Still remember her best, from her stint, on Channel 4’s “Big Breakfast”

RIP

Possibly a bit late but

Free vaccination for US army recruits

https://en.wikipedia.org/wiki/Adenovirus_vaccine

https://www.cdc.gov/adenovirus/about/symptoms.html

Its going round, very long recovery – 22days or so

Enjoy

“I would say it might be worth grouping them.” +1

6 at a time. Any real enthusiast would take a hit on buying 5 mundane ones just to get at the gem in the group

If PI, was a nice round number, would we still need leap years ?

This is a bit of a chore way of doing it but..I reckon you could set it up in about 20mins

How about just build a new helper-sheet in file one

Then
=[File2.xlsx]Week1!$G$2 in G2
&
=[File2.xlsx]Week1!$J$2 in H2

Now you can see where this is going, create a Week_No. index in column A and Line_No. in column B Then make the cell references above into variables

http://stackoverflow.com/questions/20011854/using-a-number-in-a-cell-to-generate-a-cell-reference

https://cdna.artstation.com/p/assets/images/images/001/529/126/large/alex-brady-rb1.jpg?1448036762

google “Debra Kelly A414” if you want to see why police don’t bother chasing convictions against cyclists

Me for the win then.

Large council(mostly ex-council now obvs.) estate north of london.
Rarely hear anyone speak english.
Never any trouble, though it seems every week, is firework celebration time for someone.

Happens to me all the time, using alcohol rather than meditation.

Woke up last week in a world where traffic cones are considered headwear and underpants are worn backwards.

or you can just buy

3m privacy screen

Qlikview seems to be ubiquitous across the NHS and there is a free trial version

http://www.qlik.com/en-gb

sootkins ?

NSFW google

+1 Badgers

They seem to leave it until the last second before they bolt in front of you.

Nearly jump out of my skin everytime

Dog Poo bags in trees. and I can’t work out what to do about it.

I usually cycle in a nice woodland SSI and will pick up Mcdonalds wrappers and energy drink bottles but …….

The pads are the sacrificial item

Don’t change the discs unless there is a very noticeable step in the edge.

Even then you can get them skimmed cheaply at any engineering shop.

Good but this one still my favourite

Apart from anything else why would the USA want to steal neighbour’s territory? They’re trying to keep Mexicans out not take it over. Canada? Would Canada welcome invasion the way Austria did?

America were preparing to invade Canada just before WWII

The little grub screw (covered in threadlock in the picture) will reduce throw for small hands, but also reduce pad travel , so remember to bring them in closer as well

To be fair, his vocal opposition to gun ownership, pretty much lost him the $$$$ American gig. So some principles

Get a Toyota Previa (not an ex Taxi Obvs.).

Take all the rear seats out, fit a bulkhead and “mirror” tint the windows.

Oil and Brake pads only for the rest it’s life (250k)

Gaining Grip and Control of NHS Expenditure
http://www.whh.nhs.uk/_store/documents/27januaryboardpapers.pdf
Page 44 onwards

