'A tax on invalids !sx It is shameful that such a levy should be collected by a Ministry of Health .sx . worse still there is a tax on childhood' .sx Let's give the Welfare State a shot in the arm .sx By KENNETH BARRETT .sx INCREASED National Health charges .sx A further conjuring trick with National Insurance contributions .sx The Minister of Health's announcement the other day of changes to take place in April was a signpost on the road of retreat from the first vision of nationwide personal security .sx There have been other signs of this retreat over the years .sx To many of us it has long been evident that the Welfare State was in danger of destruction from within .sx First of all , the administrators have muddled one of the main issues .sx They have been determined to uphold a meaningless fiction .sx They have insisted that part of the National Insurance stamp should go towards the cost of the National Health Service .sx This has deepened the widest-spread fallacy in the community- the mistaken idea that the man who buys his National Insurance stamp pays for the National Health Service .sx He doesn't , of course .sx The total cost of the National Health Service in this financial year will be about +867,000,000 .sx Of that vast sum , +663,000,000 comes from general taxation , not from National Insurance stamps .sx Confused .sx Small wonder that the man-in-the-street is confused .sx Because the existence of the stamp as a source of supplementary revenue to the National Health Service is a temptation to the administrator in search of the appearance of economy .sx It gives him a chance to make the Health Service look as if it costs less .sx Today the employed man pays 9s 11d .sx a week towards the whole bill of social security in his weekly stamp .sx Of that , 1s 10 1/2d .sx is earmarked for the health service .sx In April he will , as a basis , pay 9s 9d .sx a week and the same amount of 1s .sx 10 1/2d .sx will go to the health service .sx At the same time , from April , he will have to pay , if his wages are high enough an additional contribution to the State's massively confusing graduated pension scheme , unless his employer " contracts out .sx " If he is earning +15 a week , he will be paying , in all probability , 5s .sx 1d .sx a week towards the graduated scheme .sx The Minister of Health's proposals will alter the position again in July .sx His total basic contribution will be 10s .sx 7d .sx Of this a larger proportion , 2s .sx 8 1/2d .sx this time , will be earmarked for the health service .sx With the highest contribution to the graduated scheme , his stamp will cost him 15s .sx 8d .sx Don't think for one moment that it's going to stop there .sx Higher pensions will be sought .sx The health service will cost more .sx The contributions , total and fraction , will all go up again .sx The mere cost of the complex administrative tasks involved in recording contributions is vast in proportion to the amount of tax that is collected .sx Yet the tempting fiction of the stamp will always be there .sx Enemy .sx But the health service has another inside enemy .sx It is , of course , on the face of things , reasonable to charge people a little when they get some special extra benefit .sx Why shouldn't the ordinary citizen , in an age of high wages , pay some proportion of the cost of dentures or of spectacles ?sx That's the question .sx Why shouldn't the special beneficiaries pay a little extra out of their own pockets ?sx It's an insidious argument .sx It seems so reasonable .sx But once you start agreeing that the proposal is reasonable , you can reach the extreme lengths of unreason .sx For example , a well-paid patient , whose firm still continues his wages , who draws sickness benefit on top , may have surgical and hospital treatment costing many hundreds of pounds .sx And if he needs spectacles , when in hospital , he gets them free .sx And yet a widow , whose pension , for which her husband paid , is wiped out because she works for a living wage , will now have to pay 12s .sx 6d .sx for each lens in her spectacles , and 17s .sx 8d .sx for the frames .sx This is what the Minister proposes .sx The truth is that you can't make sense out of small private charges under a vastly expensive public scheme .sx You can only alter the shape of the national bill .sx But , at least , it ought to be a Minister's duty to refrain from doing positive harm just to collect a token tribute to the total tally .sx And social harm , I fear , is what two of the proposed changes are going to achieve .sx For example , from March 1 , each item on a National Health Service prescription is to cost 2s .sx Children .sx I leave out of account , for the moment , the estimate which I have been given- that nearly one-third of such items cost less than 2s .sx I am thinking of the marginally poor , who happen to be in constant ill-health .sx There are countless thousands of them .sx The retired folk , getting on in years , with their retirement pensions and +3 or so a week from their old firms .sx The man who , in protracted illness , receives half-pay from his firm .sx The Army officer's widow .sx I could go on indefinitely .sx They may need half a dozen prescribed items a week , easily .sx Twelve shillings a week .sx A tax on invalids .sx It is shameful that such a levy should be collected by a Minister of Health .sx Worse still .sx There is the tax on childhood .sx Pregnancy , like death , is democratic .sx The last war forced the state to protect the health of children through the Maternity Clinic .sx With the help of the National Health Service it has become a possession beyond price .sx All mothers go there .sx The solicitor's wife , the schoolmaster's wife , the clerk's wife , the plumber's wife , and the wife of the chap who is doing a stretch in gaol .sx Never has the health of children been better .sx Never has infantile mortality been so low .sx And one of the reasons was that it cost nothing , or very little , to take advantage of everything the clinic had to offer .sx From June 