Do we really believe the health service is equally fair to all?

Have you ever wondered how much of a deserving case you are healthwise? Imagine this scenario: you're in a casualty department surrounded by a motley crew of hacking pale things and it is made clear to you that of the 10 people waiting only three will be treated. You look around and hope you're one of them. It may well happen one day, if it's not starting to happen already. "But the NHS offers uniform care to everyone!" I hear you cry. "Regardless of sex, race or religion." Rubbish! is my answer to that. You're as likely to get fair treatment in the NHS as I am not to get heckled at the Families Need Fathers AGM.

Have you ever wondered how much of a deserving case you are healthwise? Imagine this scenario: you're in a casualty department surrounded by a motley crew of hacking pale things and it is made clear to you that of the 10 people waiting only three will be treated. You look around and hope you're one of them. It may well happen one day, if it's not starting to happen already. "But the NHS offers uniform care to everyone!" I hear you cry. "Regardless of sex, race or religion." Rubbish! is my answer to that. You're as likely to get fair treatment in the NHS as I am not to get heckled at the Families Need Fathers AGM.

The NHS is fair in the way that the university system has been shown to be fair to comprehensive-educated women from the North-east, or the Big Breakfast recruitment system to, say, huge scary women who look like wrestlers and have no bosoms to speak of.

Of course, if you're reading this paper, you're in with a good chance of being able by force of your middle-class, well-educated personality to order about a hapless junior registrar to ensure you don't get treated like a chewed-up piece of old tissue, waiting for hours, only to be cursorily examined and sent away with a dismissive sneer.

The unofficial hierarchy of healthcare has petrified into such rock-hard strata that it's going to take a very special, creative person or a bloody great bomb to come up with a way of ensuring truly fair treatment for all. A famous Neil Kinnock speech warned us about "not being poor, not being old, not being sick" under a Tory government but as far as healthcare is concerned I'm not sure too much has changed under Tony B, except that maybe they've added "and don't be a smoker or live south of the river either". All right, they're abolishing the internal market, but old attitudes die hard and a lot of patients passing through the NHS in the rosy glow of New Happiness and New Health just aren't sexy enough to treat quickly or efficiently (I use sexy in the Eighties sense of "an attractive prospect", a term much favoured in the trendsetting end of the caring professions).

So who is losing out in the NHS? Well, let's start from the bottom. A typical individual would be characterised as an elderly, homeless, poor, fag-wielding, alcoholic, working-class junkie with a chronic illness such as arthritis, a bad temper and a tendency to arrive at casualty too often. There are certain groups that the NHS appears to be quite irritated by (whether it's because they're too time-consuming, too numerous or too stigmatised, or all three, I'm not sure), who would perhaps be better served elsewhere, because their popularity rating in society is so low. Take heroin addicts, for example. A recent article in this paper described how a young man hooked on heroin and obviously dying was given only the briefest of examinations at his local hospital and sent away. On the other hand, had he been attractive, female and from Cheltenham rather than Glasgow, the treatment might have been different. One junkie in the article remarked, "We're the scum of the earth". But the scum of the earth is an ever mutating group which depends entirely on the perspective of the assessor. To me, the scum of the earth are racists, mercenaries and tabloid journalists. If anyone is going to be refused adequate health treatment, it should be them. In fact I would even go so far as to suggest that tabloid journalists should be roughed up a bit first with some mouldy vegetables.

Of course, one of the other groups that has tended to suffer in silence, and subsequently got a raw deal from the NHS, is women, particularly women with gynaecological problems. There has always been a reliance, I believe, by certain members of the medical profession on women being too embarrassed/ shy/ignorant about their own bodies to complain about bad treatment. After all, when you're trapped in a side room, feet up in the stirrups, with barely an elf's handkerchief to cover your private bits, what you learnt in assertiveness classes dribbles out of your brain very quickly. Cervical cancer screening seems to be routinely cocked up and the combination of their impenetrable medical mystique versus our blind faith means negligence goes on happening until so many people are affected that there are enough to make up a delegation to flagwave and shout, thus attracting the attention of the Government.

At the moment, it does seem to be gynaecologists particularly who are letting the side down. The medical profession has for so long had such a saintly image that some doctors can get away with it for years. Plus, so many consultants scare the crap out of administrators with their superior "I am the Emperor of the World" routine that their bad decisions and poor treatment go unchallenged.

And we haven't even tackled the elderly, the homeless, the mentally ill, smokers, and the not very pretty. All right, so maybe that last one is a little unlikely, but the "not very pretty" are being edged out everywhere else, so I can't see why in the future they shouldn't be barred from healthcare too.

How can we ensure that vulnerable people receive the care they need and powerful doctors are not allowed to run roughshod over people who are too weak or ignorant to catch them out? I don't know. But I'm sure there are some people in the NHS who do. It's just a question of getting it out of them.