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On 5 July 1948, the UK’s Health Secretary Aneurin Bevan officially started the NHS, back then a unique experiment to provide universal healthcare free at the point of use.

Seventy-five years on that ambition largely remains, enshrined in the 2011 NHS Constitution of guiding principles and pledges to the public.

But the reality is different, with data revealing access to healthcare is getting worse, inequalities are growing, and stark differences across the country are leaving large sections of the population behind.

Your address, your ethnicity, your gender, and above all else your socio-economic status are strongly tied to how long and healthy your life will be.

Average life expectancies in the UK have been increasing over time. They fell in 2020 following COVID, however progress had already started to slow before the pandemic.

Life expectancy is closely linked to poverty – more socially deprived people have lower life expectancies than those better off than them. This is called the social gradient.

This gap has widened has widened since 2013: by 0.7 years for men and 1.1 years for women.

Different areas of the country have large differences in life expectancy.

Red
areas have low life expectancies, while blue
areas have above average life expectancies.

Men in Knightsbridge, a very wealthy part of London, have an average life expectancy of 94.1 years – the highest in the country – living nearly 15 years longer than the average male.

Nearby in Westbourne, the average male life expectancy is nearly ten years less at 75.9 years.

Deaths from circulatory diseases and stroke are high in this area.

At just 66.6 years South Promenade in Blackpool has the lowest life expectancy for men in England.

Deaths from respiratory disease are high, at more than twice the rate in the average population.

Explore your area in the map below:

Postcode lottery – a north-south divide?

One of the places this gap between rich and poor is most pronounced is on The Wirral, which is home to both Birkenhead, an extremely deprived area with one of the lowest life expectancies, and Gayton, an affluent area with above average health.

Dr Laxman Ariaraj, a GP at Fender Way Health Centre who has been working in the Birkenhead area for 20 years, has witnessed health inequalities widen there over time.

He said: “Certainly access has become more difficult over that time, which would probably widen those wider determinants of health.

“The sheer volume of the people that we need to see is going to impact the amount of time we can spend doing things proactively.

“On a positive note, I think we’ve become more aware of it and that gives us an opportunity to try and do something about it.”

The government has committed to cutting NHS waiting lists, however across the country little progress has been made. The North West, where Birkenhead is located, is the worst affected region with the longest waits.

The NHS operational target is that 92% of people should be treated within 18 weeks following referral by a consultant. However, two fifths of the current 7.4 million waitlist for treatments have been waiting for longer.

The North West has experienced the biggest increase in waits in England, from 13% on the list more than four months in April 2019 (around average compared to other areas), up to 46.1% in the latest data for April 2023.

Overall, the waiting list has increased by more than three million from 4,315,000 in April 2019. At that time 87% of would-be patients had been waiting less than 18 weeks.

The situation in the north generally and the North West in particular is of even more concern given the health inequalities that already exist here.

There are some extremely disadvantaged neighbourhoods with higher levels of deprivation than in any areas of the country, such as Blackpool, and this plays a big part in poor health outcomes.

However, this doesn’t fully explain the health gap with other areas. At any cross section, London tends to have higher life expectancies, even though the areas are of similar socio-economic status:

There is no settled explanation for the phenomenon, but Dr Bola Owolabi, a GP in the Midlands and director of Health Inequalities at NHS England told Sky News that this may partly be explained by communities who are harder to track in official metrics.

Dr Owolabi said: “We recognise that there are other drivers beyond simply using the Index of Multiple Deprivation.

“For example, people experiencing homelessness or rough sleeping, and migrant communities may not show up in the data.”

Deprived areas have less access to resources

The current NHS crisis and treatment backlog affects everyone, but it may not be affecting everyone equally.

Analysis by The Health Foundation has shown a decrease in the proportion of people admitted to hospital after presenting at A&E due to bed rationing.

The most significant drop in emergency admissions was seen among people living in the most deprived areas, by 80,000 between 2019 and 2022. This was more than twice as much as the 35,000 decrease for those living in the least deprived areas.

