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  When I said 'free of charge' perhaps I should have said 'free to the user'. Obviously everything has to be paid for in the end by somebody but when the user makes no contribution or a very small one there is no motive to be economical in the use of such services. The NHS is a case in point; people are being treated to cosmetic surgery and gender re-assignments while cancer and hip replacement waiting lists increase. As a result more and more public money is being spent while clinical outcomes in the key areas continue to decline. People who can afford to pay should pay; yet there should be a means whereby the less well-off can still be accommodated. It's not rocket science but it does need a root-and-branch rethink of how the welfare state operates.

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