awarded one star in 2004-5. A new system of measuring hospital performance has now been introduced by The Healthcare Commission. The annual ‘health check’ for the financial year 2005-6 is due to be published for all Trusts in October 2006. It works on the basis of 24 essential ‘core’ standards that NHS organisations are expected to meet, plus 13 ‘developmental’ standards, or goals, they should be aiming for in future. Areas the health check covers are:

• safety

• care environment and amenities

• clinical and cost effectiveness

• governance

• patient focus

• accessible and responsive care

• public health It also looks at services that are provided across healthcare organisations, paying particular attention to the experiences of children, older people, people with long term conditions, and people with mental health problems. On 28 April 2006 the Trust reported to the Healthcare Commission that all standards had been met and that the Trust was fully compliant. A copy of the self-declaration appears on the Trust web site in the news archive at: www.qehkl.nhs.uk

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Operating and Financial Review The past year Our performance during the financial year was dominated by our accumulated deficit, which at 31 March 2006 was almost £11 million. The £11 million had been set as our ‘control total’ by Norfolk Suffolk and Cambridgeshire Strategic Health Authority. This means that we had to ensure our deficit rose no higher than £11 million. The underlying problem is that despite being one of the 12 most efficient NHS Trusts in the country, the costs of running our hospital have been more than the amount of money we have been bringing-in. Without a combined effort to tackle the problem by all departments within the Trust, our deficit would have risen to £16.4 million by the year-end. A robust Financial Recovery programme has been under way throughout the year, accelerated towards the end of the financial year with the establishment of a specialist in-house ‘Turnaround team’, assisted by external consultants. Working in partnership with our staff and local commissioning bodies we were able to streamline our services and procedures to the extent that opportunities for cost savings in excess of £7 million have been identified for the 2006-7 financial year without impacting on the standard of service to our patients. Running in tandem with our core activity of healthcare and our day-to-day concerns with finances a number of national NHS initiatives have been undertaken by our staff, in many cases in addition to their ‘day’ job, in order that tight timescales may be met. These have included � the Choose and Book programme, of which The Queen Elizabeth Hospital King’s Lynn has been a national leader,

and � the closely-linked National Programme for Information Technology - generally known as ‘NPfIT’ but now officially

re-branded as ‘Connecting for Health’ � Agenda For Change - the most comprehensive overhaul of the NHS careers, pay and employment structure since

the NHS was founded in the late 1940s � Improving Partnerships in Health - a programme continuing the work of the Joint Services Review initiated by the

local health ‘economy’ (the QEH, West Norfolk Primary Care Trust and East Cambridgeshire & Fenland Primary Care Trust), to streamline local health services, making them more efficient and improving value for money.

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The year at a glance: Improving our services and performance during the financial year included:

2005 April: A new bedside screening programme begins to test the hearing of newborn babies. June: The Chief Executive and Chair of the Trust resign in the face of mounting financial problems. June: The Critical Care Unit is pronounced an overwhelming success in giving patients a better chance of survival

than in other parts of the country. July: 1) A new Interim Chief Executive, Jane Herbert, is appointed.

2) West Newton and West Dereham wards are merged, as more emphasis is placed on care of patients in their home. 3) The Trust retains its One Star status, having achieved all key targets with the exception of achieving financial balance.

August: Denver and Elm wards are combined to form one all-female ward. A reduction of beds is made on Castleacre ward. September: Norovirus, the ‘winter vomiting virus’, affects the hospital. October: 1) Ruth May is appointed as Chief Executive, taking over from interim C/E Jane Herbert.

2) The Queen Elizabeth Hospital achieves its target for ‘100% of outpatients to be seen within 13 weeks of referral’ three months early. 3) In conjunction with West Norfolk PCT, a Rapid Assessment Team is established, with the aim of reducing emergency hospital admissions of older people. Within five months the team achieved its annual target of treating 150 potential in-patient cases along other ‘pathways’ and has since secured additional funding to extend its services.

November: 1) Sheila Childerhouse, former Chair of West Norfolk Primary Care Trust, is appointed Chair of The Queen Elizabeth Hospital

King’s Lynn NHS Trust. 2) The Trust becomes the first in the country to carry out certain types of major shoulder surgery as a day-case procedure. POSSI (it stands for Post Operative Shoulder Surgery Initiative) is a team effort involving QEH surgeons, anaesthetists, physios and administration staff, and West Norfolk PCT’s Care And Support Team (CAST).

December: 1) Funding of £535,000 is allocated to the QEH by the Strategic Health Authority and we announce that this will be used to

create a new centre for Genito-Urinary Medicine – the most up-to-date facility in this region. 2) A new Transport Co-ordinator, Sally Moore, is appointed as a direct result of the Improving Partnerships in Health (IPH)

programme to streamline transport services and make savings for the local health economy – an estimated £40,000 in a full year. 3) The Strategic Health Authority announces that the QEH is one of three NHS bodies in Norfolk to be targeted by a Department of Health-appointed ‘turnaround team’ to assist our own management team in dealing with the mounting deficit. 4) The Rev Simon Stokes vice-Chair of the Board and former acting Chair, leaves in preparation for taking up a new post leading an ecumenical project in Norwich.

