I’ve seen what happens in countries when wealthy people go private and the rest suffer. Now, from the NHS to rail services, that’s life here

It’s official. A two-tier health system, that long feared prospect that rings the death knell of the NHS, has arrived. Trusts with long waiting lists are offering and promoting “quick and easy” private services in their hospitals. It’s not a choice anyone would relish, but increasingly those who can are giving up and paying up. If you’re after a hip replacement, £10,000 can make the difference between a two-year and a two-week wait. You can get an MRI for £379 in 48 hours, and with it a diagnosis that could save a limb or a life.

The story is the same across England’s public infrastructure. Those who can, after standing on a packed train platform, the clock ticking down to an important appointment, will decamp above ground and take a taxi. Those who can will work several jobs to pay exorbitant and rising rent because they have no access to social housing. Those who can will take the hit, and those who can’t will be stranded, on the streets and in the wards.

Nesrine Malik is a Guardian columnist

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