Middle classes 'elbow their way to the front of NHS queues'

Those with money and confidence are said to exploit the complexities of the system and shove out the less well-off and less educated.

Their contacts and pushiness win them quicker and better treatment, according to the report from Civitas.

The think-tank called for market reforms and competition to restore equality.

Researcher Nick Seddon said NHS medics should do more to help the disadvantaged.

"The Government is faced with the dispiriting fact that not only have health inequalities not improved, but they have got worse," his report said.

"The middle classes are just better at insisting on their rights and standing up to administrative gatekeepers than their less confident, less articulate fellow sufferers. They demand and get priority treatment."

The study cited University of York research which found "substantial socio- economic inequality" over hip replacement operations.

Another inquiry found that the poorest patients are a third less likely to get heart bypass surgery than the most wealthy.

It pointed to postcode differences which mean it takes three days to get a CT scan - usually used for diagnosing brain injuries - at University College London but 141 days in Norwich.

There were also local differences over the provision of treatments for deafness, stroke, cancer and multiple sclerosis.

The elderly, the Civitas study said, receive worse care than the young and there is evidence that black and ethnic minority patients are given poorer mental health treatment.

The think-tank said that evidence on hip replacement operations had indicated "the effectiveness of the sharp elbows of the middle class in the welfare state".

And while poor people are more likely than others to visit a GP, they are less likely to get any further into the NHS system.

They are, the study said, referred to consultants less often, get lower rates of help for their level of need and have lower attendance rates at chronic disease clinics.

Mr Seddon said the failure of the poor to get treatment was linked to middle- class language and literacy skills and assertiveness and self-confidence. He said the more affluent were more likely to get heard.

"The ability to get the most out of the NHS becomes a matter of survival of the fittest, or richest and most educated," the study said.

"Yet this was surely what the NHS was designed to avoid."

Middle-class people are also more likely to know Health Service staff who can help them work the system, the report said.

They are "more likely to have family or friends who work in the health services, and even if these contacts are not directly used to gain access to services they act as an important source of advice on how to work the system.

"Not only are lower socioeconomic groups less healthy but the relative gap is growing," the report added.

"It is becoming increasingly clear that the NHS often does little to combat inequality, and may even make it worse by providing an inequitable service."

Civitas said governments in Switzerland and Holland had reacted to similar problems by bringing in private financing and competition between health providers.

The study comes at a time of growing criticism of the NHS over the way standards have failed to keep pace with increased costs.

Taxpayer spending has nearly doubled over the past seven years but hospitals remain mired in scandals over superbugs and the ill-treatment of old people.

What's more, doctors are under fire for taking huge pay increases while working fewer hours.