Report to:
Paul Watson,
Tony Jewell,
Medical Director, Essex SHA
Director of Clinical Services and Public Health,
Norfolk, Suffolk and Cambridgeshire SHA
Strategic Plan for Less-Common Cancers in the Mid Anglia
Cancer Network
Report on Outcome of Informal Consultation
From Jennie Fisher, Patient and Public Involvement Manager
Essex Strategic Health Authority
13 July 2005
1.
Purpose
This paper reports the outcome of informal consultation on a Strategic Plan for LessCommon Cancers in the Mid Anglia Cancer Network (MACN).
See also attached appendices:
1. Detailed summary of written feedback
2. Summary of open discussion meetings
3. Membership of the consultation reference group
Note: Informal consultation provides an opportunity for people who may be directly
affected, to be involved in the development of proposals to change services from the
start of the planning process. Locally agreed good practice guidelines1 recommend
that a discussion document is produced and that discussions and feedback received
during the informal consultation process are documented. The recommended period
for informal consultation, which precedes the formal consultation process, is one
month.
2.
Response to the Consultation
103 written responses were received and 80 people attended the three open
discussion meetings held in Colchester, Chelmsford and Ipswich during the period of
informal consultation. A small number of written responses have been received by
the SHAs after the close of the consultation. These responses were received too late
to be included in the analysis of the feedback but will inform the next stage of the
consultation.
Over two-thirds (68) of the written responses were received from Suffolk residents
and just over one third (35) were from Essex residents. The category of respondents
was fairly evenly divided between patients, public, NHS staff, local authorities and
others.
1
Good Practice Guidelines on Consultation Relating to Service Variations and Developments
in Health Overview and Scrutiny in Essex, Southend and Thurrock. February 2004
1
52 responses were from individuals and 45 were sent on behalf of organisations or
groups. 6 respondents did not state whether or not they represented the views of an
individual or of a group. Groups represented ranged in size from 2 to 6000 people
(the latter from a local authority).
The open discussion sessions in Colchester and Chelmsford were attended by 11
and 12 people respectively who represented patients, public, staff, voluntary sector
and partner organisations. 57 people attended the discussion session in Ipswich. A
large proportion of those present were patients, carers and members of staff
connected with the Head and Neck service provided by Ipswich Hospital, having
become concerned by a letter send by a Head and Neck consultant.
The following two sections of the report highlight key points raised by people in both
the written responses to the consultation and in the three discussion sessions (a full
summary is attached at appendices 1 & 2).
3.
Summary of Feedback from Written responses
See appendix 1 attached for detailed summary of feedback
3.1
Support for Suggested Model:
People responding to the informal consultation were divided on the question of which
model offers the best strategic plan for MACN and its’ patients:
9
20
54
1
19
3.2
respondents preferred Model 1 (Essex 4 and Suffolk 5)
respondents preferred Model 2 (Suffolk 20)
respondents preferred Model 3 (Essex 27 and Suffolk 27)
respondent suggested an alternative model.
respondents did not answer this question directly
Identified Benefits / Disadvantages of the Models
Many respondents identified a number of general issues which they thought should
be taken into account when choosing a strategic model. These included the rural
nature of the MACN and concerns about distance of travel for patients and carers,
road congestion and parking. Several respondents expressed anxieties about
continuity of care and social isolation for patients and the time required to establish
specialist centres.
Perceived key benefits and disadvantages to each of the models highlighted by
respondents further to those identified in the informal discussion document were as
follows:
Model 1
Opportunities which a new clinical network might bring include providing patients with
more choice, a better support structure with more effective clinical links.
Travel and transport were identified as both benefits and disadvantages of this
model. Other respondents thought that the model might further marginalise patients
in rural areas and lead to stress and confusion for patients.
2
Model 2
This model was seen by some respondents to be the least disruptive and the
quickest and cheapest to implement as it offered economies of scale and was seen
to build on existing services and infrastructure. Other benefits identified were the colocation of clinical services, better regional links and the benefit of increased
specialisation with centralised services.
However, the model was felt to ignore the outcome of previous consultations, was
perceived not to be patient-centred and might be unacceptable to two of the three
health economies within MACN. One respondent felt that there would be no
contingency if the selected centre failed for any reason (i.e. risk issues associated
with patient choice in a more market oriented health service).
Model 3
This model was felt to offer a comprehensive and seamless approach and was
perceived to build on both the outcome of previous consultations and on the strength
of existing clinical services. It was perceived to be the least disruptive model and
might assist with recruitment of specialist staff.
Disadvantages included the cost of moving resources. Two respondents highlighted
the retention of MACN as a disadvantage within this model.
3.3
Preferred Option within Model 3
Of the respondents who expressed a preference for an option within Model 3:
 30 chose Option B
 15 chose option D

