Furious debate about waiting times doesn't just happen in the UK. Tony Sheldon reports on a row about fast-track treatment preoccupying the egalitarian Dutch as they cast their votes

Dutch voters went to the polls this week to elect a new government, with a row over waiting times and equal access to healthcare high on the agenda of this normally egalitarian and consensual country.

The row began when 20 hospitals, health insurance companies, a few large employers, a couple of trade unions and a management consultancy began to offer fast-track treatment.

The plan was to launch a network separate from hospitals but using their facilities at evenings and weekends when they were lying idle. The centres would specialise in the diagnosis and treatment of work-related conditions.

Employers could pay for staff to be seen more quickly than on national waiting lists and save money by getting their employees back to work. In theory, the unemployed could also be treated - if they could find someone to pay.

A pilot scheme agreed by employers and unions in the building trade was already well advanced, with a telephone line for builders seeking a first appointment in a number of hospitals.

But other unions objected, arguing that spare capacity should be used for the benefit of all, while others warned that the scheme discriminated against old people and the unemployed.

Health minister Els Borst, a member of the centre-left party D66, and a former hospital manager, threatened action before the election.

She had in the past singled out the NHS's GP fundholding scheme as an example of the dangers of a two-tier service and was not amused to see claims of inequality emerging in her own country.

The issue has cut to the heart of Dutch society where social solidarity is a cornerstone of the mixed public/private health insurance system. Equality, in addition, is enshrined in the constitution.

The demand for preferential treatment has been driven by waiting times.

In a country of 15.65 million people, 127,000 are waiting more than four weeks for hospital treatment, and surgery can involve a six-month wait.

But the issue was then ignited by changes in the laws on sickness pay and long-term invalidity benefit which shifted the financial burden of paying sickness benefit to employers.

Dr Borst highlighted the problem in a controversial fashion by admitting that the cabinet had made errors, adding: 'We in the cabinet had not completely foreseen the consequences.'

MPs called her revelations 'remarkable' and in answer to a question from Paul Rosenmoller from the small Green/Left party, Dr Borst admitted that the cabinet did not yet have all the means to prevent a two-tier service.

Despite opposition from a majority of MPs and the health minister, the Leeuwarden Medical Centre was determined to go ahead with plans to offer consultation 'outside normal hours' on occupational health matters.

Faced with patients going abroad, its management defiantly declared: 'The discussion has gone on long enough.'

But within days it too put its plans on hold following a report by 14 groups representing hospitals, insurers, doctors and employers that outlined a plan to cut waiting times without offering preferential access to any group.

With one eye on the election, it also called for political action - including a commitment to increase the growth in health spending from 1.3 to 2.5 per cent a year.

As polling day approached, the health service itself became the opposition. Managers', hospitals' and clinicians' groups put their names to an attack on all the major parties for neglecting healthcare in their election manifestos.

Their joint statement condemns talk of reducing waiting times and employing more staff, claiming all the election programmes have gaps in health spending ranging from£1bn to£1.7bn over the next four years.

Politicians left, right and centre have attacked the health service for juggling the figures.

True or not, health staff, especially nurses, whose recruitment is crucial to cutting waiting times, have now rejected their annual pay offer and launched national protest actions.

Nurse unions are claiming 4 to 5 per cent. Employers say the government has only funded them for 3.5 per cent over two years.

Just days before voting, Dr Borst promised the cabinet would 'release money to tackle work pressure on health staff'. But that supposes she will be back in office, and the battle over pay and equity of access looks set to rumble on.