One page summary of report layout

Document Sample
One page summary of report layout Powered By Docstoc
					Financial Recovery Report


June 2006


Overall objective of the work plan is to formulate a turnaround plan that is deliverable
and achieves sustainable positive savings and profitability in 2006/07, while ensuring
long term viability is maintained.
Executive Summary
•   The Objective of this turnaround plan is to:
    –    Achieve positive underlying run-rate and sustainable positive ‘in year’ recurrent balance in 2006-07
    –    Secure ongoing operational viability and extinguish historic deficit


•   The Strategy to achieve this objective is to:
    –    Focus on the EBIT or ‘in year’ profitability as the key target to achieve in 2006-07. The turnaround plan gravitates around
         this measure of performance. It is used as the fundamental and established yardstick of measurement in a commercially
         led environment that enables management to make operating and restructuring decisions on a sound basis.
    –    Understand the make-up of the cumulative historic deficit under the unique RAB accounting rules
    –    Repay the historical deficit once underlying profitability is achieved


•   WSH occupies a prime position in the local economy as the only acute hospital within a 30 mile radius that captures an ageing
    population of 250,000. The number of presentations overall have remained at the same level as the previous year. According to
    the Office of National Statistics the total population growth is expected to be in excess of 12% over the next 15 years to 2021.
    The proportion of over 85 year olds is significantly higher than the national average and will increase by 80% over the next 15
    years. Therefore, the demand for its services is set to grow for the foreseeable future.


•   Savings of £14.5m (£11.4m recurring) have already been delivered by this Trust over the last 3 years. Savings achieved in
    2005-06 amount to £7.1m (£5m recurring) in addition to £5.5m (£5.2m recurring) achieved in 2004-05 and £1.9m (£1.2m
    recurring) in 2003-04. This Trust has been in 'cost cutting‘ mode for 3 years now and therefore there are limited 'quick' wins
    because the obvious areas have been previously addressed. Management are therefore working very hard at squeezing further
    savings out of the system but few of the initiatives identified will individually have a significant impact.


•   Savings totalling £3.7m have been identified for 2006-07 through Turnaround Initiatives which restore underlying in year
    balance in 2006-07 and, following a steady improvement from the beginning of the year, break-even is achieved in Nov-06 (See
    graph on next page). However, it should be noted that even the cumulative effect of these recurring savings (i.e. £15.1m over 4
    years) is not of a magnitude sufficient to allow repayment of the historical deficit (as calculated under the RAB rules) in the
    short term. This issue is discussed in more detail in the following two paragraphs.




                                                                  1
Executive Summary
            1.0
                                 05/06 Actual                                 06/07                                           07/08
            0.8
            0.6
            0.4
            0.2
    (£m)




            0.0
           (0.2)                                                                                                 Increase in income
           (0.4)                                                                                                 as a result of PbR
                                                                                    Ward C losure
           (0.6)
                             No management
           (0.8)             adjustments in April due to
           (1.0)             the year end process
                   Apr-05




                             Aug-05




                                                Dec-05




                                                            Apr-06




                                                                     Aug-06




                                                                                           Dec-06




                                                                                                        Apr-07




                                                                                                                             Aug-07




                                                                                                                                      Dec-07
                                      Turnaround Run Rate                             Linear (Turnaround Run Rate)



•           Importantly, using normal commercial accounting rules and the accounting rules that apply to FT Hospitals, compared to the
            RAB accounting rules, the Trust can pay back its ‘actual historical deficit’ or ‘accumulated losses’ within 3 years i.e. by Mar-09.
            Deficits calculated under the RAB rules do not represent the actual accumulated losses. This method multiplies deficits year on
            year distorting the true underlying financial position and does not, therefore, represent the actual financial position.


•           It is worth noting that even allowing for a lower level of income by performing a sensitivity analysis in 2007-08 and 2008-09,
            the sustainable positive monthly run-rate achieved in 2006-07 continues to get the Trust into in year profitability, thus enabling
            it to continue to reduce the historic deficit year-on-year.


•           Under standard commercial accounting rules the cumulative historical deficit (known under standard accounting rules as
            ‘Accumulated C/F Losses’) would be restated to the actual accurate financial position of £12m, instead of a balance sheet
            position of £21.9m (under RAB rules) as at Mar-06. This restated figure is arrived at after correcting the distortion to the actual
            financial position caused by the ‘double-counting’ of the deficit that occurs under the RAB accounting rules specific to NHS
            Trusts, i.e. once as a reduction to income and then the same deficit is counted again in calculating the C/F losses.



                                                                                2
Executive Summary

•   The Trust continues to explore opportunities for further savings for both 2006/07 and beyond.


•   Disposal of estates offers a further significant opportunity to raise c£9m cash over the next 2-3 years. This relates to 4 sites,
    namely, Harps Close Meadow, Churchfield Road, St. Leonard’s Hospital and Walnuttree Hospital. An estimated £5m-£6m is
    accounted for by Harps Close Meadow which could be completed in this financial year. The majority of this upside has not been
    included in the plan as an I&E benefit and, although the cash benefit is not in doubt, it is not clear whether and how much of
    the profit on disposals will be allowable as a I&E benefit under the NHS accounting rules and by the auditors. The ability to use
    funds generated by asset disposal to pay off historic debts is not possible under current NHS accounting rules.
    The disposal of St Leonard’s Hospital and Walnuttree Hospital are subject to a judicial review.


•   It has been strongly recommended that the Trust undertake Zero-Based Budgeting in time for next year’s budget. This process
    will challenge historical budget assumptions and is likely to reveal further opportunities for savings. A work programme is being
    established to take this forward.


•   There is a dependency on SWPCT which is in deficit and therefore also subject to a turnaround. Protracted negotiations have
    now been concluded with the PCT to finalise the income for 2006-07. This has resulted in a clinical income for 2006-07 of
    £100.8m. Total income for 2006/07 is £114m which includes education, private patients, catering and R&D.


•   As a hospital with an Reference Cost Index (RCI) below the national average at 91 it stands to benefit from the introduction of
    PbR. This is forecast to increase income by c£9m over the 4 years transition to full PbR from 2005-06 to 2008-09 based on
    current national policy. The majority of the movement in income between the years is due to more activities falling under the
    PbR tariff. However, there remains a risk that current tariff policy will be adapted in a way that reduces this projected gain.




                                                                 3
Executive Summary
•   Financial Performance
    –    To accurately measure this the profitability or loss needs to be defined as the ‘underlying in year profitability’ and
         separated from the historical deficit.