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2006 January: 1) Rates of the MRSA and C.difficile ‘superbugs’ are found to have plummeted at the QEH,

as a result of a new prescribing regime introduced by Professor Lynne Liebowitz, run in conjunction with a strict ‘hand hygiene’ campaign. 2) Work begins on an important building development – a spacious log ‘cabin’ provided as a result of a generous bequest by a late local resident for use by families of patients in the Macmillan Unit.

February: 1) A new Day Room is opened on West Raynham Ward following a major refurbishment by Friends of

the Stroke Unit, with money raised by former Mayor Councillor Paul Brandon. 2) Norovirus makes an unwelcome return to the hospital. 3) Our League of Friends announce they have donated almost £170,000 worth of new equipment to the hospital. 4) The QEH is named as one of the country’s ‘High Performing’ Trusts by the NHS Institute in undertaking hip and knee replacements. A team of their experts will find out why we are so efficient – and then help other Trusts to improve their performance. The QEH is also named by the Royal College of Physicians as one of the top 16 hospitals in the country for dealing with falls and ‘bone health’ amongst older people. 5) Chief Executive Ruth May is invited to 10 Downing Street to help celebrate the successful launch of the patient ‘Choice’ programme. The West Norfolk health economy is named as one of the national leaders in introducing Choice.

March: 1) A series of paintings by local school children, depicting scenes from Lynn’s history, is officially handed over to the

hospital by the Mayor, Councillor Trevor Manley. 2) The new patient Choose and Book system is demonstrated to the local media, who are shown that the time it now takes a GP to refer a patient to a QEH consultant is…three minutes. 3) Keith Pearson, Chair of the Strategic Health Authority, turns the first spadeful of earth on the site of the new GUM clinic, to mark the start of work. 4) The new QEH Turnaround Team, appointed in-house to oversee the Trust’s financial recovery, begins work. External consultants are brought-in to assist the recovery process. 5) Colin Bone retired as the Trust’s Medical Director.

New developments during the year A major investment by the Norfolk Suffolk and Cambridgeshire Strategic Health Authority announced in December means that the region’s development budget for sexual health capital investment is allocated to the Trust. It will lead to the provision of a new Genito-Urinary Medicine unit in the area beneath the existing Stanhoe Ward, to replace the cramped unit currently within the main hospital building, and enhance the level of service to patients. To mark the investment, Keith Pearson, Chair of the Strategic Health Authority (SHA), performed a turf-cutting ceremony on site in March.

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Risk management; health and safety; our staff The Trust is a pilot site for the new Risk Management Standards for Acute Trusts and will be assessed against the new standards in November 2006. A total of 3,813 adverse events were recorded during 2005/06 compared to 3,729 in 2004/05. Serious Untoward Incidents Seven Incidents were reported to the SHA in accordance with the Serious Untoward Incident procedure in 2005/06. Health & Safety 464 incidents involving injury to staff and visitors were reported during the year. 36 incidents were reportable to The Health & Safety Executive (HSE) in accordance with the Reporting of Incidents, Dangerous Diseases and Occurrences Regulations (RIDDOR). Incidents are reportable under RIDDOR when they result in serious injury or absence from work in excess of 3 days. The vast majority of these reports are of injuries resulting from manual handling incidents. Fire Safety 21 fire incidents were recorded in the hospital during the year. One of these was an actual fire, in the kitchen of Shouldham Ward which required the evacuation of the Macmillan Unit and Shouldham Ward. The fire started in a fan in the kitchen which overheated and led to the destruction of the kitchen, at a cost of £15,000. Our stakeholders Emphasis in recent years has been towards developing partnership arrangements with those who have a ‘stake’ in the welfare of the Trust. Our principal stakeholders continue to be our local commissioners, notably West Norfolk Primary Care Trust, East Cambridgeshire & Fenland Primary Care Trust, and South Lincolnshire Primary Care Trust. West Norfolk PCT is also responsible for Swaffham Community hospital, where we provide some services, and East Cambs and Fenland PCT runs North Cambridgeshire hospital where, again, QEH staff provide a number of services. We continue to maintain close links with the Sandringham hospital, a private BPI-owned facility adjacent to The Queen Elizabeth Hospital and sharing a number of resources. In addition, we work closely with GP practices across the three PCT areas, and the social services departments of Norfolk and Cambridgeshire County Councils. At local level we have close working relationships with the Borough Council of King’s Lynn and West Norfolk and the emergency services. East Anglian Ambulance NHS Trust maintains a presence on the hospital campus following the co-location, next to our Accident & Emergency Department, of the Out Of Hours GP centre operated by EAAT’s operator, Anglian Medical Care. Work is currently in progress to develop a dedicated helicopter landing area on site, to accommodate the Ambulance Trust’s Air Ambulance. Our staff Total staff headcount at the end of the financial year was 2,428, which equated to 2,027 whole-time equivalent posts. In addition the services of 526 nursing bank staff were used at various times. The Trust is an Equal Opportunities employer and is committed to treating all job applicants fairly, regardless of disabilities, gender orientation or ethnicity, and to making every effort to helping them in their working life. We are committed to preventing discrimination and stimulating equality of opportunity. Trust policy and information is communicated to staff in a variety of ways. A report of proceedings is prepared and distributed electronically to all staff immediately after each Board meeting. A weekly staff newsletter, Viewpoint, is posted on the intranet each Thursday. Items of urgent information are posted on the hospital intranet, and staff are alerted via e-mail incorporating a direct electronic link. Matters of a less urgent nature are raised at regular staff forum meetings and team meetings within departments. Staff are encouraged to offer feedback and constructive suggestions for service improvement at every available opportunity. 11