8 chose Option C
 Other options had minimal support
3.4
Criteria for Choice of Option
Of the respondents who answered this question, 37 agreed with the criteria
suggested for selecting an option within model 3 and 18 did not. Additional or
alternative criteria suggested for selecting an option included:
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Quality, cost and capacity (assessed by external peer review)
Practical ability to implement quickly
Co-location of clinical services
Proximity arrangements for pre and post operative care
Transport and travel times (including impact on ambulance service)
Availability of accommodation for carers / relatives of inpatients
Risk management, business and continuity arrangements
Ability to expand in line with strategic plans
Patient flows and ability to respond to patient choice
Supports outcome of previous consultations
One respondent felt that the criteria should be weighted.
3
3.5
Other comments
Many other comments were received as part of the consultation and a detailed
summary of these can be found in Appendices 1 & 2 attached. The following highlight
views expressed by five or more respondents (figures in brackets represent the
number of times a view was expressed)
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Consider congestion / travel and the need for effective public transport (16)
Desire to see specialist services located within local DGH (15)
Decisions should be based on clinical rather than political or financial
considerations – patient care should be paramount (14)
More time needed for consultation (11)
Avoid unnecessary change and waste of financial resources (10)
Strategic plan needs to incorporate all cancer networks within the SHAs areas
(9)
Develop these services as quickly as possible (7)
Concerns re: geography of MACN (artificial boundaries) (7)
Build on existing service strengths (6)
Take into account changing demography (6)
Importance of co-location of services (6)
4.
Summary of Feedback from Open Discussion Meetings
4.1
Key issues raised at the Essex meetings on 10 & 13 June 2005
There was clear support at the Colchester and Chelmsford meetings for the SHAs'
preferred Model 3, centres in more than one hospital: (8 out of 11 people and 7 out
of 12 people respectively with one person in Chelmsford preferring Model 1)
Within Model 3, 5 of the 11 people at the Colchester meeting and 10 of the 12 people
at the Chelmsford meeting expressed a preference for Option B. No preferences for
any other options were indicated at either meeting.
Other key issues raised at the two meetings included:

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
4.2
The need to ensure seamless care for patients (diagnosis/ surgery/
chemotherapy/ radiotherapy/ outpatients etc)
Maintaining accessible, local services in DGHs (to support specialist centres)
Ensuring that consultants work together
Concerns relating to patients living in rural areas, particularly with regard to
access to services and travel implications
The greatest need is for more specialization to improve treatments and
general clinical care
Key issues raised at the Suffolk meeting held on 14 June 2005
In advance of the meeting held in Ipswich on the evening of 14 June, the
Communications Department at Essex SHA received two telephone calls, one from a
patient and the other from a GP, both of whom lived in Suffolk and both of whom had
received letters from a consultant at Ipswich Hospital. The patient, who appeared to
be confused and distressed, reported that the letter stated that the SHAs were
proposing to close the head and neck service for cancer patients at the hospital in
4
order to build a car park and that a meeting was being held to discuss this on 14
June. This information was sent immediately to the Director of Clinical Services and
Public Health at NSC SHA. NSC SHA made direct contact with this patient to
address his concerns.
Fifty seven people attended the open discussion meeting in Ipswich, the majority of
whom were Ipswich hospital managers, clinical staff working in head and neck
services and patients of this service, having become concerned by a letter sent by an
Ipswich Head and Neck consultant.
Key issues raised at the meeting were:

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
5.
Extremely strong support for the head and neck clinical team at Ipswich
hospital, particularly the consultant
Equally strong support for maintaining all head and neck services at Ipswich
hospital
Concerns relating to fragmentation of care if all services (including surgery)
are not provided by one hospital
Questions relating to the rationale for specialist centres and the Improving
Outcomes Guidance
Concerns relating to access to services, particularly for patients living in rural
areas
Ongoing Involvement in the Development of the Strategic Plan
Several respondents offered ideas on how local people could be involved in
developing cancer services in the MACN area. Ideas included utilising the expertise
and experience of existing user and carer groups, engaging local community
representatives (e.g. local councillors, Patient and Public Involvement Forums), more
public discussion sessions and effective publicity via local press, radio and TV as
well as posters and flyers in clinical areas.
Nine individuals and five organisations indicated in written responses that they would
like to be actively involved in these developments.
6.
Summary of Process
The informal consultation on the development of a strategic plan for less-common
cancers in the Mid Anglia Cancer Network (MACN) took place from 20 May to 27
June 2005.
A consultation reference group consisting of representatives from the two SHAs,
Patient and Public Involvement Forums in Essex and Suffolk and Local Authority
Health Overview and Scrutiny Officers from the Essex and Suffolk County Councils is
acting as an advisory group for this consultation. Details of membership of this group
are provided in Appendix 3.
5
6.1
Publishing

A discussion document outlining a proposal for a strategic plan was made
available through a cascade distribution mechanism and through both SHA
websites.

Over 720 copies of the discussion document were sent out initially by post
and e-mail from Essex SHA on behalf of the two SHAs. In addition to this,
Norfolk, Suffolk and Cambridgeshire SHA sent out copies to NHS Trusts,
PCTs and partner organisations in the Suffolk area of MACN. This initial
distribution figure is likely to have been increased several fold by the numbers
distributed by e-mail, downloaded from the website and copied on via the
cascade system.

The website sections with the informal consultation document, feedback
forms, flyers advertising the informal discussion sessions and booking forms
were live from 20 May 2005. There were over 700 visits to this section of the
Essex SHA website during the period of consultation. NSC SHA does not
record hits on individual pages of the SHAs website.

220 additional hard copies of the discussion document have been requested
and distributed during the course of the consultation. NSC SHA sent a further
35 copies of the discussion document to Suffolk-based community
organisations. Only one additional copy was requested and sent out to a
member of the public from NSC SHA.

To support the discussion document, letters and flyers advertising the open
discussion sessions were circulated to clinical services within MACN and to
NHS Trusts, PCTs, and GP services in Essex. NSC SHA sent the document
to Trusts and PCTs to cascade to GP surgeries.

Organisations were encouraged to copy the documents and cascade the
information as widely as possible, particularly to patients, carers, service user
groups, staff and partners and to hold additional discussion sessions with
patients and service users as part of the informal consultation.
6.2
Publicity

The two SHAs released a joint press release to local press and media at the
beginning of the five week consultation process

Press coverage during the consultation period included articles in the East
Anglian Daily Times, The Ipswich Evening Star, The Essex Chronicle and the
Evening Echo (south Essex).

An interview with Paul Watson, the Medical Director of Essex SHA was
broadcast on Dream 100 FM on 1 June 2005.

Fliers advertising the open discussion sessions were sent to GP surgeries in
Essex and to MACN leads for distribution in clinical areas.

PCTs and Trusts publicised the informal consultation in internal and external
newsletters
6
7.
Preparing for the Next Stage of Consultation

A report on the outcome of the informal consultation will be submitted to the
Medical Directors of the two SHAs by Friday 8 July.

Recommendations will be made to the two SHA Boards following the
outcome of the informal consultation.

The consultation reference group will review the process of informal
consultation and plan the next stage of the consultation

A draft consultation document will be written which takes into account the
outcome of the informal consultation process. It is good practice to submit
this document to the Health Overview and Scrutiny Committee(s) for their
comments on the process.