Although the total number of days patients spent in hospital increased in most areas, it decreased for patients in the most deprived areas.

Patients in the most deprived areas in the country had 107,000 fewer days in hospital beds in 2022 compared to 2019. The net increase in bed days for emergency admissions was 329,000.

The challenge of training and retaining enough doctors and other healthcare staff to plug vacancies has also been a major challenge for the NHS in recent years to meet the needs of a growing and ageing population.

But more deprived areas have additional challenges with recruitment.

Sky News analysis has found that the local GP for someone living in one of England’s most deprived areas has, on average, a 61% higher patient workload than the average local GP for residents of the country’s wealthiest areas.

This gap has increased slightly since 2015, when it stood at 59%. That’s despite the government’s efforts to incentivise trainees to take up posts in under-served areas.

“The pressure on the NHS is potentially damaging the health of poorer people.”

The Marmot Review on health inequalities, first published in 2010 with a ten year follow up in 2020, concluded that inequalities in health and life expectancy result from social issues including employment, housing and deprivation.

Professor Sir Michael Marmot, director of The UCL Institute of Health Equity, told Sky News: “I’ve been saying for a long time that given the equity of access in the NHS, it’s highly unlikely that difficulties of access to treatment are playing a big role in the inequalities in health. I may need to modify that conclusion in the light of recent history.

“You’ve got it both ways: that the pressure on the NHS is potentially damaging the health of poorer people. And that the poor health of poorer people – because of social and economic inequalities in society – is potentially putting unbearable burden on the NHS.”

Ethnicity based inequalities

People from ethnic minority backgrounds tend to be disproportionately affected by deprivation.

Data from Ministry of Housing, Communities & Local Government suggests that ethnic minorities are far more likely to live in the most deprived 10% of neighbourhoods. 

They are also more likely to live in overcrowded conditions and low-income households – defined as living on less than 60% of the average net disposable household income. 

According to data from the latest census, more than a fifth of people from Asian backgrounds live in overcrowded conditions (having less than the required number of bedrooms).

People from black backgrounds are 6 times more likely to be living in overcrowded households than white people. 

Access to primary care health services is generally equitable for ethnic minority groups.  

However, people from ethnic minority groups are more likely to report being in poorer health and have higher mortality rates.

Research from the Health Foundation’s REAL Centre suggests that individuals from South Asian backgrounds, particularly Bangladeshi and Pakistani, have higher incidences of diagnosed chronic pain, diabetes, and cardiovascular disease.  

The prevalence of diagnosed chronic pain is around three fifths higher among Bangladeshi and Pakistani individuals compared to white individuals.

People from black African ethnicities also have a higher prevalence of chronic pain. 

Chronic pain among other conditions is also prevalent in deprived neighbourhoods. The prevalence of diagnosed chronic pain is more than double in the most deprived neighbourhoods compared to the least deprived neighbourhoods. 

However, cancer is more prevalent for people from white backgrounds and almost double than for people from South Asian backgrounds.

Hope for addressing health inequalities

The National Healthcare Inequalities Improvement Programme was set up in 2021 to tackle healthcare inequalities and ensure equitable access to healthcare and it does provide some hope for tackling health inequalities.

The programme works to deliver projects and services targeted at people living in the most deprived areas in England and others who are disadvantaged.

This includes improving access to digital services and helping people gain employment.

Dr Owolabi said: “The NHS, as a commissioner, and provider of services, is able to materially influence health inequalities.”

Many cities have decided to focus extensively on implementing the policy changes envisaged by Marmot in his review.

These cities have been named ‘Marmot cities’ and have seen significant improvement in health inequalities.

There may be some early signs of success with the programme. Coventry was one of the first of these cities to adopt Marmot principles, and in the time since, Professor Marmot says: “The percentage of children aged five with a good level of development went up…

“The percentage of 18 to 24 year olds not in employment, education or training went up. And the proportion of people earning a real living wage went up.”