    –    Due to the unique way it is accounted for in the NHS as a deduction from income, the historical deficit causes a major
         distortion to the measurement of underlying profitability due to the ‘multiple’ counting of C/F deficit under the RAB rules.
         The ‘in year’ profit/loss is the relevant commercial measure of performance that determines long-term financial viability
         and its is this that is used in the report as the key focus of this turnaround plan.


    –    It is important to note that calculation of the historical deficit includes non-controllable cost pressures of which the most
         significant ones are NICE, Superannuation and CNST increase. It should be noted that the local implementation of AfC,
         EWTD, NICE, and Consultant contract had a significant impact on the deficit.


    –    The underlying profitability as measured by EBIT after adjusting for non-recurring CRES (one-off items) shows an
         improving trend over the last year from a £7m deficit to £4.6m deficit. During this period the Trust posted recurring CRES
         savings of £5.2m and £5.0m respectively. Significantly, the run-rate has improved over the last 24 months from a
         monthly loss of £800k to £400k as at 31 March 2006.


    –    The turnaround plan shows that break-even position will be achieved in Nov-06 after which the run-rate improves to a
         sustainable level of c.£0.3m by Mar-07 and c.£0.6m by Mar-08.



    –     The following financial summary table illustrates the improving trend:




                                                                 4
Executive Summary
                                                                         Turnaround Turnaround Turnaround              CRES programmes achieved in 2005-06
                                  Actual        Actual      Actual          Plan       Plan       Plan                 amount to £7.1m (£5.0m recurring) in
£m                                2003/04       2004/05     2005/06       2006/07          2007/08       2008/09       addition to £5.5m (£5.2m recurring)
                                                                                                                       achieved in 2004-05:
Clinical Income                       85.0          92.6         95.7         100.8            110.6         115.6
                                                                                                                         • Reduction of 61 beds (in addition to 33
Other Income                          10.9          12.0         12.6          13.2             14.4          14.8
                                                                                                                           closed in 2004-5)
Gross Incom e                         95.8         104.6        108.2         114.0            125.0         130.4
                                                                                                                         • Closed 2 theatres
Pay Costs                            (67.7)        (77.3)       (77.8)        (78.7)           (81.0)        (82.5)
                                                                                                                         • Headcount reduction of 123 staff as at 31
Drug Costs                            (5.0)         (6.0)        (6.5)         (6.4)            (8.1)         (9.0)
                                                                                                                           March 2006 compared to 31 March 2005
Other Costs                          (24.7)        (26.1)       (26.5)        (26.5)           (26.2)        (26.8)
PDC dividend                          (1.7)         (2.2)        (2.1)         (2.4)            (2.4)         (2.4)      • Managed vacancies of 173 WTEs
Total Recurring Costs                (99.0)       (111.6)      (112.8)       (114.0)          (117.8)       (120.7)      • Bank costs reduced by 24% (£0.8m)

Underlying In year result             (3.2)         (7.0)        (4.6)          0.0              7.2           9.7       • Agency costs reduced by 55% (£1m)
                                                                                                                         • Centralised outpatient services – Thetford
Non-recurring CRES                     0.7           0.3          2.1              -                 -             -       to WSH
Non-recurring costs                       -             -        (0.3)         (1.4)                 -             -
                                                                                                                         • Total  157    CRES    schemes   including
Historical deficit adj                      -       (0.9)        (9.0)        (12.0)           (14.6)         (8.8)
                                                                                                                           Consultant PAs and procurement savings
Historical deficit usage charge             -           -            -         (1.2)            (1.5)         (0.9)      • Achieved access targets

Reported surplus/(deficit)            (2.5)         (7.6)       (11.8)        (14.6)            (8.8)         (0.0)
                                                                                                                       2006-07 Initiatives and CRES:
                                                                                                                         • Initiatives across Revenue generation,
                                                                                                                           Operational Services and Infrastructure
                                                                                                                         • £3.7m turnaround savings identified.
                                                                                                                         • Excludes £1m transition costs, turnaround
                                                                                                                           fees £0.2m, historic deficit £12m and
                                                                                                                           £1.2m usage recharge.
                                                                                                                         • Even allowing for sensitivity of income in
                                                                                                                           2007-08 and 2008-09, the positive monthly
                                                                                                                           run-rate continues to get the Trust into in
                                                                                                                           year profitability and thus enabling it to
                                                                                                                           continue to reduce the historic deficit year-
                                                                                                                           on-year.

                                                                                       5
Executive Summary

•   Implementation


    –    The key success factors are:
         -     Commitment from the Chairman, Board and Executive Directors exists
         -     The Trust Turnaround Team. Realistic turnaround timescales need to be agreed with the DoH
         -     Active engagement of key stakeholders to gain buy-in and drive through the changes


    –    Management capacity
         -     Changes will be driven through by local managers who will be supported by the Board and Turnaround Team
         -     Their performance will be managed through the fortnightly FRG (Financial Recovery Group) performance review
               meeting, directorate performance reviews, directorate management team meetings and individual objective setting
         -     Actions, responsibilities and timescales have been agreed as part of the turnaround plan and will be used to track
               performance
         -     Communication Plan. This has been established and Trade Unions and MPs have been briefed
         -     Making it happen. There exists a recent track record of delivering since new Chief Executive and Operations Director
               were appointed in October 2004.


    –    The estimated transition costs of £1.2m. Every effort will be made to ensure the redundancy costs are kept to a minimum
         through vacancy management and redeployment.




                                                               6
Overview: Introduction and Background
Well established and reputable DGH offering a full range of acute and diagnostic services that meets all access
targets

•   West Suffolk Hospitals NHS Trust is a District General Hospital which encompasses a population of approximately 250,000 and
    provides a comprehensive range of acute (secondary) general hospital services. According to the Office of National Statistics the
    total population growth is expected to be in excess of 12% over the next 15 years to 2021.

•   It provides care for some patients in the neighbouring counties of Norfolk, Cambridgeshire and Essex.

•   The Trust’s principle catchment population has a prevalence of older residents, with a greater proportion of females. The
    proportion of over 85 year olds is significantly higher than the national average and will increase by 80% over the next 15
    years. (Source: Office of National Statistics).

•   As well as the main hospital site (Hardwick Lane), the Trust provides outreach outpatient and radiology services at St Leonards
    Hospital, Sudbury, outpatient services from Walnuttree Hospital, Sudbury and Newmarket Hospital.