1 , instead of paying 5d .sx for the bottle of orange juice and getting a free supply of vitamin tablets and cod liver oil , there are to be higher charges .sx The orange juice will be 1s .sx 6d .sx , the cod liver oil 1s .sx , and the tablets 6d .sx a packet .sx These sums might have been deliberately fixed to keep the poorest sort of mother away .sx And it will be the child that suffers in health .sx By these particularly petty tactics , the Minister will save +1,500,000 out of the +800,000,000 and more that we have to pay .sx I have been very close to the crises , the challenge , the hopes , needs , and anomalies of the Welfare State .sx And I think the time has come to take a close look at what is going wrong .sx SLASH THIS HEALTH SERVICE RED TAPE .sx YOU will have noticed the fierce House of Commons rumpus over the proposed Health Service changes and charges .sx I gave my views in detail about these last Sunday .sx It seems from the size and shape of my mail that most of you agree with me .sx Over the debate in the House the other day brooded the shadow of the late Nye Bevan .sx He was the architect of the Health Service .sx The Act of 1946 defines his vision .sx It gives the Health Minister the duty of establishing " a comprehensive Health Service to secure improvement in the physical and mental health of the people .sx . and the prevention , diagnosis and treatment of illness .sx " To the creators of the service there was no hesitation about one further principle .sx It was to be free .sx How far have these great objectives been achieved ?sx There are no longer two standards of medical treatment , one for those who can afford it and another for those who can't .sx DOCTOR'S MERCY .sx No longer does a deduction from the wages of the lower-paid worker simply cover him during sickness , leaving his wife and children to the mercy of the family purse or the doctor's kindness .sx No longer is there a patchwork of clubs and voluntary associations seeking to ensure some kind of medical treatment for those who were not " on the panel .sx " Of course , there were ominous rumblings at the start .sx The best people , it was passionately argued , would still prefer to pay their own doctors .sx The best doctors , it was alleged , would stay resentfully out of the National Service , refusing to become the minions of a Minister .sx All these were myths created by prejudice .sx Within three months of the appointed day under the Act , 39,000,000 were on Health Service lists .sx It is officially estimated today that 97 per cent of Britain's inhabitants are using the Health Service .sx Only 600 doctors engage wholly in private practice .sx This is indeed a success story .sx But it is my task to look critically and constructively at the flaws and the failures .sx There is , in my mind , no doubt about the first mistake .sx The nationalised industry of medicine presents a stupendous administrative challenge .sx It is now so complicated that the prime purpose of it all , the prevention of ill-health , the welfare and re-assurance of the sick , can disappear in the difficulties of departmentalism .sx Today , Regional Hospital Boards plan hospital and consultant services .sx Management committees administer hospitals at local level .sx Executive councils are responsible for the general practitioner , the dentist , the supply of drugs .sx The local health authority looks after maternity services , child welfare , the visiting midwife , the health visitor , the home help and the ambulances .sx MINISTER'S JUNGLE .sx Somewhere up at the top of this jungle the Minister of Health is supposed to keep an eye on it all .sx No wonder he can't see the wood for the trees .sx The hospital service , the general medical service , the local authority , each tends to work in isolation .sx The family doctor is not encouraged to study his patient in hospital .sx Often there is no follow-up system from the hospital to the home , or , if there is one , it doesn't work .sx Each service washes its hands of responsibility when it passes a patient to another branch of the system of National Health .sx These divisions can rise to ludicrous levels .sx An ambulance will take a patient to a hospital which can't admit him but , quoting the correct rules , will refuse to drive him to a hospital which can treat and cure him .sx The costs of each section of the Health Service are scrutinised as though they were isolated problems .sx Of course , they are all interdependent .sx Busier and better general practitioners in one area can reduce the financial burden on the local hospital .sx More money spent on local authority dental services when the children are at school keeps down the bill of the general dental service when they are grown up .sx A rise in prescription costs may mean a shorter period of sickness .sx To take one illustration .sx Hospitals are given a certain amount of money to spend in any one financial year .sx They can't save any of it up and spend a little more in the following year .sx During the last month or two , therefore , of the arbitrary annual accountancy , there is a mad rush to spend anything left in the kitty .sx A National Health Service is bound to be expensive .sx It deserves to be so if it works .sx We still spend less than 4 per cent of the national income on keeping people well and treating them when sick .sx I don't call that unreasonable .sx The cost of prescriptions is a topical problem .sx Here is an ever-rising and very significant part of the bill .sx Let's look at it .sx It has more than doubled since the service started .sx Last year 214,000,000 National Health Service prescriptions were made up .sx Goodness knows how many unidentifiable pills linger in bathroom cabinets and how many bottles of cough linctus were emptied down the sink after the first distasteful dose .sx Five prescriptions a head last year , for everyone in the United Kingdom at nearly 7s .sx a go !sx The bill still goes up .sx Not primarily because doctors prescribe more , but because drugs cost more .sx