Awards During the year our Audiology and Dental staff entered a project for the Health Enterprise East Innovation Awards. Their idea – using plastic-forming equipment from the dental laboratory to form earpieces for hearing aids, streamlining the service to a ‘same day’ service, later won top prize in its category. The picture on the left shows, left to right, service managers Keith Powell (Dental) and Mark Brindle (Audiology) with their glass trophy. The award included a cheque for £3,500 to go towards improvement of their service. Recognition of a personal kind came for Mary Gore, Clinical Nurse Specialist in Palliative Care in the Macmillan Unit in March, when she was nominated by a former patient for a ‘Health Hero’ award by the magazine Top Santé. A feature giving details of her ‘special gift’ for making patients feel better was later published in the magazine’s July 2006 issue. Investors in People In recent years the Trust has been an enthusiastic supporter of the Investors in People programme and is fully committed to its ideals of staff support and development. However the difficult financial position of the Trust led a special-interest staff group to conclude that the Trust could not afford to maintain the costly annual renewal fee to the scheme. Consequently the Trust has withdrawn from Investors in People although remaining committed to its high ideals and aspirations. Agenda for Change Over the past two years the Trust has taken a lead within the NHS in this region in assimilating its staff onto the Agenda for Change programme. This is the first major review and overhaul of staff pay and conditions in more than 50 years and provides staff with a national pay structure and path for career progression. This was completed by the end of 2005. A key part of this process has been development of the Knowledge and Skills Framework, in which the ability of each staff member is recognised and developed to enable them to reach their maximum potential in their career. The West Norfolk health economy was an ‘early implementer’ of this process. Lessons learned here during development of KSF are being used by other NHS Trusts to develop the system in their own regions. Worklife balance In conjunction with West Norfolk PCT, the Trust employs a Worklife Balance Co-ordinator to assist staff in meeting the various demands of their working and home lives. One of the outcomes has been the introduction of a subsidised childcare scheme, which continues to work well.

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Social and community links The Trust continues to receive an almost overwhelming level of practical support from the hospital’s League of Friends. During the course of the year the Friends donated equipment worth £199,111 – an enormous sum - that the Trust would otherwise have been unable to fund. Money was raised by the Friends by way of various fund-raising events and also by the very popular hospital shop close to the main entrance. A high level of local support for the Trust is shown in a number of ways. Readers of the Lynn News newspaper raised £60,000 during the year to provide the permanent landing pad for the Air Ambulance, and donations continue to be made by patients and their families. One practical example of this was a very generous donation that has allowed us to construct a Scandinavian-style log cabin that will provide high quality overnight accommodation for families of patients receiving cancer treatment in the Macmillan centre. Construction began during the financial year and was completed by early summer 2006. Patients continue to rate the hospital highly in surveys as a much-appreciated local health facility. An in-patient survey carried out by the Healthcare Commission during 2005 resulted in more than 90 per cent of patients praising the hospital for its ‘excellent’ or ‘good’ care, and 97 per cent of patients saying they had ‘confidence and trust’ in the way they were looked after. The same patients also voted the hospital into the top 20 per cent of English hospitals for the very high standard of in-house catering. Our business partners Principal business partners for the hospital are our commissioners, West Norfolk PCT and East Cambs & Fenland PCT. Together we form a local health ‘economy’. In addition, work is in progress to develop links with the Practice Based Commissioning consortia for the PCTs in advance of the impending change in commissioning arrangements and the amalgamation of the Primary Care Trusts into single county-wide PCTs for their respective counties.

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Public Involvement The Trust continues to assist in the development of the role of the Patient Forum, to give lay people representation within the Trust at Board level. A programme has been set up to help Forum members learn more about the workings of the Trust and to help influence decisions at planning and committee stage onwards. Current Chair of our Patient Forum, and co-opted to our Board, is Barry Dane (pictured left). One essential part of the hospital team is our group of 380 volunteers. During 2005 they worked more than 30,000 hours at the hospital – the equivalent of 828 full weeks of work. In addition to performing a valuable service in many areas of the hospital they also freed-up hospital staff to concentrate on work requiring detailed professional skill. As an example of their work, the ‘meet and greet’ team based at the main entrance reception deals with approximately 5,000 enquiries every month – around 227 every day. Formerly engaged by the WRVS, the volunteer skill pool is now managed directly by the Trust.

Complaints During the year the Trust received 342 complaints – an increase of 75 on the previous year. Of these, 85 per cent were dealt with within 20 days, an improved performance on the previous year.

Communications Activities relating to the Trust, its staff, patients, volunteers and friends continue to be widely reported in the local media as part of our pro-active communications programme. Members of staff at various levels took part in media interviews leading to press features, television and radio coverage throughout the year, and a good relationship continues with the local media. The Trust’s internal publication for staff, Viewpoint, moved from being a quarterly publication to a weekly publication in November. A briefing document for Board members, QED, was instituted during the year to provide a news update, aimed primarily at non-executive directors, between Board meetings. Items of urgent news interest are now communicated via a ‘broadcast e-mail’ system, instituted by the Chief Executive, to all employees, to allow staff to be fully briefed on new developments before news breaks in the media.