Sky News has contacted the Department of Health and Social Care for a response to our findings.


The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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Thousands of homes now need repairs after insulation fitted under government scheme

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Thousands of homes now need repairs after insulation fitted under government scheme

Thousands of homes fitted with insulation under a flagship government scheme now need major remedial work, or risk damp and mould, the public spending watchdog has warned.

A damning report by the National Audit Office (NAO) said “clear failures” in the Energy Company Obligation (ECO) scheme to tackle fuel poverty and pollution had led to low quality installations and even potential fraud.

It blamed incompetent subcontractors and weak monitoring and government oversight for the issues, which in extreme cases could cause fires.

Fuel poverty campaigners warned the system had “let cowboys through the front door”, saying it must be fixed to bring down energy bills and keep people warm.

Almost all homes – some 98%, affecting 22,000 to 23,000 properties – fitted with external wall insulation under the ECO are affected, the NAO said.

A further 29% of homes with internal wall insulation – around 9,000 to 13,000 dwellings – also face major issues that need fixing.

A small percentage of homes – 6% with external insulation and 2% with internal – put people in immediate danger, such as poor ventilation that could cause carbon monoxide poisoning, and electrical safety issues that could start fires.

ECO is a scheme that obliges energy companies to pay for energy efficiency measures in vulnerable households out of consumer bills.

Gareth Davies, head of the NAO, said ECO is “important to help reduce fuel poverty and meet the government’s ambitions for energy efficiency”.

But “clear failures in the design and set-up” had led to “poor-quality installations, as well as suspected fraud”, he added.

‘Gaming the system’

The report says the reason things had gone so badly wrong could be down to work being subcontracted to individuals and firms who are not competent or certified, uncertainty over standards, and businesses “cutting corners” or “gaming the system”.

The energy regulator Ofgem last year estimated businesses had falsified claims for ECO installations in between 5,600 and 16,500 homes.

That means they could have claimed between £56m and £165m from energy suppliers – ultimately paid for by bill-payers.

More than 20,000 homes are said to be affected. File pic: iStock
Image:
More than 20,000 homes are said to be affected. File pic: iStock

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Martin McCluskey, the government minister for energy consumers, criticised the “unacceptable, systemic failings” that had affected thousands of families.

He added: “We are fixing the broken system the last government left by introducing comprehensive reforms to make this process clear and straightforward, and in the rare cases where things go wrong, there will be clear lines of accountability, so consumers are guaranteed to get any problems fixed quickly.”

The government urged households to take up the free audit that will be offered in a forthcoming letter, and said installers would be forced to remedy the issues free of charge.

However, insulation has the potential to vastly improve homes, analysts pointed out.

Jess Ralston from energy think tank ECIU said: “The majority of households that have benefitted from insulation schemes have lower bills and warmer, healthy homes, particularly during the early years of the gas crisis when the UK’s poor quality housing stock was one of the reasons we were so badly hit compared to other European countries.”

Simon Francis, co-ordinator of the End Fuel Poverty Coalition, said: “Insulation and ventilation, when done properly, are among the safest and most effective ways to bring down energy bills and keep people warm.”

But the report had revealed a “system that has let cowboys through the front door, leaving thousands of victims living in misery and undermining public trust”.

Sue Davies, Which? head of consumer protection policy, called it “a damning indictment of a failed scheme, where poor oversight has allowed rogue traders to cause huge damage to people’s homes and lives”.

She said the government must take swift action to rectify the damage, as well as ensuring “there is no repeat of this scandal by putting in place robust consumer protections and effective oversight”.

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Alleged Madeleine McCann family stalker left voicemails saying ‘I believe I’m really her’

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Alleged Madeleine McCann family stalker left voicemails saying 'I believe I'm really her'

A woman accused of stalking the parents of Madeleine McCann allegedly left voicemails asking the mother of the missing girl for a DNA test, a court heard.

