As Alistair Darling, the former chancellor, acknowledged yesterday: “In the long run you have got to keep your tax rates internationally competitive, which means something like the two rates we used to have.”

So the last Labour Chancellor would like the rate dropped sometime, just not yet.

Anyway back to the OP – no this is not a BBC campaign. Why do you think an organisation widely believed to be too left wing by the Tories would do that? Or the Guardian who also covered it a lot.

Interesting thread – more because of what is says about the posters than the topic. Some posters turn it into a debate about their favourite topic rather than answer the question. And some are just twits. On both sides.

The bottom line is – as was said very early on – it is the clubs choice to ride with you or not. In our MTB club we have exactly the same rule. In a road club it may be less justified by the evidence, but it is still their call. If you don’t like it, you have the choice to find another club or wear a lid. Simple isn’t it?

Its brilliant – but it isn’t bullying because it is fake

I have a pro 2 bearing tool kit. Some bits say pro2/evo on them (front bearings tools). Some only say pro 2, (rear bits) I’d be interested in the answer.

Half the teachers at my youngest’s primary are male. This is a good thing. I like him having male role models.

But reading the OP makes me wonder how much of this urge links to your recent life events. I wonder if all the chance to rebuild your relationship with your son is a big motivator?

Good luck to you mate. But worth sitting in on a week or two of classes before you take the plunge?

Merlin is yer friend. Just got a SLX full crankset with BB for 90 quid. As good as the XT it replaced

If your rings and BB are ok, and you just want the cranks, you might find a mate/someone on here who wants a new BB and rings who will split a set with you, and buying the whole thing is shedloads cheaper than buying bits.

Like Toys19 I have a Westone Thunder fretless, but a II not a I. Noce bass but the neck dive is a bitch.

Main bass is an Ibanez BTB 5 string
Also have a Takamine electroacoustic bass

My son uses the last 2 more than me and also uses a Peavy Cirrus BXP 4

We have Ashdown, Peavey and Roland combos.

Used to have a Peavey stack but gave it to a colleague’s son. He probably has better gear now as his band’s first album sold 7 million.

I also have an old (1981) Ibanez roadster which I have had from new… offers please…

oops to late to edit my post which says we should be entitled to a predictable pathway

rightplacerighttime

nope – cancellation of ops, cancelation of outpatient appointments etc etc. We don’t know the reason for the cancellaiton here – but some Consultants do seem to have their clinics or lists cancelled more regularly than others. Just because the NHS is “free at the point of contact” does not entitle us to a predictable and organised pathway.

Now it sounds like the department here was trying to fix things as best they could. I’m having an op in 2 weeks (MTB injury related) and I’Ll believe it’s going to happen when it’s been done…

I wish this was an uncommon story.

TJ A few things

1) This isn’t a troll. It is a news story today. Check the BBC.
2) I am not a Tory. Never have been.
3) I said in one post London does as nearly well as Scotland on funding.
4) I thought TJ you were English but in Scotland? So it would be a funny way to have a go at you… Sorry if I had this wrong.

Personally, I’d like to see an independent Scotland, not in the “let’s just get rid of that troublesome bunch” way I have sometimes felt about the Northern Irish, but because an independent Scotland seems to make geographical and historical and political sense.

What do you think? Why don’t the Scots want to be independent?

So English manafacturing wasn’t gutted? We had shipyards and steelworks and mines too.

Interesting to see you bring up the ancient history side of things. Who bears the grudge/grinds the axe here? 😉

And Tam Dalyell thought there was a democractic problem. Was he wrong?

Duckman perhaps I should want to grind an axe? But I don’t. And my time in Scotland was way before the current political arrangements. There does seem to be a democratic deficit though. Would we let the French vote on UK specific matters if the favour was not returned?

Junkyard I think there is a problem for the reasons encapsulated in those three statements – and I don’t know the answer. I’d be interested if you have a view.

This is a leading newstory today on the BBC. The Government is looking for one to the non-funding aspects. That is my reason for starting this thread. But you are choosing to play the man not the ball. It would be nice if you discussed the topic, but I’m not over-optimistic.

The right to vote on English stuff is excessive influence. ok? 😉

don’t suppose you are going to address the issue? The Norman Hunter of debate.

A ton of cheapo 1 1/2′ steerer forks on CRC at the moment.

Got some tapered Revs off Merlin for £314 earlier this year with a DT240 hub chucked in 😯

or Tommy Sheridan?

Junkyard nice try. whatever 😉 Which one of the following three statements is innaccurate and a petty dig?

The Barnett formula does give more to Scotland that England – but Government spending on London is almost as high. We get screwed in the South East though.

Last opinion polls I saw said that an independence vote in Scotland would not currently succeed.