A consultation plan will be agreed

The consultation document and plan will be approved by the Strategic Health
Authority (ies).
7
Appendix 1
Informal consultation on a strategic plan for less-common
cancers in the Mid Anglia Cancer Network (MACN)
Detailed Summary of Written Feedback
Total number of responses received
103
Of which
Feedback forms
E-mails
Letters
63
10
30
Category of respondents
Category of respondent
Number of respondents in category
Patient / Service User
Carer
Community / lay representative
Member of the public
NHS employee
Local Authority representative
Other
17
2
6
11
20
19
12
Multiple categories completed
Not stated
12
4
Responses completed on behalf of organisations
Of the total responses:
52
45
6
Were completed as individual responses
Were completed on behalf of organisations
Respondents did not specify whether they were responding as
individuals or on behalf of organisations
The feedback form asked respondents who were completing forms to specify how
many views were being represented and not how many people were members of the
group / organisation.
Over half of the responses completed on behalf of organisations did not answer this
question directly. These responses were mainly received from Parish Councils,
NHS Trusts and PCTs. Other group responses ranged in size from 2 to 6000 (a
local authority). A breakdown of the number of people represented in the
organisational responses is provided in the table below:
8
Stated number of peoples’ views
represented in response
Less than 10
10 – 25
26 – 100
101 – 300
301 – 1000
1001 +
Not specified
Number of respondents
8
6
1
3
1
2
24
Benefits / Disadvantages of Suggested Models
Respondents were asked to outline any benefits or disadvantages to any of the three
models which were not mentioned in the document.
Model
1
Benefits

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2
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Disadvantages
Less travel for Suffolk
residents (3)
Effective links with clinical
services (2)
Co-terminus with SHA and
county boundaries, research &
medical schools
More choice
Patient centred
Better support structure
New opportunities for clinical
networks (3)



Final choice of hospital would
depend on evaluation of each
on clinical merit (3)
Could be achieved quickly;
builds on existing
infrastructure
Cost
Least disruptive
Centralisation leads to
specialisation
More compliant with IOG (2)
Better regional links
Co-terminus with county
boundaries
Relatively central for patients
in Mid Anglia
Co-location of clinical and
related services
Economies of scale
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Travel and transport (2)
Cost
Reconfiguration of clinical
networks (4)
Stress and confusion for patients
(2)
Costly in time, money and
relationships
Marginalises patients in rural
areas (2)
Travel and transport (4)
Ignores outcomes of previous
consultations
Not patient centred (2)
Cost (2)
No contingency if hospital fails
(risk management)
Unacceptable to two of the three
health economies
Decommissioning existing
services
9
3
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Builds on existing strengths of
services (2)
Offers comprehensive and
seamless approach
Assists with recruitment of
specialist staff
Spreads services and
alleviates travel difficulties
Least disruptive (2)
Beneficial for non-cancer
surgery - skills will remain
widely available
Builds on previous
consultations


Cost of moving resources
(physical and human) to other
locations (2)
Retention of MACN (2)
General Issues which need to be taken into account in considering all 3
models
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Rurality (2)
Distance & Travel (10)
Parking (2)
Congestion
Lack of continuity of treatment
Social isolation of patients
Geographical spread of MACN
Time taken to establish services and learning curves for professionals
General Observations
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Quality, cost and time-frame for implementation (3)
Which model offers best solution for achieving IOG?
Demographic changes
Need to strengthen services in all three hospitals
Place services where surgeons have interest and expertise (2)
Does not take into account clusters of cancers
Concerns about politically driven decisions
Don’t break up existing teams
Networks should be clinically driven
Capacity issues
Benefits of co-location
Hidden costs to Social Services
Preferred Model
The feedback form asked which of the three possible models described in the
discussion document offered the best strategic plan for MACN and its patients. The
following table indicates the number of respondents who expressed a clear
preference for one model. 15 respondents either expressed no preference or
indicated a preference for more than one model.
10
Model
Number of respondents expressing a
preference for this model
9
20
54
19
1
Model 1
Model 2
Model 3
Not specified
Other
The “other” model suggested on behalf of the Suffolk Health Scrutiny Committee
was:
(a)
Existing decisions and facilities stand (Ipswich for gynaecological cancer
and Chelmsford for Upper Gastrointestinal cancer)
Future (or contended) decisions relating to Urology and Head and Neck
cancers should be made in conjunction with adjoining cancer networks.
(b)
Model
Geographical location of respondent
Mid Essex
North Essex
Essex General
Suffolk
1
0
10
2
2
0
16
2
1
0
1
0
5
20
27
15
0
13
0
20
0
2
1
68
1
2
3
Not
specified
Other
Total
Preferred Option
Fifty nine respondents expressed a clear preference for one of the options and three
respondents indicated a preference for more than one of the options within Model 3
(sixty two respondents in total) as follows:
Option
A
B
C
D
E
F
G
H
I
More than
one option
identified
Number of
Respondents
1
30
8
15
2
2
0
0
1
3
Reasons for choice of options
A
Builds on clinical excellence
Co-location of clinical services
B
Cost effective (4)
Staff retention (3)
11
Best use of existing faculties (2)
Builds on clinical excellence (6)
Local access to services
All three hospitals in network equal partners (7)
Least disruptive to patients (3)
Co-location of clinical services (2)
Least risk attached to this option
More responsive to demographic changes
Builds on outcome of previous consultations (4)
Offers best service for patients (1)
Fits with PCTs strategic plans
Reduces travel
C
Builds on existing clinical services (5)
Central location (2)
Reduces travel (2)
Fairer to patients
D
Reduces travel (5)
Builds on first class services (7)
Central geographical location (3)
Reduces patient stress
Enhances support services
Benefit of centralisation
Easy access to London
Responsive to demographic change
Offers best service for patients
Co-location of clinical services
E
Builds on existing services
F
Best selection of services available
Least travel
Specialisation of clinical services
Maintains Head and Neck surgery at local hospital
I
Criteria for choosing an option
Respondents were asked if they agreed with the suggested criteria for choosing an
option.
37
18
48
respondents agreed with the criteria
did not agree with the criteria
respondents did not address this question
Of the 18 respondents who did not agree with the suggested criteria, the following
reasons were given
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Financial criteria did not feature
Greater emphasis placed on patient needs
Greater drive to increase number of first class services
Presentation of options is biased
12
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All hospitals should have at least one specialist service
Criteria should be based on external measures, both financial and clinical
Need to maintain existing services
Criteria should be based on what would provide the best possible outcome for
patients
Access to London facilities for Essex residents
Relevance of impact on neighbouring cancer networks
Questions about IOG
Other criteria suggested for choosing an option included:

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Quality, cost and capacity
Timeframe for implementation
Criteria should be weighted
Infrastructure, robustness of services and practical ability to implement
quickly
Financial implications of options
External peer review
Cost effectiveness
Building on existing service strengths
Co-location of clinical services
Availability of accommodation for carers / relatives of inpatients
Transport and travel times
Proximity arrangements for pre and post operative care
Risk management, business and continuity arrangements
Comparative standards of treatment and care
Transportation routes to potential surgical centres and impact on ambulance
service
Rapid implementation
Availability of surgeons and nursing staff with appropriate knowledge and
skills
Ability to expand in line with strategic plans
Ability to respond to patient choice
Need to consider patient flows
Supports outcome of previous consultations
Physical facilities available
Other comments
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Consider congestion / travel and need for effective public transport (16)
Desire to see specialist services located within local DGH (15)
Decisions should be based on clinical rather than political or financial
considerations – patient care should be paramount (14)
More time needed for consultation (11)
Avoid unnecessary change and waste of financial resources (10)
Strategic plan needs to incorporate all cancer networks within the SHAs areas
(9)
Develop these services as quickly as possible (7)
Concerns re: geography of MACN (artificial boundaries) (7)
Build on existing service strengths (6)
13
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Changing demography (6)
Importance of co-location of services (6)
Need for support for strategic direction for MACN (4)
Criticism re: consultation process (open meeting in Ipswich) (5)
Rurality (3)
Treat the causes of cancer rather than the symptoms - effective screening
and detection (3)
Need for local expertise, support and follow-up (4)
Proposals too prescriptive (4)
Importance of ensuring effective patient pathways (3)
Importance of carer support (2)
Base location of services on outcome of peer review (2)
Include pancreatic and blood cancers in strategic plan (2)
Need for clinicians to work together (2)
Equity for local populations (access to services) (2)
Impact on emergency care must be taken into account (2)
Infrastructure / facilities available in each hospital
Strengthen MACN
Evaluate options for head and neck cancer with clear and objective criteria
Inconsistencies in timescales for implementing Upper GI and Urology
decisions
Cancer needs to be part of wider health strategy
Impact of patient choice
Need to build on outcome of previous consultations
Need for independent judgement of options
Car parking
Need for ownership by all three hospitals of plan
Relative costs of models
If Models 1 &2 are to be given serious consideration we should not implement
another site until we have finished the consultation
Increased waiting times for surgery with increased catchment area
Specialist units will be too large and impersonal
Additional expense of travelling for patients
Cancer patients need special care, facilities that are near to hand and
accessible
Difficulty of co-ordinating appointments
Demotivation and relocation difficulties for staff
14
Appendix 2
Informal consultation on a strategic plan for less-common
cancers in the Mid Anglia Cancer Network (MACN)
Detailed Summary of Feedback from Open Discussion
Sessions
Level of Support for Suggested Strategy