Jurors heard voicemails left by Julia Wandelt, 24, from Lubin, Poland, in which she was audibly upset.

She allegedly left the messages last year, over a period of months, and at one point asked: “What if I’m her?”

Co-defendant Karen Spragg, 61, began crying today at Leicester Crown Court and had to leave the dock when the voicemails were played.

Wandelt, whose head was down while jurors were listening, was heard saying: “I know you probably think Madeleine‘s dead. Well she is not. I really believe I’m her.

“Help me. Don’t think Madeleine is dead. This is a chance. Please, I beg you. The police don’t want to help me, they don’t want to help Madeleine. It’s all corrupt.

“I promise you that I will prove who I am because I know you love Madeleine.”

In another message, she said: “You probably believe Madeleine is not alive anymore.

Madeleine McCann went missing during a family holiday to Portugal in 2007. Pic: PA
Image:
Madeleine McCann went missing during a family holiday to Portugal in 2007. Pic: PA

“What if I am her? What if there’s a small chance that I’m her?”

Jurors also heard that, one night, Wandelt sent a message to Mrs McCann at 1am, saying: “I don’t understand why you don’t want to do a DNA test.”

Prosecutors allege that Wandelt, a Polish national, falsely claimed she was Madeleine while stalking parents Kate and Gerry McCann by sending emails, making calls and turning up at their address between June 2022 and February this year.

The court previously heard that Wandelt called and messaged Mrs McCann more than 60 times in a single day in April last year. This included alleged memories of Madeleine’s abduction.

Madeleine went missing during a family holiday to Praia da Luz in Portugal, in May 2007.

Wandelt and Spragg, of Caerau Court Road in Caerau, Cardiff, both deny one count of stalking.

The trial continues.

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Tommy Robinson refused to give phone pin to police as he drove his Bentley to Benidorm, court hears

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Tommy Robinson refused to give phone pin to police as he drove his Bentley to Benidorm, court hears

Tommy Robinson refused to hand over his phone pin when police stopped his Bentley on the way to Benidorm, a court has heard.

He allegedly told officers “Not a chance, bruv” and said he was a journalist when they pulled him aside at the Channel Tunnel at Folkestone in July 2024.

Robinson, real name Stephen Yaxley-Lennon, is accused of “frustrating” counter-terrorism powers by refusing to give access to the phone.

He denies the charge.

The right-wing political activist was flanked by security guards as he arrived at Westminster Magistrates Court for the opening of the trial on Monday.

The 42-year-old faces three months in prison and/or a £2,500 fine if found guilty.

Robinson had £13,000 and 1,900 euros on him when he was stopped and told police he was going to Benidorm in Spain for a few days, said prosecutor Jo Morris.

More on Tommy Robinson

He allegedly refused to give the pin as he claimed the phone had sensitive “journalist material” on it.

He’s said to have told police: “It’s my work, I’m a journalist,” claiming it contained information about “vulnerable girls”.

The court heard Robinson was stopped in his silver Bentley SUV because he gave “short, vague replies” about what he was doing and “made no eye contact”.

PC Mitchell Thorogood told the court it was also “unusual” he bought tickets on the day rather than in advance and was in an expensive car not registered in his name.

Pic: PA
Image:
Pic: PA

When police took Robinson into an interview room and demanded his phone, he allegedly told them: “Not a chance bruv… you look like a c*** so you ain’t having it.”

Officers said they recognised Robinson when they stopped him and his lawyer, Alisdair Williamson KC, suggested the stop may have been “discriminatory” against his political beliefs.

Police can stop anyone at a UK port and hold them for six hours if they suspect they may be involved in planning or committing acts of terrorism.

They are legally obliged to answer questions and must give access to their electronic devices or face a criminal charge.

In a video on X before the hearing, Robinson said Elon Musk had “picked up the legal bill” for “this absolute state persecution”.

The case comes a month after Robinson led a huge rally in central London under the banner ‘Unite the Kingdom’.

The trial continues.

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