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Clinical Governance Clinical Governance is an integral part of the clinical activity of the Trust. The Clinical Governance Committee has continued its programme of regular specialty reviews, which monitors and supports the individual clinical services in undertaking all aspects of clinical governance. The Clinical Audit and Effectiveness Committee has supported a comprehensive range of department multi-disciplinary audits, and has continued to lead on the distribution and monitoring of NICE guidance. The Research Governance committee reviewed and monitored the proposed research projects undertaken in a wide range of departments. A key task for the Trust was preparing the self-assessment for the Healthcare Commission. This was based on the new Healthcare Standards, divided into 49 standards covering 7 domains. The Clinical Governance Committee assured the Trust Board that the Trust was compliant with all standards. The Healthcare Commission will publish its assessment of all Trusts in October 2006

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Environmental matters Despite the financial pressures being experienced, the Trust has been able to implement a number of improvements to the estate and maintain a good standard of environment for our patients, visitors and staff. The Trust's 'Environmental Standards Action Group', including patient representation, continues to oversee the maintenance of our improvement to the Hospital environment. The Trust has assessed itself, using the guidance issued by the Department of Health, and has rated a 'good' score for both the environment and food. The assessment teams included representatives of the Patient Forum and tested aspects as diverse as the standard of furniture in the Accident and Emergency Department, through to the temperature and availability of food served to patients on our wards! The Arts Committee has commissioned a number of exhibitions of both staff and professional art and is working closely with the Arts adviser of King's Lynn and West Norfolk Borough Council to explore further opportunities. In February 2006 a number of murals painted by school children to depict King's Lynn throughout the ages, and commissioned to celebrate the town’s 800-year Charter anniversary, were handed over by the Mayor, Cllr Trevor Manley. They now form a permanent display on one of the main corridors. During the year we implemented the first two phases of our No-Smoking Policy, successfully limiting smoking in most of the main hospital, grounds and gardens. This will be extended to all areas of the hospital, including grounds, gardens and Social Club from September 2006. Car parking congestion and early-evening traffic problems have been tackled in a number of ways, including altering afternoon visiting times. The result is that it is now much easier to leave the hospital site from 4.30 pm onwards. In addition, a new 80-space car park was opened last summer ensuring that, for the most part, there are spaces available for patients, visitors and staff when required. Satisfaction with the Hospital environment can also be confirmed from the publication of the Patient Satisfaction Survey for 2005. The results for privacy and dignity, cleanliness and service were good, with the availability of food actually being rated as one of the best for England.

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Hospital cleanliness We place strong emphasis on hospital cleanliness. The reduction in MRSA and C.difficile rates is attributable to a number of factors, but one of the most significant is the high standard of cleaning that is undertaken. During the year staff on the Critical Care Unit highlighted the hygiene message with their ‘Bare Arms’ campaign, to stress the need for medical staff to scrub their hands and forearms thoroughly. During the year Professor Lynne Liebowitz, a world authority on micro-biology, joined our staff and as a result of her lead, infection rates have dropped consistently. She has subsequently been ‘loaned’ by the Trust to assist the Department of Health as part of its national MRSA/Cleaner Hospitals team, advising other NHS Trusts on how to make improvements.

Estates We have also been investing in our estates and equipment in order to provide better services to patients. Examples include: � The relocation of the out of hours base (Lyndoc) from the Southgates Practice to the

hospital site. This improves the assessment and treatment process for patients needing urgent care.

� The front entrance of the Hospital has been refurbished to provide a much more welcoming and less cluttered environment for patients and visitors. In addition, the League of Friends have funded the introduction of air conditioning within the main entrance, again providing a more pleasant environment.

� The Mayor's appeal has been extremely successful in raising funds to enable the refurbishment of the day room on the Stroke Unit, West Raynham Ward (pictured right).

� The EDP Breast Cancer appeal was successful in raising over £200k, which the Trust has added to, to facilitate the first phase of a first class dedicated Breast Cancer Unit for the growing number of patients being referred to the service.

� The Trust has also invested substantially in new equipment in order to deliver increased activity, including three new ultrasound machines to increase our diagnostic capability and additional Ophthalmology equipment in order to be able to assess and treat more cataract and glaucoma patients.

These are just a few examples of the investments made to improve the environment and service for patients.

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Emergency preparedness During the year a number of exercises were held in conjunction with our colleagues in local PCTs, the ambulance trust, police, fire service and local authority, to test our preparedness in the event of a major disaster, outbreak or epidemic. Our emergency plans are tested and revised throughout the year in ‘worst case scenario’ exercises. These take account of current health information – recent concern over the possibility of an outbreak of avian flu is just one example – or developing world events, and allow any potential gaps in our services to be addressed or updated. The cascade communications system from the Government, via the Department of Health and Strategic Health Authority to local level is tested on a regular basis.