•   The Trust has 481 beds (including maternity) and employs 2,063 Whole Time Equivalents (WTE) (as at March 2006).

•   The majority of wards in the catchment area are more affluent than the national average, however, there are pockets of rural
    deprivation.

•   The total income for 2006-07 is £114m. Suffolk West PCT (SWPCT) is the main commissioner for West Suffolk Hospital’s
    services accounting for 80% of the Trust’s £100.8m clinical income. The balance of £13.2m of income is generated from
    Education, Private patients, Catering and R&D.

•   SWPCT is also in deficit. Its turnaround plans have not yet been communicated to the Trust but given the level of dependency
    on the PCT, any plans by them to materially reduce the level of commissioning will have a material impact on the Trust’s
    ongoing financial position.
•   There are currently no concerns over the Trust’s clinical safety based on existing risk assessments or plans for the wholesale
    relocation of acute services. The Trust does not provide specialist/tertiary services.

•   The Trust has a range of well developed clinical networks, largely with Cambridge, but in addition Papworth (cardiology) and
    Ipswich (oral surgery).
                                                                   7
Overview: Methodology
•   This plan has been prepared by a turnaround team led by the Chief Executive and supported by the External Turnaround
    Director. The team consists of the Chief Executive, Finance Director, Operations Director, Medical Director, HR Director, Nursing
    Director, Facilities Director and four General Managers representing each of the directorates. Consultation has also involved the
    clinical directors and other managers.


•   There has been significant input from this team and their staff to each initiative and workstream.


•   Deloitte have provided support and technical expertise to the turnaround team.


•   The external Turnaround Director has provided extensive turnaround expertise in developing and project managing the
    completion of the plan


•   The turnaround plan has been developed in the following stages:
    –    Historical Financial Performance and analysis of deficit
    –    Assessment of underlying recurring profitability
    –    Base Case Business Plan or Budget 2006-07 to 2008-09
    –    Turnaround initiatives and further opportunities including operational productivity improvements
    –    Analysis of CRES schedule to test for robustness (where appropriate utilising Dr Foster benchmarking information e.g.
         LoS)
    –    Impact of Turnaround initiatives on Base Case Business Plan
    –    Development of Financial Turnaround Plan
    –    Determination of break-even position, run-rate and ‘in year’ profitability
    –    Key risks and sensitivities
    –    Identification of key stakeholders
    –    Implementation plan




                                                                    8
Overview: WSH Market Position
Occupying a central position for 30 miles servicing the increasing needs of an ageing population of 250,000


•   WSH occupies a strong central position being the only main DGH and A&E hospital in the area for 30 miles. Other sizeable
    DGH’s in the area include Ipswich (c30 miles), Addenbrookes (c30 miles), Colchester (c40 miles) and Hinchingbrook (c50 miles).


•   The Trust’s competitive advantage derives from its
      -     Dominant position in the local economy with a large captive population
      -     Excellent reputation as a District General Hospital providing acute services (including A&E)
      -     Loyal local residents and primary care practitioners


•   Its main weakness comes from
      -     Dependency on one PCT for 80% of its income
      -     Management capacity and pace of change


•   The number of patients presenting at the hospital has remained the same as previous year. However, the demographics of the
    population suggest that this trend is expected to rise significantly over the next 15 years. The demand for its services is
    therefore set to increase year-on-year.


•   Local residents and primary care practitioners remain loyal to the Trust.




                                                                   9
Historical Financial Performance




                10
Historical Financial Performance: 2003/04 to 2005/06
The Trust has been in a recurring underlying in year deficit from 2003/04 which peaked at £7.0m in 2004/05 but
has been reduced to £4.6m in 2005/06 as a result of significant CRES

                                  Actual        Actual      Actual            2003/04
£m                                2003/04       2004/05     2005/06           •   The Trust reported a deficit of £2.5m in 2003/04.
                                                                              •   The underlying ‘in year’ result after adjusting for Historical
Clinical Income                       85.0          92.6         95.7
                                                                                  deficit and non-recurring CRES items is £3.2m. The
Other Income                          10.9          12.0         12.6             previous year was not in deficit although to achieve this a
Gross Incom e                         95.8         104.6        108.2             number of non-recurring CRES had been implemented in
                                                                                  2002-03.
Pay Costs                            (67.7)        (77.3)       (77.8)
                                                                              •   Non-recurring CRES in 2003/04 were £0.7m out of a total
Drug Costs                            (5.0)         (6.0)        (6.5)            CRES for the year of £1.9m.
Other Costs                          (24.7)        (26.1)       (26.5)
PDC Dividend                          (1.7)         (2.2)        (2.1)
Total Recurring Costs                (99.0)       (111.6)      (112.8)        2004/05
                                                                              •   The Trust reported a deficit of £7.6m in 2004/05.
Underlying In year result             (3.2)         (7.0)        (4.6)        •   The underlying ‘in year’ result after adjusting for Historical
                                                                                  deficit and non-recurring CRES items is £7.0m.
Non-recurring CRES                     0.7           0.3          2.1
                                                                              •   Historical deficit payments of £0.9m relating to the deficit in
Non-recurring costs                       -             -        (0.3)
                                                                                  2003/04 was adjusted to give a net income of £103.7m.

Historical deficit adj                      -       (0.9)        (9.0)        •   Non-recurring CRES in 2004/05 were £0.3m out of a total
Historical deficit usage charge             -           -            -            CRES for the year of £5.5m.


Reported surplus/(deficit)            (2.5)         (7.6)       (11.8)        2005/06
                                                                              •   The Trust has reported a deficit of £11.8m in 2005/06.
                                                                              •   The underlying ‘in year’ result after adjusting for Historical
                                                                                  deficit and non-recurring CRES items is £3.8m.
                                                                              •   Historical deficit payments of £9.0m relating to the deficit in
                                                                                  2003/04 and 2004/05 was adjusted to give a net income of
                                                                                  £99.2m.
                                                                              •   Non-recurring CRES in 2005/06 were £1.9m out of a total
                                                                                  CRES for the year of £6.6m. Non-recurring CRES mainly
                                                                         11       relates to £1.6m from the review of asset life.
Historical Financial Performance: 2004/05 and 2005/06
Monthly Run Rate
The Trust has improved from an in year monthly deficit of c.£800k at the beginning of 2004/05 to c.£400k by the
end of 2005/06

