Many thanks to NHS FOR YES! for alerting me to this.

From the above research paper published online today, in the June 2026 edition of the, peer-reviewed, Health Policy journal the following key points on the relative access of the poor to hip and knee replacement.

In the UK, where healthcare is a devolved matter, England and Scotland have different policies to reduce waiting lists for elective surgery. England is redirecting NHS funding to the private sector using commercial contracts, Scotland is expanding in-house capacity.

The poor have greater need and less access to hip and knee replacement surgery.

From 1997/98 to 2018/19 Scotland increased admissions and reduced waiting times, increasing in-house NHS provision by 18 % for both treatments and without recourse to the private sector. In contrast after 2008, England’s NHS in-house provision shrank by 8 % and 18 % for hip and knee replacement respectively and the numbers of private providers delivering NHS funded surgery increased seven-fold to 155.

Inequalities in admissions grew at two and a half times the rate in England than in Scotland over the whole study period. In both countries, waiting time inequality for hip surgery fell during the period of high NHS funding and low private sector use. A two-tier system is now operating within England’s NHS.

There should be a moratorium on all further outsourcing in England.

Source: https://www.sciencedirect.com/science/article/pii/S0168851026000424?ref=pdf_download&fr=RR-2&rr=9e1d896a99adfc20