Ensure that there are tight procedures around payment approvals
Ensure that no payments are made to non-essential purchasers
Consider approaching commissioners to advance funding to temporarily improve cash flow (we have seen commissioners advancing payments over 10 rather 12 months to assist with immediate cash flow problems)
Establish weekly cash committee with operational, financial and procurement representatives present
Consider stretching creditors beyond current creditors days
Review and assess existing debtors ledger and focus on “easy wins” to target for immediate collection
Develop strategy for each debtor – assess risk, ability to net-off if provider to provider debtors / creditors where the trust is in a positive net-off position. Ensure that utilise assistance linked to recovery of income from overseas patients (Cost Recovery Support Team and Overseas Healthcare Team).
Consider process change within the collections team to optimise cash management etc.
Review and recover all private patient non-payments
If possible, discuss further support with commissioners – bring forward date when income received (from 15th to 1st) (in addition to action 1.4)
Immediately assess estates position, if there are any external landlords consider renegotiation of terms to pay in arrears rather than in advance
Assess what assets can be sold
Reduce the number of payment runs to ensure that there is a greater control over outflows
Implement cash focussed KPIs and a reporting dashboard
Ensure that invoices are issued as soon as possible rather in batches
Establish pro-active debt collection – cold call all key debtors before due date to ensure that payments are received
Develop payment plans for key and large creditors where possible to ensure smoother profile and cash conservation
Income
Create commercial board to oversee income opportunities (this should include estates value maximisation opportunities – please link this to a review of estates strategy – 3.21)
Undertake a full coding review (establish working group aimed at improvement of the depth of coding – assuming that there is not a block contract)
Ensure that any changes in coding are clearly communicated to and recorded with the commissioners to ensure that income is received.
Review income contracts with commissioners to highlight any opportunities to maximise income and to reduce penalties.
Review progress on CQUINs, RTT, activity etc. and assess the likelihood / size of penalties for non-delivery or underperformance
Optimise car parking income (if possible)
Ensure fully recovery of any income from 3rd parties (use of facilities, estates, joint appointments, consultants working outside trust, junior doctor training etc.)
Run refresher meetings with consultants and junior doctors to ensure contracts are understood and to ensure that key staff understand what levers to pull to ensure increased revenue
Consider estate rationalisation where possible (rent/sell where possible)
Review any tenant and licence agreements to see if there is any possibility to further maximise income from estates
Cost and expenditure
Finance related controls
Review the approach used by the trust to improving quality and reducing costs across the organisation. Consider alternatives such as lean etc.
Complete a full budget review – identify budget reduction opportunities and target overspend areas, create plans to bring them back in line with the initial budget
Identify the full value of the creditor ledger including unapproved invoices
Review PO system; strengthen or improve if required. Going forward any non-PO purchases should be reported by exception
Reset budget holders if required
Bring all existing orders on the system by creating POs (mainly agency staff, long term call off contracts etc.)
Reset SFIs and delegation authorities if required
Impose stringent controls over expenditure – overspends may need to be linked to disciplinary action
Establish controls over central and corporate expenditure
Review all telephony and large IT contracts – renegotiate where possible
Undertake a user review for IT and telephony – cancel all unused mobiles, telephone lines, dongles etc.
Review, reduce and control all “discretionary” spend such as travel expenses, subscriptions, training, clothing, hospitality, bed hire, office equipment etc.
Identify priory suppliers and confirm that cash is available for priority suppliers
Review all VSM pay costs – consider action (where applicable) on retire & return staff and ensure that the trust complies with guidance on “off payroll” workers and daily rates
No invoices to be paid unless matched with PO
Review scope for savings from making use, or increased use, of NHS SBS (where applicable)
Review scope for savings from making use, or increased use, of NHS Professionals (where applicable)
Review if can utilise NHS BSA to determine potential saving opportunities on 3rd party non-pay spend via NHS Supply Chain (where applicable).
Where applicable, test saving opportunities via use of NHS Core list.
Ensure that Medical Capital Equipment Asset register, medical equipment maintenance schedule and capital medical equipment procurement plans are in place.
Review saving opportunities via use of Crown Commercial Services where applicable.
VAT position has been reviewed and all recovery opportunities maximised
Procurement related controls
Review procurement, understand what contracts are due to expire/when to assess ability to renegotiate contracts or put contracts for tender
(Re)set targets for procurement for contract renegotiations
Procurement – remove rolling, value based purchase orders
Contracting related controls
Understand supplier discounts and penalties for early / late payments – set out plans to recover / avoid
Ensure that all key contracts (including agency staff) are procured via appropriate frameworks. Any off framework arrangements should not be permitted, except in exceptional circumstances.
Review or create list of all key contracts and external suppliers – including start dates, breaks etc.
Look into cost reduction via consolidation of supplier base and invoices
Ensure that the rules around professional fees over £50k are adhered to
Estates related controls
Specifically review and benchmark overall running costs for facilities and estates. Put in place cost reduction plans if above average (see utility and other contract review points)
Undertake a review of estates strategy and confirm if action points, cost reductions etc. have been undertaken. If not implement “low hanging fruit” decisions immediately
Ensure that estates have been rationalised – vacate all unused buildings, switch to rent on daily basis, room rather than floor rent etc. where possible
Ensure that all lights and heat is turned off in unused buildings (ensure that comply with insurance requirements)
Review all utility contracts to ensure that represents best value
Waste disposal is managed and monitored
Other controls
Undertake clinical and non-clinical cost benchmarking
Undertake drug formulary review and medicines management review
Ensure that all overtime and enhanced payments are subject to prior approval and are monitored and minimised where possible
PMO and CIPs
Review the existing PMO structure: is it fit for purpose and is there board support and staff buy-in?
If the answer to 4.1 is no, start working on improvement and strengthening of the PMO office
Review existing CIPs for quality, deliverability and progress