Surplus/Deficit Monthly Run Rate from 2004/05 to 2005/06

        0.0
                                                        04/05                                                                                                               05/06
       (0.2)

       (0.4)

       (0.6)
(£m)




                                                                                                                                                  No management
       (0.8)                                                                                                                                      adjustments in April due to
                                                                                                                                                  the year end process
       (1.0)

       (1.2)

       (1.4)
               May-04

                        Jun-04

                                 Jul-04

                                          Aug-04

                                                   Sep-04

                                                            Oct-04

                                                                     Nov-04

                                                                              Dec-04

                                                                                       Jan-05

                                                                                                Feb-05

                                                                                                         Mar-05

                                                                                                                       Apr-05

                                                                                                                                May-05

                                                                                                                                         Jun-05

                                                                                                                                                     Jul-05

                                                                                                                                                              Aug-05

                                                                                                                                                                       Sep-05

                                                                                                                                                                                Oct-05

                                                                                                                                                                                         Nov-05

                                                                                                                                                                                                  Dec-05

                                                                                                                                                                                                           Jan-06

                                                                                                                                                                                                                    Feb-06

                                                                                                                                                                                                                             Mar-06
                                                      Historical Surplus/(Deficit)                                                           Linear (Historical Surplus/(Deficit))
The monthly in year surplus/deficit has been adjusted to allow for any historical deficit payments, agenda for change back payments, SLA agreement changes and non
recurring CRES and costs.

•         The Trust was running at an average monthly in year deficit of c.£800k at the beginning of 2004/05.
•         By the end of 2005/06 the Trust was running at an average monthly in year deficit of c.£400k.
•         The movements in March 05 and April 05 relate to no management accounts adjustments in April due to processing the
          previous year end results. These adjustments were processed through May instead.




                                                                                                                  12
Historical Performance: Cost reduction programme
£14.5m of CRES has already been saved over the past three years, of which £11.4m is recurring. A total of 94 beds
have been reduced over the past two years (18%). The majority of all relatively easy savings have been made over
the past three years which will limit the opportunities in the forthcoming years
                                       Actual       Actual      Actual     2004/05
£m                                    2003/04      2004/05      2005/06    •  The main CRES achieved in 2004/05 related to:
                                                                                  − £200k of HDU reductions
Actual Recurring CRES                      1.20         5.21        5.01          − £450k from closing ward G6 (Sept 04)
Actual Non-recurring CRES                  0.70         0.33        2.11          − £212k from reduction in ward F7
Total Actual CRES                          1.90         5.54        7.12          − £427k increase in catering, accommodation, car parking prices
                                                                                  − £140k from alternative Npfit funding source
Budget Recurring CRES                    Not Av.        6.11        5.89 *
                                                                                  − £600k from SLA changes
Budget Non-recurring CRES                Not Av.        0.27        2.05
                                                                                  − £238k from a depreciation review
                                                                           •  The under achievement of CRES mainly relates to a £1m CRES for
Budgeted CRES                              5.42         6.38        7.94
                                                                              additional Treatment Centre income that was not realised.
                                                                           •  Total bed number were reduced by 33 beds in 2004/05.
Actual % Recurring of budget             Not Av.        85%          85%
                                                                             2005/06
Actual % Non-recurring of budget         Not Av.       125%         103%
                                                                             •    Achieved £7.1m of savings with a reduction of 61 beds, 123 staff, two
Actual % of Budget                          35%          87%         90%
                                                                                  wards, two theatres and managed vacancies of 173 WTE. Bank costs
* - Initial 2005/06 budgeted recurring CRES of £8.0m. £1.1m of CNST
                                                                                  were reduced by 24% (£0.8m) and agency costs by 55% (£1.0m) and
premium ‘holidays’ have been stripped out of the budget figure as this was
                                                                                  outpatient services were repatriated from Thetford Cottage Hospital.
an unrealistic central CRES and not ever deliverable.
                                                                             •    £5.0m of the achieved CRES were recurring, mainly relate to:
                                                                                      − £1.9m of staff reduction, vacancy savings and staff mix changes
2003/04                                                                               − £0.9 of ward and theatre closures
•  A break down of the 2003/04 CRES was not available.                                − £0.4m from asset life review
   The figures were taken from the FT diagnostics.
                                                                             •    £0.8m of the total under achievement in the planned CRES, £1.0m
                                                                                  relates to central initiatives not met, with operational directorate
                                                                                  savings saving £0.2m more than planned.
                                                                             •    The main under achieved CRES were £0.5m of further staff reductions
                                                                                  and £0.2m of delays in closing an additional ward and two theatres,
                                                                                  through extended staff consultation.
                                                                             •    Non-recurring CRES of £2.1m mainly related to £1.6m from an asset
                                                                                  life review and £0.2m of utilised charitable funds.
                                                                                 13
Historical Performance: Operational Performance
The operational performance of the Trust has continued to improve with all targets either achieved or exceeded in
2005/06
Performance Area                                     2004/05           2005/06

A&E
% of patients seen or discharged within 4 hours       96.3%             98.2% (target 98%)
Waiting lists
Inpatient waiting time                            Max 9 months          Max 6 months
Day case waiting time                             Max 9 months          Max 6months
Outpatient waiting time                           Max 17 weeks          Max 13 weeks
Nos on waiting list                                  4542                3513
Day case rates                                       73%                78%
Cancer
2 week wait                                         100%               100%
31 day diagnosis                                    100%               100%
62 day treatment                                     80% (Oct 05)       96% (Feb 06)
Data Completeness                                    58% (Nov 05)      100% (Feb 06)
MRSA
No. of Bacteraemia                                   43                28 (Target 30)
Booking – direct and partial
Outpatients                                         71.3%              100% (Dec 05)
Inpatients                                          82.8%              100% (Dec 05)
Day cases                                           92.0%              100% (Dec 05)

•     Achieved Improving Working Lives Practice plus accreditation (Highest score in NSC)
•     Good PEAT assessment (improvement on 2004-05)
•     Sickness absence reduced from 5% in 2004-05 to 4.6% in 2005-06.
•     Achieved EFL and Return on capital

                                                                 14
Base Case Business Plan
  2006-07 to 2008-09




         15
Base Case Business Plan: Overview to 2008/09
The base case forecasts the Trust to be in an underlying in year surplus by 2007/08, however 2006/07 would show
an underlying in year recurring deficit of £2.4m before any turnaround savings are overlaid
                                  Actual        Actual      Actual       Budget       Forecast       Forecast
£m                                2003/04       2004/05     2005/06      2006/07       2007/08        2008/09

