John Reid, the Secretary of State for Health, said yesterday that middle-class patients had been securing better health care than poorer people by "working the system".
Addressing the NHS Confederation's annual conference in Glasgow, Mr Reid sought to reassure Labour MPs worried that the Government's plans to set up foundation hospitals would result in a two-tier National Health Service. He pledged that ensuring "equity of access" would be one of his guiding principles.
Mr Reid invoked the spirit of Nye Bevan but admitted the aim of the NHS he founded in 1948 to provide equality of access to health care had not been fully met. "If we believe in those principles of fairness we have to work differently to bring them into reality," he said.
Mr Reid said that "equity and fairness" was "not just a fad of this Government" but "the cornerstone of the NHS itself". Despite the egalitarian principles of the health service, he said, inequality of access had persisted. Over the past 30 years, studies in specific NHS services had shown sharply differential access to different groups in society. For example, while lower socio-economic groups had about a 30 per cent higher need for hip replacements, the operation rate was about 20 per cent lower than in higher socio-economic groups.
Mr Reid conceded that "finding your way round the system" presented some people with choices that others did not have, and provided them with better health care and usually better health outcomes.
"The challenge for us as we change the system is to extend choice to all, not to deny it to those who have it but to help every patient to be an informed patient," he said, "to ensure that the choice and convenience of service does not depend either on where you live or how much you can afford.
"For people to choose well there needs to be a standardisation of information so that everyone - and not just those in the know - can have it. And there needs to be sufficient support towards transport and other considerations to make sure it is open to all."
Adopting a conciliatory tone ahead of a Commons backbench rebellion over foundation hospitals expected next month, Mr Reid admitted he had "a lot of learning to do, a lot of learning, a lot of dialogue".
He said he passionately believed in the NHS. "It is more than an institution. It was, is and will remain a noble cause. All of us recognise that and never allow it to be diminished by the cynics."
Setting out his "broad direction of travel", he listed three other guiding principles - health care free at the point of delivery; a service dedicated to patients; and ensuring greater capacity and choice.
Mr Reid said the NHS had "turned a corner" under his predecessor, Alan Milburn, and said his task now was to "turn these radical policies into radical, practical implementation on the ground."
Liam Fox, the shadow Health Secretary, said Mr Reid was facing "opposite directions", trying to reduce inequalities while at the same time establishing a two-tier system via foundation hospitals.
Dr Fox added: "It is sad John Reid has chosen to give his speech on running the NHS at a Scottish venue. Here we have an MP of a Scottish constituency telling us how to run the NHS in England and Wales when he has no responsibility for running the NHS in his own constituency."Reuse content