Strong support for suggested model (3) at the Colchester and Chelmsford
meetings (8 out of 11 people and 7 out of 12 people respectively with one
person in Chelmsford preferring Model 1)
5 of the 11 people at the Colchester meeting and 10 of the 12 people at the
Chelmsford meeting expressed a preference for Option B within Model 3. No
preferences for any other options were indicated.
Preference for a strategic model at the Ipswich meeting was less clear as the
discussion centred on the future provision of a specific service (very strong
support expressed at this meeting for maintaining head and neck surgery at
Ipswich)
Model of Care

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Advantage of co-location of services, particularly aftercare for patients
Consider needs of patients with mixed pathology (advantages of crossspecialisation)
Consider regional links
Must have seamless care if services are spilt between hospitals
A centre of excellence is a good model for cities, but may not be appropriate
for rural areas
Need to think about including haematology and pancreatic services
Include patient flows from other areas in formal consultation
Cost effectiveness of services need to be included as part of assessment of
models
Should choose the option that will produce the best outcome for each group
of cancer patients
Sub-options for Models 1 and 2 need to be included
Need to consider geographical incidence of less-common cancers
More information needed on outcomes
Expectation that surgical centre will cooperate with oncology research
Implications of patient choice on each of the models
Important to maintain an effective service in DGHs (in addition to specialist
centre)
Communication issues in potentially fragmented service
15
What Matters to Patients




Need to take into account the emotional needs of patients as well as their
physical needs
Consider patients as a whole not just as statistics
Waiting times and quality of service are important to patients
Think about the patient pathway and build this into formal consultation
Transport / Access to Services

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Concerns about increased travelling for vulnerable patients
Concerns about increased congestion and pollution with additional travel
Effect on ambulance services needs to be acknowledged
Consider undertaking a transport survey
Workforce Development Issues

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
Need to consider effects of decisions on existing units (and staff)
Knowledge and skills of staff are more important than travel considerations
Need to build on existing (clinical) strengths
Investment in services will help to increase expertise
Specialisation will help to attract and retain qualified staff
Consultants need to agree the model and work together for the sake of
patients
Need to maintain local surgeon’s expertise and level of interest as well as
staff in specialist centre
Need to listen to clinicians
Importance of multi-disciplinary team working
Infrastructure / capacity issues



Are there sufficient beds to provide the specialist surgery
Effect of changing demography
Capacity of the three hospitals to undertake research and development
Clinical Networks




The mixture of rural and urban areas within MACN presents a challenge in
choosing the right model
Artificial geography of MACN (cross boundary working)
Would be helpful to know how other clinical networks have developed
strategies
Implications for neighbouring cancer networks of each of the models
Process of consultation


Concerns about transparency in choice of preferred option
Importance of listening to people
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





Scepticism about the process of consultation
Need to build on outcome of previous consultations
Concerns re lack of detailed information on which to make decisions
Need to effectively publicise public meetings
Importance of open meetings in formal consultation process
Decision making process needs to be transparent
General Comments





Need to be clear about drivers for change
Questions about the Improving Outcomes Guidance
Formal consultation must contain financial detail
Concerns about delays in implementing some of the options
Very strong support within Suffolk for Ipswich hospital
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Appendix 3
Informal consultation on a strategic plan for less-common
cancers in the Mid Anglia Cancer Network (MACN)
Membership of Consultation Reference Group
Andy Ball
Member, Suffolk Coastal PPI Forum
Ashok Bhatt
Member, Ipswich PCT PPI Forum
Jennie Fisher
PPI Manager, Essex Strategic Health Authority
Denise Gale
Network Director, MACN
Catherine Hodson
Governance Officer, Essex County Council/Essex
HOSC
Meg Horne-Ceriani
Member, Colchester Community PPI Forum
Malcolm Jacobs
Chair, Chelmsford PPI Forum
Sue Kennedy
NSF Manager (Cancer) Norfolk Suffolk &
Cambridgeshire SHA
Deborah Knight
Head of Clinical Services, Norfolk Suffolk &
Cambridgeshire SHA
Sue Morgan
Scrutiny Officer, Suffolk County Council
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