Choice is simply code for class

Janet Street Porter in The Independent

Social mobility tsar Alan Milburn is concerned that the gap between rich and poor is increasing. But if we want equal opportunities for all, we need to stop introducing subtle forms of social demarcation in every walk of life.

It's a particularly British obsession, this determination to create mini-castes emphasising our differences rather than celebrating our strengths. The majority of us claim to be middle class, but offer us "finest" fare over "budget" and we're hooked.

Travel is another example. Budget airlines exploit our need for social demarcation, offering us the chance not to queue – at a price. The chance not to pay for our food – at a price. The chance to choose our seat – at a price. The chance to sit at the front of economy – at a price. All things that were free a decade ago. In fact, "low-cost" air travel is not egalitarian or cheap by any stretch of the imagination.

Rail travel is the same. There's talk of a new category of travel when the East Coast line franchise is offered to private investors: a class below first called "premium economy" – so standard travel will be third class, the rolling stock equivalent of below stairs. Quite soon train operators will ask us to pay to be allowed on the platform first.

I love the new high-speed train to Kent because it's all one class. Passengers are quiet; it's clean and efficient, but it's not cheap. Anyone on a budget opts to travel on the overcrowded and slow old line.

We should realise that, in modern Britain, offering us "choice" is code for implementing a class system based on ability to pay, and (by default) offering an inferior service to the poorest. Now this trend looks likely to afflict our health service.

Michael Dixon, president of the NHS Clinical Commission and chair of the NHS Alliance, says patients could soon be charged for "extras" like comfortable beds and better food. As the NHS faces a funding gap of £30bn by the end of the decade and has to deal with an ageing population, Dr Dixon thinks users should contribute more. Hospitals raise millions through the controversial practice of charging for parking (some extort £3 an hour from visitors) and making us cough up for televisions.

Dr Dixon sees nothing wrong in a two-tier system for inpatients, claiming the wealthy already use the NHS when it suits them and pay for private treatment when they have to, and the principle should be expanded. The NHS is hopelessly overburdened with administrators and this proposal would make it worse. The quality of food varies wildly from one area to another, some trusts spending just £4.15 a day per patient, others up to £15, when the average is about £9.80.

The same differences crop up in ordering supplies: money is wasted through piecemeal and uninformed purchasing. We should all get uniformity of service throughout the NHS, no matter where we fall sick. The NHS is not a bunch of Premier League football clubs, all in competition, nor is it a gang of department stores offering rival services. NHS chief executives earn large salaries and get gold-plated pensions, but the amount they are paid varies wildly, too.

Why has the NHS become like an airline or a train operator, when it should be providing a uniform top service for a classless Britain?