Middle-class people benefit more from the NHS than the poor, according to a report today from senior government advisers that overturns the long-standing boast of ministers that the health service's greatest virtue was fairness to all-comers.
They found that "affluent achievers" from the professional classes were 40% more likely to get a heart bypass than the "have-nots" from lower socio-economic groups, despite much higher mortality from heart disease in the deprived group.
Poorer people were 20% less likely to get a hip replacement, although they were 30% more likely to need one.
And even in the GP's surgery, class made a difference to the standard of care that patients could expect. Those from the two most affluent social groups got about 10 minutes of the doctor's time, while those from the other five groups averaged just over eight minutes.
The report was written by Julian le Grand, Tony Blair's health policy adviser in the Downing Street policy directorate, Anna Dixon, an adviser to John Reid, the health secretary, and three colleagues in the Department of Health.
The report said: "Relative to the better off, when ill, the poor either tend not to go to the doctor at all, or be present at a later stage in their illness.
"They often go to accident and emergency departments instead of GP surgeries, and when well, they do not access prevention services, or at least not as much as the better off."
Prof le Grand and his colleagues cast doubt on previous research showing that the poor use the NHS as much as the rich. But by studying a range of conditions they found more affluent groups benefited disproportionately in relation to their needs.
They found that patients from the lower social groups had 10% fewer preventive consultations than those from the top two groups.
The government had previously acknowledged a need to do more to improve the efficiency of the NHS and address inequalities that contributed to a wide variation in mortality rates between the inner cities and prosperous shires. But ministers continued to insist that the NHS was the fairest healthcare system in the world.
Mr Reid will develop a new argument today in a speech to the New Health Network in London. He will not try to rebut Prof le Grand's charge of unfairness, but will argue that the government's NHS reforms are the best way to improve.
He is expected to say the middle classes get more out of the health service because they are more articulate, more confident and more persistent.
They are more likely to have health professionals in their families and social networks who can help them to play the system. By contrast, patients from poorer communities are more likely to have a fatalistic view of their illness and resort to self-treatment.