Developments since the year end April 2006: A team from the QEH Audiology and Dental departments scoops first prize in a regional innovation competition held by Health Enterprise East,

beating off competition from NHS Trusts throughout East Anglia. Their award-winning innovation is to use plastic moulding equipment from the dental laboratory to form hearing-aid earpieces, which can be done as a same-day service instead of taking several weeks.

May 2006: New eye equipment worth more than £74,000 is purchased, with a grant from the Trust’s charitable fund.

We’re named as one of the country’s ‘top performers’ for our expertise in treating Fractured Neck of Femur. The NHS Institute for Innovation comments on our ‘professional skill ‘ and enthusiasm and plans to use of experiences to help train others.

Figures for possible redundancies are announced at our Board meeting, in a summary of our plan for financial recovery.

Proposed changes for the West Wing are revealed to staff. The long-term plan may include a permanent move of Chatterton House, the specialist unit for the elderly, to the QEH site.

Dr Geoff Human, Consultant Radiologist, is appointed as the Trust’s new Medical Director.

June Consultation begins with staff on forthcoming job losses. Non Executive Directors Anita Barnard and Georgina Holloway step down from the Board after deciding not to seek reappointment. July 29 staff are made redundant. ‘At risk’ letters are issued to a further group of staff. New Non Executive Directors Robin Brundle and Andrew Jessop are appointed to the Board

The future Work is progressing in tandem with our core activities in preparing the Trust for the first stages of seeking Foundation Trust status. However, our dominating concern is with returning the Trust to financial balance. Our current, revised, Financial Recovery Plan aims to achieve in-month financial balance by October 2006 and to achieve year-end financial balance by March 2007. The local health economy will experience a change of management in October 2006, when the functions of West Norfolk Primary Care Trust are taken over by a new county-wide PCT. Relationships are being developed with the local Practice Based Commissioning consortium with a view to continuing the positive influence on the patient ‘journey’ through the NHS. It is not anticipated that services to our patients will be adversely affected by the changeover to the new PCT.

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Who’s who? 2005-2006

The Board: Sheila Childerhouse Chair Anita Barnard Non Executive director Kate Gordon Non Executive Director Georgina Holloway Non Executive Director Ann Purt Non Executive Director Carol Townsend Non Executive Director Ruth May Chief Executive Rowena Barnes Director of Delivery and Performance (on secondment) Brian Lanman Director of Finance Amanda Lyes Director of Human Resources Colin Weston Director of Capital Planning and Facilities Management Gwyneth Wilson Director of Nursing, Service Quality, Infection

Prevention and Quality Control Colin Bone Medical Director (ret’d March 06. Succeeded by Dr Martin Rimmer on 1 April 06 as Interim Medical Director) Changes in the Board during the year: The following Board members stood down during the year as a result of retirement, resignation or not wishing to seek re-appointment: Jeffrey Prosser Chair (left October 2005) The Rev Simon Stokes Non-Executive Director (left December 2005) Colin Bone Medical Director (retired, March 2006) Stuart Threlfall Director of Information Management & Technology (left March 2006) The following members joined the Board during the year: Ruth May Appointed as Chief Executive on 1 October 2005 Sheila Childerhouse Appointed as Chair (from West Norfolk PCT), 1 November 2005 Kate Gordon: Non Executive Director, appointed 1 January 2006 Rowena Barnes Joined the Board on secondment as Director of Delivery and Performance, 14 November 2005 (substantive appointment with effect from 2 April 2006) Changes since the year-end: Rowena Barnes Appointed as Director of Delivery and Performance on 2 April 2006 Dr Geoff Hunnam Appointed as Medical Director on 1 July 2006 The Audit and Governance Committee The Committee is Chaired by Carol Townsend, Non Executive Director. Members of the Committee during the financial year 2005-2006 were Anita Barnard and Kate Gordon, both Non Executive Directors. The Committee is supported, and regularly attended, by internal and external auditors, the Finance Directorate and the Chief Executive.

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Senior Managers’ remuneration report This report sets out The Queen Elizabeth Hospital King’s Lynn NHS Trust policy on the remuneration of its senior managers, who are defined as those persons in senior positions having authority or responsibility for directing or controlling the major activities of the Trust, and who influence the decisions of the entity as a whole rather than the decisions of individual directorates or departments. In this context, and for the purposes of this report, senior managers are taken to be those persons who have served during the year as Executive and Non-Executive Directors on the Trust’s Board. Remuneration Committee: constitution and operation The remuneration policy for Executive Directors is set by the Remuneration Committee, a sub-committee of the Board of Directors. This Committee deals with all matters relating to the remuneration of Executive Directors and is responsible for the determination and maintenance of overall remuneration policy and review and agreement of Executive Director salaries and benefits. The members of the Committee during the year were the following Non Executive Directors: Anita Barnard Sheila Childerhouse Georgina Holloway Kate Gordon Ann Purt In addition, meetings are attended by the Chief Executive, Ruth May, and the Director of Human Resources, Amanda Lyes, who advise on matters relating to the other Executive Directors and the overall performance of the Trust. Neither is present, however, when matters concerning their own remuneration are considered. The Committee places high value on the independence of its decision-making processes. In consultation with the Director of HR the Committee draws on information from external bodies on particular remuneration matters. During the year the Committee used benchmarking information from the NHS on comparative market data to assist in the determination of pay and benefits. Non-Executive Directors: remuneration policy Non-Executive Directors receive a fee determined by the NHS Appointments Committee. This fee is reviewed annually. In addition, Non-Executive Directors are reimbursed for expenses incurred on Trust business.