Clinical Income                        85.0         92.6         95.7        103.5        110.6          115.6
Other Income                           10.9         12.0         12.6         13.2         14.4           14.8
Gross Incom e                          95.8        104.6        108.2        116.7        125.0          130.4

Pay Costs                             (67.7)       (77.3)       (77.8)       (81.8)       (84.1)         (85.8)
Drug Costs                             (5.0)        (6.0)        (6.5)        (7.3)        (8.1)          (9.0)
Other Costs                           (24.7)       (26.1)       (26.5)       (27.5)       (27.3)         (27.9)
PDC dividend                           (1.7)        (2.2)        (2.1)        (2.4)        (2.4)          (2.4)
Total Recurring Costs                 (99.0)      (111.6)      (112.8)      (119.1)      (121.9)        (125.0)

Underlying In year result              (3.2)        (7.0)        (4.6)        (2.4)         3.1            5.4

Non-recurring CRES                      0.7          0.3          2.1             -              -              -
Non-recurring costs                        -            -        (0.3)        (0.2)              -              -

Historical deficit adj                      -       (0.9)        (9.0)       (12.0)       (15.8)         (14.3)
Historical deficit usage charge             -           -            -        (1.2)        (1.6)          (1.4)

Reported surplus/(deficit)             (2.5)        (7.6)       (11.8)       (15.8)       (14.3)         (10.3)

•    Please Note: The reduction in income of £2.7m is included in the turnaround plan and not in the base case budget and the
     reduction in unfunded drug costs is deducted from this income.
•    2006/07 budget shows an in year recurring deficit of £2.4m with a reported deficit of £15.8m after a £12.0m historical deficit
     adjustment and a £1.2m deficit usage charge.
•    Total income was budgeted to increase by £8.5m (base case), mainly as a result of clarity in commissioning, with in year costs
     increasing by £4.7m across all expenditure areas. There are no CRES or transition costs included in the base case.
•    The base case also assumes no reduction in commissioning levels from SWPCT
                                                                 16
       Base Case Business Plan: Surplus/(Deficit) Bridge
          The base case forecasts the Trust to be in an underlying in year surplus by 2007/08, however 2006/07 would show
          an underlying in year deficit of £2.4m before any turnaround savings are overlaid

        Underlying In Year Surplus/deficit Bridge from 2004/05 to 2007/08
                                            8.0



                                            6.0
                                                                                                                                                                                                                                                                                      1.2
Underlying In Year Surplus/(Deficit) £ m




                                                                                                                                                                                                                                                                                                     (2.3)

                                            4.0
                                                                                                                                                                                  0.7
                                                                                                                                                                                                                                                                                                                  (0.8)


                                            2.0                                                                                                                                                  (3.9)
                                                                                                                                                                                                                                                                    7.1                                                                       3.1

                                                                                                                                                                7.8
                                            0.0
                                                                                                                                                                                                               (0.9)
                                                                                                                                                                                                                                               (2.4)
                                                                                                                                                                                                                                (1.3)
                                           (2.0)                                                                                              (4.5)


                                                   (7.0)                               0.5
                                           (4.0)                                                                  (0.4)


                                                                     3.0
                                           (6.0)


                                           (8.0)
                                                                     Clinical Income




                                                                                                                                                                Clinical Income




                                                                                                                                                                                                                                                                    Clinical Income
                                                                                       Other Income




                                                                                                                                                                                  Other Income




                                                                                                                                                                                                                                                                                      Other Income
                                                                                                                   Drug Costs




                                                                                                                                                                                                                   Drug Costs




                                                                                                                                                                                                                                                                                                                   Drug Costs
                                                                                                                                                                                                                                                2006/07 Base Case




                                                                                                                                                                                                                                                                                                                                              2007/08 Base Case
                                                                                                      Pay Costs




                                                                                                                                                                                                  Pay Costs




                                                                                                                                                                                                                                                                                                      Pay Costs
                                                                                                                                Other Costs




                                                                                                                                                                                                                                 Other Costs




                                                                                                                                                                                                                                                                                                                                Other Costs
                                                    2004/05 Actual




                                                                                                                                               2005/06 Actual




                                                                                                                                                                                                              17
Base Case Business Plan: Key Budget Assumptions
The 2006/07 budgeted income has been calculated using PbR and the expenses have been calculated based on
saving and cost pressure built over the 2005/06 budget
2006/07
•   The clinical income level was based on £103.5m for the base case budget. Negotiations with the PCT were still progressing as at
    the date of completing the final draft of this report. These negotiations have just been concluded with the final offer of clinical
    income from the PCT being £100.8m.
•   £13.2m of other income is from education (£5.4m), private patients (£0.9m), research and development (£0.1m) and other
    operating income (£6.8m).
•   The historical deficit adjustment of £12m to the income received for the year is calculated using the historical deficit from
    2005/06 of £9m, 2005/06 reported deficit of £2.8m and 2004/05 audit adjustments of £0.2m.
•   The expenditure for the 2006/07 budget has been calculated from the 2005/6 budget allowing for the full year effect of planned
    CRES in 2005/06 and any cost pressures in 2005/06. This rolled forward 2006/07 budget has then been adjusted for the
    expected increase in cost pressures and any decreases for any released costs expected during the year.
•   An in depth review has been performed with Budget Holders and Financial Performance Managers:
      –     on all adjustments to the 2005/06 budget and cost pressures assumed in the 2006/07 budget; and
      –     of the 2006/07 budgeted expenditure against the actual costs in 2005/06
•   The 2006/07 base case has stripped out all CRES and transitional costs that were not achieved or spent in 2005/06 but
    assumed in the 2006/07 budget. These have been included in the turnaround plan.
•   This means that the 2006/07 budget base case does not include any potential CRES or transition cost that need to be achieved .


2007/08 & 2008/09
•   This has been model from the FT diagnostic model
•   Income calculated from 2006/07 figures through an income model. This model takes into account the expected movement on
    activity on each speciality. The tariff is assumed to increase by inflation.
•   Expenditure is assumed to increase by inflation with some adjustment for significant known cost changes.
•   The 2007/08 and 2008/09 base case has assumed no CRES or transition cost although based on the recovery planning process
    additional CRES is achievable in these years.