Scots MPs can and do vote on all England specific issues when English MPs cannot vote on some Scotland specific issues. The SNP stance is noble.

Druidh may be right. The UK is a weird historical construct. But the current Government is looking for an answer – and I cannot see one other than independence, or a different kind of limited-power MP for Scotland and Wales. Doubt whether anything will encourage more Tory voters 😀

wwaswas Partly

More that Scots MPs including SNP, can vote on matters which do not effect Scotland one bit, whilst English MPs cannot vote in matters dealt with by the Scottish Parliament.

junkyard I live in a boringly non-multicultural bit of the southeast – so I have Scots friends, and no black ones. This is actually a national news item today – hence raising it. ok?

Surely the important thing is to have some common interests, and not be identical in every way. My partner skis pretty well, bikes a bit lamely. I ski quite a lot with her – but go away on other trips too. Ride with her only occasionally. And I don’t go to her book group and never knit. Kids and other stuff we share. Somethings I deliberately avoid taking up to give her some space.

So the truth may be a little bit less clearcut that TJ claims, after all – his wife doesn’t post on here often does she? So even he appears to have an unshared hobby 😉

In this case surely the question is how attractive MTBing is to a girl, either to do as a dating activity, or as something which suggests the OP is fit and worth a shag? And you won’t get those answers here.

Champagne cork. Problem solved

Come on – TJ told you to join a union – twice. Weren’t you listening? 😉

Can’t see the point for a student myself.

For us self-employed quacks the MDDUS can be cheaper – I only pay £4200… 🙁

But generally NHS employers do cover liability out of actions arising at work. They won’t probably support you when you get done for screwing a patient, or mucking up someones neck when you are drunk at a party, or givin “Sports Massages” with a happy ending… 😉

hmmm

this isn’t helping me kerb my urge to get one… if someone had a 2010 or 11 medium frame they wanted shot of…

Ubuntu bought a laptop I have back from the dead. Not done any photo stuff with it though.

Back to your usual quality of debate. 😉 Do you wonder why people take the mickey? When you argue with people who actually know something about the subject you are pontificating about and who challenge your view, you dig in and get nasty. Bit of a flaw eh?

Thing is I met Simon Stevens before he worked for Tony Blair and United Health. And read the White papers. And followed the debate and rhetoric. If this is new to you, you are a bit out of touch.

Anyway. Really will leave this thread now. No point in discussing it with you. You just never ever listen. 🙂

We have been facing proposed changes likes this for 10 years. Some of the anti rhetoric is straight out of the 1970s.

Just saying the NHS should be well managed is pointless. It often isn’t. There isn’t the medical management hierarchy system there is in many countries, and getting rid of poorly performing Consultants and managers is near impossible.

In the end the only way to change somethings is to open a competing shop, and see what happens then.

At age 16 he is not really going to be out till 2 am partying is he?

Choose according to ski/board facilities he needs and where you would like to be.

Again the issue here is that a private provider may be more motivated to manage the quality and delivery of a catering or other hotel service if it is on a three or five year contract with quality control than a legacy directly NHS employed catering department who feel at no risk of their jobs whatever what ever they serve up.

Some of the mankyist food I have had had been at NHS hospitals. Some of the best in Australia.

And who sacks them?

If the chief exec doesn’t see a problem and improving the service might reduce the trust’s income? I could give you details of our local trust’s last 2 chief execs which would intrigue you – but lead to a lawsuit… I even did a FOI request on one’s severance package. £540,000 I think it was. And the next one banned me from speaking to her team, because I was looking at how expensive one service was.

Just remembered another example – we looked at anticoagulation services for which an extortionate rate was being changed. We saved a 7 figure sum per year just by looking closely enough. We then saved another 6 figure sum per year by shifting most of it into Primary Care where we have a cheaper service, closer to patients, with better IT allowing better audit and quality assurance. Yet another bit of evidence.

The way you show a bad shop you are unhappy is by telling them once or twice, then shopping elsewhere. Otherwise they do not change.

I think your charming statements about how you can change things are as robust and realistic as a Miss World’s aspirations for world peace.

Bottom line – things have moved on. I am anti handing the keys to everything to outside conglomerates, even though both Labour and Conservatives have flirted with it. But there are things to be learnt from private/independent providers. Your polemic stance is 10 years too late, and ignores the benefits of an open mind about these things.

grum – I am saying the NHS is good, but not great, and could be better. I have spent a lot of time trying to get it to be better locally, at both a micro and a macro level. We cannot afford to be complacent.

We need to look at the message from that study – which is that in those two limits metrics of mortality – the UK isn’t doing badly – but there is so much more we can do. If you want to dig out some other cost-effectiveness stuff you will see slightly different results.