(cont’d)

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Executive Directors: remuneration policy The remuneration policy for Executive Directors tries to balance the Trust’s status as a public sector body (and the expectation that all areas of spend, including executive remuneration, must deliver value to the tax payer) with the fact that the Trust operates in a competitive environment and needs to offer remuneration that enables it to attract, retain and motivate high calibre individuals with the skills and competences required to lead the organisation. In doing so, the remuneration policy seeks to:

• Remunerate individuals fairly for individual responsibility and contribution

• Take into account wider salary policy and employment conditions within the Trust and the relationship that should exist between the remuneration of Executive Directors and other employees.

• Have regard to the market median levels of remuneration. The Committee’s approach to policy going forward will continue to reflect these principles, underpinned by regular review and monitoring of remuneration policy and practice in similar organisations outside the Trust. Elements of remuneration Salary Salaries are reviewed annually , taking into account external market levels and internal comparisons as well as the individual’s responsibilities and overall performance against annually agreed objectives. The basic salary is paid as a fixed sum monthly and there is no separate payment or bonus related directly to performance. Pensions All Executive Directors are eligible to participate in the NHS Pension Scheme which provides salary-related pension benefits on a defined benefit basis. Employment contracts The policy of the Remuneration Committee is for the contracts of employment of Executive Directors to contain a maximum notice period of six months. Each contract expires on the pensionable age of the individual which is the normal NHS retirement age, but is subject to earlier termination for cause or if notice is given under the contract. There is no entitlement to any additional remuneration in the event of early termination other than in the case of termination on grounds of redundancy. Remuneration received The remuneration of the Board of Directors appointed or leaving during the year is included in respect of their period of membership only. Details of remuneration and audited information Details of Directors’ remuneration for the years ended 31 March 2006 and 2005 are set out in the tables on pages 29 and 30.

Ruth May Chief Executive 26 June 2006

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Finance Director’s report At the beginning of 2005/06 the Trust forecast an ‘in year’ deficit (excluding the repayment of prior year overspends) of £5.4 million but has succeeded in limiting this to £2.4 million. However, the Trust is required to break even year on year. If a deficit is incurred, this must be repaid in the following financial year. A deficit of £8.6 million was incurred in 2004/05, which the Trust was unable to repay in 2005/06. As a result, its combined deficit for the year totalled £11.0 million. This amount will be required to be repaid in 2006/07. By limiting its ‘in year’ overspend the Trust has succeeded in maintaining its combined 2005/06 position within the control total (a maximum deficit) of £11 million which was set by the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority. The Trust, in agreement with the Strategic Health Authority, has developed a turnaround plan to address the accumulated deficit position and to achieve an in-year breakeven position. It is expected that, through successful implementation of the plan, the Trust will achieve a financial breakeven position in 2006/07 and will be able to begin the repayment of the historical debt in 2007/08. Capital Investment and cashflow The Trust invested £1,892,000 in fixed assets in 2005/06. Capital investment has been restricted to essential expenditure only in order to manage cashflow within the cash resources. It is expected that capital investment will similarly be restricted in 2006/07. The cash resource available to the Trust is determined by the Department of Health in a process which sets the Trust an external finance limit. The Trust’s external finance limit for 2005/06 was set at £13,267,000, which the Trust achieved despite the cashflow difficulties of an income and expenditure deficit. Better Payment Practice Code 92.2% of bills were paid in accordance with the better payment practice code (87.8% by value) in 2005/06. This is against a target of 95%. The cash flow problems experienced by the Trust specifically in December and January have compromised the Trust’s previous excellent performance in this area. Summary In summary, the results for 2005/06 are better than those that were forecast at the beginning of the year and the Trust has been able to meet the control total it was set. The financial strategy of the Trust is clearly set out within the Trust’s Financial Recovery Plan. Implementation of the plan has started and will be challenging. However, successful implementation of the plan will secure the future of services provided and will enable the Trust to progress towards achieving Foundation Trust Status in 2008. Brian Lanman Director of Finance

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Independent auditors’ report to the Board of The Queen Elizabeth Hospital King’s Lynn NHS Trust We have examined the summary financial statements for the year ended 31 March 2006 which comprise the Income and Expenditure Account, the Balance Sheet, the Statement of Total Recognised Gains and Losses, the Cashflow Statement and the related notes. We have also audited the information in the Trust’s Remuneration Report that is described as having been audited. This report, including the opinion, has been prepared for and only for the Board of The Queen Elizabeth Hospital King’s Lynn NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission. We do not, in giving this opinion, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing. Respective responsibilities of directors and auditors The directors are responsible for preparing the Annual Report, including the Remuneration Report. Our responsibility is to audit the part of the Remuneration Report to be audited and to report to you our opinion on the consistency of the summary financial statements within the Annual Report with the statutory financial statements. We also read the other information contained in the Annual Report and consider whether it is consistent with the audited summary financial statements. This other information comprises only the Operating and Financial Review on page 8 and the unaudited part of the Remuneration Report on pages 20 and 21. We consider the implications for our report if we become aware of any misstatements or material inconsistencies with the summary financial statements. Our responsibilities do not extend to any other information. Basis of opinion We conducted our work in accordance with Bulletin 1999/6 ‘The auditors’ statement on the summary financial statement’ issued by the Auditing Practices Board. Opinion In our opinion:

� the summary financial statements are consistent with the statutory financial statements of the Trust for the year ended 31 March 2006; and

� the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England.