                                                                 18
Base Case Business Plan: Forward Monthly Run Rate 05/06 to
07/08
The forward expected run rate on the Turnaround base case shows the Trust returning to an underlying surplus
in March 2007
Surplus/Deficit Monthly Run Rate from 2005/06 to 2007/08
        0.4
                                                            05/06                                                                                06/07 Base Case Budget                                                                                           07/08 Base Case Forecast
        0.2

        0.0

       (0.2)
(£m)




       (0.4)
                                                                                                                                                                                                                                            Increase in income as a
                                                                                                                                                                                                                                            result of PbR
       (0.6)
                                                   No management
       (0.8)                                       adjustments in April due to
                                                   the year end process
       (1.0)
               Apr-05
                        May-05
                                 Jun-05
                                          Jul-05
                                                   Aug-05
                                                            Sep-05
                                                                     Oct-05
                                                                              Nov-05
                                                                                       Dec-05
                                                                                                Jan-06
                                                                                                         Feb-06
                                                                                                                  Mar-06
                                                                                                                           Apr-06
                                                                                                                                    May-06
                                                                                                                                             Jun-06
                                                                                                                                                      Jul-06
                                                                                                                                                               Aug-06
                                                                                                                                                                        Sep-06
                                                                                                                                                                                 Oct-06
                                                                                                                                                                                          Nov-06
                                                                                                                                                                                                   Dec-06
                                                                                                                                                                                                            Jan-07
                                                                                                                                                                                                                     Feb-07
                                                                                                                                                                                                                              Mar-07
                                                                                                                                                                                                                                       Apr-07
                                                                                                                                                                                                                                                May-07
                                                                                                                                                                                                                                                         Jun-07
                                                                                                                                                                                                                                                                  Jul-07
                                                                                                                                                                                                                                                                           Aug-07
                                                                                                                                                                                                                                                                                    Sep-07
                                                                                                                                                                                                                                                                                             Oct-07
                                                                                                                                                                                                                                                                                                      Nov-07
                                                                                                                                                                                                                                                                                                               Dec-07
                                                                                                                                                                                                                                                                                                                        Jan-08
                                                                                                                                                                                                                                                                                                                                 Feb-08
                                                                                                                                                                                                                                                                                                                                          Mar-08
                                                                              Base Case Surplus/(Deficit)                                                                                                   Linear (Base Case Surplus/(Deficit))
The monthly in year surplus/deficit has been adjusted to allow for any historical deficit payments, agenda for change back payments, SLA agreement changes and non
recurring CRES and costs



•        The 2006/07 budget and the 2007/08 forecast have been phased across the year.
•        The base case is indicating a run rate of c.£200k deficit a month through 2006/07 and c.£200k to c.£300k surplus in 2007/08.
•        The base case indicates that the Trust should go into a positive monthly run rate in March 2007 by £100k.




                                                                                                                                                                          19
    Base Case Business Plan: Income
    Clinical income was budgeted to increase by £7.8m (8%) from 2005/06 to 2006/07 mainly as a result of clarity
    around commissioning, with other income budgeted to increase by £0.6m (5%) from 2005/06 to 2006/07. However,
    the final outcome of negotiations with the PCT is an increase of £5.1m or £2.7m less than the base case budget.
    Clinical Income Bridge from 2005/06 to 2006/07
                                                                                                        Income
                                                                                                        •   See following page for detail of Income calculation
                         115
                                                                                                        •   The Trust has just finalised negotiations with Suffolk
                                                                                                            West PCT (SWPCT) over the commissioning level for
                         110
                                                                                                            2006/07. This has resulted in a £2.7m gap in income
                                                                                                            than originally budgeted. This reduction has been dealt
                                                                                6.7
                                                                                                            with in the turnaround section from p.23 onwards. The
                                                                        7.9                                 implication of this under-funding is that the Trust has
    Clinical Income £m




                         105
                                                                                                            had to find additional savings from more turnaround
                                                                                                            initiatives.
                                                   1.5
                                                                                                        •   SWPCT commission 80% of the clinical income directly
                         100
                                                                                                            and therefore heads the commissioning negotiation on
                                          5.5
                                                                                                            behalf of the other PCT’s.
                                                                                          103.5
                                                                                                        •   The majority of the movement in income between the
                         95
                                                                                                            years is due to clarity in the commissioning of
                                95.7                                                                        activities between PbR and Non-PbR.

                         90
                                                                                                        •   Other income has increased from £12.6m to £13.2m in
                               2005/06   Comm.   Inflation   Activity   MFF   Clawback   2006/07            2006/07.

Clinical Income
•                          Clinical Income was budgeted to increase from £95.7m to £103.5m
                           as follows:
                               o Gain of £5.5m due to clarity in commissioning arrangements.
                               o Inflation increase of £1.5m relates to the tariff inflation
                                 impact based on the previous year level of activity.
                               o The reduction in the level of activity commissioned by the
                                 PCT of £0.6m
                               o The central MFF and clawback adjustment of £1.2m (net)

                                                                                                   20
   Base Case Business Plan: Expenditure
     Recurring expenditure is budgeted to increase by £6.2m (5.5%) from 2005/06 to 2006/07, £4.0m of which is pay
     costs and £0.8m of drug costs

    Expenditure breakdown from 2003/04 to 2008/09                                                                 2006/07
                                                                                                                  •   Recurring expenditure budgeted to
                   150
                                          Actual                                  Budget/Forecast
                                                                                                                      increase by £6.2m (5.5%) from 2005/06
                   140
                                                                                                                      to 2006/07.
                                                                                                           14.0
                                                                                                                  •   Total expenditure budgeted of £119.2m in
                   130
                                                                         12.0
                                                                                        15.9
                                                                                                                      2006/07 which is an £8.1m (7.3%)
                   120
                                                                                                                      increase from 2005/06.
                                                         9.0
                                                                                                                  •   Pay costs are budgeted to increase by
Expenditure (£m)