TJ wish I could give you the specifics of two very concrete examples of how we improved one local surgical speciality’s performance by shifting temporarily some activity privately and by commissioning changes we made. I suspect I’d be up before the GMC for “disparagement” if I did. The Hearing aid and optometry services I mentioned are commissioned at the same price/cheaper. Many hospitals already contract out chunks of cross-sectional imaging to private providers at the same tariff.

For all your hopeful statements that with the right management things can get fixed, often the management and the consultants just are not willing to change. They do not take a view of their service wider than the task they are doing at that second. Again I could name a service I have been trying to work with in developing clearer access pathways – but nothing happens. They have no incentive to change.

Ok Grum

That was indeed the one. And I’d mentioned it too.

1) Only covered 19 countries
2) Finished in 2005
3) At the time it finished. UK NHS spend was only 7.1% of GDP, by 2009 it was 9.3% and rising. Has then NHS become 31% more efficient over that 4 years? And the cost has gone up since…
4) The metrics used were very limited – not including anything happening to people over the age of 74…
5) The discussion at the end certainly flags up the limitations.

We could look at Cancer mortality where we do pretty poorly. Or CHD where we have done rather well. Main thing is the US system sucks.

Anyway – I know my place – I’m not a big hitter so I’ll scurry back under my rock. 😉

TJ have you ever considered your posting style might be slightly counterproductive? Just a thought. And you do seem to get more angry and your argument more disorganised.

grum if it was the one I alluded to as support for my argument earlier in this thread – actually it was a bit of a methodological joke… 🙂 We could learn a lot from countries other than the US, Canada for instance.

So how do we fix broken services run by complacent clinicians and obstructive managers, where patients have their appointments cancelled 7 times in a row, and get no apology, where there is no other provider within 20-30 miles…

I have worked a lot in the “collaborative” movement, and seen excellence in cooperation in some areas. But it doesn’t always happen. And in the end – taking the patient and the money out of the system can be the only way to get a solution. I could give some very specific examples here, but it would bore the pants off everyone and probably really damage my professional relationships if I blew the gaff on them… but trust me, they are out there…

Anyway – TJ more examples of cheaper/same-cost faster or better services which are now in the private sector local to me – routine Glaucoma management and Direct Cataract referral by optometrists – private providers delivering NHS Hearing Aids (which has certainly made our local Hospital Hearing Aid service up its game) – DEXA scanning for osteoporosis (not available at an NHS hospital locally but provided by one Private and one GP provider under contract. Shifting Diabetes care out of hospitals into General Practice ( in line with DUK recommendations). And the Orthopaedic centre I have already mentioned.

And you might want to look at some of the stuff going on in Dorset.

But I suspect this will be met with repeated emphatic statements ignoring the facts… 😉

One thing we can agree on – a US Insurance-led system is stupid. Admin costs and profits come to about 30%, and the US Government through medicare and medicaid spends more per capita than the UK NHS, despite the US disavowal of “Socialized Medicine”

PFI is a totally separate issue. Conflating the two is daft.

PFI is a horrendously expensive and near fraudulent financial measure to get capital costs off the government books – largely occurring under… Labour!

This is a very different issue. It is quite important not to get the two confused in one’s hurry to demonise everything which smells of capitalism. 😉

So – Tony Blair and Simon Stevens Mr Jeremy? 😛

Loving your increasingly dogmatic statements btw…

Private healthcare is not always/usually better. But a monolithic health service doesn’t work in lots of areas because of the lack of incentive for poor services to change. And some kind of competition – and incentives to services to do well is necessary to get this. In some areas this may be provided by other NHS trusts – but not always. There is no reason why Community Diagnostics needs to be Hospital or NHS based, and on many things (MRIs, endoscopies etc etc) it would be good to get them out.

The issue is non-NHS providers paid for by NHS funds. These won’t always be evil scum sucking US conglomerates. And I give you the Horder Centre at Crowborough, as an example.

Looking at private services, some of the most successful IVF services dealing with the more difficult cases are private, with some of the NHS centre results having been rather embarrassing in the past.

The NHS is generally good, generally improving, generally better than it ever has been, but has huge areas of poor performance and complacency and is not really focused enough on the way it handles people.

so TJ now you are back – would you care to address my question about Labour’s relationship with private health care providers. The Conservatives may be in bed with management consultants, but Labour were in bed with United Health, Kaiser Permanente etc etc?

The old saying. There are Old Pilots and Bold Pilots, but no Old Bold Pilots.

a real tragedy all round

Women in offices. Not always nice.

So why didn’t the Claire go up to the mug-owner and say “sorry about that – please feel free to just to tell me if I do something that upsets you” ?

This is how petty office squabbles start.

But not Mark Williams. So that’s one catch phrase you won’t hear 🙁

she asked me