Reset CIP targets for each division / directorate – ensure that these new targets have been prepared by each directorate to ensure buy-in
Review CIP quality approach – maturity level grading (idea, documentation, financial verification, quality approval, DoF CIP executive lead sign off to go live as a scheme)
Undertake series of workshops with the workforce (ensure good crosssection of staff such as clinitian, estates, finance, procurement etc) to generate ideas and buy-in
Ensure that staff receives training to use tools and templates
Establish CIP budget holders in each division / specialty to ensure that each area is accountable
Forecasts. reporting and turnaround plans
Prepare financial baseline
Assess underlying run rate vs outturn positions
Increase finance team bandwidth / review capabilities / align to divisions etc.
Reduce the number of budget holders and reset objectives
Develop turnaround plan (recovery plan)
Develop clinical service sustainability review and strategic plan
Develop structure of daily, weekly and monthly operational performance review
Develop automated key performance reports and KPI dashboards
Business cases / Capital expenditure
Review live business cases and assess what can be deferred or stopped
Review planned capital expenditure what can be deferred or stopped
Ensure that all business cases and capex is procured via appropriate framework
Governance
Create turnaround board or steering committee
Ensure that the committee meets on a regular basis and feeds back to the board and to overall staff communications
Review effectiveness of current management structures – are they effective
Consider utilisation of non-executive directors for certain roles (if the skill set fits) to increase Trust’s capacity
Create a plan to gain and maintain “grip” – including controls and processes. Ensure that the plan has key milestones and assigned responsibilities.
Management and executive board
Review necessity for various management meetings and committees etc. to free up management time
Ensure that there is a greater challenge during board and other key meetings
Establish list of ongoing and planned projects and determine what can be cancelled or delayed to free up people’s time
Establish list of budget holders and determine level of buy-in so far (link with the SFIs reset)
Turnaround board to approve all new projects across the trust (reduce distractions, focus on critical path)
Culture and communications with internal and external stakeholders
Review existing workforce communications plan and improve and change to reflect the key changes in culture and approach
Establish regular contact and communications with the staff to ensure staff understanding and engagement (maybe establish employee forum)
Establish regular workshops to gather cost saving ideas and drop in session to communicate changes
Ensure that the management and the board embraced the “culture of cuts” and of continuous improvements throughout the trust.
Establish regular contact with the trustees and ensure that they understand the key developments and changes
Establish regular contact with external stakeholders such as commissioners, other acute trusts, NHSE, Monitor etc.
Performance management
Reset executive team objectives – ensure that these are geared towards grip and stabilisation
Reset staff objectives and establish process to appraise within three months of year end. Ensure trust objectives are cascaded appropriately into personal objectives
Where possible, identify non-performing individuals across the trust and ensure that they enrol on performance improvement programmes to improve skills (co-ordinate with HR)
Create internal special measures / recovery plans for loss making specialties/directorates
Ensure that service line management is fully implemented throughout the organisation – this will require clear management structures and strong performance management buy-in.
Workforce planning
Establish vacancy control board
Assess recruitment process and establish processes to maintain quality but accelerate on boarding
Implement weekly head count tracker (temporary and substantive)
Assess number of interims, termination dates and daily rates
Consider apprentices to be hired for administration, band 1 and band 2 posts under the Agenda for Change
New recruitment to be considered on short hours e.g. 30 not 37.5
Ward staffing levels v guidance (including uplift)
Impose greater controls over bank and agency – self imposed cap on agency spend
Impose greater controls over locum spend
Review unfunded posts – check if some funds could be recovered
Consider a direct engagement model for medical and medical support staff hired through locum and agency
Consider rostering options and opportunities
Review costs associated with RTT – do the penalty savings outweight the additional spend (if applicable)
Review on-call run rate
Review contract rates ensure that all aligned by band / post etc.
Review any regular overspends on locum and agency staff – impose caps where possible
Review and compare job plans for consultants, specialist nurses – improve if and where possible
Ensure that e-rostering is in use for nurses and benefits realised
Ensure that clear systems are in use for junior doctors, consultants etc.
Monitor absence and sickness on individual, service line and trust level
Ensure that rigorous illness policy and procedure is in place to minimise absence at work.
Ensure that sickness is regularly reviewed at the board level.
Inventory
Establish current inventory levels and stock ordering system
Review stock and reset stock targets by category / area (if required)
Consider collection of excess drugs from wards and return to the pharmacy (if possible and applicable)
If possible, establish automated stock cabinets to improve stock control
Ensure that drug costs are benchmarked against peers
Off contract spend controls and reports are in place and monitored
Wastage and overspend are monitored and reported
Where possible, procurement function is fully integrated into the process and incentivised to reduce costs
Operational grip (including estates)
Ensure that uncoded spells have been minimised or eliminated – ensure that clinicians are included in the process and proper and regular training is in place.
Review and if required enhance capacity planning for each key areas such as outpatients, wards, day cases, A&E, community areas etc.
Ensure that capacity planning is fully implemented across the trust, down to sub-specialty level
Ensure that utilisation data is collected and compared to plan and peers – the data to be made available throughout the trust (board, clinicians, service lines etc.). Ensure that the data creates basis for utilisation improvement initiatives.
Ensure that key management information is shared with the clinicians to ensure that they understand performance and targets.
Review outpatient procedure to ensure that as efficient as possible and any downtime is minimised
Review theatre utilisation against peers and targets, share within the trust (where appropriate) and build into personal performance targets
Monitor bed utilisation, compare to peers and targets
Length of stay performance is actively reviewed and managed
Ensure that clear discharge policies are in place, with clearly defined responsible individuals to ensure that patients are discharged at the earliest opportunity where appropriate
Ensure that staff levels are matched to patient demand patterns to avoid waits and avoidable admissions

