There were more warnings about difficult financial times ahead for Norfolk's biggest hospital last night.

There were more warnings about difficult financial times ahead for Norfolk's biggest hospital last night.

At the Norfolk and Norwich University Hospital annual general meeting, both hospital chairman David Prior and chief executive Anna Dugdale warned of belt-tightening ahead as NHS funding is cut, along with other public spending.

Mrs Dugdale said: 'I know that the NHS will not be immune to this… There will have to be some radical changes in services and the way they are provided.' But she said the hospital was 'in a strong position'.

After the meeting she added: 'You cannot provide the same services for 20pc less money. The extent of what will change in the health service is not yet clear.'

The hospital made a surplus of more than �7m in 2008-9, most of which comes from NHS finances. Less than 1pc of its income is from private patients, and �314m of its �364m income was NHS cash paid out by primary care trusts.

The N&N held two consecutive AGMs yesterday after it ran out of space last year. Around 300 people attended in total and heard presentations from medical director Krishna Sethia on patient safety and from consultant plastic surgeon Richard Haywood on plastic surgery.

The death rate at the hospital is falling and set to fall further, the meeting was told. Mr Sethia said the hospital-standardised death rate, which is used to compare hospitals and makes allowances for variables like a more elderly population, had reduced from 95 to 85 between June last year and June this year. A rate of 100 is defined as average, with anything below that better than average. The best hospital in the country has a rate of 73. The N&N plans to reduce the rate below 80 by next April. It has set up a patient safety committee to help improve safety, and has brought in a programme of walkabouts around the hospital to report on safety issues.

The hospital will carry on holding its board meetings in secret, despite calls from a patient representative to hold them openly. Patrick Thompson, chairman of Norfolk Link, said 'the NHS should be transparent', and asked 'have you any plans to go back to holding your board meetings in public?'

Foundation trusts are allowed to hold board meetings in private, even though both government ministers and their Conservative counterparts have praised the greater openness of hospitals which hold public board meetings.

Mr Prior said: 'We do hold council of governors meetings in public. We don't intend to go back to having board meetings in public. We have come to a decision as a board that the board functions more efficiently and effectively if the meetings are in private.'

He said that if meetings were in public they would be attended by the press, who might then report any criticism made of executives.

Questions about the future of Cromer Hospital were raised at the meeting. Mrs Dugdale spoke of how the original plans for a new hospital had to be revised because of financial pressures. She said of the new scheme: 'We believe it will meet the needs of local people.'

During the public question time she was asked when the new plans would be unveiled. She said: 'The board is discussing the revised scheme for Cromer Hospital tomorrow and we will make an announcement after that.'