                   110
                                                                                        27.2
                                                                                                           27.9       £4.0m (5.2%) from 2005/06. The
                   100
                                                                         27.5                                         increase is due to £0.9m of uncontrollable
                                           26.1         26.5
                                                                                                                      incremental drift pressures and the
                   90                                                                    8.1
                                                                                                            9.0       remaining £3.3m (4.3%) from inflationary
                          24.7                                            7.3
                                                                                                                      pay increases.
                   80                      6.0           6.5
                                                                                                                  •   Drug costs are budgeted to increase by
                   70      5.0
                                                                                                           85.8
                                                                                                                      £0.8m (13.5%) from 2005/06. The large
                                                                         81.8           83.8
                                           77.3         77.8                                                          increase from 2005/06 is due to an
                   60     67.7                                                                                        increase in NICE approved high cost drug
                   50
                                                                                                                      pressures such as Herceptin, anti TNFs
                         2003/04        2004/05        2005/06          2006/07       2007/08           2008/09       and Imatinib.
                             Pay Costs                   Drug Costs                    Other Costs                •   Due to the reduction in income of £2.7m
                             Non-recurring costs         PDC Dividend                  Historical Deficit Adj         some high cost drug pressures are no
                             Historical Usage Charge     Gross Income                                                 longer being funded thus reducing the
                                                                                                                      total drugs budget . These adjustments
                                                                                                                      have been put through in the turnaround
                                                                                                                      plan section.
                                                                                                                  •   Other costs are budgeted to increase by
                                                                                                                      £1.0m (3.9%) from 2005/06 which mainly
                                                                                                                      relates to and increase in clinical supplies
                                                                                                                      and services of £0.8m (10%).
                                                                                                                  •   The PDC dividend is expected to increase
                                                                                                                      to £2.4m from £2.1m in 2005/06.
                                                                                               21
Base Case Business Plan: Cash Flow
Base Case budget shows a cash outflow of £0.1m in 2006/07 and cash neutral in 2007/8
                                                  Actual      Actual      Actual     Budget      Forecast    Forecast
£m                                                2003/04     2004/05     2005/06    2006/07      2007/08     2008/09    Cash flow

Reported surplus/(deficit)                           (2.5)       (7.6)     (11.8)     (15.8)       (14.3)      (10.3)    •   The table illustrates that the
Profit/loss on asset disposals                         0.1            -          -          -            -           -       Trust is budgeted to stay within
Total Depreciation (incl. finance lease depreciation) (4.1)       (3.8)      (1.8)      (4.2)        (4.2)       (4.4)       its cash targets throughout the
PDC Dividend                                          (1.7)       (2.2)      (2.1)      (2.4)        (2.5)       (2.4)       forecast period.
Total interest receivable                              0.1         0.1        0.2        0.1          0.1         0.1
                                                                                                                         •   The main risk to the cash flow
EBITDA                                                 3.1       (1.7)      (8.2)      (9.4)        (7.6)       (3.5)
                                                                                                                             relate to the cost of
Excluding Non cash I&E items                          (0.2)       (0.2)      (0.3)       0.9          1.2         1.0
Movement in working capital:                                                                                                 redundancies and reliance on
Stocks                                                (0.4)       0.1        (0.0)      (0.2)            -           -       £2.7m brokerage from the SHA.
Trade Debtors                                          0.9        1.6         0.3       (0.2)         0.7        (0.5)   •   Upside to the cash flow come
Other current assets                                      -          -       (0.2)       0.2             -           -       from the proceeds from asset
Trade C reditors                                       0.1       (4.0)           -      (1.2)        (1.6)       (1.4)
                                                                                                                             (mainly estates ie Harps Close
Other Non-Trade C reditors                             0.7        9.7         0.2        1.8         (3.3)       (1.8)
                                                                                                                             Meadow) disposals.
Accruals and Deferred income                           1.3       (1.3)           -          -            -           -
                                                                                                                         •   These events will occur and
CF from Operations                                    5.4         4.2        (8.3)      (8.1)      (10.6)       (6.3)        provided they happen in the
                                                                                                                             same financial year they will
C apex spend                                                                                                                 offset and the Trust will remain
Maintenance capex                                     (3.6)       (2.0)      (1.8)       (3.1)       (2.9)       (2.9)
                                                                                                                             within its cash targets.
Non maintenance capex                                 (5.0)       (2.6)      (2.8)           -           -           -
C ash receipt from asset sales                         2.5            -          -        5.0            -           -   •   The reduction in the PCT income
Interest receivable / (payable)                        0.1         0.1        0.2         0.1         0.1         0.1        of £2.7m has not been included
CF before Financing                                  (0.6)       (0.3)     (12.7)       (6.1)      (13.4)       (9.1)        in the base case but as a
                                                                                                                             turnaround adjustment.
Public Dividend C apital received                     2.9         2.5        12.4        12.0        15.9        13.9
Public Dividend C apital repaid                          -           -           -           -           -           -
Movement in Other grants/C apital received            0.1         1.1        (0.3)       (0.1)       (0.1)       (0.1)
Movement in LT C reditors & Provisions                0.2         0.4         2.7        (2.7)        0.5         0.5
Other C apital repaid                                    -           -           -           -           -           -
Movement in LT debtors                               (0.2)        0.2            -       (0.8)       (0.5)       (0.5)
Movement in Loan facility                                -           -           -           -           -           -
Dividends paid                                       (1.7)       (2.2)       (2.1)       (2.4)       (2.4)       (2.4)
Net cash (outflow) / inflow                           0.7         1.8         0.0       (0.1)       (0.0)         2.4

Opening cash balance                                  0.2         0.9         0.3        0.3          0.2        0.2
Net cash (outflow) / inflow                           0.7         1.8         0.0       (0.1)        (0.0)       2.4
Closing cash balance                                  0.9         2.7         0.3        0.2          0.2        2.6
                                                                               22
Impact of Turnaround Plan on
  Base Case Business Plan

    2006-07 to 2008-09




            23
Turnaround Business Plan: Reconciliation to the Base Case
The turnaround plan improves the underlying base case in 2006/07 by £2.4m giving a recurring in year breakeven
position for 2006/07. In 2007/08 the base case is improved by £4.2m giving a recurring in year surplus of £7.2m

£m                                                          2006/07      2007/08       2008/09

Base Case Underlying In Year Recurring Result                  (2.4)         3.1           5.4

PCT net adjustment to Income                                   (1.4)            -             -
Turnaround Initiatives                                          3.7          4.2           4.3

Turnaround Underlying In Year Recurring Result                  0.0          7.2           9.7

Non-recurring CRES                                                 -            -             -
Non-recurring costs    ESR Project (Base Case)                 (0.2)            -             -
                       Transition fees                         (0.2)            -             -
                       Transition Costs                        (1.0)            -             -

Historical deficit adj                                        (12.0)       (14.6)         (8.8)
Historical deficit usage charge                                (1.2)        (1.5)         (0.9)

Turnaround Reported surplus/(deficit)                         (14.6)        (8.8)         (0.0)
•    The PCT net adjustment of £1.4m is the net position of £2.7m reduction in income and reduction in unfunded
     drugs budget.
•    The turnaround initiatives that have been identified are summarised on page 28.