“Jeremy Hunt’s throat”

That got a laff round the office

Why can’t they get in on the joke and be a bit more “soapy” like Jordan or the Kardasians.

Killing Diana was worth an Eastenders Duff..Duff..Duff,Duff..Duff, DuffDuffDuff
but since then nothing

@ wobbliscott

Polynesian Islander before being discovered by the West obvs !!

Native American before being discovered by the West obvs !!

No Roth3childs ?

Clean it off, but no need to be fastidious

Catfish and the Bottlemen – Ride

a MTB component, after being plucked from a CNC machine in China and packed by sleep deprived weeping children and shipped out for $15.00 should cost $700.00 retail !!

Why are you guys even bothering to debate this ?

Public sector provision of anything is anathema to the Tories.

The NHS will remain a shell logo but everything thing else is now out to tender

http://spendmatters.com/uk/huge-nhs-procurement-outsourcing-ojeu-ad-published/

and the NHS cannot afford to recruit & retain “bid response teams” so will NOT win any work in competitive tenders against Serco, Virgin, Capita etc.

Its all a done deal…Chill

@ notmyrealname Daily Mail reader ?

Often find barn doors give a bit of privacy, to get changed or even have a piss in a bucket.

Ripples in a stream, but I lost all respect for armed police in 1983

Seems legit

The Dating Equation: ½(your age) + 7

Pretty close

don’t they need constant pumping out ?

Really feeling sorry for you

Had a MOTOX bike and gear nicked 10 years and I was angry/depressed for months & still having dreams about finding it for years afterwards.

There was another serious mistake made by the 777 crew – post landing…

Not judging, just saying, thats probably why they never got the hero worship

Do they include this in the sound track

Also this poor guy so nearly pulled-off another Hudson water landing earlier this year..
http://edition.cnn.com/videos/us/2016/05/28/wwii-hudson-river-crash-rachel-crane-lkl-nd.cnn

You know how MotoX and MTB are different things. Well I just just look at this as another choice. Maybe in a few yers we will see tracks(re-)opening all round the “home counties” for noise-free e-MotoX with no gravity needed.

Could be really great

I started wearing them when I realised if I teamed them with my desert boots I would NEVER BE AS cool as this gentleman.