PricewaterhouseCoopers LLP Norwich Date: 18 September 2006

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Summary Financial Statements 2005/06 The following is a summary of information from the full accounts which have been prepared in accordance with the 2005/06 Manual of Accounts for Trusts issued by the Department of Health. The full accounts are available from our web site at: www.qehkl.nhs.uk or from the Director of Finance.

Income and expenditure account 2005-06 2004-05

£000 £000

Income from activities Other operating income Operating expenses Operating deficit Gross on disposal of fixed assets Deficit before interest Interest receivable Other finance costs Deficit for the financial year Public dividend capital dividends payable Retained deficit for the year

86,997 12,233 -108,286

- 9,056 - 83 - 9,139 194

- 88 - 9,033 -1,953 -10,986

83,769 12,234 -102,691 -6,688 -41 -6,729 186 -19 -6,562 -1,937 -8,499

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Management Costs

Management costs Income Management costs as a percentage of income

2005/06 £000

4,385

96,831

4.5%

2004/05 £000

3,732

93,408

4.0%

PricewaterhouseCoopers LLP are the Trust’s external auditors and their fees for 2005/06, all of which related to statutory audit services, amounted to £161,000 (2005: £183,000)

Balance sheet Fixed Assets Intangible assets Tangible assets

Total fixed assets Stocks and work in progress Debtors Cash at bank

Total current assets Creditors falling due within 1 year Net current liabilities

Total fixed assets less current liabilities Provisions for Liabilities and charges

Total assets employed

Taxpayers’ equity Public dividend capital Revaluation reserve Donated asset reserve Government grant reserve Income and expenditure reserve

Total taxpayers’ equity

2005/06 £000 43 60,392 60,435 1,574 3,852 303 5,729 -6,862 -1,133 59,302 -1,270 58,032 56,495 17,837 4,906 88 -21,294 58,032

2004/05 £000 30 61,057 61,087 1,686 3,304 282 5,272 -10,588 -5,316 55,771 -1,354 54,417 43,207 17,138 4,797 92 -10,817 54,417

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Better Payments Practice Code * 2005/06 2004/05

Number

Number

Total bills paid in the year Total bills paid within target Percentage of bills paid within target Total bills paid in the year Total bills paid within target Percentage of bills paid within target

36,062 33,249 92.2% 43,102 37,804 87.7%

36,876 35,093 95.2% 25,093 24,193 96.4%

Recognised Gains and Losses Deficit before dividend payment Unrealised (deficit)/surplus on fixed assets revaluations/indexation Increase in Donated Asset and Government Grant Reserve Reduction in Donated Asset and Government Grant Reserve Recognised gain/(loss) for the year

2005/06 £000 -9,033 1,299 313 -299 -7,720

2004/05 £000 -6,562 -1,080 293 -277 -7,626

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* The better payments practice code requires the Trust to aim to pay all NHS and non-NHS invoices by the due date or within 30 days of receipt of goods or a valid invoice, which ever is the later.

Cash Flow Statement

Operating activities Returns on investments and servicing of finance Capital expenditure Payments to acquire fixed assets Receipts from the sale of tangible fixed assets Payments to acquire intangible fixed assets

Net cash outflow from capital expenditure Dividends paid

Net cash outflow before financing

Financing Public dividend capital received Other capital receipts

Net cash inflow from financing

Increase in cash

2005/06 £000 -9,603 200 200 -1,886 5 -25 -1,911 insert something -1,953 -13,267 13,288 - 13,288

21

2004/05 £000 -2,601 178 178 -2,844 8 - -2,836 -1,937 -7,196 7,207 14 7,221 25

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Creditors at the balance sheet date are made up of:

31 March 2006 31 March 2005

£000 £000

Amounts falling due within one year:

NHS creditors 619 4,330

Non - NHS trade creditors - revenue - other 770 686

Non - NHS trade creditors - capital 422 843

Tax and social security costs 2,323 1,743

Other creditors 945 883

Accruals and deferred income 1,783 2,103

Sub Total 6,862 10,588

No payments are due in future years under arrangements to buy out the liability for early retirements over 5 years (31 March 2005 £nil).

Other creditors include £837,000 ( 31 March 2005, £769,000) of outstanding pensions contributions at 31 March 2006.

‘Non -NHS trade creditors – capital’ are creditors in respect of fixed assets.