                                                                24
Turnaround Business Plan: Overview to 2008/09
The Turnaround Plan forecasts the Trust to break even on a recurring in year basis in 2006/07, however this will
not be sufficient to repay the Historic Deficit in the short term

                                             2006/07                   2007/08                   2008/09
                                                 Turnaround                Turnaround                Turnaround
    £m                                Base Case         Plan    Base Case         Plan    Base Case         Plan

    Clinical Income                       103.5        100.8        110.6        110.6        115.6        115.6
    Other Income                           13.2         13.2         14.4         14.4         14.8         14.8
    Gross Incom e                         116.7        114.0        125.0        125.0        130.4        130.4

    Pay Costs                             (81.8)       (78.7)       (84.1)       (81.0)       (85.8)       (82.5)
    Drug Costs                             (7.3)        (6.4)        (8.1)        (8.1)        (9.0)        (9.0)
    Other Costs                           (27.5)       (26.5)       (27.3)       (26.2)       (27.9)       (26.8)
    PDC dividend                           (2.4)        (2.4)        (2.4)        (2.4)        (2.4)        (2.4)
    Total Recurring Costs                (119.1)      (114.0)      (121.9)      (117.8)      (125.0)      (120.7)

    Underlying In year result              (2.4)         0.0          3.1          7.2          5.4          9.7

    Non-recurring CRES                         -            -            -            -            -            -
    Non-recurring costs                    (0.2)        (1.4)            -            -            -            -
                                                                                      -                         -
    Historical deficit adj                (12.0)       (12.0)       (15.8)       (14.6)       (14.3)        (8.8)
    Historical deficit usage charge        (1.2)        (1.2)        (1.6)        (1.5)        (1.4)        (0.9)

    Reported surplus/(deficit)            (15.8)       (14.6)       (14.3)        (8.8)       (10.3)        (0.0)




•     Although the plan achieves a balanced position by the end of 2008/09, under the current RAB rules the debt remains
      outstanding on the balance sheet.

•     The split of CRES between pay costs and other costs were assumed as 75% to pay costs and 25% to other costs.




                                                                                 25
Turnaround Business Plan: Forward Monthly Run Rate 05/06
to 07/08
The forward expected run rate on the Turnaround business plan shows the Trust in a recurrent monthly run rate
surplus by November 2006
Surplus/Deficit Monthly Run Rate from 2005/06 to 2007/08
        1.0
                                                            05/06                                                                                               06/07 Budget                                                                                                07/08 Forecast
        0.8
        0.6
        0.4
        0.2
(£m)




        0.0
       (0.2)
       (0.4)                                                                                                                                                                                                                                 Increase in income as a
                                                                                                                                                                                                                                             result of PbR
       (0.6)                                       No management                                                                                                        Ward C losure
       (0.8)                                       adjustments in April due to
                                                   the year end process
       (1.0)
               Apr-05
                        May-05
                                 Jun-05
                                          Jul-05
                                                   Aug-05
                                                            Sep-05
                                                                     Oct-05
                                                                              Nov-05
                                                                                       Dec-05
                                                                                                Jan-06
                                                                                                         Feb-06
                                                                                                                  Mar-06
                                                                                                                           Apr-06
                                                                                                                                    May-06
                                                                                                                                             Jun-06
                                                                                                                                                      Jul-06
                                                                                                                                                               Aug-06
                                                                                                                                                                         Sep-06
                                                                                                                                                                                  Oct-06
                                                                                                                                                                                           Nov-06
                                                                                                                                                                                                    Dec-06
                                                                                                                                                                                                             Jan-07
                                                                                                                                                                                                                      Feb-07
                                                                                                                                                                                                                               Mar-07
                                                                                                                                                                                                                                        Apr-07
                                                                                                                                                                                                                                                 May-07
                                                                                                                                                                                                                                                          Jun-07
                                                                                                                                                                                                                                                                   Jul-07
                                                                                                                                                                                                                                                                            Aug-07
                                                                                                                                                                                                                                                                                     Sep-07
                                                                                                                                                                                                                                                                                              Oct-07
                                                                                                                                                                                                                                                                                                       Nov-07
                                                                                                                                                                                                                                                                                                                Dec-07
                                                                                                                                                                                                                                                                                                                         Jan-08
                                                                                                                                                                                                                                                                                                                                  Feb-08
                                                                                                                                                                                                                                                                                                                                           Mar-08
                                                            Turnaround Run Rate                                                              Base Case Surplus/(Deficit)                                                                    Linear (Turnaround Run Rate)
The monthly in year surplus/deficit has been adjusted to allow for any historical deficit payments, agenda for change back payments, SLA agreement changes and non
recurring CRES and costs


•        The 2006/07 turnaround plan is indicating a run rate from c.£200k deficit at the start of the year to c.£100k surplus by the end
         of the year and that the Trust will go into sustainable positive monthly run rate by November 2006.
•        The 2007/08                      turnaround plan is indicating a run rate of c.£500k-£600k surplus across the whole year (excluding any new
         CRES).




                                                                                                                                                                  26
Turnaround Plan




                  27
Turnaround Plan: Initiatives Summary
Directorates have identified £3.7m of cost savings, however they are finding it increasingly difficult to identify
further costs saving initiatives – all quick wins have been identified and saved in the prior years


£'000                                                                      Benefit Target
                                                                     2006/07   2007/08    2008/09
Key Initiative
Ward closure (Surgery)                                                     408     700       700
Pay reductions                                                             167     200       200
Admin & Clerical Review                                                     34     135       135
Review of Nursing Skill Mix (Nursing)                                       18     110       110
Procurement - Confederation (Facilities)                                   175        -         -
Medicines Management (Clinical Support)                                     64     127       127
Threatre Skill mix (Surgery)                                                50     100       100
SPr Review Junior Doctor banding                                           104     104       104
1.5% Vacancy factor                                                        350     350       350
                                                                         1,370   1,826     1,826
Other initiatives per directorate *
Surgery                                                                    205     470       515
Medical                                                                    471     478       478
Clinical Support                                                           291     341       360
Women & Children                                                           186     202       202
Facilities                                                                 492     382       423
Others                                                                     658     597       597
                                                                         3,672   4,295     4,400


•       Detailed action plans are in place to support each initiative.




                                                                         28

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:13
posted:4/6/2010
language:English
pages:29