Choice is simply code for class

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?


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?

Big art, big prices

The Frieze Art Fair ends this weekend and Regent's Park will be packed with visitors. Galleries have been holding special events all over London, and the major auction houses held some of the most lavish parties. Christie's took over three floors of a disused GPO sorting office in New Oxford Street to display some massive sculptures being auctioned to support the Saatchi Gallery's policy for free entry to all exhibitions, and free education programme for schools.

There was a classic Tracey Emin bed piece with embroidered quilt and pillows, and a huge installation of Jake and Dinos Chapman's most creepy child mannequins. In a garden of fake grass these repulsive little figures still exerted a powerful punch, to the point where I didn't actually feel comfortable taking a picture on my mobile phone. Good art works regardless of size, but there is a new tendency for artists to make work that's bigger than ever before. In this show, Will Ryman's Bed (2007) was the size of a small flat, with a frighteningly vacant figure slumped across it. I don't know who buys this stuff, but the sale realised more than £3m, with many of the works achieving record prices for the artists at auction. Both beds were popular – Tracey's sold for £481,875, and Ryman's made £97,875. Mr Saatchi will have a lot more storage space.

Can Mr Pickles be sensitive?

I hope Eric Pickles will heed warnings from the Campaign to Protect Rural England about his department's plans to allow farmers to convert barns into houses and flats. At the moment, the Department for Communities and Local Government is consulting on plans to allow farmers to make three flats or small homes from each unused agricultural building. This could be a disaster for Areas of Outstanding Natural Beauty such as the Yorkshire Dales, where about 4,000 barns lie empty.

Granted, there is huge pressure to find affordable homes for local people and farm workers, but what is to stop any new conversions immediately going back on sale to cater for the huge demand for holiday homes and rental cottages? And barns don't convert easily. Unlike chapels, they don't sit by the side of a road, so fields would be cut up for access tracks. I think there's a middle way, and Mr Pickles should allow barns to be converted only when they have direct access to an existing road or are adjacent to an existing home or farmhouse. I also want solar panels banned in AONBs as they look disgusting. Farmers need cash, and while I don't want the countryside preserved in aspic, I don't trust Mr Pickles to handling this sensitively.

Through the Gloss ceiling

Angela Ahrendts leaves Burberry for a top job at Apple, which means there remain just two female chief executives in the FTSE 100. In Dublin last Thursday, I spoke at a Mansion House dinner attended by 550 high-flying females, organised by The Gloss magazine. Even at ¤150 a ticket, this event was sold out months in advance and there's already a waiting list for next year. Anya Hindmarch talked about establishing her luxury brand and the event was sponsored by Vodafone. Why isn't there something like this in London where women can dress up, feel good and network? Being interested in fashion doesn't mean you're not a feminist, as Angela A would agree.

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