Building back cancer services in England. 2021a. (accessed 13 April 2022)

Recover, reward, renew. 2021b. (accessed 13 April 2022)

Community first social care. 2021. (accessed 13 April 2022)

The state of health and care 2022. 2022. (accessed 13 April 2022)

Heading for a two-tier system?

21 April 2022
Volume 31 · Issue 8

Our NHS is a universal, centrally funded and comprehensive healthcare system, free at the point of delivery.

In England, health and social care services are under immense pressure. There are almost six million people (more than one in 10) waiting to receive care (Thomas, 2021), with the likelihood that this number will increase. There are huge disruptions to cancer care and discrepancies in who can access high-quality social care, along with an unprecedented strain on nurses and the NHS workforce (Patel and Thomas, 2021a; Thomas, 2021).

The pandemic has rapidly increased an existing decline in access to services and patient outcomes (Patel and Thomas, 2021b). This acceleration in trend is creating conditions fostering an ‘opt-out’ choice by those who have the means to pay for services, creating a two-tier system. This threatens to undermine our NHS's original objective. Across clinical areas, access to care is poor, patient outcomes are below international standards and inequalities continue to widen.

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