Healthcare has never been equal, but from 1948 we really attempted to make it so. Without short waiting times and high standards, and choice, the inequality will rise as more and more choose to pay. An unofficial 2 tier system is worse that an official and regulated one.
When more patients than previously are being denied access to care and some of them are consequently initiating exceptional or individual funding requests,12 the question of fairness arises. We already know that access to joint replacements is lower in deprived areas.3 Perhaps patients from the articulate and assertive end of the social spectrum are more likely to ask their GPs to pursue an individual funding request.
Socioeconomic status is known to determine health, but its effect on uptake of healthcare is rarely highlighted. Michael Marmot, in his book The Health Gap, says that survival of poorer patients with cancer after treatment is inferior, but he discounts the possibility that this might be related to access.4 Evidence indicates that residents of poorer neighbourhoods have reduced access, which is exacerbated by distance from services.5 A study, reported in The BMJ as Research News, showed that many patients who present to the emergency department with cancer have not seen a GP, and this was commoner in those from deprived areas.67
Nine further studies appeared in The BMJ in the first six months of 2017, either as research papers or reported as Research News, which looked at patients’ access to services in relation to deprivation.8910111213141516 Other reported studies that used big data mention using deprivation scores to adjust the statistical model in the analysis of their topic of interest, potentially forfeiting important understanding about the effect of socioeconomic status in patients’ access to services.
The assumption that the NHS is equitable must be tested. International comparisons show us to have a small, inexpensive healthcare system. It inevitably functions as a competition between patients. We must measure the different effects of increasing financial pressures on the varying strata of society.