Ruth May Brian Lanman Chief Executive Director of Finance 17 August 2006

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Statement on Internal Control The Statement on Internal Control can be found in the full accounts available from our internet site: www.qehkl.nhs.uk

2005-06 2004-05

Name T Andrews (to 02/08/05) C Annely (to 30/04/05) A Barnard C Bone S Childerhouse K Gordon J Herbert (04/07/05-31/10/05) G Holloway B Lanman (from 01/05/05) A Lyes R May (from 01/10/05) J Prosser (to 31/08/05) A Purt S Stokes (to 30/11/05) S Threlfall (to 23/03/06) C Townsend C Weston G Wilson K Walker (to 28/02/05)

Title Chief Executive Finance Director Non-Executive Medical Director Non Executive Non Executive Chief Executive Non Executive Finance Director HR Director Chief Executive Non Executive Non Executive Non Executive IM&T Director Non Executive Operations Director Nursing Director Finance Director

Salary (Bands of £5,000) 35-40 5-10 5-10 15-20 5-10 0-5 90-95 5-10 70-75 65-70 45-50 5-10 5-10 5-10 50-55 5-10 70-75 65-70 -

Other (Bands of £5,000) - - 0-5 115-120 - 0-5 - 0-5 - - - 0-5 - 0-5 - 0-5 - - -

Benefits in kind (to nearest £100) 1,100 - - - - - - - 2,900 2,900 1,300 - - - - - 3,200 4,200 -

Salary (Bands of £5,000) 90-95 10-15 5-10 15-20 - - - 5-10 - 60-65 - 15-20 5-10 5-10 50-55 5-10 70-75 60-65 70-75

Other (Bands of £5,000) - - - 170-175 - - - - - - - - - - - - - - 60-65

Benefits in kind (to the nearest £100) 3,500 - 100 - - - - 100 - 2,700 - 200 - - - 100 2,900 4,000 3,700

Salary and pension entitlements of senior managers Audited information

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2005-06 2004-05

Name T Andrews (to 02/08/05) C Annely (to 30/04/05) A Barnard C Bone S Childerhouse K Gordon J Herbert (04/07/05-31/10/05) G Holloway B Lanman (from 01/05/05) A Lyes R May (from 01/10/05) J Prosser (to 31/08/05) A Purt S Stokes (to 30/11/05) S Threlfall (1) (to 23/03/06) C Townsend C Weston G Wilson K Walker

Title Ch Exec Fin Dir Non Exec Med Dir Non Exec Non Exec Ch Exec Non Exec Fin Dir HR Dir Ch Exec Non Exec Non Exec Non Exec IM&T Dir Non Exec Ops Dir Nur Dir Fin Dir

Real increase in pension and lump sum at 60 (to nearest £1,000) - 1 - 74 - - - - - 4 8 - - - 5 - 2 4 0

Total accrued pension (to nearest £1,000) 137 63 - 254 - - - - - 61 99 - - - 76 - 85 81 -

Cash equiv transf value March 06 (to nearest £1,000) 572 217 - - - - - - - 156 269 - - - 254 - 283 264 -

Cash equiv transf value real increase (to nearest £1,000) 15 3 - - - - - - - 13 26 - - - 24 - 14 23 -

Real increase in pension and lump sum at 60 (to nearest £1,000) 40 8 - 7 - - - - - 3 - - - - 5 - 6 3 5

Total accrued pension (to nearest £1,000) 134 54 - 176 - - - - - 56 - - - - 70 - 81 75 86

Cash equiv transfer value March 05 (to nearest £1,000) 544 179 - 826 - - - - - 140 - - - - 224 - 263 236 295

Cash equiv transfer value real increase (to nearest £1,000) 173 32 - 43 - - - - - 14 - - - - 23 - 27 18 26

(1) On 23 March 2006 Mr S Threlfall left the Trust. The Trust agreed with Mr Threlfall compensation for loss of office with a value £22,750 The Trust provides Benefits in Kind to Executive Directors in the form of vehicles for business and private use. The vehicle scheme offers the Chief Executive, Finance Director, Operations Director, Nursing Director and Human Resources Director a vehicle of their choice, subject to a ceiling being incurred by the Trust. Each Director pays for their private fuel consumption and for any legislative breach.

30

(to 28/02/05)

Pensions (continued) As Non Executive Directors do not receive pensionable remuneration, there are no entries in respect of pensions for Non Executive Directors. 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 the 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 the disclosure applies. The CETV figures, and from 2005-06 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. Real increase in CETV 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 pension scheme or arrangement) and uses common market valuation factors for the start and end of the period. The various elements of the remuneration are determined for members of the Board Remuneration Committee, which has as its membership committee all Non Executive Directors plus the Chief Executive. Details of the treatment of pension liabilities in the Trust’s accounts are included within the Pensions Costs Accounting Policy note in the full financial statements.

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If you would like further information on The Queen Elizabeth Hospital King’s Lynn, or if you have any comments to make about this report, our services or facilities, please contact: The Communications Manager The Queen Elizabeth Hospital King’s Lynn Gayton Road King’s Lynn Norfolk PE30 4ET or visit our web site at: www.qehkl.nhs.uk

Published by The Queen Elizabeth Hospital King’s Lynn NHS Trust © 2006

Links to other organisations

West Norfolk Primary Care Trust www.westnorfolk-pct.nhs.uk East of England Strategic Health Authority www.eoe.nhs.uk NHS Direct www.nhsdirect.nhs.uk Department of Health www.doh.gov.uk Healthcare Commission www.healthcarecommission.org.uk Norfolk County Council www.norfolk.gov.uk Borough Council of King’s Lynn and West Norfolk www.west-norfolk.gov.uk