If you could afford it, would you pay to get quicker access to health care? Leaked minutes from a Scottish NHS chiefs meeting in September 2022 suggest that within a discussion about the unsustainability of the current service in NHS Scotland, senior leaders mentioned the possibility of designing ‘a two-tier system where the people who can afford to go private’. The British Medical Association slammed the discussion, but aren’t we already ‘sleepwalking’ into a two-tiered healthcare system?

The UK has always had a parallel private healthcare system alongside the NHS, and as waiting times increase, the proportion of people self-funding their treatment in both primary and secondary care is increasing. A report published by the Institute for Public Policy Research (IPPR) in 2022 described how the COVID-19 pandemic accelerated an existing decline in access to health care, creating ripe conditions for a growing two-tiered healthcare system. More people are paying for private insurance in the UK, and out-of-pocket expenditure is increasing faster here than in any other G7 …